BACKGROUND: Attention-deficit hyperactivity disorder (ADHD) is a pervasive disorder which affects many domains of a patient’s life. Studies show that even with treatment, the behavior of many children with ADHD will fail to normalize. This can cause stress, and impair academic, social, emotional, and familial aspects of the child’s life. This stress can affect also have a deep impact on the parents, or caregivers, of children with ADHD, including occurrence of depression, social isolation, self-blame, marital discontent, alcohol-related dysfunction. This paper aims to investigate whether the stress caused by a child’s ADHD diagnosis changes with socioeconomic factors, such as parental education or income level. The stress of ADHD on parents or caregivers can be further impacted with a comorbid disorder, and literature suggests a comorbid disorder may be the norm rather than the exception, with up to 50% of children with ADHD displaying comorbid externalizing disorders, such as Oppositional defiant disorder or Conduct disorder. METHOD: A literature search was done to find relevant articles about pediatric ADHD, parental and familial stress, and socioeconomic factors. History, etiology, diagnostic evaluation and comorbid disorders were also examined. RESULTS: Parental stress resulting from their child’s ADHD seems to be greater at lower levels of parental educational and income levels. Furthermore, socioeconomic factors, such as marital status, impacts this stress, where parents without a partner present have greater stress levels. Parental stress levels are also greater when ADHD is comorbid with an externalizing disorder. CONCLUSIONS: Parents with children with ADHD experience more stress, especially at lower income levels, and especially when comorbid with an externalizing disorder. These parents need more resources and social support and special care should be paid to their mental health as well.

Due to the nature of the complexity of the diagnosis of autism spectrum disorder (ASD), elementary-aged students with this disorder require a holistic, team-based approach to education in the school setting. A review of current literature has found that while interprofessional collaborative practice (ICP) in the school setting is effective and often recommended for students with ASD, a variety of barriers have resulted in fragmented care. Additionally, there is limited research supporting a cohesive model of interprofessional collaborative practive when working with students with ASD in the elementary school setting. This problem is likely leading to decreased outcomes for elementary-aged students with ASD. Occupational therapy practitioners’ role as holistic, client-centered practitioners creates an ability to bridge the gaps between the often-fragmented goals of the members of an interprofessional team. Interprofessional collaboration in the school setting between occupational therapy practitioners, physical therapy practitioners, psychologists, speech and language pathologists, social workers, and teachers is crucial to addressing the multi-faceted needs of children with ASD and providing the highest level of service in accordance with the Occupational Therapy Practice Framework: Domain and Process, Fourth Edition. This doctoral project aims to add to the limited body of research in this area in order to fulfill this role. The TOPPSS Model of Interprofessional Collaboration is an evidence-based school-year long plan of structured collaboration between staff members working with students with ASD in an elementary school setting through a professional development workshop. The workshop will educate participants on the TOPPSS Model of Interprofessional Collaboration. The participants that are being targeted for this workshop include elementary school-based teachers (T), occupational therapy practitioners (O), physical therapy practitioners (P), psychologists (P), speech-language pathologists (S), and social workers (S). The overall aim of this program is to improve interprofessional collaborative practice (ICP) among the participants in order to increase positive outcomes for students with ASD.

