Clinical Focus

  • Child and Adolescent Psychiatry

Professional Education

  • Medical Education:Albert Einstein College of Medicine Office of the Registrar (2004) NY
  • Fellowship:Stanford University - Dept of Psychiatry (2010) CA
  • Board Certification: Child and Adolescent Psychiatry, American Board of Psychiatry and Neurology (2011)
  • Board Certification: Psychiatry, American Board of Psychiatry and Neurology (2009)
  • Residency:Stanford University - Dept of Psychiatry (2007) CA


2018-19 Courses

Stanford Advisees


All Publications

  • Neuroanatomical abnormalities in fragile X syndrome during the adolescent and young adult years. Journal of psychiatric research Sandoval, G. M., Shim, S., Hong, D. S., Garrett, A. S., Quintin, E., Marzelli, M. J., Patnaik, S., Lightbody, A. A., Reiss, A. L. 2018; 107: 138–44


    Abnormal brain development and cognitive dysfunction have been reported both in children and in adults with fragile X syndrome (FXS). However, few studies have examined neuroanatomical abnormalities in FXS during adolescence. In this study we focus on adolescent subjects with FXS (N = 54) as compared to age- and sex-matched subjects with idiopathic intellectual disability (Comparison Group) (N = 32), to examine neuroanatomical differences during this developmental period. Brain structure was assessed with voxel-based morphometry and independent groups t-test in SPM8 software. Results showed that the FXS group, relative to the comparison group, had significantly larger gray matter volume (GMV) in only one region: the bilateral caudate nucleus, but have smaller GMV in several regions including bilateral medial frontal, pregenual cingulate, gyrus rectus, insula, and superior temporal gyrus. Group differences also were noted in white matter regions. Within the FXS group, lower FMRP levels were associated with less GMV in several regions including cerebellum and gyrus rectus, and less white matter volume (WMV) in pregenual cingulate, middle frontal gyrus, and other regions. Lower full scale IQ within the FXS group was associated with larger right caudate nucleus GMV. In conclusion, adolescents and young adults with FXS demonstrate neuroanatomical abnormalities consistent with those previously reported in children and adults with FXS. These brain variations likely result from reduced FMRP during early neurodevelopment and mediate downstream deleterious effects on cognitive function.

    View details for DOI 10.1016/j.jpsychires.2018.10.014

    View details for PubMedID 30408626

  • "Communities" of Conditions: Novel Methods for Classifying Psychiatric Disorders. Journal of the American Academy of Child and Adolescent Psychiatry Hong, D. S. 2018; 57 (4): 233–34


    In 1798, Philippe Pinel presented one of the first nosologies for psychiatric disorders, "Nosographie philosophique ou la methode de l'analyse appliquee a la medecine."1 His emphasis on psychological and physical conditions as the basis of mental illness provided a distinct departure from prior reliance on such etiologies such as demonic possession. Establishing classification schema was a much more profound innovation than a simple academic reordering of psychiatric phenomena-under Pinel's leadership at the famed Pitie-Salpetriere hospital, it also led to a radical reformation of clinical interventions, moving away from pseudoscientific practices toward psychologically based interventions. Much of this work influenced his successors in psychiatric taxonomy including Emil Kraeplin and others, ultimately forming the basis of the DSM.2 Although the DSM has been subsequently celebrated and maligned, it has been instrumental in both our conceptualization and treatment approach to psychiatric disorders. Indeed, there has been extensive effort to validate these conditions using factor analytic approaches to confirm that such conditions represent cohesive biologically based disorders, which has presented challenges.3.

    View details for DOI 10.1016/j.jaac.2018.02.002

    View details for PubMedID 29588048

  • Here/In This Issue and There/Abstract Thinking: The First Year: Incorporating Maternal Mental Health Into Child Psychiatric Practice. Journal of the American Academy of Child and Adolescent Psychiatry Hong, D. S. 2017; 56 (3): 183-184

    View details for DOI 10.1016/j.jaac.2017.01.001

    View details for PubMedID 28219481

  • Multi-Table Differential Correlation Analysis of Neuroanatomical and Cognitive Interactions in Turner Syndrome. Neuroinformatics Seiler, C., Green, T., Hong, D., Chromik, L., Huffman, L., Holmes, S., Reiss, A. L. 2017


    Girls and women with Turner syndrome (TS) have a completely or partially missing X chromosome. Extensive studies on the impact of TS on neuroanatomy and cognition have been conducted. The integration of neuroanatomical and cognitive information into one consistent analysis through multi-table methods is difficult and most standard tests are underpowered. We propose a new two-sample testing procedure that compares associations between two tables in two groups. The procedure combines multi-table methods with permutation tests. In particular, we construct cluster size test statistics that incorporate spatial dependencies. We apply our new procedure to a newly collected dataset comprising of structural brain scans and cognitive test scores from girls with TS and healthy control participants (age and sex matched). We measure neuroanatomy with Tensor-Based Morphometry (TBM) and cognitive function with Wechsler IQ and NEuroPSYchological tests (NEPSY-II). We compare our multi-table testing procedure to a single-table analysis. Our new procedure reports differential correlations between two voxel clusters and a wide range of cognitive tests whereas the single-table analysis reports no differences. Our findings are consistent with the hypothesis that girls with TS have a different brain-cognition association structure than healthy controls.

