Understanding treatment non-responders: A qualitative study of depressed adolescents' experiences of 'unsuccessful' psychotherapy.

OBJECTIVES: This paper aimed to explore the experiences of depressed adolescents who completed but did not 'respond' to standard psychotherapy, based on a lack of improvement in pre-post symptoms scores. DESIGN: This was a qualitative study employing interpretative phenomenological analysis (IPA). METHOD: Seventy-seven adolescents with moderate to severe depression were interviewed as part of a qualitative arm of a randomised controlled trial. Five adolescents' post-treatment interviews were purposively sampled, based on lack of improvement on pre-post symptom scores, and adolescents still scoring above the clinical threshold for depression. The interviews were analysed using IPA. RESULTS: Adolescents made sense of their depression as part of their identity and held negative expectations of therapy. Some aspects of therapy brought up intolerable feelings that contributed to disengagement in the therapeutic process and culminated in disappointing and hopeless endings. On the other hand, where a stronger therapeutic relationship was developed, some participants experienced certain improvements. CONCLUSIONS: Findings highlight how actively exploring the adolescent's therapy expectations, developing a strong early therapeutic relationship and being mindful of the potential impact of endings are important in therapeutic work with adolescents with depression, especially where they may have a strong sense of hopelessness and self-criticism. Moreover, the finding that adolescents experienced improvements in other domains despite a lack of symptom reduction highlights the need to review how treatment outcomes are currently defined. Integrating individual perspectives of therapy with quantitative outcome measures can provide a more nuanced insight of treatment effects.

IQ and Internalising Symptoms in Adolescents with ASD.

Intelligence quotient (IQ), has been found to relate to the presence of internalising symptoms in autism spectrum disorder (ASD). This meta-analysis sought to clarify the direction of the relationship between IQ and two prevalent internalising symptoms, anxiety and depression, in adolescents with ASD. Secondly, this study aimed to highlight methodological factors contributing to inconsistent findings in existing research. Self-reported anxiety was found to be significantly higher in youth with a lower IQ, while depression was positively associated with IQ. Consequently, parents, schools and clinicians should be cautious of underestimating anxiety in youth with a lower IQ. However, care should also be taken to ensure adolescents with ASD without intellectual disabilities are not overlooked with regards to social and emotional support.

Reaction time variability and brain white matter integrity.

OBJECTIVE: Mean speed of responding is the most commonly used measure in the assessment of reaction time (RT). An alternative measure is intraindividual variability (IIV): the inconsistency of responding across multiple trials of a test. IIV has been suggested as an important indicator of central nervous system functioning, and as such, there has been increasing interest in the associations between IIV and brain imaging metrics. Results however, have been inconsistent. The present seeks to provide a comprehensive evaluation of the associations between a variety of measures of brain white matter integrity and individual differences in choice RT (CRT) IIV. METHOD: MRI brain scans of members of the Lothian Birth Cohort 1936 were assessed to obtain measures of the volume and severity of white matter hyperintensities, and the integrity of brain white matter tracts. CRT was assessed with a 4 CRT task on a separate occasion. Data were analyzed using multiple regression (N range = 358-670). RESULTS: Greater volume of hyperintensities and more severe hyperintensities in frontal regions were associated with higher CRT IIV. White matter tract integrity, as assessed by both fractional anisotropy and mean diffusivity, showed the smallest effect sizes in associations with CRT IIV. Associations with hyperintensities were attenuated and no longer significant after controlling for M CRT. CONCLUSIONS: Taken together, the results of the present study suggested that IIV was not incrementally predictive of white matter integrity over mean speed. This is in contrast to previous reports, and highlights the need for further study. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Predicting change in quality of life from age 79 to 90 in the Lothian Birth Cohort 1921.

PURPOSE: Quality of life (QoL) decreases in very old age, and is strongly related to health outcomes and mortality. Understanding the predictors of QoL and change in QoL amongst the oldest old may suggest potential targets for intervention. This study investigated change in QoL from age 79 to 90 years in a group of older adults in Scotland, and identified potential predictors of that change. METHOD: Participants were members of the Lothian Birth Cohort 1921 who attended clinic visits at age 79 (n = 554) and 90 (n = 129). Measures at both time points included QoL (WHOQOL-BREF: four domains and two single items), anxiety and depression, objective health, functional ability, self-rated health, loneliness, and personality. RESULTS: Mean QoL declined from age 79 to 90. Participants returning at 90 had scored significantly higher at 79 on most QoL measures, and exhibited better objective health and functional ability, and lower anxiety and depression than non-returners. Hierarchical multiple regression models accounted for 20.3-56.3% of the variance in QoL at age 90. Baseline QoL was the strongest predictor of domain scores (20.3-35.6% variance explained), suggesting that individual differences in QoL judgements remain largely stable. Additional predictors varied by the QoL domain and included self-rated health, loneliness, and functional and mood decline between age 79 and 90 years. CONCLUSIONS: This study has identified potential targets for interventions to improve QoL in the oldest old. Further research should address causal pathways between QoL and functional and mood decline, perceived health and loneliness.

