Parent-adolescent conflict in teenagers with ADHD and ODD

Interpersonal Competence: A Mediator Between ODD Problems and Parent-Child Relationship Discord

A central requirement of Oppositional Defiant Disorder (ODD) consists of difficulties with interpersonal relationships. As emerging adults' transition into adulthood and seek more autonomy from parents, it is important to examine how ODD problems and parent-child discord are indirectly associated through interpersonal competencies. The current study examined the indirect effects between ODD problems in emerging adults and parent-child discord through multiple interpersonal competencies as well as the additional differences among parent-child gender dyads. Emerging adults (N = 599 individuals aged 18 to 25 years; M = 19.60, SD = 1.40; 68% females) were recruited via an online research platform and completed online survey measures of ODD problems, parent-child relationship discord, and interpersonal competence. Indirect effects were significant for the mother-daughter dyad only. Additional results, limitations, and implications are discussed.

Are Discrepancies Between Father and Adolescent Perceptions of Harsh Parenting and Conflict Associated with Adolescent Mental Health Symptoms?

Though differences in informant perceptions of family processes are associated with poorer health, few studies have examined discrepancies between father- and adolescent-report of family phenomena and their impact on adolescent mental health. This study examined how father and adolescent-reported parenting and the differences in their perceptions is related to adolescent mental health. Participants were 326 father-adolescent dyads (Fathers: Mage = 41.2; Adolescents: 7th grade students, Mage = 12.0, 48.5% female). Overall, analyses revealed significant main effects of father and/or adolescent report of father-adolescent conflict and harsh parenting on adolescent internalizing and externalizing symptoms. Analyses revealed two instances in which discrepancies between father- and adolescent-report of family phenomena was related to adolescent mental health. Given the mixed nature of the findings based on the outcome reporter, the current study discusses implications for discrepancy research and future directions to better understand discrepant perceptions as useful information on their own. The parent clinical trial is registered at ClinicalTrials.gov (Identifier: NCT03125291, Registration date: 4/13/2017).

Generating mutual support in multifamily therapy to promote father involvement and family communication quality of Chinese families of adolescents with attention deficit hyperactivity disorder: A qualitative study

Previous studies have suggested the negative impacts of attention deficit hyperactivity disorder (ADHD) on parent-adolescent interactions. Yet engaging parents, particularly the fathers, to participate in family-based interventions has been challenging in Chinese contexts given the traditional concerns about keeping the family's "face" and the influence of affiliate stigma. Empirical evidence supports multifamily therapy as an effective modality for parental engagement. This study explores the role of mutual support in promoting parental engagement and family communication quality of Chinese families of adolescents with ADHD. Inclusion criteria of the study were (a) Chinese family of at least one adolescent child having an ADHD diagnosis, (b) the adolescent child was aged between 11 and 15 years, and (c) the family participated in a multifamily therapy program. Families who had not completed a multifamily therapy program were excluded. Fourteen Chinese families of adolescents with ADHD who participated in a pilot multifamily therapy program from June 2017 to September 2018 were recruited for this qualitative study. Photo-elicited parent focus groups and photo-elicited individual interviews with adolescents were conducted. The thematic analysis revealed that a low level of hierarchy in the therapist-client relationship contributed to the building of mutual support among the families in the therapy process. The mutual support was found to play a key role in promoting acceptance, father involvement, and open communication within families of adolescents with ADHD. Discussion was conducted on the importance of the nonexpert stance of the therapist for promoting mutual support among Chinese families in a multifamily therapy process.

Unidirectional or Bidirectional? Relation between Parental Responsiveness and Emotion Regulation in Children with and without Oppositional Defiant Disorder

Parenting is crucial for emotion regulation in children. Much less is known, however, concerning the association between parenting and emotion regulation in children with oppositional defiant disorder (ODD), who are known to have poor emotion regulation. The current study aimed to examine how parental responsiveness and child emotion regulation related either unidirectionally or bidirectionally to one another over time and to investigate whether the associations were different in ODD and non-ODD groups. Data were collected each year for three consecutive years from a sample of 256 parents of children with ODD and 265 parents of children without ODD in China. The results from the random intercepts cross-lagged panel model (RI-CLPM) suggested that the directionality of the link between parental responsiveness and child emotion regulation differs according to ODD status. The non-ODD group demonstrated a unidirectional link between early emotion regulation and subsequent parental responsiveness, consistent with the "child effect". However, in the ODD group, the link between parental responsiveness and emotion regulation was transactional, in line with social coercion theory. Multiple-group comparisons found that increased parental responsiveness was more strongly associated with improved child emotion regulation in the ODD group only. The research established a dynamic and longitudinal relationship between parental responsiveness and emotion regulation and suggested that intensive interventions should aim to improve parental responsiveness to children with ODD.

ADHD and reification: Four ways a psychiatric construct is portrayed as a disease

Introduction

The descriptive classification Attention-Deficit/Hyperactivity Disorder (ADHD) is often mistaken for a disease entity that explains the causes of inattentive and hyperactive behaviors, rather than merely describing the existence of such behaviors. The present study examines discourse on ADHD to analyze how authors passively and actively contribute to reification-a fallacy in which a concept is represented as a thing existing on its own.

Methods

Critical Discourse Analysis and Qualitative Content Analysis of academic textbooks, scientific articles, websites and videos were used to analyze how ADHD is reified.

Results

The analyses reveal four ways in which inattentive and restless behaviors are presented as an entity by means of the ADHD classification: language choice, logical fallacies, genetic reductionism, and textual silence. First, language choice, such as medical jargon and metaphors aid in representing ADHD as a disease entity. Second, several logical fallacies do the same, including the relatively unknown "ecological fallacy" that refers to the erroneous belief that average group findings, such as average brain size of groups of those with an ADHD classification, can be applied on an individual level. Third, genetic reductionism is often achieved by overstating the results of twin studies and being silent about the disappointing molecular genetic research. Such textual silence is the last identified mechanism of reification and includes instances in which societal factors that affect the ADHD construct are often omitted from texts, thereby obscuring the extent to which ADHD is a limited heuristic.

Discussion

It is essential that discourse communities do not repeat these four ways of reifying behavior and social relations into an alleged entity with the acronym ADHD. The errors and habits of writing may be epistemologically violent by influencing how laypeople and professionals see children and ultimately how children may come to see themselves in a negative way. Beyond that, if the institutional world shaped to help children is based on misguided assumptions, it may cause them harm and help perpetuate the misguided narrative. To counter the dominant, reifying and medicalizing view, guidelines such as the recently published "Dutch ADHD Psychoeducation Guidelines" might be helpful.

