Factor Structure of the Teacher Strengths and Difficulties Questionnaire in a Large Community-Based Sample: An Investigation of Alternative Measurement Models

The Strengths and Difficulties Questionnaire (SDQ) is a screening measure commonly used to assess behavioral and emotional symptoms and strengths among children and adolescents. However, despite its frequent use, its underlying factor structure remains an important area of inquiry. Whereas the original five-factor structure has often been supported through exploratory factor analysis, results from confirmatory analyses continue to yield mixed results. We analyzed data from youth in Grades K through 12 from a large epidemiologic study in the Southeastern United States. Teacher-report SDQ data were used to test three confirmatory factor models by school level (i.e., elementary [Grades K-5] and secondary [Grades 6-12]): The original five-factor model, a three-factor model, and a bifactor model. Model fit indices and reliability measures supported the original five-factor model as the preferred model when using the teacher-reported SDQ with both elementary and secondary school children. Implications for using the SDQ in applied research and predictive modeling are discussed.

Predictors of Autism Spectrum Disorder and ADHD: Results from the National Survey of Children's Health

BACKGROUND

Autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) are two of the most common neurodevelopmental disorders with comorbidity rates of up to 70%. Population-based studies show differential rates of ADHD and ASD diagnosis based on sociodemographic variables. However, no studies to date have examined the role of sociodemographic factors on the likelihood of receiving an ADHD, ASD, or comorbid ASD + ADHD diagnosis in a large, nationally representative sample.

OBJECTIVE

This study aims to examine the impact of sociodemographic factors on the odds of experiencing ASD-only, ADHD-only, or both diagnoses for children in the United States.

METHODS

Using a mixed effects multinomial logistic modeling approach and data from the 2016-2018 National Survey of Children's Health, we estimated the association between sociodemographic variables and the log odds of being in each diagnostic group.

RESULTS

Sociodemographic variables were differentially related to the three diagnostic groups: ASD-only, ADHD-only, and ASD + ADHD. Compared to girls, boys experienced higher odds of all three diagnosis categories. White children had higher odds of having an ADHD-only or ASD + ADHD diagnosis compared to non-Hispanic (NH) Black, NH multiple/other race, and Hispanic children. Odds ratios for levels of parent education, household income, and birth characteristics showed varying trends across diagnostic groups.

CONCLUSIONS

Overall, our findings point to unique sets of risk factors differentially associated ASD and ADHD, with lower income standing out as an important factor associated with receiving a diagnosis of ASD + ADHD.

A Scoping Review of Factors Associated With Emotional Dysregulation in Adults With ADHD

OBJECTIVE

Emotion dysregulation is frequently seen in adults with ADHD and is associated with many adverse outcomes. We conducted a scoping review of factors associated with emotion dysregulation in adults with ADHD.

METHOD

PubMed and PsycInfo (EBSCO) were searched. Articles were included if they measured ADHD, emotional dysregulation or some aspect of emotional dysregulation, and at least one other construct. Studies examining physiological underpinnings as well as clinical trials examining the effect of ADHD medications on emotional dysregulation were excluded because recent reviews have already examined these topics.

RESULTS

Thirty-five studies were included in the review. Factors such as biological sex, comorbidities, attachment style, using certain emotional regulation strategies, and ADHD subtype tend to be related to emotion dysregulation.

CONCLUSION

Clinicians working with adults with ADHD can collect information on these factors to better understand risk for emotion dysregulation, and emotion regulation skills may be one area for intervention.

Feasibility and preliminary efficacy of structured programming and a parent intervention to mitigate accelerated summer BMI gain: a pilot study

BACKGROUND

This study assessed the initial feasibility and preliminary efficacy of providing children a free summer day camp and a parent intervention to improve self-regulation and mitigate accelerated summer BMI gain.

METHODS

This pilot 2x2 factorial randomized control trial used a mixed-methods design to evaluate providing children a free summer day camp (SCV), a parent intervention (PI), and the combination of these two strategies (SCV+PI) to mitigate accelerated summer body mass index (BMI) gain. Progression criteria for feasibility and efficacy were assessed to determine if a full-scale trial was warranted. Feasibility criteria included recruitment capability (≥80 participants recruited) retention (≥70% participants retained), compliance (≥80% of participants attending the summer program with children attending ≥60% of program days, and ≥80% of participants completing goal setting calls with ≥60% of weeks syncing their child's Fitbit), and treatment fidelity (≥80% of summer program days delivered for ≥9 h/day, and ≥80% of participant texts delivered). Efficacy criteria were assessed via achieving a clinically meaningful impact on zBMI (i.e., ≥0.15). Changes in BMI were estimated using intent-to-treat and post hoc dose-response analyses via multilevel mixed-effects regressions.

RESULTS

For recruitment, capability and retention progression criteria were met with a total of 89 families participating and 24 participants randomized to the PI group, 21 randomized to the SCV group, 23 randomized to the SCV+PI group, and 21 randomized to the control. However, fidelity and compliance progression criteria were not achieved due to COVID-19 and lack of transportation. Progression criteria for efficacy was also not achieved as intent-to-treat analyses did not show changes in BMI gain that were clinically meaningful. Post hoc dose-response analyses showed that for each day (0 to 29) of summer programming children attended they gained -0.009 (95CI= -0.018, -0.001) less in BMI z score.

CONCLUSIONS

Engagement in both the SCV and PI was not ideal due to COVID-19 and lack of transportation. Providing children with structured summer programming to mitigate accelerated summer BMI gain may be an effective strategy. However, because feasibility and efficacy progression criteria were not met, a larger trial is not warranted until further pilot work is completed to ensure children attend the programming.

TRIAL REGISTRATION

The trial reported herein was prospectively registered at ClinicalTrials.gov. Trial #: NCT04608188.

