Adolescent maturity and the brain: the promise and pitfalls of neuroscience research in adolescent health policy

Interplay between hormones and exercise on hippocampal plasticity across the lifespan

The hippocampus is a brain structure known to play a central role in cognitive function (namely learning and memory) as well as mood regulation and affective behaviors due in part to its ability to undergo structural and functional changes in response to intrinsic and extrinsic stimuli. While structural changes are achieved through modulation of hippocampal neurogenesis as well as alterations in dendritic morphology and spine remodeling, functional (i.e., synaptic) changes can be noted through the strengthening (i.e., long-term potentiation) or weakening (i.e., long-term depression) of the synapses. While age, hormone homeostasis, and levels of physical activity are some of the factors known to module these forms of hippocampal plasticity, the exact mechanisms through which these factors interact with each other at a given moment in time are not completely understood. It is well known that hormonal levels vary throughout the lifespan of an individual and it is also known that physical exercise can impact hormonal homeostasis. Thus, it is reasonable to speculate that hormone modulation might be one of the various mechanisms through which physical exercise differently impacts hippocampal plasticity throughout distinct periods of an individual's life. The present review summarizes the potential relationship between physical exercise and different types of hormones (namely sex, metabolic, and stress hormones) and how this relationship may mediate the effects of physical activity during three distinct life periods, adolescence, adulthood, and senescence. Overall, the vast majority of studies support a beneficial role of exercise in maintaining hippocampal hormonal levels and consequently, hippocampal plasticity, cognition, and mood regulation.

Cannabis and Illicit Drug Use During Neurodevelopment and the Associated Structural, Functional and Cognitive Outcomes: Protocol for a Systematic Review

Background

High rates of cannabis and illicit drug use are experienced by young people during the final stages of neurodevelopment (aged 15-24 years), a period characterized by high neuroplasticity. Frequent drug use during this time may interfere with neurophysiological and neuropsychological development pathways, potentially leading to ongoing unfavorable neuroadaptations. The dose-response relationship between illicit drug use, exposure, and individual neurodevelopmental variation is unknown but salient with global shifts in the legal landscape and increasingly liberal attitudes and perceptions of the harm caused by cannabis and illicit drugs.

Objective

This systematic review aims to synthesize longitudinal studies that investigate the effects of illicit drug use on structural, functional, and cognitive brain domains in individuals under the neural age of adulthood (25 years). This protocol outlines prospective methods that will facilitate an exhaustive review of the literature exploring pre- and post-drug use brain abnormalities arising during neurodevelopment.

Methods

Five electronic databases (Medline, Embase, PsycINFO, ProQuest Central, and Web of Science) will be systematically searched between 1990 and 2019. The search terms will be a combination of MeSH (Medical Subject Headings), with keywords adapted to each database. Study reporting will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and if relevant, study quality will be assessed using the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) approach. Eligible studies are those that sampled youth exposed to cannabis or illicit drugs and employed neurophysiological or neuropsychological assessment techniques. Studies will be excluded if participants had been clinically diagnosed with any psychiatric, neurological, or pharmacological condition.

Results

This is an ongoing review. As of February 2020, papers are in full-text screening, with results predicted to be complete by July 2020.

Conclusions

Integrating data collected on the three brain domains will enable an assessment of the links between structural, functional, and cognitive brain health across individuals and may support the early detection and prevention of neurodevelopmental harm.

Trial Registration

PROSPERO CRD42020151442; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=151442

International Registered Report Identifier (IRRID)

PRR1-10.2196/18349

Cyberbullying and Adolescent Neurobiology

Whilst it is well documented that cyberbullying is linked to poor mental health outcomes, limited research has examined how cyberbullying may influence brain development adolescents, and the influence of each of these factors. The article’s primary objective was to develop an understanding of research to date that addresses any relationship between adolescent brain development and cyberbullying. The current article reviews any existing literature regarding the impact of cyberbullying on adolescent brain development, paying particular attention to research using magnetic resonance imaging (MRI) techniques. Whilst brain studies have examined neural mechanisms associated with conduct disorders, antisocial behavior, and aggression in young people; there is a paucity of research examining these factors specifically in relation to cyberbullying. In particular, little research has examined how MRI research could help understand how the brain is affected by cyberbullying, not only in bullies and victims but also bystanders. This article highlights the gaps in the cyberbullying field in relation to neuroscience research, and the need for further, longitudinal research examining cyberbullying and how it may affect brain development in young people. This article concludes by suggesting a framework for future research, and highlights the importance of future findings for developing interventions and understanding short and long term effects.

Viscoelasticity of reward and control systems in adolescent risk taking

Heightened risk-taking tendencies during adolescence have been hypothesized to be attributable to physiological differences of maturation in key brain regions. The socioemotional system (e.g., nucleus accumbens), which is instrumental in reward response, shows a relatively earlier development trajectory than the cognitive control system (e.g., medial prefrontal cortex), which regulates impulse response. This developmental imbalance between heightened reward seeking and immature cognitive control potentially makes adolescents more susceptible to engaging in risky activities. Here, we assess brain structure in the socioemotional and cognitive control systems through viscoelastic stiffness measured with magnetic resonance elastography (MRE) and volumetry, as well as risk-taking tendencies measured using two experimental tasks in 40 adolescents (mean age ​= ​13.4 years old). MRE measures of regional brain stiffness reflect brain health and development via myelin content and glial matrix makeup, and have been shown to be highly sensitive to cognitive processes as compared to measures of regional brain volume and diffusion weighted imaging metrics. We find here that the viscoelastic and volumetric differences between the nucleus accumbens and the prefrontal cortex are correlated with increased risk-taking behavior in adolescents. These differences in development between the two brain systems can be used as an indicator of those adolescents who are more prone to real world risky activities and a useful measure for characterizing response to intervention.

