1 00:00:11,440 --> 00:00:13,640 Welcome to the Clinical Center Grand Rounds, 2 00:00:13,640 --> 00:00:17,440 a weekly series of educational lectures for physicians and 3 00:00:17,440 --> 00:00:20,080 health care professionals broadcast from the Clinical 4 00:00:20,080 --> 00:00:23,040 Center at the National Institutes of Health in 5 00:00:23,040 --> 00:00:24,840 Bethesda, MD. 6 00:00:24,840 --> 00:00:28,400 The NIH Clinical Center is the world's largest hospital totally 7 00:00:28,400 --> 00:00:32,080 dedicated to investigational research and leads the global 8 00:00:32,080 --> 00:00:35,040 effort in training today's investigators and discovering 9 00:00:35,040 --> 00:00:37,200 tomorrow's cures. 10 00:00:37,200 --> 00:00:47,960 Learn more by visiting us online at http://clinicalcenter.nih.gov 11 00:00:47,960 --> 00:00:50,800 TODAY, OUR SPEAKERS ARE DR. PHIL 12 00:00:50,800 --> 00:00:56,920 SHAW A SENIOR INVESTIGATOR 13 00:00:56,920 --> 00:01:00,120 IN AND Dr. MELISSA BROTMAN A 14 00:01:00,120 --> 00:01:03,800 STADTMAN INVESTIGATOR AND CHIEF 15 00:01:03,800 --> 00:01:06,120 OF THE NOTCH HE WILL. 16 00:01:06,120 --> 00:01:08,760 OUR FIRST SPEAKER WILL Dr. 17 00:01:08,760 --> 00:01:09,240 SHAW. 18 00:01:09,240 --> 00:01:10,760 A SENIOR INVESTIGATOR IN THE 19 00:01:10,760 --> 00:01:13,000 SOCIAL BEHAVIORAL RESEARCH AND 20 00:01:13,000 --> 00:01:15,520 AHEAD OF THE NEURAL BEHAVIOR 21 00:01:15,520 --> 00:01:21,920 CLINAL SECTION AT THE NATIONAL 22 00:01:21,920 --> 00:01:36,240 HUMAN GENOME. 23 00:01:36,240 --> 00:01:37,920 HE COMPLETED RESIDENCY AND 24 00:01:37,920 --> 00:01:39,560 INTERNAL MEDICINE AND PSYCHIATRY 25 00:01:39,560 --> 00:01:43,240 IN ENGLAND AND AS A MEMBER OF 26 00:01:43,240 --> 00:01:45,080 THE RURAL COLLEGE OF 27 00:01:45,080 --> 00:01:47,720 PSYCHIATRISTS AND Dr. SHAW IS 28 00:01:47,720 --> 00:01:48,520 RESEARCH PROGRAM EXAMS THE INNER 29 00:01:48,520 --> 00:01:50,320 PLAY OF GENOMIC AND 30 00:01:50,320 --> 00:01:52,920 ENVIRONMENTAL FACTORS EFFECTED 31 00:01:52,920 --> 00:01:54,720 DEVELOPMENT OF BEHAVIOR AND HIS 32 00:01:54,720 --> 00:01:57,320 PROGRAM FOCUSES ON THE MOST 33 00:01:57,320 --> 00:01:59,920 COMMON CHILDHOOD MENTAL ILLNESS 34 00:01:59,920 --> 00:02:03,800 AND ATTENTION DEFICIT HYPER 35 00:02:03,800 --> 00:02:06,720 ACTIVITIES DISORDERS AND IT HAS 36 00:02:06,720 --> 00:02:09,920 07% OF THE EFFECTIVE FINE OWE 37 00:02:09,920 --> 00:02:11,840 TYPE CLEANED BY GENETIC FACTORS 38 00:02:11,840 --> 00:02:12,960 AND IT'S THE COR OF 39 00:02:12,960 --> 00:02:17,040 UNDERSTANDING THE DISORDER AND 40 00:02:17,040 --> 00:02:19,160 THERE'S RESEARCH DEFINING NOVEL 41 00:02:19,160 --> 00:02:22,680 PHENOTYPES TO THE ADHD BASED AND 42 00:02:22,680 --> 00:02:23,680 NEUROIMAGING, SOCIAL EX 43 00:02:23,680 --> 00:02:26,600 BEHAVIORAL SCIENCES AND 44 00:02:26,600 --> 00:02:30,000 IDENTIFYING THE GENOMIC FACTORS 45 00:02:30,000 --> 00:02:31,160 AND TRANSLATING DISCOVERIES FOR 46 00:02:31,160 --> 00:02:33,520 TOOLS AND PROGNOSIS AND NOVEL 47 00:02:33,520 --> 00:02:34,240 TREATMENTS, FOLLOWING Dr. 48 00:02:34,240 --> 00:02:36,680 SHAW, WE'LL HAVE Dr. MELISSA 49 00:02:36,680 --> 00:02:37,920 BROTMAN, Dr. BROTMAN EARNED 50 00:02:37,920 --> 00:02:39,160 HER PH.D IN CLINICAL 51 00:02:39,160 --> 00:02:40,360 PSYCHOLOGIST FOR THE UNIVERSITY 52 00:02:40,360 --> 00:02:42,360 OF PENNSYLVANIA AND SHE 53 00:02:42,360 --> 00:02:43,800 SPECIALIZED IN COGNITIVE BEHAVE 54 00:02:43,800 --> 00:02:46,040 YOUR THERAPY FOR MOOD AND 55 00:02:46,040 --> 00:02:46,840 ANXIETY DISORDERS. 56 00:02:46,840 --> 00:02:48,600 AFTER COMPLETING HER CLINICAL 57 00:02:48,600 --> 00:02:50,840 INTERNSHIP AT THE VETERAN 58 00:02:50,840 --> 00:02:51,400 AFFAIRS MARYLAND HEALTH-CARE 59 00:02:51,400 --> 00:02:52,920 SYSTEM AND UNIVERSITY OF 60 00:02:52,920 --> 00:02:54,920 MARYLAND BATTLE MOR, SHE PURSUED 61 00:02:54,920 --> 00:02:57,040 TRAINING IN NEUROSCIENCE AND 62 00:02:57,040 --> 00:03:01,200 FOCUSING ON FUNCTIONAL MAGNETIC 63 00:03:01,200 --> 00:03:02,640 RESIDENTS IMAGING AND 64 00:03:02,640 --> 00:03:05,440 PHENOTYPING OF IRATE ABILITY IN 65 00:03:05,440 --> 00:03:06,160 YOUTH. 66 00:03:06,160 --> 00:03:09,400 THE GOAL OF THERAPEUTICS UNIT 67 00:03:09,400 --> 00:03:11,120 BRAIN BASED TREATMENT FOR 68 00:03:11,120 --> 00:03:13,400 TREATMENT WITH SERIOUS DISORDERS 69 00:03:13,400 --> 00:03:15,520 AND Dr. BROTMAN'S NEURO 70 00:03:15,520 --> 00:03:16,720 TRANSLATIONAL RESEARCH 71 00:03:16,720 --> 00:03:17,920 INTEGRATES BASIC AND CLINICAL 72 00:03:17,920 --> 00:03:18,360 APPROACHES TO THE STUDY OF MOOD 73 00:03:18,360 --> 00:03:20,520 DISORDERS IN CHILDREN AND 74 00:03:20,520 --> 00:03:21,680 ADOLESCENTS AND SPECIFICALLY, 75 00:03:21,680 --> 00:03:23,480 SHE USES EFFECTIVE NEUROSCIENCE 76 00:03:23,480 --> 00:03:26,400 TECHNIQUES TO UNDERSTAND THE 77 00:03:26,400 --> 00:03:27,000 BRAIN-BASED MECHANISMS UNDERLINE 78 00:03:27,000 --> 00:03:29,520 SEVERE IRRITABILITY IN YOUTH AND 79 00:03:29,520 --> 00:03:30,920 LEVERAGES THAT PAST 80 00:03:30,920 --> 00:03:31,600 PHYSIOLOGICAL KNOWLEDGE TO GUIDE 81 00:03:31,600 --> 00:03:34,000 THE DEVELOPMENT OF NOVEL 82 00:03:34,000 --> 00:03:34,640 TARGETED INTERVENTIONS. 83 00:03:34,640 --> 00:03:37,160 THE RESEARCH CONDUCTED IN HER 84 00:03:37,160 --> 00:03:39,720 NNT UNIT IS PART OF NIMH'S 85 00:03:39,720 --> 00:03:40,920 MISSION TO TRANSFORM THE 86 00:03:40,920 --> 00:03:41,800 UNDERSTANDING AND TREATMENT OF 87 00:03:41,800 --> 00:03:43,800 MENTAL ILLNESS DUE TO BASIC AND 88 00:03:43,800 --> 00:03:45,440 CLINICAL RESEARCH, PAVING THE 89 00:03:45,440 --> 00:03:47,800 WAY FOR PREVENTION, RECOVERY AND 90 00:03:47,800 --> 00:03:48,280 CURE. 91 00:03:48,280 --> 00:03:52,040 Dr. BROTMAN IS AS I FELLOW OF 92 00:03:52,040 --> 00:03:55,320 THE PSYCHO PHARMACOLOGY AND PAST 93 00:03:55,320 --> 00:03:58,520 CHAIR OF THE NCAP TASK FORCE AND 94 00:03:58,520 --> 00:04:00,200 SHE'S RECEIVED NUMEROUS RESEARCH 95 00:04:00,200 --> 00:04:05,000 AWARDS INCLUDING A SEA MORE S. 96 00:04:05,000 --> 00:04:06,400 KENNY TRAINING AND PHARMACOLOGY 97 00:04:06,400 --> 00:04:08,200 YOUNG INVESTIGATOR REWARD TRAVEL 98 00:04:08,200 --> 00:04:11,000 AWARD AND A CAREER INSTITUTE 99 00:04:11,000 --> 00:04:13,280 AWARD AND SHE'S BEEN AWARDED TWO 100 00:04:13,280 --> 00:04:14,800 NIH GRANTS AND IS A CONSULT 101 00:04:14,800 --> 00:04:17,400 ABILITY ON EXTRAMURAL GRANTS AND 102 00:04:17,400 --> 00:04:19,360 ASSOCIATE EDITOR OF THE JOURNAL 103 00:04:19,360 --> 00:04:20,840 OF THE AMERICAN ACADEMY CHILD 104 00:04:20,840 --> 00:04:24,520 AND PSYCHIATRY AND ON THE BOARD 105 00:04:24,520 --> 00:04:26,200 OF SEVERAL OTHER JOURNALS, NOW, 106 00:04:26,200 --> 00:04:28,200 PLEASE WELCOME OUR SPEAKERS, 107 00:04:28,200 --> 00:04:30,040 Dr. SHAW AND Dr. BOWMAN FOR 108 00:04:30,040 --> 00:04:32,000 THEIR PRESENTATION ENTITLED "AN 109 00:04:32,000 --> 00:04:36,760 ANATOMY TO APPS." 110 00:04:36,760 --> 00:04:37,800 THANK YOU FOR THE KIND 111 00:04:37,800 --> 00:04:39,240 INTRODUCTION AND IT'S A GREAT 112 00:04:39,240 --> 00:04:40,800 PLEASURE TO BE HERE TO TALK 113 00:04:40,800 --> 00:04:43,360 ABOUT THE WORK OF MY GROUP INTO 114 00:04:43,360 --> 00:04:44,080 ADHD. 115 00:04:44,080 --> 00:04:45,760 I HAVE NO FINANCIAL DISCLOSURES, 116 00:04:45,760 --> 00:04:48,360 MY WORK IS FUNDED BY THE 117 00:04:48,360 --> 00:04:51,040 INTRAMURAL PROGRAMS OF NHGRI AND 118 00:04:51,040 --> 00:04:53,120 KNIFE. 119 00:04:53,120 --> 00:04:53,520 AND. 120 00:04:53,520 --> 00:04:54,880 I'M GOING TO TALK ABOUT TWO 121 00:04:54,880 --> 00:04:56,360 YOUNG PEOPLE PARTICIPATING AT 122 00:04:56,360 --> 00:04:58,080 THE CLINICAL CENTER AND LOOK AT 123 00:04:58,080 --> 00:05:00,080 INSIGHTS INTO ATTENTION DEFICIT 124 00:05:00,080 --> 00:05:01,920 HYPER ACTIVITY DISORDERS AND 125 00:05:01,920 --> 00:05:04,200 ADHD, FROM IN VIVO AND 126 00:05:04,200 --> 00:05:05,680 NEUROIMAGING AND CONSIDER SOME 127 00:05:05,680 --> 00:05:09,160 RESENT POSTMORTEM BRAIN 128 00:05:09,160 --> 00:05:10,280 FINDINGS. 129 00:05:10,280 --> 00:05:10,840 SO I'M A PSYCHIATRIST. 130 00:05:10,840 --> 00:05:12,480 EVERY FRIDAY, I'M WITH MY TEAM 131 00:05:12,480 --> 00:05:14,120 IN THE CLINICAL CENTER SEEING 132 00:05:14,120 --> 00:05:16,600 YOUTH AND FAMILIES EFFECTED BY 133 00:05:16,600 --> 00:05:16,840 ADHD. 134 00:05:16,840 --> 00:05:18,840 I WANT TO TELL YOU ABOUT A KID 135 00:05:18,840 --> 00:05:19,320 CALLED PETER. 136 00:05:19,320 --> 00:05:21,880 HE WAS A VERY ENGAGING AND WARM 137 00:05:21,880 --> 00:05:26,080 CHILD BUT BY HIS AND HIS MOM'S 138 00:05:26,080 --> 00:05:27,840 REPORT HE WAS STRUGGLING AT 139 00:05:27,840 --> 00:05:29,640 SCHOOL AND HOME DUE TO HIS 140 00:05:29,640 --> 00:05:30,360 ATTENTIONAL FOCUS LACK. 141 00:05:30,360 --> 00:05:33,800 HE COULDN'T STAY ON A TASK FOR A 142 00:05:33,800 --> 00:05:35,280 SECOND, EVEN TASKS THAT 143 00:05:35,280 --> 00:05:36,600 INTERESTED HIM GREATLY. 144 00:05:36,600 --> 00:05:37,600 HIS PARENTS AND TEACHERS 145 00:05:37,600 --> 00:05:38,760 DESCRIBED HIM AS ALWAYS BEING 146 00:05:38,760 --> 00:05:40,960 LOST IN HIS OWN THOUGHTS, AND HE 147 00:05:40,960 --> 00:05:41,960 JUST NEVER SEEMED TO LISTEN. 148 00:05:41,960 --> 00:05:43,800 HE WAS EXTREMELY DISORGANIZED, 149 00:05:43,800 --> 00:05:45,680 KEPT LOSING ALL HIS BELONGINGS 150 00:05:45,680 --> 00:05:47,360 AND WAS CONSTANTLY DISTRACTED BY 151 00:05:47,360 --> 00:05:49,520 THINGS GOING ON AROUND HIM. 152 00:05:49,520 --> 00:05:51,080 THESE SYMPTOMS WERE PRESENT 153 00:05:51,080 --> 00:05:53,560 SINCE PRE-K AND THEY WEREN'T 154 00:05:53,560 --> 00:05:55,080 TRIVIAL, THEY WERE INTERFERING 155 00:05:55,080 --> 00:05:56,160 WITH HIS LEARNING AND HE 156 00:05:56,160 --> 00:05:57,560 REQUIRED QUITE SUBSTANTIAL 157 00:05:57,560 --> 00:05:59,480 ADDITIONAL SUPPORT AT SCHOOL. 158 00:05:59,480 --> 00:06:00,880 HIS MOTHER SAID THAT KEEPING HIM 159 00:06:00,880 --> 00:06:02,880 ON TASK AT HOME WAS A FULL-TIME 160 00:06:02,880 --> 00:06:04,840 JOB FOR HER. 161 00:06:04,840 --> 00:06:06,160 AND PETER HIMSELF WAS AWARE AND 162 00:06:06,160 --> 00:06:09,920 RATHER CRITICAL OF HIS POOR 163 00:06:09,920 --> 00:06:10,320 ATTENTIONAL FOCUS. 164 00:06:10,320 --> 00:06:12,960 HE WAS DIAGNOSED WITH ADHD, 165 00:06:12,960 --> 00:06:14,280 ATTENTION DEFICIT HYPER ACTIVITY 166 00:06:14,280 --> 00:06:16,880 DISORDER AND HE HAS AN 167 00:06:16,880 --> 00:06:18,720 INATTENTIVE PRESENTATION. 168 00:06:18,720 --> 00:06:21,000 AND HERE IS RYAN, ANOTHER 169 00:06:21,000 --> 00:06:21,720 9-YEAR-OLD CHILD TO SHARED THE 170 00:06:21,720 --> 00:06:22,800 SAME CHALLENGES. 171 00:06:22,800 --> 00:06:24,440 HE HAD A POOR ATTENTION FOCUS 172 00:06:24,440 --> 00:06:26,680 BUT IN ADDITION RYAN CONSTANTLY 173 00:06:26,680 --> 00:06:27,480 INTERRUPTED OTHERS AND DIDN'T 174 00:06:27,480 --> 00:06:29,280 LET THEM FINISH THEIR SENTENCES 175 00:06:29,280 --> 00:06:30,400 AND JUST COULDN'T WAIT HIS TURN 176 00:06:30,400 --> 00:06:32,360 IN ACTIVITIES. 177 00:06:32,360 --> 00:06:34,840 SINCE AN EARLY AGE, RYAN ALSO 178 00:06:34,840 --> 00:06:37,360 HAD ALMOST DAILY EXPLOSIVE 179 00:06:37,360 --> 00:06:38,400 TEMPER OUT BUSTS WHEN HE WAS 180 00:06:38,400 --> 00:06:40,480 ASKED TO DO THE SLIGHTEST THING 181 00:06:40,480 --> 00:06:43,480 LIKE STOP PLAYING HIS VIDEO 182 00:06:43,480 --> 00:06:44,440 GAMES OR TIDING HIS ROOMS. 183 00:06:44,440 --> 00:06:45,960 THIS WAS VERBAL BUT COULD BE 184 00:06:45,960 --> 00:06:47,880 PHYSICAL AT TIMES. 185 00:06:47,880 --> 00:06:49,560 RECENTLY, SEVERAL OUTBURSTED HAD 186 00:06:49,560 --> 00:06:51,280 OCCURRED IN THE CLASSROOM 187 00:06:51,280 --> 00:06:52,840 LEADING TO SEVERAL INDOOR 188 00:06:52,840 --> 00:06:53,280 SUSPENSIONS. 189 00:06:53,280 --> 00:06:55,440 BETWEEN THESE OUTBURSTS, HIS 190 00:06:55,440 --> 00:06:57,480 PARENTS SAID RYAN WAS GROUCHY 191 00:06:57,480 --> 00:06:58,640 AND ANGRY AND THEY FELT LIKE 192 00:06:58,640 --> 00:07:00,880 THEY WERE WALKING ON EGGSHELLS 193 00:07:00,880 --> 00:07:02,480 AROUND HIM. 194 00:07:02,480 --> 00:07:04,280 HERE, RYAN'S CHALLENGES WITH HIS 195 00:07:04,280 --> 00:07:06,760 SEVERE IRRITABILITY AND TEMPER 196 00:07:06,760 --> 00:07:08,240 OUTBURSTS, CONTRIBUTED TO HIM 197 00:07:08,240 --> 00:07:09,960 RECEIVING A DIAGNOSIS OF 198 00:07:09,960 --> 00:07:12,240 DISRUPTIVE MOOD DYSREGULATION 199 00:07:12,240 --> 00:07:15,360 DISORDER IN ADDITION TO HIS 200 00:07:15,360 --> 00:07:15,840 ADHD. 201 00:07:15,840 --> 00:07:17,880 Dr. BROTMAN, IS GOING TO TALK 202 00:07:17,880 --> 00:07:19,760 ABOUT THIS SEVERE IRRITABILITY, 203 00:07:19,760 --> 00:07:22,360 SEEN IN DMDD AND I'M GOING TO 204 00:07:22,360 --> 00:07:25,680 FOCUS ON PETER AND HIS SEVERE 205 00:07:25,680 --> 00:07:26,280 INATTENTION. 