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Background Adolescent substance use, externalizing and attention problems, and early life stress (ELS) commonly co-occur. These psychopathologies show overlapping neural dysfunction in the form of reduced recruitment of reward processing neuro-circuitries. However, it is unclear to what extent these psychopathologies show common v. different neural dysfunctions as a function of symptom profiles, as no studies have directly compared neural dysfunctions associated with each of these psychopathologies to each other. Methods In study 1, a latent profile analysis (LPA) was conducted in a sample of 266 adolescents (aged 13–18, 41.7% female, 58.3% male) from a residential youth care facility and the surrounding community to investigate substance use, externalizing and attention problems, and ELS psychopathologies and their co-presentation. In study 2, we examined a subsample of 174 participants who completed the Passive Avoidance learning task during functional magnetic resonance imaging to examine differential and/or common reward processing neuro-circuitry dysfunctions associated with symptom profiles based on these co-presentations. Results In study 1, LPA identified profiles of substance use plus rule-breaking behaviors, attention-deficit hyperactivity disorder, and ELS. In study 2, the substance use/rule-breaking profile was associated with reduced recruitment of reward processing and attentional neuro-circuitries during the Passive Avoidance task (p < 0.05, corrected for multiple comparisons). Conclusions Findings indicate that there is reduced responsivity of striato-cortical regions when receiving outcomes on an instrumental learning task within a profile of adolescents with substance use and rule-breaking behaviors. Mitigating reward processing dysfunction specifically may represent a potential intervention target for substance-use psychopathologies accompanied by rule-breaking behaviors.

Childhood socioeconomic disadvantage is a form of adversity associated with alterations in critical frontolimbic circuits involved in the pathophysiology of psychiatric disorders. Most work has focused on individual-level socioeconomic position, yet individuals living in deprived communities typically encounter additional environmental stressors that have unique effects on the brain and health outcomes. Notably, chronic and unpredictable stressors experienced in the everyday lives of youth living in disadvantaged neighborhoods may impact neural responsivity to uncertain threat.A community sample of children (There was a significant ADI × valence interaction in the middle temporal gyrus, anterior cingulate cortex, hippocampus, and amygdala. Higher ADI was associated with less amygdala activation to negatively valenced images. ADI also interacted with predictability. Higher ADI was associated with greater activation of lingual and calcarine gyri for unpredictably presented stimuli. There was no three-way interaction of ADI, valence, and predictability.Neighborhood disadvantage may impact how the brain perceives and responds to potential threats. Future longitudinal work is critical for delineating how such effects may persist across the life span and how health outcomes may be modifiable with community-based interventions and policies.

Although there is a significant link between maternal substance use and child maltreatment risk, extant literature has not investigated this link specifically among the growing number of parents abusing opioids. Underreporting of opioid use within child welfare presents further challenges in elucidating relations between maternal opioid use and child maltreatment. The purpose of the current study is to examine the link between maternal opioid use in women in substance use treatment and self-reported rates of child maltreatment and child welfare involvement of their children. We examined maternal substance use, severity of substance use, severity and type of child maltreatment of their children, and child welfare involvement across mothers who misuse opioids and misuse other substances using self-report surveys with 89 mothers. Results suggest similarities and differences among mothers who use opioids and other substances. Mothers who use opioids endorsed more significant and prolonged involvement with child welfare than mothers who use other substances. Participants did not endorse significant differences between rates of child maltreatment, and treatment engagement across groups. Given increased awareness of significant risks associated with opioid abuse, including greater risk for child maltreatment, a better understanding of its intersection with child welfare is necessary.

