Multi-modal assessment of reward functioning in adolescent anhedonia.

BACKGROUND: Anhedonia is a core symptom of depression that predicts worse treatment outcomes. Dysfunction in neural reward circuits is thought to contribute to anhedonia. However, whether laboratory-based assessments of anhedonia and reward-related neural function translate to adolescents' subjective affective experiences in real-world contexts remains unclear. METHODS: We recruited a sample of adolescents (n = 82; ages 12-18; mean = 15.83) who varied in anhedonia and measured the relationships among clinician-rated and self-reported anhedonia, behaviorally assessed reward learning ability, neural response to monetary reward and loss (as assessed with functional magnetic resonance imaging), and repeated ecological momentary assessment (EMA) of positive affect (PA) and negative affect (NA) in daily life. RESULTS: Anhedonia was associated with lower mean PA and higher mean NA across the 5-day EMA period. Anhedonia was not related to impaired behavioral reward learning, but low PA was associated with reduced nucleus accumbens response during reward anticipation and reduced medial prefrontal cortex (mPFC) response during reward outcome. Greater mean NA was associated with increased mPFC response to loss outcome. CONCLUSIONS: Traditional laboratory-based measures of anhedonia were associated with lower subjective PA and higher subjective NA in youths' daily lives. Lower subjective PA and higher subjective NA were associated with decreased reward-related striatal functioning. Higher NA was also related to increased mPFC activity to loss. Collectively, these findings demonstrate that laboratory-based measures of anhedonia translate to real-world contexts and that subjective ratings of PA and NA may be associated with neural response to reward and loss.

Mental health and clinical psychological science in the time of COVID-19: Challenges, opportunities, and a call to action.

COVID-19 presents significant social, economic, and medical challenges. Because COVID-19 has already begun to precipitate huge increases in mental health problems, clinical psychological science must assert a leadership role in guiding a national response to this secondary crisis. In this article, COVID-19 is conceptualized as a unique, compounding, multidimensional stressor that will create a vast need for intervention and necessitate new paradigms for mental health service delivery and training. Urgent challenge areas across developmental periods are discussed, followed by a review of psychological symptoms that likely will increase in prevalence and require innovative solutions in both science and practice. Implications for new research directions, clinical approaches, and policy issues are discussed to highlight the opportunities for clinical psychological science to emerge as an updated, contemporary field capable of addressing the burden of mental illness and distress in the wake of COVID-19 and beyond. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Social and Non-social Reward Processing and Depressive Symptoms Among Sexual Minority Adolescents.

Sexual minority adolescents (SMA) are more likely to suffer from depression, putatively through experiences of social stress and victimization interfering with processing of social reward. Alterations in neural reward networks, which develop during adolescence, confer risk for the development of depression. Employing both social and monetary reward fMRI tasks, this is the first neuroimaging study to examine function in reward circuitry as a potential mechanism of mental health disparities between SMA and heterosexual adolescents. Eight SMA and 38 heterosexual typically developing adolescents completed self-report measures of depression and victimization, and underwent fMRI during monetary and peer social reward tasks in which they received positive monetary or social feedback, respectively. Compared with heterosexual adolescents, SMA had greater interpersonal depressive symptoms and exhibited blunted neural responses to social, but not monetary, reward in socioaffective processing regions that are associated with depressive symptoms. Specifically, compared with heterosexual adolescents, SMA exhibited decreased activation in the right medial prefrontal cortex, left anterior insula (AI), and right temporoparietal junction (TPJ) in response to being liked. Lower response in the right TPJ was associated with greater interpersonal depressive symptoms. These results suggest that interpersonal difficulties and the underlying substrates of response to social reward (perhaps more so than response to monetary reward) may confer risk for development of depressive symptoms in SMA.

Antisocial behavior with callous-unemotional traits is associated with widespread disruptions to white matter structural connectivity among low-income, urban males.

