Temperament and Character Profiles Associated with Internalizing and Externalizing Problems in Children with Attention Deficit Hyperactivity Disorder

The Associations Between Sleep and Externalizing and Internalizing Problems in Children and Adolescents with Attention-Deficit/Hyperactivity Disorder: Empirical Findings, Clinical Implications, and Future Research Directions

Sleep problems are common in youth with attention-deficit/hyperactivity disorder (ADHD). Externalizing and internalizing problems contribute to dysfunction in youth with ADHD and are amplified by disrupted sleep. This objective of this article is to synthesize empirical studies that examined the associations between sleep and internalizing or externalizing problems in individuals with ADHD. The main findings are that sleep problems precede, predict, and significantly contribute to the manifestation of internalizing and externalizing behavior problems among children and adolescents with ADHD. Clinicians should assess sleep and integrate sleep interventions into the management of youth with ADHD.

Mental health in Canadian children and adolescents during COVID-19 pandemic: the role of personality and, coping and stress responses

In December 2019, the Coronavirus Disease (COVID-19) pandemic first emerged in China and quickly spread to other countries. Previous studies have shown that the COVID-19 pandemic and the consequences have negatively impacted the mental health of adults. Individual differences such as personality could contribute to mental health. Furthermore, coping and responses to stress may affect an individual's response to the pandemic. In the past, studies have only investigated this relationship in adults. In the current study, we examine how personality traits (using the Five-Factor Model as our framework) and Coping and Response to COVID-19 stress are related to the mental health of Canadian children and adolescents during the pandemic. Using parent reports of 100 preschoolers and 607 6-18-year-old children, we performed multiple regression analysis to explore how personality traits predict the effects of COVID-19 on mental health. The results showed that personality traits are associated with the mental health of Canadian youth during the COVID-19 pandemic. In preschoolers, Neuroticism and Agreeableness predicted the most mental health problems, and in 6-18-year-old children, Extraversion negatively predicted the most mental health problems. Also, Openness to Experience was the weakest predictor of mental health status in Canadian youth. These findings could be useful in understanding children's responses to the COVID-19 pandemic and could assist public health services delivering mental health services specifically tailored to children's personalities during and after this pandemic.

Associations between executive functioning, challenging behavior, and quality of life in children and adolescents with and without neurodevelopmental conditions

The present study sought to clarify the impact of executive and social functioning on challenging behavior and the downstream influence of challenging behavior on quality of life and functioning in a large transdiagnostic sample. Understanding these relationships is crucial for developing and designing tailored intervention strategies. In a cross-sectional study, parent informants of 2,004 children completed measures of executive and social functioning, challenging behavior, child and family quality of life, and reported on functional impacts of challenging behavior. Using structural (path) modeling, analyses evaluated the associations between executive and social functioning, including emotion regulation and risk avoidance, with overall and specific types of challenging behavior. Structural models also examined the influence of challenging behavior on child and family quality of life, including measures of the immediate and extended environment, and functional impacts on the parent/child as well as interactions with the medical/legal systems. Finally, mediational models explored the direct and indirect effects of executive and social functioning on quality of life and impact measures via challenging behavior. Results indicated that executive functioning accounts for substantial variance (R² = 0.47) in challenging behavior. In turn, challenging behavior accounts for substantial variance in child and family quality of life (R² = 0.36) and parent/child impacts (R² = 0.31). Exploratory mediational models identified direct effects from executive and social functioning measures on quality of life and functional impacts and indirect effects for executive functioning via challenging behavior. These findings support the development of new intervention strategies and suggest the need to measure executive functioning when assessing and tailoring the treatment of challenging behavior in clinical practice.

Temperament Profiles Associated with Internalizing Symptoms and Externalizing Behavior in Adolescents with ADHD

The current study investigated temperament profiles associated with internalizing symptoms and externalizing behavior in adolescents with ADHD. Participants were 121 adolescents (90 males) with ADHD, ranging in age from 13 to 18 years (M = 15.40, SD = 1.59). Emotional and behavioral ratings were obtained using the Strengths and Difficulties Questionnaire (SDQ) and temperament profiles were assessed by administering the Temperament and Character Inventory (TCI). Multivariate profile analyses and post hoc tests revealed that youth high in internalizing symptoms were significantly higher in harm avoidance and lower in self-directedness. Youth high in externalizing behavior were significantly lower in cooperativeness. No cognitive differences were observed across groups, but youth high in externalizing behavior had more ADHD symptoms and greater impairment in daily life. Findings reveal unique temperament factors associated with comorbid concerns, which may have implications for adapting and personalizing intervention efforts based on these different profiles within adolescents with ADHD.

Can Temperament and Character Traits Be Used in the Diagnostic Differentiation of Children With ADHD?

ABSTRACT

In this study, it was aimed to determine the contributions of temperament and character traits to the diagnosis of attention deficit hyperactivity disorder (ADHD) in children. Thirty-six patients between the ages of 9 and 14 with a diagnosis of combined type ADHD and 39 healthy children were included in the study. The Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version-Turkish Version and the Turgay DSM-IV Disruptive Behavior Disorders Rating Scale parent form were used to assess hyperactivity/impulsivity and inattentiveness, and comorbid disorders. The Junior Temperament and Character Inventory-Revised form was used to evaluate temperament-character traits. The classification-based association rules (CBARs) method was used for finding rules predicting ADHD accurately. Low persistence and self-directedness scores, and higher disorderliness and fatigability subgroup scores were found in the ADHD group. In CBARs, the separation of children with ADHD from healthy controls could be made with 0.83 accuracy, 0.80 sensitivity, and 0.86 specificity. The results of our study support the view that temperament-character traits can help clinical diagnosis of ADHD.

