Paulo A Graziano

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Verified

Paulo verified their affiliation via an institutional email.

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• Ph.D.
• Professor at Florida International University

Objective There is support for altered parasympathetic (PNS) and sympathetic (SNS) functioning among children with disruptive behavior disorders (DBD) which may underlie impairments in both emotion regulation (ER) and executive functioning (EF). This study examined the extent to which cardiac autonomic balance (CAB), a composite index that integrat...

Understanding the structural development of the neural speech network in early childhood is critical for characterizing speech acquisition. This study investigated speech in the developing brain by scanning 94 children aged 4-7 years using diffusion-weighted imaging (DWI) MRI. To increase sample size and performance variability, children with atten...

Objective: To examine differences in parenting factors among caregivers with children with and without externalizing behavior problems (EBP) in a community homeless shelter sample versus a stable housing sample. Method: Nine hundred and fourteen children (ages = 2.01-7.49 years, SD = 1.45 years, 40.8% female, 54.3% Black, 46.7% Hispanic) were re...

Background/Objectives: Obesity among college students has been consistently high in the recent decades. Regulatory processes such as interoception and self-regulation have been studied to identify specific health behaviors that lead to weight gain. Reduced interoception and self-regulation may lead to increased body mass index (BMI), however, vario...

Though ADHD is the most common pediatric diagnosis in community mental health clinics (CMHCs), little is known about its diagnostic accuracy in these settings. We characterize CMHC diagnostic patterns for ADHD and common comorbidities with attention to gender and racial/ethnic disparities and the impact of misdiagnosis on evidence-based treatment i...

During a school day, children make several transitions between activities, which can take away from instructional time and result in challenging behaviors. This study investigates the impact positive engagement and behavioral supports have on children’s behavior while transitioning. Participants ( N = 40; 77.5% Male; 92.5% Hispanic) were enrolled i...

Characterizing the structural development of the neural speech network in early childhood is important for understanding speech acquisition. To investigate speech in the developing brain, 94 children aged 4-7-years-old at risk for early speech disorder were scanned using diffusion weighted imaging (DWI) magnetic resonance imaging (MRI). Additionall...

Purpose Mothers experiencing homelessness undergo significant stressors in addition to parenting stress, yet the rate and treatment of postpartum depression (PPD) within this population has yet to be explored. We assessed the risk for PPD and examined the changes in PDD and parenting stress following engagement in treatment. Methods Participants i...

Externalizing behavior problems (EBP) in early childhood, including aggression, defiance, hyperactive, impulsive, and inattentive symptoms, pose significant challenges, affecting 15–34% of children. These EBP issues are associated with psychosocial impairments and substantial economic burdens to society. Behavioral-Parent Training (BPT) is an estab...

The Adolescent Brain Cognitive Development (ABCD) Study represents a pioneering initiative aimed at unraveling the complexities of behavioral and neural development in youth. In this paper, we address the multifaceted challenges inherent in extracting meaningful insights from the extensive data compiled by the ABCD initiative. Our focus is on advoc...

Children growing up in communities with limited resources and high levels of adversity face academic challenges. One measure of community factors, the Child Opportunity Index (COI), is a composite index measured at the census tract level that captures neighborhood resources and conditions (i.e., access to quality education, healthcare, and economic...

Community factors are associated with both children’s mental health and physical health. One measure of community factors, the Child Opportunity Index (COI), is a composite index measured at the census tract level that captures neighborhood resources and conditions. While greater COI has been found to relate to better overall physical health in old...

Objective: To determine the associations between interoception, self-regulation, eating behaviors, and weight status among college students. Participants: 229 female undergraduates, predominantly classified as Juniors (51.1%) and identified as Hispanic/Latinx (75%) with a mean age of 23.4 (SD = 6.3), were examined. Methods: Cross-sectional dat...

Objective: We sought to explore if specific domains of emotion dysregulation (emotion regulation [EREG], emotional reactivity/lability [EREL], emotion recognition/understanding [ERU], and callous-unemotional [CU] behaviors) were uniquely associated with diagnostic classifications. Method: This study utilized a multimodal (parent/teacher [P/T] re...

