Differential risk for late adolescent conduct problems and mood dysregulation among children with early externalizing behavior problems

Postmarketing Surveillance of Full Spectrum Hemp Extract CBD Products: Reported Adverse Events and Serious Adverse Events

BACKGROUND

There is a growing interest in products featuring hemp extracts and a demand for more data regarding their safety. To date, there is a paucity of published data on the safety of these products.

METHODS

A retrospective analysis of postmarketing surveillance data collected in the United States on full spectrum hemp extract (FSHE) products manufactured by Charlotte's Web (CW) was conducted over an 18-month period (January 2019 to July 2020). The frequency of adverse events (AEs) and serious adverse events (SAEs) was assessed by analyzing AE reports against the estimated number of consumers who purchased products and the total number of products sold.

RESULTS

During the 18-month period, approximately 646,391 consumers purchased 1,939,172 products and 431 AEs were reported by 304 individuals. The estimated percentage of consumers who reported at least one adverse event was 0.05%. The percentage of AEs per products sold was 0.02%. Most AEs (98.14%) reported were Grade 1 (i.e., asymptomatic or causing mild symptoms), as classified by the Common Terminology Criteria for Adverse Events. Seven AEs were classified as serious, and the percentage of SAEs per products sold was 0.0004%. None of the reported SAEs were classified as a Grade 4 or Grade 5 (i.e., life threatening or fatal).

CONCLUSIONS

Approximately 0.05% of consumers who purchased the CW FSHE products from January 2019 to July 2020 reported an adverse event. The percentage of AEs and SAEs per products sold was 0.02% and 0.0004%, respectively. These data demonstrate that CW FSHE products appear to be well tolerated at recommended doses.

Aggressive and Withdrawn Behaviour at School through the Lens of Teachers and Peers: A Qualitative Study

We explored teachers' understanding of children with aggressive or socially withdrawn behaviour in their classes and we associated our findings with a status of rejected, neglected, or popular, as provided by peer nominations. Five kindergarten and elementary school teachers scored their 143 pupils with the Child Behaviour Checklist for Withdrawal and Aggression. Subsequently, only those children whose scores were 1 standard deviation above the mean for withdrawal or for aggression were included in the final sample (n = 46; Mage = 6.5 years, SD = 1.7; age range = 4-9 years). The final sample included 31 children (21.67%; females = 16) who were assessed as displaying withdrawn behaviour, and 15 (10.48%; females = 5) displaying aggressive behaviour. An open-ended semi-structured interview was administered to teachers, who described children with socially withdrawn behaviour as introverted and untalkative, children with aggressive behaviour as hostile, rule-breaking and highly active, and children with socially withdrawn or aggressive behaviour as isolated, even though different reasons were provided. The results of the sociometric status in children with socially withdrawn or aggressive behaviour are discussed.

The power of family? Family social capital and the risk of externalising behaviours among youth with multiple childhood adversities

Externalising behaviour problems (EBP), or aggressive and delinquent behaviours, among youth pose a significant problem for their peers, parents, teachers and society. Many types of childhood adversities increase the risk of EBP, including maltreatment, physical punishment, domestic violence, family poverty and living in violent neighbourhoods. This study asks, to what extent do children who face multiple adversities during childhood suffer an increased risk of EBP and is family social capital (FSC) associated with a lower risk? Using seven waves of panel data from the Longitudinal Studies of Child Abuse and Neglect, I examine the accumulation of adversities associated with greater risk of EBP among youth and investigate whether FSC-family network, support and cohesion-in early childhood is associated with a reduction in EBP risk. Experiencing early and multiple adversities resulted in the worst EBP trajectories throughout childhood. Although, among youth with the highest adversities, if early family support was also high, their EBP trajectories are more favourable than their disadvantaged peers with less support. FSC may protect against EBP when multiple childhood adversities are experienced. The need for early EBP interventions and bolstering FSC are discussed.

The association between peer rejection and aggression types: A meta-analysis

BACKGROUND

Although previous studies have assessed the association between peer rejection and aggression, the results are mixed.

