Assessing the Efficacy of Large Language Models in Health Literacy: A Comprehensive Cross-Sectional Study.

Enhanced health literacy in children has been empirically linked to better health outcomes over the long term; however, few interventions have been shown to improve health literacy. In this context, we investigate whether large language models (LLMs) can serve as a medium to improve health literacy in children. We tested pediatric conditions using 26 different prompts in ChatGPT-3.5, ChatGPT-4, Microsoft Bing, and Google Bard (now known as Google Gemini). The primary outcome measurement was the reading grade level (RGL) of output as assessed by Gunning Fog, Flesch-Kincaid Grade Level, Automated Readability Index, and Coleman-Liau indices. Word counts were also assessed. Across all models, output for basic prompts such as "Explain" and "What is (are)," were at, or exceeded, the tenth-grade RGL. When prompts were specified to explain conditions from the first- to twelfth-grade level, we found that LLMs had varying abilities to tailor responses based on grade level. ChatGPT-3.5 provided responses that ranged from the seventh-grade to college freshmen RGL while ChatGPT-4 outputted responses from the tenth-grade to the college senior RGL. Microsoft Bing provided responses from the ninth- to eleventh-grade RGL while Google Bard provided responses from the seventh- to tenth-grade RGL. LLMs face challenges in crafting outputs below a sixth-grade RGL. However, their capability to modify outputs above this threshold, provides a potential mechanism for adolescents to explore, understand, and engage with information regarding their health conditions, spanning from simple to complex terms. Future studies are needed to verify the accuracy and efficacy of these tools.

Neural correlates of altered emotional responsivity to infant stimuli in mothers who use substances.

Mothers who use substances during pregnancy and postpartum may have altered maternal behavior towards their infants, which can have negative consequences on infant social-emotional development. Since maternal substance use has been associated with difficulties in recognizing and responding to infant emotional expressions, investigating mothers' subjective responses to emotional infant stimuli may provide insight into the neural and psychological processes underlying these differences in maternal behavior. In this study, 39 mothers who used substances during the perinatal period and 42 mothers who did not underwent functional magnetic resonance imaging while viewing infant faces and hearing infant cries. Afterwards, they rated the emotional intensity they thought each infant felt ('think'-rating), and how intensely they felt in response to each infant stimulus ('feel'-rating). Mothers who used substances had lower 'feel'-ratings of infant stimuli compared to mothers who did not. Brain regions implicated in affective processing (e.g., insula, inferior frontal gyrus) were less active in response to infant stimuli, and activity in these brain regions statistically predicted maternal substance-use status. Interestingly, 'think'-ratings and activation in brain regions related to cognitive processing (e.g., medial prefrontal cortex) were comparable between the two groups of mothers. Taken together, these results suggest specific neural and psychological processes related to emotional responsivity to infant stimuli may reflect differences in maternal affective processing and may contribute to differences in maternal behavior in mothers who use substances compared to mothers who do not. The findings suggest potential neural targets for increasing maternal emotional responsivity and improving child outcomes.

Relationships Between Prenatal Cocaine Exposure, Cannabis-Use Onset and Emotional and Related Characteristics in Young/Emerging Adults.

Background: Exposure to substances in utero may have significant early-life consequences. Less is known about the effects in emerging adulthood, particularly regarding patterns of substance use and related characteristics.Objectives: In this study, we recruited emerging adults, followed since birth, who had been prenatally exposed, or not, to cocaine. Individuals reported on their cannabis, alcohol, and tobacco use, and measures of impulsivity, anhedonia, emotional regulation, and mental health were obtained. Comparisons were made between emerging adults with prenatal cocaine exposure and those without. Correlations were performed between psychological measures and substance use, and regression analyses were conducted to determine potential pathways by which such measures may relate to prenatal exposure or substance use.Results: Individuals with prenatal cocaine exposure (vs. those without) used cannabis at younger ages, reported greater cannabis-use severity, and demonstrated higher impulsivity, state anxiety, and alexithymia. Earlier age of onset of cannabis use was associated with higher impulsivity, state anxiety, alexithymia, and social and physical anhedonia. Cannabis-use age-of-onset mediated the relationship between prenatal cocaine-exposure status and state anxiety and between prenatal cocaine-exposure status and cannabis-use severity in emerging adulthood but not relationships between prenatal cocaine-exposure status and impulsivity or alexithymia in emerging adulthood. Findings suggest that adults with prenatal cocaine exposure may use cannabis at younger ages, which may relate to increased anxiety and more severe use.Conclusions: These findings suggest both mechanisms and possible intervention targets to improve mental health in emerging adults with prenatal cocaine exposure.