County-Level Prevalence Estimates of Autism Spectrum Disorder in Children in the United States

Prevalence estimates of autism spectrum disorder (ASD) point to geographic and socioeconomic disparities in identification and diagnosis. Estimating national prevalence rates can limit understanding of local disparities, especially in rural areas where disproportionately higher rates of poverty and decreased healthcare access exist. Using a small area estimation approach from the 2016-2018 National Survey of Children's Health (N = 70,913), we identified geographic differences in ASD prevalence, ranging from 4.38% in the Mid-Atlantic to 2.71% in the West South-Central region. Cluster analyses revealed "hot spots" in parts of the Southeast, East coast, and Northeast. This geographic clustering of prevalence estimates suggests that local or state-level differences in policies, service accessibility, and sociodemographics may play an important role in identification and diagnosis of ASD.County-Level Prevalence Estimates of Autism Spectrum Disorder in Children in the United States.

County-level prevalence estimates of ADHD in children in the United States

PURPOSE

Attention-deficit/hyperactivity disorder (ADHD) is a common childhood disorder often characterized by long-term impairments in family, academic, and social settings. Measuring the prevalence of ADHD is important as treatment options increase around the U.S. Prevalence data helps inform decisions by care providers, policymakers, and public health officials about allocating resources for ADHD. In addition, measuring geographic variation in prevalence estimates can facilitate hypothesis generation for future analytic work. Most U.S. studies of ADHD prevalence among children focus on national or demographic group rates.

METHODS

Using a small area estimation approach and data from the 2016 to 2018 National Survey of Children's Health, we estimated childhood ADHD prevalence estimates at the census regional division, state, and county levels. The sample included approximately 70,000 children aged 5-17 years.

RESULTS

The national ADHD rate was estimated to be 12.9% (95% Confidence Interval: 11.5%, 14.4%). Counties in the West South Central, East South Central, New England, and South Atlantic divisions had higher estimated rates of childhood ADHD (55.1%, 53.6%, 49.3%, and 46.2% of the counties had rates of 16% or greater, respectively) compared to counties in the Mountain, Mid Atlantic, West North Central, Pacific, and East North Central divisions (2.1%, 4%, 5.8%, 6.9%, and 11.7% of the counties had rates of 16% or greater, respectively).

CONCLUSIONS

These local-level rates are useful for decision-makers to target programs and direct sufficient ADHD resources based on communities' needs.

Household Food Insecurity and Fear of Hypoglycemia in Adolescents and Young Adults With Diabetes and Parents of Youth With Diabetes

OBJECTIVE

To evaluate the relation between household food insecurity (HFI) and fear of hypoglycemia among young adults with type 1 and type 2 diabetes and adolescents with type 1 diabetes and their parents.

RESEARCH DESIGN AND METHODS

We analyzed cross-sectional data of 1,676 young adults with youth-onset diabetes (84% type 1, 16% type 2) and 568 adolescents (<18 years old; mean age 15.1 years) with type 1 diabetes from the SEARCH for Diabetes in Youth study. Adult participants and parents of adolescent participants completed the U.S. Household Food Security Survey Module. Adults, adolescents, and parents of adolescents completed the Hypoglycemia Fear Survey, where answers range from 1 to 4. The outcomes were mean score for fear of hypoglycemia and the behavior and worry subscale scores. Linear regression models identified associations between HFI and fear of hypoglycemia scores.

RESULTS

Adults with type 1 diabetes experiencing HFI had higher fear of hypoglycemia scores (0.22 units higher for behavior, 0.55 units for worry, 0.40 units for total; all P < 0.0001) than those without HFI. No differences by HFI status were found for adolescents with type 1 diabetes. Parents of adolescents reporting HFI had a 0.18 unit higher worry score than those not reporting HFI (P < 0.05). Adults with type 2 diabetes experiencing HFI had higher fear of hypoglycemia scores (0.19 units higher for behavior, 0.35 units for worry, 0.28 units for total; all P < 0.05) than those in food secure households.

CONCLUSIONS

Screening for HFI and fear of hypoglycemia among people with diabetes can help providers tailor diabetes education for those who have HFI and therefore fear hypoglycemia.

The Utility of the Behavior Assessment System for Children-2 Behavioral and Emotional Screening System and Strengths and Difficulties Questionnaire in Predicting Mental Disorders in the Project to Learn About Youth-Mental Health

We examined the predictive utility of the Behavior Assessment System for Children-2 Behavioral and Emotional Screening System (BASC-2-BESS) and Strengths and Difficulties Questionnaire (SDQ) in identifying students with a mental disorder. Data were collected in a two-stage study over 34 months with kindergarten-12th grade (K-12) students (aged 5-19 years) in four U.S. school districts. In Stage 1, teachers completed the BASC-2-BESS and the SDQ. In Stage 2, parents of 1,054 children completed a structured diagnostic interview to determine presence of a mental disorder. Results suggest that teacher versions of the BASC-2-BESS and SDQ have modest utility in identifying children meeting criteria for a mental disorder based on parent report. Area Under the Curve (AUC) statistics representing prediction of any externalizing disorder (.73 for both measures) were higher than the AUCs predicting any internalizing disorder (.58 for both measures). Findings can inform the use of teacher report in mental health screening, specifically the selection of measures when implementing screening procedures.

Surveillance of ADHD Among Children in the United States: Validity and Reliability of Parent Report of Provider Diagnosis

OBJECTIVE

To evaluate the appropriateness of parent-reported diagnosis of ADHD as a surveillance tool.

METHOD

We assessed agreement over time and concordance of parent-reported diagnosis against Diagnostic and Statistical Manual (DSM)-based criteria. We compared concordance of diagnosis and DSM-based criteria by child characteristics, including treatment.

RESULTS

Among parents who reported their child had ADHD, 95.7% reported it again 2 years later. Comparing diagnosis with DSM-based criteria, specificity and negative predictive value were high, sensitivity was moderate, and positive predictive value was low. Most children with an ADHD diagnosis who did not meet DSM-based criteria met sub-threshold criteria or took medication for ADHD. Concordance differed by child characteristics and treatment.

