Faculty Bibliography

OBJECTIVE/UNASSIGNED:Assessing suicide risk among children is complex, in part due to their developmental differences in identifying, recalling, and verbally describing internal states, alongside cultural differences in how distress is experienced. This study aimed to identify expressions of distress around suicide ideation or attempts through body mapping, a qualitative technique that facilitates both visual and verbal expressions. METHOD/UNASSIGNED: = 16). Children completed the Childhood Suicide Ideation Interview, which included semi-structured questions about their suicide ideation and/or attempt and a body mapping activity, where children illustrated and described their thoughts, feelings, body sensations, and social connections surrounding their suicidal crisis on a printed body silhouette. RESULTS/UNASSIGNED:Analyses conducted with Anthropac yielded 94 expressions of distress. The congruence in overall experiences across children was low (24%), yet specific somatic experiences like "shaking" (70%), "pain" (43%), and "dizziness" (39%) were prevalent. Other frequent experiences included "sad" (48%), "passive suicide ideation" (43%), and "thoughts about family" (39%). CONCLUSIONS/UNASSIGNED:Body mapping was a valuable tool for uncovering unique expressions of distress among ethnoracially diverse children. Somatic expressions, often overlooked in risk assessments, were prominent. Ours and similar studies have the potential to inform the design of culturally and developmentally responsive risk assessment tools and safety planning protocols.

When thoroughly assessed, the prevalence of attention-deficit hyperactivity disorder (ADHD) in children/adolescents is estimated at 5%. There is no evidence that ADHD is over-diagnosed in the UK. Indeed, available data point to under-diagnosis, even though rigorous updated post-COVID-19 pandemic data are not available. Some cases may be misdiagnosed due to low-quality assessment, poor adherence to national guidance or inappropriate differential diagnosis. Beyond the controversy around over- or under-diagnosis and over-medicalisation of ordinary behaviours or emotions, the main issue is that UK clinical services cannot adequately support individuals with ADHD who need help. There is a risk that the narrative claiming 'ADHD is over-diagnosed' could be used to deny people with properly-diagnosed ADHD the care they deserve.

STUDY DESIGN/METHODS:Retrospective cohort study. OBJECTIVE:Due to proximity of the surgical site to important respiratory structures, patients may undergo delayed extubation after adult cervical deformity (ACD) surgery to manage postoperative airway edema/obstruction. Herein, we evaluate relevant relationships with delayed extubation. SUMMARY OF BACKGROUND DATA/BACKGROUND:Delayed extubation is an underreported perioperative occurrence, with only a few studies conducting case-by-case reviews of prolonged intubation. METHODS:Operative ACD patients with baseline (BL) were grouped based on whether they experienced delayed extubation (DE), or leaving the OR while still intubated, versus those who were extubated successfully in the OR (non-DE). Means comparison and regression analyses identified predictors of delayed extubation and associations with peri-operative complications and outcomes. RESULTS:82 patients met inclusion criteria (mean age 62.4±13.0 y, 52.4% female, Edmonton frailty score: 5.10±2.97, ACFI score: 0.30±0.16, CCI: 1.41±1.73). 14 patients left the OR intubated, and 1(1.2%) required reintubation. DE cohort demonstrated greater Edmonton frailty scores (P=0.017) and smoking histories (P=0.031). Intraoperatively, there was a significant difference EBL (P=0.021) and rate of transfusions (DE: 27.3% v non-DE: 4.8%, P=0.12). Upper instrumented vertebra (UIV) was not associated with DE, while lower LIV increased the likelihood of DE (OR 1.1, P=0.029). Post-operatively, as expected, there was a significant difference in rate of SICU admissions (DE: 90.9% v. non-DE: 49.2%, P=0.01), although no significant differences in LOS. Greater cSVA and MGS correction from baseline was associated with increased likelihood of delayed extubation (OR 1.1, CI 95% 1.05-1.17, P<.001; OR 1.14, CI 95% 1.05-1.24, P=0.003). Furthermore, delayed extubation was a significant predictor of increased VR-Physical Component Scores (P=0.013) at 6W, and DE cohort demonstrated significantly higher VR-PCS and VR-MCS Scores at 6W (P=0.01, both). CONCLUSIONS:Baseline frailty and larger radiographic correction can be associated with delayed extubation, which can impact quality of life perioperatively. Considerations like minimizing intraoperative blood loss and degree of correction could minimize delayed extubation.

