Faculty Bibliography

PURPOSE OF REVIEW/OBJECTIVE:Many children and adolescents with attention-deficit/hyperactivity disorder (ADHD) have difficulties in their social skills and peer relationships. Because social problems exacerbate later maladjustment in ADHD populations, it is important to address this serious impairment. Although social skills training (SST) is a common intervention approach, evidence to date suggests that SST has limited efficacy, at least when provided in traditional, clinic-based settings. The current review summarizes recent advances to traditional SST approaches that may potentially enhance their efficacy. RECENT FINDINGS/RESULTS:We identify two promising directions in which SST may be modified to make it more efficacious for ADHD populations. The first direction involves providing increased reinforcement and reminders of appropriate social behavior at the point of performance to youth with ADHD (e.g., in vivo, in real life peer situations as opposed to in the clinic). We note the importance of ensuring that youth with ADHD are receptive to such reminders. The second direction involves encouraging peers to be more socially accepting and inclusive of youth with ADHD. This avenue has been understudied in the literature to date. SST for children and adolescents with ADHD may be enhanced by providing more in vivo reminders and feedback at the point of performance and by making efforts to alter peers' impressions about youth with ADHD.

BACKGROUND: The ratio of sugars to organic acids, two of the major metabolites in fleshy fruits, has been considered the most important contributor to fruit sweetness. Although accumulation of sugars and acids have been extensively studied, whether plants evolve a mechanism to maintain, sense or respond to the fruit sugar/acid ratio remains a mystery. In a prior study, we used an integrated systems biology tool to identify a group of 39 acid-associated genes from the fruit transcriptomes in four sweet orange varieties (Citrus sinensis L. Osbeck) with varying fruit acidity, Succari (acidless), Bingtang (low acid), and Newhall and Xinhui (normal acid). RESULTS: We reanalyzed the prior sweet orange fruit transcriptome data, leading to the identification of 72 genes highly correlated with the fruit sugar/acid ratio. The majority of these sugar/acid ratio-related genes are predicted to be involved in regulatory functions such as transport, signaling and transcription or encode enzymes involved in metabolism. Surprisingly, only three of these sugar/acid ratio-correlated genes are weakly correlated with sugar level and none of them overlaps with the acid-associated genes. Weighted Gene Coexpression Network Analysis (WGCNA) has revealed that these genes belong to four modules, Blue, Grey, Brown and Turquoise, with the former two modules being unique to the sugar/acid ratio control. CONCLUSION: Our results indicate that orange fruits contain a possible mechanistically distinct class of genes that may potentially be involved in maintaining fruit sugar/acid ratios and/or responding to the cellular sugar/acid ratio status. Therefore, our analysis of orange transcriptomes provides an intriguing insight into the potentially novel genetic or molecular mechanisms controlling the sugar/acid ratio in fruits.

Throughout life, rats emit ultrasonic vocalizations (USV) when confronted with an aversive situation. However, the conditions classically used to elicit USV vary greatly with the animal's age (isolation from the dam in infancy, versus nociceptive stimulation in adults). The present study is the first to characterize USV responses to the same aversive event throughout development. Specifically, infant, juvenile and adult rats were presented with mild foot-shocks and their USV frequency, duration, and relationship with respiration and behavior were compared. In juvenile and adult rats, a single class of USV is observed with an age-dependent main frequency and duration (30 kHz/400 ms in juveniles, 22 kHz/900 ms in adults). In contrast, infant rat USV were split into two classes with specific relationships with respiration and behavior: 40 kHz/300 ms and 66 kHz/21 ms. Next, we questioned if these infant USV were also emitted in a more naturalistic context by exposing pups to interactions with the mother treating them roughly. This treatment enhanced 40-kHz USV while leaving 66-kHz USV unchanged suggesting that the use of USV goes far beyond a signal studied in terms of amount of emission, and can inform us about some aspects of the infant's affective state.

