Interplay Among Self-Regulation Processes Over Time for Adolescents in the Context of Chronic Stress.

Developmental changes in self-regulation are theorized to underlie adolescents' engagement in risky behaviors, physical health, mental health, and transition to adulthood. Two central processes involved in self-regulation, self-management (i.e., planning, concentration, and problem-solving) and disinhibition (e.g., distractibility and impulsivity) appear to develop asynchronously and may be differentially activated based on contextual factors. Using a sample identified based on exposure to chronic stressors, we investigated how changes in self-management and disinhibition affect each other over time and whether these changes occur differently for boys and girls. Youth aged 8-16 (N = 708) who attended a U.S. summer camp self-reported on components of disinhibition and self-management. Cross-lagged structural equation modeling revealed a reciprocal relationship between self-management and disinhibition, with anger coping and distractibility emerging as critical factors in shaping this relationship. Changes in concentration, planning, and problem-solving were components of self-management that drove subsequent changes in boys' disinhibition (for girls, however, planning did not). Autocorrelations for both broad processes remained strong from year to year, indicating a high degree of stability in rank order despite the myriad of physical, cognitive and socioemotional changes that occur during adolescence. We discuss implications of the reciprocal model with a focus on the relative pliability of components from each process and strategies for shaping them. Planning, concentration and distractibility are highlighted as potential targets for intervention.

Patterns and predictors of adolescent engagement in a mindfulness-based social-emotional learning program.

INTRODUCTION: Although mindfulness-based interventions (MBIs) show promise for promoting positive youth development, little is known about student engagement in MBIs. Initial research presents mixed findings in MBI engagement related to participant characteristics, and there is a lack of research examining the influence of context on engagement, despite the critical role context plays in academic engagement. This study examines the contribution of student demographic characteristics and classroom context to MBI engagement. METHODS: Survey engagement data were collected at three time points from 106 ninth grade students (Mage = 14.17 years, 60.4% female, 44.2% Black, 24.8% Hispanic/Latino) who participated in the Be CALM program during the 2021-2022 school year. Latent growth curve modeling was used to examine trajectory of student engagement and assess student and classroom predictors of engagement. RESULTS: There was no overall change in the trajectory of student engagement, although variability was observed across classes. Identifying as Hispanic/Latino was associated with lower engagement (ß = -.25, p = .008), although this did not appear to be related to program experience. Peer connections predicted engagement at the end of the program (ß = .39, p < .001). Post hoc analyses suggested that student engagement may be related to teacher program delivery quality. CONCLUSIONS: Student engagement in MBIs appears related to classroom context more than student characteristics, although further research with larger samples is needed to assess the link between engagement and program outcomes. Findings have implications for designing school-based MBIs and training school staff to deliver them in culturally responsive ways.

Co-Regulation as a Support for Older Youth in the Context of Foster Care: a Scoping Review of the Literature.

Co-regulation is a relatively new theoretical framework for interventions that connects developmental science to adolescent needs and provides strategies that can be applied across contexts. It also has value in shifting the focus of interventions to the role of relationships and interactions with caring adults, as well as supportive environments. This framework may be particularly salient for older youth with foster care experience whose relationships with adults and availability of developmental supports are disrupted. To understand how co-regulation aligns with current understanding of needs and supports for this population, we conducted a scoping review that involved systematically searching four databases, coding and charting relevant information, and actively engaging expert consultants and other stakeholders. Across 46 primarily descriptive articles, co-regulation was discussed most often in relation to relationships, as expected (89% of articles). Despite theoretical and empirical evidence of the benefits of supportive environments and intentional day-to-day interactions in promoting developmental skills and competencies, these two domains of co-regulation were referenced much less (39% and 28%, respectively). Results highlight opportunities for co-regulation supports that can be provided to older youth with foster care experience by caring adults and near-aged peers in a wide range of roles. Notable limitations in the literature were identified in applying co-regulation within the context of employment and career readiness, healthy relationships, and teen parenting. Also under-researched is the role of adult self-regulation skills and co-regulation approaches for youth from diverse backgrounds, including those who identify as LGBTQ or have disabilities. Considerations for practice and future research are provided.

