Neighborhood Resource Deprivation as a Predictor of Bullying Perpetration and Resource-Driven Conduct Symptoms.

OBJECTIVE: Resource deprivation is linked to systemic factors that disproportionately impact historically marginalized communities, and theoretical work suggests that resource deprivation may increase risk for bullying behaviors. Bullying perpetration is an intransigent social problem and an early risk factor that perpetuates the school-to-prison pipeline. This study explored how resource deprivation (family- and neighborhood-level metrics) was associated with early childhood bullying behaviors and clinician-rated symptoms of psychopathology, while accounting for other known risk factors (early life stressors, traumatic events, parental arrest, domestic violence). METHOD: Participants (306 children, mean age = 4.45 years) were enrolled in a longitudinal study (Preschool Depression Study) where demographics, clinician-rated assessments of psychopathology, and parent reports of social functioning were collected. Measures of bullying behaviors (bullying perpetration, generalized aggression, and victimization) were constructed. A cross-sectional approach was employed, and analyses examined the interrelations between race, bullying-related behaviors, resource deprivation, and psychopathology, while accounting for confounding variables, at the baseline assessment time point. RESULTS: The bullying measure showed acceptable model fit (comparative fit index = 0.956, Tucker-Lewis index = 0.945, root mean square error of approximation = 0.061, standardized root mean residual = 0.052, normed χ2 ratio = 2). Neighborhood resource deprivation was more strongly associated with bullying perpetration (r = 0.324, p < .001) than generalized aggression (r = 0.236, Williams t303 = 2.11, p = .036) and remained significant when controlling for other known risk factors (parental arrests, domestic violence, stressors, traumas) and demographic factors. Bullying perpetration was linked with racial category, but the relation was fully mediated by neighborhood resource deprivation. Linear regression including bullying behaviors and symptoms of clinical psychopathology suggested that resource deprivation specifically led to increases in bullying perpetration (t = 2.831, p = .005) and clinician-rated symptoms of conduct disorder (t = 2.827, p = .005), which were attributable to increased rates of resource-driven conduct symptoms (bullies, lies to obtain goods, stolen without confrontation). CONCLUSION: Resource deprivation is strongly and specifically associated with increases in bullying perpetration. Children growing up in impoverished neighborhoods show significant increases in resource-driven conduct behaviors, yet interventions often target individual-level factors. These results highlight the need to target social inequity to reduce bullying perpetration and suggest that interventions targeting neighborhoods should be tested to reduce bullying in early childhood. DIVERSITY & INCLUSION STATEMENT: We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. We worked to ensure that the study questionnaires were prepared in an inclusive way. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. While citing references scientifically relevant for this work, we also actively worked to promote sex and gender balance in our reference list. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. One or more of the authors of this paper received support from a program designed to increase minority representation in science. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. One or more of the authors of this paper self-identifies as living with a disability. We actively worked to promote sex and gender balance in our author group. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list.

Social anxiety moderates the association between adolescent irritability and bully perpetration.

BACKGROUND: Preliminary work suggests anxiety moderates the relationship between irritability and bullying. As anxiety increases, the link between irritability and perpetration decreases. We hypothesize that any moderation effect of anxiety is driven by social anxiety symptoms. We sought to explicate the moderating effect of anxiety, while clarifying relations to other aggressive behaviors. METHODS: A sample of adolescents (n = 169, mean = 12.42 years of age) were assessed using clinician rated assessments of anxiety, parent reports of irritability and bullying behaviors (perpetration, generalized aggression, and victimization). Correlations assessed zero-order relations between variables, and regression-based moderation analyses were used to test interactions. Johnson-Neyman methods were used to represent significant interactions. RESULTS: Irritability was significantly related to bullying (r = .403, p < .001). Social, but not generalized, anxiety symptoms significantly moderated the effect of irritability on bully perpetration (t(160) = -2.94, b = -.01, p = .0038, ΔR2 = .0229, F(1, 160) = 8.635). As social anxiety symptoms increase, the link between irritability and perpetration decreases. CONCLUSIONS: Understanding how psychopathology interacts with social behaviors is of great importance. Higher social anxiety is linked to reduced relations between irritability and bullying; however, the link between irritability and other aggression remains positive. Comprehensively assessing how treatment of psychopathology impacts social behaviors may improve future intervention.

