Risk Paradigm Research Articles

Fragility, Health and the Risk Paradigm: A Health-Sensitive Framework.

Recognising that fragile contexts present a significant challenge to the Sustainable Development Goals, this paper examines the relationship between fragility and health, proposing a health-sensitive conceptual framework for understanding the impact of fragility on health outcomes. Through a comprehensive literature review and comparison of existing fragility frameworks, the study identifies five key characteristics of fragility: alignment with the risk paradigm; multidimensionality; systems perspective; state-society relationship; and appreciating fragility in relation to 'contexts' rather than 'states'. In doing so, the paper highlights the need for a multidimensional approach to fragility that includes a distinct health dimension in addition to political, security, economic, social, environmental domains. Rather than proposing a way to score or measure fragility, the authors argue in favour of a nuanced and dynamic understanding of fragility based on the interactions between the different dimensions of fragility, emphasising the impact on/interactions with health.

The enterprise activism risk model: How good intentions can jeopardize business success

Companies are increasingly expected to contribute, above and beyond a profit motive, to society. Leaders across industries have addressed the expectation by engaging in activism. While some upper echelons leaders initiate activism efforts in a way that strengthens their firms, others are struggling to do so without risking brand and business performance. This research addresses this important managerial challenge by conceptualizing activism through a risk paradigm. To do this, we first introduce and define a construct called Enterprise Activism. The construct comprises all forms of firm-initiated activism which can impact brand and business performance, such as brand activism, CEO activism, and corporate activism, regardless of who is making the decision (e.g., Chief Marketing Officer or store manager) or whether a portfolio brand or the corporate brand is involved (e.g., Harris Teeter or the corporate brand, Kroger). We then conceptualize the Enterprise Activism Risk Model, providing insight into how different types of actions can pose market share and positional advantage risks. Leveraging insight from C-level leaders, we identify ways that firm leaders can deploy the model to advance business practice. Finally, we provide a research agenda to develop new theory and evidence to help support and improve practice. The new insight provided herein provides a framework that can enable upper echelons leaders to evaluate, discuss, and navigate activism to minimize business risk.

Risk avoidance in strategic technology adoption

PurposeOrganizational technologies can be classified according to the roles they play as either commodity or strategic. Commodity technologies support common operations, while strategic technologies address perceived threats to competitiveness, often identified by strategic foresight. These must go through an adoption process before playing an effective role in strategy execution. The adoption process includes known activities, ranging from sourcing (itself from in-house development to turn-key acquisition) to operational integration. This paper aims to reveal strategic technology adoption risks that arise during strategy execution.Design/methodology/approachA gradually developed causal loop diagram model, supported by general literature, introduces three general classes of technology adoption risks: mismatched requirements, supplier dependence and unmanaged life cycles.FindingsRather than managed, these risks are incurred or avoided depending on decisions made during the adoption process.Research limitations/implicationsDespite the scarce literature coverage for the approach, examples revealing the presence of adoption risks are nevertheless available in the well-documented history of enterprise resource planning (ERP).Practical implicationsAlthough ERP is presented as a general-purpose strategic technology, the unique business features of maritime container terminals pose serious challenges to its adoption, which provides additional support to the discussion and reinforces the conclusions.Originality/valueThe approach to identifying risks in strategic technology adoption departs from the current risk paradigm in two significant ways. First, it emphasizes policy decision-making rather than external events. Second, it views risks as systemic rather than occurring independently.

Brain structural and functional signatures of multi-generational family history of suicidal behaviors in preadolescent children.

Parent-child transmission of suicidal behaviors has been extensively studied, but the investigation of a three-generation family suicide risk paradigm remains limited. In this study, we aimed to explore the behavioral and brain signatures of multi-generational family history of suicidal behaviors (FHoS) in preadolescents, utilizing a longitudinal design and the dataset from Adolescent Brain and Cognitive DevelopmentSM Study (ABCD Study®), which comprised 4 years of data and includes a total of 9,653 preadolescents. Our findings revealed that multi-generational FHoS was significantly associated with an increased risk of problematic behaviors and suicidal behaviors (suicide ideation and suicide attempt) in offspring. Interestingly, the problematic behaviors were further identified as a mediator in the multi-generational transmission of suicidal behaviors. Additionally, we observed alterations in brain structure within superior temporal gyrus (STG), precentral/postcentral cortex, posterior parietal cortex (PPC), cingulate cortex (CC), and planum temporale (PT), as well as disrupted functional connectivity of default mode network (DMN), ventral attention network (VAN), dorsal attention network (DAN), fronto-parietal network (FPN), and cingulo-opercular network (CON) among preadolescents with FHoS. These results provide compelling longitudinal evidence at the population level, highlighting the associations between multi-generational FHoS and maladaptive behavioral and neurodevelopmental outcomes in offspring. These findings underscore the need for early preventive measures aimed at mitigating the familial transmission of suicide risk and reducing the global burden of deaths among children and adolescents.

