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Meigs JM, Kiderman M, Kircanski K, Cardinale EM, Pine DS, Leibenluft E, Brotman MA, Naim R. Sleepless nights, sour moods: daily sleep-irritability links in a pediatric clinical sample. J Child Psychol Psychiatry 2024; 65:1175-1183. [PMID: 38355141 PMCID: PMC11322421 DOI: 10.1111/jcpp.13959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/02/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND Sleep, or a lack thereof, is strongly related to mood dysregulation. Although considerable research uses symptom scales to examine this relation, few studies use longitudinal, real-time methods focused on pediatric irritability. This study leveraged an ecological momentary assessment (EMA) protocol, assessing bidirectional associations between momentary irritability symptoms and daily sleep duration in a transdiagnostic pediatric sample enriched for irritability. METHODS A total of N = 125 youth (Mage = 12.58 years, SD = 2.56 years; 74% male; 68.8% White) completed digital, in vivo surveys three times a day for 7 days. For a subset of youth, their parents also completed the EMA protocol. Trait irritability was measured using youth-, parent-, and clinician-report to test its potential moderating effect on the association between sleep duration and momentary irritability. RESULTS Results from multilevel modeling dynamically linked sleep to irritability. Specifically, according to youth- and parent-report, decreased sleep duration was associated with increased morning irritability (bs ≤ -.09, ps < .049). A bidirectional association between parent-reported nightly sleep duration and anger was found-increased evening anger related to decreased nightly sleep duration, and decreased sleep duration related to increased morning anger (bs ≤ -.17, ps < .019). Trait irritability moderated this association, which was stronger for more irritable youth (b = -.03, p < .027). CONCLUSIONS This study adds to the literature and suggests sleep-irritability dynamics as a potential treatment target.
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Affiliation(s)
- Jennifer M. Meigs
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Miryam Kiderman
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Katharina Kircanski
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Elise M. Cardinale
- Psychology Department, The Catholic University of America, Washington, DC, USA
| | - Daniel S. Pine
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Ellen Leibenluft
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Melissa A. Brotman
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Reut Naim
- School of Psychological Sciences, Tel-Aviv University, Tel-Aviv, Israel
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2
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Ojha A, Jones NP, Henry T, Versace A, Gnagy EM, Joseph HM, Molina BSG, Ladouceur CD. Altered Lateral Prefrontal Cortex Functioning During Emotional Interference Resistance Is Associated With Affect Lability in Adults With Persisting Symptoms of Attention-Deficit/Hyperactivity Disorder From Childhood. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2024; 9:588-596. [PMID: 38378127 DOI: 10.1016/j.bpsc.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 01/09/2024] [Accepted: 02/12/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder characterized by inattention and/or impulsivity/hyperactivity. ADHD, especially when persisting into adulthood, often includes emotional dysregulation, such as affect lability; however, the neural correlates of emotionality in adults with heterogeneous ADHD symptom persistence remain unclear. METHODS The present study sought to determine shared and distinct functional neuroanatomical profiles of neural circuitry during emotional interference resistance using the emotional face n-back task in adult participants with persisting (n = 47), desisting (n = 93), or no (n = 42) childhood ADHD symptoms while undergoing functional magnetic resonance imaging. RESULTS Participants without any lifetime ADHD diagnosis performed significantly better (faster and more accurately) than participants with ADHD diagnoses on trials with high cognitive loads (2-back) that included task-irrelevant emotional distractors, tapping into executive functioning and emotion regulatory processes. In participants with persisting ADHD symptoms, more severe emotional symptoms were related to worse task performance. Heightened dorsolateral and ventrolateral prefrontal cortex activation was associated with more accurate and faster performance on 2-back emotional faces trials, respectively. Reduced activation was associated with greater affect lability in adults with persisting ADHD, and dorsolateral prefrontal cortex activation mediated the relationship between affect lability and task accuracy. CONCLUSIONS These findings suggest that alterations in dorsolateral prefrontal cortex function associated with greater interference in cognitive processes from emotion could represent a marker of risk for problems with emotional dysregulation in individuals with persisting ADHD and thus represent a potential therapeutic target for those with greater emotional symptoms of ADHD.
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Affiliation(s)
- Amar Ojha
- Center for Neuroscience, University of Pittsburgh, Pittsburgh, Pennsylvania; Center for the Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Neil P Jones
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Teague Henry
- Department of Psychology, University of Virginia, Charlottesville, Virginia; School of Data Science, University of Virginia, Charlottesville, Virginia
| | - Amelia Versace
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Elizabeth M Gnagy
- Department of Psychology, Florida International University, Miami, Florida
| | - Heather M Joseph
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Brooke S G Molina
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Cecile D Ladouceur
- Center for Neuroscience, University of Pittsburgh, Pittsburgh, Pennsylvania; Center for the Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania.
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3
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Karalunas SL, Dude J, Figuracion M, Lane SP. Momentary Dynamics Implicate Emotional Features in the ADHD Phenotype. Res Child Adolesc Psychopathol 2024:10.1007/s10802-024-01206-9. [PMID: 38771497 DOI: 10.1007/s10802-024-01206-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2024] [Indexed: 05/22/2024]
Abstract
Emotional dysregulation is increasingly recognized as important to the attention-deficit/hyperactivity disorder (ADHD) phenotype alongside inattention and hyperactivity-impulsivity. Studies of ADHD have relied primarily on trait-based conceptualizations that emphasize stability of symptoms across moderate developmental timescales (i.e., months to years). Trait-based conceptualizations provide a critical view but fail to account for short-term dynamic variations in the expression of ADHD symptoms and emotion. This leaves a gap in our understanding of the short-term variation in ADHD symptom expression and the dynamic relationships among ADHD symptoms and emotion. Here, we assessed caregiver report of ADHD symptoms and positive and negative emotion using ecological momentary approaches over 2 weeks in a sample of 36 children with and without ADHD between the ages of 7-12 years old. Between-person (RKF) and within-person (RC) reliability were estimated. Multilevel models tested specific covariation hypotheses between ADHD symptoms and emotion. Analyses confirmed that ADHD and emotion ratings were reliable as individual differences (i.e., between-person; RKF range 0.93-1.0) and moment-to-moment change (i.e., within-person; Rc range 0.66-0.88) measures. Multilevel models found little evidence for lagged effects between domains, but consistently identified concurrent expression of ADHD symptoms and emotions; inattention covaried most strongly with negative emotion and hyperactivity-impulsivity covaried most strongly with positive emotion. Results demonstrate the importance of complementing trait-level conceptualizations with assessment of momentary dynamics. Momentary assessment suggests important covariation of ADHD symptoms and emotion as part of the ADHD phenotype.
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Affiliation(s)
| | - Jason Dude
- Washington University in Saint Louis, Saint Louis, MO, USA
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4
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De Ronda AC, Rice L, Zhao Y, Rosch KS, Mostofsky SH, Seymour KE. ADHD-related sex differences in emotional symptoms across development. Eur Child Adolesc Psychiatry 2024; 33:1419-1432. [PMID: 37368082 PMCID: PMC10986680 DOI: 10.1007/s00787-023-02251-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 06/19/2023] [Indexed: 06/28/2023]
Abstract
To investigate developmental changes in emotion dysregulation (ED) and associated symptoms of emotional lability, irritability, anxiety, and depression, among girls and boys with and without ADHD from childhood through adolescence. Data were collected from a sample of 8-18-year-old children with (n = 264; 76 girls) and without (n = 153; 56 girls) ADHD, with multiple time-points from a subsample of participants (n = 121). Parents and youth completed rating scales assessing child ED, emotional lability, irritability, anxiety, and depression. Mixed effects models were employed to examine effects and interactions of diagnosis, sex [biological sex assigned at birth], age among boys and girls with and without ADHD. Mixed effects analyses showed sexually dimorphic developmental patterns between boys and girls, such that boys with ADHD showed a greater reduction in ED, irritability, and anxiety with age compared to girls with ADHD, whose symptom levels remained elevated relative to TD girls. Depressive symptoms were persistently elevated among girls with ADHD compared to boys with ADHD, whose symptoms decreased with age, relative to same-sex TD peers. While both boys and girls with ADHD showed higher levels of ED during childhood (compared to their sex-matched TD peers), mixed effects analyses revealed substantial sexually dimorphic patterns of emotional symptom change during adolescence: Boys with ADHD showed robust improvements in emotional symptoms from childhood to adolescence while girls with ADHD continued to show high and/or increased levels of ED, emotional lability, irritability, anxiety and depression.
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Affiliation(s)
- Alyssa C De Ronda
- Center for Neurodevelopmental and Imaging Research, Kennedy Krieger Institute, 716 North Broadway, Baltimore, MD, 21205, USA
| | - Laura Rice
- Center for Neurodevelopmental and Imaging Research, Kennedy Krieger Institute, 716 North Broadway, Baltimore, MD, 21205, USA
| | - Yi Zhao
- Department of Biostatistics, Indiana University School of Medicine, 410 West 10th Street, Indianapolis, IN, 46202, USA
| | - Keri S Rosch
- Center for Neurodevelopmental and Imaging Research, Kennedy Krieger Institute, 716 North Broadway, Baltimore, MD, 21205, USA
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 716 North Broadway, Baltimore, MD, 21205, USA
| | - Stewart H Mostofsky
- Center for Neurodevelopmental and Imaging Research, Kennedy Krieger Institute, 716 North Broadway, Baltimore, MD, 21205, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 716 North Broadway, Baltimore, MD, 21205, USA
- Department of Neurology, Johns Hopkins University School of Medicine , 716 North Broadway, Baltimore, MD, 21205, USA
| | - Karen E Seymour
- Center for Neurodevelopmental and Imaging Research, Kennedy Krieger Institute, 716 North Broadway, Baltimore, MD, 21205, USA.
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 716 North Broadway, Baltimore, MD, 21205, USA.
- Department of Mental Health, Johns Hopkins University School of Public Health, 6701 Rockledge Drive, Bethesda, MD, 20892, USA.
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5
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Johns-Mead R, Vijayakumar N, Mulraney M, Melvin G, Anderson VA, Efron D, Silk TJ. The longitudinal relationship between socioemotional difficulties and irritability in ADHD. J Affect Disord 2024; 350:573-581. [PMID: 38244802 DOI: 10.1016/j.jad.2024.01.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 01/12/2024] [Accepted: 01/14/2024] [Indexed: 01/22/2024]
Abstract
BACKGROUND Despite higher rates of irritability and socioemotional symptoms in ADHD, consensus is lacking regarding their developmental relationship and whether it differs by ADHD status. This longitudinal study sought to evaluate how peer and emotional difficulties relate to irritability in ADHD and control groups. METHODS A community sample of 336 participants (45 % ADHD) were recruited for the Children's Attention Project. Participants completed the Affective Reactivity Index and the Strengths and Difficulties Questionnaire's emotional and peer difficulties scales at baseline (mean age 10.5 years) and 18-month follow-up. Latent Change Score models assessed how emotional and peer difficulties related to irritability at baseline and longitudinally. RESULTS For both groups, more severe baseline difficulties were associated with higher concurrent irritability, and reductions in emotional and peer difficulties were associated with declining irritability. Baseline emotional difficulties predicted change in irritability for the ADHD group, while baseline peer difficulties predicted change in irritability for both groups. Baseline irritability did not predict change in emotional or peer difficulties for either. The ADHD group showed elevated irritability, emotional, and peer difficulties, and stronger baseline correlation between peer difficulties and irritability. LIMITATIONS Only two timepoints were captured, and associations with ADHD symptom severity and presentation were not investigated. Doing so may facilitate additional insights. CONCLUSIONS Change in irritability corresponded to change in socioemotional difficulties, and was driven by earlier levels of socioemotional difficulties. ADHD exacerbated aspects of the relationship between socioemotional difficulties and irritability. Socioemotional difficulties drive irritability, so may represent targets for clinical interventions.
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Affiliation(s)
- Rania Johns-Mead
- School of Psychology and the Centre for Social and Early Emotional Development (SEED), Deakin University, Geelong, Australia
| | - Nandita Vijayakumar
- School of Psychology and the Centre for Social and Early Emotional Development (SEED), Deakin University, Geelong, Australia; Murdoch Children's Research Institute, Melbourne, Australia
| | | | - Glenn Melvin
- School of Psychology and the Centre for Social and Early Emotional Development (SEED), Deakin University, Geelong, Australia
| | - Vicki A Anderson
- Murdoch Children's Research Institute, Melbourne, Australia; The Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Daryl Efron
- Murdoch Children's Research Institute, Melbourne, Australia; The Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Tim J Silk
- School of Psychology and the Centre for Social and Early Emotional Development (SEED), Deakin University, Geelong, Australia; Murdoch Children's Research Institute, Melbourne, Australia.
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6
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Leibenluft E, Allen LE, Althoff RR, Brotman MA, Burke JD, Carlson GA, Dickstein DP, Dougherty LR, Evans SC, Kircanski K, Klein DN, Malone EP, Mazefsky CA, Nigg J, Perlman SB, Pine DS, Roy AK, Salum GA, Shakeshaft A, Silver J, Stoddard J, Thapar A, Tseng WL, Vidal-Ribas P, Wakschlag LS, Stringaris A. Irritability in Youths: A Critical Integrative Review. Am J Psychiatry 2024; 181:275-290. [PMID: 38419494 DOI: 10.1176/appi.ajp.20230256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Irritability, defined as proneness to anger that may impair an individual's functioning, is common in youths. There has been a recent upsurge in relevant research. The authors combine systematic and narrative review approaches to integrate the latest clinical and translational findings and provide suggestions for addressing research gaps. Clinicians and researchers should assess irritability routinely, and specific assessment tools are now available. Informant effects are prominent, are stable, and vary by age and gender. The prevalence of irritability is particularly high among individuals with attention deficit hyperactivity disorder, autism spectrum disorder, and mood and anxiety disorders. Irritability is associated with impairment and suicidality risk independent of co-occurring diagnoses. Developmental trajectories of irritability (which may begin early in life) have been identified and are differentially associated with clinical outcomes. Youth irritability is associated with increased risk of anxiety, depression, behavioral problems, and suicidality later in life. Irritability is moderately heritable, and genetic associations differ based on age and comorbid illnesses. Parent management training is effective for treating psychological problems related to irritability, but its efficacy in treating irritability should be tested rigorously, as should novel mechanism-informed interventions (e.g., those targeting exposure to frustration). Associations between irritability and suicidality and the impact of cultural context are important, underresearched topics. Analyses of large, diverse longitudinal samples that extend into adulthood are needed. Data from both animal and human research indicate that aberrant responses to frustration and threat are central to the pathophysiology of irritability, revealing important translational opportunities.