Research suggests that children with conduct problems (CP) and callous-unemotional (CU) traits show a diminished response to behavior therapy, perhaps due to a reward-oriented, punishment insensitive learning style. Children with CP and CU may benefit from personalizing behavioral treatment for them by emphasizing rewards and de-emphasizing punishments. This hypothesis was tested in a sample of 46 children (78.3% boys), ages 7.0 to 12.6 years (M = 9.3, SD = 1.4). All participants met criteria for ODD and ADHD and 63% also met criteria for CD. Participants were oversampled for high CU, but CU scores ranged from average to high. Children received four weeks of modified behavior therapy that emphasized rewards and de-emphasized punishments and four weeks of treatment as usual, which was standard behavior therapy that balanced rewards and punishments. Treatments were implemented in a summer treatment program and compared using a within-subjects design, with order of treatment counterbalanced. Disruptive behavior was equal or slightly higher in modified behavior therapy than in standard behavior therapy on point system measures, but lower on parent weekly ratings. End of treatment ratings showed both treatments produced significant improvements compared to pre-treatment ratings but did not differ from each other. Personalizing behavior therapy for children with CP and CU produced inconsistent findings relative to standard behavior therapy. Behavior therapy is likely to be a necessary part of treatment for children with CP and CU, but treatment personalization efforts may provide some benefit by addressing other deficits shown by these children.

It has been difficult to disentangle factors conferring vulnerability to substance use disorders (SUDs) from the consequences of substance use. Reward sensitivity and impulsivity have been identified as adolescent risk factors that confer vulnerability for later problematic substance use.1,2 Studies also suggest, however, that substance use itself affects brain development and behavior and that some of the same risk factors that predispose youth to SUD (eg, reward sensitivity and impulsivity) may be brought on or worsened by the neurotoxicity of drugs of abuse.3,4 Studies examining neural and behavioral correlates of SUDs commonly include youth with varying degrees of substance exposure; thus development of vulnerabilities to substance abuse are difficult to separate from the effects of substance use. In this issue of JACC, Ivanov et al.5 advance our field's knowledge in this area by leveraging longitudinal data from the European IMAGEN dataset (n = 2,200)6 in order to characterize predictors of alcohol use at age 16 as well as trajectories of impulsivity. This design allows investigation into whether alcohol drinking in adolescence may actually be related to worsening impulsivity. The authors followed a subset of the IMAGEN sample, 304 substance-naive 14-year-olds over 2 years. Reward system function in the brain was assessed at baseline by collecting functional magnetic resonance imaging scans during a Monetary Incentive Delay (MID)7 task which assessed neural response to reward anticipation and outcome. Impulsivity and delay discounting, the propensity to select smaller immediate rewards versus larger, delayed rewards, were also assessed at baseline and follow-up. Linear regression was used to evaluate longitudinal associations among the frequency of alcohol use at age 16 and impulsivity, delay discounting, and reward system function at age 14. Reward system function was measured by activation in medial orbitofrontal cortex (mOFC) and ventral striatum regions of interest during the highest versus the lowest reward levels on the MID task. These regions are involved in key aspects of reward processing, including valuation of rewarding stimuli and outcomes.8,9.

Two of the most commonly used illegal substances by adolescents are alcohol and cannabis. Alcohol use disorder (AUD) and cannabis use disorder (CUD) are associated with poorer decision-making in adolescents. In adolescents, level of AUD symptomatology has been negatively associated with striatal reward responsivity. However, little work has explored the relationship with striatal reward prediction error (RPE) representation and the extent to which any augmentation of RPE by novel stimuli is impacted. One-hundred fifty-one adolescents participated in the Novelty Task while undergoing functional magnetic resonance imaging (fMRI). In this task, participants learn to choose novel or non-novel stimuli to gain monetary reward. Level of AUD symptomatology was negatively associated with both optimal decision-making and BOLD response modulation by RPE within striatum and regions of prefrontal cortex. The neural alterations in RPE representation were particularly pronounced when participants were exploring novel stimuli. Level of CUD symptomatology moderated the relationship between novelty propensity and RPE representation within inferior parietal lobule and dorsomedial prefrontal cortex. These data expand on an emerging literature investigating individual associations of AUD symptomatology levels versus CUD symptomatology levels and RPE representation during reinforcement processing and provide insight on the role of neuro-computational processes underlying reinforcement learning/decision-making in adolescents.

