Search

• ADHD is a risk factor for depression and requires tailored depression efforts. • Schools represent an optimal environment to reduce the disparity between research evidence and access to care for black adolescents with ADHD in urban areas. • The Behaviorally Enhancing Adolescents' Mood in Schools (BEAMS) program was iteratively developed using stakeholder feedback. • BEAMS was implemented easily by the school mental health provider and resulted in reductions in irritability and emotion regulation as depicted in case study vignettes. Attention-deficit/hyperactivity disorder (ADHD) is a prevalent disorder, particularly among Black youth and youth in urban settings. In addition to well-documented academic and social dysfunction, ADHD is associated with increased risk for depression and suicide. However, there is a stark mismatch between services available and need among adolescents with ADHD, especially those from low-income backgrounds. Implementation of services in schools is one promising way to overcome barriers to care, decrease stigma associated with mental health care, and offer the ability to practice mental health skills in a more natural environment. As such, the current study aims to (a) describe the iterative development of a school-based depression prevention program (i.e., Behaviorally Enhancing Adolescents' Mood in Schools [BEAMS]) for adolescents with ADHD in an underresourced, urban school district using stakeholder feedback; and (b) evaluate the preliminary effectiveness of an open trial of BEAMS. Raw data for all participants (n = 6; 83% Black, 17% biracial; 83% male) with indications for significant Reliable Change Indices are presented in addition to two case vignettes to illustrate treatment components and exemplify participant response. Pre- and posttreatment focus group data are presented to depict the development of the BEAMS program, lessons learned, and modifications made to BEAMS, in preparation for a larger randomized trial. Future directions are discussed. [ABSTRACT FROM AUTHOR]

Despite gaining admission to college, many students with attention-deficit/hyperactivity disorder (ADHD) struggle to achieve academic, social, and occupational success. Additionally, college students with ADHD experience higher rates of problem drinking and comorbid psychology (e.g., depression). This paper describes the development of the Students Understanding College Choices: Encouraging and Executing Decisions for Success (SUCCEEDS) program for college students diagnosed with ADHD who are engaging in problem drinking. SUCCEEDS combines ADHD psychoeducation, behavioral activation, and brief motivational intervention treatment elements to help college students with ADHD achieve healthier and more fulfilling lifestyles. SUCCEEDS aims to decrease problem drinking by increasing substance-free, goal-directed behavior allowing for success in college. The iterative treatment development process, two SUCCEEDS illustrative case examples, and reliable change indices are presented. Preliminary results suggest that SUCCEEDS may be effective in reducing problem drinking and functional impairment in areas relevant to college students (e.g., academics). • SUCCEEDS combines ADHD psychoeducation, BA, and MI treatment elements. • SUCCEEDS was developed with UCC and SHC input to enhance dissemination potential. • Two case examples illustrate the implementation of SUCCEEDS. • Case examples decreased total weekly drinks and impairment in various domains. • Preliminary evidence shows SUCCEEDS beneficial for college students with ADHD. [ABSTRACT FROM AUTHOR]

Preschoolers with attention-deficit/hyperactivity disorder (ADHD) are at increased risk for the development of comorbid conduct disorder (CD) and depression. Early predictors of serious adverse outcomes within this population include parenting characterized by high levels of negativity and low levels of positivity, maternal depression, and child emotion regulation (ER) difficulties. Parent–child interaction therapy (PCIT) is an evidence-based treatment for oppositional defiant disorder and CD that has also been shown to improve comorbid child internalizing symptoms and maternal depression by enhancing parenting and improving the parent–child relationship. PCIT-emotion development (PCIT-ED) is an adaptation for depressed preschoolers, grounded in developmental literature, which teaches parents to become “emotion coaches” for their children, in an effort to build child ER skills. In this paper, we describe the iterative process by which we implemented and adapted PCIT-ED based on our experiences treating nine children with ADHD. We present three case examples that exemplify our process in adapting the PCIT-ED manual. This work suggests that PCIT with parent emotion coaching (PCIT-ECo) may be a promising treatment approach for young children with ADHD. Future research will need to examine this adaptation relative to standard PCIT to determine whether our integration of parent emotion coaching results in added improvement in child ER, internalizing and externalizing problems, and functional impairment. [ABSTRACT FROM AUTHOR]