CONCLUSION

Parent-reported diagnosed ADHD is reliable over time. Although differences in parent-reported diagnosis and DSM-based criteria were noted, these may reflect children with milder symptoms or treated ADHD. Parent-report of child ADHD ever diagnosis may be a good single-item indicator for prevalence.

Stability of mental disorder prevalence estimates among school-aged children and adolescents: findings from the community-based project to learn about youth-mental health (PLAY-MH) and replication-PLAY-MH (Re-PLAY-MH), 2014-2017

PURPOSE

This study evaluated the stability over time of prevalence estimates of mental disorders among school-aged children from the same community.

METHODS

We compared screening status and weighted prevalence of selected mental disorders from the two-stage school-based South Carolina Project to Learn About Youth-Mental Health (Time 1) and its replication study (Time 2) conducted between 2014 and 2017. During stage 1, two teacher screeners were used to group students into high or low risk for a mental disorder. During stage 2, parents of selected students completed a structured diagnostic interview to assess whether their child met criteria for specific disorders.

RESULTS

For stage 1, 19.9% of students screened as high risk for a mental disorder at Time 2 compared to 17.8% at Time 1. Among students included at both timepoints, 9.1% screened as high risk at both timepoints while screening status changed for 20.7%. The overall prevalence of included mental disorders was approximately 18% at both time points There were no differences (P-values >.05) in prevalence of individual mental disorders between Time 1 (range:0.3%-6.7%) and Time 2 (range:1.2%-7.7%).

CONCLUSIONS

Study findings demonstrate that similar methodology yielded similar prevalence estimates of mental disorders and can inform community-level planning for improving mental health in children.

Feasibility &amp; Preliminary Efficacy of Structured Programming and a Parent Intervention to Mitigate Accelerated Summer BMI Gain: A pilot study

BackgroundThis study assessed initial feasibility and preliminary efficacy of providing children a free summer day camp and a parent intervention to improve self-regulation and mitigate accelerated summer BMI gain.MethodsThis pilot 2x2 factorial randomized control trial used a mixed methods design to evaluate providing children a free summer day camp (SCV), a parent intervention (PI), and the combination of these two strategies (SCV + PI) to mitigate accelerated summer body mass index (BMI) gain. Feasibility (i.e., recruitment capability, retention, compliance, treatment fidelity, acceptability) was examined using means, standard deviations, and percentages for relevant variables. Changes in BMI were estimated using intent-to-treat and post-hoc dose response analyses via multilevel mixed effects regressions.ResultsA total of 89 families participated, with 24 participants randomized to the PI group, 21 randomized to the SCV group, 23 randomized to the SCV + PI group, and 21 randomized to the control. Parents and children found the summer program acceptable but attendance at the summer program and engagement in the PI were low due to COVID-19 and lack of transportation. Intent-to-treat analyses showed no statistically significant difference between groups in summer BMI gain. Post-hoc dose response analyses showed that for each day (0 to 29) of summer programming children attended they gained - 0.009 (95CI= -0.018, -0.001) less in BMI z-score.ConclusionsEngagement in both the SCV and PI was not ideal and was likely due to COVID-19 and lack of transportation. Providing children with structured summer programming to mitigate accelerated summer BMI gain may be an effective strategy. Thus, a larger trial may be warranted, but more work is needed to ensure children attend the programming.Trial registration: The trial reported herein was prospectively registered at clinicaltrials.gov. Trial #:NCT04608188.

Unique considerations in the assessment of ADHD in college students

Evidence-based practice in psychology (EBPP) has long focused on treatment, but evidence-based psychological assessment (EBPA) is also crucial given the important role of accurate and reliable diagnostic practices in treatment planning. In terms of the diagnosis of attention-deficit/hyperactivity disorder (ADHD), EBPA practices are well-established for children, and more recently for adults, but for college students in particular there are special considerations that warrant attention. College students with symptoms of ADHD have some challenges that are unique, and thus the assessment and diagnosis of ADHD in these students is unique. The aim of this review is not to cover all EBPA strategies for diagnosing ADHD in emerging adult college students; rather, we will focus on the unique considerations at play in college ADHD assessment. These include (a) conceptual matters such as the appropriateness of the DSM-5 criteria for college students, the limitations of our understanding of ADHD this population because of a lack of diversity in research studies, and the issue of late-identified ADHD; and (b) practical matters, such as specific documentation needs, how to gather and interpret self- and other-report of symptoms, how to assess impairment, and alternate explanations for ADHD-like symptoms in college students.

Community-Based Prevalence of Externalizing and Internalizing Disorders among School-Aged Children and Adolescents in Four Geographically Dispersed School Districts in the United States

The Project to Learn About Youth-Mental Health (PLAY-MH; 2014-2018) is a school-based, two-stage study designed to estimate the prevalence of selected mental disorders among K-12 students in four U.S.-based sites (Colorado, Florida, Ohio, and South Carolina). In Stage 1, teachers completed validated screeners to determine student risk status for externalizing or internalizing problems or tics; the percentage of students identified as being at high risk ranged from 17.8% to 34.4%. In Stage 2, parents completed a structured diagnostic interview to determine whether their child met criteria for fourteen externalizing or internalizing disorders; weighted prevalence estimates of meeting criteria for any disorder were similar in three sites (14.8%-17.8%) and higher in Ohio (33.3%). PLAY-MH produced point-in-time estimates of mental disorders in K-12 students, which may be used to supplement estimates from other modes of mental disorder surveillance and inform mental health screening and healthcare and educational services.

Revisiting the Effect of Varying the Number of Response Alternatives in Clinical Assessment: Evidence From Measuring ADHD Symptoms

This study illustrated the effect of varying the number of response alternatives in clinical assessment using a within-participant, repeated-measures approach. Participants reported the presence of current attention-deficit/hyperactivity disorder symptoms using both a binary and a polytomous (4-point) rating scale across two counterbalanced administrations of the Current Symptoms Scale (CSS). Psychometric properties of the CSS were examined using (a) self-reported binary, (b) self-reported 4-point ratings obtained from each administration of the CSS, and (c) artificially dichotomized responses derived from observed 4-point ratings. Under the same ordinal factor analysis model, results indicated that the number of response alternatives affected item parameter estimates, standard errors, goodness of fit indices, individuals' test scores, and reliability of the test scores. With fewer response alternatives, the precision of the measurement decreased, and the power of using the goodness-of-fit indices to detect model misfit decreased. These findings add to recent research advocating for the inclusion of a large number of response alternatives in the development of clinical assessments and further suggest that researchers should be cautious about reducing the number of response categories in data analysis.

