Altered intrinsic functional connectivity of the cingulate cortex in children with severe temper outbursts

Severe temper outbursts (STO) in children are associated with impaired school and family functioning and may contribute to negative outcomes. These outbursts can be conceptualized as excessive frustration responses reflecting reduced emotion regulation capacity. The anterior cingulate cortex (ACC) has been implicated in negative affect as well as emotional control, and exhibits disrupted function in children with elevated irritability and outbursts. This study examined the intrinsic functional connectivity (iFC) of a region of the ACC, the anterior midcingulate cortex (aMCC), in 5- to 9-year-old children with STO (n = 20), comparing them to children with attention-deficit/hyperactivity disorder (ADHD) without outbursts (ADHD; n = 18). Additional analyses compared results to a sample of healthy children (HC; n = 18) and examined specific associations with behavioral and emotional dysregulation. Compared to the ADHD group, STO children exhibited reduced iFC between the aMCC and surrounding regions of the ACC, and increased iFC between the aMCC and precuneus. These differences were also seen between the STO and HC groups; ADHD and HC groups did not differ. Specificity analyses found associations between aMCC-ACC connectivity and hyperactivity, and between aMCC-precuneus iFC and emotion dysregulation. Disruption in aMCC networks may underlie the behavioral and emotional dysregulation characteristic of children with STO

Irritability in youth: A critical integrative review

Irritability, defined as proneness to anger that may reach an impairing extent, is common in youth. There has been a recent upsurge in relevant research. We combine systematic and narrative review approaches to integrate the latest clinical and translational findings and provide suggestions to address research gaps. Clinicians and researchers should assess irritability routinely; specific assessment tools are now available. Informant effects are prominent, stable, and vary by age and gender. The prevalence of irritability is particularly high in attention deficit hyperactivity disorder, autism spectrum disorder, and mood and anxiety disorders. Irritability is associated with impairment and suicidality risk independent of co-occurring diagnoses. Irritability trajectories have been identified that are differentially associated with clinical outcomes; some begin early in life. Youth irritability is associated with increased risk later in life for anxiety, depression, behavioral problems, and suicidality. Irritability is moderately heritable and genetic associations differ based on age and comorbid illnesses. Parent management training is effective for constructs related to irritability, but its efficacy in irritability should be tested rigorously, as should novel mechanism-informed interventions (e.g., those targeted to frustration exposure). Associations between irritability and suicidality and the impact of cultural context are important, under-researched topics. Large, diverse, longitudinal samples that extend into adulthood are needed. Data from both animal and human research indicate that aberrant responses to frustration and threat are central to the pathophysiology of irritability, thus affording important translational opportunities

Your Resting Brain CAREs about Your Risky Behavior

Research on the neural correlates of risk-related behaviors and personality traits has provided insight into mechanisms underlying both normal and pathological decision-making. Task-based neuroimaging studies implicate a distributed network of brain regions in risky decision-making. What remains to be understood are the interactions between these regions and their relation to individual differences in personality variables associated with real-world risk-taking.We employed resting state functional magnetic resonance imaging (R-fMRI) and resting state functional connectivity (RSFC) methods to investigate differences in the brain's intrinsic functional architecture associated with beliefs about the consequences of risky behavior. We obtained an individual measure of expected benefit from engaging in risky behavior, indicating a risk seeking or risk-averse personality, for each of 21 participants from whom we also collected a series of R-fMRI scans. The expected benefit scores were entered in statistical models assessing the RSFC of brain regions consistently implicated in both the evaluation of risk and reward, and cognitive control (i.e., orbitofrontal cortex, nucleus accumbens, lateral prefrontal cortex, dorsal anterior cingulate). We specifically focused on significant brain-behavior relationships that were stable across R-fMRI scans collected one year apart. Two stable expected benefit-RSFC relationships were observed: decreased expected benefit (increased risk-aversion) was associated with 1) stronger positive functional connectivity between right inferior frontal gyrus (IFG) and right insula, and 2) weaker negative functional connectivity between left nucleus accumbens and right parieto-occipital cortex.Task-based activation in the IFG and insula has been associated with risk-aversion, while activation in the nucleus accumbens and parietal cortex has been associated with both risk seeking and risk-averse tendencies. Our results suggest that individual differences in attitudes toward risk-taking are reflected in the brain's functional architecture and may have implications for engaging in real-world risky behaviors

