Faculty Bibliography
Searched for:
school:SOM
Department/Unit:Child and Adolescent Psychiatry
Total Results:
11535
Mind the Gap! Sleep Problems in Children With ADHD-A Qualitative Analysis of Clinician Training Needs
BACKGROUND:This study aims to explore for the first time the knowledge, understanding and management of sleep problems in children with ADHD among clinicians who specialise in sleep and ADHD. The aim was to inform the development of digital sleep awareness training for clinicians. METHOD/METHODS:Fifteen clinicians who work with children with ADHD and sleep difficulties in the United Kingdom participated in semistructured qualitative interviews. Data were analysed using a reflexive thematic analysis approach to generate and guide the content of digital sleep awareness training. RESULTS:Four core themes were developed: 'It's a Problem' highlighted the extent to which children with ADHD were reported to struggle with sleep difficulties and the impact this has on the child and family. Clinicians also discussed the difficulty they had in finding evidence-based information they could share with caregivers. With little to no formal training, most of the advice they gave came from 'learning on the job'. When discussing ADHD specific sleep difficulties and disorders, clinicians reflected on their own 'insight into limitations of knowledge'. 'Learning for practice' highlighted the divergence in the methods of learning preferred by clinicians, despite convergence of learning content needed. CONCLUSIONS:Sleep problems in children with ADHD are common, and clinicians often struggle to support these due to lack of formal training. There is a need for accessible, authoritative training for UK practitioners who work with children with ADHD.
PMCID:12979961
PMID: 41814597
ISSN: 1365-2214
CID: 6015762
Maternal Milk Allopregnanolone May Buffer Negative Associations Between Maternal Postpartum Psychological Distress and Infant Regulatory Capacity
Maternal psychological distress during pregnancy and the early postpartum period is a risk factor for dysregulated affective and regulatory function in young infants. Animal models suggest that perinatal stress may alter offspring development via allopregnanolone (ALLO) exposure. For example, variations in placentally derived ALLO in preterm infants have been linked with altered fetal neurodevelopment. However, no studies have investigated naturalistic variations in ALLO concentrations in maternal milk as a potential moderator of associations between maternal distress and infant temperament during the postnatal period. The current study assesses associations among ALLO concentrations in human milk, maternal psychological distress, and infant temperament in 81 mother-infant dyads (31 females) measured at approximately 6.5 months postpartum (M = 6.55 months, range = 5.5-8 months). Results indicated that human milk ALLO concentration moderated effects of maternal psychological distress on infant regulatory capacity. Specifically, there was a negative association between maternal psychological distress and regulatory capacity in infants of mothers with below-mean ALLO concentrations, but not in infants of mothers with above-mean ALLO concentrations. However, there were no effects of ALLO on infant negative affect or surgency/positive affect. This study provides some of the first preliminary evidence that ALLO concentrations in human milk may moderate associations between maternal psychological distress and infant regulatory capacity.
PMCID:12848642
PMID: 41603064
ISSN: 1098-2302
CID: 6003442
Integrating evidence-based early relational health programs into pediatric primary care: A mixed methods study
OBJECTIVE:Pediatric primary care (PPC) offers an ideal platform for integrating evidence-based programs (EBPs) to enhance early relational health (ERH). However, implementing such integration faces several challenges. This study uses quantitative and qualitative data to identify the barriers, facilitators, and strategies for implementing ERH-focused EBPs in PPC. METHODS:Using the Consolidated Framework for Implementation Research framework, we conducted a survey and focus groups with PPC personnel recruited through nationwide networks. The survey measured clinic readiness (i.e., challenges, resources, and needs) for integration and examined its associations with personnel roles and clinic characteristics using nested ANOVAs and multilevel regressions. Focus groups further probed potential strategies and were coded using thematic analysis. RESULTS:126 PPC personnel from 44 clinics completed the survey, and 18 participated in five focus groups. Clinics had strong leadership support for integrated services and high utilization of program resources and implementation practices, yet notable challenges in structural and human resources existed. Clinic staff perceived higher readiness for integration than other personnel roles. Lower-percent Medicaid eligible patients and urbanicity were associated with higher readiness, while academic affiliation showed both positive and negative associations. Promoting culturally responsive care, fostering team cohesion, utilizing standardized implementation processes, adopting flexible delivery and collaborative models, and partnering with local communities were key strategies for integrating EBPs. CONCLUSIONS:The findings can help PPC clinics more effectively integrate one or multiple EBPs into routine care and can inform ways to sustain such integrated services to optimize population-level reach and positive impacts on child and family well-being.
PMID: 41730331
ISSN: 1876-2867
CID: 6009732
Insurance-based Disparities in Pediatric Psychiatric Hospitalizations from 2018 to 2021: Examining Mental Health Outcomes among Medicaid and Commercially Insured Youth
Insurance type is a key indicator of structural vulnerability in pediatric mental health care and may be associated with differences in psychiatric presentation, treatment course, and diagnosis among hospitalized youth, particularly Black and Hispanic/Latino children insured by Medicaid. Despite these inequities, their impact remains understudied among psychiatrically hospitalized pediatric populations. This retrospective study analyzed 1,101 child and adolescent psychiatric patients admitted to an urban psychiatric hospital between June 2018 and November 2021. Clinical presentation, psychiatric history, treatment course, and discharge diagnoses were compared between patients' insurance by Medicaid (72%) and those with commercial insurance (28%). Compared with commercially insured patients, children and adolescents with Medicaid were more likely to be Black or Hispanic/Latino and had higher rates of trauma exposure, prior psychiatric emergency visits, and higher rates of attention-deficit/hyperactivity disorder (ADHD), impulsive/behavioral disorders, and developmental/intellectual disorders. They were more frequently admitted for aggression-related crises, more likely to receive emergency injectable medications for agitation, and had longer hospital stays. Commercially insured patients had higher rates of anxiety disorders and suicide attempt related admissions. These findings suggest children and adolescents with Medicaid who required psychiatric hospitalization had greater severity of psychosocial histories and higher-acuity inpatient courses, highlighting how structural inequities reflected by insurance type, may shape differing psychiatric treatment pathways, underscoring the need for equity-oriented interventions, particularly during periods of healthcare system strains.
