Autism spectrum disorders (ASDs) are a group of disorders that affect social, communication, and behavioral development. Identification of clinically distinct subtypes of ASDs, especially in the developmental period when delays or deficits are first recognized (i.e., in the first few years of life), can lend clues to etiology and trajectory and enhance current knowledge on early manifestations of the disorders. Moreover, identification of clinically distinct subtypes of ASDs may inform early identification efforts. Past research suggests that social relations, verbal abilities, nonverbal abilities, and the presence of certain stereotyped interests and behaviors (SIB) may be important factors in delineating subtypes of ASDs in toddlers. Yet there is no published study that examines empirically derived subtypes in a sample of such young children. Therefore, the purpose of this study was to determine whether clinically distinct subtypes can be derived from a sample of toddlers who fail an autism screen and are subsequently diagnosed with developmental concerns, including an ASD. Results found that subtypes delineated by social-communicative maturity were found in both of the aforementioned samples of children. Furthermore, the ASD only sample was also distinguished by rate and intensity of certain types of SIB. Implications for autism theory, early identification, and early intervention are discussed.

Introduction: Sickle cell disease (SCD) affects predominately African Americans and is one of the most prevalent diseases in the United States (Schecter, 1999). Research has not sufficiently examined whether pain associated with SCD impacts quality of life or whether coping impacts this relation. The purpose of this study was to examine the relation between pain and quality of life in children with SCD and to determine whether coping moderates the relation. A secondary aim was to examine associations between age and pain, quality of life, and coping. A final exploratory aim was to examine the relation between racial identity and study variables. Method: 104 children (M = 12.93 years, SD = 3.17 years) with SCD and their parents participated during a regularly scheduled SCD-related medical visit. Parents completed a demographic form. Children completed the Pediatric Pain Questionnaire (PPQ), the Pain Coping Questionnaire (PCQ), the Pediatric Quality of Life Inventory (PedsQL), Sickle Cell Disease Quality of Life (SCD-QoL), and the Multidimensional Inventory of Black Identity (MIBI). Results: After controlling for site and gender, regression analyses revealed that pain (ƒÒ = -0.37) and emotion-focused avoidance coping (ƒÒ = -0.39) were significant predictors of overall generic quality of life (PedsQL Total Score), total R2 = 0.44, F (5, 93) = 13.88, p < 0.001. There was no significant pain x coping interactions found for overall generic quality of life. Child age was not associated with study variables. Exploratory analyses revealed the MIBI Centrality Scale was associated with PCQ Approach Coping, r (80) = -0.24, p < 0.05, and the MIBI Regard Scale was correlated with PCQ Problem-Focused Avoidance Coping, r (84) = 0.30, p < 0.01. Discussion: This study found that pain and emotion-focused avoidance coping were inversely associated with quality of life in children with SCD. Coping was not found to moderate the relation between pain and overall quality of life. The associations between racial identity and coping demonstrate the importance of further examining cultural factors in children with SCD. In addition, there continues to be a need for future research to focus on the psychosocial functioning of children with SCD.

Moderate and severe pediatric traumatic brain injuries (TBI) are associated with significant familial stress and child cognitive and adaptive sequelae (Taylor et al., 1999). Research has demonstrated a relationship between familial stress and resources and child recovery of functioning following TBI (Taylor et al., 1999). We built on these findings by examining authoritarian parenting values and styles as a mediator of the relationship between parental stress and child adaptive outcomes 12-36 months following TBI or orthopedic injury (ORTHO). Participants were 21 children/adolescents with traumatic brain injuries and 23 with orthopedic injuries and one of their parents/guardians. Parents completed measures of demographics, parental stress, parenting values and styles, and child adaptive functioning. Child participants completed brief demographic questionnaires and intelligence screeners. Moderation was examined using hierarchical multiple regression. Mediation and moderated mediation were examined using bootstrapping tests of the indirect effect of parental stress on child adaptive functioning. After controlling for family insurance status, higher levels of parental stress were associated with reduced child adaptive functioning in the TBI group but not the ORTHO group. An examination of the mediational analyses revealed that higher levels of parental stress were associated with a greater reliance on authoritarian parenting styles, which was associated with reduced overall adaptive functioning and daily living skills across the two injury groups. Therefore, across groups, the relationship between parental stress and child overall adaptive functioning and daily living skills was found to be partially mediated by an authoritarian parenting style. Moderated mediation results revealed the presence of a significant interaction and 95% confidence interval on the socialization domain and indicated that the relationship between authoritarian parenting styles and child adaptive social skills differed significantly between the two groups. Our findings suggest a relationship between parental stress, authoritarian parenting styles, and child adaptive functioning in the 12-36 months following pediatric traumatic injury. Future research should explore the association among these, as well as other potentially mediating variables, both within and between the two groups with the goal of further elucidating the relationship between familial/environmental variables and child adaptive functioning following traumatic brain and orthopedic injury.

