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Youth receiving mental health services often experience numerous mania-like symptoms (1, 2). Furthermore, although symptoms of mania are, by definition, present in youth suffering from bipolar disorder, prior data have noted that many youth who experience manic symptomatology do not suffer from bipolar disorder (3-7). Whether or not a youth has suffered from a bipolar disorder, it has been noted that elevated symptoms of mania (ESM) are associated with substantial psychosocial impairments and notable degrees of psychopathology (7-9). Despite these initial investigations of children who experience ESM, very little is known about the phenomenology or symptomatic course of ESM in youth. Data from a pilot study suggested that the presence of ESM in children with attention-deficit hyperactivity disorder (ADHD) may be associated with a poorer outcome (9, 10). The National Institute of Mental Health (NIMH)-supported Longitudinal Assessment of Manic Symptoms (LAMS) study was designed to better understand the phenomenology and determinants of outcome (e.g., psychosocial functioning, diagnoses, medications, and service utilization) in children with ESM. LAMS used an epidemiological approach to assemble a cohort of 6–12-year-old children at their first outpatient mental health visit at university-affiliated clinics (11). The LAMS design used a low, sensitive threshold on a screening instrument for manic symptoms, both to capture a large portion of those already showing symptoms of bipolarity, but also to include a substantial number of cases without bipolarity who were also experiencing similar emotional and behavioral dysregulation. Initial results have confirmed the finding that ESM in clinical mental health settings for youth are, in fact, common and that the majority of children with ESM indeed do not meet DSM-IV criteria for a bipolar spectrum disorder at baseline (5). The most common diagnoses are ADHD, oppositional defiant disorder, conduct disorder, and depression, often in various combinations (3, 5, 12). A specific goal of the LAMS study was to examine the course of children’s manic symptoms over time. To this end, we evaluated whether or not children who participated demonstrated different trajectories of parent-reported manic and biphasic symptoms over the first 24 months of follow-up. Based on prior longitudinal investigations of diagnostic status, combined with the choice of a low threshold of ESM to capture a heterogeneous group of youths in terms of clinical issues, we anticipated that there would be several distinct symptom trajectories, including at least one group that showed persistent symptoms of mania and at least one group that remitted. We also anticipated that a third group might show intermediate levels of mood symptoms, but whether this would be a stable pattern, or whether manic symptoms would fluctuate, was an empirical question. We next investigated what baseline determinants differentiated these distinct trajectories. Finally, we investigated what factors occur over the span of an initial 24-month observation period that could lead to categorization into these distinct classes.

Irritable mood and temper outbursts are common in youth referred for psychiatric treatment.1,2 They are also the core features of the proposed diagnosis disruptive mood dysregulation disorder (DMDD) in DSM-5.3 DMDD is characterized primarily by frequent, severe, recurrent temper outbursts and chronically irritable and/or angry mood, both of which must be present for at least a year. The DSM-5 Work Groups raised concerns that many youth with severe, nonepisodic irritable mood are inappropriately diagnosed with bipolar disorder.4 The DMDD diagnosis was constructed to capture the phenomenology of youth with severe, chronic irritability, with the goal of reducing the chance that youth with this phenotype would receive a bipolar diagnosis. The DSM-5 Work Groups note that there is currently relatively limited research to support the DMDD diagnosis.4 Most available studies focus on an overlapping but not identical construct called severe mood dysregulation (SMD). SMD includes the core criteria of DMDD, but also requires symptoms of chronic hyperarousal such as insomnia, agitation, distractibility, racing thoughts, flight of ideas, pressured speech, and intrusiveness.5 Published research on SMD has primarily been from a carefully phenotyped cohort of 146 youth referred to the National Institute of Mental Health (NIMH) Intramural Program.6 The youth with SMD were predominantly male (66%) and had high lifetime rates of attention-deficit/hyperactivity disorder (ADHD; 85%), oppositional defiant disorder (86%), and anxiety disorders (58%). About 16% met lifetime criteria for major depressive disorder (MDD). The youth with SMD were shown to be different from youth with a specified phenotype of bipolar I disorder (requiring distinct episodes of manic symptoms, including either elated mood or grandiosity) on a number of domains, including lower familial rates of bipolar disorder, lower onset rates of manic and hypomanic episodes over prospective follow-up, and differences on several neuropsychological domains and measures of brain structure and functioning.6 Other studies relevant to the SMD/DMDD phenotype have been post hoc analyses of large datasets in which a retrospective diagnosis of SMD was derived from the existing phenotypic variables. In the Great Smoky Mountains Study, 1.8% of the sample met SMD criteria with severe functional impairment, which made it much more common than bipolar disorder (0.1% of the sample).7 The severely impaired SMD youth from this community sample were predominantly male (66%), but differed from those in the NIMH studies, as only about 32% met criteria for ADHD; 42%, for oppositional defiant disorder; and 21%, for any anxiety disorder. In addition, there was very little longitudinal stability of the SMD diagnosis (83% met SMD criteria at only 1 wave). A retrospective SMD diagnosis was applied to 4 large aggregated community samples and 2 large clinical samples, which were assessed using the NIMH Diagnostic Interview Schedule-IV.6 Preliminary analyses indicated that in the community samples, 15% of youth with oppositional defiant disorder met SMD criteria, as did about 25% of the youth with oppositional defiant disorder in the clinical samples. Additional data specific to the DMDD diagnosis are needed; however, given the time constraints involved with the release of the upcoming DSM-5, carefully performed prospective studies are not possible. One way to evaluate DMDD is to take data from existing cohorts and retrospectively construct a DMDD diagnosis, similar to what was done for SMD. The Longitudinal Assessment of Manic Symptoms (LAMS) study is one source that can provide suitable data, as participants were sampled from all children presenting for new evaluation at 9 different university-affiliated clinics and were carefully assessed using semistructured interviews. In order to evaluate the validity of the DMDD diagnosis, it is useful to keep in mind the 5 phases of systematic study proposed by Robins and Guze8 that are necessary to validate a particular diagnostic classification in psychiatry. Using the LAMS cohort, we can provide relevant data on 4 of these phases: (1) clinical description, (2) delimitation from other disorders, (3) follow-up study, and (4) family study. In this article, we examine the clinical phenomenology of LAMS participants who met a DMDD diagnostic phenotype at intake and evaluate whether the DMDD phenotype can be delimited from other diagnoses, is stable over a 2-year follow-up period, and predicts new onset of DSM-IV diagnoses. Lastly, we assess the association of the DMDD phenotype with parental history of different psychiatric disorders.

