My overarching research goal is to better elucidate the mechanisms linking emotion dysregulation and certain aspects of parenting behavior to externalizing behavior problems broadly. In order to do this, I have utilized a multi-method approach, which has included behavioral ratings, laboratory computerized testing, behavioral coding, and physiological measures of both autonomic and central nervous system activity.
More here: http://emusse2.wix.com/abc-erica-lab Phone: 305-348-1034 Address: Miami, Florida, United States
Background. In the transition from childhood to adolescence, attention-deficit/hyperactivity diso... more Background. In the transition from childhood to adolescence, attention-deficit/hyperactivity disorder (ADHD) developmental trajectories diverge. Family environment, as indexed by parental expressed emotion, may moderate these trajectories. Methods. 388 children with ADHD and 127 control children were assessed using a multi-informant, multi-method diagnostic procedure at up to three time points one year apart in an accelerated longitudinal design spanning ages 7-13 years. Latent-class growth analysis (LCGA) was used to identify developmental trajectories for both parent- and teacher-rated ADHD and ODD symptoms within the ADHD sample. Parental expressed emotion, criticism, and emotional over-involvement were coded from a 5-minute speech sample at two time points, one year apart, for 208 of these children and compared to the non-ADHD sample and among the ADHD trajectory groups. Results. Parent-rated hyperactivity yielded a four class trajectory solution in LCGA; teacher-rated inattention yielded a three-trajectory solution. Teacher-rated ODD also yielded three-trajectory solution. A parent-rated high persistent hyperactive group was more likely than the other ADHD groups to have parents with stable high criticism (34.6%, p<.001), with ODD symptoms controlled. A teacher-identified high ODD-worsening group was more likely to experience high criticism at either time point, particularly the initial time point; (87.5%, p<.001), with hyperactivity controlled. Conclusion. Parental criticism, an index of the family environment, is uniquely associated with divergent developmental trajectories among children with ADHD in addition to those associated with ODD symptoms.
Background. Peripheral epigenetic marks hold promise for understanding psychiatric illness and ma... more Background. Peripheral epigenetic marks hold promise for understanding psychiatric illness and may represent fingerprints of gene-environment interactions. We conducted an initial examination of CpG methylation variation in children with or without attention-deficit/hyperactivity disorder (ADHD). Methods. Children age 7-12 were recruited, screened, evaluated and assigned to ADHD or non-ADHD groups by defined research criteria. Two independent age-matched samples were examined, a discovery set (n=92, all boys, half control, half ADHD) and a confirmation set (n=20, half ADHD, all boys). 5-methylcytosine levels were quantified in salivary DNA using the Illumina 450K HumanMethylation array. Genes for which multiple probes were nominally significant and had a beta-difference of at least 2% were evaluated for biological relevance and prioritized for confirmation and sequence validation. Gene pathways were explored and described. Results. Two genes met the criteria for confirmation testing, VIPR2 and MYT1L; both had multiple probes meeting cutoffs and strong biological relevance. Probes on VIPR2 passed FDR correction in the confirmation set and were confirmed through bisulfite sequencing. Enrichment analysis suggested involvement of gene sets or pathways related to inflammatory processes and modulation of monoamine and cholinergic neurotransmission. Conclusions. Although it is unknown to what extent CpG methylation seen in peripheral tissue reflect transcriptomic changes in the brain, these initial results indicate that peripheral DNA methylation markers in ADHD may be promising and suggest targeted hypotheses for future study in larger samples.
Although attention deficit/hyperactivity disorder (ADHD) is associated with impairment in working... more Although attention deficit/hyperactivity disorder (ADHD) is associated with impairment in working memory and short-term memory, up to half of individual children with ADHD perform within a normative range. Heterogeneity in other ADHD-related mechanisms, which may compensate for or combine with cognitive weaknesses, is a likely explanation. One candidate is the robustness of parasympathetic regulation (as indexed by respiratory sinus arrhythmia; RSA). Theory and data suggest that a common neural network is likely tied to both heart-rate regulation and certain cognitive functions (including aspects of working and short-term memory). Cardiac-derived indices of parasympathetic reactivity were collected during short-term memory (STM) storage and rehearsal tasks from 243 children (116 ADHD, 127 controls). ADHD was associated with lower STM performance, replicating previous work. In addition, RSA reactivity moderated the association between STM and ADHD – both as a category and a dimension – independent of comorbidity. Specifically, conditional effects revealed that high levels of withdrawal interacted with weakened STM but high levels of augmentation moderated a positive association predicting ADHD. Thus, variations in parasympathetic reactivity may help explain neuropsychological heterogeneity in ADHD.
Background. Early environmental influences are increasingly of interest in understanding ADHD as ... more Background. Early environmental influences are increasingly of interest in understanding ADHD as a neurodevelopmental condition, particularly in light of recognition of the likely genotype by environment interplay underlying this condition. Breastfeeding duration predicts cognitive development, as well as development of brain white matter connectivity in a fashion similar to that seen in ADHD. Prior studies show an association of breastfeeding and ADHD but without adequate evaluation of ADHD. Methods. A case control cohort of 474 children 7-13 years of age was examined, 291 with well-characterized ADHD and the rest typically developing controls. Mothers retrospectively reported on breast feeding initiation and duration. Results. Initiation of breastfeeding was not associated with ADHD, but shorter duration of breastfeeding was associated with child ADHD with a medium effect size (d=.40, p<.05); this effect held after covarying a broad set of potential confounders, including child oppositional defiant and conduct problems and including maternal and paternal ADHD and depression. Effects were replicated across both parent and teacher ratings of child ADHD symptoms. Conclusion. Shorter duration of breastfeeding is among several risk factors in early life associated with future ADHD, or else longer duration is protective. The direction of this effect is unknown. It may be that children with difficult temperament are more difficult to breastfeed or that breastfeeding provides nutrients or other benefits that reduce future chance of ADHD.
IMPORTANCE Psychiatric nosology is limited by behavioral and biological heterogeneity
within exis... more IMPORTANCE Psychiatric nosology is limited by behavioral and biological heterogeneity within existing disorder categories. The imprecise nature of current nosologic distinctions limits both mechanistic understanding and clinical prediction.We demonstrate an approach consistent with the National Institute of Mental Health Research Domain Criteria initiative to identify superior, neurobiologically valid subgroups with better predictive capacity than existing psychiatric categories for childhood attention-deficit/hyperactivity disorder (ADHD). OBJECTIVE To refine subtyping of childhood ADHD by using biologically based behavioral dimensions (ie, temperament), novel classification algorithms, and multiple external validators. DESIGN, SETTING, AND PARTICIPANTS A total of 437 clinicallywell-characterized, community-recruited children, with and without ADHD, participated in an ongoing longitudinal study. Baseline data were used to classify children into subgroups based on temperament dimensions and examine external validators including physiological and magnetic resonance imaging measures. One-year longitudinal follow-up data are reported for a subgroup of the ADHD sample to address stability and clinical prediction. MAIN OUTCOMES AND MEASURES Parent/guardian ratings of children on a measure of temperament were used as input features in novel community detection analyses to identify subgroups within the sample. Groups were validated using 3 widely accepted external validators: peripheral physiological characteristics (cardiac measures of respiratory sinus arrhythmia and pre-ejection period), central nervous system functioning (via resting-state functional connectivitymagnetic resonance imaging), and clinical outcomes (at 1-year longitudinal follow-up). RESULTS The community detection algorithm suggested 3 novel types of ADHD, labeled as mild (normative emotion regulation), surgent (extreme levels of positive approachmotivation), and irritable (extreme levels of negative emotionality, anger, and poor soothability). Types were independent of existing clinical demarcations including DSM-5 presentations or symptom severity. These types showed stability over time and were distinguished by unique patterns of cardiac physiological response, resting-state functional brain connectivity, and clinical outcomes 1 year later. CONCLUSIONS AND RELEVANCE Results suggest that a biologically informed temperament-based typology, developed with a discovery-based community detection algorithm, provides a superior description of heterogeneity in the ADHD population than does any current clinical nosologic criteria. This demonstration sets the stage for more aggressive attempts at a tractable, biologically based nosology.
