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

School-Based Intervention for Adolescents With ADHD: Predictors of Effects on Academic, Behavioral, and Social Functioning

Adolescents with attention-deficit/hyperactivity disorder (ADHD) experience significant academic, behavioral, and social skill difficulties including underachievement, risk for school dropout, poor peer relations, and emotion dysregulation. Although stimulant medication reduces ADHD symptoms, psychosocial and educational interventions are necessary to address functional impairments. We examined the nature and predictors of academic, behavioral, and social skills trajectories in response to multicomponent organizational and interpersonal skills training in 92 high school students with ADHD. Latent trajectory class analyses revealed positive treatment response ranging from 61.5% (report card grades) to 100% (inattention symptoms, organizational skills, social skills). Organizational skill and academic grade treatment response trajectories were predicted by assigned sex, pretreatment anxiety, and treatment dosage, while improvement in behavioral and social functioning was associated with better emotion regulation and family relations prior to treatment along with stronger working alliance with treatment coach at midtreatment. Multicomponent organizational and interpersonal skills training appears effective for most high school students with ADHD and the degree treatment-induced change is associated with multiple malleable factors can be leveraged to enhance intervention response.

Social Functioning Outcomes of a High School-Based Treatment Program for Adolescents with ADHD

OBJECTIVE

We evaluated the extent to which receiving the multi-component treatment of the Challenging Horizons Program (CHP) would lead to significant improvements in social functioning, as well as in inattention, internalizing symptoms, parent stress, and emotion dysregulation for high-school-aged adolescents with attention-deficit hyperactivity disorder (ADHD).

METHOD

Participants were 186 high-school-aged adolescents (74% White) with a diagnosis of ADHD who were randomly assigned to either CHP (n = 92; 80% boys; M age = 15.0; SD = 0.8) or Community Care (CC; n = 94; 78% boys; M age = 15.1; SD = 0.9) within each of 12 participating schools. Parent and adolescent reports of social functioning were the primary outcome measures. Secondary outcomes included ratings of symptoms of ADHD and related disorders, parent stress, and emotion regulation.

RESULTS

Intent-to-treat analyses using hierarchical linear modeling revealed significant group-by-time interactions of medium magnitude (d range = .40 to .52) on parent-rated social skills. Significant group-by-time benefits were also identified for adolescent self-rated social skills as well as the secondary outcomes of parent-rated inattention symptoms, emotion regulation, and parenting stress.

DISCUSSION

CHP appears to benefit social skills along with related characteristics for adolescents with ADHD. Understanding these unique findings for this population informs additional research related to treatment mechanisms and effectiveness trials.

Impairment's Role in the Pathway From Externalizing Psychopathology to Depressive Symptoms in Adolescents With ADHD

OBJECTIVE

This study examined the role of academic, social, and family impairment in the pathway from externalizing psychopathology to depression among young adolescents with ADHD in a multiple mediation model.

METHOD

The sample included adolescents with ADHD enrolled in an intervention trial. Parent ratings of externalizing psychopathology were measured at eligibility assessment, adolescent self-reported depressive symptoms were measured at eligibility and at the end of treatment, and parent-rated impairment was measured in the middle of treatment. A multiple mediation model was used to examine mediating effects of impairment types in the pathway from externalizing psychopathology to depression.

RESULTS

Parent-reported family impairment significantly mediated the association between externalizing psychopathology and depressive symptoms.

CONCLUSIONS

Results suggest family impairment mediates the association between externalizing psychopathology and depressive symptoms beyond academic and social impairment for youth with ADHD. Findings implicate the importance of targeting family functioning during early adolescence to prevent depression.

School connectedness mediates the association of social function with depressive symptoms in teenagers with attention deficit hyperactivity disorder

BACKGROUND

Depressive symptoms commonly co-occur in teenagers with attention deficit hyperactivity disorder (ADHD), and poor social function is a known predictor of depressive symptoms. This study's purpose was to determine whether school connectedness mediates the association between social function and depressive symptoms in teenagers with ADHD.

