Faculty Bibliography

OBJECTIVES:Past research suggests that youth with sex chromosome aneuploidies (SCAs) present with verbal fluency deficits. However, most studies have focused on sex chromosome trisomies. Far less is known about sex chromosome tetrasomies and pentasomies. Thus, the current research sought to characterize verbal fluency performance among youth with sex chromosome trisomies, tetrasomies, and pentasomies by contrasting how performance varies as a function of extra X number and X versus Y status. METHODS:Participants included 79 youth with SCAs and 42 typically developing controls matched on age, maternal education, and racial/ethnic background. Participants completed the phonemic and semantic conditions of a verbal fluency task and an abbreviated intelligence test. RESULTS:Both supernumerary X and Y chromosomes were associated with verbal fluency deficits relative to controls. These impairments increased as a function of the number of extra X chromosomes, and the pattern of impairments on phonemic and semantic fluency differed for those with a supernumerary X versus Y chromosome. Whereas one supernumerary Y chromosome was associated with similar performance across fluency conditions, one supernumerary X chromosome was associated with relatively stronger semantic than phonemic fluency skills. CONCLUSIONS:Verbal fluency skills in youth with supernumerary X and Y chromosomes are impaired relative to controls. However, the degree of impairment varies across groups and task condition. Further research into the cognitive underpinnings of verbal fluency in youth with SCAs may provide insights into their verbal fluency deficits and help guide future treatments. (JINS, 2018, 24, 917-927).

Despite the effectiveness of exposure-based cognitive behavioral therapy (CBT) for anxiety disorders, few individuals in need receive this treatment, particularly in community mental health settings serving low-income adults. The present study took a preliminary step to understand these barriers by conducting a series of key informant interviews and focus groups among patients, providers, clinical administrators, and policy makers. Several themes emerged as barriers to the delivery of exposure-based CBT in these settings, including therapist training and compentency issues, logistical issues, and funding stream issues. Clinical implications and future research that can build from these data are discussed.

New York City (NYC) public hospitals recently mandated that all pregnant women be screened for depression, but no funds were allocated for screening or care coordination/treatment, and research suggests that unfunded mandates are not likely to be successful. To address this, we implemented an on-site depression prevention intervention (NYC ROSE) for positive depression screens among pregnant, mostly Black and Hispanic, lower-income women in one public hospital. In this paper, we used Aarons' implementation model to describe the successes and challenges of screening and intervention. Patient tracking sheets and electronic medical records were abstracted. Key informant interviews and an informal focus group were conducted, and staff observations were reviewed; common implementation themes were identified and fit into Aarons' model. We found that a lack of funding and staff training, which led to minimal psychoeducation for patients, were outer context factors that may have made depression screening difficult, screening results unreliable, and NYC ROSE enrollment challenging. Although leadership agreed to implement NYC ROSE, early involvement of all levels of staff and patients would have better informed important inner context factors, like workflow and logistical/practical challenges. There was also a mismatch between the treatment model and the population being served; patients often lived too far away to receive additional services on site, and economic issues were often a higher priority than mental health services. Screening and interventions for perinatal depression are essential for optimal family health, and a detailed, thoughtful and funded approach can help ensure effectiveness of such efforts.

: 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

Objective/UNASSIGNED:Maternal depression is a common, chronic set of disorders associated with significant burden to caregivers, children and families. Some evidence suggests that depression is associated with perceptions of barriers to child mental health treatment and premature termination from services. However, this relationship has not yet been examined among a predominantly low-income sample, which is at disproportionately high risk of depression, child mental health problems, and treatment drop out. Accordingly, the purpose of this study is to examine the relationships between caregiver depression and perceived barriers to treatment. Methods/UNASSIGNED:Three hundred twenty (n=320) children between the ages of 7 to 11 and their caregivers were assigned to either the 4 Rs and 2Ss for Strengthening Families, which is a multiple family group intervention, or services as usual (SAU) consisting of typical outpatient mental health services. Caregiver depression was measured by the Center for Epidemiologic Depression Scale; perceived barriers to treatment were assessed via the Kazdin Barriers to Treatment Scale. Results/UNASSIGNED:Clinically significant levels of depressive symptoms at baseline were significantly associated with greater scores in all four barriers to treatment subscales (stressors and obstacles competing with treatment, treatment demands and issues, perceived relevance, relationship with therapist) at post-test. Conclusions/UNASSIGNED:Addressing maternal mental health, and attending to stressors that impede poverty-impacted families from child services is critical for the health and functioning of caregivers, and to ensure that children with mental health problems receive treatment.

Statistical learning-extracting regularities in the environment-may underlie complex social behavior. 124 children, 56 with autism and 68 typically developing, ages 2-8 years, completed a novel visual statistical learning task on an iPad. Averaged together, children with autism demonstrated less learning on the task compared to typically developing children. However, multivariate classification analyses characterized individual behavior patterns, and demonstrated a subset of children with autism had similar learning patterns to typically developing children and that subset of children had less severe autism symptoms. Therefore, statistically averaging data resulted in missing critical heterogeneity. Variability in statistical learning may help to understand differences in autism symptoms across individuals and could be used to tailor and inform treatment decisions.

To date, there are no biomarkers for major depressive disorder (MDD) treatment response in clinical use. Such biomarkers could allow for individualized treatment selection, reducing time spent on ineffective treatments and the burden of MDD. In search of such a biomarker, multisite pretreatment and early-treatment (1 week into treatment) structural magnetic resonance (MR) images were acquired from 184 patients with MDD randomized to an 8-week trial of the selective serotonin reuptake inhibitor (SSRI) sertraline or placebo. This study represents a large, multisite, placebo-controlled effort to examine the association between pretreatment differences or early-treatment changes in cortical thickness and treatment-specific outcomes. For standardization, a novel, robust site harmonization procedure was applied to structural measures in a priori regions (rostral and caudal anterior cingulate, lateral orbitofrontal, rostral middle frontal, and hippocampus), chosen based on previously published reports. Pretreatment cortical thickness or volume did not significantly associate with SSRI response. Thickening of the rostral anterior cingulate cortex in the first week of treatment was associated with better 8-week responses to SSRI (p = 0.010). These findings indicate that frontal lobe structural alterations in the first week of treatment may be associated with long-term treatment efficacy. While these associational findings may help to elucidate the specific neural targets of SSRIs, the predictive accuracy of pretreatment or early-treatment structural alterations in classifying treatment remitters from nonremitters was limited to 63.9%. Therefore, in this large sample of adults with MDD, structural MR imaging measures were not found to be clinically translatable biomarkers of treatment response to SSRI or placebo.

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