Examining the role of neuropsychology in community-based pediatric mental health care.

Numerous investigations have demonstrated a link between neuropsychological functioning and mental health. Children with a history of neurological compromise are more vulnerable to mental illness and there is a growing literature indicating that neurocognitive functioning predicts psychosocial outcomes in adulthood. However, not much is known about how neuropsychological information is utilized in community-based mental health care. Thus, we examined what neuropsychological information is available to pediatric centers and how neuropsychological functioning relates to treatment outcomes in these settings. Two content analyses were conducted to identify mental health indicators across different intake sources and these results were compared to a structured intake. Further, a series of standardized neurocognitive and neuroemotional measures were completed and these indices were correlated with treatment outcomes. Qualitative results confirmed that neuropsychological factors are often overlooked when utilizing current approaches and that observable symptoms are a primary focus of treatment. Additionally, neurocognitive deficits were associated with self-reported interpersonal difficulties and caregivers' reports of externalizing; however, only caregiver-reported externalizing challenges correlated with treatment outcomes. Importantly, neurocognitive challenges were associated with long-term treatment responses, suggesting that these factors may be an important therapeutic target. Collectively, these findings indicate a need to incorporate neuropsychological factors in pediatric mental health treatment.

Clinician Knowledge, Confidence, and Treatment Practices in Their Provision of Psychotherapy to Autistic Youth and Youth with ADHD.

Autistic youth have an increased risk of mental health problems. Despite the efficacy of various psychotherapeutic approaches for autistic youth, they often do not receive these interventions. Research is needed to identify patterns of effective treatment for autistic youth and whether they differ from those used for youth with other neurodevelopmental conditions (e.g., attention-deficit hyperactivity disorder; ADHD). We compared clinicians' (N = 557) knowledge, confidence and practices when treating autistic youth and youth with ADHD. Although ratings were moderately high overall and similar interventions were used for both groups, clinicians were significantly less knowledgeable and confident when supporting autistic clients compared to clients with ADHD. Thus, improving clinician perspectives may help facilitate treatment for autistic youth with mental health problems.

Investigating cannabis use and associated symptoms among university students with and without a history of concussion.

Recently, there has been a growing interest in the use of cannabis after traumatic brain injury (TBI); however, little is known about the long-term effects of cannabis on milder injuries and post-concussive symptoms. Further, substance use often increases post-TBI and, thus, individuals who chronically use cannabis may unknowingly be exceeding safe or therapeutic doses. The current cross-sectional study explores the prevalence of cannabis use among university students with and without a history of concussion and examines the relationship between concussion and post-concussive symptoms as a function of cannabis use. Eighty-four undergraduates (n = 51 without a prior concussion; n = 33 with a prior concussion) completed a series of questionnaires, capturing their head injury history, current and past substance use, and post-concussive symptomatology. Results indicated that those with a history of concussion were more likely to use cannabis and had higher cannabis use severity scores compared to those without a previous concussion. Further, among cannabis users only, concussion severity demonstrated a significant positive association with post-concussive symptom (e.g., headaches, memory problems) severity (i.e., frequency, intensity, duration). Taken together, the long-term use of cannabis may be detrimental to individuals with a history of concussion, exacerbating, rather than mitigating, post-concussive symptoms.

Alcohol misuse and traumatic brain injury: a review of the potential roles of dopaminergic dysfunction and physiological underarousal post-injury.

Although many researchers have demonstrated an increase in alcohol use following traumatic brain injury (TBI), there is also a body of research indicating that alcohol misuse predisposes one to injury and precedes TBI. Accordingly, various mechanisms have been proposed (e.g., self-medication, dampened levels of arousal, dopaminergic dysfunction, etc.) and variable results have emerged. This paper reviews the empirical evidence, for and against, TBI as a risk factor for alcohol misuse. In particular, this paper focuses on the brain-behavior relationships involved and examines the roles of physiological underarousal and dopaminergic dysfunction in the development of alcohol misuse after injury. Alcohol misuse impedes community reintegration among TBI survivors and creates additional rehabilitative challenges. Thus, in order to inform and improve treatment outcomes among this vulnerable population, a deeper understanding of the neural mechanisms implicated is needed.

Developing an understanding of others' emotional states: Relations among affective theory of mind and empathy measures in early childhood.

