Faculty Bibliography

BACKGROUND AND OBJECTIVE/OBJECTIVE:Randomised controlled trials (RCTs) have demonstrated that pharmacotherapy reduces symptoms of attention-deficit/hyperactivity disorder (ADHD) at a group level, but efficacy and tolerability vary across individuals. Clinico-demographic characteristics may act as predictors and/or moderators of treatment efficacy and tolerability, but systematic evidence remains limited. Therefore, we systematically analysed RCTs of ADHD medications to identify potential demographic and clinical predictors/moderators of efficacy and tolerability across the lifespan. METHODS:Randomised controlled trials were identified from the MED-ADHD database ( https://med-adhd.org/ ), a repository of RCTs of medications for ADHD in children, adolescents and adults. The database is based on systematic searches of multiple electronic sources, including PubMed, BIOSIS Previews, CINAHL, the Cochrane Central Registry of Controlled Trials and EMBASE, and is also complemented by unpublished data obtained from manufacturers and study authors. We used the most recent (2026) version of MED-ADHD. The risk of bias was assessed using the revised Cochrane risk-of-bias tool (RoB 2). RESULTS:Among the 171 RCTs screened, 62 assessed clinico-demographic factors as possible predictors or moderators of treatment efficacy and tolerability. Age was the most examined characteristic (56.4%) followed by, among the top five, psychiatric comorbidities (53.2%), sex (46.8%), baseline ADHD symptom severity (27.4%), and ADHD presentation (24.2%). Most RCTs reported no significant findings although there was preliminary evidence of associations with age (17.7%), psychiatric comorbidities (17.7%), baseline ADHD symptom severity (16.1%), sex (11.3%), and ADHD presentation (4.8%). Risk of bias was rated high in 37% of RCTs. CONCLUSIONS:Stringent sample selection and reliance on group-level analyses may limit the power to detect predictors and moderators of treatment efficacy and tolerability in classical RCTs. Consequently, the current evidence provides limited and inconsistent guidance on clinically meaningful predictors/moderators. However, variables such as age, psychiatric comorbidities, sex, baseline severity and ADHD presentation have been the most frequently examined with positive findings and may hold promise. Future research should prioritise individual participant data meta-analyses of RCTs, alongside well-powered analyses of a comprehensive observational dataset, to more robustly investigate these associations and support treatment stratification through predictive models.

OBJECTIVES/OBJECTIVE:To systematically evaluate the certainty of evidence for treatment strategies across age groups and mood phases in bipolar disorder, and develop an open access web platform to facilitate shared decision making. DESIGN/METHODS:Living umbrella review, evaluation, analysis, and communication hub (U-REACH) project. DATA SOURCES/METHODS:PubMed, PsycInfo, and Cochrane library databases, from inception to 19 November 2024. ELIGIBILITY CRITERIA FOR SELECTING STUDIES/METHODS:Systematic reviews with network or pairwise meta-analyses of randomised controlled trials of pharmacological, nutraceutical, psychosocial, brain stimulation, or circadian rhythm based treatments, administered as monotherapy (without concurrent interventions), augmentation treatment (interventions added to an ongoing treatment regimen), or combination treatment (simultaneous initiation of two different interventions), examining any age group, bipolar disorder phase (ie, acute bipolar depression, mania or mixed episodes, or maintenance), treatment, control, or outcome. RESULTS:77 studies met the inclusion criteria (21 network meta-analyses and 56 pairwise meta-analyses), including 116 unique pharmacological (n=74), brain stimulation (n=18), nutraceutical (n=13), psychosocial (n=8), and circadian rhythm based (n=3) treatments as monotherapy, augmentation, or combination therapy, along with five control interventions. These studies covered 133 unique outcomes (45 efficacy outcomes and 88 safety outcomes) resulting in 2510 meta-analyses with Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) ratings of the certainty of the evidence as high (n=236), moderate (n=827), low (n=986), and very low (n=461). A communication hub, the Evidence Based Interventions for Bipolar Disorder (EBI-BD) platform, was developed and the full results are freely available (https://ebibd-database.org), including the preference based tool (12 interventions and 17 safety outcomes). Interventions effective across outcomes varied by phases. For bipolar depression, effective interventions in adults were cariprazine, divalproex or valproate, fluoxetine, ketamine (augmentation), lamotrigine, lumateperone, lurasidone, olanzapine, olanzapine with fluoxetine, and quetiapine, whereas effective interventions in children and adolescents were lurasidone and olanzapine with fluoxetine. For mania episodes, effective interventions in adults were aripiprazole, asenapine, carbamazepine, cariprazine, divalproex or valproate, haloperidol, lithium, olanzapine, paliperidone, quetiapine (also augmentation), risperidone (also as augmentation), tamoxifen, and ziprasidone, whereas effective interventions in children and adolescents were aripiprazole, asenapine, olanzapine, quetiapine, and risperidone. For maintenance, interventions effective across outcomes in adults were aripiprazole (also the long acting injectable formulation), asenapine, divalproex or valproate, lithium, olanzapine, group psychoeducation (augmentation), quetiapine, and risperidone long acting injectable formulation. Interventions effective across phases were aripiprazole (also as augmentation and as a long acting injectable formulation), asenapine, cariprazine, cognitive behavioural therapy (augmentation), divalproex or valproate, lamotrigine, lithium, olanzapine (also as augmentation), paliperidone, quetiapine (also as augmentation), and risperidone (also as augmentation and the long acting injectable formulation) (adults). Treatment effects by neuroscience based nomenclature classes are also reported. CONCLUSIONS:The EBI-BD tool can help clinicians make evidence based, personalised treatment decisions for bipolar disorder. This resource can inform clinical guidelines and provides a foundation for continuously improving bipolar disorder care as new evidence emerges. TRIAL REGISTRATION/BACKGROUND:Open Science Framework https://osf.io/pjmvn/ READERS' NOTE: This is a living systematic review and may be updated in the next two years if additional evidence emerges.

