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Mechanisms of Change in Developmental Psychopathology: Speaker’s Abstracts

Dr. Ronald Dahl

Adolescent brain development: A Framework for Understanding Unique Vulnerabilities and Opportunities for Intervention

Adolescence is a period of increased vulnerability for developing a wide range of behavioral and emotional problems in youth. These vulnerabilities emerge at the interface of biological, behavioral, and social changes during this period of maturation. This presentation considers the role of brain/behavior/social-context interactions during pubertal maturation that can influence individual trajectories-in both negative and positive ways (i.e. opportunities for early intervention). A model is described that focuses on neurobehavioral changes at puberty that lead to an increased tendency toward risk-taking, sensation-seeking, and emotional reactivity in adolescence. These biologically-based changes in affective systems contribute to emotional and motivational changes that start to manifest relatively early in adolescence. In contrast, the self-regulatory skills and cognitive judgments needed to manage the often-intense emotional experiences of adolescence tend to mature gradually (and relatively slowly) across late adolescence. The combination of early (pubertal-influenced) affective changes and the relatively late emergence of reliable self-control skills needed to deal with the strong emotional influences often leads to a maturational gap during which adolescents' behavior can reveal erratic, risky, and affectively-influenced behavior. This maturational gap appears to be particularly relevant for adolescents experiencing social contexts that activate emotional challenges that can transiently overwhelm these gradually-emerging cognitive skills in self-control and judgment. Empirical data from controlled studies that support key aspects of this model are described in this presentation. The clinical and social policy implications of this model-and its relevance to developing more effective early intervention-are presented along with a discussion of future research directions that can help to inform a deeper understanding of these complex but important issues.

Dr. Rutger Engels
The booze, the bar and the others: Studies on peer influences on alcohol use

Theoretical models on how people are being influenced by peers with respect to health behaviors like smoking, drinking, or drug use, are primarily tested with (correlational) longitudinal designs. Conducting studies examining social influence processes as they unfold in real time are required to critically test and subsequently adapt these models. I will present a line of research consisting of a) observations of social and contextual influences on alcohol use in groups, and b) observational experimental studies testing processes of social and non-social imitation on alcohol use. All studies are conducted in semi-naturalistic settings at the university (bar lab) and outside the university (cafe). I will discuss moderators on the individual (e.g., genetic susceptibility, social comparison tendencies), partner (e.g., looks) and interpersonal (e.g., quality of interaction) level. The implications of these studies for prevention of juvenile alcohol misuse and its consequences will be addressed.

Dr. Candice Odgers
Neighborhood effects on children’s health and development

It is well established that children and adolescents growing up in deprived neighborhoods are at risk for poor educational, emotional and health outcomes. However, we know very little about how neighborhood-level risk factors are translated into child outcomes. This talk will present data from the Environmental-Risk (E-Risk) Longitudinal Twin Study, an ongoing study of 2,232 same-sex twins and their families assessed at ages 5, 7, 10, and 12, that has also conducted state-of-the art assessments of the neighborhoods in which these families live. The E-Risk Study is an example of a ‘neurons to neighborhood’ approach (Shonkoff & Phillips, 2000) in testing how neighborhood-level factors influence children’s early emerging behavior and health problems. Recent advances in the ecological assessment of social environments, or ‘ecometrics’, are creating new possibilities for moving beyond measuring neighborhood poverty and are providing a window for exploring the mechanisms through which neighborhood-level social processes may influence behavior and health. Through the use of a genetically informative design, the proposed research begins to fill the current black box of environmental variance that is associated with children’s early emerging mental health problems and explicate how neighborhood factors may influence the developmental course of children’s health and behavior.

Dr. Christopher Lalonde
Cultural continuity as a protective factor against suicide among Canada’s First Nations Youth

The program of research that I will describe centers on identity formation and the role of culture in the health and wellbeing of First Nations youth. In particular, I will focus on the problem of suicide among First Nations youth. Suicide rates are substantially higher for Indigenous peoples in Canada and sensationalized media accounts of an “epidemic” of suicide within “the Aboriginal” population are all too common. The goal of this presentation will be to demonstrate that such claims are incorrect, insulting, and dangerous. Using suicide data collected in British Columbia, I will show that the view is incorrect because, while suicide rates are higher for First Nations youth, this increased risk is not a result of simply being Aboriginal. In contrast, suicide risk varies widely across First Nations communities—some have rates many times higher than the provincial average, while others have not experienced a single suicide in nearly two decades. Ignoring the cultural diversity that exists among First Nations communities by referring to suicide as an “Aboriginal” problem is not only insulting to sovereign peoples, but also dangerous because it leads to policy decisions that target suicide prevention resources within communities that have no suicide problem, while under-serving communities with tragically high suicide rates. Before mounting wide-spread campaigns of intervention, we should ask how it is that some communities have managed (seemingly against all odds) to “solve” the problem of youth suicide. The work to be described has uncovered a set of community-level factors that are associated with decreased suicide risk. In communities that: (1) take their cultural past and traditions seriously and that devote effort to preserving and promoting culture, and that (2) work to gain local control of key civic services that allow the community to navigate toward a shared vision of their own collective future, suicide rates drop to zero. Finding ways to promote these forms of “cultural continuity” would seem to offer some hope of redressing the health gap that exists between First Nations and other Canadians.

