Social adjustment in the offspring of parents with bipolar affective disorder

The social adjustment of the adolescent offspring of parents with bipolar affective disorder (n=41) was compared to that of the offspring of parents with nonaffective psychiatric disorders (n=22) and the offspring of normal controls (n=26). In addition, the relationship between social adjustment and cyclothymia in offspring was determined. Social adjustment was assessed using the Life Activities Inventory, a new measure developed to assess social functioning in adolescents and young adults. Cyclothymia was assessed with the General Behavior Inventory. As a group, the offspring of bipolar parents did not differ significantly from either control group on social adjustment. However, the cyclothymic offspring of bipolar parents exhibited significantly poorer social adjustment than the noncyclothymic offspring of bipolars and the offspring of psychiatric and normal controls. These findings suggest that poor social functioning in the adolescent offspring of parents with bipolar illness may be associated with the early manifestations of affective disorder. In addition, these data indicate that despite its subsyndromal intensity, cyclothymia can result in significant social impairment.This study was supported in part by National Institute of Mental Health (NIMH) Research Grant MH-39782 to Daniel N. Klein and NIMH Grants MH-33083 and MH-37195 to Richard A. Depue.     

The interview for antisocial behavior: Psychometric characteristics and concurrent validity with child psychiatric inpatients

The present study evaluated psychometric features and correlates of the Interview for Antisocial Behavior (IAB), a new measure designed to assess antisocial child behavior. Parents of 264 psychiatric inpatients (ages 6–13 years) completed the measure to evaluate antisocial behavior of their children. The investigation evaluated the relation of IAB scores to clinically derived diagnoses and to aggression and externalizing behaviors, as measured by different raters (parents, teachers), across different settings (home, school, hospital), and with different assessment methods (rating scales, behavioral role-play test). The results indicated that the IAB showed acceptable levels of internal consistency. A priori scores (severity, duration, total antisocial behavior) and factor analytically derived scales (Arguing/Fighting, Covert Antisocial Behaviors, Self-Injury) distinguished children with a DSM III diagnosis of conduct disorder, and scores on the IAB were more consistently related to other measures of aggression and externalizing behavior than to measures of internalizing behavior or overall severity of dysfunction. The implications of the results for use of the measure, particularly in relation to evaluation of the overt-covert dimension of antisocial behavior, are discussed.Completion of this research was facilitated by a Research Scientist Development Award (MH00353) and by grants (MH35408, MH39642) from the National Institute of Mental Health and the Rivendell Foundation.     

In-session gaming as a tool in treating adolescent problematic gaming

For some adolescent gamers, playing online games may become problematic, impairing functioning in personal, family, and other life domains. Parental and family factors are known to influence the odds that adolescents may develop problematic gaming (PG), negative parenting and conflictual family dynamics increasing the risk, whereas positive parenting and developmentally supportive family dynamics protecting against PG. This suggests that a treatment for adolescent PG should not only address the gaming behaviors and personal characteristics of the youth, but also the parental and family domains. An established research-supported treatment meeting these requirements is multidimensional family therapy (MDFT), which we adapted for use as adolescent PG treatment. We report here on one adaptation, applying in-session gaming. In-session demonstration of the “problem behavior” is feasible and informative in PG. In the opening stage of therapy, we use in-session gaming to establish an alliance between the therapist and the youth. By inviting them to play games, the therapist demonstrates that they are taken seriously, thus boosting treatment motivation. Later in treatment, gaming is introduced in family sessions, offering useful opportunities to intervene in family members' perspectives and interactional patterns revealed in vivo as the youth plays the game. These sessions can trigger strong emotions and reactions from the parents and youth and give rise to maladaptive transactions between the family members, thus offering ways to facilitate new discussions and experiences of each other. The insights gained from the game demonstration sessions aid the therapeutic process, more so than mere discussion about gaming.     

Centering culture in the treatment of opioid use disorder with American Indian and Alaska Native Communities: Contributions from a National Collaborative Board

American Indian/Alaska Native (AI/AN) communities are disproportionally impacted by the opioid overdose epidemic. There remains a dearth of research evaluating methods for effectively implementing treatments for opioid use disorder (OUD) within these communities. We describe proceedings from a 2-day Collaborative Board (CB) meeting tasked with developing an implementation intervention for AI/AN clinical programs to improve the delivery of medications to treat OUD (MOUD). The CB was comprised of Elders, cultural leaders, providers, individuals with lived experience with OUD, and researchers from over 25 communities, organizations, and academic institutions. Conversations were audio-recorded, transcribed, and coded by two academic researchers with interpretation oversight provided by the CB. These proceedings provided a foundation for ongoing CB work and a frame for developing the program-level implementation intervention using a strength-based and holistic model of OUD recovery and wellbeing. Topics of discussion posed to the CB included engagement and recovery strategies, integration of extended family traditions, and addressing stigma and building trust with providers and clients. Integration of traditional healing practices, ceremonies, and other cultural practices was recommended. The importance of centering AI/AN culture and involving family were highlighted as priorities for the intervention.     