Autism spectrum disorder (ASD) is a neurodevelopmental condition, with ex vivo studies suggesting its neurobiological origin as early as the first and second trimester of pregnancy. Functional MRI studies using graph-theoretical approaches have isolated features in the global connectome architecture that distinguish toddlers with ASD from their typically developing peers. Additionally, functional connectivity patterns in the infant brain have shown to be predictive of later ASD diagnosis. An important yet unexplored question in the literature is whether graph-theoretical differences are evident prior to infancy, in the brain of fetuses who will later exhibit ASD traits in early childhood. In this study, we address this question using a sample of 88 children with both quality-assured fetal brain resting-state functional MRI data and standardized parent assessment of ASD traits including social-emotional and social communication skills and repetitive and restricted behaviors at age 3. Multiple regression analyses revealed no significant associations between fetal global graph features (e.g., network segregation, integration, and small-world architecture) and ASD traits at age 3 (p's > 0.1). Therefore, our findings do not provide support for prenatal emergence of global topographical differences of brain functional organization in fetuses who later develop ASD traits. However, this does not rule out the possibility of other neural signatures in the fetal functional connectome that may predict autistic traits and future ASD diagnosis.

OBJECTIVES/OBJECTIVE:Adolescents transitioning from child and adolescent mental health services (CAMHS) to adult mental health services (AMHS) may face challenges in accurately identifying and reporting their mental health symptoms, often leading to discrepancies between clinician and patient evaluations. Using data from the MILESTONE project, this study aims to assess clinician-adolescent concordance over 24 months and identify domains of psychopathology with the highest disparities. METHODS:Participants were assessed at baseline, 9, 15, and 24 months using the Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA) scale and were categorized in four diagnostic groups. Hierarchical cluster analysis identified symptom-based subgroups of patients based on clinician and patient-rated HoNOSCA scores. Concordance was evaluated through multilevel linear regression models, while Bland-Altman plots examined agreement between scores across time points. RESULTS:Two clusters of patients were identified: one characterized by lower severity and greater prevalence, the other by higher complexity and fewer individuals. Clinician-patient concordance increased over time, rising from 77% to 83% by the second time point and stabilizing. Concordance varied across diagnostic categories, with anxiety showing the highest agreement and ADHD the lowest. CONCLUSIONS:Improved communication, psychoeducation, and tailored interventions may facilitate greater patient-clinician alignment, thereby supporting more favorable outcomes during this critical developmental period. TRIAL REGISTRATION/BACKGROUND:ISRCTN83240263; NCT03013595.

BACKGROUND/UNASSIGNED:Umbrella reviews, or overviews of reviews, synthesize information using systematic reviews (SRs) as their unit of analysis. Although a formal guideline exists for reporting umbrella reviews of healthcare interventions (i.e. Preferred Reporting Items for Overviews of Reviews [PRIOR]), no formal guideline exists for conducting and/or reporting umbrella reviews of observational studies that examine epidemiological associations. OBJECTIVE/UNASSIGNED:To review the existing guidance on conducting and/or reporting umbrella reviews of observational studies on epidemiological associations, as part of the process of developing a formal reporting guideline. METHODS/UNASSIGNED:We reviewed the scoping review conducted in the context of PRIOR development and identified documents through forward citation search in PubMed, Scopus, and manual search in Google Scholar, Google Search up to December 22, 2024. Documents, regardless of format, were included if they provided guidance for conducting and/or reporting umbrella reviews of observational studies (including meta-research studies of their features). Title/abstract screening and data extraction were performed independently and in duplicate and summarized narratively by stages of the umbrella review process. RESULTS/UNASSIGNED:The search retrieved 4491 unique records, with 96 full texts assessed and eight documents included. These documents, published between 2014 and 2023, offered guidance across seven topic areas, but overall guidance on conducting and/or reporting is limited. These areas include the answerable questions, prerequisite considerations, the scope of umbrella reviews, searching for SRs, primary data collection, analysis, presentation, and assessing the certainty/quality of the body of evidence. CONCLUSION/UNASSIGNED:There is a need for dedicated, practical, and evidence-based formal reporting guidelines for umbrella reviews of observational studies on epidemiological associations. This review lays the groundwork for developing the PRIOR-extension for such studies: the Preferred Reporting Items for Umbrella Reviews of Cross-sectional, Case-control, and Cohort Studies.

