The teen brain: insights from neuroimaging

Age at First Exposure to Repetitive Head Impacts Is Associated with Smaller Thalamic Volumes in Former Professional American Football Players

Thalamic atrophy has been associated with exposure to repetitive head impacts (RHI) in professional fighters. The aim of this study is to investigate whether or not age at first exposure (AFE) to RHI is associated with thalamic volume in symptomatic former National Football League (NFL) players at risk for chronic traumatic encephalopathy (CTE). Eighty-six symptomatic former NFL players (mean age = 54.9 ± 7.9 years) were included. T1-weighted data were acquired on a 3T magnetic resonance imager, and thalamic volumes were derived using FreeSurfer. Mood and behavior, psychomotor speed, and visual and verbal memory were assessed. The association between thalamic volume and AFE to playing football and to number of years playing was calculated. Decreased thalamic volume was associated with more years of play (left: p = 0.03; right: p = 0.03). Younger AFE was associated with decreased right thalamic volume (p = 0.014). This association remained significant after adjusting for total years of play. Decreased left thalamic volume was associated with worse visual memory (p = 0.014), whereas increased right thalamic volume was associated with fewer mood and behavior symptoms (p = 0.003). In our sample of symptomatic former NFL players at risk for CTE, total years of play and AFE were associated with decreased thalamic volume. The effect of AFE on right thalamic volume was almost twice as strong as the effect of total years of play. Our findings confirm previous reports of an association between thalamic volume and exposure to RHI. They suggest further that younger AFE may result in smaller thalamic volume later in life.

Attachment, Emotion Regulation, Childhood Abuse and Assault: Examining Predictors of NSSI Among Adolescents

In this study we examined the relative risk of Non-Suicidal Self-Injury (NSSI) associated with a history of physical and sexual abuse/assault, poor attachment relationships, and poor emotion regulation among adolescents. A total of 2,637 adolescents (aged 12-15 years) completed questionnaires at 3 time-points: baseline, 12, and 24 months later. Across the study, 9.4% reported a history of NSSI. Each of past or recent abuse/assault, poor attachment relationships, and poor emotion regulation was associated with NSSI. We also observed a potential "high-risk" group among those reporting recent sexual abuse or assault. Knowledge of abuse history, recent sexual assault, attachment, and emotion regulatory ability will enable clinicians to assist adolescents in avoiding some of the more negative outcomes of these, including NSSI.

Reflective functioning, maternal attachment, mind-mindedness, and emotional availability in adolescent and adult mothers at infant 3 months

The study evaluated reflective functioning (RF), maternal attachment, mind-mindedness, and emotional availability among 44 adolescent mother-infant dyads and 41 adult mother-infant dyads. At infant age 3 months, mother-infant interaction was coded with the mind-mindedness coding system and Emotional Availability Scales; mother attachment and RF were evaluated with the Adult Attachment Interview (AAI). Adolescent mothers (vs. adult mothers) were more insecure and had lower RF; they were also less sensitive, more intrusive and hostile, and less structuring of their infant's activity; they used fewer attuned mind-related comments and fewer mind-related comments appropriate to infant development. In adult mothers, the Mother Idealizing and Lack of Memory AAI scales were correlated to non-attuned mind-related comments and the Father Anger scale to negative mind-related comments. In adult mothers, RF was associated with sensitivity. This was not the case with adolescent mothers. In both groups of mothers, there were no associations between sensitivity and mind-mindedness.

Age of first exposure to American football and long-term neuropsychiatric and cognitive outcomes

Previous research suggests that age of first exposure (AFE) to football before age 12 may have long-term clinical implications; however, this relationship has only been examined in small samples of former professional football players. We examined the association between AFE to football and behavior, mood and cognition in a large cohort of former amateur and professional football players. The sample included 214 former football players without other contact sport history. Participants completed the Brief Test of Adult Cognition by Telephone (BTACT), and self-reported measures of executive function and behavioral regulation (Behavior Rating Inventory of Executive Function-Adult Version Metacognition Index (MI), Behavioral Regulation Index (BRI)), depression (Center for Epidemiologic Studies Depression Scale (CES-D)) and apathy (Apathy Evaluation Scale (AES)). Outcomes were continuous and dichotomized as clinically impaired. AFE was dichotomized into <12 and ⩾12, and examined continuously. Multivariate mixed-effect regressions controlling for age, education and duration of play showed AFE to football before age 12 corresponded with >2 × increased odds for clinically impaired scores on all measures but BTACT: (odds ratio (OR), 95% confidence interval (CI): BRI, 2.16,1.19-3.91; MI, 2.10,1.17-3.76; CES-D, 3.08,1.65-5.76; AES, 2.39,1.32-4.32). Younger AFE predicted increased odds for clinical impairment on the AES (OR, 95% CI: 0.86, 0.76-0.97) and CES-D (OR, 95% CI: 0.85, 0.74-0.97). There was no interaction between AFE and highest level of play. Younger AFE to football, before age 12 in particular, was associated with increased odds for impairment in self-reported neuropsychiatric and executive function in 214 former American football players. Longitudinal studies will inform youth football policy and safety decisions.

Sex matters: repetitive mild traumatic brain injury in adolescent rats

Objective

Whether sex differences contribute to the heterogeneity of mild traumatic brain injury (mTBI) and repeated mTBI (RmTBI) outcomes in adolescents is unknown. Therefore, this study examined changes in, and differences between, male and female rats following single mTBI and RmTBI.

Methods

Rats were given a single mTBI, RmTBI (i.e., 3x), or sham injuries. Injuries were administered using a lateral impact model that mimics forces common in human mTBI. After the final injury, rats underwent extensive behavioral testing to examine cognition, motor function, and anxiety‐ and depressive‐like behavior. Postmortem analyses investigated gene expression and structural changes in the brain.

Results

Many of the outcomes exhibited a sex‐dependent response to RmTBI. While all rats given RmTBI had deficits in balance, motor coordination, locomotion, and anxiety‐like behavior, only male rats given RmTBI had short‐term working memory deficits, whereas only females given RmTBI had increased depressive‐like behavior. Volumetric and diffusion weighted MRI analyses found that while RmTBI‐induced atrophy of the prefrontal cortex was greater in female rats, only the male rats exhibited worse white matter integrity in the corpus callosum following RmTBI. Sex‐dependent changes in brain expression of mRNA for glial fibrillary acidic protein, myelin basic protein, and tau protein were also observed following injury.

