Decision-making and Risky Behavior in Individuals with Attention-Deficit/Hyperactivity Disorder: A 10-year Longitudinal Study

Attention-deficit hyperactivity disorder is associated with risky and unhealthy behaviours among adolescents

OBJECTIVES

Attention-deficit hyperactivity disorder (ADHD) is highly prevalent among adolescents globally, particularly in Israel. This study aimed to evaluate associations between ADHD and engagement in risky/unhealthy behaviours among adolescents.

STUDY DESIGN

Cross-sectional study.

METHODS

Students participating in the 2015-2016 National Health Survey completed self-administered questionnaires, providing demographic, medical and behavioural information (n = 4616, 11-18 years old, 50.2% male). Multivariable logistic regression analyses assessed the associations between ADHD and risky/unhealthy behaviours, including current tobacco/hookah smoking, alcohol consumption (≥1 serving/month), excessive screen time (≥4 h/d), non-compliance with physical activity and sleep recommendations (<1 h/d, and <8 or <9 h/d depending on age, respectively) and unhealthy lifestyle (engagement in ≥3 of these behaviours).

RESULTS

A total of 752 participants reported ever being diagnosed with ADHD (287 of whom were treated with stimulants) and 3864 individuals were included in a non-ADHD comparison group. ADHD was significantly associated with higher prevalence of smoking (odds ratio [OR] 2.15; 95% confidence interval [CI]: 1.65, 2.80), alcohol consumption (OR 1.38; 95% CI: 1.10, 1.73) and excessive screen time [OR 1.41; 95% CI: 1.18, 1.70), each adjusted for sociodemographic characteristics and the other risky/unhealthy behaviours. Unhealthy lifestyle was twice as common in the ADHD group (OR 2.03; 95% CI: 1.64, 2.51). Stimulant-treated and non-treated adolescents with ADHD did not differ in demographic or behavioural characteristics.

CONCLUSIONS

ADHD was significantly associated with an unhealthy lifestyle among adolescents. These behaviours should be detected early and prevention measures put in place to limit their harmful consequences in this adolescent population. Additional large-scale prospective research is needed to deepen the understanding of this association.

Cool and hot executive function problems in young children: linking self-regulation processes to emerging clinical symptoms

Self-regulation (SR) difficulties are implicated in a wide range of disorders which develop in childhood, including attention deficit hyperactivity disorder (ADHD), oppositional defiance disorder (ODD), anxiety and depression. However, the integration of the existing research evidence is challenging because of varying terminology and the wide range of tasks used, as well as the heterogeneity and comorbidity within and across diagnostic categories. The current study used the Research Domain Criteria (RDoC) framework to guide the examination of different SR processes in young children showing a wide range of symptomatology. Children (aged 4-8) referred by teachers for moderate-to-high conduct, hyperactivity and/or emotional problems at school (assessed using the Strengths and Difficulties Questionnaire (SDQ) subscales; n = 212), and children in SDQ typical ranges (n = 30) completed computerised cognitive control and decision-making tasks. Parents completed questionnaires to assess ADHD, ODD, anxiety and depression symptoms (n = 191). Compared to children with no teacher-reported difficulties, those with moderate-to-high problems showed poorer visuomotor control and decision-making. A factor analysis revealed that task variables adhered to RDoC dimensions and predicted variance in specific disorders: difficulties in cognitive control predicted ADHD symptoms, low reward-seeking was associated with depression and high reward-seeking was associated with ODD. This study highlights how the assessment of cognitive processes positioned within the RDoC framework can inform our understanding of disorder-specific and transdiagnostic difficulties in SR which are associated with diverse clinical symptoms in children.

Profiles of executive functions in middle childhood and prediction of later self-regulation

Most research on the development of executive functions (EF) has applied variable-oriented approaches, neglecting the potential inter- and intraindividual interplay of these capacities. In a person-oriented approach, the present study identified varying profiles of performance for three cool EF facets: inhibition, working-memory updating, and cognitive flexibility, as well as two hot EF facets: affective decision-making and delay of gratification, in a community sample of 1,657 children (T1; age: 6-11 years, M = 8.36 years, 52.1% female) via latent profile analysis. The best-fitting model allowed for partial dependence across the three cool EF and included four profiles: all-average (69.4% of the children), low-delay (19.0%), regulated-decision-making (7.0%), and low-inhibition (4.6%). Age, binary sex, socio-economic status, multilingualism, and processing speed were identified as significant characteristics of EF profile membership. Longitudinally, a higher probability of belonging to the low-inhibition profile predicted lower rates of the self-regulatory outcome of inhibitory control 1 year later, while belonging to the regulated-decision-making profile predicted lower rates of the ability to plan and organize 3 years later. These results not only demonstrate the existence of subgroups with different concurrent within-person expressions of EF performance, but also identify related characteristics and longitudinal outcomes of subgroup membership. In turn, these conclusions stress the importance of person-oriented research to inform on differing weaknesses or strengths in EF performance for varying individuals, thereby providing valuable insight for educational and clinical research into the design of effective personalized support or interventions during middle childhood.

Predictors of Quality of Life and Functional Impairments in Emerging Adults With and Without ADHD: A 10-Year Longitudinal Study

OBJECTIVE

We tested the hypotheses that (1) a diagnosis of ADHD in childhood or adolescence is associated with reduced quality of life (QoL) and everyday functioning in emerging adulthood, and (2) executive function (EF) deficits, internalizing difficulties, and ADHD symptoms predict reduced QoL and more functional impairments.

METHOD

We assessed 85 children and adolescents with ADHD and 50 typically developing (TD) peers at baseline (M_age = 11.6 years, 58% males), 2-year follow-up, and 10-year follow-up with neuropsychological tests of EF and self-reports.

RESULTS

Individuals with ADHD reported lower QoL and functional impairments in emerging adulthood compared to TD peers. More internalizing difficulties and ADHD symptoms at baseline and 2-year follow-up significantly predicted lower QoL and more functional impairments at the 10-year follow-up.

CONCLUSION

ADHD and internalizing difficulties in childhood or adolescence have a negative impact on QoL and everyday functioning in emerging adulthood.