- Email: [email protected]
34.2 DIALECTICAL BEHAVIOR THERAPY
CLINICAL PERSPECTIVES 34.0 – 34.2
Objectives: The aim of this study is to determine whether healthy subjects are able to modulate their neural activity using source-localized EEG-phase neurofeedback (NFB) training. The functional connectivity networks of fMRI and EEG were used to evaluate possible changes for real EEG-phase NFB compared with sham EEG-phase NFB. Methods: Healthy male subjects (n ¼ 21; age 19–30 years) underwent a 30minute single session of low-resolution electromagnetic tomography-based EEG-phase NFB (eight rounds at three min, one-minute breaks between the sessions) in a sham-controlled experimental crossover design. The NFB protocol was based on bilateral intrahemispheric phase synchronization of the ɑ1, ɑ2, and b1 bands (8–15 Hz) in Brodmann areas (BAs) 7, 8, 9, 40, and 39. If subjects were able to increase EEG-phase synchronization for at least one second, a visual feedback reward was given. Simultaneous EEG-fMRI recordings were done before and after real and sham EEG-phase NFB, followed by a go/no-go task. EEG recordings and go/no-go event-related potentials were also recorded outside the 3T MRI scanner. Results: The preliminary results of the field-cycled MRI measurements indicate that there is an up-regulation in BAs 21 and 47 for the frontal-parietal network and default mode network and a down-regulation in BAs 45, 46, 9, 38, 20, 21, 22, and 23 for the auditory network and dorsal attention network after real NFB compared with sham NFB. There were bigger clusters of reduced connectivity patterns (320 voxels) compared with increased functional connectivity clusters (79 voxels). Seed-based functional connectivity analyses will be integrated in the final analysis of previously defined resting state networks that were found by Dr. Angela Laird and colleagues in 2011 to be highly relevant in the cognitive domain. The preliminary resting-state EEG results showed a global reduction in absolute power of the d band and the high b bands and increased ɑ-band EEG activity after real versus sham NFB. The results also suggest that increased EEG ɑ activity is associated negatively with the blood-oxygen-level dependent signal in frontal-temporal brain regions. Furthermore, increased EEG ɑ phase was associated with reduced dand q-EEG power. Conclusions: Based on our results, we conclude that EEG-phase NFB can change brain activity in the short term.
R http://dx.doi.org/10.1016/j.jaac.2016.07.638
CLINICAL PERSPECTIVES 34 BEYOND THE PRESCRIPTION PAD: PSYCHOTHERAPY INTERVENTIONS FOR YOUTH WITH SEVERE MENTAL ILLNESS AND TREATMENT NONADHERENCE Mary S. Ahn, MD, University of Massachusetts, 55 Lake Avenue North, Worcester, MA 01655; Sergio V. Delgado, MD Objectives: Youth with severe mental illness (SMI) adhere poorly to the recommended medications and other treatments, with prevalence of nonadherence ranging between 30 and 60 percent. Medication nonadherence is multifactorial, but the root causes can be both analyzed and minimized by a strong therapeutic alliance and understanding of the psychological and social factors. Therefore, CAPs are in a unique position to introduce components of evidence-based psychotherapies into their clinical practice to address treatment nonadherence, even in settings outside of the traditional psychotherapy encounter. This session will introduce strategies based on evidence-based psychotherapies that may be used to address this common problem. Methods: A review of the rationale for the presentations on treatment nonadherence in SMI will be provided. Dr. David Miklowitz will present his work on family-focused therapy. Dr. Blaise Aguirre will present strategies rooted in dialectical behavior therapy. Dr. Victor Fornari will bridge behavioral and interpersonal psychotherapy interventions using psychodynamically informed strategies for developing a therapeutic alliance. Results: With translation of both research and innovative clinical approaches, this session uses different psychotherapeutic strategies that can be used to
S52
www.jaacap.org
address treatment nonadherence in youth with SMI. Dr. Sergio Delgado will be our expert discussant to lead and moderate the panel to allow for audience participation and questions. Conclusions: CAPs working with SMI youth can use modular psychotherapy techniques in a variety of treatment settings to address treatment nonadherence.
