Executive function in children with disruptive mood dysregulation disorder compared to attention-deficit/hyperactivity disorder and oppositional defiant disorder, and in children with different irritability levels.

Addressing current challenges in research on disruptive mood dysregulation disorder (DMDD), this study aims to compare executive function in children with DMDD, children with attention-deficit/hyperactivity disorder (ADHD), and children with oppositional defiant disorder (ODD). We also explore associations between irritability, a key DMDD characteristic, and executive function in a clinical sample regardless of diagnosis. Our sample include children (6-12 years) referred to child psychiatric clinics. Measures of daily-life (parent-reported questionnaire) and performance-based (neuropsychological tasks) executive function were applied. Identifying diagnoses, clinicians administered a standardized semi-structured diagnostic interview with parents. Irritability was assessed by parent-report. First, we compared executive function in DMDD (without ADHD/ODD), ADHD (without DMDD/ODD), ODD (without DMDD/ADHD) and DMDD + ADHD (without ODD). Second, we analyzed associations between executive function and irritability using the total sample. In daily life, children with DMDD showed clinically elevated and significantly worse emotion control scores compared to children with ADHD, and clinically elevated scores on cognitive flexibility compared to norm scores. Children with DMDD had significantly less working memory problems than those with ADHD. No differences were found between DMDD and ODD. Increased irritability was positively associated with emotional dyscontrol and cognitive inflexibility. For performance-based executive function, no diagnostic differences or associations with irritability were observed. We discuss how, in daily life, children with high irritability-levels get overwhelmed by feelings without accompanying regulatory capacities.

Salivary cortisol levels relate to cognitive performance in children prenatally exposed to methadone or buprenorphine.

Opioid maintenance therapy (OMT) is generally recommended for pregnant opioid-dependent women. However, much is still unknown about the potential long-term effects of prenatal methadone and buprenorphine exposure. This study explored the long-term effects of prenatal methadone and buprenorphine exposure in a cohort (n = 41) of children, aged 9-11 years, using the Wechsler Abbreviated Scale of Intelligence (WASI) to measure cognitive development and salivary cortisol samples to measure HPA-axis activity. Prenatally exposed children scored significantly lower on all four subtests of WASI (vocabulary, similarities, block design, and matrix reasoning), compared to a comparison group (all p < .05). No group differences were found for salivary cortisol levels or cortisol reactivity levels (all p > .05). Cortisol levels significantly predicted matrix reasoning scores for the OMT group, ß = -65.58, t(20) = 15.70, p = .02. Findings suggest that prenatal exposure to methadone or buprenorphine does not have long-term effects on children's HPA-axis functioning. However, since children of women in OMT scored significantly lower on tasks of cognitive function, careful follow-up throughout the school years and across adolescence is recommended.

Prefrontal glutamate levels predict altered amygdala-prefrontal connectivity in traumatized youths.

BACKGROUND: Neurobiological models of stress and stress-related mental illness, including post-traumatic stress disorder, converge on the amygdala and the prefrontal cortex (PFC). While a surge of research has reported altered structural and functional connectivity between amygdala and the medial PFC following severe stress, few have addressed the underlying neurochemistry. METHODS: We combined resting-state functional magnetic resonance imaging measures of amygdala connectivity with in vivo MR-spectroscopy (1H-MRS) measurements of glutamate in 26 survivors from the 2011 Norwegian terror attack and 34 control subjects. RESULTS: Traumatized youths showed altered amygdala-anterior midcingulate cortex (aMCC) and amygdala-ventromedial prefrontal cortex (vmPFC) connectivity. Moreover, the trauma survivors exhibited reduced levels of glutamate in the vmPFC which fits with the previous findings of reduced levels of Glx (glutamate + glutamine) in the aMCC (Ousdal et al., 2017) and together suggest long-term impact of a traumatic experience on glutamatergic pathways. Importantly, local glutamatergic metabolite levels predicted the individual amygdala-aMCC and amygdala-vmPFC functional connectivity, and also mediated the observed group difference in amygdala-aMCC connectivity. CONCLUSIONS: Our findings suggest that traumatic stress may influence amygdala-prefrontal neuronal connectivity through an effect on prefrontal glutamate and its compounds. Understanding the neurochemical underpinning of altered amygdala connectivity after trauma may ultimately lead to the discovery of new pharmacological agents which can prevent or treat stress-related mental illness.

Life Threat and Sleep Disturbances in Adolescents: A Two-Year Follow-Up of Survivors From the 2011 Utøya, Norway, Terror Attack.

