Neurocognitive and mental health impact of adrenoleukodystrophy across the lifespan: Insights for the era of newborn screening.

X-linked adrenoleukodystrophy (ALD) is a rare inherited neurological disorder that poses considerable challenges for clinical management throughout the lifespan. Although males are generally more severely affected than females, the time course and presentation of clinical symptoms are otherwise difficult to predict. Opportunities to improve outcomes for individuals with ALD are rapidly expanding due to the introduction of newborn screening programs for this condition and an evolving treatment landscape. The aim of this comprehensive review is to synthesize current knowledge regarding the neurocognitive and mental health effects of ALD. This review provides investigators and clinicians with context to improve case conceptualization, inform prognostic counseling, and optimize neuropsychological and mental health care for patients and their families. Results highlight key predictive factors and brain-behavior relationships associated with the diverse manifestations of ALD. The review also discusses considerations for endpoints within clinical trials and identifies gaps to address in future research.

Redefining Exposure: Using Mobile Technology and Geospatial Analysis to Explore When and Where Chicago Adolescents are Exposed to Neighborhood Characteristics.

Differences in how individuals navigate and interact with physical space have clear implications for when and where they are exposed to environmental characteristics. To address this reality, we propose and test a novel method with a sample of Chicago adolescents that links individual GPS coordinates with locations of environmental characteristics as a strategy to increase precision in the measurement of environmental exposures. We use exposure to violent crime as an example and link the GPS coordinates of 51 youth collected over a one-week period during the summer of 2016 to locations and times of violent crime. We explore different spatial and temporal parameters to determine whether an exposure occurred. Using the 660-foot (201 m), 24-hour operationalization, we found that youth were exposed to a total of 126 violent crimes, with an average of 3.82 (SD = 3.24) per respondent. This was higher than the 12 that were identified when exposure was calculated as the number of violent crimes occurring within 660 feet (201 m) of youths' residential addresses during the week-long assessment period. Examining correlations between the different exposure variables and measures of youths' psychological functioning, we found the largest relationships when using the GPS-based indices. We present a strategy for measuring exposure to environmental characteristics using GPS data. Higher rates of crime exposure are found based on GPS coordinates than with residential address. GPS-based exposure measures are related to youths' psychological functioning.

Encouraging Parenting Behaviors That Promote Early Childhood Development Among Caregivers From Low-Income Urban Communities: A Randomized Static Group Comparison Trial of a Primary Care-Based Parenting Program.

Objectives Encouraging key parenting behaviors in early infancy may help decrease income-related developmental disparities. In this study we assessed whether a brief, primary care-based program (Sit Down and Play; SDP) could be successful in impacting key parenting behaviors that promote early childhood development. Methods An ethnically diverse group of predominantly low-income caregivers of children 2-6 months of age were enrolled, interviewed, and randomized to intervention (n = 20) or control (n = 20) groups. Intervention families received SDP at recruitment and the subsequent well-child visit. Control families were provided handouts regarding developmental milestones. One month after the second well-child visit, all families were reinterviewed (n = 34; 85% retention rate). Using open-ended questions and standardized measures (i.e., StimQ), parents were asked about parenting behaviors central to children's development: (1) participation in cognitively stimulating activities, (2) provision of learning materials, and (3) the quality of parent-child verbal interactions. Potential impact on perceived parenting confidence was also explored utilizing The Parenting Sense of Competence Scale. Analyses were conducted using chi square tests and analysis of variance. Results A significant main effect of time, and as hypothesized, an interaction between time and condition emerged that favored SDP on play behaviors (p = 0.03). Post-intervention, SDP families had significantly higher levels of interactional activities between a parent and child that promote cognitive development (p = 0.02). Conclusions for Practice Results appear promising for an accessible, low-intensity program delivered in the primary care setting. Further studies to determine the effectiveness of SDP on parenting behaviors and subsequent developmental outcomes are warranted.

Making meaning from money: Subjective social status and young children's behavior problems.

While early exposure to poverty has been linked to decrements in children's behavior through underlying pathways of parenting stress and depression, extant research has typically relied on the use of objective measures of socioeconomic status (SES) to test these associations. However, children's development may be shaped by the ways that parents perceive social class, which may operate independently and differentially from objective SES. Using structural equation modeling, the present study explores relationships between parents' ratings of subjective social status (SSS), objective indicators of SES (income-to-needs ratio, education, employment status), and young children's (ages 0-3) behavior problems among 173 low-income families living in an urban area in the northeast United States. In addition, we consider whether parents' stress and depression underlie these associations. Results demonstrate negative relationships from both objective SES and SSS to parents' well-being. Moreover, in keeping with the Family Stress Model, we find that both SES and SSS are related to children's adjustment via parents' stress and depression; parents who have lower levels of education, are not employed, and who report lower SSS also report higher levels of stress, which in turn is related to higher levels of children's behavior problems. To our knowledge, this is the first study to test assumptions of the Family Stress Model using both subjective and objective indicators of social status, and one of few studies exploring linkages between parents' perceptions of SSS and children's behavior problems. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Symptom Dimensions and Trajectories of Functioning Among Bipolar Youth: A Cluster Analysis.

