Ecological model of school engagement and attention-deficit/hyperactivity disorder in school-aged children

Hyperactivity and Impulsivity Symptoms Mediate the Association Between Adverse Childhood Experiences and Reading Achievement: A LONGSCAN Cohort Study

Adverse Childhood Experiences (ACEs) include various childhood stressors that can negatively impact the health and well-being of children. ACEs are associated with poor academic achievement. Attention is strongly associated with academic achievement, and there is a graded relationship between ACEs exposure and subsequent development of parent-reported ADHD; however, it is unclear whether ADHD symptoms mediate the relationship between ACEs and academic achievement. This study tested a model of mediation by ADHD symptoms between ACEs and academic achievement (measured by reading score). This retrospective cohort analysis utilized data from the Longitudinal Study on Child Abuse and Neglect (LONGSCAN), a data consortium exploring the impact of child maltreatment (n = 494). There were relatively even numbers of male and female child participants, and the majority of caregivers were either non-Hispanic White or Black. Path analyses were modeled for ACEs as a sum score and separately for individual ACE exposures, with number of symptoms of Inattention (IN) and Hyperactivity/Impulsivity (H/I) as mediators, and academic achievement as the outcome, adjusting for covariates. ACEs were highly prevalent in this sample (M = 5.10, SD = 1.90). After retaining significant covariates, significant direct associations (P < .05) were seen between ACE sum score and IN (β = .14) and H/I (β = .21), and between H/I and reading score (β=-.14). A higher ACE score was associated with lower reading scores through variation in H/I, but not IN. H/I mediated the relationship between ACEs and reading score in this high-risk population, providing new insight into relationships between ACEs and academic achievement, which can inform interventions.

The long-term impact of the COVID-19 pandemic on children with ADHD in terms of participation, support, and barriers at home

PURPOSE

The purpose of this study was to compare the long-term impact of the COVID-19 pandemic on participation, support, and barriers at home in children with attention deficit hyperactivity disorder (ADHD) and without ADHD.

DESIGN AND METHODS

This study included a total of 227 participants with a mean age of 11.93 ± 2.96 years, comprising 116 children and adolescents with ADHD and 111 without ADHD. The parents or primary caregivers of all the children completed the Participation and Environment Measure for Children and Youth (PEM-CY), which was used to assess participation and environmental factors in the home. The Student's t-test was used to compare numeric data and Chi-square test to categorical data between children and adolescents with ADHD and those without ADHD in all three settings.

RESULTS

The children with ADHD were determined to play computer and video games significantly more than children without ADHD (p < 0.001). The mean frequency of participation in arts, crafts, music, hobbies (p < 0.001), school preparation (<0.0001), and homework (<0.003) was significantly higher in children without ADHD. A moderate effect size (ϕ = 0.42) was determined in respect of cognitive demands making it more difficult for children with ADHD to participate in home activities than children without ADHD.

CONCLUSIONS

Children with ADHD were negatively affected in terms of participating in home activities than their typically developing peers. In addition, cognitive demands prevented their participation and involvement in the home environment while cognitive demands were a support for non-ADHD children.

PRACTICAL IMPLICATIONS

A highlight of this research was the comprehensive investigation of the long-term effect of the COVID-19 pandemic on participation in all activities at home, in addition to the support and barriers in the home environment for children with ADHD compared to typically developing peers.

Early Adverse Childhood Experiences and Positive Functioning during Adolescence

Adverse childhood experiences (ACEs) have been shown to have consequences for adolescent development, yet little is known about the association between ACEs and positive functioning. Positive functioning evaluates engagement, perseverance, optimism, connectedness, and happiness, which are intimately related to pro-social behavior. As skills associated with sociability in adolescence often carry on into adulthood, understanding the developmental origins in inequalities in pro-social behavior, as measured by positive functioning, is key to ensuring equitable life chances across the life course. Subsequently, the Fragile Families and Child Wellbeing Study (FFCWS; n = 3444) was used to examine how early exposure to cumulative ACEs, plus the timing and duration of those ACEs may be associated with positive functioning development in adolescence. The sample consisted of urban-born youth (49% female) with the mean age of 15. Racial/ethnic breakdown of the sample is 18% non-Hispanic White, 49% non-Hispanic Black, 25% Hispanic, and 8% "Other". Overall, estimates suggest that roughly 88% of these youth experienced at least one ACE by age five. The findings indicate that cumulation, timing, and duration of early ACEs are related to overall adolescent positive functioning and four out of the five domains (perseverance, optimism, connectedness, and happiness), even after controlling for more recent ACEs. This study highlights the critical impact of very early ACEs on youth positive functioning, which may confer further physical, mental, and social disadvantages into adulthood. Positive functioning can serve as a protective factor against some of the negative consequences of adversity, and ensuring that all families receive proper supports may limit the lifelong effects of adversity, and most importantly, prevent ACEs from occurring in the first place.

