The domain-variant indirect association between electrophysiological response to reward and ADHD presentations is moderated by dopaminergic polymorphisms

BACKGROUND

Understanding the etiopathogenesis of attention-deficit/hyperactivity disorder (ADHD) may necessitate decomposition of the heterogeneous clinical phenotype into more homogeneous intermediate phenotypes. Reinforcement sensitivity is a promising candidate, but the exact nature of the ADHD-reward relation - including how, for whom, and to which ADHD dimensions atypicalities in reward processing are relevant - is equivocal.

METHODS

Aims were to examine, in a carefully phenotyped sample of adolescents (N = 305; Mage = 15.30 years, SD = 1.07; 39.7% girls), whether functional dopaminergic polymorphisms implicated in both reward processing and ADHD (1) are differentially associated with event-related potentials (ERPs) of reward anticipation at distinct levels of ADHD risk (nno risk = 174, nat-risk = 131, ndiagnosed = 83); and (2) moderate the indirect effect of dispositional affectivity on the association between ERPs and ADHD domains.

RESULTS

In adolescents at-risk for or with ADHD, carrying a hypodopaminergic allele was associated with enhanced ERPs of attention allocation to cue and attenuated ERPs of anticipatory attention to feedback. No associations were observed in adolescents not at-risk for or without ADHD. Controlling for age and sex, both the negative indirect effect of positive affectivity (PA) on the association between ERPs and inattention and the positive indirect effect of PA on the association between ERPs and hyperactivity/impulsivity were supported only for those with high activity dopamine transporter (DAT) alleles.

CONCLUSIONS

Reward and affective processing are promising intermediate phenotypes relevant to disentangling ADHD developmental pathways. Consistent with developmental multifinality, through the successive effects of reward anticipation and positive affectivity, functional dopaminergic variants may confer protection against inattention or risk for hyperactivity/impulsivity.

The Association Between Prenatal Maternal Stress and Adolescent Affective Outcomes is Mediated by Childhood Maltreatment and Adolescent Behavioral Inhibition System Sensitivity

Prenatal maternal stress is linked to offspring outcomes; however, there is little research on adolescents, behavioral, transdiagnostic outcomes, or the mechanisms through which relations operate. We examined, in N = 268 adolescents (Mage = 15.31 years; SD = 1.063; 57.8% boys) whether prenatal maternal stress is associated with adolescent affective outcomes; whether this association is mediated, serially, by childhood home atmosphere and adolescent behavioral inhibition system (BIS) sensitivity; and whether mediational effects are moderated by adolescent attention-deficit/hyperactivity disorder or maternal internalizing symptomology. Prenatal maternal daily stress and major life events were associated with adolescent outcomes through childhood negative atmosphere/neglect and BIS sensitivity, with no evidence of moderation. Results have implications regarding the effect of prenatal maternal stress on offspring outcomes and regarding corresponding sensitive periods.

Emotion Dysregulation Is Associated With Social Impairment Among Young Adolescents With ADHD

OBJECTIVE

The purpose of this study was to evaluate aspects of emotion dysregulation (ED) that characterize young adolescents with ADHD, examine the effects of subtype and comorbidity, and determine the extent to which ED is related to aggression and rule-breaking and social impairment.

METHOD

We examined which aspects of ED are most relevant to ADHD in 180 young adolescents (75% boys), as well as whether ED differs across ADHD subtypes or comorbid oppositional defiant disorder (ODD) status. We also examined the association between ED and aggression, rule-breaking, and social impairment.

RESULTS

Young adolescent females and males with ADHD exhibited various manifestations of ED, including behavioral dyscontrol in the presence of strong emotions and inflexibility/slow return to emotional baseline. ED did not differ as a function of ADHD subtype or comorbid ODD. Three aspects of ED, namely, low threshold for emotional excitability/impatience, behavioral dyscontrol in the face of strong emotions, and inflexibility/slow return to baseline, predicted three of six measured indices of parent- and self-reported social impairment, above and beyond comorbid ODD.

