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Inci Izmir SB, Aktan ZD, Ercan ES. The Comparison of Psychological Factors and Executive Functions of Children with Attention Deficit Hyperactivity Disorder and Cognitive Disengagement Syndrome to ADHD and ADHD Comorbid with Oppositional Defiant Disorder. J Atten Disord 2024:10870547241267379. [PMID: 39092505 DOI: 10.1177/10870547241267379] [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: 08/04/2024]
Abstract
OBJECTIVE The study aims to examine family functionality, emotion regulation difficulties, preference for loneliness, social exclusion, internalizing and externalizing disorders, and executive functions in children with Attention Deficit Hyperactivity Disorder (ADHD) and Cognitive Disengagement Syndrome (CDS) and compare with ADHD, and ADHD+ Oppositional Defiant Disorder (ODD). METHOD This study included 842 children aged 8-12 years. The subjects were categorized according to DSM-V as ADHD (n = 246), ADHD + ODD (n = 212), ADHD + CDS (n = 176), and Control group (n = 207). The solitude and social exclusion, difficulties in emotion dysregulation and Barkley SCT scales, Child Behavior Checklist, family assessment device, and Central Vital Signs (CNSVS) test were used. RESULTS According to the study, children with ADHD + CDS had higher rates of internalizing disorders. They also preferred being alone and experienced more difficulty communicating with their parents and solving problems within the family. Additionally, these children had difficulty recognizing and understanding the emotional reactions of others. The ADHD + ODD group presented a poorer performance on CNSVS domain tests except for the psychomotor speed test than other groups. Also, ADHD + CDS children had the lowest psychomotor speed scores and lower scores on reaction time and cognitive flexibility than pure ADHD children. CONCLUSION This study will contribute to the etiology, treatment, and clinical discrimination of ADHD + CDS.
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Yılmaz Y, Bahadır E. Cognitive disengagement syndrome and attention deficit hyperactivity disorder: An examination of relationships with alexithymia and emotion regulation difficulties. APPLIED NEUROPSYCHOLOGY. ADULT 2024:1-7. [PMID: 39087375 DOI: 10.1080/23279095.2024.2385444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Abstract
Cognitive disengagement syndrome (CDS) and ADHD are considered distinct but interrelated constructs. This study aimed to investigate the prevalence of elevated CDS symptoms and increased ADHD risk in the general population, and their relationships with emotion regulation difficulty (ERD) and alexithymia. Out of 1166 participants, 142 with known psychiatric conditions were excluded, resulting in 1024 participants. Participants completed various scales including Adult ADHD Self-Report Screening Scale for DSM-5 (ASRS-5), Barkley Adult Sluggish Cognitive Tempo (SCT) Scale, Difficulties in Emotion Regulation Scale-Short Form (DERS-16), and the Toronto Alexithymia Scale (TAS-20). Four groups were formed based on Barkley and ASRS-5 scores: Group 1) No elevated CDS symptoms and Low risk of ADHD, Group 2) No elevated CDS symptoms and Increased risk of ADHD, Group 3) Elevated CDS symptoms and Low risk of ADHD, Group 4) Elevated CDS symptoms and Increased risk of ADHD. Elevated CDS symptoms was found in 10% of participants, and increased ADHD risk in 9.2%. Among probable ADHD cases, 40% had elevated CDS symptoms, while 60% of elevated CDS symptoms cases had increased ADHD risk. Group 4 (elevated CDS symptoms and increased risk of ADHD) had the highest ERD and alexithymia scores, while Group 1(no elevated CDS symptoms and low risk of ADHD) had the lowest. Regression analyses showed that CDS scores predicted ERD (47%) and alexithymia (32%) better than ADHD scores (ERD: 36%, alexithymia: 23%). CDS and ADHD appear as significant concepts that could be involved in the etiology of ERD and alexithymia.
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Affiliation(s)
- Yavuz Yılmaz
- Department of Psychiatry, Sivas Cumhuriyet University, Faculty of Medicine, Sivas, Turkey
| | - Erdi Bahadır
- Departmant of Psychiatry, Hackalı Baba State Hospital, Trabzon, Turkey
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Gomez R, Houghton SJ. Incremental Validity of Trait Impulsivity, Dysfunctional Emotional Regulation, and Affect Lability in the Predictions of Attention Deficit Hyperactivity Disorder and Oppositional Defiant Disorder Symptoms in Adults. Behav Sci (Basel) 2024; 14:598. [PMID: 39062421 PMCID: PMC11273999 DOI: 10.3390/bs14070598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 06/25/2024] [Accepted: 06/28/2024] [Indexed: 07/28/2024] Open
Abstract
Difficulties in emotion regulation (DER) is a defining feature of attention deficit hyperactivity disorder (ADHD), and arguments are being made for it to be considered as a defining feature of oppositional defiant disorder (ODD). However, the consensus is that it is better viewed as an important correlate distinct from ADHD. This study examined the incremental validity of DER over and above trait impulsivity (TI) in the predictions of ADHD and ODD symptoms. It also examined the incremental validity of affect lability (AL) over and above TI and (DER) in these predictions. Five hundred and twenty-five adults from the general community completed a series of questionnaires. A model-based SEM approach for evaluating incremental validity indicated that TI predicted ADHD and ODD symptoms over age; DER predicted ADHD and ODD symptoms over age and TI; and AL did not predict ADHD and ODD symptoms over and above age, IT, or DER. In addition, AL predicted ADHD and ODD symptoms over age and TI, and DER also predicted ADHD and ODD symptoms over and above age, TI, and AL. In conclusion, TI is core to ADHD, and although DER is important, it is unlikely to be relevant as a diagnostic indicator for ADHD or ODD. These findings notwithstanding, there is need for caution when interpreting our findings, as the study did not control for potentially influencing factors on emotional regulation such as age, gender, culture, and existing psychopathologies.
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Affiliation(s)
- Rapson Gomez
- School of Health and Biomedical Sciences, Federation University, Melbourne, VIC 3000, Australia;
| | - Stephen J Houghton
- Graduate School of Education, University of Western Australia, Perth, WA 6009, Australia
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Hawkey EJ, Williams AI, Chung S, Owens EB, Pfiffner LJ. Emotion Regulation and Organizational Skills in Children With ADHD Symptoms Are Associated With Behavioral Parent Training Adherence. J Atten Disord 2024; 28:1320-1330. [PMID: 38726593 DOI: 10.1177/10870547241251725] [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: 06/12/2024]
Abstract
OBJECTIVE Behavioral parent training (BPT) is a well-established treatment for ADHD; however, treatment response is variable. Consistency in parent skill use during BPT is known to influence child outcomes post-treatment, while less research has focused on specific child factors that may be impacting parent skill utilization during treatment. The current study examined associations between child organizational skills and emotion dysregulation (ED) with parent treatment adherence during BPT and post-treatment child impairment. METHOD Parents of 72 children (Mage = 8.31) with ADHD symptoms and impairment participated in BPT which was embedded in a 12-week, multicomponent, school-based intervention for children delivered by school mental health clinicians. Outcomes included parent treatment adherence and child improvements in global impairment post-treatment. RESULTS Greater pre-treatment child organizational problems were associated with less parent treatment adherence regardless of ADHD symptom severity. Worse pre-treatment child ED was associated with more impairment post-treatment regardless of ADHD symptom severity whereas the effects of child ED on parent treatment adherence were moderated by child ADHD symptom severity. CONCLUSION The current study suggests that pre-treatment child ED and organizational difficulties impact parent treatment adherence to behavioral interventions targeting ADHD symptoms, potentially in unique ways, and should be considered in future BPT treatment studies.
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Affiliation(s)
| | | | - Sara Chung
- University of California, San Francisco, CA, USA
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Milligan MA, Deyo AG, Vrabec A, Snyder M, Kidwell KM. Attention-deficit/hyperactivity symptoms and loss of control eating in emerging adults: Role of psychological resilience. Eat Behav 2024; 54:101901. [PMID: 38925001 DOI: 10.1016/j.eatbeh.2024.101901] [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: 11/16/2023] [Revised: 06/17/2024] [Accepted: 06/21/2024] [Indexed: 06/28/2024]
Abstract
OBJECTIVE This study aimed to fill a gap in the literature regarding the role of resilience in the relationship between symptoms of Attention-Deficit/Hyperactivity Disorder (ADHD) and loss of control (LOC) eating in a nonclinical sample of emerging adults. Resilience was examined as a potential moderator and as a potential mediator of ADHD symptoms and engagement in LOC eating behaviors. Improved understanding of this relationship may inform clinical intervention and risk screening methodologies for disordered eating behaviors in college students. METHODS Participants were undergraduate students (N = 386) from a private university in the northeastern United States. Linear regression analysis examined whether greater ADHD symptoms related to greater LOC eating. Pathway analyses examined resilience as either a moderator or mediator of the relationship between ADHD symptoms and LOC eating. RESULTS A direct positive relationship was found between ADHD symptoms and LOC eating (p < .05). Resilience partially mediated this relationship, such that increased ADHD symptoms indirectly related to increased LOC eating through low resilience (p < .05). CONCLUSION Findings indicate that undergraduate students with greater ADHD symptoms engaged in more frequent LOC eating, and that low resilience was a partial mediator of this positive relationship.
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Affiliation(s)
- Megan A Milligan
- Department of Psychology, Syracuse University, Syracuse, NY 13244, United States.
| | - Alexa G Deyo
- Department of Psychology, Syracuse University, Syracuse, NY 13244, United States
| | - Alison Vrabec
- Department of Psychology, Syracuse University, Syracuse, NY 13244, United States
| | - Matthew Snyder
- Department of Psychology, Syracuse University, Syracuse, NY 13244, United States
| | - Katherine M Kidwell
- Department of Psychology, Syracuse University, Syracuse, NY 13244, United States
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Waschbusch DA, Cao VT, Shroff DM, Bansal PS, Willoughby MT. Measuring Children's Reward and Punishment Sensitivity: An Initial Psychometric Evaluation of the Contingency Response Rating Scale. Assessment 2024:10731911241256536. [PMID: 38869172 DOI: 10.1177/10731911241256536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2024]
Abstract
Existing research shows that children's responses to rewards and punishments are essential for understanding attention-deficit/hyperactivity disorder, oppositional defiant disorder, conduct disorder, and callous-unemotional traits. The present study developed the Contingency Response Rating Scale (CRRS) to fulfill the need for a reliable and valid measure of children's contingency response style that is brief, easy to use in applied settings, and provides additional information to existing clinical measures. We examined the psychometric properties of the CRRS in a sample of 196 children (ages 5-12), most of whom were referred to evaluate attention and behavior problems in an outpatient clinic. Using principal axis factoring, we identified five factors: (a) punishment ineffectiveness, (b) reward ineffectiveness, (c) punishment dysregulation, (d) reward dysregulation, and (e) contingency insensitivity. The subscales based on these factors showed acceptable test-retest and internal consistency reliability, and scale intercorrelations varied from low to moderate. The subscales also captured significant variance not explained by child or parent demographics and were associated with measures of psychopathology and impairment. The results provide preliminary evidence that the CRRS may be a helpful tool for assessing reward and punishment sensitivity in children with attention and behavior problems.
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Haza B, Gosling CJ, Ciminaghi F, Conty L, Pinabiaux C. Research Review: Social cognition and everyday social skills in children and adolescents with attention-deficit/hyperactivity disorder: a meta-analysis of case-control studies. J Child Psychol Psychiatry 2024. [PMID: 38860431 DOI: 10.1111/jcpp.14006] [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] [Accepted: 04/01/2024] [Indexed: 06/12/2024]
Abstract
BACKGROUND Previous studies that have assessed social cognition in Attention-Deficit/Hyperactivity Disorder (ADHD) have produced inconsistent findings. To summarize these data and shed light upon moderators that may explain observed inconsistencies, we conducted a systematic review and meta-analysis exploring social cognition (Theory of Mind (ToM), Empathy, Facial and Non-Facial Emotion Recognition) and Everyday Social Skills in children and adolescents with ADHD. METHODS The current meta-analysis involved 142 studies including 652 effect sizes. These studies compared children and adolescents with ADHD (n = 8,300) and with typical development (n = 7,983). RESULTS Participants with ADHD exhibited moderate to very large deficits in ToM (SMD = 0.84, 95% CI = 0.68-0.99), Facial Emotion Recognition (SMD = 0.63, 95% CI = 0.46-0.81), and Everyday Social Skills (SMD = 1.23, 95% CI = 1.08-1.37). The magnitude of these impairments was similar when considering effect sizes adjusted for some covariates and the methodological quality of the studies. Few studies have investigated Empathy and Non-Facial Emotion Recognition, which precludes definitive conclusions. CONCLUSIONS Children and adolescents with ADHD experience robust impairments in ToM, Facial Emotion Recognition and Everyday Social Skills. Future studies should explore whether these deficits are a consequence of difficulties in other areas of cognition (e.g., executive functioning). We have made all our raw data open access to facilitate the use of the present work by the community (e.g., clinicians looking for tools, assessing social impairments, or researchers designing new studies).