Attention-Deficit/Hyperactivity Disorder (ADHD) symptom profiles are known to undergo changes throughout development, rendering the neurobiological assessment of ADHD challenging across different developmental stages. Particularly in young children (ages 4 to 7 years), measuring inhibitory control network activity in the brain has been a formidable...

Objective To assess differences in child physical health outcomes and metrices associated with obesity in a sample of predominantly Hispanic/Latinx young children with and without attention-deficit/hyperactivity disorder (ADHD). Methods Participants included 127 children diagnosed with ADHD and 96 typically developing (TD) children between 4 and 7...

Background Youth with ADHD are at risk of academic impairments, dropping out of high school, and dysfunction in young adulthood. Interventions delivered early in high school could prevent these harmful outcomes, yet few high school students with ADHD receive treatment due to limited access to intervention providers. This study will test a peer-deli...

Objective: As part of a larger community-based, service-driven research project, the primary purpose of this pilot randomized study was to examine the feasibility and acceptability of delivering time-limited adaptations of parent-child interaction therapy (PCIT) and child-parent psychotherapy (CPP) within a sample of children experiencing homeless...

Though behavior therapy (BT) for ADHD in adolescence is evidence-based, almost no work examines its implementation and effectiveness in community settings. A recent randomized community-based trial of an evidence-based BT for adolescent ADHD (Supporting Teens' Autonomy Daily; STAND; N = 278) reported high clinician, parent, and youth acceptability...

Although many prevention and treatment programs exist for children and families, there have been no reviews specifically examining their impact on infant mental health at the program level. Therefore, the purpose of the current review was to a) systematically examine prevention and treatment programs targeting infant mental health outcomes (i.e. in...

Experiencing homelessness in infancy has been linked to negative physical and mental health outcomes. Parental well-being and the parent–infant relationship can also be negatively impacted by experiencing homelessness. While numerous parent-based infant mental health programs have been identified by a recent review, the goal of this study was to fu...

Although the efficacy of online administration of behavioral parent training (BPT) programs is well-established, such programs address a single risk factor (behavioral functioning) for school readiness difficulties (comprised of academics, cognitive skills, and social, emotional, and behavioral functioning). The current study aims to examine the fe...

The current study aimed to identify the key neurobiology of attention‐deficit/hyperactivity disorder (ADHD), as it relates to ADHD diagnostic category and symptoms of hyperactive/impulsive behaviour and inattention. To do so, we adapted a predictive modelling approach to identify the key structural and diffusion‐weighted brain imaging measures and...

ADHD is the most prevalent behavioral condition among children (8.4%). Diagnosis involves thorough history taking, collateral ratings, and determining impairment. Community providers often do not diagnose ADHD based on current standards of best practice, which may create disparities. Our study aims to examine the concordance between gold-standard A...

Children and adolescents (“youth”) experiencing homelessness are at a disproportionately high risk of exposure to potentially traumatic events (PTE). However, limited evidence exists as to what interventions are effective when implemented with this high-risk population. The purpose of this study was to (1) document the mental health and trauma-rela...

Objective To characterize routine non-pharmacological care for youth with ADHD. Methods 76 audio-recorded work-samples were collected from community mental health therapists in a large metropolitan area in the United States and were analyzed for operationally defined practice elements commonly included in evidence-based non-pharmacological treatme...

Objective Infectious diseases, such as coronavirus disease 2019 (COVID-19), are commonly transmitted by respiratory droplets and contact with contaminated surfaces. Individuals with attention-deficit/hyperactivity disorder (ADHD) are more likely to be infected with COVID-19 and experience more hospitalizations than individuals without ADHD. The cur...

Energy compensation indices are commonly used to examine self-regulation of food intake in children. However, previous studies failed to consider children's ability to self-regulate under complete autonomy. This study examined self-regulation of food intake among young children and the effect of calorie manipulation on food/nutrient intake using an...