Maternal psychological risk and the neural correlates of infant face processing: A latent profile analysis.

Maternal psychological factors, including anxiety, depression, and substance use, may negatively affect parenting. Previous works with mothers have often assessed each of these factors in isolation despite their frequent co-occurrence. Psychological factors have also been associated with neural processing of facial stimuli, specifically the amplitude (i.e., size) and latency (i.e., timing) of the face-specific N170 event-related potential. In the current study, 106 mothers completed measures assessing maternal psychological factors-anxiety, depression, and substance use. A latent profile analysis was used to identify profiles of psychological factors and assess profile associations with the N170 elicited by infant faces and with parental reflective functioning (PRF) as a measure related to caregiving. Two profiles (termed high and low psychological risk) were identified, with the higher risk profile associated with delayed N170 latency responses to infant faces. An exploratory analysis evidenced an indirect effect between the higher psychological risk profile and lower PRF through delayed N170 latency responses to infant faces. Taken together, maternal psychological risk across multiple indicators may together shape neural processing of infant faces, which may have downstream consequences for caregiving.

"Morphologic Severity and Age at Surgery Are Associated with School Age Neurocognitive Outcomes in Metopic Craniosynostosis".

BACKGROUND: Radiographic severity of metopic synostosis has been suggested as a predictor of long-term neurocognitive outcomes, and artificial intelligence (AI) has recently been used to quantify severity. Age at surgery is predictive of long-term neurocognition in sagittal synostosis but has not been adequately explored in metopic synostosis. METHODS: Children ages 6 to 18 years old with corrected metopic synostosis underwent testing of intelligence quotient (IQ), academic achievement, and visuomotor integration (VMI). Various manual measurements and AI-derived severity scores were determined. Scans were categorized as moderate or severe for head-to-head comparisons and multivariable linear regressions were used to assess the relationship of age at surgery and severity with neurocognitive outcomes. RESULTS: 41 patients with average age at testing of 10.8 ± 3.4 years were included. 18 patients were in the severe group while 23 patients were in the moderate group with average ages at surgery 6.6 ± 2.7 and 10.6 ± 8.4 months, respectively (p = 0.062). Greater AI-derived severity was significantly associated with lower reading comprehension (p = 0.040 and 0.018) and reading composite scores (p = 0.024 and p = 0.008). Older age at surgery was significantly associated with lower VMI scores (p-values ranging from 0.017 to 0.045) and reading composite scores (p = 0.047 and 0.019). CONCLUSIONS: This study suggests an association between greater AI-derived radiographic severity and lower reading ability in corrected metopic synostosis. Older age at surgery was independently associated with lower reading ability and visuomotor integration. Surgical correction may mitigate neurodevelopmental differences based on severity that have been observed pre-operatively.

Participation in an Attachment-Based Home Visiting Program Is Associated with Lower Child Salivary C-Reactive Protein Levels at Follow-Up.

OBJECTIVE: Exposure to early childhood adversity is associated with an increased risk for physiological disruption, including increased inflammation. Early interventions that support the mother-child relationship have been shown to potentially buffer negative psychosocial outcomes related to early adversity, but it is unclear whether these interventions have long-term biological effects. We evaluated whether prior participation in Minding the Baby® (MTB), an attachment-based home visiting intervention for young mother-infant dyads living in underserved communities, is associated with lower child salivary inflammatory biomarkers compared with controls at follow-up. METHODS: Ninety-seven maternal-child dyads (n = 43 intervention and n = 54 controls) enrolled in a follow-up study of the MTB randomized controlled trial, an average of 4.6 years after RCT completion. Children provided salivary specimens. We used adjusted linear regression to examine the relationship between MTB participation and child salivary inflammatory biomarkers (C-reactive protein [CRP], interleukin [IL]-1ß, IL-6, IL-8, and TNF-α). RESULTS: Children were on average 6.6 years old, 48% female, and identified as non-Hispanic/Latino Black/African American (34%) and Hispanic/Latino (63%). Participation in MTB was associated with lower salivary CRP levels (ß = -0.31, SE = 0.28, p = 0.003) compared with controls. Participation in MTB was not associated with salivary cytokine levels. DISCUSSION: Participation in an intensive two-generation home visiting intervention such as MTB may reduce salivary inflammatory biomarkers associated with early childhood adversity. Replication and further research are needed to improve the understanding of the potential for early childhood interventions to buffer the biological embedding of early adversity.

