Faculty Bibliography

The higher-order theory (HOT) of consciousness has often been misunderstood by critics. Here, we clarify its position on several issues, and distinguish it from other views, such as the global workspace theory (GWT) and early sensory models (e.g., first-order local recurrency theories). For example, HOT has been criticized for overintellectualizing consciousness. We show that, while higher-order states are cognitively assembled, the requirements are in fact considerably less than often presumed. In this sense, HOT may be viewed as an intermediate position between GWT and early sensory views. We also clarify that most proponents of HOT do not stipulate consciousness as equivalent to metacognition or confidence. Furthermore, compared with other existing theories, HOT can arguably account better for complex everyday experiences, such as emotions and episodic memories. This makes HOT particularly useful as a framework for conceptualizing pathological mental states.

The ability to recognize and identify a smell is highly dependent on multisensory context and expectation, for example, hearing the name of the odor source. Here, we develop a novel auditory-odor association task in rats, wherein the animal learn that a specific auditory tone, when associated with a specific odor, predicts reward (Go signal), whereas the same tone associated with a different odor, or vice versa, is not (No-Go signal). The tone occurs prior to the onset of the odor, allowing physiological analyses of sensory-evoked local field potential activity to each stimulus in primary auditory cortex and anterior piriform cortex. In trained animals that have acquired the task, both auditory and subsequent olfactory cues activate beta band oscillations in both the auditory and piriform cortices, suggesting multisensory integration. Naïve animals show no such multisensory responses, suggesting the response is learned. In addition to the learned multisensory evoked responses, functional connectivity between auditory and piriform cortex, as assessed with spectral coherence and phase lag index, is enhanced. Importantly, both the multi-sensory evoked responses and the functional connectivity are context-dependent. In trained animals, the same auditory stimuli presented in the home cage evoke no responses in auditory or piriform cortex, and functional connectivity between the sensory cortices is reduced. Together, the results demonstrate how learning and context shape the expression of multisensory cortical processing. Given that odor identification impairment is associated with preclinical dementia in humans, the mechanisms suggested here may help develop experimental models to assess effects of neuropathology on behavior.Significance statement An important feature in mammalian olfaction is the multisensory support provided by "higher" senses, such as hearing and vision. In humans, such multisensory context and expectation, for example hearing the name of the odor source, facilitates the identification of a smell. An impaired ability to identify odors is a sensitive predictor of cognitive decline and neurodegenerative dementia. We found that rats trained on a tone-odor association task, but not untrained rats, showed elevated electrophysiological responses in both auditory and olfactory cortices, as well as increased functional connectivity between these regions, during task engagement. These results provide evidence of a multisensory integration process that might provide clues to how neuropathology affects the brain.

The majority of youth in the juvenile justice system have experienced multiple traumatic events in their lives, including community violence, physical abuse, neglect, and traumatic loss. These high prevalence rates, coupled with the known negative consequences of trauma in childhood and adolescence, have led to a greater emphasis on implementing trauma-informed services and practices within juvenile justice settings. However, although many stakeholders and government entities have expressed support for creating more trauma-informed juvenile justice systems, there is still limited empirical knowledge about which interventions are most effective at improving outcomes, particularly at the organizational or facility level. In an effort to fill this gap, the current study evaluated the impact of a trauma-informed milieu intervention, including skills training for youth and training for staff, on rates of violence at two secure juvenile detention facilities (N = 14,856) located in a large Northeastern city. The analyses revealed that the intervention was significantly related to a reduction of violent incidents in Facility A, with no impact on incidents in Facility B. Follow-up analyses revealed that a larger proportion of eligible youth in Facility A completed the skills group program as compared with eligible youth in Facility B (16% vs. 9%). This finding has important implications for the implementation of trauma-informed interventions for youth in juvenile detention settings, as it suggests that to impact outcomes at the facility level, a minimum threshold of youth may need to be exposed to the intervention. In addition, reductions in violence at Facility A were only realized after both staff training and youth skills components were implemented, suggesting that both components are necessary to create change at the facility level. Future research is needed to further explore the impact of organizational and implementation-level factors on trauma-informed care outcomes in juvenile justice settings.

We examined the stability of and cross-influences between externalizing behaviors and intervention engagement among children participating in a randomized clinical trial of an intervention for disruptive behavioral youth. Analyses also accounted for the influence of caregiver depression, family relationship quality, and sociodemographic factors (race, income) on the relationship between behaviors and intervention engagement. Analyses were based on 118 children participating in the Coping Power intervention. Composite variables were created to represent externalizing behaviors and intervention engagement constructs. Associations between these composite variables were examined over 24 treatment sessions. Findings indicated a regressive relationship among externalizing behaviors, i.e., baseline externalizing behaviors were positively associated with immediate follow-up behaviors. There were also dynamic relationships observed among engagement constructs. Notably, engagement with in-session activities during sessions 1-8 was positively associated with out-of-session activity engagement during the same treatment time period. Engagement with out-of-session activities during sessions 1-8 was positively associated with in-session activity engagement during sessions 9-16, indicating a complete mediation between early and middle in-session engagement through the mechanism of early out-of-session engagement. A crosslag relationship was observed: middle in-session engagement was negatively associated with externalizing behaviors at immediate follow-up. Finally, an interaction of race by income on immediate follow-up externalizing behaviors was observed, such that Black children's externalizing behaviors remain static regardless of income level while White children's behaviors decreased with higher income. Our findings support the contention that focusing on intervention engagement may be especially important in prevention interventions.

