Does Childhood Executive Function Predict Adolescent Functional Outcomes in Girls with ADHD?

We prospectively followed an ethnically and socioeconomically diverse sample of preadolescent girls with ADHD (n = 140) and matched comparison girls (n = 88) over a period of 5 years, from middle childhood through early/mid-adolescence. Our aim was to examine the ability of measures of childhood executive function (EF) to predict functional outcomes in adolescence. Measures of neuropsychological functioning comprised the childhood predictors, with academic, social, and global functioning serving as adolescent criterion measures. Results indicated that childhood EF predicted (a) academic achievement and social functioning across our entire sample (independent of diagnostic group status) and (b) global functioning only in girls with ADHD (independent of IQ). These results highlight the non-specificity of EF deficits and suggest the importance of assessing and developing interventions that target EF impairments, particularly in those at high-risk for negative outcomes, in order to prevent long-term difficulties across a range of important functional domains.     

Heterogeneity in ADHD: Neurocognitive predictors of peer,family, and academic functioning

Childhood attention-deficit/hyperactivity disorder (ADHD) is associated with impairments in peer, family, and academic functioning. Although impairment is required for diagnosis, children with ADHD vary significantly in the areas in which they demonstrate clinically significant impairment. However, relatively little is known about the mechanisms and processes underlying these individual differences. The current study examined neurocognitive predictors of heterogeneity in peer, family, and academic functioning in a well-defined sample of 44 children with ADHD aged 8–13 years (M = 10.31, SD = 1.42; 31 boys, 13 girls; 81% Caucasian). Reliable change analysis indicated that 98% of the sample demonstrated objectively-defined impairment on at least one assessed outcome measure; 65% were impaired in two or all three areas of functioning. ADHD children with quantifiable deficits in academic success and family functioning performed worse on tests of working memory (d = 0.68 to 1.09), whereas children with impaired parent-reported social functioning demonstrated slower processing speed (d = 0.53). Dimensional analyses identified additional predictors of peer, family, and academic functioning. Working memory abilities were associated with individual differences in all three functional domains, processing speed predicted social functioning, and inhibitory control predicted family functioning. These results add to a growing literature implicating neurocognitive abilities not only in explaining behavioral differences between ADHD and non-ADHD groups, but also in the substantial heterogeneity in ecologically-valid functional outcomes associated with the disorder.     

Working Memory Deficits and Social Problems in Children with ADHD

Social problems are a prevalent feature of ADHD and reflect a major source of functional impairment for these children. The current study examined the impact of working memory deficits on parent- and teacher-reported social problems in a sample of children with ADHD and typically developing boys (N = 39). Bootstrapped, bias-corrected mediation analyses revealed that the impact of working memory deficits on social problems is primarily indirect. That is, impaired social interactions in children with ADHD reflect, to a significant extent, the behavioral outcome of being unable to maintain a focus of attention on information within working memory while simultaneously dividing attention among multiple, on-going events and social cues occurring within the environment. Central executive deficits impacted social problems through both inattentive and impulsive-hyperactive symptoms, whereas the subsidiary phonological and visuospatial storage/rehearsal systems demonstrated a more limited yet distinct relationship with children’s social problems.     

Examining Manual and Visual Response Inhibition Among ADHD Subtypes

This study compared inhibitory functioning among ADHD subtype groups on manual and visual versions of the stop task. Seventy-six children, identified as ADHD/I (n = 17), ADHD/C (n = 43), and comparison (n = 20) completed both tasks. Results indicated that both ADHD groups were slower to inhibit responses than the comparison group on both tasks. Comparison children were faster to inhibit than activate responses on both tasks. Children in the ADHD groups also demonstrated this robust pattern on the manual task. However, on the visual task, the ADHD groups evidenced slowed inhibition comparable to the time required to activate responding. This implies that the visual task is more sensitive than the manual task to inhibitory deficits associated with ADHD. The ADHD/I and the ADHD/C groups did not differ on most measures, suggesting that neither stop task is effective in differentiating the subtypes. These findings extend work highlighting the role of disinhibition in ADHD, and contrast recent work suggesting divergence between ADHD subtypes.     