Adolescent Mental Health and Family Economic Hardships: The Roles of Adverse Childhood Experiences and Family Conflict

Rising and economically disproportionate rates of adverse mental health outcomes among children and youth warrant research investigating the complex pathways stemming from socioeconomic status. While adverse childhood experiences (ACEs) have been considered a possible mechanism linking socioeconomic status (SES) and child and youth psychopathology in previous studies, less is understood about how family environments might condition these pathways. Using data from a longitudinal, multiple-wave study, the present study addresses this gap by examining the direct relationships between family economic status and youth internalizing and externalizing symptoms, if ACEs mediate these relationships, and if conflictual family environments moderate these direct and indirect relationships. The data were obtained from 5510 youth participants [mean age at baseline = 9.52 (SD = 0.50), 47.7% female, 2.1% Asian, 10.3% Black, 17.6% Hispanic, 9.8% Multiracial/Multiethnic, 60.2% White] and their caretakers from the baseline, 1-year, and 2-year follow up waves. Conditional process analysis assessed the direct, indirect, and moderated relationships in separate, equivalent models based on youth- versus caregiver-raters of ACEs and youth psychopathology to capture potential differences based on the rater. The results of both the youth- and caregiver-rated models indicated that lower family economic status directly predicted higher levels of externalizing symptoms, and ACEs indirectly accounted for higher levels of internalizing and externalizing symptoms. Additionally, family conflict moderated some, but not all, of these relationships. The study's findings highlight that lower family economic status and ACEs, directly and indirectly, contribute to early adolescent psychopathology, and conflictual family environments can further intensify these relationships. Implementing empirically supported policies and interventions that target ACEs and family environments may disrupt deleterious pathways between SES and youth psychopathology.

Impact of COVID-19 on Youth With ADHD: Predictors and Moderators of Response to Pandemic Restrictions on Daily Life

We examined COVID-19 symptoms and infection rates, disruptions to functioning, and moderators of pandemic response for 620 youth with ADHD and 614 individually matched controls (70% male; M_age = 12.4) participating in the Adolescent Brain and Cognitive Development study. There were no group differences in COVID-19 infection rate; however, youth with ADHD were more likely to exhibit COVID-19 symptoms (d = 0.25), greater sleep problems (d = -0.52), fear and negative emotions to infection risk (d = -0.56), trouble with remote learning (d = -0.54), rule-breaking behavior related to COVID-19 restrictions (d = -0.23), family conflict (d = -0.13), and were less prepared for the next school year (d = 0.38). Youth with ADHD were less responsive to protective environmental variables (e.g., parental monitoring, school engagement) during the pandemic and may need more specialized support with return to in-person schooling and daily activities.

Effects of the Targeted Intervention for Five- to Six-Year-Old Children Affected by Attentional and Concentration Developmental Risks: Results of a Dynamic Prospective Cohort Study Conducted in Socially Deprived Regions in Germany

Epidemiological data reveal that there is a need for prevention measures specifically targeted at children with low SES. In the German federal state Mecklenburg-Western Pomerania preschools in socially deprived regions can apply for additional funds to support children with developmental risks. Mandatory criteria for obtaining these funds involve an annual assessment of all children using the “Dortmunder Developmental Screening for Preschools (DESK 3–6 R).” This instrument can detect and monitor developmental risks in the domains fine motor skills, gross motor skills, language, cognition, and social development. In this study, we examine the domain “Attention and concentration,” which is included for the 5 to 6-year-old age group, using data from two consecutive survey waves (sw). Research questions: (1) Does the prevalence rate ratio (PRR) improve over time? (2) Is the rate of improvements (developmental risk at sw1, no developmental risk at sw2) higher than the rate of deteriorations (no developmental risk at sw1, developmental risk at sw2)? Prospective cohort analysis (n = 940). The prevalence rate of a developmental risk in this DESK domain decreases over time (PRR = 0.78; p = 0.019). The ratio of the rate of improvements is 8.47 times higher than the rate of deteriorations. The results provide evidence of the effectiveness of targeted intervention measures in preschools focusing on skills that improve attention and concentration. This is significant considering the small-time interval and the categorization method of DESK scores. Nevertheless, over the same time period, the DESK results of some children deteriorated. Therefore, preschools also have to be aware that it is natural for some children to show modest declines in their skills over time. German Clinical Trials Register, ID: DRKS00015134, Registered on 29 October 2018, retrospectively registered.

