Faculty Bibliography

With every disaster, there are fault lines that deepen our understanding of what has happened and what needs to come. The events over the past 18 months including the coronavirus disease 2019 (COVID-19) pandemic as well as the murder of George Floyd and the associated protests throughout the United States brought those fault lines into stark relief by highlighting the history of systemic racism that has fostered marginalization and discrimination against Black Americans. These clouds of systemic racism and discrimination-encompassing 250 years of slavery, 100 years of Jim Crow, police brutality, redlining, and the resulting high rates of poverty and poorer health outcomes-have created systems in which Black Americans face unequal and unequitable stressful situations. The medical community is now beginning to take notice of this race-based traumatic stress, a term coined by Carter in 2007,¹ to describe how social determinants of health impacted by racial discrimination can "get under the skin" through the accumulative effects of ongoing exposure to toxic stress.².

Among the many impacts of the Coronavirus disease (COVID-19) pandemic, one of the most dramatic was the immediate closure of in-person schooling in March/April 2020 when parents were faced with much greater responsibility in supporting their children's learning. Despite this, few studies have examined parents' own perspectives of this experience. The aims of this preliminary study were to (a) identify challenges, benefits, and useful strategies related to remote learning and (b) examine differences in findings across two countries, between parents of youth with and without attention-deficit/hyperactivity disorder (ADHD), and between parents of children and adolescents. To address these aims, parent responses to open-ended questions on the Home Adjustment to COVID-19 Scale (HACS; Becker, Breaux, et al., 2020) were examined across three studies conducted in the United States and Australia (N = 606, children: 68.5% male, ages 6-17 years). The challenges most frequently expressed by parents included the child's difficulty staying on task (23.8% of parents), lack of motivation (18.3%), remote learning factors (17.8%), and lack of social interaction (14.4%). The most frequently expressed strategy related to using routines and schedules (58.2%) and the biggest benefit was more family time (20.3%). Findings were largely consistent across countries, ADHD status, and age, with a few notable group differences. Given that the most common challenges involved child- (e.g., difficulties with staying on task and motivation), parent- (e.g., balancing remote learning with work responsibilities), and school- (e.g., remote instruction difficulties) related factors, there is a need for improved support across these systems going forward. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

BACKGROUND:Preliminary country-specific reports suggest that the COVID-19 pandemic has a negative impact on the mental health of the healthcare workforce. In this paper, we summarize the protocol of the COVID-19 HEalth caRe wOrkErS (HEROES) study, an ongoing, global initiative, aimed to describe and track longitudinal trajectories of mental health symptoms and disorders among health care workers at different phases of the pandemic across a wide range of countries in Latin America, Europe, Africa, Middle-East, and Asia. METHODS:Participants from various settings, including primary care clinics, hospitals, nursing homes, and mental health facilities, are being enrolled. In 26 countries, we are using a similar study design with harmonized measures to capture data on COVID-19 related exposures and variables of interest during two years of follow-up. Exposures include potential stressors related to working in healthcare during the COVID-19 pandemic, as well as sociodemographic and clinical factors. Primary outcomes of interest include mental health variables such as psychological distress, depressive symptoms, and posttraumatic stress disorders. Other domains of interest include potentially mediating or moderating influences such as workplace conditions, trust in the government, and the country's income level. RESULTS:As of August 2021, ~ 34,000 health workers have been recruited. A general characterization of the recruited samples by sociodemographic and workplace variables is presented. Most participating countries have identified several health facilities where they can identify denominators and attain acceptable response rates. Of the 26 countries, 22 are collecting data and 2 plan to start shortly. CONCLUSIONS:This is one of the most extensive global studies on the mental health of healthcare workers during the COVID-19 pandemic, including a variety of countries with diverse economic realities and different levels of severity of pandemic and management. Moreover, unlike most previous studies, we included workers (clinical and non-clinical staff) in a wide range of settings.