Time for a paradigm change: Problems with the financial industry's approach to operational risk.

Organizational and risk cultures in the financial industry are argued to be the root cause of banking problems. It is concerning that financial regulators and practitioners still consider the industry to be seriously fragile in several respects, particularly to operational risks and risks associated with digital transformation and innovation-not that the risks of organizational misconduct have disappeared. The rescue of Credit Suisse in 2023 confirms this. This paper employs extant theories of organizational culture, learning, and action to critically evaluate the existing risk paradigm in banking and to highlight its deficiencies, which practitioners can only address by questioning the flawed assumptions and dysfunctional values and behaviors found to be endemic in banks. However, business and risk practitioners are also married to institutional approaches that focus on assessing risk and measuring historical losses to allocate regulatory capital, rather than forward-looking approaches to measure and manage risk. This requires a paradigm change. This paper presents a novel risk measurement and accounting methodology, Risk Accounting, to help underpin such change. Risk accounting measures risk exposure in quantitative and qualitative terms and can be implemented using an AI-enabled digital architecture that could solve endemic problems with risk data aggregation and analysis. Significantly, risk accounting enables a financial value to be placed on risk exposures at a granular level. This level of transparency provides an incentive to change behaviors in banks and support cultural change while providing a basis for a paradigm change in the way operational risk is managed.

No Acceptable Losses: Risk, Prevention, and Justice

Abstract Beginning in the nineteenth century, social statistics inspired a vision of society as a population characterized by a certain distribution of risks. The introduction of the risk paradigm has deep implications for central concepts in Christian social ethics like distributive justice, with this vision leading to a new concept of distributive justice as the equal distribution of risk. This essay describes tensions that arise due to the risk paradigm in relation to distributive justice: risks can always be further reduced, risk mitigation creates other risks, and there is no inherent rule of justice for balancing risks. While recognition of shared risk can create social cohesion, it also leads to interest groups struggling over which risks to confront. The essay illustrates these problems with two examples from health care: preventive health programs that manage disease risk through medication, and debates over school closures in respond to the Covid pandemic. Christian bioethics, as it wrestles with issues of justice, must address the problems created by the risk paradigm.

African Indigenous Knowledge of Climate Change and Disaster Risk Management in Changing Climate

Climate change presents an unprecedented challenge to humanity. The changing climate threatens the very existence of humankind and the ways of life on Earth, including indigenous knowledge systems. The indigenous knowledge systems are threatened by climate change because they depend on natural factors such as trees, animals, and wind patterns, which can be affected by climate change. As the changing climate posits a significant challenge to the survival of species on earth, it begs the question ‘Are indigenous knowledge systems still relevant in a changing climate? This paper examined the African indigenous knowledge of climate change and disaster risk management in the context of the changing climate. The research was conducted in Mozambique, Kenya, Ethiopia, Tunisia, Nigeria, Burkina Faso, and Cameroon. The seven countries represent the six climatic zones in Africa. Africa's climate is categorised into six climate zones. These are equatorial, humid tropical, tropical, Sahelian, Mediterranean, and Desert. Following an in-depth analysis, the research found that, by contrast, the African indigenous knowledge systems and practices have evolved with the changing climate as the African indigenous communities have developed some of the advanced adaptation options to build resilience to climate change and the changing disaster risk paradigm

A crime risk-based approach for urban planning. A methodological proposal

The issue of urban security is of great importance in city policies and a prerequisite for the creation of sustainable cities and communities. The pursuit of secure conditions requires the integration of different existing approaches in order to achieve effective and lasting results. The methodology focuses on the crime risk concept, for which no instrument currently available in Literature provides an unambiguous definition or complete assessment. The aim of the research is the definition of a risk model in which the different security approaches converge and maximise their synergy through the construction of a Spatial Composite Crime Risk Index (IRc), structured according to the disaster risk paradigm. Its spatial nature allows the spatial component of crime risk to be highlighted. The associated crime risk map gives a snapshot of the risk conditions in the area under study. It highlights the presence, the magnitude and the superficial extension of the critical areas for which appropriate intervention strategies can be envisaged. The model was applied to the city of Milan. The quantitative result obtained, i.e. the crime risk map, confirms the usefulness and effectiveness of introducing the latter into the information layers used when defining Urban Planning tools. This would allow an in-depth analysis of the territory through the construction of risk scenarios.

