Executive Functioning and Engagement in Physical and Relational Aggression among Children with ADHD

Contexts and Parental Management Strategies for Child-to-Parent Violence in Adolescents with Attention-Deficit/Hyperactivity Disorder: A Qualitative Study

BACKGROUND/OBJECTIVES

This qualitative study was conducted to understand the experiences of parents of adolescents with attention-deficit/hyperactivity disorder (ADHD) regarding experiences of child-to-parent violence (CPV), including the contexts of parent-child conflict in which CPV occurred, types of CPV, victimized parents' feelings and responses to CPV, and parents' strategies for better handling of CPV based on past experiences.

METHODS

Data from open and in-depth interviews with 18 parents who have experienced CPV perpetrated by their children with ADHD were subject to reflexive thematic analysis.

RESULTS

The results revealed various contexts in which parent-child conflicts (CPV) occurred. Parents reported the experiences of psychological aggression, physical aggression, and restrictions on movement. In addition to experiencing feelings of distress, fear, and frustration, parents adopted various strategies for coping with adolescents' CPV, such as leaving the scene, pushing back, rational communication, controlling their own emotions, encouraging their children to express their feelings, and seeking help. Parents suggested that practicing communicating with their children using real-life examples and learning parenting skills is essential to the prevention of CPV and the mitigation of serious consequences.

CONCLUSIONS

Our findings can provide healthcare professionals with key insights into the contexts of CPV and the management strategies used by parents of adolescents with ADHD.

Attention-Deficit/Hyperactivity Disorder Symptoms and Anger and Aggression in Russian Adolescents

Objective

Aggression is a multifaceted behavior that involves cognitive, behavioral, and affective components. Although aggressive behaviors are commonly observed among individuals with attention-deficit/hyperactivity disorder (ADHD), potential sex-specific aspects of the association between ADHD symptoms and different components of aggression need to be evaluated, while also controlling for comorbid problems.

Method

In the present cross-sectional study, self-reported data were collected from 2,838 adolescents (mean age = 14.89 years) from Russia on ADHD symptoms and cognitive (anger rumination, aggressive beliefs), behavioral (physical, verbal, social, proactive), and affective (trait anger) aspects of aggression as well as comorbid emotional and conduct problems. Generalized linear model analyses were used to examine the associations between ADHD symptoms and aggression and to explore sex differences, while also adjusting for comorbid problems.

Results

Clinically significant levels of ADHD symptoms were associated with all components of aggression, and the associations remained significant after adjusting for emotional and conduct problems. Overall, females had higher levels of trait anger and anger rumination, whereas males had higher levels of aggressive beliefs, proactive aggression, and physical and verbal aggression. There was also a sex-specific association, where males with ADHD symptoms reported higher levels of social aggression. Conduct problems moderated the association between ADHD and aggression, increasing the likelihood of trait anger and social aggression in adolescents without ADHD symptoms.

Conclusion

Clinically significant levels of ADHD symptoms seem to impact all components of aggression independent of comorbidity. It is therefore important to consider aggression when evaluating and treating ADHD.

Functional and structural connectivity of the subregions of the amygdala in ADHD children with or without ODD

OBJECTIVES

The current study aimed to investigate the structural and functional connectivity of the subregions of the amygdala in children with Attention Deficit/Hyperactivity Disorder (ADHD) only or comorbid with Oppositional Defiant Disorder (ODD).

METHODS

A total of 354 children with ADHD-only, 161 children with ADHD and ODD (ADHD + ODD), and 100 healthy controls were enrolled. The Child Behavior Checklist (CBCL) and the Behavior Rating Inventory of Executive Function (BRIEF) were filled out by caregivers. Analysis of covariance (ANCOVA) was performed to test group-wise differences in these behavioral measures. A subsample comprising 209 participants underwent a resting-state functional MRI scan and a diffusion-weighted imaging (DWI) scan. Functional connectivity and structural connectivity were calculated using bilateral subregions of the Amygdala as seeds. Between-group voxel-wise comparisons were conducted.

