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Department/Unit:Child and Adolescent Psychiatry

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Rule-based and information-integration perceptual category learning in children with attention-deficit/hyperactivity disorder

Huang-Pollock, Cynthia L; Maddox, W Todd; Tam, Helen
OBJECTIVE: Suboptimal functioning of the basal ganglia is implicated in attention-deficit/hyperactivity disorder (ADHD). These structures are important to the acquisition of associative knowledge, leading some to theorize that associative learning deficits might be expected, despite the fact that most extant research in ADHD has focused on effortful control. We present 2 studies that examined the acquisition of explicit rule-based (RB) and associative information integration (II) category learning among school-age children with ADHD. METHOD AND RESULTS: In Study 1, we found deficits in both RB and II category learning tasks among children with ADHD (n = 81) versus controls (n = 42). Children with ADHD tended to sort by the more salient but irrelevant dimension (in the RB paradigm) and were unable to acquire a consistent sorting strategy (in the II paradigm). To disentangle whether the deficit was localized to II category learning versus a generalized inability to consider more than 1 stimulus dimension, in Study 2 children completed a conjunctive RB paradigm that required consideration of 2 stimulus dimensions. Children with ADHD (n = 50) continued to underperform controls (n = 33). CONCLUSIONS: Results provide partial support for neurocognitive developmental theories of ADHD that suggest that associative learning deficits should be found, and highlight the importance of using analytic approaches that go beyond asking whether an ADHD-related deficit exists to why such deficits exist.
PMCID:4104575
PMID: 24635709
ISSN: 1931-1559
CID: 2384132

Interorganizational Relationships Among Family Support Organizations and Child Mental Health Agencies

Acri, Mary C; Palinkas, Larry; Hoagwood, Kimberly E; Shen, Sa; Schoonover, Diana; Reutz, Jennifer Rolls; Landsverk, John
This study examined: (1) qualitative aspects of close working relationships between family support organizations and child mental health agencies, including effective and ineffective characteristics of the relationship and aspects that they would change, and (2) the impact of the working relationship upon the family support organization. Semi-structured interviews were conducted with 40 directors of family support organizations characterized as having a close working relationship with a child mental health agency. Three main themes emerged regarding the quality of the working relationship: (a) interactional factors, including shared trust, communication, collaboration and service coordination; (b) aspects of the inner context of the family support organization, mental health agency, or both, including alignment of goals and values and perceptions of mental health services; and (c) outer contextual factors external to the organizations, such as financial and county regulations. Responses to the perceived impact of the relationship was divided into two themes: positive impacts (e.g. gained respect, influence and visibility), and negative impacts (e.g. lack of trust). This study lays the foundation for future research to better understand the mechanisms underlying interorganizational relationships in communities among different types of providers to create a more seamless continuum of services for families of children with mental health conditions.
PMCID:3534836
PMID: 22865099
ISSN: 0894-587x
CID: 174610

Synapses lacking astrocyte appear in the amygdala during consolidation of Pavlovian threat conditioning

Ostroff, Linnaea E; Manzur, Mustfa K; Cain, Christopher K; Ledoux, Joseph E
There is growing evidence that astrocytes, long held to merely provide metabolic support in the adult brain, participate in both synaptic plasticity and learning and memory. Astrocytic processes are sometimes present at the synaptic cleft, suggesting that they might act directly at individual synapses. Associative learning induces synaptic plasticity and morphological changes at synapses in the lateral amygdala (LA). To determine whether astrocytic contacts are involved in these changes, we examined LA synapses after either threat conditioning (also called fear conditioning) or conditioned inhibition in adult rats using serial section transmission electron microscopy (ssTEM) reconstructions. There was a transient increase in the density of synapses with no astrocytic contact after threat conditioning, especially on enlarged spines containing both polyribosomes and a spine apparatus. In contrast, synapses with astrocytic contacts were smaller after conditioned inhibition. This suggests that during memory consolidation astrocytic processes are absent if synapses are enlarging but present if they are shrinking. We measured the perimeter of each synapse and its degree of astrocyte coverage, and found that only about 20-30% of each synapse was ensheathed. The amount of synapse perimeter surrounded by astrocyte did not scale with synapse size, giving large synapses a disproportionately long astrocyte-free perimeter and resulting in a net increase in astrocyte-free perimeter after threat conditioning. Thus astrocytic processes do not mechanically isolate LA synapses, but may instead interact through local signaling, possibly via cell-surface receptors. Our results suggest that contact with astrocytic processes opposes synapse growth during memory consolidation. J. Comp. Neurol., 2013. (c) 2013 Wiley Periodicals, Inc.
PMCID:3997591
PMID: 24338694
ISSN: 0021-9967
CID: 816662