The Development of Adolescent Chronic Pain following Traumatic Brain Injury and Surgery: The Role of Diet and Early Life Stress

Pain is evolutionarily necessary for survival in that it reduces tissue damage by signaling the body to respond to a harmful stimulus. However, in many circumstances, acute pain becomes chronic, and this is often dysfunctional. Adolescent chronic pain is a growing epidemic with an unknown etiology and limited effective treatment options. Given that the relationship between acute pain and chronic pain is not straightforward, there is a need to better understand the factors that contribute to the chronification of pain. Since early life factors are critical to a variety of outcomes in the developmental and adolescent periods, they pose promise as potential mechanisms that may underlie the transition from acute to chronic pain. This review examines two early life factors: poor diet and adverse childhood experiences (ACEs); they may increase susceptibility to the development of chronic pain following surgical procedures or traumatic brain injury (TBI). Beyond their high prevalence, surgical procedures and TBI are ideal models to prospectively understand mechanisms underlying the transition from acute to chronic pain. Common themes that emerged from the examination of poor diet and ACEs as mechanisms underlying this transition included: prolonged inflammation and microglia activation leading to sensitization of the pain system, and stress-induced alterations to hypothalamic-pituitary-adrenal axis function, where cortisol is likely playing a role in the development of chronic pain. These areas provide promising targets for interventions, the development of diagnostic biomarkers, and suggest that biological treatment strategies should focus on regulating the neuroinflammatory and stress responses in an effort to modulate and prevent the development of chronic pain.

Weak correlations between cerebellar tests

Eyeblink conditioning, finger tapping, and prism adaptation are three tasks that have been linked to the cerebellum. Previous research suggests that these tasks recruit distinct but partially overlapping parts of the cerebellum, as well as different extra-cerebellar networks. However, the relationships between the performances on these tasks remain unclear. Here we tested eyeblink conditioning, finger tapping, and prism adaptation in 42 children and 44 adults and estimated the degree of correlation between the performance measures. The results show that performance on all three tasks improves with age in typically developing school-aged children. However, the correlations between the performance measures of the different tasks were consistently weak and without any consistent directions. This reinforces the view that eyeblink conditioning, finger tapping, and prism adaptation rely on distinct mechanisms. Consequently, performance on these tasks cannot be used separately to assess a common cerebellar function or to make general conclusions about cerebellar dysfunction. However, together, these three behavioral tasks have the potential to contribute to a nuanced picture of human cerebellar functions during development.

Parents Demand and Teenager Refuses Epidural Anesthesia

A 15-year-old girl is scheduled to undergo an upper lobectomy to debulk metastatic Ewing sarcoma. The anesthesiologist recommended placement of a thoracic epidural catheter to provide postoperative analgesia. The patient did not want a needle to be placed near her spine. She was terrified that the procedure would be painful and that it might paralyze her. Although the anesthesiologist reassured her that sedation and local anesthesia would make the procedure comfortable, she remained vehemently opposed to the epidural procedure. The parents spoke privately to the anesthesiologist and asked for placement of the epidural after she was asleep. They firmly believed that this would provide optimal postoperative analgesia and thus would be in her best interest. Experts discuss the pros and cons of siding with the patient or parents.

Meeting the Developmental Needs of Young Adults Diagnosed with Serious Mental Health Challenges: the Emerge Model

Adult providers struggle to engage 18-25-year olds despite high rates of serious mental health challenges observed among this age group. A new model, called "Emerge," combines the intensive outreach and multidisciplinary team-based approach used in Assertive Community Treatment with Positive Youth Development principles and practices used in the Transition to Independence Process Model. Emerge bridges youth and adult services, focuses on supporting transition-to-adulthood milestone achievement, and is a sister team to Coordinated Specialty Care for recent psychosis onset. This paper describes Emerge components, practices, and findings from a feasibility pilot study using agency administrative data. Most prevalent goals were employment and social support/relationship related. The majority made progress on individual goals, engaged in employment and education, and experienced decreased psychiatric hospitalizations. Community mental health policy and practice implications are discussed, including funding blending of evidence-based practices for those transitioning to adulthood with youth-onset serious mental health conditions.

User Preferences for the Design of a Mobile Health System to Support Transition-Age Youth With Epilepsy

BACKGROUND

Transition-age youth with epilepsy (TAYWE) experience poor self management and adverse health outcomes. The purpose of this study was to gain the perspectives of TAYWE, their caregivers, and clinicians to inform the design of a mobile health (mHealth) system to support the self-management needs of TAYWE.

METHODS

Individual semi-structured interviews and focus groups were conducted with TAYWE, their caregivers, and clinicians who manage their care.

RESULTS

Sixteen TAYWE and seven caregivers participated in focus group sessions, and four clinicians were interviewed. Participants expressed the need for an mHealth system that addressed privacy, supervision of caregiver involvement, a user-friendly system design, and motivation to sustain ongoing use. Three themes evolved: current mobile app use, mHealth systems features and functions, and implementation concerns.

DISCUSSION

Data from this study informs the design of an mHealth system to support self-management in TAYWE and identifies important areas for practitioners to address when providing health care to TAYWE.

Married very young adolescent girls in Niger at greatest risk of lifetime male partner reproductive coercion and sexual violence

OBJECTIVE

The purpose of this analysis was to compare and contrast reproductive health (RH), gender equity attitudes, and intimate partner violence (IPV) among married very young adolescent (VYA) girls with married older adolescent girls and young women (AGYW) in rural Niger given limited literature on the topic.

METHODS

We conducted an exploratory analysis of baseline data from the Reaching Married Adolescents Trial in Dosso region, Niger. We report counts and percents, by age group (13-14 years (VYA), 15-16 years, 17-19 years), of AGYW's self-efficacy to use family planning (FP), accurate knowledge of FP, current use of modern FP, and unintended last pregnancy (UIP); lifetime reproductive coercion (RC), physical IPV, and sexual IPV; and gender equity attitudes. We also assess whether percents differ between VYA and older groups using Pearson's Chi-Square and Fisher's exact p-values. Results are stratified by parity. Finally, we use logistic regression to consider associations.

RESULTS

There were 49 VYA, 248 girls aged 15-16, and 775 AGYW aged 17-19 in our sample (n = 1072). Accurate knowledge of FP, self-efficacy to use FP, current use of modern FP, and UIP increased with age; all percents between VYA and AGYW 17-19 were marginally or statistically significantly different. We also saw VYA report higher lifetime RC and sexual IPV versus older groups, with sexual IPV statistically different between VYA and girls 17-19. Parous VYA reported a significantly higher percent of lifetime RC versus older AGYW. Among 17-19 year-olds, odds of current use of FP were higher among AGYW who reported physical IPV, and odds of UIP were higher among those reporting more gender equitable attitudes, both adjusted for parity.