206 00:07:26,280 --> 00:07:28,880 JUST AS HE WAS ABOUT TO HAVE A 207 00:07:28,880 --> 00:07:30,480 RESEARCH MRI HE ASKED WHAT MIGHT 208 00:07:30,480 --> 00:07:32,440 BE GOING ON IN THE BRAIN DO YOU 209 00:07:32,440 --> 00:07:33,480 THINK TO EXPLAIN THIS? 210 00:07:33,480 --> 00:07:35,560 WELL THERE ARE A HOST OF BRAIN 211 00:07:35,560 --> 00:07:37,360 DIFFERENCES ASSOCIATED WITH ADHD 212 00:07:37,360 --> 00:07:39,680 AND HERE I'M GOING TO FOCUS ON A 213 00:07:39,680 --> 00:07:41,120 THEORY OF ADHD WHICH LARGELY 214 00:07:41,120 --> 00:07:42,880 DERIVED FROM NEUROIMAGING 215 00:07:42,880 --> 00:07:44,240 FINDINGS AND IT'S CALLED A 216 00:07:44,240 --> 00:07:47,520 DEFAULT MODE INTERFERENCE MODEL. 217 00:07:47,520 --> 00:07:50,280 WHAT CAN NEUROIMAGING TELL US 218 00:07:50,280 --> 00:07:51,440 ABOUT ADHD? 219 00:07:51,440 --> 00:07:52,960 WELL, MRI GIVES ULSRUD A WINDOW 220 00:07:52,960 --> 00:07:54,280 INTO THE DEVELOPING BRAIN AND 221 00:07:54,280 --> 00:07:56,200 I'M GOING TO FOCUS ON BRAIN 222 00:07:56,200 --> 00:07:57,280 FUNCTION. 223 00:07:57,280 --> 00:07:59,040 PARTICULARLY THE PATTERNS OF 224 00:07:59,040 --> 00:08:00,200 BRAIN ACTIVITY THAT ARE DETECTED 225 00:08:00,200 --> 00:08:02,960 WHEN A SUBJECT IS AT REST IN 226 00:08:02,960 --> 00:08:03,800 THIS DOING NOTHING SPECIFIC. 227 00:08:03,800 --> 00:08:06,560 THIS IS THE RESTING STATE FMRI. 228 00:08:06,560 --> 00:08:08,520 NOW THE MOST PROMINENT 229 00:08:08,520 --> 00:08:09,680 FUNCTIONAL NETWORK TO EMERGE IN 230 00:08:09,680 --> 00:08:11,600 THE BRAIN WHEN A SUBJECT IS AT 231 00:08:11,600 --> 00:08:14,480 REST, INCLUDES SEVERAL DISTINCT 232 00:08:14,480 --> 00:08:16,160 MID-LINE BRAIN REGIONS THAT I 233 00:08:16,160 --> 00:08:18,320 SHOW HERE AND THIS IS CALLED THE 234 00:08:18,320 --> 00:08:19,720 DEFAULT MODE NETWORK. 235 00:08:19,720 --> 00:08:22,080 SO WHAT THE BRAIN LOOKS LIKE 236 00:08:22,080 --> 00:08:24,520 DURING TASK FREE AND PROCESS 237 00:08:24,520 --> 00:08:27,640 ORGANIZE WHEN THE MIND IS NOT 238 00:08:27,640 --> 00:08:28,600 WANDERING. 239 00:08:28,600 --> 00:08:31,400 TYPICAL KIDS, THE DEFAULT MODE 240 00:08:31,400 --> 00:08:33,680 NETWORKS TENDS TO OPPOSE IS 241 00:08:33,680 --> 00:08:35,280 ANTAGONISTIC OR ANTI-CORAL EIGHT 242 00:08:35,280 --> 00:08:36,880 WITH THE NETWORKS THAT SUPPORT 243 00:08:36,880 --> 00:08:39,800 ATTENTION AND COGNITIVE CONTROL 244 00:08:39,800 --> 00:08:40,520 THAT YOU SEE HERE. 245 00:08:40,520 --> 00:08:42,880 THE DEFAULT MODE NETWORK 246 00:08:42,880 --> 00:08:44,840 INTERFERENCE THEORY STATES THAT 247 00:08:44,840 --> 00:08:46,920 AN ADHD THERE'S A LOSS OF THIS 248 00:08:46,920 --> 00:08:48,840 FINE COUNTERBALANCE BETWEEN THE 249 00:08:48,840 --> 00:08:51,880 DEFAULT MODE AND THE TASK 250 00:08:51,880 --> 00:08:52,720 POSITIVE NETWORKS. 251 00:08:52,720 --> 00:08:55,280 AND ANALOGY IS THE ON-LINE 252 00:08:55,280 --> 00:08:56,680 ACTIVITY OF THE BRAIN IS 253 00:08:56,680 --> 00:08:58,480 REPEATEDLY INTERRUPTED BY THE 254 00:08:58,480 --> 00:09:00,360 BRAIN GOING OFF LINE AMONGST 255 00:09:00,360 --> 00:09:03,000 THOSE WITH ADHD. 256 00:09:03,000 --> 00:09:04,000 NOW THERE'S GOOD DATA SHOWING 257 00:09:04,000 --> 00:09:06,280 THAT SUCH INTERFERENCE IS 258 00:09:06,280 --> 00:09:08,280 ASSOCIATED BEHAVIORAL WITH 259 00:09:08,280 --> 00:09:09,720 ATTENTION OF LAPSES, VARIABILITY 260 00:09:09,720 --> 00:09:12,480 IN RESPONSE TIME AND THE 261 00:09:12,480 --> 00:09:14,000 SUBJECTIVE FEELING OF MIND 262 00:09:14,000 --> 00:09:14,640 WANDERING. 263 00:09:14,640 --> 00:09:16,840 IN ADDITION TO THE BRAIN'S 264 00:09:16,840 --> 00:09:17,880 FUNCTIONALITY ACTIVITY, WE CAN 265 00:09:17,880 --> 00:09:19,840 LOOK AT STRUCTURAL BACK BONES OF 266 00:09:19,840 --> 00:09:20,360 THESE NETWORKS. 267 00:09:20,360 --> 00:09:22,040 THESE BACK BONES ARE FORMED BY 268 00:09:22,040 --> 00:09:24,920 WHITE MATTER TRACKS JOINED 269 00:09:24,920 --> 00:09:25,800 TOGETHER DIFFERENT BRAIN 270 00:09:25,800 --> 00:09:26,400 REGIONS. 271 00:09:26,400 --> 00:09:27,760 WE CAN LOOK AT THE MICRO 272 00:09:27,760 --> 00:09:28,840 STRUCTURE OF THESE TRACKS USING 273 00:09:28,840 --> 00:09:33,320 AN MRI MODALITY CALLED IMAGING 274 00:09:33,320 --> 00:09:34,960 AND SO WHEN THE EVIDENCE FOR THE 275 00:09:34,960 --> 00:09:36,680 DEFAULT MODE INTERFERENCE 276 00:09:36,680 --> 00:09:37,080 NETWORK? 277 00:09:37,080 --> 00:09:40,800 IF YOU DO A SIMPLE TALLY OF 30 278 00:09:40,800 --> 00:09:42,080 INDIVIDUAL STUDIES INTO IT, MOST 279 00:09:42,080 --> 00:09:44,000 SUPPORT THE MODEL BUT SOME DON'T 280 00:09:44,000 --> 00:09:46,280 AND THE SUPPORT IS AT A HIGH 281 00:09:46,280 --> 00:09:48,880 LEVEL WITH MUCH LESS AGREEMENT 282 00:09:48,880 --> 00:09:50,080 ON DETAILS. 283 00:09:50,080 --> 00:09:52,680 TWO META ANALYSIS INTEGRATED THE 284 00:09:52,680 --> 00:09:54,280 PUBLIC'S FINDINGS IN AN EFFORT 285 00:09:54,280 --> 00:09:56,560 TO GET A CLEAR, MORE CONSISTENT 286 00:09:56,560 --> 00:09:58,360 FINDING BUT THEY ENDED UP GIVING 287 00:09:58,360 --> 00:10:00,240 DIFFERENT RESULTS, ONE BROADLY 288 00:10:00,240 --> 00:10:01,440 SUPPORTED THE MODEL AND THE 289 00:10:01,440 --> 00:10:03,320 OTHER DID NOT. 290 00:10:03,320 --> 00:10:05,680 NOW THE INCONSISTENCY IN THE 291 00:10:05,680 --> 00:10:07,400 MATTER REFLECTS DIFFERENCES IN 292 00:10:07,400 --> 00:10:09,080 THIS STUDY THEY INCLUDED. 293 00:10:09,080 --> 00:10:11,840 IN ADDITION, THE META ANALYSIS 294 00:10:11,840 --> 00:10:14,320 RELIED ENTIRELY ON PUBLISHED 295 00:10:14,320 --> 00:10:16,680 FINDINGS OF GROUP DIFFERENCES 296 00:10:16,680 --> 00:10:18,560 THAT EACH INDIVIDUAL STUDY 297 00:10:18,560 --> 00:10:19,560 DECLARED SIGNIFICANT AND THIS 298 00:10:19,560 --> 00:10:21,160 THRESHOLD FOR SIGNIFICANCE CAN 299 00:10:21,160 --> 00:10:23,760 VARY A LOT BETWEEN STUDIES. 300 00:10:23,760 --> 00:10:25,680 ALSO, IT'S POSSIBLE THAT A META 301 00:10:25,680 --> 00:10:27,600 ANALYSIS TO MISS A SIGNAL IF IT 302 00:10:27,600 --> 00:10:29,360 FALLS JUST BELOW SIGNIFICANCE IN 303 00:10:29,360 --> 00:10:30,680 SEVERAL STUDIES. 304 00:10:30,680 --> 00:10:33,880 AND FINALLY I'LL NOTE, EVEN THE 305 00:10:33,880 --> 00:10:35,800 LARGEST META ANALYSIS INCLUDED 306 00:10:35,800 --> 00:10:36,880 AROUND 2,000 SUBJECTS WHICH IS 307 00:10:36,880 --> 00:10:38,600 UNDER PAR TO DETECT SOME VERY, 308 00:10:38,600 --> 00:10:41,000 VERY SMALL EFFECTS. 309 00:10:41,000 --> 00:10:43,280 SO IN RESPONSE TO THESE 310 00:10:43,280 --> 00:10:44,760 LIMITATIONS, MY GROUP AND SOME 311 00:10:44,760 --> 00:10:47,280 OTHERS, HAVE LEVERAGED THE 312 00:10:47,280 --> 00:10:48,080 INCREASING AVAILABLE OF NOT 313 00:10:48,080 --> 00:10:50,880 LARGE IMAGING DATASETS SUCH AS 314 00:10:50,880 --> 00:10:53,080 THE UNITED STATES STUDY OF 315 00:10:53,080 --> 00:10:54,840 ADOLESCENT BRAIN DEVELOPMENT, 316 00:10:54,840 --> 00:10:55,880 THE ABCD. 317 00:10:55,880 --> 00:10:58,480 THESE DATA ALLOW US TO CONDUCT 318 00:10:58,480 --> 00:11:01,000 IMAGING STUDIES WITH OVER 10,000 319 00:11:01,000 --> 00:11:02,520 SUBJECTS AND THIS IS ABOUT TWO 320 00:11:02,520 --> 00:11:04,560 ORDERS OF MAGNITUDE HIGHER THAN 321 00:11:04,560 --> 00:11:07,440 THE AVERAGE INDIVIDUAL MRI 322 00:11:07,440 --> 00:11:07,640 STUDY. 323 00:11:07,640 --> 00:11:11,040 IN THIS WORK WE ALSO FOCUS ON 324 00:11:11,040 --> 00:11:12,880 INDIVIDUAL-LEVEL RAW IMAGING 325 00:11:12,880 --> 00:11:13,080 DATA. 326 00:11:13,080 --> 00:11:14,320 INTEGRATING THE DATA THROUGH 327 00:11:14,320 --> 00:11:16,320 META ANALYSIS. 328 00:11:16,320 --> 00:11:17,160 MEGA ANALYSIS. 329 00:11:17,160 --> 00:11:18,920 SO JUST TO STRESS AGAIN, THIS IS 330 00:11:18,920 --> 00:11:20,640 A VERY DIFFERENT APPROACH FROM 331 00:11:20,640 --> 00:11:22,880 META ANALYSIS WHICH INTEGRATE 332 00:11:22,880 --> 00:11:24,280 PUBLISHED FINDINGS SUMMARIZING 333 00:11:24,280 --> 00:11:26,120 GROUP DIFFERENCES AND HERE WE'RE 334 00:11:26,120 --> 00:11:28,280 LOOKING AT INDIVIDUAL LEVEL RAW 335 00:11:28,280 --> 00:11:28,480 DATA. 336 00:11:28,480 --> 00:11:29,880 AND THIS WORK IN MY GROUP HAS 337 00:11:29,880 --> 00:11:32,800 BEEN LED BY GUSTAVO, LUKE AND 338 00:11:32,800 --> 00:11:34,160 MARINE AND THE FIRST FINDINGS 339 00:11:34,160 --> 00:11:35,480 HAVE BEEN PUBLISHED. 340 00:11:35,480 --> 00:11:38,080 SO HERE IS A OVERVIEW OF THE 341 00:11:38,080 --> 00:11:38,760 PROCESS. 342 00:11:38,760 --> 00:11:41,080 FIRST WE OBTAIN IMAGING DATA 343 00:11:41,080 --> 00:11:42,680 FROM LARGE COHORTS AND SO FAR 344 00:11:42,680 --> 00:11:45,120 WE'VE GOT DATA ON ABOUT 12,000 345 00:11:45,120 --> 00:11:45,680 YOUTH. 346 00:11:45,680 --> 00:11:47,360 THE UNIFORM PROCESSING PIPELINE 347 00:11:47,360 --> 00:11:49,840 WE USE IS A WELL VALIDATED ONE 348 00:11:49,840 --> 00:11:52,000 IMPLEMENTED ON SUPER COMMUTING 349 00:11:52,000 --> 00:11:53,440 FACILITIES AT NIH. 350 00:11:53,440 --> 00:11:54,840 AND ONE OF THE GREATEST 351 00:11:54,840 --> 00:11:56,520 ADVANTAGES OF THIS UNIFORM 352 00:11:56,520 --> 00:11:59,040 PROCESSING PIPELINE, IS QUALITY 353 00:11:59,040 --> 00:11:59,440 CONTROL. 354 00:11:59,440 --> 00:12:01,160 SO FOR EXAMPLE, IN OUR WORK, WE 355 00:12:01,160 --> 00:12:04,280 CAN EXCLUDE THE TOP 10 OR 20% OF 356 00:12:04,280 --> 00:12:06,400 SCAMS THAT SHOW EXCESSIVE MOTION 357 00:12:06,400 --> 00:12:09,520 ON ANY OF THE MANY PARA AM TERES 358 00:12:09,520 --> 00:12:10,040 WE CALCULATE. 359 00:12:10,040 --> 00:12:12,680 AS A RESULT OF THIS, WE EXCLUDE 360 00:12:12,680 --> 00:12:15,720 BETWEEN 20 TO 35% OF DATA. 361 00:12:15,720 --> 00:12:17,480 GIVEN THE VERY LARGE SAMPLE 362 00:12:17,480 --> 00:12:19,880 SIZE, IT IT ALSO LIES TO MATCH 363 00:12:19,880 --> 00:12:22,400 ONE TO ONE ON KEY POTENTIAL COP 364 00:12:22,400 --> 00:12:25,320 FINES, SUCH AS THE DEGREE OF 365 00:12:25,320 --> 00:12:26,880 INSCANNER HEAD MOTION. 366 00:12:26,880 --> 00:12:29,480 THE LARGE SIZE ALSO ALLOWS US TO 367 00:12:29,480 --> 00:12:30,680 CONSIDER IMPORTANT FACTORS SUCH 368 00:12:30,680 --> 00:12:32,480 AS THE CORRELATIONS OF 369 00:12:32,480 --> 00:12:39,240 MEDICATION USE AND CO MORBID 370 00:12:39,240 --> 00:12:39,840 CO-MORBIDITIES. 371 00:12:39,840 --> 00:12:42,400 WE CAN ALSO CONSIDER THE ADHD AS 372 00:12:42,400 --> 00:12:48,680 A DIAGNOSIS AND ADHD AS A 373 00:12:48,680 --> 00:12:49,760 CONTINUOUS BEHAVIORAL TRADE. 374 00:12:49,760 --> 00:12:51,680 ALL OF THESE WE'RE LOOKING FOR 375 00:12:51,680 --> 00:12:52,400 ASSOCIATIONS WITH ADHD AND IN 376 00:12:52,400 --> 00:12:57,520 ALL OF THEM WE CONTROL 377 00:12:57,520 --> 00:12:59,080 STATISTICALLY IT WAS ACQUIRED AT 378 00:12:59,080 --> 00:12:59,760 MULTIPLE DIFFERENT SITES. 379 00:12:59,760 --> 00:13:01,560 SO FIRST OF ALL, LET'S CONSIDER 380 00:13:01,560 --> 00:13:04,720 THE HYPOTHESIS THAT AN ADHD 381 00:13:04,720 --> 00:13:06,560 THERE WILL BE CONNECTIVITY 382 00:13:06,560 --> 00:13:08,480 BETWEEN THE DEFAULT AND THE TASK 383 00:13:08,480 --> 00:13:10,000 POSITIVE NETWORKS. 384 00:13:10,000 --> 00:13:12,440 WELL FIRST OF ALL WE DID A CASE 385 00:13:12,440 --> 00:13:14,920 CONTROL CONTRAST WITH 1,300 KIDS 386 00:13:14,920 --> 00:13:18,960 WITH DIAGNOSIS ABLE ADHD AND 387 00:13:18,960 --> 00:13:20,200 1,300 UNEFFECTED INDIVIDUALS. 388 00:13:20,200 --> 00:13:21,840 WHO WERE VERY TIGHTLY MATCHED IN 389 00:13:21,840 --> 00:13:25,040 TERMS OF THEIR GENDER, AGE AND 390 00:13:25,040 --> 00:13:26,920 DEGREE OF IN SCANNER MOTION. 391 00:13:26,920 --> 00:13:28,880 NOW IN THE UNEFFECTED OR NEURO 392 00:13:28,880 --> 00:13:29,640 TYPICAL INDIVIDUALS, WE WOULD 393 00:13:29,640 --> 00:13:32,400 EXPECT THAT THE DEFAULT MODE NED 394 00:13:32,400 --> 00:13:34,360 WORK WILL BE EMPTY CORRELATED OR 395 00:13:34,360 --> 00:13:38,480 OPPOSED TO MOST TRAFFI TASK POSITIVE 396 00:13:38,480 --> 00:13:39,280 NETWORKS. 