PMID: 41712091
ISSN: 1573-6709
CID: 6005022
Wondering About Wandering
PMCID:12920163
PMID: 41726572
ISSN: 1535-7597
CID: 6009622
The role of negative affectivity in the developmental pathway linking perinatal complications to behavioral and emotional problems in children
Although temperamental negative affectivity has been identified as a developmental mechanism mediating the link between perinatal risk and internalizing problems in early childhood, its role in predicting broader behavioral and emotional problems across childhood remains understudied. We examined the longitudinal relations among perinatal complications (i.e., prenatal maternal depression and cardiometabolic complications, preterm birth, and low birth weight), children's negative affectivity (M
PMID: 41693363
ISSN: 1469-2198
CID: 6004282
Leveraging clinical sleep data across multiple pediatric cohorts for insights into neurodevelopment: the retrospective analysis of sleep in Pediatric (RASP) cohorts study
Sleep disturbances are prominent across neurodevelopmental disorders (NDDs) and may reflect specific abnormalities in brain development and function. Overnight polysomnography (PSG) allows for detailed investigation of sleep architecture, offering a unique window into neurocircuit function. Analysis of existing pediatric PSGs from clinical studies could enhance the availability of sleep studies in pediatric patients with NDDs towards a better understanding of mechanisms underlying abnormal development in NDDs. Here, we introduce and characterize a retrospective collection of 1527 clinical pediatric overnight PSGs across five different sites. We first developed an automated stager trained on independent pediatric sleep data, which yielded better performance compared to a generic stager trained primarily on adults. Using consistent staging across cohorts, we derived a panel of EEG micro-architectural features. This unbiased approach replicated broad trajectories previously described in typically developing sleep architecture. Further, we found sleep architecture disruptions in children with Down's Syndrome (DS) that were consistent across independent cohorts. Finally, we built and evaluated a model to predict age from sleep EEG metrics, which recapitulated our previous findings of younger predicted brain age in children with DS. Altogether, by creating a resource pooled from existing clinical data we expanded the available datasets and computational resources to study sleep in pediatric populations, specifically towards a better understanding of sleep in NDDs. This Retrospective Analysis of Sleep in Pediatric (RASP) cohorts dataset, including staging annotation derived from our automated stager, is deposited at https://sleepdata.org/datasets/rasp.
PMID: 40488421
ISSN: 1550-9109
CID: 5868972
Devaluation of response-produced safety signals reveals circuits for goal-directed versus habitual avoidance in dorsal striatum
Active avoidance responses (ARs) are instrumental behaviors that prevent harm. Adaptive ARs may contribute to active coping, whereas maladaptive avoidance habits are implicated in anxiety and obsessive-compulsive disorders. The AR learning mechanism has remained elusive, as successful avoidance trials produce no obvious reinforcer. We used a novel outcome-devaluation procedure in rats to show that ARs are positively reinforced by response-produced feedback cues that develop into safety signals during training. Males were sensitive to feedback devaluation after moderate training, but not overtraining, consistent with a transition from goal-directed to habitual avoidance. Using chemogenetics and feedback devaluation, we also show that goal-directed vs. habitual ARs depend on dorsomedial vs. dorsolateral striatum, suggesting a significant overlap between the mechanisms of avoidance and rewarded instrumental behavior. Females were insensitive to feedbackdevaluation due to a remarkable context-dependence of counterconditioning. However, degrading the contingency between avoidance and feedback suggests that both sexes rely on safety signals to perform goal-directed ARs.
PMID: 41663373
ISSN: 2041-1723
CID: 6001832
The International Guideline for the Definition, Classification, Diagnosis and Management of Urticaria
This update and revision of the international guideline for urticaria was developed in accordance with the methods recommended by Cochrane and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group. It is an initiative of the Global Allergy and Asthma Excellence Network (GA2LEN) and its Urticaria and Angioedema Centers of Reference and Excellence (UCAREs and ACAREs), with the participation of 210 delegates from 107 national and international societies, from 59 countries. The consensus conference was held on December 6th, 2024. This guideline was acknowledged and accepted by the European Union of Medical Specialists (UEMS). Urticaria is a frequent, mast cell-driven disease, defined by a rapid appearance of wheals, angioedema, or both. The lifetime prevalence of acute urticaria is estimated to be approximately 20%. Chronic urticaria, categorized as either chronic spontaneous urticaria or chronic inducible urticaria, is disabling, impairs quality of life, and affects performance at work and school, however, novel therapies are available. This updated version of the international guideline for urticaria covers the definition and classification of urticaria and outlines expert-guided and evidence-based diagnostic and therapeutic approaches for the different subtypes of urticaria.
PMID: 41649409
ISSN: 1398-9995
CID: 6000592
Associations of neighborhood deprivation and household income during pregnancy on child externalizing and internalizing problems
Socioeconomic disadvantage has been established as a key risk factor for adverse child behavioral outcomes. Understanding how individual components of socioeconomic status (SES) interact with each other can elucidate protective factors and inform interventions and policies to promote positive developmental outcomes. This study examined the interactive effects of prenatal household income and neighborhood deprivation on child externalizing and internalizing problems (N = 793; M
PMCID:12888081
PMID: 41645600
ISSN: 1469-2198
CID: 6000512
