Volume 48, Number 6: June 2009

Several articles in this month’s Journal examine internalizing disorders and traits. There are also articles exploring the basicscience of disorders including the physiological responses of children with internalizing conditions and the role of the amygdala inbipolar disorder. Moderators and mediators to improve therapeutic approaches are also included. This issue represents the widebreadth of behaviors in the children we treat and the wide range of knowledge that the field and the Journal are incorporating intothe understanding of these illnesses and their treatments. The accompanying editorial by Douglas Novins (p. 585) and the InContext piece by Michael Wessells (p. 587) point to the importance of research, assessment, and treatment of specific populationsof children.

The article by Kennedy et al. (p. 602) demonstrates the impact of a relatively low-intensity parenting intervention on theexpression of both anxiety and behavioral inhibition in preschool children. As parental anxiety did not change during thisintervention, the authors note that the addition of a component addressing parental anxiety may further increase the effect size.Reeb-Sutherland et al. (p. 610) use psychophysiology to connect an early risk factor for anxiety, behavioral inhibition, and thediagnosis of anxiety disorders in children and adolescents. They demonstrate that adolescents previously described as behaviorallyinhibited, with a lifetime diagnosis of an anxiety disorder, are more likely to respond with a fear-potentiated startle response duringa nonthreatening safety condition than those adolescents with a previous history of behavioral inhibition who do not have currentanxiety. Put together, these articles suggest that early intervention targeting behaviorally inhibited children using either parentinginterventions in the preschool period and/or social skills training and exposure in older children may have an impact on anadolescent’s future response to nonthreatening conditions and perhaps decrease the risk for developing anxiety disorders. Furtherextensions of psychophysiological studies for child and adolescent psychiatric problems are the topic of this month’s accom-panying There section.

One final article focuses on internalizing symptoms in this month’s Journal. Hallett et al. (p. 618) present an analysis of thegenotypic and phenotypic relations between internalizing symptoms and autistic symptoms. They provide data suggesting thatthat co-occurrence does not necessarily mean a similar genetic basis. Using a general population twin sample of 8- and 9-year-olds,they demonstrate that the phenotypic association between autistic symptoms and non-OCD internalizing symptoms is explainedonly minimally by shared genetic factors between the two types of symptoms.

Two articles examine the science of pediatric bipolar disorder, one at the basic science level and the other at the treatment level.Kalmar et al (p. 636) examine the relation between amygdala volume and activation in response to emotional stimuli inadolescents with bipolar disorder. They find an inverse correlation between amygdala size and activation in these adolescents andpresent potential explanatory mechanisms. Looking for moderators of treatment response in pediatric bipolar disorder, Miklowitzet al (p. 643) demonstrate that children from families with high expressed emotion (described here as critical, hostile, and/oremotionally overinvolved) improve significantly more after a 21-week family-focused therapy compared with a 3-session psy-choeducational program. However, children from lowYexpressed emotion families tend to improve equally with either program.Finally, Hazell et al (p. 662) also explore therapeutics but turn their attention to deliberate self-harm. Their results failed toreplicate the efficacy of a group therapy intervention for deliberate self-harm among adolescents (predominantly female subjects).

H E R E In This Issue

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Psychophysiology in Child and Adolescent Psychiatry

With new findings from functional magnetic resonance imaging and positron emission tomography emerging monthly in theJournal and elsewhere, there would seem no need for any other techniques to link brain to function. Yet in this issue of the Journal,Reeb-Sutherland et al. (p. 610) remind us that there are methods to explore the neural constructs underlying behavior. Additionalpsychophysiological methods, including event-related potentials (ERPs), heart rate monitoring, pupillometry, eye movementmonitoring, electromyography, and galvanic skin response offer different, yet likely equally informative, windows into therelations between neural function and behavior. For example, psychophysiological measures can be used to explore fear andaffective modulation. Using skin conductance and electromyographic measurement of the eyeblink startle response, male subjectswith conduct disorder showed impaired differential fear conditioning and a lessened eyeblink startle reflex, consistent with theprospect of abnormal amygdalar functioning in conduct disorder.1 Using a different psychophysiological measurement, prepulseinhibition (PPI), where a weak stimulus inhibits a startle response to an intense stimulus, Roussos et al. demonstrated that PPI islowest in control subjects who have the val158 allele of the catechol-O-methyltransferase (COMT) gene.2 This work is particularlyinteresting to child and adolescent psychiatrists because of the associations of the val158 allele with schizophrenia, especially inadolescents abusing cannabis3 and the association of low PPI in adult schizophrenia.