RESULTS

The ADHD + ODD group had more anxious/depressed moods, more delinquent and aggressive behaviors, more emotional control problems, and more inhibition deficits than the ADHD-only group (all PBonferroni-corrected < 0.05). Compared with the control and ADHD + ODD groups, the ADHD-only group displayed increased FC strength between the amygdala subregions and the left caudate, left putamen, and frontal cortex. Regarding structural connectivity (SC), the ADHD-only group demonstrated higher streamline density in the left internal capsule, corpus callosum, and the right superior corona radiata. The altered SC was associated with emotional problems in children with ADHD, while the altered FC was associated with other ADHD-related clinical features.

CONCLUSIONS

Altered structural and functional connectivity of the subregions of the amygdala in children with ADHD compared with their healthy counterparts were respectively associated with ADHD-related behavioral and emotional problems.

CLINICAL TRIAL NUMBER

not applicable.

Positive Emotion Dysregulation and Social Impairments in Adolescents with and without ADHD

Although research suggests that emotion dysregulation may underlie adolescents' social impairments, studies have focused almost exclusively on the dysregulation of negative emotions. The present study addressed this gap in the literature by examining whether behavioral manifestations of positive emotion dysregulation are also implicated. A sample of 13-18-year-old adolescents (56.8% female) with and without a childhood diagnosis of attention-deficit/hyperactivity disorder (ADHD) was used, increasing variability in impairment profiles. Adolescents self-reported behavioral difficulties related to positive emotion dysregulation (i.e., impulse control difficulties, difficulties engaging in goal-directed behavior, and non-acceptance of positive emotions), negative emotion dysregulation, and social impairments (i.e., peer rejection, friendship quality, deviant peer affiliation, aggression, and victimization); parents rated adolescent's ADHD symptoms. Regression analyses indicated that impulse control difficulties when experiencing positive emotions uniquely predicted greater conflict in the best friend relationship, deviant peer affiliation, aggression, and victimization, even when accounting for negative emotion dysregulation and current ADHD symptoms. The significant effect of impulse control difficulties on these social impairments was consistent when accounting for oppositional defiant disorder and depression symptoms and when examining the main predictors only in adolescents with childhood or adolescent clinical elevations in ADHD symptoms. These results are the first to indicate that even for adolescents with ADHD, positive emotion dysregulation, and specifically impulse control difficulties, may significantly predict social challenges.

Effects of an online mindfulness-based program for parents of children with attention deficit/hyperactivity disorder: a pilot, mixed methods study

Objectives

Online mindfulness-based program (MBP) for parents and families especially in clinical population is limited. Engagement and significant dropout are major issues in MBP implementation. This pilot study examined the effects of an online mindfulness-based program (MBP) on parents of children with Attention Deficit/Hyperactivity Disorder (ADHD).

Methods

A mixed methods study was applied to evaluate the effects of the MBP. A total of 43 parents were recruited and were randomly assigned into intervention group and waitlist control group. The online MBP lasted for 28 days, including 20 psychoeducation videos, homework audio guidance, and four instructor-led online group meetings. Purposive sampling was used to recruit parents who completed the program to share their experiences and suggestions for improving the program in semi-structured online interviews.

Results

Quantitative data showed that participants from the online MBP reported a medium to large effect on the reduction of child ADHD symptoms. In semi-structured interviews, participants reported positive experiences in their help seeking intention, and personal changes, such as emotion regulation and quality attention to their children. Participants further made suggestions for improvement.

Conclusions

The effect of online MBP is promising, and the program should be conducted. A large scale randomized controlled trial should be conducted to investigate the effects of MBP in clinical populations.

Clinical trial registration

ClinicalTrials.gov NCT05480423.

Associations of bullying perpetration and peer victimization subtypes with preadolescent's suicidality, non-suicidal self-injury, neurocognition, and brain development

BACKGROUND

Although both peer victimization and bullying perpetration negatively impact preadolescents' development, the underlying neurobiological mechanism of this adverse relationship remains unclear. Besides, the specific psycho-cognitive patterns of different bullying subtypes also need further exploration, warranting large-scale studies on both general bullying and specific bullying subtypes.

