Faculty Bibliography

Youth with developmental disabilities (DD) are often at increased suicide risk. However, clinician guidance on suicide prevention practices specific to the DD population is rarely available, which may result in care disparities. The current study examined whether rates of standard suicide risk screening in two pediatric emergency departments (ED) differed for youth with and without DD. Then, using data from a NIMH-funded initiative, we compared youth with and without DD on demographic, visit, and clinical characteristics to identify possible factors related to differences in screening rates. Disparities in the completion of suicide risk screening with youth with DD were identified in standard care but few differences were found across groups to suggest a rationale, holding important clinical and research implications.

Decades of research on the developmental origins of health and disease highlight how prenatal and perinatal conditions are associated with long-term neurocognitive development. Exposures such as maternal stress, substance use, metabolic disorders, obstetric complications, low birthweight, and preterm birth have been linked to differences in brain, cognition, and mental health. Yet, most prior studies have been limited by small sample sizes, narrow exposure measures, or isolated outcomes. The Adolescent Brain Cognitive Development (ABCD) Study provides an unparalleled opportunity to overcome these limitations with nearly 12,000 children recruited at ages 9-10 across the United States, followed longitudinally with harmonized multimodal MRI, cognitive and behavioral testing, biospecimens, genetic data, and rich environmental measures in a diverse cohort. Retrospective caregiver reports provide key prenatal and perinatal information, which can be prospectively related to neurodevelopmental outcomes across adolescence. This review synthesizes findings from 111 ABCD-based studies published from 2017 to 2026. Results implicate maternal health conditions, substance use, birth outcomes, and cumulative adversity as being associated with variation in brain, cognitive, and behavioral development. Leveraging its size and diversity, ABCD has fostered advanced analytic approaches, such as multimodal integration of imaging and behavioral data, and longitudinal tracking of developmental trajectories, rarely possible elsewhere. While methodological challenges remain, including retrospective reporting and imaging site variability, ABCD offers unique opportunities to clarify pathways of vulnerability and resilience within an observational framework. Insights from this work can inform public health strategies and guide policies to reduce prenatal risks and strengthening early-life environments to optimize developmental outcomes.

BACKGROUND AND OBJECTIVE/OBJECTIVE:Randomised controlled trials (RCTs) have demonstrated that pharmacotherapy reduces symptoms of attention-deficit/hyperactivity disorder (ADHD) at a group level, but efficacy and tolerability vary across individuals. Clinico-demographic characteristics may act as predictors and/or moderators of treatment efficacy and tolerability, but systematic evidence remains limited. Therefore, we systematically analysed RCTs of ADHD medications to identify potential demographic and clinical predictors/moderators of efficacy and tolerability across the lifespan. METHODS:Randomised controlled trials were identified from the MED-ADHD database ( https://med-adhd.org/ ), a repository of RCTs of medications for ADHD in children, adolescents and adults. The database is based on systematic searches of multiple electronic sources, including PubMed, BIOSIS Previews, CINAHL, the Cochrane Central Registry of Controlled Trials and EMBASE, and is also complemented by unpublished data obtained from manufacturers and study authors. We used the most recent (2026) version of MED-ADHD. The risk of bias was assessed using the revised Cochrane risk-of-bias tool (RoB 2). RESULTS:Among the 171 RCTs screened, 62 assessed clinico-demographic factors as possible predictors or moderators of treatment efficacy and tolerability. Age was the most examined characteristic (56.4%) followed by, among the top five, psychiatric comorbidities (53.2%), sex (46.8%), baseline ADHD symptom severity (27.4%), and ADHD presentation (24.2%). Most RCTs reported no significant findings although there was preliminary evidence of associations with age (17.7%), psychiatric comorbidities (17.7%), baseline ADHD symptom severity (16.1%), sex (11.3%), and ADHD presentation (4.8%). Risk of bias was rated high in 37% of RCTs. CONCLUSIONS:Stringent sample selection and reliance on group-level analyses may limit the power to detect predictors and moderators of treatment efficacy and tolerability in classical RCTs. Consequently, the current evidence provides limited and inconsistent guidance on clinically meaningful predictors/moderators. However, variables such as age, psychiatric comorbidities, sex, baseline severity and ADHD presentation have been the most frequently examined with positive findings and may hold promise. Future research should prioritise individual participant data meta-analyses of RCTs, alongside well-powered analyses of a comprehensive observational dataset, to more robustly investigate these associations and support treatment stratification through predictive models.