CONCLUSIONS

We observed differences in RH, RC, and sexual IPV among married VYA and older AGYW in rural Niger. VYA should be prioritized in research to confirm and further understand their RH needs.

Striving for perfection, accepting the reality: A reflection on adherence to airway clearance and inhalation therapy for paediatric patients with chronic suppurative lung disease

Non-adherence to prescribed treatment is considered the foremost cause of treatment failure in chronic medical conditions. Airway clearance techniques (ACT) play a key role in the management of chronic suppurative lung disease yet, along with inhaled therapies such as nebulised antibiotics, adherence to these is often lower than to other treatments. In this review we discuss methods of monitoring adherence to these therapies and potential barriers and outline suggestions for improving adherence in the paediatric population.

No boundaries: a 2 year experience in a specialized youth mental health care program in the Netherlands

AIM

Young people around the age of 18 receiving mental health care usually face the transition from child and adolescent (CAMHS) to adult mental health services (AMHS) bringing the risk of disruption in continuity of care. Recognizing the importance of early intervention in this vulnerable life-period, this study aims to emphasize the importance of a client-centred approach and continuity of care for this age group. For a deeper understanding of the specific needs of this group, the working method of a Dutch youth mental health (YMH) team working in a secondary mental health care setting is described, including some clinical characteristics and treatment results of patients who accessed this service.

METHODS

Data consist of a detailed description of the working method of the YMH team combined with clinical characteristics of all patients aged 15-25 years accessing the services of the YMH team over a two-year period.

RESULTS

The YMH team incorporated suggestions of earlier research into a client centred treatment. Key elements were multidisciplinary meetings, transcending diagnosis, flexibility and collaboration with other care providers. Clinical records showed a complex patient population and significant treatment effect.

CONCLUSIONS

The group of emerging adults accessing the YMH team can be described as a patient group with a high diversity and complexity of disorders and problems. Continuity of care was met when patients turned 18, allowing treatments to be successfully performed by the same team of professionals using a client-centred approach.

Readiness for Medical School: a Radical Proposal

Readiness for medical school, like readiness for reading, includes physiological, psychological, educational, and sociological aspects of growth. Full cognitive and neurodevelopment including higher levels of adult thought order occur generally towards the ends of the third decade. Earlier patient care experiences and an understanding of the social and structural determinants of health demand some experiences in the world. We believe a requirement to prove medical school readiness should be to hold a job for a year that interfaces with the public and proves responsibility, reliability, and accountability as documented by a supervisor.

[Assessment of the maturity of juvenile and young adult offenders according to §105 of German juvenile law: a developmental psychology perspective]

Assessment of the maturity of juvenile and young adult offenders according to §105 of German juvenile law: a developmental psychology perspective Abstract. Since 1953, according to § 105 of the German JGG (Jugendgerichtsgesetz/Juvenile Court Act), it has been possible to convict offenders aged 18.0 y-20y 11 mo either as juveniles or as adults, depending on their developmental status. Yet unambiguous criteria defining the individual stages of development are available neither to judges nor to experts. Thus, for this age group this may lead judges to make arbitrary decisions impairing the right of equal treatment before the law in Germany. In the absence of clear criteria for assessing maturity, experts nearly always recommend judging such offenders as juveniles. Recent findings from the neurosciences and developmental psychology show that not only juveniles but adolescents and young adults up to the age of 25y usually have significant potential for development. After an overview of the legal practices pertaining to juveniles in Germany and throughout Europe, we propose alternatives for the individual assessment of maturity.

Using the Gibbs Function as a Measure of Human Brain Development Trends from Fetal Stage to Advanced Age

We propose to use a Gibbs free energy function as a measure of the human brain development. We adopt this approach to the development of the human brain over the human lifespan: from a prenatal stage to advanced age. We used proteomic expression data with the Gibbs free energy to quantify human brain’s protein–protein interaction networks. The data, obtained from BioGRID, comprised tissue samples from the 16 main brain areas, at different ages, of 57 post-mortem human brains. We found a consistent functional dependence of the Gibbs free energies on age for most of the areas and both sexes. A significant upward trend in the Gibbs function was found during the fetal stages, which is followed by a sharp drop at birth with a subsequent period of relative stability and a final upward trend toward advanced age. We interpret these data in terms of structure formation followed by its stabilization and eventual deterioration. Furthermore, gender data analysis has uncovered the existence of functional differences, showing male Gibbs function values lower than female at prenatal and neonatal ages, which become higher at ages 8 to 40 and finally converging at late adulthood with the corresponding female Gibbs functions.

Revisiting the Empirical Status of Social Learning Theory on Substance Use: A Systematic Review and Meta-Analysis

Background: Despite ample empirical research testing components of Akers' Social Learning Theory (SLT) on substance use, no research to date has attempted to synthesize the empirical evidence. Objectives: The purpose of this article is to synthesize prior research that has examined the utility of SLT for predicting specific types of substance use, both legal and illegal. Methods: Using a systematic review and meta-analysis, the current study estimated the effect size results from 83 primary studies published between 1974 and 2018 that had empirically tested concepts of Akers' SLT regarding substance use. In addition, moderator analyses examined variations in effect sizes across measurement constructs and among specific types of substance use. Results: Results indicated medium-sized weighted mean effect size estimates for SLT in relation to substance use. Regarding conceptualization of SLT, measures of Differential Association produced the strongest effect size estimates. Moderator analyses also revealed that mean effect size estimates were largest for soft drugs, for studies conducted in the context of the United States, and for adult samples. Conclusions: The authors conclude that SLT constructs may be better suited for explaining soft drug use than hard drug use. Given the relatively sparse primary research that has controlled for temporal ordering, collected data from multiple differential associates, or considered opportunity effects, caution in the interpretation of synthesis results is warranted.

