Clinical Assistant Professor, Psychiatry and Behavioral Sciences - Child and Adolescent Psychiatry
PhD Training:California School of Professional Psychology at Alliant University (2011) CA
Fellowship:Stanford University School of Medicine (2013) CA
Internship:Creighton University-School of Medicine (2011) NE
Central coherence in adolescents with bulimia nervosa spectrum eating disorders
INTERNATIONAL JOURNAL OF EATING DISORDERS
2015; 48 (5): 487-493
Weak central coherence-a tendency to process details at the expense of the gestalt-has been observed among adults with bulimia nervosa (BN) and is a potential candidate endophenotype for eating disorders (EDs). However, as BN behaviors typically onset during adolescence it is important to assess central coherence in this younger age group to determine whether the findings in adults are likely a result of BN or present earlier in the evolution of the disorder. This study examines whether the detail-oriented and fragmented cognitive inefficiency observed among adults with BN is observable among adolescents with shorter illness duration, relative to healthy controls.The Rey-Osterrieth Complex Figure Test (RCFT) was administered to a total of 47 adolescents with DSM5 BN, 42 with purging disorder (PD), and 25 healthy controls (HC). Performance on this measure was compared across the three groups.Those with BN and PD demonstrated significantly worse accuracy scores compared to controls in the copy and delayed recall condition with a moderate effect size. These findings were exacerbated when symptoms of BN increased.Poorer accuracy scores reflect a fragmented and piecemeal strategy that interferes with visual-spatial integration in BN spectrum disorders. This cognitive inefficiency likely contributes to broad difficulties in executive functioning in this population especially in the context of worsening bulimic symptoms. The findings of this study support the hypothesis that poor global integration may constitute a cognitive endophenotype for BN.
View details for DOI 10.1002/eat.22340
View details for Web of Science ID 000356684500006
View details for PubMedID 25146149
Set-shifting among adolescents with anorexia nervosa
INTERNATIONAL JOURNAL OF EATING DISORDERS
2012; 45 (7): 909-912
Set-shifting difficulties are documented for adults with anorexia nervosa (AN). However, AN typically onsets in adolescents and it is unclear if set-shifting difficulties are a result of chronic AN or present earlier in its course. This study examined whether adolescents with short duration AN demonstrated set-shifting difficulties compared to healthy controls (HC).Data on set-shifting collected from the Delis-Kaplan executive functioning system and Wisconsin card sort task (WCST) as well as eating psychopathology were collected from 32 adolescent inpatients with AN and compared with those from 22 HCs.There were no differences in set-shifting in adolescents with AN compared to HCs on most measures.The findings suggest that set-shifting difficulties in AN may be a consequence of AN. Future studies should explore set-shifting difficulties in a larger sample of adolescents with the AN to determine if there is sub-set of adolescents with these difficulties and determine any relationship of set-shifting to the development of a chronic from of AN.
View details for DOI 10.1002/eat.22027
View details for Web of Science ID 000310271600014
View details for PubMedID 22692985
Set-Shifting Among Adolescents With Bulimic Spectrum Eating Disorders
2012; 74 (8): 869-872
Set-shifting difficulties are observed among adults with bulimia nervosa (BN). This study aimed to assess whether adolescents with BN and BN spectrum eating disorders exhibit set-shifting problems relative to healthy controls.Neurocognitive data from 23 adolescents with BN were compared with those from 31 adolescents with BN-type eating disorder not otherwise specified and 22 healthy controls on various measures of set-shifting (Trail Making Task [shift task], Color-Word Interference, Wisconsin Card Sorting Test, and Brixton Spatial Anticipation Task).No significant differences in set-shifting tasks were found among groups (p >.35), and effect sizes were small (Cohen f < 0.17).Cognitive inflexibility may develop over time because of the eating disorder, although it is possible that there is a subset of individuals in whom early neurocognitive difficulty may result in a longer illness trajectory. Future research should investigate the existence of neurocognitive taxons in larger samples and use longitudinal designs to fully explore biomarkers and illness effects.clinicaltrials.gov NCT00879151.
View details for DOI 10.1097/PSY.0b013e31826af636
View details for Web of Science ID 000310047800011
View details for PubMedID 23001391