CONCLUSIONS

ED is associated with ADHD among young adolescents, does not differ based on ADHD subtype or ODD status, and is associated with social impairment.

Neural Reactivity to Angry Faces Predicts Treatment Response in Pediatric Anxiety

Although cognitive-behavioral psychotherapy (CBT) and pharmacotherapy are evidence-based treatments for pediatric anxiety, many youth with anxiety disorders fail to respond to these treatments. Given limitations of clinical measures in predicting treatment response, identifying neural predictors is timely. In this study, 35 anxious youth (ages 7-19 years) completed an emotional face-matching task during which the late positive potential (LPP), an event-related potential (ERP) component that indexes sustained attention towards emotional stimuli, was measured. Following the ERP measurement, youth received CBT or selective serotonin reuptake inhibitor (SSRI) treatment, and the LPP was examined as a predictor of treatment response. Findings indicated that, accounting for pre-treatment anxiety severity, neural reactivity to emotional faces predicted anxiety severity post- CBT and SSRI treatment such that enhanced electrocortical response to angry faces was associated with better treatment response. An enhanced LPP to angry faces may predict treatment response insofar as it may reflect greater emotion dysregulation or less avoidance and/or enhanced engagement with environmental stimuli in general, including with treatment.

Threat distractor and perceptual load modulate test-retest reliability of anterior cingulate cortex response

Accumulating data from fMRI studies implicate the rostral anterior cingulate cortex (rACC) in inhibition of attention to threat distractors that compete with task-relevant goals for processing resources. However, little data is available on the reliability of rACC activation. Our aim in the current study was to examine test-retest reliability of rACC activation over a 12-week period, in the context of a validated emotional interference paradigm that varied in perceptual load. During functional MRI, 23 healthy volunteers completed a task involving a target letter in a string of identical letters (low load) or in a string of mixed letters (high load) superimposed on angry, fearful, and neutral face distractors. Intraclass correlation coefficients (ICCs) indicated that under low, but not high perceptual load, rACC activation to fearful vs. neutral distractors was moderately reliable. Conversely, regardless of perceptual load, rACC activation to angry vs. neutral distractors was not reliable. Regarding behavioral performance, ICCs indicated that accuracy was not reliable regardless of distractor type or perceptual load. Although reaction time (RT) was similarly not reliable regardless of distractor type under low perceptual load, RT to angry vs. neutral distractors and to fearful vs. neutral distractors was reliable under high perceptual load. Together, results indicate the test-retest reliability of rACC activation and corresponding behavioral performance are context dependent; reliability of the former varies as a function of distractor type and level of cognitive demand, whereas reliability of the latter depends on behavioral index (accuracy vs. RT) and level of cognitive demand but not distractor type.

Neurofunctional correlates of behavioral inhibition system sensitivity during attentional control are modulated by perceptual load

Although the Behavioral Inhibition System (BIS) is associated with threat-sensitivity, little is known about its neurofunctional correlates during cognitive control over task-irrelevant threat distractors. Thirty non-clinical participants, who ranged in BIS sensitivity, completed an attentional control paradigm during fMRI. The paradigm varied in cognitive demand with low perceptual load comprising identical target letters and high perceptual load comprising a target letter in a mixed letter string; each superimposed on threatening and neutral face distractors. Whole-brain results indicated that individuals with higher, relative to lower BIS sensitivity, exhibited enhanced dorsolateral prefrontal cortex activation to angry (vs. neutral) and enhanced dorsal anterior cingulate cortex activation to fearful (vs. neutral) face distractors under low load whereas no differences in activation were observed under high load. These findings are consistent with literature indicating that the BIS is involved in conflict processing, including between cognitive and emotional or motivational goals.