Childhood maltreatment is linked to Posttraumatic Stress Disorder (PTSD) in adulthood. Neural attention network function contributes to resilience against PTSD following maltreatment; oxytocin administration alters functional connectivity differentially among resilient to PTSD groups. The present study examined intrinsic connectivity between ventral and dorsal neural attention networks (VAN and DAN) to clarify the nature of dysfunction versus resilience in the context of maltreatment-related PTSD, and to explore differential dysfunction related to varied aspects of maltreatment. Oxytocin administration was examined as a factor in these relationships. Resting-state functional connectivity data were collected from 39 adults with maltreatment histories, with and without PTSD, who were randomly assigned to receive oxytocin or placebo. We found that PTSD and sexual abuse (SA) were associated with reduced VAN-DAN connectivity. There were no significant effects with regard to physical abuse. Oxytocin was associated with greater VAN-DAN connectivity strength. These preliminary findings suggest dysfunction within attentional systems in PTSD, as well as following SA. Further, oxytocin may help ameliorate attentional neurocircuitry dysfunction in individuals with PTSD and those with maltreatment histories.

Two of the most commonly used substances by adolescents in the United States are cannabis and alcohol. Cannabis Use Disorder (CUD) and Alcohol Use Disorder (AUD) are associated with impairments in decision-making processes. One mechanism for impaired decision-making in these individuals is thought to be an inability to adequately represent future events during decision-making. In the current study involving 112 adolescents, we used a comparative optimism task to examine the relationship between relative severity of CUD/AUD (as indexed by the CUD/AUD Identification Tests [CUDIT/AUDIT]) and atypical function within neural systems underlying affect-based neural represenation future events. Greater CUDIT scores were negatively related to responses within subgenual anterior and posterior cingulate cortex when processing high-intensity potential future positive and negative events. There was also a particularly marked negative relationship between CUD symptoms and blood oxygen level-dependent (BOLD) responses within visual and premotor cortices to high-intensity, negatively valenced potential future events. However, AUD symptom severity was not associated with dysfunction within these brain regions. These data indicate that relative risk/severity of CUD is associated with reduced responsiveness to future high-intensity events. This may impair decision-making where future significant consequences should guide response choice.

Background The two most commonly used illegal substances by adolescents in the United States are alcohol and cannabis. Alcohol use disorder (AUD) and cannabis use disorder (CUD) have been associated with dysfunction in decision-making processes in adolescents. One potential mechanism for these impairments is thought to be related to abnormalities in reward and punishment processing. However, very little work has directly examined potential differential relationships between AUD and CUD symptom severity and neural dysfunction during decision making in adolescents. Methods In the current study, 154 youths participated in a passive avoidance learning task during functional magnetic resonance imaging to investigate the relationship between relative severity of AUD/CUD and dysfunction in processing reward and punishment feedback. Results Increasing Alcohol Use Disorder Identification Test scores were associated with reduced neural differentiation between reward and punishment feedback within regions of striatum, posterior cingulate cortex, and parietal cortex. However, increasing Cannabis Use Disorder Identification Test scores were not associated with any neural dysfunction during the passive avoidance task. Conclusions These data expand on emerging literature that relative severity of AUD is associated with reduced responsivity to rewards in adolescents and that there are differential associations between AUD and CUD symptoms and neurocircuitry dysfunction in the developing adolescent brain.

Alcohol and cannabis are two substances that are commonly abused by adolescents in the United States and which, when abused, are associated with negative medical and psychiatric outcomes across the lifespan. These negative psychiatric outcomes may reflect the detrimental impact of substance abuse on neural systems mediating emotion processing and executive attention. However, work indicative of this has mostly been conducted either in animal models or adults with Alcohol and/or Cannabis Use Disorder (AUD/CUD). Little work has been conducted in adolescent patients. In this study, we used the Affective Stroop task to examine the relationship in 82 adolescents between AUD and/or CUD symptom severity and the functional integrity of neural systems mediating emotional processing and executive attention. We found that AUD symptom severity was positively related to amygdala responsiveness to emotional stimuli and negatively related to responsiveness within regions implicated in executive attention and response control (i.e., dorsolateral prefrontal cortex, anterior cingulate cortex, precuneus) as a function of task performance. In contrast, CUD symptom severity was unrelated to amygdala responsiveness but positively related to responsiveness within regions including precuneus, posterior cingulate cortex, and inferior parietal lobule as a function of task performance. These data suggest differential impacts of alcohol and cannabis abuse on the adolescent brain., Highlights • Alcohol and cannabis are the most widely abused substances by adolescents. • AUDIT scores are related to amygdala hyperactivity to emotional stimuli. • AUDIT scores are related to hypoactivity in executive attention neuro-circuitry. • CUDIT scores are related to hyperactivity in executive attention neuro-circuitry.