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Affiliation(s)
- Ellen Leibenluft
- Emotion and Development Branch, NIMH, Bethesda, Md. (Leibenluft, Brotman, Kircanski, Malone, Pine); Faculty of Brain Sciences, Division of Psychiatry and Division of Psychology and Language Sciences, University College London (Allen, Stringaris); Departments of Psychiatry, Pediatrics, and Psychological Science, University of Vermont, Burlington (Althoff); Department of Psychological Sciences, University of Connecticut, Storrs (Burke); Division of Child and Adolescent Psychiatry, Department of Psychiatry (Carlson), Department of Psychology (Klein, Silver), and Department of Psychiatry (Klein), Stony Brook University, Stony Brook, N.Y.; Division of Child and Adolescent Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Mass. (Dickstein); Department of Psychology, University of Maryland, College Park (Dougherty); Department of Psychology, University of Miami, Coral Gables, Fla. (Evans); Departments of Psychiatry, Psychology, and Clinical and Translational Science, University of Pittsburgh, Pittsburgh (Mazefsky); Department of Psychiatry, Oregon Health and Science University, Portland (Nigg); Department of Psychology, Washington University at St. Louis, St. Louis (Perlman); Department of Psychology, Fordham University, New York (Roy); Child Mind Institute, New York (Salum); Division of Psychological Medicine and Clinical Neurosciences, Wolfson Centre for Young People's Mental Health, Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, Wales, United Kingdom (Shakeshaft, Thapar); Division of Child and Adolescent Mental Health, Children's Hospital Colorado, University of Colorado School of Medicine, Denver (Stoddard); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Tseng); Child and Adolescent Mental Health Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain (Vidal-Ribas); Department of Medical Social Sciences, Institute for Innovations in Developmental Sciences, and Institute for Policy Research, Northwestern University, Chicago (Wakschlag); First Department of Psychiatry, National and Kapodistrian University of Athens, and Aiginiteion Hospital, Athens, Greece (Stringaris)
| | - Laura E Allen
- Emotion and Development Branch, NIMH, Bethesda, Md. (Leibenluft, Brotman, Kircanski, Malone, Pine); Faculty of Brain Sciences, Division of Psychiatry and Division of Psychology and Language Sciences, University College London (Allen, Stringaris); Departments of Psychiatry, Pediatrics, and Psychological Science, University of Vermont, Burlington (Althoff); Department of Psychological Sciences, University of Connecticut, Storrs (Burke); Division of Child and Adolescent Psychiatry, Department of Psychiatry (Carlson), Department of Psychology (Klein, Silver), and Department of Psychiatry (Klein), Stony Brook University, Stony Brook, N.Y.; Division of Child and Adolescent Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Mass. (Dickstein); Department of Psychology, University of Maryland, College Park (Dougherty); Department of Psychology, University of Miami, Coral Gables, Fla. (Evans); Departments of Psychiatry, Psychology, and Clinical and Translational Science, University of Pittsburgh, Pittsburgh (Mazefsky); Department of Psychiatry, Oregon Health and Science University, Portland (Nigg); Department of Psychology, Washington University at St. Louis, St. Louis (Perlman); Department of Psychology, Fordham University, New York (Roy); Child Mind Institute, New York (Salum); Division of Psychological Medicine and Clinical Neurosciences, Wolfson Centre for Young People's Mental Health, Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, Wales, United Kingdom (Shakeshaft, Thapar); Division of Child and Adolescent Mental Health, Children's Hospital Colorado, University of Colorado School of Medicine, Denver (Stoddard); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Tseng); Child and Adolescent Mental Health Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain (Vidal-Ribas); Department of Medical Social Sciences, Institute for Innovations in Developmental Sciences, and Institute for Policy Research, Northwestern University, Chicago (Wakschlag); First Department of Psychiatry, National and Kapodistrian University of Athens, and Aiginiteion Hospital, Athens, Greece (Stringaris)
| | - Robert R Althoff
- Emotion and Development Branch, NIMH, Bethesda, Md. (Leibenluft, Brotman, Kircanski, Malone, Pine); Faculty of Brain Sciences, Division of Psychiatry and Division of Psychology and Language Sciences, University College London (Allen, Stringaris); Departments of Psychiatry, Pediatrics, and Psychological Science, University of Vermont, Burlington (Althoff); Department of Psychological Sciences, University of Connecticut, Storrs (Burke); Division of Child and Adolescent Psychiatry, Department of Psychiatry (Carlson), Department of Psychology (Klein, Silver), and Department of Psychiatry (Klein), Stony Brook University, Stony Brook, N.Y.; Division of Child and Adolescent Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Mass. (Dickstein); Department of Psychology, University of Maryland, College Park (Dougherty); Department of Psychology, University of Miami, Coral Gables, Fla. (Evans); Departments of Psychiatry, Psychology, and Clinical and Translational Science, University of Pittsburgh, Pittsburgh (Mazefsky); Department of Psychiatry, Oregon Health and Science University, Portland (Nigg); Department of Psychology, Washington University at St. Louis, St. Louis (Perlman); Department of Psychology, Fordham University, New York (Roy); Child Mind Institute, New York (Salum); Division of Psychological Medicine and Clinical Neurosciences, Wolfson Centre for Young People's Mental Health, Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, Wales, United Kingdom (Shakeshaft, Thapar); Division of Child and Adolescent Mental Health, Children's Hospital Colorado, University of Colorado School of Medicine, Denver (Stoddard); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Tseng); Child and Adolescent Mental Health Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain (Vidal-Ribas); Department of Medical Social Sciences, Institute for Innovations in Developmental Sciences, and Institute for Policy Research, Northwestern University, Chicago (Wakschlag); First Department of Psychiatry, National and Kapodistrian University of Athens, and Aiginiteion Hospital, Athens, Greece (Stringaris)
| | - Melissa A Brotman
- Emotion and Development Branch, NIMH, Bethesda, Md. (Leibenluft, Brotman, Kircanski, Malone, Pine); Faculty of Brain Sciences, Division of Psychiatry and Division of Psychology and Language Sciences, University College London (Allen, Stringaris); Departments of Psychiatry, Pediatrics, and Psychological Science, University of Vermont, Burlington (Althoff); Department of Psychological Sciences, University of Connecticut, Storrs (Burke); Division of Child and Adolescent Psychiatry, Department of Psychiatry (Carlson), Department of Psychology (Klein, Silver), and Department of Psychiatry (Klein), Stony Brook University, Stony Brook, N.Y.; Division of Child and Adolescent Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Mass. (Dickstein); Department of Psychology, University of Maryland, College Park (Dougherty); Department of Psychology, University of Miami, Coral Gables, Fla. (Evans); Departments of Psychiatry, Psychology, and Clinical and Translational Science, University of Pittsburgh, Pittsburgh (Mazefsky); Department of Psychiatry, Oregon Health and Science University, Portland (Nigg); Department of Psychology, Washington University at St. Louis, St. Louis (Perlman); Department of Psychology, Fordham University, New York (Roy); Child Mind Institute, New York (Salum); Division of Psychological Medicine and Clinical Neurosciences, Wolfson Centre for Young People's Mental Health, Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, Wales, United Kingdom (Shakeshaft, Thapar); Division of Child and Adolescent Mental Health, Children's Hospital Colorado, University of Colorado School of Medicine, Denver (Stoddard); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Tseng); Child and Adolescent Mental Health Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain (Vidal-Ribas); Department of Medical Social Sciences, Institute for Innovations in Developmental Sciences, and Institute for Policy Research, Northwestern University, Chicago (Wakschlag); First Department of Psychiatry, National and Kapodistrian University of Athens, and Aiginiteion Hospital, Athens, Greece (Stringaris)
| | - Jeffrey D Burke
- Emotion and Development Branch, NIMH, Bethesda, Md. (Leibenluft, Brotman, Kircanski, Malone, Pine); Faculty of Brain Sciences, Division of Psychiatry and Division of Psychology and Language Sciences, University College London (Allen, Stringaris); Departments of Psychiatry, Pediatrics, and Psychological Science, University of Vermont, Burlington (Althoff); Department of Psychological Sciences, University of Connecticut, Storrs (Burke); Division of Child and Adolescent Psychiatry, Department of Psychiatry (Carlson), Department of Psychology (Klein, Silver), and Department of Psychiatry (Klein), Stony Brook University, Stony Brook, N.Y.; Division of Child and Adolescent Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Mass. (Dickstein); Department of Psychology, University of Maryland, College Park (Dougherty); Department of Psychology, University of Miami, Coral Gables, Fla. (Evans); Departments of Psychiatry, Psychology, and Clinical and Translational Science, University of Pittsburgh, Pittsburgh (Mazefsky); Department of Psychiatry, Oregon Health and Science University, Portland (Nigg); Department of Psychology, Washington University at St. Louis, St. Louis (Perlman); Department of Psychology, Fordham University, New York (Roy); Child Mind Institute, New York (Salum); Division of Psychological Medicine and Clinical Neurosciences, Wolfson Centre for Young People's Mental Health, Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, Wales, United Kingdom (Shakeshaft, Thapar); Division of Child and Adolescent Mental Health, Children's Hospital Colorado, University of Colorado School of Medicine, Denver (Stoddard); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Tseng); Child and Adolescent Mental Health Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain (Vidal-Ribas); Department of Medical Social Sciences, Institute for Innovations in Developmental Sciences, and Institute for Policy Research, Northwestern University, Chicago (Wakschlag); First Department of Psychiatry, National and Kapodistrian University of Athens, and Aiginiteion Hospital, Athens, Greece (Stringaris)
| | - Gabrielle A Carlson
- Emotion and Development Branch, NIMH, Bethesda, Md. (Leibenluft, Brotman, Kircanski, Malone, Pine); Faculty of Brain Sciences, Division of Psychiatry and Division of Psychology and Language Sciences, University College London (Allen, Stringaris); Departments of Psychiatry, Pediatrics, and Psychological Science, University of Vermont, Burlington (Althoff); Department of Psychological Sciences, University of Connecticut, Storrs (Burke); Division of Child and Adolescent Psychiatry, Department of Psychiatry (Carlson), Department of Psychology (Klein, Silver), and Department of Psychiatry (Klein), Stony Brook University, Stony Brook, N.Y.; Division of Child and Adolescent Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Mass. (Dickstein); Department of Psychology, University of Maryland, College Park (Dougherty); Department of Psychology, University of Miami, Coral Gables, Fla. (Evans); Departments of Psychiatry, Psychology, and Clinical and Translational Science, University of Pittsburgh, Pittsburgh (Mazefsky); Department of Psychiatry, Oregon Health and Science University, Portland (Nigg); Department of Psychology, Washington University at St. Louis, St. Louis (Perlman); Department of Psychology, Fordham University, New York (Roy); Child Mind Institute, New York (Salum); Division of Psychological Medicine and Clinical Neurosciences, Wolfson Centre for Young People's Mental Health, Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, Wales, United Kingdom (Shakeshaft, Thapar); Division of Child and Adolescent Mental Health, Children's Hospital Colorado, University of Colorado School of Medicine, Denver (Stoddard); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Tseng); Child and Adolescent Mental Health Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain (Vidal-Ribas); Department of Medical Social Sciences, Institute for Innovations in Developmental Sciences, and Institute for Policy Research, Northwestern University, Chicago (Wakschlag); First Department of Psychiatry, National and Kapodistrian University of Athens, and Aiginiteion Hospital, Athens, Greece (Stringaris)
| | - Daniel P Dickstein
- Emotion and Development Branch, NIMH, Bethesda, Md. (Leibenluft, Brotman, Kircanski, Malone, Pine); Faculty of Brain Sciences, Division of Psychiatry and Division of Psychology and Language Sciences, University College London (Allen, Stringaris); Departments of Psychiatry, Pediatrics, and Psychological Science, University of Vermont, Burlington (Althoff); Department of Psychological Sciences, University of Connecticut, Storrs (Burke); Division of Child and Adolescent Psychiatry, Department of Psychiatry (Carlson), Department of Psychology (Klein, Silver), and Department of Psychiatry (Klein), Stony Brook University, Stony Brook, N.Y.; Division of Child and Adolescent Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Mass. (Dickstein); Department of Psychology, University of Maryland, College Park (Dougherty); Department of Psychology, University of Miami, Coral Gables, Fla. (Evans); Departments of Psychiatry, Psychology, and Clinical and Translational Science, University of Pittsburgh, Pittsburgh (Mazefsky); Department of Psychiatry, Oregon Health and Science University, Portland (Nigg); Department of Psychology, Washington University at St. Louis, St. Louis (Perlman); Department of Psychology, Fordham University, New York (Roy); Child Mind Institute, New York (Salum); Division of Psychological Medicine and Clinical Neurosciences, Wolfson Centre for Young People's Mental Health, Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, Wales, United Kingdom (Shakeshaft, Thapar); Division of Child and Adolescent Mental Health, Children's Hospital Colorado, University of Colorado School of Medicine, Denver (Stoddard); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Tseng); Child and Adolescent Mental Health Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain (Vidal-Ribas); Department of Medical Social Sciences, Institute for Innovations in Developmental Sciences, and Institute for Policy Research, Northwestern University, Chicago (Wakschlag); First Department of Psychiatry, National and Kapodistrian University of Athens, and Aiginiteion Hospital, Athens, Greece (Stringaris)
| | - Lea R Dougherty
- Emotion and Development Branch, NIMH, Bethesda, Md. (Leibenluft, Brotman, Kircanski, Malone, Pine); Faculty of Brain Sciences, Division of Psychiatry and Division of Psychology and Language Sciences, University College London (Allen, Stringaris); Departments of Psychiatry, Pediatrics, and Psychological Science, University of Vermont, Burlington (Althoff); Department of Psychological Sciences, University of Connecticut, Storrs (Burke); Division of Child and Adolescent Psychiatry, Department of Psychiatry (Carlson), Department of Psychology (Klein, Silver), and Department of Psychiatry (Klein), Stony Brook University, Stony Brook, N.Y.; Division of Child and Adolescent Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Mass. (Dickstein); Department of Psychology, University of Maryland, College Park (Dougherty); Department of Psychology, University of Miami, Coral Gables, Fla. (Evans); Departments of Psychiatry, Psychology, and Clinical and Translational Science, University of Pittsburgh, Pittsburgh (Mazefsky); Department of Psychiatry, Oregon Health and Science University, Portland (Nigg); Department of Psychology, Washington University at St. Louis, St. Louis (Perlman); Department of Psychology, Fordham University, New York (Roy); Child Mind Institute, New York (Salum); Division of Psychological Medicine and Clinical Neurosciences, Wolfson Centre for Young People's Mental Health, Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, Wales, United Kingdom (Shakeshaft, Thapar); Division of Child and Adolescent Mental Health, Children's Hospital Colorado, University of Colorado School of Medicine, Denver (Stoddard); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Tseng); Child and Adolescent Mental Health Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain (Vidal-Ribas); Department of Medical Social Sciences, Institute for Innovations in Developmental Sciences, and Institute for Policy Research, Northwestern University, Chicago (Wakschlag); First Department of Psychiatry, National and Kapodistrian University of Athens, and Aiginiteion Hospital, Athens, Greece (Stringaris)
| | - Spencer C Evans
- Emotion and Development Branch, NIMH, Bethesda, Md. (Leibenluft, Brotman, Kircanski, Malone, Pine); Faculty of Brain Sciences, Division of Psychiatry and Division of Psychology and Language Sciences, University College London (Allen, Stringaris); Departments of Psychiatry, Pediatrics, and Psychological Science, University of Vermont, Burlington (Althoff); Department of Psychological Sciences, University of Connecticut, Storrs (Burke); Division of Child and Adolescent Psychiatry, Department of Psychiatry (Carlson), Department of Psychology (Klein, Silver), and Department of Psychiatry (Klein), Stony Brook University, Stony Brook, N.Y.; Division of Child and Adolescent Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Mass. (Dickstein); Department of Psychology, University of Maryland, College Park (Dougherty); Department of Psychology, University of Miami, Coral Gables, Fla. (Evans); Departments of Psychiatry, Psychology, and Clinical and Translational Science, University of Pittsburgh, Pittsburgh (Mazefsky); Department of Psychiatry, Oregon Health and Science University, Portland (Nigg); Department of Psychology, Washington University at St. Louis, St. Louis (Perlman); Department of Psychology, Fordham University, New York (Roy); Child Mind Institute, New York (Salum); Division of Psychological Medicine and Clinical Neurosciences, Wolfson Centre for Young People's Mental Health, Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, Wales, United Kingdom (Shakeshaft, Thapar); Division of Child and Adolescent Mental Health, Children's Hospital Colorado, University of Colorado School of Medicine, Denver (Stoddard); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Tseng); Child and Adolescent Mental Health Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain (Vidal-Ribas); Department of Medical Social Sciences, Institute for Innovations in Developmental Sciences, and Institute for Policy Research, Northwestern University, Chicago (Wakschlag); First Department of Psychiatry, National and Kapodistrian University of Athens, and Aiginiteion Hospital, Athens, Greece (Stringaris)
| | - Katharina Kircanski
- Emotion and Development Branch, NIMH, Bethesda, Md. (Leibenluft, Brotman, Kircanski, Malone, Pine); Faculty of Brain Sciences, Division of Psychiatry and Division of Psychology and Language Sciences, University College London (Allen, Stringaris); Departments of Psychiatry, Pediatrics, and Psychological Science, University of Vermont, Burlington (Althoff); Department of Psychological Sciences, University of Connecticut, Storrs (Burke); Division of Child and Adolescent Psychiatry, Department of Psychiatry (Carlson), Department of Psychology (Klein, Silver), and Department of Psychiatry (Klein), Stony Brook University, Stony Brook, N.Y.; Division of Child and Adolescent Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Mass. (Dickstein); Department of Psychology, University of Maryland, College Park (Dougherty); Department of Psychology, University of Miami, Coral Gables, Fla. (Evans); Departments of Psychiatry, Psychology, and Clinical and Translational Science, University of Pittsburgh, Pittsburgh (Mazefsky); Department of Psychiatry, Oregon Health and Science University, Portland (Nigg); Department of Psychology, Washington University at St. Louis, St. Louis (Perlman); Department of Psychology, Fordham University, New York (Roy); Child Mind Institute, New York (Salum); Division of Psychological Medicine and Clinical Neurosciences, Wolfson Centre for Young People's Mental Health, Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, Wales, United Kingdom (Shakeshaft, Thapar); Division of Child and Adolescent Mental Health, Children's Hospital Colorado, University of Colorado School of Medicine, Denver (Stoddard); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Tseng); Child and Adolescent Mental Health Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain (Vidal-Ribas); Department of Medical Social Sciences, Institute for Innovations in Developmental Sciences, and Institute for Policy Research, Northwestern University, Chicago (Wakschlag); First Department of Psychiatry, National and Kapodistrian University of Athens, and Aiginiteion Hospital, Athens, Greece (Stringaris)
| | - Daniel N Klein
- Emotion and Development Branch, NIMH, Bethesda, Md. (Leibenluft, Brotman, Kircanski, Malone, Pine); Faculty of Brain Sciences, Division of Psychiatry and Division of Psychology and Language Sciences, University College London (Allen, Stringaris); Departments of Psychiatry, Pediatrics, and Psychological Science, University of Vermont, Burlington (Althoff); Department of Psychological Sciences, University of Connecticut, Storrs (Burke); Division of Child and Adolescent Psychiatry, Department of Psychiatry (Carlson), Department of Psychology (Klein, Silver), and Department of Psychiatry (Klein), Stony Brook University, Stony Brook, N.Y.; Division of Child and Adolescent Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Mass. (Dickstein); Department of Psychology, University of Maryland, College Park (Dougherty); Department of Psychology, University of Miami, Coral Gables, Fla. (Evans); Departments of Psychiatry, Psychology, and Clinical and Translational Science, University of Pittsburgh, Pittsburgh (Mazefsky); Department of Psychiatry, Oregon Health and Science University, Portland (Nigg); Department of Psychology, Washington University at St. Louis, St. Louis (Perlman); Department of Psychology, Fordham University, New York (Roy); Child Mind Institute, New York (Salum); Division of Psychological Medicine and Clinical Neurosciences, Wolfson Centre for Young People's Mental Health, Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, Wales, United Kingdom (Shakeshaft, Thapar); Division of Child and Adolescent Mental Health, Children's Hospital Colorado, University of Colorado School of Medicine, Denver (Stoddard); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Tseng); Child and Adolescent Mental Health Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain (Vidal-Ribas); Department of Medical Social Sciences, Institute for Innovations in Developmental Sciences, and Institute for Policy Research, Northwestern University, Chicago (Wakschlag); First Department of Psychiatry, National and Kapodistrian University of Athens, and Aiginiteion Hospital, Athens, Greece (Stringaris)
| | - Eleanor P Malone
- Emotion and Development Branch, NIMH, Bethesda, Md. (Leibenluft, Brotman, Kircanski, Malone, Pine); Faculty of Brain Sciences, Division of Psychiatry and Division of Psychology and Language Sciences, University College London (Allen, Stringaris); Departments of Psychiatry, Pediatrics, and Psychological Science, University of Vermont, Burlington (Althoff); Department of Psychological Sciences, University of Connecticut, Storrs (Burke); Division of Child and Adolescent Psychiatry, Department of Psychiatry (Carlson), Department of Psychology (Klein, Silver), and Department of Psychiatry (Klein), Stony Brook University, Stony Brook, N.Y.; Division of Child and Adolescent Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Mass. (Dickstein); Department of Psychology, University of Maryland, College Park (Dougherty); Department of Psychology, University of Miami, Coral Gables, Fla. (Evans); Departments of Psychiatry, Psychology, and Clinical and Translational Science, University of Pittsburgh, Pittsburgh (Mazefsky); Department of Psychiatry, Oregon Health and Science University, Portland (Nigg); Department of Psychology, Washington University at St. Louis, St. Louis (Perlman); Department of Psychology, Fordham University, New York (Roy); Child Mind Institute, New York (Salum); Division of Psychological Medicine and Clinical Neurosciences, Wolfson Centre for Young People's Mental Health, Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, Wales, United Kingdom (Shakeshaft, Thapar); Division of Child and Adolescent Mental Health, Children's Hospital Colorado, University of Colorado School of Medicine, Denver (Stoddard); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Tseng); Child and Adolescent Mental Health Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain (Vidal-Ribas); Department of Medical Social Sciences, Institute for Innovations in Developmental Sciences, and Institute for Policy Research, Northwestern University, Chicago (Wakschlag); First Department of Psychiatry, National and Kapodistrian University of Athens, and Aiginiteion Hospital, Athens, Greece (Stringaris)
| | - Carla A Mazefsky
- Emotion and Development Branch, NIMH, Bethesda, Md. (Leibenluft, Brotman, Kircanski, Malone, Pine); Faculty of Brain Sciences, Division of Psychiatry and Division of Psychology and Language Sciences, University College London (Allen, Stringaris); Departments of Psychiatry, Pediatrics, and Psychological Science, University of Vermont, Burlington (Althoff); Department of Psychological Sciences, University of Connecticut, Storrs (Burke); Division of Child and Adolescent Psychiatry, Department of Psychiatry (Carlson), Department of Psychology (Klein, Silver), and Department of Psychiatry (Klein), Stony Brook University, Stony Brook, N.Y.; Division of Child and Adolescent Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Mass. (Dickstein); Department of Psychology, University of Maryland, College Park (Dougherty); Department of Psychology, University of Miami, Coral Gables, Fla. (Evans); Departments of Psychiatry, Psychology, and Clinical and Translational Science, University of Pittsburgh, Pittsburgh (Mazefsky); Department of Psychiatry, Oregon Health and Science University, Portland (Nigg); Department of Psychology, Washington University at St. Louis, St. Louis (Perlman); Department of Psychology, Fordham University, New York (Roy); Child Mind Institute, New York (Salum); Division of Psychological Medicine and Clinical Neurosciences, Wolfson Centre for Young People's Mental Health, Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, Wales, United Kingdom (Shakeshaft, Thapar); Division of Child and Adolescent Mental Health, Children's Hospital Colorado, University of Colorado School of Medicine, Denver (Stoddard); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Tseng); Child and Adolescent Mental Health Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain (Vidal-Ribas); Department of Medical Social Sciences, Institute for Innovations in Developmental Sciences, and Institute for Policy Research, Northwestern University, Chicago (Wakschlag); First Department of Psychiatry, National and Kapodistrian University of Athens, and Aiginiteion Hospital, Athens, Greece (Stringaris)
| | - Joel Nigg
- Emotion and Development Branch, NIMH, Bethesda, Md. (Leibenluft, Brotman, Kircanski, Malone, Pine); Faculty of Brain Sciences, Division of Psychiatry and Division of Psychology and Language Sciences, University College London (Allen, Stringaris); Departments of Psychiatry, Pediatrics, and Psychological Science, University of Vermont, Burlington (Althoff); Department of Psychological Sciences, University of Connecticut, Storrs (Burke); Division of Child and Adolescent Psychiatry, Department of Psychiatry (Carlson), Department of Psychology (Klein, Silver), and Department of Psychiatry (Klein), Stony Brook University, Stony Brook, N.Y.; Division of Child and Adolescent Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Mass. (Dickstein); Department of Psychology, University of Maryland, College Park (Dougherty); Department of Psychology, University of Miami, Coral Gables, Fla. (Evans); Departments of Psychiatry, Psychology, and Clinical and Translational Science, University of Pittsburgh, Pittsburgh (Mazefsky); Department of Psychiatry, Oregon Health and Science University, Portland (Nigg); Department of Psychology, Washington University at St. Louis, St. Louis (Perlman); Department of Psychology, Fordham University, New York (Roy); Child Mind Institute, New York (Salum); Division of Psychological Medicine and Clinical Neurosciences, Wolfson Centre for Young People's Mental Health, Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, Wales, United Kingdom (Shakeshaft, Thapar); Division of Child and Adolescent Mental Health, Children's Hospital Colorado, University of Colorado School of Medicine, Denver (Stoddard); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Tseng); Child and Adolescent Mental Health Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain (Vidal-Ribas); Department of Medical Social Sciences, Institute for Innovations in Developmental Sciences, and Institute for Policy Research, Northwestern University, Chicago (Wakschlag); First Department of Psychiatry, National and Kapodistrian University of Athens, and Aiginiteion Hospital, Athens, Greece (Stringaris)
