- Email: [email protected]
35.3 ADVANCED NEUROIMAGING TECHNIQUES FOR ASSESSING BRAIN DEVELOPMENT
CLINICAL PERSPECTIVES 35.3 – 36.0
long pervasive psychiatric conditions, such as autism, and possibly for the initiation of processes resulting in later onset psychopathology. This presentation aims to provide an overview of the growing abilities of pediatric imaging to comprehensively map the development of neural circuitry (i.e., the connectome) in the early years of life and during the prenatal period. Implications for efforts to delineate typical from atypical development will be discussed. Methods: Dr. Adriana Di Martino will review recent methodological advances in functional and structural imaging for the developing connectome, including natural sleep MRI (for infants and toddlers/preschoolers) and fetal imaging. She will discuss the potential translational impact of these methodologies. Examples of possible uses in the future will be provided, which can range from identifying etiologic factors contributing to the development of mental illness to informing assessments of risk and prognosis. Current gaps and obstacles that need to be addressed also will be highlighted. Results: The audience will gain insight into the impact of recent technical and methodological advances on our ability to characterize early brain development in vivo. Furthermore, participants will learn of the short-term implications for our understanding of how abnormal patterns of brain connectivity emerge and potential long-term implications for translational pursuits (e.g., inform assessment of risk and prognosis). Finally, they will learn of the gaps and obstacles that must be addressed for these visions to be realized. Conclusions: Although brain connectomics has just begun to understand normative early developmental trajectories and their interfering factors, examples of its potential for translational impact are growing. As the field continues to overcome technical challenges, the potential for brain imaging to deliver clinically useful findings will continue to increase.
ASD IMAGS ND http://dx.doi.org/10.1016/j.jaac.2016.07.647
35.3 ADVANCED NEUROIMAGING TECHNIQUES FOR ASSESSING BRAIN DEVELOPMENT R. Cameron Craddock, PhD, Child Mind Institute, 445 Park Ave, New York, NY 10022-2606 Objectives: Emergent MRI and brain stimulation techniques are enabling new ways of assessing structural and functional processes underlying brain development and determining how they are affected by mental health disorders. This presentation will review recent innovations in real-time fMRI, quantitative MRI, and brain stimulation techniques and describe how they are being used to shed light on brain development. Dr. R. Cameron Craddock will critically review both the strengths and weaknesses of these techniques and identify key areas where these methods have the potential for the biggest payoff. Methods: Each of the real-time fMRI, quantitative MRI, and brain stimulation techniques will be covered in separate sections of this presentation. The discussion of each of the methods will begin with a brief overview of the underlying technology, the neuroscientific interpretations of its measurement, and the types of experimental questions that it can help answer. This will be followed by a description of some of the real-world challenges associated with the use of methods in child and adolescent populations and examples of how these are overcome in ongoing experiments. Dr. Craddock will conclude the presentation with some ideas on ways in which these techniques can be combined to provide a more comprehensive understanding of normal and abnormal brain development. Results: After attending this talk, audience members should have a better understanding of real-time fMRI, quantitative MRI, and brain stimulation techniques and their use for mapping brain development. They will learn about the types of hypotheses that these techniques can and cannot test and gain some insight into what it takes to use these methods in their research. They will be able to critically evaluate the literature that uses these methods and have a better understanding of the potential payoffs of these methods for understanding mental health disorders. Conclusions: Technological advances in neuroimaging and brain stimulation technology are broadening the repertoire of experimental techniques available for measuring the processes underlying structural and functional changes during brain development. These techniques allow the brain to be
S54
www.jaacap.org
studied in exciting new ways that offer promise for accelerating the pace of biological psychiatry research.
