Faculty Bibliography

Early behaviors that differentiate later biomarkers for psychopathology can guide preventive efforts while also facilitating pathophysiological research. We tested whether error-related negativity (ERN) moderates the link between early behavior and later psychopathology in two early childhood phenotypes: behavioral inhibition and irritability. From ages 2 to 7 years, children (n = 291) were assessed longitudinally for behavioral inhibition (BI) and irritability. Behavioral inhibition was assessed via maternal report and behavioral responses to novelty. Childhood irritability was assessed using the Child Behavior Checklist. At age 12, an electroencephalogram (EEG) was recorded while children performed a flanker task to measure ERN, a neural indicator of error monitoring. Clinical assessments of anxiety and irritability were conducted using questionnaires (i.e., Screen for Child Anxiety Related Disorders and Affective Reactivity Index) and clinical interviews. Error monitoring interacted with early BI and early irritability to predict later psychopathology. Among children with high BI, an enhanced ERN predicted greater social anxiety at age 12. In contrast, children with high childhood irritability and blunted ERN predicted greater irritability at age 12. This converges with previous work and provides novel insight into the specificity of pathways associated with psychopathology.

OBJECTIVE:To estimate long-term stimulant treatment associations on standardized height, weight and BMI trajectories from childhood to adulthood in the Multimodal Treatment Study of Attention-Deficit/Hyperactivity Disorder (MTA). METHOD/METHODS:Of 579 children with DSM-IV ADHD-Combined Type at baseline (ages 7.0-9.9 years) and 289 classmates (local normative comparison group, LNCG), 568 and 258 respectively, were assessed 8 times over 16 years (final mean age = 24.7). Parent interview data established subgroups with self-selected Consistent (N=53, 9%), Inconsistent (N=374, 66%), and Negligible (N=141, 25%) stimulant medication use, as well as cases starting stimulants prior to MTA entry (N=211, 39%). Height and weight growth trajectories were calculated for each subgroup. RESULTS:Height z-scores trajectories differed among subgroups (F=2.22, P<0.0001) and by stimulant use prior to study entry (F=2.22, P<0.001). The subgroup x assessment interaction was significant (F=2.81, P<0.0001). Paired comparisons revealed significant subgroup differences at end-point: Consistent shorter than Negligible (-0.66 z-units / -4.06 cm /1.6 inches, t=-3.17, P<0.0016), Consistent shorter than Inconsistent (-0.45 z-units / -2.74 cm / -1.08 inches, t=-2.39, P<0.0172), and the Consistent shorter than LNCG (-0.54 z-units/+3.34 cm/ 1.31 inches, t=-3.30, P<0.001). Weight z-scores initially diverged among subgroups, converged in adolescence, and then diverged again in adulthood when the Consistent outweighed the LNCG (+ 3.561 z-units / +7.47 kg / +16.46 pounds, P<0.0001). CONCLUSION/CONCLUSIONS:Compared with those negligibly medicated and the LNCG, 16 years of consistent stimulant treatment of children with ADHD in the MTA was associated with changes in height trajectory, a reduction of adult height, and an increase in weight and BMI.

This article describes the application of the Collective Impact Model as an innovative conceptual framework for developing a pedagogical process for advancing academic success and retention for underrepresented nursing students. A more diverse nursing workforce is critical to promoting health equity and supporting a culture of health by providing access to culturally and linguistically appropriate care. By strategically applying this framework to a complex issue in nursing education, we discuss a process that may lead to increased academic success and NCLEX®RN pass rates for underrepresented students.

Background:In recent years, there has been an increasing burden of child and adolescent mental illness recognized in the United States, and the need for pediatric mental health care is growing. Pediatric consultation-liaison (C-L) psychiatrists are increasingly playing a role in the management of medical and psychiatric disease for pediatric patients. The field is a fast-moving one, with understanding of new neuropsychiatric disease entities; reformulation of prior disease entities; and new interdisciplinary treatments and models of care. Methods:In this study, we aim to review recent advances in the field of pediatric C-L psychiatry, including new diagnostic entities, updated management of frequently encountered clinical presentations, and developments in systems of care. Conclusion:The advances in pediatric C-L psychiatry are broad and serve to promote more streamlined, evidence-based care for the vulnerable population of psychiatrically ill pediatric medical patients. More work remains to determine the most effective interventions for the wide array of presentations seen by pediatric C-L psychiatrists.

OBJECTIVE:Precise phenotypic characterization of prenatal tobacco exposure (PTE)-related disruptive behavior (DB) that integrates nuanced measures of both exposures and outcomes is optimal for elucidating underlying mechanisms. Using this approach, our goals were to identify dimensions of DB most sensitive to PTE prior to school entry and assess contextual variation in these dimensions. METHODS:A community obstetric sample of N = 369 women (79.2% lifetime smokers; 70.2% pregnancy smokers) from two Midwestern cities were assessed for PTE using cotinine-calibrated interview-based reports at 16, 28, and 40 weeks of gestation. A subset of n = 244 who completed observational assessments with their 5-year-old children in a subsequent preschool follow-up study constitute the analytic sample. Using two developmentally-meaningful dimensions previously associated with emergent clinical risk for DB-irritability and noncompliance-we assessed children with 2 parent-report scales: the Multidimensional Assessment Profile of Disruptive Behavior (MAP-DB) and the Early Childhood Inventory (ECI). We also assessed children by direct observation across 3 interactional contexts with the Disruptive Behavior Diagnostic Observation Schedule (DB-DOS). We used generalized linear models to examine between-child variability across behavioral dimensions, and mixed effects models to examine directly observed within-child variability by interactional context. RESULTS:Increasing PTE predicted increasing impairment in preschoolers' modulation of negative affect (irritability), but not negative behavior (noncompliance) across reported (MAP-DB) and observed (DB-DOS) dimensional measures. Moreover, children's PTE-related irritability was more pronounced when observed with parents than with the examiner. The ECI did not detect PTE-related irritability nor noncompliance. CONCLUSIONS:Nuanced, dimension- and context-specific characterization of PTE-related DB described can optimize early identification of at-risk children.