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During the course of adolescence, reductions occur in cortical thickness and gray matter (GM) volume, along with a 65% reduction in slow-wave (delta) activity during sleep (SWA) but empirical data linking these structural brain and functional sleep differences, is lacking. Here, we investigated specifically whether age-related differences in cortical thickness and GM volume and cortical thickness accounted for the typical age-related difference in slow-wave (delta) activity (SWA) during sleep. 132 healthy participants (age 12–21 years) from the National Consortium on Alcohol and NeuroDevelopment in Adolescence study were included in this cross-sectional analysis of baseline polysomnographic, electroencephalographic, and magnetic resonance imaging data. By applying mediation models, we identified a large, direct effect of age on SWA in adolescents, which explained 45% of the variance in ultra-SWA (0.3–1 Hz) and 52% of the variance in delta-SWA (1 to <4 Hz), where SWA was lower in older adolescents, as has been reported previously. In addition, we provide evidence that the structure of several, predominantly frontal, and parietal brain regions, partially mediated this direct age effect, models including measures of brain structure explained an additional 3–9% of the variance in ultra-SWA and 4–5% of the variance in delta-SWA, with no differences between sexes. Replacing age with pubertal status in models produced similar results. As reductions in GM volume and cortical thickness likely indicate synaptic pruning and myelination, these results suggest that diminished SWA in older, more mature adolescents may largely be driven by such processes within a number of frontal and parietal brain regions.

Neurodevelopment continues through adolescence, with notable maturation of white matter tracts comprising regional fiber systems progressing at different rates. To identify factors that could contribute to regional differences in white matter microstructure development, large samples of youth spanning adolescence to young adulthood are essential to parse these factors. Recruitment of adequate samples generally relies on multi-site consortia but comes with the challenge of merging data acquired on different platforms. In the current study, diffusion tensor imaging (DTI) data were acquired on GE and Siemens systems through the National Consortium on Alcohol and NeuroDevelopment in Adolescence (NCANDA), a multi-site study designed to track the trajectories of regional brain development during a time of high risk for initiating alcohol consumption. This cross-sectional analysis reports baseline Tract-Based Spatial Statistic (TBSS) of regional fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (L1), and radial diffusivity (LT) from the five consortium sites on 671 adolescents who met no/low alcohol or drug consumption criteria and 132 adolescents with a history of exceeding consumption criteria. Harmonization of DTI metrics across manufacturers entailed the use of human-phantom data, acquired multiple times on each of three non-NCANDA participants at each site's MR system, to determine a manufacturer-specific correction factor. Application of the correction factor derived from human phantom data measured on MR systems from different manufacturers reduced the standard deviation of the DTI metrics for FA by almost a half, enabling harmonization of data that would have otherwise carried systematic error. Permutation testing supported the hypothesis of higher FA and lower diffusivity measures in older adolescents and indicated that, overall, the FA, MD, and L1 of the boys were higher than those of the girls, suggesting continued microstructural development notable in the boys. The contribution of demographic and clinical differences to DTI metrics was assessed with General Additive Models (GAM) testing for age, sex, and ethnicity differences in regional skeleton mean values. The results supported the primary study hypothesis that FA skeleton mean values in the no/low-drinking group were highest at different ages. When differences in intracranial volume were covaried, FA skeleton mean reached a maximum at younger ages in girls than boys and varied in magnitude with ethnicity. Our results, however, did not support the hypothesis that youth who exceeded exposure criteria would have lower FA or higher diffusivity measures than the no/low-drinking group; detecting the effects of excessive alcohol consumption during adolescence on DTI metrics may require longitudinal study. •FA analysis examined 671 adolescents and 132 adolescents with high alcohol or drug use.•Novel harmonization of FA across manufacturers was based on human-phantom data.•Regional FA skeleton mean values of the controls were highest at different ages.•Youth with high exposure criteria did not have lower FA than controls.•Highest FA was detected earlier for girls than boys and varied with ethnicity.