397 00:13:39,280 --> 00:13:40,400 THIS WAS IN DEED THE CASE. 398 00:13:40,400 --> 00:13:42,280 ALSO WE EXPECT THOSE WITH ADHD 399 00:13:42,280 --> 00:13:45,000 TO SHOW LESS OF THIS 400 00:13:45,000 --> 00:13:48,240 ANTAGONISTIC RELATIONSHIP AND 401 00:13:48,240 --> 00:13:49,280 LESS OF THE ANTI-CORAL RACE. 402 00:13:49,280 --> 00:13:50,440 THIS IS BROADLY COMPATIBLE WITH 403 00:13:50,440 --> 00:13:52,560 THE DEFAULT MODE NETWORK 404 00:13:52,560 --> 00:13:54,400 INTERFERING IN YOU LIKE, WITH 405 00:13:54,400 --> 00:13:57,760 MORE TASK POSITIVE NETWORKS. 406 00:13:57,760 --> 00:13:59,760 NOW THIS DIAGNOSTIC EFFECT WAS 407 00:13:59,760 --> 00:14:01,200 PARTICULARLY STRONG BETWEEN THE 408 00:14:01,200 --> 00:14:03,240 DEFAULT MODE AND THE ATTENTION 409 00:14:03,240 --> 00:14:04,480 NETWORK SHOWN HERE. 410 00:14:04,480 --> 00:14:06,040 THE RELATIONSHIP WAS REALLY 411 00:14:06,040 --> 00:14:06,960 VERY, VERY SIGNIFICANT AS YOU 412 00:14:06,960 --> 00:14:10,120 CAN SEE FROM THE P VALUES. 413 00:14:10,120 --> 00:14:12,080 IT'S ALSO HELPFUL TO REPRESENT 414 00:14:12,080 --> 00:14:13,680 CASE CONTROL DIFFERENCES AS 415 00:14:13,680 --> 00:14:15,400 EFFECT SIZES AND THESE CAPTURED 416 00:14:15,400 --> 00:14:17,720 THE STRENGTH OF A FINDING, NOT 417 00:14:17,720 --> 00:14:21,080 JUST IT'S SIGNIFICANCE. 418 00:14:21,080 --> 00:14:22,600 THE DIFFERENCE OF HOW THE 419 00:14:22,600 --> 00:14:23,360 DEFAULT MODE WAS CONNECTED TO 420 00:14:23,360 --> 00:14:25,640 THE ATTENTION NETWORKS, WAS 421 00:14:25,640 --> 00:14:27,320 ASSOCIATED WITH AN OVER ALL 422 00:14:27,320 --> 00:14:29,920 EFFECT SIZE OF ABOUT NOT .1 #, 423 00:14:29,920 --> 00:14:31,840 IT IT IS SHOWN IN RED. 424 00:14:31,840 --> 00:14:34,920 AND THIS IS THE MEGA ANALYTIC OR 425 00:14:34,920 --> 00:14:36,360 COMBINED EFFECT SIZE THAT IS 426 00:14:36,360 --> 00:14:38,120 DERIVED FROM THE INDIVIDUAL 427 00:14:38,120 --> 00:14:44,600 CONTRIBUTING COHORTS IN BLACK. 428 00:14:44,600 --> 00:14:46,360 IT MEANS THE DISTRIBUTION OF 429 00:14:46,360 --> 00:14:48,280 THIS FUNCTIONAL CONNECTIVITY 430 00:14:48,280 --> 00:14:50,200 PROPERTY AND THOSE WITH AND 431 00:14:50,200 --> 00:14:52,080 WITHOUT ADHD, ARE ONLY VERY 432 00:14:52,080 --> 00:14:53,760 SLIGHTLY SEPARATED BY ABOUT A 433 00:14:53,760 --> 00:14:57,120 TENTH OF A STANDARD DEVIATION. 434 00:14:57,120 --> 00:14:58,920 AND A SIMILAR PICTURE IN 435 00:14:58,920 --> 00:15:00,480 MARRIAGE WHEN WE CONSIDERED ADHD 436 00:15:00,480 --> 00:15:01,360 MUCH TRADES. 437 00:15:01,360 --> 00:15:03,760 HERE MEASURED BY PARENTAL 438 00:15:03,760 --> 00:15:04,800 REPORTS OF ATTENTION PROBLEMS 439 00:15:04,800 --> 00:15:07,240 USING A WELL-STANDARDIZED 440 00:15:07,240 --> 00:15:08,640 QUESTIONNAIRE AND DATA IN THIS 441 00:15:08,640 --> 00:15:09,960 STUDY THE PAST QUALITY CONTROL 442 00:15:09,960 --> 00:15:12,560 WHERE THEY LIVE ON ABOUT 10,000 443 00:15:12,560 --> 00:15:13,280 YOUTH. 444 00:15:13,280 --> 00:15:15,520 HERE, WE FIND THAT MORE SYMPTOMS 445 00:15:15,520 --> 00:15:17,240 OF ADHD MEANT THAT THEY OFF LINE 446 00:15:17,240 --> 00:15:19,160 BRAIN WAS MORE PRONE TO 447 00:15:19,160 --> 00:15:20,400 INTERRUPT THE ON-LINE TASK 448 00:15:20,400 --> 00:15:22,640 ORIENTED BRAIN, THERE WAS LESS 449 00:15:22,640 --> 00:15:23,720 ANTI-CORRELATION. 450 00:15:23,720 --> 00:15:24,680 AGAIN, THESE ARE VERY 451 00:15:24,680 --> 00:15:26,920 SIGNIFICANT EFFECTS AND THEY ARE 452 00:15:26,920 --> 00:15:28,440 TIED TO SMALL EFFECTS, YOU CAN 453 00:15:28,440 --> 00:15:30,520 SEE THEM IN RED AND THEY HOVER 454 00:15:30,520 --> 00:15:34,520 AT A VALUE OF ABOUT JUST UNDER 455 00:15:34,520 --> 00:15:35,120 .1. 456 00:15:35,120 --> 00:15:36,920 NOW THEY'RE VERY ROBUST FINDINGS 457 00:15:36,920 --> 00:15:38,120 AND FOR EXAMPLE, THEY CAN'T BE 458 00:15:38,120 --> 00:15:39,680 EXPLAINED BY THE POSSIBILITY 459 00:15:39,680 --> 00:15:41,280 THAT THERE'S WITH ADHD WERE 460 00:15:41,280 --> 00:15:43,880 MOVING MORE IN THIS SCANNER AND 461 00:15:43,880 --> 00:15:45,200 THEY CASES IN CONTROLS WERE VERY 462 00:15:45,200 --> 00:15:46,680 TIGHTLY MATCHED ON THIS 463 00:15:46,680 --> 00:15:50,080 PARAMETER OF INSCANNER MOTION. 464 00:15:50,080 --> 00:15:50,680 ALSO, THE FINDINGS WEREN'T DUE 465 00:15:50,680 --> 00:15:52,080 TO MEDICATION EFFECTS AS THEY 466 00:15:52,080 --> 00:15:53,280 HELD WHERE THEY EXCLUDE EVERYONE 467 00:15:53,280 --> 00:15:54,880 WHO WAS ON ANY MEDICATIONS 468 00:15:54,880 --> 00:15:57,200 INCLUDING PSYCHO STIMULANTS FOR 469 00:15:57,200 --> 00:15:57,680 ADHD. 470 00:15:57,680 --> 00:16:00,960 HOWEVER AGAIN I'LL * THE EFFECTS 471 00:16:00,960 --> 00:16:02,760 ARE SMALL. 472 00:16:02,760 --> 00:16:04,480 O WHAT OF THE BRAINS STRUCTURAL 473 00:16:04,480 --> 00:16:05,440 CONNECTIONS? 474 00:16:05,440 --> 00:16:06,440 REMEMBER THESE ARE THE THINGS 475 00:16:06,440 --> 00:16:08,280 MADE UP BY WHITE MATTER TRACKS. 476 00:16:08,280 --> 00:16:11,200 HERE THE HYPOTHESIS IS THAT ADHD 477 00:16:11,200 --> 00:16:13,680 AND ITS PROBLEMS WILL BE 478 00:16:13,680 --> 00:16:15,200 ASSOCIATED WITH ALTER MICRO 479 00:16:15,200 --> 00:16:16,320 STRUCTURE OF THE WHITE MATTER 480 00:16:16,320 --> 00:16:17,280 TRACKS THAT CONNECT THE 481 00:16:17,280 --> 00:16:18,960 DIFFERENT PARTS OF THE 482 00:16:18,960 --> 00:16:23,320 FUNCTIONAL NETWORKS TOGETHER. 483 00:16:23,320 --> 00:16:25,680 THIS SHOWS A GLASS BRAIN AND THE 484 00:16:25,680 --> 00:16:27,120 WHITE MATTER TRACKS ARE KNOWN 485 00:16:27,120 --> 00:16:27,800 IT. 486 00:16:27,800 --> 00:16:30,440 IN CASE CONTROL ANALYSIS, WE 487 00:16:30,440 --> 00:16:32,200 FIND THAT ADHD WAS ASSOCIATED 488 00:16:32,200 --> 00:16:34,800 WITH DECREASES IN A MEASURE OF 489 00:16:34,800 --> 00:16:38,600 WHITE MATTER MICRO STRUCTURE 490 00:16:38,600 --> 00:16:42,080 CALLED FRACTURE ANI IS SO IT TR 491 00:16:42,080 --> 00:16:44,120 OPY, IT'S SHOWN HERE BY LOG P 492 00:16:44,120 --> 00:16:45,480 VALUES AND DARKER COLORS 493 00:16:45,480 --> 00:16:47,080 INDICATE MORE SIGNIFICANCE. 494 00:16:47,080 --> 00:16:47,960 FINDINGS THAT WERE SIGNIFICANT 495 00:16:47,960 --> 00:16:49,600 AFTER AN ADJUSTMENT FOR MULTIPLE 496 00:16:49,600 --> 00:16:56,400 TESTING ARE SHOWN WITH THE 497 00:16:56,400 --> 00:16:57,720 ASTERISKS AND THESE LIE IN THE 498 00:16:57,720 --> 00:17:00,840 DEFAULT MODE AND VEN TRAL 499 00:17:00,840 --> 00:17:02,360 ATTENTION NETWORKS. 500 00:17:02,360 --> 00:17:05,320 THEY WERE SIMILAR FINDINGS WHEN 501 00:17:05,320 --> 00:17:07,000 WE LOOKED AT ADHD TRADES 502 00:17:07,000 --> 00:17:08,480 MEASURED AGAIN IN ABOUT KIDS 503 00:17:08,480 --> 00:17:12,000 AGAIN THESE ARE REPORTED BY 504 00:17:12,000 --> 00:17:13,520 PARENTAL QUESTIONNAIRE SO HERE 505 00:17:13,520 --> 00:17:15,440 AS WE'RE FUNCTIONAL CONNECTIVITY 506 00:17:15,440 --> 00:17:17,680 WE'RE SEEING THE STRUCTURAL 507 00:17:17,680 --> 00:17:18,360 CONNECTIVITY CORRELATES OF ADHD 508 00:17:18,360 --> 00:17:21,720 AS A DIAGNOSIS, ARE VERY SIMILAR 509 00:17:21,720 --> 00:17:24,680 TO THOSE OF ADHDS TREATED AS A 510 00:17:24,680 --> 00:17:27,680 CONTINUOUS BEHAVIORAL TRAIT. 511 00:17:27,680 --> 00:17:30,800 HERE I UNPACK THE TWO MOST MANY 512 00:17:30,800 --> 00:17:31,920 SIGNIFICANT ASSOCIATIONS BETWEEN 513 00:17:31,920 --> 00:17:33,480 ATTENTION PROBLEMS AND WHITE 514 00:17:33,480 --> 00:17:34,680 MATTER TRACKED MICRO STRUCTURE. 515 00:17:34,680 --> 00:17:36,320 AND AS YOU CAN SEE THE P VALUES 516 00:17:36,320 --> 00:17:38,800 ARE TINY AND INDICATING HIGHLY 517 00:17:38,800 --> 00:17:40,480 SIGNIFICANT GROUP DIFFERENCES 518 00:17:40,480 --> 00:17:42,040 BUT THE EFFECT SIZES ARE SMALL 519 00:17:42,040 --> 00:17:43,680 AND NOT INDICATING THAT THE 520 00:17:43,680 --> 00:17:48,000 MAGNITUDE OF THIS DIFFERENCE IS 521 00:17:48,000 --> 00:17:51,520 MODEST. 522 00:17:51,520 --> 00:17:52,960 HERE ARE OTHER SYMPTOM 523 00:17:52,960 --> 00:17:56,360 DIMENSIONS, AS YOU CAN SEE, 524 00:17:56,360 --> 00:17:58,680 SOCIAL PROBLEMS WHICH MIGHT BE 525 00:17:58,680 --> 00:18:00,840 THOUGHT TO HAVE BARRING ON 526 00:18:00,840 --> 00:18:02,080 AUTISTIC SPECTRUM CHALLENGES 527 00:18:02,080 --> 00:18:04,000 SHOW A SIMILAR PATTERN OF 528 00:18:04,000 --> 00:18:05,480 ASSOCIATION. 529 00:18:05,480 --> 00:18:06,160 INTERESTINGLY, PROBLEMS WELL 530 00:18:06,160 --> 00:18:08,680 MOOD OR ANXIETY WERE NOT 531 00:18:08,680 --> 00:18:09,880 ASSOCIATED HERE WITH ALTERED 532 00:18:09,880 --> 00:18:12,560 WHITE MATTER MICRO STRUCTURE. 533 00:18:12,560 --> 00:18:15,640 HERE WE'RE FINDING THAT THE 534 00:18:15,640 --> 00:18:19,680 ALTERATIONS SO SOME DEGREE OF 535 00:18:19,680 --> 00:18:22,160 SPECIFICITY TO BEHAVIOR ALDO 536 00:18:22,160 --> 00:18:22,520 MAIN. 537 00:18:22,520 --> 00:18:24,160 SO JUST TO SUMMARIZE, 538 00:18:24,160 --> 00:18:25,040 FUNCTIONSAL AND STRUCTURAL 539 00:18:25,040 --> 00:18:28,280 CONNECTION ACTIVITY SHOW ROBUST 540 00:18:28,280 --> 00:18:30,280 HIGHLY SIGNIFICANT ADHD 541 00:18:30,280 --> 00:18:31,280 ASSOCIATED CHANGES BROADLY IN 542 00:18:31,280 --> 00:18:34,360 LINE WITH THE DEFAULT MODE 543 00:18:34,360 --> 00:18:35,080 INTERFERENCE MODEL. 544 00:18:35,080 --> 00:18:36,960 HOWEVER, THE EFFECT SIZES ARE 545 00:18:36,960 --> 00:18:41,920 SMALL, THE SUPPORT IS MODEST. 546 00:18:41,920 --> 00:18:43,400 IN SHORT THIS IS A PART OF THE 547 00:18:43,400 --> 00:18:45,080 STUDY AND A LARGE PART FOR A SUB 548 00:18:45,080 --> 00:18:46,640 MET OF CHILDREN BUT AT MOST IT'S 549 00:18:46,640 --> 00:18:51,960 ONE VERY SMALL PART OF A COMPLEX 550 00:18:51,960 --> 00:18:52,200 PUZZLE. 551 00:18:52,200 --> 00:18:53,600 IT'S IMPORTANT TO REALIZE THIS 552 00:18:53,600 --> 00:18:56,360 ISN'T THE LAST WORD. 553 00:18:56,360 --> 00:18:57,920 MIGHT LARGER ADHD DIFFERENCES BE 554 00:18:57,920 --> 00:18:59,360 FIND ELSEWHERE IN THE BRAIN AND 555 00:18:59,360 --> 00:19:01,160 THE ANSWER IS ALMOST YES AND 556 00:19:01,160 --> 00:19:04,800 FIRST OF ALL, NEUROIMAGING IS A 557 00:19:04,800 --> 00:19:06,200 RAPIDLY ADVANCING SCIENCE WHERE 558 00:19:06,200 --> 00:19:09,360 ROUTINELY IMAGING AT SEVEN TESLA 559 00:19:09,360 --> 00:19:11,920 COMPARED TO 1.45 TESLA IN PLACE 560 00:19:11,920 --> 00:19:13,520 WHEN I JOINED NIH 20 YEARS AGO 561 00:19:13,520 --> 00:19:15,480 AND THESE STRONGER FIELDS ALLOWS 562 00:19:15,480 --> 00:19:19,000 TO QUANTIFY NEURO TRANSMITTERS 563 00:19:19,000 --> 00:19:22,920 WITH CONSIDERABLE ACCURACY 564 00:19:22,920 --> 00:19:24,280 INCLUDING GAB A AND GLUTEAMATE 565 00:19:24,280 --> 00:19:25,720 WHICH I'LL TALK ABOUT LATER. 566 00:19:25,720 --> 00:19:28,160 ALL THE STUDIES ARE CROSS 567 00:19:28,160 --> 00:19:30,640 SECTIONAL AND TREAT ADHD AS A 568 00:19:30,640 --> 00:19:33,160 UNIT ENTITY OR DIMENSION AND IT 569 00:19:33,160 --> 00:19:35,480 SEEMS HIGHLY LIKELY THAT THERE 570 00:19:35,480 --> 00:19:37,800 MAY BE SUBGROUPS OF CHILDREN 571 00:19:37,800 --> 00:19:40,480 WITH ADHD WHO WILL SHOW MORE 572 00:19:40,480 --> 00:19:41,960 PRONOUNCED NEURAL DIFFERENCES. 573 00:19:41,960 --> 00:19:43,520 PERHAPS IT WILL BE CHILDREN WHO 574 00:19:43,520 --> 00:19:47,320 HAVE CERTAIN GENETIC 575 00:19:47,320 --> 00:19:49,280 DIFFERENCES. 576 00:19:49,280 --> 00:19:51,720 CHILDREN DEFINED BY FEATURES 577 00:19:51,720 --> 00:19:53,320 SUCH AS SEVERE IRRITABILITY AND 578 00:19:53,320 --> 00:19:55,920 WHAT IF WE LOOK OVER TIME? 579 00:19:55,920 --> 00:20:00,280 WELL IT SEEMS HIGHLY LIKELY THE 580 00:20:00,280 --> 00:20:02,280 CHILD WHO HAS ADHD THAT PERSISTS 581 00:20:02,280 --> 00:20:04,320 FOR 10 YEARS MAY HAVE MORE MARK 582 00:20:04,320 --> 00:20:05,680 NEURAL DIFFERENCES THAN THE 583 00:20:05,680 --> 00:20:07,880 YOUTH WITH ADHD AND ADMITS WITH 584 00:20:07,880 --> 00:20:09,880 AGE OR FLUCTUATES WITH AGE. 585 00:20:09,880 --> 00:20:11,400 MY GROUP IS PARTICULARLY EXCITED 586 00:20:11,400 --> 00:20:12,800 BY THE LAST LONGITUDINAL 587 00:20:12,800 --> 00:20:14,000 APPROACH AS OVER THE YEARS, 588 00:20:14,000 --> 00:20:16,240 WE'VE AMASSED A CONSIDERABLE 589 00:20:16,240 --> 00:20:18,000 AMOUNT OF EVIDENCE THAT 590 00:20:18,000 --> 00:20:19,400 DIFFERENCES RELATED TO ADHD ARE 591 00:20:19,400 --> 00:20:23,440 MUCH DIFFERENT IF IF YOU LOOK 592 00:20:23,440 --> 00:20:24,520 LONGITUDINALLY RATHER THAN CROSS 593 00:20:24,520 --> 00:20:26,080 SECTIONALLY AND EFFECT SIZES 594 00:20:26,080 --> 00:20:27,880 MOVE FROM SMALL TOWARDS BEING 595 00:20:27,880 --> 00:20:29,160 MEDIUM. 