Executive Functioning Characteristics Associated with ADHD Comorbidity in Adolescents with Disruptive Behavior Disorders

The nature of executive dysfunction in youth with disruptive behavior disorders (DBD) remains unclear, despite extensive research in samples of children with attention-deficit hyperactivity disorder (ADHD). To determine the relationship between DBD, ADHD, and executive function deficits in aggressive teens, adolescents with DBD and comorbid ADHD (DBD + ADHD; n = 25), DBD without ADHD (DBD-ADHD; n = 23), and healthy controls (HC; n = 25) were compared on neurocognitive tests and questionnaires measuring executive functioning. Teens with DBD + ADHD performed worse on both neurocognitive and questionnaire measures of executive function than the DBD-ADHD and HC groups. Results suggest that subgroups of DBD may exist depending on the presence or absence of comorbid ADHD, which may have implications for the selection and efficacy of treatment strategies.     

Parental Reports of Executive Dysfunction in Adolescents with Bipolar Disorder

Bipolar disorder (BPD) is a serious mental illness that affects children and adolescents at a rate similar to that seen in adults. Extremely little is known, however, about cognitive functioning in childhood and adolescent BPD. The present study represents an initial effort to examine executive functioning in adolescents with BPD who are in a manic or mixed mood state, by collecting data from caregivers about the participants' performance on everyday tasks thought to be mediated by executive functioning abilities, using the Behavior Rating Inventory of Executive Function. In comparison to healthy volunteers, adolescents with BPD exhibited significant elevations across all of the measured functional domains. These elevations were evident even in adolescents with BPD who did not have comorbid ADHD, although they were most prominent in those with comorbidity. The findings suggest that adolescents with BPD have functional deficits on tasks requiring executive functioning skills that are not explicable solely on the basis of comorbid ADHD.     

Conceptualizing the Prospective Relationship Between Social Support,Stress, and Depressive Symptoms Among Adolescents

The goal of the current study is to examine the relationship amongst social support, stress, and depressive symptoms within a transactional and diathesis-stress framework using a multi-wave, longitudinal design. At the initial assessment, adolescents (n = 258) completed self-report measures assessing social support (peer, classmate, parent, and total), dependent interpersonal stress, anxious symptoms, and depressive symptoms. Additionally, participants reported stress and symptomology in each of the four waves spanning six months. Results of time-lagged, idiographic, multilevel modeling indicated that stress mediated the relationship between lower parental, classmate, and total social support and subsequent depressive, but not anxious, symptoms. In contrast, lower levels of peer support were not associated with higher levels of stress and subsequent depressive symptoms. Additionally, only classmate support deficits significantly moderated the relationship between stress and depressive symptoms. Overall, the results suggest that deficits in parental and classmate support may play a greater role in contributing to adolescent depression as compared to deficits in peer support.     

Parental reports of executive dysfunction in adolescents with bipolar disorder.

Bipolar disorder (BPD) is a serious mental illness that affects children and adolescents at a rate similar to that seen in adults. Extremely little is known, however, about cognitive functioning in childhood and adolescent BPD. The present study represents an initial effort to examine executive functioning in adolescents with BPD who are in a manic or mixed mood state, by collecting data from caregivers about the participants' performance on everyday tasks thought to be mediated by executive functioning abilities, using the Behavior Rating Inventory of Executive Function. In comparison to healthy volunteers, adolescents with BPD exhibited significant elevations across all of the measured functional domains. These elevations were evident even in adolescents with BPD who did not have comorbid ADHD, although they were most prominent in those with comorbidity. The findings suggest that adolescents with BPD have functional deficits on tasks requiring executive functioning skills that are not explicable solely on the basis of comorbid ADHD.     

Few Preschool Boys and Girls with ADHD are Well-Adjusted During Adolescence

To estimate the prevalence of being well-adjusted in adolescence, boys and girls with (n = 96) and without (n = 126) attention-deficit/hyperactivity disorder (ADHD) were assessed seven times in eight years starting when they were 4–6 years of age. Symptoms of ADHD, ODD/CD, and depression/anxiety in addition to social skills and social preference were gathered using multiple methods and informants. Being well-adjusted was defined by surpassing thresholds in at least four of the five domains. At the 7- and 8-year follow-up, when youth were 11–14 years old, probands were significantly less likely to be well-adjusted relative to age- and ethnicity-matched control children. Only a minority of children with ADHD was well-adjusted in adolescence when emotional, behavioral, and social domains were considered simultaneously. Even when their ADHD symptoms improved over time, most probands exhibited significant impairment 7–8 years after their initial assessment.     