COMP IMAGS NEURODEV http://dx.doi.org/10.1016/j.jaac.2016.07.648
35.4 DIFFERENTIATING TYPICAL AND ATYPICAL PATTERNS OF BRAIN DEVELOPMENT Theodore Satterthwaite, MD, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104 Objectives: Major domains of psychopathology are increasingly conceptualized as disorders of brain development. However, the accurate delineation of normative patterns of brain development is a critical prerequisite for brain “growth charts” that could be used for early identification of psychopathology. Dr. Theodore Satterthwaite will review recent multimodal neuroimaging efforts to define normative patterns of brain development, as well as psychopathology associated with abnormal brain maturation. Throughout this session, he will highlight important challenges to this research, including data quality and clinical comorbidity. Methods: An overview of studies demonstrating the feasibility of developing “growth charts” of human brain development will be provided, as well as their potential utility in identifying pathological developmental and diagnostic profiles. The Philadelphia Neurodevelopmental Cohort (PNC), a large-scale community-based neuroimaging sample group that included adolescents (n ¼ 1,601; ages 8–21 years) who completed multimodal imaging (T1 structural imaging, resting-state fMRI, arterial spin labeled MRI, nback task) will be used as an example and for lessons learned. Diverse psychopathology was present in the sample group, with rates similar to population studies. The relative utility of categorical and dimensional data analysis models will be discussed. Results: Measures of brain structure, function, and connectivity provide complementary insights into how the brain develops. The audience will learn about the importance of accounting for sex differences and the impact of data quality when deriving trajectories. The ability of these measures to differentiate pathological populations and those with subtle subclinical symptoms (e.g., psychosis spectrum) will be explored, with particular focus on executive and limbic networks. Conclusions: Normative patterns of brain development provide a critical baseline for studies of developmental psychopathology. It is noteworthy that different domains of psychopathology show both common and dissociable changes in brain structure and function. Observed abnormalities align with models of developmental psychopathology, as well as with reports from clinical samples in adults. The presence of such abnormalities in youth suggests opportunities for early identification and intervention using imaging biomarkers.
IMAGS NEURODEV RDOC http://dx.doi.org/10.1016/j.jaac.2016.07.649
CLINICAL PERSPECTIVES 36 FROM PERSECUTION TO RESILIENCE: EXAMINING THE MENTAL HEALTH SUPPORTS FOR LESBIAN, GAY, BISEXUAL, AND TRANSGENDER YOUTH ACROSS THE GLOBE Shervin Shadianloo, MD, Child Psychiatry, Hofstra Northwell School of Medicine, 75-59 263rd Street, ACP building, Glen Oaks, NY 11004; Shirley Alleyne, MBBS, Department of Medicine, University of the West Indies, Cave Hill Campus, Cave Hill, St. Michael G11, Barbados; Ayesha I. Mian, MD Objectives: Lesbian, gay, bisexual, and transgender (LGBT) youth face more challenges and discrimination compared to their peers, which can have a negative impact on their mental health. There is a paucity of research on the
J OURNAL
OF THE
AMERICAN ACADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 55 NUMBER 10S OCTOBER 2016
long pervasive psychiatric conditions, such as autism, and possibly for the initiation of processes resulting in later onset psychopathology. This presentation aims to provide an overview of the growing abilities of pediatric imaging to comprehensively map the development of neural circuitry (i.e., the connectome) in the early years of life and during the prenatal period. Implications for efforts to delineate typical from atypical development will be discussed. Methods: Dr. Adriana Di Martino will review recent methodological advances in functional and structural imaging for the developing connectome, including natural sleep MRI (for infants and toddlers/preschoolers) and fetal imaging. She will discuss the potential translational impact of these methodologies. Examples of possible uses in the future will be provided, which can range from identifying etiologic factors contributing to the development of mental illness to informing assessments of risk and prognosis. Current gaps and obstacles that need to be addressed also will be highlighted. Results: The audience will gain insight into the impact of recent technical and methodological advances on our ability to characterize early brain development in vivo. Furthermore, participants will learn of the short-term implications for our understanding of how abnormal patterns of brain connectivity emerge and potential long-term implications for translational pursuits (e.g., inform assessment of risk and prognosis). Finally, they will learn of the gaps and obstacles that must be addressed for these visions to be realized. Conclusions: Although brain connectomics has just begun to understand normative early developmental trajectories and their interfering factors, examples of its potential for translational impact are growing. As the field continues to overcome technical challenges, the potential for brain imaging to deliver clinically useful findings will continue to increase.
