Faculty Bibliography

Children's maladaptive cognitive attributions may elicit affective reactions that contribute to depressive and anxious symptoms. This study investigated cognitive-affective pathways in depressive and anxious symptoms in a sample of 110 prepubertal children, evaluating children's specific appraisals of experiences of parental discipline as well as general attributional style, along with their hopelessness, self-esteem, and shame. Pathways toward depressive and anxious symptoms were tested simultaneously to identify potential unique etiological mechanisms. Results suggested that lower self-esteem strongly contributed to depressive and anxious symptoms, whereas shame related to depression only and hopelessness related to depression only marginally. Additionally, general negative attributional style and low sense of control over discipline related to all three affective elements. Lastly, low sense of discipline control directly predicted depressive symptoms, whereas beliefs that discipline was undeserved directly predicted anxious symptoms. Future work should continue to examine the role of children's discipline-specific attributions, which appear important in internalizing symptoms.

Exposure to traumatic events early in life has been associated with significant adverse neurodevelopmental consequences.^1,2 Ideally, protecting children from trauma would prevent these consequences. Unfortunately, once a child is exposed to early trauma, the only means of prevention requires implementing effective interventions toward the mechanisms known to have caused the consequences. Therefore, it is imperative to carefully define the true mechanistic pathways from which the neurodevelopmental consequences of early trauma result. The process of determining the correct pathway(s) is not a trivial matter, as is made clear from a valiant effort reported in this issue of the Journal titled, "Early Sexual Trauma Exposure and Neural Response Inhibition in Adolescence and Young Adults: Trajectories of Frontal Theta Oscillations During a Go/No-Go Task."³ This editorial reviews the effort to infer causal mechanism in this article, and introduces a literature that can improve the field's capacity to infer causes from observational data.

OBJECTIVE:Network meta-analyses (NMAs) are gaining traction as the preferred method for evidence synthesis of intervention studies. This review aimed to summarize the basics of NMAs and conduct a meta-review of available NMAs on the treatment of child and adolescent psychiatric disorders by appraising their quality. METHOD/METHODS:PubMed (Medline), PsycInfo, Embase, Ovid Medline, and Web of Knowledge were systematically searched (last update January 9, 2018). The quality of each included NMA was appraised using the AMSTAR-2 tool and the PRISMA-NMA checklist, which includes specific items for NMAs. RESULTS:Eighteen NMAs (6 on attention-deficit/hyperactivity disorder; 4 on psychotic disorders; 2 on depression; 2 on anxiety disorders; 1 on obsessive-compulsive disorder; 1 on disruptive behavior disorder, 1 on bipolar disorder, and 1 on antipsychotics across disorders) were retrieved. Results from the AMSTAR-2 assessment showed that only 27% of appraised NMAs were rated as moderate quality; most were rated as low (33%) or critically low (40%) quality. Only 3 of the appraised NMAs reported on all PRISMA-NMA items specific for NMAs; the network structure was graphically presented in most NMAs (80%), and inconsistency was described in only 47%. CONCLUSION/CONCLUSIONS:Given the paucity of head-to-head trials in child and adolescent psychiatry, NMAs have the potential to contribute to the field, because they provide evidence-based hierarchies for treatment decision making, even in the absence of trials directly comparing at least 2 treatments. However, because of important limitations in the included NMAs, additional methodologically sound NMAs are needed to inform future guidelines and clinical practice in child and adolescent psychiatry.

Spatiotemporal shape models capture the dynamics of shape change over time and are an essential tool for monitoring and measuring anatomical growth or degeneration. In this paper we evaluate non-parametric shape regression on the challenging problem of modeling early childhood sub-cortical development starting from birth. Due to the flexibility of the model, it can be challenging to choose parameters which lead to a good model fit yet does not over fit. We systematically test a variety of parameter settings to evaluate model fit as well as the sensitivity of the method to specific parameters, and we explore the impact of missing data on model estimation.

Over the past two decades, research on pediatric bipolar disorder has grown geometrically. The diagnosis of pediatric bipolar disorder was met with enthusiasm, which in healthy doses catalyzed change, and skepticism, which in good measure pushes for rigor. Skepticism led to productive questions about the phenomenology of pediatric bipolar disorder and how best to diagnose and treat it. With regard to prevalence, key questions included whether it was increasing over time, and whether it was limited to the United States. In 2011, we published a meta-analysis addressing the prevalence questions; results indicated that bipolar disorder manifested at statistically indistinguishable rates in youth community samples across the world. In their recent paper, Parry et al. examine the studies included in the 2011 meta-analysis using a qualitative approach. Their opinion piece represents a step backwards; every study has shortcomings, but in focusing on a dozen individual studies, Parry et al. fail to take into account the preponderance of evidence - literally thousands of articles across countries, cohorts and methodologies - that support the existence of bipolar disorder in both prepubescent youth and adolescents. This commentary addresses misperceptions regarding the diagnosis of bipolar disorder in youth, particularly with regard to cross-informant agreement, to present converging data from international sources regarding the onset of bipolar disorder in childhood, and to correct the false claim that pediatric bipolar disorder is controversial. As clinicians and researchers, we have an obligation to do what we can to improve the lives of youth affected by mental illness. Denying the existence of a serious mood disorder will not serve the best interests of young people and will perpetuate the long delays many experience before getting an accurate diagnosis, appropriate treatment, and a fair chance at a good quality of life.