P TREAT Sponsored by AACAP's Psychotherapy Committee and Early Career Psychiatrist Committee http://dx.doi.org/10.1016/j.jaac.2016.07.640
34.1 FAMILY-FOCUSED THERAPY David J. Miklowitz, PhD, University of California, Los Angeles, 760 Westwood Plaza, Room 58-217, Los Angeles, CA 90024-1759 Objectives: This presentation presents family-focused therapy (FFT) as applied to adolescents and transitional aged youth who have been newly diagnosed with BD or psychosis. Methods: The speaker will describe the basic features of FFT, including how one proceeds with 1) psychoeducation; 2) communication enhancement training; and 3) problem solving. The presentation will focus on teaching skills to assist in engaging the adolescent or young adult in family psychoeducational sessions, including addressing resistance to the diagnosis, taking medications, or learning new coping skills. Some of the same strategies are also useful with family members who have different views on the nature, causes, or treatment of the patient’s mood disturbances. Results: The speaker will highlight common therapeutic strategies for addressing resistance in family psychoeducational treatment, such as 1) naming the patient as the expert in the disorder; 2) validating multiple viewpoints; 3) clarifying objectives; and 4) labeling resistance as healthy and expectable. The strategies that may be useful with younger versus adolescent/young adult patients will also be discussed. Conclusions: Resistance to treatment is conceptualized as an expression of difficulties in coming to terms with a recurrent mood or psychotic disorder and the functional limitations it imposes.
BD FT TREAT Supported by NIMH Grants MH097007 and MH093676 and the Deutsch, Kayne, Attias, and Danny Alberts Family Foundations http://dx.doi.org/10.1016/j.jaac.2016.07.641
34.2 DIALECTICAL BEHAVIOR THERAPY Blaise Aguirre, McLean Hospital, 116 Mill St., Belmont, MA 02478 Objectives: The goal of this session is to present DBT as applied to the therapeutic alliance, as well as targeting treatment-interfering behaviors with adolescents and transitional aged youth who have emotion regulation problems or borderline personality disorder. Methods: The speaker will describe the basic features of DBT, including how one proceeds with the following: 1) motivating the adolescent for treatment; 2) recognizing treatment-interfering behavior or nonadherence; and 3) using self-disclosure as a therapeutic tool and alliance building. The presentation will focus on teaching skills to assist in engaging the adolescent or young adult and to use the relationship to focus on specific techniques to optimize an effective treatment course. Results: The speaker will highlight common therapeutic strategies for addressing motivation for treatment, alliance, and target when the adherence to the treatment becomes problematic. The therapeutic strategies are indicated as follows: 1) establish specific and measurable goals for treatment; 2) use commitment strategies to solidify the agreement to treatment; 3) target treatment-interfering behaviors; and 4) explicitly establish that there are two people in the real therapeutic relationship. Conclusions: Despite the common opinion among mental health professionals that a therapeutic alliance is difficult to establish and maintain with adolescents with borderline personality disorder, our experience has shown that using DBT, including the commitment and motivational strategies, together with judicious self-disclosure, all of which is embedded in the
J OURNAL
OF THE
AMERICAN ACADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 55 NUMBER 10S OCTOBER 2016
CLINICAL PERSPECTIVES 34.3 – 35.2
treatment, these adolescents typically develop strong, trusting, and enduring relationships with their therapists.
