Media outlets have suggested that rates of child maltreatment may increase during the global COVID-19 pandemic. The few empirical studies that have examined pandemic related changes in rates of child ...maltreatment have relied predominantly on reports of suspected maltreatment.
This study examines rates of documented, substantiated child maltreatment resulting in foster care placement, as well as demographic correlates of child maltreatment within the foster care system, before and during the COVID-19 pandemic.
Data were available for all youth in the FL foster care system from January 1, 2001 through June 30, 2020 (i.e., > 304,000 youth; > 1.1 million total placements).
This study utilizes data from the Florida State Automated Child Welfare Information System (SACWIS).
Results revealed a decrease in the number of youths placed in the FL foster care system during the COVID-19 pandemic with the greatest reduction in April, 2020 during the Safer-at-Home Order (24 % fewer youth in 2020 than 2019). In contrast, the percentage of placements into foster care due to maltreatment increased by 3.34 %. Demographic-linked differences were observed in placement rates and exposure to maltreatment.
While prior work suggests that reports of child maltreatment have decreased during the COVID-19 pandemic, this study demonstrates that overall rates of substantiated maltreatment resulting in foster care placement have increased for White youth, while rates of placement of due to inadequate supervision, emotional neglect, and/or parental substance use have decreased for Black youth. Implications for policy and future research are discussed.
Background
Peripheral epigenetic marks hold promise for understanding psychiatric illness and may represent fingerprints of gene–environment interactions. We conducted an initial examination of CpG ...methylation variation in children with or without attention‐deficit/hyperactivity disorder (ADHD).
Methods
Children age 7–12 were recruited, screened, evaluated and assigned to ADHD or non‐ADHD groups by defined research criteria. Two independent age‐matched samples were examined, a discovery set (n = 92, all boys, half control, half ADHD) and a confirmation set (n = 20, half ADHD, all boys). 5‐methylcytosine levels were quantified in salivary DNA using the Illumina 450 K HumanMethylation array. Genes for which multiple probes were nominally significant and had a beta difference of at least 2% were evaluated for biological relevance and prioritized for confirmation and sequence validation. Gene pathways were explored and described.
Results
Two genes met the criteria for confirmation testing, VIPR2 and MYT1L; both had multiple probes meeting cutoffs and strong biological relevance. Probes on VIPR2 passed FDR correction in the confirmation set and were confirmed through bisulfite sequencing. Enrichment analysis suggested involvement of gene sets or pathways related to inflammatory processes and modulation of monoamine and cholinergic neurotransmission.
Conclusions
Although it is unknown to what extent CpG methylation seen in peripheral tissue reflect transcriptomic changes in the brain, these initial results indicate that peripheral DNA methylation markers in ADHD may be promising and suggest targeted hypotheses for future study in larger samples.
Psychiatric nosology is limited by behavioral and biological heterogeneity within existing disorder categories. The imprecise nature of current nosologic distinctions limits both mechanistic ...understanding and clinical prediction. We demonstrate an approach consistent with the National Institute of Mental Health Research Domain Criteria initiative to identify superior, neurobiologically valid subgroups with better predictive capacity than existing psychiatric categories for childhood attention-deficit/hyperactivity disorder (ADHD).
To refine subtyping of childhood ADHD by using biologically based behavioral dimensions (i.e., temperament), novel classification algorithms, and multiple external validators.
A total of 437 clinically well-characterized, community-recruited children, with and without ADHD, participated in an ongoing longitudinal study. Baseline data were used to classify children into subgroups based on temperament dimensions and examine external validators including physiological and magnetic resonance imaging measures. One-year longitudinal follow-up data are reported for a subgroup of the ADHD sample to address stability and clinical prediction.
Parent/guardian ratings of children on a measure of temperament were used as input features in novel community detection analyses to identify subgroups within the sample. Groups were validated using 3 widely accepted external validators: peripheral physiological characteristics (cardiac measures of respiratory sinus arrhythmia and pre-ejection period), central nervous system functioning (via resting-state functional connectivity magnetic resonance imaging), and clinical outcomes (at 1-year longitudinal follow-up).
