Through a series of three protocols, we are using functional magnetic resonance imaging (fMRI) to examine neurocognitive correlates of pediatric mood and anxiety disorders. Such work holds the potential to dramatically impact public health, for various reasons. Mood and anxiety disorder dramatically alter the well-being of children and adolescents. fMRI research is vital for generating new treatments. As such, this protocol holds the hope of generating such new treatments. Moreover, most adult mood and anxiety disorders also emerge from earlier disorders, manifest in childhood. Therefore, not only might this protocol dramatically alter the well-being of youth, but it also holds the hope of improving the lives of adults. The central focus of the protocol is on individual differences in neural circuitry function, as they relate to individual differences in behavior. Thus, in the most important aspect of the protocols, we are attempting to document deficits in brain systems mediating reward-related processes, attention bias, and emotional memory in pediatric mood and anxiety disorders. Initial findings from this project actually document the occurence of many such deficits, providing some of the first evidence establishing neuroscientific correlates of pediatric mood and anxiety disorders. In subsequent work, we also replicated these findings, already demonstrating these individual differences in broad groups of disorders more than five times. One major question to emerge from these initial set of findings concerns the degree to which these correlates represent distinct markers in specific forms of pediatric mental illnesses remain unclear. Only after addressing these remaining questions on specificity will neuroscience work be able to inform attempts to improve methods for diagnosis and treatment in pediatric mental illnesses. Thus, a particularly important goal in coming years will be to contrast neurocognitive profiles among individual groups of pediatric mood and anxiety disorders. Prior neuropsychological studies in children as well as in adults note that mood and anxiety disorders are associated with deficits in attention modulation and emotional memory. Prior imaging studies in healthy adults note that tasks requiring attention modulation or emotional memory engage cortico-limbic brain regions previously implicated in adult mood and anxiety disorders. These regions include the amygdala, ventro-medial prefrontal cortex, cingulate gyrus, and hippocampus. As a result, we hypothesize that fMRI attention modulation and emotional memory paradigms will engage these cortico-limbic brain regions in both psychiatrically healthy and impaired subjects. We actually already have confirmed this hypothesis in broad groups of children, based on procedures in approximately 300 children and adolescents with various forms of psychopathology. Each received neurocognitive examinations, and a subset received fMRI examinations. Each received standardized assessments of response to treatment. As part of our studies in healthy subjects, we also successfully developed each of the fMRI protocols that will be used in the current project. As noted above, many of our initial hypotheses have been confirmed, and our studies are now moving forward to examine issues of specificity and to consider how our findings might be used to inform advances in treatment. During the coming year, we will be continue the process of analyzing the extinsive data emerging from the fMRI studies performed as part of this protocol;we also will continue to analyze data from behavioral studies in patient groups. Moreover, we also are in the midst of acquiring data with new protocols. Based on the results of these analyses, we also plan to prepare a number of manuscripts. Beyond these ongoing behavioral and fMRI studies, our group is also involved in various collaborations that have led to analyses of other data sets and reporting of research findings. We have also developed a new treatment, based on our initial findings, that we have begun piloting as part of these projects.
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