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Toenders YJ, de Moor MHM, van der Cruijsen R, Green K, Achterberg M, Crone EA. Within-person biological mechanisms of mood variability in childhood and adolescence. Hum Brain Mapp 2024; 45:e26766. [PMID: 39046072 DOI: 10.1002/hbm.26766] [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] [Received: 12/11/2023] [Revised: 05/24/2024] [Accepted: 06/10/2024] [Indexed: 07/25/2024] Open
Abstract
Mood variability, the day-to-day fluctuation in mood, differs between individuals and develops during adolescence. Because adolescents show higher mood variability and average mood than children and adults, puberty might be a potential biological mechanism underlying this increase. The goal of this preregistered developmental study was to examine the neural and hormonal underpinnings of adolescent-specific within-person changes in mood variability, with a specific focus on testosterone, cortisol, pubertal status, and resting-state functional brain connectivity. Data from two longitudinal cohorts were used: the L-CID twin study (aged 7-13, N at the first timepoint = 258) and the accelerated Leiden Self-Concept study (SC; aged 11-21, N at the first timepoint = 138). In both studies resting-state functional magnetic resonance imaging (rs-fMRI) data was collected, as well as daily mood. Additionally, in the SC study self-reported puberty testosterone and cortisol were collected. Random intercept cross-lagged panel models (RI-CLPM) were used to study the within-person relations between these biological measures and mood variability and average mood. Mood variability and average mood peaked in adolescence and testosterone levels and self-reported puberty also showed an increase. Connectivity between prefrontal cortex (dlPFC and vmPFC) and subcortical regions (caudate, amygdala) decreased across development. Moreover, higher testosterone predicted average negative mood at the next time point, but not vice versa. Further, stronger vmPFC-amygdala functional connectivity predicted decreases in mood variability. Here, we show that brain connectivity during development is an important within-person biological mechanism of the development of mood in adolescents. PRACTITIONER POINTS: Mood variability peaks in adolescence. Within-person changes in testosterone predict within-person changes in mood. Within-person changes in vmPFC-amygdala connectivity predict within-person changes in mood variability.
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Affiliation(s)
- Yara J Toenders
- Developmental and Educational Psychology, Leiden University, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden University, Leiden, The Netherlands
- Erasmus School of Social and Behavioral Sciences, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Marleen H M de Moor
- Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | | | - Kayla Green
- Erasmus School of Social and Behavioral Sciences, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Michelle Achterberg
- Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Eveline A Crone
- Developmental and Educational Psychology, Leiden University, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden University, Leiden, The Netherlands
- Erasmus School of Social and Behavioral Sciences, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Arnold VK, López FA, Childress AC, Po MD, Uchida CL, Cuthbertson L, Sallee FR, Incledon B. A Post-Hoc Analysis of Emotional Lability With Delayed-Release/Extended-Release Methylphenidate in Children Aged 6 to 12 Years of Age Participating in Two Phase 3 Clinical Trials. J Atten Disord 2024; 28:1186-1197. [PMID: 38600754 PMCID: PMC11107132 DOI: 10.1177/10870547241243155] [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] [Indexed: 04/12/2024]
Abstract
OBJECTIVE DR/ER-MPH (formerly HLD200) is an evening-dosed delayed-release and extended-release methylphenidate approved for the treatment of ADHD in patients ≥6 years. Post hoc analyses of two pivotal Phase 3 trials: HLD200-107 (NCT02493777) and HLD200-108 (NCT02520388) evaluated emotional lability (EL) with DR/ER-MPH treatment. METHODS Differences in Conners Global Index-Parent (CGI-P) EL subscale scores and age- and gender-adjusted T-scores over an open-label titration phase (HLD200-107) and between treatment and placebo groups at endpoint (HLD200-108) were evaluated. RESULTS In HLD200-107 (N = 117) mean CGI-P EL subscale scores improved from 5.3 to 1.3 (p < .0001) after 6 weeks; in HLD200-108 significant improvements were observed in the treatment group (n = 81) versus placebo (n = 80; 3.11 vs. 4.08; p = .0053). T-scores showed an improvement with DR/ER-MPH treatment in both trials. Few emotional adverse events (AEs) were reported. CONCLUSION DR/ER-MPH treatment resulted in statistically significant improvements in EL to the level of non-ADHD peers as contextualized by T-scores.
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Affiliation(s)
| | - Frank A. López
- Pediatrix Neurology and Epilepsy Research Center, Winter Park, FL, USA
| | - Ann C. Childress
- Center for Psychiatry and Behavioral Medicine Inc., Las Vegas, NV, USA
| | | | | | | | | | - Bev Incledon
- Ironshore, Camana Bay, Grand Cayman, Cayman Islands
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3
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Lee MW, Yang NJ, Mok HK, Yang RC, Chiu YH, Lin LC. Music and movement therapy improves quality of life and attention and associated electroencephalogram changes in patients with attention-deficit/hyperactivity disorder. Pediatr Neonatol 2024:S1875-9572(24)00048-2. [PMID: 38641441 DOI: 10.1016/j.pedneo.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 10/06/2023] [Accepted: 11/10/2023] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) is the most common neurobehavioral disorder. Treatments for ADHD include pharmacological and nonpharmacological therapy. However, pharmacological treatments have side effects such as poor appetite, sleep disturbance, and headache. Moreover, nonpharmacological treatments are not effective in ameliorating core symptoms and are time-consuming. Hence, developing an alternative and effective treatment without (or with fewer) side effects is crucial. Music therapy has long been used to treat numerous neurological diseases. Although listening to music is beneficial for mood and cognitive functions in patients with ADHD, research on the effects of music and movement therapy in children with ADHD is lacking. METHODS The present study investigated the effects of an 8-week music and movement intervention in 13 children with ADHD. The Pediatric Quality of Life Inventory (PedsQL) was used to evaluate changes in participants' quality of life. Conners' Kiddie Continuous Performance Test (K-CPT 2) and the Swanson, Nolan, and Pelham rating scale (SNAP-IV) were used to assess core symptoms. Electroencephalogram (EEG) recordings were analyzed to determine neurophysiological changes. RESULTS The results revealed that the participants' quality of life increased significantly after the 8-week intervention. Furthermore, the participants' hit reaction times in the block 1 and block 2 tests of K-CPT 2 decreased significantly after the intervention. EEG analysis demonstrated an increase in alpha power and Higuchi's fractal dimension and a decrease in delta power in certain EEG channels. CONCLUSION Our music and movement intervention is a potential alternative and effective tool for ADHD treatment and it can significantly improve patients' quality of life and attention.
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Affiliation(s)
- Mei-Wen Lee
- Department of Music, National Sun Yat-Sen University, Kaohsiung City, Taiwan
| | - Ni-Jung Yang
- Center for Humanities and Arts Education, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Hin-Kiu Mok
- Department of Oceanography, National Sun Yat-Sen University, Kaohsiung City, Taiwan
| | - Rei-Cheng Yang
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan; Department of Pediatrics, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Yi-Hung Chiu
- Department of Information Engineering, I-Shou University, Kaohsiung City, Taiwan
| | - Lung-Chang Lin
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan; Department of Pediatrics, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan.
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4
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Johns-Mead R, Vijayakumar N, Mulraney M, Melvin G, Anderson VA, Efron D, Silk TJ. The longitudinal relationship between socioemotional difficulties and irritability in ADHD. J Affect Disord 2024; 350:573-581. [PMID: 38244802 DOI: 10.1016/j.jad.2024.01.151] [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: 10/12/2023] [Revised: 01/12/2024] [Accepted: 01/14/2024] [Indexed: 01/22/2024]
Abstract
BACKGROUND Despite higher rates of irritability and socioemotional symptoms in ADHD, consensus is lacking regarding their developmental relationship and whether it differs by ADHD status. This longitudinal study sought to evaluate how peer and emotional difficulties relate to irritability in ADHD and control groups. METHODS A community sample of 336 participants (45 % ADHD) were recruited for the Children's Attention Project. Participants completed the Affective Reactivity Index and the Strengths and Difficulties Questionnaire's emotional and peer difficulties scales at baseline (mean age 10.5 years) and 18-month follow-up. Latent Change Score models assessed how emotional and peer difficulties related to irritability at baseline and longitudinally. RESULTS For both groups, more severe baseline difficulties were associated with higher concurrent irritability, and reductions in emotional and peer difficulties were associated with declining irritability. Baseline emotional difficulties predicted change in irritability for the ADHD group, while baseline peer difficulties predicted change in irritability for both groups. Baseline irritability did not predict change in emotional or peer difficulties for either. The ADHD group showed elevated irritability, emotional, and peer difficulties, and stronger baseline correlation between peer difficulties and irritability. LIMITATIONS Only two timepoints were captured, and associations with ADHD symptom severity and presentation were not investigated. Doing so may facilitate additional insights. CONCLUSIONS Change in irritability corresponded to change in socioemotional difficulties, and was driven by earlier levels of socioemotional difficulties. ADHD exacerbated aspects of the relationship between socioemotional difficulties and irritability. Socioemotional difficulties drive irritability, so may represent targets for clinical interventions.
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Affiliation(s)
- Rania Johns-Mead
- School of Psychology and the Centre for Social and Early Emotional Development (SEED), Deakin University, Geelong, Australia
| | - Nandita Vijayakumar
- School of Psychology and the Centre for Social and Early Emotional Development (SEED), Deakin University, Geelong, Australia; Murdoch Children's Research Institute, Melbourne, Australia
| | | | - Glenn Melvin
- School of Psychology and the Centre for Social and Early Emotional Development (SEED), Deakin University, Geelong, Australia
| | - Vicki A Anderson
- Murdoch Children's Research Institute, Melbourne, Australia; The Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Daryl Efron
- Murdoch Children's Research Institute, Melbourne, Australia; The Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Tim J Silk
- School of Psychology and the Centre for Social and Early Emotional Development (SEED), Deakin University, Geelong, Australia; Murdoch Children's Research Institute, Melbourne, Australia.
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Zhang SH, Yang TX, Wu ZM, Wang YF, Lui SSY, Yang BR, Chan RCK. Identifying subgroups of attention-deficit/hyperactivity disorder from the psychopathological and neuropsychological profiles. J Neuropsychol 2024; 18:173-189. [PMID: 37377171 DOI: 10.1111/jnp.12334] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 06/05/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023]
Abstract
The Research Domain Criteria (RDoC) advocates the dimensional approach in characterizing mental disorders. We followed RDoC to characterize children with ADHD using profiling based on the cognitive and psychopathological domains. We aimed to identify and validate ADHD subtypes with different clinical characteristics and functional impairments. We recruited 362 drug-naïve children with ADHD and 103 typically developing controls. The cluster analysis was used to identify subgroups based on the Child Behaviour Checklist (CBCL) and the Behaviour Rating Inventory of Executive Function (BRIEF). The subgroups' clinical characteristics and functional impairments were assessed using the WEISS Functional Impairment Rating Scale-Parent Report (WFIRS-P) and the Conners Parent Symptom Questionnaire (PSQ). The cluster analysis yielded four subgroups: (1) ADHD with severe impairment in psychopathology and executive functions (EF), (2) ADHD with mild executive dysfunctions and normal-level psychopathology, (3) ADHD with severe externalizing problems and (4) ADHD with severe executive dysfunctions. These subgroups showed different clinical characteristics and degrees of functional impairment. The EF impairment group displayed more serious learning problems and worse life skills than the externalizing group. The two groups with externalizing problems (i.e. the severe impairment group and the externalizing group) both exhibited higher rates of the combined subtype of ADHD and higher rates of comorbid ODD. Different subtypes of ADHD displayed different profiles of internalizing and externalizing problems and levels of executive dysfunctions. In particular, the subtype with severe impairment in EF exhibited more learning problems and worse life skills, suggesting EF is a critical target for intervention in children with ADHD.
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Affiliation(s)
| | - Tian-Xiao Yang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Zhao-Min Wu
- Shenzhen Children's Hospital, Shenzhen, China
| | - Yu-Feng Wang
- Peking University Sixth Hospital/Institute of Mental Health, National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Simon S Y Lui
- Department of Psychiatry, School of Clinical Medicine, The University of Hong Kong, Hong Kong, China
| | | | - Raymond C K Chan
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
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6
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Talty A, Speyer LG, Eisner MP, Ribeaud D, Murray AL, Obsuth I. The role of student-teacher relationships in the association between negative parenting practices and emotion dynamics - Combining longitudinal and ecological momentary assessment data. JOURNAL OF RESEARCH ON ADOLESCENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR RESEARCH ON ADOLESCENCE 2023; 33:1268-1280. [PMID: 37395433 DOI: 10.1111/jora.12874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 05/03/2023] [Accepted: 06/15/2023] [Indexed: 07/04/2023]
Abstract
Emotion dysregulation is increasingly implicated as a transdiagnostic risk factor in the etiology of mental health problems. This project aimed to explore the links between emotion regulation, negative parenting and student-teacher relationships using longitudinal and ecologically valid data. A sample of n = 209 young people enrolled in the 'Decades-to-Minutes' (D2M) study, based in Zurich, Switzerland, provided data from the ages of 7-20 via parent- and self-report questionnaires and ecological momentary assessment. Data were analyzed using Dynamic Structural Equation Modeling (DSEM). Worse student-teacher relationships predicted increased negative affectivity and emotional lability. Negative parenting practices predicted emotional lability only via their impact on student-teacher relationships. The findings point to worse student-teacher relationships as risk factors in the socioemotional development of children and young people.