Feasibility of combining biosensor and ecological momentary assessment to measure stress experiences among economically disadvantaged adolescents.

Adolescent stress is complex and impairing. Novel measures are needed to understand stress variability within individuals over time from a physiological as well as a subjective perspective. To test the feasibility of combining ecological momentary assessment (EMA) and wearable biosensors to assess adolescent stress, using an idiographic approach with experience sampling methods. A small sample (n = 23) of predominantly African American, economically disadvantaged adolescents were asked to complete EMA surveys four times per day and wear an armband measuring Heart rate (HR) and skin response for a 2-week period. Descriptive analyses examined number of hours of armband wear, percentage of viable data, and percentage of surveys completed by gender and race. Associations between biosensor data and EMA reports within and across individuals were also examined using hierarchical linear regression. EMA survey completion was good (81%) as was adherence to biosensor protocols, although technological difficulties interfered with collection of HR variability for youth with darker skin tones. Youth reported stressful events in 12.79% of EMA surveys, although 43% reported no negative mood experiences. Convergent validity was supported for detecting between-person (EMA) and within-person (EMA and biosensors) variability in stress across time, although associations across youth were highly variable. Results suggest value for biobehavioral methods in understanding day-to-day stress in adolescents but highlight variability in stress experiences as well as technological limitations, especially for youth of colour.

Meta-analysis of early adolescent self-regulation interventions: Moderation by intervention and outcome type.

INTRODUCTION: Self-regulation has been identified as a highly promising target for interventions promoting broad wellbeing across development; however, there appear to be notable limitations in efficacy for early adolescents in particular. One possible reason is that the emotion regulation needs of youth have not been intentionally targeted in many interventions for this age group. The aim of this study is to advance understanding of how different intervention approaches defined from a clear theoretical model may impact different types of outcomes and with regard to different types of measures. METHODS: We conducted a systematic literature review of four databases using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and identified 33 studies of early adolescents (aged 10-15) using five different intervention approaches that were methodologically rigorous (e.g., randomized controlled trial design with low risk of bias). Studies were conducted predominantly in North America (58%), and Western Europe (30%). RESULTS: A two-level mixed-effects meta-analysis indicated a small but significant overall intervention effect (Hedges g = 0.12). When examined by intervention type, effects were significant only for approaches focusing predominantly on emotion regulation (g = 0.20), which significantly improved behavioral outcomes as well as emotional outcomes. Approaches examining cognitive regulation, parent training, physical activity, and working memory did not differ significantly from zero. Across intervention types, outcomes demonstrated the largest effects for youth report of emotional distress. CONCLUSION: Overall, results suggest that emotion regulation may be a critically important self-regulation mechanism during early adolescence and demonstrates value in the use of applied theoretical frameworks to operationalize intervention approaches and outcomes.

Incorporating callous-unemotional behaviors into school-based research.

This study investigated the utility of including teacher-reported callous-unemotional (CU) behaviors in the assessment of disruptive behaviors in school-based research. Participants included 138 first- and second-grade children (68% male; 76% eligible for free or reduced-price lunch; 61% Black, 9% Latinx, 23% White, and 7% multiracial) who completed assessments during the baseline assessment of an intervention study. Results indicated that teachers could distinguish CU from traditional indicators of disruptive behavior, including attention deficit hyperactivity disorder (ADHD) behaviors and conduct problems (CP). When considered alone, there was mixed evidence for the utility of CU behaviors. Although higher levels of CU behaviors explained unique variation in teacher-reported social competence and global impairment, CU behaviors did not explain unique variation in disciplinary infractions, classroom behavior, or academic functioning after accounting for ADHD and CP behaviors. A different pattern of results was evident when CU was considered in conjunction with ADHD and CP behaviors. Latent profile analyses identified three subgroups of participants (i.e., a nondisruptive group, an ADHD group, and a comorbid group, who exhibited elevated levels of ADHD, CP, and CU). Compared to the nondisruptive group, the ADHD group exhibited higher rates of off-task classroom behavior and worse academic functioning. The comorbid group exhibited moderate-to-large differences from both groups on teacher-reported and objective outcomes. The implications of these results are discussed with respect to the potential value of incorporating CU behaviors, which are becoming prominent in clinical psychology and psychiatry, into school-based research and for school psychology practice. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Addressing Barriers to Primary Care Screening and Referral to Prevention for Youth Risky Health Behaviors: Evidence Regarding Potential Cost-Savings and Provider Concerns.