Apolipoprotein E genotype does not moderate the associations of depressive symptoms, neuroticism and allostatic load with cognitive ability and cognitive aging in the Lothian Birth Cohort 1936.

OBJECTIVES: In this replication-and-extension study, we tested whether depressive symptoms, neuroticism, and allostatic load (multisystem physiological dysregulation) were related to lower baseline cognitive ability and greater subsequent cognitive decline in older adults, and whether these relationships were moderated by the E4 allele of the apolipoprotein E (APOE) gene. We also tested whether allostatic load mediated the relationships between neuroticism and cognitive outcomes. METHODS: We used data from the Lothian Birth Cohort 1936 (n at Waves 1-3: 1,028 [M age = 69.5 y]; 820 [M duration since Wave 1 = 2.98 y]; 659 [M duration since Wave 1 = 6.74 y]). We fitted latent growth curve models of general cognitive ability (modeled using five cognitive tests) with groups of APOE E4 non-carriers and carriers. In separate models, depressive symptoms, neuroticism, and allostatic load predicted baseline cognitive ability and subsequent cognitive decline. In addition, models tested whether allostatic load mediated relationships between neuroticism and cognitive outcomes. RESULTS: Baseline cognitive ability had small-to-moderate negative associations with depressive symptoms (ß range = -0.20 to -0.17), neuroticism (ß range = -0.27 to -0.23), and allostatic load (ß range = -0.11 to 0.09). Greater cognitive decline was linked to baseline allostatic load (ß range = -0.98 to -0.83) and depressive symptoms (ß range = -1.00 to -0.88). However, APOE E4 allele possession did not moderate the relationships of depressive symptoms, neuroticism and allostatic load with cognitive ability and cognitive decline. Additionally, the associations of neuroticism with cognitive ability and cognitive decline were not mediated through allostatic load. CONCLUSIONS: Our results suggest that APOE E4 status does not moderate the relationships of depressive symptoms, neuroticism, and allostatic load with cognitive ability and cognitive decline in healthy older adults. The most notable positive finding in the current research was the strong association between allostatic load and cognitive decline.

Brain grey and white matter predictors of verbal ability traits in older age: The Lothian Birth Cohort 1936.

Cerebral grey and white matter MRI parameters are related to general intelligence and some specific cognitive abilities. Less is known about how structural brain measures relate specifically to verbal processing abilities. We used multi-modal structural MRI to investigate the grey matter (GM) and white matter (WM) correlates of verbal ability in 556 healthy older adults (mean age = 72.68 years, s.d. = .72 years). Structural equation modelling was used to decompose verbal performance into two latent factors: a storage factor that indexed participants' ability to store representations of verbal knowledge and an executive factor that measured their ability to regulate their access to this information in a flexible and task-appropriate manner. GM volumes and WM fractional anisotropy (FA) for components of the language/semantic network were used as predictors of these verbal ability factors. Volume of the ventral temporal cortices predicted participants' storage scores (ß = .12, FDR-adjusted p = .04), consistent with the theory that this region acts as a key substrate of semantic knowledge. This effect was mediated by childhood IQ, suggesting a lifelong association between ventral temporal volume and verbal knowledge, rather than an effect of cognitive decline in later life. Executive ability was predicted by FA fractional anisotropy of the arcuate fasciculus (ß = .19, FDR-adjusted p = .001), a major language-related tract implicated in speech production. This result suggests that this tract plays a role in the controlled retrieval of word knowledge during speech. At a more general level, these data highlight a basic distinction between information representation, which relies on the accumulation of tissue in specialised GM regions, and executive control, which depends on long-range WM pathways for efficient communication across distributed cortical networks.

Predictors of ageing-related decline across multiple cognitive functions.

It is critical to discover why some people's cognitive abilities age better than others'. We applied multivariate growth curve models to data from a narrow-age cohort measured on a multi-domain IQ measure at age 11 years and a comprehensive battery of thirteen measures of visuospatial, memory, crystallized, and processing speed abilities at ages 70, 73, and 76 years (n = 1091 at age 70). We found that 48% of the variance in change in performance on the thirteen cognitive measures was shared across all measures, an additional 26% was specific to the four ability domains, and 26% was test-specific. We tested the association of a wide variety of sociodemographic, fitness, health, and genetic variables with each of these cognitive change factors. Models that simultaneously included all covariates accounted for appreciable proportions of variance in the cognitive change factors (e.g. approximately one third of the variance in general cognitive change). However, beyond physical fitness and possession of the APOE e4 allele, very few predictors were incrementally associated with cognitive change at statistically significant levels. The results highlight a small number of factors that predict differences in cognitive ageing, and underscore that correlates of cognitive level are not necessarily predictors of decline. Even larger samples will likely be required to identify additional variables with more modest associations with normal-range heterogeneity in aging-related cognitive declines.