Introduction: Bipolar disorder is associated with cortical abnormalities, including deficits in intracortical myelination. Intracortical myelin follows an inverted-U trajectory over the lifetime, but this trajectory is blunted in individuals with bipolar disorder. Little is understood about which genetic factors contribute to these deficits. Neuregulin-1, a cell-signalling protein, has been shown to contribute to cortical abnormalities and increase susceptibility to related disorders. Assessing the prevalence of neuregulin-1 polymorphisms, notably rs6994992, in bipolar disorder may elucidate the genetic contributors of intracortical myelin deficits and increase our understanding of factors causing susceptibility to bipolar disorder. Methods: 67 participants with bipolar disorder type I and 75 healthy control participants were included. T1-weighted MRI images were collected and processed to create R1 cortical maps, a proxy measure of intracortical myelin. Participant blood samples were genotyped at the rs6994992 locus. Linear models were used to test whether intracortical myelin can be predicted by age, bipolar diagnosis and NRG1 genotype. Results: Intracortical myelin is significantly predicted by age, diagnosis and genotype together in the motor cortex (left: R2 = 0.09, p < 0.01, right: R2 = 0.06, p < 0.05), the right premotor cortex (R2 = 0.095, p < 0.001), and the right inferior frontal cortex (R2 = 0.098, p < 0.001). Age is a significant individual predictor of intracortical myelin in the right dorsal anterior cingulate cortex, the bilateral motor cortex, the right premotor cortex, and the right inferior frontal cortex. Conclusions and Future Directions: Our study suggests that the right premotor, bilateral primary motor, and right inferior frontal cortices are regions of interest for understanding how intracortical myelin changes throughout the lifetime, especially in bipolar disorder. Future work should examine the impact of polygenic risk scores of bipolar disorder on intracortical myelin. / Thesis / Master of Science (MSc) / Bipolar disorder is associated with neurobiological changes, including cortical abnormalities, contributing to a greater disorder burden. Cortical myelination changes throughout the lifetime and larger deficits are found in individuals with bipolar disorder. However, the role of genetics in these intracortical myelin deficits is largely unknown. This thesis investigates how intracortical myelin content in various regions of the cortex is impacted by age, bipolar disorder diagnosis, and neuregulin gene variants. The goal of this research is to contribute to a better understanding of how genetics and age impact intracortical myelin in bipolar disorder to better understand the neurobiological changes of the disorder.

Borderline personality disorder (BPD) is associated with distress in and dissolution of romantic relationships. BPD is a relational disorder. The complex interaction between BPD and romantic relationships continues to warrant further attention, as decreased BPD symptoms are associated with increased relational effectiveness. The current study was one of the first qualitative studies that used dyadic data to examine the experience and impact of BPD on couples' relationships. Semi-structured conjoint interviews were conducted with couples with a partner with BPD (N = 10) using interpretative phenomenology. This study provides a rich understanding of the experiences of couples with BPD by exploring not only how BPD impacts couples' romantic relationships, but how couples cope with BPD. Although BPD was experienced as a relational stressor, couples utilized resources to buffer against the impact of BPD in their relationship. Three superordinate themes emerged from the data that illustrate the couple experience of navigating BPD: (a) the individual lived experience of BPD, (b) the shared experience of BPD as a relational stressor, and (c) adaptive dyadic coping in the context of BPD. Dyadic coping and shared externalization emerged as key factors in adaptive couple functioning in the context of BPD. The lived experiences of these couples provide therapists and other couples with an increased understanding of the resources and skills that support successful dyadic coping with BPD. / Master of Science / Borderline personality disorder (BPD) imposes significant stress on romantic relationships. BPD is associated with increased distress in and dissolution of romantic relationships. However, individuals in recovery from BPD report high relationship satisfaction. Decreased BPD symptoms are associated with increased relational effectiveness, but it is less clear whether reducing BPD symptoms leads to greater relational effectiveness or if relational effectiveness reduces symptoms of BPD. To better understand the complex relationship between BPD and romantic relationships, conjoint interviews were conducted with couples who were navigating the management of BPD. Ten semi-structured conjoint interviews were analyzed using interpretative phenomenology. Three themes emerged from the data that illustrate the couple experience of navigating BPD: (a) the individual lived experience of BPD, (b) the shared experience of BPD as a relational stressor, and (c) adaptive dyadic coping in the context of BPD. Dyadic coping and shared externalization emerged as key factors in adaptive couple functioning in the context of BPD. Couples navigating BPD benefit from many of the same couple coping strategies that other couples utilize to manage common stressors in life.

