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Department/Unit:Child and Adolescent Psychiatry

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Mobile Health (mHealth): Building the Case for Adapting Emerging Technologies for Justice-Involved Youth [Editorial]

Bath, Eraka; Tolou-Shams, Marina; Farabee, David
The term justice-involved youth encompasses a broad range of youth. It can include youth who have not been detained and have been placed on probation or diversion programs, as well re-entry populations transitioning out of detention facilities or stated custody and placed on probation or parole. There are more than 1.3 million juvenile arrests per year, and on any given day there are 50,821 youth incarcerated in the United States. Of the 716,000 delinquency cases, probation is court-ordered for approximately half.1 Even among these youth who are supervised in the community, rates of mental health and substance use disorders are high, with more than two-thirds reporting substance use problems or other mental health disorders.2 However, these youth often have a hard time connecting to and staying in treatment,3 and recidivism is high-most commonly for failing to satisfy the myriad (and well intentioned) conditions of their probation.4 Dual diagnosis (ie, co-occurring psychiatric and substance use disorders) in justice-involved youth is one of the most significant predictors of recidivism,5 and, as such, closing the gap between need and receipt of substance use and mental health treatment for justice-involved youth could potentially offset rates of re-offending into adulthood.6 Despite high rates of mental health and substance use disorders among justice-involved adolescents, only 15% of detained youth receive mental health treatment for their condition(s); this number falls to 8% once these youth re-enter the community.7 These statistics regarding treatment receipt among justice-involved youth are important to consider not only from a health care perspective but also in terms of public health significance and policy.
PMID: 30522732
ISSN: 1527-5418
CID: 3610832

Gender Dysphoria in Childhood and Adolescence

Chapter by: Janssen, Aron; Busa, Samantha
in: Complex disorders in pediatric psychiatry : a clinician's guide by Driver, David; Thomas, Shari S (Eds)
St. Louis, Missouri : Elsevier, [2018]
pp. 1-10
ISBN: 0323511473
CID: 3574172

Maternal reflective functioning, interpersonal violence-related posttraumatic stress disorder, and risk for psychopathology in early childhood

Suardi, Francesca; Moser, Dominik Andreas; Sancho Rossignol, Ana; Manini, Aurélia; Vital, Marylène; Merminod, Gaëlle; Kreis, Axelle; Ansermet, François; Rusconi Serpa, Sandra; Schechter, Daniel Scott
The aim of this study was to examine associations between maternal mentalization, interactive behavior, and child symptoms in families in which mothers suffer from interpersonal violence-related posttraumatic stress disorder (IPV-PTSD). Fifty-six mothers and children (aged 12-42 months) including mothers with a diagnosis of IPV-PTSD were studied. Mentalization was measured by the Parental Reflective Functioning (PRF) Scale. Interactive behavior during free-play was measured via the CARE-Index. Child symptoms were measured by the Infant-Toddler Social and Emotional Assessment (ITSEA). Data analyses included non-parametric correlations and multiple linear regression. Results showed that lower IPV-PTSD and higher Maternal Reflective Functioning (MRF) were related to greater maternal sensitivity. Lower MRF and greater controlling behavior were related to child dysregulation. MRF was found to be lower in the subgroup of IPV-PTSD when the child's father was the perpetrator of IPV. Both MRF and interactive behavior are thus likely to be important targets for intervention during sensitive periods of early social-emotional development.
PMID: 30560713
ISSN: 1469-2988
CID: 3556972

4D Continuous Medial Representation Trajectory Estimation for Longitudinal Shape Analysis

Hong, S; Fishbaugh, J; Gerig, G
Morphological change of anatomy over time has been of great interest for tracking disease progression, aging, and growth. Shape regression methods have shown great success to model the shape changes over time to create a smooth and representative shape trajectory of sparsely scanned medical images. Shape changes modeled by shape regression methods can be affected by pose changes of shapes caused by neighboring anatomies. Such pose changes can cause informative local shape changes to be obscured and neglected in longitudinal shape analysis. In this paper, we propose a method that estimates a continuous trajectory of medial surfaces with correspondence over time to track longitudinal pose changes and local thickness changes separately. A spatiotemporally continuous medial surface trajectory is estimated by integrating velocity fields from a series of continuous medial representations individually estimated for each shape in a continuous 3D shape trajectory. The proposed method enables straightforward analysis on continuous local thickness changes and pose changes of a continuous multi-object shape trajectory. Longitudinal shape analysis which makes use of correspondence and temporal coherence of the estimated continuous medial surface trajectory is demonstrated with experiments on synthetic examples and real anatomical shape complexes
SCOPUS:85057431716
ISSN: 0302-9743
CID: 3566362

Intergenerational Transmission of DNA Methylation Signatures Associated with Early Life Stress