OBJECTIVE

This article presents a meta-analysis of the association between peer rejection and aggression types (overt vs. relational) among children and adolescents.

PARTICIPANTS AND SETTING

A total of 61 eligible studies with 70 independent effect sizes were included in the analysis (45,966 participants, M_age = 10.34, SD = 3.13).

METHODS

First, random-effects meta-analyses were conducted to explore the association between peer rejection and aggression types (overt vs. relational). Next, moderation analyses were conducted based on the Q statistics for categorical variables (culture, reporting method of peer rejection, reporting method of aggression) and the meta-regression analyses for continuous variable (age).

RESULTS

Peer rejection was positively correlated with overall aggression (r = 0.42, 95 % CI [0.38, 0.47], p < 0.001), overt aggression (r = 0.46, 95 % CI [0.38, 0.54], p < 0.001) and relational aggression (r = 0.43, 95 % CI [0.35, 0.51], p < 0.001). This correlation was positive for each type when controlling for other form of aggression. Moderation analyses suggested that reporting method of aggression (self-report vs. peer-nomination vs. adult-report vs. observation), reporting method of peer rejection (self-report vs. peer-nomination vs. adult-report) and culture (collectivist vs. individualist) were moderators of the association between peer rejection and overall aggression. Culture moderated the association between peer rejection and overt aggression, while age moderated the association between peer rejection and relational aggression.

CONCLUSIONS

The findings showed a strong positive association between peer rejection and aggression, although this association varied by aggression type and other moderating variables.

Parent training for the treatment of irritability in children and adolescents: a multisite randomized controlled, 3-parallel-group, evaluator-blinded, superiority trial

Background

Irritability is common in children and adolescents with Attention Deficit Hyperactivity Disorder (ADHD), Oppositional Defiant Disorder (ODD) and with anxiety/depressive disorders. Although youth irritability is linked with psychiatric morbidity, little is known regarding its non-pharmacological treatments. Developing non-pharmacological treatments for children with severe, chronic irritability is an important target for clinical research. To achieve this goal, we will test the benefits of parent-focused therapies in reducing irritability. The aim of the study is to compare Parent Management Training (PMT) and Non-Violent Resistance Training (NVR) programs with treatment-as-usual (TAU) on the improvement of irritability in children and adolescents with a baseline Parent-rated Affective Reactivity Index of 4 or higher, in the context of ADHD and other emotional and behavioural disorders. Additionally, we will assess (i) improvement of irritability at different times and according to different informants (parents, children, clinicians); (ii) improvement of parental strategies; and (iii) acceptability of the interventions, exploring possible mechanisms of the therapeutic effect.

Methods

Two hundred and seventy participants between 6 and 15 years with ADHD and other emotional and behavioural disorders will be recruited and randomly assigned with their parents to the PMT, NVR, and TAU groups. PMT and NVR programs have 10 online sessions and two booster sessions at 1 and at 3 months. The primary outcome measure is the change from baseline at 3 months after completion of the program of the Clinician-rated Affective Rating Scale (CL-ARI) assessed by a blind evaluator. Secondary outcome measures include the change from baseline from those scales: the CL-ARI, the Clinical Global Impression Improvement scale, the Parenting and Familial Adjustment Scales, the Child-rated Cranky thermometers and the Parent-rated ARI. We will assess the parent’s expressed emotions and reflexivity during the online five-minute speech sample, clinical dimensions through the Child Behavior Checklist 6–18 and the Inventory of Callous Unemotional traits. Evaluations will be done remotely at baseline and at 1- and 3-months follow-up visits.

Discussion

We expect a benefit in controlling irritability in the treatment groups. This will constitute an important achievement in promoting parental support programs in the treatment of irritability in the context of emotional and behavioural disorders.

Clinicaltrials.gov. Number: NCT05528926. Registered on the 2nd of September, 2022.