ADHD Symptoms as Risk Factors for Intimate Partner Violence Perpetration and Victimization

Preliminary evidence underscores links between attention-deficit hyperactivity disorder (ADHD) symptoms and intimate partner violence (IPV) perpetration and victimization. However, little is known about whether ADHD symptoms are uniquely associated with IPV perpetration and victimization beyond well-established risk factors of IPV commonly associated with the disorder. In a cross-sectional design, 433 college students rated their ADHD symptoms as well as frequencies of psychological and physical IPV perpetration and victimization. Additional risk factors of IPV included childhood maltreatment, primary psychopathy, alcohol abuse, and illicit drug use. Correlational analyses indicated that students with greater ADHD symptom severity reported higher rates of psychological and physical IPV perpetration, and higher rates of psychological IPV victimization. Regression analyses indicated that ADHD symptoms were not additive risk factors of psychological IPV perpetration and victimization. Students reporting any alcohol abuse or illicit drug use endorsed high rates of psychological IPV perpetration and victimization, regardless of their level of ADHD symptoms. However, students who reported no alcohol abuse or drug use, but did report greater ADHD symptom severity-particularly inattention, indicated higher rates of psychological IPV perpetration and victimization than those reporting no alcohol abuse or drug use and low ADHD symptoms. These findings extend prior research by indicating that alcohol abuse and illicit drug use moderate associations between ADHD symptoms and psychological IPV perpetration and victimization. Investigations are needed to identify mechanisms of the association between ADHD symptoms and IPV perpetration and victimization, particularly those abusing alcohol and drugs, for appropriate prevention and intervention efforts to be developed.

Attenuated neural reactivity to happy faces is associated with rule breaking and social problems in anxious youth

Pediatric anxiety is associated with comorbid externalizing behaviors and social problems, and these associations may be related to altered emotion processing. The late positive potential (LPP), an event-related potential component, is a neural marker of emotion processing, and there is evidence that anxious youth exhibits enhanced LPPs to threatening signals. It is unknown, however, if differences in the LPP are related to externalizing behaviors and social problems co-occurring with anxiety and if these associations are driven by altered processing of threatening (angry or fearful faces) or rewarding (happy faces) socio-emotional signals. Thus, in the present study, we examined, in a sample of 39 anxious youth, the association between LPPs, following socio-emotional signals and externalizing behaviors and social problems. Results indicated an association between attenuated LPPs in response to happy faces and greater rule-breaking and social problems. These findings suggest that differences in positive socio-emotional signal processing are related to heterogeneity in pediatric anxiety and that LPPs are a sensitive index of such heterogeneity.

Error-related brain activity in youth and young adults before and after treatment for generalized or social anxiety disorder

Increased error monitoring, as measured by the error-related negativity (ERN), has been shown to persist after treatment for obsessive-compulsive disorder in youth and adults; however, no previous studies have examined the ERN following treatment for related anxiety disorders. We used a flanker task to elicit the ERN in 28 youth and young adults (8-26years old) with primary diagnoses of generalized anxiety disorder (GAD) or social anxiety disorder (SAD) and 35 healthy controls. Patients were assessed before and after treatment with cognitive-behavioral therapy (CBT) or selective serotonin reuptake inhibitors (SSRI), and healthy controls were assessed at a comparable interval. The ERN increased across assessments in the combined sample. Patients with SAD exhibited an enhanced ERN relative to healthy controls prior to and following treatment, even when analyses were limited to SAD patients who responded to treatment. Patients with GAD did not significantly differ from healthy controls at either assessment. Results provide preliminary evidence that enhanced error monitoring persists following treatment for SAD in youth and young adults, and support conceptualizations of increased error monitoring as a trait-like vulnerability that may contribute to risk for recurrence and impaired functioning later in life. Future work is needed to further evaluate the ERN in GAD across development, including whether an enhanced ERN develops in adulthood or is most apparent when worries focus on internal sources of threat.

Attention-deficit/hyperactivity disorder and social skills in youth: a moderated mediation model of emotion dysregulation and depression

Although studies document an association between Attention-Deficit/Hyperactivity Disorder (ADHD) and social problems, little is known about mediating or moderating mechanisms underlying this association. We examined whether, among youth, emotion dysregulation (ED) mediates the negative association between ADHD and social skills, and whether this mediational process is moderated by symptoms of depression. A total of 171 youth with ADHD (76 % male; Mage = 12.15, SD = 0.95) and their parents completed measures of ED, depression, and social skills. Results indicated that, after controlling for oppositional defiant disorder, the negative association between ADHD and social skills was mediated by ED. Further, this indirect effect was relevant for youth with non-clinical and subclinical levels of depression but not for those with clinical levels of depression. These findings underscore the importance of ED in the association between ADHD and social functioning among youth and suggest a need for additional research to understand how and when ED impacts such functioning.

