Faculty Bibliography

Pediatric brain imaging holds significant promise for understanding neurodevelopment. However, the requirement to remain still inside a noisy, enclosed scanner remains a challenge. Verbal or visual descriptions of the process, and/or practice in MRI simulators are the norm in preparing children. Yet, the factors predictive of successfully obtaining neuroimaging data remain unclear. We examined data from 250 children (6-12 years, 197 males) with autism and/or attention-deficit/hyperactivity disorder. Children completed systematic MRI simulator training aimed to habituate to the scanner environment and minimize head motion. An MRI session comprised multiple structural, resting-state, task and diffusion scans. Of the 201 children passing simulator training and attempting scanning, nearly all (94%) successfully completed the first structural scan in the sequence, and 88% also completed the following functional scan. The number of successful scans decreased as the sequence progressed. Multivariate analyses revealed that age was the strongest predictor of successful scans in the session, with younger children having lower success rates. After age, sensorimotor atypicalities contributed most to prediction. Results provide insights on factors to consider in designing pediatric brain imaging protocols.

Effective organizational skills (e.g., time management, materials management, and task planning) are associated with academic success, yet some children struggle to gain these skills without intervention. While evidence-based organizational skills interventions for pediatric clinical populations exist, none target organizationally impaired general populations in a primary school setting. In Organizational Skills Training-School (OST-S), school professionals teach small groups of 4th"“5th grade organizationally impaired elementary school students skills associated with tracking assignments, managing materials, time management, and planning. This open pilot study of 33 students examined: a. the feasibility of adapting and implementing an established clinic-based, individualized treatment (OST-C) to a group format in a school setting, b. the program's acceptability among children, parents, and school partners, and c. whether participating children improved in the same functional areas that OST-C positively influenced. Results indicated that we could adapt the intervention, school partners could implement it, and participants could accept it. Pre-post improvements in organizational skills (as rated by parents, teachers, and children), homework problems, and academic performance demonstrated the potential effectiveness of OST-S, suggesting the need for further efficacy work.

News of a videogame that received FDA clearance to treat youth with attention-deficit hyperactivity disorder (ADHD) garnered a great deal of media attention and raised questions about the role of digital cognitive training programs for treatment. In order for clinicians and clients to understand this news for the purposes of making treatment decisions one must have an understanding of what it means for a treatment to be considered evidence-based and an understanding of what is required to obtain FDA clearance. Finally, in order to fully inform decisions about treatment, clinicians and parents must be able to consider the evidence supporting cognitive training programs in relation to other treatments available for children with ADHD. A review of these standards and the evidence supporting cognitive training in general, and the new videogame that received recent FDA clearance (EndeavorRX^TM) specifically, revealed an overall lack of support for this approach to treatment. There are multiple psychosocial and pharmacological treatment options with much more evidence supporting their effectiveness than any commercially available cognitive training program. The contrast between receiving FDA clearance without evidence of any observable benefits to the child is explained within a description of the FDA process for clearance and approval. Finally, these conclusions are described in the context of clinicians' decisions regarding services offered and procedures for explaining this to families who may have seen the media attention related to FDA clearance.
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Objectives: Replicated findings indicate that those with ADHD frequently demonstrate deficits in executive functions (EF) (eg, problems with attention control, behavior control, working memory, and planning). Clinicians should have a clear understanding of the impact that these deficits have upon individual, family, and school functioning. This presentation will: 1) summarize investigations of EF deficits in ADHD; 2) show how EF deficits can affect daily functioning; 3) discuss limitations when broad and abstract methods for building skills in EF have been tried; and 4) review the findings of emerging treatments that address practical EF deficits that have contributed to improvements in organizational skills, family functioning, and school performance. Attendees will learn how to incorporate this work in assessment, referral, and treatment practices.
Method(s): Based upon findings, some teams have developed methods to train core EF skills, including working memory, attention control, and impulse control. Using varied designs, the impact of these methods on ADHD symptoms, family interactions, and school behavior has been tested. Other research groups have created and tested interventions to address behavioral deficits in organization, time management, and planning (which are found to be present in more than 50 percent of youth with ADHD). These latter interventions, tested in randomized controlled trials, look to increase organizational skills as functional impairments that emerge from deficient EF.
Result(s): The first set of studies, testing the training in core EF skills, have found significant changes on tasks similar to training tasks but with limited improvements in ADHD symptoms, home interactions, and school performance. On the other hand, the other interventions targeting related behavioral deficits have found substantial improvements in home and school functioning. Improved organizational skills, improved family relations, and improved academics have resulted and have led to more positive views of teachers and school, in general. The interventions contribute to persistent home and school success.
Conclusion(s): Broad and abstract methods for addressing EF deficits have proven to be ineffective. However, by addressing practical reflections of EF deficits, some relatively new but sound interventions are changing the course for youth with ADHD. ADHD, EBP, TREAT
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Objectives: Organizational Skills Training (OST), is a 10-week psychosocial intervention found effective in improving organizational, time management, and planning (OTMP) skills in children with Attention-Deficit/Hyperactivity Disorder (ADHD). Little is known about the feasibility of identifying brain markers for treatment response. Using resting state fMRI (R-fMRI), we aimed to examine neuronal correlates of post-treatment change as a first step toward larger controlled studies of objective predictors of treatment response. Methods: We examined pre- and post-OST R-fMRI data of 15 children (12 males; mean age: 9+/-1 year) with ADHD and significant impairments in OTMP skills indexed by total scores on Children's Organizational Skills Scales-Parent (COSS-P) or Teacher (COSS-T). Our primary outcome measure was the change in COSS-P scores. As secondary summary outcome measure, we used prepost Z-score differences averaged across COSS-T, Homework Problems Checklist, Academic Progress Report and Academic Performance Rating scales. We selected a priori the intrinsic functional connectivity (iFC) of the dorsal anterior cingulate cortex (dACC), based on its role on cognitive control. Multivariate distance matrix regression (MDMR) analysis additionally allowed for whole-brain explorations. Follow-up iFC analyses were conducted on regions with significant within-subject post-OST differences by MDMR analysis. Results: COSS-P decreased significantly (t=7.1, p< 0.0001). In a cluster involving striatum bilaterally, dACC iFC decreased post-OST; these decreases were positively correlated with COSS-P improvements (r=.34, NS) and to improvements in the summary outcome (r=.63; p<0.03). MDMR analyses revealed iFC changes in the right medial and lateral precentral cortex. Followup seed-based iFC analyses of this region showed significant decreases in cortico-striatal iFC post-OST. Conclusions: Results support the feasibility of identifying changes in brain iFC after OST. Two distinct analysis converged on decreased corticosubcortical iFC post-treatment which related to change in clinical measures. As decreases in striato-cortical iFC characterize typical development, results suggest regionally-specific enhanced maturational effects of OST