METHOD

In this secondary analysis, we selected 313 (74%) of 425 teenagers with ADHD (male 72%, mean age = 15 years) who had completed data on depressive symptoms, social function, and school connectedness in the Fragile Families and Child Well-Being Study. The mediation effect of school connectedness was tested by multiple regression using SPSS PROCESS macro with 5000 bootstrap samples controlling covariates (teenagers' age, gender, and race, their relationship with primary caregivers, type of school teenager attends, time of living with primary caregivers, and primary caregivers' education).

RESULTS

Social function predicted depressive symptoms (direct effect = -0.132, 95% CI = -0.218, -0.045). School connectedness mediated the relationship between social function and depressive symptoms (indirect effect = -0.084; 95% CI = -0.130, -0.045).

CONCLUSION

This study points to the importance of considering school factors in understanding depression symptoms in children with ADHD. Also, clinicians should consider asking teenagers about school-related factors such as school connectedness which is likely important in understanding the experience of depressive symptoms in this population. Identifying ways to help enhance school connectedness for young people with ADHD should be prioritized.

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

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

Family Stress and Rural African-American Adolescents' Depressive Symptoms

PURPOSE

Limited longitudinal research investigates the effects of family stress on the development of depressive symptoms among African-American adolescents. This study tests a developmental model of the family and intrapersonal processes linking family stress to depressive symptoms from the ages of 11 to 15 years. We hypothesized that family stress would predict increases in caregiver-youth conflict, which in turn would predict decreases in adolescents' self-control, a proximal predictor of increases in depressive symptoms.

METHODS

The sample consisted of 472 African-American youths and their primary caregivers from eight rural counties in southern Georgia who provided data at four time points (youth of ages 11-15 years). Hypotheses were tested with structural equation modeling.

RESULTS

Results were consistent with study hypotheses. Family stress significantly predicted depressive symptoms via intermediate effects on caregiver-youth conflict and adolescent self-control. The indirect influence of family stress via these intermediate processes was significant.

CONCLUSIONS

Findings suggest tha, when families experience stress, caregiver-youth conflict increases, which may lead to the development of poor self-control in youth, a proximal predictor of increases in depressive symptoms. Findings have implications for the development of prevention programs for rural African-American adolescents.

Top problems of adolescents and young adults with ADHD during the COVID-19 pandemic

OBJECTIVE

ADHD symptom severity appears to be exacerbated during the COVID-19 pandemic. The present study surveyed top problems experienced by adolescents and young adults (A/YAs) with ADHD during the COVID-19 pandemic to identify possible reasons for symptom escalation and potential targets for intervention. We also explored perceived benefits of the pandemic for A/YAs with ADHD.

METHOD

At the outbreak of the COVID-19 pandemic (April-June 2020), we administered self and parent ratings about current and pre-pandemic top problem severity and benefits of the pandemic to a sample of convenience (N = 134 A/YAs with ADHD participating in a prospective longitudinal study).

RESULTS

The most common top problems reported in the sample were social isolation (parent-report: 26.7%; self-report: 41.5%), difficulties engaging in online learning (parent-report: 23.3%, self-report: 20.3%), motivation problems (parent-report: 27.9%), and boredom (self-report: 21.3%). According to parent (d = 0.98) and self-report (d = 1.33), these top problems were more severe during the pandemic than in prior months. Contrary to previous speculation, there was no evidence that pandemic-related changes mitigated ADHD severity. Multi-level models indicated that A/YAs with higher IQs experienced severer top problems exacerbations at the transition to the COVID-19 pandemic.

CONCLUSIONS

For A/YAs with ADHD, several risk factors for depression and school dropout were incurred during the early months of the COVID-19 pandemic. A/YAs with ADHD should be monitored for school disengagement and depressive symptoms during the COVID-19 pandemic. Recommended interventions attend to reducing risk factors such as increasing social interaction, academic motivation, and behavioral activation among A/YAs with ADHD.

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.