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Affiliation(s)
- Belen Haza
- Laboratory of Cognitive Functioning and Dysfunctioning (DysCo), Université Paris Nanterre, Nanterre, France
| | - Corentin J Gosling
- Laboratory of Cognitive Functioning and Dysfunctioning (DysCo), Université Paris Nanterre, Nanterre, France
- Laboratory of Psychopathology and Health Process, Université Paris Cité, Boulogne Billancourt, France
- Faculty of Environmental and Life Sciences, School of Psychology, Centre for Innovation in Mental Health (CIMH), University of Southampton, Southampton, UK
| | - Flavia Ciminaghi
- Laboratory of Cognitive Functioning and Dysfunctioning (DysCo), Université Paris Nanterre, Nanterre, France
| | - Laurence Conty
- Laboratory of Cognitive Functioning and Dysfunctioning (DysCo), Université Paris Nanterre, Nanterre, France
| | - Charlotte Pinabiaux
- Laboratory of Cognitive Functioning and Dysfunctioning (DysCo), Université Paris Nanterre, Nanterre, France
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Karalunas SL, Dude J, Figuracion M, Lane SP. Momentary Dynamics Implicate Emotional Features in the ADHD Phenotype. Res Child Adolesc Psychopathol 2024:10.1007/s10802-024-01206-9. [PMID: 38771497 DOI: 10.1007/s10802-024-01206-9] [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] [Accepted: 04/22/2024] [Indexed: 05/22/2024]
Abstract
Emotional dysregulation is increasingly recognized as important to the attention-deficit/hyperactivity disorder (ADHD) phenotype alongside inattention and hyperactivity-impulsivity. Studies of ADHD have relied primarily on trait-based conceptualizations that emphasize stability of symptoms across moderate developmental timescales (i.e., months to years). Trait-based conceptualizations provide a critical view but fail to account for short-term dynamic variations in the expression of ADHD symptoms and emotion. This leaves a gap in our understanding of the short-term variation in ADHD symptom expression and the dynamic relationships among ADHD symptoms and emotion. Here, we assessed caregiver report of ADHD symptoms and positive and negative emotion using ecological momentary approaches over 2 weeks in a sample of 36 children with and without ADHD between the ages of 7-12 years old. Between-person (RKF) and within-person (RC) reliability were estimated. Multilevel models tested specific covariation hypotheses between ADHD symptoms and emotion. Analyses confirmed that ADHD and emotion ratings were reliable as individual differences (i.e., between-person; RKF range 0.93-1.0) and moment-to-moment change (i.e., within-person; Rc range 0.66-0.88) measures. Multilevel models found little evidence for lagged effects between domains, but consistently identified concurrent expression of ADHD symptoms and emotions; inattention covaried most strongly with negative emotion and hyperactivity-impulsivity covaried most strongly with positive emotion. Results demonstrate the importance of complementing trait-level conceptualizations with assessment of momentary dynamics. Momentary assessment suggests important covariation of ADHD symptoms and emotion as part of the ADHD phenotype.
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Affiliation(s)
| | - Jason Dude
- Washington University in Saint Louis, Saint Louis, MO, USA
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Henning CT, Summerfeldt LJ, Parker JDA. Longitudinal Associations Between Symptoms of ADHD and Life Success: From Emerging Adulthood to Early Middle Adulthood. J Atten Disord 2024; 28:1139-1151. [PMID: 38504446 PMCID: PMC11016205 DOI: 10.1177/10870547241239148] [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: 03/21/2024]
Abstract
OBJECTIVE To expand on current adult ADHD literature by investigating the stability of ADHD symptomatology (i.e., inattention and hyperactivity-impulsivity) across a 15-year period (from emerging adulthood to early middle adulthood) and the relative contributions of ADHD symptomatology to life success. METHOD A sample of 320 post-secondary students was initially assessed for ADHD symptomatology using the Conners' Adult ADHD Rating Scale (CAARS). Fifteen years later, participants were re-assessed using the CAARS and several measures of life success (e.g., relationship satisfaction, career satisfaction, and stress levels). RESULTS Inattention and hyperactivity-impulsivity symptoms showed strong stability across the 15-year period. Additionally, inattention symptoms during emerging adulthood and early middle adulthood were consistently associated with poorer life success (i.e., lower relationship and career satisfaction), particularly for men. Associations for hyperactivity-impulsivity symptoms were less consistent. CONCLUSION ADHD symptomatology can be conceptualized as a stable, dimensional trait across adulthood, with important impacts on life success.
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De Ronda AC, Rice L, Zhao Y, Rosch KS, Mostofsky SH, Seymour KE. ADHD-related sex differences in emotional symptoms across development. Eur Child Adolesc Psychiatry 2024; 33:1419-1432. [PMID: 37368082 PMCID: PMC10986680 DOI: 10.1007/s00787-023-02251-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 06/19/2023] [Indexed: 06/28/2023]
Abstract
To investigate developmental changes in emotion dysregulation (ED) and associated symptoms of emotional lability, irritability, anxiety, and depression, among girls and boys with and without ADHD from childhood through adolescence. Data were collected from a sample of 8-18-year-old children with (n = 264; 76 girls) and without (n = 153; 56 girls) ADHD, with multiple time-points from a subsample of participants (n = 121). Parents and youth completed rating scales assessing child ED, emotional lability, irritability, anxiety, and depression. Mixed effects models were employed to examine effects and interactions of diagnosis, sex [biological sex assigned at birth], age among boys and girls with and without ADHD. Mixed effects analyses showed sexually dimorphic developmental patterns between boys and girls, such that boys with ADHD showed a greater reduction in ED, irritability, and anxiety with age compared to girls with ADHD, whose symptom levels remained elevated relative to TD girls. Depressive symptoms were persistently elevated among girls with ADHD compared to boys with ADHD, whose symptoms decreased with age, relative to same-sex TD peers. While both boys and girls with ADHD showed higher levels of ED during childhood (compared to their sex-matched TD peers), mixed effects analyses revealed substantial sexually dimorphic patterns of emotional symptom change during adolescence: Boys with ADHD showed robust improvements in emotional symptoms from childhood to adolescence while girls with ADHD continued to show high and/or increased levels of ED, emotional lability, irritability, anxiety and depression.
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Affiliation(s)
- Alyssa C De Ronda
- Center for Neurodevelopmental and Imaging Research, Kennedy Krieger Institute, 716 North Broadway, Baltimore, MD, 21205, USA
| | - Laura Rice
- Center for Neurodevelopmental and Imaging Research, Kennedy Krieger Institute, 716 North Broadway, Baltimore, MD, 21205, USA
| | - Yi Zhao
- Department of Biostatistics, Indiana University School of Medicine, 410 West 10th Street, Indianapolis, IN, 46202, USA
| | - Keri S Rosch
- Center for Neurodevelopmental and Imaging Research, Kennedy Krieger Institute, 716 North Broadway, Baltimore, MD, 21205, USA
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 716 North Broadway, Baltimore, MD, 21205, USA
| | - Stewart H Mostofsky
- Center for Neurodevelopmental and Imaging Research, Kennedy Krieger Institute, 716 North Broadway, Baltimore, MD, 21205, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 716 North Broadway, Baltimore, MD, 21205, USA
- Department of Neurology, Johns Hopkins University School of Medicine , 716 North Broadway, Baltimore, MD, 21205, USA
| | - Karen E Seymour
- Center for Neurodevelopmental and Imaging Research, Kennedy Krieger Institute, 716 North Broadway, Baltimore, MD, 21205, USA.
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 716 North Broadway, Baltimore, MD, 21205, USA.
- Department of Mental Health, Johns Hopkins University School of Public Health, 6701 Rockledge Drive, Bethesda, MD, 20892, USA.
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Hernandez ML, Garcia AM, Spiegel JA, Dick AS, Graziano PA. Multimodal Assessment of Emotion Dysregulation in Children with and without ADHD and Disruptive Behavior Disorders. 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; 53:444-459. [PMID: 38270592 PMCID: PMC11192619 DOI: 10.1080/15374416.2024.2303706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
OBJECTIVE We sought to explore if specific domains of emotion dysregulation (emotion regulation [EREG], emotional reactivity/lability [EREL], emotion recognition/understanding [ERU], and callous-unemotional [CU] behaviors) were uniquely associated with diagnostic classifications. METHOD This study utilized a multimodal (parent/teacher [P/T] reports and behavioral observations) approach to examine emotion dysregulation in a sample of young children (68.7% boys; mean age = 5.47, SD = 0.77, 81.4% Latinx) with attention-deficit/hyperactivity disorder (ADHD Only; n = 46), ADHD + disruptive behavior disorders (ADHD+DBD; n = 129), and typically developing (TD) children (n = 148). RESULTS All three diagnostic groups were significantly different from one another on P/T reports of EREG, EREL and CU. For the ADHD+DBD group, P/T reported worse EREG and EREL, and higher mean scores of CU, compared to both ADHD Only and TD groups. The ADHD+DBD group also performed significantly worse than the TD group (but not the ADHD Only group) on observed measures of EREG, EREL and ERU. P/T reported EREG, EREL and CU for the ADHD Only group were significantly worse than the TD group. Using multinomial logistic regression, P/T reported EREG, EREL, and CU were significantly associated with diagnostic status above and beyond observed measures of emotion dysregulation. The model successfully classified children with ADHD+DBD (91.3%) and TD (95.9%); however, children in the ADHD Only group were correctly identified only 45.7% of time. CONCLUSION Our findings suggest that measures of emotion dysregulation may be particularly helpful in correctly identifying children with ADHD+DBD, but not necessarily children with ADHD Only.
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Dussault M, Thompson RB. Fundamental Themes in Social-Emotional Learning: A Theoretical Framework for Inclusivity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:506. [PMID: 38673417 PMCID: PMC11050119 DOI: 10.3390/ijerph21040506] [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: 11/07/2023] [Revised: 01/20/2024] [Accepted: 01/26/2024] [Indexed: 04/28/2024]
Abstract
Social-emotional learning (SEL) is a rapidly growing field of research that has garnered significant attention in recent years. Each facet of SEL research in fields such as education, mental health, and developmental research has used specific methodologies and terms in their narrow research focus. In education specifically, where the most SEL research has been produced, many frameworks have implementation requirements. The lack of a framework focused on overarching themes without implementation requirements prevents the fields from coming together to compile and compare research and progress to create parent-, adult-, or mental health-specific SEL programs. This paper provides a conceptual analysis of SEL, aimed at clarifying the concept and deconstructing its various facets. This framework is needed to acknowledge the many different terms and skills for the same principle while also narrowing down definitions for clarity. The resulting framework can be used as a basis for future research, practice, and policy discussions in the field.
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Affiliation(s)
- Mickayla Dussault
- Psychology Department, University of Southern Maine, Portland, ME 04103, USA;
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Marques S, Correia-de-Sá T, Guardiano M, Sampaio-Maia B, Ferreira-Gomes J. Emotion dysregulation and depressive symptoms mediate the association between inhibitory control difficulties and aggressive behaviour in children with ADHD. Front Psychiatry 2024; 15:1329401. [PMID: 38690203 PMCID: PMC11059059 DOI: 10.3389/fpsyt.2024.1329401] [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: 10/28/2023] [Accepted: 04/02/2024] [Indexed: 05/02/2024] Open
Abstract
Background/objectives Impulsive aggressive behaviour, although not a core symptom, is often part of the clinical presentation of attention-deficit/hyperactivity disorder (ADHD). Recently, impulsive aggression has been attributed to emotion dysregulation, which is currently conceptualised as a transdiagnostic factor and seems to contribute to the co-occurrence of other problems in ADHD. Thus, this study investigated the presence of impulsive aggressive behaviour and explored whether emotion dysregulation mediates the relationship between inhibitory control difficulties and aggressive behaviour in children with ADHD. Because ADHD may act as a risk factor for the development of other conditions, such as internalising problems, we aimed to understand whether depressive symptoms contribute to this relationship. Methods Seventy-two children were recruited from a hospital and the community, 38 of whom had ADHD and 34 were typically developing (TD). Parents completed the Child Behaviour Checklist, the Behaviour Rating Inventory of Executive Function, and the Emotion Regulation Checklist. Simple mediation and serial mediation models were performed to test our hypotheses. Results Aggressive behaviour was significantly higher in ADHD children compared to TD children. Emotion dysregulation fully mediated the relationship between inhibitory control difficulties and aggressive behaviour in ADHD children. Adding depressive symptoms to the model increased the explained variance in aggressive behaviour. Conclusion The main result of our study supports the role of emotion dysregulation and depressive symptoms in mediating the relationship between inhibitory control difficulties and impulsive aggressive behaviour in children with ADHD. This highlights that aggressive behaviour is, in part, a result of the inability of the child to appropriately regulate their emotions. Future interventions may be tailored to improve emotion regulation skills to address aggressive behaviour.
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Affiliation(s)
- Sofia Marques
- Institute of Psychology and Educational Sciences, Lusíada University, Porto, Portugal
- CIPD—Psychology for Development Research Centre, Lusíada University, Porto, Portugal
| | - Teresa Correia-de-Sá
- Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal
- INEB—Institute of Biomedical Engineering, University of Porto, Porto, Portugal
- i3S—Institute for Research & Innovation in Health, University of Porto, Porto, Portugal
| | - Micaela Guardiano
- Department of Paediatrics, Unit of Neurodevelopmental Paediatrics, University Hospital Centre of São João, Porto, Portugal
| | - Benedita Sampaio-Maia
- INEB—Institute of Biomedical Engineering, University of Porto, Porto, Portugal
- i3S—Institute for Research & Innovation in Health, University of Porto, Porto, Portugal
- Faculty of Dental Medicine, University of Porto, Porto, Portugal
| | - Joana Ferreira-Gomes
- Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal
- i3S—Institute for Research & Innovation in Health, University of Porto, Porto, Portugal
- IBMC—Institute for Molecular and Cell Biology, University of Porto, Porto, Portugal
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Inci Izmir SB, Aktan ZD, Ercan ES. Assessing the mediating relationships between psychological factors in children with attention deficit hyperactivity disorder and cognitive disengagement syndrome. APPLIED NEUROPSYCHOLOGY. CHILD 2024:1-17. [PMID: 38615909 DOI: 10.1080/21622965.2024.2341251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
This study aims to investigate the predictive and mediating relationships between emotion dysregulation, internalizing disorders, family functionality, loneliness preference, and executive functions (EF) in children with attention deficit hyperactivity disorder and cognitive disengagement syndrome (ADHD + CDS). This study included 176 children and adolescents (92 boys, 84 girls) who were diagnosed with ADHD + CDS according to the Diagnostic and Statistical Manual of Mental Disorders, the Fifth Edition criteria by a fellowship-trained child and adolescent psychiatrist, between ages 8 -12 (M = 10, SD = 1.52) with a convenience sampling method. The solitude scale for children, difficulties in emotion dysregulation scale, Child Behavior Checklist, Barkley Sluggish Cognitive Tempo Scale, Family assessment device, and CNS Vital Signs test were used. The results showed that difficulty in emotion regulation, preference for loneliness, internalizing disorders and CDS symptom severity did not have a mediating effect between family functionality and EF. Still, emotion dysregulation mediates the relationship between EF and internalizing disorders by itself and through loneliness preference. Also, preference for loneliness and emotion dysregulation had a mediating effect between family functionality and internalizing disorders. Finally, it was found that the effect of emotion regulation difficulty, loneliness preference, and internalizing disorders had a mediating role between CDS symptom severity and family functionality. In conclusion, the information obtained from this study on the etiology of CDS may guide future studies.
