Faculty Bibliography

The objective of this study was to explore the buffering effect of support on the association between stress and postpartum depression (PPD) among immigrant women. We surveyed 223 Chinese pregnant or postpartum (within one year post-delivery) immigrant women in New York City. Surveys were conducted in English, Simplified Chinese or Mandarin, March-June 2021. PPD was measured with the Edinburgh PPD scale (EPDS); scores of 13 or higher indicate probable depression. Perceived stress was measured with one question, "How often did you feel stressed in the past week?"; responses were collapsed into a binary measure: Never/Rarely and Sometimes/Often/Always. Support was assessed with a general question about perception of receiving needed support and the Patient-Reported Outcomes Measurement Information System (PROMIS) V2.0 Short Form Informational, Instrumental, and Emotional Support measures. Bivariate and multivariable general linear regression models assessed the relationship among stress, support, and PPD. The EPDS mean score was 11.9 (95%CI:11.1-12.7) and 50% (95%CI: 42-57%) had EPDS scores ≥ 13, indicative of serious symptoms; 56% felt stressed in the past week and 37% reported getting needed support. Among women without perceived needed support, mean EPDS scores were higher among women who were stressed compared with women who were not (adjusted mean difference (aMD) 5.4; 95%CI:3.3-7.5); the association between stress and EPDS score was attenuated among women with needed support (aMD 1.1; 95%CI:-1.0, 3.1). Similar patterns held for emotional and instrumental support. Perceived and social support attenuated the association between perceived stress and depression symptoms among Chinese immigrant women. Enhancing support may be effective in countering the impact of stressors on PPD.

The transition from pediatric to adult healthcare is a critical stage for young individuals with chronic neurological disorders, particularly those with rare and complex epilepsies. This paper aims to explore the practice of transition by healthcare providers within EpiCARE. Through a comprehensive questionnaire, developed in collaboration with European Patient Advocacy Groups, this study investigates the current management of transition and identifies key barriers hindering stakeholders' needs. The questionnaire was completed by 60 EpiCARE members. Half of the respondents reported existing written transition procedures in their centers. Findings reveal significant hurdles in dedicated transition services, with nearly half of the respondents indicating their centers lack such pipelines. A critical gap exists in multidisciplinary team involvement, with inconsistent participation from key specialists like psychiatrists and social workers. The transition process typically begins at 16-18 years according to 70% of respondents; though 61% believe it should occur prior to the age of 17, highlighting the need for early planning to prevent gaps in care continuity. Furthermore, routinely used informal communication methods for clinical coordination underscore the need for standardized protocols and structured processes. This survey highlights the urgent need for tailored transition protocols that address the unique challenges of managing patients with rare and complex epilepsies, emphasizing the importance of integrating psychosocial support, optimizing comorbidity management, and ensuring coordination by experts in transitional care for these conditions. Fostering collaboration among healthcare providers, patients, and families is essential for refining transition strategies and ensuring comprehensive care for individuals with rare and complex epilepsies. Further initiatives are required to bridge the gaps between pediatric and adult healthcare systems, enhancing the overall quality of life for this vulnerable population. PLAIN LANGUAGE SUMMARY: Moving from child to adult healthcare is a key step for young people with rare and complex epilepsies. This study surveyed EpiCARE centers to understand how transitions are managed. Only half have written procedures, and many lack dedicated services or full specialist teams. Most start the transition at ages 16-18, but many believe it should begin earlier. Communication is often informal, without clear protocols. The results highlight the urgent need for structured, personalized transition plans that include psychological support and expert coordination to ensure continuous, high-quality care into adulthood.