Cyber risk management for autonomous passenger ships using threat-informed defense-in-depth

Recent innovations in the smart city domain have led to the proposition of a new mode of transportation utilizing Autonomous Passenger Ships (APS) or ferries in inland waterways. The novelty of the APS concept influenced the cyber risk paradigm and led to different considerations regarding attack objectives, techniques as well as risk management approaches. The main factor that has led to this is the autoremote operational mode, which refers to autonomous operations and remote supervision and control in case of emergency. The autoremote operational mode influences the risk of cyber attacks due to the increased connectivity and reliance on technology for automating navigational functions. On the other hand, the presence of passengers without crew members imposes a safety risk factor in cyber attacks. In this paper, we propose a new cyber risk management approach for managing the cyber risks against cyber physical systems in general and Autonomous Passenger Ships in particular. Our proposed approach aims to improve the Defense-in-Depth risk management strategy with additional components from the Threat-Informed Defense strategy allowing for more evolved cyber risk management capabilities. Moreover, we have utilized the proposed cyber risk management approach for the proposition of a cybersecurity architecture for managing the cyber risks against an APS use case named milliAmpere2. Additionally, we present our results after conducting a Systematic Literature Review (SLR) in cybersecurity evaluation in the maritime domain. Then, the findings of the SLR were utilized for a suitable evaluation of the proposed risk management approach. Our findings suggest that our proposed risk management approach named Threat-Informed Defense-in-Depth is capable of enriching several risk management activities across different stages in the system development life cycle. Additionally, a comprehensive evaluation of the cybersecurity posture of milliAmpere2 has been conducted using several approaches including risk evaluation, simulation, checklist, and adversary emulation. Our evaluation has uncovered several limitations in the current cybersecurity posture and proposed actions for improvement.

Governing systemic and cascading disaster risk in Indonesia: where do we stand and future outlook

PurposeThis paper aims to identify key factors for a contextualised Systemic Risk Governance (SRG) framework and subsequently explore how systemic risks can be managed and how local institutional mechanisms can be tweaked to deal with the complex Indonesian risk landscape.Design/methodology/approachUsing a case study from Palu triple-disasters in Central Sulawesi, Indonesia, the authors demonstrate how inland earthquakes in 2018 created cascading secondary hazards, namely tsunamis, liquefactions and landslides, caused unprecedented disasters for the communities and the nation. A qualitative analysis was conducted using the data collected through a long-term observation since 2002.FindingsThe authors argue that Indonesia has yet to incorporate an SRG approach in its responses to the Palu triple-disasters. Political will is required to adopt more appropriate risk governance modes that promote the systemic risk paradigm. Change needs to occur incrementally through hybrid governance arrangements ranging from formal/informal methods to self- and horizontal and vertical modes of governance deemed more realistic and feasible. The authors recommend that this be done by focusing on productive transition and local transformation.Originality/valueThere is growing awareness and recognition of the importance of systemic and cascading risks in disaster risk studies. However, there are still gaps between research, policy and practice. The current progress of disaster risk governance is not sufficient to achieve the Sendai Framework for Disaster Risk Reduction (2015–2030) unless there is an effective governing system in place at the local level that allow actors and institutions to simultaneously manage the interplays of multi-hazards, multi-temporal, multi-dimensions of vulnerabilities and residual risks. This paper contributes to these knowledge gaps.