METHODS

We adopted a retrospective methodology by utilizing the data from the Adolescent Brain and Cognitive DevelopmentSM Study (ABCD Study®) cohort collected between July 2018 and January 2021. Participants were preadolescents aged from 10 to 13 years. The main purpose of our study is to examine the associations of general and specific peer victimization/bullying perpetration with preadolescents' (1) suicidality and non-suicidal self-injury; (2) executive function and memory, including attention inhibition, processing speed, emotion working memory, and episodic memory; (3) brain structure abnormalities; and (4) brain network disturbances. Age, sex, race/ethnicity, body mass index (BMI), socioeconomic status (SES), and data acquisition site were included as covariates.

RESULTS

A total of 5819 participants aged from 10 to 13 years were included in this study. Higher risks of suicide ideation, suicide attempt, and non-suicidal self-injury were found to be associated with both bullying perpetration/peer victimization and their subtypes (i.e., overt, relational, and reputational). Meanwhile, poor episodic memory was shown to be associated with general victimization. As for perpetration, across all four tasks, significant positive associations of relational perpetration with executive function and episodic memory consistently manifested, yet opposite patterns were shown in overt perpetration. Notably, distinct psycho-cognitive patterns were shown among different subtypes. Additionally, victimization was associated with structural brain abnormalities in the bilateral paracentral and posterior cingulate cortex. Furthermore, victimization was associated with brain network disturbances between default mode network and dorsal attention network, between default mode network and fronto-parietal network, and ventral attention network related connectivities, including default mode network, dorsal attention network, cingulo-opercular network, cingulo-parietal network, and sensorimotor hand network. Perpetration was also associated with brain network disturbances between the attention network and the sensorimotor hand network.

CONCLUSIONS

Our findings offered new evidence for the literature landscape by emphasizing the associations of bullying experiences with preadolescents' clinical characteristics and cognitive functions, while distinctive psycho-cognitive patterns were shown among different subtypes. Additionally, there is evidence that these associations are related to neurocognitive brain networks involved in attention control and episodic retrieval. Given our findings, future interventions targeting ameliorating the deleterious effect of bullying experiences on preadolescents should consider their subtypes and utilize an ecosystemic approach involving all responsible parties.

Treatment of US Children With Attention-Deficit/Hyperactivity Disorder in the Adolescent Brain Cognitive Development Study

Importance

Characterizing the extent and pattern of unmet needs for treatment of children with attention-deficit/hyperactivity disorder (ADHD) could help target efforts to improve access to ADHD medications and outpatient mental health care.

Objective

To describe current ADHD medication use and lifetime outpatient mental health care among a large national sample of children with ADHD.

Design, Setting, and Participants

This study uses cross-sectional survey data from the first wave of the Adolescent Brain and Cognitive Development Study (n = 11 723), conducted from June 1, 2016, to October 15, 2018, among 1206 school children aged 9 and 10 years who met parent-reported Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) criteria for current ADHD. Statistical analysis was performed from March 23, 2022, to March 10, 2023.

Main Outcomes and Measures

Current ADHD medications including stimulants and nonstimulants, lifetime outpatient mental health care, or either treatment. Weighted results are reported.

Results

Among a sample of 11 723 children, 1206 had parent-reported ADHD (aged 9-10 years; 826 boys [68.2%]; 759 White, non-Hispanic children [62.2%]), 149 (12.9%) were currently receiving ADHD medications. Children receiving ADHD medications included a significantly higher percentage of boys (15.7% [121 of 826]) than girls (7.0% [28 of 108]), White children (14.8% [104 of 759]) than Black children (9.4% [22 of 206]), children of parents without a high school education (32.2% [9 of 36]) than of parents with a bachelor's degree or higher (11.5% [84 of 715]), and children with the combined subtype of ADHD (17.0% [83 of 505]) than with the inattentive subtype (9.5% [49 of 523]). Approximately 26.2% of children (301 of 1206) with parent-reported ADHD had ever received outpatient mental health care. Children receiving outpatient mental health care included a significantly higher percentage of children whose parents had a high school education (36.2% [29 of 90]) or some college (31.0% [109 of 364]) than a bachelor's degree or higher (21.3% [153 of 715]), children with family incomes of less than $25 000 (36.5% [66 of 176]) or $25 000 to $49 999 (27.7% [47 of 174]) than $75 000 or more (20.1% [125 of 599]), and children with the combined subtype of ADHD (33.6% [166 of 505]) than with the predominantly inattentive subtype (20.0% [101 of 523]) or the hyperactive-impulsive subtype (22.4% [34 of 178]) of ADHD.