Stenz, Ludwig; Schechter, Daniel S; Serpa, Sandra Rusconi; Paoloni-Giacobino, Ariane
Early life stress in humans (i.e. maltreatment, violence exposure, loss of a loved one) and in rodents (i.e. disrupted attachment or nesting, electric shock, restraint, predator odor) occurs during critical steps of neural circuit formation. ELS in humans is associated with increased risk for developmental psychopathology, including anxious and depressive phenotypes. The biological mechanisms underlying these potentially persistent maladaptive changes involve long-term epigenetic modifications, which have been suggested to be potentially transmissible to subsequent generations. DNA methylation is an epigenetic mechanism that modifies gene expression patterns in response to environmental challenges and influences mutation rates. It remains to be seen whether a functionally relevant fraction of DNA methylation marks can escape genome-wide erasures that occur in primordial germ cells and after fertilization within the zygote. Early life-stress-triggered changes in epigenetic mediated transmission of acquired behavioral traits among humans have been assessed mainly by targeting genes involved in the hypothalamic-pituitary-adrenal (HPA) axis, such as NR3C1 and FKBP5. Recently, researchers examining epigenetic transmission have begun to apply genome-wide approaches. In humans, reduced representation bisulfite sequencing (RRBS) was performed on peripheral samples that were obtained from individuals who were prenatally exposed to the "Dutch Hunger Winter", resulting in two Differentially Methylated Regions (DMRs) in INSR and CPTIA genes that were functionally, biologically and technically validated, and significantly associated with birth weights and LDL cholesterol levels in offspring. In rodents, non-genomic intergenerational transmission of anxiety which was associated with differentially methylated enhancers that were putatively involved in lipid signaling and synaptic/neurotransmission in hippocampal granule cells, was discovered also using RRBS. Finally, transgenerational transmission of altered behaviors was associated with sperm-derived microRNAs produced by ELS male mice. The field of epigenetic transmission is just beginning to enter the epigenomic era by using genome-wide analyses. Such approaches remain of strong interest to human studies, first in order to help to assess the relevance of the previous targeted studies, and second to discover new important epigenetic modifications of potential clinical importance. New discoveries may help to assess how transmittable the negative impact of stress may be to offspring. The latter may open doors for future treatments and resilience-promoting interventions, as well as new approaches to treat the effects of childhood trauma before the onset of psychiatric disorder.
PMCID:6225454
PMID: 30532646
ISSN: 1389-2029
CID: 3556272

Constructing treatment decision rules based on scalar and functional predictors when moderators of treatment effect are unknown

Ciarleglio, Adam; Petkova, Eva; Ogden, Todd; Tarpey, Thaddeus
Treatment response heterogeneity poses serious challenges for selecting treatment for many diseases. To better understand this heterogeneity and to help in determining the best patient-specific treatments for a given disease, many clinical trials are collecting large amounts of patient-level data prior to administering treatment in the hope that some of these data can be used to identify moderators of treatment effect. These data can range from simple scalar values to complex functional data such as curves or images. Combining these various types of baseline data to discover "biosignatures" of treatment response is crucial for advancing precision medicine. Motivated by the problem of selecting optimal treatment for subjects with depression based on clinical and neuroimaging data, we present an approach that both (1) identifies covariates associated with differential treatment effect and (2) estimates a treatment decision rule based on these covariates. We focus on settings where there is a potentially large collection of candidate biomarkers consisting of both scalar and functional data. The validity of the proposed approach is justified via extensive simulation experiments and illustrated using data from a placebo-controlled clinical trial investigating antidepressant treatment response in subjects with depression.
PMCID:6287762
PMID: 30546161
ISSN: 0035-9254
CID: 3556342

Diffusional kurtosis imaging of the corpus callosum in autism

Sui, Yu Veronica; Donaldson, Jeffrey; Miles, Laura; Babb, James S; Castellanos, Francisco Xavier; Lazar, Mariana
Background/UNASSIGNED:The corpus callosum is implicated in the pathophysiology of autism spectrum disorder (ASD). However, specific structural deficits and underlying mechanisms are yet to be well defined. Methods/UNASSIGNED:) diffusivities, which reflect myelination and microstructural organization of the extracellular space. The relationships between DKI metrics and processing speed, a cognitive feature known to be impaired in ASD, were also examined. Results/UNASSIGNED: > .05). Conclusion/UNASSIGNED:Decreased DKI metrics suggested that ASD may be associated with axonal deficits such as reduced axonal caliber and density in the corpus callosum, especially in the mid and posterior callosal areas. These data suggest that impaired interhemispheric connectivity may contribute to decreased processing speed in ASD participants.
PMCID:6293510
PMID: 30559954
ISSN: 2040-2392
CID: 3556472

Developmental and neurobehavioral transitions in survival circuits [Review]

Sullivan, Regina M.; Opendak, Maya
Although animals of all ages experience threats, the neurobehavioral response to threat shows fundamental changes across development in altricial species, including humans and rodents. Although the mature animal has an arsenal of defensive strategies to engage, including attack, escape, hide or freeze, the motorically immature infant exhibits age-appropriate responses to threats that involve approach to the caregiver for protection. The neurobiology supporting this difference relies on both the immature state of the infant brain and neural networks specifically adapted to its unique environmental niche. Using examples from innate threats, we review the development of threat survival circuit neurobiology to illustrate developmental transitions and the important role of the caregiver in controlling the infant's neurobehavioral response to threat.
ISI:000451771300009
ISSN: 2352-1546
CID: 3545072

QuilliChew extended-release chewable tablets for the treatment of ADHD in patients ages 6 years old and above

Childress, Ann; Ponce De Leon, Bernice; Owens, Mark
INTRODUCTION/BACKGROUND:(MPH-ERCT) is an ER methylphenidate designed to be chewed before swallowing. The technology and pharmacokinetics, along with efficacy and safety data, are presented. Expert opinion: Extensive safety and efficacy data exist for MPH. ER formulations can be distinguished by preparation (tablet, capsule, liquid) and onset and duration of effect, but efficacy is similar for all ER MPH products. Each formulation has attributes, such as ease of titration, portability, and taste, that make it more acceptable for certain patients. Because AMPH and MPH are so effective, current technology research is focused on improving safety, convenience, and onset and duration of effect.
PMID: 30404549
ISSN: 1744-7593
CID: 3543002

Aging out or continuing on? Exploring strategies to prepare marginalized youth for a transition to recovery in adulthood

Manuel, Jennifer I; Munson, Michelle R; Dino, Mary; Villodas, Melissa L; Barba, Antonia; Panzer, Paula G
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).
PMID: 30507240
ISSN: 1559-3126
CID: 3520212