Publications by authors named "Judith Crowell"

30 Publications

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Development of Emotion Regulation in Typically Developing Children.

Authors:
Judith A Crowell

Child Adolesc Psychiatr Clin N Am 2021 07;30(3):467-474

Putnam Hall- South Campus, Stony Brook University, Stony Brook, NY 11794, USA. Electronic address:

Emotion regulation (ER) is a complex process that combines inherent as well as environmental and learned components of reactivity and regulation. Elements of ER are present from birth and are elaborated across development. An understanding of emotion dysregulation requires careful examination of all the elements that constitute typical ER so that relevant domains can be therapeutically targeted. This contribution reviews the development of ER in typically developing youth to set the stage for discussion of points of intervention.
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http://dx.doi.org/10.1016/j.chc.2021.04.001DOI Listing
July 2021

Understanding, Assessing, and Intervening with Emotion Dysregulation in Autism Spectrum Disorder: A Developmental Perspective.

Child Adolesc Psychiatr Clin N Am 2021 04;30(2):335-348

Child and Adolescent Psychiatry, Stony Brook Outpatient, Department of Psychiatry, Stony Brook Hospital, Putnam Hall-South Campus, Stony Brook, NY 11794-8790, USA.

This article provides a comprehensive review of emotion dysregulation (ED) in individuals with autism spectrum disorder (ASD). The authors describe ED from a developmental perspective, and highlight how aberrations in social development and a restricted-repetitive repertoire of behaviors, render individuals with ASD more vulnerable to ED. The article also summarizes how ED in children and adolescents with ASD has been measured and conceptualized in research and clinic settings. Evidence-based pharmacologic and cognitive behavioral interventions targeting ED in ASD are summarized, with a focus on how such approaches are tailored to the developmental needs of individuals with ASD.
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http://dx.doi.org/10.1016/j.chc.2020.10.013DOI Listing
April 2021

Stepped Treatment for Attention-Deficit/Hyperactivity Disorder and Aggressive Behavior: A Randomized, Controlled Trial of Adjunctive Risperidone, Divalproex Sodium, or Placebo After Stimulant Medication Optimization.

J Am Acad Child Adolesc Psychiatry 2021 02 30;60(2):236-251. Epub 2020 Jan 30.

Renaissance School of Medicine, Stony Brook University, New York.

Objective: Stimulant medications are the most prevalent first-line pharmacotherapy for attention-deficit/hyperactivity disorder, but children with aggressive behavior often receive multiagent treatment. There is sparse evidence for the benefits of adjunctive medications when stimulant monotherapy provides inadequate benefit for aggressive behavior, yet the adverse effects of common adjuncts are well established. This study compared the efficacy in reducing aggressive behavior of risperidone (RISP), divalproex sodium (DVPX), and placebo (PBO) added to stimulant medication among childrenwhose symptoms persisted after individually optimized stimulant treatment.

Method: This trial enrolled 6- to 12-year-old with attention-deficit/hyperactivity disorder, a disruptive disorder, significant aggressive behavior, and prior stimulant treatment. Open, systematically titrated stimulant treatment identified patients with inadequate reductions in aggressive behavior, who were then randomly assigned to receive adjunctive RISP, DVPX, or PBO under double-blinded conditions for 8 weeks. Family-based behavioral treatment was offered throughout the trial. The primary outcome was the parent-completed Retrospective Modified Overt Aggression Scale.

Results: Participants included 175 children (mean [SD] age 9.48 [2.04] years, 19% female). Of participants, 151 completed the stimulant optimization phase, with aggression remitting among 96 (63%), and 45 were randomly assigned to adjunctive treatment groups. The adjunctive RISP group showed greater reductions in aggression ratings than the PBO group (least squares means difference [ΔLSM], -2.33; 95% CI, -3.83 to -0.82; effect size [ES], -1.32), as did the DVPX group (ΔLSM, -1.60; 95% CI, -3.18 to -0.03; ES, -0.91). Mean standardized body mass index scores increased more among RISP-treated participants than participants receiving PBO (ΔLSM, 1.54; 95% CI, 0.68 to 2.40; ES, 0.58).

Conclusion: High response rate during the trial's open stimulant optimization phase suggests that rigorous titration of stimulant medication and concurrent behavioral therapy may avert the need for additional medications. Among nonremitters, RISP and DVPX were efficacious adjunctive treatments, although RISP was associated with weight gain.

Clinical Trial Registration Information: Effectiveness of Combined Medication Treatment for Aggression in Children With Attention Deficit With Hyperactivity Disorder (The SPICY Study); https://www.clinicaltrials.gov; NCT00794625.
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http://dx.doi.org/10.1016/j.jaac.2019.12.009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7390668PMC
February 2021

Commentary: Sports participation at 4 years old? Thoughts on mental health-risk trajectories in the longitudinal study of Australian children - a commentary on Vella et al. (2018).

Authors:
Judith A Crowell

Child Adolesc Ment Health 2019 May 3;24(2):149-151. Epub 2018 Dec 3.

Division of Child and Adolescent Psychiatry, Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA.

Vella and colleagues (this issue) report on children in the kindergarten cohort of the Longitudinal Study of Australian Children (LSAC) study, using predictors from age 4 years to identify six trajectories of mental health risk from ages 4-12. Somewhat surprisingly, they find that among some predictable candidates for risk, such as sex and family income, that sports participation at age four emerges as a novel predictor of low difficulty with respect to mental health trajectories across the next 8 years. Is this a case of mens sana in corpore sano? Or is sports participation, that is, swimming, dancing, gymnastics, and team sports, a proxy for other factors? What can the various predictors and the trajectories of mental health risk from this longitudinal study tell us about interventions to reduce risk?
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http://dx.doi.org/10.1111/camh.12290DOI Listing
May 2019

Parenting behavior and the development of children with autism spectrum disorder.