| | - Susan B Perlman
- Emotion and Development Branch, NIMH, Bethesda, Md. (Leibenluft, Brotman, Kircanski, Malone, Pine); Faculty of Brain Sciences, Division of Psychiatry and Division of Psychology and Language Sciences, University College London (Allen, Stringaris); Departments of Psychiatry, Pediatrics, and Psychological Science, University of Vermont, Burlington (Althoff); Department of Psychological Sciences, University of Connecticut, Storrs (Burke); Division of Child and Adolescent Psychiatry, Department of Psychiatry (Carlson), Department of Psychology (Klein, Silver), and Department of Psychiatry (Klein), Stony Brook University, Stony Brook, N.Y.; Division of Child and Adolescent Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Mass. (Dickstein); Department of Psychology, University of Maryland, College Park (Dougherty); Department of Psychology, University of Miami, Coral Gables, Fla. (Evans); Departments of Psychiatry, Psychology, and Clinical and Translational Science, University of Pittsburgh, Pittsburgh (Mazefsky); Department of Psychiatry, Oregon Health and Science University, Portland (Nigg); Department of Psychology, Washington University at St. Louis, St. Louis (Perlman); Department of Psychology, Fordham University, New York (Roy); Child Mind Institute, New York (Salum); Division of Psychological Medicine and Clinical Neurosciences, Wolfson Centre for Young People's Mental Health, Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, Wales, United Kingdom (Shakeshaft, Thapar); Division of Child and Adolescent Mental Health, Children's Hospital Colorado, University of Colorado School of Medicine, Denver (Stoddard); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Tseng); Child and Adolescent Mental Health Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain (Vidal-Ribas); Department of Medical Social Sciences, Institute for Innovations in Developmental Sciences, and Institute for Policy Research, Northwestern University, Chicago (Wakschlag); First Department of Psychiatry, National and Kapodistrian University of Athens, and Aiginiteion Hospital, Athens, Greece (Stringaris)
| | - Daniel S Pine
- Emotion and Development Branch, NIMH, Bethesda, Md. (Leibenluft, Brotman, Kircanski, Malone, Pine); Faculty of Brain Sciences, Division of Psychiatry and Division of Psychology and Language Sciences, University College London (Allen, Stringaris); Departments of Psychiatry, Pediatrics, and Psychological Science, University of Vermont, Burlington (Althoff); Department of Psychological Sciences, University of Connecticut, Storrs (Burke); Division of Child and Adolescent Psychiatry, Department of Psychiatry (Carlson), Department of Psychology (Klein, Silver), and Department of Psychiatry (Klein), Stony Brook University, Stony Brook, N.Y.; Division of Child and Adolescent Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Mass. (Dickstein); Department of Psychology, University of Maryland, College Park (Dougherty); Department of Psychology, University of Miami, Coral Gables, Fla. (Evans); Departments of Psychiatry, Psychology, and Clinical and Translational Science, University of Pittsburgh, Pittsburgh (Mazefsky); Department of Psychiatry, Oregon Health and Science University, Portland (Nigg); Department of Psychology, Washington University at St. Louis, St. Louis (Perlman); Department of Psychology, Fordham University, New York (Roy); Child Mind Institute, New York (Salum); Division of Psychological Medicine and Clinical Neurosciences, Wolfson Centre for Young People's Mental Health, Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, Wales, United Kingdom (Shakeshaft, Thapar); Division of Child and Adolescent Mental Health, Children's Hospital Colorado, University of Colorado School of Medicine, Denver (Stoddard); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Tseng); Child and Adolescent Mental Health Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain (Vidal-Ribas); Department of Medical Social Sciences, Institute for Innovations in Developmental Sciences, and Institute for Policy Research, Northwestern University, Chicago (Wakschlag); First Department of Psychiatry, National and Kapodistrian University of Athens, and Aiginiteion Hospital, Athens, Greece (Stringaris)
| | - Amy Krain Roy
- Emotion and Development Branch, NIMH, Bethesda, Md. (Leibenluft, Brotman, Kircanski, Malone, Pine); Faculty of Brain Sciences, Division of Psychiatry and Division of Psychology and Language Sciences, University College London (Allen, Stringaris); Departments of Psychiatry, Pediatrics, and Psychological Science, University of Vermont, Burlington (Althoff); Department of Psychological Sciences, University of Connecticut, Storrs (Burke); Division of Child and Adolescent Psychiatry, Department of Psychiatry (Carlson), Department of Psychology (Klein, Silver), and Department of Psychiatry (Klein), Stony Brook University, Stony Brook, N.Y.; Division of Child and Adolescent Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Mass. (Dickstein); Department of Psychology, University of Maryland, College Park (Dougherty); Department of Psychology, University of Miami, Coral Gables, Fla. (Evans); Departments of Psychiatry, Psychology, and Clinical and Translational Science, University of Pittsburgh, Pittsburgh (Mazefsky); Department of Psychiatry, Oregon Health and Science University, Portland (Nigg); Department of Psychology, Washington University at St. Louis, St. Louis (Perlman); Department of Psychology, Fordham University, New York (Roy); Child Mind Institute, New York (Salum); Division of Psychological Medicine and Clinical Neurosciences, Wolfson Centre for Young People's Mental Health, Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, Wales, United Kingdom (Shakeshaft, Thapar); Division of Child and Adolescent Mental Health, Children's Hospital Colorado, University of Colorado School of Medicine, Denver (Stoddard); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Tseng); Child and Adolescent Mental Health Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain (Vidal-Ribas); Department of Medical Social Sciences, Institute for Innovations in Developmental Sciences, and Institute for Policy Research, Northwestern University, Chicago (Wakschlag); First Department of Psychiatry, National and Kapodistrian University of Athens, and Aiginiteion Hospital, Athens, Greece (Stringaris)
| | - Giovanni A Salum
- Emotion and Development Branch, NIMH, Bethesda, Md. (Leibenluft, Brotman, Kircanski, Malone, Pine); Faculty of Brain Sciences, Division of Psychiatry and Division of Psychology and Language Sciences, University College London (Allen, Stringaris); Departments of Psychiatry, Pediatrics, and Psychological Science, University of Vermont, Burlington (Althoff); Department of Psychological Sciences, University of Connecticut, Storrs (Burke); Division of Child and Adolescent Psychiatry, Department of Psychiatry (Carlson), Department of Psychology (Klein, Silver), and Department of Psychiatry (Klein), Stony Brook University, Stony Brook, N.Y.; Division of Child and Adolescent Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Mass. (Dickstein); Department of Psychology, University of Maryland, College Park (Dougherty); Department of Psychology, University of Miami, Coral Gables, Fla. (Evans); Departments of Psychiatry, Psychology, and Clinical and Translational Science, University of Pittsburgh, Pittsburgh (Mazefsky); Department of Psychiatry, Oregon Health and Science University, Portland (Nigg); Department of Psychology, Washington University at St. Louis, St. Louis (Perlman); Department of Psychology, Fordham University, New York (Roy); Child Mind Institute, New York (Salum); Division of Psychological Medicine and Clinical Neurosciences, Wolfson Centre for Young People's Mental Health, Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, Wales, United Kingdom (Shakeshaft, Thapar); Division of Child and Adolescent Mental Health, Children's Hospital Colorado, University of Colorado School of Medicine, Denver (Stoddard); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Tseng); Child and Adolescent Mental Health Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain (Vidal-Ribas); Department of Medical Social Sciences, Institute for Innovations in Developmental Sciences, and Institute for Policy Research, Northwestern University, Chicago (Wakschlag); First Department of Psychiatry, National and Kapodistrian University of Athens, and Aiginiteion Hospital, Athens, Greece (Stringaris)
| | - Amy Shakeshaft
- Emotion and Development Branch, NIMH, Bethesda, Md. (Leibenluft, Brotman, Kircanski, Malone, Pine); Faculty of Brain Sciences, Division of Psychiatry and Division of Psychology and Language Sciences, University College London (Allen, Stringaris); Departments of Psychiatry, Pediatrics, and Psychological Science, University of Vermont, Burlington (Althoff); Department of Psychological Sciences, University of Connecticut, Storrs (Burke); Division of Child and Adolescent Psychiatry, Department of Psychiatry (Carlson), Department of Psychology (Klein, Silver), and Department of Psychiatry (Klein), Stony Brook University, Stony Brook, N.Y.; Division of Child and Adolescent Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Mass. (Dickstein); Department of Psychology, University of Maryland, College Park (Dougherty); Department of Psychology, University of Miami, Coral Gables, Fla. (Evans); Departments of Psychiatry, Psychology, and Clinical and Translational Science, University of Pittsburgh, Pittsburgh (Mazefsky); Department of Psychiatry, Oregon Health and Science University, Portland (Nigg); Department of Psychology, Washington University at St. Louis, St. Louis (Perlman); Department of Psychology, Fordham University, New York (Roy); Child Mind Institute, New York (Salum); Division of Psychological Medicine and Clinical Neurosciences, Wolfson Centre for Young People's Mental Health, Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, Wales, United Kingdom (Shakeshaft, Thapar); Division of Child and Adolescent Mental Health, Children's Hospital Colorado, University of Colorado School of Medicine, Denver (Stoddard); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Tseng); Child and Adolescent Mental Health Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain (Vidal-Ribas); Department of Medical Social Sciences, Institute for Innovations in Developmental Sciences, and Institute for Policy Research, Northwestern University, Chicago (Wakschlag); First Department of Psychiatry, National and Kapodistrian University of Athens, and Aiginiteion Hospital, Athens, Greece (Stringaris)
| | - Jamilah Silver
- Emotion and Development Branch, NIMH, Bethesda, Md. (Leibenluft, Brotman, Kircanski, Malone, Pine); Faculty of Brain Sciences, Division of Psychiatry and Division of Psychology and Language Sciences, University College London (Allen, Stringaris); Departments of Psychiatry, Pediatrics, and Psychological Science, University of Vermont, Burlington (Althoff); Department of Psychological Sciences, University of Connecticut, Storrs (Burke); Division of Child and Adolescent Psychiatry, Department of Psychiatry (Carlson), Department of Psychology (Klein, Silver), and Department of Psychiatry (Klein), Stony Brook University, Stony Brook, N.Y.; Division of Child and Adolescent Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Mass. (Dickstein); Department of Psychology, University of Maryland, College Park (Dougherty); Department of Psychology, University of Miami, Coral Gables, Fla. (Evans); Departments of Psychiatry, Psychology, and Clinical and Translational Science, University of Pittsburgh, Pittsburgh (Mazefsky); Department of Psychiatry, Oregon Health and Science University, Portland (Nigg); Department of Psychology, Washington University at St. Louis, St. Louis (Perlman); Department of Psychology, Fordham University, New York (Roy); Child Mind Institute, New York (Salum); Division of Psychological Medicine and Clinical Neurosciences, Wolfson Centre for Young People's Mental Health, Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, Wales, United Kingdom (Shakeshaft, Thapar); Division of Child and Adolescent Mental Health, Children's Hospital Colorado, University of Colorado School of Medicine, Denver (Stoddard); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Tseng); Child and Adolescent Mental Health Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain (Vidal-Ribas); Department of Medical Social Sciences, Institute for Innovations in Developmental Sciences, and Institute for Policy Research, Northwestern University, Chicago (Wakschlag); First Department of Psychiatry, National and Kapodistrian University of Athens, and Aiginiteion Hospital, Athens, Greece (Stringaris)
| | - Joel Stoddard
- Emotion and Development Branch, NIMH, Bethesda, Md. (Leibenluft, Brotman, Kircanski, Malone, Pine); Faculty of Brain Sciences, Division of Psychiatry and Division of Psychology and Language Sciences, University College London (Allen, Stringaris); Departments of Psychiatry, Pediatrics, and Psychological Science, University of Vermont, Burlington (Althoff); Department of Psychological Sciences, University of Connecticut, Storrs (Burke); Division of Child and Adolescent Psychiatry, Department of Psychiatry (Carlson), Department of Psychology (Klein, Silver), and Department of Psychiatry (Klein), Stony Brook University, Stony Brook, N.Y.; Division of Child and Adolescent Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Mass. (Dickstein); Department of Psychology, University of Maryland, College Park (Dougherty); Department of Psychology, University of Miami, Coral Gables, Fla. (Evans); Departments of Psychiatry, Psychology, and Clinical and Translational Science, University of Pittsburgh, Pittsburgh (Mazefsky); Department of Psychiatry, Oregon Health and Science University, Portland (Nigg); Department of Psychology, Washington University at St. Louis, St. Louis (Perlman); Department of Psychology, Fordham University, New York (Roy); Child Mind Institute, New York (Salum); Division of Psychological Medicine and Clinical Neurosciences, Wolfson Centre for Young People's Mental Health, Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, Wales, United Kingdom (Shakeshaft, Thapar); Division of Child and Adolescent Mental Health, Children's Hospital Colorado, University of Colorado School of Medicine, Denver (Stoddard); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Tseng); Child and Adolescent Mental Health Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain (Vidal-Ribas); Department of Medical Social Sciences, Institute for Innovations in Developmental Sciences, and Institute for Policy Research, Northwestern University, Chicago (Wakschlag); First Department of Psychiatry, National and Kapodistrian University of Athens, and Aiginiteion Hospital, Athens, Greece (Stringaris)
| | - Anita Thapar
- Emotion and Development Branch, NIMH, Bethesda, Md. (Leibenluft, Brotman, Kircanski, Malone, Pine); Faculty of Brain Sciences, Division of Psychiatry and Division of Psychology and Language Sciences, University College London (Allen, Stringaris); Departments of Psychiatry, Pediatrics, and Psychological Science, University of Vermont, Burlington (Althoff); Department of Psychological Sciences, University of Connecticut, Storrs (Burke); Division of Child and Adolescent Psychiatry, Department of Psychiatry (Carlson), Department of Psychology (Klein, Silver), and Department of Psychiatry (Klein), Stony Brook University, Stony Brook, N.Y.; Division of Child and Adolescent Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Mass. (Dickstein); Department of Psychology, University of Maryland, College Park (Dougherty); Department of Psychology, University of Miami, Coral Gables, Fla. (Evans); Departments of Psychiatry, Psychology, and Clinical and Translational Science, University of Pittsburgh, Pittsburgh (Mazefsky); Department of Psychiatry, Oregon Health and Science University, Portland (Nigg); Department of Psychology, Washington University at St. Louis, St. Louis (Perlman); Department of Psychology, Fordham University, New York (Roy); Child Mind Institute, New York (Salum); Division of Psychological Medicine and Clinical Neurosciences, Wolfson Centre for Young People's Mental Health, Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, Wales, United Kingdom (Shakeshaft, Thapar); Division of Child and Adolescent Mental Health, Children's Hospital Colorado, University of Colorado School of Medicine, Denver (Stoddard); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Tseng); Child and Adolescent Mental Health Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain (Vidal-Ribas); Department of Medical Social Sciences, Institute for Innovations in Developmental Sciences, and Institute for Policy Research, Northwestern University, Chicago (Wakschlag); First Department of Psychiatry, National and Kapodistrian University of Athens, and Aiginiteion Hospital, Athens, Greece (Stringaris)
| | - Wan-Ling Tseng
- Emotion and Development Branch, NIMH, Bethesda, Md. (Leibenluft, Brotman, Kircanski, Malone, Pine); Faculty of Brain Sciences, Division of Psychiatry and Division of Psychology and Language Sciences, University College London (Allen, Stringaris); Departments of Psychiatry, Pediatrics, and Psychological Science, University of Vermont, Burlington (Althoff); Department of Psychological Sciences, University of Connecticut, Storrs (Burke); Division of Child and Adolescent Psychiatry, Department of Psychiatry (Carlson), Department of Psychology (Klein, Silver), and Department of Psychiatry (Klein), Stony Brook University, Stony Brook, N.Y.; Division of Child and Adolescent Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Mass. (Dickstein); Department of Psychology, University of Maryland, College Park (Dougherty); Department of Psychology, University of Miami, Coral Gables, Fla. (Evans); Departments of Psychiatry, Psychology, and Clinical and Translational Science, University of Pittsburgh, Pittsburgh (Mazefsky); Department of Psychiatry, Oregon Health and Science University, Portland (Nigg); Department of Psychology, Washington University at St. Louis, St. Louis (Perlman); Department of Psychology, Fordham University, New York (Roy); Child Mind Institute, New York (Salum); Division of Psychological Medicine and Clinical Neurosciences, Wolfson Centre for Young People's Mental Health, Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, Wales, United Kingdom (Shakeshaft, Thapar); Division of Child and Adolescent Mental Health, Children's Hospital Colorado, University of Colorado School of Medicine, Denver (Stoddard); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Tseng); Child and Adolescent Mental Health Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain (Vidal-Ribas); Department of Medical Social Sciences, Institute for Innovations in Developmental Sciences, and Institute for Policy Research, Northwestern University, Chicago (Wakschlag); First Department of Psychiatry, National and Kapodistrian University of Athens, and Aiginiteion Hospital, Athens, Greece (Stringaris)
| | - Pablo Vidal-Ribas
- Emotion and Development Branch, NIMH, Bethesda, Md. (Leibenluft, Brotman, Kircanski, Malone, Pine); Faculty of Brain Sciences, Division of Psychiatry and Division of Psychology and Language Sciences, University College London (Allen, Stringaris); Departments of Psychiatry, Pediatrics, and Psychological Science, University of Vermont, Burlington (Althoff); Department of Psychological Sciences, University of Connecticut, Storrs (Burke); Division of Child and Adolescent Psychiatry, Department of Psychiatry (Carlson), Department of Psychology (Klein, Silver), and Department of Psychiatry (Klein), Stony Brook University, Stony Brook, N.Y.; Division of Child and Adolescent Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Mass. (Dickstein); Department of Psychology, University of Maryland, College Park (Dougherty); Department of Psychology, University of Miami, Coral Gables, Fla. (Evans); Departments of Psychiatry, Psychology, and Clinical and Translational Science, University of Pittsburgh, Pittsburgh (Mazefsky); Department of Psychiatry, Oregon Health and Science University, Portland (Nigg); Department of Psychology, Washington University at St. Louis, St. Louis (Perlman); Department of Psychology, Fordham University, New York (Roy); Child Mind Institute, New York (Salum); Division of Psychological Medicine and Clinical Neurosciences, Wolfson Centre for Young People's Mental Health, Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, Wales, United Kingdom (Shakeshaft, Thapar); Division of Child and Adolescent Mental Health, Children's Hospital Colorado, University of Colorado School of Medicine, Denver (Stoddard); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Tseng); Child and Adolescent Mental Health Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain (Vidal-Ribas); Department of Medical Social Sciences, Institute for Innovations in Developmental Sciences, and Institute for Policy Research, Northwestern University, Chicago (Wakschlag); First Department of Psychiatry, National and Kapodistrian University of Athens, and Aiginiteion Hospital, Athens, Greece (Stringaris)
| | - Lauren S Wakschlag
- Emotion and Development Branch, NIMH, Bethesda, Md. (Leibenluft, Brotman, Kircanski, Malone, Pine); Faculty of Brain Sciences, Division of Psychiatry and Division of Psychology and Language Sciences, University College London (Allen, Stringaris); Departments of Psychiatry, Pediatrics, and Psychological Science, University of Vermont, Burlington (Althoff); Department of Psychological Sciences, University of Connecticut, Storrs (Burke); Division of Child and Adolescent Psychiatry, Department of Psychiatry (Carlson), Department of Psychology (Klein, Silver), and Department of Psychiatry (Klein), Stony Brook University, Stony Brook, N.Y.; Division of Child and Adolescent Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Mass. (Dickstein); Department of Psychology, University of Maryland, College Park (Dougherty); Department of Psychology, University of Miami, Coral Gables, Fla. (Evans); Departments of Psychiatry, Psychology, and Clinical and Translational Science, University of Pittsburgh, Pittsburgh (Mazefsky); Department of Psychiatry, Oregon Health and Science University, Portland (Nigg); Department of Psychology, Washington University at St. Louis, St. Louis (Perlman); Department of Psychology, Fordham University, New York (Roy); Child Mind Institute, New York (Salum); Division of Psychological Medicine and Clinical Neurosciences, Wolfson Centre for Young People's Mental Health, Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, Wales, United Kingdom (Shakeshaft, Thapar); Division of Child and Adolescent Mental Health, Children's Hospital Colorado, University of Colorado School of Medicine, Denver (Stoddard); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Tseng); Child and Adolescent Mental Health Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain (Vidal-Ribas); Department of Medical Social Sciences, Institute for Innovations in Developmental Sciences, and Institute for Policy Research, Northwestern University, Chicago (Wakschlag); First Department of Psychiatry, National and Kapodistrian University of Athens, and Aiginiteion Hospital, Athens, Greece (Stringaris)
| | - Argyris Stringaris
- Emotion and Development Branch, NIMH, Bethesda, Md. (Leibenluft, Brotman, Kircanski, Malone, Pine); Faculty of Brain Sciences, Division of Psychiatry and Division of Psychology and Language Sciences, University College London (Allen, Stringaris); Departments of Psychiatry, Pediatrics, and Psychological Science, University of Vermont, Burlington (Althoff); Department of Psychological Sciences, University of Connecticut, Storrs (Burke); Division of Child and Adolescent Psychiatry, Department of Psychiatry (Carlson), Department of Psychology (Klein, Silver), and Department of Psychiatry (Klein), Stony Brook University, Stony Brook, N.Y.; Division of Child and Adolescent Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Mass. (Dickstein); Department of Psychology, University of Maryland, College Park (Dougherty); Department of Psychology, University of Miami, Coral Gables, Fla. (Evans); Departments of Psychiatry, Psychology, and Clinical and Translational Science, University of Pittsburgh, Pittsburgh (Mazefsky); Department of Psychiatry, Oregon Health and Science University, Portland (Nigg); Department of Psychology, Washington University at St. Louis, St. Louis (Perlman); Department of Psychology, Fordham University, New York (Roy); Child Mind Institute, New York (Salum); Division of Psychological Medicine and Clinical Neurosciences, Wolfson Centre for Young People's Mental Health, Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, Wales, United Kingdom (Shakeshaft, Thapar); Division of Child and Adolescent Mental Health, Children's Hospital Colorado, University of Colorado School of Medicine, Denver (Stoddard); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Tseng); Child and Adolescent Mental Health Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain (Vidal-Ribas); Department of Medical Social Sciences, Institute for Innovations in Developmental Sciences, and Institute for Policy Research, Northwestern University, Chicago (Wakschlag); First Department of Psychiatry, National and Kapodistrian University of Athens, and Aiginiteion Hospital, Athens, Greece (Stringaris)
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7
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Figuracion MT, Kozlowski MB, Macknyk KS, Heise MB, Pieper SM, Alperin BR, Morton HE, Nigg JT, Karalunas SL. The Relationship Between Emotion Dysregulation and Error Monitoring in Adolescents with ADHD. Res Child Adolesc Psychopathol 2024; 52:605-620. [PMID: 37843650 DOI: 10.1007/s10802-023-01127-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2023] [Indexed: 10/17/2023]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is emblematic of the limitations of existing diagnostic categories. One potential solution, consistent with the Research Domain Criteria (RDoC) initiative, is to interrogate psychological mechanisms at the behavioral and physiological level together to try and identify meaningful subgroups within existing categories. Such approaches provide a way to revise diagnostic boundaries and clarify individual variation in mechanisms. Here, we illustrate this approach to help resolve heterogeneity in ADHD using a combination of behaviorally-rated temperament measures from the Early Adolescent Temperament Questionnaire; cognitive performance on three difference conditions of an emotional go/no-go task; and electroencephalogram (EEG)-measured variation in multiple stages of error processing, including the error-related negativity (ERN) and positivity (Pe). In a large (N = 342), well-characterized sample of adolescents with ADHD, latent profile analysis identified two ADHD temperament subgroups: 1) emotionally regulated and 2) emotionally dysregulated (with high negative affect). Cognitive and EEG assessment in a subset of 272 adolescents (nADHD = 151) found that the emotionally dysregulated group showed distinct patterns of change in early neural response to errors (ERN) across emotional task conditions as compared to emotionally-regulated ADHD adolescents and typically-developing controls. Both ADHD groups showed blunted later response to errors (Pe) that was stable across emotional task conditions. Overall, neural response patterns identified important differences in how trait and state emotion interact to affect cognitive processing. Results highlight important temperament variation within ADHD that helps clarify its relationship to the ERN, one of the most prominent putative neural biomarkers for psychopathology.