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Affiliation(s)
| | - Z Deniz Aktan
- Child and Adolescent Clinical Psychology Department, Isik University, Istanbul, Turkey
| | - Eyüp Sabri Ercan
- Child and Adolescent Psychiatry Department, Medical Faculty, Ege University, Izmir, Turkey
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15
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Figuracion MT, Kozlowski MB, Macknyk KS, Heise MB, Pieper SM, Alperin BR, Morton HE, Nigg JT, Karalunas SL. The Relationship Between Emotion Dysregulation and Error Monitoring in Adolescents with ADHD. Res Child Adolesc Psychopathol 2024; 52:605-620. [PMID: 37843650 DOI: 10.1007/s10802-023-01127-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: 09/12/2023] [Indexed: 10/17/2023]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is emblematic of the limitations of existing diagnostic categories. One potential solution, consistent with the Research Domain Criteria (RDoC) initiative, is to interrogate psychological mechanisms at the behavioral and physiological level together to try and identify meaningful subgroups within existing categories. Such approaches provide a way to revise diagnostic boundaries and clarify individual variation in mechanisms. Here, we illustrate this approach to help resolve heterogeneity in ADHD using a combination of behaviorally-rated temperament measures from the Early Adolescent Temperament Questionnaire; cognitive performance on three difference conditions of an emotional go/no-go task; and electroencephalogram (EEG)-measured variation in multiple stages of error processing, including the error-related negativity (ERN) and positivity (Pe). In a large (N = 342), well-characterized sample of adolescents with ADHD, latent profile analysis identified two ADHD temperament subgroups: 1) emotionally regulated and 2) emotionally dysregulated (with high negative affect). Cognitive and EEG assessment in a subset of 272 adolescents (nADHD = 151) found that the emotionally dysregulated group showed distinct patterns of change in early neural response to errors (ERN) across emotional task conditions as compared to emotionally-regulated ADHD adolescents and typically-developing controls. Both ADHD groups showed blunted later response to errors (Pe) that was stable across emotional task conditions. Overall, neural response patterns identified important differences in how trait and state emotion interact to affect cognitive processing. Results highlight important temperament variation within ADHD that helps clarify its relationship to the ERN, one of the most prominent putative neural biomarkers for psychopathology.
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Affiliation(s)
| | - Michael B Kozlowski
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA
| | - Katelyn S Macknyk
- Department of Psychological Sciences, Purdue University, West Lafayette, IN, USA
| | - Madelyn B Heise
- Department of Psychological Sciences, Purdue University, West Lafayette, IN, USA
| | - Sarah M Pieper
- Department of Psychological Sciences, Purdue University, West Lafayette, IN, USA
| | - Brittany R Alperin
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA
| | - Hannah E Morton
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA
| | - Joel T Nigg
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA
| | - Sarah L Karalunas
- Department of Psychological Sciences, Purdue University, West Lafayette, IN, USA
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16
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Restoy D, Oriol-Escudé M, Alonzo-Castillo T, Magán-Maganto M, Canal-Bedia R, Díez-Villoria E, Gisbert-Gustemps L, Setién-Ramos I, Martínez-Ramírez M, Ramos-Quiroga JA, Lugo-Marín J. Emotion regulation and emotion dysregulation in children and adolescents with Autism Spectrum Disorder: A meta-analysis of evaluation and intervention studies. Clin Psychol Rev 2024; 109:102410. [PMID: 38401510 DOI: 10.1016/j.cpr.2024.102410] [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: 03/30/2023] [Revised: 01/14/2024] [Accepted: 02/19/2024] [Indexed: 02/26/2024]
Abstract
Children and adolescents with Autism Spectrum Disorder (ASD) often experience challenges in emotion regulation (ER) and emotion dysregulation (ED) which can interfere with their adaptive functioning. This study aimed to systematically review and meta-analyze the evidence on ER/ED in children and/or adolescents with ASD, examining its relationship with the following variables: internalizing and externalizing symptoms, cognitive function and social skills, and the effectiveness of non-pharmacological interventions addressing ER difficulties. Both electronic and manual searches were conducted to identify potential studies. Fifty-five studies were included in the meta-analysis. A statistically significant between-group difference was found, suggesting greater ER/ED challenges in the ASD group. Also, the ASD group showed more maladaptive ER strategies and fewer adaptive ER strategies compared to the non-ASD participants. Additionally, more severe ASD and poorer social skills were associated with greater ED and poorer ER skills, respectivelly. Furthermore, there was a significant correlation between internalizing symptomatology and both adaptive and maladaptive ER strategies. Studies of non-pharmacological interventions showed significant improvement in both ER and ED. These results imply that assessing ER/ED in children and adolescents with ASD should be part of the evaluation process, and it should also be a focal point for intervention in this population.
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Affiliation(s)
- Damián Restoy
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain
| | | | - Teresa Alonzo-Castillo
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain
| | - María Magán-Maganto
- Centro de Atención Integral al Autismo-InFoAutismo. INICO-Instituto Universitario de Integración en la Comunidad, University of Salamanca. Salamanca, Spain
| | - Ricardo Canal-Bedia
- Centro de Atención Integral al Autismo-InFoAutismo. INICO-Instituto Universitario de Integración en la Comunidad, University of Salamanca. Salamanca, Spain
| | - Emiliano Díez-Villoria
- Centro de Atención Integral al Autismo-InFoAutismo. INICO-Instituto Universitario de Integración en la Comunidad, University of Salamanca. Salamanca, Spain
| | - Laura Gisbert-Gustemps
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain; Biomedical Network Research Centre on Mental Health (CIBERSAM), Madrid, Spain; Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - Imanol Setién-Ramos
- Psychiatric Genetics Unit, Vall d'Hebron Research Institute (VHIR), Barcelona, Catalonia, Spain
| | - María Martínez-Ramírez
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain
| | - Josep Antoni Ramos-Quiroga
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain; Biomedical Network Research Centre on Mental Health (CIBERSAM), Madrid, Spain; Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain; Psychiatric Genetics Unit, Vall d'Hebron Research Institute (VHIR), Barcelona, Catalonia, Spain
| | - Jorge Lugo-Marín
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain; Centro de Atención Integral al Autismo-InFoAutismo. INICO-Instituto Universitario de Integración en la Comunidad, University of Salamanca. Salamanca, Spain; Biomedical Network Research Centre on Mental Health (CIBERSAM), Madrid, Spain; Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain.
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17
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Dimakos J, Gauthier-Gagné G, Lin L, Scholes S, Gruber R. The Associations Between Sleep and Externalizing and Internalizing Problems in Children and Adolescents with Attention-Deficit/Hyperactivity Disorder: Empirical Findings, Clinical Implications, and Future Research Directions. Psychiatr Clin North Am 2024; 47:179-197. [PMID: 38302206 DOI: 10.1016/j.psc.2023.06.012] [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: 02/03/2024]
Abstract
Sleep problems are common in youth with attention-deficit/hyperactivity disorder (ADHD). Externalizing and internalizing problems contribute to dysfunction in youth with ADHD and are amplified by disrupted sleep. This objective of this article is to synthesize empirical studies that examined the associations between sleep and internalizing or externalizing problems in individuals with ADHD. The main findings are that sleep problems precede, predict, and significantly contribute to the manifestation of internalizing and externalizing behavior problems among children and adolescents with ADHD. Clinicians should assess sleep and integrate sleep interventions into the management of youth with ADHD.
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Affiliation(s)
- Jenny Dimakos
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Gabrielle Gauthier-Gagné
- Attention Behavior and Sleep Lab, Douglas Mental Health University Institute, Montréal, Quebec H4H 1R3, Canada
| | - Lanyi Lin
- Attention Behavior and Sleep Lab, Douglas Mental Health University Institute, Montréal, Quebec H4H 1R3, Canada
| | - Samantha Scholes
- Attention Behavior and Sleep Lab, Douglas Mental Health University Institute, Montréal, Quebec H4H 1R3, Canada; Department of Educational and Counselling Psychology, McGill University, Montréal, Quebec, Canada
| | - Reut Gruber
- Attention Behavior and Sleep Lab, Douglas Mental Health University Institute, Montréal, Quebec H4H 1R3, Canada; Department of Psychiatry, Faculty of Medicine, McGill University, Montréal, Quebec, Canada.
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18
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Graziano PA, Sibley MH, Coxe SJ, Bickman L, Martin P, Scheres A, Hernandez ML. Community-Delivered Evidence-Based Practice and Usual Care for Adolescent Attention-Deficit/Hyperactivity Disorder: Examining Mechanistic Outcomes. Behav Ther 2024; 55:412-428. [PMID: 38418050 PMCID: PMC10902603 DOI: 10.1016/j.beth.2023.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 08/01/2023] [Accepted: 08/04/2023] [Indexed: 03/01/2024]
Abstract
Previous research suggests that routine psychosocial care for adolescents with attention-deficit/hyperactivity disorder (ADHD) is an eclectic and individualized mix of diluted evidence-based practices (EBPs) and low-value approaches. This study evaluated the extent to which a community-delivered EBP and usual care (UC) for adolescents with ADHD produce differential changes in theorized behavioral, psychological, and cognitive mechanisms of ADHD. A randomized community-based trial was conducted with double randomization of adolescent and community therapists to EBP delivery supports (Supporting Teens' Autonomy Daily [STAND]) versus UC delivery. Participants were 278 culturally diverse adolescents (ages 11-17) with ADHD and caregivers. Mechanistic outcomes were measured at baseline, post-treatment, and follow-up using parent-rated, observational, and task-based measures. Results using linear mixed models indicated that UC demonstrated superior effects on parent-rated and task-based executive functioning relative to STAND. However, STAND demonstrated superior effects on adolescent motivation and reducing parental intrusiveness relative to UC when it was delivered by licensed therapists. Mechanisms of community-delivered STAND and UC appear to differ. UC potency may occur through improved executive functioning, whereas STAND potency may occur through improved teen motivation and reducing low-value parenting practices. However, when delivered by unlicensed, community-based therapists, STAND did not enact proposed mechanisms. Future adaptations of community-delivered EBPs for ADHD should increase supports for unlicensed therapists, who comprise the majority of the community mental health workforce.
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Affiliation(s)
| | - Margaret H Sibley
- University of Washington School of Medicine, Seattle Children's Research Institute, and Florida International University
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19
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Martin-Moratinos M, Bella-Fernández M, Rodrigo-Yanguas M, González-Tardón C, Sújar A, Li C, Wang P, Royuela A, Lopez-Garcia P, Blasco-Fontecilla H. Effectiveness of a Serious Video Game (MOON) for Attention Deficit Hyperactivity Disorder: Protocol for a Randomized Clinical Trial. JMIR Res Protoc 2024; 13:e53191. [PMID: 38393773 PMCID: PMC10924267 DOI: 10.2196/53191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 12/20/2023] [Accepted: 01/11/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Attention deficit hyperactivity disorder (ADHD) is the most common neurodevelopmental disorder in childhood and adolescence, with a prevalence of 5% and associated difficulties and worse prognosis if undetected. Multimodal treatment is the treatment of choice. However, sometimes treatment can be insufficient or have drawbacks. OBJECTIVE This study protocol aims to demonstrate the effectiveness of cognitive training through the serious video game The Secret Trail of Moon (MOON) in improving emotional regulation in people with ADHD. METHODS This is a prospective, unicenter, randomized, unblinded, pre- and postintervention study. The groups will be randomized (MOON vs control) via an electronic case report form. The MOON intervention will be performed 2 times per week for 10 weeks (30 minutes per session). The first 5 weeks (10 sessions) will be conducted face-to-face at the Puerta de Hierro University Hospital, and the remaining weeks will be conducted via the internet at the participants' homes. The total sample consists of 152 patients aged between 7 and 18 years. All participants have a clinical diagnosis of ADHD under pharmacological treatment. Data collection will be used to obtain demographic and clinical data. The data will be recorded using REDCap. Measures will be made through clinical scales for parents and objective tests of cognitive functioning in patients. Additional information on academic performance will be collected. The study has a power greater than 80% to detect differences. Student t test, 2-factor analysis of variance (ANOVA), and Mann-Whitney analyses will be performed according to each variable's characteristics. RESULTS The study was approved by the Research Ethics Committee of the Puerta de Hierro University Hospital on December 14, 2022. As of September 26, 2023, we have enrolled 62 participants, and 31 participants have completed the study. This clinical trial was funded by the Comunidad de Madrid (IND2020/BMD-17544). The approximate completion date is March 2024. CONCLUSIONS Serious video games such as MOON can be motivational tools that complement multimodal treatment for ADHD. TRIAL REGISTRATION ClinicalTrials.gov; NCT06006871; https://clinicaltrials.gov/study/NCT06006871. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/53191.