The Factor Structure and Gender Invariance of ADHD Symptoms in College Students

Previous studies examining the factor structure of attention-deficit/hyperactivity disorder (ADHD) symptoms in adults using self-report measures have shown mixed results, supporting two-, three-, and bifactor solutions. The current study further investigated the structure of ADHD symptoms in adults using the Current Symptoms Scale and rigorous model evaluation in a sample of 892 college students. Confirmatory factor analysis was used to analyze and compare five-factor structures; a single-factor model, a two-factor model, a three-factor model, and two bifactor models. A single-factor model with correlated residuals best fit the data. Factor correlations with nearly all related constructs (i.e., symptoms of oppositional defiant disorder, depression, impairment, previous ADHD diagnosis, grades, and substance use) were significant in the expected directions and the model was invariant across gender. These findings contribute to a growing body of work suggesting a unidimensional factor may best represent ADHD symptoms in adults. Implications are discussed.

Is ADHD, independent of ODD, associated with whether and why college students misuse stimulant medication?

Although previous research suggests that undergraduates with untreated or undertreated attention-deficit/hyperactivity disorder (ADHD) symptoms may have academic motives for stimulant medication misuse, no previous work has examined the relation of ADHD symptoms, controlling for comorbid oppositional defiant disorder (ODD), to misuse, or has explored how these symptoms are differentially related to motives for misuse. Among a sample of 900 students from one public university, the current study first tested whether increased ADHD symptomology (using the Current Symptoms Scale, CSS) was associated with an increased likelihood of misusing stimulant medication, controlling for comorbid ODD. We then examined whether those with increased ADHD symptomology were more likely to report academic motives for misuse. The prevalence rate of misuse in the past year was 22%. Participants who met symptom count criteria for ADHD (controlling for comorbid ODD) were 2.90 times more likely to misuse stimulant medication than those who did not. Among misusers, those who met ADHD criteria were also 2.80 times more likely to report academic motives for misuse. These results support that stimulant medication misuse is likely driven, in part, by inadequate or absent care for the executive functioning impairments associated with ADHD. Therefore, a greater focus on assessment and treatment of college students with ADHD symptoms is warranted. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Forming first impressions of children: the role of attention-deficit/hyperactivity disorder symptoms and emotion dysregulation

BACKGROUND

Previous research on peer status of children with attention-deficit/hyperactivity disorder (ADHD) has focused on already-established peer groups, rendering the specific social behaviors that influence peers' initial impressions largely unknown. Recently, theorists have argued that emotion dysregulation is a key aspect of ADHD, with empirical work finding relations between emotion dysregulation and social outcomes. Therefore, the current study focuses on the initial interactions among children varying in ADHD symptoms duringh a novel playgroup, proposing that emotion dysregulation displayed during the playgroup may serve as a possible pathway between ADHD symptoms and peers' initial negative impressions.

METHODS

Participants were 233 elementary-age children ranging from 8 to 10 years old (M = 8.83, 70% male). Parents and teachers rated children's ADHD symptoms and related impairment; 51% of the children met criteria for an ADHD diagnosis. Then, children participated with unfamiliar peers in a three-hour playgroup that included three structured and two unstructured tasks. After the tasks, children and staff rated each child on social outcomes. Coders unaware of child's diagnostic status watched videos of the groups and rated each child's global emotion dysregulation during each task.

RESULTS

Using multiple raters and methods, ADHD severity was associated with more negative peer ratings, through observed emotion dysregulation. Results were consistent for both parent and teacher ratings of ADHD severity as well as for both peer ratings of likeability and staff ratings of perceived peer likeability.

CONCLUSIONS

When focusing on improving peers' initial impressions of children with ADHD symptoms, emotion dysregulation may be a valuable target for intervention.

The Role of Body Image in the Link Between ADHD and Depression Symptoms Among College Students

OBJECTIVE

Given the link between negative body image and depression symptoms, body image may affect the association between ADHD and depression symptoms. We evaluated the degree to which a variety of body image constructs mediated the association between ADHD and depression symptoms.

METHOD

Participants were undergraduate psychology students ( N = 627, age: M = 20.23, SD = 1.40, 60% female, 47% European American) who completed an online assessment.

RESULTS

Results indicated that ADHD symptoms were indirectly associated with increased depression symptoms, and that negative evaluation of physical appearance, overweight preoccupation, and body dissatisfaction mediated the association between ADHD and depression symptoms. ADHD symptoms were also directly associated with increased depression symptoms.

CONCLUSION

Body image appears to play a role in the association between ADHD and depression symptoms for college students. Implications for future research and clinical practice are discussed.

Symptoms of Depression and ADHD in Relation to Stimulant Medication Misuse Among College Students

BACKGROUND

The misuse of stimulant medications, commonly used for the treatment of attention-deficit/hyperactivity disorder (ADHD), is a concern on college campuses.

OBJECTIVE

This study sought to examine the relations between the misuse of stimulant medications and symptoms of depression and ADHD.

METHOD

Eight hundred and ninety students ages 18-26 from one public university took a web-based survey including rating scales measuring symptoms of depression and ADHD.

RESULTS

The prevalence rate of misuse in the past year was 23%. Symptoms of depression were significantly related to misuse; however, once symptoms of ADHD were included in the analysis, depression was no longer a significant predictor. Further, there was not a significant interaction between ADHD and depression, but symptoms of ADHD were significantly related to misuse. Conclusions/Importance: Results suggest that attention difficulties may be one of the most important factors in predicting stimulant medication misuse. Therefore, prevention efforts to reduce the misuse of stimulant medication would be most successful when targeting students with symptoms of inattention.

