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DuPaul GJ, Evans SW, Cleminshaw-Mahan CL, Fu Q. School-Based Intervention for Adolescents With ADHD: Predictors of Effects on Academic, Behavioral, and Social Functioning. Behav Ther 2024; 55:680-697. [PMID: 38937043 DOI: 10.1016/j.beth.2024.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 11/26/2023] [Accepted: 01/11/2024] [Indexed: 06/29/2024]
Abstract
Adolescents with attention-deficit/hyperactivity disorder (ADHD) experience significant academic, behavioral, and social skill difficulties including underachievement, risk for school dropout, poor peer relations, and emotion dysregulation. Although stimulant medication reduces ADHD symptoms, psychosocial and educational interventions are necessary to address functional impairments. We examined the nature and predictors of academic, behavioral, and social skills trajectories in response to multicomponent organizational and interpersonal skills training in 92 high school students with ADHD. Latent trajectory class analyses revealed positive treatment response ranging from 61.5% (report card grades) to 100% (inattention symptoms, organizational skills, social skills). Organizational skill and academic grade treatment response trajectories were predicted by assigned sex, pretreatment anxiety, and treatment dosage, while improvement in behavioral and social functioning was associated with better emotion regulation and family relations prior to treatment along with stronger working alliance with treatment coach at midtreatment. Multicomponent organizational and interpersonal skills training appears effective for most high school students with ADHD and the degree treatment-induced change is associated with multiple malleable factors can be leveraged to enhance intervention response.
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Chacko A, Merrill BM, Kofler MJ, Fabiano GA. Improving the efficacy and effectiveness of evidence-based psychosocial interventions for attention-deficit/hyperactivity disorder (ADHD) in children and adolescents. Transl Psychiatry 2024; 14:244. [PMID: 38851829 PMCID: PMC11162428 DOI: 10.1038/s41398-024-02890-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 02/14/2024] [Accepted: 03/22/2024] [Indexed: 06/10/2024] Open
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a prevalent, chronic, and impairing mental health disorder of childhood. Decades of empirical research has established a strong evidence-based intervention armamentarium for ADHD; however, limitations exist in regards to efficacy and effectiveness of these interventions. We provide an overview of select evidence-based interventions for children and adolescents, highlighting potential approaches to further improving the efficacy and effectiveness of these interventions. We conclude with broader recommendations for interventions, including considerations to moderators and under-explored intervention target areas as well as avenues to improve access and availability of evidence-based interventions through leveraging underutilized workforces and leveraging technology.
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Fabiano GA, Lupas K, Merrill BM, Schatz NK, Piscitello J, Robertson EL, Pelham WE. Reconceptualizing the approach to supporting students with attention-deficit/hyperactivity disorder in school settings. J Sch Psychol 2024; 104:101309. [PMID: 38871418 PMCID: PMC11331420 DOI: 10.1016/j.jsp.2024.101309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 09/19/2023] [Accepted: 03/16/2024] [Indexed: 06/15/2024]
Abstract
The long-term academic outcomes for many students with attention-deficit/hyperactivity disorder (ADHD) are strikingly poor. It has been decades since students with ADHD were specifically recognized as eligible for special education through the Other Health Impaired category under the Education for all Handicapped Children Act of 1975, and similarly, eligible for academic accommodations through Section 504 of the 1973 Rehabilitation Act. It is time to acknowledge that these school-policies have been insufficient for supporting the academic, social, and behavioral outcomes for students with ADHD. Numerous reasons for the unsuccessful outcomes include a lack of evidence-based interventions embedded into school approaches, minimizing the importance of the general education setting for promoting effective behavioral supports, and an over-reliance on assessment and classification at the expense of intervention. Contemporary behavioral support approaches in schools are situated in multi-tiered systems of support (MTSS); within this article we argue that forward-looking school policies should situate ADHD screening, intervention, and maintenance of interventions within MTSS in general education settings and reserve special education eligibility solely for students who require more intensive intervention. An initial model of intervention is presented for addressing ADHD within schools in a manner that should provide stronger interventions, more quickly, and therefore more effectively.
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Evans SW, DuPaul GJ, Benson K, Owens JS, Fu Q, Cleminshaw C, Kipperman K, Margherio S. Social Functioning Outcomes of a High School-Based Treatment Program for Adolescents with ADHD. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2024; 53:413-428. [PMID: 37494306 DOI: 10.1080/15374416.2023.2235693] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
OBJECTIVE We evaluated the extent to which receiving the multi-component treatment of the Challenging Horizons Program (CHP) would lead to significant improvements in social functioning, as well as in inattention, internalizing symptoms, parent stress, and emotion dysregulation for high-school-aged adolescents with attention-deficit hyperactivity disorder (ADHD). METHOD Participants were 186 high-school-aged adolescents (74% White) with a diagnosis of ADHD who were randomly assigned to either CHP (n = 92; 80% boys; M age = 15.0; SD = 0.8) or Community Care (CC; n = 94; 78% boys; M age = 15.1; SD = 0.9) within each of 12 participating schools. Parent and adolescent reports of social functioning were the primary outcome measures. Secondary outcomes included ratings of symptoms of ADHD and related disorders, parent stress, and emotion regulation. RESULTS Intent-to-treat analyses using hierarchical linear modeling revealed significant group-by-time interactions of medium magnitude (d range = .40 to .52) on parent-rated social skills. Significant group-by-time benefits were also identified for adolescent self-rated social skills as well as the secondary outcomes of parent-rated inattention symptoms, emotion regulation, and parenting stress. DISCUSSION CHP appears to benefit social skills along with related characteristics for adolescents with ADHD. Understanding these unique findings for this population informs additional research related to treatment mechanisms and effectiveness trials.
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Affiliation(s)
| | - George J DuPaul
- Department of Education and Human Services, Lehigh University
| | | | | | - Qiong Fu
- Department of Education and Human Services, Lehigh University
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Ruchkin V, Wallonius M, Odekvist E, Kim S, Isaksson J. Memory training with the method of loci for children and adolescents with ADHD-A feasibility study. APPLIED NEUROPSYCHOLOGY. CHILD 2024; 13:137-145. [PMID: 36344263 DOI: 10.1080/21622965.2022.2141120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The aim of this study was to investigate if training with the memory technique Method of Loci (MoL) is feasible for children and adolescents with ADHD. Twelve children (aged 9-17 years) with ADHD participated. Training with MoL was done using a mobile application, memorizing a sequence of 20-80 pictures, intended to be carried out five times per week for 4 weeks. Feasibility was assessed with pre- and post-intervention ratings, and with interviews after the training. Qualitative data were analyzed with content analysis. Those who trained with MoL performed better on memory test and reported fewer ADHD symptoms after completing the training, as compared to their baseline levels. All of these children would recommend the training to peers but the duration of training varied considerably. The participants and their parents reported that the MoL training was easy and fun to use, although lack of motivation, distractions in every-day life, and lack of routines created challenges. We conclude that training with MoL was considered feasible by most of the participants. Future research should try to make the intervention more acceptable by motivating the participants and limiting potential distractions and involving larger study groups and controls to study the efficacy of the training.
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Affiliation(s)
- Vladislav Ruchkin
- Child and Adolescent Psychiatry Unit, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
- Child Study Center, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Marwin Wallonius
- Child and Adolescent Psychiatry Unit, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Emma Odekvist
- Child and Adolescent Psychiatry Unit, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Sharmeen Kim
- Child and Adolescent Psychiatry Unit, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Johan Isaksson
- Child and Adolescent Psychiatry Unit, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
- Department of Women's and Children's Health, Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Karolinska Institutet & Stockholm Health Care Services, Stockholm, Sweden
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Thorell LB, Klint Carlander AK, Demetry Y, Marainen L, Nilsson S, Skoglund C. Parental Experiences of Distance Learning in Families with and without an Adolescent with ADHD/ASD: A Large Qualitative Survey Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:388. [PMID: 38673301 PMCID: PMC11049798 DOI: 10.3390/ijerph21040388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 03/19/2024] [Accepted: 03/22/2024] [Indexed: 04/28/2024]
Abstract
One of the greatest COVID-19-related challenges for children and their families was managing distance learning due to school closures. We also know from previous research that families with a child with a neurodevelopmental disorder such as ADHD or ASD were struggling more than others but also experienced some positive effects. However, few qualitative studies have been conducted. The present study therefore aimed to investigate parental experiences of the negative and positive effects of distance learning during the COVID-19 pandemic in a large sample of families with an adolescent with ADHD and/or ASD and a matched comparison group (n = 682). Data were collected through open-ended questions as part of a larger survey study. Five main themes with different sub-themes were identified for both negative and positive effects: (1) Teaching, (2) Social, (3) Support, (4) Child factors, and (5) Home environment. In addition, the main theme "Technical problems" was identified for negative effects. Families with a child with ADHD/ASD reported negative effects related to "Child factors" and "Support" more frequently than the controls, as well as negative effects related to some aspects of "Teaching" and "Technical problems". Regarding positive effects, significant group differences were primarily found for the theme "Child factors". These findings are discussed both in terms of how to best prepare for possible future pandemics, but also of how to best provide educational support for children with ADHD and/or ASD when schools are open.
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Affiliation(s)
- Lisa B. Thorell
- Department of Clinical Neuroscience, Karolinska Institutet, 17177 Stockholm, Sweden
| | | | - Youstina Demetry
- Department of Clinical Neuroscience, Karolinska Institutet, 17177 Stockholm, Sweden
| | - Lisa Marainen
- Department of Clinical Neuroscience, Karolinska Institutet, 17177 Stockholm, Sweden
| | - Sarah Nilsson
- Department of Clinical Neuroscience, Karolinska Institutet, 17177 Stockholm, Sweden
| | - Charlotte Skoglund
- Department of Women and Child Health, Uppsala University, 75124 Uppsala, Sweden
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Hulsbosch AK, Beckers T, De Meyer H, Danckaerts M, Van Liefferinge D, Tripp G, Van der Oord S. Instrumental learning and behavioral persistence in children with attention-deficit/hyperactivity-disorder: does reinforcement frequency matter? J Child Psychol Psychiatry 2023; 64:1631-1640. [PMID: 37040877 DOI: 10.1111/jcpp.13805] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/06/2023] [Indexed: 04/13/2023]
Abstract
BACKGROUND Prominent theoretical accounts of attention-deficit/hyperactivity-disorder (ADHD) hypothesize that reinforcement learning deficits underlie symptoms of ADHD. The Dynamic Developmental Theory and the Dopamine Transfer Deficit hypothesis assume impairments in both the acquisition and extinction of behavior, especially when learning occurs under partial (non-continuous) reinforcement, and subsequently the Partial Reinforcement Extinction Effect (PREE). Few studies have evaluated instrumental learning in ADHD and the results are inconsistent. The current study investigates instrumental learning under partial and continuous reinforcement schedules and subsequent behavioral persistence when reinforcement is withheld (extinction) in children with and without ADHD. METHODS Large well-defined samples of children with ADHD (n = 93) and typically developing (TD) children (n = 73) completed a simple instrumental learning task. The children completed acquisition under continuous (100%) or partial (20%) reinforcement, followed by a 4-min extinction phase. Two-way (diagnosis by condition) ANOVAs evaluated responses needed to reach the learning criterion during acquisition, and target and total responses during extinction. RESULTS Children with ADHD required more trials to reach criterion compared to TD children under both continuous and partial reinforcement. After partial reinforcement, children with ADHD executed fewer target responses during extinction than TD children. Children with ADHD executed more responses than TD children during extinction, irrespective of learning condition. CONCLUSIONS The findings demonstrate general difficulties in instrumental learning in ADHD, that is, slower learning irrespective of reinforcement schedule. They also show faster extinction following learning under partial reinforcement in those with ADHD, that is, a diminished PREE. Children with ADHD executed more responses during extinction. Results are theoretically important, with clinical implications for understanding and managing learning difficulties in those with ADHD, as they suggest poorer reinforcement learning and lower behavioral persistence.
