- Email: [email protected]
Hyperactivity Disorder
INSTITUTES 1.4 — 1.7
difference fails to reach statistical significance. Antidepressant response occurs early in the course of treatment (within the first two weeks), and the odds of additional increases in response plateaus by the eighth week of treatment. Antidepressants are associated with increased activation in children and adolescents with anxiety disorders (OR: 1.86), whereas, in general, tolerability of antidepressants is lower in the SSNRIs relative to SSRIs. Conclusions: SSRI/SSNRIs are well tolerated and efficacious for the treatment of non-OCD anxiety disorders, although sparse data exist for other psychopharmacologic treatments in this population.
ADP, AD, AXX http://dx.doi.org/10.1016/j.jaac.2017.07.506
1.4 ADVANCED PSYCHOPHARMACOLOGIC TREATMENT FOR THE CHILD AND ADOLESCENT WITH AUTISM SPECTRUM DISORDER Jeremy Veenstra-VanderWeele, MD, Columbia University, [email protected] Objectives: The goals of this session are to update the participants about current evidence on medications in autism spectrum disorder (ASD) and to provide an approach to assessment, treatment, and referral for co-occurring behavioral and psychiatric problems, with an emphasis on making decisions by balancing potential benefits and risks. Methods: A clinical case example will be used to provide a relevant framework for decision making using an evidence-based approach. Recent systematic reviews, meta-analyses, and practice pathways, as well as randomized controlled trials from 2016 and 2017, will be reviewed and presented. Results: This presentation will describe current evidence for treatment of irritability/aggression symptoms, repetitive behavior, co-occurring ADHD, and cooccurring anxiety symptoms in ASD. Integrated medical, psychiatric, and behavioral assessment for these symptoms will be discussed, with an emphasis on practical approaches for evaluation and management. Treatment pathways for different symptom domains will be presented, including irritability/aggression, repetitive behavior, ADHD, anxiety, and mood symptoms. A common clinical case presentation will be used as an example of the potential benefits and risks in management of psychiatric and behavioral comorbidity in ASD. Conclusions: Children and adolescents with ASD often present with multiple medical and behavioral problems that can best be managed using an integrated approach coordinated by a frontline provider who steps up to lead a coordinated care team.
ASD, CM, PPC http://dx.doi.org/10.1016/j.jaac.2017.07.507
1.5 PSYCHOPHARMACOLOGIC TREATMENT OF MOODS, EPISODES, AND OUTBURSTS Gabrielle A. Carlson, MD, SUNY at Stony Brook, Gabrielle. [email protected] Objectives: Bipolar disorder (BD) guidelines need to address the prevailing mood being treated (mania or depression), the fact that it is relapsing and recurring, and for some who feel that there is a prepubertal subtype, the fact that there are explosive outbursts that characterize it. Disruptive mood dysregulation disorder (DMDD) is also defined by irritable mood and often crippling outbursts. This presentation will discuss current thinking about treatment of these components. There are some similarities and differences. Methods: Two cases will be presented that illustrate the issues that often need to be treated in patients with BD and DMDD. The current status of the treatment literature for BD mania and depression will be reviewed, pulling in adult psychiatry literature where relevant. For DMDD, the question of how to treat the outbursts will be discussed. Results: There are no new approved treatments for mania in young people, although there are several new neuroleptic drugs available for adults. There have been some advances in the treatment of bipolar depression. Finally, the current status of managing severely irritable children will be discussed, although there is not enough literature to provide data on treatment trials, and clearly there are no FDA-approved medications for DMDD. Treatments include many of the medications for which there is an abundant literature on
JOURNAL OF THE AMERICAN ACADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 56 NUMBER 10S OCTOBER 2017
adverse events. Treatment guidelines do take the question of medication safety into consideration. Conclusions: Although advances are gradually being made in treating children with severe mood problems, there is a considerable distance yet to go.