Long-term neurocognitive outcomes in 204 single-suture craniosynostosis patients.

PURPOSE: Craniosynostosis, which describes premature fusion of one or more cranial sutures, has been associated with a variety of neurocognitive deficits. We sought to explore the cognitive profiles of the various types of single-suture, non-syndromic craniosynostosis (NSC). METHODS: A retrospective review of children 6-18 years old with surgically corrected NSC who underwent neurocognitive testing (Weschler Abbreviated Scale of Intelligence, Beery-Buktenica Developmental Test of Visuomotor Integration) from the years 2014-2022 was conducted. RESULTS: 204 patients completed neurocognitive testing (139 sagittal, 39 metopic, 22 unicoronal, 4 lambdoid suture). 110 (54%) of the cohort was male, and 150 (74%) were White. Mean IQ was 106.10±14.01 and mean age at surgery and testing were 9.0±12.2 months and 10.9±4.0 years, respectively. Sagittal synostosis was associated with higher scores than metopic synostosis, with significant differences in verbal IQ (109.42±15.76 vs 101.37±10.41), full-scale IQ (108.32±14.44 vs 100.05±11.76), visuomotor integration (101.62±13.64 vs 92.44±12.07), visual perception (103.81±12.42 vs 95.87±11.23), and motor coordination (90.45±15.60 vs 84.21±15.44). Sagittal synostosis was associated with significantly higher scores for visuomotor integration (101.62±13.64 vs 94.95±10.24) and visual perception (103.81±12.42 vs 94.82±12.75) than unicoronal synostosis. CONCLUSIONS: Compared to patients with sagittal synostosis, patients with metopic synostosis exhibited lower scores in verbal IQ, full-scale IQ, visuomotor integration, visual perception, and motor control after surgical correction. Despite surgical correction for premature metopic suture fusion, the effect on the adjacent frontal lobe and white matter connections to other regions of the brain may have a lasting functional impact. Patients with unicoronal synostosis exhibited lower visuomotor integration and visual perception scores.

Reframing caring for parents who struggle with substance-use disorders.

Nancy Suchman and the colleagues she influenced have produced ground-breaking and attitude-challenging work in understanding how parenting and substance use come together. Dr Suchman and her colleagues make the claim that there is nothing about a substance-use disorder that precludes effective and sensitive caring for children especially with interventions that focus on the parent-child relationship. Suchman's legacy is to highlight how substance use as an illness pulls individuals away from important, caring relationships and limits their giving themselves to those relationships. Restoring the salience of caring relationships and of the individual's ability to care may be as impactful on their substance use as a strict focus on the reduction of drug use and achieving abstinence.

Nancy Suchman y los colegas sobre quienes ella ha ejercido influencia han producido un trabajo innovador y de reto a las actitudes sobre la comprensión de cómo la crianza y el uso de sustancias conviven juntas. La doctora Suchman y sus colegas insisten en el hecho de que no hay nada acerca del trastorno de uso de sustancias que no permita el cuidado eficaz y sensible para niños, especialmente con intervenciones que se enfocan en la relación progenitor-niño. El legado de Suchman es enfatizar cómo el uso de sustancias como enfermedad aleja a los individuos de relaciones importantes y afectuosas y les limita en el proceso de entregarse a tales relaciones. Restaurar la importancia de relaciones afectuosas y de la habilidad del individuo para mantener una relación afectuosa pudiera ser tan impactante en su uso de sustancias como un enfoque estricto para reducir el uso de drogas y lograr el estado de abstinencia.

Nancy Suchman, et les collègues qu'elle a influencés, a fait un travail novateur et généreusement combatif pour la compréhension de la manière dont le parentage et la toxicomanie se rassemblent. Le docteur Suchman et ses collègues soutiennent qu'il n'y a rien dans un trouble lié à l'usage d'une substance qui empêche le soin efficace et sensible aux enfants, surtout avec des interventions qui se focalisent sur la relation parent-enfant. L'héritage légué par Suchman consiste à mettre en lumière la façon dont la toxicomanie en tant que maladie détache les individus de relations importantes et attentionnées et limite le don qu'ils font d'eux-mêmes à ces relations. Le fait de restaurer la prépondérance de relations attentionnées et la capacité de l'individu à prendre soin peut avoir autant d'impact sur leur toxicomanie qu'une attention stricte à la réduction d'utilisation des drogues et l'atteinte de l'abstinence.