Interpretation

These findings suggest that in adolescent mTBI, sex matters; and future studies incorporating both male and females are warranted to provide a greater understanding of injury prognosis and better inform clinical practice.

Multimodal Neuroimaging of Frontolimbic Structure and Function Associated With Suicide Attempts in Adolescents and Young Adults With Bipolar Disorder

OBJECTIVE

Bipolar disorder is associated with high risk for suicidal behavior that often develops in adolescence and young adulthood. Elucidation of involved neural systems is critical for prevention. This study of adolescents and young adults with bipolar disorder with and without a history of suicide attempts combines structural, diffusion tensor, and functional MR imaging methods to investigate implicated abnormalities in the morphology and structural and functional connectivity within frontolimbic systems.

METHOD

The study had 26 participants with bipolar disorder who had a prior suicide attempt (the attempter group) and 42 participants with bipolar disorder without a suicide attempt (the nonattempter group). Regional gray matter volume, white matter integrity, and functional connectivity during processing of emotional stimuli were compared between groups, and differences were explored for relationships between imaging modalities and associations with suicide-related symptoms and behaviors.

RESULTS

Compared with the nonattempter group, the attempter group showed significant reductions in gray matter volume in the orbitofrontal cortex, hippocampus, and cerebellum; white matter integrity in the uncinate fasciculus, ventral frontal, and right cerebellum regions; and amygdala functional connectivity to the left ventral and right rostral prefrontal cortex. In exploratory analyses, among attempters, there was a significant negative correlation between right rostral prefrontal connectivity and suicidal ideation and between left ventral prefrontal connectivity and attempt lethality.

CONCLUSIONS

Adolescent and young adult suicide attempters with bipolar disorder demonstrate less gray matter volume and decreased structural and functional connectivity in a ventral frontolimbic neural system subserving emotion regulation. Among attempters, reductions in amygdala-prefrontal functional connectivity may be associated with severity of suicidal ideation and attempt lethality.

Gender-Affirming Pharmacological Interventions for Youth With Gender Dysphoria: When Treatment Guidelines Are Not Enough

Youth with gender dysphoria, also known as transgender youth, are increasingly presenting to multidisciplinary clinics within academic pediatric centers across the United States. Gender-affirming pharmacological interventions for adolescents with gender dysphoria may be used to promote positive psychological well-being and mental health outcomes. Interventions range from completely reversible to partially irreversible, based on the age and sexual maturity of the adolescent. For each intervention, dilemmas and controversies exist regarding age at treatment initiation, treatment duration, safety, and cost. Pharmacists' awareness of these considerations and interventions is important when providing evidence-based gender-affirming care to this underserved population.

Synaptoimmunology - roles in health and disease

Mounting evidence suggests that the nervous and immune systems are intricately linked. Many proteins first identified in the immune system have since been detected at synapses, playing different roles in normal and pathological situations. In addition, novel immunological functions are emerging for proteins typically expressed at synapses. Under normal conditions, release of inflammatory mediators generally represents an adaptive and regulated response of the brain to immune signals. On the other hand, when immune challenge becomes prolonged and/or uncontrolled, the consequent inflammatory response leads to maladaptive synaptic plasticity and brain disorders. In this review, we will first provide a summary of the cell signaling pathways in neurons and immune cells. We will then examine how immunological mechanisms might influence synaptic function, and in particular synaptic plasticity, in the healthy and pathological CNS. A better understanding of neuro-immune system interactions in brain circuitries relevant to neuropsychiatric and neurological disorders should provide specific biomarkers to measure the status of the neuroimmunological response and help design novel neuroimmune-targeted therapeutics.

Response to a mindful self-compassion intervention in teens: A within-person association of mindfulness, self-compassion, and emotional well-being outcomes

As adolescence can be a stressful developmental stage, the purpose of this study was to determine if a novel mindful self-compassion program would decrease stress, depressive symptoms, and anxiety and increase resilience, gratitude, and curiosity/exploration (positive risk-taking), and to ascertain if mindfulness and self-compassion co-varied with these outcomes over time. Forty-seven adolescents in the southeast U.S. enrolled in an 8-week mindful self-compassion course in five cohorts. Measures were assessed at pre-intervention, post-intervention, and 6-week follow-up. Multilevel growth analyses revealed main effects of time on perceived stress, resilience, curiosity/exploration and gratitude. Additionally, both mindfulness and self-compassion co-varied with perceived stress and depressive symptoms; mindfulness also co-varied with anxiety and self-compassion co-varied with resilience and curiosity/exploration. Implications of these findings are that this program has potential in decreasing stress and increasing resilience and positive risk-taking. Future studies with a control group need to be conducted to confirm these findings.

Screening of autism based on task-free fMRI using graph theoretical approach

Studies on autism spectrum disorder (ASD) have indicated several dysfunctions in the structure, and functional organization of the brain. However, findings have not been established as a general diagnostic tool yet. In this regard, current study proposed an automatic screening method for recognition of ASDs from healthy controls (HCs) based on their brain functional abnormalities. In this paradigm, brain functional networks of 60 adolescent and young adult males (29 ASDs and 31 HCs) were estimated from subjects' task-free fMRI data. Then, autism screening was developed based on characteristics of the functional networks using the following steps: A) local and global parameters of the brain functional network were calculated using graph theory. B) network parameters of the ASDs were statistically compared to the HCs. C) significantly altered parameters were used as input features of the screening system. D) performance of the system was verified using various classification techniques. The support vector machine showed superiority to others with an accuracy of 92%. Subsequently, reliability of the results was examined using an independent dataset including 20 ASDs and 20 HCs. Our findings suggest that local parameters of the brain functional network, despite the individual variability, can potentially be used for autism screening.

Distracted Walking, Bicycling, and Driving: Systematic Review and Meta-Analysis of Mobile Technology and Youth Crash Risk

This article examined the impact of mobile technology on young pedestrians, bicyclists, and drivers. A systematic search yielded 41 articles meeting inclusion criteria: peer-reviewed, published before February 1, 2016, behavioral outcome related to pedestrian, bicycling, or driving in the presence of mobile technology use, youth sample. Eleven studies were meta-analyzed to evaluate increased risk for crash/near-crash while distracted. Risk of bias and quality of research were assessed. Across methodologies, developmental stages, and type of distracting task, mobile technology use impairs youth safety on the road. Quality of evidence was low (pedestrian) to moderate (driving). Findings are discussed from the perspective of cognitive and visual distractions. Policy and behavioral efforts should continue to reduce mobile technology use in transportation settings.

