Focusing on faces

Researchers find neurons in amygdala of autistic individuals have reduced sensitivity to eye region of others' faces Difficulties in social interaction are considered to be one of the behavioral hallmarks of autism spectrum disorders (ASDs). Previous studies have shown these difficulties to be related to differences in how the brains of autistic individuals process sensory information about faces. Now, a group of researchers led by California Institute of Technology (Caltech) neuroscientist Ralph Adolphs has made the first recordings of the firings of single neurons in the brains of autistic individuals, and has found specific neurons in a region called the amygdala that show reduced processing of the eye region of faces. Furthermore, the study found that these same neurons responded more to mouths than did the neurons seen in the control-group individuals. "We found that single brain cells in the amygdala of people with autism respond differently to faces in a way that explains many prior behavioral observations," says Adolphs, Bren Professor of Psychology and Neuroscience and professor of biology at Caltech and coauthor of a study in the November 20 issue of Neuron that outlines the team's findings. "We believe this shows that abnormal functioning in the amygdala is a reason that people with autism process faces abnormally." The amygdala has long been known to be important for the processing of emotional reactions. To make recordings from this part of the brain, Adolphs and lead author Ueli Rutishauser, assistant professor in the departments of neurosurgery and neurology at Cedars-Sinai Medical Center and visiting associate in biology at Caltech, teamed up with Adam Mamelak, professor of neurosurgery and director of functional neurosurgery at Cedars-Sinai, and neurosurgeon Ian Ross at Huntington Memorial Hospital in Pasadena, California, to recruit patients with epilepsy who had electrodes implanted in their medial temporal lobes—the area of the brain where the amygdala is located—to help identify the origin of their seizures. Epileptic seizures are caused by a burst of abnormal electric activity in the brain, which the electrodes are designed to detect. It turns out that epilepsy and ASD sometimes go together, and so the researchers were able to identify two of the epilepsy patients who also had a diagnosis of ASD. By using the implanted electrodes to record the firings of individual neurons, the researchers were able to observe activity as participants looked at images of different facial regions, and then correlate the neuronal responses with the pictures. In the control group of epilepsy patients without autism, the neurons responded most strongly to the eye region of the face, whereas in the two ASD patients, the neurons responded most strongly to the mouth region. Moreover, the effect was present in only a specific subset of the neurons. In contrast, a different set of neurons showed the same response in both groups when whole faces were shown. "It was surprising to find such clear abnormalities at the level of single cells," explains Rutishauser. "We, like many others, had thought that the neurological abnormalities that contribute to autism were spread throughout the brain, and that it would be difficult to find highly specific correlates. Not only did we find highly specific abnormalities in single-cell responses, but only a certain subset of cells responded that way, while another set showed typical responses to faces. This specificity of these cell populations was surprising and is, in a way, very good news, because it suggests the existence of specific mechanisms for autism that we can potentially trace back to their genetic and environmental causes, and that one could imagine manipulating for targeted treatment." "We can now ask how these cells change their responses with treatments, how they correspond to similar cell populations in animal models of autism, and what genes this particular population of cells expresses," adds Adolphs. To validate their results, the researchers hope to identify and test additional subjects, which is a challenge because it is very hard to find people with autism who also have epilepsy and who have been implanted with electrodes in the amygdala for single-cell recordings, says Adolphs. "At the same time, we should think about how to change the responses of these neurons, and see if those modifications correlate with behavioral changes," he says MHC Continuing Education ### Funding for the research outlined in the Neuron paper, titled "Single-neuron correlates of abnormal face processing in autism," was provided by the Simons Foundation, the Gordon and Betty Moore Foundation, the Cedars-Sinai Medical Center, Autism Speaks, and the National Institute of Mental Health. Additional coauthors were Caltech postdoctoral scholar Oana Tudusciuc and graduate student Shuo Wang.

Most teen mental health problems go untreated

Less than half of teenagers with mental health problems receive any sort of treatment DURHAM, N.C. -- More than half of adolescents with psychiatric disorders receive no treatment of any sort, says a new study by E. Jane Costello, a Duke University professor of psychology and epidemiology and associate director of the Duke Center for Child and Family Policy. When treatment does occur, the providers are rarely mental health specialists, says the study, which was based on a survey of more than 10,000 American teenagers LPC Continuing Education The country's mental health system has come under scrutiny in recent years, following a string of mass shootings, such as the murders at Columbine High in Colorado, in which mental illness seems to have played a role. The new study underlines the need for better mental health services for adolescents, Costello said. "It's still the case in this country that people don't take psychiatric conditions as seriously as they should," Costello said. "This, despite the fact that these conditions are linked to a whole host of other problems." Costello noted that not all teens in the study fared the same. Treatment rates varied greatly for different mental disorders, for instance. Adolescents with ADHD, conduct disorder or oppositional defiant disorder received mental health care more than 70 percent of the time. By contrast, teens suffering from phobias or anxiety disorders were the least likely to be treated. Results also varied greatly by race, with black youths significantly less likely to be treated for mental disorders than white youths. The care that teenagers received also varied greatly. In many cases, care was provided by pediatricians, school counselors or probation officers rather than by people with specialized mental health training. There simply are not enough qualified child mental health professionals to go around, Costello said. "We need to train more child psychiatrists in this country," Costello said. "And those individuals need to be used strategically, as consultants to the school counselors and others who do the lion's share of the work." The study draws on data from the National Comorbidity Survey Adolescent Supplement, a nationally representative face-to-face survey of 10,148 adolescents between the ages of 13 and 17. It was published online Nov. 15 in Psychiatric Services Youth with Co-occuring Substance Abuse and Mental Health Disorders CE Course ### The research was supported by NIDA (grants U01-DA024413, DA011301, and DA022308), NIMH (grant MH083964), and the NIMH Intramural Research Program. CITATION: "Services for Adolescents With Psychiatric Disorders: 12-Month Data From the National Comorbidity Survey–Adolescent," E. Jane Costello, Jian-ping He, Nancy A. Sampson, Ronald C. Kessler and Kathleen Ries Merikangas. Psychiatric Services 2013. doi: 10.1176/appi.ps.201100518

Bradley Hospital researchers link lack of sleep in teens to higher risk of illness