Parental stress is a well-established risk factor for adverse child outcomes, including the development of aggression, externalizing behavior problems, and anxiety, as well as compromised emotional coping, impaired social cognition, and diminished treatment response. Abuse potential represents a mechanism by which parental stress may impact child social competence and behavior; evidence links parental stress to abuse potential, and abuse potential to a range of negative child social competence and behavioral outcomes. The current study assessed relationships between parental stress, abuse potential, and child social and behavioral outcomes over time. Parents of children ages 2–6 years (N = 610, 44% girls) reported on perceived parental stress and attitudes towards abuse and neglect, as well as child social competence and behavior problems, before and after a caregiver-directed, community-based intervention. Changes in parental stress, abuse potential, and child social and behavioral outcomes were examined using panel analyses, while controlling for intervention effects and demographic variables. Parental stress predicted child social competence, anxiety/withdrawal, and anger/aggression over time; while the links between stress and anxiety/withdrawal, and stress and social competence, were mediated by child abuse potential, the link between stress and anger/aggression was not mediated by child abuse potential. Findings suggest that abuse potential represents a mechanism by which parental stress and child social and behavioral outcomes are linked. Further, screening for child social competence deficits may identify children at risk for abuse, as well as parents in need of services to reduce stress.

Alcohol and cannabis are two of the most commonly used substances by adolescents and are associated with adverse medical and psychiatric outcomes. These adverse psychiatric outcomes may reflect the negative impact of alcohol and/or cannabis abuse on neural systems mediating reward and/or error detection. However, work indicative of this has mostly been conducted in adults with Alcohol and/or Cannabis Use Disorder (i.e., AUD and CUD), with relatively little work in adolescent patients. Furthermore, of the work that has been conducted in adolescents, groups were based on categorical diagnoses of AUD and/or CUD, so the relationship between AUD and/or CUD symptom severity in adolescents and neural dysfunction is unclear. We used a Monetary Incentive Delay (MID) task to examine the relationship between AUDIT and/or CUDIT scores and functional integrity of neuro-circuitries mediating reward processing and error detection within 150 adolescents. Our findings indicate that AUDIT score is negatively related to activity in reward processing neuro-circuitry in adolescents. However, CUDIT score is negatively related to activity in brain regions involved in error detection. Each of these relationships reflected a medium effect size (Partial-η2 0.09-0.14). These data suggest differential impacts of AUD and CUD on reward versus error detection neuro-circuitries within the adolescent brain. Keywords: Adolescent, Alcohol use disorder, Anterior cingulate cortex, Cannabis use disorder, fMRI, Striatum

Objective Most research on irritability and child psychopathology has focused on depressive disorders, bipolar disorder, and/or oppositional defiant disorder (ODD). Less is known about relationships between child anxiety and irritability and moderators of such associations. Method Structural equation modeling (SEM) was used to examine associations between anxiety severity and irritability in a large sample of treatment-seeking youth with anxiety disorders (N = 663, aged 7–19 years, mean = 12.25 years), after accounting for comorbid depressive disorders and ODD. Additional analyses examined whether associations were moderated by child gender, age, and generalized anxiety disorder (GAD) status. Results There was a direct link between child anxiety and irritability even after accounting for comorbid depressive disorders and ODD. Links between child anxiety and irritability were robust across child gender and age. Furthermore, relationships between child anxiety and irritability were comparable across youth with and without GAD, suggesting that the anxiety–irritability link is relevant across child anxiety disorders and not confined to youth with GAD. Conclusion Findings add to an increasing body of evidence linking child irritability to a range of internalizing and externalizing psychopathologies, and suggest that child anxiety assessment should systematically incorporate irritability evaluations. Moreover, youth in clinical settings displaying irritability should be assessed for the presence of anxiety. Treatments for childhood anxiety may do well to incorporate new treatment modules as needed that specifically target problems of irritability.

