2020 Associates Week

Yale Child Study Center

Poster session highlighting the latest research from investigators and trainees at the Yale Child Study Center. Click on a poster to enlarge, and please leave comments and questions under "Join the Discussion".


More info: https://medicine.yale.edu/childstudy/2020-associates-week/

Filter displayed posters (104 keywords)

ASD (2) COVID-19 (2) Genomics (2) Intimate Partner Violence (2) childhood anxiety (2) development (2) disruptive behavior (2) emotion regulation (2) prefrontal cortex (2) show more... Adversity (1) Anxiety (1) Attachment (1) Autism (1) Brain structure (1) CBT (1) COVID-19 pandemic (1) Child Maltreatment (1) Clinical psychology (1) Connecticut educators (1) Demographics (1) EEG (1) Educators of Color (1) Failure to Launch (1) Fatherhood (1) Fathers (1) Frontal Alpha Asymmetry (1) Health (1) Heart rate (1) Hikikomori (1) Home Visiting (1) Intervention (1) Irritability (1) Medical education (1) Mental Health (1) OCD (1) Parental Guidance (1) Psychopathology (1) Reflective Parenting (1) SPACE (1) Sexual health (1) Standardized patients (1) Synchronous videoconferencing (1) Whole-Exome Sequencing (1) adolescents (1) advocacy (1) anxiety sensitivity (1) autism (1) autism spectrum disorder (1) brain connectivity (1) cell lineage tracing (1) child maltreatment (1) childhood anxiety treatments (1) cognition (1) cortical development (1) cortical evolution (1) early childhood (1) educator well-being (1) electroencephalogram (1) electroencephalography (1) emotion (1) emotion knowledge (1) emotions (1) event related potential (1) executive function (1) experience sampling methodology (1) fMRI (1) family accommodation (1) fathers (1) fmri (1) frontoamygdala circuitry (1) frustration (1) genetics (1) home visiting (1) imaging (1) intimate partner violence (1) irritability (1) living individuals (1) mothers (1) motivation (1) neurodevelopmental disorders (1) neuroimaging (1) parental modulation (1) parenting (1) parents (1) photo elicitation (1) program evaluation (1) qualitative methods (1) racial congruence (1) reward (1) screening (1) semi-structured interviews (1) sex differences (1) social and emotional learning (1) social avoidance (1) social exclusion (1) somatic mutations (1) stress (1) teachers (1) telehealth (1) telemedicine (1) treatment access (1) unemployment (1) well-being (1) zebrafish (1)
Show Posters:

Adolescents’ Emotions and Emotion Regulation during the Onset of the COVID-19 Pandemic

Rachel Baumsteiger, Cynthia Willner, Jessica Hoffmann, Christina Cipriano, Beatris Garcia, Violet Tan, and Marc Brackett

Abstract
Presented by
Rachel Baumsteiger <rachel.baumsteiger@yale.edu>
Keywords
emotions, adolescents, COVID-19, emotion regulation, experience sampling methodology

An event related potential investigation of social exclusion in fathers with and without histories of intimate partner violence

Ciara McFaul, Caroline Martin, Dr. Carla Stover, Dr. Michael Crowley, Dr. Jia Wiu, Dr. Helena Rutherford

Abstract
Extant evidence suggests men with a history of intimate partner violence (IPV) tend to process social-cognitive information differently to non-offending males. As a group, men with a history of IPV tend to have significant impairment in executive functions and their neural correlates compared to controls. Among social-cognitive events, social rejection affects interpersonal functioning, such that adults who have been excluded are more likely to attribute hostile intent to others. Previous work finds the late positive potential (LPP) modulation in response to emotionally charged stimuli, including social rejection events. Here, we investigated differences in slow wave neural activity in fathers of children under the age of three with and without histories of IPV (n= 43). Event-related potentials (ERPs) were assessed in response to a laboratory-induced form of social exclusion. Cyberball is a computer-simulated ball-toss game where participants experience fair play trials followed by rejection. Results showed significant time-dependent variation in slow-wave activity (400-900 ms) in left frontal cortical and posterior regions for rejection events between IPV fathers and controls. These findings suggest differences in the processing of social-cognitive events, emerging in less than a second in fathers with and without histories of IPV. Findings are discussed in the context of IPV neural correlates with implications for intervention.
Presented by
Ciara McFaul <ciara.mcfaul@yale.edu>
Keywords
EEG, electroencephalogram, intimate partner violence, social exclusion, event related potential

Boys and girls show different structural brain biomarkers of disruptive behavior

Karim Ibrahim, Carla Kalvin, Fangyong Li, George He, Gregory McCarthy & Denis G. Sukhodolsky

Abstract
Alterations in brain structure, particularly amygdala and prefrontal regions involved in emotion regulation, are associated with disruptive behaviors in children. However, the relationship between sex differences in brain structure and disruptive behavior in children remains poorly understood. In this study, we examined sex differences in gray matter volume and cortical thickness in children with disruptive behavior. We found reduced amygdala volume in both boys and girls with disruptive behavior compared to controls. Boys with disruptive behavior showed reduced cortical volume and thickness in the ventromedial prefrontal cortex, while girls with disruptive behavior showed the opposite pattern. In particular, girls with disruptive behavior showed similar cortical thickness and volume of the prefrontal cortex to controls. Sex-specific associations were also found with amygdala volume and callous-unemotional traits. These findings advance identification of sex-specific brain biomarkers.
Presented by
Karim Ibrahim <karim.ibrahim@yale.edu>
Keywords
Brain structure, emotion regulation, sex differences, disruptive behavior, prefrontal cortex