The article presents a study which predicts the link between behavioral inhibition (BI) and anxiety disorders such as social anxiety disorder (SAD) in later life. Participants in the study include 126 adolescents aged 14 to 16 years who were recruited when they were still four months old and temperaments were measured when they were between the ages of 14 months and 7 years. The findings suggest that stable maternal-reported early BI is significant in identifying and preventing SAD.

Attendees at this presentation have the opportunity to learn about evolving models of delivering behavioral interventions to youth through videoconferencing, telebehavioral health (TBH). Third, Eve-Lynn Nelson, PhD, the Director of the Center for Telemedicine and Telehealth at the University of Kansas Medical Center, presents her work in pediatric health psychology. She reviews several nationally funded TBH health psychology programs, including obesity, diabetes, parenteral nutrition, and palliative care. [Extracted from the article]

ADHD is common in parents of children with ADHD, and little is known about how to select, sequence, or combine treatments in multiplex families in which both a child and a parent have ADHD. Over a 3-year period, 35 dyads consisting of a child aged 3-8 years with ADHD symptoms not yet treated with stimulant medications and a mother with ADHD were first randomized to receive 8 weeks of behavioral parent training (BPT) or individually titrated maternal stimulant medication (MSM). [Extracted from the article]

Objective: To characterize lifetime and current rates of attention-deficit/hyperactivity disorder (ADHD) treatments among US children and adolescents with current ADHD and describe the association of these treatments with demographic and clinical factors.Study Design: Data are from the 2014 National Survey of the Diagnosis and Treatment of ADHD and Tourette Syndrome, a follow-back survey of parents from the 2011-2012 National Survey of Children's Health. Weighted analyses focused on receipt of ADHD treatment among children aged 4-17 years with current ADHD (n = 2495) by 4 treatment types: medication, school supports, psychosocial interventions, and alternative treatments.Results: Medication and school supports were the most common treatments received, with two-thirds of children and adolescents with ADHD currently receiving each treatment. Social skills training was the most common psychosocial treatment ever received (39%), followed by parent training (31%), peer intervention (30%), and cognitive behavioral therapy (20%). Among alternative treatments, 9% were currently taking dietary supplements, and 11% had ever received neurofeedback. Most children (67%) had received at least 2 of the following: current medication treatment, current school supports, or lifetime psychosocial treatment; 7% had received none of these 3 treatment types.Conclusions: A majority of school-aged children and adolescents with ADHD received medication treatment and school supports, whereas fewer received recommended psychosocial interventions. Efforts to increase access to psychosocial treatments may help close gaps in service use by groups currently less likely to receive treatment, which is important to ensure that the millions of school-aged US children diagnosed with ADHD receive quality treatment. [ABSTRACT FROM AUTHOR]

Abstract The present study examined the impact of frustration on risk-taking in college students with low and high ADHD symptomatology (L-ADHD and H-ADHD). Participants completed the Balloon Analogue Risk Task (BART) following induced frustration from a mood manipulation task (experimental session) and following no mood manipulation (control session). A manipulation check revealed a significant three-way interaction where the H-ADHD group reported higher frustration levels compared to the L-ADHD group, particularly in response to the frustration induction in the experimental condition. Primary results revealed that the L-ADHD group exploded significantly fewer balloons in the experimental condition compared to the control condition; there was a nonsignificant difference of balloon explosions across conditions for the H-ADHD group. The study provides initial laboratory-based support for the impact of frustration on the risk behavior of those with low and high levels of ADHD, with potential implications for future studies and ultimately for intervention. [ABSTRACT FROM AUTHOR]

An abstract of the article "Sequencing Treatments for Mothers With Attention-Deficit/Hyperactivity Disorder and Their Young Children: A Smart Pilot" by Andrea Chronis-Tuscano is presented.

