A network analysis of developmental change in ADHD symptom structure from preschool to adulthood

A Network Approach to Understanding the Role of Executive Functioning and Alpha Oscillations in Inattention and Hyperactivity-Impulsivity Symptoms of ADHD

OBJECTIVE

ADHD is a prevalent neurodevelopmental disorder characterized by symptoms of inattention and hyperactivity-impulsivity. Impairments in executive functioning (EF) are central to models of ADHD, while alpha-band spectral power event-related decreases (ERD) have emerged as a putative electroencephalography (EEG) biomarker of EF in ADHD. Little is known about the roles of EF and alpha ERD and their interactions with symptoms of ADHD.

METHOD

We estimated network models of ADHD symptoms and integrated alpha ERD measures into the symptom network.

RESULTS

EF emerges as a bridge network node connecting alpha ERD and the hyperactivity/impulsivity and inattention symptoms. We found that EF most closely relates to a subset of symptoms, namely the motoric symptoms, "seat" (difficulty staying seated), and "runs" (running or climbing excessively).

CONCLUSIONS

EF functions as a bridge node connecting alpha ERD and the ADHD symptom network. Motoric-type symptoms and EF deficits may constitute important nodes in the interplay between behavior/symptoms, cognition, and neurophysiological markers of ADHD.

The Relationship Between Social Anxiety Disorder and ADHD in Adolescents and Adults: A Systematic Review

OBJECTIVE

This review aimed to systematically gather empirical data on the link between social anxiety disorder and ADHD in both clinical and non-clinical populations among adolescents and adults.

METHOD

Literature searches were conducted in PsycInfo, PubMed, Scopus, and Web of Science, resulting in 1,739 articles. After screening, 41 articles were included. Results were summarized using a narrative approach.

RESULTS

The prevalence of ADHD in adolescents and adults with SAD ranged from 1.1% to 72.3%, while the prevalence of SAD in those with ADHD ranged from 0.04% to 49.5%. Studies indicate that individuals with both SAD and ADHD exhibit greater impairments. All studies were judged to be of weak quality, except for two studies which were rated moderate quality.

DISCUSSION

Individuals with SAD should be screened for ADHD and vice versa, to identify this common comorbidity earlier. Further research is needed to better understand the prevalence of comorbid ADHD and SAD in adolescents.

NREM Slow-Wave Activity in Adolescents Is Differentially Associated With ADHD Levels and Normalized by Pharmacological Treatment

BACKGROUND

A compelling hypothesis about attention-deficit/hyperactivity disorder (ADHD) etiopathogenesis is that the ADHD phenotype reflects a delay in cortical maturation. Slow-wave activity (SWA) of non-rapid eye movement (NREM) sleep electroencephalogram (EEG) is an electrophysiological index of sleep intensity reflecting cortical maturation. Available data on ADHD and SWA are conflicting, and developmental differences, or the effect of pharmacological treatment, are relatively unknown.

METHODS

We examined, in samples (Mage = 16.4, SD = 1.2), of ever-medicated adolescents at risk for ADHD (n = 18; 72% boys), medication-naïve adolescents at risk for ADHD (n = 15, 67% boys), and adolescents not at risk for ADHD (n = 31, 61% boys) matched for chronological age and controlling for non-ADHD pharmacotherapy, whether ADHD pharmacotherapy modulates the association between NREM SWA and ADHD risk in home sleep.

RESULTS

Findings indicated medication-naïve adolescents at risk for ADHD exhibited greater first sleep cycle and entire night NREM SWA than both ever-medicated adolescents at risk for ADHD and adolescents not at risk for ADHD and no difference between ever-medicated, at-risk adolescents, and not at-risk adolescents.

CONCLUSIONS

Results support atypical cortical maturation in medication-naïve adolescents at risk for ADHD that appears to be normalized by ADHD pharmacotherapy in ever-medicated adolescents at risk for ADHD. Greater NREM SWA may reflect a compensatory mechanism in middle-later adolescents at risk for ADHD that normalizes an earlier occurring developmental delay.

Impact of Distractors on Sustained Attention and Inhibition in Children With ADHD

OBJECTIVE

This study examines the impact of visual and auditory distractors on attention and inhibition in children with and without ADHD.

METHOD

The study used the MOXO d-CPT child version. The sample consisted of 208 children aged 8 to 12 years, including 64 with ADHD and 144 controls.

RESULTS

Children with ADHD and controls differed in their reaction to distracting stimuli; visual distractors cause a higher decrease in sustained attention and inhibitory control in the ADHD group. Moreover, auditory distractors generate improved performance in the control group but not in the ADHD group. In addition, age-related effects were found in both sustained attention and inhibitory control in all children, regardless of whether the ADHD condition was present.

CONCLUSIONS

The findings indicate that children with ADHD performed poorer compared to controls, and that distractors differently affected the performance of the two groups.

Effortful Control Protects Against Familial Liability for ADHD: Longitudinal Results from the ABCD Study in the United States

Effortful control, the ability to regulate complex and goal-directed behavior, may protect individuals from developing mental health symptoms. This study tested the potential for child effortful control and executive functioning to buffer the effects of familial liability for attention deficit hyperactivity disorder (ADHD) problems across a one-year timeframe. Data from the prospectively-collected Adolescent Brain Cognitive Development (ABCD)® study were used to examine whether caregiver-rated child effortful control and executive functioning moderated the association between familial ADHD risk and later ADHD symptoms in a sample of children (N = 6,133; ages 9-10 years at baseline). Two independent variables were considered to compare the predictive powers of specific (family ADHD) and broad (family psychopathology) risk factors. Two additional moderating variables (surgency, negative affect) were tested to examine specificity of effortful control and executive functioning as moderators. All variables of interest were measured on a continuum and via caregiver report. At high levels of effortful control and executive functioning, there was no association between familial liability for ADHD or broad psychopathology and later child ADHD problems. The moderator effects were specific to effortful control and executive functioning domains. Etiological models of heritable psychiatric disorders, such as ADHD, should consider the risk and protective contributions of individual traits, such as effortful control and executive functioning. Clinical prevention and intervention efforts may target self-regulation skills in children to buffer against familial liability for ADHD problems.

Unpacking the overlap between Autism and ADHD in adults: A multi-method approach

The overlap between Autism and Attention-Deficit Hyperactivity Disorder (ADHD) is widely observed in clinical settings, with growing interest in their co-occurrence in neurodiversity research. Until relatively recently, however, concurrent diagnoses of Autism and ADHD were not possible. This has limited the scope for large-scale research on their cross-condition associations, further stymied by a dearth of open science practices in the neurodiversity field. Additionally, almost all previous research linking Autism and ADHD has focused on children and adolescents, despite them being lifelong conditions. Tackling these limitations in previous research, 5504 adults - including a nationally representative sample of the UK (Study 1; n = 504) and a large pre-registered study (Study 2; n = 5000) - completed well-established self-report measures of Autism and ADHD traits. A series of network analyses unpacked the associations between Autism and ADHD at the individual trait level. Low inter-item connectivity was consistently found between conditions, supporting the distinction between Autism and ADHD as separable constructs. Subjective social enjoyment and hyperactivity-impulsivity traits were most condition-specific to Autism and ADHD, respectively. Traits related to attention control showed the greatest Bridge Expected Influence across conditions, revealing a potential transdiagnostic process underlying the overlap between Autism and ADHD. To investigate this further at the cognitive level, participants completed a large, well-powered, and pre-registered study measuring the relative contributions of Autism and ADHD traits to attention control (Study 3; n = 500). We detected age- and sex-related effects, however, attention control did not account for the covariance between Autism and ADHD traits. We situate our findings and discuss future directions in the cognitive science of Autism, ADHD, and neurodiversity, noting how our open datasets may be used in future research.

A network analysis of psychopathology in young Black children: Implications for predicting outcomes in adolescence

OBJECTIVE

Network analysis may identify specific symptoms involved in the maintenance and development of psychopathology. This approach, however, has not been applied to the study of young Black children, a population facing unique challenges and developmental risks. It is also unclear whether network analysis identifies early symptoms in Black children that are linked to their longer-term difficulties and strengths in adolescence.