Brain networks under frustration predicts irritability in youths

Wan-Ling Tseng, Dustin Scheinost, Javid Dadashkarimi, Ellen Leibenluft

Abstract
Irritability cuts across many pediatric disorders and is a common presenting complaint in child psychiatry; however, its neural mechanisms remain unclear. One core feature of irritability is low frustration tolerance. In this study, we used fMRI to examine the ability of brain connectivity (i.e., how different brain regions communicate with each other) when youth experience frustration inside the scanner to predict their irritability symptoms. This study included 69 youth (mean age=14.55 years) with varying levels of irritability across diagnostic groups: disruptive mood dysregulation disorder (n=20), attention-deficit/hyperactivity disorder (n=14), anxiety disorder (n=12), and controls (n=23). During fMRI, participants completed a frustrating cognitive flexibility task. Frustration was evoked by manipulating task difficulty such that, on trials requiring cognitive flexibility, “frustration” blocks had a 50% error rate and some rigged feedback, while “non-frustration” blocks had a 10% error rate. Child- and parent-reports of the Affective Reactivity Index were used as dimensional measures of irritability. Connectome-based predictive modeling, a machine learning approach, with 10-fold cross validation was conducted to identify brain networks predicting irritability. Connectivity during frustration (but not non-frustration) blocks predicted child-reported irritability (ρ=.24, p=.03). Results were adjusted for age, sex, motion, ADHD, and anxiety symptoms. The predictive networks of irritability were primarily within motor-sensory networks; among motor-sensory, subcortical, and salience networks; and between these networks and frontoparietal and medial frontal networks. This study provides preliminary evidence that individual differences in irritability may be associated with functional connectivity during frustration, a phenotype-relevant state.
Presented by
Wan-Ling Tseng <wan-ling.tseng@yale.edu>
Keywords
Irritability, frustration, brain connectivity, fMRI

CT Educators: SEL in Times of Uncertainty and Stress

Morgan Mannweiler, Violet Tan, Jennifer Seibyl, Rachel Baumsteiger

Abstract
Educator well-being is impacted by many aspects of the work environment (e.g. fair pay, workplace climate, relationships with colleagues, autonomy). These factors are linked to stress levels and job commitment and satisfaction (Schreyer & Krause, 2016). In turn, educators’ emotions at work are correlated with overall well-being and ultimately quality of teaching (Brackett et al., 2013). The transactional and highly interpersonal nature of teaching translates to extensive emotional labor, which educators must endure to maintain strong relationships with their students. During these unprecedented times, we sought to explore the current emotional state of educators given the increased logistical and emotional burdens, such as learning new technology, shifting school policies, and personal health concerns. In September of 2020, the Yale Center for Emotional Intelligence launched a 10-hour online course for all educators in Connecticut, entitled Social and Emotional Learning in Times of Uncertainty and Stress: Research-Based Strategies, to help mediate educators’ negative emotions due to the global pandemic and racial, political, and socioeconomic divide (Cipriano & Brackett, 2020). Over 1,300 educators in Connecticut completed the Affective Experiences Scale, which consists of word items that describe different feelings and emotions, before beginning the course (Floman et al., 2020). Despite the presumed additional stressors of being a racial and/or ethnic minority, such as workplace microaggressions and racial incongruence, Educators of Color were more likely to report experiencing positive emotions.
Presented by
Morgan Mannweiler, Jennifer Seibyl and Violet Tan <morgan.mannweiler@yale.edu>
Keywords
Educators of Color, COVID-19 pandemic, social and emotional learning, emotion, educator well-being, Connecticut educators

Deployment of a Multimedia Screening Tool for ASD in a Diverse Community Setting: Feasibility and Usability

M. Wilkinson, K. Chawarska, E. Barney, J. C. Snider, E. S. Kim, Q. Wang, Q. A. Wang, C. A. Wall, M. Kim, B. Li, M. Mademtzi, C. Foster, D. Macris, F. E. Kane-Grade, A. Milgramm, P. Heymann, E. Hilton, A. Zakin, H. Neiderman, K. Villarreal., Y. A. Ahn, M. C. Aubertine, F. Shic, & S. Macari

Abstract
Background: With increasing prevalence of autism spectrum disorder (ASD), there is an urgent need to identify children at risk as early as possible, especially among diverse populations. To address this, we created a tablet-based multimedia screener system, the Yale Adaptive Multimedia Screener (YAMS). The app provides time-efficient screening through an easy-to-understand platform that automates scoring of risk.

Objectives: To examine the feasibility, acceptability, and usability of a tablet-based multimedia screener in a diverse population of children (10-33 months) in primary pediatric care centers serving under-resourced populations.

