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This cross‐sectional study examined how perceived partner drinking relates to relationship satisfaction and symptoms of anxiety and depression across romantic drinking partnerships. Participants included 239 cisgender, heterosexual undergraduate students in current romantic relationships (Mage = 19.74; 76.15% female; 87.87% White) who reported their own and their romantic partner's drinking. Associations between drinking partnerships, identified via K‐medoid cluster analysis, and internalizing symptomatology were examined utilizing hierarchical linear regression. Perceived partner drinking problems were associated with symptoms of depression but not anxiety. Two drinking quantity (concordant light, concordant heavy) and three drinking problem (concordant light, discordant female high, discordant male high) partnerships were identified. Broadly, men's anxiety and relationship satisfaction were significantly impacted by their drinking quantity and problem partnerships, respectively; this effect was not observed for women. The findings of this study extend extant research on the impact of romantic partner drinking to unmarried, collegiate emerging adults who are at an increased risk of internalizing symptomatology and alcohol use and inform conceptualization of drinking partnerships at the drinking quantity and drinking problem level. [ABSTRACT FROM AUTHOR]

Justice-involved youth experience significantly higher rates of adverse childhood experiences (ACEs) compared to the general population, which lead to negative outcomes such as greater criminal involvement and mental health disorders. Such effects emphasize the need to examine the role of protective factors on the development of these negative outcomes. This study uses data from 519 youth referred to a probation department in Southeast Texas to examine the effects of ACEs and the direct and mitigating effects of protective factors on a youth's criminal involvement and mental health symptoms. Results from hierarchical linear regression models emphasize the negative effects of ACEs on these outcomes, as well as the potential ceiling effect of protective factors based on ACE severity. [ABSTRACT FROM AUTHOR]

The current study integrates previous research on adverse childhood experiences (ACEs) and long-term health outcomes to examine associations between ACEs, sleep duration, and depression in a diverse, mostly healthy, sample of young adults. We examine whether sleep duration mediates the association between ACEs and depression among young adults, and whether ethnicity may moderate observed relationships between ACEs, sleep duration and depression. Data were collected from 518 young adults (66.8% female, Mage=19.79 years, SDage=3.43 years) enrolled in undergraduate Psychology courses at a large Southwestern university. Participants primarily reported their racial/ethnic background as Non-Hispanic White (60.6%) and Hispanic/Latino (25.1%). Participants self-reported their ACEs exposure, sleep characteristics, and depressive symptoms. In addition to calculating overall exposure to ACEs, scores for the specific dimensions of adversity were also calculated (Abuse, Neglect, Exposure to Violence). Results supported a mediation model whereby higher reports of ACEs were associated with depressive symptoms both directly and through sleep duration. Results were not moderated by ethnicity. Findings provide support for sleep duration as one potential pathway through which ACEs may be associated with depressive symptoms in young adulthood, and suggest that this pathway is similar in Hispanic and non-Hispanic young adults. [ABSTRACT FROM AUTHOR]

Objective: While the lack of relation between performance- and inventory-based executive function (EF) measures is well documented, there remains ambiguity between self-report EFs and closely related constructs (e.g., impulsivity) assessed via the same method. The degree of convergence between purported EF measures with similar yet distinct constructs contain important theoretical implications for available EF assessment strategies and their construct validity. A newer measure of EF, the Behavior Regulation Inventory of Executive Functions—Adult (BRIEF-A), allows for more direct comparisons to self-reported measures of impulsivity, such as the commonly used Urgency, Planning, Perseverance, Sensation Seeking—Positive Urgency (UPPS-P) assessment. Method: The present study used factor analysis and hierarchical regression to explore the associations between the BRIEF-A and UPPS-P, using alcohol and cannabis consumption across various outcomes (i.e., quantity-frequency and consequences) as an external criterion. Participants were 339 undergraduate students (Mage = 19.35; Female = 63%) from a large southwestern university. Results: The BRIEF-A and UPPS-P demonstrated strong correlations at both higher- and lower order facets. While the BRIEF-A was a significant correlate to many substance use outcomes, these relations were generally weaker than those seen with the UPPS-P. Hierarchical regression suggested limited contributions of the BRIEF-A over and above the UPPS-P. Conclusions: Overall, this study suggested substantial overlap between impulsigenic factors and EFs when measured by self-report, and limited utility of EF measures to account for unique variance with substance use outcomes in this sample. [ABSTRACT FROM AUTHOR]