The effect of increased minimum wage on child externalizing behaviors

The Family Stress Model (FSM) has been used to show the relationship between socioeconomic disadvantage and child externalizing behaviors and suggests that interventions promoting economic security may be a promising approach to reduce child externalizing behavior. Using longitudinal data from the Fragile Families and Child Wellbeing study from 2002 to 2010 we examined the effect of minimum wage laws on child externalizing behaviors through a difference in difference in differences (DDD) study design. Externalizing behavior was assessed with the Child Behavior Checklist (CBCL) using the rule breaking, attention problems, and violence subscales. DDD analyses suggest a $1 increase in the minimum wage was associated with a 2% reduction in violent behaviors (β = -1.90, 95%CI[-3.12, -0.68], p = 0.003) for the most vulnerable families headed by a primary caregiver with less than a high school education. The study results suggest that increases in the minimum wage are associated with reductions in the most severe and costly externalizing behaviors among children. Study results contribute to a growing body of literature showing that increased family incomes have positive impacts on child development, and that minimum wage policy is potentially an effective mechanism for the primary prevention of violence.

Zusammenhänge zwischen dissozialen Verhaltensweisen und Stresserleben bei Jugendlichen

Zusammenfassung. Dissoziale Verhaltensweisen wie Wutanfälle, Lügen und Stehlen bis hin zu gewaltsamen Übergriffen gegenüber Peers, Lehrpersonen und Eltern stellen hohe Belastungen für die soziale Umwelt der Jugendlichen dar. Obwohl kognitiv-emotionale Stressverarbeitungsprozesse eine zentrale Bedeutung für die Erklärung von Verhaltensproblemen haben, analysiert bislang keine Studie systematisch das Stresserleben bei Jugendlichen mit dissozialem Verhalten in unterschiedlichen Lebensbereichen. Diese Studie geht der Fragestellung nach, inwiefern Jugendliche mit dissozialem Verhalten in verschiedenen Lebensbereichen (u. a. Eltern, Schule, Zukunftsplanung, Freizeit, Peerbeziehungen) Stress empfinden. Die Stichprobe umfasst N = 91 Jugendliche (Altersrange 12 – 16, 39 Mädchen), von denen N = 44 dissoziale Verhaltensweisen aufweisen. Verhaltensprobleme und Stresserleben wurden mittels standardisierter Instrumente erfasst. In hierarchischen Regressionsanalysen erklären dissoziale Verhaltensweisen bedeutsame Varianz des Stresserlebens. In Bezug auf die Zukunft (z. B. Angst vor Arbeitslosigkeit) sowie schulische Stressoren (z. B. Leistungsversagen) ist das Stresserleben dissozialer Jugendlicher erhöht, im Freizeitbereich sowie im Umgang mit Peers bestehen keine bedeutsamen Unterschiede zur Kontrollgruppe. Die Ergebnisse implizieren spezifische kognitiv-emotionale Stressverarbeitungsprozesse bei dissozialen Jugendlichen, deren mögliche Bedeutung für Verhaltensänderungen in schulischen und anderen pädagogischen Kontexten diskutiert wird.

Transitions between socio-emotional and cognitive vulnerability profiles from early to middle childhood: a population study using multi-agency administrative records

Adult psychosocial difficulties, including psychiatric disorders, are often preceded by childhood psychosocial vulnerabilities, presenting critical windows of opportunity for preventative intervention. The present study aimed to identify longitudinal patterns (representing transitions between profiles) of childhood socio-emotional and cognitive vulnerability in the general population from early to middle childhood, in relation to key risk factors (e.g. parental mental illness and offending). Data were drawn from the New South Wales Child Development Study, which combines intergenerational multi-agency administrative records with cross-sectional assessments using data linkage methods. We analysed data from childhood assessments of socio-emotional and cognitive functioning at two time points (ages 5-6 and 10-11 years) that were linked with administrative data from government departments of health, child protection, and education for 19,087 children and their parents. Latent profile analyses were used to identify socio-emotional and cognitive profiles at each time point, and latent transition analyses were used to determine the probability and potential moderators of transition between profiles at each age. Three developmental profiles were identified in early childhood, reflecting typically developing, emotionally vulnerable, and cognitively vulnerable children, respectively; two profiles were identified in middle childhood, reflecting typically developing and vulnerable children. Child's sex, child protection services contact, parental mental illness, and parental offending influenced children's transitions between different vulnerability profiles, with the strongest effects for parental mental illness and child protection contact. Early detection of vulnerable children and factors promoting resilience are important steps in directing future health and social policy, and service planning for vulnerable children.