Infants learn nouns during object-naming events-moments when caregivers name the object of infants' play (e.g., ball as infant holds a ball). Do caregivers also label the actions of infants' play (e.g., roll as infant rolls a ball)? We investigated connections between mothers' verb inputs and infants' actions. We video-recorded 32 infant-mother dyads for 2 hr at home (13 month olds, n = 16; 18 month olds, n = 16; girls, n = 16; White, n = 23; Asian, n = 2; Black, n = 1; other, n = 1; multiple races, n = 5; Hispanic/Latinx, n = 2). Dyads were predominantly from middle-class to upper middle-class households. We identified each manual verb (e.g., press, shake) and whole-body verb (e.g., kick, go) that mothers directed to infants. We coded whether infants displayed manual and/or whole-body actions during a 6-s window surrounding the verb (i.e., 3 s prior and 3 s after the named verb). Mothers' verbs and infant actions were largely congruent: Whole-body verbs co-occurred with whole-body actions, and manual verbs co-occurred with manual actions. Moreover, half of mothers' verbs corresponded precisely to infants' concurrent action (e.g., infant pressed button as mother said, "Press the button"). In most instances, mothers commented on rather than instigated infants' actions. Findings suggest that verb learning is embodied, such that infants' motor actions offer powerful cues to verb meanings. Furthermore, our approach highlights the value of cross-domain research integrating infants' developing motor and language skills to understand word learning. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

This valuable contribution by Findling et al. reports on trends in diagnostic patterns since the inclusion of disruptive mood dysregulation disorder (DMDD) in the DSM-5. As the authors note, the introduction of the DMDD diagnosis was designed to address the problematic over-diagnosis of bipolar disorder and the associated rise in antipsychotic and polypharmacy use in youths.¹ Using a large, national, electronic health record database (n = 14,157), this study showed a clear increase in the treated prevalence of DMDD from 2016 to 2018 (0.08-0.35%, p < .0001) coupled with a decrease in the treated prevalence of bipolar disorder from 2015 to 2018 (0.42%-0.36%, p < .0001).¹ This suggests that the introduction of DMDD did seem to achieve the aim of reducing the rates of bipolar diagnoses. In what is discouraging but not surprising news, the study demonstrates a troubling increase in the use of antipsychotics (58.9% DMDD vs 51.0% bipolar disorder) and polypharmacy in the DMDD cohort compared to the bipolar disorder cohort (45.0% DMDD vs 37.4% bipolar disorder).¹.

Emotion knowledge (EK) is a malleable set of skills that is central to social interactions and school success during early childhood. The current study describes an anti-racist approach to adapting an EK measure that assesses knowledge of facial expressions to be ecologically valid for young children of color attending pre-Kindergarten (pre-K) programs in a large urban school district. This approach involved (1) attending to race/ethnicity in selection of visual stimuli, (2) ensuring appropriate translation and language for administration, and (3) exploring the functioning of the measure within a racially, ethnically, and linguistically diverse group of children. A total of 235 children (67.4% Latinx, 14.1% non-Latinx Black, 7.1% non-Latinx White, 7.8% Asian, 3.6% another racial/ethnicity) were assessed in English (74%) or Spanish (26%) during the fall of pre-K (mean age = 4.4). Both English and Spanish versions appear to have similar reliability, although accuracy levels were lower when administered in Spanish. No differences in mean accuracy scores were found across racial/ethnic groups or for boys versus girls. This study contributes to the growing literature necessary to advance anti-racist research in affective science.

Clinical guidelines currently recommend practitioners titrate stimulant medications, i.e., methylphenidate (MPH) and amphetamines (AMP), to the dose that maximizes symptom control without eliciting intolerable adverse events (AEs) when treating attention-deficit/hyperactivity disorder (ADHD) in school-aged children/adolescents. However, robust evidence-base regarding the effects of doses and dosing strategies of stimulants on clinical outcomes in the treatment of children/adolescents with ADHD is currently lacking and stimulants are often underdosed in clinical practice. To address this gap and provide rigorous evidence-base in relation to the dose and dosing strategy of stimulants, we conducted the largest systematic review and dose-response meta-analysis examining change in ADHD symptoms (efficacy), and treatment discontinuations due to AEs (tolerability) and any reason (acceptability). We conducted one-stage random-effects dose-response meta-analyses examining MPH and AMP separately, stratifying trials based on fixed-dose and flexible-dose design. Daily doses of stimulants were converted to MPH- and AMP-equivalent doses by adjusting for different pharmacokinetics across formulations. We also conducted pairwise meta-analyses to provide indirect comparisons between flexible-dose versus fixed-dose trials. Our study included 65 RCTs involving 7 877 children/adolescents. Meta-analyses of fixed-dose trials for both MPH and AMP demonstrated increased efficacy and increased likelihood of discontinuation due to AEs with increasing doses of stimulants. The incremental benefits of stimulants in terms of efficacy decreased beyond 30 mg of MPH or 20 mg of AMP in fixed-dosed trials. In contrast, meta-analyses of flexible-dose trials for both MPH and AMP demonstrated increased efficacy and reduced likelihood of discontinuations for any reason with increasing stimulant doses. The incremental benefits of stimulants in terms of efficacy remained constant across the FDA-licensed dose range for MPH and AMP in flexible-dose trials. Our results suggest that flexible titration as needed, i.e., considering the presence of ADHD symptoms, and tolerated, i.e., considering the presence of dose-limiting AEs, to higher doses of stimulants is associated with both improved efficacy and acceptability because practitioners can increase/reduce doses based on control of ADHD symptoms/dose-limiting AEs. Although fixed-dose trials that are required by the FDA are valuable to characterize dose-dependency, they may underestimate the true potential benefit of trialing dose-increases of stimulants in clinical practice by not allowing dose adjustment based on response and tolerability. Additional research is required to investigate potential long-term effects of using high doses of stimulants in clinical practice.

