- Email: [email protected]
3.5 REWARD PREDICTION ERROR IN DRUG-NAÏVE YOUTH AT RISK FOR SUBSTANCE ABUSE
NEW RESEARCH POSTERS 3.5 – 3.7
Objectives: ADHD is a disorder marked by a consistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning. It is one of the most prevalent mental health diagnoses identified in school-age children, increasing their risk for academic/social difficulties and psychiatric comorbidities. Often times, children with a history of prenatal exposure to alcohol and substances present to psychiatric clinics with symptoms of ADHD. Throughout my 12-week clinical experience in an urban outpatient university-based ADHD clinic, two such patients were evaluated. Methods: First, we examine the case of a female patient (age 8 years) who presented with a history of premature delivery, failure to thrive, developmental delays, and in utero exposure to alcohol for evaluation of learning and behavioral concerns. Next, we will discuss the case of a male patient (age 9 years), with a past medical history of partial complex epilepsy (febrile seizures) and in utero exposure to cocaine and methamphetamine, who presented to the clinic for disruptive behavior and concerns of ADHD or ODD. Results: Prenatal exposure to alcohol and substances are some of the most important preventable causes of birth defects, intellectual disability, and neurodevelopmental disorders. Heavy prenatal exposure to alcohol could lead to fetal alcohol spectrum disorders (FASD), which may include a variety of disorders composed of varying levels of physical, neurological, behavioral, and cognitive impairments. Prenatal cocaine exposure has been correlated with negative effects on behavior problems, alterations in various aspects of executive functioning, including visual-motor ability, attention, and working memory. Prenatal amphetamine exposure has negative effects on fetal growth and neurobehavior. Conclusions: It is imperative to distinguish ADHD from similar symptoms caused by FASD and substance use because their treatment regimens will differ from those typically used to treat ADHD. A comprehensive literature search on ADHD and comorbid teratogen exposures will be conducted detailing the neuropathology of toxic exposures as related to the development of ADHD, as well as the diagnostic considerations when there is comorbidity.
ADOL ALC ADHD Supported by AACAP’s Summer Medical Student Fellowship, Supported by the Campaign for America’s Kids (CFAK) and partially supported by Ruth and Peter Metz Family Foundation http://dx.doi.org/10.1016/j.jaac.2016.09.135
3.5 REWARD PREDICTION ERROR IN DRUG-NA€IVE YOUTH AT RISK FOR SUBSTANCE ABUSE Kristen Kim, BA, Rutgers University, 185 South Orange Avenue, Newark, NJ 07103; Muhammad A. Parvaz, PhD; Iliyan Ivanov, MD; Jeffrey H. Newcorn, MD Objectives: Reward prediction error (RPE) is the violation of reward anticipation that enables individuals to learn from previous experiences and modify future behavior to maximize reward and minimize punishment. Impaired RPE has been associated with SUD, but it is unclear whether it is a consequence of long-term substance use or a predisposition to SUD. ADHD and parental SUD are known clinical risk factors for SUD and thus may also be related to RPE deficits. This study examined the hypothesis that drugnaïve youth with ADHD and/or parental SUD would exhibit impaired behavior modification following RPE. Methods: Forty-one drug-naïve youth (males ¼ 33, females ¼ 8; ages 8-13 years; mean ¼ 10.1, SD ¼ 1.6) were divided into three groups: healthy control (HC) subjects (n ¼ 11); low risk (LR) participants with ADHD (n ¼ 15); and high risk (HR) participants with ADHD and parental SUD (n ¼ 15). Response times (RT) and accuracy were recorded as participants performed the AnticipationConflict-Reward Task. To evaluate positive RPE (pRPE; better than expected outcome) and negative RPE (nRPE; worse than expected outcome), we calculated mean RTs for trials following reward outcomes and punishment outcomes, respectively. Results: A 2 (pRPE, nRPE) 3 (HC, LR, HR) repeated-measures ANCOVA with accuracy as a covariate revealed a significant main effect of RPE on
J OURNAL OF THE AMERICAN ACADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 55 NUMBER 10S OCTOBER 2016
RT (F1,36 ¼ 9.65, P ¼ 0.004), such that the RT for nRPE was higher than that for pRPE across all groups. Although the interaction between RPE and the group was not significant (F2,36 ¼ 2.19, P ¼ 0.127), there seemed to be an interaction driven by HC and HR. To explore this further, we conducted a 2 (pRPE, nRPE) 2 (HC, HR) repeated-measures ANCOVA with accuracy as a covariate, which revealed a significant main effect of RPE (F1,23 ¼ 8.23, P ¼ 0.009) and interaction between RPE and group (F1,23 ¼ 4.31, P ¼ 0.049). Conclusions: The RPE effect was greater in HC versus HR, as the latter did not modulate their behavior based on preceding rewards and punishments. This finding suggests that children with SUD risk factors, especially the added burden of parental SUD, have deficits in learning from prior experiences and that RPE impairment may confer vulnerability to SUD. Future studies may further investigate these effects by using task paradigms that specifically target RPE and by including a group of children with parental SUD only.