Brain development and ADHD

Attention-Deficit/Hyperactivity Disorder (ADHD) is characterized by excessive inattention, hyperactivity, and impulsivity, either alone or in combination. Neuropsychological findings suggest that these behaviors result from underlying deficits in response inhibition, delay aversion, and executive functioning which, in turn, are presumed to be linked to dysfunction of frontal– striatal–cerebellar circuits. Over the past decade, magnetic resonance imaging (MRI) has been used to examine anatomic differences in these regions between ADHD and control children. In addition to quantifying differences in total cerebral volume, specific areas of interest have been prefrontal regions, basal ganglia, the corpus callosum, and cerebellum. Differences in gray and white matter have also been examined. The ultimate goal of this research is to determine the underlying neurophysiology of ADHD and how specific phenotypes may be related to alterations in brain structure

The role of treatment acceptability in the initiation of treatment for ADHD

Approximately 50 percent of families of children with ADHD fail to pursue, or adhere to, recommended treatments. The present study examines parent ratings of the acceptability of pharmacological and behavioral treatments for ADHD and the relationships between these ratings and subsequent pursuit of treatment. Fifty-five families whose children received an evaluation for ADHD completed questionnaires and were contacted 3 to 4 months later to assess their pursuit of treatment. Consistent with previous research, parents rated behavior therapy as more acceptable than medication. Parent ratings of medication acceptability significantly predict pursuit of pharmacological treatment, whereas ratings of the acceptability of behavior therapy do not predict pursuit of this treatment. Preliminary analyses found that Caucasian parents’ ratings of medication are significantly higher than those of non-Caucasian parents. Furthermore, Caucasian families were more likely to pursue a recommendation for pharmacological treatment than non-Caucasian families. The clinical and research implications of these results are considered

Pediatric Anxiety DisordersA Clinical Guide /

X, 387 p. 8 illus.online resource

A Critical Review of Attentional Threat Bias and Its Role in the Treatment of Pediatric Anxiety Disorders

Threat bias, or exaggerated selective attention to threat, is considered a key neurocognitive factor in the etiology and maintenance of pediatric anxiety disorders. However, upon closer examination of the literature, there is greater heterogeneity in threat-related attentional biases than typically acknowledged. This is likely impacting progress that can be made in terms of interventions focused on modifying this bias and reducing anxiety, namely attention bias modification training. We suggest that the field may need to take a step back from developing interventions and focus research efforts on improving the methodology of studying attention bias itself, particularly in a developmental context. We summarize a neurocognitive model that addresses the issue of heterogeneity by broadly incorporating biases toward and away from threat, linking this variation to key neurodevelopmental factors, and providing a basis for future research aimed at improving the utility of threat bias measures and interventions in clinical practice

The case of Molly L.: Use of a family cognitive-behavioral treatment for childhood anxiety

The present case study illustrates how a family cognitive-behavioral therapy (FCBT) was used to treat a 9-year-old girl diagnosed with separation anxiety disorder and agoraphobia without panic. The first half of treatment focused on teaching specific coping skills, whereas the second half consisted of exposure tasks that provided opportunities for Molly to practice what she had learned. The therapy also addressed issues of family communication and emotional expression. Through flexible application of the manual, the therapist helped Molly with her own self-image and expectations for coping. Following treatment, Molly and her parents reported that her anxiety had decreased and that her coping skills had improved. Overall, this case illustrates the successful and application of FCBT and highlights the importance of applying a treatment manual flexibly to address client needs