Faculty Bibliography
Searched for:
Department/Unit:Child and Adolescent Psychiatry
Total Results:
11618
Child & adolescent psychiatric clinics of North America. 2018:27(3):357-365.DOI: 10.1016/j.chc.2018.02.001
The State of Emergency Child and Adolescent Psychiatry: Raising the Bar
The current state of emergency child and adolescent psychiatry includes common historical challenges to safe and effective care as well as recent innovations in multiple settings that increase the quality of that care. These include (1) enhancements within pediatric emergency departments (EDs), (2) specialized and dedicated child psychiatry emergency programs that are hospital based, (3) telepsychiatry programs that spread access to child psychiatric evaluation and treatment planning, and (4) community-based mobile programs diverting youth from EDs. Together, these highlight the work in North America over the past 5Â years to improve the care of youth in psychiatric crisis.
PMID: 29933787
ISSN: 1558-0490
CID: 3158392
Abnormal Serotonin Levels During Perinatal Development Lead to Behavioral Deficits in Adulthood
Serotonin (5-HT) is one of the best-studied modulatory neurotransmitters with ubiquitous presynaptic release and postsynaptic reception. 5-HT has been implicated in a wide variety of brain functions, ranging from autonomic regulation, sensory perception, feeding and motor function to emotional regulation and cognition. The role of this neuromodulator in neuropsychiatric diseases is unquestionable with important neuropsychiatric medications, e.g., most antidepressants, targeting this system. Importantly, 5-HT modulates neurodevelopment and changes in its levels during development can have life-long consequences. In this mini-review, we highlight that exposure to both low and high serotonin levels during the perinatal period can lead to behavioral deficits in adulthood. We focus on three exogenous factors that can change 5-HT levels during the critical perinatal period: dietary tryptophan depletion, exposure to serotonin-selective-reuptake-inhibitors (SSRIs) and poor early life care. We discuss the effects of each of these on behavioral deficits in adulthood.
PMCID:5997829
PMID: 29928194
ISSN: 1662-5153
CID: 3157662
Analysis of shared heritability in common disorders of the brain
Disorders of the brain can exhibit considerable epidemiological comorbidity and often share symptoms, provoking debate about their etiologic overlap. We quantified the genetic sharing of 25 brain disorders from genome-wide association studies of 265,218 patients and 784,643 control participants and assessed their relationship to 17 phenotypes from 1,191,588 individuals. Psychiatric disorders share common variant risk, whereas neurological disorders appear more distinct from one another and from the psychiatric disorders. We also identified significant sharing between disorders and a number of brain phenotypes, including cognitive measures. Further, we conducted simulations to explore how statistical power, diagnostic misclassification, and phenotypic heterogeneity affect genetic correlations. These results highlight the importance of common genetic variation as a risk factor for brain disorders and the value of heritability-based methods in understanding their etiology.
PMCID:6097237
PMID: 29930110
ISSN: 1095-9203
CID: 3157462
Child & adolescent psychiatric clinics of North America. 2018:27(3):455-465.DOI: 10.1016/j.chc.2018.02.007
Social Services and Behavioral Emergencies: Trauma-Informed Evaluation, Diagnosis, and Disposition
The emergency department's role in a psychiatric crisis is to assess for safety, provide crisis interventions, reach a diagnosis, make decisions about disposition and treatment, and provide linkage to the next level of care within the hospital or in the community. The evaluation of children and adolescents involved in the child welfare system brings numerous additional challenges to this already-complex environment, including familial and systemic issues and an almost ubiquitous history of trauma. This article endeavors to increase understanding of child welfare-related issues and provides insight toward using a more trauma-informed and comprehensive approach that incorporates all these factors.
PMID: 29933794
ISSN: 1558-0490
CID: 3158412
Child & adolescent psychiatric clinics of North America. 2018:27(3):367-386.DOI: 10.1016/j.chc.2018.02.002
Crisis in the Emergency Department: The Evaluation and Management of Acute Agitation in Children and Adolescents
Acute agitation in children and adolescents in the emergency department carries significant risks to patients and staff and requires skillful management, using both nonpharmacologic and pharmacologic strategies. Effective management of agitation requires understanding and addressing the multifactorial cause of the agitation. Careful observation and multidisciplinary collaboration is important. Medical work-up of agitated patients is also critical. Nonpharmacologic deescalation strategies should be first line for preventing and managing agitation and should continue during and after medication administration. Choice of medication should focus on addressing the cause of the agitation and any underlying psychiatric syndromes.