BACKGROUND: ParentCorps is a family-centered enhancement to pre-kindergarten programming in elementary schools and early education centers. When implemented in high-poverty, urban elementary schools serving primarily Black and Latino children, it has been found to yield benefits in childhood across domains of academic achievement, behavior problems, and obesity. However, its long-term cost-effectiveness is unknown. METHODS: We determined the cost-effectiveness of ParentCorps in high-poverty, urban schools using a Markov Model projecting the long-term impact of ParentCorps compared to standard pre-kindergarten programming. We measured costs and quality adjusted life years (QALYs) resulting from the development of three disease states (i.e., drug abuse, obesity, and diabetes); from the health sequelae of these disease states; from graduation from high school; from interaction with the judiciary system; and opportunity costs of unemployment with a lifetime time horizon. The model was built, and analyses were performed in 2015-2016. RESULTS: ParentCorps was estimated to save $4387 per individual and increase each individual's quality adjusted life expectancy by 0.27 QALYs. These benefits were primarily due to the impact of ParentCorps on childhood obesity and the subsequent predicted prevention of diabetes, and ParentCorps' impact on childhood behavior problems and the subsequent predicted prevention of interaction with the judiciary system and unemployment. Results were robust on sensitivity analyses, with ParentCorps remaining cost saving and health generating under nearly all assumptions, except when schools had very small pre-kindergarten programs. CONCLUSIONS: Effective family-centered interventions early in life such as ParentCorps that impact academic, behavioral and health outcomes among children attending high-poverty, urban schools have the potential to result in longer-term health benefits and substantial cost savings.

Objectives: The goal of this session is to bring Clinical Perspectives and the eponymous JAACAP column "into life" by casting content from recent and forthcoming installments of the series into the popular "TED Talk" (Technology, Education, and Design Talk) format. Methods: Following the format first established at the 2014 Annual Meeting, this will be a 180-minute session co-moderated by JAACAP Editor-in-Chief Andres Martin and Assistant Editor for Clinical Perspectives Laura Prager. The session will start with a brief introduction providing the background, context, and "ground rules" for an effective TED Talk, including adherence to tight time limits and minimal use of audiovisual supports. The authors of five published or forthcoming Clinical Perspectives will then each present a 15-minute TED Talk of their respective articles. Each presentation will be followed by five minutes of interactive and moderated discussion. There will be a short break between speakers, allowing for a brief introduction. The session will end with overarching concluding remarks, time for discussion, and an invitation for new submissions. Results: All five presentations will discuss child psychiatric takes on topics of acute public health relevance and social concern that have been featured prominently in the lay media. Conclusions: Child and adolescent psychiatry is grounded in solid clinical practice, and it is from this clinical substrate that important research questions and hypotheses first arise. Clinical Perspectives provides a forum to consider and revisit clinical phenomena anew, a platform from which to reclaim the excitement that first drew us into our chosen field. The TED Talk format, which has been so successful in the global dissemination of Technology, Education, and Design ideas, can be successfully borrowed to reveal that child and adolescent psychiatry does indeed have (clinical) "ideas worth spreading."

Objectives: Schools have long been recognized as major centers for provision of almost universally available health education and services. Seventy to 80 percent of children and adolescents who do receive mental healthcare do so in the school setting. School-based telepsychiatry is an underutilized modality to mitigate the limited access to mental health services for many youth, especially in rural communities. Methods: During the presentation, we will provide a review of the literature regarding use of school-based telepsychiatry. We will then review the design and implementation of the New York University (NYU) school-based telepsychiatry program in partnership with the New York State Office of Mental Health, highlighting key features. Results: We will report on the characteristics of the schools and patients participating in the NYU school-based telepsychiatry program. We will describe the experience of patients and trainees with school-based telepsychiatry, including impediments and successeswithassessment and treatment.Data will beprovided for school-based telepsychiatry services completed since the program was piloted. We will discuss demographics, diagnostic composition, and treatments conducted, as well as clinician and patient/family satisfaction with the modality. Conclusions: Schools are an ideal location for healthcare education and provision. Follow-up for mental health services in schools is much higher than in traditional community mental health facilities. School-based telepsychiatry is a modality that can be successfully implemented in underserved areas to significantly enhance the availability of needed mental health services for children and adolescents. Focus on education for psychiatric trainees in the modality and development of formal curricula is of outmost importance as the modality continues to gain increased utilization

