Faculty Bibliography

Objectives: The presentation will provide practical applications of research studies that demonstrate the negative impact of social determinants of race, gender, and sexual orientation on patient health and treatment outcomes. The presentation will allow participants to examine the intersections of race, gender, and sexual orientation as essential elements to discuss openly with patients, as a method of strengthening the therapeutic alliance and acceptance of mental health treatment.
Method(s): The data will be presented on implicit bias and its effect on the patient-physician relationship and health care outcomes. The data also will be presented on the use of conversations with patients on race, gender, and sexuality in empowering both clinicians and their patients toward improved treatment outcomes.
Result(s): When conversations of politics, diversity, and inclusion are juxtaposed with issues of race, gender, and sexual orientation, the effects on health care and impact on treatment become highly complex. If these challenging and important conversations are left unexplored by clinicians, it can be detrimental to both patients and families.
Conclusion(s): Exploring topics of race and sexual/gender identity with patients is challenging and uncomfortable for many clinicians, but these conversations can yield surprising and often powerful clinical information that lends itself to improved outcomes and therapeutic alliance. This can occur through the explicit acknowledgment of stressors facing minority populations, as well as the identification of effective supports and coping strategies. ETHN, GID, LGBT
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Objectives: Digital innovation has the potential to transform both the science and practice of child mental health. Creation of pediatric digital health tools requires that bioethics, human-centered design, and clinical and scientific expertise are integrated with digital tool development, digital data collection, and data analytics. In this talk, we will describe the opportunities for innovations in pediatric digital mental health and the concurrent ethical and security risks. We will then present a framework and design methodology for creating ethical, human-centered, clinically informed, and evidence-based digital tools for children's mental health.
Method(s): The data presented will come from our experience founding and leading the New York University Langone Department of Child and Adolescent Psychiatry's WonderLab, which creates pediatric digital mental health tools that are evidence based, scalable, and ethical, as well as beautiful and fun so that parents and children would want to use them. The WonderLab brings clinical, scientific, digital engineering, digital design, data science, and bioethics expertise together with user engagement and a "build, measure, learn" agile development culture and methodology. We will use the WonderLab team's development and launch of our first app-based study, "When to Wonder: Picky Eating," to illustrate our framework and methodology.
Result(s): We will describe the innovation opportunities in pediatric digital mental health, including innovation in measurement, engagement, access, and collaborative methodologies. We will then present the ethical, privacy, security, and safety risks related to digital health applications and app-based data collection with children and their families. Finally, we will describe how the WonderLab team, methodology, and products innovate across multiple domains within an explicit ethical and clinically informed framework.
Conclusion(s): Digital innovation and data science have great potential to address the challenges facing our patients and our field. To build ethical and useful digital health tools for children's mental health requires multidisciplinary teams, user engagement, collaborative agile methodology, and a framework that ensures that innovations are integrated with and reflect our ethics and commitment to children. R, COMP, DAM
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Objectives: We will: 1) describe the WonderLab, a digital health initiative within the New York University Langone Health Department of Child and Adolescent Psychiatry; 2) introduce When to Wonder: Picky Eating, which is the WonderLab's first early childhood mental health digital study; and 3) present preliminary data from this study. Our first objective is to demonstrate how smartphone-based tools developed to assess children in their homes and the use of advanced data analytics can transform how, when, and where we assess young children's development and mental health. Our second objective is to share how our multidisciplinary team and agile development methodology enable us to build and launch a consumer-facing pediatric health app within an academic medical center.
Method(s): The WonderLab creates scalable mobile digital health tools to collect multimodal data in children's homes at the individual, family, and population levels. In December 2018, we released When to Wonder: Picky Eating, a national study with consent, enrollment, study activities, and feedback fully integrated in iOS and Android apps that parents download from the app stores. When to Wonder: Picky Eating focuses on the emotions and behaviors related to picky eating in children under the age of 7 years. Data sources include parent-report, video, audio, and an active task that children and parents play independently to quantify children's food preferences.
Result(s): We will present preliminary data from When to Wonder: Picky Eating to characterize normative and clinically significant emotions and behaviors related to picky eating. We will also share data on recruitment and engagement using social media, app performance, and "lessons learned" about digital pediatric health.