Background: To determine whether familial transmission is shared between autism spectrum disorder... more Background: To determine whether familial transmission is shared between autism spectrum disorders and attention-deficit/hyperactivity disorder, we assessed the prevalence, rates of comorbidity, and familial transmission of both disorders in a large population-based sample of children during a recent 7 year period. Methods: Study participants included all children born to parents with the Kaiser Permanente Northwest (KPNW) Health Plan between 1 January 1998 and 31 December 2004 (n = 35,073). Children and mothers with physician-identified autism spectrum disorders (ASD) and/or attention-deficit/hyperactivity disorder (ADHD) were identified via electronic medical records maintained for all KPNW members. Results: Among children aged 6–12 years, prevalence was 2.0% for ADHD and 0.8% for ASD; within those groups, 0.2% of the full sample (19% of the ASD sample and 9.6% of the ADHD sample) had co-occurring ASD and ADHD, when all children were included. When mothers had a diagnosis of ADHD, first born offspring were at 6-fold risk of ADHD alone (OR = 5.02, p < .0001) and at 2.5-fold risk of ASD alone (OR = 2.52, p < .01). Results were not accounted for by maternal age, child gestational age, child gender, and child race. Conclusions: Autism spectrum disorders shares familial transmission with ADHD. ADHD and ASD have a partially overlapping diathesis. Keywords: Attention-deficit/hyperactivity disorder, autism spectrum disorder, shared familial transmission.
Objective: How best to capture heterogeneity in attention-deficit/hyperactivity disorder
(ADHD) u... more Objective: How best to capture heterogeneity in attention-deficit/hyperactivity disorder (ADHD) using biomarkers has been elusive. This study evaluated whether emotion reactivity and regulation provide a means to achieve this. Method: Participants were classified into three groups: children with ADHD plus low prosocial behavior (hypothesized to be high in callous/unemotional traits; n ¼ 21); children with ADHD with age-appropriate prosocial behavior (n ¼ 54); and typically developing children (n ¼ 75). Children completed a task with four conditions: negative induction, negative suppression, positive induction, and positive suppression of affect. The task required children to view an emotion-laden film clip, while either facially mimicking (induction) or masking (suppression) the emotion of the main character. Parasympathetic and sympathetic nervous system activity were assessed via respiratory sinus arrhythmia (RSA) and cardiac pre-ejection period (PEP), respectively. Symptoms of anxiety, conduct, and oppositional defiant disorders were treated as covariates. Results: The ADHDtypical- prosocial group displayed atypically elevated parasympathetic reactivity (emotion dysregulation) during positive induction, along with increased sympathetic activity (elevated arousal) across conditions. In contrast, the ADHD-low-prosocial group displayed reduced parasympathetic reactivity and reduced sympathetic activity (low emotional arousal) across baseline and task conditions. Thus, both ADHD groups had altered patterns of autonomic functioning, but in two distinct forms. Conclusion: Although ADHD is heterogeneous clinically, results suggest that ADHD is also heterogeneous with regard to physiological indices of emotion and regulation. Future studies of emotion, regulation, and ADHD should take this into account. Further study of physiological responding in ADHD may yield clinically and etiologically distinct domains or groups. J. Am. Acad. Child Adolesc. Psychiatry; 2013; 52(2):163-171. Key Words: attention-deficit/hyperactivity disorder, autonomic nervous system, callous/unemotional traits, emotionality, emotion regulation
Child abuse predicts a wide range of long-lasting deleterious outcomes,
including disruptions in ... more Child abuse predicts a wide range of long-lasting deleterious outcomes, including disruptions in the biological systems central to emotion arousal and regulation. However, little is known about the specific ways in which child abuse affects adulthood sympathetic reactivity and recovery. This study investigated the association between child abuse experience and adult skin conductance level and habituation in 85 at-risk women as they completed a self- -report trauma questionnaire. Childhood emotional abuse was independently associated with blunted skin conductance habituation over the course of survey completion after controlling for other abuse subtypes and current trauma symptoms. These results suggest that women emotionally abused as children experience prolonged emotional arousal and poor physiological regulation of emotion in response to reminders of traumatic experiences.
Adult caregivers’ idealization of their parents as assessed by the
Adult Attachment Interview is ... more Adult caregivers’ idealization of their parents as assessed by the Adult Attachment Interview is a risk factor for the intergenerational transmission of the insecure-avoidant attachment style. This study evaluated a briefer screening approach for identifying parental idealization, testing the utility of prenatal maternal self-report measures of recalled betrayal trauma and parental care in childhood to predict observationally assessed infant attachment avoidance with 58 mother–infant dyads 18 months postpartum. In a logistic regression that controlled for maternal demographics, prenatal psychopathology, and postnatal sensitivity, the interaction between women’s self-reported childhood high betrayal trauma and the level of care provided to them by their parents was the only significant predictor of 18-month infant security versus avoidance. Results suggest that betrayal trauma and recalled parental care in childhood can provide a means of identifying caregivers whose infant children are at risk for avoidant attachment, potentially providing an efficient means for scientific studies and clinical intervention aimed at preventing the intergenerational transmission of attachment problems.
Research on maternal neural response to infant distress highlights circuits that may underlie
dif... more Research on maternal neural response to infant distress highlights circuits that may underlie differences in quality of maternal behavior. However, it is far from clear which circuits are relevant to maternal sensitivity, as opposed to other maternal behavioral dimensions, particularly after the early postpartum. This study examined maternal sensitivity, intrusiveness, and mother–infant dyadic harmony as correlates of mothers’ neural responses to the cries of their own infants. Twenty-two primiparous mothers were observed during an interaction with their infants at 18 months postpartum. In a separate functional neuroimaging session, mothers were exposed to their own infant’s cry sound, as well as unfamiliar infant’s cry and control sounds. Mothers who displayed more sensitive behaviors with their infant exhibited greater activation to their own infant’s cry compared to that of an unfamiliar infant in the right frontal pole and inferior frontal gyrus. Mothers who displayed more intrusive behaviors with their infant showed greater activation in the left anterior insula and temporal pole, while mothers who had more harmonious interactions with their infant displayed greater activation in left hippocampal regions. The roles of these areas in the regulation of maternal emotion and stress, self and other awareness, and empathy are examined.
Introduction:Attentiondeficithyperactivitydisorder(ADHD)capturesaheterogeneousgroupofchildren,who... more Introduction:Attentiondeficithyperactivitydisorder(ADHD)capturesaheterogeneousgroupofchildren,whoarecharacterizedbyarangeofcognitiveandbehavioralsymp-toms.Previousresting-statefunctionalconnectivityMRI(rs-fcMRI)studieshavesoughttounderstandtheneuralcorrelatesofADHDbycomparingconnectivitymeasurementsbetweenthosewithandwithoutthedisorder,focusingprimarilyoncortical–striatalcircuitsmediatedbythethalamus.TointegratethemultiplephenotypicfeaturesassociatedwithADHDandhelpresolveitsheterogeneity,itishelpfultodeterminehowspecificcircuitsrelatetouniquecognitivedomainsoftheADHDsyndrome.SpatialworkingmemoryhasbeenproposedasakeymechanisminthepathophysiologyofADHD.Methods:Wecor-relatedthers-fcMRIoffivethalamicregionsofinterest(ROIs)withspatialspanworkingmemoryscoresinasampleof67childrenaged7–11years[ADHDandtypicallydevelop-ingchildren(TDC)].Inanindependentdataset,wethenexaminedgroupdifferencesinthalamo-striatalfunctionalconnectivitybetween70ADHDand89TDC(7–11years)fromtheADHD-200dataset.ThalamicROIswerecreatedbasedonpreviousmethodsthatuti-lizeknownthalamo-corticalloopsandrs-fcMRItoidentifyfunctionalboundariesinthethalamus.Results/Conclusion:Usingthesethalamicregions,wefoundatypicalrs-fcMRIbetweenspecificthalamicgroupingswiththebasalganglia.Toidentifythethalamiccon-nectionsthatrelatetospatialworkingmemoryinADHD,onlyconnectionsidentifiedinboththecorrelationalandcomparativeanalyseswereconsidered.Multipleconnectionsbetweenthethalamusandbasalganglia,particularlybetweenmedialandanteriordor-salthalamusandtheputamen,wererelatedtospatialworkingmemoryandalsoalteredinADHD.Thesethalamo-striataldisruptionsmaybeoneofmultipleatypicalneuralandcognitivemechanismsthatrelatetotheADHDclinicalphenotype.