    View details for DOI 10.1007/s12021-017-9351-z

    View details for PubMedID 29270892

  • X-Chromosome Effects on Attention Networks: Insights from Imaging Resting-State Networks in Turner Syndrome. Cerebral cortex (New York, N.Y. : 1991) Green, T., Saggar, M., Ishak, A., Hong, D. S., Reiss, A. L. 2017: 1–8


    Attention deficit hyperactivity disorder (ADHD) is strongly affected by sex, but sex chromosomes' effect on brain attention networks and cognition are difficult to examine in humans. This is due to significant etiologic heterogeneity among diagnosed individuals. In contrast, individuals with Turner syndrome (TS), who have substantially increased risk for ADHD symptoms, share a common genetic risk factor related to the absence of the X-chromosome, thus serving as a more homogeneous genetic model. Resting-state functional MRI was employed to examine differences in attention networks between girls with TS (n = 40) and age- sex- and Tanner-matched controls (n = 33). We compared groups on resting-state functional connectivity measures from data-driven independent components analysis (ICA) and hypothesis-based seed analysis. Using ICA, reduced connectivity was observed in both frontoparietal and dorsal attention networks. Similarly, using seeds in the bilateral intraparietal sulcus (IPS), reduced connectivity was observed between IPS and frontal and cerebellar regions. Finally, we observed a brain-behavior correlation between IPS-cerebellar connectivity and cognitive attention measures. These findings indicate that X-monosomy contributes affects to attention networks and cognitive dysfunction that might increase risk for ADHD. Our findings not only have clinical relevance for girls with TS, but might also serve as a biological marker in future research examining the effects of the intervention that targets attention skills.

    View details for DOI 10.1093/cercor/bhx188

    View details for PubMedID 28981595

  • Here/In This Issue and There/Abstract Thinking: The Data Revolution Has Arrived, but Are We Ready? A Call to Action for Child Psychiatry. Journal of the American Academy of Child and Adolescent Psychiatry Hong, D. S. 2016; 55 (9): 741-742

    View details for DOI 10.1016/j.jaac.2016.07.002

    View details for PubMedID 27566111

  • Here/In This Issue and There/Abstract Thinking: Wielding Weapons: The Intersection Between Firearms and Child Psychiatry. Journal of the American Academy of Child and Adolescent Psychiatry Hong, D. S. 2016; 55 (3): 153-154

    View details for DOI 10.1016/j.jaac.2015.12.012

    View details for PubMedID 26903245

  • Here/In This Issue and There/Abstract Thinking: The Secret Lives of Adolescents: Are We Asking the Right Questions? Journal of the American Academy of Child and Adolescent Psychiatry Hong, D. S. 2015; 54 (9): 697-698

    View details for DOI 10.1016/j.jaac.2015.06.013

    View details for PubMedID 26299287

  • Here/In This Issue and There/Abstract Thinking: The Art (and Science) of Psychotherapy. Journal of the American Academy of Child and Adolescent Psychiatry Hong, D. S. 2015; 54 (3): 157-158

    View details for DOI 10.1016/j.jaac.2014.12.013

    View details for PubMedID 25721178

  • Aberrant parietal cortex developmental trajectories in girls with Turner syndrome and related visual-spatial cognitive development: a preliminary study. American journal of medical genetics. Part B, Neuropsychiatric genetics : the official publication of the International Society of Psychiatric Genetics Green, T., Chromik, L. C., Mazaika, P. K., Fierro, K., Raman, M. M., Lazzeroni, L. C., Hong, D. S., Reiss, A. L. 2014; 165B (6): 531-540