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Affiliation(s)
- Marina Martin-Moratinos
- Department of Psychiatry, Puerta de Hierro University Hospital, Health Research Institute Puerta de Hierro-Segovia de Arana, Majadahonda, Madrid, Spain, Spain
- Faculty of Medicine, Autonoma University of Madrid, Madrid, Spain
| | - Marcos Bella-Fernández
- Department of Psychiatry, Puerta de Hierro University Hospital, Health Research Institute Puerta de Hierro-Segovia de Arana, Majadahonda, Madrid, Spain, Spain
- Faculty of Psychology, Autonoma University of Madrid, Madrid, Spain
- Department of Psychology, Pontifical University of Comillas, Madrid, Spain
| | | | | | - Aaron Sújar
- Department of Computer Engineering, Universidad Rey Juan Carlos, Móstoles, Madrid, Spain
| | - Chao Li
- Department of Psychiatry, Puerta de Hierro University Hospital, Health Research Institute Puerta de Hierro-Segovia de Arana, Majadahonda, Madrid, Spain, Spain
- Faculty of Medicine, Autonoma University of Madrid, Madrid, Spain
| | - Ping Wang
- Department of Psychiatry, Puerta de Hierro University Hospital, Health Research Institute Puerta de Hierro-Segovia de Arana, Majadahonda, Madrid, Spain, Spain
- Faculty of Medicine, Autonoma University of Madrid, Madrid, Spain
| | - Ana Royuela
- Clinical Biostatistics Unit, Consortium for Biomedical Research Network in Epidemiology and Public Health, Madrid, Spain
| | - Pilar Lopez-Garcia
- Faculty of Medicine, Autonoma University of Madrid, Madrid, Spain
- Spain Biomedical Research Networking Center for Mental Health Network, Madrid, Spain
| | - Hilario Blasco-Fontecilla
- Department of Psychiatry, Puerta de Hierro University Hospital, Health Research Institute Puerta de Hierro-Segovia de Arana, Majadahonda, Madrid, Spain, Spain
- Faculty of Medicine, Autonoma University of Madrid, Madrid, Spain
- Spain Biomedical Research Networking Center for Mental Health Network, Madrid, Spain
- ITA Center Mental Health Specialists, Madrid, Spain
- Health Sciences School and Medical Center, Universidad Internacional de La Rioja, Madrid, Spain
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20
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Rahali M, Fongaro E, Franc N, Nesensohn J, Purper-Ouakil D, Kerbage H. Expected changes in parenting after an online parent training for ADHD. L'ENCEPHALE 2024; 50:59-67. [PMID: 37005192 DOI: 10.1016/j.encep.2023.01.007] [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: 10/20/2022] [Revised: 12/26/2022] [Accepted: 01/10/2023] [Indexed: 04/03/2023]
Abstract
BACKGROUND Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder in children and adolescents. Treatments for this population should be multidisciplinary and must be initiated as early as possible. Non-pharmacological interventions for ADHD include psychoeducation, parent behavioural training programs and school interventions and accommodations. In response to the COVID-19 pandemic, we developed an online version of a combined psychoeducation and behavioural training program to facilitate access to mental health treatment and ensure continuity of care. OBJECTIVE The study assessed the acceptability of this online parent training program, among parents and caretakers of children and adolescents with ADHD. METHODS The program consisted of ten online sessions over the course of two consecutive days (five sessions a day). Satisfaction, usefulness and general comments about the program were assessed with open-ended questions and visual-analogous scales. Parents/caretakers' use of strategies to manage behavioural problems was assessed using the Parenting and Family Adjustment Scales. RESULTS A total of 206 parents participated in the online program 175 of whom completed the evaluation. Participants were satisfied with the content of the program. More than half of participants had already started using strategies included in the program. The engagement was high and no major obstacles were identified other than some internet connection issues. DISCUSSION In our survey, online delivery was described as more convenient, and participants were satisfied with the content of the program finding it beneficial for their child. Despite this, some difficulties in implementing new strategies were observed. Online BTP increased access to the BTP programs while being effective on ADHD symptoms and behavioural disturbances. CONCLUSIONS With these measures, we hope to improve engagement in online psychoeducation and behavioural therapy programs. Future research evaluating online behavioural training programs should focus on ways to make them more accessible and adaptable to families' obstacles.
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Affiliation(s)
- M Rahali
- Médecine Psychologique de l'Enfant et de l'Adolescent MPEA1, Hôpital Saint-Éloi, CHU de Montpellier, 80, avenue Augustin-Fliche, 34090 Montpellier, France
| | - E Fongaro
- Médecine Psychologique de l'Enfant et de l'Adolescent MPEA1, Hôpital Saint-Éloi, CHU de Montpellier, 80, avenue Augustin-Fliche, 34090 Montpellier, France; CESP, Inserm U 1018, UVSQ Psychiatry Development and Trajectories, Villejuif, France.
| | - N Franc
- Médecine Psychologique de l'Enfant et de l'Adolescent MPEA1, Hôpital Saint-Éloi, CHU de Montpellier, 80, avenue Augustin-Fliche, 34090 Montpellier, France
| | - J Nesensohn
- Médecine Psychologique de l'Enfant et de l'Adolescent MPEA1, Hôpital Saint-Éloi, CHU de Montpellier, 80, avenue Augustin-Fliche, 34090 Montpellier, France
| | - D Purper-Ouakil
- Médecine Psychologique de l'Enfant et de l'Adolescent MPEA1, Hôpital Saint-Éloi, CHU de Montpellier, 80, avenue Augustin-Fliche, 34090 Montpellier, France; CESP, Inserm U 1018, UVSQ Psychiatry Development and Trajectories, Villejuif, France
| | - H Kerbage
- Médecine Psychologique de l'Enfant et de l'Adolescent MPEA1, Hôpital Saint-Éloi, CHU de Montpellier, 80, avenue Augustin-Fliche, 34090 Montpellier, France; CESP, Inserm U 1018, UVSQ Psychiatry Development and Trajectories, Villejuif, France
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21
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Sells RC, Liversedge SP, Chronaki G. Vocal emotion recognition in attention-deficit hyperactivity disorder: a meta-analysis. Cogn Emot 2024; 38:23-43. [PMID: 37715528 DOI: 10.1080/02699931.2023.2258590] [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: 03/10/2023] [Revised: 06/06/2023] [Accepted: 06/28/2023] [Indexed: 09/17/2023]
Abstract
There is debate within the literature as to whether emotion dysregulation (ED) in Attention-Deficit Hyperactivity Disorder (ADHD) reflects deviant attentional mechanisms or atypical perceptual emotion processing. Previous reviews have reliably examined the nature of facial, but not vocal, emotion recognition accuracy in ADHD. The present meta-analysis quantified vocal emotion recognition (VER) accuracy scores in ADHD and controls using robust variance estimation, gathered from 21 published and unpublished papers. Additional moderator analyses were carried out to determine whether the nature of VER accuracy in ADHD varied depending on emotion type. Findings revealed a medium effect size for the presence of VER deficits in ADHD, and moderator analyses showed VER accuracy in ADHD did not differ due to emotion type. These results support the theories which implicate the role of attentional mechanisms in driving VER deficits in ADHD. However, there is insufficient data within the behavioural VER literature to support the presence of emotion processing atypicalities in ADHD. Future neuro-imaging research could explore the interaction between attention and emotion processing in ADHD, taking into consideration ADHD subtypes and comorbidities.
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Affiliation(s)
- Rohanna C Sells
- School of Psychology and Computer Science, University of Central Lancashire, UK
| | - Simon P Liversedge
- School of Psychology and Computer Science, University of Central Lancashire, UK
| | - Georgia Chronaki
- School of Psychology and Computer Science, University of Central Lancashire, UK
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22
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Han J, Koser K, Mamey MR, Vanderbilt DL, Schonfeld DJ, Yin L, Deavenport-Saman A. Mediation of Parental Aggravation in the Association Between ADHD Severity and Electronic Media Use: A National Survey of Children's Health Study. J Atten Disord 2024; 28:127-138. [PMID: 37905519 DOI: 10.1177/10870547231205028] [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: 11/02/2023]
Abstract
OBJECTIVE To determine whether the association between ADHD severity and electronic media use was mediated by parental aggravation. METHODS This was a retrospective analysis from the 2016 to 2017 National Survey of Children's Health (NSCH) involving children ages of 3 to 17 years with parent-reported ADHD (n = 5,930). Path analyses were used to model the relationships between ADHD severity with parental aggravation (PA) as a mediator, and electronic device (ED) and television (TV) use as outcomes, controlling for covariates. RESULTS Parental aggravation mediated the relationship between ADHD severity and ED use and TV use (indirect effects: β = .02, p < .001; β = .01, p = .004). When stratified by age, the mediation effect between ADHD and ED use remained significant for adolescents and school-age children, and mediation between ADHD and TV use remained significant only for adolescents. CONCLUSION These findings suggest a need to develop targeted interventions to address PA and manage excessive electronic media use in children with moderate/severe ADHD.
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Affiliation(s)
- Jennifer Han
- Kaiser Permanente Riverside Medical Center, CA, USA
| | | | | | - Douglas L Vanderbilt
- Children's Hospital Los Angeles, CA, USA
- USC Keck School of Medicine, Los Angeles, CA, USA
| | - David J Schonfeld
- Children's Hospital Los Angeles, CA, USA
- USC Keck School of Medicine, Los Angeles, CA, USA
| | - Larry Yin
- USC Keck School of Medicine, Los Angeles, CA, USA
- Children's Hospital Los Angeles, CA, USA
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23
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Petruso F, Giff A, Milano B, De Rossi M, Saccaro L. Inflammation and emotion regulation: a narrative review of evidence and mechanisms in emotion dysregulation disorders. Neuronal Signal 2023; 7:NS20220077. [PMID: 38026703 PMCID: PMC10653990 DOI: 10.1042/ns20220077] [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: 03/21/2023] [Revised: 10/25/2023] [Accepted: 10/27/2023] [Indexed: 12/01/2023] Open
Abstract
Emotion dysregulation (ED) describes a difficulty with the modulation of which emotions are felt, as well as when and how these emotions are experienced or expressed. It is a focal overarching symptom in many severe and prevalent neuropsychiatric diseases, including bipolar disorders (BD), attention deficit/hyperactivity disorder (ADHD), and borderline personality disorder (BPD). In all these disorders, ED can manifest through symptoms of depression, anxiety, or affective lability. Considering the many symptomatic similarities between BD, ADHD, and BPD, a transdiagnostic approach is a promising lens of investigation. Mounting evidence supports the role of peripheral inflammatory markers and stress in the multifactorial aetiology and physiopathology of BD, ADHD, and BPD. Of note, neural circuits that regulate emotions appear particularly vulnerable to inflammatory insults and peripheral inflammation, which can impact the neuroimmune milieu of the central nervous system. Thus far, few studies have examined the link between ED and inflammation in BD, ADHD, and BPD. To our knowledge, no specific work has provided a critical comparison of the results from these disorders. To fill this gap in the literature, we review the known associations and mechanisms linking ED and inflammation in general, and clinically, in BD, ADHD, and BD. Our narrative review begins with an examination of the routes linking ED and inflammation, followed by a discussion of disorder-specific results accounting for methodological limitations and relevant confounding factors. Finally, we critically discuss both correspondences and discrepancies in the results and comment on potential vulnerability markers and promising therapeutic interventions.
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Affiliation(s)
| | - Alexis E. Giff
- Department of Neuroscience, School of Life Sciences, École Polytechnique Fédérale de Lausanne, Switzerland
| | - Beatrice A. Milano
- Sant’Anna School of Advanced Studies, Pisa, Italy
- University of Pisa, Pisa, Italy
| | | | - Luigi Francesco Saccaro
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Switzerland
- Department of Psychiatry, Geneva University Hospital, Switzerland
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24
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Musella KE, Weyandt LL. Attention-deficit hyperactivity disorder and youth's emotion dysregulation: A systematic review of fMRI studies. APPLIED NEUROPSYCHOLOGY. CHILD 2023; 12:353-366. [PMID: 36065486 DOI: 10.1080/21622965.2022.2119142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
A number of adverse outcomes are associated with emotion dysregulation, and ADHD secondary to emotion dysregulation is a frequent comorbidity that may result in poorer performance and quality of life among youth. Recent neuroimaging research has observed significant functional differences in youth with ADHD compared to healthy controls. Therefore, the aims of this systematic review were to summarize the literature on functional connectivity of emotion dysregulation in youth with ADHD, identify methodological challenges and limitations, and provide directions for future research. Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines were followed to conduct a systematic review across three databases, and 13 studies were identified for inclusion. Across the studies, 14 primary regions were examined; 12 of the 13 studies identified a significant association between functional connectivity of emotion dysregulation and youth with ADHD. Although studies varied in the structures investigated, the most notable differences appeared in the prefrontal cortex, orbitofrontal cortex, amygdala, and ventral striatum in ADHD participants. Future research concerning this topic may help contribute to the understanding of this association by utilizing longitudinal research designs, controlling for psychiatric comorbidities and emotion dysregulation severity, inclusion of more diverse samples and ensuring that studies are adequately powered.