596 00:20:29,160 --> 00:20:34,320 SO TO THI END, WE HAVE 30,000 OF 597 00:20:34,320 --> 00:20:36,080 MODEL DATASETS TO SEE IF THE 598 00:20:36,080 --> 00:20:38,680 DIFFERENCE SYMPTOMS OF 599 00:20:38,680 --> 00:20:40,640 TRAJECTORIES OF ADHD ARE TIED TO 600 00:20:40,640 --> 00:20:42,480 MORE MARKED NEURAL DIFFERENCES, 601 00:20:42,480 --> 00:20:44,320 PARTICULARLY IN HOW THE DEFAULT 602 00:20:44,320 --> 00:20:45,640 MODE NETWORK INCOMPETENTER ACTS 603 00:20:45,640 --> 00:20:49,680 WITH TASK POSITIVE NETWORK. 604 00:20:49,680 --> 00:20:51,240 NOW ON TO A DIFFERENT WAY OF 605 00:20:51,240 --> 00:20:52,080 LOOKING AT THE BRAIN. 606 00:20:52,080 --> 00:20:53,360 I'VE BEEN TALKING A LOT ABOUT 607 00:20:53,360 --> 00:20:55,360 HIGH MRI STUDIES PROVIDING A 608 00:20:55,360 --> 00:20:58,280 WINDOW INTO THE BRAIN OF 609 00:20:58,280 --> 00:20:59,240 CHILDREN WHO ARE GROWING UP WITH 610 00:20:59,240 --> 00:20:59,920 ADHD. 611 00:20:59,920 --> 00:21:01,840 HOWEVER, IMAGING HAS MANY 612 00:21:01,840 --> 00:21:03,880 LIMITATIONS, FOR EXAMPLE, IT CAN 613 00:21:03,880 --> 00:21:07,200 DETERMINE HOW GENES THAT MAY BE 614 00:21:07,200 --> 00:21:08,640 IMPORTANT TO ADHD MIGHT DEFER IN 615 00:21:08,640 --> 00:21:09,480 THEIR EXPRESSION OF THE BRAIN 616 00:21:09,480 --> 00:21:13,160 AND IN THIS REGARD, POSTMORTEM 617 00:21:13,160 --> 00:21:13,760 STUDIES REPEAT INVALUABLE AND 618 00:21:13,760 --> 00:21:16,080 THE ABSENCE IS SUCH DATA IN ADHD 619 00:21:16,080 --> 00:21:18,000 HAS BEEN A MAJOR BARRIER TOWARDS 620 00:21:18,000 --> 00:21:20,360 OUR UNDERSTANDING OF MOLECULAR 621 00:21:20,360 --> 00:21:22,040 MECHANISMS UNDERPINNING THE 622 00:21:22,040 --> 00:21:22,680 DISORDER. 623 00:21:22,680 --> 00:21:26,000 SO IN COLLABORATION WITH THE 624 00:21:26,000 --> 00:21:27,720 HUMAN BRAIN COLLECTION CORE AND 625 00:21:27,720 --> 00:21:32,280 IMC AND THE VALUE CORE OF NHGRI, 626 00:21:32,280 --> 00:21:34,640 WE CONDUCTED THE FIRST STUDY TO 627 00:21:34,640 --> 00:21:37,080 DETERMINE DIFFERENCES IN THE 628 00:21:37,080 --> 00:21:40,400 EXPRESSION OF JEEP, THE 629 00:21:40,400 --> 00:21:41,600 TRANSRIPTOME AND THOSE WITH AND 630 00:21:41,600 --> 00:21:42,920 WITHOUT LIFETIME HISTORIES OF 631 00:21:42,920 --> 00:21:43,880 ADHD. 632 00:21:43,880 --> 00:21:48,880 WE FOCUSED ON TWO BRAIN REGIONS, 633 00:21:48,880 --> 00:21:51,040 AND AS THESE INSTRUCTION TURES 634 00:21:51,040 --> 00:21:52,240 SUPPORT COGNITIVE PROCESSES THAT 635 00:21:52,240 --> 00:21:54,000 ARE OFTEN DISRUPTED IN THE 636 00:21:54,000 --> 00:21:58,600 DISORDER AND WE OBTAINED TISSUE 637 00:21:58,600 --> 00:21:59,880 FROM 27 DONORS WITH HISTORY OF 638 00:21:59,880 --> 00:22:02,600 ADHD AND # # UNEFFECTED 639 00:22:02,600 --> 00:22:04,640 COMPARISON DONORS WITH THE AGE 640 00:22:04,640 --> 00:22:06,320 OF 22 AND HERE IS THE OVERVIEW 641 00:22:06,320 --> 00:22:09,200 OF THE PROCESSING DETAILS AND 642 00:22:09,200 --> 00:22:10,880 RNA WAS EXTRACTED AND SEQUENCES 643 00:22:10,880 --> 00:22:16,080 BY OUR COLLEAGUES DATA UNDERWENT 644 00:22:16,080 --> 00:22:18,360 CONTROL CONTROL AND WE HAD THE 645 00:22:18,360 --> 00:22:22,440 GENE EXPRESSION RELATED TO ADHD. 646 00:22:22,440 --> 00:22:23,520 WE CONSIDERED TECHNICAL FACTORS 647 00:22:23,520 --> 00:22:25,640 WITH SEQUENCING BATCH AND 648 00:22:25,640 --> 00:22:27,680 BIOLOGICAL FACTORS SUCH AS 649 00:22:27,680 --> 00:22:28,360 POPULATION STRUCTURE AND 650 00:22:28,360 --> 00:22:29,880 CLINICAL FACTORS SUCH AS 651 00:22:29,880 --> 00:22:32,400 HISTORIES OF SUBSTANCE ABUSE AND 652 00:22:32,400 --> 00:22:33,080 DEPRESSION. 653 00:22:33,080 --> 00:22:34,880 AND SO WHAT DID WE FIND? 654 00:22:34,880 --> 00:22:37,920 WELL THESE VOLCANO SHOW 655 00:22:37,920 --> 00:22:38,480 DIFFERENTIAL GENE EXPRESSION 656 00:22:38,480 --> 00:22:40,080 DEGREE OF DIFFERENCES ON THE X 657 00:22:40,080 --> 00:22:43,480 AXIS AND SIGNIFICANCE IS ON THE 658 00:22:43,480 --> 00:22:49,320 Y AXIS THE MANHATTAN PLOTS SHOW 659 00:22:49,320 --> 00:22:51,880 AND THEY ARE CORRECTIONAL FOR 660 00:22:51,880 --> 00:22:54,920 MULTIPLE ARE SHOWN IN RED AND 661 00:22:54,920 --> 00:22:57,680 OVER ALL, THE DIFFERENTIAL 662 00:22:57,680 --> 00:22:58,760 EXPRESSION AND THE CONTEXT AND 663 00:22:58,760 --> 00:23:00,680 THEY WERE ALL OVER EXPRESSED IN 664 00:23:00,680 --> 00:23:02,880 ADHD AND THEY'RE IN THIS CORNER 665 00:23:02,880 --> 00:23:03,200 HERE. 666 00:23:03,200 --> 00:23:06,160 THERE WAS ONLY ONE GENE THAT APP 667 00:23:06,160 --> 00:23:08,120 TAPED DIFFERENTIAL SIGNIFICANT 668 00:23:08,120 --> 00:23:09,680 EXPRESSION FOR THE QUALITY. 669 00:23:09,680 --> 00:23:11,720 OF THE 14 GENES, SEVERAL HAVE 670 00:23:11,720 --> 00:23:13,480 ALREADY BEEN IMPLICATED IN 671 00:23:13,480 --> 00:23:15,280 PSYCHIATRIC DISORDER AND THIS 672 00:23:15,280 --> 00:23:17,960 INCLUDES NOT JUST ADHD AND ALSO 673 00:23:17,960 --> 00:23:21,720 ALCOHOL DEPENDABL DANCE AND A MAJOR 674 00:23:21,720 --> 00:23:22,040 DEPRESSION. 675 00:23:22,040 --> 00:23:24,000 THESE GENES HAVE BEEN TIED TO 676 00:23:24,000 --> 00:23:25,480 NEURO PLASTIC PROCESS THAT'S 677 00:23:25,480 --> 00:23:27,480 HAVE BEEN IMPLICATED IN THE 678 00:23:27,480 --> 00:23:30,360 PATHOGENESIS OF ADHD. 679 00:23:30,360 --> 00:23:33,440 WE ASKED IF GENES THAT WERE 680 00:23:33,440 --> 00:23:34,920 DIFFERENTIALLY EXPRESSED LAY IN 681 00:23:34,920 --> 00:23:38,440 ANY KEY BIOLOGICAL PATHWAYS UNS 682 00:23:38,440 --> 00:23:40,240 GENE SET ENRICHMENT ANALYSIS AND 683 00:23:40,240 --> 00:23:40,800 THEY DID. 684 00:23:40,800 --> 00:23:43,400 THE GRAPH SHOWS THE DEGREE OF 685 00:23:43,400 --> 00:23:45,640 SIGNIFICANT ENRICHMENT AND THE 686 00:23:45,640 --> 00:23:46,800 TIMING POINTED TO GENES THAT ARE 687 00:23:46,800 --> 00:23:48,440 INVOLVED IN NEURO TRANSMISSION, 688 00:23:48,440 --> 00:23:50,400 ALL IN NEURO TRANSMITTER ARE 689 00:23:50,400 --> 00:23:53,480 HIGHLIGHTED IN RED. 690 00:23:53,480 --> 00:23:56,240 THESE INCLUDE TRANSIT PERCENT 691 00:23:56,240 --> 00:23:57,640 TRAPS MIGHTER AND GABA THE 692 00:23:57,640 --> 00:24:03,000 BRAIN'S MAJOR INHIBITORY 693 00:24:03,000 --> 00:24:03,960 TRANSMITTER. 694 00:24:03,960 --> 00:24:05,280 WE ASKED GENE EXPRESSION 695 00:24:05,280 --> 00:24:06,960 DIFFERENCES RESEMBLE THOSE IN 696 00:24:06,960 --> 00:24:09,080 PSYCHIATRIC DISORDERS AND IN 697 00:24:09,080 --> 00:24:09,640 DEED THEY DID. 698 00:24:09,640 --> 00:24:13,000 THIS IS SHOWN HERE. 699 00:24:13,000 --> 00:24:15,160 EACH SHOWS A DIFFERENT DISORDER 700 00:24:15,160 --> 00:24:16,120 AND EACH DOT REPRESENTS A 701 00:24:16,120 --> 00:24:17,200 DIFFERENT STUDY. 702 00:24:17,200 --> 00:24:19,200 AND YOU CAN SEE THE CORRELATIONS 703 00:24:19,200 --> 00:24:21,480 WERE GENERALLY MODEST AND VARIED 704 00:24:21,480 --> 00:24:24,160 BY STUDY AND OVER ALL 705 00:24:24,160 --> 00:24:27,640 SIGNIFICANCE, WAS A TAPED FOR ATTAINED FOR 706 00:24:27,640 --> 00:24:29,760 ADHD AND AUTISTIC SPECTRUM 707 00:24:29,760 --> 00:24:31,680 DISORDERS, SCHIZOPHRENIA AND BY 708 00:24:31,680 --> 00:24:35,400 OLE AR EFFECTIVE DISORDER AND SO 709 00:24:35,400 --> 00:24:38,360 TO SUMMARIZE, WE FIND THAT 710 00:24:38,360 --> 00:24:40,040 SIGNIFICANT DIFFERENCES IN GENE 711 00:24:40,040 --> 00:24:42,080 EXPRESSION IN BRAIN REGIONS 712 00:24:42,080 --> 00:24:44,400 PIVOTAL THAT ADHD AND THESE 713 00:24:44,400 --> 00:24:46,040 DIFFERENTIALLY EXPRESS GENES AND 714 00:24:46,040 --> 00:24:47,840 ENRICH PATHWAYS INVOLVED IN 715 00:24:47,840 --> 00:24:50,680 NEURO TRANSMISSION AND JUST AS 716 00:24:50,680 --> 00:24:51,960 ADHD OVERLAPS WITH MANY OTHER 717 00:24:51,960 --> 00:24:53,880 PSYCHIATRIC CHALLENGES, A 718 00:24:53,880 --> 00:24:55,280 CLINICAL COGNITIVE AND NEURO 719 00:24:55,280 --> 00:24:57,880 LEVELS AND SO IS WE FIND 720 00:24:57,880 --> 00:24:59,440 SIMILARITY IN ALTERATIONS IN 721 00:24:59,440 --> 00:25:02,040 GREEN EXPRESSION ACROSS 722 00:25:02,040 --> 00:25:02,480 DISORDERS. 723 00:25:02,480 --> 00:25:05,200 WE'RE NOW TAKING THIS POSTMORTEM 724 00:25:05,200 --> 00:25:06,480 WORK FORWARD LOOKING AT GENE 725 00:25:06,480 --> 00:25:08,480 CHANGES NOT AT THE LEVEL OF 726 00:25:08,480 --> 00:25:10,200 BRAIN TISSUE WE'VE DONE AND THE 727 00:25:10,200 --> 00:25:14,080 LEVEL OF INDIVIDUAL NUCLEI AND 728 00:25:14,080 --> 00:25:17,040 I'LL END BY ASKING HOW CAN WE 729 00:25:17,040 --> 00:25:18,480 BRIDGE TOGETHER SUCH POSTMORTEM 730 00:25:18,480 --> 00:25:20,360 WORK WITH IN VIVO IMAGING? 731 00:25:20,360 --> 00:25:22,280 WELL TO GIVE JUST ONE EXAMPLE, 732 00:25:22,280 --> 00:25:24,760 THE POSTMORTEM WORK POINTED 733 00:25:24,760 --> 00:25:28,840 STRONGLY TO GENES INVOLVED IN 734 00:25:28,840 --> 00:25:32,840 GABA AND GLU IT TAMATERGIC AND 735 00:25:32,840 --> 00:25:36,720 WE CAN QUANTIFY BOTH GABA AND 736 00:25:36,720 --> 00:25:37,520 GLUTE MATE LEVELS IN KIDS SO 737 00:25:37,520 --> 00:25:39,600 WE'RE NOW ASKING IF THESE NEURO 738 00:25:39,600 --> 00:25:41,880 TRANSMITTERS ARE ALTERED ACROSS 739 00:25:41,880 --> 00:25:43,240 DEVELOPMENT IN CHILDREN GROWING 740 00:25:43,240 --> 00:25:46,200 UP, WITH ADHD, AND A MANNER 741 00:25:46,200 --> 00:25:47,880 ANALOGOUS TO THAT SCENE IN OUR 742 00:25:47,880 --> 00:25:50,680 GENE EXPRESSION STUDY. 743 00:25:50,680 --> 00:25:52,320 AND ON THAT NOTE I'LL JUST END, 744 00:25:52,320 --> 00:25:55,040 AGAIN BY THANKING MY TEAM. 745 00:25:55,040 --> 00:25:58,680 I'D LIKE TO ACKNOWLEDGE THE OPEN 746 00:25:58,680 --> 00:26:03,280 DATASETDATASETS WE USED AND COLLABORATE 747 00:26:03,280 --> 00:26:05,200 AND I'LL HAND OVER TO Dr. 748 00:26:05,200 --> 00:26:06,880 MELISSA BROTMAN AS WE CONSIDER 749 00:26:06,880 --> 00:26:08,640 THE INATTENTION TA PETER FINDS 750 00:26:08,640 --> 00:26:10,600 SO CHALLENGES TO SOME OF THE 751 00:26:10,600 --> 00:26:12,120 CHALLENGES THAT RYAN FACED, 752 00:26:12,120 --> 00:26:13,440 THANK YOU. 753 00:26:13,440 --> 00:26:14,480 THANK YOU SO MUCH FOR IN 754 00:26:14,480 --> 00:26:16,480 INVITING ME TODAY. 755 00:26:16,480 --> 00:26:19,160 AND THANK YOU TO Dr. SHAW FOR 756 00:26:19,160 --> 00:26:23,080 SUCH A EXCITING INTRODUCTION. 757 00:26:23,080 --> 00:26:30,280 HE SPOKE A LOT ABOUT TH ANATOMY OF 758 00:26:30,280 --> 00:26:33,320 ADHD AND I'M GOING TO SPEAK OF 759 00:26:33,320 --> 00:26:34,440 SEVERE IRRITABILITY AND MOBILE 760 00:26:34,440 --> 00:26:35,080 APPLICATIONS IN APPS. 761 00:26:35,080 --> 00:26:37,680 I HAVE NO CONFLICTS TO DISCLOSE, 762 00:26:37,680 --> 00:26:39,560 ALL THE RESEARCH I'LL BE TALKING 763 00:26:39,560 --> 00:26:41,320 ABOUT TODAY WAS FUNDED BY THE 764 00:26:41,320 --> 00:26:44,520 INTRAMURAL RESEARCH PROGRAM AT 765 00:26:44,520 --> 00:26:46,840 NIMH AND TWO NIH BENCH TO 766 00:26:46,840 --> 00:26:51,360 BEDSIDE AWARD PROGRAMS. 767 00:26:51,360 --> 00:26:52,680 SO I HAVE FOUR LEARNING 768 00:26:52,680 --> 00:26:54,080 OBJECTIVES I WANT TO REVIEW 769 00:26:54,080 --> 00:26:54,560 TODAY. 770 00:26:54,560 --> 00:26:57,400 FIRST, WHAT I WANT TO DO, IS 771 00:26:57,400 --> 00:27:00,120 REALLY DEFINE IRRITABILITY, 772 00:27:00,120 --> 00:27:02,800 ADHD, AND THIS STANDARD 773 00:27:02,800 --> 00:27:05,480 PSYCHOLOGICAL PROCESS OF 774 00:27:05,480 --> 00:27:06,480 INHIBITORY CONTROL. 775 00:27:06,480 --> 00:27:07,920 THEN WHAT I WANT TO DO IS TALK 776 00:27:07,920 --> 00:27:10,440 ABOUT SOME OF THE ADVANTAGES OF 777 00:27:10,440 --> 00:27:14,680 DEVELOPING MOBILE APPLICATIONS 778 00:27:14,680 --> 00:27:15,760 TO PROBE THESE SPECIFIC 779 00:27:15,760 --> 00:27:18,560 PSYCHOLOGICAL PROCESSES AND 780 00:27:18,560 --> 00:27:20,600 THIRD I WANT TO INTRODUCE A GAME 781 00:27:20,600 --> 00:27:23,440 WE DEVELOPED CALLED CALM-IT AND 782 00:27:23,440 --> 00:27:26,440 THE GOAL OF THIS MOBILE APP IS 783 00:27:26,440 --> 00:27:29,280 TO SPECIFICALLY MEASURE 784 00:27:29,280 --> 00:27:30,120 INHIBITORY CONTROL. 