Study also finds consistent sleep pattern can reduce risk of illness EAST PROVIDENCE, R.I. – Newly released findings from Bradley Hospital published in the Journal of Sleep Research have found that acute illnesses, such as colds, flu, and gastroenteritis were more common among healthy adolescents who got less sleep at night. Additionally, the regularity of teens' sleep schedules was found to impact their health. The study, titled "Sleep patterns are associated with common illness in adolescents," was led by Kathryn Orzech, Ph.D. of the Bradley Hospital Sleep Research Laboratory CEUs For Nurses Orzech and her team compared three outcomes between longer and shorter sleepers: number of illness bouts, illness duration, and school absences related to illness. The team found that bouts of illness declined with longer sleep for both male and female high school students. Longer sleep was also generally protective against school absences that students attributed to illness. There were gender differences as well, with males reporting fewer illness bouts than females, even with similar sleep durations. Orzech's team analyzed total sleep time in teens for six-day windows both before and after a reported illness and found a trend in the data toward shorter sleep before illness vs. wellness. Due to the difficulty of finding teens whose illnesses were spaced in such a way to be statistically analyzed, Orzech also conducted qualitative analysis, examining individual interview data for two short-sleeping males who reported very different illness profiles. This analysis suggested that more irregular sleep timing across weeknights and weekends (very little sleep during the week and "catching up" on sleep during the weekend), and a preference for scheduling work and social time later in the evening hours can both contribute to differences in illness outcomes, conclusions that are also supported in the broader adolescent sleep literature. "Some news reaches the general public about the long-term consequences of sleep deprivation, such as the links between less sleep and weight gain," said Orzech. "However, most of the studies of sleep and health have been done under laboratory conditions that cannot replicate the complexities of life in the real world. Our study looked at rigorously collected sleep and illness data among adolescents who were living their normal lives and going to school across a school term." "We showed that there are short-term outcomes, like more acute illness among shorter-sleeping adolescents, that don't require waiting months, years or decades to show up," Orzech continued. "Yes, poor sleep is linked to increased cardiovascular disease, to high cholesterol, to obesity, to depression, etc., but for a teenager, staying healthy for the dance next week, or the game on Thursday, may be more important. This message from this study is clear: Sleep more, and more regularly, get sick less." Mary Carskadon, Ph.D., director of the Bradley Hospital Sleep Research Laboratory, commented on Orzech's study, "We have long been examining the sleep cycles of teenagers and how we might be able to help adolescents - especially high school students - be better rested and more functional in a period of their lives where sleep seems to be a luxury." Carskadon continued, "In the future, these findings identifying specific issues in individual sleep patterns may be a useful way to help adolescents begin to prioritize sleep." ### Research reported in this publication was supported by the National Institute of Mental Health of the National Institutes of Health under award numbers MH45945 and MH79179, and T32 training grant MH19927. Direct financial and infrastructure support for this project was received through the Lifespan Office of Research Administration. The principal affiliation of Carskadon is Bradley Hospital (a member hospital of the Lifespan health system in Rhode Island). She is also a professor of psychiatry and human behavior at The Warren Alpert Medical School of Brown University. Orzech was a postdoctoral fellow in the Bradley Hospital Sleep Research Laboratory at the time of the research, and is currently a postdoctoral fellow with the Charting the Digital Lifespan project based at the University of Dundee in Scotland, UK. About Bradley Hospital Founded in 1931, Bradley Hospital, located in East Providence, R.I., was the nation's first psychiatric hospital devoted exclusively for children and adolescents. It remains a nationally recognized center for children's mental health care, training and research. Bradley Hospital was awarded the distinction of 'Top Performer on Key Quality Measures' for both 2011 and 2012 by The Joint Commission, the leading accreditor of health organizations in the U.S. Bradley Hospital is the only hospital in Rhode Island and the only psychiatric hospital in New England to receive this designation. Bradley Hospital is a member of the Lifespan health system and is a teaching hospital for The Warren Alpert Medical School of Brown University. Follow us on Facebook and on Twitter (@BradleyHospital).

Regenstrief and IU study: Older adults with severe mental illness challenge healthcare system

INDIANAPOLIS – Although older adults with serious mental illness didn't have more recorded physical illness and had fewer outpatient visits to primary care physicians, they made more medical emergency department visits and had considerably longer medical hospitalizations than older adults without mental illness according to a study conducted by researchers from the Regenstrief Institute and the Indiana University Center for Aging Research. "Our comparison of health care utilization between seriously mentally ill patients and age-matched primary-care patients provides critical data for the physicians, health care systems and policy makers who will be caring for the growing number of older adults, many of whom have mental illness," said Regenstrief Institute investigator Hugh C. Hendrie, M.B., Ch.B., D.Sc., Indiana University Center for Aging Research center scientist and professor of psychiatry at the IU School of Medicine. Dr. Hendrie, who is a geriatric psychiatrist and health services researcher, is the first author of the study. The study, "Comorbidity Profile and Healthcare Utilization in Elderly Patients With Serious Mental Illnesses," is published in the December issue of The American Journal of Geriatric Psychiatry. A 2012 report from the Institute of Medicine estimated that as many of one in five older adults have one or more mental health conditions or problems stemming from substance misuse or abuse. The IOM report authors included Regenstrief Institute investigator Christopher Callahan, M.D., Cornelius and Yvonne Pettinga Professor of Medicine at the IU School of Medicine who is also a co-author of the new study. Dr. Callahan is founding director of the IU Center for Aging Research Social Worker Continuing Education The American Journal of Geriatric Psychiatry study notes, "The increased likelihood of falls together with the significantly greater number of emergency department visits and length of hospitalization also suggest that those with severe mental illness represent a vulnerable elderly population that deserve more intensive studies, leading hopefully to a better integrated model of medical and psychiatric care including consideration of psychosocial factors." Individuals with severe mental illness in the study were patients of Eskenazi Health Midtown Community Mental Health. The patients had severe chronic depression (48 percent), schizophrenia (39 percent) and bipolar disorder (14 percent). Others in the study were patients from Wishard-Eskenazi primary care sites. "This study highlights a major challenge faced by older adults with severe mental illnesses and the increased burden it places on our health care system," said Julie L. Szempruch, RN, CNS, associate vice president of Eskenazi Health Midtown Community Mental Health. ### Authors of "Comorbidity Profile and Healthcare Utilization in Elderly Patients With Serious Mental Illnesses," in addition to Drs. Hendrie and Callahan, are Donald Lindgren, LCSW, Donald P. Hay, M.D., Kathleen A. Lane, M.S., Sujuan Gao, Ph.D., Christianna Purnell, B.A., Stephanie Munger, M.P.H., Faye Smith, M.A., Jeanne Dickens, M.D., and Malaz A. Boustani, M.D., M.P.H. The study was supported by National Institute of Mental Health grant MH080827-01A1.

Clinician observations of preschoolers' behavior help to predict ADHD at school age

Consider how preschool children behave across multiple contexts to identify those at risk for later ADHD, study emphasizes Don't rely on one source of information about your preschoolers' inattention or hyperactivity. Rather, consider how your child behaves at home as well as information from his or her teacher and a clinician. This advice comes from Sarah O'Neill, of The City College of New York, based on research she conducted at Queens College (CUNY), in an article published in Springer's Journal of Abnormal Child Psychology. The study examines how well parent, teacher, and clinician ratings of preschoolers' behavior are able to predict severity and diagnosis of attention deficit hyperactivity disorder (ADHD) at age six Professional Counselor Continuing Education Characterized by developmentally inappropriate levels of inattention, hyperactivity, and impulsivity, ADHD is one of the most frequently diagnosed childhood psychiatric disorders. Although many studies focusing on school-aged children have shown that parents and teachers -- rather than clinician observations alone -- are more likely to assess ADHD accurately, scant evidence exists to support similar conclusions with preschoolers. To fill this gap in the research, O'Neill and colleagues followed a group of 104 hyperactive and/or inattentive three- and four-year-olds for a period of two years. Both parents and teachers rated the preschoolers' behavior. In addition, clinicians, who were blind to parent and teacher reports, completed ratings of preschoolers' behavior during a psychological testing session. By the time the children reached age six, more than half (53.8 percent) had been diagnosed with ADHD. The likelihood of such a diagnosis increased when all three informants had rated the child as high on symptoms at age three or four. Furthermore, after analyzing the reports separately, the research team found that parents' reports were critical, particularly when combined with either teacher or clinician reports. Teacher reports alone were not as useful, and the research team ascribed the relative inability of educators' reports to predict a child's ADHD status over time to possible situational variables. Preschoolers may initially have difficulty adjusting to the structured classroom setting, but this disruptive behavior is time-limited to the transition to school. Teachers' perceptions of "difficult" behavior may also be affected by factors such as classroom setting and size as well as their expectations of children's behavior. As a result of the study findings, O'Neill and her team emphasize the importance of using information from multiple informants who have seen the child in different settings. Parent reports of preschoolers' behavior appear to be crucial, but these alone are not sufficient. Augmenting the parent report with that of the teacher and/or clinician is necessary. Also important are clinician observations of preschoolers during psychological testing, which are predictive of an ADHD diagnosis and its severity over time. Being able to identify children at risk for poorer outcomes may help educators and clinicians to plan appropriate interventions. "Consider a preschool child's behavior in different contexts," O'Neill emphasized. "Although parents' reports of preschoolers' inattention, hyperactivity, or impulsivity are very important, ideally we would not rely solely on them. At least for young children, the clinician's behavioral observations appear to hold prognostic utility." ### Reference: O'Neill, S. et al. (2013). Reliable Ratings or Reading Tea Leaves: Can Parent, Teacher, and Clinician Behavioral Ratings of Preschoolers Predict ADHD at Age Six? Journal of Abnormal Child Psychology. DOI 10.1007/s10802-013-9802-4