Although most research with youth exposed to violent manmade disasters has focused on internalizing problems, recent work suggests conduct problems (CPs) may also manifest in exposed youth. However, the extent to which youth postevent CPs present independently, versus co-present in conjunction with PTSD symptoms, remains unclear. The present study examined PTS and CP symptom profiles among affected Boston-area youth following the 2013 Boston Marathon bombing. This study used latent profile analysis to identify distinct PTS and CP symptom profiles among Boston-area youth ages 4-19 years (N=344) affected by the Boston Marathon bombing events. PTS and CPs were measured using the UCLA-PTSD-RI and the SDQ parent reports, respectively. Analyses identified 3 distinct profiles: presentations characterized by (a) low PTS, low CPs, (b) moderate PTS, low CPs, and (c) high PTS, elevated CPs. The profile characterized by the highest PTS was the only profile with elevated CPs; hyperarousal and emotional numbing/avoidance symptoms showed the greatest distinguishing properties among profiles with and without elevated CP. Types of traumatic exposure experienced by youth were differentially associated with profiles. Specifically, direct (but not relational) exposure distinguished youth classified in the profile showing elevated CPs. Findings suggest interventions following violent manmade disasters may do well to incorporate CP modules when working with youth showing the greatest hyperarousal and emotional numbing, and/or who have directly witnessed the most violence.

Mental health research demonstrates that children with conduct problems (CP) and callous-unemotional (CU) traits differ in important ways from children with CP alone, including differences in primary caregiver attachment quality. This research suggests CU may also influence the quality of attachment between children with CP and their teachers. This study compared children with CP alone (CP), CU alone (CU), both CP and CU (CPCU), and neither CP nor CU (comparison) on measures of the student–teacher relationship (STR). Participants were 1,554 students from seven elementary schools. Teachers completed ratings of STR, behavior (CP, CU, attention-deficit/hyperactivity disorder [ADHD]), and impairment approximately 4 to 6 weeks after the start of the school year, and again 4 to 6 weeks before the school year’s end. Random intercept hierarchical linear models (HLMs) showed that (a) children with CPCU had the highest conflict and lowest closeness with teachers at the start of the school year and the greatest end-of- year impairment, (b) higher conflict and lower closeness with teachers at the school year’s start were associated with greater end-of-the-year impairment, (c) there was no interaction between group (CP, CU, CPCU, or comparison) and STR in predicting end-of-the-year outcomes, and (d) ADHD was robustly associated with end-of-the-year impairment.

The current study investigated whether and how callous-unemotional traits (CU) moderated the association between specific parenting practices and child conduct problems (CP) with a special consideration of informant patterns. Associations between CU, ODD and CD symptom severity, and the parenting practices of deficient monitoring, positive involvement, and negative/ineffective discipline were examined across parent and teacher reports on 851 elementary-school students. Relative to children with low CU, in children with high CU: (1) positive parenting was associated with lower CD, but increased ODD; (2) negative/ineffective discipline was associated with increased ODD; (3) deficient monitoring was associated with increased CD. Results were not robust across informants. These findings suggest that in the context of CU, the associations between parenting and CP differ based on parenting characteristics, CP dimensions, and informant, and that families may benefit from treatment targeting specific parenting practices based on CP symptom profiles.

