Interpersonal coping among boys with ADHD

Gender-specific motivational pathways in ADHD-related inattention and gaming disorder symptoms

Comorbidity between attention-deficit/hyperactivity disorder (ADHD) and gaming disorder (GD) is widely recognized in the literature. Previous research has indicated gender-dependent underlying mechanisms in the development and maintenance of problematic gaming. Motivational research presents an opportunity to provide further insight regarding the nature of this association. Self-report data were collected from videogame players (N = 14,740) using an online survey in collaboration with a popular gaming magazine. The survey included items concerning symptoms of ADHD and GD, motives for gaming, and time spent playing videogames. Structural equation modeling was used to create two parallel mediation models (one for males, one for females), including motives to play games as mediators. This was done to potentially explain psychological drivers of the association between ADHD and GD. Results demonstrated a common pathway from inattention to GD symptom severity through the immersion/escapism motivation for both males (β = 0.068; p < 0.001) and females (β = 0.081; p < 0.05), while the paths from inattention to GD symptom severity through the habit/boredom motive (β = 0.094; p < 0.001) and competition motive (β = 0.021; p < 0.001) were only significant for males. Gamers experiencing symptoms of ADHD, especially inattentive symptoms, are at risk of the occurrence of GD symptoms through videogames becoming a source of maladaptive coping with daily psychological disturbances. Males experiencing inattentive symptoms tend to additionally develop problematic patterns of use through videogame playing, becoming a subjectively meaningless and boredom-reduction-oriented habitual activity or a platform of virtual competition. Unique differences suggest the necessity of different treatment approaches for males and females.

Symptoms of ADHD Predict Lower Adaptation to the COVID-19 Outbreak: Financial Decline, Low Adherence to Preventive Measures, Psychological Distress, and Illness-Related Negative Perceptions

OBJECTIVE

The COVID-19 outbreak created numerous multidimensional stressors, to which people show different levels of vulnerability. The current paper examines whether symptoms of ADHD are associated with poorer adaptation.

METHOD

After the first quarantine in Israel, 2,055 adults participated in an online survey. Participants completed scales probing adaptation indicators: financial status, adherence to preventive measures, mental health, and COVID-19 related perceptions. Background measures, including the level of symptoms of ADHD, were collected.

RESULTS

Adaptation indicators negatively correlated with the level of symptoms of ADHD. Financial decline explained a small portion of the link between ADHD and decreased mental health. Background risk-taking, anti-social, and pro-social behavior partially explained the link between ADHD and non-adherence to preventive measures. COVID-19 related perceptions also partially explained that link.

CONCLUSION

This study suggests that people with ADHD are more vulnerable to the challenges created by the COVID-19 pandemic and therefore deserve special attention and care.

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.

Enhanced Brief Motivational Intervention for College Student Drinkers With ADHD: Goal-Directed Activation as a Mechanism of Change

College students with attention-deficit/hyperactivity disorder (ADHD) are at risk for alcohol-related problems and disorders relative to their typically developing peers. Despite risk, the optimal therapeutic approach for reducing problem alcohol use in students with ADHD, and mechanisms of change underlying treatment effects in this population, are largely unknown. The current study evaluated putative mechanisms of change in a randomized controlled trial of two harm reduction interventions for college student drinkers with ADHD (N = 113; 49% male): brief motivational intervention plus supportive counseling (BMI + SC) versus brief motivational intervention plus behavioral activation (BMI + BA). Results showed that participants in the BMI + BA condition engaged in more goal-directed activation and less avoidant behavior over the course of treatment compared to those in the BMI + SC condition, in turn predicting reductions in alcohol-related negative consequences. Effects were more robust 1 month following intervention, and diminished by 3 months. Sensitivity analyses revealed a significant indirect effect of treatment condition on alcohol-related negative consequence via reductions in avoidance over treatment. Post hoc moderated mediations showed that BMI + BA engaged target mechanisms more robustly for students with more severe ADHD and depressive symptoms compared to BMI + SC. These findings support the application of BMI + BA intervention, particularly in targeting goal-directed activation and avoidance/rumination in at-risk student drinkers with ADHD.