Understanding ADHD in Black Adolescents in Urban Schools: A Qualitative Examination of Factors that Influence ADHD Presentation, Coping Strategies, and Access to Care

The high school years are a challenging developmental period for adolescents with attention-deficit/hyperactivity disorder (ADHD), their families, and those who work with them in the school system. Moreover, racially minoritized families and schools in low-resource, urban settings often experience additional adverse experiences that can make access to evidence-based mental health care particularly difficult. This qualitative investigation into the experiences of Black high school students with ADHD, their caregivers, teachers, and school mental health providers (SMHPs) aimed to understand this community's experiences with ADHD across development and to explore the barriers/facilitators to adequate services. Through focus group interviews with stakeholders (i.e., 6 adolescents with a diagnosis of ADHD, 5 caregivers of adolescents with ADHD, 6 teachers, 5 school mental health providers), themes emerged related to (1) developmental changes observed in ADHD presentation in high school students and (2) contextual factors (including barriers/facilitators to optimal school and home functioning). These themes led to the development of an ecological model that show various contextual factors influencing the experiences of Black adolescents with ADHD in under-resourced urban public high schools (e.g., adolescents' coping strategies, caregiver involvement, teacher burden or lack of ADHD-knowledge, socioeconomic status, access to care). This qualitative study represents the first step of a treatment development project assessing the implementation of a depression prevention intervention for Black adolescents with ADHD in urban public-school settings. Clinical implications (e.g., coordination of care between home and schools, increasing attention to social determinants of health, ensuring culturally competent discussion of ADHD and its treatment) are discussed.

School Engagement and Context: A Multilevel Analysis of Adolescents in 31 Provincial-Level Regions in China

According to ecological system theory, both the microsystem environment (home environment) and the more macrolevel environment (provincial environment) influence school engagement in adolescents. This study tests an ecological model of adolescents’ school engagement with 19,084 middle school students across 31 provincial-level regions in China. Multilevel modeling is used to predict adolescents’ school engagement (behavior, emotion, and cognition) at two levels, individual [gender and family socioeconomic status (SES)] and provincial (economy, public cultural facilities, technological industry and education). The school engagement of students varies significantly across provincial-level regions. SES positively affects the school engagement of students. Students benefit from the provincial environment when the economy is booming, public cultural facilities are adequate and education is flourishing. The development of the technology industry fails to boost students’ school engagement. Limitations and future directions are discussed.

Social participation to support good mental health in neurodisability

BACKGROUND

Young people with neurodisability experience lower levels of mental wellbeing and are at increased risk of mental illness compared with their non-disabled peers. Social participation is recognized as a protective factor against mental illness and a potential pathway to support better mental wellbeing in neurodisability.

METHOD

This co-design study involved young people, parents and clinicians. First, possible interventions were identified through a rapid systematic evidence review. Any study designs were considered, which included people with a neurodisability aged 0-18 years, which evaluated a therapy intervention with social participation and mental health outcomes. Titles and abstracts were screened by two reviewers, from the included studies data were extracted and then presented using written summaries. Second, the summaries were discussed and prioritized in stakeholder groups with young people, parents and clinicians. Groups were audio recorded and framework analysis was used to identify and specify intervention elements and their delivery.

RESULTS

The evidence review identified 13,870 records, from which 43 were included. These records were published 1994-2017 and reported studies with 4-249 participants aged 16 months-18 years with a range of neurodisabilities. Five intervention approaches (social skills training, arts, sports, technology and play) were identified from the review. Two themes emerged from the stakeholder groups: intervention in the real world, feeling judged and feeling safe. The groups prioritized an intervention in real-world social leisure contexts (i.e. existing clubs and groups) using nine key intervention elements (e.g. feedback and positive verbal reinforcement) delivered by club leaders trained by healthcare professionals using five intervention procedures (e.g. a manual and video training).

CONCLUSION

This study has identified core elements of social participation interventions that may improve mental health outcomes in young people with neurodisability, which should now be tested.

Definitions and Operationalization of Mental Health Problems, Wellbeing and Participation Constructs in Children with NDD: Distinctions and Clarifications

Children with impairments are known to experience more restricted participation than other children. It also appears that low levels of participation are related to a higher prevalence of mental health problems in children with neurodevelopmental disorders (NDD). The purpose of this conceptual paper is to describe and define the constructs mental health problems, mental health, and participation to ensure that future research investigating participation as a means to mental health in children and adolescents with NDD is founded on conceptual clarity. We first discuss the difference between two aspects of mental health problems, namely mental disorder and mental illness. This discussion serves to highlight three areas of conceptual difficulty and their consequences for understanding the mental health of children with NDD that we then consider in the article: (1) how to define mental health problems, (2) how to define and assess mental health problems and mental health, i.e., wellbeing as separate constructs, and (3) how to describe the relationship between participation and wellbeing. We then discuss the implications of our propositions for measurement and the use of participation interventions as a means to enhance mental health (defined as wellbeing). Conclusions: Mental disorders include both diagnoses related to impairments in the developmental period, i.e., NDD and diagnoses related to mental illness. These two types of mental disorders must be separated. Children with NDD, just like other people, may exhibit aspects of both mental health problems and wellbeing simultaneously. Measures of wellbeing defined as a continuum from flourishing to languishing for children with NDD need to be designed and evaluated. Wellbeing can lead to further participation and act to protect from mental health problems.