Faculty Bibliography

Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental condition in  children and young people worldwide. Robust estimates of its incidence, prevalence, and burden are essential for informing public health policy and planning. Using data from the Global Burden of Disease Study 2021 (GBD 2021), this global population-based analysis assessed ADHD among individuals under 20 years of age across 204 countries and territories from 1990 to 2021. The study examined incidence, prevalence, and disability-adjusted life years (DALYs) associated with ADHD. In 2021, there were an estimated 46,890,733 (95% uncertainty interval [UI]: 32,136,904-67,271,064) prevalent cases and 4,111,621 (2,775,203-5,954,941) incident cases globally in individuals under 20 years. ADHD accounted for 574,979 (294,277-977,557) DALYs, with a global prevalence rate of 1.78% (1.22-2.55%) and an incidence rate of 0.16% (0.11-0.23%). The global DALY rate was 21.8 (11.2-37.1) per 100,000 population. Prevalence and incidence were highest in Australia, with rates of 5.62% (4.16-7.46%) and 0.49% (0.34-0.66%), respectively. Between 1990 and 2021, global prevalence and incidence rates decreased modestly by 6.0 and 5.81%, respectively. Across all GBD regions, prevalence was higher in males than females (2.52 vs 0.99%) and increased with higher socio-demographic index levels. Overall, the GBD 2021 study provides the most comprehensive global estimates of ADHD burden in young people. These findings are important for guiding policymakers and stakeholders, although potential methodological limitations suggest that the prevalence, incidence, and burden of ADHD may be underestimated.

The dramatic rise in pediatric mental health visits to emergency departments that started in the 1990s continues, reflecting an ongoing youth mental health crisis. There is an urgent need for a comprehensive care continuum with accessible outpatient services capable of identifying and supporting the mental health needs of children regardless of acuity, payor, and geographic setting. A fully realized child mental health continuum of care meets children where they are; adequately funds services from the outpatient clinic to the inpatient unit; delivers evidence-based treatments targeted to reduce mental health symptoms; and supports the development of a skilled behavioral health workforce.

INTRODUCTION/BACKGROUND:Sexual and gender minority (SGM) populations experience health disparities linked to minority stress (socially-based stressors), including proximal (e.g., SGM internalized stigma) and distal stressors (e.g., negative bias from non-SGM people toward SGM individuals). We synthesized and evaluated the effectiveness of interventions reducing proximal and distal SGM stress. METHODS:We followed PRISMA and Joanna Briggs Institute guidelines (CRD42024604568). Five databases were searched and eligible studies evaluated interventions reducing minority stress with sufficient data for effect size estimation. We estimated three-level multivariate meta-regression models for distal and proximal minority stress using restricted maximum likelihood estimation and robust standard error estimates. RESULTS:Fifty-one studies (31 distal, 20 proximal) with 11253 participants (SGM n = 3168) were included. Distal stress interventions yielded a null-to-small pooled effect (g = 0.185, 95% CI = 0.078, 0.292). Psychological interventions had a small effect (g = 0.361, 95% CI = 0.178, 0.544) and outperformed psychoeducation and social contact-based interventions (-0.257 < β < -0.221, p < 0.05). For proximal minority stress, although the overall pooled effect was nonsignificant (g = 0.071, 95% CI = -0.154, 0.297) the intervention × outcome interaction was (Wald Q = 4.661, p = 0.005). Narrative therapy targeting identity affirmation showed a large pooled effect (g = 1.846, 95% CI = 1.032, 2.659). Pairwise contrasts using this intervention-outcome combination as reference indicated that psychoeducation and psychological interventions had greater effects on internalized stigma and perceived social support (2.172 < β < 2.719, p < 0.05). CONCLUSION/CONCLUSIONS:Psychological interventions may reduce both proximal and distal stress. However, aligning interventions to specific minority stressors may yield greater benefit on SGM populations' health.

