Faculty Bibliography

The perinatal period represents a time of profound neurobiological, cognitive, and emotional change. While evidence points to the neuroplasticity of matrescence as adaptive in supporting the transition to motherhood, the perinatal period also entails subjective reports of cognitive difficulty known as "mommy brain" as well as a heightened vulnerability to mental health challenges. The role of cognition in the etiology of postpartum depression is a promising area of investigation into targets for maternal mental health intervention, considering evidence that important cognitive changes occur during the perinatal period, and given that cognitive alterations are key features of mood disorders. Here we review evidence for cognitive plasticity in matrescence, with a particular focus on executive function (EF) given its overlapping significance for adaptation to parenthood, central role in managing the mental load of motherhood, and implications in mood regulation and mood disorders. We also review evidence for EF changes in perinatal depression and major depressive disorder more broadly. Despite the strong association between EF impairments and major depressive disorder, research on EF changes in perinatal depression remains limited. Understanding normative EF changes during this period is essential for better understanding the relationship between EF, perinatal depression, and the mental load of motherhood. Consideration for these cognitive, neurobiological, and psychosocial factors of matrescence is critical for addressing maternal mental health and developing interventions that support parental well-being.

INTRODUCTION/UNASSIGNED:Assessing sustained attention presents methodological challenges, particularly when spanning diverse populations whose baseline sensorimotor functioning may vary significantly. METHODS/UNASSIGNED:This study introduces the Continuous Performance Critical Stability Task (cpCST), a novel paradigm combining high-density sampling of behavior (30 Hz), individualized calibration, and fixed-difficulty assessment to measure attentional control. In a sample of 166 adults (ages 18-76), we evaluated the psychometric properties of the cpCST's instantaneous reaction time (iRT) metric derived through dynamic time warping. RESULTS/UNASSIGNED:The cpCST demonstrated exceptional reliability (bootstrap split-half r = 0.999) and predictive validity for cognitive performance (flanker and Woodcock-Johnson) and cardiorespiratory fitness (VO2submax). The task achieved high temporal efficiency, with just 2 min of data correlating at r = 0.94 with full-task performance, outperforming a standard arrow-based flanker task. The cpCST's individualized calibration effectively isolated attentional control processes from baseline sensorimotor function, eliminating age-related slowing effects typically observed in reaction time tasks. DISCUSSION/UNASSIGNED:This approach offers methodological advantages for lifespan studies, clinical populations, integration with neurophysiological measures, and computational modeling approaches while addressing limitations of existing attention assessment paradigms.

In youth, lithium is an effective medication for mood disorders, particularly for mixed and manic episodes of bipolar disorder, and is generally well-tolerated. In some clinical contexts, lithium is used off-label to manage other conditions. We conducted a scoping review of studies on the efficacy/effectiveness and safety/tolerability of lithium for treating youths with psychiatric conditions other than mood disorders or neurological disorders. We searched EMBASE, MEDLINE, PsycINFO, PubMed, and ClinicalTrials.gov up to March 31, 2025, with no restrictions on language or document type. We included studies of any design involving children and adolescents (mean age up to 18) treated with lithium, either as monotherapy or in combination with other psychotropic agents. We assessed study quality using the appropriate NHLBI tools and visually summarized the results with a heat map displaying sample size by study design and conditions, as well as the timeline of included studies' publication years. From 2687 records initially identified, after de-duplication removal and screening, 367 full-text reports were assessed, and 41 studies were included in the review, grouped by type of psychiatric or neurological disorder, most of which had a small sample. Among the assessed studies, 60 % of were considered of "fair" quality and 40 % of "poor" quality. Overall, although the clinical use of lithium beyond bipolar disorder in youth is increasing, the underlying evidence base remains limited. More rigorous research based on RCTs and observational studies with designs aimed at reducing confounding are needed to guide clinical practice.

Stimulants such as methylphenidate (MPH) are the first-line pharmacological treatment for attention-deficit/hyperactivity disorder (ADHD). Although stimulants are effective at a group level, individual response varies, which advocates for tailored treatment approaches. Prior studies suggested that neurobiological measures following a single dose of stimulants are indicative of longer-term clinical response. To expand these findings, we tested whether an association between acute and longer-term treatment response can also be identified using measures commonly used in clinic. Sixty adults with ADHD completed clinico-neuropsychological measures, including the Barkley Adult ADHD Rating Scale-IV (BAARS-IV) and the Quantitative behavior (Qb) test, following a single dose of MPH (20 mg) and placebo. These measures were repeated after two-month MPH treatment to ascertain response. We tested associations between single-dose and longer-term response using univariate and multivariable (Lasso) regression approaches. We also ran correlations between predicted and true outcome measures. Univariate regressions showed significant associations between single-dose and two-month improvement in BAARS hyperactivity/impulsivity and Qb scores (all p < 0.001 but Qb activity, p = 0.006). Multivariable models including acute response and baseline clinicodemographic measures yielded significant correlations between predicted and actual values for all BAARS-IV and Qb scores at follow-up, except for BAARS inattention and Qb activity. Most had large/very large effect size (up to r = 0.69). These findings suggest that specific clinico-neuropsychological changes following a single dose of MPH may be indicative of longer-term treatment response, especially when combined with pre-treatment clinico-demographic characteristics. Once validated in larger and more heterogeneous samples, these results may support more informed and individualized treatment approaches for ADHD.

