The association of ADHD and depression: mediation by peer problems and parent-child difficulties in two complementary samples

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.

Networks of Neurodevelopmental Traits, Socioenvironmental Factors, Emotional Dysregulation in Childhood, and Depressive Symptoms Across Development in Two U.K. Cohorts

OBJECTIVE

Previous population-based studies have identified associations between childhood neurodevelopmental traits and depression in childhood, adolescence, and young adulthood. However, neurodevelopmental traits are highly correlated with each other, which could confound associations when traits are examined in isolation. The authors sought to identify unique associations between multiple neurodevelopmental traits in childhood and depressive symptoms across development, while taking into account co-occurring difficulties, in multivariate analyses.

METHODS

Data from two U.K. population-based cohorts, the Twins Early Development Study (TEDS) (N=4,407 independent twins) and the Avon Longitudinal Study of Parents and Children (ALSPAC) (N=10,351), were independently analyzed. Bayesian Gaussian graphical models were estimated to investigate pairwise conditional associations between neurodevelopmental traits (autism and ADHD symptoms and general cognitive, learning, and communication abilities), socioenvironmental stressors (academic performance and peer relations), and emotional dysregulation in childhood (ages 7-11) and depressive symptoms across development (ages 12, 16, and 21).

RESULTS

In both cohorts, bivariate correlations indicated several associations between neurodevelopmental traits and depressive symptoms across development. However, based on replicated findings across cohorts, these pairs of variables were mostly conditionally independent, and none were conditionally associated, after accounting for socioenvironmental stressors and emotional dysregulation. In turn, socioenvironmental stressors and emotional dysregulation were conditionally associated with both neurodevelopmental traits and depressive symptoms. Based on replicated findings across cohorts, neurodevelopmental traits in childhood could be associated only indirectly with depressive symptoms across development.

CONCLUSIONS

This study indicates that associations between childhood neurodevelopmental traits and depressive symptoms across development could be explained by socioenvironmental stressors and emotional dysregulation. The present findings could inform future research aimed at the prevention of depression in youths with neurodevelopmental disorders.

Illuminating the daily life experiences of adolescents with and without ADHD: protocol for an ecological momentary assessment study

INTRODUCTION

Adolescents with attention-deficit/hyperactivity disorder (ADHD) are at elevated risk of a range of difficulties, among which emotion regulation, peer and co-occurring mental health problems are prominent challenges. To better support adolescents with ADHD, ecologically valid interventions that can be embedded in daily life to target the most proximal antecedents of these challenges are needed. Ecological momentary assessment (EMA) designs are ideally suited to meeting this need.

METHODS AND ANALYSES

In the mental health in the moment ADHD study, we will use an EMA design to capture the daily life experiences of approximately 120 adolescents aged 11-14 years with a clinical diagnosis of ADHD and the same number of age-matched and gender-matched peers without a diagnosis of ADHD. We will combine this with comprehensive information gathered from online surveys. Analysing the data using techniques such as dynamic structural equation modelling, we will examine, among other research questions, the role of emotion regulation and peer problems in mediating the links between characteristics of ADHD and commonly co-occurring outcomes such as anxiety, depression and conduct problems. The results can help inform interventions to support improved peer functioning and emotion regulation for adolescents with ADHD.

ETHICS AND DISSEMINATION

This study received a favourable ethical opinion through the National Health Service ethical review board and the University of Edinburgh PPLS Research Ethics panel. The results will be disseminated through journal publications, conferences and seminar presentations and to relevant stakeholders, such as those with ADHD, their families and clinicians.

Psychological Treatments for Hyperactivity and Impulsivity in Children with ADHD: A Narrative Review

Treatment of the ADHD types (hyperactive-impulsive, inattentive, and combined) in children has rarely been studied separately, although their prognostic courses differ widely. In addition, data show that improvements in hyperactivity/impulsivity are hard to achieve. Thus, we focused on treatments tailored to hyperactivity/impulsivity. We examined meta-analyses and systematic reviews within the inter- and intra-individual treatments and found that psychoeducation and training for parents, school-based interventions, reinforcement strategies, and neurofeedback consistently showed small to moderate effect sizes in reducing hyperactivity/impulsivity in children. Conversely, emotional self-regulation, social skills, and cognitive trainings showed unsatisfactory results. In summary, we found that the quality of usual care can be surpassed when the designated interventions are purposefully combined into a multimodal treatment program.

The role of perceived threats on mental health, social, and neurocognitive youth outcomes: A multicontextual, person-centered approach

Perceived threat in youth's environments can elevate risk for mental health, social, and neurocognitive difficulties throughout the lifespan. However, few studies examine variability in youth's perceptions of threat across multiple contexts or evaluate outcomes across multiple domains, ultimately limiting our understanding of specific risks associated with perceived threats in different contexts. This study examined associations between perceived threat in youth's neighborhood, school, and family contexts at ages 9-10 and mental health, social, and neurocognitive outcomes at ages 11-12 within a large US cohort (N = 5525) enrolled in the Adolescent Brain Cognitive DevelopmentSM Study (ABCD Study®). Latent profile analysis revealed four distinct profiles: Low Threat in all contexts, Elevated Family Threat, Elevated Neighborhood Threat, and Elevated Threat in all contexts. Mixed-effect models and post hoc pairwise comparisons showed that youth in Elevated Threat profile had poorer mental health and social outcomes 2 years later. Youth in the Elevated Family Threat profile uniquely showed increased disruptive behavior symptoms, whereas youth in the Elevated Neighborhood Threat profile predominantly displayed increased sleep problems and worse neurocognitive outcomes 2 years later. Together, findings highlight the importance of considering perceptions of threat across multiple contexts to achieve a more nuanced developmental picture.

Associations of meeting 24-h movement behavior guidelines with cognitive difficulty and social relationships in children and adolescents with attention deficit/hyperactive disorder

BACKGROUND

Evidence-based 24-h movement behavior (24-HMB) guidelines have been developed to integrate recommendations for the time spent on physical activity, sedentary behavior, and sleep. For children and adolescents, these 24-HMB guidelines recommend a maximum of two hours of recreational screen time (as part of sedentary behavior), a minimum of 60 min per day of moderate to vigorous physical activity (MVPA), and an age-appropriate sleep duration (9-11 h for 5 to 13-year-olds; 8-10 h for 14 to 17-year-olds). Although adherence to the guidelines has been associated with positive health outcomes, the effects of adhering to the 24-HMB recommendations have not been fully examined in children and adolescents with attention eficit/hyperactive disorder (ADHD). Therefore, this study examined potential associations between meeting the 24-HMB guidelines and indicators of cognitive and social difficulties in children and adolescents with ADHD.

METHODS

Cross-sectional data on 3470 children and adolescents with ADHD aged between 6 and 17 years was extracted from the National Survey for Children's Health (NSCH 2020). Adherence to 24-HMB guidelines comprised screen time, physical activity, and sleep. ADHD-related outcomes included four indicators; one relating to cognitive difficulties (i.e., serious difficulties in concentrating, remembering, or making decisions) and three indicators of social difficulties (i.e., difficulties in making or keeping friends, bullying others, being bullied). Logistic regression was performed to determine the associations between adherence to 24-HMB guidelines and the cognitive and social outcomes described above, while adjusting for confounders.

