Faculty Bibliography

Introduction: Child fatigue has been associated with behavioral outcomes, including aggression, hyperactivity, and conduct problems, which may affect academic performance. We explored whether fatigue was associated with external behavioral health outcomes in a predominantly Black (Afro-Caribbean and African-American) student population (90%). Ratings of parent and teacher agreement of child fatigue was evaluated. This analysis was part of a larger research program, which included a cluster randomized controlled trial in ten public elementary schools in historically disinvested neighborhoods.
Method(s): A total of 804 first-graders (7+/- 0.6 years old) participated in the study focused on child self-regulation, mental health achievement, parenting and parent involvement. Externalizing behaviors (i.e., conduct problems, aggression, and hyperactivity) were reported by teachers using the Behavior System for Children (BASC-2). A composite score of teacher-perceived child fatigue was created based on ratings of child fatigue, morning alertness, and falling asleep in class. Parent perception of child fatigue was assessed using the Children's Sleep Habits Questionnaire. Regression analysis was conducted to determine the association between teacher's reports of child fatigue and externalizing behavior problems. Cohen's kappa coefficient assessed parent and teacher agreement of child fatigue based on categorical classification of presence of child fatigue.
Result(s): Children who were perceived as fatigued (i.e., tiredness and falling asleep in class) by their teacher were more likely to have a high BASC externalizing composite score (T=60 cut off) (beta = -0.24, p<.001). Cohen's kappa of 0.004 (p<0.05) showed a slight discordance in perception of child fatigue comparing reports from teachers and parents, although results were not significant.
Conclusion(s): Teacher perception of child fatigue was significantly associated with teacher BASC T-score of child externalizing behavior outcomes. Future studies should explore longitudinal relationships between fatigue and mental health

Introduction: Short sleep duration promotes metabolic dysregulation and obesity. We have previously shown that acute sleep restriction increases neuronal activity in response to food stimuli in areas of interoception and reward, such as the insula and orbitofrontal cortex. However, whether chronic mild sleep restriction impacts food reward valuation in the brain remains unknown. In an ongoing study, we assess the effects of mild 6-week sleep restriction on intrinsic functional connectivity (iFC) across reward and interoception- related brain circuitry.
Method(s): To date, 16 adult men and women (age 29.0+/-5.3 years and BMI 26.9+/-2.6 kg/m²at study entry) took part in this randomized, crossover, outpatient trial of 2 phases: habitual sleep (HS; >=7 h/night) and sleep restriction (SR; -1.5 h/night relative to HS). All participants were screened with actigraphy over a two-week period to ensure adequate sleep duration of 7-9 h/night (average screening total sleep time: 7.65+/-0.58 h/night). Two resting-state (task-free) functional MRI scans (Siemens Skyra 3T, TR=2.5s, two 5-min runs) were collected during the final week of each phase. Here we report preliminary analyses using the Data Processing & Analysis of Brain Imaging V2.3-170105 toolbox with paired-sample t-tests across the whole brain.
Result(s): Average sleep duration in the HS phase was 7.55+/-0.55 h/ night vs. 6.10+/-0.49 h/night during SR (p<0.0001). Examining iFC of 17 previously studied regions-of-interest relevant to food valuation and interoception yielded two significant results after correction for Gaussian Random Field (p<0.001 at voxel level, cluster p<0.05). iFC was greater following SR than HS for (1) left inferior frontal gyrus with medial prefrontal cortex (mPFC); and (2) mPFC with bilateral superior temporal gyrus.
Conclusion(s): This study provides preliminary evidence of decreased segregation between a key anterior node of the default mode network (mPFC) and nodes of the salience and somatosensory (auditory) networks under prolonged mild SR. Such iFC changes, suggesting atypical network coupling, if confirmed in the completed sample, will be examined in the future in relation to key measures of metabolism and cardiovascular risks

Prior studies of mother-infant interaction have generally used a variable-centered approach to associate face-to-face communication with psychosocial outcomes. Herein, we use a person-centered approach to identify clusters of infants who exhibit similar behavioral profiles during face-to-face communication with their mothers. Four infant communication channels were examined-gaze, facial affect, vocal affect, and head orientation-coded from videotape at a 1-s temporal resolution. We used k-means clustering to classify community infants (N = 132) into 10 groups, based on variation in the intercept and the autocorrelation function at the first time lag, representing respectively the overall level of behavior and the predictability of the infant's moment-by-moment behavioral stream, in each of the 4 communication channels. In this exploratory study, 10 clusters were identified, some with unusual levels or predictability of behavior in varying channels, and clusters associated differentially with risk outcomes (infant 4-month temperament and 12-month attachment). Distinct forms of affective dysregulation were identified: sustained negative vocal affect associated with degree of disorganization; random vocal affect associated with attachment resistance; random facial affect and vocal affect, irrespective of positive/negative valence, associated with infant difficult temperament. Clustering multiple channels of infant communication generated unique behavioral profiles and predicted 4- and 12-month outcomes, suggesting that these clusters may indeed represent natural types of infant communicative behavior, not easily observed with the naked eye, that may be useful behavioral markers of clinical risk. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