Dr. Stephen Hinshaw
Empirically supported treatments for ADHD and mechanisms of change

Although evidence-based treatments now exist for externalizing behavior problems and disorders, two crucial problems are salient: (a) no treatment to date has provided the kinds of extended and generalized benefits needed to eliminate the devastating impairments related to such problems, and (b) we have only begun to explore the moderator and mediator variables that may get us closer to understanding for whom such interventions are maximally effective--and how they exert their effects. In this presentation, I focus on the prevalent and impairing condition of ADHD. I first address the two evidence-based treatment strategies for this disorder during childhood, medications and behavioral interventions, and then review evidence regarding moderator variables (baseline characteristics that predict differential response to treatment) and mediator variables (processes occurring during the period of active intervention that may explain how and why treatment works). Depressingly, children with the most severe forms of ADHD, whose parents have symptoms of depression and whose intellectual abilities are sub average, show far less robust response to stimulant medication than do their counterparts with more favorable clinical presentations. On the other hand, evidence from the Multimodal Treatment Study of Children with ADHD reveals that when parents show meaningful improvement in their negative/inconsistent/ineffective discipline styles during receipt of multimodal treatment (i.e., medication management plus intensive behavior therapy), children's improvements in school lead to normalization. Needed directions in mechanism-related research on externalizing behavior disorders are emphasized.

Dr. Brooke Molina
Growth in alcohol consumption among teenagers with childhood ADHD: the role of ADHD-related impairments and parenting

Childhood Attention-Deficit/Hyperactivity Disorder (ADHD) is generally understood to be an early vulnerability for alcoholism, drug abuse, and nicotine dependence. Approximately one-third of adolescents in treatment for addictions suffer from ADHD, and prospective longitudinal studies of children diagnosed with ADHD typically report elevated use or dependence in late adolescence. The association tends to be modest in size and conduct problems usually accompany or precede this adolescent outcome. Although some controversy exists about the specificity of the linkage between ADHD and the addictions, research is now at a stage when explanatory models need to be investigated if an association is detected. The Pittsburgh ADHD Longitudinal Study (PALS) is following 364 children with ADHD and 240 demographically similar individuals without ADHD through adolescence and early adulthood. The PALS reported higher rates of heavy drinking and alcohol use disorders among the adolescents with, versus without, childhood ADHD (Molina et al. 2007). Analyses have moved into testing of potential explanatory variables that may moderate or mediate this risk. ADHD is well-known to be associated with impairments in daily life functioning which may also serve to partially explain risk for alcohol behaviors and which may ultimately function as treatment targets. These include poor performance at school, deficits in social functioning, the development or persistence of conduct problems, and the persistence of impulsivity and inattention. Whether parenting behavior can dampen risk is a logical question. Unfortunately, mental health problems common to alcoholics tend to run in families in which a child is diagnosed with ADHD; these problems may also account for risk. I will present our most recent longitudinal analyses of alcohol consumption and potential explanatory variables in the PALS. The results will highlight the role of parenting and ADHD-related impairments in the development of teenage drinking behavior. Analyses such as these have the potential, ultimately, to inform our understanding, and treatment, of ADHD-related risk for teen drinking.

Dr. Thomas Dishion
Deviant by design: Linking our understanding of peer relationship dynamics to the success or failure of interventions of conduct problems

This presentation will summarize four sets of findings related to mechanisms in development and psychopathology. First, results will be described on analyses of the developmental precursors to movement into peer cliques that are conducive to deviant peer clustering and peer contagion. Second, studies of the microsocial dynamics among adolescent friends that contribute to the development and maintenance of both adolescent drug use and antisocial behavior will be described, Third, the findings from developmental research indicating that the individual differences in adolescent self-regulation serves a protective function with respect to peer influence on problem behavior. Four, findings will be discussed that suggest interventions for problem behavior have predictable effects depending on whether they increase or decrease peer clustering and contagion. In general, this research will be discussed in terms of the importance of understanding mechanisms underlying the ebb and flow of maladaptation over the course of development, and how this understanding informs intervention science.

Dr. Isabela Granic
Brain and behavioural processes of change associated with successful interventions for aggressive children and families

Children with aggressive behavior problems have difficulties regulating negative emotions. Our research uses behavioural and brain methods to investigate different habits of emotion regulation in subtypes of aggressive children and changes in those habits with successful intervention. The general hypothesis we have been testing is that aggressive and/or anxious children are rigid in their emotional responses to threat. We have been examining this hypothesis by studying changes in (1) observed parent-child interactions and (2) brain regions responsible for flexible self-control. Our assessment are conducted before and after a 12-week program combining Cognitive-behavioural Therapy (CBT) and Parent-management Training (PMT) for aggressive children. In the studies I will be presenting, at pre- and post-treatment, parents and children were videotaped engaging in standardized problem-solving interactions. These observations showed that emotional flexibility and the ability to repair conflicts were two key processes of change that led to clinically significant treatment gains. Brain activity using EEG methods was recorded from children comorbid for aggressive and anxious symptoms, along with age-matched nonclinical children, during a task designed to elicit negative emotion and initiate emotion regulation. Children who improved with treatment showed a reduction in ventral activation from pre- to post-treatment, bringing them in line with nonclinical comparison children, while those who did not improve maintained high activation in this region. Our results suggest that too much ventral prefrontal activity and/or too little dorsal prefrontal activity contribute to both rigid interpersonal interactions and hamper clinical improvement. Videotapes demonstrating these change processes will be presented and discussion will focus on the clinical implications for tailoring treatments for subtypes of aggressive children and families.