RESULTS

In total, 44.8% of participants met at least one movement behavior guideline, while only 5.7% met all three. Adjusted logistic regressions further showed that meeting all three guidelines was associated with lower odds of cognitive difficulties in relation to none of the guidelines, but the strongest model included only screen time and physical activity as predictors (OR = 0.26, 95% CI 0.12-0.53, p < .001). For social relationships, meeting all three guidelines was associated with lower odds of difficulty keeping friends (OR = 0.46, 95% CI 0.21-0.97, p = .04) in relation to none of the guidelines. Meeting the guideline for screen time was associated with lower odds of being bullied (OR = 0.61, 95% CI 0.39-0.97, p = .04) in relation to none of the guidelines. While screen time only, sleep only and the combination of both were associated with lower odds of bullying others, sleep alone was the strongest predictor (OR = 0.44, 95% CI 0.26-0.76, p = .003) in relation to none of the guidelines.

CONCLUSION

Meeting 24-HMB guidelines was associated with reduced likelihood of cognitive and social difficulties in children and adolescents with ADHD. These findings highlight the importance of adhering to healthy lifestyle behaviors as outlined in the 24-HMB recommendations with regard to cognitive and social difficulties in children and adolescents with ADHD. These results need to be confirmed by longitudinal and interventional studies with a large sample size.

Impairment's Role in the Pathway From Externalizing Psychopathology to Depressive Symptoms in Adolescents With ADHD

OBJECTIVE

This study examined the role of academic, social, and family impairment in the pathway from externalizing psychopathology to depression among young adolescents with ADHD in a multiple mediation model.

METHOD

The sample included adolescents with ADHD enrolled in an intervention trial. Parent ratings of externalizing psychopathology were measured at eligibility assessment, adolescent self-reported depressive symptoms were measured at eligibility and at the end of treatment, and parent-rated impairment was measured in the middle of treatment. A multiple mediation model was used to examine mediating effects of impairment types in the pathway from externalizing psychopathology to depression.

RESULTS

Parent-reported family impairment significantly mediated the association between externalizing psychopathology and depressive symptoms.

CONCLUSIONS

Results suggest family impairment mediates the association between externalizing psychopathology and depressive symptoms beyond academic and social impairment for youth with ADHD. Findings implicate the importance of targeting family functioning during early adolescence to prevent depression.

The role of moment-to-moment dynamics of perceived stress and negative affect in co-occurring ADHD and internalising symptoms

A maladaptive response to stress in individuals with high ADHD traits may be a key factor explaining co-occurring ADHD symptoms and internalising problems. The current study investigates whether between-person differences in ADHD traits are associated with differences in the within-person moment-to-moment coupling of stress and negative affect; and whether these can explain between-person differences in internalising problems (N = 262, median-age 20). Results of a dynamic structural equation model indicated that between-person differences in ADHD traits significantly moderated the daily life coupling between stress and negative affect. Further, higher ADHD traits were associated with stronger stress carry-over and higher mean levels of negative affect. Stress carry-over and mean levels of negative affect mediated the association between ADHD traits and internalising problems.

ADHD symptoms and diurnal cortisol in adolescents: The importance of comorbidities

BACKGROUND

Altered regulation of diurnal cortisol has been associated with both dimensional symptoms and clinical diagnoses of attention deficit-hyperactivity disorder (ADHD). Indeed, a recent meta-analysis suggests that lower diurnal cortisol output may be a biomarker of attention deficit-hyperactivity disorder (ADHD); importantly, however, the influence of psychiatric comorbidities on this association has not been characterized. Approximately two-thirds of children with ADHD have at least one co-occurring neuropsychiatric condition, and altered HPA-axis function has been implicated in many of these conditions. Using dimensional measures of psychopathology, we examined whether comorbid symptoms influence the association of ADHD symptoms with daily cortisol output.

METHODS

138 adolescents (ages 11-15 years) completed measures of symptoms of psychopathology and provided saliva samples over two days. We analyzed whether ADHD symptoms were related to morning, afternoon, and evening cortisol, the cortisol awakening response (CAR) and cumulative daily cortisol (area under the curve with respect to ground [AUCg]) while accounting for symptoms of three psychiatric disorders that are commonly comorbid with ADHD: conduct disorder (CD), anxiety, and depression. In sensitivity analyses, we included symptoms of oppositional defiant disorder (ODD) in place of CD symptoms.

FINDINGS

After controlling for symptoms of CD, anxiety, and depression, ADHD symptoms were associated significantly with higher cumulative diurnal cortisol (AUCg), morning cortisol, and afternoon cortisol. Symptoms of CD, anxiety and depression were not associated significantly with any cortisol metrics; however, in sensitivity analyses, ODD symptoms were associated with lower AUCg and morning cortisol.

DISCUSSION

Our findings highlight the distinct influence of ADHD and externalizing symptoms on cortisol output. Further work is needed to examine the specificity of altered HPA-axis activity as a biomarker of ADHD and to elucidate whether symptoms of ADHD differ in their association with diurnal cortisol as a function of their severity.

Longitudinal associations between early childhood irritability and adolescent depression symptoms in autistic children are mediated by peer relationships but not educational engagement

In the general population, irritability is associated with later depression. Despite irritability being more prevalent in autistic children, the long-term sequelae are not well explored. We tested whether irritability in early childhood predicted depression symptoms in autistic adolescents, and whether associations could be explained by difficulties in peer relationships and lower educational engagement. Analyses tested the longitudinal associations between early childhood irritability (ages 3-5) and adolescent depression symptoms (age 14) in a prospective inception cohort of autistic children (N = 390), followed from early in development shortly after they received a clinical diagnosis. Mediators were measured in mid-childhood (age 10) by a combination of measures, from which latent factors for peer relationships and educational engagement were estimated. Results showed early childhood irritability was positively associated with adolescent depression symptoms, and this association remained when adjusting for baseline depression. A significant indirect pathway through peer relationships was found, which accounted for around 13% of the association between early childhood irritability and adolescent depression, suggesting peer problems may partially mediate the association between irritability and later depression. No mediation effects were found for education engagement. Results highlight the importance of early screening and intervention for co-occurring irritability and peer problems in young autistic children.

Secure Attachment Relationships With Mothers, But Not Fathers, Moderate the Relation Between Attention-Deficit Hyperactivity Symptoms and Delinquency in Adolescents

OBJECTIVE

The primary aim of this study was to investigate whether secure parent-adolescent attachment relationships moderate the longitudinal relation between 9th grade (G9) ADHD symptoms and 12th grade (G12) delinquency within a community sample of adolescents.

METHOD

Participants included 335 9th graders, of whom 203 students completed measures again in 12th grade. Mothers reported on their adolescents' ADHD symptoms and aggressive behaviors, and adolescents completed measures of their own delinquency and their perceptions of their parent-child attachment relationships.

RESULTS

G9 ADHD symptoms predicted increases in G12 delinquent behaviors. Moderation effects were also found such that G9 ADHD symptoms predicted G12 delinquency for only those youth who had moderate or low levels of secure maternal attachment. Paternal secure attachment did not moderate the effects of G9 ADHD symptoms on G12 delinquency.

CONCLUSION

Findings underscore the importance of secure maternal attachment relationships in the development of delinquency among adolescents with ADHD symptoms.