Purpose: Though prosocial attributes are linked to positive outcomes among justice-involved adolescents and are a mainstay of numerous interventions, few measures have been specifically designed to evaluate prosocial functioning within this population. Although multiple instruments measuring aspects of prosocial behavior exist, these instruments were not designed to measure prosocial behaviors among youth in juvenile justice settings. This study aims to provide a preliminary validation of a new measure of prosocial attributes (the Prosocial Status Inventory – PSI), which was designed to comprehensively evaluate in greater depth the prosocial functioning of urban, justice-involved youth. Design/methodology/approach: Youth (n = 51) were recruited as part of a larger study and were participants in a community-based mentoring program in a large, urban county in the Southern USA. Youth completed the PSI at baseline prior to their participation in the community-based mentoring program. The authors obtained follow-up data on recidivism from the county juvenile justice department. Findings: PSI scores were positively related to a lower rate of recidivism and a decrease in offending frequency over a 12-month follow-up period. Originality/value: The current findings complement previous work, suggesting that prosocial attributes are measurable and related to important outcomes among justice-involved youth and support the utility of strengths-based treatment approaches. Moreover, it provides preliminary evidence of the utility of a new self-report measure to assess these traits within a juvenile justice population. [ABSTRACT FROM AUTHOR]

We investigated the interaction of mental health needs and race and ethnicity on juvenile justice placement decisions. Mental health diagnoses and placement decisions were collected for a large (n = 9765) sample of justice‐involved youth in the state of Texas from 2007 to 2008. Analyses revealed Black and Hispanic youth were overrepresented in secure facilities, although race and ethnicity were not predictive of disposition decisions beyond legal variables. Substance use interacted with race and ethnicity such that Black and Hispanic youth with substance use diagnoses were less likely than non‐Hispanic White youth to be placed in secure settings. Youth with internalizing or externalizing mental health diagnoses received similar placement decisions regardless of race or ethnicity. Findings are in contrast to prior investigations of the interaction of race/ethnicity and mental health needs on placement decisions, perhaps due to the use of mental health diagnoses in the current study rather than other indicators of mental health need. Future research should investigate potential bias present within psychosocial evaluations and resulting mental health diagnoses within the juvenile justice system to inform their utility in the placement decision‐making process, and how these social identities interact to influence each step along the juvenile justice system pathway to identify potential points of biased decision making that may compound the adverse effects of juvenile justice system involvement for youth. [ABSTRACT FROM AUTHOR]

Justice‐involved youth (JIY) experience extremely high prevalence rates of trauma prior to their involvement in the juvenile justice system. Trauma outcomes are heterogeneous, long‐term, and may influence JIY outcomes. Although specific evidence‐based treatments (EBTs) target trauma symptoms, few studies have examined treatment outcomes in relation to adolescent populations, and even fewer have examined treatment outcomes in relation to JIY. This review examines evidence supporting the effectiveness of trauma‐focused treatments with JIY. The existing literature suggests trauma‐focused interventions may be a promising avenue for improving both mental health and juvenile justice outcomes for JIY. Clinical practice and policy implications are discussed. [ABSTRACT FROM AUTHOR]

Objective: ADHD is a neurodevelopmental disorder affecting millions of adults worldwide. Continuous performance tests (CPTs) are widely used as assessment and diagnostic tools; however, their use in diagnosing undiagnosed ADHD in adults has been questioned due to their lack of specificity and sensitivity. This review sought to outline relevant findings concerning the diagnostic utility of the Conner's Continuous Performance Test (CCPT) in adults. Method: This systematic review followed the a priori guide outlined by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. Articles were gathered from PsycINFO, PsycArticles, Cochrane, Scopus, Google Scholar, and PubMed. Results: Thirty-five articles were reviewed and analyzed. Most articles reviewed used outpatient and university populations. Moderate reliability, subpar discriminant and ecological validity, and mixed sensitivity and specificity were noted. Conclusion: The results of this review lend support to previous critiques of the CCPT's diagnostic and utility as a treatment measure. [ABSTRACT FROM AUTHOR]