Digital Relationality, Rights, Resilience: Conceptualising a Digital Social Ecology for Children’s Birth Family Relationships When in Care or Adopted

AbstractThe use of digital communication technology by children residing in out-of-home care or adopted from foster care has mainly been approached hesitantly and from a risk paradigm. The Covid-19 pandemic catalysed many digital and social work intersections, including practices used for birth family contact where in-person visits were supplemented or replaced with ‘virtual’ contact via digital devices. Whilst technology-mediated contact is characterised as ‘virtual’, the relationships it facilitates and emotions it generates are very real within children’s social ecology. Digital ubiquity in social life and the rapid pace of technological change presents significant ethical and practical tensions. To help social workers navigate this complexity of ‘contact-in-reality’ and facilitate safe, ethical use of digital communication technology for birth family contact, we connect an understanding of the dynamics of birth family contact with literature on children’s use of digital technology and ecological concepts of person-in-environment to offer a digital social ecology heuristic for social work practice. Three key aspects cut across all systems and levels, referred to here as the three Digital R’s: digital relationality; digital rights; and digital resilience. Future research is needed to understand how these dynamics play out.

Extreme Inflation and Time-Varying Expected Consumption Growth

In a parsimonious regime switching model, we find strong evidence that expected consumption growth varies over time. Adding inflation as a second variable, we uncover two states in which expected consumption growth is low, one with high and one with negative expected inflation. Embedded in a general equilibrium asset pricing model with learning, these dynamics replicate the observed time variation in stock return volatilities and stock-bond return correlations. They also provide an alternative derivation for a measure of time-varying disaster risk suggested by Watcher [ Wachter J (2013 ) Can time-varying risk of rare disasters explain aggregate stock market volatility? J. Finance 68(3):987–1035]. implying that both the disaster and the long-run risk paradigm can be extended toward explaining movements in the stock-bond correlation. This paper was accepted by Kay Giesecke, finance. Funding: We gratefully acknowledge research and financial support from the Leibniz Center for Financial Research SAFE (formerly Research Center SAFE, funded by the State of Hessen initiative for research LOEWE). Supplemental Material: The data files and online appendices are available at https://doi.org/10.1287/mnsc.2022.4451 .

Cooking outdoors or with cleaner fuels does not increase malarial risk in children under 5\xa0years: a cross-sectional study of 17 sub-Saharan African countries

BackgroundSmoke from solid biomass cooking is often stated to reduce household mosquito levels and, therefore, malarial transmission. However, household air pollution (HAP) from solid biomass cooking is estimated to be responsible for 1.67 times more deaths in children aged under 5 years compared to malaria globally. This cross-sectional study investigates the association between malaria and (i) cleaner fuel usage; (ii) wood compared to charcoal fuel; and, (iii) household cooking location, among children aged under 5 years in sub-Saharan Africa (SSA).MethodsPopulation-based data was obtained from Demographic and Health Surveys (DHS) for 85,263 children within 17 malaria-endemic sub-Saharan countries who were who were tested for malaria with a malarial rapid diagnostic test (RDT) or microscopy. To assess the independent association between malarial diagnosis (positive, negative), fuel type and cooking location (outdoor, indoor, attached to house), multivariable logistic regression was used, controlling for individual, household and contextual confounding factors.ResultsHousehold use of solid biomass fuels and kerosene cooking fuels was associated with a 57% increase in the odds ratio of malarial infection after adjusting for confounding factors (RDT adjusted odds ratio (AOR):1.57 [1.30–1.91]; Microscopy AOR: 1.58 [1.23–2.04]) compared to cooking with cleaner fuels. A similar effect was observed when comparing wood to charcoal among solid biomass fuel users (RDT AOR: 1.77 [1.54–2.04]; Microscopy AOR: 1.21 [1.08–1.37]). Cooking in a separate building was associated with a 26% reduction in the odds of malarial infection (RDT AOR: 0.74 [0.66–0.83]; Microscopy AOR: 0.75 [0.67–0.84]) compared to indoor cooking; however no association was observed with outdoor cooking. Similar effects were observed within a sub-analysis of malarial mesoendemic areas only.ConclusionCleaner fuels and outdoor cooking practices associated with reduced smoke exposure were not observed to have an adverse effect upon malarial infection among children under 5 years in SSA. Further mixed-methods research will be required to further strengthen the evidence base concerning this risk paradigm and to support appropriate public health messaging in this context.

