Faculty Bibliography

The Strategies to Enhance Positive Parenting (STEPP) program, an enhanced behavioral parent training (BPT) intervention, was developed to improve engagement in and outcomes following treatment for single-mother families of school-age youth with attention-deficit/hyperactivity disorder (ADHD). A previous randomized clinical trial of the STEPP program demonstrated that the intervention resulted in statistically significant improvements at the group-level in child oppositional behavior, various areas of child impairment, parental stress, and parenting behavior, relative to a wait-list control condition and a traditional BPT group. Despite benefits at the group-level, little is known about outcomes at the individual-level of enhanced BPT relative to traditional BPT for various child- and parent-level outcomes. The current study compares the extent to which traditional BPT and the STEPP program result in reliable change and recovery across various child- and parent-level outcomes in a sample of 80, 5-12 year old youth with ADHD (70 % male). Analyses demonstrated the benefit of participating in either BPT treatment; and participation in the STEPP program compared to traditional BPT was associated with only minimal incremental clinical benefit. Results, as well as clinical and research implications for assessment and treatment of high-risk families of youth with ADHD enrolled in BPT are discussed.

The JCPP has just published a virtual issue focusing specifically on the journal's contribution to progress in the field of ADHD neuropsychology over last 30 years and its role in establishing the foundations of next generation ADHD neuropsychology models. The virtual issue is structured around six themes. Here we provide a precis of the issue summarizing these themes and illustrating each with a reference to an influential paper published over the last 5 years.

BACKGROUND:It has been well documented that, along with tonsillar herniation, Chiari Malformation Type I (CMI) is associated with smaller posterior cranial fossa (PCF) and altered cerebrospinal fluid (CSF) flow and tissue motion in the craniocervical junction. OBJECTIVE:This study assesses the relationship between PCF volumetry and CSF and tissue dynamics toward a combined imaging-based morphological-physiological characterization of CMI. Multivariate analysis is used to identify the subset of parameters that best discriminates CMI from a healthy cohort. METHODS:Eleven length and volumetric measures of PCF, including crowdedness and 4th ventricle volume, 4 measures of CSF and cord motion in the craniocervical junction, and 5 global intracranial measures, including intracranial compliance and pressure, were measured by magnetic resonance imaging (MRI) in 36 symptomatic CMI subjects (28 female, 37 ± 11 years) and 37 control subjects (24 female, 36 ± 12 years). The CMI group was further divided based on symptomatology into "typical" and "atypical" subgroups. RESULTS:Ten of the 20 morphologic and physiologic measures were significantly different between the CMI and the control cohorts. These parameters also had less variability and stronger significance in the typical CMI compared with the atypical. The measures with the most significance were clival and supraocciput lengths, PCF crowdedness, normalized PCF volume, 4th ventricle volume, maximal cord displacement (P < .001), and MR measure of intracranial pressure (P = .007). Multivariate testing identified cord displacement, PCF crowdedness, and normalized PCF as the strongest discriminator subset between CMI and controls. MR measure of intracranial pressure was higher in the typical CMI cohort compared with the atypical. CONCLUSION/CONCLUSIONS:The identified 10 complementing morphological and physiological measures provide a more complete and symptomatology-relevant characterization of CMI than tonsillar herniation alone.

OBJECTIVE: Project Training and Education for the Advancement of Children's Health (TEACH) provides training, consultation and referral support to build child and adolescent mental health (MH) expertise among primary care providers (PCPs). This study describes how TEACH engages PCP, how program components lead to changes in practice and how contextual factors influence sustainability. METHOD: Thirty PCPs randomly selected from 139 trained PCPs and 10 PCPs from 143 registered with TEACH but not yet trained completed semistructured interviews. PCP selection utilized purposeful sampling for region, rurality and specialty. Interviews were recorded, transcribed and analyzed using grounded theory. RESULTS: PCP participation was facilitated by perceived patient needs, lack of financial and logistic barriers and continuity of PCP-program relationships from training to ongoing consultation. Trained PCPs reported more confidence interacting with families about MH, assessing severity, prescribing medication and developing treatment plans. They were encouraged by satisfying interactions with MH specialists and positive feedback from families. Barriers included difficulties implementing screening, time constraints, competing demands, guarded expectations for patient outcomes and negative impressions of the MH system overall. CONCLUSIONS: Programs like TEACH can increase PCP confidence in MH care and promote increased MH treatment in primary care and through collaboration with specialists. Sustainability may depend on the PCP practice context and implementation support.

Background: Although ecstasy (MDMA) use is not as prevalent in the United States (US) as it was in the early 2000s, use remains popular among adolescents and young adults. Few recent studies have examined ecstasy use in national samples among those at particularly high risk for use-adolescents approaching adulthood. Research is needed to delineate sociodemographic correlates of use in this group. Methods: Data were examined from a nationally representative sample of high school seniors in the US (modal age = 18) from the Monitoring the Future study (years 2007-2012; weighted N = 26,504). Data from all cohorts were aggregated and correlates of recent (last 12-month) use of ecstasy were examined. Results: Roughly 4.4% of high school seniors reported use of ecstasy within the last year. Females and religious students were consistently at lower odds for use. Black and Hispanic students, and students residing with two parents, were at lower odds for ecstasy use, until controlling for other drug use. Odds of use were consistently increased for those residing in a city, students with weekly income of >$50 from a job, and students earning >$10 weekly from other sources. Lifetime use of alcohol, cigarettes, marijuana, and other illicit drugs each robustly increased odds of ecstasy use. Conclusion: Subgroups of high school seniors, defined by specific sociodemographic factors, and those who have used other drugs, are currently at high risk for ecstasy initiation and use. Since ecstasy is regaining popularity in the US, prevention efforts should consider these factors.

