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6.82 NOVEL TECHNIQUES FOR ELUCIDATING NEUROPHYSIOLOGICAL MECHANISMS OF SELECTIVE MUTISM
NEW RESEARCH POSTERS 6.82 – 6.84
dopamine inhibition might help explain its dampening effect on maternal perception of child anxiety. More research is needed to further elucidate prolactin’s contribution to maternal cognition and behavior, and its subsequent effect on the family system of an anxious child.
ANX NEURO SAC Supported by NIH grants K23MH103555 and KL2TR000140 http://dx.doi.org/10.1016/j.jaac.2016.09.400
6.82 NOVEL TECHNIQUES FOR ELUCIDATING NEUROPHYSIOLOGICAL MECHANISMS OF SELECTIVE MUTISM Erica J. Ho, BA, Center for the Developing Brain, Child Mind Institute, 445 Park Ave, Fl 2, New York, NY 10022; Lindsay Alexander, MPH, Child Mind Institute, 445 Park Ave, New York, NY 10022; Nicolas Langer, PhD; Maki S. Koyama, PhD; Helen Y. Xu, BA; Renee K. Jozanovic; Grace Russo, BA; Rachel Busman, PsyD; Michael P. Milham, MD; Simon P. Kelly, PhD Objectives: Selective mutism (SM) is a rare anxiety disorder that impairs the ability of a child to speak in some social settings, but not all. Although SM is well characterized from a phenomenological perspective, its neurophysiological mechanisms remain underspecified. Our goals were to: 1) develop a behavioral performance task in which the impact of social, situational demands on children with SM can be quantified; and 2) create objective, EEGbased measures of response preparation during the paradigm that potentially relate to the observed behavioral differences. Methods: Twenty-five participants ages 5-11 with and without SM diagnoses completed a novel, computerized Response Paradigm with high-density EEG acquisition. Participants were presented with a simple color-decision task in a 2x2 design: (Respond via button press vs. vocalization) x (Stranger absent vs. present). Behavioral dependent measures were task accuracy, response time, and voice volume. Participants’ parents completed a brief questionnaire assessing their child’s frequency of speech in different social settings and overall functional impairment. Slow response-preparation potentials were analyzed in the EEG by subjecting response-locked waveforms to regression tests to identify channels whose slopes significantly increased or decreased prior to the response. Results: ANCOVA analyses indicated that worse SM symptoms were associated with lower speaking volume (F¼4.95, p<.05), and greater response time when the stranger was present (F¼5.98; p<0.05). There was also a three-way interaction between response mode, stranger presence, and symptom severity (F¼13.74, p<.01). As expected, we found a motor preparatory signal over the central regions, and a vocal preparatory signal over more anterior regions; the more severe the SM symptoms, the more similar the vocal and motor signals (r¼-.31; p<.05). Conclusions: This preliminary study demonstrates the feasibility of developing a cognitive neuroscience-based framework for indexing abnormalities in SM, which is essential to providing a greater understanding of SM’s neural basis.
