Executive Functions and Attachment Relationships in Children With ADHD: Links to Externalizing/Internalizing Problems, Social Skills, and Negative Mood Regulation

The relationship between cumulative family risk and depression in left-behind children: a moderated mediation model

BACKGROUND

This study proposed a moderated mediation model to examine the mediating role of core self-evaluation in the relationship between cumulative family risk and depression among left-behind children, and whether this process was moderated by school climate.

METHODS

A total of 415 rural left-behind children from 35 townships in Anhui Province (54.46% males; mean age = 12.53, SD = 2.27) were randomly conducted in June 2023 using convenience sampling. Data were processed and analyzed using SPSS 25.0 and PROCESS 3.3.

RESULTS

After controlling for gender, age, grade, and left-behind type, cumulative family risk positively predicted depression in left-behind children (β = 0.18, p < 0.001). Core self-evaluation fully mediated the relationship between cumulative family risk and depression in left-behind children (indirect effect = 0.10, 95%CI = [0.06, 0.15]). Moreover, school climate moderated the relationship between cumulative family risk and core self-evaluation (the first half of the mediation pathway) (β =-0.13, p < 0.01). Specifically, as the school climate level increased, cumulative family risk became more predictive of core self-evaluation (Blow = - 0.001, p > 0.05; Bhigh = - 0.26, p < 0.001).

CONCLUSION

Creating a favourable family and school climate and improving core self-evaluation are beneficial to reduce depression in left behind children.

Exploring correlations between Conners' Continuous Performance Test and subjective measures of attention deficit hyperactivity disorder symptoms in a paediatric clinical sample

INTRODUCTION

Attention deficit hyperactivity disorder (ADHD) is a childhood-onset neurodevelopmental condition characterised by inattention and/or hyperactivity-impulsivity. The ADHD symptoms are often evaluated and quantified using various assessment tools, such as the Conners' Continuous Performance Test II (CCPT-II), ADHD Rating Scale (ADHD-RS), Child Behaviour Checklist (CBCL), Clinical Global Assessment Scale (CGAS) and Clinical Global Impression Scale (CGIS). This study sought to compare CCPT-II with parent- and clinician-rated rating scales (ADHD-RS, CBCL, CGAS and CGIS) in measuring the core ADHD symptoms within the paediatric ADHD population.

METHODS

The data, gathered from a large-scale randomised controlled trial involving 172 children aged 6-12 years with ADHD, was pooled, and a Pearson correlation analysis was conducted.

RESULTS

No significant correlations were observed between CCPT-II and ADHD-RS, as well as the various subscales of CBCL, CGAS and CGIS.

CONCLUSION

While CCPT-II may offer insights into ADHD symptomatology, its relationship with parent- and clinician-rated rating scales such as ADHD-RS, CBCL, CGAS and CGIS appears limited. Further research is warranted to elucidate the nuances of these assessment tools and their roles in evaluating ADHD.

Geraniol (GER) attenuated chronic sleep restriction (CSR)-induced neuroinflammation in adolescent mice

Sleep insufficiency is a significant health problem worldwide, and adolescent sleep restriction (SR) could induce multiple neurodevelopmental disorders in the central nervous system (CNS). Microglial-mediated neuroinflammation plays a vital role in multiple neurological diseases, and recent research showed the regulation effect of immunoproteasome on microglia functions. Geraniol (GER), an important ingredient in many essential oils, possesses diverse pharmacological properties like anti-inflammatory and antioxidant. The present study was designed to evaluate the neuroprotective effect of GER on SR in adolescent mice and further investigate the underlying mechanisms. Our results displayed that 14 days of chronic sleep restriction (CSR) induced cognitive decline, and anxiety-like and attention-deficit behaviors, which were mitigated by GER pretreatment. GER administration also reversed microglial pro-inflammatory response under CSR stimulation in the anterior cingulate cortex (ACC) regions by reducing the expression and secretion of cytokines like IL-1β and TNF-α. Mechanism research showed that LMP7 mRNA was selectively up-regulated under CSR treatment but down-regulated by GER administration. Proteasome activity and protein expression of LMP7 were consistent with mRNA data. ONX-0914 was applied to inhibit LMP7 selectively, and data validated that GER might alleviate CSR-induced neuroinflammation by regulating LMP7. Our study provides evidence that LMP7 is a critical regulator of CSR-induced proinflammation, and geraniol might be a promising therapy against CSR-induced neurodevelopmental disorders.