Despite growing evidence and support for co-locating behavioral services in primary care to prevent risky health behaviors, implementation of these services has been limited due to a lack of reimbursement for services and negative perceptions among providers. We investigated potential to overcome these barriers based on new developments in healthcare funding and screening and referral to prevention (SRP) in primary care based on the Consolidated Framework for Implementation Research (CFIR), which could guide future SRP implementation strategies. To investigate the economic need for healthcare-based SRP, we quantified hospital charges to healthcare payors for services arising from adolescent risky behaviors (e.g., substance use, risky sex). Annual North Carolina (NC) hospital charges for these services exceeded $327 M (2019 dollars), suggesting high potential for cost savings if SRP can curb hospital services associated with risky behaviors. To investigate provider barriers and facilitators, we surveyed 151 NC pediatricians and 230 NC family therapists about their attitudes regarding a recently developed well-child visit SRP with family-based prevention. Both sets of professionals reported widespread need for and interest in the SRP but cited barriers of lack of reimbursement, training, and referrals to/from each other. Physicians, but not family therapists, reported concerns with poor patient or parent compliance. Many barriers could be resolved by co-locating family therapists in pediatric clinics to conduct well-child SRP. Our results support further research to develop business models for payor-funded SRP and CFIR-guided research to develop implementation strategies for primary care SRP to prevent adolescent risky health behaviors.

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.

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.

An Applied Contextual Model for Promoting Self-Regulation Enactment Across Development: Implications for Prevention, Public Health and Future Research.

This theoretical paper presents a public health approach for promoting self-regulation across development that is based in cross-disciplinary theory and research. The self-regulation promotion model includes three key approaches that are each dependent on the relationship that children and youth have with caregivers: teaching self-regulation skills, building supportive environments, and providing co-regulation. This model extends the science of self-regulation insofar as it: (1) focuses on promoting wellbeing (not only reducing risks) across domains of functioning, (2) addresses self-regulation intervention across childhood and through young adulthood, (3) integrates multiple theories and applies them to intervention in meaningful ways, and (4) identifies specific strategies that can be used in natural developmental contexts and that address the social ecological environment as well as the individual child. We describe seven key principles that support the model including a description of self-regulation processes and implications for promoting self-regulation at each developmental stage. We end with broad implications for intervention, highlighting the relevance of the self-regulation promotion model for practitioners, policy makers, and prevention researchers.

Impact of a Neuroscience-Based Health Education Course on High School Students' Health Knowledge, Beliefs, and Behaviors.

PURPOSE: The purpose of this pilot study was to evaluate the potential of an innovative high school neuroscience-based health course for implementation feasibility and impact on student outcomes. METHODS: Thirteen teachers from two high schools participated in this quasi-experimental pilot study including 395 students (202 in the intervention classes and 193 in the comparison classes). Students completed pre/post online surveys assessing their knowledge, beliefs, and behaviors. Our analysis strategy for multi-item measures was to estimate the effects of the intervention on latent change scores in structural equation models. RESULTS: Students in the neuroscience health classes showed a significant increase in neuroscience knowledge as compared to students in the comparison group (difference estimate in proportion correct metric, adjusted for covariates = .04; 95% confidence interval [.01, .06]). However, none of the other primary outcomes showed a significant difference between conditions. Teachers in the intervention group were observed implementing the neuroscience and health components more often than the self-regulation and growth mindset components. Students in the neuroscience group were more likely to mention the importance of caring for their brain and its link to health behaviors. CONCLUSIONS: Findings demonstrate that information about the link between health behaviors and brain functioning can be successfully integrated into a high school health education course, although effects on student health beliefs and behaviors were not observed. Additional development work should focus on clarifying the theoretical mechanisms of change, integrating the neuroscience content with self-regulation and growth mindset, and providing additional professional development for teachers.

ReGAE 12: preventing glaucoma blindness in the Caribbean through implementation of the Moorfields Safer Surgery System and skills transfer from the UK to Trinidad and Tobago.