Adolescent Ethanol Exposure Leads to Stimulus-Specific Changes in Cytokine Reactivity and Hypothalamic-Pituitary-Adrenal Axis Sensitivity in Adulthood

Adolescent alcohol use comprises a significant public health concern and is often characterized by binge-like consumption patterns. While ethanol exposure in adulthood has been shown to alter the stress response, including the Hypothalamic–Pituitary–Adrenal (HPA) axis, few studies have examined whether binge-like ethanol exposure during adolescence results in enduring changes in HPA axis sensitivity in adulthood. In the present studies, adolescent Sprague-Dawley rats were given intragastric (i.g.) intubations of ethanol (4 g/kg) or vehicle once per day for three consecutive days, beginning on postnatal day (P) 30 (±1). This exposure was followed by a 2-day period of rest/withdrawal. Rats received a total of either two (Experiments 1, 2 and 3) or four (Experiment 4) cycles of ethanol exposure and were subsequently allowed to age normally until adulthood. In Experiment 1, adult, (P71–75), ethanol- or vehicle-exposed rats received a 60 min restraint stress challenge. In Experiment 2, rats received a 50 μg/kg injection of lipopolysaccharide (LPS). In Experiment 3, rats received a challenge of 2.5 g/kg ethanol (intraperitoneally; i.p.). In Experiment 4, male and female ethanol- or vehicle- exposed rats received a 50 μg/kg injection of LPS. In all experiments, blood samples were collected for later assessment of corticosterone (CORT), blood ethanol concentrations (BECs), and the cellular fraction of blood was analyzed for cytokine gene expression. As expected, all three challenges led to a time-dependent surge in CORT. Gene expression analyses of cytokines (Interleukin [IL]-6, IL-1β, and Tumor necrosis factor alpha [TNFα]) from the cellular fraction of blood revealed unique, time-dependent patterns of cytokine expression depending upon the nature of the adult challenge incurred (restraint, LPS, or EtOH). Importantly, adolescent ethanol exposure led to attenuated restraint and LPS-induced cytokine expression in males, whereas female rats displayed an absence of cytokine alterations, and a tendency toward heightened HPA axis reactivity. These findings suggest that adolescent ethanol exposure may cause lasting alterations in cytokine regulation and HPA axis sensitivity that (a) persist into adulthood; (b) may vary depending on the nature of the challenge incurred during adulthood; and that (c) are sex-specific.

Teacher Evaluations of Executive Functioning in Schoolchildren Aged 9-12 and the Influence of Age, Sex, Level of Parental Education

Executive functions (EFs) develop over the period of early childhood and adolescence up until young adulthood. Individual children differ substantially in the pace at which their EFs develop, and characteristics such as sex and the level of parental education (LPE) are thought to contribute to these differences. In the present study, we assessed age-related changes in EFs as perceived and evaluated by teachers and parents as well as the influence of sex and LPE on their evaluations. We used a newly developed observer-report questionnaire, the Amsterdam Executive Function Inventory (AEFI). The AEFI assesses three important components of the executive aspects of daily life behavior in 13 questions: Attention; Self-control and Self-monitoring; and Planning and Initiative taking. Teachers and parents evaluated these aspects of executive functioning in 186 schoolchildren in grades 3–6 (age: 9–12 years). Age effects within grades and differences in social economic status between the four participating schools were controlled. Results showed a significant increase in teacher-perceived EFs from third to fourth grades and from fifth to sixth grades. This development was influenced both by the sex of the child and by the LPE. As perceived by teachers, the component self-control and self-monitoring was higher for girls than for boys, and planning abilities were higher for children from families with a higher LPE. Additional analyses showed that there is a systematic and statistically significant difference between the evaluations of the teachers and that of parents. Parents reported higher scores for planning, whereas teachers reported higher scores for self-control and self-monitoring. Evaluations by parents and teachers were different for girls, but not for boys. These findings are important because they imply that the development of EFs as perceived by parents and teachers is influenced by child-related factors. Second, there are clear differences in evaluations between teachers and parents. The AEFI appears to be a tool that is easily used by parents and teachers and shows potential for monitoring the development of EFs as perceived by significant others during young adolescence.

Adolescents’ perceptions of alcohol

Purpose

Rising trends in alcohol consumption and early drinking initiation pose serious health risks especially for adolescents. Learner’s prior knowledge about alcohol gained from the social surroundings and the media are important sources that can impact the learning outcomes in health education. The purpose of this paper is to map adolescents’ perceptions of alcohol in Punjab, India and how these perceptions are related to their attitudes towards their social surroundings and the media.

Design/methodology/approach

The questionnaire was created after informal discussions with local people who consume alcohol and discussions with alcohol-related experts. Students from five schools (n=379, average age=13.6 years) in the urban region of Punjab, India, filled in a questionnaire. Quantitative tests were performed on the questionnaire data. Summative content analysis was performed for the textbook content about alcohol from classes 1 to 10.

Findings

Data suggest that students gain knowledge about alcohol from multiple sources, including society, the media and education. While society and the media can give misinformation, education did not provide them with factual scientific information about alcohol. Students from financially marginalized social surroundings experience the presence and use of alcohol more frequently; they trust the media and celebrities somewhat unquestioningly and, hence, are more at-risk.

Research limitations/implications

All participants in informal discussions as well as all participating schools in the study were from urban regions. Data about individual’s socio-economic conditions was not collected.

Originality/value

This research investigates perceptions of alcohol that are derived from adolescents’ social surroundings, perceptions of the media and perceptions gained through educational guidance in a developing country. Such multi-dimensional investigations have not been conducted earlier.

Development of Tract-Specific White Matter Pathways During Early Reading Development in At-Risk Children and Typical Controls

Developmental dyslexia is a neurodevelopmental disorder with a strong genetic basis. Previous studies observed white matter alterations in the left posterior brain regions in adults and school-age children with dyslexia. However, no study yet has examined the development of tract-specific white matter pathways from the pre-reading to the fluent reading stage in children at familial risk for dyslexia (FHD+) versus controls (FHD-). This study examined white matter integrity at pre-reading, beginning, and fluent reading stages cross-sectionally ( n = 78) and longitudinally (n = 45) using an automated fiber-tract quantification method. Our findings depict white matter alterations and atypical lateralization of the arcuate fasciculus at the pre-reading stage in FHD+ versus FHD- children. Moreover, we demonstrate faster white matter development in subsequent good versus poor readers and a positive association between white matter maturation and reading development using a longitudinal design. Additionally, the combination of white matter maturation, familial risk, and psychometric measures best predicted later reading abilities. Furthermore, within FHD+ children, subsequent good readers exhibited faster white matter development in the right superior longitudinal fasciculus compared with subsequent poor readers, suggesting a compensatory mechanism. Overall, our findings highlight the importance of white matter pathway maturation in the development of typical and atypical reading skills.