Objective: Attaining competence in assessment is a necessary step in graduate training and has been defined to include multiple domains of training relevant to this attainment. While important to ensure trainees meet these standards of training, it is critical to understand how and if competence shapes a trainees' professional identity, therein promoting lifelong competency. Methods: The current study assessed currently enrolled graduate trainees' knowledge and perception of their capabilities related to assessment to determine if self‐reported and performance‐based competence would incrementally predict their intention to use assessment in their future above basic training characteristics and intended career interests. Results: Self‐reported competence, but not performance‐based competence, played an incremental role in trainees' intention to use assessments in their careers. Multiple graduate training characteristics and practice experiences were insignificant predictors after accounting for other relative predictors (i.e., intended career settings, integrated reports). Conclusion: Findings are discussed about the critical importance of incorporating a hybrid competency‐capability assessment training framework to further emphasize the role of trainee self‐efficacy in hopes of promoting lifelong competence in their continued use of assessments. Significance Statement: This study examines health service psychology trainees' intention to engage in psychological assessment and the incremental role of self‐reported competence. Findings highlight the significance of self‐reported competence above performance‐based competence in assessment when predicting long‐term professional identity, which in turn promotes lifelong competence. [ABSTRACT FROM AUTHOR]

Adverse childhood experiences (ACEs) are related to a host of deleterious physical and mental health outcomes. The ACE-International Questionnaire (ACE-IQ) was developed to assess categories of ACEs (e.g., sexual, emotional, and physical abuse) in internationally representative samples. Though the ACE-IQ has been used world-wide, little work has examined the structure of this measure. Further, much of the modeling techniques implemented lacked theoretical rationale. The present work used two principal components analyses (PCA) to evaluate the ACE-IQ structure using both the identified ACE categories as defined by the World Health Organization (WHO) and using the ACE-IQ items as individual indicators. Using theWHOmethod, a twocomponent structure was indicated. Alternatively, a PCA of the individual items yielded a six-component structure. Results highlight the importance of theoretically grounded measure evaluation and the potential distinctions amongst types of ACEs. Implications and future directions for research and practice are discussed. [ABSTRACT FROM AUTHOR]

There is growing interest in saliva microRNAs (miRNAs) as non-invasive biomarkers for human disease. Such an approach requires understanding how differences in experimental design affect miRNA expression. Variations in technical methodologies, coupled with inter-individual variability may reduce study reproducibility and generalizability. Another barrier facing salivary miRNA biomarker research is a lack of recognized "control miRNAs". In one of the largest studies of human salivary miRNA to date (922 healthy individuals), we utilized 1225 saliva samples to quantify variability in miRNA expression resulting from aligner selection (Bowtie1 vs. Bowtie2), saliva collection method (expectorated vs. swabbed), RNA stabilizer (presence vs. absence), and individual biological factors (sex, age, body mass index, exercise, caloric intake). Differential expression analyses revealed that absence of RNA stabilizer introduced the greatest variability, followed by differences in methods of collection and aligner. Biological factors generally affected a smaller number of miRNAs. We also reported coefficients of variations for 643 miRNAs consistently present in saliva, highlighting several salivary miRNAs to serve as reference genes. Thus, the results of this analysis can be used by researchers to optimize parameters of salivary miRNA measurement, exclude miRNAs confounded by numerous biologic factors, and identify appropriate miRNA controls. [ABSTRACT FROM AUTHOR]

Disability is an important facet of diversity. Although diversity in clinical training in health service psychology has improved considerably, training often neglects accessibility and inclusion for individuals with sensory disabilities. The limited research to date documents that trainees with sensory disabilities (TSDs) report extensive barriers and are consistently underrepresented in clinical settings. Furthermore, few resources have been developed to guide accommodating TSD in clinical training. Accordingly, our goals in this article are twofold as follows: (a) to highlight the barriers in clinical training faced by TSD and (b) to provide recommendations for trainees, supervisors, clinical leadership, and directors of clinical training to improve accessibility and inclusion for TSD. We offer vignettes to illustrate barriers faced by TSD and suggest guidelines to improve access for TSD. [ABSTRACT FROM AUTHOR]