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Affiliation(s)
- An-Katrien Hulsbosch
- Behavior, Health and Psychopathology, KU Leuven, Leuven, Belgium
- Child and Youth Institute, KU Leuven, Leuven, Belgium
| | - Tom Beckers
- Behavior, Health and Psychopathology, KU Leuven, Leuven, Belgium
- Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Hasse De Meyer
- Department of Psychology, National University of Singapore, Singapore City, Singapore
| | - Marina Danckaerts
- Leuven Brain Institute, KU Leuven, Leuven, Belgium
- Center for Developmental Psychiatry, KU Leuven, Leuven, Belgium
- University Psychiatric Centre, KU Leuven, Leuven, Belgium
| | | | - Gail Tripp
- Human Developmental Neurobiology Unit, Okinawa Institute of Science and Technology Graduate University, Onna, Okinawa, Japan
| | - Saskia Van der Oord
- Behavior, Health and Psychopathology, KU Leuven, Leuven, Belgium
- Child and Youth Institute, KU Leuven, Leuven, Belgium
- Leuven Brain Institute, KU Leuven, Leuven, Belgium
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Margherio SM, Evans SW, Monopoli WJ, Langberg JM. Cost-Effectiveness of a Training Intervention for Adolescents with ADHD. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2023; 52:819-833. [PMID: 33630716 DOI: 10.1080/15374416.2021.1875323] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The aim of this study was to examine the costs and cost-effectiveness of a school-based training intervention delivered at varying levels of intensity with adolescents with attention-deficit/hyperactivity disorder (ADHD). Costs were examined in relation to post-treatment and 6-month follow-up effects of the Challenging Horizons Program (CHP), a training intervention for adolescents with ADHD. METHOD A total of 326 middle-school students (71% male; 77% White) with ADHD were randomized to an after-school version of the CHP (CHP-AS), a less-intensive mentoring version (CHP-M), or routine community care. Detailed time logs were maintained throughout the study and were used to estimate costs associated with each condition. Student grade point average (GPA) and parent-rated ADHD symptoms and organization skills were collected at post-treatment and 6-month follow-up. RESULTS The cost analysis revealed that CHP-AS was more costly per student than CHP-M, both in terms of overall costs and direct expenses to the school. However, CHP-AS was less costly per hour of intervention provided to the youth than CHP-M. Incremental cost-effectiveness ratios revealed that CHP-M may be the more cost-effective option for post-treatment effects, yet CHP-AS may be the more cost-effective option in the long term for sustained gains in organization skills and GPA. CONCLUSIONS This study provides stakeholders important information to make decisions regarding allocation of finite monetary resources to meet their prioritized goals.
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AlOmar RS, AlShamlan NA, Al-Johani WM, Almayyad AH, Alotaibi HK, Alsamin SI, Alfrayyan NY, Boubshait LA, Alghamdi LM, Al-Shammari MA. Adult ADHD Positive Screening and Sibship, Birth Order and Academic Achievement: Implications for Epidemiologists and Physicians in the Kingdom of Saudi Arabia. Psychol Res Behav Manag 2023; 16:4069-4081. [PMID: 37817910 PMCID: PMC10561610 DOI: 10.2147/prbm.s426715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 09/22/2023] [Indexed: 10/12/2023] Open
Abstract
Background Attention deficit hyperactivity disorder (ADHD) among the youth and university students differs internationally. This study aims to assess the prevalence of ADHD positivity from a validated screening test among medical students across the Kingdom of Saudi Arabia (KSA) and its associated sociodemographic and family-related factors and the impact of ADHD on students' academic performance. Also, to highlight the implications of the current findings on epidemiologists and family physicians in the region. Methods This cross-sectional study utilised the Adult ADHD Self-Report Scale (ASRS) symptom checklist along with several questions on sociodemographic, siblings and personal academic achievement. Multivariable logistic regression models were performed to obtain the Odds Ratios (ORs) of risk of ADHD screening positivity and their 95% confidence intervals (CIs) against potential predictors. Results The overall prevalence of positively screened medical students was 38.86%. After adjustment, a statistically significant increased risk of ADHD positivity was observed for students who had one sibling (OR = 1.70, 95% CI = 1.09-2.64). Also, upon examination of birth order, a significant increased risk was observed for students who were firstborn (OR = 1.22, 95% CI = 1.02-1.47). With regard to academic achievement, both before and after adjustment, students who screened positive had a 14% increased risk of obtaining an F GPA (OR = 1.14, 95% CI = 0.99-1.30). Conclusion A considerable number of medical students are potentially positive for ADHD. Albeit not diagnostically confirmed - this indicates that a substantial number of people have displayed symptoms akin to ADHD, but were not clinically diagnosed. Research into ADHD in the region is still in its infancy, and epidemiologists would benefit from high-quality databases to address this condition. Also, primary care physicians should develop skills in detecting and managing ADHD in children at an earlier age to improve symptoms in adulthood.
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Affiliation(s)
- Reem S AlOmar
- Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
| | - Nouf A AlShamlan
- Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
| | - Wejdan M Al-Johani
- Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
| | - Ali H Almayyad
- Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
| | - Hadeel K Alotaibi
- Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
| | - Sarah I Alsamin
- Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
| | - Naif Y Alfrayyan
- Internal Medicine Department, Psychiatry Division, Security Forces Hospital, Riyadh, Kingdom of Saudi Arabia
| | - Leila A Boubshait
- Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
| | - Layla M Alghamdi
- Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
| | - Malak A Al-Shammari
- Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
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Macphee FL, Brewer SK, Sibley MH, Graziano P, Raiker JS, Coxe SJ, Martin P, Van Dreel SJ, Rodriguez MO, Lyon AR, Page TF. Study protocol of a randomized trial of STRIPES: a schoolyear, peer-delivered high school intervention for students with ADHD. BMC Psychol 2023; 11:268. [PMID: 37670368 PMCID: PMC10481510 DOI: 10.1186/s40359-023-01291-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 08/21/2023] [Indexed: 09/07/2023] Open
Abstract
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-delivered intervention (STRIPES) for general education 9th grade students with impairing ADHD symptoms. METHODS A type 1 hybrid effectiveness-implementation design will be used to evaluate the effectiveness of STRIPES and explore the intervention's implementability. Analyses will test the impact of STRIPES vs. enhanced school services control on target mechanisms and determine whether differences in basic cognitive profiles moderate intervention response. The acceptability and feasibility of STRIPES and treatment moderators will also be examined. DISCUSSION This study will generate knowledge about the effectiveness and implementability of STRIPES, which will inform dissemination efforts in the future. A peer-delivered high school intervention for organization, time management, and planning skills can provide accessible and feasible treatment targeting declines in academic motivation, grades, and attendance during the ninth-grade year. TRIAL REGISTRATION This study is registered on OSF Registries (10.17605/OSF.IO/Q8V6S).
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Affiliation(s)
- Fiona L Macphee
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA, USA
| | - Stephanie K Brewer
- Department of Psychiatry & Behavioral Sciences, School of Medicine, University of Washington, 6200 NE 74th St, Suite 100, Seattle, WA, 98115, USA.
| | - Margaret H Sibley
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA, USA
| | - Paulo Graziano
- Department of Psychology, Florida International University, Miami, FL, USA
| | - Joseph S Raiker
- Department of Psychology, Florida International University, Miami, FL, USA
| | - Stefany J Coxe
- Department of Psychology, Florida International University, Miami, FL, USA
| | - Pablo Martin
- Department of Psychology, Florida International University, Miami, FL, USA
| | - Shauntal J Van Dreel
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA, USA
| | - Mercedes Ortiz Rodriguez
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA, USA
| | - Aaron R Lyon
- Department of Psychiatry & Behavioral Sciences, School of Medicine, University of Washington, 6200 NE 74th St, Suite 100, Seattle, WA, 98115, USA
| | - Timothy F Page
- Department of Management, H. Wayne Huizenga College of Business and Entrepreneurship Nova Southeastern University, Florida, USA
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Capps RE, Shea ML, Evans SW. Retrospective Report of Academic Motivation Among College Students With Elevated ADHD Symptoms. J Atten Disord 2023; 27:1284-1295. [PMID: 37158164 DOI: 10.1177/10870547231172799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
OBJECTIVE Children with ADHD exhibit deficits in academic motivation compared to their peers. Yet conceptualizations of motivation according to prominent motivation theories connected to achievement have not been studied in college-bound youth with ADHD symptoms. METHOD This study examined motivation according to these theories, differences in motivation by ADHD symptoms, and how the cross-sectional association between motivation and achievement varies by ADHD symptoms. The sample included 461 first-year college students retrospectively reporting their motivation and achievement in their last year of high school. RESULTS Results indicated differences in motivation by ADHD symptoms. Mastery achievement goal orientation was uniquely associated with achievement and exerted beneficial effects on achievement at moderate to high ADHD symptom levels. CONCLUSION Motivation may operate differently in association with achievement for college-bound youth with ADHD symptoms compared to youth with no to low symptoms.
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Ryst E, Childress A. An updated safety review of the current drugs for managing ADHD in children. Expert Opin Drug Saf 2023; 22:1025-1040. [PMID: 37843488 DOI: 10.1080/14740338.2023.2271392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 10/12/2023] [Indexed: 10/17/2023]
Abstract
INTRODUCTION Attention-Deficit/Hyperactivity Disorder (ADHD) is a highly prevalent condition that causes persistent problems with attention and/or hyperactivity-impulsivity and often results in significant impairment when left untreated. Medications for this disorder continue to evolve and provide new treatment options. Ongoing review of related medication safety and tolerability remains an important task for prescribers. AREAS COVERED This manuscript provides an updated safety review of medications used to treat ADHD in children and adolescents. PubMed and OneSearch online databases were utilized to search for literature relevant to the topic of ADHD medications and safety. Clinical trials of medications used to treat ADHD, systematic reviews and meta-analyses, and articles covering specific safety issues (adverse or unfavorable events) such as cardiovascular effects, seizures, impact on growth, depression, suicidal ideation, substance use disorders, psychosis, and tics are described. EXPERT OPINION Available pharmacologic treatments for ADHD have favorable efficacy, safety and tolerability and allow many patients to achieve significant improvement of their symptoms. Despite the availability of multiple stimulant and non-stimulant formulations, some individuals with ADHD may not tolerate available medications or attain satisfactory improvement. To satisfy unmet clinical needs, ADHD pharmaceutical research with stimulant and nonstimulant formulations targeting dopamine, norepinephrine, and novel receptors is ongoing.
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Affiliation(s)
- Erika Ryst
- College of Education and Human Development, University of Nevada, Reno, USA
| | - Ann Childress
- Center for Psychiatry and Behavioral Medicine, Inc, Las Vegas, NV, USA
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Capps RE, Wilson ED, Evans SW, Allan DM, Langberg JM. Impairment's Role in the Pathway From Externalizing Psychopathology to Depressive Symptoms in Adolescents With ADHD. J Atten Disord 2023; 27:887-898. [PMID: 36915046 DOI: 10.1177/10870547231159911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
OBJECTIVE This study examined the role of academic, social, and family impairment in the pathway from externalizing psychopathology to depression among young adolescents with ADHD in a multiple mediation model. METHOD The sample included adolescents with ADHD enrolled in an intervention trial. Parent ratings of externalizing psychopathology were measured at eligibility assessment, adolescent self-reported depressive symptoms were measured at eligibility and at the end of treatment, and parent-rated impairment was measured in the middle of treatment. A multiple mediation model was used to examine mediating effects of impairment types in the pathway from externalizing psychopathology to depression. RESULTS Parent-reported family impairment significantly mediated the association between externalizing psychopathology and depressive symptoms. CONCLUSIONS Results suggest family impairment mediates the association between externalizing psychopathology and depressive symptoms beyond academic and social impairment for youth with ADHD. Findings implicate the importance of targeting family functioning during early adolescence to prevent depression.