Methods: 409 infants and toddlers were identified as potential participants. 132 (32.3%) families missed well-child appointments. Of the remaining 277 families, 56 (20.2%) were not approached (schedule conflicts, insufficient English). 221 families were invited to participate and187 enrolled (84.6%). Results: 95(51%) children were African-American, 56(30%) more than one race, 28(15%) Caucasian, and 8(4%) were Asian. 82(44%) children were Hispanic. 51(27%) were single parents. Education level for 112(60%) parents was a high school degree or less. Five usability questions covering helpfulness of videos, satisfaction with duration, and ability to understand questions, rated on a scale of 1-7, resulted in average score 6.52, suggesting YAMS is a highly usable app.

Conclusions: This study suggests challenges and successes in reaching a racially-, ethnically- and socioeconomically-diverse inner-city population. Though difficult to approach some families due to missed appointments, among participants there was high satisfaction with the YAMS screening app. Our high participation rate will allow continuation of the development process by expanding the testing into additional community settings.

Presented by
Suzanne Macari <suzanne.macari@yale.edu>
Keywords
autism, ASD, screening

Early developmental asymmetries in cell lineage trees in living individuals

Liana Fasching*, Yeongjun Jang*, Simone Tomasi, Jeremy Schreiner, Livia Tomasini, Melanie Brady, Taejeong Bae, Vivekananda Sarangi, Nikolaos Vasmatzis, Yifan Wang, Anna Szekely, Thomas V. Fernandez, James F. Leckman, Alexej Abyzov and Flora M. Vaccarino

Abstract
Somatic mutations (SM) are genomic alterations that are not inherited by the parents, but that arise after fertilization. An average of 1.3 SM occur at each cell division and are indelible genomic markers that are passed to all daughter cells. This allows us to trace cell lineages. For the first time in living individuals, we were able to reconstruct very early cell divisions. In addition we found that cell divisions appear to be asymmetrical (one daughter cell contributes more than the other daughter cell). SM could help us to understand personal characteristics, that are not inherited from our parents. Early SM are likely also present in the brain and could impact brain development.
Presented by
Liana Fasching <liana.fasching@yale.edu>
Keywords
somatic mutations, cell lineage tracing, living individuals,

Engaging Adolescent’s in Home- Based Treatment: An Action Research Study

Krystal Finch, DSW, LCSW

Abstract
Adolescent engagement in home-based treatment is a challenge within the social work field. To promote positive social change throughout the field, clinicians must understand the emphasis on enhanced clinical skills to support adolescent engagement in treatment. Therefore, it is important to understand the goals to enhance commitment in treatment and improve therapeutic relationships that may further support an increase in the health and development of adolescents served. Six social work clinicians participated in a focus group to address the clinical roles, characteristics, and skills essential for reducing barriers related to adolescent engagement, including the areas of competence, respect, empathy, and passion.
Presented by
Krystal Finch <krystal.finch@yale.edu>
Keywords

Genetic Contribution of Copy-Number Variation to Obsessive-Compulsive Disorder

Sarah B. Abdallah, Emily Olfson, Thomas V. Fernandez

Abstract
Background: OCD is ranked among 10 most debilitating disorders of any kind by WHO. Genetic causes of OCD are poorly understood, limiting therapeutic advances. Genetic copy number variants (CNVs) have led to the discovery of risk genes in other neuropsychiatric disorders, but have been less studied in OCD. Methods: We examined CNVs in 101 OCD patients and their parents to identify rare inherited and de novo (spontaneous) CNVs. Results: We identified rare genetic copy-number variants in whole-exome sequencing data from patients with obsessive-compulsive disorder. These variants are more common in cases vs. controls and overlap genes related to cell cycle and nuclear transport. Conclusions: Rare genetic deletions are enriched in OCD patients compared to controls, suggesting they may play a role in OCD etiology. Genes containing rare CNVs may provide future avenues of exploration for studies of OCD pathophysiology.
Presented by
Sarah Abdallah <sarah.abdallah@yale.edu>
Keywords
Genomics, OCD

How can zebrafish help us to understand genetic and biological mechanisms in autism spectrum disorders?

Hellen Weinschutz Mendes, Tianying Chen, Sundas Ijaz, Christina Szi, Catalina Sakai, Jeffrey Eilbott, Brent Vander Wyk, Ellen J. Hoffman

Abstract
Objective: Autism spectrum disorders (ASD) are a devastating group of neurodevelopmental disorders characterized by deficits in social interaction, communication, and repetitive behaviors. Our goal is to understand how the disruption of ASD risk genes leads to alterations in molecular and circuit-level mechanisms. To accomplish this, we use zebrafish mutants of “high confidence” ASD risk genes to identify structural, pharmacological, and circuit-level mechanisms underlying ASD. Methods: Using CRISPR/Cas9, we generated zebrafish mutants of 10 ASD risk genes. To visualize structural changes in the developing brain, we use automated deep phenotyping and transgenic lines labeling GABAergic and glutamatergic neurons. We use high-throughput pharmaco-behavioral profiling of rest-wake and visual-startle behaviors to identify novel drug candidates. In vivo calcium imaging of GCaMP-expressing fish is used to visualize changes in neural activity resulting from risk gene disruption. Results: We identified the behavioral “fingerprints” of zebrafish mutants of the ASD risk genes: cntnap2, chd8, cul3, dyrk1a, grin2b, katnal2, scn1lab, and tbr1. We found that zebrafish mutants of cntnap2 and scn1lab have GABAergic deficits and nighttime hyperactivity. Interestingly, we identified estrogenic compounds as selective suppressors of the behavioral phenotype of cntnap2 mutants. Specifically, we found that the plant-derived estrogen, biochanin A, reverses nighttime hyperactivity in mutants. Conclusions: High-throughput functional analyses across zebrafish mutants of ASD risk genes identify points of convergence and novel drug candidates with relevance to ASD.
Presented by
Ellen Hoffman <ellen.hoffman@yale.edu>
Keywords
autism spectrum disorder, genetics, zebrafish, development