Comprehension of direct and indirect sarcastic remarks in children and adolescents with Tourette’s syndrome

Previous research has reported that aspects of social cognition such as nonliteral language comprehension are impaired in adults with Tourette’s syndrome (TS), but little is known about social cognition in children and adolescents with TS. The present study aims to evaluate a measure of sarcasm comprehension suitable for use with children and adolescents (Experiment 1), and to examine sarcasm comprehension in children and adolescents with TS-alone or TS and attention deficit hyperactivity disorder (ADHD; Experiment 2). In Experiment 1, the measure of sarcasm comprehension was found to be sensitive to differences in nonliteral language comprehension for typically-developing children aged 10 to 11 years old compared to children aged 8 to 9 years old; the older group performed significantly better on the comprehension of scenarios ending with either direct or indirect sarcastic remarks, whereas the two age groups did not differ on the comprehension of scenarios ending with sincere remarks. In Experiment 2, both the TS-alone and TS+ADHD groups performed below the level of the control participants on the comprehension of indirect sarcasm items but not on the comprehension of direct sarcasm items and sincere items. Those with TS+ADHD also performed below the level of the control participants on measures of interference control and fluency. The findings are discussed with reference to the possible contribution of executive functioning and mentalizing to the patterns of performance.     

The Delinquency Outcomes of Boys with ADHD with and Without Comorbidity

This study examined the association between childhood ADHD and juvenile delinquency by examining data from the Pittsburgh ADHD Longitudinal Study (PALS), a follow-up study of individuals diagnosed with ADHD in childhood (ages 5–12) and recontacted in adolescence and young adulthood for yearly follow-up (age at first follow-up interview M = 17.26, SD = 3.17). Participants were 288 males with childhood ADHD and 209 demographically similar males without ADHD who were recruited into the follow-up study. Delinquency information gathered yearly during the second through eighth follow-up provided a comprehensive history of juvenile delinquency for all participants. Four childhood diagnostic groups [ADHD-only (N = 47), ADHD + ODD (N = 135), ADHD + CD (N = 106), and comparison (N = 209)] were used to examine group differences on delinquency outcomes. Analyses were conducted across three dimensions of delinquency (i.e., severity, age of initiation, and variety). Individuals with childhood ADHD + CD displayed significantly worse delinquency outcomes than the other three groups, across almost all indices of offending. When compared to comparison participants, boys with ADHD-only and ADHD + ODD in childhood displayed earlier ages of delinquency initiation, a greater variety of offending, and higher prevalence of severe delinquency. These findings suggest that although childhood ADHD + CD creates the greatest risk for delinquency, boys with ADHD-only and ADHD + ODD also appear at a higher risk for later offending. The patterns of offending that emerged from the PALS are discussed in the context of the relationship between ADHD, comorbidity, and delinquency.     

Personality Characteristics Associated with Persistent ADHD in Late Adolescence

This study focused on the personality characteristics associated with Attention-deficit/Hyperactivity disorder (ADHD) in a longitudinal sample of youth, with a particular focus on differences between those with and without persisting ADHD symptoms. Participants with ADHD (n = 90) were initially evaluated when they were 7–11 years old, and re-assessed at 16–22 years of age. Matched control subjects (n = 80) were recruited at the time of the follow-up evaluation. At follow-up, the Kiddie-SADS-PL, a semi-structured psychiatric interview, and the NEO-PI, a self-report personality inventory, were administered. Data were analyzed using multivariate analyses of variance (MANOVA). Results indicate that childhood ADHD is associated with lower scores on the NEO Conscientiousness subscale in adolescents/young adults—irrespective of the degree of ADHD persistence. In contrast, ratings of Neuroticism and Agreeableness appear to be more closely linked to adolescent status; those with persisting symptoms only exhibited increased Neuroticism and decreased Agreeableness. These results suggest that ADHD, and the degree to which symptoms persist into adolescence, may be closely linked to personality structure.     