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Affiliation(s)
- Katharine E Musella
- Department of Psychology, University of Rhode Island, Kingston, Rhode Island, USA
| | - Lisa L Weyandt
- Department of Psychology, University of Rhode Island, Kingston, Rhode Island, USA
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Murray A, Speyer L, Thye M, Stewart T, Obsuth I, Kane J, Whyte K, Devaney J, Rohde LA, Ushakova A, Rhodes S. Illuminating the daily life experiences of adolescents with and without ADHD: protocol for an ecological momentary assessment study. BMJ Open 2023; 13:e077222. [PMID: 37775284 PMCID: PMC10546102 DOI: 10.1136/bmjopen-2023-077222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 08/31/2023] [Indexed: 10/01/2023] Open
Abstract
INTRODUCTION Adolescents with attention-deficit/hyperactivity disorder (ADHD) are at elevated risk of a range of difficulties, among which emotion regulation, peer and co-occurring mental health problems are prominent challenges. To better support adolescents with ADHD, ecologically valid interventions that can be embedded in daily life to target the most proximal antecedents of these challenges are needed. Ecological momentary assessment (EMA) designs are ideally suited to meeting this need. METHODS AND ANALYSES In the mental health in the moment ADHD study, we will use an EMA design to capture the daily life experiences of approximately 120 adolescents aged 11-14 years with a clinical diagnosis of ADHD and the same number of age-matched and gender-matched peers without a diagnosis of ADHD. We will combine this with comprehensive information gathered from online surveys. Analysing the data using techniques such as dynamic structural equation modelling, we will examine, among other research questions, the role of emotion regulation and peer problems in mediating the links between characteristics of ADHD and commonly co-occurring outcomes such as anxiety, depression and conduct problems. The results can help inform interventions to support improved peer functioning and emotion regulation for adolescents with ADHD. ETHICS AND DISSEMINATION This study received a favourable ethical opinion through the National Health Service ethical review board and the University of Edinburgh PPLS Research Ethics panel. The results will be disseminated through journal publications, conferences and seminar presentations and to relevant stakeholders, such as those with ADHD, their families and clinicians.
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Affiliation(s)
- Aja Murray
- Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Lydia Speyer
- Department of Psychology, Lancaster University, Edinburgh, UK
| | - Melissa Thye
- Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Tracy Stewart
- Moray House of Education and Sport, University of Edinburgh, Edinburgh, UK
| | - Ingrid Obsuth
- Clinical and Health Psychology Department, University of Edinburgh, Edinburgh, UK
| | - Jennifer Kane
- Clinical and Health Psychology Department, University of Edinburgh, Edinburgh, UK
| | - Katie Whyte
- Department of Psychology, St Andrew's University, St Andrews, UK
| | - John Devaney
- School of Social and Political Science, University of Edinburgh, Edinburgh, UK
| | - Luis Augusto Rohde
- ADHD Outpatient Program and Developmental Psychiatry Program, Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- National Institute of Developmental Psychiatry & National Center for Research and Innovation in Mental Health, Sao Paolo, Brazil
- UniEduk, Brazil, Brazil
| | - Anastasia Ushakova
- Centre for Computing, Health Informatics and Statistics, Lancaster University, Lancaster, UK
| | - Sinead Rhodes
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
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Feng M, Xu J, Zhai M, Wu Q, Chu K, Xie L, Luo R, Li H, Xu Q, Xu X, Ke X. Behavior Management Training for Parents of Children with Preschool ADHD Based on Parent-Child Interactions: A Multicenter Randomized Controlled, Follow-Up Study. Behav Neurol 2023; 2023:3735634. [PMID: 37727252 PMCID: PMC10506873 DOI: 10.1155/2023/3735634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 08/12/2023] [Accepted: 09/01/2023] [Indexed: 09/21/2023] Open
Abstract
Objective There is a need to develop optimized, evidence-based parent training programs tailored for preschoolers with attention deficit hyperactivity disorder (ADHD). The objective of this study was to explore a behavioral management training program aimed at the parents of preschool children with ADHD, which directly analyzes parent-child interaction from the perspective of system theory, and the intervention effect on ADHD in preschool children. Methods A multicenter randomized controlled study was conducted using system-based group therapy with 62 parents of preschool children with ADHD aged four to six years. ADHD symptoms, behavioral and emotional problems, and social functioning were compared with 61 control children whose parents did not receive training by applying the ADHD Rating Scale (ADHD-RS), Strengths and Difficulties Questionnaire (SDQ), and Questionnaire-Children with Difficulties (QCD) at the time of subject entry and at two and six months of entry, respectively. Results The results of the ADHD-RS assessment showed that children in the intervention group had significantly lower factor scores for attention deficit, hyperactivity, and impulsivity than the children in the control group after parental training and at follow-up (P < 0.05). Total scores on the SDQ scale, as well as character problems, hyperactivity, and peer interaction scores, significantly decreased with statistically significant differences (all P < 0.05), and emotional symptoms and prosocial behavior did not notable decline (P > 0.05). Compared with the control group, the total scores of the QCD scale and the scores of each factor in the intervention group remained significantly higher at the follow-up (P < 0.05). Conclusion After continuous intervention for eight weeks, parents were able to help the children with preschool ADHD to improve their ADHD symptoms and emotional behavioral and social functioning significantly, and the efficacy was maintained at the four-month follow-up; the systemic-based parent training in behavior management (PTBM) is applicable to the treatment of preschool ADHD and is worth promoting.
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Affiliation(s)
- Min Feng
- Nanjing Rehabilitation Medical Center, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Juncai Xu
- School of Engineering, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Mengyao Zhai
- Nanjing Rehabilitation Medical Center, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Qiaorong Wu
- Nanjing Rehabilitation Medical Center, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Kangkang Chu
- Nanjing Rehabilitation Medical Center, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Liping Xie
- West China Second University Hospital, Sichuan University, Chengdu 610041, China
| | - Rong Luo
- West China Second University Hospital, Sichuan University, Chengdu 610041, China
| | - Huiping Li
- Children's Hospital of Fudan University, Shanghai 20110, China
| | - Qiong Xu
- Children's Hospital of Fudan University, Shanghai 20110, China
| | - Xiu Xu
- Children's Hospital of Fudan University, Shanghai 20110, China
| | - Xiaoyan Ke
- Nanjing Rehabilitation Medical Center, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China
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Chan ESM, Barroso C, Groves NB, Marsh CL, Black K, Jaisle EM, Kofler MJ. A preliminary 'shortlist' of individual, family, and social-community assets to promote resilience in pediatric ADHD. RESEARCH IN DEVELOPMENTAL DISABILITIES 2023; 140:104568. [PMID: 37531816 PMCID: PMC10529619 DOI: 10.1016/j.ridd.2023.104568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 06/16/2023] [Accepted: 07/04/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND Understanding factors that promote resilience in pediatric ADHD is important though highly understudied. AIMS The current study sought to provide a preliminary 'shortlist' of key individual, family, and social-community assets among children with ADHD. METHODS AND PROCEDURES The study included well-characterized, clinically-evaluated samples of children with (n=108) and without ADHD (n=98) ages 8-13 years (M=10.31; 41.3% girls; 66.5% White/Non-Hispanic). All subsets regression and dominance analysis identified the subset of predictors that accounted for the most variance in broad-based resilience for children with ADHD and their relative importance. Findings were compared for children with versus without ADHD as preliminary evidence regarding the extent to which identified assets are promotive, protective, or conditionally helpful. OUTCOMES AND RESULTS Higher levels of peer acceptance, social skills, and academic performance were top predictors of resilience among children with ADHD. Better child working memory, attention, higher levels of hyperactivity, older age, and fewer parent self-reported mental health concerns were also identified as predictors of resilience in ADHD. Both overlapping and unique factors were associated with resilience for children with versus without ADHD. Conclusions and Results: These results, if replicated, provide a strong preliminary basis for strength-based basic/applied research on key assets that promote resilience in ADHD.
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Affiliation(s)
| | - Connie Barroso
- Texas A&M University, Department of Educational Psychology, USA
| | | | | | - Katie Black
- Florida State University, Department of Psychology, USA
| | - Emma M Jaisle
- Florida International University, Department of Psychology, USA
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Abed M, Mansureh HH, Masoud GAL, Elaheh H, Mohammad-Hossein NHK, Yamin BD, Abdol-Hossein V. Construction of Meta-Thinking Educational Program Based on Mental-Brain Simulation ( MTMBS) and Evaluating its Effectiveness on Executive Functions, Emotion Regulation, and Impulsivity in Children With ADHD: A Resting-State Functional MRI Study. J Atten Disord 2023; 27:1223-1251. [PMID: 36843348 DOI: 10.1177/10870547231155436] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
OBJECTIVE The aim of present research was to make a Meta-Thinking educational program based on mental-brain simulation and to evaluate its effectiveness on executive functions, emotion regulation and impulsivity in children with ADHD. METHODS The research method was Embedded Design: Embedded Experimental Model. The research sample included 32 children with ADHD who were randomly assigned to two experimental and control groups. The intervention was implemented for eight sessions of 1.5 hr for the experimental group, and fMRI images were taken from them, while the control group didn't receive any treatment. Finally, using semi-structured interviews, coherent information was collected from the parents of the experimental group about the changes made. Data were analyzed with SPSS-24, MAXQDA, fMRIprep, and FSL software. RESULTS The Meta-Thinking Educational Program had effect on performance of ADHD children and suppressed brain regions related to DMN. CONCLUSION The Implementation of this educational program plays a vital role in improving psychological problems of children with ADHD.
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Pachiti I, Milienos FS, Dimitropoulou P. Child ViReal Support Program: A Randomized Controlled Trial Study for Effective Support of Parents Raising Children with Attention Deficits. Behav Sci (Basel) 2023; 13:691. [PMID: 37622831 PMCID: PMC10451949 DOI: 10.3390/bs13080691] [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: 06/30/2023] [Revised: 07/25/2023] [Accepted: 08/16/2023] [Indexed: 08/26/2023] Open
Abstract
Attention deficit hyperactivity disorder (ADHD) results in various functioning impairments in children's lives and families. Parents of children with ADHD report high levels of parenting stress, low levels of parental self-efficacy, and use of more authoritarian and/or permissive parenting practices than parents of typically developing children. Intervention programs need to address both children's and parents' needs and multimodal intervention programs could cover this demand. The aim of this study was to examine the efficacy of "Child ViReal Support Program"-a multi-level evidence-based comprehensive program-on parenting stress, parental self-efficacy, parenting practices, and the core symptoms of children's ADHD. Families with a child diagnosed with ADHD (n = 16) were randomly allocated to two groups (PC and CP; P = parent training, C = child training), and a cross-over design was utilized. Participating parents completed, in four different times during the study, the Parenting Stress Index-Short Form, the Parenting Sense of Competence Scale, the Parenting Styles and Dimensions Questionnaire-Short Version, and the parent form of the ADHD Rating Scale-IV. Parents from both groups, after their participation in the parent training, demonstrated reduced parenting stress, enhanced parental self-efficacy, and increased the employ of democratic parenting practices. More than that, they reported decreased levels of inattention and impulsivity/hyperactivity for their children. Evidence-based multi-level intervention programs could produce positive effects on parents and children by incorporating effective methods and tools in accordance with the needs and the demands of the family context.
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Affiliation(s)
- Iouliani Pachiti
- Department of Psychology, University of Crete, 74150 Rethymno, Greece;
- Applied Psychology Laboratory, Center for Research and Studies, University of Crete, 74150 Rethymno, Greece
| | - Fotios S. Milienos
- Department of Sociology, Panteion University of Social and Political Sciences, 17671 Athens, Greece;
| | - Panagiota Dimitropoulou
- Department of Psychology, University of Crete, 74150 Rethymno, Greece;
- Applied Psychology Laboratory, Center for Research and Studies, University of Crete, 74150 Rethymno, Greece
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Sökmen Z, Karaca S. The effect of Self-Regulation Based Cognitive Psychoeducation Program on emotion regulation and self-efficacy in children diagnosed with attention deficit hyperactivity disorder. Arch Psychiatr Nurs 2023; 44:122-128. [PMID: 37197856 DOI: 10.1016/j.apnu.2023.04.005] [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: 09/06/2022] [Revised: 02/18/2023] [Accepted: 04/17/2023] [Indexed: 05/19/2023]
Abstract
AIM This study aimed to determine the effect of Self-Regulation Based Cognitive Psychoeducation Program on emotion regulation and self-efficacy in children diagnosed with attention deficit hyperactivity disorder (ADHD) and receiving medication. METHOD The sample of this study with control group and pre-test, post-test and follow-up randomized experimental design consisted of children followed in the child and adolescent mental health outpatient clinic of a state hospital. The data were evaluated by parametric and non-parametric analyses. RESULTS A statistically significant increase was determined in the internal functional emotion regulation mean scores of children, who participated in the Self-Regulation Based Cognitive Psychoeducation Program, measured before, immediately after, and 6 months after the intervention (p < 0.05). A statistically significant increase was also found in their external functional emotion regulation mean scores measured before and 6 months after the intervention (p < 0.05). In addition, a statistically significant difference was found between their internal dysfunctional and external dysfunctional emotion regulation mean scores measured before and 6 months after the intervention; however the mean scores of those in the control group 6 months after the intervention were higher than those in the intervention group (p < 0.05). Furthermore, there was a statistically significant increase in their self-efficacy mean scores measured before and 6 months after the intervention (p < 0.05). CONCLUSION The Self-Regulation Based Cognitive Psychoeducation Program was found be effective in increasing the levels of emotion regulation and self-efficacy in children with ADHD.