ADOL P TREAT http://dx.doi.org/10.1016/j.jaac.2016.07.642
34.3 PSYCHODYNAMICALLY INFORMED THERAPY Victor Fornari, MD, Zucker Hillside Hospital, 7559 263rd St, Glen Oaks, NY 11004-1100 Objectives: Youth with severe mental illness who are nonadherent present a particular challenge to the clinician and to their families. Strategies that incorporate psychodynamic understanding of the youth and their family will be presented to describe ways in which the clinician can intervene to enhance adherence by a deeper understanding of the youth. As psychotherapy research has developed, there is a greater appreciation for the importance of the relationship to enhance treatment adherence for youth with severe mental illness. Individual and family strategies that incorporate psychodynamic understanding of the youth have been used to enhance adherence. Methods: After a brief overview of psychodynamic principles in the treatment of youth with severe mental illness, this presentation will review studies of psychodynamically informed therapies for the treatment of youth with severe mental illness. Clinical vignettes will be used to highlight psychodynamic treatment interventions for youth with severe mental illness, particularly the long-term follow-up of one patient. Results: Psychodynamically informed therapies represent a valued treatment option for young people with severe mental illness who are nonadherent to treatment, although research evidence remains limited in this area. Treating a young person with severe mental illness who is nonadherent can be a long journey and may continue long into adulthood, even when the developmental challenges of childhood and adolescence have been navigated. Conclusions: Although psychodynamic principles and treatment are frequently incorporated into the care of youth with severe mental illness who are nonadherent, further research will need to be conducted to clarify the most effective treatment and to determine what works, for whom it works, and how or why the treatment works.
ADOL P TREAT http://dx.doi.org/10.1016/j.jaac.2016.07.643
CLINICAL PERSPECTIVES 35 CAN BRAIN IMAGING CHANGE THE GAME FOR CHILD AND ADOLESCENT MENTAL HEALTH? A LOOK AT TODAY AND TOMORROW Michael P. Milham, MD, Child Mind Institute, 333 E 49th St Apt 6C, New York, NY 10017-1690; Bennett L. Leventhal, MD Objectives: The past two decades have witnessed the maturation of pediatric MRI. Most promising for child and adolescent mental health are recent demonstrations of the feasibility for the following: 1) providing reliable individual-level “fingerprints” of brain function and structure; 2) mapping neurodevelopmental trajectories for the typical and atypical brain; 3) predicting clinically meaningful variables from MRI data; and 4) amassing large-scale datasets through open science. Novel MRI methodologies and brain stimulation approaches are promising to expand the breadth of questions that can be addressed. This Clinical Perspectives will delineate practical expectations for the role of brain imaging in child and adolescent mental health through the lens of a 5- and 20-year perspective. Methods: Goals for developmental imaging will be discussed, including the following: 1) redefinition of psychiatric nosology in terms of neuroscience; 2) development of biomarkers with predictive value (e.g., diagnosis, prognosis, risk); and 3) mapping the neurodevelopmental origins of mental illness. Advances in early life imaging that promise to map neurobiological phenomenology underlying the development of illness will be reviewed (e.g., toddler, neonatal, fetal MRI). Efforts to build “growth charts” for typical and atypical
J OURNAL OF THE AMERICAN ACADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 55 NUMBER 10S OCTOBER 2016
brain development will be discussed, along with aims to predict clinically relevant variables (e.g., diagnosis) from MRI data. Attention will be drawn to emerging imaging (e.g., real-time fMRI, quantitative structural MRI) and brain stimulation approaches that can extend the scope of inquiry. Gaps and needs will be highlighted throughout, along with the ability of open science to speed advancement. Results: The audience will gain an understanding of recent advances in neuroimaging and how they can improve characterizations of mental illness. Criteria that need to be met before reaching clinical utility and remaining obstacles will be delineated clearly. The value of open science as a means of accelerating the pace of advancement will be obviated. Conclusions: Imaging can transform our understanding of mental illness in the next 5 years and leave a meaningful impact on clinical practice in the next 20 years. Recent scientific paradigm shifts, along with advances in methodologies and adoption of open science, are bolstering the likelihood of success.