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Vňuková M, Děchtěrenko F, Weissenberger S, Anders M, Ptáček R. Childhood School Performance in Adults Diagnosed with Attention-Deficit/Hyperactivity Disorder. J Atten Disord 2023; 27:307-312. [PMID: 36484286 DOI: 10.1177/10870547221140601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Children with ADHD often tend to underperform in school. This partial study aimed to find out if the school experience of adults with higher ADHD symptomatology differs from those with lower and no ADHD symptomatology. METHOD Based on the results of ASRS questionnaires, the respondents were divided into three groups (low, medium, and high) according to the manifested ADHD symptomatology. We explored their school experiences by looking at their grades for behavior at school, notes regarding their attendance, school expulsion, and other school experiences. RESULTS Children with higher ADHD symptomatology were significantly more likely to be expelled, receive notes for bad behavior, disturbing or forgetting as well as receive reprimands from teachers. CONCLUSION Our results show that children with increased ADHD symptomatology experience more difficulties with school behavior, they are frequently reprimanded, and they do receive more negative feedback regarding their attendance and tardiness from teachers.
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Affiliation(s)
- Martina Vňuková
- First Faculty of Medicine Charles University in Prague and General University Hospital in Prague, Czech Republic
| | | | - Simon Weissenberger
- First Faculty of Medicine Charles University in Prague and General University Hospital in Prague, Czech Republic
| | - Martin Anders
- First Faculty of Medicine Charles University in Prague and General University Hospital in Prague, Czech Republic
| | - Radek Ptáček
- First Faculty of Medicine Charles University in Prague and General University Hospital in Prague, Czech Republic
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15
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Danielson ML, Kassab HD, Lee M, Owens JS, Evans SW, Lipton C, Charania S, Young HE, Kubicek LF, Flory K, Cuffe SP. The Utility of the Behavior Assessment System for Children-2 Behavioral and Emotional Screening System and Strengths and Difficulties Questionnaire in Predicting Mental Disorders in the Project to Learn About Youth-Mental Health. PSYCHOLOGY IN THE SCHOOLS 2023; 60:2320-2341. [PMID: 37970221 PMCID: PMC10642258 DOI: 10.1002/pits.22856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 01/03/2023] [Indexed: 01/22/2023]
Abstract
We examined the predictive utility of the Behavior Assessment System for Children-2 Behavioral and Emotional Screening System (BASC-2-BESS) and Strengths and Difficulties Questionnaire (SDQ) in identifying students with a mental disorder. Data were collected in a two-stage study over 34 months with kindergarten-12th grade (K-12) students (aged 5-19 years) in four U.S. school districts. In Stage 1, teachers completed the BASC-2-BESS and the SDQ. In Stage 2, parents of 1,054 children completed a structured diagnostic interview to determine presence of a mental disorder. Results suggest that teacher versions of the BASC-2-BESS and SDQ have modest utility in identifying children meeting criteria for a mental disorder based on parent report. Area Under the Curve (AUC) statistics representing prediction of any externalizing disorder (.73 for both measures) were higher than the AUCs predicting any internalizing disorder (.58 for both measures). Findings can inform the use of teacher report in mental health screening, specifically the selection of measures when implementing screening procedures.
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Affiliation(s)
- Melissa L Danielson
- Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Atlanta GA
| | | | - Mary Lee
- Department of Psychology, Ohio University, Athens, OH
| | | | | | - Corey Lipton
- Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Atlanta GA
- Oak Ridge Institute for Science and Education, Oak Ridge, TN
| | - Sana Charania
- Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Atlanta GA
- Oak Ridge Institute for Science and Education, Oak Ridge, TN
| | - Hayley Elia Young
- Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Atlanta GA
- Rollins School of Public Health, Emory University, Atlanta, GA
| | - Lorraine F Kubicek
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Kate Flory
- Department of Psychology, University of South Carolina, Columbia, SC
| | - Steven P Cuffe
- Department of Psychiatry, University of Florida College of Medicine, Jacksonville, FL
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16
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Meyer J, Zetterqvist V, Unenge Hallerbäck M, Ramklint M, Isaksson J. Moderators of long-term treatment outcome when comparing two group interventions for adolescents with ADHD: who benefits more from DBT-based skills training? BMC Psychiatry 2022; 22:767. [PMID: 36474201 PMCID: PMC9724371 DOI: 10.1186/s12888-022-04435-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 11/28/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Psychosocial interventions for adolescents with attention-deficit/hyperactivity disorder (ADHD), targeting emotional dysregulation and impulsive behaviors, have been requested, but the heterogeneity within this group makes it unlikely that there is one treatment that fits all. The aim of this study was to identify which adolescents with ADHD might have an effect from a structured skills training group (SSTG) based on dialectical behavioral therapy, by exploring pre-treatment characteristics as potential moderators of long-term treatment outcome. METHODS This study was based on follow-up data from a randomized controlled trial comparing the SSTG (n = 71) to a psychoeducational control intervention (n = 57) for adolescents with ADHD (15-18 years old). Clinical characteristics (sex, age, medication status, ADHD presentation, severity of ADHD symptom, psychiatric comorbidity, impairment of emotional dysregulation and functional impairment) were explored as potential moderators of pre-treatment to follow-up change in ADHD symptoms and functional impairment. Moderation analyses were performed using the PROCESS macro for SPSS. RESULTS Three moderators (severity of hyperactivity/impulsivity, conduct problems and impairment of emotional dysregulation) were identified in regard to the outcome self-rated change in ADHD symptoms. Participants with elevated pre-scores on these variables had a better effect of the SSTG than of the psychoeducational control intervention. No moderators were found in regard to the parental-rated outcomes. CONCLUSIONS The SSTG seems to be beneficial for adolescents with ADHD who perceive pronounced symptoms of hyperactivity/impulsivity, conduct problems and emotional dysregulation. Our findings need to be confirmed in future trials evaluating dialectical behavioral therapy-based skills training for adolescents with ADHD, where these moderators could be used as criteria for inclusion or stratification. TRIAL REGISTRATION https://doi.org/10.1186/ISRCTN17366720 , retrospectively registered.
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Affiliation(s)
- Jenny Meyer
- grid.8993.b0000 0004 1936 9457Department of Medical Sciences, Child and Adolescent Psychiatry Unit, Uppsala University, Uppsala, Sweden ,grid.4714.60000 0004 1937 0626Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | - Vendela Zetterqvist
- grid.8993.b0000 0004 1936 9457Department of Medical Sciences, Child and Adolescent Psychiatry Unit, Uppsala University, Uppsala, Sweden ,grid.4714.60000 0004 1937 0626Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Maria Unenge Hallerbäck
- grid.15895.300000 0001 0738 8966School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden ,grid.20258.3d0000 0001 0721 1351Public Health Sciences, Karlstad University, Karlstad, Sweden
| | - Mia Ramklint
- grid.8993.b0000 0004 1936 9457Department of Medical Sciences, Child and Adolescent Psychiatry Unit, Uppsala University, Uppsala, Sweden
| | - Johan Isaksson
- Department of Medical Sciences, Child and Adolescent Psychiatry Unit, Uppsala University, Uppsala, Sweden. .,Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
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17
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Niemi S, Lagerström M, Alanko K. School attendance problems in adolescent with attention deficit hyperactivity disorder. Front Psychol 2022; 13:1017619. [PMID: 36506967 PMCID: PMC9726763 DOI: 10.3389/fpsyg.2022.1017619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 11/01/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction: A link between having a neurodevelopmental disorder, such as attention deficit hyperactivity disorder (ADHD) and school absenteeism, has been found in previous studies. Why ADHD poses a risk for absenteeism remains unclear, and insight into the mechanisms of the association is needed. The aim of the present study was to investigate school attendance problems (SAP) and both the symptoms related and the perceived reasons for them, as reported by adolescents with ADHD (n = 95), compared with neurotypical adolescents (n = 1,474). Method: The current study (N = 1,569) was part of the School absence in Finland-project. SAPs were measured with the Inventory of School Attendance Problems (ISAP). The ISAP questionnaire contains a symptom scale (ISAP S) and a function scale (ISAP F), which shows if and how the symptoms impacts school attendance. A linear mixed effects model was used to analyze outcomes on the ISAP factors, controlling for background variables living status, gender, other diagnoses, highest level of education for the parent and age. Results: Results show that adolescents with ADHD had been more absent from school compared to neurotypical adolescents during the prior 12-weeks. Adolescents with ADHD showed significantly more symptoms of agoraphobia/panic, problems within the family and problems with parents than neurotypical peers. The symptoms separation anxiety, agoraphobia/panic, aggression, problems within the family and problems with parents more often were perceived as the reason for SAP (ISAP F). Discussion: The results are in line with our initial hypotheses and previous studies. Because of the low response rate on the ISAP F scale, the results regarding reasons for SAPs should be interpreted with caution. Future research could examine specific preventive actions of SAPs for adolescents with ADHD, and different subtypes of ADHD.
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18
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The Homework Problems Checklist: Psychometric Properties and Usefulness in teens with and without ADHD. SCHOOL MENTAL HEALTH 2022. [DOI: 10.1007/s12310-022-09548-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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19
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Piscitello J, Altszuler AR, Mazzant JR, Babinski DE, Gnagy EM, Page TF, Molina BSG, Pelham WE. The Impact of ADHD on Maternal Quality of Life. Res Child Adolesc Psychopathol 2022; 50:1275-1288. [PMID: 35648330 PMCID: PMC9613519 DOI: 10.1007/s10802-022-00935-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2022] [Indexed: 11/24/2022]
Abstract
Childhood attention-deficit/hyperactivity disorder (ADHD) is associated with substantial burden to caregiver quality of life (QoL). However, a paucity of work has focused on quantifying QoL among caregivers of adolescents with a history of ADHD. The purpose of the current study was (1) to quantify maternal QoL in a sample of mothers of adolescents with and without childhood ADHD; and (2) to examine predictors (i.e., parent and child characteristics and behavior) associated with maternal QoL. Participants included mothers of adolescents with (N = 110) and without ADHD (N = 90) ranging in age from 13 to 18 (M = 16.09, 92% male). The Quality Adjusted Life-Year (QALY) was used to calculate maternal QoL using two health domains (i.e., anxiety/depression and disruption in daily activities) commonly impacted by raising youth with ADHD. QALYs are valued monetarily to estimate disease burden. Mothers of adolescents with childhood ADHD experienced significantly worse QoL relative to mothers in the comparison group. Maternal depression, as well as adolescent age, ADHD status, and discipline problems significantly predicted lower levels of maternal QALY health status index, with ADHD being the strongest predictor. This is equal to a reduction in 1.96 QALYs when summed over the course of a child's lifetime and is associated with a loss of $98,000 to $196,000. Results of the investigation help to further elucidate the health impacts incurred by families of adolescents with ADHD and have important public health implications. Further, parental QoL should be considered when conceptualizing the financial and negative health impact of ADHD.
