Brain activity underlying negative self- and other-perception in adolescents: The role of attachment-derived self-representations

One of teenagers’ key developmental tasks is to engage in new and meaningful relationships with peers and adults outside the family context. Attachment-derived expectations about the self and others in terms of internal attachment working models have the potential to shape such social reorientation processes critically and thereby influence adolescents’ social-emotional development and social integration. Because the neural underpinnings of this developmental task remain largely unknown, we sought to investigate them by functional magnetic resonance imaging. We asked n = 44 adolescents (ages 12.01–18.84 years) to evaluate positive and negative adjectives regarding either themselves or a close other during an adapted version of the well-established self-other trait-evaluation task. As measures of attachment, we obtained scores reflecting participants’ positive versus negative attachment-derived self- and other-models by means of the Relationship Questionnaire. We controlled for possible confounding factors by also obtaining scores reflecting internalizing/externalizing problems, schizotypy, and borderline symptomatology. Our results revealed that participants with a more negative attachment-derived self-model showed increased brain activity during positive and negative adjective evaluation regarding the self, but decreased brain activity during negative adjective evaluation regarding a close other, in bilateral amygdala/parahippocampus, bilateral anterior temporal pole/anterior superior temporal gyrus, and left dorsolateral prefrontal cortex. These findings suggest that a low positivity of the self-concept characteristic for the attachment anxiety dimension may influence neural information processing, but in opposite directions when it comes to self- versus (close) other-representations. We discuss our results in the framework of attachment theory and regarding their implications especially for adolescent social-emotional development and social integration.     

The integration of social influence and reward: Computational approaches and neural evidence

Decades of research have established that decision-making is dramatically impacted by both the rewards an individual receives and the behavior of others. How do these distinct influences exert their influence on an individual’s actions, and can the resulting behavior be effectively captured in a computational model? To address this question, we employed a novel spatial foraging game in which groups of three participants sought to find the most rewarding location in an unfamiliar two-dimensional space. As the game transitioned from one block to the next, the availability of information regarding other group members was varied systematically, revealing the relative impacts of feedback from the environment and information from other group members on individual decision-making. Both reward-based and socially-based sources of information exerted a significant influence on behavior, and a computational model incorporating these effects was able to recapitulate several key trends in the behavioral data. In addition, our findings suggest how these sources were processed and combined during decision-making. Analysis of reaction time, location of gaze, and functional magnetic resonance imaging (fMRI) data indicated that these distinct sources of information were integrated simultaneously for each decision, rather than exerting their influence in a separate, all-or-none fashion across separate subsets of trials. These findings add to our understanding of how the separate influences of reward from the environment and information derived from other social agents are combined to produce decisions.     

Psychometric Properties of a Social Skills Assessment using a Virtual Environment

Social Anxiety Disorder (SAD) is a marked and persistent fear of social and/or performance situations in which embarrassment or scrutiny from others may occur. One form of behavioral assessment is a Role Play Task (RPT). However, RPTs often are not feasible in clinical settings due to the common obstacles in implementation. Thus, the current study examines the feasibility, acceptability and psychometric properties of a virtual environment based social skills assessment compared to the traditional RPT. Forty-six children, ages 7 to 14, participated in two assessment conditions: RPT and a virtual environment behavioral assessment (VE BAT). Participants reported self-ratings of anxiety and acceptability, while blinded observers rated social skills and overall social anxiety. An ANCOVA, covarying for age, revealed (a) no significant task difference for voice volume, speech latency, number of words spoken, effectiveness, and SAM ratings; (b) that the VE BAT was more feasible to implement in terms of personnel time and costs and; (c) more overall anxiety during the RPT task than during the VE BAT task. In addition, the VE BAT demonstrated moderate concurrent validity when correlating the self-report ratings of anxiety with the Social Phobia and Anxiety Inventory for Children (SPAI-C). The current study addresses many of the impediments to conducting RPTs in a clinical setting and, overall, supports the utilization of VE BATS as a viable alternative for the behavioral assessment of social skills in children. Further implications address the potential for the armamentarium for social skills training with children with SAD.     