Prenatal exposure to per- and polyfluoroalkyl substances (PFAS) and neurobehavior in US children through 8 years of age: The HOME study

BACKGROUND

Studies of prenatal per- and polyfluoroalkyl substances (PFAS) and attention deficit hyperactivity disorder (ADHD)-related behaviors in children are inconsistent.

OBJECTIVES

To examine associations between maternal serum PFAS concentrations and child behavior in 241 mother-child dyads within the Health Outcomes and Measures of the Environment (HOME) Study.

METHODS

We quantified perfluorooctanoate (PFOA), perfluorooctane sulfonate (PFOS), perfluorohexane sulfonate (PFHxS), and perfluorononanoate (PFNA) in maternal serum collected during pregnancy or at delivery. We evaluated a total of 17 outcomes of child behavior using the Behavioral Assessment System for Children-2 (BASC-2) at 5 and 8 years (n = 240) and ADHD diagnostic symptoms and criteria with the Diagnostic Interview Schedule for Children-Young Child (DISC-YC) at 5 years (n = 190). We used linear mixed models and logistic regression with generalized estimating equations to assess associations between PFAS and continuous or dichotomous "at risk" BASC-2 scores; negative binomial regression to calculate incident rate ratios for counts of ADHD symptoms; and Poisson regression with robust standard errors to calculate relative risks of meeting ADHD diagnostic criteria.

RESULTS

Each ln-unit increase in PFOS, PFHxS, and PFNA was associated with higher BASC-2 scores and increased odds of "at-risk" scores for externalizing behaviors, including hyperactivity (PFOS: odds ratio [OR] 2.7, 95% confidence interval [CI] 1.2, 5.9; PFHxS: OR 2.5, 95% CI 1.5, 4.3; PFNA: OR 3.2, 95% CI 1.3, 8.0). PFHxS was also associated with internalizing problems (OR 2.0, 95% CI 1.1, 3.4) and somatization (OR 2.2, 95% CI 1.2, 4.0). PFOS and PFNA were significantly associated with 50-80% more DISC-YC symptoms and diagnostic criteria related to hyperactive-impulsive type ADHD. Prenatal PFNA was associated with increased risk of any-type ADHD.

CONCLUSIONS

Prenatal PFOS and PFNA were consistently associated with measures related to hyperactive-impulsive type ADHD across two validated assessment instruments. PFHxS was associated with increased problems with both externalizing and internalizing behaviors. No associations were noted between PFOA and child neurobehavior.

Predicting the Adult Clinical and Academic Outcomes in Boys With ADHD: A 7- to 10-Year Follow-Up Study in China

Background: Attention-deficit/hyperactivity disorder (ADHD) often persists into adulthood and causes adverse effects on social functioning. The present study aimed to widely investigate the predictors, particularly childhood intelligence quotient (IQ) and family environment factors, on adult clinical and academic outcomes in boys with ADHD. Methods: A total of 101 boys with ADHD in a Chinese Han ADHD cohort were followed up 7-10 years later. Baseline ADHD symptoms were evaluated using the parent version of the ADHD Rating Scale-IV (ADHD-RS-IV) and the Chinese version of the Conners' Parent Rating Scale-Revised (CPRS-48). The intelligence of the child was tested by the China-Wechsler Intelligence Scale for Children (C-WISC), and family function was assessed by the Family Environment Scale-Chinese Edition (FES-CV). Adult ADHD persistence was defined using DSM-IV criteria for ADHD, and academic outcome fell into two categories: higher academic level group (studying in senior middle school or above) and lower academic level group (studying in vocational secondary schools or below). Results: Stepwise multiple logistic regression analysis revealed that the father's character, impulsive-hyperactive index as measured by the CPRS-48, and intellectual-cultural index as measured by the FES-CV independently predicted clinical outcomes in adults, with an AUC of 0.770 (p < 0.001, 95% CI = 0.678-0.863). The corresponding sensitivity and specificity were 0.743 and 0.727, respectively. The father's education level, family economic level, and verbal IQ (VIQ) on the C-WISC independently predicted adult academic outcomes, with an AUC of 0.870 (p < 0.001, 95% CI = 0.796-0.944). The corresponding sensitivity and specificity were 0.813 and 0.783, respectively. Conclusion: Initial ADHD symptom severity and IQ, father's character and education level, and family atmosphere and function affect adult clinical and academic outcomes. Addressing these areas early may help to improve the prognosis of ADHD into adulthood.

The Associations Between Sleep and Externalizing and Internalizing Problems in Children and Adolescents with Attention-Deficit/Hyperactivity Disorder: Empirical Findings, Clinical Implications, and Future Research Directions

Sleep problems are common in youth with attention-deficit/hyperactivity disorder (ADHD). Externalizing and internalizing problems contribute to dysfunction in youth with ADHD and are amplified by disrupted sleep. This objective of this article is to synthesize empirical studies that examined the associations between sleep and internalizing or externalizing problems in individuals with ADHD. The main findings are that sleep problems precede, predict, and significantly contribute to the manifestation of internalizing and externalizing behavior problems among children and adolescents with ADHD. Clinicians should assess sleep and integrate sleep interventions into the management of youth with ADHD.