The goal of this study was to examine whether parent attention-deficit/hyperactivity disorder (ADHD) symptoms impact parenting outcomes (i.e., parenting practices and stress) after group-based Parent Child Interaction Therapy (PCIT). The study included parents of preschoolers (Mage = 4.97) with autism spectrum disorder and co-occurring externalizin...

Adverse childhood experiences (ACEs) put millions of children at risk for later health problems. As childhood represents a critical developmental period, it is important to understand how ACEs impact brain development in young children. In addition, children with attention-deficit/hyperactivity disorder (ADHD) are more likely than typically develop...

Community implementation of evidence-based practices (EBPs) for Attention Deficit/Hyperactivity Disorder (ADHD) is greatly lacking. A recent randomized community-based trial of an EBP for ADHD (Supporting Teens’ Autonomy Daily; STAND) demonstrated suboptimal implementation and effectiveness outcomes. In the present study, we conducted an Innovation...

Background: Pediatric obesity represents a significant public health concern, especially for Hispanic school-aged children. This study examined via a randomized trial the efficacy of a family-based intervention [Healthy Lifestyle Summer Camp and Parenting program (HLSC+HLPP)] compared with a child-based camp intervention [Healthy Lifestyle Summer C...

The ability to dissociate axonal density in vivo from other microstructural properties is important for the diagnosis and treatment of neurologic disease, and new methods to do so are being developed. We investigated one such method—restricted diffusion imaging (RDI)—to see whether it can more accurately replicate histological axonal density patter...

The current study aimed to identify the key neurobiology of Attention-Deficit/Hyperactivity Disorder (ADHD), as it relates to ADHD diagnostic category and symptoms of hyperactive/impulsive behavior and inattention. To do so, we adapted a predictive modeling approach to identify the key structural and diffusion weighted brain imaging measures, and t...

The purpose of the study was to a) examine school readiness (SR) outcomes in preschoolers with externalizing behavior problems (EBPs) and language impairment (LI) after receiving an intensive multidisciplinary SR intervention and b) examine changes in language as predictors of improvements in SR treatment outcomes via an open trial design. Preschoo...

Increasing evidence supports the existence of time-related impairments in school-aged children and adults with Attention-Deficit/Hyperactivity Disorder (ADHD), but this deficit has not yet been investigated in preschoolers with ADHD. The aim of the current study was to determine the extent to which time-related impairments can be identified within...

Emotion dysregulation (ED) is prevalent among youth with Attention-Deficit/Hyperactivity Disorder (ADHD) and significantly impacts functioning. Nuanced measurement of ED is central to understanding its role in this disorder and informing treatment approaches. The present study examined the factor structure of the Emotion Regulation Checklist (ERC)...

Objective: This study examined the extent to which individual differences in executive function (EF) and emotion regulation (ER) were uniquely associated with inattention and hyperactivity symptoms of ADHD, respectively. Method: Participants included 249 preschool children with at-risk or clinically elevated levels of externalizing behavior problem...

Background Callous‐unemotional (CU) behaviors are important for identifying severe patterns of conduct problems (CP). One major fiber tract implicated in the development of CP is the uncinate fasciculus (UF), which connects amygdala and orbitofrontal cortex (OFC). The goals of the current study were to (a) explore differences in the white matter mi...

This study examined the cost-effectiveness of standard parent-child interaction therapy (PCIT) and three adaptations: intensive-PCIT (I-PCIT), small group PCIT, and large group PCIT. This study used cost-effectiveness analyses to calculate average cost-effectiveness ratios, which represents the average cost for one family to change one standard dev...

Given the negative trajectories of early behavior problems associated with ADHD, early diagnosis is considered critical to enable intervention and treatment. To this end, the current investigation employed machine learning to evaluate the relative predictive value of parent/teacher ratings, behavioral and neural measures of executive function (EF)...

Among preschool children referred for psychological assessment and intervention, attention-deficit/hyperactivity disorder (ADHD) is the most commonly diagnosed disorder. In order to create school-based interventions that are consistently and effectively implemented by teachers, it is important to understand teachers’ knowledge and beliefs about ADH...

