Factors Associated With Adherence to a Low Fermentable Carbohydrate Diet in Children With Functional Gastrointestinal Disorders.

BACKGROUND: The low-fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) diet (LFD) has been associated with reduced symptomology in pediatric functional gastrointestinal disorders (FGIDs). The LFD is a complex dietary intervention that may be difficult to follow; thus, there is great interest in determining factors that contribute to adherence. OBJECTIVE: To examine whether baseline abdominal pain, emotional/behavioral problems, or quality of life predict adherence to the LFD in children with FGIDs. DESIGN: This was a single-group pre-post intervention design within a larger randomized controlled trial. PARTICIPANTS/SETTING: Thirty 7- to 12-year-old children with FGIDs were recruited from pediatric gastrointestinal and primary care settings throughout Texas from 2019 to 2021. Evaluated participants were randomized to an LFD intervention as part of a larger randomized controlled trial. INTERVENTION: Participants received dietary counseling and followed the LFD for 3 weeks. MEASURES: Emotional or behavioral problems and quality of life were obtained via parent report, and abdominal pain was measured via child report. Adherence was assessed by using diet records and computed by a decrease in consumption of overall FODMAP intake. STATISTICAL ANALYSES PERFORMED: A hierarchical generalized linear mixed regression model examined factors associated with adherence. RESULTS: Greater baseline quality of life was associated with better adherence to the LFD (beta coefficient ß = -.02, P = 0.03), and baseline emotional/behavioral problems and abdominal pain complaints were not significantly associated with adherence (all Ps > 0.28). CONCLUSIONS: Higher child quality of life as reported by parents was related to increased adherence to this complex dietary intervention.

Psychological and Psychiatric Comorbidities in Youth with Serious Physical Illness.

An estimated one in six children in the United States suffers from a mental disorder, including mood, anxiety, or behavioral disorders. This rate is even higher in children with chronic medical illness. This manuscript provides a concise review of the symptoms that comprise mental conditions often observed in children with chronic illness or at the end of life. It further provides some guidance to help clinicians distinguish normative from pathological presentations. Evidence-based psychotherapy interventions, potentially applicable to the acute inpatient setting, are briefly summarized. Broad recommendations are made regarding both psychotherapeutic as well as pharmacotherapeutic interventions, with a review of common or serious medication side effects. Finally, delirium recognition and management are summarized.

Methylphenidate Improves Autonomic Functioning among Youth with Attention-Deficit/Hyperactivity Disorder.

Psychostimulants are commonly prescribed medications for youth with attention-deficit/hyperactivity disorder (ADHD). Limited studies have evaluated how psychostimulants (e.g., methylphenidate [MPH]) impact autonomic nervous system (ANS) indexes among youth with ADHD. Understanding the effects of MPH on autonomic functioning is essential, given that youth with ADHD have been shown to experience atypical autonomic functioning (i.e., reduced activity across both sympathetic and parasympathetic branches) compared to typically developing youth. The current study investigated how a specific psychostimulant, Osmotic Release Oral System [OROS] MPH, impacts parasympathetic (indexed by respiratory sinus arrhythmia [RSA]) and sympathetic (indexed by electrodermal activity [EDA]) functioning among youth with ADHD via a within-subjects, double-masked, cross-over design. Two hundred fifty-six participants (157 youth with ADHD), ages 5 to 13 years, completed a two-minute resting baseline task while electrocardiograph and electrodermal data were obtained. Youth with ADHD completed the resting baseline task twice, 3 weeks apart, once during active medication and once during placebo conditions (counterbalanced). Typically developing youth were assessed without medication or placebo. Youth with ADHD during the placebo condition exhibited reduced RSA and EDA compared to typically developing youth. In contrast, youth with ADHD during the medication condition did not differ significantly from typically developing youth with respect to either RSA nor EDA. As such, OROS MPH appears to normalize RSA and EDA levels among youth with ADHD to levels comparable to typically developing youth. Future studies including indexes of the ANS among youth with ADHD are urged to consider the impact of MPH.

The role of temperament in alcohol use among college students.

