Preliminary examination of ADHD inattentive and cognitive disengagement syndrome symptoms in relation to probe-caught mind-wandering during a sustained attention to response task

OBJECTIVE

The role of mind-wandering- periods of internally-directed distractibility - among patients with attention-deficit/hyperactivity disorder (ADHD) has recently garnered attention, though few studies have assessed mind-wandering using thought probes during a sustained attention to response task (SART) or examined the possible role of cognitive disengagement syndrome (CDS) symptoms. We examined whether parent- and/or teacher-reported ADHD-inattentive (ADHD-IN) or CDS symptoms were independently associated with probe-caught mind-wandering.

METHODS

Fifty-four children (ages 9-12; 35.2% female) completed a SART with thought probes inquiring about various on- and off-task thoughts, including mind-wandering and distraction. Questionnaires provided information on demographics, medication treatment, and parent- and teacher-reported ADHD-IN and CDS symptoms. Regression models were estimated separately by informant to examine whether ADHD-IN or CDS symptoms were uniquely associated with mind-wandering or distraction frequency during the SART.

RESULTS

Higher teacher-reported CDS ratings, but not ADHD-IN ratings, were uniquely associated with more probe-caught mind-wandering. No significant findings related to parent-reported symptoms or probe-caught distraction were observed.

CONCLUSIONS

These preliminary findings add to an emerging body of work pointing to CDS as more consistently or strongly associated than ADHD-IN with mind-wandering. Theoretical and clinical implications are discussed.

Examining Patterns and Predictors of ADHD Teens' Skill-Learning Trajectories During Enhanced FOrward Concentration and Attention Learning (FOCAL+) Training

OBJECTIVE

Examine patterns and predictors of skill learning during multisession Enhanced FOrward Concentration and Attention Learning (FOCAL+) training.

BACKGROUND

FOCAL+ teaches teens to reduce the duration of off-road glances using real-time error learning. In a randomized controlled trial, teens with ADHD received five sessions of FOCAL+ training and demonstrated significant reductions in extended glances (>2-s) away from the roadway (i.e., long-glances) and a 40% reduced risk of a crash/near-crash event. Teens' improvement in limiting long-glances as assessed after each FOCAL+ training session has not been examined.

METHOD

Licensed teen (ages 16-19) drivers with ADHD (n = 152) were randomly assigned to five sessions of either FOCAL+ or modified standard driver training. Teens completed driving simulation assessments at baseline, after each training session, and 1 month and 6 months posttraining. Naturalistic driving was monitored for one year.

RESULTS

FOCAL+ training produced a 53% maximal reduction in long-glances during postsession simulated driving. The number of sessions needed to achieve maximum performance varied across participants. However, after five FOCAL+ training sessions, number of long-glances was comparable irrespective of when teens achieved their maximum performance. The magnitude of reduction in long-glances predicted levels of long-glances during simulated driving at 1 month and 6 months posttraining but not naturalistic driving outcomes. FOCAL+ training provided the most benefit during training to teens who were younger and had less driving experience.

CONCLUSION

FOCAL+ training significantly reduces long-glances beginning at the 1st training session.

APPLICATION

Providing five FOCAL+ training sessions early on during teen driving may maximize benefit.

Mathematics abilities associated with adaptive functioning in preschool children born preterm

It is well known that infants born very preterm (VPT) often demonstrate deficits in mathematical abilities in early childhood which are associated with poorer academic outcomes. Mathematic skills are also critical for other areas of functioning. However, it is not known whether mathematics skills are associated with adaptive functioning in children born preterm. Infants born at ≤31 weeks gestation and full term were recruited at birth and followed over time. At the 36-month corrected age assessment, children were administered the Early Number Concepts subtest of the Differential Abilities Scale, Second Edition, and caregivers completed the Adaptive Behavior Assessment System, Third Edition. After controlling for age, sex, cognitive abilities, and caregiver education, performance on the mathematics measure was uniquely and positively associated with adaptive behavior for preschool children in the VPT group only. Exploratory analyses revealed this association to be specifically related to the Practical and Social composites. Knowledge of concepts of number and quantity were associated with better adaptive functioning, particularly for behaviors related to functioning at home and in the community and play/social functioning, for children born VPT. Although replication is warranted, it would appear that mathematical skills may be an important early intervention target for children born VPT.

[Formula: see text] Neurocognition in children with cognitive disengagement syndrome: accurate but slow

Cognitive disengagement syndrome (CDS), previously termed sluggish cognitive tempo (SCT), is characterized by excessive daydreaming, mental confusion, and slowed behavior or thinking. Prior research has found inconsistent relations between CDS and neurocognition, though most studies have used small or ADHD-defined samples, non-optimal measures of CDS, and/or examined limited neurocognitive domains. Accordingly, this study examined the association of parent- and teacher-reported CDS symptoms using a comprehensive neurocognitive battery in a sample of 263 children (aged 8-12) selected with a range of CDS symptomatology. Parents and teachers provided ratings of CDS and ADHD inattentive (ADHD-IN) symptoms. Path analyses were conducted to examine CDS and ADHD-IN as unique predictors of neurocognitive functioning after covarying for age, sex, and family income. CDS symptoms were uniquely associated with slower performance across a range of cognitive domains, including verbal inhibition, rapid naming/reading, planning, divided attention, and set shifting. In contrast, ADHD-IN symptoms were uniquely associated with poorer performance on a Go/NoGo task (inhibition/distractibility), visual scanning and discrimination, and interference control. Findings from the current study, amongst the first to recruit children based on levels of CDS symptomatology, provide the strongest evidence to date that the neurocognitive phenotype of CDS is characterized by slowed cognitive processing, and add to its validity as a separate syndrome from ADHD. If replicated, these findings have implications for assessment, treatment, and school accommodations for CDS. Neuroimaging studies exploring the neurobiological basis of CDS are also needed.

A Multi-Method Examination of Peer Functioning in Children with and without Cognitive Disengagement Syndrome

OBJECTIVE

Cognitive disengagement syndrome (CDS) includes excessive daydreaming, mental confusion, and hypoactive behaviors that are distinct from attention-deficit/hyperactivity disorder inattentive (ADHD-IN) symptoms. A growing number of studies indicate that CDS symptoms may be associated with ratings of social withdrawal. However, it is important to examine this association in children specifically recruited for the presence or absence of CDS, and to incorporate multiple methods including direct observations of peer interactions. The current study builds on previous research by recruiting children with and without clinically elevated CDS symptoms and using a multi-method, multi-informant design including recess observations and parent, teacher, and child rating scales.

METHOD

Participants were 207 children in grades 2-5 (63.3% male), including 103 with CDS and 104 without CDS, closely matched on grade and sex.

RESULTS

Controlling for family income, medication status, internalizing symptoms, and ADHD-IN severity, children with CDS were observed during recess to spend more time alone or engaging in parallel play, as well as less time involved in direct social interactions, than children without CDS. Children with CDS were also rated by teachers as being more asocial, shy, and socially disinterested than children without CDS. Although children with and without CDS did not differ on parent- or self-report ratings of shyness or social disinterest, children with CDS rated themselves as lonelier than children without CDS.

CONCLUSIONS

Findings indicate that children with CDS have a distinct profile of peer functioning and point to the potential importance of targeting withdrawal in interventions for youth with elevated CDS symptoms.

Use of the Weekly Calendar Planning Activity to Assess Executive Function in Adolescents With Autism Spectrum Disorder

IMPORTANCE

Youths with autism spectrum disorder (ASD) have challenges with executive function (EF). However, there are few measures to objectively assess EF, such as time management and prioritization. The Weekly Calendar Planning Activity (WCPA) is a promising performance-based EF measure that has rarely been used with youths with ASD.

OBJECTIVE

To characterize the performance of youths with ASD on the WCPA and the association of WCPA performance with caregiver-rated EF.

DESIGN

Observational and summary data obtained during a baseline evaluation for a research study.

SETTING

Middle school.

PARTICIPANTS

Thirty-nine adolescents with ASD and without an intellectual disability.

METHOD

Youth were administered the WCPA; caregivers completed EF ratings. Descriptive statistics characterized WCPA performance. Correlations between WCPA scores and age, IQ, and EF ratings were computed.

RESULTS

The majority of youth performed poorly on the WCPA and lacked insight into their poor performance. Many struggled to enter appointments. Appointment accuracy was <30%. The most common errors were location errors. Appointment accuracy and planning time were moderately associated with IQ but not with caregiver-rated EF or age.

