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Mingins JE, Tarver J, Pearson E, Edwards G, Bird M, Crawford H, Oliver C, Shelley L, Waite J. Development and psychometric properties of the Clinical Anxiety Scale for People with Intellectual Disabilities (ClASP-ID). J Neurodev Disord 2024; 16:43. [PMID: 39068415 PMCID: PMC11283710 DOI: 10.1186/s11689-024-09554-9] [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: 01/03/2024] [Accepted: 06/25/2024] [Indexed: 07/30/2024] Open
Abstract
BACKGROUND There is a critical need for the development of dependable and valid anxiety assessment tools suitable for people with moderate to severe intellectual disabilities, particularly those who speak few or no words. Distinguishing anxiety from distress caused by physical discomfort (pain) or characteristics associated with autism, prevalent in this population, necessitates specialised assessment tools. This study (a) developed a parent-report anxiety questionnaire tailored for individuals with severe to moderate intellectual disabilities, potentially with a co-diagnosis of autism, and (b) evaluated the psychometric attributes of this novel measure. METHODS A comprehensive approach involving literature reviews, inspection of existing tools, and interviews with clinicians and parents guided the creation of the Clinical Anxiety Scale for People with Intellectual Disabilities. The tool was completed by parents or caregivers (N = 311) reporting on individuals aged 4 or older with intellectual disabilities. RESULTS Exploratory factor analysis indicated a four-factor structure encompassing anxiety, pain, low energy/withdrawal, and consolability. The anxiety factor explained the most variance in scores (26.3%). The anxiety, pain, low energy/withdrawal subscales demonstrated robust internal consistency (α = 0.81-0.92), and convergent, divergent, and discriminant validity. Robustness of these subscales was further evidenced by test-retest reliability (ICC = 0.79-0.88) and inter-rater reliability (ICC = 0.64-0.71). Subgroup analyses consistently demonstrated strong psychometric properties among individuals diagnosed with non-syndromic autism (N = 98), children (N = 135), adults (N = 175), and across diverse communication abilities within the sample. Moreover, individuals diagnosed with both autism and anxiety exhibited significantly higher scores on the anxiety subscale compared to those without an anxiety diagnosis, while showing no difference in autism characteristic scores. CONCLUSIONS The findings indicate that the Clinical Anxiety Scale for People with Intellectual Disabilities is a promising measure for use across diverse diagnostic groups, varying communication abilities, and with people with moderate to severe intellectual disabilities.
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Affiliation(s)
- Jessica Eliza Mingins
- School of Psychology, College of Health and Life Sciences, Aston University, Birmingham, B4 7 ET, United Kingdom.
| | - Joanne Tarver
- School of Psychology, College of Health and Life Sciences, Aston University, Birmingham, B4 7 ET, United Kingdom
| | - Effie Pearson
- School of Psychology, College of Health and Life Sciences, Aston University, Birmingham, B4 7 ET, United Kingdom
| | - Georgina Edwards
- School of Health and Care, Coventry University, Priory St, Coventry, CV1 5FB, England
| | - Megan Bird
- School of Psychology, College of Health and Life Sciences, Aston University, Birmingham, B4 7 ET, United Kingdom
| | - Hayley Crawford
- Mental Health and Wellbeing Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, England
| | - Chris Oliver
- School of Psychology, University of Birmingham, Edgbaston, B15 2TT, England
| | - Lauren Shelley
- School of Psychology, College of Health and Life Sciences, Aston University, Birmingham, B4 7 ET, United Kingdom
| | - Jane Waite
- School of Psychology, College of Health and Life Sciences, Aston University, Birmingham, B4 7 ET, United Kingdom
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Wilkes-Gillan S, Parsons L, Parsons D, Mahoney N, Hancock N, Cordier R, Lincoln M, Chen YWR, Bundy A. An evaluation of intervention appropriateness from the perspective of parents: A peer-mediated, play-based intervention for children with ADHD. Aust Occup Ther J 2024. [PMID: 39032070 DOI: 10.1111/1440-1630.12981] [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: 12/03/2023] [Revised: 07/03/2024] [Accepted: 07/04/2024] [Indexed: 07/22/2024]
Abstract
INTRODUCTION A peer-mediated, play-based intervention has been developed to address social participation challenges experienced by children with ADHD. To facilitate implementation into clinical practice, interventions should be evaluated for appropriateness to the end-user, as well as effectiveness. Previous research demonstrated the approach is effective for improving children's social play skills. This study aimed to evaluate the appropriateness of the intervention for children with ADHD and their families. METHODS Parents of children with ADHD who participated in the play-based intervention were interviewed 1 month after completion. Parents were asked about their perspective of parent and children's experiences of the intervention, the perceived benefits for children and parents, the logistics of participating, and recommended adaptations to the intervention. Interviews were analysed thematically, and themes were mapped to the elements of the adopted definition of appropriateness to understand whether parents supported the appropriateness of the intervention for their families. CONSUMER AND COMMUNITY INVOLVEMENT Consumers were not directly involved in the decisions made about this study. FINDINGS One core theme, 'collaborative efforts', emerged from the data. Major themes comprising the core theme were 'on the same page', 'therapeutic relationship', and 'getting the job done'. Three sub-themes of 'engagement and motivation', 'the effort was worth it for the reward', and 'Rome wasn't built in a day' were nested within the major themes. CONCLUSION Parents largely supported the appropriateness of the intervention, indicating it addressed an important goal for their child, participation was a positive experience, and they perceived the intervention to be beneficial. Future adaptions of the intervention are needed to increase its ecological validity and to generalise the strategies to other social environments and playmates, such as peers at school. PLAIN LANGUAGE SUMMARY This study looked at an intervention that uses play with peers to help children with ADHD develop their play skills. The researchers wanted to know if parents thought the intervention was a good fit for their families and if it helped their children. Parents gave an interview a month after the intervention ended. They were asked about their thoughts on the intervention, how it helped their children and themselves, how easy it was to take part, and what changes could be made to make the intervention better. After analysing parents' answers, the researchers found parents mostly agreed that the intervention was a good fit. They said it helped their children to play with their peers, and they had a good time doing it. Parents thought the intervention was helpful, they liked that it was a joint effort between them and the occupational therapist, and they felt it was worth the effort. However, they also suggested some changes. They wanted the intervention to fit into other real-life social situations, such as school, so their children could use the skills they learned in other places. Overall, parents thought the intervention was helpful and suitable for their children and themselves, but some changes might make it more helpful.
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Affiliation(s)
- Sarah Wilkes-Gillan
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Lauren Parsons
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Dave Parsons
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Natasha Mahoney
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Nicola Hancock
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Reinie Cordier
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
- Department of Social Work, Education and Community Wellbeing, Faculty of Health and Life Sciences, University of North Umbria, Newcastle upon Tyne, UK
| | - Michelle Lincoln
- Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Yu-Wei Ryan Chen
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Anita Bundy
- Department of Occupational Therapy, College of Health and Human Sciences, Colorado State University, Fort Collins, Colorado, USA
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Ramos-Galarza C, Brito D, Rodríguez B, Guerrero B, Cruz-Cárdenas J, Bolaños-Pasquel M. Systematic Review of Executive Function Stimulation Methods in the ADHD Population. J Clin Med 2024; 13:4208. [PMID: 39064248 PMCID: PMC11278469 DOI: 10.3390/jcm13144208] [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: 05/21/2024] [Revised: 06/24/2024] [Accepted: 06/27/2024] [Indexed: 07/28/2024] Open
Abstract
Background/Objectives: Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by elevated motor activity, impulsivity, and attention deficit. Approximately 5% of the population suffers from this disorder. Among the key explanations of ADHD, executive functions play an important role in understanding the symptomatology present in this disorder and in determining the main treatment strategies for affected patients. We present a systematic review that seeks to identify the treatment methods developed to support executive functions in individuals with ADHD. Methods: Articles were analyzed in the SCOPUS, PUBMED, and Science Direct databases. Initially, 739 articles were found. After applying inclusion and exclusion criteria, 30 articles remained and were included in the data extraction process. Results: Among the primary treatments identified, 14 studies propose psychological training for executive functions, 9 studies recommend medication, 5 studies suggest digital interventions, and 1 study advocates for sports as beneficial for executive functions. Conclusions: The data are discussed around the need to develop new proposals to enhance the executive functions of individuals with ADHD, thereby improving their performance in educational, personal, social, and family activities impacted by this disorder.
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Affiliation(s)
- Carlos Ramos-Galarza
- Factultad de Psicología, Pontificia Universidad Católica del Ecuador, Quito 170525, Ecuador; (D.B.); (B.R.); (B.G.)
| | - Deyaneira Brito
- Factultad de Psicología, Pontificia Universidad Católica del Ecuador, Quito 170525, Ecuador; (D.B.); (B.R.); (B.G.)
| | - Brayan Rodríguez
- Factultad de Psicología, Pontificia Universidad Católica del Ecuador, Quito 170525, Ecuador; (D.B.); (B.R.); (B.G.)
| | - Brenda Guerrero
- Factultad de Psicología, Pontificia Universidad Católica del Ecuador, Quito 170525, Ecuador; (D.B.); (B.R.); (B.G.)
| | - Jorge Cruz-Cárdenas
- Centro de Investigación Estec, Facultad de Administración y Negocios, Universidad Indoamérica, Quito 170301, Ecuador;
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Schulz ML, Wood CE, Fogarty A, Brown SJ, Gartland D, Giallo R. Intimate partner violence exposure during infancy and social functioning in middle childhood: An Australian mother and child cohort study. Child Dev 2024; 95:817-830. [PMID: 37882462 DOI: 10.1111/cdev.14032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 09/18/2023] [Accepted: 10/09/2023] [Indexed: 10/27/2023]
Abstract
Social functioning of children with experiences of intimate partner violence (IPV) between caregivers in early childhood has received less attention than emotional-behavioral outcomes. Drawing on data from 1507 ten-year-old Australian-born children and their mothers participating in a community-based longitudinal study, this study examined the associations between IPV exposure during infancy and social development during middle childhood. IPV during the first 12 months of life was associated with lower social skills, higher peer problems, and peer victimization at age 10 years, while accounting for concurrent IPV. This study provides evidence for the long-term impacts of early-life IPV exposure on children's social functioning, and the importance of prevention and early intervention programs focused on social development following experiences of IPV.