OBJECTIVE:To evaluate the association between attention-deficit/hyperactivity disorder (ADHD) and atypical sensory processing patterns. METHOD/METHODS:For this systematic review and meta-analysis, PubMed, Embase, and Web of Science were searched from their inception until June 30, 2024. Studies examining sensory processing patterns using questionnaires in participants with a diagnosis of ADHD compared with healthy controls were included. The study risk of bias was assessed using a modified Newcastle-Ottawa Scale. A random-effects meta-analysis was conducted using R Version 4.3.1 software, considering sensory modulation severity atypicities as the primary outcome. The risk of publication bias was explored, and sensitivity analyses were conducted to test the robustness of findings. RESULTS:= 97%). Heterogeneity was high in all analyses. Only 9 studies were deemed at overall low risk of bias. CONCLUSION/CONCLUSIONS:Even though available ADHD clinical guidelines do not specifically mention the need to assess sensory processing in ADHD, this meta-analysis suggests that this should be systematically explored in the evaluation of children and adults referred for ADHD. PLAIN LANGUAGE SUMMARY/CONCLUSIONS:This systematic review and meta-analysis examined 30 studies including over 5,000 participants to assess the link between attention-deficit/hyperactivity disorder (ADHD) and atypical sensory processing. Findings show that individuals with ADHD experience significantly higher sensory sensitivity, sensory avoidance, sensory seeking, and low sensory registration compared to controls. Given their impact on daily functioning, assessing sensory processing could improve clinical evaluations for both children and adults with ADHD. STUDY REGISTRATION INFORMATION/UNASSIGNED:Association between ADHD and sensory processing disorder: A systematic review and meta-analysis; https://www.crd.york.ac.uk/PROSPERO/view/CRD42022325271. DIVERSITY & INCLUSION STATEMENT/UNASSIGNED:We actively worked to promote sex and gender balance in our author group. 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. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science.

Improving meaningful outcomes is the main goal of clinical care for mental disorders. Traditionally, the focus in clinical research and practice has been on outcome domains that refer to symptom severity or service use (e.g., hospitalization), relate to categorical diagnoses, and favour clinician-rated measures. More recently, self-rated and dimensional as well as transdiagnostic outcome domains have gained traction, and functioning, quality of life and well-being/life satisfaction, along with the construct of personal recovery, have become a stronger focus. These key multidimensional outcome domains need to be properly defined and assessed. Further, the concepts of "functional" and "personal" recovery need to be differentiated. "Functional recovery" is defined by observed functioning across the domains of self-care, social interactions, leisure time activities, and educational or vocational activities. "Personal recovery" involves the subjective sense of living a personally meaningful life, irrespective of whether symptoms continue, or ongoing/intermittent support is needed. Despite the multi-stakeholder relevance of these outcome domains, no comprehensive account of how to measure them is available. To fill this gap, we provide here an overview of the main tools to assess functioning, quality of life/well-being/life satisfaction, and personal recovery outcomes across mental disorders in adults, aiming to also identify additional needs that should be addressed. We identified tools that can be used in clinical and research practice to assess people with the following mental health conditions: anxiety disorders, bipolar disorder, dementias, eating disorders, major depressive disorder, obsessive-compulsive and related disorders, personality disorders, post-traumatic stress disorder, schizophrenia, and substance use disorders. Both transdiagnostic and disorder-specific measures are described. Suggested tools were selected keeping feasibility and scalability needs in mind. The incorporation of these measures in both research and clinical care will enrich patient assessment as well as treatment planning and evaluation, increasing the likelihood of enhanced outcomes in people living with mental disorders.

OBJECTIVE:Attention-deficit/hyperactivity disorder (ADHD) is associated with lower birth weight, but also with obesity in childhood. Findings on the direction of this association are mixed. This study investigated the relationship between weight and ADHD from birth across development. METHOD/METHODS:We used data from the Millennium Cohort Study (MCS), collected at 7 time points between age 9 months and 17 years. ADHD diagnosis status and scores on the Strength and Difficulties Questionnaire (SDQ) were used to create an ADHD group and a control group. Random intercept cross-lagged panel models were conducted in female individuals (n = 4,051) and male individuals (n = 3,857) to examine bidirectional associations between body mass index (BMI) z scores and SDQ scores between ages 3 and 17 years. Analyses were adjusted for common risk factors for ADHD and obesity, such as sex assigned at birth, multiple births, and ADHD medication status. RESULTS:Children in the ADHD group were significantly lighter in weight at birth than the control group (t[5674] = 2.65, 95% CI = 0.02, 0.14, p = .008) and were significantly more likely to have obesity at age 5 years onward (odds ratio range = 1.57-2.46, relative risk range 0.98-2.29). Path analyses conducted separately for male and female individuals showed that higher ADHD symptoms in female individuals at ages 7, 11, and 14 years significantly predicted higher BMI z scores at ages 11, 14, and 17 years, respectively. In male individuals, this association was seen only between ages 11 and 14 years (β = 0.07; 95% CI = 0.04-0.10, p < .001). CONCLUSION/CONCLUSIONS:Results suggest that interventions for children with ADHD, and their parents, should begin as soon as possible, ideally prenatally. Developmental sex differences should be considered.