This study used machine-learning algorithms to make unbiased estimates of the relative importance of various multilevel data for classifying cases with schizophrenia (n = 60), schizoaffective disorder (n = 19), bipolar disorder (n = 20), unipolar depression (n = 14), and healthy controls (n = 51) into psychiatric diagnostic categories. The Random Forest machine learning algorithm, which showed best efficacy (92.9% SD: 0.06), was used to generate variable importance ranking of positive, negative, and general psychopathology symptoms, cognitive indexes, global assessment of function (GAF), and parental ages at birth for sorting participants into diagnostic categories. Symptoms were ranked most influential for separating cases from healthy controls, followed by cognition and maternal age. To separate schizophrenia/schizoaffective disorder from bipolar/unipolar depression, GAF was most influential, followed by cognition and paternal age. For classifying schizophrenia from all other psychiatric disorders, low GAF and paternal age were similarly important, followed by cognition, psychopathology and maternal age. Controls misclassified as schizophrenia cases showed lower nonverbal abilities, mild negative and general psychopathology symptoms, and younger maternal or older paternal age. The importance of symptoms for classification of cases and lower GAF for diagnosing schizophrenia, notably more important and distinct from cognition and symptoms, concurs with current practices. The high importance of parental ages is noteworthy and merits further study.

Although pharmacological therapies are recommended as a key component in the treatment of attention-deficit hyperactivity disorder, their use continues to prompt intense debate. Despite considerable research efforts, several gaps in the knowledge base and several questions over the quality of evidence exist. Particular issues surrounding pharmacological treatments include uncertainties about long-term effectiveness and safety, safety profiles in adults, and the comparative effectiveness of different medications. In this Review, we focus on four key methodological issues for future research: (1) the use of appropriate trial designs; the need for (2) outcome measures targeting effectiveness beyond symptom control and (3) safety outcome measures; and (4) the application of clinical and administrative research databases to assess real-world outcomes. Potential solutions include increased use of randomised placebo-controlled withdrawal trials and large pharmacoepidemiological studies that use electronic health-care records on the long-term effectiveness and safety of medications. Pragmatic head-to-head randomised trials would also provide direct evidence on comparative effectiveness and safety profiles.

BACKGROUND:Prior follow-up studies of attention-deficit/hyperactivity disorder (ADHD) have mostly been from North America. They have provided a good deal of information about ADHD, but whether these results generalize to population samples and to other countries is not certain. Most prior studies have also not assessed predictors of possible new onsets of ADHD in non-ADHD youth or the validity of subthreshold forms of the disorder. METHODS:1,012 families were recruited at baseline, when a telephone interview assessed a child in the 6-12 years age range. The interview covered symptoms of ADHD, conduct disorder, and oppositional defiant disorder as well as family living situation, school performance, sleep disturbance, eating habits, use of supplemental iron, and history of ADHD treatment. Nine years later, the persistence of ADHD and its impairments and the emergence of new conditions were assessed. DSM-5 diagnostic criteria were used to diagnose ADHD. RESULTS:492 of the 1,012 participants seen at baseline were followed up 9 years later, at a mean age of 18 years. At follow-up, 16.7% of the children diagnosed with ADHD at baseline met full criteria for ADHD and 11.1% met criteria for subthreshold ADHD, yielding a persistence rate of 27.8%. Among children not diagnosed with ADHD at baseline, 1.1% met criteria for ADHD at follow-up. The persistence of ADHD and new onsets of ADHD were predicted by several baseline clinical features and by a family history of ADHD. CONCLUSIONS:We replicated predictors of the persistence of ADHD found in prior studies and provide new data about predictors of new ADHD onsets in the population. Our findings about subthreshold ADHD support a dimensional conceptualization of the disorder, highlighting the potential clinical utility of a subthreshold diagnostic category. This study also contributes to the ongoing debate regarding adult-onset ADHD.