Despite growing interest in conceptualizing ADHD as involving disrupted emotion regulation, few s... more Despite growing interest in conceptualizing ADHD as involving disrupted emotion regulation, few studies have examined the physiological mechanisms related to emotion regulation in children with this disorder. This study examined parasympathetic and sympathetic nervous system reactivity via measures of respiratory sinus arrhythmia (RSA) and cardiac pre-ejection period (PEP) in children with ADHD (n = 32) and typically developing controls (n = 34), using a novel emotion task with four conditions: negative induction, negative suppression, positive induction, and positive suppression of affect. Both groups showed strong task-response effects in RSA. However, typically developing children showed systematic variation in parasympathetic activity (RSA) depending on both emotion valence (more activation for negative emotion, reduced activation for positive emotion) and task demand (more activation for suppression than induction). In contrast, children with ADHD displayed a stable pattern of elevated parasympathetic activity (RSA) across all task conditions compared to baseline. No group differences in sympathetic activity (PEP) were observed. It is concluded ADHD in childhood is associated with abnormal parasympathetic mechanisms involved in emotion regulation.
Previous research has established that maternal depression is a risk factor for a variety of nega... more Previous research has established that maternal depression is a risk factor for a variety of negative developmental outcomes among infants and children. Although low levels of maternal sensitivity have been hypothesized to explain this risk, the biological mechanisms underlying the association between maternal depressive symptoms and low levels of maternal sensitivity have been largely underexplored. This study examined the roles of postnatal depressive symptoms and parasympathetic nervous system functioning as predictors of low levels of maternal sensitivity, during a stressful mother–infant interaction—the reunion phase of the Still-Face Paradigm. Depressive symptoms and traitlike predispositions toward parasympathetic dysregulation, as indexed by low resting levels of respiratory sinus arrhythmia, were associated independently with less sensitive parenting. Discussion considers that during stressful mother–infant interactions, both mothers with depressive symptoms and mothers predisposed to parasympathetic dysregulation may have fewer emotional, physiological, and psychological resources with which to respond sensitively to their infants’ cues.
Background—A key underlying process that may contribute to attention-deficit/hyperactivity
disord... more Background—A key underlying process that may contribute to attention-deficit/hyperactivity disorder (ADHD) involves alterations in reward evaluation, including assessing the relative value of immediate over delayed rewards. This study examines whether children with ADHD discount the value of delayed rewards to a greater degree than typically developing children using a delay discounting task. Methods—Children aged 7–9 years diagnosed with ADHD and controls completed a task in which they chose between a hypothetical $10 available after a delay (7, 30, 90 and 180 days) versus various amounts available immediately. Results—ADHD participants discounted more steeply than controls. However, this effect did not survive covarying of IQ. Conclusions—ADHD is associated with a steeper delay gradient when contemplating hypothetical later rewards, but not independently of IQ. The interplay of cognitive processing and IQ with reward evaluation in ADHD requires further exploration.
Computerized administration of clinical instruments is not an entirely
new phenomenon. The first ... more Computerized administration of clinical instruments is not an entirely new phenomenon. The first personal computers were introduced into wide use in the 1970s. Rapid adoption of computer-based testing paralleled this development. By the 1980s, the research literature was replete with considerations of the inherent advantages and limitations of automated assessment of a myriad of clinical domains. In particular, the application of computers to the evaluation of cognition has been widely studied. This body of research has generally fallen into one of two categories: (1) the translation of existing standardized tests to computerized administration and (2) the development of new computer tests and batteries for the assessment of cognitive function. Somewhere between these two categories are approaches that have adapted existing tests in a new way using computer administration. The Cambridge Neuropsychological Test Automated Battery (CANTAB) is an example of a battery that has successfully combined standard cognitive test paradigms with novel formats.
Background. In the transition from childhood to adolescence, attention-deficit/hyperactivity diso... more Background. In the transition from childhood to adolescence, attention-deficit/hyperactivity disorder (ADHD) developmental trajectories diverge. Family environment, as indexed by parental expressed emotion, may moderate these trajectories. Methods. 388 children with ADHD and 127 control children were assessed using a multi-informant, multi-method diagnostic procedure at up to three time points one year apart in an accelerated longitudinal design spanning ages 7-13 years. Latent-class growth analysis (LCGA) was used to identify developmental trajectories for both parent- and teacher-rated ADHD and ODD symptoms within the ADHD sample. Parental expressed emotion, criticism, and emotional over-involvement were coded from a 5-minute speech sample at two time points, one year apart, for 208 of these children and compared to the non-ADHD sample and among the ADHD trajectory groups. Results. Parent-rated hyperactivity yielded a four class trajectory solution in LCGA; teacher-rated inattention yielded a three-trajectory solution. Teacher-rated ODD also yielded three-trajectory solution. A parent-rated high persistent hyperactive group was more likely than the other ADHD groups to have parents with stable high criticism (34.6%, p<.001), with ODD symptoms controlled. A teacher-identified high ODD-worsening group was more likely to experience high criticism at either time point, particularly the initial time point; (87.5%, p<.001), with hyperactivity controlled. Conclusion. Parental criticism, an index of the family environment, is uniquely associated with divergent developmental trajectories among children with ADHD in addition to those associated with ODD symptoms.
Background. Peripheral epigenetic marks hold promise for understanding psychiatric illness and ma... more Background. Peripheral epigenetic marks hold promise for understanding psychiatric illness and may represent fingerprints of gene-environment interactions. We conducted an initial examination of CpG methylation variation in children with or without attention-deficit/hyperactivity disorder (ADHD). Methods. Children age 7-12 were recruited, screened, evaluated and assigned to ADHD or non-ADHD groups by defined research criteria. Two independent age-matched samples were examined, a discovery set (n=92, all boys, half control, half ADHD) and a confirmation set (n=20, half ADHD, all boys). 5-methylcytosine levels were quantified in salivary DNA using the Illumina 450K HumanMethylation array. Genes for which multiple probes were nominally significant and had a beta-difference of at least 2% were evaluated for biological relevance and prioritized for confirmation and sequence validation. Gene pathways were explored and described. Results. Two genes met the criteria for confirmation testing, VIPR2 and MYT1L; both had multiple probes meeting cutoffs and strong biological relevance. Probes on VIPR2 passed FDR correction in the confirmation set and were confirmed through bisulfite sequencing. Enrichment analysis suggested involvement of gene sets or pathways related to inflammatory processes and modulation of monoamine and cholinergic neurotransmission. Conclusions. Although it is unknown to what extent CpG methylation seen in peripheral tissue reflect transcriptomic changes in the brain, these initial results indicate that peripheral DNA methylation markers in ADHD may be promising and suggest targeted hypotheses for future study in larger samples.
Although attention deficit/hyperactivity disorder (ADHD) is associated with impairment in working... more Although attention deficit/hyperactivity disorder (ADHD) is associated with impairment in working memory and short-term memory, up to half of individual children with ADHD perform within a normative range. Heterogeneity in other ADHD-related mechanisms, which may compensate for or combine with cognitive weaknesses, is a likely explanation. One candidate is the robustness of parasympathetic regulation (as indexed by respiratory sinus arrhythmia; RSA). Theory and data suggest that a common neural network is likely tied to both heart-rate regulation and certain cognitive functions (including aspects of working and short-term memory). Cardiac-derived indices of parasympathetic reactivity were collected during short-term memory (STM) storage and rehearsal tasks from 243 children (116 ADHD, 127 controls). ADHD was associated with lower STM performance, replicating previous work. In addition, RSA reactivity moderated the association between STM and ADHD – both as a category and a dimension – independent of comorbidity. Specifically, conditional effects revealed that high levels of withdrawal interacted with weakened STM but high levels of augmentation moderated a positive association predicting ADHD. Thus, variations in parasympathetic reactivity may help explain neuropsychological heterogeneity in ADHD.