OBJECTIVE:To better understand the value of DNR orders for critically ill infants in the NICU. METHODS:A prospective mixed-methods approach was utilized including chart review of infants who died in a regional NICU over a twenty-six-month period and surveys of their neonatologists, neonatal fellows, and nurses. RESULTS:40 infants died during the study period and 120 staff surveys were completed. Infants with DNR orders were of a higher gestational age at birth and a higher chronological age at death. Nurses were more likely to perceive benefit from DNR orders than physicians. Medical staff recollection of the existence of DNR orders was not always accurate. Time and fear of adding unnecessary emotional burden to parents were identified as barriers to DNR order implementation. An advanced care planning model built on open communication instead of DNR order documentation was deemed the best approach. CONCLUSION/CONCLUSIONS:Though DNR orders are beneficial for a subset of infants, DNR orders are likely not applicable for all infants who die in the NICU. More important is supportive, individualized communication between families and the medical team to ensure quality end-of-life care. IMPACT/CONCLUSIONS:In the adult and pediatric ICU literature, DNR orders are associated with improved qualitative "good death" assessments and decreased familial decision regret. In the NICU, rates of DNR usage aren't well reported and their overall utility is unclear. Though DNR orders can help guide clinical decision making in the NICU and may be associated with higher quality ethical discussion, our data suggest that they are not applicable in all patient cases. We hope that this work will help guide approaches to end-of-life care in the NICU and underscore the importance of frequent, open communication between families and their medical team.

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.

Attention-deficit/hyperactivity disorder (ADHD) was once thought to be solely a childhood condition. Now it is well established that it can persist into adulthood, with an estimated worldwide prevalence of around 2.5%. Additionally, up to 70% of individuals with childhood-onset ADHD continue to experience impairing symptoms as adults, even if they no longer meet the criteria for a formal diagnosis. The validity of adult ADHD initially faced strong criticism. Today, empirical research supports its descriptive validity (identifying characteristic signs and symptoms), predictive validity (concerning specific outcomes, courses, and responses to treatment), and concurrent validity (evidence related to its underlying causes and biological mechanisms). Despite this progress, unresolved questions and ongoing debates about adult ADHD persist. This paper summarizes current empirical evidence, alongside uncertainties and controversies, regarding the definition, epidemiology, diagnosis, etiology, neurobiology, and management of ADHD in adults. Crucially, we also include perspectives from individuals with lived experience of this condition, highlighting their views on unmet needs and priorities for improving care. Key uncertainties and controversies on adult ADHD include: a) the possibility of late-onset ADHD; b) the significance of emotional dysregulation as a core symptom; c) the definition and characterization of functional impairment; d) the persistence of comorbid psychiatric and somatic conditions after accounting for confounders; e) the relevance of executive dysfunction in the definition of the condition; f) the use of objective diagnostic measures; g) the long-term effects of treatments; and h) the role of non-pharmacological interventions. Further research on adult ADHD is urgently needed. Funding for studies on this condition lags behind that for childhood ADHD and other mental disorders in adulthood. Hopefully, efforts by clinicians, researchers and other stakeholders will ultimately help ensure that adults with ADHD are better understood, supported, and empowered to thrive.

IMPORTANCE/UNASSIGNED:The comparative effectiveness of 2 transitions of care programs for improving health status and reducing readmissions among patients hospitalized with heart failure is unknown. OBJECTIVE/UNASSIGNED:To compare the effectiveness adding mobile integrated health (MIH) to a transitions of care coordinator for improving health status and reducing 30-day all-cause readmissions among patients discharged after heart failure. DESIGN, SETTINGS, AND PARTICIPANTS/UNASSIGNED:The Mighty-Heart randomized clinical trial included Medicare- or Medicaid-enrolled adult (≥18 years) patients hospitalized with heart failure in 11 New York City (New York) hospitals between January 2021 and September 2024. Participants were randomized 1:1 to MIH or TOCC. TOCC provided a follow-up call by a nurse 48 to 72 hours after discharge. MIH included the same TOCC postdischarge call, and added ongoing nurse care coordination, community paramedic home visits, and facilitated synchronous telehealth with emergency medicine physicians. Data analysis occurred between September 2024 and June 2025. INTERVENTIONS/UNASSIGNED:Receiving MIH plus TOCC or TOCC alone during the first 30 days after hospital discharge. MAIN OUTCOMES AND MEASURES/UNASSIGNED:Coprimary outcomes were health status at 30 days measured with the Kansas City Cardiomyopathy Questionnaire Overall Summary score, and 30-day all-cause hospital readmission, with heart failure-specific readmissions as a secondary outcome. RESULTS/UNASSIGNED:Among 2003 participants (median [IQR] age, 67 [58-78] years; 1040 female [52%]), no adjusted differences were observed in the Kansas City Cardiomyopathy Questionnaire Overall Summary score at 30 days between MIH and TOCC groups (mean difference, 1.83; 95% CI, -0.75 to 4.40; P = .16). Exploratory analysis showed a significant age-by-treatment interaction effect, with younger participants who received MIH having larger improvement in health status (β: 4.40; 95% CI, 1.01 to 7.79). There were no significant differences in overall 30-day readmissions between study groups (20.3% vs 20.4%; odds ratio, 0.99; 95% CI, 0.83 to 1.19; P = .95). CONCLUSIONS AND RELEVANCE/UNASSIGNED:This randomized clinical trial found that MIH conferred no additional benefit on health status or 30-day readmissions for postacute patients with heart failure compared to TOCC alone. Preliminary subgroup analyses suggest potential variations in MIH effects by age and sex; therefore, further research is warranted. TRIAL REGISTRATION/UNASSIGNED:ClinicalTrials.gov Identifier: NCT04662541.

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.