OBJECTIVES/OBJECTIVE:To systematically evaluate the certainty of evidence for treatment strategies across age groups and mood phases in bipolar disorder, and develop an open access web platform to facilitate shared decision making. DESIGN/METHODS:Living umbrella review, evaluation, analysis, and communication hub (U-REACH) project. DATA SOURCES/METHODS:PubMed, PsycInfo, and Cochrane library databases, from inception to 19 November 2024. ELIGIBILITY CRITERIA FOR SELECTING STUDIES/METHODS:Systematic reviews with network or pairwise meta-analyses of randomised controlled trials of pharmacological, nutraceutical, psychosocial, brain stimulation, or circadian rhythm based treatments, administered as monotherapy (without concurrent interventions), augmentation treatment (interventions added to an ongoing treatment regimen), or combination treatment (simultaneous initiation of two different interventions), examining any age group, bipolar disorder phase (ie, acute bipolar depression, mania or mixed episodes, or maintenance), treatment, control, or outcome. RESULTS:77 studies met the inclusion criteria (21 network meta-analyses and 56 pairwise meta-analyses), including 116 unique pharmacological (n=74), brain stimulation (n=18), nutraceutical (n=13), psychosocial (n=8), and circadian rhythm based (n=3) treatments as monotherapy, augmentation, or combination therapy, along with five control interventions. These studies covered 133 unique outcomes (45 efficacy outcomes and 88 safety outcomes) resulting in 2510 meta-analyses with Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) ratings of the certainty of the evidence as high (n=236), moderate (n=827), low (n=986), and very low (n=461). A communication hub, the Evidence Based Interventions for Bipolar Disorder (EBI-BD) platform, was developed and the full results are freely available (https://ebibd-database.org), including the preference based tool (12 interventions and 17 safety outcomes). Interventions effective across outcomes varied by phases. For bipolar depression, effective interventions in adults were cariprazine, divalproex or valproate, fluoxetine, ketamine (augmentation), lamotrigine, lumateperone, lurasidone, olanzapine, olanzapine with fluoxetine, and quetiapine, whereas effective interventions in children and adolescents were lurasidone and olanzapine with fluoxetine. For mania episodes, effective interventions in adults were aripiprazole, asenapine, carbamazepine, cariprazine, divalproex or valproate, haloperidol, lithium, olanzapine, paliperidone, quetiapine (also augmentation), risperidone (also as augmentation), tamoxifen, and ziprasidone, whereas effective interventions in children and adolescents were aripiprazole, asenapine, olanzapine, quetiapine, and risperidone. For maintenance, interventions effective across outcomes in adults were aripiprazole (also the long acting injectable formulation), asenapine, divalproex or valproate, lithium, olanzapine, group psychoeducation (augmentation), quetiapine, and risperidone long acting injectable formulation. Interventions effective across phases were aripiprazole (also as augmentation and as a long acting injectable formulation), asenapine, cariprazine, cognitive behavioural therapy (augmentation), divalproex or valproate, lamotrigine, lithium, olanzapine (also as augmentation), paliperidone, quetiapine (also as augmentation), and risperidone (also as augmentation and the long acting injectable formulation) (adults). Treatment effects by neuroscience based nomenclature classes are also reported. CONCLUSIONS:The EBI-BD tool can help clinicians make evidence based, personalised treatment decisions for bipolar disorder. This resource can inform clinical guidelines and provides a foundation for continuously improving bipolar disorder care as new evidence emerges. TRIAL REGISTRATION/BACKGROUND:Open Science Framework https://osf.io/pjmvn/ READERS' NOTE: This is a living systematic review and may be updated in the next two years if additional evidence emerges.