    Turner syndrome (TS) arises from partial or complete absence of the X-chromosome in females. Girls with TS show deficits in visual-spatial skills as well as reduced brain volume and surface area in the parietal cortex which supports these cognitive functions. Thus, measuring the developmental trajectory of the parietal cortex and the associated visual-spatial cognition in TS may provide novel insights into critical brain-behavior associations. In this longitudinal study, we acquired structural MRI data and assessed visual-spatial skills in 16 (age: 8.23 ± 2.5) girls with TS and 13 age-matched controls over two time-points. Gray and white matter volume, surface area and cortical thickness were calculated from surfaced based segmentation of bilateral parietal cortices, and the NEPSY Arrows subtest was used to assess visual-spatial ability. Volumetric and cognitive scalars were modeled to obtain estimates of age-related change. The results show aberrant growth of white matter volume (P = 0.011, corrected) and surface area (P = 0.036, corrected) of the left superior parietal regions during childhood in girls with TS. Other parietal sub-regions were significantly smaller in girls with TS at both time-points but did not show different growth trajectories relative to controls. Furthermore, we found that visual-spatial skills showed a widening deficit for girls with TS relative to controls (P = 0.003). Young girls with TS demonstrate an aberrant trajectory of parietal cortical and cognitive development during childhood. Elucidating aberrant neurodevelopmental trajectories in this population is critical for determining specific stages of brain maturation that are particularly dependent on TS-related genetic and hormonal factors. © 2014 Wiley Periodicals, Inc.

    View details for DOI 10.1002/ajmg.b.32256

    View details for PubMedID 25044604

  • Here/In This Issue and There/Abstract Thinking: Learning Disorders and ADHD: Are LDs Getting the Attention They Deserve? Journal of the American Academy of Child and Adolescent Psychiatry Hong, D. S. 2014; 53 (9): 933-934

    View details for DOI 10.1016/j.jaac.2014.06.006

    View details for PubMedID 25151413

  • Influence of the x-chromosome on neuroanatomy: evidence from turner and klinefelter syndromes. journal of neuroscience Hong, D. S., Hoeft, F., Marzelli, M. J., Lepage, J., Roeltgen, D., Ross, J., Reiss, A. L. 2014; 34 (10): 3509-3516


    Studies of sex effects on neurodevelopment have traditionally focused on animal models investigating hormonal influences on brain anatomy. However, more recent evidence suggests that sex chromosomes may also have direct upstream effects that act independently of hormones. Sex chromosome aneuploidies provide ideal models to examine this framework in humans, including Turner syndrome (TS), where females are missing one X-chromosome (45X), and Klinefelter syndrome (KS), where males have an additional X-chromosome (47XXY). As these disorders essentially represent copy number variants of the sex chromosomes, investigation of brain structure across these disorders allows us to determine whether sex chromosome gene dosage effects exist. We used voxel-based morphometry to investigate this hypothesis in a large sample of children in early puberty, to compare regional gray matter volumes among individuals with one (45X), two (typically developing 46XX females and 46XY males), and three (47XXY) sex chromosomes. Between-group contrasts of TS and KS groups relative to respective sex-matched controls demonstrated highly convergent patterns of volumetric differences with the presence of an additional sex chromosome being associated with relatively decreased parieto-occipital gray matter volume and relatively increased temporo-insular gray matter volumes. Furthermore, z-score map comparisons between TS and KS cohorts also suggested that this effect occurs in a linear dose-dependent fashion. We infer that sex chromosome gene expression directly influences brain structure in children during early stages of puberty, extending our understanding of genotype-phenotype mechanisms underlying sex differences in the brain.

    View details for DOI 10.1523/JNEUROSCI.2790-13.2014

    View details for PubMedID 24599451

    View details for PubMedCentralID PMC3942570

  • Aberrant neurocognitive processing of fear in young girls with Turner syndrome SOCIAL COGNITIVE AND AFFECTIVE NEUROSCIENCE Hong, D. S., Bray, S., Haas, B. W., Hoeft, F., Reiss, A. L. 2014; 9 (3): 255-264


    Appraisal of fearful stimuli is an integral aspect of social cognition. Neural circuitry underlying this phenomenon has been well-described and encompasses a distributed network of affective and cognitive nodes. Interestingly, this ability to process fearful faces is impaired in Turner syndrome (TS), a genetic disorder of females in which all or part of an X chromosome is missing. However, neurofunctional correlates for this impairment have not been well-studied, particularly in young girls. Given that the core features of TS include X chromosome gene haploinsufficiency and secondary sex hormone deficiencies, investigation of fearful face processing may provide insights into the influence of X chromosome gene expression on this network. Therefore, we examined behavioral and neural responses during an explicit emotional face labeling task in 14 prepubertal girls with TS and 16 typically developing age-matched controls (6-13 years). We demonstrate that girls with TS have a specific impairment in the identification of fearful faces and show decreased activation in several cognitive control regions, including the anterior dorsal anterior cingulate cortex, dorsolateral prefrontal cortex and posterior cingulate gyrus. Our results indicate that aberrant functional activation in dorsal cognitive regions plays an integral role in appraisal of, and regulation of response to fear in TS.