ANX NEPSYC R http://dx.doi.org/10.1016/j.jaac.2016.09.401
6.83 PARENT–CHILD DISCREPANCIES IN REPORTING PEDIATRIC ANXIETY SYMPTOMS: EFFECTS OF FAMILY RELATIONS AND STRESS Anna Yeo, MA, Child Mind Institute, 1 Teleport Drive, Suite 201, Staten Island, NY 10311; Charissa Andreotti, PhD; Meagan Kovacs, MS; Yael Osman, BA; Lindsay Alexander, MPH; Michael P. Milham, MD Objectives: The identification of factors contributing to the discrepancies in parent and self reporting of anxiety symptoms is essential for efforts focused on screening for pediatric anxiety disorders. Prior work has already highlighted a number of factors, including child age, gender, intelligence, autism, and social desirability. Here, we attempt to draw greater attention to potential contributions of family environmental and relational factors (e.g.,
J OURNAL OF THE AMERICAN ACADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 55 NUMBER 10S OCTOBER 2016
interparental conflicts, parenting practices, socioeconomic status), as well as replicate prior work. Methods: Data were collected from clinically referred youth (N¼183; ages 817) participating in the CMI Health Brain Network research initiative. Assessments included in the present work included: Screen for Childhood Anxiety Related Emotional Disorders (SCARED; parent and child), Social Responsiveness Scale, Children’s Perception of Interparental Conflict Scale, Barratt Simplified Measure of Social Status, and Alabama Parenting Questionnaire. Standardized difference scores were computed using parent and child total SCARED scores. Backward stepwise multiple linear regression was utilized to predict informant discrepancies from child and family characteristics. To confirm the effects of significant variables found by the regression model, one-way analyses of variance (ANOVA) were conducted after dividing participants into terciles. Results: In the stepwise regression, high FSIQ, low social cognition and motivation, elevated self-blame and perceived threat of interparental conflict, and poor parental supervision were indicated as significant predictors of underreporting by children. Regardless of order of entry, the six predictor model accounted for 32 percent of variance in standardized difference scores, F(6, 108)¼ 8.473, p<.001, R2¼.320). ANOVA independently confirmed significant group differences in levels of discrepancies for perceived threat (F(2, 146)¼ 7.163, p< .001) and social motivation (F(2, 178)¼ 14.339, p< .001), with trending support for poor parental supervision (p< .1). Conclusions: In addition to confirming the effects of children’s intelligence and social communication skills, our results emphasize the importance of considering family stress and relations in interpreting disparities among informants in the reporting of pediatric anxiety symptoms.
ANX PAT RI Supported by private philanthropies http://dx.doi.org/10.1016/j.jaac.2016.09.402
6.84 COMORBID CONDITIONS, QUALITY OF LIFE, AND FAMILY FUNCTIONING IN CHILDREN AND ADOLESCENTS WITH TOURETTE’S DISORDER Seda Erbilgin, MD, Child and Adolescent Psychiatry, Istanbul University, Konaklar Mah. Faruk Nafiz Camlibel Sok, Final Apt. No 3 D 22 4. Levent, Istanbul 34330, Turkey; Ayse Kilincaslan, MD Objectives: TD is a neuropsychiatric disorder with childhood onset, characterized by multiple motor and vocal tics. In this study, we aimed to investigate social-demographic characteristics, tic severity, comorbid conditions, family functioning and their relation with quality of life in children and adolescents with TD. Methods: Sixty-five volunteers, aged between 7 and 18, who were being followed up in Istanbul Faculty of Medicine, Child and Adolescent Psychiatry Outpatient Clinic for TD were evaluated. Children with intellectual disability and autistic spectrum disorder were excluded. Yale Global Tic Severity Scale, Kiddie-Schedule for Affective Disorders and Schizophrenia – Present and Lifetime Version (KSADS-PL), Pediatric Quality of Life Inventory and Family Assessment Device - General Functioning subscale were administered to all participants. Results: Sixty-one (93.8 percent) of all participants met criteria for at least one co-occurring psychiatric diagnosis and the mean number of lifetime comorbid diagnoses was 3.681.7. Most common comorbid diagnosis was attention deficit/ hyperactivity disorder with the ratio of 83.1 percent. Specific phobia (49.6 percent) was the second most common, followed by obsessive compulsive disorder (32.3 percent). In 32.3 percent of all participants, TD accompanied by both ADHD and OCD. Lower quality of life was associated with number of comorbid disorders and tic severity and the associations were more significant in parent reports (tic severity r¼-0.42 p<0,01, number of comorbid disorders r¼ -0,55 p<0,01) compared to child reports (tic severity r¼ -0,27 p<0,032, number of comorbid disorders r¼ -0,38 p¼0,02). Despite the weak but significant negative relationship with quality of life-child report scores, general family functioning had no significant relationship with other parameters. Conclusions: TD is often accompanied by other psychiatric disorders. Comorbid psychiatric diagnosis and tic severity are associated with lower quality of life. Our results suggest that comorbid psychiatric conditions have greater negative impact on quality of life compared to tic severity.
www.jaacap.org
S231
dopamine inhibition might help explain its dampening effect on maternal perception of child anxiety. More research is needed to further elucidate prolactin’s contribution to maternal cognition and behavior, and its subsequent effect on the family system of an anxious child.