More symmetrical children have faster and more consistent choice reaction times.

Greater cognitive ability in childhood is associated with increased longevity, and speedier reaction time (RT) might account for much of this linkage. Greater bodily symmetry is linked to both higher cognitive test scores and faster RTs. It is possible, then, that differences in bodily system integrity indexed by symmetry may underlie the associations of RT and intelligence with increased longevity. However, RT and symmetry have seldom been examined in the same study, and never in children. Here, in 2 large samples aged 4 to 15 (combined n = 856), we found that more symmetrical children had significantly faster mean choice RT and less variability in RT. These associations of faster and less variable RT with greater symmetry early in life raise the possibility that the determinants of longevity in part originate in processes influencing bodily system integrity early in the life-course.

Reaction time and incident cancer: 25 years of follow-up of study members in the UK Health and Lifestyle Survey.

OBJECTIVES: To investigate the association of reaction time with cancer incidence. METHODS: 6900 individuals aged 18 to 94 years who participated in the UK Health and Lifestyle Survey in 1984/1985 and were followed for a cancer registration for 25 years. RESULTS: Disease surveillance gave rise to 1015 cancer events from all sites. In general, there was essentially no clear pattern of association for either simple or choice reaction time with cancer of all sites combined, nor specific malignancies. However, selected associations were found for lung cancer, colorectal cancer and skin cancer. CONCLUSIONS: In the present study, reaction time and its components were not generally related to cancer risk.

Retrospective validation of WTAR and NART scores as estimators of prior cognitive ability using the Lothian Birth Cohort 1936.

In order to assess the degree of cognitive decline resulting from a pathological state, such as dementia, or from a normal aging process, it is necessary to know or to have a valid estimate of premorbid (or prior) cognitive ability. The National Adult Reading Test (NART; Nelson & Willison, 1991) and the Wechsler Test of Adult Reading (WTAR; Psychological Corporation, 2001) are 2 tests developed to estimate premorbid or prior ability. Due to the rarity of actual prior ability data, validation studies usually compare NART/WTAR performance with measures of current abilities in pathological and nonpathological groups. In this study, we validate the use of WTAR scores and extend the validation of the use of NART scores as estimates of prior ability, vis-à-vis the actual prior (childhood) cognitive ability. We do this in a large sample of healthy older people, the Lothian Birth Cohort 1936 (Deary, Gow, Pattie, & Starr, 2012; Deary et al., 2007). Both NART and WTAR scores were correlated with cognitive ability tested in childhood (r = .66-.68). Scores on both the NART and the WTAR had high stability over a period of 3 years in old age (r in excess of .90) and high interrater reliability. The NART accounted for more unique variance in childhood intelligence than did the WTAR.

Bodily symmetry increases across human childhood.

BACKGROUND: Although bodily symmetry is widely used in studies of fitness and individual differences, little is known about how symmetry changes across development, especially in childhood. AIMS: To test how, if at all, bodily symmetry changes across childhood. STUDY DESIGN: We measured bodily symmetry via digital images of the hands. Participants provided information on their age. We ran polynomial regression models testing for associations between age and symmetry. SUBJECTS: 887 children attending a public science event aged between 4 and 15 years old. OUTCOME MEASURES: Mean asymmetry for the eight traits (an average of the asymmetry scores for the lengths and widths of digits 2 to 5). RESULTS: Symmetry increases in childhood and we found that this period of development is best described by a nonlinear function. CONCLUSION: Symmetry may be under active control, increasing with time as the organism approaches an optimal state, prior to a subsequent decline in symmetry during senescence. The causes and consequences of this contrasting pattern of developmental improvement in symmetry and reversal in old age should be studied in more detail.

Age differences in intra-individual variability in simple and choice reaction time: systematic review and meta-analysis.