Increased Alpha-Band Connectivity During Tic Suppression in Children With Tourette Syndrome Revealed by Source Electroencephalography Analyses.

BACKGROUND: Tourette syndrome (TS) is a neurodevelopmental disorder involving chronic motor and phonic tics. Most individuals with TS can suppress their tics for at least a short period of time. Yet, the brain correlates of tic suppression are still poorly understood. METHODS: In the current study, high-density electroencephalography was recorded during a resting-state and a tic suppression session in 72 children with TS. Functional connectivity between cortical regions was assessed in the alpha band (8-13 Hz) using an electroencephalography source connectivity method. Graph theory and network-based statistics were used to assess the global network topology and to identify brain regions showing increased connectivity during tic suppression. RESULTS: Graph theoretical analyses revealed distinctive global network topology during tic suppression, relative to rest. Using network-based statistics, we found a subnetwork of increased connectivity during tic suppression (p < .001). That subnetwork encompassed many cortical areas, including the right superior frontal gyrus and the left precuneus, which are involved in the default mode network. We also found a condition-by-age interaction, suggesting age-mediated increases in connectivity during tic suppression. CONCLUSIONS: These results suggest that children with TS suppress their tics through a brain circuit involving distributed cortical regions, many of which are part of the default mode network. Brain connectivity during tic suppression also increases as youths with TS mature. These results highlight a mechanism by which children with TS may control their tics, which could be relevant for future treatment studies.

Adult attachment is related to maternal neural response to infant cues: an ERP study.

Maternal attachment security is an important predictor of caregiving . However, little is known regarding the neurobiological mechanisms by which attachment influences processing of infant cues, a critical component of caregiving. We examined whether attachment security, measured by the Adult Attachment Interview, might relate to neural responses to infant cues using event-related potentials. Secure (n=35) and insecure (n=24) mothers viewed photographs of infant faces and heard recordings of infant vocalizations while electroencephalography was recorded. We examined initial processing of infant faces (N170) and cries (N100), and attentional allocation to infant faces and cries (P300). Secure mothers were significantly faster than insecure mothers to orient to infant cries (N100), structurally encode their own infant's face (N170), and attend to infant faces (P300). These differences may elucidate mechanisms underlying how attachment may shape neural processing of infant cues and highlight the use ofsocial neuroscientific approaches in examining clinically relevant aspects of attachment.

Longitudinal Outpatient and School-Based Service Use among Children with Nonsyndromic Craniosynostosis.

BACKGROUND: Although nonsyndromic craniosynostosis has been associated with neurodevelopmental sequelae, a lesser amount of emphasis has been placed on the need for related supportive services. This study assessed the prevalence of such services among children surgically treated for nonsyndromic craniosynostosis and identified predictors of service use. METHODS: Parents of children with nonsyndromic craniosynostosis were recruited from an online craniosynostosis support network and surveyed regarding their child's use of various outpatient and school-based services. Multiple stepwise regression was performed to identify predictive variables for each type of intervention. RESULTS: A total of 100 surveys were completed. Of these, 45 percent of parents reported use of one or more outpatient support services for their children. The most commonly used services were speech therapy (26.0 percent) and physical therapy (22.0 percent), although the use of services such as psychology/psychiatry increased among older children (18.2 percent in children aged 6 to 10 years). Among school-age children ( n = 49), the majority of parents (65.3 percent) reported school-based assistance for their children, most commonly for academic (46.9 percent) or behavioral (42.9 percent) difficulties. Significant predictive variables ( p < 0.05 following stepwise regression) for increases in various outpatient and school-based services included male sex, African American race/ethnicity, higher parental income, the presence of siblings in the household, increased age at the time of surgery, and sagittal synostosis. CONCLUSIONS: Parents of children with nonsyndromic craniosynostosis reported frequent use of outpatient and school-based supportive services throughout childhood. These services may incur a significant burden of care on families. The multifactorial nature of predictive models highlights the importance of cross-disciplinary collaboration to address each child's longitudinal needs.