Introduction: Major depressive disorder (MDD), generalized anxiety disorder (GAD), and bipolar disorder (BD) are mental illnesses associated with socio-cognitive functional impairments, reduced quality of life, and increased risk of medical and psychiatric comorbidities. These disorders are also associated with unhealthy patterns in several fundamental lifestyle areas according to the current notions of lifestyle psychiatry, such as diet, physical activity, substance use, sleep, stress management, and social relationships. With the rising prevalence rates of poor mental well-being following the onset of the COVID-19 pandemic, it is essential to understand the relationship between a multifactorial lifestyle and the presence of psychiatric symptoms. Thus, the aim of this thesis was to assess the association between a multidimensional lifestyle and symptoms of MDD and GAD during the COVID-19 pandemic, and lifestyle patterns among symptomatic individuals with BD. We additionally reviewed the literature on lifestyle interventions for improvement of outcomes related to BD. Results: Unhealthy lifestyle behaviours were associated with symptoms of MDD and GAD during the COVID-19 pandemic in Spain, Brazil, and Canada. Machine learning analyses revealed strong predictive power for detecting the presence of these symptoms through lifestyle behaviours and perceptions. Individuals with BD engage in more unhealthy lifestyles than healthy individuals across all the core areas of lifestyle psychiatry, regardless of the polarity of the mood episode. Furthermore, to date, traditional lifestyle domains such as diet, physical activity, and sleep have been the most frequently targeted domains for interventions to improve mood symptoms and functional outcomes of BD, while domains such as substance use, stress management and social relationships have been more neglected. In addition, multidimensional lifestyle interventions have demonstrated a higher efficacy rate of improving outcomes of BD than single-domain interventions, however, there has been a lack of interventions for BD targeting majority of the core lifestyle domains. Conclusion: The findings suggest that multidimensional unhealthy lifestyles are associated with symptoms of MDD, GAD, and BD. These results support the current notions of lifestyle psychiatry, indicating that a multidimensional assessment of lifestyle behaviours and perceptions can be a beneficial approach towards understanding the cumulative impact of various lifestyle patterns on psychiatric symptoms. This work highlights the importance of imposing a holistic approach towards studying the association between lifestyle factors and psychiatric disorders in order to implement effective, personalized preventive and treatment strategies for mental health disorders. / Thesis / Doctor of Philosophy (PhD) / People experiencing symptoms of psychiatric disorders may also engage in more unhealthy routines and behaviours in everyday life. Lifestyle is a construct characterized by behaviours and perceptions in multiple areas of life which are fundamental for the overall well-being of a person. The aim of this thesis was to investigate the relationship between multidimensional lifestyle characteristics and symptoms of depression, anxiety, and bipolar disorder (BD). We examined the association between multidimensional lifestyle and symptoms of depression and anxiety in the general populations of Spain, Brazil, and Canada during the COVID-19 pandemic. We also assessed the relationship between unhealthy behaviours and symptomatic individuals with BD in comparison to healthy individuals, and the importance of lifestyle interventions for improvement of outcomes related to BD. The findings indicated an association between multidimensional unhealthy lifestyles and symptoms of depression and anxiety during COVID-19. Unhealthy lifestyles across all domains were also seen in people with BD currently experiencing a mood episode, while lifestyle interventions for BD have shown promising results so far. A multidimensional approach to evaluating quality of lifestyle can be beneficial for developing preventive and treatment lifestyle strategies for common psychiatric disorders.

The past several years have witnessed significant interest in the role that residential neighbourhoods play in shaping child development. There is evidence that contextual attributes of neighbourhoods exert an influence on development, over and above compositional characteristics. These findings suggest that neighbourhood-based interventions may be successful at improving population-level child development outcomes, over policy aimed at individual-based change. However, the reliance on respondent perception of neighbourhood attributes in the existing research is vulnerable to bias. Thus this research employing a quantitative approach to the study of the neighbourhood built environment addresses a significant gap. Drawing from independent sets of data, linked geographically (Early Development Instrument, Google Street View-Systematic Social Observation of a random sample of street segments in each census tract, and the Canadian Marginalization Index), I use correlation and regression analysis to examine the link between neighbourhood physical disorder and child-friendliness, structural disadvantage, and child development at the census tract level in Victoria, B.C. Results indicate physical disorder is the neighbourhood attribute having the most salient impact across multiple domains of child development. Furthermore, the link between neighbourhood child-friendliness and most EDI domains was not in the direction or as significant as hypothesized. This may suggest the need for a more detailed measurement tool to assess quality of each feature as well as presence or absence. Findings also indicate that physical disorder and structural disadvantage may be on the same causal pathway towards shaping children’s health and wellbeing.Overall, this research improves our understanding of the complex interaction between children and their neighbourhoods, and its contribution to healthy development. By identifying the need for a more detailed measurement tool, this research provides evidence for the design of future studies. Furthermore, findings from this study provide evidence in support of population-level intervention to promote healthy child development through improvement of neighbourhood aesthetic. / Thesis / Master of Arts (MA)