PURPOSE/OBJECTIVE:Emotion Dysregulation (ED) in children with ASD are linked to behavioral challenges, such as aggression, self-injurious behaviors, and anxiety. Parenting stress, often elevated in families of autistic children, also significantly influences child behavioral outcomes. However, little is known about the dynamics among parenting stress, child ED, and behavioral problems in ASD, especially during the early developmental period. The primary aim of the study was to examine the mediating role of child ED in the association between parenting stress and future child behavioral outcomes in toddlers/preschoolers with ASD. METHODS:The sample included 51 autistic young children aged 18-53 months and their caregivers. Parenting stress (PSI-SF), child ED (BRIEF-ECI), and behavioral problems (CBCL) were assessed, with 30 participants completing a 12-month follow-up. Analyses were conducted starting with Pearson correlations, followed by mediation analyses using the PROCESS macro to examine the mediating role of ED. RESULTS:Higher parenting stress was correlated with more severe ED and increased behavioral challenges in children. Mediation analyses revealed that child ED fully mediated the relation between parenting stress and child behavioral challenges. A significant mediation effect of child ED was found on the association between PSI-SF Parental Distress subdomain and child internalizing behaviors. CONCLUSIONS:Child ED may play a key role mediating the association between parenting stress and child internalizing behavioral problems in autistic toddlers/preschoolers. Interventions targeting both parental well-being and child ED development could improve behavioral outcomes.

Toxicity of prenatal ethanol leading to fetal alcohol spectrum disorders (FASDs) has been linked to disturbances in retinoic acid (RA) signaling necessary for embryonic development. While ethanol exposure in the postnatal day 7 (P7) mice, which induces immediate neurodegeneration and long-lasting GABAergic cell loss and behavioral deficits, has been used for the third trimester FASD model, involvement of RA signaling in the process has not been well explored. Using RARE-LacZ reporter mice that express β-galactosidase (β-Gal) under the control of retinoic acid response element (RARE), we examined RA signaling activity of the forebrains of P8 and P30 mice with or without P7 ethanol treatment. In all experimental groups, β-Gal was expressed mainly in the hippocampus with the strongest expression in the granule cell layer of dentate gyrus. In addition, β-Gal was expressed in pyramidal neurons and parvalbumin (PV) neurons in CA1-3 pyramidal layer and in astrocytes scattered around the CA1-3 region although PV neurons were only examined at P30 because of the low PV expression at P8. β-Gal was also expressed in the anteroventral/anteromedial (AV/AM) thalamus and the retrosplenial (Rs) and Tbr1-positive (+) layer 6 cortices. β-Gal-expressing PV neurons were also found in the cortex such as Rs, while β-Gal was barely detected in somatostatin neurons in any brain regions examined. Such region and cell specific β-Gal expression was significantly higher in P8 brains than P30 brains in various brain regions. P7 ethanol reduced β-Gal expression in the CA1-3 pyramidal layer, Tbr1 + cortical layer 6, and the AV/AM thalamus at P8 or P30 or both. Although P7 ethanol decreased PV cells in CA2-3 pyramidal layers as reported, it decreased β-Gal+ PV cells more drastically. The active RA signaling found in PV neurons and the effects of P7 ethanol on the signaling suggest that reduced RA signaling by P7 ethanol may disturb PV cell maturation and enhance long-lasting brain abnormalities.

Living in neighborhoods characterized by physical and social disorder (e.g., litter, abandoned buildings, crime) is associated with poorer cognitive functioning. However, much of this work relies on decontextualized laboratory tasks, limiting insight into how everyday environmental experiences shape day-to-day cognitive functioning. Here, we introduce the Neighborhood Errand Task (NET), a novel navigation paradigm designed to approximate memory and information processing during wayfinding within disordered neighborhood contexts. Participants first learned a route through map study and guided practice, then completed navigation trials requiring choices between learned-familiar routes and novel-shortcut routes. Neighborhood disorder was experimentally manipulated via environmental cues and intermittent surprise "robbery" events. A diverse sample of U.S. adults (N = 100) completed the NET alongside self-reports of perceived neighborhood disorder and risky/impulsive behavior. Greater perceived neighborhood disorder was associated with poorer wayfinding in the learned route and shortcut trials, which may reflect differences in information processing, caution, strategy selection, or specific memory processes. Furthermore, inefficient navigation amplified the relationship between perceived neighborhood disorder and engagement in risky/impulsive behavior, suggesting that cognitive inefficiencies and environmental perceptions heighten vulnerability to behavioral dysregulation. By embedding cognition in a realistic, navigable context, the NET highlights how environmental adversity may shape adaptations relevant to survival.

