Aggression Among Children with ADHD,Anxiety, or Co-occurring Symptoms: Competing Exacerbation and Attenuation Hypotheses

Competing hypotheses for explaining the role of anxiety in the relation between attention-deficit/hyperactivity disorder (ADHD) symptoms and childhood aggression were evaluated. Two studies tested whether anxiety exacerbated, attenuated, or had no effect on the relation between ADHD and aggression subtypes among psychiatrically hospitalized children. In Study 1 (N = 99), children who scored above clinical cut-off levels for anxiety only, ADHD only, and co-occurring ADHD and anxiety were compared on aggression subtypes (i.e., reactive, proactive, overt, and relational aggression). In Study 2, the moderating role of anxiety on the relation between ADHD and aggression subtypes was examined with a larger sample (N = 265) and with continuous variables. No support was found for either the attenuation or exacerbation hypothesis, and results remained consistent when separately examining hyperactivity/impulsivity and inattention symptoms of ADHD. Although ADHD symptoms were significantly associated with all aggression subtypes, this association did not remain when including symptoms of oppositional defiant disorder.     

Risk Factors Associated with Proactive and Reactive Aggression in a Child Psychiatric Inpatient Sample

Proactive and reactive aggression represent distinct functions of aggression that are associated with different risk factors, including individual and contextual characteristics. However, more research evaluating the interactive effects of risk factors is needed. The current study evaluated whether corporal punishment moderated the influence of neighborhood problems and anger coping on proactive and reactive aggression in a child psychiatric inpatient sample of 6 to 13 year olds (n?=?151). Findings were compared across child- and caregiver-reports of aggression. Consistent with expectations, anger coping was more strongly associated with reactive aggression than proactive aggression across informants. In contrast, perceived neighborhood problems were only associated with child-reports of proactive aggression, with corporal punishment moderating this association. Specifically, the association between neighborhood problems and proactive aggression was only evident at high levels of corporal punishment. Treatment implications and future directions are discussed.     

Toddlers' context-varying emotions, maternal responses to emotions, and internalizing behaviors

Relations of toddlers' observed negative affect in high- and low-threat contexts to maternal perceptions of their toddlers' internalizing problems and to mothers' responses to emotions (RTE) for fear and sadness were examined. Child-driven, parent-driven, and reciprocal transactional models across 1 year were directly compared. Two-year-old toddlers (N = 106) participated in lab-based activities to elicit distress, and their negative affect was coded. Mothers completed measures of their child's internalizing behaviors and their responses to their toddler's fear and sadness at ages 2 and 3. At age 2, only negative affect in low-threat contexts was associated with greater internalizing problems. Mothers' punishing and minimizing RTE at age 2 predicted an increase in internalizing problems across 1 year. Age 2 internalizing problems predicted an increase in mother's use of supportive RTE over time. Results highlight the importance of considering the context of toddlers' negative affective displays and supported a reciprocal conceptualization of toddlers' internalizing behaviors and mothers' RTE.     

Sluggish Cognitive Tempo in Psychiatrically Hospitalized Children: Factor Structure and Relations to Internalizing Symptoms, Social Problems, and Observed Behavioral Dysregulation

As research examining sluggish cognitive tempo (SCT) advances, it is important to examine the structure and validity of SCT in a variety of samples, including samples of children who are clinically-distressed but not referred specifically for attention-deficit/hyperactivity disorder (ADHD). The present study used a large sample of psychiatrically hospitalized children (N?=?680; 73 % male; 66 % African American) between the ages of 6 and 12 to examine the latent structure of SCT, ADHD, oppositional defiant disorder (ODD), depression, and anxiety using confirmatory factor analysis (CFA). Results of the CFA analyses demonstrated that SCT is distinct from these other dimensions of child psychopathology, including ADHD inattention, depression, and anxiety. Regression analyses indicated that SCT symptoms were positively associated with depression and, to a lesser degree, anxiety. SCT symptoms were also positively associated with children’s general social problems, whereas SCT symptoms were negatively associated with an observational measure of behavioral dysregulation (i.e., frequency of time-outs received as a part of a manualized behavior modification program). These associations were significant above and beyond relevant child demographic variables (i.e., age, sex, race), children’s other mental health symptoms (i.e., ADHD, ODD, depression, anxiety symptoms), and, for all relations except child anxiety, parents’ own anxiety and depression symptoms.     

Dyadic Affective Flexibility and Emotional Inertia in Relation to Youth Psychopathology: An Integrated Model at Two Timescales

The current review examines characteristics of temporal affective functioning at both the individual and dyadic level. Specifically, the review examines the following three research questions: (1) How are dyadic affective flexibility and emotional inertia operationalized, and are they related to youth psychopathology? (2) How are dyadic affective flexibility and emotional inertia related, and does this relation occur at micro- and meso-timescales? and (3) How do these constructs combine to predict clinical outcomes? Using the Flex3 model of socioemotional flexibility as a frame, the current study proposes that dyadic affective flexibility and emotional inertia are bidirectionally related at micro- and meso-timescales, which yields psychopathological symptoms for youth. Specific future directions for examining individual, dyadic, and cultural characteristics that may influence relations between these constructs and psychopathology are also discussed.     

Friendship Intimacy Exchange Buffers the Relation between ADHD Symptoms and Later Social Problems among Children Attending an After-School Care Program

The friendships of children displaying symptoms of attention-deficit/hyperactivity disorder (ADHD) have been understudied, particularly in comparison to the domain of peer rejection. This study tested whether friendship intimacy exchange buffers the prospective relation between ADHD symptoms and social problems 1 year later in a sample of children attending a community-based after-school program. Children (N?=?131; 53 % boys; 66 % African American) ranging from 5 to 13 years of age participated in this study. At baseline, children reported on friendship intimacy exchange with their identified best friend, and program staff rated children on ADHD symptoms and social problems. Staff ratings of children’s social problems were collected again 1 year later. Multiple regression analyses indicated that, after controlling for demographic variables and baseline social problems, friendship intimacy exchange significantly moderated the association between ADHD symptoms and social problems at the one-year follow-up. Specifically, the relation between ADHD and social problems was no longer significant for children reporting high levels of friendship intimacy exchange. This moderation was not further qualified by either child age or sex, although boys were more likely than girls to report low rates of friendship intimacy exchange. These findings indicate the importance of friendship intimacy for children displaying ADHD symptoms, who often experience significant peer problems. Friendship quality may be a promising target for prevention and intervention efforts in mitigating some of the long-term social problems associated with ADHD symptomatology, and future research is needed to extend these findings to other domains of friendship quality and clinical samples of children with ADHD.     

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.