    View details for DOI 10.1093/scan/nss133

    View details for Web of Science ID 000336488300001

    View details for PubMedID 23171616

    View details for PubMedCentralID PMC3980805

  • Cognitive and neurological aspects of sex chromosome aneuploidies LANCET NEUROLOGY Hong, D. S., Reiss, A. L. 2014; 13 (3): 306-318


    Sex chromosome aneuploidies are a common group of disorders that are characterised by an abnormal number of X or Y chromosomes. However, many individuals with these disorders are not diagnosed, despite established groups of core features that include aberrant brain development and function. Clinical presentations often include characteristic profiles of intellectual ability, motor impairments, and rates of neurological and psychiatric disorders that are higher than those of the general population. Advances in genetics and neuroimaging have substantially expanded knowledge of potential mechanisms that underlie these phenotypes, including a putative dose effect of sex chromosome genes on neuroanatomical structures and cognitive abilities. Continuing attention to emerging trends in research of sex chromosome aneuploidies is important for clinicians because it informs appropriate management of these common genetic disorders. Furthermore, improved understanding of underlying neurobiological processes has much potential to elucidate sex-related factors associated with neurological and psychiatric disease in general.

    View details for Web of Science ID 000332264300013

    View details for PubMedID 24556008

  • Here/In this issue and there/abstract thinking: personalized psychiatry: are we almost there? Journal of the American Academy of Child and Adolescent Psychiatry Hong, D. S. 2014; 53 (3): 263-264

    View details for DOI 10.1016/j.jaac.2013.12.014

    View details for PubMedID 24565352

  • Brain morphology in children with 47, XYY syndrome: a voxel- and surface-based morphometric study. Genes, brain, and behavior LePage, J., Hong, D. S., Raman, M., Marzelli, M., Roeltgen, D. P., Lai, S., Ross, J., Reiss, A. L. 2014; 13 (2): 127-134


    The neurocognitive and behavioral profile of individuals with 47,XYY is increasingly documented; however, very little is known about the effect of a supernumerary Y-chromosome on brain development. Establishing the neural phenotype associated with 47,XYY may prove valuable in clarifying the role of Y-chromosome gene dosage effects, a potential factor in several neuropsychiatric disorders that show a prevalence bias toward males, including autism spectrum disorders. Here, we investigated brain structure in 10 young boys with 47,XYY and 10 age-matched healthy controls by combining voxel-based morphometry (VBM) and surface-based morphometry (SBM). The VBM results show the existence of altered gray matter volume (GMV) in the insular and parietal regions of 47,XYY relative to controls, changes that were paralleled by extensive modifications in white matter (WM) bilaterally in the frontal and superior parietal lobes. The SBM analyses corroborated these findings and revealed the presence of abnormal surface area and cortical thinning in regions with abnormal GMV and WMV. Overall, these preliminary results demonstrate a significant impact of a supernumerary Y-chromosome on brain development, provide a neural basis for the motor, speech and behavior regulation difficulties associated with 47,XYY and may relate to sexual dimorphism in these areas.

    View details for DOI 10.1111/gbb.12107

    View details for PubMedID 24308542

    View details for PubMedCentralID PMC3918511

  • Aberrant Functional Network Recruitment of Posterior Parietal Cortex in Turner Syndrome HUMAN BRAIN MAPPING Bray, S., Hoeft, F., Hong, D. S., Reiss, A. L. 2013; 34 (12): 3117-3128


    Turner syndrome is a genetic disorder caused by the complete or partial absence of an X chromosome in affected women. Individuals with TS show characteristic difficulties with executive functions, visual-spatial and mathematical cognition, with relatively intact verbal skills, and congruent abnormalities in structural development of the posterior parietal cortex (PPC). The functionally heterogeneous PPC has recently been investigated using connectivity-based clustering methods, which sub-divide a given region into clusters of voxels showing similar structural or functional connectivity to other brain regions. In the present study, we extended this method to compare connectivity-based clustering between groups and investigate whether functional networks differentially recruit the PPC in TS. To this end, we parcellated the PPC into sub-regions based on temporal correlations with other regions of the brain. fMRI data were collected from 15 girls with TS and 14 typically developing (TD) girls, aged 7-14, while they performed a visual-spatial task. Temporal correlations between voxels in the PPC and a set of seed regions were calculated, and the PPC divided into clusters of voxels showing similar connectivity. It was found that in general the PPC parcellates similarly in TS and TD girls, but that regions in bilateral inferior parietal lobules, and posterior right superior parietal lobule, were reliably recruited by different networks in TS relative to TD participants. These regions showed weaker correlation in TS with a set of regions involved in visual processing. These results suggest that abnormal development of visuospatial functional networks in TS may relate to the well documented cognitive difficulties in this disorder.