METHODS

We conducted a network analysis of emotional and behavioral difficulties in 1238 Black (non-Hispanic) children from the age-3 assessment in the Future of Families and Child Wellbeing Study (47 % female). We also explored whether early childhood symptoms predict subsequent caregiver-reported internalizing and externalizing problems, and youth-reported social competencies and extracurricular and community involvement, at the age-15 assessment.

RESULTS

We identified specific symptoms of externalizing and emotional reactivity as central in the network. Symptoms of emotional reactivity were also involved in comorbidity, bridging different communities of symptoms. Using elastic net models, we identified specific central and bridge symptoms, but also peripheral network symptoms, that contributed uniquely to the prediction of internalizing and externalizing problems in adolescence. Early childhood symptoms were less predictive of positive outcomes in adolescence.

CONCLUSIONS

This study identified central and bridge symptoms in young Black children, an underrepresented population in network analysis research. Some of these central and bridge symptoms, but also peripheral network symptoms, may be useful targets in early interventions to prevent long-term difficulties. Conversely, network approaches to understanding early psychopathology may have less utility for predicting Black children's subsequent strengths in adolescence.

Development of a human-analogue, 3-symptom domain Dog ADHD and Functionality Rating Scale (DAFRS)

The family dog, in its natural environment, exhibits neuropsychological deficits redolent of human psychiatric disorders, including behaviours that are similar to human attention-deficit/hyperactivity disorder (ADHD) symptoms. Based on standard questionnaire methods in humans, we aimed to develop and validate a detailed, psychometrically improved tool to assess owner views on relevant dog behaviours. We modified available questionnaires by adding items that allow for separate analysis of impulsivity, and items on functional impairment. We collected data from 1168 owners for different validation steps of the new questionnaire and, similarly to assessment of humans where teachers also evaluate as an expert control, we collected data from dog trainers. Exploratory and confirmatory factor analysis revealed 3 factors: inattention (IA), hyperactivity (H) and impulsivity (I), corresponding to all three human symptom dimensions in dogs. Test-retest analyses showed excellent agreement between measurements for all factors. Similarly to findings with humans, trainer-owner rating comparisons showed fair (IA) to moderate (H, I) agreement. As in humans, greater ADHD scores were associated with greater functional impairment scores. We suggest that in dogs, similarly to humans, parallel examination of (extreme) ADHD and functional impairment scores could help distinguish diagnosable individuals, after further validation of the questionnaire using a relevant behaviour test.

Arousal dysregulation and executive dysfunction in attention deficit hyperactivity disorder (ADHD)

Attention deficit/hyperactivity disorder (ADHD) is a heterogeneous neurodevelopmental condition, that continues to have an elusive etiological background. A number of extant models and theories have historically intended to explain the many factors contributing to ADHD behaviors. One of the most accepted hypotheses has been the executive dysfunction theory associating reduction in executive control to abnormalities in structure and operational dysfunction of dopaminergic signaling networks. Nevertheless, executive functions are not always impaired in ADHD, and the literature describes other symptoms commonly reported suggesting individuals with ADHD would appear to suffer from a more general deficit. Another existing line of research, that has gained much attention recently, establishes that ADHD would have dysregulated states of brain arousal that would account for its commonly observed cognitive deficits and behavioral symptoms, described as the state regulation theory, which has now included measures of autonomic function. This article describes some important aspects that compose and challenge these two most influential theoretical constructs, executive dysfunction and state-regulation, based on their empirical evidence, implying the need to reevaluate the norms used to classify individuals and establish ADHD diagnosis. Large number of controversial results continue to exist within the study of ADHD biological and/or performance markers, possibly due to such heterogeneity and variability within the same diagnosis. The need to resolve these issues and establish newly revised diagnostic criteria for ADHD is critical, as therapeutic success depends on having accurately identified underlying neurophysiological factors in order to appropriately address them in treatment.

Impulsivity as key bridge symptoms in cross-sectional and longitudinal networks of ADHD and ODD

BACKGROUND

Impulsivity is viewed as key to attention-deficit/hyperactivity disorder (ADHD) and disruptive behavior disorders (DBD). Yet, to date, no work has provided an item-level analysis in longitudinal samples across the critical developmental period from childhood into adolescence, despite prior work suggesting items exhibit differential relevance with respect to various types of impairment. The current study conducted a novel longitudinal network analysis of ADHD and oppositional defiant disorder (ODD) symptoms between childhood and adolescence, with the important applied prediction of social skills in adolescence.

METHODS

Participants were 310 children over-recruited for clinical ADHD issues followed longitudinally for six years in total with gold standard diagnostic procedures and parent and teacher ratings of symptoms and social outcomes.

RESULTS

Findings from baseline, Year 3, and Year 6 suggested Difficulty waiting turn, Blurts, and Interrupts/intrudes were key bridge items across cross-sectional and longitudinal parent-reported DBD networks. Furthermore, shortened symptom lists incorporating these symptoms were stronger predictors of teacher-rated social skills 5 years later compared to total DBD scores.

CONCLUSIONS

Such findings are consistent with the trait impulsivity theory of DBD and ADHD and may inform useful screening tools and personalized intervention targets for children at risk for DBD during adolescence.

An Open-Label Study of a Wearable Device Targeting ADHD, Executive Function, and Academic Performance

OBJECTIVE

This was an open-label pilot study to test the feasibility and preliminary efficacy of a wearable digital intervention developed to improve on-task behavior. This was an exploratory study to test for specificity of response on parent- and teacher-reported symptom outcomes in attention and hyperactive/impulsive symptoms, as well as domains of functional impairment, including school behavior and learning and executive function.

METHOD

Participants included 38 children aged 8-12 years with a parent-reported past diagnosis of ADHD. Following baseline ratings from parents (N = 38) and teachers (N = 26), participants wore the device to school for four weeks. Parent and teacher ratings of ADHD symptoms, executive function, and functional impairment were repeated at the end of the four-week intervention period.

RESULTS

Statistically significant improvement was seen in the total scores for all parent and nearly all teacher outcomes, with moderate effect size improvements in attention, organization and planning, self-monitoring, school functioning, and teacher-reported academic performance.

CONCLUSIONS

Preliminary evidence from this open-label pilot study suggests that having a child interact with a wearable device to self-monitor attention is feasible. This exploratory, open-label pilot study found real-world improvement in functional domains, including academic performance. Future research will require a blinded, randomized, controlled trial using an appropriate sham comparator to confirm these findings.

A longitudinal investigation of parental ratings and performance metrics for executive functioning and symptom severity in clinically referred youth with ADHD

There remains a knowledge gap concerning the persistence of attention deficit hyperactivity disorder (ADHD) over the longer term. The current study aimed to investigate the change in parent-rated, and performance-based metrics of executive functioning (EF) and the relationship between these EF metrics and ADHD symptoms in individuals with ADHD from childhood/adolescence to young adulthood. This was done by examining possible improvements in parent-rated EF and performance-based measures of inattention and inhibition over a three-year interval and their relationship to ADHD outcomes in 137 clinically referred youth with ADHD (mean age = 12.4 years, SD = 3.1). Participants' parents completed the Behavior Rating Inventory of Executive Function (BRIEF) and the Swanson-Nolan-Pelham Scale at baseline and follow-up. Participants completed the Conners' Continuous Performance Test, Version II (CPT II) at baseline and follow-up. Statistical analyses were performed with Linear Mixed Models. The sex- and age-standardized measures Commission and Hit reaction time (RT) subscales of the CPT II and parent-rated metacognitive, and behavior regulation composites of the BRIEF were largely stable between measuring points. CPT Omissions, Hit RT standard error (reaction time variability), and parent-rated ADHD symptom scores improved slightly. BRIEF composites and reaction time variability were related to ADHD symptoms using longitudinal data. Overall, behavioral aspects of EF, as observed by parents in the home context, appear to play a significant role in the trajectory of childhood ADHD.

The domain-variant indirect association between electrophysiological response to reward and ADHD presentations is moderated by dopaminergic polymorphisms

BACKGROUND

Understanding the etiopathogenesis of attention-deficit/hyperactivity disorder (ADHD) may necessitate decomposition of the heterogeneous clinical phenotype into more homogeneous intermediate phenotypes. Reinforcement sensitivity is a promising candidate, but the exact nature of the ADHD-reward relation - including how, for whom, and to which ADHD dimensions atypicalities in reward processing are relevant - is equivocal.