Multi-Trajectories of Conduct Problems, Hyperactivity/Inattention, and Peer Problems Across Childhood: Results from the Growing Up in Scotland Birth Cohort

Using a person-centred approach, this study inspected multi-trajectories of conduct problems, hyperactivity/inattention and peer problems, and associated risk factors for group membership. The sample included 3,578 children (50.8% males) from a population birth cohort in Scotland (Growing Up in Scotland). The parental version of the Strengths and Difficulties Questionnaire (SDQ) was used when children were 4, 5, 6, 7, and 10 years old. Antecedent factors at the perinatal, child, and family levels were collected using parental reports, observation, and standardised assessments at 10, 24, and 36 months. A group-based multi-trajectory analysis was employed. Findings showed that a six-group model best fit the data. Identified groups included non-engagers, normative, decreasing externalising/low peer problems, low externalising/moderate peer problems, moderate externalising/increasing peer problems and multimorbid moderate-high chronic. Findings suggest multimorbidity between externalising behaviours and peer problems in the more elevated groups. Two common protective factors emerged across all groups: caregiver mental health and parent-infant attachment. Identified risk factors were specific to group membership. Risk factors for the most elevated group included single-parent status, social deprivation, previous neonatal intensive care unit admission, child sex, whilst children's expressive language was a protective factor. Taken together, findings contribute to the emerging literature modelling trajectories of externalising behaviours and peer problems simultaneously and have important practical implications for prevention of problems in childhood, by identifying targets at the perinatal, child, and family levels.

Multi-Trajectories of Conduct Problems, Hyperactivity/Inattention, and Peer Problems Across Childhood: Results from the Growing Up in Scotland Birth Cohort

Using a person-centred approach, this study inspected multi-trajectories of conduct problems, hyperactivity/inattention and peer problems, and associated risk factors for group membership. The sample included 3,578 children (50.8% males) from a population birth cohort in Scotland (Growing Up in Scotland). The parental version of the Strengths and Difficulties Questionnaire (SDQ) was used when children were 4, 5, 6, 7, and 10 years old. Antecedent factors at the perinatal, child, and family levels were collected using parental reports, observation, and standardised assessments at 10, 24, and 36 months. A group-based multi-trajectory analysis was employed. Findings showed that a six-group model best fit the data. Identified groups included non-engagers, normative, decreasing externalising/low peer problems, low externalising/moderate peer problems, moderate externalising/increasing peer problems and multimorbid moderate-high chronic. Findings suggest multimorbidity between externalising behaviours and peer problems in the more elevated groups. Two common protective factors emerged across all groups: caregiver mental health and parent-infant attachment. Identified risk factors were specific to group membership. Risk factors for the most elevated group included single-parent status, social deprivation, previous neonatal intensive care unit admission, child sex, whilst children's expressive language was a protective factor. Taken together, findings contribute to the emerging literature modelling trajectories of externalising behaviours and peer problems simultaneously and have important practical implications for prevention of problems in childhood, by identifying targets at the perinatal, child, and family levels.

Practitioner Review: Attention-deficit hyperactivity disorder and autism spectrum disorder - the importance of depression

Young people with neurodevelopmental disorders, such as attention-deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD), show high rates of mental health problems, of which depression is one of the most common. Given that depression in ASD and ADHD is linked with a range of poor outcomes, knowledge of how clinicians should assess, identify and treat depression in the context of these neurodevelopmental disorders is much needed. Here, we give an overview of the latest research on depression in young people with ADHD and ASD, including possible mechanisms underlying the link between ADHD/ASD and depression, as well as the presentation, assessment and treatment of depression in these neurodevelopmental disorders. We discuss the implications for clinicians and make recommendations for critical future research in this area.

Mindfulness Interventions for Attention Deficit Hyperactivity Disorder: A Systematic Review and Meta-Analysis

Attention Deficit Hyperactivity Disorder (ADHD) is a common neurodevelopmental condition impacting children and adults. Current treatments are limited and there is increasing interest in the use of mindfulness, which is growing in popularity. Previous systematic reviews have typically focused on specific ages, outcome measures or interventions. The current review aimed to take a more comprehensive approach. Title and abstract searches were performed in five databases for randomized and non-randomized controlled trials or pre-post studies with participants with an ADHD diagnosis or a score above a clinically relevant cut-off on a validated ADHD measure. Studies had to measure symptoms of ADHD, global or social functioning. Extraction of key information including participant status (i.e., diagnosis, scale scores, comorbidities, medication use), study design, and outcome measures was conducted. Effect sizes (Hedge’s g) were calculated and where a measure had been used in at least three studies with the same population, meta-analyses were considered. Twenty-nine studies were initially identified, with seven deemed poor quality and removed from further analysis leaving, 22 studies containing data from 1237 children and adults with ADHD along with data from 525 family members. The data indicate possible benefits of mindfulness on self-compassion, quality of life, wellbeing, depression, and anxiety. The findings also suggest that mindfulness may also improve ADHD symptoms, executive function, problematic behaviours, and emotional dysregulation, although results vary by age of patient and measures used. Parent stress and parenting style have received limited attention, highlighting the need for more studies in these areas. Whilst the data presented suggest that mindfulness may be beneficial, the evidence base is not as strong as the popularity of the approach. Many of the studies lacked blind assessment, adequate randomization, or suitable control conditions. As such high-quality controlled studies considering medication, other psychosocial interventions, use of active and in active controls and comorbidity as well as longer follow-up periods, are needed to confirm this.

Does emotion dysregulation mediate the association between ADHD symptoms and internalizing problems? A longitudinal within-person analysis in a large population-representative study

BACKGROUND

Previous research has suggested that children with attention-deficit/hyperactivity disorder (ADHD) symptoms commonly show emotion dysregulation difficulties. These difficulties may partly explain the strong tendency for internalizing problems such as anxiety and depression to co-occur with ADHD symptoms. However, no study has yet provided a longitudinal analysis of the within-person links between ADHD symptoms, emotion dysregulation, and internalizing problems necessary to examine this hypothesis from a developmental perspective.

METHODS

We used data from the age 3, 5, and 7 waves of the large UK population-representative Millennium Cohort Study (n = 9,619, 4,885 males) and fit gender-stratified autoregressive latent trajectory models with structured residuals (ALT-SR) to disaggregate within- and between-person relations between ADHD symptom, emotion dysregulation, and internalizing problem symptoms.

RESULTS

We found that emotion dysregulation significantly mediated the longitudinal within-person association between ADHD symptoms and internalizing problems.

CONCLUSIONS

Results underline the promise of targeting emotion dysregulation as a means of preventing internalizing problems co-occurring with ADHD symptoms.

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].

Mediating Factors in Within-Person Developmental Cascades of Externalising, Internalising and ADHD Symptoms in Childhood

Previous studies have offered evidence for peer problems and academic achievement as mediators in developmental cascades from externalising to internalising problems, and from ADHD symptoms to both internalising and externalising problems. However, these mediators have not been found to fully account for these cascades, indicating that there may be additional mediators involved. This study investigated the role of harsh parenting and parental involvement alongside academic achievement and peer problems in mediating within-person developmental cascades from externalising to internalising problems and from ADHD symptoms to internalising and externalising problems using autoregressive latent trajectory models with structured residuals. Models were fit for parent- and teacher-reports on children’s psychosocial development as measured by the Social Behaviour Questionnaire (SBQ) collected over ages 7, 9, and 11 in an ethnically diverse Swiss longitudinal cohort study (z-proso; N = 1387, 51% male). Results indicated that, when appropriately disentangling within- from between-person effects, none of the considered factors acted as significant mediators in longitudinal within-person relations between ADHD, internalising and externalising problems; hence, mediating mechanisms in developmental cascades remain to be identified.

