Faculty Bibliography

Transgender and gender-nonconforming (TGNC) youth who suffer from gender dysphoria are at a substantially elevated risk of numerous adverse physical and psychosocial outcomes compared with their cisgender peers. Innovative treatment options used to support and affirm an individual's preferred gender identity can help resolve gender dysphoria and avoid many negative sequelae of nontreatment. Yet, despite advances in these relatively novel treatment options, which appear to be highly effective in addressing gender dysphoria and mitigating associated adverse outcomes, ethical challenges abound in ensuring that young patients receive appropriate, safe, affordable treatment and that access to this treatment is fair and equitable. Ethical considerations in gender-affirming care for TGNC youth span concerns about meeting the obligations to maximize treatment benefit to patients (beneficence), minimizing harm (nonmaleficence), supporting autonomy for pediatric patients during a time of rapid development, and addressing justice, including equitable access to care for TGNC youth. Moreover, although available data describing the use of gender-affirming treatment options are encouraging, and the risks of not treating TGNC youth with gender dysphoria are evident, little is known about the long-term effects of both hormonal and surgical interventions in this population. To support ethical decision-making about treatment options, we encourage the development of a comprehensive registry in the United States to track long-term patient outcomes. In the meantime, providers who work with TGNC youth and their families should endeavor to offer ethically sound, patient-centered, gender-affirming care based on the best currently available evidence.

Future orientation (FO) has received increasing attention for its positive effects on adolescent well-being and successful transition to adulthood. Although numerous measures of FO exist, most are not developmentally appropriate for diverse populations of adolescents, do not assess all theoretical components of FO, and/or were not developed for administration in schools. Additionally, the invariance of existing measures across racial/ethnic groups has not been examined using appropriately rigorous procedures. Using data from 2575 students in grades 6-9, this study examined the psychometric quality and measurement invariance of the FO scale on the School Success Profile (SSP) across African American (34.8%), Latino (27.0%), and European American (38.1%) subsamples. A one-factor model fit the data well in all three groups. Analyses identified only a small number of noninvariant parameters, supporting the conclusion that the scale has partial measurement invariance across the three groups. On average, African Americans had significantly higher levels of FO than the other two groups; mean scores for Latinos and European Americans were lower and statistically equivalent to each other. Construct validity of the SSP FO scale was also supported by findings of medium-sized relationships of FO scores to scores on five other constructs: low grades, school engagement, parent educational support, psychological distress, and school behavior. Multiple group tests of the magnitude and direction of the validity relationships indicated statistical equivalence across the three groups. Results support the use of the SSP FO scale by school psychologists to assess FO and to evaluate the effects of interventions targeting FO as a promoter of well-being and school success.

Recent studies suggest that infants and toddlers evaluate others based on their prosocial and antisocial behaviors and engage in prosocial behaviors themselves. It is unknown to what extent infants' responses in such studies reveal stable individual differences in social and/or moral competence that persist throughout development. The current study (N = 63) demonstrates that infants' performance in sociomoral evaluation and action studies (mean age = 12 months) predicts social and behavioral adjustment at age 4 years. Specifically, a stronger preference for moral actions as an infant was associated with parent reports of fewer callous-unemotional traits, the domain most conceptually related to sociomoral evaluation and action, during preschool. Critically, preschool moral adjustment was uniquely associated with infants' sociomoral responding and not with other more general aspects of infant functioning. When 2 children with an autism spectrum disorder diagnosis were included in the sample, correlations between infant and preschool functioning were more widespread. Taken together, these results provide evidence for developmental continuity in the sociomoral domain and suggest that infants' early behavioral tendencies may be building blocks for subsequent sociomoral development.

