Family, Mental Health, and Placement Outcomes of a Low-cost Preventive Intervention for Youth in Foster Care

This study assessed secondary outcomes of Connecting, a low-cost, self-directed, family-based prevention program for families with youth placed in their care by state child welfare agencies. Families caring for youth aged 11 to 15 years within Washington State were recruited and randomly assigned into either the Connecting program (n = 110) or a treatment-as-usual control condition (n = 110). The program included a 10-week sequence of self-directed family activities and DVDs with video clips. Survey data were collected from caregivers and youth at baseline, immediately post-intervention, and at 12 and 24 months post-intervention; placement data was collected from the child welfare department as well. Intention-to-treat analyses focused on 5 classes of secondary outcomes at 24 months post-intervention: caregiver-youth bonding, family climate, youth risk behavior attitudes, youth mental health, and placement stability. There were no intervention effects in the full sample. In subgroup analyses, among older youth (ages 16 - 17) but not younger youth (ages 13 - 15), the Connecting condition (vs. controls) yielded more frequent caregiver-reported bonding communication, bonding activities, warmth, and positive interactions, as well as less favorable youth attitudes towards early initiation of sexual behavior and substance use, and fewer youth self-injurious thoughts. Consistent with the social development model, the divergent outcomes between younger and older youth suggests Connecting's driving mechanisms involve social processes that undergo critical shifts between early and mid-adolescence. Overall, the Connecting program showed promise in older youth for long-term promotion of caregiver-youth bonding, healthy behaviors, and mental health, but did not demonstrate long-term efficacy in facilitating stable or permanent placement of youth in care.

Two-Year Risk Behavior Outcomes from Connecting, a Prevention Program for Caregivers and Youth in Foster Care

This study experimentally tested risk behavior outcomes of Connecting, a low-cost, self-directed, family-based prevention program for families with youth placed in their care by state child welfare agencies. Families caring for youth aged 11 to 15 years from across Washington State were recruited and randomly assigned to either the self-directed program with supplemental support (n = 110) or a treatment as usual control condition (n = 110). Program materials included a workbook with family activities and DVDs with video clips. Over the 10-week program, participants received motivational support contacts to prompt program completion. Survey data were collected from youth and their caregivers at baseline, directly following intervention, then again at 12 and 24 months post-intervention. Intervention effects at 24-month follow-up were found to be moderated by age. Among 16- to 17-year-old youth at follow-up, there was an intervention benefit yielding reduced use of any substance (OR = 0.71, 95% CI [0.54, 0.93], p = 0.01) and nonviolent delinquency (OR = 0.73, 95% CI [0.57, 0.94], p = 0.02). There was no intervention effect among adolescents aged 13 to 15 years for any risk behaviors. This evidence suggests that the developmental timing of a self-directed, family-focused preventive intervention for youth and their caregivers in the foster care system may influence risk behaviors that typically emerge in late adolescence. ClinicalTrials.gov Identifier: NCT03157895.

Featured Article: Adolescent Condom Use and Connectivity in the Social-Planful Brain

Objective

To reduce rates of sexually transmitted infections (STIs) and unwanted pregnancy among adolescents, it is critical to investigate brain connectivity that may underlie adolescents' sexual health decision-making in the context of intercourse. This study explored relationships between adolescent condom use frequency and the brain's resting-state functional connectivity, to identify differential patterns of social-affective processing among sexually active youth.

Methods

In this study, N = 143 sexually active adolescents (68.5% male, Mage = 16.2 years, SD = 1.06) completed magnetic resonance imaging and reported past 3-month frequency of condom use. Resting-state connectivity, seeded on a social region of the brain, the temporoparietal junction (TPJ), was assessed to determine its correspondence with protected sex (condom use).

Results

Condom use was associated with positive connectivity between the left TPJ and bilateral inferior frontal gyrus (IFG). This relationship was observed in adolescent males only; no connectivity differences were observed with adolescent females.

Conclusions

This study reflects functional synchrony between nodes of the "social brain," including the TPJ, and a region of planfulness and control, the IFG. The relationship between these regions suggests that adolescents who have more coordinated systems of communication between these critical components of the brain are more likely to be successful in planning and engaging in safer sexual decision-making; for young males, this differentiated more frequent from less frequent condom use. In turn, interventions designed to reduce STIs/human immunodeficiency virus may benefit from targeting social-planfulness dimensions to help youth implement safer sex behaviors.

Four Mechanistic Models of Peer Influence on Adolescent Cannabis Use

Purpose of review

Most adolescents begin exploring cannabis in peer contexts, but the neural mechanisms that underlie peer influence on adolescent cannabis use are still unknown. This theoretical overview elucidates the intersecting roles of neural function and peer factors in cannabis use in adolescents.

Recent findings

Novel paradigms using functional magnetic resonance imaging (fMRI) in adolescents have identified distinct neural mechanisms of risk decision-making and incentive processing in peer contexts, centered on reward-motivation and affect regulatory neural networks; these findings inform a theoretical model of peer-driven cannabis use decisions in adolescents.

Summary

We propose four "mechanistic profiles" of social facilitation of cannabis use in adolescents: (1) peer influence as the primary driver of use; (2) cannabis exploration as the primary driver, which may be enhanced in peer contexts; (3) social anxiety; and (4) negative peer experiences. Identification of "neural targets" involved in motivating cannabis use may inform clinicians about which treatment strategies work best in adolescents with cannabis use problems, and via which social and neurocognitive processes.