BACKGROUND/UNASSIGNED:Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder that often persists into adulthood, negatively impacting occupational, social, and economic outcomes. The Adult ADHD Investigator Symptom Rating Scale (AISRS) is a clinician-administered tool designed to evaluate ADHD symptom severity and treatment response. However, a validated Japanese version is not available. This study evaluated the reliability and convergent validity of the Japanese version of the AISRS (AISRS-Japanese) in adults with ADHD. METHODS/UNASSIGNED:Following linguistic validation procedures, the AISRS was translated into Japanese and reviewed by clinicians for conceptual and clinical equivalence. This was a multicenter, longitudinal, non-interventional study assessing the psychometric properties of the AISRS-Japanese. The evaluation instruments were the AISRS-Japanese, the Adult ADHD Self-Report Scale (ASRS-Japanese version), and the Clinical Global Impressions-Severity (CGI-S) scale. Reliability assessments included internal consistency (Cronbach's alpha), test-retest, intra-rater, and inter-rater reliability (intraclass correlation coefficient [ICC] and G(q,k) coefficients). Convergent validity was evaluated via Pearson's correlation between AISRS-Japanese and ASRS-Japanese version scores. RESULTS/UNASSIGNED:In total, 61 adults with ADHD were included in the analysis. The mean age of the study participants was 34 years, 52.5% (32/61) were male, and 75.4% (46/61) were moderately ill (CGI-S score of 4). The AISRS-Japanese demonstrated internal consistency for the total scale (Cronbach's alpha = 0.83) and the hyperactivity/impulsivity and inattention subscales (0.76 and 0.75, respectively). Test-retest reliability was good (ICC: total, 0.77; hyperactivity/impulsivity, 0.79; inattention, 0.83), as was intra-rater reliability (ICC: total, 0.76; hyperactivity/impulsivity, 0.77; inattention, 0.83). Inter-rater reliability was excellent (G(q,k): total, 0.96; hyperactivity/impulsivity, 0.97; inattention, 0.96). Convergent validity of the ASRS-Japanese version was high (correlation coefficient: total, 0.89; hyperactivity/impulsivity, 0.88; inattention, 0.84). CONCLUSION/UNASSIGNED:These results provide evidence supporting the reliability and convergent validity of AISRS-Japanese as a semi-structured tool for assessing ADHD symptoms in Japanese adults.

BACKGROUND:Parents in the United Kingdom seeking an assessment for attention-deficit/hyperactivity disorder (ADHD) for their child experience a significant wait before receiving an appointment with Child and Adolescent Mental Health Services (CAMHS), yet little has been written on how parents experience this period. Through qualitative interviews, we sought to understand how the period of waiting from being accepted onto a service waitlist and receiving a diagnostic assessment impacts parents and their children. METHOD:The study was nested within a large randomised controlled trial. We conducted semi-structured interviews with 41 parents of children aged 5-11 years. 30% of parents had waited between 18 and 24 months on a CAMHS waitlist, with 10% waiting more than 2 years. Reflexive thematic analysis was used to analyse data. RESULTS:At the point of the interview, around 50% of children were still waiting for an initial assessment. Six themes reflecting parents' uncertainty around the assessment process, lack of communication from services, the importance of receiving a diagnosis, difficulty accessing support and the negative impact of waiting on mental health and education, as well as recommendations to improve communication between services and families, emerged. CONCLUSION:Parents recognised the pressures on services to offer timely support; however, their well-being could be substantially improved by more clarity around wait times, as well as more effective signposting and support from services concerning the assessment process. This may help alleviate some of the stressors associated with their child's assessment journey, such as feeling responsible for their child's difficulties and the burden of supporting their educational needs. PATIENT AND PUBLIC CONTRIBUTION:This study was nested within the OPTIMA trial, where PPI panel members provided ongoing support in various aspects of the study, including advising on participant communication, study design and data analysis. All PPI members have lived experience of having a neurodivergent child. For this study, the PPI co-produced the interview schedule and took part in transcript analysis using a thematic framework approach. To acknowledge their contributions, members of the PPI panel are included as co-authors.

Large language models (LLMs) have shown increasing promise in the mental health field. LLMs are especially well suited to play a role in the labor-intensive, costly process of clinical assessment, as they can interact with a patient or participant directly to conduct a mental health assessment. We conducted a preregistered scoping review to (a) describe the unique capabilities of LLMs for clinical assessment, (b) determine the current state of the field in applying LLMs to directly assess patient/participant mental health (including screening, diagnosis, and monitoring of symptoms), and (c) highlight future research to facilitate the application of LLMs. We included work published in both Chinese and English. Only 10 studies met criteria for direct LLM-based mental health assessment. The evidence base was recent and heterogeneous: Four studies focused primarily on diagnostic interviewing or classification, five on symptom or severity assessment, and one on task-based multimodal depression assessment. Studies varied across text, voice, and multimodal formats, and depression was the dominant target. Across studies, stronger performance tended to be reported in tools that used structured interviewing logic, domain-specific adaptation, and clinically anchored reference standards. However, the evidence base remains small, with many studies employing limited validation procedures, and heavily weighted toward early-stage or nonjournal publications. The limited pace of academic validation means that, at present, LLMs are best understood as emerging assessment-support tools rather than replacements for clinical evaluation. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

