Showing papers by "Bradley Hospital published in 2020"
TL;DR: It is found that females received a first diagnosis of ASD at a later age than males, potentially due to more advanced language abilities in females with ASD, and this is the first analysis of a large, population‐based U.S. cohort with ASD.
Abstract: The objective of this study was to establish a large, densely sampled, U.S. population-based cohort of people with autism spectrum disorder (ASD). The Rhode Island Consortium for Autism Research and Treatment (RI-CART) represents a unique public-private-academic collaboration involving all major points of service for families in Rhode Island affected by ASD. Diagnosis was based on direct behavioral observation via the Autism Diagnostic Observation Schedule, Second Edition. For the first 1,000 participants, ages ranged from 21 months to 64 years. Using Geographic Information System and published prevalence rates, the overall cohort is estimated to represent between 20% and 49% of pediatric age persons in Rhode Island with ASD, with demographics representative of U.S. Census. We observed a high rate of co-occurring medical and psychiatric conditions in affected individuals. Among the most prominent findings of immediate clinical importance, we found that females received a first diagnosis of ASD at a later age than males, potentially due to more advanced language abilities in females with ASD. In summary, this is the first analysis of a large, population-based U.S. cohort with ASD. Given the depth of sampling, the RI-CART study reflects an important new resource for studying ASD in a representative U.S. population. Psychiatric and medical comorbidities in ASD constitute a substantial burden and warrant adequate attention as part of overall treatment. Our study also suggests that new strategies for earlier diagnosis of ASD in females may be warranted. Autism Res 2020, 13: 474-488. © 2020 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: The Rhode Island Consortium for Autism Research and Treatment (RI-CART) represents a unique public-private-academic collaboration involving all major points of service for families in Rhode Island affected by autism spectrum disorder (ASD). In this article, we provide results from the first 1,000 participants, estimated to represent >20% of affected families in the state. Importantly, we find a later age at first diagnosis of ASD in females, which potentially calls attention to the need for improved early diagnosis in girls. Also, we report a high rate of co-occurring medical and psychiatric conditions in affected individuals.
28 citations
TL;DR: Results indicate that within this sample of psychiatrically hospitalized youth, psychosis-risk symptoms were uniquely linked to STB, and suggest that attention to psychosis-spectrum symptoms may be clinically important for better assessment and treatment of suicidal youth.
16 citations
TL;DR: The findings showed that veterans with PTSD have disrupted amygdala–vmPFC functional connectivity and greater localized vmPFC processing under threat modulation of goal-directed behavior, specifically related to successfully avoiding loss of monetary rewards.
Abstract: To investigate how unpredictable threat during goal pursuit impacts fronto-limbic activity and functional connectivity in posttraumatic stress disorder (PTSD), we compared military veterans with PTSD (n = 25) vs. trauma-exposed control (n = 25). Participants underwent functional magnetic resonance imaging (fMRI) while engaged in a computerized chase-and-capture game task that involved optimizing monetary rewards obtained from capturing virtual prey while simultaneously avoiding capture by virtual predators. The game was played under two alternating contexts-one involving exposure to unpredictable task-irrelevant threat from randomly occurring electrical shocks, and a nonthreat control condition. Activation in and functional connectivity between the amygdala and ventromedial prefrontal cortex (vmPFC) was tested across threat and nonthreat task contexts with generalized psychophysiological interaction (gPPI) analyses. PTSD patients reported higher anxiety than controls across contexts. Better task performance represented by successfully avoiding capture by predators under threat compared with nonthreat contexts was associated with stronger left amygdala-vmPFC functional connectivity in controls and greater vmPFC activation in PTSD patients. PTSD symptom severity was negatively correlated with vmPFC activation in trauma-exposed controls and with right amygdala-vmPFC functional connectivity across all participants in the threat relative to nonthreat contexts. The findings showed that veterans with PTSD have disrupted amygdala-vmPFC functional connectivity and greater localized vmPFC processing under threat modulation of goal-directed behavior, specifically related to successfully avoiding loss of monetary rewards. In contrast, trauma survivors without PTSD relied on stronger threat-modulated left amygdala-vmPFC functional connectivity during goal-directed behavior, which may represent a resilience-related functional adaptation.
14 citations
TL;DR: It is found that high BMI adolescents had significantly greater olfactory sensitivity than normal BMI adolescents and for the first time variation in chemosensory acuity in relation to pubertal stage is demonstrated.