The Effect of Neurodevelopmental Disorders Characteristics on Aspects of Social Functioning

AIM

The purpose of this study was to estimate the extent to which neurodevelopmental disorders (NDD's) symptoms (motor, sensory, attention and executive function) are associated with aspects of social function among school aged children.

METHODS

This cross-sectional study included 39 children aged 6-9 years old (71.8% boys) who were referred to child development centers due to motor, sensory, and/or cognitive difficulties. The parents completed NDD's symptoms questionnaires: Developmental Coordination Disorder Questionnaire; Child Sensory Profile-2; Attention Deficit Hyperactive Disorder (ADHD) Rating Scale and the Behavior Rating Inventory of Executive Function. They also completed the Social Skills Improvement System and a social participation measure.

RESULTS

Analysis demonstrated low to moderate correlations between social functioning aspects and the majority of NDD's symptoms. Executive functioning was the only predictor of social skills and social participation and accounted for most of the variability of behavioral problems, alongside a small contribution of ADHD symptoms.

CONCLUSION

The findings contribute to the accumulating body of knowledge regarding social abilities of children with NDD's and suggest new information as to the effect of executive functions in this domain. Along with conducting a routine evaluation of social skills among children suspected to have NDD's, executive functions should also be comprehensively evaluated.

Relationship between Quality of Life and Adult Attachment Factors in Mothers of Children with and without Type 1 Diabetes

The mothers of children with a specific clinical situation such as type 1 diabetes mellitus may have a higher level of stress, causing a worse perception of their quality of life, greater anxiety, and greater avoidance (adult attachment factors). The objective of this research was to verify if there is a relationship between the adult attachment factors of mothers of children with and without type 1 diabetes mellitus and the perception of the quality of life of these mothers. This survey was carried out from July to September 2022, with mothers of children aged 5 to 10 years, with and without diabetes. The data were collected through an online questionnaire, with socioeconomic data from the attachment scale Experience in Close Relationship-(Reduced), and the questionnaire on the quality of life, the WHOQOL-abbreviated questionnaire. For statistical analysis, the Statistical Package for Social Science 24 was used. A total of 45 mothers of children with DM1 and 55 mothers of healthy children were evaluated. The mothers of children with DM1 had a worse perception of their quality of life when compared to the mothers of healthy children (p < 0.05), with no difference in terms of the attachment style. Therefore, it is understood that actions aimed at improving the quality of life of these mothers are necessary.

How Self-Regulation and Executive Functions Deficits Affect Quality of Life of Children/Adolescents with Emotional Regulation Disorders

BACKGROUND

Deficits in self-regulation and executive functions (EFs) frequently characterize children/adolescents with emotional regulation disorders and restrict their daily function and quality of life (QOL). These deficits are mainly manifested by neuropsychological measures in laboratory settings. This study aimed to compare self-regulation and EFs by ecological measures to reflect the implications in daily life between children with emotional regulation disorders and healthy controls and examine the relations between self-regulation, EFs and QOL in the study group.

METHODS

the participants were 49 children aged 8-18: 25 children/adolescents with emotional regulation disorders and 24 healthy children. The parents completed a socio-demographic questionnaire, the Child Behavior Checklist (CBCL), the Behavior Rating Inventory of Executive Functions (BRIEF) and the Pediatric Quality of Life Inventory (Peds-QL).

RESULTS

The study group had greater self-regulation difficulties (internalization and externalization problems), executive dysfunctions (EFdys) (including metacognition difficulties) and a lower QOL. Their internalization and externalization problems correlated with reduced EFs and QOL. Internalization predicted the physical and emotional QOLs, while metacognition predicted social and school-related QOLs.

CONCLUSIONS

Deficits in self-regulation and EFs are prevalent in children/adolescents with emotional disorders and restrict their daily function and QOL. Therefore, they should be routinely evaluated by ecological instruments to reflect daily restrictions.

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.

The comparison of sluggish cognitive tempo, processing speed, and executive functions in female children with specific learning disabilities and typically developing female children: A pilot study

This study investigated the association of sluggish cognitive tempo (SCT), processing speed, and executive function (EF) in children with specific learning disabilities (SLD), and the typically developing children (TD) (60 female students aged between 8 and 10). Child and Adolescent Behavior Inventory-Parent Version (CABI), the Barkley Deficits in Executive Functioning Scale-Children and Adolescents (BDEFS-CA), and Wechsler Intelligence Scale for Children-IV (the Processing Speed Index (PSI) were used to assess SCT, processing speed, and EF. The results showed that SCT problems were higher in children with SLD (p < 0.001). In addition, results showed that children with SLD had poorer performance on processing speed (p < 0.001) compared to the TD group. Executive dysfunctioning in self-management to time, self-organization, problem-solving, self-restraint, self-motivation, and self-regulation of emotions were poorer in children with SLD than TD group (p < 0.05). This study provides initial evidence that SCT symptoms are poor in female children with SLD, and associated with executive dysfunction and poor processing speed.