Shortfall Risk Models When Information on Loss Function Is Incomplete

Utility-based shortfall risk measures effectively captures a decision maker's risk attitude on tail losses. In this paper, we consider a situation where the decision maker's risk attitude toward tail losses is ambiguous and introduce a robust version of shortfall risk, which mitigates the risk arising from such ambiguity. Specifically, we use some available partial information or subjective judgement to construct a set of plausible utility-based shortfall risk measures and define a so-called preference robust shortfall risk as through the worst risk that can be measured in this (ambiguity) set. We then apply the robust shortfall risk paradigm to optimal decision-making problems and demonstrate how the latter can be reformulated as tractable convex programs when the underlying exogenous uncertainty is discretely distributed.

Research Trends in Media Pedagogy: Between the Paradigm of Risk and the Paradigm of Opportunity

The use of computers, internet, and smartphones in the learning and teaching process has become an irreversible fact. Information and communication technologies (ICT) are now one of the fundamental teaching resources and even one of the principal teaching environments. The widespread use of ICT stands in positive correlation to the growing number of studies on educational aspects of the use of new media in schooling. The dynamically growing number of publications in this field requires reflection on the directions of research in the intensely developing sub-discipline of education science, i.e. media pedagogy. The aim of the article is to explore the two dominant directions of research on didactic and upbringing aspects of ICT use in education. The text presents the assumptions and processes assigned to both the opportunity paradigm and the risk paradigm of media pedagogy. These paradigms clash, giving rise to research directed at positive or negative phenomena related to the digitalization of schooling and educational processes. The text is an attempt to draw attention not only to the development of media pedagogy, but also to methodological errors resulting from anchoring research to only one trend.

New Outlook on the Space Radiation Risk Paradigm for Remote beyond-Magnetosphere Missions to the Moon and Mars

New Outlook on the Space Radiation Risk Paradigm for Remote beyond-Magnetosphere Missions to the Moon and Mars

<i>Breaking the Silos</i>: an online serious game for multi-risk disaster risk reduction (DRR) management

Abstract. The increased complexity of disaster risk, due to climate change, expected population growth and the increasing interconnectedness of disaster impacts across communities and economic sectors, requires disaster risk reduction (DRR) measures that are better able to address these growing complexities. Especially disaster risk management (DRM) practitioners need to be able to oversee these complexities. Nonetheless, in the traditional risk paradigm, there is a strong focus on single hazards and the risk faced by individual communities and economic sectors. The development of the game and how it aims to support a shift from a single-risk to a multi-risk paradigm are discussed in detail. Breaking the Silos is a serious game designed to support various stakeholders (including policy makers, risk managers, researchers) in understanding and managing the complexities of DRR measures in a multi-risk (multi-hazard) setting, thereby moving away from hazard-silo thinking. What sets Breaking the Silos apart from other disaster risk games is its explicit focus on multi-risk challenges. The game includes different hazard types and intensities (and their interactions), different impact indicators, and (a)synergies between DRR measures. Moreover, the spread of expert knowledge between different participants and the high levels of freedom and randomness in the game design contribute to a realistic game. The game was launched during the World Bank GFDRR's Understanding Risk 2020 Forum and later played again with the same settings with researchers from the Swiss Federal Institute of Technology (ETH) in Zurich. Feedback from the pre- and post-game surveys indicates that Breaking the Silos was found useful by the participants in increasing awareness of the complexities of risk.

Digital Piracy among Young Adults: The Role of Values and Time Perspectives

The aim of the research is to measure the extent of piracy among young adults and to relate this phenomenon to variables, such as values and time orientation. The research fits into the risk paradigm of cyber research. The research was carried out in Northern Cyprus, a country with a persistently high rate of digital piracy. The research involved 318 young adults (Mean Age: 20.9, SD: 2.47). The research process was conducted through the triangulation of three questionnaires: Piracy Risk Scale, Time Perspective Inventory, and the Values Scale. Based on the data collected, it was noted that piracy is not a rare phenomenon among young people (similar to other e-risks), and it is most common for files related to entertainment to be systematically downloaded. Digital piracy is linked to the level of digital competence, as well as hedonistic and fatalistic attitudes to time and values such as materialism and sense of honour. Despite technological developments maximising the legal circulation of cultural and other digital content, piracy has still not been completely eliminated.