The community detection algorithm suggested 3 novel types of ADHD, labeled as mild (normative emotion regulation), surgent (extreme levels of positive approach-motivation), and irritable (extreme levels of negative emotionality, anger, and poor soothability). Types were independent of existing clinical demarcations including DSM-5 presentations or symptom severity. These types showed stability over time and were distinguished by unique patterns of cardiac physiological response, resting-state functional brain connectivity, and clinical outcomes 1 year later.
Results suggest that a biologically informed temperament-based typology, developed with a discovery-based community detection algorithm, provides a superior description of heterogeneity in the ADHD population than does any current clinical nosologic criteria. This demonstration sets the stage for more aggressive attempts at a tractable, biologically based nosology.
Literature has suggested that ADHD may be associated with increased risk of obesity. If so, this would have important clinical implications.
To clarify the size of the association between ADHD and ...obesity and to evaluate key moderators of the association including medication, gender, age, and psychiatric comorbidity.
Two preliminary studies are presented to supply critical additional data for the meta-analysis: a two-year longitudinal study of an ADHD case–control sample of 313 children aged 7–11, and a national survey study of 45,309 families in the United States using the 2012 National Survey of Children's Health. Formal meta-analysis was then conducted. The identification procedure yielded 43 studies, reporting 225 comparisons or effect sizes, studying 703,937 participants An overall effect size was estimated with a random effects model (after pooling within study using a modified fixed effects model). Effect size was then examined in relation to medication, gender, age, and psychiatric comorbidity.
The new study of children revealed no reliable association of ADHD and body mass index at any age or time point. In the national survey, ADHD was associated with obesity only in adolescent girls but not in children or boys; this effect was statistically accounted for by covarying of depression and conduct disorder. In the meta-analysis, the composite effect size was OR=1.22 (95% CI=1.11–1.34); 22 studies provided effects with medication controlled, yielding a composite effect size of OR=1.30 (95% CI=1.12–1.50). Pooled across age the association without covariates was reliable in females (OR=1.19 1.01–1.41) but not males (OR=1.10 0.95–1.23) although males and females did not statistically differ. Pooled across gender, the association was significantly larger in adults (>18years) (OR=1.37 1.19–1.58) than in youth (OR=1.13 1.00–1.27), p=.04.
ADHD has a small overall association with obesity, but this effect is moderate in adults. The effect is likely to be of no clinical significance in children, possible clinical significance in adolescent girls with comorbid disorders, and of clinical relevance by adulthood.
•ADHD and obesity may be associated but effect moderators are unclear.•A meta-analysis of 43 studies was conducted.•A reliable overall ADHD-to-obesity association was found with a small effect size.•The effect was larger in adults over 18years old than in children.•This association may be of minimal clinical impact in children but more in adults.
Objective: How best to capture heterogeneity in attention-deficit/hyperactivity disorder (ADHD) using biomarkers has been elusive. This study evaluated whether emotion reactivity and regulation ...provide a means to achieve this. Method: Participants were classified into three groups: children with ADHD plus low prosocial behavior (hypothesized to be high in callous/unemotional traits; n = 21); children with ADHD with age-appropriate prosocial behavior (n = 54); and typically developing children (n = 75). Children completed a task with four conditions: negative induction, negative suppression, positive induction, and positive suppression of affect. The task required children to view an emotion-laden film clip, while either facially mimicking (induction) or masking (suppression) the emotion of the main character. Parasympathetic and sympathetic nervous system activity were assessed via respiratory sinus arrhythmia (RSA) and cardiac pre-ejection period (PEP), respectively. Symptoms of anxiety, conduct, and oppositional defiant disorders were treated as covariates. Results: The ADHD-typical-prosocial group displayed atypically elevated parasympathetic reactivity (emotion dysregulation) during positive induction, along with increased sympathetic activity (elevated arousal) across conditions. In contrast, the ADHD-low-prosocial group displayed reduced parasympathetic reactivity and reduced sympathetic activity (low emotional arousal) across baseline and task conditions. Thus, both ADHD groups had altered patterns of autonomic functioning, but in two distinct forms. Conclusion: Although ADHD is heterogeneous clinically, results suggest that ADHD is also heterogeneous with regard to physiological indices of emotion and regulation. Future studies of emotion, regulation, and ADHD should take this into account. Further study of physiological responding in ADHD may yield clinically and etiologically distinct domains or groups. (Contains 2 figures and 3 tables.)
Attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) are believed to partially share genetic factors and biological influences. As the number of children with these ...diagnoses rises, so does the number of younger siblings at presumed risk for ADHD and ASD; reliable recurrence risk estimates within and across diagnoses may aid screening and early detection efforts and enhance understanding of potential shared causes.
To examine within-diagnosis sibling recurrence risk and sibling cross-aggregation of ADHD and ASD among later-born siblings of children with either disorder.
Using data extracted from medical records of 2 large health care systems in the United States, estimates of recurrence risk and cross-aggregation in later-born siblings of children with ADHD or ASD were compared with later-born siblings of children without these diagnoses. One data set included children seen between January 1, 1995, and December 31, 2013; the other included children born between January 1, 1998, and May 17, 2010. Participants included 15 175 later-born siblings of children with ADHD, ASD, and no known diagnosis. The study was conducted from October 2, 2017, to August 14, 2018.
Diagnoses of ASD or ADHD in the later-born sibling, ascertained from medical records, were the primary outcomes of interest; moderators included sex, gestational age, and maternal age.
A total of 15 175 later-born siblings were classified by familial risk status based on the older child's diagnostic status: ADHD risk (n = 730; male 51.92%), ASD risk (n = 158; male 48.10%), and no known risk (n = 14 287; male 50.73%). Compared with later-born siblings of children without ADHD or ASD, later-born siblings of children with ASD were more likely to be diagnosed with ASD (odds ratio OR, 30.38; 95% CI, 17.73-52.06) or ADHD in the absence of ASD (OR, 3.70; 95% CI, 1.67-8.21). Compared with later-born siblings of children without a diagnosis, later-born siblings of children with ADHD were more likely to be diagnosed with ADHD (OR, 13.05; 95% CI, 9.86-17.27) or ASD in the absence of ADHD (OR, 4.35; 95% CI, 2.43-7.79).
Later-born siblings of children with ASD or ADHD appear to be at elevated risk for the same disorder, but also of being diagnosed with the other disorder. These findings provide further support for shared familial mechanisms underlying ASD and ADHD, which may be useful for genetic and prospective developmental studies. Later-born siblings of children with ADHD or ASD should be monitored for both conditions.
Attention-deficit/hyperactivity disorder (ADHD) is characterized by heterogeneous behaviors and symptoms, developmental trajectories, and treatment response. Isolating intermediate phenotypes that ...are superior to current DSM-based nosology in order to explain such heterogeneity is integral to enhancing etiological theory, improving clinical assessment, predicting treatment response, and developing tailored treatments. To this end, this review provides an integrated developmental psychopathology and National Institute of Mental Health Research Domain Criteria (RDoC) approach to ADHD. In particular, associations between ADHD and RDoC domains of cognition (specifically working memory) and positive valence (reward anticipation/delay/receipt) are discussed. These domains are examined across behavioral and neurocircuitry levels of analysis and placed within a developmental context via examining associations among RDoC domains, relevant features of ADHD, and environmental correlates implicated across development. Limitations of the existing literature and proposed future directions are explored. Importantly, future work should focus on novel approaches that account for developmental shifts in functioning of relevant RDoC domains over time, as well as further examination of the interaction across RDoC domains and levels of analysis.