Emotion processing and regulatory deficits have been well established in individuals diagnosed with bipolar disorder (BD). Both structural and functional neural deficits have been associated with the presence of psychiatric symptoms in BD. In Chapter 2, we reviewed cortical thickness deficits found in patients with BD. It is unclear however, how early these deficits appear; whether they contribute to risk, or whether these deficits develop as a consequence of the onset of symptoms. To address this, many researchers have turned to high-risk offspring populations. These high-risk offspring are at much greater risk of developing BD by virtue of having a parent diagnosed with BD. Moreover, the presence of anxiety, depression or ADHD related symptoms in this population suggest these children are at even greater risk to develop BD. By comparing high-risk offspring with and without the symptoms can help to elicudate neural correlates associated with risk and resilience for BD. It was the aim of this thesis research to investigate the behavioural, structural and functional correlates of risk. Specifically, presented in this thesis, we compared the gray matter integrity, through volume (Chapter 3) and cortical thickness (Chapter 4) techniques, in symptomatic and asymptomatic high-risk offspring to healthy children of healthy parents. We also compared the ability of these offspring to perform an emotion-labelling task (Chapter 5) and engage in emotional conflict monitoring and conflict adaptation during an fMRI scan (Chapter 6). Altogether, our results provide evidence for the presence of gray matter volume, emotion labelling, and conflict monitoring and conflict adaptation functional deficits in high-risk offspring compared to healthy children of healthy parents. With the exception of cortical thickness, we found that the deficits between symptomatic and asymptomatic high-risk offspring were comparable. This suggests that behavioural, structural and functional deficits may reflect neural correlates of risk and are not associated with the presence of symptoms. / Thesis / Doctor of Philosophy (PhD)

no abstract provided. / Thesis / Master of Science (MSc)

Antipsychotic medications are highly effective in the treatment of patients experiencing first-episode psychosis. However, some patients do not respond to the first antipsychotic medication they are given, and may require trials of several drugs before an effective treatment is found. While antipsychotics may take months to achieve their full effect, recent evidence suggests that it is possible to predict whether a patient will respond to a particular drug by assessing early response after as little as 2 weeks of treatment. Assessing early antipsychotic response has the potential to improve treatment strategies for psychotic patients, but there is still a great deal of uncertainty about what early response can and cannot predict, and how the predictive value of early response differs among drugs and patient populations. The work presented in this thesis addresses some of the most pressing questions about early antipsychotic response in several samples of antipsychotic-naive patients with first-episode psychosis. This work demonstrates that: (1) the appropriate time point at which to assess early response differs between antipsychotic drugs; (2) early improvement in depressive and manic symptoms predicts treatment outcome, while early improvement in anxiety symptoms may not; (3) strong early response is associated with decreased rates of extrapyramidal side-effects; (4) early antipsychotic response can predict long-term treatment outcome at least 2 years after treatment initiation; (5) the appropriate time point at which to assess early response differs in patients who receive antidepressant treatment in addition to antipsychotic treatment; (6) patients with a poor early response may benefit from being switched to another antipsychotic, particularly one with a distinct receptor binding profile. These results highlight several weaknesses of the current literature, suggesting that early antipsychotic response should be assessed differently depending on the psychiatric symptom profile of each patient and the specific medications that are being used. However, the data presented here also emphasize the potential therapeutic value of assessing early response. The ability of early response to predict treatment outcome appears to be even greater than previously thought, and understanding how to appropriately use this important assessment to guide treatment strategies may improve the efficiency and efficacy of treatment for psychotic patients. / Thesis / Doctor of Philosophy (PhD)

Thesis advisor: Stefano Anzellotti / Autism Spectrum Disorder (ASD) displays uniquely in every individual, creating disparities in symptom severity, genetics, and functional connectivity. Examining the relationship between genetic and functional connectivity variability could help to better understand individual differences in ASD. From this, improved diagnosis, treatment, and understanding of ASD can be developed. To resolve individual differences in symptom severity and presentation, I generated matrices of subject functional connectivity data and compared this to gene expression maps. Multivariate regression analysis was performed on the data to anticipate ASD symptoms from these correlation matrices and to establish which genes have the largest impact on these predictions. The ANOVAs ran on the data were not significant, but there were several genes implicated in specific aspects of ASD. STX1A, MVP, CDKL5, and RABEP2 were the only genes correlated across more than one subtype of ASD. These results pave the way for future research to investigate the roles of these genes in a larger size of ASD subjects. / Thesis (BS) — Boston College, 2023. / Submitted to: Boston College. College of Arts and Sciences. / Discipline: Departmental Honors. / Discipline: Psychology and Neuroscience.