Academic pathways between attention problems and depressive symptoms among urban African American children

Networks of Neurodevelopmental Traits, Socioenvironmental Factors, Emotional Dysregulation in Childhood, and Depressive Symptoms Across Development in Two U.K. Cohorts

OBJECTIVE

Previous population-based studies have identified associations between childhood neurodevelopmental traits and depression in childhood, adolescence, and young adulthood. However, neurodevelopmental traits are highly correlated with each other, which could confound associations when traits are examined in isolation. The authors sought to identify unique associations between multiple neurodevelopmental traits in childhood and depressive symptoms across development, while taking into account co-occurring difficulties, in multivariate analyses.

METHODS

Data from two U.K. population-based cohorts, the Twins Early Development Study (TEDS) (N=4,407 independent twins) and the Avon Longitudinal Study of Parents and Children (ALSPAC) (N=10,351), were independently analyzed. Bayesian Gaussian graphical models were estimated to investigate pairwise conditional associations between neurodevelopmental traits (autism and ADHD symptoms and general cognitive, learning, and communication abilities), socioenvironmental stressors (academic performance and peer relations), and emotional dysregulation in childhood (ages 7-11) and depressive symptoms across development (ages 12, 16, and 21).

RESULTS

In both cohorts, bivariate correlations indicated several associations between neurodevelopmental traits and depressive symptoms across development. However, based on replicated findings across cohorts, these pairs of variables were mostly conditionally independent, and none were conditionally associated, after accounting for socioenvironmental stressors and emotional dysregulation. In turn, socioenvironmental stressors and emotional dysregulation were conditionally associated with both neurodevelopmental traits and depressive symptoms. Based on replicated findings across cohorts, neurodevelopmental traits in childhood could be associated only indirectly with depressive symptoms across development.

CONCLUSIONS

This study indicates that associations between childhood neurodevelopmental traits and depressive symptoms across development could be explained by socioenvironmental stressors and emotional dysregulation. The present findings could inform future research aimed at the prevention of depression in youths with neurodevelopmental disorders.

Practitioner Review: Attention-deficit hyperactivity disorder and autism spectrum disorder - the importance of depression

Young people with neurodevelopmental disorders, such as attention-deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD), show high rates of mental health problems, of which depression is one of the most common. Given that depression in ASD and ADHD is linked with a range of poor outcomes, knowledge of how clinicians should assess, identify and treat depression in the context of these neurodevelopmental disorders is much needed. Here, we give an overview of the latest research on depression in young people with ADHD and ASD, including possible mechanisms underlying the link between ADHD/ASD and depression, as well as the presentation, assessment and treatment of depression in these neurodevelopmental disorders. We discuss the implications for clinicians and make recommendations for critical future research in this area.

Developmental Trajectory of Inattention and Its Association With Depressive Symptoms in Adolescence: Peer Relationships as a Mediator

This study investigated the developmental trajectory of inattention symptoms as a predictor of later depressive symptoms in adolescence, and examined potential mediating role of peer relationships in this process. Participants were adolescents who were part of the large longitudinal panel study on Korean Youths, Korean Children & Youth Panel Survey 2010 (KCYPS 2010) of the National Youth Policy Institute (NYPI). Specifically, data were drawn from two cohorts of KCYPS that differed in participant age (Panel 1: 2003 birth cohort, n = 2,342, 48.2% girls; Panel 2: 2000 birth cohorts, n = 2,378, 40.0% girls). We analyzed data collected from 2010 to 2016 when children in panel 1 were 6-7 to 12-13 years old, and children in panel 2 were 9-10 to 15-16 years old. Results of latent growth modeling (LGM) were as follows. In Panel 1, the inattention symptoms increased from 9-10 to 12-13 years. Otherwise, the inattention symptoms decreased from 11-12 to 15-16 years in panel 2. Additionally, in both panels, initial status and slope of inattention significantly predicted later levels of depressive symptoms, and peer relationships partly mediated the association between inattention trajectory and depressive symptoms. The findings are discussed with respect to considering the growth of inattention and the quality of peer relationships as promising targets for early identification and intervention of depression in adolescents.

Exploring the relationship between ADHD, its common comorbidities, and their relationship to organizational skills

BACKGROUND

Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder affecting numerous executive functioning skills, such as organizational skills. While the relationship between the inattention aspect of ADHD and poor organizational skills is well documented, it is still unclear if lower organizational skills are only associated with ADHD or if they are also associated with other comorbid disorders commonly diagnosed in conjunction with ADHD. The purpose of the present study is to investigate the relationship between organizational skills and ADHD in adults, as well as the impact of comorbid disorders on ADHD in relation to organizational skills.

METHODS

Four hundred seven (n = 201 with a diagnosis of ADHD) adults from the general population were recruited online. Participants completed a measure of organizational skills, measures assessing levels of ADHD, depression, and anxiety, and extensive demographic information related to their diagnosis of ADHD or other possible diagnosis.

RESULTS

Participants with a diagnosis of ADHD were significantly more likely to have a comorbid diagnosis of depression and/or anxiety. Organizational skills were significantly lower in individuals who reported having received a diagnosis of ADHD, but not in those with a past diagnosis of depression and anxiety. However, organizational skills were lower in individuals currently experiencing higher levels of depression and anxiety. The results of regression analyses suggest that levels of organizational skills are most strongly predicted by inattention and more weakly predicted by comorbid disorders.

DISCUSSION

These results highlight the centrality of organizational skills deficit in ADHD as well as the influence of the inattention component over other components commonly observed in ADHD on organizational skills. Suggestions for treatment of ADHD in adults are discussed.