The minimum age of criminal responsibility, international variation, and the Dual Systems Model in neurodevelopment

Considering the numbers of children and adolescents in conflict with the law, there is a concern about the ways in which they are being dealt with in the criminal justice system. This paper examines issues relating to the minimum age of criminal responsibility, the differences across countries, and the broad principles and international guidelines in this regard. Additionally, the rebuttable presumption of doli incapax, which is included in many legal systems, is discussed. This is done specifically with concerns regarding the psychological evaluation of criminal capacity, considering the lack of valid and reliable measures, as well as the vagueness of the concept of criminal capacity. An examination of the neurodevelopment evidence in relation to children's criminal behaviour, risk taking, and impulse control are discussed. The latest research evidence raises doubt about the extent to which adolescents can be held criminally responsible. The responsibility of expert witnesses to enlighten courts on this matter is crucial to avoid unnecessarily criminalising children and adolescents who may not have the requisite capacity to be held criminally liable.

Recruitment strategies and challenges: Lessons learned from a coal ash and children's health study

The purpose of this paper is to describe the approaches and recruitment strategies of a study focused on the impact of coal fly ash on neurobehavioral performance among children living in proximity to coal-burning power plants. Challenges encountered with each recruitment approach are highlighted as well as solutions used to overcome those challenges and ultimately enroll children and one of their parents or guardians. To ensure participants were distributed throughout the study area, geographical information systems were used to guide recruitment and achieve the target sample size (N = 300). Several approaches were employed to recruit the number of needed participants, including "shoe leather" or door-to-door recruitment, placement of flyers and brochures in public spaces, mailings to targeted addresses, media announcements, and local government outreach. Since September 2015, 265 participants have been enrolled in the study using a combination of the described recruitment approaches. Even with a well-designed plan, it is important to re-examine strategies at every step to maximize recruitment efforts. Researcher flexibility in adapting to new strategies is vital in facilitating recruitment efforts, and the recruitment of participants in the study remains a dynamic and evolving process.

Caffeine consumption during development alters spine density and recovery from repetitive mild traumatic brain injury in young adult rats

Caffeine is the most commonly used psychostimulant throughout the world, with its consumption being especially prevalent among adolescents and young adults, as over 75% of this group consumes caffeine daily. Similarly, the adolescent and young adult age group exhibit the highest incidence of traumatic brain injury (TBI). Given that both caffeine consumption and mild TBI (mTBI) are more prevalent among the late adolescent/young adult age group and that changes in dendritic spine morphology during this developmental period are poorly understood, this study sought to examine the effects of caffeine consumption during late adolescence/early adulthood on recovery from repetitive mTBI (RmTBI). The study specifically focused on changes to neuronal dendritic morphology as synaptic changes likely underlie long-term behavioral outcomes. The results demonstrate that during young adulthood caffeine consumption differentially affects the RmTBI outcomes of males and females, where the effects of caffeine and RmTBI were often additive in males while being equally detrimental, but rarely additive, in females. In general, caffeine and RmTBI induced the greatest impairments in males on cognitive and motor tasks whereas in females the most significant detriments were on pain-related tasks. Both caffeine and RmTBI increased spine density in the Cg3 (medial prefrontal cortex [mPFC]), AID (orbitofrontal cortex [OFC]), and nucleus accumbens (NAc), which is proposed to reflect an impairment in the normal pruning processes. Overall, despite caffeine's neuroprotective abilities among other age groups, this study offers concerning results regarding the detrimental effects of caffeine and RmTBI, in isolation, and especially in combination, in this susceptible population.

Research in adolescent healthcare: The value of qualitative methods

BACKGROUND

The vast majority of publications about adolescent healthcare use a quantitative methodology that often involves long and expensive research protocols with results that do not always provide answers adequate to the complexity of the questions being asked. The qualitative method is sometimes a more effective alternative for exploring some of these. This method can be defined from its objective, which is to generate theoretical hypotheses, its mandatory consideration of the researcher's subjectivity, and the importance it ascribes to the context of the participants' experience. Among the many techniques of qualitative research, the use of phenomenological methods, in particular, interpretative phenomenological analysis (IPA), is highly developed in medical research.

OBJECTIVES

To define the qualitative method and describe the principal stages of a phenomenological qualitative study.

RESULTS

The three stages of a qualitative study are data collection (population and sampling, data collection methods), data analysis, and writing up the results. Purposive sampling makes it possible to include participants who can describe in detail, and as experts, their experience during semi-structured interviews. The analysis takes place in two stages, the first very descriptive, the second more interpretative. The results are written-up in a narrative form, including both direct quotations from the interviews and the researchers' interpretation.

DISCUSSION

The issues of health promotion and healthcare associated with the management of chronic symptoms or diseases in adolescents involve an extremely rich and complex context. Qualitative methods make it possible to approach these questions and to understand them better by generating hypotheses from a rigorous scientific procedure appropriate to the context and objectives. In addition to being used on their own, they can be used on an exploratory basis early in a quantitative study to help define it better, for explanatory purposes, to help understand complex quantitative results, or combined with a quantitative study. The qualitative and quantitative results will then be integrated.

Evaluating a Web-Based Health-Promoting Dialogue Tool in School Health Services: Feasibility and User Experiences

Adolescence is a sensitive period in life and a time to redefine and learn new skills. In Norway, school health services provide individual health-promoting consultations with all eighth-grade students. As an aid to support these consultations, a dialogue tool called SchoolHealth was developed using a co-creation approach. SchoolHealth consists of a web-based health information form designed to be completed by the students and generates individual feedback reports to help the school nurses to prepare for the consultation and tailor it to the individual student's need. Our aims were to evaluate the feasibility and user experiences of SchoolHealth among students and school nurses using a mixed methods approach. A total of 79 eighth-grade students (69% of those invited) and four school nurses from three schools participated. Analyses indicated that SchoolHealth was feasible, promoted reflection among students, and helped prepare students and school nurses for the consultation.

The development of inhibitory control in adolescence and prospective relations with delinquency

INTRODUCTION

Despite the central role of inhibitory control in models of adolescent development, few studies have examined the longitudinal development of inhibitory control within adolescence and its prospective association with maladaptive outcomes. The current study evaluated: 1) growth in inhibitory control from early- to middle-adolescence, and 2) the relation between inhibitory control and later delinquency.

METHODS

Participants included 387 parent-child dyads (11-13 years old at Wave 1; 55% female; USA). Across three annual assessments, teens completed the Stop Signal Task (SST), and parents completed the Inhibitory Control subscale of the Early Adolescent Temperament Questionnaire-Revised. Teens self-reported their delinquent behaviors in early (Mage = 12.1) and middle adolescence (Mage = 14.1) and emerging adulthood (Mage = 18.2).