Attentional Performance in Children and Adolescents with Tic Disorder and Co-Occurring Attention-Deficit/Hyperactivity Disorder: New Insights from a 2 × 2 Factorial Design Study

The aim of the present study was to investigate the effect of both tic disorder (TD) and attention-deficit/hyperactivity disorder (ADHD) on attentional functions. N = 96 children and adolescents participated in the study, including n = 21 subjects with TD, n = 23 subjects with ADHD, n = 25 subjects with TD+ADHD, and n = 27 controls. Attentional performance was tested based on four computerized attention tasks (sustained attention, divided attention, go/nogo and set shifting). The effect of TD as well as ADHD on attentional performance was tested using a 2 × 2 factorial approach. A diagnosis of TD had no negative impact on attentional functions but was associated with improved performance in the set shifting task. By contrast, regardless of a diagnosis of TD, subjects with ADHD were found to perform worse in the sustained attention, divided attention and go/nogo task. No interaction effect between the factors TD and ADHD was revealed for any of the attention measures. Our results add to findings from other areas of research, showing that in subjects with TD and ADHD, ADHD psychopathology is often the main source of impairment, whereas a diagnosis of TD has little or no impact on neuropsychological performance in most cases and even seems to be associated with adaptive mechanisms.     

How Distinctive are ADHD and RD? Results of a Double Dissociation Study

The nature of the comorbidity between Attention-Deficit/Hyperactivity Disorder (ADHD) and Reading Disability (RD) was examined using a double dissociation design. Children were between 8 and 12 years of age and entered into four groups: ADHD only (n = 24), ADHD+RD (n = 29), RD only (n = 41) and normal controls (n = 26). In total, 120 children participated in the study; 38 girls and 82 boys. Both ADHD and RD were associated with impairments in inhibition and lexical decision, although inhibition and lexical decision were more severely impaired in RD than in ADHD. Visuospatial working memory deficits were specific to children with only ADHD. It is concluded that there was overlap on lexical decision and to a lesser extent on inhibition between ADHD and RD. In ADHD, impairments were dependent on IQ, which suggest that the overlap in lexical decision and inhibition is different in origin for ADHD and RD. The ADHD only group was specifically characterized by deficits in visuospatial working memory. Hence, no double dissociation between ADHD and RD was found on executive functioning and lexical decision.     

Co-occurring Mental Health Problems and Peer Functioning Among Youth with Attention-Deficit/Hyperactivity Disorder: A Review and Recommendations for Future Research

It is well established that children and adolescents with attention-deficit/hyperactivity disorder (ADHD) frequently experience co-occurring mental health problems in addition to difficulties in their peer relationships. Although substantial research has focused on the extent to which peer functioning contributes to subsequent co-occurring mental health problems, much less research has considered how co-occurring mental health problems affect peer functioning domains. Therefore, the purpose of this review is to examine the effect of co-occurring mental health problems on the peer functioning of youth with ADHD. The impact of co-occurring externalizing (i.e., oppositional defiant disorder, conduct disorder) and internalizing (i.e., anxiety, depression) symptoms are reviewed, with a focus on whether these co-occurring symptoms exacerbate, attenuate, or have no effect across peer domains of social skills/competence, peer status, and friendship among youth with ADHD. Drawing from a developmental psychopathology framework, this review then draws attention to relevant causal processes and developmental cascades (including social-cognitive, affective, and family and parenting factors) in offering promising avenues for future work.     

Mentalisierung und externalisierende Verhaltensstörungen in der Adoleszenz

Social cognition creates the conditions for successful human interaction. Externalizing disorders are characterized by a failure of adequate social cooperation. Therefore, social cognition seems to be a key factor in understanding externalizing behavior, its etiology and treatment options. The present article combines the clinical theory of mentalization with the state-of-the-art of empirical data on externalizing behavior and of the theory-of-mind research as well as research on social information processing. Empirical evidence suggests that there are distinct deficits in social cognition depending on the type of aggression (proactive or reactive). However, even though it is known from a neurobiological perspective that social cognition is reorganized in adolescence, research on externalizing behavior and social cognition in adolescence is limited. Hence the analysis of two studies is presented which compared reflective functioning between a group of late adolescent violent offenders and a control group. A total of 42 young men participated in the studies and were interviewed with the adult attachment interview. Interviews were coded with the reflective functioning scale. Results showed that violent offenders scored significantly lower on the reflective functioning scale than age and gender matched controls. This result is independent of intelligence. Instrumental proactive aggression and psychopathic tendencies are also strongly associated with lower reflective functioning. The results underline the importance of therapeutic interventions for externalizing adolescents which enhance reflective functioning.     