Young Road Fatalities

This study presents the findings from in-depth interviews with 24 people from 15 families in Norway who lost their young son or daughter in a traffic accident. Their grief has several dimensions: the loss of a young life, the loss of life quality, the effect on family events and their meaning, and the new responsibilities brought onto family members. For each young fatality, many relatives and friends are affected with a wide range of emotional and socioeconomic consequences. Parents report that grief is more overwhelming during the first few years and never disappears, while over the years they slowly learn to cope with it. Here we especially highlight the role of traffic authorities and what professional actors can do to meet the bereaved with empathy and minimize negative effects.

Brain connectivity networks and longitudinal trajectories of depression symptoms in adolescence

High levels of depression during adolescence may contribute to the risk for future depression later in life. This study examined the relationship between the developmental timing of depressive symptoms, and brain structural outcomes in late adolescence. In a prior work, we examined longitudinal trajectories of depressive symptoms in 243 adolescents (121 males and 122 females), and identified four subgroups: a normative group with stable low levels of depression, two groups with declining symptoms, and one group with increasing symptoms. For the current paper, diffusion-weighted MRI images were acquired at the final wave of the study, and used to perform white matter tractography and brain network analysis. The four depression trajectory groups were tested for differences in brain connectivity variables. This revealed differences in several frontal and temporal regions. The groups that had experienced elevated depression symptoms in early adolescence differed from the normative group in a greater number of areas than the group who had experienced depression later. Affected tracts corresponded to areas of white matter that are still maturing during this period, particularly frontolimbic regions. These findings support the proposition that the timing and duration of depression symptoms during adolescence are associated with brain structural outcomes.

Behavioral Control and Reward Sensitivity in Adolescents' Risk Taking Behavior: A Longitudinal TRAILS Study

Neurodevelopmental theories of risk behavior hypothesize that low behavioral control in combination with high reward sensitivity explains adolescents’ risk behavior. However, empirical studies examining this hypothesis while including actual risk taking behavior in adolescence are lacking. In this study we tested whether the imbalance between behavioral control and reward sensitivity underlies risk taking behavior in adolescence, using a nationally representative longitudinal sample of 715 adolescents, of which 66% revealed an increased risk for mental health problems. To assess behavioral control at age 11 we used both self-report (effortful control) as well as behavioral measures of cognitive control (i.e., working memory and response inhibition). Reward sensitivity was assessed with the Bangor Gambling Task. The main finding of this study was that effortful control at age 11 was the best predictor of risk taking behavior (alcohol and cannabis use) at age 16, particularly among adolescents who were more reward sensitive. Risk taking behavior in adolescents might be explained by relatively weak behavioral control functioning combined with high sensitivity for reward.

A content analysis of emotional concerns expressed at the time of receiving a cancer diagnosis: An observational study of consultations with adolescent and young adult patients and their family members

PURPOSE

Little is known about the emotional concerns expressed by adolescent and young adult (AYA) patients in consultations when a diagnosis of cancer is delivered. Here, we investigated the content of such concerns and how health care providers respond to them.

METHOD

We audio-recorded nine consultations with AYA cancer patients (ages: 12-25 years) at the time of diagnosis. We have previously identified and coded 135 emotional concerns and the responses to these in the nine consultations using the Verona Coding Definitions of Emotional Sequences (VR-CoDES) framework. Here, we used qualitative content analysis to study these emotional concerns and categorize them according to overarching themes. We then quantitatively explored associations between the themes of the concerns and whether the responses to them varied according to their themes.

RESULTS

We identified four themes for the content of concerns: "Side-effects/late-effects" (39%), "What happens in the near future/practical aspects" (16%), "Fear" (27%) and "Sadness" (17%) (e. g. crying, sighing or other sounds that expressed sadness). Health care providers' responses did not appear to vary according to the different themes of concerns, but typically consisted of providing medical information.

CONCLUSION

The content analysis revealed that patients and family members expressed a wide range of emotional concerns. Health care providers tended to respond to the content-aspect of the concerns, but did rarely explicitly acknowledge the affective-aspect of the concerns. The effect of responses to patients' emotional concerns in the important first consultations about the cancer diagnosis and planned treatment should be investigated in future studies.

Binge ethanol drinking during adolescence modifies cocaine responses in mice

Binge ethanol drinking is an emerging pattern of excessive consumption among adolescents and young adults. Repeated ethanol intoxication has negative consequences during critical periods of brain development. Therefore, binge ethanol intake represents a vulnerability factor that promotes subsequent manifestations of neuropsychiatric disorders. In this study, we investigated the effects of oral binge ethanol intake during adolescence on the subsequent effects of cocaine in C57BL/6 mice. Firstly, we evaluated the oral ethanol intake of two binge ethanol procedures with different ethanol concentrations (20% v/v versus 30%, v/v). The highest ethanol intake was found in mice exposed to the lower ethanol concentration (20% v/v). In a second experiment, mice exposed to binge ethanol procedure were evaluated to study the effects of cocaine on locomotor activity, behavioural sensitization, and the reinforcing effects of cocaine in the self-administration paradigm. Mice exposed to ethanol binging showed discrete detrimental effects in responses to cocaine in the different experiments evaluated. Our findings revealed that the pattern of binge ethanol consumption in adolescent mice here evaluated produced a weak facilitation of cocaine responses. The present study highlights the importance of interventions to limit the deleterious effects of binge ethanol drinking during adolescence.