RESULTS

Latent growth curve models indicated that SST performance improved curvilinearly from early to middle adolescence (ages 11-15), with growth slowing around middle adolescence. However, no growth in parent-reported inhibitory control was observed. Lower task-based and parent-reported inhibitory control in early adolescence predicted greater increases in delinquency from middle adolescence to emerging adulthood. However, rate of growth in task-based inhibitory control was unrelated to later delinquency.

CONCLUSIONS

This longitudinal study provides a novel examination of the development of inhibitory control across early and middle adolescence. Results suggest that the degree to which inhibitory control confers risk for later delinquency may be captured in early adolescence, consistent with neurodevelopmental accounts of delinquency risk. Differences across assessment tools also highlight the need for careful measurement considerations in future work, as task-based measures may be better suited to capture within-person changes over time.

Curlin M, Holtz TH, Mannheimer S, Marzinke MA, Amico KR, Liu A, Piwowar-Manning E, Eshleman SH, Dye BJ, Gandhi M, Grant RM. Short- and Long-Term Pharmacologic Measures of HIV Pre-exposure Prophylaxis Use Among High-Risk Men Who Have Sex With Men in HPTN 067/ADAPT

BACKGROUND

The effectiveness of oral emtricitabine (FTC)/tenofovir (TFV) disoproxil fumarate-based HIV pre-exposure prophylaxis (PrEP) depends on adherence. Pharmacologic measures help interpret patterns and predictors of PrEP adherence.

SETTING

We analyzed data from the subsample of men who have sex with men enrolled in HPTN 067/ADAPT in Bangkok, Thailand, and Harlem, NY, U.S.

METHODS

After a 5-week directly observed therapy period, participants were randomized to daily, time-driven, or event-driven PrEP. Follow-up occurred at weeks 4, 12, and 24 after randomization. Plasma and hair FTC/TFV levels indicated short- and long-term PrEP use, respectively. Electronic pill bottle data (Wisepill) were collected weekly. Pearson correlation coefficients between PrEP use measures were calculated; linear mixed models assessed predictors of plasma and hair drug concentrations.

RESULTS

Among 350 participants (median age: 31 years, interquartile range: 25-38), 49.7% were from Harlem, half had less than college education, and 21% reported heavy alcohol use. In multivariable models, being enrolled in Harlem, being in non-daily arms, and having less than college education were associated with lower hair FTC/TFV concentrations; heavy alcohol use was associated with higher concentrations. Similar results were found for plasma concentrations by site and arm, but older age and greater number of sex partners were associated with higher concentrations. Hair and plasma FTC/TFV concentrations were moderately correlated with Wisepill data (r ≥ 0.29) across visits.

CONCLUSIONS

In HPTN067, plasma, hair, and Wisepill data correlated with one another and served as complementary adherence measures. Site, arm, education, age, alcohol, and sexual behavior influenced patterns of adherence.

In the Long Run: Physical Activity in Early Life and Cognitive Aging

A certain degree of age-related cognitive decline is normal; however, some people retain more cognitive function than others. Cognitive impairment is associated with an increased risk of dementia. Thus, understanding the factors that contribute to cognitive reserve is crucial, so effective strategies for the prevention of dementia can be developed. Engaging in physical activity can delay cognitive decline and reduce the risk of dementia and a number of early life conditions have been shown to have long-lasting effects on cognition. This mini-review combines these two observations to evaluate the evidence from both animal models and epidemiological studies for physical activity in early life (≤30 years) delaying cognitive decline in later life (cognition tested ≥60 years). Three epidemiological studies were found; two showed a positive association and one found none. The latter was deemed to have an unreliable method. A review of animal studies found none that analyzed the effect of physical activity in early life on cognition in later life. However, in rodent models that analyzed mid-life cognition, runners showed improved cognition and enhanced adult hippocampal neurogenesis, changes which were preserved across the life span. Currently, there is insufficient evidence to conclude whether physical activity in early life may delay cognitive decline in later life, but these results indicate that further studies are warranted. Future human research should be in the form of longitudinal studies that begin below ≤15 years and assess sex differences. Crucially, the physical activity data must define type, quantity and intensity of exercise.

Conhecimento de adolescentes acerca dos benefícios do exercício físico para a saúde mental

Resumo A adolescência é uma fase de várias transformações estruturais e funcionais. O exercício físico é capaz de promover plasticidade adaptativa sobre o sistema nervoso, reduzindo os riscos de futuras patologias psiquiátricas. Essa pesquisa teve como objetivo investigar o conhecimento dos adolescentes acerca dos benefícios do exercício físico sobre a saúde mental. Trata-se de um estudo transversal, realizado em uma escola estadual de um município do Centro-Oeste de Minas Gerais. Para coleta de dados, além de um questionário próprio desenvolvido para medir o conhecimento acerca dos benefícios do Exercício Físico sobre a Saúde Mental, foram utilizados o International Physical Activity Questionnaire, e o questionário socioeconômico da Associação Brasileira de Empresas de Pesquisa. Os dados foram analisados por meio de ferramentas de estatística descritiva e pelos testes de Kruskal-Wallis e de qui-quadrado, a um nível de significância de 5%. Verificou-se que indivíduos mais ativos possuíam maior conhecimento acerca dos benefícios do exercício físico para a saúde mental em relação aos indivíduos sedentários. Assim, o conhecimento pode ser um fator protetor contra o sedentarismo e a inatividade física, melhorando significativamente o aspecto relacionado à qualidade de vida do adolescente.

Mind the gap: A review and recommendations for statistically evaluating Dual Systems models of adolescent risk behavior

According to Dual Systems models (Casey et al., 2008; Luna and Wright, 2016; Steinberg, 2008), a rapidly-developing socioemotional system and gradually-developing cognitive control system characterize adolescent brain development. The imbalance hypothesis forwarded by Dual Systems models posits that the magnitude of the imbalance between these two developing systems should predict the propensity for engaging in a variety of risk behaviors. The current integrative review argues that the excitement generated by the imbalance hypothesis and its implications for explaining adolescent risk behaviors has not been meet with equal efforts to rigorously test this hypothesis. The goal of the current review is to help guide the field to consider appropriate and rigorous methods of testing the imbalance hypothesis. First, we review the analytic approaches that have been used to test the imbalance hypothesis and outline statistical and conceptual limitations of these approaches. Next, we discuss the utility of two longitudinal analytic approaches (Latent Difference Scores and Growth Mixture Modeling) for testing the imbalance hypothesis. We utilize data from a large community adolescent sample to illustrate each approach and argue that Latent Difference Scores and Growth Mixture Modeling approaches enhance the specificity and precision with which the imbalance hypothesis is evaluated.

