Cognitive assessment using ERP in child and adolescent psychiatry: Difficulties and opportunities

Event related potentials (ERPs) represent powerful tools to investigate cognitive functioning in child and adolescent psychiatry. So far, the available body of research has largely focused on advancements in analysis methods, with little attention given to the perspective of assessment. The aim of this brief report is to provide recommendations for cognitive ERPs assessment that can be applied across diagnostic categories in child and adolescent psychiatry research. First, we discuss major issues for ERPs testing using examples from common psychiatric disorders. We conclude by summing up our recommendations for methodological standards and highlighting the potential role of ERPs in the field

Locked down with my eating disorder: a retrospective study on the impact of COVID-19 lockdown on adolescents with eating disorders

BACKGROUND: Negative effects of COVID-19 lockdowns have been reported in adult patients with feeding and eating disorders (FED) whereas evidence of its impact on young clinical populations is still limited and somewhat inconsistent. The present study aims to investigate the effect of the first COVID-19 lockdown on a range of FED symptoms in children and adolescents: (a) already receiving treatment in our specialist service for FED when the pandemic hit, and (b) prospectively evaluated in our service from October 2020 to July 2021. METHODS: Out of sixty-one eligible patients with a broad spectrum of FED invited, forty-five young patients (aged 11–18) consented to participate and were included. An ad-hoc survey, consisting of open questions, multiple choice questions, yes/no questions, and a symptoms checklist, was administered online. RESULTS: About half of the participants (46.7%) reported a positive effect of lockdown on FED symptomatology. Patients with anorexia nervosa (AN) reported the highest rate of symptomatology worsening (58.6%). Younger patients (11–13 years) showed a greater improvement of symptoms compared to older ones (14–18 years of age). COVID-19 lockdown was identified as the precipitating factor for FED onset in 60.7% of newly evaluated patients. CONCLUSION: Evidence from our investigation points out that although the COVID-19 pandemic was a precipitating factor for a FED for many active and newly referred patients, it had a positive impact on youth who were already in treatment and younger participants

Patterns of maladaptive exercise behavior from ages 14-24 in a longitudinal cohort

Background: Exercise for weight loss and maladaptive exercise (exercise that results in negative consequences or interference with daily life) are common behaviors among youth and are associated with increased risk of disordered eating symptoms. The current study clarifies processes that influence exercise-related risk in adolescence and young adulthood, including the frequency with which young people transition between engaging in exercise for weight loss and experiencing negative consequences of this behavior. Method: Participants from the Avon Longitudinal Study of Parents and Children (ALSPAC) reported on eating disorder cognitions at age 14, and exercise behavior at ages 14, 16, 18, and 24 years old. Analyses examined rates of transition between the categories of ‘No Exercise for Weight Loss’, ‘Exercise for Weight Loss’, and ‘Maladaptive Exercise’ over time, identified overall trends in endorsement of exercise for weight loss and maladaptive exercise, and clarified predictors of these behaviors. Results: Endorsement of exercise for weight loss and maladaptive exercise increased over time in both males and females. Those in the ‘Exercise for Weight Loss’ category were more likely than those in the ‘No Exercise for Weight Loss Category’ to transition to ‘Maladaptive Exercise’ over time. Body mass index (Age 13) and fear of weight gain (Age 14) were consistent predictors of maladaptive exercise across sex. Conclusions: Results support re-framing motivations for exercise in youth away from weight loss at a population level and targeting reductions in fear of weight gain for high-risk individuals

EEG Biomarkers in Children and Adolescents With Feeding and Eating Disorders: Current Evidence and Future Directions

Introduction: Electroencephalography (EEG) represents a powerful tool to detect abnormal neural dynamics in child and adolescent psychiatry. Feeding and Eating Disorders (FEDs), such as anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), and avoidant restrictive food intake disorder (ARFID) onset in childhood and adolescence. EEG has rarely been used to examine cortical brain activity in children and adolescents with FEDs. This review aims to summarize EEG findings in FEDs amongst children and adolescents, and to highlight areas deserving further research. / Methods: We searched the literature for EEG studies on children and adolescents with FEDs using Google Scholar, PsycINFO, Medline, and PubMed. / Results: Twelve studies were identified, the majority focusing on AN (N = 10). The identified studies suggest reduced action monitoring control (preparatory waves, N200, P300), specific perceptual-cognitive styles to body/face perception (late positive potentials/early posterior negativity), as well as fundamental changes in posterior theta oscillations in AN. Behavioral traits of BN/BED (i.e., loss of control eating, emotional eating), and AN seem to be associated with an increased attentional reactivity (P300) to visual food stimuli. / Conclusion: Electroencephalography research in children and adolescents with FEDs is limited and mostly focused on AN. While EEG abnormalities seem consistent with a reduced top-down control and attentional allocation deficits in AN, altered attention specific to food cues emerges across FEDs. Overcoming conventional EEG analyses, and investigating spatial properties (i.e., electrical neuroimaging), will enhance our understanding of FEDs neurobiology

Cardiac interoception in Anorexia Nervosa: A resting-state heartbeat-evoked potential study