Childhood Trajectories of Hyperactivity/Inattention Symptoms and Diurnal Cortisol in Middle Adolescence: Results from a UK Birth Cohort

OBJECTIVE

Children with attention-deficit/hyperactivity disorder (ADHD) show hypoactivity of the hypothalamic-pituitary-adrenal (HPA) axis. Whether the association between hyperactivity/inattention symptoms with HPA axis dysfunction holds in the general child population too is not clear.

METHOD

We assessed associations between longitudinal trajectories of hyperactivity/inattention symptoms during ages 4 to 13 years and basal cortisol profiles at age 15 in a British general population cohort.

RESULTS

Adolescents with persistently high levels of hyperactivity/inattention symptoms since childhood showed lower total morning cortisol and a smaller diurnal decline, even after adjusting for confounders. No associations were found between any of the symptom trajectories and cortisol awakening response, diurnal slope or daily output of cortisol.

CONCLUSION

This study provides evidence for hypocortisolism among adolescents with chronic hyperactivity/inattention symptoms in the general population.

ADHD and ODD Dimensions: Time Varying Prediction of Internalizing Problems from Childhood to Adolescence

OBJECTIVE

Although childhood ADHD is a risk factor for internalizing problems, it consists of separable inattention and hyperactivity dimensions that differentially predict outcomes. Oppositional defiant disorder also consists of separable dimensions (i.e., irritable, oppositional), co-occurs with ADHD, and predicts internalizing outcomes. To discern independent associations with internalizing problems, dimensions must be considered simultaneously.

METHODS

Controlling for age, sex, and race, we tested inattention, hyperactivity, irritability, and oppositionality as time-varying predictors of 6 to 7-year prospective change in parent- and teacher-rated internalizing problems in 230 ethnically- diverse (50% Caucasian) 5 to 10 year old youth (M = 7.4 years, 68% male) with (n = 120) and without ADHD (n = 110).

RESULTS

Escalating inattention and irritability, but not hyperactivity and oppositionality, uniquely predicted internalizing problems.

CONCLUSION

These findings suggest that inattention and irritability are unique risk factors for later internalizing problems. These dimensions may catalyze internalizing problems across development and constitute important intervention targets.

Prospectively Predicting Adult Depressive Symptoms from Adolescent Peer Dysfunction: a Sibling Comparison Study

Previous studies have shown that peer dysfunction in adolescence predicts depression in adulthood, even when controlling for certain individual- and/or family-level characteristics. However, these studies have not controlled for numerous potential familial confounders, precluding causal inferences. The present study therefore used a sibling comparison design (i.e., comparing siblings within families) to test whether peer dysfunction (e.g., lack of friendships, victimization) in adolescence continues to predict depression in adulthood after accounting for unmeasured familial confounds and individual characteristics in adolescence. Participants’ (N = 85) dysfunction with peers was assessed in adolescence (M_age = 13.21, SD = 3.47) by self- and parent-report, and adult depressive symptoms were assessed up to five times, up to 38 years later. Multilevel modeling was used to examine the effect of adolescent peer dysfunction on adult depressive symptoms after adjusting for familial confounds and/or individual characteristics in adolescence (e.g., baseline depressive symptoms, dysfunctional relations with siblings/parents). Both self-reported (b = 1.28, p < 0.001) and parent-reported (b = 0.56, p = 0.032) adolescent peer dysfunction were associated with greater depressive symptom severity in adulthood in unadjusted models. Self-reported (but not parent-reported) adolescent peer dysfunction continued to predict adult depressive symptoms after controlling for familial confounding and measured covariates such as adolescent depressive symptoms and relations with siblings and parents (b = 1.06, p = 0.035). Although confidence intervals were wide and the potentially confounding effects of numerous individual-level factors were not ruled out, these findings provide preliminary evidence that perceived peer dysfunction in adolescence may be an unconfounded risk factor for depressive symptoms in adulthood.

Developmental Trajectory of Inattention and Its Association With Depressive Symptoms in Adolescence: Peer Relationships as a Mediator

This study investigated the developmental trajectory of inattention symptoms as a predictor of later depressive symptoms in adolescence, and examined potential mediating role of peer relationships in this process. Participants were adolescents who were part of the large longitudinal panel study on Korean Youths, Korean Children & Youth Panel Survey 2010 (KCYPS 2010) of the National Youth Policy Institute (NYPI). Specifically, data were drawn from two cohorts of KCYPS that differed in participant age (Panel 1: 2003 birth cohort, n = 2,342, 48.2% girls; Panel 2: 2000 birth cohorts, n = 2,378, 40.0% girls). We analyzed data collected from 2010 to 2016 when children in panel 1 were 6-7 to 12-13 years old, and children in panel 2 were 9-10 to 15-16 years old. Results of latent growth modeling (LGM) were as follows. In Panel 1, the inattention symptoms increased from 9-10 to 12-13 years. Otherwise, the inattention symptoms decreased from 11-12 to 15-16 years in panel 2. Additionally, in both panels, initial status and slope of inattention significantly predicted later levels of depressive symptoms, and peer relationships partly mediated the association between inattention trajectory and depressive symptoms. The findings are discussed with respect to considering the growth of inattention and the quality of peer relationships as promising targets for early identification and intervention of depression in adolescents.

Facial emotion recognition impairment predicts social and emotional problems in children with (subthreshold) ADHD

Children with attention-deficit/hyperactivity disorder (ADHD) symptoms often experience social and emotional problems. Impaired facial emotion recognition has been suggested as a possible underlying mechanism, although impairments may depend on the type and intensity of emotions. We investigated facial emotion recognition in children with (subthreshold) ADHD and controls using a novel task with children's faces of emotional expressions varying in type and intensity. We further investigated associations between emotion recognition accuracy and social and emotional problems in the ADHD group. 83 children displaying ADHD symptoms and 30 controls (6-12 years) completed the Morphed Facial Emotion Recognition Task (MFERT). The MFERT assesses emotion recognition accuracy on four emotions using five expression intensity levels. Teachers and parents rated social and emotional problems on the Strengths and Difficulties Questionnaire. Repeated measures analysis of variance revealed that the ADHD group showed poorer emotion recognition accuracy compared to controls across emotions (small effect). The significant group by expression intensity interaction (small effect) showed that the increase in accuracy with increasing expression intensity was smaller in the ADHD group compared to controls. Multiple regression analyses within the ADHD group showed that emotion recognition accuracy was inversely related to social and emotional problems, but not prosocial behavior. Not only children with an ADHD diagnosis, but also children with subthreshold ADHD experience impairments in facial emotion recognition. This impairment is predictive for social and emotional problems, which may suggest that emotion recognition may contribute to the development of social and emotional problems in these children.