Compr Psychiatry 2019 04 20;90:21-29. Epub 2018 Nov 20.

Stony Brook University, United States of America.

Autism spectrum disorders (ASD) are neurodevelopmental disorders in which multiple genetic and environmental factors play roles. Symptoms of deficits in social communication and restrictive, repetitive behavioral patterns emerge early in a child's development. While parents do not cause these difficulties, impairments in social relatedness can strain parent child interactions and parental stress can have negative transactional effects that impede children development. Conversely, as with typically developing children, parental behavior can also enhance development in ASD and parents play a role in many interventions. In this review we examine parental contributions to the development of children with ASD, focusing on social communication and emotion regulation. We address parent and family characteristics that may impede development so they can be identified in families and interventions developed to target them.
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http://dx.doi.org/10.1016/j.comppsych.2018.11.007DOI Listing
April 2019

IV. CO-CONSTRUCTION OF ATTACHMENT REPRESENTATIONS AND AFFECT-REGULATING COGNITIONS: THE ROLE OF MATERNAL ATTACHMENT SECURITY.

Monogr Soc Res Child Dev 2018 12;83(4):60-73

This study focused on the role of maternal co-construction skills in building attachment relevant representations in early childhood. Thirty-four mothers and their 4- to 5-year-old children were presented with two co-construction tasks, one an attachment storytelling task, the other an affect discussion task about emotion-laden situations. Maternal co-construction skills were assessed with several scales that scored the quality of the co-construction partnership, the mother's skill in prompting elaboration, and helping build an explanatory framework. Mothers completed the Attachment Script Assessment (ASA) and the Adult Attachment Interview (AAI) as well. Results indicated that mothers' secure base script knowledge (ASA) was significantly related to communication effectiveness, encouraging elaboration of storylines, and using open-ended and why questions. Maternal AAI coherence showed similar relations to co-construction support.
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http://dx.doi.org/10.1111/mono.12391DOI Listing
December 2018

Prevalence and Treatment Outcomes of Persistent Negative Mood Among Children with Attention-Deficit/Hyperactivity Disorder and Aggressive Behavior.

J Child Adolesc Psychopharmacol 2016 Mar 8;26(2):164-73. Epub 2016 Jan 8.

4 Department of Psychiatry, Stony Brook University, State University of New York , Stony Brook, New York.

Objective: Diagnostic criteria for disruptive mood dysregulation disorder (DMDD) require 1) periodic rageful outbursts and 2) disturbed mood (anger or irritability) that persists most of the time in between outbursts. Stimulant monotherapy, methodically titrated, often culminates in remission of severe aggressive behavior, but it is unclear whether those with persistent mood symptoms benefit less.This study examined the association between the presence of persistent mood disturbances and treatment outcomes among children with attention-deficit/hyperactivity disorder (ADHD) and periodic aggressive, rageful outbursts.

Methods: Within a cohort of children with ADHD and aggressive behavior (n = 156), the prevalence of persistent mood symptoms was evaluated at baseline and after completion of a treatment protocol that provided stimulant monotherapy and family-based behavioral treatment (duration mean [SD] = 70.04 [37.83] days). The relationship of persistent mood symptoms on posttreatment aggressive behavior was assessed, as well as changes in mood symptoms.

Results: Aggressive behavior and periodic rageful outbursts remitted among 51% of the participants. Persistent mood symptoms at baseline did not affect the odds that aggressive behavior would remit during treatment. Reductions in symptoms of sustained mood disturbance accompanied reductions in periodic outbursts. Children who at baseline had high irritability but low depression ratings showed elevated aggression scores at baseline and after treatment; however, they still displayed large reductions in aggression.

Conclusions: Among aggressive children with ADHD, aggressive behaviors are just as likely to decrease following stimulant monotherapy and behavioral treatment among those with sustained mood symptoms and those without. Improvements in mood problems are evident as well. Therefore, the abnormalities in persistent mood described by DMDD's criteria do not contraindicate stimulant therapy as initial treatment among those with comorbid ADHD. Rather, substantial improvements may be anticipated, and remission of both behavioral and mood symptoms seems achievable for a proportion of patients.

Trial Registration: ClinicalTrials.gov (U.S.); IDs: NCT00228046 and NCT00794625; www.clinicaltrials.gov.
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http://dx.doi.org/10.1089/cap.2015.0112DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4800385PMC
March 2016

Metabolic pathways link childhood adversity to elevated blood pressure in midlife adults.

Obes Res Clin Pract 2016 Sep - Oct;10(5):580-588. Epub 2015 Dec 1.

Boston VA Healthcare System, Boston, MA, United States; Division of Endocrinology, Diabetes & Metabolism, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States.

Childhood adversity is a risk factor for adult health outcomes, including obesity and hypertension. This study examines whether childhood adversity predicted mean arterial pressure through mechanisms of central obesity and leptin, adiponectin, and/or insulin resistance, and including dietary quality. 210 Black/African Americans and White/European Americans, mean age=45.8; ±3.3 years, were studied cross-sectionally. Path analyses were used to specify a chain of predictive variables in which childhood adversity predicted waist-hip ratio and dietary quality, circulating levels of hormones, and in turn, mean arterial pressure, adjusting for race, gender, and antihypertensive medications. Direct paths were found between childhood adversity, waist-hip ratio, and leptin levels and between leptin and dietary quality to mean arterial pressure. Systolic and diastolic blood pressures were similarly predicted. Early adversity appears to developmentally overload and dysregulate endocrine systems through increased risk for obesity, and through a direct impact on leptin that in turn, impacts blood pressure.
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http://dx.doi.org/10.1016/j.orcp.2015.10.009DOI Listing
October 2017

Security of attachment to spouses in late life: Concurrent and prospective links with cognitive and emotional wellbeing.

