Faculty Bibliography

In order to facilitate the adoption of innovative practices in the mental health service system, providers require access to both new information and methodologies, and ongoing training, supervision and consultation. Technical Assistance centers have been proposed as a way to disseminate effective interventions through the provision of resources including information, ongoing training and consultation. The purpose of this study is to describe the New York State Technical Assistance Center's reach across the child public mental health service system and variations in characteristics of training activities, including dosage, content and method of format. Between 2011 and 2015, 460 (92.6%) of all New York State mental health clinics attended a training. The most highly attended events focused on business practices, followed by evidence-based treatments and clinic practices, and trauma-informed care. All were delivered via a webinar format, and were less than one day in duration. The behavioral health service system must be equipped to adapt to changing clinical and business practices in order to provide quality care and remain fiscally viable. New York State's TA center reached the majority of child mental health service providers across the state. Next steps are to closely examine the impact of TA supports upon adoption and sustained use of practices. Implications of these findings and additional future directions are presented.

Trauma experienced in early life has unique neurobehavioral outcomes related to later life psychiatric sequelae. Recent evidence has further highlighted the context of infant trauma as critical, with trauma experienced within species-atypical aberrations in caregiving quality as particularly detrimental. Using data from primarily rodent models, we review the literature on the interaction between trauma and attachment in early life, which highlights the role of the caregiver's presence in engagement of attachment brain circuitry and suppressing threat processing by the amygdala. Together these data suggest that infant trauma processing and its enduring effects are impacted by both the immaturity of brain areas for processing trauma and the unique functioning of the early-life brain, which is biased towards forming robust attachments regardless of the quality of care. Understanding the critical role of the caregiver in further altering early life brain processing of trauma is important for developing age-relevant treatment and interventions.

OBJECTIVE:Risk-taking during adolescence is a leading cause of mortality; Neuroscience research examining pubertal effects on decision-making is needed to better inform interventions, particularly among youth with attention-deficit/hyperactivity (ADHD) and disruptive behavior disorders (DBD), who are particularly prone to risky decision-making. We examined effects of pubertal development on risky decision-making and neural activation during decision-making among youth with ADHD/DBDs. METHOD/METHODS:Forty-six 11-12-year-olds (29.4% girls; 54.9% white; Tanner M(SD) = 2.08(1.32)) who met DSM-5 criteria for ADHD/DBD completed the Balloon Analog Risk Task (BART) during fMRI scanning. We examined effects of Tanner stage, sex, and age on risky decision-making (mean wager at which individuals stopped balloon inflation) and neural activation in the middle frontal gyrus and the ventral striatum during the choice and outcome phases of decision-making. RESULTS:Those in earlier pubertal stages made riskier decisions during the BART compared to those in later Tanner stages (β=-0.62, p =  .02). Later pubertal stage was associated with greater activation in the left middle frontal gyrus (β=0.61, p = .03) during the choice phase and in the right ventral striatum in response to rewards (β=0.59, p = .03). CONCLUSION/CONCLUSIONS:Youth with ADHD/DBD in later stages of puberty, regardless of age, show greater ventral striatal activation in response to rewards.

Resting-state functional MRI (R-fMRI) research has recently entered the era of "big data", however, few studies have provided a rigorous validation of the physiological underpinnings of R-fMRI indices. Although studies have reported that various neuropsychiatric disorders exhibit abnormalities in R-fMRI measures, these "biomarkers" have not been validated in differentiating structural lesions (brain tumors) as a concept proof. We enrolled 60 patients with intracranial tumors located in the unilateral cranialcavity and 60 matched normal controls to test whether R-fMRI indices can differentiate tumors, which represents a prerequisite for adapting such indices as biomarkers for neuropsychiatric disorders. Common R-fMRI indices of tumors and their counterpart control regions, which were defined as the contralateral normal areas (for amplitude of low frequency fluctuations (ALFF), fractional ALFF (fALFF), regional homogeneity (ReHo) and degree centrality (DC)) and ipsilateral regions surrounding the tumors (for voxel-mirrored homotopic connectivity (VMHC)), were comprehensively assessed. According to robust paired t-tests with a Bonferroni correction, only VMHC (Fisher's r-to-z transformed) could successfully differentiate substantial tumors from their counterpart normal regions in patients. Furthermore, ALFF and DC were not able to differentiate tumor from normal unless Z-standardization was employed. To validate the lower power of the between-subject design compared to the within-subject design, each metric was calculated in a matched control group, and robust two-sample t-tests were used to compare the patient tumors and the normal controls at the same place. Similarly, only VMHC succeeded in differentiating significant differences between tumors and the sham tumor areas of normal controls. This study tested the premise of R-fMRI biomarkers for differentiating lesions, and brings a new understanding to physical significance of the Z-standardization.