Neuroanatomy and Neuropathology of Autism Spectrum Disorder in Humans

Autism spectrum disorder (ASD) is a lifelong heterogeneous neurodevelopmental condition that is associated with differences in brain anatomy and connectivity. Yet, the molecular and cellular mechanisms that underpin the atypical developmental of the brain in ASD remain poorly understood. Here, we review the findings of in vivo neuroimaging studies examining the time course of atypical brain development in ASD and relate the different neurodevelopmental stages that are atypical in ASD to the known neurobiological mechanisms that drive the maturation of the typically developing brain. In particular, we focus on the notion of 'early brain overgrowth' in ASD, which may lead to differences in the formation of the brain's micro- and macro-circuitry. Moreover, we attempt to link the in vivo reports describing differences in brain anatomy and connectivity on the macroscopic level to the increasing number of post-mortem studies examining the neural architecture of the brain in ASD on the microscopic level. In addition, we discuss future directions and outstanding questions in this particular field of research and highlight the need for establishing the link between micro- and macro-pathology in the same set of individuals with ASD based on advances in genetic, molecular and imaging techniques. In combination, these may proof to be invaluable for patient stratification and the development of novel pharmacotherapies in the future.

Relationship Between Unsupervised Time and Participation in an Emotion Regulation Intervention and Risk Outcomes

OBJECTIVE

This study is a secondary analysis of outcomes examining risk behavior in the context of the naturalistic occurrence of parental monitoring and participation in an emotion regulation intervention over a 12-month period.

METHOD

Early adolescents with mental health symptoms (N=420), ages 12-14 years, were recruited and randomized into either an Emotional Regulation (ER) or Health Promotion (HP) condition. Assessments included adolescent self-report of unsupervised time, substance use and sexual behavior at baseline, 6-months, and one year post-intervention. Analytic groups were formed by intervention condition (ER or HP) and baseline reports of unsupervised time (≤1× per week or >1× per week of unsupervised time with opposite sex peers) resulting in a total of four groups. Logistic regression and time-to-event analyses were used to test differences in substance use and delay of sexual initiation between the groups.

RESULTS

Participation in the ER intervention in the presence of low unsupervised time was superior in reducing both substance use and sexual initiation than either factor alone; and either factor alone was more effective than the absence of both.

CONCLUSION

Findings suggest that interventions targeting health risk behaviors, including substance use and sexual risk behavior, among early adolescents with mental health symptoms may be more effective when targeting both internal (e.g., emotional regulation) and external (e.g., unsupervised time spent with peers) protective factors. Limiting unsupervised time spent with peers through parental monitoring may serve to scaffold and reinforce early adolescent acquisition of effective emotion regulation which can be employed during emotionally arousing risk situations.

A Cross-sectional Anthropometric Study of Cranial Capacity among Ukwuani People of South Nigeria

BACKGROUND

Cranial capacity is used as a measure of brain volume and has a relationship with age and gender. The purpose of this study was to provide normative data and population-, age- and gender-specific regression formulae related to cranial capacity using head dimensions among the Ukwuani people of Nigeria.

METHODS

This study included 605 subjects grouped according to age as follows: 6-12 years, 13-19 years and ≥20 years. A cross-sectional study design using multistage sampling technique was adopted. Head length, head width, and auricular head height were measured in centimetres using a spreading caliper, and cranial capacity was calculated. The data were analysed using SPSS 20. Descriptive and inferential statistics were applied. A t-test was used to identify significant gender differences. Regression analyses were performed to derive age-, gender- and population-specific models. P-values < 0.05 were considered significant.

RESULTS

In all the parameters, males had significantly higher values than females (P < 0.05). The mean (SD) cranial capacity values at 6-12 years, 13-19 years and ≥20 years were 1176.95 (98.35) cc, 1288.59 (113.21) cc and 1408.90 (116.44) cc, respectively.

CONCLUSIONS

All the parameters exhibited sexual dimorphism. Cranial capacity was found to increase with age. The models derived in this work will be relevant to population and growth studies as well as forensic anthropology.

Risky Behaviors: Integrating Adolescent Egocentrism with the Theory of Planned Behavior

Of all age groups, adolescents are at the highest risk for experiencing negative health outcomes associated with risky behaviors. Persuasive messages targeting adolescents that urge them to refrain from tobacco use and alcohol consumption have not been met with great success, perhaps in part due to adolescent egocentrism. The utility of the theory of planned behavior applied to health outcomes has been supported across multiple health behaviors for adults. Perhaps integrating the two constructs of adolescent egocentrism with the three components of the theory of planned behavior will better enable researchers to persuade adolescents to refrain from risky behaviors, leading to improved health outcomes.

Brief report: Feasibility of a mindfulness and self-compassion based mobile intervention for adolescents

The aim of the study was to test the feasibility of a mindfulness and self-compassion based program for adolescents, to be delivered though mobile phones. Twenty racially and ethnically diverse US adolescents enrolled in a study to use the app for 30 days, after which they provided satisfaction data and participated in focus groups to describe their experiences and offer suggestions for improving the app. Usage data were also captured. Results indicated that participants used the app on the majority of days over the intervention period, reported finding it helpful for managing stress, and provided suggestions for substantive areas for improvement. These findings suggest that a mobile app may be a feasible way to disseminate a mindfulness and selfcompassion based program widely among adolescents.

Gender dysphoria in adolescence

Adolescents presenting with gender-related concerns are increasingly seeking support from providers from a variety of disciplines within health care settings across the world. For those treating young people who meet the criteria for the DSM 5 diagnosis of gender dysphoria (GD), complex decisions in clinical care are common. Defining best practice with this population with respect to interventions that span mental health, physical, and surgical domains can be challenging, given a relative dearth of empirical data available; yet practice guidelines have emerged from different professional organizations which can aid with this. For this review paper, a broad literature search was performed to identify relevant studies pertaining to the care of adolescents with GD. In addition, an overview of trends in clinical practice, including shifts in conceptualization of how clinicians and patients define care that is considered affirming when working with this population, is described. This paper explores the characteristics of referral patterns to specialized clinics, provides a brief overview of gender identity development in adolescence, and then describes the phenomenology of known aetiological factors and co-occurring psychiatric issues in adolescents with GD. Additionally, clinical management considerations that detail assessment aims and common treatment interventions across disciplines will be explored.