PMID: 29933788
ISSN: 1558-0490
CID: 3158402
Implementing evidence-based psychotherapies for children and adolescents within complex mental health systems
New York, NY, US: Guilford Press, 2018
pp. 466-483
ISBN: 978-1-4625-2269-9
CID: 3155642
Are ADHD medications under or over prescribed worldwide?: Protocol for a systematic review and meta-analysis
INTRODUCTION/BACKGROUND:Attention-Deficit/Hyperactivity Disorder (ADHD) is a common neurodevelopmental disorder, characterized by age inappropriate and impairing levels of inattention and/or hyperactivity/impulsivity. Pharmacotherapy is an important part of the ADHD multimodal treatment. The extent to which ADHD is pharmacologically over or under treated worldwide is controversial. We aimed to estimate the pooled worldwide rate of ADHD pharmacological treatment in individuals with and without the disorder. METHOD AND ANALYSIS/UNASSIGNED:We will include published or unpublished studies reporting the rates of ADHD pharmacological treatment in participants with and without ADHD of any age group. Population-based, cohort, or follow-up studies, as well as data from insurance health system and third-party reimbursements will be eligible. Searches will be performed in a large number of electronic databases, including Medline, Embase, CINAHL, Cochrane, PsycINFO, Web of Science, and Scopus. The primary outcome will be the prevalence of ADHD pharmacological treatment in individuals with ADHD and without ADHD. Two independent reviewers will perform the screening, and data extraction process. Study quality/bias will be assessed with the Newcastle-Ottawa scale by 2 independent reviewers. To test the robustness of the findings, we will perform a series of sensitivity and meta-regression analysis. Analyses will be performed with R and STATA software. ETHICS AND DISSEMINATION/UNASSIGNED:No IRB approval will be necessary. The results of this systematic review and meta-analysis will be presented at international conferences and published in peer-reviewed journals. REGISTRATION AND STATUS/UNASSIGNED:PROSPERO 2018 CRD42018085233.
PMCID:6023876
PMID: 29901582
ISSN: 1536-5964
CID: 3154812
Variety Wins: Soccer-Playing Robots and Infant Walking
Although both infancy and artificial intelligence (AI) researchers are interested in developing systems that produce adaptive, functional behavior, the two disciplines rarely capitalize on their complementary expertise. Here, we used soccer-playing robots to test a central question about the development of infant walking. During natural activity, infants' locomotor paths are immensely varied. They walk along curved, multi-directional paths with frequent starts and stops. Is the variability observed in spontaneous infant walking a "feature" or a "bug?" In other words, is variability beneficial for functional walking performance? To address this question, we trained soccer-playing robots on walking paths generated by infants during free play and tested them in simulated games of "RoboCup." In Tournament 1, we compared the functional performance of a simulated robot soccer team trained on infants' natural paths with teams trained on less varied, geometric paths-straight lines, circles, and squares. Across 1,000 head-to-head simulated soccer matches, the infant-trained team consistently beat all teams trained with less varied walking paths. In Tournament 2, we compared teams trained on different clusters of infant walking paths. The team trained with the most varied combination of path shape, step direction, number of steps, and number of starts and stops outperformed teams trained with less varied paths. This evidence indicates that variety is a crucial feature supporting functional walking performance. More generally, we propose that robotics provides a fruitful avenue for testing hypotheses about infant development; reciprocally, observations of infant behavior may inform research on artificial intelligence.
PMCID:5954208
PMID: 29867427
ISSN: 1662-5218
CID: 3154362
Explicit and Implicit Positive Illusory Bias in Children With ADHD
OBJECTIVE:Children with ADHD overestimate their own social and behavioral competence when using explicit self-report measures, a phenomenon known as Positive Illusory Bias (PIB). This study examined whether children with ADHD show PIB when self-perceptions are measured implicitly, reflecting associations that are relatively difficult to consciously control. METHOD/METHODS:Participants were 23 children (ages 6.8-9.8) with ADHD and 55 typically developing (TD) children. Children's explicit self-perceptions of competence were measured via self-report on the Self-Perception Profile for Children; their implicit associations were assessed using an Implicit Association Test. Parent and teacher ratings formed an adult-reported composite indicator of children's competence, to which children's self-perceptions were compared. RESULTS:Children with ADHD overestimated their competence as compared with adult-informant reports on both explicit and implicit measures, whereas TD children tended to be accurate. CONCLUSION/CONCLUSIONS:Inflated self-perceptions in children with ADHD may exist on an implicit level outside of conscious awareness.
PMID: 26534927
ISSN: 1557-1246
CID: 3149912
The independent and interacting effects of socioeconomic status and dual-language use on brain structure and cognition
Family socioeconomic status (SES) is strongly associated with children's cognitive development, and past studies have reported socioeconomic disparities in both neurocognitive skills and brain structure across childhood. In other studies, bilingualism has been associated with cognitive advantages and differences in brain structure across the lifespan. The aim of the current study is to concurrently examine the joint and independent associations between family SES and dual-language use with brain structure and cognitive skills during childhood. A subset of data from the Pediatric Imaging, Neurocognition and Genetics (PING) study was analyzed; propensity score matching established an equal sample (N = 562) of monolinguals and dual-language users with similar socio-demographic characteristics (Mage = 13.5, Range = 3-20 years). When collapsing across all ages, SES was linked to both brain structure and cognitive skills. When examining differences by age group, brain structure was significantly associated with both income and dual-language use during adolescence, but not earlier in childhood. Additionally, in adolescence, a significant interaction between dual-language use and SES was found, with no difference in cortical surface area (SA) between language groups of higher-SES backgrounds but significantly increased SA for dual-language users from lower-SES families compared to SES-matched monolinguals. These results suggest both independent and interacting associations between SES and dual-language use with brain development. To our knowledge, this is the first study to concurrently examine dual-language use and socioeconomic differences in brain structure during childhood and adolescence.
PMID: 29877603
ISSN: 1467-7687
CID: 3149632