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Affiliation(s)
- Zeynep Sökmen
- Marmara University, Institute of Health Science, Department of Psychiatric Nursing, Istanbul, Turkey.
| | - Semra Karaca
- Marmara University, Institute of Health Science, Department of Psychiatric Nursing, Istanbul, Turkey
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Robin M, Surjous L, Belbèze J, Bonnardel L, Lamas C, Silva J, Peres V, Corcos M. Four attachment-based categories of emotion regulation in adolescent psychic troubles. Front Psychol 2023; 14:1133980. [PMID: 37275718 PMCID: PMC10237043 DOI: 10.3389/fpsyg.2023.1133980] [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: 12/29/2022] [Accepted: 04/06/2023] [Indexed: 06/07/2023] Open
Abstract
Introduction Emotion regulation is altered in many psychiatric disorders in adolescence, but the understanding of mechanisms that underlie this alteration is still poor. Methods The PERCEPT study explores alexithymia, empathy, facial emotion recognition (FER) and defence mechanisms in a sample of adolescents in psychiatric care (n = 61, 74% of girls, mean age = 15.03 y.o.), in relation with participants' attachment styles. Results Results revealed correlations between attachment dimensions and all of the emotion regulation variables, suggesting that attachment modalities have functional links with emotional regulation at its different levels: FER accuracy was inversely correlated with avoidant attachment, while affective empathy, difficulty in identifying feelings (alexithymia) and immature as well as neurotic defence mechanisms were positively correlated with anxious attachment. Moreover, attachment categories delineated distinct emotional perception profiles. In particular, preoccupied attachment included adolescents with the highest levels of facial emotion perception (sensitivity and accuracy) and of affective empathy, whereas detached attachment included adolescents with the lowest levels of these variables. Neurotic defence mechanisms and difficulty to identify feelings were correlated with preoccupied attachment; immature defence mechanisms and difficulty to describe feelings to others characterized fearful attachment. Discussion These results suggest that attachment categories underlie emotion regulation processes in psychiatric disorders in adolescence. Theoretical and clinical implications are discussed.
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Affiliation(s)
- Marion Robin
- Department of Adolescent and Young Adult Psychiatry, Institut Mutualiste Montsouris, Paris, France
- CESP, INSERM U1178, Paris-Saclay University, Villejuif, France
| | - Luc Surjous
- Department of Adolescent and Young Adult Psychiatry, Institut Mutualiste Montsouris, Paris, France
- Paris Cité University, Paris, France
| | - Jean Belbèze
- Department of Adolescent and Young Adult Psychiatry, Institut Mutualiste Montsouris, Paris, France
- Paris Cité University, Paris, France
| | - Lucile Bonnardel
- Department of Adolescent and Young Adult Psychiatry, Institut Mutualiste Montsouris, Paris, France
| | - Claire Lamas
- Department of Adolescent and Young Adult Psychiatry, Institut Mutualiste Montsouris, Paris, France
| | - Jérôme Silva
- Department of Adolescent and Young Adult Psychiatry, Institut Mutualiste Montsouris, Paris, France
| | - Victoire Peres
- Department of Adolescent and Young Adult Psychiatry, Institut Mutualiste Montsouris, Paris, France
| | - Maurice Corcos
- Department of Adolescent and Young Adult Psychiatry, Institut Mutualiste Montsouris, Paris, France
- Paris Cité University, Paris, France
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Leib SI, Miller SA, Chin E. Latent structure of working memory and emotion regulation in pediatric ADHD. Child Neuropsychol 2023; 29:644-665. [PMID: 35975287 DOI: 10.1080/09297049.2022.2107626] [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] [Indexed: 10/15/2022]
Abstract
Working memory is a key cognitive function that is often implicated in ADHD and may represent an underlying cognitive endophenotype of the disorder. Working memory is related to emotion regulation, which is a common area of impairment in children with ADHD. Given the high rate of comorbid diagnoses with ADHD, children with comorbid internalizing, externalizing, and developmental disorders may present with variable working memory profiles and subsequent emotion regulation deficits. This study aimed to adequately characterize the latent structure of working memory impairments and emotional regulation outcomes in a clinical sample of children ages 6-16 with ADHD. This study also examined the interplay between the identified working memory/emotion regulation patterns, demographic characteristics, and the role of comorbid diagnoses. Results highlighted two distinct, invariant, unrestricted classes of working memory/emotion regulation. Class 1 (Average; 62% of the sample) had significantly lower digit-span scores, and generally persevered emotion regulation functioning per parent/teacher report. Class 2 (Emotionally Dysregulated) had average working memory scores, and elevated emotion regulation problems. The working memory indicators had small correlations with parents (and not teacher) measures of emotion regulation. Finally, latent class membership did not differ by comorbid diagnosis, age, gender, or verbal IQ. Findings elucidate heterogeneity in common domains affected by ADHD and suggest that this heterogeneity may not be due to demographic/comorbidity factors. The role of varying information reports is discussed, and potential assessment and treatment implications are highlighted.
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Affiliation(s)
- Sophie I Leib
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, USA
| | - Steven A Miller
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, USA
| | - Esther Chin
- Ascension Alexian Brothers Neurosciences Institute, IL, USA
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Dugré JR, Potvin S. Neural bases of frustration-aggression theory: A multi-domain meta-analysis of functional neuroimaging studies. J Affect Disord 2023; 331:64-76. [PMID: 36924847 DOI: 10.1016/j.jad.2023.03.005] [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: 06/01/2022] [Revised: 02/01/2023] [Accepted: 03/06/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Early evidence suggests that unexpected non-reward may increase the risk for aggressive behaviors. Despite the growing interest in understanding brain functions that may be implicated in aggressive behaviors, the neural processes underlying such frustrative events remain largely unknown. Furthermore, meta-analytic results have produced discrepant results, potentially due to substantial differences in the definition of anger/aggression constructs. METHODS Therefore, we conducted a coordinate-based meta-analysis, using the activation likelihood estimation algorithm, on neuroimaging studies examining reward omission and retaliatory behaviors in healthy subjects. Conjunction analyses were further examined to discover overlapping brain activations across these meta-analytic maps. RESULTS Frustrative non-reward deactivated the orbitofrontal cortex, ventral striatum and posterior cingulate cortex, whereas increased activations were observed in midcingulo-insular regions. Retaliatory behaviors recruited the left fronto-insular and anterior midcingulate cortices, the dorsal caudate and the primary somatosensory cortex. Conjunction analyses revealed that both strongly activated midcingulo-insular regions. LIMITATIONS Spatial overlap between neural correlates of frustration and retaliatory behaviors was conducted using a conjunction analysis. Therefore, neurobiological markers underlying the temporal sequence of the frustration-aggression theory should be interpreted with caution. CONCLUSIONS Nonetheless, our results underscore the role of anterior midcingulate/pre-supplementary motor area and fronto-insular cortex in both frustration and retaliatory behaviors. A neurobiological framework for understanding frustration-based impulsive aggression is provided.
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Affiliation(s)
- Jules R Dugré
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montréal, Canada; Department of Psychiatry and Addiction, Faculty of Medicine, University of Montreal, Montréal, Canada.
| | - Stéphane Potvin
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montréal, Canada; Department of Psychiatry and Addiction, Faculty of Medicine, University of Montreal, Montréal, Canada.
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Goulter N, Balanji S, Davis BA, James T, McIntyre CL, Smith E, Thornton EM, Craig SG, Moretti MM. Psychometric Evaluation of the Affect Regulation Checklist: Clinical and Community Samples, Parent-Reports and Youth Self-Reports. JOURNAL OF RESEARCH ON ADOLESCENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR RESEARCH ON ADOLESCENCE 2023; 33:344-360. [PMID: 35699159 DOI: 10.1111/jora.12779] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The Affect Regulation Checklist (ARC) was designed to capture affect dysregulation, suppression, and reflection. Importantly, affect dysregulation has been established as a transdiagnostic mechanism underpinning many forms of psychopathology. We tested the ARC psychometric properties across clinical and community samples and through both parent-report and youth self-report information. Clinical sample: Participants included parents (n = 814; Mage = 43.86) and their child (n = 608; Mage = 13.98). Community sample: Participants included independent samples of parents (n = 578; Mage = 45.12) and youth (n = 809; Mage = 15.67). Exploratory structural equation modeling supported a three-factor structure across samples and informants. Dysregulation was positively associated with all forms of psychopathology. In general, suppression was positively associated with many forms of psychopathology, and reflection was negatively associated with externalizing problems and positively associated with internalizing problems.
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Louveau C, Ellul P, Iftimovici A, Dubreucq J, Laidi C, Leyrolle Q, Purper-Ouakil D, Jacquemont S, Lyonnet S, Barthélémy C, Krebs MO, Bai J, Olivier P, Chaumette B. Neurodevelopmental disorders (NDD) without boundaries: research and interventions beyond classifications. J Neural Transm (Vienna) 2023; 130:473-479. [PMID: 36719463 DOI: 10.1007/s00702-023-02586-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
On June 2022, the 2nd Webinar "Neurodevelopmental Disorders (NDD) without boundaries took place at the Imagine Institute in Paris and was broadcasted live and in replay. The aim of this webinar is to address NDD in a dimensional rather than in a categorical approach. Several speakers were invited to present their researches on the subject. Classifications in NDD were discussed: irritability in NDD, involvement of the immune system in neurodevelopment, nutrition and gut microbiota modulate brain inflammation and neurodevelopment, co-occurring conditions in autistic adolescents and adults without intellectual disability. Classifications in psychiatric disorders were asked: mapping the effect of genes on cognition and autism risk, epigenetics and symptomatic trajectory in neurodevelopmental disorders, the autism-schizophrenia continuum in two examples: minor neurological signs and EEG microstates, the cerebellum in schizophrenia and autism: from imaging to intervention perspectives. Both genetic and environmental factors, along with clinical and imaging features, argue toward a continnum between NDD but also with adult psychiatric presentations. This new paradigm could modify the therapeutic strategy, with the development of large-spectrum treatments or new psychotherapies addressing co-occuring symptoms. The complexity and the heterogeneity of NDD apply well to the next scientific and political challenges: developing international convergence to push back the frontiers of our knowledge. This article is a summary of the 2nd webinar "Neurodevelopmental Disorders (NDD) without boundaries: research and interventions beyond classifications" sponsored by the French National Academy of Medicine, the autism and neurodevelopmental disorders scientific interest group (GIS), the International Research Network Dev-O-Psy and the French Institute of Psychiatry (GDR3557). Oral presentations are available as a replay on the following website (in French): https://autisme-neurodev.org/evenements/2022/04/12/tnd-sans-frontieres-la-recherche-et-les-interventions-au-dela-des-classifications/ .
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Affiliation(s)
| | - Pierre Ellul
- Excellence Centre for Autism and Neuro-Developmental Disorders, Child and Adolescent Psychiatry Department, Robert Debré Hospital, Paris Cité University, Paris, France
- Immunology, Immunopathology, Immunotherapy, INSERM U959, Sorbonne University, Paris, France
| | - Anton Iftimovici
- GHU-Paris Psychiatrie et Neurosciences, Paris, France
- Université de Paris, INSERM U1266, Institute of Psychiatry and Neuroscience of Paris, Paris, France
| | - Julien Dubreucq
- Child and Adolescent Psychiatry Department, Saint-Etienne University Hospital and CNRS UMR 5229, Institute of Cognitive Neuroscience Marc Jeannerod, University Lyon 1, Bron, France
| | | | - Quentin Leyrolle
- Univ. Bordeaux, INRAE, Bordeaux INP, NutriNeuro, UMR 1286, Bordeaux, France
| | - Diane Purper-Ouakil
- CHU Montpellier-Saint Eloi Hospital, University of Montpellier, Unit of Child and Adolescent Psychiatry (MPEA1), Montpellier, France
- Center for Research in Epidemiology and Population Health (CESP), INSERM U 1018, Paris-Saclay University, Villejuif, France
| | - Sebastien Jacquemont
- Department of Pediatrics, Sainte Justine Hospital Research Center, University of Montreal, Montreal, QC, H4A3J1, Canada
| | - Stanislas Lyonnet
- INSERM-UMR1163, Université Paris Cité, Institut Imagine, Paris, France
| | - Catherine Barthélémy
- Faculty of Medicine, University of Tours, Tours, France
- Autism and NDD GIS (GIS Autisme et Troubles du Neurodéveloppement), Paris, France
| | - Marie-Odile Krebs
- GHU-Paris Psychiatrie et Neurosciences, Paris, France
- Université de Paris, INSERM U1266, Institute of Psychiatry and Neuroscience of Paris, Paris, France
- Autism and NDD GIS (GIS Autisme et Troubles du Neurodéveloppement), Paris, France
| | - Jing Bai
- Université de Paris, INSERM U1266, Institute of Psychiatry and Neuroscience of Paris, Paris, France
| | - Paul Olivier
- Autism and NDD GIS (GIS Autisme et Troubles du Neurodéveloppement), Paris, France.
| | - Boris Chaumette
- GHU-Paris Psychiatrie et Neurosciences, Paris, France
- Université de Paris, INSERM U1266, Institute of Psychiatry and Neuroscience of Paris, Paris, France
- Autism and NDD GIS (GIS Autisme et Troubles du Neurodéveloppement), Paris, France
- Department of Psychiatry, McGill University, Montreal, Canada
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Sturrock A, Freed J. Preliminary data on the development of emotion vocabulary in typically developing children (5-13 years) using an experimental psycholinguistic measure. Front Psychol 2023; 13:982676. [PMID: 36798644 PMCID: PMC9928212 DOI: 10.3389/fpsyg.2022.982676] [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: 07/01/2022] [Accepted: 11/25/2022] [Indexed: 02/04/2023] Open
Abstract
Introduction Vocabulary of emotion is integral to emotional development and emotional intelligence is associated with improved mental health outcomes. Many language disordered groups experience emotional difficulties; Developmental Language Disorders, Attention Deficit Hyperactivity Disorder and autism. However, (as in the case of autism) research tends to focus on assessing recognition of emotional states, rather than exploring labeling skills. Where labeling is assessed, measures have focused on early-acquired vocabulary (happy, sad, angry) or self/parent reporting. To date, no objective assessment has been made of vocabulary of emotion across childhood. Methods This study uses an experimental psycholinguistic measure, The Emotion Vocabulary: Expressive and Receptive ability measure (EVER) which includes two tasks (receptive vocabulary and word generation/expressive vocabulary). This measure has capacity to demonstrate vocabulary growth across age groups. 171 participants (5.0-13.11 years) completed The EVER Measure, alongside two closely matched standardized measures of basic language: BPVS (receptive vocabulary task) and CELF (word-association task). Assessments were completed online and en vivo (COVID testing restrictions dependent). Results As predicted, children's accuracy increased on both receptive and expressive emotion vocabulary tasks, in line with age at time of testing. EVER scores were significantly predicted by age and correlated with matched basic language scores. Secondary analysis provided preliminary findings on age of acquisition for specific emotion vocabulary items. Discussion The findings consequently demonstrate proof of concept for the use of The EVER Measure in assessing emotional vocabulary across childhood. This study provides important preliminary data on generating and recognizing emotion labels across typical child development. Critically, it extends current knowledge on emotion vocabulary acquisition into middle childhood, where linguistic ability is relatively mature. As such, findings have implications for research with potential clinical application in the assessment of older children, with either language or emotional differences or both. Findings demonstrate the need for a standardized tool, and its potential application in research and clinical practice is explored. A large-scale study offering proof of concept and reliability of The EVER Measure is indicated.