A Novel Cognitive Training Program Targets Stimulus-Driven Attention to Alter Symptoms, Behavior, and Neural Circuitry in Pediatric Anxiety Disorders: Pilot Clinical Trial.

Objective: Pediatric anxiety disorders are associated with increased stimulus-driven attention (SDA), the involuntary capture of attention by salient stimuli. Increased SDA is linked to increased activity in the right ventrolateral prefrontal cortex (rVLPFC), especially in the portion corresponding to the ventral attention network (VAN). In this study, we present a small clinical trial using a novel attention training program designed to treat pediatric anxiety by decreasing SDA and activity in the rVLPFC. Methods: Children ages 8-12 with anxiety disorders (n = 18) participated in eight sessions of attention training over a 4-week period. At baseline and after completing training, participants completed clinical anxiety measures and a battery of cognitive tasks designed to measure three different aspects of attention: SDA, goal-oriented attention, and threat bias. A subset of participants (n = 12) underwent baseline and post-training neuroimaging while engaged in an SDA task. Brain analyses focused on activity within the rVLPFC. Results: Parent (p < 0.001)-, child (p < 0.002)-, and clinician-rated (p < 0.02) anxiety improved significantly over the course of training. Training significantly altered SDA [F(1,92) = 8.88, corrected p-value (pcor) < 0.012, uncorrected p-value (puncor) < 0.004]. Anxiety improvement correlated with improvements in goal-directed attention [r(10) = 0.60, pcor < 0.12 puncor < 0.04]. Within an area of the rVLPFC corresponding to the cingulo-opercular network (CON), there was a main effect of training [F(1,20) = 6.75, pcor < 0.16, puncor < 0.02], with decreasing signal across training. There was a significant interaction between training and anxiety on this region's activity [F(1,20) = 9.48, pcor < 0.048, puncor < 0.006]. Post hoc testing revealed that post-training activity within this CON area correlated with residual anxiety [r(10) = 0.68, p < 0.02]. Conclusions: SDA and rVLPFC neural activity may be novel therapeutic targets in pediatric anxiety. After undergoing a training paradigm aimed at modifying this aspect of attention and its underlying neural circuitry, patients showed lower anxiety, changes in SDA and goal-oriented attention, and decreased activity in the CON portion of the rVLPFC.

Differential processing of risk and reward in delinquent and non-delinquent youth.

The present study examined the behavioral and neural differences in risky decision-making between delinquent (n = 23) and non-delinquent (n = 27) youth ages 13-17 years (M = 16, SD = 0.97) in relation to reward processing. While undergoing functional neuroimaging, participants completed an experimental risk task wherein they received feedback about the riskiness of their behavior in the form of facial expressions that morphed from happy to angry. Behavioral results indicated that delinquent youth took fewer risks and earned fewer rewards on the task than non-delinquent youth. Results from whole-brain analyses indicated no group differences in sensitivity to punishments (i.e. angry faces), but instead showed that delinquent youth evinced greater neural tracking of reward outcomes (i.e. cash-ins) in regions including the ventral striatum and inferior frontal gyrus. While behavioral results show that delinquent youth were more risk-averse, the neural results indicated that delinquent youth were also more reward-driven, potentially suggesting a preference for immediate rewards. Results offer important insights into differential decision-making processes between delinquent and non-delinquent youth.

Developmental pathways from preschool temper tantrums to later psychopathology.

Temper tantrums are sudden, overt negative emotional displays that are disproportionate to the eliciting event. Research supports that severe temper tantrums during the preschool period are associated with preschool psychopathology, but few studies have identified which characteristics of preschool tantrums are predictive of distal psychopathological outcomes in later childhood and adolescence. To examine this question, we used a prospective, longitudinal dataset enriched for early psychopathology. Participants (N = 299) included 3-to 6-year-old children (47.8% female) assessed for tantrums and early childhood psychopathology using diagnostic interviews and then continually assessed using diagnostic interviews over 10 subsequent time points throughout childhood and adolescence. We identified two unique groupings of tantrum behaviors: aggression towards others/objects (e.g., hitting others) and aggression towards self (e.g., hitting self). While both types of tantrum behaviors were associated with early childhood psychopathology severity, tantrum behaviors characterized by aggression towards self were more predictive of later psychopathology. Children displaying high levels of both types of tantrum behaviors had more severe externalizing problems during early childhood and more severe depression and oppositional defiant disorder across childhood and adolescence. Findings suggest that tantrum behaviors characterized by aggression towards self are particularly predictive of later psychopathology.