14 citations
TL;DR: Results suggest that early adversity influences child behavior problems through child temperament, particularly for boys, and supports the perspective that temperament is influenced by characteristics of the early rearing environment.
Abstract: Early adversity is associated with both internalizing and externalizing problems among children, and effects of adversity on dimensions of child temperament may underlie these links. However, very ...
12 citations
TL;DR: The study illuminates the importance of assessing SGM status in clinical care and highlights the need to evaluate sexual and gender minority specific risk factors for self-injurious thoughts and behaviors in youth.
11 citations
TL;DR: The NIH Toolbox appears to display an appropriate ability to detect EF deficits secondary to self-reported depression in childhood, and these measures display comparable psychometric properties to clinically available EF measures in a pediatric neuropsychology setting.
Abstract: Despite preliminary research, there remain inconsistent findings with regard to the role of executive functioning (EF) deficits in childhood anxiety and depression. This report examined the associa...
10 citations
TL;DR: Specific techniques within this CBT include motivational interviewing to build commitment and target oppositionality; creation of an anger hierarchy; in-session controlled, gradual exposure; and parent training focusing on contingency management to counteract the instrumental learning deficits in irritable youth.
10 citations
TL;DR: It is suggested that sleep interventions and treatment of thought problems may be important for reducing SI, within and outside the context of depression.
Abstract: Objectives: Thought problems, such as hallucinations and delusional or disorganized ideas, have been associated with increased sleep problems and risk for suicidal ideation (SI). Sleep problems hav...
8 citations
TL;DR: The Preschoolers Adjustment and Intergenerational Risk (PAIR) project as discussed by the authors aimed at understanding adversity and resilience in parent-preschooler dyads, including strategies used to bring community participants into the project, including being present after school at Head Start programs, word of mouth, social media, and flyering, as well as the success rates of various methods.
7 citations
TL;DR: Examination of indirect pathways involving domestic violence (DV), parenting practices (punitive discipline and responsive), and preschool children’s internalizing and externalizing symptoms revealed that the moderating role of chaos was specific to DV, rather than general to other forms of adversity.
Abstract: This study examined the moderating role of household chaos in indirect pathways involving domestic violence (DV), parenting practices (punitive discipline and responsive), and preschool children’s internalizing and externalizing symptoms. We hypothesized that high levels of household chaos would amplify links between domestic violence and parenting difficulties, and that parenting difficulties would in turn predict child behavior problems. Participants in this multimethod (survey, semi-structured interview, child protection records) study included 274 preschool children (Mage = 50.86 months) and their primary caregivers who were assessed in the home at two time-points spaced 6 months apart. Child welfare documentation of moderate-severe maltreatment within the last 6 months was present for 52% of children, 44% were in households characterized by DV, and most families qualified for public assistance. Hypotheses were tested using path analysis with manifest variables within a structural equation modeling framework. All models provided excellent fit to the data. DV was associated with punitive discipline practices only when household chaos was high. Punitive discipline practices in turn predicted greater child externalizing symptoms 6 months later. Follow-up analyses revealed that the moderating role of chaos was specific to DV, rather than general to other forms of adversity (child maltreatment, lifetime contextual stressors, traumatic events). This interaction between DV and chaos was salient even when controlling for exposure to other adversities and demographic covariates. Results point to multiple potential targets of intervention that may ultimately buffer children from the risk posed by experiencing DV in the home.
TL;DR: A relationship between early sexual abuse and neuropsychological deficits, specifically executive function and IQ deficits is demonstrated, contributing to the limited research on the detrimental effects of sexual abuse in a pediatric inpatient population.
Abstract: Objective: The aim of this study was to understand the detrimental effects of sexual abuse on neuropsychological variables including child’s intelligence, executive functioning (EF), and learning/m...
TL;DR: The results of autoregressive structural equation models indicated that mothers who perceived their own mothers as highly supportive in childhood were more likely to engage in scaffolding behaviors with their infants, who in turn made greater progress in reaching developmental milestones from 6 to 12 months postpartum.