Parent–Teen Interactions as Predictors of Depressive Symptoms in Adolescents with Headache

This study investigated parent–adolescent conflict, family functioning, and adolescent autonomy as predictors of depressive symptoms in adolescents with primary headache. Frequent headaches during adolescence can have a negative impact on activity levels and psychological functioning. Depression is particularly prevalent in adolescents with headache but little research has examined the role of parent–teen interactions in predicting depressive symptoms. Thirty adolescents diagnosed with migraine or chronic daily headache completed self-report measures of pain intensity, parent–adolescent conflict, family functioning, and depression. Adolescents and their parents also participated in three videotaped interaction tasks, scored by independent raters to assess adolescent autonomy. Regression models revealed that pain intensity, parent–adolescent conflict, and autonomy predicted depressive symptoms. Higher levels of conflict, poorer family functioning and lower levels of autonomy were associated with more depressive symptoms. This study highlights the association between parent–teen interactions and psychological functioning in adolescents with primary headache. Implications for intervention are discussed.     

Social brain development and the affective consequences of ostracism in adolescence

Recent structural and functional imaging studies have provided evidence for continued development of brain regions involved in social cognition during adolescence. In this paper, we review this rapidly expanding area of neuroscience and describe models of neurocognitive development that have emerged recently. One implication of these models is that neural development underlies commonly observed adolescent phenomena such as susceptibility to peer influence and sensitivity to peer rejection. Experimental behavioural evidence of rejection sensitivity in adolescence is currently sparse. Here, we describe a study that directly compared the affective consequences of an experimental ostracism manipulation (Cyberball) in female adolescents and adults. The ostracism condition led to significantly greater affective consequences in the adolescents compared with adults. This suggests that the ability to regulate distress resulting from ostracism continues to develop between adolescence and adulthood. The results are discussed in the context of models of neurocognitive development.     

Social Withdrawal Subtypes during Early Adolescence in India

The overarching goal of this study was to examine the associations between three social withdrawal subtypes (shyness, unsociability, avoidance), peer isolation, peer difficulties (victimization, rejection, exclusion, low acceptance), and loneliness in India during early adolescence. Participants were 194 adolescents in Surat, India (M age = 13.35 years). Peer nominations of peer relations and socioemotional behaviors were gathered, along with self-reports of reasons for being alone and loneliness. Preliminary evidence of validity for the self-report measure of withdrawal subtypes and isolation was found, and factor analyses indicated that shyness, unsociability, and avoidance represent related, but distinct forms of withdrawal that are distinct from isolation. Shyness and avoidance were uniquely associated with loneliness and exclusion, but unsociability was not. The association between avoidance and loneliness was mediated by exclusion. Findings suggest that social withdrawal may be best conceptualized as a multifaceted construct during childhood and adolescence, in Western and non-Western societies.     

Linkages between childhood executive functioning and adolescent social functioning and psychopathology in girls with ADHD

We followed an ethnically and socioeconomically diverse sample of preadolescent girls with ADHD (n = 140) and matched comparison girls (n = 88) over a period of 5 years, from middle childhood through early/midadolescence, with the aim of determining whether childhood levels of executive function (EF) would predict adolescent multi-informant outcomes of social functioning and psychopathology, including comorbidity between externalizing and internalizing symptomatology. Predictors were well-established measures of planning, response inhibition, and working memory, along with a control measure of fine motor control. Independent of ADHD versus comparison group status, (a) childhood planning and response inhibition predicted adolescent social functioning and (b) childhood planning predicted comorbid internalizing/externalizing disorders in adolescence. Subgroup status (ADHD-Combined, ADHD-Inattentive, and comparison) moderated the relationship between childhood planning and adolescent internalizing/externalizing comorbidity, with the combined type revealing particularly strong associations between baseline planning and adolescent comorbidity. Mediation analyses indicated that adolescent social functioning mediated the prediction from childhood EF to comorbidity at follow-up; in turn, in the girls with ADHD, adolescent comorbidity mediated the prediction from childhood EF to social functioning at follow-up. We conclude that childhood interventions should target EF impairments in addition to behavioral symptoms.