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The Effects of Attention-Deficit/Hyperactivity Disorder Symptoms on the Association between Head Impacts and Post-Season Neurocognitive and Behavioral Outcomes. J Int Neuropsychol Soc 2023; 29:24-34. [PMID: 35105403 DOI: 10.1017/s1355617721001491] [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: 02/01/2023]
Abstract
OBJECTIVE Having attention-deficit/hyperactivity disorder (ADHD) is a risk factor for concussion that impacts concussion diagnosis and recovery. The relationship between ADHD and repetitive subconcussive head impacts on neurocognitive and behavioral outcomes is less well known. This study evaluated the role of ADHD as a moderator of the association between repetitive head impacts on neurocognitive test performance and behavioral concussion symptoms over the course of an athletic season. METHOD Study participants included 284 male athletes aged 13-18 years who participated in high school football. Parents completed the Strengths and Weaknesses of ADHD Symptoms and Normal Behavior (SWAN) ratings about their teen athlete before the season began. Head impacts were measured using an accelerometer worn during all practices and games. Athletes and parents completed behavioral ratings of concussion symptoms and the Attention Network Task (ANT), Digital Trail Making Task (dTMT), and Cued Task Switching Task at pre- and post-season. RESULTS Mixed model analyses indicated that neither head impacts nor ADHD symptoms were associated with post-season athlete- or parent-reported concussion symptom ratings or neurocognitive task performance. Moreover, no relationships between head impact exposure and neurocognitive or behavioral outcomes emerged when severity of pre-season ADHD symptoms was included as a moderator. CONCLUSION Athletes' pre-season ADHD symptoms do not appear to influence behavioral or neurocognitive outcomes following a single season of competitive football competition. Results are interpreted in light of several study limitations (e.g., single season, assessment of constructs) that may have impacted this study's pattern of largely null results.
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Soler-Gutiérrez AM, Pérez-González JC, Mayas J. Evidence of emotion dysregulation as a core symptom of adult ADHD: A systematic review. PLoS One 2023; 18:e0280131. [PMID: 36608036 PMCID: PMC9821724 DOI: 10.1371/journal.pone.0280131] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 12/21/2022] [Indexed: 01/07/2023] Open
Abstract
Attention Deficit Hyperactivity Disorder (ADHD) is a developmental disorder, with an onset in childhood, that accompanies the person throughout their life, with prevalence between 3 and 5% in adults. Recent studies point towards a fourth core symptom of the disorder related to the emotional information processing that would explain the repercussions that ADHD has on the social, academic, and professional life of the people affected. This review aims to describe emotion dysregulation features as well as the brain activity associated in adults with ADHD. A search of the scientific literature was launched in specialized databases: PsycInfo, Medline, Eric, PsycArticle, Psicodoc and Scopus, following PRISMA guidelines. Twenty-two articles met the inclusion criteria: (a) an ADHD clinical diagnosis, (b) participants over 18 years old, (c) emotion regulation measurement, (d) empirical studies, and (c) in English. Due to the heterogeneity of the studies included, they were classified into three sections: measures and features of emotion regulation (ER) in people with ADHD, neurological and psychophysiological activity related to ER, and treatments. The studies found that meet the selection criteria are scarce and very heterogeneous both in aims and in sample features. Adults with ADHD show a more frequent use of non-adaptive emotion regulation strategies compared to people without ADHD symptoms. Moreover, emotion dysregulation was associated with symptom severity, executive functioning, psychiatric comorbidities, and even with criminal conviction. Different patterns of brain activity were observed when people with and without ADHD were compared. These results may suggest that psychopharmacological treatments as well as behavioral therapies could be useful tools for improving emotional difficulties in adult ADHD.
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Affiliation(s)
- Ana-María Soler-Gutiérrez
- Faculty of Psychology, Universidad Nacional de Educación a Distancia (UNED), Madrid, Spain
- Escuela Internacional de Doctorado de la UNED (EIDUNED), Universidad Nacional de Educación a Distancia (UNED), Madrid, Spain
| | | | - Julia Mayas
- Faculty of Psychology, Universidad Nacional de Educación a Distancia (UNED), Madrid, Spain
- * E-mail:
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Zhu F, Zhu X, Bi X, Kuang D, Liu B, Zhou J, Yang Y, Ren Y. Comparative effectiveness of various physical exercise interventions on executive functions and related symptoms in children and adolescents with attention deficit hyperactivity disorder: A systematic review and network meta-analysis. Front Public Health 2023; 11:1133727. [PMID: 37033046 PMCID: PMC10080114 DOI: 10.3389/fpubh.2023.1133727] [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: 12/29/2022] [Accepted: 03/08/2023] [Indexed: 04/11/2023] Open
Abstract
Background Physical exercise has been recommended as an important nonpharmacological therapeutic strategy for managing attention deficit hyperactivity disorder (ADHD). We conducted a network meta-analysis (NMA) to assess the comparative impact of different physical exercise modalities on enhancing executive functions (EFs) and alleviating symptoms in children and adolescents with ADHD. Methods We searched Web of Science, PubMed, Embase, Cochrane Central Register of Controlled Trials, SPORTDiscus, PsycINFO, CNKI, and clinical trials databases from inception to October 20, 2022. Randomized controlled trials (RCTs) and quasi-experimental studies investigating physical exercise for ADHD-related symptoms of hyperactivity/impulsivity and inattention, and executive functions were included. The frequentist random-effect NMA method was applied to pool the results. Results A total of 59 studies (including 39 RCTs, 5 quasi-RCTs, and 15 self-controlled trials) published between 1983 and 2022 were incorporated into the systematic review, of which 44 studies with 1757 participants were eligible for meta-analysis. All types of physical exercise were effective in improving EFs (SMD = 1.15, 95% CI: 0.83 to 1.46), and open-skill activities which require participants to react in a dynamically changing and externally paced environment induced the most incredible benefits for executive functions (SUCRA = 98.0%, SMD = 1.96, and 95% CI: 1.15 to 2.77). Subgroup analyses for EFs revealed varied findings that open-skill activities were the most promising physical exercise type for improving inhibitory control (SUCRA = 99.1%, SMD = 1.94, and 95% CI: 1.24 to 2.64), and closed-skill activities dominated by aerobic exercises had a slightly higher probability of being the most promising physical exercise intervention for working memory (SUCRA = 75.9%, SMD = 1.21, and 95% CI: -0.22 to 2.65), and multicomponent physical exercise tended to be the most effective in cognitive flexibility (SUCRA = 70.3%, SMD = 1.44, and 95% CI: -0.19 to 3.07). Regarding ADHD-related symptoms, closed-skill activities dominated by aerobic exercises might be more advantageous for hyperactivity/impulsivity (SUCRA = 72.5%, SMD = -1.60, and 95% CI: -3.02 to -0.19) and inattention (SUCRA = 96.3%, SMD = -1.51, and 95% CI: -2.33 to -0.69) improvement. Conclusion Physical exercise can significantly help to alleviate the symptoms of ADHD and improve executive functions in children and adolescents with ADHD. Most of all, to promote adherence to treatment, they should be encouraged to perform the physical exercises that they enjoy most.
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Affiliation(s)
- Feilong Zhu
- College of Physical Education and Sports, Beijing Normal University, Beijing, China
| | - Xiaotong Zhu
- College of Physical Education and Sports, Beijing Normal University, Beijing, China
| | - Xiaoyu Bi
- College of Physical Education and Sports, Beijing Normal University, Beijing, China
| | - Dongqing Kuang
- College of Physical Education and Sports, Beijing Normal University, Beijing, China
| | - Boya Liu
- School of Social Ecology, University of California, Irvine, Irvine, CA, United States
| | - Jingyi Zhou
- College of Physical Education and Sports, Beijing Normal University, Beijing, China
| | - Yiming Yang
- College of Physical Education and Sports, Beijing Normal University, Beijing, China
| | - Yuanchun Ren
- College of Physical Education and Sports, Beijing Normal University, Beijing, China
- *Correspondence: Yuanchun Ren,
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Jaisle EM, Groves NB, Black KE, Kofler MJ. Linking ADHD and ASD Symptomatology with Social Impairment: The Role of Emotion Dysregulation. Res Child Adolesc Psychopathol 2023; 51:3-16. [PMID: 36326970 PMCID: PMC9913618 DOI: 10.1007/s10802-022-00982-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2022] [Indexed: 11/06/2022]
Abstract
Children with attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) often experience social impairments. These children also frequently struggle with emotion regulation, and extant literature suggests that emotion dysregulation predicts social impairment in both clinical and neurotypical populations. However, the evidence base linking ADHD/ASD with social impairment comes primarily from samples meeting full diagnostic criteria for ADHD and/or ASD despite evidence that both syndromes reflect extreme ends of natural continuums that are normally distributed across the general population. To our knowledge, the present study is the first to concurrently examine unique and overlapping relations among ADHD/ASD symptoms, emotion regulation, and social difficulties using multi-informant measures (parent, teacher) with a clinically-evaluated sample of 108 children ages 8-13 (40 girls; 66% White/Non-Hispanic) with and without clinically-elevated ASD and ADHD symptoms and other common clinical disorders. Bias-corrected, bootstrapped conditional effects modeling revealed that ADHD-inattentive (β=-0.23) and ASD-social communication (β=-0.20) symptoms predicted social impairment directly, whereas ADHD-hyperactive/impulsive (β=-0.06) and ASD-restricted/repetitive behavior/interests (β=-0.06) symptoms predicted social impairment only via their shared associations with emotion dysregulation. Sensitivity analyses revealed that most relations were robust to control for item overlap across measures. In contrast, only the ADHD-inattention/social impairment link was robust to control for mono-informant bias, highlighting the importance of multi-informant methods and the potential for different determinants of social functioning across settings. Overall, this study implicates emotion regulation skills and all four ADHD/ASD symptom clusters as potential influences on children's social functioning, albeit with a more nuanced and potentially setting-specific pattern than suggested by prior work.
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Karalunas SL, Antovich D, Miller N, Nigg JT. Prospective prediction of developing internalizing disorders in ADHD. J Child Psychol Psychiatry 2022; 64:768-778. [PMID: 36464786 DOI: 10.1111/jcpp.13731] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/14/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Clinical course in attention-deficit/hyperactivity disorder (ADHD) is highly heterogeneous with respect to both core symptoms and associated features and impairment. Onset of comorbid anxiety and mood disorders during later childhood and adolescence is one critical aspect of divergent outcomes in ADHD. Characterizing heterogeneity in onset of anxiety and depression and identifying prospective predictors of these divergent courses may facilitate early identification of the children most at risk. METHODS A total of 849 children recruited for a case-control study of ADHD development, aged 7-12 years at baseline, completed up to six annual waves of comprehensive clinical and cognitive assessment, including multi-informant behavior ratings, parent semi-structured clinical diagnostic interviews, and measures of executive function (EF). Latent class growth curve analyses (LCGAs) characterized patterns of anxiety and depression over time. Trajectories were predicted from baseline parent-rated child temperament, lab-measured child EF, coded parental criticism, and child-reported self-blame for inter-parental conflict. RESULTS Latent class growth curve analyses separately identified three trajectories for anxiety and three for depression: persistently high, persistently low, and increasing. Temperamental fear/sadness and irritability were independent predictors that interacted with family characteristics. Baseline parental criticism and self-blame for inter-parental conflict exerted influence but only in the context of low temperamental risk. Better baseline child working memory was associated with delayed onset of depression. CONCLUSIONS The interaction of baseline child emotional features with EF or family environment predicted divergent courses of both anxiety and depression from middle-childhood to mid-adolescence. Results suggest modifiable risk factors associated with prospective differences in long-term outcomes.
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Affiliation(s)
| | - Dylan Antovich
- Psychiatry and Behavioral Neuroscience, Oregon Health and Science University, Portland, OR, USA
| | - Natalie Miller
- Psychiatry and Behavioral Neuroscience, Oregon Health and Science University, Portland, OR, USA
| | - Joel T Nigg
- Psychiatry and Behavioral Neuroscience, Oregon Health and Science University, Portland, OR, USA
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Öztekin I, Garic D, Bayat M, Hernandez ML, Finlayson MA, Graziano PA, Dick AS. Structural and diffusion-weighted brain imaging predictors of attention-deficit/hyperactivity disorder and its symptomology in very young (4- to 7-year-old) children. Eur J Neurosci 2022; 56:6239-6257. [PMID: 36215144 PMCID: PMC10165616 DOI: 10.1111/ejn.15842] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 09/15/2022] [Accepted: 09/21/2022] [Indexed: 12/29/2022]
Abstract
The current study aimed to identify the key neurobiology of attention-deficit/hyperactivity disorder (ADHD), as it relates to ADHD diagnostic category and symptoms of hyperactive/impulsive behaviour and inattention. To do so, we adapted a predictive modelling approach to identify the key structural and diffusion-weighted brain imaging measures and their relative standing with respect to teacher ratings of executive function (EF) (measured by the Metacognition Index of the Behavior Rating Inventory of Executive Function [BRIEF]) and negativity and emotion regulation (ER) (measured by the Emotion Regulation Checklist [ERC]), in a critical young age range (ages 4 to 7, mean age 5.52 years, 82.2% Hispanic/Latino), where initial contact with educators and clinicians typically take place. Teacher ratings of EF and ER were predictive of both ADHD diagnostic category and symptoms of hyperactive/impulsive behaviour and inattention. Among the neural measures evaluated, the current study identified the critical importance of the largely understudied diffusion-weighted imaging measures for the underlying neurobiology of ADHD and its associated symptomology. Specifically, our analyses implicated the inferior frontal gyrus as a critical predictor of ADHD diagnostic category and its associated symptomology, above and beyond teacher ratings of EF and ER. Collectively, the current set of findings have implications for theories of ADHD, the relative utility of neurobiological measures with respect to teacher ratings of EF and ER, and the developmental trajectory of its underlying neurobiology.