Emotion recognition/understanding (ERU), which is the ability to correctly identify emotional states in others as well as one's self, plays a key role in children's social-emotional development and is often targeted in early intervention programs. Yet the extent to which young children's ERU predicts their intervention response remains unclear. The...

Objective ADHD symptom severity appears to be exacerbated during the COVID-19 pandemic. The present study surveyed top problems experienced by adolescents and young adults (A/YAs) with ADHD during the COVID-19 pandemic to identify possible reasons for symptom escalation and potential targets for intervention. We also explored perceived benefits of...

Purpose Whereas many prevention and treatment programs exist for children and families, there have been no reviews specifically examining infant mental health outcomes. Furthermore, despite high rates of infants and families experiencing homelessness, little work has evaluated the effectiveness of these parenting programs in such vulnerable populat...

Objective: As part of a larger community-based, service driven research project, the purpose of this study was to 1) document the clinical needs of sheltered children (i.e., externalizing behavior problems [EBP], trauma symptoms, and developmental status) and 2) examine the effectiveness of time-limited adaptations of Parent Child Interaction Thera...

Objective: This study examined associations between temperament (negative affect, effortful control, and surgency) and symptoms of attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) within a diverse preschool sample. Interactions between temperament and parenting in the prediction of ADHD/ODD symptoms before and...

Evidence-based behavior therapy for adolescent ADHD faces implementation challenges in real-world settings. The purpose of this trial was to investigate the relationship between implementation fidelity and outcomes among adolescents receiving services in the active treatment arm (N=114; Motivational Interviewing (MI)-enhanced parent-teen behavior t...

Speech articulation is supported by a number of perisylvian cortical and subcortical brain regions, and this network is structurally connected by several long association fiber pathways. One of these, the frontal aslant tract (FAT), connects the pre-supplementary motor area (pre-SMA) and SMA and the inferior frontal gyrus pars opercularis (IFGOp)....

Neurite Orientation Dispersion and Density Imaging (NODDI) offers enormous promise for illuminating microstructural processes involved in brain development. Through the use of NODDI, our study examined myelination and synapse formation across typical (TD) and atypical brain development, and whether these microstructural properties predict executive...

Given the negative trajectories of early behavior problems associated with Attention-Deficit/Hyperactivity Disorder (ADHD), early diagnosis of ADHD is considered critical to enable early intervention and treatment. To this end, the current investigation employed machine learning to evaluate the relative predictive value of parent/teacher ratings, a...

Background Callous-unemotional (CU) behaviors are important for identifying severe patterns of conduct problems (CP). One major fiber tract implicated in the development of CP is the uncinate fasciculus (UF), which connects amygdala and orbitofrontal cortex (OFC). The goals of the current study were to 1) explore differences in the white matter mic...

Background The ability to dissociate axonal density in vivo from other microstructural properties of white matter is important for the diagnosis and treatment of neurologic disease, and new methods to do so are being developed. We investigated one such method–restricted diffusion imaging (RDI)–to see whether it can more accurately replicate histolo...

Objective This study tests the effectiveness of parent-teen psychotherapy for adolescent ADHD (Supporting Teens’ Autonomy Daily; STAND) versus Usual Care (UC) in four community clinics. Method A randomized clinical trial was conducted with double randomization of adolescents and therapists to STAND vs. UC. Participants were 278 culturally-diverse...

The current study examined the feasibility and initial efficacy of the Summer Treatment Program for Pre-kindergarteners (STP-PreK) with 37 preschoolers with autism spectrum disorder (ASD) and externalizing behavior problems (EBP). Parents and teachers reported on children’s behavior, social/adaptive skills, and self-regulation. Children completed a...

Objective: The current study examined the comparative efficacy of a more intensive version of Parent-Child Interaction Therapy (I-PCIT; 5 days/week over 2 weeks) versus a time-limited weekly PCIT format (1 day/week over 10 weeks) in treating early childhood externalizing behavior problems. Method: Using a randomized trial design, 60 young childr...