Social rejection, popularity, peer victimization, and self-injurious thoughts and behaviors among adolescents: A systematic review and meta-analysis

Self-injurious thoughts and behaviors (SITBs) are significant public health problems in adolescence. The current article provides a comprehensive systematic review examining the relationship between events leading to perceived low relational evaluation (e.g. social rejection) and SITBs among adolescents. Theoretical work posits that low relational evaluation is experienced as psychologically painful, a known correlate of SITBs. Therefore, events leading to low relational evaluation may be particularly informative in understanding the context of SITBs. The current review examines how experiences of low relational evaluation that are hypothesized to elicit psychological pain, such as social rejection, low popularity, and peer victimization are related to engagement in SITBs in adolescence. A total of 56 articles meeting inclusion criteria were identified. The hypothesis of an association between indicators of low relational evaluation and SITBs was generally supported throughout the literature, with more consistency found among studies examining suicidal ideation specifically. However, interpretation of the findings is constrained by various methodological limitations of studies. The present review concludes with a theoretical conceptualization of the relationship between perceived relational value and SITBs, leveraging social and evolutionary psychological theory, to guide future research into this topic.

Bottom-up and top-down approaches to understanding oppositional defiant disorder symptoms during early childhood: a mixed method study

BACKGROUND

Children with clinical levels of conduct problems are at high risk of developing mental health problems such as persistent antisocial behavior or emotional problems in adolescence. Serious conduct problems in childhood also predict poor functioning across other areas of life in early adulthood such as overweight, heavy drinking, social isolation and not in employment or education. It is important to capture those children who are most at risk, early in their development. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is commonly used in clinical settings, to identify children with conduct problems such as oppositional defiant disorder (ODD).This paper presents a cross-sectional study in a clinical setting, and describes behaviors in 3- to 8-year-olds with ODD. Our aim was to investigate whether there were problematic behaviors that were not captured by the diagnosis of ODD, using two different methods: a clinical approach (bottom-up) and the nosology for the diagnosis of ODD (top-down).

METHOD

Fifty-seven children with clinical levels of ODD participated in the study. The mothers were interviewed with both open questions and with a semi-structured diagnostic interview K-SADS. The data was analyzed using a mixed method, convergent, parallel qualitative/quantitative (QUAL + QUAN) design. For QUAL analysis qualitative content analysis was used, and for QUAN analysis associations between the two data sets, and ages-groups and gender were compared using Chi-square test.

RESULTS

In the top-down approach, the ODD criteria helped to identify and separate commonly occurring oppositional behavior from conduct problems, but in the bottom-up approach, the accepted diagnostic criteria did not capture the entire range of problematic behaviors-especially those behaviors that constitute a risk for antisocial behavior.

CONCLUSIONS

The present study shows a gap between the diagnoses of ODD and conduct disorder (CD) in younger children. Antisocial behaviors manifest in preschool and early school years are not always sufficiently alarming to meet the diagnosis of CD, nor are they caught in their entirety by the ODD diagnostic tool. One way to verify suspicion of early antisocial behavior in preschool children would be to specify in the ODD diagnosis if there also is subclinical CD.

Using Early Childhood Behavior Problems to Predict Adult Convictions

The current study examined whether teacher and parent ratings of externalizing behavior during kindergarten and 1st grade accurately predicted the presence of adult convictions by age 25. Data were collected as part of the Fast Track Project. Schools were identified based on poverty and crime rates in four locations: Durham, NC, Nashville, TN, Seattle, WA, and rural, central PA. Teacher and parent screening measures of externalizing behavior were collected at the end of kindergarten and 1st grade. ROC curves were used to visually depict the tradeoff between sensitivity and specificity and best model fit was determined. Five of the six combinations of screen scores across time points and raters met both the specificity and sensitivity cutoffs for a well-performing screening tool. When data were examined within each site separately, screen scores performed better in sites with high base rates and models including single teacher screens accurately predicted convictions. Similarly, screen scores performed better and could be used more parsimoniously for males, but not females (whose base rates were lower in this sample). Overall, results indicated that early elementary screens for conduct problems perform remarkably well when predicting criminal convictions 20 years later. However, because of variations in base rates, screens operated differently by gender and location. The results indicated that for populations with high base rates, convictions can be accurately predicted with as little as one teacher screen taken during kindergarten or 1st grade, increasing the cost-effectiveness of preventative interventions.