BACKGROUND:Parents in the United Kingdom seeking an assessment for attention-deficit/hyperactivity disorder (ADHD) for their child experience a significant wait before receiving an appointment with Child and Adolescent Mental Health Services (CAMHS), yet little has been written on how parents experience this period. Through qualitative interviews, we sought to understand how the period of waiting from being accepted onto a service waitlist and receiving a diagnostic assessment impacts parents and their children. METHOD:The study was nested within a large randomised controlled trial. We conducted semi-structured interviews with 41 parents of children aged 5-11 years. 30% of parents had waited between 18 and 24 months on a CAMHS waitlist, with 10% waiting more than 2 years. Reflexive thematic analysis was used to analyse data. RESULTS:At the point of the interview, around 50% of children were still waiting for an initial assessment. Six themes reflecting parents' uncertainty around the assessment process, lack of communication from services, the importance of receiving a diagnosis, difficulty accessing support and the negative impact of waiting on mental health and education, as well as recommendations to improve communication between services and families, emerged. CONCLUSION:Parents recognised the pressures on services to offer timely support; however, their well-being could be substantially improved by more clarity around wait times, as well as more effective signposting and support from services concerning the assessment process. This may help alleviate some of the stressors associated with their child's assessment journey, such as feeling responsible for their child's difficulties and the burden of supporting their educational needs. PATIENT AND PUBLIC CONTRIBUTION:This study was nested within the OPTIMA trial, where PPI panel members provided ongoing support in various aspects of the study, including advising on participant communication, study design and data analysis. All PPI members have lived experience of having a neurodivergent child. For this study, the PPI co-produced the interview schedule and took part in transcript analysis using a thematic framework approach. To acknowledge their contributions, members of the PPI panel are included as co-authors.

Large language models (LLMs) have shown increasing promise in the mental health field. LLMs are especially well suited to play a role in the labor-intensive, costly process of clinical assessment, as they can interact with a patient or participant directly to conduct a mental health assessment. We conducted a preregistered scoping review to (a) describe the unique capabilities of LLMs for clinical assessment, (b) determine the current state of the field in applying LLMs to directly assess patient/participant mental health (including screening, diagnosis, and monitoring of symptoms), and (c) highlight future research to facilitate the application of LLMs. We included work published in both Chinese and English. Only 10 studies met criteria for direct LLM-based mental health assessment. The evidence base was recent and heterogeneous: Four studies focused primarily on diagnostic interviewing or classification, five on symptom or severity assessment, and one on task-based multimodal depression assessment. Studies varied across text, voice, and multimodal formats, and depression was the dominant target. Across studies, stronger performance tended to be reported in tools that used structured interviewing logic, domain-specific adaptation, and clinically anchored reference standards. However, the evidence base remains small, with many studies employing limited validation procedures, and heavily weighted toward early-stage or nonjournal publications. The limited pace of academic validation means that, at present, LLMs are best understood as emerging assessment-support tools rather than replacements for clinical evaluation. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