METHODS

Aims were to examine, in a carefully phenotyped sample of adolescents (N = 305; Mage = 15.30 years, SD = 1.07; 39.7% girls), whether functional dopaminergic polymorphisms implicated in both reward processing and ADHD (1) are differentially associated with event-related potentials (ERPs) of reward anticipation at distinct levels of ADHD risk (nno risk = 174, nat-risk = 131, ndiagnosed = 83); and (2) moderate the indirect effect of dispositional affectivity on the association between ERPs and ADHD domains.

RESULTS

In adolescents at-risk for or with ADHD, carrying a hypodopaminergic allele was associated with enhanced ERPs of attention allocation to cue and attenuated ERPs of anticipatory attention to feedback. No associations were observed in adolescents not at-risk for or without ADHD. Controlling for age and sex, both the negative indirect effect of positive affectivity (PA) on the association between ERPs and inattention and the positive indirect effect of PA on the association between ERPs and hyperactivity/impulsivity were supported only for those with high activity dopamine transporter (DAT) alleles.

CONCLUSIONS

Reward and affective processing are promising intermediate phenotypes relevant to disentangling ADHD developmental pathways. Consistent with developmental multifinality, through the successive effects of reward anticipation and positive affectivity, functional dopaminergic variants may confer protection against inattention or risk for hyperactivity/impulsivity.

Identifying Symptoms of ADHD and Disruptive Behavior Disorders Most Strongly Associated with Functional Impairment in Children: A Symptom-Level Approach

To enhance the understanding of how symptoms of attention-deficit/hyperactivity disorder (ADHD) and disruptive behavior disorders such as oppositional defiant disorder (ODD), conduct disorder (CD), including callous-unemotional (CU) traits, differentially relate to functional impairment (FI). Participants were 474 German school-age children (age: M = 8.90, SD = 1.49, 81% male) registered for participation in the ESCAschool trial (ESCAschool: Evidence-based, Stepped Care of ADHD in school-aged children). Clinicians assessed the severity of individual symptoms and five FI domains specifically associated with ADHD symptoms or ODD/CD/CU symptoms using a semi-structured clinical interview. We conducted two multiple linear regression analyses, combined with relative importance analyses, to determine the impact of individual symptoms on global FI associated with ADHD and ODD/CD/CU symptoms. Next, we estimated two networks and identified the strongest associations of ADHD symptoms or ODD/CD/CU symptoms with the five FI domains. Symptoms varied substantially in their associations with global FI. The ADHD symptom Easily Distracted (15%) and ODD symptom Argues with Adults (10%) contributed most strongly to the total explained variance. FI related to academic performance, home life and family members, and psychological strain were most strongly associated with ADHD inattention symptoms, whereas FI related to relationships with adults and relationships with children and recreational activities were most strongly associated with hyperactivity-impulsivity symptoms. By comparison, the ODD/CD/CU symptoms most closely linked to FI domains originated from the ODD and CD dimensions. Our findings contribute to a growing body of literature on the importance of analyzing individual symptoms and highlight that symptom-based approaches can be clinically useful.

Utility of the Limited Prosocial Emotions Specifier in Preschoolers With Conduct Problems

This study examined the clinical utility of the "Limited Prosocial Emotions" (LPE) specifier (i.e., prevalence rates, group differences, and predictive utility) in a high-risk preschool sample (N = 109, M age = 4.77) presenting with conduct problems (CPs; n = 59). First, LPE prevalence rates ranged from 7.7% to 89.8%. Next, few group differences were observed between with CP-only and CP+LPE; youth with CP+LPE differed from youth with CP-only on callous-unemotional (CU) traits and verbal ability, but not on externalizing or internalizing psychopathology, nor on parenting experiences. In the full sample, youth with LPE differed from youth without LPE on externalizing and internalizing psychopathology, parenting, and verbal ability. Finally, LPE predicted greater baseline CP but did not predict trajectories of CP. Findings highlight the clinical utility of the LPE specifier during early childhood and call for a refinement of the LPE specifier to improve its clinical value.

Developmental changes in the structure of shyness and internalizing symptoms from early to middle childhood: A network analysis

Shyness is a temperamental trait that shares considerable conceptual overlap with aspects of internalizing problems, creating difficulties in operationalizing and assessing these two constructs and their association. This study addresses these issues by employing network analyses. Participants were, white, N = 555 children (M_age  = 52.45 months, SD = 15.96, 55% girls) followed longitudinally over 4 years (2016-2010) in Norway. Teachers rated child shyness and assessed children's internalizing symptoms. Results suggest that two behavioral shyness traits were the most central aspects of shyness. The centrality of these aspects was robust across age. The most influential symptom connecting internalizing symptoms with shyness was "unhappy." Shyness became more differentiated with development, and associations between anxiety-related symptoms and shyness increased as children entered formal schooling.

Gaze-based attention refocusing training in virtual reality for adult attention-deficit/hyperactivity disorder

BACKGROUND

Attention-deficit/hyperactivity disorder (ADHD) is characterized by substantial interindividual heterogeneity that challenges the systematic assessment and treatment. Considering mixed evidence from previous neurofeedback research, we present a novel feedback system that relies on gaze behavior to detect signs of inattention while performing a neuropsychological attention task in a virtual seminar room. More specifically, an audiovisual feedback was given whenever participants averted their gaze from the given task.

METHODS

Eighteen adults with ADHD and 18 healthy controls performed a continuous performance task (CPT) in virtual reality under three counterbalanced conditions in which either gaze-based feedback, sham feedback, or no feedback was provided. In all conditions, phases of high and low virtual distraction alternated. CPT errors and reaction times, proportions of gaze dwell times (e.g., task focus or distraction focus), saccade characteristics, EEG theta/beta ratios, head movements, and an experience sampling of ADHD symptoms were analyzed.

RESULTS

While patients can be discriminated well from healthy controls in that they showed more omission errors, higher reaction times, higher distraction-related dwell times, and more head movements, the feedback did not immediately improve task performance. It was also indicated that sham feedback was rather associated with an aggravation of symptoms in patients.

CONCLUSIONS

Our findings demonstrate sufficient suitability and specificity for this holistic ADHD symptom assessment. Regarding the feedback, a single-session training was insufficient to achieve learning effects based on the proposed metacognitive strategies. Future longitudinal, multi-session trials should conclusively examine the therapeutic efficacy of gaze-based virtual reality attention training in ADHD.

TRIAL REGISTRATION

drks.de (identifier: DRKS00022370).

Data-Driven Methods for Predicting ADHD Diagnosis and Related Impairment: The Potential of a Machine Learning Approach

Current diagnostic criteria for ADHD include several symptoms that highly overlap in conceptual meaning and interpretation. Additionally, inadequate sensitivity and specificity of current screening tools have hampered clinicians' ability to identify those at risk for related outcomes. Using machine learning techniques, the current study aimed to propose a novel algorithm incorporating key ADHD symptoms to predict concurrent and future (i.e., five years later) ADHD diagnosis and related impairment levels. Participants were 399 children with and without ADHD; multiple informant measures of ADHD symptoms, global impairment, academic performance, and social skills were included as part of an accelerated longitudinal design. Results suggested eight symptoms as most important in predicting impairment outcomes five years later: (1) Has difficulty sustaining attention in tasks or play activities, (2) Does not follow through on instructions and fails to finish work, (3) Has difficulty organizing tasks and activities, (4) Avoids tasks (e.g., schoolwork, homework) that require sustained mental effort, (5) Is often easily distracted, (6) Is often forgetful in daily activities, (7) Fidgets with hands or feet or squirms in seat, and (8) Interrupts/intrudes on others. The algorithm comprising this abbreviated list of symptoms performed just as well as or significantly better than one comprising all 18 symptoms in predicting future global impairment and academic performance, but not social skills. It also predicted concurrent and future ADHD diagnosis with 81-93% accuracy. Continued development of screening tools will be key to ensuring access to clinical services for youth at risk for ADHD.

ADHD and political participation: An observational study

BACKGROUND AND OBJECTIVE

Over the past decade, researchers have been seeking to understand the consequences of adult attention-deficit/hyperactivity disorder (ADHD) for different types of everyday behaviors. In this study, we investigated the associations between ADHD and political participation and attitudes, as ADHD may impede their active participation in the polity.