785 00:27:30,120 --> 00:27:33,640 FOURTH, I'M GOING TO SHARE SOME 786 00:27:33,640 --> 00:27:37,120 DATA THAT DEMONSTRATES SOME 787 00:27:37,120 --> 00:27:40,280 EARLY FEASIBILITY THAT IS WILL 788 00:27:40,280 --> 00:27:42,040 CHILDREN ACTUALLY PLAY THE GAME? 789 00:27:42,040 --> 00:27:43,960 SOME EARLY VALIDITY, THAT IS IS 790 00:27:43,960 --> 00:27:47,080 DOES THE GAME ACTUALLY MEASURE 791 00:27:47,080 --> 00:27:49,520 THE CONSTRUCT OF INHIBITORY 792 00:27:49,520 --> 00:27:52,440 CONTROL, RELIABILITY THAT IS 793 00:27:52,440 --> 00:27:54,320 PERFORMANCE, IS IT STABLE OVER 794 00:27:54,320 --> 00:27:57,360 TIME AND SOME EARLY CLINICAL 795 00:27:57,360 --> 00:27:59,200 ASSOCIATIONS THAT IS PERFORMANCE 796 00:27:59,200 --> 00:28:01,880 ON THIS MOBILE APP ASSOCIATED 797 00:28:01,880 --> 00:28:04,760 WITH SPECIFIC SYMPTOMS OF 798 00:28:04,760 --> 00:28:06,520 PSYCHOPATHOLOGY AND I'LL END BY 799 00:28:06,520 --> 00:28:07,640 TALKING ABOUT SOME FUTURE 800 00:28:07,640 --> 00:28:12,080 DIRECTIONS OF OUR WORK. 801 00:28:12,080 --> 00:28:15,400 SO, AS Dr. SHAW TALKED ABOUT, 802 00:28:15,400 --> 00:28:16,960 IRRITABILITY AND ADHD ARE AMONG 803 00:28:16,960 --> 00:28:19,240 THE MOST COMMON REASONS YOUTH 804 00:28:19,240 --> 00:28:23,480 ARE BROUGHT IN TO BE PSYCHIATRIC 805 00:28:23,480 --> 00:28:24,160 EVALUATION AND CARE. 806 00:28:24,160 --> 00:28:26,680 WHAT DO WE MEAN BY IRRITABILITY? 807 00:28:26,680 --> 00:28:29,960 AN IRRITABILITY, IT'S DEFINED 808 00:28:29,960 --> 00:28:34,960 ESSENTIALLY AS AN INCREASE ON 809 00:28:34,960 --> 00:28:35,920 PRONENESS TO ANGER, THESE 810 00:28:35,920 --> 00:28:37,680 CHILDREN HAVE A PRO TENSE TEE 811 00:28:37,680 --> 00:28:40,800 TOWARDS AN ANGRY, GRUMPY, CRANKY 812 00:28:40,800 --> 00:28:42,960 MOOD AND A LOW THRESHOLD FOR 813 00:28:42,960 --> 00:28:45,000 TEMPER OUTBURSTS. 814 00:28:45,000 --> 00:28:47,480 AND AS Dr. SHAW MENTIONED, 815 00:28:47,480 --> 00:28:50,280 THERE'S A RELATIVELY NEW 816 00:28:50,280 --> 00:28:53,920 DIAGNOSIS IN DSM5 CALLED 817 00:28:53,920 --> 00:28:55,280 DISRUPTED MOOD DYSREGULATION 818 00:28:55,280 --> 00:28:56,920 DISORDER WHERE YOUTH ARE 819 00:28:56,920 --> 00:28:58,480 SPECIFICALLY CHARACTERIZED BY 820 00:28:58,480 --> 00:29:02,240 CHRONIC IRRITABILITY AND TEMPER 821 00:29:02,240 --> 00:29:03,520 OUTBURSTS. 822 00:29:03,520 --> 00:29:05,800 NOW, FOLKS TEND TO BE SOME WHAT 823 00:29:05,800 --> 00:29:07,560 MORE FAMILIAR WITH THE DIAGNOSIS 824 00:29:07,560 --> 00:29:09,680 OF ATTENTION DEFICIT HYPER 825 00:29:09,680 --> 00:29:12,200 ACTIVITY DISORDER. 826 00:29:12,200 --> 00:29:13,080 OR ADHD. 827 00:29:13,080 --> 00:29:15,440 WHICH AS WE KNOW IS ASSOCIATED 828 00:29:15,440 --> 00:29:19,760 WITH GENERAL INATTENTION, TRACT 829 00:29:19,760 --> 00:29:21,360 ABILITY AND HYPER ACTIVITY. 830 00:29:21,360 --> 00:29:24,880 NOW INTERESTINGLY, BOTH YOUTH 831 00:29:24,880 --> 00:29:26,600 WITH IRRITABILITY AND CHILDREN 832 00:29:26,600 --> 00:29:29,640 DIAGNOSED WITH ADHD, HAVE 833 00:29:29,640 --> 00:29:32,640 DIFFICULTY INHIBITING RESPONSES. 834 00:29:32,640 --> 00:29:35,440 AND IN CLINICALLY, IF WE THINK 835 00:29:35,440 --> 00:29:36,280 ABOUT THIS, THIS MAKES SENSE. 836 00:29:36,280 --> 00:29:38,320 WHEN AN IRRITABLE CHILD GETS 837 00:29:38,320 --> 00:29:42,200 REAL HE'S ANGRY, THEY OFTEN 838 00:29:42,200 --> 00:29:43,880 YELL, SCREAM, MAY THROW 839 00:29:43,880 --> 00:29:47,960 SOMETHING, SLAM A DOOR, AND KIDS 840 00:29:47,960 --> 00:29:50,080 WITH ADHD HAVE PROBLEMS 841 00:29:50,080 --> 00:29:51,880 INHIBITING THEIR RESPONSES. 842 00:29:51,880 --> 00:29:54,240 THEY OFTEN CALL OUT ANSWERS, 843 00:29:54,240 --> 00:29:59,040 SPEAK OUT OF TURN, ACT BEFORE 844 00:29:59,040 --> 00:29:59,880 THEY THINK. 845 00:29:59,880 --> 00:30:03,120 SO WHAT IS INHIBITORY CONTROL? 846 00:30:03,120 --> 00:30:07,400 INHIBITORY CONTROL IS A VERY 847 00:30:07,400 --> 00:30:09,280 SPECIFIC COGNITIVE PROCESS THAT 848 00:30:09,280 --> 00:30:10,280 PSYCHOLOGISTS MEASURE AND IT'S 849 00:30:10,280 --> 00:30:15,360 SPECIFICALLY DEFINED AS ONES' 850 00:30:15,360 --> 00:30:18,440 ABILITY TO MODIFY A PRE POTENT 851 00:30:18,440 --> 00:30:20,200 OR DOMINANT RESPONSE. 852 00:30:20,200 --> 00:30:23,280 THAT IS, IT'S DEFINED AS ONES' 853 00:30:23,280 --> 00:30:27,360 ABILITY TO SUPPRESS GOAL 854 00:30:27,360 --> 00:30:29,320 IRRELEVANCE STIMULI IN ORDER TO 855 00:30:29,320 --> 00:30:32,160 EXECUTE A SPECIFIC BEHAVIOR. 856 00:30:32,160 --> 00:30:34,480 AND THIS BEHAVIORAL PROCESS HAS 857 00:30:34,480 --> 00:30:37,280 BEEN EXTENSIVE LEASE STUDIED AND 858 00:30:37,280 --> 00:30:38,720 MAPPED ON TO SPECIFIC 859 00:30:38,720 --> 00:30:40,040 NEUROCIRCUIT TREE AND INCLUDING 860 00:30:40,040 --> 00:30:43,280 AREAS OF THE PREFRONTAL CORTEX, 861 00:30:43,280 --> 00:30:45,520 INTERIOR SINGULAR CORTEX AND 862 00:30:45,520 --> 00:30:47,400 AREAS IN THE DEFAULT MODE 863 00:30:47,400 --> 00:30:51,280 NETWORK AS Dr. SHAW DISCUSSED. 864 00:30:51,280 --> 00:30:53,680 NOW, NOT SURPRISINGLY, THESE ARE 865 00:30:53,680 --> 00:30:57,480 AREAS WE OFTEN SEE DYSFUNCTION 866 00:30:57,480 --> 00:30:59,280 IN YOUTH STRUGGLING WITH 867 00:30:59,280 --> 00:31:00,160 IRRITABILITY AND ADHD. 868 00:31:00,160 --> 00:31:02,760 AND OVER THE PAST SEVERAL 869 00:31:02,760 --> 00:31:04,400 DECADES, PSYCHOLOGISTS HAVE 870 00:31:04,400 --> 00:31:07,280 DEVELOPED A LARGE SUITE OF 871 00:31:07,280 --> 00:31:09,080 BEHAVIORAL TASK THAT ASSESSED 872 00:31:09,080 --> 00:31:14,400 ONES' ABILITY TO WITH HOLD OR 873 00:31:14,400 --> 00:31:15,400 CHANGE A PRE POTENT RESPONSE 874 00:31:15,400 --> 00:31:19,480 INCLUDING THE STOP LAY TASK THAT 875 00:31:19,480 --> 00:31:23,400 THE AXCPX AND THE FLANKER. 876 00:31:23,400 --> 00:31:26,040 NOW THESE TASKS ARE EXTREMELY 877 00:31:26,040 --> 00:31:28,880 ROBUST AND THEIR ABILITY TO 878 00:31:28,880 --> 00:31:31,400 ASSESS PER DEFICITS IN 879 00:31:31,400 --> 00:31:32,200 INHIBITORY CONTROL, HOWEVER, 880 00:31:32,200 --> 00:31:34,760 THESE TASKS TEND TO BE QUITE NOT 881 00:31:34,760 --> 00:31:39,200 TIME INTENSIVE THAT THEY'RE VERY 882 00:31:39,200 --> 00:31:39,680 BORING. 883 00:31:39,680 --> 00:31:42,680 IF YOU ASK CHILDREN, THEY REPORT 884 00:31:42,680 --> 00:31:43,840 THIS. 885 00:31:43,840 --> 00:31:45,880 ALSO, THEY'RE NOT GENERALLY 886 00:31:45,880 --> 00:31:49,880 ACCESSIBLE TO THE COMMUNITY AT 887 00:31:49,880 --> 00:31:52,160 LARGE. 888 00:31:52,160 --> 00:31:54,560 SO IN THE PAST SEVERAL YEARS, 889 00:31:54,560 --> 00:31:56,440 TECHNOLOGICAL ADVANCES HAVE 890 00:31:56,440 --> 00:31:57,280 PROVIDED CLINICIAN AND 891 00:31:57,280 --> 00:31:58,880 RESEARCHERS WITH MORE ACCESSIBLE 892 00:31:58,880 --> 00:32:01,880 PLATFORMS INCLUDING MOBILE 893 00:32:01,880 --> 00:32:03,160 APPLICATIONS AND MOBILE AND 894 00:32:03,160 --> 00:32:04,520 WEARABLE DEVICES. 895 00:32:04,520 --> 00:32:06,720 SO, SOME OF THE ADVANTAGES OF 896 00:32:06,720 --> 00:32:08,600 THESE MOBILE APPS, OF COURSE, 897 00:32:08,600 --> 00:32:10,920 THEY'RE MUCH MORE ACCESSIBLE TO 898 00:32:10,920 --> 00:32:13,040 THE COMMUNITY AND WE SAW THIS TO 899 00:32:13,040 --> 00:32:15,480 BE ESPECIALLY TRUE DURING THE 900 00:32:15,480 --> 00:32:17,280 PANDEMIC WHEN WE WEREN'T ABLE TO 901 00:32:17,280 --> 00:32:19,440 SEE CHILDREN AND FAMILIES IN THE 902 00:32:19,440 --> 00:32:21,480 CLINIC, WE COULD DEVELOP AND 903 00:32:21,480 --> 00:32:22,920 PUSH THESE MOBILE APPS TO 904 00:32:22,920 --> 00:32:24,880 CHILDREN TO COMPLETE AT HOME OR 905 00:32:24,880 --> 00:32:29,120 OUTSIDE THE CLINIC. 906 00:32:29,120 --> 00:32:30,280 WE ALSO LEARNED THE IMPORTANCE 907 00:32:30,280 --> 00:32:37,760 OF GATHERING THESE DATA I AM IN VIVO, 908 00:32:37,760 --> 00:32:39,440 WHERE THESE INTENSE EMOTIONS AND 909 00:32:39,440 --> 00:32:40,920 DYSFUNCTIONAL BEHAVIORS ARE MOST 910 00:32:40,920 --> 00:32:44,000 LIKELY TO OCCUR. 911 00:32:44,000 --> 00:32:46,160 WE ALSO HAD THE ABILITY TO HAVE 912 00:32:46,160 --> 00:32:48,960 THESE CHILDREN PLAY THESE GAMES 913 00:32:48,960 --> 00:32:51,280 MULTIPLE TIMES OVER THE DAVE AND 914 00:32:51,280 --> 00:32:52,680 MULTIPLE TIMES OVER THE DAY 915 00:32:52,680 --> 00:32:54,840 WITHIN A WEEK. 916 00:32:54,840 --> 00:32:56,040 AND BY HAVING CHILDREN PLAY 917 00:32:56,040 --> 00:33:00,280 THESE GAMES, MANY TIMES, WE CAN 918 00:33:00,280 --> 00:33:02,200 CAPTURE VARIABILITY IN 919 00:33:02,200 --> 00:33:03,040 PERFORMANCE OVER TIME. 920 00:33:03,040 --> 00:33:06,400 AND WE CAN ALSO CAPTURE CHANGES 921 00:33:06,400 --> 00:33:07,000 IN EMOTION. 922 00:33:07,000 --> 00:33:09,000 AND THESE MULTIPLE REPLICATES 923 00:33:09,000 --> 00:33:11,600 CAN START TO GIVE US A WINDOW 924 00:33:11,600 --> 00:33:14,720 INTO CAUSALITY AND THAT IS, IT 925 00:33:14,720 --> 00:33:17,080 GIVES US THE OPPORTUNITY TO 926 00:33:17,080 --> 00:33:19,520 START TO ASK QUESTIONS LIKE, DO 927 00:33:19,520 --> 00:33:23,000 SPECIFIC BEHAVIORS LIKE IMPAIRED 928 00:33:23,000 --> 00:33:25,120 INHIBITORY CONTROL, TEND TO BE 929 00:33:25,120 --> 00:33:26,880 WORSE BEFORE SAY A TEMPER 930 00:33:26,880 --> 00:33:28,640 OUTBURST IN A CHILD WITH SEVERE 931 00:33:28,640 --> 00:33:32,680 AND IMPAIRING IRRITABILITY. 932 00:33:32,680 --> 00:33:34,920 AND IF WE CAN ACTUALLY PREDICT 933 00:33:34,920 --> 00:33:38,360 TEMPER OUTBURSTS BEFORE THEY 934 00:33:38,360 --> 00:33:39,480 OCCUR, ULTIMATELY WE MAY BE ABLE 935 00:33:39,480 --> 00:33:42,400 TO INTERVENE BEFORE THAT 936 00:33:42,400 --> 00:33:43,600 DYSFUNCTIONAL EMOTIONAL EVENT 937 00:33:43,600 --> 00:33:45,600 PRESENTS ITSELF. 938 00:33:45,600 --> 00:33:50,120 SO AS A RECAP, INHAD HIB TORI 939 00:33:50,120 --> 00:33:52,480 CONTROL IS A ESTABLISHED 940 00:33:52,480 --> 00:33:53,680 PSYCHOLOGICAL PROCESS DEFINED AS 941 00:33:53,680 --> 00:33:56,400 ONES' ABILITY TO WITH HOLD OR 942 00:33:56,400 --> 00:33:59,080 MODIFY A PRE POTENT RESPONSE. 943 00:33:59,080 --> 00:34:01,320 INHIBITORY CONTROL IS ASSOCIATED 944 00:34:01,320 --> 00:34:03,600 WITH IRRITABILITY AND ADHD. 945 00:34:03,600 --> 00:34:06,400 AND WE HAVE THESE VERY ROBUST 946 00:34:06,400 --> 00:34:07,800 STANDARDIZED TASK BUT THEY'RE 947 00:34:07,800 --> 00:34:09,560 NOT PARTICULARLY ACCESSIBLE TO 948 00:34:09,560 --> 00:34:12,760 THE COMMUNITY. 949 00:34:12,760 --> 00:34:14,520 MUCH SOP OUR GOAL AND THIS IS 950 00:34:14,520 --> 00:34:15,960 PARTICULARLY TRUE DURING THE 951 00:34:15,960 --> 00:34:18,920 ACUTE STAY AT HOME ORDERS DURING 952 00:34:18,920 --> 00:34:21,680 COVID-19 WAS TO DEVELOP AND TEST 953 00:34:21,680 --> 00:34:23,560 AN ENGAGING MOBILE APP THAT 954 00:34:23,560 --> 00:34:27,000 COULD RELIABLY PROBE INHIBITORY 955 00:34:27,000 --> 00:34:29,960 CONTROL IN VIVO AND THAT IS 956 00:34:29,960 --> 00:34:30,800 NATURALISTIC LEASE, WELL KIDS TO 957 00:34:30,800 --> 00:34:33,520 PLAY THE GAMES AT HOME. 958 00:34:33,520 --> 00:34:34,880 WE CREATED THIS GAME THAT COULD 959 00:34:34,880 --> 00:34:38,640 BE DOWNLOADED ON AN iPHONE AND 960 00:34:38,640 --> 00:34:43,480 THAT TAKES PLACES IN SPACE. 961 00:34:43,480 --> 00:34:45,120 EACH GALAXY REPRESENTS A 962 00:34:45,120 --> 00:34:47,680 DISTINCT LEVEL OR BLOCK OF 963 00:34:47,680 --> 00:34:50,680 TRIALS AND WHILE EXPLORING THE 964 00:34:50,680 --> 00:34:51,440 GALAXY, PARTICIPANTS ARE 965 00:34:51,440 --> 00:34:54,280 INSTRUCTED TO DESTROY OR NOT 966 00:34:54,280 --> 00:34:57,480 SWIPE THEIR FINGER ACROSS THIS 967 00:34:57,480 --> 00:35:00,280 SCREEN, CERTAINLY TARGETS AND 968 00:35:00,280 --> 00:35:02,200 NOT SWIPE OR INHIBIT THEIR MOTOR 969 00:35:02,200 --> 00:35:04,680 RESPONSE TO OTHER TARGETS. 970 00:35:04,680 --> 00:35:08,520 SO, WHAT I'M GOING TO SHOW YOU 971 00:35:08,520 --> 00:35:09,520 HERE, IS A CHILD'S PLAYING A 972 00:35:09,520 --> 00:35:11,280 GAME AND I'M GOING TO WALK YOU 973 00:35:11,280 --> 00:35:19,360 THROUGH WHAT THEY'RE DOING. 974 00:35:19,360 --> 00:35:21,480 THE CHILDREN ARE BEING INSTRUCT 975 00:35:21,480 --> 00:35:23,200 TODAY WIPE THE RED, PURPLE AND 976 00:35:23,200 --> 00:35:27,360 YELLOW CIRCLES BUT NOT THE 977 00:35:27,360 --> 00:35:29,720 YELLOW SUN. 978 00:35:29,720 --> 00:35:31,000 THE CHILD IS SWIPING THE 979 00:35:31,000 --> 00:35:36,440 TARGETS, AVOID THAT YELLOW SUN. 980 00:35:36,440 --> 00:35:38,400 SWIPING THE TARGETS. 981 00:35:38,400 --> 00:35:39,960 THEY SWIPED THE SUN. 982 00:35:39,960 --> 00:35:42,880 SWEEPING THE TARGETS. 983 00:35:42,880 --> 00:35:44,680 AND THEN SWEEPING THE YELLOW SUN 984 00:35:44,680 --> 00:35:47,520 AND TO POINT OUT, WHEN THE 985 00:35:47,520 --> 00:35:55,080 CHILD'S SWIPES THE TARGET, THEY 986 00:35:55,080 --> 00:36:14,360 GAIN POINTS -- WE COULD SEE IF THE 987 00:36:14,360 --> 00:36:16,480 CHILD SWIPED THE PURPLE, BLUE OR 988 00:36:16,480 --> 00:36:19,400 RED CIRCLE OR NOT. 989 00:36:19,400 --> 00:36:21,920 AND USING THESE INDIVIDUAL 990 00:36:21,920 --> 00:36:24,640 RESPONSES, WE CAN THEN CALCULATE 991 00:36:24,640 --> 00:36:27,120 EACH CHILD INHIBITORY CONTROL 992 00:36:27,120 --> 00:36:32,480 PERFORMANCE BY USING A METRIC 993 00:36:32,480 --> 00:36:33,320 CALLED DEPRIME. 