Critical chemsex studies: Interrogating cultures of sexualized drug use beyond the risk paradigm

This article proposes and outlines a critical approach to the study of chemsex. The vast majority of chemsex research takes place within the broad field of health, particularly LGBTQ+ health, which ultimately frames such work using a paradigm of risk. This article follows previous research that calls attention to the limitations of this perspective, and suggests the value in formalising more generative, explorative and critical approaches to the phenomenon. Based on this previous scholarship and the contributions to the special issue, we propose that ‘critical chemsex studies’ operates along three axes: one working within public health that attempts to move beyond the risk paradigm; another which attempts to understand its cultural dimensions as it interrogates the discursive, sociopolitical, technological and economic landscapes in which chemsex has materialised, and finally; a third centering pleasure and its organisation of gay identity, intimacy, and sociability. Finally, we look to the future of critical chemsex studies, calling for more diverse works on national and regional differences in chemsex culture, as well as how the framework can be adapted in order to leverage its capacities for the women, trans and non-binary people who are under-represented in the current literature.

Association of Multigenerational Family History of Depression With Lifetime Depressive and Other Psychiatric Disorders in Children

Three-generation family studies of depression have established added risk of psychopathology for offspring with 2 previous generations affected with depression compared with 1 or none. Because of their rigorous methodology, there are few of these studies, and existing studies are limited by sample sizes. Consequently, the 3-generation family risk paradigm established in family studies can be a critical neuropsychiatric tool if similar transmission patterns are reliably demonstrated with the family history method. To examine the association of multigenerational family history of depression with lifetime depressive disorders and other psychopathology in children. In this analysis of the Adolescent Brain Cognitive Development (ABCD) study data, retrospective, cross-sectional reports on psychiatric functioning among 11 200 children (generation 3 [G3]) and parent reports on parents' (G2) and grandparents' (G1) depression histories were analyzed. The ABCD study sampling weights were used for generalized estimating equation models and descriptive analyses. Data were collected from September 2016 to November 2018, and data were analyzed from July to November 2020. Four risk categories were created, reflecting how many prior generations had history of depression: (1) neither G1 nor G2 (G1-/G2-), (2) only G1 (G1+/G2-), (3) only G2 (G1-/G2+), and (4) both G1 and G2 (G1+/G2+). Child lifetime prevalence and relative risks of psychiatric disorders were based on child and caregiver reports and grouped according to familial risk category derived from G1 and G2 depression history. Among 11 200 included children, 5355 (47.8%) were female, and the mean (SD) age was 9.9 (0.6) years. By parent reports, the weighted prevalence of depressive disorder among children was 3.8% (95% CI, 3.2-4.3) for G1-/G2- children, 5.5% (95% CI, 4.3-7.1) for G1+/G2- children, 10.4% (95% CI, 8.6-12.6) for G1-/G2+ children, and 13.3% (95% CI, 11.6-15.2) for G1+/G2+ children (Cochran-Armitage trend = 243.77; P < .001). The weighted suicidal behavior prevalence among children was 5.0% (95% CI, 4.5-5.6) for G1-/G2- children, 7.2% (95% CI, 5.8-8.9) for G1+/G2- children, 12.1% (95% CI, 10.1-14.4) for G1-/G2+ children, and 15.0% (95% CI, 13.2-17.0) for G1+/G2+ children (Cochran-Armitage trend = 188.66; P < .001). By child reports, the weighted prevalence of depressive disorder was 4.8% (95% CI, 4.3-5.5) for G1-/G2- children, 4.3% (95% CI, 3.2-5.7) for G1+/G2- children, 6.3% (95% CI, 4.9-8.1) for G1-/G2+ children, and 7.0% (95% CI, 5.8-8.5) for G1+/G2+ children (Cochran-Armitage trend = 9.01; P = .002), and the weighted prevalence of suicidal behaviors was 7.4% (95% CI, 6.7-8.2) for G1-/G2- children, 7.0% (95% CI, 5.6-8.6) for G1+/G2- children, 9.8% (95% CI, 8.1-12.0) for G1-/G2+ children, and 13.8% (95% CI, 12.1-15.8) for G1+/G2+ children (Cochran-Armitage trend = 46.69; P < .001). Similar patterns were observed for other disorders for both parent and child reports and across sex, socioeconomic status, and race/ethnicity. In this study, having multiple prior affected generations was associated with increased risk of childhood psychopathology. Furthermore, these findings were detectable even at prepubertal ages and existed in diverse racial/ethnic and socioeconomic groups. Clinically, they underscore the need for screening for family history in pediatric settings and highlight implications for biological research with homogenous subgroups using magnetic resonance imaging or genetic analyses.