CONCLUSIONS AND RELEVANCE

Overall, the WCPA was cognitively demanding for youths with ASD without an intellectual disability. These results have implications for using evidence-based strategies to teach adolescents with ASD how to manage their time and plan and prioritize homework assignments, upcoming tests or quizzes, and extracurricular activities. Plain-Language Summary: Youths with autism spectrum disorder have significant problems with executive function, particularly organization, prioritization, time management, and planning. There are few objective, performance-based measures of executive function, especially those that can be used with autistic youths. To our knowledge, this study is the first to use the Weekly Calendar Planning Activity (WCPA) with autistic adolescents who do not have an intellectual disability. The WCPA captured their deficits related to executive function and could be a useful tool for assessment and treatment planning.

Executive Functioning as a Predictor of Adverse Driving Outcomes in Teen Drivers With ADHD

OBJECTIVE

The present study examined the association between executive functioning (EF) and risky driving behaviors in teens with ADHD.

METHOD

Teens diagnosed with ADHD (n = 179; Mage = 17.4 years) completed two 15-min drives in a fixed-base driving simulator. EF was assessed using parent- and self-report Behavior Rating Inventory of Executive Functioning (BRIEF-2), a temporal reproduction task, and a Go/No-Go task (GNG). Driving outcomes included known predictors of crashes: count of long (>2 s) off-road glances, standard deviation (SD) of lane position (SDLP), mean speed, and SD speed. Generalized linear mixed models, controlling for intelligence and driving experience, were conducted.

RESULTS

Higher rates of GNG commission errors predicted higher rates of long off-road glances. Lower parent-rated EF and increased rates of GNG omission errors predicted SDLP. Higher rates of GNG commission errors also predicted faster average driving speed.

CONCLUSION

Heterogeneity in EF is associated with differences in teen ADHD risky driving behaviors.

Achieving Independence and Mastery in School: A School-Based Executive Function Group Intervention for Autistic Middle Schoolers

Executive functioning (EF) deficits, such as challenges with planning, organization, and materials management, negatively impact academic performance, particularly for middle-school students with autism spectrum disorder (ASD) without intellectual disability (ID). The aim was to assess the initial efficacy of the school-based version of the Achieving Independence and Mastery in School (AIMS) intervention in a pilot randomized clinical trial. 47 autistic middle-schoolers without ID attending nine different schools were randomized to participate in AIMS or to wait to receive AIMS the following semester (waitlist control = WLC). Youth, caregivers, and teachers rated academic EFs and academic functioning, and youth completed an objective EF measure, at baseline and outcome (post). Effect sizes were computed comparing baseline and post measures within each group. Individuals randomized to AIMS improved from baseline to post on academic EF outcome measures with small to moderate effect sizes, compared to WLC, who made some improvements but with generally smaller effect sizes. Analyses with academic functioning measures showed a similar pattern of results. These promising results suggest that AIMS delivered in the school by school-based personnel to small groups of students with ASD without ID can improve academic EF skills.

School Challenges and Services Related to Executive Functioning for Fully Included Middle Schoolers with Autism

The educational services available for fully included middle schoolers with autism spectrum disorder (ASD) in the general education setting are not well known. Even less is known about how the executive functioning (EF) deficits of such youth are addressed in the classroom. The current study sought to identify the challenges, including EF, that middle schoolers with ASD face and the services that they receive on their Individualized Education Program (IEP), and also explore specific strategies used to build EF skills at school. A convenience data sample was obtained from focus groups with educational personnel (n = 15), and qualitative analyses of IEPs were conducted in middle schoolers with ASD with EF deficits (n = 23). Results confirmed that social communication and EF challenges are common. Multiple services and accommodations were identified, although EF challenges were rarely targeted on IEPs. Factors that may facilitate the success of EF strategies in the classroom are discussed.

ABCD_Harmonizer: An Open-source Tool for Mapping and Controlling for Scanner Induced Variance in the Adolescent Brain Cognitive Development Study

Data from multisite magnetic resonance imaging (MRI) studies contain variance attributable to the scanner that can reduce statistical power and potentially bias results if not appropriately managed. The Adolescent Cognitive Brain Development (ABCD) study is an ongoing, longitudinal neuroimaging study acquiring data from over 11,000 children starting at 9-10 years of age. These scans are acquired on 29 different scanners of 5 different model types manufactured by 3 different vendors. Publicly available data from the ABCD study include structural MRI (sMRI) measures such as cortical thickness and diffusion MRI (dMRI) measures such as fractional anisotropy. In this work, we 1) quantify the variance attributable to scanner effects in the sMRI and dMRI datasets, 2) demonstrate the effectiveness of the data harmonization approach called ComBat to address scanner effects, and 3) present a simple, open-source tool for investigators to harmonize image features from the ABCD study. Scanner-induced variance was present in every image feature and varied in magnitude by feature type and brain location. For almost all features, scanner variance exceeded variability attributable to age and sex. ComBat harmonization was shown to effectively remove scanner induced variance from all image features while preserving the biological variability in the data. Moreover, we show that for studies examining relatively small subsamples of the ABCD dataset, the use of ComBat harmonized data provides more accurate estimates of effect sizes compared to controlling for scanner effects using ordinary least squares regression.

The shifting role of fluid reasoning in reading among children evaluated for ADHD

Children with attentional difficulties are more likely than their peers to experience challenges in basic reading skills, including phonemic decoding and word recognition. Such challenges may require reliance on higher-order cognitive functions such as fluid reasoning (Gf) to attain reading proficiency. The present study sought to clarify the role of Gf in phonemic decoding and word recognition among children-in grades 1-7 (n = 156)-being evaluated for attention-deficit/hyperactivity disorder (ADHD). Effects of Gf were examined in relation to crystallized knowledge (Gc). Results indicated that Gf exerted a direct effect onto phonemic decoding in early grades (grades 1-2) but not in later grades (grades 3-7). Gf also exerted an indirect effect onto phonemic decoding-through Gc-in later grades (grades 3-7) but not in early grades (grades 1-2). Finally, Gf exerted an indirect effect onto word recognition through phonemic decoding in grades 1-4 but not in grades 5-7. Altogether, findings show that Gf plays a direct role in younger children's phonemic decoding and an indirect role in word recognition (through Gc) in later grades, suggesting a shift in Gf's role across grade levels. Although findings need replication in longitudinal research, current results have implications for both typical and atypical reading development.

Academic functioning in children with and without sluggish cognitive tempo

Sluggish cognitive tempo (SCT) is increasingly conceptualized as a transdiagnostic set of symptoms associated with poorer functional outcomes, although the extent to which SCT is associated with academic functioning remains unclear. This study recruited children based on the presence or absence of clinically elevated SCT symptoms, using a multi-informant and multi-method design to provide a comprehensive examination of academic functioning in children with and without clinically elevated SCT symptoms. Participants were 207 children in Grades 2-5 (ages 7-11 years; 63.3% male), including 103 with clinically elevated teacher-reported SCT symptoms and 104 without elevated SCT, closely matched on grade and sex. A multi-informant, multi-method design that included standardized achievement testing, curriculum-based measurement (CBM), grades, classroom and laboratory observations, and parent and teacher rating scales was used. Children with elevated SCT symptoms had poorer academic functioning than their peers across most domains examined. Specifically, compared to children without SCT, children with elevated SCT had significantly lower grade point average (d = 0.42) and standardized achievement scores (ds = 0.40-0.77), poorer CBM performance including lower productivity (ds = 0.39-0.51), poorer homework performance and organizational skills (ds = 0.58-0.85), and lower teacher-reported academic skills (ds = 0.63-0.74) and academic enablers (ds = 0.66-0.74). The groups did not significantly differ on percentage of time on task during classroom observations or academic enabler interpersonal skills. Most effects were robust to control of family income, medication use, and attention-deficit/hyperactivity disorder inattentive symptoms, although effects for motivation and study skills academic enablers were reduced. This study demonstrates that children with clinically elevated SCT symptoms have wide-ranging academic difficulties compared to their peers without SCT. Findings point to the potential importance of assessing and treating SCT to improve academic outcomes.

Trial of Training to Reduce Driver Inattention in Teens with ADHD

BACKGROUND

Teens with attention deficit-hyperactivity disorder (ADHD) are at increased risk for motor vehicle collisions. A computerized skills-training program to reduce long glances away from the roadway, a contributor to collision risk, may ameliorate driving risks among teens with ADHD.