Suicide is a leading cause of death worldwide. Although inconsistent, impulsivity has been identified as a risk factor for suicidal thoughts and behaviors, and these inconsistent findings can largely be attributed to varying operationalizations of impulsivity. As such, the UPPS model of impulsivity provides a clear definition of impulsivity and its associated features that may provide utility in clarifying unreliable findings between impulsivity and suicide. This review aimed to summarize relevant information pertaining to the UPPS model of impulsivity and suicide. This systematic review followed the a priori guide outlined by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. Articles were gathered from PsycINFO, PsycArticles, Scopus, and PubMed. Twenty-eight articles were reviewed and analyzed. Most articles reviewed reported on indirect (i.e., through mediators and moderators) associations between the UPPS dimensions and suicidal behaviors. Additionally, results noted limited between-group differences in UPPS facets among individuals with a history of suicide attempts and those without a history of suicide attempts, those with a history of suicide attempts and individuals with suicide ideation, and those with suicide ideation and those without suicide ideation, with the exception of lack of premeditation. The results of this review indicate support for the UPPS model of impulsivity as a theoretical starting point when examining the relation between impulsivity and suicide. Further, findings are helpful for clinicians and case conceptualization. Particularly, suicide risk assessment and treatment would be impacted based on impulsivity traits and suicide history. [ABSTRACT FROM AUTHOR]

Assessment is critical to health service psychology and represents a core area of coverage during doctoral training. Despite this, training practices in assessment are understudied. Accordingly, this study utilized a national sampling of students (n = 534) enrolled in an American Psychological Association-accredited health service psychology doctoral program with substantive training in clinical or counseling psychology. We asked trainees to rate their competency for instruments in which they had training. We examined trends in training experiences, including both theory-based education and applied clinical opportunities, and explored differences in instrument training trends across program type (PhD/PsyD) and program discipline (clinical/counseling). Results of this study suggest a general convergence with professional practice trends in terms of instrument coverage, less clinical training, and exposure compared with didactic methods and generally small differences across program type and discipline in perceived competence and instrument exposure. Implications for training and education in psychological assessment are discussed. [ABSTRACT FROM AUTHOR]

Background: The predoctoral internshipAQ4 training year is the capstone training experience for health service doctoral students. Previous research has explored what applicant characteristics are desired by internship sites and has not thoroughly explored differences between types of sites or criteria importance at different stages of applicant consideration (interview vs. ranking). Aims: We evaluate current perceptions of doctoral student internship applications by training directors. Materials and Methods: Internship training directors of APA‐accredited sites report on the importance of different application materials during interview and ranking decisions. We also compare these rankings across site types. Results: Results indicate that internship sites were generally consistent in their criteria rankings; however, there were also some differences. Intern applicant "fit" continues to be the most important criteria by which applicants are judged at all stages of consideration. Qualitative analysis found that "fit" varied by site across themes of treatment, applicant, and site characteristics. Discussion: We discuss implications in their preparation of internship applications. In addition to the practical guidance for students, we discuss how program changes can increase applicant site competitiveness. [ABSTRACT FROM AUTHOR]

Mentoring provides a relational intervention that can promote positive youth development among adolescents who are involved in the juvenile justice system. The perspectives of mentors engaging these youth, particularly insights considered through a cultural humility lens, have been largely absent from the literature to date. This study examined predominately White, middle‐ to upper‐class adult mentors' experiences mentoring racially diverse, working‐class youth. Semi‐structured qualitative interviews were completed with 23 mentors participating in a community‐based mentoring program. Themes were derived from inductive content analysis. Emergent themes illustrative of the mentoring process included (a) establishing a connection despite differences, (b) identifying mentees' personal and environmental challenges, and (c) raising consciousness around structural issues. Despite coming from different backgrounds and experiences, mentors who worked with justice‐involved adolescents were motivated to connect with their mentees. Mentors developed a greater awareness of structural challenges influencing adolescents by learning about the multifaceted experiences and needs of their mentees. [ABSTRACT FROM AUTHOR]