BACKGROUND:Research demonstrates the effectiveness of evidence-based psychological treatment adjunctive to pharmacotherapy for reducing mood symptoms in bipolar disorder. However, access to these treatments is limited, and innovative strategies are needed to ensure that more patients with bipolar disorder receive the gold-standard treatments that may help them achieve wellness. "Stepped care" models of psychological service delivery represent one potential solution to this problem of treatment access. Under a stepped care model, patients are assigned the minimum necessary psychological treatment for symptom improvement. This typically means that patients who are experiencing more symptoms are assigned to a treatment of greater intensity (e.g., weekly individual therapy) whereas patients who are experiencing fewer symptoms are assigned to a treatment of relatively lesser intensity (e.g., biweekly group therapy). Stepped care models are dynamic, meaning that the level of treatment can be modified depending on the patient's response. Stepped care models have been explored in other clinical populations but require further exploration in bipolar disorder. METHODS:Members of the Psychological Interventions Task Force for the International Society of Bipolar Disorders conducted a narrative review of stepped care models and their application to bipolar disorder. RESULTS:We found evidence that stepped care models are useful approaches to delivering psychosocial treatments for bipolar disorder. We discuss several contextual factors in executing stepped care models in this population (i.e., cultural and pediatric applications), as well as share an example of a stepped care model-Focused Integrated Team-based Treatment for Bipolar Disorder (FITT-BD)-that is currently being evaluated in an academic medical center. CONCLUSION/CONCLUSIONS:Further research is warranted to develop and assess robust stepped care models to determine whether they can improve access to treatment of bipolar disorder while not sacrificing outcomes.

BACKGROUND:This study aims to explore for the first time the knowledge, understanding and management of sleep problems in children with ADHD among clinicians who specialise in sleep and ADHD. The aim was to inform the development of digital sleep awareness training for clinicians. METHOD/METHODS:Fifteen clinicians who work with children with ADHD and sleep difficulties in the United Kingdom participated in semistructured qualitative interviews. Data were analysed using a reflexive thematic analysis approach to generate and guide the content of digital sleep awareness training. RESULTS:Four core themes were developed: 'It's a Problem' highlighted the extent to which children with ADHD were reported to struggle with sleep difficulties and the impact this has on the child and family. Clinicians also discussed the difficulty they had in finding evidence-based information they could share with caregivers. With little to no formal training, most of the advice they gave came from 'learning on the job'. When discussing ADHD specific sleep difficulties and disorders, clinicians reflected on their own 'insight into limitations of knowledge'. 'Learning for practice' highlighted the divergence in the methods of learning preferred by clinicians, despite convergence of learning content needed. CONCLUSIONS:Sleep problems in children with ADHD are common, and clinicians often struggle to support these due to lack of formal training. There is a need for accessible, authoritative training for UK practitioners who work with children with ADHD.

Maternal psychological distress during pregnancy and the early postpartum period is a risk factor for dysregulated affective and regulatory function in young infants. Animal models suggest that perinatal stress may alter offspring development via allopregnanolone (ALLO) exposure. For example, variations in placentally derived ALLO in preterm infants have been linked with altered fetal neurodevelopment. However, no studies have investigated naturalistic variations in ALLO concentrations in maternal milk as a potential moderator of associations between maternal distress and infant temperament during the postnatal period. The current study assesses associations among ALLO concentrations in human milk, maternal psychological distress, and infant temperament in 81 mother-infant dyads (31 females) measured at approximately 6.5 months postpartum (M = 6.55 months, range = 5.5-8 months). Results indicated that human milk ALLO concentration moderated effects of maternal psychological distress on infant regulatory capacity. Specifically, there was a negative association between maternal psychological distress and regulatory capacity in infants of mothers with below-mean ALLO concentrations, but not in infants of mothers with above-mean ALLO concentrations. However, there were no effects of ALLO on infant negative affect or surgency/positive affect. This study provides some of the first preliminary evidence that ALLO concentrations in human milk may moderate associations between maternal psychological distress and infant regulatory capacity.

OBJECTIVE:Pediatric primary care (PPC) offers an ideal platform for integrating evidence-based programs (EBPs) to enhance early relational health (ERH). However, implementing such integration faces several challenges. This study uses quantitative and qualitative data to identify the barriers, facilitators, and strategies for implementing ERH-focused EBPs in PPC. METHODS:Using the Consolidated Framework for Implementation Research framework, we conducted a survey and focus groups with PPC personnel recruited through nationwide networks. The survey measured clinic readiness (i.e., challenges, resources, and needs) for integration and examined its associations with personnel roles and clinic characteristics using nested ANOVAs and multilevel regressions. Focus groups further probed potential strategies and were coded using thematic analysis. RESULTS:126 PPC personnel from 44 clinics completed the survey, and 18 participated in five focus groups. Clinics had strong leadership support for integrated services and high utilization of program resources and implementation practices, yet notable challenges in structural and human resources existed. Clinic staff perceived higher readiness for integration than other personnel roles. Lower-percent Medicaid eligible patients and urbanicity were associated with higher readiness, while academic affiliation showed both positive and negative associations. Promoting culturally responsive care, fostering team cohesion, utilizing standardized implementation processes, adopting flexible delivery and collaborative models, and partnering with local communities were key strategies for integrating EBPs. CONCLUSIONS:The findings can help PPC clinics more effectively integrate one or multiple EBPs into routine care and can inform ways to sustain such integrated services to optimize population-level reach and positive impacts on child and family well-being.