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Affiliation(s)
- Jennifer Piscitello
- Center for Children and Families, Florida International University, 11200 SW 8th Street, Miami, FL, 33199, US.
| | - Amy R Altszuler
- Center for Children and Families, Florida International University, 11200 SW 8th Street, Miami, FL, 33199, US
| | - Jessica Robb Mazzant
- Center for Children and Families, Florida International University, 11200 SW 8th Street, Miami, FL, 33199, US
| | - Dara E Babinski
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, US
| | - Elizabeth M Gnagy
- Center for Children and Families, Florida International University, 11200 SW 8th Street, Miami, FL, 33199, US
| | - Timothy F Page
- Department of Management, H. Wayne Huizenga College of College of Business and Entrepreneurship, Nova Southeastern University, Davie, FL, US
| | - Brooke S G Molina
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, US
| | - William E Pelham
- Center for Children and Families, Florida International University, 11200 SW 8th Street, Miami, FL, 33199, US
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20
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Fabiano GA, Tower D, Valente M, Rejman E, Rodriguez Z. An Observational Study of the Morning and Evening Behavior of Individuals With and Without Attention-Deficit/Hyperactivity Disorder. J Atten Disord 2022; 26:1199-1211. [PMID: 34911376 DOI: 10.1177/10870547211063644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Evidence of ADHD symptoms and impairments were documented in the morning and evening hours for individuals diagnosed with ADHD. These results illustrate additional areas in need of attention in the refinement of treatments for adults with ADHD.
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Affiliation(s)
| | - Devon Tower
- Florida International University, Buffalo, NY, USA
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21
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Di Lonardo Burr SM, LeFevre JA, Arnold LE, Epstein JN, Hinshaw SP, Molina BSG, Hechtman L, Hoza B, Jensen PS, Vitiello B, Pelham WE, Howard AL. Paths to postsecondary education enrollment among adolescents with and without childhood attention-deficit/hyperactivity disorder (ADHD): A longitudinal analysis of symptom and academic trajectories. Child Dev 2022; 93:e563-e580. [PMID: 35635061 DOI: 10.1111/cdev.13807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We examined developmental trajectories of attention-deficit/hyperactivity disorder (ADHD) symptoms, standardized achievement, and school performance for adolescents with and without ADHD who did and did not enroll in postsecondary education (PSE; N = 749; 79% boys; 63% White, 17% non-Hispanic Black, 10% Hispanic, and 10% other ethnicities). In a multisite study (recruitment based in New York, North Carolina, Pennsylvania, California, and Quebec), participants were originally enrolled between 1994 and 1998 at ages 7 to 9.9 and followed up through 2012 (Mage = 25 at final follow-up). Adolescents who eventually enrolled in PSE had less severe symptoms, but differences were modest and trajectories were similar over time. For all adolescents, standardized achievement trajectories declined up to two thirds of a standard deviation from ages 9 to 17. By the end of high school, the average GPA of adolescents with ADHD was three quarters of a point higher for those who eventually enrolled in PSE compared to those who did not. Overall, school performance mattered more than academic achievement for understanding eventual enrollment of adolescents with ADHD.
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Affiliation(s)
- Sabrina M Di Lonardo Burr
- Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Cognitive Science, Carleton University, Ottawa, Ontario, Canada
| | - Jo-Anne LeFevre
- Department of Cognitive Science, Carleton University, Ottawa, Ontario, Canada.,Department of Psychology, Carleton University, Ottawa, Ontario, Canada
| | - L Eugene Arnold
- Department of Psychiatry and Behavioral Health, Ohio State University, Columbus, Ohio, USA
| | - Jeffrey N Epstein
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital, Cincinnati, Ohio, USA
| | - Stephen P Hinshaw
- Department of Psychology, University of California, Berkeley, California, USA
| | - Brooke S G Molina
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Lily Hechtman
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Betsy Hoza
- Department of Psychological Science, University of Vermont, Burlington, Vermont, USA
| | - Peter S Jensen
- The REACH Institute, New York, New York, USA.,Department of Psychiatry, University of Arkansas for the Medical Sciences, Little Rock, Arkansas, USA
| | - Benedetto Vitiello
- Department of Public Health and Pediatrics, University of Torino, Torino, Italy
| | - William E Pelham
- College of Arts, Sciences, and Education, Florida International University, Miami, Florida, USA
| | - Andrea L Howard
- Department of Psychology, Carleton University, Ottawa, Ontario, Canada
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22
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Meyer J, Alaie I, Ramklint M, Isaksson J. Associated predictors of functional impairment among adolescents with ADHD-a cross-sectional study. Child Adolesc Psychiatry Ment Health 2022; 16:29. [PMID: 35382854 PMCID: PMC8985377 DOI: 10.1186/s13034-022-00463-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 03/24/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) in adolescence is associated with functional impairment in several domains of life. To enable development of interventions that more effectively target functional impairment in this age group, the associations between clinical characteristics and impairment need to be clarified. The aim of this study was to investigate the associations between ADHD and functional impairment, if they varied by sex, and the potential impact of comorbid psychiatric symptoms on the associations. METHODS This was a cross-sectional study including adolescents with ADHD (n = 164) and a reference group of adolescents without ADHD (n = 106). Self-ratings and parental ratings of functional impairment in different life domains were used as outcomes in all analyses. Differences between groups were investigated with comparative analyses. General linear models (GLMs) were used to explore associations between ADHD symptoms and functional impairment in adolescents with ADHD, while adjusting for of comorbid symptoms, sex, and medication. RESULTS Adolescents with ADHD displayed higher levels of functional impairment than peers without ADHD, and girls with ADHD rated higher impairment than their male counterparts. The combined ADHD presentation was associated with the highest levels of self-reported impairment, while parental ratings indicated comparable levels of overall impairment across presentations. In the adjusted GLMs, symptoms of inattention were strongly associated with self- and parent-rated impairment in school, but symptoms of hyperactivity/impulsivity were not, whereas symptoms of both inattention and hyperactivity/impulsivity were modestly associated with self-rated impairment with friends. Further, both emotional and conduct problems were associated with impairment in daily life. CONCLUSIONS Our results suggest that attention difficulties, in particular, seem to impair academic functioning in adolescents with ADHD, and interventions targeting such difficulties are warranted. In addition, comorbid symptoms need to be assessed and treated, and self-reports of functioning should be included in research and clinical practice involving adolescents.
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Affiliation(s)
- Jenny Meyer
- Child and Adolescent Psychiatry Unit, Department of Medical Sciences, Uppsala University, 751 85, Uppsala, Uppsala, Sweden.
| | - Iman Alaie
- grid.8993.b0000 0004 1936 9457Child and Adolescent Psychiatry Unit, Department of Medical Sciences, Uppsala University, 751 85 Uppsala, Uppsala, Sweden ,grid.4714.60000 0004 1937 0626Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Mia Ramklint
- grid.8993.b0000 0004 1936 9457Child and Adolescent Psychiatry Unit, Department of Medical Sciences, Uppsala University, 751 85 Uppsala, Uppsala, Sweden
| | - Johan Isaksson
- grid.8993.b0000 0004 1936 9457Child and Adolescent Psychiatry Unit, Department of Medical Sciences, Uppsala University, 751 85 Uppsala, Uppsala, Sweden ,grid.4714.60000 0004 1937 0626Centre for Psychiatry Research, Department of Women’s and Children’s Health, Karolinska Institute Centre of Neurodevelopmental Disorders (KIND), Karolinska Institutet, Stockholm, Sweden
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23
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Henning C, Summerfeldt LJ, Parker JDA. ADHD and Academic Success in University Students: The Important Role of Impaired Attention. J Atten Disord 2022; 26:893-901. [PMID: 34384265 PMCID: PMC8859654 DOI: 10.1177/10870547211036758] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To improve on several methodological issues regarding current literature investigating the relationship between ADHD symptomatology and academic success in adults and examine the relative contributions of specific dimensions of ADHD symptomatology (i.e., inattention, hyperactivity, and impulsivity) to post-secondary academic success. METHOD A large sample of 3,688 post-secondary students were examined using a longitudinal design. The Conners' Adult ADHD Rating Scale (CAARS) was used to assess adult ADHD symptoms and academic success was assessed using students' official academic records (e.g., final GPAs and degree completion status). RESULTS Students with greater inattention symptomatology at the start of their academic program showed consistently poorer long-term academic success (i.e., lower GPAs, higher dropout rates), regardless of gender. CONCLUSION Inattention symptoms are the primary driver of the relationship between ADHD symptomatology and academic underachievement in adults. Post-secondary education institutions should target and prioritize educational programming for inattention symptoms of ADHD in at-risk post-secondary students.
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Affiliation(s)
| | | | - James D. A. Parker
- Trent University, Peterborough, ON, Canada,James D. A. Parker, Department of Psychology, Trent University, 1600 West Bank Drive, DNA Building, Suite C104, Peterborough, ON K9J 7B8, Canada.
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24
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Fabiano GA, Naylor J, Pelham WE, Gnagy EM, Burrows-MacLean L, Coles E, Chacko A, Wymbs BT, Walker KS, Wymbs F, Garefino A, Mazzant JR, Sastry AL, Tresco KE, Waschbusch DA, Massetti GM, Waxmonsky J. Special Education for Children with ADHD: Services Received and a Comparison to Children with ADHD in General Education. SCHOOL MENTAL HEALTH 2022. [DOI: 10.1007/s12310-022-09514-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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25
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Condo JS, Chan ESM, Kofler MJ. Examining the effects of ADHD symptoms and parental involvement on children's academic achievement. RESEARCH IN DEVELOPMENTAL DISABILITIES 2022; 122:104156. [PMID: 35007980 PMCID: PMC8944944 DOI: 10.1016/j.ridd.2021.104156] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 11/23/2021] [Accepted: 12/20/2021] [Indexed: 05/17/2023]
Abstract
OBJECTIVE Our understanding of the role of parental involvement in academic outcomes for children with ADHD is limited, with mixed evidence suggesting a positive association between parental involvement and academic achievement for pediatric ADHD but limited evidence regarding how this varies based on ADHD symptom severity, ADHD symptom domains, or co-occurring ODD symptoms. In this context, the present study aimed to examine the effects of parental involvement, ADHD symptoms, and comorbid ODD on children's overall, reading, and math achievement. METHOD A well-characterized clinically-evaluated sample of 162 children recruited through a university-based children's learning/behavioral health clinic and community resources (ages 8-13; 50 girls; 69% Caucasian/Non-Hispanic) were administered standardized academic achievement tests, with parents and teachers completing measures of parental involvement and ADHD symptoms, respectively. RESULTS Inattention, but not hyperactivity-impulsivity, was associated with lower academic achievement in all tested models (β= -.16 to -.22, all p < .03). Surprisingly, parental involvement had significant negative associations with math and overall academic achievement (β= -.13 to -.26, both p< .05) and did not moderate the relations between ADHD symptoms and academic achievement in any tested model. Comorbid ODD symptoms did not significantly predict academic achievement or interact with parental involvement in any tested model. These findings were robust to control for child IQ, age, sex, SES, anxiety, and depression. CONCLUSION Parental involvement may not serve as a protective factor against academic underachievement for children with clinically elevated ADHD symptoms, and may predict lower rather than higher academic achievement for clinically evaluated children in general.
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Affiliation(s)
- Jaida S Condo
- Florida State University, Department of Psychology, United States
| | | | - Michael J Kofler
- Florida State University, Department of Psychology, United States.
