Faculty Bibliography

OBJECTIVES/OBJECTIVE:To assess the effects of and related evidence certainty of interventions for attention deficit/hyperactivity disorder (ADHD) across an individual's lifespan, and to develop a continuously updated web platform for people with lived experience of ADHD as a method to disseminate living evidence synthesis for shared decision making. DESIGN/METHODS:Umbrella review and platform for shared decision making. DATA SOURCES/METHODS:Six databases from inception to 19 January 2025. Study authors were contacted for additional information when necessary. ELIGIBILITY CRITERIA FOR SELECTING STUDIES/METHODS:Systematic reviews that used meta-analyses of randomised controlled trials were eligible if they compared a drug or non-drug intervention with a passive control in individuals with a diagnosis of ADHD. Primary outcomes were severity of ADHD symptoms, analysed by rater type (clinician-rated, parent-rated, teacher-rated, or self-rated) and time point (short term (12 weeks, or study endpoint), medium term (26 weeks), and long term (52 weeks)),acceptability (participants dropping out for any reason), and tolerability (participants dropping out owing to any side effects). Secondary outcomes included daily functioning, quality of life, comorbid symptoms, and key side effects (decreased sleep and appetite). DATA SYNTHESIS/RESULTS:Eligible meta-analyses were re-estimated with a standardised statistical approach. Methodological quality was assessed using AMSTAR-2. Evidence certainty was evaluated using an algorithmic version of the GRADE framework, adapted for drug and non-drug interventions. RESULTS:115 of 414 full text articles were deemed eligible and 299 were excluded; the eligible articles comprised 221 unique combinations of participants, interventions, comparators, and outcomes. For each combination, the most recent and methodologically robust meta-analysis was selected for re-estimation, which gave 221 re-estimated meta-analyses in total, derived from 47 meta-analytic reports. In the short term, alpha-2 agonists, amphetamines, atomoxetine, methylphenidate, and viloxazine showed medium to large effect sizes in reducing the severity of ADHD symptoms in children and adolescents, with moderate to high certainty evidence. Methylphenidate showed consistent benefits across raters (standardised mean difference >0.75, 95% confidence interval (CI) 0.56 to 1.03; moderate or high certainty evidence). These interventions showed lower tolerability than the placebo, but this effect was not significant for methylphenidate and atomoxetine. In adults, atomoxetine, cognitive behavioural therapy, methylphenidate (and, when restricting analyses to high quality trials, amphetamines) showed at least moderate certainty evidence of efficacy on ADHD symptoms, with medium effect sizes. Methylphenidate, amphetamines, and atomoxetine had worse tolerability than placebo (methylphenidate, risk ratio 0.50, 95% CI 0.36 to 0.69; amphetamines, 0.40, 0.22 to 0.72; atomoxetine, 0.45, 0.35 to 0.58). Some non-drug interventions (acupuncture and cognitive behavioural therapy in children and adolescents, and mindfulness in adults) showed large effect sizes for ADHD symptoms, but with low certainty evidence. No high certainty, long term evidence was found for any intervention. An online platform showing effects and evidence certainty of each intervention across age groups, time points, and outcomes (https://ebiadhd-database.org/) was developed. CONCLUSIONS:This review provides updated evidence to inform patients, practitioners, and guideline developers how best to manage ADHD symptoms. The online platform should facilitate the implementation of shared decision making in daily practice. TRIAL REGISTRATION/BACKGROUND:Open Science Framework https://osf.io/ugqy6/.

OBJECTIVE:To examine the receipt of screening, services, and counseling during prepregnancy reproductive health, prenatal care, and postpartum care visits by disability status among people with recent live births in the United States. METHODS:Cross-sectional data were from 24 states in PRAMS (Pregnancy Risk Assessment Monitoring System) that included the WGSS (Washington Group Short Set of Questions) on Disability (October 2018-December 2020). Participants reported receipt of screening, services, and counseling during prepregnancy reproductive health care visits, prenatal care visits, and a postpartum checkup at 4-6 weeks postdelivery. Associations between the extent of disability (some and a lot of difficulty vs none) and components of health care visits were estimated using modified Poisson regression, adjusted for sociodemographic characteristics (adjusted prevalence ratios [aPRs] and 95% CIs). RESULTS:A total of 41,027 participants were included in analyses; 33.7% (n=14,047) reported having some difficulty and 6.2% (n=2,714) reported having a lot of difficulty. Differences were observed for screening, services, and counseling received at health care visits by disability status. During prepregnancy reproductive health care visits, people with any difficulty reported similar receipt of care as those with no difficulty, with the exception of a lower prevalence of discussions about improving their health (aPR 0.92; 95% CI, 0.86-0.98) and sexually transmitted infections (aPR 0.89; 95% CI, 0.83-0.95). During prenatal and postpartum visits, people with any difficulty had a lower prevalence of discussions about lifestyle behaviors, pregnancy weight gain and weight loss, interpersonal violence, mental health, breastfeeding, and birth control, as well as being tested for diabetes (aPR ranged from 0.72-0.99). CONCLUSION/CONCLUSIONS:Perinatal health care visits provide opportunities to improve health and assist in the transition to parenthood. Our findings highlight the need for strategies to reduce barriers to care for people with disabilities and facilitate effective communication during visits.

