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Department/Unit:Child and Adolescent Psychiatry

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Treatment for PTSD related to childhood abuse: a randomized controlled trial

Cloitre, Marylene; Stovall-McClough, K Chase; Nooner, Kate; Zorbas, Patty; Cherry, Stephanie; Jackson, Christie L; Gan, Weijin; Petkova, Eva
OBJECTIVE: Posttraumatic stress disorder (PTSD) related to childhood abuse is associated with features of affect regulation and interpersonal disturbances that substantially contribute to impairment. Existing treatments do not address these problems or the difficulties they may pose in the exploration of trauma memories, an efficacious and frequently recommended approach to resolving PTSD. The authors evaluated the benefits and risks of a treatment combining an initial preparatory phase of skills training in affect and interpersonal regulation (STAIR) followed by exposure by comparing it against two control conditions: Supportive Counseling followed by Exposure (Support/Exposure) and skills training followed by Supportive Counseling (STAIR/Support). METHOD: Participants were women with PTSD related to childhood abuse (N=104) who were randomly assigned to the STAIR/Exposure condition, Support/Exposure condition (exposure comparator), or STAIR/Support condition (skills comparator) and assessed at posttreatment, 3 months, and 6 months. RESULTS: The STAIR/Exposure group was more likely to achieve sustained and full PTSD remission relative to the exposure comparator, while the skills comparator condition fell in the middle (27% versus 13% versus 0%). STAIR/Exposure produced greater improvements in emotion regulation than the exposure comparator and greater improvements in interpersonal problems than both conditions. The STAIR/Exposure dropout rate was lower than the rate for the exposure comparator and similar to the rate for the skills comparator. There were significantly lower session-to-session PTSD symptoms during the exposure phase in the STAIR/Exposure condition than in the Support/Exposure condition. STAIR/Exposure was associated with fewer cases of PTSD worsening relative to both of the other two conditions. CONCLUSIONS: For a PTSD population with chronic and early-life trauma, a phase-based skills-to-exposure treatment was associated with greater benefits and fewer adverse effects than treatments that excluded either skills training or exposure
PMID: 20595411
ISSN: 1535-7228
CID: 111617

Testing Tic Suppression: Comparing the Effects of Dexmethylphenidate to No Medication in Children and Adolescents with Attention-Deficit/Hyperactivity Disorder and Tourette's Disorder

Lyon, Gholson J; Samar, Stephanie M; Conelea, Christine; Trujillo, Marcel R; Lipinski, Christina M; Bauer, Christopher C; Brandt, Bryan C; Kemp, Joshua J; Lawrence, Zoe E; Howard, Jonathan; Castellanos, F Xavier; Woods, Douglas; Coffey, Barbara J
Abstract Objective: The aim of this study was to conduct a pilot study testing whether single-dose, immediate-release dexmethylphenidate (dMPH) can facilitate tic suppression in children and adolescents with attention-deficit/hyperactivity disorder (ADHD) and Tourette's disorder (TD) or chronic tic disorders. The primary hypothesis is that dMPH will improve behaviorally reinforced tic suppression in a standard tic suppression paradigm (TSP). Methods: Ten children with ADHD and TD were given dMPH on one visit and no medication on another, using a random crossover design. On both days, following a baseline period, subjects were reinforced for suppressing tics using a standard TSP. Results: Thirteen subjects were enrolled; 10 subjects (mean age 12.7 +/- 2.6; 90% male) completed all study procedures. Relative to the no-medication condition, tics were reduced when children were given a single dose of dMPH. Behavioral reinforcement of tic suppression resulted in lower rates of tics compared to baseline, but dMPH did not enhance this suppression. Conclusion: Preliminary results indicate replication of prior studies of behavioral tic suppression in youths with TD and without ADHD. In addition, our findings indicate tic reduction (and not tic exacerbation) with acute dMPH challenge in children and adolescents with ADHD and TD
PMCID:2958463
PMID: 20807066
ISSN: 1557-8992
CID: 112050

Imaging-genetics applications in child psychiatry

Pine, Daniel S; Ernst, Monique; Leibenluft, Ellen
OBJECTIVE: To place imaging-genetics research in the context of child psychiatry. METHOD: A conceptual overview is provided, followed by discussion of specific research examples. RESULTS: Imaging-genetics research is described linking brain function to two specific genes, for the serotonin-reuptake-transporter protein and a monoamine oxidase enzyme. Work is then described on phenotype selection in imaging genetics. CONCLUSIONS: Child psychiatry applications of imaging genetics are only beginning to emerge. The approach holds promise for advancing understandings of pathophysiology and therapeutics.
PMCID:2997350
PMID: 20643311
ISSN: 0890-8567
CID: 161839

Longitudinal dimensionality of adolescent psychopathology: testing the differentiation hypothesis