Background. Early environmental influences are increasingly of interest in understanding ADHD as ... more Background. Early environmental influences are increasingly of interest in understanding ADHD as a neurodevelopmental condition, particularly in light of recognition of the likely genotype by environment interplay underlying this condition. Breastfeeding duration predicts cognitive development, as well as development of brain white matter connectivity in a fashion similar to that seen in ADHD. Prior studies show an association of breastfeeding and ADHD but without adequate evaluation of ADHD. Methods. A case control cohort of 474 children 7-13 years of age was examined, 291 with well-characterized ADHD and the rest typically developing controls. Mothers retrospectively reported on breast feeding initiation and duration. Results. Initiation of breastfeeding was not associated with ADHD, but shorter duration of breastfeeding was associated with child ADHD with a medium effect size (d=.40, p<.05); this effect held after covarying a broad set of potential confounders, including child oppositional defiant and conduct problems and including maternal and paternal ADHD and depression. Effects were replicated across both parent and teacher ratings of child ADHD symptoms. Conclusion. Shorter duration of breastfeeding is among several risk factors in early life associated with future ADHD, or else longer duration is protective. The direction of this effect is unknown. It may be that children with difficult temperament are more difficult to breastfeed or that breastfeeding provides nutrients or other benefits that reduce future chance of ADHD.
IMPORTANCE Psychiatric nosology is limited by behavioral and biological heterogeneity
within exis... more IMPORTANCE Psychiatric nosology is limited by behavioral and biological heterogeneity within existing disorder categories. The imprecise nature of current nosologic distinctions limits both mechanistic understanding and clinical prediction.We demonstrate an approach consistent with the National Institute of Mental Health Research Domain Criteria initiative to identify superior, neurobiologically valid subgroups with better predictive capacity than existing psychiatric categories for childhood attention-deficit/hyperactivity disorder (ADHD). OBJECTIVE To refine subtyping of childhood ADHD by using biologically based behavioral dimensions (ie, temperament), novel classification algorithms, and multiple external validators. DESIGN, SETTING, AND PARTICIPANTS A total of 437 clinicallywell-characterized, community-recruited children, with and without ADHD, participated in an ongoing longitudinal study. Baseline data were used to classify children into subgroups based on temperament dimensions and examine external validators including physiological and magnetic resonance imaging measures. One-year longitudinal follow-up data are reported for a subgroup of the ADHD sample to address stability and clinical prediction. MAIN OUTCOMES AND MEASURES Parent/guardian ratings of children on a measure of temperament were used as input features in novel community detection analyses to identify subgroups within the sample. Groups were validated using 3 widely accepted external validators: peripheral physiological characteristics (cardiac measures of respiratory sinus arrhythmia and pre-ejection period), central nervous system functioning (via resting-state functional connectivitymagnetic resonance imaging), and clinical outcomes (at 1-year longitudinal follow-up). RESULTS The community detection algorithm suggested 3 novel types of ADHD, labeled as mild (normative emotion regulation), surgent (extreme levels of positive approachmotivation), and irritable (extreme levels of negative emotionality, anger, and poor soothability). Types were independent of existing clinical demarcations including DSM-5 presentations or symptom severity. These types showed stability over time and were distinguished by unique patterns of cardiac physiological response, resting-state functional brain connectivity, and clinical outcomes 1 year later. CONCLUSIONS AND RELEVANCE Results suggest that a biologically informed temperament-based typology, developed with a discovery-based community detection algorithm, provides a superior description of heterogeneity in the ADHD population than does any current clinical nosologic criteria. This demonstration sets the stage for more aggressive attempts at a tractable, biologically based nosology.
Background: To determine whether familial transmission is shared between autism spectrum disorder... more Background: To determine whether familial transmission is shared between autism spectrum disorders and attention-deficit/hyperactivity disorder, we assessed the prevalence, rates of comorbidity, and familial transmission of both disorders in a large population-based sample of children during a recent 7 year period. Methods: Study participants included all children born to parents with the Kaiser Permanente Northwest (KPNW) Health Plan between 1 January 1998 and 31 December 2004 (n = 35,073). Children and mothers with physician-identified autism spectrum disorders (ASD) and/or attention-deficit/hyperactivity disorder (ADHD) were identified via electronic medical records maintained for all KPNW members. Results: Among children aged 6–12 years, prevalence was 2.0% for ADHD and 0.8% for ASD; within those groups, 0.2% of the full sample (19% of the ASD sample and 9.6% of the ADHD sample) had co-occurring ASD and ADHD, when all children were included. When mothers had a diagnosis of ADHD, first born offspring were at 6-fold risk of ADHD alone (OR = 5.02, p < .0001) and at 2.5-fold risk of ASD alone (OR = 2.52, p < .01). Results were not accounted for by maternal age, child gestational age, child gender, and child race. Conclusions: Autism spectrum disorders shares familial transmission with ADHD. ADHD and ASD have a partially overlapping diathesis. Keywords: Attention-deficit/hyperactivity disorder, autism spectrum disorder, shared familial transmission.
Objective: How best to capture heterogeneity in attention-deficit/hyperactivity disorder
(ADHD) u... more Objective: How best to capture heterogeneity in attention-deficit/hyperactivity disorder (ADHD) using biomarkers has been elusive. This study evaluated whether emotion reactivity and regulation provide a means to achieve this. Method: Participants were classified into three groups: children with ADHD plus low prosocial behavior (hypothesized to be high in callous/unemotional traits; n ¼ 21); children with ADHD with age-appropriate prosocial behavior (n ¼ 54); and typically developing children (n ¼ 75). Children completed a task with four conditions: negative induction, negative suppression, positive induction, and positive suppression of affect. The task required children to view an emotion-laden film clip, while either facially mimicking (induction) or masking (suppression) the emotion of the main character. Parasympathetic and sympathetic nervous system activity were assessed via respiratory sinus arrhythmia (RSA) and cardiac pre-ejection period (PEP), respectively. Symptoms of anxiety, conduct, and oppositional defiant disorders were treated as covariates. Results: The ADHDtypical- prosocial group displayed atypically elevated parasympathetic reactivity (emotion dysregulation) during positive induction, along with increased sympathetic activity (elevated arousal) across conditions. In contrast, the ADHD-low-prosocial group displayed reduced parasympathetic reactivity and reduced sympathetic activity (low emotional arousal) across baseline and task conditions. Thus, both ADHD groups had altered patterns of autonomic functioning, but in two distinct forms. Conclusion: Although ADHD is heterogeneous clinically, results suggest that ADHD is also heterogeneous with regard to physiological indices of emotion and regulation. Future studies of emotion, regulation, and ADHD should take this into account. Further study of physiological responding in ADHD may yield clinically and etiologically distinct domains or groups. J. Am. Acad. Child Adolesc. Psychiatry; 2013; 52(2):163-171. Key Words: attention-deficit/hyperactivity disorder, autonomic nervous system, callous/unemotional traits, emotionality, emotion regulation
Child abuse predicts a wide range of long-lasting deleterious outcomes,
including disruptions in ... more Child abuse predicts a wide range of long-lasting deleterious outcomes, including disruptions in the biological systems central to emotion arousal and regulation. However, little is known about the specific ways in which child abuse affects adulthood sympathetic reactivity and recovery. This study investigated the association between child abuse experience and adult skin conductance level and habituation in 85 at-risk women as they completed a self- -report trauma questionnaire. Childhood emotional abuse was independently associated with blunted skin conductance habituation over the course of survey completion after controlling for other abuse subtypes and current trauma symptoms. These results suggest that women emotionally abused as children experience prolonged emotional arousal and poor physiological regulation of emotion in response to reminders of traumatic experiences.
Adult caregivers’ idealization of their parents as assessed by the
Adult Attachment Interview is ... more Adult caregivers’ idealization of their parents as assessed by the Adult Attachment Interview is a risk factor for the intergenerational transmission of the insecure-avoidant attachment style. This study evaluated a briefer screening approach for identifying parental idealization, testing the utility of prenatal maternal self-report measures of recalled betrayal trauma and parental care in childhood to predict observationally assessed infant attachment avoidance with 58 mother–infant dyads 18 months postpartum. In a logistic regression that controlled for maternal demographics, prenatal psychopathology, and postnatal sensitivity, the interaction between women’s self-reported childhood high betrayal trauma and the level of care provided to them by their parents was the only significant predictor of 18-month infant security versus avoidance. Results suggest that betrayal trauma and recalled parental care in childhood can provide a means of identifying caregivers whose infant children are at risk for avoidant attachment, potentially providing an efficient means for scientific studies and clinical intervention aimed at preventing the intergenerational transmission of attachment problems.