Childhood ADHD and Executive Functioning: Unique Predictions of Early Adolescent Depression

Given the increasing prevalence of adolescent depression, identification of its early predictors and elucidation of the mechanisms underlying its individual differences is imperative. Controlling for baseline executive functioning (EF), we tested separate ADHD dimensions (i.e., inattention, hyperactivity-impulsivity) as independent predictors of early adolescent depression, including temporally-ordered causal mediation by academic functioning and social problems, using structural equation modeling. At baseline, participants consisted of 216 children (67% male) ages 6–9 years old with (n = 112) and without (n = 104) ADHD who subsequently completed Wave 2 and 3 follow-ups approximately two and four years later, respectively. Predictors consisted of separate parent and teacher ratings of childhood ADHD and laboratory-based assessments of key EF domains. At Wave 2, parents and teachers completed normed rating scales of youth academic and social functioning; youth completed standardized assessments of academic achievement. At Wave 3, youth self-reported depression. Baseline inattention positively predicted early adolescent depression whereas childhood hyperactivity-impulsivity and EF did not. Neither academic nor social functioning significantly mediated predictions of depression from baseline ADHD and EF. We consider prediction of early adolescent depression from inattention, including directions for future intervention and prevention research.

Attachment Anxiety Moderates the Association Between ADHD and Psychological Distress

This study aims at examining the possible moderating role of attachment style in the association between ADHD and psychological distress, namely, anxiety and depression symptoms. Study included ninty nine participants: Sixty adults with ADHD diagnosis and thirty nine adults without ADHD or other neurological and/or psychiatric disorders. All participants completed the Patient Health Questionnaire (PHQ-9), State-Trait Anxiety (STAI) questionnaires, Emotion in Close Relationships (ECR-R) questionnaire and Adult ADHD Self-Report Scale-Version 1.1 (ASRS-v1.1). Adults with ADHD had greater symptoms of depression (p < .001) and anxiety (p < .001) than adults without ADHD. Process analysis yielded that attachment anxiety moderated the association between ADHD, anxiety and depression, therefore only adults with ADHD that had moderate to high attachment anxiety exhibited higher levels of depression (p < .01) and anxiety (p < .001). No moderating effect was observed for attachment avoidance. Moreover, we did not find correlations between ADHD, anxiety and depression when secure attachment was the moderator; indicating that secure attachment could serve as a "protective factor" against psychological distress among ADHD individuals. Among anxiously attached adults, ADHD was associated with higher levels psychological distress. These findings highlight the important role of attachment style in mental health of adults with ADHD.

Do ADHD Symptoms and Relationship Quality With Mothers and Best Friends Across High School Predict Depressive Symptoms for Adolescents?

Objective: Symptoms of ADHD place adolescents at increased risk for depression. The transition from middle to high school may magnify depression risk. This study examined whether changes in adolescents' negative relationship quality with their mothers and best friends from eighth to 12th grades mediated the longitudinal relations between ADHD and depressive symptoms. Method: 368 adolescents (48.5% male) were initially recruited. Results: Boys with elevated ADHD symptoms in the eighth grade reported steeper increases in negative relationship quality with their mothers relative to girls, and that this trajectory mediated the relation between ADHD and depressive symptoms. ADHD symptoms were also associated with increases in negative friendship quality across high school for boys; however, this did not mediate the relation between ADHD and depressive symptoms for either sex. Conclusion: Growth in mother-adolescent negative relationship quality may be one mechanism that explains the development of depressive symptoms in adolescent boys with elevated ADHD symptoms.

Dependent Stress Mediates the Relation Between ADHD Symptoms and Depression

Objective: Depression and attention-deficit hyperactivity disorder (ADHD) are prevalent and highly comorbid. ADHD symptoms are associated with specific dependent (i.e., self-generated) stressors in children, and there is a strong link between dependent stress and depression. Despite continued comorbidity of ADHD and depressive symptoms into adulthood, it is unknown whether stress generation mediates the relation between ADHD and subsequent depressive symptoms in emerging adulthood, a period of heightened stress. Method: We tested this mediation model in a semester-long longitudinal study of 224 college students (aged 18-23 years). We additionally tested whether this model differed between inattentive versus hyperactive/impulsive ADHD symptoms given evidence that they vary in their relations to stress and depression. Results: Dependent stress mediated the association between total ADHD symptoms at baseline and later depressive symptoms; these effects were equivalent for inattentive versus hyperactive/impulsive ADHD symptoms. Conclusion: These findings suggest stress generation as a mechanism for increased depression in individuals with ADHD symptoms.

Investigating Friendship Difficulties in the Pathway from ADHD to Depressive Symptoms. Can Parent-Child Relationships Compensate?

Attention deficit/hyperactivity disorder (ADHD) is associated with friendship difficulties. This may partly account for the increasingly recognised association between ADHD and subsequent depression. Little is known about the types of friendship difficulties that could contribute to the association between ADHD and depressive symptoms and whether other relationships, such as parent-child relationships, can mitigate against potential adverse effects of friendship difficulties. In a representative UK school sample (n = 1712), three main features of friendship (presence of friends, friendship quality and characteristics of the individual's classroom friendship group) were assessed in a longitudinal study with two assessment waves (W1, W2) during the first year of secondary school (children aged 11-12 years). These friendship features (W1) were investigated as potential mediators of the prospective association between teacher-rated ADHD symptoms (W1) and self-rated depressive symptoms (W2) seven months later. Parent-child relationship quality (W1) was tested as a moderator of any indirect effects of ADHD on depression via friendship. ADHD symptoms were inversely associated with friendship presence, friendship quality and positive characteristics of classroom friendship groups. Depressive symptoms were inversely associated with presence and quality of friendships. Friendship quality had indirect effects in the association between ADHD and subsequent depressive symptoms. There was some evidence of moderated mediation, whereby indirect effects via friendship quality attenuated slightly as children reported warmer parent-child relationships. This highlights the importance of considering the quality of friendships and parent-child relationships in children with ADHD symptoms. Fostering good quality relationships may help disrupt the link between ADHD symptomology and subsequent depression risk.

Helpful family climate moderates the relationship between perceived family support of ADHD symptoms and depression: a conditional process model

BACKGROUND

Symptoms of attention deficit hyperactivity disorder (ADHD) are commonly comorbid with depression This study aimed to examine the relationship between ADHD symptoms and depression through perceived family support and to explore whether the magnitude of the relationship depended on the type of family climate of medical students.

METHODS

This cross-sectional study was conducted among 124 first year medical students in Thailand. Participants completed questionnaires on ADHD symptoms, depression, perceived family support, and 9 types of family climate. The questionnaires included the Adult ADHD Self-Report Scale Screener, Patient Health Questionnaire-9, and revised Thai Multidimensional Scale of Perceived Social Support. Mediational analysis was adopted to examine the mediating role of perceived family support in the relationship between ADHD symptoms and depression, while moderation analysis was applied to examine the extent of the relationship depending on family climate.

RESULTS

The relationship between ADHD symptoms and depression was moderate. Perceived family support partially mediated this relationship after controlling for age and sex. Among the types of family climate, only helpful family climate was a significant moderator of perceived family support and depression. The moderated mediation model increased the variance in depression from 17% by the mediation model to 21%. However, follow-up conditional mediational analysis showed that the indirect effect of ADHD symptoms on depression via perceived family support was not significant and that this effect did not vary linearly as a function of helpful family climate.

CONCLUSION

The findings of the study revealed that poor family support might be one risk of developing depression in the context of ADHD symptoms. Further study on providing intervention concerning family support among those with ADHD symptoms should be warranted. In addition, a study on helpful family climate in a larger sample size, in other populations, and in a longitudinal fashion for a more robust conclusion is encouraged.

