Perspectives on Factors Impacting Youth’s Reentry into Residential Care: An Exploratory Study

Multiple placements in therapeutic residential care is expensive, and is associated with poor outcomes; thus, identifying barriers to successful reintegration into the home and community school settings is essential for developing appropriate post-discharge supports, and reducing societal costs. Participants were seven youth (four female; three White/Caucasian, one Black/African American, one Hispanic/Latino, two multi-racial) recently readmitted to a therapeutic residential care program and five of their primary caregivers (four female; four White/Caucasian, one Black/African American). Through semi-structured interviews with caregivers and youth, this exploratory study investigated (1) the perceptions of preparedness for the youth’s successful transition from therapeutic residential care to the home setting, (2) the post-discharge factors that contributed to the youth’s return to care, and (3) the lessons learned about the youth’s transition from therapeutic residential care to home. The results of this exploratory, qualitative study revealed rich information about youth and their caregivers’ perspectives about their experiences prior to returning to care, such as the importance of healthy relationships (family and peers), transition planning, and post-discharge supports at the individual, family, and school levels.     

Communication of Genetic Risk Information to Daughters in Families with Fragile X Syndrome: The Parent’s Perspective

Parental approaches to communicating information about genetic disorders to their children may be an important determinant in how the children manage stress as well as their adjustment and adaptation to that information. We explored communication patterns through structured interviews with 46 parents of daughters who learned about their genetic risk status as minors. Three different levels of knowledge about fragile X syndrome were explored: 1) informing that it has been diagnosed in the family and is an inherited disorder, 2) informing about the possibility of a daughter being a carrier, and 3) if testing had been done, informing the daughter of her actual carrier status. Additionally, parental perceptions of their daughter’s understanding of the information were explored along with frequency of discussions. We found that communication about genetic risk was initiated by the parents. Five disclosure patterns were identified with variations in style, content, and frequency of communication related to the information that was being disclosed. Aspects of resilient communication were present for all levels of disclosure; however, as the information became more personally relevant for the daughter such as disclosure about the possibility of “being a carrier” for fragile X syndrome and there was uncertainty regarding potential outcomes, the conversations included fewer resilient characteristics. Uncertainty about what and how to present information may negatively affect a parent’s ability to include elements of resilient communication when disclosing genetic risk information.     

Working memory deficits, increased anxiety-like traits, and seizure susceptibility in BDNF overexpressing mice

BDNF regulates components of cognitive processes and has been implicated in psychiatric disorders. Here we report that genetic overexpression of the BDNF mature isoform (BDNF-tg) in female mice impaired working memory functions while sparing components of fear conditioning. BDNF-tg mice also displayed reduced breeding efficiency, higher anxiety-like scores, high self-grooming, impaired prepulse inhibition, and higher susceptibility to seizures when placed in a new empty cage, as compared with wild-type (WT) littermate controls. Control measures of general health, locomotor activity, motor coordination, depression-related behaviors, and sociability did not differ between genotypes. The present findings, indicating detrimental effects of life-long increased BDNF in mice, may inform human studies evaluating the role of BDNF functional genetic variations on cognitive abilities and vulnerability to psychiatric disorders.     

Glucocorticoids are required for extinction of predator stress-induced hyperarousal

Background

The role of glucocorticoids in extinction of traumatic memories has not been fully characterized despite its potential as a therapeutic target for acquired posttraumatic stress disorder (PTSD). The predator stress paradigm allows us to determine whether glucocorticoids mediate the extinction of both context-dependent and context-independent fear memories.

Methods

Male C57BL/6J mice were exposed to a predator (cat) then repeatedly exposed to the predator stress context in the absence of the cat. Context-dependent (associative) fear memory was assessed as suppression of activity during re-exposure to the predator stress context without the cat (extinction trials). Context-independent fear (non-associative) was assessed seven days after extinction trials using measures of hyperarousal and anxiety-like behaviours in environments unlike the predator stress context. To assess the role of glucocorticoids, mice were injected with metyrapone (50 mg/kg) 90 min prior to extinction trials in predator stressed mice and context-dependent and context-independent fear memories were assessed. Finally, metyrapone-treated predator stressed mice were injected with corticosterone (5 or 10 mg/kg) immediately following extinction trials and context-dependent and context-independent fear memories were assessed.