Research on maternal neural response to infant distress highlights circuits that may underlie
dif... more Research on maternal neural response to infant distress highlights circuits that may underlie differences in quality of maternal behavior. However, it is far from clear which circuits are relevant to maternal sensitivity, as opposed to other maternal behavioral dimensions, particularly after the early postpartum. This study examined maternal sensitivity, intrusiveness, and mother–infant dyadic harmony as correlates of mothers’ neural responses to the cries of their own infants. Twenty-two primiparous mothers were observed during an interaction with their infants at 18 months postpartum. In a separate functional neuroimaging session, mothers were exposed to their own infant’s cry sound, as well as unfamiliar infant’s cry and control sounds. Mothers who displayed more sensitive behaviors with their infant exhibited greater activation to their own infant’s cry compared to that of an unfamiliar infant in the right frontal pole and inferior frontal gyrus. Mothers who displayed more intrusive behaviors with their infant showed greater activation in the left anterior insula and temporal pole, while mothers who had more harmonious interactions with their infant displayed greater activation in left hippocampal regions. The roles of these areas in the regulation of maternal emotion and stress, self and other awareness, and empathy are examined.
Introduction:Attentiondeficithyperactivitydisorder(ADHD)capturesaheterogeneousgroupofchildren,who... more Introduction:Attentiondeficithyperactivitydisorder(ADHD)capturesaheterogeneousgroupofchildren,whoarecharacterizedbyarangeofcognitiveandbehavioralsymp-toms.Previousresting-statefunctionalconnectivityMRI(rs-fcMRI)studieshavesoughttounderstandtheneuralcorrelatesofADHDbycomparingconnectivitymeasurementsbetweenthosewithandwithoutthedisorder,focusingprimarilyoncortical–striatalcircuitsmediatedbythethalamus.TointegratethemultiplephenotypicfeaturesassociatedwithADHDandhelpresolveitsheterogeneity,itishelpfultodeterminehowspecificcircuitsrelatetouniquecognitivedomainsoftheADHDsyndrome.SpatialworkingmemoryhasbeenproposedasakeymechanisminthepathophysiologyofADHD.Methods:Wecor-relatedthers-fcMRIoffivethalamicregionsofinterest(ROIs)withspatialspanworkingmemoryscoresinasampleof67childrenaged7–11years[ADHDandtypicallydevelop-ingchildren(TDC)].Inanindependentdataset,wethenexaminedgroupdifferencesinthalamo-striatalfunctionalconnectivitybetween70ADHDand89TDC(7–11years)fromtheADHD-200dataset.ThalamicROIswerecreatedbasedonpreviousmethodsthatuti-lizeknownthalamo-corticalloopsandrs-fcMRItoidentifyfunctionalboundariesinthethalamus.Results/Conclusion:Usingthesethalamicregions,wefoundatypicalrs-fcMRIbetweenspecificthalamicgroupingswiththebasalganglia.Toidentifythethalamiccon-nectionsthatrelatetospatialworkingmemoryinADHD,onlyconnectionsidentifiedinboththecorrelationalandcomparativeanalyseswereconsidered.Multipleconnectionsbetweenthethalamusandbasalganglia,particularlybetweenmedialandanteriordor-salthalamusandtheputamen,wererelatedtospatialworkingmemoryandalsoalteredinADHD.Thesethalamo-striataldisruptionsmaybeoneofmultipleatypicalneuralandcognitivemechanismsthatrelatetotheADHDclinicalphenotype.
Despite growing interest in conceptualizing ADHD as involving disrupted emotion regulation, few s... more Despite growing interest in conceptualizing ADHD as involving disrupted emotion regulation, few studies have examined the physiological mechanisms related to emotion regulation in children with this disorder. This study examined parasympathetic and sympathetic nervous system reactivity via measures of respiratory sinus arrhythmia (RSA) and cardiac pre-ejection period (PEP) in children with ADHD (n = 32) and typically developing controls (n = 34), using a novel emotion task with four conditions: negative induction, negative suppression, positive induction, and positive suppression of affect. Both groups showed strong task-response effects in RSA. However, typically developing children showed systematic variation in parasympathetic activity (RSA) depending on both emotion valence (more activation for negative emotion, reduced activation for positive emotion) and task demand (more activation for suppression than induction). In contrast, children with ADHD displayed a stable pattern of elevated parasympathetic activity (RSA) across all task conditions compared to baseline. No group differences in sympathetic activity (PEP) were observed. It is concluded ADHD in childhood is associated with abnormal parasympathetic mechanisms involved in emotion regulation.
Previous research has established that maternal depression is a risk factor for a variety of nega... more Previous research has established that maternal depression is a risk factor for a variety of negative developmental outcomes among infants and children. Although low levels of maternal sensitivity have been hypothesized to explain this risk, the biological mechanisms underlying the association between maternal depressive symptoms and low levels of maternal sensitivity have been largely underexplored. This study examined the roles of postnatal depressive symptoms and parasympathetic nervous system functioning as predictors of low levels of maternal sensitivity, during a stressful mother–infant interaction—the reunion phase of the Still-Face Paradigm. Depressive symptoms and traitlike predispositions toward parasympathetic dysregulation, as indexed by low resting levels of respiratory sinus arrhythmia, were associated independently with less sensitive parenting. Discussion considers that during stressful mother–infant interactions, both mothers with depressive symptoms and mothers predisposed to parasympathetic dysregulation may have fewer emotional, physiological, and psychological resources with which to respond sensitively to their infants’ cues.
Background—A key underlying process that may contribute to attention-deficit/hyperactivity
disord... more Background—A key underlying process that may contribute to attention-deficit/hyperactivity disorder (ADHD) involves alterations in reward evaluation, including assessing the relative value of immediate over delayed rewards. This study examines whether children with ADHD discount the value of delayed rewards to a greater degree than typically developing children using a delay discounting task. Methods—Children aged 7–9 years diagnosed with ADHD and controls completed a task in which they chose between a hypothetical $10 available after a delay (7, 30, 90 and 180 days) versus various amounts available immediately. Results—ADHD participants discounted more steeply than controls. However, this effect did not survive covarying of IQ. Conclusions—ADHD is associated with a steeper delay gradient when contemplating hypothetical later rewards, but not independently of IQ. The interplay of cognitive processing and IQ with reward evaluation in ADHD requires further exploration.
Computerized administration of clinical instruments is not an entirely
new phenomenon. The first ... more Computerized administration of clinical instruments is not an entirely new phenomenon. The first personal computers were introduced into wide use in the 1970s. Rapid adoption of computer-based testing paralleled this development. By the 1980s, the research literature was replete with considerations of the inherent advantages and limitations of automated assessment of a myriad of clinical domains. In particular, the application of computers to the evaluation of cognition has been widely studied. This body of research has generally fallen into one of two categories: (1) the translation of existing standardized tests to computerized administration and (2) the development of new computer tests and batteries for the assessment of cognitive function. Somewhere between these two categories are approaches that have adapted existing tests in a new way using computer administration. The Cambridge Neuropsychological Test Automated Battery (CANTAB) is an example of a battery that has successfully combined standard cognitive test paradigms with novel formats.
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Papers by Erica Musser
Methods. 388 children with ADHD and 127 control children were assessed using a multi-informant, multi-method diagnostic procedure at up to three time points one year apart in an accelerated longitudinal design spanning ages 7-13 years. Latent-class growth analysis (LCGA) was used to identify developmental trajectories for both parent- and teacher-rated ADHD and ODD symptoms within the ADHD sample. Parental expressed emotion, criticism, and emotional over-involvement were coded from a 5-minute speech sample at two time points, one year apart, for 208 of these children and compared to the non-ADHD sample and among the ADHD trajectory groups.
Results. Parent-rated hyperactivity yielded a four class trajectory solution in LCGA; teacher-rated inattention yielded a three-trajectory solution. Teacher-rated ODD also yielded three-trajectory solution. A parent-rated high persistent hyperactive group was more likely than the other ADHD groups to have parents with stable high criticism (34.6%, p<.001), with ODD symptoms controlled. A teacher-identified high ODD-worsening group was more likely to experience high criticism at either time point, particularly the initial time point; (87.5%, p<.001), with hyperactivity controlled.