School attendance problems in adolescent with attention deficit hyperactivity disorder

Introduction: A link between having a neurodevelopmental disorder, such as attention deficit hyperactivity disorder (ADHD) and school absenteeism, has been found in previous studies. Why ADHD poses a risk for absenteeism remains unclear, and insight into the mechanisms of the association is needed. The aim of the present study was to investigate school attendance problems (SAP) and both the symptoms related and the perceived reasons for them, as reported by adolescents with ADHD (n = 95), compared with neurotypical adolescents (n = 1,474). Method: The current study (N = 1,569) was part of the School absence in Finland-project. SAPs were measured with the Inventory of School Attendance Problems (ISAP). The ISAP questionnaire contains a symptom scale (ISAP S) and a function scale (ISAP F), which shows if and how the symptoms impacts school attendance. A linear mixed effects model was used to analyze outcomes on the ISAP factors, controlling for background variables living status, gender, other diagnoses, highest level of education for the parent and age. Results: Results show that adolescents with ADHD had been more absent from school compared to neurotypical adolescents during the prior 12-weeks. Adolescents with ADHD showed significantly more symptoms of agoraphobia/panic, problems within the family and problems with parents than neurotypical peers. The symptoms separation anxiety, agoraphobia/panic, aggression, problems within the family and problems with parents more often were perceived as the reason for SAP (ISAP F). Discussion: The results are in line with our initial hypotheses and previous studies. Because of the low response rate on the ISAP F scale, the results regarding reasons for SAPs should be interpreted with caution. Future research could examine specific preventive actions of SAPs for adolescents with ADHD, and different subtypes of ADHD.

Psychosocial functioning of adolescents with ADHD in the family, school and peer group: A scoping review protocol

Objective

The objective of this scoping review is to investigate what is known about the psychosocial functioning of adolescents with ADHD. All basic life environments (family, school and peer group) will be considered.

Introduction

Adolescence is especially critical for people with ADHD–natural maturation may be accompanied by changing symptoms of ADHD. A number of childhood difficulties transform during adolescence and contribute to problems in various areas that comprise psychosocial functioning. The available studies focus on selected domains of psychosocial functioning of adolescents with ADHD, however, to the authors’ best knowledge, there is no comprehensive description of this issue. The lack of such a description is the main rationale for conducting this scoping review.

Inclusion criteria

Pointing to the PCC elements (population, concept, context), the scoping review will include primary studies on the concept of psychosocial functioning (including functioning in the family, school and peer group). In the included studies, the term "psychosocial functioning" (or related) had to be used explicitly. The population will be adolescents (10 to 19 years old) with a formal diagnosis of ADHD (DSM classification) or Hyperkinetic Syndrome (ICD-9) or Hyperkinetic Disorders (ICD-10). There will be no restrictions on the research context.

Methods

The methodology of scoping reviews will be applied in accordance with the guidelines of the Joanna Briggs Institute (JBI). The following databases: Academic Search Ultimate, ERIC, MEDLINE, ProQuest Central, PsycInfo, Scopus, and databases under the Web of Science will be searched for primary studies in peer-reviewed journals, written in English and published since 1987. The analyses will be based mainly on frequency counts of the components of psychosocial functioning and population characteristics. The results will be presented in tabular form and supplemented with a descriptive summary. The protocol has been registered on the Open Science Framework: https://doi.org/10.17605/OSF.IO/MS82H [registration DOI].

The link between school climate and mental health among an ethnically diverse sample of middle school youth

School climate consistently relates to adolescent adjustment across academic, socioemotional, and behavioral domains. Although past research highlights the impact of school climate on youths' experience of internalizing symptoms and violent behavior, examination of potential links with specific externalizing processes is limited. The current study examined associations between middle school students' perceived school climate and internalizing and externalizing mental health symptoms. A positive school climate was hypothesized to be inversely related to all mental health measures. Seventh grade students (N = 2768; 50% female) were recruited from 24 Texas middle schools. Participants completed baseline self-reports of perceived school climate across three dimensions (student-student relationships, student-teacher relationships, and awareness/need of reporting violence) as well as self-reports of internalizing (i.e., depression and anxiety) and externalizing (i.e., impulsivity and hostility) symptoms. Multilevel regression analyses were implemented to test all hypotheses, controlling for participant sex and race/ethnicity. Results indicated student-student relationships were negatively related to depressive symptoms, student-teacher relationships were positively related to anxiety and negatively linked to hostility, and help-seeking/reporting awareness was inversely related to all four indices of mental health. The current research underscores the impact of school climate on adolescents' psychological adjustment and emphasizes the need to address awareness and responsivity in reporting concerning school behavior.

Effect of Maternal Anxiety on Parenting Stress of Fathers of Children With ADHD

BACKGROUND

Hyperactivity, inattention, and impulsivity of children with attention deficit hyperactivity disorder (ADHD) increase parenting stress and familial conflict. Among parent-related factors, maternal mental health has been studied in-depth, but studies on paternal factors in this context are scarce. This cross-sectional study was conducted of children with ADHD and their parents in South Korea. We investigated the relationships between ADHD symptom severity of children and the mental health of their mothers and fathers.

METHODS

The study included 70 children with ADHD and their 140 married heterosexual parents (70 fathers and 70 mothers). Children completed the Child Depression Inventory and State-Anxiety Inventory for children, and their parents completed the Korean ADHD rating scale-IV, Adult ADHD self-report scale, State-Anxiety Inventory, Patient Health Questionnaire-9, and Parental Stress Scale.

RESULTS

There was a significant positive correlation between children's ADHD symptoms and maternal anxiety symptom severity, whereby more severe ADHD symptoms were associated with more severe maternal anxiety symptoms. There was also a significant positive correlation between maternal anxiety symptom severity and paternal parenting stress severity, whereby more severe maternal anxiety was associated with more severe paternal parenting stress. A mediation model showed that paternal parenting stress severity was not directly related to children's ADHD symptoms, but the severity of maternal anxiety mediated this relationship.

CONCLUSION

The present study found the importance of mental health in mothers of children with ADHD and the interrelatedness of mental health within families. Future assessments and treatment of children with ADHD should include both the children and their parents.

Mindfulness Training for Children with ADHD and Their Parents: A Randomized Control Trial

OBJECTIVE

The aim of this randomized control trial is to analyze the efficacy of a Mindfulness-based program (MYmind) in improving ADHD symptoms, associated problems, executive functions, and family functioning.

METHOD

The sample was composed of 30 children (9-14 years old) with an ADHD diagnosis and their parents. Participants were randomized into two groups, the MYmind group (n = 15) and a wait-list group (n = 15). Participants were assessed in three time periods: pre-, post-intervention, and at 6-month follow-up.

RESULTS

After the program, parents reported a decrease in parenting stress and improvements in parenting styles. Six months after the intervention, parents reported significant improvements in children's inattention symptoms, executive functions, learning problems, aggression, and peer relations. Overreactivity was the only variable that showed a decrease in both the post-test and follow-up periods.

CONCLUSION

These results suggest that the MYmind program is a promising treatment for children with ADHD and their parents.

ADHD Symptoms and Health-Related Quality of Life of Adolescents and Young Adults

Abstract. Background: Adolescence and young adulthood present particularly challenging periods for individuals affected by attention-deficit hyperactivity disorder (ADHD) symptoms. However, unlike childhood ADHD, ADHD among adolescents and young adults has been studied less frequently. A concept that can be used to characterize the experiences of individuals with ADHD symptoms is health-related quality of life (HRQoL), which encompasses well-being in various dimensions. Aims: The present study used a school-based sample in the German-speaking part of Switzerland to investigate the association between ADHD symptoms and HRQoL of adolescents and young adults. Method: A total of 907 individuals aged 14–24 years ( M = 17.69; SD = 1.66; 58.9% female) were surveyed regarding ADHD symptoms and HRQoL. Results: Multiple hierarchical regression analyses disclosed that ADHD symptoms were negatively related to all subdimensions of HRQoL. Moreover, adolescents with clinically significant or subclinical ADHD symptoms showed lower values in all examined dimensions – physical, emotional, self-esteem, family, friends/peers, and school/education – than adolescents with unremarkable ADHD symptoms. An exception was the well-being concerning friends/peers. Limitations: The present study used a cross-sectional design and a selective sample of school classes. ADHD symptoms were assessed using self-reports without any diagnostic judgment. Conclusion: The results illustrate the comprehensive effects of ADHD symptoms on well-being during adolescence and young adulthood. They highlight the importance of focusing more on ADHD during these stages of age, also considering individuals with symptoms in the subclinical range.