BACKGROUND: Accurate assessment of pediatric bipolar disorder (BD) is important for allocating appropriate treatment, but it is complicated by significant heterogeneity in symptom presentation and high rates of comorbidity. Investigating clinical subtypes of the disorder may help to clarify diagnostic boundaries and inform targeted treatment. This study used a full diagnostic instrument to examine symptom patterns among youth with BD. METHOD: Trained interviewers completed the Washington University Kiddie Schedule for Affective Disorders and Schizophrenia (WASH-U-KSADS) with 71 children (7 to 13 y of age) and families as part of the baseline assessment for a randomized clinical trial of Child- and Family-focused Cognitive-Behavioral Therapy (CFF-CBT) compared with treatment as usual (TAU) for pediatric BD. All participants met DSM-IV-TR criteria for a bipolar spectrum disorder. Hierarchical and K-means cluster analyses were performed. Resultant clusters were compared on symptom severity and psychosocial functioning at baseline and across treatment. RESULTS: Two distinct symptom profiles emerged: "dysregulated/defiant" and "classic presentation." The dysregulated/defiant cluster was characterized by more externalizing and disruptive behaviors, whereas the classic cluster presented with more severe depression, hallmark manic symptoms, anxiety, and inattention. CFF-CBT consistently promoted psychosocial coping skills, such as problem solving and self-control, for the dysregulated/defiant cluster. TAU also promoted these skills among the individuals in the classic presentation group but not those with symptoms in the dysregulated/defiant cluster. DISCUSSION: Pediatric BD may be characterized by distinct phenotypes with unique etiologies and pathways to impairment. The use of a parametric approach to classify the diverse symptom presentations helped yield valuable insights into how to promote the best prognosis for improved functional outcomes in CFF-CBT versus TAU for youth with pediatric BD.

Child- and Family-Focused Cognitive Behavioral Therapy for Pediatric Bipolar Disorder: Applications for Suicide Prevention.

Despite high rates of suicide ideation (SI) and behavior in youth with pediatric bipolar disorder (PBD), little work has examined how psychosocial interventions impact suicidality among this high-risk group. The current study examined SI outcomes in a randomized clinical trial comparing Child- and Family-Focused Cognitive Behavioral Therapy (CFF-CBT) for PBD versus psychotherapy treatment-as-usual (TAU). Although not designed for suicide prevention, CFF-CBT addresses child and family factors related to suicide risk and thus was hypothesized to generalize to the treatment of suicidality. Participants included 71 youth aged 7-13 years (M = 9.17, SD = 1.60) with DSM-IV-TR bipolar I, II, or not otherwise specified randomly assigned, with parent(s), to receive CFF-CBT or TAU. Both treatments consisted of 12 weekly and 6 monthly booster sessions. Suicide ideation was assessed via clinician interview at baseline, posttreatment, and 6-month follow-up. Results indicated that SI was prevalent pretreatment: 39% of youth reported current suicidal thoughts. All youth significantly improved in the likelihood and intensity of ideation across treatment, but group differences were not significant. Thus, findings suggest that early intervention for these high-risk youth may reduce SI, and at this stage of suicidality, youth may be responsive to even nonspecialized treatment.

Rapid Learning in a Children's Museum via Analogical Comparison.

We tested whether analogical training could help children learn a key principle of elementary engineering-namely, the use of a diagonal brace to stabilize a structure. The context for this learning was a construction activity at the Chicago Children's Museum, in which children and their families build a model skyscraper together. The results indicate that even a single brief analogical comparison can confer insight. The results also reveal conditions that support analogical learning.

Validating new summary indices for the Childhood Trauma Interview: associations with first onsets of major depressive disorder and anxiety disorders.

Childhood and adolescent adversity is of great interest in relation to risk for psychopathology, and interview measures of adversity are thought to be more reliable and valid than their questionnaire counterparts. One interview measure, the Childhood Trauma Interview (CTI; Fink et al., 1995), has been positively evaluated relative to similar measures, but there are some psychometric limitations to an existing scoring approach that limit the full potential of this measure. We propose several new summary indices for the CTI that permit examination of different types of adversity and different developmental periods. Our approach creates several summary indices: one sums the severity scores of adversities endorsed; another utilizes the number of minor and major (moderate to severe) adversities. The new indices were examined in association with first onsets of major depressive disorder (MDD) and anxiety disorders across a 5-year period using annual clinical diagnostic interviews (Structured Clinical Interview for DSM-IV-TR). Summary scores derived with the previously used approach were also examined for comparison. Data on 332 participants came from the Youth Emotion Project, a longitudinal study of risk for emotional disorders. Results support the predictive validity of the proposed summary scoring methods and indicate that several forms of major (but typically not minor) adversity are significantly associated with first onsets of MDD and anxiety disorders. Finally, multivariate regression models show that, in many instances, the new indices contributed significant unique variance predicting disorder onsets over and above the previously used summary indices.