Conclusion. Parental criticism, an index of the family environment, is uniquely associated with divergent developmental trajectories among children with ADHD in addition to those associated with ODD symptoms.
within existing disorder categories. The imprecise nature of current nosologic distinctions
limits both mechanistic understanding and clinical prediction.We demonstrate an approach
consistent with the National Institute of Mental Health Research Domain Criteria initiative to
identify superior, neurobiologically valid subgroups with better predictive capacity than
existing psychiatric categories for childhood attention-deficit/hyperactivity disorder (ADHD).
OBJECTIVE To refine subtyping of childhood ADHD by using biologically based behavioral
dimensions (ie, temperament), novel classification algorithms, and multiple external
validators.
DESIGN, SETTING, AND PARTICIPANTS A total of 437 clinicallywell-characterized,
community-recruited children, with and without ADHD, participated in an ongoing
longitudinal study. Baseline data were used to classify children into subgroups based on
temperament dimensions and examine external validators including physiological and
magnetic resonance imaging measures. One-year longitudinal follow-up data are reported for
a subgroup of the ADHD sample to address stability and clinical prediction.
MAIN OUTCOMES AND MEASURES Parent/guardian ratings of children on a measure of
temperament were used as input features in novel community detection analyses to identify
subgroups within the sample. Groups were validated using 3 widely accepted external
validators: peripheral physiological characteristics (cardiac measures of respiratory sinus
arrhythmia and pre-ejection period), central nervous system functioning (via resting-state
functional connectivitymagnetic resonance imaging), and clinical outcomes (at 1-year
longitudinal follow-up).
RESULTS The community detection algorithm suggested 3 novel types of ADHD, labeled as
mild (normative emotion regulation), surgent (extreme levels of positive approachmotivation),
and irritable (extreme levels of negative emotionality, anger, and poor
soothability). Types were independent of existing clinical demarcations including DSM-5
presentations or symptom severity. These types showed stability over time and were
distinguished by unique patterns of cardiac physiological response, resting-state functional
brain connectivity, and clinical outcomes 1 year later.
CONCLUSIONS AND RELEVANCE Results suggest that a biologically informed
temperament-based typology, developed with a discovery-based community detection
algorithm, provides a superior description of heterogeneity in the ADHD population than
does any current clinical nosologic criteria. This demonstration sets the stage for more
aggressive attempts at a tractable, biologically based nosology.
attention-deficit/hyperactivity disorder, we assessed the prevalence, rates of comorbidity, and familial transmission
of both disorders in a large population-based sample of children during a recent 7 year period. Methods: Study
participants included all children born to parents with the Kaiser Permanente Northwest (KPNW) Health Plan
between 1 January 1998 and 31 December 2004 (n = 35,073). Children and mothers with physician-identified
autism spectrum disorders (ASD) and/or attention-deficit/hyperactivity disorder (ADHD) were identified via
electronic medical records maintained for all KPNW members. Results: Among children aged 6–12 years, prevalence
was 2.0% for ADHD and 0.8% for ASD; within those groups, 0.2% of the full sample (19% of the ASD sample and 9.6%
of the ADHD sample) had co-occurring ASD and ADHD, when all children were included. When mothers had a
diagnosis of ADHD, first born offspring were at 6-fold risk of ADHD alone (OR = 5.02, p < .0001) and at 2.5-fold risk
of ASD alone (OR = 2.52, p < .01). Results were not accounted for by maternal age, child gestational age, child
gender, and child race. Conclusions: Autism spectrum disorders shares familial transmission with ADHD. ADHD
and ASD have a partially overlapping diathesis. Keywords: Attention-deficit/hyperactivity disorder, autism
spectrum disorder, shared familial transmission.
(ADHD) using biomarkers has been elusive. This study evaluated whether emotion reactivity
and regulation provide a means to achieve this. Method: Participants were classified into
three groups: children with ADHD plus low prosocial behavior (hypothesized to be high in
callous/unemotional traits; n ¼ 21); children with ADHD with age-appropriate prosocial
behavior (n ¼ 54); and typically developing children (n ¼ 75). Children completed a task with
four conditions: negative induction, negative suppression, positive induction, and positive
suppression of affect. The task required children to view an emotion-laden film clip, while either
facially mimicking (induction) or masking (suppression) the emotion of the main character.
Parasympathetic and sympathetic nervous system activity were assessed via respiratory sinus
arrhythmia (RSA) and cardiac pre-ejection period (PEP), respectively. Symptoms of anxiety,
conduct, and oppositional defiant disorders were treated as covariates. Results: The ADHDtypical-
prosocial group displayed atypically elevated parasympathetic reactivity (emotion
dysregulation) during positive induction, along with increased sympathetic activity (elevated
arousal) across conditions. In contrast, the ADHD-low-prosocial group displayed reduced
parasympathetic reactivity and reduced sympathetic activity (low emotional arousal) across
baseline and task conditions. Thus, both ADHD groups had altered patterns of autonomic
functioning, but in two distinct forms. Conclusion: Although ADHD is heterogeneous
clinically, results suggest that ADHD is also heterogeneous with regard to physiological
indices of emotion and regulation. Future studies of emotion, regulation, and ADHD should
take this into account. Further study of physiological responding in ADHD may yield clinically
and etiologically distinct domains or groups. J. Am. Acad. Child Adolesc. Psychiatry; 2013;
52(2):163-171. Key Words: attention-deficit/hyperactivity disorder, autonomic nervous
system, callous/unemotional traits, emotionality, emotion regulation
including disruptions in the biological systems central to
emotion arousal and regulation. However, little is known about the
specific ways in which child abuse affects adulthood sympathetic
reactivity and recovery. This study investigated the association
between child abuse experience and adult skin conductance level
and habituation in 85 at-risk women as they completed a self-
-report trauma questionnaire. Childhood emotional abuse was
independently associated with blunted skin conductance habituation
over the course of survey completion after controlling for other
abuse subtypes and current trauma symptoms. These results suggest
that women emotionally abused as children experience prolonged
emotional arousal and poor physiological regulation of emotion in
response to reminders of traumatic experiences.
Adult Attachment Interview is a risk factor for the intergenerational
transmission of the insecure-avoidant attachment style.
This study evaluated a briefer screening approach for identifying
parental idealization, testing the utility of prenatal maternal
self-report measures of recalled betrayal trauma and parental care
in childhood to predict observationally assessed infant attachment
avoidance with 58 mother–infant dyads 18 months postpartum.
In a logistic regression that controlled for maternal demographics,
prenatal psychopathology, and postnatal sensitivity, the interaction between women’s self-reported childhood high betrayal trauma
and the level of care provided to them by their parents was the
only significant predictor of 18-month infant security versus avoidance.
Results suggest that betrayal trauma and recalled parental
care in childhood can provide a means of identifying caregivers
whose infant children are at risk for avoidant attachment,
potentially providing an efficient means for scientific studies and
clinical intervention aimed at preventing the intergenerational
transmission of attachment problems.
differences in quality of maternal behavior. However, it is far from clear which circuits
are relevant to maternal sensitivity, as opposed to other maternal behavioral dimensions,
particularly after the early postpartum. This study examined maternal sensitivity, intrusiveness,
and mother–infant dyadic harmony as correlates of mothers’ neural responses
to the cries of their own infants. Twenty-two primiparous mothers were observed during
an interaction with their infants at 18 months postpartum. In a separate functional
neuroimaging session, mothers were exposed to their own infant’s cry sound, as well as
unfamiliar infant’s cry and control sounds. Mothers who displayed more sensitive behaviors
with their infant exhibited greater activation to their own infant’s cry compared to
that of an unfamiliar infant in the right frontal pole and inferior frontal gyrus. Mothers
who displayed more intrusive behaviors with their infant showed greater activation in the
left anterior insula and temporal pole, while mothers who had more harmonious interactions
with their infant displayed greater activation in left hippocampal regions. The roles
of these areas in the regulation of maternal emotion and stress, self and other awareness,
and empathy are examined.
long-term outcomesandremainsamajorpublichealthconcern.Recenttheorieshaveproposed
that ADHDarisesfromalterationsinmultipleneuralpathways.Alterationsinrewardcircuits
are hypothesizedasonecoredysfunction,leadingtoalteredprocessingofanticipatedrewards.