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26
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Cherkasova MV, Roy A, Molina BSG, Scott G, Weiss G, Barkley RA, Biederman J, Uchida M, Hinshaw SP, Owens EB, Hechtman L. Review: Adult Outcome as Seen Through Controlled Prospective Follow-up Studies of Children With Attention-Deficit/Hyperactivity Disorder Followed Into Adulthood. J Am Acad Child Adolesc Psychiatry 2022; 61:378-391. [PMID: 34116167 DOI: 10.1016/j.jaac.2021.05.019] [Citation(s) in RCA: 47] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 04/28/2021] [Accepted: 06/01/2021] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To describe adult outcome of people with attention-deficit/hyperactivity disorder (ADHD) diagnosed in childhood and its several key predictors via a review of 7 North American controlled prospective follow-up studies: Montreal, New York, Milwaukee, Pittsburgh, Massachusetts General Hospital (MGH), Berkeley, and 7-site Multimodal Treatment Study of Children With ADHD (MTA). METHOD All studies were prospective and followed children with a diagnosis of ADHD and an age- and gender-matched control group at regular intervals from childhood (6-12 years of age) through adolescence into adulthood (20-40 years of age), evaluating symptom and syndrome persistence, functional outcomes, and predictors of these outcomes. RESULTS The rates of ADHD syndrome persistence ranged from 5.7% to 77%, likely owing to varying diagnostic criteria and the source of information (self-report vs informant report) across the studies. However, all studies observed high rates of symptomatic persistence ranging from 60% to 86%. The 7 studies were largely consistent in finding that relative to control groups, research participants with childhood-diagnosed ADHD had significant impairments in the areas of educational functioning, occupational functioning, mental health, and physical health as well as higher rates of substance misuse, antisocial behavior, and unsafe driving. The most consistently observed predictors of functional outcomes included ADHD persistence and comorbidity, especially with disruptive behavior disorders. CONCLUSION Childhood ADHD has high rates of symptomatic persistence, which is associated with negative functional outcomes. Characteristics that predict these negative outcomes, such as comorbid disruptive behavior disorders, may be important targets for intervention.
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Affiliation(s)
| | | | | | | | - Gabrielle Weiss
- McGill University, Montreal, and the University of British Columbia, Vancouver, Canada
| | | | | | - Mai Uchida
- Massachusetts General Hospital, Harvard Medical School, Boston
| | - Stephen P Hinshaw
- University of California Berkeley and the University of California San Francisco, California
| | | | - Lily Hechtman
- McGill University Health Center, Montreal, Quebec, Canada; Division of Child Psychiatry, McGill University, Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada.
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27
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Sunde HF, Kleppestø TH, Gustavson K, Nordmo M, Reme B, Torvik FA. The ADHD deficit in school performance across sex and parental education: A prospective sibling‐comparison register study of 344,152 Norwegian adolescents. JCPP ADVANCES 2022. [DOI: 10.1002/jcv2.12064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Hans Fredrik Sunde
- Centre for Fertility and Health Norwegian Institute of Public Health Oslo Norway
- Department of Psychology University of Oslo Oslo Norway
| | - Thomas H. Kleppestø
- Centre for Fertility and Health Norwegian Institute of Public Health Oslo Norway
| | - Kristin Gustavson
- Department of Psychology University of Oslo Oslo Norway
- Department of Mental Disorders Norwegian Institute of Public Health Oslo Norway
| | - Magnus Nordmo
- Centre for Fertility and Health Norwegian Institute of Public Health Oslo Norway
| | - Bjørn‐Atle Reme
- Centre for Fertility and Health Norwegian Institute of Public Health Oslo Norway
| | - Fartein Ask Torvik
- Centre for Fertility and Health Norwegian Institute of Public Health Oslo Norway
- Promenta Research Centre, Department of Psychology, University of Oslo Oslo Norway
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Rhodes JD, Kennedy TM, Walther CA, Gnagy EM, Pelham WE, Molina BS. Smoking-Specific Risk Factors in Early Adulthood That Mediate Risk of Daily Smoking by Age 29 for Children with ADHD. J Atten Disord 2022; 26:525-536. [PMID: 33769107 PMCID: PMC9747070 DOI: 10.1177/10870547211003664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To test whether smoking-specific risk factors in early adulthood mediate prediction to daily smoking from childhood ADHD. METHODS Participants were 237 with and 164 without childhood ADHD. A smoking risk profile score comprising smoking-specific factors measured between ages 18 to 25 (e.g., craving severity) and age of initiation was tested as mediator of the association between childhood ADHD and age 29 daily smoking. RESULTS Childhood ADHD predicted age 29 smoking (β = -.15, p = .019), 35% of ADHD versus 17% of nonADHD, and the profile score (β = -.07, p = .004), which in turn mediated prediction to age 29 daily smoking (β = -.03; p = .007). When tested individually, three profile variables (# cigarettes/day, difficulty concentrating during abstinence, and nicotine dependence) were significant mediators (ps = 0.005-0.038), above and beyond early adult smoking, ADHD persistence, and delinquency. CONCLUSIONS These behavioral smoking characteristics help explain later daily cigarette smoking for adults with ADHD histories and may need to be targeted in intervention.
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Anderman EM, Gilman R, Liu X, Ha SY. The relations of inattention and hyperactivity to academic cheating in adolescents with executive functioning problems. PSYCHOLOGY IN THE SCHOOLS 2022. [DOI: 10.1002/pits.22644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Eric M. Anderman
- Department of Educational Studies, College of Education and Human Ecology The Ohio State University Columbus Ohio USA
| | | | - Xingfeiyue Liu
- Department of Educational Studies, College of Education and Human Ecology The Ohio State University Columbus Ohio USA
| | - Seung Yon Ha
- Department of Educational Studies, College of Education and Human Ecology The Ohio State University Columbus Ohio USA
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Zendarski N, Guo S, Sciberras E, Efron D, Quach J, Winter L, Bisset M, Middeldorp CM, Coghill D. Examining the Educational Gap for Children with ADHD and Subthreshold ADHD. J Atten Disord 2022; 26:282-295. [PMID: 33317376 DOI: 10.1177/1087054720972790] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The present study examined the impact of Attention Deficit Hyperactivity Disorder (ADHD) on core educational outcomes in two large community cohorts of Australian school children. METHOD Academic (reading and numeracy) and non-academic (school engagement, attendance, peer victimization, and parental expectations) outcomes were compared between children with ADHD, subthreshold ADHD, and controls when children were in grade 5 (M age = 10.5). Data were drawn from the Longitudinal Study of Australian Children birth cohort (LSAC; N = 3,540) and the Children's Attention Project (CAP; N = 356). RESULTS Both subthreshold ADHD and ADHD groups had poorer outcomes on all measures, with medium effects sizes. Differences were not evident between subthreshold ADHD and ADHD groups. CONCLUSIONS Educational outcomes examined in this study highlight the educational risk for upperprimary school children with ADHD or subthreshold ADHD, in comparison to their peers. Monitoring these outcomes is necessary to inform policy, practice, and intervention.
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Affiliation(s)
- Nardia Zendarski
- The University of Melbourne, Melbourne, Australia.,Murdoch Children's Research Institute, Melbourne, Australia
| | - Shuaijun Guo
- The University of Melbourne, Melbourne, Australia.,Murdoch Children's Research Institute, Melbourne, Australia
| | - Emma Sciberras
- The University of Melbourne, Melbourne, Australia.,Murdoch Children's Research Institute, Melbourne, Australia.,Deakin University, Geelong, Australia
| | - Daryl Efron
- The University of Melbourne, Melbourne, Australia.,Murdoch Children's Research Institute, Melbourne, Australia.,Department General Medicine, Royal Children's Hospital, Melbourne Australia
| | - Jon Quach
- The University of Melbourne, Melbourne, Australia.,Murdoch Children's Research Institute, Melbourne, Australia
| | | | - Matthew Bisset
- Murdoch Children's Research Institute, Melbourne, Australia.,Deakin University, Geelong, Australia
| | - Christel M Middeldorp
- The University of Queensland, Brisbane, Australia.,Children's Health Queensland Hospital and Health Service, Brisbane Australia
| | - David Coghill
- The University of Melbourne, Melbourne, Australia.,Murdoch Children's Research Institute, Melbourne, Australia
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Evaluation of a structured skills training group for adolescents with attention-deficit/hyperactivity disorder: a randomised controlled trial. Eur Child Adolesc Psychiatry 2022; 31:1-13. [PMID: 33721085 PMCID: PMC9343260 DOI: 10.1007/s00787-021-01753-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 02/26/2021] [Indexed: 10/25/2022]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) in adolescence is associated with behavioural, emotional and interpersonal problems, and non-pharmacological treatments targeting these difficulties have been requested. The objective of this study was to evaluate the effectiveness and acceptance of an age-adapted structured skills training group (SSTG) for adolescents with ADHD. Adolescents (n = 184, ages 15-18 years) with a diagnosis of ADHD were randomly assigned to either the SSTG, which is based on dialectical behavioural therapy, or an active control group based on psychoeducation. Symptoms of ADHD, behavioural and emotional problems, functional impairment, and health-related outcomes were assessed with self-ratings and parental ratings two weeks before, two weeks after, and six months after treatment. All participants who completed the pre-treatment measurements (n = 164) were included in the main analyses, which were conducted using a linear mixed model. Our results demonstrated no significant group differences in favour of the SSTG for any of the study outcomes. A majority of the participants in both groups reported that they had increased their knowledge about ADHD, improved their ability to manage problems related to the diagnosis, and would recommend the treatment to others. We conclude that the SSTG seems to be acceptable for adolescents with ADHD in a clinical context. However, the treatment was not proved to be more effective or more acceptable than the psychoeducational control intervention.Trial registration: http://www.isrctn.com/ISRCTN17366720,11/05/2016 , retrospectively registered.
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Imbeault A, Pagani LS. Participation in organized sport and disruptive behavior in childhood: A prospective, population-based study. Prev Med 2021; 153:106780. [PMID: 34509523 DOI: 10.1016/j.ypmed.2021.106780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 06/11/2021] [Accepted: 09/01/2021] [Indexed: 11/30/2022]
Abstract
Child disruptive behavior refers to ongoing patterns of disorganized, uncooperative, and defiant behavior. Sport involvement promotes positive child development. However, few longitudinal studies have tested the association between organized sport participation and the behavioral components of disruptive behavior. First, we aim to examine the link between inattentive, hyperactive, aggressive, and oppositional behavior at age 4 years and trajectories of organized sport participation from ages 6 to 10 years. Then, we compare children, according to trajectory membership, on outcome differences on these same behaviors at age 12 years. Data are from the Quebec Longitudinal Study of Child Development (N = 1492). Child behavior was assessed by questionnaires completed by mothers at age 4 years and teachers at age 12 years. Preschool child inattention as perceived by mothers, significantly reduced the odds of middle childhood organized sport participation by 7% (95% CI = 1.00-1.15). Low or inconsistent participation in organized sport was subsequently associated with increased inattention (d = 0.28) by the end of sixth grade. These findings are above and beyond individual and family characteristics and baseline behavior. No other associations were statistically significant. Inattentive children who participated less in organized sport showed a greater likelihood toward increases in attention deficit by the end of sixth grade. To improve engagement from these children, coaches and trainers should use strategies that support positive experiences such as developing a one-to-one alliance with the child, favoring social cooperation through team spirit, and focusing on the performance experience rather than the outcome of winning or losing.