METHODS

This observational study used data from an online panel studying the adult Jewish population in Israel, collected prior the national elections of April 2019 (N = 1369). ADHD symptoms were assessed using the 6-item Adult ADHD Self-Report (ASRS-6). Political participation (traditional and digital), news consumption habits, and attitudinal measures were assessed using structured questionnaires. Multivariate linear regression analyses were conducted to analyze the association between ADHD symptoms (ASRS score <17) and reported political participation and attitudes.

RESULTS

200 respondents (14.6%) screened positive for ADHD based on the ASRS-6. Our findings show that individuals with ADHD are more likely to participate in politics than individuals without ADHD symptoms (B = 0.303, SE = 0.10, p = .003). However, participants with ADHD are more likely to be passive consumers of news, waiting for current political news to reach them instead of actively searching for it (B = 0.172, SE = 0.60, p = .004). They are also more prone to support the idea of silencing other opinions (B = 0.226, SE = 0.10, p = .029). The findings hold when controlling for age, sex, level of education, income, political orientation, religiosity, and stimulant therapy for ADHD symptoms.

CONCLUSIONS

Overall, we find evidence that individuals with ADHD display a unique pattern of political activity, including greater participation and less tolerance of others' views, but not necessarily showing greater active interest in politics. Our findings add to a growing body of literature that examines the impact of ADHD on different types of everyday behaviors.

Associations between inattention and impulsivity ADHD symptoms and disordered eating risk in a community sample of young adults

BACKGROUND

Symptoms of attention deficit hyperactivity disorder (ADHD) and trait impulsivity have been associated with disordered eating but are seldom assessed in community studies, or longitudinally and little is known about the mediating mechanisms.

METHODS

We tested associations between ADHD symptoms and disordered eating cross-sectionally and between trait impulsivity and disordered eating longitudinally. We utilised data from a normative cohort of young adults (642 participants: 65% female, M_age = 23 years). Participants were classified as high risk or low risk for disordered eating using the SCOFF instrument. In the first two steps of both cross-sectional and longitudinal hierarchical logistic regression models, demographics and covariates were entered. For the cross-sectional regression, Adult ADHD self-report scale (ASRS) scores, separated into inattentive and hyperactive/impulsive symptoms, were entered in the third step. In a separate longitudinal model, Barratt impulsivity scale subscales (attentional, motor and non-planning impulsivity) were entered in the third step. Depression, as assessed by the moods and feelings questionnaire (MFQ), was examined as a mediator.

RESULTS

Cross-sectionally, sex, MFQ score and inattentive symptoms predicted disordered eating risk (model R² = 20%). Longitudinally, sex, MFQ score and attentional impulsivity predicted disordered eating risk (model R² = 16%). The relationship between inattentive symptoms and the disordered eating risk was partially mediated by MFQ score, whereas the relationship between attentional impulsivity and the disordered eating risk was fully mediated by MFQ scores.

CONCLUSIONS

These data highlight (1) a specific role for inattentive symptoms of ADHD and (2) the importance of both depression and impulsivity in predicting eating disorder risk.

A symptom level perspective on reactive and proactive aggressive behaviours and ADHD symptoms in childhood

OBJECTIVE

Attention-Deficit/Hyperactivity Disorder (ADHD) is one of the most prevalent childhood disorders, affecting around 3.4% of children worldwide. A common and impairing correlate of ADHD is aggressive behaviour. ADHD symptoms and aggression are both heterogeneous and it has been speculated that certain symptoms of ADHD might be more important in aggressive behaviours of different types than others. This study uses a symptom-level analysis to investigate the concurrent and temporal links between ADHD symptoms and aggressive behaviours.

METHODS

Using Gaussian Graphical Models and Graphical Vector Autoregression Models, longitudinal and cross-sectional networks of ADHD symptoms and aggressive behaviours, measured using parent-reported Social Behaviour Questionnaires, were estimated. Participants included 1,246 children taking part in the longitudinal Swiss z-proso cohort study at ages 7, 9 and 11.

RESULTS

The longitudinal network highlighted that ADHD symptoms and aggressive behaviours share a multitude of reciprocal temporal relations, with inattentive ADHD symptoms preceding both reactive and proactive aggression. Cross-sectional networks suggested that hyperactive/impulsive symptoms were predominantly connected to reactive aggressive behaviours but also to a form of proactive aggression, namely dominating other children.

CONCLUSION

Findings provide preliminary evidence which specific symptoms are the most promising targets for reducing aggressive behaviours in children with ADHD. They also highlight the potential importance of targeting feedback loops resulting from aggressive behaviours. Future research is needed to better understand the mechanisms through which ADHD and aggressive behaviours become linked.

Networks of Neuropsychological Functions in the Clinical Evaluation of Adult ADHD

This study applied network analysis to explore the relations between neuropsychological functions of individuals in the clinical evaluation of attention-deficit/hyperactivity disorder (ADHD) in adulthood. A total of 319 participants from an outpatient referral context, that is, 173 individuals with ADHD (ADHD group) and 146 individuals without ADHD (n-ADHD group), took part in this study and completed a comprehensive neuropsychological assessment. A denser network with stronger global connectivity was observed in the ADHD group compared to the n-ADHD group. The strongest connections were consistent in both networks, that is, the connections between selective attention and vigilance, and connections between processing speed, fluency, and flexibility. Further centrality estimation revealed attention-related variables to have the highest expected influence in both networks. The observed relationships between neuropsychological functions, and the high centrality of attention, may help identify neuropsychological profiles that are specific to ADHD and optimize neuropsychological assessment and treatment planning of individuals with cognitive impairment.

Effectiveness of Clinic-Based Brief Behavioral Intervention (BBI) in Long-term Reduction of ADHD Symptoms Among Preschoolers

Preschoolers commonly experience symptoms of ADHD and disruptive behavior problems. Behavioral parent management training (PMT) is an evidence-based intervention for addressing both ADHD and disruptive behaviors in this population; however, many PMT programs are burdensome in length and have limited data regarding long-term effectiveness for ADHD specific outcomes. This study examined outcomes up to 1 year following completion of a brief behavioral intervention (M = 6.51 sessions) for preschoolers. Participants were children aged 2-6 years with clinically significant disruptive behaviors and their parents. Results demonstrated significant improvements in parent-reported child hyperactivity and inattention from pre-to-post intervention, with sustained improvement at 6 months and 1 year post intervention. Teacher-reported hyperactivity and inattention also showed significant improvements from pre-to-post intervention, which were maintained across time points. These results were also found among a subset of participants with clinically significant ADHD symptoms at baseline. This study highlights the long-term effectiveness of a brief PMT program to address symptoms of ADHD and disruptive behaviors in preschoolers. Findings support the recommendation to offer PMT as a first-line intervention for preschoolers with ADHD symptoms to reduce the need for early intervention with stimulant medication and address comorbid disruptive behaviors.

Associations among ADHD symptoms, ODD symptoms, and borderline personality features: A network analysis

Attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) are common childhood syndromes that exhibit a high degree of comorbidity. Both ADHD and ODD symptoms in childhood predict higher levels of borderline personality features (BPF) later in development. Yet ADHD, ODD, and BPF each consist of a heterogeneous group of symptoms, and symptom-level associations between these groups remain unclear. The present study examined symptom-level associations, as well as sex differences in symptom-level associations, among ADHD, ODD, and BPF using network analysis. Caregivers of 962 children between the ages of 5 and 12 completed rating scales of ADHD, ODD, and BPF. Assessment of Bridge Expected Influence indicated a number of bridge symptoms linking ADHD to ODD; these bridge symptoms were primarily from the hyperactive-impulsive (rather than the inattentive) dimension of ADHD (e.g., blurts out answers, leaves seat, runs excessively). A smaller number of bridge symptoms were identified linking ADHD and ODD to BPF, and these bridge symptoms were different for girls versus boys. Overall, several ADHD hyperactive-impulsive symptoms were related to the BPF item gets in trouble for doing things without thinking, and the ODD item touchy/easily annoyed was related to the BPF item goes back and forth between different feelings. Moreover, whereas we observed stronger links between ODD antagonistic symptoms (e.g., blames others) and BPF among girls, we observed stronger links between ODD oppositional symptoms (e.g., defies/refuses to comply) and BPF among boys. Taken together, results provide a more nuanced, symptom-level understanding of the overlap among ADHD, ODD, and BPF.