Objective: Behavioral inhibition (BI) is an infant temperament characterized by heightened reactivity and negative affect in response to novel people and situations. BI is among the earliest and strongest predictors of future anxiety problems. However, not all children with a history of BI will manifest anxiety problems. A growing body of evidence suggests that proactive control skills may help buffer youth with BI from future anxiety difficulties; yet, it remains unclear how temperament may interact with the development of cognitive control to influence anxiety risk. The present study tested whether enhancements in proactive control occurring during adolescence may reduce risk for anxiety among youth with a history of BI.Method: Participants included 185 adolescents (56% female) whose temperament was assessed during toddlerhood. In adolescence, participants completed anxiety assessments and an AX Continuous Performance Test (AX-CPT) to assess cognitive control strategy. Both assessments were administered at age 13 years and again at 15 years.Results: Latent change score modeling revealed that, on average, participants increasingly used proactive control strategies and experienced worsening anxiety from age 13-15 years. Early BI was associated with a smaller anxiety increase from 13-15 years, but only among participants whose proactive control skills improved at mean or greater rates.Conclusion: The present findings suggest that greater proactive control development during adolescence protects youth with high BI from age-related increases in anxiety. Results support a framework that highlights cognitive control as a key moderator of anxiety risk among children with a history of high BI. [ABSTRACT FROM AUTHOR]

Objective: Behavioral inhibition (BI) is an early childhood temperament characterized by fearful responses to novelty and avoidance of social interactions. During adolescence, a subset of children with stable childhood BI develop social anxiety disorder and concurrently exhibit increased error monitoring. The current study examines whether increased error monitoring in 7-year-old, behaviorally inhibited children prospectively predicts risk for symptoms of social phobia at age 9 years. Method: A total of 291 children were characterized on BI at 24 and 36 months of age. Children were seen again at 7 years of age, when they performed a Flanker task, and event-related potential (ERP) indices of response monitoring were generated. At age 9, self- and maternal-report of social phobia symptoms were obtained. Results: Children high in BI, compared to those low in BI, displayed increased error monitoring at age 7, as indexed by larger (i.e., more negative) error-related negativity (ERN) amplitudes. In addition, early BI was related to later childhood social phobia symptoms at age 9 among children with a large difference in amplitude between ERN and correct-response negativity (CRN) at age 7. Conclusions: Heightened error monitoring predicts risk for later social phobia symptoms in children with high BI. Research assessing response monitoring in children with BI may refine our understanding of the mechanisms underlying risk for later anxiety disorders and inform prevention efforts. [ABSTRACT FROM AUTHOR]

Objective: Behavioral interventions are well established treatments for children with attention-deficit/hyperactivity disorder (ADHD). However, insight into moderators of treatment outcome is limited.Method: We conducted an individual participant data meta-analysis (IPDMA), including data of randomized controlled behavioral intervention trials for individuals with ADHD <18 years of age. Outcomes were symptoms of ADHD, oppositional defiant disorder (ODD), and conduct disorder (CD) and impairment. Moderators investigated were symptoms and impairment severity, medication use, age, IQ, sex, socioeconomic status, and single parenthood.Results: For raters most proximal to treatment, small- to medium-sized effects of behavioral interventions were found for symptoms of ADHD, inattention, hyperactivity/impulsivity (HI), ODD and CD, and impairment. Blinded outcomes were available only for small preschool subsamples and limited measures. CD symptoms and/or diagnosis moderated outcome on ADHD, HI, ODD, and CD symptoms. Single parenthood moderated ODD outcome, and ADHD severity moderated impairment outcome. Higher baseline CD or ADHD symptoms, a CD diagnosis, and single parenthood were related to worsening of symptoms in the untreated but not in the treated group, indicating a protective rather than an ameliorative effect of behavioral interventions for these children.Conclusion: Behavioral treatments are effective for reducing ADHD symptoms, behavioral problems, and impairment as reported by raters most proximal to treatment. Those who have severe CD or ADHD symptoms, a CD diagnosis, or are single parents should be prioritized for treatment, as they may evidence worsening of symptoms in the absence of intervention. [ABSTRACT FROM AUTHOR]

