Developmental deviation in delay discounting as a transdiagnostic indicator of risk for child psychopathology.

BACKGROUND: The tendency to prefer smaller, immediate rewards over larger, delayed rewards is known as delay discounting (DD). Developmental deviations in DD may be key in characterizing psychiatric and neurodevelopmental disorders. Recent work empirically supported DD as a transdiagnostic process in various psychiatric disorders. Yet, there is a lack of research relating developmental changes in DD from mid-childhood to adolescence to psychiatric and neurodevelopmental disorders. Additionally, examining the interplay between socioeconomic status/total household income (THI) and psychiatric symptoms is vital for a more comprehensive understanding of pediatric pathology and its complex relationship with DD. METHODS: The current study addresses this gap in a robust psychiatric sample of 1843 children and adolescents aged 5-18 (M = 10.6, SD = 3.17; 1,219 males, 624 females). General additive models (GAMs) characterized the shape of age-related changes in monetary and food reward discounting for nine psychiatric disorders compared with neurotypical youth (NT; n = 123). Over 40% of our sample possessed a minimum of at least three psychiatric or neurodevelopmental disorders. We used bootstrap-enhanced Louvain community detection to map DD-related comorbidity patterns. We derived five subtypes based on diagnostic categories present in our sample. DD patterns were then compared across each of the subtypes. Further, we evaluated the effect of cognitive ability, emotional and behavioral problems, and THI in relation to DD across development. RESULTS: Higher discounting was found in six of the nine disorders we examined relative to NT. DD was consistently elevated across development for most disorders, except for depressive disorders, with age-specific DD differences compared with NTs. Community detection analyses revealed that one comorbidity subtype consisting primarily of Attention-Deficit/Hyperactivity Disorder (ADHD) Combined Presentation and anxiety disorders displayed the highest overall emotional/behavioral problems and greater DD for the food reward. An additional subtype composed mainly of ADHD, predominantly Inattentive Presentation, learning, and developmental disorders, showed the greatest DD for food and monetary rewards compared with the other subtypes. This subtype had deficits in reasoning ability, evidenced by low cognitive and academic achievement performance. For this ADHD-I and developmental disorders subtype, THI was related to DD across the age span such that participants with high THI showed no differences in DD compared with NTs. In contrast, participants with low THI showed significantly worse DD trajectories than all others. Our results also support prior work showing that DD follows nonlinear developmental patterns. CONCLUSIONS: We demonstrate preliminary evidence for DD as a transdiagnostic marker of psychiatric and neurodevelopmental disorders in children and adolescents. Comorbidity subtypes illuminate DD heterogeneity, facilitating the identification of high-risk individuals. Importantly, our findings revealed a marked link between DD and intellectual reasoning, with children from lower-income households exhibiting lower reasoning skills and heightened DD. These observations underscore the potential consequences of compromised self-regulation in economically disadvantaged individuals with these disorders, emphasizing the need for tailored interventions and further research to support improved outcomes.

Children with attention-deficit/hyperactivity disorder spend more time in hyperconnected network states and less time in segregated network states as revealed by dynamic connectivity analysis.

Previous studies in children with attention-deficit/hyperactivity disorder (ADHD) have observed functional brain network disruption on a whole-brain level, as well as on a sub-network level, particularly as related to the default mode network, attention-related networks, and cognitive control-related networks. Given behavioral findings that children with ADHD have more difficulty sustaining attention and more extreme moment-to-moment fluctuations in behavior than typically developing (TD) children, recently developed methods to assess changes in connectivity over shorter time periods (i.e., "dynamic functional connectivity"), may provide unique insight into dysfunctional network organization in ADHD. Thus, we performed a dynamic functional connectivity (FC) analysis on resting state fMRI data from 38 children with ADHD and 79 TD children. We used Hidden semi-Markov models (HSMMs) to estimate six network states, as well as the most probable sequence of states for each participant. We quantified the dwell time, sojourn time, and transition probabilities across states. We found that children with ADHD spent less total time in, and switched more quickly out of, anticorrelated states involving the default mode network and task-relevant networks as compared to TD children. Moreover, children with ADHD spent more time in a hyperconnected state as compared to TD children. These results provide novel evidence that underlying dynamics may drive the differences in static FC patterns that have been observed in ADHD and imply that disrupted FC dynamics may be a mechanism underlying the behavioral symptoms and cognitive deficits commonly observed in children with ADHD.

Computerized Assessment of Motor Imitation as a Scalable Method for Distinguishing Children With Autism.

BACKGROUND: Imitation deficits are prevalent in autism spectrum conditions (ASCs) and are associated with core autistic traits. Imitating others' actions is central to the development of social skills in typically developing populations, as it facilitates social learning and bond formation. We present a Computerized Assessment of Motor Imitation (CAMI) using a brief (1-min), highly engaging video game task. METHODS: Using Kinect Xbox motion tracking technology, we recorded 48 children (27 with ASCs, 21 typically developing) as they imitated a model's dance movements. We implemented an algorithm based on metric learning and dynamic time warping that automatically detects and evaluates the important joints and returns a score considering spatial position and timing differences between the child and the model. To establish construct validity and reliability, we compared imitation performance measured by the CAMI method to the more traditional human observation coding (HOC) method across repeated trials and two different movement sequences. RESULTS: Results revealed poorer imitation in children with ASCs than in typically developing children (ps < .005), with poorer imitation being associated with increased core autism symptoms. While strong correlations between the CAMI and HOC methods (rs = .69-.87) confirmed the CAMI's construct validity, CAMI scores classified the children into diagnostic groups better than the HOC scores (accuracyCAMI = 87.2%, accuracyHOC = 74.4%). Finally, by comparing repeated movement trials, we demonstrated high test-retest reliability of CAMI (rs = .73-.86). CONCLUSIONS: Findings support the CAMI as an objective, highly scalable, directly interpretable method for assessing motor imitation differences, providing a promising biomarker for defining biologically meaningful ASC subtypes and guiding intervention.

Stimulant dosage and age, race, and insurance type in a sample of children with attention-deficit/hyperactivity disorder.

OBJECTIVE: The aim of this study was to examine the association of age, race, insurance, and other factors with the prescription of stimulant medications. METHODS: A retrospective chart review was conducted on 242 subjects, 4.8-19.8 years of age, treated in an urban referral center with a stable dose of stimulant medication for at least 6 months. Subjects were predominantly male (74.8%), African-American (52.9%), and insured by Medicaid (71.0%). The effects of age, race, insurance, gender, cognitive level, additional psychopharmacologic medications, and other factors on prescribed total daily dose (mg/day) and dose by weight (mg/kg/dose) were examined. RESULTS: Race and insurance type together were associated with specific patterns of stimulant dosage, with higher dosing seen in Medicaid-insured non-African-American children and in privately insured African-American children. Total daily dose increased with age; however, there was an inverse relationship between age and dose by weight. There were no significant associations of gender, cognitive level, use of additional psychopharmacological medications, or other factors with total daily dose or dose by weight. CONCLUSIONS: The sociocultural factors of race and insurance type were related to dosing of stimulant medications in children. Total daily doses increased with age, while younger children were treated with higher weight-based doses. Attention to these factors should be given in the titration of stimulant medications in the treatment of ADHD. Other factors, including gender, had no specific association.