Conclusions and Relevance

This cross-sectional study of children with parent-reported ADHD suggests that most were not receiving ADHD medications and had never received outpatient mental health care. Gaps in treatment, which were not directly associated with socioeconomic disadvantage, underscore the challenges of improving communication and access to outpatient mental health care for children with ADHD.

ADHD Symptoms, Peer Problems, and Emotion Dysregulation as Longitudinal and Concurrent Predictors of Adolescent Borderline Personality Features

OBJECTIVE

ADHD and borderline personality (BP) disorder are highly comorbid and characterized by emotion dysregulation and peer problems. However, limited research has examined social and emotional predictors of BP features in samples that include youth with ADHD.

METHOD

Using a sample of 124 youth with and without ADHD (52% female), ADHD symptoms, peer problems, and emotion dysregulation were assessed in childhood (8-13 years) and in adolescence, along with BP features (13-18 years).

RESULTS

In addition to the significant effect of ADHD symptoms, teacher-rated child peer victimization and adolescent-reported peer victimization, poorer close friendships, and emotion dysregulation domains significantly predicted adolescent BP features. Greater parent-rated child and adolescent emotion dysregulation domains also significantly predicted adolescent BP features, with ADHD symptoms no longer significant.

CONCLUSION

Even for youth with ADHD, peer and emotional vulnerabilities in childhood and adolescence may serve as important markers of risk for adolescent BP features.

Identifying Relationally Aggressive Students: How Aligned are Teachers and Peers?

Relational aggression is characterized by attempts to damage another's relationships or social status and is a major concern affecting academic, socioemotional, behavioral, and health outcomes, particularly for urban, minority youth. Teachers and peers frequently disagree about which students are relationally aggressive. Factors associated with peer and teacher discordant and concordant identification of relationally aggressive students were explored including prosocial behavior, perceived popularity, academic competence, and gender. Participants included 178 3rd-5th grade students across 11 urban classrooms. Findings revealed that students were more likely to be rated as relationally aggressive by their peers but not their teacher as scores on peer nominations for prosocial behavior decreased, while teacher-rated academic motivation/participation increased. Female students were more likely to be concordantly identified by peers and teachers as relationally aggressive when ratings for overt aggression increased. These results highlight the utility of obtaining ratings from multiple informants as well as the difficulty in accurately identifying all students who may benefit from interventions targeting relational aggression. Findings also suggest factors that may be related to the potential shortcomings of current measures and provide avenues for additional research to improve detection of relationally aggressive students.

Promoting Executive Function Skills in Preschoolers Using a Play-Based Program

In recent years, play has been shown to be a powerful means to enhance learning and brain development. It is also known that through play children enhance their executive function (EF) skills. Furthermore, well-developed EF in preschoolers has been shown to be an important predictor for later academic and life success. Armed with this information a program, Building Brains and Futures (BBF), for developing EF through play was designed for 3–5-year-old. The program consisted of 10 simple, fun, and interactive games selected to enhance various facets of EF. The 10 games included were: dimensional change card sort, lips and ears, block building, musical freeze, opposites, pretend play, red light/green light, shared project, Simon says, and wait for it. The program was implemented with a group of children shown to have challenges with respect to kindergarten readiness. The approach was first, to build adult capability by sharing knowledge of brain development, EF, and the importance of play with educators, caregivers, and parents. Second, to build skills in delivering the program in the school setting. Children engaged with the program of games for a minimum of 6 weeks. Their performance on a battery of direct measures of EF, language, and motor skills, were recorded before and after the program. The results showed improvement in all three domains. In addition, adopters of the BBF program reported it was easily and successfully integrated into their existing preschool curricula. The importance of intentional adult directed play in building developmental learning, including EF, is discussed.