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Affiliation(s)
- Madison L Schulz
- Department of Psychological Sciences, Swinburne University of Technology, Victoria, Hawthorn, Australia
- Murdoch Children's Research Institute, Victoria, Parkville, Australia
| | - Catherine E Wood
- Department of Psychological Sciences, Swinburne University of Technology, Victoria, Hawthorn, Australia
| | - Alison Fogarty
- Murdoch Children's Research Institute, Victoria, Parkville, Australia
| | - Stephanie J Brown
- Murdoch Children's Research Institute, Victoria, Parkville, Australia
- Department of Paediatrics, University of Melbourne, Victoria, Parkville, Australia
- Department of General Practice, University of Melbourne, Victoria, Parkville, Australia
- South Australian Health and Medical Research Institute, South Australia, Adelaide, Australia
| | - Deirdre Gartland
- Murdoch Children's Research Institute, Victoria, Parkville, Australia
- Department of Paediatrics, University of Melbourne, Victoria, Parkville, Australia
| | - Rebecca Giallo
- Murdoch Children's Research Institute, Victoria, Parkville, Australia
- School of Psychology, Deakin University, Victoria, Geelong, Australia
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Marsh CL, Harmon SL, Cho S, Chan ESM, Gaye F, DeGeorge L, Black KE, Irwin Harper LN, Kofler MJ. Does Anxiety Systematically Bias Estimates of Executive Functioning Deficits in Pediatric Attention-Deficit/Hyperactivity Disorder? Res Child Adolesc Psychopathol 2024; 52:773-787. [PMID: 38157122 PMCID: PMC11216413 DOI: 10.1007/s10802-023-01152-y] [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: 11/09/2023] [Indexed: 01/03/2024]
Abstract
Growing evidence suggests that childhood ADHD is associated with larger impairments in working memory relative to inhibition. However, most studies have not considered the role of co-occurring anxiety on these estimates - a potentially significant confound given prior evidence that anxiety may increase working memory difficulties but decrease inhibition difficulties for these children. The current study extends prior work to examine the extent to which co-occurring anxiety may be systematically affecting recent estimates of the magnitude of working memory/inhibitory control deficits in ADHD. The carefully-phenotyped sample included 197 children with ADHD and 142 children without ADHD between the ages of 8 and 13 years (N = 339; Mage = 10.31, SD = 1.39; 144 female participants). Results demonstrated that ADHD diagnosis predicted small impairments in inhibitory control (d = 0.31) and large impairments in working memory (d = 0.99). However, child trait anxiety assessed dimensionally across multiple informants (child, parent, teacher) did not uniquely predict either executive function, nor did it moderate estimates of ADHD-related working memory/inhibition deficits. When evaluating anxiety categorically and controlling for ADHD, anxiety diagnosis predicted slightly better working memory (d = 0.19) but not inhibitory control for clinically evaluated children generally. Findings from the current study indicate that trait anxiety, measured dimensionally or categorically, does not differentially affect estimates of executive dysfunction in pediatric ADHD. Further, results suggest that trait anxiety is generally not associated with executive dysfunction above and beyond the impact of co-occurring ADHD. Future research is needed to further assess the role of anxiety in ADHD behavioral symptomatology, neurocognitive functioning, and mechanisms underlying these relations.
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Affiliation(s)
- Carolyn L Marsh
- Florida State University, Department of Psychology, 1107 W. Call Street, Tallahassee, FL, 32306-4301, USA
| | - Sherelle L Harmon
- Florida State University, Department of Psychology, 1107 W. Call Street, Tallahassee, FL, 32306-4301, USA
| | - Sooyun Cho
- Florida State University, Department of Psychology, 1107 W. Call Street, Tallahassee, FL, 32306-4301, USA
| | - Elizabeth S M Chan
- Rutgers University, Graduate School of Applied and Professional Psychology, Piscataway, NJ, USA
| | - Fatou Gaye
- Florida State University, Department of Psychology, 1107 W. Call Street, Tallahassee, FL, 32306-4301, USA
| | - Lauren DeGeorge
- Florida State University, Department of Psychology, 1107 W. Call Street, Tallahassee, FL, 32306-4301, USA
| | - Katie E Black
- Florida State University, Department of Psychology, 1107 W. Call Street, Tallahassee, FL, 32306-4301, USA
| | - Lauren N Irwin Harper
- Johns Hopkins All Children's Hospital, Center for Behavioral Health, St. Petersburg, FL, USA
| | - Michael J Kofler
- Florida State University, Department of Psychology, 1107 W. Call Street, Tallahassee, FL, 32306-4301, USA.
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Mahdavi F, Asgarian FS, Aghajani M. The Effect of Ear Acupressure on Behavioral Problems in Children with Attention-Deficit/Hyperactivity Disorder: A Randomized Clinical Trial. Med Acupunct 2024; 36:93-101. [PMID: 38659722 PMCID: PMC11036156 DOI: 10.1089/acu.2023.0028] [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: 04/26/2024] Open
Abstract
Objective Due to the limits on treatment for people with attention-deficit/hyperactivity disorder (ADHD), ear acupressure treatment has been considered. This study examined the effect of ear acupressure on behavioral problems of children with ADHD. Materials and Methods This randomized controlled trial was conducted in 70 children with ADHD who were randomized into 2 groups. The intervention group received ear acupressure in treatment points and the control group received massage at neutral points. Behavioral problems were measured 3 times: (1) baseline; week 4; and week 8. The last timepoint was a follow-up, using the Child Behavior Checklist. Results The intervention group had fewer behavioral problems at all 3 timepoints than the control group (Cohen's ∂ = 1.49; 95% confidence interval at week 4: 20.97, 47.43).The ear acupressure group had a large effect size with respect to reduction of attention problems at week 4 (∂ = 1.88) and week 8 (∂ = 1.48) than the control group. Conclusions Ear acupressure induced significant reduction of the behavioral problems of children with ADHD. Further research can evaluate the use and continuity of the effectiveness of this treatment as a complementary treatment in addition to the usual treatments for these children.
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Affiliation(s)
- Fatemeh Mahdavi
- Student Research Committee, Kashan University of Medical Sciences, Kashan, Iran
| | - Fatemeh Sadat Asgarian
- Social Determinants of Health (SDH) Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Mohammad Aghajani
- Infectious Diseases Research Center, Kashan University of Medical Sciences, Kashan, Iran
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Martin R, McKay E, Kirk H. Lowered social motivation is associated with adolescent attention deficit hyperactivity disorder and social anxiety symptoms. Clin Child Psychol Psychiatry 2024; 29:338-352. [PMID: 37995373 PMCID: PMC10748457 DOI: 10.1177/13591045231218475] [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: 11/25/2023]
Abstract
BACKGROUND Difficulties in social skills are highly prevalent in children and adolescents with attention deficit hyperactivity disorder (ADHD), however, the reasons for these social difficulties are poorly understood. This study aimed to understand social motivation in children (aged 5-8) and adolescents (aged 13-17) with and without ADHD, and the relationship between social anxiety and social motivation in youth with ADHD. METHOD 204 parents of children and adolescents with and without ADHD completed online questionnaires on social motivation, social anxiety, and ADHD symptoms. RESULTS Adolescents with ADHD had significantly lower social motivation than typically developing adolescents, and children with ADHD. Higher social anxiety significantly predicted lowered social motivation in participants with ADHD. CONCLUSIONS These findings indicate a unique pattern of social motivation in ADHD, specifically a reduction during adolescence, reflecting social intervention inefficacy. Additionally, these findings establish a link between social motivation and social anxiety, suggesting that they may act as barriers to social intervention.
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Affiliation(s)
- Rachael Martin
- Rachael Martin, Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, 18 Innovation Walk, Wellington Road, Clayton, VIC 3800, Australia.
| | | | - Hannah Kirk
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
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Chaulagain A, Lyhmann I, Halmøy A, Widding-Havneraas T, Nyttingnes O, Bjelland I, Mykletun A. A systematic meta-review of systematic reviews on attention deficit hyperactivity disorder. Eur Psychiatry 2023; 66:e90. [PMID: 37974470 PMCID: PMC10755583 DOI: 10.1192/j.eurpsy.2023.2451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 05/29/2023] [Accepted: 08/31/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND There are now hundreds of systematic reviews on attention deficit hyperactivity disorder (ADHD) of variable quality. To help navigate this literature, we have reviewed systematic reviews on any topic on ADHD. METHODS We searched MEDLINE, PubMed, PsycINFO, Cochrane Library, and Web of Science and performed quality assessment according to the Joanna Briggs Institute Manual for Evidence Synthesis. A total of 231 systematic reviews and meta-analyses met the eligibility criteria. RESULTS The prevalence of ADHD was 7.2% for children and adolescents and 2.5% for adults, though with major uncertainty due to methodological variation in the existing literature. There is evidence for both biological and social risk factors for ADHD, but this evidence is mostly correlational rather than causal due to confounding and reverse causality. There is strong evidence for the efficacy of pharmacological treatment on symptom reduction in the short-term, particularly for stimulants. However, there is limited evidence for the efficacy of pharmacotherapy in mitigating adverse life trajectories such as educational attainment, employment, substance abuse, injuries, suicides, crime, and comorbid mental and somatic conditions. Pharmacotherapy is linked with side effects like disturbed sleep, reduced appetite, and increased blood pressure, but less is known about potential adverse effects after long-term use. Evidence of the efficacy of nonpharmacological treatments is mixed. CONCLUSIONS Despite hundreds of systematic reviews on ADHD, key questions are still unanswered. Evidence gaps remain as to a more accurate prevalence of ADHD, whether documented risk factors are causal, the efficacy of nonpharmacological treatments on any outcomes, and pharmacotherapy in mitigating the adverse outcomes associated with ADHD.