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Affiliation(s)
- Arianne Imbeault
- Département de psychologie, Université de Montréal, Montréal, Québec, Canada.
| | - Linda S Pagani
- École de Psychoéducation, Université de Montréal, Montréal, Québec, Canada; School Environment Research Group (SERG), Université de Montréal, Montréal, Québec, Canada; Ste-Justine Hospital Research Center, Montréal, Québec, Canada
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33
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Prefrontal and frontostriatal structures mediate academic outcomes associated with ADHD symptoms. BRAIN DISORDERS 2021. [DOI: 10.1016/j.dscb.2021.100023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Hulsbosch AK, De Meyer H, Beckers T, Danckaerts M, Van Liefferinge D, Tripp G, Van der Oord S. Systematic Review: Attention-Deficit/Hyperactivity Disorder and Instrumental Learning. J Am Acad Child Adolesc Psychiatry 2021; 60:1367-1381. [PMID: 33862167 DOI: 10.1016/j.jaac.2021.03.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 02/10/2021] [Accepted: 03/16/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Although instrumental learning deficits are, among other deficits, assumed to contribute to attention-deficit/hyperactivity disorder (ADHD), no comprehensive systematic review of instrumental learning deficits in ADHD exists. This review examines differences between ADHD and typically developing (TD) children in basic instrumental learning and the effects of reinforcement form, magnitude, schedule, and complexity, as well as effects of medication, on instrumental learning in children with ADHD. METHOD A systematic search of PubMed, PsyINFO, CINAHL, EMBASE+EMBASE CLASSIC, ERIC, and Web of Science was conducted for articles up to March 16, 2020. Experimental studies comparing instrumental learning between groups (ADHD versus TD) or a manipulation of reinforcement/medication within an ADHD sample were included. Quality of studies was assessed with an adapted version of the Hombrados and Waddington criteria to assess risk of bias in (quasi-) experimental studies. RESULTS A total of 19 studies from among 3,384 non-duplicate screened articles were included. No difference in basic instrumental learning was found between children with ADHD and TD children, nor effects of form or magnitude of reinforcement. Results regarding reinforcement schedule and reversal learning were mixed, but children with ADHD seemed to show deficits in conditional discrimination learning compared to TD children. Methylphenidate improved instrumental learning in children with ADHD. Quality assessment showed poor quality of studies with respect to sample sizes and outcome and missing data reporting. CONCLUSION The review identified very few and highly heterogenous studies, with inconsistent findings. No clear deficit was found in instrumental learning under laboratory conditions. Children with ADHD do show deficits in complex forms of learning, that is, conditional discrimination learning. Clearly more research is needed, using more similar task designs and manipulations.
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Affiliation(s)
- An-Katrien Hulsbosch
- Mrs. Hulsbosch, Dr. De Meyer, and Prof. Drs. Beckers, Danckaerts, and Van der Oord are with KU Leuven, Belgium.
| | - Hasse De Meyer
- Mrs. Hulsbosch, Dr. De Meyer, and Prof. Drs. Beckers, Danckaerts, and Van der Oord are with KU Leuven, Belgium; Dr. De Meyer is also with the HELP University, Kuala Lumpur, Malaysia
| | - Tom Beckers
- Mrs. Hulsbosch, Dr. De Meyer, and Prof. Drs. Beckers, Danckaerts, and Van der Oord are with KU Leuven, Belgium
| | - Marina Danckaerts
- Mrs. Hulsbosch, Dr. De Meyer, and Prof. Drs. Beckers, Danckaerts, and Van der Oord are with KU Leuven, Belgium; Dr. Van Liefferinge and Prof. Dr. Danckaerts also are with the University Psychiatric Centre KU Leuven, Belgium
| | - Dagmar Van Liefferinge
- Dr. Van Liefferinge and Prof. Dr. Danckaerts also are with the University Psychiatric Centre KU Leuven, Belgium
| | - Gail Tripp
- Prof. Dr. Tripp is with the Okinawa Institute of Science and Technology (OIST) Graduate University, Japan
| | - Saskia Van der Oord
- Mrs. Hulsbosch, Dr. De Meyer, and Prof. Drs. Beckers, Danckaerts, and Van der Oord are with KU Leuven, Belgium; Prof. Dr. Van der Oord is with the University of Amsterdam, the Netherlands
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Bikic A, Dalsgaard S, Olsen KD, Sukhodolsky DG. Organizational skills training for children with ADHD: study protocol for a randomized, controlled trial. Trials 2021; 22:752. [PMID: 34715906 PMCID: PMC8556963 DOI: 10.1186/s13063-021-05499-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 07/29/2021] [Indexed: 11/21/2022] Open
Abstract
Background Problems with sustained attention, impulsivity, and hyperactivity are the most prominent symptoms of attention-deficit hyperactivity disorder (ADHD), but many children with this diagnosis also present with poor organizational skills that are important in relation to school. These problems tend to increase from childhood to adolescence and are often not well managed by medication. Organizational skills training (OST) is a range of behavioral interventions that specifically target organizational skills deficits. Evidence supports the effect of OST on improving organizational skills, inattention, and academic performance in children with ADHD. Because previous clinical trials included mostly children above the age of 8 years, this trial includes children in the age range 6–13 years to expand the knowledge on the effects of OST in younger children. Previous OST research has also shown improvement on inattention in parent ratings; we will investigate if a change in inattention can be confirmed with neurocognitive tests. Finally, little is known about predictors of treatment response in OST. Objectives The primary objective is to investigate if OST has positive effects on organizational skills in children with ADHD. The primary outcome measurement is the parent-rated Children’s Organizational Skills Scale (COSS), collected before and at the end of the 10 week intervention. Secondary and exploratory outcomes include inattention ratings, family and school functioning, and cognitive functions measured before the intervention period, immediately after, and at a 6 month follow-up. Additional objectives are to investigate both neurocognitive outcomes and age as predictors of treatment response. Methods This is a randomized clinical superiority trial investigating the effect of OST vs a treatment-as-usual (TAU) control group for children with ADHD in the age range of 6–13 years. All participants (n = 142) receive TAU. OST is administered in a group format of 10 weekly sessions. Adverse events are monitored by study clinicians during weekly therapy sessions and all assessments. Data analyses will be conducted using mixed linear regression models with random intercepts for patients, adjusted for the stratification variables and the baseline value. Perspectives This study will provide important new knowledge and expand on existing research in the field of non-pharmacological treatment of children with ADHD. OST can potentially have a significant impact on the lives of children with ADHD by helping them learn how to cope with their present deficits and to become more independent and self-reliant. It is also important to investigate predictors of treatment response in order to optimize OST. Trial registration ClinicalTrials.gov NCT03160378. Registered on May 19, 2017. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05499-9.
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Affiliation(s)
- Aida Bikic
- Child and Adolescent Mental Health Services Southern Jutland, Kresten Phillipsens Vej 15, Aabenraa, Region of Southern Denmark, Denmark. .,Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Winsløwparken 19, 3, Odense C, Denmark.
| | - Søren Dalsgaard
- National Centre of Register-based research, Department of Economics and Business, Aarhus University, Fuglesangs Allé 4, Aarhus, Denmark
| | - Kristoffer Dalsgaard Olsen
- Child and Adolescent Mental Health Services Southern Jutland, Kresten Phillipsens Vej 15, Aabenraa, Region of Southern Denmark, Denmark
| | - Denis G Sukhodolsky
- Child Study Centre, Yale University School of Medicine, 230 South Frontage Road, New Haven, CT, USA
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Coxe S, Sibley MH, Becker SP. Presenting problem profiles for adolescents with ADHD: differences by sex, age, race, and family adversity. Child Adolesc Ment Health 2021; 26:228-237. [PMID: 33350581 DOI: 10.1111/camh.12441] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/22/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Adolescents with attention-deficit/hyperactivity disorder (ADHD) experience developmentally distinct challenges from children and adults with ADHD. Yet no work in this age group identifies treatment-related phenotypes that can inform treatment matching, development of tailored treatments, and screening efforts. METHOD This study uses Latent Profile Analysis to detect unique presenting problem profiles among adolescents with ADHD and to test whether these profiles differ by key individual characteristics (age, sex, race, family adversity level). Participants were 854 ethnically diverse adolescents (ages 10-17) from the ADHD Teen Integrative Data Analysis Longitudinal (TIDAL) dataset who were assessed at clinical referral. Parent, adolescent, and teacher ratings, educational testing, and school records measured eight key presenting problems at intake. RESULTS A three-profile solution emerged. ADHD simplex (63.7%) was characterized by a mix of the ADHD-Inattentive and ADHD-Combined subtypes, moderate impairment levels, and infrequent comorbidities. ADHD + internalizing (11.4%) was characterized by higher likelihood of comorbid anxiety and/or depression. The disruptive/disorganized ADHD (24.9%) profile was characterized by severe organization, time management, and planning (OTP) problems, the ADHD-Combined subtype, and frequent disruptive behavior at school. Age did not vary across these phenotypes. More females were present in the ADHD + internalizing phenotype; males were more likely to be found in the disruptive/disorganized ADHD phenotype. Higher family adversity and African American race were associated with the disruptive/disorganized ADHD phenotype. CONCLUSIONS Adolescents with ADHD demonstrate varying presenting problem phenotypes that vary by sex, family adversity, and race/ethnicity. Consideration of these phenotypes may inform treatment matching and efforts to improve screening among under-diagnosed groups.
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Affiliation(s)
- Stefany Coxe
- Department of Psychology, Florida International University, Miami, FL, USA
| | - Margaret H Sibley
- Seattle Children's Research Institute, University of Washington School of Medicine, Seattle, WA, USA
| | - Stephen P Becker
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Zulauf-McCurdy CA, Coxe SJ, Lyon AR, Aaronson B, Ortiz M, Sibley MH. Study protocol of a randomised trial of Summer STRIPES: a peer-delivered high school preparatory intervention for students with ADHD. BMJ Open 2021; 11:e045443. [PMID: 34344674 PMCID: PMC8336126 DOI: 10.1136/bmjopen-2020-045443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION High schoolers with attention-deficit/hyperactivity disorder (ADHD) experience substantial impairments, particularly in the school setting. However, very few high school students with ADHD receive evidence-based interventions for their difficulties. We aim to improve access to care by adapting evidence-based psychosocial intervention components to a low-resource and novel school-based intervention model, Summer STRIPES (Students Taking Responsibility and Initiative through Peer Enhanced Support). Summer STRIPES is a brief peer-delivered summer orientation to high school with continued peer-delivered sessions during ninth grade. METHODS AND ANALYSIS Participants will be 72 rising ninth grade students with ADHD who are randomised to receive either Summer STRIPES or school services as usual. Summer STRIPES will be delivered by 12 peer interventionists in a school setting. Outcomes will be measured at baseline, start of ninth grade, mid-ninth grade and end-of-ninth grade. At each assessment, self, parent and teacher measures will be obtained. We will test the effect of Summer STRIPES (compared with school services as usual) on ADHD symptoms and key mechanisms (intrinsic motivation, extrinsic motivation, executive functions) as well as key academic outcomes during the ninth-grade year (Grade Point Average (GPA), class attendance). ETHICS AND DISSEMINATION Findings will contribute to our understanding of how to improve access and utilisation of care for adolescents with ADHD. The protocol is approved by the institutional review board at Seattle Children's Research Institute. The study results will be disseminated through publications in peer-reviewed journals and presentations at scientific conferences. TRIALS REGISTRATION NUMBER NCT04571320; pre-results.
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Affiliation(s)
| | - Stefany J Coxe
- Department of Psychology, Florida International University, Miami, Florida, USA
| | - Aaron R Lyon
- Psychiatry & Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Ben Aaronson
- Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Mercedes Ortiz
- Psychiatry & Behavioral Sciences, Seattle Children's Research Institute, University of Washington, Seattle, Washington, USA
| | - Margaret H Sibley
- Psychiatry & Behavioral Sciences, Seattle Children's Research Institute, University of Washington, Seattle, Washington, USA
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DuPaul GJ, Evans SW, Owens JS, Cleminshaw CL, Kipperman K, Fu Q, Benson K. School-based intervention for adolescents with attention-deficit/hyperactivity disorder: Effects on academic functioning. J Sch Psychol 2021; 87:48-63. [PMID: 34303447 DOI: 10.1016/j.jsp.2021.07.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 02/24/2021] [Accepted: 07/01/2021] [Indexed: 10/20/2022]
Abstract
Multi-component training interventions such as the Challenging Horizons Program (CHP) improve organization skills and academic functioning of middle school students with attention-deficit/hyperactivity disorder (ADHD); however, few studies have investigated treatment for high school students. We explored the extent to which CHP adapted for high school would improve proximal (e.g., organization skills, homework performance) and distal (e.g., report card grades) academic outcomes through 6-month follow-up relative to a community care (CC) condition. Participants included 186 adolescents who were randomly assigned to CHP (n = 92; 80% male; M age = 15.0; SD = 0.8) or CC (n = 94; 78% male; M age = 15.1; SD = 0.9) with CHP delivered over one school year. Parent, teacher, and self-report ratings of organization skills and academic performance, report card grades, and achievement tests were collected across multiple occasions. Intent-to-treat analyses using hierarchical linear modeling revealed significant improvements of small to medium magnitude (d range = 0.32 to 0.58) for parent-rated organization skills, homework performance, and academic functioning at 6-month follow-up. CHP effect on grades was small, but associated with a less steep decline than that found for CC. No statistically significant effects on teacher or self-report ratings were obtained. CHP appears efficacious for ameliorating organization skills and homework performance deficits exhibited by high school students with ADHD and can protect against decline in report card grades experienced by these students. CHP may require supplementation with academic skills instruction for some students and may need implementation beyond one school year to produce durable effects.