Clin Psychol Sci 2015 Jun;3(4):516-529

Department of Psychiatry, Stony Brook University.

Social ties are powerful predictors of late-life health and wellbeing. Although many adults maintain intimate partnerships into late life, little is known about mental models of attachment to spouses and how they influence aging. Eighty-one elderly heterosexual couples (162 individuals) were interviewed to examine the structure of attachment security to their partners and completed measures of cognition and wellbeing concurrently and 2.5 years later. Factor analysis revealed a single factor for security of attachment. Higher security was linked concurrently with greater marital satisfaction, fewer depressive symptoms, better mood, and less frequent marital conflicts. Greater security predicted lower levels of negative affect, less depression, and greater life satisfaction 2.5 years later. For women, greater security predicted better memory 2.5 years later and attenuated the link between frequency of marital conflict and memory deficits. Late in life, mental models of attachment to partners are linked to wellbeing concurrently and over time.
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http://dx.doi.org/10.1177/2167702614541261DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4579537PMC
June 2015

Early life adversity and/or posttraumatic stress disorder severity are associated with poor diet quality, including consumption of trans fatty acids, and fewer hours of resting or sleeping in a US middle-aged population: A cross-sectional and prospective study.

Metabolism 2015 Nov 26;64(11):1597-610. Epub 2015 Sep 26.

Section of Endocrinology, Boston VA Healthcare System/Harvard Medical School, 150 S. Huntington Avenue, Jamaica Plain, MA 02130, USA; Department of Internal Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA.

Background: Early life adversity (ELA) and post-traumatic stress disorder (PTSD) are associated with poorer psychological and physical health. Potential underlying mechanisms and mediators remain to be elucidated, and the lifestyle habits and characteristics of individuals with ELA and/or PTSD have not been fully explored. We investigated whether the presence of ELA and/or PTSD are associated with nutrition, physical activity, resting and sleeping and smoking.

Methods: A cross-sectional sample of 151 males and females (age: 45.6±3.5 years, BMI: 30.0±7.1 kg/m(2)) underwent anthropometric measurements, as well as detailed questionnaires for dietary assessment, physical activity, resting and sleeping, smoking habits and psychosocial assessments. A prospective follow-up visit of 49 individuals was performed 2.5 years later and the same outcomes were assessed. ELA and PTSD were evaluated as predictors, in addition to a variable assessing the combined presence/severity of ELA-PTSD. Data were analyzed using analysis of covariance after adjusting for several socioeconomic, psychosocial and anthropometric characteristics.

Results: Individuals with higher ELA or PTSD severity were found to have a poorer diet quality (DASH score: p=0.006 and p=0.003, respectively; aHEI-2010 score: ELA p=0.009), including further consumption of trans fatty acids (ELA p=0.003); the differences were significantly attenuated null after adjusting mainly for education or income and/or race. Further, individuals with higher ELA severity reported less hours of resting and sleeping (p=0.043) compared to those with zero/lower ELA severity, and the difference remained significant in the fully adjusted model indicating independence from potential confounders. When ELA and PTSD were combined, an additive effect was observed on resting and sleeping (p=0.001); results remained significant in the fully adjusted model. They also consumed more energy from trans fatty acids (p=0.017) tended to smoke more (p=0.008), and have less physical activity (PTSD p=0.024) compared to those with no or lower ELA and PTSD severity. Adjustments for sociodemographic factors and/or BMI rendered results of the above lifestyle parameters non-significant. The analysis of the prospective data showed similar trends to the cross-sectional analysis, further supporting the conclusions, although statistical significance of results was lower due to the lower number of participants.

Conclusion: Fewer hours of resting and sleeping and poorer diet quality are linked to ELA and/or PTSD, indicating that these pathways might underlie the development of several metabolic abnormalities in individuals with ELA and/or PTSD. Differences in terms of diet quality are significantly attenuated by race and/or education and/or income, whereas differences in other lifestyle habits of individuals with and without ELA and/or PTSD, such as physical activity, are mostly explained by confounding sociodemographic variables and/or body mass index.
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http://dx.doi.org/10.1016/j.metabol.2015.08.017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4609606PMC
November 2015

Diet quality and diet patterns in relation to circulating cardiometabolic biomarkers.

Clin Nutr 2016 Apr 7;35(2):484-490. Epub 2015 Apr 7.

Division of Endocrinology, Diabetes, and Metabolism, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA; Section of Endocrinology, Boston VA Healthcare System, Harvard Medical School, Boston, MA 02130, USA. Electronic address:

Background & Aims: We examined the effects of diet quality and dietary patterns in relation to biomarkers of risk including leptin, soluble intracellular adhesion molecule 1 (sICAM-1), C-reactive protein (CRP), and irisin.

Methods: We analyzed data from 196 adults cross-sectionally. Dietary patterns were identified by factor analysis and diet quality scores were generated using a validated food-frequency questionnaire.

Results: Both the alternate healthy eating index-2010 (AHEI-2010) and the Dietary Approaches to Stop Hypertension (DASH) scores were negatively related to CRP, even after controlling for body mass index and total energy intake. Similarly, the prudent diet pattern was negatively related to leptin, sICAM-1, and CRP, whereas the Western diet pattern showed positive associations with these markers; however, after adjusting for all confounders, the associations only remained significant for leptin and sICAM-1. Irisin was positively associated with DASH and the prudent diet after controlling for all confounders (standardized β = 0.23, P = 0.030; standardized β = 0.25, P = 0.021, respectively). Irisin showed positive associations with increasing fruit consumption, whereas the levels of irisin decreased as meat consumption increased.