994 00:36:33,320 --> 00:36:35,680 DEPRIME IS A MEASURE OF 995 00:36:35,680 --> 00:36:38,680 SENSITIVITY WHEREBY WE SUBTRACT 996 00:36:38,680 --> 00:36:41,320 THE STANDARDIZED RATE OF THOSE 997 00:36:41,320 --> 00:36:42,720 YELLOW HIT SUNS THAT IS IS THE 998 00:36:42,720 --> 00:36:44,360 NUMBER OF TIMES THAT THEY SWIPED 999 00:36:44,360 --> 00:36:45,600 NOT WHEN THEY WEREN'T SUPPOSED 1000 00:36:45,600 --> 00:36:47,880 TOP OR THE NUMBER OF MISTAKES 1001 00:36:47,880 --> 00:36:50,360 FROM THE STANDARDIZED RATE OF 1002 00:36:50,360 --> 00:36:56,600 HIT CIRCLES THAT IS GOOD 1003 00:36:56,600 --> 00:37:00,840 PERFORMANCE AND A HIGHER DEEP 1004 00:37:00,840 --> 00:37:03,520 CRIME INCOMPETENT GATES BETTER 1005 00:37:03,520 --> 00:37:05,080 PERFORMANCE OR INHIBITORY 1006 00:37:05,080 --> 00:37:05,520 CONTROL. 1007 00:37:05,520 --> 00:37:12,880 WE ADMINISTERED THIS TASK TO 148 1008 00:37:12,880 --> 00:37:13,880 YOUTH AND CHILDREN BETWEEN THE 1009 00:37:13,880 --> 00:37:18,320 AVERAGE OF EIGHT AND 18 WITH A 1010 00:37:18,320 --> 00:37:19,840 LITTLE OVER A LITTLE OVER HALF 1011 00:37:19,840 --> 00:37:20,360 BEING NOW. 1012 00:37:20,360 --> 00:37:22,280 WHEN CHILDREN PLAYED THE GAME WE 1013 00:37:22,280 --> 00:37:26,480 ACTUALLY ALSO ASKED CHILDREN AND 1014 00:37:26,480 --> 00:37:28,720 PARENTS TO COMPLETE SYMPTOM 1015 00:37:28,720 --> 00:37:30,760 MEASURES ASSESSING LEVELS OF 1016 00:37:30,760 --> 00:37:32,960 IRRITABILITY AND ADHD, AND 1017 00:37:32,960 --> 00:37:35,680 ANXIETY, AND DEPRESSION. 1018 00:37:35,680 --> 00:37:37,800 AND NOTABLY WE RECRUITED 1019 00:37:37,800 --> 00:37:42,280 CHILDREN FROM OUR ON GOING 1020 00:37:42,280 --> 00:37:43,240 CLINICAL CHARACTERIZATION 1021 00:37:43,240 --> 00:37:44,680 STUDIES WHERE EACH CHILD HAD A 1022 00:37:44,680 --> 00:37:47,760 PRIMARY DYING KNOW IS OF EITHER 1023 00:37:47,760 --> 00:37:49,280 DISRUPTIVE MOOD DYSREGULATION 1024 00:37:49,280 --> 00:37:52,800 DISORDER, DMDD AND THESE ARE 1025 00:37:52,800 --> 00:37:54,560 CHILDREN WHO ARE ENRICHED OF 1026 00:37:54,560 --> 00:37:57,760 HIGH LEVELS OF IRRITABILITY AND 1027 00:37:57,760 --> 00:38:00,080 TEMPER OFFERS AND A DIAGNOSIS OF 1028 00:38:00,080 --> 00:38:01,880 HYPER ACTIVITY DISORDERS AND 1029 00:38:01,880 --> 00:38:04,080 CHILDREN WITH THE PRIMARY 1030 00:38:04,080 --> 00:38:07,480 DIAGNOSIS OF ANXIETY DISORDERS 1031 00:38:07,480 --> 00:38:10,480 AND SEPARATION ANXIETY AND 1032 00:38:10,480 --> 00:38:11,960 SOCIAL PHOBIA AND KIDS WITH 1033 00:38:11,960 --> 00:38:14,680 OPPOSITION DEFINED DISORDER ALSO 1034 00:38:14,680 --> 00:38:16,640 ENRICHED FOR IRRITABILITY AND 1035 00:38:16,640 --> 00:38:18,680 TYPICALLY DEVELOPING HEALTHY 1036 00:38:18,680 --> 00:38:22,880 CONTROL YOUTH WITH NO CLINICAL 1037 00:38:22,880 --> 00:38:24,280 DIAGNOSIS. 1038 00:38:24,280 --> 00:38:26,680 WE PRE REGISTERED THIS REPORT 1039 00:38:26,680 --> 00:38:30,760 OUTLINING THE MAIN HYPOTHESIS 1040 00:38:30,760 --> 00:38:32,200 AND QUESTIONS, THE FIRST AUTHOR 1041 00:38:32,200 --> 00:38:35,560 IS Dr. ALYSE CARDINALLY WHO A 1042 00:38:35,560 --> 00:38:37,600 TENURE TRACK PROFESSOR AT 1043 00:38:37,600 --> 00:38:39,040 CATHOLIC UNIVERSITY. 1044 00:38:39,040 --> 00:38:43,480 AND WE HAVE FOUR PRIMARY 1045 00:38:43,480 --> 00:38:44,000 QUESTIONS. 1046 00:38:44,000 --> 00:38:44,440 FIRST, FEASIBILITY. 1047 00:38:44,440 --> 00:38:47,360 IS IT FEASIBLE TO DEVELOP AN 1048 00:38:47,360 --> 00:38:48,560 INHIBITORY CONTROL MOBILE APP 1049 00:38:48,560 --> 00:38:57,840 AND THAT IS, WILL THE DATA BE 1050 00:38:57,840 --> 00:39:00,640 USEABLE AND AND THEY ARE ENGAGE 1051 00:39:00,640 --> 00:39:05,280 AND PLAY THE GAME PROPERLY 1052 00:39:05,280 --> 00:39:07,400 SECOND, IS THE TASK VALID, THAT 1053 00:39:07,400 --> 00:39:11,400 IS DOES THE APP IN FACT MEASURE 1054 00:39:11,400 --> 00:39:14,720 THIS CON INFRASTRUCTUR CONSTRUCT OF CONTRO L. 1055 00:39:14,720 --> 00:39:16,400 SPECIFICALLY IS PERFORMANCE ON 1056 00:39:16,400 --> 00:39:20,280 THIS MOBILE APP RELATED TO THESE 1057 00:39:20,280 --> 00:39:20,800 STANDARDIZED ESTABLISHED 1058 00:39:20,800 --> 00:39:25,520 MEASURES OF INHIBITORY CONTROL 1059 00:39:25,520 --> 00:39:26,360 TASKS. 1060 00:39:26,360 --> 00:39:27,920 IS THE TASK RELIABLE, IF 1061 00:39:27,920 --> 00:39:31,320 CHILDREN PLAY THE GAME MULTIPLE 1062 00:39:31,320 --> 00:39:33,600 TIMES HOW STABLE IS THEIR 1063 00:39:33,600 --> 00:39:35,280 PERFORMANCE OVER TIME. 1064 00:39:35,280 --> 00:39:37,680 AND IS THE TASK CLINICALLY 1065 00:39:37,680 --> 00:39:39,560 RELEVANT THAT IS IS IS 1066 00:39:39,560 --> 00:39:41,600 PERFORMANCE ON THE TASK 1067 00:39:41,600 --> 00:39:42,760 ASSOCIATED WITH SPECIFIC 1068 00:39:42,760 --> 00:39:46,760 SYMPTOMS OF IRRITABILITY AND 1069 00:39:46,760 --> 00:39:47,480 ADHD? 1070 00:39:47,480 --> 00:39:52,600 SO QUESTION ONE, ALMOST CHILDREN 1071 00:39:52,600 --> 00:39:54,480 PLAY THE GAME WELL IN BRIEF, WE 1072 00:39:54,480 --> 00:39:59,040 FOUND IN 148 YOUTH, WE FOUND 1073 00:39:59,040 --> 00:40:02,760 THAT 99 THE DATA WERE USEABLE. 1074 00:40:02,760 --> 00:40:04,320 WERE THEY ENGAGED IN TRYING TO 1075 00:40:04,320 --> 00:40:06,880 SWIPE THE RED, BLUE AND PURPLE 1076 00:40:06,880 --> 00:40:09,400 COLORED CIRCLES AND ALSO YES AND 1077 00:40:09,400 --> 00:40:11,240 WE FOUND THAT 91% OF THE TRIALS 1078 00:40:11,240 --> 00:40:13,680 THAT THE CHILDREN APPEARED TO BE 1079 00:40:13,680 --> 00:40:17,280 ENGAGED, AND TRYING TO SWIPE 1080 00:40:17,280 --> 00:40:17,640 THOSE TARGETS. 1081 00:40:17,640 --> 00:40:20,680 SO THE BOTTOM LINE HERE IS IS 1082 00:40:20,680 --> 00:40:23,520 THIS SHOWS PRELIMINARY 1083 00:40:23,520 --> 00:40:27,440 FEASIBILITY OF THIS TASK AND 1084 00:40:27,440 --> 00:40:29,760 QUESTION TOO AND WAS PERFORMANCE 1085 00:40:29,760 --> 00:40:32,480 ON THE TASK RELATE TODAY'S THIS 1086 00:40:32,480 --> 00:40:35,440 STANDARDIZED TASK PERFORMANCE. 1087 00:40:35,440 --> 00:40:38,840 SO AS YOU RECALL WE HAVE THESE 1088 00:40:38,840 --> 00:40:40,480 ESTABLISHED TASK THAT'S WE KNOW 1089 00:40:40,480 --> 00:40:43,320 MEASURE INHIBITORY CONTROL AND 1090 00:40:43,320 --> 00:40:46,680 IN A SUBSET OF 91 YOUTH OF THE 1091 00:40:46,680 --> 00:40:48,880 148 WHO COMPLETED THE APP, WE 1092 00:40:48,880 --> 00:40:51,040 HAD THEIR PERFORMANCE ON SOME OF 1093 00:40:51,040 --> 00:40:56,320 THESE STANDARDIZED TASKS AND I'M 1094 00:40:56,320 --> 00:40:59,400 NOT REQUESTINNOT GOING TO GET INTO ALL THE 1095 00:40:59,400 --> 00:41:01,040 DETAILS BUT THE BOTTOM LINE IS 1096 00:41:01,040 --> 00:41:03,880 WE CAN EXTRACT A LATE ANT 1097 00:41:03,880 --> 00:41:05,280 VARIABLE BUT EACH CHILD'S 1098 00:41:05,280 --> 00:41:07,880 PERFORMANCE ON THE STANDARDIZED 1099 00:41:07,880 --> 00:41:10,640 TASKS AND THIS BLATANT VARIABLE 1100 00:41:10,640 --> 00:41:12,280 REPRESENTS THAT THE SHARED 1101 00:41:12,280 --> 00:41:14,560 VARIANCE ASSOCIATED WITH THE 1102 00:41:14,560 --> 00:41:17,280 UNDERSTAND LYING CONSTRUCT AND 1103 00:41:17,280 --> 00:41:19,200 INHIBITORY CONTROL ACROSS THESE 1104 00:41:19,200 --> 00:41:20,720 STANDARDIZED TASKS. 1105 00:41:20,720 --> 00:41:22,280 AND THEN WHAT WE DID IS WE 1106 00:41:22,280 --> 00:41:24,160 LOOKED AT THE RELATIONSHIP 1107 00:41:24,160 --> 00:41:26,280 BETWEEN THE PERFORMANCE ON THIS 1108 00:41:26,280 --> 00:41:29,280 APP AND THE PERFORMANCE ON THIS 1109 00:41:29,280 --> 00:41:33,080 INHIBITORY CONTROL LATE ANT 1110 00:41:33,080 --> 00:41:44,920 FACTOR. 1111 00:41:44,920 --> 00:41:46,440 WHAT WILL WE SEE IS A 1112 00:41:46,440 --> 00:41:48,680 SIGNIFICANT POSITIVE 1113 00:41:48,680 --> 00:41:51,440 ASSOCIATION. 1114 00:41:51,440 --> 00:41:54,080 THAT IS YOUTH DEPRIME 1115 00:41:54,080 --> 00:41:55,840 PERFORMANCE ON THE APP WAS 1116 00:41:55,840 --> 00:42:00,880 POSITIVELY CORRELATED WITHEL 1117 00:42:00,880 --> 00:42:04,440 OVER ALL INHIBITORY CONTROL LATE 1118 00:42:04,440 --> 00:42:07,120 ANT FACTOR AND THIS DEMONSTRATES 1119 00:42:07,120 --> 00:42:13,720 PRELIMINARY VALIDITY OF COMET CALM-IT 1120 00:42:13,720 --> 00:42:14,400 PERFORMANCE. 1121 00:42:14,400 --> 00:42:15,920 NEXT, WE WANTED TO KNOW IF 1122 00:42:15,920 --> 00:42:16,800 CHILDREN PLAYED THE GAME 1123 00:42:16,800 --> 00:42:20,240 MULTIPLE TIMES, WAS THEIR 1124 00:42:20,240 --> 00:42:21,440 PERFORMANCE STABLE OVER TIME? 1125 00:42:21,440 --> 00:42:26,480 WHAT WE DID HERE, WAS WE 1126 00:42:26,480 --> 00:42:29,280 ADMINISTERED THE TASK TO A 1127 00:42:29,280 --> 00:42:31,280 SUBSET OF YOUTH NINE DAYS APART. 1128 00:42:31,280 --> 00:42:38,880 WE CALCULATED RELIABILITY, TWO 1129 00:42:38,880 --> 00:42:39,480 WAYS. 1130 00:42:39,480 --> 00:42:43,320 AND IN DEED, WHAT WE SEE HERE IS 1131 00:42:43,320 --> 00:42:45,200 THAT YOUTH'S CALM-IT IT 1132 00:42:45,200 --> 00:42:49,280 PERFORMANCE WAS RELIABLE OVER 1133 00:42:49,280 --> 00:42:50,880 TIME. 1134 00:42:50,880 --> 00:42:52,200 FINALLY AND WHAT IS MOST 1135 00:42:52,200 --> 00:42:53,760 INTERESTING TO ME IS WE WANTED 1136 00:42:53,760 --> 00:42:56,240 TO SEE IF THIS TASK PERFORMANCE 1137 00:42:56,240 --> 00:42:59,160 WAS CLINICALLY RELEVANT. 1138 00:42:59,160 --> 00:43:03,160 THAT IS IS THE COMET DEEP PRIME 1139 00:43:03,160 --> 00:43:05,360 ASSOCIATED WITH SIM? 1140 00:43:05,360 --> 00:43:08,600 AS YOU RECALL, WE EXPECT THE 1141 00:43:08,600 --> 00:43:09,680 PERFORMANCE TO BE SPECIFICALLY 1142 00:43:09,680 --> 00:43:13,200 ASSOCIATED WITH SYMPTOMS OF 1143 00:43:13,200 --> 00:43:15,200 IRRITABILITY AND ADHD. 1144 00:43:15,200 --> 00:43:18,120 SO WHAT WE SEE HERE ON THESE TWO 1145 00:43:18,120 --> 00:43:20,600 GRAPHS, THESE ARE RATINGS ARE 1146 00:43:20,600 --> 00:43:23,480 IRRITABILITY AND ON THE X AXIS, 1147 00:43:23,480 --> 00:43:28,400 WE HAVE THAT CALM-IT IT DEPRIME 1148 00:43:28,400 --> 00:43:33,960 PERFORMANCE IN THE Y AXIS WE SEE 1149 00:43:33,960 --> 00:43:36,880 PAIR RATED IRRITABILITY ON THE 1150 00:43:36,880 --> 00:43:38,960 BOTTOM WE SEE CHILD RATED 1151 00:43:38,960 --> 00:43:40,080 IRRITABILITY AND WHAT WE SEE 1152 00:43:40,080 --> 00:43:43,000 HERE IS THAT HIGHER DEPRIME 1153 00:43:43,000 --> 00:43:44,520 PERFORMANCE, OR BETTER 1154 00:43:44,520 --> 00:43:49,640 PERFORMANCE ON INHIBITORY 1155 00:43:49,640 --> 00:43:50,800 CONTROL, WAS ASSOCIATED WITH 1156 00:43:50,800 --> 00:43:54,680 LOWER LEVELS OF PARENT AND CHILD 1157 00:43:54,680 --> 00:43:56,000 REPORTED IRRITABILITY. 1158 00:43:56,000 --> 00:43:58,080 HIGHER LEVELS OF IRRITABILITY AS 1159 00:43:58,080 --> 00:43:59,680 RATED BY THE PARENT AND THE 1160 00:43:59,680 --> 00:44:03,440 CHILD, WERE RELATED TO FOUR 1161 00:44:03,440 --> 00:44:04,480 INHIBITORY CONTROL PERFORMANCE 1162 00:44:04,480 --> 00:44:07,680 ON THIS MOBILE APP. 1163 00:44:07,680 --> 00:44:09,880 WE FOUND THIS SIMILAR PATTERN AS 1164 00:44:09,880 --> 00:44:14,080 WE LOOKED AT THE ASSOCIATION 1165 00:44:14,080 --> 00:44:14,920 BETWEEN COMET DEPRIME 1166 00:44:14,920 --> 00:44:16,840 PERFORMANCE AND SYMPTOMS OF 1167 00:44:16,840 --> 00:44:18,800 ADHD. 1168 00:44:18,800 --> 00:44:21,800 AGAIN, LOWER PERFORMANCE ON THE 1169 00:44:21,800 --> 00:44:24,120 INHIBITORY CONTROL METRICS WAS 1170 00:44:24,120 --> 00:44:27,080 ASSOCIATED WITH HIGHER SYMPTOMS 1171 00:44:27,080 --> 00:44:27,880 OF ADHD. 1172 00:44:27,880 --> 00:44:29,840 SO WHAT WE'RE SEEING HERE IS 1173 00:44:29,840 --> 00:44:32,400 SOME SPECIFIC ASSOCIATION ON THE 1174 00:44:32,400 --> 00:44:34,360 DEEP PRIME INHIBITORY CONTROL 1175 00:44:34,360 --> 00:44:36,280 PERFORMANCE ON THE MOBILE APP 1176 00:44:36,280 --> 00:44:41,360 INEL YOUTH WITH IRRITABILITY AND 1177 00:44:41,360 --> 00:44:43,560 ADHD. 1178 00:44:43,560 --> 00:44:45,280 WE'RE SEEING NO ASSOCIATIONS OF 1179 00:44:45,280 --> 00:44:47,200 DEEP PRIME INHIBITORY CONTROL 1180 00:44:47,200 --> 00:44:55,480 PERFORMANCE WITH ANXIETY AND 1181 00:44:55,480 --> 00:44:56,240 DEPRESSION. 