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Brain motivational circuitry in human adolescence is poorly characterized. One theory holds that risky behavior in adolescence results in part from a relatively overactive ventral striatal (VS) motivational circuit that readily energizes approach toward salient appetitive cues. However, other evidence fosters a theory that this circuit is developmentally underactive, in which adolescents approach more robust incentives (such as risk taking or drug experimentation) to recruit this circuitry. To help resolve this, we compared brain activation in 12 adolescents (12-17 years of age) and 12 young adults (22-28 years of age) while they anticipated the opportunity to respond to obtain monetary gains as well as to avoid monetary losses. In both age groups, anticipation of potential gain activated portions of the VS, right insula, dorsal thalamus, and dorsal midbrain, where the magnitude of VS activation was sensitive to gain amount. Notification of gain outcomes (in contrast with missed gains) activated the mesial frontal cortex (mFC). Across all subjects, signal increase in the right nucleus accumbens during anticipation of responding for large gains independently correlated with both age and self-rated excitement about the high gain cue. In direct comparison, adolescents evidenced less recruitment of the right VS and right-extended amygdala while anticipating responding for gains (in contrast with anticipation of nongains) compared with young adults. However, brain activation after gain outcomes did not appreciably differ between age groups. These results suggest that adolescents selectively show reduced recruitment of motivational but not consummatory components of reward-directed behavior.

The therapy manuals included in this volume—the Unified Protocols for Transdiagnostic Treatment of Emotional Disorders in Children (UP-C) and Adolescents (UP-A)—include evidence-based treatment strategies to assist child and adolescent clients to function better in their lives. The manuals include specific guidelines for treatment delivery, and they also contain information about how to introduce parent-directed strategies to help promote long-term uptake of youth-directed therapy skills. The evidence-based treatment skills presented may be applied by therapists to children and adolescents with a wide variety of emotional disorders. This treatment guide takes a transdiagnostic approach to the treatment of emotional disorders. Some of the disorders that may be targeted include anxiety disorders and depressive disorders. This treatment is flexible enough for use with some trauma and stress-related disorders (including adjustment disorders), somatic symptom disorders, tic disorders and obsessive-compulsive disorders. The transdiagnostic presentation of evidence-based intervention techniques within these treatments may be particularly useful for children and adolescents presenting with multiple emotional disorders or mixed/subclinical symptoms of several emotional disorders.

The loss of an expected child can be devastating and traumatizing for parents, placing them at risk for postloss mental health complications, such as complicated or traumatic grief. The authors review the psychological and social impacts of perinatal loss and describe the standard care provided in the hospital. The authors review studies that examine the efficacy of standard care and highlight the need for empirical evidence confirming the efficacy of these current interventions. The authors provide recommendations for health care professionals in contact with the perinatally bereaved and suggest areas for future research.

Given the relationship between internalizing disorders and deficits in emotion regulation in youth, the emotion science literature has suggested several avenues for increasing the efficacy of interventions for youth presenting with anxiety and depression. These possibilities include the identification and addition of emotion-regulation skills to existing treatment packages and broadening the scope of those emotions addressed in cognitive-behavioral treatments. Current emotion-focused interventions designed to meet one or both of these goals are discussed, and the developmental influences relevant to the selection of emotion-focused treatment goals are explored using the framework of a modal model of emotion regulation. These various lines of evidence are woven together to support the utility of a novel emotion-focused, cognitive-behavioral intervention, the Unified Protocol for the Treatment of Emotional Disorders in Youth, a transdiagnostic treatment protocol that aims to treat the range of emotional disorders (i.e., anxiety and depression) simultaneously. Avenues for future directions in treatment outcome and assessment of emotion regulation are also discussed.