Sterba, Sonya K; Copeland, William; Egger, Helen L; Jane Costello, E; Erkanli, Alaattin; Angold, Adrian
BACKGROUND: The differentiation hypothesis posits that the underlying liability distribution for psychopathology is of low dimensionality in young children, inflating diagnostic comorbidity rates, but increases in dimensionality with age as latent syndromes become less correlated. This hypothesis has not been adequately tested with longitudinal psychiatric symptom data. METHODS: Confirmatory factor analyses of DSM-IV symptoms from seven common Axis I syndromes--major depression, generalized anxiety, separation anxiety, social anxiety, attention deficient hyperactivity, conduct, and oppositional defiant disorders--were conducted longitudinally, from ages 9 to 16, using the general-population Great Smoky Mountains Study sample. RESULTS: An eight-syndrome model fit well at all ages, and in both genders. It included social anxiety, separation anxiety, oppositional defiant, and conduct syndromes, along with a multidimensional attention deficit-hyperactivity syndrome (i.e., inattention, hyperactivity, and impulsivity) and a unidimensional major depression/generalized anxiety syndrome. A high degree of measurement invariance across age was found for all syndromes, except for major depression/generalized anxiety. Major depression and generalized anxiety syndromes slightly diverged at age 14-16, when they also began to explain more symptom variance. Additionally, correlations between some emotional and disruptive syndromes showed slight differentiation. CONCLUSIONS: Marked developmental differentiation of psychopathology, as implied by the orthogenetic principle, is not a prominent cause of preadolescent and adolescent psychiatric comorbidity.
PMCID:3630513
PMID: 20345843
ISSN: 1469-7610
CID: 2101812

Engaging families into child mental health treatment: updates and special considerations

Gopalan, Geetha; Goldstein, Leah; Klingenstein, Kathryn; Sicher, Carolyn; Blake, Clair; McKay, Mary M
OBJECTIVE: The current paper reviews recent findings regarding how to conceptualize engagement and factors influencing engagement, treatment attendance rates, and interventions that work. METHOD: Research related to the definition of engagement, predictors of engagement and treatment termination, attendance rates, and engaging interventions are summarized as an update to the McKay and Bannon (2004) review. RESULTS: Despite ongoing advances in evidence-based treatments and dissemination strategies, engaging families into mental health treatment remains a serious challenge. Within the last several years, a number of technological advances and interventions have emerged to address this problem. Families with children who present disruptive behavior challenges and symptoms of trauma are considered in terms of the unique barriers they experience regarding engagement in treatment. CONCLUSIONS: Potential solutions to increase treatment utilization and further research in this area are discussed.
PMCID:2938751
PMID: 20842273
ISSN: 1719-8429
CID: 289602

Genetic and environmental contributions to neonatal brain structure: A twin study

Gilmore, John H; Schmitt, James Eric; Knickmeyer, Rebecca C; Smith, Jeffrey K; Lin, Weili; Styner, Martin; Gerig, Guido; Neale, Michael C
Twin studies have found that global brain volumes, including total intracranial volume (ICV), total gray matter, and total white matter volumes are highly heritable in adults and older children. Very little is known about genetic and environmental contributions to brain structure in very young children and whether these contributions change over the course of development. We performed structural imaging on a 3T MR scanner of 217 neonatal twins, 41 same-sex monozygotic, 50 same-sex dizygotic pairs, and 35 "single" twins-neonates with brain scans unavailable for their co-twins. Tissue segmentation and parcellation was performed, and structural equation modeling was used to estimate additive genetic, common environmental, and unique environmental effects on brain structure. Heritability of ICV (0.73) and total white matter volume (0.85) was high and similar to that described in older children and adults; the heritability of total gray matter (0.56) was somewhat lower. Heritability of lateral ventricle volume was high (0.71), whereas the heritability of cerebellar volume was low (0.17). Comparison with previous twin studies in older children and adults reveal that three general patterns of how heritability can change during postnatal brain development: (1) for global white matter volumes, heritability is comparable to reported heritability in adults, (2) for global gray matter volume and cerebellar volume, heritability increases with age, and (3) for lateral ventricle volume, heritability decreases with age. More detailed studies of the changes in the relative genetic and environmental effects on brain structure throughout early childhood development are needed.
PMCID:3109622
PMID: 20063301
ISSN: 1097-0193
CID: 1780412

