Developmental pathways to attention-deficit/hyperactivity disorder and disruptive behavior disorders: Investigating the impact of the stress response on executive functioning

Mindfulness-based intervention in adolescents at risk for excess weight gain: 1.5-year follow-up of pilot randomized controlled trial

BACKGROUND

Mindfulness-based intervention (MBI) may offer a novel means of preventing excess weight gain in adolescents, theoretically by decreasing stress-eating through altering executive functioning (EF) and food-reward sensitivity.

METHODS

N = 54 12-17y girls and boys at-risk for excess weight gain (i.e., BMI ≥70th percentile or two biological parents with reported obesity [BMI ≥30 kg/m2]) participated in a 1.5-year follow-up of a pilot randomized controlled trial comparing 6-week/6-session MBI (n = 29) and a health education (HE) control (n = 25). Laboratory stress-eating, food-reward sensitivity, EF, perceived stress, and BMI/adiposity were re-assessed at 1.5-years with validated measures. Changes from baseline to 1.5-year follow-up were explored with ANCOVA, accounting for the respective baseline outcome, age, and sex.

RESULTS

Compared to MBI (M = -21, SE = 59), HE had greater increases in stress-eating from baseline to 1.5-years (M = 194, SE = 63, Cohen's d = 0.59, p = .01). There were no other between-condition differences.

DISCUSSION

MBI may prevent worsening stress-eating for adolescents at-risk for excess weight gain. The potential for MBI as an intervention for stress-eating and ultimately, weight stabilization warrants testing in an adequately-powered trial.

Suggestibility and confabulation among individuals with Fetal Alcohol Spectrum Disorder: A review for criminal justice, forensic mental health, and legal interviewers

Fetal Alcohol Spectrum Disorders (FASD) are conditions arising from prenatal alcohol exposure which results in a range of neurodevelopmental deficits in areas including cognition, memory, language, executive functioning, emotional regulation, and adaptive functioning. Deficits in various neurodevelopmental areas can range from mild to severe, depending on many factors including the quantity and timing of alcohol exposure during the prenatal development period. During interviews in criminal justice, forensic mental health, and legal contexts (e.g., criminal investigations, cross examination, victim interviews, interviews for lawsuits, forensic evaluations, pre-sentence investigations), deficits associated with FASD may elevate the risk of suggestibility and confabulation. These issues can result in negative jurisprudence-related outcomes, including impulsive Miranda rights waivers, incorrect assumptions of competency, inaccurate or incomplete information gathering, misinterpretation of intent, witness reliability issues, court ordered treatment completion problems, probation and parole violations, false confessions, and false accusations. The aim of the present article is to explain the context in which these issues can arise and provide criminal justice, forensic mental health, and legal professionals with key guidelines that can assist in minimizing suggestibility and confabulation when interviewing persons with FASD. We hope that the suggestions and strategies presented in this article will reduce potential obstructions of justice and enhance the quality of information obtained from individuals impacted by FASD. A brief discussion is also provided to identify additional research and training opportunities needed to clarify "best practices" for professionals tasked with evaluating the challenges facing this unique population.

Psychiatric Disorders in the Adolescent Offspring of Mothers with Thyroid Problems During Pregnancy

Maternal thyroid problems during pregnancy have been linked to neurocognitive impairments in children. While studies suggest that disorders of maternal thyroid function during pregnancy are associated with symptoms of mental health problems in children, little is known about the risk of clinically significant psychiatric disorders in adolescence. A sample of 2451 Canadian adolescents enrolled in the Ontario Child Health Study completed the Mini International Neuropsychiatric Interview for Children and Adolescents at 12-17 years of age. Their mothers self-reported thyroid problems during pregnancy. Gestational thyroid problems were associated with offspring oppositional defiant disorder (ODD; OR 3.73; 95% CI 1.69-8.24), conduct disorder (CD; OR 12.95; 95% CI 5.12-32.75), and social anxiety disorder (SAD; OR 6.25; 95% CI 2.53-15.47). Neither sex nor gestational age moderated associations between prenatal thyroid dysfunction and the majority of outcomes. School performance mediated 8% of the association between thyroid problems and SAD, 21% for CD and 53% for ODD.