The development of racial identity in Black boys is a critical aspect of their overall mental health and well-being. This article explores the unique societal and cultural challenges faced by Black boys in the context of identity formation and mental health outcomes. It critiques the one size fits all approach in clinical settings and advocates for an equitably tailored approach that emphasizes cultural competence, cultural responsiveness, and the importance of understanding the lived experiences of Black youth. By integrating these elements into clinical practice, mental health professionals can provide more effective and compassionate care promoting their mental health and resilience.

Maternal mental health during the perinatal period has been linked to the development of infant emotion regulation capacity, largely through its impact on caregiver-infant interactions during the first year of life. The majority of studies have focused on the effects of maternal depression, even though maternal anxiety is more prevalent and its effects on infant outcomes are less well understood. The current study aims to 1) explore differences in infant affect and regulatory behaviors across two commonly implemented infant stress-induction paradigms and 2) evaluate the differential effects of depression and anxiety on infant regulatory behaviors. Six-month-old infants and their mothers (N = 126) completed two tasks remotely in the home: the Arm Restraint task and the Still-Face Paradigm. Maternal depression and anxiety symptoms were measured using the Edinburgh Postnatal Depression Scale (EPDS) subscales. Within-person results indicated no significant associations among infant regulatory behaviors nor infant reactivity across the two paradigms. Additionally, no significant associations were found between maternal mental health and infant regulatory behaviors during the Still-Face Paradigm. However, higher EPDS composite scores were associated with fewer infant avoidance behaviors during the Arm Restraint task, and this result was driven by items on the anxiety subscale. These findings suggest that infant regulatory behaviors may differ depending on task used and may also be influenced by subclinical levels of maternal anxiety, but not maternal depression.

OBJECTIVE:This study aimed at identifying moderators of efficacy of stimulants against placebo to inform personalized recommendations for treatment in preschool children (< 6 years) with attention-deficit/hyperactivity disorder (ADHD). METHOD/METHODS:We acquired individual-level participant data from two randomized placebo-controlled trials (RCTs) of preschool ADHD: MAPPA (8-week methylphenidate, 102 participants, Brazil) and SPD489-347 (6-week lisdexamfetamine, 148 participants, US). We evaluated the moderator and predictor effects of baseline demographic (age, sex, race, ethnicity, maternal educational level) and baseline clinical (ADHD symptom severity, intelligence quotient, number of psychiatric comorbidities) characteristics, as available, on endpoint ADHD symptom severity scores. Data from each study were analyzed separately with linear mixed-effects model for repeated measures. For categorical variables, we also computed treatment effects (i.e., stimulants versus placebo) within subgroups and, when possible, pooled them alongside subgroup data from PATS (5-week methylphenidate, 165 participants, US) in random-effects meta-analyses. RESULTS:Stimulants had greater efficacy against placebo in White children compared to Black children considering data from US studies. Older age was not a moderator of greater efficacy of stimulants against placebo, nor was it associated with worse ADHD symptom severity at endpoint. Greater baseline ADHD symptom severity was associated with higher ADHD symptom severity at endpoint independently of the assigned treatment group. CONCLUSION/CONCLUSIONS:Race, but not older age or baseline ADHD symptom severity, may moderate the efficacy of stimulants for preschool ADHD. Given the post hoc nature of subgroup analyses, the findings should be interpreted as exploratory and viewed as hypothesis for confirmation in future studies.