Johns Hopkins research may improve early detection of dementia

Using scores obtained from cognitive tests, Johns Hopkins researchers think they have developed a model that could help determine whether memory loss in older adults is benign or a stop on the way to Alzheimer's disease. The risk of developing dementia increases markedly when a person is diagnosed with mild cognitive impairment, a noticeable and measurable decline in intellectual abilities that does not seriously interfere with daily life. But physicians have no reliable way to predict which people with mild cognitive impairment are likely to be in the 5 to 10 percent a year who progress to dementia. In a proof-of-concept study, the Johns Hopkins investigators analyzed records of 528 people age 60 and over, who were referred to the Johns Hopkins Medical Psychology Clinic for cognitive testing as part of a dementia work-up between 1996 and 2004. The results were compared to those of 135 healthy older adults who participated in a study of normal aging. Both groups completed tests of memory, language, attention, processing speed and drawing abilities from which 13 scores were recorded Nursing CEUs Since each person is naturally more skillful in some areas than in others, the scores of healthy adults showed a symmetrical, bell-shaped range: Most of their scores were high, a few were a bit lower, and a few were even lower. By grouping the patients into cohorts based on the severity of their dementia, the researchers found a trend in the test scores that is likely to mimic the deterioration of an individual's scores over time. At the outset, he says, Alzheimer's disease subtly disrupts some mental abilities, while leaving others intact. Thus, well before a person develops clear cognitive impairment, his or her performance declines slightly on a few measures. When shown on a graph, these changes cause the healthy symmetric, bell-shaped curve to shift and become asymmetrical. Regardless of how low a person's test scores were, the researchers determined that lopsidedness in their score distribution correlated with dementia. They predicted that people with low scores that were evenly distributed were not likely to develop dementia. But those with clearly lopsided test score distributions on the 13 measures administered were already experiencing varying levels of dementia. "Departures from the normal bell-shaped pattern of variability on cognitive tests might determine which people with low scores develop dementia," says David J. Schretlen, Ph.D., a professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine and leader of a study published online Nov. 12 in the journal Neuropsychology. Since these declines can be subtle, the researchers also increased the precision of cognitive testing by accounting for the effects of age, sex, race and education on test performance. The challenge for doctors, Schretlen explains, is that most normal, healthy people will produce a few low scores on cognitive testing. That makes it nearly impossible to know at the outset whether a patient who reports forgetfulness and produces one or two low scores has a benign form of mild cognitive impairment, or is in the earliest stage of dementia. As a result, doctors often tell such patients to return for follow-up testing in a year or two. But if future research confirms it, this new statistical model could help doctors get the prognosis right earlier in the disease, at the first visit, and start treating patients accordingly. Mostly, Schretlen says, doctors could use the new model to reassure patients who are not at risk of dementia, while fast-tracking interventions for those who are. Because there currently are no effective treatments for Alzheimer's disease, those likely headed that way could be counseled to take the good time they have to organize their affairs, and do things they have always wanted to do. They also could be fast-tracked into clinical trials of medications to slow the progression of dementia. "If we are going to have any hope of helping patients with Alzheimer's disease, we need to do it as early as possible," Schretlen says. "Once the brain deteriorates, there's no coming back." Recent failures of drugs in late-stage clinical trials for Alzheimer's disease have been a real blow, he adds, but new treatments are being developed. The new way of reading existing test scores follows a 2008 study by the same researchers showing that one of every six healthy adults scored poorly on two or more of 10 tests in a brief cognitive battery — even though there was nothing wrong with them. The main reason it is difficult to tell whether older people have benign mild cognitive impairment or not is because they are not routinely screened for cognitive impairment, he says. A visit to a specialist comes only after someone has noticed symptoms, and then cognitive testing is interpreted without the benefit of a baseline assessment. What would solve this problem, he says, would be for everyone over the age of 55 to get routine neurocognitive testing every five years. ### The study was supported by the Therapeutic Cognitive Neuroscience Fund; the Benjamin and Adith Miller Family Endowment on Aging, Alzheimer's and Autism; the William and Mary Ann Wockenfuss Research Fund Endowment; and the National Institutes of Health's National Institute of Mental Health (MH60504). Under an agreement with Psychological Assessment Resources, Inc., Schretlen is entitled to a share of royalties on sales of a test and software used in the study. The terms of this arrangement are being managed by The Johns Hopkins University in accordance with its conflict-of-interest policies. Other Johns Hopkins researchers involved in the study include Gila Z. Reckess, Ph.D.; Mark Varvaris, B.A.; and Barry Gordon, M.D., Ph.D. For more information about Schretlen, click here. Johns Hopkins Medicine (JHM), headquartered in Baltimore, Maryland, is a $6.7 billion integrated global health enterprise and one of the leading health care systems in the United States. JHM unites physicians and scientists of the Johns Hopkins University School of Medicine with the organizations, health professionals and facilities of The Johns Hopkins Hospital and Health System. JHM's vision, "Together, we will deliver the promise of medicine," is supported by its mission to improve the health of the community and the world by setting the standard of excellence in medical education, research and clinical care. Diverse and inclusive, JHM educates medical students, scientists, health care professionals and the public; conducts biomedical research; and provides patient-centered medicine to prevent, diagnose and treat human illness. JHM operates six academic and community hospitals, four suburban health care and surgery centers, and more than 30 primary health care outpatient sites. The Johns Hopkins Hospital, opened in 1889, was ranked number one in the nation for 21 years in a row by U.S. News & World Report. For more information about Johns Hopkins Medicine, its research, education and clinical programs, and for the latest health, science and research news, visit http://www.hopkinsmedicine.org Aging and Long Term Care CE Course Johns Hopkins Medicine Media Relations and Public Affairs

MFT Intern Continuing Education

The California Board of Behavioral Sciences (CA BBS) has approved Aspira Continuing Education as a CE provider for MFT Interns (provider #PCE4374). Only certain courses are approved to be taken from an approved online CE provider like Aspira. The following Aspira courses are approved to be taken online by California MFT Interns. Click on the link below to go to the corresponding CEU Course Description page: •Child Abuse Assessment and Reporting CEU Course (7 hours) •Human Sexuality CEU Course (10 hours) •Spousal and Partner Abuse CEU Course (15 hours) •Aging and Long Term Care CEU Course (10 hours) Click here: BBS Website – Additional Coursework Requirements for verification. The following extra coursework is required as well but must be taken at an approved university: •Alcoholism and Chemical Dependency (1 semester unit; must be in your degree program if your school is in California) •Psychological Testing (2 semester units or 3 quarter units) •Psychopharmacology (2 semester units or 3 quarter units) •California Law and Professional Ethics (2 semester units or 3 quarter units) View Aspira's CEU Pricing page to see how to pay for Aspira's CE courses. View Aspira's CEU Offers page to see the latest offers and discounts available. Also, see how to earn free CEUs.

