Hats Off: Journal Awards 2018

Abstract

Every summer, your president, your editor, and last years’ Journal award winners are challenged with selecting 3 new award-winning articles. To be eligible, articles must epitomize scholarly excellence in a key area of our discipline and have been published in the Journal between July of the previous year and June of the current year by a lead or senior author who is a child and adolescent psychiatrist and an American Academy of Child and Adolescent Psychiatry (AACAP) member. Each of the Academy’s prestigious Journal Awards acknowledges the need for more and better mental health research and funding and for improving mental health in children and adolescents. By supporting and collaborating with other organizations to provide these awards, the Academy encourages innovative research that contributes to improving the care and treatment of young people. The 2018 AACAP Norbert and Charlotte Rieger Award for Scientific Achievement was awarded to Stacy S. Drury, MD, PhD, the Remigio Gonzalez, MD, Professor of Child Psychiatry and Associate Director of the Tulane Brain Institute, New Orleans, Louisiana. This award recognizes the most significant article by a child and adolescent psychiatrist published in the Journal during the past year.1Gray S.A.O. Jones C.W. Theall K.P. Glackin E. Drury S.S. Thinking across generations: unique contributions of maternal early life and prenatal stress to infant physiology.J Am Acad Child Adolesc Psychiatry. 2017; 56: 922-929Abstract Full Text Full Text PDF PubMed Scopus (41) Google Scholar Dr. Drury and her colleagues took a mechanistic approach to the increasing literature suggesting that risk for child mental health problems might begin before conception, influenced by maternal exposure to adversity across her life course. In this study they examined infants’ respiratory sinus arrhythmia (RSA), a parasympathetic-mediated biomarker, based on evidence that the autonomic nervous system is one of the earliest developing stress response systems and has established links to emergent emotional and biobehavioral self-regulation. Recognizing that maternal exposure to adversity can differ across the lifespan, the authors sought to determine the potential unique and additive effects of mothers’ prenatal stress and exposure to adverse childhood experiences (ACEs) on her child’s developing self-regulation. The relatively brief and simple to obtain ACE score was selected owing to increasing support for its utility as a screener across health outcomes, recognizing the limitations with any retrospective self-report measure. Leveraging data from a prospective longitudinal cohort of community-recruited pregnant women and their infants, Dr. Drury and her colleagues tested the differential effects of maternal ACE score and her self-reported prenatal stress on infants’ RSA at 4 months of age. Maternal ACE score predicted a lower RSA starting point, suggesting a lower environmental responsiveness, perhaps in anticipation that reactivity to repeated stressors would be biologically costly. However, these same alterations might be “adaptive at a cost,” because lower RSA also has been associated with future psychopathology risk. A different, and sex-specific, pattern was delineated for the impact of prenatal maternal stress. Specifically, in boys only, increased prenatal maternal stress resulted in dampened RSA recovery to a dyadic stressor. There are several implications for these findings. First, although it is not possible to intervene to prevent maternal ACE exposure in pregnant women, it is possible to influence prenatal stress. Clinical interventions targeting high-risk mothers that consider life course exposure to adversity but target decreasing prenatal stress could have uniquely powerful benefits for offspring. Second, because maternal ACE score and prenatal stress were only partially correlated, and their biological effects on the infant differed, studies seeking to define the impact of prenatal stress on long-term outcomes need to carefully consider the potential effects of preconception exposures. Third, efforts addressing persistence of health disparities would benefit from a life course perspective that does not simply focus on the current experiences of a child but integrates exposures across generations—not only in determining the negative effects but also, equally important, when measuring the efficacy. For child psychiatry the conceptualization of family history and its role in developmental psychopathology have always incorporated information beyond just what is happening in the present. This study simply extends this approach to include the conceptualization of biomarkers of risk and further highlights the importance of early life experiences within and across generations. The 2018 AACAP Klingenstein Third Generation Foundation Award for Research in Depression or Suicide was awarded to Judah Weathers, MD, DPhil, of Yale School of Medicine, New Haven, Connecticut. This award recognizes the best article on suicide and/or depression published in the Journal during the past year.2Weathers J. Lippard E.T.C. Spencer L. Pittman B. Wang F. Blumberg H.P. Longitudinal diffusion tensor imaging study of adolescents and young adults with bipolar disorder.J Am Acad Child Adolesc Psychiatry. 