ASD IMAGS ND http://dx.doi.org/10.1016/j.jaac.2016.07.647
35.3 ADVANCED NEUROIMAGING TECHNIQUES FOR ASSESSING BRAIN DEVELOPMENT R. Cameron Craddock, PhD, Child Mind Institute, 445 Park Ave, New York, NY 10022-2606 Objectives: Emergent MRI and brain stimulation techniques are enabling new ways of assessing structural and functional processes underlying brain development and determining how they are affected by mental health disorders. This presentation will review recent innovations in real-time fMRI, quantitative MRI, and brain stimulation techniques and describe how they are being used to shed light on brain development. Dr. R. Cameron Craddock will critically review both the strengths and weaknesses of these techniques and identify key areas where these methods have the potential for the biggest payoff. Methods: Each of the real-time fMRI, quantitative MRI, and brain stimulation techniques will be covered in separate sections of this presentation. The discussion of each of the methods will begin with a brief overview of the underlying technology, the neuroscientific interpretations of its measurement, and the types of experimental questions that it can help answer. This will be followed by a description of some of the real-world challenges associated with the use of methods in child and adolescent populations and examples of how these are overcome in ongoing experiments. Dr. Craddock will conclude the presentation with some ideas on ways in which these techniques can be combined to provide a more comprehensive understanding of normal and abnormal brain development. Results: After attending this talk, audience members should have a better understanding of real-time fMRI, quantitative MRI, and brain stimulation techniques and their use for mapping brain development. They will learn about the types of hypotheses that these techniques can and cannot test and gain some insight into what it takes to use these methods in their research. They will be able to critically evaluate the literature that uses these methods and have a better understanding of the potential payoffs of these methods for understanding mental health disorders. Conclusions: Technological advances in neuroimaging and brain stimulation technology are broadening the repertoire of experimental techniques available for measuring the processes underlying structural and functional changes during brain development. These techniques allow the brain to be
S54
www.jaacap.org
studied in exciting new ways that offer promise for accelerating the pace of biological psychiatry research.
COMP IMAGS NEURODEV http://dx.doi.org/10.1016/j.jaac.2016.07.648
35.4 DIFFERENTIATING TYPICAL AND ATYPICAL PATTERNS OF BRAIN DEVELOPMENT Theodore Satterthwaite, MD, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104 Objectives: Major domains of psychopathology are increasingly conceptualized as disorders of brain development. However, the accurate delineation of normative patterns of brain development is a critical prerequisite for brain “growth charts” that could be used for early identification of psychopathology. Dr. Theodore Satterthwaite will review recent multimodal neuroimaging efforts to define normative patterns of brain development, as well as psychopathology associated with abnormal brain maturation. Throughout this session, he will highlight important challenges to this research, including data quality and clinical comorbidity. Methods: An overview of studies demonstrating the feasibility of developing “growth charts” of human brain development will be provided, as well as their potential utility in identifying pathological developmental and diagnostic profiles. The Philadelphia Neurodevelopmental Cohort (PNC), a large-scale community-based neuroimaging sample group that included adolescents (n ¼ 1,601; ages 8–21 years) who completed multimodal imaging (T1 structural imaging, resting-state fMRI, arterial spin labeled MRI, nback task) will be used as an example and for lessons learned. Diverse psychopathology was present in the sample group, with rates similar to population studies. The relative utility of categorical and dimensional data analysis models will be discussed. Results: Measures of brain structure, function, and connectivity provide complementary insights into how the brain develops. The audience will learn about the importance of accounting for sex differences and the impact of data quality when deriving trajectories. The ability of these measures to differentiate pathological populations and those with subtle subclinical symptoms (e.g., psychosis spectrum) will be explored, with particular focus on executive and limbic networks. Conclusions: Normative patterns of brain development provide a critical baseline for studies of developmental psychopathology. It is noteworthy that different domains of psychopathology show both common and dissociable changes in brain structure and function. Observed abnormalities align with models of developmental psychopathology, as well as with reports from clinical samples in adults. The presence of such abnormalities in youth suggests opportunities for early identification and intervention using imaging biomarkers.
IMAGS NEURODEV RDOC http://dx.doi.org/10.1016/j.jaac.2016.07.649
CLINICAL PERSPECTIVES 36 FROM PERSECUTION TO RESILIENCE: EXAMINING THE MENTAL HEALTH SUPPORTS FOR LESBIAN, GAY, BISEXUAL, AND TRANSGENDER YOUTH ACROSS THE GLOBE Shervin Shadianloo, MD, Child Psychiatry, Hofstra Northwell School of Medicine, 75-59 263rd Street, ACP building, Glen Oaks, NY 11004; Shirley Alleyne, MBBS, Department of Medicine, University of the West Indies, Cave Hill Campus, Cave Hill, St. Michael G11, Barbados; Ayesha I. Mian, MD Objectives: Lesbian, gay, bisexual, and transgender (LGBT) youth face more challenges and discrimination compared to their peers, which can have a negative impact on their mental health. There is a paucity of research on the
J OURNAL
OF THE
AMERICAN ACADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 55 NUMBER 10S OCTOBER 2016