New study identifies signs of autism in the first months of life

Scientists at Marcus Autism Center, Children's Healthcare of Atlanta and Emory University School of Medicine identify markers of social disability present in 2 to 6-month-old infants later diagnosed with autism Researchers at Marcus Autism Center, Children's Healthcare of Atlanta and Emory University School of Medicine have identified signs of autism present in the first months of life. The researchers followed babies from birth until 3 years of age, using eye-tracking technology, to measure the way infants look at and respond to social cues. Infants later diagnosed with autism showed declining attention to the eyes of other people, from the age of 2 months onwards. The results are reported in the Nov. 6, 2013 advanced online publication of the journal Nature. The study followed two groups of infants, one at low and one at high risk for having autism spectrum disorders. High-risk infants had an older sibling already diagnosed with autism, increasing the infant's risk of also having the condition by 20 fold. In contrast, low-risk infants had no first, second, or third degree relatives with autism. "By following these babies from birth, and intensively within the first six months, we were able to collect large amounts of data long before overt symptoms are typically seen," said Warren Jones, Ph.D., the lead author on the study. Teams of clinicians assessed the children longitudinally and confirmed their diagnostic outcomes at age 3. Then the researchers analyzed data from the infants' first months to identify what factors separated those who received an autism diagnosis from those who did not. What they found was surprising MFT Intern Continuing Education "We found a steady decline in attention to other people's eyes, from 2 until 24 months, in infants later diagnosed with autism," said co-investigator Ami Klin, Ph.D., director of Marcus Autism Center. Differences were apparent even within the first 6 months, which has profound implications. "First, these results reveal that there are measurable and identifiable differences present already before 6 months. And second, we observed declining eye fixation over time, rather than an outright absence. Both these factors have the potential to dramatically shift the possibilities for future strategies of early intervention." Jones is director of research at Marcus Autism Center and assistant professor in the Department of Pediatrics at Emory University School of Medicine. Klin is director of Marcus Autism Center, chief of the Division of Autism & Related Disorders in the Department of Pediatrics at Emory University School of Medicine and a Georgia Research Alliance Eminent Scholar. The researchers caution that what they observed would not be visible to the naked eye, but requires specialized technology and repeated measurements of a child's development over the course of months. "To be sure, parents should not expect that this is something they could see without the aid of technology," said Jones, "and they shouldn't be concerned if an infant doesn't happen to look at their eyes at every moment. We used very specialized technology to measure developmental differences, accruing over time, in the way that infants watched very specific scenes of social interaction." Before they can crawl or walk, babies explore the world intensively by looking at it, and they look at faces, bodies, and objects, as well as other people's eyes. This exploration is a natural and necessary part of infant development, and it sets the stage for brain growth. The critical implications of the study relate to what it reveals about the early development of social disability. Although the results indicate that attention to others' eyes is already declining by 2 to 6 months in infants later diagnosed with autism, attention to others' eyes does not appear to be entirely absent. If infants were identified at this early age, interventions could more successfully build on the levels of eye contact that are present. Eye contact plays a key role in social interaction and development, and in the study, those infants whose levels of eye contact diminished most rapidly were also those who were most disabled later in life. This early developmental difference also gives researchers a key insight for future studies. "The genetics of autism have proven to be quite complex. Many hundreds of genes are likely to be involved, with each one playing a role in just a small fraction of cases, and contributing to risk in different ways in different individuals," said Jones. "The current results reveal one way in which that genetic diversity may be converted into disability very early in life. Our next step will be to expand these studies with more children, and to combine our eye-tracking measures with measures of gene expression and brain growth." ### The study, Attention to Eyes is Present But In Decline in 2-6 Month-Olds Later Diagnosed with Autism was funded by the Simons Foundation, the National Institute of Mental Health, the Marcus Foundation and the Whitehead Foundation. More information can be found at http://www.marcus.org/infants. Marcus Autism Center Marcus Autism Center is a not-for-profit organization and an affiliate of Children's Healthcare of Atlanta that treats more than 5,500 children with autism and related disorders a year. As one of the largest autism centers in the U.S. and one of only three National Institutes of Health Autism Centers of Excellence, Marcus Autism Center offers families access to the latest research, comprehensive evaluations and intensive behavior treatments. With the help of research grants, community support and government funding, Marcus Autism Center aims to maximize the potential of children with autism today and transform the very nature of autism for future generations. Visit marcus.org for more information.

OHSU Vollum Institute research gives new insight into how antidepressants work in the brain

Vollum Institute scientist publishes two papers on neurotransmission in today’s edition of Nature Research from Oregon Health & Science University's Vollum Institute, published in the current issue of Nature, is giving scientists a never-before-seen view of how nerve cells communicate with each other. That new view can give scientists a better understanding of how antidepressants work in the human brain — and could lead to the development of better antidepressants with few or no side effects. The article in today’s edition of Nature came from the lab of Eric Gouaux, Ph.D., a senior scientist at OHSU's Vollum Institute and a Howard Hughes Medical Institute Investigator. The article describes research that gives a better view of the structural biology of a protein that controls communication between nerve cells. The view is obtained through special structural and biochemical methods Gouaux uses to investigate these neural proteins. The Nature article focuses on the structure of the dopamine transporter, which helps regulate dopamine levels in the brain. Dopamine is an essential neurotransmitter for the human body's central nervous system; abnormal levels of dopamine are present in a range of neurological disorders, including Parkinson's disease, drug addiction, depression and schizophrenia. Along with dopamine, the neurotransmitters noradrenaline and serotonin are transported by related transporters, which can be studied with greater accuracy based on the dopamine transporter structure. The Gouaux lab's more detailed view of the dopamine transporter structure better reveals how antidepressants act on the transporters and thus do their work Alcoholism and Drug Abuse Counselors Continuing Education The more detailed view could help scientists and pharmaceutical companies develop drugs that do a much better job of targeting what they're trying to target — and not create side effects caused by a broader blast at the brain proteins. "By learning as much as possible about the structure of the transporter and its complexes with antidepressants, we have laid the foundation for the design of new molecules with better therapeutic profiles and, hopefully, with fewer deleterious side effects," said Gouaux. Gouaux's latest dopamine transporter research is also important because it was done using the molecule from fruit flies, a dopamine transporter that is much more similar to those in humans than the bacteria models that previous studies had used. The dopamine transporter article was one of two articles Gouaux had published in today’s edition of Nature. The other article also dealt with a modified amino acid transporter that mimics the mammalian neurotransmitter transporter proteins targeted by antidepressants. It gives new insights into the pharmacology of four different classes of widely used antidepressants that act on certain transporter proteins, including transporters for dopamine, serotonin and noradrenaline. The second paper in part was validated by findings of the first paper — in how an antidepressant bound itself to a specific transporter. "What we ended up finding with this research was complementary and mutually reinforcing with the other work — so that was really important," Gouaux said. "And it told us a great deal about how these transporters work and how they interact with the antidepressant molecules." Gouaux's discoveries over the years in neurotransmission have established him as one of the top investigators in his field. His research has important implications for understanding the mechanisms of not just antidepressants, but also drugs used for the treatment of a wide range of psychiatric and neurological diseases. Gouaux's co-authors on the dopamine transporter paper were both members of his lab; Aravind Penmatsa, Ph.D., and Kevin Wang, Ph.D. Gouaux's co-authors on the second Nature paper were also members or former members of his lab: Hui Wang, Ph.D.; April Goehring, Ph.D.; Kevin Wang, Aravind Penmatsa and Ryan Ressler, Ph.D. Both papers were funded by the American Heart Association, the National Institute of Mental Health, (1F32MH093120 and 5R37MH070039) and the Howard Hughes Medical Institute. About the OHSU Vollum Institute The Vollum Institute is a privately endowed research institute at OHSU and is dedicated to basic research that will lead to new treatments for neurological and psychiatric diseases. Vollum scientists have transformed the field of neuroscience and, in particular, have been pioneers in the study of cellular signaling, neuronal development, gene regulation and the neurobiology of disease. About OHSU Oregon Health & Science University is a nationally prominent research university and Oregon’s only public academic health center. It serves patients throughout the region with a Level 1 trauma center and nationally recognized Doernbecher Children’s Hospital. OHSU operates dental, medical, nursing and pharmacy schools that rank high both in research funding and in meeting the university’s social mission. OHSU’s Knight Cancer Institute helped pioneer personalized medicine through a discovery that identified how to shut down cells that enable cancer to grow without harming healthy ones. OHSU Brain Institute scientists are nationally recognized for discoveries that have led to a better understanding of Alzheimer’s disease and new treatments for Parkinson’s disease, multiple sclerosis and stroke. OHSU’s Casey Eye Institute is a global leader in ophthalmic imaging, and in clinical trials related to eye disease.