ADHD in Children and Adults: Diagnosis and Prognosis

Attention-Deficit Hyperactivity Disorder (ADHD) is a prevalent neuropsychiatric disorder associated with significant impairment and distress throughout the lifespan. Recent investigations have shed light on different aspects regarding the trajectory of ADHD, including reports on risk factors in childhood, that are associated with remission or persistence in adulthood. Despite significant advances in our understanding of the pathophysiology of the disorder, the diagnosis of ADHD remains strictly clinical and is based on behavioral symptoms of inattention, impulsivity, and hyperactivity. In this chapter we review the diagnostic process of ADHD, discuss the clinical presentation of the disorder across the lifespan, and examine patterns of comorbidity and longitudinal predictor of outcomes.

Parenting Stress during Late Adolescence in Mothers of Individuals with ADHD with and without ODD

Although children with ADHD continue to experience impairment well into adolescence, research exploring the experiences of their parents during late adolescence is lacking. Thus, we examined changes in parenting stress and family conflict in mothers of adolescents with ADHD during the transition to early adulthood. We also explored predictors of these changes in addition to investigating differences in these trajectories due to comorbid ODD. Forty-nine mothers of adolescents with ADHD only and thirty-seven mothers of adolescents with ADHD/ODD reported on parenting stress and perceptions of family conflict at baseline (mean age = 16.88) and at 3-month, 9-month, and 15-month follow up assessments. Growth curve modeling indicated that both groups of mothers reported relative declines in parenting stress and family conflict across time. However, the mothers of adolescents with ADHD/ODD persistently reported more stress and conflict. Furthermore, decreases in family conflict were more predictive of reduced parenting stress in families of adolescents only diagnosed with ADHD. Our findings suggest that comorbid ODD is associated with parenting stress during late adolescence. Thus, interventions should focus on further reducing this stress as adolescents with ADHD/ODD transition to adulthood.

Daily Behaviors, Worries and Emotions in Children and Adolescents with ADHD and Learning Difficulties during the COVID-19 Pandemic

The aim of the present study was to investigate the effects of the coronavirus crisis on behavioral and emotional parameters in children and adolescents with ADHD and Learning Difficulties. A total of 101 children, 5–18 years old, were included in the study, 63 (44 boys) of which were diagnosed with ADHD and learning difficulties (ADHD/LD) and 38 were healthy children (19 boys). The CRISIS questionnaire for parents/caregivers was used. The questionnaire was completed during the first national lockdown in Greece and the data referred to two time-points: 3 months before, and the past 2 weeks. A significant deterioration in the “Emotion/Worries (EW)” symptoms was observed during the pandemic in the control group (2.62 ± 0.16 vs. 2.83 ± 0.18, p < 0.001). No such differences were noted in the ADHD group: 3.08 ± 0.25 vs. 3.12 ± 0.29, p = 0.12. Provision of educational and activities support was related to increased EW before the crisis. In ADHD/LD children, higher parental education and child’s younger age were related to increased symptoms of EW. In the entire group, previous mental health conditions, increasing stress due to restrictions, and increased COVID-related worries were positively associated with the EW symptoms during the crisis. Less affected relations with friends and less reduction in contact with people outside the home were negatively related with EW during the crisis. The study revealed specific parameters that negatively affected the emotional and behavioral variables of children with ADHD and learning difficulties.

A Study of the Reliability and Validity of the Korean Version of DSM-5 Symptom Measure-Inattention and Anger for Parent and Guardian of Child Age 6 to 17

OBJECTIVES

This study was conducted to investigate the reliability and validity of the Korean version of the DSM-5 Level 2 Cross-Cutting Symptom Measure-inattention [Swanson, Nolan and Pelham, version IV (SNAP-IV)] and anger [Patient-Reported Outcome Measurement Information System (PROMIS) Anger] for parents and guardians of children aged 6-17 years.

METHODS

We included 104 children and adolescents diagnosed with attention-deficit/hyperactivity disorder (ADHD), ADHD with anxiety and depression, depressive disorder, anxiety disorder, and tic disorder with somatic symptoms (ADHD=41, depression=9, anxiety=14, ADHD+anxious depression=11, tic+somatic symptoms=29). Their ages ranged from 8 years to 15 years. The participants' mothers completed the SNAP-IV, PROMIS Anger scale, Korean version of the IOWA Conners Rating Scale (K-IOWA), and Korean ADHD Rating Scale (K-ARS) so that the reliability and validity of the SNAP-IV and PROMIS Anger scales, which are DSM-5 scales for assessing inattention and anger of children and adolescents, could be examined.

RESULTS

The reliability coefficient of SNAP-IV (Cronbach's α) was 0.94. The correlation coefficients between SNAP-IV, K-IOWA inattention, and K-ARS inattention scores ranged from 0.73 to 0.86. The mean SNAP-IV scores of the ADHD and the ADHD+anxious depression groups were significantly higher than those of the anxiety and the tic+somatic symptoms groups. The reliability coefficient of the PROMIS Anger was 0.91. The correlation coefficient between PROMIS Anger and K-IOWA oppositional/defiant scores was 0.75. The PROMIS Anger mean score of the ADHD+anxious depression group tended to be higher than that of the other groups.

CONCLUSION

These results suggest that the Korean version of the DSM-5 Level 2 Cross-Cutting Symptom Measure-inattention and anger for parent and guardian of child age 6-17 might be a reliable and valid test and may be useful for screening children and adolescents with ADHD.

Top problems of adolescents and young adults with ADHD during the COVID-19 pandemic

OBJECTIVE

ADHD symptom severity appears to be exacerbated during the COVID-19 pandemic. The present study surveyed top problems experienced by adolescents and young adults (A/YAs) with ADHD during the COVID-19 pandemic to identify possible reasons for symptom escalation and potential targets for intervention. We also explored perceived benefits of the pandemic for A/YAs with ADHD.

METHOD

At the outbreak of the COVID-19 pandemic (April-June 2020), we administered self and parent ratings about current and pre-pandemic top problem severity and benefits of the pandemic to a sample of convenience (N = 134 A/YAs with ADHD participating in a prospective longitudinal study).

RESULTS

The most common top problems reported in the sample were social isolation (parent-report: 26.7%; self-report: 41.5%), difficulties engaging in online learning (parent-report: 23.3%, self-report: 20.3%), motivation problems (parent-report: 27.9%), and boredom (self-report: 21.3%). According to parent (d = 0.98) and self-report (d = 1.33), these top problems were more severe during the pandemic than in prior months. Contrary to previous speculation, there was no evidence that pandemic-related changes mitigated ADHD severity. Multi-level models indicated that A/YAs with higher IQs experienced severer top problems exacerbations at the transition to the COVID-19 pandemic.