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Affiliation(s)
| | - Michael B Kozlowski
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA
| | - Katelyn S Macknyk
- Department of Psychological Sciences, Purdue University, West Lafayette, IN, USA
| | - Madelyn B Heise
- Department of Psychological Sciences, Purdue University, West Lafayette, IN, USA
| | - Sarah M Pieper
- Department of Psychological Sciences, Purdue University, West Lafayette, IN, USA
| | - Brittany R Alperin
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA
| | - Hannah E Morton
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA
| | - Joel T Nigg
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA
| | - Sarah L Karalunas
- Department of Psychological Sciences, Purdue University, West Lafayette, IN, USA
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8
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Edmunds SR, Jones A, Braverman Y, Fogler J, Rowland K, Faja SK. Irritability as a Transdiagnostic Risk Factor for Functional Impairment in Autistic and Non-autistic Toddlers and Preschoolers. Res Child Adolesc Psychopathol 2024; 52:551-565. [PMID: 38060090 DOI: 10.1007/s10802-023-01150-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2023] [Indexed: 12/08/2023]
Abstract
Trait irritability in toddlerhood is a powerful risk factor for later internalizing and externalizing challenges in non-autistic children, but the predictive clinical utility of irritability is unknown in autism. Irritability is a trait-level emotional response (i.e., frustration) to a blocked goal and is one source of disruptive behavior. Irritability has two facets: Frustration is the degree to which emotion is elevated after a blocked goal, while soothability is the rate of recovery from peak distress. We aimed to: (1) compare and describe the two facets of irritability in non-autistic and young autistic children, and (2) assess whether children's reward sensitivity and executive function moderate the relation between irritability and clinical symptoms. Participants were 90 autistic (n=43) and non-autistic (n = 47) 2- and 4-year-olds. Autistic children did not have different levels of frustration but were more difficult to soothe compared to non-autistic children, according to parents. Further, frustration and soothability were less strongly correlated for autistic compared to non-autistic children. For all children, executive function (specifically, inhibition) moderated, or ameliorated the strength of, the relation between irritability (both soothability and frustration) and externalizing challenges. This study provides evidence for irritability as a transdiagnostic risk factor for clinically significant emotion regulation challenges. Further, the effect of trait irritability may be ameliorated by children's executive function in a transdiagnostic manner. Future work should examine the unique aspects of soothability to how irritability presents within autism, as well as evaluate and modify emotion regulation interventions for autistic toddlers and preschoolers.
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Affiliation(s)
- Sarah R Edmunds
- Department of Psychology, University of South Carolina, Columbia, SC, USA.
| | - Aiko Jones
- Division of Developmental Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Yael Braverman
- Department of Neurology, Boston Children's Hospital, Boston, MA, USA
| | - Jason Fogler
- Division of Developmental Medicine, Boston Children's Hospital, Boston, MA, USA
- Leadership Education in Neurodevelopmental & Related Disabilities, Institute for Community Inclusion, Boston, MA, USA
| | - Katie Rowland
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Susan K Faja
- Division of Developmental Medicine, Boston Children's Hospital, Boston, MA, USA
- Departments of Pediatrics & Psychiatry and Behavioral Sciences, Harvard Medical School, Boston, MA, USA
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9
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Alacha HF, Rosen PJ, Bufferd SJ. Children's emotional reactivity and negative affect predict future ADHD symptom severity beyond initial ADHD symptom severity. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02403-z. [PMID: 38502319 DOI: 10.1007/s00787-024-02403-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 02/18/2024] [Indexed: 03/21/2024]
Abstract
Children with Attention-Deficit/Hyperactivity Disorder (ADHD) often experience significant emotion dysregulation. However, there is limited longitudinal data on associations between multiple aspects of emotion dysregulation and ADHD symptoms. Additionally, given substantial evidence that increased levels and variability of negative affect (NA) are identified in children with ADHD, it is important to examine the role of NA in this relationship. The present study used momentary and longitudinal data to examine the relation between two aspects of emotion dysregulation (emotional lability and emotional reactivity), the two ADHD symptom clusters separately (inattentive and hyperactive/impulsive), total ADHD symptom severity, and NA variability over a period of six months. Participants (N = 68) were parents of children aged 7-12 years old (M = 9.80, SD = 1.34) who completed baseline and 6-month follow-up reports of children's ADHD symptoms and emotion dysregulation as well as ecological momentary assessments (EMA) of their children's NA for one week. Results were threefold: (1) children's emotional reactivity predicted inattentive, hyperactive/impulsive, and total ADHD symptom severity above and beyond initial ADHD symptom severity, but emotional lability did not significantly predict severity of any ADHD symptom cluster; (2) NA variability predicted hyperactive/impulsive and total ADHD symptom severity, but not inattentive severity; and (3) initial ADHD symptom severity did not predict emotion dysregulation at follow-up. The current study provides novel insight regarding the longitudinal influence of specific aspects of emotion dysregulation and NA on ADHD symptom severity in children and suggests that targeting emotional reactivity could minimize ADHD symptom severity.
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Affiliation(s)
- Helena F Alacha
- Department of Psychological and Brain Sciences, University of Louisville, 317 Life Sciences Building, Louisville, KY, 40292, USA.
| | - Paul J Rosen
- Department of Pediatrics, University of Louisville School of Medicine, 571 S Floyd St, Louisville, KY, 40202, USA
- Norton Children's Behavioral and Mental Health, 200 E Chestnut St #200, Louisville, KY, 40202, USA
| | - Sara J Bufferd
- Department of Psychological and Brain Sciences, University of Louisville, 317 Life Sciences Building, Louisville, KY, 40292, USA
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10
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McKay CC, Scheinberg B, Xu EP, Kircanski K, Pine DS, Brotman MA, Leibenluft E, Linke JO. Modeling Shared and Specific Variances of Irritability, Inattention, and Hyperactivity Yields Novel Insights Into White Matter Perturbations. J Am Acad Child Adolesc Psychiatry 2024:S0890-8567(24)00108-4. [PMID: 38452811 DOI: 10.1016/j.jaac.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 12/16/2023] [Accepted: 02/27/2024] [Indexed: 03/09/2024]
Abstract
OBJECTIVE Irritability, inattention, and hyperactivity, which are common presentations of childhood psychopathology, have been associated with perturbed white matter microstructure. However, similar tracts have been implicated across these phenotypes; such non-specificity could be rooted in their high co-occurrence. To address this problem, we use a bifactor approach parsing unique and shared components of irritability, inattention, and hyperactivity, which we then relate to white matter microstructure. METHOD We developed a bifactor model based on the Conners Comprehensive Behavioral Rating Scale in a sample of youth with no psychiatric diagnosis or a primary diagnosis of attention-deficit/hyperactivity disorder or disruptive mood dysregulation disorder (n = 521). We applied the model to an independent yet sociodemographically and clinically comparable sample (n = 152), in which we tested associations between latent variables and fractional anisotropy (FA). RESULTS The bifactor model fit well (comparative fit index = 0.99; root mean square error of approximation = 0.07). The shared factor was positively associated with an independent measure of impulsivity (ρS = 0.88, pFDR < .001) and negatively related to whole-brain FA (r = -0.20), as well as FA of the corticospinal tract (all pFWE < .05). FA increased with age and deviation from this curve, indicating that altered white matter maturation was associated with the hyperactivity-specific factor (r = -0.16, pFWE < .05). Inattention-specific and irritability-specific factors were not linked to FA. CONCLUSION Perturbed white matter microstructure may represent a shared neurobiological mechanism of irritability, inattention, and hyperactivity related to heightened impulsivity. Furthermore, hyperactivity might be uniquely associated with a delay in white matter maturation.
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Affiliation(s)
- Cameron C McKay
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
| | - Brooke Scheinberg
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
| | - Ellie P Xu
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
| | - Katharina Kircanski
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
| | - Daniel S Pine
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
| | - Melissa A Brotman
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
| | - Ellen Leibenluft
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
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11
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Carlson GA, Althoff RR, Singh MK. Future Directions: The Phenomenology of Irritable Mood and Outbursts: Hang Together or Hang Separately 1. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2024; 53:309-327. [PMID: 38588602 DOI: 10.1080/15374416.2024.2332999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
Recognition of the importance of irritable mood and outbursts has been increasing over the past several decades. This "Future Directions" aims to develop a set of recommendations for future research emphasizing that irritable mood and outbursts "hang together," but have important distinctions and thus also need to "hang separately." Outbursts that are the outcome of irritable mood may be quite different from outbursts that are the trigger or driving force that make youth and his/her environment miserable. What, then, is the relation between irritable mood and outbursts? As the field currently stands, we not only cannot answer this question, but we may also lack the tools to effectively do so. Here, we will propose recommendations for understanding the phenomenology of irritable mood and outbursts so that more directed and clinically useful assessment tools can be designed. We discuss the transdiagnostic and treatment implications that relate to improvements in measurement. We describe the need to do more than repurpose our current assessment tools, specifically interviews and rating scales, which were designed for different purposes. The future directions of the study and treatment of irritable mood and outbursts will require, among others, using universally accepted nomenclature, supporting the development of tools to measure the characteristics of each irritable mood and outbursts, understanding the effects of question order, informant, development and longitudinal course, and studying the ways in which outbursts and irritable mood respond to treatment.
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Affiliation(s)
- Gabrielle A Carlson
- Psychiatry and Pediatrics, Renaissance School of Medicine at Stony Brook University
| | - Robert R Althoff
- Psychiatry, Pediatrics, & Psychological Science, University of Vermont
| | - Manpreet Kaur Singh
- Professor of Psychiatry and Behavioral Sciences, University of California Davis School of Medicine
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12
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McKay CC, De Jesus AV, Peterson O, Leibenluft E, Kircanski K. Cross-Sectional and Longitudinal Relations Among Irritability, Attention-Deficit/Hyperactivity Disorder Symptoms, and Inhibitory Control. J Am Acad Child Adolesc Psychiatry 2024:S0890-8567(24)00003-0. [PMID: 38272350 DOI: 10.1016/j.jaac.2023.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 09/29/2023] [Accepted: 01/16/2024] [Indexed: 01/27/2024]
Abstract
OBJECTIVE Irritability and attention-deficit/hyperactivity disorder (ADHD) symptoms frequently co-occur in youth. Although ADHD has been associated with inhibitory control deficits, the literature on irritability and inhibitory control is mixed. Examining how irritability, ADHD symptoms, and inhibitory control interrelate both cross-sectionally and longitudinally across development could shed light on common and distinct mechanisms of youth psychopathology. METHOD We utilized a cross-lagged panel model with data from 2 time points (at ages 10 and 12 years) of the Adolescent Brain and Cognitive Development (ABCD) Study (N = 7,444, or ∼63% of the baseline sample with full data at each time point) to test cross-sectional and longitudinal associations among parent-reported irritability and ADHD symptoms and behaviorally assessed inhibitory control. This was performed separately across discovery and replication subsamples, each n = 3,722. RESULTS As expected, irritability and ADHD symptoms exhibited strong cross-sectional and reciprocal cross-lagged associations. Higher ADHD symptoms at age 10 years were associated concurrently with poorer inhibitory control and predicted poorer inhibitory control at age 12. Contrary to predictions, inhibitory control was not significantly associated with irritability cross-sectionally, nor was it predictive of later irritability or ADHD symptoms. CONCLUSION These findings highlight strong links between irritability and ADHD. Although inhibitory control deficits were linked to ADHD and predictive of its symptom course, inhibitory control had no significant associations with irritability. Future research should investigate other candidate mechanisms of the co-occurrence of irritability and ADHD symptoms and predictors of their developmental trajectories.
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Affiliation(s)
- Cameron C McKay
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland.
| | - Alethea Vittali De Jesus
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
| | - Olivia Peterson
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
| | - Ellen Leibenluft
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
| | - Katharina Kircanski
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
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13
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Evans SC, Hamilton JL, Boyd SI, Karlovich AR, Ladouceur CD, Silk JS, Bylsma LM. Daily Associations Between Sleep and Affect in Youth at Risk for Psychopathology: The Moderating Role of Externalizing Symptoms. Res Child Adolesc Psychopathol 2024; 52:35-50. [PMID: 37405590 PMCID: PMC10766867 DOI: 10.1007/s10802-023-01087-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2023] [Indexed: 07/06/2023]
Abstract
Problems with sleep, emotion regulation, and externalizing psychopathology are interrelated, but little is known about their day-to-day associations in youth. We examined self-reported daily sleep quality as a bidirectional predictor of next-day positive and negative affect (PA/NA), with externalizing symptoms as a moderator. Data were drawn from an ecological momentary assessment (EMA) study involving 82 youths (ages 9-13; 50% female; 44% White, 37% Black/African American) at high (n = 41) or low (n = 41) familial risk for psychopathology. Parents rated youths' externalizing symptoms at baseline. Youths then completed a 9-day EMA protocol, reporting sleep quality 1x/day and affect 4-8x/day. Daily means, peaks, and variability in PA and NA were computed. Multilevel models examined bidirectional associations between sleep and affect (between- and within-person), testing externalizing symptoms as a moderator and controlling for age and sex. In models of sleep predicting affect: Within-person, poorer-than-usual sleep quality predicted greater variability and higher peaks in next-day NA, but only for youth with higher levels of externalizing symptoms. Between-person, poor sleep quality and higher levels of externalizing symptoms predicted lower mean and peak PA. In models of affect predicting sleep: Within-person, lower-than-usual mean PA predicted poorer subsequent sleep quality, but only for youth with higher levels of externalizing symptoms. Between-person, youths with higher mean and peak PA had better sleep quality. These findings suggest that affective functioning is bidirectionally linked to daily self-reported sleep quality among high- and low-risk youth. Specific disturbances in daily sleep-affect cycles may be distinctly associated with externalizing psychopathology.
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Affiliation(s)
- Spencer C Evans
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | | | | | | | - Cecile D Ladouceur
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jennifer S Silk
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Lauren M Bylsma
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA.
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA.
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14
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Wiggins JL, Ureña Rosario A, MacNeill LA, Krogh‐Jespersen S, Briggs‐Gowan M, Smith JD, Wakschlag LS. Prevalence, stability, and predictive utility of the Multidimensional Assessment of Preschoolers Scales clinically optimized irritability score: Pragmatic early assessment of mental disorder risk. Int J Methods Psychiatr Res 2023; 32:e1991. [PMID: 37728118 PMCID: PMC10654826 DOI: 10.1002/mpr.1991] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 08/11/2023] [Accepted: 08/17/2023] [Indexed: 09/21/2023] Open
Abstract
OBJECTIVES Characterizing the scope and import of early childhood irritability is essential for real-world actualization of this reliable indicator of transdiagnostic mental health risk. Thus, we utilize pragmatic assessment to establish prevalence, stability, and predictive utility of clinically significant early childhood irritability. METHODS Data included two independent, diverse community samples of preschool age children (N = 1857; N = 1490), with a subset enriched for risk (N = 425) assessed longitudinally from early childhood through preadolescence (∼4-9 years old). A validated, brief (2-item) scale pragmatically assessed clinically significant irritability. In the longitudinal subsample, clinical interviews assessed internalizing/externalizing disorders. RESULTS One in five preschool-age children had clinically significant irritability, which was independently replicated. Irritability was highly stable through preadolescence. Children with versus without clinically significant early childhood irritability had greater odds of early onset, persistent internalizing/externalizing disorders. The pragmatic assessment effectively screened out low-risk children and identified 2/3 of children with early-onset, persistent psychopathology. CONCLUSIONS Clinically significant early childhood irritability prevalence is akin to the pediatric obesity epidemic and may warrant similar universal screening/intervention. Also, irritability's stability demonstrates the common guidance "they'll grow out of it" to be false. Finally, pragmatic irritability assessment has transdiagnostic predictive power and addresses a need for feasible measures to flag risk.