Effects of Duloxetine Treatment on Cognitive Flexibility and BDNF Expression in the mPFC of Adult Male Mice Exposed to Social Stress during Adolescence

Early stress is a significant risk factor for the onset of mood disorders such as depression during adulthood. Impairments in cognitive flexibility mediated by prefrontal cortex (PFC) dysfunction are increasingly recognized as important etiological and pathological factors in the development of depression. Our previous study demonstrated that social defeat stress during early adolescence produced delayed deficits in cognitive flexibility in adult mice. The potential molecular mechanisms underlying these long-term consequences remain unclear. One candidate molecule is brain-derived neurotrophic factor (BDNF), which plays a vital role in neural development and synaptic plasticity. In this study, we initially examined the effects of adolescent social stress on cognitive flexibility and PFC BDNF expression within a week after the last stress exposure and 6 weeks later during adulthood. Adolescent (PND 28) male mice were subjected to stress or control manipulation for 10 days. The attentional set-shifting task (AST) was used to assess cognitive flexibility. Levels of BDNF mRNA and protein in the PFC were examined after behavioral testing. The results demonstrated that previously stressed mice exhibited delayed extra-dimensional set-shifting deficits in AST when tested as adults but not when tested as adolescents. Consistent with the cognitive alterations, adolescent stress induced dynamic alterations in BDNF expression in the medial PFC (mPFC), with a transient increase observed shortly after the stress, followed by a decrease 6 weeks later during adulthood. Next, we further determined the effects of chronic treatment with the antidepressant duloxetine during early adulthood on cognitive and molecular alterations induced by adolescent stress. Compared with the controls, duloxetine treatment reversed the cognitive deficits and increased the BDNF protein expression in the mPFC during adulthood in previously stressed mice. These findings demonstrated that BDNF expression in the mPFC was sensitive to adolescent social stress, which may contribute to the disturbance of the development and later functioning of this brain region.

Age and Gender Differences in the Associations of Self-Compassion and Emotional Well-being in A Large Adolescent Sample

Adolescence is a challenging developmental period marked with declines in emotional well-being; however, self-compassion has been suggested as a protective factor. This cross-sectional survey study (N = 765, grades 7th to 12th; 53 % female; 4 % Hispanic ethnicity; 64 % White and 21 % Black) examined whether adolescents' self-compassion differed by age and gender, and secondly, whether its associations with emotional well-being (perceived stress, life satisfaction, distress intolerance, depressive symptoms, and anxiety) also differed by age and gender. The findings indicated that older females had the lowest self-compassion levels compared to younger females or all-age males. Self-compassion was associated with all emotional well-being measures, and gender and/or age moderated the associations with anxiety and depressive symptoms. Among older adolescents, self-compassion had a greater protective effect on anxiety for boys than for girls. Additionally, older adolescents with low and average self-compassion had greater levels of depressive symptoms than those with high self-compassion. These results may inform for whom and at what age self-compassion interventions may be implemented to protect adolescents from further declines in emotional well-being.

Informed Consent in Decision-Making in Pediatric Practice

Informed consent should be seen as an essential part of health care practice; parental permission and childhood assent is an active process that engages patients, both adults and children, in their health care. Pediatric practice is unique in that developmental maturation allows, over time, for increasing inclusion of the child's and adolescent's opinion in medical decision-making in clinical practice and research. This technical report, which accompanies the policy statement "Informed Consent in Decision-Making in Pediatric Practice" was written to provide a broader background on the nature of informed consent, surrogate decision-making in pediatric practice, information on child and adolescent decision-making, and special issues in adolescent informed consent, assent, and refusal. It is anticipated that this information will help provide support for the recommendations included in the policy statement.

Neural changes induced by antipsychotic administration in adolescence: A review of studies in laboratory rodents

Adolescence is characterized by major remodelling processes in the brain. Use of antipsychotic drugs (APDs) in adolescents has increased dramatically in the last 20 years; however, our understanding of the neurobiological consequences of APD treatment on the adolescent brain has not kept the same pace and significant concerns have been raised. In this review, we examined currently available preclinical studies of the effects of APDs on the adolescent brain. In animal models of neuropsychiatric disorders, adolescent APD treatment appears to be protective against selected structural, behavioural and neurochemical phenotypes. In "neurodevelopmentally normal" adolescent animals, a range of short- and long-term alterations in behaviour and neurochemistry have been reported. In particular, the adolescent brain appears to be sensitive to long-term locomotor/reward effects of chronic atypical APDs in contrast with the outcomes in adults. Long-lasting changes in dopaminergic, glutamatergic and gamma-amino butyric acid-ergic systems induced by adolescent APD administration have been observed in the nucleus accumbens. A detailed examination of other potential target regions such as striatum, prefrontal cortex and ventral tegmental area is still required. Through identification of specific neural pathways targeted by adolescent APD treatment, future studies will expand the current knowledge on long-term neural outcomes which are of translational value.

Adolescent Social Defeat Induced Alterations in Social Behavior and Cognitive Flexibility in Adult Mice: Effects of Developmental Stage and Social Condition

Negative social experiences during adolescence increase the risk of psychiatric disorders in adulthood. Using "resident-intruder" stress, the present study aimed to investigate the effects of adolescent social defeat on emotional and cognitive symptoms associated with psychiatric disorders during adulthood and the effects of the developmental stage and social condition on this process. In Experiment 1, animals were exposed to social defeat or manipulation for 10 days during early adolescence (EA, postnatal days [PND] 28-37), late adolescence (LA, PND 38-47), and adulthood (ADULT, PND 70-79) and then singly housed until the behavioral tests. Behaviors, including social avoidance of the defeat context and cortically mediated cognitive flexibility in an attentional set-shifting task (AST), were assessed during the week following stress or after 6 weeks during adulthood. We determined that social defeat induced significant and continuous social avoidance across age groups at both time points. The mice that experienced social defeat during adulthood exhibited short-term impairments in reversal learning (RL) on the AST that dissipated after 6 weeks. In contrast, social defeat during EA but not LA induced a delayed deficit in extra-dimensional set-shifting (EDS) in adulthood but not during adolescence. In Experiment 2, we further examined the effects of social condition (isolation or social housing after stress) on the alterations induced by social defeat during EA in adult mice. The adult mice that had experienced stress during EA exhibited social avoidance similar to the avoidance identified in Experiment 1 regardless of the isolation or social housing after the stress. However, social housing after the stress ameliorated the cognitive flexibility deficits induced by early adolescent social defeat in the adult mice, and the social condition had no effect on cognitive function. These findings suggest that the effects of social defeat on emotion and cognitive function are differentially affected by the developmental stage and social condition. EA may comprise a particularly sensitive developmental period in which social defeat may produce a delayed impairment in cognitive flexibility during adulthood, and the social condition following stress appears to play an important intermediary role in the development of these cognitive deficits.