Identifying Neural Markers of Peer Dysfunction in Girls with ADHD

Very little research has prioritized girls with ADHD, despite accumulating evidence showing that girls with ADHD experience broader and more severe peer dysfunction relative to boys with ADHD. Attention to identifying the neural mechanisms underlying the peer difficulties of girls with ADHD is critical in order to develop targeted intervention strategies to improve peer functioning. New efforts to address the peer dysfunction of girls with ADHD are discussed.

Physiological Correlates of Sluggish Cognitive Tempo in Children: Examining Autonomic Nervous System Reactivity during Social and Cognitive Stressor Tasks

It is important to establish correlates of sluggish cognitive tempo (SCT) across units of analysis and to better understand how SCT may be conceptualized in models of psychopathology. The current study examined SCT symptoms in relation to automatic nervous system reactivity during social and cognitive stressor tasks. Participants were 61 children ages 8-12 years with a full range of attention-deficit/hyperactivity disorder (ADHD) symptom severity. Parents provided ratings of SCT and parents and teachers completed measures that were used to create composite indices of ADHD symptoms. Children were administered standardized peer rejection and impossible puzzle tasks, during which their respiratory sinus arrhythmia (RSA) and skin conductance level (SCL) reactivity were recorded. Regression analyses indicated that SCT symptoms were unassociated with RSA reactivity to either task. Greater SCT symptoms were significantly associated with greater SCL reactivity to peer rejection. Greater SCT symptoms were not significantly associated with SCL reactivity to the impossible puzzle task. The pattern of findings was unchanged in sensitivity analyses that controlled for ADHD symptoms, internalizing symptoms, medication status, or sex. This study provides the first evidence that SCT symptoms are associated with sympathetic nervous system reactivity. These findings suggest that SCT symptoms may be associated with greater behavioral inhibition system activation, and reactivity may be especially pronounced in social challenges.

Differences in associations between problematic video-gaming, video-gaming duration, and weapon-related and physically violent behaviors in adolescents

Seemingly mixed findings have been reported on possible relationships between video-gaming and violent or aggressive behaviors. Given the prevalence of gaming in adolescents and potential harms associated with violent behaviors, relationships between problematic gaming, gaming engagement, and risk behaviors involving weapons and physical violence require further research. This study examined in a large sample of high-school students the relationships between problem-gaming severity, gaming duration, and violence-related measures including weapon-carrying, having been threatened by someone with a weapon, perceived insecurity, physical fights and serious fights leading to injuries. Potential moderation by sensation-seeking and impulsivity was also tested. Participants were 3,896 Connecticut high-school adolescents. Chi-square, logistic regression, and moderation models were conducted. Adolescents with at-risk/problem gaming, compared to low-risk and non-gaming adolescents, reported more weapon-carrying, having been threatened with weapons, feeling unsafe at school, and serious fighting leading to injury. Among those reporting gaming, weekly time spent gaming was associated with problem-gaming severity. Those with longer (versus shorter) gaming durations were more likely to report weapon-carrying and feeling unsafe at school. Sensation-seeking moderated associations between at-risk/problem gaming and weapon-carrying frequency. Associations between gaming quantity and problem-gaming severity and measures of weapon-carrying and physical violence in adolescents suggest that understanding further their mechanistic relationships may be important in promoting safer developmental trajectories for youth. Future longitudinal studies may provide important insight into the etiologies underlying these relationships and such information may help develop more effective prevention and intervention strategies.