Orbitofrontal cortex connectivity as a mechanism of adolescent behavior change

An increasing number of studies have implicated the role of network functional connectivity in addiction. Yet, none have examined functional connectivity as a potential mechanism of adolescent behavior change. We examined the underlying neural mechanism of a promising treatment for adolescents, motivational interviewing (MI). We began by employing psychophysiological interaction (PPI) to evaluate network response in a sample of adolescent cannabis users (N=30). Next, we examined correlations between network connectivity and clinical metrics of treatment outcome. PPI analyses seeded on the orbitofrontal cortex (OFC) showed significant increases in functional connectivity across the inferior frontal gyrus (IFG), precentral gyrus, anterior and posterior cingulate gyrus, supplementary motor area (SMA), superior frontal gyrus, pallidus, caudate, and parahippocampal gyrus. Further, greater functional connectivity between the OFC and anterior cingulate/medial frontal gyrus was associated with less behavior change (e.g., greater post-treatment cannabis problems). These data support the role of the OFC network as a mechanism of adolescent treatment response.

Cognitive distortions mediate depression and affective response to social acceptance and rejection

BACKGROUND

The emotional context insensitivity (ECI) hypothesis suggests individuals with depression have blunted affective responses to both positive and negative events. We tested ECI in a social context to examine how depression relates to affective responses to social acceptance and rejection outcomes. Furthermore, we aimed to identify cognitive mechanisms linking depression with affective response to social feedback. Finally, we tested whether these processes are similar for social anxiety.

METHOD

90 participants (age 18-26 years; 53 women) completed the two-visit Chatroom task. At Visit 1 they rated their expectations about being liked by 60 peers. At Visit 2 they completed self-reports of depressive and social anxiety symptoms, and of cognitive flexibility, then received acceptance or rejection feedback from each peer and rated their affective response.

RESULTS

Greater depressive symptoms related to negative expectancy bias, lower cognitive flexibility, and less positive affective response to acceptance, but did not relate to rejection. Negative expectations and cognitive flexibility mediated the relationship between depressive symptoms and affective response for acceptance; only negative expectations mediated rejection responses. These cognitive mechanisms were not related to social anxiety.

LIMITATIONS

A community sample was used to assess depression. Rumination and current mood state were omitted as potential predictors of affective response.

CONCLUSIONS

Findings support the ECI framework. Depression but not social anxiety interferes with positive and negative affect through cognitively mediated dampening of emotional response to social acceptance and rejection. Emotion regulation strategies in depression therapy can target social flexibility to improve alignment of affective reactions to social outcomes.

Expectancy bias mediates the link between social anxiety and memory bias for social evaluation

Social anxiety (SA) involves a multitude of cognitive symptoms related to fear of evaluation, including expectancy and memory biases. We examined whether memory biases are influenced by expectancy biases for social feedback in SA. We hypothesised that, faced with a socially evaluative event, people with higher SA would show a negative expectancy bias for future feedback. Furthermore, we predicted that memory bias for feedback in SA would be mediated by expectancy bias. Ninety-four undergraduate students (55 women, mean age = 19.76 years) underwent a two-visit task that measured expectations about (Visit 1) and memory of (Visit 2) feedback from unknown peers. Results showed that higher levels of SA were associated with negative expectancy bias. An indirect relationship was found between SA and memory bias that was mediated by expectancy bias. The results suggest that expectancy biases are in the causal path from SA to negative memory biases for social evaluation.

Gaining insight into adolescent vulnerability for social anxiety from developmental cognitive neuroscience

Social anxiety disorder (SAD) markedly impairs daily functioning. For adolescents, SAD can constrain typical development precisely when social experiences broaden, peers' opinions are highly salient, and social approval is actively sought. Individuals with extreme, impairing social anxiety fear evaluation from others, avoid social interactions, and interpret ambiguous social cues as threatening. Yet some degree of social anxiety can be normative and non-impairing. Furthermore, a temperament of behavioral inhibition increases risk for SAD for some, but not all adolescents with this temperament. One fruitful approach taken to understand the mechanisms of social anxiety has been to use neuroimaging to link affect and cognition with neural networks implicated in the neurodevelopmental social reorientation of adolescence. Although initial neuroimaging studies of adolescent SAD and risk for SAD underscored the role of fear-processing circuits (e.g., the amygdala and ventral prefrontal cortex), recent work has expanded these circuits to include reward-processing structures in the basal ganglia. A growing focus on reward-related neural circuitry holds promise for innovative translational research needed to differentiate impairing from normative social anxiety and for novel ways to treat adolescent SAD that focus on both social avoidance and social approach.

Will they like me? Adolescents' emotional responses to peer evaluation

Relative to children and adults, adolescents are highly focused on being evaluated by peers. This increased attention to peer evaluation has implications for emotion regulation in adolescence, but little is known about the characteristics of the evaluatee and evaluator that influence emotional reactions to evaluative outcomes. The present study used a computer-based social evaluation task to examine predictors of adolescents' emotional responses to feedback from unknown peers. Nine-to-seventeen-year-olds (N = 36) completed the "chatroom task" and indicated the degree to which each peer would be interested in interacting with them and how good they felt after receiving acceptance and rejection feedback from peers. We examined whether adolescents' age and gender impacted their emotional responses to being accepted or rejected by peers of different age groups (i.e., early or middle adolescence) and genders. We also tested whether expectations about peers' interest was associated with variability in adolescents' emotional responses to the evaluative outcome. Upon being accepted by middle adolescent male peers, females in the middle relative to early years of adolescence reported greater well-being, whereas males reported similar levels of well-being regardless of their own age. Following acceptance from middle adolescent female peers, females reported greater well-being than males. Adolescents with high expectations for being liked by peers felt better after being accepted versus rejected relative to those with low expectations. For adolescents with low expectations, acceptance and rejection were associated with similar levels of well-being. Adolescents' emotional responses to peer evaluation are influenced by specific individual characteristics and antecedent preparation for evaluation that may serve an emotion regulatory purpose.