BACKGROUND/UNASSIGNED:Fetal cardiomyopathy is a rare condition, often with an unknown cause and associated with high perinatal mortality. Recent years have seen improvement in fetal cardiac screening, genetic testing, and management. We sought to investigate genetic associations and clinical outcomes of fetal cardiomyopathy in the contemporary era. METHODS/UNASSIGNED:A single-arm (descriptive) retrospective cohort study of fetal cardiomyopathy cases diagnosed from January 2017 to December 2021 at 26 North American centers in the Fetal Heart Society Research Collaborative was undertaken. Cases attributable to maternal diabetes, extra-cardiac conditions, structural heart disease, or arrhythmias were excluded. Genetic testing results, extra-cardiac structural anomalies, and outcomes were collected. Logistic regression was performed to determine prenatal risk factors for death or cardiac transplantation by 1-year of age. Descriptive competing-risk analyses (cumulative incidence functions) and Kaplan-Meier survival estimates were used to describe outcomes. Multivariable logistic regression with 5 prespecified covariates was performed to identify prenatal factors associated with death or cardiac transplantation by 1-year of age. RESULTS/UNASSIGNED:≤0.001) were significantly associated with death or transplant by 1-year of age. CONCLUSIONS/UNASSIGNED:Fetal cardiomyopathy outcomes have improved in the current era, although only half achieve 1-year cardiac transplant-free survival. Genetic testing identifies a cause in one-third of cases. Hydrops at the time of fetal cardiomyopathy diagnosis and a prenatal diagnosis of extra-cardiac structural anomalies remain important risk factors for mortality.

IMPORTANCE/UNASSIGNED:Public concern and speculation have emerged around a possible link between neonatal male circumcision (NMC) and autism spectrum disorder (ASD). Evidence is limited and inconsistent. OBJECTIVE/UNASSIGNED:To examine associations between NMC and child ASD and autism-related traits and behaviors. DESIGN, SETTING, AND PARTICIPANTS/UNASSIGNED:This prospective cohort study was conducted among cohort sites participating in the Environmental Influences on Child Health Outcomes (ECHO) Cohort between February 2003 and September 2025. Statistical analyses were conducted from November 2025 to February 2026. The analysis included male, singleton children with data on NMC status and child ASD. EXPOSURE/UNASSIGNED:NMC status within 28 days of birth at a medical facility. MAIN OUTCOMES AND MEASURES/UNASSIGNED:ASD diagnosis was based on parent report of diagnosis by a medical professional or documentation of criterion standard clinical assessments. Social Responsiveness Scale (SRS-2) T-scores assessed the presence and distribution of autism traits, and Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) Autism Spectrum Problems subscale T-scores from the Child Behavior Checklist (CBCL) 1.5/5 assessed the occurrence of child autism-related behaviors. RESULTS/UNASSIGNED:The sample included 2771 male children from 14 ECHO sites, of whom 1840 (66%) were circumcised before hospital discharge, and 192 (7%) had an autism diagnosis. Among 1840 circumcised males, 108 (6%) had autism, compared with 84 of 931 uncircumcised males (9%). Mean (SD) age at autism diagnosis was 3.8 (2.2) years. Among circumcised males, 31 (4%) were administered acetaminophen during the procedure, and 128 (7%) within the 30 days after birth. After adjusting for confounders, there was no association between NMC and ASD diagnosis (odds ratio [OR], 0.83; 95% CI, 0.59-1.17). After stratification by region, preterm birth, and neonatal intensive care unit admission, an inverse or no association was observed between NMC and ASD diagnosis. Adjusted analyses showed no associations between NMC and SRS-2 continuous (β = -0.62; 95% CI, -1.46 to 0.22) or binary (OR, 0.75; 95% CI, 0.48-1.15) T-scores. Similarly, no associations were observed between NMC and CBCL 1.5/5 continuous (β = 0.01; 95% CI, -0.54 to 0.56) or binary (OR, 1.30; 95% CI, 0.75-2.26) T-scores. Overall, inverse or no associations were observed across all strata for SRS-2 and CBCL 1.5/5 outcomes. CONCLUSIONS AND RELEVANCE/UNASSIGNED:This cohort study yielded no evidence that NMC was associated with ASD risk, whether assessed by parent report of medical professional diagnosis or validated instruments measuring autism-related traits and behavior. These findings may provide reassurance for families who are considering or have elected NMC for their child.