1182 00:44:56,240 --> 00:44:57,760 WE FOUND FEE ABILITY IN YOUTH 1183 00:44:57,760 --> 00:45:01,480 ENGAGE AND COMPLETED THE TASK 1184 00:45:01,480 --> 00:45:03,120 AND WE FOUND SOME EARLY 1185 00:45:03,120 --> 00:45:05,320 INDICATIONS OF VALIDITY AND THAT 1186 00:45:05,320 --> 00:45:07,400 THIS ACT PERFORMANCE WAS RELATED 1187 00:45:07,400 --> 00:45:11,440 TO A LATE APARTMENT FACTOR OF 1188 00:45:11,440 --> 00:45:12,880 INHIBITORY CONTROL AND WE FOUND 1189 00:45:12,880 --> 00:45:15,120 SOME SUPPORT OF RELIABILITY IN 1190 00:45:15,120 --> 00:45:17,480 THAT THE APP PERFORMANCE WAS 1191 00:45:17,480 --> 00:45:18,640 STABLE OVER TIME. 1192 00:45:18,640 --> 00:45:20,560 AND WE FOUND SOME SUPPORT FOR 1193 00:45:20,560 --> 00:45:24,840 CLINICAL RELEVANCE, AND THAT THE 1194 00:45:24,840 --> 00:45:26,000 INHIBITORY CONTROL PERFORMANCE 1195 00:45:26,000 --> 00:45:27,960 AS MEASURED BY THE MOBILE APP 1196 00:45:27,960 --> 00:45:31,040 WAS ASSOCIATED WITH SPECIFIC 1197 00:45:31,040 --> 00:45:33,360 CLINICAL PHENOTYPES OF 1198 00:45:33,360 --> 00:45:35,440 IRRITABILITY AND ADHD. 1199 00:45:35,440 --> 00:45:38,280 SO, WHAT ARE OUR NEXT STEPS? 1200 00:45:38,280 --> 00:45:41,240 WELL, WE'RE STARTING TO REPEAT 1201 00:45:41,240 --> 00:45:43,320 THESE CALM-IT IT GAMES MULTIPLE 1202 00:45:43,320 --> 00:45:46,160 TIMES OVER THE DAY AND PAIR IT 1203 00:45:46,160 --> 00:45:49,080 IT WITH IN VIVO CLINICAL 1204 00:45:49,080 --> 00:45:49,680 PHENOTYPING, AGAIN, MULTIPLE 1205 00:45:49,680 --> 00:45:54,320 TIMES OVER THE DAY. 1206 00:45:54,320 --> 00:45:55,040 OVER SEVERAL DAYS. 1207 00:45:55,040 --> 00:45:57,920 THE VIDEO ON THE LEFT IS RATE-IT 1208 00:45:57,920 --> 00:45:59,080 WHICH IS ANOTHER APP WE 1209 00:45:59,080 --> 00:46:02,200 DEVELOPED WHICH IS AN ECOLOGICAL 1210 00:46:02,200 --> 00:46:05,160 MOMENTARY ASSESSMENT APP WHICH 1211 00:46:05,160 --> 00:46:07,160 ESSENTIALLY ASKS QUESTIONS AS TO 1212 00:46:07,160 --> 00:46:09,280 HOW WORRIED THE CHILD IS FEELING 1213 00:46:09,280 --> 00:46:10,920 IN THE MOMENT. 1214 00:46:10,920 --> 00:46:13,160 WHAT LEVELS OF ANGER, 1215 00:46:13,160 --> 00:46:14,120 FRUSTRATION, AND IRRITABILITY 1216 00:46:14,120 --> 00:46:18,360 ARE THEY EXPERIENCING? 1217 00:46:18,360 --> 00:46:19,160 AND WE'RE HAVING CHILD 1218 00:46:19,160 --> 00:46:19,760 PORNOGRAPHY AND THEIR PARENTS 1219 00:46:19,760 --> 00:46:22,200 RATE THE SYSTEMS MANY TIMES OVER 1220 00:46:22,200 --> 00:46:24,200 THE COURSE OF COGNITIVE 1221 00:46:24,200 --> 00:46:26,080 BEHAVIORAL THERAPY TO GET A 1222 00:46:26,080 --> 00:46:29,400 DEVELOPS GRANULAR ASSESSMENT OF 1223 00:46:29,400 --> 00:46:30,880 THE TEMPORAL DYNAMICS OF THESE 1224 00:46:30,880 --> 00:46:33,800 SYSTEMS OVER THE COURSE OF 1225 00:46:33,800 --> 00:46:34,080 TREATMENT. 1226 00:46:34,080 --> 00:46:36,480 WE CAN THEN SEE IF THESE 1227 00:46:36,480 --> 00:46:38,880 INHIBITORY CONTROLS DEFICITS 1228 00:46:38,880 --> 00:46:41,920 INCREASE SAY PRIOR TO A TEMPER 1229 00:46:41,920 --> 00:46:43,800 OUTBURST OR IF THERE'S CERTAIN 1230 00:46:43,800 --> 00:46:47,400 PATTERNS OVER THE COURSE OF DIE DAY OR 1231 00:46:47,400 --> 00:46:50,000 THE COURSE OF WEEK AND SEE IF 1232 00:46:50,000 --> 00:46:53,240 TEMPER OUTBURST, SAY PROCEED 1233 00:46:53,240 --> 00:46:54,440 POOR INHIBITORY CONTROL AND WE 1234 00:46:54,440 --> 00:46:57,600 CAN ALSO SEE HOW THE SYMPTOMS 1235 00:46:57,600 --> 00:47:00,040 AND CALM-IT IT DEPRIME 1236 00:47:00,040 --> 00:47:01,000 PERFORMANCE CHANGE OVER THE 1237 00:47:01,000 --> 00:47:05,880 COURSE OF PSYCHOTHERAPY. 1238 00:47:05,880 --> 00:47:07,840 SO OUR LONG-TERM GOAL IS TO 1239 00:47:07,840 --> 00:47:11,480 BUILD A MOBILE PLATFORM TO 1240 00:47:11,480 --> 00:47:13,720 REALLY DEVELOP THERAPEUTICS, 1241 00:47:13,720 --> 00:47:15,160 THAT IS, WE WANT TO INTEGRATE 1242 00:47:15,160 --> 00:47:18,080 DIGITAL CLINICAL PHENOTYPING 1243 00:47:18,080 --> 00:47:19,080 WITH TREATMENT. 1244 00:47:19,080 --> 00:47:23,040 SO, WHAT WE WANT TO DO HERE IS 1245 00:47:23,040 --> 00:47:25,000 REAL IS REALLY GATHER THESE 1246 00:47:25,000 --> 00:47:27,720 GRANULAR, CLINICAL SYMPTOMS, 1247 00:47:27,720 --> 00:47:30,520 NATURALISTICALLY IN VIVO AND 1248 00:47:30,520 --> 00:47:32,880 ALONG WITH THIS DEEP BEHAVIORAL 1249 00:47:32,880 --> 00:47:35,080 PHENOTYPING, SUCH AS IDENTIFYING 1250 00:47:35,080 --> 00:47:38,680 DEFICITS AND INHIBITORY CONTROL 1251 00:47:38,680 --> 00:47:41,120 AND THE CLIP CAL AND BEHAVIORAL 1252 00:47:41,120 --> 00:47:42,800 DEFICITS TO TARGET THESE 1253 00:47:42,800 --> 00:47:45,600 POTENTIAL DEFICITS TOGETHER AND 1254 00:47:45,600 --> 00:47:48,160 ULTIMATELY WITH THE GOAL OF 1255 00:47:48,160 --> 00:47:52,680 INTERVENING AND PREDICTING 1256 00:47:52,680 --> 00:47:54,480 BEFORE AN OUTBURST MAY OCCUR. 1257 00:47:54,480 --> 00:47:55,800 HOWEVER, I WANT TO KNOWS THAT 1258 00:47:55,800 --> 00:47:59,440 WE'RE IN THE VERY EARLY DAYS OF 1259 00:47:59,440 --> 00:48:01,720 THIS WORK AND THE SPECIFIC 1260 00:48:01,720 --> 00:48:04,880 CONCRETE CLINICAL BENEFITS ARE 1261 00:48:04,880 --> 00:48:07,520 LIKELY MANY YEARS AWAY. 1262 00:48:07,520 --> 00:48:10,160 SO, IN SUMMARY, I DEFINED 1263 00:48:10,160 --> 00:48:11,680 IRRITABILITY, WE TALKED ABOUT 1264 00:48:11,680 --> 00:48:13,920 ADHD AND INHIBITORY CONTROL. 1265 00:48:13,920 --> 00:48:16,040 WE TALKED ABOUT SOME OF THE 1266 00:48:16,040 --> 00:48:18,040 ADVANTAGES OF DEVELOPING MOBILE 1267 00:48:18,040 --> 00:48:19,560 APPS. 1268 00:48:19,560 --> 00:48:22,680 AND I INTRODUCED CALM-IT IT AND 1269 00:48:22,680 --> 00:48:23,800 DEMONSTRATED EARLY FEASIBILITY, 1270 00:48:23,800 --> 00:48:25,320 VALIDITY, RELIABILITY AND 1271 00:48:25,320 --> 00:48:28,280 CLINICAL ASSOCIATIONS WITH 1272 00:48:28,280 --> 00:48:29,000 IRRITABILITY AND ADHD. 1273 00:48:29,000 --> 00:48:31,000 AND I TALKED ABOUT SOME FUTURE 1274 00:48:31,000 --> 00:48:33,200 DIRECTIONS OF OUR WORK. 1275 00:48:33,200 --> 00:48:35,320 AND WITH THAT, I WANT TO THANK 1276 00:48:35,320 --> 00:48:37,480 THE AUDIENCE FOR THEIR TIME AND 1277 00:48:37,480 --> 00:48:38,480 ATTENTION. 1278 00:48:38,480 --> 00:48:41,120 I SPECIFICALLY WANT TO THANK THE 1279 00:48:41,120 --> 00:48:43,480 PATIENCE AND THEIR FAMILIES FOR 1280 00:48:43,480 --> 00:48:46,480 THEIR DEDICATION TO RESEARCH. 1281 00:48:46,480 --> 00:48:50,000 THE NIMH-IRP, DR. SEUSS ANNA 1282 00:48:50,000 --> 00:48:59,280 MORE A AND -- COLLABORATORS, AND 1283 00:48:59,280 --> 00:49:00,240 POSTDOCS IN THE LAB. 1284 00:49:00,240 --> 00:49:04,440 AND FOR THAT, I WANT TO END BY 1285 00:49:04,440 --> 00:49:05,400 SEEING IF WE HAVE TIME FOR 1286 00:49:05,400 --> 00:49:09,480 QUESTIONS TO OPEN UP TO THE 1287 00:49:09,480 --> 00:49:14,520 GROUP. 1288 00:49:14,520 --> 00:49:15,240 >> Tom Burklow: THANK YOU AND WE 1289 00:49:15,240 --> 00:49:16,040 HAVE A LOT OF INTERESTING 1290 00:49:16,040 --> 00:49:17,680 QUESTIONS AND WE HAVE SOME TIME 1291 00:49:17,680 --> 00:49:19,040 TO ANSWER THAT. 1292 00:49:19,040 --> 00:49:21,600 SO, FIRST I WANT TO THANK YOU 1293 00:49:21,600 --> 00:49:25,560 FOR SHARING YOUR REALLY 1294 00:49:25,560 --> 00:49:28,080 IMPORTANT AND WORK WHICH IS 1295 00:49:28,080 --> 00:49:31,080 OFFERING SOME REALLY UNIQUE AND 1296 00:49:31,080 --> 00:49:32,280 CRITICAL INSIGHTS INTO COMMON 1297 00:49:32,280 --> 00:49:34,120 DISEASE IN CHILDHOOD, WHICH HAS 1298 00:49:34,120 --> 00:49:35,960 OBVIOUSLY A VERY SIGNIFICANT 1299 00:49:35,960 --> 00:49:38,200 PSYCHOSOCIAL AND EDUCATIONAL 1300 00:49:38,200 --> 00:49:39,080 MORBIDITY. 1301 00:49:39,080 --> 00:49:41,080 SO, LET ME JUST SEE WHAT WE 1302 00:49:41,080 --> 00:49:41,280 HAVE. 1303 00:49:41,280 --> 00:49:43,040 SO, THE FIRST QUESTION IS FOR 1304 00:49:43,040 --> 00:49:46,040 Dr. BROTMAN. 1305 00:49:46,040 --> 00:49:50,560 WAS THE CALM-IT IT APP MODELED 1306 00:49:50,560 --> 00:49:54,280 AFTER THE FRUIT AND NINJA GAME? 1307 00:49:54,280 --> 00:49:56,600 DID THEY PLAY THE GAME BEFORE? 1308 00:49:56,600 --> 00:49:57,280 THEORETICALLY THE CHILDREN MIGHT 1309 00:49:57,280 --> 00:50:01,400 BE BETTER AT THE GAME IF THEY 1310 00:50:01,400 --> 00:50:05,080 PRACTICED THE GAME BEFORE. 1311 00:50:05,080 --> 00:50:05,680 >> Melissa Brotman: YES, IT 1312 00:50:05,680 --> 00:50:07,760 ACTUALLY WAS, IT'S SIMILAR TO 1313 00:50:07,760 --> 00:50:11,080 THE FRUIT NINJA GAME AND WE 1314 00:50:11,080 --> 00:50:13,480 INTEGRATED ASPECTS OF THE FRUIT 1315 00:50:13,480 --> 00:50:15,600 AND NINJA GAME ALONG WITH THE 1316 00:50:15,600 --> 00:50:17,960 STANDARDIZED INHIBITORY CONTROL 1317 00:50:17,960 --> 00:50:20,000 TASKS OF THE STOP SIGNAL. 1318 00:50:20,000 --> 00:50:21,960 WE DID ASK INDIVIDUALS HOW MUCH 1319 00:50:21,960 --> 00:50:23,640 THEY HAD PLAYED AND IT DOES NOT 1320 00:50:23,640 --> 00:50:28,720 SEEM TO BE RELATED. 1321 00:50:28,720 --> 00:50:30,680 HOWEVER IT WAS A BASELINE AND 1322 00:50:30,680 --> 00:50:34,400 APARTMENT TO BUILD FROM. 1323 00:50:34,400 --> 00:50:35,640 >> GREAT, THANK YOU. 1324 00:50:35,640 --> 00:50:37,400 AND BEING THE EMPTY NESTER, I 1325 00:50:37,400 --> 00:50:39,440 DON'T KNOW WHAT THE FRUIT NINJA 1326 00:50:39,440 --> 00:50:40,280 GAME IS. 1327 00:50:40,280 --> 00:50:45,240 IT WAS NEW TO ME. 1328 00:50:45,240 --> 00:50:47,320 SECOND QUESTION, WAS IT CALM-IT 1329 00:50:47,320 --> 00:50:49,000 IT ADMINISTERED IN A LAB OR HOME 1330 00:50:49,000 --> 00:50:49,240 SETTING. 1331 00:50:49,240 --> 00:50:51,120 IF THE HOME, WAS THE SETTING WAS 1332 00:50:51,120 --> 00:50:52,560 THE APP RECORDED, FOR EXAMPLE, 1333 00:50:52,560 --> 00:50:55,520 TIME OF DAY AND DURING OR AFTER 1334 00:50:55,520 --> 00:50:56,920 SCHOOL, WAS THEIR MOOD EFFECTING 1335 00:50:56,920 --> 00:50:58,480 THEIR PERFORMANCE AND YOU 1336 00:50:58,480 --> 00:50:59,680 TOUCHED ON IT A LITTLE BIT BUT 1337 00:50:59,680 --> 00:51:00,680 CAN YOU ELABORATE? 1338 00:51:00,680 --> 00:51:02,800 >> YES, THAT'S AN EXCELLENT 1339 00:51:02,800 --> 00:51:03,080 QUESTION. 1340 00:51:03,080 --> 00:51:06,160 SO, YES, IN DEED, WE DID GET 1341 00:51:06,160 --> 00:51:09,280 VERY SPECIFIC DATA AS TO WHEN 1342 00:51:09,280 --> 00:51:11,240 THE CHILD WAS PLAYING THE GAME 1343 00:51:11,240 --> 00:51:15,960 AND WHAT TIME OF DAY AND WE DID 1344 00:51:15,960 --> 00:51:21,280 GET THOSE PARENT EX CHIL AND METRICS OF 1345 00:51:21,280 --> 00:51:23,680 IRRITABILITY AND ADHD AND SANITY 1346 00:51:23,680 --> 00:51:25,680 AND WHAT OUR NEXT STEP IS TO DO 1347 00:51:25,680 --> 00:51:29,680 IS TO REALLY PAIR IT WITH THAT 1348 00:51:29,680 --> 00:51:31,280 RATE-IT MAP WHERE WE GET A 1349 00:51:31,280 --> 00:51:32,800 SPECIFIC ASSESSMENT OF CLINICAL 1350 00:51:32,800 --> 00:51:35,640 SYMPTOMS AT THE TIME OF THE GAME 1351 00:51:35,640 --> 00:51:35,960 PERFORMANCE. 1352 00:51:35,960 --> 00:51:39,160 SO WE CAN SEE REALLY 1353 00:51:39,160 --> 00:51:41,280 SPECIFICALLY IF IRRITABILITY SAY 1354 00:51:41,280 --> 00:51:43,440 WITHIN THE PAST HOUR PRIOR TO 1355 00:51:43,440 --> 00:51:45,800 THE GAME PERFORMANCE INFLUENCED 1356 00:51:45,800 --> 00:51:48,280 IT AND THE METRICS WE GOT NOW 1357 00:51:48,280 --> 00:51:50,440 THAT WERE THE PARENT AND CHILD 1358 00:51:50,440 --> 00:51:52,560 REPORT, WERE OVER THE COURSE OF 1359 00:51:52,560 --> 00:51:55,520 THE WEEK SO IT IT WAS LESS TIED 1360 00:51:55,520 --> 00:51:58,240 TO THE SPECIFIC TIME IN WHICH 1361 00:51:58,240 --> 00:51:59,680 THE CHILD PLAYED THE GAME. 1362 00:51:59,680 --> 00:52:03,320 BUT IN OUR NEXT ROUND OF 1363 00:52:03,320 --> 00:52:04,160 RESEARCH, THAT'S ACTUALLY 1364 00:52:04,160 --> 00:52:07,760 SPECIFICALLY WHAT WE DO WANT TO 1365 00:52:07,760 --> 00:52:08,160 DO. 1366 00:52:08,160 --> 00:52:08,840 >> Tom Burklow: THANK YOU, VERY 1367 00:52:08,840 --> 00:52:09,200 MUCH. 1368 00:52:09,200 --> 00:52:12,320 THIS QUESTION IS FOR Dr. SHAW. 1369 00:52:12,320 --> 00:52:13,280 IT WAS MENTIONED IN THE 1370 00:52:13,280 --> 00:52:15,200 INTRODUCTION THAT THE GENETIC 1371 00:52:15,200 --> 00:52:16,480 FACTORS ACCOUNT FOR A LARGE 1372 00:52:16,480 --> 00:52:18,600 PREPORTION OF THE PHENOTYPE IN 1373 00:52:18,600 --> 00:52:19,800 CHILDHOOD CASES OF ADHD. 1374 00:52:19,800 --> 00:52:23,200 QUESTION IS, ARE SIMILAR 1375 00:52:23,200 --> 00:52:24,400 PATTERNS OF DIFFERENCES IN 1376 00:52:24,400 --> 00:52:26,480 FINANCINGAL AND STRUCTURAL 1377 00:52:26,480 --> 00:52:30,080 CONNECTIVITY BETWEEN PARENT AND 1378 00:52:30,080 --> 00:52:30,880 CHILD? 1379 00:52:30,880 --> 00:52:31,480 >> Melissa Brotman: THAT'S A 1380 00:52:31,480 --> 00:52:31,800 GREAT POINT. 1381 00:52:31,800 --> 00:52:33,680 AS YOU MENTIONED, ADHD IS ONE OF 1382 00:52:33,680 --> 00:52:36,200 THE MOST INHERITABLE OF ALL THE 1383 00:52:36,200 --> 00:52:37,360 NEURO DEVELOPMENT CHALLENGES AND 1384 00:52:37,360 --> 00:52:39,000 IT'S UP THERE WITH AUTISTIC 1385 00:52:39,000 --> 00:52:40,440 SPECTRUM DISORDER AND 1386 00:52:40,440 --> 00:52:42,880 SCHIZOPHRENIA AND BY POLAR AND 1387 00:52:42,880 --> 00:52:45,600 80% OF THE PHENOTYPES ARE 1388 00:52:45,600 --> 00:52:47,920 ATTRIBUTABLE TO INHERITABLE 1389 00:52:47,920 --> 00:52:48,160 FACTORS. 