Salivary cortisol and behavioral response to social evaluative threat in adolescents with autism spectrum disorder

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by deficits in social behavior. One possible explanation for social communication deficits in ASD could be differences in biological systems that support responses to environmental stimuli. If so, it is unclear if differences in the arousal response to social stimuli in ASD are due to reduced interest in social information, or to an increased stress response. The hypothalamic pituitary adrenal axis facilitates arousal and the stress response to sensory input, including social stimuli. Previous research shows blunted cortisol response to social evaluative threat in children with ASD. The majority of prior work has focused on children with ASD, but adolescents with ASD are understudied. The adolescent period is of interest, as this developmental epoch is associated with increased salience of social evaluative threat in typically developing (TD) populations. In this study, we employed the Trier Social Stress Test (TSST), a laboratory paradigm that involves exposure to social evaluative threat, to study the cortisol and behavioral response to social evaluative threat in ASD and TD adolescents. Salivary cortisol data were collected at six time points before and after the TSST. Behavioral data were collected using video recordings of the TSST, which were then operationalized and coded. Paired sample t-tests were used to calculate within-group cortisol response to the TSST. Cortisol significantly increased in response to the TSST in the TD group but not the ASD group. The TD group showed a trend for more self-soothing behaviors during the stressor than the ASD group. The lack of a cortisol response to the TSST in the ASD group suggests that the TSST is not interpreted as stressful or salient for ASD adolescents. Autism Res 2017, 10: 346-358. © 2016 International Society for Autism Research, Wiley Periodicals, Inc.

Self-regulation interventions to reduce consumption of sugar-sweetened beverages in adolescents

This study evaluated the efficacy of self-regulation interventions through the use of drink-specific implementation intentions and drink-specific Go/No-Go training tasks as compensatory strategies to modify inhibitory control to reduce intake of sugar-sweetened beverages (SSB). In a between-subjects randomized manipulation of implementation intentions and Go/No-Go training to learn to inhibit sugary drink consumption, 168 adolescents reporting inhibitory control problems over sugary drinks and foods were recruited from high schools in southern California to participate. Analysis of covariance overall test of effects revealed no significant differences between the groups regarding calories consumed, calories from SSBs, grams of sugar consumed from drinks, or the number of unhealthy drinks chosen. However, subsequent contrasts revealed SSB implementation intentions significantly reduced SSB consumption following intervention while controlling for inhibitory control failure and general SSB consumption during observation in a lab setting that provided SSBs and healthy drinks, as well as healthy and unhealthy snacks. Specifically, during post-intervention observation, participants in the sugar-sweetened beverage implementation intentions (SSB-II) conditions consumed significantly fewer calories overall, fewer calories from drinks, and fewer grams of sugar. No effects were found for the drink-specific Go/No-Go training on SSB or calorie consumption. However, participants in SSB-II with an added SSB Go/No-Go training made fewer unhealthy drink choices than those in the other conditions. Implementation intentions may aid individuals with inhibitory (executive control) difficulties by intervening on pre-potent behavioral tendencies, like SSB consumption.

The Longitudinal Association Between Competitive Video Game Play and Aggression Among Adolescents and Young Adults

The longitudinal association between competitive video game play and aggression among young adults and adolescents was examined. Young adults (N = 1,132; M_age  = 19 years) were surveyed annually over 4 years about their video game play and aggression, and data from a 4-year longitudinal study of adolescents (N = 1,492; M_age  = 13 years) was reanalyzed. The results demonstrated a longitudinal association between competitive video game play and aggressive behavior among both age groups. In addition, competitive video game play predicted higher levels of aggressive affect over time, which, in turn, predicted higher levels of aggressive behavior over time, suggesting that aggressive affect was a mechanism of this link. These findings highlight the importance of investigating competitive elements of video game play that may predict aggression over time.

Web-Based Assessment of Mental Well-Being in Early Adolescence: A Reliability Study

BACKGROUND

The ever-increasing use of the Internet among adolescents represents an emerging opportunity for researchers to gain access to larger samples, which can be queried over several years longitudinally. Among adolescents, young adolescents (ages 11 to 13 years) are of particular interest to clinicians as this is a transitional stage, during which depressive and anxiety symptoms often emerge. However, it remains unclear whether these youngest adolescents can accurately answer questions about their mental well-being using a Web-based platform.

OBJECTIVE

The aim of the study was to examine the accuracy of responses obtained from Web-based questionnaires by comparing Web-based with paper-and-pencil versions of depression and anxiety questionnaires.

METHODS

The primary outcome was the score on the depression and anxiety questionnaires under two conditions: (1) paper-and-pencil and (2) Web-based versions. Twenty-eight adolescents (aged 11-13 years, mean age 12.78 years and SD 0.78; 18 females, 64%) were randomly assigned to complete either the paper-and-pencil or the Web-based questionnaire first. Intraclass correlation coefficients (ICCs) were calculated to measure intrarater reliability. Intraclass correlation coefficients were calculated separately for depression (Children's Depression Inventory, CDI) and anxiety (Spence Children's Anxiety Scale, SCAS) questionnaires.

RESULTS

On average, it took participants 17 minutes (SD 6) to answer 116 questions online. Intraclass correlation coefficient analysis revealed high intrarater reliability when comparing Web-based with paper-and-pencil responses for both CDI (ICC=.88; P<.001) and the SCAS (ICC=.95; P<.001). According to published criteria, both of these values are in the "almost perfect" category indicating the highest degree of reliability.

CONCLUSIONS

The results of the study show an excellent reliability of Web-based assessment in 11- to 13-year-old children as compared with the standard paper-pencil assessment. Furthermore, we found that Web-based assessments with young adolescents are highly feasible, with all enrolled participants completing the Web-based form. As early adolescence is a time of remarkable social and behavioral changes, these findings open up new avenues for researchers from diverse fields who are interested in studying large samples of young adolescents over time.

Adolescent neurobiological susceptibility to social context

Adolescence has been characterized as a period of heightened sensitivity to social contexts. However, adolescents vary in how their social contexts affect them. According to neurobiological susceptibility models, endogenous, biological factors confer some individuals, relative to others, with greater susceptibility to environmental influences, whereby more susceptible individuals fare the best or worst of all individuals, depending on the environment encountered (e.g., high vs. low parental warmth). Until recently, research guided by these theoretical frameworks has not incorporated direct measures of brain structure or function to index this sensitivity. Drawing on prevailing models of adolescent neurodevelopment and a growing number of neuroimaging studies on the interrelations among social contexts, the brain, and developmental outcomes, we review research that supports the idea of adolescent neurobiological susceptibility to social context for understanding why and how adolescents differ in development and well-being. We propose that adolescent development is shaped by brain-based individual differences in sensitivity to social contexts - be they positive or negative - such as those created through relationships with parents/caregivers and peers. Ultimately, we recommend that future research measure brain function and structure to operationalize susceptibility factors that moderate the influence of social contexts on developmental outcomes.