Antisocial behavior (AB), including violence, criminality, and substance abuse, is often linked to deficits in emotion processing, reward-related learning, and inhibitory control, as well as their associated neural networks. To better understand these deficits, the structural connections between brain regions implicated in AB can be examined using diffusion tensor imaging (DTI), which assesses white matter microstructure. Prior studies have identified differences in white matter microstructure of the uncinate fasciculus (UF), primarily within offender samples. However, few studies have looked beyond the UF or determined whether these relationships are present dimensionally across the range of AB and callous-unemotional (CU) traits. In the current study, we examined associations between AB and white matter microstructure from major fiber tracts, including the UF. Further, we explored whether these associations were specific to individuals high on CU traits. Within a relatively large community sample of young adult men from low-income, urban families (N = 178), we found no direct relations between dimensional, self-report measures of either AB or CU traits and white matter microstructure. However, we found significant associations between AB and white matter microstructure of several tracts only for those with high co-occurring levels of CU traits. In general, these associations did not differ according to race, socioeconomic status, or comorbid psychiatric symptoms. The current results suggest a unique neural profile of severe AB in combination with CU traits, characterized by widespread differences in white matter microstructure, which differs from either AB or CU traits in isolation and is not specific to hypothesized tracts (i.e., the UF).

Help me Feel Better! Ecological Momentary Assessment of Anxious Youths' Emotion Regulation with Parents and Peers.

Anxious youth often have trouble regulating negative affect (NA) and tend to over-rely on parents when faced with challenges. It is unclear how social interactions with parents or peers actually helps or hinders anxious youths' success in regulating NA. The aim of this study was to examine whether the success of anxious youths' emotion regulation strategies differed according to social context. We compared the effectiveness of co-ruminating, co-problem solving and co-distracting with parents/peers for regulating anxious youth's NA in response to stress in their daily lives. We also examined the benefit of attempting each strategy socially vs. non-socially (e.g., co-ruminating vs. ruminating). One-hundred-seventeen youth (9-14) with a current diagnosis of Separation Anxiety Disorder, Generalized Anxiety Disorder, and/or Social Phobia completed an ecological momentary assessment (14 calls over 5 days), reporting on recent stressors, their affective state, presence of others, and emotion regulation strategies within the prior hour. Mixed linear models revealed that co-distracting was the most effective social strategy for reducing NA, but only for boys. Co-rumination was the least effective social strategy for regulating NA. Regarding social context, only co-distracting was more effective for regulating NA over distracting alone, but only among anxious boys. Results suggest that co-rumination is an ineffective use of social support for regulating NA. Anxious boys may benefit from social support by co-distracting with parents/peers, but improper use may reflect avoidance and contribute to long-term anxiety maintenance. Results extend research on gender differences in interpersonal relationships and emotion regulation.

Amygdala reactivity as a marker of differential susceptibility to socioeconomic resources during early adulthood.

Models of differential susceptibility hypothesize that neural function may be a marker of differential susceptibility to context, but no studies have tested this hypothesis. Using a sample of 310 young men from low-income urban neighborhoods, this study investigated amygdala reactivity to facial expressions as a moderator of the relations between socioeconomic resources and later antisocial behavior (AB) and income. For individuals with high amygdala reactivity, greater socioeconomic resources at age 20 predicted less AB and greater income at age 22. For young men with low amygdala reactivity, however, socioeconomic resources at age 20 did not predict later outcomes. Amygdala reactivity to fearful facial expressions, key to the etiology of AB, moderated links between resources and AB. In contrast, amygdala reactivity more generally to multiple facial expressions moderated the effects of resources on later income attainment. Both interactions met rigorous quantitative criteria for patterns of differential susceptibility rather than diathesis stress or vantage sensitivity. Moreover, these associations remained significant after inclusion of socioeconomic resources during earlier developmental periods. These results suggest that greater amygdala reactivity to facial expressions is a marker of greater susceptibility to context, for better or for worse, during the transition to adulthood. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Reducing Risk for Substance Use by Economically Disadvantaged Young Men: Positive Family Environments and Pathways to Educational Attainment.

Using prospective, longitudinal data spanning 10 years (age = 10-20) from a study of 295 economically disadvantaged males, the current investigation evaluated a developmental model that links early family environment and later educational aspirations, extracurricular activities, and educational attainment to substance use in early adulthood. The results indicate that a positive family environment during adolescence (low family conflict, high family warmth, and effective child management) predicted educational involvements during adolescence that promoted educational attainment during early adulthood. Finally, higher levels of educational attainment were associated with less substance use in early adulthood, even after controlling for adolescent substance use. These findings suggest that positive parenting promotes educational achievements that increase resilience to substance use for economically disadvantaged males.