The emergence and stability of attention deficit hyperactivity disorder in boys with fragile X syndrome

BACKGROUND

Children with fragile X syndrome (FXS) are at high risk for developing a range of behavioural disorders, including attention deficit/hyperactivity disorder (ADHD) and autism spectrum disorders (ASD). However, very few studies have investigated the comorbid profile of FXS and ADHD and the possible dissociation from the FXS and ASD profile. The present study examined the relationship of childhood temperament characteristics of the Surgency facet (activity level, impulsivity, approach, shyness, and smiling and laughter) and the severity of ADHD and ASD features at two measurement time points in childhood, preschool (ages 3-4) and at school entry (ages 5-6).

METHODS

The study consisted of males with FXS measured at each time point (preschool and school entry), as well as comparison of typically developing (TD) boys at the preschool measurement time point. Parent reported measures of temperament and behavioural symptoms were collected at each time point. Multiple regression analyses were used to analyse obtained data.

RESULTS

Elevated activity level scores are associated with ADHD scores at preschool age and elevated shyness and decreased smiling and laughter are strongly associated with ADHD scores upon school entry. Impulsivity emerges as a strong indicator of elevated ADHD scores around school age, but even preschool impulsivity scores demonstrate some predictive value for higher ADHD scores later in school. Finally, no Surgency characteristic was significantly related to ASD scores at any age.

CONCLUSIONS

Impulsivity serves as an indicator of elevated ADHD symptoms across development periods in boys with FXS, while activity level is just indicative of higher ADHD scores at the preschool age. The Surgency facet of temperament at either age does not predict strong relationships of comorbid pathologies of ADHD and ASD in FXS. However, Surgency characteristics may serve as informative discriminative factors when studying behavioural outcomes in boys with FXS.

ADHD and Suicidal Ideation: The Roles of Emotion Regulation and Depressive Symptoms Among College Students

OBJECTIVE

ADHD appears to increase risk for both depression and suicidal ideation, while ADHD and depression are also associated with emotion regulation deficits. Thus, we evaluated the degree to which depression mediated the association between ADHD and suicidal ideation, as well as the degree to which emotion regulation deficits moderated the association ADHD shared with depression and suicidal ideation in a nonclinical sample.

METHOD

Participants were undergraduate psychology students (N = 627; age: M = 20.23, SD = 1.40; 60% female; 47% European American) who completed an online assessment.

RESULTS

Results indicated that ADHD indirectly increased suicidal ideation through depression. Emotion regulation deficits of accepting negative emotions, emotional awareness, and goal-oriented behavior moderated the indirect effect of ADHD on suicidal ideation.

CONCLUSION

Depression appears to play an important mediating role in suicidal ideation for college students with ADHD, and specific emotion regulation deficits appear to amplify the effects of ADHD on depression and suicidal ideation.

Disruptive Behavior Disorders and Marijuana Use: The Role of Depressive Symptoms

OBJECTIVE

The present study sought to examine the relations among disruptive behavior disorders (DBDs; ie, attention-deficit/hyperactivity disorder [ADHD], conduct disorder [CD], oppositional defiant disorder [ODD]), depressive symptoms, and marijuana use among a sample of late adolescents and emerging adults.

METHOD

A total of 900 students (75.8% female, 80.3% Caucasian, M_age = 20) from a large public university completed an online survey.

RESULTS

Findings indicated that depressive symptoms mediated the relation between the marijuana use and past symptoms of ADHD, past diagnosis of ADHD, CD symptoms, CD diagnosis, and ODD diagnosis.

CONCLUSION

Depressive symptoms represent a link between DBDs and marijuana use that is suggested, but not well documented in the existing literature. The current findings add to this evidence and suggest a need to assess individuals presenting with symptoms of DBDs for depressive symptoms, as this symptom pattern may result in a greater likelihood of marijuana use.

Abstract PD01-07: High throughput sequencing following cross-linked immune-precipitation (HITS-CLIP) of Argonaute protein reveals novel miRNA regulatory pathways of Estrogen Receptor in breast cancer

Micro RNAs (miRNAs) are a class of small non-coding RNAs with well-known regulatory roles in normal physiological processes and cancer. Conventionally their study has been based on defining single miRNA-mRNA target interactions using a combination of miRNA expression arrays and bioinformatic predictions of binding to the 3′ untranslated regions of genes, followed by miRNA over-expression in the relevant cell type. These approaches present circumstantial evidence for binding of a particular miRNA to its target but do not allow the study of global interactions nor provide direct evidence of binding. In order to study the genome wide impact of miRNA regulation in breast cancer we chose to use a recently described biochemical technique called Cross-Linked Immune-Precipitation of Argonaute (AGO) protein followed by high throughput sequencing (HITS-CLIP). Cross-linking of RNA to adjacent protein moieties by ultraviolet (UV) light allows for stringent isolation of the miRNA-mRNA-AGO complexes by immune precipitation (IP); miRNA-mRNA interaction within the RNA-induced silencing complex (RISC) is known to occur within the folds of AGO. The isolated miRNA-mRNA-AGO complexes are then analyzed with next generation sequencing (NGS) to determine the miRNA-mRNA interactome. We performed HITS-CLIP on three well characterized breast cancer cell lines that represent ER+, Her2+ and triple negative (TN) disease (MCF7, BT474 and MDA231). To determine the role of miRNAs in coordinating the response to the estrogen receptor axis, MCF7 and BT474 cells were analyzed with or without short term (24 hour) estrogen treatment.