Networks of ADHD and SCT Symptoms in Emerging Adulthood

OBJECTIVE

Emerging adulthood (18-25 years) is a transitional and understudied developmental period. Yet, little is known about how specific symptoms of ADHD, as well as those from the related SCT domain, may differentially relate to one another during this period, if there are differences based on biological sex, or how closely results will align with adulthood.

METHODS

We used network analysis techniques to explore the structure of ADHD and SCT symptoms within emerging adulthood, with additional comparisons between sexes as well as between emerging adulthood and adulthood. Using an online platform, 8,506 adults reported on their symptoms of ADHD and SCT.

RESULTS

Symptoms grouped together within their respective domains during emerging adulthood with no significant differences in overall network structure between sexes. Similarly, network structure appeared to be robust across emerging adulthood and adulthood.

CONCLUSION

Such consistency supports a conceptualization of ADHD in emerging adulthood as similar to adulthood.

A network perspective on abnormal child behavior in primary school students

Abnormal child behavior is a complex entity including among others disorders such as ADHD, a neuropsychiatric disorder interfering with the normal development of the child, and combining many comorbidities. There are no specific tools designed to assess abnormal child behavior, although well-known ADHD screening tools such as the CTRS-R:S go beyond the disorder itself and cover the wider construct. This can be understood as the complex system of mutually influencing entities, that is why the aim of this study was to investigate the items of the CTRS-R:S as a psychological network. We analyzed a data set of 525 children in French-speaking primary schools from Belgium, and estimated a Bayesian Gaussian Graphical Model with a Bayes Factor of 30. We identified highly connected nodes from each community of the CTRS-R:S to build an additional network of communities. In the domain network, Oppositional and Cognitive skills share the strongest connection in the network. The 28-item network was overall positively connected albeit the presence of some negative connections. The spinglass algorithm identified eight domains in the CTRS-R:S network that causally influence each other. The network approach is a useful framework to investigate the domains of abnormal child behavior as well as the interplay between individual symptoms.

Evaluating ADHD Assessment for Dogs: A Replication Study

The family dog, in its natural environment, exhibits neuropsychological deficits redolent of human psychiatric disorders, including behaviours similar to human Attention-Deficit/Hyperactivity Disorder (ADHD) symptoms. For dogs, Vas and colleagues developed a 13-item questionnaire to measure inattention and hyperactivity/impulsivity (Dog ARS; 2007). We re-assessed, in a large sample of dogs (N = 319), psychometric properties of the Dog ARS, to identify possible limitations as a basis for further development. We examined the cross-study stability of factor structure and 40-day temporal stability of item and subscale scores and compared owner-report with expert (dog trainer)-report (n = 86), paralleling human parent/teacher assessments. To identify ambiguous items, we administered a modified version (including “I don’t know” options, N = 520) to a different sample. We could replicate the factor structure with evidence of good internal consistency and test–retest reliability of both subscales. Agreement between owner and trainer ratings was fair (inattention) and moderate (hyperactivity/impulsivity). Three ambiguous items were identified. Overall, we claim that the Dog ARS is a reliable tool to assess ADHD-like behaviour in dogs, but in its current form, it is not suitable to detect diagnosable individuals, as it does not comprise items assessing functional impairment, and also, the inclusion of owner-expert ratings in the evaluation process would be necessary.

Multisource Longitudinal Network and Latent Variable Model Analyses of ADHD Symptoms in Children

Objective: Multisource longitudinal network analysis was used to determine if between-child and within-child variance of attention-deficit/hyperactivity disorder (ADHD) symptoms provided unique findings of ADHD relative to latent variable model (LVM) analyses.Method: Mothers and fathers of 802 Spanish first-grade children (54% boys) provided ratings of ADHD symptoms at two time points six weeks apart (assessment 1: 723 mothers and 603 fathers; assessment 2: 667 mothers and 584 fathers). Network and latent variable models were applied to the ratings.Results: Inattention, hyperactivity, and mixed hyperactive/impulsive symptom communities occurred for the within- and between-children's symptom networks with the results being consistent across mothers and fathers, especially for the between-children's symptom networks. LVM analyses identified three factors with the same symptoms on each factor as in the symptom communities. These models also showed invariance across mothers and fathers as well as assessments.Conclusions: Longitudinal networks provided several useful insights for ADHD, including centrality symptoms that differed across between- and within-child levels. However, many findings were also largely consistent with the LVM analyses. Future studies should use novel methods (e.g., intensive longitudinal measurement) and analytic tools to determine if more unique theoretical and clinical findings emerge when applying network analysis to longitudinally measured ADHD symptoms.

Network analysis of 18 attention-deficit/hyperactivity disorder symptoms suggests the importance of "Distracted" and "Fidget" as central symptoms: Invariance across age, gender, and subtype presentations

The network theory of mental disorders conceptualizes psychiatric symptoms as networks of symptoms that causally interact with each other. Our present study aimed to explore the symptomatic structure in children with attention-deficit/hyperactivity disorder (ADHD) using network analyses. Symptom network based on 18 items of ADHD Rating Scale-IV was evaluated in 4,033 children and adolescents with ADHD. The importance of nodes was evaluated quantitatively by examining centrality indices, including Strength, Betweenness and Closeness, as well as Predictability and Expected Influence (EI). In addition, we compared the network structure across different subgroups, as characterized by ADHD subtypes, gender and age groups to evaluate its invariance. A three-factor-community structure was identified including inattentive, hyperactive and impulsive clusters. For the centrality indices, the nodes of "Distracted" and "Fidget" showed high closeness and betweenness, and represented a bridge linking the inattentive and hyperactive/impulsive domains. "Details" and "Fidget" were the most common endorsed symptoms in inattentive and hyperactive/impulsive domains respectively. On the contrary, the "Listen" item formed a peripheral node showing weak links with all other items within the inattentive cluster, and the "Loss" item as the least central node by all measures of centrality and with low predictability value. The network structure was relatively invariant across gender, age and ADHD subtypes/presentations. The 18 items of ADHD core symptoms appear not equivalent and interchangeable. "Distracted" and "Fidget" should be considered as central, or core, symptoms for further evaluation and intervention. The network-informed differentiation of these symptoms has the potentials to refine the phenotype and reduce heterogeneity.

Developmental Relations Between Internalising Problems and ADHD in Childhood: a Symptom Level Perspective

ADHD and internalising problems commonly co-occur with up to 50% of children diagnosed with ADHD also suffering from anxiety or depression. However, their developmental relations are currently not well understood. Longitudinal symptom level analyses can provide valuable insights into how difficulties in these areas of psychosocial functioning affect each other. Using Gaussian Graphical Models and Graphical Vector Autoregression Models, this study estimated cross-sectional and longitudinal networks of ADHD and internalising symptoms in 1387 children using parent- and teacher-reported Social Behaviour Questionnaires (SBQ) when children were aged 7, 9 and 11. Cross-sectional and longitudinal networks suggested that ADHD shares reciprocal relations with internalising symptoms through a number of potential bridge symptoms that are primarily connected to anxiety symptoms. High scores on child cannot sit still, is restless, or hyperactive were found to be the strongest bridge symptom acting as an antecedent to higher internalising symptoms whereas child is worried was the strongest antecedent for higher ADHD symptoms. Findings of this study highlight several potential bridge symptoms that may serve as key intervention targets and further emphasise the need for clinicians to assess children presenting with ADHD symptoms for internalising problems and vice versa.

Community Implementation of MI-Enhanced Behavior Therapy for Adolescent ADHD: Linking Fidelity to Effectiveness

Evidence-based behavior therapy for adolescent ADHD faces implementation challenges in real-world settings. The purpose of this trial was to investigate the relationship between implementation fidelity and outcomes among adolescents receiving services in the active treatment arm (N = 114; Motivational Interviewing [MI]-enhanced parent-teen behavior therapy) of a community-based randomized trial of adolescent ADHD treatment. Participants received therapy from community clinicians (N = 44) at four agencies in a large, ethnically diverse metropolitan setting. Therapists provided self-report of session-by-session adherence to content fidelity checklists and audio recordings of sample sessions that were coded for MI integrity. Parents provided report of ADHD symptoms and family impairment at baseline, posttreatment, and follow-up, while academic records were obtained directly from the local school district. Results indicated that content fidelity significantly waned across the 10 manualized sessions (d = -1.23); these trends were steepest when therapy was delivered outside the office-setting and parent attendance was low. Community therapist self-report of content fidelity predicted significantly greater improvements in academic impairment from baseline to follow-up. MI delivery quality was not associated with improved outcomes; contrary to hypotheses, lower MI relational scores predicted significantly greater improvements in family impairment over time. Findings indicate that community-based outcomes for evidence-based ADHD treatment are enhanced when treatment is implemented with fidelity. Future work should revise community-based implementation strategies for adolescent ADHD treatment to prevent declines in fidelity over time, thereby improving outcomes.