Brain Biopsy Findings Link Major Depressive Disorder to Neuroinflammation, Oxidative Stress, and Neurovascular Dysfunction: A Case Report [Letter]

Najjar, Souhel; Pearlman, Daniel M; Hirsch, Scott; Friedman, Kent; Strange, John; Reidy, Jason; Khoukaz, Maya; Ferrell, Richard B; Devinsky, Orrin; Najjar, Amanda; Zagzag, David
PMID: 24075735
ISSN: 0006-3223
CID: 688022

Maximizing the conditional overlap in business surveys

Schiopu-Kratina, Loana; Fillion, Jean-Marc; Mach, Lenka; Reiss, Philip T
This article presents novel sequential methods of sample coordination appropriate for a repeated survey, with a stratified design and simple random sampling without replacement (SRSWOR) selection within each stratum, when the composition or definition of strata changes. Such changes could be the result of updating the frame for births, deaths, or the modification of the industry classification system. Given that a sample has already been selected according to a first (before the frame updates) SRSWOR design, our general aim is to select a minimum number of new units for the second (after the updates) survey while preserving the first-order inclusion probabilities of units in the second SRSWOR design. Sequential methods presently in use can attain a large expected overlap, but do not control the overlap on each pair of selected samples. In this article we present a set of new methods for maximizing the expected overlap, which can handle realistic situations when strata and the associated sample sizes are large. These methods include one that not only maximizes the expected overlap but, for any initially selected sample, maximizes its overlap with the second sample; its superior performance is illustrated with numerical examples. (C) 2014 Elsevier B.V. All rights reserved.
ISI:000336705800011
ISSN: 1873-1171
CID: 2511332

Applying Public Health Frameworks to Advance the Promotion of Mental Health Among Asian American Children

Huang, Keng-Yen; Calzada, Esther; Kamboukos, Dimitra; Rhule, Dana; Sharma, Kirsten Cullen; Cheng, Sabrina; Brotman, Laurie Miller
Asian American (ASA) children experience high rates of mental health problems. Although there is a pressing need to utilize population approaches, emerging frameworks from the fields of public and population health have not been applied to ASA children. This paper addresses this gap by first discussing applications of the National Prevention Strategy (NPS), a population strategy developed from the Social Determinants of Health perspective, to guide ASA prevention work. Next, we provide a practical example to illustrate how the NPS can be applied to prevention program design (using ParentCorps as an example) and dissemination and implementation processes to broadly address ASA children's mental health needs. Finally, we present preliminary data on the feasibility of applying this population strategy to ASA families and a framework for researchers who are considering disseminating and implementing evidence-based programs to ASA or ethnic minority pediatric populations.
PMCID:4258409
PMID: 25505500
ISSN: 1948-1985
CID: 1410932

Emotional granularity and social functioning in individuals with schizophrenia: An experience sampling study

Kimhy, David; Vakhrusheva, Julia; Khan, Samira; Chang, Rachel W; Hansen, Marie C; Ballon, Jacob S; Malaspina, Dolores; Gross, James J
Previous research has shown that healthy individuals who fail to differentiate among emotional states (i.e., those with low emotional granularity; EG) have poorer social functioning (SF) than those with high EG. It is unknown, however, whether these associations extend to clinical disorders characterized by impaired SF, such as schizophrenia. In the present study, we compared SF and EG in individuals with schizophrenia and healthy controls, and then, within the schizophrenia group, we examined the links between EG and SF. Employing an Experience Sampling Method approach, 77 individuals with schizophrenia and 27 healthy controls rated their momentary emotions (sadness, anxiety, anger, and happiness) up to 10 times/day over a two-day period using mobile electronic devices. For each participant, we then calculated the within-subject average correlations among the momentary emotion ratings, producing two EG indices - EGIall for all emotions and EGIneg for negative ones. A subsample of participants with schizophrenia also completed self-report, interview, and ability-based measures of SF. Compared to healthy controls, individuals with schizophrenia displayed significantly poorer SF and lower EGIall, but comparable EGIneg. Within the schizophrenia group, hierarchical multiple regression analyses indicated that EGIall, but not EGIneg, significantly predicted social dysfunction after controlling for emotional awareness, symptoms, and emotional intensity and variability. Our findings indicate that individuals with schizophrenia have a relatively intact ability to differentiate among negative emotions in everyday life. However, they experience significant difficulties differentiating between positive and negative emotions, and this may contribute to their social difficulties.
PMCID:4000561
PMID: 24561000
ISSN: 0022-3956
CID: 883562