Objectives: Organization, time management, and planning (OTMP) difficulties have an impact on a substantial proportion (~50 percent) of children with ADHD, and they improve with behavioral intervention. Given symptomatic overlap between ASD and ADHD, children with ASD may also experience OTMP impairments. To date, examinations of this domain in ASD are missing. Objectives include the following: 1) to characterize the nature and extent of OTMP deficits in children with ASD and identify rates of ADHD comorbidity in children with ASD with and without OTMP impairments (ASD+, ASD-, respectively); and 2) to identify similarities and differences between the ASD+ and ASD- subgroups and children with ADHD and OTMP impairments (ADHD+). Methods: We examined data (N = 85) of children aged 8-13 years with DSM-IV-TR diagnoses of ASD (n = 35) or ADHD (n = 31), as well as typically developing children (TDC) (n = 19). ANOVA compared the groups on parent scores on the Children's Organizational Skills Scale (COSS-P) and the subgroups on ASD traits, ADHD traits, and executive functions (ratings on the Social Responsiveness Scale, Conners' Parent Rating Scale, and Behavior Rating Inventory of Executive Functions). A threshold for significance was set at P = 0.01. Results: Children with ASD and ADHD had higher (i.e., more severe) COSS-P Total T scores than TDC. Forty-two percent of the children with ASD were ASD+ (i.e., COSS-P Total T >65), and 47 percent were categorized as ADHD+. Eighty-seven percent of the ASD+ had comorbid ADHD per clinician's interview, in contrast with only 27 percent of the ASD- subgroup. The severity of ADHD traits and executive dysfunction was no different between ASD+ and ADHD+ groups. In contrast, ASD- children had significantly lower ratings of ADHD and executive function severity than children with OTMP deficits. It is noteworthy that the ASD+ and ASD- groups differed in ASD ratings. Results were replicated with a second, independent sample group (N = 150). Conclusions: A substantial proportion of children with ASD exhibited OTMP functional impairment difficulties, which accompanied other symptoms typically observed in ADHD. Given the availability of evidence-based interventions for OTMP impairments in ADHD, adaptations of this intervention for this population may be warranted