COVID-19 Traumatic Disaster Appraisal and Stress Symptoms Among Health Care Workers: Insights From the Yale Stress Self-assessment.

OBJECTIVE: To determine to what extent did health care workers experience the pandemic as a severe stress event. METHODS: This cross-sectional evaluation of 8299 health care workers, representing a 22% response rate, utilized machine learning to predict high levels of escalating stress based on demographics and known predictors for adverse psychological outcomes after trauma. RESULTS: A third of health care workers experienced the pandemic as a potentially traumatic stress event; a greater proportion of health care workers experienced high levels of escalating stress. Predictive factors included sense of control, ability to manage work-life demands, guilt or shame, age, and level of education. Gender was no longer predictive after controlling for other factors. Escalating stress was especially high among nonclinical academics and clinical private practitioners. CONCLUSION: Findings suggest adverse effects on total worker health, care quality, professionalism, retention, and acute and chronic mental health.

An intergenerational lifespan perspective on the neuroscience of prenatal substance exposure.

Prenatal substance exposure has the potential to impact a variety of domains, with neurobiological effects that last throughout the lifespan. Different substances may impact the brain in both specific and diffuse ways; however, the aberrant neural outcomes following exposure tend to coalesce in three areas: (1) sensorimotor development; (2) arousal, motivation, and reward; and (3) executive functioning, impulse control, and emotion regulation. This manuscript represents a summary and update of a previous review (Morie et al., 2019). We organize this piece by domain and summarize data from published neuroimaging studies that examine the neural correlates of prenatal exposure across developmental stages. While the published neuroimaging literature in the area of prenatal exposure has a range of sampling concerns that may limit generalizability as well as longitudinal prediction, the findings to date do point to domains of interest warranting further study. With this caveat, we synthesize the extant findings to describe ways in which prenatal substance exposure is associated with developmental psychopathology and implicated in potentially aberrant behavioral patterns beginning in infancy and persisting through childhood, adolescence, adulthood, and even parenthood. We also examine how substance abuse may impact parenting behaviors that in turn influences infant and child behavior in ways that may be additive or obscure the direct teratological effects of prenatal exposure. Given this observation, we offer an additional intergenerational lens through which prenatal substance exposure should be studied.

Posttraumatic Stress Symptoms and the Quality of Maternal-Child Interactions in Mothers of Preterm Infants.

OBJECTIVE: The purpose of this study was to examine associations between maternal trauma exposure, posttraumatic stress symptoms, and directly observed maternal-child interactions among a diverse cohort of mother-preterm infant dyads at 12-month corrected age. METHODS: We conducted a retrospective cohort study. Maternal trauma exposure and posttraumatic stress symptoms were measured using the Modified Posttraumatic Stress Disorder Symptom Scale at baseline and 6 and 12 months. The primary outcome was directly observed maternal-child interactions at 12-month corrected age using the Coding Interactive Behavior Manual. We used linear regression models to estimate the associations between trauma exposure, posttraumatic stress symptoms (and symptom clusters), and observer-rated maternal-child interactions. RESULTS: Among the 236 participants, 89 (37.7%) self-reported as Black and 98 (41.5%) as Latina; mean gestational age of the infants was 31.6 weeks (SD 2.6). Mothers with posttraumatic stress symptoms demonstrated greater maternal sensitivity (ß = 0.32; 95% confidence interval [CI], 0.06-0.58; standardized effect size = 0.39) and greater dyadic reciprocity (ß = 0.39; 95% CI, 0.04-0.73; standardized effect size = 0.36) compared with those not exposed to trauma; however, we did not observe significant differences between trauma-exposed but asymptomatic women and those not exposed to trauma. Across symptom clusters, differences in maternal sensitivity and dyadic reciprocity were most pronounced for mothers with avoidance and re-experiencing symptoms, but not hyperarousal symptoms. CONCLUSION: Maternal posttraumatic stress symptoms seem to be associated with the quality of maternal-child interactions at age 1 year among a cohort of urban, mother-preterm infant dyads. These findings have implications for strength-based intervention development.

Exploring resting frontal EEG and reflective functioning in maternal substance use.