ADHD Substance Use Disorders Supported by NIDA grants K23PA-00-003 and R03DA257961 http://dx.doi.org/10.1016/j.jaac.2016.09.136
3.6 DOES THE TFEQ RESTRAINT SCALE PREDICT EATING BEHAVIOR IN A LABORATORY MEAL? Rachel A. Zambrowicz, BA, Psychiatry, Columbia University, 1051 Riverside Drive, New York, NY 10032; Eve Khlyavich Freidl, MD; Evelyn Attia, MD Objectives: Studies have generally failed to find a significant relationship between common measures of dietary restraint and food consumption. This raises the question of whether these scales represent valid measures of dietary restriction. The aim of the present study was to investigate whether the restraint subscale of the Three Factor Eating Questionnaire (TFEQ-R) predicts caloric intake in a laboratory meal. Methods: Data were collected from 7 studies conducted at the Columbia Eating Disorders Research Unit. In each of these studies, subjects completed the TFEQ-R and participated in one of two laboratory meals. 183 participants were included in the analysis: 83 patients with anorexia nervosa (AN), 30 patients with bulimia nervosa (BN), and 70 healthy controls (HC). Participants represented a mixed age population, including adolescents and young adults. The association between TFEQ-R scores and caloric intake was explored. Results: In the total sample, TFEQ-R showed a significant negative correlation with calories consumed. This relationship was significant for the HC and BN group, but not for the AN group. When binge meals (i.e. >2000 calories) were excluded from the analysis, there was a stronger negative correlation between TFEQ-R and calories consumed. This relationship was significant for all groups (HC, BN, and AN). All analyses remained significant after controlling for BMI. Conclusions: Individuals that score higher on dietary restraint consume significantly fewer calories during a laboratory meal. In contrast to previous studies, these results suggest the TFEQ-R represents a valid measure of dietary restriction.
EA Supported by the American Academy of Child and Adolescent Psychiatry http://dx.doi.org/10.1016/j.jaac.2016.09.137
3.7 SEX DIFFERENCES IN WEIGHT RESTORATION AND QUALITY OF LIFE AFTER FAMILY-BASED TREATMENT OF CHILDREN AND ADOLESCENTS WITH RESTRICTIVE EATING DISORDERS Dallas Argueso, BS, Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, 3440 Market Street, Suite 200, Philadelphia, PA 19104; Laurel Weaver, MD, PhD; Rebecka Peebles, MD
www.jaacap.org
S143
Objectives: ADHD is a disorder marked by a consistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning. It is one of the most prevalent mental health diagnoses identified in school-age children, increasing their risk for academic/social difficulties and psychiatric comorbidities. Often times, children with a history of prenatal exposure to alcohol and substances present to psychiatric clinics with symptoms of ADHD. Throughout my 12-week clinical experience in an urban outpatient university-based ADHD clinic, two such patients were evaluated. Methods: First, we examine the case of a female patient (age 8 years) who presented with a history of premature delivery, failure to thrive, developmental delays, and in utero exposure to alcohol for evaluation of learning and behavioral concerns. Next, we will discuss the case of a male patient (age 9 years), with a past medical history of partial complex epilepsy (febrile seizures) and in utero exposure to cocaine and methamphetamine, who presented to the clinic for disruptive behavior and concerns of ADHD or ODD. Results: Prenatal exposure to alcohol and substances are some of the most important preventable causes of birth defects, intellectual disability, and neurodevelopmental disorders. Heavy prenatal exposure to alcohol could lead to fetal alcohol spectrum disorders (FASD), which may include a variety of disorders composed of varying levels of physical, neurological, behavioral, and cognitive impairments. Prenatal cocaine exposure has been correlated with negative effects on behavior problems, alterations in various aspects of executive functioning, including visual-motor ability, attention, and working memory. Prenatal amphetamine exposure has negative effects on fetal growth and neurobehavior. Conclusions: It is imperative to distinguish ADHD from similar symptoms caused by FASD and substance use because their treatment regimens will differ from those typically used to treat ADHD. A comprehensive literature search on ADHD and comorbid teratogen exposures will be conducted detailing the neuropathology of toxic exposures as related to the development of ADHD, as well as the diagnostic considerations when there is comorbidity.