Analysis of sequencing data revealed several novel miRNA-mRNA interactions that target the ER pathway. For example, miR-9 directly regulates ER expression and miR-193a is involved in regulating expression of the ER co-activator NCOA3. We confirmed the biological relevance of these results using functional in vitro studies where manipulation of both miR-193a and miR-9 altered the responsiveness of breast cancer cells to tamoxifen. These results were further validated by quantitation of both transcript (RT-PCR) and protein (Western Blot) levels after transfection of miRNA precursors. Functional binding between these miRNAs and putative binding targets in the 3′ Untranslated Regions (3′ UTRs) were also validated by luciferase-based reporter assays. Finally, we performed global analysis of miRNAs and their targets (as predicted by the HITS-CLIP datasets across all cell lines); this predicted regulation of core cellular processes such as cell proliferation, DNA repair and metabolism as being targeted by highly abundant miRNAs such as miR-27a and miR-21. In addition, our datasets confirmed previous reports of miRNA regulation of ER pathway such as miR-221 regulation of ER itself and miR-34a regulation of Myc. In summary, genome-wide biochemical approaches like HITS-CLIP allow for defining novel and clinically relevant miRNA-based regulatory pathways of endocrine responsiveness and resistance in breast cancer. In addition, breast cancer subtype specific biological pathways targeted by individual miRNAs can be predicted by this approach.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr PD01-07.

Appetitive motivation and negative emotion reactivity among remitted depressed youth

Depression has been characterized as involving altered appetitive motivation and emotional reactivity. Yet no study has examined objective indices of emotional reactivity when the appetitive/approach system is suppressed in response to failure to attain a self-relevant goal and desired reward. Three groups of youth (N = 98, ages 9-15; remitted depressed, n = 34; externalizing disordered without depression, n = 30; and healthy controls, n = 34) participated in a novel reward striving task designed to activate the appetitive/approach motivation system. Objective facial expressions of emotion were videotaped and coded throughout both failure (i.e., nonreward) and control (success and reward) conditions. Observational coding of facial expressions as well as youths' subjective emotion reports showed that the remitted depressed youth specifically exhibited more negative emotional reactivity to failure in the reward striving task, but not the control condition. Neither externalizing disordered (i.e., attention deficit hyperactivity disorder, conduct disorder, and/or oppositional defiant disorder) nor control youth displayed greater negative emotional reactivity in either the failure or control condition. Findings suggest that depression among youth is related to dysregulated appetitive motivation and associated negative emotional reactivity after failing to achieve an important, self-relevant goal and not attaining reward. These deficits in reward processing appear to be specific to depression as externalizing disordered youth did not display negative emotional reactivity to failure after their appetitive motivation system was activated.

Symptoms of ADHD and close friendships in adolescence

OBJECTIVE

This study examined the relationship of ADHD symptoms to different aspects of close friendship quality as rated by both adolescents (target adolescent and a close friend) within a friendship dyad.

METHOD

Participants were 41 same-sex friendship dyads who completed questionnaires about their friendship. Separate symptom dimensions of ADHD (inattention and hyperactivity-impulsivity) were examined. Teacher and parent ratings of social functioning were also used.

RESULTS

Symptoms of inattention, hyperactivity-impulsivity, and overall ADHD were positively related to target-reported friendship quality, and symptoms of inattention and total ADHD were positively associated with friend-reported friendship quality. Potential explanations for these surprising findings were explored.

CONCLUSION

Results suggest that the close friendships of adolescents with symptoms of ADHD may be distinct from the peer rejection commonly faced by this population and that adolescents with symptoms of ADHD may have at least one close, positive friendship. Treatment implications and future research directions are discussed.

Childhood ADHD symptoms and risk for cigarette smoking during adolescence: School adjustment as a potential mediator

Although a large body of research suggests that children with attention-deficit/hyperactivity disorder (ADHD) are at increased risk for cigarette smoking during adolescence compared with their non-ADHD peers, much less research has examined why. The current study addressed this gap in the literature by examining middle school adjustment, broadly defined, as a possible mediator of the relation between childhood ADHD symptoms and cigarette smoking during middle adolescence (10th grade). Longitudinal data were collected from a community sample of 754 youth using self-report and parent report along with school records, and a novel statistical technique was used in the process of testing for mediation. Consistent with hypotheses, school adjustment was found to mediate the relation between childhood ADHD symptoms and later cigarette smoking, even after controlling for early externalizing problems. Results have implications for etiological theories of adolescent deviant behavior and suggest that successful smoking prevention programs targeting youth with ADHD should include a school adjustment component.

Are symptoms of ADHD related to substance use among college students?

Attention-deficit/hyperactivity disorder (ADHD) is a common childhood disorder that often persists into adolescence and adulthood and has been associated with an increased risk for substance use. Due to improved treatment and educational policies, more students with high levels of ADHD symptoms are attending college despite continued ADHD symptoms. Little research has examined whether college students with higher levels of ADHD symptoms are at increased risk for heavy substance use compared to college students with few ADHD symptoms. The current study examined the relation of ADHD symptoms to substance use (e.g., cigarette smoking, alcohol use, marijuana use, and cocaine use). We hypothesized that greater ADHD symptomatology (inattentive, hyperactive/impulsive, and total ADHD) would be related to higher rates of cigarette smoking, alcohol use, alcohol-problems, and illicit drug use. Participants were 889 college undergraduates who completed an online survey. Results suggest that ADHD symptoms, particularly inattentive symptoms, were positively associated with cigarette smoking and problems associated with alcohol after controlling for conduct disorder (CD) symptoms. ADHD symptoms were not significantly associated with alcohol use or illicit drug use after the effects of CD symptoms were accounted for. Results have important implications for prevention and treatment of college student substance use. Limitations and future directions are discussed.