Self-Reported Depressive Symptoms and Suicidality in Adolescents with Attention-Deficit/Hyperactivity Disorder: Roles of Bullying Involvement, Frustration Intolerance, and Hostility

This study examined the relationships of cyberbullying and traditional bullying victimization and perpetration, perceived family function, frustration discomfort, and hostility with self-reported depressive symptoms and suicidality in adolescents diagnosed as having attention-deficit/hyperactivity disorder (ADHD). Both the self-reported severity of depressive symptoms on the Center for Epidemiological Studies Depression Scale and the occurrence of suicidal ideation or a suicide attempt on the suicidality module of the Kiddie Schedule for Affective Disorders and Schizophrenia were assessed in 195 adolescents with ADHD. The adolescents completed the Cyberbullying Experiences Questionnaire, Chinese version of the School Bullying Experience Questionnaire, Frustration–Discomfort Scale, Buss–Durkee Hostility Inventory, and Family APGAR Index. Caregivers completed the ADHD problems component of the Child Behavior Checklist for Ages 6–18. Multiple regression analyses were used to examine the correlates for each of self-reported depressive symptoms and suicidality. The results showed that after the effects of gender, age, ADHD symptoms, and family function were controlled, greater frustration discomfort and bullying perpetration significantly predicted self-reported depressive symptoms. Being cyberbullying victims and displaying hostility significantly predicted the risk of suicidality. Various types of bullying involvement, frustration intolerance, and hostility significantly predicted self-reported depressive symptoms and suicidality in adolescents with ADHD. By monitoring and intervening in these factors, we can reduce the risk of depression-related problems and suicidality in adolescents with ADHD.

Cortisol response to acute psychosocial stress in ADHD compared to conduct disorder and major depressive disorder: A systematic review

BERNHARD, A., J. S. Mayer, N. Fann, and C. M. Freitag. Cortisol response to acute psychosocial stress in ADHD compared to Conduct Disorder and Major Depressive Disorder: A systematic review. NEUROSCI BIOBEHAV REV XX(X) XXX-XXX, 2020. - Heterogeneous alterations of the cortisol stress response in Attention-deficit/hyperactivity Disorder (ADHD) were recently reported by a systematic literature review. To investigate the moderating effect of frequent psychiatric comorbidities, we systematically searched for studies on cortisol stress response to psychosocial stress in ADHD compared to Conduct Disorder (CD) and Major Depressive Disorder (MDD) following PRISMA guidelines. EBSCOhost and PubMed databases were searched in July 2020, employing relevant keywords. Nineteen studies met inclusion criteria. While blunted cortisol stress response was consistently reported in individuals with CD and/or Oppositional Defiant Disorder (ODD), alterations of cortisol stress response were less pronounced in ADHD. Consistently blunted cortisol stress response in ADHD was only found in children with comorbid CD/ODD. Results on cortisol stress response in children and adolescents with MDD were mixed, and no indication for influence of comorbid MDD on cortisol stress response in ADHD was found. Taken together, altered cortisol stress response in ADHD is driven by comorbidity with disruptive behavior disorders. Limitations of previous research and suggestions for future studies are discussed.

Impact of Perceived Social Support on the Relationship between ADHD and Depressive Symptoms among First Year Medical Students: A Structural Equation Model Approach

BACKGROUND

Attention deficit hyperactivity disorder (ADHD) is associated with depression among college students, while perceived social support is also associated with depression, especially among young adults. This study aimed to examine to what extent perceived social support mediated the relationship between ADHD symptoms and depressive symptoms.

METHODS

In total, 124 first year medical students completed the Adult ADHD Self-Report Scale Screener (ASRS), the Patient Health questionnaire-9 and the revised Thai Multidimensional scale of perceived social support reflecting ADHD symptoms, depressive symptoms, and perceive social support, i.e., family members, friends and other significant people, respectively. Structural equation modeling was used to investigate the hypothesized mediation model.

RESULTS

ADHD symptoms exhibited a significant indirect effect on depressive symptoms via perceived social support. ADHD symptoms initially had a direct effect on depression; thereafter, it reduced to a non-significance effect after perceived social support was added. The total variance explained by this model was 35.2%. The mediation model with family support as a mediator showed the highest effect size.

CONCLUSIONS

The study highlighted the importance of perceived social support, particularly family support, on depressive symptoms among young medical students experiencing ADHD symptoms. The model suggests promising relationships for further research on ADHD-related depression and potential treatment in the future.

Is Attention-Deficit/Hyperactivity Disorder a Risk Syndrome for Parkinson's Disease?

Recent epidemiological evidence indicates that diagnosis of attention-deficit/hyperactivity disorder (ADHD) is associated with increased risk for diseases of the basal ganglia and cerebellum, including Parkinson's disease (PD). The evidence reviewed here indicates that deficits in striatal dopamine are a shared component of the causal chains that produce these disorders. Neuropsychological studies of adult ADHD, prodromal PD, and early-stage PD reveal similar deficits in executive functions, memory, attention, and inhibition that are mediated by similar neural substrates. These and other findings are consistent with the possibility that ADHD may be part of the PD prodrome. The mechanisms that may mediate the association between PD and ADHD include neurotoxic effects of stimulants, other environmental exposures, and Lewy pathology. Understanding the nature of the association between PD and ADHD may provide insight into the etiology and pathogenesis of both disorders. The possible contribution of stimulants to this association may have important clinical and public health implications.

Recurrence and Timing of Maternal Depression Predict Early Adolescent Functioning for Children With and Without ADHD

Objective: To examine recurrence and timing of maternal depression as predictors of depressive and conduct symptoms in children with and without ADHD. Method: Children aged 4 to 6 years (125 ADHD, 122 comparison) were followed over 8 years. Maternal depression was assessed annually. Youth depressive and conduct symptoms were assessed at ages 12 to 14. Results: Recurrence of maternal depression predicted youth depressive and conduct symptoms at ages 12 to 14; child ADHD moderated relations between recurrence of maternal depression and youth depressive (but not conduct) symptoms. Early adolescent exposure to maternal depression predicted age 12 to 14 depressive symptoms for all children. Exposure to maternal depression during early childhood, childhood, and early adolescence each independently predicted youth conduct symptoms. Conclusion: Recurrence and timing of maternal depression predict comorbid symptoms in early adolescents, particularly for youth with ADHD. Findings inform the prevention of comorbidities in children with ADHD where maternal depression is present. (J. of Att. Dis. XXXX; XX(X) XX-XX).

An ecological momentary assessment study of the role of emotional dysregulation in co-occurring ADHD and internalising symptoms in adulthood

Previous ecological momentary assessment (EMA) research in children has suggested that emotional dysregulation problems are commonly associated with ADHD symptoms and may help explain their relatively strong co-occurrence with anxiety and depression (collectively referred to as 'internalising problems'); however, this has yet to be replicated for adults. In this study, we used data from a n=260 longitudinal cohort and EMA study, to evaluate the hypothesis that emotional dysregulation mediates the association between ADHD symptoms and internalising problems in emerging adulthood. Emotional dysregulation was based on affect data collected in near real time and in ecological context over a 14-day period, providing a measure of emotional lability in the context of participants' daily lives. Cross-sectional mediation was tested using structural equation modelling. Emotional lability significantly mediated the association between ADHD symptoms and internalising problems. Results suggest that interventions that address the emotional dysregulation aspects of ADHD are likely to be beneficial for preventing and managing secondary internalising symptoms.