The nucleusaccumbens(NAcc)isparticularlyimportantforrewardprocesses;task-basedfMRI
studies havefoundatypicalactivationofthisregionwhiletheparticipantsperformedareward
task. UnderstandinghowrewardcircuitsareinvolvedwithADHDmaybefurtherenhancedby
considering howtheNAccinteractswithotherbrainregions.Hereweusedthetechniqueof
resting-state functionalconnectivityMRI(rs-fcMRI)toexaminethealterationsintheNAcc
interactions andhowtheyrelatetoimpulsivedecisionmakinginADHD.Usingrs-fcMRI,this
study: examineddifferencesinfunctionalconnectivityoftheNAccbetweenchildrenwithADHD
and controlchildren;correlatedthefunctionalconnectivityofNAccwithimpulsivity,as
measured byadelaydiscountingtask;andcombinedthesetwoinitialsegmentstoidentifythe
atypical NAccconnectionsthatwereassociatedwithimpulsivedecisionmakinginADHD.
WefoundthatfunctionalconnectivityofNAccwasatypicalinchildrenwithADHDandtheADHD-related increasedconnectivitybetweenNAccandtheprefrontalcortexwasassociated
with greaterimpulsivity(steeperdelayed-rewarddiscounting).Thesefindingsareconsistent
with thehypothesisthatatypicalsignalingoftheNAcctotheprefrontalcortexinADHDmay
lead toexcessiveapproachandfailureinestimatingfutureconsequences;thus,leadingto
impulsive behavior.
infants and children. Although low levels of maternal sensitivity have been hypothesized to explain this risk, the biological mechanisms underlying
the association between maternal depressive symptoms and low levels of maternal sensitivity have been largely underexplored. This study examined
the roles of postnatal depressive symptoms and parasympathetic nervous system functioning as predictors of low levels of maternal sensitivity,
during a stressful mother–infant interaction—the reunion phase of the Still-Face Paradigm. Depressive symptoms and traitlike predispositions toward
parasympathetic dysregulation, as indexed by low resting levels of respiratory sinus arrhythmia, were associated independently with less sensitive
parenting. Discussion considers that during stressful mother–infant interactions, both mothers with depressive symptoms and mothers predisposed to
parasympathetic dysregulation may have fewer emotional, physiological, and psychological resources with which to respond sensitively to their infants’
cues.
disorder (ADHD) involves alterations in reward evaluation, including assessing the relative value
of immediate over delayed rewards. This study examines whether children with ADHD discount
the value of delayed rewards to a greater degree than typically developing children using a delay
discounting task.
Methods—Children aged 7–9 years diagnosed with ADHD and controls completed a task in
which they chose between a hypothetical $10 available after a delay (7, 30, 90 and 180 days)
versus various amounts available immediately.
Results—ADHD participants discounted more steeply than controls. However, this effect did not
survive covarying of IQ.
Conclusions—ADHD is associated with a steeper delay gradient when contemplating
hypothetical later rewards, but not independently of IQ. The interplay of cognitive processing and
IQ with reward evaluation in ADHD requires further exploration.
new phenomenon. The first personal computers were introduced into
wide use in the 1970s. Rapid adoption of computer-based testing
paralleled this development. By the 1980s, the research literature was
replete with considerations of the inherent advantages and limitations
of automated assessment of a myriad of clinical domains. In particular,
the application of computers to the evaluation of cognition has been
widely studied. This body of research has generally fallen into one
of two categories: (1) the translation of existing standardized tests to
computerized administration and (2) the development of new computer
tests and batteries for the assessment of cognitive function. Somewhere
between these two categories are approaches that have adapted existing
tests in a new way using computer administration. The Cambridge
Neuropsychological Test Automated Battery (CANTAB) is an example
of a battery that has successfully combined standard cognitive test
paradigms with novel formats.
Methods. 388 children with ADHD and 127 control children were assessed using a multi-informant, multi-method diagnostic procedure at up to three time points one year apart in an accelerated longitudinal design spanning ages 7-13 years. Latent-class growth analysis (LCGA) was used to identify developmental trajectories for both parent- and teacher-rated ADHD and ODD symptoms within the ADHD sample. Parental expressed emotion, criticism, and emotional over-involvement were coded from a 5-minute speech sample at two time points, one year apart, for 208 of these children and compared to the non-ADHD sample and among the ADHD trajectory groups.
Results. Parent-rated hyperactivity yielded a four class trajectory solution in LCGA; teacher-rated inattention yielded a three-trajectory solution. Teacher-rated ODD also yielded three-trajectory solution. A parent-rated high persistent hyperactive group was more likely than the other ADHD groups to have parents with stable high criticism (34.6%, p<.001), with ODD symptoms controlled. A teacher-identified high ODD-worsening group was more likely to experience high criticism at either time point, particularly the initial time point; (87.5%, p<.001), with hyperactivity controlled.
Conclusion. Parental criticism, an index of the family environment, is uniquely associated with divergent developmental trajectories among children with ADHD in addition to those associated with ODD symptoms.
within existing disorder categories. The imprecise nature of current nosologic distinctions
limits both mechanistic understanding and clinical prediction.We demonstrate an approach
consistent with the National Institute of Mental Health Research Domain Criteria initiative to
identify superior, neurobiologically valid subgroups with better predictive capacity than
existing psychiatric categories for childhood attention-deficit/hyperactivity disorder (ADHD).
OBJECTIVE To refine subtyping of childhood ADHD by using biologically based behavioral
dimensions (ie, temperament), novel classification algorithms, and multiple external
validators.
DESIGN, SETTING, AND PARTICIPANTS A total of 437 clinicallywell-characterized,
community-recruited children, with and without ADHD, participated in an ongoing
longitudinal study. Baseline data were used to classify children into subgroups based on
temperament dimensions and examine external validators including physiological and
magnetic resonance imaging measures. One-year longitudinal follow-up data are reported for
a subgroup of the ADHD sample to address stability and clinical prediction.
MAIN OUTCOMES AND MEASURES Parent/guardian ratings of children on a measure of
temperament were used as input features in novel community detection analyses to identify
subgroups within the sample. Groups were validated using 3 widely accepted external
validators: peripheral physiological characteristics (cardiac measures of respiratory sinus
arrhythmia and pre-ejection period), central nervous system functioning (via resting-state
functional connectivitymagnetic resonance imaging), and clinical outcomes (at 1-year
longitudinal follow-up).
RESULTS The community detection algorithm suggested 3 novel types of ADHD, labeled as
mild (normative emotion regulation), surgent (extreme levels of positive approachmotivation),
and irritable (extreme levels of negative emotionality, anger, and poor
soothability). Types were independent of existing clinical demarcations including DSM-5
presentations or symptom severity. These types showed stability over time and were
distinguished by unique patterns of cardiac physiological response, resting-state functional
brain connectivity, and clinical outcomes 1 year later.
CONCLUSIONS AND RELEVANCE Results suggest that a biologically informed
temperament-based typology, developed with a discovery-based community detection
algorithm, provides a superior description of heterogeneity in the ADHD population than
does any current clinical nosologic criteria. This demonstration sets the stage for more
aggressive attempts at a tractable, biologically based nosology.
attention-deficit/hyperactivity disorder, we assessed the prevalence, rates of comorbidity, and familial transmission
of both disorders in a large population-based sample of children during a recent 7 year period. Methods: Study
participants included all children born to parents with the Kaiser Permanente Northwest (KPNW) Health Plan
between 1 January 1998 and 31 December 2004 (n = 35,073). Children and mothers with physician-identified
autism spectrum disorders (ASD) and/or attention-deficit/hyperactivity disorder (ADHD) were identified via
electronic medical records maintained for all KPNW members. Results: Among children aged 6–12 years, prevalence
was 2.0% for ADHD and 0.8% for ASD; within those groups, 0.2% of the full sample (19% of the ASD sample and 9.6%
of the ADHD sample) had co-occurring ASD and ADHD, when all children were included. When mothers had a
diagnosis of ADHD, first born offspring were at 6-fold risk of ADHD alone (OR = 5.02, p < .0001) and at 2.5-fold risk
of ASD alone (OR = 2.52, p < .01). Results were not accounted for by maternal age, child gestational age, child
gender, and child race. Conclusions: Autism spectrum disorders shares familial transmission with ADHD. ADHD
and ASD have a partially overlapping diathesis. Keywords: Attention-deficit/hyperactivity disorder, autism
spectrum disorder, shared familial transmission.