Child attachment and ADHD: a systematic review

Attention Deficit/Hyperactivity Disorder (ADHD) is a frequent neurodevelopmental disorder in children. ADHD has a multifactorial origin, combining genetic and environmental factors. Several studies suggested an influence of early parent-child relationships on the symptomatic expression of ADHD. In this review, we examine the studies that have investigated the links between attachment and ADHD in children. We searched for studies published between January 2000 and November 2019 on PsychInfo, PubMed, and Scopus. Selected studies included a theoretically based measure of attachment and an explicit measure of ADHD symptoms or an ADHD diagnosis. Studies that included children from adoption, institutionalization, or mistreatment were not included. We found only 26 studies meeting the inclusion criteria. Almost all these studies indicated a link between the attachment type and the presence of attentional difficulties and hyperactivity. However, associations were better explained, in several studies, by confounding factors such as comorbidities, cognitive difficulties, or contextual factors. The method used to assess attachment and parental mental health also had an impact. An increasing number of studies show a link between the type of attachment and the presence of attentional difficulties and hyperactivity in children. However, the nature of this link remains unclear. Implications for future research are discussed.

Self-management of daily life tasks in diploma-track youth with disabilities

PURPOSE

Youth with disabilities who graduate with a regular high school diploma often continue to have difficulties in their daily functioning that ultimately impact adulthood outcomes. To better understand these functional difficulties and determine how best to address them, it is important to distinguish deficits in discrete skills from difficulty organizing skills to self-manage complex tasks associated with adult roles. The purpose of this study was to explore the extent to which challenges in social, executive function and behavior management factors relate to these two aspects of daily functioning.

METHODS

This is a secondary analysis of the National Longitudinal Transition Study 2 funded by the United States Department of Education. The direct and indirect associations between youth underlying factors and self-management of daily life tasks (SMDLT) versus discrete functional skills were modelled using structural equation modelling.

RESULTS

A model incorporating social skills, communication, and behavior regulation explained 55% of the variance in SMDLT. In contrast, the model predicting discrete functional skills had fewer significant associations and described less variance (37%) in the outcome.

CONCLUSIONS

Findings suggest that using measures of SMDLT and designing targeted interventions for SMDLT might help improve participation in independent living and productivity for diploma-track youth with disabilities.Implications for rehabilitationSuccessful transition from high school to adult roles requires the ability to self-manage the daily life tasks required for those roles, such as employment, post-secondary education, and independent living.The ability to self-manage daily tasks is distinct from mastery of discrete functional skills and should be assessed with measures that uniquely examine this domain.Social and communication skills, executive functioning, and behavioral regulation, are important contributors to the ability to self-manage life tasks for diploma-track youth with disabilities and should be incorporated into multifaceted interventions.Interventions to improve self-management of tasks should include teaching strategies and practice coordinating underlying skills in flexible ways that meet the varying demands of tasks and diverse environments.

Is ADHD a way of conceptualizing long-term emotional stress and social disadvantage?

Background

The prevalent, neuropsychiatric, deficit perspective on children and youth diagnosed with ADHD prohibits a multidimensional approach where socio-economic status, family stress and relationships within the families are relevant factors to examine. Assessments of ADHD through the use of rating scales and short-term interventions may lead not only to overdiagnosis but also to a reductionistic approach in the psychiatric field. This literature review aims to address research outside the prevailing discourse on ADHD as an organic brain dysfunction and broaden the perspectives on children's behavioral difficulties.

Methods

The articles included in this applied, mixed-method, systematic review includes 26 peer-reviewed articles, both English and French, with a search focus on ADHD in children and youth related to Attachment styles and relationships.

Results

In the studies reported, researchers approached correlations between ADHD and attachment in different ways, and in most cases, there was a caution to address causality. The role of parents was found to be both buffering and aggravating for the appearance of ADHD. In the French case studies, the diagnosis was conceptualized as a relational phenomenon where the child's behavior was inseparable from family member's suffering.