Conclusion(s): We create clinically and scientifically valid digital tools that parents and children want to use. We integrate clinical, scientific, engineering, design, data science, and bioethics expertise with collaborative user engagement and a "build, measure, learn" agile development culture. Our app-based study demonstrates how to build digital health tools that collect and analyze population-level and individual-level, multimodal data about children and families in the home. These new tools and approaches have the potential to transform our engagement with families and our delivery of care. EA, EC, MED
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Objectives: The risk for psychopathology increases with the number of adverse childhood experiences. Summing a number of experiences, however, assumes that all adversity equitably confers risk and operates through complementary mechanisms. To disentangle neurobiological pathways between disparate events and mental health, we examined how threat and deprivation-2 common dimensions of adversity-relate to early childhood psychopathology. Threat or the presence of experiences involving harm or threat of harm affects emotional control. Deprivation or absence of expected environmental inputs affects higher-order cognitive function. If threat and deprivation differentially affect brain development, then they may differentially relate to psychopathology, especially among young children.
Method(s): To examine these patterns, we used the Duke Preschool Anxiety Study, a cross-sectional study of youth ages 2-6 years enrolled through primary care from 2007 to 2011, weighted to reflect a screened population of 3433. Threat and deprivation were operationalized using questions from the Conflict Tactics Scale-2, Conflict Tactics Scale for Parent and Child, and Preschool Age Psychiatric Assessment. Threat measured physical or sexual abuse, domestic violence, and violent neighborhood. Deprivation measured neglect and lack of cognitive stimulation. Poisson regression with robust standard errors estimated adjusted prevalence ratios (PR) jointly for deprivation and threat in relation to counts for total symptoms and symptoms for specific disorders, such as anxiety, depression, and ADHD, in 760 children.
Result(s): Threat (47%) and deprivation (18%) were common; 36 percent of children had at least one disorder, and the total number of symptoms ranged from 0 to 46. Threat-exposed children had 40 percent more total symptoms (95% CI 1.2-1.6) than unexposed children after adjusting for deprivation and demographic covariates. Deprivation was not meaningfully associated with total symptom count (PR 1.1, 95% CI 0.9-1.5) after adjusting for threat and demographic covariates.
Conclusion(s): These disparate associations among threat, deprivation, and mental health symptomatology may reflect the young age of these children or our approach designed to distinguish the unique contributions of deprivation and threat, lending support to the dimensional model of adversity and psychopathology. CAN, PSP, PSC
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Objectives: This study investigated the following: 1) how maternal interpersonal violence (IPV)-PTSD and/or maternal exposure to violent events during childhood might affect children's capacities of emotion comprehension; and 2) how traumatized mothers perceive their own child's capacities for emotion comprehension.
Method(s): This longitudinal follow-up study of mothers and toddlers included 37 mothers exposed to IPV with PTSD and 26 mothers without PTSD. The study also included their school-age children (mean age = 7.1 years, SD = 1.2). Measures included the Test of Emotional Comprehension (TEC). The TEC investigates children's understanding of emotions ranging from basic comprehension (ie, external causes on emotions) to a deeper, more complex type of understanding (ie, mixed emotions, possibility of regulating emotions). Both children and mothers responded, with mothers asked to respond as they imagined their child would. Data analyses included Mann-Whitney U nonparametric group comparisons and logistic regression modeling.
Result(s): Mothers with IPV-PTSD compared with control subjects underestimated their children's capacities for emotional comprehension (U = 327.5, p < 0.05). When looking at specific maternal adverse childhood experiences (ACEs), physical abuse and exposure to family violence were associated with higher levels of maternal misattribution of child responses on the TEC after covarying for socioeconomic status and maternal depression (p < 0.01).
Conclusion(s): Mothers who have childhood exposure to physical abuse and family violence are more likely to make errors in emotional comprehension when asked to take their school-age child's perspective. Mothers suffering from related PTSD tend to underestimate their children's capacity for emotional comprehension. These findings will be contextualized in light of published findings from the toddler phase of this study and discussed in terms of their implications for intervention. AGG, PAT, CAN
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AIM/OBJECTIVE:To strengthen the theoretical understanding of illness acceptance in adolescents and to inform healthcare strategies geared toward supporting adolescents with chronic illness. BACKGROUND:Illness acceptance is associated with positive health outcomes. Though well understood in adults with chronic illness, less is known about how this phenomenon ensues in adolescents. Adolescents may have a difficult time accepting an illness due to their unique developmental needs. Consequently, they are vulnerable to poor health outcomes. DESIGN/METHODS:Concept analysis. DATA SOURCES/METHODS:A literature search through 2 databases (PubMed and PsycINFO) and a hand-search through Google were conducted to identify uses of the concept. REVIEW METHODS/METHODS:The Walker and Avant method of concept analysis. RESULTS:Four attributes of illness acceptance were identified: understanding of illness, overcoming limitations, normalization, and readiness for responsibility. Antecedents that predisposed illness acceptance included peer and family support, disease management education, and developmental readiness. Positive consequences of illness acceptance included high self-esteem, improved quality of life, resilience, identity formation, and better disease control. CONCLUSIONS:Establishing a standardized conceptual understanding of how illness acceptance ensues in adolescents can enable nurses and other health professionals to tailor developmentally appropriate care strategies and optimize the overall quality of life for this unique patient population.