Early childhood is a critical period for overall development and well-being, yet children from low-income and low-resourced families, such as Chinese American immigrant families, often have unmet mental health needs as they face additional barriers like limited English proficiency and health literacy. Cultural and linguistic adaptation is essential for equitable access to resources and care. Despite the need, early childhood mental health among Chinese American families remains significantly understudied. A digital mental health solution may pose greater access and convenience to address the mental health needs of this community. Thus, this study aims to collaboratively develop a web-based app called OurChild, which provides culturally and linguistically adapted early childhood mental health and development resources for Chinese American immigrant families in New York City. Using the Participatory Cultural Adaptation Framework for Implementation Research (PCAFIR), the project involves a multiphased participatory co-design process: 1. understanding community needs through formative research and engagement; 2. building a digital library with evidence-based and culturally tailored content; 3. designing a culturally tailored web-based app using a participatory approach; and 4. refining and validating the design through user testing. Informed by formative data from existing studies and programs; focus groups and interviews with community experts (n = 6) and parents (n = 11); user testing with parents (n = 11), and through an iterative re-design process, the app was designed to be user-friendly, culturally relevant, and evidence-based. This study described the co-design process and highlighted the lessons learned in developing culturally tailored digital health tools to promote digital health equity for underserved communities.

BACKGROUND:Children from migrant families with absent parents are more likely to have poorer physical and mental health than children from non-migrant families. The impact of labor migration on left-behind family members in South Asian countries is not well-known. This study aimed to examine the patterns of labor migration and its impact on the health and development of children and their caregivers in rural Nepal. METHODS:Baseline family data collected from a school-based violence prevention program were utilized. Parents/caregivers (N = 346) with school-aged children (aged 3 to 15 years attending nursery to primary grades) from the rural Arghakhanchi district of Nepal were included in the study. A series of descriptive and chi-square analyses were carried out to explore the pattern of labor migration and differences between labor-migrant and non-labor-migrant families. Multivariate linear and logistic regression analyses were applied to explore the correlates and moderators involved. RESULTS:Labor migration has been a common practice in rural Nepal, with an estimated 49% of families having parents working overseas, mostly in India (57%) and Gulf countries (39%) on low-skill labor jobs. Labor migration was significantly associated with left-behind caregivers' and children's mental health. Left-behind caregivers in father-only labor-migrant families reported higher levels of depression than did parents in non-labor migrant families and left-behind children from labor-migrant families reported greater anger than did children from non-labor migrant families. The impact of labor migration on families was moderated by social class. For low social-class father migrant families, left-behind children were at greater risk for developmental delay and behavioral problems, but there seems to be a protective effect for high social-class father migrant families (with lower risk of developmental delay and problem behaviors compared to all other groups). CONCLUSIONS:Labor migration has a substantial impact on the mental health of left-behind families and children. The impact of labor migration may vary by living social-cultural context. Understanding the complex dynamics of labor migration has important implications for local and global migration-related health service planning.

BACKGROUND:Depression rates are higher in women, especially during periods of hormonal fluctuation. Reproductive system disorders (RSDs), which often disrupt hormonal balance, may contribute to this mental health burden. Despite their prevalence and significant health implications, the link between RSDs and depression remains underexplored, leaving a gap in understanding these women's mental health risks. METHODS:Using Danish nationwide health registers (2005-2018), we conducted a cohort study of 2,295,824 women aged 15-49, examining depression outcomes in 265,891 women diagnosed with 24 RSDs, including endometriosis, polycystic ovary syndrome, and pain-related diagnoses. For each RSD, age-matched controls were selected. We calculated incidence rates, incidence rate ratios, and prevalence proportions of depression diagnoses or antidepressant use around RSD diagnosis. RESULTS:Across all RSD subtypes, women demonstrated higher rates of depression both before and after diagnosis, with a peak within the year following diagnosis. Incidence rate ratios within 1 year of RSD diagnosis ranged from 1.15 (95% confidence interval [CI] 1.06-1.25) to 2.09 (95% CI 1.98-2.21), depending on RSD subtype. Elevated depression prevalence was observed 3 years before diagnosis, suggesting mental health impacts may have preceded clinical RSD identification. CONCLUSIONS:This study reveals a striking association between RSDs and depression. Women with RSDs are more likely to suffer from depression, before and after RSD diagnosis, highlighting the need for integrated mental health screening and intervention. With over 10% of women affected by RSDs, addressing this overlooked mental health burden is imperative for improving well-being in a significant portion of the population.