Longitudinal attention-deficit/hyperactivity disorder symptom networks in childhood and adolescence: Key symptoms, stability, and predictive validity

The current study visualized attention-deficit/hyperactivity disorder (ADHD) symptom networks in a longitudinal sample of participants across childhood and adolescence with exploratory examination of age and gender effects. Eight hundred thirty-six children ages 7-13 years were followed annually for 8 years in total. Across parent and teacher report, results suggested "is easily distracted" and "difficulties sustaining attention" as central symptoms across three testing points (i.e., Year 1, Year 3, and Years 5-8 collapsed). "Difficulties following instructions" and "intrudes/interrupts" also emerged as parent-reported central symptoms. Assessment of network structure across the three testing points suggested global robustness of relations among ADHD symptoms from midchildhood into early adolescence. However, relations among symptoms that cause problems in school settings (i.e., being easily distracted) were stronger in teacher-reported than parent-reported networks. When aggregated into a sum score, central symptoms during Year 1 predicted total difficulties related to mental health problems 5 years later just as well as all 18 symptoms. Central symptoms of ADHD may be useful as screeners of future emotional and behavioral difficulties. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Identifying the Inter-Domain Relations Among ODD, CD, and CU Traits in Preschool Children Using Network Analysis

Oppositional defiant disorder (ODD) and conduct disorder (CD) are two of the most common forms of disruptive behavior disorders during childhood. Callous-unemotional (CU) traits are an important factor in understanding the presentation of these externalizing forms of psychopathology. ODD, CD, and CU traits are highly related constructs, yet little work has examined how these externalizing forms of psychopathology are related at the domain level. The current study utilized network analysis to identify the distinct domains that explain the associations among ODD, CD, and CU traits. In a sample of 104 preschoolers (M age = 4.76), results demonstrated that the symptom domains of (a) angry/irritable mood and argumentative/defiant behavior, (b) aggression to people and animals, and (c) callousness were the primary bridge domains for ODD, CD, and CU traits, respectively. Findings of the current study offer a more nuanced insight into the relations amongst ODD, CD, and CU traits. Identification of bridge symptom domains can inform intervention practices by targeting specific symptom domains that are contributing to the maintenance of such aggressive and disruptive behaviors.

Examination of developmental pathways from preschool temperament to early adolescent ADHD symptoms through initial responsiveness to reward

To identify sources of phenotypic heterogeneity in attention-deficit/hyperactivity disorder (ADHD) accounting for diversity in developmental/ pathogenic pathways, we examined, in a large sample of youth (N = 354), (a) associations between observed temperamental emotionality at age 3, an electrocortical index (i.e., reward positivity [RewP]) of initial responsiveness to reward at age 9, and ADHD symptoms at age 12, and (b) whether the association between emotionality and ADHD symptoms is mediated by initial responsiveness to reward. Bivariate analyses indicated greater positive emotionality (PE) was associated with enhanced RewP, lower age-9ADHD and lower age-12 inattention (IA). Negative emotionality (NE) was not associated with RewP or ADHD. Mediation analyses revealed the association between PE and hyperactivity/impulsivity (H/I) was mediated by RewP; enhanced RewP was associated with greater H/I. Greater PE was associated with enhanced RewP at a trend level. These effects held accounting for age-9 ADHD, age-12 IA and age-12 oppositional defiant and conduct disorder symptoms. As such, preschool emotionality is associated with adolescent ADHD-H/I symptoms through late childhood initial responsiveness to reward. These relations indicate that individual differences in emotionality and reward responsiveness may be informative for personalizing ADHD interventions.

Prenatal and perinatal factors associated with ADHD risk in schoolchildren: EPINED epidemiological study

The aim of this study is to assess the relationship between pre- and perinatal factors and ADHD in a sample of scholars exploring differences between ADHD presentations and spectrum of severity. A total of 6720 scholars (aged 3-4 and 10-11) participated in a double-phase epidemiologic cross-sectional study (Epidemiological Study of Neurodevelopmental Disorders, EPINED), and a sample of 646 scholars (ADHD risk, ASD risk and controls without risk) were individually assessed in the second phase of the study. The ADHD diagnosis, based on DSM-5 criteria, was performed with the Kiddie-Schedule for Affective Disorders & Schizophrenia, Present & Lifetime Version. Associations for the different ADHD presentations between prenatal, perinatal and postnatal factors and ADHD (n = 168), subclinical ADHD (n = 88) and non-ADHD (n = 310) were analysed. Logistic regression models showed that gestational diabetes (p = 0.012), instrumental delivery (p = 0.011), family history of psychopathology (p = 0.033) and maternal ADHD phenotype (p = 0.023) were associated with ADHD. These factors were related to the hyperactive-impulsive and combined presentations, but they were not related to the inattentive presentation. Maternal weight gain was associated with subclinical ADHD. In conclusion, metabolic disorder in the pregnancy, difficulties in childbirth and specific family phenotype were related to ADHD, specifically with hyperactive-impulsive presentation, but not in subclinical ADHD.

Unique longitudinal relationships between symptoms of psychopathology in youth: A cross-lagged panel network analysis in the ABCD study

BACKGROUND

The network theory suggests that psychopathology may reflect causal relationships between individual symptoms. Several studies have examined cross-sectional relationships between individual symptoms in youth. However, these studies cannot address the directionality of the temporal relationships hypothesized by the network theory. Therefore, we estimated the longitudinal relationships between individual internalizing, externalizing, and attention symptoms in youth.

METHODS

Data from 4,093 youth participants in the Adolescent Brain Cognitive Development (ABCD) study were used. Symptoms were assessed using the Brief Problem Monitor, which was administered at three time points spaced six months apart. Unique longitudinal relationships between symptoms at T1 and T2 were estimated using cross-lagged panel network modeling. Network replicability was assessed by comparing this network to an identically estimated replication network of symptoms at T2 predicting symptoms at T3.

RESULTS

After controlling for all other symptoms and demographic covariates, depressed mood, inattention, and worry at T1 were most predictive of other symptoms at T2. In contrast, threats of violence and destructiveness at T2 were most prospectively predicted by other symptoms at T1. The reciprocal associations between depressed mood and worthlessness were among the strongest bivariate relationships in the network. Comparisons between the original network and the replication network (correlation between edge lists = .61; individual edge replicability = 64%-84%) suggested moderate replicability.

CONCLUSIONS

Although causal inferences are precluded by the observational design and methodological considerations, these findings demonstrate the directionality of relationships between individual symptoms in youth and highlight depressed mood, inattention, and worry as potential influencers of other symptoms.

A network analysis of problematic smartphone use symptoms in a student sample

BACKGROUND AND AIMS

Previous research has established risk factors for problematic smartphone use (PSU), but few studies to date have explored the structure of PSU symptoms. This study capitalizes on network analysis to identify the core symptoms of PSU in a large sample of students.

METHODS

This research investigated 26,950 grade 4 students (male = 13,271) and 11,687 grade 8 students (male = 5,739) using the smartphone addiction proneness scale (SAPS). The collected data were analyzed using a network analysis method, which can provide centrality indexes to determine the core symptoms of PSU. The two networks from the different groups were compared using a permutation test.

RESULTS

The results indicated that the core symptoms of students' problematic smartphone use were the loss of control and continued excessive use across the two samples.

DISCUSSION AND CONCLUSIONS

These findings suggest that loss of control is a key feature of problematic smartphone use. The results also provide some evidence relevant to previous research from the perspective of network analysis and some suggestions for future treatment or prevention of students' problematic smartphone use.

Network Analysis of ADHD and ODD Symptoms: Novel Insights or Redundant Findings with the Latent Variable Model?

