Gender and Autism Program: A novel clinical service model for gender-diverse/transgender autistic youth and young adults.

Objective: Situated in Children's National Hospital (CNH)'s Neuropsychology Division, the Gender and Autism Program (GAP) is the first clinical service dedicated to the needs of autistic gender-diverse/transgender youth. This study describes GAP clinical assessment profiles and presents a multi-perspective programmatic review of GAP evaluation services. Method: Seventy-five consecutive gender- and neuropsychologically-informed GAP evaluations were analyzed, including demographics, gender and autism characterization, and primary domains evaluated. Three program-based Delphi studies were conducted and identify: clinician priorities and challenges in providing care, program administrator lessons learned and ongoing barriers, and considerations adapting this model for a rural academic medical center. Results: Nearly two-thirds of referrals were transfeminine. Most youth had existing autism diagnoses; of those undiagnosed, three-quarters were found to be autistic. Five goals of evaluations were identified: Mental health was always assessed, and most evaluations also assessed gender-related needs in the context of autism neurodiversity. Neuropsychological characterization of strengths and challenges informed personalized accommodations to support youth gender-related self-advocacy. Clinicians emphasized frequent youth safety concerns. Administrators emphasized the need for specialized training for working with families. Components for adaptation of the GAP in a rural academic medical center were identified. Conclusions: Since its founding, the GAP has proven a sustainable neuropsychology-based service with consistent referral flow and insurance authorizations. Capturing staff perspectives through rigorous Delphi methods, and addressing the GAP's feasibility and replicability, this study provides a road map for replicating this service. We also highlight GAP training of specialist clinicians, fundamental to addressing the desperate shortage of providers in this field.

The Importance of Both Individual Differences and Dyadic Processes in Children's Emotion Expression.

Although children display strong individual differences in emotion expression, they also engage in emotional synchrony or reciprocity with interaction partners. To understand this paradox between trait-like and dyadic influences, the goal of the current study was to investigate children's emotion expression using a Social Relations Model (SRM) approach. Playgroups consisting typically of four same-sex unfamiliar nine-year-old children (N = 202) interacted in a round-robin format (6 dyads per group). Each dyad completed two 5-minute tasks, a challenging frustration task and a cooperative planning task. Observers coded children's emotions during the tasks (happy, sad, angry, anxious, neutral) on a second-by-second basis. SRM analyses provided substantial evidence of both the trait-like nature of children's emotion expression (through significant effects for actor variance, multivariate actor-actor correlations, and multivariate intrapersonal correlations) and the dyadic nature of their emotion expression (through significant effects for partner variance, relationship variance, dyadic reciprocity correlations, and multivariate interpersonal correlations).

Emotion transmission in peer dyads in middle childhood.

This study investigated emotion transmission among peers during middle childhood. Participants included 202 children (111 males; race: 58% African American, 20% European American, 16% Mixed race, 1% Asian American, and 5% Other; ethnicity: 23% Latino(a) and 77% Not Latino(a); Mincome  = $42,183, SDincome  = $43,889; Mage  = 9.49; English-speaking; from urban and suburban areas of a mid-Atlantic state in the United States). Groups of four same-sex children interacted in round-robin dyads in 5-min tasks during 2015-2017. Emotions (happy, sad, angry, anxious, and neutral) were coded and represented as percentages of 30-s intervals. Analyses assessed whether children's emotion expression in one interval predicted change in partners' emotion expression in the next interval. Findings suggested: (a) escalation of positive and negative emotion [children's positive (negative) emotion predicts an increase in partners' positive (negative) emotion], and (b) de-escalation of positive and negative emotion (children's neutral emotion predicts a decrease in partners' positive or negative emotion). Importantly, de-escalation involved children's display of neutral emotion and not oppositely valenced emotion.

Children's social information processing predicts both their own and peers' conversational remarks.