Abstract: OBJECTIVE This study evaluated the intergenerational indirect effects of maternal childhood experiences on infant progress in reaching developmental milestones through maternal scaffolding behaviors We hypothesized that mothers who perceived their own mothers as highly supportive in childhood, even in the context of adverse childhood experiences (ACEs), would be more likely to engage in scaffolding with their infants, which in turn would predict greater infant developmental progress (eg, less risk for developmental delay) METHODS Participants included 295 low-income mothers and their infants who were assessed prenatally and at 6 and 12 months postpartum Mothers retrospectively reported on their childhood experiences, maternal parenting behaviors were observationally rated at 6 months postpartum, and infant developmental progress (communication, problem-solving, gross motor, fine motor, and personal-social) was assessed at 6 and 12 months postpartum using the Ages and Stages Questionnaire RESULTS The results of autoregressive structural equation models indicated that mothers who perceived their own mothers as highly supportive in childhood were more likely to engage in scaffolding behaviors with their infants, who in turn made greater progress (eg, showed less risk for developmental delay) in reaching developmental milestones from 6 to 12 months postpartum Follow-up analyses revealed that indirect effects were specific to infant problem-solving and communication skills Maternal ACEs were not associated with parenting or infant developmental progress CONCLUSION Parenting behaviors in 1 generation influence parenting behaviors in the next, which has implications for infant developmental progress The results may inform evidence-based preventive interventions for mothers and infants living in contexts of risk
TL;DR: Although self- efficacy was not related to brain morphometry, self-efficacy beliefs may constitute an important mechanism through which CBT and psychopharmacological interventions decrease fear and anxiety symptoms in youth.
Abstract: Objective: Despite the advances in the field of neuroscience, many questions remain regarding the mechanisms of anxiety, as well as moderators of treatment outcome. Long-term adverse outcomes for a...
TL;DR: The development of criteria and terminology to characterize neurocognitive deficit syndromes would provide clinicians with the opportunity to more systematically identify and treat their patients and provide researchers the chance to develop neurocognition-targeted interventions for patients.
Abstract: Neurocognition is one of the strongest predictors of clinical and functional outcomes across the spectrum of psychopathology, yet there remains a dearth of unified neurocognitive nosology and available neurocognition-targeted interventions. Neurocognitive deficits manifest in a transdiagnostic manner, with no psychiatric disorder uniquely affiliated with one specific deficit. In fact, recent research has identified that essentially all investigated disorders are comprised of 3-4 neurocognitive profiles. This within-disorder neurocognitive heterogeneity has hampered the development of novel, neurocognition-targeted interventions, as only a portion of patients with any given disorder possess neurocognitive deficits that would warrant neurocognitive intervention. The development of criteria and terminology to characterize these neurocognitive deficit syndromes would provide clinicians with the opportunity to more systematically identify and treat their patients and provide researchers the opportunity to develop neurocognition-targeted interventions for patients. This perspective will summarize recent work and discuss possible approaches for neurocognition-focused diagnosis and treatment in psychiatry.
TL;DR: Childhood adversity is linked with unhealthy eating behaviours and obesity, but the mechanisms underlying this association are unclear, specifically the transgenerational behavioural precursors that develop in early childhood.
Abstract: Background Childhood adversity is linked with unhealthy eating behaviours and obesity, but the mechanisms underlying this association are unclear, specifically the transgenerational behavioural precursors that develop in early childhood. Objective To determine whether adversity predicts change in obesogenic food consumption through child emotion dysregulation, and whether caregiver emotion dysregulation modifies this association. Methods Participants included 190 low-income caregiver-child dyads (mean child age = 4.31 years [SD = 0.85]). Cumulative lifetime adversity exposure was assessed via study-created measure. The Difficulties with Emotion Regulation Scale and Emotion Regulation Checklist assessed caregiver and child emotion dysregulation, respectively. Children's obesogenic food consumption was assessed at two time points 6 months apart using a caregiver-report measure: the Children's Eating Habits Questionnaire. Moderated mediation models were tested using autoregressive structural equation modelling. Results Cumulative lifetime adversity was associated with child emotion dysregulation only when caregiver emotion dysregulation was high. Child emotion dysregulation in turn was associated with greater obesogenic food consumption 6 months later. Conclusions Among young children with caregivers high in emotion dysregulation, cumulative lifetime adversity was linked to an increase in obesogenic food consumption through child emotion dysregulation.
TL;DR: The literature on effective treatment options for children and adolescents struggling with suicide, NSSI, and other self-injurious behaviors (SIBs) is relatively limited.