Diffusion tensor imaging changes following mild, moderate and severe adult traumatic brain injury: a meta-analysis

Diffusion tensor imaging quantifies the asymmetry (fractional anisotropy; FA) and amount of water diffusion (mean diffusivity/apparent diffusion coefficient; MD/ADC) and has been used to assess white matter damage following traumatic brain injury (TBI). In healthy brains, diffusion is constrained by the organization of axons, resulting in high FA and low MD/ADC. Following a TBI, diffusion may be altered; however the exact nature of these changes has yet to be determined. A meta-analysis was therefore conducted to determine the location and extent of changes in DTI following adult TBI. The data from 44 studies that compared the FA and/or MD/ADC data from TBI and Control participants in different regions of interest (ROIs) were analyzed. The impact of injury severity, post-injury interval (acute: ≤ 1 week, subacute: 1 week-3 months, chronic: > 3 months), scanner details and acquisition parameters were investigated in subgroup analyses, with the findings indicating that mild TBI should be examined separately to that of moderate to severe injuries. Lower FA values were found in 88% of brain regions following mild TBI and 92% following moderate-severe TBI, compared to Controls. MD/ADC was higher in 95% and 100% of brain regions following mild and moderate-severe TBI, respectively. Moderate to severe TBI resulted in larger changes in FA and MD/ADC than mild TBI. Overall, changes to FA and MD/ADC were widespread, reflecting more symmetric and a higher amount of diffusion, indicative of white matter damage.

Trends and drug-related correlates in residential mobility among young adults in the United States, 2003-2016

INTRODUCTION

Young adulthood, typically conceptualized as stretching from the late teens to the mid-twenties, is a period of elevated risk for residential mobility (i.e., moving or changing residences frequently) and drug involvement. However, our understanding of the trends and drug-related correlates of residential mobility among young adults remains limited.

METHODS

We analyzed national trend data from the National Survey on Drug Use and Health (2003-2016) on residential mobility and drug involvement among young adults (N = 230,790) in the United States. For tests of trend, we conducted logistic regression analyses with survey year specified as a continuous independent variable and residential mobility as the dependent variable (no/yes), controlling for sociodemographic factors.

RESULTS

The prevalence of residential mobility was stable among females, but decreased significantly-a 20% reduction in the relative proportion of respondents-among males during the study period (AOR = 0.98, 95% CI = 0.97-0.99). Male and female young adults reporting residential mobility were significantly more likely to report involvement in all drug-related outcomes examined, but effects were larger among females for drug selling and drug-related arrests.

DISCUSSION

Study findings show that a substantial minority of young adults experience residential mobility and that, while rates are declining among young men, the experience of mobility is connected with risk for drug involvement, particularly among females. Mobility may be an important target for drug prevention/intervention efforts, but further research is needed to provide insight into how mobility and drug involvement are connected in the lives of young adults.

It is time for an ethical, evidence-based approach to youth presenting to the ED with an opioid overdose

Currently, there is a dangerous inconsistency between our current understanding of adolescent development and the effects of drugs on cognition when compared to our collective approach to youth who present in the emergency department with an opioid overdose. We call upon practitioners to embrace a new paradigm and we ask the Canadian Pediatric Society (CPS) to spearhead the development of guidelines to advise on best practices to manage youth who present to the emergency department with an illicit drug overdose.

Neurobiological mechanisms underlying the sleep-pain relationship in adolescence: A review

Adolescence characterizes a period of significant change in brain structure and function, causing the neural circuitry to be particularly susceptible to the environment and various other experiences. Chronic pain and sleep deprivation represent major health issues that plague adolescence. A bidirectional relationship exists between sleep and pain; however, emerging evidence suggests that sleep disturbances have a stronger influence on subsequent pain than vice versa. The neurobiological underpinnings of this relationship, particularly during adolescence, are poorly understood. This review examines the current literature regarding sleep and pain in adolescence, with a particular focus on the neurobiological mechanisms underlying pain, sleep problems, and the neural circuitry that potentially links the two. Finally, a research agenda is outlined to stimulate future research on this topic. Given the high prevalence of these health issues during adolescence and the debilitating effects they inflict on nearly every domain of development, it is crucial that we determine the neurobiological mechanisms fundamental to this relationship and identify potential therapeutic strategies.

Engaging rural young mothers in a technology-based intervention for depression

Peripartum depression is prevalent among young mothers (ages 25 and younger), and low family support can exacerbate depressive symptoms. The current study explores an innovative method for engaging young mothers in a family-based intervention to help reduce peripartum depressive symptoms. This descriptive study includes details on the baseline characteristics of participants, integrative support teams, and a service delivery method to engage families living rural communities. In conclusion, engaging depressed young mothers living in rural communities requires a multifaceted approach. Our approach has demonstrated promise in engaging this hard-to-reach population. Implications for clinical practice and future research are addressed.

Influence of young adult cognitive ability and additional education on later-life cognition

How and when education improves cognitive capacity is an issue of profound societal importance. Education and later-life education-related factors, such as occupational complexity and engagement in cognitive-intellectual activities, are frequently considered indices of cognitive reserve, but whether their effects are truly causal remains unclear. In this study, after accounting for general cognitive ability (GCA) at an average age of 20 y, additional education, occupational complexity, or engagement in cognitive-intellectual activities accounted for little variance in late midlife cognitive functioning in men age 56-66 (n = 1009). Age 20 GCA accounted for 40% of variance in the same measure in late midlife and approximately 10% of variance in each of seven cognitive domains. The other factors each accounted for <1% of the variance in cognitive outcomes. The impact of these other factors likely reflects reverse causation-namely, downstream effects of early adult GCA. Supporting that idea, age 20 GCA, but not education, was associated with late midlife cortical surface area (n = 367). In our view, the most parsimonious explanation of our results, a meta-analysis of the impact of education, and epidemiologic studies of the Flynn effect is that intellectual capacity gains due to education plateau in late adolescence/early adulthood. Longitudinal studies with multiple cognitive assessments before completion of education would be needed to confirm this speculation. If cognitive gains reach an asymptote by early adulthood, then strengthening cognitive reserve and reducing later-life cognitive decline and dementia risk may really begin with improving educational quality and access in childhood and adolescence.