Risk Factors for Depression in Adolescents With ADHD: The Impact of Cognitive Biases and Stress

Objective: Youth diagnosed with ADHD are at heightened risk of depression. However, many do not develop depression. Individuals with specific cognitive biases are more likely to develop depression yet it remains untested whether these vulnerability-stress models apply to depression risk in youth with ADHD. Method: We examined whether interpretation and attention biases moderated the relation between stressful life events and depressive symptoms in a sample of adolescents (M_age = 14.42) with ADHD (n = 59) and without ADHD (n = 36). Results: Youth with ADHD experienced more stressful life events compared with those without ADHD. Interpretation biases moderated the association between stress and depressive symptoms in youth with and without ADHD. Attention biases moderated the association between stress and depressive symptoms in the non-ADHD youth only. Conclusion: These results enhance our understanding of vulnerability for depression in adolescence with ADHD and inform targeted prevention and treatment models during this critical developmental juncture.

Difference in Psychic Distress Lived by Parents With ADHD Children and Parents With Healthy Children: Focus on Gender Differences

Objective: ADHD has a complex and negative influence on the family system. The aim of this study was to analyze the perception of emotional distress in a group of parents of children with ADHD. Method: A sample was recruited from the public health system ADHD Unit at Sant Joan de Déu Hospital (Barcelona). The parents of 60 children with newly diagnosed ADHD and the parents of 60 healthy children were included. Results: Higher levels of distress in families with children with ADHD were seen. The distress is present in both parents, with a higher prevalence in the mothers group. A positive correlation was found between ADHD symptoms in the children and the distress reported by parents. A three times higher rate of separations and divorce among parents of children with ADHD was seen. Conclusion: ADHD in children and adolescents increases the emotional distress reported by parents, mainly related to the severity of symptoms present in the children.

Cognitive mechanisms underlying depressive disorders in ADHD: A systematic review

The risk for major depressive disorder (MDD) is considerably increased in young adults with attention-deficit/hyperactivity disorder (ADHD) but underlying mechanisms are poorly understood. This review explores ADHD-specific neurocognitive impairments as possible underlying mechanisms for ADHD-depression comorbidity. Two systematic literature searches were conducted in EBSCOhost, PubMED, and Cochrane Reviews databases according to PRISMA guidelines. The first search identified 18 meta-analyses of cross-sectional and longitudinal studies on cognitive dysfunctions in MDD across the lifespan. The second search identified six original studies on reaction time variability in MDD. During acute depression, children and adults showed cognitive deficits that overlapped with some of the ADHD-related impairments. Findings from remitted patients, high-risk individuals, and few prospective studies suggest that a subset of these shared impairments, specifically executive dysfunctions (selective attention, verbal fluency, working memory) and long-term memory problems, are candidate pre-existing risk markers of depression. We discuss if and how these specific neurocognitive mechanisms may mediate developmental pathways from ADHD to depression. If replicated by longitudinal studies, these findings may guide future prevention strategies.

What explains the link between childhood ADHD and adolescent depression? Investigating the role of peer relationships and academic attainment

There is increasing evidence that childhood Attention-Deficit Hyperactivity Disorder (ADHD) elevates risk of later depression, but the mechanisms behind this association are unclear. We investigated the relationship between childhood ADHD symptoms and late-adolescent depressive symptoms in a population cohort, and examined whether academic attainment and peer problems mediated this association. ALSPAC (Avon Longitudinal Study of Parents and Children) is an ongoing prospective longitudinal population-based UK cohort that has collected data since September 1990. 2950 individuals with data on parent-reported ADHD symptoms in childhood (7.5 years) and self-reported depressive symptoms in late adolescence (17.5 years) were included in analyses. 2161 individuals with additional data at age 16 years on parent-reported peer problems as an indicator of peer relationships and formal examination results (General Certificate of Secondary Education; GCSE) as an indicator of academic attainment were included in mediation analyses. Childhood ADHD symptoms were associated with higher depressive symptoms (b = 0.49, SE = 0.11, p < 0.001) and an increased odds of clinically significant depressive symptoms in adolescence (OR = 1.27, 95% CI 1.15-1.41, p < 0.001). The association with depressive symptoms was mediated in part by peer problems and academic attainment which accounted for 14.68% and 20.13% of the total effect, respectively. Childhood ADHD is associated with increased risk of later depression. The relationship is mediated in part by peer relationships and academic attainment. This highlights peer relationships and academic attainment as potential targets of depression prevention and intervention in those with ADHD. Future research should investigate which aspects of peer relationships are important in conferring later risk for depression.

Self-Rated Depressive Symptoms in Children and Youth with and without Cerebral Palsy: A Pilot Study

Children with cerebral palsy (CP) often exhibit mental health problems, such as depressive symptoms. The purpose of this study was to describe the self-rated depressive symptoms in children with and without CP and to investigate the associated predictors. Participants included 24 children with CP and 33 typically developing (TD) children. Depressive symptoms were assessed using the Birleson Depression Self-Rating Scale for Children. Parents of the participants completed the Strengths and Difficulties Questionnaire. Severity of self-rated depressive symptoms was higher in children with CP than that in TD children. Particularly, decline in activities and enjoyment was identified as a contributor to the increased severity of depressive symptoms. Hierarchical multiple regression analysis revealed that the greater severity of depressive symptoms in children with CP was mediated by hyperactivity/inattention and peer problems. Our study suggests that it is imperative to provide opportunities to participate in social activities from an early age.

Depression and ADHD-Related Risk for Substance Use in Adolescence and Early Adulthood: Concurrent and Prospective Associations in the MTA

Childhood attention-deficit/hyperactivity disorder (ADHD) is prospectively linked to substance use and disorder. Depression emerging in adolescence is an understudied risk factor that may explain some of this risk. In the present study, we considered mediating and moderating roles of adolescent depression in explaining this association by using longitudinal data from the prospective 16-year follow-up of the Multimodal Treatment Study of ADHD (MTA). Participants were 547 children diagnosed with DSM-IV ADHD Combined Type, and 258 age- and sex-matched comparison children. In adolescence, depressive symptoms did not exacerbate effects of childhood ADHD on any substance use. For both groups, time-varying and average depressive symptoms were associated with more frequent use of all substances. Prospectively, we found no evidence of depression mediation to adult substance use. However, adolescent depression moderated the association between childhood ADHD and adult marijuana use. Although adults without ADHD histories used marijuana more frequently if they had elevated depressive symptoms in adolescence, marijuana use by adults with ADHD histories was independent of their adolescent depression. In adulthood, depression diagnoses and ADHD persistence continued to operate as independent, additive correlates of substance use risk. Our findings suggest a circumscribed role for depression in substance use risk that adds to, but does not alter or explain, ADHD-related risk.

Why does early childhood deprivation increase the risk for depression and anxiety in adulthood? A developmental cascade model

BACKGROUND

Using data from the English & Romanian Adoptees (ERA) study, we recently reported that early time-limited exposure to severe institutional deprivation is associated with early-onset and persistent neurodevelopmental problems and later-onset emotional problems. Here, we examine possible reasons for the late emergence of emotional problems in this cohort. Our main focus is on testing a developmental cascade mediated via the functional impact of early-appearing neurodevelopmental problems on late adolescent functioning. We also explore a second putative pathway via sensitization to stress.