The goal of the current study was to investigate whether children's social information processing (SIP) predicts their conversations with peers, including both their remarks to peers and peers' remarks to them. When children (N = 156; 55% male; United States; Representation by Race: 60% African American, 18% Mixed race, 15% European American, 7% Other; Representation by Latino/a Ethnicity: 22% Latino/a, 78% Not Latino/a; Mincome = $39,419) were 8 years old, we assessed their aggressive and prosocial SIP using the Social Information Processing Application (SIP-AP). When children were 9 years old, they participated in playgroups typically consisting of four same-sex unfamiliar children who interacted in a round-robin format. Each dyad completed a five-minute frustration task and a five-minute planning task. Observers coded children's verbalizations into six prosocial categories (Suggest, Agree, Solicit Input, Ask, Encourage, State Personal) and four antisocial categories (Command, Disagree, Discourage, Aggress). Children with higher aggressive SIP made more antisocial and fewer prosocial statements, whereas children with higher prosocial SIP made more prosocial and fewer antisocial statements. Furthermore, children with higher aggressive SIP elicited more antisocial and fewer prosocial statements from peers, whereas children with higher prosocial SIP elicited more prosocial and fewer antisocial statements from peers. Children's antisocial and prosocial remarks mediated relations between their aggressive SIP and peers' subsequent antisocial and prosocial remarks. Findings are discussed in terms of: (a) the use of SIP to predict more subtle social behaviors in children's social interaction, and (b) cycles of social interactions that maintain and reinforce children's SIP patterns. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

A comprehensive review of cerebral oximetry in cardiac surgery.

BACKGROUND: Patients who undergo cardiac surgery are at increased risk of stroke, postoperative cognitive decline, and delirium. These neurocognitive complications have led to increased costs, intensive care unit stays, morbidity, and mortality. As a result, there is a significant push to mitigate any neurological complications in cardiac surgery patients. Near-infrared spectroscopy to measure regional cerebral oxygen saturations has gained consideration due to its noninvasive and user-friendly nature. Cerebral oximetry desaturations during cardiac surgery have been linked to an array of adverse clinical outcomes. However, the most effective intraoperative interventions to protect this vulnerable patient population have yet to be ascertained. AIM OF STUDY: To provide a comprehensive summary of the intraoperative management for cerebral oximetry desaturations during cardiac surgery. The review highlights clinical outcomes from cerebral oximetry use to quantify the importance of identifying cerebral desaturations during cardiac surgery. The review then interrogates possible interventions for cerebral oximetry desaturations in an effort to determine which interventions are most efficacious and to enlighten possible areas for further research. METHODS: A narrative review of randomized controlled trials, observational studies, and systematic reviews with metanalyses was performed through August 2021. RESULTS: There is significant heterogeneity among patient populations for which cerebral oximetry monitoring has been studied in cardiac surgery. Further, the definition of a clinically significant cerebral desaturation and the assessment of neurocognitive outcomes varied substantially across studies. As a result, metanalysis is challenging and few conclusions can be drawn. Cerebral oximetry use during cardiac surgery has not been associated with improvements in neurocognitive outcomes, morbidity, or mortality to date. The evidence to support a particular intervention for an acute desaturation is equivocal. CONCLUSIONS: Future research is needed to quantify a clinically significant cerebral desaturation and to determine which interventions for an acute desaturation effectively improve clinical outcomes.

Susceptibility to peer influence in adolescents: Associations between psychophysiology and behavior.

The current study investigated in-the-moment links between adolescents' autonomic nervous system activity and susceptibility to three types of peer influence (indirect, direct, continuing) on two types of behavior (antisocial, prosocial). The sample included 144 racially ethnically diverse adolescents (46% male, 53% female, 1% other; M age  = 16.02 years). We assessed susceptibility to peer influence behaviorally using the Public Goods Game (PGG) while measuring adolescents' mean heart rate (MHR) and pre-ejection period (PEP). Three key findings emerged from bivariate dual latent change score modeling: (1) adolescents whose MHR increased more as they transitioned from playing the PGG alone (pre-influence) to playing while simply observed by peers (indirect influence) displayed more prosocial behavior; (2) adolescents whose PEP activity increased more (greater PEP activity = shorter PEP latency) as they transitioned from indirect influence to being encouraged by peers to engage in antisocial behavior (direct influence) engaged in more antisocial behavior; and (3) adolescents whose PEP activity decreased less as they transitioned from direct influence on prosocial behavior to playing the PGG alone again (continuing influence) displayed more continuing prosocial behavior (marginal effect). The discussion focuses on the role of psychophysiology in understanding adolescents' susceptibility to peer influence.