    View details for DOI 10.1002/hbm.22131

    View details for Web of Science ID 000326068700001

    View details for PubMedID 22711287

    View details for PubMedCentralID PMC4360970

  • Here/In this issue and there/abstract thinking: adolescence to adulthood: are some children falling into the gap? Journal of the American Academy of Child and Adolescent Psychiatry Hong, D. S. 2013; 52 (9): 885-886

    View details for DOI 10.1016/j.jaac.2013.06.014

    View details for PubMedID 23972687

  • Cortical Brain Morphology in Young, Estrogen-Naive, and Adolescent, Estrogen-Treated Girls with Turner Syndrome CEREBRAL CORTEX Lepage, J., Mazaika, P. K., Hong, D. S., Raman, M., Reiss, A. L. 2013; 23 (9): 2159-2168


    Turner syndrome (TS) is a genetic condition that permits direct investigation of the complex interaction among genes, hormones, behavior, and brain development. Here, we used automated segmentation and surface-based morphometry to characterize the differences in brain morphology in children (n = 30) and adolescents (n = 16) with TS relative to age- and sex-matched control groups (n = 21 and 24, respectively). Our results show that individuals with TS, young and adolescent, present widespread reduction of gray matter volume, white matter volume and surface area (SA) over both parietal and occipital cortices bilaterally, as well as enlarged amygdala. In contrast to the young cohort, adolescents with TS showed significantly larger mean cortical thickness and significantly smaller total SA compared with healthy controls. Exploratory developmental analyses suggested aberrant regional brain maturation in the parahippocampal gyrus and orbitofrontal regions from childhood to adolescence in TS. These findings show the existence of abnormal brain morphology early in development in TS, but also suggest the presence of altered neurodevelopmental trajectories in some regions, which could potentially be the consequences of estrogen deficiency, both pre- and postnatally.

    View details for DOI 10.1093/cercor/bhs195

    View details for Web of Science ID 000322661100013

    View details for PubMedID 22806268

  • Genomic imprinting effects of the x chromosome on brain morphology. journal of neuroscience Lepage, J., Hong, D. S., Mazaika, P. K., Raman, M., Sheau, K., Marzelli, M. J., Hallmayer, J., Reiss, A. L. 2013; 33 (19): 8567-8574


    There is increasing evidence that genomic imprinting, a process by which certain genes are expressed in a parent-of-origin-specific manner, can influence neurogenetic and psychiatric manifestations. While some data suggest possible imprinting effects of the X chromosome on physical and cognitive characteristics in humans, there is no compelling evidence that X-linked imprinting affects brain morphology. To address this issue, we investigated regional cortical volume, thickness, and surface area in 27 healthy controls and 40 prepubescent girls with Turner syndrome (TS), a condition caused by the absence of one X chromosome. Of the young girls with TS, 23 inherited their X chromosome from their mother (X(m)) and 17 from their father (X(p)). Our results confirm the existence of significant differences in brain morphology between girls with TS and controls, and reveal the presence of a putative imprinting effect among the TS groups: girls with X(p) demonstrated thicker cortex than those with X(m) in the temporal regions bilaterally, while X(m) individuals showed bilateral enlargement of gray matter volume in the superior frontal regions compared with X(p). These data suggest the existence of imprinting effects of the X chromosome that influence both cortical thickness and volume during early brain development, and help to explain variability in cognitive and behavioral manifestations of TS with regard to the parental origin of the X chromosome.

    View details for DOI 10.1523/JNEUROSCI.5810-12.2013

    View details for PubMedID 23658194

    View details for PubMedCentralID PMC3696011

  • Impact of cognitive profile on social functioning in prepubescent females with Turner syndrome CHILD NEUROPSYCHOLOGY Lepage, J., Dunkin, B., Hong, D. S., Reiss, A. L. 2013; 19 (2): 161-172


    Social deficits are prevalent in Turner syndrome (TS); however, the extent to which these difficulties are secondary to characteristic cognitive impairments is not well known. Here, we sought to establish the relative contribution of executive functions, visuospatial abilities, and IQ to social difficulties in young girls with TS. Forty TS girls and 19 typically developing (TD) children were assessed with the Social Responsiveness Scale (SRS), the Motor-Free Visual Spatial Test (MVPT-3), the Behavior Rating Inventory of Executive Function (BRIEF), and an IQ test. Hierarchical multiple regression analyses were conducted with the SRS subscales as outcome variables. In a first step, the cognitive factors were entered (verbal IQ, BRIEF global score, MVPT-3, and age), followed by the group variable in a second step. In comparison to TD, TS participants were significantly impaired on all main measures. All six regression models with the SRS subscales were significant and revealed that global executive functions explained the largest portion of the variance on all subscales and the total score. Even after controlling for cognitive elements, the group factor still explained a significant portion of the variance of the Social Cognition, Social Awareness, and Autistic Mannerisms subscales. In contrast, the group factor was not a significant predictor of Social Motivation and Social Communication scores. These results suggest that executive dysfunctions play a role in social impairments encountered in TS, but also that some specific aspects of social behavior are altered beyond what can be attributed to cognitive difficulties in this population.