METHODS

We evaluated a computerized skills-training program designed to reduce long glances (lasting ≥2 seconds) away from the roadway in drivers 16 to 19 years of age with ADHD. Participants were randomly assigned in a 1:1 ratio to undergo either enhanced Focused Concentration and Attention Learning, a program that targets reduction in the number of long glances (intervention) or enhanced conventional driver's education (control). The primary outcomes were the number of long glances away from the roadway and the standard deviation of lane position, a measure of lateral movements away from the center of the lane, during two 15-minute simulated drives at baseline and at 1 month and 6 months after training. Secondary outcomes were the rates of long glances and collisions or near-collisions involving abrupt changes in vehicle momentum (g-force event), as assessed with in-vehicle recordings over the 1-year period after training.

RESULTS

During simulated driving after training, participants in the intervention group had a mean of 16.5 long glances per drive at 1 month and 15.7 long glances per drive at 6 months, as compared with 28.0 and 27.0 long glances, respectively, in the control group (incidence rate ratio at 1 month, 0.64; 95% confidence interval [CI], 0.52 to 0.76; P<0.001; incidence rate ratio at 6 months, 0.64; 95% CI, 0.52 to 0.76; P<0.001). The standard deviation of lane position (in feet) was 0.98 SD at 1 month and 0.98 SD at 6 months in the intervention group, as compared with 1.20 SD and 1.20 SD, respectively, in the control group (difference at 1 month, -0.21 SD; 95% CI, -0.29 to -0.13; difference at 6 months, -0.22 SD; 95% CI, -0.31 to -0.13; P<0.001 for interaction for both comparisons). During real-world driving over the year after training, the rate of long glances per g-force event was 18.3% in the intervention group and 23.9% in the control group (relative risk, 0.76; 95% CI, 0.61 to 0.92); the rate of collision or near-collision per g-force event was 3.4% and 5.6%, respectively (relative risk, 0.60, 95% CI, 0.41 to 0.89).

CONCLUSIONS

In teens with ADHD, a specially designed computerized simulated-driving program with feedback to reduce long glances away from the roadway reduced the frequency of long glances and lessened variation in lane position as compared with a control program. During real-world driving in the year after training, the rate of collisions and near-collisions was lower in the intervention group. (Funded by the National Institutes of Health; ClinicalTrials.gov number, NCT02848092.).

Differential diagnoses of irritability and temper loss in a 6-year-old

Irritability and temper loss are common concerns among young children seen for mental health diagnostic evaluations and represent features of nearly a dozen childhood mental health conditions. Thus, careful assessment of irritability and temper loss is essential for informing case conceptualization, diagnosis, and treatment recommendations. The current case study provides a clinical description of a 6-year-old Black male ("Tyler") seen in a tertiary pediatric medical center for concerns related to significant inattention, hyperactivity, impulsivity, oppositional behaviors, irritability, and severe temper loss displayed at home and school. The clinical description summarizes findings from rating scales and diagnostic evaluations, case conceptualization, as well as treatment recommendations. Detailed suggestions for clinicians regarding strategies for assessing irritability and temper loss and questions to consider when seeking clarification to inform differential diagnoses are provided.

Virtual Ontogeny of Cortical Growth Preceding Mental Illness

BACKGROUND

Morphology of the human cerebral cortex differs across psychiatric disorders, with neurobiology and developmental origins mostly undetermined. Deviations in the tangential growth of the cerebral cortex during pre/perinatal periods may be reflected in individual variations in cortical surface area later in life.

METHODS

Interregional profiles of group differences in surface area between cases and controls were generated using T1-weighted magnetic resonance imaging from 27,359 individuals including those with attention-deficit/hyperactivity disorder, autism spectrum disorder, bipolar disorder, major depressive disorder, schizophrenia, and high general psychopathology (through the Child Behavior Checklist). Similarity of interregional profiles of group differences in surface area and prenatal cell-specific gene expression was assessed.

RESULTS

Across the 11 cortical regions, group differences in cortical area for attention-deficit/hyperactivity disorder, schizophrenia, and Child Behavior Checklist were dominant in multimodal association cortices. The same interregional profiles were also associated with interregional profiles of (prenatal) gene expression specific to proliferative cells, namely radial glia and intermediate progenitor cells (greater expression, larger difference), as well as differentiated cells, namely excitatory neurons and endothelial and mural cells (greater expression, smaller difference). Finally, these cell types were implicated in known pre/perinatal risk factors for psychosis. Genes coexpressed with radial glia were enriched with genes implicated in congenital abnormalities, birth weight, hypoxia, and starvation. Genes coexpressed with endothelial and mural genes were enriched with genes associated with maternal hypertension and preterm birth.

CONCLUSIONS

Our findings support a neurodevelopmental model of vulnerability to mental illness whereby prenatal risk factors acting through cell-specific processes lead to deviations from typical brain development during pregnancy.

Consortium neuroscience of attention deficit/hyperactivity disorder and autism spectrum disorder: The ENIGMA adventure

Neuroimaging has been extensively used to study brain structure and function in individuals with attention deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) over the past decades. Two of the main shortcomings of the neuroimaging literature of these disorders are the small sample sizes employed and the heterogeneity of methods used. In 2013 and 2014, the ENIGMA-ADHD and ENIGMA-ASD working groups were respectively, founded with a common goal to address these limitations. Here, we provide a narrative review of the thus far completed and still ongoing projects of these working groups. Due to an implicitly hierarchical psychiatric diagnostic classification system, the fields of ADHD and ASD have developed largely in isolation, despite the considerable overlap in the occurrence of the disorders. The collaboration between the ENIGMA-ADHD and -ASD working groups seeks to bring the neuroimaging efforts of the two disorders closer together. The outcomes of case-control studies of subcortical and cortical structures showed that subcortical volumes are similarly affected in ASD and ADHD, albeit with small effect sizes. Cortical analyses identified unique differences in each disorder, but also considerable overlap between the two, specifically in cortical thickness. Ongoing work is examining alternative research questions, such as brain laterality, prediction of case-control status, and anatomical heterogeneity. In brief, great strides have been made toward fulfilling the aims of the ENIGMA collaborations, while new ideas and follow-up analyses continue that include more imaging modalities (diffusion MRI and resting-state functional MRI), collaborations with other large databases, and samples with dual diagnoses.

Analysis of structural brain asymmetries in attention-deficit/hyperactivity disorder in 39 datasets

OBJECTIVE

Some studies have suggested alterations of structural brain asymmetry in attention-deficit/hyperactivity disorder (ADHD), but findings have been contradictory and based on small samples. Here, we performed the largest ever analysis of brain left-right asymmetry in ADHD, using 39 datasets of the ENIGMA consortium.

METHODS

We analyzed asymmetry of subcortical and cerebral cortical structures in up to 1,933 people with ADHD and 1,829 unaffected controls. Asymmetry Indexes (AIs) were calculated per participant for each bilaterally paired measure, and linear mixed effects modeling was applied separately in children, adolescents, adults, and the total sample, to test exhaustively for potential associations of ADHD with structural brain asymmetries.

RESULTS

There was no evidence for altered caudate nucleus asymmetry in ADHD, in contrast to prior literature. In children, there was less rightward asymmetry of the total hemispheric surface area compared to controls (t = 2.1, p = .04). Lower rightward asymmetry of medial orbitofrontal cortex surface area in ADHD (t = 2.7, p = .01) was similar to a recent finding for autism spectrum disorder. There were also some differences in cortical thickness asymmetry across age groups. In adults with ADHD, globus pallidus asymmetry was altered compared to those without ADHD. However, all effects were small (Cohen's d from -0.18 to 0.18) and would not survive study-wide correction for multiple testing.

CONCLUSION

Prior studies of altered structural brain asymmetry in ADHD were likely underpowered to detect the small effects reported here. Altered structural asymmetry is unlikely to provide a useful biomarker for ADHD, but may provide neurobiological insights into the trait.