Examining the validity of the Early Identification System - Student Version for screening in an elementary school sample

As many as 1 in 5 youth in the United States experience social, emotional, and behavioral problems. However, many students with mental health concerns are unidentified and do not receive adequate care. The purpose of this study was to evaluate the factor structure, measurement invariance, and the concurrent and predictive validity of the Early Identification System-Student Report (EIS-SR), a screener for social, emotional, and behavioral problems, using a sample of over 5000 students from Grades 3 to 5. The EIS-SR was developed by using extant literature on the risk indicators that lead to social, emotional, and behavioral challenges among children and youth. As expected, seven subscales were identified as having adequate factor loadings. Furthermore, the measure was determined to be invariant across grade level (n = 5005), gender (n = 5005), and between Black and White students (n = 1582). The concurrent validity of the Internalizing Behavior, Attention and Academic Issues, Emotion Dysregulation, and School Disengagement subscales was supported by correlations with comparable subscales of the Behavior Assessment System for Children-3rd Edition (BASC-3; n = 382). Additionally, the EIS-SR subscales administered in the fall of the school year were predictive of important outcomes in spring, including attendance (n = 4780), disciplinary referrals (n = 4938), bully victimization (n = 4670), math academic achievement scores (n = 4736), and reading (n = 4772) academic achievement scores. The EIS-SR holds promise as a feasible and technically adequate screening tool for use in elementary schools.

Dependent Stress Mediates the Relation Between ADHD Symptoms and Depression

Objective: Depression and attention-deficit hyperactivity disorder (ADHD) are prevalent and highly comorbid. ADHD symptoms are associated with specific dependent (i.e., self-generated) stressors in children, and there is a strong link between dependent stress and depression. Despite continued comorbidity of ADHD and depressive symptoms into adulthood, it is unknown whether stress generation mediates the relation between ADHD and subsequent depressive symptoms in emerging adulthood, a period of heightened stress. Method: We tested this mediation model in a semester-long longitudinal study of 224 college students (aged 18-23 years). We additionally tested whether this model differed between inattentive versus hyperactive/impulsive ADHD symptoms given evidence that they vary in their relations to stress and depression. Results: Dependent stress mediated the association between total ADHD symptoms at baseline and later depressive symptoms; these effects were equivalent for inattentive versus hyperactive/impulsive ADHD symptoms. Conclusion: These findings suggest stress generation as a mechanism for increased depression in individuals with ADHD symptoms.

Impact of Perceived Social Support on the Relationship between ADHD and Depressive Symptoms among First Year Medical Students: A Structural Equation Model Approach

BACKGROUND

Attention deficit hyperactivity disorder (ADHD) is associated with depression among college students, while perceived social support is also associated with depression, especially among young adults. This study aimed to examine to what extent perceived social support mediated the relationship between ADHD symptoms and depressive symptoms.

METHODS

In total, 124 first year medical students completed the Adult ADHD Self-Report Scale Screener (ASRS), the Patient Health questionnaire-9 and the revised Thai Multidimensional scale of perceived social support reflecting ADHD symptoms, depressive symptoms, and perceive social support, i.e., family members, friends and other significant people, respectively. Structural equation modeling was used to investigate the hypothesized mediation model.

RESULTS

ADHD symptoms exhibited a significant indirect effect on depressive symptoms via perceived social support. ADHD symptoms initially had a direct effect on depression; thereafter, it reduced to a non-significance effect after perceived social support was added. The total variance explained by this model was 35.2%. The mediation model with family support as a mediator showed the highest effect size.

CONCLUSIONS

The study highlighted the importance of perceived social support, particularly family support, on depressive symptoms among young medical students experiencing ADHD symptoms. The model suggests promising relationships for further research on ADHD-related depression and potential treatment in the future.

Association of Child Mental Health with Child and Family Characteristics in Rural China: A Cross-Sectional Analysis

Assessing the mental health problems encountered by school children and understanding the contributing factors are crucial to inform strategies aimed at improving mental health in low-resource contexts. However, few studies have investigated the mental health problems among disadvantaged children in poorer countries. This study examines the prevalence of mental health problems in rural China and their association with child and family characteristics. The study uses survey data from 9696 children in 120 rural primary schools and measures child mental health using the Strengths and Difficulties Questionnaire (SDQ). Overall, 17.9% of the sample children were found to be in the abnormal range of the SDQ total difficulties scores. The mean score was 12.93 (SD = 4.94). Abnormal scores were associated with child and family characteristics, including older child age (Odds Ratio, OR = 0.704, 95% CI: 0.611, 0.810; p < 0.001), gender (OR = 1.235, 95% CI: 1.112, 1.371; p < 0.001), and academic performance (OR = 0.421, 95% CI: 0.369, 0.480; p < 0.001). Reading time was found to be protective for mental health. Risk factors include excessive screen time (OR = 1.685, 95% CI: 1.409, 2.016; p < 0.001) and being bullied (OR = 3.695, 95% CI: 3.301, 4.136; p < 0.001). Our study suggests that future mental health illness prevention programs in rural China should consider targeting different aspects of children's social contexts.

Cognitive mechanisms underlying depressive disorders in ADHD: A systematic review

The risk for major depressive disorder (MDD) is considerably increased in young adults with attention-deficit/hyperactivity disorder (ADHD) but underlying mechanisms are poorly understood. This review explores ADHD-specific neurocognitive impairments as possible underlying mechanisms for ADHD-depression comorbidity. Two systematic literature searches were conducted in EBSCOhost, PubMED, and Cochrane Reviews databases according to PRISMA guidelines. The first search identified 18 meta-analyses of cross-sectional and longitudinal studies on cognitive dysfunctions in MDD across the lifespan. The second search identified six original studies on reaction time variability in MDD. During acute depression, children and adults showed cognitive deficits that overlapped with some of the ADHD-related impairments. Findings from remitted patients, high-risk individuals, and few prospective studies suggest that a subset of these shared impairments, specifically executive dysfunctions (selective attention, verbal fluency, working memory) and long-term memory problems, are candidate pre-existing risk markers of depression. We discuss if and how these specific neurocognitive mechanisms may mediate developmental pathways from ADHD to depression. If replicated by longitudinal studies, these findings may guide future prevention strategies.