CONCLUSIONS

For A/YAs with ADHD, several risk factors for depression and school dropout were incurred during the early months of the COVID-19 pandemic. A/YAs with ADHD should be monitored for school disengagement and depressive symptoms during the COVID-19 pandemic. Recommended interventions attend to reducing risk factors such as increasing social interaction, academic motivation, and behavioral activation among A/YAs with ADHD.

Maltreatment and Affective and Behavioral Problems in Emerging Adults With and Without Oppositional Defiant Disorder Symptoms: Mediation by Parent-Child Relationship Quality

The current study examined the indirect effect of maternal and paternal emotional and physical maltreatment on affective and behavioral symptoms of oppositional defiant disorder (ODD) through parent-child relationship quality; gender and overall ODD symptoms were examined as moderators. Participants included 2,362 emerging adults who completed questionnaires about parental emotional and physical maltreatment, parent-child relationship quality, and affective and behavioral ODD symptoms. These characteristics were compared across parent and child gender (i.e., maternal and paternal effects as well as male and female differences) as well as participants reporting high and low ODD symptoms. In the low ODD group, indirect effects of emotional maltreatment occurred in all parent-child dyads except the mother-son dyad, whereas in the high ODD group, indirect effects occurred only in the father-son dyad. Indirect effects of physical maltreatment occurred only in the father-son dyad in the low ODD group, and only in the mother-daughter dyad on behavioral ODD symptoms in the high ODD group. The results suggest that specific parent-child gender dyads respond differently, warranting further investigation of gender effects. Moreover, emerging adults in the low ODD symptoms group demonstrated a positive association between parental maltreatment and ODD symptoms and a negative association between parent-child relationship quality and ODD symptoms, whereas those high in the high ODD symptoms group did not demonstrate these associations. That is, emerging adults reporting high ODD symptoms demonstrated no relationship between their ODD symptoms and harsh parenting, suggesting an ineffective coercive process.

Mindful Parenting Behaviors and Emotional Self-Regulation in Children With ADHD and Controls

OBJECTIVE

Mindfulness is defined as paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally and these behaviors can be applied to parenting. Thus far, it is not understood whether mindful parenting (MP) differs in parents of children with and without attention-deficit/hyperactivity disorder (ADHD), and how MP relates to other parenting practices and children's self-regulation.

METHODS

This study examined the relationships between MP, parenting behaviors and children's self-regulation in 120 families with child ADHD (85% male; mean age = 11.93) and 105 control families (62% male; mean age = 11.98). Parents completed measures of MP (Interpersonal Mindfulness in Parenting Scale), parenting behaviors (parenting warmth, consistency, and anger assessed with the Longitudinal Study of Australian Children measures), psychological distress (Kessler 6), and children's self-regulation (Social Skills Improvement System-self-control subscale).

RESULTS

When compared with controls, parents of children with ADHD reported significantly lower MP. Higher MP was associated with lower levels of parent psychological distress, higher levels of parenting warmth and consistency, lower levels of parenting anger, and higher child emotion self-regulation in both groups. In mediation analyses, MP was indirectly associated with child emotion self-regulation through lower parenting anger, with the model accounting for 55% of the variance in child self-regulation.

CONCLUSIONS

MP is a useful construct for understanding parent behaviors, and children's emotion self-regulation.

Parental ADHD Symptoms and Inhibitory Control in Relation to Parenting Among Mothers of Children With and Without ADHD

Objective: The study examined how the interplay between maternal ADHD symptoms and maternal inhibitory control and child ADHD is related to parenting behaviors. Method: The sample included 141 mothers and their 8- to 12-year-old children, 61 children with ADHD and 80 without. Parenting was measured using self-reports (i.e., overreactive and lax parenting) and observation (i.e., negative and supportive parenting). Maternal inhibitory control was measured using a neurocognitive task. Hierarchical multiple regressions were conducted to predict parenting, controlling for child sex, conduct behaviors, and parenting distress. Results: Interactions between maternal ADHD symptoms and maternal inhibitory control suggested that hyperactive-impulsive symptoms were linked to parenting negativity only when inhibitory control was low, and maternal inattention symptoms were related to lax parenting only when maternal inhibitory control was high or when children did not have ADHD. Conclusion: Results indicate the importance of maternal regulation processes in the mechanisms linking maternal ADHD with parenting.

Childhood ADHD and Involvement in Early Pregnancy: Mechanisms of Risk

Objective: ADHD is associated with risky sexual behavior and early pregnancy, but few studies have examined mechanisms of risk linking childhood ADHD to early pregnancy. The present study utilized data from the Multimodal Treatment Study of ADHD to examine potential mechanisms that may account for the association between childhood ADHD and becoming pregnant or causing a pregnancy by age 18. Method: Participants were 579 children with ADHD and 289 comparison peers followed over 16 years. Results: Relative to the comparison group, those with childhood ADHD were at more than two times increased risk of early pregnancy. Univariately, persistence of ADHD symptoms, delinquency/substance use, and academic performance/achievement during adolescence each mediated the association between childhood ADHD and early pregnancy. When considered together, only delinquency/substance use remained a significant mediator of this relationship. Conclusion: Findings point toward specific targets of intervention for youth with ADHD to prevent early pregnancy.

Implementing Parent-Teen Motivational Interviewing + Behavior Therapy for ADHD in Community Mental Health

Despite the promise of psychosocial interventions for adolescent Attention Deficit Hyperactivity Disorder (ADHD), there are no studies that examine their implementation in community mental health contexts. In this study, we evaluate the implementation of community-based Supporting Teens' Autonomy Daily (STAND), a parent-teen Motivational Interviewing + Behavior Therapy intervention for adolescents with ADHD. Adolescents with ADHD (N = 225), who were clients at four community mental health agencies, received treatment from 82 therapists. There was double randomization of adolescents and therapists to STAND or Usual Care (UC). Nearly all therapists randomized to STAND completed the training and regularly attended supervision, rating STAND as acceptable and lower burden than UC practices. In the STAND group, MI competence and implementation were lower than in university trials (benchmark range, 19.5% for reflection to question ratio to 83.1% for technical globals). MI integrity in the STAND group was significantly higher than UC across most MITI indices. Content fidelity was adequate in STAND's engagement and skills phases (76.4-85.0%), but not its planning phase (24.4%). Therapists commonly neglected weekly review of goals and home practice and deviated from manualized pace and sequencing of therapy tasks. Learning MI was more challenging for bilingual therapists and therapists with more years of experience. STAND was delivered with higher integrity in earlier sessions and office-based sessions. Discussion identifies future directions for exporting adolescent ADHD interventions to community settings. Patient outcome data for this trial is presented elsewhere. Trial Registration: NCT02694939 www.clinicaltrials.gov .

Utilizing the Common-Sense model of illness representations to explore children's perceptions of, and coping with ADHD

BACKGROUND

Attention Deficit Hyperactivity Disorder (ADHD) among children is associated with difficulties in everyday functioning. According to the Common-Sense Model of Illness Representations (CSM), individuals' beliefs about their illness condition guide their attempts to cope with it. The model suggests five dimensions of illness representations: beliefs regarding the identity of the symptoms, its duration, causes, consequences, and one's ability to achieve control over it.