Trajectories of Response to Treatments in Children with ADHD and Word Reading Difficulties

This study investigated patterns of response to intervention in children with co-occurring attention-deficit/hyperactivity disorder (ADHD) and reading difficulties (RD), who participated in a randomized clinical trial examining the efficacy of reading intervention, ADHD treatment, or combined treatments. Growth Mixture Modeling (GMM) was used to investigate trajectories of parent and teacher academic impairment ratings and child oral reading fluency, and whether trajectories were predicted by pre-treatment covariates (ADHD severity, reading achievement, phonemic awareness, rapid letter naming, anxiety, oppositional defiant disorder), for 216 children with ADHD/RD in 2nd-5th grade (61.1% male; 72.2% African American; 8.8 ± 1.3 years of age). GMM revealed three trajectories for academic impairment (6.9-24.2% stable, 23.7-78.7% moderately improving, and 14.1-52.1% steeply improving) and oral reading fluency (20.8% low improving, 42.1% moderate improving, and 37.1% high improving). Children in the reading intervention were more likely to be in the stable or moderately improving trajectory than those in the ADHD and combined treatments, who were more likely to be in the steeply improving trajectory for academic impairment. Relative to the ADHD intervention, children in the reading intervention were more likely to be in the high improving trajectory than the moderate or low improving trajectory for oral reading fluency. Children without comorbid anxiety and with better reading skills showed a more positive treatment response for teacher-rated academic progress and oral reading fluency. Results highlight the importance of examining individual differences in response to reading and ADHD interventions. Intervention modality predicted differences in parent/teacher ratings of academic progress as well as reading fluency.

Diffusion MRI Microstructural Abnormalities at Term-Equivalent Age Are Associated with Neurodevelopmental Outcomes at 3 Years of Age in Very Preterm Infants

BACKGROUND AND PURPOSE

Microstructural white matter abnormalities on DTI using Tract-Based Spatial Statistics at term-equivalent age are associated with cognitive and motor outcomes at 2 years of age or younger. However, neurodevelopmental tests administered at such early time points are insufficiently predictive of mild-moderate motor and cognitive impairment at school age. Our objective was to evaluate the microstructural antecedents of cognitive and motor outcomes at 3 years' corrected age in a cohort of very preterm infants.

MATERIALS AND METHODS

We prospectively recruited 101 very preterm infants (<32 weeks' gestational age) and performed DTI at term-equivalent age. The Differential Ability Scales, 2nd ed, Verbal and Nonverbal subtests, and the Bayley Scales of Infant and Toddler Development, 3rd ed, Motor subtest, were administered at 3 years of age. We correlated DTI metrics from Tract-Based Spatial Statistics with the Bayley Scales of Infant and Toddler Development, 3rd ed, and the Differential Ability Scales, 2nd ed, scores with correction for multiple comparisons.

RESULTS

Of the 101 subjects, 84 had high-quality DTI data, and of these, 69 returned for developmental testing (82%). Their mean (SD) gestational age was 28.4 (2.5) weeks, and birth weight was 1121.4 (394.1) g. DTI metrics were significantly associated with Nonverbal Ability in the corpus callosum, posterior thalamic radiations, fornix, and inferior longitudinal fasciculus and with Motor scores in the corpus callosum, internal and external capsules, posterior thalamic radiations, superior and inferior longitudinal fasciculi, cerebral peduncles, and corticospinal tracts.

CONCLUSIONS

We identified widespread microstructural white matter abnormalities in very preterm infants at term that were significantly associated with cognitive and motor development at 3 years' corrected age.

Comparison of Adaptive Functioning Measures in Adolescents with Autism Spectrum Disorder Without Intellectual Disability

There is limited literature examining the adaptive functioning of adolescents with autism spectrum disorder (ASD). This study aimed to (a) document Vineland Adaptive Behavior Scales (VABS-3) and Adaptive Behavior Assessment System (ABAS-3) adaptive behavior profiles of adolescents with ASD; (b) examine the comparability of the two measures; and (c) assess potential discrepancies between IQ and adaptive behaviors. Participants included 14- to 18-year-olds with ASD without intellectual disability. Significant adaptive skills deficits were observed with most scores at least one standard deviation below the mean. Relative weaknesses were observed for social and daily living skills. The absolute magnitude of VABS-3 and ABAS-3 scores differed. There were significant discrepancies between IQ and adaptive functioning. These findings have implications for clinicians and researchers.

Effects of intraventricular hemorrhage on white matter microstructural changes at term and early developmental outcomes in infants born very preterm

PURPOSE

Very preterm (VPT) infants are at high risk for motor and behavioral deficits. We investigated microstructural differences using diffusion tensor imaging (DTI) among VPT infants with different grades of intraventricular hemorrhage (IVH), their association with early motor function and temperament ratings, and the potential moderating effect of IVH severity on the above structure-function relations.

METHODS

Fifty-seven VPT (≤32 weeks gestational age) infants with IVH (Low Grade (Papile grading I/II): 42; High Grade (III/IV): 15) were studied. DTI was acquired between 39 and 44 weeks postmenstrual age and was analyzed using the tract-based spatial statistics approach. Early motor function and temperament were assessed at 3-month corrected age based on the Hammersmith Infant Neurological Examination (HINE) and Infant Behavioral Questionnaire - Revised, Short Version (IBQ-R-S), respectively.

RESULTS

Significantly lower fractional anisotropy and higher mean, axial, and/or radial diffusivity were found in VPT infants with High Grade IVH compared to Low Grade IVH (p < 0.05). Significant associations were found between DTI metrics and motor function in both IVH groups and between DTI and Fear temperament ratings in the High Grade IVH Group (all p < 0.05). IVH severity had a significant moderating effect on the relation between DTI and motor and Fear ratings (p < 0.05).

CONCLUSION

DTI is a sensitive neuroimaging biomarker providing a refined understanding of the impact and location of differing severities of IVH on the developing white matter of VPT infants. Early motor and behavioral outcomes are associated with microstructural changes that are influenced by severity of IVH.

Testing the Longitudinal Structure and Change in Sluggish Cognitive Tempo and Inattentive Behaviors From Early Through Middle Childhood

Previous studies have demonstrated that sluggish cognitive tempo (SCT) behaviors are empirically distinct from inattentive (IN) behaviors that are used to define attention-deficit/hyperactivity disorder. However, most studies used cross-sectional designs during middle childhood. Using parent and teacher ratings from the Family Life Project (N = 1,173), we investigated the factor structure, longitudinal measurement invariance, developmental trajectories, and predictors of developmental change in SCT and IN from age 3 years through Grade 5. SCT and IN were dissociable but correlated constructs that exhibited longitudinal invariance for both informants. Mean levels of SCT increased modestly with age, becoming more prominent between age 5 years and first grade, while IN was more stable. Lower parental education was associated with higher parent- and teacher-reported SCT, male sex was associated with higher teacher-reported IN, and African American race was associated with higher teacher-reported IN but lower teacher-reported SCT. These findings support the validity of SCT starting in early childhood.

A Qualitative Analysis of Contextual Factors Relevant to Suspected Late-Onset ADHD

Objective: Recent studies suggest attention-deficit/hyperactivity disorder (ADHD) may emerge post-childhood. We integrate qualitative methods to systematically characterize contextual factors that may (a) delay identification of ADHD in childhood and (b) inform why ADHD symptoms emerge post-childhood. Method: Suspected late-onset ADHD cases from the local normative comparison group of the Multimodal Treatment Study of ADHD completed a qualitative interview (14 young adults and 7 caregivers). Interviews were qualitatively analyzed. Results: We identified five themes. Three themes may attenuate or delay identification of childhood ADHD: external factors (e.g., supportive adults), internal factors (e.g., strong intellectual functioning), and other factors (e.g., dismissive attitudes toward ADHD). Two themes may accompany an increase in ADHD symptoms post-childhood: external factors (e.g., increased external demands) and internal factors (e.g., perceived stress). Conclusion: Clinicians should probe these factors in suspected late-onset cases to address (a) whether, how, and to what extent ADHD was attenuated in childhood and (b) why symptoms emerge post-childhood.

The Association of Executive Functioning With Academic, Behavior, and Social Performance Ratings in Children With ADHD

This study investigated the association of a performance-based measure of executive functioning (EF) with academic, social, and behavioral performance ratings in a convenience sample of 153 children aged 5 to 12 (78% male, 83% Caucasian) diagnosed with attention-deficit/hyperactivity disorder (ADHD). Multivariate regression showed that above and beyond age and ADHD severity, poorer EF performance was uniquely associated with more impairment in reading, written expression, and math by teacher report, and more impairment in the overall school and reading domains by parent report. ADHD symptoms were more strongly associated with ratings of impairment in social relationships, organized peer activities, and classroom behaviors than EF performance. Age did not moderate the findings, but younger children were rated as having more trouble with participation in organized activities by parents, as more likely to disrupt class by teachers, and to have problematic relationships with peers by parents and teachers. EF and academic performance appeared worst in the groups seen as highly symptomatic and impaired by both parents and teachers, and by teachers only. EF deficits may be a specific risk factor for academic impairment in children with ADHD.