1390 00:52:48,160 --> 00:52:50,080 SO THAT'S MUCH HIGHER THAN MOOD 1391 00:52:50,080 --> 00:52:52,360 AND ANXIETY WHICH IS 20% OR 30P. 1392 00:52:52,360 --> 00:52:54,840 IT'S VERY, VERY HERITABLE AND 1393 00:52:54,840 --> 00:52:57,760 IT'S A BEHAVIOR ABLE TRAIT WITH 1394 00:52:57,760 --> 00:52:58,880 ADHD AT THE EXTREME END. 1395 00:52:58,880 --> 00:53:01,280 YOU ARE ASKING ABOUT THE 1396 00:53:01,280 --> 00:53:03,000 HERITABILITY OF STRUCTURAL AND 1397 00:53:03,000 --> 00:53:05,200 FUNCTIONAL CONNECTIONS BUT IN 1398 00:53:05,200 --> 00:53:05,600 THE BRAIN. 1399 00:53:05,600 --> 00:53:06,720 WE STUDIED THAT. 1400 00:53:06,720 --> 00:53:08,680 WE BROUGHT IN A STUDIES A WHILE 1401 00:53:08,680 --> 00:53:09,480 BACK, ONE OF THE NICE THINGS 1402 00:53:09,480 --> 00:53:11,040 ABOUT BEING HERE IS YOU CAN DO 1403 00:53:11,040 --> 00:53:11,880 STUDIES LIKE THIS. 1404 00:53:11,880 --> 00:53:14,880 WE GOT AN EX TENDED 1405 00:53:14,880 --> 00:53:15,520 MULTI-GENERATIONAL FAMILIES AND 1406 00:53:15,520 --> 00:53:17,000 WHICH MANY, MANY INDIVIDUALS 1407 00:53:17,000 --> 00:53:19,440 WERE AFFECTED BY ADHD AND ON 1408 00:53:19,440 --> 00:53:20,680 AVERAGE THERE WAS AT LEAST A 1409 00:53:20,680 --> 00:53:22,880 THIRD OF THE INDIVIDUALS ACROSS 1410 00:53:22,880 --> 00:53:24,760 GENERATIONS, HAD A DIAGNOSIS OF 1411 00:53:24,760 --> 00:53:25,280 ADHD. 1412 00:53:25,280 --> 00:53:27,440 IN ADULTS IT WAS ABOUT A 10% 1413 00:53:27,440 --> 00:53:29,120 INCREASE AND THE POPULATIONEL 1414 00:53:29,120 --> 00:53:32,800 PREVALENCE SO IT'S A VERY, VERY 1415 00:53:32,800 --> 00:53:33,880 ENRICHED ADHD FAMILY. 1416 00:53:33,880 --> 00:53:35,840 SO WE BROUGHT THE FAMILIES IN 1417 00:53:35,840 --> 00:53:37,480 AND ALL OF THE FAMILIES, ALL THE 1418 00:53:37,480 --> 00:53:39,920 DIFFERENT GENERATIONS HAD 1419 00:53:39,920 --> 00:53:41,000 NEUROIMAGING, MAPPING THE 1420 00:53:41,000 --> 00:53:42,520 STRUCTURAL AND FUNCTIONAL 1421 00:53:42,520 --> 00:53:44,040 CONNECTIVITY AND WE DID EX LEASE 1422 00:53:44,040 --> 00:53:45,000 MANY, WHAT YOU SUGGESTED, WE 1423 00:53:45,000 --> 00:53:46,440 LOOKED AT THE INHER ABILITY OF 1424 00:53:46,440 --> 00:53:48,320 THE STRUCTURAL AND FUNCTIONAL 1425 00:53:48,320 --> 00:53:49,280 CONNECTIONS ACROSS THE BRAIN AND 1426 00:53:49,280 --> 00:53:52,400 WE FOUND THAT SOME OF THEM ARE 1427 00:53:52,400 --> 00:53:54,440 EXTREMELY HERITABLE AND VERY 1428 00:53:54,440 --> 00:53:56,160 STRONGLY TIED TO ADHD. 1429 00:53:56,160 --> 00:54:00,120 FOR EXAMPLE, PARTS OF THE CORPIS 1430 00:54:00,120 --> 00:54:02,080 COLOSAL IS VERY HERITABILITY AND 1431 00:54:02,080 --> 00:54:04,600 ASSOCIATED WITH SYSTEMS OF ADHD. 1432 00:54:04,600 --> 00:54:05,240 THE NEAT THING ABOUT THIS SORT 1433 00:54:05,240 --> 00:54:07,840 OF WORK, IS YOU CAN IMAGINE 1434 00:54:07,840 --> 00:54:09,000 THERE'S STACKS OF POTENTIAL 1435 00:54:09,000 --> 00:54:10,560 THINGS WE CAN LOOK AT IN THE 1436 00:54:10,560 --> 00:54:12,840 BRAIN AND AMONG STRUCTURAL AND 1437 00:54:12,840 --> 00:54:13,760 FUNCTIONAL CONNECTIONS WHEN WE 1438 00:54:13,760 --> 00:54:14,720 GO GENE HUNTING. 1439 00:54:14,720 --> 00:54:18,320 WE CAN NARROW THAT SPACE DOWN BY 1440 00:54:18,320 --> 00:54:19,080 PRIORITIZING THE PROPERTIES IN 1441 00:54:19,080 --> 00:54:20,680 THE BRAIN THAT ARE BOTH 1442 00:54:20,680 --> 00:54:22,360 CHARITABLE, HIGHLY HERITABLE AND 1443 00:54:22,360 --> 00:54:25,480 STRONGLY ASSOCIATED WITH ADHD. 1444 00:54:25,480 --> 00:54:26,480 THAT NARROWS THE TARGETS DOWN 1445 00:54:26,480 --> 00:54:27,680 FOR GENETICS. 1446 00:54:27,680 --> 00:54:33,480 SO YES, THAT'S SOME WORK WE'VE 1447 00:54:33,480 --> 00:54:33,680 DONE. 1448 00:54:33,680 --> 00:54:35,600 >> Tom Burklow: THANK YOU. 1449 00:54:35,600 --> 00:54:37,320 QUESTION FOR Dr. BROTMAN, ARE 1450 00:54:37,320 --> 00:54:40,080 YOU LOOKING FOR ANY CLINICAL, 1451 00:54:40,080 --> 00:54:43,520 COMMUNITY SITES TO TEST A 1452 00:54:43,520 --> 00:54:44,480 CALM-APP? 1453 00:54:44,480 --> 00:54:45,280 >> Melissa Brotman: SO, THERE'S 1454 00:54:45,280 --> 00:54:49,800 ACTUALLY BEEN QUITE A LOT OF 1455 00:54:49,800 --> 00:54:50,080 INTEREST. 1456 00:54:50,080 --> 00:54:51,840 FIRST AMONG RESEARCHERS, 1457 00:54:51,840 --> 00:54:53,720 EXTRAMURAL RESEARCHERS WHO ARE 1458 00:54:53,720 --> 00:54:55,280 INTERESTED IN USING THIS ALONG 1459 00:54:55,280 --> 00:54:58,560 WITH SOME OF THEIR CURRENT 1460 00:54:58,560 --> 00:55:00,520 STUDIES WHEREBY THEY'RE 1461 00:55:00,520 --> 00:55:02,240 ASSESSING INHIBITORY CONTROL IN 1462 00:55:02,240 --> 00:55:04,880 THEIR PATIENT POPULATIONS. 1463 00:55:04,880 --> 00:55:08,800 AND SO THAT IS THE FIRST STEP IN 1464 00:55:08,800 --> 00:55:11,480 SEEING THAT OTHER EXTRAMURAL 1465 00:55:11,480 --> 00:55:13,680 RESEARCHERS WANT TO SEE IF THEIR 1466 00:55:13,680 --> 00:55:15,760 ASSOCIATIONS WITH OTHER CLINICAL 1467 00:55:15,760 --> 00:55:19,760 PHENOMENONS, WE ALSO HAVE BEEN 1468 00:55:19,760 --> 00:55:23,360 ASKED BY GENERAL INDIVIDUALS AND 1469 00:55:23,360 --> 00:55:23,920 CHILD PORNOGRAPHY WHO HAVE 1470 00:55:23,920 --> 00:55:25,040 PLAYED THE GAME AND ENROLLED IN 1471 00:55:25,040 --> 00:55:27,200 OUR STUDY WHO THEN WANT TO HAVE 1472 00:55:27,200 --> 00:55:29,320 THEIR FRIENDS PLAY. 1473 00:55:29,320 --> 00:55:31,200 AT THIS POINT IN TIME IT'S 1474 00:55:31,200 --> 00:55:32,480 ACTUALLY NOT ON THE APP STORE 1475 00:55:32,480 --> 00:55:34,360 AND WE'RE HOLDING BACK ON THAT 1476 00:55:34,360 --> 00:55:36,680 FOR NOW FOR IRB AND OTHER 1477 00:55:36,680 --> 00:55:37,280 REASONS. 1478 00:55:37,280 --> 00:55:39,880 BUT THAT IS KIND OF THE NEXT 1479 00:55:39,880 --> 00:55:43,160 GENERATION OF WHAT WE WANTED DO 1480 00:55:43,160 --> 00:55:45,480 WHEN WE HONE THE SPECIFIC TASK 1481 00:55:45,480 --> 00:55:48,040 MORE SPECIFICALLY AND REALLY 1482 00:55:48,040 --> 00:55:52,240 DRILL DOWN ON ITS VALIDITY OF 1483 00:55:52,240 --> 00:55:53,480 RELIABILITY AND WHAT WE'RE DOING 1484 00:55:53,480 --> 00:55:55,680 ALSO NOW IS SEEING IF THERE ARE 1485 00:55:55,680 --> 00:55:58,360 ALSO ASSOCIATIONS WITH ACTUAL 1486 00:55:58,360 --> 00:55:59,480 NEURO CORRELATES WHEN WE BRING 1487 00:55:59,480 --> 00:56:03,120 KIDS INTO THE CLINIC TO PLAY 1488 00:56:03,120 --> 00:56:07,440 RELATED I AM HI INHIBITORY CONTROL TASKS 1489 00:56:07,440 --> 00:56:10,760 IN FMRI. 1490 00:56:10,760 --> 00:56:12,640 >> Tom Burklow: THANK YOU. 1491 00:56:12,640 --> 00:56:14,160 ANOTHER QUESTION TO BE Dr. 1492 00:56:14,160 --> 00:56:14,760 SHAW. 1493 00:56:14,760 --> 00:56:17,440 WHETHER OR NOT THESE CHANGES 1494 00:56:17,440 --> 00:56:19,680 THAT ARE BEING NOTED EVOLVE WITH 1495 00:56:19,680 --> 00:56:21,480 AGE AND TREATMENT AND ARE THERE 1496 00:56:21,480 --> 00:56:22,680 MARKERS OR CHANGES THAT ARE 1497 00:56:22,680 --> 00:56:24,920 SPECIFICALLY ASSOCIATED WITH 1498 00:56:24,920 --> 00:56:27,880 RESPONSE AND MEDICATIONS? 1499 00:56:27,880 --> 00:56:30,360 >> 1500 00:56:30,360 --> 00:56:30,960 >> Philip Shaw: ABSOLUTELY. 1501 00:56:30,960 --> 00:56:32,240 THE INTERACTION, THE WAY THE 1502 00:56:32,240 --> 00:56:34,280 DIFFERENT NETWORKS OF THE BRAIN 1503 00:56:34,280 --> 00:56:35,360 TALK TO EACH O. DEFINITELY 1504 00:56:35,360 --> 00:56:37,600 EVOLVES WITH AGE AND GENERAL 1505 00:56:37,600 --> 00:56:40,320 NETWORKS GET MORE SEGREGATE AND 1506 00:56:40,320 --> 00:56:41,200 CLEVER AND THEY CROSS TALK 1507 00:56:41,200 --> 00:56:43,080 BETWEEN NETWORKS WITH AIMING 1508 00:56:43,080 --> 00:56:44,480 BECOMES MORE REFINED. 1509 00:56:44,480 --> 00:56:47,160 THERE'S AN ARGUMENT THAT KIDS 1510 00:56:47,160 --> 00:56:48,480 WITH ADHD WHAT IS HAPPENING IS 1511 00:56:48,480 --> 00:56:49,880 THEY'RE GOING TO GET THERE BUT 1512 00:56:49,880 --> 00:56:51,760 IT MIGHT TAKE A LITTLE BIT 1513 00:56:51,760 --> 00:56:52,960 LONGER DEVELOPMENTALLY FOR THEM 1514 00:56:52,960 --> 00:56:55,760 TO END UP AT THE SAME POINT. 1515 00:56:55,760 --> 00:56:57,160 AND THE OTHER EXCELLENT QUESTION 1516 00:56:57,160 --> 00:56:59,480 IS WHAT'S THE EFFECT OF 1517 00:56:59,480 --> 00:57:00,080 MEDICATIONS? 1518 00:57:00,080 --> 00:57:01,240 VERY INTERESTINGLY THE MOST 1519 00:57:01,240 --> 00:57:02,760 COMMON MEDICATION AND WIDELY 1520 00:57:02,760 --> 00:57:05,520 USED MEDICATIONS FOR ADHD ARE 1521 00:57:05,520 --> 00:57:07,040 PSYCHO STIMULANTS SUCH AS ADD 1522 00:57:07,040 --> 00:57:09,560 ORAL AND RIDDERRAL AND HIGHLY 1523 00:57:09,560 --> 00:57:10,200 EFFECTIVE TREATMENTS. 1524 00:57:10,200 --> 00:57:12,600 WHEN YOU LOOK AT THE SCANNER, 1525 00:57:12,600 --> 00:57:15,200 WHEN THE MEDICATIONS IS AT ITS 1526 00:57:15,200 --> 00:57:17,120 PEAK, THIS ACTUALLY CROSS TALK 1527 00:57:17,120 --> 00:57:20,000 BETWEEN THE NETWORKS IS SHIFTED 1528 00:57:20,000 --> 00:57:21,640 IN ADHD TOWARDS MORE TYPICAL 1529 00:57:21,640 --> 00:57:25,040 PATTERNS ACUTELY X WHE. 1530 00:57:25,040 --> 00:57:26,440 WHEN THE MEDICATION WASHES OUT 1531 00:57:26,440 --> 00:57:27,400 IT GOES BACK TO HOW IT WAS 1532 00:57:27,400 --> 00:57:29,880 BEFORE SO IT'S A VERY 1533 00:57:29,880 --> 00:57:31,160 FASCINATING FINDING THAT SICKO 1534 00:57:31,160 --> 00:57:31,800 SIM YOU PLANT MEDICATION ONLY 1535 00:57:31,800 --> 00:57:34,080 AND REAL OWE ONLY AT ITS PEAK IT 1536 00:57:34,080 --> 00:57:35,480 IT WASHES OUT QUICKLY ACTUALLY 1537 00:57:35,480 --> 00:57:37,320 AND IT WILL SHIFT THE WAY THAT 1538 00:57:37,320 --> 00:57:39,320 NETWORKS TALK TOO ONE ANOTHER IN 1539 00:57:39,320 --> 00:57:40,680 MORE TYPICAL PATTERN WHICH OF 1540 00:57:40,680 --> 00:57:42,680 COURSE MAKES PERFECT SENSE 1541 00:57:42,680 --> 00:57:44,320 BECAUSE YOU WATCH A CHILD WHO IS 1542 00:57:44,320 --> 00:57:49,040 ON A STIMULANT AN THEIR INTENTIONAL 1543 00:57:49,040 --> 00:57:50,600 INCREASE WHEN THEY TAKE THE 1544 00:57:50,600 --> 00:57:51,680 MEDICATIONS. 1545 00:57:51,680 --> 00:57:52,480 >> Tom Burklow: THANK YOU, Dr. 1546 00:57:52,480 --> 00:57:52,720 SHAW. 1547 00:57:52,720 --> 00:57:54,280 WE HAVE TIME FOR ONE MORE 1548 00:57:54,280 --> 00:57:54,880 QUESTION. 1549 00:57:54,880 --> 00:57:56,160 THIS IS ACTUALLY FOR Dr. 1550 00:57:56,160 --> 00:57:59,120 BROTMAN AND THAT IS, DO CLASSIC 1551 00:57:59,120 --> 00:58:00,480 MEDICATIONS FOR ADHD SUCH AS 1552 00:58:00,480 --> 00:58:02,680 STIMULANTS IMPROVE THE 1553 00:58:02,680 --> 00:58:04,760 INHIBITORY CONTROL? 1554 00:58:04,760 --> 00:58:05,280 >> Melissa Brotman: IT'S 1555 00:58:05,280 --> 00:58:08,480 ACTUALLY A REALLY INTERESTING 1556 00:58:08,480 --> 00:58:11,480 QUESTION. 1557 00:58:11,480 --> 00:58:16,000 IN DEED, YES, WHEN INDIVIDUALS 1558 00:58:16,000 --> 00:58:17,680 ARE PRESCRIBED STIMULANTS, 1559 00:58:17,680 --> 00:58:18,840 PARTICULARLY THOSE WITH ADHD AR 1560 00:58:18,840 --> 00:58:20,960 THOSE STRUGGLING WITH 1561 00:58:20,960 --> 00:58:22,360 IRRITABILITY, WE DO SEE 1562 00:58:22,360 --> 00:58:23,880 IMPROVEMENTS IN INHIBITORY 1563 00:58:23,880 --> 00:58:27,280 CONTROL ON THOSE STANDARDIZED 1564 00:58:27,280 --> 00:58:27,720 TASKS. 1565 00:58:27,720 --> 00:58:29,280 IT IT MAKES US GET TO 1566 00:58:29,280 --> 00:58:30,440 UNDERSTANDING SOME OF THE 1567 00:58:30,440 --> 00:58:32,040 MECHANISMS WHEREBY SOME OF THESE 1568 00:58:32,040 --> 00:58:33,840 TREATMENTS MAY ACTUALLY BE 1569 00:58:33,840 --> 00:58:34,440 WORKING. 1570 00:58:34,440 --> 00:58:36,880 SO IN DEED, WE DO SEE 1571 00:58:36,880 --> 00:58:38,200 IMPROVEMENT THIS IS INHIBITORY 1572 00:58:38,200 --> 00:58:42,520 CONTROL AS A FUNCTION OF 1573 00:58:42,520 --> 00:58:44,320 STIMULANT RESPONSE. 1574 00:58:44,320 --> 00:58:44,840 >> Tom Burklow: GOOD. 1575 00:58:44,840 --> 00:58:46,000 WELL, I THINK WITH THAT THAT 1576 00:58:46,000 --> 00:58:47,280 BRINGS US UP TO THE HOUR. 1577 00:58:47,280 --> 00:58:49,760 I WANT TO THANK BOTH OF YOU FOR 1578 00:58:49,760 --> 00:58:52,720 YOUR BRILLIANT AND INFORMATIVE 1579 00:58:52,720 --> 00:58:53,720 PRESENTATIONS TODAY. 1580 00:58:53,720 --> 00:58:55,000 AND SO THE NIH COMMUNITY, THANK 1581 00:58:55,000 --> 00:58:57,920 YOU FOR JOINING US AND HAVE A 1582 00:58:57,920 --> 00:58:58,840 WONDERFUL AFTERNOON. 1583 00:58:58,840 --> 00:58:59,120 THANK YOU. 1584 00:58:59,120 --> 00:58:59,680 >> THANK YOU.