Theory of mind (ToM) consists of cognitive and affective components; however, few studies have evaluated the coherence of affective ToM measures and their associations with empathy. This research examined the relations among affective ToM tasks and assessments of empathy, measured directly and via parent reports in 4- to 6-year-olds. Children (N = 117) completed: an Appearance-Reality Emotion Task, an adapted Reading the Mind in the Eyes Test, an Affective Stories Task, and an empathy task. Parents reported on children's ToM and empathy, and language was assessed using a Picture Vocabulary Test. Controlling for language, no relationships were found among affective ToM measures and children's age was only related to the Affective Stories Task. Further, controlling for age, only parent-reported empathy was associated with the Appearance-Reality Emotion Task. Once vocabulary and age were controlled, measures of affective ToM are unrelated and different developmental patterns emerged across measures. Statement of contribution What is already known on this subject Affective theory of mind is a distinct subcomponent of theory of mind that corresponds to an independent developmental mechanism. However, little research has been conducted on affective ToM, its developmental trajectory during the preschool years, its assessment, and its relationship with related constructs, such as empathy. What the present study adds Children's performance on affective ToM tasks was unrelated once age and language abilities were accounted for. Thus, there is a need to examine affective ToM and its measurement more extensively to ensure we are effectively capturing this construct. This study was the first to establish a Preschool Reading the Mind in the Eyes Task that uses images of children and pictorial response options and an Affective Stories Task that captures age-related changes in affective ToM beyond language skills.

Examining the "reading the mind in the eyes test" as an assessment of subtle differences in affective theory of mind after concussion.

Objective: This research examined affective theory of mind (ToM) differences between university students with and without a history of concussion using the revised Reading the Mind in the Eyes Test (RMET). Although, previous studies have shown that affective ToM is subserved by the ventromedial prefrontal cortex - a region that is vulnerable in head injury - few have examined whether subtle deficits in affective ToM are evident after concussion. Given the RMET's sensitivity to affective deficits following moderate-to-severe traumatic brain injury, the current study examined its validity following concussion and its correlation with related ToM measures and constructs, such as empathy.Method: Seventy-seven students with and without a history of self-reported concussion completed the RMET, the Interpersonal Reactivity Index, a novel Perspective-Taking Task, and the Questionnaire of Cognitive and Affective Empathy. Indices of spelling/reading capabilities were obtained and baseline electrodermal activation was recorded as an index of arousal.Results: RMET performance did not differ between individuals with and without a prior concussion when controlling for sex and spelling/reading skills and was not correlated with other measures of affective ToM, empathy, and arousal. However, spelling/reading skills were found to be a predictor of RMET performance among both concussion and no-concussion groups.Conclusions: Together, these findings imply that the RMET is not sensitive to ToM impairments after concussion and may be related to language skills among neurotypical students.

Physiological underarousal as a mechanism of aggressive behavior in university athletes with a history of concussion.

INTRODUCTION: Research has indicated that athletes who engage in high-risk athletic activities, such as football and hockey, have riskier personalities than their low-risk and nonathlete counterparts (Ahmadi et al., 2011, Procedia Soc Behav Sci, 30 and 247-251; Zuckerman, 1983, Biological bases of sensation seeking, impulsivity, and anxiety, Lawrence Erlbaum Assoc Inc.). For instance, increased sensation-seeking and aggression are common in high-risk athletes, rendering these individuals more likely to sustain a subsequent injury, such as concussion. Elevated levels of certain personality traits, including impulsivity and aggression, have also been observed after concussion (Goswami et al., 2016, Brain Struct Funct, 221 and 1911-1925). The purpose of this study therefore was to determine whether aggressive behavior in university athletes may be accounted for, in part, by a history of concussion, rather than exclusively athletic status. METHODS: Using a quasi-experimental design, 66 university students (n = 18 nonathletes, n = 24 low-risk athletes, n = 24 high-risk athletes) with (n = 27) and without a history of concussion (n = 39) completed the Buss & Perry Aggression Questionnaire (BPAQ; Buss & Perry, , J Pers Soc Psychol, 63 and 452) and provided electrodermal activation (EDA) as an index of physiological arousal. RESULTS: It was found that decreased physiological arousal among students with a history of concussion was associated with greater endorsement of physical aggression. Moreover, athletic status did not account for this pattern of aggression, as athletes and nonathletes did not differ in terms of self-reported aggressive tendencies. CONCLUSIONS: Physiological compromise after concussive injury may act as an independent mechanism of aggressive behavior in athletes beyond factors, such as athletic status.

The relationship between concussion and alcohol consumption among university athletes.

INTRODUCTION: This study investigated concussion as a potential risk factor for increased alcohol consumption in university athletes. METHODS: Using a cross-sectional design, 41 university students (37% with a history of concussion) completed self-report measures, while electrodermal activation (EDA) was recorded for each participant to capture baseline physiological arousal. RESULTS: As expected, concussion status significantly predicted alcohol consumption over and above athletic status, b = 0.34, p = 0.034, 95% CI [0.195, 4.832], such that those with a prior concussion history engaged in greater alcohol consumption. Importantly, concussion status also significantly predicted baseline physiological arousal, b = -0.39, p = 0.014, 95% CI [-0.979, -0.120], such that those with a history of concussion exhibited lower EDA. CONCLUSIONS: Elevated alcohol consumption among athletes is a pronounced associate of concussion in sports and may be a behavioral reflection of disruption to the orbitofrontal cortex - an area implicated in inhibition.