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Affiliation(s)
- Anna Talty
- Clinical & Health Psychology, University of Edinburgh, Edinburgh, UK
| | - Lydia G Speyer
- Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Manuel P Eisner
- Institute of Criminology, University of Cambridge, Cambridge, UK
- Jacobs Center for Productive Youth Development, University of Zurich, Zürich, Switzerland
| | - Denis Ribeaud
- Jacobs Center for Productive Youth Development, University of Zurich, Zürich, Switzerland
| | - Aja L Murray
- Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Ingrid Obsuth
- Clinical & Health Psychology, University of Edinburgh, Edinburgh, UK
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7
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Lee KS, Lebowitz ER, Silverman WK, Tseng W. Transactional associations of child irritability and anxiety with parent psychological control in Taiwanese school-aged children. JCPP ADVANCES 2023; 3:e12192. [PMID: 38054061 PMCID: PMC10694542 DOI: 10.1002/jcv2.12192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 07/13/2023] [Indexed: 12/07/2023] Open
Abstract
Background Child irritability and anxiety are associated with parent psychological control; yet their transactional relations over time are not well-characterized at the within-person level. Research addressing generalizability of past Western-based literature in non-Western, collectivist community samples is lacking. Methods Sample comprised 285 children aged 8.8-11.4 years (145 girls; Mage = 9.9 years, SD = 0.6) in Northern Taiwan. Participants were assessed at baseline (T1), 6-month (T2), and 12-month (T3) follow-ups. Child irritability and anxiety symptoms were assessed using parent-rated Child Behavior Checklist. Parent psychological control was assessed using the parent- and child-rated Psychological Control Scale. Within-person processes were specified using the random-intercept cross-lagged panel models. Results Models showed that psychological control predicted increased child irritability when analyzing parenting data from parents and children. However, the lagged effect from psychological control to child anxiety was only seen in parent-rated parenting data. We found limited evidence for a back-and-forth transactional pathway among constructs. Child irritability predicted increased child anxiety in all models. Conclusions Directional effects from psychological control to child irritability and anxiety support parent-involved interventions that prioritize collaborative parenting and positive reinforcement techniques. Future validations in combined clinical and typically developing samples and direct cross-cultural comparisons are warranted.
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Affiliation(s)
- Ka Shu Lee
- Department of Experimental PsychologyUniversity of OxfordOxfordUK
- Yale Child Study CenterYale School of MedicineNew HavenConnecticutUSA
| | - Eli R. Lebowitz
- Yale Child Study CenterYale School of MedicineNew HavenConnecticutUSA
| | | | - Wan‐Ling Tseng
- Yale Child Study CenterYale School of MedicineNew HavenConnecticutUSA
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8
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Johns‐Mead R, Vijayakumar N, Mulraney M, Melvin G, Youssef G, Sciberras E, Anderson VA, Nicholson JM, Efron D, Hazel P, Silk TJ. Categorical and dimensional approaches to the developmental relationship between ADHD and irritability. J Child Psychol Psychiatry 2023; 64:1422-1431. [PMID: 37170636 PMCID: PMC10952727 DOI: 10.1111/jcpp.13818] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/16/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND Attention deficit hyperactivity disorder (ADHD) and irritability commonly co-occur, and follow similar developmental trajectories from childhood to adolescence. Understanding of the developmental relationship between these co-occurrences is limited. This study provides a longitudinal assessment of how ADHD diagnostic status and symptom patterns predict change in irritability. METHODS A community sample of 337 participants (45.2% ADHD), recruited for the Childhood Attention Project, completed the Affective Reactivity Index (ARI) to measure irritability at baseline (mean age 10.5 years) and follow-up after 18-months. Latent change score models were used to assess how (a) baseline ADHD vs. control group status, (b) baseline symptom domain (inattention, hyperactivity-impulsivity) and (c) longitudinal change in ADHD symptom severity predicted change in irritability. RESULTS Irritability was significantly higher among the ADHD group than controls; however, change in irritability over time did not differ between groups. When assessed across the entire cohort, change in irritability was predicted by higher symptom count in the hyperactive-impulsive domain, but not the inattentive domain. Greater declines in ADHD symptoms over time significantly predicted greater declines in irritability. Baseline ADHD symptom severity was found to significantly predict change in irritability; however, baseline irritability did not significantly predict change in ADHD symptoms. CONCLUSIONS ADHD symptoms-particularly hyperactive-impulsive symptoms-predict the degree and trajectory of irritability during childhood and adolescence, even when symptoms are below diagnostic thresholds. The use of longitudinal, dimensional and symptom domain-specific measures provides additional insight into this relationship.
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Affiliation(s)
- Rania Johns‐Mead
- Centre for Social and Early Emotional Development (SEED) and School of PsychologyDeakin UniversityGeelongVic.Australia
| | - Nandita Vijayakumar
- Centre for Social and Early Emotional Development (SEED) and School of PsychologyDeakin UniversityGeelongVic.Australia
| | - Melissa Mulraney
- Institute for Social NeuroscienceISN PsychologyIvanhoeVic.Australia
| | - Glenn Melvin
- Centre for Social and Early Emotional Development (SEED) and School of PsychologyDeakin UniversityGeelongVic.Australia
| | - George Youssef
- Centre for Social and Early Emotional Development (SEED) and School of PsychologyDeakin UniversityGeelongVic.Australia
| | - Emma Sciberras
- Centre for Social and Early Emotional Development (SEED) and School of PsychologyDeakin UniversityGeelongVic.Australia
- Murdoch Children's Research InstituteMelbourneVic.Australia
| | - Vicki A. Anderson
- Murdoch Children's Research InstituteMelbourneVic.Australia
- The Royal Children's HospitalMelbourneVic.Australia
- Department of PaediatricsUniversity of MelbourneMelbourneVic.Australia
| | | | - Daryl Efron
- Murdoch Children's Research InstituteMelbourneVic.Australia
- The Royal Children's HospitalMelbourneVic.Australia
- Department of PaediatricsUniversity of MelbourneMelbourneVic.Australia
| | - Philip Hazel
- Sydney Medical School, Faculty of Medicine and HealthThe University of SydneySydneyNSWAustralia
| | - Tim J. Silk
- Centre for Social and Early Emotional Development (SEED) and School of PsychologyDeakin UniversityGeelongVic.Australia
- Murdoch Children's Research InstituteMelbourneVic.Australia
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Functional connectivity based brain signatures of behavioral regulation in children with ADHD, DCD, and ADHD-DCD. Dev Psychopathol 2023; 35:85-94. [PMID: 34937602 DOI: 10.1017/s0954579421001449] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Behavioral regulation problems have been associated with daily-life and mental health challenges in children with neurodevelopmental conditions such as attention-deficit/hyperactivity disorder (ADHD) and developmental coordination disorder (DCD). Here, we investigated transdiagnostic brain signatures associated with behavioral regulation. Resting-state fMRI data were collected from 115 children (31 typically developing (TD), 35 ADHD, 21 DCD, 28 ADHD-DCD) aged 7-17 years. Behavioral regulation was measured using the Behavior Rating Inventory of Executive Function and was found to differ between children with ADHD (i.e., children with ADHD and ADHD-DCD) and without ADHD (i.e., TD children and children with DCD). Functional connectivity (FC) maps were computed for 10 regions of interest and FC maps were tested for correlations with behavioral regulation scores. Across the entire sample, greater behavioral regulation problems were associated with stronger negative FC within prefrontal pathways and visual reward pathways, as well as with weaker positive FC in frontostriatal reward pathways. These findings significantly increase our knowledge on FC in children with and without ADHD and highlight the potential of FC as brain-based signatures of behavioral regulation across children with differing neurodevelopmental conditions.
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Naim R, Shaughnessy S, Smith A, Karalunas SL, Kircanski K, Brotman MA. Real-time assessment of positive and negative affective fluctuations and mood lability in a transdiagnostic sample of youth. Depress Anxiety 2022; 39:870-880. [PMID: 36325887 PMCID: PMC9729410 DOI: 10.1002/da.23293] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 09/30/2022] [Accepted: 10/22/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Emotional lability, defined as rapid and/or intense affect fluctuations, is associated with pediatric psychopathology. Although numerous studies have examined labile mood in clinical groups, few studies have used real-time assessments in a well-characterized transdiagnostic sample, and no prior study has included participants with disruptive mood dysregulation disorder (DMDD). The present study leverages ecological momentary assessment (EMA) to assess emotional lability in a transdiagnostic pediatric sample. METHODS One hundred thirty participants ages 8-18 with primary diagnoses of DMDD, attention-deficit/hyperactivity disorder (ADHD), an anxiety disorder (ANX), or healthy volunteers completed a previously validated 1-week EMA protocol. Clinicians determined diagnoses based on semi-structured interviews and assessed levels of functional impairment. Participants reported momentary affective states and mood change. Composite scores of fluctuations in positive and negative affect were generated. Affect fluctuations were compared between diagnostic groups and tested for their association with functional impairment. RESULTS Diagnostic groups differed in levels of negative and positive emotional lability. DMDD patients demonstrated the highest level of labile mood compared with other groups. Emotional lability was associated with global impairment in the whole sample. CONCLUSIONS Both positive and negative emotional lability is salient in pediatric psychopathology and is associated with functional impairment, particularly in DMDD youth.
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Affiliation(s)
- Reut Naim
- Emotion and Development Branch, National Institute of
Mental Health, Bethesda, MD,Corresponding author- Reut Naim, National
Institute of Mental Health, Bldg. 15K, MSC 2670, Bethesda, MD 20892-2670, Phone:
301-827-6138,
| | - Shannon Shaughnessy
- Emotion and Development Branch, National Institute of
Mental Health, Bethesda, MD
| | - Ashley Smith
- Emotion and Development Branch, National Institute of
Mental Health, Bethesda, MD
| | - Sarah L. Karalunas
- Department of Psychological Sciences, Purdue University,
West Lafayette, IN
| | - Katharina Kircanski
- Emotion and Development Branch, National Institute of
Mental Health, Bethesda, MD
| | - Melissa A. Brotman
- Emotion and Development Branch, National Institute of
Mental Health, Bethesda, MD
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Preschool Irritability Predicts Adolescent Psychopathology and Functional Impairment: A 12-Year Prospective Study. J Am Acad Child Adolesc Psychiatry 2022; 61:554-564.e1. [PMID: 34481916 PMCID: PMC9951107 DOI: 10.1016/j.jaac.2021.08.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 07/30/2021] [Accepted: 08/26/2021] [Indexed: 01/16/2023]
Abstract
OBJECTIVE The long-term clinical and functional outcomes of preschool-age irritability are unknown. This study examined longitudinal associations of preschool irritability with psychiatric disorders and functional impairment assessed in adolescence in a large community sample. METHOD A total of 453 children were assessed at age 3 and again at ages 12 and/or 15. At age 3, parents were interviewed about their child's irritability, other psychiatric symptoms, and functional impairment with the Preschool Age Psychiatric Assessment (PAPA). In adolescence, both parents and youths were interviewed with the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime (K-SADS-PL) to assess youth psychopathology and functional impairment; youths also completed the UCLA Life Stress Interview (LSI) to assess different domains of functioning. Lastly, youths and parents completed the Children's Depression Inventory 2 (CDI 2) and the Screen for Child Anxiety Related Disorders (SCARED). RESULTS Irritability at age 3 predicted internalizing and externalizing disorders in adolescence; parent-reported anxiety and depressive symptoms; and greater functional impairment, including poorer peer functioning, poorer physical health, and antidepressant and educational service use, even after controlling for baseline psychiatric disorders. All longitudinal associations persisted after further adjusting for well-established early life risk markers for psychopathology. CONCLUSION The findings of this study underscore the clinical significance and predictive power of preschool irritability and provide support for its use in large-scale identification and intervention efforts.