Selective sharing: The impact of patterns of communication in young people experiencing maternal cancer

BACKGROUND

Adolescents that experience parental cancer can have significant difficulties and may be at a greater risk of emotional and behavioural problems; however, some studies have found that this experience can also be empowering and can promote positive growth. Open communication specifically has been associated with coping and less psychological distress in adolescents experiencing parental cancer.

AIMS

The aim of this study is to identify communication patterns in adolescents that faced maternal cancer to provide recommendations for practice on how best to support adolescents at this challenging time.

METHODS

Adolescents (n = 15) completed semistructured interviews with the main researcher to explore their experiences at the time of maternal cancer. Specifically, this study is a qualitative secondary thematic analysis.

RESULTS

The term "selective sharing" was coined to characterise adolescent communication patterns, as they selected who they wished to talk to and how much information about maternal illness they shared. Barriers for adolescent open communication included perceived unavailability of their mothers to talk, fear, geographical separation from their families, previous family communication patterns, and the time since maternal diagnosis. Benefits of open communication included access to affection, support and information, as well as validation of their emotions and improved coping. Adolescents also provided recommendations to peers and practitioners based on their own experiences.

CONCLUSIONS

Adolescent communication patterns need to be evaluated as this can impact on their ability to cope with maternal cancer diagnosis. Practitioners can facilitate and encourage open communication, including both factual information about cancer and the emotions and thoughts adhered to this experience for adolescents, mothers, friends, and their families to support them at this challenging time.

Cognitive, Neurological, and Behavioral Features in Adults With KCNJ11 Neonatal Diabetes

OBJECTIVE

Central nervous system (CNS) features in children with permanent neonatal diabetes (PNDM) due to KCNJ11 mutations have a major impact on affected families. Sulfonylurea therapy achieves outstanding metabolic control but only partial improvement in CNS features. The effects of KCNJ11 mutations on the adult brain and their functional impact are not well understood. We aimed to characterize the CNS features in adults with KCNJ11 PNDM compared with adults with INS PNDM.

RESEARCH DESIGN AND METHODS

Adults with PNDM due to KCNJ11 mutations (n = 8) or INS mutations (n = 4) underwent a neurological examination and completed standardized neuropsychological tests/questionnaires about development/behavior. Four individuals in each group underwent a brain MRI scan. Test scores were converted to Z scores using normative data, and outcomes were compared between groups.

RESULTS

In individuals with KCNJ11 mutations, neurological examination was abnormal in seven of eight; predominant features were subtle deficits in coordination/motor sequencing. All had delayed developmental milestones and/or required learning support/special schooling. Half had features and/or a clinical diagnosis of autism spectrum disorder. KCNJ11 mutations were also associated with impaired attention, working memory, and perceptual reasoning and reduced intelligence quotient (IQ) (median IQ KCNJ11 vs. INS mutations 76 vs. 111, respectively; P = 0.02). However, no structural brain abnormalities were noted on MRI. The severity of these features was related to the specific mutation, and they were absent in individuals with INS mutations.

CONCLUSIONS

KCNJ11 PNDM is associated with specific CNS features that are not due to long-standing diabetes, persist into adulthood despite sulfonylurea therapy, and represent the major burden from KCNJ11 mutations.

Youth-Onset Type 2 Diabetes and the Developing Brain

PURPOSE OF REVIEW

This review describes the literature evaluating the potential adverse effects of youth-onset type 2 diabetes on the developing brain. A summary of recently published articles and the current state of knowledge are covered succinctly in this manuscript.

RECENT FINDINGS

Current literature suggests both cognitive and brain structural differences are found in youth with type 2 diabetes. Studies have shown poorer scores in a number of neurocognitive domains, particularly in areas of executive functioning and memory. Additionally, imaging studies have found differences in brain gray matter volume, white matter volume, and microstructural integrity. These findings are largely consistent with the adult literature. Youth with type 2 diabetes demonstrate lower cognitive scores and structural brain differences. Although causality has not yet been established, these findings are important because these individuals are still undergoing neurodevelopmental maturation.

Investigating the Impact of a Musical Intervention on Preschool Children's Executive Function

The impact of music interventions on the cognitive skills of young children has become the focus of a growing number of research studies in recent years. This study investigated the effect of weekly musicianship training on the executive function abilities of 3-to-4-year-old children at a London, United Kingdom preschool, using a two-phase experimental design. In Phase 1, 14 children (Group A) took part in eight weekly musicianship classes, provided by a specialist music teacher, while 25 children (Groups B and C combined) engaged in nursery free play. Results of this Phase showed Group A to have improved on two measures relating to planning and inhibition skills. During Phase 2, Group A continued with music classes, while Group B began music classes for the first time and Group C took part in an art intervention. Repeated measures ANOVA found no significant difference in performance improvement between the three participant groups during phase 2; however, the performance difference between groups was nearing significance for the peg tapping task (p = 0.06). The findings from this study contribute to current debates about the potential cognitive benefit of musical interventions, including important issues regarding intervention duration, experimental design, target age groups, executive function testing, and task novelty.

Mild traumatic brain injury: Is DTI ready for the courtroom?