ObjectivesThis study aimed to determine the feasibility of recruiting, implementing and delivering an acceptance and commitment therapy (ACT) intervention for mild traumatic brain injury (mTBI) (ACTion-mTBI) within a multidisciplinary outpatient mTBI rehabilitation services. The study also aimed to conduct a preliminary investigation of group differences between ACTion-mTBI and an equivalent cognitive behavioural therapy (CBT) intervention on various outcome measures and psychological treatment targets.DesignA two-arm quasiexperimental feasibility study.SettingFive mTBI rehabilitation clinics throughout New Zealand.InterventionPsychologists working in mTBI rehabilitation clinics throughout New Zealand were trained to deliver ACTion-mTBI or CBT. Eligible participants were assigned to either of these interventions based on the psychologist available at the clinic they were referred to. ACTion-mTBI is a five sessions intervention that incorporates all six components of the ACT model. The CBT intervention is an equivalent intervention and incorporating all four components of the CBT model. Both interventions are adapted for an mTBI context.Primary outcome measuresThe primary outcomes were related to the feasibility of ACTion-mTBI. This included recruitment, retention and treatment adherence of participants, study procedure and fidelity of treatment delivery.Secondary outcome measuresTo explore group differences between ACTion-mTBI and CBT on functional disability, postconcussion symptoms, mental health, valued living and psychological flexibility.ResultsThe intervention proved feasible to implement with community-based mTBI rehabilitation services. Attrition rates were comparable between the two psychological interventions and fidelity to the treatments was high. At post-treatment, when covarying pretreatment scores, ACTion-mTBI had a significantly greater improvement in functional disability than CBT (moderate effect). ACTion-mTBI also had a significantly greater reduction in postconcussion symptoms, anxiety and stress. Promisingly, significant improvements in psychological flexibility was also found post-treatment. There were no group differences on depressive symptoms and valued living.ConclusionWe conclude that a full clinical trial of ACTion-mTBI for individuals with mTBI is feasible and warranted.Trial registration numberACTRN1262100059482.

Background Accurate measurement of trajectories in longitudinal studies, considered the gold standard method for tracking functional growth during adolescence, decline in aging, and change after head injury, is subject to confounding by testing experience. Methods We measured change in cognitive and motor abilities over four test sessions (baseline and three annual assessments) in 154 male and 165 female participants (baseline age 12–21 years) from the National Consortium on Alcohol and NeuroDevelopment in Adolescence (NCANDA) study. At each of the four test sessions, these participants were given a test battery using computerized administration and traditional pencil and paper tests that yielded accuracy and speed measures for multiple component cognitive (Abstraction, Attention, Emotion, Episodic memory, Working memory, and General Ability) and motor (Ataxia and Speed) functions. The analysis aim was to dissociate neurodevelopment from testing experience by using an adaptation of the twice-minus-once tested method, which calculated the difference between longitudinal change (comprising developmental plus practice effects) and practice-free initial cross-sectional performance for each consecutive pairs of test sessions. Accordingly, the first set of analyses quantified the effects of learning (i.e., prior test experience) on accuracy and after speed domain scores. Then developmental effects were  determined for each domain for accuracy and speed having removed the measured learning effects. Results The greatest gains in performance occurred between the first and second sessions, especially in younger participants, regardless of sex, but practice gains continued to accrue thereafter for several functions. For all 8 accuracy composite scores, the developmental effect after accounting for learning was significant across age and was adequately described by linear fits. The learning-adjusted developmental effects for speed were adequately described by linear fits for Abstraction, Emotion, Episodic Memory, General Ability, and Motor scores, although a nonlinear fit was better for Attention, Working Memory, and Average Speed scores. Conclusion Thus, what appeared as accelerated cognitive and motor development was, in most cases, attributable to learning. Recognition of the substantial influence of prior testing experience is critical for accurate characterization of normal development and for developing norms for clinical neuropsychological investigations of conditions affecting the brain.

Critical changes in adolescence involve brain cognitive maturation of inhibitory control processes that are essential for a myriad of adult functions. Cognitive control advances into adulthood as there is more flexible integration of component processes, including inhibitory control of conflicting information, overwriting inappropriate response tendencies, and amplifying relevant responses for accurate execution. Using a modified Stroop task with fMRI, we investigated the effects of age, sex, and puberty on brain functional correlates of cognitive and motor control in 87 boys and 91 girls across the adolescent age range. Results revealed dissociable brain systems for cognitive and motor control processes, whereby adolescents flexibly adapted neural responses to control demands. Specifically, when response repetitions facilitated planning-based action selection, frontoparietal-insular regions associated with cognitive control operations were less activated, whereas cortical-pallidal-cerebellar motor regions associated with motor skill acquisition, were more activated. Attenuated middle cingulate cortex activation occurred with older adolescent age for both motor control and cognitive control with automaticity from repetition learning. Sexual dimorphism for control operations occurred in extrastriate cortices involved in visuo-attentional selection: While boys enhanced extrastriate selection processes for motor control, girls activated these regions more for cognitive control. These sex differences were attenuated with more advanced pubertal stage. Together, our findings show that brain cognitive and motor control processes are segregated, demand-specific, more efficient in older adolescents, and differ between sexes relative to pubertal development. Our findings advance our understanding of how distributed brain activity and the neurodevelopment of automaticity enhances cognitive and motor control ability in adolescence.