Conclusions: Irisin was directly associated with healthy diet types and patterns. Further studies regarding these mechanisms are warranted. This trial is registered at http://www.clinicaltrials.gov. Identifier: NCT01853332.
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http://dx.doi.org/10.1016/j.clnu.2015.03.022DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4596724PMC
April 2016

Attachment and the metabolic syndrome in midlife: the role of interview-based discourse patterns.

Psychosom Med 2014 Oct;76(8):611-21

From Judge Baker Children's Center (C.R.D., N.U., C.C-D., J.A.C.), Boston, Massachusetts; Boston College (E.D.), Boston, Massachusetts; Department of Psychiatry, Cambridge Health Alliance (A.R.B.), Cambridge, Massachusetts; Department of Psychology (S.D.N.), North Carolina State University, Raleigh, North Carolina; Division of Endocrinology (C.S.M.), Diabetes & Metabolism, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; Section of Endocrinology, Boston VA Healthcare System, Harvard Medical School, Boston, Massachusetts (C.S.M.); Department of Psychiatry (J.A.C.), Stony Brook University School of Medicine, Stony Brook, New York.

Objective: Adult attachment discourse patterns and current family relationship quality were examined as correlates of health behaviors and number of metabolic syndrome (MetS) criteria met, and as mediators of the link between childhood adversity and these health outcomes.

Methods: A sample of 215 white/European American and black/African American adults aged 35 to 55 years were examined using a cross-sectional study design. Discourse was assessed with the Adult Attachment Interview, using coherence (a marker of attachment security), unresolved trauma/loss (a marker of disorganized cognitions related to trauma or loss), and idealization (minimizing stressful experiences and their impact) scores. Relationship quality, adverse childhood experiences, and current depressive symptoms were assessed, as were health behaviors of diet, exercise, and smoking. MetS includes obesity, elevated blood pressure, elevated fasting glucose, high triglycerides, and low high-density lipoprotein cholesterol.

Results: Using path analysis and including childhood adversity severity and depressive symptoms in the model, both Adult Attachment Interview coherence and unresolved trauma/loss were directly linked to the number of MetS criteria (r = 0.186 and r = 0.170, respectively). Idealization was indirectly linked to MetS through poor diet (r = 0.183). The final model explained 21% of the variance in scores for the number of MetS criteria met.

Conclusions: Insecure adult attachment is associated with increased risk of MetS.
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http://dx.doi.org/10.1097/PSY.0000000000000107DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5483991PMC
October 2014

Cumulative adversity in early childhood is associated with increased BMI and behavioural problems.

Authors:
Judith A Crowell

Evid Based Nurs 2015 Apr 11;18(2):48-9. Epub 2014 Aug 11.

Department of Psychiatry, Stony Brook University, Stony Brook, New York, USA.

Implications for practice and research: Mental health problems and obesity are significant outcomes for children experiencing adversity in early life. Behavioural outcomes and body mass index (BMI) are more consistently reported for children experiencing adversity in early life compared with blood pressure (BP). Incomplete data due to drop out over time and a reliance on parental reporting are challenges for large longitudinal studies; future research directions include balancing and testing such investigations with smaller in-depth studies.
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http://dx.doi.org/10.1136/eb-2014-101878DOI Listing
April 2015

Early life adversity is associated with elevated levels of circulating leptin, irisin, and decreased levels of adiponectin in midlife adults.

J Clin Endocrinol Metab 2014 Jun 20;99(6):E1055-60. Epub 2014 Mar 20.

Division of Newborn Medicine (K.E.J.), Boston Children's Hospital, Boston, Division of Endocrinology and Metabolism (K.E.J., K.-H.P., L.Z., A.S.-E., B.T., M.B., C.S.M.), Beth Israel Deaconess Medical Center, and Harvard Medical School (K.E.J., C.S.M.), Boston, Massachusetts 02215; Department of Family Medicine (K.-H.P.), Hallym University Sacred Heart Hospital, Hallym University, Gyeonggi-do 431-070, Korea; Section of Endocrinology (L.Z., A.S.-E., B.T., M.B., C.S.M.), Division of Endocrinology, Boston Veterans Affairs Healthcare System, Jamaica Plain, Massachusetts 02130; Section of Endocrinology, Diabetes, and Nutrition (A.S.-E., B.T., C.S.M.), Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts 02118; Judge Baker Children's Center (N.U., D.W., C.R.D., J.A.C.), Boston, Massachusetts 02120; and Department of Psychiatry and Behavioral Sciences (J.A.C.), Stony Brook University School of Medicine, Stony Brook, New York 11794.

Context: Early-life adversity, defined as physical, emotional, or sexual abuse and neglect before 18 years of age, is associated with metabolic syndrome, obesity, and type 2 diabetes mellitus in adult life. However, the underlying mechanism is not fully understood, and whether adipomyokines are associated with early-life adversity independent of other factors such as body mass index, psychosocial risks, and health behaviors is not known.

Objectives: The objective of the study was to evaluate the association between early-life adversity and circulating the levels of the adipomyokines such as leptin, adiponectin, and irisin and the inflammatory marker, C-reactive protein (CRP). DESIGN/SUBJECTS/SETTING: This study was a cross-sectional study of 95 adults at a university-based research center. We collected venous blood from participants and analyzed serum for leptin, adiponectin, irisin, and CRP.