BACKGROUND/UNASSIGNED:This paper provides an overview of adapting a micro-savings program originally developed in the United States to a resource-limited setting in Uganda, highlighting this specific case of adapting a program from one country to another. The program involved opening Child Development Accounts (CDAs) to support saving among adolescents girls and their families. Guided by the asset theory and institutional theory, the paper discusses the challenges and opportunities faced during the adaptation and implementation process. The findings offer insights that can inform efforts to expand similar micro-savings programs in other resource-limited communities. METHODS/UNASSIGNED:This paper utilizes data from the Suubi4Her study (2017-2022), a longitudinal intervention involving 1,260 adolescent girls in Southern Uganda. The analysis focused on saving behaviors among the entire sample and a subsample of 690 participants who opened CDAs. We examined self-reported and administrative savings outcomes over 30 months, encompassing bank savings behavior and savings beyond the initial deposit. Analyses also addressed key sociodemographic and psychosocial factors. A mixed-effect and adjusted logistic regression model were applied. RESULTS/UNASSIGNED:At enrollment, the participant's mean age was 15.37 years. The intervention improved bank saving behavior, evidenced by significant intervention-by-time interaction effects [χ2(2) = 43.38, p < 0.01], demonstrating a substantial increase in the odds of bank saving behavior in the intervention group at Wave 2 (OR = 78.85, 95% CI: 18.76, 331.51, p < 0.01) and Wave 3 (OR = 80.95, 95% CI: 19.31, 339.26, p < 0.01) compared to baseline within the control group. In the analysis of additional saving beyond the initial deposit, participants whose schools were located within 2 km of their home had significantly higher odds of saving (OR = 2.74, 95% CI: 1.72-4.37, p < 0.01), while older participants had lower odds (OR = 0.83, 95% CI: 0.68-0.99, p = 0.04). Living nearer to a bank was associated with increased odds of additional saving (OR = 1.74, 95% CI: 0.84-3.62, p = 0.13), though this association did not reach statistical significance. CONCLUSIONS AND IMPLICATIONS/UNASSIGNED:These findings suggest that, overall, CDA-based micro-saving programs implementation is possible even in resource limited communities like Uganda, and when given the opportunity, families living in low-income households can utilize the CDA "infrastructure" to save. Overall, for the saving intervention to yield its intended benefits, institutional barriers need to be addressed, including bringing the bank services to the people and providing financial literacy training to instill the culture of saving from a young age.

Educational initiatives that address the gap between basic/preclinical and clinical practices are important to effectively translate basic science discoveries to benefit patients. The ILAE Neurobiology Commission conducted a pilot project aimed at exposing basic and preclinical scientists engaged in epilepsy research to general clinical issues pertaining to the diagnosis and care of people with epilepsy. This aim was addressed through a two-week-long, on-site clinical training program for 50 basic scientists in 21 epilepsy centers across 18 countries in the six ILAE regions (with a maximum of 3 basic scientists per center). The learning objectives and the training module were discussed and defined by the project organizing committee, which consisted of Neurobiology Commission members and a team of epileptologists representing different geographical regions. The training activities were conducted at each epilepsy center under the local supervision of clinical tutors. Each basic scientist was exposed to 50.3 ± 23.3 (range 16-89) hours of intensive and dedicated clinical training, coordinated by 2-3 tutors per center, assisted by 6.8 ± 3.6 colleagues. A structured test consisting of 17 general clinical epilepsy questions was completed by the trainees before and after the training activity. The learning assessment was based on the comparison between responses to the exit and entry tests. After the on-site clinical exposure, the proportion of correct answers increased to 87% compared to 61% in the entry test. Structured post-training questionnaires demonstrated very high satisfaction of trainees and all involved tutors across the different aspects of the training module. This global pilot study demonstrated that on-site attendance by basic scientists in specialized clinical settings up-scaled their knowledge of clinical epileptology and facilitated networking with clinicians. Expansion of this pilot to further centers should be considered to understand how exposure to clinical practice affects research direction and quality of translational epilepsy research. PLAIN LANGUAGE SUMMARY: Epilepsy research has long benefitted from collaboration between scientists and clinicians. Early exposure of researchers to people with epilepsy and their care teams may strengthen future impact. This pilot study tested a two-week immersive experience where small teams of basic scientists shadowed clinicians during their work at hospitals around the world. Questionnaires showed high satisfaction among both groups. Results support expanding such training, with the backing of the International League Against epilepsy and aligned centers, to build understanding, interest, and long-term commitment, ensuring bench research is informed by and translates to clinical practice and improved quality of life for patients.