A significant number of adolescents have been exposed to traumatic life events. However, knowledge about the specific sleep disturbance that occurs in individuals after trauma exposure is predominantly based on studies of adults. This study reports specific sleep disturbance in 42 survivors of the 2011 mass shooting at a youth summer camp on the Norwegian island Utøya, mean age = 20.91 years, SD = 2.32, 62.5% females. When compared with matched controls, significantly more survivors reported having sleep disturbances, 52.4% versus 13.6%, d = 0.93, of which onset began at the time of the shooting, χ2 = 14.9, p < .001. The prevalence of insomnia, 56.3% versus 11.0%, d = 0.73; excessive daytime sleepiness, 34.4% versus 13.6%, d = 0.61; symptoms of obstructive sleep apnea, 18.8% versus 0%, d = 0.70; and frequent nightmares, 37.5% versus 2.3%, d = 0.90, were all higher in the survivors than in the controls. In a subgroup of survivors (n = 20) with psychiatric diagnoses, sleep disturbances were more prevalent than in survivors without psychiatric diagnosis. Actigraphy data revealed delayed bedtime, sleep onset, and rise time in survivors compared with controls, ts > 1.7, ps = .044 to .028. These results corroborate the effects of a life threat on the range and extent of sleep disturbances, and emphasize the need to better assess and treat sleep disorders in adolescents exposed to trauma.

Positive events protect children from causal false memories for scripted events.

Adults produce fewer inferential false memories for scripted events when their conclusions are emotionally charged than when they are neutral, but it is not clear whether the same effect is also found in children. In the present study, we examined this issue in a sample of 132 children aged 6-12 years (mean 9 years, 3 months). Participants encoded photographs depicting six script-like events that had a positively, negatively, or a neutral valenced ending. Subsequently, true and false recognition memory of photographs related to the observed scripts was tested as a function of emotionality. Causal errors-a type of false memory thought to stem from inferential processes-were found to be affected by valence: children made fewer causal errors for positive than for neutral or negative events. Hypotheses are proposed on why adults were found protected against inferential false memories not only by positive (as for children) but also by negative endings when administered similar versions of the same paradigm.

Maltreated and non-maltreated children's true and false memories of neutral and emotional word lists in the Deese/Roediger-McDermott task.

Maltreated (n=26) and non-maltreated (n=31) 7- to 12-year-old children were tested on the Deese/Roediger-McDermott (DRM) false memory task using emotional and neutral word lists. True recall was significantly better for non-maltreated than maltreated children regardless of list valence. The proportion of false recall for neutral lists was comparable regardless of maltreatment status. However, maltreated children showed a significantly higher false recall rate for the emotional lists than non-maltreated children. Together, these results provide new evidence that maltreated children could be more prone to false memory illusions for negatively valenced information than their non-maltreated counterparts.

The Emotional Child Witness Effect Survives Presentation Mode.

The emotional witness effect - the phenomenon whereby people are affected by the emotional manner in which a witness presents testimony - constitutes a possible source of wrongful decisions in legal contexts. One stereotypical view of abused children is that they should be sad when talking about their experiences of maltreatment, whereas children may in fact express a variety of emotional expressions when talking about abusive events. This raises the question as to whether there is an optimal mode in which to present child victim testimony that could reduce the possible influence of displayed emotions. In the present study, mock police interviews were carried out with female child actors, role-playing the victims of physical abuse by their stepfather, telling the same story with four emotional expressions (neutral, sad, angry, or positive). Laypersons (N = 465) were presented with the interviews as transcripts with the emotional reactions of the child witness noted, audio recordings, or videotaped recordings. Participants then rated the credibility of the victim witness. Replicating previous results, the "sad" expression elicited the highest credibility ratings across all modes of presentations. Presentation mode affected ratings of credibility, with the transcript versions resulting in the highest ratings. Copyright © 2016 John Wiley & Sons, Ltd.

The developmental trajectory of pointing perception in the first year of life.

The present study investigated the development of the neural basis of pointing perception in 6-month- and 13-month-old infants. In a spatial-cueing paradigm, infants were presented with a peripheral target followed by a hand pointing toward (congruent condition) or away (incongruent condition) from the previously cued location. EEG responses to the presentation of the hand were measured. Thirteen-month-olds demonstrated larger amplitudes of ERP component P400 to incongruent compared to congruent pointing gestures over posterior temporal areas; 6-month-olds did not show any differential activation. This result suggests that the neural correlates of pointing perception undergo substantial development between 6 and 13 months of age.

Visual selective attention is impaired in children prenatally exposed to opioid agonist medication.