ANX NEURO SAC Supported by NIH grants K23MH103555 and KL2TR000140 http://dx.doi.org/10.1016/j.jaac.2016.09.400
6.82 NOVEL TECHNIQUES FOR ELUCIDATING NEUROPHYSIOLOGICAL MECHANISMS OF SELECTIVE MUTISM Erica J. Ho, BA, Center for the Developing Brain, Child Mind Institute, 445 Park Ave, Fl 2, New York, NY 10022; Lindsay Alexander, MPH, Child Mind Institute, 445 Park Ave, New York, NY 10022; Nicolas Langer, PhD; Maki S. Koyama, PhD; Helen Y. Xu, BA; Renee K. Jozanovic; Grace Russo, BA; Rachel Busman, PsyD; Michael P. Milham, MD; Simon P. Kelly, PhD Objectives: Selective mutism (SM) is a rare anxiety disorder that impairs the ability of a child to speak in some social settings, but not all. Although SM is well characterized from a phenomenological perspective, its neurophysiological mechanisms remain underspecified. Our goals were to: 1) develop a behavioral performance task in which the impact of social, situational demands on children with SM can be quantified; and 2) create objective, EEGbased measures of response preparation during the paradigm that potentially relate to the observed behavioral differences. Methods: Twenty-five participants ages 5-11 with and without SM diagnoses completed a novel, computerized Response Paradigm with high-density EEG acquisition. Participants were presented with a simple color-decision task in a 2x2 design: (Respond via button press vs. vocalization) x (Stranger absent vs. present). Behavioral dependent measures were task accuracy, response time, and voice volume. Participants’ parents completed a brief questionnaire assessing their child’s frequency of speech in different social settings and overall functional impairment. Slow response-preparation potentials were analyzed in the EEG by subjecting response-locked waveforms to regression tests to identify channels whose slopes significantly increased or decreased prior to the response. Results: ANCOVA analyses indicated that worse SM symptoms were associated with lower speaking volume (F¼4.95, p<.05), and greater response time when the stranger was present (F¼5.98; p<0.05). There was also a three-way interaction between response mode, stranger presence, and symptom severity (F¼13.74, p<.01). As expected, we found a motor preparatory signal over the central regions, and a vocal preparatory signal over more anterior regions; the more severe the SM symptoms, the more similar the vocal and motor signals (r¼-.31; p<.05). Conclusions: This preliminary study demonstrates the feasibility of developing a cognitive neuroscience-based framework for indexing abnormalities in SM, which is essential to providing a greater understanding of SM’s neural basis.