Results: Circulating leptin, irisin, and CRP levels were significantly higher in the highest adversity tertile group compared with low and middle tertile groups (P < .001 for leptin, P = .01 for irisin, and P = .02 for CRP). Adiponectin levels were lower in the highest tertile group compared with the low and middle tertile groups (P = .03). After adjusting for demographic variables, physical activity, diet, current mental health, and body mass index, the associations between early-life adversity leptin, irisin, and did not change. However, adiponectin and CRP levels were no longer significantly related to early life adversity.

Conclusion: Early-life adversity is directly associated with elevated circulating leptin and irisin, and indirectly associated with elevated CRP and decreased adiponectin. These findings suggest that these adipomyokines may play a role in the pathogenesis of metabolic abnormality in a population with significant early life adversity.
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http://dx.doi.org/10.1210/jc.2013-3669DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5377585PMC
June 2014

Diet quality is associated with circulating C-reactive protein but not irisin levels in humans.

Metabolism 2014 Feb 29;63(2):233-41. Epub 2013 Oct 29.

Division of Endocrinology, Diabetes, and Metabolism, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA; Section of Endocrinology, Boston VA Healthcare System, Harvard Medical School, Boston, MA 02130, USA.

Objective: Adherence to a healthy diet has been shown to decrease the incidence of obesity and associated comorbidities. C-reactive protein (CRP) is an established inflammatory marker and irisin was recently identified as a molecule which may play a role in energy regulation and obesity but whether diet alters irisin levels remains unknown. We aimed to investigate the association between circulating irisin, leptin, and CRP levels and dietary quantity and quality using the Alternate Healthy Eating Index (AHEI) and the Alternate Mediterranean Diet Score (aMED).

Materials/methods: The study evaluated dietary data and biomarker levels of 151 participants between 2009 and 2011 (71 male vs. 80 female, over 35 years old, obese 43.7%). AHEI and aMED scores were calculated based on data derived from self-administered 110-item food-frequency questionnaires estimating usual nutrient intake over the past year. Cross-sectional associations between dietary quantity, quality, body composition by bioelectric impedance, and biomarker levels including irisin, leptin, and CRP after fasting were assessed.

Results: CRP, but not irisin, was negatively correlated with AHEI (r=-0.34) and aMED (r=-0.31). Irisin was positively correlated with BMI (r=0.22), fat mass (r=0.21), waist circumference (r=0.24), waist-hip ratio (r=0.20), leptin (r=0.32), and CRP (r=0.25). Participants with the highest AHEI scores tended to have 11.6% lower concentrations of irisin (P for trend =0.09), but they were not significant after adjustment for potential confounders. Better diet quality was associated with lower CRP concentrations (P for trend=0.02) in multivariate model. Percentage of energy from carbohydrate was inversely associated with CRP.

Conclusions: Unlike CRP, irisin is not associated with dietary quality or quantity.
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http://dx.doi.org/10.1016/j.metabol.2013.10.011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4373656PMC
February 2014

Callous-unemotional traits, proactive aggression, and treatment outcomes of aggressive children with attention-deficit/hyperactivity disorder.

J Am Acad Child Adolesc Psychiatry 2013 Dec 25;52(12):1281-93. Epub 2013 Sep 25.

University of Texas Health Science Center (HSC) at San Antonio; North Shore-Long Island Jewish (LIJ) Health System. Electronic address:

Objective: Stimulant treatment improves impulse control among children with attention-deficit/hyperactivity disorder (ADHD). Decreased aggression often accompanies stimulant pharmacotherapy, suggesting that impulsiveness is integral to aggressive behavior in these children. However, children with high callous-unemotional (CU) traits and proactive aggression may benefit less from ADHD pharmacotherapy, because their aggressive behavior seems more purposeful and deliberate. This study's objective was to determine whether pretreatment CU traits and proactive aggression affect treatment outcomes among aggressive children with ADHD receiving stimulant monotherapy.

Method: We implemented a stimulant optimization protocol with 160 children 6 to 13 years of age (mean [SD] age of 9.31 [2.02] years; 78.75% male) with ADHD, oppositional defiant or conduct disorder, and significant aggressive behavior. Family-focused behavioral intervention was provided concurrently. The primary outcome was the Retrospective Modified Overt Aggression Scale. The Antisocial Process Screening Device and the Aggression Scale, also completed by parents, measured CU traits and proactive aggression, respectively. Analyses examined moderating effects of CU traits and proactive aggression on outcomes.

Results: In all, 82 children (51%) experienced remission of aggressive behavior. Neither CU traits nor proactive aggression predicted remission (CU traits: odds ratio [OR] = 0.94, 95% CI = 0.80-1.11; proactive aggression, OR = 1.05, 95% CI = 0.86-1.29). Children whose overall aggression remitted showed decreases in CU traits (effect size = -0.379, 95% CI = -0.60 to -0.16) and proactive aggression (effect size = -0.463, 95% CI = -0.69 to -0.23).

Conclusions: Findings suggest that pretreatment CU traits and proactive aggression do not forecast worse outcomes for aggressive children with ADHD receiving optimized stimulant pharmacotherapy. With such treatment, CU traits and proactive aggression may decline alongside other behavioral improvements. Clinical trial registration information--Medication Strategies for Treating Aggressive Behavior in Youth With Attention Deficit Hyperactivity Disorder; http://clinicaltrials.gov/; NCT00228046; and Effectiveness of Combined Medication Treatment for Aggression in Children With Attention Deficit With Hyperactivity Disorder (The SPICY Study); http://clinicaltrials.gov/; NCT00794625.
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http://dx.doi.org/10.1016/j.jaac.2013.08.024DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4530123PMC
December 2013

Detailed assessments of childhood adversity enhance prediction of central obesity independent of gender, race, adult psychosocial risk and health behaviors.