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Affiliation(s)
- Jillian Lee Wiggins
- Department of PsychologySan Diego State UniversitySan DiegoCaliforniaUSA
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical PsychologySan DiegoCaliforniaUSA
| | - Ana Ureña Rosario
- Department of PsychologySan Diego State UniversitySan DiegoCaliforniaUSA
| | - Leigha A. MacNeill
- Department of Medical Social SciencesFeinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA
- Institute for Innovations in Developmental SciencesNorthwestern UniversityEvanstonIllinoisUSA
| | - Sheila Krogh‐Jespersen
- Institute for Innovations in Developmental SciencesNorthwestern UniversityEvanstonIllinoisUSA
| | | | - Justin D. Smith
- Department of Population Health SciencesUniversity of UtahSalt Lake CityUtahUSA
| | - Lauren S. Wakschlag
- Department of Medical Social SciencesFeinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA
- Institute for Innovations in Developmental SciencesNorthwestern UniversityEvanstonIllinoisUSA
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15
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Johns‐Mead R, Vijayakumar N, Mulraney M, Melvin G, Youssef G, Sciberras E, Anderson VA, Nicholson JM, Efron D, Hazel P, Silk TJ. Categorical and dimensional approaches to the developmental relationship between ADHD and irritability. J Child Psychol Psychiatry 2023; 64:1422-1431. [PMID: 37170636 PMCID: PMC10952727 DOI: 10.1111/jcpp.13818] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/16/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND Attention deficit hyperactivity disorder (ADHD) and irritability commonly co-occur, and follow similar developmental trajectories from childhood to adolescence. Understanding of the developmental relationship between these co-occurrences is limited. This study provides a longitudinal assessment of how ADHD diagnostic status and symptom patterns predict change in irritability. METHODS A community sample of 337 participants (45.2% ADHD), recruited for the Childhood Attention Project, completed the Affective Reactivity Index (ARI) to measure irritability at baseline (mean age 10.5 years) and follow-up after 18-months. Latent change score models were used to assess how (a) baseline ADHD vs. control group status, (b) baseline symptom domain (inattention, hyperactivity-impulsivity) and (c) longitudinal change in ADHD symptom severity predicted change in irritability. RESULTS Irritability was significantly higher among the ADHD group than controls; however, change in irritability over time did not differ between groups. When assessed across the entire cohort, change in irritability was predicted by higher symptom count in the hyperactive-impulsive domain, but not the inattentive domain. Greater declines in ADHD symptoms over time significantly predicted greater declines in irritability. Baseline ADHD symptom severity was found to significantly predict change in irritability; however, baseline irritability did not significantly predict change in ADHD symptoms. CONCLUSIONS ADHD symptoms-particularly hyperactive-impulsive symptoms-predict the degree and trajectory of irritability during childhood and adolescence, even when symptoms are below diagnostic thresholds. The use of longitudinal, dimensional and symptom domain-specific measures provides additional insight into this relationship.
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Affiliation(s)
- Rania Johns‐Mead
- Centre for Social and Early Emotional Development (SEED) and School of PsychologyDeakin UniversityGeelongVic.Australia
| | - Nandita Vijayakumar
- Centre for Social and Early Emotional Development (SEED) and School of PsychologyDeakin UniversityGeelongVic.Australia
| | - Melissa Mulraney
- Institute for Social NeuroscienceISN PsychologyIvanhoeVic.Australia
| | - Glenn Melvin
- Centre for Social and Early Emotional Development (SEED) and School of PsychologyDeakin UniversityGeelongVic.Australia
| | - George Youssef
- Centre for Social and Early Emotional Development (SEED) and School of PsychologyDeakin UniversityGeelongVic.Australia
| | - Emma Sciberras
- Centre for Social and Early Emotional Development (SEED) and School of PsychologyDeakin UniversityGeelongVic.Australia
- Murdoch Children's Research InstituteMelbourneVic.Australia
| | - Vicki A. Anderson
- Murdoch Children's Research InstituteMelbourneVic.Australia
- The Royal Children's HospitalMelbourneVic.Australia
- Department of PaediatricsUniversity of MelbourneMelbourneVic.Australia
| | | | - Daryl Efron
- Murdoch Children's Research InstituteMelbourneVic.Australia
- The Royal Children's HospitalMelbourneVic.Australia
- Department of PaediatricsUniversity of MelbourneMelbourneVic.Australia
| | - Philip Hazel
- Sydney Medical School, Faculty of Medicine and HealthThe University of SydneySydneyNSWAustralia
| | - Tim J. Silk
- Centre for Social and Early Emotional Development (SEED) and School of PsychologyDeakin UniversityGeelongVic.Australia
- Murdoch Children's Research InstituteMelbourneVic.Australia
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16
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Becker SP, Willcutt EG, Leopold DR, Fredrick JW, Smith ZR, Jacobson LA, Burns GL, Mayes SD, Waschbusch DA, Froehlich TE, McBurnett K, Servera M, Barkley RA. Report of a Work Group on Sluggish Cognitive Tempo: Key Research Directions and a Consensus Change in Terminology to Cognitive Disengagement Syndrome. J Am Acad Child Adolesc Psychiatry 2023; 62:629-645. [PMID: 36007816 PMCID: PMC9943858 DOI: 10.1016/j.jaac.2022.07.821] [Citation(s) in RCA: 44] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 06/28/2022] [Accepted: 08/15/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of this work was 2-fold: (1) to evaluate current knowledge and identify key directions in the study of sluggish cognitive tempo (SCT); and (2) to arrive at a consensus change in terminology for the construct that reflects the current science and may be more acceptable to researchers, clinicians, caregivers, and patients. METHOD An international Work Group was convened that, in early 2021, compiled an online archive of all research studies on SCT and summarized the current state of knowledge, noted methodological issues, and highlighted future directions, and met virtually on 10 occasions in 2021 to discuss these topics and terminology. RESULTS Major progress has been made over the last decade in advancing our understanding of SCT across the following domains of inquiry: construct measurement and stability; genetic, environmental, pathophysiologic, and neuropsychological correlates; comorbid conditions; functional impairments; and psychosocial and medication interventions. Findings across these domains are summarized, and potential avenues to pursue in the next generation of SCT-related research are proposed. Following repeated discussions on terminology, the Work Group selected "cognitive disengagement syndrome" (CDS) to replace "SCT" as the name for this construct. This term was deemed to best satisfy considerations that should apply when selecting terms for a condition or syndrome, as it does not overlap with established terms for other constructs, is not offensive, and reflects the current state of the science. CONCLUSION It is evident that CDS (SCT) has reached the threshold of recognition as a distinct syndrome. Much work remains to further clarify its nature (eg, transdiagnostic factor, separate disorder, diagnostic specifier), etiologies, demographic factors, relations to other psychopathologies, and linkages to specific domains of functional impairment. Investigators are needed with interests and expertise spanning basic, clinical, and translational research to advance our understanding and to improve the lives of individuals with this unique syndrome.
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Affiliation(s)
- Stephen P Becker
- Cincinnati Children's Hospital Medical Center, Ohio, and the University of Cincinnati College of Medicine, Ohio.
| | | | | | - Joseph W Fredrick
- Cincinnati Children's Hospital Medical Center, Ohio, and the University of Cincinnati College of Medicine, Ohio
| | | | - Lisa A Jacobson
- Kennedy Krieger Institute, Johns Hopkins School of Medicine, Baltimore, Maryland
| | | | - Susan D Mayes
- Waschbusch are with Penn State College of Medicine, Hershey, Pennsylvania
| | | | - Tanya E Froehlich
- Cincinnati Children's Hospital Medical Center, Ohio, and the University of Cincinnati College of Medicine, Ohio
| | - Keith McBurnett
- University of California San Francisco, San Francisco, California
| | - Mateu Servera
- IDISBA Institute, University of the Balearic Islands, Palma, Spain
| | - Russell A Barkley
- Virginia Commonwealth University, School of Medicine, Richmond, Virginia
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17
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Bhatara VS, Bernstein B, Fazili S. Complementary and Integrative Treatments of Aggressiveness/Emotion Dysregulation: Associated with Disruptive Disorders and Disruptive Mood Dysregulation Disorder. Child Adolesc Psychiatr Clin N Am 2023; 32:297-315. [PMID: 37147041 DOI: 10.1016/j.chc.2022.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Youth with emotional dysregulation (ED) and irritability/aggression, common in disruptive disorders (frequently comorbid with attention-deficit/hyperactivity disorder), are underserved by conventional treatments. Anger dysregulation is usually the core feature of ED. Complementary and integrative Medicine (CIM) treatments for youth with disruptive disorders and ED are reviewed. Broad-spectrum micronutrient supplementation has a medium effect and is supported by two double-blind randomized controlled trials using similar formulations. Other CIM treatments supported by controlled data but needing further research, include omega-3 fatty acid supplementation, music therapy, martial arts, restricting exposure to media violence, decreasing sleep deprivation, and increased exposure to green-blue spaces.
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Affiliation(s)
- Vinod S Bhatara
- Department of Psychiatry, University of South Dakota, Sanford School of Medicine, Sioux Falls, SD, USA; Department of Pediatrics, University of South Dakota, Sanford School of Medicine, Sioux Falls, SD, USA.
| | - Bettina Bernstein
- Philadelphia College of Osteopathic Medicine, 4170 City Ave, Philadelphia, PA 19131, USA; Department of Child and Adolescent Psychiatry, The Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA
| | - Sheeba Fazili
- University of South Dakota Sanford School of Medicine, 4400 West 69th street, suite 1500, Sioux Falls, SD 57104, USA
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18
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Jones SA, Tipsord J, Nagel BJ, Nigg JT. A preliminary study of white matter correlates of a laboratory measure of attention and motor stability in attention-deficit/hyperactivity disorder. J Psychiatr Res 2023; 160:110-116. [PMID: 36804107 PMCID: PMC10023490 DOI: 10.1016/j.jpsychires.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 01/17/2023] [Accepted: 02/05/2023] [Indexed: 02/10/2023]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a complex behavioral disorder, often difficult and time consuming to diagnose. Laboratory assessment of ADHD-related constructs of attention and motor activity may be helpful in elucidating neurobiology; however, neuroimaging studies evaluating laboratory measures of ADHD are lacking. In this preliminary study, we assessed the association between fractional anisotropy (FA), a measure of white matter microstructure, and laboratory measures of attention and motor behavior using the QbTest, a widely used measure thought to improve clinician diagnostic confidence. This is the first look at neural correlates of this widely used measure. The sample included adolescents and young adults (ages 12-20, 35% female) with ADHD (n = 31) and without (n = 52). As expected, ADHD status was associated with motor activity, and cognitive inattention and impulsivity in the laboratory. With regard to MRI findings, laboratory observed motor activity and inattention were associated with greater FA in white matter regions of the primary motor cortex. All three laboratory observations were associated with lower FA in regions subserving fronto-striatal-thalamic and frontoparietal (i.e. superior longitudinal fasciculus) circuitry. Further, FA in white matter regions of the prefrontal cortex appeared to mediate the relationship between ADHD status and motor activity on the QbTest. These findings, while preliminary, suggest that performance on certain laboratory tasks is informative with regard to neurobiological correlates of subdomains of the complex ADHD phenotype. In particular, we provide novel evidence for a relationship between an objective measure of motor hyperactivity and white matter microstructure in motor and attentional networks.
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Affiliation(s)
- Scott A Jones
- Department of Psychiatry, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA.
| | - Jessica Tipsord
- Department of Psychiatry, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA
| | - Bonnie J Nagel
- Department of Psychiatry, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA; Department of Behavioral Neuroscience, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA
| | - Joel T Nigg
- Department of Psychiatry, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA; Department of Behavioral Neuroscience, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA
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19
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Nigg JT, Karalunas SL, Mooney MA, Wilmot B, Nikolas MA, Martel MM, Tipsord J, Nousen EK, Schmitt C, Ryabinin P, Musser ED, Nagel BJ, Fair DA. The Oregon ADHD-1000: A new longitudinal data resource enriched for clinical cases and multiple levels of analysis. Dev Cogn Neurosci 2023; 60:101222. [PMID: 36848718 PMCID: PMC9984785 DOI: 10.1016/j.dcn.2023.101222] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 01/31/2023] [Accepted: 02/20/2023] [Indexed: 02/27/2023] Open
Abstract
The fields of developmental psychopathology, developmental neuroscience, and behavioral genetics are increasingly moving toward a data sharing model to improve reproducibility, robustness, and generalizability of findings. This approach is particularly critical for understanding attention-deficit/hyperactivity disorder (ADHD), which has unique public health importance given its early onset, high prevalence, individual variability, and causal association with co-occurring and later developing problems. A further priority concerns multi-disciplinary/multi-method datasets that can span different units of analysis. Here, we describe a public dataset using a case-control design for ADHD that includes: multi-method, multi-measure, multi-informant, multi-trait data, and multi-clinician evaluation and phenotyping. It spans > 12 years of annual follow-up with a lag longitudinal design allowing age-based analyses spanning age 7-19 + years with a full age range from 7 to 21. Measures span genetic and epigenetic (DNA methylation) array data; EEG, functional and structural MRI neuroimaging; and psychophysiological, psychosocial, clinical and functional outcomes data. The resource also benefits from an autism spectrum disorder add-on cohort and a cross sectional case-control ADHD cohort from a different geographical region for replication and generalizability. Datasets allowing for integration from genes to nervous system to behavior represent the "next generation" of researchable cohorts for ADHD and developmental psychopathology.
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Affiliation(s)
- Joel T Nigg
- Department of Psychiatry & Behavioral Neuroscience, Oregon Health & Science University, USA.
| | | | - Michael A Mooney
- Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, USA
| | - Beth Wilmot
- Oregon Clinical and Translational Research Institute, Oregon Health & Science University, USA
| | - Molly A Nikolas
- Department of Psychological and Brain Sciences, University of Iowa, USA
| | | | - Jessica Tipsord
- Department of Psychiatry & Behavioral Neuroscience, Oregon Health & Science University, USA
| | - Elizabeth K Nousen
- Department of Psychiatry & Behavioral Neuroscience, Oregon Health & Science University, USA
| | - Colleen Schmitt
- Department of Psychiatry & Behavioral Neuroscience, Oregon Health & Science University, USA
| | - Peter Ryabinin
- Knight Cancer Institute, Oregon Health & Science University, USA
| | - Erica D Musser
- Department of Psychology, Florida International University, USA
| | - Bonnie J Nagel
- Department of Psychiatry & Behavioral Neuroscience, Oregon Health & Science University, USA
| | - Damien A Fair
- Department of Pediatrics, Masonic Institute for the Developing Brain, Institute of Child Development, College of Education and Human Development, University of Minnesota, USA.
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20
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Sonuga-Barke EJS, Becker SP, Bölte S, Castellanos FX, Franke B, Newcorn JH, Nigg JT, Rohde LA, Simonoff E. Annual Research Review: Perspectives on progress in ADHD science - from characterization to cause. J Child Psychol Psychiatry 2023; 64:506-532. [PMID: 36220605 PMCID: PMC10023337 DOI: 10.1111/jcpp.13696] [Citation(s) in RCA: 31] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/08/2022] [Indexed: 12/20/2022]
Abstract
The science of attention-deficit/hyperactivity disorder (ADHD) is motivated by a translational goal - the discovery and exploitation of knowledge about the nature of ADHD to the benefit of those individuals whose lives it affects. Over the past fifty years, scientific research has made enormous strides in characterizing the ADHD condition and in understanding its correlates and causes. However, the translation of these scientific insights into clinical benefits has been limited. In this review, we provide a selective and focused survey of the scientific field of ADHD, providing our personal perspectives on what constitutes the scientific consensus, important new leads to be highlighted, and the key outstanding questions to be addressed going forward. We cover two broad domains - clinical characterization and, risk factors, causal processes and neuro-biological pathways. Part one focuses on the developmental course of ADHD, co-occurring characteristics and conditions, and the functional impact of living with ADHD - including impairment, quality of life, and stigma. In part two, we explore genetic and environmental influences and putative mediating brain processes. In the final section, we reflect on the future of the ADHD construct in the light of cross-cutting scientific themes and recent conceptual reformulations that cast ADHD traits as part of a broader spectrum of neurodivergence.
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Affiliation(s)
- Edmund J S Sonuga-Barke
- School of Academic Psychiatry, Institute of Psychology, Psychiatry & Neuroscience, King’s College London. UK
- Department of Child & Adolescent Psychiatry, Aarhus University, Denmark
| | - Stephen P. Becker
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, United States
- Department of Pediatrics, University of Cincinnati College of Medicine, United States
| | - Sven Bölte
- Department of Women’s and Children’s Health, Karolinska Institutet, Sweden
- Division of Child and Adolescent Psychiatry, Center for Psychiatry Research, Stockholm County Council, Sweden
| | - Francisco Xavier Castellanos
- Department of Child and Adolescent Psychiatry, New York University Grossman School of Medicine, USA
- Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, USA
| | - Barbara Franke
- Departments of Human Genetics and Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Joel T. Nigg
- Department of Psychiatry, Oregon Health and Science University, USA
| | - Luis Augusto Rohde
- ADHD Outpatient Program & Developmental Psychiatry Program, Hospital de Clinica de Porto Alegre, Federal University of Rio Grande do Sul, Brazil; National Institute of Developmental Psychiatry, Brazil
| | - Emily Simonoff
- School of Academic Psychiatry, Institute of Psychology, Psychiatry & Neuroscience, King’s College London. UK
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21
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Waxmonsky JG. Editorial: Can Too Much Positive Emotion Be Bad for You? J Am Acad Child Adolesc Psychiatry 2023; 62:288-289. [PMID: 36526160 DOI: 10.1016/j.jaac.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 12/06/2022] [Indexed: 12/15/2022]
Abstract
There has been increasing focus on the assessment and treatment of irritability over the past decade in recognition of the impairment produced by abnormally persistent or excessive displays of negative emotions. However, emotional dysregulation may not be valence specific, and the impact of excessive or abnormally persistent displays of positive affect has received little attention. In their review in this issue of the Journal, Vogel et al.1 argue that it should receive more attention. They do an admirable job synthesizing the developmental and clinical literature to support the potential value of assessing the capacity to regulate positive affect in an attempt to determine if too much of good thing can in fact be bad for you.
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22
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Goh PK, Smith TE, Lee CA, Bansal PS, Eng AG, Martel MM. Etiological Networks of Attention-Deficit/Hyperactivity Disorder during Childhood and Adolescence. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2023; 52:230-243. [PMID: 34348521 PMCID: PMC8814051 DOI: 10.1080/15374416.2021.1946820] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The purpose of the current study was to use network analysis techniques to parse relations between attention-deficit/hyperactivity disorder (ADHD) symptom domains, domains of executive function, and temperament traits. METHODS Participants were 420 children aged 6-17 years (55% boys). The majority of the participants were Caucasian (72.86%) and 50% of the sample met diagnostic criteria for ADHD. Both parents and teachers provided ratings of participants' ADHD symptom severity. Parents completed questionnaires pertaining to participants' temperament traits, and participants completed well-validated laboratory measures of executive function. RESULTS Results suggested effortful control as demonstrating the strongest relations with ADHD, particularly the parent-reported inattentive symptom domain. Additionally, negative effects appeared to demonstrate weaker but still notable relations primarily with the parent-reported hyperactive/impulsive symptom domain. Measures of executive function did not appear to demonstrate relations with any measures of ADHD symptoms or temperament traits. The results were generally replicated in a distinct sample (n = 732, 7-13 years, 63% boys, 81% White), although differences emerged pertaining to the role of surgency (i.e., related to the hyperactive/impulsive symptom domain in the replication but not the primary sample). CONCLUSIONS Overall, findings provided support for the primary role of effortful control, as well as secondary roles for negative affect and surgency, as key risk markers for the characterization of ADHD. Additional exploration of the overlap between temperament and executive function, as pertaining to ADHD, may help clarify heterogeneity in phenotypes and suggest priorities for targeted interventions outside of traditional symptoms.
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Affiliation(s)
| | - Tess E Smith
- Department of Psychology, University of Kentucky
| | - Christine A Lee
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center
| | | | - Ashley G Eng
- Department of Psychology, University of Kentucky
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23
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Vogel AC, Brotman MA, Roy AK, Perlman SB. Review: Defining Positive Emotion Dysregulation: Integrating Temperamental and Clinical Perspectives. J Am Acad Child Adolesc Psychiatry 2023; 62:297-305. [PMID: 36007814 PMCID: PMC11323061 DOI: 10.1016/j.jaac.2022.06.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 05/19/2022] [Accepted: 08/15/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Although emotion dysregulation has been defined as a maladaptive process of emotional experiences, there is no specific reference to the emotional valence of the dysregulation. To date, child psychiatry has focused primarily on dysregulation of negative affect. Here, we suggest that positive emotion dysregulation requires additional clinical and research attention. METHOD First, we present a developmental approach to the study of positive emotion regulation within a temperament framework. Second, we describe emerging research findings regarding dysregulation of positive emotion in early childhood. Third, we integrate neuroscientific approaches to positive emotion regulation and introduce a framework for future investigations and clinical applications. RESULTS Dysregulation in positive affect can be examined from temperamental, developmental, clinical, and neuroscientific perspectives. Both temperamental surgency, which includes positive affect, and the proposed clinical extension, excitability, are associated with increased risk of externalizing symptoms and clinical impairment in youth. CONCLUSION Studying the role of both temperamental surgency and clinically impairing positive affect, or excitability, in developmental psychopathology will help to elucidate the full spectrum of emotion dysregulation and to clarify the neural basis of dysregulation. A more comprehensive conceptualization of positively valanced emotion dysregulation will provide a more nuanced understanding of developmental risk and potential targets for intervention. DIVERSITY & INCLUSION STATEMENT One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science.