OBJECTIVE: The objective of the study was to present evidence of successful skills transfer of the Moorfields Safer Surgery System (MSSS) from the UK to Trinidad and Tobago and the safety and efficacy of this technique. METHODS: Hospital-based retrospective, consecutive, non-comparative case series study of 33 eyes (24 African-Caribbean patients; 16 male patients) with primary open-angle glaucoma undergoing trabeculectomy + mitomycin C (MSSS) by a single surgeon with UK Glaucoma Fellowship training. The clinical outcome measures included intraocular pressure (IOP), bleb morphology, postsurgical interventions, postoperative complications, and best-corrected visual acuity (BCVA) at the final follow-up. RESULTS: All patients were self-identified as African-Caribbean. The median age was 56 years (range 34-79 years). The mean preoperative IOP on maximum tolerated medical treatment was 22.4 mmHg (SD=5.9 mmHg). With or without medication, IOP was ≤21 mmHg in 92.6% at 1 year and 87.5% at 5 years. At 1 year, IOP was ≤18 mmHg in 78%, ≤15 mmHg in 73% and ≤14 mmHg in 52%. Removal of scleral flap releasable suture(s) was performed in 84%, 5-fluorouracil injection(s) in 88% and bleb needling revision in 38%. The most common complication was early transient bleb leak (52%). No patient developed endophthalmitis, hypotony maculopathy, suprachoroidal hemorrhage, or malignant glaucoma. At the final follow-up, 91% had excellent or satisfactory bleb morphology, and 73% had equal or better BCVA. CONCLUSION: Skills transfer between different geographical and economic regions contributes to the prevention of avoidable blindness through disease control - one of the core strategies of the World Health Organization's Vision 2020 initiative. In the Caribbean (Trinidad and Tobago), the MSSS was utilized by a surgeon with Glaucoma Fellowship training and achieved outcomes similar to best-published data. This success can be reproduced in other geographic locations.

Investigating teacher and student effects of the Incredible Years Classroom Management Program in early elementary school.

The present paper reports on the results of a cluster randomized trial of the Incredible Years® Teacher Classroom Management Program (IY-TCM) and its effects on early elementary teachers' management strategies, classroom climate, and students' emotion regulation, attention, and academic competence. IY-TCM was implemented in 11 rural and semi-rural schools with K-2 teachers and a diverse student sample. Outcomes were compared for 45 teachers who participated in five full day training workshops and brief classroom consultation and 46 control teachers; these 91 teachers had a total of 1192 students. A high level of teacher satisfaction was found and specific aspects of the training considered most valuable for early elementary teachers were identified. Hierarchical linear modeling indicated a statistically significant intervention effect on Positive Climate in the classroom (d=0.45) that did not sustain into the next school year. No main effects on student outcomes were observed, although a priori moderator analyses indicated that students with elevated social-behavioral difficulties benefitted with regard to prosocial behavior (d=0.54) and inattention (d=-0.34). Results highlight potential benefits and limitations of a universal teacher training program for elementary students, and suggest strategies for future delivery of the IY-TCM program and areas for future research.

The Qualitative Interview Study of Persistent and Nonpersistent Substance Use in the MTA: Sample Characteristics, Frequent Use, and Reasons for Use.

OBJECTIVE: To evaluate participants' perceptions about frequent use and reasons for substance use (SU) in the qualitative interview study, an add-on to the multimodal treatment study of ADHD (MTA). METHOD: Using the longitudinal MTA database, 39 ADHD cases and 19 peers with Persistent SU, and 86 ADHD cases and 39 peers without Persistent SU were identified and recruited. In adulthood, an open-ended interview was administered, and SU excerpts were indexed and classified to create subtopics (frequent use and reasons for use of alcohol, marijuana, and other drugs). RESULTS: For marijuana, the Persistent compared with Nonpersistent SU group had a significantly higher percentage of participants describing frequent use and giving reasons for use, and the ADHD group compared with the group of peers had a significantly higher percentage giving "stability" as a reason for use. CONCLUSION: Motivations for persistent marijuana use may differ for adults with and without a history of ADHD.

Turning Points in the Lives of Youth of With/Without ADHD: Are They Linked to Changes in Substance Use?

