Journal of the American Academy of Child & Adolescent Psychiatry RSS feed: Articles in Press. Mission Statement Advancing the science of pediatric mental health and promoting the care of youth and their families. Scope The Journal of the American Academy of Child and Adolescent Psychiatry welcomes manuscripts from diverse viewpoints including but not limited to: genetic, epidemiological, neurobiological, psychopathological, cognitive, behavioral, and psychodynamic investigations. The Journal also seeks to promote the well being of children and families by publishing scholarly papers on such subjects as health policy, legislation, advocacy, culture, and service provision as they pertain to the mental health of children and families. http://www.jaacap.com//inpress?rss=yesElsevier Inc.en © 2012 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved. Journal of the American Academy of Child & Adolescent Psychiatry0890-85672012-05-07 © 2012 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.jaacap.com/article/PIIS0890856712002328/abstract?rss=yes Objectives: This study used proton magnetic resonance spectroscopy (1H MRS) to evaluate the in vivo effects of extended-release divalproex sodium on the glutamatergic system in adolescents with bipolar disorder, and to identify baseline neurochemical predictors of clinical remission. Method: Adolescents with bipolar disorder who were experiencing a manic or mixed episode (N = 25) were treated with open-label, extended-release divalproex (serum levels 85–125 μg/mL) and underwent 1H MRS scanning at baseline (before treatment) and on days 7 and 28. Healthy comparison subjects (n = 15) also underwent 1H MRS scanning at the same time points. Glutamate (Glu) and glutamate+glutamine (Glx) concentrations were measured in three voxels: anterior cingulate cortex (ACC), left ventrolateral prefrontal cortex (LVLPFC), and right ventrolateral prefrontal cortex (RVLPFC), and were compared between bipolar and healthy subjects. Within the bipolar subjects, Glu and Glx concentrations at baseline and each time point were also compared between remitters and nonremitters after divalproex treatment. Results: At baseline, no differences in Glu or Glx concentrations between bipolar and healthy subjects were observed. Group (HC vs. BP) by time effects revealed an interaction for Glu in the ACC, and change over time effects for Glx were noted in the ACC in patients with bipolar disorder (increase from day 0 to day 7 and then a decrease from day 7 to day 28) but not in HC. Remitters had significantly lower baseline Glx concentrations in LVLPFC, and in remitters the change in LVLPFC Glu correlated with the change in YMRS score. Conclusions: Successful treatment of mania with divalproex may be predicted by lower baseline concentrations of Glx in the LVLPFC. In addition, in remitters, the degree of symptomatic improvement is related to the change in Glu concentrations in this region, suggesting that divalproex may work via modulation of the prefrontal glutamatergic system in youth with bipolar disorder. Glutamatergic Effects of Divalproex in Manic Adolescents: A Proton Magnetic Resonance Spectroscopy Study - Corrected ProofJeffrey R. Strawn, Nick C. Patel, Wen-Jang Chu, Jing-Huei Lee, Caleb M. Adler, Mi Jung Kim, Holly S. Bryan, David C. Alfieri, Jeffrey A. Welge, Thomas J. Blom, Jayasree J. Nandagopal, Stephen M. Strakowski, Melissa P. DelBello10.1016/j.jaac.2012.03.009Journal of the American Academy of Child & Adolescent Psychiatry (2012)2012-05-07Journal of the American Academy of Child & Adolescent Psychiatry2012-05-07NEW RESEARCHhttp://www.jaacap.com/article/PIIS0890856712002274/abstract?rss=yes Objective: To examine the prevalence/predictors of mental health (MH) problems and services use in 12- to 36-month-old children who had been investigated for maltreatment. Method: Data came from the second National Survey of Child and Adolescent Well-Being (NSCAW II), a longitudinal study of youth ages 0 to 17.5 years referred to US child welfare agencies. These analyses involved 1117 children 12 to 36 months of age. Sociodemographic, social services, developmental and health data were collected on the children and caregivers. Outcomes were scores over the clinical cutoffs on the Brief Infant Toddler Social and Emotional Assessment (BITSEA) Scales for 12- to 18-month-olds and the Child Behavior Checklist (CBCL) for 19- to 36-month-olds. Results: In all, 34.6% of 12-18-month-olds scored high on the Problem Scale of the BITSEA, and 20.9% on the Competence Scale, whereas 10.0% of 19- to 36-month-olds scored over the CBCL clinical cut-off. Children of black ethnicity were less likely