Neonatal Brain Response to Deviant Auditory Stimuli and Relation to Maternal Trait Anxiety.

OBJECTIVE: Excessive response to unexpected or "deviant" stimuli during infancy and early childhood represents an early risk marker for anxiety disorders. However, research has yet to delineate the specific brain regions underlying the neonatal response to deviant stimuli near birth and the relation to risk for anxiety disorders. The authors used task-based functional MRI (fMRI) to delineate the neonatal response to deviant stimuli and its relationship to maternal trait anxiety. METHODS: The authors used fMRI to measure brain activity evoked by deviant auditory stimuli in 45 sleeping neonates (mean age, 27.8 days; 60% female; 64% African American). In 41 of the infants, neural response to deviant stimuli was examined in relation to maternal trait anxiety on the State-Trait Anxiety Inventory, a familial risk factor for offspring anxiety. RESULTS: Neonates manifested a robust and widespread neural response to deviant stimuli that resembles patterns found previously in adults. Higher maternal trait anxiety was related to higher responses within multiple brain regions, including the left and right anterior insula, the ventrolateral prefrontal cortex, and multiple areas within the anterior cingulate cortex. These areas overlap with brain regions previously linked to anxiety disorders and other psychiatric illnesses in adults. CONCLUSIONS: The neural architecture sensitive to deviant stimuli robustly functions in newborns. Excessive responsiveness of some circuitry components at birth may signal risk for anxiety and other psychiatric disorders.

Whole-Brain Resting-State Functional Connectivity Patterns Associated With Pediatric Anxiety and Involuntary Attention Capture.

BACKGROUND: Pediatric anxiety disorders are linked to dysfunction in multiple functional brain networks, as well as to alterations in the allocation of spatial attention. We used network-level analyses to characterize resting-state functional connectivity (rs-fc) alterations associated with 1) symptoms of anxiety and 2) alterations in stimulus-driven attention associated with pediatric anxiety disorders. We hypothesized that anxiety was related to altered connectivity of the frontoparietal, default mode, cingulo-opercular, and ventral attention networks and that anxiety-related connectivity alterations that include the ventral attention network would simultaneously be related to deviations in stimulus-driven attention. METHODS: A sample of children (n = 61; mean = 10.6 years of age), approximately half of whom met criteria for a current anxiety disorder, completed a clinical assay, an attention task, and rs-fc magnetic resonance imaging scans. Network-level analyses examined whole-brain rs-fc patterns associated with clinician-rated anxiety and with involuntary capture of attention. Post hoc analyses controlled for comorbid symptoms. RESULTS: Elevated clinician-rated anxiety was associated with altered connectivity within the cingulo-opercular network, as well as between the cingulo-opercular network and the ventral attention, default mode, and visual networks. Connectivity between the ventral attention and cingulo-opercular networks was associated with variation in both anxiety and stimulus-driven attention. CONCLUSIONS: Pediatric anxiety is related to aberrant connectivity patterns among several networks, most of which include the cingulo-opercular network. These results help clarify the within- and between-network interactions associated with pediatric anxiety and its association with altered attention, suggesting that specific network connections could be targeted to improve specific altered processes associated with anxiety.

Attention Alterations in Pediatric Anxiety: Evidence From Behavior and Neuroimaging.