Depression Therapy Effective for Poor, Minority Moms

Faced with the dual demands of motherhood and poverty, as many as one fourth of low-income minority mothers struggle with major depression. But the stigma associated with mental illness coupled with limited access to quality treatment prevent the majority of these struggling women from receiving help. Now a new study shows that screening for the disorder and providing short-term, relationship-focused therapy through weekly home visits can relieve depression among minority mothers, even in the face of poverty and personal histories of abuse or violence. Such help can have far reaching benefits not only for mothers, but also for their children, say the authors. "It's amazing, really," says psychologist Sheree Toth, lead author and executive director of the University of Rochester's Mt. Hope Family Center. "This research tracked a 14-week intervention for mothers who are terribly overwhelmed, surrounded by high-crime neighborhoods, lacking social support, and often traumatized—my fear was, 'this is never going to work.'" But to the surprise of Toth and her Rochester team, the series of convenient, one-hour therapy sessions relieved depression in participants much better than standard clinic-based care. The study participants also continued to improve eight-months after the treatment ended, regaining a sense of hope and control over their lives and reporting feeling more connected to and supported by others. For example, on the Beck Depression Inventory (BDI), a widely used questionnaire in which a score of 19 or above indicates major depression, women in the study group saw their depressive symptoms decline from an average of 27 at the beginning of therapy to 9.6 eight months after the program concluded. By contrast, women who received community care remained clinically depressed, with an average BDI score of 21 at the follow-up.

Women who received home-based interpersonal therapy saw their depression subside by the end of treatment and continue to improve eight months later. Women who received standard care experienced much less relief. The results, says Toth, point to the need for screening high-risk populations. None of these women were seeking treatment, but were identified instead through a questionnaire and an interview at physicians' offices and clinics for the Women, Infants, and Children (WIC) subsidized nutrition program. Says Toth: "When I go to the doctor, they ask me if I use my seatbelt. Why would we not be asking questions about depression when we know the chances of being hit by a car are way less than the chances of being hit by depression? People are suffering needlessly." Published online November 8 in Development and Psychopathology, the findings are good news for mothers and their children alike. "Extensive research has shown that young children whose primary caregivers are depressed often begin life on the wrong foot," explains Toth. "They may fail to develop secure attachments, setting them up for a cascade of difficulties, from behavior problems during childhood and failure in school to involvement in the juvenile justice system and major psychiatric problems down the road." Despite the widespread prevalence of depression among minority mothers, researchers have largely overlooked this vulnerable population. "In fact, studies that formed the empirical base for the American Psychiatric Association guidelines for depression treatment included 3,860 participants, with only 27 identified as African American and none as being of Latina descent," the authors write. To address the imbalance, the researchers tracked 128 low-income mothers of one-year-olds, 60 percent of whom were Black, 20 percent Hispanic, and 20 percent Caucasian. In addition to poverty, the vast majority of these mothers faced extensive life challenges. All but 6 percent had been depressed for more than a year, 87 percent reported histories of child abuse, 30 percent had been raped or sexually assaulted by a relative, and 27 percent suffered from posttraumatic stress disorder. The study tested the effectiveness of interpersonal psychotherapy, a short-term depression treatment that has worked with more advantaged populations. "A big part of this approach is instilling hope," says Robin Sturm, a co-author and one of the family therapists who worked on the study. She and other therapists first help clients recognize that feelings, such as a lack of energy or motivation, are symptoms of depression not signs of laziness or other character flaws. "If they can separate themselves from the symptoms, it helps them see that they can get better," says Sturm. The bulk of the intervention then focuses on identifying and easing one or two key relationship problems in clients' lives. This could be overcoming the loss of a loved one, reconnecting with a family member, or learning how to resolve conflicts with a partner. Using a variety of tools, from role-playing to analyzing arguments, participants practice more effective ways to interact. "The aha moment is when these women realize, 'I have a sense of control,'" says Sturm. "Perhaps there is domestic violence. They can't control what the other person does, but they can control what they do. That stuck feeling is the hallmark of depression." A critical element of the study model was to offer therapy in clients' homes, an option chosen by 85 percent of participants. "It sends a powerful message that I am willing to come to you," explains Sturm, who, if needed, also met with clients in her car or drove them to the clinic for their appointment. "When people are depressed, it may be too hard to have the energy to make it to appointments," she says. The program's flexibility also reduced the need for childcare and transportation, resulting in a compliance rate of 100 percent, the authors report. Therapists were also sensitive to the stigma of mental illness in minority communities. If clients appeared uncomfortable with a diagnosis like depression, therapists used terms like overwhelmed or moody instead and stressed that such feelings were common for parents faced with the demands of childrearing. Instead of therapy, they sometimes describe their appointments as "spending some time talking about how you are feeling." The program involved no anti-depressants or other medication, further distancing the intervention from psychiatric care, says Sturm. To assess the effectiveness of this flexible, problem-solving approach, the study randomly assigned a second group of mothers to standard community care, matched by race, education, age, and other factors. The control group received clinic-based counseling or cognitive behavior therapy, a common short-term treatment for depression, along with a variety of other interventions, including medication, support groups, and marital and family counseling. The comparison was clear: home-based, interpersonal psychotherapy lifted depression much more effectively than standard care. The findings underscore the importance of actively screening and offering culturally sensitive, convenient care for our most vulnerable populations, says co-author Fred Rogosch, associate professor of psychology at the University of Rochester and director of research for Mt. Hope Family Center. In one clinical trial, 83 percent of low-income young minority women referred for treatment for depression did not attend even one session. "Most of these women don't even like to talk about depression. Most of these women would never have asked for treatment," says Rogosch. "When I go to the doctor, they ask me if I use my seatbelt," says Sheree Toth. "Why would we not be asking questions about depression when we know the chances of being hit by a car are way less than the chances of being hit by depression? People are suffering needlessly." "We also are concerned about the children of mothers who feel isolated, helpless, and angry. That is not the ideal emotional environment for infants and toddlers to grow up in. Reaching out to these mothers is critical for their children," says Rogosch. Even with the creative accommodations offered in this study, Rogosch notes that 40 percent of mothers identified as depressed declined all care. The authors suggest that future research should explore ways to make the interview process even more welcoming. Assaf Oshri and Julie Gravener from the University of Rochester and Antonio Alexander Morgan-López from the University of North Carolina at Chapel Hill also contributed to the paper. The research was supported by the National Institutes of Mental Health, grant MH091070 LPC Continuing Education About the University of Rochester The University of Rochester (www.rochester.edu) is one of the nation's leading private universities. Located in Rochester, N.Y., the University gives students exceptional opportunities for interdisciplinary study and close collaboration with faculty through its unique cluster-based curriculum. Its College, School of Arts and Sciences, and Hajim School of Engineering and Applied Sciences are complemented by its Eastman School of Music, Simon School of Business, Warner School of Education, Laboratory for Laser Energetics, School of Medicine and Dentistry, School of Nursing, Eastman Institute for Oral Health, and the Memorial Art Gallery.