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Affiliation(s)
- Ashmita Chaulagain
- Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Ingvild Lyhmann
- Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Anne Halmøy
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Tarjei Widding-Havneraas
- Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Olav Nyttingnes
- Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Ingvar Bjelland
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Arnstein Mykletun
- Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
- Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
- Department of Community Medicine, UiT – The Arctic University of Norway, Tromsø, Norway
- Centre for Work and Mental Health, Nordland Hospital, Bodø, Norway
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Hosoki M, Eidsness MA, Bruckert L, Travis KE, Feldman HM. Associations of behavioral problems with white matter circuits connecting to the frontal lobes in school-aged children born at term and preterm. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.11.08.23298268. [PMID: 37986772 PMCID: PMC10659456 DOI: 10.1101/2023.11.08.23298268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
Introduction This study investigated whether behavioral problems in children were associated with fractional anisotropy (FA) of white matter tracts connecting from other brain regions to right and left frontal lobes. We considered internalizing and externalizing behavioral problems separately and contrasted patterns of associations in children born at term and very preterm. Methods Parents completed the Child Behavior Checklist/6-18 questionnaire to quantify behavioral problems when their children were age 8 years (N=36 FT and 37 PT). Diffusion magnetic resonance scans were collected at the same age and analyzed using probabilistic tractography. We used multiple linear regression to investigate the strength of association between age-adjusted T-scores of internalizing and externalizing problems and mean fractional anisotropy (mean-FA) of right and left uncinate, arcuate, and anterior thalamic radiations, controlling for birth group and sex. Results Regression models predicting internalizing T-scores from mean-FA found significant group-by-tract interactions for the left and right arcuate and right uncinate. Internalizing scores were negatively associated with mean-FA of left and right arcuate only in children born at term (pleft AF =0.01, pright AF =0.01). Regression models predicting externalizing T-scores from mean-FA found significant group-by-tract interactions for the left arcuate and right uncinate. Externalizing scores were negatively associated with mean-FA of right uncinate in children born at term (pright UF =0.01) and positively associated in children born preterm (pright UF preterm =0.01). Other models were not significant. Conclusions In this sample of children with scores for behavioral problems across the full range, internalizing and externalizing behavioral problems were negatively associated with mean-FA of white matter tracts connecting to frontal lobes in children born at term; externalizing behavioral problems were positively associated with mean-FA of the right uncinate in children born preterm. The different associations by birth group suggest that the neurobiology of behavioral problems differs in the two birth groups.
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Affiliation(s)
- Machiko Hosoki
- Corresponding Author: Machiko Hosoki, Developmental-Behavioral Pediatrics, Stanford University School of Medicine, 3145 Porter Drive, MC 5395, Palo Alto, CA 94304,
| | - Margarita Alethea Eidsness
- Division of Developmental-Behavioral Pediatrics, Department of Pediatrics, Stanford University School of Medicine
| | | | - Katherine E. Travis
- Division of Developmental-Behavioral Pediatrics, Department of Pediatrics, Stanford University School of Medicine
| | - Heidi M Feldman
- Division of Developmental-Behavioral Pediatrics, Department of Pediatrics, Stanford University School of Medicine
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Ehrler M, Bellinger DC, Cassidy AR, Newburger JW, Calderon J. Social cognition and behavioral outcomes in congenital heart disease: profiles and neuropsychiatric comorbidities. Child Neuropsychol 2023; 29:1041-1063. [PMID: 37017255 DOI: 10.1080/09297049.2023.2196398] [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: 04/11/2022] [Accepted: 03/17/2023] [Indexed: 04/06/2023]
Abstract
Autism spectrum disorders are more prevalent in children with congenital heart disease (CHD) than in the general population. Children with CHD without diagnosed autism are also at increased risk for neurodevelopmental and psychiatric impairments. We characterized social and behavioral outcomes in children with CHD and examined neurodevelopmental and psychiatric comorbidities. Children without diagnosed autism who underwent infant open-heart surgery were eligible. Parent-reports assessed social communication, unusual behaviors, self-regulation, anxiety, and executive function (EF). Neuropsychological tests assessing theory of mind (ToM), working memory, and verbal comprehension were administered. Outcomes were compared to normative data. Linear regressions were estimated with parent-reported scores and ToM abilities as outcomes. Predictors were anxiety symptoms, parent-reported EF, and working memory scores. Covariates were age, parental education, ADHD diagnosis, and verbal comprehension. Clinically relevant comorbidities were identified (N children scoring ≥1SD below the norm). Fifty-six children (10.8 ± 1.8 years) participated virtually. Compared to norms, children with CHD had impaired ToM, more unusual behaviors (p = .002), and less self-regulation (p = .018), but better social communication (p = .014). "Autism-like" traits were positively associated with anxiety symptoms (ß(95% CI) = 0.28(0.08-0.49), p = .008) and worse working memory (ß(95% CI) = -0.36(-0.59-0.13), p = .003). Twenty-one out of 22 children who displayed clinically relevant social and behavioral scores also showed anxiety symptoms (n = 4), impaired EF (n = 7), or both (n = 10). Children with CHD without diagnosed autism have elevated unusual behaviors, lower self-regulation, and impaired ToM. There is a high risk of co-existing anxiety and impaired EF which may increase disease burden. Targeted therapeutic interventions are needed to reduce long-term psychosocial risks in these children.AbbreviationAttention deficit/hyperactivity disorder (ADHD), Autism Spectrum Rating Scale (ASRS), Behavior Rating Inventory of Executive Functions for school-aged children, 2nd Edition (BRIEF-2), cardiopulmonary bypass (CPB), congenital heart disease (CHD), Empathy/Systematizing Quotient Child Version (ESQ-C), Multidimensional Anxiety Scale for Children, 2nd Edition (MASC-2), Social Responsiveness Scale (School-age form), 2nd Edition (SRS-2), theory of mind (ToM), Theory of Mind Task Battery (ToM-TB), Wechsler Intelligence Scale for Children, 5th edition (WISC-V).
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Affiliation(s)
- Melanie Ehrler
- Child Development Center, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
- Departments of Cardiology, Cardiac Neurodevelopmental Program, Boston Children's Hospital, Boston, MA, USA
| | - David C Bellinger
- Departments of Psychiatry, Cardiac Neurodevelopmental Program, Boston Children's Hospital, Boston, MA, USA
- Departments of Neurology, Cardiac Neurodevelopmental Program, Boston Children's Hospital, Boston, MA, USA
- Departments of Psychiatry, Harvard Medical School, Harvard University, Boston, MA, USA
- Departments of Neurology, Harvard Medical School, Harvard University, Boston, MA, USA
| | - Adam R Cassidy
- Departments of Psychiatry, Cardiac Neurodevelopmental Program, Boston Children's Hospital, Boston, MA, USA
- Departments of Psychiatry, Harvard Medical School, Harvard University, Boston, MA, USA
- Departments of Psychiatry and Psychology & Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Jane W Newburger
- Departments of Cardiology, Cardiac Neurodevelopmental Program, Boston Children's Hospital, Boston, MA, USA
- Pediatrics, Harvard Medical School, Harvard University, Boston, USA
| | - Johanna Calderon
- Departments of Psychiatry, Harvard Medical School, Harvard University, Boston, MA, USA
- National Institute of Health and Medical Research, Inserm U1046 PhyMedExp, Cardiac Neurodevelopment Research, University of Montpellier, Montpellier, France
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11
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Ingeborgrud CB, Oerbeck B, Friis S, Zeiner P, Pripp AH, Aase H, Biele G, Dalsgaard S, Overgaard KR. Anxiety and depression from age 3 to 8 years in children with and without ADHD symptoms. Sci Rep 2023; 13:15376. [PMID: 37717097 PMCID: PMC10505233 DOI: 10.1038/s41598-023-42412-7] [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: 06/28/2022] [Accepted: 09/10/2023] [Indexed: 09/18/2023] Open
Abstract
Childhood anxiety and depressive symptoms may be influenced by symptoms of attention deficit/hyperactivity disorder (ADHD). We investigated whether parent- and teacher-reported anxiety, depressive and ADHD symptoms at age 3 years predicted anxiety disorders and/or depression in children with and without ADHD at age 8 years. This study is part of the longitudinal, population-based Norwegian Mother, Father and Child Cohort Study. Parents of 3-year-olds were interviewed, and preschool teachers rated symptoms of anxiety disorders, depression and ADHD. At age 8 years (n = 783), Child Symptom Inventory-4 was used to identify children who fulfilled the diagnostic criteria for anxiety disorders and/or depression (hereinafter: Anx/Dep), and ADHD. Univariable and multivariable logistic regression analyses were used. In the univariable analyses, parent-reported anxiety, depressive and ADHD symptoms, and teacher-reported anxiety symptoms at age 3 years all significantly predicted subsequent Anx/Dep. In the multivariable analyses, including co-occurring symptoms at age 3 years and ADHD at 8 years, parent-reported anxiety and depressive symptoms remained significant predictors of subsequent Anx/Dep. At age 3 years, regardless of ADHD symptoms being present, asking parents about anxiety and depressive symptoms, and teachers about anxiety symptoms, may be important to identify children at risk for school-age anxiety disorders and/or depression.