Abstract: Suicide is currently the second leading cause of death for 10–34 year-olds. Moreover, up to 20% of adolescents report engaging in non-suicidal self-injury (NSSI) at some point in their lifetime. Despite the urgent need, the literature on effective treatment options for children and adolescents struggling with suicide, NSSI, and other self-injurious behaviors (SIBs) is relatively limited. This article reviews the efficacy of current treatments for youth suicidality and SIBs. Most of the existing literature on treatment for suicidality and NSSI in children and adolescents is focused on psychotherapy, specifically cognitive behavioral therapy (CBT), dialectical behavioral therapy (DBT), psychoeducation, family therapy, and school-based interventions. In contrast, psychopharmacology studies have focused on addressing disorders related to suicidality and NSSI such as major depressive disorder, rather than on the behaviors themselves. Currently, there is no single treatment that is considered the gold standard for child and adolescents struggling with suicidality and NSSI. While individual psychotherapies, including CBT and DBT, and psychopharmacological agents, such as selective serotonin reuptake inhibitors (SSRIs), show promise in addressing suicide and related psychopathology, there is considerable need for novel approaches to address the underlying mechanisms leading to youth suicidality and NSSI.
TL;DR: Examination of maltreatment chronicity and coping style in foster adolescents revealed that youth with more maltreatment who avoided problems had less psychiatric hospitalizations, suggesting that avoiding problems may be more protective for youth with the most chronic abuse and neglect.
Abstract: Child maltreatment is associated with internalizing and externalizing problems in adolescents, as well as psychiatric hospitalizations, which represent severe mental health difficulties and substantial burden on individuals and the health care system. These negative outcomes are especially prevalent in youth in foster care. Not all youth exposed to maltreatment, however, demonstrate poor mental health outcomes. Additional factors, such as maltreatment chronicity and coping style, may help explain why some (but not all) youth develop major psychiatric problems. The purpose of the present study was to examine how maltreatment chronicity and coping style were associated with internalizing, externalizing, and psychiatric hospitalizations, and whether coping style moderated the relation between maltreatment chronicity and mental health in a sample of foster adolescents. Participants were 283 adolescents ages 12-19 residing in foster care. Youth reported on maltreatment, coping, and mental health; caregivers reported on mental health. Psychiatric hospitalizations were obtained from medical records. Youth who experienced more maltreatment had higher caregiver- and self-reported internalizing, and more psychiatric hospitalizations. Youth who approached problems directly had lower caregiver-reported internalizing and externalizing, while youth who dealt with stressors alone had higher self-reported internalizing and externalizing, and more psychiatric hospitalizations. Youth who avoided facing their problems had less psychiatric hospitalizations. Further, a significant interaction revealed that youth with more maltreatment who avoided problems had less psychiatric hospitalizations, suggesting that avoiding problems may be more protective for youth with the most chronic abuse and neglect. Findings highlight the importance of examining both maltreatment and coping.
TL;DR: A significantly different relationship between microstructural integrity of multiple white matter regions and CF performance in BD and age-matched typically developing control youths is found, indicating an aberrant relationship between CF and underlying white matter microstructure in youth with BD.
Abstract: Prior studies using behavioral tasks and neuroimaging have shown that children and adolescents with bipolar disorder (BD) have deficits in cognitive flexibility (CF)-defined as adaptation to changing rewards and punishments. However, no study, to our knowledge, has examined the white matter microstructural correlates of CF in youth with BD. To address this gap, we examined the relationship between CF assessed with the Cambridge Neuropsychological Testing Automated Battery (CANTAB)'s Intra-Extra Dimensional Set Shift task (ID/ED) and diffusion tensor imaging analyzed with FSL's preprocessing tools and Tract-Based Spatial Statistics (TBSS). We found a significantly different relationship between microstructural integrity of multiple white matter regions and CF performance in BD (n=28) and age-matched typically developing control (TDC) youths (n=26). Evaluation of the slopes of linear regressions in BD vs. TDC (ID/ED Simple Reversal error rate vs. fractional anisotropy) revealed significantly different slopes across the groups, indicating an aberrant relationship between CF and underlying white matter microstructure in youth with BD. These results underscore the importance of examining specific CF-neuroimaging relationships in BD youth. Future longitudinal studies could seek to define the white matter microstructural trajectories in BD vs. TDC, and relative to CF deficits and BD illness course.
TL;DR: Controlling with adult literature, this study identified minimal sex differences in the course of youth with bipolar disorder or operationalized BD or diverges according to sex in adulthood.