Objective: The COVID-19 pandemic has brought unprecedented changes to young adults' lives, resulting in mental health difficulties for many; however, some individuals are particularly prone to heightened anxiety. Little is known about the early life predictors of anxiety during the pandemic. We examined a developmental pathway from behavioral inhibition (BI), a temperament characterized by fearful responses toward novelty, to changes in young adults' anxiety during the initial period of the pandemic. We hypothesized that a stable pattern of BI across early childhood would predict greater adolescent worry dysregulation, which in turn would predict increases in young adult anxiety during a stressful phase of the pandemic.Method: Participants (N = 291; 54% female) were followed from toddlerhood to young adulthood. BI was observed at ages 2 and 3 years. Social wariness was observed at age 7 years. Participants rated their worry dysregulation in adolescence (age 15) and anxiety in young adulthood (age 18) at 2 assessments during the COVID-19 pandemic, 1 month apart.Results: A significant moderated mediation, in which a stable pattern of BI from toddlerhood to childhood, as compared to the absence of this pattern, predicted greater worry dysregulation in adolescence. Worry dysregulation predicted elevated young adult anxiety in the second assessment during COVID-19, even after accounting for the first assessment.Conclusion: This study identifies a developmental pathway from toddlerhood BI to young adults' elevated anxiety during the COVID-19 pandemic. Findings have implications for early identification of individuals at risk for dysregulated worry and the prevention of anxiety during stressful life events in young adulthood. [ABSTRACT FROM AUTHOR]

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

Objective: Behavioral inhibition (BI) is a temperament identified in early childhood that is a risk factor for later social anxiety. However, mechanisms underlying the development of social anxiety remain unclear. To better understand the emergence of social anxiety, longitudinal studies investigating changes at behavioral neural levels are needed.Method: BI was assessed in the laboratory at 2 and 3 years of age (N = 268). Children returned at 12 years, and an electroencephalogram was recorded while children performed a flanker task under 2 conditions: once while believing they were being observed by peers and once while not being observed. This methodology isolated changes in error monitoring (error-related negativity) and behavior (post-error reaction time slowing) as a function of social context. At 12 years, current social anxiety symptoms and lifetime diagnoses of social anxiety were obtained.Results: Childhood BI prospectively predicted social-specific error-related negativity increases and social anxiety symptoms in adolescence; these symptoms directly related to clinical diagnoses. Serial mediation analysis showed that social error-related negativity changes explained relations between BI and social anxiety symptoms (n = 107) and diagnosis (n = 92), but only insofar as social context also led to increased post-error reaction time slowing (a measure of error preoccupation); this model was not significantly related to generalized anxiety.Conclusion: Results extend prior work on socially induced changes in error monitoring and error preoccupation. These measures could index a neurobehavioral mechanism linking BI to adolescent social anxiety symptoms and diagnosis. This mechanism could relate more strongly to social than to generalized anxiety in the peri-adolescent period. [ABSTRACT FROM AUTHOR]

Parenting practices, especially those characterized by harsh and neglectful behaviors, have a significant impact on child development. Despite the importance of parenting, little attention has been paid to personality-linked constructs that may guide how parents make decisions regarding their interactions with their children. For instance, parents who focus on getting their child to do something immediately may engage in behaviors that yield rapid compliance (e.g., hitting, yelling) at the expense of longer-term parent-child relationship quality. Building on literatures examining the effects of time horizon on behavior, this series of studies examined the development of a measure of parental time horizon to evaluate whether parents who focus on short-term (immediate) consequences of their actions experience higher rates of parenting distress and engage in more negative parenting behaviors. Study 1 examined the psychometric properties of a parenting-adapted Consideration of Future Consequences Scale, finding that more immediate time orientation was associated with greater parenting stress. Study 2 replicated these results and relations to parenting distress, suggesting that time orientation was associated with positive and negative parenting behaviors in a socioeconomically distressed sample. Together, these studies demonstrate support for further evaluating parental time orientation and its effects on parent and child outcomes. • Parental time horizon was associated with parental distress and parenting behaviors. • Parents focused on the immediate term reported more stress and harsher parenting. • Parents with longer time horizons engaged in more positive parenting practices. [ABSTRACT FROM AUTHOR]