Executive Function and Psychopathology: A Neurodevelopmental Perspective

Executive function (EF) skills are neurocognitive skills that support the reflective, top-down coordination and control of other brain functions, and there is neural and behavioral evidence for a continuum from more "cool" EF skills activated in emotionally neutral contexts to more "hot" EF skills needed for the reversal of motivationally significant tendencies. Difficulties in EF are transdiagnostic indicators of atypical development. A neurodevelopmental model traces the pathway from adverse childhood experiences and stress to disruption of the development of neural systems supporting reflection and EF skills to an increased risk for general features of psychopathology. Research indicates that EF skills can be cultivated through scaffolded training and are a promising target for therapeutic and preventive intervention. Intervention efficacy can be enhanced by mitigating disruptive bottom-up influences such as stress, training both hot and cool EF skills, and adding a reflective, metacognitive component to promote far transfer of trained skills.

Context matters: A review to formulate a conceptual framework for coaching as a disability accommodation

Although dyslexia affects 5-8% of the workforce this developmental disorder has not been sufficiently researched in adult populations. Yet a diagnosis confers legal protections as employers must provide disability 'accommodations' to assist work functioning and performance. The implementation of such accommodations, including coaching, lacks theoretical framing and evaluations of impact in practice. Recognizing a need for conceptual work, we undertook a narrative, systematic scoping review from a realist pragmatic epistemology, taking an iterative approach to define and address the review question: 'to what extent, and under what conditions, can face-to-face learning interventions improve Working Memory (WM) and Self-Efficacy (SE) and can these lead to functional improvements related to work performance?' Informed by expert and stakeholder consultation and user data, our review extracted and synthesized 25 studies from eleven countries to identify potentially applicable learning intervention theories, their effects upon WM and SE but also functional outcomes such as comprehension. We suggest that intervention protocols informed by Social Cognitive Learning Theory can improve SE, as would be expected, and more surprisingly also WM. The development of metacognition, stress management and fidelity to Goal Setting Theory were identified as valuable intervention features. We propose that coaching activities may provide a more contextualized environment for transfer of learning from WM to functional skills such as comprehension, when compared to computerized training interventions. We call for theoretically underpinned, primary studies to evaluate interventions with adult dyslexic populations to further our understanding of disability accommodations.

“How Do We Solve This Task?”

Abstract. The study examines (a) whether gestational age relates to parental scaffolding (SCA), when controlling for child cognitive development, parenting stress, and socioeconomic status, and (b) how SCA links to parent–child problem-solving performance. The sample included 142 parents with a full-term or preterm 2-year-old toddler (corrected age). Parents’ SCA during one of two (randomly assigned) problem-solving tasks was rated on five scales (use of SCA means, cognitive support, metacognitive support, transfer or responsibility, contingency management). The results suggest that gestational age is positively related to parents’ transfer of responsibility and metacognitive support. The effects decrease, however, once covariates are controlled for. Regarding the problem-solving performance, direct effects were observed from parents’ cognitive and metacognitive support, transfer of responsibility, and contingency management. The data also confirm an indirect effect of parents’ use of SCA means on the problem-solving performance, partially mediated via parents’ cognitive support. Implications for the design of interventions are discussed.

Children's stress regulation mediates the association between prenatal maternal mood and child executive functions for boys, but not girls

Prenatal exposure to maternal mood disturbances shapes children's cognitive development reflected in the critical construct of executive functions (EFs). Little is known, however, about underlying mechanisms. By examining cortisol responses in both everyday and lab challenge settings, we tested whether the child/offspring hypothalamic-pituitary-adrenal axis mediates effects of prenatal maternal mood on child EFs at age 6. In 107 Canadian children born to women with a wide range of anxious and depressive symptoms during pregnancy, we found that in boys but not girls, depressed and/or anxious prenatal maternal mood is associated with heightened diurnal cortisol levels in everyday settings, as well as heightened cortisol reactivity to a lab challenge and that this heightened reactivity was associated with poorer EFs. Among boys we also observed that cortisol reactivity but not diurnal cortisol mediated the association between depressed and/or anxious prenatal maternal mood and EFs. Depressed and/or anxious prenatal maternal mood was related to child EFs for both girls and boys. To our knowledge, this is the first study to demonstrate a mediating role for child stress regulation in the association between prenatal maternal stress-related mood disturbances and child EFs, providing evidence of a mechanism contributing to fetal programming of cognition.

Meta-Analyses of Externalizing Disorders: Genetics or Prenatal Alcohol Exposure?

BACKGROUND

Externalizing disorders are heritable precursors to alcohol dependence, common in children of alcoholics (COA), and in children with prenatal alcohol exposure (PAE). Pregnancies involving alcohol exposure sufficient to affect the fetus may involve women with genetic risk for alcohol dependence. We hypothesized that known PAE will increase the odds of having an externalizing disorder compared to COA.

