Phenoscreening: a developmental approach to research domain criteria-motivated sampling.

BACKGROUND: To advance early identification efforts, we must detect and characterize neurodevelopmental sequelae of risk among population-based samples early in development. However, variability across the typical-to-atypical continuum and heterogeneity within and across early emerging psychiatric/neurodevelopmental disorders represent fundamental challenges to overcome. Identifying multidimensionally determined profiles of risk, agnostic to DSM categories, via data-driven computational approaches represents an avenue to improve early identification of risk. METHODS: Factor mixture modeling (FMM) was used to identify subgroups and characterize phenotypic risk profiles, derived from multiple parent-report measures of typical and atypical behaviors common to autism spectrum disorder, in a community-based sample of 17- to 25-month-old toddlers (n = 1,570). To examine the utility of risk profile classification, a subsample of toddlers (n = 107) was assessed on a distal, independent outcome examining internalizing, externalizing, and dysregulation at approximately 30 months. RESULTS: FMM results identified five asymmetrically sized subgroups. The putative high- and moderate-risk groups comprised 6% of the sample. Follow-up analyses corroborated the utility of the risk profile classification; the high-, moderate-, and low-risk groups were differentially stratified (i.e., HR > moderate-risk > LR) on outcome measures and comparison of high- and low-risk groups revealed large effect sizes for internalizing (d = 0.83), externalizing (d = 1.39), and dysregulation (d = 1.19). CONCLUSIONS: This data-driven approach yielded five subgroups of toddlers, the utility of which was corroborated by later outcomes. Data-driven approaches, leveraging multiple developmentally appropriate dimensional RDoC constructs, hold promise for future efforts aimed toward early identification of at-risk-phenotypes for a variety of early emerging neurodevelopmental disorders.

Risk and Adversity, Parenting Quality, and Children's Social-Emotional Adjustment in Families Experiencing Homelessness.

A multimethod, multi-informant design was used to examine links among sociodemographic risk, family adversity, parenting quality, and child adjustment in families experiencing homelessness. Participants were 245 homeless parents (Mage  = 31.0, 63.6% African American) and their 4- to 6-year-old children (48.6% male). Path analyses revealed unique associations by risk domain: Higher sociodemographic risk predicted more externalizing behavior and poorer teacher-child relationships, whereas higher family adversity predicted more internalizing behavior. Parenting quality was positively associated with peer acceptance and buffered effects of family adversity on internalizing symptoms, consistent with a protective effect. Parenting quality was associated with lower externalizing behavior only when sociodemographic risk was below the sample mean. Implications for research and practice are discussed.

The Child Life Challenges Scale (CLCS): Associations of a Single-Item Rating of Global Child Adversity with Children's Total Life Stressors and Parent's Childhood Adversity.

BACKGROUND: Although many existing measures tabulate specific risk factors to yield cumulative risk indices, there is a need for low-burden strategies to estimate general adversity exposure. AIMS AND METHODS: This study introduces a brief, new measure of lifetime adversity, the Child Life Challenges Scale (CLCS), and examines its validity in a sample of parents and children residing in emergency housing. The CLCS comprises a single global item for rating cumulative life challenges utilizing either a paper-pencil scale or a sliding scale on a tablet. Parents are provided with anchor examples of mild and extreme challenges and asked to mark a location along the scale reflecting number and severity of challenges in their children's lives to date. Study participants included 99 parents and their 3- to 6-year-old children. RESULTS: CLCS scores were moderately associated with children's parent-reported total life stressors, and these associations were robust to controls for parental history of adversity, parental distress, and family demographics. Control variables also did not moderate associations between CLCS scores and total life stressors, suggesting that the CLCS functions similarly across a range of sociodemographic risk. Paper-pencil and tablet versions showed similar convergent validity. CONCLUSION: The CLCS shows promise as an efficient measure for estimating children's lifetime adversity with minimal parent or administrator burden.

Moderators of two dual eating disorder and obesity prevention programs.

Few trials have investigated factors that moderate the effects of eating disorder and obesity prevention programs, which may inform inclusion criteria and intervention refinements. We examined factors hypothesized to moderate the effects of the Healthy Weight eating disorder/obesity prevention program that promotes gradual healthy changes, and Project Health that adds cognitive dissonance activities. College students at risk for both outcomes because of weight concerns (N = 364, 72% female) were randomized to these interventions or an educational video condition, completing pretest, posttest, and 6, 12, and 24-month follow-up assessments. Healthy Weight and Project Health produced significantly larger reductions in eating disorder symptoms versus video controls for individuals with higher negative affect, emotional eating, dietary fat/sugar intake, and perceived pressure to be thin. Project Health also produced significantly less increases in BMI versus video controls for individuals with lower negative affect. Results suggest that these interventions produce larger eating disorder symptom reductions for individuals at elevated risk for eating pathology but hint that weight gain prevention effects may be attenuated by elevated negative affect. Results imply that larger eating disorder symptom reductions will result when implemented with individuals with both weight concerns and one of the additionally identified risk factors.