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Affiliation(s)
- Christine Baalsrud Ingeborgrud
- Institute of Clinical Medicine, Division of Mental Health and Addiction, Child and Adolescent Psychiatry Unit, University of Oslo, Pb 1039 Blindern, 0315, Oslo, Norway.
| | - Beate Oerbeck
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Svein Friis
- Institute of Clinical Medicine, Division of Mental Health and Addiction, Child and Adolescent Psychiatry Unit, University of Oslo, Pb 1039 Blindern, 0315, Oslo, Norway
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Pål Zeiner
- Institute of Clinical Medicine, Division of Mental Health and Addiction, Child and Adolescent Psychiatry Unit, University of Oslo, Pb 1039 Blindern, 0315, Oslo, Norway
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Are Hugo Pripp
- Oslo Centre of Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Heidi Aase
- Department of Child Health and Development, Norwegian Institute of Public Health, Oslo, Norway
| | - Guido Biele
- Department of Child Health and Development, Norwegian Institute of Public Health, Oslo, Norway
| | - Søren Dalsgaard
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Child and Adolescent Psychiatry, Mental Health Services of the Capital Region, Glostrup, Denmark
| | - Kristin Romvig Overgaard
- Institute of Clinical Medicine, Division of Mental Health and Addiction, Child and Adolescent Psychiatry Unit, University of Oslo, Pb 1039 Blindern, 0315, Oslo, Norway
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
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12
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Thorpe D, Mirhashem R, Shen J, Roulston C, Fox K, Schleider J. Ecological-Systems Contributors to Internalizing Symptoms in a US Sample of Adolescents During the COVID-19 Pandemic. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2023:1-16. [PMID: 37616119 PMCID: PMC10891302 DOI: 10.1080/15374416.2023.2246556] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
OBJECTIVE Internalizing problems are common in adolescence and increased substantially during the COVID-19 pandemic. Although rates of anxiety and depression have since improved, the general increase in the prevalence of mental health problems and disruptions to mental health services during the COVID-19 pandemic has resulted in huge gaps in care. Although research has primarily focused on proximal correlates of internalizing problems, a growing literature suggests that factors outside youths' immediate microsystems are equally crucial for their mental well-being. Thus, it is important to investigate multisystemic correlates of internalizing problems to inform individual and community-based interventions to address the current mental health burden. METHOD Leveraging secondary data from a nationally diverse U.S. sample of 2,954 adolescents (ages 13-16), we examined the associations between factors at multiple levels of youths' ecologies - spanning indicators of threat and deprivation - and their depression and anxiety symptoms during the COVID-19 pandemic. Furthermore, in follow-up exploratory analyses, we examined if these associations differed by adolescents' racial/ethnic groups. RESULTS Consistent with socioecological models, we found that indicators of threat and deprivation in the adolescents' immediate home and more distal neighborhood environments were associated with depression and anxiety symptoms. The patterns of associations were similar across racial/ethnic groups in multigroup structural equation models. Additionally, we found that mean levels of internalizing symptoms and socioecological predictors significantly differed across racial/ethnic groups. CONCLUSION These findings have important implications for understanding multi-level contributors to adolescent mental health, which may inform research, practice, and policy.
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Affiliation(s)
| | | | - Jenny Shen
- Department of Psychology, Stony Brook University
| | | | - Kathryn Fox
- Department of Psychology, University of Denver
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13
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McKay E, Kirk H, Martin R, Cornish K. Social difficulties in adolescent attention deficit hyperactivity disorder: Social motivation, social anxiety and symptom severity as contributing factors. J Clin Psychol 2023; 79:1113-1129. [PMID: 36413514 DOI: 10.1002/jclp.23462] [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: 02/28/2022] [Accepted: 11/12/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Many interventions have been developed to address the social difficulties commonly experienced by adolescents with attention-deficit/hyperactivity disorder (ADHD), yet they are largely ineffective. OBJECTIVE This study examined social impairment among adolescents with and without ADHD, determining whether gender, social anxiety, age, and ADHD symptom type (inattention and hyperactivity/impulsivity) and severity are associated with social impairment. METHOD Parents and primary caregivers of adolescents (aged 13-17) with (n = 76) and without ADHD (n = 36) completed the Strengths and Weaknesses of ADHD and Normal Behavior, Social Responsiveness Scale 2nd Edition, and Spence Children's Anxiety Scale. RESULTS Adolescents with ADHD scored significantly higher than TD adolescents across social impairment domains. ADHD symptoms were associated with severity of impairment in all domains excluding Social Motivation. Hyperactivity/impulsivity and social anxiety predicted social impairment, whereas gender did not. CONCLUSION Adolescents with ADHD are more likely to experience social impairment than TD adolescents, and interventions targeting symptom reduction and social anxiety may improve these social impairments.
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Affiliation(s)
- Erin McKay
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Hannah Kirk
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Rachael Martin
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Kim Cornish
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
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14
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Rabelo-da-Ponte FD, Verdolini N, Goularte JF, Serafim SD, Caldieraro MAK, Vieta E, Ramos-Quiroga JA, Amoretti S, Rosa AR. Identifying pathways between psychiatric symptoms and psychosocial functioning in the general population. Eur Neuropsychopharmacol 2023; 67:86-94. [PMID: 36640692 DOI: 10.1016/j.euroneuro.2022.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 11/07/2022] [Accepted: 11/08/2022] [Indexed: 01/15/2023]
Abstract
The present study aims to identify pathways between psychiatric network symptoms and psychosocial functioning and their associated variables among functioning clusters in the general population. A cross-sectional web-based survey was administered in a total of 3,023 individuals in Brazil. The functioning clusters were derived by a previous study identifying three different groups based on the online Functioning Assessment Short Test. Networking analysis was fitted with all items of the Patient-Reported Outcomes Measurement Information System for depression and for anxiety (PROMIS) using the mixed graphical model. A decision tree model was used to identify the demographic and clinical characteristics of good and low functioning. A total of 926 (30.63%) subjects showed good functioning, 1,436 (47.50%) participants intermediate functioning, and 661 (21.86%) individuals low functioning. Anxiety and uneasy symptoms were the most important nodes for good and intermediate clusters but anxiety, feeling of failure, and depression were the most relevant symptoms for low functioning. The decision tree model was applied to identify variables capable to discriminate individuals with good and low functioning. The algorithm achieved balanced accuracy 0.75, sensitivity 0.87, specificity 0.63, positive predictive value 0.63 negative predictive value 0.87 (p<0.001), and an area under the curve of 0.83 (95%CI:0.79-0.86, p<0.01). Our results show that individuals who present psychological distress are more likely to experience poor functional status, suggesting that this subgroup should receive a more comprehensive psychiatric assessment and mental health care.
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Affiliation(s)
- Francisco Diego Rabelo-da-Ponte
- Department of Social, Genetic & Developmental Psychiatry, Institute of Psychology, Psychiatry and Neurosciences, King's College London, London, United Kingdom
| | - Norma Verdolini
- Bipolar and Depressive Disorders Unit, Hospìtal Clinic de Barcelona, Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Institute of Neurosciences (UBNeuro), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Barcelona, Catalonia, Spain
| | - Jeferson Ferraz Goularte
- Laboratory of Molecular Psychiatry, Centro de Pesquisa Experimental (CPE) and Centro de Pesquisa Clínica (CPC), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil; Instituto Nacional de Ciência e Tecnologia Translacional em Medicina (INCT-TM), Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul, School of Medicine, Graduate Program in Psychiatry and Behavioral Sciences, Department of Psychiatry, Porto Alegre, RS, Brazil
| | - Silvia Dubou Serafim
- Laboratory of Molecular Psychiatry, Centro de Pesquisa Experimental (CPE) and Centro de Pesquisa Clínica (CPC), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil; Instituto Nacional de Ciência e Tecnologia Translacional em Medicina (INCT-TM), Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul, School of Medicine, Graduate Program in Psychiatry and Behavioral Sciences, Department of Psychiatry, Porto Alegre, RS, Brazil
| | - Marco Antonio Knob Caldieraro
- Laboratory of Molecular Psychiatry, Centro de Pesquisa Experimental (CPE) and Centro de Pesquisa Clínica (CPC), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil; Instituto Nacional de Ciência e Tecnologia Translacional em Medicina (INCT-TM), Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul, School of Medicine, Graduate Program in Psychiatry and Behavioral Sciences, Department of Psychiatry, Porto Alegre, RS, Brazil
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Hospìtal Clinic de Barcelona, Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Institute of Neurosciences (UBNeuro), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Barcelona, Catalonia, Spain
| | - J Antoni Ramos-Quiroga
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain; Department of Psychiatry and Forensic Medicine, Universitat Autonoma de Barcelona, Barcelona, Catalonia, Spain; Psychiatric Genetics Unit, Group of Psychiatry, Mental Health and Addictions, Vall d'Hebron Research Institute (VHIR), Universitat Autonoma de Barcelona, CIBERSAM, Instituto de Salud Carlos III, Barcelona, Catalonia, Spain
| | - Silvia Amoretti
- Bipolar and Depressive Disorders Unit, Hospìtal Clinic de Barcelona, Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Institute of Neurosciences (UBNeuro), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Barcelona, Catalonia, Spain; Psychiatric Genetics Unit, Group of Psychiatry, Mental Health and Addictions, Vall d'Hebron Research Institute (VHIR), Universitat Autonoma de Barcelona, CIBERSAM, Instituto de Salud Carlos III, Barcelona, Catalonia, Spain.
| | - Adriane R Rosa
- Laboratory of Molecular Psychiatry, Centro de Pesquisa Experimental (CPE) and Centro de Pesquisa Clínica (CPC), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil; Instituto Nacional de Ciência e Tecnologia Translacional em Medicina (INCT-TM), Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul, School of Medicine, Graduate Program in Psychiatry and Behavioral Sciences, Department of Psychiatry, Porto Alegre, RS, Brazil; Department of Pharmacology, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.