Adolescent development of inhibition as a function of SES and gender: Converging evidence from behavior and fMRI.

The ability to adaptively inhibit responses to tempting/distracting stimuli in the pursuit of goals is an essential set of skills necessary for adult competence and wellbeing. These inhibitory capacities develop throughout childhood, with growing evidence of important maturational changes occurring in adolescence. There also has been intense interest in the role of social adversity on the development of executive function, including inhibitory control. We hypothesized that the onset of adolescence could be a time of particular opportunity/vulnerability in the development of inhibition due to the large degree of maturational changes in neural systems involved in regulatory control. We investigated this hypothesis in a longitudinal study of adolescents by examining the impact of socioeconomic status (SES) on the maturation of inhibition and concurrent brain function. Furthermore, we examined gender as a potential moderator of this relationship, given evidence of gender-specificity in the developmental pathways of inhibition as well as sex differences in adolescent development. Results reveal that lower SES is associated with worse behavioral inhibition over time and a concurrent increase in anterior cingulate (ACC) activation, but only in girls. We also found that lower SES girls exhibited decreased ACC ↔ dorsolateral prefrontal cortex (dlPFC) coupling over time. Our findings suggest that female adolescents with lower SES appear to develop less efficient inhibitory processing in dlPFC, requiring greater and relatively unsuccessful compensatory recruitment of ACC. In summary, the present study provides a novel window into the neural mechanisms by which the influence of SES on inhibition may be transmitted during adolescence.

Adolescent girls' neural response to reward mediates the relation between childhood financial disadvantage and depression.

BACKGROUND: Children who experience socioeconomic disadvantage are at heightened risk for developing depression; however, little is known about neurobiological mechanisms underlying this association. Low socioeconomic status (SES) during childhood may confer risk for depression through its stress-related effects on the neural circuitry associated with processing monetary rewards. METHODS: In a prospective study, we examined the relationships among the number of years of household receipt of public assistance from age 5-16 years, neural activation during monetary reward anticipation and receipt at age 16, and depression symptoms at age 16 in 123 girls. RESULTS: Number of years of household receipt of public assistance was positively associated with heightened response in the medial prefrontal cortex during reward anticipation, and this heightened neural response mediated the relationship between socioeconomic disadvantage and current depression symptoms, controlling for past depression. CONCLUSIONS: Chronic exposure to socioeconomic disadvantage in childhood may alter neural circuitry involved in reward anticipation in adolescence, which in turn may confer risk for depression.

Developmental pathways to sexual risk behavior in high-risk adolescent boys.

OBJECTIVE: Adolescent boys' involvement in pregnancy and sexual risk behavior is a public health concern. Although research has identified predictors of sexual risk behavior during adolescence, few studies have investigated precursors to boys' sexual risk behavior beginning in early childhood, the identification of which could serve to inform interventions and help reduce involvement in pregnancy. Our goal was to identify early developmental pathways associated with sexual risk behavior in a sample of low-income adolescent boys. METHODS: Data from a prospective longitudinal study in 310 at-risk boys were used to examine externalizing problems, mothers' depressive symptoms, and low-nurturant parenting in early childhood (1.5, 2, and 3.5 years old) and daring, externalizing, parental monitoring, and deviant peer affiliation during emerging adolescence (11 and 12 years old) as precursors of sexual risk behavior between the ages 15 and 20 years. Structural equation modeling was used to explore pathways associated with later high-risk sexual behavior (HRSB). RESULTS: In multivariate analyses, adolescent daring and deviant peer affiliation at age 12 were associated with later HRSB. Furthermore, deviant peer affiliation during emerging adolescence mediated the relationship between mothers' depressive symptoms and nurturant parenting during early childhood and later adolescent HRSB. CONCLUSIONS: Family-based risk factors in early childhood are predictive of HRSB in adolescence but are also influenced, and in some cases mediated, by relationships with peers and child characteristics during emerging adolescence.

Parsing dimensional vs diagnostic category-related patterns of reward circuitry function in behaviorally and emotionally dysregulated youth in the Longitudinal Assessment of Manic Symptoms study.