A mixture-model approach to linking ADHD to adolescent onset of illicit drug use

Prior research findings have been mixed as to whether attention-deficit/hyperactivity disorder (ADHD) is related to illicit drug use independent of conduct problems (CP). With the current study, the authors add to this literature by investigating the association between trajectories of ADHD symptoms across childhood and adolescence and onset of illicit drug use, with and without controlling for CP. In a longitudinal panel study of a community sample of 754 girls and boys recruited in kindergarten, this research question was examined with a combination of growth mixture modeling (to model parent-reported ADHD symptom trajectories) and survival analysis (to model youth-reported initiation of illicit drug use). Results revealed a 3-class model of ADHD trajectories, with 1 class exhibiting no or minimal symptoms throughout childhood and adolescence, another class showing a convex shape (an increase, then a decrease in symptoms) across time, and a third class showing a concave shape (a decrease, then a slight increase in symptoms) over time. The concave-trajectory class demonstrated significantly earlier onset of illicit drug use than the minimal-problem class, with the convex-trajectory class falling between (but not significantly different from either of the other two classes). These results did not change when the authors added CP to the model as a covariate. Implications of findings for theory and practice are discussed.

Prospective association of childhood attention-deficit/hyperactivity disorder (ADHD) and substance use and abuse/dependence: a meta-analytic review

Given the clinical and public health significance of substance disorders and the need to identify their early risk factors, we examined the association of childhood attention-deficit/hyperactivity disorder (ADHD) with substance use (nicotine, alcohol, marijuana) and abuse/dependence outcomes (nicotine, alcohol, marijuana, cocaine, other). To strengthen a potential causal inference, we meta-analyzed longitudinal studies that prospectively followed children with and without ADHD into adolescence or adulthood. Children with ADHD were significantly more likely to have ever used nicotine and other substances, but not alcohol. Children with ADHD were also more likely to develop disorders of abuse/dependence for nicotine, alcohol, marijuana, cocaine, and other substances (i.e., unspecified). Sex, age, race, publication year, sample source, and version of the Diagnostic and Statistical Manual of Mental Disorders (DSM) used to diagnose ADHD did not significantly moderate the associations with substance outcomes that yielded heterogeneous effect sizes. These findings suggest that children with ADHD are significantly more likely to develop substance use disorders than children without ADHD and that this increased risk is robust to demographic and methodological differences that varied across the studies. Finally, few studies addressed ADHD and comorbid disruptive behavior disorders (DBD), thus preventing a formal meta-analytic review. However, we qualitatively summarize the results of these studies and conclude that comorbid DBD complicates inferences about the specificity of ADHD effects on substance use outcomes.

The acquired preparedness model of risk for bulimic symptom development

The authors applied person-environment transaction theory to test the acquired preparedness model of eating disorder risk. The model holds that (a) middle-school girls high in the trait of ineffectiveness are differentially prepared to acquire high-risk expectancies for reinforcement from dieting or thinness; (b) those expectancies predict subsequent binge eating and purging; and (c) the influence of the disposition of ineffectiveness on binge eating and purging is mediated by dieting or thinness expectancies. In a three-wave longitudinal study of 394 middle-school girls, the authors found support for the model. Seventh-grade girls' scores on ineffectiveness predicted their subsequent endorsement of high-risk dieting or thinness expectancies, which in turn predicted subsequent increases in binge eating and purging. Statistical tests of mediation supported the hypothesis that the prospective relation between ineffectiveness and binge eating was mediated by dieting or thinness expectancies, as was the prospective relation between ineffectiveness and purging. This application of a basic science theory to eating disorder risk appears fruitful, and the findings suggest the importance of early interventions that address both disposition and learning.

Selective attention to affective stimuli and clinical depression among youths: role of anxiety and specificity of emotion

Cognitive models of psychopathology posit that the content or focus of information-processing biases (e.g., attentional biases) is disorder specific: Depression is hypothesized to be characterized by attentional biases specifically for depression-relevant stimuli (e.g., sad facial expressions), whereas anxiety should relate particularly to attentional biases to threat-relevant stimuli (e.g., angry faces). However, little research has investigated this specificity hypothesis and none with a sample of youths. The present study examined attentional biases to emotional faces (sad, angry, and happy compared with neutral) in groups of pure depressed, pure anxious, comorbid depressed and anxious, and control youths (ages 9-17 years; N = 161). Consistent with cognitive models, pure depressed and pure anxious youths exhibited attentional biases specifically to sad and angry faces, respectively, whereas comorbid youths exhibited attentional biases to both facial expressions. In addition, control youths exhibited attentional avoidance of sad faces, and comorbid boys avoided happy faces. Overall, findings suggest that cognitive biases and processing of particular emotional information are specific to pure clinical depression and anxiety, and results inform etiological models of potentially specific processes that are associated with internalizing disorders among youths.

Investigating the roles of neighborhood environments and housing-based social support in the relocation of persons made homeless by hurricane Katrina

This study examined whether social support tied to relocation efforts and neighborhood social climate may mediate the effects of stressful life events on mental health outcomes following Hurricane Katrina. Participants were 108 adult persons made homeless by Hurricane Katrina and evacuated to Columbia, South Carolina. Civic leaders developed an intervention model that emphasized (a) a one-stop point of entry, (b) living in hotels and apartments rather than shelters, and (c) matching hotels with volunteer "hosts" to assist in relocation efforts. Results revealed that perceived neighborhood factors and satisfaction with host relationship were related to several mental health outcomes. Neighborhood social climate partially mediated several mental health outcomes. Implications of this intervention model and the utility of social ecological perspectives on homelessness interventions are discussed.

The role of personality dispositions to risky behavior in predicting first-year college drinking

AIMS

US college student drinking is associated with enormous risks to health, safety and productivity. Recent advances in personality research that have delineated multiple, separate dispositions to engage in risky behaviors may help to clarify the personality contribution to risk for this problem.

DESIGN

The authors compared the prospective roles of sensation seeking, lack of planning, lack of perseverance, negative urgency and positive urgency (dispositions to engage in rash action when in an unusually negative or positive mood, respectively) in predicting increases in drinking frequency, drinking quantity and negative outcomes from consumption across the first year of college.

SETTING

University of Kentucky campus.

PARTICIPANTS

A total of 418 first-year US college students enrolled in an Introduction to Psychology course during the first assessment; 293 participants completed both phases of the study.

MEASUREMENTS

Participants completed self-report measures of personality and drinking behavior twice during the first year of college [the UPPS-R Impulsive Behavior Scale, positive urgency measure (PUM) and Drinking Styles Questionnaire (DSQ)].