IMPORTANCE/UNASSIGNED:Public concern and speculation have emerged around a possible link between neonatal male circumcision (NMC) and autism spectrum disorder (ASD). Evidence is limited and inconsistent. OBJECTIVE/UNASSIGNED:To examine associations between NMC and child ASD and autism-related traits and behaviors. DESIGN, SETTING, AND PARTICIPANTS/UNASSIGNED:This prospective cohort study was conducted among cohort sites participating in the Environmental Influences on Child Health Outcomes (ECHO) Cohort between February 2003 and September 2025. Statistical analyses were conducted from November 2025 to February 2026. The analysis included male, singleton children with data on NMC status and child ASD. EXPOSURE/UNASSIGNED:NMC status within 28 days of birth at a medical facility. MAIN OUTCOMES AND MEASURES/UNASSIGNED:ASD diagnosis was based on parent report of diagnosis by a medical professional or documentation of criterion standard clinical assessments. Social Responsiveness Scale (SRS-2) T-scores assessed the presence and distribution of autism traits, and Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) Autism Spectrum Problems subscale T-scores from the Child Behavior Checklist (CBCL) 1.5/5 assessed the occurrence of child autism-related behaviors. RESULTS/UNASSIGNED:The sample included 2771 male children from 14 ECHO sites, of whom 1840 (66%) were circumcised before hospital discharge, and 192 (7%) had an autism diagnosis. Among 1840 circumcised males, 108 (6%) had autism, compared with 84 of 931 uncircumcised males (9%). Mean (SD) age at autism diagnosis was 3.8 (2.2) years. Among circumcised males, 31 (4%) were administered acetaminophen during the procedure, and 128 (7%) within the 30 days after birth. After adjusting for confounders, there was no association between NMC and ASD diagnosis (odds ratio [OR], 0.83; 95% CI, 0.59-1.17). After stratification by region, preterm birth, and neonatal intensive care unit admission, an inverse or no association was observed between NMC and ASD diagnosis. Adjusted analyses showed no associations between NMC and SRS-2 continuous (β = -0.62; 95% CI, -1.46 to 0.22) or binary (OR, 0.75; 95% CI, 0.48-1.15) T-scores. Similarly, no associations were observed between NMC and CBCL 1.5/5 continuous (β = 0.01; 95% CI, -0.54 to 0.56) or binary (OR, 1.30; 95% CI, 0.75-2.26) T-scores. Overall, inverse or no associations were observed across all strata for SRS-2 and CBCL 1.5/5 outcomes. CONCLUSIONS AND RELEVANCE/UNASSIGNED:This cohort study yielded no evidence that NMC was associated with ASD risk, whether assessed by parent report of medical professional diagnosis or validated instruments measuring autism-related traits and behavior. These findings may provide reassurance for families who are considering or have elected NMC for their child.

INTRODUCTION/UNASSIGNED:Young Black children experience poorer sleep health than children from other racial/ethnic groups. Tailored family-centered interventions are needed to improve sleep health among young Black children. Tailoring requires information about parent perceptions, practices and context. The purpose of this study was to (1) understand the contextual definition of sleep health for Black families; (2) bedtime routines and sleep practices among Black families; and (3) parent preferences that may inform intervention design. METHODS/UNASSIGNED:We engaged 30 Black parents of 3-8-year-old children with mild sleep problems (e.g., child takes >30 min to fall asleep at bedtime) in this study. Parents completed three ratings scales about sleep health practices and child bedtime behavior and a semi-structured interview. Statistical analysis included descriptive statistics and correlations. We used an implementation science rapid qualitative analysis approach to analyze qualitative data from the interviews. RESULTS/UNASSIGNED:The final sample identified as 52% African-American, 14% Jamaican, 10% Haitian, and 26% mixed multi-ethnic groups. Parent mean age was 41 years and child mean age were 5 years old. About 80% of responders were women. About one-third of the sample held a doctoral degree, and half the sample had a bachelor's or Master's degree. Parents answered 56% of sleep knowledge questions accurately (ranging from 32 to 100%) and reported an average of two sleep problems. Parents described healthy sleep as involving flexibility in sleep timing and bedtime routines. More than half of parents reported co-sleeping practices, with reasons ranging from a strategy to address night wakings, to a way to preserve bonding. Later child bedtime (after 9 pm) was associated with bedtime resistance, permissive parenting, and parent stress. Many parents reported that they had poor sleep quality and duration. DISCUSSION/UNASSIGNED:Findings elucidate a range of factors to consider in tailoring sleep health interventions for Black families of young children. These include the common practice of co-sleeping, parents' value for flexibility related to bedtime and bedtime routines, and parents' own challenges with getting enough and good quality sleep. Tailored family-centered interventions will benefit from considering these factors.