A latent variable model (LVM) and network analysis (NA) were applied to mother and father ratings of attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) symptoms to determine if NA offers unique insights relative to the LVM. ADHD-inattention (IN), ADHD-hyperactivity/impulsivity (HI), and ODD symptoms along with academic competence behaviors (reading, arithmetic, and writing skills) were rated by mothers and fathers of Brazilian (n = 894), Thai (n = 2075), and United States (n = 817) children (M_age = 9.04, SD = 2.12, 49.5% females). LVM indicated that (1) the ADHD-IN, ADHD-HI, and ODD three-factor model yielded a close global-fit with no localized ill-fit; (2) nearly all loadings were substantial; (3) like-symptom loadings, like-symptom thresholds, and like-factor means showed invariance across mothers and fathers; (4) the three factors showed convergent and discriminant validity across mothers and fathers; and (5) only the ADHD-IN showed a unique negative relationship with academic competence. NA indicated that (1) a walktrap community analysis resulted in ADHD-IN, ADHD-HI, and ODD symptom communities; (2) the three symptom communities were consistent across mothers and fathers; (3) only three ADHD-IN symptoms showed unique relationships with the three academic competence items. NA has proven useful for numerous mental disorders. In the current study, NA results were mostly congruent with the LVM model, with a few notable exceptions. The results are discussed in the context of model assumptions and application considerations in the context of ADHD/ODD symptoms relative to other symptom dimensions.

Toward a Revised Nosology for Attention-Deficit/Hyperactivity Disorder Heterogeneity

Attention-deficit/hyperactivity disorder (ADHD) is among the many syndromes in the psychiatric nosology for which etiological signal and clinical prediction are weak. Reducing phenotypic and mechanistic heterogeneity should be useful to arrive at stronger etiological and clinical prediction signals. We discuss key conceptual and methodological issues, highlighting the role of dimensional features aligned with Research Domain Criteria and cognitive, personality, and temperament theory as well as neurobiology. We describe several avenues of work in this area, utilizing different statistical, computational, and machine learning approaches to resolve heterogeneity in ADHD. We offer methodological and conceptual recommendations. Methodologically, we propose that an integrated approach utilizing theory and advanced computational logic to address targeted questions, with consideration of developmental context, can render the heterogeneity problem tractable for ADHD. Conceptually, we conclude that the field is on the cusp of justifying an emotionally dysregulated subprofile in ADHD that may be useful for clinical prediction and treatment testing. Cognitive profiles, while more nascent, may be useful for clinical prediction and treatment assignment in different ways depending on developmental stage. Targeting these psychological profiles for neurobiological and etiological study to capture different pathophysiological routes remains a near-term opportunity. Subtypes are likely to be multifactorial, cut across multiple dimensions, and depend on the research or clinical outcomes of interest for their ultimate selection. In this context parallel profiles based on cognition, emotion, and specific neural signatures appear to be on the horizon, each with somewhat different utilities. Efforts to integrate such cross-cutting profiles within a conceptual dysregulation framework are well underway.

Sluggish cognitive tempo and ADHD symptoms in relation to task-unrelated thought: Examining unique links with mind-wandering and rumination

Recent theoretical and empirical evidence highlights associations between attention-deficit/hyperactivity disorder (ADHD) symptoms and task-unrelated thought, including mind-wandering and rumination. However, it has been hypothesized that sluggish cognitive tempo (SCT), characterized by daydreaming and staring behaviors, may uniquely relate to task-unrelated thought. The purpose of the present study was to test whether SCT symptoms are associated with greater mind-wandering and rumination, and whether this association remains when controlling for ADHD and internalizing symptoms. Participants (N = 4679; 18-29 years; 69% female; 80.9% White) enrolled in six universities in the United States completed measures of SCT, ADHD symptoms, internalizing symptoms, and rumination, as well as two scales used to assess mind-wandering. Although ADHD symptoms were correlated with greater self-reported mind-wandering and rumination, relations with mind-wandering on the daydreaming frequency scale, reflective rumination, and brooding rumination were attenuated when controlling for SCT and internalizing symptoms. Above and beyond other psychopathology dimensions, SCT symptoms were uniquely associated with greater self-reported mind-wandering and both reflective and brooding rumination. Additionally, SCT symptoms were more strongly associated than other psychopathology dimensions with the mind-wandering measure of daydreaming frequency. Results provide the first empirical support for unique and robust associations between SCT symptoms and task-unrelated thought, while suggesting that the link between ADHD and mind-wandering may be less robust than previously suggested.

Psychosocial assessment of families caring for a child with acute lymphoblastic leukemia, epilepsy or asthma: Psychosocial risk as network of interacting symptoms

The purpose of this study is to assess psychosocial risk across several pediatric medical conditions and test the hypothesis that different severe or chronic pediatric illnesses are characterized by disease specific enhanced psychosocial risk and that risk is driven by disease specific connectivity and interdependencies among various domains of psychosocial function using the Psychosocial Assessment Tool (PAT). In a multicenter prospective cohort study of 195 patients, aged 5–12, 90 diagnosed with acute lymphoblastic leukemia (ALL), 42 with epilepsy and 63 with asthma, parents completed the PAT2.0 or the PAT2.0 generic version. Multivariate analysis was performed with disease as factor and age as covariate. Graph theory and network analysis was employed to study the connectivity and interdependencies among subscales of the PAT while data-driven cluster analysis was used to test whether common patterns of risk exist among the various diseases. Using a network modelling approach analysis, we observed unique patterns of interconnected domains of psychosocial factors. Each pathology was characterized by different interdependencies among the most central and most connected domains. Furthermore, data-driven cluster analysis resulted in two clusters: patients with ALL (89%) mostly belonged to cluster 1, while patients with epilepsy and asthma belonged primarily to cluster 2 (83% and 82% respectively). In sum, implementing a network approach improves our comprehension concerning the character of the problems central to the development of psychosocial difficulties. Therapy directed at problems related to the most central domain(s) constitutes the more rational one because such an approach will inevitably carry over to other domains that depend on the more central function.

Applying network analysis to understand depression and substance use in Indian adolescents

INTRODUCTION

Network analysis has been used to better understand relationships between depressive symptoms. Existing work has rarely examined networks of adolescents or individuals in non-western countries.

METHODS

We used data from 13,035 adolescents (52.5% male; Mage=13.8) from Bihar, a low-resource state in India. Depression was measured using the Patient Health Questionnaire-9, and substance use was measured using a questionnaire adapted from the World Health Organization. We modeled a network of depressive symptoms and a network examining connections between depressive symptoms and substance use.

RESULTS

The most commonly reported depressive symptoms were sleep problems, poor appetite, and low energy. In the depression network, feeling like a failure and sad mood were the most central symptoms, and somatic symptoms clustered together. To our surprise, depressive symptoms were only weakly associated with substance use.

LIMITATIONS

Our study uses cross-sectional data, which are not sufficient to draw causal inferences about the relationships between symptoms. Additionally, we used an exploratory data-driven approach, and we did not pose a priori hypotheses about the relationships between symptoms.

DISCUSSION

Our findings suggest that feelings like a failure and sad mood are highly central symptoms in Indian adolescents; future research may examine if these symptoms are strong targets for intervention. Sad mood has commonly been identified as a central symptom of depression in western samples, while feeling like a failure has not. We offer avenues for future research, illustrating how network analysis may enhance our ability to understand, prevent, and treat psychopathology in LMICs.

Gestational and perinatal exposure to diazinon causes long-lasting neurobehavioral consequences in the rat

Diazinon is a widely-used organophosphate pesticide. Pulsatile exposure to diazinon during neonatal development has previously been shown cause long-term neurobehavioral impairments in rats. However, the effects of chronic low concentration exposures during perinatal development remain unclear. This experiment evaluated such effects in Sprague-Dawley rats by implanting osmotic pumps in breeder females prior to conception (N = 13-15 litters per condition) which then delivered chronic, zero order kinetic low-level infusions of 0, 114 or 228 ug/day of diazinon throughout pregnancy. One male and one female from each litter was assessed with a battery of behavioral tests that continued from four weeks of age into adulthood. Litter was used as the unit of variance for the analysis of variance test of significance, with sex as a within litter factor. Diazinon treatment condition was the between subjects factor and time or sessions were repeated measures. Chronic diazinon exposure from pre-mating until the neonatal period caused a significant (p < 0.05) increase in percent of time spent on the open arms of the elevated plus maze, an index of risk-taking behavior. Gestational and lactational diazinon exposure also caused a significant (p < 0.05) degree of hyperactivity in the Figure-8 apparatus during adolescence, specifically affecting the early part of the hour-long test session. This effect had dissipated by the time the rats reached adulthood. Diazinon exposure also caused a significant impairment in novel object recognition, a test of cognitive function. Offspring exposed to 228 ug/day diazinon (p < 0.05) showed significantly less preference for the novel vs. familiar object than controls during the first five minutes of the novel object recognition test.