Pre-Pandemic Peer Relations Predict Adolescents' Internalizing Response to Covid-19.

The goal of the current longitudinal study was to investigate the role of adolescents' peer victimization and aggression prior to COVID-19 on the change in their depressive and anxious symptoms from pre- to mid-pandemic. We hypothesized that, although adolescents overall would display an increase in internalizing symptoms from pre- to mid-pandemic, this response would be weakened or perhaps even reversed when adolescents experienced high levels of victimization or aggression prior to the pandemic. Participants included 96 racially/ethnically diverse adolescents (42 males, 53 females; 1 other) with an average age of 16.79 years (SD = 0.60). At Time 1 (T1; June 2019 through February 2020; pre-pandemic), adolescents completed self-report measures of their peer relations (aggression, victimization) and internalizing symptoms (depressive, anxious). At Time 2 (T2; May through July 2020; mid-pandemic), adolescents completed self-report measures of their internalizing symptoms (depressive, anxious). On average, adolescents' anxious and depressive symptoms increased from T1 to T2, although they exhibited substantial variability, with reports ranging from decreasing symptoms to increasing symptoms. Although on average adolescents reported increases in anxious symptoms from T1 to T2, adolescents with higher T1 peer victimization reported less positive change in anxious symptoms. Similarly, although on average adolescents reported increases in depressive symptoms from T1 to T2, adolescents with higher levels of T1 aggression reported less positive change in depressive symptoms from T1 to T2. Discussion focused on restrictions on in-person peer interactions necessitated by COVID-19 that may reduce adolescents' distress when their pre-pandemic daily lives were characterized by negative peer relations.

Validation of the Social Information Processing Application (SIP-AP) across genders, socioeconomic levels, and forms of aggression.

The goals of the current study were to (a) replicate the factor structure of the Social Information Processing Application (SIP-AP), (b) evaluate the measurement invariance of the SIP-AP across genders, socioeconomic (SES) levels, and forms of aggression, and (c) assess the convergent validity of the SIP-AP through associations with aggression, social competence, and rule-breaking behavior. Participants were 189 racially/ethnically diverse children (53% male; Mage = 8.50 years) who completed the SIP-AP. Parents reported on children's aggression and social competence, children reported on their aggression, and we observed children's rule-breaking behavior. A five-factor model including Hostile Cue Interpretations, Aggressive Goals, Aggressive Responses, Aggressive Response Evaluations, and Prosocial SIP replicated in this sample. The model was invariant across genders, SES levels, and forms of aggression (physical, relational, covert, property destruction). Girls reported more Aggressive Goals than boys. Children from more economically disadvantaged families reported higher levels of Hostile Cue Interpretations, Aggressive Goals, and Aggressive Response Evaluations. Aggression was related to all SIP constructs in expected directions, social competence was negatively associated with Hostile Cue Interpretations, and rule-breaking behavior was positively linked to Aggressive Goals, Aggressive Responses, and Aggressive Response Evaluations. Results are discussed in terms of the psychometric strengths of the SIP-AP. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Levels and Instability of Daily Self-Esteem in Adolescents: Relations to Depressive and Anxious Symptoms.