BACKGROUND: Pediatric anxiety disorders involve greater capture of attention by threatening stimuli. However, it is not known if disturbances extend to nonthreatening stimuli, as part of a pervasive disturbance in attention-related brain systems. We hypothesized that pediatric anxiety involves greater capture of attention by salient, nonemotional stimuli, coupled with greater activity in the portion of the inferior frontal gyrus (IFG) specific to the ventral attention network (VAN). METHODS: A sample of children (n = 129, 75 girls, mean 10.6 years of age), approximately half of whom met criteria for a current anxiety disorder, completed a task measuring involuntary capture of attention by nonemotional (square boxes) and emotional (angry and neutral faces) stimuli. A subset (n = 61) completed a task variant during functional magnetic resonance imaging. A priori analyses examined activity in functional brain areas within the right IFG, supplemented by a whole-brain, exploratory analysis. RESULTS: Higher clinician-rated anxiety was associated with greater capture of attention by nonemotional, salient stimuli (F1,125 = 4.94, p = .028) and greater activity in the portion of the IFG specific to the VAN (F1,57 = 10.311, p = .002). Whole-brain analyses confirmed that the effect of anxiety during capture of attention was most pronounced in the VAN portion of the IFG, along with additional areas of the VAN and the default mode network. CONCLUSIONS: The pathophysiology of pediatric anxiety appears to involve greater capture of attention to salient stimuli, as well as greater activity in attention-related brain networks. These results provide novel behavioral and brain-based targets for treatment of pediatric anxiety disorders.

Overcontrol and neural response to errors in pediatric anxiety disorders.

Multiple risk factors that may contribute to the development and severity of pediatric anxiety disorders, one of which is dimensional overcontrol. Overcontrol is a constellation of characteristics including heightened performance monitoring, inflexibility, perfectionism and aversion to making mistakes. In this study, we examined overcontrol in children with anxiety disorders and tested whether the underlying dimension of overcontrol specifically explains altered brain response to errors in pediatric anxiety disorders. Parent-reported scores of child overcontrol were collected in a sample of children (ages 8-12 years) with (n = 35) and without (n = 34) anxiety disorders and the relationship of overcontrol and anxiety symptoms to neural responding to errors during functional magnetic resonance imaging (fMRI) was examined. Results indicated childhood overcontrol was elevated in pediatric anxiety disorders and was significantly associated with anxiety severity, even when controlling for comorbid depression and ADHD. Additionally, overcontrol was associated with reduced neural response to errors versus correct responses in the bilateral dorsal anterior cingulate cortex (dACC) and insula, even when controlling for anxiety symptoms. Overcontrol may serve as an underlying mechanism associated with clinical pediatric anxiety that demonstrates significant associations with aberrant neural error responding. Overcontrol may be an underlying mechanism contributing to pediatric anxiety that could be targeted for early intervention.

An item response theory analysis of the Prodromal Questionnaire-Brief Child Version: Developing a screening form that informs understanding of self-reported psychotic-like experiences in childhood.

The Prodromal Questionnaire-Brief Child Version (PQ-BC) has been developed as a tool for identifying psychotic-like experiences (PLEs) in school-age children. The current study examined the psychometric properties of the PQ-BC, examined how well the PQ-BC estimates the latent construct of PLEs (θ̂), and began the process of developing a screening form informed by item response theory (IRT). Utilizing the baseline (N = 11,129) sample from the Adolescent Brain Cognitive Development study, we examined which PQ-BC items provide the most information and best discriminate individuals experiencing PLEs. Using hierarchical linear models (HLMs), we found that θ̂ scores were significantly associated with several previously identified predictors of psychosis spectrum symptoms (i.e., history of psychosis, internalizing symptoms, cognitive impairments, developmental milestone delays, and resting-state functional connectivity impairments) at baseline and Year 1 (n = 5,532). Using item-level information and discrimination parameters of the PQ-BC from the baseline sample, we created a 7-item screening form. HLMs generally found significant associations between screening form scores for both baseline and Year 1 with the aforementioned predictors. The analyses provide evidence for the validity of a screening form derived from the PQ-BC using IRT-derived parameters. This screening form could prove useful when the full measure is not feasible. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Differential Behavioral and Neural Profiles in Youth With Conduct Problems During Risky Decision-Making.

Neuroimaging work has examined neural processes underlying risk taking in adolescence, yet predominantly in low-risk youth. To determine whether we can extrapolate from current neurobiological models, this functional magnetic resonance imaging study investigated risk taking and peer effects in youth with conduct problems (CP; N = 19) and typically developing youth (TD; N = 25). Results revealed higher real-life risk taking, lower risky decisions, and no peer effects on a risk-taking task in CP youth. CP youth showed greater ventral striatum (VS) activity during safe than risky decisions, whereas TD youth showed greater VS activation during risky decisions. Differential VS activity explained higher real-life risk taking in CP youth. Findings provide preliminary evidence that risk-taking behavior in youth with CD problems is characterized by differential neural patterns.

