Faculty Bibliography

INTRODUCTION/BACKGROUND:The treatment of pediatric aggression often involves psychotropic agents. Despite growing research on pediatric psychopharmacology, however, clinical issues regarding medication management of persistent behavioral problems remain poorly addressed. METHOD/METHODS:A review of the literature from 1980 to November, 2005 yielded 45 randomized, placebo-controlled trials that addressed the treatment of aggression as either a primary or secondary outcome variable. Effect sizes (ES) (Cohen's d) were calculated for studies that met inclusion criteria. RESULTS:Overall ES for psychotropic agents in treating aggression was 0.56. Despite variability in psychiatric diagnoses, select agents showed moderate to large effects on maladaptive aggression. Most studies focused on younger children (mean age = 10.4 years), and were of short duration (7 to 70 days). Largest effects were noted with methylphenidate for co-morbid aggression in ADHD (mean ES = 0.9, combined n = 844) and risperidone for persistent behavioral disturbances in youth with conduct disorder and sub-average IQ (mean ES = 0.9, combined n = 875). CONCLUSION/CONCLUSIONS:A growing literature supports the use of certain medications for managing pediatric aggression. Future studies should distinguish between impulsive and predatory aggression, and examine the efficacy of agents over longer treatment periods.

OBJECTIVE: To investigate rates of response and remission in adults with obsessive-compulsive disorder (OCD) after 12 weeks of evidence-based treatment. METHOD: Post hoc analyses of response and remission were conducted using data from a multisite, randomized, controlled trial comparing the effects of 12 weeks of exposure and ritual prevention (EX/RP), clomipramine (CMI), their combination (EX/RP+CMI), or pill placebo (PBO) in 122 adults with OCD (DSM-III-R or DSM-IV criteria). Response was defined as a decrease in symptoms; remission was defined as minimal symptoms after treatment. Different response and remission definitions were constructed based on criteria used in prior studies. For each definition, the proportion of responders or remitters in each treatment group was then compared. RESULTS: There were significant differences (p<.05) among the 4 treatment groups in the proportion of responders and remitters. In pairwise comparisons, EX/RP+CMI and EX/RP each produced significantly more responders and remitters than PBO; CMI produced significantly more responders and remitters than PBO for some definitions but not for others. When remission was defined as a Yale-Brown Obsessive Compulsive Scale (YBOCS) score of 12 or less, significantly more EX/RP+CMI (18/31 [58%]) and EX/RP (15/29 [52%]) patients entering treatment achieved remission than either CMI (9/36 [25%]) or PBO (0/26 [0%]) patients. However, even in treatment completers, many CMI and some EX/RP+CMI and EX/RP patients did not achieve remission (remission rates for YBOCS<or=12: EX/RP+CMI=13/19 [68%]; EX/RP=15/21 [71%]; CMI=8/27 [30%]; PBO=0/20 [0%]). CONCLUSION: EX/RP (with or without CMI) can lead to superior treatment outcome compared with CMI alone in OCD patients without comorbid depression. However, many OCD patients who receive evidence-based treatment do not achieve remission

The purpose of this study was to evaluate the effectiveness of a 2-component intervention for biological and foster parent (pairs) to improve parenting practices, co-parenting, and child externalizing problems. Participants were biological and foster parents (N=128) of primarily neglected children (ages 3 to 10 years) placed in regular foster homes. Biological and foster parents were randomly assigned in pairs to the intervention (n=80) or a usual care (n=48) condition. Intervention families received a 12-week parenting course (Incredible Years) and a newly developed co-parenting component. Key findings included significant gains in positive parenting and collaborative co-parenting for both biological and foster parents at the end of the intervention. At follow-up, intervention parents sustained greater improvement in positive parenting, showed gains in clear expectations, and reported a trend for fewer child externalizing problems. Findings supported the feasibility of offering joint parenting training to meet the needs of participating families and demonstrated that the co-parenting construct applied to families in the foster care system was amenable to intervention

Previous research has indicated that patients with a family history of schizophrenia show a greater degree of cognitive and neuropsychological impairment than patients without a family history. We examined the neurocognitive performance, using the WAIS-R, of 51 patients with a family history (familial) and 103 patients without a family history (sporadic) to determine if differences exist that may help to explain the heterogeneous neuropsychological profile of the illness. The family history groups did not differ with respect to gender, diagnosis, ethnicity, age, age of onset, education or duration of illness. Multivariate analyses, covarying for age of onset and education, showed the sporadic group performed significantly better than the familial group on the digit symbol and object assembly subtests, with a trend level difference in overall performance IQ score. Additionally, we identified significant gender differences in favor of males for full scale and verbal IQ, the information, digit span, block design, and arithmetic subtests, and at a trend level, the picture assembly subtest. The family history group differences reflect relative dysfunction in visual attention and scanning, visuomotor control, and spatial processing and reasoning. Overall, the results suggest that sporadic patients have better perceptual-organizational skills and faster speed of processing

The past decade witnessed an increased use of stimulants for the treatment of attention-deficit/hyperactivity disorder (ADHD) in preschool children. However, the reluctance of parents of preschoolers to place their young children on stimulants () coupled with the paucity of information regarding the long-term effects of stimulants in preschoolers makes the development and testing of nonpharmacological treatments for preschoolers with ADHD a major public health priority. This article addresses this issue. First, we highlight issues relating to the existence of ADHD in preschoolers as a clinically significant condition and the need for effective treatment. Second, we examine issues related to the use of pharmacological therapies in this age group in terms of efficacy, side effects, and acceptability. Third, we discuss existing nonpharmacological interventions for preschoolers and highlight the potential value of parent training in particular. Finally, we introduce one candidate intervention, the New Forest Parenting Package, and present initial evidence for its clinical value as well as data on potential barriers and limitations. ©2006Lippincott Williams & Wilkins, Inc.

BACKGROUND: A number of studies have found brain enlargement in autism, but there is disagreement as to whether this enlargement is limited to early development or continues into adulthood. In this study, cortical gray and white tissue volumes were examined in a sample of adolescents and adults with autism who had demonstrated total brain enlargement in a previous magnetic resonance imaging (MRI) study. METHODS: An automated tissue segmentation program was applied to structural MRI scans to obtain volumes of gray, white, and cerebrospinal fluid (CSF) tissue on a sample of adolescent and adult males ages 13-29 with autism (n = 23) and controls (n = 15). Regional differences for brain lobes and brain hemispheres were also examined. RESULTS: Significant enlargement in gray matter volume was found for the individuals with autism, with a disproportionate increase in left-sided gray matter volume. Lobe volume enlargements were detected for frontal and temporal, but not parietal or occipital lobes, in the subjects with autism. Age and nonverbal IQ effects on tissue volume were also observed. CONCLUSIONS: These findings give evidence for left-lateralized gray tissue enlargement in adolescents and adults with autism, and demonstrate a regional pattern of cortical lobe volumes underlying this effect.

Building of atlases representing average and variability of a population of images or of segmented objects is a key topic in application areas like brain mapping, deformable object segmentation and object classification. Recent developments in image averaging, i.e. constructing an image which is central within the population, focus on unbiased atlas building with nonlinear deformations. Groupwise nonlinear image averaging creates images which appear sharper than linear results. However, volumetric atlases do not explicitely carry a notion of statistics of embedded shapes. This paper compares population-based linear and non-linear image averaging on 3D objects segmented from each image and compares voxel-based versus surface-based representations. Preliminary results suggest improved locality of group average differences for the nonlinear scheme, which might lead to increased significance for hypothesis testing. Results from a clinical MRI study with sets of subcortical structures of children scanned at two years with follow-up at four years are shown.