(ADHD) using biomarkers has been elusive. This study evaluated whether emotion reactivity
and regulation provide a means to achieve this. Method: Participants were classified into
three groups: children with ADHD plus low prosocial behavior (hypothesized to be high in
callous/unemotional traits; n ¼ 21); children with ADHD with age-appropriate prosocial
behavior (n ¼ 54); and typically developing children (n ¼ 75). Children completed a task with
four conditions: negative induction, negative suppression, positive induction, and positive
suppression of affect. The task required children to view an emotion-laden film clip, while either
facially mimicking (induction) or masking (suppression) the emotion of the main character.
Parasympathetic and sympathetic nervous system activity were assessed via respiratory sinus
arrhythmia (RSA) and cardiac pre-ejection period (PEP), respectively. Symptoms of anxiety,
conduct, and oppositional defiant disorders were treated as covariates. Results: The ADHDtypical-
prosocial group displayed atypically elevated parasympathetic reactivity (emotion
dysregulation) during positive induction, along with increased sympathetic activity (elevated
arousal) across conditions. In contrast, the ADHD-low-prosocial group displayed reduced
parasympathetic reactivity and reduced sympathetic activity (low emotional arousal) across
baseline and task conditions. Thus, both ADHD groups had altered patterns of autonomic
functioning, but in two distinct forms. Conclusion: Although ADHD is heterogeneous
clinically, results suggest that ADHD is also heterogeneous with regard to physiological
indices of emotion and regulation. Future studies of emotion, regulation, and ADHD should
take this into account. Further study of physiological responding in ADHD may yield clinically
and etiologically distinct domains or groups. J. Am. Acad. Child Adolesc. Psychiatry; 2013;
52(2):163-171. Key Words: attention-deficit/hyperactivity disorder, autonomic nervous
system, callous/unemotional traits, emotionality, emotion regulation
including disruptions in the biological systems central to
emotion arousal and regulation. However, little is known about the
specific ways in which child abuse affects adulthood sympathetic
reactivity and recovery. This study investigated the association
between child abuse experience and adult skin conductance level
and habituation in 85 at-risk women as they completed a self-
-report trauma questionnaire. Childhood emotional abuse was
independently associated with blunted skin conductance habituation
over the course of survey completion after controlling for other
abuse subtypes and current trauma symptoms. These results suggest
that women emotionally abused as children experience prolonged
emotional arousal and poor physiological regulation of emotion in
response to reminders of traumatic experiences.
Adult Attachment Interview is a risk factor for the intergenerational
transmission of the insecure-avoidant attachment style.
This study evaluated a briefer screening approach for identifying
parental idealization, testing the utility of prenatal maternal
self-report measures of recalled betrayal trauma and parental care
in childhood to predict observationally assessed infant attachment
avoidance with 58 mother–infant dyads 18 months postpartum.
In a logistic regression that controlled for maternal demographics,
prenatal psychopathology, and postnatal sensitivity, the interaction between women’s self-reported childhood high betrayal trauma
and the level of care provided to them by their parents was the
only significant predictor of 18-month infant security versus avoidance.
Results suggest that betrayal trauma and recalled parental
care in childhood can provide a means of identifying caregivers
whose infant children are at risk for avoidant attachment,
potentially providing an efficient means for scientific studies and
clinical intervention aimed at preventing the intergenerational
transmission of attachment problems.
differences in quality of maternal behavior. However, it is far from clear which circuits
are relevant to maternal sensitivity, as opposed to other maternal behavioral dimensions,
particularly after the early postpartum. This study examined maternal sensitivity, intrusiveness,
and mother–infant dyadic harmony as correlates of mothers’ neural responses
to the cries of their own infants. Twenty-two primiparous mothers were observed during
an interaction with their infants at 18 months postpartum. In a separate functional
neuroimaging session, mothers were exposed to their own infant’s cry sound, as well as
unfamiliar infant’s cry and control sounds. Mothers who displayed more sensitive behaviors
with their infant exhibited greater activation to their own infant’s cry compared to
that of an unfamiliar infant in the right frontal pole and inferior frontal gyrus. Mothers
who displayed more intrusive behaviors with their infant showed greater activation in the
left anterior insula and temporal pole, while mothers who had more harmonious interactions
with their infant displayed greater activation in left hippocampal regions. The roles
of these areas in the regulation of maternal emotion and stress, self and other awareness,
and empathy are examined.
long-term outcomesandremainsamajorpublichealthconcern.Recenttheorieshaveproposed
that ADHDarisesfromalterationsinmultipleneuralpathways.Alterationsinrewardcircuits
are hypothesizedasonecoredysfunction,leadingtoalteredprocessingofanticipatedrewards.
The nucleusaccumbens(NAcc)isparticularlyimportantforrewardprocesses;task-basedfMRI
studies havefoundatypicalactivationofthisregionwhiletheparticipantsperformedareward
task. UnderstandinghowrewardcircuitsareinvolvedwithADHDmaybefurtherenhancedby
considering howtheNAccinteractswithotherbrainregions.Hereweusedthetechniqueof
resting-state functionalconnectivityMRI(rs-fcMRI)toexaminethealterationsintheNAcc
interactions andhowtheyrelatetoimpulsivedecisionmakinginADHD.Usingrs-fcMRI,this
study: examineddifferencesinfunctionalconnectivityoftheNAccbetweenchildrenwithADHD
and controlchildren;correlatedthefunctionalconnectivityofNAccwithimpulsivity,as
measured byadelaydiscountingtask;andcombinedthesetwoinitialsegmentstoidentifythe
atypical NAccconnectionsthatwereassociatedwithimpulsivedecisionmakinginADHD.
WefoundthatfunctionalconnectivityofNAccwasatypicalinchildrenwithADHDandtheADHD-related increasedconnectivitybetweenNAccandtheprefrontalcortexwasassociated
with greaterimpulsivity(steeperdelayed-rewarddiscounting).Thesefindingsareconsistent
with thehypothesisthatatypicalsignalingoftheNAcctotheprefrontalcortexinADHDmay
lead toexcessiveapproachandfailureinestimatingfutureconsequences;thus,leadingto
impulsive behavior.
infants and children. Although low levels of maternal sensitivity have been hypothesized to explain this risk, the biological mechanisms underlying
the association between maternal depressive symptoms and low levels of maternal sensitivity have been largely underexplored. This study examined
the roles of postnatal depressive symptoms and parasympathetic nervous system functioning as predictors of low levels of maternal sensitivity,
during a stressful mother–infant interaction—the reunion phase of the Still-Face Paradigm. Depressive symptoms and traitlike predispositions toward
parasympathetic dysregulation, as indexed by low resting levels of respiratory sinus arrhythmia, were associated independently with less sensitive
parenting. Discussion considers that during stressful mother–infant interactions, both mothers with depressive symptoms and mothers predisposed to
parasympathetic dysregulation may have fewer emotional, physiological, and psychological resources with which to respond sensitively to their infants’
cues.
disorder (ADHD) involves alterations in reward evaluation, including assessing the relative value
of immediate over delayed rewards. This study examines whether children with ADHD discount
the value of delayed rewards to a greater degree than typically developing children using a delay
discounting task.
Methods—Children aged 7–9 years diagnosed with ADHD and controls completed a task in
which they chose between a hypothetical $10 available after a delay (7, 30, 90 and 180 days)
versus various amounts available immediately.
Results—ADHD participants discounted more steeply than controls. However, this effect did not
survive covarying of IQ.
Conclusions—ADHD is associated with a steeper delay gradient when contemplating
hypothetical later rewards, but not independently of IQ. The interplay of cognitive processing and
IQ with reward evaluation in ADHD requires further exploration.
new phenomenon. The first personal computers were introduced into
wide use in the 1970s. Rapid adoption of computer-based testing
paralleled this development. By the 1980s, the research literature was
replete with considerations of the inherent advantages and limitations
of automated assessment of a myriad of clinical domains. In particular,
the application of computers to the evaluation of cognition has been
widely studied. This body of research has generally fallen into one
of two categories: (1) the translation of existing standardized tests to
computerized administration and (2) the development of new computer
tests and batteries for the assessment of cognitive function. Somewhere
between these two categories are approaches that have adapted existing
tests in a new way using computer administration. The Cambridge
Neuropsychological Test Automated Battery (CANTAB) is an example
of a battery that has successfully combined standard cognitive test
paradigms with novel formats.