Attention deficit hyperactivity disorder (ADHD) is emblematic of unresolved heterogeneity in psychiatric disorders- the variation in biological, clinical, and psychological correlates that impedes ...progress on etiology. One approach to this problem is to characterize subgroups using measures rooted in biological or psychological theory, consistent with the National Institute of Mental Health's research domain criteria initiative. Within ADHD, a promising application involves using emotion trait profiles that can address the role of irritability as a complicating feature for ADHD. Here, a new sample of 186 children with ADHD was evaluated using community detection analysis to determine if meaningful subprofiles existed and if they replicated those previously identified. The new sample and a prior sample were pooled for evaluation of (a) method dependence, (b) longitudinal assessment of the stability of classifications, and (c) clinical prediction 2 years later. Three temperament profiles were confirmed within the ADHD group: one with normative emotional functioning ("mild"), one with high surgency ("surgent"), and one with high negative affect ("irritable"). Profiles were similar across statistical clustering approaches. The irritable group had the highest external validity: It was moderately stable over time and it enhanced prospective prediction of clinical outcomes beyond standard baseline indicators. The irritable group was not reducible to ADHD + oppositional defiant disorder, ADHD + disruptive mood dysregulation disorder, or other patterns of comorbidity. Among the negative affect domains studied, trait proneness to anger uniquely contributed to clinical prediction. Results extend our understanding of chronic irritability in psychiatric disorders and provide prospects for a fresh approach to assessing ADHD heterogeneity focused on the distinction between ADHD with and without anger/irritability.
Public Significance Statement
This work identifies a group of children with ADHD and irritable mood who are at increased risk for negative outcomes. Addition of a specifier in the ADHD diagnostic criteria based on the presence or absence of irritability could be considered.
Children with attention deficit/hyperactivity disorder (ADHD) display alterations in both emotion reactivity and regulation. One mechanism underlying such alternations may be reduced coherence among ...emotion systems (i.e., autonomic, facial affect). The present study sought to examine this. One hundred children (50 with ADHD combined presentation), 7-11 years of age (62% male, 78% White), completed an emotion induction and suppression task. This task was coded for facial affect behavior across both negative and positive emotion eliciting task conditions. Electrocardiogram and impedance cardiography data were acquired throughout the task. Time-linked coherence of facial affect behavior and autonomic reactivity and regulation were examined during the induction conditions using hierarchical linear modeling. Although ADHD and typically developing children did not differ with respect to rates of facial affect behavior displayed (all Fs < 2.09, ps > .29), the ADHD group exhibited reduced coherence between facial affect behavior and an index of parasympathetic functioning (i.e., respiratory sinus arrhythmia), γ
= -0.03, SE = 0.02, t(138) = -1.96, p = .05. In contrast, children in the control group displayed a significant, positive, γ
= 0.06, SE = 0.01, t(138) = 4.07, p < .001, association between facial affect behavior and respiratory sinus arrhythmia. Children with ADHD may receive conflicting emotional signals at the levels of facial affective behavior and parasympathetic functioning when compared to typically developing youth. Weakened coherence among these emotion systems may be an underlying mechanism of emotion dysregulation in ADHD. Implications for etiology and treatment are discussed.
Research on maternal neural response to infant distress highlights circuits that may underlie differences in quality of maternal behavior. However, it is far from clear which circuits are relevant to ...maternal sensitivity, as opposed to other maternal behavioral dimensions, particularly after the early postpartum. This study examined maternal sensitivity, intrusiveness, and mother-infant dyadic harmony as correlates of mothers' neural responses to the cries of their own infants. Twenty-two primiparous mothers were observed during an interaction with their infants at 18 months postpartum. In a separate functional neuroimaging session, mothers were exposed to their own infant's cry sound, as well as unfamiliar infant's cry and control sounds. Mothers who displayed more sensitive behaviors with their infant exhibited greater activation to their own infant's cry compared to that of an unfamiliar infant in the right frontal pole and inferior frontal gyrus. Mothers who displayed more intrusive behaviors with their infant showed greater activation in the left anterior insula and temporal pole, while mothers who had more harmonious interactions with their infant displayed greater activation in left hippocampal regions. The roles of these areas in the regulation of maternal emotion and stress, self and other awareness, and empathy are examined.
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