Having passed the one-year anniversary of the initial DSM-5 publication, this paper presents a guiding summary of key areas of change—and lack thereof—across DSM definitions of disorders affecting anxious youth, and offers data-informed evaluations and commentaries clarifying the areas in which DSM-5 should be celebrated as a meaningful advancement in the assessment of child anxiety, diagnostic dilemmas in child anxiety assessment from previous DSM editions that remain unresolved in DSM-5, and areas in which DSM-5 may have actually introduced new problems into the assessment of child anxiety. We organize our review and commentary around five of the meaningful changes in DSM-5 with implications for the assessment of anxious youth: (1) the new classification of selective mutism as an anxiety disorder; (2) the removal of the social anxiety disorder “generalized” specifier and the new addition of a “performance-only” specifier; (3) the revised operationalization of agoraphobia and the decoupling of agoraphobia from panic disorder; (4) the creation of a new category—disruptive mood dysregulation disorder—for diagnosing youth presenting with chronic irritability and severe temper outbursts; and (5) the revised classification of anxiety disorders not otherwise specified in the DSM. We then turn our attention to discuss four areas of noted diagnostic dilemmas in the assessment of child anxiety from DSM-IV that remain unresolved in the new DSM-5: (1) the phenomenological overlap between the OCD and generalized anxiety disorder (GAD) definitions; (2) the phenomenological overlap between GAD and major depressive disorder (MDD) definitions; (3) differential diagnostic utility across the separation anxiety disorder symptoms; and (4) the extent to which youth presenting with multiple marked and persistent fears should be assigned multiple distinct diagnoses of specific phobia.

This study explores the use of stimulant medication for parents with attention-deficit/hyperactivity disorder (ADHD) who also have adolescents with ADHD.Five parents, diagnosed with ADHD, had their dose of lisdexamfetamine (LDX) titrated to optimal effect. Next, parents and their adolescents completed two interactions, once when parents were on placebo and once when parents were on optimal dose of LDX, to assess acute effects of parental medication on parenting during a neutral discussion (NeuDiss), a problem discussion (ProbDiss), and a homework task (HW).Parents demonstrated a significant decrease in the ratio of commands to total verbalizations during the NeuDiss on LDX compared with placebo. Although no other statistically significant effects emerged at the p0.05 level, moderate to large effects of medication on some aspects of parenting related to the amount and timing of speech (i.e., total verbalizations, total commands, ratio of commands to total verbalizations, and responsiveness) emerged and varied by task. Parental stimulant medication did not appear to impact the content of parents' speech (i.e., use of negative talk or praise).These results add to a growing literature suggesting that treatment for parental ADHD may impact parenting performance, and suggest that attention to parental ADHD in treatment for adolescents with ADHD may possibly enhance family functioning.

The conduct problems of children with callous-unemotional (CU) traits (i.e., lack of empathy, lack of guilt/lack of caring behaviors) are particularly resistant to current behavioral interventions, and it is possible that differential sensitivities to punishment and reward may underlie this resistance. Children with conduct problems and CU (CPCU) are less responsive to behavioral punishment techniques (e.g., time-out), whereas reward techniques (e.g., earning points for prizes or activities) are effective for reducing conduct problems. This study examined the efficacy of modified behavioral interventions, which de-emphasized punishment (Condition B) and emphasized reward techniques (Condition C), compared with a standard behavioral intervention (Condition A). Interventions were delivered through a summer treatment program over 7 weeks with an A-B-A-C-A-BC-A design to a group of 11 children (7–11 years; 91% male). All children were diagnosed with either oppositional defiant disorder or conduct disorder, in addition to attention-deficit hyperactivity disorder. Results revealed the best treatment response occurred during the low-punishment condition, with rates of negative behavior (e.g., aggression, teasing, stealing) increasing over the 7 weeks. However, there was substantial individual variability in treatment response, and several children demonstrated improvement during the modified intervention conditions. Future research is necessary to disentangle treatment effects from order effects, and implications of group treatment of CPCU children (i.e., deviancy training) are discussed.

This study examines the effects of parental lisdexamfetamine (LDX) treatment on parent–child interactions. Participants were 30 parents (27 % were male) and their children aged 5–12 years, both diagnosed with DSM-IV attention-deficit/hyperactivity disorder (ADHD). Optimal LDX dose (30, 50, or 70 mg/day) was determined for parents during a 3-week open-label titration, followed by a within-subjects trial of the acute impact of LDX and placebo on observable parent–child interactions. Two laboratory-based, parent–child interactions simulating typical family tasks (e.g., homework, joint play) were conducted within 2 weeks, once with the adult on a blinded optimal dose of LDX and once on placebo (phase I). Parents were then randomly assigned to continue blinded treatment with LDX or placebo for another month followed by a third interaction task (phase II) to assess the ongoing effects of LDX on parent–child interactions. The primary outcome was the change in rate of parenting behaviors coded during the parent–child interaction tasks. Secondary outcomes included observed rates of children’s inappropriate behaviors during the laboratory tasks and changes in parental ADHD symptom severity (ADHD-Rating Scale). Twenty parents (67 %) completed the trial. In phase I, medication was associated with a significant reduction in negative talk by parents (p = 0.0066, d = −0.47). There was a Medication × Task interaction (p = 0.0235) with a reduction in children’s negative behaviors in the homework phase only (p = 0.0154, d = −0.58). In phase II, LDX was associated with significant increases in praise by parents (d = 0.81) and reductions in parental commands (d = −0.88) and children’s inappropriate behaviors (d = −0.84) (all p-values