BACKGROUND:Recent epidemiological evidence links early-life obesity and metabolic dysregulation to adult psychosis vulnerability, though a causal relationship remains unclear. Establishing causality in highly heritable psychotic disorders requires 1) demonstrating that early-life metabolic factors mediate between genetic vulnerability and psychosis trajectory, 2) dissecting mechanisms leading to early-life obesity in genetically vulnerable individuals, and 3) clarifying downstream neurodevelopmental pathways linking early-life obesity to psychosis symptoms. METHODS:Here we investigated bidirectional pathways linking behavioral, body mass index (BMI), and neurodevelopmental trajectories in a unique longitudinal cohort of 184 individuals at high genetic risk for psychosis, due to 22q11.2 deletion syndrome (22q11DS), and 182 neurotypical control individuals, followed-up since childhood. We combined repeated BMI measurements with clinical/neurocognitive phenotyping and neuroimaging. We investigated the relationship between BMI trajectories with risk of psychosis and tested whether altered cortical or cerebellar development could underlie this association. RESULTS:Childhood behavioral impulsivity predicted early and progressive deviations in BMI trajectories, mediating the effects of 22q11DS vulnerability to early-life obesity. Chronic BMI increases manifesting during childhood predicted the subsequent emergence of psychosis during late adolescence/early adulthood, mediating the effects of behavioral impulsivity. A dose-effect relationship linked duration of increased BMI status to worsening of motor and cognitive disorganization, a key schizophrenia symptom domain, which was mediated by progressive gray matter volume reductions in posterior-inferior cerebellum. CONCLUSIONS:These findings suggest that metabolic dysregulation associated with obesity may link childhood behavioral impulsivity to psychosis vulnerability in 22q11DS by influencing cerebellar maturation. These findings might support preventive interventions targeting early-life metabolic trajectories in individuals at risk of psychosis.

IMPORTANCE/UNASSIGNED:Studies suggest developmental concerns for infants born during the COVID-19 pandemic, but evidence on its impact on toddler behavioral and emotional well-being remains limited. OBJECTIVE/UNASSIGNED:To assess whether birth timing relative to the COVID-19 pandemic is associated with toddler internalizing and externalizing problems. DESIGN, SETTING, AND PARTICIPANTS/UNASSIGNED:This retrospective cohort study utilized Environmental Influences on Child Health Outcomes (ECHO) cohort data collected between September 27, 2009, and July 21, 2023. Children were divided into 3 groups: the prepandemic group, who were born and assessed before March 13, 2020; the pandemic-assessed group, who were born before March 13, 2020, but assessed after that date; and the pandemic-born group, who were born and assessed on or after March 13, 2020. Data were collected from 9 ECHO cohort sites across the United States and Puerto Rico. EXPOSURE/UNASSIGNED:The COVID-19 pandemic, designated as starting on March 13, 2020. MAIN OUTCOME AND MEASURE/UNASSIGNED:Parent-reported internalizing and externalizing symptoms on the Preschool Child Behavior Checklist (CBCL 1½-5) at age 18 to 39 months. RESULTS/UNASSIGNED:The 3438 children (mean [SD] age, 2.33 years [5.38 months]; 1770 [51.5%] male; 537 [16.2%] Black, 1722 [50.1%] Hispanic; and 1538 [44.7%] White) were divided into 3 groups: 1323 in the prepandemic group (mean [SD] age, 2.41 years [5.66 months]); 1690 in the pandemic-assessed group (mean [SD] age, 2.32 years [5.16 months]); and 425 in the pandemic-born group (mean [SD] age, 2.14 years [4.47 months]). Both the pandemic-assessed group (unadjusted β = -1.51; 95% CI, -2.27 to -0.75; adjusted β = -1.73; 95% CI, -2.48 to -0.99) and the pandemic-born group (unadjusted β = -2.03; 95% CI, -3.13 to -0.93; adjusted β = -1.90; 95% CI, -2.99 to -0.80) had lower levels of internalizing problems compared with the prepandemic (ie, historical) group. Similarly, both the pandemic-assessed (unadjusted β = -1.74; 95% CI, -2.46 to -1.02; adjusted β = -1.81; 95% CI, -2.53 to -1.09) and the pandemic-born group (unadjusted β = -3.16; 95% CI, -4.20 to -2.12; adjusted β = -3.17; 95% CI, -4.22 to -2.12) each had lower levels of externalizing problems compared with the prepandemic group. CONCLUSIONS AND RELEVANCE/UNASSIGNED:In this study, toddlers with prenatal and postnatal as well as those with only postnatal COVID-19 pandemic exposure showed fewer internalizing and externalizing problems than those born and assessed prior to the onset of the pandemic. These findings underscore the need for further research to identify protective factors that may buffer the impact of the pandemic on child behavior.