ADOL ALC ADHD Supported by AACAP’s Summer Medical Student Fellowship, Supported by the Campaign for America’s Kids (CFAK) and partially supported by Ruth and Peter Metz Family Foundation http://dx.doi.org/10.1016/j.jaac.2016.09.135
3.5 REWARD PREDICTION ERROR IN DRUG-NA€IVE YOUTH AT RISK FOR SUBSTANCE ABUSE Kristen Kim, BA, Rutgers University, 185 South Orange Avenue, Newark, NJ 07103; Muhammad A. Parvaz, PhD; Iliyan Ivanov, MD; Jeffrey H. Newcorn, MD Objectives: Reward prediction error (RPE) is the violation of reward anticipation that enables individuals to learn from previous experiences and modify future behavior to maximize reward and minimize punishment. Impaired RPE has been associated with SUD, but it is unclear whether it is a consequence of long-term substance use or a predisposition to SUD. ADHD and parental SUD are known clinical risk factors for SUD and thus may also be related to RPE deficits. This study examined the hypothesis that drugnaïve youth with ADHD and/or parental SUD would exhibit impaired behavior modification following RPE. Methods: Forty-one drug-naïve youth (males ¼ 33, females ¼ 8; ages 8-13 years; mean ¼ 10.1, SD ¼ 1.6) were divided into three groups: healthy control (HC) subjects (n ¼ 11); low risk (LR) participants with ADHD (n ¼ 15); and high risk (HR) participants with ADHD and parental SUD (n ¼ 15). Response times (RT) and accuracy were recorded as participants performed the AnticipationConflict-Reward Task. To evaluate positive RPE (pRPE; better than expected outcome) and negative RPE (nRPE; worse than expected outcome), we calculated mean RTs for trials following reward outcomes and punishment outcomes, respectively. Results: A 2 (pRPE, nRPE) 3 (HC, LR, HR) repeated-measures ANCOVA with accuracy as a covariate revealed a significant main effect of RPE on
J OURNAL OF THE AMERICAN ACADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 55 NUMBER 10S OCTOBER 2016
RT (F1,36 ¼ 9.65, P ¼ 0.004), such that the RT for nRPE was higher than that for pRPE across all groups. Although the interaction between RPE and the group was not significant (F2,36 ¼ 2.19, P ¼ 0.127), there seemed to be an interaction driven by HC and HR. To explore this further, we conducted a 2 (pRPE, nRPE) 2 (HC, HR) repeated-measures ANCOVA with accuracy as a covariate, which revealed a significant main effect of RPE (F1,23 ¼ 8.23, P ¼ 0.009) and interaction between RPE and group (F1,23 ¼ 4.31, P ¼ 0.049). Conclusions: The RPE effect was greater in HC versus HR, as the latter did not modulate their behavior based on preceding rewards and punishments. This finding suggests that children with SUD risk factors, especially the added burden of parental SUD, have deficits in learning from prior experiences and that RPE impairment may confer vulnerability to SUD. Future studies may further investigate these effects by using task paradigms that specifically target RPE and by including a group of children with parental SUD only.
ADHD Substance Use Disorders Supported by NIDA grants K23PA-00-003 and R03DA257961 http://dx.doi.org/10.1016/j.jaac.2016.09.136
3.6 DOES THE TFEQ RESTRAINT SCALE PREDICT EATING BEHAVIOR IN A LABORATORY MEAL? Rachel A. Zambrowicz, BA, Psychiatry, Columbia University, 1051 Riverside Drive, New York, NY 10032; Eve Khlyavich Freidl, MD; Evelyn Attia, MD Objectives: Studies have generally failed to find a significant relationship between common measures of dietary restraint and food consumption. This raises the question of whether these scales represent valid measures of dietary restriction. The aim of the present study was to investigate whether the restraint subscale of the Three Factor Eating Questionnaire (TFEQ-R) predicts caloric intake in a laboratory meal. Methods: Data were collected from 7 studies conducted at the Columbia Eating Disorders Research Unit. In each of these studies, subjects completed the TFEQ-R and participated in one of two laboratory meals. 183 participants were included in the analysis: 83 patients with anorexia nervosa (AN), 30 patients with bulimia nervosa (BN), and 70 healthy controls (HC). Participants represented a mixed age population, including adolescents and young adults. The association between TFEQ-R scores and caloric intake was explored. Results: In the total sample, TFEQ-R showed a significant negative correlation with calories consumed. This relationship was significant for the HC and BN group, but not for the AN group. When binge meals (i.e. >2000 calories) were excluded from the analysis, there was a stronger negative correlation between TFEQ-R and calories consumed. This relationship was significant for all groups (HC, BN, and AN). All analyses remained significant after controlling for BMI. Conclusions: Individuals that score higher on dietary restraint consume significantly fewer calories during a laboratory meal. In contrast to previous studies, these results suggest the TFEQ-R represents a valid measure of dietary restriction.
EA Supported by the American Academy of Child and Adolescent Psychiatry http://dx.doi.org/10.1016/j.jaac.2016.09.137
3.7 SEX DIFFERENCES IN WEIGHT RESTORATION AND QUALITY OF LIFE AFTER FAMILY-BASED TREATMENT OF CHILDREN AND ADOLESCENTS WITH RESTRICTIVE EATING DISORDERS Dallas Argueso, BS, Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, 3440 Market Street, Suite 200, Philadelphia, PA 19104; Laurel Weaver, MD, PhD; Rebecka Peebles, MD
www.jaacap.org
S143