A Pilot Randomized Controlled Trial of the Family Assessment and Feedback Intervention (FAFI): Effects on Mental Health Literacy and Attitudinal Engagement with Health Supports and Services.

This randomized controlled trial tested the Family Assessment and Feedback Intervention (FAFI), a new intervention to enhance family engagement with emotional and behavioral health services. The FAFI is a guided conversation with families about results of their multidimensional assessment that is set in the context of motivational enhancement. It differs from other assessment-with-feedback interventions by extending the focus of assessment beyond the target child to parents and the family environment, addressing parental emotional and behavioral problems and competencies, spanning a broad range of children's and parents' strengths and difficulties, and being generalizable to many settings and practitioners. Participants were 81 families in primary care pediatrics. The FAFI was associated with a significant increase in parental mental health literacy and with an increase in parental attitudinal engagement with health supports and services that closely approached statistical significance (p = .052), while controlling for children's age and gender and family socioeconomic status.

The Potential of Real-Time Behavior and Well-Being Assessments to Improve Medical Student Wellness.

PROBLEM: Medical students experience psychological distress more frequently than age-matched peers. Tracking medical student well-being has typically been limited to once- or twice-per-year questionnaires. Ongoing, real-time assessment of student behavior and well-being could facilitate individualized, timely interventions. APPROACH: Faculty at the University of Vermont, in conjunction with the Larner College of Medicine Office of Medical Education, developed a novel smartphone app in 2021 called WE MD to track and support medical student wellness. The app included the following features: (1) nightly surveys assessing wellness-related behaviors (e.g., social interaction, sleep, exercise) and outcomes (i.e., mood, focus, stress, overall well-being); (2) health reports that enabled users to graph various combinations of their own behaviors and outcomes, allowing them to visualize trends and understand possible correlations between behaviors and outcomes; (3) a resource library with articles and educational videos related to specific wellness behaviors or outcomes; and (4) research-based "insights" or brief tips intended to promote healthy habits. Participants also received virtual "coins" for interacting with the app that could be exchanged for various items in an online store. OUTCOMES: The WE MD program enrolled a substantial portion of the medical school population (43%); most of the students used the app on a regular basis. Students found the app to be acceptable and appreciated many features and also provided feedback on how to improve the app. Information from the nightly survey data converged with established measures but also identified variability over time in wellness behaviors and outcomes. NEXT STEPS: Data from the WE MD program suggest that app-based daily tracking of wellness behaviors and outcomes is a feasible, promising approach to promote student wellness and identify real-time patterns and risk periods for medical students. The app will be revised based on student feedback and adapted for use by students, residents, and faculty.

Ice hockey summit II: zero tolerance for head hits and fighting.

OBJECTIVE: To present currently known basic science and on-ice influences of sport related concussion (SRC) in hockey, building upon the Ice Hockey Summit I action plan (2011) to reduce SRC. METHODS: The prior summit proceedings included an action plan intended to reduce SRC. As such, the proceedings from Summit I served as a point of departure, for the science and discussion held during Summit II (Mayo Clinic, Rochester MN, October, 2013). Summit II focused on Basic Science of Concussions in Ice Hockey: Taking Science Forward; (2) Acute and Chronic Concussion Care: Making a Difference; (3) Preventing Concussions via Behavior, Rules, Education and Measuring Effectiveness; (4) Updates in Equipment: their Relationship to Industry Standards and (5) Policies and Plans at State, National and Federal Levels to reduce SRC. Action strategies derived from the presentations and discussion described in these sectors were subsequently voted on for purposes of prioritization. The following proceedings include the knowledge and research shared by invited faculty, many of whom are health care providers and clinical investigators. RESULTS: The Summit II evidence based action plan emphasizes the rapidly evolving scientific content of hockey SRC. It includes the most highly prioritized strategies voted on for implementation to decrease concussion. CONCLUSIONS: The highest priority action items identified from the Summit include: 1) eliminate head hits from all levels of ice hockey, 2) change body checking policies, and 3) eliminate fighting in all amateur and professional hockey.

Cortical thickness maturation and duration of music training: health-promoting activities shape brain development.