This cross-sectional study examines the association of amount and different type of childhood maltreatment with responsiveness in regions of the brain implicated in emotional responding and response control in youths., Key Points Question Are the amount and type (abuse vs neglect) of childhood maltreatment differentially associated with the responsiveness of regions of the brain implicated in emotional responding and response control? Findings In this cross-sectional study including 116 youths aged 10 to 18 years, the amount of childhood maltreatment was inversely associated with the responsiveness of regions of the brain involved in response control and positively associated with emotional responding. This association was also found specifically for abuse but not for neglect. Meaning Different types of childhood maltreatment may have different associations with atypical neural responses; therefore, they may have different associations with different forms of psychiatric neurobiology., Importance Childhood maltreatment is associated with serious developmental consequences that may be different depending on the form of maltreatment. However, relatively little research has investigated this issue despite implications for understanding the development of psychiatric disorders after maltreatment. Objective To determine the association of childhood maltreatment and potential differential associations of childhood abuse or neglect with neural responsiveness within regions of the brain implicated in emotional responding and response control. Design, Setting, and Participants In this cross-sectional study, participants aged 10 to 18 years with varying levels of prior maltreatment as indexed by the Childhood Trauma Questionnaire (CTQ) were recruited from a residential care facility and the surrounding community. Blood oxygen level–dependent response data were analyzed via 2 analyses of covariance that examined 2 (sex) × 3 (task condition [view, congruent, incongruent]) × 3 (valence [negative, neutral, positive]) with Blom-transformed covariates: (1) total CTQ score; and (2) abuse and neglect subscores. Data were collected from April 1, 2016, to June 30, 2018. Data analyses occurred from June 10, 2018, to October 31, 2018. Main Outcomes and Measures Blood oxygenation level–dependent signals in response to an Affective Stroop task were measured via functional magnetic resonance imaging. Results The sample included 116 youths (mean [SD] age, 15.0 [2.2] years; 70 [60.3%] male). Fifteen participants reported no prior maltreatment. The remaining 101 participants (87.1%) reported at least some prior maltreatment, and 55 (54.5%) reported significant maltreatment, ie, total CTQ scores were greater than the validated CTQ score threshold of 40. There were significant total CTQ score × task condition associations within the bilateral postcentral gyrus, left precentral gyrus, midcingulate cortex, middle temporal gyrus, and superior temporal gyrus (left postcentral gyrus: F = 11.73; partial η2 = 0.14; right postcentral and precentral gyrus: F = 9.81; partial η2 = 0.10; midcingulate cortex: F = 12.76; partial η2 = 0.12; middle temporal gyrus: F = 13.24; partial η2 = 0.10; superior temporal gyrus: F = 10.33; partial η2 = 0.11). In all examined regions of the brain, increased maltreatment was associated with decreased differential responsiveness to incongruent task trials compared with view trials (left postcentral gyrus: r = −0.34; 95% CI, −0.17 to −0.51; right postcentral and precentral gyrus: r = −0.31; 95% CI, −0.14 to −0.49; midcingulate cortex: r = −0.36; 95% CI, −0.18 to −0.53; middle temporal gyrus: r = −0.35; 95% CI, −0.17 to −0.52; superior temporal gyrus: r = −0.37; 95% CI, −0.20 to −0.55). These interactions were particularly associated with level of abuse rather than neglect. A second analysis of covariance revealed significant abuse × task condition (but not neglect × task) interactions within the midcingulate cortex (F = 13.96; partial η2 = 0.11), right postcentral gyrus and inferior parietal lobule (F = 15.21; partial η2 = 0.12), left postcentral and precentral gyri (F = 11.16; partial η2 = 0.12), and rostromedial frontal cortex (F = 10.36; partial η2 = 0.08)). In all examined regions of the brain, increased abuse was associated with decreased differential responsiveness to incongruent task trials compared with view trials (midcingulate cortex: partial r = −0.33; P