Individual-specific functional connectivity of the amygdala: A substrate for precision psychiatry.

The amygdala is central to the pathophysiology of many psychiatric illnesses. An imprecise understanding of how the amygdala fits into the larger network organization of the human brain, however, limits our ability to create models of dysfunction in individual patients to guide personalized treatment. Therefore, we investigated the position of the amygdala and its functional subdivisions within the network organization of the brain in 10 highly sampled individuals (5 h of fMRI data per person). We characterized three functional subdivisions within the amygdala of each individual. We discovered that one subdivision is preferentially correlated with the default mode network; a second is preferentially correlated with the dorsal attention and fronto-parietal networks; and third subdivision does not have any networks to which it is preferentially correlated relative to the other two subdivisions. All three subdivisions are positively correlated with ventral attention and somatomotor networks and negatively correlated with salience and cingulo-opercular networks. These observations were replicated in an independent group dataset of 120 individuals. We also found substantial across-subject variation in the distribution and magnitude of amygdala functional connectivity with the cerebral cortex that related to individual differences in the stereotactic locations both of amygdala subdivisions and of cortical functional brain networks. Finally, using lag analyses, we found consistent temporal ordering of fMRI signals in the cortex relative to amygdala subdivisions. Altogether, this work provides a detailed framework of amygdala-cortical interactions that can be used as a foundation for models relating aberrations in amygdala connectivity to psychiatric symptoms in individual patients.

Perceiving facial affective ambiguity: A behavioral and neural comparison of adolescents and adults.

The current study examined perceptual differences between adults and youth in perceiving ambiguous facial expressions. We estimated individuals' internal representation for facial expressions and compared it between age groups (adolescents: N = 108, Mage = 13.04 years, 43.52% female; adults: N = 81, Mage = 31.54, 65.43% female). We found that adolescents' perceptual representation for facial emotion is broader than that of adults', such that adolescents experience more difficulty in identifying subtle configurational differences of facial expressions. At the neural level, perceptual uncertainty in face-selective regions (e.g., fusiform face area, occipital face area) were significantly higher for adolescents than for adults, suggesting that adolescents' brains more similarly represent lower intensity emotional faces than do adults'. Our results provide evidence for age-related differences concerning psychophysical differences in perceptual representation of emotional faces at the neural and behavioral level. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Maternal Buffering of Adolescent Dysregulation in Socially Appetitive Contexts: From Behavior to the Brain.

Adolescents are more susceptible to dysregulation in positive social contexts, compared to children. We investigated whether maternal presence would buffer these effects in adolescence. Fifty-four adolescents and children (age range = 8-17 years, Mage  = 13.38 years) completed a social go-nogo task during an fMRI scan alone and in the presence of their mother. We found age-related patterns, such that older relative to younger youth displayed more disinhibition toward socially appetitive than socially aversive stimuli, which was buffered by maternal presence. Furthermore, with age, maternal buffering in socially appetitive contexts elicited heightened activation in the ventromedial prefrontal cortex and amygdala-medial prefrontal cortex connectivity. Findings underscore the importance of caregivers in promoting the neural regulation of their offspring during adolescence.

Prevalence and correlates of maladaptive guilt in middle childhood.

BACKGROUND: Maladaptive guilt can develop by age three and is associated with severe affective psychopathology in adolescents and adults. Yet, little is known about its prevalence prior to adolescence, or which children are at greatest risk of developing this symptom. This study examined the prevalence and correlates of maladaptive guilt in middle childhood. METHODS: This study examined a large community sample of 9-to 10-year-old children (N = 4485) from the Adolescent Brain and Cognitive Development (ABCD) study. Maladaptive guilt was assessed through the Kiddie Schedule for Affective Disorders and Schizophrenia for DSM-5. Parental rejection, family conflict, and parental depression were assessed via questionnaires. RESULTS: In depressed children, a 1-month prevalence of maladaptive guilt of 18.4% and a lifetime prevalence of 30.8% was found. Lifetime rates ranged from 1.8 to 4.1% in children with other psychiatric disorders. Cross-sectionally, maladaptive guilt was associated with lower family income-to-needs, greater family conflict, a history of maternal depression, and greater parental rejection. These findings held when controlling for children's depressive severity, indicating that these associations are specific to maladaptive guilt. LIMITATIONS: Maladaptive guilt was assessed through one item, though many studies of maladaptive guilt measure the symptom in this manner. CONCLUSIONS: Findings suggest that it may be beneficial for clinicians to assess for maladaptive guilt beyond the context of assessment for depression, particularly with children of low socioeconomic status and children of depressed mothers, whom this study suggests are at higher risk. Negative family climates and parenting might also be important targets of preventative interventions.