Preschool Neuropsychological Predictors of School-aged Sluggish Cognitive Tempo and Inattentive Behaviors

Sluggish cognitive tempo (SCT) is characterized by excessive daydreaming, slowed thinking, and mental confusion and 'fogginess'. A growing body of research supports the empirical differentiation of sluggish cognitive tempo (SCT) from the inattentive (IN) behaviors that characterize attention-deficit/hyperactivity disorder (ADHD). Further SCT and IN are uniquely associated with clinical correlates across academic, social, and emotional domains; however, there is limited understanding of how neuropsychological functioning contributes to SCT and/or IN behaviors. The two broad domains of neuropsychological functioning that have been most frequently examined in relation to SCT behaviors are processing speed and executive functions (EF). The present study tested whether EF and processing speed measured when children were on average age five years were predictive of teacher-rated IN and SCT behaviors in 1st - 3rd grades. Participants included 1,022 children from the Family Life Project, an ongoing prospective longitudinal study of child development in low-income, non-metropolitan communities. EF and processing speed uniquely made independent contributions to the prediction of IN and SCT. In secondary analyses that focused on specific facets of EF and processing speed, inhibitory control and working memory abilities predicted lower IN but not SCT behaviors, whereas slower processing speed significantly predicted both greater SCT and IN behaviors. These results are discussed as they inform developmental models of SCT and IN.

Childhood ADHD and Involvement in Early Pregnancy: Mechanisms of Risk

Objective: ADHD is associated with risky sexual behavior and early pregnancy, but few studies have examined mechanisms of risk linking childhood ADHD to early pregnancy. The present study utilized data from the Multimodal Treatment Study of ADHD to examine potential mechanisms that may account for the association between childhood ADHD and becoming pregnant or causing a pregnancy by age 18. Method: Participants were 579 children with ADHD and 289 comparison peers followed over 16 years. Results: Relative to the comparison group, those with childhood ADHD were at more than two times increased risk of early pregnancy. Univariately, persistence of ADHD symptoms, delinquency/substance use, and academic performance/achievement during adolescence each mediated the association between childhood ADHD and early pregnancy. When considered together, only delinquency/substance use remained a significant mediator of this relationship. Conclusion: Findings point toward specific targets of intervention for youth with ADHD to prevent early pregnancy.

Sluggish cognitive tempo and processing speed in adolescents with ADHD: do findings vary based on informant and task?

Few studies have examined whether behavioral sluggish cognitive tempo (SCT) symptoms are related to speeded task performance. Mixed findings in existing research could be due to previous studies using a broad conceptualization of processing speed, not including self-report of SCT symptoms, and relying on non-optimal measures of SCT. Using a multi-informant design with both parent- and adolescent-reported SCT symptoms, the present study provides a preliminary test of the hypothesis that SCT symptoms would be associated with slower performance on tasks having greater graphomotor and fine motor demands. Participants were 80 adolescents (ages 13-17 years; 71% male) with attention-deficit/hyperactivity disorder (ADHD). Adolescents and parents completed ratings of SCT. Adolescents were administered the Wechsler Symbol Search and Coding subtests and the Grooved Pegboard Test. When adjusting for age, sex, and ADHD symptom severity, parent-reported SCT symptoms were not significantly associated with Symbol Search or Coding scores but were significantly associated with slower Grooved Pegboard time. Adolescent-reported SCT symptoms were not significantly associated with Symbol Search but were significantly associated with lower Coding scores and slower Grooved Pegboard time. Findings provide preliminary support for the hypothesis that SCT may be more clearly associated with processing speed task performance as motor demands increase and provide a potential explanation for the mixed literature on SCT in relation to processing speed by demonstrating that the presence and magnitude of associations vary by informant and task.

Impact of sleep restriction on affective functioning in adolescents with attention-deficit/hyperactivity disorder

BACKGROUND

Shortened sleep and affective disturbances are both prevalent in adolescents with attention-deficit/hyperactivity disorder (ADHD), yet the causal link between these domains has not been examined. This study investigated whether shortened sleep duration is causally linked to affective functioning in adolescents with ADHD.

METHODS

Participants were 48 adolescents (75% male) aged 14-17 years with ADHD who successfully completed a three-week sleep protocol using an experimental crossover design. The protocol included a phase stabilization week, followed, in randomized counterbalanced order, by one week of sleep restriction (6.5 hr in bed) and one week of sleep extension (9.5 hr in bed). Sleep was monitored with objective actigraphy, and all participants included in this study obtained ≥1 hr actigraphy-measured sleep duration during extension compared to restriction. Parents and adolescents provided daily ratings of positive and negative affect during the extension and restriction conditions. Ratings of affect, internalizing symptoms, and emotion regulation were collected at laboratory visits conducted at the end of each week.

RESULTS

Both parents and adolescents reported greater depressive symptoms and lower positive affect during restriction compared to extension. Parents also reported greater negative affect and emotion dysregulation among adolescents during sleep restriction than extension. No effects were found for parent- or adolescent-reported anxiety symptoms or for adolescent-reported emotion regulation or negative affect.

CONCLUSIONS

Findings from this study provide the first evidence that shortened sleep duration is a causal contributor to the affect and mood disturbances frequently experienced by adolescents with ADHD, particularly as observed by parents. Targeting sleep may be important to reduce affective disturbances in adolescents with ADHD.

Subcortical Brain Volume, Regional Cortical Thickness, and Cortical Surface Area Across Disorders: Findings From the ENIGMA ADHD, ASD, and OCD Working Groups

OBJECTIVE

Attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and obsessive-compulsive disorder (OCD) are common neurodevelopmental disorders that frequently co-occur. The authors sought to directly compare these disorders using structural brain imaging data from ENIGMA consortium data.

METHODS

Structural T1-weighted whole-brain MRI data from healthy control subjects (N=5,827) and from patients with ADHD (N=2,271), ASD (N=1,777), and OCD (N=2,323) from 151 cohorts worldwide were analyzed using standardized processing protocols. The authors examined subcortical volume, cortical thickness, and cortical surface area differences within a mega-analytical framework, pooling measures extracted from each cohort. Analyses were performed separately for children, adolescents, and adults, using linear mixed-effects models adjusting for age, sex, and site (and intracranial volume for subcortical and surface area measures).

RESULTS

No shared differences were found among all three disorders, and shared differences between any two disorders did not survive correction for multiple comparisons. Children with ADHD compared with those with OCD had smaller hippocampal volumes, possibly influenced by IQ. Children and adolescents with ADHD also had smaller intracranial volume than control subjects and those with OCD or ASD. Adults with ASD showed thicker frontal cortices compared with adult control subjects and other clinical groups. No OCD-specific differences were observed across different age groups and surface area differences among all disorders in childhood and adulthood.

CONCLUSIONS

The study findings suggest robust but subtle differences across different age groups among ADHD, ASD, and OCD. ADHD-specific intracranial volume and hippocampal differences in children and adolescents, and ASD-specific cortical thickness differences in the frontal cortex in adults, support previous work emphasizing structural brain differences in these disorders.

Achieving Independence and Mastery in School: An Open Trial in the Outpatient Setting

Youth with autism spectrum disorders (ASD) without intellectual disability frequently experience academic problems, in part due to executive functioning (EF) deficits. There are currently no evidence-based interventions targeting academic EF skills (e.g., organization, prioritization, etc.) for middle school youth with ASD. The need is critical given increasing demands on these skills during the transition from elementary to middle school. An intervention targeting academic EF skills, Achieving Independence and Mastery in School (AIMS), was recently developed. This paper reports on an open trial of the AIMS-Outpatient intervention with 21 middle schoolers with ASD. Results suggest high feasibility/satisfaction, and improved EF, particularly in the domains of organization and materials management. These promising results support further intervention development work and suggest that academic EF skills are malleable in youth with ASD.