CWRU study finds mending ruptures in client-therapist relationship during PTSD treatment has positive benefits

In order for prolonged exposure therapy, an evidence-based psychotherapy for PTSD, to reach its full potential, any misperceptions or ruptures in trust and communication between therapist and client need fixing, according to a new Case Western Reserve University study. The study, reported in the Journal of Consulting and Clinical Psychology online article, “Patterns of Therapeutic Alliance: Rupture-Repair Episodes in Prolonged Exposure for PTSD,” is among the first to examine how ruptures in the relationship between the therapist and client can damage a patient’s treatment outcome. An alliance rupture may occur when there is a break in the therapist-client bond. For example, ruptures in the therapeutic relationship may occur when therapeutic progress stalls, negative feelings arise between the therapist and client, or when the work in therapy becomes challenging PTSD - Clinical Practice Guideline for Management of Post Traumatic Stress “We want therapists to know that a rupture in the therapeutic relationship isn’t a bad thing, as long as the therapist tends to it,” said Stephanie Keller, one of the study’s researchers and a Case Western Reserve doctoral student in clinical psychology. “However, if the rupture is not repaired, then your patient may not do as well in treatment.” The research study included 116 people who experienced a traumatic event such as childhood sexual or physical abuse, physical assault, or combat exposure, and had a primary diagnosis of PTSD. Participants engaged in a 10-session treatment program called prolonged exposure (PE) therapy. To help therapists chart progress and examine the therapeutic relationship, each client assessed his or her own PTSD symptoms and perception of their relationship with the therapist during treatment. This helped researchers to identify those clients who experience no ruptures in the therapeutic relationship (a stable relationship), clients who experienced a rupture that was subsequently repaired, and those with ruptures that went unrepaired LCSW Continuing Education The first PE session outlined what would happen over the course of treatment to set specific goals. Exposure-based exercises began in the second session, which included exposure to anxiety-provoking situations that served as trauma-reminders and talking about their traumatic experiences. In this sample, 28 percent of patients experiences a repaired rupture and 18 percent experienced a rupture, or dip in the therapeutic relationship, that was never repaired. An unresolved rupture in the therapist-client relationship became a predictor for a poorer outcome in treatment, Keller said. She also said more research is needed to figure out why these alliance ruptures occur and how to best repair them. The research was funded through a National Institute of Mental Health PTSD research project, directed by Norah Feeny, Ph. D. from Case Western Reserve University and Lori A. Zoellner, Ph. D. from the University of Washington. Other researchers contributing to the project were lead investigator and Case Western Reserve alumna AnnaMaria Aguirre McLauglin, and Eric A. Youngstrom, of the University of North Carolina at Chapel Hill.

Interactive computer program helps patients talk with their physician about depression

(SACRAMENTO, Calif.) – Patients who used an interactive computer program about depression while waiting to see their primary-care doctor were nearly twice as likely to ask about the condition and significantly more likely to receive a recommendation for antidepressant drugs or a mental-health referral from their physician, according to a new study by researchers at UC Davis. The study, published online today in the Journal of the American Medical Association, was conducted to evaluate the effectiveness of a waiting-room intervention that encourages primary- care patients to discuss depression symptoms and care with their physician. While patients who received treatment or a referral for depression did not report improved mental health 12 weeks later, the study did show that providing information to patients about depression is an effective way to start the conversation in a primary-care setting about mental health. "We have developed an easy-to-use tool to help people with depression identify the symptoms, feel more comfortable discussing it with a primary-care provider and accept treatment if it is needed," said Anthony Jerant, professor of family and community medicine at UC Davis and senior author of the study. "This brief and relatively inexpensive intervention could be easily and widely implemented in a variety of health-care settings." Depression is an underrecognized and undertreated condition that can easily be overlooked during a typical primary-care visit. While calculating the number of people suffering from untreated depression is difficult, the Centers for Disease Control estimates that nationally 1-in-10 adults has reported symptoms of depression. The National Institute of Mental Health has said that major depressive disorders affect approximately 14.8 million American adults, or about 6.7 percent of the U.S. population age 18 and older in a given year. When left untreated, depression poses high costs to society, jeopardizing relationships and employment, decreasing quality of life, prompting alcohol and drug abuse and, in some cases, leading to the higher risk of suicide Core Elements in Responding to Mental Health Crises CE Course Three waiting-room interventions tested The new study involved nearly 900 patients and 135 primary-care clinicians at seven Northern California health-care sites. Prior to their medical appointments, patients were screened for depression. All patients were then randomized to view one of three interventions: •A video – similar to a public-service announcement – focused on recognizing depression and talking with doctors about symptoms •An interactive multimedia computer program that provided patients with instant feedback and information tailored to different levels of depressive symptoms and treatment preferences •A non-depression-related video on healthy sleep The clinicians did not know which intervention their patients viewed. Immediately after the patients' appointments, the researchers determined if the patients discussed depression with their clinicians and whether they left with prescriptions for medications to treat depression and if they received a referral for mental-health services. Help for the most depressed The results showed that patients with baseline depression who either watched the informational video or used the computer program were nearly twice as likely as control subjects to request information about depression during their appointment. Those who used the interactive computer program were significantly more likely to receive a prescription or referral for depression (26 percent) than were those who viewed either the depression video (17.5 percent) or the video on sleep (16.3 percent). The computer program had the greatest impact on patients who were most depressed, according to the baseline screening. The investigators also studied the effects of the interventions on people who were not likely to be depressed according to the baseline screening. Among these patients, rates of prescribing and referral were low (about 5 percent) and did not differ by intervention group. According to Richard Kravitz, UC Davis professor of internal medicine and lead author of the study, it is important for public-health interventions to avoid inadvertently expanding unnecessary treatments that can do more harm than good and waste health-care resources. "We were concerned that the interventions could lead to treatment for depression for those who do not actually have it," said Kravitz. "Our interactive computer program, however, increased help for those who needed it the most without increasing treatment for those who didn't." According to Jerant, this study is the largest to compare "targeted" versus "tailored" interventions for stimulating people with depression to seek and accept treatment. Targeted interventions, such as the informational video used in the study, use terms and images most likely to resonate with the target audience, based on specific demographic factors. Four different versions were used in this study, targeted toward gender and income levels. The video took about three minutes to watch. Tailored interventions, such as the study's interactive computer program, integrate patient-specific answers to deliver information and guidance. The program used in the study, developed by the study investigators, prompted users to answer questions about symptoms of depression, informed users as to whether or not they were likely to be depressed, and provided guidance depending on the users' specific needs and interests. Patients assigned to the computer program spent about two to 15 minutes on it, with a median of five minutes. Kravitz speculated that the informational video did not work as well because, like a television commercial advertising a medication, it may require multiple repetitions to be effective. In contrast, the interactive computer program quickly provided a high level of personalization, which may account for its higher degree of effectiveness with a single use. The UC Davis investigators intend to further refine and study the interactive computer model to identify patients who need to receive more extensive treatment for their depression Professional Counselor Continuing Education ### Other UC Davis investigators on the study were Peter Franks, Daniel Tancredi, Christina Slee, Robert Bell, Debora Paterniti, Camille Cipri, Ana-Maria Iosif, Andrew Hudnut, Simon Dvorak and Charles Turner. Additional authors were Maga Jackson-Triche of the Northern California VA Health Care System, Steven Kelly-Reif of Kaiser Permanente Medical Group in Sacramento, Mitchell Feldman and Sarah Olson of UC San Francisco, and Ronald Epstein and Paul Duberstein of University of Rochester in New York. The study, titled "Patient Engagement Programs for Recognition and Initial Treatment of Depression in Primary Care," was supported by grants from the National Institute of Mental Health (1R01MH079387, K24MH072756 and K24MH02712).