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15
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Targeting Neuroinflammation with Abscisic Acid Reduces Pain Sensitivity in Females and Hyperactivity in Males of an ADHD Mice Model. Cells 2023; 12:cells12030465. [PMID: 36766806 PMCID: PMC9914171 DOI: 10.3390/cells12030465] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 01/28/2023] [Accepted: 01/29/2023] [Indexed: 02/04/2023] Open
Abstract
Attention deficit/hyperactivity disorder (ADHD) is a neurodevelopmental syndrome characterized by dopaminergic dysfunction. In this study, we aimed to demonstrate that there is a link between dopaminergic deficit and neuroinflammation that underlies ADHD symptoms. We used a validated ADHD mice model involving perinatal 6-OHDA lesions. The animals received abscisic acid (ABA), an anti-inflammatory phytohormone, at a concentration of 20 mg/L (drinking water) for one month. We tested a battery of behavior tests, learning and memory, anxiety, social interactions, and pain thresholds in female and male mice (control and lesioned, with or without ABA treatment). Postmortem, we analyzed microglia morphology and Ape1 expression in specific brain areas related to the descending pain inhibitory pathway. In females, the dopaminergic deficit increased pain sensitivity but not hyperactivity. In contrast, males displayed hyperactivity but showed no increased pain sensitivity. In females, pain sensitivity was associated with inflammatory microglia and lower Ape1 levels in the anterior cingulate cortex (ACC) and posterior insula cortex (IC). In addition, ABA treatment alleviated pain sensitivity concomitant with reduced inflammation and normalized APE1. In males, ABA reduced hyperactivity but had no significant effect on inflammation in these areas. This is the first study proving a sex-dependent association between dopamine dysfunction and inflammation in specific brain areas, hence leading to different behavioral outcomes in a mouse model of ADHD. These findings provide new clues for potential treatments for ADHD.
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16
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Hargitai LD, Livingston LA, Waldren LH, Robinson R, Jarrold C, Shah P. Attention-deficit hyperactivity disorder traits are a more important predictor of internalising problems than autistic traits. Sci Rep 2023; 13:31. [PMID: 36646771 PMCID: PMC9842645 DOI: 10.1038/s41598-022-26350-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 12/13/2022] [Indexed: 01/18/2023] Open
Abstract
Autism Spectrum Disorder (ASD) and Attention-Deficit Hyperactivity Disorder (ADHD) are both linked to internalising problems like anxiety and depression. ASD and ADHD also often co-occur, making their individual statistical contributions to internalising disorders difficult to investigate. To address this issue, we explored the unique associations of self-reported ASD traits and ADHD traits with internalising problems using a large general population sample of adults from the United Kingdom (N = 504, 49% male). Classical regression analyses indicated that both ASD traits and ADHD traits were uniquely associated with internalising problems. Dominance and Bayesian analyses confirmed that ADHD traits were a stronger, more important predictor of internalising problems. However, brief depression and anxiety measures may not provide a comprehensive index of internalising problems. Additionally, we focused on recruiting a sample that was representative of the UK population according to age and sex, but not ethnicity, a variable that may be linked to internalising disorders. Nevertheless, our findings indicate that while ASD and ADHD uniquely predict internalising problems, ADHD traits are a more important statistical predictor than ASD traits. We discuss potential mechanisms underlying this pattern of results and the implications for research and clinical practice concerning neurodevelopmental conditions.
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Affiliation(s)
- Luca D. Hargitai
- grid.7340.00000 0001 2162 1699Department of Psychology, University of Bath, Bath, BA2 7AY UK
| | - Lucy A. Livingston
- grid.5600.30000 0001 0807 5670Neuroscience and Mental Health Research Institute, Cardiff University, Cardiff, UK ,grid.13097.3c0000 0001 2322 6764Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Lucy H. Waldren
- grid.7340.00000 0001 2162 1699Department of Psychology, University of Bath, Bath, BA2 7AY UK
| | - Ross Robinson
- grid.7340.00000 0001 2162 1699Department of Psychology, University of Bath, Bath, BA2 7AY UK
| | - Christopher Jarrold
- grid.5337.20000 0004 1936 7603School of Psychological Science, University of Bristol, Bristol, BS8 1TU UK
| | - Punit Shah
- grid.7340.00000 0001 2162 1699Department of Psychology, University of Bath, Bath, BA2 7AY UK
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17
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Bethune SC, Rogers MA, Smith D, Whitley J, Hone M, McBrearty N. The Impact of Internalizing Symptoms on Impairment for Children With ADHD: A Strength-Based Perspective. J Atten Disord 2023; 27:26-37. [PMID: 35924282 PMCID: PMC9716483 DOI: 10.1177/10870547221115874] [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] [Indexed: 11/17/2022]
Abstract
BACKGROUND/PURPOSE This study aims to investigate the influence of internalizing symptoms on functional impairment for children with ADHD, and whether child strengths and parenting strengths have moderating effects on this relationship. METHODS Participants included 209 children with ADHD and their caregivers seeking mental health services between the ages of 5 and 11 years. To examine the moderating effects of parenting and child strengths, ordinary least squares regression models were tested using the PROCESS macro for SPSS (v3.5). RESULTS Results suggest that levels of internalizing symptoms influence functional impairment in children with ADHD. Child strengths moderate the relationship between internalizing symptoms and functional impairment when internalizing symptoms are medium to high. CONCLUSION Findings from this study demonstrate that facilitating child strengths can help moderate functional impairment for children who experience ADHD and internalizing symptoms.
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Affiliation(s)
| | - Maria A. Rogers
- Carleton University, Ottawa, ON, Canada,Maria A. Rogers, Department of Psychology, Carleton University, Ottawa, ON K1S 5B6, Canada.
| | | | | | - Michael Hone
- Crossroads Children’s Mental Health Centre, Ottawa, ON, Canada
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18
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Greenberg A, De Los Reyes A. When Adolescents Experience Co-Occurring Social Anxiety and ADHD Symptoms: Links With Social Skills When Interacting With Unfamiliar Peer Confederates. Behav Ther 2022; 53:1109-1121. [PMID: 36229110 DOI: 10.1016/j.beth.2022.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 04/21/2022] [Accepted: 04/23/2022] [Indexed: 11/19/2022]
Abstract
Adolescents with elevated social anxiety commonly experience peer-related impairments - particularly with same-age, unfamiliar peers - stemming from their avoidant behaviors. Yet, peer-related impairments are not unique to social anxiety. For example, adolescents who experience social anxiety may also experience symptoms of attention deficit/hyperactivity disorder (ADHD), which also increase risk for peer-related impairments. Relative to social anxiety, peer-related impairments linked to ADHD symptoms more likely stem from hyperactivity (i.e., approach behaviors). These distinct pathways point to adolescents with elevated social anxiety and ADHD symptoms (i.e., social anxiety + ADHD) experiencing particularly high peer-related impairments, which commonly manifest as behavioral displays of low social skills when interacting with unfamiliar peers. We tested this notion in a mixed-clinical/community sample of 134 14- to 15-year-old adolescents and their parents. Adolescents participated in a series of social interaction tasks designed to simulate how adolescents interact with same-age, unfamiliar peers. Trained observers independently rated adolescents on observed social skills within these interactions. Both parents and adolescents completed parallel surveys of social anxiety and ADHD symptoms, which we used to identify social anxiety + ADHD adolescents as well as other combinations of social anxiety and ADHD symptoms (i.e., neither, elevated on one but not the other). Adolescents with social anxiety + ADHD displayed significantly lower social skills, relative to all other groups. Among adolescents, social anxiety + ADHD may have a compounding effect on social skills. As such, therapists working with social anxiety + ADHD adolescents should probe for peer-related impairments and factors implicated in the development and maintenance of these impairments.
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Behavioral and brain functional characteristics of children with Attention-Deficit/Hyperactivity disorder and anxiety trait. Brain Imaging Behav 2022; 16:2657-2665. [PMID: 36076128 DOI: 10.1007/s11682-022-00722-w] [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: 01/20/2022] [Revised: 08/25/2022] [Accepted: 08/26/2022] [Indexed: 11/02/2022]
Abstract
The current study aimed to explore the behavioral, daily-life executive functional, and brain functional connectivity patterns in children with attention-deficit/hyperactivity disorder (ADHD) and anxiety. A total of 246 children with non-comorbid ADHD and 91 healthy controls (HCs) participated in the current study, among whom 175 subjects went through resting-state functional magnetic resonance imaging (fMRI) scans. The ADHD participants were divided into two subgroups: ADHD with a high level of anxiety (ADHD + ANX) and ADHD with a low level of anxiety (ADHD-ANX). The Child Behavior Checklist (CBCL) and the Behavior Rating Inventory of Executive Function (BRIEF) were used to capture the behavioral and daily-life executive functional characteristics. Independent component analysis with dual regression models was applied to the fMRI data. All statistical models were estimated with age and sex as covariates. Compared with the ADHD-ANX group, the ADHD + ANX group showed more withdrawn, somatic, social, thought, attention, delinquent, and aggressive problems (all corrected p < 0.05). The ADHD + ANX group also displayed more impaired emotional control and working memory than the ADHD-ANX (all corrected p < 0.05). The ADHD-ANX group, but not the ADHD + ANX group, showed elevated functional connectivity within the default mode network compared with the HC group. The mean function connectivity within the default mode network significantly mediated the correlation between anxiety level and attention problems. In sum, anxiety in children with ADHD was associated with more social, emotional, and behavioral problems, more impaired daily-life executive function, and altered brain function. Our work provides important information on the heterogeneity of ADHD.