AIMS

The study aimed to explore the validity of the CSM-dimensions of illness representations for children with ADHD, while also exploring the possible relationships between types of beliefs and coping strategies.

METHOD

A deductive qualitative content analysis was used for analyzing data constructed from semi-structured individual interviews with 14 children diagnosed with ADHD.

RESULTS

The results have shown that there is a variation in children's beliefs regarding their ADHD. Those beliefs are, for the most part, captured by the five CSM-dimensions. An additional dimension of 'Uniqueness' is suggested, which reflects children's beliefs on the way ADHD distinguishes them from other children. Patterns regarding types of beliefs and types of coping strategies were identified.

CONCLUSIONS

The CSM is a useful theoretical model to understand children's beliefs of, and coping with their ADHD.

Development and Validation of the Parental Smartphone Use Management Scale (PSUMS): Parents' Perceived Self-Efficacy with Adolescents with Attention Deficit Hyperactivity Disorder

The psychometric properties of the Parental Smartphone Use Management Scale (PSUMS) and its prospective relationships with symptoms of smartphone addiction and attention deficit hyperactivity disorder (ADHD) were studies in a sample of parents of adolescents with ADHD. This is a scale to measure parents’ perceived self-efficacy on managing their children’s smartphone use. Construct validity (exploratory factor analysis and confirmatory factor analysis), criterion-related validity (known-group validity and concurrent validity), and reliability (Cronbach’s alpha) were performed for data analyses. The results showed that the PSUMS had good factorials validity and high reliabilities, with Cronbach’s alphas ranging between 0.93 and 0.95. The 17-item PSUMS accounted for 78.58% of the total variance and contains three theoretically and statistically appropriate subscales: reactive management, proactive management, and monitoring. Strong relationships were found between parental smartphone use management and symptoms of smartphone addiction and ADHD in expected directions. Moreover, parents of children with smartphone addiction yielded lower scores on all three PSUMS subscales than parents of children without smartphone addiction. The PSUMS is considered a valuable and reliable tool in the study of parental management on their adolescent children’s smartphone use, while providing us with important targets for intervention.

Relational impairments, sluggish cognitive tempo, and severe inattention are associated with elevated self-rated depressive symptoms in adolescents with ADHD

This study examines how ADHD-related symptoms and impairments interact to predict depression symptoms in young adolescents with ADHD. A sample of 342 adolescents (71% male, mean age = 13 years old) with DSM-IV-TR diagnosed ADHD completed baseline clinical assessments upon entry to a psychosocial treatment study for ADHD. Ratings of ADHD and sluggish cognitive tempo (SCT) symptoms, and social and academic impairment were obtained from parents, while ratings of depressive symptoms and conflict with parents were obtained from youth. Among adolescents with ADHD, elevated depressive symptoms were associated with higher SCT symptom severity, lower hyperactive/impulsive (HI) symptom severity, higher social impairments, higher conflict with parents, and lower academic problems. Interaction effects indicated that clinically significant depressive symptoms were most likely to occur when high levels of parent-youth conflict were present along with high inattentive (IN) symptoms, high SCT, and/or low HI. Among children and adolescents with ADHD, depression prevention efforts might target IN/SCT symptom management, as well as improving interpersonal relationships with parents and peers. Future work is needed to verify these findings longitudinally.

Impaired Interparental Relationships in Families of Children With Attention-Deficit/Hyperactivity Disorder (ADHD)

Abstract. Research on attention-deficit/hyperactivity disorder (ADHD) in children and adolescents has traditionally focused on the genetic and neurobiological aspects of the disorder, but the role of family relationships has been much less systematically examined. There is growing evidence that the quality of interparental relationships and a child’s ADHD symptoms are reciprocally related. Because the literature appears to be inconsistent, this meta-analysis aims to summarize previous research and assess whether there are robust differences in the quality of interparental relationships between parents of children with ADHD and parents of healthy children. This meta-analysis of 15 studies with 43 effect sizes revealed a small but significant difference ( d = .24), which indicates that parents of a child with ADHD report poorer relationship quality than parents of healthy children. This effect was moderated by the child’s age and did not depend on whether the child had a comorbid oppositional defiant disorder (ODD) or conduct disorder (CD). The causality of this relationship has yet to be determined.

Parent Emotion Expression and Autonomic-Linked Emotion Dysregulation in Childhood ADHD

Despite evidence that ADHD is associated with disruptions in emotion regulation, few studies have examined the biological correlates of emotion dysregulation among children with this disorder. Prior work has pointed to roles of the parasympathetic and sympathetic nervous system, as indexed via respiratory sinus arrhythmia (RSA) and cardiac pre-ejection period (PEP), respectively. Work in typically developing populations suggests that parenting behavior and parental emotion expression may shape the development of these systems. To date, a single study has examined the independent and interactive roles of autonomic nervous system functioning and parent emotion expression in youth with ADHD. This study seeks to extend that work. 86 children (42 with ADHD), aged 8-12 years, and a parent completed a parent-child interaction task, while electrocardiography and impedance cardiography data were recorded to derive RSA and PEP. Parent and child emotion word use (positive and negative valence) were coded from recordings of the task. Parents of youth with ADHD used fewer positive emotion words throughout the task. Additionally, throughout the task, children with ADHD engaged in excessive RSA withdrawal from baseline. Further, the association between RSA reactivity and ADHD diagnosis was moderated by parent positive emotion word use. Specifically, those with RSA augmentation and parents displaying high positive affect across the task conditions were least likely to have an ADHD diagnosis. If replicated and extended, these results support the use of interventions specifically designed to increase parental modeling of positive emotions, while simultaneously focusing on building emotion regulation skills in youth with ADHD.

Maternal ADHD Symptoms, Personality, and Parenting Stress: Differences Between Mothers of Children With ADHD and Mothers of Comparison Children

OBJECTIVE

Mothers raising a child with ADHD can experience high parenting stress. We evaluated if mothers' personality traits and own ADHD symptoms could also affect parenting stress.

METHOD

430 biological mothers from the Multimodal Treatment Study of Children with ADHD (MTA mothers) and 237 of a local normative comparison group (LNCG mothers) were evaluated at baseline. Interactions were tested between mothers' group and maternal personality/ADHD symptoms related to parenting stress.

RESULTS

Compared to LNCG, MTA mothers had higher parenting stress, self-reported ADHD, neuroticism, and lower conscientiousness and agreeableness. When personality and ADHD were evaluated together, ADHD symptoms interacted with mothers' group: high maternal ADHD was positively associated with parenting stress for LNCG but not MTA mothers.

CONCLUSION

Personality traits or ADHD characteristics do not appear operative for the high parenting stress of mothers of a child with ADHD. However, high maternal ADHD or low conscientiousness are associated with stress levels similar to raising a child with ADHD.

Testing the Similarity Fit/Misfit Hypothesis in Adolescents and Parents With ADHD

OBJECTIVE

Higher rates of conflict are observed between adolescents with ADHD and their parents due to cognitive, academic, social, and behavioral difficulties. Conflict should be even more pronounced when parents have ADHD themselves; however, some research suggests that parents with ADHD may have increased tolerance toward children who share similar challenges (i.e., similarity-fit hypothesis).