Human Sexuality CE Course

Human Sexuality CE Course (10 hours) Description $ - For course pricing details, see our Pricing page by clicking on the "Pricing" tab above. This course is designed to help you: •Define the different study/research areas of human sexuality. •Increase familiarity with concepts related to the psychology of sex •Identify and evaluate clinical perspectives related to sexual activity and lifestyles. •Explore the impact religious belief systems on sex. •Learn specific laws related to sex and sexual crimes. •Identify the causes and symptoms of STDs •Increase familiarity with sexual disorders online counselor ceus, online ceus for mfts, social workers ceu’s, nurses ce, BBS, NBCC approved provider, ASW, Intern, online ceus, ceus for MFTs, ce courses for counselors, Social Worker ceus, continuing education units for LPCs, MHC ceus, LCSW, ASW and MFT Intern ceus, Board approved ceus in many states, national board approval ceus, alcohol and drug abuse counselor ceus. See chart below for your state and license. Click here to return to Aspira Continuing Education's Home page of CEUs for MFTs, Social Workers, Professional Counselors and Interns

Bad boys: Research predicts whether boys will grow out of it -- or not

ANN ARBOR --- Using the hi-tech tools of a new field called neurogenetics and a few simple questions for parents, a University of Michigan researcher is beginning to understand which boys are simply being boys and which may be headed for trouble. “When young children lie or cheat or steal, parents naturally wonder if they’ll grow out of it,” says Luke Hyde, a U-M psychologist who is studying the development and treatment of antisocial behavior. Hyde, a faculty associate at the U-M Institute for Social Research (ISR) and assistant professor of psychology, is speaking at ISR on November 11 on how genes, experience and the brain work together to heighten or reduce the risks that normal childhood transgressions will develop into full-blown conduct disorders in adolescence and early adulthood. His talk is part of the ISR Research Center for Group Dynamics seminar series on violence and aggression, and is free and open to the public. “The lifetime prevalence of conduct disorder is around 10 percent, and even higher in males and low-income populations,” says Hyde. “The total cost to society is enormous, since these behaviors are often chronic, lasting through adulthood.” MHC Continuing Education With colleagues at U-M, Duke University, the University of Pittsburgh, and other institutions, Hyde has been exploring the role of the environment and biology as they interact over time to shape behavior. In particular, he is using the techniques of a new field called neurogenetics, which combines genetics, neuroscience and psychology, to learn how genes and neural processes interact with harsh environments, including dangerous neighborhoods and harsh parents, and with a child’s own levels of empathy and personality traits, to increase the risk of antisocial behavior. In one recent study, for example, Hyde and colleagues studied subjects with over-reactive amygdala responses . The amygdala is an almond-shaped part of the brain’s primitive limbic system involved in processing fear and other visceral emotions. It has been associated with impulsive, aggressive behavior, as well as anxiety disorders and depression. “Previous research suggests that the amygdala becomes over-reactive probably as a result of both genetics and experience,” says Hyde. “And once the amygdala is over-reactive, people tend to behave in an anxious, over-reactive way to things they see as a potential threat. “Our study found that this tendency is moderated by a person’s environment, including the social support they get. If they’re not getting support from family, friends, neighbors, or professionals, then the link between the amygdala and anxious behavior is much stronger.” In another study, Hyde and colleagues showed that kids who are impulsive are only at higher risk of engaging in antisocial behavior if they live in dangerous neighborhoods. He also identified specific items within childhood behavior checklists that can be used as early as the age of three to identify kids who will likely have worse trajectories for anti-social behavior compared to other children who have similar behavior problems, such as throwing tantrums. These items assess observable behaviors that include whether the child is cruel to animals, doesn’t seem to feel guilty after misbehaving, is sneaky, lies, is selfish or won’t share, and won’t change his or her behavior as a result of punishment. “The results of this test aren’t really meaningful until age three or three-and-a-half,” says Hyde. “Before that, many of these behaviors are fairly common, and don’t predict anything. But after age three, if children are still behaving in these ways, their behavior is more likely to escalate in the following years rather than improve.” There is good news, though. Kids who scored high on this test benefitted just as much as other kids from interventions, according to Hyde. These interventions, often called parent management training, focus on giving parents better skills to manage child behavior problems, including training parents to spend more positive time with their kids, use time-outs instead of physical punishments, and reward good behavior by giving out stickers. “Parents need to know that intervention works, especially if it’s done early,” says Hyde. “They need to go for help if they see signs of trouble. Clinical psychologists, among other professionals, have empirically supported treatments that are quite effective for children, especially in this age period.” ### Funding for this research was provided by The National Institute of Drug Abuse, the National Institute of Mental Health, and the National Heart, Lung and Blood Institute. Established in 1949, the University of Michigan Institute for Social Research (ISR) is the world's largest academic social science survey and research organization, and a world leader in developing and applying social science methodology, and educating researchers and students from around the world. For more information, visit the ISR Web site at http://home.isr.umich.edu

Teens in child welfare system show higher drug abuse rate

PISCATAWAY, NJ – Teenagers in the child welfare system are at higher-than-average risk of abusing marijuana, inhalants and other drugs, according to a study in the November issue of the Journal of Studies on Alcohol and Drugs. However, the study also shows that parental involvement matters. "When youth perceive that their parents or caregivers are actively engaged in their lives, this may steer them away from drugs," according to lead researcher Danielle L. Fettes, Ph.D., of the University of California, San Diego. "Youth who feel supported by parents tend to have a better sense of self and better mental health and, in this case, are less likely to engage in high-risk behaviors—which is important for this already high-risk population." Using data from two national surveys, Fettes and colleagues found that 18 percent of teens in the welfare system admitted to ever smoking marijuana, versus 14 percent of other teens. Meanwhile, 12 percent said they'd abused inhalants, compared with 6 percent of other U.S. kids. In addition, although abuse of "hard drugs," like cocaine and heroin, was less common, teens in child welfare were still at greater risk: Six percent admitted to ever using the drugs, versus 4 percent of other teens. The findings are not necessarily surprising, according to Fettes. It's known that kids who enter the child welfare system typically have some risk factors for drug use—such as a history of domestic abuse or mental health issues. But until now, there had been little research into their actual rates of substance abuse, Fettes said. For their study, she and her colleagues culled data from two national health surveys: one covered 730 12- to 14-year-olds in the child welfare system; the other included 4,445 kids the same age from the general U.S. population. Overall, teens in the welfare system were more likely to have tried marijuana, inhalants or hard drugs—but not alcohol. Around 40 percent of kids in each survey admitted to drinking at some point in their lives LSW Continuing Education That, according to Fettes, may reflect a couple of facts. "Alcohol is readily available to teenagers," she said, "and drinking is something of a normative behavior to them." But whereas drug use was more common among teens in the welfare system, not all of those kids were at equal risk. A key risk factor—for all teens in the study—was delinquency. Teenagers who admitted to things like shoplifting, theft, running away or using a weapon were at increased risk of both drug and alcohol abuse. On the other hand, some family factors seemed to protect kids from falling into drug use. Teens from two-parent homes were generally less likely to report drug use—and so were kids who said they felt close to their parents or other guardian. For the parents and others who care for these kids, Fettes said it's important to be aware of the increased risk of substance abuse. On the wider scale, Fettes said that right now, there are typically multiple, distinct service systems working with teens in the child welfare system. They may also be receiving mental health services and alcohol and other drug counseling, as well as having contact with the criminal justice system. "Often, they don't work together," she noted. "Given the increased risk, the child welfare system may be an ideal venue to incorporate proven prevention and intervention programs for youth substance use," Fettes concluded. "Drug abuse screening and treatment, or referrals for treatment, should be a regular part of kids' case management." ### Fettes, D. L., Aarons, G. A., & Green, A. E. (November 2013). Higher rates of adolescent substance use in child welfare versus community populations in the United States. Journal of Studies on Alcohol and Drugs, 74(6), 825. To arrange an interview with Danielle L. Fettes, Ph.D., please contact Debra Kain at ddkain@ucsd.edu or 619-543-6202. The Journal of Studies on Alcohol and Drugs is published by the Center of Alcohol Studies at Rutgers, The State University of New Jersey. It is the oldest substance-abuse journal published in the United States. To learn about education and training opportunities for addiction counselors and others at the Rutgers Center of Alcohol Studies, please visit AlcoholStudiesEd.rutgers.edu.