Introduction Insomnia often develops during adolescence, with girls being at greater risk than boys. Alterations in response to psychosocial stress have been linked to the etiology of the disorder, but it remains unclear whether the reactivity of the major stress systems (hypothalamic-pituitary-adrenal (HPA) axis and autonomic nervous system (ANS)) in response to stress is altered in adolescents with insomnia. Methods Forty-seven post-pubertal adolescents (age range: 16-20 years, 28 female) with (N=16; insomnia group) and without (N=31; control group) insomnia symptomatology underwent two randomized nights of polysomnographic (PSG) laboratory recordings. Participants underwent an experimental pre-bedtime stress anticipation protocol (stress night) and a control night during which they engaged in neutral activities before bedtime. The morning after the stress night, participants underwent the Trier Social Stress Test (TSST), a standardized protocol that requires participants to complete verbal and arithmetic tasks in front of observers. On both nights, heart rate (HR) was measured across the night and cortisol was collected upon awakening and 30 minutes later to calculate cortisol awakening responses (CAR). Stress perception, salivary cortisol (HPA activity), and HR were measured during the TSST. Results There were no differences in nocturnal HR recovery or in the CAR on the stress night compared with the control night in either group. Morning pre-TSST stress levels did not differ between groups. Both groups exhibited significant increases in HR in response to the TSST (p< 0.05). HR was higher in girls compared to boys in the control group at baseline (p< 0.05). Potential group differences in HPA responses to the TSST were inconclusive due to the apparent confounding effect of the CAR on cortisol responses to stress: many participants did not show a cortisol response to the task and larger CARs were associated with an attenuated cortisol response. Conclusion There were no significant differences in HR responses to anticipation of experimental stress during the night or in response to the morning TSST between adolescents with and without insomnia. Further work is needed to examine whether altered responses to stress may emerge if insomnia becomes chronic. Support (if any) This study was supported by the National Heart, Lung and Blood Institute (NHLBI) grant R01HL139652(MdZ).

The coronavirus disease 2019 (COVID-19) pandemic has significantly increased depression rates, particularly in emerging adults. The aim of this study was to examine longitudinal changes in depression risk before and during COVID-19 in a cohort of emerging adults in the U.S. and to determine whether prior drinking or sleep habits could predict the severity of depressive symptoms during the pandemic. Participants were 525 emerging adults from the National Consortium on Alcohol and NeuroDevelopment in Adolescence (NCANDA), a five-site community sample including moderate-to-heavy drinkers. Poisson mixed-effect models evaluated changes in the Center for Epidemiological Studies Depression Scale (CES-D-10) from before to during COVID-19, also testing for sex and age interactions. Additional analyses examined whether alcohol use frequency or sleep duration measured in the last pre-COVID assessment predicted pandemic-related increase in depressive symptoms. The prevalence of risk for clinical depression tripled due to a substantial and sustained increase in depressive symptoms during COVID-19 relative to pre-COVID years. Effects were strongest for younger women. Frequent alcohol use and short sleep duration during the closest pre-COVID visit predicted a greater increase in COVID-19 depressive symptoms. The sharp increase in depression risk among emerging adults heralds a public health crisis with alarming implications for their social and emotional functioning as this generation matures. In addition to the heightened risk for younger women, the role of alcohol use and sleep behavior should be tracked through preventive care aiming to mitigate this looming mental health crisis.

Introduction Insomnia is common in adolescence, particularly in older girls, with an overall prevalence comparable to major depression. Despite being associated with adverse outcomes such as an increased risk for substance dependence and suicidality, insomnia in adolescence is still under-recognized, under-diagnosed, and under-treated, and poorly described in the literature. This study aims to investigate the clinical features of insomnia in adolescence, in both boys and girls. Methods Eighty-five post-pubertal adolescents (16–18 years) with (N=39, 26 girls) and without (N=46, 28 girls) DSM-5 insomnia symptoms underwent a detailed clinical evaluation, including a clinical interview with a trained clinician and an extensive questionnaire battery investigating sleep behaviors, stress, coping skills, emotion regulation, mood, and personality traits. Results Adolescents with insomnia symptoms exhibit poorer sleep and sleep-related behaviors, such as higher insomnia severity scores, lower sleep hygiene, higher dysfunctional beliefs and attitudes about sleep, and higher pre-sleep negative thought content compared with controls (p<0.05). They also indicated higher stress levels associated with school performance and peer pressure, higher susceptibility to work overload and greater depressive symptoms than controls (p<0.05). Insomnia girls reported a lower perceived sleep quality, higher perceived stress levels, and a higher sleep vulnerability to stress than insomnia boys (p<0.05). Exploratory network analyses unveiled profound group differences in the extent of multi-symptoms’ interconnection, with network complexity being lower in adolescents with insomnia symptoms and showing distinct symptoms’ centrality and clustering. Conclusion Insomnia in adolescence needs to be considered in the context of both classical insomnia-related features, as well as adolescence-specific factors, such as school and peer stress. Network analysis may be a promising approach to unveil hidden relationships and patterns among insomnia symptoms and behaviors, and to better characterize insomnia, possibly advancing early recognition and treatment of the disorder. Support (if any) National Heart, Lung and Blood Institute (NHLBI) R01HL139652 (to MdZ)