to have elevated scores on the BITSEA Problem Scale, whereas children who lived with a never-married caregiver were five times more likely to have elevated scores. Competence problems were associated with prior child welfare history. Elevated CBCL scores were associated with living with a depressed caregiver. Few children with identified MH problems, 2.2%, received an MH service. When we added parenting skills training that might be related to the treatment of child problems, 19.2% received a service. Conclusions: Identifiable MH problems are common, but few children receive services for those problems. The lack of services received by these young, multi-challenged children is a services systems and social policy failure. Mental Health Problems in Young Children Investigated by U.S. Child Welfare Agencies - Corrected ProofSarah McCue Horwitz, Michael S. Hurlburt, Amy Heneghan, Jinjin Zhang, Jennifer Rolls-Reutz, Emily Fisher, John Landsverk, Ruth E.K. Stein10.1016/j.jaac.2012.03.006Journal of the American Academy of Child & Adolescent Psychiatry (2012)2012-05-04Journal of the American Academy of Child & Adolescent Psychiatry2012-05-04NEW RESEARCHhttp://www.jaacap.com/article/PIIS0890856712002249/abstract?rss=yes Objective: There is increasing emphasis on dimensional conceptualizations of psychopathology, but empirical evidence of their utility is just emerging. In particular, although a range of multidimensional models have been proposed, the relative fit of competing models has rarely been tested. Furthermore, developmental considerations have received scant attention. In this study, we tested a developmentally based, four-dimensional model of disruptive behavior theorized to represent the defining features of disruptive behavior at preschool age: Temper Loss, Noncompliance, Aggression, and Low Concern for Others. Method: Model testing was conducted in two independent samples of preschoolers: Clinically Enriched Sample (n = 336) and Epidemiologic Sample (n = 532). The tau-equivalent confirmatory factor analyses were used to test the fit of the Developmental Model relative to three leading competing models (DSM opositional defiant disorder (ODD)/conduct disorder (CD) Model, “Callous” Model, and an “Irritable/Headstrong/Hurtful” Model). Reliability of the four dimensions was also tested. Validity of the dimensions was tested by predicting multi-informant, multi-method ratings of disruptive behavior and impairment, and incremental utility relative to DSM symptoms. Results: In both samples, the Developmental Model demonstrated a superior fit compared with the competing models within the full sample, and across key demographic sub-groups. Validity was also demonstrated, including incremental utility relative to DSM-IV disruptive behavior symptoms. Conclusions: Critical next steps for achieving scientific consensus about the optimal dimensional model of disruptive behavior and its clinical application are discussed. Putting Theory to the Test: Modeling a Multidimensional, Developmentally-Based Approach to Preschool Disruptive Behavior - Corrected ProofLauren S. Wakschlag, David B. Henry, Patrick H. Tolan, Alice S. Carter, James L. Burns, Margaret J. Briggs-Gowan10.1016/j.jaac.2012.03.005Journal of the American Academy of Child & Adolescent Psychiatry (2012)2012-04-30Journal of the American Academy of Child & Adolescent Psychiatry2012-04-30NEW RESEARCHhttp://www.jaacap.com/article/PIIS0890856712001438/abstract?rss=yes Objective: Assessment of inattention and hyperactivity in preschoolers is highly dependent upon parental reports. Such reports are compromised by parental attitudes and mental health. Our study aimed to examine associations of inattention and hyperactivity/impulsivity from maternal reports on the Conners' Parent Rating Scale (CPRS) with brain morphology assessed using structural magnetic resonance imaging (MRI) and diffusion tensor imaging (DTI) in 6-year-old boys. Method: Large deformation diffeomorphic metric brain mapping was used to assess brain morphology on MRI and DTI in 96 six-year-old boys, including cortical thickness, subcortical shapes, and fractional anisotropy (FA) of deep white matter tracts (DWMTs). Linear regression examined associations between these measures of brain structures and mothers' CPRS ratings of their child's inattention and hyperactivity/impulsivity. Results: Our results revealed that temporal and parietal cortices, as well as posterior white matter and callosal tracts are associated with inattention and hyperactivity/impulsivity symptoms among six-year-old boys. Inattention and hyperactivity/impulsivity symptoms share common neural circuits, but