    View details for DOI 10.1080/09297049.2011.647900

    View details for Web of Science ID 000315675600004

    View details for PubMedID 22372383

    View details for PubMedCentralID PMC3485432

  • White Matter Aberrations in Prepubertal Estrogen-Naive Girls with Monosomic Turner Syndrome CEREBRAL CORTEX Yamagata, B., Barnea-Goraly, N., Marzelli, M. J., Park, Y., Hong, D. S., Mimura, M., Reiss, A. L. 2012; 22 (12): 2761-2768


    Turner syndrome (TS) offers a unique opportunity to investigate associations among genes, the brain, and cognitive phenotypes. In this study, we used 3 complementary analyses of diffusion tensor imaging (DTI) data (whole brain, region of interest, and fiber tractography) and a whole brain volumetric imaging technique to investigate white matter (WM) structure in prepubertal, nonmosaic, estrogen-naive girls with TS compared with age and sex matched typically developing controls. The TS group demonstrated significant WM aberrations in brain regions implicated in visuospatial abilities, face processing, and sensorimotor and social abilities compared with controls. Extensive spatial overlap between regions of aberrant WM structure (from DTI) and regions of aberrant WM volume were observed in TS. Our findings indicate that complete absence of an X chromosome in young females (prior to receiving exogenous estrogen) is associated with WM aberrations in specific regions implicated in characteristic cognitive features of TS.

    View details for DOI 10.1093/cercor/bhr355

    View details for Web of Science ID 000310965200005

    View details for PubMedID 22172580

    View details for PubMedCentralID PMC3491765

  • Cognition and behavior in Turner syndrome: a brief review. Pediatric endocrinology reviews : PER Hong, D. S., Reiss, A. L. 2012; 9: 710-712


    There is increasing evidence that Turner syndrome is associated with a distinct pattern of cognitive and neurophysiological characteristics. Typically this has been characterized by relative strengths in verbal skills, contrasting with relative weaknesses in arithmetic, visuospatial and executive function domains. Potential differences in social cognitive processing have also been identified. More recently, applications of neuroimaging techniques have further elucidated underlying differences in brain structure, function and connectivity in individuals with Turner syndrome. Ongoing research in this area is focused on establishing a unified mechanistic model incorporating genetic influences from the X chromosome, sex hormone contributions, neuroanatomical variation and differences in cognitive processes. This review broadly covers current understanding of how X-monosomy impacts neurocognitive phenotype both from the perspective of cognitive-behavioral and neuroimaging studies. Furthermore, relevant clinical aspects of identifying potential learning difficulties and providing anticipatory guidance for affected individuals with TS, are briefly discussed.

    View details for PubMedID 22946281

  • Genomic Imprinting Effects on Cognitive and Social Abilities in Prepubertal Girls with Turner Syndrome JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM Lepage, J., Hong, D. S., Hallmayer, J., Reiss, A. L. 2012; 97 (3): E460-E464


    Recent evidence suggests that the cognitive and social manifestations associated with Turner syndrome (TS) might be influenced by epigenetic factors in the form of genomic imprinting. However, due to small and heterogeneous samples, inconsistent results have emerged from these studies.The objective of this prospective study was to establish the impact of genomic imprinting on neurocognitive abilities and social functioning in young girls with TS.An extensive battery of neuropsychological assessments was administered to 65 children with TS who had never been exposed to estrogen treatment, 24 of whom had an X-chromosome from paternal origin (Xpat) and 41 from maternal origin (Xmat).The Wechsler scales of intelligence, the Motor-Free Visual Spatial test-3, the Wide Range Assessment of Visual Motor Ability, and the attention/executive domain of the NEPSY were used to assess cognitive abilities. Social functioning was assessed with the Social Responsiveness Scale and the Behavior Assessment System for Children-2.Results showed that although individuals with Xpat obtained lower scores than their counterparts with Xmat on most cognitive and social measures, only the Perceptual Reasoning Index of the intelligence scale yielded significant differences after correction for multiple comparisons.Overall, these results suggest that although some aspects of the neuropsychological profile of TS may be influenced by epigenetic factors, the sociocognitive phenotype associated with the disorder is not modulated by genomic imprinting.