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Oddo LE, Miller NV, Felton JW, Cassidy J, Lejuez CW, Chronis-Tuscano A. Maternal Emotion Dysregulation Predicts Emotion Socialization Practices and Adolescent Emotion Lability: Conditional Effects of Youth ADHD Symptoms. Res Child Adolesc Psychopathol 2022; 50:211-224. [PMID: 32778993 PMCID: PMC7874497 DOI: 10.1007/s10802-020-00686-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Maternal emotional functioning and emotion socialization practices can facilitate or hinder children's emotional development, and youth with symptoms of attention-deficit/hyperactivity disorder (ADHD) are at increased risk for emotion lability. However, little is known about the independent and interactive effects of maternal emotion dysregulation and adolescent ADHD symptoms on maternal emotion socialization and adolescent emotion lability over time. Using secondary data analyses of a longitudinal community sample of youth and their mothers (Nbaseline = 247; 43.7% female), the current study examined direct and indirect effects of maternal emotion dysregulation on adolescent emotion lability via supportive and non-supportive emotion socialization practices as mediators, and the extent to which adolescent ADHD symptoms moderated these longitudinal pathways. Mothers reported on all study constructs. Results showed that non-supportive parenting responses to adolescents' negative emotional expressions partially mediated the association between maternal emotion dysregulation and adolescent emotion lability, and the effect was stronger at higher levels of youth ADHD symptom severity. Results suggest that parent- and youth-level characteristics interact to confer risk for non-supportive emotion socialization practices and adolescent emotion lability. This research contributes uniquely to theory and research on ADHD and emotional functioning across adolescence. Future research should extend this work by utilizing multi-modal assessment.
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Affiliation(s)
- Lauren E. Oddo
- University of Maryland, College Park, Department of Psychology, 4094 Campus Dr., College Park, MD 20742
| | - Natalie V. Miller
- University of Maryland, College Park, Department of Psychology, 4094 Campus Dr., College Park, MD 20742
| | - Julia W. Felton
- University of Maryland, College Park, Department of Psychology, 4094 Campus Dr., College Park, MD 20742
- Michigan State University, Division of Public Health, 200 East 1st St Flint, MI 48502
| | - Jude Cassidy
- University of Maryland, College Park, Department of Psychology, 4094 Campus Dr., College Park, MD 20742
| | - Carl W. Lejuez
- University of Maryland, College Park, Department of Psychology, 4094 Campus Dr., College Park, MD 20742
- University of Kansas, College of Liberal Arts and Sciences, 1450 Jayhawk Blvd. Lawrence, KS 66045
| | - Andrea Chronis-Tuscano
- University of Maryland, College Park, Department of Psychology, 4094 Campus Dr., College Park, MD 20742
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13
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Sanabra M, Gómez-Hinojosa T, Grau N, Alda JA. Deficient Emotional Self-Regulation and Sleep Problems in ADHD with and without Pharmacological Treatment. J Atten Disord 2022; 26:426-433. [PMID: 33472511 DOI: 10.1177/1087054720986242] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The purpose of this study is to analyse DESR and its influence on sleep parameters in three different groups of children and adolescents: a group newly diagnosed with ADHD naïve, a group with ADHD under pharmacological treatment and a control group. METHOD Subjects were a total of 327 children and adolescents. Two groups diagnosed with ADHD: 108 medication-naïve and 80 under pharmacological treatment; and one group with 136 healthy subjects. DESR was defined using anxious/depressed, attention problems and aggressive behaviors (AAA) scales from the Child Behavior Checklist (CBCL), and sleep through the Sleep Disturbance Scale for Children. RESULTS Significant differences were found comparing the three groups (p = .001), with a significantly higher profile on DESR in ADHD subjects, especially those who did not undergo treatment, and a positive correlation between DESR and sleep. CONCLUSION Children and adolescents with ADHD without treatment present higher DESR than healthy controls and consequently higher sleep problems.
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Affiliation(s)
- Miriam Sanabra
- Attention Deficit Hyperactivity Disorder Unit of Hospital de Sant Joan de Déu, Barcelona, Spain.,Universitat de Ramón Llull, Barcelona, Spain
| | | | - Núria Grau
- Attention Deficit Hyperactivity Disorder Unit of Hospital de Sant Joan de Déu, Barcelona, Spain
| | - Jose A Alda
- Attention Deficit Hyperactivity Disorder Unit of Hospital de Sant Joan de Déu, Barcelona, Spain.,Children and Adolescent Mental Health Research Group, Institut de Recerca Sant Joan de Déu, Research Group Mental Health Interventions
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14
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Chutko L, Yakovenko E, Surushkina S, Anisimova T, Sergeev A, Didur M, Cherednichenko D. Emotional and behavioral dysregulation in children with attention deficit hyperactivity disorder. Zh Nevrol Psikhiatr Im S S Korsakova 2022; 122:100-107. [DOI: 10.17116/jnevro2022122061100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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15
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Vogel AC, Tillman R, El-Sayed NM, Jackson JJ, Perlman SB, Barch DM, Luby JL. Trajectory of emotion dysregulation in positive and negative affect across childhood predicts adolescent emotion dysregulation and overall functioning. Dev Psychopathol 2021; 33:1722-1733. [PMID: 36238204 PMCID: PMC9555228 DOI: 10.1017/s0954579421000705] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Emotion dysregulation is cross-diagnostic and impairing. Most research has focused on dysregulated expressions of negative affect, often measured as irritability, which is associated with multiple forms of psychopathology and predicts negative outcomes. However, the Research Domain Criteria (RDoC) include both negative and positive valence systems. Emerging evidence suggests that dysregulated expressions of positive affect, or excitability, in early childhood predict later psychopathology and impairment above and beyond irritability. Typically, irritability declines from early through middle childhood; however, the developmental trajectory of excitability is unknown. The impact of excitability across childhood on later emotion dysregulation is also yet unknown. In a well-characterized, longitudinal sample of 129 children studied from ages 3 to 5.11 years through 14 to 19 years, enriched for early depression and disruptive symptoms, we assessed the trajectory of irritability and excitability using multilevel modeling and how components of these trajectories impact later emotion dysregulation. While irritability declines across childhood, excitability remains remarkably stable both within and across the group. Overall levels of excitability (excitability intercept) predict later emotion dysregulation as measured by parent and self-report and predict decreased functional magnetic resonance imaging activity in cognitive emotion regulation regions during an emotion regulation task. Irritability was not related to any dysregulation outcome above and beyond excitability.
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Affiliation(s)
- Alecia C. Vogel
- Department of Psychiatry, Washington University in St. Louis School of Medicine, St Louis, MO, USA
| | - Rebecca Tillman
- Department of Psychiatry, Washington University in St. Louis School of Medicine, St Louis, MO, USA
| | - Nourhan M. El-Sayed
- Department of Psychological and Brain Sciences, Washington University in St. Louis, MO, USA
| | - Joshua J. Jackson
- Department of Psychological and Brain Sciences, Washington University in St. Louis, MO, USA
| | - Susan B. Perlman
- Department of Psychiatry, Washington University in St. Louis School of Medicine, St Louis, MO, USA
| | - Deanna M. Barch
- Department of Psychiatry, Washington University in St. Louis School of Medicine, St Louis, MO, USA
- Department of Psychological and Brain Sciences, Washington University in St. Louis, MO, USA
| | - Joan L. Luby
- Department of Psychiatry, Washington University in St. Louis School of Medicine, St Louis, MO, USA
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16
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Keren H, Zheng C, Jangraw DC, Chang K, Vitale A, Rutledge RB, Pereira F, Nielson DM, Stringaris A. The temporal representation of experience in subjective mood. eLife 2021; 10:62051. [PMID: 34128464 PMCID: PMC8241441 DOI: 10.7554/elife.62051] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 06/02/2021] [Indexed: 12/24/2022] Open
Abstract
Humans refer to their mood state regularly in day-to-day as well as clinical interactions. Theoretical accounts suggest that when reporting on our mood we integrate over the history of our experiences; yet, the temporal structure of this integration remains unexamined. Here, we use a computational approach to quantitatively answer this question and show that early events exert a stronger influence on reported mood (a primacy weighting) compared to recent events. We show that a Primacy model accounts better for mood reports compared to a range of alternative temporal representations across random, consistent, or dynamic reward environments, different age groups, and in both healthy and depressed participants. Moreover, we find evidence for neural encoding of the Primacy, but not the Recency, model in frontal brain regions related to mood regulation. These findings hold implications for the timing of events in experimental or clinical settings and suggest new directions for individualized mood interventions.
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Affiliation(s)
- Hanna Keren
- Section of Clinical and Computational Psychiatry, National Institute of Mental Health, National Institutes of Health, Bethesda, United States
| | - Charles Zheng
- Machine Learning Team, National Institute of Mental Health, National Institutes of Health, Bethesda, United States
| | - David C Jangraw
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, United States
| | - Katharine Chang
- Section of Clinical and Computational Psychiatry, National Institute of Mental Health, National Institutes of Health, Bethesda, United States
| | - Aria Vitale
- Section of Clinical and Computational Psychiatry, National Institute of Mental Health, National Institutes of Health, Bethesda, United States
| | - Robb B Rutledge
- Department of Psychology, Yale University, New Haven, United States.,Max Planck UCL Centre for Computational Psychiatry and Ageing Research, University College London, London, United Kingdom.,Wellcome Centre for Human Neuroimaging, University College London, London, United Kingdom
| | - Francisco Pereira
- Machine Learning Team, National Institute of Mental Health, National Institutes of Health, Bethesda, United States
| | - Dylan M Nielson
- Section of Clinical and Computational Psychiatry, National Institute of Mental Health, National Institutes of Health, Bethesda, United States
| | - Argyris Stringaris
- Section of Clinical and Computational Psychiatry, National Institute of Mental Health, National Institutes of Health, Bethesda, United States
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17
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Wilson MK, Cornacchio D, Brotman MA, Comer JS. Measuring Irritability in Early Childhood: A Psychometric Evaluation of the Affective Reactivity Index in a Clinical Sample of 3- to 8-Year-Old Children. Assessment 2021; 29:1473-1481. [PMID: 34060361 DOI: 10.1177/10731911211020078] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The parent-report Affective Reactivity Index (ARI-P) is the most studied brief scale specifically developed to assess irritability, but relatively little is known about its performance in early childhood (i.e., ≤8 years). Support in such populations is particularly important given developmental shifts in what constitutes normative irritability across childhood. We examined the performance of the ARI-P in a diverse, treatment-seeking sample of children ages 3 to 8 years (N = 115; mean age = 5.56 years; 58.4% from ethnic/racial minority backgrounds). In this sample, confirmatory factor analysis supported the single-factor structure of the ARI-P previously identified with older youth. ARI-P scores showed large associations with another irritability index, as well as small-to-large associations with aggression, anxiety, depression, and attention problems, supporting the convergent and concurrent validity of the ARI-P when used with children in this younger age range. Findings support the ARI-P as a promising parent-report tool for assessing irritability in early childhood, particularly in clinical samples.
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18
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Christiansen H, Hirsch O, Beheshti A, Chavanon ML. Emotions or attention – what are predictors for the development of childhood psychopathology? A longitudinal study with pre- and elementary school children. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-01842-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AbstractCurrent debate has identified the factors emotion knowledge (EK) and attention as specific trajectories longitudinally influencing psychopathological development in childhood. The “Emotion Knowledge Hypothesis” assumes that children with great emotion skills have high self-regulating abilities that result in lower cognitive load and stronger attention capacities. Attention problems are thus perceived as a consequence of reduced EK. According to the competing “Attention Effect Hypothesis”, attention problems and EK deficits are associated because of impaired learning capacities due to attention problems. According to this hypothesis, attention problems are predictive of impaired EK. If those specific trajectories are disrupted, this might attenuate the development of later behavior problems. The present study tests those competing hypotheses replicating previous studies in this field to shed light on potential psychopathology trajectories. A total of 136 pre- and elementary school children as well as their teachers participated in this study. Children’s symptoms of inattention as well as their emotional competences were assessed 3 times over a 12-month period. We applied multilevel structural equation modelling and cross-lagged panel models for data analysis. Overall, we noted a drop in inattention scores and rise in emotional competences over the one-year course, indicating maturation effects. There was a significant but very small effect for attention scores predicting emotional competences. With respect to the question whether interventions should focus on the “Emotion Knowledge” or “Attention Effect” hypothesis, our findings imply that none of them has superiority over the other. Therefore, both emotion knowledge and attention are crucial for development, and that children with deficits in either domain should receive targeted interventions in order to disrupt potentially harmful developmental pathways.
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19
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Zhu J, Xiao B, Hipson W, Yan C, Coplan RJ, Li Y. Social Avoidance and Social Adjustment: The Moderating Role of Emotion Regulation and Emotion Lability/Negativity Among Chinese Preschool Children. Front Psychol 2021; 12:618670. [PMID: 33790837 PMCID: PMC8005725 DOI: 10.3389/fpsyg.2021.618670] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 02/12/2021] [Indexed: 11/13/2022] Open
Abstract
The present study explored the role of emotion regulation and emotion lability/negativity as a moderator in the relation between child social avoidance and social adjustment (i.e., interpersonal skills, asocial behavior, peer exclusion) in Chinese culture. Participants were N = 194 children (102 boys, 92 girls, Mage = 70.82 months, SD = 5.40) recruited from nine classrooms in two public kindergartens in Shanghai, People’s Republic of China. Multi-source assessments were employed with mothers rating children’s social avoidance and teachers rating children’s emotion regulation, emotion lability/negativity and social adjustment outcomes. The results indicated that the relations between social avoidance and social adjustment difficulties were more negative among children lower in emotion regulation, but not significant for children with higher emotion regulation. In contrast, the relations between social avoidance and social adjustment difficulties were more positive among children higher in emotion lability/negativity, but not significant for children with lower emotion lability/negativity. This study informs us about how emotion regulation and emotion lability/negativity are jointly associated with socially avoidant children’s development. As well, the findings highlight the importance of considering the meaning and implication of social avoidance in Chinese culture.