METHODS

The odds ratios of 3 externalizing disorders (attention-deficit hyperactivity disorder [ADHD], conduct disorder [CD], and oppositional defiant disorder [ODD]) were obtained for 2 domains: (i) PAE and (ii) COA, by estimating the logged odds ratio (LOR) for each study. Permutation tests were implemented to compare LORs for PAE versus COA studies within each disorder, including PAE versus an alcohol dependent (AD) mother and PAE versus an AD father.

RESULTS

In PAE studies, the odds of ADHD and CD were elevated. Rates of all 3 disorders were elevated in COA studies. Permutation tests revealed that the mean LOR for ADHD was significantly higher in PAE studies compared to: COA (p = 0.01), AD mother (p < 0.05), and AD father (p = 0.03). No differences were found for ODD (p = 0.09) or CD (p = 0.21).

CONCLUSIONS

These results provide compelling evidence of an increased risk of ADHD in those with PAE beyond that due to parental alcohol dependence or a genetic liability, consistent with a unique etiology most likely due to direct alcohol exposure during prenatal development.

Divergence in Morris Water Maze-Based Cognitive Performance under Chronic Stress Is Associated with the Hippocampal Whole Transcriptomic Modification in Mice

Individual susceptibility determines the magnitude of stress effects on cognitive function. The hippocampus, a brain region of memory consolidation, is vulnerable to stressful environments, and the impact of stress on hippocampus may determine individual variability in cognitive performance. Therefore, the purpose of this study was to define the relationship between the divergence in spatial memory performance under chronically unpredictable stress and an associated transcriptomic alternation in hippocampus, the brain region of spatial memory consolidation. Multiple strains of BXD (B6 × D2) recombinant inbred mice went through a 4-week chronic variable stress (CVS) paradigm, and the Morris water maze (MWM) test was conducted during the last week of CVS to assess hippocampal-dependent spatial memory performance and grouped animals into low and high performing groups based on the cognitive performance. Using hippocampal whole transcriptome RNA-sequencing data, differential expression, PANTHER analysis, WGCNA, Ingenuity's upstream regulator analysis in the Ingenuity Pathway Analysis® and phenotype association analysis were conducted. Our data identified multiple genes and pathways that were significantly associated with chronic stress-associated cognitive modification and the divergence in hippocampal dependent memory performance under chronic stress. Biological pathways associated with memory performance following chronic stress included metabolism, neurotransmitter and receptor regulation, immune response and cellular process. The Ingenuity's upstream regulator analysis identified 247 upstream transcriptional regulators from 16 different molecule types. Transcripts predictive of cognitive performance under high stress included genes that are associated with a high occurrence of Alzheimer's and cognitive impairments (e.g., Ncl, Eno1, Scn9a, Slc19a3, Ncstn, Fos, Eif4h, Copa, etc.). Our results show that the variable effects of chronic stress on the hippocampal transcriptome are related to the ability to complete the MWM task and that the modulations of specific pathways are indicative of hippocampal dependent memory performance. Thus, the divergence in spatial memory performance following chronic stress is related to the unique pattern of gene expression within the hippocampus.

La escucha de música antes del TSST regula los niveles de cortisol en saliva independiente de la preferencia musical

El presente estudio evaluó si la escucha de música preferida por los participantes o la música relajante elegida por los investigadores previa al protocolo de estrés social modificado TSST (Trier Social Stress Test) afectaba el desempeño de las actividades realizadas durante el propio test, modulaba la respuesta de estrés que este induce, y en conjunto con el estresor, afectaba el desempeño en una tarea de atención en setenta y seis estudiantes universitarios asignados a uno de seis grupos: música relajante del investigador, música preferida por el participante y silencio, con o sin TSST. Los resultados mostraron que la escucha de ambos tipos de música provocó un incremento más lento en los niveles de cortisol en saliva luego del TSST, mientras que el aumento en la ansiedad estado evaluada con el IDARE (Inventario de Ansiedad Rasgo-Estado) fue semejante en todos los grupos. No se encontraron diferencias debidas a la música en el desempeño de las tareas evaluadas. Se discute sobre la modulación de la escucha de música en la respuesta fisiológica de estrés por la posible inducción de reacciones emocionales de manera independiente de la preferencia musical.