The current study examined whether individual differences in depressive and anxious symptoms relate to level of daily self-esteem and instability of daily self-esteem in adolescence. Participants were a racially and ethnically diverse sample of adolescents (79 girls, 65 boys; M age = 13.53 years). Adolescents reported on their depressive and anxious symptoms during a baseline home visit. Then, adolescents reported on their daily self-esteem over the course of 12 consecutive days. Using hierarchical linear modeling analyses, level of daily self-esteem was negatively associated with depressive but not anxious symptoms. In addition, a positive relation emerged between instability of daily self-esteem and depressive symptoms when controlling for level of self-esteem; a similar relation did not emerge for anxious symptoms. The differential findings that emerged between both level and instability of daily self-esteem and depressive versus anxious symptoms may be linked to differences in the temporal orientation of these two types of internalizing symptoms; specifically, depressive symptoms result from backward-looking rumination over previous experiences, whereas anxious symptoms emerge from forward-looking worry about future events (Wenze et al., 2012).

Effects of the Mother-Child Education Program on Parenting Stress and Disciplinary Practices Among Refugee and Other Marginalized Communities in Lebanon: A Pilot Randomized Controlled Trial.

OBJECTIVE: Few randomized controlled trials (RCTs) have explored the implementation and impact of early childhood parenting education programs in very fragile contexts and humanitarian settings. We tested the effects of a group-based intervention, the Mother-Child Education Program (MOCEP), on parenting stress and practices among two refugee communities and one other marginalized community in Beirut, Lebanon. METHOD: A pilot wait-list RCT was conducted to assess the program's impact on maternal, child (average age: 4 years), and dyadic outcomes. A total of 106 mother-child dyads were randomly assigned to either the intervention group (n = 53) or the wait-list control group (n = 53). Analysis was conducted by modified intention-to-treat and supplemental analyses through multiple imputation of missing post-intervention data. RESULTS: Forty families (38%) withdrew early from the study. After completing the program, mothers in the intervention group showed a reduction in their harsh parenting practices, as indexed by the Disciplinary Style Questionnaire (Cohen's d = -0.76, 95% CI = -1.24, -0.27) and in their level of parenting stress, as indexed by the Parenting Stress Index-Short Form (PSI-SF; Cohen's d = -0.90, 95% CI = -1.39, -0.40). Exploratory but underpowered analyses of dyadic interactions revealed reductions in the PSI were associated with a reduction in harsh parenting after the intervention. However, we did not detect any positive impact on behavioral or emotional outcomes among the children. CONCLUSION: Our analyses suggest that MOCEP had a positive impact on disciplinary practices and parenting stress in a context of high fragility, but that broader effects on maternal and child outcomes may be dependent on program attendance and the availability of other services. We discuss implications of this pilot study for practice and research of a largely unexplored area of program evaluation. CLINICAL TRIAL REGISTRATION INFORMATION: Mother and Child Education Program in Palestinian Refugee Camps; https://clinicaltrials.gov; NCT02402556.

Relations between Reactive and Proactive Aggression and Daily Emotions in Adolescents.

The current study examined whether individual differences in reactive and proactive aggression: 1) relate to level of daily emotion, including happiness, sadness, anger, and fear, 2) predict across-day variability in these emotions, and 3) moderate reactivity of these emotions to positive and negative events. Participants were a racially/ethnically diverse sample of 144 adolescents (80 girls, 64 boys; M age = 13.55 years; SD = 1.34). Adolescents self-reported on reactive and proactive aggression in a home visit prior to the collection of daily data. Using daily dairy procedures, adolescents then reported on their daily emotions and positive/negative events over 12 consecutive days. Higher reactive aggression was associated with greater levels of daily anger, more variability in anger across days, and heightened angry reactivity to negative events. Additionally, higher reactive aggression predicted lower levels of daily happiness but greater happy reactivity to positive events. Finally, higher reactive aggression was linked to increased variability in daily fear. In contrast, proactive aggression was largely unrelated to adolescents' daily emotions, with the exception that higher proactive aggression predicted less variability in happiness across days. Results indicate that reactive aggression is characterized by significant emotionality at the daily level, and proactive aggression is characterized by lack of emotionality.