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20
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Morgan JE, Dvorsky MR, Meza JI, Schumacher LT, Pfiffner LJ. Co-Occurring Psychopathology Moderates Social Skills Improvement in a Randomized Controlled Trial of a Collaborative School-Home Intervention for Children with ADHD. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2022; 51:543-555. [PMID: 32930610 PMCID: PMC7956906 DOI: 10.1080/15374416.2020.1815206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Children with ADHD often exhibit marked impairment in their social skills, but evidence-based psychosocial interventions for ADHD have shown limited efficacy in remediating these deficits. Co-occurring psychopathology exacerbates social deficits in children with ADHD and is a plausible moderator of treatment response. To identify factors contributing to variable social skills treatment response, we examined co-occurring externalizing, depression, and anxiety symptoms as moderators of social skills outcomes in a randomized controlled trial of the Collaborative Life Skills (CLS) program, an evidence-based collaborative school-home ADHD intervention. METHOD Participants were 159 children with ADHD (M age = 8.35 years, 28.3% female) at 27 schools in an urban public school district. Twenty-three schools were randomly assigned to CLS or usual services, with an additional four schools assigned to Spanish-adapted CLS or usual services. Multi-informant measures of co-occurring psychopathology and social skills were collected at baseline and post-treatment. RESULTS Parent-rated externalizing and depression symptoms moderated treatment effects on social skills, whereby higher symptomatology in each domain was unrelated to social skills improvement in the CLS group but predicted worsening social skills in response to usual services. In contrast, teacher-rated anxiety moderated treatment effects on social skills, whereby higher anxiety predicted greater social skills improvement in response to CLS but was unrelated to social skills outcomes following usual services. CONCLUSIONS Findings reflect novel evidence that child psychopathology domains exhibit unique moderating effects on social skills treatment response in children with ADHD. We discuss implications for optimizing evidence-based interventions to target social impairment in this population.
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Affiliation(s)
- Julia E. Morgan
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA
| | - Melissa R. Dvorsky
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA
| | - Jocelyn I. Meza
- Department of Psychiatry, University of California, Los Angeles, Los Angeles, CA
| | - Lauren T Schumacher
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA
| | - Linda J. Pfiffner
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA
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21
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Mammarella IC, Cardillo R, Semrud-Clikeman M. Do comorbid symptoms discriminate between autism spectrum disorder, ADHD and nonverbal learning disability? RESEARCH IN DEVELOPMENTAL DISABILITIES 2022; 126:104242. [PMID: 35526491 DOI: 10.1016/j.ridd.2022.104242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 03/27/2022] [Accepted: 04/19/2022] [Indexed: 06/14/2023]
Abstract
Characterizing the functioning of individuals with neurodevelopmental disorders is crucial to their diagnosis. Research has found that children with different neurodevelopmental disorders, including autism spectrum disorders (ASD), attention deficit and hyperactivity disorder (ADHD), and nonverbal learning disability (NLD), may have comorbid symptoms of anxiety and depression, and problems with pragmatic language. The main aim of the present study was to identify any differences in the above-mentioned comorbid symptoms associated with these clinical profiles. A second aim was to establish how well signs of pragmatic language difficulties could discriminate between the three clinical profiles, in terms of their diagnostic power. For this purpose, 107 participants from 8 to 16 years old with a diagnosis of ASD, ADHD or NLD were compared with a group of typically-developing children. Self-reports on symptoms of anxiety and depression, and parents' reports on social and communication problems were analyzed. Our findings confirmed that symptoms of anxiety and depression, and problems with pragmatic language are associated with different neurodevelopmental disorders, but not in the same way. In terms of diagnostic power, we found that pragmatic language difficulties clearly discriminated children with ASD, ADHD or NLD from typically-developing children. Importantly, pragmatic language difficulties also discriminated adequately between ASD and NLD. Our findings are discussed in terms of the value of considering comorbid symptoms to obtain a more accurate diagnosis of neurodevelopmental disorders.
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Affiliation(s)
- Irene C Mammarella
- Department of Developmental and Social Psychology, University of Padova, Italy.
| | - Ramona Cardillo
- Department of Developmental and Social Psychology, University of Padova, Italy
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22
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Does Anxiety Symptomatology Affect Bullying Behavior in Children and Adolescents with ADHD? CHILD & YOUTH CARE FORUM 2022. [DOI: 10.1007/s10566-022-09681-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Abstract
Background
Anxiety disorders are common comorbidities in children and adolescents with attention-deficit/hyperactivity disorder (ADHD) who are also at a high risk of bullying behavior. However, little is known about the roles of anxiety symptomatology in the relationship between ADHD and bullying behavior.
Objective
This cross-sectional, clinic-based study aims to investigate the associations between anxiety symptomatology and bullying involvement in youth with ADHD.
Method
One hundred and eighty children and adolescents with ADHD aged 10–18 years participated in the study. The Screen for Child Anxiety-Related Emotional Disorders (SCARED) was self-rated, and the participants were interviewed with the Revised Olweus Bully/Victim Questionnaire to categorize bullying involvement. Data were analyzed through percentage, nonparametric statistics, chi-squared statistics, and logistic regression analysis.
Results
Sixty-nine percent of youth with ADHD reported involvement in bullying, of which 33.3%, 8.9%, and 27.2% were classified as victims, bullies, and bully-victims, respectively. The means and 95% confidence intervals of the total SCARED scores showed a significant difference among bullying behavior groups. The highest SCARED scores could be noticed in the victim and bully-victim groups, with the lowest scores observed in the bully group. Youth with ADHD who had comorbid anxiety were 3.51 times more likely to be bullied than those who did not have anxiety.
Conclusions
A differential effect of anxiety symptomatology on bullying behavior in youth with ADHD was evident. These results highlight the utility of including anxiety in the conceptualization of bullying problems in youth with ADHD to plan successful anti-bullying interventions.
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23
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Arildskov TW, Sonuga-Barke EJS, Thomsen PH, Virring A, Østergaard SD. How much impairment is required for ADHD? No evidence of a discrete threshold. J Child Psychol Psychiatry 2022; 63:229-237. [PMID: 34041741 DOI: 10.1111/jcpp.13440] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/05/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND A diagnosis of attention-deficit/hyperactivity disorder (ADHD) requires the presence of impairment alongside symptoms above a specific frequency and severity threshold. However, the question of whether that symptom threshold represents anything more than an arbitrary cutoff on a continuum of impairment requires further empirical study. Therefore, we present the first study investigating if the relationship between ADHD symptom severity and functional impairment is nonlinear in a way that suggests a discrete, nonarbitrary symptom level threshold associated with a marked step increase in impairment. METHODS Parent reports on the ADHD-Rating Scale (ADHD-RS-IV), the Weiss Functional Impairment Rating Scale (WFIRS-P), and the Strengths and Difficulties Questionnaire were collected in a general population sample of 1st, 2nd, and 3rd graders (N = 1,914-2,044). RESULTS Piecewise linear regression analyses and nonlinear regression modeling both demonstrated that the relationship between symptom severity (ADHD-RS-IV total score) and impairment (WFIRS-P mean score) was characterized by a gradual linear increase in impairment with higher symptom severity and no apparent step increase or changing rate of increase in impairment at a certain high ADHD-RS-IV total score level. Controlling for socioeconomic status, sex, and co-occurring conduct and emotional symptoms did not alter these results, though comorbid symptoms had a significant effect on impairment. CONCLUSIONS There was no clear evidence for a discrete, nonarbitrary symptom severity threshold with regard to impairment. The results highlight the continued need to consider both symptoms and impairment in the diagnosis of ADHD.
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Affiliation(s)
- Trine Wigh Arildskov
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Aarhus N, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Edmund J S Sonuga-Barke
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Per Hove Thomsen
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Aarhus N, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Anne Virring
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Aarhus N, Denmark
| | - Søren D Østergaard
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Affective Disorders, Aarhus University Hospital, Psychiatry, Aarhus N, Denmark
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24
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Anderman EM, Gilman R, Liu X, Ha SY. The relations of inattention and hyperactivity to academic cheating in adolescents with executive functioning problems. PSYCHOLOGY IN THE SCHOOLS 2022. [DOI: 10.1002/pits.22644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Eric M. Anderman
- Department of Educational Studies, College of Education and Human Ecology The Ohio State University Columbus Ohio USA
| | | | - Xingfeiyue Liu
- Department of Educational Studies, College of Education and Human Ecology The Ohio State University Columbus Ohio USA
| | - Seung Yon Ha
- Department of Educational Studies, College of Education and Human Ecology The Ohio State University Columbus Ohio USA
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25
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Bjelland I, Posserud MB, Wergeland GJ. Dialogue Based Early Detection-Development of a Novel Approach for Detection of Mental Health Problems Among Children in Daycare Centers. Front Psychiatry 2022; 13:696531. [PMID: 35250653 PMCID: PMC8896884 DOI: 10.3389/fpsyt.2022.696531] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 01/24/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Among 1-7 years old children the worldwide prevalence of mental disorders is ~20%. Without treatment, the prognosis of such disorders in children is poor. Early intervention is estimated to result in a positive return. However, traditional screening to detect children at need is particularly challenging due to the concerns by false positives. The aim of the current study was to develop a more acceptable though effective method using the existing annual evaluation meetings between parents and teachers in a more systematic and goal directed way. The method should build on the teacher's and parents' complementary knowledge and perception of the child, and fit into the everyday routines in daycare centers. METHOD During a period of 6 years, a developmental process aiming for a novel screening method was carried out in cooperation with eight Norwegian daycare centers. After conception of the idea, the framework of the Dialogue Based Early Detection including the first version of the Early Worry Questionnaire (EWQ) was constructed. An iterative process involving parents and teachers completing workshops and subsequent testing facilitated a re-modeling of the method. RESULTS In the resulting Dialogue Based Early Detection a 36-item version of EWQ was completed by both parents and teachers ahead of the annual parent-teacher meeting. During that meeting the participants should try to reach a consensus whether there was a concern, some uncertainty, or no worry for the child, and which appropriate actions should be taken for a possible follow up. Both parents and teachers reported that the EWQ supported them in verbalizing already existing worries for the child. Teachers reported that parents were better prepared and participated more actively in the evaluation meetings. However, some parents complained that there was too much focus on possible worries. During the testing, challenges of language development, conduct, emotional reactions, toileting, attention, and eating were detected among the children. CONCLUSION The Dialogue Based Early Detection method was endorsed by both teachers and parents and holds promise as a tool for improving early awareness and identification of developmental and mental health problems of preschool children in daycare centers.