The Cascading Effects of Externalizing Behaviors and Academic Achievement Across Developmental Transitions: Implications for Prevention and Intervention

Children's behavior and achievement problems are interrelated causes of distress for individuals, schools, and families, and generate long-term individual and societal costs. Yet, little is known about how the timing and direction of relationships involving achievement and problem behaviors (1) varies by standardized versus teacher ratings of achievement and (2) changes as students enter adolescence and begin secondary school. Using data from the Study of Early Child Care and Youth Development (N = 1048, 50.05% female), we employed longitudinal structural equation modeling to examine the relationship between externalizing behaviors and two forms of achievement from third through ninth grade. Results revealed that externalizing behaviors in grades three, five, and six directly and indirectly influenced teacher ratings of school achievement in grades 5, 6, and 9, and indirectly influenced standardized assessments of achievement over time. The reciprocal relationships involving externalizing behaviors and school achievement were especially strong from grade 6 to grade 9with their contemporaneous association peaking in grade 9. Demographic and maturational factors influenced the average levels of externalizing behaviors and achievement scores over development, but none altered the timing and direction of these relationships. Our findings highlight early adolescence as an important period for implementing evidence-based interventions related to the reduction of externalizing behaviors and improvements in achievement. Implications for prevention research, practice, and policy are discussed.

Depressive Symptoms and the Link with Academic Performance among Rural Taiwanese Children

Previous studies reflect a high prevalence of depressive symptoms among Taiwanese adolescents (ages 13–18), but there is an absence of literature related to the risk of depression of children in Taiwan (ages 6–12), particularly among potentially vulnerable subgroups. To provide insight into the distribution of depressive symptoms among children in rural Taiwan and measure the correlation between academic performance, we conducted a survey of 1655 randomly selected fourth and fifth-grade students at 92 sample schools in four relatively low-income counties or municipalities. Using the Center for Epidemiological Studies-Depression Scale (CES-D) we assessed the prevalence of depressive symptoms in this sample, in addition to collecting other data, such as performance on a standardized math test as well as information on a number of individual and household characteristics. We demonstrate that the share of children with clinically significant symptoms is high: 38% of the students were at risk of general depression (depression score ≥ 16) and 8% of the students were at risk of major depression (depression score > 28). The results of the multivariate regression and heterogeneous analysis suggest that poor academic performance is closely associated with a high prevalence of depressive symptoms. Among low-performing students, certain groups were disproportionately affected, including girls and students whose parents have migrated away for work. Results also suggest that, overall, students who had a parent who was an immigrant from another country were at greater risk of depression. These findings highlight the need for greater resource allocation toward mental health services for elementary school students in rural Taiwan, particularly for at-risk groups.

Attention-deficit/hyperactivity disorder symptoms in children with surgically corrected Ventricular Septal Defect, Transposition of the Great Arteries, and Tetralogy of Fallot

BACKGROUND

Children with complex CHD are at risk for psychopathology such as severe attention-deficit/hyperactivity disorder symptoms after congenital heart surgery.

OBJECTIVE

The aim of this study was to investigate if children with Ventricular Septal Defect, Transposition of Great Arteries, or Tetralogy of Fallot have an increased occurrence of attention-deficit/hyperactivity disorder symptoms compared with the background population and to investigate differences between the three CHDs in terms of occurrence and appearance of attention-deficit/hyperactivity disorder symptoms.

METHOD

A national register-based survey was conducted, including children aged 10-16 years with surgically corrected CHDs without genetic abnormalities and syndromes. The Attention-Deficit/Hyperactivity Disorder-Rating Scale questionnaires were filled in by parents and school teachers.

RESULTS

In total, 159 out of 283 questionnaires were completed among children with CHDs and compared with age- and sex-matched controls. Children with CHDs had significantly increased inattention scores (p = 0.009) and total attention-deficit/hyperactivity disorder scores (p = 0.008) compared with controls. Post hoc analyses revealed that children with Tetralogy of Fallot had significantly higher inattention scores compared with children both with Ventricular Septal Defect (p = 0.043) and controls (p = 0.004).

CONCLUSION

Attention-deficit/hyperactivity disorder symptoms and inattention symptoms were significantly more frequent among children aged 10-16 years with CHDs, in particular in children with corrected Tetralogy of Fallot.

Attention deficit hyperactivity disorder and comorbidity: A review of literature

Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder with onset in early childhood. It is a clinically heterogenous condition with comorbidity posing a distinct challenge to diagnosing and managing these children and adolescents. This review aims to provide an overview of comorbidity with ADHD including other neurodevelopmental disorders, learning disorders, externalising and internalising disorders. Challenges in screening for, diagnosing and managing comorbidity with ADHD are summarised. Also, methodological challenges and future directions in research in this interesting field are highlighted.

Relational impairments, sluggish cognitive tempo, and severe inattention are associated with elevated self-rated depressive symptoms in adolescents with ADHD

This study examines how ADHD-related symptoms and impairments interact to predict depression symptoms in young adolescents with ADHD. A sample of 342 adolescents (71% male, mean age = 13 years old) with DSM-IV-TR diagnosed ADHD completed baseline clinical assessments upon entry to a psychosocial treatment study for ADHD. Ratings of ADHD and sluggish cognitive tempo (SCT) symptoms, and social and academic impairment were obtained from parents, while ratings of depressive symptoms and conflict with parents were obtained from youth. Among adolescents with ADHD, elevated depressive symptoms were associated with higher SCT symptom severity, lower hyperactive/impulsive (HI) symptom severity, higher social impairments, higher conflict with parents, and lower academic problems. Interaction effects indicated that clinically significant depressive symptoms were most likely to occur when high levels of parent-youth conflict were present along with high inattentive (IN) symptoms, high SCT, and/or low HI. Among children and adolescents with ADHD, depression prevention efforts might target IN/SCT symptom management, as well as improving interpersonal relationships with parents and peers. Future work is needed to verify these findings longitudinally.

