Sarah Francazio

Cognitive flexibility differentiates young adults exhibiting obsessive-compulsive behaviors from controls

The National Institute of Mental Health has proposed a shift toward classifying clusters of disorders on the basis of underlying biomarkers and neurological correlates. The present study sought to determine whether cognitive flexibility represents one such construct underlying obsessive-compulsive behaviors (OCBs), a cluster of behaviors characteristic of OCD and other body-focused repetitive behaviors (BFRBs), including trichotillomania, pathological skin picking, nail biting, and tic disorders. One-hundred and twenty-four undergraduate students completed the Depression Anxiety and Stress Scales, Padua Inventory-Washington State University Revision, Massachusetts General Hospital-Hairpulling Scale, Skin Picking Scale, and an Intradimensional/Extradimensional Shift (IDED) Test. Analyses were performed using a subsample of participants who met criteria for inclusion in the OCB group and a control group (N=56). Results indicated that young adults in the OCB group demonstrated significantly poorer performance on the IDED compared to controls. However, hierarchical regression analyses revealed that increased deficits in cognitive flexibility failed to predict worsened OCB severity-as assessed via a composite score. These results suggest that while cognitive flexibility differentiates those exhibiting OCBs from controls, it does not appear to be related to OCB severity. Future research is needed to replicate these results in larger clinical samples.

An Examination of Executive Functioning in Young Adults Exhibiting Body-Focused Repetitive Behaviors.

Abstract Body-focused repetitive behaviors (BFRBs), including hair pulling, nail biting, and skin picking are repetitive, habitual, and compulsive in nature. Although characteristic of disorders such as trichotillomania and skin picking disorder, BFRBs are associated with other psychiatric conditions as well. To date, research has failed to examine neurocognitive risk factors, particularly executive functioning, implicated in BFRBs utilizing a transdiagnostic approach. The present study recruited 53 participants (n = 27 demonstrating BFRBs and n = 26 randomly selected controls) from a larger sample of young adults. Participants completed an automated neurocognitive test battery including tasks of cognitive flexibility, working memory, and planning and organization. Results revealed that participants in the BFRB group demonstrated significantly poorer cognitive flexibility (d = 0.63) than controls. No differences were noted in other neurocognitive domains. However, planning and organization demonstrated a significant relationship with various BFRB severity measures. Implications, limitations, and avenues for further research are discussed.

Examining the Relationship Between Anxiogenic Parenting Practices and Cognitive Flexibility in Youth

Cognitive flexibility (CF), a subdomain of executive functioning (EF), involves abilities such as set shifting and reversal learning. Some variability in CF is normative across youth due to the gradual refinement of broader EF along with the prefrontal cortex. Prior research has suggested that a supportive parenting environment contributes to strong EF, whereas harsh/controlling parenting is associated with deficits. The current investigation explores whether certain parenting practices (e.g., parental accommodation, over-involvement, modeling) are associated with such deficits. Anxiogenic parenting and CF were assessed in 112 youth aged 9 to 17 years, with results demonstrating that parenting practices were not predictive of CF in these youth. Age accounted for the majority of differences in set shifting performance, potentially emphasizing the influence of parenting at different stages of development. Accordingly, future research is necessary to determine the potential impact of anxiogenic parenting at specific points in the development of CF.

An Investigation of Executive Functioning in Pediatric Anxiety

Although science’s understanding (e.g., etiology, maintaining factors, etc.) of pediatric anxiety and related problems has grown substantially over recent years, several aspects to anxiety in youths remain elusive, particularly with relation to executive functioning. To this end, the current study sought to examine several facets to executive functioning (i.e., cognitive flexibility, inhibition, planning, working memory) within a transdiagnostic sample of youths exhibiting varying degrees of anxiety symptoms. One hundred six youths completed a comprehensive battery, including several self-report measures (e.g., Multidimensional Anxiety Scale for Children [MASC] or MASC-2) and an automated neurocognitive battery of several executive functioning tasks (Intradimensional/Extradimensional [IDED], Stop Signal [SST], Spatial Span [SSP], Stockings of Cambridge [SOC] tasks). Regression analyses indicated that youths exhibiting marked anxiety symptoms demonstrated increased planning time and probability of inhibition compared with youths with minimal or no anxiety symptoms. Youths with marked anxiety symptoms similarly demonstrated better cognitive flexibility (i.e., set shifting) compared with youths with minimal anxiety. In addition, analyses indicated a trend such that youths exhibiting marked anxiety symptoms demonstrated poorer working memory compared with youths with no anxiety symptoms. Group classification did not predict remaining outcomes. Limitations and future areas of research are discussed.