Important advances in neuroscience and neuroimaging have revolutionized our understanding of the human brain. Many of these advances provide new evidence regarding compensable injuries that have been used to support changes in legal policy. For example, we now know that regions of the brain involved in decision making continue to develop into the mid-20s, and this information weighs heavily in determining that execution or automatic sentence of life without the possibility of parole for someone younger than 18 years old, at the time of the crime, violates the 8th Amendment prohibition against "cruel and unusual punishment." The probative value of other testimony regarding neuroimaging, however, is less clear, particularly for mild traumatic brain injury (mTBI), also known as concussion. There is nonetheless some evidence that new imaging technologies, most notably diffusion tensor imaging (DTI), may be useful in detecting mTBI. More specifically, DTI is sensitive to detecting diffuse axonal brain injuries in white matter, the most common brain injury in mTBI. DTI is, in fact, the most promising technique available today for such injuries and it is beginning to be used clinically, although it remains largely within the purview of research. Its probative value is also not clear as it may be both prejudicial and misleading given that standardization is not yet established for use in either the clinic or the courtroom, and thus it may be premature for use in either. There are also concerns with the methods and analyses that have been used to provide quantitative evidence in legal cases. It is within this context that we provide a commentary on the use of neuroimaging in the courtroom, most particularly DTI, and the admissibility of evidence, as well as the definition and role of expert testimony. While there is a great deal of evidence demonstrating cognitive impairments in attention, processing speed, memory, and concentration from neuropsychological testing following mTBI, we focus here on the more recent introduction of DTI imaging in the courtroom. We also review definitions of mTBI followed by admissibility standards for scientific evidence in the courtroom, including Daubert criteria and two subsequent cases that comprise the so-called Daubert trilogy rulings on the admissibility of expert testimony. This is followed by a brief review of neuroimaging techniques available today, the latter with an emphasis on DTI and its application to mTBI. We then review some of the court rulings on the use of DTI. We end by highlighting the importance of neuroimaging in providing a new window on the brain, while cautioning against the premature use of new advances in imaging in the courtroom before standards are established in the clinical arena, which are informed by research. We also discuss further what is needed to reach a tipping point where such advances will provide important and meaningful data with respect to their probative value.

Motivated Reasoning and HIV Risk? Views on Relationships, Trust, and Risk from Young Women in Cape Town, South Africa, and Implications for Oral PrEP

In high prevalence environments relationship characteristics are likely to be associated with HIV risk, yet evidence indicates general underestimation of risk. Furthermore uncertainty about partner's risk may challenge PrEP demand among young African women. We conducted quantitative and qualitative interviews with women before and after HIV discussions with partners, to explore how partner's behavior affected risk perceptions and interest in PrEP. Twenty-three women were interviewed once; twelve had a follow-up interview after speaking to their partners. Fourteen women were willing to have their partner contacted; yet two men participated. Several themes related to relationships and risk were identified. These highlighted that young women's romantic feelings and expectations influenced their perceptions of risk within their relationships, consistent with the concept of motivated reasoning. Findings emphasize challenges in using risk to promote HIV prevention among young women. Framing PrEP in a positive empowering way that avoids linking it to relationship risk may ultimately encourage greater uptake.

Individual predictors of adolescent adjustment to maternal cancer: The role of perceived stress, coping, social support, attachment, and self-efficacy

BACKGROUND

Cancer is among the leading causes of morbidity and mortality around the world. The National Cancer Registry of Ireland reported in 2015 that there were 9312 new cases of female cancers per year, breast cancer being the most common type diagnosed. Research has identified that parental cancer is a stressful situation that can have a strong impact on adolescents' lives; however, some adolescents can turn a negative event into a way of enhancing their skills and psychological resources. This variability needs to be explored further to identify how individual differences contribute to different adjustment experiences for adolescents whose mothers are diagnosed with cancer, namely differences in adolescent coping, self-efficacy, social support, life satisfaction, and attachment.

AIM

The objective of this study was to examine the relative impact of perceived stress, coping, perceived social support, maternal attachment, and self-efficacy on adolescent adjustment (mood and life satisfaction).

METHOD

Data was collected from 40 adolescents within 38 months of a maternal cancer diagnosis. They completed online questionnaires assessing perceived stress, coping, perceived social support, attachment, self-efficacy, and adjustment (life satisfaction, negative affect, positive affect, depression, and anxiety).

RESULTS

Hierarchical regression analyses showed that perceived stress and coping were the strongest predictors of adjustment explaining variance on all adjustment indices. Maternal attachment, perceived social support, and self-efficacy were less powerful predictors of adjustment. The model, however, failed to explain any variance on depression and anxiety. Moderation analyses revealed that social support moderated the relationship between perceived stress and positive affect for adolescents with high levels of perceived social support.

CONCLUSIONS

Findings show that lower perceived stress and positive coping were the best predictors of adjustment in adolescents facing maternal cancer. Results suggest that adolescents could be screened for levels of perceived stress and coping style to identify adolescents who are at risk of poor adjustment when they are adjusting to maternal cancer.

The Extent and Risk of Violent Victimization Among International College Students Enrolled in the United States: A Gendered Analysis

Although the risk of being violently victimized in college has been established for college students in the United States in general, this risk has not been explored for international college students. Using data from the Fall 2012 National College Health Assessment Survey, the extent to which international college students experience violent victimization is assessed. In addition, the risk factors for violent victimization for international students are compared with those for domestic students. Finally, in multivariate analyses, whether being an international student influences risk of violent victimization is examined and whether this relationship is moderated by gender is considered. Findings indicate that international students in general have lower risk profiles, in that they reported lower rates of drug use, binge drinking, being a first-year undergraduate student, and having a disability. Multivariate analyses, however, revealed that being an international student reduces the odds of violent victimization among only females.

Stress, alcohol and infection during early development: A brief review of common outcomes and mechanisms

Although stress is an adaptive physiological response to deal with adverse conditions, its occurrence during the early stages of life, such as infancy or adolescence, can induce adaptations in multiple physiological systems, including the reproductive axis, the hypothalamic-pituitary-adrenal (HPA) axis, the limbic cortex and the immune system. These early changes have consequences in adult life, as seen in the physiological and behavioural responses to stress. This review highlights the impact of several stress challenges incurred at various stages of development (perinatal, juvenile, adolescent periods) and how the developmental timing of early-life stress confers unique physiological adaptations that may persist across the lifespan. In doing so, we emphasise how intrinsic sex differences in the stress response might contribute to sex-specific vulnerabilities, the molecular processes underlying stress in the adult, and potential therapeutic interventions to mitigate the effects of early stage stress, including the novel molecular mechanism of SUMOylation as a possible key target of HPA regulation during early-life stress.

Social Media and New Technology: A Primer

Social media and new media are becoming increasingly important in the lives of preteens and teens. This article reviews what is currently known about positive and negative effects of social media, social networking, and internet use and what safety measures should be considered.