Early life stress (ELS) is a significant risk factor for the emergence of internalizing problems in adolescence. Beginning in adolescence, females are twice as likely as males to experience internalizing disorders. The present study was designed to examine sex differences in the association between ELS and internalizing problems in early pubertal adolescents, and whether and how corticolimbic function and connectivity may underlie these associations. Fifty-nine early pubertal males and 78 early pubertal females, ages 9–13 years (all Tanner Stage 3 or below) underwent functional magnetic resonance imaging as they performed an emotion label task that robustly interrogates corticolimbic function. Participants were also interviewed about their experience of ELS. Females exhibited a positive association between ELS and internalizing problems, whereas males exhibited no such association. Whole-brain and amygdala region of interest analyses indicated that whereas females exhibited a positive association between ELS and the ventrolateral prefrontal cortex during implicit emotion regulation, males showed no such association. Activation in these regions was positively associated with internalizing problems in females but not males; however, activation in these regions did not mediate the association between ELS and internalizing problems. Finally, both boys and girls exhibited an association between ELS and increased negative connectivity between the right ventrolateral prefrontal cortex and bilateral amygdala. Using a carefully characterized sample of early pubertal adolescents, the current study highlights important sex differences in the development of corticolimbic circuitry during a critical period of brain development. These sex differences may play a significant role in subsequent risk for internalizing problems.

To complete the curriculum, learners rotating through a pediatric palliative care service are asked to submit a piece of reflective writing. Here, we share an edited version of the narrative one student submitted, accompanied by a brief consideration of the numerous benefits of reflective writing for medical trainees (including improved communication and professionalism skills, as well as increased levels of empathy and comfort when facing complex or difficult situations). Additionally, we describe how brief personal narratives may serve to reduce common misconceptions and confusion by educating patients, families, and clinicians about the reality and the role of pediatric palliative care.

Purpose: More than 1,500,000 adolescents in the United States report using emergency services for the majority of their medical needs. Although the American Council for Graduate Medical Education offers some guidance on the inclusion of pediatric topics in an emergency medicine (EM) residency curriculum, it does not specifically address adolescent-related competencies. We aimed to develop a consensus on which adolescent health topics are most important to cover in a didactic curriculum for EM residents.Methods: Physicians from multiple specialties, such as EM, pediatric EM, and adolescent medicine, were invited as panelists in a modified Delphi process. In round 1, the panelists were asked to determine which competencies in adolescent medicine are most important for a graduating EM resident to master. In round 2, they were asked to specify the competencies that should be included in an EM residency didactic curriculum. In round 3, they prioritized the most critical competencies for curriculum inclusion.Results: Consensus was reached on a total of 26 topics that were found crucial to be included in a didactic curriculum for EM residents. Of these, the panel prioritized the following: (1) “manage a patient presenting after reported sexual assault,” (2) “accurately diagnose ovarian torsion,” and (3) “manage a patient presenting for symptoms of sexually transmitted infection.” Conclusion: The modified Delphi process yielded recommendations to guide the development of an adolescent medicine curriculum for EM residents. Sexual and reproductive healthcare issues were identified as the most important topics.