FINDINGS

Whereas sensation seeking related to increases in the frequency with which college students drank alcohol, positive urgency predicted increases in (i) the quantity of alcohol students consumed at any given drinking episode and (ii) negative outcomes experienced from drinking.

CONCLUSIONS

It appears that although sensation seeking is a risk factor for participation in drinking behaviors, risk for increased quantity of consumption and its negative outcomes may be more a function of dyscontrol stemming from high positive mood for college students.

Alcohol and cigarette use and misuse among Hurricane Katrina survivors: psychosocial risk and protective factors

The present study examined survivors' use and misuse of cigarettes and alcohol following Hurricane Katrina. We also examined several psychosocial factors that we expected would be associated with higher or lower rates of substance use following the hurricane. Participants were 209 adult survivors of Hurricane Katrina interviewed in Columbia, SC or New Orleans, LA between October 31, 2005 and May 13, 2006. Results revealed that survivors were smoking cigarettes, consuming alcohol, and experiencing alcohol consumption-related problems at a substantially higher rate than expected based on pre-hurricane prevalence data. Results also suggested that certain psychosocial factors were associated with participants' substance use and misuse following the hurricane.

Feasibility and preliminary efficacy of an after-school program for middle schoolers with ADHD: a randomized trial in a large public middle school

OBJECTIVE

This pilot study tests the feasibility and preliminary efficacy of an after-school treatment program for middle schoolers with ADHD using a randomized clinical trial design.

METHOD

A total of 23 students with ADHD (25% female, 48% African American) from a large public middle school were randomly assigned to a 10-week program or to community comparison. Manualized treatment targeted educational, social, and recreational skills, homework completion, and school and home behavior. Parents participated.

RESULTS

Recruitment and randomization targets were easily met (87% completion). Parent and teacher satisfaction was positive. Small to medium treatment effects resulted despite greater medication use in the control group, with improvements in functioning for the program-treated youth or absence of deterioration relative to the comparison group.

CONCLUSION

Despite testing an abbreviated version of the after-school program (< 5 months), this study reveals feasibility and palatability for this intervention and modest beneficial effects on behavioral and academic outcomes.

Clinical Research After Catastrophic Disasters: Lessons Learned From Hurricane Katrina

When catastrophic disasters such as Hurricane Katrina strike, psychologists and other mental health professionals often wonder how to use resources and fill needed roles. We argue that conducting clinical research in response to disasters is 1 important way that these professionals can contribute. However, we recognize that designing and implementing a clinical research study can be a daunting task, particularly in the context of the personal and system-wide chaos that follows most disasters. Thus, we offer a detailed description of our own experiences with conducting clinical research as part of our response to Hurricane Katrina. We describe our study design, recruitment and data collection efforts, and summarize and synthesize the lessons we have learned from this endeavor. Our hope is that others who may wish to conduct disaster-related research will learn from our mistakes and successes.

Delinquent behavior and emerging substance use in the MTA at 36 months: prevalence, course, and treatment effects

OBJECTIVE

To compare delinquent behavior and early substance use between the children in the Multimodal Treatment Study of Children With ADHD (MTA; N = 487) and those in a local normative comparison group (n = 272) at 24 and 36 months postrandomization and to test whether these outcomes were predicted by the randomly assigned treatments and subsequent self-selected prescribed medications.

METHOD

Most MTA children were 11 to 13 years old by 36 months. Delinquency seriousness was coded ordinally from multiple measures/reporters; child-reported substance use was binary.

RESULTS

Relative to local normative comparison group, MTA children had significantly higher rates of delinquency (e.g., 27.1% vs. 7.4% at 36 months; p = .000) and substance use (e.g., 17.4% vs. 7.8% at 36 months; p = .001). Children randomized to intensive behavior therapy reported less 24-month substance use than other MTA children (p = .02). Random effects ordinal growth models revealed no other effects of initial treatment assignment on delinquency seriousness or substance use. By 24 and 36 months, more days of prescribed medication were associated with more serious delinquency but not substance use.

CONCLUSIONS

Cause-and-effect relationships between medication treatment and delinquency are unclear; the absence of associations between medication treatment and substance use needs to be re-evaluated at older ages. Findings underscore the need for continuous monitoring of these outcomes as children with attention-deficit/hyperactivity disorder enter adolescence.

Thinness and eating expectancies predict subsequent binge-eating and purging behavior among adolescent girls

One's expectancies for reinforcement from eating or from thinness are thought to represent summaries of one's eating-related learning history and to thus influence the development of binge-eating and purging behavior. In a 3-year longitudinal study, the authors tested this hypothesis and the hypothesis that binge eating also influences subsequent expectancy development. The authors used trajectory analysis to identify groups of middle school girls who followed different trajectories of binge eating, purging, eating expectancies, and thinness expectancies. Initial eating and thinness reinforcement expectancies identified girls whose binge eating and purging increased during middle school, and expectancies differentiated girls who began these problem behaviors from girls who did not. Initial binge-eating scores differentiated among eating expectancy developmental trajectories. The onset of most behaviors can be understood in terms of learned expectancies for reinforcement from these behaviors. The same model can be applied to the risk for eating disorders.

Childhood ADHD Predicts Risky Sexual Behavior in Young Adulthood

This study compared young adults (ages 18 to 26) with and without childhood attention deficit hyperactivity disorder (ADHD) on self-reported risky sexual behaviors. Participants were 175 men with childhood ADHD and 111 demographically similar men without ADHD in the Pittsburgh ADHD Longitudinal Study (PALS). Childhood ADHD predicted earlier initiation of sexual activity and intercourse, more sexual partners, more casual sex, and more partner pregnancies. Although childhood conduct problems did contribute significantly to risky sexual behaviors among participants with ADHD, there was also an independent contribution of ADHD, suggesting that the characteristic deficits of the disorder or other associated features may be useful childhood markers of later vulnerability.