Maternal substance use is associated with altered neural activity and poor offspring outcomes, which may be facilitated by suboptimal caregiving in the form of impaired parental reflective functioning (PRF). To investigate these associations, the resting-state frontal electroencephalography (EEG) power of 48 substance-using mothers and 37 non-substance-using mothers were examined, specifying seven frequency bands: delta, theta, alpha, alpha1, alpha2, beta, and gamma. Substance-using mothers exhibited enhanced beta and gamma spectral power compared to non-substance-using mothers, potentially reflecting higher arousal states in substance-using mothers. There were no between-group differences in any component of PRF (i.e., levels of pre-mentalizing, certainty, and interest and curiosity). Whole-sample analyses revealed significant positive correlations between pre-mentalizing and delta spectral power. Taken together, these findings suggest potential neural correlates of maternal substance use and PRF, providing an important next step into examining associations between maternal substance use and poor child outcomes.

Se asocia el uso materno de sustancias con la actividad neural alterada y el débil resultado en los hijos, lo cual pudiera ser favorecido por una prestación de cuidado subóptima en forma de un impedido funcionamiento con reflexión (PRF) en el progenitor. Para investigar estas asociaciones, se examinó la fuerza de la electroencefalografía frontal en estado de descanso de 48 madres que usaban sustancia y 37 madres que no usaban sustancias, especificando siete bandas de frecuencia: delta, theta, alpha, alpha 1, alpha 2, beta y gamma. Las madres que usaban sustancias mostraron una fuerza espectral aumentada en beta y gamma, tal como se les comparó con las madres que no usaban sustancias, lo que potencialmente refleja estados más altos de agitación en las madres que usaban sustancias. No se dieron diferencias entre grupos en ninguno de los componentes de PRF (v.g. niveles de pre-mentalización, opacidad e interés y curiosidad). Los análisis de todas las muestras revelaron correlaciones positivas significativas entre pre-mentalización y la fuerza espectral delta. Tomándolos en conjunto, estos resultados indican posibles correlaciones neurales entre del uso materno de sustancias y PRF, lo cual aporta un importante próximo paso para examinar las asociaciones entre el uso materno de sustancias y los débiles resultados en el niño.

La toxicomanie maternelle est liée à une activité neuronale altérée et de mauvais résultats sur les enfants de la personne, ce qui peut être facilité par un mode de soin suboptimal sous la forme d'un fonctionnement de réflexion parentale (PRF en anglais) altéré. Pour enquêter sur ces liens, l'électroencéphalographie frontale au repos (EEG) de 48 mères toxicomanes et de 37 mères non-toxicomanes a été examiné, plus spécifiquement sur quatre bandes de fréquences : delta, thêta, alpha, alpha1, alpha2, béta, et gamma. Les mères toxicomanes ont fait preuve d'une puissance spectrale de béta et gamma importante comparées aux mères non-toxicomanes, ce qui reflète peut-être de plus d' états d'excitation chez les mères toxicomanes. Nous n'avons observé aucune différence entre les groupes pour ce qui concerne les composantes de la PRF (soit, niveaux de pré-mentalisation, d'opacité, d'intérêt et de curiosité). Des analyses sur tout l'échantillon ont révélé des corrélations positives importantes entre la puissance spectrale de pré-mentalisation et la puissance spectrale delta. Considérés dans l'ensemble, ces résultats suggèrent un corrélat neural potentiel de la toxicomanie maternelle et de la PRF, ce qui présente une nouvelle étape importante dans l'examen des liens entre la toxicomanie maternelle et les mauvais résultats sur l'enfant.

Trajectories and Outcomes of Adolescents that Ride With an Impaired Driver/Drive While Impaired.