The role of stress coping strategies for life impairments in ADHD

Attention-deficit/hyperactivity disorder (ADHD) is commonly accompanied by functional impairments within personal, professional, and social context as well as further psychological distress. The role of perceived stress has been examined in this regard, although little is known about the influence of stress coping strategies. We examined the dynamics between ADHD symptomatology, stress coping strategies, and life impairments in a sample of 230 clinical and non-clinical adult individuals. ADHD was associated with low probability of choosing adaptive but high probability of implementing maladaptive stress coping strategies as well as with increased life impairments. Adaptive stress coping showed little effects beyond the associations between ADHD and life impairments, whereas some maladaptive coping strategies increased current life impairments over and above the effects of ADHD and further psychological distress. The present findings emphasize the need of professional support in adults with ADHD and the necessity to include stress coping strategies in respective treatment approaches aimed at reducing life impairments.

Stressverarbeitungsfragebogen für Kinder und Jugendliche (SVF-KJ)

Zusammenfassung. Der Stressverarbeitungsfragebogen für Kinder und Jugendliche (SVF-KJ) erhebt die soziale und schulische Stressverarbeitung über 9 Subtests und 36 Items. Der Gültigkeitsbereich wurde in der aktuellen Version von 2016 auf die Altersspanne von 8 bis 16 Jahre erweitert. Ferner wurden 4 Items geringfügig angepasst und aktuelle Normen wurden erhoben. Die Normwerte und psychometrischen Gütekriterien wurden bei N = 1 087 Kindern und Jugendlichen ermittelt. Befunde von konfirmatorischen Faktorenanalysen bestätigten die Zuordnung der Items zu den Subtests, die sich in früheren exploratorischen Faktorenanalysen ergeben hatten. Korrelationsanalysen sprechen für eine hinreichend divergente Validität gegenüber dem Konstrukt „Emotionsregulation“. Schließlich wurde an einer Teilstichprobe von N = 374 deutschen Kindern und Jugendlichen die interne Konstruktvalidität bekräftigt, indem erwartungskonforme Geschlechts- und Altersunterschiede nachgewiesen wurden. Insgesamt unterstützen die weiteren Analysen, dass der SVF-KJ die Stressverarbeitungsdispositionen im Kindes- und Jugendalter valide erfasst.

Between- and within-person associations between negative life events and alcohol outcomes in adolescents with ADHD

Escalations in alcohol use during adolescence may be linked with exposure to negative life events, but most of this research has focused on between-person associations. Moreover, adolescents with attention-deficit hyperactivity disorder (ADHD) may be an especially vulnerable population, reporting more life events and alcohol involvement and may even be more sensitive to the effects of life events on alcohol outcomes compared with those without ADHD. We tested the between- and within-person effects of the number and perceptions of negative life events on the development of alcohol use outcomes from age 14 to 17 years in 259 adolescents with and without ADHD using generalized estimating equations. Between-person differences in exposure to negative life events across adolescence, but not the perception of those events, were associated with a higher likelihood of alcohol use and drunkenness at age 17 years. Within-person differences in life events were associated with alcohol use above and beyond that predicted by an adolescents' typical trajectory over time. Parent- and teacher-reported ADHD symptoms were associated with more negative perceptions of life events and with greater alcohol use and drunkenness at age 17 years, but symptoms did not moderate the life event-alcohol association. Interventions should consider the variables that produce vulnerability to life events as well as the immediate impact of life events. That the accumulation of life events, rather than their perceived negativity, was associated with alcohol outcomes indicates that interventions targeting the reduction of negative events, rather than emotional response, may be more protective against alcohol use in adolescence. (PsycINFO Database Record

Anger-irritability as a mediator of attention deficit hyperactivity disorder risk for adolescent alcohol use and the contribution of coping skills

BACKGROUND

Research on susceptibility to alcohol use disorder within the attention deficit/hyperactivity disorder (ADHD) population has begun to expand examination of putative moderators and mediators in order to develop effective treatments. Specific dysregulated emotions have been separately associated with ADHD and with alcohol use difficulties. The current study is the first to conjointly study these variables by testing anger-irritability as a mediator of ADHD risk for adolescent alcohol use.

METHODS

Frequency of binge drinking, drunkenness, and alcohol problems were examined for 142 children with ADHD followed into adolescence and compared to 100 demographically similar youth without ADHD. Parent-rated anger-irritability was tested as a mediator. Behavioral and cognitive coping skills, which are key clinical treatment targets, were studied as moderators of these associations.

RESULTS

Childhood ADHD was positively associated with anger-irritability and the drinking outcomes in adolescence. Anger-irritability mediated the association between ADHD and alcohol use problems, but not binge drinking or drunkenness. Behavioral and cognitive, but not avoidant, coping played a moderating role, but only of the association between childhood ADHD and anger-irritability.