Increased risk of developing psychiatric disorders in children with attention deficit and hyperactivity disorder (ADHD) receiving sensory integration therapy: a population-based cohort study

Parents of children with attention deficit hyperactivity disorder (ADHD) have been found to prefer sensory integration (SI) training rather than guideline-recommended ADHD treatment. This study investigated whether SI intervention for children with ADHD was associated with a reduced risk of subsequent mental disorders. From children < 8-years-old newly diagnosed with ADHD in a nationwide population-based dataset, we established a SI cohort and a non-SI cohort (N =  1945) matched by propensity score. Incidence and hazard ratios of subsequent psychiatric disorders were compared after a maximum follow-up of 9 years. The incidence of psychiatric disorders was 1.4-fold greater in the SI cohort, with an adjusted hazard ratio of 1.41 (95% confidence interval 1.20-1.67), comparing to the non-SI cohort. Risks were elevated for emotional disturbances, conduct disorders, and adjustment disorders independent of age, gender, or comorbidity. Among children with only psychosocial intervention, the incidence of psychiatric disorders was 3.5-fold greater in the SI cohort than in the non-SI cohort. To our knowledge, this is the first study to report an increased risk of developing psychiatric disorders for children with ADHD who received SI compared to those who did not. Potential adverse effects of SI for ADHD children should be carefully examined and discussed before practice.

Does Child Likeability Mediate the Link Between Academic Competence and Depressive Symptoms in Early Elementary School?

The present study investigated the role of teacher-rated likeability as a mediator of the relation between low academic competence and depressive symptoms in elementary-aged children. Analyses focused on a sample of children at risk for child maltreatment living in Hawaii (n = 380). Structural equation modeling supported the hypothesized negative relations between academic competence in first grade and depressive symptoms in third grade controlling for correlated constructs (e.g., baseline social avoidance, parenting stress, externalizing problems, and internalizing symptoms). Teacher-rated likeability in second grade negatively mediated the effect of academic competence on depressive symptoms. Implications for understanding the role of early academic skill deficits and social judgments on risk for depressive symptoms as well as recommendations for interventions and prevention strategies are discussed.

Estimated prevalence and associated risk factors of attention deficit hyperactivity disorder (ADHD) among medical college students in a Chinese population

BACKGROUND

To investigate the prevalence of attention deficit hyperactivity disorder (ADHD) among medical college students in a Chinese population.

METHODS

A cross-sectional design was used to collect demographic data on participants and their symptoms of ADHD, anxiety, and depression. Data were collected through questionnaires filled out on a computer or through WeChat, a widely used social media app.

RESULTS

The prevalence of ADHD among 5693 college students was 3.5% (3.02∼3.98%). Individuals with ADHD showed higher scores on scales of anxiety and depression symptoms (both p < 0.05) than the general population. There was a significant difference in the prevalence of ADHD grouped by smoking, drinking, suicidal ideation, suicidal plans, suicidal attempt, anxiety and depression (p < 0.05). The odds ratio (OR) of ADHD was high for suicidal ideation, suicide plans, suicide attempts, anxiety and depression, with ORs of 5.901, 5.46, 6.011, 8.037 and 7.88, respectively. The ORs of suicidal behaviors for ADHD were decreased after adjusting for covariates such as drinking, smoking and depression.

LIMITATIONS

The sample was exclusively selected from three medical-related colleges, which might not be best representation of college students in China. Furthermore, majority of the participants were females.

CONCLUSIONS

ADHD remains a common disorder among Chinese medical college students and is significantly associated with suicidal behaviors, anxiety and depression. It is important to increase awareness and promote effective interventions to this particular population.

Internet addiction and attention-deficit-hyperactivity disorder: Effects of anxiety, depression and self-esteem

BACKGROUND

Attention-deficit-hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders of childhood. Behavioral disinhibition, poor neurocognitive skills and immediate reward preference in children with ADHD have been suggested as risk factors for Internet addiction (IA). The aim of the present study was therefore to investigate the relationship between IA and depression, anxiety, and self-esteem in adolescents with ADHD, and to identify the features of Internet use that predict IA.

METHODS

We studied 111 patients with ADHD aged 12-18 years, and 108 healthy controls. The ADHD patients and controls were asked to complete a sociodemographic data form, the Internet Addiction Scale (IAS), Children's Depression Inventory, Childhood Screening Scale for Anxiety in Children, and the Rosenberg Self-Esteem Scale.

RESULTS

IAS total score in the adolescents with ADHD was significantly higher than in the control group. Compared with the control group, the ADHD group depression scale score was significantly higher, and self-esteem score significantly lower (P < 0.05 for both). There was no difference between the groups in anxiety score. IAS score had a positive correlation with depression and anxiety scores, and a negative correlation with self-esteem score.

CONCLUSION

The relationship between IA scale score and depression, anxiety and self-esteem scale scores were similar in the ADHD and the control group. In addition, IAS subscale and total scores were significantly higher in the ADHD group than the control group, even after controlling for the effects of self-esteem, depression and anxiety scores. Thus, ADHD is thought to be an independent risk factor for depression, anxiety and self-esteem, and, hence, for IA.

Trajectories of internalizing problems during the transition to adolescence in children with and without conduct problems

Children with conduct problems are at greater risk for internalizing problems. The objectives of this study were to (1) examine trajectories of internalizing problems among children with and without clinically significant conduct problems during the transition to adolescence; and (2) identify how academic achievement, peer rejection, parent socioeconomic status, maternal distress, parental warmth, child temperament, and receptive verbal functioning explained differences between the two groups. Children with conduct problems ( N = 388, 45% girls) and a comparison sample without conduct problems ( N = 299, 52% girls) were recruited from Quebec, Canada, when they were between the ages of 7 and 10 years, and were followed across 4 years. Mothers and teachers provided information on internalizing problems each year. Having clinically significant conduct problems was associated with higher initial levels of internalizing problems according to mothers and teachers, but not with changes in internalizing problems over time. With regards to teacher ratings, academic achievement, peer rejection, and negative emotionality partially explained differences in internalizing problems for youth with and without conduct problems. For mother ratings, maternal distress, negative emotionality, and peer rejection completely explained the association for girls, and partially explained the association for boys. Findings supported a multi-rater approach for understanding risk for internalizing problems among children with and without conduct problems. In particular, they highlight the importance of differences across context for understanding factors associated with vulnerability to internalizing problems.