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Bergman A, Hallin AE. The effect of picture support on narrative retells in Swedish adolescents with ADHD. CLINICAL LINGUISTICS & PHONETICS 2021; 35:690-705. [PMID: 32985272 DOI: 10.1080/02699206.2020.1825816] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 09/14/2020] [Accepted: 09/14/2020] [Indexed: 06/11/2023]
Abstract
ADHD is characterized by executive functioning (EF) deficits, which in turn may affect language, and therefore EF demands in language assessment tasks are important to consider. This study aims to inform clinical practice by 1) comparing and describing narrative retells in Swedish adolescents with and without ADHD, and 2) investigating the effects of picture support on narration in the two groups. Fifteen adolescents with ADHD and 31 with typical development (TD) participated. Two carefully matched narratives for retelling, one with and one without picture support were administered, transcribed, and analyzed regarding content and linguistic complexity (macro- and microlevel measures). The results showed that the ADHD group included less content than the TD group in both tasks, measured in fewer story grammar units and details. Both groups included more story grammar units in the task without picture support. The TD group had shorter retells with higher syntactic complexity in the task with picture support compared to the task without picture support. Compared to TD peers, retells without picture support from the ADHD group were significantly shorter and had a higher proportion of grammatical errors. These results show different strengths and weaknesses in the two groups and indicate that the narrative task without picture support, which places higher demands on EF, captured a linguistic vulnerability in the ADHD group. In conclusion, the choice of narrative task is important to consider in clinical practice to enable accurate descriptions of linguistic strengths and weaknesses in individuals with ADHD, and aid in differential diagnosis.
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Affiliation(s)
- Anna Bergman
- Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Speech Language Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Anna Eva Hallin
- Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Speech Language Pathology, Karolinska Institutet, Stockholm, Sweden
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Sibley MH, Bickman L, Coxe SJ, Graziano PA, Martin P. Community Implementation of MI-Enhanced Behavior Therapy for Adolescent ADHD: Linking Fidelity to Effectiveness. Behav Ther 2021; 52:847-860. [PMID: 34134825 PMCID: PMC8217725 DOI: 10.1016/j.beth.2020.10.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 10/23/2020] [Accepted: 10/24/2020] [Indexed: 10/23/2022]
Abstract
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 therapy) of a community-based randomized trial of adolescent ADHD treatment. Participants received therapy from community clinicians (N = 44) at four agencies in a large, ethnically diverse metropolitan setting. Therapists provided self-report of session-by-session adherence to content fidelity checklists and audio recordings of sample sessions that were coded for MI integrity. Parents provided report of ADHD symptoms and family impairment at baseline, posttreatment, and follow-up, while academic records were obtained directly from the local school district. Results indicated that content fidelity significantly waned across the 10 manualized sessions (d = -1.23); these trends were steepest when therapy was delivered outside the office-setting and parent attendance was low. Community therapist self-report of content fidelity predicted significantly greater improvements in academic impairment from baseline to follow-up. MI delivery quality was not associated with improved outcomes; contrary to hypotheses, lower MI relational scores predicted significantly greater improvements in family impairment over time. Findings indicate that community-based outcomes for evidence-based ADHD treatment are enhanced when treatment is implemented with fidelity. Future work should revise community-based implementation strategies for adolescent ADHD treatment to prevent declines in fidelity over time, thereby improving outcomes.
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Affiliation(s)
- Margaret H Sibley
- University of Washington School of Medicine, Seattle Children's Research Institute; Florida International University.
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Evans SW, Allan D, Xiang J, Margherio SM, Owens JS, Langberg JM. Organization interventions as a mediator of change in grades in the Challenging Horizons Program. J Sch Psychol 2021; 87:18-27. [PMID: 34303445 DOI: 10.1016/j.jsp.2021.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 02/28/2021] [Accepted: 05/14/2021] [Indexed: 12/28/2022]
Abstract
This study evaluated whether an organization intervention was a mediator of change for grade point average (GPA) in a randomized clinical trial of a school-based treatment program for adolescents with attention deficit hyperactivity disorder (ADHD). A demographically diverse sample of 148 participants (105 males) with a diagnosis of ADHD were recruited from nine middle schools. Comprehensive diagnostic evaluations were completed and participants were randomized into one of three conditions (two active treatment conditions, one control condition) for a randomized clinical trial that lasted an entire school year. The results of the trial are reported elsewhere (Evans et al., 2016; Schultz et al., 2017); in this study we evaluated four of the criteria for determining mediation as reported by Kazdin (2007) to determine whether response to the organization intervention in this school-based treatment program mediated the relationship between dosage and GPA beyond previous GPA. The results provided evidence that response to the organization intervention mediated the relationship between intervention dosage and change in GPA.
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Affiliation(s)
- Steven W Evans
- Ohio University, Department of Psychology, Athens, OH 45701, United States.
| | - Darcey Allan
- Ohio University, Department of Psychology, Athens, OH 45701, United States.
| | - Joe Xiang
- Ohio University, Department of Psychology, Athens, OH 45701, United States.
| | | | - Julie Sarno Owens
- Ohio University, Department of Psychology, Athens, OH 45701, United States.
| | - Joshua M Langberg
- Virginia Commonwealth University, Department of Psychology, Richmond, VA 23284, United States.
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Hare MM, Graziano PA. The Cost-Effectiveness of Parent-Child Interaction Therapy: Examining Standard, Intensive, and Group Adaptations. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 48:499-513. [PMID: 32935144 PMCID: PMC7960556 DOI: 10.1007/s10488-020-01083-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2020] [Indexed: 10/23/2022]
Abstract
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 deviation on each outcome measure: externalizing behavior problems, positive parenting skills, negative parenting skills, child compliance, and parenting stress. While it had the lowest initial set up cost, results indicated that standard PCIT was the least cost-effective option in reducing child disruptive behaviors and in increasing child compliance. Large group PCIT was the most cost-effective in increasing positive parenting skills and child compliance and in reducing negative parenting skills and parenting stress. I-PCIT was the most cost-effective in reducing child disruptive behaviors and the second most cost-effective option in increasing positive parenting skills and child compliance and in decreasing negative parenting. As large group and I-PCIT were the most cost-effective in different domains, both could be recommended to parents as treatment options. Future research should confirm our cost-effective results within community settings.
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Affiliation(s)
- Megan M Hare
- Department of Psychology, Center for Children and Families, Florida International University, 11200 SW 8th St., Miami, FL, 33199, USA
| | - Paulo A Graziano
- Department of Psychology, Center for Children and Families, Florida International University, 11200 SW 8th St., Miami, FL, 33199, USA.
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43
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Sibley MH, Ortiz M, Gaias LM, Reyes R, Joshi M, Alexander D, Graziano P. Top problems of adolescents and young adults with ADHD during the COVID-19 pandemic. J Psychiatr Res 2021; 136:190-197. [PMID: 33610946 PMCID: PMC8009847 DOI: 10.1016/j.jpsychires.2021.02.009] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 01/25/2021] [Accepted: 02/08/2021] [Indexed: 12/16/2022]
Abstract
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 the pandemic for A/YAs with ADHD. METHOD At the outbreak of the COVID-19 pandemic (April-June 2020), we administered self and parent ratings about current and pre-pandemic top problem severity and benefits of the pandemic to a sample of convenience (N = 134 A/YAs with ADHD participating in a prospective longitudinal study). RESULTS The most common top problems reported in the sample were social isolation (parent-report: 26.7%; self-report: 41.5%), difficulties engaging in online learning (parent-report: 23.3%, self-report: 20.3%), motivation problems (parent-report: 27.9%), and boredom (self-report: 21.3%). According to parent (d = 0.98) and self-report (d = 1.33), these top problems were more severe during the pandemic than in prior months. Contrary to previous speculation, there was no evidence that pandemic-related changes mitigated ADHD severity. Multi-level models indicated that A/YAs with higher IQs experienced severer top problems exacerbations at the transition to the COVID-19 pandemic. CONCLUSIONS For A/YAs with ADHD, several risk factors for depression and school dropout were incurred during the early months of the COVID-19 pandemic. A/YAs with ADHD should be monitored for school disengagement and depressive symptoms during the COVID-19 pandemic. Recommended interventions attend to reducing risk factors such as increasing social interaction, academic motivation, and behavioral activation among A/YAs with ADHD.
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Affiliation(s)
- Margaret H Sibley
- University of Washington, 1410 Campus Parkway, Seattle, WA, USA; Seattle Children's Research Institute, 1900 9th Avenue, Seattle, WA, USA.
| | - Mercedes Ortiz
- Seattle Children's Research Institute, 1900 9th Avenue, Seattle, WA, USA
| | - Larissa M Gaias
- University of Massachusetts Lowell, 220 Pawtucket St, Lowell, MA, USA
| | - Rosemary Reyes
- University of Washington, 1410 Campus Parkway, Seattle, WA, USA
| | - Mahima Joshi
- University of Washington, 1410 Campus Parkway, Seattle, WA, USA
| | - Dana Alexander
- University of Washington, 1410 Campus Parkway, Seattle, WA, USA
| | - Paulo Graziano
- Florida International University, 11200 SW 8th Street, Miami, FL, USA
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Kamal M, Al-Shibli S, Shahbal S, Yadav SK. Impact of attention deficit hyperactivity disorder and gender differences on academic and social difficulties among adolescents in Qatari Schools. Qatar Med J 2021:11. [PMID: 33777722 PMCID: PMC7961152 DOI: 10.5339/qmj.2021.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 09/20/2020] [Indexed: 11/18/2022] Open
Abstract
Background: To evaluate the social and academic impact of adolescents with Attention Deficit Hyperactivity Disorder (ADHD) and gender differences compared with their non-ADHD peers. Methods: A cross-sectional descriptive study using a standardized rating scale of teacher observations was conducted in the schools of Qatar from 7th to 12th grades. Teachers completed Swanson, Nolan, and Pelham (SNAP-IV) rating scale questionnaires for the ADHD core symptoms together with nine questions to evaluate the academic and social difficulties in all participants. Results: A total of 1775 students (mean age: 15 ± 1.5 years; boys/girls: 717/1058) were included in this study. Based on the SNAP-IV rating scale, 150 students were showing core symptoms of ADHD and classified as having ADHD (8.5%; boys/girls; 93/57) and 1625 students as non-ADHD peers (91.5%; boys/girls; 624/1001). Prevalence of ADHD among adolescent students is 8.5%, and it varied significantly between genders with 13% of boys and 5.4% of girls affected by this disorder. Adolescents with ADHD had more academic and social difficulties than their non-ADHD peers, the boys more so than the girls. Boys with inattentive subtype of ADHD had more academic difficulties than girls, while girls had more social difficulties than boys. Conclusion: The results of this study revealed that ADHD among adolescents is substantially associated with academic and social difficulties in the school environment. Gender differences among students with ADHD should be considered in the school and clinical environment.