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Affiliation(s)
- Alecia C Vogel
- Drs. Vogel and Perlman are with Washington University School of Medicine, St. Louis, Missouri. Dr. Brotman is with the National Institute of Mental Health, Bethesda, Maryland. Dr. Roy is with Fordham University, Bronx, New York.
| | - Melissa A Brotman
- Drs. Vogel and Perlman are with Washington University School of Medicine, St. Louis, Missouri. Dr. Brotman is with the National Institute of Mental Health, Bethesda, Maryland. Dr. Roy is with Fordham University, Bronx, New York
| | - Amy Krain Roy
- Drs. Vogel and Perlman are with Washington University School of Medicine, St. Louis, Missouri. Dr. Brotman is with the National Institute of Mental Health, Bethesda, Maryland. Dr. Roy is with Fordham University, Bronx, New York
| | - Susan B Perlman
- Drs. Vogel and Perlman are with Washington University School of Medicine, St. Louis, Missouri. Dr. Brotman is with the National Institute of Mental Health, Bethesda, Maryland. Dr. Roy is with Fordham University, Bronx, New York
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Flynn MM, Rosen PJ, Reese JS, Slaughter KE, Alacha HF, Olczyk AR. Examining the influence of irritability and ADHD on domains of parenting stress. Eur Child Adolesc Psychiatry 2023; 32:353-366. [PMID: 34510265 DOI: 10.1007/s00787-021-01868-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 09/01/2021] [Indexed: 11/24/2022]
Abstract
Parents of children with ADHD typically report higher levels of parenting stress than parents of typically developing children. Children with ADHD display developmentally inappropriate levels of hyperactivity, impulsivity, and inattention. Some children with ADHD are also prone to particularly high levels of tonic irritability that may explain some of the impairments typically found in ADHD. The present study sought to determine the unique impact of ADHD and tonic irritability on child-related parenting stress domains (e.g., difficult child, parent-child dysfunctional interactions). 145 mothers of children with and without ADHD aged 7-12 years participated in the current study. Mothers completed self-report measures of parenting stress as well as a diagnostic structured interview. Ecological momentary assessment (EMA) was used to assess tonic irritability in an ecological environment. Indirect effects models were specified using PROCESS Model 4. For the parent-child dysfunctional interaction domain, the data were best fit by a model specifying a significant total effect of ADHD that was fully accounted for by an indirect effect through irritability. For the difficult child domain, model testing indicated a significant total effect of ADHD that was partially accounted for by an indirect effect through irritability. The current study adds support to the growing body of literature acknowledging the role of tonic irritability in children with ADHD. Furthermore, the results provide novel insight in the complex relation of irritability, child ADHD, and domains of parenting stress.
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25
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Tan HX, Md Kamal A, Thurairajasingam S, Phipps ME. Addressing Emotional Dysregulation and Potential Pharmacogenetic Implication of 5-HTTLPR Genotype in Attention Deficit Hyperactivity Disorder. Complex Psychiatry 2023; 9:70-88. [PMID: 37404870 PMCID: PMC10315004 DOI: 10.1159/000529732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 02/08/2023] [Indexed: 08/24/2023] Open
Abstract
Background This review unpacks the emotional presentation of externalizing behaviors in attention deficit hyperactivity disorder (ADHD), by diving into the psychophysiology, neurophysiology, and neurogenetics in relation to executive function. The correlations among these three variables are identified, showing that standard assessments for ADHD leave out the emotional dysregulation element. This may lead to suboptimal management outcomes during the developmental progression into adolescence and adulthood. Summary The emotional impulsivity manifestation in adolescence and adulthood related to the under-managed emotional dysregulation in childhood is found to be associated with subtle confounding impact of 5-HTTLPR (serotonin-transporter-linked promoter region) genotype. The genotype of interest affects the neurochemistry, neurophysiology, and psychophysiology of the cognition for executive function. The established practice of using methylphenidate in treating ADHD surprisingly has a neurogenetic effect in targeting the genotype of interest. Methylphenidate provides neuroprotective effects throughout the neurodevelopment timeline from childhood to adulthood. Key Messages The emotional dysregulation element in ADHD which is often overlooked should be addressed to improve the prognostic outcomes in adolescence and adulthood.
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Affiliation(s)
- Hao Xuan Tan
- Medical Education Unit, Jeffrey Cheah School of Medicine and Health Sciences, Monash University (Sunway Campus), Subang Jaya, Malaysia
| | - Adam Md Kamal
- Medical Department, Mackay Hospital and Health Service, Mackay, QLD, Australia
| | | | - Maude Elvira Phipps
- Department of Human Genetics, Jeffrey Cheah School of Medicine and Health Sciences, Monash University (Sunway Campus), Subang Jaya, Malaysia
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26
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Karalunas SL, Antovich D, Miller N, Nigg JT. Prospective prediction of developing internalizing disorders in ADHD. J Child Psychol Psychiatry 2022; 64:768-778. [PMID: 36464786 DOI: 10.1111/jcpp.13731] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/14/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Clinical course in attention-deficit/hyperactivity disorder (ADHD) is highly heterogeneous with respect to both core symptoms and associated features and impairment. Onset of comorbid anxiety and mood disorders during later childhood and adolescence is one critical aspect of divergent outcomes in ADHD. Characterizing heterogeneity in onset of anxiety and depression and identifying prospective predictors of these divergent courses may facilitate early identification of the children most at risk. METHODS A total of 849 children recruited for a case-control study of ADHD development, aged 7-12 years at baseline, completed up to six annual waves of comprehensive clinical and cognitive assessment, including multi-informant behavior ratings, parent semi-structured clinical diagnostic interviews, and measures of executive function (EF). Latent class growth curve analyses (LCGAs) characterized patterns of anxiety and depression over time. Trajectories were predicted from baseline parent-rated child temperament, lab-measured child EF, coded parental criticism, and child-reported self-blame for inter-parental conflict. RESULTS Latent class growth curve analyses separately identified three trajectories for anxiety and three for depression: persistently high, persistently low, and increasing. Temperamental fear/sadness and irritability were independent predictors that interacted with family characteristics. Baseline parental criticism and self-blame for inter-parental conflict exerted influence but only in the context of low temperamental risk. Better baseline child working memory was associated with delayed onset of depression. CONCLUSIONS The interaction of baseline child emotional features with EF or family environment predicted divergent courses of both anxiety and depression from middle-childhood to mid-adolescence. Results suggest modifiable risk factors associated with prospective differences in long-term outcomes.
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Affiliation(s)
| | - Dylan Antovich
- Psychiatry and Behavioral Neuroscience, Oregon Health and Science University, Portland, OR, USA
| | - Natalie Miller
- Psychiatry and Behavioral Neuroscience, Oregon Health and Science University, Portland, OR, USA
| | - Joel T Nigg
- Psychiatry and Behavioral Neuroscience, Oregon Health and Science University, Portland, OR, USA
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27
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Öztekin I, Garic D, Bayat M, Hernandez ML, Finlayson MA, Graziano PA, Dick AS. Structural and diffusion-weighted brain imaging predictors of attention-deficit/hyperactivity disorder and its symptomology in very young (4- to 7-year-old) children. Eur J Neurosci 2022; 56:6239-6257. [PMID: 36215144 PMCID: PMC10165616 DOI: 10.1111/ejn.15842] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 09/15/2022] [Accepted: 09/21/2022] [Indexed: 12/29/2022]
Abstract
The current study aimed to identify the key neurobiology of attention-deficit/hyperactivity disorder (ADHD), as it relates to ADHD diagnostic category and symptoms of hyperactive/impulsive behaviour and inattention. To do so, we adapted a predictive modelling approach to identify the key structural and diffusion-weighted brain imaging measures and their relative standing with respect to teacher ratings of executive function (EF) (measured by the Metacognition Index of the Behavior Rating Inventory of Executive Function [BRIEF]) and negativity and emotion regulation (ER) (measured by the Emotion Regulation Checklist [ERC]), in a critical young age range (ages 4 to 7, mean age 5.52 years, 82.2% Hispanic/Latino), where initial contact with educators and clinicians typically take place. Teacher ratings of EF and ER were predictive of both ADHD diagnostic category and symptoms of hyperactive/impulsive behaviour and inattention. Among the neural measures evaluated, the current study identified the critical importance of the largely understudied diffusion-weighted imaging measures for the underlying neurobiology of ADHD and its associated symptomology. Specifically, our analyses implicated the inferior frontal gyrus as a critical predictor of ADHD diagnostic category and its associated symptomology, above and beyond teacher ratings of EF and ER. Collectively, the current set of findings have implications for theories of ADHD, the relative utility of neurobiological measures with respect to teacher ratings of EF and ER, and the developmental trajectory of its underlying neurobiology.
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Affiliation(s)
- Ilke Öztekin
- Center for Children and Families and Department of Psychology, Florida International University, Miami, Florida, USA.,Exponent, Inc., Philadelphia, Pennsylvania, USA
| | - Dea Garic
- Carolina Institute for Developmental Disabilities, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Mohammadreza Bayat
- Center for Children and Families and Department of Psychology, Florida International University, Miami, Florida, USA
| | - Melissa L Hernandez
- Center for Children and Families and Department of Psychology, Florida International University, Miami, Florida, USA
| | - Mark A Finlayson
- School of Computing and Information Sciences, Florida International University, Miami, Florida, USA
| | - Paulo A Graziano
- Center for Children and Families and Department of Psychology, Florida International University, Miami, Florida, USA
| | - Anthony Steven Dick
- Center for Children and Families and Department of Psychology, Florida International University, Miami, Florida, USA
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28
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Inconsistencies between Subjective Reports of Cognitive Difficulties and Performance on Cognitive Tests are Associated with Elevated Internalising and Externalising Symptoms in Children with Learning-related Problems. Res Child Adolesc Psychopathol 2022; 50:1557-1572. [PMID: 35838930 PMCID: PMC9653343 DOI: 10.1007/s10802-022-00930-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2022] [Indexed: 11/27/2022]
Abstract
Children with learning difficulties are commonly assumed to have underlying cognitive deficits by health and educational professionals. However, not all children referred for psycho-educational assessment will be found to have deficits when their abilities are measured by performance on cognitive tasks. The primary aim of this study was to estimate the prevalence of this inconsistent cognitive profile (ICP) in a transdiagnostic sample of children referred by health and education service providers for problems related to attention, learning and memory (N = 715). A second aim was to explore whether elevated mental health problems were associated with ICPs. Findings suggest that approximately half of this sample could be characterised as having an ICP. Cognitive difficulties, whether identified by parent ratings or task performance, were associated with elevated internalising and externalising difficulties. Crucially, a larger discrepancy between a parent's actual ratings of a child's cognitive difficulties and the ratings that would be predicted based on the child's performance on cognitive tasks was associated greater internalising and externalising difficulties for measures of working memory, and greater externalising difficulties for measures of attention. These findings suggest that subjective cognitive difficulties occurring in the absence of any task-based performance deficits may be a functional problem arising from mental health problems.
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29
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Naim R, Shaughnessy S, Smith A, Karalunas SL, Kircanski K, Brotman MA. Real-time assessment of positive and negative affective fluctuations and mood lability in a transdiagnostic sample of youth. Depress Anxiety 2022; 39:870-880. [PMID: 36325887 PMCID: PMC9729410 DOI: 10.1002/da.23293] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 09/30/2022] [Accepted: 10/22/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Emotional lability, defined as rapid and/or intense affect fluctuations, is associated with pediatric psychopathology. Although numerous studies have examined labile mood in clinical groups, few studies have used real-time assessments in a well-characterized transdiagnostic sample, and no prior study has included participants with disruptive mood dysregulation disorder (DMDD). The present study leverages ecological momentary assessment (EMA) to assess emotional lability in a transdiagnostic pediatric sample. METHODS One hundred thirty participants ages 8-18 with primary diagnoses of DMDD, attention-deficit/hyperactivity disorder (ADHD), an anxiety disorder (ANX), or healthy volunteers completed a previously validated 1-week EMA protocol. Clinicians determined diagnoses based on semi-structured interviews and assessed levels of functional impairment. Participants reported momentary affective states and mood change. Composite scores of fluctuations in positive and negative affect were generated. Affect fluctuations were compared between diagnostic groups and tested for their association with functional impairment. RESULTS Diagnostic groups differed in levels of negative and positive emotional lability. DMDD patients demonstrated the highest level of labile mood compared with other groups. Emotional lability was associated with global impairment in the whole sample. CONCLUSIONS Both positive and negative emotional lability is salient in pediatric psychopathology and is associated with functional impairment, particularly in DMDD youth.
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Affiliation(s)
- Reut Naim
- Emotion and Development Branch, National Institute of
Mental Health, Bethesda, MD,Corresponding author- Reut Naim, National
Institute of Mental Health, Bldg. 15K, MSC 2670, Bethesda, MD 20892-2670, Phone:
301-827-6138,
| | - Shannon Shaughnessy
- Emotion and Development Branch, National Institute of
Mental Health, Bethesda, MD
| | - Ashley Smith
- Emotion and Development Branch, National Institute of
Mental Health, Bethesda, MD
| | - Sarah L. Karalunas
- Department of Psychological Sciences, Purdue University,
West Lafayette, IN
| | - Katharina Kircanski
- Emotion and Development Branch, National Institute of
Mental Health, Bethesda, MD
| | - Melissa A. Brotman
- Emotion and Development Branch, National Institute of
Mental Health, Bethesda, MD
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30
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Kozlowski MB, Antovich D, Karalunas SL, Nigg JT. Temperament in middle childhood questionnaire: New data on factor structure and applicability in a child clinical sample. Psychol Assess 2022; 34:1081-1092. [PMID: 36174168 PMCID: PMC9772251 DOI: 10.1037/pas0001180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The Temperament in Middle Childhood Questionnaire (TMCQ) is one of a family of instruments representing one of the major conceptual models of child temperament. The present study reports new psychometric information on the TMCQ using a larger sample than in prior factor-analytic studies of this instrument. Data from parent ratings of 1,418 children were utilized. The sample of community volunteers included 697 typically developing youth and 721 defined by research diagnostic procedures as having attention-deficit/hyperactivity disorder. Results failed to support the original proposed structure of the TMCQ, but found support for a structure with 12 subscales that confirmed a substantial portion of the lower order factor structure. However, the intended three-factor higher order structure was not able to be fully recovered. Two-group invariance was supported in the final model, supporting use in studies of typical and atypical development. In conclusion, with some modifications the TMCQ remains a useful research measure at the lower order factor level. The validity of the higher order structure is less clear, likely due to measure-specific limitations, and suggests a need for some refinement to the measure. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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31
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Agelink van Rentergem JA, Bathelt J, Geurts HM. Clinical subtyping using community detection: Limited utility? Int J Methods Psychiatr Res 2022:e1951. [PMID: 36415153 DOI: 10.1002/mpr.1951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/13/2022] [Accepted: 09/25/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To discover psychiatric subtypes, researchers are adopting a method called community detection. This method was not subjected to the same scrutiny in the psychiatric literature as traditional clustering methods. Furthermore, many community detection algorithms have been developed without psychiatric sample sizes and variable numbers in mind. We aim to provide clarity to researchers on the utility of this method. METHODS We provide an introduction to community detection algorithms, specifically describing the crucial differences between correlation-based and distance-based community detection. We compare community detection results to results of traditional methods in a simulation study representing typical psychiatry settings, using three conceptualizations of how subtypes might differ. RESULTS We discovered that the number of recovered subgroups was often incorrect with several community detection algorithms. Correlation-based community detection fared better than distance-based community detection, and performed relatively well with smaller sample sizes. Latent profile analysis was more consistent in recovering subtypes. Whether methods were successful depended on how differences were introduced. CONCLUSIONS Traditional methods like latent profile analysis remain reasonable choices. Furthermore, results depend on assumptions and theoretical choices underlying subtyping analyses, which researchers need to consider before drawing conclusions on subtypes. Employing multiple subtyping methods to establish method dependency is recommended.
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Affiliation(s)
- Joost A Agelink van Rentergem
- Department of Psychology, Dutch Autism & ADHD Research Centre (d'Arc), University of Amsterdam, Amsterdam, The Netherlands
| | - Joe Bathelt
- Department of Psychology, Dutch Autism & ADHD Research Centre (d'Arc), University of Amsterdam, Amsterdam, The Netherlands.,Department of Psychology, Royal Holloway, University of London, Egham, UK
| | - Hilde M Geurts
- Department of Psychology, Dutch Autism & ADHD Research Centre (d'Arc), University of Amsterdam, Amsterdam, The Netherlands.,Leo Kannerhuis (Youz/Parnassia Groep), Amsterdam, The Netherlands
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32
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Nili AN, Krogh-Jespersen S, Perlman SB, Estabrook R, Petitclerc A, Briggs-Gowan MJ, Sherlock PR, Norton ES, Wakschlag LS. Joint Consideration of Inhibitory Control and Irritability in Young Children: Contributions to Emergent Psychopathology. Res Child Adolesc Psychopathol 2022; 50:1415-1427. [PMID: 35838931 PMCID: PMC9753138 DOI: 10.1007/s10802-022-00945-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2022] [Indexed: 10/17/2022]
Abstract
Deficits in self-regulation capacity have been linked to subsequent impairment and clinical symptomology across the lifespan. Prior work has identified difficulty regulating angry emotions (i.e., irritability) as a powerful transdiagnostic indicator of current and future clinical concerns. Less is known regarding how irritability intersects with cognitive features of self-regulation, in particular inhibitory control, despite its mental health relevance. A promising avenue for improving specificity of clinical predictions in early childhood is multi-method, joint consideration of irritability and inhibitory control capacities. To advance early identification of impairment and psychopathology risk, we contrast group- and variable-based models of neurodevelopmental vulnerability at the interface of irritability and inhibitory control in contexts of varied motivational and emotional salience. This work was conducted in a longitudinal study of children recruited at well-child visits in Midwestern pediatric clinics at preschool age (N = 223, age range = 3-7 years). Group-based models (clustering and regression of clusters on clinical outcomes) indicated significant heterogeneity of self-regulation capacity in this sample. Meanwhile, variable-based models (continuous multiple regression) evidenced associations with concurrent clinical presentation, future symptoms, and impairment across the broad spectrum of psychopathology. Irritability transdiagnostically indicated internalizing and externalizing problems, concurrently and longitudinally. In contrast, inhibitory control was uniquely associated with attention-deficit/hyperactivity symptoms. We present these findings to advance a joint consideration approach to two promising indicators of neurodevelopmental vulnerability and mental health risk. Models suggest that both emotional and cognitive self-regulation capacities can address challenges in characterizing the developmental unfolding of psychopathology from preschool to early childhood age.
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Affiliation(s)
- Amanda N Nili
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 633 N. St. Clair, Suite 1900, Chicago, IL, 60611, USA.
- Institute for Innovations in Developmental Sciences, Northwestern University, Evanston, IL, USA.
| | - Sheila Krogh-Jespersen
- Institute for Innovations in Developmental Sciences, Northwestern University, Evanston, IL, USA
| | - Susan B Perlman
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, USA
| | - Ryne Estabrook
- Department of Psychology, University of Illinois at Chicago, Chicago, IL, USA
| | | | | | - Phil R Sherlock
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 633 N. St. Clair, Suite 1900, Chicago, IL, 60611, USA
| | - Elizabeth S Norton
- Institute for Innovations in Developmental Sciences, Northwestern University, Evanston, IL, USA
- School of Communications, Northwestern University, Evanston, IL, USA
| | - Laurie S Wakschlag
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 633 N. St. Clair, Suite 1900, Chicago, IL, 60611, USA
- Institute for Innovations in Developmental Sciences, Northwestern University, Evanston, IL, USA
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33
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Foss S, So RP, Petty CR, Waber DP, Wright RJ, Bosquet Enlow M. Effects of Maternal and Child Lifetime Traumatic Stress Exposures, Infant Temperament, and Caregiving Quality on Preschoolers' Executive Functioning. Dev Neuropsychol 2022; 47:327-352. [PMID: 36475997 PMCID: PMC9837737 DOI: 10.1080/87565641.2022.2147180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
We examined effects of maternal and child lifetime traumatic stress exposures, infant temperament, and caregiving quality on parent ratings of preschoolers' executive functioning (EF). Maternal lifetime trauma was associated with preschoolers' EF problems; this association was mediated by greater child trauma exposure. Infant temperament was associated with EF abilities, particularly among females. Among males, infant extraversion/surgency mediated the association of maternal lifetime trauma with poorer child EF. Caregiving quality was negatively associated with maternal and child trauma exposures but did not predict child EF. Findings have implications for interventions to identify children at risk for poor EF and optimize outcomes.