At-risk youth are more likely to engage in delinquent behaviors and be involved in the juvenile justice system (JJS). Improving outcomes for such youth increasingly include long-term administration of psychotropic medications (PM). Current research addresses short-term utility of PM, but evidence is mixed regarding long-term effectiveness. Using a large, cross-national, at-risk youth sample (n = 2065), this study examined how PM influenced total delinquent behaviors in a given year, and JJS entry, over a seven-year time period. PM treatment did not significantly decrease delinquent behaviors among youth; nor prevent entry into the JJS. Implications for policy and practice are discussed. [ABSTRACT FROM AUTHOR]

Traumatic brain injury (TBI) is known to contribute to deficits in executive functioning (EF). Executive functioning abilities are disrupted in adolescents with either conduct disorder or oppositional defiant disorder, collectively known as disruptive behavior disorders (DBDs). There is little research on the relationship between executive dysfunction and DBDs in a group with a confirmed history of TBI. The current study endeavored to examine EF abilities, as measured by parent report on the Behavior Rating Inventory of Executive Function (BRIEF), in four groups: (1) adolescents with a TBI history and co-occurring DBDs history, (2) adolescents with a TBI history and no DBDs history, (3) adolescents with an orthopedic injury (OI) history and co-occurring DBDs history, and (4) adolescents with an OI history and no DBDs history. Groups were matched on the basis of age at injury and estimated socioeconomic status. Participants were evaluated at five time-points throughout the study, within 1 month of injury (initial assessment), 3, 12, 18, and 24 months post-injury. Results indicated the TBI and DBDs group was not significantly different from the OI and DBDs group, and both DBDs groups suffered higher levels of executive dysfunction than the TBI only and OI only groups, which were not significantly different from each other. Results also showed across the four groups, EF deficits were significantly lower at 1 month and 24 months post-injury, suggesting a positive trajectory in EF skill development. Results are discussed in terms of the prognostic importance of EF deficits in children with DBDs. [ABSTRACT FROM AUTHOR]

The present study expands upon the Interpersonal Psychological Theory of Suicide (IPTS), examining its relationship with the need for affect (NFA), a construct explaining attitudes toward seeking both positive and negative emotions. A sample of 576 emerging adults completed measures of NFA, IPTS, suicide proneness, and demographics online. Findings include NFA accounting for a small significant amount of suicide proneness, a positive association between approaching emotions and one indicator of suicide proneness, negative association between approaching emotions and thwarted belongingness, and positive associations between avoidance of emotions with both perceived burdensomeness and thwarted belongingness. Findings are discussed concerning NFA as a theoretically and practically relevant factor for understanding suicide. [ABSTRACT FROM AUTHOR]

Researchers have found providing employment opportunities for ex-offenders through job training programs to be effective at reducing recidivism. Examining various community-based programs for ex-offenders can be beneficial as they may be able to provide more stable and consistent programming without relying on the justice system. This study examined employment outcomes of graduates with and without criminal histories ( n = 617) from a community-based vocational training program. Results showed that ex-offender graduates obtained employment at equal rates to nonoffender graduates and received equal pay to their nonoffender counterparts. This could indicate that for the vocationally educated ex-offender, employment outcomes may be able to equal those of other job-searching individuals with similar backgrounds but without a criminal history. Community-based programs for ex-offenders may be able to provide effective programming to improve vocational attainment within this group, thereby potentially easing the burden on criminal justice institutions as the sole provider of offender rehabilitation. [ABSTRACT FROM AUTHOR]

The present article investigates the traumatic brain injury (TBI)-suicide link, assessing whether (a) TBI accounts for variance in suicide risk, and (b) the interpersonal-psychological theory of suicide can be applied to TBI status. Matched case-control procedures applied to archival college student health data identified TBI and non-TBI subsamples (84 total). Individuals with a TBI possessed higher suicide risk than those without. Even accounting for the relative influence of strong suicide risk factors (i.e., depression, perceived burdensomeness, thwarted belongingness, and acquired capability), TBI was robustly associated with suicide risk. TBI history would be valuable to ascertain in assessing suicide risk. [ABSTRACT FROM AUTHOR]