APS, BD, DMDD http://dx.doi.org/10.1016/j.jaac.2017.07.508
1.6 RECOGNITION AND MANAGEMENT OF SECOND-GENERATION ANTIPSYCHOTICASSOCIATED ADVERSE EFFECTS Melissa P. DelBello, MD, MS, University of Cincinnati, [email protected]; Jeffrey R. Strawn, MD, University of Cincinnati, [email protected]; Luis Patino Duran, MD, University of Cincinnati, [email protected] Objectives: The goal of this session is to review tolerability data of antipsychotic drugs and mood stabilizers in youth and to present evidence-based monitoring and management strategies for selected adverse effects, including dyslipidemia, weight gain, and hyperprolactinemia. Methods: This presentation will briefly review tolerability and adverse effects data from randomized trials of second-generation antipsychotic (SGA) drugs and mood stabilizers in youth. Evidence for specific interventions to manage metabolic adverse effects, including metformin and omega-3 fatty acids, will be reviewed. We will also review data supporting the use of aripiprazole for hyperprolactinemia. Results: SGAs and mood stabilizers vary in their risk for specific adverse effects. Moreover, weight gain, dyslipidemia, and hyperprolactinemia may present specific challenges in youth. Results from randomized controlled trials of youth treated with SGA suggest that metformin is safe, well tolerated, and effective in attenuating treatment-related weight gain and improves insulin sensitivity. Aripiprazole may be an effective treatment for lowering prolactin levels of individuals treated with SGA drugs. Conclusions: Metabolic risk profiles vary between specific antipsychotic drugs and should inform treatment selection. Education on adverse effects, as well as dietary and lifestyle counseling should be part of any antipsychotic treatment regimen. Routine monitoring of side effects is essential, and benefits must be balanced against the varying adverse effect risks; however, specific evidence-based pharmacologic interventions may mitigate treatment-related adverse effects of SGA drugs.
APS, BD, PTA http://dx.doi.org/10.1016/j.jaac.2017.07.509
1.7 PHARMACOLOGIC STRATEGIES IN TREATMENT-REFRACTORY ATTENTION-DEFICIT/ HYPERACTIVITY DISORDER Timothy E. Wilens, MD, Massachusetts General Hospital and Harvard University, [email protected] Objectives: Increasingly difficult cases of children with ADHD are presenting to child psychiatrists requiring practitioners to learn new strategies for the management of medication-related side effects, refractory core-ADHD symptoms, and treatment of comorbidities. Methods: A systematic review of the literature from historic, recently completed, and ongoing trials was reviewed to elucidate data on stimulant and nonstimulant treatments for ADHD. The limited data on the management of side effects were punctuated by anecdotal and open reports. Results: The literature, combined with clinical experience, indicates that alterations in the use of traditional stimulants in existing and novel release forms, atomoxetine, a agonists, the use of alternative agents, and combinations of medications can enhance a patient’s response to ADHD treatment. Strategies exist for management of common comorbid conditions. Many side effects are predictable and can be managed. Conclusions: Pharmacologic strategies will be reported for those who 1) have not responded to traditional agents; 2) present with comorbidities; and 3) are experiencing treatment-emergent adverse effects. Both empirically derived data and illustrative cases will be used in the presentation.
