JAMA Pediatrics: Adolescent Psychiatry Topic Collection

Unnecessary Suffering Potential Unmet Mental Health Needs of Unaccompanied Alien Children Potential Unmet Mental Health Needs of UACs

Kennedy EG. — Mon, 01 Apr 2013 00:00:00 GMT

Mental illness is one of the most prevalent health problems among children worldwide, with displaced children having a substantially greater burden of illness. Yet, our health care system is not recognizing or addressing the needs of potentially the most vulnerable subset of displaced children in the United States: unaccompanied alien children (UAC).

Regional Brain Morphometry and Impulsivity in Adolescents Following Prenatal Exposure to Cocaine and Tobacco Prenatal Exposure to Cocaine and Tobacco

Liu J, Lester BM, Neyzi N, et al. — Mon, 01 Apr 2013 00:00:00 GMT

Importance

Animal studies have suggested that prenatal cocaine exposure (PCE) deleteriously influences the developing nervous system, in part attributable to its site of action in blocking the function of monoamine reuptake transporters, increasing synaptic levels of serotonin and dopamine.

Objective

To examine the brain morphologic features and associated impulsive behaviors in adolescents following prenatal exposure to cocaine and/or tobacco.

Design

Magnetic resonance imaging data and behavioral measures were collected from adolescents followed up longitudinally in the Maternal Lifestyle Study.

Setting

A hospital-based research center.

Participants

A total of 40 adolescent participants aged 13 to 15 years were recruited, 20 without PCE and 20 with PCE; a subset of each group additionally had tobacco exposure. Participants were selected and matched based on head circumference at birth, gestational age, maternal alcohol use, age, sex, race/ethnicity, IQ, family poverty, and socioeconomic status.

Main Outcome Measures

Subcortical volumetric measures of the thalamus, caudate, putamen, pallidum, hippocampus, amygdala, and nucleus accumbens; cortical thickness measures of the dorsolateral prefrontal cortex and ventral medial prefrontal cortex; and impulsivity assessed by Conners' Continuous Performance Test and the Sensation Seeking Scale for Children.

Results

After controlling for covariates, cortical thickness of the right dorsolateral prefrontal cortex was significantly thinner in adolescents following PCE (P = .03), whereas the pallidum volume was smaller in adolescents following prenatal tobacco exposure (P = .03). Impulsivity was correlated with thalamic volume following either PCE (P = .05) or prenatal tobacco exposure (P = .04).

Conclusions and Relevance

Prenatal cocaine or tobacco exposure can differentially affect structural brain maturation during adolescence and underlie enhanced susceptibility to impulsivity. Additional studies with larger sample sizes are warranted.

Impact of Fetal Drug Exposures on the Adolescent Brain Impact of Drug Exposure on the Adolescent Brain

Volkow ND. — Mon, 01 Apr 2013 00:00:00 GMT

Drug use during pregnancy, which in the United States is estimated at 1 million individuals each year, puts the newborn at increased risk for multiple adverse health outcomes. While the deleterious effects of alcohol, and to a lesser extent nicotine, to the fetus are well recognized, those of illicit drugs are much less understood. Drugs can harm the fetus both via effects to the placenta interfering with nutrient delivery and through direct effects to the fetus. Moreover, the high lipophilicity of drugs ensures that significant concentrations reach the fetus' brain and other organs. Thus, the consequences of fetal drug exposure on brain development and function, and ultimately on behavior, constitute an important area of research.