IMPORTANCE: Pediatric disorders characterized by behavioral and emotional dysregulation pose diagnostic and treatment challenges because of high comorbidity, suggesting that they may be better conceptualized dimensionally rather than categorically. Identifying neuroimaging measures associated with behavioral and emotional dysregulation in youth may inform understanding of underlying dimensional vs disorder-specific pathophysiologic features. OBJECTIVE: To identify, in a large cohort of behaviorally and emotionally dysregulated youth, neuroimaging measures that (1) are associated with behavioral and emotional dysregulation pathologic dimensions (behavioral and emotional dysregulation measured with the Parent General Behavior Inventory 10-Item Mania Scale [PGBI-10M], mania, depression, and anxiety) or (2) differentiate diagnostic categories (bipolar spectrum disorders, attention-deficit/hyperactivity disorder, anxiety, and disruptive behavior disorders). DESIGN, SETTING, AND PARTICIPANTS: A multisite neuroimaging study was conducted from February 1, 2011, to April 15, 2012, at 3 academic medical centers: University Hospitals Case Medical Center, Cincinnati Children's Hospital Medical Center, and University of Pittsburgh Medical Center. Participants included a referred sample of behaviorally and emotionally dysregulated youth from the Longitudinal Assessment of Manic Symptoms (LAMS) study (n = 85) and healthy youth (n = 20). MAIN OUTCOMES AND MEASURES: Region-of-interest analyses examined relationships among prefrontal-ventral striatal reward circuitry during a reward paradigm (win, loss, and control conditions), symptom dimensions, and diagnostic categories. RESULTS: Regardless of diagnosis, higher PGBI-10M scores were associated with greater left middle prefrontal cortical activity (r = 0.28) and anxiety with greater right dorsal anterior cingulate cortical (r = 0.27) activity to win. The 20 highest (t = 2.75) and 20 lowest (t = 2.42) PGBI-10M-scoring youth showed significantly greater left middle prefrontal cortical activity to win compared with 20 healthy youth. Disruptive behavior disorders were associated with lower left ventrolateral prefrontal cortex activity to win (t = 2.68) (all P < .05, corrected). CONCLUSIONS AND RELEVANCE: Greater PGBI-10M-related left middle prefrontal cortical activity and anxiety-related right dorsal anterior cingulate cortical activity to win may reflect heightened reward sensitivity and greater attention to reward in behaviorally and emotionally dysregulated youth regardless of diagnosis. Reduced left ventrolateral prefrontal cortex activity to win may reflect reward insensitivity in youth with disruptive behavior disorders. Despite a distinct reward-related neurophysiologic feature in disruptive behavior disorders, findings generally support a dimensional approach to studying neural mechanisms in behaviorally and emotionally dysregulated youth.

Comparisons across depression assessment instruments in adolescence and young adulthood: an item response theory study using two linking methods.

Item response theory (IRT) methods allow for comparing the utility of instruments based on the range and precision of severity assessed by each instrument. As adolescents and young adults can display rapid increases in depressive symptoms, there is a crucial need to sensitively assess mild elevations of symptoms (as an index of initial risk) and moderate-severe symptoms (as an indicator of treatment disposition). We compare the information assessed by the Beck Depression Inventory (BDI) to the newly developed Patient Reported Outcome Measurement Information System - Depression measure (PROMIS-Depression), and the Center for Epidemiologic Studies - Depression (CES-D) scale. The present work is based on data from two fully independent samples of community adolescents and young adults. One sample completed the BDI and CES-D (n = 1,482) and the second sample (n = 673) completed the PROMIS-Depression measure and the CES-D. Using two different IRT-based linking methods, (1) equating based on common items and (2) concurrent calibration methods, analyses revealed that the PROMIS-Depression measure assessed information over the widest range of depressive severity with greatest measurement precision relative to the other instruments. This was true for both the 28-item and 8-item versions of the PROMIS-Depression measure. Findings suggest that the PROMIS-Depression measure assessed depression severity with greatest precision and over the widest severity range of the assessed instruments. However, future work is necessary to demonstrate that the PROMIS-Depression measure has reliable associations with external criteria and is sensitive to treatment response.

Real-world affect and social context as predictors of treatment response in child and adolescent depression and anxiety: an ecological momentary assessment study.

