Faculty Bibliography

OBJECTIVE:/UNASSIGNED:The authors examined the impact of a Web-based shared decision-making application, MyCHOIS-CommonGround, on ongoing outpatient mental health treatment engagement (all users) and antipsychotic medication adherence (users with schizophrenia). METHODS:/UNASSIGNED:An intervention study was conducted by comparing Medicaid-enrolled MyCHOIS-CommonGround users in 12 participating mental health clinics (N=472) with propensity score-matched adults receiving services in nonparticipating clinics (N=944). Medicaid claims were used to assess ongoing treatment engagement and antipsychotic adherence (among individuals with schizophrenia) one year prior to and after entry into the cohort. Multilevel linear models were conducted to estimate the effects of the MyCHOIS-CommonGround program over time. RESULTS:/UNASSIGNED:No differences during the baseline year were found between the MyCHOIS-CommonGround group and the matched control group on demographic, diagnostic, or service use characteristics. At one-year follow-up, engagement in outpatient mental health services was significantly higher for MyCHOIS-CommonGround users than for the control group (months with a service, 8.54±.22 versus 6.95±.15; β=1.40, p<.001). Among individuals with schizophrenia, antipsychotic medication adherence was also higher during the follow-up year among MyCHOIS-CommonGround users compared with the control group (proportion of days covered by medication, .78±.04 versus .69±.03; β=.06, p<.01). CONCLUSIONS:/UNASSIGNED:These findings provide new evidence that shared decision-making tools may promote ongoing mental health treatment engagement for individuals with serious mental illness and improved antipsychotic medication adherence for those with schizophrenia.

Post-traumatic stress disorder (PTSD) is an important and often neglected comorbidity of pregnancy; left untreated, it can lead to serious health complications for the mother and developing fetus. Structured interviews were conducted to identify risk factors of PTSD among culturally diverse women with depressive symptomatology receiving perinatal services at community obstetric/gynecologic clinics. Women abused as adults, with two or more instances of trauma, greater trauma severity, insomnia, and low social support were more likely to present perinatal PTSD symptoms. Perinatal PTSD is prevalent and has the potential for chronicity. It is imperative healthcare providers recognize salient risk factors and integrate culturally sensitive screening, appropriate referral, and treatment services for perinatal PTSD.

Although infants learn and remember, they rapidly forget, a phenomenon known as infantile amnesia. While myriad mechanisms impact this rapid forgetting, the molecular events supporting memory maintenance have yet to be explored. To explore memory mechanisms across development, we used amygdala-dependent odor-shock conditioning and focused on mechanisms important in adult memory, the AMPA receptor subunits GluA1/2 and upstream protein kinases important for trafficking AMPAR, protein kinase M zeta (PKMζ) and iota/lambda (PKCι/λ). We use odor-shock conditioning in infant rats because it is late-developing (postnatal day, PN10) and can be modulated by corticosterone during a sensitive period in early life. Our results show that memory-related molecules did not change in pups too young to learn threat (PN8) but were activated in pups old enough to learn (PN12), with increased PKMζ-PKCι/λ and GluA2 similar to that observed in adult memory, but with an uncharacteristic decrease in GluA1. This molecular signature and behavioral avoidance of the conditioned odor was recapitulated in PN8 pups injected with CORT before conditioning to precociously induce learning. Blocking learning via CORT inhibition in older pups (PN12) blocked the expression of these molecules. PN16 pups showed a more adult-like molecular cascade of increased PKMζ-PKCι/λ and GluA1-2. Finally, at all ages, zeta inhibitory peptide (ZIP) infusions into the amygdala 24 hr after conditioning blocked memory. Together, these results identify unique features of memory processes across early development: AMPAR subunits GluA1/2 and PKC isoform expression are differentially used, which may contribute to mechanisms of early life forgetting.

OBJECTIVE:The majority of children who initially engage in mental health treatment in the United States drop out prematurely, a problem further exacerbated among children living in poverty. This study examined the relationships between sociodemographic characteristics, barriers to treatment use, and session attendance. METHODS:Data were obtained from participants (N=225) in the 4R2S field trial. Barriers were measured using the Kazdin Barriers to Treatment Participation Scale. RESULTS:Barriers endorsed by families attending less treatment primarily aligned with practical rather than perceptual obstacles. Critical events linked to lower attendance included moving too far away from the clinic, a job change, and a child's moving out of the home. CONCLUSIONS:Child mental health programs serving low-income families may consider structural modifications to allow for greater family support as well as flexibility in treatment delivery by leveraging technology. Future research is needed to evaluate barriers to treatment and alternate modalities in relation to service utilization.