Assessing sluggish cognitive tempo and ADHD inattention in elementary students: Empirical differentiation, invariance across sex and grade, and measurement precision

To advance the research examining the sluggish cognitive tempo (SCT) construct, a key priority has been to develop assessment tools that are reliable and valid. The current study builds upon existing work by conducting the most thorough psychometric evaluation to date of the teacher-reported Child and Adolescent Behavior Inventory (CABI) SCT and attention-deficit/hyperactivity disorder inattention (ADHD-IN) modules in a large sample of elementary students. Participants were 7,613 students (Grades 2-5; 50.3% boys) attending 24 elementary schools in 3 school districts. Teachers (N = 398) provided ratings of SCT, ADHD-IN, academic impairment, and social impairment. An a priori 2-factor model with cross-loadings found the SCT items to demonstrate excellent structural validity with ADHD-IN items. The measurement properties of the SCT and ADHD-IN constructs were also invariant across sex and grade. SCT and ADHD-IN were both uniquely associated with academic and social impairment. Graded response item response theory analysis indicated that the SCT and ADHD-IN scales provided a high level of information and precision. The current study replicates and extends previous research and provides the strongest psychometric evidence to date of teacher-rated SCT using the CABI. The teacher-report CABI may be especially useful in the school-based screening of SCT and ADHD-IN. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Early brain abnormalities in infants born very preterm predict under-reactive temperament

BACKGROUND

Early temperament may mediate the association between brain abnormalities following preterm birth and neurodevelopmental outcomes.

AIMS

This exploratory study investigated whether brain abnormalities in infants born very preterm predicted temperament.

STUDY DESIGN

Infants born prematurely underwent structural MRI at term. Mother self-reported depression symptoms at the scanning visit, and the Infant Behavior Questionnaire-Revised-Short (IBQ-R-S) about their infant at 3-months corrected age.

SUBJECTS

Infants (n = 214) born at ≤32 weeks gestation (M = 29.29, SD = 2.60). Average post-menstrual age at the MRI scan was 42.72 weeks (SD = 1.30). The majority of the infants were male (n = 115), and Caucasian (n = 145) or African American (n = 58). The average birthweight in grams was 1289.75 (SD = 448.5).

OUTCOME MEASURES

Infant Behavior Questionnaire-Revised-Short (IBQ-R-S) subscales.

RESULTS

Multivariate regression showed white matter abnormalities predicted lower ratings on High Intensity Pleasure and Vocal Reactivity, grey matter abnormalities predicted lower ratings on High Intensity Pleasure and Cuddliness, and cerebellar abnormalities predicted lower ratings on Fear and Sadness IBQ-R-S subscales adjusting for gestational age and sex. The pattern of results was essentially unchanged when maternal depression and socioeconomic status were included in the model.

CONCLUSIONS

Early MRI-diagnosed brain abnormalities in infants born very preterm were associated less vocalization and engagement during cuddling, decreased ability to take pleasure in stimulating activities, and lower emotionality in fear and sadness domains. Although replication is warranted, an under-reactive temperament in infants born preterm may have a neurobiological basis.

Behavioral Parent Training for ADHD Reduces Situational Severity of Child Noncompliance and Related Parental Stress

Objective: Parents are more likely to seek treatment when a child's behaviors cause impairment and increase parental burden. Thus, it is important to document the effectiveness of behavioral parent training (BPT) on the pervasiveness and severity of children's behavior and related parental distress. Method: Data were obtained from 304 parents of school-aged children with attention-deficit hyperactivity disorder (ADHD) attending BPT groups in an outpatient setting. Results: After BPT, parents reported fewer and less severe problematic situations related to child noncompliance, particularly for chores, homework, mealtimes, and peer interactions. Parents also reported significantly reduced stress related to parenting a child with ADHD. Improvements in Nonfamilial Transactions and Task Performance were associated with reductions in degree of parental stress. Conclusion: BPT offered in a real-world clinical setting has meaningful impacts on the child behaviors that lead parents to seek treatment and reduces stress related to parenting a child with ADHD.

Clinical correlates of sluggish cognitive tempo in adolescents with autism spectrum disorder

Adolescents with autism spectrum disorder frequently experience social communication difficulties, executive functioning deficits, and anxiety and depressive symptoms, which are similar to the symptoms and correlates of sluggish cognitive tempo. Although sluggish cognitive tempo is related to, but distinct from, the inattentive and hyperactive-impulsive symptoms of attention-deficit/hyperactivity disorder that commonly co-occur with autism spectrum disorder, few studies have examined sluggish cognitive tempo in autism spectrum disorder. We examined whether sluggish cognitive tempo and attention-deficit/hyperactivity disorder were differentially associated with autism symptomatology, daily life executive functioning, and internalizing and externalizing symptoms in 51 adolescents (ages 13-18 years) with autism spectrum disorder without intellectual disability. Regression analyses controlling for age and IQ showed that sluggish cognitive tempo symptoms, but not attention-deficit/hyperactivity disorder symptoms, were associated with increased autism symptomatology and internalizing symptoms. Attention-deficit/hyperactivity disorder symptoms, but not sluggish cognitive tempo symptoms, were associated with increased externalizing behaviors and behavior regulation deficits. Both sluggish cognitive tempo and attention-deficit/hyperactivity disorder were independently associated with increased metacognitive deficits. This study provides preliminary evidence that sluggish cognitive tempo symptoms are elevated in autism spectrum disorder and associated with key clinical correlates, with implications for the assessment and treatment in adolescents with autism spectrum disorder.

The Effects of ADHD Treatment and Reading Intervention on the Fluency and Comprehension of Children with ADHD and Word Reading Difficulties: A Randomized Clinical Trial

Many students with reading difficulties and disabilities (RD) also have Attention Deficit/Hyperactivity Disorder (ADHD). This randomized clinical trial compared the effects of ADHD treatment alone (medication, parent training), intensive reading intervention alone, and their combination on the reading fluency and comprehension of students with both disorders. Students with ADHD and RD were randomly assigned to receive (a) Reading Intervention only (n=74), (b) ADHD Treatment only (n=78), or (c) simultaneous Combined ADHD and RD Treatment (n=70). For phonemic decoding fluency, the Reading Intervention group and the Combined Treatment group both had significantly better outcomes than the ADHD Treatment group, but did not differ from one another. For passage comprehension, the ADHD Treatment group had significantly better outcomes than the Reading Intervention group, while the other groups did not differ from one another. ADHD treatment may support passage comprehension in this population, while fluent decoding is best supported through intensive reading intervention.

Brain Imaging of the Cortex in ADHD: A Coordinated Analysis of Large-Scale Clinical and Population-Based Samples

OBJECTIVE

Neuroimaging studies show structural alterations of various brain regions in children and adults with attention deficit hyperactivity disorder (ADHD), although nonreplications are frequent. The authors sought to identify cortical characteristics related to ADHD using large-scale studies.

METHODS

Cortical thickness and surface area (based on the Desikan-Killiany atlas) were compared between case subjects with ADHD (N=2,246) and control subjects (N=1,934) for children, adolescents, and adults separately in ENIGMA-ADHD, a consortium of 36 centers. To assess familial effects on cortical measures, case subjects, unaffected siblings, and control subjects in the NeuroIMAGE study (N=506) were compared. Associations of the attention scale from the Child Behavior Checklist with cortical measures were determined in a pediatric population sample (Generation-R, N=2,707).

RESULTS

In the ENIGMA-ADHD sample, lower surface area values were found in children with ADHD, mainly in frontal, cingulate, and temporal regions; the largest significant effect was for total surface area (Cohen's d=-0.21). Fusiform gyrus and temporal pole cortical thickness was also lower in children with ADHD. Neither surface area nor thickness differences were found in the adolescent or adult groups. Familial effects were seen for surface area in several regions. In an overlapping set of regions, surface area, but not thickness, was associated with attention problems in the Generation-R sample.

CONCLUSIONS

Subtle differences in cortical surface area are widespread in children but not adolescents and adults with ADHD, confirming involvement of the frontal cortex and highlighting regions deserving further attention. Notably, the alterations behave like endophenotypes in families and are linked to ADHD symptoms in the population, extending evidence that ADHD behaves as a continuous trait in the population. Future longitudinal studies should clarify individual lifespan trajectories that lead to nonsignificant findings in adolescent and adult groups despite the presence of an ADHD diagnosis.