Morphine is the most widely prescribed opiate for alleviation of persistent pain; however, it is becoming increasingly clear that morphine is less potent in women compared to men. Morphine primarily binds mu opioid receptors, which are densely localized in the midbrain periaqueductal gray (PAG). Anatomical and physiological studies conducted in the 1960s identified the PAG, and its projections to the rostral ventromedial medulla (RVM) and spinal cord dorsal horn, as an essential neural circuit mediating opioid-based analgesia. Remarkably, the majority of studies since then were conducted in males with the implicit assumption that this circuit was the same in females; this is not the case. It is now well established that morphine produces greater analgesia in males compared to females in a wide range of vertebrates, however, the mechanism(s) driving this sex difference is not clear. Our recent studies indicate that two factors appear to be contributing to the sexually dimorphic effects of morphine. First, there are sex differences in the anatomy and physiology of the descending inhibitory pathway on which morphine acts to produce analgesia. Specifically, the projections from the PAG to the RVM are sexually dimorphic and activated to a greater degree by both inflammatory pain and systemic morphine in males. In the absence of pain, the PAG-RVM circuit is activated to a greater degree in males compared to females, while this activation steadily declines during the development of tolerance in males only. We also have evidence of a sexually dimorphic expression of mu opioid receptor within the PAG that appears to contribute to sex differences in morphine potency. Microinjection of morphine directly into the PAG produces significantly greater analgesia in males, indicating that the PAG is sufficient for eliciting this sexually dimorphic behavior. Furthermore, mu opioid receptor-expressing PAG neurons are necessary for eliciting a sexually dimorphic response to morphine as lesioning mu opioid receptor-expressing neurons attenuates analgesia in males only. Together, these data indicate that the PAG-RVM pathway and mu opioid receptor expression in the PAG is sexually dimorphic and provides a primary mechanism for sex differences in morphine potency.

Memory impairments are common in individuals with temporal lobe epilepsy (TLE). This is understandable given that temporal lobe brain structures involved in TLE play a central role in encoding memories. It is widely accepted that individuals whose seizure focus is in the left temporal lobe (LTLE) tend to have verbal memory impairments, whereas individuals whose seizure focus is in the right temporal lobe (RTLE) tend to have visuospatial memory impairments. However, evidence of functional subdivisions within the left and right temporal lobes in both the animal and human literature suggest that more specific subtypes of memory impairment may exist in TLE based on differences in seizure foci. The aim of this study was to identify more specific subtypes of memory-impairments in patients with intractable TLE using several measures of memory functioning and cluster analysis. Identification of more specific memory subtypes in TLE could have prognostic significance for patients and contribute to our knowledge about the organization of memory systems of the human brain. Four memory subtypes were identified in this sample: 1) patients with mild to moderate figural memory deficits; 2) patients with moderate to severe figural memory deficits, mild facial recognition deficits, and mild attention/concentration deficits; 3) patients with severe figural memory deficits and mild verbal episodic memory deficits; and 4) patients with no episodic or semantic memory deficits. Unexpectedly, the subtypes found did not exhibit the expected pattern of verbal memory impairments with left temporal lobe damage/dysfunction or visuospatial memory impairments with right temporal lobe damage/dysfunction. However, consistent with the literature, there was a trend towards some clusters with better verbal memory having higher left hippocampal volumes; and a trend towards one cluster with facial recognition deficits having lower anterior temporal lobe volumes. Small sample sizes in this study limited the ability to clearly validate many of the cluster differences, particularly differences in brain volumes. Nevertheless, the results of this study support the hypothesis that subtypes of memory impairment do exist in patients with TLE. With larger sample sizes, it is plausible that additional subtypes may be found, or the characteristics of the subtypes found may become clearer.

Problem gambling currently affects between 5-7% of youth ages 12-18 (Hardooon & Derevensky, 2002); however, rates of problem gambling among youth who are involved with the Juvenile Justice System are more than twice that of school sample rates (Lieberman & Cuadrado, 2002). Furthermore, disordered gambling often co-occurs with substance use and criminal activity (Huang & Boyer, 2007), issues that are compounded in the Juvenile Justice population. The current study assessed gambling behaviors and risk factors of 145 youth involved in juvenile, juvenile drug, and family courts. Results indicated that nearly 13% of these youth are currently problem gamblers, and that males and African-Americans had higher problem gambling rates than female and Caucasian youth. Furthermore, gambling-related crime, substance use, scope of gambling activities, and time in detention facilities were all predictive of problem gambling severity, while suicidal ideation, urban environment, and lottery sales per capita were not. Finally, having a parent with a gambling problem also emerged as a risk factor;however, the risk was greater for males than for females. These results present a distinct need for youth to be screened for gambling problems upon entering and exiting the Juvenile Justice System, and for prevention and intervention services to be offered within juvenile and family court settings. Furthermore, communities need to take an active role in preventing youth gambling problems through increasing public awareness and insuring that appropriate and accurate messages reflecting gambling opportunities and outcomes are presented.