Metabolism 2014 Feb 7;63(2):199-206. Epub 2013 Nov 7.

Judge Baker Children's Center, 53 Parker Hill Avenue, Boston, MA 02120, USA; Department of Psychiatry and Behavioral Science, Stony Brook University School of Medicine, Stony Brook, NY.

Objective: This study examined whether a novel indicator of overall childhood adversity, incorporating number of adversities, severity, and chronicity, predicted central obesity beyond contributions of "modifiable" risk factors including psychosocial characteristics and health behaviors in a diverse sample of midlife adults. The study also examined whether the overall adversity score (number of adversities × severity × chronicity) better predicted obesity compared to cumulative adversity (number of adversities), a more traditional assessment of childhood adversity.

Materials/methods: 210 Black/African Americans and White/European Americans, mean age=45.8; ±3.3 years, were studied cross-sectionally. Regression analysis examined overall childhood adversity as a direct, non-modifiable risk factor for central obesity (waist-hip ratio) and body mass index (BMI), with and without adjustment for established adult psychosocial risk factors (education, employment, social functioning) and heath behavior risk factors (smoking, drinking, diet, exercise).

Results: Overall childhood adversity was an independent significant predictor of central obesity, and the relations between psychosocial and health risk factors and central obesity were not significant when overall adversity was in the model. Overall adversity was not a statistically significant predictor of BMI.

Conclusions: Overall childhood adversity, incorporating severity and chronicity and cumulative scores, predicts central obesity beyond more contemporaneous risk factors often considered modifiable. This is consistent with early dysregulation of metabolic functioning. Findings can inform practitioners interested in the impact of childhood adversity and personalizing treatment approaches of obesity within high-risk populations. Prevention/intervention research is necessary to discover and address the underlying causes and impact of childhood adversity on metabolic functioning.
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http://dx.doi.org/10.1016/j.metabol.2013.08.013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5423443PMC
February 2014

Circulating irisin in relation to insulin resistance and the metabolic syndrome.

J Clin Endocrinol Metab 2013 Dec 20;98(12):4899-907. Epub 2013 Sep 20.

Harvard Medical School, JP9B52A, Boston, MA 02130.

Context: Irisin, a recently identified hormone, has been proposed to regulate energy homeostasis and obesity in mice. Whether irisin levels are associated with risk of the metabolic syndrome (MetS), cardiometabolic variables, and cardiovascular disease (CVD) risk in humans remains unknown.

Objective: Our objective was to assess the associations between baseline serum irisin levels and MetS, cardiometabolic variables, and CVD risk.

Design, Setting, And Subjects: We conducted a comparative cross-sectional evaluation of baseline circulating levels of the novel hormone irisin and the established adipokine adiponectin with MetS, cardiometabolic variables, and CVD risk in a sample of 151 subjects.

Results: Baseline irisin levels were significantly higher in subjects with MetS than in subjects without MetS. Irisin was associated negatively with adiponectin (r = -0.4, P < .001) and positively with body mass index (r = 0.22, P = .008), systolic (r = 0.17, P = .04) and diastolic (r = 0.27, P = .001) blood pressure, fasting glucose (r = 0.25, P = .002), triglycerides (r = 0.25, P = .003), and homeostasis model assessment for insulin resistance (r = 0.33, P < .001). After adjustment for potential confounders, including body mass index, subjects in the highest tertile of irisin levels were more likely to have MetS (odds ratio [OR] = 9.44, 95% confidence interval [CI] = 2.66-33.44), elevated fasting blood glucose (OR = 5.80, 95% CI = 1.72-19.60), high triglycerides (OR = 3.89, 95% CI = 1.16-13.03), and low high-density lipoprotein cholesterol (OR = 3.30, 95% CI = 1.18-9.20). Irisin was independently associated with homeostasis model assessment for insulin resistance and general Framingham risk profile in multiple linear regression analyses after adjustment for confounders. Adiponectin demonstrated the expected associations with outcomes.

Conclusions: Irisin is associated with increased risk of MetS, cardiometabolic variables, and CVD in humans, indicating either increased secretion by adipose/muscle tissue and/or a compensatory increase of irisin to overcome an underlying irisin resistance in these subjects.
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http://dx.doi.org/10.1210/jc.2013-2373DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3849667PMC
December 2013

AAI coherence predicts caregiving and care seeking behavior: secure base script knowledge helps explain why.

Attach Hum Dev 2013 9;15(3):316-31. Epub 2013 Apr 9.

Department of Psychology, Emory University, Atlanta, GA, USA.

Previous research has demonstrated significant links between the Adult Attachment Interview (AAI) and secure base use and support in marital interactions. The mechanisms underlying such findings have not been examined in detail. This paper examines the hypothesis that script-like attachment representations shape both attachment narratives and attachment-related caregiving behavior and thus helps explain the correlation between them. Crowell et al. ( 2002 ) reported that AAI transcript coherence is significantly related to adults' caregiving and care seeking in couple problem solving interactions. In a random selection of 60 cases from that study, we assessed the extent to which interviewees conceptualized their early attachment experiences in terms of a secure base script. A series of regression analyses demonstrated that approximately 80% of the correlation between AAI coherence and laboratory caregiving and care seeking reported by Crowell et al. ( 2002 ) is accounted for by secure base script knowledge. Scoring secure base script knowledge from AAI transcripts is a useful step toward understanding links between early experience, adult attachment representations, and adults' ability to provide and seek support in close relationships.
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http://dx.doi.org/10.1080/14616734.2013.782657DOI Listing
February 2014

Anxiety in boys with attention-deficit/hyperactivity disorder with and without chronic multiple tic disorder.