BACKGROUND: Intra-individual variability in reaction time (RT IIV) is considered to be an index of central nervous system functioning. Such variability is elevated in neurodegenerative diseases or following traumatic brain injury. It has also been suggested to increase with age in healthy ageing. OBJECTIVES: To investigate and quantify age differences in RT IIV in healthy ageing; to examine the effect of different tasks and procedures; to compare raw and mean-adjusted measures of RT IIV. DATA SOURCES: Four electronic databases: PsycINFO, Medline, Web of Science and EMBASE, and hand searching of reference lists of relevant studies. STUDY ELIGIBILITY: English language journal articles, books or book chapters, containing quantitative empirical data on simple and/or choice RT IIV. Samples had to include younger (under 60 years) and older (60 years and above) human adults. STUDY APPRAISAL AND SYNTHESIS: Studies were evaluated in terms of sample representativeness and data treatment. Relevant data were extracted, using a specially-designed form, from the published report or obtained directly from the study authors. Age-group differences in raw and RT-mean-adjusted measures of simple and choice RT IIV were quantified using random effects meta-analyses. RESULTS: Older adults (60+ years) had greater RT IIV than younger (20-39) and middle-aged (40-59) adults. Age effects were larger in choice RT tasks than in simple RT tasks. For all measures of RT IIV, effect sizes were larger for the comparisons between older and younger adults than between older and middle-aged adults, indicating that the age-related increases in RT IIV are not limited to old age. Effect sizes were also larger for raw than for RT-mean-adjusted RT IIV measures. CONCLUSIONS: RT IIV is greater among older adults. Some (but not all) of the age-related increases in RT IIV are accounted for by the increased RT means.

Predicting mortality from human faces.

OBJECTIVE: To investigate whether and to what extent mortality is predictable from facial photographs of older people. METHODS: High-quality facial photographs of 292 members of the Lothian Birth Cohort 1921, taken at the age of about 83 years, were rated in terms of apparent age, health, attractiveness, facial symmetry, intelligence, and well-being by 12 young-adult raters. Cox proportional hazards regression was used to study associations between these ratings and mortality during a 7-year follow-up period. RESULTS: All ratings had adequate reliability. Concurrent validity was found for facial symmetry and intelligence (as determined by correlations with actual measures of fluctuating asymmetry in the faces and Raven Standard Progressive Matrices score, respectively), but not for the other traits. Age as rated from facial photographs, adjusted for sex and chronological age, was a significant predictor of mortality (hazard ratio = 1.36, 95% confidence interval = 1.12-1.65) and remained significant even after controlling for concurrent, objectively measured health and cognitive ability, and the other ratings. Health as rated from facial photographs, adjusted for sex and chronological age, significantly predicted mortality (hazard ratio = 0.81, 95% confidence interval = 0.67-0.99) but not after adjusting for rated age or objectively measured health and cognition. Rated attractiveness, symmetry, intelligence, and well-being were not significantly associated with mortality risk. CONCLUSIONS: Rated age of the face is a significant predictor of mortality risk among older people, with predictive value over and above that of objective or rated health status and cognitive ability.

Sex differences in reaction time mean and intraindividual variability across the life span.

Men are often found to have faster and less variable reaction times (RTs) than do women. However, it has not been established whether these differences occur in children. One suggestion is that sex differences in RT variability may be due to the effect of sex hormones on the brain and, by implication, may be expected in adults but not in children. The present study investigates sex differences in RT mean and intraindividual variability in a sample that includes both children and adults (age range = 4-75 years). Mean and intraindividual variability of simple RT (SRT) and 4-choice RT (CRT) were measured in 1,994 visitors to science festivals held in Edinburgh, Scotland, in 2008 and 2009 and in Cheltenham and Cambridge, England, in 2008. The commonly reported pattern of decreasing RT mean and variability in childhood and adolescence, followed by an increase in mean and variability through adulthood and into old age, was confirmed. Greater intraindividual variability for females in SRT and CRT was observed in adults but not in children. Males had significantly faster mean SRT than did females across the life span, but there were no sex differences in mean CRT.

The effects of high altitude on choice reaction time mean and intra-individual variability: Results of the Edinburgh Altitude Research Expedition of 2008.

OBJECTIVE: This study aimed to investigate the effects of high altitude on reaction time (RT) mean and intra-individual variability. METHOD: Ten students (6 men, 4 women) took a 4-choice RT test and had their vital signs and Lake Louise (LL) score measured on 21 occasions during the Edinburgh Altitude Research Expedition of 2008 to the Western Himalayas (max. altitude 5,565 m). RESULTS: Linear mixed modeling revealed that mean RT was significantly impaired at altitudes above 4,000 m (p < .001), but relatively unaffected below that threshold. An estimated increase in RT between 4,000 and 5,000 m was 15.5 ms, 95% CI [11.1, 19.9]. LL score was related to slower RTs (B = 1.97, 95% CI [0.70, 3.23], p < .01), while number of errors was associated with faster RTs (B = -1.50, 95% CI [-2.60, -0.39], p < .01). There were persistent practice effects in mean RT (B = -2.16, 95% CI [-2.49, -1.83], p < .001. Log-transformed intra-individual variability in RT increased with higher LL scores (B = 0.01801, 95% CI [0.0049, 0.0311], p < .01) and decreased with rising temperature (B = -0.00754, 95% CI [-0.0119, -0.0032], p < .001). However, after controlling for mean RT, these effects were no longer significant. CONCLUSIONS: RTs become significantly impaired above a threshold of 4,000 m. Altitude-related changes in RT intra-individual variability were accounted for by mean RT.