AIMS: To examine whether prenatal exposure to opioid agonist medication is associated with visual selective attention and general attention problems in early childhood. METHOD: Twenty-two children (mean age = 52.17 months, SD = 1.81) prenatally exposed to methadone, 9 children (mean age = 52.41 months, SD = 1.42) prenatally exposed to buprenorphine and 25 nonexposed comparison children (mean age = 51.44 months, SD = 1.31) were tested. Visual selective attention was measured with a Tobii 1750 Eye Tracker using a spatial negative priming paradigm. Attention problems were measured using the Child Behavior Checklist. RESULTS: The comparison group demonstrated a larger spatial negative priming effect (mean = 23.50, SD = 45.50) than the exposed group [mean = -6.84, SD = 86.39, F(1,50) = 5.91, p = 0.019, η(2) = 0.11]. No difference in reported attention problems was found [F(1,51) = 1.63, p = 0.21, η(2) = 0.03]. Neonatal abstinence syndrome and prenatal exposure to marijuana were found to predict slower saccade latencies in the exposed group (b = 54.55, SE = 23.56, p = 0.03 and b = 88.86, SE = 32.07, p = 0.01, respectively). CONCLUSION: Although exposed children did not appear to have attention deficits in daily life, lower performance on the SNP task indicates subtle alteration in the attention system.

High accuracy but low consistency in children's long-term recall of a real-life stressful event.

The accuracy and consistency of children's memories of their removals from their biological families by the Child Protective Services (CPS) was investigated. A researcher was present during the removals and documented what happened. A total of 37 maltreated children, aged 3 to 12 years, were interviewed 1 week and 3 months after the removals. The accuracy of the memory reports was high at both time points, but their consistency was fairly low; in all age groups (3-6, 7-10, and 11-12 years), a high percentage of new accurate information was reported during the second interview and a high percentage of the accurate information reported in the first interview was omitted in the second interview. Older children were significantly more consistent in their memory reports than younger children. The results show that low consistency in memory does not imply memory inaccuracy and has implications for the interpretation of successive interviews of children in forensic contexts.

Inferential false memories of events: negative consequences protect from distortions when the events are free from further elaboration.

The present experiment was conducted to investigate whether negative emotionally charged and arousing content of to-be-remembered scripted material would affect propensity towards memory distortions. We further investigated whether elaboration of the studied material through free recall would affect the magnitude of memory errors. In this study participants saw eight scripts. Each of the scripts included an effect of an action, the cause of which was not presented. Effects were either negatively emotional or neutral. Participants were assigned to either a yes/no recognition test group (recognition), or to a recall and yes/no recognition test group (elaboration + recognition). Results showed that participants in the recognition group produced fewer memory errors in the emotional condition. Conversely, elaboration + recognition participants had lower accuracy and produced more emotional memory errors than the other group, suggesting a mediating role of semantic elaboration on the generation of false memories. The role of emotions and semantic elaboration on the generation of false memories is discussed.

Neuropsychological mechanisms of social difficulties in disruptive mood dysregulation disorder versus oppositional defiant disorder.

Children with Disruptive Mood Dysregulation Disorder (DMDD) or Oppositional Defiant Disorder (ODD) are characterized by irritability and social difficulties. However, the mechanisms underlying these disorders could be different. This study explores differences in social cognition and executive function (EF) across DMDD and ODD and the influence of these factors and their interaction on social problems in both groups. Children with DMDD (n = 53, Mage = 9.3) or ODD (n = 39, Mage = 9.6) completed neuropsychological tasks measuring social cognition (Theory of Mind and Face-Emotion Recognition) and EF (cognitive flexibility, inhibition, and working memory). Parents reported social problems. More than one-third of the children with DMDD and almost two-thirds of those with ODD showed clear difficulties with Theory of Mind. Most children with DMDD (51-64%) or ODD (67-83%) showed difficulties with EF. In children with DMDD, worse EF (ß = -.36) was associated with more social problems, whereas in children with ODD, better EF (ß = .44) was associated with more social problems. In those with ODD, but not in those with DMDD, the interaction between social cognition and EF contributed to the explained variance of social problems (ß = -1.97). Based on the observed interaction pattern, enhanced EF may lead to increased social problems among children with ODD who also exhibit social cognition difficulties. This study suggests the existence of distinct neuropsychological mechanisms underlying the social issues observed in children with DMDD versus those with ODD.

Disruptive Mood Dysregulation Disorder in a Norwegian Clinical Child Population.