Deficits in executive functions among youths with autism spectrum disorders: an age-stratified analysis

BACKGROUND

Impaired executive function (EF) is suggested to be one of the core features in individuals with autism spectrum disorders (ASD); however, little is known about whether the extent of worse EF in ASD than typically developing (TD) controls is age-dependent. We used age-stratified analysis to reveal this issue.

METHOD

We assessed 111 youths with ASD (aged 12.5 ± 2.8 years, male 94.6%) and 114 age-, and sex-matched TD controls with Digit Span and four EF tasks of the Cambridge Neuropsychological Test Automated Battery (CANTAB): Spatial Span (SSP), Spatial Working Memory (SWM), Stockings of Cambridge (SOC), and Intradimensional/Extradimensional Shift Test (I/ED).

RESULTS

Compared to TD controls, youths with ASD performed poorer on the Digit Span, SWM, SOC, and I/ED tasks. The performance of all the tasks improved with age for both groups. Age-stratified analyses were conducted due to significant age × group interactions in visuospatial planning (SOC) and set-shifting (I/ED) and showed that poorer performance on these two tasks in ASD than TD controls was found only in the child (aged 8-12 years) rather than the adolescent (aged 13-18 years) group. By contrast, youths with ASD had impaired working memory, regardless of age. The increased magnitude of group difference in visuospatial planning (SOC) with increased task demands differed between the two age groups but no age moderating effect on spatial working memory.

CONCLUSIONS

Our findings support deficits in visuospatial working memory and planning in youths with ASD; however, worse performance in set-shifting may only be demonstrated in children with ASD.

Répondre aux besoins des parents adolescents et de leurs enfants

Les parents adolescents et leurs enfants sont deux patients d’âge pédiatrique pour les dispensateurs de soins, et ont chacun leurs propres besoins de santé. Les jeunes parents et leur enfant peuvent être à risque de voir leur santé en souffrir, non pas directement à cause de l’âge de la mère, mais de la pauvreté et des autres inégalités en matière de déterminants sociaux de la santé. Pour bien évaluer les besoins de santé de l’enfant et de sa mère, il faut privilégier une approche objective, des outils de dépistage appropriés et des questions ouvertes qui tiennent compte à la fois de la prévention et des problèmes de santé aigus. Il est possible d’anticiper les besoins coexistants de cette dyade, car ils portent sur la croissance et le développement, la santé mentale du nourrisson et de l’adolescente, l’alimentation et la sécurité alimentaire, la sécurité, les relations, les pratiques parentales, l’éducation, la santé sexuelle et l’aide à trouver du soutien et des ressources. Les dispensateurs de soins qui comprennent le développement des adolescentes et intègrent des éléments du « foyer médical » axé sur les patients à leur pratique sont les mieux placés pour favoriser des résultats de santé positifs, tant pour la mère que pour son nourrisson.

The cost and impact of compulsivity: A research perspective

Compulsivity is the defining feature of various psychiatric disorders including Obsessive Compulsive Related Disorders (OCRDs), and other compulsive, impulsive, and addictive disorders. These disorders are disabling, chronic conditions with an early onset and high rates of comorbidity, misdiagnoses, and delay in treatment onset. Disorders of compulsivity are responsible for considerable socioeconomic burden to society. We review the costs and impacts of compulsivity. In order to facilitate earlier diagnosis and targeted treatments, we examine the overlapping mechanisms that underlie compulsivity. We reconceptualize psychiatric disorders based on core features of compulsivity, highlight challenges in harmonizing research in children and adults, describe newer research methodologies, and point to future directions that can impact the costs and impact of disorders of compulsivity.

Tailoring the delivery of cancer diagnosis to adolescent and young adult patients displaying strong emotions: An observational study of two cases

Delivering the bad news of a cancer diagnosis to adolescent and young adult (AYA) patients who display strong emotions is particularly challenging not the least because AYAs are at a vulnerable developmental stage. Due to the lack of research on how to personalize the delivery of bad news to AYA patients’ emotions we report a case study of the communicative behavior of oncologists in two such consultations to describe the complexity of the phenomena at study. We audio-recorded and transcribed consultations where oncologists delivered cancer diagnoses to nine AYAs aged 12–25 years. Two of these patients displayed particularly strong emotional behavior (anger, fear, and sadness) and were chosen as cases. An interpretative analysis in three steps was applied to investigate the oncologists’ communicative behavior when delivering bad news. The focus was on how the oncologists responded to the strong but different emotional behaviors of the AYAs. We also related the oncologists’ communicative behavior to elements from a widely used protocol for delivering bad news. We found that the oncologists applied five communication strategies: elicit patient perspective, provide information, respond to patient's expression of emotion (acknowledging and containing emotions), encourage commitment to treatment, and provide hope. The findings illustrate how oncologists’ communicative behavior may be tailored to individual expressions of emotions in AYA cancer patients.

Developmental psychopathology in an era of molecular genetics and neuroimaging: A developmental neurogenetics approach

The emerging field of neurogenetics seeks to model the complex pathways from gene to brain to behavior. This field has focused on imaging genetics techniques that examine how variability in common genetic polymorphisms predict differences in brain structure and function. These studies are informed by other complimentary techniques (e.g., animal models and multimodal imaging) and have recently begun to incorporate the environment through examination of Imaging Gene × Environment interactions. Though neurogenetics has the potential to inform our understanding of the development of psychopathology, there has been little integration between principles of neurogenetics and developmental psychopathology. The paper describes a neurogenetics and Imaging Gene × Environment approach and how these approaches have been usefully applied to the study of psychopathology. Six tenets of developmental psychopathology (the structure of phenotypes, the importance of exploring mechanisms, the conditional nature of risk, the complexity of multilevel pathways, the role of development, and the importance of who is studied) are identified, and how these principles can further neurogenetics applications to understanding the development of psychopathology is discussed. A major issue of this piece is how neurogenetics and current imaging and molecular genetics approaches can be incorporated into developmental psychopathology perspectives with a goal of providing models for better understanding pathways from among genes, environments, the brain, and behavior.