Faculty Bibliography

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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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: 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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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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In the last 15 years, there has been a marked increase in the number of available stimulant formulations with the emphasis on long-acting formulations, and the introduction of several novel delivery systems such as orally dissolving tablets, chewable tablets, extended-release liquid formulations, transdermal patches, and novel "beaded" technology. All of these formulations involve changes to the pharmaceutical delivery systems of the two existing compounds most commonly employed to treat attention-deficit/hyperactivity disorder (ADHD), amphetamine (AMP) and methylphenidate (MPH). In addition to these new formulations, our knowledge about the individual differences in response has advanced and contributes to a more nuanced approach to treatment. The clinician can now make increasingly informed choices about these formulations and more effectively individualize treatment in a way that had not been possible before. In the absence of reliable biomarkers that can predict individualized response to ADHD treatment, clinical knowledge about differences in MPH and AMP pharmacodynamics, pharmacokinetics, and metabolism can be utilized to personalize treatment and optimize response. Different properties of these new formulations (delivery modality, onset of action, duration of response, safety, and tolerability) will most likely weigh heavily into the clinician's choice of formulation. To manage the broad range of options that are now available, clinicians should familiarize themselves in each of these categories for both stimulant compounds. This review is meant to serve as an update and a guide to newer stimulant formulations and includes a brief review of ADHD and stimulant properties.

This narrative review is aimed at presenting the most recent evidence on the association between attention-deficit/hyperactivity disorder (ADHD) and obesity. The review is informed by previous relevant systematic reviews and a search in Pubmed and PsycINFO up to 1 August 2019. Although the association between ADHD and obesity would seem, at first, paradoxical, in the past two decades there has been an increasing number of studies on this topic. The present review shows that there is meta-analytic evidence supporting a significant association between these two conditions, at least in adults. Growing evidence is also being published on the genetic and environmental factors underlying the association. However, the cause-effects paths, as well as the exact mechanisms explaining the association, remain unclear. Additionally, empirical evidence guiding the management/treatment of patients with the two conditions is still limited. Therefore, after almost 20 years from the first report of a link between ADHD and obesity, this association continues to be puzzling.

For individuals with gender dysphoria, gender-affirming surgeries (GAS) are one means of reducing the significant distress associated with primary and secondary sex characteristics misaligned with their gender identity. This article uses a systematic review to examine the existing literature on the psychological benefits of GAS. Findings from this review indicate that GAS can lead to multiple, significant improvements in psychological functioning. Methodological differences in the literature demonstrate the need for additional research to draw more definitive conclusions about the psychological benefits of GAS.

Stable representation of information in distributed neural connectivity is critical to function effectively in the world. Despite the dynamic nature of the brain's functional architecture, characterizing its temporal stability within a continuous state has been largely neglected. Here we characterized stability of functional architecture at a dynamic timescale (∼1 min) for each brain voxel by measuring the concordance of dynamic functional connectivity (DFC) over time, compared between association and unimodal regions, and established its reliability using test-retest resting-state fMRI data of adults from an open dataset. After the measure of functional stability was established, we further employed another fMRI open dataset which included movie-watching and resting-state data of children and adolescents, to explore how stability was modified by natural viewing from its intrinsic form, with specific focus on the associative and primary visual cortices. The results showed that high-order association regions, especially the default mode network, demonstrated high stability during resting-state scans, while primary sensory-motor cortices revealed relatively lower stability. During movie watching, stability in the primary visual cortex was decreased, which was associated with larger DFC variation with neighboring regions. By contrast, higher-order regions in the ventral and dorsal visual stream demonstrated increased stability. The distribution of functional stability and its modification describes a profile of the brain's stability property, which may be useful reference for examining distinct mental states and disorders.