Discussion

This review article illustrates how children's difficulties in terms of ADHD symptoms can be addressed through a paradigm where emotional and cognitive dysregulation is understood through psychosocial factors rather than as a neurological condition. In our view, to avoid an overly reductionistic and medicalized approach to children's behavioral difficulties, it is time to reiterate the value of the biopsychosocial perspective.

Conclusion

Professionals and researchers need to acknowledge that becoming diagnosed with ADHD has a strong connection to economic disadvantage, social status, and familial care. The academic discourse of addressing brain dysfunctions might serve the unintended purpose of masking emotional stress and social disadvantage that manifests across generations. A biopsychosocial approach to ADHD including family, emotional history, and socio-economic issues could imply a lesser focus on medical treatment as a first choice.

Adolescents' executive functions: Links to inattention, hyperactivity-impulsivity, trait mindfulness, and attachment relationships with fathers and mothers

BACKGROUND AND OBJECTIVES

Considering the important role of executive functions (EF) for adjustment across the lifespan, this study aimed to deepen understanding of protective/risk factors for EF in a potentially vulnerable population: adolescents with ADHD. This study compared adolescents with versus without ADHD for differences in EF, attachment relationships with fathers/mothers, and trait mindfulness and investigated these possible protective/risk factors' contributions to EF in both adolescent groups.

METHODS

Ninth graders (N = 91; 49 boys, 42 girls) ages 14-15 years (M = 14.50, SD = 0.50) comprised 45 with ADHD and 46 with typical development (TD). Adolescents completed three self-reports (trait mindfulness, attachment to mother/father). Mothers rated their adolescents' ADHD symptoms and EF.

RESULTS AND CONCLUSION

Significantly more maladaptive outcomes emerged for adolescents with ADHD than TD in their EF, attachment with mothers, and mindfulness. Regression analyses demonstrated the significant risk posed by ADHD symptoms and the protection offered by trait mindfulness and attachment with fathers in explaining EF. Discussion focused on understanding these protective/risk factors' possibly unique and complementary roles, suggesting interventions for adolescents with ADHD in family and school settings.

Early Adverse Childhood Experiences and Social Skills Among Youth in Fragile Families

Adverse childhood experiences (ACEs) are associated with negative health and behavioral outcomes across the life course, yet little is known about the association between early ACEs and social skills among youth. As social skills are often shaped by home environments, and social skills developed in adolescence often persist into adulthood, understanding the processes that drive inequalities in developmental outcomes, such as social skills, is imperative. The present study used data from the Fragile Families and Child Wellbeing Study (FFCW; n = 3245) and ordinary least squares regression analyses to explore the associations between early ACEs by age 5 (i.e., cumulative, timing, duration) and youth social skills (components include: emotional maturity, communication skills, intentionality, and social competence). The weighted sample consisted of urban-born youth (44% female) with a mean age of 15. Racial/ethnic breakdown of the sample is 37% non-Hispanic White, 25% non-Hispanic Black, 28% Hispanic, and 10% 'Other'. Overall, estimates suggest that nearly 79% of these youth experienced at least one ACE by age 5. Furthermore, the results indicated that as the number of early ACEs increased, deficits in social skills also increased. Moreover, the timing of exposure to early ACEs (i.e., high early, intermittent, chronic high) decreased social skills. The findings underscore the unique and robust links between early ACEs and youth social skills, underlining the importance of ACE exposure in social skill development.

Interpersonal Negotiation Skills in ADHD

Social interaction difficulties are amongst the most prevalent and pervasive adverse outcomes for children and adolescents with ADHD. Problem-solving strategies are impaired in affected individuals, according to the literature. This study aimed to investigate the social problem-solving skills of children and adolescents with and without ADHD, using objective quantitative measures provided by the Interpersonal Negotiation Strategies Interview (INSI). Because verbal communication skills and working memory may be impaired in ADHD, we investigated their contribution to the performance. Forty-three children and adolescents with ADHD and 27 clinical controls with clinical diagnoses other than ADHD completed the INSI along with measures of verbal communication skills (Verbal Comprehension Index [VCI]): Similarities, Vocabulary and Comprehension subtests from the Wechsler Battery, visual (Corsi Blocks) and verbal (Digit Span) working memory tasks. Groups performed similarly on measures of intellectual functioning, working memory, and verbal communication. For the entire sample, VCI scores were positively correlated with INSI performance scores. The ADHD group performed worse on the INSI than the clinical control group. Linear regression analysis showed that inattention and hyperactivity/impulsivity levels and Similarities predicted INSI's performance. Our findings indicate that interpersonal negotiation difficulties in ADHD are related to DSM-5 defining symptoms of the disorder.