Abstract: OBJECTIVE Despite substantial literature on sex differences in adults with bipolar disorder (BD), little is known about this topic in youth; this study examines sex differences in mood symptomatology and psychiatric comorbidity in prospectively followed youth with BD. METHODS A subsample of the Course and Outcome of Bipolar Youth study (N = 370; female n = 199, male n = 171) enrolled October 2000-July 2006 (age at intake = 7-17.11 years) who met DSM-IV criteria for bipolar I disorder (BD-I; n = 221), bipolar II disorder (BD-II; n = 26), or operationalized BD not otherwise specified (BD-NOS; n = 123) with ≥ 4 years follow-up was included. Analyses examined sex differences at intake and, prospectively, in mood symptomatology and psychiatric comorbidity for a mean ± SD follow-up of 10.5 ± 1.72 years. RESULTS Females were older than males at intake (mean ± SD age = 13.33 ± 3.32 vs 12.04 ± 3.16 years; P = .0002) and at age at mood onset (9.33 ± 4.22 vs 7.53 ± 3.74 years; P < .0001). After adjustment for confounders, males spent more time with syndromal ADHD (Padjusted = .001) and females spent more time with syndromal anxiety (Padjusted = .02). There were trends toward males spending more time with substance use disorder and females having more non-suicidal self-injurious behavior (Padjusted = .07 and .09, respectively). There were no sex differences on outcome variables, including rate of or time to recovery and recurrence. CONCLUSIONS Contrasting with adult literature, this study identified minimal sex differences in the course of youth with BD. Longer-term studies are needed to clarify if youth-onset BD remains a "sex neutral" subtype of BD or diverges according to sex in adulthood.
TL;DR: Compared longitudinal trajectories of youth with Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV Bipolar Disorder (BD), grouped at baseline by presence/absence of increased energy during their worst lifetime mood episode, indicate no clinically relevant longitudinal group differences.
TL;DR: A workshop focused on nursing interventions related to SUD utilizing Orlando's Nursing Theory and Brief Intervention Therapy appeared to be effective in increasing nurses' competence and confidence if working with youth and their families dealing with substance use issues.
Abstract: Topic Mental illness and substance use have become areas of concern throughout society. One of the greatest concerns affecting the United States is the increased prevalence of opioid use and accidental overdose. The opioid epidemic not only impacts adults, it also affects the nation's most vulnerable youth. Children and adolescents are at high risk for substance abuse due to multiple risk factors including negative life events, family dysfunction, and parental substance abuse. Purpose Pediatric nurses must be prepared to care for children and families who experience opioid addiction and overdose. The aim of the quality improvement project was to improve the skill set of nurses working with children and adolescents with substance use disorders (SUDs) in a pediatric psychiatric hospital. Sources used Nurses attended a 2-hr workshop focused on nursing interventions related to SUD utilizing Orlando's Nursing Theory and Brief Intervention Therapy. Following the workshop, nurses reported their perceived competence in caring for individuals at risk for or identified with SUD increased. Conclusion The workshop appeared to be effective in increasing nurses' competence and confidence if working with youth and their families dealing with substance use issues.
TL;DR: This study explores the relation between psychosis‐spectrum symptoms and psychotherapy readiness among psychiatrically hospitalized adolescents, a foundational step for developing more effective psychotherapy engagement approaches for this population.
Abstract: AIM Early psychosocial treatment for psychosis-spectrum symptoms has been linked to positive outcomes, whereas delayed treatment is associated with poorer prognosis. Thus, there is a critical need to bolster psychotherapy engagement efforts, particularly among high-risk groups and during high-risk periods, in order to maximize recovery. This study explores the relation between psychosis-spectrum symptoms and psychotherapy readiness among psychiatrically hospitalized adolescents, a foundational step for developing more effective psychotherapy engagement approaches for this population. METHODS Adolescents (n = 704; 12-18 years) who were admitted to a psychiatric inpatient unit completed the Readiness for Psychotherapy Index (RPI), a psychosis-spectrum questionnaire (PRIME Screen), and a brief diagnostic interview at intake. Correlational patterns and regression analyses were used to explore associations between variables. RESULTS The PRIME Screen was negatively associated with the RPI Openness subscale and positively associated with the Distress subscale, beyond the effects of demographics (ie, age, sex, race) and psychiatric diagnoses. CONCLUSIONS Results indicate that the RPI probes multiple facets of psychotherapy readiness that have unique associations with psychosis-spectrum experiences. Adolescents with higher PRIME scores endorsed greater mental health-related distress and lower levels of openness to psychotherapy. These psychotherapy readiness factors warrant further exploration, as they may be significant barriers or facilitators to engaging adolescents with psychosis-spectrum symptoms in much needed early treatment services.
13 Jan 2020
05 Sep 2020