Background/UNASSIGNED:while focusing on its contextualization for the Kenyan school-community mental health settings. Methods to document the progress and impacts are also described. Methods/UNASSIGNED:The design of the system and research strengthening activities is guided by a SMART-Africa Capacity Building framework. Two areas of capacity are focused. Mental health system capacity focuses on building political wills, leadership, transdisciplinary partnership, and stakeholders' global competency in evidence child mental health policy, intervention, and service implementation research. Implementation research capacity building focuses on building researchers' implementation research competency by carrying out an EBI implementation research (using a Hybrid Type II effectiveness-implementation). For illustration purpose, we describe how the system strengthening strategies has been applied in Kenya, and how the mixed methods design applied to assess the value and impacts of the capacity building activities. Feedback data and evaluation data collection using qualitative and quantitative methods for both areas of capacity building are still ongoing. Data will be analyzed and compared across countries in 2020-2021. Conclusion/UNASSIGNED:Our work has shown some feasibility of applying the theory-guided system strengthening model in improving child mental health service system and research capacity in one of the three SMART-Africa partnering countries. Our mental health landscape and resource mapping in Kenya also illustrated that capacity building in SSA countries involved complex dynamic, history, and some overlap efforts with multiple partnerships, and these are critical to consider in training activity and evaluation design.

The current study investigated the impacts of parental behaviors (threat communication and comforting) on children's COVID-19 fears and whether effects differed by age. Caregivers of 283 children (5.5-17 years, M = 10.17, SD = 3.25) from 186 families completed online measures assessing children's and parents' COVID-19-related fears, children's sources of COVID-19 threat information, and parents' engagement in behaviors to reduce child distress (i.e., comfort behaviors). Higher COVID-19 fear in parents was associated with greater communication of COVID-19 threat information, which was associated with higher COVID-19 fear in younger, but not older, children. Over and above parental fear and threat communication, greater exposure to COVID-19 threat information from community sources (e.g., media, school, friends) was associated with greater COVID-19 fear in children, regardless of age. Greater engagement of parental comfort behaviors buffered the association between community sources of COVID-19 threat information and COVID-19 fears in older, but not younger, children. These findings suggest that younger children might be more vulnerable to developing heightened COVID-19 fears as a result of increasing sources of COVID-19 threat information in their lives. This study highlights the importance of supporting the socioemotional well-being of children and families through the COVID-19 pandemic and beyond.

OBJECTIVE:To explore associations between food insecurity, health behaviors, and academic performance among undergraduates at a private, urban US university. METHODS:A cross-sectional web-based survey was conducted among a convenience sample of New York University undergraduates. Multivariable logistic regression estimated associations of food security (using the 6-item US Household Food Security Survey Module) and health behaviors (fruit/vegetable, beverage and alcohol intakes, and sleep), self-rated health, and academic performance. RESULTS:Of the 257 students who completed the survey, 41% reported food insecurity. Food insecurity was associated with approximately 2-fold higher odds of sugar-sweetened beverage consumption (adjusted odds ratio, 1.97; 95% confidence interval, 1.14-3.41) and fair/poor health (adjusted odds ratio, 2.29; 95% confidence interval, 1.23-4.25). CONCLUSIONS AND IMPLICATIONS/CONCLUSIONS:Increased awareness of food insecurity and associated health behaviors among students has implications for higher education's provision of on-campus food support programs.