Longitudinal Evaluation of the Role of Academic and Social Impairment and Parent-Adolescent Conflict in the Development of Depression in Adolescents with ADHD

Older adolescents with attention-deficit/hyperactivity disorder (ADHD) have a significantly increased likelihood of developing comorbid depression. It is important to evaluate factors during the early adolescent period that may contribute to this risk. A predominant theory is that impairment and failure experiences lead to the development of low-self efficacy and depression, and that parent and family factors also play a role. In a sample of 326 young adolescents with ADHD (Mage = 12), the present study evaluated whether parent-adolescent conflict mediated the association between social and academic impairment and the development of depression. This study builds upon prior work by evaluating these associations longitudinally and by using a multi-rater approach, including the parent, adolescent, and teacher perspectives. Social and academic impairment directly predicted depression controlling for baseline levels of depression and change in ADHD symptoms. The association between social impairment and depression was partially mediated by parent-adolescent conflict. Mediation through conflict was not found for academic impairment, and the association between academic impairment and depression was no longer significant when accounting for conflict. These findings highlight the importance of social impairment in the development of depression in adolescents with ADHD. Caregivers may play an important role in determining whether adolescents with ADHD internalize social impairment and failure experiences and develop depressive symptoms. Implications of these findings in terms of the importance of interventions focused on parent-adolescent conflict are discussed.

Socioeconomic Status and Internalizing Symptoms in Chilean Children: Does Reserve Capacity Matter?

Informed by the reserve capacity model, we examined pathways between socioeconomic status (SES) and internalizing symptoms (IS) in 1119 Chilean 10-year-olds. Mediators included parental disciplinary style and reserve capacity resources (RCR), namely home environment, parent-child engagement, and self-esteem, and conduct problems. Using structural equation modeling, the model was stratified by gender. For boys, the SES-IS relationship was mediated by the home environment and parental disciplinary style. For girls, the SES-IS relationship was mediated by the home environment, parent-child engagement, self-esteem, and conduct problems. Findings suggest different RCR may protect against IS in a sample of Chilean children.

Prevalence and correlates of attention-deficit hyperactivity disorder symptoms in Korean college students

BACKGROUND

Attention-deficit hyperactivity disorder (ADHD) persists into adulthood in a high proportion of cases, causing social difficulties and affective problems. We evaluated the prevalence of symptoms of ADHD and the correlates thereof in Korean college students.

METHODS

A total of 2,172 college students, stratified to reflect geographical differences, were asked to complete self-report questionnaires on ADHD symptoms, depression, and related factors.

RESULTS

ADHD symptoms were found in 7.6% of college students. Univariate analysis revealed that younger students had higher rates of ADHD symptoms than did older students. We found significant associations between ADHD symptoms and problematic alcohol use, depression, and lifetime suicidal behavior. Multivariate analysis revealed that ADHD symptoms in adults were significantly associated with depression (odds ratio [OR] =4.69; 95% confidence interval [CI] 3.23-6.80; P<0.001) and overweight or obesity (OR =1.50; 95% CI 1.02-2.22; P=0.040), after controlling for sex and age.

CONCLUSION

These results have implications in terms of the mental health interventions required to assess problems such as depression, alcohol use, obesity, and suicidality in young adults with ADHD symptoms.

Blood manganese levels in relation to comorbid behavioral and emotional problems in children with attention-deficit/hyperactivity disorder

Patients with attention-deficit/hyperactivity disorder (ADHD) appear to be more vulnerable to the development of other psychiatric disorders than the general population. The proposed neurotoxic mechanisms of manganese involve striatal dopamine neurotransmission, implicated in the pathophysiology of ADHD. We investigated whether the adverse impact of manganese is particularly pronounced in children with ADHD. Blood manganese concentration and diagnosis of ADHD were assessed in a general population of 890 children, aged 8-11 years. The main outcome measure was the Child Behavior Checklist (CBCL). A significant interaction was found between ADHD status and blood manganese level in predicting CBCL total problems score as well as anxiety/depression, social problems, delinquent behavior, aggressive behavior, internalizing problems, and externalizing problems. The directions of the interactions indicated that blood manganese level was more positively correlated with CBCL scores in ADHD children than in the healthy population. In ADHD children, only the fifth quintile of blood manganese concentration was significantly associated with the CBCL total problems score. ADHD children may be more vulnerable than the general school-age population to the neurotoxic effects of manganese exposure, which lead to an elevated risk of developing comorbid mental conditions.

Academic achievement, self-concept and depression in Taiwanese children: Moderated mediation effect

The primary purpose of this study was to utilize a multidimensional perspective to examine whether children’s self-concept served as a mediator between academic achievement and depression, and to further investigate whether this mediation effect was moderated by the ages of children. The participants consisted of 632 Taiwanese children in the grades 3 to 6. In the mediation analyses, results found that self-concept, representing a multifaceted and hierarchical structure, was intermediate in the relationship between academic achievement and depression. In further moderated mediation analyses, results indicated that the mediation effect of academic achievement on depression was moderated by the ages or children, with a higher effect for younger children (grades 3–4) than older children (grades 5–6). Finally, this study discussed several empirical and methodological implications of the findings.