www.jaacap.org
S135
INSTITUTES 1.8 — 2.2
ATA, ADHD, PPC http://dx.doi.org/10.1016/j.jaac.2017.07.510
1.8 PSYCHOPHARMACOLOGIC TREATMENT OF TICS AND TOURETTE’S DISORDER Barbara J. Coffey, MD, MS, Icahn School of Medicine at Mount Sinai, [email protected] Objectives: The goals of this session are to describe a systematic approach to disentangling tic and nontic psychiatric symptoms in the evaluation and treatment of children and adolescents with tics and Tourette’s disorder (TD) and to discuss evidence-based guidelines for use of formally approved and off-label medications for the treatment of tics. Methods: Review of recent studies on the use of neuroleptic drugs, a agonists, stimulants, and other medications in patients with TD and comorbid psychiatric disorders will provide updated evidence for efficacy. Data on adverse effects of the major classes of medication used to treat patients with tic disorders will be reviewed. Guidelines for balancing effectiveness against risk will be presented. Results: Aripiprazole is now formally approved for labeling for the treatment of tics in TD. However, as experience has accumulated, so have metabolic problems with use of this medication. Stimulants, among the most effective psychopharmacological treatments for ADHD in youth and adults, are being used increasingly in children and adolescent with tic disorders. Although there is no evidence to suggest that stimulants cause or increase tics, some children may be vulnerable to new onset or exacerbations of tics in the context of stimulant treatment. a Agonists, which are used off label, are frequently recommended as first-line agents for treatment of tics for youth and adults with TD because of their relatively benign adverse effect profile; however, these medications often cause sedation or irritability. Comprehensive behavioral intervention for tics (CBIT) is often recommended as first-line treatment for tics, but trained therapists are difficult to find. Finally, novel agents, which may provide a more favorable benefit to risk ratio for treatment of tics, have been investigated in the past several years, but these agents are not commercially available. Guidelines for choice of target symptoms, medication class, and suggested algorithms will be recommended for youth and adults with tics and TD. Conclusions: Clinical decision making can be complicated in treatment of Tourette’s disorder, as comorbidity with other psychiatric disorders is frequent. Tic and nontic symptoms need to be disentangled and prioritized, and effectiveness and risk need to be weighed for individual patients to determine the best approach to management.
PPC, TICS, TD http://dx.doi.org/10.1016/j.jaac.2017.07.511
INSTITUTE 2 RESEARCH INSTITUTE: THIS IS YOUR BRAIN ON CHILD PSYCHIATRY. ANY QUESTIONS? A PRACTICAL UPDATE ON THE IMPACT OF NEUROIMAGING FINDINGS IN CHILD PSYCHIATRY Daniel P. Dickstein, MD, Brown University and Bradley Hospital, [email protected]; David Cochran, MD, PhD, UMass Medical School, david.cochran@umassmemorial. org; Bradley Peterson, MD, Children’s Hospital Los Angeles, [email protected] Objectives: This Institute will provide updates on the current state of neuroimaging research from a practical, clinician-focused standpoint and discuss future challenges and opportunities for clinically relevant imaging research. It will provide a clear description of how neuroimaging shapes our understanding of psychiatric diagnoses and treatments today and show an appreciation of how this will change over the next 10 years Methods: The Institute will consist of seven presentations in three sections. After each set of presentations, there will be a panel discussion
S136
www.jaacap.org
involving the preceding presenters. In part one (Drs. Milham and Gogtay), the focus will be on how neuroimaging informs our current understanding of mental health disorders, in comparison to typical development. In part two (Drs. Delbello, Croarkin, and Leibenluft), we will focus on how neuroimaging has informed treatment of neuropsychiatric disorders in three modalities: psychopharmacology, somatic therapy (specifically repetitive transcranial magnetic stimulation), and cognitive therapies. In part three (Drs. Frazier and Poldrack), the focus will shift to large-scale questions of how the challenges associated with neuroimaging datasets will be addressed in the future. Results: The Institute will provide attendees with an up-to-date assessment of how neuroimaging studies inform our current understanding of mental health disorders, how they have led to developments in treatment across disorders and modalities, and how the challenges associated with broader use of neuroimaging data are being addressed. Conclusions: These presentations will provide a comprehensive look into how neuroimaging is being used to directly answer important clinical questions and demonstrate the relevance of these findings to clinical practice. Continued innovation and refinement are needed to realize the full potential of pediatric neuroimaging. Open science and interdisciplinary collaboration can accelerate the pace of progress toward these goals.