IMAGS NEURODEV RDOC http://dx.doi.org/10.1016/j.jaac.2016.07.645
35.1 CLINICALLY USEFUL BRAIN IMAGING FOR CHILD AND ADOLESCENT MENTAL HEALTH: CAN WE GET THERE? Michael P. Milham, MD, Child Mind Institute, 333 E 49th St Apt 6C, New York, NY 10017-1690 Objectives: After decades of research, biological psychiatry has yet to deliver clinically useful tests. As a result, a number of paradigm shifts have emerged, each promising to bring us closer to clinically useful deliverables. Examples include the following: 1) syndrome-focused conceptualizations of mental illness being called into question by initiatives, such as the US NIH NIMH Research Domain Criteria; 2) growing awareness that the vast majority of psychiatric illnesses are neurodevelopmental in origin; and 3) an increasing emphasis on big data research models, which necessitate discovery science and large-scale sample groups. This presentation will review the emerging biological psychiatry agenda, identifying potential deliverables for child and adolescent mental health from imaging, as well as changes needed to ensure success. Methods: Dr. Michael Milham will scope out an agenda of biological psychiatry for child and adolescent mental health. He will emphasize goals as follows: 1) redefine psychiatric nosology in terms of neuroscience; 2) revolutionize clinical practice through the development of biomarkers; and 3) bring personalized medicine to psychiatry. The readiness of MRI imaging approaches will be discussed through the lens of the criteria used to evaluate clinical tests (e.g., validity, reliability, sensitivity, specificity). Gaps and needs will be identified, and the potential of emerging conceptual, analytical, and cultural innovations to address them will be highlighted. The critical role of large-scale data generation initiatives and open science will be emphasized. Results: The audience will learn of the promises of brain imaging for child and adolescent mental health while also developing a practical understanding of the obstacles ahead that must be overcome to significantly affect public health. They will learn about large-scale initiatives helping to deliver the data necessary to “change the game” for child and adolescent mental health, as well as the design needs for future studies to continue this process. Practical expectations for the short and long-term will be proposed. Conclusions: Recent paradigm shifts in biological psychiatry may be the key to pediatric neuroimaging attaining deliverable clinically useful tools. Their implementation will require a combination of increased investment in largescale and scalable open-science solutions to obtain the prerequisite data.
IMAGS NSS RDOC http://dx.doi.org/10.1016/j.jaac.2016.07.646
35.2 ARE WE GETTING CLOSER TO UNRAVELING THE MISWIRED CONNECTOME? Adriana DiMartino, MD, NYU Child Study Center, 215 Lexington Ave, New York, NY 10016-6023 Objectives: Dramatic changes in typical brain organization occur during the first 5 years of life. There is a critical time window for the emergence of life-
www.jaacap.org
S53
Objectives: The aim of this study is to determine whether healthy subjects are able to modulate their neural activity using source-localized EEG-phase neurofeedback (NFB) training. The functional connectivity networks of fMRI and EEG were used to evaluate possible changes for real EEG-phase NFB compared with sham EEG-phase NFB. Methods: Healthy male subjects (n ¼ 21; age 19–30 years) underwent a 30minute single session of low-resolution electromagnetic tomography-based EEG-phase NFB (eight rounds at three min, one-minute breaks between the sessions) in a sham-controlled experimental crossover design. The NFB protocol was based on bilateral intrahemispheric phase synchronization of the ɑ1, ɑ2, and b1 bands (8–15 Hz) in Brodmann areas (BAs) 7, 8, 9, 40, and 39. If subjects were able to increase EEG-phase synchronization for at least one second, a visual feedback reward was given. Simultaneous EEG-fMRI recordings were done before and after real and sham EEG-phase NFB, followed by a go/no-go task. EEG recordings and go/no-go event-related potentials were also recorded outside the 3T MRI scanner. Results: The preliminary results of the field-cycled MRI measurements indicate that there is an up-regulation in BAs 21 and 47 for the frontal-parietal network and default mode network and a down-regulation in BAs 45, 46, 9, 38, 20, 21, 22, and 23 for the auditory network and dorsal attention network after real NFB compared with sham NFB. There were bigger clusters of reduced connectivity patterns (320 voxels) compared with increased functional connectivity clusters (79 voxels). Seed-based functional connectivity analyses will be integrated in the final analysis of previously defined resting state networks that were found by Dr. Angela Laird and colleagues in 2011 to be highly relevant in the cognitive domain. The preliminary resting-state EEG results showed a global reduction in absolute power of the d band and the high b bands and increased ɑ-band EEG activity after real versus sham NFB. The results also suggest that increased EEG ɑ activity is associated negatively with the blood-oxygen-level dependent signal in frontal-temporal brain regions. Furthermore, increased EEG ɑ phase was associated with reduced dand q-EEG power. Conclusions: Based on our results, we conclude that EEG-phase NFB can change brain activity in the short term.