Integrating clinical and research training in child psychiatry: fifteen-year outcomes from a federally supported program

Amanda Calhoun, Michael H. Bloch, Dorothy Stubbe, James F. Leckman, Andres Martin

Abstract
Presented by
Amanda Calhoun <amanda.calhoun@yale.edu>
Keywords

Investigating the Neurobiology of Fathers with Histories of Intimate Partner Violence (IPV) in response to Infant Distress

Ellie Baker, Ciara McFaul, Jia Wu, Ivett Karina Sandoval, Michael J. Crowley, Helena Rutherford, Carla Stover

Abstract
Intimate partner violence (IPV) commonly occurs in families, impacting the child’s development directly through exposure to violence and indirectly through disruptions in parenting. This study investigates the impact of IPV on the neural and physiological responses to infant’s distress in fathers. Frontal electroencephalogram (EEG) asymmetry, as a measure of motivational tendencies, and heart rate data were collected from 25 fathers with IPV perpetration histories and 19 fathers without IPV histories in response to videos of an infant’s distress and white noise, as well as during a baseline (no stimulus) condition. IPV perpetrators evidenced greater left frontal EEG asymmetry, indicating greater approach motivation, across all conditions. Relative to baseline, cries elicited a decrease in left frontal asymmetry in both groups, whereas white noise elicited decrease in left frontal asymmetry only in controls. Adverse childhood experiences (ACEs), particularly family adversity experiences such as household violence, predicted frontal asymmetry response to white noise and trended in the prediction of frontal asymmetry response to cry. While Heart Rate differed across conditions, there were no differences between IPV and control group. Increased difficulties in emotion regulation was associated with increased heart rate to cry and white noise. Together these results reveal neural and physiological differences between fathers with and without IPV histories associated with ACEs and emotion dysregulation, perhaps indicating pathways of risk for the intergenerational transmission of IPV. Further research is required to understand how neural and physiological responses impact parenting and the potential implications for clinical practice and policy.
Presented by
Ellie Baker <ellie.baker@kcl.ac.uk>
Keywords
Intimate Partner Violence, Fatherhood, Frontal Alpha Asymmetry, Adversity, Heart rate

Let's talk about sex, doc: Video-based examples of sexual health conversations help CAPs help kids

Linda Drozdowicz, Elisabeth Gordon, Desiree Shapiro, Isheeta Zalpuri, Colin Stewart, Edwin Williamson, Andrés Martin

Abstract
Matters of sexuality and sexual health are common in the practice of child and adolescent psychiatry (CAP), yet clinicians can feel ill-equipped to address them with confidence. To address this gap in training and practice, we developed, implemented, and evaluated an educational module enhanced by videotaped depictions of expert clinicians interacting with professional actors performing as standardized patients (SPs).
Presented by
Linda Drozdowicz, MD <linda.drozdowicz@yale.edu>
Keywords
Medical education, Synchronous videoconferencing, Standardized patients, Sexual health, Autism

Minding the Baby® Home Visiting: Health, Attachment, Parenting, and Child Mental Health Outcomes

Arietta Slade, PhD; Lois S. Sadler, PhD, RN; Crista Marchesseault, MAT, MA

Abstract
The Minding the Baby® Home Visiting (MTB-HV) clinical model was developed in 2002 and has been delivered to first-time young families in New Haven, Connecticut for over 18 years. MTB-HV was developed to serve families facing economic and social adversity, often including histories of adverse childhood experiences and developmental trauma. It is the only evidence based home visiting model to have combined documented impacts on health, attachment, and child mental health outcomes. When compared with control families at the end of the two RCT study periods, MTB-HV families demonstrated the following findings, all of which were significant within the samples: 1) lower rates of obesity and higher rates of normal weight in MTB-HV toddlers, 2) higher rates of on-time pediatric immunization; 3) lower rates of rapid subsequent childbearing; 4) a trend toward lower rates of child protection referrals; 5)higher levels of reflective parenting; 6) higher rates of secure attachment; 7) lower rates of disorganized attachment; 8) less disrupted teen mother-child interactions. Additionally, at 1-3 year follow-up, there were significantly lower rates of maternally reported externalizing disorders in MTB-HV children. In a longer-term follow-up study, preliminary analysis of data from MTB-HV families with 4-9 year-old children suggests that intervention parents are more supportive and more reflective, and that their children have fewer externalizing and total problem behaviors.
Presented by
Crista Marchesseault <crista.marchesseault@yale.edu>
Keywords
Home Visiting, Health, Attachment, Reflective Parenting, Mental Health

Mother’s Milk Cortisol Predicts Brain Growth and Cognitive Development in Rhesus Monkeys