IMAGS, R, NEURODEV Sponsored by the Research Committee and Supported by the Research Initiative http://dx.doi.org/10.1016/j.jaac.2017.07.513
2.1 MAKING NEUROIMAGING MORE REPRODUCIBLE AND TRANSPARENT Russell A. Poldrack, PhD, Stanford University, russpold@ stanford.edu; Krzysztof J. Gorgolewski, Stanford University, [email protected] Objectives: There is increasing concern that common research practices may reduce the reproducibility and generalizability of research findings. These concerns are particularly acute for domains such as functional neuroimaging in which the data are high-dimensional and there is a great deal of flexibility in data analysis. Methods: I will discuss a number of approaches that are being developed to improve reproducibility, including study preregistration, the tracking of analysis workflows across the lifespan of a project, and the quantification of how results vary across workflows. I will also discuss several strategies to increase transparency, including data/code sharing and detailed standards for data and metadata description and study reporting. Results: I will present the brain imaging data structure (BIDS) and BIDS applications (Apps) projects, both of which provide the basis for greater transparency and reproducibility of data analyses. Conclusions: Current practices must be improved if we hope to achieve a robust understanding of psychiatric disorders using neuroimaging.
DAM, IMAGS, NEURODEV Supported by the Laura and John Arnold Foundation, NIDA Grants R21DA034316, and National Science Foundation Grant ACI-1131441 http://dx.doi.org/10.1016/j.jaac.2017.07.514
2.2 CLINICALLY USEFUL BRAIN IMAGING FOR NEUROPSYCHIATRY: CAN WE GET THERE? Michael P. Milham, MD, PhD, Child Mind Institute, eszter. [email protected] Objectives: In the past decade, resting-state fMRI (R-fMRI) has emerged as a mainstream imaging approach. Despite initial concerns regarding the nature of fMRI signals at rest, insufficient understanding of the physiology underlying R-fMRI fluctuations, and lack of agreement about appropriate preprocessing and data reduction steps, the field has since documented high reproducibility of findings and moderate-to-high test-retest reliability. Large-scale, multicenter studies have demonstrated the value of R-fMRI for characterizing
J OURNAL
OF THE
AMERICAN A CADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 56 NUMBER 10S OCTOBER 2017
difference fails to reach statistical significance. Antidepressant response occurs early in the course of treatment (within the first two weeks), and the odds of additional increases in response plateaus by the eighth week of treatment. Antidepressants are associated with increased activation in children and adolescents with anxiety disorders (OR: 1.86), whereas, in general, tolerability of antidepressants is lower in the SSNRIs relative to SSRIs. Conclusions: SSRI/SSNRIs are well tolerated and efficacious for the treatment of non-OCD anxiety disorders, although sparse data exist for other psychopharmacologic treatments in this population.
ADP, AD, AXX http://dx.doi.org/10.1016/j.jaac.2017.07.506
1.4 ADVANCED PSYCHOPHARMACOLOGIC TREATMENT FOR THE CHILD AND ADOLESCENT WITH AUTISM SPECTRUM DISORDER Jeremy Veenstra-VanderWeele, MD, Columbia University, [email protected] Objectives: The goals of this session are to update the participants about current evidence on medications in autism spectrum disorder (ASD) and to provide an approach to assessment, treatment, and referral for co-occurring behavioral and psychiatric problems, with an emphasis on making decisions by balancing potential benefits and risks. Methods: A clinical case example will be used to provide a relevant framework for decision making using an evidence-based approach. Recent systematic reviews, meta-analyses, and practice pathways, as well as randomized controlled trials from 2016 and 2017, will be reviewed and presented. Results: This presentation will describe current evidence for treatment of irritability/aggression symptoms, repetitive behavior, co-occurring ADHD, and cooccurring anxiety symptoms in ASD. Integrated medical, psychiatric, and behavioral assessment for these symptoms will be discussed, with an emphasis on practical approaches for evaluation and management. Treatment pathways for different symptom domains will be presented, including irritability/aggression, repetitive behavior, ADHD, anxiety, and mood symptoms. A common clinical case presentation will be used as an example of the potential benefits and risks in management of psychiatric and behavioral comorbidity in ASD. Conclusions: Children and adolescents with ASD often present with multiple medical and behavioral problems that can best be managed using an integrated approach coordinated by a frontline provider who steps up to lead a coordinated care team.