OBJECTIVE:This study aimed to improve our understanding of how to best assist marginalized youth during their transition to adulthood, and how to provide them services that help them achieve independence within existing public systems of care. METHOD/METHODS:Using purposive sampling methods, 17 direct service providers and supervisors of a large behavioral health organization participated in individual interviews and focus groups. RESULTS:A team of analysts identified eight primary themes: (a) the primacy of consistent and caring relationships with adults; (b) working with youth and family concurrently; (c) the complicated dance of autonomy and independence; (d) engagement of alumni and peers in service delivery; (e) transition navigator: an active not passive approach to becoming an adult; (f) youth as the drivers of treatment and recovery; (g) provider training and resources to address the unique needs of transition-age youth; and (h) broadening the definition of treatment. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE/CONCLUSIONS:Our findings have important implications for practice, including (a) adapting clinical practice to meet the unique needs of transition-age youth and young adults; (b) engaging and expanding positive support systems; and (c) shifting the mindset of transition-age youth and young adults, their caregivers, and providers from a perspective of "aging out" of the mental health system to a perspective of "continuing on" in the management of their mental health through treatment and rehabilitation as needed as young adults. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

While static functional connectivity (sFC) of resting state fMRI (rfMRI) measures the average functional connectivity (FC) over the entire rfMRI scan, dynamic FC (dFC) captures the temporal variations of FC at shorter time windows. Although numerous studies have implemented dFC analyses, only a few studies have investigated the reliability of dFC and this limits the biological interpretation of dFC. Here, we used a large cohort (N = 820) of subjects and four rfMRI scans from the Human Connectome Project to systematically explore the relationship between sFC, dFC and their test-retest reliabilities through intra-class correlation (ICC). dFC ICC was explored through the sliding window approach with three dFC statistics (standard deviation, ALFF, and excursion). Excursion demonstrated the highest dFC ICC and the highest age prediction accuracy. dFC ICC was generally higher at window sizes less than 40 s sFC and dFC were negatively correlated. Compared to sFC, dFC was less reliable. While sFC and sFC ICC were positively correlated, dFC and dFC ICC were negatively correlated, indicating that FC that was more dynamic was less reliable. Intra-network FCs in the frontal-parietal, default mode, sensorimotor and visual networks demonstrated high sFC and low dFC. Moreover, ICCs of both sFC and dFC in these regions were higher. The above results were consistent across two brain atlases and independent component analysis-based networks, multiple window sizes and all three dFC statistics. In summary, dFC is less reliable than sFC and additional experiments are required to better understand the neurophysiological relevance of dFC.

Youth with autism spectrum disorder (ASD) are psychiatrically hospitalized at high rates. Though specialized psychiatric units are effective, few specialized units exist. The ASD Care Pathway (ASD-CP) was developed as a scalable approach to improving care in general psychiatric units through staff training and a package of autism-specific intervention strategies. An evaluation of the effectiveness of the ASD-CP in a public hospital child psychiatric service compared 18 months (n = 17) versus 18 months (n = 20) post implementation. Average length of hospital stay decreased 40% (22.4-13.4 days) and use of crisis interventions decreased 77% (holds/restraints; 0.65/day to 0.15/day), though each result only approached statistical significance (p = 0.07; 0.057). This study provides preliminary evidence for improved outcomes after implementation of an ASD-CP.

Parents' cognitive schemas about parenting, personal vulnerabilities, and personal resources may affect their risk of engaging in parent-child aggression (PCA). This longitudinal study examined predictors of change in mothers' and fathers' PCA risk across the transition to parenthood, comparing trajectories of parents evidencing high versus low sociodemographic risk. Potential predictors involved parenting-relevant schemas (consistent with Social Information Processing theory, including approval of PCA, negative attributions of child behavior, and knowledge of nonphysical discipline options), personal vulnerabilities (psychopathology, intimate partner violence, substance use issues), and resources (problem-focused coping, emotion regulation, social support, and partner satisfaction). Results indicated that increases in PCA approval, negative child behavior attributions, and symptoms of psychopathology, as well as decreases in problem-focused coping skills, emotion regulation ability, and partner satisfaction, all significantly predicted changes in mothers' and fathers' PCA risk over time-regardless of risk group status. Notably, increases in intimate partner violence victimization and decreases in social support satisfaction predicted mothers' but not fathers' PCA risk change; moreover, increases in knowledge of nonphysical discipline alternatives or in substance use issues did not predict change in PCA risk for either mothers or fathers. Risk groups differed in PCA risk across all predictors with minimal evidence of differential trajectories. Overall, these findings have important implications for child abuse prevention programs involving both universal and secondary abuse prevention efforts.

