A National Institutes of Health Approach for Advancing Research to Improve Youth Mental Health and Reduce Disparities.

Even before the COVID-19 pandemic, mental health challenges were the leading cause of disability and poor health outcomes in youth. Challenges are even greater for youth from racially and ethnically minoritized groups in the United States. Racially and ethnically minoritized youth are more vulnerable to mental health problems than White adolescents, yet are less likely to use mental health services. In late 2021, the National Institutes of Health (NIH) sponsored a virtual conference to examine the state of the science around youth mental health disparities (YMHD), focusing on youth from racially and ethnically minoritized populations and the intersection of race and ethnicity with other drivers of mental health disparities. Key findings and feedback gleaned from the conference have informed strategic planning processes related to YMHD, which has included the development of a strategic framework and funding opportunities, designed to reduce YMHD. This commentary briefly describes the collaborative approach used to develop this framework and other strategies implemented across the NIH to address YMHD and serves as an urgent call to action.

Annual Research Review: The contributions of the RDoC research framework on understanding the neurodevelopmental origins, progression and treatment of mental illnesses.

The National Institute of Mental Health (NIMH) proposed the Research Domain Criteria (RDoC) initiative as an alternate way to organize research of mental illnesses, by looking at dimensions of functioning rather than being tied to categorical diagnoses. This paper briefly discusses the motivation for and organization of RDoC, and then explores the NIMH portfolio and recent work to monitor the utility and progress that RDoC has afforded developmental research. To examine how RDoC has influenced the NIMH developmental research portfolio over the last decade, we employed a natural language processing algorithm to identify the number of developmental science grants classified as incorporating an RDoC approach. Additional portfolio analyses examine temporal trends in funded RDoC-relevant grants, publications and citations, and research training opportunities. Reflecting on how RDoC has influenced the focus of grant applications, we highlight examples from research on Attention-Deficit Hyperactivity Disorder (ADHD), childhood irritability, and Autism Spectrum Disorder (ASD). Lastly, we consider how the dimensional and transdiagnostic approaches emphasized in RDoC have facilitated research on personalized intervention for heterogeneous disorders and preventive/early interventions targeting emergent or subthreshold psychopathology.

What does distractibility in ADHD reveal about mechanisms for top-down attentional control?

In this study, we attempted to clarify whether distractibility in ADHD might arise from increased sensory-driven interference or from inefficient top-down control. We employed an attentional filtering paradigm in which discrimination difficulty and distractor salience (amount of image "graying") were parametrically manipulated. Increased discrimination difficulty should add to the load of top-down processes, whereas increased distractor salience should produce stronger sensory interference. We found an unexpected interaction of discrimination difficulty and distractor salience. For difficult discriminations, ADHD children filtered distractors as efficiently as healthy children and adults; as expected, all three groups were slower to respond with high vs. low salience distractors. In contrast, for easy discriminations, robust between-group differences emerged: ADHD children were much slower and made more errors than either healthy children or adults. For easy discriminations, healthy children and adults filtered out high salience distractors as easily as low salience distractors, but ADHD children were slower to respond on trials with low salience distractors than they did on trials with high salience distractors. These initial results from a small sample of ADHD children have implications for models of attentional control, and ways in which it can malfunction. The fact that ADHD children exhibited efficient attentional filtering when task demands were high, but showed deficient and atypical distractor filtering under low task demands suggests that attention deficits in ADHD may stem from a failure to efficiently engage top-down control rather than an inability to implement filtering in sensory processing regions.

Posterior parietal cortex and the filtering of distractors.

Neural systems for visual processing can focus attention on behaviorally relevant objects, filtering out competing distractors. Neurophysiological studies in animals and brain imaging studies in humans suggest that such filtering depends on top-down inputs to extrastriate visual areas, originating in structures important for attentional control. To test whether the posterior parietal cortex may be a necessary source of signals that filter distractors, we measured the ability of a patient with bilateral parietal lesions to discriminate the features of a target surrounded by distractors of variable contrast. In the presence of distractors, the patient was impaired at discriminating both grating orientation and faces, and the magnitude of the impairment increased with distractor salience. These attentional deficits are remarkably similar to those caused by damage to monkey extrastriate regions V4 andor TEO, which are thought to be recipients of top-down attentional feedback. In contrast to the effects of V4 and TEO lesions, however, the parietal lesions impaired performance even with widely spaced targets and distractors, a finding consistent with the projections of parietal cortex to visual processing areas covering a wide range of receptive field sizes and eccentricities.