ASD, CM, PPC http://dx.doi.org/10.1016/j.jaac.2017.07.507
1.5 PSYCHOPHARMACOLOGIC TREATMENT OF MOODS, EPISODES, AND OUTBURSTS Gabrielle A. Carlson, MD, SUNY at Stony Brook, Gabrielle. [email protected] Objectives: Bipolar disorder (BD) guidelines need to address the prevailing mood being treated (mania or depression), the fact that it is relapsing and recurring, and for some who feel that there is a prepubertal subtype, the fact that there are explosive outbursts that characterize it. Disruptive mood dysregulation disorder (DMDD) is also defined by irritable mood and often crippling outbursts. This presentation will discuss current thinking about treatment of these components. There are some similarities and differences. Methods: Two cases will be presented that illustrate the issues that often need to be treated in patients with BD and DMDD. The current status of the treatment literature for BD mania and depression will be reviewed, pulling in adult psychiatry literature where relevant. For DMDD, the question of how to treat the outbursts will be discussed. Results: There are no new approved treatments for mania in young people, although there are several new neuroleptic drugs available for adults. There have been some advances in the treatment of bipolar depression. Finally, the current status of managing severely irritable children will be discussed, although there is not enough literature to provide data on treatment trials, and clearly there are no FDA-approved medications for DMDD. Treatments include many of the medications for which there is an abundant literature on
JOURNAL OF THE AMERICAN ACADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 56 NUMBER 10S OCTOBER 2017
adverse events. Treatment guidelines do take the question of medication safety into consideration. Conclusions: Although advances are gradually being made in treating children with severe mood problems, there is a considerable distance yet to go.
APS, BD, DMDD http://dx.doi.org/10.1016/j.jaac.2017.07.508
1.6 RECOGNITION AND MANAGEMENT OF SECOND-GENERATION ANTIPSYCHOTICASSOCIATED ADVERSE EFFECTS Melissa P. DelBello, MD, MS, University of Cincinnati, [email protected]; Jeffrey R. Strawn, MD, University of Cincinnati, [email protected]; Luis Patino Duran, MD, University of Cincinnati, [email protected] Objectives: The goal of this session is to review tolerability data of antipsychotic drugs and mood stabilizers in youth and to present evidence-based monitoring and management strategies for selected adverse effects, including dyslipidemia, weight gain, and hyperprolactinemia. Methods: This presentation will briefly review tolerability and adverse effects data from randomized trials of second-generation antipsychotic (SGA) drugs and mood stabilizers in youth. Evidence for specific interventions to manage metabolic adverse effects, including metformin and omega-3 fatty acids, will be reviewed. We will also review data supporting the use of aripiprazole for hyperprolactinemia. Results: SGAs and mood stabilizers vary in their risk for specific adverse effects. Moreover, weight gain, dyslipidemia, and hyperprolactinemia may present specific challenges in youth. Results from randomized controlled trials of youth treated with SGA suggest that metformin is safe, well tolerated, and effective in attenuating treatment-related weight gain and improves insulin sensitivity. Aripiprazole may be an effective treatment for lowering prolactin levels of individuals treated with SGA drugs. Conclusions: Metabolic risk profiles vary between specific antipsychotic drugs and should inform treatment selection. Education on adverse effects, as well as dietary and lifestyle counseling should be part of any antipsychotic treatment regimen. Routine monitoring of side effects is essential, and benefits must be balanced against the varying adverse effect risks; however, specific evidence-based pharmacologic interventions may mitigate treatment-related adverse effects of SGA drugs.
