Faculty Bibliography

This study describes sexual health knowledge in perinatally HIV-infected (PHIV+) and perinatally-exposed uninfected (PHIV-) ethnic-minority youth, ages 9-16 years, residing in NYC (n=316). Data on youth sexual health knowledge (e.g., pregnancy, STDs, birth control) and caregiver-adolescent communication about sexual health were examined. Participants in both groups answered only 35% of the sexual health knowledge questions correctly (mean=6.6/19). Higher scores were found among youth who reported more communication about sex with caregivers (vs. those who did not report talking about sex with caregivers; 8.54 vs. 5.84, p<.001) and among PHIV+ youth who were aware of their status (vs. PHIV+ youth who were not; 7.27 vs. 4.70, p<.001). Age was positively correlated with sexual health knowledge (beta=.489, p<.001). Both PHIV+ and PHIV- youth had poor sexual health knowledge, suggesting a need for sexual health education for both groups. Data suggest that interventions focused on caregiver-child risk communication may be important for prevention.

An increasingly important goal of psychiatry is the use of brain imaging data to develop predictive models. Here we present two contributions to statistical methodology for this purpose. First, we propose and compare a set of wavelet-domain procedures for fitting generalized linear models with scalar responses and image predictors: sparse variants of principal component regression and of partial least squares, and the elastic net. Second, we consider assessing the contribution of image predictors over and above available scalar predictors, in particular via permutation tests and an extension of the idea of confounding to the case of functional or image predictors. Using the proposed methods, we assess whether maps of a spontaneous brain activity measure, derived from functional magnetic resonance imaging, can meaningfully predict presence or absence of attention deficit/hyperactivity disorder (ADHD). Our results shed light on the role of confounding in the surprising outcome of the recent ADHD-200 Global Competition, which challenged researchers to develop algorithms for automated image-based diagnosis of the disorder.

The present study investigated whether an 8-day intensive treatment for panic disorder in adolescents conferred a corollary benefit of ameliorating symptoms of depression. Participants included 57 adolescents between the ages of 11 and 18 who were randomly assigned to an intensive panic treatment for adolescents with or without parental involvement. Paired samples t tests and hierarchical linear models (HLM) indicated that participants' total depression score and scores on depression subscales declined from baseline to the 3-month follow-up. Additional HLM analyses indicated that the interaction term between age and parent involvement was a significant moderator in the negative slope for adolescent depression, with younger participants benefitting more from treatment without parent involvement than older participants with regard to depression symptoms.

Traditionally, we define "emotions" as feelings and "feelings" as conscious experiences. Conscious experiences are not readily studied in animals. However, animal research is essential to understanding the brain mechanisms underlying psychological function. So how can we make study mechanisms related to emotion in animals? I argue that our approach to this topic has been flawed and propose a way out of the dilemma: to separate processes that control so-called emotional behavior from the processes that give rise to conscious feelings (these are often assumed to be products of the same brain system). I will use research on fear to explain the way that I and many others have studied fear in the laboratory, and then turn to the deep roots of what is typically called fear behavior (but is more appropriately called defensive behavior). I will illustrate how the processes that control defensive behavior do not necessarily result in conscious feelings in people. I conclude that brain mechanisms that detect and respond to threats non-consciously contribute to, but are not the same as, mechanisms that give rise to conscious feelings of fear. This distinction has important implications for fear and anxiety disorders, since symptoms based on non-conscious and conscious processes may be vulnerable to different factors and subject to different forms of treatment.

Psychostimulants such as methylphenidate and amphetamine are the first-line pharmacologic treatments for Attention-Deficit/Hyperactivity Disorder (ADHD). They are considered prototypical cognitive enhancers but their effects on standard laboratory indices of cognitive function are modest when administered acutely, and even less substantial chronically. However, large-scale observational studies in patients with ADHD have detected stimulant-associated decreases of criminal acts, transportation accidents, slightly improved academic performance, and possible protection against drug abuse. These effects likely reflect modulation of broader domains such as emotional regulation and motivation which have been under-examined. Efforts to clarify the ontological relations between cognitive tasks and their underlying constructs should be incorporated into the Research Domain Criteria project and similar harmonization initiatives.

Mothers with Interpersonal Violence-Related Post-Traumatic Stress Disorder (IPV-PTSD) may experience their toddler&#39;s routine expression of distress and/or helplessness as a trigger of post-traumatic stress. We review evidence in support of this hypothesis from two studies conducted in New York and Geneva. In both studies, mothers and toddlers (ages 12-42 months) were recruited from the community. They entered a protocol including filmed interviews, mother-child interactions and an experimental psychotherapeutic intervention session the Clinician Assisted Videofeedback Exposure Session (CAVES). For a sub-sample of mothers, a functional neuroimaging study was conducted prior to the CAVES, involving mothers watching video-clips of their own and unfamiliar toddlers during separation and play. Following the fMRI scan, mothers rated their own stress while watching the video-clips. Mothers with IPV-PTSD found seeing their own and unfamiliar children during separation as significantly more stressful than controls. Parenting stress was correlated with the severity of maternal PTSD as was decreased maternal availability to their toddlers for joint attention. fMRI revealed less neural activity in the medial prefrontal cortex in both studies. The paper shows how the CAVES technique targets IPV-PTSD mothers own emotional dysregulation upon exposure to child distress and helplessness and supports maternal reflective capacity. Clinical examples are discussed.