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Affiliation(s)
- Jingjing Zhu
- Department of Preschool Education, Shanghai Normal University, Shanghai, China
| | - Bowen Xiao
- Department of Psychology, Carleton University, Ottawa, ON, Canada
| | - Will Hipson
- Department of Psychology, Carleton University, Ottawa, ON, Canada
| | - Chenyu Yan
- Shanghai Normal University, Tianhua College, Shanghai, China
| | - Robert J Coplan
- Department of Psychology, Carleton University, Ottawa, ON, Canada
| | - Yan Li
- Department of Preschool Education, Shanghai Normal University, Shanghai, China
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20
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Abstract
Based on its course over time, irritability is linked to depression cross-sectionally and longitudinally. Cross-sectionally, irritability takes an episodic form as a symptom in pediatric depression; yet, irritability in the absence of depressed mood or anhedonia is rare. Longitudinally, chronic irritability has been shown to predict depression rather than bipolar disorder or externalizing disorders. Evidence suggests that the link between irritability and depression is explained mostly by shared genetic risk. Both conditions are also associated with higher rates of family history of depression, childhood temperaments and personality styles, and negative parenting styles. The treatment implications are discussed.
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Affiliation(s)
- Pablo Vidal-Ribas
- Social and Behavioral Science Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, 6710 Rockledge Drive, Building 6710B, Room 3153A, Bethesda, MD 20892, USA.
| | - Argyris Stringaris
- Section of Clinical and Computational Psychiatry, National Institute of Mental Health, National Institutes of Health, 9000 Rockville Pike, Building 15k, Room 208, Bethesda, MD 20892, USA. https://twitter.com/argStringaris
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21
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Blader JC. Attention-Deficit Hyperactivity Disorder and the Dysregulation of Emotion Generation and Emotional Expression. Child Adolesc Psychiatr Clin N Am 2021; 30:349-360. [PMID: 33743943 DOI: 10.1016/j.chc.2020.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Individuals with attention-deficit/hyperactivity disorder (ADHD) frequently experience strong reactions to emotionally evocative situations. Difficulties modulating anger and other upsets have clinically significant behavioral consequences. Those with ADHD may have anomalies in emotion generation, emotion expression, or both that predispose to these problems. The association between ADHD and emotion dysregulation raises Important clinical and research issues, including possible heterogeneity in the mechanisms by which they are related. Although first-line treatments for ADHD often help to resolve emotional dysregulation symptoms as well, the evidence base for widespread practice of combination pharmacotherapy remains sparse. Psychosocial treatments that engage processes underlying emotional dysregulation are in development.
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Affiliation(s)
- Joseph C Blader
- Department of Psychiatry and Behavioral Sciences, Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, Mail Stop 7719, San Antonio, TX 78229, USA.
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22
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Katsuki D, Yamashita H, Yamane K, Kanba S, Yoshida K. Clinical Subtypes in Children with Attention-Deficit Hyperactivity Disorder According to Their Child Behavior Checklist Profile. Child Psychiatry Hum Dev 2020; 51:969-977. [PMID: 32166459 DOI: 10.1007/s10578-020-00977-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
This study sought to identify subgroups of attention-deficit hyperactivity disorder (ADHD) defined by specific patterns of emotional and behavioral symptoms according to the parent-rated Child Behavior Checklist (CBCL). Our clinical sample comprised 314 children (aged 4 to 15 years) diagnosed with ADHD according to the DSM-5. In addition, comorbid psychiatric disorders, general functioning, and medication status were assessed. Cluster analysis was performed on the CBCL syndrome subscales and yielded a solution with four distinct subgroups. The "High internalizing/externalizing" group displayed an overlap between internalizing and externalizing problems in the CBCL profile. In addition, the "High internalizing/externalizing" group revealed a high rate of comorbid autism spectrum disorder and elevated autistic traits. The "Inattention and internalizing" group revealed a high rate of the predominantly inattentive presentation according to ADHD specifier from the DSM-5. The "Aggression and externalizing" group revealed a high rate of comorbid oppositional defiant disorder and conduct disorder. The "Less psychopathology" group scored low on all syndrome scales. Children with ADHD were subdivided into four distinct subgroups characterized by psychopathological patterns, with and without internalizing and externalizing problems. The overlap between internalizing and externalizing problems may be mediated with emotional dysregulation and associated neurobiological bases.
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Affiliation(s)
- Daisuke Katsuki
- Department of Child Psychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. .,Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashiku, Fukuoka City, Fukuoka, 8128582, Japan.
| | - Hiroshi Yamashita
- Department of Child Psychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kenichi Yamane
- Department of Child Psychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shigenobu Kanba
- Japan Depression Center, Tokyo, Japan.,Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashiku, Fukuoka City, Fukuoka, 8128582, Japan
| | - Keiko Yoshida
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashiku, Fukuoka City, Fukuoka, 8128582, Japan.,Iris Psychiatric Clinic, Fukuoka, Japan
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23
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Leaberry KD, Rosen PJ, Fogleman ND, Walerius DM, Slaughter KE. Comorbid Internalizing and Externalizing Disorders Predict Lability of Negative Emotions Among Children With ADHD. J Atten Disord 2020; 24:1989-2001. [PMID: 28992752 DOI: 10.1177/1087054717734647] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: A subset of children with ADHD experience more frequent, sudden, and intense shifts toward negative emotions. The current study utilized ecological momentary assessment (EMA) to provide a valid assessment of the impact of comorbid internalizing and externalizing disorders on negative emotional lability (EL) among children with ADHD. Method: Parents of 58, 8- to 12-year-old children with ADHD were administered a diagnostic interview to assess for ADHD and for the presence of comorbid disorders. Parents completed EMA-based ratings of their child's negative emotions three times daily for a total of 28 days. Results: Children with a comorbid internalizing disorder or children with comorbid oppositional defiant disorder (ODD) experienced significantly greater EMA-derived negative EL than children without comorbid disorders over time. Children with multiple comorbidities experienced greater EL than children with single comorbidities. Conclusion: Overall, this study suggested that both comorbid ODD and comorbid internalizing disorders contribute to negative EL among children with ADHD.
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Mauri M, Grazioli S, Crippa A, Bacchetta A, Pozzoli U, Bertella S, Gatti E, Maggioni E, Rosi E, Diwadkar V, Brambilla P, Molteni M, Nobile M. Hemodynamic and behavioral peculiarities in response to emotional stimuli in children with attention deficit hyperactivity disorder: An fNIRS study. J Affect Disord 2020; 277:671-680. [PMID: 32911217 DOI: 10.1016/j.jad.2020.08.064] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 06/30/2020] [Accepted: 08/24/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Children with attention deficit hyperactivity disorder (ADHD) exhibit behavioral inhibition deficits, which often lead to emotional dysregulation (ED) affecting individual ability to control emotions and behavioral responses. In ADHD, ED is associated with poor outcomes and comorbidities, with both externalizing and internalizing disorders. This work aims to evaluate sensitivity to emotional stimuli in children with ADHD using functional Near Infrared Spectroscopy (fNIRS). METHODS During frontal fNIRS recording, 20 children with ADHD and 25 typically developing (TD) peers performed a visual continuous performance task with stimuli of different emotional content (i.e., positive, negative, neutral, and control stimuli without emotional content). This is a cognitive task designed to evaluate the ability to recognize emotional stimuli and to deal with emotional interference. RESULTS The ADHD sample showed more variability in response time to stimuli and more false alarms compared to TD group. fNIRS data showed between-group differences in right prefrontal and frontal cortices, with wider hemoglobin concentration changes in the TD group, during positive, negative, and neutral conditions. LIMITATIONS Owing to the limited possibility of near infrared light to penetrate tissue, fNIRS can only measure cortical activations, while it would be of interest to identify the subcortical areas linked to emotional processing, too. CONCLUSIONS Findings suggest the presence of emotional processing deficits in children with ADHD, as suggested by poor performances on the e-CPT task, and of peculiar sensitivity to emotional stimuli, linked to atypical hemodynamics of right prefrontal and frontal areas.
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Affiliation(s)
- Maddalena Mauri
- Child Psychopathology Unit, Scientific Institute IRCCS Eugenio Medea, via Don Luigi Monza 20, 23842, Bosisio Parini (LC), Bosisio Parini, Italy; PhD Program in Neuroscience, School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Silvia Grazioli
- Child Psychopathology Unit, Scientific Institute IRCCS Eugenio Medea, via Don Luigi Monza 20, 23842, Bosisio Parini (LC), Bosisio Parini, Italy.
| | - Alessandro Crippa
- Child Psychopathology Unit, Scientific Institute IRCCS Eugenio Medea, via Don Luigi Monza 20, 23842, Bosisio Parini (LC), Bosisio Parini, Italy
| | - Andrea Bacchetta
- Child Psychopathology Unit, Scientific Institute IRCCS Eugenio Medea, via Don Luigi Monza 20, 23842, Bosisio Parini (LC), Bosisio Parini, Italy
| | - Uberto Pozzoli
- Computational Biology, Scientific Institute IRCCS Eugenio Medea, Bosisio Parini, Italy
| | - Silvana Bertella
- Child Psychopathology Unit, Scientific Institute IRCCS Eugenio Medea, via Don Luigi Monza 20, 23842, Bosisio Parini (LC), Bosisio Parini, Italy
| | - Erika Gatti
- Child Psychopathology Unit, Scientific Institute IRCCS Eugenio Medea, via Don Luigi Monza 20, 23842, Bosisio Parini (LC), Bosisio Parini, Italy
| | - Eleonora Maggioni
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Eleonora Rosi
- Child Psychopathology Unit, Scientific Institute IRCCS Eugenio Medea, via Don Luigi Monza 20, 23842, Bosisio Parini (LC), Bosisio Parini, Italy
| | - Vaibhav Diwadkar
- Departments of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, United States
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Massimo Molteni
- Child Psychopathology Unit, Scientific Institute IRCCS Eugenio Medea, via Don Luigi Monza 20, 23842, Bosisio Parini (LC), Bosisio Parini, Italy
| | - Maria Nobile
- Child Psychopathology Unit, Scientific Institute IRCCS Eugenio Medea, via Don Luigi Monza 20, 23842, Bosisio Parini (LC), Bosisio Parini, Italy
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25
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Tatsiopoulou P, Porfyri GN, Bonti E, Diakogiannis I. Childhood ADHD and Early-Onset Bipolar Disorder Comorbidity: A Case Report. Brain Sci 2020; 10:E883. [PMID: 33233667 PMCID: PMC7699781 DOI: 10.3390/brainsci10110883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 11/11/2020] [Accepted: 11/18/2020] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Recent research has highlighted an increased rate of co-morbidity between the neurodevelopmental-behavioral disorder of attention deficit hyperactivity disorder (ADHD) and a variety of psychiatric disorders, such as mood disorders or bipolar disorder (BD). The etiology and clinical course of BD are considered to be determined by both genetic and environmental factors, either aggravating or improving. AIM This follow-up study of an adolescent aimed to clarify the co-morbidity between ADHD and BD. We also discuss the controversies surrounding the two diagnoses in younger populations and describe several aspects of concern regarding diagnosis, differential diagnosis, therapeutic planning/intervention, and prognosis. METHODS Reporting of a two-year follow-up study of a bipolar 15-year-old female patient with a previous diagnosis of ADHD during childhood. RESULTS Despite the occurrence of major risk factors, such as early onset and positive family history, the patient's condition rapidly remitted with medication, without relapse and/or rehospitalization during the following two years, due to the stability of her cooperation, and support of a stable and caring familial environment. Early diagnosis of BD and differential diagnoses of ADHD are considered crucial protective factors leading to an appropriate planning of treatment. In addition, parental involvement and empathic attitude towards the patient supported the latter to cooperate and comply with the treatment, enhancing positive outcomes and stability. CONCLUSIONS Research is required into the reliability and validity of diagnostic protocols and criteria for BD in children and adolescents, and also into the development of individualized therapeutic planning.
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Affiliation(s)
- Paraskevi Tatsiopoulou
- 1st Department of Psychiatry, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, General Hospital “Papageorgiou”, Ring Road Thessaloniki, N. Efkarpia, 54603 Thessaloniki, Greece; (G.-N.P.); (E.B.); (I.D.)
