Social Cognition and Interpersonal Impairment in Young Adolescents with ADHD

The purpose of this study is twofold. First, it aims to examine whether the impairment in peer functioning and social-cognitive deficits (i.e., hostile attribution bias, social comprehension, social problem-solving) found in elementary school aged children with ADHD also occur in adolescence. Second, it aims to provide evidence for a predictive relationship between these social-cognitive deficits and an adolescent’s functional impairment in the social domain. To address these aims, several social-cognitive tasks were administered to a small sample of young adolescents with ADHD (N = 27) and a comparison sample without an ADHD diagnosis (N = 18). Parent report of functional impairment and peer sociometric data were also gathered. Comparisons of both parent and peer report of adolescent social functioning suggest that individuals with ADHD continue to experience difficulties with peers into the adolescent years and data from the social-cognitive tasks show evidence of social comprehension and problem-solving deficits. Further analyses indicated a significant link between functional impairment and social cognition. Findings herein are discussed in the context of both the developmental changes that arise during adolescence and consideration of the importance of social cognition for understanding the impaired social functioning experienced by adolescents with ADHD.     

Interventions to Address the Academic Impairment of Children and Adolescents with ADHD

There exists a strong link between ADHD and academic underachievement. Both the core behavioral symptoms of ADHD and associated executive functioning deficits likely contribute to academic impairment. Current evidence-based approaches to the treatment of ADHD (i.e., stimulant medication, clinical behavior therapy and classroom behavioral interventions) have demonstrated a robust impact on behavioral variables such as attention and disruptive behavior within classroom analogue settings; however, their efficacy in improving academic outcomes is much less clear. Although surprisingly few treatment outcome studies of ADHD have attempted to incorporate interventions that specifically target academic outcomes, the studies that are available suggest that these interventions may be beneficial. The state of the treatment literature for addressing academic impairment in children and adolescents with ADHD will be reviewed herein, as well as limitations of current research, and directions for future research.     

Associations of Parent-Adolescent Discrepancies in Family Cohesion and Conflict with Adolescent Impairment

Family cohesion and family conflict are important protective and risk factors respectively in the development of child psychopathology. Our study examines parent-adolescent discrepancy of the family environment constructs, family cohesion and family conflict, and their associations with adolescent impairment. The sample consists of 141 parent-adolescent dyads evaluated at an outpatient behavioral health clinic. The mean adolescent age is 14.8 (range 11–18) while the mean parent age is 48.9 (range 32–67). Findings show that adolescents report significantly less family cohesion but do not differ significantly in reports of family conflict. Greater family cohesion is associated with less adolescent impairment by multiple reporters. Nonetheless, greater family conflict is associated with more adolescent impairment by the same reporter. The results show that both adolescent and parent reports of family cohesion and conflict are important to consider when integrating information gathered in a clinical assessment.     

Examining Anxiety and Depression as Moderators of the Associations Between ADHD Symptoms and Academic and Social Problems in Hispanic Adolescents

The effects of attention-deficit/hyperactivity disorder (ADHD) symptoms on the psychosocial functioning of Hispanic youth have been understudied. It also remains unclear if the well-established associations between ADHD symptoms and academic and social impairment are exacerbated by co-occurring internalizing symptoms. The purposes of the present study were to (1) examine whether ADHD symptoms would be associated with academic and social problems while also controlling for oppositional defiant disorder (ODD) symptoms, and (2) test the hypothesis that anxious and depressive symptoms would moderate the relations between ADHD symptoms and academic and social problems. Participants were 142 at-risk Hispanic adolescents (54 % male, ages 14–19) who reported on their anxious and depressive symptoms, as well as their teachers who reported on adolescents’ ADHD symptoms, ODD symptoms, academic problems, and social problems. When the psychopathology variables were included simultaneously in a path model, ADHD was the only domain significantly positively associated with academic problems. In contrast, ODD and depressive symptoms were the only domains significantly positively associated with social problems when all of the psychopathology variables were included in the path model. No moderation effects were found in relation to academic problems, although a significant ADHD × depression interaction was found in relation to social problems. Specifically, ADHD symptoms were not associated with social problems among adolescents who reported low levels of depressive symptoms, but the association between ADHD symptoms and social problems was significant at higher levels of depression. In addition to targeting oppositionality, attending to the combined presence of ADHD and depressive symptoms will be important for reducing the social impairments among Hispanic adolescents.     