Mothers' parenting stress is associated with salivary cortisol profiles in children with attention deficit hyperactivity disorder

The aim of this study was to explore the relation between mothers' parenting stress and the functioning of the hypothalamic-pituitary-adrenal axis (HPAA), as expressed by daily salivary cortisol concentrations, in their children diagnosed with attention deficit hyperactivity disorder (ADHD). Seventy-five children aged 6-11 years diagnosed with ADHD predominant hyperactive-impulsive/combined (ADHD-HI/C, N = 49) and inattentive symptoms (ADHD-I, N = 26) and 45 healthy peers and their mothers participated in the study. Μothers completed measures assessing their children's ADHD status, perceived parenting stress (Parenting Stress Index - Short Form, PSI-SF), mothers' symptoms of psychopathology, social support and socioeconomic status. Children's salivary cortisol samples were collected at six different time points on a single day. Mothers of children with ADHD-HI/C reported higher levels of parenting stress than mothers of children with ADHD-I and controls. All PSI-SF subscales showed significant associations with children's cortisol awakening response (CAR) in both ADHD groups, with the exception of the parental distress subscale in the ADHD-I group. In both ADHD groups, the parent-child dysfunctional interaction subscale, the difficult child subscale and the PSI total score were significantly associated with children's CAR. An interrelation is revealed between mothers' high levels of parenting stress and HPAA functioning in children with ADHD. In this population, CAR has been identified as a sensitive peripheral measure of HPAA functioning in children. Lay summaryThis study showed that in families of children diagnosed with ADHD, there is a complex relation between the mothers' high levels of parenting stress and children's atypical hypothalamic-pituitary-adrenal axis functioning.

Prenatal Alcohol Exposure in Rodents As a Promising Model for the Study of ADHD Molecular Basis

A physiological parallelism, or even a causal effect relationship, can be deducted from the analysis of the main characteristics of the “Alcohol Related Neurodevelopmental Disorders” (ARND), derived from prenatal alcohol exposure (PAE), and the behavioral performance in the Attention-deficit/hyperactivity disorder (ADHD). These two clinically distinct disease entities, exhibits many common features. They affect neurological shared pathways, and also related neurotransmitter systems. We briefly review here these parallelisms, with their common and uncommon characteristics, and with an emphasis in the subjacent molecular mechanisms of the behavioral manifestations, that lead us to propose that PAE in rats can be considered as a suitable model for the study of ADHD.

A lasting effect of postnatal sevoflurane anesthesia on the composition of NMDA receptor subunits in rat prefrontal cortex

Sevoflurane is widely used in pediatric anesthesia and studies have shown that it is capable of inducing neurodegeneration and subsequent cognitive disorders in the developing brain. However, the evidence that anesthetics are toxic to the human brain is insufficient. N-Methyl-d-aspartate (NMDA) receptors, critical for learning and memory, display expression changes with age and can be modulated by inhalation anesthetics. Generally, NMDA receptor (NR) type 1 is expressed at birth, peaks around the third postnatal week, and then declines slightly to adult levels. NR2Bs slowly decrease and NR2As gradually increase during postnatal development. These developmental switches of NMDA receptor subunits composition mark the transition from immature to adult neural processing and allow for the final maturation of associative learning abilities. In this study, we aimed to evaluate the effect of repeated sevoflurane anesthesia on NMDA receptor subunits composition in the developing rat brain and related behavioral disorders. Six-day-old male Sprague Dawley rats were randomly allocated into either a control group (group con) or a sevoflurane group (group sevo). Group sevo inhaled 2.1% sevoflurane carried by 70% oxygen for 2h each day from postnatal day (PND) 6 to PND 8. The same procedure, without applying the sevoflurane, was executed in group con. The membrane protein expression of NR1, NR2A and NR2B in the prefrontal cortex (PFC) and hippocampus was assessed at the end of the three days of anesthesia and at PND 21. An open field test was carried out to assess spontaneous locomotion on PNDs 21, 28 and 35. Y maze performance was used to assess attention and working memory on PND 28. Sevoflurane induced upregulation of NR1 and NR2B in the PFC at the end of anesthesia. On PND 21, NR1 and NR2B receptors were significantly increased whereas NR2A receptors were significantly decreased in the PFC in group sevo. Sevoflurane-treated rats showed hyper-locomotion and impairment of working memory in the behavior tests. These results indicate that repeated sevoflurane anesthesia at early stage of life can induce a long lasting effect of interfering with NMDA receptor subunits composition in rat PFC. These changes may contribute to the effects of sevoflurane on neuronal development and subsequent neurobehavioral disorders.