Elizabeth E. Van Voorhees

Diffusion Tensor Measures of the Corpus Callosum in Adolescents With Adolescent Onset Alcohol Use Disorders

BACKGROUND In adults, myelination injury is associated with alcoholism. Maturation of the corpus callosum is prominent during adolescence. We hypothesized that subjects with adolescent-onset alcohol use disorders (AUD; defined as Diagnostic and Statistical Manual of Mental Disorders-IV alcohol dependence or abuse) would have myelination microstructural differences compared to controls. METHODS Adolescent subjects (25 males, 7 females) with an AUD (16.9 +/- 1.2 years), who were recruited from substance abuse treatment programs and had co-morbid mental disorders, and 28 sociodemographically similar healthy controls (17 males, 11 females; 15.9 +/- 1.1 years) underwent a 3.0 T MRI diffusion tensor imaging scan. RESULTS Measures of rostral body fractional anisotropy (FA) were higher in the AUD group than in the control group. Compared to controls, mean diffusivity (MD) was lower, while FA was higher, in the AUD group in the isthmus region. Anterior corpus callosum microstructural development differed in adolescents with AUD, as age was positively (not negatively) associated with rostrum MD and age was negatively (not positively) associated with rostrum FA. There were sex by group interactions in that control females had higher posterior midbody FA when compared to female adolescents with AUD. CONCLUSIONS Lower MD and higher FA values in the AUD group suggest pre-morbid vulnerability for accelerated prefrontal and temporo-parietal myelin maturation that may enhance the risk for adolescent AUD. Significant (and opposite to developmentally expected) correlations were seen between anterior corpus callosum MD and FA measures and age in the AUD group, suggesting neurotoxic effects of alcohol on adolescent corpus callosum microstructure. As seen in adults, female adolescents with AUD may be especially vulnerable to corpus callosum microstructural injury. Further diffusion tensor imaging studies of corpus callosum maturation in children at familial risk for alcoholism, and in those with AUD, need to be done to elucidate these mechanisms.

The Effects of Child Maltreatment on the Hypothalamic-Pituitary-Adrenal Axis

Abnormal functioning of the hypothalamic-pituitary-adrenal (HPA) axis, a critical mammalian stress response system, has been associated with emotional responses such as anxiety and depression, as well as with behavioral and cognitive processes such as aggression, learning and memory deficits, and failure of response inhibition. This review examines the evidence for HPA axis dysregulation related to childhood maltreatment. It is concluded that child maltreatment may lead to disruptions in HPA axis functioning, and that factors such as age of maltreatment, parental responsiveness, subsequent exposure to stressors, type of maltreatment, and type of psychopathology or behavioral disturbance displayed may influence the degree and patterning of HPA disturbance.

Community Violence Exposure in University Students A Replication and Extension

This study validates a survey for community violence exposure, provides details of exposure in young adults, and determines psychological effects. 518 university students completed the Survey of Exposure to Community Violence (SECV) and questionnaires regarding trauma and socioemotional outcomes. Participants were divided into high, moderate, or low witnessing and victimization groups. Results showed SECV validity, with violent trauma more frequently reported in moderate/high victimization groups. 93.2% of respondents reported witnessing and 76.4% being victimized by violence. The most frequent events involved being hit, threatened, or seeing a gun/knife used as a weapon. The most frequent perpetrators were non-family members, except for domestic violence. The most frequent location was near home, although school was noted for peer victimization. High-exposure groups reported greater depression, aggression, interpersonal problems, and post-traumatic stress disorder symptoms. This replicates and extends previous findings on the prevalence of violence exposure and its negative effects in todays young adults.

Childhood trauma exposure in Iraq and Afghanistan war era veterans: Implications for posttraumatic stress disorder symptoms and adult functional social support

OBJECTIVE This study examined the relationship among childhood trauma, posttraumatic stress disorder (PTSD) symptoms, and adult social support in a large sample of veterans who served in the military after 09/11/2001, with a specific focus on the potential role of the PTSD avoidance and numbing cluster as intervening in the association between childhood abuse and adult functional social support. METHOD Participants were 1,301 veterans and active duty soldiers who have served in the military since 09/11/2001; a subsample of these participants (n=482) completed an inventory of current functional social support. Analyses included linear regression and nonparametric bootstrapping procedures. RESULTS After controlling for combat exposure, exposure to childhood trauma was associated with PTSD symptoms in adulthood. Further, PTSD symptoms, and particularly PTSD avoidance/numbing cluster symptoms, intervened in the relationship between childhood trauma and adult functional social support. CONCLUSIONS Findings support the association of childhood trauma (both abuse related and other, non-abuse related trauma) with PTSD symptoms in military personnel and veterans, even after accounting for combat exposure. Additionally, the avoidance and numbing symptom cluster of childhood trauma-based PTSD may be particularly salient in compromising ones subsequent ability to garner functional social support in adulthood.