OBJECTIVE: Response to treatment in child and adolescent affective disorders is variable, with limited ability of any one treatment to improve outcome across patients. Unfortunately, we know little about the factors that explain this variability in treatment response. Individual differences in the social and affective dynamics of daily life could help to elucidate the characteristics of youth who respond to treatment. METHODS: We used ecological momentary assessment of negative affect, positive affect, and companions in natural settings over 4 days in a sample of young people with depressive and anxiety disorders who participated in an 8-week open trial of cognitive behavioral therapy (CBT), selective serotonin reuptake inhibitors (SSRIs), or a combination of the two. Clinicians rated participants' clinical severity at five time points, and participants reported their symptoms before and after treatment. Latent growth curve models were used to predict rate of change in clinical severity from pretreatment affect in natural settings. RESULTS: Participants with high positive affect (PA), low negative affect (NA), and a high PA:NA ratio at baseline had lower severity, depressive symptoms, and anxiety symptoms at the end of treatment. Lower posttreatment symptoms were associated with spending more time with fathers and less time with peers before treatment. Although baseline affect was not associated with initial symptom severity, high NA and low PA:NA at baseline were related to slower rate of decline of severity during treatment. When baseline symptoms were included in models, NA and PA:NA predicted rate of decline in severity during treatment, whereas self-reported depressive and anxiety symptoms at baseline did not. CONCLUSION: A more typical profile of baseline affective functioning in natural settings-that is, lower NA and higher PA-and time with fathers, could provide a foundation for treatment response in children and adolescents. Affective and social dynamics in natural settings could ultimately help investigate which young people might benefit from current treatments.

Emotional reactivity and regulation in anxious and nonanxious youth: a cell-phone ecological momentary assessment study.

BACKGROUND: Reviews have highlighted anxious youths' affective disturbances, specifically, elevated negative emotions and reliance on ineffective emotion regulation strategies. However, no study has examined anxious youth's emotional reactivity and regulation in real-world contexts. METHODS: This study utilized an ecological momentary assessment approach to compare real-world emotional experiences of 65 youth with generalized anxiety disorder, social anxiety disorder, or social phobia (ANX) and 65 age-matched healthy controls (CON), ages 9-13 years. RESULTS: Hierarchical linear models revealed that ANX reported higher levels of average past-hour peak intensity of nervous, sad and upset emotions than CON youth but similar levels during momentary reports of current emotion. As expected, ANX youth reported more frequent physiological reactions in response to a negative event; however, there were no group differences in how frequently they used cognitive-behavioral strategies. Avoidance, distraction and problem solving were associated with the down-regulation of all negative emotions except nervousness for both ANX and CON youth; however, group differences emerged for acceptance, rumination and physiological responding. CONCLUSIONS: In real-world contexts, ANX youth do not report higher levels of momentary negative emotions but do report heightened negative emotions in response to challenging events. Moreover, ANX youth report no differences in how frequently they use adaptive regulatory strategies but are more likely to have physiological responses to challenging events. They are also less effective at using some strategies to down-regulate negative emotion than CON youth.

Daily emotional dynamics in depressed youth: a cell phone ecological momentary assessment study.

This study used a new cell phone ecological momentary assessment approach to investigate daily emotional dynamics in 47 youths with major depressive disorder (MDD) and 32 no-psychopathology controls (CON) (ages 7-17 years). Information about emotional experience in the natural environment was obtained using answer-only cell phones, while MDD youths received an 8-week course of cognitive behavioral therapy and/or psychopharmacological treatment. Compared with CON youths, MDD youths reported more intense and labile global negative affect; greater sadness, anger, and nervousness; and a lower ratio of positive to negative affect. These differences increased with pubertal maturation. MDD youths spent more time alone and less time with their families than CON youths. Although differences in emotional experiences were found across social contexts, MDD youths were more negative than CON youths in all contexts examined. As the MDD participants progressed through treatment, diagnostic group differences in the intensity and lability of negative affect decreased, but there were no changes in the ratio of positive to negative affect or in measures of social context. We discuss methodological innovations and advantages of this approach, including improved ecological validity and access to information about variability in emotions, change in emotions over time, the balance of positive and negative emotions, and the social context of emotional experience.