Objectives: This clinical perspectives session presents preliminary data on the outcomes of a clinical pathway (CP) for children and adolescents with autism spectrum disorder (ASD) or intellectual disability (ID) who were hospitalized in a general child psychiatric unit at a public hospital. Methods: Children with ASD are at greater risk of psychiatric hospitalization than their neurotypical peers. Although care in specialized psychiatry units has preliminary evidence for positive outcomes, the vast majority of children in the United States are treated in general units that are not designed for this challenging population. Review of best practices and expert consensus was used to design and implement a CP in three child and adolescent inpatient units at Bellevue Hospital Center. Fidelity to the CP was examined by use of a checklist. Retrospective chart review was used to identify patients eligible for the CP in the 18 months before implementation and compare outcomes (mean length of stay, use of intramuscular medications, and use of restraint) of patients exposed to the CP in the first 18 months of implementation. Results: Treatment fidelity to the CP was acceptable based on checklist review. Record review identified over 70 patients with ASD who were admitted in the 18 months before implementation. Of these patients, approximately 50 percent met CP eligibility criteria. Outcomes for these admissions were compared with outcomes for 30 admissions to the CP. Preliminary analysis indicated improved outcomes post-CP implementation. Conclusions: Expert consensus has indicated that expanded, targeted admission assessment; basic supports for functional communication; predictable routines; developmentally appropriate milieu of activities, including physical activities; and increased density of positive reinforcement are critical elements for effective inpatient care of children with ASD or ID. The design and pilot implementation of a clinical pathway using these elements at Bellevue Hospital Center over 18 months showed that it is feasible to incorporate these principles in a general inpatient child psychiatry unit and may improve outcomes

States are restructuring health care delivery with a focus on cost savings and care quality. Building on lessons learned from the first statewide roll-out of the NY State Managing and Adapting Practice (MAP) program, we targeted adaptations to the MAP trainings with the goal of addressing key factors related to clinician dropout. We describe these adaptations made to MAP version 2, using Damschroder et al.'s (2009) theoretical model of the consolidated Framework for Implementation Research (CFIR). our adaptations were connected with each of the five domains: intervention characteristics, outer setting (incentives and cost), inner setting (leadership/champions), characteristics of the individuals, and the process of training implementation (planning, engaging, executing, and reflecting and evaluating. Next, we compared dropout rates between MAP version 1 (v1) and MAP version 2 (v2). Because the structural adaptations aimed to increase retention rate by targeting factors hypothesized to be associated with empirically derived predictors of dropout, we expected that the dropout rate would be significantly lower in MAP v2. We then examined associations of clinician sociodemographic characteristics, clinical characteristics, and attitudes with dropout. Although older participant age was significantly associated with dropout in MAP v1, we hypothesized that participant age will not be a significant predictor of dropout in MAP v2 because MAP v2 adaptations focused on age-related factors. However, we expected clinic region, which is immutable, to remain a significant predictor of dropout.

Purpose The African American church has long been recognized as a valuable partner for health interventions in the community. While an extensive literature exists documenting the potential efficacy of diabetes education programs in church settings, there has yet to be an effort to leverage spiritual beliefs and practices to promote diabetes self-management and shared decision making within a faith-based framework that is culturally tailored to the African American church. The purpose of this article is to describe the translation of a clinic-based diabetes education program into faith-based education curriculum tailored for use in the African American church. Conclusions Themes extracted from focus groups and input from a faith-based community partner provided a methodical and patient-informed foundation for culturally tailoring and piloting a diabetes self-management curriculum for the African American church setting. This study illustrates how spirituality can be incorporated into interventions to enhance health promotion and behavioral change among African Americans with diabetes. Participants in our study described how religious beliefs play an active role in many aspects of diabetes care, including self-management behaviors, coping strategies, and patient/provider communication. In addition, this intervention can serve as a model for the development of patient-centered health interventions.

PURPOSE: The purpose of this review was to synthesize current knowledge about anxiety among adolescent survivors of pediatric cancer and highlights areas for future research. METHODS: Systematic literature searches were conducted in five databases for articles published anytime before December 28, 2015. Manuscripts were reviewed by a team of six coders. Included manuscripts reported outcomes relevant to anxiety, worry, and post-traumatic stress in survivors of pediatric cancer (age at the time of study: 10-22 years) who were off treatment. RESULTS: Twenty-four articles met inclusion criteria. Included results were categorized into the following domains: post-traumatic stress, anxiety, cancer-related worry, and interventions. With the exception of post-traumatic stress, there was little research about anxiety in this population; however, studies generally indicated that adolescent survivors of pediatric cancer are at elevated risk for anxiety, post-traumatic stress symptoms, and cancer-related worry. CONCLUSIONS: This review provides preliminary evidence that anxiety is a relevant, but understudied, psychosocial outcome for adolescent survivors of pediatric cancer. More research is needed to better understand the presentation of anxiety in this population, its effect on survivors' quality of life, and possible areas for intervention.