Apples to apples? Neural correlates of emotion regulation differences between high- and low-risk adolescents.

Adolescence has been noted as a period of increased risk taking. The literature on normative neurodevelopment implicates aberrant activation of affective and regulatory regions as key to inhibitory failures. However, many of these studies have not included adolescents engaging in high rates of risky behavior, making generalizations to the most at-risk populations potentially problematic. We conducted a comparative study of nondelinquent community (n = 24, mean age = 15.8 years, 12 female) and delinquent adolescents (n = 24, mean age = 16.2 years, 12 female) who completed a cognitive control task during functional magnetic resonance imaging, where behavioral inhibition was assessed in the presence of appetitive and aversive socioaffective cues. Community adolescents showed poorer behavioral regulation to appetitive relative to aversive cues, whereas the delinquent sample showed the opposite pattern. Recruitment of the inferior frontal gyrus, medial prefrontal cortex, and tempoparietal junction differentiated community and high-risk adolescents, as delinquent adolescents showed significantly greater recruitment when inhibiting their responses in the presence of aversive cues, while the community sample showed greater recruitment when inhibiting their responses in the presence of appetitive cues. Accounting for behavioral history may be key in understanding when adolescents will have regulatory difficulties, highlighting a need for comparative research into normative and nonnormative risk-taking trajectories.

Links between adolescent bullying and neural activation to viewing social exclusion.

Neuroscientists who have studied bullying have primarily focused on the psychopathology of diagnosable offenders or the resulting symptomatology of victimization. Less attention has been given to theories that suggest that bullying may be an interpersonal strategy. In an exploratory study, we recruited a sample of adolescents (N = 24) who engaged in high rates of delinquent behavior and collected self-report ratings of bullying behaviors. During an fMRI scan, adolescents observed instances of social exclusion and social inclusion. The adolescents' self-reported bullying was associated with greater ventral striatum, amygdala, medial prefrontal cortex, and insula activation when viewing social exclusion > social inclusion. Activation in these regions is commonly associated with reward-learning, salience monitoring, and motivational processes, suggesting that bullies show altered processing of interpersonal cues and social dynamic experiences in their environment. Our findings highlight the need for developmental neuroscientists to further explore the role of social motivation in processing socio-affective information, with a particular focus on goal-directed antisocial behavior.

Not just social sensitivity: Adolescent neural suppression of social feedback during risk taking.

Adolescence is a period of sensitivity to social stimuli. In particular, research has focused on the increased sensitivity to risks and social information seen during adolescence. However, recent evidence also suggests that adolescents can flexibly use information in service of their goals, raising an interesting question: are adolescents able to selectively discount social information if it conflicts with their goals? To test this question, fifty-five children and adolescents (ages 8-17 years) completed a social variant of the Balloon Analogue Risk Task during an fMRI session. Adolescents showed decreased tracking of negative social feedback in regions involved in salience-monitoring (e.g. insula) and social processing (e.g., TPJ, pSTS). Age-related changes in neural processing of risk and social feedback contributed to better performance for older participants. These results suggest that adolescents are able to suppress goal-irrelevant social feedback, rather than being uniformly hyper-sensitive to social information.

Letting the good times roll: adolescence as a period of reduced inhibition to appetitive social cues.

Given the spike in risky behaviors that accompanies adolescence, the need to examine the processes and contextual factors that influence disinhibition for adolescents is of great import. Using an emotionally salient cognitive control task, we examined how socially appetitive and aversive cues differentially affect behavioral inhibition across development. In Study 1 (N = 94, ages 8-30 years), we found that socially appetitive cues were particularly detrimental to inhibition, a finding driven by our adolescent sample. In Study 2 (N = 35, ages 12-17 years), we sought to explore the neural processes implicated in suboptimal inhibition during adolescence. Replicating our behavioral findings from Study 1, socially appetitive cues again caused detriments to inhibition compared with socially aversive cues. At the neural level, increased activation in affective regions (amygdala and ventral striatum) while viewing socially appetitive relative to socially aversive cues was correlated with increases in disinhibition. Furthermore, both whole-brain and functional connectivity analyses suggest recruitment of affective and social-detection networks (fusiform, bilateral temporoparietal junction) may account for the increased focus on appetitive relative to aversive cues. Together, our findings suggest that adolescents show detriments in inhibition to socially appetitive contexts, which is related to increased recruitment of affective and social processing neural regions.