METHOD

We tested the similarity-fit model and its converse, the similarity-misfit model, in a sample of 93 ADHD adolescents, 63 comparison adolescents, and their parents with varying levels of ADHD. Quantity and intensity of conflict were examined in mothers and fathers separately.

RESULTS

We found evidence for the similarity-fit process in fathers, and similarity misfit in mothers, particularly regarding quantity of conflict between parent and adolescent.

CONCLUSION

Results indicate the importance of differential parental roles in mothers and fathers, and have implications for involving parents in treatment for ADHD in adolescents.

A Review of the Clinical Utility of Systematic Behavioral Observations in Attention Deficit Hyperactivity Disorder (ADHD)

This review evaluates the clinical utility of tools for systematic behavioral observation in different settings for children and adolescents with ADHD. A comprehensive search yielded 135 relevant results since 1990. Observations from naturalistic settings were grouped into observations of classroom behavior (n = 58) and of social interactions (n = 25). Laboratory observations were subdivided into four contexts: independent play (n = 9), test session (n = 27), parent interaction (n = 11), and peer interaction (n = 5). Clinically relevant aspects of reliability and validity of employed instruments are reviewed. The results confirm the usefulness of systematic observations. However, no procedure can be recommended as a stand-alone diagnostic method. Psychometric properties are often unsatisfactory, which reduces the validity of observational methods, particularly for measuring treatment outcome. Further efforts are needed to improve the specificity of observational methods with regard to the discrimination of comorbidities and other disorders.

Protocol for the STAR (Sheffield Treatments for ADHD) project: an internal pilot study assessing the feasibility of the Trials within Cohorts (TwiCs) design to test the effectiveness of interventions for children with ADHD

Background

Attention deficit hyperactivity disorder (ADHD) is a common and growing problem and a leading cause of child referrals to Child and Adult Mental Health Services (CAMHS). It is a drain on resources across nationally funded support agencies and associated with negative outcomes such as early criminality, school disruption and antisocial behaviour. Mainstream interventions (pharmacological and behavioural) demonstrate effectiveness whilst implemented, but are costly, often have unwanted side effects and do not appear to be affecting long-term outcomes.Development of a robust evidence base for the effectiveness of current and novel interventions and their impact over the long term is required. The aim of the Sheffield Treatments for ADHD Research (STAR) project is to facilitate a rigorous evidence base in order to provide information about the comparative (cost) effectiveness and acceptability of multiple interventions to key stakeholders.

Methods

The Trials within Cohorts (TwiCs) design was used to build a cohort of children with a diagnosis of ADHD and conduct a three-armed pilot trial of the clinical and cost effectiveness of two novel interventions: (a) treatment by nutritional therapists and (b) treatment by homoeopaths, compared to (c) treatment as usual.Participants are recruited to the STAR long-term observational cohort, and their outcomes of interest (ADHD symptoms, health-related quality of life, school disruption, resource use and criminality) are measured every 6 months by carers and (blinded) teachers. Two promising interventions were identified for the first randomised controlled trial embedded in the cohort. A random selection of eligible participants is offered treatments (a) and (b). The outcomes of those offered treatment are compared to those not offered treatment using intention to treat (ITT) analysis.The feasibility of recruiting to the cohort and the trial, delivering the interventions, the effectiveness of the interventions and the appropriateness, sensitivity and collectability of outcomes is trialled.

Discussion

The results of this trial will provide information on the feasibility of the TwiCs design to facilitate multiple trials of potential interventions for children with ADHD, and the acceptability, clinical and cost effectiveness of two potential interventions for ADHD to ADHD stakeholders including service providers. Future stages of the STAR project will test other treatments informed by the results in stage 1.

Trial registration

ISRCTN number 17723526. 10.1186/ISRCTN17723526. Date assigned 27/4/15.

Toward Developing Laboratory-Based Parent-Adolescent Conflict Discussion Tasks that Consistently Elicit Adolescent Conflict-Related Stress Responses: Support from Physiology and Observed Behavior

Parent-adolescent conflict poses risk for youth maladjustment. One potential mechanism of this risk is that stress in the form of increased arousal during conflict interactions results in adolescents' impaired decision-making. However, eliciting consistent adolescent stress responses within laboratory-based tasks of parent-adolescent conflict (i.e., conflict discussion tasks) is hindered by task design. This limitation may stem from how conflict topics are assessed and selected for discussion. Within a sample of 47 adolescents (ages 14-17) and parents, we investigated whether a modified version of a conflict discussion task could elicit physiological (i.e., arousal) and behavioral (i.e., hostility) displays of adolescents' conflict-related stress responses. We assessed parent-adolescent conflict via structured interview to identify topics for dyads to discuss during the task. We randomly assigned dyads to complete a 5-minute task to discuss either a putatively benign topic (i.e., control condition) or a conflict topic while undergoing direct assessments of continuous arousal. Trained raters coded dyad members' hostile behavior during the task. Adolescents in the conflict condition exhibited significantly greater levels of arousal than adolescents in the control condition. We observed an interaction between discussion condition and baseline conflict. Specifically, higher baseline conflict predicted greater hostile behavior for adolescents in the conflict condition, yet we observed the inverse relation for adolescents in the control condition. Our modified laboratory discussion task successfully elicited both physiological and behavioral displays of adolescent conflict-related stress. These findings have important implications for leveraging experimental paradigms to understand causal links between parent-adolescent conflict and adolescent psychopathology, and their underlying mechanisms.

Development and validation of the Parents' Perceived Self-Efficacy to Manage Children's Internet Use Scale for parents of adolescents with attention-deficit/hyperactivity disorder

Background and aims This study developed and validated the Parents' Perceived Self-Efficacy to Manage Children's Internet Use Scale (PSMIS) in the parents of children with attention-deficit/hyperactivity disorder (ADHD). Methods In total, 231 parents of children with ADHD were invited to complete the PSMIS, followed by the Chen Internet Addiction Scale and the short version of Swanson, Nolan, and Pelham, Version IV Scale - Chinese version for analyzing Internet addiction severity and ADHD symptoms, respectively. Results The results of exploratory and confirmatory factor analyses confirmed the four-factor structure of the 18-item PSMIS. The significant difference in the levels of parents' perceived self-efficacy between the parents of children with and without Internet addiction supported the criterion-related validity of the PSMIS. The internal consistency and 1-month test-retest reliability were acceptable. Conclusion The results indicate that the PSMIS has acceptable validity and reliability and can be used for measuring parents' perceived self-efficacy to manage children's Internet use among parents of children with ADHD.

Psychotherapy for Adolescents With Attention-Deficit Hyperactivity Disorder: A Pediatrician's Guide

Attention-deficit hyperactivity disorder (ADHD) presents with high levels of inattention, impulsiveness, and hyperactivity. ADHD starts in childhood and results in impairments that continue into adulthood. ADHD symptoms lead to decreased functionality in various life domains and result in poor academics, behavioral challenges, delayed independence, and strained relationships. Despite advances in diagnosis and treatment, persistent residual symptoms are common, highlighting the need for novel treatment strategies. This article aims to provide a review of the psychotherapeutic interventions available for teens that receive pharmacotherapy but continue to struggle with the residual symptoms of ADHD that interfere with academic function, relationship formation, and psychological development.

