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As a novel approach to conceptualizing executive functions, this study applied network analysis to a common battery of executive function tests administered to a sample covering the life span. Participants (N = 3,944; age: M = 20.8 years, SD = 19.6, range: 3-85; maternal/self education: M = 12.9 years, SD = 2.6; 53.3% girls/women, 46.7% boys/men; 61.1% White, 18.2% African American, 14.0% Latinx, 6.8% other races/ethnicities) completed tests of inhibition, shifting, and updating/working memory. Zero-order and partial correlation network models were calculated for divided age groups, with network parameters compared between groups: edge weights, corresponding to zero-order or partial correlations between two executive functions; expected influence, quantifying centrality; and global strength, quantifying differentiation. Executive functions differentiated from childhood to adolescence and dedifferentiated during young adulthood, with further dedifferentiation at older adulthood. Shifting emerged as more central than other abilities in adolescence and adulthood versus childhood, with a mediational role of shifting between inhibition and updating/working memory. A network approach can appropriately capture the unity and diversity of executive functions, by which unity reflects the reciprocal engagement between diverse abilities to produce goal-directed behavior. The engagement between abilities, and a mediational role of shifting between inhibition and updating/working memory, may be necessary for the emergence of effective goal-directed behavior. Through a network approach, the unity of executive functions represents an emergent property of the dynamics between multiple abilities (e.g., inhibition, shifting, and updating/working memory) that, when working effectively in tandem, lead to integrative processes (e.g., problem solving) that contribute to successful executive behavior and goal attainment.

Objective: The current study sought to clarify and harness the incremental validity of emotional dysregulation and unawareness (EDU) in emerging adulthood, beyond ADHD symptoms and with respect to concurrent classification of impairment and co-occurring problems, using machine learning techniques. Method: Participants were 1,539 college students (M age = 19.5, 69% female) with self-reported ADHD diagnoses from a multisite study who completed questionnaires assessing ADHD symptoms, EDU, and co-occurring problems. Results: Random forest analyses suggested EDU dimensions significantly improved model performance (p s <.001) in classifying participants with impairment and internalizing problems versus those without, with the resulting ADHD + EDU classification model demonstrating acceptable to excellent performance (except in classification of Work Impairment) in a distinct sample. Variable importance analyses suggested inattention sum scores and the Limited Access to Emotional Regulation Strategies EDU dimension as the most important features for facilitating model classification. Conclusion: Results provided support for EDU as a key deficit in those with ADHD that, when present, helps explain ADHD's co-occurrence with impairment and internalizing problems. Continued application of machine learning techniques may facilitate actuarial classification of ADHD-related outcomes while also incorporating multiple measures. [ABSTRACT FROM AUTHOR]

Current assessment protocols for attention-deficit/hyperactivity disorder (ADHD) focus heavily on a set of highly overlapping symptoms, with well-validated factors like cognitive disengagement syndrome (CDS), executive function (EF), age, sex, and race and ethnicity generally being ignored. Using machine learning techniques, the current study aimed to validate recent findings proposing a subset of ADHD symptoms that, together, predict ADHD diagnosis, severity, and impairment level better than the full symptom list, while also testing whether the inclusion of the factors listed above could further increase accuracy. Parents of 1,922 children (50.1% male) aged 6–17 years completed rating scales of ADHD, CDS, EF, and impairment. Results suggested nine symptoms as most important in predicting outcomes: (a) has difficulty sustaining attention in tasks or play activities; (b) does not follow through on instructions and fails to finish work; (c) avoids tasks (e.g., schoolwork, homework) that require sustained mental effort; (d) is often easily distracted; (e) has difficulty organizing tasks and activities; (f) is often forgetful in daily activities; (g) fidgets with hands or feet or squirms in seat; (h) interrupts/intrudes on others; and (i) shifts around excessively or feels restless or hemmed in. The abbreviated algorithm achieved accuracy rates that did not significantly differ compared to an algorithm comprising all 18 symptoms in predicting impairment, while also demonstrating excellent discriminative ability in predicting ADHD diagnosis. Adding CDS and EF to the abbreviated algorithm further improved the prediction of global impairment. Continued refinement of screening tools will be key to ensuring access to clinical services for youth at risk for ADHD. General Scientific Summary: This study suggests that nine core symptoms of attention-deficit/hyperactivity disorder (ADHD), when incorporated into a machine learning algorithm, can predict ADHD diagnosis and impairment with accuracy equal to that of all 18 symptoms. The inclusion of executive function and cognitive disengagement syndrome in the algorithm appeared to further improve accuracy, although age, sex, and parent race and ethnicity did not. Deployment of this algorithm into schools and pediatrician offices could provide the best and most efficient means to simultaneously screen for the risk of ADHD and impairment. [ABSTRACT FROM AUTHOR]