Controlled Substance Reconciliation Accuracy Improvement Using Near Real-Time Drug Transaction Capture from Automated Dispensing Cabinets.

BACKGROUND: Accurate accounting of controlled drug transactions by inpatient hospital pharmacies is a requirement in the United States under the Controlled Substances Act. At many hospitals, manual distribution of controlled substances from pharmacies is being replaced by automated dispensing cabinets (ADCs) at the point of care. Despite the promise of improved accountability, a high prevalence (15%) of controlled substance discrepancies between ADC records and anesthesia information management systems (AIMS) has been published, with a similar incidence (15.8%; 95% confidence interval [CI], 15.3% to 16.2%) noted at our institution. Most reconciliation errors are clerical. In this study, we describe a method to capture drug transactions in near real-time from our ADCs, compare them with documentation in our AIMS, and evaluate subsequent improvement in reconciliation accuracy. METHODS: ADC-controlled substance transactions are transmitted to a hospital interface server, parsed, reformatted, and sent to a software script written in Perl. The script extracts the data and writes them to a SQL Server database. Concurrently, controlled drug totals for each patient having care are documented in the AIMS and compared with the balance of the ADC transactions (i.e., vending, transferring, wasting, and returning drug). Every minute, a reconciliation report is available to anesthesia providers over the hospital Intranet from AIMS workstations. The report lists all patients, the current provider, the balance of ADC transactions, the totals from the AIMS, the difference, and whether the case is still ongoing or had concluded. Accuracy and latency of the ADC transaction capture process were assessed via simulation and by comparison with pharmacy database records, maintained by the vendor on a central server located remotely from the hospital network. For assessment of reconciliation accuracy over time, data were collected from our AIMS from January 2012 to June 2013 (Baseline), July 2013 to April 2014 (Next Day Reports), and May 2014 to September 2015 (Near Real-Time Reports) and reconciled against pharmacy records from the central pharmacy database maintained by the vendor. Control chart (batch means) methods were used between successive epochs to determine if improvement had taken place. RESULTS: During simulation, 100% of 10,000 messages, transmitted at a rate of 1295 per minute, were accurately captured and inserted into the database. Latency (transmission time to local database insertion time) was 46.3 ± 0.44 milliseconds (SEM). During acceptance testing, only 1 of 1384 transactions analyzed had a difference between the near real-time process and what was in the central database; this was for a "John Doe" patient whose name had been changed subsequent to data capture. Once a transaction was entered at the ADC workstation, 84.9% (n = 18 bins; 95% CI, 78.4% to 91.3%) of these transactions were available in the database on the AIMS server within 2 minutes. Within 5 minutes, 98.2% (n = 18 bins; 95% CI, 97.2% to 99.3%) were available. Among 145,642 transactions present in the central pharmacy database, only 24 were missing from the local database table (mean = 0.018%; 95% CI, 0.002% to 0.034%). Implementation of near real-time reporting improved the controlled substance reconciliation error rate compared to the previous Next Day Reports epoch, from 8.8% to 5.2% (difference = -3.6%; 95% CI, -4.3% to -2.8%; P < 10). Errors were distributed among staff, with 50% of discrepancies accounted for by 12.4% of providers and 80% accounted for by 28.5% of providers executing transactions during the Near Real-Time Reports epoch. CONCLUSIONS: The near real-time system for the capture of transactional data flowing over the hospital network was highly accurate, reliable, and exhibited acceptable latency. This methodology can be used to implement similar data capture for transactions from their drug ADCs. Reconciliation accuracy improved significantly as a result of implementation. Our approach may be of particular utility at facilities with limited pharmacy resources to audit anesthesia records for controlled substance administration and reconcile them against dispensing records.