Vowel sounds in words affect mental construal and shift preferences for targets

Maglio, Sam J; Rabaglia, Cristina D; Feder, Michael A; Krehm, Madelaine; Trope, Yaacov
A long tradition in sound symbolism describes a host of sound-meaning linkages, or associations between individual speech sounds and concepts or object properties. Might sound symbolism extend beyond sound-meaning relationships to linkages between sounds and modes of thinking? Integrating sound symbolism with construal level theory, we investigate whether vowel sounds influence the mental level at which people represent and evaluate targets. We propose that back vowels evoke abstract, high-level construal, while front vowels induce concrete, low-level construal. Two initial studies link front vowels to the use of greater visual and conceptual precision, consistent with a construal account. Three subsequent studies explore construal-dependent tradeoffs as a function of vowel sound contained in the target's name. Evaluation of objects named with back vowels was driven by their high- over low-level features; front vowels reduced or reversed this differentiation. Thus, subtle linguistic cues appear capable of influencing the very nature of mental representation.
PMID: 24392711
ISSN: 1939-2222
CID: 1763502

Sleep alterations in children with refractory epileptic encephalopathies: a polysomnographic study

Carotenuto, Marco; Parisi, Pasquale; Esposito, Maria; Cortese, Samuele; Elia, Maurizio
Data on the relationship between sleep disturbances and refractory epileptic encephalopathies (EEs) are scarce. Our aim was to assess, by means of nocturnal polysomnography, if children with EEs present with objective alterations in sleep organization. Twenty-three children with EEs (12 males; mean age: 8.7+/-1.4years) and 40 healthy controls (22 males; mean age: 8.8+/-1.1years) underwent an overnight full polysomnography (PSG). Relative to controls, children with EEs showed a significant reduction in all PSG parameters related to sleep duration time in bed (TIB-min p<0.001), total sleep time (TST-min p<0.001), and sleep percentage (SPT-min p<0.001), as well as significantly higher REM latency (FRL-min p<0.001), rate in stage shifting (p=0.005), and number of awakenings/hour (p=0.002). Relative to controls, children with EEs also showed significant differences in respiratory parameters (AHI/h p<0.001, ODI/h p<0.001, SpO2% p<0.001, SpO2 nadir% p<0.001) and a higher rate of periodic limb movements (PLMs% p<0.001). Our findings suggest that sleep evaluation could be considered mandatory in children with refractory epileptic encephalopathy in order to improve the clinical management and the therapeutic strategies.
PMID: 24802904
ISSN: 1525-5050
CID: 1154462

Validation of a claims-based antipsychotic polypharmacy measure

Leckman-Westin, Emily; Kealey, Edith; Gupta, Nitin; Chen, Qingxian; Gerhard, Tobias; Crystal, Stephen; Olfson, Mark; Finnerty, Molly
Purpose Given the metabolic and neurologic side effects of antipsychotics and concerns about the increased risks associated with concomitant use, antipsychotic polypharmacy is a quality concern. This study assessed the operating characteristics of a Medicaid claims-based measure of antipsychotic polypharmacy. Methods A random sample from 10 public mental health clinics and 312 patients met criteria for this study. Medical record extractors were blind to measure status. We examined the prevalence, sensitivity, specificity, and positive predictive value (PPV) in Medicaid claims, testing nine different definitions of antipsychotic polypharmacy, including >14, >60, or >90 days concurrent use of >/=2 antipsychotic agents, each with allowable gaps of up to 0, 14, or 32 days in days' supply of antipsychotic medications. Results All Medicaid claims measure definitions tested had excellent specificity and PPV (>91%). Good to excellent sensitivity was dependent upon use of a 32-day gap allowance, particularly as duration of concurrent antipsychotic use increased. The proposed claims-based measure (90-day concurrent use of >/=2 or more antipsychotics, allowing for a 32-day gap) had excellent specificity (99.1%, 95%CI: 98.2-99.6) and PPV (90.9%, 95%CI: 83.1-95.7) with good sensitivity (79.4%, 95%CI: 70.4-86.6). The overall level of concordance between claims and medical record-based categorization of antipsychotic polypharmacy was high (96.4%, n = 301/312 clients, Cohen's K = 84.7, 95%CI: 75.9-93.5). Discrepant cases were reviewed, and implications are discussed. Conclusions Administrative claims data can be used to construct valid measures of antipsychotic polypharmacy
PMCID:4486331
PMID: 24664793
ISSN: 1053-8569
CID: 1062192