R http://dx.doi.org/10.1016/j.jaac.2016.07.638
CLINICAL PERSPECTIVES 34 BEYOND THE PRESCRIPTION PAD: PSYCHOTHERAPY INTERVENTIONS FOR YOUTH WITH SEVERE MENTAL ILLNESS AND TREATMENT NONADHERENCE Mary S. Ahn, MD, University of Massachusetts, 55 Lake Avenue North, Worcester, MA 01655; Sergio V. Delgado, MD Objectives: Youth with severe mental illness (SMI) adhere poorly to the recommended medications and other treatments, with prevalence of nonadherence ranging between 30 and 60 percent. Medication nonadherence is multifactorial, but the root causes can be both analyzed and minimized by a strong therapeutic alliance and understanding of the psychological and social factors. Therefore, CAPs are in a unique position to introduce components of evidence-based psychotherapies into their clinical practice to address treatment nonadherence, even in settings outside of the traditional psychotherapy encounter. This session will introduce strategies based on evidence-based psychotherapies that may be used to address this common problem. Methods: A review of the rationale for the presentations on treatment nonadherence in SMI will be provided. Dr. David Miklowitz will present his work on family-focused therapy. Dr. Blaise Aguirre will present strategies rooted in dialectical behavior therapy. Dr. Victor Fornari will bridge behavioral and interpersonal psychotherapy interventions using psychodynamically informed strategies for developing a therapeutic alliance. Results: With translation of both research and innovative clinical approaches, this session uses different psychotherapeutic strategies that can be used to
S52
www.jaacap.org
address treatment nonadherence in youth with SMI. Dr. Sergio Delgado will be our expert discussant to lead and moderate the panel to allow for audience participation and questions. Conclusions: CAPs working with SMI youth can use modular psychotherapy techniques in a variety of treatment settings to address treatment nonadherence.
P TREAT Sponsored by AACAP's Psychotherapy Committee and Early Career Psychiatrist Committee http://dx.doi.org/10.1016/j.jaac.2016.07.640
34.1 FAMILY-FOCUSED THERAPY David J. Miklowitz, PhD, University of California, Los Angeles, 760 Westwood Plaza, Room 58-217, Los Angeles, CA 90024-1759 Objectives: This presentation presents family-focused therapy (FFT) as applied to adolescents and transitional aged youth who have been newly diagnosed with BD or psychosis. Methods: The speaker will describe the basic features of FFT, including how one proceeds with 1) psychoeducation; 2) communication enhancement training; and 3) problem solving. The presentation will focus on teaching skills to assist in engaging the adolescent or young adult in family psychoeducational sessions, including addressing resistance to the diagnosis, taking medications, or learning new coping skills. Some of the same strategies are also useful with family members who have different views on the nature, causes, or treatment of the patient’s mood disturbances. Results: The speaker will highlight common therapeutic strategies for addressing resistance in family psychoeducational treatment, such as 1) naming the patient as the expert in the disorder; 2) validating multiple viewpoints; 3) clarifying objectives; and 4) labeling resistance as healthy and expectable. The strategies that may be useful with younger versus adolescent/young adult patients will also be discussed. Conclusions: Resistance to treatment is conceptualized as an expression of difficulties in coming to terms with a recurrent mood or psychotic disorder and the functional limitations it imposes.