This investigation surveyed students (n = 91) from 16 American Psychological Association accredited doctoral programs in clinical and counseling psychology about knowledge and training in personality assessment. We report self-perceived competency on specific instruments as well as training trends in coursework and instrument exposure in clinical settings. We also evaluate skill at interpretation on a popular personality instrument using two tasks, a narrative interpretation where trainees estimate an originating score profile using a standardized interpretive report and a symptom probability task where trainees predict the likelihood of symptoms based on a score profile. The Minnesota Multiphasic Personality Inventory-2 (MMPI-2) and Personality Assessment Inventory (PAI) were the most frequently trained and utilized and had the highest self-perceived competence. When given interpretation tasks to evaluate assessment skills using the MMPI-2-RF, trainee performance was variable and discrepant from a comparison expert panel given the same tasks. Overall, our results suggest that there is a need for further, and more comprehensive, study on competence and training according to the experience of trainees. We note that there is variability across instruction on instrument use, exposure to instruments in practice, and practical skill level. We highlight our findings across four conceptual areas and discuss the implications for the observed trends: frequency of instrument exposure, trainee beliefs of competence, trainee interpretation skills, and reporting of testing interpretation. This pilot study provides the first evaluation of assessment training patterns as reported by health service psychology trainees. Results indicate that, in general, trainee instrument exposure and use mirror those of practicing psychologists; however, there is notable variability in how assessment results are reported and in trainee competency. Additional research evaluating health service psychology training should utilize student participants so that direct evaluations of competency and outcomes are possible. [ABSTRACT FROM AUTHOR]

Articles in this series (Callahan & Watkins, 2018a, 2018b, 2018c, 2018d) elucidate a concerning lack of research on training in the field of health service psychology. There are many factors that impact the scant evidence available, including aspects of training programs themselves, aspects of our current funding climate, the structure and influence of universities, a lack of diversity in graduate students and faculty, and the flexibility (or the perception of a lack thereof) inherent in the practice of psychology and the accrediting bodies that influence our training. There are numerous ways to improve our evidence base for training, especially those related to supporting and growing the number of researchers engaged in this area of study. Some external factors outside individual program control will likely limit the speed with which improvements can be made, but a great deal can be done within our programs to make significant changes that have the potential to influence both training and client outcomes. [ABSTRACT FROM AUTHOR]

This brief report summarizes the basic principles and common applications of the flipped classroom, highlighting its use in the teaching of psychology. Evidence regarding the effectiveness of the inverted teaching model is reviewed and an argument for its use within graduate-level psychology courses is provided. Two examples of graduate-level psychology courses (i.e., cognitive abilities and objective personality assessment) that incorporate elements of the flipped classroom are presented, along with suggestions for other applied courses. Finally, the authors discuss potential benefits and barriers for redesigning a traditionally formatted class to adhere to an inverted format. [ABSTRACT FROM AUTHOR]

Children of incarcerated parents may grieve this loss, yet perceptions of their grief are understudied. Using vignettes varying by age (adult/child) and grief response (prolonged/resilient), we examined differences between perceptions of adults and children grieving parental incarceration. Participants rated grief response appropriateness, comfort providing support, and grief therapy recommendations for the grieving person in the vignette. Participants perceived resilience as more appropriate than prolonged grief [F (1, 224) = 9.02, p = .003, η2 = .04]. Age did not predict outcomes. Recommending grief therapy was higher for prolonged grief, yet 53% of participants with resilient vignettes recommended the person should seek grief therapy, which is concerning given possible iatrogenic effects. Thus, laypeople may have stigma toward individuals grieving parental incarceration, regardless of age. [ABSTRACT FROM AUTHOR]

Cannabis use and the prevalence of cannabis use disorder (CUD) among emerging adults are on the rise. Several indicators of cannabis use (e.g., quantity, frequency) as they relate to negative outcomes have been posited in the extant literature. Despite research examining links between indicators and cannabis outcomes, few assessments of cannabis use indicators exist. The Daily Sessions, Frequency, Age of Onset, and Quantity of Cannabis Use Inventory (DFAQ-CU) was developed to assess cannabis use across a range of factors. However, the factor structure of the DFAQ-CU has not been replicated. Further, the DFAQ-CU was modeled using reflective strategies despite formative strategies being conceptually appropriate. The present study utilized principal components analyses (PCA) and principal axis factoring (PAF) to evaluate the structure of the DFAQ-CU. PCA yielded a four-component solution; PAF resulted in a five-factor solution. Linear regression found significant relations between PCA components and PAF factors with CUD symptoms and cannabis-related problems; however, effect sizes were larger for the PAF suggesting possible misdisattenuation. The PCA components demonstrated evidence of discriminant and convergent validity with measures of cannabis and alcohol behavior. The study informs research and clinical work through the refinement of cannabis use assessment and enhancing our understanding of the importance of model selection., (© 2023 Authors et al.)