Associations of Lifetime Depression with Trauma Exposure,Other Environmental Adversities,and Impairment in Adolescents with ADHD

Depression is a common, potentially devastating comorbidity in youth with attention-deficit/hyperactivity disorders (ADHD). Various environmental adversities are well-described as correlates of depression in general pediatric populations, but not in youth with ADHD. In 104 adolescents with ADHD, we examined potential environmental correlates of lifetime depression, including trauma exposure, recent negative life events and current parent-child conflict, along with current and past ADHD severity and current impairment. Controlling for demographic variables, comorbid disorders, and ADHD severity, we noted significant associations between lifetime depression and environmental adversities, including victimization trauma, parent-child conflict, and behaviorally-independent negative life events. Current impairment but not ADHD severity was also highly associated with lifetime depression, controlling for the same covariates. Findings from this preliminary, cross-sectional study suggest that environmental adversities and impairment in youth with ADHD should also be targeted along with the ADHD when contemplating strategies to treat or prevent comorbid depression.     

Social and Academic Impairment in Youth with ADHD, Predominately Inattentive Type and Sluggish Cognitive Tempo

Sluggish cognitive tempo (SCT) was originally identified as a construct that characterized the inattention problems of some children with attention deficit disorder (ADD). Research has indicated that using SCT symptoms to identify a subset of youth with attention-deficit/hyperactivity disorder, predominately inattentive type (ADHD-IT) may elucidate distinct patterns of impairment and thereby improve the external validity of ADHD subtypes. The objective of the current study was to investigate whether youth with clinically-assessed ADHD-IT and high levels of SCT exhibit unique social and academic impairments. In a clinic-referred sample of youth (N?=?209; 23 % female) aged 6 to 17 years, participants who met criteria for three different groups were identified: ADHD, Combined Type (ADHD-CT; n?=?80), ADHD-IT with low SCT symptoms (n?=?74), and ADHD-IT with high SCT symptoms (n?=?55). These groups were compared on indicators of social and academic functioning while considering the effects of co-occurring internalizing and disruptive behavior disorders. Youth with ADHD-IT high in SCT exhibited uniquely elevated withdrawal, as well as low leadership and low peer-directed relational and overt aggression, which were not accounted for by co-occurring disorders. This high-SCT group was also the only group to have more homework problems than the ADHD-CT group, but only when other disruptive behavior disorders were absent. The distinctiveness of the high-SCT group, which was primarily evident in social as opposed to academic functioning, provides partial support for the external validity and clinical utility of SCT.     

Longitudinal Association of Sluggish Cognitive Tempo with Depression in Adolescents and the Possible Role of Peer Victimization

Research on Child and Adolescent Psychopathology - It is unknown whether sluggish cognitive tempo (SCT) is prospectively associated with depression in adolescence, and possible processes linking...     

Longitudinal Associations between Depression and Aggression in Children and Adolescents

Due to the longstanding and detrimental effects of engaging in aggressive behaviour and of experiencing symptoms of internalizing problems in children and adolescents, there is an increasing interest in identifying the temporal sequence between these 2 problems with previous research yielding inconsistent findings. Therefore, the longitudinal links between relational aggression, physical aggression, and depression were examined across 7 years in a sample of 643 children (54 % girls) aged 10 at Time 1. Three models were compared— (1) the failure model, in which aggression predicted depression, (2) the acting out model, in which depression predicted aggression, and (3) a reciprocal model, in which both aggression and depression shared a reciprocal relation over time. Cross-lagged path analyses using structural equation modeling supported the failure model (i.e., engaging in relational and physical aggression predicts subsequent depressive symptoms). Findings were similar for boys and girls. These findings add to the literature suggesting that externalizing problems precede internalizing problems.     