BD FT TREAT Supported by NIMH Grants MH097007 and MH093676 and the Deutsch, Kayne, Attias, and Danny Alberts Family Foundations http://dx.doi.org/10.1016/j.jaac.2016.07.641
34.2 DIALECTICAL BEHAVIOR THERAPY Blaise Aguirre, McLean Hospital, 116 Mill St., Belmont, MA 02478 Objectives: The goal of this session is to present DBT as applied to the therapeutic alliance, as well as targeting treatment-interfering behaviors with adolescents and transitional aged youth who have emotion regulation problems or borderline personality disorder. Methods: The speaker will describe the basic features of DBT, including how one proceeds with the following: 1) motivating the adolescent for treatment; 2) recognizing treatment-interfering behavior or nonadherence; and 3) using self-disclosure as a therapeutic tool and alliance building. The presentation will focus on teaching skills to assist in engaging the adolescent or young adult and to use the relationship to focus on specific techniques to optimize an effective treatment course. Results: The speaker will highlight common therapeutic strategies for addressing motivation for treatment, alliance, and target when the adherence to the treatment becomes problematic. The therapeutic strategies are indicated as follows: 1) establish specific and measurable goals for treatment; 2) use commitment strategies to solidify the agreement to treatment; 3) target treatment-interfering behaviors; and 4) explicitly establish that there are two people in the real therapeutic relationship. Conclusions: Despite the common opinion among mental health professionals that a therapeutic alliance is difficult to establish and maintain with adolescents with borderline personality disorder, our experience has shown that using DBT, including the commitment and motivational strategies, together with judicious self-disclosure, all of which is embedded in the
J OURNAL
OF THE
AMERICAN ACADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 55 NUMBER 10S OCTOBER 2016
CLINICAL PERSPECTIVES 34.3 – 35.2
treatment, these adolescents typically develop strong, trusting, and enduring relationships with their therapists.
ADOL P TREAT http://dx.doi.org/10.1016/j.jaac.2016.07.642
34.3 PSYCHODYNAMICALLY INFORMED THERAPY Victor Fornari, MD, Zucker Hillside Hospital, 7559 263rd St, Glen Oaks, NY 11004-1100 Objectives: Youth with severe mental illness who are nonadherent present a particular challenge to the clinician and to their families. Strategies that incorporate psychodynamic understanding of the youth and their family will be presented to describe ways in which the clinician can intervene to enhance adherence by a deeper understanding of the youth. As psychotherapy research has developed, there is a greater appreciation for the importance of the relationship to enhance treatment adherence for youth with severe mental illness. Individual and family strategies that incorporate psychodynamic understanding of the youth have been used to enhance adherence. Methods: After a brief overview of psychodynamic principles in the treatment of youth with severe mental illness, this presentation will review studies of psychodynamically informed therapies for the treatment of youth with severe mental illness. Clinical vignettes will be used to highlight psychodynamic treatment interventions for youth with severe mental illness, particularly the long-term follow-up of one patient. Results: Psychodynamically informed therapies represent a valued treatment option for young people with severe mental illness who are nonadherent to treatment, although research evidence remains limited in this area. Treating a young person with severe mental illness who is nonadherent can be a long journey and may continue long into adulthood, even when the developmental challenges of childhood and adolescence have been navigated. Conclusions: Although psychodynamic principles and treatment are frequently incorporated into the care of youth with severe mental illness who are nonadherent, further research will need to be conducted to clarify the most effective treatment and to determine what works, for whom it works, and how or why the treatment works.