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Affiliation(s)
- Ilke Öztekin
- Center for Children and Families and Department of Psychology, Florida International University, Miami, Florida, USA.,Exponent, Inc., Philadelphia, Pennsylvania, USA
| | - Dea Garic
- Carolina Institute for Developmental Disabilities, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Mohammadreza Bayat
- Center for Children and Families and Department of Psychology, Florida International University, Miami, Florida, USA
| | - Melissa L Hernandez
- Center for Children and Families and Department of Psychology, Florida International University, Miami, Florida, USA
| | - Mark A Finlayson
- School of Computing and Information Sciences, Florida International University, Miami, Florida, USA
| | - Paulo A Graziano
- Center for Children and Families and Department of Psychology, Florida International University, Miami, Florida, USA
| | - Anthony Steven Dick
- Center for Children and Families and Department of Psychology, Florida International University, Miami, Florida, USA
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McKay E, Cornish K, Kirk H. Impairments in Emotion Recognition and Positive Emotion Regulation Predict Social Difficulties in Adolescent With ADHD. Clin Child Psychol Psychiatry 2022:13591045221141770. [PMID: 36440882 DOI: 10.1177/13591045221141770] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Emotional dysregulation, poor emotion recognition and impaired response inhibition have been highlighted as potential contributors to social difficulties in adolescents with attention-deficit/hyperactivity disorder (ADHD). It is currently unknown how these areas of impairment relate to one another; therefore, this study aims to identify the areas of emotion regulation which are associated with social difficulties in adolescents with ADHD, and determine whether emotion regulation mediates the relationship between deficits in response inhibition and emotion recognition, and social functioning, in this cohort. METHODS Thirty Australian adolescents (Male = 21) with ADHD completed measures of response inhibition, emotion recognition, and emotion regulation. RESULTS Positive emotion regulation was significantly associated with social difficulties. Although emotion recognition significantly predicted social difficulties, there was no relationship between emotion recognition and emotion regulation in this sample, ruling out emotion regulation as a mediator of emotion recognition and social difficulties. Whilst response inhibition was significantly correlated with positive emotion regulation, positive emotion regulation did not mediate the relationship between response inhibition and social difficulties. CONCLUSIONS Difficulties recognising and regulating emotions appear to independently contribute to social difficulties in adolescents with ADHD. Interventions to increase emotional understanding and developing strategies to down-regulate positive emotions may be beneficial.
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Affiliation(s)
- Erin McKay
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, 2541Monash University, Clayton, VIC, Australia
| | - Kim Cornish
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, 2541Monash University, Clayton, VIC, Australia
| | - Hannah Kirk
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, 2541Monash University, Clayton, VIC, Australia
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Astenvald R, Frick MA, Neufeld J, Bölte S, Isaksson J. Emotion dysregulation in ADHD and other neurodevelopmental conditions: a co-twin control study. Child Adolesc Psychiatry Ment Health 2022; 16:92. [PMID: 36443776 PMCID: PMC9706824 DOI: 10.1186/s13034-022-00528-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 11/15/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Emotion dysregulation (ED) is common in attention-deficit/hyperactivity disorder (ADHD) and often results in adverse outcomes. However, ED has been suggested as a transdiagnostic construct, why the specific association between ADHD and ED when adjusting for other mental health conditions needs further investigation. It is also important to determine the aetiological basis of the association between ADHD and ED to inform the theoretical conceptualization of ADHD. METHOD This study used a co-twin control design, including a sample of dizygotic (DZ) and monozygotic (MZ) twins (N = 389; 45.8% females, age = 8-31 years, MZ twin pairs 57.6%). ED was assessed using the dysregulation profile from the parent-rated Child Behaviour Checklist and its adult version. Regression analyses were used across individuals and within the pairs, while adjusting for diagnoses of autism, intellectual disability, other neurodevelopmental conditions and affective conditions. RESULTS ADHD was significantly associated with ED, even when adjusting for age, sex, attention problems and other mental health conditions, and was the diagnosis most strongly associated with ED. Within-pair analyses revealed that twins with ADHD had higher levels of ED compared to their co-twin without ADHD. This association remained within DZ twins and was non-significant in the MZ subsample, with non-overlapping confidence intervals between the DZ and MZ estimates. CONCLUSION ADHD is strongly and in part independently linked to ED, stressing the importance of early detection and treatment of emotional difficulties within this group. The findings from the within-pair analyses indicate a genetic influence on the association between ADHD and ED.
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Affiliation(s)
- Rebecka Astenvald
- Department of Medical Sciences, Child and Adolescent Psychiatry Unit, Uppsala University, Uppsala, Sweden
| | - Matilda A Frick
- Department of Medical Sciences, Child and Adolescent Psychiatry Unit, Uppsala University, Uppsala, Sweden
- Department of Psychology, Division of Emotion Psychology, Uppsala University, Uppsala, Sweden
| | - Janina Neufeld
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women's and Children's Health, Karolinska Institutet & Stockholm Health Care Services, Stockholm, Sweden
- Swedish Collegium for Advanced Study (SCAS), Uppsala, Sweden
| | - Sven Bölte
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women's and Children's Health, Karolinska Institutet & Stockholm Health Care Services, Stockholm, Sweden
- Curtin Autism Research Group, Curtin School of Allied Health, Curtin University, Perth, WA, Australia
- Child and Adolescent Psychiatry, Stockholm Health Care Services, Stockholm, 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 Health Care Services, Stockholm, Sweden.
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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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McQuade JD. ADHD Symptoms, Peer Problems, and Emotion Dysregulation as Longitudinal and Concurrent Predictors of Adolescent Borderline Personality Features. J Atten Disord 2022; 26:1711-1724. [PMID: 35535649 DOI: 10.1177/10870547221098174] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE ADHD and borderline personality (BP) disorder are highly comorbid and characterized by emotion dysregulation and peer problems. However, limited research has examined social and emotional predictors of BP features in samples that include youth with ADHD. METHOD Using a sample of 124 youth with and without ADHD (52% female), ADHD symptoms, peer problems, and emotion dysregulation were assessed in childhood (8-13 years) and in adolescence, along with BP features (13-18 years). RESULTS In addition to the significant effect of ADHD symptoms, teacher-rated child peer victimization and adolescent-reported peer victimization, poorer close friendships, and emotion dysregulation domains significantly predicted adolescent BP features. Greater parent-rated child and adolescent emotion dysregulation domains also significantly predicted adolescent BP features, with ADHD symptoms no longer significant. CONCLUSION Even for youth with ADHD, peer and emotional vulnerabilities in childhood and adolescence may serve as important markers of risk for adolescent BP features.
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Hamerman R, Cohen N. Emotion control training enhances reappraisal success among individuals with reported ADHD symptoms. Sci Rep 2022; 12:14058. [PMID: 35982138 PMCID: PMC9388606 DOI: 10.1038/s41598-022-18441-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 08/11/2022] [Indexed: 12/03/2022] Open
Abstract
Previous research indicates that training individuals to recruit cognitive control before exposure to negative pictures can facilitate the propensity to use reappraisal and reappraisal success. Individuals with attention deficit hyperactivity disorder (ADHD) experience difficulties in cognitive control and emotion regulation, so they may especially benefit from such training. Individuals reporting high ADHD symptoms and controls were randomly assigned to one of two training conditions. In the high emotion control (H-EC) training condition, negative pictures were typically preceded by a stimulus that recruits cognitive control. In contrast, in the low emotion control (L-EC) training condition, negative pictures were typically preceded by a stimulus that does not recruit cognitive control. Participants were then asked to recall an adverse personal event and to reappraise the event. As predicted, instructed reappraisal was more effective in reducing negative mood in the H-EC training compared to the L-EC training. Furthermore, compared to controls, individuals with reported ADHD symptoms showed a greater propensity to use reappraisal after writing the event and a more considerable reduction in event significance and negativity following the instructed reappraisal assignment. We argue that employing cognitive control over emotional information has a causal role in reappraisal use and success among individuals with ADHD symptoms.
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Affiliation(s)
- Revital Hamerman
- Department of Special Education, University of Haifa, 199 Abba Khoushy Ave, 3498838, Haifa, Israel.
| | - Noga Cohen
- Department of Special Education, University of Haifa, 199 Abba Khoushy Ave, 3498838, Haifa, Israel. .,Department of Special Education, The Edmond J. Safra Brain Research Center for the Study of Learning Disabilities, University of Haifa, 199 Abba Khoushy Ave, 3498838, Haifa, Israel.
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Longitudinal Associations of Children’s Hyperactivity/Inattention, Peer Relationship Problems and Mobile Device Use. SUSTAINABILITY 2022. [DOI: 10.3390/su14148845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Children with emotional, behavioral or relationship problems may be more inclined to use mobile touchscreen devices (MTSDs: mobiles and tablets) to regulate their emotions or compensate for the lack of social relationships, which, in turn, may affect their symptoms. Bi-directional longitudinal associations between behavioral difficulties and MTSD use were analyzed. Participants were parents of children aged 4–6 years old at first data collection (n = 173), and 7–9 years old at second data collection (n = 98). They reported on their child’s MTSD use and behavioral difficulties at two time points (T1 and T2). It was analyzed whether T1 MTSD use predicts T2 behavioral difficulties (controlling for demographics and T1 behavioral difficulties); and whether T1 behavioral difficulties predict T2 MTSD use (controlling for demographics and T1 MTSD use). Additionally, cross-sectional associations between behavioral difficulties and MTSD use were analyzed. Children’s T1 hyperactivity/inattention score positively associated with T2 MTSD use, and peer relationship problems and MTSD use positively associated in T2. Pre-schoolers with more hyperactive inattentive symptoms may use MTSDs more to regulate their emotions. The association between peer relationship problems and MTSD use in T2 is consistent with poorer socio-cognitive skills in MTSD user children and may be bi-directional.
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The three-year outcome of emotional symptoms in clinically referred youth with ADHD and their relationship to neuropsychological functions. Scand J Child Adolesc Psychiatr Psychol 2022; 10:72-86. [PMID: 35903554 PMCID: PMC9284941 DOI: 10.2478/sjcapp-2022-0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background Further knowledge is needed regarding long-term outcome of emotional symptoms, and the interplay between these symptoms and neuropsychological functioning in youth with attention deficit hyperactivity disorder (ADHD). Objective We aimed to explore the effect of performance-based neurocognitive functions and parent-rated behavioral executive functioning (EF) on self-rated and parent-rated internalizing symptoms longitudinally in clinically referred youth with ADHD (n = 137; mean age = 12.4 years). We also aimed to examine the change in self-rated emotional symptoms in the ADHD group and a Control group (n = 59; mean age = 11.9 years). Method At baseline, and three years later, parents completed rating scales of their child’s ADHD symptoms (Swanson Nolan Pelham Scale, Version IV – SNAP-IV), emotional symptoms (Five To Fifteen Questionnaire, Strengths, and Difficulties Questionnaire), and EF (Behavior Rating Inventory of Executive Function). At the same time, the child completed self-report measures of Anxiety, Depression, and Anger Inventories (the Beck Youth Inventories) and neurocognitive measures (Conner’s Continuous Performance Test, Version II (CPT-II), Working Memory and Processing Speed composites (Wechsler Intelligence Scales). Statistical analyses were linear and logistic mixed models. Results Using longitudinal data, parent- and self-ratings of emotional symptoms were associated with parent-ratings of EF behavior in youth with ADHD. Plan/organizing deficits were associated with Anxiety and Anger over and above other metacognitive subscales, while Emotional Control was related to Anger over and above other behavior regulation subscales. In the ADHD group, Anger symptoms improved across measuring points. When controlling for age, Anxiety, and Depression symptoms were largely stable in both groups, however at higher levels in the ADHD group. The differences in anxiety and depression symptoms across groups decreased over time. Conclusions The current study emphasizes the importance of identification, monitoring, and treatment of emotional symptoms, and behavioral aspects of EF in youth with ADHD.
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Baweja R, Waxmonsky JG. Updates in Pharmacologic Strategies for Emotional Dysregulation in Attention Deficit Hyperactivity Disorder. Child Adolesc Psychiatr Clin N Am 2022; 31:479-498. [PMID: 35697397 DOI: 10.1016/j.chc.2022.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Emotional dysregulation (ED) manifesting as irritability or aggression produces appreciable impairment in children with attention deficit hyperactivity disorder and a main reason why they present for treatment. Central nervous system (CNS) stimulants seem to be a safe and tolerable treatment of most youth with these presentations. Optimization of CNS stimulants dose in combination with psychosocial interventions led to reductions in ED. Randomized controlled trials support that addition of risperidone further reduces aggression when these treatments are not sufficient. There is evidence for the efficacy of divalproex, molindone and selective serotonin reuptake inhibitor improve these outcomes when used as adjunct to CNS stimulants.
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Affiliation(s)
- Raman Baweja
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, 500 University Drive, Hershey, PA 17033, USA.
| | - James G Waxmonsky
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, 500 University Drive, Hershey, PA 17033, USA
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