The association of ADHD and depression: mediation by peer problems and parent-child difficulties in two complementary samples

Children with attention-deficit/hyperactivity disorder (ADHD) are at increased risk for the development of depression, with evidence that peer and academic difficulties mediate predictions of later depression from ADHD. In the present study, we hypothesized that parent-child relationship difficulties may be an additional potential mediator of this association. Academic, peer, and parent-child functioning were tested as mediators of the association of attention problems and depression in two distinctly different yet complementary samples. Study 1 was a cross-sectional sample of 5- to 10-year-old children (N = 230) with and without ADHD. Study 2 was a prospective longitudinal sample of 472 youth, followed prospectively from birth to age 20 years, at risk for depression. Despite differences in age, measures, and designs, both studies implicated peer and parent-child problems as unique mediators of depressive symptoms, whereas academic difficulties did not uniquely mediate the ADHD-depression association. Furthermore, inattention symptoms, but not hyperactivity, predicted depressive symptoms via the disruption of interpersonal functioning. The inclusion of oppositional defiant disorder into models impacted results and supported its independent role in parent-child problems. Implications include support for interventions that target interpersonal competence, which may effectively reduce the risk of depression among children with ADHD.

The comorbidity of anxiety and depressive symptoms in older adults with attention-deficit/hyperactivity disorder: a longitudinal study

BACKGROUND

Comorbidity between Attention-Deficit/Hyperactivity Disorder (ADHD) and depression and anxiety disorders in children and young to middle-aged adults has been well documented in the literature. Yet, it is still unknown whether this comorbidity persists into later life. The aim of this study is therefore to examine the comorbidity of anxiety and depressive symptoms among older adults with ADHD. This is examined both using cross-sectional and longitudinal data.

METHODS

Data were used from the Longitudinal Aging Study Amsterdam (LASA). Participants were examined in three measurement cycles, covering six years. They were asked about depressive and anxiety symptoms. To diagnose ADHD, the DIVA 2.0, a diagnostic interview was administered among a subsample (N=231, age 60-94). In addition to the ADHD diagnosis, the association between the sum score of ADHD symptoms and anxiety and depressive symptoms was examined. Data were analyzed by means of linear regression analyses and linear mixed models.

RESULTS

Both ADHD diagnosis and more ADHD symptoms were associated with more anxiety and depressive symptoms cross-sectionally as well as longitudinally. The longitudinal analyses showed that respondents with higher scores of ADHD symptoms reported an increase of depressive symptoms over six years whereas respondents with fewer ADHD symptoms remained stable.

LIMITATIONS

The ADHD diagnosis is based on the DSM-IVcriteria, which were developed for children, and have not yet been validated in (older) adults.

CONCLUSIONS

It appears that the association between ADHD and anxiety/depression remains in place with aging. This suggests that, in clinical practice, directing attention to both in concert may be fruitful.

Inattention symptoms predict level of depression in early childhood

OBJECTIVE

To investigate the potential bidirectional relationships between severity of inattention and depression across early childhood.

METHODS

Children (N = 216) from the New York, NY, metropolitan area were recruited when they were aged 3 to 4 years (T1) and studied again at age 6 (T2) and 7 (T3) years. Child inattention symptoms were measured using the Kiddie-Schedule for Affective Disorders and Schizophrenia for School-Aged Children-Present and Lifetime, along with both parent and teacher reports on the Behavior Assessment System for Children, Second Edition (BASC-2). Severity of child depression was assessed at each time point using parent and teacher reports on the BASC-2. After examining correlations between child inattention and depression, structural equation modeling was used to investigate whether child inattention was longitudinally related to child depression, and whether child depression symptoms were associated with later child inattention.

RESULTS

Severity of child inattention at T1 and T2 was longitudinally associated with increased severity of child depression at T2 and T3, respectively. Early child depression was not longitudinally associated with later child inattention.

CONCLUSION

Child inattention is a risk factor for increased levels of child depression. Pediatricians and clinicians who assess children's inattention symptoms also need to investigate symptoms of depression. This study makes a case for treating children's inattention symptoms at preschool and early childhood, before emotional problems become more severe.

Children with co-occurring academic and behavior problems in first grade: distal outcomes in twelfth grade

The aim of the current study was to evaluate the eleven year longitudinal association between students identified in first grade as having academic and behavior problems and distal outcomes in twelfth grade. The study extends prior research that identified latent classes of academic and behavior problems in a longitudinal community sample of 678 predominately African American first-grade students. The type and number of classes identified in first grade differed by gender, but results indicated that students within the classes of behavior and academic problems had long-term negative outcomes in the twelfth grade. The class with co-occurring academic and behavior problems in first grade had the greatest risk for negative distal outcomes for both boys and girls including higher likelihood of special education placement, mental health service use, poor academic achievement, and school dropout. Implications for prevention, early intervention, and current practices in schools are discussed.

Codevelopment of delinquent and depressive symptoms across adolescence: time-invariant and time-varying effects of school and social failure

The codevelopment of delinquent behaviors and depressive symptoms from Grade 9 to 11 was investigated on an Italian sample of 518 adolescents (399 male) after the transition to high school, evaluating the time-invariant effects of past school failure and social failure and the time-varying effects of school achievement and social problems. Bivariate latent growth model showed a positive correlation between the two intercepts and the two slopes, suggesting that during adolescence the two trajectories are reciprocally and causally related over time. Time-invariant predictors--past school failure and social failure--explain interindividual variability only for delinquent growth. Time-varying covariates--school achievement and social problems--are significantly associated with both trajectories. These time-varying variables can act as snares, mechanisms responsible for accelerating the otherwise normative pattern of increase of delinquent behaviors and actively retarding the normative decrease of depressive symptoms over adolescence. Findings highlight how interventions aimed to promote competence during adolescence can be an effective way to prevent psychopathology or to reduce its impact.