IMPAIRED EXECUTIVE FUNCTIONING IN PEDIATRIC TRICHOTILLOMANIA (HAIR PULLING DISORDER).

No neurocognitive examinations of pediatric trichotillomania (hair pulling disorder; HPD) have taken place. As a result, sciences understanding of the underlying pathophysiology associated with HPD in youths is greatly lacking. The present study seeks to begin to address this gap in the literature via examination of executive functioning in a stimulant‐free sample of children with HPD.

Parent psychopathology as a mediator of the relationship between anxiety and sleep problems in children.

INTRODUCTION Sleep problems exert a negative impact on youths and their families. Parent and child mental health represent 2 posited, yet understudied, risk factors for sleep problems in youths. As such, this study sought to examine the role that parental psychopathology may play in mediating the relationship between child anxiety and sleep problems utilizing Internet sampling procedures. METHOD Parents (n = 83; 90.4% female) answered questions about their own mental health, and about their childs (n = 83; 77.1% female) anxiety and sleep. RESULTS Analyses found that parent anxiety and stress mediated the relationship between child anxiety and sleep problems. DISCUSSION This is the first study to examine the joint roles of parent psychopathology and child anxiety in explaining sleep problems in youths. Limitations notwithstanding, these results suggest that both parent- and child-level variables are important for developing a more comprehensive understanding of child sleep problems. Future areas of research are discussed.

Translating the semi-structured assessment for drug dependence and alcoholism in the Western Pacific: rationale, study design and reliability of alcohol dependence.

AIMS The aims of this study were to develop a bilingual version of the Semi-Structured Assessment for Drug Dependence and Alcoholism (SSADDA) in English and Samoan and determine the reliability of assessments of alcohol dependence in American Samoa. METHODS The study consisted of development and reliability-testing phases. In the development phase, the SSADDA alcohol module was translated and the translation was evaluated through cognitive interviews. In the reliability-testing phase, the bilingual SSADDA was administered to 40 ethnic Samoans, including a sub-sample of 26 individuals who were retested. RESULTS Cognitive interviews indicated the initial translation was culturally and linguistically appropriate except items pertaining to alcohol tolerance, which were modified to reflect Samoan concepts. SSADDA reliability testing indicated diagnoses of DSM-III-R and DSM-IV alcohol dependence were reliable. Reliability varied by language of administration. CONCLUSION The English/Samoan version of the SSADDA is appropriate for the diagnosis of DSM-III-R alcohol dependence, which may be useful in advancing research and public health efforts to address alcohol problems in American Samoa and the Western Pacific. The translation methods may inform researchers translating diagnostic and assessment tools into different languages and cultures.

Strategies to Manage Common Co-occurring Psychiatric Conditions

Abstract Obsessive-compulsive disorder (OCD) demonstrates substantial prevalence and significant impairment among youths. Though efficacious treatments are available, several limitations exist (e.g., some children are nonresponsive to treatment). One challenge to delivering efficacious treatments may be the frequent comorbidities found among children in this population. In efforts to provide comprehensive treatment, clinicians must carefully consider implications of comorbidities, as well as the appropriate treatment modifications. To this end, the present chapter seeks to identify and discuss several frequent comorbidities found among children with OCD (i.e., attention-deficit/hyperactivity disorder, oppositional defiant disorder, generalized anxiety disorder, and tic disorders) and further provide practical and flexible strategies for addressing such comorbidities within treatment. Notably, review of the current literature indicates several similarities, as well as unique differences, between OCD and these comorbidities, with critical implications for the therapy process (e.g., implications for recommended treatment approach; potential effects of comorbidity on treatment progress, etc.).