Factors Associated with Healthy and Impaired Social Functioning in Young Adolescents with ADHD

There is variability in the extent to which adolescents with attention-deficit/hyperactivity disorder (ADHD) exhibit social impairment, as the same diagnosis does not necessarily entail impairment in the same area(s) of functioning. The current study entailed a cross-sectional examination of enhancers to healthy social functioning and risk factors to parent- and self-rated social impairment in 324 middle school youth (ages 10–14 years) with ADHD. A series of binary logistic regression analyses were conducted to evaluate a risk-resilience model for social functioning, including testing compensatory (i.e., main; buffering) and protective (i.e., interaction) effects of enhancers in the presence of identified risk factors. Youth conduct problems, youth depression, and negative parenting emerged as risk factors. Self-rated social acceptance, activity participation (breadth and intensity), and parent involvement were enhancers of healthy social functioning. Of these enhancers, activity participation (breadth and intensity) and parent involvement showed buffering effects against the negative impact of the risk factors on social functioning. None of the enhancers displayed protective effects. The findings of this study enhance our understanding of the social functioning of young adolescents with ADHD, who comprise an understudied population relative to younger children with similar problems.     

Social Skills Mediate the Association of ADHD and Depression in Preadolescents

Childhood attention-deficit/hyperactivity disorder (ADHD) is a replicated risk factor for depression, but the explanatory factors underlying this association have not been reliably identified. Given that social skills (i.e., cooperation, assertion, responsibility, self-control) are sensitive to early ADHD and predict later depression, we tested whether individual differences in social skills individually and collectively mediated predictions of depressive symptoms from early ADHD symptoms. In an ethnically diverse (50 % non-Caucasian) sample of 232 children with (n = 124) and without ADHD (n = 108) followed prospectively for two years (aged 5–10 at Wave 1; 7–12 at Wave 2), we gathered multi-informant (i.e., parent, teacher) and multi-method (e.g., rating scale, structured interview) assessment of key constructs. Using a multiple mediation framework with bootstrapping and statistical control of sex, Wave 1 depression, Wave 1 oppositional defiant disorder (ODD), Wave 1 anxiety, and Wave 2 ADHD symptoms, an independent mediation effect emerged for parent-rated self-control in the prediction of Wave 2 depression (parent-rated) from Wave 1 ADHD symptoms (combined parent and teacher ratings). Teacher-rated social skills at Wave 1 also collectively mediated this association, with teacher-rated assertion emerging as a unique mediator. We discuss the role of social skills in emergent depression among youth with ADHD and consider implications for prevention and intervention.     

Cognitive Functioning in Adolescents with Self-Reported ADHD and Depression: Results from a Population-Based Study

This study aims to assess cognitive functioning differences among adolescents with retrospectively self-reported: ADHD and an onset of depression, only ADHD, only depression, and neither ADHD nor depression. Data from the Tracking Adolescents’ Individual Lives Survey (TRAILS) cohort was used in this study. Neuropsychological functioning was assessed in 1549 adolescents, at baseline and follow-up (mean ages 11 and 19 years). The Composite International Diagnostic Interview was used to classify adolescents into 4 groups: ADHD with onset of depression, only ADHD, only depression, and neither ADHD nor depression. Linear mixed effects models were used to analyse group differences in cognitive functioning at baseline and follow-up, and the change in cognitive functioning between these 2 time-points. Results showed a significant main effect of group on response time variability at baseline, working memory maintenance at follow up, and change in response time variability scores between baseline and follow-up. As compared to the healthy and depressed-only groups, adolescents with only ADHD showed longer response time variability at baseline and, which declined between baseline and follow-up. Adolescents with ADHD plus depression showed higher reaction time for working memory maintenance than the depressed only and healthy groups at follow-up. In conclusion, adolescents with self-reported ADHD show poorer cognitive functioning than healthy adolescents and those with only depression. Amongst adolescents with ADHD, specific cognitive domains show poor functioning depending on the presence or absence of comorbid depression. While adolescents with only ADHD have lower reaction time variability, those with comorbid depression have poorer working memory maintenance.     

Parenting Adolescents with ADHD: Maternal and Adolescent Contributions and the Intervening Role of Stress

Journal of Child and Family Studies - Compared to parents of typically developing youth, parents of children and adolescents with ADHD tend to engage in fewer positive and more negative parenting...     