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An examination of reciprocal associations between substance use and effortful control across adolescence using a bifactor model of externalizing symptoms. Dev Psychopathol 2020; 33:1507-1519. [PMID: 32662367 DOI: 10.1017/s0954579420000644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Early adolescence is thought to represent a window of vulnerability when exposure to substances is particularly harmful, partly because the neurotoxic effects of adolescent substance use may derail self-regulation development. However, previous studies fail to account for externalizing symptoms, such as aggression and delinquency, that accompany adolescent substance use and may also derail the development of self-regulation. The current study aims to clarify whether the neurotoxic effects of adolescent substance use are associated with deficits in effortful control (EC) after accounting for externalizing symptoms and to examine reciprocal relationships between EC, externalizing symptoms, and substance use. A longitudinal sample of adolescents (N = 387) was used to estimate bifactor models of externalizing symptoms across five assessments (Mage = 11.6 to 19.9). The broad general externalizing factors were prospectively associated with declines in EC across adolescence and emerging adulthood. However, the narrow substance use specific factors were not prospectively associated with EC. Findings suggest that the broader externalizing context, but not the specific neurotoxic effects of substance use, may hamper self-regulation development. It is critical to account for the hierarchical structure of psychopathology, namely externalizing symptoms, when considering development of EC.
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Abstract
Research into irritability has focused largely on its developmental and child-adolescent manifestations. Although irritability appears to be as elemental an experience as anxiety or depression, diagnoses highlighting irritability as the focal ingredient have yet to be delineated for adults. Instead, irritability-related diagnoses in adults have largely emphasized externalizing behaviors, depressed mood, and personality. Consequently, patients complaining of irritability are sometimes shoehorned into diagnostic categories that they do not experience as authentic representations of their lived experiences. This article proposes that the symptom of irritability might be productively reenvisioned as a focal point, analogous to anxiety and depression, around which irritability-related syndromes and disorders in adults might coalesce. If anxiety, depressive, insomnia, and pain disorders, why not irritability disorders? Both state and trait characteristics of irritability can lend themselves to DSM diagnostic frames. Based on clinical observations, specific irritability disorders in adults can be envisioned, modeled as Irritability Disorder of Adulthood, Irritability Disorder Secondary to Another Medical Condition, Substance-Induced Irritability Disorder, Adjustment Disorder With Irritable Mood, and the like. Further delineation of irritability phenomena, syndromes, and possible disorders in adults is warranted to advance investigation, guide assessment, and improve treatment.
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Affiliation(s)
- Joel Yager
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, Colorado
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Abstract
Individuals with autism spectrum disorder (ASD) tend to experience difficulties with emotion regulation (ER). Treatments designed to address ER difficulties in individuals with ASD are emerging. The authors review cognitive-behavioral therapy (CBT) and mindfulness-based treatments that have focused on ER difficulties in youth and young adults with ASD. In general, these treatments addressing ER skills have included awareness of emotions/psychoeducation about emotions, frustration tolerance, and ER skills, as well as practice and use of these skills during group therapy that sometimes includes caregivers. The results from these interventions are encouraging for individuals with high-functioning ASD because ER skills tend to improve following treatment. The inclusion of ER in other ASD treatments is discussed.
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Affiliation(s)
| | | | - Judy Reaven
- Departments of Pediatrics and Psychiatry at the University of Colorado, Anschutz Medical Campus, Aurora, Colorado
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Villalta L, Khadr S, Chua KC, Kramer T, Clarke V, Viner RM, Stringaris A, Smith P. Complex post-traumatic stress symptoms in female adolescents: the role of emotion dysregulation in impairment and trauma exposure after an acute sexual assault. Eur J Psychotraumatol 2020; 11:1710400. [PMID: 32002143 PMCID: PMC6968575 DOI: 10.1080/20008198.2019.1710400] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 10/17/2019] [Accepted: 12/04/2019] [Indexed: 12/02/2022] Open
Abstract
Background: Adolescents are at high risk of sexual assault compared to any other age group. The pattern of post-traumatic stress symptoms plus life-impairing disturbances in self-organization (emotion dysregulation, negative self-concept and interpersonal problems) is termed Complex Post-Traumatic Stress Disorder (CPTSD). Research about CPTSD after sexual assault in adolescents is limited owing to the challenges associated with assessing this group. This study aims to determine the frequency and structure of CPTSD, and the relationship of emotion dysregulation with impairment and additional trauma exposure among adolescents who have been sexually assaulted. Method: Prospective cohort study of adolescents attending the Sexual Assault Referral Centres serving London over a 2-year period. We conducted cross-sectional analyses (n = 99) on data collected 4-5 months after sexual assault, and Confirmatory Factor Analyses (CFA) and Latent Class Analyses (LCA) to determine the CPTSD profile. CTPSD was defined according to the ICD-11, selecting symptom indicators from the following measures: Strengths and Difficulties Questionnaire (SDQ), Children's Revised Impact of Event Scale (CRIES-13), Short version of the Mood and Feelings Questionnaire (S-MFQ), The Development and Well-Being Assessment (DAWBA). We analysed the association of CPTSD symptom domains with impairment (measured with the SDQ, and the Children's Global Assessment Scale; C-GAS) and with additional trauma exposure. Results: The frequency of ICD-11 PTSD was 59%, and of ICD-11 CPTSD was 40%. CPTSD symptoms showed a strong fit for a correlated 4-factor model, and LCA distinguished a class of participants with high levels of CPTSD symptoms. Emotion dysregulation was associated with impairment in functioning and exposure to trauma beyond other self-organization disturbances and core PTSD symptoms. Conclusions: Disturbances in self-organization are frequent in sexually assaulted adolescents, and emotion dysregulation is associated with impairment and further exposure to trauma. Emotion dysregulation should be considered in preventive and treatment strategies for these vulnerable youth.
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Affiliation(s)
- Laia Villalta
- Child and Adolescent Psychiatry and Psychology Department of Hospital Sant Joan de Déu of Barcelona, University of Barcelona (UB), Barcelona, Spain
| | - Sophie Khadr
- Population, Policy & Practice Research Programme, UCL Institute of Child Health, London, UK.,The Havens Sexual Assault Referral Centres, King's College Hospital, London, UK.,Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Kia-Chong Chua
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Tami Kramer
- The Centre for Mental Health, Imperial College London, London, UK
| | - Venetia Clarke
- The Havens Sexual Assault Referral Centres, King's College Hospital, London, UK
| | - Russell M Viner
- Population, Policy & Practice Research Programme, UCL Institute of Child Health, London, UK
| | - Argyris Stringaris
- Mood Brain & Development Unit, Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Patrick Smith
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Clinical, cortical thickness and neural activity predictors of future affective lability in youth at risk for bipolar disorder: initial discovery and independent sample replication. Mol Psychiatry 2019; 24:1856-1867. [PMID: 31628415 PMCID: PMC6814510 DOI: 10.1038/s41380-018-0273-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 07/31/2018] [Accepted: 09/07/2018] [Indexed: 01/02/2023]
Abstract
We aimed to identify markers of future affective lability in youth at bipolar disorder risk from the Pittsburgh Bipolar Offspring Study (BIOS) (n = 41, age = 14, SD = 2.30), and validate these predictors in an independent sample from the Longitudinal Assessment of Manic Symptoms study (LAMS) (n = 55, age = 13.7, SD = 1.9). We included factors of mixed/mania, irritability, and anxiety/depression (29 months post MRI scan) in regularized regression models. Clinical and demographic variables, along with neural activity during reward and emotion processing and gray matter structure in all cortical regions at baseline, were used to predict future affective lability factor scores, using regularized regression. Future affective lability factor scores were predicted in both samples by unique combinations of baseline neural structure, function, and clinical characteristics. Lower bilateral parietal cortical thickness, greater left ventrolateral prefrontal cortex thickness, lower right transverse temporal cortex thickness, greater self-reported depression, mania severity, and age at scan predicted greater future mixed/mania factor score. Lower bilateral parietal cortical thickness, greater right entorhinal cortical thickness, greater right fusiform gyral activity during emotional face processing, diagnosis of major depressive disorder, and greater self-reported depression severity predicted greater irritability factor score. Greater self-reported depression severity predicted greater anxiety/depression factor score. Elucidating unique clinical and neural predictors of future-specific affective lability factors is a step toward identifying objective markers of bipolar disorder risk, to provide neural targets to better guide and monitor early interventions in bipolar disorder at-risk youth.
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31
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Slaughter KE, Leaberry KD, Fogleman ND, Rosen PJ. Reactive and proactive aggression in children with and without ADHD and negative emotional lability. SOCIAL DEVELOPMENT 2019. [DOI: 10.1111/sode.12402] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Kelly E. Slaughter
- Department of Psychological and Brain Sciences University of Louisville Louisville Kentucky
| | - Kirsten D. Leaberry
- Department of Psychological and Brain Sciences University of Louisville Louisville Kentucky
| | - Nicholas D. Fogleman
- Department of Psychological and Brain Sciences University of Louisville Louisville Kentucky
| | - Paul J. Rosen
- Department of Psychological and Brain Sciences University of Louisville Louisville Kentucky
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32
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Vogel AC, Jackson JJ, Barch DM, Tillman R, Luby JL. Excitability and irritability in preschoolers predicts later psychopathology: The importance of positive and negative emotion dysregulation. Dev Psychopathol 2019; 31:1067-1083. [PMID: 31109387 PMCID: PMC7059859 DOI: 10.1017/s0954579419000609] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Emotion dysregulation is a risk factor for the development of a variety of psychopathologic outcomes. In children, irritability, or dysregulated negative affect, has been the primary focus, as it predicts later negative outcomes even in very young children. However, dysregulation of positive emotion is increasingly recognized as a contributor to psychopathology. Here we used an exploratory factor analysis and defined four factors of emotion dysregulation: irritability, excitability, sadness, and anhedonia, in the preschool-age psychiatric assessment collected in a sample of 302 children ages 3-5 years enriched for early onset depression. The irritability and excitability factor scores defined in preschoolers predicted later diagnosis of mood and externalizing disorders when controlling for other factor scores, social adversity, maternal history of mood disorders, and externalizing diagnoses at baseline. The preschool excitability factor score predicted emotion lability in late childhood and early adolescence when controlling for other factor scores, social adversity, and maternal history. Both excitability and irritability factor scores in preschoolers predicted global functioning into the teen years and early adolescence, respectively. These findings underscore the importance of positive, as well as negative, affect dysregulation as early as the preschool years in predicting later psychopathology, which deserves both further study and clinical consideration.
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Affiliation(s)
- Alecia C. Vogel
- Department of Psychiatry, Washington University in St. Louis School of Medicine
| | - Joshua J. Jackson
- Department of Psychological and Brain Sciences, Washington University in St. Louis
| | - Deanna M. Barch
- Department of Psychiatry, Washington University in St. Louis School of Medicine
- Department of Psychological and Brain Sciences, Washington University in St. Louis
| | - Rebecca Tillman
- Department of Psychiatry, Washington University in St. Louis School of Medicine
| | - Joan L. Luby
- Department of Psychiatry, Washington University in St. Louis School of Medicine
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33
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Rusby JC, Westling E, Crowley R, Mills KL, Light JM. Associations between marijuana use and anxious mood lability during adolescence. Addict Behav 2019; 92:89-94. [PMID: 30597336 DOI: 10.1016/j.addbeh.2018.12.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 12/13/2018] [Accepted: 12/21/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To date, research investigating the association between adolescent marijuana use and anxiety is mixed, given differences in how anxiety is measured and the age ranges studied. The research is further limited as many relevant studies have small sample sizes. This investigation examines the association between marijuana use (use in the past 30 days) and anxious mood lability (rapid fluctuation in emotional states) during early adolescence (average age 14.4, spring of 8th grade) through midadolescence (10th grade). METHODS Participating adolescents (N = 466; 52.8% female) were from rural and suburban communities and 38% were Hispanic/Latino. Ecological Momentary Assessment (EMA) was used to measure adolescents' anxious mood in real time; the EMAs were collected within 30 days of the adolescent report of their marijuana use. RESULTS Multilevel models with measurement waves (7 time points) nested in individuals showed that anxious mood lability was significantly higher for adolescents reporting recent marijuana use compared to those reporting no recent marijuana use. Although females were higher than males in anxious mood lability, the association between anxious mood lability and recent marijuana use did not differ by gender. Post hoc analysis showed that the associations between anxious mood lability and recent marijuana use did not differ between assessments conducted pre and post legalization of adult recreational marijuana use. CONCLUSIONS The association between recent marijuana use and anxious mood lability for youth is important for understanding the developmental processes of cannabis use and anxious mood disorders in adolescence and young adulthood.