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Affiliation(s)
- Sophie Foss
- Department of Psychiatry and Behavioral Sciences, Boston Children’s Hospital, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Rachel P. So
- Department of Psychiatry and Behavioral Sciences, Boston Children’s Hospital, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Carter R. Petty
- Institutional Centers for Clinical and Translational Research, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Deborah P. Waber
- Department of Psychiatry and Behavioral Sciences, Boston Children’s Hospital, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Rosalind J. Wright
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Pediatrics, Kravis Children’s Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Institute for Exposomic Research, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Michelle Bosquet Enlow
- Department of Psychiatry and Behavioral Sciences, Boston Children’s Hospital, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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34
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Begum‐Ali J, Goodwin A, Mason L, Pasco G, Charman T, Johnson MH, Jones EJ. Altered theta-beta ratio in infancy associates with family history of ADHD and later ADHD-relevant temperamental traits. J Child Psychol Psychiatry 2022; 63:1057-1067. [PMID: 35187652 PMCID: PMC9540467 DOI: 10.1111/jcpp.13563] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/11/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Uncovering the neural mechanisms that underlie symptoms of attention deficit hyperactivity disorder (ADHD) requires studying brain development prior to the emergence of behavioural difficulties. One new approach to this is prospective studies of infants with an elevated likelihood of developing ADHD. METHODS We used a prospective design to examine an oscillatory electroencephalography profile that has been widely studied in both children and adults with ADHD - the balance between lower and higher frequencies operationalised as the theta-beta ratio (TBR). In the present study, we examined TBR in 136 10-month-old infants (72 male and 64 female) with/without an elevated likelihood of developing ADHD and/or a comparison disorder (Autism Spectrum Disorder; ASD). RESULTS Infants with a first-degree relative with ADHD demonstrated lower TBR than infants without a first-degree relative with ADHD. Further, lower TBR at 10 months was positively associated with temperament dimensions conceptually related to ADHD at 2 years. TBR was not altered in infants with a family history of ASD. CONCLUSIONS This is the first demonstration that alterations in TBR are present prior to behavioural symptoms of ADHD. However, these alterations manifest differently than those sometimes observed in older children with an ADHD diagnosis. Importantly, altered TBR was not seen in infants at elevated likelihood of developing ASD, suggesting a degree of specificity to ADHD. Taken together, these findings demonstrate that there are brain changes associated with a family history of ADHD observable in the first year of life.
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Affiliation(s)
- Jannath Begum‐Ali
- Centre for Brain and Cognitive DevelopmentDepartment of Psychological SciencesBirkbeck, University of LondonLondonUK
| | - Amy Goodwin
- Department of Forensic and Neurodevelopmental SciencesInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
| | - Luke Mason
- Centre for Brain and Cognitive DevelopmentDepartment of Psychological SciencesBirkbeck, University of LondonLondonUK
| | - Greg Pasco
- Psychology DepartmentInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
| | - Tony Charman
- Psychology DepartmentInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
| | - Mark H. Johnson
- Centre for Brain and Cognitive DevelopmentDepartment of Psychological SciencesBirkbeck, University of LondonLondonUK,Department of PsychologyUniversity of CambridgeCambridgeUK
| | - Emily J.H. Jones
- Centre for Brain and Cognitive DevelopmentDepartment of Psychological SciencesBirkbeck, University of LondonLondonUK
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Yang Y, Shields GS, Zhang Y, Wu H, Chen H, Romer AL. Child executive function and future externalizing and internalizing problems: A meta-analysis of prospective longitudinal studies. Clin Psychol Rev 2022; 97:102194. [PMID: 35964337 DOI: 10.1016/j.cpr.2022.102194] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 08/01/2022] [Accepted: 08/04/2022] [Indexed: 12/01/2022]
Abstract
To determine the association between executive function and later externalizing and internalizing problems, we conducted a meta-analysis of 167 studies (1098 effect sizes, total N = 66,119) that explored the longitudinal associations between executive functions in children and subsequent externalizing and internalizing problems. The results indicated that greater child executive function was prospectively associated with fewer attention-deficit/hyperactivity disorder (ADHD) symptoms, fewer conduct problems, fewer oppositional defiant disorder symptoms, less substance use, fewer broad externalizing problems, fewer depression symptoms, and fewer broad internalizing problems, but not with subsequent anxiety symptoms. Moderator analyses revealed that the sample type moderated the associations of executive function with both ADHD symptoms and conduct problems. Age of assessment moderated the association with broad externalizing problems, and executive function context moderated associations with both substance use and broad internalizing problems. These findings suggest that executive function in children prospectively predicts numerous externalizing and internalizing behaviors, suggesting that executive function may be an important target for psychopathology prevention programs and interventions.
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Affiliation(s)
- Yingkai Yang
- Faculty of Psychology, Southwest University, Chongqing, China.
| | - Grant S Shields
- Department of Psychological Science, University of Arkansas, Fayetteville, AR, USA
| | - Yaoyao Zhang
- The Lab of Mental Health and Social Adaptation, Faculty of Psychology, Research Center of Mental Health Education, Southwest University, Chongqing, China
| | - Huimin Wu
- The Lab of Mental Health and Social Adaptation, Faculty of Psychology, Research Center of Mental Health Education, Southwest University, Chongqing, China
| | - Hong Chen
- Faculty of Psychology, Southwest University, Chongqing, China; Key Laboratory of Cognition and Personality (Ministry of Education), Southwest University, Chongqing, China.
| | - Adrienne L Romer
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA, USA.; Harvard Medical School, Belmont, MA, USA
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36
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Waxmonsky J, Fosco W, Waschbusch D, Babinski D, Baweja R, Pegg S, Cao V, Shroff D, Kujawa A. The Impact of Irritability and Callous Unemotional Traits on Reward Positivity in Youth with ADHD and Conduct Problems. Res Child Adolesc Psychopathol 2022; 50:1027-1040. [PMID: 35182261 PMCID: PMC9388699 DOI: 10.1007/s10802-022-00901-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2022] [Indexed: 11/29/2022]
Abstract
Children with attention-deficit/hyperactivity disorder (ADHD) and conduct problems exhibit significant variability in functioning and treatment response that cannot be fully accounted for by differences in symptom severity. Reward responsivity (RR) is a potential transdiagnostic means to account for this variability. Irritability and callous-unemotional (CU) traits moderate associations between both ADHD and conduct problems with multiple realms of functioning. Both are theorized to be associated with RR, but associations in clinical samples are unknown. In 48 youth ages 5-12 with ADHD referred for treatment of conduct problems, we examined RR using a guessing task where participants select a door icon to win and lose money. Analyses focused on the reward positivity (RewP) event-related potential in response to gain and loss feedback, which reliably peaks approximately 300 ms after feedback. Frequentist and Bayesian approaches assessed main effects of ADHD, Conduct Disorder (CD) and non-irritable Oppositional Defiant Disorder (ODD) symptoms with RR, plus interactions between symptoms and affective dimensions (irritability, CU). CD and ODD were hypothesized to be associated with altered RR, with irritability and CU moderating these associations. Across models, a reliable CD x irritability interaction emerged, indicating enhanced RewP when irritability was elevated and CD symptoms were low. CU did not moderate any associations with RR, and little support was found for associations between RR and other symptom domains. As neural response to reward varied with levels of irritability and CD symptoms, RR may hold potential as a clinically-relevant biomarker in youth with ADHD and conduct problems.
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Affiliation(s)
- James Waxmonsky
- Department of Psychiatry, Penn State College of Medicine, Hershey, PA, USA.
| | - Whitney Fosco
- Department of Psychiatry, Penn State College of Medicine, Hershey, PA, USA
| | - Daniel Waschbusch
- Department of Psychiatry, Penn State College of Medicine, Hershey, PA, USA
| | - Dara Babinski
- Department of Psychiatry, Penn State College of Medicine, Hershey, PA, USA
| | - Raman Baweja
- Department of Psychiatry, Penn State College of Medicine, Hershey, PA, USA
| | - Samantha Pegg
- Department of Psychology and Human Development, Vanderbilt University, Nashville, TN, USA
| | - Vanessa Cao
- Department of Psychiatry, Penn State College of Medicine, Hershey, PA, USA
| | - Delshad Shroff
- Department of Psychiatry, Penn State College of Medicine, Hershey, PA, USA
| | - Autumn Kujawa
- Department of Psychology and Human Development, Vanderbilt University, Nashville, TN, USA
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37
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Lahey BB, Tong L, Pierce B, Hedeker D, Berman MG, Cardenas-Iniguez C, Moore TM, Applegate B, Tiemeier H, Kaczkurkin AN. Associations of polygenic risk for attention-deficit/hyperactivity disorder with general and specific dimensions of childhood psychological problems and facets of impulsivity. J Psychiatr Res 2022; 152:187-193. [PMID: 35752070 PMCID: PMC10001434 DOI: 10.1016/j.jpsychires.2022.06.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 06/07/2022] [Accepted: 06/10/2022] [Indexed: 11/24/2022]
Abstract
A polygenic risk score (PRS) for attention-deficit/hyperactivity disorder (ADHD) has been found to be associated with ADHD in multiple studies, but also with many other dimensions of problems. Little is known, however, about the processes underlying these transdiagnostic associations. Using data from the baseline and 1-year follow-up assessments of 9- to 10-year-old children in the Adolescent Brain Cognitive Development™ (ABCD©) Study, associations were assessed between an ADHD PRS and both general and specific factors of psychological problems defined in bifactor modeling. Additionally, prospective mediated paths were tested from the ADHD PRS to dimensions of problems in the follow-up assessment through baseline measures of executive functioning (EF) and two facets of impulsivity: lower perseverance and greater impulsiveness in the presence of surgent positive emotions. Previous findings of modest but significant direct associations of the ADHD PRS with the general factor of psychological problems were replicated in both assessments in 4,483 children of European ancestry. In addition, significant statistical mediation was found from the ADHD PRS to the general factor, specific ADHD, and conduct problems in the follow-up assessment through each of the two facets of impulsivity. In contrast, EF did not statistically mediate associations between the ADHD PRS and psychological problems. These results suggest that polygenic risk transdiagnostically influences both psychological problems and facets of impulsivity, perhaps partly through indirect pathways via facets of impulsivity.
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Affiliation(s)
- Benjamin B Lahey
- Department of Public Health Sciences, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA.
| | - Lin Tong
- Department of Public Health Sciences, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA
| | - Brandon Pierce
- Department of Public Health Sciences, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA
| | - Donald Hedeker
- Department of Public Health Sciences, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA
| | - Marc G Berman
- Department of Psychology, University of Chicago, 5848 S University Ave, Chicago, IL, 60637, USA.
| | - Carlos Cardenas-Iniguez
- Keck School of Medicine, University of Southern California, 1975 Zonal Avenue, Los Angeles, CA, 90033, USA
| | - Tyler M Moore
- Department of Psychiatry, University of Pennsylvania School of Medicine, 3700 Hamilton Walk, Philadelphia, PA, 19104, USA.
| | - Brooks Applegate
- Department of Educational Leadership, Research & Technology, Western Michigan University, 1903 West Michigan Avenue, Kalamazoo, MI, 49008, USA.
| | - Henning Tiemeier
- Chan School of Public Health, Harvard University, 677 Huntington Avenue, Boston, MA, 02215, USA.
| | - Antonia N Kaczkurkin
- Department of Psychology, Vanderbilt University, 2301 Vanderbilt Place, Nashville, TN, 37240-7817, USA.
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38
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Abstract
It is widely agreed that the DSM-5, the handbook of psychiatric diagnosis, suffers from both high overlap among its putative disorders and high heterogeneity (variability) within each disorder. While these may appear to be opposite problems, in fact both may stem from failure to recognize transdiagnostic dimensions of emotion, cognition, and personality, among others, that inform psychopathology. These fundamental nosological challenges are exemplified in the case of attention-deficit/hyperactivity disorder (ADHD). In ADHD, broad clinical heterogeneity has defied easy clinical prediction of outcomes or clean statistical differentiation of meaningful, biologically informative sub-groups. Progress for ADHD heterogeneity looks promising, however, when we consider dimensions of trait affectivity such as surgency and negative affectivity, their constituent lower order traits such as irritability, and the integrative function of self-regulation. Focusing on developments in the study of temperament traits and ADHD as they relate to emotional dysregulation, several lines of investigation are proving useful. Utilization of selective computational models, biological validators, and longitudinal analyses points toward potential improvements in nosology and clinical assessment in the future by taking temperament traits into account.
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39
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Buitelaar J, Bölte S, Brandeis D, Caye A, Christmann N, Cortese S, Coghill D, Faraone SV, Franke B, Gleitz M, Greven CU, Kooij S, Leffa DT, Rommelse N, Newcorn JH, Polanczyk GV, Rohde LA, Simonoff E, Stein M, Vitiello B, Yazgan Y, Roesler M, Doepfner M, Banaschewski T. Toward Precision Medicine in ADHD. Front Behav Neurosci 2022; 16:900981. [PMID: 35874653 PMCID: PMC9299434 DOI: 10.3389/fnbeh.2022.900981] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 05/16/2022] [Indexed: 11/17/2022] Open
Abstract
Attention-Deficit Hyperactivity Disorder (ADHD) is a complex and heterogeneous neurodevelopmental condition for which curative treatments are lacking. Whilst pharmacological treatments are generally effective and safe, there is considerable inter-individual variability among patients regarding treatment response, required dose, and tolerability. Many of the non-pharmacological treatments, which are preferred to drug-treatment by some patients, either lack efficacy for core symptoms or are associated with small effect sizes. No evidence-based decision tools are currently available to allocate pharmacological or psychosocial treatments based on the patient's clinical, environmental, cognitive, genetic, or biological characteristics. We systematically reviewed potential biomarkers that may help in diagnosing ADHD and/or stratifying ADHD into more homogeneous subgroups and/or predict clinical course, treatment response, and long-term outcome across the lifespan. Most work involved exploratory studies with cognitive, actigraphic and EEG diagnostic markers to predict ADHD, along with relatively few studies exploring markers to subtype ADHD and predict response to treatment. There is a critical need for multisite prospective carefully designed experimentally controlled or observational studies to identify biomarkers that index inter-individual variability and/or predict treatment response.
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Affiliation(s)
- Jan Buitelaar
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, Netherlands.,Karakter Child and Adolescent Psychiatry University Center, Nijmegen, Netherlands
| | - Sven Bölte
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women's and Children's Health, Karolinska Institutet, Solna, Sweden.,Child and Adolescent Psychiatry, Stockholm Health Care Services, Stockholm, Sweden.,Curtin Autism Research Group, School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, WA, Australia
| | - Daniel Brandeis
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany.,Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Arthur Caye
- Department of Psychiatry, Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.,National Institute of Developmental Psychiatry for Children and Adolescents, São Paulo, Brazil
| | - Nina Christmann
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Samuele Cortese
- Centre for Innovation in Mental Health, Academic Unit of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, United Kingdom.,Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, United Kingdom.,Solent National Health System Trust, Southampton, United Kingdom.,Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York, NY, United States.,Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - David Coghill
- Departments of Paediatrics and Psychiatry, Royal Children's Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - Stephen V Faraone
- Departments of Psychiatry, Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, New York, NY, United States
| | - Barbara Franke
- Departments of Human Genetics and Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
| | - Markus Gleitz
- Medice Arzneimittel Pütter GmbH & Co. KG, Iserlohn, Germany
| | - Corina U Greven
- Karakter Child and Adolescent Psychiatry University Center, Nijmegen, Netherlands.,Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands.,King's College London, Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
| | - Sandra Kooij
- Amsterdam University Medical Center, Location VUMc, Amsterdam, Netherlands.,PsyQ, Expertise Center Adult ADHD, The Hague, Netherlands
| | - Douglas Teixeira Leffa
- Department of Psychiatry, Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.,National Institute of Developmental Psychiatry for Children and Adolescents, São Paulo, Brazil
| | - Nanda Rommelse
- Karakter Child and Adolescent Psychiatry University Center, Nijmegen, Netherlands.,Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
| | - Jeffrey H Newcorn
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Guilherme V Polanczyk
- Department of Psychiatry, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Luis Augusto Rohde
- National Institute of Developmental Psychiatry for Children and Adolescents, São Paulo, Brazil.,ADHD Outpatient Program and Developmental Psychiatry Program, Hospital de Clinica de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Emily Simonoff
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - Mark Stein
- Department of Psychiatry and Behavioral Sciences, Seattle, WA, United States
| | - Benedetto Vitiello
- Department of Public Health and Pediatric Sciences, Section of Child and Adolescent Neuropsychiatry, University of Turin, Turin, Italy.,Department of Public Health, Johns Hopkins University, Baltimore, MA, United States
| | - Yanki Yazgan
- GuzelGunler Clinic, Istanbul, Turkey.,Yale Child Study Center, New Haven, CT, United States
| | - Michael Roesler
- Institute for Forensic Psychology and Psychiatry, Neurocenter, Saarland, Germany
| | - Manfred Doepfner
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical Faculty of the University of Cologne, Cologne, Germany.,School for Child and Adolescent Cognitive Behavioural Therapy, University Hospital of Cologne, Cologne, Germany
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
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40
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Morris SE, Sanislow CA, Pacheco J, Vaidyanathan U, Gordon JA, Cuthbert BN. Revisiting the seven pillars of RDoC. BMC Med 2022; 20:220. [PMID: 35768815 PMCID: PMC9245309 DOI: 10.1186/s12916-022-02414-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 05/23/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND In 2013, a few years after the launch of the National Institute of Mental Health's Research Domain Criteria (RDoC) initiative, Cuthbert and Insel published a paper titled "Toward the future of psychiatric diagnosis: the seven pillars of RDoC." The RDoC project is a translational research effort to encourage new ways of studying psychopathology through a focus on disruptions in normal functions (such as reward learning or attention) that are defined jointly by observable behavior and neurobiological measures. The paper outlined the principles of the RDoC research framework, including emphases on research that acquires data from multiple measurement classes to foster integrative analyses, adopts dimensional approaches, and employs novel methods for ascertaining participants and identifying valid subgroups. DISCUSSION To mark the first decade of the RDoC initiative, we revisit the seven pillars and highlight new research findings and updates to the framework that are related to each. This reappraisal emphasizes the flexible nature of the RDoC framework and its application in diverse areas of research, new findings related to the importance of developmental trajectories within and across neurobehavioral domains, and the value of computational approaches for clarifying complex multivariate relations among behavioral and neurobiological systems. CONCLUSION The seven pillars of RDoC have provided a foundation that has helped to guide a surge of new studies that have examined neurobehavioral domains related to mental disorders, in the service of informing future psychiatric nosology. Building on this footing, future areas of emphasis for the RDoC project will include studying central-peripheral interactions, developing novel approaches to phenotyping for genomic studies, and identifying new targets for clinical trial research to facilitate progress in precision psychiatry.