Abstract: A failure of neural changes initiated by the estrogen surge in late pregnancy to reverse the valence of infant stimuli from aversive to rewarding is associated with dysfunctional maternal behavior in nonhuman mammals. Estrogen receptor-α plays the crucial role in mediating these neural effects of estrogen priming. This preliminary study examines associations between estrogen receptor-α gene polymorphisms and human maternal behavior. Two polymorphisms were associated with human negative maternal parenting. Furthermore, hemodynamic responses in functional magnetic resonance imaging to child stimuli in neural regions associated with social cognition fully mediated the association between genetic variation and negative parenting. This suggests testable hypotheses regarding a biological pathway between genetic variants and dysfunctional human maternal parenting. [Copyright &y& Elsevier]

The article focuses on a study which examines whether startle reflex responses differ between behaviorally inhibited (BI) adolescents with anxiety disorders compared to those who do not. The study identifies behavioral or physiological markers which may be used to differentiate between BI adolescents with and without anxiety disorders. Results of the study show that the startle response in adolescents posts a high risk for anxiety disorder development, and its pattern is suggestive of abnormal inhibitory fear process.

Abstract: There is currently controversy regarding the need for and the effectiveness of behavior modification for children with attention-deficit hyperactivity disorder (ADHD) despite years of study and multiple investigations reporting beneficial effects of the intervention. A meta-analysis was conducted by identifying relevant behavioral treatment studies in the literature. One-hundred seventy-four studies of behavioral treatment were identified from 114 individual papers that were appropriate for the meta-analysis. Effect sizes varied by study design but not generally by other study characteristics, such as the demographic variables of the participants in the studies. Overall unweighted effect sizes in between group studies (.83), pre-post studies (.70), within group studies (2.64), and single subject studies (3.78) indicated that behavioral treatments are highly effective. Based on these results, there is strong and consistent evidence that behavioral treatments are effective for treating ADHD. [Copyright &y& Elsevier]

Background: Behaviorally inhibited (BI) children who also exhibit enhanced response monitoring might be at particularly high risk for anxiety disorders. The current study tests the hypothesis that response monitoring, as manifest in the error-related negativity (ERN), moderates the association between BI and anxiety. Methods: Participants (n = 113; 73 male) assessed for early-childhood BI were re-assessed as adolescents with a clinical interview and a flanker paradigm that generated behavioral data and event-related potentials (ERPs). Risk for anxiety disorders in adolescents was examined as a function of childhood-BI status and adolescent performance on the flanker paradigm. Results: Adolescents with childhood BI displayed ERP evidence of enhanced response monitoring, manifest as large ERNs. The ERN moderated the relationship between early BI and later clinically significant disorders. Conclusions: Physiological measures of response monitoring might moderate associations between early-childhood BI and risk for psychopathology. The subset of children with BI and enhanced response monitoring might face greater risk for later-life clinical anxiety than children with either BI or enhanced response monitoring alone. [Copyright &y& Elsevier]

College students with ADHD are at elevated risk for alcohol-related problems and disorders, given symptoms of inattention and impulsivity, which characterize the disorder. Participants also completed laboratory paradigms before beginning treatment, including neurocognitive measures of inhibitory control (stop signal task) and frustration tolerance (modified mirror tracing persistence task). Across treatments, individual differences in inhibitory control and frustration tolerance predicted a reduction in substance use with treatment. [Extracted from the article]