The Role of Irritability in the Treatment of Behavior Disorders: A Review of Theory, Research, and a Proposed Framework

Research provides strong evidence that the symptoms of Oppositional Defiant Disorder (ODD) are comprised of at least two dimensions: irritability and defiance. Given that these two dimensions have distinct etiologies and long-term risk profiles, they may also warrant different treatment approaches. In particular, impaired emotion regulation plays a central role in the irritable dimension of ODD. As such, this subgroup of youth and their families may benefit from greater consideration of and attention to emotion-focused strategies than is standard in traditional Behavioral Parent Training (BPT) approaches. In support of this hypothesis, this review will (1) examine the etiological models guiding the theoretical approach to standard BPT; (2) evaluate theory and research on emotion socialization broadly and its role in the etiology and maintenance of irritability in children with BDs; (3) propose an emotion socialization-based etiological model for the irritable dimension of child oppositionality; and (4) argue for the use of emotion-focused parent training in the treatment of such youth. Clinical implications, gaps in the current state of the literature, and future directions for research will also be discussed.

Suicidal behaviors and irritability in children and adolescents: a systematic review of the nature and mechanisms of the association

While many psychiatric disorders are associated with an increased risk for suicidal behaviors (SB) in children and adolescents, a few studies have explored the role of clinical symptoms based on a dimensional approach. Irritability is seen as a marker, a general psychopathology, and a symptom of both externalizing and internalizing disorders. In this review, we are interested in determining whether and how irritability can predict SB in youth. First, we reviewed consistencies and variation in the literature linking irritability to suicidal ideation (SI) and suicide attempt (SA). Second, based on the available models, we proposed specific mechanistic pathways, whereby irritability may modulate the risk for SB. Irritability has been found associated with SB both in cross-sectional and in longitudinal studies. The relation is consistent in different settings (i.e., general population and clinical settings) and across psychiatric disorders. The association is reduced but persists after adjusting for psychiatric disorder, including depression. On one hand, irritability constitutes a risk factor for SI via the onset of internalized disorder. On the other hand, irritable youth may be more prone to attempt suicide when experiencing SI. The measures for irritability were heterogeneous. A limited number of studies were designed to explore the role of mediators and/or moderators. Recognizing irritability in children and adolescents is a key issue with regards to suicide prevention.

Sleep and disruptive mood dysregulation disorder: A pilot actigraphy study

OBJECTIVE

To explore the clinical characteristics and motor activity profile during sleep periods of children and adolescents presenting with disruptive mood dysregulation disorder (DMDD).

METHOD

Twenty-one youths (mean age±standard deviation, 11.7±3 years) wore a wrist actigraph for 9 consecutive days (including both school days and non-school days), to measure sleep parameters: sleep latency, sleep efficiency and the number and duration of periods of wakefulness after sleep onset (WASO). We divided the night-time actigraphy recording sessions into three sections and compared the first and last thirds of the night.

RESULTS

All the study participants had a psychiatric comorbidity (primarily attention deficit hyperactivity disorder, depressive disorder or anxiety disorder). On non-school days, bedrest onset and activity onset were shifted later by about 1h. There was no significant difference between school days and non-school days with regard to the total sleep time. Sleep efficiency was significantly greater on non-school days. Sleep was fragmented on both school days and non-school days. The mean number of episodes of WASO was 24.9 for school days and 30.9 for non-school days. Relative to the first third of the night, we observed a significantly greater number of episodes of WASO during the last third of the night, a period associated with a larger proportion of rapid eye movement (REM) sleep.