ADHD Correlates, Comorbidity, and Impairment in Community and Treated Samples of Children and Adolescents

Patterns of correlates, comorbidity and impairment associated with attention-deficit hyperactivity disorder (ADHD) in children and youth were examined in representative samples from the community and from treatment facilities serving medically indigent youth in Puerto Rico. Information from caretakers and youths was obtained using the Diagnostic Interview Schedule for Children, (version IV), measures of global impairment, and a battery of potential correlates. In the community (N = 1,896) and the treated samples (N = 763), 7.5 and 26.2% of the children, respectively, met criteria for DSM-IV ADHD in the previous year. Although the prevalence rates and degree of impairment differed, the general patterns of correlates, comorbidity and impairment were similar in both populations. The exceptions were associated with conduct disorder, anxiety, impairment in the ADHD comorbid group, and age factors that appeared to be related to selection into treatment.     

Coping with COVID-19: Longitudinal Impact of the Pandemic on Adjustment and Links with Coping for Adolescents with and without ADHD

Research on Child and Adolescent Psychopathology - Understanding factors that foster resilience and buffer against the negative psychological impact of COVID-19 is critical to inform efforts to...     

The Role of Positive Psychology Constructs in Predicting Mental Health and Academic Achievement in Children and Adolescents: A Two-Year Longitudinal Study

This longitudinal study presents the first examination of the relation between positive psychology constructs, mental health and academic achievement of students in Portugal. Using a sample of 367 middle-school students, the study revealed that crosssectional and longitudinal patterns of correlations between positive variables were consistent with expectations for the most part and suggested that hope, life satisfaction and self-worth have meaningful relations with mental health and academic achievement. In addition, no significant changes were found between the variables in study across the administrations and throughout the two cohorts, and all the variables in study demonstrate moderate to high stability across a 1- and 2-year time frame. Hope predicts students?? academic achievement, and life satisfaction was the strongest predictor of mental health, over 2-years. The implications of the findings are discussed with reference to prior studies and for future research.     

Perfectionism, Coping, Social Support, and Depression in Maltreated Adolescents

The current study examined the associations among dimensions of perfectionism, coping, social support, and depression in 58 adolescents with a history of maltreatment. Participants completed the Child-Adolescent Perfectionism, multidimensional measures of coping and social support, and the CES-D Depression Scale. Correlational analyses showed that depression was associated with socially prescribed perfectionism, internalized emotion-oriented coping, avoidant-oriented distancing, and low family support and peer support. Analyses of coping responses and perfectionism established links between self-oriented perfectionism and internalized emotion-oriented coping responses and self-reliant problem-solving. Socially prescribed perfectionism was associated with avoidance-oriented coping (i.e., distancing). While self-oriented perfectionism and social support were unrelated, socially prescribed perfectionism was associated with reduced levels of family support. Collectively, the findings highlight the roles of poor coping and social support as contributors to the emotional distress experienced by maltreated adolescents. Moreover, it is suggested that the distress experienced by perfectionistic youth with a history of maltreatment reflects, in part, the role of maladaptive coping styles and coping resource deficits. Our findings support further consideration of personality dimensions such as perfectionism as contributors to poor functioning among maltreated youth.     

The Development and Role of the Therapeutic Alliance in Supportive Psychotherapy with Adolescents

The formation of a therapeutic alliance is considered a central issue in therapy, and particularly crucial and challenging in work with adolescents. The relational and technical components of the therapeutic alliance were examined from the perspective of the adolescent client. 40 emotionally disturbed adolescent girls, aged 13 to 16 years, received brief supportive psychotherapy in the school setting. The alliance was assessed at sessions 3, 6 and 9, and outcome was evaluated on measures of internalizing problems, self-esteem, adjustment and client satisfaction. The results indicated the stability of the alliance between sessions 3 and 6, followed by significant linear increases between sessions 6 and 9. The strength of the alliance was most consistently related to reductions in internalising problems and client estimates of change. The implications for training and clinical practice with adolescent clients are discussed and future research avenues outlined.