内侧前额皮层-伏隔核环路在决策冲动中的作用：基于动物模型的研究

注意缺陷多动障碍(attentiondeficit/hyperactivitydisorder,ADHD)行为控制不足与决策冲动密切相关,后者受内侧前额皮层(medial prefrontal cortex, mPFC)与伏隔核(nucleus accumbens, NAc)调节。为调查ADHD决策冲动与m PFC-NAc间功能耦合的关系,研究采用ADHD模型SHR (spontaneously hypertensive rat, SHR)大鼠,结合延迟折扣任务和在体电生理,研究发现,与对照Wistar (WIS)大鼠相比, SHR大鼠对延迟大奖赏的选择百分比降低; WIS大鼠m PFC-NAc的Theta频段相干值表现为延迟选择时显著大于立即选择时、首次选择时大于连续选择时、转换试次时大于连续试次时,而SHR大鼠在上述条件均低于WIS大鼠。回归分析发现m PFC-NAc的相干差值与延迟大奖赏选择率显著正相关。结果表明m PFC-NAc间功能联系减弱是ADHD决策冲动缺陷的重要环路基础,该缺陷与其深度信息加工以及策略转换能力受损有关,扩展了ADHD决策冲动的认知和神经机制的认识。     

Year of Zoom in a Year of Doom: Lessons Learned Delivering ERP Remotely During the COVID-19 Pandemic

In response to the COVID-19 pandemic and consequential shutdown measures, many mental health professionals started providing therapy to patients exclusively via telehealth. Our research center, which specializes in studying and treating obsessive-compulsive disorder (OCD), historically has provided in-person exposure and response prevention (ERP) to adults with OCD, but shifted to telehealth during the pandemic. Unlike in other modes of talk therapy, ERP’s emphasis on therapist-supervised exposures presented unique opportunities and challenges to delivering treatment entirely via a virtual platform. This paper provides case examples to illustrate lessons we learned delivering ERP exclusively via telehealth in New York from March 2020 through June 2021 and offers recommendations for future study and practice. Though we observed a number of drawbacks to fully remote ERP, we also discovered advantages to delivering ERP this way, meriting additional research attention.     

Comparison of two video prompting interventions to teach daily living skills to adolescents with autism

The present study used an adapted alternating treatment design to evaluate and compare the effects of video prompting (VP) and video prompting plus frequency building (VP + FB) to teach daily living skills to three adolescents with autism spectrum disorder. Results demonstrated all three students made substantial improvements over their baseline performance using VP and VP + FB. Furthermore, a strong intervention effect emerged for VP and VP + FB conditions when compared to the control task. However, in terms of one intervention proving superior to the other (e.g., VP to VP + FB), the data offer a mixed interpretation with VP + FB affecting changes better for two of the three students. The FB component in the VP + FB produced strong, consistent gains for all students in terms of retention.     

Telehealth parent training for a young child at risk for autism spectrum disorder

The global pandemic has highlighted the importance of telehealth to access behavioral interventions. Face-to-face parent training improves the development and behaviors of young children at risk for autism spectrum disorder (ASD). We evaluated a telehealth parent training intervention for a child at risk for ASD. Two parents identified possible early ASD symptoms in their 30-month-old son (lack of imitation, pointing, and vocal manding). Both parents simultaneously received telehealth behavioral skills training on the Parent Intervention for Children at Risk for Autism program for 1 hour per week over 29 weeks. Multiple baseline designs across parent and child behaviors showed that both parents improved their parent teaching fidelity above 80% and the child improved on all trained behaviors. This study expands the utility of telehealth behavioral parent training to young children at risk for ASD to mitigate early symptoms of ASD.     

“It's wrong to relax,you have to be on the go,go, go,all the time”: Emotional transformation in a case of emotion-focused therapy for generalised anxiety disorder

Generalised anxiety disorder (GAD) is a highly prevalent, chronic and impairing disorder. The aim of this study was to qualitatively describe the transformation in emotional processing across 16 sessions of a successful emotion-focused therapy (EFT) treatment for GAD. A theoretical framework derived from the EFT model of in-session emotional transformation proposed by Pascual-Leone and Greenberg was used as the basis for qualitative analysis. Additionally, the Classification of Affective Meaning States, the Client-Expressed Arousal Scale-III and the Client Emotional Productivity Scale-Revised were utilised by observer–raters to classify moment-by-moment shifts in client affective-meaning states, emotional arousal and emotional productivity. Results supported the emotion transformation model. The client presented in a state of poorly differentiated but highly aroused distress provoked by identifiable interpersonal and intrapersonal triggers. Emotional and behavioural avoidance provoked by fear of pain was evident. Accessing core pain and responding to attendant needs with compassion and protective anger was shown to facilitate the higher order emotional processing states of grief, relief and agency. Implications are proposed, including that addressing core emotional vulnerability may be a critical intervention in the successful treatment of GAD.     

自闭症谱系障碍社交动机理论：机制及干预探索

自闭症谱系障碍(Autism Spectrum Disorder, ASD)表现为社会交往困难以及重复刻板兴趣或行为。社交动机理论提出ASD个体是由于社交动机缺乏导致的社交障碍。目前该理论缺乏理论元素及结构关系的系统论证, 及基于此理论的低龄ASD儿童群体的研究证据。本研究拟采用心理实验法、眼动及近红外脑成像技术, 探索低龄ASD儿童早期社交奖赏、社交定向异常眼动标记及眶额叶脑区活动的神经机制。此外, 通过音乐奖赏强化学习的干预方式改善该理论的核心元素(社交奖赏), 观测能否改善ASD儿童的社交动机。本研究的开展有望对该理论进行系统验证, 并形成改善社交行为的潜在干预方案。