BACKGROUND: Disruptive Mood Dysregulation Disorder was included in DSM-5 to accommodate new research addressing aspects of emotional dysregulation in children suffering from disruptive behavior problems. Despite growing interest in Disruptive Mood Dysregulation Disorder, few studies have looked at prevalence rates in European clinical populations. The primary objective of this study was to examine the prevalence and characteristics associated with Disruptive Mood Dysregulation Disorder in a Norwegian clinical sample. METHODS: The present study assessed children 6-12 years of age referred to a mental health clinic for evaluation and treatment (N = 218, Mage = 9.6, 60.4% boys) and compared those who did and did not meet Disruptive Mood Dysregulation Disorder diagnostic criteria. Diagnoses were determined using K-SADS-PL 2013. Associated difficulties at home and in school were measured by Achenbach Systems of Empirically Based Assessment battery. RESULTS: In this clinical sample, 24% met the diagnostic criteria for Disruptive Mood Dysregulation Disorder. Children with Disruptive Mood Dysregulation Disorder were more likely than those without Disruptive Mood Dysregulation Disorder to be male (77% vs. 55%, p = .008), be living in poverty, have multiple mental health diagnoses (79% vs. 53%, p = .001), and have lower global functioning levels as measured by Children's Global Assessment Scale (range 0-100, M = 47, SD = 8.5 vs. M = 57, SD = 11.4, p=<.001). Finally, parents and teachers of children with Disruptive Mood Dysregulation Disorder reported lower overall competence and adaptive functioning, and higher total symptom load than children with other diagnoses. CONCLUSION: Disruptive Mood Dysregulation Disorder is highly prevalent in a Norwegian clinical sample and displays a high symptom load. Our results are in accordance with similar studies. Consistent findings across the world may support Disruptive Mood Dysregulation Disorder as a valid diagnostic category.

The effects of acute tryptophan depletion on impulsivity and mood in adolescents engaging in non-suicidal self-injury.

OBJECTIVE: Non-suicidal self-injury (NSSI) is associated with impaired emotion regulation and impulsivity. Low serotonin (5-hydroxytryptamine) function is associated with NSSI, impaired emotion regulation and impulsivity. We investigated the effects of experimentally lowered 5-hydroxytryptamine activity, via acute tryptophan depletion (ATD), on impulsive action, reflection impulsivity and mood in female adolescents engaging in NSSI. METHODS: Thirty-two female adolescents engaging in NSSI participated in a parallel group ATD study. Following ATD, impulsive action was assessed using the Continuous Performance Test, Identical Pairs Version. Reflection impulsivity was assessed using the Matching Familiar Figures Test. Mood-lowering was examined using the Profile of Mood States. RESULTS: Following ATD, the participants showed an impulsive response style (as reflected in their low ß) and increased attentional capacity (as reflected in their elevated d'). ATD did not affect reflection impulsivity or mood. CONCLUSIONS: Acute tryptophan depletion caused an impulsive response style and increased attentional capacity. Importantly, the findings suggest that low serotonin function is a vulnerability among female adolescents for engaging in NSSI when in emotional distress.

Children's and adults' memory for emotional pictures: examining age-related patterns using the Developmental Affective Photo System.

Two studies were conducted to examine theoretical questions about children's and adults' memory for emotional visual stimuli. In Study 1, 7- to 9-year-olds and adults (N=172) participated in the initial creation of the Developmental Affective Photo System (DAPS). Ratings of emotional valence, arousal, and complexity were obtained. In Study 2, DAPS pictures were presented to 20 8- to 12-year-olds and 30 adults, followed by a recognition memory test. Children and adults recognized aversive images better than neutral images. Moreover, children and adults recognized high and moderate arousal images more accurately than low arousal images. Adults' memory for neutral images exceeded that of children, but there were no developmental differences in memory for aversive pictures. Theoretical and methodological implications are discussed.

Maltreatment is associated with specific impairments in executive functions: a pilot study.

Child maltreatment is associated with a host of adverse consequences. Few studies exist that map maltreated children's performance on neurocognitive tests particularly sensitive to brain and behavior associations. The aim of the present study was to investigate whether maltreated children differed in their executive functioning compared to their nonmaltreated peers, and if they did so in specific ways. Tasks aimed at measuring set shifting, spatial working memory, and inhibition were administered. Trauma-related symptomatology was further assessed to study the potential effect of maltreatment-related psychopathology on executive functioning. A univariate analysis of variance showed that maltreated children (n = 21) performed significantly poorer compared to their nonmaltreated peers (n = 22) on the Spatial Working Memory task. Symptoms of trauma-related psychopathology were not associated with performance on the executive functions tests. In conclusion, maltreatment was not associated with a global deficit in children's executive functions. Thus, when considering maltreated children's cognitive functioning, specific measures of executive functions should be applied.