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Abstract
PURPOSE OF REVIEW Emotional symptoms are common and persistent in youth and adults with attention-deficit/hyperactivity disorder (ADHD) and cause clinically significant impairments. We review recent neuropsychological, neurophysiological, and peripheral psychophysiological evidence for emotion and emotion regulation deficits in ADHD across youth and adults. RECENT FINDINGS Central and autonomous nervous system correlates argue in favor of more general self-regulation deficits and also specific emotional deficits in ADHD. These include general performance deficits in executive functions, and structural as well as functional impairments in neuronal networks associated with top-down self-regulation. Specific deficits with bottom-up emotional activation in the amygdala and emotion evaluation associated with the orbitofrontal cortex have also been described. Furthermore, vagally mediated, high-frequency heart rate variability is associated with emotional self-regulation deficits throughout the life span. The current evidence is based on multilevel studies that assess associations of emotion regulation. However, further studies that adequately consider the processual recursive character of emotion generation and regulation may give important new insights into emotional regulation of ADHD. Emotion regulation deficits in ADHD are associated with specific as well as general self-regulation deficits traceable on the level of neuropsychological, neurophysiological, and psychophysiological assessments. The temporal dynamics of the interplay of those different systems need further study in order to optimize and personalize treatment of emotion regulation difficulties, including emotional reactivity, in patients with ADHD.
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35
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Hafeman DM, Chase HW, Monk K, Bonar L, Hickey MB, McCaffrey A, Graur S, Manelis A, Ladouceur CD, Merranko J, Axelson DA, Goldstein BI, Goldstein TR, Birmaher B, Phillips ML. Intrinsic functional connectivity correlates of person-level risk for bipolar disorder in offspring of affected parents. Neuropsychopharmacology 2019; 44:629-634. [PMID: 30410014 PMCID: PMC6333834 DOI: 10.1038/s41386-018-0264-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 10/05/2018] [Accepted: 10/28/2018] [Indexed: 12/31/2022]
Abstract
Offspring of parents with bipolar disorder (OBP) are at increased risk to develop bipolar disorder (BD). Alterations in resting-state functional connectivity (rsFC) have been identified in OBP; however, replication has been limited and correlation with person-level risk is unknown. A recent study found reduced rsFC between left inferior frontal gyrus (IFG) and clusters in the left insula (LINS), lentiform nucleus (LENT), and midcingulate cortex (MCING) in OBP (Roberts et al. 2017); here, we aim to extend these findings to at-risk youth. We scanned a subset of the Pittsburgh Bipolar Offspring Study, a longitudinal study of OBP and community controls. Twenty-four OBP, 20 offspring of control parents with non-bipolar psychopathology (OCP), and 27 healthy controls (HC) had acceptable rsFC data. After preprocessing steps, we assessed group differences in seed-based rsFC between the IFG and target clusters (LINS, LENT, MCING) using multivariate regression. Next, we tested whether rsFC correlated with person-level risk score and with other dimensional measures. We did not find group differences in rsFC between IFG and target regions. Within OBP, risk score negatively correlated with IFG-LINS rsFC (p = 0.002). Across groups, mood lability correlated negatively with rsFC between IFG and target regions (p = 0.0002), due to negative correlation with IFG-LINS (p = 0.0003) and IFG-MCING (p = 0.001) rsFC. While group-level differences were not replicated, IFG-LINS rsFC was negatively correlated with a person-level risk score in OBP and with mood lability (a predictor of BD) across the sample. Thus, IFG-LINS rsFC might constitute a risk marker, within OBP, for the development of BD.
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Affiliation(s)
- Danella M. Hafeman
- 0000 0004 1936 9000grid.21925.3dUniversity of Pittsburgh, 3811O Hara St, Pittsburgh, PA 15213 USA
| | - Henry W. Chase
- 0000 0004 1936 9000grid.21925.3dUniversity of Pittsburgh, 3811O Hara St, Pittsburgh, PA 15213 USA
| | - Kelly Monk
- 0000 0004 1936 9000grid.21925.3dUniversity of Pittsburgh, 3811O Hara St, Pittsburgh, PA 15213 USA
| | - Lisa Bonar
- 0000 0004 1936 9000grid.21925.3dUniversity of Pittsburgh, 3811O Hara St, Pittsburgh, PA 15213 USA
| | - Mary Beth Hickey
- 0000 0004 1936 9000grid.21925.3dUniversity of Pittsburgh, 3811O Hara St, Pittsburgh, PA 15213 USA
| | - Alicia McCaffrey
- 0000 0004 1936 9000grid.21925.3dUniversity of Pittsburgh, 3811O Hara St, Pittsburgh, PA 15213 USA
| | - Simona Graur
- 0000 0004 1936 9000grid.21925.3dUniversity of Pittsburgh, 3811O Hara St, Pittsburgh, PA 15213 USA
| | - Anna Manelis
- 0000 0004 1936 9000grid.21925.3dUniversity of Pittsburgh, 3811O Hara St, Pittsburgh, PA 15213 USA
| | - Cecile D. Ladouceur
- 0000 0004 1936 9000grid.21925.3dUniversity of Pittsburgh, 3811O Hara St, Pittsburgh, PA 15213 USA
| | - John Merranko
- 0000 0004 1936 9000grid.21925.3dUniversity of Pittsburgh, 3811O Hara St, Pittsburgh, PA 15213 USA
| | - David A. Axelson
- 0000 0004 0392 3476grid.240344.5Nationwide Children’s Hospital and The Ohio State University, Columbus, OH USA
| | - Benjamin I. Goldstein
- 0000 0001 2157 2938grid.17063.33Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Tina R. Goldstein
- 0000 0004 1936 9000grid.21925.3dUniversity of Pittsburgh, 3811O Hara St, Pittsburgh, PA 15213 USA
| | - Boris Birmaher
- 0000 0004 1936 9000grid.21925.3dUniversity of Pittsburgh, 3811O Hara St, Pittsburgh, PA 15213 USA
| | - Mary L. Phillips
- 0000 0004 1936 9000grid.21925.3dUniversity of Pittsburgh, 3811O Hara St, Pittsburgh, PA 15213 USA
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DeSerisy M, Hirsch E, Roy AK. The Contribution of Sensory Sensitivity to Emotional Lability in Children with ADHD Symptoms. EVIDENCE-BASED PRACTICE IN CHILD AND ADOLESCENT MENTAL HEALTH 2019; 4:319-327. [PMID: 33033744 DOI: 10.1080/23794925.2019.1647122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Emotional lability and sensory sensitivity have been shown to contribute to the overall clinical picture in children with attention deficit hyperactivity disorder (ADHD; Dunn & Bennett, 2002; Sobanski et al., 2010). Further, both of these characteristics have been individually demonstrated to contribute to poorer quality of life, increased functional impairment, and poorer treatment response (Anastopoulos et al., 2010; Boterberg & Warreyn, 2016). However, to date, no study has evaluated the relationship among all three of these factors. The current study hypothesized that increased sensory sensitivity would moderate the relationship between hyperactive/impulsive symptoms of ADHD and emotional lability in youth. Results indicate that heightened sensory sensitivity strengthens the relationship between hyperactive/impulsive symptoms of ADHD and emotional lability in children with three or more clinically impairing ADHD symptoms. This dimensional approach was taken in accordance with growing evidence that even children with sub-threshold ADHD experience significant functional impairment and high rates of sensory sensitivity (Hong et al., 2014). These findings suggest that clinicians treating children with ADHD symptoms and emotional lability should consider assessing for sensory sensitivity as integration of multi-sensory techniques or referral to concurrent occupational therapy may significantly improve treatment outcomes and quality of life for these children and their families.
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Affiliation(s)
- Mariah DeSerisy
- Department of Psychology, Fordham University, Bronx, N.Y., USA
| | - Emily Hirsch
- Department of Psychology, Fordham University, Bronx, N.Y., USA
| | - Amy Krain Roy
- Department of Psychology, Fordham University, Bronx, N.Y., USA.,Department of Child and Adolescent Psychiatry, NYU Langone School of Medicine, New York, N.Y., USA
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Theory of mind and emotion regulation difficulties in children with ADHD. Psychiatry Res 2018; 270:117-122. [PMID: 30245374 DOI: 10.1016/j.psychres.2018.09.034] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 07/15/2018] [Accepted: 09/16/2018] [Indexed: 11/23/2022]
Abstract
Social cognition deficits and emotion dysregulation (ED) are frequently separately studied in relation to ADHD. This study aimed to examine the link between theory of mind (ToM) abilities and ED in children with ADHD. Participants were 200 children aged 11-17 years (study group, n = 100; healthy controls, n = 100). Emotion regulation skills were quantified by using the Difficulties in Emotion Regulation Scale (DERS). ToM was quantified by three different tasks. Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision (DSM-IV-TR) Disruptive Behavior Disorders Rating Scale - parents form was used for determination of ADHD symptom severity (ADHD-SS). Children in the study group had more overall difficulties regulating their emotions than healthy controls. Within the study group, a significant correlation was found between the scores of DERS-total and ADHD-SS; and between the scores of DERS-total and gender. The linear regression showed that the predictor variables accounted for 56% of the variation in DERS-total. Unexpected Outcomes Test (UOT) scores significantly improved the accountability of the total variance when added to the linear regression. Our findings show that theory of mind deficits may partly explain ED in children with ADHD.
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38
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Te Brinke LW, Schuiringa HD, Menting ATA, Deković M, de Castro BO. A cognitive versus behavioral approach to emotion regulation training for externalizing behavior problems in adolescence: Study protocol of a randomized controlled trial. BMC Psychol 2018; 6:49. [PMID: 30305174 PMCID: PMC6180356 DOI: 10.1186/s40359-018-0261-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 09/20/2018] [Indexed: 12/19/2022] Open
Abstract
Background Interventions for adolescents with externalizing behavior problems are generally found to be only moderately effective, and treatment responsiveness is variable. Therefore, this study aims to increase intervention effectiveness by examining effective approaches to train emotion regulation, which is considered to be a crucial mechanism involved in the development of externalizing behavior problems. Specifically, we aim to disentangle a cognitive and behavioral approach to emotion regulation training. Methods A randomized controlled parallel-group study with two arms will be used. Participants are adolescents between 12 and 16 years old, with elevated levels of externalizing behavior problems. Participants will be randomly assigned to either the control condition or the intervention condition. Participants in the intervention condition receive both a cognitive and behavioral emotion regulation module, but in different sequences. Primary outcome measures are emotion regulation skills, emotion regulation strategies, and externalizing behavior problems. Questionnaires will be completed at pre-test, in-between modules, and post-test. Moreover, intensive longitudinal data is collected, as adolescents will complete weekly and daily measures. Discussion Gaining insight into which approaches to emotion regulation training are more effective, and for whom, is important because it may lead to the adaptation of effective intervention programs for adolescents with externalizing behavior problems. Eventually, this could lead to individually tailored evidence-based interventions. Trial registration The trial is registered at the Central Committee on Research Involving Human Subjects (NL61104.041.17, September 20th, 2017) and the Dutch Trial Register (NTR7334, July 10th, 2018).
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Affiliation(s)
- L W Te Brinke
- Department of Developmental Psychology, Utrecht University, Heidelberglaan 1, 3584, CS, Utrecht, The Netherlands. .,Utrecht University, PO BOX 80140, 3508, TC, Utrecht, The Netherlands.
| | - H D Schuiringa
- Department of Developmental Psychology, Utrecht University, Heidelberglaan 1, 3584, CS, Utrecht, The Netherlands
| | - A T A Menting
- Department of Developmental Psychology, Utrecht University, Heidelberglaan 1, 3584, CS, Utrecht, The Netherlands
| | - M Deković
- Department of Clinical Child and Family Studies, Utrecht University, Heidelberglaan 1, 3584, CS, Utrecht, The Netherlands
| | - B O de Castro
- Department of Developmental Psychology, Utrecht University, Heidelberglaan 1, 3584, CS, Utrecht, The Netherlands
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Franke B, Michelini G, Asherson P, Banaschewski T, Bilbow A, Buitelaar JK, Cormand B, Faraone SV, Ginsberg Y, Haavik J, Kuntsi J, Larsson H, Lesch KP, Ramos-Quiroga JA, Réthelyi JM, Ribases M, Reif A. Live fast, die young? A review on the developmental trajectories of ADHD across the lifespan. Eur Neuropsychopharmacol 2018; 28:1059-1088. [PMID: 30195575 PMCID: PMC6379245 DOI: 10.1016/j.euroneuro.2018.08.001] [Citation(s) in RCA: 320] [Impact Index Per Article: 53.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 06/25/2018] [Accepted: 08/07/2018] [Indexed: 02/07/2023]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is highly heritable and the most common neurodevelopmental disorder in childhood. In recent decades, it has been appreciated that in a substantial number of cases the disorder does not remit in puberty, but persists into adulthood. Both in childhood and adulthood, ADHD is characterised by substantial comorbidity including substance use, depression, anxiety, and accidents. However, course and symptoms of the disorder and the comorbidities may fluctuate and change over time, and even age of onset in childhood has recently been questioned. Available evidence to date is poor and largely inconsistent with regard to the predictors of persistence versus remittance. Likewise, the development of comorbid disorders cannot be foreseen early on, hampering preventive measures. These facts call for a lifespan perspective on ADHD from childhood to old age. In this selective review, we summarise current knowledge of the long-term course of ADHD, with an emphasis on clinical symptom and cognitive trajectories, treatment effects over the lifespan, and the development of comorbidities. Also, we summarise current knowledge and important unresolved issues on biological factors underlying different ADHD trajectories. We conclude that a severe lack of knowledge on lifespan aspects in ADHD still exists for nearly every aspect reviewed. We encourage large-scale research efforts to overcome those knowledge gaps through appropriately granular longitudinal studies.