Amanda M. Dettmer, Jerrold S. Meyer, Katie Hinde

Abstract
Hormones in mother's milk, particularly glucocorticoids like cortisol, are known to influence offspring development. This work extends the window of lactational programming to the neonatal period. In 42 mother/infant rhesus monkey dyads, mother's milk cortisol measured in the first month postpartum predicted several measures of infant brain growth as well as cognitive development later in infancy.
Presented by
Amanda Dettmer <amanda.dettmer@yale.edu>
Keywords

Motivation Improves Working Memory by Shaping Neural Signals in the Prefrontal and Parietal Cortex

Youngsun T. Cho, Flora Moujaes, Charles H. Schleifer, Martina Starc, Jie Lisa Ji, Nicole Santamauro, Brendan Adkinson, Antonija Kolobaric, Morgan Flynn, John H. Krystal, John D. Murray, Grega Repovs, Alan Anticevic

Abstract
Motivation and cognition are refined throughout childhood and adolescence. Motivation and cognition are co-disrupted in many psychiatric illnesses: depression, ADHD, schizophrenia and substance use disorders. We still do not know how the brain links motivation and cognition to achieve goal-directed behaviors, in turn, limiting our ability to design meaningful treatments for psychiatric illnesses. We designed a task to measure the brain-wide effects of incentives on working memory. 33 typically developing young adults were tested using fMRI (functional magnetic resonance imaging). Our results showed that the prospect of monetary reward or loss improved working memory. Neural signals increased in prefrontal and parietal cortices when working memory was incentivized. Greater neural signal was associated with better spatial working memory. Receiving money based on working memory performance affected emotional and pain based brain regions. Future work will examine how these circuits change in adolescents with depression over time.
Presented by
Youngsun Cho <youngsun.cho@yale.edu>
Keywords
cognition, motivation, reward, development, fmri, imaging

Negative Emotional Reactivity, Effortful Control, and Self Regulatory Strategies in Toddlers with ASD

N. Powell, M. Butler, E. Yhang, C. Nutor, C. D. Gershman, K. Joseph, H. Feiner, D. Goncalves Fortes, S. Macari, A. Vernetti, K. Chawarska, K. Powell

Abstract
Presented by
Kelly Powell <kelly.powell@yale.edu>
Keywords

Parental Regulation of Frontoamygdala Circuitry is Associated with Family Accommodation in Pediatric Anxiety

Cristina Nardini*, Sadie Zacharek*, Hannah Spencer, Paola Odriozola, Alyssa Martino, Tess Anderson, Grace Hommel, Carla Marin , Wendy Silverman, Eli Lebowitz**, Dylan Gee**

Abstract
Anxiety is one of the most prevalent mental health concerns in youth, affecting 30% of children, yet up to 50% remain symptomatic following standard evidence-based psychosocial treatment (e.g., CBT) for childhood anxiety. Difficulty regulating fear is a core feature of childhood anxiety that is associated with weaker prefrontal control of amygdala reactivity. Anxious children often depend heavily on their caregivers for comfort during fearful situations. Family accommodations (caregivers’ changes in behavior to help a child avoid distress) contribute to external regulation of children’s fear in the short-term but can carry long-term consequences such as over-dependence on caregivers for emotion regulation. Examining the neurobiological influences of maternal regulation of emotional reactivity in children with anxiety disorders may inform the development of novel, effective parent-based interventions.

Neuroimaging data from the first 19 clinically anxious children (ages 6-12) who served as participants of a larger ongoing clinical trial. The Family Accommodations Scale-Anxiety (FASA) was used to assess the extent of family accommodation. To evaluate the influence of maternal presence on child fear regulation, children completed two runs of a fearful faces task in a functional magnetic resonance imaging (fMRI) scanner: once alone and once in the presence of their mother (condition order counterbalanced across participants).

Linear mixed-effects analysis showed significant associations between higher levels of family accommodation and the impact of maternal presence on child ventromedial prefrontal cortex activation (p = 0.014) to fearful faces. Specifically, children who experienced higher levels of family accommodation showed a greater reduction in amygdala reactivity and stronger frontoamygdala connectivity in the presence of their mother (relative to her absence).

Developing more effective forms of interventions specifically tailored to children is an urgent need, as current evidence-based treatments have not been uniformly effective. These novel findings enhance our understanding of the neural pathways through which caregivers modulate children’s fear and suggest a model for how anxious children may become dependent upon family accommodation. These results can inform the development of alternative parent-based treatment interventions to improve independent fear regulation in anxious children.
Presented by
Cristina Nardini <cristina.nardini@yale.edu>
Keywords
family accommodation, frontoamygdala circuitry, parental modulation, childhood anxiety

Pivoting in the pandemic: a qualitative study of child and adolescent psychiatrists in the times of COVID-19