Childhood mental health, emotional, and behavioral problems are common and have reached crisis proportions, yet they often go undetected and untreated despite being responsible for significant morbidity and mortality. Approximately 16% of children under 6 years of age have clinically significant mental health difficulties, which require attention in early life¹ Early intervention in infant mental health can have a profound impact on a child's future development and well-being. While pediatric primary care is an ideal setting for early detection of mental, emotional, and behavioral symptoms and social determinants of health, until recently, mental health training for pediatric residents was limited to elective experiences that were not standardized nor mandatory. With the recent ACGME addition of a required mental health rotation in pediatric residency curricula, our service assembled a panel of experts in infant mental health to identify the most important curricular elements to include as part of the Pediatrics Mental Health rotation in our safety net hospital. In the Pediatric Mental Health rotation at our institution, one of the four pediatric mental health rotation weeks was dedicated to Infant/Preschool Mental Health (0-6 years old). This manuscript provides background information and resources that can be used by pediatricians, and which can assist in the process of designing curricula for pediatric residents.

INTRODUCTION/UNASSIGNED:Young Black children experience poorer sleep health than children from other racial/ethnic groups. Tailored family-centered interventions are needed to improve sleep health among young Black children. Tailoring requires information about parent perceptions, practices and context. The purpose of this study was to (1) understand the contextual definition of sleep health for Black families; (2) bedtime routines and sleep practices among Black families; and (3) parent preferences that may inform intervention design. METHODS/UNASSIGNED:We engaged 30 Black parents of 3-8-year-old children with mild sleep problems (e.g., child takes >30 min to fall asleep at bedtime) in this study. Parents completed three ratings scales about sleep health practices and child bedtime behavior and a semi-structured interview. Statistical analysis included descriptive statistics and correlations. We used an implementation science rapid qualitative analysis approach to analyze qualitative data from the interviews. RESULTS/UNASSIGNED:The final sample identified as 52% African-American, 14% Jamaican, 10% Haitian, and 26% mixed multi-ethnic groups. Parent mean age was 41 years and child mean age were 5 years old. About 80% of responders were women. About one-third of the sample held a doctoral degree, and half the sample had a bachelor's or Master's degree. Parents answered 56% of sleep knowledge questions accurately (ranging from 32 to 100%) and reported an average of two sleep problems. Parents described healthy sleep as involving flexibility in sleep timing and bedtime routines. More than half of parents reported co-sleeping practices, with reasons ranging from a strategy to address night wakings, to a way to preserve bonding. Later child bedtime (after 9 pm) was associated with bedtime resistance, permissive parenting, and parent stress. Many parents reported that they had poor sleep quality and duration. DISCUSSION/UNASSIGNED:Findings elucidate a range of factors to consider in tailoring sleep health interventions for Black families of young children. These include the common practice of co-sleeping, parents' value for flexibility related to bedtime and bedtime routines, and parents' own challenges with getting enough and good quality sleep. Tailored family-centered interventions will benefit from considering these factors.

Trajectories of age-related neurocognitive decline are nonuniform, and are impacted by numerous environmental and physiological factors. Earlier life phases set the stage for later life neurocognitive function, with midlife marking a critical transition characterized by increasing variability in cognitive, affective, and physiological functioning. Despite its importance, this turbulent period remains underrepresented in open neuroimaging data resources. To address this gap, the Nathan Kline Institute - Rockland Sample (NKI-RS) created 'Mapping Interindividual Variation in the Aging Connectome' (MIVAC), an openly shared, multimodal dataset designed to map brain aging trajectories beginning in midlife and assess the influence of key modifiable factors linked to dementia prevention such as cardiorespiratory fitness, sleep, and mood. This longitudinal investigation includes 348 community-ascertained participants aged 38 to 71 years at baseline, with 219 participants completing 3 annual timepoints. Data collection incorporated deep phenotyping, including detailed assessment of cognitive, behavioral, medical, and cardiorespiratory fitness domains, to compliment multimodal neuroimaging (resting-state fMRI, diffusion MRI, morphometric MRI, and arterial spin labeling) and biospecimen collection. The protocol harmonizes with prior NKI-RS sub studies, enabling lifespan cross-sectional or longitudinal questions, while incorporating age-specific considerations for cognitive and neural aging. The full dataset is openly available.