Purpose/UNASSIGNED:Methylphenidate (MPH), the first-line medication in children with attention-deficit/hyperactivity disorder (ADHD), is associated with increased risk of sleep disorders. Melatonin has both hypnotic and chronobiotic properties that influence circadian rhythm sleep disorders. This study explores the effectiveness of melatonin in children with ADHD who developed sleep problems after starting MPH. Patients and methods/UNASSIGNED:This study, based on a clinical database, included 74 children (69 males, mean age 11.6±2.2 years) naturalistically treated with MPH (mean dosage 33.5±13.5 mg/d). The severity of sleep disorder (sleep onset delay) was recorded at baseline and after a follow-up of at least 4 weeks using a seven-point Likert scale according to the Clinical Global Impression Severity score. Effectiveness of melatonin on sleep (mean dosage 1.85±0.84 mg/d) after 4 weeks was assessed using a seven-point Likert scale according to the Clinical Global Impression Improvement (CGI-I) score, and patients who scored 1 (very much improved) or 2 (much improved) were considered responders. Results/UNASSIGNED:<0.001). According to the CGI-I score, 45 patients (60.8%) responded to the treatment with melatonin. Gender and age (children younger and older than 12 years) did not affect the response to melatonin on sleep. Patients with or without comorbidities did not differ according to sleep response. Specific comorbidities with disruptive behavior disorders (oppositional defiant disorder or conduct disorder), affective (mood and anxiety) disorders and learning disabilities did not affect the efficacy of melatonin on sleep. Treatment was well tolerated, and no side effects related to melatonin were reported. Conclusion/UNASSIGNED:In children with ADHD with sleep problems after receiving MPH treatment, melatonin may be an effective and safe treatment, irrespective of gender, age and comorbidities.

Intrinsic neural activity ubiquitously persists in all physiological states. However, how intrinsic brain activity (iBA) changes over a short time remains unknown. To uncover the brain dynamics' theoretic underpinning, electrophysiological relevance, and neuromodulation, we identified iBA dynamics on simulated data, electroencephalogram-functional magnetic resonance imaging (EEG-fMRI) data, and repetitive transcranial magnetic stimulation (rTMS) fMRI data using sliding-window analysis. The temporal variability (dynamics) of iBA were quantified using the variance of the amplitude of low-frequency fluctuations (ALFF) over time. We first used simulated fMRI data to examine the effects of various parameters including window length, and step size on dynamic ALFF. Secondly, using EEG-fMRI data, we found that the heteromodal association cortex had the most variable dynamics while the limbic regions had the least, consistent with previous findings. Additionally, the temporal variability of dynamic ALFF depended on EEG power fluctuations. Moreover, using rTMS fMRI data, we found that the temporal variability of dynamic ALFF could be modulated by rTMS. Taken together, these results provide an evidence about the theory, relevance, and adjustability of iBA dynamics.

Short duration of marriage (DoM) is a risk factor for preeclampsia that is also related to the risk for schizophrenia. This analysis examined the risk for schizophrenia associated with DoM and its independence from parental psychiatric disorders, parental ages and fathers' age at marriage.

Detecting pathogen threats and avoiding disease is fundamental to human survival. The behavioral immune system (BIS) framework outlines a set of psychological functions that may have evolved for this purpose. Disgust is a core emotion that plays a pivotal role in the BIS, as it activates the behavioral avoidance motives that prevent people from being in contact with pathogens. To date, there has been little agreement on how disgust sensitivity might underlie moral judgments. Here, we investigated moral violations of "purity" (assumed to elicit disgust) and violations of "harm" (assumed to elicit anger). We hypothesized that individual differences in BIS-related traits would be associated with greater disgust (vs. anger) reactivity to, and greater condemnation of Purity (vs. Harm) violations. The study was pre-registered (https://osf.io/57nm8/). Participants (N = 632) rated scenarios concerning moral wrongness or inappropriateness and regarding disgust and anger. To measure individual differences in the activation of the BIS, we used our recently developed Body Odor Disgust Scale (BODS), a BIS-related trait measure that assesses individual differences in feeling disgusted by body odors. In line with our predictions, we found that scores on the BODS relate more strongly to affective reactions to Purity, as compared to Harm, violations. In addition, BODS relates more strongly to Moral condemnation than to perceived Inappropriateness of an action, and to the condemnation of Purity violations as compared to Harm violations. These results suggest that the BIS is involved in moral judgment, although to some extent this role seems to be specific for violations of "moral purity," a response that might be rooted in disease avoidance. Data and scripts to analyze the data are available on the Open Science Framework (OSF) repository: https://osf.io/tk4x5/. Planned analyses are available at https://osf.io/x6g3u/.

OBJECTIVES/OBJECTIVE:Access to firearms is an independent risk factor for completed suicide and homicide, and the American Academy of Pediatrics recommends that pediatricians screen and counsel about firearm access and safe storage. This study investigates how often pediatric residents screen for access to firearms or counsel about risk-reduction in patients with suicidal or homicidal ideation. METHODS:Retrospective chart review of visits by patients under the age of 19 years presenting to the pediatric emergency department (ED) of a tertiary academic medical center January-December 2016. Visits were eligible if there was an ultimate ED discharge diagnosis of "suicidal ideation," "suicide attempt," or "homicidal ideation" as identified by ICD-10 codes and the patient was seen by a pediatric resident prior to evaluation by psychiatry. Descriptive statistics were used to analyze results. RESULTS:Ninety-eight patients were evaluated by a pediatric resident for medical assessment before evaluation by a psychiatry team during the study period and were therefore eligible for inclusion. Screening for firearm access was documented by a pediatric resident in 5/98 (5.1%) patient encounters. Twenty-five patients (25.5%) had no documented screening for firearm access by any provider during the ED visit, including in five cases when patients were discharged home. CONCLUSIONS:Pediatric residents rarely document screening for firearm access in patients with known suicidal or homicidal ideation who present to the ED. Additional understanding of the barriers to screening and potential strategies for improving screening and counseling are critical to providing appropriate care for high-risk pediatric patients.