Madeline DiGiovanni, Indigo Weller, MS, MFA, Andrés Martin, MD, MPH

Abstract
Objectives: We examined the personal and professional impacts of the COVID-19 pandemic on child and adolescent psychiatrists' (CAP) development, practice, and shifting values, to inform how the field may move forward post-pandemic. Methods: We used photo-elicitation and semi-structured interviews of child and adolescent psychiatrists (n=24) practicing in the US. Participants were selected as a diverse convenience sample of American Academy of Child and Adolescent Psychiatry members. We analyzed transcripts using thematic analysis and used NVivo 12.0 software to complement our manual coding. Results: We identified four main “exposure” themes of the pandemic, which have engendered a reevaluation of and a recommitment to the aims of each clinician and the field of CAP more broadly. These themes include exposing: 1) Inefficiencies in day-to-day operations (barriers to care and migration to Zoom); 2) Changes to physician identity (work-life boundaries and priorities); 3) Intra-professional challenges (loss of professional trust); and 4) The CAP’s role in society in response to the shifting conversations on race (addressing inequity in practice and research). Even as we identified a collective agreement toward the need for implementing change, just what needs to change, and how that change will be realized, remain contested. Conclusions: The four exposures, augmented by a national confrontation with race and equity, have engendered a field-wide reckoning with known inequities. They have reinvigorated collective responses and calls to action. The divergent mindsets to change and leadership have provided an aperture for what values and practices the field might instill in the next generation of CAP.
Presented by
Madeline DiGiovanni <madeline.digiovanni@yale.edu>
Keywords
qualitative methods, COVID-19, photo elicitation, advocacy, telemedicine, semi-structured interviews

Racial Congruence and Teacher Well-Being

Annette Ponnock, Nadja Umlauf, James Floman

Abstract
There is a misalignment in the United States in the racial composition of students and teachers (NCES, 2018). The student population in the United States is less than 50% white, however the teacher population is over 80% white. Although most prior research on racial congruence has focused on students, teachers benefit from racial congruence as well. Studies have found that teachers in racially congruent classrooms and/or schools are more collegial with staff, have higher job satisfaction, and less attrition (e.g., Fairchild et al., 2012). However, research on the impact of racial congruence on teachers is relatively scant. The sample of the present study consisted of 3,340 teachers from around the United States. Teachers were coded as either white or BIPOC (that is, Black, Indigenous, or Person of Color). The schools in which they taught were coded as white if their student population was greater than 50% white and BIPOC if their student population was greater than 50% BIPOC. We dummy coded group membership using white teachers in white schools as the reference category and conducted a structural equation model to determine how group membership impacted teachers’ well-being. We found that BIPOC teachers in BIPOC schools had the most job satisfaction and personal accomplishment, however also the most emotional exhaustion. These findings indicate that there is a greater need to support BIPOC teachers in general, especially when in schools with majority BIPOC students.
Presented by
Annette Ponnock <annette.ponnock@yale.edu>
Keywords
well-being, racial congruence, teachers

Retinoic Acid Regulates the Development of Prefrontal-Thalamus Connectivity

Kartik Pattabiraman MD, PhD; Mikihito Shibata PhD; Belen Galdos Lorente PhD; David Andrijevic MD; Navjot Kaur PhD; Andre Sousa PhD; Nenad Sestan MD, PhD

Abstract
The specialization of higher-order processing or association areas in the human cerebral cortex is thought to underlie complex cognitive capabilities. One well-described specialization is the expansion of the primate prefrontal cortex (PFC) and its connections with the mediodorsal thalamus (MD), which are crucial for cognitive flexibility and working memory and altered in disorders such as ASD and schizophrenia. However, the mechanisms underlying the development and expansion of the PFC and PFC-MD connectivity remain elusive. Previous analyses of the developing human and macaque brain revealed that the transcriptomic differences between neocortical areas are prominent and often transient during mid-fetal development, a crucial period for the initial assembly of neocortical neural circuits which shows a convergence of both ASD and schizophrenia-associated genes. Thus, we hypothesized that the molecular processes governing the developmental specification and evolutionary diversification of the PFC could be revealed by differential regional gene expression analysis of the mid-fetal primate neocortex. Here we report an anterior-to-posterior, PFC-enriched, gradient of retinoic acid (RA) and genes regulated by RA in the mid-fetal human and macaque neocortex. We observed multiple potential sources of RA in the PFC, including primate-specific expression and cortical expansion of RA synthesizing enzymes compared to mouse. Gene deletion in mice revealed that RA signaling in the PFC is required for proper molecular patterning of prefrontal areas, frontal cortex synaptogenesis and development of PFC-MD connectivity. Together, these findings reveal a critical role for RA signaling in PFC development and, potentially, its evolutionary expansion.
Presented by
Kartik Pattabiraman <kartik.pattabiraman@yale.edu>
Keywords
cortical development, prefrontal cortex, neurodevelopmental disorders, cortical evolution

Statewide Implementation of Fathers for Change (F4C)

Carla S. Stover, Ph.D., Rebecca Beebe, Ph.D. Megan Clough

Abstract
Purpose. A substantial number of families are involved with the child welfare system because of children’s exposure to intimate partner violence (IPV), which has significant impact on the health of the entire family. This study presents a program evaluation for a statewide implementation of a fatherhood focused individual and family treatment for men referred by the child welfare system and provided by six community mental health agencies. Methods. Data from 373 fathers and their coparents referred to Fathers for Change (F4C) were analyzed to assess a) the feasibility of F4C and b) the impact of the intervention on IPV as measured by mothers’ reports on the Abusive Behavior Inventory, children’s exposure to conflict on the Coparenting Relationship Scale, and fathers’ symptoms. Results. Completion rates for the program were 73%. Age, race, severity of IPV and alcohol misuse were not associated with drop out, but those with significant drug use problems were 2.3 times more likely to drop out. Among treatment completers, mothers reported significantly reduced IPV and children’s exposure to conflict, with medium to large effect sizes. Fathers reported significant improvements in their emotion regulation, parental reflective functioning, as well as anger and hostility. Conclusions. F4C was feasible with high completion rates and significant reductions in IPV and children’s exposure to conflict.
Presented by
Carla Stover <carla.stover@yale.edu>
Keywords
Intimate Partner Violence, Child Maltreatment, Fathers, Intervention