Results

Repeated re-exposure to the predator stress context without the cat present extinguished context-dependent fear memory, and also reduced hyperarousal, a generalized, chronic PTSD-like symptom. We show that extinction of context-independent predator stress-induced hyperarousal is dependent on endogenous glucocorticoids during the extinction trials. Furthermore, the inhibition of extinction by metyrapone on startle amplitude was reduced by exogenous administration of corticosterone following extinction trials. Overall, these data implicate glucocorticoids in the extinction of hyperarousal, a core symptom of PTSD.     

Rapid reacquisition of native phoneme contrasts after disuse: you do not always lose what you do not use

Infants attune to their birth language during the second half of infancy. However, internationally adopted children are often uniquely required to attune to their birth language, and then reattune to their adoptive language. Children who were adopted from India into America at ages 6-60 months (N = 8) and had minimal further exposure to their birth languages were compared to age-matched American non-adopted controls. Without training, neither group could discriminate a phonemic contrast that occurs in their birth language but not in English. However, after training on the contrast, the adopted group (N = 8) improved significantly and discriminated the contrast more accurately than their non-adopted peers. While English had explicitly replaced the birth language of the adopted sample, traces of early exposure conferred privileges on subsequent learning. These findings are consistent with behavioral and neurophysiological data from animals that have identified some of the mechanisms underlying such a 'retention without further use' phenomenon.     

Expectation and temperament moderate amygdala and dorsal anterior cingulate cortex responses to fear faces

A chronic tendency to avoid novelty is often the result of a temperamental bias called inhibited temperament, and is associated with increased risk for anxiety disorders. Neuroimaging studies have demonstrated that an inhibited temperament is associated with increased amygdalar blood-oxygenation-level-dependent (BOLD) response to unfamiliar faces that were not expected; however, the effects of variations in expectancy remain unknown. Using functional magnetic resonance imaging (fMRI), we studied BOLD response to infrequently encountered fear faces that were either expected or not expected in 42 adults with an inhibited or an uninhibited temperament. Individuals with an inhibited temperament had greater amygdala, but less dorsal anterior cingulate cortex (dACC), BOLD response when the stimuli were expected. In contrast, those with an uninhibited temperament had a smaller amygdala but larger dorsal anterior cingulate cortex BOLD response when expecting to see fear faces. These findings demonstrate temperament differences in expectancy effects and provide preliminary evidence for the dACC as a neural substrate mediating differences in inhibited temperament. Enhanced amygdala sensitivity coupled with weak inhibitory control from the dACC may form a neural circuit mediating behaviors characteristic of inhibited temperament and risk for anxiety disorders.     

A temporally dynamic context effect that disrupts voice onset time discrimination of rapidly successive stimuli

Across three experiments, voice onset time discrimination along a /ba/-/pa/ continuum was found to be influenced by the order of presentation of rapidly successive stimuli. Specifically, discrimination was disrupted when a relatively unambiguous /pa/ syllable was presented before, rather than after, a more ambiguous /pa/ or /ba/ syllable. In Experiments 1 and 2, for between-category discrimination, this order effect was significant at interstimulus intervals (ISIs) below 250 msec, but not at 250 or 1,000 msec. In Experiments 2 and 3, the order effect was also significant for within-category discrimination at ISIs below 250 msec. In addition, in Experiment 3 this order effect was not diminished by provision of performance feedback across eight testing sessions. These findings reveal a particular vulnerability of phonological processing in response to rapidly successive stimuli and may have implications for mathematical and neural models of speech processing of normal and impaired populations.     

Racial-Ethnic Differences in Genetic Amniocentesis Uptake

The objective of this study was to determine the role of health beliefs in genetic amniocentesis acceptance in a diverse racial-ethnic population. Participants completed a previously-validated questionnaire consisting of three sections: (1) demographics, (2) amniocentesis knowledge, and (3) health beliefs, which assessed perceived susceptibility, seriousness of potential impact, benefits of testing, and barriers to testing. The results showed that Hispanic women were less likely to accept amniocentesis (51.5% vs. Caucasian 82.8%, African American 82.9%, Asian 82.8%). Education level was the only demographic factor higher among acceptors. Women who accepted amniocentesis had higher perceived seriousness, susceptibility, and benefits HBM scores and higher knowledge scores than women who declined. HBM scores and knowledge predicted the amniocentesis decision correctly 91.5% of the time. Individual health beliefs and knowledge play a greater role in genetic amniocentesis acceptance than do demographic factors such as race-ethnicity.