Peer victimization, poor academic achievement, and the link between childhood externalizing and internalizing problems

This study explored whether early elementary school aged children's externalizing problems impede academic functioning and foster negative social experiences such as peer victimization, thereby making these children vulnerable for developing internalizing problems and possibly increasing their externalizing problems. It also explored whether early internalizing problems contributed to an increase in externalizing problems. The study examined 1,558 Canadian children from ages 6 to 8years. Externalizing and internalizing problems, peer victimization, and school achievement were assessed annually. Externalizing problems lead to academic underachievement and experiences of peer victimization. Academic underachievement and peer victimization, in turn, predicted increases in internalizing problems and in externalizing problems. These pathways applied equally to boys and girls. No links from internalizing to externalizing problems were found.

Psychological and educational interventions for preventing depression in children and adolescents

BACKGROUND

Depression is common in young people, has a marked negative impact and is associated with self-harm and suicide. Preventing its onset would be an important advance in public health.  

OBJECTIVES

To determine whether psychological or educational interventions, or both, are effective in preventing the onset of depressive disorder in children and adolescents.

SEARCH METHODS

The Cochrane Depression, Anxiety and Neurosis Review Group's trials registers (CCDANCTR) were searched at the editorial base in July 2010. Update searches of MEDLINE, EMBASE, PsycINFO and ERIC were conducted by the authors in September 2009. Conference abstracts, reference lists of included studies and reviews were searched and experts in the field contacted.

SELECTION CRITERIA

Randomised controlled trials of psychological or educational prevention programmes, or both, compared with placebo, any comparison intervention, or no intervention for young people aged 5 to 19 years-old, who did not currently meet diagnostic criteria for depression or who were below the clinical range on standardised, validated, and reliable rating scales of depression, or both, were included.

DATA COLLECTION AND ANALYSIS

Two authors independently assessed studies for inclusion and rated their quality. Sample sizes were adjusted to take account of cluster designs and multiple comparisons. We contacted study authors for additional information where needed. 

MAIN RESULTS

Fifty-three studies including 14,406 participants were included in the analysis. There were only six studies with clear allocation concealment, participants and assessors were mostly not blind to the intervention or blinding was unclear so that the overall risk of bias was moderately high. Sixteen studies including 3240 participants reported outcomes on depressive diagnosis. The risk of having a depressive disorder post-intervention was reduced immediately compared with no intervention (15 studies; 3115 participants risk difference (RD) -0.09; 95% confidence interval (CI) -0.14 to -0.05; P<0.0003), at three to nine months (14 studies; 1842 participants; RD -0.11; 95% CI -0.16 to -0.06) and at 12 months (10 studies; 1750 participants; RD -0.06; 95% CI -0.11 to -0.01). There was no evidence for continued efficacy at 24 months (eight studies; 2084 participant; RD -0.01; 95% CI -0.04 to 0.03) but limited evidence of efficacy at 36 months (two studies; 464 participants; RD -0.10; 95% CI -0.19 to -0.02). There was significant heterogeneity in all these findings. There was no evidence of efficacy in the few studies that compared intervention with placebo or attention controls.

AUTHORS' CONCLUSIONS

There is some evidence from this review that targeted and universal depression prevention programmes may prevent the onset of depressive disorders compared with no intervention. However, allocation concealment is unclear in most studies, and there is heterogeneity in the findings. The persistence of findings suggests that this is real and not a placebo effect. 

Inattention and hyperactivity and the achievement gap among urban minority youth

OBJECTIVES

To outline the prevalence and disparities of inattention and hyperactivity among school-aged urban minority youth, causal pathways through which inattention and hyperactivity adversely affects academic achievement, and proven or promising approaches for schools to address these problems.

METHODS

Literature review.

RESULTS

Approximately 4.6 million (8.4%) of American youth aged 6-17 have received a diagnosis of attention deficit/hyperactivity disorder (ADHD), and almost two thirds of these youth are reportedly under treatment with prescription medications. Urban minority youth are not only more likely to be affected but also less likely to receive accurate diagnosis and treatment. Causal pathways through which ADHD may affect academic achievement include sensory perceptions, cognition, school connectedness, absenteeism, and dropping out. In one study, youth with diagnosed ADHD were 2.7 times as likely to drop out (10.0% vs. 22.9%). A similar odds ratio for not graduating from high school was found in another prospective study, with an 8-year follow-up period (odds ratio = 2.4). There are many children who are below the clinical diagnostic threshold for ADHD but who exhibit signs and symptoms that interfere with learning. Evidence-based programs emphasizing functional academic and social outcomes are available.

CONCLUSIONS

Inattention and hyperactivity are highly and disproportionately prevalent among school-aged urban minority youth, have a negative impact on academic achievement through their effects on sensory perceptions, cognition, school connectedness, absenteeism, and dropping out, and effective practices are available for schools to address these problems. This prevalent and complex syndrome has very powerful effects on academic achievement and educational attainment, and should be a high priority in efforts to help close the achievement gap.

Prospective association of childhood attention-deficit/hyperactivity disorder (ADHD) and substance use and abuse/dependence: a meta-analytic review

Given the clinical and public health significance of substance disorders and the need to identify their early risk factors, we examined the association of childhood attention-deficit/hyperactivity disorder (ADHD) with substance use (nicotine, alcohol, marijuana) and abuse/dependence outcomes (nicotine, alcohol, marijuana, cocaine, other). To strengthen a potential causal inference, we meta-analyzed longitudinal studies that prospectively followed children with and without ADHD into adolescence or adulthood. Children with ADHD were significantly more likely to have ever used nicotine and other substances, but not alcohol. Children with ADHD were also more likely to develop disorders of abuse/dependence for nicotine, alcohol, marijuana, cocaine, and other substances (i.e., unspecified). Sex, age, race, publication year, sample source, and version of the Diagnostic and Statistical Manual of Mental Disorders (DSM) used to diagnose ADHD did not significantly moderate the associations with substance outcomes that yielded heterogeneous effect sizes. These findings suggest that children with ADHD are significantly more likely to develop substance use disorders than children without ADHD and that this increased risk is robust to demographic and methodological differences that varied across the studies. Finally, few studies addressed ADHD and comorbid disruptive behavior disorders (DBD), thus preventing a formal meta-analytic review. However, we qualitatively summarize the results of these studies and conclude that comorbid DBD complicates inferences about the specificity of ADHD effects on substance use outcomes.