Surveillance Bias in Child Protective Services Reporting by Home Visitors

Margaret L. Holland, Rose M. Taylor, John M. Leventhal, Denise A. Esserman

Abstract
Research trials report that home-visited (HV) families have higher rates of reports to Child Protective Services (CPS) for suspected child abuse or neglect than comparison group families, although reducing abuse and neglect are important goals of these programs. HV families may have more opportunity for reports than comparison group families due to the home visitor; this increase is called surveillance bias. We estimated the magnitude of surveillance bias in a statewide HV program. We linked HV program data to state birth certificate data (n=3,300; enrollment 2005-15) and created a comparison group with the remaining birth certificate dyads using propensity score matching (n=13,091). These groups were matched within the CPS data system to provide CPS report data. We used difference-in-difference analysis to estimate the absolute risk difference in the change in overall reports and investigated reports in the 6-months pre- and post-HV intervention vs. comparison group (using the match HV dyad’s engagement timing). On average, children were 1.5 years old (SD: 1.5) at the end of HV engagement. In the 6 months prior to the end of HV engagement (or equivalent), 3.95% of families had any report and 3.30% had investigated reports; in the following 6 months 3.85% had any report and 3.06% had investigated reports. There was significant surveillance bias, with the HV group having 1.18% more investigated report in the last 6 months of the program than the comparison group (p<.01). When evaluating this program, surveillance bias should be considered.
Presented by
Maggie Holland <margaret.holland@yale.edu>
Keywords
home visiting, child maltreatment, program evaluation

The association between autistic traits, executive function and emotion knowledge in preschoolers

Abi Eveleigh, MRes; Craig Bailey, PhD; Irem Korucu, PhD

Abstract
Individuals with Autism Spectrum Disorder (ASD) have been shown to have difficulties with emotion knowledge and executive function (EF), with these difficulties extending to individuals with high levels of autistic traits in the general population. This study investigated how autistic traits in a large, diverse sample of preschoolers (N=441) related to performance on an emotion knowledge task. EF has also been found to be associated with emotional abilities and therefore the role of EF was explored to see if EF moderated this association. Using multilevel regressions, significant associations were found between autistic traits and emotion knowledge. EF was not found to moderate this association, suggesting that EF and emotion knowledge difficulties in children exhibiting autistic behaviours are independent of each other. These findings have implications for interventions that target executive and emotion abilities for children exhibiting behaviours relating to ASD in early childhood.
Presented by
Abi Eveleigh <abigail.eveleigh@yale.edu>
Keywords
ASD, emotion knowledge, executive function, early childhood

The effects of prenatal stress on neural responses to infant cries in expectant mothers and fathers

Amanda F. Lowell, PhD, Sarah Peoples, MRes, Madison Bunderson, BS, Cody Bartz, BS, & Helena J.V. Rutherford, PhD

Abstract
Prenatal stress is associated with detrimental perinatal outcomes for parents including depression, anxiety, and decreased caregiving sensitivity. Accumulating research has evidenced value in examining how parents respond to infant cues at a neural level, which may elucidate mechanisms by which stress impacts caregiving sensitivity, and parent and child outcomes. One approach that can be used to understand parental sensitivity even before birth is the event-related potential technique, which measures stages of neural processing of caregiving cues, including infant cries. We examined whether prenatal stress affected perceptual (N1,P2) and attentional (LPP) neural markers of infant cry processing in expectant parents. Expectant parents (38 mothers, 30 fathers) during the third trimester of pregnancy listened to 2-second recordings of high- and low-distress infant cries while electroencephalography was recorded to measure event-related potentials. Parents also reported on current life stress. Prenatal stress impacted parents’ LPP elicited by infant cries: Specifically, higher levels of stress were associated with a larger LPP response to low-distress (but not high-distress) cries, independent of parental sex. There was no association between stress and the N1 or P2. The LPP reflects sustained attentional processing of motivationally-relevant stimuli, suggesting that low-distress cries were particularly salient to expectant parents with elevated stress levels. This increased attentional processing of low-distress cries in highly-stressed parents may reflect uncertainty regarding infant distress level, thereby requiring greater interpretive effort. Overall, the impact of prenatal stress on caregiving may already be observed in pregnancy, motivating intervention prenatally for mothers as well as fathers.
Presented by
Amanda Lowell <amanda.lowell@yale.edu>
Keywords
mothers, fathers, parents, stress, neuroimaging, electroencephalography