Evidence-based psychosocial treatments for children and adolescents with attention-deficit/hyperactivity disorder

The purpose of this research was to update the Pelham and Fabiano ( 2008 ) review of evidence-based practices for children and adolescents with attention-deficit/hyperactivity disorder. We completed a systematic review of the literature published between 2007 and 2013 to establish levels of evidence for psychosocial treatments for these youth. Our review included the identification of relevant articles using criteria established by the Society of Clinical Child and Adolescent Psychology (see Southam-Gerow & Prinstein, in press ) using keyword searches and a review of tables of contents. We extend the conceptualization of treatment research by differentiating training interventions from behavior management and by reviewing the growing literature on training interventions. Consistent with the results of the previous review we conclude that behavioral parent training, behavioral classroom management, and behavioral peer interventions are well-established treatments. In addition, organization training met the criteria for a well-established treatment. Combined training programs met criteria for Level 2 (Probably Efficacious), neurofeedback training met criteria for Level 3 (Possibly Efficacious), and cognitive training met criteria for Level 4 (Experimental Treatments). The distinction between behavior management and training interventions provides a method for considering meaningful differences in the methods and possible mechanisms of action for treatments for these youth. Characteristics of treatments, participants, and measures, as well as the variability in methods for classifying levels of evidence for treatments, are reviewed in relation to their potential effect on outcomes and conclusions about treatments. Implications of these findings for future science and practice are discussed.

Measuring ADHD and ODD symptoms and impairment using high school teachers' ratings

We analyzed the results of high school teachers' ratings of symptoms of attention deficit hyperactivity disorder (ADHD) and oppositional defiant disorder, as well as school-related impairment of 875 adolescents. One hundred forty-three teachers at 19 high schools across 4 states each rated 6 students from their first-period classes according to selection criteria that led to ratings for 3 male and 3 female students. Factor analyses were conducted on the symptom measure to test hypotheses pertaining to the divergence of impulsivity and hyperactivity dimensions. Normative values for the Disruptive Behavior Disorder-Teacher Rating Scale and Impairment Rating Scale are reported, as well as important differences related to age, race, and gender. Gender and age contrasts revealed that boys were rated as more symptomatic and impaired than girls and younger adolescents were rated as having more problems than older adolescents in most areas. African American adolescents were rated higher on measures of symptoms and impairment than their Caucasian peers. Large differences in normative levels of hyperactivity/impulsivity and inattention are reported that are consistent with a reduced likelihood of a diagnosis of ADHD-C as children get older. Implications for the interpretation of ratings from high school teachers are discussed.

Suicide and Impossible Worlds

Background: Suicide has a devastating impact on both survivors and society, and many obstacles to improving prevention efforts stem from our inadequate understanding of suicidality. A potential source of this shortcoming is that the majority of empirical studies focus only on a single specified etiology of suicide. Aims: To address this limitation, we present a further promising way to understand the suicidal state. We do so (1) by providing a brief review of something known as worlds theory ( Bergner, 2006 ), and (b) by presenting the results of a study exploring the relationship between a person’s taking it that his or her world is impossible/nonviable and his or her suicidal state. Methods: In this research, participants were asked to assess the perceived levels of world viability (vs. impossibility/nonviability) of 12 actual persons depicted in clinical vignettes. Results: As predicted, participants judged the worlds of suicidal committers significantly more nonviable than those of suicide attempters, and these in turn significantly more nonviable than those of mentally disordered but nonsuicidal persons. Conclusions: These findings indicate that the worlds of suicidal persons are unlivable – in worlds terms: impossible. We discuss implications of these findings for understanding the suicidal state and for intervening therapeutically.