Importance: Traumatic brain injury (TBI) is known to cause widespread neural disruption in the cerebrum. However, less is known about the association of TBI with cerebellar structure and how such changes may alter executive functioning., Objective: To investigate alterations in subregional cerebellum volume and cerebral white matter microstructure after pediatric TBI and examine subsequent changes in executive function., Design, Setting, and Participants: This retrospective cohort study combined 12 data sets (collected between 2006 and 2020) from 9 sites in the Enhancing Neuroimaging Genetics Through Meta-Analysis Consortium Pediatric TBI working group in a mega-analysis of cerebellar structure. Participants with TBI or healthy controls (some with orthopedic injury) were recruited from trauma centers, clinics, and institutional trauma registries, some of which were followed longitudinally over a period of 0.7 to 1.9 years. Healthy controls were recruited from the surrounding community. Data analysis occurred from October to December 2022., Exposure: Accidental mild complicated-severe TBI (msTBI) for those in the TBI group. Some controls received a diagnosis of orthopedic injury., Main Outcomes and Measures: Volume of 18 cerebellar lobules and vermal regions were estimated from 3-dimensional T1-weighted magnetic resonance imaging (MRI) scans. White matter organization in 28 regions of interest was assessed with diffusion tensor MRI. Executive function was measured by parent-reported scores from the Behavior Rating Inventory of Executive Functioning., Results: A total of 598 children and adolescents (mean [SD] age, 14.05 [3.06] years; range, 5.45-19.70 years; 386 male participants [64.5%]; 212 female participants [35.5%]) were included in the study, with 314 participants in the msTBI group, and 284 participants in the non-TBI group (133 healthy individuals and 151 orthopedically injured individuals). Significantly smaller total cerebellum volume (d = -0.37; 95% CI, -0.52 to -0.22; P < .001) and subregional cerebellum volumes (eg, corpus medullare; d = -0.43; 95% CI, -0.58 to -0.28; P < .001) were observed in the msTBI group. These alterations were primarily seen in participants in the chronic phase (ie, >6 months postinjury) of injury (total cerebellar volume, d = -0.55; 95% CI, -0.75 to -0.35; P < .001). Smaller cerebellum volumes were associated with higher scores on the Behavior Rating Inventory of Executive Functioning Global Executive Composite score (β = -208.9 mm3; 95% CI, -319.0 to -98.0 mm3; P = .008) and Metacognition Index score (β = -202.5 mm3; 95% CI, -319.0 to -85.0 mm3; P = .02). In a subset of 185 participants with longitudinal data, younger msTBI participants exhibited cerebellum volume reductions (β = 0.0052 mm3; 95% CI, 0.0013 to 0.0090 mm3; P = .01), and older participants slower growth rates. Poorer white matter organization in the first months postinjury was associated with decreases in cerebellum volume over time (β=0.52 mm3; 95% CI, 0.19 to 0.84 mm3; P = .005)., Conclusions and Relevance: In this cohort study of pediatric msTBI, our results demonstrated robust cerebellar volume alterations associated with pediatric TBI, localized to the posterior lobe. Furthermore, longitudinal cerebellum changes were associated with baseline diffusion tensor MRI metrics, suggesting secondary cerebellar atrophy. These results provide further understanding of secondary injury mechanisms and may point to new opportunities for intervention.