hyperactivity/impulsivity ratings associate with more extensive cortical areas, such as frontal regions, and with white matter tracts emphasizing executive control. There were no associations detected between inattention (or hyperactivity/impulsivity) and the shape of subcortical structures. Conclusions: Our results suggested specific rather than widespread neural circuits involved in inattention and hyperactivity/impulsivity in young children, which is congruent with existing findings in older children and adolescents, and in adults with attention-deficit/hyperactivity disorder (ADHD). Hence, our study supported the dimensional view of ADHD, that is, that symptoms of inattention and hyperactivity/impulsivity lie on a continuum. Inattention and Hyperactivity Predict Alterations in Specific Neural Circuits Among 6-Year-Old Boys - Corrected ProofAnqi Qiu, Anne Rifkin-Graboi, Ta Anh Tuan, Jidan Zhong, Michael J. Meaney10.1016/j.jaac.2012.02.017Journal of the American Academy of Child & Adolescent Psychiatry (2012)2012-04-26Journal of the American Academy of Child & Adolescent Psychiatry2012-04-26NEW RESEARCHhttp://www.jaacap.com/article/PIIS0890856712001931/abstract?rss=yes Objective: This study aimed to investigate the longitudinal course of daily living skills in a large, community-based sample of adolescents and adults with autism spectrum disorders (ASD) over a 10-year period. Method: Adolescents and adults with ASD (n = 397) were drawn from an ongoing, longitudinal study of individuals with ASD and their families. A comparison group of 167 individuals with Down syndrome (DS) were drawn from a linked longitudinal study. The Waisman Activities of Daily Living Scale was administered four times over a 10-year period. Results: We used latent growth curve modeling to examine change in daily living skills. Daily living skills improved for the individuals with ASD during adolescence and their early 20s, but plateaued during their late 20s. Having an intellectual disability was associated with lower initial levels of daily living skills and a slower change over time. Individuals with DS likewise gained daily living skills over time, but there was no significant curvature in the change. Conclusions: Future research should explore what environmental factors and interventions may be associated with continued gains in daily living skills for adults with ASD. Developmental Trajectories in Adolescents and Adults With Autism: The Case of Daily Living Skills - Corrected ProofLeann E. Smith, Matthew J. Maenner, Marsha Mailick Seltzer10.1016/j.jaac.2012.03.001Journal of the American Academy of Child & Adolescent Psychiatry (2012)2012-04-26Journal of the American Academy of Child & Adolescent Psychiatry2012-04-26NEW RESEARCHhttp://www.jaacap.com/article/PIIS0890856712001426/abstract?rss=yes Objective: Rage attacks have been documented in youth with varied psychiatric disorders, but few data have been reported on the clinical characteristics and correlates of rage attacks among children with obsessive-compulsive disorder (OCD). Method: Participants were 86 children (ages 6–16 years) with a primary diagnosis of OCD. Patients and their primary caregiver were administered clinician-rated measures of obsessive-compulsive severity and rage severity. Children completed the Center for Epidemiologic Studies Depression Scale and the Child Sheehan Disability Scale-Child, whereas parents completed the Rage Attacks Questionnaire, Aberrant Behavior Checklist—Irritability Scale, Children's Affective Lability Scale, and Child Sheehan Disability Scale-Parent. Results: Rage was common among youth with OCD and was associated with varied clinical characteristics. Rage severity accounted for functional impairment beyond the influence of obsessive-compulsive symptom severity; however, these relations were explained by the impact of family accommodation. Conclusions: These data suggest that rage attacks are relatively common, have a negative impact on illness presentation, and contribute to functional impairment above and beyond obsessive-compulsive symptom severity. Rage may contribute to family accommodation of symptoms, which may further affect obsessive-compulsive symptom severity and impairment. Rage Attacks in Pediatric Obsessive-Compulsive Disorder: Phenomenology and Clinical Correlates - Corrected ProofEric A. Storch, Anna M. Jones, Caleb W. Lack, Chelsea M. Ale, Michael L. Sulkowski, Adam B. Lewin, Alessandro S. De Nadai, Tanya K. Murphy10.1016/j.jaac.2012.02.016Journal of the American Academy of Child & Adolescent Psychiatry (2012)2012-04-19Journal of the American Academy of Child & Adolescent Psychiatry2012-04-19NEW RESEARCH