Selective flowers to attract and enhance Telenomus laeviceps (Hymenoptera: Scelionidae): a released biocontrol agent of Mamestra brassicae (Lepidoptera: Noctuidae)

The importance of the right food source for the survival and reproduction of certain insect species is well documented. In the case of biocontrol agents, this is even more important in order to reach a high predation or parasitation performance. The egg parasitoid Telenomus laeviceps (Förster, 1861) (Hymenoptera: Scelionidae) is a promising candidate for mass release as a biological control agent of the cabbage moth Mamestra brassicae (Linnaeus, 1758) (Lepidoptera: Noctuidae). However, adult T. laeviceps need a sugar-rich food source to increase their parasitation performance and produce a good amount of female offspring. Released biocontrol agents were shown to benefit from conservation biocontrol, which includes the provision of selected flowers as nectar resources for beneficial insects. In Switzerland, Centaurea cyanus L. (Asteraceae), Fagopyrum esculentum Moench (Polygonaceae) and Vicia sativa L. (Fabaceae) are successfully implemented in the field to attract and promote natural enemies of different cabbage pests. In this study, we investigated the potential of these selected flowers to attract and promote T. laeviceps under laboratory conditions. In Y-tube olfactometer experiments, we first tested whether the three nectar providing plant species are attractive to T. laeviceps. Furthermore, we assessed their effects on survival and parasitation performance of adult T. laeviceps. We found that flowers of F. esculentum and C. cyanus were attractive in contrast to V. sativa. Also fecundity and the number of female offspring produced were higher for females kept on F. esculentum and C. cyanus than on V. sativa. In contrast, survival was similar on all treatments. Our findings present a further key step towards the implementation of T. laeviceps as a biocontrol agent.

The Revised Child Anxiety and Depression Scales (RCADS): Psychometric Evaluation in Children Evaluated for ADHD

Co-occurring internalizing symptoms are common and important to assess in children with attention-deficit/hyperactivity disorder (ADHD). One frequently used child self-report measure of internalizing symptoms is the Revised Child Anxiety and Depression Scales (RCADS), yet the psychometric properties of the RCADS remain unexamined in children referred for ADHD specifically. The present study evaluated the RCADS in 117 children (ages 8-12; 66% male) evaluated for suspected ADHD at an ADHD specialty clinic (83% met criteria for ADHD). In addition to the RCADS, children completed measures of social anxiety and depression. Parents completed the RCADS-Parent Version (RCADS-P) in addition to other measures of internalizing and externalizing symptoms. Children and parents both completed a measure of aggression. Factor structure, reliability, and convergent/discriminant validity of the RCADS were examined. Results supported the six-factor structure of the child-report RCADS (Separation Anxiety, Social Phobia, Generalized Anxiety Disorder, Panic Disorder, and Obsessive Compulsive Disorder, Major Depressive Disorder). The RCADS demonstrated adequate reliability as well as convergent and discriminant validity with other child ratings. The total anxiety score on the RCADS also demonstrated convergent and discriminant validity with parent measures, though the depression score on the RCADS did not. Findings provide preliminary psychometric support for the RCADS in children referred for ADHD.

Honing in on the Social Difficulties Associated With Sluggish Cognitive Tempo in Children: Withdrawal, Peer Ignoring, and Low Engagement

Sluggish cognitive tempo (SCT) symptoms are associated with social difficulties in children, though findings are mixed and many studies have used global measures of social impairment. The present study tested the hypothesis that SCT would be uniquely associated with aspects of social functioning characterized by withdrawal and isolation, whereas attention deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) symptoms would be uniquely associated with aspects of social functioning characterized by inappropriate responding in social situations and active peer exclusion. Participants were 158 children (70% boys) between 7-12 years of age being evaluated for possible ADHD. Both parents and teachers completed measures of SCT, ADHD, ODD, and internalizing (anxiety/depression) symptoms. Parents also completed ratings of social engagement and self-control. Teachers also completed measures assessing asociality and exclusion, as well as peer ignoring and dislike. In regression analyses controlling for demographic characteristics and other psychopathology symptoms, parent-reported SCT symptoms were significantly associated with lower social engagement (e.g., starting conversations, joining activities). Teacher-reported SCT symptoms were significantly associated with greater asociality/withdrawal and ratings of more frequent ignoring by peers, as well as greater exclusion. ODD symptoms and ADHD hyperactive-impulsive symptoms were more consistently associated with other aspects of social behavior, including peer exclusion, being disliked by peers, and poorer self-control during social situations. Findings provide the clearest evidence to date that the social difficulties associated with SCT are primarily due to withdrawal, isolation, and low initiative in social situations. Social skills training interventions may be effective for children displaying elevated SCT symptomatology.

Academic Skills Groups for Middle School Children With ADHD in the Outpatient Mental Health Setting: An Open Trial

OBJECTIVE

To conduct an open trial assessing the initial efficacy of an intervention focusing on increasing skills related to academic performance (planning, organization, studying, and homework behaviors) for middle school children diagnosed with ADHD. The intervention is modeled on evidence-based interventions but designed for administration in the outpatient setting.

METHOD

Parents and their children diagnosed with ADHD attended seven weekly group sessions targeting academic, organizational, and homework skills. Parents completed the Homework Problem Checklist and Impairment Rating Scale pre- and post-treatment.

RESULTS

Following intervention, significant improvements in homework completion and management, as well as reductions in academic impairment and improvements in parent confidence and family relations, were reported.

CONCLUSION

Despite limitations including small sample size and lack of a control group, our results demonstrate initial efficacy of an academic skills intervention designed for use in the outpatient setting with middle school children diagnosed with ADHD on clinically relevant outcome measures.

Attention-Deficit/Hyperactivity Disorder-Related Deficits and Psychostimulant Medication Effects on Comprehension of Audiovisually Presented Educational Material in Children

Objective: We aimed to (1) examine differences in observed visual attention and motor activity, as well as comprehension of a science video between children with and without attention-deficit/hyperactivity disorder (ADHD) and (2) explore if psychostimulant medication improves ADHD behaviors and comprehension of a science video in children with ADHD. Method: Children aged 7-11 with (n = 91) and without (n = 45) ADHD watched a science video and then completed a comprehension test. Then, children with ADHD began a 4-week within-subject, randomized, double-blind crossover trial of methylphenidate (MPH). At post-testing, children were randomized to receive placebo or their optimal dosage, watched another science film, and completed a comprehension test. Results: Children with ADHD exhibited higher rates of motor activity during, and worse comprehension of material discussed within, the science video. Mediation models revealed that increased motor activity suppressed between-group differences in comprehension. MPH improved comprehension and visual attention, but not motor activity during the science video. Conclusion: Children with ADHD may benefit from MPH to improve comprehension of and sustained attention during audiovisually presented learning material.

Negative Consequences of Poor Driving Outcomes Reported by Adolescents With and Without ADHD

OBJECTIVE

Although adolescents with ADHD report less driving experience, a greater proportion of adolescents with ADHD report receiving at least one ticket; however, no study has examined the severity of infractions committed by adolescent drivers with ADHD.

METHOD

A total of 61 adolescents (28 ADHD, 33 controls) aged 16 to 17 with a valid driver's license completed a self-report Driving History Questionnaire (DHQ), which asked about months of driving experience, negative driving outcomes, and severity of consequences.

RESULTS

A greater proportion of adolescents with ADHD reported receiving fines, points on their driver's license, and remedial driving class. Furthermore, adolescents with ADHD reported attending a greater number of hours in remedial driving class, and a greater expense associated with fines.

CONCLUSION

Importantly, ADHD-related negative driving outcomes manifest early in driving careers. Furthermore, increased negative consequences of poor and/or risky driving among adolescents with ADHD were evident despite having fewer months of independent driving.

A preliminary investigation of reaction time variability in relation to social functioning in children evaluated for ADHD

Reaction time variability (RTV) is a ubiquitous phenomenon in Attention-Deficit/Hyperactivity Disorder (ADHD). Few studies have examined RTV in relation to functional outcomes such as social impairment in children with ADHD. In this exploratory study, we investigated whether RTV is associated with social functioning in children at risk for ADHD. Specifically, we explored the association between RTV (tau derived from correct go trials of a Stop-Signal task) and social functioning in 198 children ages 7-12 years referred for an ADHD evaluation. Social functioning measures included child and/or parent ratings of social competence, aggression, social problems, and impairment in relationships. In regression analyses that also included Oppositional Defiant Disorder symptoms and sex, higher RTV was significantly associated with lower ratings of social competence, and higher proactive/reactive aggression ratings on the child self-report measures. RTV was not significantly associated with parent report of social functioning or relationship impairment. This study provides preliminary evidence that RTV may be associated with social functioning in children at risk for ADHD. We propose that lapses of attention affecting cognitive control may also negatively impact social information processing thereby affecting social functioning. Replication is warranted and longitudinal studies are needed to investigate whether RTV predicts social dysfunction in ADHD.

