Searched for: Department/Unit:Child and Adolescent Psychiatry
Can Medication Effects Be Determined Using National Registry Data? A Cautionary Reflection on Risk of Bias in "Big Data" Analytics [Comment]
Sonuga-Barke, Edmund J S
PMID: 27839559
ISSN: 1873-2402
CID: 3093642
Closing the Racial Discipline Gap in Classrooms by Changing Teacher Practice
Gregory, Anne; Hafen, Christopher A; Ruzek, Erik; Mikami, Amori Yee; Allen, Joseph P; Pianta, Robert C
Black students are issued school discipline sanctions at rates higher than members of other racial and ethnic groups, underscoring the need for professional development that addresses this gap. In 86 secondary classrooms, a randomized controlled trial examined the effects of a 2-year teacher coaching program, My Teaching Partner Secondary (MTP-S). Results from the second year of coaching and the year after coaching was discontinued replicated previous findings from the first year of coaching-intervention teachers had no significant disparities in discipline referral between Black students and their classmates, compared to teachers in the control condition, for whom racial discipline gaps remained. Thus, MTP-S effects were replicated in the second year of coaching and maintained when coaching was withdrawn. Mediational analyses identified mechanisms for these effects; Black students had a low probability of receiving disciplinary referrals with teachers who increased skills to engage students in high-level analysis and inquiry.
PMCID:5302858
PMID: 28190913
ISSN: 0279-6015
CID: 3087442
Editorial: The effects of early trauma and deprivation on human development - from measuring cumulative risk to characterizing specific mechanisms [Editorial]
Zeanah, Charles H; Sonuga-Barke, Edmund J S
Science is not a linear process of accumulating knowledge. To the contrary, progress in understanding is most likely to occur, especially in less 'mature' disciplines, when healthy debate between opposing points of view create a dialectic in which thesis and antithesis force a new synthesis. In developmental psychopathology, such tension between opposing schools of thought continue to play a vital role in driving discovery across a wide range of topics.
PMID: 27647049
ISSN: 1469-7610
CID: 3090932
Reward-Based Spatial Learning in Teens With Bulimia Nervosa
Cyr, Marilyn; Wang, Zhishun; Tau, Gregory Z; Zhao, Guihu; Friedl, Eve; Stefan, Mihaela; Terranova, Kate; Marsh, Rachel
OBJECTIVE:To assess the functioning of mesolimbic and fronto-striatal areas involved in reward-based spatial learning in teenaged girls with bulimia nervosa (BN) that might be involved in the development and maintenance of maladaptive behaviors characteristic of the disorder. METHOD/METHODS:We compared functional magnetic resonance imaging blood oxygen level-dependent response in 27 adolescent girls with BN to that of 27 healthy, age-matched control participants during a reward-based learning task that required learning to use extra-maze cues to navigate a virtual 8-arm radial maze to find hidden rewards. We compared groups in their patterns of brain activation associated with reward-based spatial learning versus a control condition in which rewards were unexpected because they were allotted pseudo-randomly to experimentally prevent learning. RESULTS:Both groups learned to navigate the maze to find hidden rewards, but group differences in brain activity associated with maze navigation and reward processing were detected in the fronto-striatal regions and right anterior hippocampus. Unlike healthy adolescents, those with BN did not engage the right inferior frontal gyrus during maze navigation, activated the right anterior hippocampus during the receipt of unexpected rewards (control condition), and deactivated the left superior frontal gyrus and right anterior hippocampus during expected reward receipt (learning condition). These patterns of hippocampal activation in the control condition were significantly associated with the frequency of binge-eating episodes. CONCLUSION/CONCLUSIONS:Adolescents with BN displayed abnormal functioning of the anterior hippocampus and fronto-striatal regions during reward-based spatial learning. These findings suggest that an imbalance in control and reward circuits may arise early in the course of BN. Clinical trial registration information-An fMRI Study of Self-Regulation in Adolescents With Bulimia Nervosa; https://clinicaltrials.gov/; NCT00345943.