    View details for DOI 10.1210/jc.2011-2916

    View details for Web of Science ID 000301229600020

    View details for PubMedID 22238395

    View details for PubMedCentralID PMC3319213

  • Contribution of Executive Functions to Visuospatial Difficulties in Prepubertal Girls With Turner Syndrome DEVELOPMENTAL NEUROPSYCHOLOGY Lepage, J., Dunkin, B., Hong, D. S., Reiss, A. L. 2011; 36 (8): 988-1002


    Turner syndrome (TS) is a genetic disorder caused by the absence of one X-chromosome in females. Individuals with TS often demonstrate a cognitive profile characterized by poor visuospatial abilities, which may in part be due to executive function impairments. Here, we assessed the neuropsychological profile of 36 prepubertal girls with TS and 20 typically developing children to examine the relationship between executive function and visuospatial abilities. Multiple linear regression analyses revealed that executive functions were closely associated with visuospatial abilities in TS but not in controls. These results suggest that executive dysfunctions observed in TS contribute to their visuospatial impairments.

    View details for DOI 10.1080/87565641.2011.584356

    View details for Web of Science ID 000296931600003

    View details for PubMedID 22004020

  • Reduced Functional Connectivity during Working Memory in Turner Syndrome CEREBRAL CORTEX Bray, S., Dunkin, B., Hong, D. S., Reiss, A. L. 2011; 21 (11): 2471-2481


    Turner syndrome (TS) is a genetic disorder affecting females, resulting from the complete or partial absence of an X chromosome. The cognitive profile of TS shows relative strengths in the verbal domain and weaknesses in the procedural domain, including working memory. Neuroimaging studies have identified differences in the morphology of the parietal lobes, and white matter pathways linking frontal and parietal regions, as well as abnormal activation in dorsal frontal and parietal regions. Taken together these findings suggest that abnormal functional connectivity between frontal and parietal regions may be related to working memory impairments in TS, a hypothesis we tested in the present study. We scanned TS and typically developing participants with functional magnetic resonance imaging while they performed visuospatial and phonological working memory tasks. We generated a seed region in parietal cortex based on structural differences in TS and found that functional connectivity with dorsal frontal regions was reduced during working memory in TS. Finally, we found that connectivity was correlated with task performance in TS. These findings suggest that structural brain abnormalities in TS affect not only regional activity but also the functional interactions between regions and that this has important consequences for behavior.

    View details for DOI 10.1093/cercor/bhr017

    View details for Web of Science ID 000295413200005

    View details for PubMedID 21441396

    View details for PubMedCentralID PMC3183420

  • Psychosocial Functioning and Social Cognitive Processing in Girls with Turner Syndrome JOURNAL OF DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS Hong, D. S., Dunkin, B., Reiss, A. L. 2011; 32 (7): 512-520


    Turner syndrome (TS) is a common genetic disorder caused by partial or complete absence of the second X chromosome in females and is associated with a characteristic neurocognitive profile traditionally described by discrepancy between verbal and performance IQ. Difficulties in social functioning have also been increasingly identified in this population. The purpose of this study was to examine elements of social competence and cognition in a pre-estrogen population of girls with TS.The authors administered psychosocial and neurocognitive measures to examine metrics of social function and intelligence in a group of young girls with TS, pre-estrogen treatment (n = 42) and control peers (n = 32), aged between 3 and 12 years.Girls with TS demonstrated significantly decreased social competency on all dimensions of the Social Responsiveness Scale, with the exception of the Social Motivation subscale, where ratings were comparable with typically developing peers. Performance on social cognitive tasks was also impaired on NEPSY Memory for Faces and Theory of Mind tasks. Differences were further observed on Behavioral Assessment Scales for Children subscales of Hyperactivity, Atypicality, Attention, Social Skills, Activities of Daily Living, and Functional Communication. Group differences in social cognition or behavior remained significant after adjusting for verbal IQ.This study supports the hypothesis that young girls with TS who have not yet received estrogen treatment demonstrate significantly impaired social cognition. Improved understanding of differences in social competence and cognition can increase awareness and inform clinical approaches to identifying and treating social difficulties in individuals with TS.

    View details for DOI 10.1097/DBP.0b013e3182255301

    View details for Web of Science ID 000294421200004

    View details for PubMedID 21743350

    View details for PubMedCentralID PMC3179767

  • Neuroanatomical spatial patterns in Turner syndrome NEUROIMAGE Marzelli, M. J., Hoeft, F., Hong, D. S., Reiss, A. L. 2011; 55 (2): 439-447