J Child Adolesc Psychopharmacol 2009 Dec;19(6):737-48

Department of Psychiatry and Behavioral Science, Stony Brook University, Stony Brook, New York 11794-8790, USA.

Objective: This study examined the psychosocial and behavioral concomitants of anxiety in clinic-referred boys with attention-deficit/hyperactivity disorder (ADHD) with and without chronic multiple tic disorder (CMTD).

Method: ADHD boys with (n = 65) and without (n = 94) CMTD were evaluated with measures of psychiatric symptoms, mental health risk factors, and academic and social performance.

Results: Boys with CMTD evidenced more severe anxiety and less social competence and were more likely to be living with only one biological parent than the ADHD Only group, but the magnitude of group differences was generally small. The severity of generalized anxiety, separation anxiety, social phobia, and obsessive-compulsive symptoms were uniquely associated with a different pattern of risk factors, and there was some evidence that these patterns differed for the two groups of boys.

Conclusion: Boys with CMTD had a relatively more severe and complex pattern of anxiety that was associated with different clinical features, all of which suggests that ADHD plus CMTD might better be conceptualized as a distinct clinical entity from ADHD Only. However, findings from the extant literature are mixed, and therefore this remains a topic for further study.
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http://dx.doi.org/10.1089/cap.2009.0013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2830213PMC
December 2009

Parental divorce and adult children's attachment representations and marital status.

Attach Hum Dev 2009 Jan;11(1):87-101

State University of New York at Stony Brook, NY, USA.

The purpose of this study was to explore adult attachment as a means of understanding the intergenerational transmission of divorce, that is, the propensity for the children of divorce to end their own marriages. Participants included 157 couples assessed 3 months prior to their weddings and 6 years later. Participants completed the Adult Attachment Interview and questionnaires about their relationships, and were videotaped with their partners in a couple interaction task. Results indicated that, in this sample, adult children of divorce were not more likely to divorce within the first 6 years of marriage. However, parental divorce increased the likelihood of having an insecure adult attachment status. For women, age at the time of their parents' divorce was related to adult attachment status, and the influence on attachment representations may be more enduring. Among adult children of divorce, those who were classified as secure in their attachment representations were less likely to divorce in the early years of marriage than insecure participants.
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http://dx.doi.org/10.1080/14616730802500867DOI Listing
January 2009

Prospective associations from family-of-origin interactions to adult marital interactions and relationship adjustment.

J Fam Psychol 2008 Apr;22(2):274-86

Judge Baker Children's Center, Department of Psychiatry, Harvard Medical School, MA USA.

To test the social learning-based hypothesis that marital conflict resolution patterns are learned in the family of origin, longitudinal, observational data were used to assess prospective associations between family conflict interaction patterns during adolescence and offspring's later marital conflict interaction patterns. At age 14 years, 47 participants completed an observed family conflict resolution task with their parents. In a subsequent assessment 17 years later, the participants completed measures of marital adjustment and an observed marital conflict interaction task with their spouse. As predicted, levels of hostility and positive engagement expressed by parents and adolescents during family interactions were prospectively linked with levels of hostility and positive engagement expressed by offspring and their spouses during marital interactions. Family-of-origin hostility was a particularly robust predictor of marital interaction behaviors; it predicted later marital hostility and negatively predicted positive engagement, controlling for psychopathology and family-of-origin positive engagement. For men, family-of-origin hostility also predicted poorer marital adjustment, an effect that was mediated through hostility in marital interactions. These findings suggest a long-lasting influence of family communication patterns, particularly hostility, on offspring's intimate communication and relationship functioning.
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http://dx.doi.org/10.1037/0893-3200.22.2.274DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3072794PMC
April 2008

Attachment and externalizing disorders: a developmental psychopathology perspective.

J Am Acad Child Adolesc Psychiatry 2006 Apr;45(4):440-51

State University of New York at Stony Brook, NY 11794-8790, USA.

Objective: Attachment theory offers an intriguing formulation of protection and risk that ties together key aspects of behavior, emotion, and cognition. The authors present links among attachment status, other developmental domains, and the development and maintenance of externalizing disorders to illustrate an approach to integrating attachment theory and relationship research with the study of externalizing symptoms.

Method: The authors review the literature on the attachment system's theoretical and empirical associations with domains of emotion regulation, social attributions, socialization and moral development, and intergenerational transmission of behavior, as well as with externalizing behaviors.

Results: There are a number of risk and protective connections between attachment security and other developmental processes that are associated with externalizing disorders.

Conclusions: Knowledge of relational processes, in this case, attachment relationships, can contribute to an understanding of etiology, maintenance, and treatment of externalizing disorders.
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http://dx.doi.org/10.1097/01.chi.0000196422.42599.63DOI Listing
April 2006

Adolescent psychiatric hospitalization and mortality, distress levels, and educational attainment: follow-up after 11 and 20 years.

Arch Pediatr Adolesc Med 2004 Aug;158(8):749-52

Department of Psychiatry and Biobehavioral Sciences and Neuropsychiatric Institute, David Geffen School of Medicine, University of California, Los Angeles 90095-1759, USA.

Background: Adolescents with early psychiatric hospitalization are likely to be at a significant risk for long-term difficulties.

Objective: To examine early adulthood outcomes of psychiatrically hospitalized adolescents.

Design: Inception cohort recruited from 1978 to 1981 and observed until 2002.