Background: Impulsivity is viewed as key to attention‐deficit/hyperactivity disorder (ADHD) and disruptive behavior disorders (DBD). Yet, to date, no work has provided an item‐level analysis in longitudinal samples across the critical developmental period from childhood into adolescence, despite prior work suggesting items exhibit differential relevance with respect to various types of impairment. The current study conducted a novel longitudinal network analysis of ADHD and oppositional defiant disorder (ODD) symptoms between childhood and adolescence, with the important applied prediction of social skills in adolescence. Methods: Participants were 310 children over‐recruited for clinical ADHD issues followed longitudinally for six years in total with gold standard diagnostic procedures and parent and teacher ratings of symptoms and social outcomes. Results: Findings from baseline, Year 3, and Year 6 suggested Difficulty waiting turn, Blurts, and Interrupts/intrudes were key bridge items across cross‐sectional and longitudinal parent‐reported DBD networks. Furthermore, shortened symptom lists incorporating these symptoms were stronger predictors of teacher‐rated social skills 5 years later compared to total DBD scores. Conclusions: Such findings are consistent with the trait impulsivity theory of DBD and ADHD and may inform useful screening tools and personalized intervention targets for children at risk for DBD during adolescence. [ABSTRACT FROM AUTHOR]

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder that affects individuals from all life stages, genders, and races/ethnicities. Accurate assessment of ADHD across different populations is essential as undiagnosed ADHD is associated with numerous costly negative public health outcomes and is complicated by high comorbidity and developmental change in symptoms over time. Predictive analysis suggests that best-practice evidence-based assessment of ADHD should include both ADHD-specific and broadband rating scales from multiple informants with consideration of IQ, academic achievement, and executive function when there are concerns about learning. For children under age 12, parent and teacher ratings should be averaged. For adolescents and adults, informant reports should be prioritized when self- and other-report are inconsistent. Future research should provide more stringent evaluation of the sensitivity of measures to treatment response and developmental change over time as well as further validate measures on historically understudied populations (i.e., adults, women, and racial/ethnic minorities). [ABSTRACT FROM AUTHOR]

The purpose of the current study was to use network analysis techniques to parse relations between attention-deficit/hyperactivity disorder (ADHD) symptom domains, domains of executive function, and temperament traits. Participants were 420 children aged 6–17 years (55% boys). The majority of the participants were Caucasian (72.86%) and 50% of the sample met diagnostic criteria for ADHD. Both parents and teachers provided ratings of participants' ADHD symptom severity. Parents completed questionnaires pertaining to participants' temperament traits, and participants completed well-validated laboratory measures of executive function. Results suggested effortful control as demonstrating the strongest relations with ADHD, particularly the parent-reported inattentive symptom domain. Additionally, negative effects appeared to demonstrate weaker but still notable relations primarily with the parent-reported hyperactive/impulsive symptom domain. Measures of executive function did not appear to demonstrate relations with any measures of ADHD symptoms or temperament traits. The results were generally replicated in a distinct sample (n = 732, 7–13 years, 63% boys, 81% White), although differences emerged pertaining to the role of surgency (i.e., related to the hyperactive/impulsive symptom domain in the replication but not the primary sample). Overall, findings provided support for the primary role of effortful control, as well as secondary roles for negative affect and surgency, as key risk markers for the characterization of ADHD. Additional exploration of the overlap between temperament and executive function, as pertaining to ADHD, may help clarify heterogeneity in phenotypes and suggest priorities for targeted interventions outside of traditional symptoms. [ABSTRACT FROM AUTHOR]

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

Using network analysis and random forest regression, this study identified attention-deficit/hyperactivity disorder (ADHD) symptoms most important for indicating impairment in various functional domains. Participants comprised a nationally representative sample of 1249 adults in the United States. Bridge symptoms were identified as those demonstrating unique relations with impairment domains that, in total, were stronger than those involving other symptoms. Results suggested three inattentive (i.e., difficulty organizing; does not follow through; makes careless mistakes) and one hyperactive (difficulty engaging in leisure activities) bridge symptoms. Random forest regression results supported bridge symptoms as most important (compared to other symptoms) for predicting global and specific impairment domains. Hyperactive/impulsive symptoms appeared more strongly related to impairment in women, whereas difficulty organizing and easily distracted appeared more related to impairment in men. Clarification of bridge symptoms may help identify core characteristics of ADHD in adulthood and specify screening and intervention targets to reduce risk for related impairment. [ABSTRACT FROM AUTHOR]