The Effectiveness of Short- and Long-Acting Stimulant Medications for Adolescents With ADHD in a Naturalistic Secondary School Setting

OBJECTIVE

Stimulant medication is an efficacious and first-line approach to treating ADHD in adolescence. However, less is known about the effectiveness of this approach as a treatment in real-world settings. The complicated nature of the secondary school environment and documented adolescent nonadherence with stimulant medication may undermine the exportability of this approach.

METHOD

This study investigates stimulant medication effectiveness and adherence in a sample of adolescents with ADHD who were observed in their natural secondary school environment.

RESULTS

Results indicated that the effect of stimulant medication on adolescent functioning is smaller in naturalistic settings than in previous analogue studies. Long-acting pemoline produced greater adherence than the short-acting methylphenidate (MPH), but parents and adolescents preferred the short-acting MPH.

CONCLUSIONS

Overall, adolescents reported very low satisfaction with stimulant medication. Findings are discussed.

Acute Effects of MPH on the Parent-Teen Interactions of Adolescents With ADHD

This study explored the nature of interactions between adolescent males with ADHD and their mothers, and the effects of methylphenidate (MPH) on an analogue parent-teen interaction task. Twenty-five adolescent males with ADHD ( M = 13.6 years) and their mothers and 14 non-ADHD adolescent males ( M = 13.4 years) and their mothers completed ratings of perceived dyadic conflict. Behavioral observations of dyads during 10-min conflict-resolution tasks were also collected. The ADHD dyads completed these tasks twice, with adolescents receiving either 0.3 mg/kg MPH or placebo. Videotaped sessions were coded using the Parent-Adolescent Interaction Rating Scale. Following the conflict-resolution task, participants rated their perceived conflict and affect during the interaction. Findings indicated higher conflict in the ADHD dyads, and minimal MPH effects on parent-teen interactions during the analogue task. Results suggest that stimulant medication does not produce meaningful acute effects on parent-teen interactions.

Parenting Stress of Parents of Adolescents with Attention-Deficit Hyperactivity Disorder

This study examined parenting stress among parents of adolescents with Attention-Deficit Hyperactivity Disorder (ADHD). The sample comprised 138 adolescents (84 ADHD, 52 boys, 32 girls; 54 non-ADHD, 24 boys, 30 girls) age 13 to 18 and their parents. Mothers (n = 135) and fathers (n = 98) of participating teens completed the Stress Index for Parents of Adolescents. Mothers and fathers of adolescents with ADHD reported more stress than parents of adolescents without ADHD with regard to their children's challenging behaviors (Adolescent domain stress). Mothers of adolescents with ADHD also reported that they experienced elevated levels of stress in terms of role restrictions, feelings of social alienation, conflict with their partner, feelings of guilt and incompetence (Parent domain stress), and relationship with their children (Adolescent-Parent Relationship domain stress; APR). The extent to which clinical levels of adolescent Oppositional Defiant Disorder (ODD) symptoms or externalizing behavior in general were associated with parenting stress depended on the rater of these behaviors. Parenting stress was associated with higher levels of ODD and other externalizing behaviors when these behaviors were rated by parents but not when they were rated by teachers. In addition, over and above adolescent ADHD classification, mothers' self-reported ADHD symptoms were associated with higher parenting stress in the Adolescent and Parent domains, and fathers' self-reported ADHD symptoms were associated with lower APR stress. The results suggest directions that should be considered for addressing parenting stress when designing interventions for families of adolescents with ADHD.

A school consultation intervention for adolescents with ADHD: barriers and implementation strategies

BACKGROUND

Academic impairment is among the most troubling domains of impairment for adolescents with Attention Deficit/Hyperactivity Disorder (ADHD).

METHOD

This investigation presents results of a yearlong academic intervention delivered to adolescents with ADHD (N = 218) by engaging school staff as interventionists through behavioral consultation with an outside mental health professional.

RESULTS

The intervention was coordinated successfully in some cases, but not in others. The principal challenge to intervention coordination was sustaining monthly contact between consultants and interventionists (38.5% success rate) and scheduling in-person consultation meetings with interventionists (40.0% success rate). Implementation of the intervention was enhanced when the student (a) attended a public (vs. private) school, (b) had an IEP or Section 504 plan in place, (c) was in middle school (vs. high school), (d) had a parent who communicated regularly with the school, and (e) had a special education support staff member or counselor (vs. teacher or administrator) as a school interventionist.

CONCLUSIONS

Considering these data, recommendations are provided for effective coordination of academic interventions for adolescents with ADHD.

School Experiences of Adolescents With Attention-Deficit/Hyperactivity Disorder

This article reports on a qualitative study of the school experiences of adolescents with attention-deficit/hyperactivity disorder (ADHD) in the context of quantitative research on teacher attitudes and practices, adolescent self-appraisals, and social and family relationships. Twelve adolescents with ADHD participated in in-depth, semistructured interviews addressing major aspects of school life. Using a modified grounded theory framework, researchers coded these interviews. Three themes emerged: (a) support for a performance deficit, (b) academic and social engagement, and (c) moving from dependence to independence. What is most striking is the low level of agency students demonstrated; that is, rather than acting with purpose on their environments, they seemed to react to things that happened to them. These findings suggest that teachers of adolescents with ADHD know about the nature of the disorder, understand that students' difficulties with organization and academic performance are not typically intentional, use evidence-based interventions to support students, and provide the monitoring and scaffolding needed for academic achievement. The students also provide specific suggestions for parents and peers regarding the supports they need to be successful.

Parent-teen behavior therapy + motivational interviewing for adolescents with ADHD

OBJECTIVE

This study evaluates a parent-teen skills-based therapy for attention deficit/hyperactivity disorder (ADHD) blended with motivational interviewing (MI) to enhance family engagement. Supporting Teens' Autonomy Daily (STAND) is an adolescent-specific treatment for ADHD that targets empirically identified adolescent (i.e., organization, time management, and planning, or OTP skills) and parent-based (i.e., monitoring and contingency management) mechanisms of long-term outcome through individual parent-teen sessions.

METHOD

The current randomized trial (N = 128) evaluates efficacy at posttreatment and 6-month follow-up. Participants were ethnically diverse teens (7.7% non-Hispanic White, 10.8% African American, 78.5% Hispanic, 3.0% other) randomly assigned to STAND or Treatment As Usual (TAU).

RESULTS

Primary findings were that (1) STAND was delivered in an MI-adherent fashion and most families fully engaged in treatment (85% completed); (2) STAND produced a range of significant acute effects on ADHD symptoms, OTP skills, homework behavior, parent-teen contracting, implementation of home privileges, parenting stress, and daily homework recording; and (3) 6 months after treatment ceased, effects on ADHD symptom severity, OTP skills, and parenting stress maintained, while parent use of contracting and privilege implementation strategies, as well as teen daily homework recording and homework behavior gains, were not maintained.