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Affiliation(s)
- Barbara Franke
- Department of Human Genetics, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Giorgia Michelini
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, Social, Genetic & Developmental Psychiatry Centre, London, UK
| | - Philip Asherson
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, Social, Genetic & Developmental Psychiatry Centre, London, UK
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Andrea Bilbow
- Attention Deficit Disorder Information and Support Service (ADDISS), Edgware, UK; ADHD-Europe, Brussels, Belgium
| | - Jan K Buitelaar
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Cognitive Neuroscience, Nijmegen, The Netherlands
| | - Bru Cormand
- Department of Genetics, Microbiology and Statistics, Faculty of Biology, Universitat de Barcelona, Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, Spain; Institut de Biomedicina de la Universitat de Barcelona (IBUB), Barcelona, Catalonia, Spain; Institut de Recerca Sant Joan de Déu (IR-SJD), Esplugues de Llobregat, Catalonia, Spain
| | - Stephen V Faraone
- Departments of Psychiatry and of Neuroscience and Physiology, State University of New York Upstate Medical University, New York, USA; K.G. Jebsen Centre for Neuropsychiatric Disorders, Department of Biomedicine, University of Bergen, Bergen, Norway
| | - Ylva Ginsberg
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
| | - Jan Haavik
- K.G. Jebsen Centre for Neuropsychiatric Disorders, Department of Biomedicine, University of Bergen, Bergen, Norway; Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Jonna Kuntsi
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, Social, Genetic & Developmental Psychiatry Centre, London, UK
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
| | - Klaus-Peter Lesch
- Division of Molecular Psychiatry, Center of Mental Health, University of Würzburg, Würzburg, Germany; Laboratory of Psychiatric Neurobiology, Institute of Molecular Medicine, I.M. Sechenov First Moscow State Medical University, Moscow, Russia; Department of Translational Neuroscience, School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, The Netherlands
| | - J Antoni Ramos-Quiroga
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain; Psychiatric Genetics Unit, Vall d'Hebron Research Institute (VHIR), Barcelona, Catalonia, Spain; Biomedical Network Research Centre on Mental Health (CIBERSAM), Barcelona, Catalonia, Spain; Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - János M Réthelyi
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary; MTA-SE NAP-B Molecular Psychiatry Research Group, Hungarian Academy of Sciences, Budapest, Hungary
| | - Marta Ribases
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain; Psychiatric Genetics Unit, Vall d'Hebron Research Institute (VHIR), Barcelona, Catalonia, Spain; Biomedical Network Research Centre on Mental Health (CIBERSAM), Barcelona, Catalonia, Spain
| | - Andreas Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Frankfurt am Main, Germany
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Uçar HN, Vural AP. Irritability and Parenting Styles in Adolescents With Attention-Deficit/Hyperactivity Disorder: A Controlled Study. J Psychosoc Nurs Ment Health Serv 2018; 56:33-43. [PMID: 29667700 DOI: 10.3928/02793695-20180412-02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Accepted: 02/22/2018] [Indexed: 11/20/2022]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) affects functioning of the family, decreasing interactions and loyalty and increasing conflict between adolescents with ADHD and their families. Irritable mood and difficulties with emotional dysregulation are common in children with ADHD. The objective of the current study was to assess levels of irritability in adolescents with ADHD using self- and parent-report scales, and investigate the relationship between irritability levels and parental attitudes. A total of 47 adolescents with ADHD and 39 adolescents with typical development participated in the current study. Findings demonstrated that higher levels of parent-reported irritability were associated with decreased egalitarian attitudes in the ADHD group. Although other parental attitudes were not associated with self- and parent-reported irritability, evaluation of the relationship between parental attitudes and irritability in adolescents with ADHD, which can guide diagnosis and treatment of ADHD, is of critical importance. [Journal of Psychosocial Nursing and Mental Health Services, 56(9), 33-43.].
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O'Donnell LA, Ellis AJ, Van de Loo MM, Stange JP, Axelson DA, Kowatch RA, Schneck CD, Miklowitz DJ. Mood instability as a predictor of clinical and functional outcomes in adolescents with bipolar I and bipolar II disorder. J Affect Disord 2018; 236:199-206. [PMID: 29747137 PMCID: PMC5997484 DOI: 10.1016/j.jad.2018.04.021] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 03/02/2018] [Accepted: 04/02/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND Traditional assessment and treatment of bipolar disorder (BD) often overlooks an important feature of the illness, mood instability (MI). MI - the presence of intense, rapidly shifting emotional states - is associated with a number of poor prognostic outcomes. This study examined whether MI among adolescents with BD was cross-sectionally related to bipolar subtype (I vs. II) and prognostically associated with symptoms and functioning over 3 months. METHODS Participants included 145 adolescents (mean age: 15.6 years ± 1.4) with BD I or II with a mood episode in the previous 3 months. Depression and (hypo)mania instability were computed using the root mean square successive difference (rMSSD) score, reflecting both the size and temporal order of changes in weekly depression and (hypo)mania scores (over 12 weeks) from the Adolescent Longitudinal Interval Follow-Up Evaluation. RESULTS Greater depression instability was associated with BD II, whereas greater (hypo)mania instability was associated with BD I. Baseline MI, particularly depression, predicted more instability, a higher percentage of weeks in a clinical mood state, and poorer global functioning over 3 months, even when covarying concurrent mood severity scores. LIMITATIONS The clinical measure of symptoms used retrospective reports of clinically significant symptoms only. We were unable to standardize medication use or adherence. CONCLUSIONS MI differs by diagnostic subtype, is relatively stable over time, and predicts clinical and functional outcomes. Targeting MI should be considered a clinical focus to augment traditional methods of assessing and treating BD during adolescence to enhance clinical and functional outcomes.
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Affiliation(s)
- Lisa A O'Donnell
- School of Social Work, Wayne State University, Detroit, MI, USA.
| | - Alissa J Ellis
- Semel Institute, University of California, Los Angeles, CA, USA
| | | | | | - David A Axelson
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Robert A Kowatch
- The Ohio State University College of Medicine, Columbus, OH, USA
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Bailen NH, Green LM, Thompson RJ. Understanding Emotion in Adolescents: A Review of Emotional Frequency, Intensity, Instability, and Clarity. EMOTION REVIEW 2018. [DOI: 10.1177/1754073918768878] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Adolescence is a time of transition from childhood to adulthood during which significant changes occur across multiple domains, including emotional experience. This article reviews the relevant literature on adolescents’ experience of four specific dimensions of emotion: emotional frequency, intensity, instability, and clarity. In an effort to examine how emotional experiences change as individuals approach adulthood, we examine these dimensions across ages 10 to 19, and review how the emotional functioning of adolescents compares to that of adults. In addition, we explore whether and how gender and puberty explain age differences in emotional experience. Finally, we discuss how these findings could inform future research on both the typical trajectory of emotional experience and the development of psychopathology in adolescence.
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Affiliation(s)
- Natasha H. Bailen
- Department of Psychological and Brain Sciences, Washington University in St. Louis, USA
| | - Lauren M. Green
- Department of Psychological and Brain Sciences, Washington University in St. Louis, USA
- Missouri Institute of Mental Health, University of Missouri – St. Louis, USA
| | - Renee J. Thompson
- Department of Psychological and Brain Sciences, Washington University in St. Louis, USA
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Stringaris A, Vidal-Ribas P, Brotman MA, Leibenluft E. Practitioner Review: Definition, recognition, and treatment challenges of irritability in young people. J Child Psychol Psychiatry 2018; 59:721-739. [PMID: 29083031 DOI: 10.1111/jcpp.12823] [Citation(s) in RCA: 117] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/29/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Irritability is one of the most common reasons for referral to child and adolescent mental health services and is the main characteristic of the new diagnosis of disruptive mood dysregulation disorder (DMDD). However, the recognition and management of irritability presents a major challenge in clinical practice and may be partly responsible for the dramatic increase in antipsychotic prescribing in recent years. METHODS In this review, we provide up-to-date information on the definition and mechanisms underlying irritability, and its assessment in clinical practice. We aim to discuss the latest research on DMDD, and the presence of severe irritability in the context of other disorders, as well as to recommend a treatment algorithm. RESULTS Severe irritability is associated with aberrant reward processing and bias toward threatening stimuli. Several measures are available to easily assess irritability. The recent diagnosis of DMDD captures children whose main problem is severe irritability and differ from those with bipolar disorder in longitudinal outcomes, family history, and behavioral and neural correlates. Treatment of irritability might depend on the context it appears. Indirect evidence suggests that parent management training (PMT) and cognitive behavioral therapy (CBT) are the most supported psychological treatments for irritability. CONCLUSIONS Irritability, recognized as a mood problem rather than a purely behavioral manifestation, is a common condition for young people. Practitioners should not ignore irritability as it is associated with substantial morbidity and impairment. Although there are no trials with irritability as main outcome, clinicians can apply several existing pharmacological and psychological interventions for its treatment. Also, new promising approaches relying on pathophysiological findings, such as exposure-based cognitive behavioral therapy techniques and interpretation bias training (IBT), are being currently investigated.
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Affiliation(s)
- Argyris Stringaris
- Mood Brain and Development Unit, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
| | - Pablo Vidal-Ribas
- Mood Brain and Development Unit, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA.,Institute of Psychiatry, Psychology and Neuroscience, Department of Child and Adolescent Psychiatry, King's College London, London, UK
| | - Melissa A Brotman
- Section on Mood Dysregulation and Neuroscience, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
| | - Ellen Leibenluft
- Section on Mood Dysregulation and Neuroscience, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
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Humphreys KL, Schouboe SNF, Kircanski K, Leibenluft E, Stringaris A, Gotlib IH. Irritability, Externalizing, and Internalizing Psychopathology in Adolescence: Cross-Sectional and Longitudinal Associations and Moderation by Sex. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2018; 48:781-789. [PMID: 29667523 DOI: 10.1080/15374416.2018.1460847] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Irritability is a common feature of many psychiatric disorders, including both externalizing and internalizing disorders. There is little research, however, examining associations between irritability and these symptom domains, particularly during the important developmental period of adolescence, characterized by sex differences in the prevalence of disorders. We examined the cross-sectional associations between irritability, measured with the Affective Reactivity Index, and symptoms of externalizing and internalizing domains of psychopathology, measured with the Youth Self Report, in a volunteer community sample (N = 183) of 9- to 13-year-old (M = 11.39, SD = 1.07) boys and girls (37% White/Caucasian, 8% Asian, 11% Hispanic, 8% African American, 2% Native American, 2% Pacific Islander, 28% Other, and 3% not reported). A subset of the sample (n = 112) provided data at a 2-year follow-up, used to extend these associations. There were no sex differences in levels of irritability; however, the associations between irritability and symptom domains were moderated by sex. Specifically, in girls, irritability was associated equally with externalizing and internalizing symptoms. In contrast, in boys, irritability was associated more strongly with externalizing symptoms than with internalizing symptoms. Thus, across both sexes, irritability was moderately associated with externalizing symptoms, but the association between irritability and internalizing symptoms was stronger in girls than in boys. At follow-up, sex moderated the association between baseline irritability and later externalizing and internalizing symptoms. These findings indicate that irritability is associated with both externalizing and internalizing symptoms in early adolescence and that irritability is associated with internalizing symptoms more strongly in girls than in boys.
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Affiliation(s)
| | | | | | - Ellen Leibenluft
- Emotion and Development Branch, National Institute of Mental Health
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45
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Villalta L, Smith P, Hickin N, Stringaris A. Emotion regulation difficulties in traumatized youth: a meta-analysis and conceptual review. Eur Child Adolesc Psychiatry 2018; 27:527-544. [PMID: 29380069 DOI: 10.1007/s00787-018-1105-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 01/03/2018] [Indexed: 11/27/2022]
Abstract
This article provides a quantitative and conceptual review of emotion regulation difficulties in trauma-exposed young people, and informs future directions in the field. Despite long-standing interest in the influence of emotion regulation difficulties on different internalizing and externalizing psychiatric disorders in childhood, several questions remain unresolved with respect to children and adolescents with PTSD (post-traumatic stress disorder). Meta-analytic data from adult victims suggest that emotion regulation problems are associated with PTSD, but this has never been studied in children and young people. We therefore provide a conceptual review of features related to the phenomenology, assessment, severity and treatment of emotion regulation difficulties in trauma-exposed children and young people. We combine this with a meta-analysis of published literature. We searched studies in Medline, PsychINFO, and Embase databases based on pre-selected criteria. Eight hundred and eighty-six papers were identified and 41 were included. We found that children and adolescents with a diagnosis of PTSD reported more emotion regulation difficulties than those who did not develop PTSD, and that the overall association between the two symptom dimensions was moderately strong. We identify a number of research priorities: the development of instruments to assess emotion regulation difficulties in children, the design of studies that describe its prevalence in young epidemiological traumatized samples, its predictive role in the onset, severity and persistence of post-traumatic symptoms, and its relevance as a moderator, outcome or treatment target for young survivors.