Objective: This study utilized a multimodal approach to examine emotion dysregulation (ED) in young children with attention-deficit/hyperactivity disorder (ADHD), ADHD + oppositional defiant disorder (ODD), and typically developing (TD) children. Methods: We sought to explore if specific domains of ED (emotion regulation [ER], negativity/lability [...

The objective of this study is to evaluate support for three hypotheses about the etiology of adolescent-onset ADHD symptoms: (1) a “cool” cognitive load hypothesis, (2) a “hot” rewards processing hypothesis, and (3) a trauma exposure hypothesis. Participants (N = 50) were drawn from two public high schools in a culturally diverse metropolitan area...

Despite the promise of psychosocial interventions for adolescent Attention Deficit Hyperactivity Disorder (ADHD), there are no studies that examine their implementation in community mental health contexts. In this study, we evaluate the implementation of community-based Supporting Teens’ Autonomy Daily (STAND), a parent-teen Motivational Interviewi...

Objective: To examine how fidget spinners affect children with ADHD’s gross motor activity and attentional functioning in class, both during the initial and final phase of an intensive evidence-based behavioral treatment. Method: Using an A-B-A-B design, 60 children (Mage = 4.86 years, 83% Hispanic) diagnosed with ADHD participated in the study. Fo...

Attention-Deficit/Hyperactivity Disorder (ADHD) is associated with academic failure in high school; however the underpinnings of these difficulties are insufficiently understood. This study examined deficits in self-regulated learning in a sample of high school students with ADHD (n = 32) compared to demographically similar classmates without ADHD...

Callous-unemotional (CU) traits are important characteristics for identifying severe patterns of conduct problems (CP). The current study focused on (a) identifying subgroups of young children displaying a combination of CP and CU behaviors and (b) examining the extent to which executive functioning (EF) and emotion regulation (ER) are associated w...

Although obsessive–compulsive disorder (OCD) has often been characterized as an internalizing disorder, some children with OCD exhibit externalizing behaviors that are specific to their OCD. This study sought to demonstrate that parents perceive both internalizing and externalizing behaviors in childhood OCD by examining the factor structure of the...

Objective We examined the association between parent and child fruit and vegetable (F&V) intake, physical activity (PA), and body mass index in an ethnic minority and low-income sample. Methods The study sample consisted of 86 children ages 5–7 years (80% Hispanic) and their parents. Three parent health variables (healthy weight, recommended F&V se...

Objective The purpose of the current study was to evaluate the feasibility and initial efficacy of a large-group, time-limited Parent Child Interaction Therapy (PCIT) adaptation for parents of children with autism spectrum disorder (ASD) and externalizing behavior problems (EBP). Methods Participants included parents of 37 preschoolers (Mage = 4.8...

The purpose of the current study was to identify profiles of self-regulation across executive functioning (EF) and emotion regulation (ER) and examine profiles’s impact on treatment outcomes. Participants included 100 preschoolers (Mage = 4.73, 75% Male, 79% Hispanic) including 37 with autism spectrum disorder and attention-deficit/hyperactivity di...

The goals of this study were to (a) isolate the ideal length (i.e., 4 or 8 weeks) of the Summer Treatment Program for Kindergarteners (STP-PreK) for improving school readiness and kindergarten success outcomes of preschool children with externalizing behavior problems (EBPs) during the transition to kindergarten; and (b) compare the STP-PreK model...

The purpose of the current study was to examine the role of autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) symptoms in predicting deficits in self-regulation across the domains of executive functioning and emotion regulation. Parents of 40 preschoolers with externalizing behavior problems reported on children’s A...

This study examined the role of callous-unemotional (CU) traits in preschoolers with externalizing behavior problems (EBP) and their response to time-out (TO). One hundred ninety preschoolers (76% boys, Mage = 4.92) with at-risk/clinically elevated levels of EBP participated in an 8-week summer treatment program (STP-PreK). Total number of minutes...