Interactions between risk factors in the prediction of onset of eating disorders: Exploratory hypothesis generating analyses.

OBJECTIVE: Because no study has tested for interactions between risk factors in the prediction of future onset of each eating disorder, this exploratory study addressed this lacuna to generate hypotheses to be tested in future confirmatory studies. METHOD: Data from three prevention trials that targeted young women at high risk for eating disorders due to body dissatisfaction (N = 1271; M age 18.5, SD 4.2) and collected diagnostic interview data over 3-year follow-up were combined to permit sufficient power to predict onset of anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), and purging disorder (PD) using classification tree analyses, an analytic technique uniquely suited to detecting interactions. RESULTS: Low BMI was the most potent predictor of AN onset, and body dissatisfaction amplified this relation. Overeating was the most potent predictor of BN onset, and positive expectancies for thinness and body dissatisfaction amplified this relation. Body dissatisfaction was the most potent predictor of BED onset, and overeating, low dieting, and thin-ideal internalization amplified this relation. Dieting was the most potent predictor of PD onset, and negative affect and positive expectancies for thinness amplified this relation. CONCLUSIONS: Results provided evidence of amplifying interactions between risk factors suggestive of cumulative risk processes that were distinct for each disorder; future confirmatory studies should test the interactive hypotheses generated by these analyses. If hypotheses are confirmed, results may allow interventionists to target ultra high-risk subpopulations with more intensive prevention programs that are uniquely tailored for each eating disorder, potentially improving the yield of prevention efforts.

Mediators of two selective prevention interventions targeting both obesity and eating disorders.

The present study tested hypothesized mechanisms underlying the effects of two selective prevention interventions targeting both obesity and eating disorders (Healthy Weight and the newly developed Project Health), relative to video control. Tests examined mediation for the significant weight gain prevention and eating disorder symptom prevention effects previously reported. College students (N = 364; 72% women) with weight concerns were randomized to condition and assessed for 2-years post-intervention. Project Health participants had significant improvements in 2 of the 7 proposed mediators relative to comparisons (i.e., cognitive dissonance, the unhealthy Western dietary pattern) but change in these variables did not mediate its effect on long-term BMI change. Two variables emerged as full mediators of the eating disorder prevention effects for both experimental interventions: body dissatisfaction and negative affect. Analyses failed to support the exploratory hypothesis that change in eating disorder symptoms mediated the effects of condition on BMI gain. This report is the among the first to examine mediation for programs aimed at preventing both weight gain and eating disorders, particularly in mixed-gender groups. Mediational analyses are essential in identifying the mechanism of intervention action, which can inform improvements to prevention programs.

The slope of cortisol from awakening to 30 min post-wake in post-institutionalized children and early adolescents.

This study examined the association between early life adversity, in the form of early rearing in an institution (orphanage), and the slope of cortisol in the first thirty minutes after waking in 277 children, aged 7 through 15 years old, who had either been adopted between 6 and 60 months of age into well-resourced homes in the United States or born into similar homes. The adopted youth were divided at the median (age 16 months) into those adopted earlier (earlier-adopted, EA) and later (later-adopted, LA). The purpose of this study was to examine the post-waking slope in cortisol in post-institutionalized youth, predicting that it would be blunted, especially in later-adopted youth, when compared to the non-adopted (NA) youth. A secondary goal was to examine whether there would be some evidence of less blunting of the first 30 min of the cortisol awakening response among the children further along in pubertal development (i.e., Pubertal Recalibration Hypothesis). Pubertal stage was determined by nurse exam. Salivary cortisol was assessed at 0 and 30-min post-awakening on three days. The results showed that LA children had a blunted wake-30 min cortisol slope relative to NA and EA children. Neither the age by group nor pubertal stage by group analyses were significant. However, the majority of the sample were in early stages of puberty (56% in stages 1 & 2), thus the power was low for detecting such an interaction. This is the first year of a cohort-sequential longitudinal study examining early experiences and pubertal influences on the HPA axis, so it will be important to re-examine this question as the sample ages.