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Affiliation(s)
- L Villalta
- Child and Adolescent Psychiatry Department, Hospital Sant Joan de Deu, Passeig de Sant Joan de Déu, 2, Esplugues de Llobrega, 08950, Barcelona, Spain.
| | - P Smith
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - N Hickin
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - A Stringaris
- Mood Brain & Development Unit, Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
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Kunze B, Wang B, Isensee C, Schlack R, Ravens-Sieberer U, Klasen F, Rothenberger A, Becker A. Gender associated developmental trajectories of SDQ-dysregulation profile and its predictors in children. Psychol Med 2018; 48:404-415. [PMID: 28637519 DOI: 10.1017/s0033291717001714] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Severe mood dysregulation is common in childhood and can be highly impairing. The Dysregulation Profile (DP) can be considered as a broader phenotype of emotional dysregulation, including affect, cognition and behaviour. Since mood dysregulation may persist, but differently in boys and girls, the gender associated course needs to be considered longitudinally to gain a better insight in order to support the children more adequately. This study is focusing on gender associated subgroup trajectories of the Strengths and Difficulties Questionnaire-Dysregulation Profile (SDQ-DP) in middle childhood (9-13 years of age) and includes the potential impact of clinical and psychosocial characteristics. METHOD The data set was available from the BELLA study on mental health and well-being in children and adolescents, which is the mental health module of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). A representative epidemiological sample of 564 children living in Germany was examined at three assessment points over 2 years (data collection 2003-2006). The SDQ-DP of children aged 9-13 years was evaluated using Latent Class Growth Analysis (LCGA). RESULTS For both genders three trajectories with low (girls 67.0% and boys 59.5%), moderate (girls 28.0% and boys 31.7%) and high SDQ-DP (girls 5.0% and boys 8.8%) scores were detected. The courses of low and moderate subgroups were stable, while in the high SDQ-DP subgroup boys showed a decreasing and girls an increasing trend in symptom severity on a descriptive level. The results of the multinomial logistic regression analyses revealed a significant influence of mainly externalising but also internalising problems both increasing the risk of moderate and high SDQ-DP in both genders. Good quality of life was a protective factor for the SDQ-DP course in all subgroups. CONCLUSION In addition to the known clinical and scientific value of the SDQ-DP, three distinguishable trajectories of SDQ-DP in boys and girls could be found. High externalising problems at the beginning of the trajectory were associated with an undesirable course of SDQ-DP. These findings might be helpful for better psychoeducation, counselling and monitoring in clinical cases and public health.
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Affiliation(s)
- B Kunze
- Clinic for Child and Adolescent Psychiatry and Psychotherapy,University Medical Center Göttingen,Germany
| | - B Wang
- Clinic for Child and Adolescent Psychiatry and Psychotherapy,University Medical Center Göttingen,Germany
| | - C Isensee
- Clinic for Child and Adolescent Psychiatry and Psychotherapy,University Medical Center Göttingen,Germany
| | - R Schlack
- Robert Koch Institute,Department of Epidemiology and Health Monitoring,Berlin,Germany
| | - U Ravens-Sieberer
- Department of Child and Adolescent Psychiatry and Psychotherapy,University Medical Center Hamburg- Eppendorf,Germany
| | - F Klasen
- Department of Child and Adolescent Psychiatry and Psychotherapy,University Medical Center Hamburg- Eppendorf,Germany
| | - A Rothenberger
- Clinic for Child and Adolescent Psychiatry and Psychotherapy,University Medical Center Göttingen,Germany
| | - A Becker
- Clinic for Child and Adolescent Psychiatry and Psychotherapy,University Medical Center Göttingen,Germany
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Physiological Emotion Regulation in Children with ADHD with and without Comorbid Internalizing Disorders: a Preliminary Study. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2018. [DOI: 10.1007/s10862-018-9644-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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48
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Bottelier MA, Schrantee A, Ferguson B, Tamminga HGH, Bouziane C, Kooij JJS, de Ruiter MB, Reneman L. Age-dependent effects of acute methylphenidate on amygdala reactivity in stimulant treatment-naive patients with Attention Deficit/Hyperactivity Disorder. Psychiatry Res Neuroimaging 2017; 269:36-42. [PMID: 28938219 DOI: 10.1016/j.pscychresns.2017.09.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 09/06/2017] [Accepted: 09/10/2017] [Indexed: 11/18/2022]
Abstract
In the present study, we investigate whether methylphenidate (MPH) affects emotional processing and whether this effect is modulated by age. We measured amygdala reactivity with functional Magnetic Resonance Imaging (fMRI) during processing of angry and fearful facial expressions in male stimulant treatment-naive patients with ADHD (N = 35 boys; N = 46 men) and 23 healthy control subjects (N = 11 boys; N = 12 men). In ADHD patients, we also measured amygdala reactivity 90min after an acute oral challenge with MPH (0.5mg/kg). Mean amygdala reactivity was analyzed for all subjects using a repeated measures analysis of variance (ANOVA). Whole-brain maps were analyzed for the patients only. At baseline, we found a age*diagnosis effect approaching significance (p = 0.05) in the right amygdala due to lower reactivity in children with Attention Deficit/Hyperactivity Disorder (ADHD) vs. controls (-31%), but higher reactivity in adults with ADHD vs. controls (+31%). MPH significantly reduced right amygdala reactivity in all patients, resulting in further reductions in children. In the left amygdala, reduction of amygdala reactivity was confined to adult ADHD patients whereas there was no change in children with ADHD. MPH-induced decrease of amygdala reactivity in adults might be a promising avenue for managing emotional dysregulation when replicated for chronic MPH treatment.
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Affiliation(s)
- Marco A Bottelier
- Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Brain Imaging Center, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Department of Child, and Adolescent Psychiatry, Triversum, Alkmaar, The Netherlands
| | - Anouk Schrantee
- Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Brain Imaging Center, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Amsterdam Brain and Cognition, University of Amsterdam, Amsterdam, The Netherlands
| | - Bart Ferguson
- Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Brain Imaging Center, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Brain Center Rudolph Magnus, Department of Psychiatry, University Medical Center, Utrecht, The Netherlands
| | - Hyke G H Tamminga
- Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Dutch Autism and ADHD research center, University of Amsterdam, Amsterdam, The Netherlands
| | - Cheima Bouziane
- Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Brain Imaging Center, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - J J Sandra Kooij
- PsyQ, psycho-medical programs, Expertise Center Adult ADHD, Den Haag, The Netherlands
| | - Michiel B de Ruiter
- Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Brain Imaging Center, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Liesbeth Reneman
- Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Brain Imaging Center, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Amsterdam Brain and Cognition, University of Amsterdam, Amsterdam, The Netherlands.
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Villemonteix T, Marx I, Septier M, Berger C, Hacker T, Bahadori S, Acquaviva E, Massat I. Attentional control of emotional interference in children with ADHD and typically developing children: An emotional N-back study. Psychiatry Res 2017; 254:1-7. [PMID: 28437666 DOI: 10.1016/j.psychres.2017.04.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 02/28/2017] [Accepted: 04/15/2017] [Indexed: 10/19/2022]
Abstract
Emotional interference control refers to the ability to remain focused on goal-oriented processes when confronted with disrupting but irrelevant emotional stimuli, a process that may be impaired in children and adults with attention deficit/hyperactivity disorder (ADHD). However, emotional interference levels are known to be associated with trait anxiety, and patients with ADHD often display elevated levels of trait anxiety, such as these may have confounded previous findings of decreased emotional interference control in this population. In the present study, male and female 8-13 years old (mean =11.0 years) children with ADHD (n=33) and typically developing (TD) children (n=24) performed a visual emotional working memory (n-back) task with 2 memory loads and three different background pictures (neutral/positive/negative), and trait anxiety measures were obtained. Children with ADHD performed less well, and displayed increased emotional interference in the presence of aversive distractors when compared with TD children. Contrary to our expectations, trait anxiety did not mediate the association between diagnostic group membership and the degree of emotional interference control; however, co-morbid ODD was associated with decreased levels of emotional interference in ADHD. Future research should aim at characterizing the mechanisms subtending decreased emotional interference control in the ADHD population.
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Affiliation(s)
- Thomas Villemonteix
- EA 2007, Psychopathology and Neuropsychology Lab., Université Paris 8, Saint-Denis, France; UR2NF - Neuropsychology and Functional Neuroimaging Research Unit, Centre de Recherche Cognition et Neurosciences, Université Libre de Bruxelles (ULB), Bruxelles, Belgium.
| | - Ivo Marx
- Department of Child and Adolescent Psychiatry, Neurology, Psychosomatics and Psychotherapy, University Medicine Rostock, Rostock, Germany
| | - Mathilde Septier
- Assistance Publique-Hôpitaux de Paris, Department of Child and Adolescent Psychiatry, Robert-Debré Hospital, Paris, France; Inserm, U894, Psychiatry and NeurosciXence Center, Paris, France
| | - Christoph Berger
- Department of Child and Adolescent Psychiatry, Neurology, Psychosomatics and Psychotherapy, University Medicine Rostock, Rostock, Germany
| | - Thomas Hacker
- Department of Psychiatry and Psychotherapy, University Medicine Rostock, Rostock, Germany
| | - Sara Bahadori
- Assistance Publique-Hôpitaux de Paris, Department of Child and Adolescent Psychiatry, Robert-Debré Hospital, Paris, France; Inserm, U894, Psychiatry and NeurosciXence Center, Paris, France
| | - Eric Acquaviva
- Assistance Publique-Hôpitaux de Paris, Department of Child and Adolescent Psychiatry, Robert-Debré Hospital, Paris, France
| | - Isabelle Massat
- UR2NF - Neuropsychology and Functional Neuroimaging Research Unit, Centre de Recherche Cognition et Neurosciences, Université Libre de Bruxelles (ULB), Bruxelles, Belgium; Laboratory of Experimental Neurology, ULB, Bruxelles, Belgium; National Fund of Scientific Research (FNRS) Belgium
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50
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Maire J, Galéra C, Meyer E, Salla J, Michel G. Is emotional lability a marker for attention deficit hyperactivity disorder, anxiety and aggression symptoms in preschoolers? Child Adolesc Ment Health 2017; 22:77-83. [PMID: 32680322 DOI: 10.1111/camh.12168] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/06/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Emotional lability (EL) is frequent in school-aged children with attention deficit hyperactivity disorder (ADHD) and is associated with more frequent comorbidities and more severe impairment. However, little research has investigated the association between EL, ADHD and comorbid symptoms in preschoolers. This study assessed dimensional EL in preschoolers and its link with ADHD symptoms (e.g. hyperactivity-impulsivity and inattention) and behavioural and emotional problems (e.g. aggression and anxiety). METHOD One hundred and fifty-four preschoolers aged 3-6 years old were rated on questionnaires by parents. EL was assessed with the index from the Conners Rating Scale-Revised and behavioural and emotional problems with an adapted version of the Social Behavior Questionnaire. Multiple linear regressions analyses were conducted. RESULTS Higher EL was associated with higher hyperactivity-impulsivity, inattention, anxiety and aggression problems. After controlling for other behavioural and emotional problems and sociodemographic variables, EL remained associated with hyperactivity-impulsivity and anxiety. CONCLUSIONS Emotional lability seems to be a potential marker for ADHD symptoms with internalizing problems in preschoolers and could be a target for diagnosis and early interventions. This finding should be treated with caution as the study was limited by the low response rate of the participants and consequently the small sample size.
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Affiliation(s)
- Jenna Maire
- Department Health and Achievement in the Young, Center for Research Bordeaux Population Health, INSERM U1219, 33076, Bordeaux Cedex, France
| | - Cédric Galéra
- Department Health and Achievement in the Young, Center for Research Bordeaux Population Health, INSERM U1219, 33076, Bordeaux Cedex, France
| | - Eric Meyer
- Department Health and Achievement in the Young, Center for Research Bordeaux Population Health, INSERM U1219, 33076, Bordeaux Cedex, France
| | - Julie Salla
- Department Health and Achievement in the Young, Center for Research Bordeaux Population Health, INSERM U1219, 33076, Bordeaux Cedex, France
| | - Grégory Michel
- Department Health and Achievement in the Young, Center for Research Bordeaux Population Health, INSERM U1219, 33076, Bordeaux Cedex, France
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