OBJECTIVE: To assess the extent to which playing a musical instrument is associated with cortical thickness development among healthy youths. METHOD: Participants were part of the National Institutes of Health (NIH) Magnetic Resonance Imaging (MRI) Study of Normal Brain Development. This study followed a longitudinal design such that participants underwent MRI scanning and behavioral testing on up to 3 separate visits, occurring at 2-year intervals. MRI, IQ, and music training data were available for 232 youths (334 scans), ranging from 6 to 18 years of age. Cortical thickness was regressed against the number of years that each youth had played a musical instrument. Next, thickness was regressed against an "Age × Years of Playing" interaction term. Age, gender, total brain volume, and scanner were controlled for in analyses. Participant ID was entered as a random effect to account for within-person dependence. False discovery rate correction was applied (p ≤ .05). RESULTS: There was no association between thickness and years playing a musical instrument. The "Age × Years of Playing" interaction was associated with thickness in motor, premotor, and supplementary motor cortices, as well as prefrontal and parietal cortices. Follow-up analysis revealed that music training was associated with an increased rate of thickness maturation. Results were largely unchanged when IQ and handedness were included as covariates. CONCLUSION: Playing a musical instrument was associated with more rapid cortical thickness maturation within areas implicated in motor planning and coordination, visuospatial ability, and emotion and impulse regulation. However, given the quasi-experimental nature of this study, we cannot rule out the influence of confounding variables.

Does early mentorship in child and adolescent psychiatry make a difference? The Klingenstein Third-Generation Foundation Medical Student Fellowship Program.

OBJECTIVE: There is a critical shortage of child and adolescent psychiatrists in the United States. Increased exposure, through mentorship, clinical experiences, and research opportunities, may increase the number of medical students selecting child and adolescent psychiatry (CAP) as a career choice. METHOD: Between 2008 and 2011, 241 first-year participants of a program to increase exposure to CAP, funded by the Klingenstein Third-Generation Foundation (KTGF) at 10 medical schools completed baseline surveys assessing their opinions of and experiences in CAP, and 115 second-year participants completed follow-up surveys to reflect 1 year of experience in the KTGF Program. RESULTS: Students reported significantly increased positive perception of mentorship for career and research guidance, along with perceived increased knowledge and understanding of CAP. CONCLUSIONS: Results suggest that the KTGF Program positively influenced participating medical students, although future studies are needed to determine whether these changes will translate into more medical students entering the field of CAP.

Can genetics help psychometrics? Improving dimensionality assessment through genetic factor modeling.

In the present article, we discuss the role that quantitative genetic methodology may play in assessing and understanding the dimensionality of psychological (psychometric) instruments. Specifically, we study the relationship between the observed covariance structures, on the one hand, and the underlying genetic and environmental influences giving rise to such structures, on the other. We note that this relationship may be such that it hampers obtaining a clear estimate of dimensionality using standard tools for dimensionality assessment alone. One situation in which dimensionality assessment may be impeded is that in which genetic and environmental influences, of which the observed covariance structure is a function, differ from each other in structure and dimensionality. We demonstrate that in such situations settling dimensionality issues may be problematic, and propose using quantitative genetic modeling to uncover the (possibly different) dimensionalities of the underlying genetic and environmental structures. We illustrate using simulations and an empirical example on childhood internalizing problems.

Twins, tissue, and time: an assessment of SNPs and CNVs.

With the desire to assess genetic variation across the lifespan in large-scale collaborative projects, one question is whether inference of copy number (CN) is sensitive to the source of material for deoxyribonucleic acid (DNA) analysis (e.g., blood and buccal) and another question is whether CN is stable as individual sage. Here, we address these questions by applying Affymetrix 6.0 single nucleotide polymorphism (SNP)micro-arrays to 1,472 DNA samples from 710 individuals from the Netherlands Twin Register, including twin and non-twin individuals (372 with buccal and blood derived DNA and 388 with longitudinal data).Similar concordance for CN and genotype inference between samples from the same individual [or from the monozygotic (MZ) co-twins] was found for blood and buccal tissues. There was a small but statistically significant decrease in across-tissue concordance compared with concordance of samples from the same tissue type. No temporal effect was seen on CN variation from the 388 individuals sampled at two time points ranging from 1 to 12 years apart. The majority of our individuals were sampled at age younger than 20 years. Genotype concordance was very high (~ > 99%) between co-twins from 43 MZ pairs. For75 dizygotic (DZ) pairs, ~was ~65%. CN estimates were highly consistent between co-twins from MZ pairs for both deletions (f?2 ~ 90%) and duplications (~ ~ 86%). For DZ, these were similar for within-individual comparisons, but naturally lower between co-twins (~ ~ 50-60%). These results suggest that DNA from buccal samples perform as well as DNA from blood samples on the current generation of micro-array technologies.