Children's memories of removal: a test of attachment theory.

We report a study of parents' attachment orientations and children's autobiographical memory for an experience that according to Bowlby's (1982) attachment theory should be particularly threatening-children's forced separation from their parents. It was hypothesized that individual differences in parents' attachment orientations would be associated with children's distress and memory for this highly traumatic event. Children (n = 28) were observed during forced removal from home or school by Child Protective Services due to allegations of child maltreatment. Children's memory for the removal was tested 1 week later, and biological parents (n = 28) completed an adult attachment measure. Parental attachment anxiety significantly predicted children's distress during less stressful phases of the removal, R(2) = .25, and parents' attachment-related avoidance predicted fewer correct memory reports from the children (i.e., fewer hits to open-ended questions, R(2) = .16, and fewer hits to direct questions, R(2) = .27). The findings indicate that attachment theory provides important guidance for understanding children's autobiographical memory for traumatic events.

Excessive hair cortisol concentration as an indicator of psychological disorders in children.

Cortisol in hair is a new biomarker assessing long-term hypothalamic-pituitary-adrenal (HPA) axis activity, which is related to emotion regulation. We compare hair cortisol concentrations (HCC), in clinically referred children with disruptive mood dysregulation disorder (DMDD) (n = 19), children with other types of psychological disorders (n = 48), and healthy subjects (n = 36). We also investigate the association between HCC and irritability, age, and sex. Our results show that children with DMDD or other types of psychological disorders have higher HCC than healthy subjects, p < .001, ηp2 = .39. No difference between children with DMDD and those with other types of psychological disorders was found, p = .91, nor an association between HCC and irritability in the clinical sample, p = .32. We found a significant negative correlation between HCC and age in those with DMDD, r = -0.54, p < .05, but not in the normative sample, r = -0.20, p = .25. No differences in HCC between girls and boys were found in the normative sample, p = .49. Children in need of psychological treatment, including those with DMDD, seem to have dysregulated HPA-axis activity over time. Excessive accumulated cortisol concentrations in hair could be an indicator of a psychological disorder in children.

Infant behavioural effects of smartphone interrupted parent-infant interaction.

Infants are vulnerable to changes in the dyadic synchrony with their caregivers, as demonstrated in numerous experiments employing the still-face paradigm. The sudden lack of attunement causes infant stress reactions and the still-face literature have suggested potential long-term costs of this in terms of development of social, emotional and cognitive skills. Acknowledging the rapid technological development accompanied by altered practices in the parent-infant interaction, the current study investigates infant behavioural reactions in a similar experimental paradigm, manipulating parental responsiveness and sensitivity in a slightly different manner. In the current study, the parent interrupts the ongoing interaction, simulating occupation with a smartphone, rather than making a 'still-face'. In a cross-sectional design, infants of six, nine and twelve months display increased levels of protest behaviour in response to the interrupted interaction with their parent, together with lowered levels of positive engagement and social monitoring, suggesting similar behavioural responses as the still-face effect. Implications for infant social and emotional development, as well as for mindful tech habits are discussed.

Underlying mechanisms of disruptive mood dysregulation disorder in children: A systematic review by means of research domain criteria.

Background: A systematic overview of underlying mechanisms in the new disruptive mood dysregulation disorder (DMDD) diagnosis is needed. The Research Domain Criteria (RDoC) represent a system of six domains of human functioning, which aims to structure the understanding of the nature of mental illnesses. By means of the RDoC framework, the objective of this systematic review is to synthesize available data on children and youths <18 years suffering from DMDD as reported in peer reviewed papers. Methods: A literature search guided by PRISMA was conducted using Medline, PsychInfo, and Embase, while the RDoC domains were employed to systematize research findings. Risk of bias in the included studies was examined. Results: We identified 319 studies. After study selection, we included 29 studies. Twenty-one of these had findings relating to >1 RDoC domain. The risk of bias assessment shows limitations in the research foundation of current knowledge on mechanisms of DMDD. Discussion: Reviewing self-report, behavior and neurocircuit findings by means of RDoC domains, we suggest that DMDD youths have a negative interpretation bias in social processes and valence systems. In occurrence of a negative stimuli interpretation, aberrant cognitive processing may arise. However, current knowledge of DMDD is influenced by lack of sample diversity and open science practices. Conclusion: We found the six RDoC domains useful in structuring current evidence of the underlying mechanisms of DMDD. Important opportunities for future studies in this field of research are suggested. In clinical practice, this comprehensive summary on DMDD mechanisms can be used in psychoeducation and treatment plans.