The Study of Psychopathology from the Network Analysis Perspective: A Systematic Review

BACKGROUND

Network analysis (NA) is an analytical tool that allows one to explore the map of connections and eventual dynamic influences among symptoms and other elements of mental disorders. In recent years, the use of NA in psychopathology has rapidly grown, which calls for a systematic and critical analysis of its clinical utility.

METHODS

Following PRISMA guidelines, a systematic review of published empirical studies applying NA in psychopathology, between 2010 and 2017, was conducted. We included the literature published in PubMed and PsycINFO using as keywords any combination of "network analysis" with the terms "anxiety," "affective disorders," "depression," "schizophrenia," "psychosis," "personality disorders," "substance abuse" and "psychopathology."

RESULTS

The review showed that NA has been applied in a plethora of mental disorders in adults (i.e., 13 studies on anxiety disorders; 19 on mood disorders; 7 on psychosis; 1 on substance abuse; 1 on borderline personality disorder; 18 on the association of symptoms between disorders), and 6 on childhood and adolescence.

CONCLUSIONS

A critical examination of the results of each study suggests that NA helps to identify, in an innovative way, important aspects of psychopathology like the centrality of the symptoms in a given disorder as well as the mutual dynamics among symptoms. Yet, despite these promising results, the clinical utility of NA is still uncertain as there are important limitations on the analytic procedures (e.g., reliability of indices), the type of data included (e.g., typically restricted to secondary analysis of already published data), and ultimately, the psychometric and clinical validity of the results.

Structure of ADHD/ODD Symptoms in Spanish Preschool Children: Dangers of Confirmatory Factor Analysis for Evaluation of Rating Scales

Confirmatory factor analysis (CFA) is often used to evaluate attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) symptom ratings by parents and teachers. An ADHD-inattention (IN), ADHD-hyperactivity/impulsivity (HI), and ODD three-factor model is usually the best model. Acceptable CFA models, however, can hide symptoms with poor convergent and discriminant validity. To demonstrate this issue, CFA models (i.e., cross-loadings set to zero) along with exploratory CFA models (i.e., cross-loadings allowed) were applied to parent (n = 308) and teacher (n = 258) ratings of ADHD/ODD symptoms with Spanish preschool children (M_age = 4.78, SD = .84, 56% boys). While the three-factor CFA model provided an acceptable-fit with moderate to substantial symptom-factor loadings, the three-factor exploratory CFA model, however, found a large number of the symptoms failed to show convergent and discriminant validity. These outcomes argue for the use of exploratory CFA procedures in the initial evaluation of ADHD/ODD rating scales.

Annual Research Review: Pediatric posttraumatic stress disorder from a neurodevelopmental network perspective

BACKGROUND

Experiencing traumatic stress is common and may lead to posttraumatic stress disorder (PTSD) in a number of children and adolescents. Research using advanced imaging techniques is beginning to elucidate some of the neurobiological correlates of the traumatic stress response in youth.

METHODS

This paper summarizes the emerging network perspective of PTSD symptoms and reviews brain imaging research emphasizing structural and functional connectivity studies that employ magnetic resonance imaging techniques in pediatric samples.

RESULTS

Differences in structural connections and distributed functional networks such as the salience, default mode, and central executive networks are associated with traumatic and severe early life stress. The role of development has been relatively underappreciated in extant studies though there is evidence that critical brain regions as well as the structural and functional networks implicated undergo significant change in childhood and these typical developmental differences may be affected by traumatic stress.

CONCLUSIONS

Future research will benefit from adopting a truly developmental approach that considers children's growth as a meaningful effect (rather than simply a covariate) interacting with traumatic stress to predict disruptions in the anatomical, functional, and connective aspects of brain systems thought to underlie the network of PTSD symptoms. Linking symptom networks with neurodevelopmental network models may be a promising avenue for future work.

Predicting ADHD Symptoms in Adolescence from Early Childhood Temperament Traits

Extreme levels of certain temperament traits can be early markers of different developmental pathways of attention-deficit/hyperactivity disorder (ADHD). However, the long-term utility of using these traits as predictors of ADHD is not fully known. This study includes 64 male adolescents (M age = 13.5), who have been followed since birth as part of a longitudinal study. The primary aim was to test effortful control (EC), activity level, and anger, measured in early childhood - both with mother's reports and laboratory assessments -as predictors of ADHD symptoms in adolescence. Further, we investigated the specificity of this prediction to the different ADHD symptom domains. The results demonstrated that early temperament dimensions of EC and activity level were predictive of ADHD symptoms about 10 years later, when the participants reached adolescence. Moreover, activity level showed specificity only to hyperactivity-impulsivity symptoms whereas EC was a predictor of the two symptom domains. Anger had a predictive correlation with ADHD symptoms; however, it did not have a unique predictive contribution. These results emphasize the relevance of EC and activity level in the developmental course of ADHD. Identification of early risk factors can lead to more efficient design and implementation of intervention programs.

A network analysis approach to ADHD symptoms: More than the sum of its parts

In interpreting attention-deficit/hyperactivity disorder (ADHD) symptoms, categorical and dimensional approaches are commonly used. Both employ binary symptom counts which give equal weighting, with little attention to the combinations and relative contributions of individual symptoms. Alternatively, symptoms can be viewed as an interacting network, revealing the complex relationship between symptoms. Using a novel network modelling approach, this study explores the relationships between the 18 symptoms in the Diagnostic Statistical Manual (DSM-5) criteria and whether network measures are useful in predicting outcomes. Participants were from a community cohort, the Children’s Attention Project. DSM ADHD symptoms were recorded in a face-to-face structured parent interview for 146 medication naïve children with ADHD and 209 controls (aged 6–8 years). Analyses indicated that not all symptoms are equal. Frequencies of endorsement and configurations of symptoms varied, with certain symptoms playing a more important role within the ADHD symptom network. In total, 116,220 combinations of symptoms within a diagnosis of ADHD were identified, with 92% demonstrating a unique symptom configuration. Symptom association networks highlighted the relative importance of hyperactive/impulsive symptoms in the symptom network. In particular, the ‘motoric’-type symptoms as well as interrupts as a marker of impulsivity in the hyperactive domain, as well as loses things and does not follow instructions in the inattentive domain, had high measures of centrality. Centrality-measure weighted symptom counts showed significant association with clinical but not cognitive outcomes, however the relationships were not significantly stronger than symptom count alone. The finding may help to explain heterogeneity in the ADHD phenotype.

Heterogeneity in Cognitive and Socio-Emotional Functioning in Adolescents With On-Track and Delayed School Progression

Adolescence is characterized by considerable changes in cognitive and socio-emotional skills. There are considerable differences between adolescents with regards to the development of these skills. However, most studies examine adolescents' average functioning, without taking into account this heterogeneity. The current study applies network analysis in order to examine heterogeneity of cognitive and socio-emotional functioning in adolescents on-track or delayed in their school progression. Data was collected at two time-points for on-track (n = 320) and delayed (n = 69) adolescents (Mage = 13.30 years, SDage = 0.77). Repeated measures ANOVA showed no significant differences between the groups in cognitive and socio-emotional functioning (p's > 0.05). Network analysis revealed that executive functions play a key role in the network of cognitive, social, and emotional functioning. This is especially the case in the delayed group where executive functions are even more central, both at T1 (inhibition and shifting) and T2 (shifting). Subsequent community analysis revealed three profiles in both groups: a well-adapted and well-balanced group, a group with high levels of need for arousal and risk-taking, and a group with regulation problems. Compared to on-track adolescents, delayed adolescents showed even higher levels of risk-taking in the second profile and higher levels of executive function problems in the third profile at T1. These differences were leveled out at T2, indicating adolescents in the delayed group catch up with their peers. This study highlights the intricate balance between cognitive, social and emotional functioning in adolescents in relation to school performance and provides preliminary evidence of the importance of taking individual differences within groups into account.