APS, BD, PTA http://dx.doi.org/10.1016/j.jaac.2017.07.509
1.7 PHARMACOLOGIC STRATEGIES IN TREATMENT-REFRACTORY ATTENTION-DEFICIT/ HYPERACTIVITY DISORDER Timothy E. Wilens, MD, Massachusetts General Hospital and Harvard University, [email protected] Objectives: Increasingly difficult cases of children with ADHD are presenting to child psychiatrists requiring practitioners to learn new strategies for the management of medication-related side effects, refractory core-ADHD symptoms, and treatment of comorbidities. Methods: A systematic review of the literature from historic, recently completed, and ongoing trials was reviewed to elucidate data on stimulant and nonstimulant treatments for ADHD. The limited data on the management of side effects were punctuated by anecdotal and open reports. Results: The literature, combined with clinical experience, indicates that alterations in the use of traditional stimulants in existing and novel release forms, atomoxetine, a agonists, the use of alternative agents, and combinations of medications can enhance a patient’s response to ADHD treatment. Strategies exist for management of common comorbid conditions. Many side effects are predictable and can be managed. Conclusions: Pharmacologic strategies will be reported for those who 1) have not responded to traditional agents; 2) present with comorbidities; and 3) are experiencing treatment-emergent adverse effects. Both empirically derived data and illustrative cases will be used in the presentation.
www.jaacap.org
S135
INSTITUTES 1.8 — 2.2
ATA, ADHD, PPC http://dx.doi.org/10.1016/j.jaac.2017.07.510
1.8 PSYCHOPHARMACOLOGIC TREATMENT OF TICS AND TOURETTE’S DISORDER Barbara J. Coffey, MD, MS, Icahn School of Medicine at Mount Sinai, [email protected] Objectives: The goals of this session are to describe a systematic approach to disentangling tic and nontic psychiatric symptoms in the evaluation and treatment of children and adolescents with tics and Tourette’s disorder (TD) and to discuss evidence-based guidelines for use of formally approved and off-label medications for the treatment of tics. Methods: Review of recent studies on the use of neuroleptic drugs, a agonists, stimulants, and other medications in patients with TD and comorbid psychiatric disorders will provide updated evidence for efficacy. Data on adverse effects of the major classes of medication used to treat patients with tic disorders will be reviewed. Guidelines for balancing effectiveness against risk will be presented. Results: Aripiprazole is now formally approved for labeling for the treatment of tics in TD. However, as experience has accumulated, so have metabolic problems with use of this medication. Stimulants, among the most effective psychopharmacological treatments for ADHD in youth and adults, are being used increasingly in children and adolescent with tic disorders. Although there is no evidence to suggest that stimulants cause or increase tics, some children may be vulnerable to new onset or exacerbations of tics in the context of stimulant treatment. a Agonists, which are used off label, are frequently recommended as first-line agents for treatment of tics for youth and adults with TD because of their relatively benign adverse effect profile; however, these medications often cause sedation or irritability. Comprehensive behavioral intervention for tics (CBIT) is often recommended as first-line treatment for tics, but trained therapists are difficult to find. Finally, novel agents, which may provide a more favorable benefit to risk ratio for treatment of tics, have been investigated in the past several years, but these agents are not commercially available. Guidelines for choice of target symptoms, medication class, and suggested algorithms will be recommended for youth and adults with tics and TD. Conclusions: Clinical decision making can be complicated in treatment of Tourette’s disorder, as comorbidity with other psychiatric disorders is frequent. Tic and nontic symptoms need to be disentangled and prioritized, and effectiveness and risk need to be weighed for individual patients to determine the best approach to management.