Introduction: For young drivers, independent transportation has been noted to offer them opportunities that can be beneficial as they enter early adulthood. However, those that choose to engage in riding with an impaired driver (RWI) and drive while impaired (DWI) over time can face negative consequences reducing such opportunities. This study examined the prospective association of identified longitudinal trajectory classes among adolescents that RWI and DWI with their later health, education, and employment in emerging adulthood. Methods: We analyzed all seven annual assessments (Waves, W1-W7) of the NEXT Generation Health Study, a nationally representative longitudinal study starting with 10th grade (2009-2010 school year). Using all seven waves, trajectory classes were identified by latent class analysis with RWI (last 12 months) and DWI (last 30 days) dichotomized as ≥once = 1 vs. none = 0. Results: Four RWI trajectories and four DWI trajectories were identified: abstainer, escalator, decliner, and persister. For RWI and DWI trajectories respectively, 45.0% (N=647) and 76.2% (N=1,657) were abstainers, 15.6% (N=226) and 14.2% (N=337) were escalators, 25.0% (N=352) and 5.4% (N=99) were decliners, and 14.4% (N=197) and 3.8% (N=83) persisters. RWI trajectories were associated with W7 health status (χ2=13,20, p<.01) and education attainment (χ2=18.37, p<.01). Adolescent RWI abstainers reported better later health status than RWI escalators, decliners, and persisters; and decliners reported less favorable later education attainment than abstainers, escalators, and persisters. DWI trajectories showed no association with health status, education attainment, or employment. Conclusions: Our findings suggest the importance of later health outcomes of adolescent RWI. The mixed findings point to the need for more detailed understanding of contextual and time-dependent trajectory outcomes among adolescents engaging in RWI and DWI.

The process of emotion identification: Considerations for psychiatric disorders.

Emotional regulation is important for mental health and behavioral regulation. A relevant precursor to emotional regulation may involve identification of one's emotions. Here, we propose a model of seven components that may provide a foundation for emotion identification. These factors include baseline mood, monitoring, physiological responses, interoception, past personal experiences regarding emotions/metacognition, context, and labeling. We additionally examine how deficits in different components may contribute to the concept of alexithymia, which is defined by difficulty identifying and describing one's own emotions. Ultimately, we explore how the model may support a relationship between specific psychiatric disorders and alexithymia. The proposed model may help explain emotional identification impairment in multiple psychiatric disorders and guide future research and treatment development efforts.

Mapping the complex causal mechanisms of drinking and driving behaviors among adolescents and young adults.

BACKGROUND: The proportion of motor vehicle crash fatalities involving alcohol-impaired drivers declined substantially between 1982 and 1997, but progress stopped after 1997. The systemic complexity of alcohol-impaired driving contributes to the persistence of this problem. This study aims to identify and map key feedback mechanisms that affect alcohol-impaired driving among adolescents and young adults in the U.S. METHODS: We apply the system dynamics approach to the problem of alcohol-impaired driving and bring a feedback perspective for understanding drivers and inhibitors of the problem. The causal loop diagram (i.e., map of dynamic hypotheses about the structure of the system producing observed behaviors over time) developed in this study is based on the output of two group model building sessions conducted with multidisciplinary subject-matter experts bolstered with extensive literature review. RESULTS: The causal loop diagram depicts diverse influences on youth impaired driving including parents, peers, policies, law enforcement, and the alcohol industry. Embedded in these feedback loops are the physical flow of youth between the categories of abstainers, drinkers who do not drive after drinking, and drinkers who drive after drinking. We identify key inertial factors, discuss how delay and feedback processes affect observed behaviors over time, and suggest strategies to reduce youth impaired driving. CONCLUSION: This review presents the first causal loop diagram of alcohol-impaired driving among adolescents and it is a vital first step toward quantitative simulation modeling of the problem. Through continued research, this model could provide a powerful tool for understanding the systemic complexity of impaired driving among adolescents, and identifying effective prevention practices and policies to reduce youth impaired driving.

Examining Mothers' Childhood Maltreatment History, Parental Reflective Functioning, and the Long-Term Effects of the Minding the Baby® Home Visiting Intervention.

Research is needed to better understand how childhood maltreatment history affects parental reflective capacities, and whether early childhood interventions help mitigate these effects. We examined associations between childhood maltreatment and current parenting (parental reflective functioning, parenting behaviors) among mothers who participated in a follow-up study (N = 97) of the Minding the Baby® (MTB) randomized control trial. MTB is a home visiting program that aims to help mothers understand their child's mental states (feelings, intentions, needs) by promoting parental reflective functioning. Mothers retrospectively reported childhood maltreatment using the Childhood Trauma Questionnaire. Endorsing a higher number of childhood maltreatment subtypes was associated with less supportive/engaged parenting and higher pre-mentalizing modes, or difficulty with appropriately reflecting on the child's mental states. These relationships were not moderated by participation in the MTB intervention. However, exploratory analyses of individual maltreatment subtypes revealed that participation in MTB may mitigate the harmful effects of childhood emotional abuse on pre-mentalizing modes, specifically. Further research is needed to understand the mechanisms through which early childhood interventions may prevent intergenerational cycles of maltreatment.