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Sultan RS, Liu SM, Hacker KA, Olfson M. Adolescents With Attention-Deficit/Hyperactivity Disorder: Adverse Behaviors and Comorbidity. J Adolesc Health 2021; 68:284-291. [PMID: 33541601 DOI: 10.1016/j.jadohealth.2020.09.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 09/14/2020] [Accepted: 09/27/2020] [Indexed: 12/31/2022]
Abstract
PURPOSE AND OBJECTIVE There is growing evidence that adolescents with ADHD develop long-term impairments and adverse outcomes, yet less is known about their adverse behaviors. To quantify rates of mental health comorbidities in adolescents with ADHD and compare the risks of adverse behaviors among adolescents with and without ADHD. METHODS We performed a cohort analysis of 6,483 youth from the National Comorbidity Survey Adolescent Supplement (NCS-A), a nationally representative in-person structured diagnostic interview of adolescents aged 14-18 years focusing on mental, emotional, and behavioral disorders. MAIN OUTCOMES (1) Percentages with comorbid anxiety, mood, disruptive behavior, and substance use disorders. (2) Strength of associations of ADHD with several adverse behaviors, including suicidal symptoms, aggression, behavior regulation, life events, education, and substance use. Odds ratios were adjusted for age, sex, and race. RESULTS Among the sample of 6,483 adolescents, overall, 9.5% met the criteria for ADHD. Most (69.5%) of adolescents with ADHD had at least one comorbid mental health condition. As compared to adolescents without ADHD, those with ADHD were significantly more likely to have had a suicide attempt (aOR 2.9, 95% CI = 1.3-6.6) and to have had perpetrated physical aggression (aOR 2.3, 95% CI = 1.7-3.2). Adolescents with ADHD were also more likely to have been expelled from school or fired from a job (aOR 3.3, 95% CI = 1.7-6.5) and to have had problems related to drinking alcohol (95% CI = 1.2-2.9). CONCLUSIONS ADHD in adolescents is a complicated disorder with elevated risks for a wide range of adverse behaviors.
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Affiliation(s)
- Ryan S Sultan
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York State Psychiatric Institute, New York, New York.
| | - Shang-Min Liu
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York State Psychiatric Institute, New York, New York
| | - Karen A Hacker
- Allegheny County Health Department, University of Pittsburgh School of Medicine and Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Mark Olfson
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York State Psychiatric Institute, New York, New York
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46
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Shabat T, Fogel-Grinvald H, Anaby D, Golos A. Participation Profile of Children and Youth, Aged 6-14, with and without ADHD, and the Impact of Environmental Factors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:E537. [PMID: 33440680 PMCID: PMC7828023 DOI: 10.3390/ijerph18020537] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 01/06/2021] [Accepted: 01/07/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Children and youth with attention deficit hyperactivity disorder (ADHD) may experience difficulties in participation, but few studies examine their participation and the environmental factors affecting participation. This study explored the participation and the environmental factors of children and youth, with and without attention deficit hyperactivity disorder (ADHD), in the following three settings: home, school, and community. MATERIALS AND METHODS Parents of 65 participants aged 6-14 (M = 9.91, SD = 1.87) with and without ADHD completed the Participation and Environment Measure for Children and Youth (PEM-CY) questionnaire, which evaluates participation and environmental factors, along with demographic and screening questionnaires. RESULTS The ADHD group (n = 31) scored significantly lower than the non-ADHD group (n = 34) in "frequency" at home, "involvement", and overall environmental support in all settings, with parents expressing a greater desire to change their child's home and community participation. For the ADHD group, a relationship was found between environmental support and involvement in all three settings. CONCLUSIONS The findings demonstrated differences in the participation of children and youth with ADHD across different settings, compared to those without ADHD, and confirmed the effect of environmental factors on participation, especially involvement. It is essential to consider participation measures and environmental factors when designing interventions for children and youth with ADHD.
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Affiliation(s)
- Tair Shabat
- School of Occupational Therapy, Faculty of Medicine, Hebrew University, Jerusalem 91240, Israel; (T.S.); (H.F.-G.)
| | - Haya Fogel-Grinvald
- School of Occupational Therapy, Faculty of Medicine, Hebrew University, Jerusalem 91240, Israel; (T.S.); (H.F.-G.)
| | - Dana Anaby
- School of Physical and Occupational Therapy, McGill University, Montreal, QC H3G 1Y5, Canada;
| | - Anat Golos
- School of Occupational Therapy, Faculty of Medicine, Hebrew University, Jerusalem 91240, Israel; (T.S.); (H.F.-G.)
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47
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Katzenmajer-Pump L, Farkas BF, Varga BA, Jansma JM, Balázs J. Low Level of Perfectionism as a Possible Risk Factor for Suicide in Adolescents With Attention-Deficit/Hyperactivity Disorder. Front Psychiatry 2021; 12:707831. [PMID: 34589006 PMCID: PMC8473605 DOI: 10.3389/fpsyt.2021.707831] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 08/17/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction: Suicide is one of the leading causes of death among adolescents. Although it is known that both perfectionism and attention-deficit/hyperactivity disorder ('ADHD') are important risk factors for suicide, there are no studies that have investigated the relationship between suicidal behavior and perfectionism among people with ADHD. Aim: The current study investigates the association between perfectionism and suicide in adolescents with ADHD. Method: Subjects included 88 adolescents with ADHD and 96 non-clinical control adolescents. We used the Multidimensional Perfectionism Scale to evaluate perfectionism as well as its separate traits, and the Mini International Neuropsychologic Interview Kid to evaluate psychiatric disorders and suicidal behavior. Differences between the groups were statistically evaluated using t-tests, a Poisson regression analysis with suicide as a discrete variable, and a logistic regression analysis with suicide as a binary variable. Results: Compared to the control group, the ADHD group showed a significantly lower level on the adaptive 'Organization' trait of perfectionism, but not on any other trait, and a significantly higher level of suicidal behavior. Logistic regression results indicated a significant association for perfectionism in general (OR = 0.93, p = 0.003), and for the 'Personal Standards' trait (OR: 0.82, p = 0.039). Poisson regression analysis also showed a significant association with perfectionism in general (IRR = 0.90; p < 0.001) and with the 'Personal standards' trait model (IRR = 0.81, p = 0.019). Discussion: Our results indicate that a low level of perfectionism, in particular 'Personal standards', may be a risk factor for suicidal behavior in adolescents with ADHD. We recommend that psychoeducation and therapy of adolescents with ADHD should consider focusing on adaptive perfection as a possible risk factor for suicide as well.
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Affiliation(s)
- Luca Katzenmajer-Pump
- Institute of Psychology, Eötvös Loránd University, Doctoral School of Psychology, Budapest, Hungary
| | | | - Balázs András Varga
- Institute of Psychology, Eötvös Loránd University, Doctoral School of Psychology, Budapest, Hungary
| | - Johan M Jansma
- Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery, UMC Utrecht, Utrecht, Netherlands
| | - Judit Balázs
- Department of Developmental and Clinical Child Psychology, Institute of Psychology, Eötvös Loránd University, Budapest, Hungary.,Department of Psychology, Bjørknes University College, Oslo, Norway
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48
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Meinzer MC, LeMoine KA, Howard AL, Stehli A, Arnold LE, Hechtman L, Hinshaw SP, Molina BSG, Murray DW, Sibley MH, Swanson JM, Tamm L, Chronis-Tuscano A. Childhood ADHD and Involvement in Early Pregnancy: Mechanisms of Risk. J Atten Disord 2020; 24:1955-1965. [PMID: 28938857 PMCID: PMC5957781 DOI: 10.1177/1087054717730610] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: ADHD is associated with risky sexual behavior and early pregnancy, but few studies have examined mechanisms of risk linking childhood ADHD to early pregnancy. The present study utilized data from the Multimodal Treatment Study of ADHD to examine potential mechanisms that may account for the association between childhood ADHD and becoming pregnant or causing a pregnancy by age 18. Method: Participants were 579 children with ADHD and 289 comparison peers followed over 16 years. Results: Relative to the comparison group, those with childhood ADHD were at more than two times increased risk of early pregnancy. Univariately, persistence of ADHD symptoms, delinquency/substance use, and academic performance/achievement during adolescence each mediated the association between childhood ADHD and early pregnancy. When considered together, only delinquency/substance use remained a significant mediator of this relationship. Conclusion: Findings point toward specific targets of intervention for youth with ADHD to prevent early pregnancy.
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Affiliation(s)
| | | | | | | | | | | | - Stephen P. Hinshaw
- University of California, Berkeley, USA,University of California, San Francisco, USA
| | | | | | | | | | - Leanne Tamm
- Cincinnati Children’s Hospital Medical Center, OH, USA
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49
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Sibley MH, Coxe SJ, Page TF, Pelham WE, Yeguez CE, LaCount PA, Barney S. Four-Year Follow-Up of High versus Low Intensity Summer Treatment for Adolescents with ADHD. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2020; 51:750-763. [PMID: 33210938 DOI: 10.1080/15374416.2020.1833734] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Despite an emergence of psychosocial treatments for adolescent ADHD, their long-term effects are unknown. METHOD We examine four-year outcomes of a randomized controlled trial (N = 218) comparing high-intensity (HI; 412 h, $4,373 per participant) versus low-intensity (LI; 24 h, $97 per participant) skills-based summer intervention delivered to adolescents with ADHD at two secondary school transitions (6th/9th grade). Quantitative and qualitative analyses evaluated group×time and group×grade×time effects on 4-year outcomes. RESULTS Relative to LI, a single dose of HI had modest but lasting effects on teen organization skills (d =.40) and ADHD symptoms (9th grade only: d =.27 to.31) at 4-year follow-up. There was no long-term incremental effect of HI (vs. LI) for parent-teen conflict, GPA, or parent use of contingency management. Treatment appeared most effective when delivered to older adolescents (i.e., 9th versus 6th grade), suggesting the long-term impact of ADHD treatment may increase with age. Qualitative data corroborated that the primary long-term benefit of HI (vs. LI) treatment was to organization skills; many of the remaining perceived benefits were to parent and teen psychological variables (i.e., increased self-esteem, self-awareness, parental optimism). HI offered no incremental benefit to long-term educational or clinical service utilization or costs. CONCLUSIONS Modest therapeutic benefits of adolescent ADHD treatment are maintained long term. However, HI treatment did not impact outcomes that could defray the intervention's high costs ($4,373) compared to LI treatment ($97).
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Affiliation(s)
- Margaret H Sibley
- Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine.,Center for Child Health, Behavior, and Development, Seattle Children's Research Institute
| | - Stefany J Coxe
- Department of Psychology, Florida International University
| | - Timothy F Page
- Department of Psychology, Florida International University
| | | | | | - Patrick A LaCount
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute
| | - Samantha Barney
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute
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50
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Rodríguez C, Torrance M, Betts L, Cerezo R, García T. Effects of ADHD on Writing Composition Product and Process in School-Age Students. J Atten Disord 2020; 24:1735-1745. [PMID: 28490212 DOI: 10.1177/1087054717707048] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: This study examined the relationship between ADHD and writing performance. Method: Students in Grades 3 to 7, 84 with ADHD and 135 age- and gender-matched controls completed a writing task (including process logs), and measures of working memory and attention. Results: Students with ADHD wrote texts of similar length but with poorer structure, coherence, and ideation. In all, 6.7% of the variance in writing quality was explained by whether or not the student had an ADHD diagnosis, after control for IQ and age-within-year, with ADHD students producing text that was less coherent, well structured, and ideationally rich, and spending less time thinking about and reviewing their text. Half of the effect on text quality could be attributed to working memory and sustained attention effects. Conclusion: ADHD has some effect on writing performance, which can, in part, be explained by working memory and attentional deficits.
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