ADOL P TREAT http://dx.doi.org/10.1016/j.jaac.2016.07.643
CLINICAL PERSPECTIVES 35 CAN BRAIN IMAGING CHANGE THE GAME FOR CHILD AND ADOLESCENT MENTAL HEALTH? A LOOK AT TODAY AND TOMORROW Michael P. Milham, MD, Child Mind Institute, 333 E 49th St Apt 6C, New York, NY 10017-1690; Bennett L. Leventhal, MD Objectives: The past two decades have witnessed the maturation of pediatric MRI. Most promising for child and adolescent mental health are recent demonstrations of the feasibility for the following: 1) providing reliable individual-level “fingerprints” of brain function and structure; 2) mapping neurodevelopmental trajectories for the typical and atypical brain; 3) predicting clinically meaningful variables from MRI data; and 4) amassing large-scale datasets through open science. Novel MRI methodologies and brain stimulation approaches are promising to expand the breadth of questions that can be addressed. This Clinical Perspectives will delineate practical expectations for the role of brain imaging in child and adolescent mental health through the lens of a 5- and 20-year perspective. Methods: Goals for developmental imaging will be discussed, including the following: 1) redefinition of psychiatric nosology in terms of neuroscience; 2) development of biomarkers with predictive value (e.g., diagnosis, prognosis, risk); and 3) mapping the neurodevelopmental origins of mental illness. Advances in early life imaging that promise to map neurobiological phenomenology underlying the development of illness will be reviewed (e.g., toddler, neonatal, fetal MRI). Efforts to build “growth charts” for typical and atypical
J OURNAL OF THE AMERICAN ACADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 55 NUMBER 10S OCTOBER 2016
brain development will be discussed, along with aims to predict clinically relevant variables (e.g., diagnosis) from MRI data. Attention will be drawn to emerging imaging (e.g., real-time fMRI, quantitative structural MRI) and brain stimulation approaches that can extend the scope of inquiry. Gaps and needs will be highlighted throughout, along with the ability of open science to speed advancement. Results: The audience will gain an understanding of recent advances in neuroimaging and how they can improve characterizations of mental illness. Criteria that need to be met before reaching clinical utility and remaining obstacles will be delineated clearly. The value of open science as a means of accelerating the pace of advancement will be obviated. Conclusions: Imaging can transform our understanding of mental illness in the next 5 years and leave a meaningful impact on clinical practice in the next 20 years. Recent scientific paradigm shifts, along with advances in methodologies and adoption of open science, are bolstering the likelihood of success.
IMAGS NEURODEV RDOC http://dx.doi.org/10.1016/j.jaac.2016.07.645
35.1 CLINICALLY USEFUL BRAIN IMAGING FOR CHILD AND ADOLESCENT MENTAL HEALTH: CAN WE GET THERE? Michael P. Milham, MD, Child Mind Institute, 333 E 49th St Apt 6C, New York, NY 10017-1690 Objectives: After decades of research, biological psychiatry has yet to deliver clinically useful tests. As a result, a number of paradigm shifts have emerged, each promising to bring us closer to clinically useful deliverables. Examples include the following: 1) syndrome-focused conceptualizations of mental illness being called into question by initiatives, such as the US NIH NIMH Research Domain Criteria; 2) growing awareness that the vast majority of psychiatric illnesses are neurodevelopmental in origin; and 3) an increasing emphasis on big data research models, which necessitate discovery science and large-scale sample groups. This presentation will review the emerging biological psychiatry agenda, identifying potential deliverables for child and adolescent mental health from imaging, as well as changes needed to ensure success. Methods: Dr. Michael Milham will scope out an agenda of biological psychiatry for child and adolescent mental health. He will emphasize goals as follows: 1) redefine psychiatric nosology in terms of neuroscience; 2) revolutionize clinical practice through the development of biomarkers; and 3) bring personalized medicine to psychiatry. The readiness of MRI imaging approaches will be discussed through the lens of the criteria used to evaluate clinical tests (e.g., validity, reliability, sensitivity, specificity). Gaps and needs will be identified, and the potential of emerging conceptual, analytical, and cultural innovations to address them will be highlighted. The critical role of large-scale data generation initiatives and open science will be emphasized. Results: The audience will learn of the promises of brain imaging for child and adolescent mental health while also developing a practical understanding of the obstacles ahead that must be overcome to significantly affect public health. They will learn about large-scale initiatives helping to deliver the data necessary to “change the game” for child and adolescent mental health, as well as the design needs for future studies to continue this process. Practical expectations for the short and long-term will be proposed. Conclusions: Recent paradigm shifts in biological psychiatry may be the key to pediatric neuroimaging attaining deliverable clinically useful tools. Their implementation will require a combination of increased investment in largescale and scalable open-science solutions to obtain the prerequisite data.
IMAGS NSS RDOC http://dx.doi.org/10.1016/j.jaac.2016.07.646
35.2 ARE WE GETTING CLOSER TO UNRAVELING THE MISWIRED CONNECTOME? Adriana DiMartino, MD, NYU Child Study Center, 215 Lexington Ave, New York, NY 10016-6023 Objectives: Dramatic changes in typical brain organization occur during the first 5 years of life. There is a critical time window for the emergence of life-
www.jaacap.org
S53