2018; 57: 111-117Abstract Full Text Full Text PDF PubMed Scopus (15) Google Scholar Hilary Blumberg, MD, was the senior author and Dr. Weathers was the first author of the article that reported differences between adolescents and young adults with bipolar disorder compared with healthy adolescents and young adults in changes with age and over time in white matter of the uncinate fasciculus, the fiber tract carrying major connections of the amygdala-ventral prefrontal cortex system that subserves emotion regulation. The adolescents and young adults with bipolar disorder did not show expected increases in the structural integrity of the uncinate fasciculus with increasing age (12–23 years) or over time (longitudinal study over approximately 2.5 years). These neuroimaging findings support a neurodevelopmental model for bipolar disorder in which the developmental trajectory of the connections within the amygdala-ventral prefrontal cortex system during adolescence is altered. Because differences also were found in a subgroup euthymic at the 2 time points, the altered development of the system might be a trait feature of bipolar disorder neurodevelopment. This article is important because it contributes to a growing body of data supporting adolescence as a critical period in the development of bipolar disorder. Moreover, it provides new evidence that implicates white matter in the underlying neurodevelopmental pathophysiology. The findings highlight the importance of future longitudinal neuroimaging investigations in bipolar disorder on development of the circuitry that subserves emotion regulation to further elucidate the developmental pathophysiology. This could lead to new targets for early identification and treatment and, if strategies are identified that can help realign the developmental trajectories toward health, to targets to potentially halt the development of the disorder. The 2018 AACAP Elaine Schlosser Lewis Award for Research on Attention-Deficit Disorder was awarded to Jeffrey H. Newcorn, MD, of the Icahn School of Medicine at Mount Sinai, New York. This award recognizes the best article published in the Journal on attention-deficit disorder written by a child and adolescent psychiatrist during the past year.3Schulz K.P. Bédard A.C.V. Fan J. et al.Striatal activation predicts differential therapeutic responses to methylphenidate and atomoxetine.J Am Acad Child Adolesc Psychiatry. 2017; 56: 602-609Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar In this functional magnetic resonance imaging (fMRI) study, Dr. Newcorn and his team (notably, Kurt Schulz, PhD, his primary collaborator in this study and other fMRI studies in attention-deficit/hyperactivity disorder [ADHD] and its treatment) examined activation during an inhibitory control task in association with treatment with atomoxetine and methylphenidate to determine whether they could identify biomarker predictors of differential response. Thirty-six youth 7 to 17 of age were treated with the 2 medications using a randomized crossover design; children had fMRI scans off medication and their response to the 2 medications was recorded. Of note, increased task-related activation in the right caudate nucleus was associated with robust improvement for methylphenidate and little improvement for atomoxetine. Furthermore, response to atomoxetine predicted motor cortex activation. A unique aspect of this study is that all subjects received the 2 medications; the within-subjects design ensures that the fMRI findings are not driven by group differences in demographic/clinical features that could potentially account for differences in medication response. The authors conclude that differences between the 2 medications in striatal function might represent the neuropharmacologic basis for preferential response to methylphenidate over atomoxetine within individuals, when this occurs, and the basis for overall greater response to methylphenidate than atomoxetine seen in head-to-head studies. They further suggest that these are the first findings to identify possible biomarker predictors of differential response to the stimulant methylphenidate over the non-stimulant atomoxetine and overall response to atomoxetine in youth with ADHD. These candidate biomarkers could be of interest to clinicians because of the high level of nonresponse to atomoxetine (approximately 40% of treated youth do not achieve an adequate response) and the extended time (typically, weeks) required to achieve optimal response to this medication. Although the findings have considerable promise for directing future research on personalized treatment of ADHD, the authors note that they are not yet sufficiently developed to be applied to clinical practice. Nevertheless, the approach used in this study illustrates that it eventually might be possible to predict differential treatment response in ADHD using a biomarker-driven approach. The Journal’s excellence reflects the hard work of authors and peer reviews and of a commitment to advancing pediatric mental health through scientific originality and rigor and through adherence to the highest ethical standards. We salute the authors of all articles published during this interval and celebrate this year’s recipients for their remarkable accomplishments.