Smoking during pregnancy may increase risk of bipolar disorder in offspring

A study published today in the American Journal of Psychiatry suggests an association between smoking during pregnancy and increased risk for developing bipolar disorder (BD) in adult children. Researchers at the New York State Psychiatric Institute and the Department of Epidemiology at the Mailman School of Public Health at Columbia University, in collaboration with scientists at the Kaiser Permanente Division of Research in Oakland, California, evaluated offspring from a large cohort of pregnant women who participated in the Child Health and Development Study (CHDS) from 1959-1966. The study was based on 79 cases and 654 comparison subjects. Maternal smoking during pregnancy was associated with a twofold increased risk of BD in their offspring. Smoking during pregnancy is known to contribute to significant problems in utero and following birth, including low birth weight and attentional difficulties. This is the first study to suggest an association between prenatal tobacco exposure and BD, a serious psychiatric illness marked by significant shifts in mood that alternate between periods of depression and mania. Symptoms typically become noticeable in the late teens or early adulthood. "These findings underscore the value of ongoing public health education on the potentially debilitating, and largely preventable, consequences that smoking may have on children over time," said Alan Brown, MD, MPH, senior author and Professor of Clinical Psychiatry and Epidemiology at the New York State Psychiatric Institute, Columbia University and Mailman School of Public Health. The authors wrote: "Much of the psychopathology associated with prenatal tobacco exposure clusters around the 'externalizing' spectrum, which includes attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), conduct disorder (CD), and substance abuse disorders. Although not diagnostically classified along the externalizing spectrum, BD shares a number of clinical characteristics with these disorders, including inattention, irritability, loss of self-control, and proclivity to drug/alcohol use." In effect, children who were exposed to tobacco smoke in utero may exhibit some symptoms and behaviors that are found in BD. A previous study by Dr. Brown and colleagues found that flu virus in pregnant mothers was associated with a fourfold increased risk that their child would develop BD LCSW Continuing Education ### Funding for the study was provided by the National Institute of Mental Health and the National Institute on Child Health and Development. The authors declare no financial or other conflicts of interest. About Columbia University's Mailman School of Public Health Founded in 1922, Columbia University's Mailman School of Public Health pursues an agenda of research, education, and service to address the critical and complex public health issues affecting New Yorkers, the nation and the world. The Mailman School is the third largest recipient of NIH grants among schools of public health. Its over 450 multi-disciplinary faculty members work in more than 100 countries around the world, addressing such issues as preventing infectious and chronic diseases, environmental health, maternal and child health, health policy, climate change & health, and public health preparedness. It is a leader in public health education with over 1,300 graduate students from more than 40 nations pursuing a variety of master's and doctoral degree programs. The Mailman School is also home to numerous world-renowned research centers including the International Center for AIDS Care and Treatment Programs (ICAP), and the Center for Infection and Immunity. For more information, please visit http://www.mailman.columbia.edu Columbia University Department of Psychiatry & NYS Psychiatric Institute Columbia Psychiatry is ranked among the best departments and psychiatric research facilities in the nation and has contributed greatly to the understanding and treatment of psychiatric disorders. It is home to distinguished clinicians and researchers noted for their clinical and research advances in the diagnosis and treatment of depression, suicide, schizophrenia, BD and anxiety disorders, eating disorders, and childhood psychiatric disorders. Visit http://columbiapsychiatry.org/ for more information. Founded in 1959 by Jacob Yerushalmy at the University of California, Berkeley, The Child Health and Development Studies (CHDS) enrolled 15,000 families who were members of the Kaiser Permanente Medical Care Plan between 1959 and 1967. CHDS scientists discovered ways to make pregnancy safer for mothers and their babies. Now they are discovering connections between early life and cancer, heart disease, diabetes, fertility and mental illness. The National Institute of Child Health and Development of the National Institutes of Health makes this unique research possible through continuing support over 40 years. The CHDS is now a part of the Public Health Institute, Berkeley California. About the Kaiser Permanente Division of Research The Kaiser Permanente Division of Research conducts, publishes and disseminates epidemiologic and health services research to improve the health and medical care of Kaiser Permanente members and the society at large. It seeks to understand the determinants of illness and well-being and to improve the quality and cost-effectiveness of health care. Currently, the Division's 550+ staff are working on more than 350 ongoing research studies in behavioral health and aging, cancer, cardiovascular and metabolic conditions, health care delivery and policy, infectious diseases, vaccine safety and effectiveness, and women's and children's health.

Bipolar and pregnant

Bipolar drugs lose effect during pregnancy, so women need higher doses to stay well CHICAGO --- New Northwestern Medicine® research offers one of the first in-depth studies of how physiological changes during pregnancy reduce the effects of a commonly used drug to treat bipolar disorder, making women more vulnerable to recurring episodes. The new findings will help psychiatrists and physicians prevent bipolar manic and depressive symptoms during pregnancy, which are risky for the health of the mother and her unborn child. When a woman with bipolar disorder becomes pregnant, she and her physician often don't realize her medication needs adjusting to prevent the symptoms from coming back – a higher risk during pregnancy. There also is little information and research to guide dosing for psychiatric medications during pregnancy Social Worker Continuing Education Approximately 4.4 million women in the U.S. have bipolar disorder with women of childbearing age having the highest prevalence. The new study shows the blood concentration of the commonly used drug lamotrigine decreases in pregnant women. About half of the women in the study had worsening depressive symptoms as their lamotrigine blood levels dropped. The drug levels fall because women have increased metabolism during pregnancy. "Now physicians change the dose of the drug in response to women's symptoms worsening," said lead investigator Crystal Clark, M.D., an assistant professor of psychiatry and behavioral sciences at Northwestern University Feinberg School of Medicine and a psychiatrist at Northwestern Memorial Hospital. "We need to optimize their medication dosing so they stay well." The study results will help physicians understand how to increase their patients' doses during pregnancy and then reduce them postpartum to avoid toxicity, Clark said. Guidelines for prescribing the drug for pregnant women with the disorder also are included. The study was published Nov. 1 in the American Journal of Psychiatry. Depressive episodes -- as opposed to manic -- are most likely to recur in pregnant women with bipolar disorder. "The safety of the fetus is at risk," Clark said. "Pregnant women that are depressed are less likely to take care of themselves which often leads to poor nutrition, lack of compliance with prenatal care and isolation from family and friends. It has also been linked to premature births and babies with low birth weights among other poor birth outcomes." ### The study was supported by grant R01 MH 075921 from the National Institute of Mental Health of the National Institutes of Health. NORTHWESTERN NEWS: http://www.northwestern.edu/newscenter/