Using Prevention Science to Promote Children’s Mental Health: The Founding of the Missouri Prevention Center

Decades of research have demonstrated, now convincingly, that emotional and behavioral syndromes and many of their antecedent risks can be prevented. Much of this progress can be traced to the founding and expansion of the relatively young field called prevention science, an interdisciplinary field that emerged in the early 1990s to address the need for an integrated model for prevention-related research. The present article is intended to provide a specific example of prevention science in action for counseling psychologists. To illustrate key preventive science principles, the authors describe the formation and activities of the Missouri Prevention Center, a program that uses prevention science to promote children’s mental health. In particular, the authors use research produced by the center to highlight the various phases of prevention intervention research. They conclude with implications for counseling psychologists.

Diversidade de resultados no estudo do transtorno de déficit de atenção e hiperatividade

Com este artigo pretende-se abordar a problemática da diversidade de dados na investigação do Transtorno de Déficit de Atenção e Hiperatividade (TDAH). Apresenta-se uma revisão da literatura centrada na heterogeneidade de conclusões relativas à caracterização do transtorno, à distinção dos subtipos, aos contextos de informação, às diferenças de gênero e à comorbidade. Na tentativa de compreender a disparidade de conclusões, salientam-se potenciais fatores explicativos, nomeadamente a heterogeneidade das amostras, a diversidade de metodologias e de procedimentos de investigação, entre outros. A revisão efetuada baseou-se, majoritariamente, em publicações referenciadas pelas bases de dados PsycInfo e ERIC, e, pontualmente, PubMed e Elsevier Direct.

A review of co-morbid depression in pediatric ADHD: etiology, phenomenology, and treatment

This paper reviews the literature and highlights the need for further research regarding the phenomenology, etiology, assessment, and treatment of co-morbid depression in patients with attention-deficit/hyperactivity disorders (ADHD). Depression occurs in youths with ADHD at a significantly higher rate than in youths without ADHD. Youths with ADHD and depression together have a more severe course of psychopathology and a higher risk of long-term impairment and suicide than youths with either disorder alone. Assessment of such co-morbid depression is complicated by overlapping symptoms with ADHD and with other disorders that commonly occur with ADHD. Depressive disorders typically emerge several years after the onset of ADHD and may arise from environmental difficulties associated with chronic ADHD that interact with genetic risks as the child gets older. Despite a scarcity of well-designed treatment studies for youths with ADHD and co-morbid depression, there is increasing preliminary evidence for the role of stimulants, selective serotonergic reuptake inhibitors, bupropion, and atomoxetine to target either or both disorders. There is also some indirect evidence for the benefit of combining pharmacological treatments with psychosocial interventions that specifically target relevant environmental factors and functional impairments.

Inattention, hyperactivity, and school performance in a population of school-age children with complex congenital heart disease

INTRODUCTION

There is a growing interest in characterizing the neurodevelopmental outcomes of school-age survivors of cardiac surgery. The purpose of this study was to examine a population of 5- to 10-year-old children who underwent newborn cardiac surgery for complex congenital heart disease to characterize and assess risk factors for problems with inattention and hyperactivity, as well as the use of remedial school services.

PATIENTS AND METHODS

This study was a cross-sectional analysis of patients who underwent newborn cardiac surgery and were enrolled in a neuroprotection trial conducted at our institution between 1992 and 1997. Parents and teachers completed questionnaires for the school-age child to elicit information pertaining to the child's general health and academic performance. The severity of hyperactivity and inattention were assessed by using 2 standardized questionnaires (Attention-Deficit/Hyperactivity Disorder Rating Scale-IV and Behavior Assessment System for Children). In addition to calculating descriptive estimates of their occurrence, single-covariate logistic regression models were specified and tested by using 3 different outcomes (inattention, hyperactivity, and use of remedial school services) and 14 different covariates representing preoperative, intraoperative, and postoperative factors.

RESULTS

Data were obtained from parents and/or teachers for 109 children. Fifty-three (49%) were receiving some form of remedial academic services, and 15% were assigned to a special-education classroom. The number of children receiving clinically significant scores for inattention and hyperactivity on the Behavior Assessment System for Children was 3 to 4 times higher than observed in the general population. On the Attention-Deficit/Hyperactivity Disorder Rating Scale-IV, 30% of the parents reported high-risk scores for inattention and 29% reported high-risk scores for hyperactivity. No perioperative factors were statistically associated with adverse outcomes.

CONCLUSION

In this cohort of children with complex congenital heart disease, a significant proportion of the children were at risk for inattention and hyperactivity, and nearly half were using remedial school services. We did not identify any perioperative risk factors, which correlated with high-risk scores or the use of remedial school services. Ongoing neurodevelopmental follow-up and screening are recommended in this vulnerable population.

Low Academic Competence in First Grade as a Risk Factor for Depressive Cognitions and Symptoms in Middle School

The present study investigated the role of low academic competence in the emergence of depressive cognitions and symptoms. Structural equation modeling was conducted on a longitudinal sample of African American boys (n = 253) and girls (n = 221). Results supported the hypothesized path models from academic competence in 1st grade to depressive symptoms in 7th grade, controlling for a host of correlated constructs (conduct problems, inattention, social problems). Perceived control in 6th grade mediated the effect of academic competence on depressive symptoms. Although the models fit the data well for both boys and girls, the path coefficients were notably larger for girls; in particular, multiple-group analysis revealed a statistically stronger effect of low academic competence on perceptions of control for girls. The study and findings fit well with counseling psychologists' commitment to prevention activities and to culture-specific research. Implications for designing interventions and prevention strategies for children with early academic problems are discussed.