Objective We report active treatment group differences on response and remission rates and changes in anxiety severity at weeks 24 and 36 for the Child/Adolescent Anxiety Multimodal Study (CAMS). Method CAMS youth (N=488; 74%≤12 years) with DSM-IV separation, generalized, or social anxiety disorder were randomized to 12 weeks of cognitive behavior therapy (CBT), sertraline (SRT), CBT+SRT (COMB), or medication management/pill placebo (PBO). Responders attended 6 monthly booster sessions in their assigned treatment arm; youth in COMB and SRT continued on their medication throughout this period. Efficacy of COMB, SRT, and CBT (N=412) was assessed at 24 and 36 weeks postrandomization. Youth randomized to PBO (n=76) were offered active CAMS treatment if nonresponsive at week 12 or over follow-up and were not included here. Independent evaluators blind to study condition assessed anxiety severity, functioning, and treatment response. Concomitant treatments were allowed but monitored over follow-up. Results Most (>80%) acute responders maintained positive response at both weeks 24 and 36. Consistent with acute outcomes, COMB maintained advantage over CBT and SRT, which did not differ, on dimensional outcomes; the 3 treatments did not differ on most categorical outcomes over follow-up. Compared to COMB and CBT, youth in SRT obtained more concomitant psychosocial treatments, while those in SRT and CBT obtained more concomitant combined (medication plus psychosocial) treatment. Discussion COMB maintained advantage over CBT and SRT on some measures over follow-up, while the 2 monotherapies remained indistinguishable. The observed convergence of COMB and monotherapy may be related to greater use of concomitant treatment during follow-up among youth receiving the monotherapies, although other explanations are possible. While outcomes were variable, most CAMS-treated youth enjoyed sustained treatment benefit. Clinical trial registration information— Child and Adolescent Anxiety Disorders (CAMS); http://clinicaltrials.gov; NCT00052078.

Perinatal loss is a unique and potentially traumatizing experience that can leave bereaved parents struggling with a host of mental health difficulties. In this exploratory study of the predictors and mental health outcomes associated with perinatal loss, we examined a cohort of women who experienced a perinatal loss within the previous 5 years. Results suggest perinatal loss is associated with considerable distress and impairment for some women, with greater severity primarily predicted by maladaptive coping skills, low social support, and intense emotionality following the loss. The majority of women in this sample were satisfied with the care they received in the hospital after their loss, including their engagement in reportedly contentious bereavement rituals in the medical setting. Limitations of this research are noted, and suggestions for future research and clinical care are provided.Childbirth is one of the most significant milestones in human life, filled with hope, expectation, joy, fear, and faith. Yet, for the 1%-2% of couples who experience a perinatal loss in the United States

Individuals with chronic tic disorders (CTDs) frequently describe aversive subjective sensory sensations that precede their tics. The first aim of the present study was to explore the psychometric properties of a standardized self-report measure to assess premonitory urges in CTDs, The Premonitory Urge for Tics Scale (PUTS), by replicating the analyses of Woods et al. (J Dev Behav Pediatr 26:397-403, 2005) using a sample twice the size of theirs. The second aim was to conduct an exploratory factor analysis of the PUTS. Eighty-four youth with CTDs, recruited from a pediatric OCD and tic specialty clinic, completed the PUTS while their caregivers completed The Parent Tic Questionnaire (PTQ) and a demographic measure. Consistent with (Woods et al. J Dev Behav Pediatr 26:397-403, 2005), the PUTS was found to be internally consistent (α = 0.82) and significantly correlated with overall tic severity as measured by the PTQ (r = 0.24, p < 0.05) as well as the PTQ number (r = 0.34, p < 0.01) and intensity (r = 0.24, p < 0.05) subscales. A factor-analysis of the PUTS revealed a two-factor solution with one factor capturing the quality of premonitory sensations while the other factor assessed the overall intensity of the urges. These results support the use of the PUTS in reliably measuring premonitory urges, particularly in children over the age of 10 years. Additionally, these findings highlight that urges are uniformly reported across gender and age and are more closely associated with number of tics than the frequency or intensity of tics.