BACKGROUND:Preexposure prophylaxis (PrEP) reduces risk of human immunodeficiency virus infection for many gay and bisexual men (GBM); however, bacterial sexually transmitted infections associated with decreasing condom use among users is of concern. Center for Disease Control and Prevention's guidelines for PrEP use recommend bacterial sexually transmitted infection screening every 6 months. We sought to investigate comprehensive PrEP care, defined as: (1) discussion of sexual behavior, (2) blood sample, (3) urine sample, (4) rectal sample (rectal swab), and (5) throat sample (throat swab), provided at the user's last PrEP appointment. METHODS:The PrEP-using GBM in New York City (n = 104) were asked about their last PrEP care visit. We examined associations of demographics (age, race/ethnicity, and education), recent number of condomless anal sex events, time on PrEP, and health care provider type on receiving comprehensive care at last visit using fully adjusted binary logistic regression. RESULTS:At their last visit, nearly all men (94%) gave blood for testing, 88% provided a urine sample, and 77% discussed sexual behavior with their provider. However, only 51% reported having a rectal swab, and 48% an oral swab. Only 32% of men received comprehensive PrEP care at their last PrEP visit. Odds of receiving comprehensive care were significantly higher among younger men, men with a bachelor's degree or more education, and those who reported more condomless anal sex. CONCLUSIONS:Less than one third of GBM received comprehensive human immunodeficiency virus/sexually transmitted infection counseling and testing at their last visit. These findings indicate further efforts are needed to prepare health care providers for prescribing and managing patients on PrEP.

RATIONALE/BACKGROUND:Weight gain during treatment with antipsychotics is a prominent side-effect, especially with some second-generation antipsychotics, such as olanzapine and clozapine, and pharmacological treatments which ameliorate this side-effect are important to investigate. Decreases in histaminergic transmission in the brain induced by antipsychotics may be one of the mechanisms contributing to weight gain. Since betahistine is a histaminergic agonist, it may potentially counteract the weight gain effects of antipsychotics. METHOD/METHODS:We conducted a double-blind placebo-controlled study to evaluate the effects of 12 weeks of treatment with betahistine (N = 29) or placebo (N = 22) in adolescents and adults on anthropomorphically measured weight-related parameters, appetite, and fasting glucose-lipid and leptin levels in 51 patients treated with first and/or second-generation antipsychotics who had gained weight during treatment or had high body-mass-index (BMI). Psychopathology and side-effects were also assessed with relevant scales. RESULTS:In a sub-group of patients being treated with olanzapine or clozapine (n = 26), betahistine was significantly (P < .05) better than placebo in preventing increases in weight (3.1 kg less weight gain than placebo), BMI, and waist circumference. Betahistine did not decrease weight or BMI in patients treated with other antipsychotics. There was also no effect of betahistine on preventing weight or BMI gain in the total combined sample of all subjects. Betahistine did not significantly improve appetite or glucose-lipid measures in either subgroup. There were no significant differences in side-effects or psychopathology changes in the betahistine- vs. placebo-treated patients. CONCLUSIONS:These results suggest that betahistine may potentially be a useful adjunctive drug for decreasing weight gain in patients treated with antipsychotics that are potent histamine antagonists, such as olanzapine or clozapine, but may not be useful for this purpose in patients on other antipsychotic medications. The results justify larger placebo-controlled studies to further confirm these effects before specific recommendations can be made for routine use.

Faces are often used in psychological and neuroimaging research to assess perceptual and emotional processes. Most available stimulus sets, however, represent minimal diversity in both race and ethnicity, which may confound understanding of these processes in diverse/racially heterogeneous samples. Having a diverse stimulus set of faces and emotional expressions could mitigate these biases and may also be useful in research that specifically examines the effects of race and ethnicity on perceptual, emotional and social processes. The racially diverse affective expression (RADIATE) face stimulus set is designed to provide an open-access set of 1,721 facial expressions of Black, White, Hispanic and Asian adult models. Moreover, the diversity of this stimulus set reflects census data showing a change in demographics in the United States from a white majority to a nonwhite majority by 2020. Psychometric results are provided describing the initial validity and reliability of the stimuli based on judgments of the emotional expressions.