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Affiliation(s)
- Ingvar Bjelland
- Division of Psychiatry, Department of Child and Adolescent Mental Health Services, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Maj-Britt Posserud
- Division of Psychiatry, Department of Child and Adolescent Mental Health Services, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Gro Janne Wergeland
- Division of Psychiatry, Department of Child and Adolescent Mental Health Services, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
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26
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Lavigne-Cervan R, Costa-López B, Juárez-Ruiz de Mier R, Sánchez-Muñoz de León M, Real-Fernández M, Navarro-Soria I. Implications of the Online Teaching Model Derived from the COVID-19 Lockdown Situation for Anxiety and Executive Functioning in Spanish Children and Adolescents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910456. [PMID: 34639755 PMCID: PMC8508010 DOI: 10.3390/ijerph181910456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/01/2021] [Accepted: 10/03/2021] [Indexed: 11/24/2022]
Abstract
Given the seriousness of the existing situation regarding the mental health of children and adolescents relating to the confinement period imposed due to COVID-19, we conducted this study to describe the effects of the confinement on state anxiety and executive functioning dimensions in a period of online educational modality. A sample of 953 children and adolescents was assessed. A sociodemographic questionnaire, the State Anxiety Inventory for Children (STAIC), and the Behavioral Evaluation of Executive Function (BRIEF-2) scale were applied. The analysis of the results indicates that 68.8% of children and adolescents presented medium–high levels of anxiety. Regarding sex, females showed higher levels of anxiety and worse levels of executive functioning. Although the group aged 11 to 18 years showed methodologically higher state anxiety (p = 0.041) than the group aged 6 to 10 years, the difference was not clinically relevant (δ = −0.113). The state anxiety variable was also correlated positively and significantly to the three executive functioning dimensions explored. In conclusion, it seems evident that COVID-19 lockdowns could have psychological and emotional effects on children and adolescents.
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Affiliation(s)
- Rocío Lavigne-Cervan
- Department of Developmental and Educational Psychology, University of Malaga, 29071 Malaga, Spain; (R.L.-C.); (R.J.-R.d.M.)
| | - Borja Costa-López
- Department of Health Psychology, University of Alacant, Ctra. Sant Vicent del Raspeig, s/n, 03690 San Vicente, Spain;
| | - Rocío Juárez-Ruiz de Mier
- Department of Developmental and Educational Psychology, University of Malaga, 29071 Malaga, Spain; (R.L.-C.); (R.J.-R.d.M.)
| | | | - Marta Real-Fernández
- Department of Developmental and Educational Psychology, University of Alacant, Ctra. Sant Vicent del Raspeig, s/n, 03690 San Vicente, Spain;
| | - Ignasi Navarro-Soria
- Department of Developmental and Educational Psychology, University of Alacant, Ctra. Sant Vicent del Raspeig, s/n, 03690 San Vicente, Spain;
- Correspondence:
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27
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Speyer LG, Eisner M, Ribeaud D, Luciano M, Auyeung B, Murray AL. Developmental Relations Between Internalising Problems and ADHD in Childhood: a Symptom Level Perspective. Res Child Adolesc Psychopathol 2021; 49:1567-1579. [PMID: 34363556 PMCID: PMC8557182 DOI: 10.1007/s10802-021-00856-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2021] [Indexed: 12/14/2022]
Abstract
ADHD and internalising problems commonly co-occur with up to 50% of children diagnosed with ADHD also suffering from anxiety or depression. However, their developmental relations are currently not well understood. Longitudinal symptom level analyses can provide valuable insights into how difficulties in these areas of psychosocial functioning affect each other. Using Gaussian Graphical Models and Graphical Vector Autoregression Models, this study estimated cross-sectional and longitudinal networks of ADHD and internalising symptoms in 1387 children using parent- and teacher-reported Social Behaviour Questionnaires (SBQ) when children were aged 7, 9 and 11. Cross-sectional and longitudinal networks suggested that ADHD shares reciprocal relations with internalising symptoms through a number of potential bridge symptoms that are primarily connected to anxiety symptoms. High scores on child cannot sit still, is restless, or hyperactive were found to be the strongest bridge symptom acting as an antecedent to higher internalising symptoms whereas child is worried was the strongest antecedent for higher ADHD symptoms. Findings of this study highlight several potential bridge symptoms that may serve as key intervention targets and further emphasise the need for clinicians to assess children presenting with ADHD symptoms for internalising problems and vice versa.
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Affiliation(s)
| | - Manuel Eisner
- Violence Research Centre, Institute of Criminology, University of Cambridge, Cambridge, UK.,Jacobs Center for Productive Youth Development, University of Zurich, Zurich, Switzerland
| | - Denis Ribeaud
- Jacobs Center for Productive Youth Development, University of Zurich, Zurich, Switzerland
| | - Michelle Luciano
- Department of Psychology, Univsersity of Edinburgh, Edinburgh, UK
| | - Bonnie Auyeung
- Department of Psychology, Univsersity of Edinburgh, Edinburgh, UK.,Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Aja Louise Murray
- Department of Psychology, Univsersity of Edinburgh, Edinburgh, UK.,Violence Research Centre, Institute of Criminology, University of Cambridge, Cambridge, UK
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28
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Morris S, Ling M, Sheen J, Sciberras E. Variation in latent social profiles of adolescent ADHD and related clinical features. Psychiatry Res 2021; 302:114014. [PMID: 34102374 DOI: 10.1016/j.psychres.2021.114014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 05/13/2021] [Indexed: 12/15/2022]
Abstract
Social impairment is a hallmark of Attention-deficit/hyperactivity disorder (ADHD), but the extent of variation in adolescent social strengths and weaknesses is unclear. We compared teacher-reported characteristics of social functioning in adolescents with a history of ADHD (N = 340), and without ADHD (N = 182) from the NIMH Collaborative Multisite Multimodal Treatment Study of Children with ADHD (MTA) at 72-month follow-up (13 - 15.9 years-old). Latent profile analysis of teacher-reported cooperation, assertion and self-control on the Social Skills Rating System (SSRS), was used to identify "social profiles". Their associations with clinical features were explored. Significant differences in social functioning were identified between adolescents with a history of ADHD, and without ADHD (ES = 0.54 - 0.77). Four distinct social profiles were identified in adolescents with a history of ADHD: unskilled (N = 24, 7%), low average (N = 144, 42%), average (N = 141, 41%), and skilled (N = 31, 9%). Profiles with worse social functioning (low average, unskilled) displayed more symptoms of inattention, hyperactivity/impulsivity, oppositionality, depression, global impairment, and were less liked, more rejected and ignored by peers than average and skilled. Social profile membership was not associated with sex, anxiety symptoms, or remittance / persistence of ADHD. Social functioning in adolescents with a history of ADHD is variable, and associated with worse symptomology, global functioning, and peer relationships, irrespective of persistence or remittance of ADHD. Group level summaries of social difficulties in ADHD may be inadequate given nearly half of adolescents with a history of ADHD presented with average or skilled social profiles.
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Affiliation(s)
- Sarah Morris
- School of Psychology, Deakin University, Geelong, VIC, Australia
| | - Mathew Ling
- School of Psychology, Deakin University, Geelong, VIC, Australia
| | - Jade Sheen
- School of Psychology, Deakin University, Geelong, VIC, Australia
| | - Emma Sciberras
- School of Psychology, Deakin University, Geelong, VIC, Australia; Murdoch Childrens Research Institute, Parkville, VIC, Australia; Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia.
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29
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Shi X, Ji Y, Cai S, Wu Y, Zhang L, Shen L, Jiang Z, Chen Y. Comorbidities and functional impairments in children with attention deficit hyperactivity disorder in China: a hospital-based retrospective cross-sectional study. BMJ Open 2021; 11:e042196. [PMID: 33753435 PMCID: PMC7986753 DOI: 10.1136/bmjopen-2020-042196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES The aim of this study was to assess comorbidity patterns and functional impairment in children with and without attention deficit hyperactivity disorder (ADHD). DESIGN Hospital-based retrospective cross-sectional study; data collection occurred between 2016 and 2019. SETTINGS AND PATIENTS A total of 8256 children and adolescents, 6-17 years of age, with suspected ADHD agreed to participate in this hospital-based cross-sectional study over a 4-year period in China. Comorbidities and social functions were assessed according to the scales Vanderbilt ADHD Diagnostic Parent Rating Scale and Weiss Functional Impairment Rating Scale-Parent Form, which were completed by the parents of the study participants. RESULTS Of the 8256 children, 5640 were diagnosed with ADHD. Other 2616 children who did not meet the ADHD diagnostic criteria were classified as the N-ADHD group . The proportion of comorbidities (47.4%) and functional impairments (84.5%) in the ADHD group were higher than the N-ADHD group (p≤0.001). The functional impairment scores in all of the six domains, including family, academic, life skills, self-concept, social activities and risky activities, were significantly higher in the ADHD group than the N-ADHD group (p≤0.001). The functional impairment in ADHD group with comorbidities was more severe than those without comorbidities (p≤0.001). Comorbidities and core symptoms both can affect the functions of children with ADHD. Logistics regression analysis indicated that in all of the six functional domains, the effect of comorbidities on functional impairment exceeded the effects of ADHD core symptoms. CONCLUSIONS Comorbidities had the greatest influence on different areas of adaptive functioning in children with ADHD. Clinical management of children suspected to have ADHD should address multiple comorbidities and functional impairments assessment, as well as core symptom analysis.