Alcohol use and alcohol use disorder (AUD) among young adults are important public health concerns. The high prevalence and negative effects of alcohol use suggests that there is a need for improved understanding of the mechanisms underlying alcohol use. The current study utilizes the model of adult temperament proposed by Evans and Rothbart (2007) as the framework with which to examine the interplay among temperament domains and alcohol use. Specifically, we examined individual and interactive associations among self-report ratings of positive affect, negative affect, effortful control, orienting sensitivity and alcohol use patterns, among a large sample of college students. ANOVA and linear regression analyses indicated that positive affect was associated with engagement in hazardous alcohol use and binge drinking. Furthermore, effortful control was associated with reduced engagement in overall alcohol use. These results corroborate and extend previous work which suggests that positive affect and effortful control temperament domains are linked to alcohol use patterns in college-age young adults. These findings may serve as an important step for informed decision-making about prevention and intervention efforts related to problematic alcohol use in young adults.

Understanding Substance use Policies and Associated Ethical Concerns: A survey of Pediatric Transplant Centers.

Psychosocial risk factors, such as substance use, have been linked to poor post-transplant outcomes for solid organ transplant patients, including poor medication adherence, increased risk for rejection, and even graft failure. Despite universal consensus that substance use is an increasing problem among youth, many pediatric transplant centers do not have policies in place to address substance use and no universal guidelines exist regarding assessment during the pre-transplant evaluation in this population. An online survey was administered via REDCap™ and directed toward medical leaders (ie, medical and surgical directors) of national heart, kidney, and liver transplant centers. Questions examined the following: perspectives on the need for a universal transplant center policy on pediatric substance use, abuse, and dependence; timing and frequency of evaluation for substance use; specific substances which would elicit respondents' concerns; and ethical concerns surrounding substance use. Data were analyzed using descriptive statistics. Data were collected from 52 respondents from 38 transplant centers, with the majority (n = 40; 77%) reporting no substance use policy in place for pediatric transplant patients. However, many endorsed concerns if a pediatric patient was found to be using specific substances. Our findings further highlight the need for a universal substance use policy across pediatric solid organ transplant centers. The results from the distributed survey will help to provide guidelines and best practices when establishing a universal policy for substance use.

Emotion Regulation via the Autonomic Nervous System in Children with Attention-Deficit/Hyperactivity Disorder (ADHD): Replication and Extension.

Attention-deficit/hyperactivity disorder (ADHD) is a prevalent disorder characterized by symptoms of inattention, hyperactivity, and/or impulsivity, as well as executive dysfunction. Recent work underlines the importance in understanding the role of emotion reactivity and regulatory deficits in the context of the disorder. One study (i.e., Musser et al. 2011) utilized a positive and negative emotion induction and suppression task, as well as indexes of autonomic nervous system reactivity, to examine emotional functioning in youth with ADHD. This study revealed inflexible parasympathetic-based regulation across emotion conditions among youth with ADHD compared to typically developing youth. The present study sought to replicate and extend these findings to a clinically recruited, diverse sample, while also examining sympathetic functioning. Two hundred fifty-nine participants (160 youth with ADHD), aged 5 to 13, completed the task utilized in Musser et al. 2011, while indexes of parasympathetic (i.e., respiratory sinus arrhythmia [RSA]) and sympathetic (i.e., pre-ejection period [PEP] and electrodermal activity [EDA]) reactivity were obtained. ADHD was associated with significantly elevated parasympathetic (i.e., augmented RSA) and sympathetic (as indexed by EDA) reactivity. Overall, results replicate and extend Musser et al. 2011, revealing sympathetic-linked disruptions in emotion reactivity and parasympathetic-linked disruptions in emotion regulation among youth with ADHD. Future studies of behavioral therapies for ADHD should consider the efficacy of adding an emotion regulation skills training component.

Response Inhibition, Response Execution, and Emotion Regulation among Children with Attention-Deficit/Hyperactivity Disorder.

