Childhood ADHD and Negative Self-Statements: Important Differences Associated With Subtype and Anxiety Symptoms

Comorbidities and functional impairments in children with attention deficit hyperactivity disorder in China: a hospital-based retrospective cross-sectional study

OBJECTIVES

The aim of this study was to assess comorbidity patterns and functional impairment in children with and without attention deficit hyperactivity disorder (ADHD).

DESIGN

Hospital-based retrospective cross-sectional study; data collection occurred between 2016 and 2019.

SETTINGS AND PATIENTS

A total of 8256 children and adolescents, 6-17 years of age, with suspected ADHD agreed to participate in this hospital-based cross-sectional study over a 4-year period in China. Comorbidities and social functions were assessed according to the scales Vanderbilt ADHD Diagnostic Parent Rating Scale and Weiss Functional Impairment Rating Scale-Parent Form, which were completed by the parents of the study participants.

RESULTS

Of the 8256 children, 5640 were diagnosed with ADHD. Other 2616 children who did not meet the ADHD diagnostic criteria were classified as the N-ADHD group . The proportion of comorbidities (47.4%) and functional impairments (84.5%) in the ADHD group were higher than the N-ADHD group (p≤0.001). The functional impairment scores in all of the six domains, including family, academic, life skills, self-concept, social activities and risky activities, were significantly higher in the ADHD group than the N-ADHD group (p≤0.001). The functional impairment in ADHD group with comorbidities was more severe than those without comorbidities (p≤0.001). Comorbidities and core symptoms both can affect the functions of children with ADHD. Logistics regression analysis indicated that in all of the six functional domains, the effect of comorbidities on functional impairment exceeded the effects of ADHD core symptoms.

CONCLUSIONS

Comorbidities had the greatest influence on different areas of adaptive functioning in children with ADHD. Clinical management of children suspected to have ADHD should address multiple comorbidities and functional impairments assessment, as well as core symptom analysis.

Attention-Deficit/Hyperactivity Disorder Predominantly Inattentive Subtype/Presentation: Research Progress and Translational Studies

Research on the predominantly inattentive attention-deficit/hyperactivity disorder (ADHD-PI) subtype/presentation is important given its high prevalence, but paradoxically it is under-recognized and undertreated. The temporal stability of the inattention symptom could impact the high worldwide prevalence of ADHD-PI. Some evidence suggests differences in the nature of attentional deficit in ADHD-PI vs. that in other subtypes. Impairments in neuropsychological, neurocognitive, and social functioning are also evident in ADHD-PI, which could be specific to the subtype (e.g., processing speed, social perception, and skills), or differ from others in severity. Neuroimaging studies have also revealed ADHD-PI-specific neuropathological abnormalities and those that are shared with other subtypes. ADHD-PI is highly comorbid with learning and internalizing (e.g., anxiety and depression) disorders. There is no solid evidence for ADHD-PI-specific genetic etiologies and differential responses of subtypes to ADHD medications. Translational studies have used the Wistar Kyoto/NCrl substrain which requires further characterizations as an ADHD-PI model. Overall, ADHD-PI research has been conducted in the context of the Diagnostic and Statistical Manual, which arguably does not conform to the widely recognized "dimensional" view of ADHD. The Research Domain Criteria has been proposed to provide a novel framework for understanding the nature of neuropsychiatric illnesses and ultimately improve their diagnosis and treatment.

From Impulse to Action? Cognitive Mechanisms of Impulsivity-Related Risk for Externalizing Behavior

Trait impulsivity is an established risk factor for externalizing behavior problems in adolescence, but little is understood about the cognitive mechanisms involved. Negative automatic thoughts are associated with externalizing behaviors and impulsivity is associated with less cognitive reappraisal. This study sought to adapt the bioSocial Cognitive Theory (bSCT) of impulsivity and substance use (an externalizing behavior) for externalizing behavior in general. It was predicted that only the component of impulsivity characterized by lack of forethought (rash impulsiveness; RI) would be associated with (non-substance use-related) externalizing behaviors, not reward sensitivity/drive. Further, this association would be mediated by negative automatic thoughts. Participants were 404 (226 female, 63%) adolescents from 6 high schools across South-East Queensland (age = 13-17 years, mean age = 14.97 years, SD = 0.65 years) of mostly Australian/New Zealand (76%) or European (11%) descent. Participants completed self-report measures of impulsivity, negative automatic thoughts, and externalizing behaviors. Path analysis revealed that, as predicted, only RI was uniquely associated with negative automatic thoughts and externalizing behaviors. However, only negative automatic thoughts centered around hostility mediated the positive association between RI and externalizing behaviors, with the indirect mediation effect being smaller than the direct association. In contrast to substance use, only one component of impulsivity, RI, was associated with general adolescent externalizing behavior. Hostile automatic thoughts may be an important mechanism of risk, supporting a role for cognitive-behavioral interventions. Other biopsychosocial mechanisms are clearly involved and the bSCT may provide a useful framework to guide future research.

Self-Concept and Inattention or Hyperactivity-Impulsivity Symptomatology: The Role of Anxiety

Attention-deficit/hyperactivity disorder (ADHD) has been associated with low levels of self-concept (academic, emotional, social or physical), although this association can differ in the function of the inattention or hyperactivity-impulsivity symptomatology. Furthermore, the relation between ADHD and self-concept can be mediated or moderated by the levels of anxiety. This work is aimed to examine the differential effect of inattention symptomatology and hyperactivity-impulsivity symptomatology on academic, emotional, social and physical self-concept and the mediating or moderating role of anxiety in this relationship. A total of 167 students (70.7% boys and 29.3% girls) aged between 11 and 16 participated in this study. Students' ADHD symptomatology, self-concept in four areas (academic, emotional, social and physical self-concept) and trait anxiety were measured with the State-Trait Anxiety Inventory for Children. The results indicate that trait anxiety mediates the relationship between inattention and emotional, social and physical self-concept but does not moderate this relationship. Trait anxiety does not mediate or moderate the relationship between hyperactivity-impulsivity symptoms and self-concept. When inattention symptomatology increases, academic self-concept decreases directly, but students' emotional, social and physical self-concept decreases indirectly through trait anxiety.