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Affiliation(s)
- Xiaoyan Shi
- Department of Child and Adolescent Healthcare, Children's Hospital of Soochow University, Suzhou, China
| | - Yiting Ji
- Department of Child and Adolescent Healthcare, Children's Hospital of Soochow University, Suzhou, China
| | - Shizhong Cai
- Department of Child and Adolescent Healthcare, Children's Hospital of Soochow University, Suzhou, China
| | - Ying Wu
- Department of Child and Adolescent Healthcare, Children's Hospital of Soochow University, Suzhou, China
| | - Lijun Zhang
- Department of Child and Adolescent Healthcare, Children's Hospital of Soochow University, Suzhou, China
| | - Ling Shen
- Department of Child and Adolescent Healthcare, Children's Hospital of Soochow University, Suzhou, China
| | - Zhiying Jiang
- Department of Child and Adolescent Healthcare, Children's Hospital of Soochow University, Suzhou, China
| | - Yan Chen
- Department of Child and Adolescent Healthcare, Children's Hospital of Soochow University, Suzhou, China
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30
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Janiczak D, Perez-Reisler M, Ballard R. Diagnosis and Management of Comorbid Anxiety and ADHD in Pediatric Primary Care. Pediatr Ann 2020; 49:e436-e439. [PMID: 33034659 DOI: 10.3928/19382359-20200922-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) and anxiety disorders, which are the most common pediatric mental health problems, frequently co-occur. The overlap of symptoms and the varied presentations of both disorders can make diagnosis and treatment planning challenging. Picking an initial treatment target with reassessment of the diagnoses based on response may help clinicians successfully treat children with comorbid ADHD/anxiety. Treating ADHD with stimulants can lead to improvement in ADHD-related anxiety symptoms. Treating anxiety can reduce anxiety-related attentional problems and executive functioning. Atomoxetine and alpha agonists treat ADHD and may have some benefit for anxiety symptoms. Behavioral treatment should be part of the plan for ADHD co-occurring with anxiety disorders. [Pediatr Ann. 2020;49(10):e436-e439.].
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31
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Comorbid anxiety and irritability symptoms and their association with cognitive functioning in children with ADHD. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2020; 48:1035-1046. [PMID: 32462307 DOI: 10.1007/s10802-020-00658-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Anxiety and irritability symptoms frequently co-occur in children with Attention-Deficit/Hyperactivity Disorder (ADHD). This study aims to investigate whether irritability and anxiety are uniquely associated with performance on measures of cognitive functioning in children with ADHD and whether these associations hold when accounting for confounding variables. Baseline data was used from a randomised controlled trial of cognitive behavioural therapy for anxiety in children with ADHD (N = 219, 8-13 years). Anxiety was assessed using the child- and parent-reported Spence Children's Anxiety Scale, while irritability was assessed using the parent-reported Affective Reactivity Index. Children completed the National Institutes of Health Toolbox - Cognition Battery. Higher symptoms of anxiety were uniquely associated with performance on the Dimensional Card Change Sort Test (β = -2.75, confidence interval (CI) [-4.97, -.52], p = .02) and the List Sort Working Memory Test (β = -2.57, CI [-4.43, -.70], p = .01), while higher symptoms of irritability were negatively associated with Picture Vocabulary Test (β = -2.00, CI [-3.83, -.16], p = .03). These associations did not survive correction for multiple comparisons. There was little evidence of an association between anxiety or irritability symptoms and cognitive functioning. Frequent co-occurrence of anxiety and irritability suggests clinicians working with children with ADHD should assess co-morbid symptom profiles to inform the provision of optimum care.
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32
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Sciberras E, Efron D, Patel P, Mulraney M, Lee KJ, Mihalopoulos C, Engel L, Rapee RM, Anderson V, Nicholson JM, Schembri R, Hiscock H. Does the treatment of anxiety in children with Attention-Deficit/Hyperactivity Disorder (ADHD) using cognitive behavioral therapy improve child and family outcomes? Protocol for a randomized controlled trial. BMC Psychiatry 2019; 19:359. [PMID: 31722690 PMCID: PMC6854614 DOI: 10.1186/s12888-019-2276-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 09/09/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Up to 60% of children with Attention-Deficit/Hyperactivity Disorder (ADHD) meet diagnostic criteria for at least one anxiety disorder, including Social, Generalized and/or Separation Disorder. Anxiety in children with ADHD has been shown to be associated with poorer child and family functioning. Small pilot studies suggest that treating anxiety in children with ADHD using cognitive-behavioral therapy (CBT) has promising benefits. In a fully powered randomized controlled trial (RCT), we aim to investigate the efficacy of an existing CBT intervention adapted for children with ADHD and comorbid anxiety compared with usual care. METHODS This RCT is recruiting children aged 8-12 years (N = 228) from pediatrician practices in Victoria, Australia. Eligibility criteria include meeting full diagnostic criteria for ADHD and at least one anxiety disorder (Generalized, Separation or Social). Eligible children are randomized to receive a 10 session CBT intervention (Cool Kids) versus usual clinical care from their pediatrician. The intervention focuses on building child and parent skills and strategies to manage anxiety and associated impairments including cognitive restructuring and graded exposure. Minor adaptations have been made to the delivery of the intervention to meet the needs of children with ADHD including increased use of visual materials and breaks between activities. The primary outcome is change in the proportion of children meeting diagnostic criteria for an anxiety disorder at 5 months randomization. This will be assessed via diagnostic interview with the child's parent (Anxiety Disorders Interview Schedule for Children V) conducted by a researcher blinded to intervention condition. Secondary outcomes include a range of child (e.g., anxiety symptoms, ADHD severity, behavior, quality of life, sleep, cognitive functioning, school attendance) and parent (e.g., mental health, parenting behaviors, work attendance) domains of functioning assessed at 5 and 12 months post-randomization. Outcomes will be analyzed using logistic and mixed effects regression. DISCUSSION The results from this study will provide evidence on whether treating comorbid anxiety in children with ADHD using a CBT approach leads to improvements in anxiety and/or broader functional outcomes. TRIAL REGISTRATION This trial was prospectively registered: Current Controlled Trials ISRCTN59518816 (https://doi.org/10.1186/ISRCTN59518816). The trial was first registered 29/9/15 and last updated 15/1/19.
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Affiliation(s)
- Emma Sciberras
- School of Psychology, Deakin University, Geelong, Vic, Australia. .,Murdoch Children's Research Institute, Parkville, Vic, Australia. .,University of Melbourne, Parkville, Vic, Australia.
| | - Daryl Efron
- 0000 0000 9442 535Xgrid.1058.cMurdoch Children’s Research Institute, Parkville, Vic Australia ,0000 0001 2179 088Xgrid.1008.9University of Melbourne, Parkville, Vic Australia ,0000 0004 0614 0346grid.416107.5The Royal Children’s Hospital, Parkville, Vic Australia
| | - Pooja Patel
- 0000 0000 9442 535Xgrid.1058.cMurdoch Children’s Research Institute, Parkville, Vic Australia
| | - Melissa Mulraney
- 0000 0000 9442 535Xgrid.1058.cMurdoch Children’s Research Institute, Parkville, Vic Australia ,0000 0001 2179 088Xgrid.1008.9University of Melbourne, Parkville, Vic Australia
| | - Katherine J. Lee
- 0000 0000 9442 535Xgrid.1058.cMurdoch Children’s Research Institute, Parkville, Vic Australia ,0000 0001 2179 088Xgrid.1008.9University of Melbourne, Parkville, Vic Australia
| | - Cathy Mihalopoulos
- 0000 0001 0526 7079grid.1021.2School of Psychology, Deakin University, Geelong, Vic Australia
| | - Lidia Engel
- 0000 0001 0526 7079grid.1021.2School of Psychology, Deakin University, Geelong, Vic Australia
| | - Ronald M. Rapee
- 0000 0001 2158 5405grid.1004.5Centre for Emotional Health, Macquarie University, Sydney, NSW Australia
| | - Vicki Anderson
- 0000 0000 9442 535Xgrid.1058.cMurdoch Children’s Research Institute, Parkville, Vic Australia ,0000 0001 2179 088Xgrid.1008.9University of Melbourne, Parkville, Vic Australia ,0000 0004 0614 0346grid.416107.5The Royal Children’s Hospital, Parkville, Vic Australia
| | - Jan M. Nicholson
- 0000 0001 2342 0938grid.1018.8Judith Lumley Centre, La Trobe University, Bundoora, Vic Australia
| | - Rachel Schembri
- 0000 0000 9442 535Xgrid.1058.cMurdoch Children’s Research Institute, Parkville, Vic Australia
| | - Harriet Hiscock
- 0000 0000 9442 535Xgrid.1058.cMurdoch Children’s Research Institute, Parkville, Vic Australia ,0000 0001 2179 088Xgrid.1008.9University of Melbourne, Parkville, Vic Australia ,0000 0004 0614 0346grid.416107.5The Royal Children’s Hospital, Parkville, Vic Australia
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33
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Social anxiety is associated with poorer peer functioning for girls but not boys with ADHD. Psychiatry Res 2019; 281:112524. [PMID: 31542589 PMCID: PMC6886386 DOI: 10.1016/j.psychres.2019.112524] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 08/16/2019] [Accepted: 08/16/2019] [Indexed: 11/22/2022]
Abstract
There is mixed evidence for whether or not co-occurring anxiety is associated with poorer peer functioning in children with attention-deficit/hyperactivity disorder (ADHD), which may be partly due to studies typically using a global measure of anxiety and failing to consider possible sex differences. The present study examined child-reported social anxiety in relation to peer functioning and whether this association differs by sex in 93 children (66% male; ages 8-12) with ADHD. Children, parents, and teachers completed a measure of social acceptance, and teachers also completed measures of asociality, peer exclusion, peer dislike, and peer ignoring. Regression analyses examined the interaction between social anxiety and sex in relation to the peer functioning variables, with age, race, ADHD subtype, and oppositional defiant disorder symptoms included as covariates. Social anxiety was associated with lower parent-reported social acceptance, with no sex differences in the association. However, significant interaction effects were found for child- and teacher-rated social acceptance, as well as peer exclusion and peer ignoring such that social anxiety was associated with less competence, more exclusion, and greater ignoring for girls but not boys. Findings indicate that social anxiety is associated with poorer peer functioning for girls more so than boys with ADHD.
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