Setting: Northeastern United States.

Participants: Adolescents (aged 12-15 years) from 2 matched cohorts were recruited and assessed repeatedly across 20 years: 70 psychiatrically hospitalized youths and 76 public high school students.

Main Outcome Measures: Death, emotional distress, high school completion, and educational attainment.

Results: Psychiatrically hospitalized youths were significantly more likely to die and to report higher levels of emotional distress. Hospitalized youths were significantly less likely to graduate from high school and complete college and graduate school.

Conclusions: The association between psychiatric symptoms sufficient to result in psychiatric hospitalization during adolescence and later mortality, emotional distress, high school completion, and educational attainment is striking. Further study is needed to identify and understand linkages between adolescent psychiatric impairment and decrements in adult functioning, particularly the processes that may underlie these linkages. Increasing school completion and educational attainment among hospitalized youths may minimize decrements in adult adaptation.
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http://dx.doi.org/10.1001/archpedi.158.8.749DOI Listing
August 2004

Reading others emotions: The role of intuitive judgments in predicting marital satisfaction, quality, and stability.

J Fam Psychol 2004 Mar;18(1):58-71

Judge Baker Children's Center and Harvard Medical School, Boston, MA, USA.

This study examined links between emotion expression in couple interactions and marital quality and stability. Core aspects of emotion expression in marital interactions were identified with the use of naive observational coding by multiple raters. Judges rated 47 marital discussions with 15 emotion descriptors. Coders' pooled ratings yielded good reliability on 4 types of emotion expression: hostility, distress, empathy, and affection. These 4 types were linked with concurrent marital satisfaction and interviewer ratings of marital adjustment as well as with marital stability at a 5-year follow-up. The study also examined the extent to which naive judges' ratings of emotion expression correspond to "expert" ratings using the Specific Affect Coding System (SPAFF). The unique advantages of naive coding of emotion expression in marital interaction are discussed.
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http://dx.doi.org/10.1037/0893-3200.18.1.58DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1770839PMC
March 2004

When "new" meets "old": configurations of adult attachment representations and their implications for marital functioning.

Dev Psychol 2004 Mar;40(2):295-314

Department of Psychology, State University of New York at Stony Brook, Stony Brook, NY, USA.

Two studies addressed the implications of concordance versus discrepancy of attachment representations in individuals at 2 stages in their marital relationships. Engaged (n = 157) and dating (n = 101) couples participated in a multimethod 6-year longitudinal study of adult attachment. Individuals completed the Adult Attachment Interview (AAI), the Current Relationship Interview (CRI), and various questionnaires and were observed in interactions with partners. On the basis of AAI and CRI classifications, participants were placed in one of four groups: Secure-sub(AAI)/Secure-sub(CRI), Secure-sub(AAI)/Insecure-sub(CRI), Insecure-sub(AAI)/Secure-sub(CRI), or Insecure-sub(AAI)/Insecure-sub(CRI). Each of the configurations showed a particular pattern of behavior, feelings about relationships and the self, and likelihood of relationship breakup. The findings of the studies address important points about the protective effects of attachment security and have interesting implications for the extension of attachment theory into adulthood.
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http://dx.doi.org/10.1037/0012-1649.40.2.295DOI Listing
March 2004

Assessment of attachment security in a clinical setting: observations of parents and children.

Authors:
Judith A Crowell

J Dev Behav Pediatr 2003 Jun;24(3):199-204

Child and Adolescent Psychiatry, State University of New York at Stony Brook, New York, USA.

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http://dx.doi.org/10.1097/00004703-200306000-00012DOI Listing
June 2003

Assessing secure base behavior in adulthood: development of a measure, links to adult attachment representations, and relations to couples' communication and reports of relationships.

Dev Psychol 2002 Sep;38(5):679-93

Department of Psychiatry, State University of New York at Stony Brook, 11794, USA.

A focus on the secure base phenomenon creates a framework for exploring the function of the attachment system in adulthood. Engaged couples (N = 157) were videotaped in a problem-solving interaction and assessed using the Secure Base Scoring System (SBSS), a system based on Ainsworth's analyses of infant-parent secure base use and support. Study 1 showed behavior was significantly related to representations assessed with the Adult Attachment Interview (M. Main & R. Goldwyn, 1994). In Study 2, the interactions were independently scored with the Rapid Marital Interaction Coding System (RMICS; R. E. Heyman & D. Vivian, 1993), a communication-based system. The SBSS predicted relationship variables beyond the RMICS, especially for women. Results indicate that the secure base phenomenon provides a cogent perspective on adult attachment behavior.
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September 2002

Stability of attachment representations: the transition to marriage.

Dev Psychol 2002 Jul;38(4):467-79

Department of Psychiatry, State University of New York at Stony Brook, 11794-2500, USA.

This study examined the stability of adult attachment representations across the transition to marriage. One hundred fifty-seven couples were assessed using the Adult Attachment Interview (AAI; C. George, N. Kaplan, & M. Main, 1985), the Current Relationship Interview (J. A. Crowell & G. Owens, 1996), and measures describing relationship functioning and life events 3 months prior to their weddings and 18 months into their marriages. The authors tested the hypotheses that attachment classifications are stable and that change is related to experiences in the relationship and/or life events; 78% of the sample received the same primary AAI classification (secure, preoccupied, and dismissing) at both times. Change was toward increased security and was associated with feelings and cognitions about the relationship. Only 46% of participants initially classified as unresolved retained the classification. Stability of the unresolved classification was associated with stressful life events and relationship aggression.
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http://dx.doi.org/10.1037//0012-1649.38.4.467DOI Listing
July 2002
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