PMCID:5098471
PMID: 27806864
ISSN: 1527-5418
CID: 3093112
ADHD-associated risk taking is linked to exaggerated views of the benefits of positive outcomes
Shoham, Rachel; Sonuga-Barke, Edmund J S; Aloni, Hamutal; Yaniv, Ilan; Pollak, Yehuda
Attention deficit and hyperactivity disorder (ADHD) is often assumed to be associated with increased engagement in risk-taking behaviors. The current study sought to understand the mental processes underlying this association using a theory-driven behavioral economics perspective. Psychological risk-return models suggest that risk and benefit are inherently subjective, and risk taking is best understood as the interplay between cognitions and motivations regarding the benefits and risks of alternatives. A sample of 244 adults was assessed for ADHD symptoms. The likelihood of engagement in a range of risky behaviors (e.g., driving without wearing a seat belt), the magnitude of perceived benefit and risk ascribed to these behaviors, and benefit and risk attitudes of each participant were extracted from the Domain Specific Risk Taking (DOSPERT) scales. ADHD symptoms were correlated with more risky behaviors and perception of greater benefits from engaging in these behaviors, but were not correlated with risk perception. Mediation analysis revealed that the association between ADHD symptoms and engagement in risk taking was mediated by perceived benefits. These findings highlight the idea that people with high level ADHD symptoms tend to engage in risky behaviors because they find such behavior particularly appealing, rather than because they seek risk per se.
PMCID:5057118
PMID: 27725684
ISSN: 2045-2322
CID: 3092102
Attention training for infants at familial risk of ADHD (INTERSTAARS): study protocol for a randomised controlled trial
Goodwin, Amy; Salomone, Simona; Bolton, Patrick; Charman, Tony; Jones, Emily J H; Pickles, Andrew; Robinson, Emily; Smith, Tim; Sonuga-Barke, Edmund J S; Wass, Sam; Johnson, Mark H
BACKGROUND:Attention deficit hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder that can negatively impact on an individual's quality of life. It is pathophysiologically complex and heterogeneous with different neuropsychological processes being impaired in different individuals. Executive function deficits, including those affecting attention, working memory and inhibitory control, are common. Cognitive training has been promoted as a treatment option, based on the notion that by strengthening the neurocognitive networks underlying these executive processes, ADHD symptoms will also be reduced. However, if implemented in childhood or later, when the full disorder has become well-established, cognitive training has only limited value. INTERSTAARS is a trial designed to test a novel approach to intervention, in which cognitive training is implemented early in development, before the emergence of the disorder. The aim of INTERSTAARS is to train early executive skills, thereby increasing resilience and reducing later ADHD symptoms and associated impairment. METHODS/DESIGN:Fifty 10-14-month-old infants at familial risk of ADHD will participate in INTERSTAARS. Infants will be randomised to an intervention or a control group. The intervention aims to train early attention skills by using novel eye-tracking technology and gaze-contingent training paradigms. Infants view animated games on a screen and different events take place contingent on where on the screen the infant is looking. Infants allocated to the intervention will receive nine weekly home-based attention training sessions. Control group infants will also receive nine weekly home visits, but instead of viewing the training games during these visits they will view non-gaze-contingent age-appropriate videos. At baseline and post treatment, infant attention control will be assessed using a range of eye-tracking, observational, parent-report and neurophysiological measures. The primary outcome will be a composite of eye-tracking tasks used to assess infant attention skills. Follow-up data will be collected on emerging ADHD symptoms when the infants are 2 and 3Â years old. DISCUSSION:This is the first randomised controlled trial to assess the potential efficacy of cognitive training as a prevention measure for infants at familial risk of ADHD. If successful, INTERSTAARS could offer a promising new approach for developing early interventions for ADHD. TRIAL REGISTRATION:International Standard Randomised Controlled Trial registry: ISRCTN37683928 . Registered on 22 June 2015.
PMCID:5192597
PMID: 28031039
ISSN: 1745-6215
CID: 3096262
Methylphenidate for ADHD in children and adolescents: throwing the baby out with the bathwater [Comment]
Banaschewski, Tobias; Buitelaar, Jan; Chui, Celine S L; Coghill, David; Cortese, Samuele; Simonoff, Emily; Wong, Ian C K
A recent Cochrane review assessed the efficacy of methylphenidate for attention-deficit/hyperactivity disorder (ADHD) in children and adolescents. Notwithstanding the moderate-to-large effect sizes for ADHD symptom reduction found in the meta-analysis, the authors concluded that the quality of the evidence is low and therefore the true magnitude of these effects remains uncertain. We identified a number of major concerns with the review, in the domains of study inclusion, approaches to quality assessment and interpretation of data relating to serious adverse events as well as of the clinical implications of the reported effects. We also found errors in the extraction of data used to estimate the effect size of the primary outcome. Considering all the shortcomings, the conclusion in the Cochrane review that the status of the evidence is uncertain is misplaced. Professionals, parents and patients should refer to previous reviews and existing guidelines, which include methylphenidate as one of the safe and efficacious treatment strategies for ADHD.