Research has demonstrated that problem gambling is associated with substance and alcohol abuse (Petry, Stinson, & Grant, 2005), participation in criminal activities (McCorkle, 2002; Meyer & Stadler, 1999), and involvement in the criminal justice system (NORC, 1999). This study assessed problem gambling and its relation to crime and substance use within a population in which these risk factors are compounded: Adults mandated to participate in drug and DUI courts. Results indicate that the prevalence and severity of problem gambling may be higher within this population than any other. Furthermore, the results of qualitative and quantitative analyses converged to highlight that gambling, crime and substance use are interrelated behaviors, as each may lead to and/or reinforce the other. These findings suggest that problem gambling is a salient issue among substance-abusing offenders and that resources should be dedicated to screening those involved with the criminal justice system for problem gambling, establishing evidence based best practices in the prevention and treatment of problem gambling within this population, and that such practices may incorporate components addressing gambling, crime, and substance use.

Parent and child readiness to change have been identified as emerging areas informing pediatric obesity interventions. The purpose of this study was to increase understanding of child and parent readiness to change in obese youth by examining how these constructs are related to demographic variables, as well as to psychosocial functioning, in a sample of obese youth presenting for weight- management treatment. A secondary aim was to examine consistency between parent and child readiness to change. Two hundred twenty-eight 7- to 17-year-old children and their parents participated during the child’s initial assessment at a multidisciplinary weight-management clinic. Demographic variables included in analyses were child Body Mass Index, parent Body Mass Index, child age, child gender, child race, and family income. Children completed measures of quality of life, depression, social anxiety, internalizing and externalizing symptoms, and readiness to change. Parents completed assessments of children’s quality of life, children’s internalizing and externalizing symptoms, and parents’ own readiness to change. The child’s Body Mass Index was significantly related to both parent and child readiness to change. There was also a significant positive relation between child readiness to change and the child’s own report of social anxiety symptoms, as well as a curvilinear relation with internalizing symptoms, such as depression. In addition to the child’s Body Mass Index, parent readiness to change was positively related to the child’s age and was higher in African American parents than in European American parents. Race moderated the relation between parent readiness to change and health-related quality of life, internalizing symptoms, and externalizing problems. Parents and children were discordant in their ratings of readiness to change, with parents tending to report higher levels; the child’s Body Mass Index moderated the relation between parent and child report of readiness to change. Clinical implications and future directions are discussed.

Risk factors tend to be negatively associated with developmental outcomes such as academic achievement and language skills. Promotive factors, on the other hand, may foster resilience in at-risk children. Some children, such as children with intellectual disabilities, experience relatively more risks than other children do. The purpose of this study was to examine the effects of risks, adaptive behavior, and an intervention on the language and reading growth of children with intellectual abilities over the course of a yearlong reading intervention in which they were participants. The results suggested that, on average, risks were negatively associated and adaptive behaviors were positively associated with initial language and reading scores. Additionally, participants evidenced significant progress on their language and reading scores over the course of the intervention, but neither adaptive behavior nor risk was related to this growth, which may suggest that students from differing backgrounds and with differing levels of adaptive skill can profit from high-quality reading instruction.

Attention biases to trauma-related information contribute to symptom maintenance in Posttraumatic Stress Disorder (PTSD); this phenomenon has been observed through various behavioral studies, although findings from studies using a precise, direct bias task, the dot probe, have been mixed. PTSD neuroimaging studies have indicated atypical function in specific brain regions involved with attention bias; when viewing emotionally-salient cues or engaging in tasks that require attention, individuals with PTSD have demonstrated altered activity in brain regions implicated in cognitive control and attention allocation, including the medial prefrontal cortex (mPFC), dorsolateral prefrontal cortex (dlPFC) and amygdala. However, remarkably few PTSD neuroimaging studies have employed tasks that both measure attentional strategies being engaged and include emotionally-salient information. In the current study of attention biases in highly traumatized African-American adults, a version of the dot probe task that includes stimuli that are both salient (threatening facial expressions) and relevant (photographs of African-American faces) was administered to 19 participants with and without PTSD during functional magnetic resonance imaging (fMRI). I hypothesized that: 1) individuals with PTSD would show a significantly greater attention bias to threatening faces than traumatized controls; 2) PTSD symptoms would be associated with a significantly greater attentional bias toward threat expressed in African-American, but not Caucasian, faces; 3) PTSD symptoms would be significantly associated with abnormal activity in the mPFC, dlPFC, and amygdala during presentation of threatening faces. Behavioral data did not provide evidence of attentional biases associated with PTSD. However, increased activation in the dlPFC and regions of the mPFC in response to threat cues was found in individuals with PTSD, relative to traumatized controls without PTSD; this may reflect hyper-engaged cognitive control, attention, and conflict monitoring resources in these individuals. Additionally, viewing threat in same-race, both not other-race, faces was associated with increased activation in the mPFC. These findings have important theoretical and treatment implications, suggesting that PTSD, particularly in those individuals who have experienced chronic or multiple types of trauma, may be characterized less by top-down “deficits” or failures, but by imbalanced neurobiological and cognitive systems that become over-engaged in order to “control” the emotional disruption caused by trauma-related triggers.