Overweight is increasing in children, leading to negative health consequences. Children also lack appropriate levels of important vitamins and nutrients in their diets. Environmental cues, such as food proximity, have been shown to influence consumption rates in adults. The present study has tested whether proximity to either a nutrient-dense or caloric-dense food would influence children’s snack consumption in a day care setting. Children ( N = 46, age range 3.4-11) consumed more of both nutrient- and energy-dense foods when they are sitting closer to the food than if they are sitting farther away from the food, above and beyond the effects of age. The data indicate that it may be possible to increase the consumption of nutrient-dense foods or decrease the consumption of energy-dense foods, respectively, by modifying the proximity of such foods within a child’s environment.

Caregivers often struggle with food neophobia on the part of young children. This study examined whether labeling novel healthy foods with fun names would increase children’s willingness to try those foods and encourage them to eat more of those foods in a child care setting. Thirty-nine toddler and preschool age children (mean age = 3.9 years) were served each of three foods twice, once labeled with a fun name and once with a healthy name. Percentage of the food consumed by each child was recorded. Overall, children ate a greater percentage of the target foods when they were labeled with fun names. Also, a larger percentage of the children tasted the foods when they were labeled with fun names. This simple strategy could be effective for increasing consumption of healthy foods among young children.

Objectification theory posits that valuing one's body for appearance rather than performance is associated with a range of negative psychological outcomes. This theory has been tested in women, but has received less empirical attention in men. This study examined the relation between self-objectification and ideal body shape in both men and women. One hundred eighty-three college students (111 women, 72 men) completed a questionnaire containing measures of self-objectification and ideal body shape (using a figure array ranging from non-muscular to very muscular). Consistent with hypotheses, women desired a less muscular body and men desired a more muscular body. Women also self-objectified more than men. In addition, there was an interaction between sex and self-objectification on ideal body shape. For women, higher self-objectification scores were related to a desire for a less muscular body. For men, higher self-objectification scores were related to a desire for a more muscular body. Self-objectification theory is a useful framework for understanding body image issues in men. However, the relation between self-objectification and other body related variables may differ for men and women.

Although overweight children and adolescents experience a number of immediate difficulties, little research has investigated the long-term psychological consequences for individuals who were overweight as children or adolescents despite their weight status as young adults. The goal of this study was to examine the relations between individuals' retrospective reports of their weight and height during elementary and high school, and their past and current weight concerns. It was expected that individuals who recall being overweight as a child or adolescent would have more weight concerns than their peers who recall being normal weight, even after controlling for current body size. Participants were 174 females and 61 males, ranging in age from 18-20 (M=18.66 yr, SD=0.63). For females, perceived elementary school weight in comparison to their peers significantly predicted current weight concerns, p

Objective: Anti-fat prejudice is a common attitude in our society, and it has implications for those who hold and are targets of this prejudice. Little is known, however, about how parents’ anti-fat attitudes impact the ways they feed their young children. We hypothesized that parents’ attitudes about weight would predict parents’ restrictive feeding practices above and beyond the effects of the child's actual weight and the parents’ concern about child overweight. Research Methods and Procedures: A total of 126 mothers and 102 fathers returned surveys about anti-fat attitudes, feeding practices (restriction for weight and restriction for health), and concern about child overweight. Results: Parental concern about child overweight was related to higher restrictive feeding practices for both mothers and fathers. Parents’ anti-fat attitudes also predicted restrictive feeding above and beyond the effects of parent and child BMI and parental concern about overweight. Discussion: These findings suggest that parents’ anti-fat attitudes impact the way they feed their children.