Leading telemental healthcare programs are increasingly harnessing new technologies in innovative ways to broaden the reach of supported care for children and adolescents. Technology-based delivery methods drawing on synchronous videoteleconferencing can transcend geographic barriers to quality care and remotely provide real-time services to affected families, regardless of their proximity to an expert mental health facility.The present review considers critical issues specific to family-based telemental healthcare, including: 1) Navigating varying levels of technological literacy across generations of participants; 2) deciding which family members to include in family-based telemental healthcare; 3) ensuring the safety of participants in family-based telemental healthcare; 4) optimizing therapeutic alliance and engagement in family-based telemental healthcare; 5) navigating logistical concerns in the conducting of sessions; and 6) ensuring privacy in family-based telemental healthcare.We discuss illustrations of recent child telemental healthcare advances that have focused explicitly on family-based treatment approaches, including Internet-delivered Parent-Child Interaction Therapy and Internet-delivered family-based cognitive-behavioral therapy for early-onset OCD.We conclude with a consideration of future directions for the field of family-based telemental healthcare.

A large body of work documents the heavy mental health burden of youth exposure to disasters, but the majority of this research has focused on posttraumatic stress and internalizing symptoms. Less is known about associations between disaster exposure and children's conduct problems (CPs), or variables that may moderate such relationships. Given well-documented links between CPs and children's exposure to community violence, youth with greater prior community violence exposure through residence in high-crime areas may be particularly vulnerable to the impacts of disaster exposure on CPs. We surveyed Boston-area caregivers (N = 460) in the first 6 months following the 2013 Marathon bombing on their children's event-related exposures, as well as CPs. To estimate prior violent crime exposure, children's neighborhoods were assigned corresponding violent crime rates obtained from the Federal Bureau of Investigation's uniform crime reporting statistics. Almost 1 in 6 Boston-area children assessed in this convenience sample showed clinically elevated CPs in the aftermath of the Boston Marathon bombing and subsequent manhunt. Prior violent crime exposure significantly moderated the link between children's manhunt exposure (but not bombing exposure) and child CPs. Manhunt exposure was related to increased CPs among children living in areas with high and medium (but not low) levels of prior violent crime. Children living in neighborhoods characterized by violent crime may be at particularly increased risk for developing CPs after violent manmade disasters. As most postdisaster child intervention efforts focus on posttraumatic stress, efforts are needed to develop programs targeting child CPs, particularly for youth dwelling in violent neighborhoods.

Much has changed since Victorian times, when psychology was dominated by the concept of precocity, in which children and adolescents were conceptualized as being merely miniature versions of adults. The implications of this conceptualization were both numerous and profound, not the least of which was that it fostered an ignorance of the relationship between ontogeny and pathology. Over time, this precocial view was eventually abandoned in favor of one with a greater appreciation for lifespan developmental processes. Most child and adolescent practitioners today receive clinical training steeped in a developmental perspective (Cicchetti & Cohen, 2006; Cicchetti & Toth, 2009; Ollendick & Hirshfeld-Becker, 2002). In this chapter, we discuss the phenomenon of social anxiety in children and adolescents. We adopt a biopsychosocial model of pathology, where case formulation is approached with a thorough appreciation for the various individual factors at play within the context of larger family, academic and cultural systems (Adler, 2009; Engel, 1977). We propose pediatric social anxiety is a product of the interaction among various biological, developmental, and social factors and begin with a thorough review of these systems. Next, we propose a model of social anxiety that outlines the reciprocal interactions between youth and these biopsychosocial systems. Finally, we describe an evidence-based therapeutic intervention for pediatric social phobia and conclude with recommendations for clinicians who work with this unique and often highly impaired clinical population