ANX NEPSYC R http://dx.doi.org/10.1016/j.jaac.2016.09.401
6.83 PARENT–CHILD DISCREPANCIES IN REPORTING PEDIATRIC ANXIETY SYMPTOMS: EFFECTS OF FAMILY RELATIONS AND STRESS Anna Yeo, MA, Child Mind Institute, 1 Teleport Drive, Suite 201, Staten Island, NY 10311; Charissa Andreotti, PhD; Meagan Kovacs, MS; Yael Osman, BA; Lindsay Alexander, MPH; Michael P. Milham, MD Objectives: The identification of factors contributing to the discrepancies in parent and self reporting of anxiety symptoms is essential for efforts focused on screening for pediatric anxiety disorders. Prior work has already highlighted a number of factors, including child age, gender, intelligence, autism, and social desirability. Here, we attempt to draw greater attention to potential contributions of family environmental and relational factors (e.g.,
J OURNAL OF THE AMERICAN ACADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 55 NUMBER 10S OCTOBER 2016
interparental conflicts, parenting practices, socioeconomic status), as well as replicate prior work. Methods: Data were collected from clinically referred youth (N¼183; ages 817) participating in the CMI Health Brain Network research initiative. Assessments included in the present work included: Screen for Childhood Anxiety Related Emotional Disorders (SCARED; parent and child), Social Responsiveness Scale, Children’s Perception of Interparental Conflict Scale, Barratt Simplified Measure of Social Status, and Alabama Parenting Questionnaire. Standardized difference scores were computed using parent and child total SCARED scores. Backward stepwise multiple linear regression was utilized to predict informant discrepancies from child and family characteristics. To confirm the effects of significant variables found by the regression model, one-way analyses of variance (ANOVA) were conducted after dividing participants into terciles. Results: In the stepwise regression, high FSIQ, low social cognition and motivation, elevated self-blame and perceived threat of interparental conflict, and poor parental supervision were indicated as significant predictors of underreporting by children. Regardless of order of entry, the six predictor model accounted for 32 percent of variance in standardized difference scores, F(6, 108)¼ 8.473, p<.001, R2¼.320). ANOVA independently confirmed significant group differences in levels of discrepancies for perceived threat (F(2, 146)¼ 7.163, p< .001) and social motivation (F(2, 178)¼ 14.339, p< .001), with trending support for poor parental supervision (p< .1). Conclusions: In addition to confirming the effects of children’s intelligence and social communication skills, our results emphasize the importance of considering family stress and relations in interpreting disparities among informants in the reporting of pediatric anxiety symptoms.
ANX PAT RI Supported by private philanthropies http://dx.doi.org/10.1016/j.jaac.2016.09.402
6.84 COMORBID CONDITIONS, QUALITY OF LIFE, AND FAMILY FUNCTIONING IN CHILDREN AND ADOLESCENTS WITH TOURETTE’S DISORDER Seda Erbilgin, MD, Child and Adolescent Psychiatry, Istanbul University, Konaklar Mah. Faruk Nafiz Camlibel Sok, Final Apt. No 3 D 22 4. Levent, Istanbul 34330, Turkey; Ayse Kilincaslan, MD Objectives: TD is a neuropsychiatric disorder with childhood onset, characterized by multiple motor and vocal tics. In this study, we aimed to investigate social-demographic characteristics, tic severity, comorbid conditions, family functioning and their relation with quality of life in children and adolescents with TD. Methods: Sixty-five volunteers, aged between 7 and 18, who were being followed up in Istanbul Faculty of Medicine, Child and Adolescent Psychiatry Outpatient Clinic for TD were evaluated. Children with intellectual disability and autistic spectrum disorder were excluded. Yale Global Tic Severity Scale, Kiddie-Schedule for Affective Disorders and Schizophrenia – Present and Lifetime Version (KSADS-PL), Pediatric Quality of Life Inventory and Family Assessment Device - General Functioning subscale were administered to all participants. Results: Sixty-one (93.8 percent) of all participants met criteria for at least one co-occurring psychiatric diagnosis and the mean number of lifetime comorbid diagnoses was 3.681.7. Most common comorbid diagnosis was attention deficit/ hyperactivity disorder with the ratio of 83.1 percent. Specific phobia (49.6 percent) was the second most common, followed by obsessive compulsive disorder (32.3 percent). In 32.3 percent of all participants, TD accompanied by both ADHD and OCD. Lower quality of life was associated with number of comorbid disorders and tic severity and the associations were more significant in parent reports (tic severity r¼-0.42 p<0,01, number of comorbid disorders r¼ -0,55 p<0,01) compared to child reports (tic severity r¼ -0,27 p<0,032, number of comorbid disorders r¼ -0,38 p¼0,02). Despite the weak but significant negative relationship with quality of life-child report scores, general family functioning had no significant relationship with other parameters. Conclusions: TD is often accompanied by other psychiatric disorders. Comorbid psychiatric diagnosis and tic severity are associated with lower quality of life. Our results suggest that comorbid psychiatric conditions have greater negative impact on quality of life compared to tic severity.
www.jaacap.org
S231