Objective: A deficit in interoception - the ability to perceive, interpret and integrate afferent signals about the physiological state of the body - has been shown in Anorexia Nervosa (AN), and linked to altered hunger sensations, body dysmorphia, and abnormal emotional awareness. The present high-density electroencephalography (hdEEG) study aims to assess cardiac interoception in AN and to investigate its neural correlates, using an objective neurophysiological measure. // Method: Heartbeat-evoked potentials (HEPs) were computed from 5 min of resting-state EEG and electrocardiogram (ECG) data and compared between individuals with AN (N = 22) and healthy controls (HC) (N = 19) with waveform, topographic, and source imaging analyses. // Results: Differences in the cortical representation of heartbeats were present between AN and HC at a time window of 332–348 ms after the ECG R-peak. Source imaging analyses revealed a right-sided hypoactivation in AN of brain regions linked to interoceptive processing, such as the anterior cingulate and orbitofrontal areas. // Conclusions: To the best of our knowledge, this is the first study using hdEEG to localise the underlying sources of HEPs in AN. Results point to altered interoceptive processing during resting-state in AN. As our participants had a short duration of illness, this might not be the consequence of prolonged starvation. Interventions targeted at interoception could provide an additional tool to facilitate recovery

Temporal dynamics of cognitive flexibility in adolescents with anorexia nervosa: A high-density EEG study

Impairment in cognitive flexibility is a core symptom of anorexia nervosa (AN) and is associated with treatment resistance. Nevertheless, studies on the neural basis of cognitive flexibility in adolescent AN are rare. This study aimed to investigate brain networks underlying cognitive flexibility in adolescents with AN. To address this aim, participants performed a Dimensional Change Card Sorting task during high-density electroencephalography (EEG) recording. Anxiety was measured with the State–Trait Anxiety Inventory. Data were collected on 22 girls with AN and 23 controls. Evoked responses were investigated using global-spatial analysis. Adolescents with AN showed greater overall accuracy, fewer switch trial errors and reduced inverse efficiency switch cost relative to controls, although these effects disappeared after adjusting for trait and state anxiety. EEG results indicated augmented early visual orienting processing (P100) and subsequent impaired attentional mechanisms to task switching (P300b) in subjects with AN. During task switching, diminished activations in subjects with AN were identified in the posterior cingulate, calcarine sulcus and cerebellum, and task repetitions induced diminished activations in a network involving the medial prefrontal cortex, and several posterior regions, compared with controls. No significant associations were found between measures of cognitive flexibility and anxiety in the AN group. Findings of this study suggest atypical neural mechanisms underlying cognitive flexibility in adolescents with AN. More importantly, our findings suggest that different behavioural profiles in AN could relate to differences in anxiety levels. Future research should investigate the efficacy of cognitive training to rebalance brain networks of cognitive flexibility in AN

Temporal effects of maternal psychological distress on child mental health problems at ages 3, 5, 7 and 11: analysis from the UK Millennium Cohort Study

Background: Psychological distress is common among women of childbearing age, and limited longitudinal research suggests prolonged exposure to maternal distress is linked to child mental health problems. Estimating effects of maternal distress over time is difficult due to potential influences of child mental health problems on maternal distress and time-varying confounding by family circumstances. Methods: We analysed the UK Millennium Cohort Study, a nationally representative sample with data collected throughout childhood. Adopting a marginal structural modelling framework, we investigated effects of exposure to medium/high levels of maternal psychological distress (Kessler-6 score 8+) on child mental health problems (Strengths and Difficulties Questionnaire borderline/abnormal behaviour cut-off) using maternal and child mental health data at 3, 5, 7 and 11 years, accounting for the influence of child mental health on subsequent maternal distress, and baseline and time-varying confounding. Results: Prior and concurrent exposures to maternal distress were associated with higher levels of child mental health problems at ages 3, 5, 7 and 11 years. For example, elevated risks of child mental health problems at 11 years were associated with exposure to maternal distress from 3 years [risk ratio (RR) 1.27 (95% confidence interval (CI) 1.08–1.49)] to 11 years [RR 2.15 (95% CI 1.89–2.45)]. Prolonged exposure to maternal distress at ages 3, 5, 7 and 11 resulted in an almost fivefold increased risk of child mental health problems. Conclusions: Prior, concurrent and, particularly, prolonged exposure to maternal distress raises risks for child mental health problems. Greater support for mothers experiencing distress is likely to benefit the mental health of their children

Anxiety disorders predict fasting to control weight:A longitudinal large cohort study of adolescents

To determine whether anxiety disorders are prospectively associated with fasting for weight-loss/to avoid weight-gain, a behaviour that precedes and is typical of anorexia nervosa (AN), during adolescence

Frequency and patterns of eating disorder symptoms in early adolescence

PURPOSE: There are still uncertainties about manifestations of early adolescent eating disorders (ED) and their effects. We aimed to determine the prevalence of ED symptoms in early adolescence, derive symptoms dimensions, and determine their effects on social and psychological outcomes and subsequent body mass index (BMI). METHODS: Data on 7,082 adolescents aged 13 years from the Avon Longitudinal Study of Parents and Children were obtained on ED symptoms, resulting impairment and family burden and emotional and behavioral disorders using the parental version of the Developmental and Well-being Assessment. Exploratory structural equation models were used to derive ED symptoms dimensions separately by sex and to relate these to contemporary outcomes (impairment, burden, and emotional and behavioral disorders) and a distal outcome (objective BMI at age 15 years). RESULTS: Extreme levels of fear of weight gain, avoidance of fattening foods, and distress about weight and shape were common among girls (11%). Three ED symptoms dimensions were identified: bingeing/overeating, weight/shape concern and weight-control behaviors, and food restriction. Bingeing/overeating was strongly associated with higher functional impairment, family burden, and comorbid psychopathology. Bingeing/overeating and weight/shape concern and weight-control behaviors predicted higher BMI 2 years later, whereas food restriction predicted lower BMI. These effects did not change when BMI at age 13 years was included in the model. CONCLUSIONS: Eating disorder cognitions are common among young teenage girls. Eating disorder symptoms have adverse cross-sectional and distal consequences, in particular on increasing body weight 2 years later. These findings have important implications for early identification of adolescents engaging in ED behaviors and for obesity prevention