Smoking Withdrawal Symptoms Are More Severe Among Smokers With ADHD and Independent of ADHD Symptom Change: Results From a 12-Day Contingency-Managed Abstinence Trial

INTRODUCTION Smokers with attention deficit hyperactivity disorder (ADHD) have greater difficulty quitting than those without ADHD, but preliminary data (McClernon, Kollins, Lutz, Fitzgerald, Murray, Redman, et al., 2008) suggest equivalent severity of withdrawal symptoms following brief abstinence. The objective of this study was to characterize the differential effects of intermediate term smoking abstinence on self-reported withdrawal and ADHD symptoms in adult smokers with and without ADHD. METHODS Forty adult (50% female), nontreatment seeking moderate-to-heavy smokers with and without ADHD were enrolled in a 12-day quit study in which monetary incentives were provided for maintaining biologically verified abstinence. Self-reported withdrawal, mood, and ADHD symptoms were measured pre- and post-quitting. RESULTS ADHD and controls did not vary on smoking or demographic variables. Significant Group × Session interactions were observed across a broad range of withdrawal symptoms and were generally characterized by greater withdrawal severity among ADHD smokers, particularly during the first 5 days of abstinence. In addition, Group × Sex × Session interactions were observed for craving, somatic symptoms, negative affect, and habit withdrawal; these interactions were driven by greater withdrawal severity among females with ADHD. Group × Session interactions were not observed for ADHD symptom scales. CONCLUSIONS The results of this study suggest that smokers with ADHD, and ADHD females in particular, experience greater withdrawal severity during early abstinence-independent of effects on ADHD symptoms. Whereas additional research is needed to pinpoint mechanisms, our findings suggest that smoking cessation interventions targeted at smokers with ADHD should address their more severe withdrawal symptoms following quitting.

Reliability and Validity of Self- and Other-Ratings of Symptoms of ADHD in Adults

Objective: Few studies have examined concordance between raters of ADHD symptoms in adults; there is less information on how well rating scales function in distinguishing adult ADHD from other disorders. This study examined these variables using the Conners Adult ADHD Rating Scales (CAARS). Method: The sample included 349 adults evaluated for attention problems. Correlations and kappa values were calculated using self- and observer-ratings of item-level symptoms; sensitivity, specificity, and discriminant validity of cluster scores in predicting clinician diagnoses were computed for 269 participants. Results: Item-level concordance rates ranged from slight to fair. Cluster scores demonstrated a poor balance of sensitivity and specificity in predicting ADHD diagnosis; a high percentage of participants with internalizing disorders had scores in the clinical range. Conclusion: Self-and observer- ratings on the CAARS provide clinically relevant data about attention problems in adults, but the instrument does not effectively distinguish between ADHD and other adult psychiatric disorders. (J. of Att. Dis. 2011; 15(3) 224-234)

Self-Reported Pain Complaints among Afghanistan/Iraq Era Men and Women Veterans with Comorbid Posttraumatic Stress Disorder and Major Depressive Disorder

OBJECTIVE Research has shown significant rates of comorbidity among posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and pain in prior era veterans but less is known about these disorders in Iraq and Afghanistan war era veterans. This study seeks to extend previous work by evaluating the association among PTSD, MDD, and pain (back, muscle, and headache pain) in this cohort. METHOD A sample of 1,614 veterans, recruited from 2005 to 2010, completed a structured clinical interview and questionnaires assessing trauma experiences, PTSD symptoms, depressive symptoms, and pain endorsement. RESULTS Veterans with PTSD endorsed pain-related complaints at greater rates than veterans without PTSD. The highest rate of pain complaints was observed in veterans with comorbid PTSD/MDD. Women were more likely to endorse back pain and headaches but no gender by diagnosis interactions were significant. CONCLUSIONS Findings highlight the complex comorbid relationship between PTSD, MDD, and pain among Iraq and Afghanistan veterans. This observed association suggests that integrated, multidisciplinary treatments may be beneficial, particularly when multiple psychological and physical health comorbidities are present with pain. Further support may be indicated for ongoing education of mental health and primary care providers about these co-occurring disorders.