Attention-deficit/hyperactivity disorder (ADHD) is associated with deficits in response inhibition, response execution, and emotion regulation. However, the nature of the associations among these deficits remains unclear. Thus, this study examines these associations using a multi-method design. One hundred sixty-six children (aged 5-13 years; 66.3% male; 75 with ADHD) completed two conditions (i.e., neutral and fear) of an emotional go/no-go task. Parasympathetic-based regulation was indexed via respiratory sinus arrhythmia (RSA), and sympathetic-based reactivity was indexed via cardiac pre-ejection period (PEP). Overall, children exhibited more difficulty with response execution (i.e., more omission errors, fewer correct go responses) and less difficulty with response inhibition (i.e., fewer commission errors, more correct no-go responses) during the fear condition than the neutral condition. Children with ADHD displayed more difficulty with response execution during the fear condition compared to typically developing youth. Additionally, children with ADHD displayed parasympathetic-based dysregulation (i.e., RSA increase from baseline) and reduced sympathetic-based reactivity (i.e., PEP lengthening) compared to typically developing youth across task conditions. In sum, children with ADHD demonstrate greater difficulty with response execution during emotionally salient contexts, as well as parasympathetic-based emotion dysregulation. Future work should examine these associations longitudinally with the aim of predicting impairment and treatment response in youth with ADHD.

Parent Emotion Expression and Autonomic-Linked Emotion Dysregulation in Childhood ADHD.

Despite evidence that ADHD is associated with disruptions in emotion regulation, few studies have examined the biological correlates of emotion dysregulation among children with this disorder. Prior work has pointed to roles of the parasympathetic and sympathetic nervous system, as indexed via respiratory sinus arrhythmia (RSA) and cardiac pre-ejection period (PEP), respectively. Work in typically developing populations suggests that parenting behavior and parental emotion expression may shape the development of these systems. To date, a single study has examined the independent and interactive roles of autonomic nervous system functioning and parent emotion expression in youth with ADHD. This study seeks to extend that work. 86 children (42 with ADHD), aged 8-12 years, and a parent completed a parent-child interaction task, while electrocardiography and impedance cardiography data were recorded to derive RSA and PEP. Parent and child emotion word use (positive and negative valence) were coded from recordings of the task. Parents of youth with ADHD used fewer positive emotion words throughout the task. Additionally, throughout the task, children with ADHD engaged in excessive RSA withdrawal from baseline. Further, the association between RSA reactivity and ADHD diagnosis was moderated by parent positive emotion word use. Specifically, those with RSA augmentation and parents displaying high positive affect across the task conditions were least likely to have an ADHD diagnosis. If replicated and extended, these results support the use of interventions specifically designed to increase parental modeling of positive emotions, while simultaneously focusing on building emotion regulation skills in youth with ADHD.

Specificity of Reward Sensitivity and Parasympathetic-Based Regulation among Children with Attention-Deficit/Hyperactivity and Disruptive Behavior Disorders.

Attention-deficit/hyperactivity disorder (ADHD) is associated with disruptionsin reward sensitivity and regulatory processes. However, it is unclear whether thesedisruptions are better explained by comorbid disruptive behavior disorder (DBD)symptomology. This study sought to examine this question using multiple levels ofanalysis (i.e., behavior, autonomic reactivity). One hundred seventeen children (aged 6 to 12 years; 72.6% male; 69 with ADHD) completed theBalloon-Analogue Risk Task (BART) to assess external reward sensitivity behaviorally.Sympathetic-based internal reward sensitivity and parasympathetic-based regulationwere indexed via cardiac pre-ejection period (PEP) and respiratory sinus arrhythmia(RSA), respectively. Children with ADHD exhibited reduced internal reward sensitivity (i.e.,lengthened PEP; F(1,112)=4.01, p=0.047) compared to healthy controls and werecharacterized by greater parasympathetic-based dysregulation (i.e., reduced RSAaugmentation F(1,112)=10.12, p=0.002). However, follow-up analyses indicated theADHD effect was better accounted for by comorbid DBD diagnoses; that is, childrenwith ADHD and comorbid ODD were characterized by reduced internal rewardsensitivity (i.e., lengthened PEP; t=2.47, p=0.046) and by parasympathetic-baseddysregulation (i.e., reduced RSA augmentation; t=3.51, p=0.002) in response to rewardwhen compared to typically developing youth. Furthermore, children with ADHD and comorbid CD exhibited greater behaviorally-based external reward sensitivity (i.e.,more total pops; F(3,110)= 5.96, p=0.001) compared to children with ADHD only (t=3.87, p=0.001) and children with ADHD and ODD (t=3.56, p=0.003). Results suggest that disruptions in sensitivity to reward may be betteraccounted for, in part, by comorbid DBD.Key Words: attention-deficit/hyperactivity disorder, autonomic nervous system,disruptive behavior disorders, reward sensitivityPowered.