    Turner syndrome (TS) is a highly prevalent genetic condition caused by partial or complete absence of one X-chromosome in a female and is associated with a lack of endogenous estrogen during development secondary to gonadal dysgenesis. Prominent cognitive weaknesses in executive and visuospatial functions in the context of normal overall IQ also occur in affected individuals. Previous neuroimaging studies of TS point to a profile of neuroanatomical variation relative to age and sex matched controls. However, there are no neuroimaging studies focusing on young girls with TS before they receive exogenous estrogen treatment to induce puberty. Information obtained from young girls with TS may help to establish an early neural correlate of the cognitive phenotype associated with the disorder. Further, univariate analysis has predominantly been the method of choice in prior neuroimaging studies of TS. Univariate approaches examine between-group differences on the basis of individual image elements (i.e., a single voxel's intensity or the volume of an a priori defined brain region). This is in contrast to multivariate methods that can elucidate complex neuroanatomical profiles in a clinical population by determining the pattern of between-group differences from many image elements evaluated simultaneously. In this case, individual image elements might not be significantly different between groups but can still contribute to a significantly different overall spatial pattern. In this study, voxel-based morphometry (VBM) of high-resolution magnetic resonance images was used to investigate differences in brain morphology between 13 pediatric, pre-estrogen girls with monosomic TS and 13 age-matched typically developing controls (3.0 T imaging: mean age 9.1±2.1). A similar analysis was performed with an older cohort of 13 girls with monosomic TS and 13 age-matched typically developing controls (1.5 T imaging: mean age 15.8±4.5). A multivariate, linear support vector machine analysis using leave-one-out cross-validation was then employed to discriminate girls with TS from typically developing controls based on differences in neuroanatomical spatial patterns and to assess how accurately such patterns translate across heterogeneous cohorts. VBM indicated that both TS cohorts had significantly reduced gray matter volume in the precentral, postcentral, and supramarginal gyri and enlargement of the left middle and superior temporal gyri. Support vector machine (SVM) classifiers achieved high accuracy for discriminating brain morphology patterns in TS from typically developing controls and also displayed spatial patterns consistent with the VBM results. Furthermore, the SVM classifiers identified additional neuroanatomical variations in individuals with TS, localized in the hippocampus, orbitofrontal cortex, insula, caudate, and cuneus. Our results demonstrate robust spatial patterns of altered brain morphology in developmentally dynamic populations with TS, providing further insight into the neuroanatomical correlates of cognitive-behavioral features in this condition.

    View details for DOI 10.1016/j.neuroimage.2010.12.054

    View details for Web of Science ID 000287556200001

    View details for PubMedID 21195197

    View details for PubMedCentralID PMC3035734



    Turner syndrome (TS) is a relatively common neurogenetic disorder characterized by complete or partial monosomy-X in a phenotypic female. TS is associated with a cognitive profile that typically includes intact intellectual function and verbal abilities with relative weaknesses in visual-spatial, executive, and social cognitive domains. In this report, we review previous and current research related to the cognitive profile of TS. We also discuss how cognitive impairments in this syndrome may reflect integrative rather than modular deficits. For example, the less commonly reported areas of verbal difficulty in TS and certain visual-spatial deficits seem significantly influenced by impairments in executive function and spatially loaded stimuli. We provide a summary of cognitive testing measures used in the assessment of visual-spatial and executive skills, which includes test domain descriptions as well as a comprehensive examination of social cognitive function in TS. This review concludes with a discussion of ecological interpretations regarding the meaning of cognitive deficits in TS at the individual level.

    View details for DOI 10.1002/ddrr.79

    View details for Web of Science ID 000273207500002

    View details for PubMedID 20014362

    View details for PubMedCentralID PMC3114458

  • Posttraumatic stress disorder following traumatic injury: Narratives as unconscious indicators of psychopathology BULLETIN OF THE MENNINGER CLINIC Hashemi, B., Shaw, R. J., Hong, D. S., Hall, R., Nelson, K., Steiner, H. 2008; 72 (3): 179-190


    Current conventional assessment methodologies used to diagnose posttraumatic stress disorder (PTSD) rely heavily on symptom counts obtained from clinical interviews or self-report questionnaires. Such measures may underestimate the impact of traumatic events, particularly in individuals who deny or repress emotional distress. This case report illustrates the use of two methods of narrative analysis to assess unconscious representations of PTSD. Linguistic analysis and a computerized analysis of referential activity were able to capture unconscious aspects of the traumatic experience.

    View details for Web of Science ID 000260482800002

    View details for PubMedID 18990054



    Eosinophilic meningoencephalitis (EM) is usually a self-limited neurological illness commonly accompanied by a variety of neurological symptoms. The presence of acute psychotic symptoms in EM, however, has not previously been reported, and there is no literature to guide its treatment and management. In this case report, the onset of psychotic symptoms in a hypoactive delirium and their significant improvement following the administration of atypical antipsychotics are described in a boy with EM. This case report demonstrates the efficacy and safety of antipsychotic agents during the acute phase of meningoencephalitis.

    View details for DOI 10.2190/PM.38.3.e

    View details for Web of Science ID 000261315400005

    View details for PubMedID 19069573