Objective. Patients with adult attention-deficit/ hyperactivity disorder (ADHD) and bipolar disorder can present with similar symptoms, including increased energy, distractibility, disorganization, impulsivity, hyperactivity, and rapid speech. Determining whether the patient has either, or possibly both, of these syndromes can be a complex task. This review attempts to clarify where these disorders overlap, both symptomatically and epidemiologically, and where they diverge, to help clinicians increase the accuracy of their diagnoses. Changes to diagnostic criteria from the fourth to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (from DSM-IV-TR to DSM-5) are discussed, as is the evidence base for pharmacological treatments. Method. Studies and sources were identified using computerized searches. Results. Adult ADHD and bipolar disorder have multiple overlapping symptoms, but there are differences in prevalence (ADHD affects 4.4% of adults in the United States versus 1.4% for bipolar disorder), onset of symptoms (usually before age 7 years in ADHD versus after age 12 years in bipolar disorder), disease course (chronic in ADHD versus cyclical in bipolar disorder), mood symptoms (absent in ADHD but always present in bipolar disorder), and psychotic symptoms (absent in ADHD but sometimes present in bipolar disorder). Approximately 20% of adult patients with ADHD also have bipolar disorder, while 10%-20% of patients with bipolar disorder have adult ADHD. Comorbidity of bipolar disorder and ADHD is associated with an earlier age of onset and a more chronic and disabling course of bipolar disorder, as well as more psychiatric comorbidity. Conclusion. Distinguishing between adult ADHD and bipolar disorder requires careful attention to phenomenology and awareness of epidemiology, with a focus on childhood history, lifetime course of symptoms, and the possibility of comorbidity. (Journal of Psychiatric Practice 2014;20:428-437).

Methylphenidate (MPH) is a commonly used medication for the treatment of children with Attention-Deficit/Hyperactivity Disorders (ADHD). However, its prescription to adult with ADHD and narcoleptic patients raises the question of how the brain would be impacted by MPH exposure during pregnancy. The goal of this study was to elucidate the long-term neurobiological consequences of a prenatal exposure to MPH using a rat model. We focused on the effects of such treatment on the adult dopamine (DA) system and on the reactivity of animals to natural rewards. This study shows that adult male rats prenatally exposed to MPH displayelevated expression of presynaptic DA markers in the DA cell bodies and the striatum. Our results also suggest that MPH-treated animals could exhibited an increased tonic DA activity in the mesolimbic pathway, an altered signal-to-noise ratio after a pharmacological stimulation, and a decreased reactivity to the locomotor effects of cocaine.Finally, we demonstrated that MPH rats displaya decreased preference and motivation for sucrose.This is the first preclinical study reporting long-lasting neurobiological alterations of DA networks as well as alterations in motivational behaviors for natural rewards after a prenatal exposure to MPH. These results raise concerns about the possible neurobiological consequences of MPH treatment during pregnancy.

The ability to take action in the face of threat is highly diverse across individuals. What are the neural processes that determine individual differences in the ability to cope with danger? We hypothesized that the extent of synchronization between amygdala, striatum, and medial prefrontal cortex (mPFC) would predict successful active coping performance. To test this, we developed a novel computer task based on the principals of Sidman avoidance. Healthy human participants learned through trial and error to move a marker between virtual game board compartments once every 3 s to avoid mild shocks. Behaviorally, participants exhibited large individual differences. Strikingly, both amygdala-mPFC and caudate-mPFC coupling during active coping trials covaried with final active coping performance across participants. These findings indicate that synchronization between mPFC subregions, and both amygdala and caudate predicts whether individuals will achieve successful active coping performance by the end of training. Thus, successful performance of adaptive actions in the face of threat requires functional synchronization of a neural circuit consisting of mPFC, striatum, and amygdala. Malfunction in the crosstalk between these components might underlie anxiety symptoms and impair individuals' ability to actively cope under stress. This opens an array of possibilities for therapeutic targets for fear and anxiety disorders.

Individuals with ASD often demonstrate elevated rates of challenging behaviors, such as tantrums, aggression, and property destruction. The current study examined the relationship between cognitive abilities and conduct problem behaviors in 263 children aged 18 to 39 months. Cognitive development was measured utilizing the cognitive developmental quotient (DQ) on the Battelle Developmental Inventory, Second Edition (BDI-2). Participants were separated into two groups: (1) low cognitive DQgroup (cognitive DQ less than or equal to 70), and (2) typical cognitive DQgroup (cognitive DQgreater than 70). Conduct problems were assessed using the Tantrum/Conduct Behavior subscale of the Baby and Infant Screen for Children with aUtIsm Traits, Part 2 (BISCUIT-Part 2). Higher rates of overall conduct problem behaviors were observed in young children with ASD and typical cognitive development relative to children with low cognitive development. Comparisons of specific conduct behaviors indicated cognitive ability may be associated with particular presentations of conduct problems. Implications are discussed. (C) 2014 Elsevier Ltd. All rights reserved.