A virtual reality-based FMRI study of reward-based spatial learning

Marsh, Rachel; Hao, Xuejun; Xu, Dongrong; Wang, Zhishun; Duan, Yunsuo; Liu, Jun; Kangarlu, Alayar; Martinez, Diana; Garcia, Felix; Tau, Gregory Z; Yu, Shan; Packard, Mark G; Peterson, Bradley S
Although temporo-parietal cortices mediate spatial navigation in animals and humans, the neural correlates of reward-based spatial learning are less well known. Twenty-five healthy adults performed a virtual reality fMRI task that required learning to use extra-maze cues to navigate an 8-arm radial maze and find hidden rewards. Searching the maze in the spatial learning condition compared to the control conditions was associated with activation of temporo-parietal regions, albeit not including the hippocampus. The receipt of rewards was associated with activation of the hippocampus in a control condition when using the extra-maze cues for navigation was rendered impossible by randomizing the spatial location of cues. Our novel experimental design allowed us to assess the differential contributions of the hippocampus and other temporo-parietal areas to searching and reward processing during reward-based spatial learning. This translational research will permit parallel studies in animals and humans to establish the functional similarity of learning systems across species; cellular and molecular studies in animals may then inform the effects of manipulations on these systems in humans, and fMRI studies in humans may inform the interpretation and relevance of findings in animals.
PMCID:2914178
PMID: 20570684
ISSN: 0028-3932
CID: 934322

No association between music ability and hand preference in children

Piro, Joseph; Ortiz, Camilo
Hand preference was studied in 2 groups of children-children with musical ability and children without musical ability-to examine whether particular markers that may connect with handedness patterns, such as bias away from dextrality or mixed-handedness, stabilize during childhood and are associated with musical ability. Children were administered the Edinburgh Handedness Inventory to determine levels of right, left, and mixed handedness. Results demonstrated no differences in hand preference between both cohorts of children, suggesting the relative independence of musical ability and handedness. However, the inclusion of handedness as a motor marker for musical ability in children in conjunction with other preexisting neurocognitive factors cannot be entirely discounted
PMID: 20739270
ISSN: 1940-1027
CID: 143267

The possible role of the kynurenine pathway in adolescent depression with melancholic features

Gabbay, Vilma; Klein, Rachel G; Katz, Yisrael; Mendoza, Sandra; Guttman, Leah E; Alonso, Carmen M; Babb, James S; Hirsch, Glenn S; Liebes, Leonard
BACKGROUND: Although adolescent major depressive disorder (MDD) is acknowledged to be a heterogeneous disorder, no studies have reported on biological correlates of its clinical subgroups. This study addresses this issue by examining whether adolescent MDD with and without melancholic features (M-MDD and NonM-MDD) have distinct biological features in the kynurenine pathway (KP). The KP is initiated by pro-inflammatory cytokines via induction of the enzyme indoleamine 2,3-dioxygenase (IDO), which degrades tryptophan (TRP) into kynurenine (KYN). KYN is further metabolized into neurotoxins linked to neuronal dysfunction in MDD. Hypotheses were that, compared to healthy controls and to NonM-MDD adolescents, adolescents with M-MDD would exhibit: (i) increased activation of the KP [i.e., increased KYN and KYN/TRP (reflecting IDO activity)]; (ii) greater neurotoxic loads [i.e., increased 3-hydroxyanthranilic acid (3-HAA, neurotoxin) and 3-HAA/KYN (reflecting production of neurotoxins)]; and (iii) decreased TRP. We also examined relationships between severity of MDD and KP metabolites. METHODS: Subjects were 20 adolescents with M-MDD, 30 adolescents with NonM-MDD, and 22 healthy adolescents. MDD episode duration had to be >or= 6 weeks and Children's Depression Rating Scale-Revised (CDRS-R) scores were >or= 36. Blood samples were collected at AM after an overnight fast and analyzed using high-performance liquid chromatography. Group contrasts relied on analysis of covariance based on ranks, adjusted for age, gender, and CDRS-R scores. Analyses were repeated excluding medicated patients. Fisher's protected least significant difference was used for multiple comparisons. RESULTS: As hypothesized, KYN/TRP ratios were elevated and TRP concentrations were reduced in adolescents with M-MDD compared to NonM-MDD adolescents (p = .001 and .006, respectively) and to healthy controls (p = .008 and .022, respectively). These findings remained significant when medicated patients were excluded from the analyses. Significant correlations were obtained exclusively in the M-MDD group between KYN and 3-HAA/KYN and CDRS-R. CONCLUSIONS: Findings support the notion that adolescent M-MDD may represent a biologically distinct clinical syndrome
PMCID:3711227
PMID: 20406333
ISSN: 1469-7610
CID: 111344

Bridging the gap: solving spatial means-ends relations in a locomotor task

Berger, Sarah E; Adolph, Karen E; Kavookjian, Alisan E
Using a means-means-ends problem-solving task, this study examined whether 16-month-old walking infants (N = 28) took into account the width of a bridge as a means for crossing a precipice and the location of a handrail as a means for augmenting balance on a narrow bridge. Infants were encouraged to cross from one platform to another over narrow and wide bridges located at various distances from a wooden handrail. Infants attempted to walk over the wide bridge more often than the narrow one and when the handrail was within reach. Infants demonstrated parallel problem solving by modifying exploratory behaviors and bridge-crossing strategies that simultaneously accounted for the spatial and functional relations between body and bridge, body and handrail, and bridge and handrail.
PMCID:4018234
PMID: 20840227
ISSN: 1467-8624
CID: 1651812