Eye-movement monitoring is another psychophysiological technique being explored in relation to psychopathology. Looking atyoung first-episode patients with schizophrenia and their siblings, de Wilde and colleagues explored whether an antisaccade test(looking in the direction opposite a stimulus) was associated with schizophrenia.4 Adolescents with first-episode schizophreniademonstrated impairment at inhibiting a reflexive saccade and made more errors in eye movements.4 Using a visual searchparadigm, researchers have demonstrated that subjects with pervasive developmental disorder searched for a target stimulus morequickly but used the same general strategy as controls. This suggests that the subjects with pervasive developmental disorder haveenhanced discriminatory visual search abilities, which, the authors hypothesize, is consistent with neuroanatomical findings.5

Event-related potentials allow researchers to examine fine-tuned temporal relations between a stimulus and neural electricalactivity that is detectable on the scalp. Event-related potentials have demonstrated that action monitoring and error processing arealtered in children with attention-deficit/hyperactivity disorder6 and that these ERP components have significant genetic cor-relations.7 Similarly, researchers studying autism have turned to ERPs to examine the neural processing underlying facialemotional processing. Both detection and configural processing of faces showed impairment, suggesting that it takes more effortfor the individual with autism to extract the information from the face. In individuals with autism, it seems that more and differentbrain areas are recruited to compensate for this impairment, even within the first 300 milliseconds of visual presentation of a face.8

Overall, psychophysiological and cognitive neuroscientific methods provide information about how basic neural functions goawry in child psychiatric conditions. These techniques offer novel insights into the neurobiology underlying psychiatricconditions. Eventually, these techniques may lead to more precise grouping of patients for research studies and potentially fornovel treatment approaches.

Robert Althoff, M.D., Ph.D.ralthoff@uvm.edu

DOI: 10.1097/CHI.0b013e3181a1f589

Disclosure: The author reports no conflicts of interest.

REFERENCES

1. Fairchild G, Van Goozen SH, Stollery SJ, Goodyer IM. Fear conditioning and affective modulation of the startle reflex in male adolescents with early-onsetor adolescence-onset conduct disorder and healthy control subjects. Biol Psychiatry. 2008;63:279Y285.

2. Roussos P, Giakoumaki SG, Rogdaki M, Pavlakis S, Frangou S, Bitsios P. Prepulse inhibition of the startle reflex depends on the catechol O-methyltransferaseVal158Met gene polymorphism. Psychol Med. 2008;38:1651Y1658.

3. Caspi A, Moffitt TE, Cannon M et al. Moderation of the effect of adolescent-onset cannabis use on adult psychosis by a functional polymorphism in thecatechol-O-methyltransferase gene: longitudinal evidence of a gene X environment interaction. Biol Psychiatry. 2005;57:1117Y1127.

4. de Wilde OM, Bour L, Dingemans P, Boeree T, Linszen D. Antisaccade deficit is present in young first-episode patients with schizophrenia but not in theirhealthy young siblings. Psychol Med. 2008;38:871Y875.

5. Kemner C, van Ewijk L, van Engeland H, Hooge I. Brief report: eye movements during visual search tasks indicate enhanced stimulus discriminability insubjects with PDD. J Autism Dev Disord. 2008;38:553Y557.

6. Albrecht B, Brandeis D, Uebel H et al. Action monitoring in boys with attention-deficit/hyperactivity disorder, their nonaffected siblings, and normal controlsubjects: evidence for an endophenotype. Biol Psychiatry. 2008;64:615Y625.

7. Anokhin AP, Golosheykin S, Heath AC. Heritability of frontal brain function related to action monitoring. Psychophysiology. 2008;45:524Y534.8. Wong TK, Fung PC, Chua SE, McAlonan GM. Abnormal spatiotemporal processing of emotional facial expressions in childhood autism: dipole source analysis

of event-related potentials. Eur J Neurosci. 2008;28:407Y416.

T H E R E Abstract Thinking

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