METHODS

The ERA study includes 165 Romanian individuals who spent their early lives in grossly depriving institutions and were subsequently adopted into UK families, along with 52 UK adoptees with no history of deprivation. Age six years symptoms of neurodevelopmental problems and age 15 anxiety/depression symptoms were assessed via parental reports. Young adult symptoms of depression and anxiety were assessed by both parent and self-reports; young adults also completed measures of stress reactivity, exposure to adverse life events, and functioning in work and interpersonal relationships.

RESULTS

The path between early institutional deprivation and adult emotional problems was mediated via the impact of early neurodevelopmental problems on unemployment and poor friendship functioning during the transition to adulthood. The findings with regard to early deprivation, later life stress reactivity, and emotional problems were inconclusive.

CONCLUSIONS

Our analysis suggests that the risk for adult depression and anxiety following extreme institutional deprivation is explained through the effects of early neurodevelopmental problems on later social and vocational functioning. Future research should more fully examine the role of stress susceptibility in this model.

Factors associated with symptoms of attention deficit hyperactivity disorder among medical students in Cameroon: a web-based cross-sectional study

INTRODUCTION

Attention deficit hyperactivity disorder (ADHD) is a chronic mental disorder that is associated with poor productivity, with a significant impact on the quality of life.

OBJECTIVES

To determine factors associated with symptoms of ADHD among medical students in Cameroon.

DESIGN

A web-based cross-sectional study.

SETTING

Participants were recruited through a social media platform, WhatsApp, from 24 June to 2 September 2018.

PARTICIPANTS

Medical students aged 18 years and older from seven medical schools in Cameroon. All non-medical students and all medical residents were excluded.

RESULTS

Data from a total of 491 eligible participants were analysed. The median age was 25 (IQR 21-25) years and 54% were of the participants were female. The prevalence of self-reported symptoms of ADHD was 24.4% (95% CI 20.6% to 28.3%). Histories of chronic disease (adjusted OR (AOR) 2.96; 95% CI 1.49 to 5.86, p=0.002), family history of ADHD (AOR 3.38; 95% CI 1.04 to 10.44, p=0.035), severe depression (AOR=3.49; 95% CI 1.82 to 6.77, p<0.001) and anxiety disorder (AOR 2.06; 95% CI 1.25 to 3.36, p=0.004) were found to be independently associated with the symptoms of ADHD.

CONCLUSION

ADHD may be a highly prevalent mental disorder among medical students, and is associated with severe depression, anxiety disorders and chronic diseases. There is a need to conduct a large-scale prospective cohort study with interviews to estimate the true prevalence and incidence of ADHD among medical students in Cameroon, and to determinant the risk factors associated with the disorder.

Family and Maternal Characteristics of Children With Co-Occurring ADHD and Depression

Objective: This study examined differences between children with ADHD and comorbid depression (n = 26), ADHD only (n = 111), and a community control group (n = 130) on measures of family and maternal characteristics. Method: The present study utilized a large, community sample. Diagnoses required positive endorsements from multiple sources. ANOVAs and chi-square tests were conducted to determine group differences. Results: Compared with children with ADHD alone and community controls, mothers of depressed ADHD children reported decreased family cohesion, limited participation in social/recreational activities, increased maternal depressive symptoms, difficulty coping with parenting roles, and higher rates of bipolar and anxiety disorders. Mothers of children with ADHD (with or without comorbid depression) reported increased conflict, decreased cohesion, and poor maternal coping compared with community controls. Conclusion: Findings are consistent with prior literature suggesting that families of children with ADHD and depression demonstrate both similar and unique characteristics. Clinical implications are discussed.

Association Analysis Between the rs1899663 Polymorphism of HOTAIR and Risk of Psychiatric Conditions in an Iranian Population

Recent studies have shown contribution of long non-coding RNAs (lncRNAs) in the pathogenesis of a number of psychiatric disorders. In the current study, we investigated the association between a single nucleotide polymorphism in the lncRNA HOX transcript antisense intergenic RNA (HOTAIR) and risk of diverse neuropsychiatric conditions in Iranian population. The selected polymorphism (rs1899663) is an intronic variant of this lncRNA which has been associated with several cancers in different populations. This SNP was genotyped in 323 individuals with methamphetamine addiction, 55 children with attention-deficit hyperactive disorder (ADHD), 138 patients with bipolar disorder 1 (BPD1), 86 patients with BPD2, 53 patients with major depressive disorder (MDD), and 194 patients with schizophrenia (SCZ). There was no significant association between rs1899663 genotypes and risk of methamphetamine addiction or SCZ in any assessed inheritance model. There was a significant association between rs1899663 SNP and risk of BPD1 in allelic, co-dominant, and dominant models (P values of 0.003, 0.009, and 0.003, respectively). The T allele of this SNP conferred risk of BPD1 (OR (95% CI) = 1.70 (1.20-2.41)). This SNP was associated with risk of BPD2 in allelic and dominant models (P values of 0.02 and 0.04). The T allele of this SNP was revealed to be the risk allele for BPD2 as well (OR (95% CI) = 1.61 (1.09-2.40)). Besides, the mentioned SNP was associated with susceptibility to MDD in allelic and dominant models (P values of 0.01 and 0.03). Finally, the rs1899663 was associated with risk of ADHD in allelic, co-dominant, and dominant models (P values of 3.6E-4, 0.002, and 1.2E-4, respectively). The current investigation highlights the role of rs1899663 in conferring risk of BPD1, BPD2, MDD, and ADHD and suggests a similar underlying genetic background for these conditions.

Trajectories of Verbal and Physical Peer Victimization Among Children with Comorbid Oppositional Defiant Problems, Conduct Problems and Hyperactive-Attention Problems

The high levels of comorbidity between oppositional/conduct problems and hyperactivity/attention problems underscore the need for assessing how vulnerability for peer victimization is shaped by overlap among these behavior problems. Children (mean age 8.39, SD = 0.93) participating in a longitudinal study of the development of conduct problems (N = 744; 348 girls) in Quebec, Canada, were evaluated by their teachers regarding experiences of peer verbal and physical victimization every year for 6 years. Parent and teacher ratings of clinically significant oppositional/conduct problems, and hyperactivity/attention problems, as well as cormorbid opposition defiant/conduct problems and hyperactivity/attention problems were regressed onto trajectories of verbal and physical victimization. While behavior problems (both alone and together) were associated with higher levels of verbal and physical victimization, some variation was observed across rater and type of victimization. Ultimately, these findings suggest the importance of adapting programming for reducing victimization to children with oppositional and conduct problems.

Association of ADHD and Executive Functioning With Childhood Depression

Objective: Despite its association with increased severity and treatment resistance, relatively little is known about the correlates of early-onset childhood depression. ADHD and executive functioning (EF) are each related to depression. Given their covariation, we tested the independent association of ADHD dimensions (i.e., inattention, hyperactivity) and EF with childhood depression using structural equation modeling to identify potential targets for intervention. Method: Participants were 225 five- to 10-year-old children (68% male) with (n = 117) and without (n = 108) ADHD. Youth completed laboratory assessments of EF, and parent, teacher, and youth reports of depression were gathered. Results: With control of EF and anxiety, across informants, inattention, but not hyperactivity, was positively related to child depression. EF was positively associated with depression according to parent ratings only. Conclusion: We consider the association of inattention and EF with childhood depression, including implications for intervention and prevention from a developmental psychopathology framework.