Understanding Barriers to Initial Treatment Engagement among Underserved Families Seeking Mental Health Services

This mixed method study examined factors associated with parents not attending their child’s mental health treatment after initially seeking help for their 2–5 year old child. It was part of a larger study comparing two evidence-based treatments among low-income racial/ethnic minority families seeking child mental health services. Of 123 parents who initiated mental health treatment (71?% African American or multi-racial; 97.6?% low-income), 36 (29.3?%) never attended their child’s first treatment session. Socio-demographic characteristics, parenting stress, depression, severity of child behavior problems, and length of treatment delay from intake to first scheduled treatment session were compared for families who did and did not attend their first treatment session. Parents who never attended their child’s first treatment session were more likely to live with more than four adults and children (p?=?.007) and have more depressive symptoms (p?=?.003). Median length of treatment delay was 80 days (IQR?=?55) for those who attended and 85 days (IQR?=?67.5) for those who did not attend their child’s first treatment session (p?=?.142). Three themes emerged from caregiver interviews: (a) expectations about the treatment, (b) delays in getting help, and (c) ambivalence about research participation. Findings suggest the need to develop better strategies for addressing risk factors early in the treatment process and reducing the length of time families with adverse psychosocial circumstances must wait for child mental health treatment.     

Perceptions of Stress,Coping, and Intervention Preferences among Caregivers of Disadvantaged Children with Asthma

Asthma remains the most prevalent chronic illness among children. Despite the substantial body of literature examining children with asthma, few studies have examined parents’ perspectives of the condition and experiences of caregiver stress. Parents of children with chronic illnesses experience elevated stress and may have limited opportunities to cope with complex emotions while caring for children with asthma. Drawing from focus groups and interviews with African American and Hispanic parents of children with asthma, this qualitative study was conducted as part of a patient-centered engagement process to inform the refinement of an intervention aimed at reducing stress among parents of children with asthma. All data were transcribed and underwent three waves of inductive analysis. The content analysis indicated that the unpredictable nature of asthma and the caregiving burden associated with managing children’s asthma contributed to parents’ stress, and external contexts compounded the impact of these stressors. Parents also reported having difficulty identifying how they coped with stress and employed approaches to coping with stress that they applied intermittently but encountered several barriers to enacting known or available coping strategies. Analyses also revealed that parents desired a multimodal stress reduction intervention that emphasized building relationships, allowed for flexibility, and encouraged staff-parent communication. Whereas African American and Hispanic parents’ experiences of stress and coping strategies were similar, their preferences differed in regards to incorporating technology into the intervention, the credentials of facilitators, and the salience of language preferences. Understanding the complexities of stressors facing caregivers is important for developing interventions to support parents and children coping with asthma, and in particular when working with families from diverse backgrounds.     

A family-focused randomized controlled trial to prevent adolescent alcohol and tobacco use: The moderating roles of positive parenting and adolescent gender

Four years of longitudinal data from 2,153 families with a 5th- or 6th-grade preadolescent participating in a family-focused pediatric primary-care-based prevention program were used to examine whether prevention effects were moderated by positive parenting and/or adolescent gender. Alcohol and tobacco use, internalizing problems, and externalizing problems were examined. Although findings revealed no main effect of the prevention program, positive parenting and adolescent gender were moderators of internalizing problems and adolescent gender was a moderator of externalizing problems. Clinical implications and future directions for research are discussed.     

Does Happiness Predict Medication Adherence among African Americans with Hypertension?

Poor medication adherence is a leading cause of excessive cardiovascular morbidity among African Americans. Many adherence-promoting interventions have addressed economic barriers, improved the patient-provider relationship, simplified regimens, and used reminder systems; however, the problem of low adherence remains intractable. Meanwhile, positive psychological attributes that might serve to promote medication adherence have not been fully explored. To address this gap, we examined the association between happiness and medication adherence among low-income African Americans with hypertension treated in a safety-net setting. Data were obtained from the Alabama Collaboration for Cardiovascular Equality, 2007?C2008. Happiness was measured using the 4-item scale of Lyubomirsky and Lepper; low, moderate, and high happiness were defined by tertiles because of the non-normal distribution. Medication adherence was assessed with the Morisky Medication Adherence Scale. Associations were quantified with ordinal logistic regression. Our sample of 573 African Americans was 71.6?% female and had an average age?±?SD of 53.6?±?9.7?years and a median happiness score of 5.2. Compared to participants with low happiness, the odds (OR; 95?% CI) of being in a better medication adherence category were greater for those with moderate (1.53; 1.02?C2.27) and high (2.26; 1.52-3.37) happiness, after adjusting for age, sex, income, education, and difficulty paying for medical care. Within this cohort of low-income African Americans with hypertension, participants with greater happiness exhibited better medication adherence. Although one interpretation of our study is that more adherent patients are naturally happier, our findings raise the possibility that adding happiness-boosting components may increase the effectiveness of more traditional adherence interventions.