The purpose of this study was to examine the additional benefit of an adaptive Cogmed working memory training (CWMT) to a social-emotional/self-regulation classroom curriculum for preschoolers with externalizing behavior problems (EBP). Participants for this study included 49 children (71% boys, Mage = 4.52) with at-risk or clinically elevated leve...

Objective: The purpose of the study was to identify profiles of social functioning for preschoolers with externalizing behavior problems (EBP) and examine how profiles are predictive of response to a behavioral treatment program. Method: 139 preschoolers with EBP participated in an 8-week Summer Treatment Program for Pre-Kindergartners (STP-PreK...

In this review, we examine the structural connectivity of a recently-identified fiber pathway, the frontal aslant tract (FAT), and explore its function. We first review structural connectivity studies using tract-tracing methods in non-human primates, and diffusion-weighted imaging and electrostimulation in humans. These studies suggest a monosynap...

We investigated the development of a recently identified white matter pathway, the frontal aslant tract (FAT) and its association with executive function and externalizing behaviors in a sample of 129 neurotypical male and female human children ranging in age from 7 months to 19 years. We found that the FAT could be tracked in 92% of those children...

Objective: To examine within an at-risk/clinical sample of preschool-aged children with externalizing problems: (1) which disruptive behavior and attention disorder symptoms (i.e., inattention, hyperactivity/impulsivity, and oppositionality/aggression) and (2) what aspects of parenting (e.g., discipline practices or stress) are related to children...

This study sought to examine parent perceptions of medication use for 151 preschool children (M age = 5.05 years, 78% male, 82% Hispanic/Latino) with or at-risk for ADHD who were medication naive. Parents completed questionnaires regarding family background and perceptions of medication treatment. Parents and teachers completed ratings of child dia...

Within an at-risk sample of preschoolers with externalizing behavior problems (EBP), the current study examined the initial promise of a multimodal intervention, the Summer Treatment Program for Pre-Kindergarteners (STP-PreK), in improving parenting outcomes. Using an open trial design, 154 parents and their preschool children (73% male; M age = 5....

The current study examined differences in working memory (WM) between monolingual and bilingual Hispanic/Latino preschoolers with disruptive behavior disorders (DBDs). A total of 149 children (Mage = 5.10 years, SD = 0.53; 76% male) with elevated levels of DBDs, as indicated by their parents or teachers, were recruited to participate in an 8-week s...

Objective: To examine initial outcomes of an 8-week Healthy-Lifestyle Intervention Program (HIP) which included children's participation in a daily summer camp along with parents' participation in a parenting program focused on overweight/obesity. Methods: Using a nonrandomized pilot trial design, 16 children (M child age = 6.42 yr; 81% male; 10...

The purpose of this study was to examine how parental homework completion, session attendance, and treatment knowledge influenced parenting practices and confidence in using learned skills during behavioral parent training (BPT). Parents of 54 preschoolers (Mage = 5.07, 82% Hispanic/Latino) with externalizing behavior problems participated in an 8-...

We investigated the development of a recently-identified white matter pathway, the frontal aslant tract (FAT) and its association to executive function and externalizing behaviors in a sample of 129 neurotypical children ranging in age from 7 months to 19-years. We found that the FAT could be tracked in 92% of those children, and that the pathway s...

Research has demonstrated an association between parenting stress and child behavior problems, and suggested levels of parenting stress are higher among parents of children at risk for behavior problems, such as those with autism and developmental delay (ASD/DD). The goal of the present study was to conduct a systematic review of parenting stress a...

Behavioral parent training (BPT) and attachment interventions have demonstrated efficacy in improving outcomes for young children. Despite theoretical overlap in these approaches, the literature has evolved separately, particularly with respect to outcome measurement in BPT. We examined the impact of the Infant Behavior Program (IBP), a brief home-...

This study examined the extent to which positive and negative parenting relates to conduct problems (CP) and callous-unemotional (CU) traits among 172 adolescents (72 % males; Mage = 16.91 years, SD = .67) with attention-deficit/hyperactivity disorder and whether CU traits moderate the link between parenting and CP. Mothers reported on their adoles...