Adolescent personality profiles, neighborhood income, and young adult alcohol use: a longitudinal study.

Personality traits and socioeconomic factors such as neighborhood income have been identified as risk factors for future alcohol abuse, but findings have been inconsistent possibly due to interactions between risk and protective factors. The present study examined the prediction of drinking behavior using empirically derived multi-trait patterns and tested for moderation by average neighborhood income. Using latent profile analysis (LPA) in a sample of 863 Dutch adolescents, four empirical personality profiles based on 6 traits were observed: Extraverted, Dysregulated, Neurotic, and Regulated. Dysregulated and Extraverted youth drank higher quantities of alcohol more frequently in young adulthood relative to the Regulated group, above and beyond the effects of baseline adolescent drinking, age, and sex. Profile levels of neuroticism did not appear to affect drinking behavior. Average neighborhood income did not moderate adolescent personality and young adult drinking. These findings suggest that future alcohol research should consider individual trait patterns to inform prevention and intervention efforts, and theories implicating both positive and negative emotionality traits as risk factors for drinking are preferable to those emphasizing the importance of the latter.

Assessment of dysregulated children using the Child Behavior Checklist: a receiver operating characteristic curve analysis.

Disorders of self-regulatory behavior are common reasons for referral to child and adolescent clinicians. Here, the authors sought to compare 2 methods of empirically based assessment of children with problems in self-regulatory behavior. Using parental reports on 2,028 children (53% boys) from a U.S. national probability sample of the Child Behavior Checklist (CBCL; T. M. Achenbach & L. A. Rescorla, 2001), the receiver operating characteristic curve analysis was applied to compare scores on the Posttraumatic Stress Problems Scale (PTSP) of the CBCL with the CBCL Dysregulation Profile (DP), identified using latent class analysis of the Attention Problems, Aggressive Behavior, and Anxious/Depressed scales of the CBCL. The CBCL-PTSP score demonstrated an area under the curve of between .88 and .91 for predicting membership in the CBCL-DP profile for boys and for girls. These findings suggest that the CBCL-PTSP, which others have shown does not uniquely identify children who have been traumatized, does identify the same profile of behavior as the CBCL-DP. Therefore, the authors recommend renaming the CBCL-PTSP the Dysregulation Short Scale and provide some guidelines for the use of the CBCL-DP scale and the CBCL-PTSP in clinical practice.

Assessment of motor milestones in twins.

The aim of this study was to investigate the reliability of obtaining through mailed surveys maternal reports of specific major motor milestones achievement. To accomplish this aim we compared and contrasted mailed survey data and telephone interview data on a series of questions about age at which motor milestones were achieved. We used monthly telephone interviews with mothers of 238 twin pairs, beginning at age 6 months, which ascertained the age at which each specific milestone was met. The contrasting 'through the mail' survey was sent after the second birthday of an independent group of children, and included 463 twin pairs. All twins were born between March 2003 and March 2004. Comparisons were made for the following 5 milestones: sitting without support, hands and knees crawling, turning from back to belly, standing without support, and walking without support. There was no difference between the concurrent telephone interviews and the retrospective through the mail survey on any of the landmarks, except 'standing without support'. From this work we conclude that data on achieving milestones can be reliably obtained through the mail using retrospective surveys when the children are 2 years of age.

Multi-informant assessment of temperament in children with externalizing behavior problems.

We examined the criterion validity of parent and self-report versions of the Junior Temperament and Character Inventory (JTCI) in children with high levels of externalizing problems. The sample included 412 children (206 participants and 206 siblings) participating in a family study of attention and aggressive behavior problems. Criterion validity analyses included (a) correlations between temperament scales and emotional and behavioral scales and (b) correlations between temperament and intelligence and achievement scales. Temperament scales displayed strong convergent and discriminant validity. Across informants and samples, JTCI scales assessing novelty seeking and harm avoidance discriminated between internalizing and externalizing problems. Reward dependence, persistence, cooperativeness, and self-directedness displayed similar patterns of negative relations to emotional and behavioral scales and positive relations to intelligence, achievement, and competence.