Fluid reasoning and reading difficulties among children with ADHD

Background: Children with attention-deficit/hyperactivity disorder (ADHD) commonly experience difficulties in reading and in fluid reasoning (Gf). According to Cattell's Investment Theory (1987), Gf is a causal factor in the development of crystallized knowledge (Gc) and academic skills; therefore, the co-occurrence of reading and Gf difficulties within ADHD may not be coincidental. Methods: In the present study with children with both ADHD and reading difficulties (n = 187; 61% male; M_age = 9.2), we utilized mediation analyses to test direct and indirect (through Gc, phonemic awareness, and rapid automatized naming [RAN]) effects of Gf on four basic reading skills: untimed word recognition, untimed phonemic decoding, word reading efficiency, and phonemic decoding efficiency. Results: The direct effect of Gf on all reading skills was nonsignificant; however, significant indirect effects were observed. Specifically, Gf exerted an effect indirectly onto all reading skills through a serial and joint mechanism comprised of Gc and phonemic awareness (i.e., Gf → Gc → phonemic awareness → reading achievement). Gf also exerted an effect indirectly onto untimed word recognition and phonemic decoding through phonemic awareness (i.e., Gf → phonemic awareness → untimed word recognition/untimed phonemic decoding). Conclusion: Results build upon Cattell's Investment Theory by linking Gf with reading difficulties among children with ADHD, suggesting that such difficulties may arise from weaknesses in Gf and insufficient investment of Gf into reading through Gc and phonemic awareness.

The impact of comorbid mental health symptoms and sex on sleep functioning in children with ADHD

Children with attention-deficit/hyperactivity disorder (ADHD) display more sleep problems than their peers, but it remains unclear whether comorbid mental health symptoms [i.e., anxiety, depression, oppositional-defiant disorder (ODD)] are uniquely related to sleep functioning. It is also largely unknown whether boys and girls with ADHD differ in their sleep functioning. This study (1) examined whether boys or girls with ADHD differ in their sleep functioning, (2) evaluated comorbid symptoms as uniquely related to sleep functioning domains, and (3) explored whether sex moderated associations between comorbid symptoms and sleep. Participants were 181 children (ages 7-13; 69% male; 82% White) diagnosed with ADHD. Parents completed measures assessing their child's ADHD symptoms, comorbid symptoms, and sleep functioning. Girls had poorer sleep functioning than boys across most sleep functioning domains. Sixty percent of children met cutoff criteria for having sleep problems, though rates differed significantly between girls (75%) and boys (53%). No differences in rates of sleep problems were found between ADHD subtypes/presentations or between younger and older children. In path models including ADHD and comorbid symptom dimensions, anxiety symptoms were uniquely associated with increased bedtime resistance and sleep anxiety, ADHD hyperactive-impulsive symptoms were associated with more night wakings and more parasomnia behaviors, and ODD and depressive symptoms were associated with shorter sleep duration. Depression was also uniquely associated with increased daytime sleepiness and overall sleep problems. Sex did not moderate associations between comorbid symptoms and sleep problems. This study provides important preliminary evidence that girls with ADHD experience more sleep problems than boys with ADHD. Findings also demonstrate that the associations between comorbid symptoms and sleep functioning in children with ADHD vary based on both the specific symptoms and sleep domains examined.

Psychosocial Screening Among Youth Seeking Weight Management Treatment

The objectives of this study were to identify rates of, and factors associated with, "at-risk" scores on a brief psychosocial screener among overweight/obese youth seeking weight management treatment, as well as concordance between youth and caregiver reports. A retrospective chart review of 1443 consecutive patients ages 4 to 18 years and their caregivers was conducted. Almost 1 in 4 youth with overweight/obesity presented with psychosocial symptoms in the at-risk range for significant mental health issues based on caregiver report on the Pediatric Symptom Checklist (PSC) and 1 in 6 based on youth self-report on the Youth Pediatric Symptom Checklist (Y-PSC). Concordance between caregiver and youth was fair (agreement 24% to 40%). Higher scores were associated with male sex and older age on the PSC and with indication of depressive disorder in the electronic medical record on the Y-PSC. Conducting a brief psychosocial screen in comprehensive weight management programs is feasible and clinically indicated.

Are sluggish cognitive tempo symptoms associated with executive functioning in preschoolers?

The aim of this study is to investigate whether sluggish cognitive tempo (SCT) symptoms are associated with neurocognitive task performance and ratings of real-world executive functioning (EF) in preschoolers at risk for attention-deficit/hyperactivity disorder (ADHD). The associations between parent- and teacher-rated SCT symptoms and neuropsychological task performance and ratings of EF in 61 4-year-old preschool children (51 boys, 10 girls) with self-regulation difficulties were examined, with regression analyses controlling for the effects of ADHD inattention symptoms. In the study sample, higher teacher-rated SCT symptoms are significantly associated with poorer performance on tasks of visual-perceptual abilities, auditory and visual attention, sustained and selective attention, inhibitory control, pre-numerical/numerical concepts, and slower processing speed, but SCT symptoms are not significantly associated with working memory, attention shifting or cognitive flexibility when controlling for ADHD inattention. Higher parent-rated SCT symptoms are significantly associated with visual-perceptual abilities. ADHD inattention symptoms are more strongly associated than SCT with daily life EF ratings; neither parent- nor teacher-rated SCT symptoms are significantly associated with daily life ratings of inhibition, working memory, or planning/organization after controlling for ADHD inattention. This study suggests that SCT symptoms contribute to EF deficits at least on neurocognitive tasks assessing visual-perceptual/spatial abilities, attention to detail and processing speed, as observed in this sample of young children at risk for ADHD, and may be an important intervention target.

Go/No Go task performance predicts cortical thickness in the caudal inferior frontal gyrus in young adults with and without ADHD

Response inhibition deficits are widely believed to be at the core of Attention-Deficit Hyperactivity Disorder (ADHD). Several studies have examined neural architectural correlates of ADHD, but research directly examining structural correlates of response inhibition is lacking. Here we examine the relationship between response inhibition as measured by a Go/No Go task, and cortical surface area and thickness of the caudal inferior frontal gyrus (cIFG), a region implicated in functional imaging studies of response inhibition, in a sample of 114 young adults with and without ADHD diagnosed initially during childhood. We used multiple linear regression models to test the hypothesis that Go/No Go performance would be associated with cIFG surface area or thickness. Results showed that poorer Go/No Go performance was associated with thicker cIFG cortex, and this effect was not mediated by ADHD status or history of substance use. However, independent of Go/No Go performance, persistence of ADHD symptoms and more frequent cannabis use were associated with thinner cIFG. Go/No Go performance was not associated with cortical surface area. The association between poor inhibitory functioning and thicker cIFG suggests that maturation of this region may differ in low performing participants. An independent association of persistent ADHD symptoms and frequent cannabis use with thinner cIFG cortex suggests that distinct neural mechanisms within this region may play a role in inhibitory function, broader ADHD symptomatology, and cannabis use. These results contribute to Research Domain Criteria (RDoC) by revealing novel associations between neural architectural phenotypes and basic neurobehavioral processes measured dimensionally.

Psychometric Validation of the Revised Child Anxiety and Depression Scales-Parent Version (RCADS-P) in Children Evaluated for ADHD

Children with attention-deficit/hyperactivity disorder (ADHD) frequently experience comorbid internalizing symptoms. The Revised Child Anxiety and Depression Scales-Parent Version (RCADS-P) is a frequently used measure of anxiety and depression in children, though its psychometric properties remain unexamined in children referred for ADHD specifically. The present study evaluated the RCADS-P in 372 children (age 7-12 years; 68% male) referred for evaluation at an ADHD specialty clinic (89% met criteria for ADHD). In addition to the RCADS-P, parents completed the Vanderbilt ADHD Diagnostic Rating Scale and Child Behavior Checklist and were administered the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children semistructured diagnostic interview. Teacher ratings were available for approximately half of the sample. Factor structure, reliability, convergent/discriminant validity, and sensitivity/specificity were examined. Results supported the six-factor structure of the RCADS-P. The RCADS-P demonstrated adequate internal consistency as well as convergent and discriminant validity with other parent ratings and, to a somewhat lesser extent, teacher ratings. Children with an internalizing diagnosis had higher RCADS-P scores than children without an internalizing diagnosis. Finally, the RCADS-P had good-to-excellent diagnostic efficiency, and a total sum score of 25 had excellent sensitivity and fair specificity. Findings provide psychometric support for the RCADS-P in children with ADHD.