Can attachment predict core and comorbid symptoms of attention-deficit/hyperactivity disorder beyond executive functions and emotion regulation?

OBJECTIVE

Previous findings propose an association between attachment and symptoms of attention-deficit/hyperactivity disorder (ADHD). However, the predictive ability of attachment beyond deficits in executive functioning (EF) and emotion regulation is understudied.

METHOD

Using a dimensional perspective, we examined the longitudinal role of attachment on ADHD and comorbid symptoms, accounting for EF and emotion regulation. The sample consisted of 84 children (aged 8-13 years), oversampled for ADHD symptoms (42% had a diagnosis of ADHD). We assessed attachment with the Child Attachment Interview, EF with laboratory tests, and emotion regulation with parental ratings. Parents and teachers rated symptoms at baseline (T1) and at follow-up 2 years later (T2).

RESULTS

Attachment insecurity was positively correlated with ADHD symptoms at T2 but with no unique contribution to symptoms beyond EF and emotion regulation. In contrast, poor EF and emotion regulation contributed to more ADHD and ODD/CD symptoms at T2. Poor emotion regulation contributed to more anxiety at T2.

CONCLUSIONS

The results have important implications for understanding the mechanisms underpinning symptom expression in middle childhood/early adolescence and may guide the search for tailored interventions to reduce and prevent symptoms.

PRACTITIONER POINTS

Executive functions and emotion regulation should be explored as targets for intervention in personalized treatment. The current results do not support attachment as a target for intervention at a group level, although this does not rule out that individuals/families with attachment difficulties may benefit from training programmes promoting secure attachment bonds.

ATTACHMENT STYLE IN CHILDREN WITH CHRONIC DISEASES: A COMPREHENSIVE REVIEW

Objective:

To investigate how attachment style has been studied in children with chronic disease in the scientific literature, and what repercussions this attachment has on this population.

Data sources:

An integrative review of the literature was carried out from a survey in the LILACS, MEDLINE and SciELO databases, including original national and international publications in Portuguese, Spanish and English from 2007 to 2018, using the descriptors “apego” and “criança” in the Health Sciences Descriptors (DeCS), and “attachment” and “children” for the Medical Subject Headings (MeSH). Sixteen (16 articles) were obtained for the sample analysis.

Data synthesis:

The chronic diseases found in the research were neurobehavioral disorders such as attention deficit hyperactivity disorder (ADHD) and autism, childhood obesity, and chronic migraine. The predominant attachment style was insecurity, which could compromise the biopsychosocial development of the child.

Conclusions:

The type of attachment between child and primary caregiver may be considered a protective or risk factor for child development. Considering this premise, it is important to equip/inform families based on dialogic educational practices, in which professionals create opportunities and means for families to develop their skills and competencies, and acquire resources which meet the child’s needs. It is important that this professional helps the family to build secure bases for their child with chronic disease, understanding that the main focus for promoting child development is in the family unit.

The Dissociation between Adult Intelligence and Personality with Respect to Maltreatment Episodes and Externalizing Behaviors Occurring in Childhood

Here we analyze the simultaneous relationships among five variables. Two refer to childhood (episodes of various forms of maltreatment and externalizing behaviors), whereas three refer to early adulthood (intelligence, personality, and socialization difficulties). The 120 individuals considered for the present report were invited from the 650 schoolchildren participating in the Longitudinal Study of Intelligence and Personality (Minas Gerais, Brazil). The complete sample was recruited in 2002 (T1; mean age = 10.0; standard deviation (SD) = 2.2) and 120 were tested again in 2014-17 (T2; mean age = 23.5; SD = 2.2). Externalizing behaviors were registered at T1, whereas the remaining variables were obtained at T2. These were the main results: (1) externalizing behaviors predict future social effectiveness (as estimated by the general factor of personality derived from the NEO Personality Inventory-Revised (NEO-PI-R) and socialization difficulties computed from the socialization scale (SOC)) and future intelligence performance (as assessed by a set of fluid and crystallized tests); (2) episodes of self-reported childhood maltreatment predict social effectiveness, but not intelligence; (3) maltreatment and externalizing behaviors are unrelated; and (4) social effectiveness (personality) and intelligence are unrelated. Therefore, the findings support the dissociation between adult intelligence and personality with respect to maltreatment episodes and externalizing behaviors occurring in childhood. Implications of these findings for social policies aimed at preventing adult socially ineffective personalities are underscored.