PMID: 27935807
ISSN: 1468-960x
CID: 3095112
China's health assistance to Africa: opportunism or altruism?
Lin, Shuang; Gao, Liangmin; Reyes, Melissa; Cheng, Feng; Kaufman, Joan; El-Sadr, Wafaa M
China has made substantial health commitments to Africa in the past several decades. However, while much has been written regarding China-Africa aid overall, relatively little attention has been given to China's health aid. To better understand these investments, we provide an overview of the current framework and characteristics of China's health aid to Africa. China's health assistance has been perceived by some as opportunistic, largely as a demonstration of China's engagement in "soft power" and an attempt to enhance its access to natural resources and political favors by African countries. Others have attributed altruistic intent, aiming to support the advancement of the health of populations in the African continent with a "no strings attached" approach. Our overview demonstrated that despite the magnitude of China's health assistance, many questions remain regarding the scope of this aid, its effectiveness and the governance mechanisms that guide the conceptualization and implementation of such efforts. We also identified the need for a systematic and rigorous evaluation of the various elements of China's health assistance to African countries in order to gain a deeper understanding of how priorities and allocations for health aid are determined, how such aid fits within the specific African country's health strategies and to assess the effectiveness of such aid. Insights garnered through such an assessment could help determine future priorities for investment as well as inform efforts to optimize the value of China's aid for the populations of the recipient countries.
PMCID:5135833
PMID: 27912773
ISSN: 1744-8603
CID: 3094792
Decreased Anterior Cingulate Cortex γ-Aminobutyric Acid in Youth With Tourette's Disorder
Freed, Rachel D; Coffey, Barbara J; Mao, Xiangling; Weiduschat, Nora; Kang, Guoxin; Shungu, Dikoma C; Gabbay, Vilma
BACKGROUND:γ-Aminobutyric acid has been implicated in the pathophysiology of Tourette's disorder. The present study primarily sought to examine in vivo γ-aminobutyric acid levels in the anterior cingulate cortex in psychotropic medication-free adolescents and young adults. Secondarily, we sought to determine associations between γ-aminobutyric acid in the anterior cingulate cortex and measures of tic severity, tic-related impairment, and anxiety and depression symptoms. METHODS:γ-Aminobutyric acid levels were measured using proton magnetic resonance spectroscopy. Analysis of covariance compared γ-aminobutyric acid levels in 15 youth with Tourette's disorder (mean age = 15.0, S.D. = 2.7) and 36 healthy comparison subjects (mean age = 15.9, S.D. = 2.1). Within the Tourette disorder group, we examined correlations between γ-aminobutyric acid levels and tic severity and tic-related impairment, as well as anxiety and depression severity. RESULTS:Anterior cingulate cortex γ-aminobutyric acid levels were lower in participants with Tourette's disorder compared with control subjects. Within the Tourette disorder group, γ-aminobutyric acid levels did not correlate with any clinical measures. CONCLUSIONS:Our findings support a role for γ-aminobutyric acid in Tourette's disorder. Larger prospective studies will further elucidate this role.
PMID: 27743746
ISSN: 1873-5150
CID: 3092222
How teacher emotional support motivates students: The mediating roles of perceived peer relatedness, autonomy support, and competence
Ruzek, Erik A; Hafen, Christopher A; Allen, Joseph P; Gregory, Anne; Mikami, Amori Yee; Pianta, Robert C
Multilevel mediation analyses test whether students' mid-year reports of classroom experiences of autonomy, relatedness with peers, and competence mediate associations between early in the school year emotionally-supportive teacher-student interactions (independently observed) and student-reported academic year changes in mastery motivation and behavioral engagement. When teachers were observed to be more emotionally-supportive in the beginning of the school year, adolescents reported academic year increases in their behavioral engagement and mastery motivation. Mid-year student reports indicated that in emotionally-supportive classrooms, adolescents experienced more developmentally-appropriate opportunities to exercise autonomy in their day-to-day activities and had more positive relationships with their peers. Analyses of the indirect effects of teacher emotional support on students' engagement and motivation indicated significant mediating effects of autonomy and peer relatedness experiences, but not competence beliefs, in this sample of 960 students (ages 11-17) in the classrooms of 68 middle and high school teachers in 12 U.S. schools.
PMCID:5298258
PMID: 28190936
ISSN: 0959-4752
CID: 3087452