OBJECTIVE:Autism spectrum disorder (ASD) is a neurodevelopmental condition with early-life origins. Maternal health conditions during pregnancy have been linked to autism risk, but most studies focus on single populations, limiting generalizability. We examined whether associations previously reported in a Danish registry-based study hold in a U.S. METHOD/METHODS:We analyzed electronic health records of children born between 2010 and 2017 at Kaiser Permanente Northern California (KPNC) and their mothers. Maternal diagnoses were classified as chronic or non-chronic, and associations with ASD in the child were assessed using Cox models, adjusting for sociodemographic factors, healthcare utilization, and comorbid maternal diagnoses. Methods were aligned with the Danish study for comparability. RESULTS:Among 224,353 children in the KPNC cohort, 5,448 (2.4%) were diagnosed with autism. Of the 42 maternal diagnoses significantly associated with autism in Denmark, 38 were evaluable in KPNC, and 18 remained statistically significant after adjustment. Most associations had point estimates consistent with the Danish study, particularly psychiatric and cardiometabolic conditions. CONCLUSION/CONCLUSIONS:Despite demographic and healthcare differences, 35 of the 38 associations found in the Danish study replicated qualitatively (direction of effect) in the U.S. cohort, suggesting robust cross-setting relevance. Further research is needed to explore underlying mechanisms and effect modifiers.

Mental disorders are increasingly understood as disorders of brain development. Large and heterogeneous samples are required to define generalizable links between brain development and psychopathology. To this end, we introduce Reproducible Brain Charts (RBC), an open resource that integrates data from 5 large studies of brain development in youth from three continents (N = 6,346). Bifactor models were used to create harmonized psychiatric phenotypes, capturing major dimensions of psychopathology. Following rigorous quality assurance, neuroimaging data were carefully curated and processed using consistent pipelines in a reproducible manner. Initial analyses of RBC emphasize the benefit of careful quality assurance and data harmonization in delineating developmental effects and associations with psychopathology. Critically, all RBC data-including harmonized psychiatric phenotypes, unprocessed images, and fully processed imaging derivatives-are openly shared without a data use agreement via the International Neuroimaging Data-sharing Initiative. Together, RBC facilitates large-scale, reproducible, and generalizable research in developmental and psychiatric neuroscience.

Recent medical advances are allowing more youth with neuromuscular disorders to live into adulthood, thus increasing the necessity to transition youth from pediatric to adult medical care. Examining salient factors and processes for successful transition planning from pediatric to adult medical care in youth with neuromuscular disorders is a nascent field of study. The current study aims to address the key quality improvement question of identifying factors to consider when planning for transition by exploring the views of youth with neuromuscular disorders, caregivers, and providers within a multidisciplinary clinic regarding current care transition practices via quantitative and qualitative approaches. Both qualitative and quantitative results highlighted patient-endorsed importance of transition and emphasized the need for future tailored supports to facilitate gleaning skills for transition. Overall, this study offers valuable insights from patients, parents, and providers about challenges and best practices involved in transition planning for young adults with neuromuscular disorders.

STUDY QUESTION/OBJECTIVE:Is there an association between infertility diagnosis and long-term adult-onset psychiatric conditions in women? SUMMARY ANSWER/CONCLUSIONS:Infertility diagnosis in women is linked to higher risks of mood disorders, anxiety- and stress-related disorders, and behavioral syndromes with physical components, but not schizophrenia or other psychotic disorders, particularly notable from 9 years after the first infertility diagnosis. WHAT IS KNOWN ALREADY/BACKGROUND:Infertility, especially in women, is associated with major mental health challenges around the time of diagnosis. However, the long-term connection with a wide range of psychiatric disorders is largely unknown. STUDY DESIGN, SIZE, DURATION/METHODS:This study employed a matched-pair design within the UK Biobank (UKB) cohort, including 3893 females with a diagnosis of infertility and 15 603 matched female controls, totaling 19 496 participants. PARTICIPANTS/MATERIALS, SETTING, METHODS/METHODS:Female UKB participants with a diagnosis of infertility were matched to females without the diagnosis in a 1:4 ratio based on year of birth, index of deprivation of their residency area, and primary care data linkage status. The diagnosis of female infertility was identified by the first occurrence of a primary or secondary diagnosis in either primary care or hospital records. Additional analyses explored interactions between infertility diagnosis and both miscarriage and childbearing status on psychiatric conditions. MAIN RESULTS AND THE ROLE OF CHANCE/RESULTS:Diagnosis of infertility was associated with higher risks of mood disorders, anxiety- and stress-related disorders, and behavioral syndromes with physical components, but not with schizophrenia or other psychotic disorders. The most notable increases in the risk of psychiatric diagnoses were observed 9 years after the first infertility diagnosis. No significant interactions were found between infertility diagnosis and either miscarriage or childbearing status on psychiatric conditions. Sensitivity analysis confirmed the robustness of these associations across different data sources for infertility diagnosis and psychiatric condition ascertainment. LIMITATIONS, REASONS FOR CAUTION/CONCLUSIONS:The study's limitations include the racial homogeneity and the overall healthier status of the UKB cohort compared to the general UK population and the potential underestimation of associations due to misclassification of subfecund women. WIDER IMPLICATIONS OF THE FINDINGS/CONCLUSIONS:These results emphasize the need for integrated mental health support in infertility care and long-term monitoring of infertility patients for psychiatric risks. STUDY FUNDING/COMPETING INTEREST(S)/BACKGROUND:None. No competing interests were declared. TRIAL REGISTRATION NUMBER/BACKGROUND:n/a.