DISCUSSION

Sleep appeared to be fragmented in the study population of youths with DMDD. The greater frequency of WASO in the last third of the night points to a possible impairment of the motor inhibition normally associated with REM sleep.

Attention-Deficit/Hyperactivity Disorder, Trait Impulsivity, and Externalizing Behavior in a Longitudinal Sample

Attention-deficit/hyperactivity disorder (ADHD) is highly comorbid with and predictive of externalizing behavior, yet is most often examined categorically, not dimensionally. We tested a recently proposed trait impulsivity model by dimensionally examining measures of childhood inattention and hyperactivity/impulsivity separately as predictors of later externalizing behavior in an all-female longitudinal sample of 228 young women. We also examined influences of parenting and peer relations, given the transactional nature and importance of environmental factors. We analyzed the relative contribution of hyperactive/impulsive (HI) and inattentive (IA) symptoms of girls with and without childhood-diagnosed ADHD (M age = 9.5; 140 ADHD and 88 Comparison) to the development of externalizing behaviors in adolescence (M age = 14.2) and early adulthood (M age = 19.6). Authoritarian parenting was examined as a moderator and adolescent externalizing behavior as a mediator of the relation between childhood HI and later externalizing behavior. Childhood HI symptoms significantly predicted multiple externalizing behaviors in adolescence and early adulthood, after accounting for IA and covariates (ΔR ² ranged from 2.6 to 7.5 %). Mother's authoritarian parenting moderated this relation. Adolescent externalizing behavior mediated the relation between childhood HI symptoms and early adult externalizing behavior. In no case did childhood IA significantly predict externalizing behavior after accounting for HI symptoms. Findings support a trait impulsivity model, as HI symptoms, but not IA symptoms, significantly predicted later externalizing behavior. Results support the importance of dimensional predictors of developmental trajectories. We discuss implications for assessment, intervention, and future research.

Randomized Clinical Trial of Dialectical Behavior Therapy for Preadolescent Children With Disruptive Mood Dysregulation Disorder: Feasibility and Outcomes

OBJECTIVE

Persistent irritability and behavior outbursts in disruptive mood dysregulation disorder (DMDD) are associated with severe impairment in childhood and with negative adolescent and adult outcomes. There are no empirically established treatments for DMDD. This study examined the feasibility and preliminary efficacy of dialectical behavior therapy adapted for preadolescent children (DBT-C) with DMDD.

METHOD

Children 7 to 12 years old with DMDD (N = 43) were randomly assigned 1:1 to DBT-C or treatment as usual (TAU). The 6 domains of feasibility included recruitment, randomization, retention, attendance, participants' satisfaction, and therapist adherence. Blinded raters assessed participants at baseline, after 8, 16, 24, and 32 weeks, and at 3-month follow-up. The primary efficacy outcome was the positive response rate on the Clinical Global Impression-Improvement scale. Improvements in behavior outbursts and angry/irritable mood were assessed by the Clinical Global Impression-Severity scale.

RESULTS

Mean number of participants randomized per month was 2.53 ± 2.72. Participants in DBT-C (n = 21) attended 89% of sessions compared with 48.6% in TAU (n = 22). Eight TAU participants (36.4%) dropped out compared with none in DBT-C. Parents and children in DBT-C expressed significantly higher treatment satisfaction than those in TAU. The rate of positive response was 90.4% in DBT-C compared with 45.5% in TAU, despite 3 times as many participants in TAU receiving psychiatric medications. Remission rates were 52.4% for DBT-C and 27.3% for TAU. Improvements were maintained at 3-month follow-up. Therapists showed adherence to DBT-C.

CONCLUSION

DBT-C demonstrated feasibility in all prespecified domains. Outcomes also indicated preliminary efficacy of DBT-C. Clinical trial registration information-Adapting DBT for Children With DMDD: Pilot RCT; http://clinicaltrials.gov/; NCT01862549.

Do early internalizing and externalizing problems predict later irritability in adolescents with attention-deficit/hyperactivity disorder?