CONCLUSIONS

Active coping strategies by adolescents with ADHD may reduce the vulnerability to alcohol problems through a reduction of negative emotions. Future research on additional mediators and treatments that target these skills is encouraged.

The relationship between ADHD symptomatology and self-harm, suicidal ideation, and suicidal behaviours in adults: a pilot study

The aim of this study was to explore whether individuals with attention-deficit/hyperactivity disorder (ADHD) are at risk of harm over the lifespan due to increased rates of self-harm, suicidal ideation and suicidal behaviour, and whether this association is mediated by psychosocial factors. Sixty-six adults (43 men, 23 women; 18-65 years) participated in this study involving clinical interview and retrospective self-report measures of ADHD symptoms, self-harm/suicidal behaviour, mental health disorders, and coping style measures. Significant associations were found between ADHD symptom severity and self-reported histories of self-harm behaviour, suicidal ideation, and suicide attempts (all p values<.05). These relationships between self-destructive behaviours and ADHD symptom severity were found to be significantly and differentially mediated by psychosocial variables (all p values<.05) including comorbidity (mood, anxiety, drug, and alcohol abuse disorders) and emotion-focussed coping style. This study suggests that linkages between self-injurious behaviour and ADHD symptomatology may be due primarily to comorbid mental health disorders and emotion-focussed coping. The identification of these mediating factors and processes may potential pathways for intervention in reducing suicide and self-harm risk amongst those with ADHD symptoms.

Evaluation of a Stress Management Training Program for Adults With ADHD-A Pilot Study

We conducted a pilot study to examine the feasibility, acceptance, and subjective effectiveness of a new stress management training program tailored to the needs of adults with attention deficit hyperactivity disorder (ADHD). After a baseline evaluation of perceived chronic stress and coping strategies, 18 adults with ADHD participated in four sessions of stress management training and completed posttests on chronic stress and additional measures. Participants rated the acceptance and effectiveness of the training as high. Positive effects were found with respect to perceptions of excessive demands at work, chronic worry, and general stress experience. The findings suggest that stress management training is a valuable adjuvant for the treatment of ADHD in adults. Further development and evaluation of the intervention is desirable.

Defizitäre adaptive Emotions- regulation bei Kindern mit ADHS

Zielsetzung: Hauptziel der vorliegenden Studie ist es zu untersuchen, ob sich Kinder mit und ohne ADHS in den von ihnen angewendeten Emotionsregulationsstrategien unterscheiden. Zudem wird betrachtet, inwieweit die Emotionsregulationsmuster der Kinder mit ADHS mit weiteren psychischen Auffälligkeiten zusammenhängen. Methodik: 21 Kinder mit und 20 Kinder ohne ADHS im Alter von 10–13 Jahren bearbeiteten den Fragebogen zur Emotionsregulation bei Kindern und Jugendlichen (FEEL-KJ, Grob & Smolenski, 2005 ). Die Eltern der Studienteilnehmer füllten den Fragebogen zu Stärken Schwächen für Eltern (SDQ, Woerner, Becker & Rothenberger, 2004 ) aus. Ergebnisse: Kinder mit ADHS berichteten zur Regulation ihrer Emotionen seltener von adaptiven Strategien Gebrauch zu machen als die Kontrollprobanden, während sich im Selbstbericht hinsichtlich der maladaptiven Strategien keine Unterschiede zeigten. Im Einzelnen manifestierten sich signifikante Gruppenunterschiede bei den adaptiven Strategien «Kognitives Problemlösen», «Problemorientiertes Handeln», «Stimmung anheben», «Umbewertung» und «Zerstreuung». Auch gaben die Kinder mit ADHS an, signifikant seltener die Strategie «Soziale Unterstützung» einzusetzen. Im Rahmen von Korrelationsanalysen konnten ferner bedeutsame negative Zusammenhänge zwischen adaptiver Emotionsregulation und psychischen Auffälligkeiten nachgewiesen werden. Schlussfolgerungen: Von ADHS-betroffenen Kindern werden insbesondere solche Emotionsregulationsstrategien seltener eingesetzt, die auf eine problemfokussierte Änderung der jeweiligen Belastungssituation abzielen. Vor allem diejenigen Kinder mit ADHS leiden unter weiteren psychischen Auffälligkeiten, die besonders selten auf adaptive Emotionsregulationsstrategien zurückgreifen.