Gender variance and dysphoria are present across all classes, ethnicities, and experiences, including among those with severe and chronic mental illness. In these, our most vulnerable populations, adequate assessment and treatment of gender dysphoria often is overlooked despite evidence that appropriate treatment of gender dysphoria leads to improvement in psychological functioning (Smith, van Goozen, Kuiper, & Cohen-Kettenis, 2005). The World Professional Association for Transgender Health recommend in their Standards of Care that somatic and surgical treatments for gender dysphoria should be made available to those with medical or mental illness with the caveat that "[the illness] must be reasonably well-controlled (2011)." In this article, we will utilize case-based material to elucidate the challenges of treating gender dysphoria in the context of complex mental illness such as bipolar disorder, schizophrenia, and sexual trauma, and the pitfalls of defining "well-controlled" for the sake of treatment.

Objectives: Toxic stress in young children, also known as adverse childhood experiences (ACEs), may lead to changes in their nervous system, affect their development, and influence their mental and physical health. Pediatricians and child and adolescent psychiatrists are uniquely positioned to help families in difficult situations to reduce the risk of recurring trauma. They are also in the best position to make accurate diagnoses and to design appropriate, multimodal treatment plans. This often can involve treatment of several family members, particularly because trauma is often transmitted intergenerationally and needs to be addressed accordingly. This Symposium will bring the audience up to date on work being conducted on ACEs in a number of areas. It will introduce participants to the latest research findings in the ACE literature on young children. It will focus on recent neurophysiological findings related to the transgenerational carryover of maternal ACEs. New information about the role of fathers in ACE research will be provided, and targeted interventions that may be used in primary care settings will be described.
Method(s): This Symposium will consist of 5 parts: 1) a presentation on ACEs and opportunities for intervention in Early Head Start (EHS) programs; 2) a review of transgenerational effects of maternal ACEs and their implications for future studies; 3) a review of the literature on the roles of fathers in ACE studies and paternal risk factors for child maltreatment; 4) a discussion of maternal ACEs, PTSD, and maternal attribution of child emotional comprehension; and 5) a brief summary discussion of the program as a whole followed by a question-and-answer session.
Result(s): Participants will learn that ACEs are associated with numerous chronic health problems in young children. They will be able to recognize that there are various screening methods that effectively assess for ACEs. At the end of the Symposium, participants will identify the importance of individual and systems-level approaches that can help promote resilience and counteract ACEs.
Conclusion(s): Screening and intervention for ACEs are feasible and should be part of most child and adolescent psychiatry and pediatrics' programs. This Symposium offers up-to-date information on the latest ACE-related research. STRESS, CAN, EC
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Fixation is essential for preserving cellular morphology in biomedical research. However, it may also affect spectra captured in multispectral fluorescence microscopy, impacting molecular interpretations. To investigate fixation effects on tissue, multispectral fluorescence microscopy images of pairs of samples with and without fixation are captured. Each pixel might exhibit overlapping spectra, creating a blind source separation problem approachable with linear unmixing. With multiple excitation wavelengths, unmixing is intuitively extended to tensor factorizations. Yet these approaches are limited by nonlinear effects like attenuation. Further, light exposure during image acquisition introduces subtle Brownian motion between image channels of non-fixed tissue. Finally, hypothesis testing for spectral differences due to fixation is nontrivial as retrieved spectra are paired sequential samples. To these ends, we present three contributions, (1) a novel robust non-negative tensor factorization using the β-divergence and L _2,1-norm, which decomposes the data into a low-rank multilinear and group-sparse non-multilinear tensor without making any explicit nonlinear modeling choices or assumptions on noise statistics; (2) a diffeomorphic atlas-based strategy for motion correction; (3) a non-parametric hypothesis testing framework for paired sequential data using functional principal component analysis.