OBJECTIVE:Sleep disturbances are a feature of attention-deficit/hyperactivity disorder (ADHD) and an adverse event (AE) of methylphenidate treatment. The authors sought to clarify methylphenidate-associated sleep problems and how studies are affected by confounding factors. DATA SOURCES/METHODS:Published studies in English collected via online databases and unpublished data from www.clinicaltrials.gov and US Food and Drug Administration websites. Sources were searched from inception to August 2017. STUDY SELECTION/METHODS:Included were blinded placebo-controlled studies of youth with ADHD conducted in naturalistic settings, leading to 35 studies yielding 75 observations of sleep-related AEs. These studies comprised 3,079 drug-exposed and 2,606 placebo-treated patients. DATA EXTRACTION/METHODS:Two PhD-level reviewers reviewed each study for inclusion. Four PhD/PharmD-level reviewers extracted data in duplicate. Discrepancies were resolved by discussion or, if needed, by the senior author. RESULTS:Increased pooled relative risks (RRs) were found for methylphenidate-associated sleep-related AEs for insomnia (general), initial insomnia, middle insomnia, combined insomnia, and sleep disorder. Several sample or study design features were significantly associated with the RR for sleep-related AEs and the methylphenidate formulation studied (P < .05). After correction for confounding variables, significant differences among drugs were found for initial insomnia, insomnia (general), and sleep disorder (P < .0001) as the other categories could not be tested due to insufficient studies. The findings also show that the RR and its interpretation are constrained by the placebo AE rate. CONCLUSIONS:Several types of insomnia and sleep problems are associated with methylphenidate treatment. Study design and sample features influence the RR statistic. By showing that the rate of placebo AEs impacts the RR, this study provides the field with a useful covariate for adjusting RR statistics.

The relationship between ADHD and suicidal spectrum behaviors (SSBs) remains uncertain. We conducted the first meta-analysis on the association between ADHD and SSBs taking possible confounders into account. Based on a pre-registered protocol (PROSPERO-CRD42018093003), we searched Pubmed, Ovid and Web of Knowledge databases through April 6^th, 2018, with no language/publication type restrictions, and contacted study authors for unpublished data/information. From a pool of 2,798 references, we retained 57 studies. Random-effects models were performed. Study quality was rated using the Newcastle-Ottawa Scale. After pooling crude ORs, we found a significant association between ADHD and suicidal attempts (2.37, 95% CI = 1.64 to 3.43; I² = 98.21), suicidal ideations (3.53, 2.94 to 4.25; I²â€‰= 73.73), suicidal plans (4.54, 2.46 to 8.37; I² = 0), and completed suicide (6.69, 3.24 to 17.39; I² = 87.53). Results did not substantially change when pooling adjusted ORs. Findings were also in general robust to sensitivity analyses to assess possible moderators. Awareness of the association between ADHD and SSBs should contribute to more effectively prevent SSBs.

Aim: The following work aims to investigate the putative correlation between early trauma and cognitive functions, as well as psychotic symptoms and cognitive functions, in individuals diagnosed with schizophrenia. Methods: A quantitative assessment was performed with 20 individuals diagnosed with schizophrenia according to the 5th edition of the Diagnostic and Statistical Manual (DSM-5) criteria and who were in ongoing outpatient treatment in Psychosocial Care Centres in Brazil. Clinical measurements comprised a semistructured clinical interview, a screening questionnaire for common mental disorders, the Positive and Negative Syndrome Scale (PANSS), and the Early Trauma Inventory Self-Report-Short Form (ETISR-SF). Cognitive assessment included Beta III test, Concentrated Attention (CA) test, Color Trails Test (CTT), and Visual Face Memory (VFM) test. Results: Age-adjusted analysis showed a negative correlation between early trauma and visual memory performance (r = -0.585, p = 0.007) and negative symptoms and attention performance (r = -0.715, p = 0.000). Conclusion: Although a cause-effect relationship cannot be firmly stated, an association between early trauma experience and cognitive impairment such as visual memory, as well as a relationship between negative symptoms and attention domains, is suggested by our preliminary findings. Future studies with larger sample sizes and prospective design will clarify the long-term effects of early exposure to trauma and its clinical meaning in terms of developing psychotic-related illness.

Odors affect perception of social cues in visual environments. Although often underestimated, people use their sense of smell to guide approach or avoidance behavior in social contexts. However, underlying psychological mechanisms are not well known. Prior work suggested olfactory effects are due to increased attention or arousal, or depend on the congruency between olfactory and visual cues. Our aim was to assess how odors influence attentional processes using a dot-probe task with odor-congruent and odor-incongruent facial expressions (happy, disgusted and neutral expressions paired with pleasant odor, unpleasant odor and no-odor). In a preregistered analysis plan, we hypothesized either faster reaction times attributed to arousal from odors in general, or to faces that were emotionally congruent with the odors. We also hypothesized time-on-task effects specific to the odor compared to the control condition. Using Bayesian linear models, we found strong evidence that the faces were rated as more arousing and emotional in odor contexts. However, the dot-probe task did in fact not provide an effective cue to selective visual attention, and odors did not modulate overall attention to the faces. However, we found a time-on-task effect such that in the unpleasant odor condition, response times decreased over time, whereas in the no-odor and pleasant condition there was a slight increase in response times. We conclude that time-on-task effects is an interesting venue for odor-visual interaction research, and such effects might explain inconsistent findings in the prior research literature.