Stressinduzierte Herabsetzung der Aufmerksamkeit bei jungen Erwachsenen mit ADHS-ähnlicher Symptomatik

Zusammenfassung. Theoretischer Hintergrund: Modelle zur Aufrechterhaltung des ADHS-Syndroms postulieren, dass die allgemeine Aufmerksamkeitsleistung und damit auch die Selbstaufmerksamkeit durch Stress vermindert werden kann. Fragestellung: In der Studie wurde geprüft, ob sich dieser Effekt bereits bei Personen aus der gesunden Bevölkerung zeigt, die einen hohen Ausprägungsgrad an ADHS-ähnlicher Symptomatik aufweisen. Methode: 84 Männer mit einem mittleren Alter von 23 Jahren wurden getestet. Die Stressinduktion erfolgte durch mentale Arithmetik aus dem Trier Sozial Stress-Test. Die Aufmerksamkeitsleistung wurde mit dem Frankfurter Aufmerksamkeitsinventar gemessen. Die Gruppierung der Probanden erfolgte durch Median-Split aufgrund der Selbstbeurteilungsskala aus den Homburger ADHS-Skalen für Erwachsene in solche mit hoher bzw. niedriger ADHS-Tendenz. Ergebnisse: Bezüglich der Aufmerksamkeitsleistung zeigte sich der erwartete Interaktionseffekt (Gruppierung × Bedingung) mit schlechterer Leistung nach Stress nur für Personen mit hoher ADHS-Tendenz (p < .002). Schlussfolgerung: Die Ergebnisse deuten auf den Nutzen der Einbeziehung spezifischer stressbezogener Bausteine in Behandlungsprogramme für ADHS-Patienten hin.

Anesthesia induction, emergence, and postoperative behaviors in children with attention-deficit/hyperactivity disorders

BACKGROUND/AIM

Given the increasing prevalence of attention-deficit and attention-deficit hyperactivity disorders (ADHD), anesthesiologists are now presented with a greater number of children who are diagnosed with these conditions. This prospective, observational study was designed to compare anesthesia induction, emergence, and postoperative behaviors in children with and without ADHD.

METHODS/MATERIALS

The sample included 268 children, 4-17 years of age undergoing elective surgery with a confirmed diagnosis of ADHD. A cohort of children without ADHD, matched for age, gender, and procedure served as controls. Preoperative cooperation, induction, and emergence behaviors were measured using established scales. Postoperative maladaptive behaviors were measured using a modified Post-Hospital Behavioral Questionnaire that was administered via telephone 1 week after surgery.

RESULTS

Children with ADHD were significantly less cooperative at induction of anesthesia compared with controls (20.9% vs 10.6% respectively, P = 0.001). Although some control children exhibited an increase in maladaptive behaviors postoperatively, these behaviors were significantly greater among children with ADHD. In particular, relative to their normal behaviors, children with ADHD had greater difficulties in concentration and decision-making; were more disobedient, impulsive, fidgety, had poor appetite; were difficult to talk to; and exhibited an increase in temper tantrums following surgery.

CONCLUSIONS

This is the first prospective study to our knowledge that has examined the perioperative and postoperative behaviors of children with ADHD compared to those without this disorder. These results are important in alerting anesthesiologists, parents, and teachers to the potential for difficulties during induction of anesthesia and postoperative behavioral problems at home and in school, respectively.

Exekutive Funktionen bei Jungen mit Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung im Kindesalter

Die Studie ging der Frage nach, ob die uneinheitlichen Befunde zu einem globalen Defizit in exekutiven Funktionen bei Kindern mit Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung (ADHS) durch Altersunterschiede erklärt werden können. Es wurde ein zweifaktorieller Versuchsplan mit den Faktoren „Gruppe“ (n = 45 Jungen mit ADHS vom Mischtyp vs. n = 45 gesunde, nach Alter und Intelligenz parallelisierte Jungen) und „Alter“ (8 – 9 vs. 10 – 12 Jahre) untersucht. Insgesamt zeigten die Jungen mit ADHS in allen exekutiven Komponenten signifikant schlechtere Leistungen als die gesunden Jungen. Außerdem wiesen die jüngeren Jungen schlechtere exekutive Leistungen auf als die älteren Jungen. Demnach sprechen unsere Befunde für ein globales Defizit in den exekutiven Funktionen und für die Annahme einer Entwicklungsabweichung bei Jungen mit ADHS.