Parental influences on child report of relational attribution biases during early childhood

Influences on social cognition, such as hostile attribution biases, are a relatively understudied topic despite the association of hostile attribution biases with important developmental and clinical outcomes. From a developmental perspective, it is particularly important to understand the early development of biases regarding how the intentions of others are perceived, especially in the relationship context. Therefore, understanding potential correlates, such as parental influences, of such biases during early childhood may be especially important. The current study (N = 121) was designed to explore several gaps and limitations in the hostile intent attribution literature, especially the lack of research on hostile attribution biases for relational provocations and associated parent behavior. In particular, this gap was addressed by investigating parental influences on hostile attribution biases for relational provocations during early childhood (i.e., 3-5 years of age) using parent and child reports. It was found that parent hostile attribution biases for relational provocations was significantly associated with child hostile attribution biases for relational provocations. Furthermore, it was demonstrated that parent relational aggression was related to parenting practices. Implications for research and practice are discussed.

Borderline Personality Features Mediate the Association Between ADHD, ODD, and Relational and Physical Aggression in Girls

OBJECTIVE

This study investigates borderline personality features (BPF) as a mediator of the association between ADHD and ODD symptoms and aggression in girls.

METHOD

Parents of 118 girls ( M_age = 11.40 years old) with and without ADHD completed ratings of ADHD and ODD severity, and parents and youth provided ratings of physical and relational aggression.

RESULTS

ADHD, ODD, and their subfactors were significantly correlated with BPF, and these variables were associated with aggression measures. BPF fully mediated the association between total ODD symptom severity and relational and physical aggression by parent and youth report. At the subfactor level, BPF fully mediated the association between hyperactivity/impulsivity and oppositional behavior and physical and relational aggression.

CONCLUSION

These findings add to a growing literature showing the relevance of BPF as a risk factor for poor social functioning in youth and point to the importance of continued work examining BPF among girls with ADHD and ODD.

Experiences of physical and relational victimization in children with ADHD: The role of social problems and aggression

The social risk factors for physical and relational peer victimization were examined within a mixed-gender sample of children with and without attention-deficit/hyperactivity disorder (ADHD). Participants were 124 children (ages 8-12 years; 48% boys), with 47% exhibiting sub-clinical or clinical elevations in ADHD symptoms. ADHD and oppositional defiant disorder (ODD) symptom counts were assessed based on parent- and teacher-reports; parents rated children's social problems and teachers rated children's use of physical and relational aggression and experiences of physical and relational victimization. A multiple mediator model was used to test whether there were indirect effects of ADHD or ODD symptoms on physical and relational victimization through social problems, physical aggression, or relational aggression. At the bivariate level, ADHD and ODD symptoms were both significantly associated with higher rates of physical and relational victimization. In the mediational model, there were significant indirect effects of ADHD symptoms on relational victimization via social problems, of ODD on relational victimization via relational aggression, and of ODD symptoms on physical victimization via physical aggression. Results suggest that there are distinct risk factors implicated in the physical and relational victimization of youth with ADHD and that the co-occurrence of ODD symptoms is important to assess. Clinical implications for addressing victimization in children with ADHD are discussed.

Early risk pathways to physical versus relational peer aggression: The interplay of externalizing behavior and corporal punishment varies by child sex

Children who aggress against their peers may use physical or relational forms, yet little research has looked at early childhood risk factors and characteristics that uniquely predict high levels of relational versus physical aggression in preadolescence. Accordingly, the main aim of our study was to link early corporal punishment and externalizing behavior to children's physical and relational peer aggression during preadolescence and to examine how these pathways differed by sex. Participants were 193, 3-year-old boys (39%) and girls who were reassessed following the transition to kindergarten (5.5 years) and preadolescence (10.5 years). A series of autoregressive, cross-lagged path analyses were conducted to examine the relationships between child externalizing problems and corporal punishment at ages 3 and 5.5 years, and their association with physical and relational aggression at age 10.5. Multiple group analysis was used to determine whether pathways differed by sex. Three developmental pathways were identified: (i) direct associations between stable childhood externalizing problems and later physical aggression; (ii) a direct pathway from early corporal punishment to preadolescent relational and physical peer aggression; and (iii) an indirect pathway from early corporal punishment to later physical aggression via continuing externalizing problems in middle childhood. Child sex moderated the nature of these pathways, as well as the direction of association between risk and outcome variables. These data advance our understanding of the etiology of distinct forms of peer aggression and highlight the potential for more efficacious prevention and intervention efforts in the early childhood years.