CONCLUSION

Skills-based behavior therapy blended with MI is an acutely efficacious treatment for adolescents with ADHD although more work is needed to establish the nature of long-term effects. (PsycINFO Database Record

Suicidality and its relationships with individual, family, peer, and psychopathology factors among adolescents with attention-deficit/hyperactivity disorder

The aim of this study was to examine the prevalence rates of suicidal intent and its correlates among adolescents diagnosed with ADHD in Taiwan. A total of 287 adolescents aged 11-18 years and diagnosed with ADHD participated in this study. Their suicidal ideation and suicide attempts were assessed. Logistic regression analysis was used to examine the associations of suicide with individual, family, peer, ADHD, and psychopathology factors. A total of 12.2% of the participants reported suicidal ideation or a suicide attempt. A logistic regression analysis model showed that adolescents who were older, were bullying perpetrators, and reported high depression level were more likely to have suicidal intent. These three factors were also significantly correlated with suicidal ideation; however, only having high depression level was significantly correlated with suicidal attempts. The results of this study showed that a high proportion of adolescents with ADHD reported suicidal ideation or a suicide attempt. Multiple factors were significantly associated with suicidal intent among adolescents with ADHD. Clinicians, educational professionals, and parents of adolescents with ADHD should monitor the possibility of suicide in adolescents with ADHD who exhibit the correlates of suicidal intent identified in this study.

Maternal ADHD, Parenting, and Psychopathology Among Mothers of Adolescents With ADHD

OBJECTIVE

This study describes the parenting and psychopathology of mothers with ADHD of adolescents with ADHD (MCA), non-ADHD mothers of adolescents with ADHD (CA), and non-ADHD mothers of adolescents without ADHD (COMP).

METHOD

Two sets of pairwise comparisons: (a) COMP versus CA and (b) CA versus MCA were conducted. We hypothesized that CA would experience greater distress in parenting and psychopathology compared with COMP and that MCA would experience even more impairment compared with CA.

RESULTS

Few differences emerged in comparisons of CA and COMP, with the exception of CA reporting greater parent-adolescent conflict and internalizing problems. In contrast, differences consistently emerged in comparisons of MCA and CA showing more difficulty for MCA in parenting and psychopathology.

CONCLUSION

These findings underscore the need for treatments that address parental ADHD when adolescent ADHD is the intended target.

Perceived Parent-Child Relations, Conduct Problems, and Clinical Improvement Following the Treatment of Oppositional Defiant Disorder

Our objective in this study was to examine the moderating influence of parent-child relationship quality (as viewed by the child) on associations between conduct problems and treatment responses for children with oppositional defiant disorder (ODD). To date, few studies have considered children's perceptions of relationship quality with parents in clinical contexts even though extant studies show the importance of this factor in children's behavioral adjustment in non-clinical settings. In this study, 123 children (ages 7 - 14 years, 61.8% male, 83.7% white) who fulfilled DSM-IV criteria for ODD received one of two psychosocial treatments: Parent Management Training or Collaborative & Proactive Solutions. In an earlier study, both treatments were found to be effective and equivalent in treatment outcomes (Ollendick et al., in press). In the current study, pre-treatment maternal reports of conduct problems and pre-treatment child reports of relations with parents were used to predict outcomes in ODD symptoms and their severity following treatment. Elevated reports of children's conduct problems were associated with attenuated reductions in both ODD symptoms and their severity. Perceived relationship quality with parents moderated the ties between conduct problems and outcomes in ODD severity but not the number of symptoms. Mother reports of elevated conduct problems predicted attenuated treatment response only when children viewed relationship quality with their parents as poorer. When children viewed the relationship as higher quality, they did not show an attenuated treatment response, regardless of reported conduct problems. The current findings underscore the importance of children's perspectives in treatment response and reductions in externalizing child behaviors.

Multi-level risk factors and developmental assets associated with aggressive behavior in disadvantaged adolescents

The current study examined multilevel risk factors and developmental assets on longitudinal trajectories of aggressive behavior in a diverse sample of rural adolescents. Using ecological and social capital theories, we explored the impact of positive and negative proximal processes, social capital, and contextual characteristics (i.e., school and neighborhood) on adolescent aggression. Data came from the Rural Adaptation Project, which is a 5-year longitudinal panel study of more than 4,000 middle and high school students from 40 public schools in two rural, low income counties in North Carolina. A three-level HLM model (N = 4,056 at Wave 1, 4,251 at Wave 2, and 4,256 at Wave 3) was estimated to predict factors affecting the change trajectories of aggression. Results indicated that negative proximal processes in the form of parent-adolescent conflict, friend rejection, peer pressure, delinquent friends, and school hassles were significant predictors of aggression. In addition, social capital in the form of ethnic identity, religious orientation, and school satisfaction served as buffers against aggression. Negative proximal processes were more salient predictors than positive proximal processes. School and neighborhood characteristics had a minimal impact on aggression. Overall, rates of aggression did not change significantly over the 3-year study window. Findings highlight the need to intervene in order to decrease negative interactions in the peer and parent domains.

Meta-analysis of quality of life in children and adolescents with ADHD: By both parent proxy-report and child self-report using PedsQL™

Attention deficit hyperactivity disorder (ADHD) is a prevalent developmental disorder that seriously and negatively impacts a child's health-related quality of life (HRQOL). However, no meta-analysis has been conducted to examine the magnitude of impact, domains affected and factors moderating the impact. This review included nine studies that compared HRQOL of children or adolescents with ADHD with those with typical development using both child self-reports and parent proxy-reports. Seven among nine studies were meta-analytically synthesized to examine the degree of impact of ADHD on children and adolescents, parent-child discrepancy, and the moderators. The results indicate that ADHD impact a child's or adolescent's HRQOL negatively with a moderate effect in physical and a severe effect in psychosocial (i.e., emotional, social, and school) domains. Parental ratings of overall HRQOL in children or adolescents with ADHD were not significantly different from child's ratings when compared with typically developing children and adolescents. Age was negatively associated with all domains of HRQOL in children and adolescents with ADHD both by parent- and child-ratings, and the strongest effect was found in parental ratings of child's emotional HRQOL, with a moderate correlation. This meta-analysis suggests that HRQOL may be assessed in children and adolescents with ADHD both by parent proxy- and child self-reports, and that interventions may be planned accordingly. Future meta-analysis may explore how measures of HRQOL and other factors including child, parental, familiar and school characteristics influence the impact of ADHD and the parent-child agreement in children and adolescents.

Overview of Attention Deficit Hyperactivity Disorder in Young Children

Attention deficit hyperactivity disorder (ADHD) is a complex disorder, which can be seen as a disorder of life time, developing in preschool years and manifesting symptoms (full and/or partial) throughout the adulthood; therefore, it is not surprising that there are no simple solutions. The aim of this paper is to provide a short and concise review which can be used to inform affected children and adults; family members of affected children and adults, and other medical, paramedical, non-medical, and educational professionals about the disorder. This paper has also tried to look into the process of how ADHD develops; what are the associated problems; and how many other children and adults are affected by such problems all over the world basically to understand ADHD more precisely in order to develop a better medical and or non-medical multimodal intervention plan. If preschool teachers and clinicians are aware of what the research tells us about ADHD, the varying theories of its cause, and which areas need further research, the knowledge will assist them in supporting the families of children with ADHD. By including information in this review about the connection between biological behavior, it is hoped that preschool teachers and clinicians at all levels will feel more confident about explaining to parents of ADHD children, and older ADHD children themselves about the probable causes of ADHD.