Objective: Our study addressed aims (1) to test the hypothesis that moderate-severe traumatic brain injury (TBI) in pediatric patients is associated with widespread white matter (WM) disruption, (2) to test the hypothesis that age and sex affect WM organization after injury, and (3) to examine associations between WM organization and neurobehavioral outcomes., Methods: Data from 10 previously enrolled, existing cohorts recruited from local hospitals and clinics were shared with the Enhancing NeuroImaging Genetics Through Meta-Analysis (ENIGMA) Pediatric Moderate/Severe TBI (msTBI) working group. We conducted a coordinated analysis of diffusion MRI (dMRI) data using the ENIGMA dMRI processing pipeline., Results: Five hundred seven children and adolescents (244 with complicated msTBI and 263 controls) were included. Patients were clustered into 3 postinjury intervals: acute/subacute, <2 months; postacute, 2 to 6 months; and chronic, ≥6 months. Outcomes were dMRI metrics and postinjury behavioral problems as indexed by the Child Behavior Checklist. Our analyses revealed altered WM diffusion metrics across multiple tracts and all postinjury intervals (effect sizes range d = -0.5 to -1.3). Injury severity is a significant contributor to the extent of WM alterations but explained less variance in dMRI measures with increasing time after injury. We observed a sex-by-group interaction: female patients with TBI had significantly lower fractional anisotropy in the uncinate fasciculus than controls (β = 0.043), which coincided with more parent-reported behavioral problems (β = -0.0027)., Conclusions: WM disruption after msTBI is widespread, persistent, and influenced by demographic and clinical variables. Future work will test techniques for harmonizing neurocognitive data, enabling more advanced analyses to identify symptom clusters and clinically meaningful patient subtypes., (© 2021 American Academy of Neurology.)

Traumatic brain injury (TBI) is known to contribute to deficits in executive functioning (EF). Executive functioning abilities are disrupted in adolescents with either conduct disorder or oppositional defiant disorder, collectively known as disruptive behavior disorders (DBDs). There is little research on the relationship between executive dysfunction and DBDs in a group with a confirmed history of TBI. The current study endeavored to examine EF abilities, as measured by parent report on the Behavior Rating Inventory of Executive Function (BRIEF), in four groups: (1) adolescents with a TBI history and co-occurring DBDs history, (2) adolescents with a TBI history and no DBDs history, (3) adolescents with an orthopedic injury (OI) history and co-occurring DBDs history, and (4) adolescents with an OI history and no DBDs history. Groups were matched on the basis of age at injury and estimated socioeconomic status. Participants were evaluated at five time-points throughout the study, within 1 month of injury (initial assessment), 3, 12, 18, and 24 months post-injury. Results indicated the TBI and DBDs group was not significantly different from the OI and DBDs group, and both DBDs groups suffered higher levels of executive dysfunction than the TBI only and OI only groups, which were not significantly different from each other. Results also showed across the four groups, EF deficits were significantly lower at 1 month and 24 months post-injury, suggesting a positive trajectory in EF skill development. Results are discussed in terms of the prognostic importance of EF deficits in children with DBDs.

Callous-unemotional (CU) traits designate a unique subset of youth with externalizing psychopathology who have a severe pattern of aggressive behavior and tend to have worse outcomes in treatment. However, little research has addressed how CU traits relate to different components of psychotherapy, such as the therapeutic alliance. The current study examined the role of CU traits in predicting therapeutic alliance in 59 adolescents (M age = 15.3, 51% female, 64% Hispanic American, 15% African American) who were part of a larger randomized naturalistic trial of outpatient behavioral psychotherapy. Multilevel regression analysis further investigated the role of therapeutic alliance in predicting treatment outcome (as measured by self-reported delinquency) and the moderating role of CU traits. Results suggested that regardless of the severity of their externalizing problems, youth with higher levels of CU traits reported more positive ratings of therapeutic alliance. In addition, a positive therapeutic alliance predicted reductions in delinquent behavior, and this association was even stronger for youth higher in CU traits. Our results suggest that CU traits are related to improvement in the formation of the therapeutic alliance among youth with externalizing psychopathology, perhaps because these youth lack many of the social and emotional deficits that other youth with conduct problems possess. Adolescents high in CU traits should not be viewed as untreatable. Indeed, the therapeutic alliance may be an important mechanism for affecting meaningful change in these adolescents' lives. (PsycINFO Database Record, ((c) 2017 APA, all rights reserved).)