OBJECTIVE:Most studies of pediatric bipolar disorder (BP) combine youth who have manic symptoms, but do not meet criteria for BP I/II, into one "not otherwise specified" (NOS) group. Consequently, little is known about how youth with cyclothymic disorder (CycD) differ from youth with BP NOS. The objective of this study was to determine whether youth with a research diagnosis of CycD (RDCyc) differ from youth with operationalized BP NOS. METHOD:Participants from the Course and Outcome of Bipolar Youth study were evaluated to determine whether they met RDCyc criteria. Characteristics of RDCyc youth and BP NOS youth were compared at baseline, and over eight-years follow-up. RESULTS:Of 154 youth (average age 11.96 (3.3), 42% female), 29 met RDCyc criteria. RDCyc youth were younger (p = .04) at baseline. Over follow-up, RDCyc youth were more likely to have a disruptive behavior disorder (p = .01), and were more likely to experience irritability (p = .03), mood reactivity (p = .02), and rejection sensitivity (p = .03). BP NOS youth were more likely to develop hypomania (p = .02), or depression (p = .02), and tended to have mood episodes earlier in the eight-year follow-up period. LIMITATIONS:RDCyc diagnoses were made retrospectively and followed stringent criteria, which may highlight differences that, under typical clinical conditions and more vague criteria, would not be evident. CONCLUSION:There were few differences between RDCyc and BP NOS youth. However, the ways in which the groups diverged could have implications; chronic subsyndromal mood symptoms may portend a severe, but ultimately non-bipolar, course. Longer follow-up is necessary to determine the trajectory and outcomes of CycD symptoms.

Please note that following publication of the original article [1], one of the authors has flagged that the abbreviations section lists "BRIC" as "Britain, Russia, India and China".

Autism spectrum disorder (ASD) is a group of neurodevelopmental disorders with multiple biological etiologies and highly variable symptoms. Using a novel analytical framework that integrates cortex-wide MRI markers of vertical (i.e., thickness, tissue contrast) and horizontal (i.e., surface area, geodesic distance) cortical organization, we could show that a large multi-centric cohort of individuals with ASD falls into 3 distinctive anatomical subtypes (ASD-I: cortical thickening, increased surface area, tissue blurring; ASD-II: cortical thinning, decreased distance; ASD-III: increased distance). Bootstrap analysis indicated a high consistency of these biotypes across thousands of simulations, while analysis of behavioral phenotypes and resting-state fMRI showed differential symptom load (i.e., Autism Diagnostic Observation Schedule; ADOS) and instrinsic connectivity anomalies in communication and social-cognition networks. Notably, subtyping improved supervised learning approaches predicting ADOS score in single subjects, with significantly increased performance compared to a subtype-blind approach. The existence of different subtypes may reconcile previous results so far not converging on a consistent pattern of anatomical anomalies in autism, and possibly relate the presence of diverging corticogenic and maturational anomalies. The high accuracy for symptom severity prediction indicates benefits of MRI biotyping for personalized diagnostics and may guide the development of targeted therapeutic strategies.

: media-1vid110.1542/5804911922001PEDS-VA_2017-3737Video Abstract BACKGROUND: African American adolescents appear to be the most at risk for asthma morbidity and mortality even compared with other minority groups, yet there are few successful interventions for this population that are used to target poorly controlled asthma.

OBJECTIVE: Children with NF1 display multiple structural and functional changes in the central nervous system, such as white matter alterations, and a unique profile of neuropsy-chological cognitive abnormalities. Assessment of resting state networks (RSNs) can reveal differences in the functional architecture of the developing brain in response to neurofibromin deficiency resulting from NF1 mutation. Here, we focused on resting-state functional connectivity between the subcortical striatum and cortical networks differentiated as primary (e.g., visual, somatomotor) versus association (e.g., ventral attention, default). MATERIAL-METHODS: Eighteen children with NF1 who had resting-state fMRI scans were group-matched (age, gender and head movement) with 18 typically developing children (TDC) from the ABIDE repository. Coherent slow fluctuations in the fMRI signal across the entire brain were used to interrogate the pattern of functional connectivity of cortical-subcortical structures. Assessment of RSNs was done using a previously established automated clustering algorithm. RESULTS: NF1 children demonstrated abnormal organization of association networks, particularly, deficient long-distance functional connectivity. Examining the contribution of the striatum revealed that corticostriatal functional connectivity was altered, with NF1 children demonstrating diminished functional connectivity between striatum and the ventral attention network, as well as the posterior cingulate area, which is associated with the default network. By contrast, somatomotor functional connectivity with the striatum was increased. Functional connectivity of the visual network with the striatum did not differ in the NF1 group. CONCLUSION: These findings suggest that, much like in animal studies, the striatum plays a major role in NF1 cognitive pathogenesis. In addition, the "immature" pattern of deficient long distance functional connectivity suggests that NF1-associated myelin abnormalities may also play a significant role in the disrupted formation of RSNs

Interpreting iconic gestures can be challenging for children. Here, we explore the features and functions of iconic gestures that make them more challenging for young children to interpret than instrumental actions. In Study 1, we show that 2.5-year-olds are able to glean size information from handshape in a simple gesture, although their performance is significantly worse than 4-year-olds'. Studies 2 to 4 explore the boundary conditions of 2.5-year-olds' gesture understanding. In Study 2, 2.5-year-old children have an easier time interpreting size information in hands that reach than in hands that gesture. In Study 3, we tease apart the perceptual features and functional objectives of reaches and gestures. We created a context in which an action has the perceptual features of a reach (extending the hand toward an object) but serves the function of a gesture (the object is behind a barrier and not obtainable; the hand thus functions to represent, rather than reach for, the object). In this context, children struggle to interpret size information in the hand, suggesting that gesture's representational function (rather than its perceptual features) is what makes it hard for young children to interpret. A distance control (Study 4) in which a person holds a box in gesture space (close to the body) demonstrates that children's difficulty interpreting static gesture cannot be attributed to the physical distance between a gesture and its referent. Together, these studies provide evidence that children's struggle to interpret iconic gesture may stem from its status as representational action. (PsycINFO Database Record