Trajectories of highly dependent adult children: a retrospective study

Uri Berger and Eli Lebowitz

Abstract
Not much is known about factors contributing to adult children becoming highly dependent on their parents (also known as failure to launch and Hikikomori). Specifically, it is unclear which characteristics at a young age contribute to this phenomenon later in life. In this study we use data from the National Longitudinal Study of Adolescent to Adult Health (Add Health). The study has two goals: first, to examine which demographic and mental characteristics at ages 12-to-18 contribute to this phenomenon at an older age. Second, to examine the persistence of the condition. That is, we want to learn what percentage of individuals who have been highly dependent on their parents at as young adults remain dependent at older ages. Our results indicate that adults with FTL, compared with adults without FTL, had significantly more problem indicators as adolescents. Furthermore, FTL status in young adulthood frequently persists over several years and is associated with hospitalization and additional problems including substance related problems. In conclusion, FTL can be traced to functioning in adolescence. Some characteristics may drive the FTL individuals to longer periods of dependency (e.g., avoidance). Furthermore, once an individual show signs of FTL there is a high risk (5:1) of additional negative outcomes later in life.
Presented by
Uri Berger <uri.berger@yale.edu>
Keywords
Clinical psychology, Demographics, Failure to Launch, Hikikomori, Parental Guidance, Psychopathology, social avoidance, unemployment

Treatments for Childhood Anxiety Reduce Anxiety Sensitivity

Cristina Nardini, Carla Marin, Wendy Silverman, Eli Lebowitz

Abstract
Anxiety sensitivity (AS) is the fear of anxiety-related feelings and sensations, resulting in a negative interpretation of bodily symptoms (e.g., shortness of breath, increased heart rate). These sensations are further interpreted as signals for impending, harmful events, which could entail social, physical, or psychological consequences. Consistent with the adult literature, research suggests that child AS is a risk factor for anxiety disorders. Studies with adult samples have demonstrated that AS significantly decreases after cognitive behavioral therapies (CBTs) for anxiety, but no study has examined whether treatments for childhood anxiety also significantly reduce AS.

Participants were 97 children (ages 7-14 years) with a primary DSM-5 anxiety disorder enrolled in a randomized clinical trial for childhood anxiety. Participants were randomized to either 12 weeks of individual CBT or 12 weeks of a novel, parent based treatment for childhood anxiety, Supportive Parenting for Anxious Childhood Emotions (SPACE). The Child Anxiety Sensitivity Index was used to assess AS before and after treatment.

Anxiety sensitivity scores significantly decreased from pre- to post-treatment collapsing across both treatment arms. The analysis controlled for baseline levels of child anxiety severity, child age, and child sex. There were no significant differences in AS reduction between CBT and SPACE.

The present study addressed the need to examine the impact of child anxiety treatments on AS in children with anxiety disorders. These novel findings, showing similar significant reductions in AS following SPACE and CBT, highlight that these cognitive-behavioral and parent-based interventions are effective at reducing ancillary symptoms that typically heighten anxiety.
Presented by
Cristina Nardini
Keywords
anxiety sensitivity, childhood anxiety treatments, childhood anxiety, CBT, SPACE

Using Digital Parenting Program to Improve Access to Treatment for Pediatric Irritability

Sonia N. Rowley, Andrea Diaz-Stransky, David Grodberg, Denis G. Sukhodolsky

Abstract
This study was conducted to evaluate the feasibility and potential effects of a digital parenting intervention for young children with high levels of irritability and disruptive behavior. The “Tantrum Tool” is an alternative to in-person treatments that uses videoconferencing with expert clinicians and self-guided online modules to eliminate access barriers. The 80% completion rate in this pilot study suggests the feasibility of this intervention for larger clinical trials. There were also statistically significant and clinically meaningful reductions in parent-rated irritability and noncompliance. Furthermore, the magnitude of stress in the parent-child system reduced over the course of the intervention. This data provides an important foundation for planning a randomized controlled trial powered to test the efficacy of this digital parent training intervention.
Presented by
Denis Sukhodolsky <denis.sukhodolsky@yale.edu>
Keywords
telehealth, parenting, irritability, disruptive behavior, treatment access

Whole-exome sequencing in childhood anxiety disorders identifies de novo damaging variants

Emily Olfson, MD PhD, Grace Hommel, BS, Eli Lebowitz, PhD, Wendy Silverman, PhD ABPP, Thomas Fernandez, MD

Abstract
Genomic research can provide new insights into the biology of childhood anxiety disorders. Although a genetic contribution towards anxiety has long been recognized, progress in identifying specific reproducible risk genes has been slow. In contrast, genomic research has led to significant progress in other childhood-onset neuropsychiatric conditions in part because of efforts to assess the role of de novo (spontaneous) variants. Taking this approach, we performed the first whole-exome sequencing study of childhood anxiety disorders. Specifically, DNA sequencing was performed in 76 parent-child trios recruited from the Program for Anxiety Disorders at the Yale Child Study Center. By comparing these individuals to 225 previously sequenced control parent-child trios, this study provides new evidence that de novo likely gene disruptive variants (including frameshift indels and premature stop codons) and predicted damaging missense variants are significantly enriched in anxiety cases compared to controls (rate ratio= 2.07, p=0.04). These damaging de novo variants occur in genes that are expressed in the brain and overlap with risk genes for other neurodevelopmental conditions. Furthermore, exploratory pathway analyses suggest the importance of long-term depression and dopaminergic synapses. Overall, this research provides novel insight into the biological underpinnings of childhood anxiety disorders, which is an important step for improving our understanding of these common and impairing conditions.
Presented by
Emily Olfson <emily.olfson@yale.edu>
Keywords
Genomics, Anxiety, Whole-Exome Sequencing