PPC, TICS, TD http://dx.doi.org/10.1016/j.jaac.2017.07.511
INSTITUTE 2 RESEARCH INSTITUTE: THIS IS YOUR BRAIN ON CHILD PSYCHIATRY. ANY QUESTIONS? A PRACTICAL UPDATE ON THE IMPACT OF NEUROIMAGING FINDINGS IN CHILD PSYCHIATRY Daniel P. Dickstein, MD, Brown University and Bradley Hospital, [email protected]; David Cochran, MD, PhD, UMass Medical School, david.cochran@umassmemorial. org; Bradley Peterson, MD, Children’s Hospital Los Angeles, [email protected] Objectives: This Institute will provide updates on the current state of neuroimaging research from a practical, clinician-focused standpoint and discuss future challenges and opportunities for clinically relevant imaging research. It will provide a clear description of how neuroimaging shapes our understanding of psychiatric diagnoses and treatments today and show an appreciation of how this will change over the next 10 years Methods: The Institute will consist of seven presentations in three sections. After each set of presentations, there will be a panel discussion
S136
www.jaacap.org
involving the preceding presenters. In part one (Drs. Milham and Gogtay), the focus will be on how neuroimaging informs our current understanding of mental health disorders, in comparison to typical development. In part two (Drs. Delbello, Croarkin, and Leibenluft), we will focus on how neuroimaging has informed treatment of neuropsychiatric disorders in three modalities: psychopharmacology, somatic therapy (specifically repetitive transcranial magnetic stimulation), and cognitive therapies. In part three (Drs. Frazier and Poldrack), the focus will shift to large-scale questions of how the challenges associated with neuroimaging datasets will be addressed in the future. Results: The Institute will provide attendees with an up-to-date assessment of how neuroimaging studies inform our current understanding of mental health disorders, how they have led to developments in treatment across disorders and modalities, and how the challenges associated with broader use of neuroimaging data are being addressed. Conclusions: These presentations will provide a comprehensive look into how neuroimaging is being used to directly answer important clinical questions and demonstrate the relevance of these findings to clinical practice. Continued innovation and refinement are needed to realize the full potential of pediatric neuroimaging. Open science and interdisciplinary collaboration can accelerate the pace of progress toward these goals.
IMAGS, R, NEURODEV Sponsored by the Research Committee and Supported by the Research Initiative http://dx.doi.org/10.1016/j.jaac.2017.07.513
2.1 MAKING NEUROIMAGING MORE REPRODUCIBLE AND TRANSPARENT Russell A. Poldrack, PhD, Stanford University, russpold@ stanford.edu; Krzysztof J. Gorgolewski, Stanford University, [email protected] Objectives: There is increasing concern that common research practices may reduce the reproducibility and generalizability of research findings. These concerns are particularly acute for domains such as functional neuroimaging in which the data are high-dimensional and there is a great deal of flexibility in data analysis. Methods: I will discuss a number of approaches that are being developed to improve reproducibility, including study preregistration, the tracking of analysis workflows across the lifespan of a project, and the quantification of how results vary across workflows. I will also discuss several strategies to increase transparency, including data/code sharing and detailed standards for data and metadata description and study reporting. Results: I will present the brain imaging data structure (BIDS) and BIDS applications (Apps) projects, both of which provide the basis for greater transparency and reproducibility of data analyses. Conclusions: Current practices must be improved if we hope to achieve a robust understanding of psychiatric disorders using neuroimaging.
DAM, IMAGS, NEURODEV Supported by the Laura and John Arnold Foundation, NIDA Grants R21DA034316, and National Science Foundation Grant ACI-1131441 http://dx.doi.org/10.1016/j.jaac.2017.07.514
2.2 CLINICALLY USEFUL BRAIN IMAGING FOR NEUROPSYCHIATRY: CAN WE GET THERE? Michael P. Milham, MD, PhD, Child Mind Institute, eszter. [email protected] Objectives: In the past decade, resting-state fMRI (R-fMRI) has emerged as a mainstream imaging approach. Despite initial concerns regarding the nature of fMRI signals at rest, insufficient understanding of the physiology underlying R-fMRI fluctuations, and lack of agreement about appropriate preprocessing and data reduction steps, the field has since documented high reproducibility of findings and moderate-to-high test-retest reliability. Large-scale, multicenter studies have demonstrated the value of R-fMRI for characterizing
J OURNAL
OF THE
AMERICAN A CADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 56 NUMBER 10S OCTOBER 2017