OBJECTIVE:This study describes the experiences of adult psychiatry residents working in an established faculty-led asylum clinic within a community-based, academic residency program at the Cambridge Health Alliance. METHODS:Eighteen psychiatry residents who participated in the asylum clinic were sent electronic surveys asking about their background and experience. Respondents' responses were collected anonymously. RESULTS:Sixteen out of 18 (89%) trainees responded. Thirteen respondents had a personal history with immigration. Fifty-three percent of residents wanted to utilize their professional standing to advance moral good. Writing up affidavits was noted to be challenging by nine (60%) of 15 trainees. Ninety-four percent (15/16) of trainees noted that they would be willing to perform future evaluations. Most noted that performing evaluations had a significant impact on their clinical practice and their conceptualization of their own roles as psychiatrists. CONCLUSIONS:Participating in asylum evaluations impacts residents' sense of themselves as psychiatrists and expands their views about psychiatrists' roles.

This study recruited a prospective cohort of 380 pregnant women before, during, or after Superstorm Sandy in 2012 to examine the association between disaster-related pre- and post-natal maternal stress and offspring temperament at 6 months-old. Mothers prospectively reported stressful experiences during the storm and rated their child's temperament 6 months postpartum. Results indicated that length of time without phone or electricity and financial loss was associated with offspring negative affect, whereas financial loss and threat of death or injury was associated with emotion dysregulation. Furthermore, offspring born before the storm had greater negative affect and lower emotion regulation than those born after the storm. Given the probable increase in the occurrence of natural disasters due to climate change in recent years (McCarthy, Intergovernmental Panel on Climate Change, Climate change 2001: impacts, adaptation, and vulnerability: contribution of Working Group II to the third assessment report of the Intergovernmental Panel on Climate Change, Cambridge University Press, Cambridge, 2001), our results highlight the necessity of education and planning to help ameliorate any potential consequences on the developing infant.

Purpose: Instagram has grown over the years to become one of the most popular social media platforms, and three quarters of teens who use social media use Instagram. In recent years, "Finstas", or "fake" Instagrams have grown in popularity among US teenagers. Finsta accounts are subsidiary Instagram accounts with highly selected audiences where owners can post material that is not associated with their main account. Public Twitter posts (tweets) can provide insight into communication about these clandestine accounts not available through Instagram due to the inherent private nature of these accounts. This exploratory study uses natural language processing (NLP) techniques on tweets about Finsta accounts to gain insight into this phenomenon. Method(s): An R-script was developed to pull data from the Twitter API to capture tweets longitudinally that were in English, from North America, and specifically mention some form of the stem and lemmatized word "Finsta." As there are no current studies on Finsta accounts, a comprehensive thematic analysis was then performed on the corpus of tweets to develop qualitative insights on this phenomenon. A quantitative process involved further cleaning and removing of stop-words to develop a Ngram frequency chart of the lemmatized words in the corpus of tweets to better understand the ways in which people were communicating about Finsta accounts. Result(s): 10,000 tweets containing the word "Finsta" were pulled from the Twitter API. After a comprehensive cleaning process, 5,159 tweets were then analyzed qualitatively to identify themes as a preliminary inquiry into this relatively new phenomenon. Themes identified within the corpus were: a desire for privacy compared to their main account, a place to share information that may be politically incorrect or would get users in trouble if shared on accounts with wider viewership, and a place to showcase real life. Ngram frequency words highlight similar words common to social media, "follow," "like," and "post" being amongst the most popular; however, within this corpus there are high frequencies of the words, "private," "sad," "nudes," "spam," "rant," "exposed," "emotional," and "outlet," tied to contextual themes indicating that Finstas may be an outlet for emotional catharsis in a "safe space." A Finsta user may have twenty followers (as opposed to 1000 on their main account) that include their closest friends. They may post blurry pictures without filters, with long captions detailing their negative emotional state. This sensitive content is posted with the underlying assumption that their friends will keep this information private. Conclusion(s): Preliminary analyses indicate that Finstas are a new way for teens to connect with peers in a controlled space online, where they can truly express themselves. Additionally, there is also a great deal of gossip, exhibitionism, risk-taking, and other attention-seeking behaviors typical of adolescence that manifest in ways not seen on users' primary accounts. Finsta accounts fulfill a vital role in the lives of adolescents looking for ways to authentically connect, share, and create community that is not offered through traditional uses of social media. Sources of Support: NYU CAMS Undergraduate Internship