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Affiliation(s)
- Sarah E Morris
- National Institute of Mental Health, Neuroscience Center, 6001 Executive Blvd, Bethesda, MD, 20892, USA.
| | | | - Jenni Pacheco
- National Institute of Mental Health, Neuroscience Center, 6001 Executive Blvd, Bethesda, MD, 20892, USA
| | - Uma Vaidyanathan
- National Institute of Mental Health, Neuroscience Center, 6001 Executive Blvd, Bethesda, MD, 20892, USA.,Present affiliation: Boehringer Ingelheim, Ingelheim am Rhein, Germany
| | - Joshua A Gordon
- National Institute of Mental Health, Neuroscience Center, 6001 Executive Blvd, Bethesda, MD, 20892, USA
| | - Bruce N Cuthbert
- National Institute of Mental Health, Neuroscience Center, 6001 Executive Blvd, Bethesda, MD, 20892, USA
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41
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Joseph HM, Lorenzo NE, Wang FL, Wilson MA, Molina BSG. The interaction between infant negative emotionality and cognition predicts ADHD-related behaviors in toddlerhood. Infant Behav Dev 2022; 68:101742. [PMID: 35749823 PMCID: PMC9447408 DOI: 10.1016/j.infbeh.2022.101742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 05/20/2022] [Accepted: 06/13/2022] [Indexed: 11/05/2022]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a highly prevalent disorder commonly identified in childhood. Affective and cognitive characteristics that are identifiable as early as infancy could be signals of risk for developing ADHD. Specifically, the interplay between emotionality and cognition may be important in predicting early symptoms of ADHD. This study examined the independent and interactive effects of infant negative emotionality and cognition on the development of inattention and hyperactivity/impulsivity in toddlerhood among infants at high and low familial likelihood for ADHD. Participants were 64 infants (M = 8.7, SD = 1.8) at high (n = 32) and low (n = 32) familial likelihood for ADHD, defined as at least one parent with ADHD or two parents without ADHD, respectively. Negative emotionality and cognition in infancy were assessed using the Infant Behavior Questionnaire and the Bayley's Scales of Infant and Toddler Development, and ADHD symptoms were assessed at toddler follow-up (M= 20.0, SD= 3.2) using the Child Behavior Checklist. Accounting for the quality of parent-child interaction, infants' negative emotionality (β = .033, p = .938) and cognition (β = .006, p = .884) did not independently predict toddlers' ADHD-related behaviors, but their interaction did (β = .110, p = .019). For infants with higher levels of cognition (>95th percentile), higher negative emotionality predicted more ADHD-related behaviorss. For infants with lower levels of cognition (<11th percentile), higher negative emotionality predicted fewer ADHD-related behaviors. There may be two affective-cognitive pathways to inattention and hyperactivity/impulsivity in toddlerhood. The combination of higher levels of negative emotionality and cognition may result in greater frustration when goals are blocked, resulting in the expression of dysregulated behaviors (i.e., ADHD symptoms). Alternatively, low levels of negative emotionality and cognition combined may lead to dysregulation that is primarily cognitive in nature (such as the inattention symptoms of ADHD). Investigating affective and cognitive processes simultaneously may be important for increasing understanding of the early signals of ADHD risk.
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Affiliation(s)
- Heather M Joseph
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Nicole E Lorenzo
- Department of Psychology, University of Maryland, MD, USA; Department of Psychology, American University, USA
| | - Frances L Wang
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Brooke S G Molina
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
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42
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Tzang RF, Chang YC. Generalized structural equation modeling: Symptom heterogeneity in attention-deficit/hyperactivity disorder leading to poor treatment efficacy. World J Psychiatry 2022; 12:787-800. [PMID: 35978969 PMCID: PMC9258275 DOI: 10.5498/wjp.v12.i6.787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 10/15/2021] [Accepted: 05/07/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Treatment efficacy for attention-deficit/hyperactivity disorder (ADHD) is reported to be poor, possibly due to heterogeneity of ADHD symptoms. Little is known about poor treatment efficacy owing to ADHD heterogeneity.
AIM To use generalized structural equation modeling (GSEM) to show how the heterogeneous nature of hyperactivity/impulsivity (H/I) symptoms in ADHD, irritable oppositional defiant disorder (ODD), and the presentation of aggression in children interferes with treatment responses in ADHD.
METHODS A total of 231 children and adolescents completed ADHD inattention and H/I tests. ODD scores from the Swanson, Nolan, and Pelham, version IV scale were obtained. The child behavior checklist (CBCL) and parent’s satisfaction questionnaire were completed. The relationships were analyzed by GSEM.
RESULTS GSEM revealed that the chance of ADHD remission was lower in children with a combination of H/I symptoms of ADHD, ODD symptoms, and childhood aggressive behavior. ODD directly mediated ADHD symptom severity. The chance of reaching remission based on H/I symptoms of ADHD was reduced by 13.494% [= exp (2.602)] in children with comorbid ADHD and ODD [odds ratio (OR) = 2.602, 95% confidence interval (CI): 1.832-3.373, P = 0.000] after adjusting for the effects of other factors. Childhood aggression mediated ODD symptom severity. The chance of reaching remission based on ODD symptoms was lowered by 11.000% [= 1 - exp (-0.117)] in children with more severe baseline symptoms of aggression based on the CBCL score at study entry [OR = -0.117, 95%CI: (-0.190)-(-0.044), P = 0.002].
CONCLUSION Mediation through ODD symptoms and aggression may influence treatment effects in ADHD after adjusting for the effects of baseline ADHD symptom severity. More attention could be directed to the early recognition of risks leading to ineffective ADHD treatment, e.g., symptoms of ODD and the presentation of aggressive or delinquent behaviors and thought problems in children with ADHD.
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Affiliation(s)
- Ruu-Fen Tzang
- Department of Child and Adolescent Psychiatry, Mackay Memorial Hospital, Taipei 104, Taiwan
- Department of Childhood Care and Education, Mackay Junior College of Medicine, Nursing, and Management, New Taipei City 112, Taiwan
| | - Yue-Cune Chang
- Department of Mathematics, Tamkang University, New Taipei City 251, Taiwan
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43
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Grabell AS, Santana AM, Thomsen KN, Gonzalez K, Zhang Z, Bivins Z, Rahman T. Prefrontal modulation of frustration-related physiology in preschool children ranging from low to severe irritability. Dev Cogn Neurosci 2022; 55:101112. [PMID: 35576725 PMCID: PMC9118525 DOI: 10.1016/j.dcn.2022.101112] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 04/21/2022] [Accepted: 04/25/2022] [Indexed: 11/03/2022] Open
Abstract
Limbic-prefrontal connectivity during negative emotional challenges underpins a wide range of psychiatric disorders, yet the early development of this system is largely unknown due to difficulties imaging young children. Functional Near-Infrared Spectroscopy (fNIRS) has advanced an understanding of early emotion-related prefrontal activation and psychopathology, but cannot detect activation below the outer cortex. Galvanic skin response (GSR) is a sensitive index of autonomic arousal strongly influenced by numerous limbic structures. We recorded simultaneous lateral prefrontal cortex (lPFC) activation via fNIRS and GSR in 73 3- to 5-year-old children, who ranged from low to severe levels of irritability, during a frustration task. The goal of the study was to test how frustration-related PFC activation modulated psychophysiology in preschool children, and whether associations were moderated by irritability severity. Results showed lPFC activation significantly increased, and GSR levels significantly decreased, as children moved from frustration to rest, such that preschoolers with the highest activation had the steepest recovery. Further, this relation was moderated by irritability such that children with severe irritability showed no association between lPFC activation and GSR. Results suggest functional connections between prefrontal and autonomic nervous systems are in place early in life, with evidence of lPFC down-regulation of frustration-based stress that is altered in early psychopathology. Combining fNIRS and GSR may be a promising novel approach for inferring limbic-PFC processes that drive early emotion regulation and psychopathology.
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44
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Irritability and Emotional Impulsivity as Core Feature of ADHD and ODD in Children. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2022. [DOI: 10.1007/s10862-022-09974-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AbstractThe categorical approach of diagnosing mental disorders entails the problem of frequently occurring comorbidities, suggesting a more parsimonious structure of psychopathology. In this study, we therefore aim to assess how affective dysregulation (AD) is associated with attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) in children. To assess AD in children aged 8–12 years (n = 391), we employed the parent version of a newly constructed parent rating scale. Following item reduction, we conducted exploratory and confirmatory factor analyses to establish a factorial structure of AD. One core dimension was identified, comprising irritability and emotional impulsivity, and two smaller dimensions, comprising positive emotionality and exuberance. Subsequently, we examined five different latent factor models – a unidimensional model, a first-order correlated factor model, a second-order correlated factor model, a traditional bifactor model, and a bifactor S-1 model, in which the first-order factor AD-Irritability/Emotional Impulsivity (II) was modeled as the general reference factor. A bifactor S-1 model with the a priori defined general reference domain AD-II provided the best fit to our data and was straightforward to interpret. This model showed excellent model fit and no anomalous factor loadings. This still held true, when comparing it to bifactor S-1 models with ADHD/ODD-related reference factors. Differential correlations with emotion regulation skills and the established Parent Proxy Anger Scale validate the interpretation of the different dimensions. Our results suggest that irritability/emotional impulsivity might be a common core feature of ADHD and ODD.
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45
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Pacheco J, Garvey MA, Sarampote CS, Cohen ED, Murphy ER, Friedman-Hill SR. Annual Research Review: The contributions of the RDoC research framework on understanding the neurodevelopmental origins, progression and treatment of mental illnesses. J Child Psychol Psychiatry 2022; 63:360-376. [PMID: 34979592 PMCID: PMC8940667 DOI: 10.1111/jcpp.13543] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/29/2021] [Indexed: 12/22/2022]
Abstract
The National Institute of Mental Health (NIMH) proposed the Research Domain Criteria (RDoC) initiative as an alternate way to organize research of mental illnesses, by looking at dimensions of functioning rather than being tied to categorical diagnoses. This paper briefly discusses the motivation for and organization of RDoC, and then explores the NIMH portfolio and recent work to monitor the utility and progress that RDoC has afforded developmental research. To examine how RDoC has influenced the NIMH developmental research portfolio over the last decade, we employed a natural language processing algorithm to identify the number of developmental science grants classified as incorporating an RDoC approach. Additional portfolio analyses examine temporal trends in funded RDoC-relevant grants, publications and citations, and research training opportunities. Reflecting on how RDoC has influenced the focus of grant applications, we highlight examples from research on Attention-Deficit Hyperactivity Disorder (ADHD), childhood irritability, and Autism Spectrum Disorder (ASD). Lastly, we consider how the dimensional and transdiagnostic approaches emphasized in RDoC have facilitated research on personalized intervention for heterogeneous disorders and preventive/early interventions targeting emergent or subthreshold psychopathology.
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Affiliation(s)
- Jennifer Pacheco
- Division of Translational Research, National Institute of Mental Health
- RDoC Unit, National Institute of Mental Health
| | | | | | - Elan D. Cohen
- Office of Science Policy, Planning, and Communications, National Institute of Mental Health
| | - Eric R. Murphy
- Division of Translational Research, National Institute of Mental Health
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46
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Auerbach RP. RDoC and the developmental origins of psychiatric disorders: How did we get here and where are we going? J Child Psychol Psychiatry 2022; 63:377-380. [PMID: 35133013 DOI: 10.1111/jcpp.13582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/12/2022] [Indexed: 11/28/2022]
Abstract
About a decade ago, the National Institute of Mental Health (NIMH) proposed an innovative framework, the Research Domain Criteria (RDoC), to classify psychiatric disorders. This complementary approach has been used with existing diagnostic systems to identify transdiagnostic factors that inform early detection of mental health disturbances and critically, provide novel targets for interventions. An additional goal, however, has been to clarify developmental processes and illness trajectories by operationalizing dimensional constructs during sensitive periods of neurofunctional development to capture the early emergence of behavioral alterations and impairment. As developmental factors are inherent to all RDoC systems and the units of analysis therein, NIMH shepherded developmental-oriented research with targeted funding opportunity announcements. This resulting work has highlighted promising phenotypes and biological markers related to psychiatric illness across the lifespan.
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Affiliation(s)
- Randy P Auerbach
- Department of Psychiatry, Columbia University, New York, NY, USA.,Division of Clinical Developmental Neuroscience, Sackler Institute, New York, NY, USA.,Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, NY, USA
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47
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Karalunas SL, Ostlund BD, Alperin BR, Figuracion M, Gustafsson HC, Deming EM, Foti D, Antovich D, Dude J, Nigg J, Sullivan E. Electroencephalogram aperiodic power spectral slope can be reliably measured and predicts ADHD risk in early development. Dev Psychobiol 2022; 64:e22228. [PMID: 35312046 PMCID: PMC9707315 DOI: 10.1002/dev.22228] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 08/20/2021] [Accepted: 10/12/2021] [Indexed: 12/12/2022]
Abstract
The aperiodic exponent of the electroencephalogram (EEG) power spectrum has received growing attention as a physiological marker of neurodevelopmental psychopathology, including attention-deficit/hyperactivity disorder (ADHD). However, its use as a marker of ADHD risk across development, and particularly in very young children, is limited by unknown reliability, difficulty in aligning canonical band-based measures across development periods, and unclear effects of treatment in later development. Here, we investigate the internal consistency of the aperiodic EEG power spectrum slope and its association with ADHD risk in both infants (n = 69, 1-month-old) and adolescents (n = 262, ages 11-17 years). Results confirm good to excellent internal consistency in infancy and adolescence. In infancy, a larger aperiodic exponent was associated with greater family history of ADHD. In contrast, in adolescence, ADHD diagnosis was associated with a smaller aperiodic exponent, but only in children with ADHD who had not received stimulant medication treatment. Results suggest that disruptions in cortical development associated with ADHD risk may be detectable shortly after birth via this approach. Together, findings imply a dynamic developmental shift in which the developmentally normative flattening of the EEG power spectrum is exaggerated in ADHD, potentially reflecting imbalances in cortical excitation and inhibition that could contribute to long-lasting differences in brain connectivity.
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Affiliation(s)
| | | | | | | | | | | | - Dan Foti
- Department of Psychological Sciences, Purdue University
| | - Dylan Antovich
- Department of Psychiatry, Oregon Health and Science University
| | - Jason Dude
- Department of Psychological Sciences, Purdue University
| | - Joel Nigg
- Department of Psychiatry, Oregon Health and Science University
| | - Elinor Sullivan
- Department of Psychiatry, Oregon Health and Science University
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48
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Evans SC, Corteselli KA, Edelman A, Scott H, Weisz JR. Is Irritability a Top Problem in Youth Mental Health Care? A Multi-informant, Multi-method Investigation. Child Psychiatry Hum Dev 2022:10.1007/s10578-021-01301-8. [PMID: 35064392 DOI: 10.1007/s10578-021-01301-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/02/2021] [Indexed: 11/03/2022]
Abstract
Irritability is often described as a common problem affecting youth referred for mental health services; however, little is known about the prevalence and nature of irritability as a focus of treatment. We examined assessment data from a diverse sample of youths (N = 206; ages 7-15; 52% male, 48% female; 33% White, 27% Black, 25% Latinx) referred for outpatient treatment of emotional and behavioral concerns. Caregivers and youths completed nomothetic (standardized checklist) and idiographic (free response) measures at intake. Irritability was identified as a top problem (TP) in 58% of cases, commonly reported by caregivers (38%), youths (42%), or both (23%)-rates that were significantly greater than those of other TP domains (depression, anxiety, ADHD, conduct, and defiance). Further analyses identified clinical correlates of irritability TPs, with results supporting the incremental utility of multiple informants and methods. Findings suggest that irritability is among the most common problems for which families seek youth treatment.
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Affiliation(s)
- Spencer C Evans
- Department of Psychology, University of Miami, Coral Gables, FL, USA.
| | | | - Audrey Edelman
- Department of Psychology, Yale University, New Haven, CT, USA
| | - Hannah Scott
- Department of Psychological Science, University of Vermont, Burlington, VT, USA
| | - John R Weisz
- Department of Psychology, Harvard University, Cambridge, MA, USA
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49
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Breaux R, Dunn NC, Swanson CS, Larkin E, Waxmonsky J, Baweja R. A Mini-Review of Pharmacological and Psychosocial Interventions for Reducing Irritability Among Youth With ADHD. Front Psychiatry 2022; 13:794044. [PMID: 35237188 PMCID: PMC8882725 DOI: 10.3389/fpsyt.2022.794044] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 01/24/2022] [Indexed: 12/03/2022] Open
Abstract
Approximately a third of children and adolescents with attention-deficit/hyperactivity disorder (ADHD) experience significant irritability; despite this, no study has reviewed whether interventions for youth with ADHD can improve irritability. This mini review sought to address this gap in the literature by discussing existing pharmacological and psychosocial interventions for irritability among children and adolescents with ADHD. A literature search was conducted in April 2021, with a total of 12 intervention articles identified (six pharmacological, one psychosocial, five combined). Studies were excluded if they did not involve an intervention, a measure of irritability, or the population was not youth with ADHD. Of these articles, two were with an ADHD only sample; seven included ADHD with comorbid disruptive behavior, disruptive mood dysregulation disorder (DMDD), or severe mood dysregulation (SMD); and three included ADHD with comorbid autism spectrum disorder (ASD). Findings suggest that central nervous system stimulants used alone or in combination with behavior therapy are effective at reducing irritability in youth with ADHD only or comorbid ADHD and DMDD/SMD. Less evidence was found for the efficacy of guanfacine and atomoxetine for youth with ADHD only or comorbid ADHD and ASD. Parent training alone or in combination with atomoxetine was found to be effective at reducing irritability in youth with comorbid ADHD and ASD. Future research assessing the efficacy of other psychosocial interventions, particularly cognitive behavioral therapy is necessary, as are randomized trials assessing intervention sequencing and intensity among youth with ADHD. Researchers are advised to utilize well-validated measures of irritability in future research.
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Affiliation(s)
- Rosanna Breaux
- Coping Skills and Learning to Manage Emotions Readily (CALMER) Lab, Department of Psychology, Virginia Polytechnic Institute and State University, Blacksburg, VA, United States
| | - Nicholas C Dunn
- Coping Skills and Learning to Manage Emotions Readily (CALMER) Lab, Department of Psychology, Virginia Polytechnic Institute and State University, Blacksburg, VA, United States
| | - Courtney S Swanson
- Coping Skills and Learning to Manage Emotions Readily (CALMER) Lab, Department of Psychology, Virginia Polytechnic Institute and State University, Blacksburg, VA, United States
| | - Emma Larkin
- Coping Skills and Learning to Manage Emotions Readily (CALMER) Lab, Department of Psychology, Virginia Polytechnic Institute and State University, Blacksburg, VA, United States
| | - James Waxmonsky
- Attention and Behavior Clinic, Department of Psychiatry and Behavioral Health, Penn State Milton S. Hershey Medical Center, Hershey, PA, United States
| | - Raman Baweja
- Attention and Behavior Clinic, Department of Psychiatry and Behavioral Health, Penn State Milton S. Hershey Medical Center, Hershey, PA, United States
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50
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Edmunds SR, Fogler J, Braverman Y, Gilbert R, Faja S. Resting frontal alpha asymmetry as a predictor of executive and affective functioning in children with neurodevelopmental differences. Front Psychol 2022; 13:1065598. [PMID: 36710763 PMCID: PMC9880425 DOI: 10.3389/fpsyg.2022.1065598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 12/21/2022] [Indexed: 01/15/2023] Open
Abstract
The relative difference of resting EEG frontal alpha activation between left and right hemispheres (FAA; i.e., asymmetry) correlates with global approach and avoidance tendencies. FAA may relate to problems with executive and affective functioning in children with neurodevelopmental differences, including autism and ADHD. We (1) characterize relative left vs. right FAA in autistic, ADHD, and neurotypical children (NT) and (2) investigate whether FAA predicts "hot" executive function or emotion dysregulation. Participants were 97 7- to 11-year-old autistic, ADHD, and NT Children. Children with ADHD displayed greater left (relative to right) FAA compared to autistic and neurotypical children. Children with ADHD displayed greater challenges with "hot" EF on a gambling task than autistic children, whereas children with co-occurring autism and ADHD had greater parent-reported emotion dysregulation than NT and autism-only groups. Greater left FAA predicted worse hot EF for all children but was not significantly related to emotion dysregulation. Regardless of clinical diagnosis, relatively greater left FAA relates to hot EF. While hot EF deficits may be specific to ADHD rather than autism, both together confer additive risk for emotion dysregulation. Future research should explore the functional relation between FAA, reward processing, and affect for children with different EF-related neurodevelopmental differences.
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Affiliation(s)
- Sarah R Edmunds
- Department of Psychology, University of South Carolina, Columbia, SC, United States.,Division of Developmental Medicine, Boston Children's Hospital, Boston, MA, United States
| | - Jason Fogler
- Division of Developmental Medicine, Boston Children's Hospital, Boston, MA, United States.,Departments of Pediatrics & Psychiatry and Behavioral Sciences, Harvard Medical School, Boston, MA, United States.,Leadership Education in Neurodevelopmental & Related Disabilities/Institute for Community Inclusion, Boston, MA, United States
| | - Yael Braverman
- Division of Developmental Medicine, Boston Children's Hospital, Boston, MA, United States
| | - Rachel Gilbert
- Department of Pediatrics, Johns Hopkins University, Baltimore, MD, United States
| | - Susan Faja
- Division of Developmental Medicine, Boston Children's Hospital, Boston, MA, United States.,Departments of Pediatrics & Psychiatry and Behavioral Sciences, Harvard Medical School, Boston, MA, United States
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