OBJECTIVE

Irritable mood is common in children with attention-deficit/hyperactivity disorder. Research to date has primarily comprised cross-sectional studies; thus, little is known about the antecedents of irritability. Furthermore, existing cross-sectional studies generally focus on the association between irritability and comorbidities and do not examine broader aspects of functioning. Finally, previous research has neglected to include child-report of irritability. This study aimed to address these gaps using data from a longitudinal study of children with attention-deficit/hyperactivity disorder.

METHOD

Children aged 5-13 years (mean = 10.2; standard deviation = 1.9) with attention-deficit/hyperactivity disorder were recruited from pediatric practices across Victoria, Australia. This study reports on those who had reached adolescence (12 years or older, mean = 13.8; standard deviation = 1.2) at the 3-year follow-up ( n = 140). Internalizing and externalizing problems were measured using the Strengths and Difficulties Questionnaire. At follow-up, parent-reported and adolescent self-reported irritability was assessed using the Affective Reactivity Index. Parent and adolescent outcomes measured at follow-up included attention-deficit/hyperactivity disorder symptom severity, sleep, behavior and parent mental health.

RESULTS

Children with externalizing problems at age 10 had higher parent-reported irritability (β = 0.31, 95% confidence interval = [0.17,-0.45], p = 0.001) in adolescence. Cross-sectional analyses found that irritability was associated with increased attention-deficit/hyperactivity disorder symptom severity and sleep problems; poorer emotional, behavioral and social functioning; and poorer parent mental health.

CONCLUSION

Our findings highlight the importance of assessing for and managing early conduct problems in children with attention-deficit/hyperactivity disorder, as these predict ongoing irritability which, in turn, is associated with poorer functioning across a number of domains.

The interaction between parenting and children's cortisol reactivity at age 3 predicts increases in children's internalizing and externalizing symptoms at age 6

Little is known about the role of stress reactivity in the emergence of psychopathology across early childhood. In this longitudinal study, we tested the hypothesis that child cortisol reactivity at age 3 moderates associations between early parenting and children's internalizing and externalizing symptoms from age 3 to age 6. One hundred and sixty children were assessed at age 3, and 135 children were reassessed at age 6. At age 3, we exposed children to stress-inducing laboratory tasks, during which we obtained four salivary cortisol samples, and parental hostility was assessed using an observational parent-child interaction task. At ages 3 and 6, child psychiatric symptoms were assessed using a clinical interview with parents. The results indicated that the combination of high child cortisol reactivity and high observed parental hostility at age 3 was associated with greater concurrent externalizing symptoms at age 3 and predicted increases in internalizing and externalizing symptoms from age 3 to age 6. Findings highlight that increased stress reactivity, within the context of hostile parenting, plays a role in the emergence of psychopathology from preschool to school entry.

Social Functioning in Children With or At Risk for Attention Deficit/Hyperactivity Disorder: A Meta-Analytic Review

Considerable work has demonstrated significant impairment in social functioning for children with attention deficit/hyperactivity disorder (ADHD). The social functioning profiles of children with ADHD are marked by impairments across diverse domains as they tend to experience greater rates of peer rejection, have lower levels of social skills, and have impaired social cognitions. The purpose of this study was to (a) quantitatively examine the association between ADHD and deficits across several domains of social functioning (peer functioning, social skills, social information processing), (b) examine differences in the magnitude of such associations, and (c) examine the effect of potential moderators. A meta-analysis of 109 studies (n = 104,813) revealed that children with ADHD have the most impairment within the peer functioning domain (weighted effect size [ES] r = .33) followed by significantly smaller effects within the social skills (weighted ES r = .27) and social information-processing domains (weighted ES r = .27). When examining potential moderators, results revealed that the association between ADHD and deficits within the social skills domain was weaker among studies that controlled for co-occurring conduct problems (CP). Studies that utilized sociometric and teacher reports of peer status reported the largest effects within the peer functioning domain. In addition, studies that utilized the "gold standard" approach to diagnosing ADHD documented the largest effects within both the social skills and peer functioning domains. Last, studies utilizing younger samples revealed the largest effects for deficits within the peer functioning domain. Theoretical and clinical implications are discussed.