Sex, ADHD symptoms, and smoking outcomes: An integrative model

Both females and individuals with Attention-Deficit/Hyperactivity Disorder (ADHD) have been found to be at increased risk for a range of smoking outcomes, and recent empirical findings have suggested that women with ADHD may be particularly vulnerable to nicotine dependence. On a neurobiological level, the dopamine reward processing system may be implicated in the potentially unique interaction of nicotine with sex and with ADHD status. Specifically, nicotine appears to mitigate core ADHD symptoms through interaction with the dopamine reward processing system, and ovarian hormones have been found to interact with nicotine within the dopamine reward processing system to affect neurotransmitter release and functioning. This article synthesizes data from research examining smoking in women and in individuals with ADHD to build an integrative model through which unique risk for cigarette smoking in women with ADHD can be systematically explored. Based upon this model, the following hypotheses are proposed at the intersection of each of the three variables of sex, ADHD, and smoking: (1) individuals with ADHD have altered functioning of the dopamine reward system, which diminishes their ability to efficiently form conditioned associations based on environmental contingencies; these deficits are partially ameliorated by nicotine; (2) nicotine interacts with estrogen and the dopamine reward system to increase the positive and negative reinforcement value of smoking in female smokers; (3) in adult females with ADHD, ovarian hormones interact with the dopamine reward system to exacerbate ADHD-related deficits in the capacity to form conditioned associations; and (4) during different phases of the menstrual cycle, nicotine and ovarian hormones may interact differentially with the dopamine reward processing system to affect the type and value of reinforcement smoking provides for women with ADHD. Understanding the bio-behavioral mechanisms underlying cigarette addiction in specific populations will be critical to developing effectively tailored smoking prevention and cessation programs for these groups. Overall, the goal of this paper is to examine the interaction of sex, smoking, and ADHD status within the context of the dopamine reward processing system not only to elucidate potential mechanisms specific to female smokers with ADHD, but also to stimulate consideration of how the examination of such individual differences can inform our understanding of smoking more broadly.

Monetary incentives promote smoking abstinence in adults with attention deficit hyperactivity disorder (ADHD).

Individuals with attention deficit hyperactivity disorder (ADHD) smoke at rates significantly higher than the general population and have more difficulty quitting than nondiagnosed individuals. Currently, there are no evidence-based approaches for reducing smoking specifically in individuals with ADHD. Adult regular smokers with or without ADHD participated in a study of extended smoking withdrawal where monetary incentives were used to promote abstinence. Participants were paid according to an escalating schedule for maintaining abstinence measured as self-report of no smoking and an expired air carbon monoxide (CO) level of <or=4 parts per million. Sixty-four percent (14/22) of smokers with ADHD and 50% (11/22) of smokers without ADHD maintained complete abstinence for the 2-week duration of the study. Twenty-two percent (5/22) and 9% (2/22) of smokers with ADHD and without ADHD, respectively, maintained continued abstinence for up to 10 days following the removal of the contingencies. Though abstinence rates were higher for the smokers with ADHD, the group differences were not statistically significant. Results suggest that monetary incentives may be a useful approach for promoting abstinence in adult smokers with ADHD, perhaps owing to altered reinforcement processes in these individuals.

Deliberate Self-Harm and Suicidal Ideation Among Male Iraq/Afghanistan-Era Veterans Seeking Treatment for PTSD

The objectives of the present research were to examine the prevalence of deliberate self-harm (DSH) among 214 U.S. male Iraq/Afghanistan-era veterans seeking treatment for posttraumatic stress disorder (PTSD) and to evaluate the relationship between DSH and suicidal ideation within this population. Approximately 56.5% (n = 121) reported engaging in DSH during their lifetime; 45.3% (n = 97) reported engaging in DSH during the previous 2 weeks. As hypothesized, DSH was a significant correlate of suicidal ideation among male Iraq/Afghanistan-era veterans, OR = 3.88, p < .001, along with PTSD symptom severity, OR = 1.03, p < .001, and combat exposure, OR = 0.96, p = .040. A follow-up analysis identified burning oneself, OR = 17.14, p = .017, and hitting oneself, OR = 7.93, p < .001, as the specific DSH behaviors most strongly associated with suicidal ideation. Taken together, these findings suggest that DSH is quite prevalent among male Iraq/Afghanistan-era veterans seeking treatment for PTSD and is associated with increased risk for suicidal ideation within this population. Routine assessment of DSH is recommended when working with male Iraq/Afghanistan veterans seeking treatment for PTSD.