The simultaneous assessment of and relations between children's sympathetic and parasympathetic psychophysiology and their reactive and proactive aggression.

The goal of the current study was to examine the link between children's psychophysiology and aggression when both constructs were assessed simultaneously in scenarios designed to provide the opportunity to aggress for either a reactive reason or a proactive reason. Both sympathetic nervous system (SNS) activity (skin conductance) and parasympathetic nervous system (PNS) activity (respiratory sinus arrhythmia or RSA), as well as their interaction, were included as physiological measures. Participants were 35 5th-grade children who were placed in two virtual-peer scenarios; one scenario provided the opportunity to aggress in response to peer provocation (i.e., reactive aggression) and the other scenario provided the opportunity to aggress for instrumental gain (i.e., proactive aggression). Both skin conductance and RSA were assessed at the time that children were given the opportunity to aggress; this simultaneous assessment of psychophysiology and aggression allowed for an examination of in-the-moment relations between the two constructs. For the reactive scenario, RSA moderated the in-the-moment relation between skin conductance and aggression such that the association was positive at low RSA but negative at high RSA. For the proactive scenario, skin conductance negatively predicted aggression in-the-moment, and RSA positively predicted aggression in-the-moment, but their interaction was not a significant predictor of aggression. Theoretical implications for reactive and proactive aggression and underlying physiological processes are discussed.

A preliminary study of movement intensity during a Go/No-Go task and its association with ADHD outcomes and symptom severity.

OBJECTIVE: At present, there are no well-validated biomarkers for attention-deficit/hyperactivity disorder (ADHD). The present study used an infrared motion tracking system to monitor and record the movement intensity of children and to determine its diagnostic precision for ADHD and its possible associations with ratings of ADHD symptom severity. METHODS: A Microsoft motion sensing camera recorded the movement of children during a modified Go/No-Go Task. Movement intensity measures extracted from these data included a composite measure of total movement intensity (TMI measure) and a movement intensity distribution (MID measure) measure across 15 frequency bands (FB measures). In phase 1 of the study, 30 children diagnosed with ADHD or at subthreshold for ADHD and 30 matched healthy controls were compared to determine if measures of movement intensity successfully distinguished children with ADHD from healthy control children. In phase 2, associations between measures of movement intensity and clinician-rated ADHD symptom severity (Clinical Global Impression Scale [CGI] and the ADHD-Rating Scale IV [ADHD-RS]) were examined in a subset of children with ADHD (n = 14) from the phase I sample. RESULTS: Both measures of movement intensity were able to distinguish children with ADHD from healthy controls. However, only the measures linked to the 15 pre-determined 1 Hz frequency bands were significantly correlated with both the CGI scores and ADHD-RS total scores. CONCLUSIONS: Preliminary findings suggest that measures of movement intensity, particularly measures linked to the 10-11 and 12-13 Hz frequency bands, have the potential to become valid biomarkers for ADHD.

The protective role of teacher preference for at-risk children's social status.

Aggressive behaviors have been associated with social costs (e.g., rejection) and benefits (e.g., popularity) in previous studies. The current study sought to examine the moderating effect of teacher preference on the association between distinct forms of aggressive behavior (i.e., physical aggression and relational aggression) and social status (i.e., rejection and popularity), and to explore whether these associations differed for boys and girls. Fourth and fifth grade students (N = 193) completed peer nomination procedures to assess rejection and aggressive behavior and teachers provided self-reports of their preferences for their students. Findings indicated that relationally aggressive girls were more likely to be popular with their peers when their teachers also liked them. In addition, both relationally and physically aggressive girls were less likely to be rejected by their peers when their teachers liked them. Although physical aggression was most strongly associated with rejection among boys whose teachers liked them, relational aggression predicted popularity among boys whose teachers disliked them. Results suggest that teacher preferences may be a particularly important factor contributing to both physically and relationally aggressive children's social status (e.g., rejection and popularity), especially for girls.