Objective: The aim of this study is to validate the Adult ADHD Self-Report Scale (ASRS) and Adult ADHD Investigator Symptom Rating Scale (AISRS) expanded versions, including executive function deficits (EFDs) and emotional dyscontrol (EC) items, and to present ASRS and AISRS pilot normative data. Method: Two patient samples (referred and primary care physician [PCP] controls) were pooled together for these analyses. Results: Final analysis included 297 respondents, 171 with adult ADHD. Cronbach's alphas were high for all sections of the scales. Examining histograms of ASRS 31-item and AISRS 18-item total scores for ADHD controls, 95% cutoff scores were 70 and 23, respectively; histograms for pilot normative sample suggest cutoffs of 82 and 26, respectively. Conclusion: (a) ASRS- and AISRS-expanded versions have high validity in assessment of core 18 adult ADHD Diagnostic and Statistical Manual of Mental Disorders (DSM) symptoms and EFD and EC symptoms. (b) ASRS (31-item) scores 70 to 82 and AISRS (18-item) scores from 23 to 26 suggest a high likelihood of adult ADHD.

Children with the autosomal dominant single gene disorder, neurofibromatosis type 1 (NF1), display multiple structural and functional changes in the central nervous system, resulting in neuropsychological cognitive abnormalities. Here we assessed the pathological functional organization that may underlie the behavioral impairments in NF1 using resting-state functional connectivity MRI. Coherent spontaneous fluctuations in the fMRI signal across the entire brain were used to interrogate the pattern of functional organization of corticocortical and corticostriatal networks in both NF1 pediatric patients and mice with a heterozygous mutation in the Nf1 gene (Nf1^+/-). Children with NF1 demonstrated abnormal organization of cortical association networks and altered posterior-anterior functional connectivity in the default network. Examining the contribution of the striatum revealed that corticostriatal functional connectivity was altered. NF1 children demonstrated reduced functional connectivity between striatum and the frontoparietal network and increased striatal functional connectivity with the limbic network. Awake passive mouse functional connectivity MRI in Nf1^+/- mice similarly revealed reduced posterior-anterior connectivity along the cingulate cortex as well as disrupted corticostriatal connectivity. The striatum of Nf1^+/- mice showed increased functional connectivity to somatomotor and frontal cortices and decreased functional connectivity to the auditory cortex. Collectively, these results demonstrate similar alterations across species, suggesting that NF1 pathogenesis is linked to striatal dysfunction and disrupted corticocortical connectivity in the default network.

Objective: Quality measures (QMs; also known as Quality Indicators) quantify health care processes, outcomes, patient perceptions, and organizational structure and/or systems that are relevant to the provision of high-quality health care. We describe the first phase of a project that has as its ultimate goal the creation and validation of QMs for tracking the screening, diagnosis, treatment, and clinical follow-up of adults with ADHD. This will fill an important gap in the field of Adult ADHD because QMs for adult ADHD do not exist. Method: We followed the guidelines of the U.S. Agency for Healthcare Research and Quality (AHRQ) for the development of QMs. These guidelines call for two phases: (1) Identify Candidate QMs and (2) Assess Candidate QMs. This article describes the results of our Phase 1 activities. To generate QMs for adult ADHD, we took the following steps: (a) searched the clinical/research literature for adult ADHD QMs; (b) convened a multidisciplinary panel comprising clinical and research experts and had them brainstorm potential QMs in the areas of screening, diagnosis, treatment, follow-up, care coordination, and patient experience; (c) compared these QMs with existing guidelines for adult ADHD to see if any potential QMs had been missed, this led to a draft list of 46 QMs; (d) had 28 ADHD experts rate the importance, reliability, validity, feasibility, and usability of the QMs. Results: The literature review found several QMs for ADHD in youth but none for ADHD in adults. The brainstorming session generated 52 QMs. The survey showed that all of these QMs were highly rated but that there was sufficient variability in ratings to prioritize some QMs over others. Conclusion: Based on these results, we prioritized QMs to carry forward into the next phase of the project. This work fills an important gap for the clinical care of adult patients with ADHD and helps to set a precedent for mental health, which has lagged behind other areas of medicine in developing QMs.