OBJECTIVE: This study examines the behavior beliefs, social supports, and turning points in individuals with/without ADHD related to their substance use/abuse (SU/A) decisions. METHOD: The coded interviews from 60 participants with/without ADHD were compared for their SU/A decisions and precipitants with these decisions among abstainers, persisters, and desisters. RESULTS: ADHD participants reported fewer social advantages to avoid SU/A than non-ADHD participants. Desisters and persisters reported more social advantages of using drugs than abstainers. Persisters reported both more negative and positive psychological/physiological effects of SU/A. ADHD participants reported fewer positive role models in their lives. Non-ADHD patients reported more positive turning points than ADHD participants, regardless of SU/A status. CONCLUSION: ADHD individuals face challenges in making healthy decisions about SU/A due to lack of positive role models. Reinforcing accurate behavioral beliefs may be important to change behaviors in individuals with SU/A or to prevent SU/A initiation in ADHD individuals.

Follow-Up of Young Adults With ADHD in the MTA: Design and Methods for Qualitative Interviews.

OBJECTIVE: Qualitative interviews with 183 young adults (YA) in the follow-up of the Multimodal Treatment Study of Children With and Without ADHD (MTA) provide rich information on beliefs and expectations regarding ADHD, life's turning points, medication use, and substance use (SU). METHOD: Participants from four MTA sites were sampled to include those with persistent and atypically high SU, and a local normative comparison group (LNCG). Respondents were encouraged to "tell their story" about their lives, using a semistructured conversational interview format. RESULTS: Interviews were reliably coded for interview topics. ADHD youth more often desisted from SU because of seeing others going down wrong paths due to SU. Narratives revealed very diverse accounts and explanations for SU-ADHD influences. CONCLUSION: Qualitative methods captured the perspectives of YAs regarding using substances. This information is essential for improving resilience models in drug prevention and treatment programs and for treatment development for this at-risk population.

How Substance Users With ADHD Perceive the Relationship Between Substance Use and Emotional Functioning.

OBJECTIVE: Although substance use (SU) is elevated in ADHD and both are associated with disrupted emotional functioning, little is known about how emotions and SU interact in ADHD. We used a mixed qualitative-quantitative approach to explore this relationship. METHOD: Narrative comments were coded for 67 persistent (50 ADHD, 17 local normative comparison group [LNCG]) and 25 desistent (20 ADHD, 5 LNCG) substance users from the Multimodal Treatment Study of Children with ADHD (MTA) adult follow-up (21.7-26.7 years-old). RESULTS: SU persisters perceived SU positively affects emotional states and positive emotional effects outweigh negative effects. No ADHD group effects emerged. Qualitative analysis identified perceptions that cannabis enhanced positive mood for ADHD and LNCG SU persisters, and improved negative mood and ADHD for ADHD SU persisters. CONCLUSION: Perceptions about SU broadly and mood do not differentiate ADHD and non-ADHD SU persisters. However, perceptions that cannabis is therapeutic may inform ADHD-related risk for cannabis use.

Young adult outcomes in the follow-up of the multimodal treatment study of attention-deficit/hyperactivity disorder: symptom persistence, source discrepancy, and height suppression.

BACKGROUND: The Multimodal Treatment Study (MTA) began as a 14-month randomized clinical trial of behavioral and pharmacological treatments of 579 children (7-10 years of age) diagnosed with attention-deficit/hyperactivity disorder (ADHD)-combined type. It transitioned into an observational long-term follow-up of 515 cases consented for continuation and 289 classmates (258 without ADHD) added as a local normative comparison group (LNCG), with assessments 2-16 years after baseline. METHODS: Primary (symptom severity) and secondary (adult height) outcomes in adulthood were specified. Treatment was monitored to age 18, and naturalistic subgroups were formed based on three patterns of long-term use of stimulant medication (Consistent, Inconsistent, and Negligible). For the follow-up, hypothesis-generating analyses were performed on outcomes in early adulthood (at 25 years of age). Planned comparisons were used to estimate ADHD-LNCG differences reflecting persistence of symptoms and naturalistic subgroup differences reflecting benefit (symptom reduction) and cost (height suppression) associated with extended use of medication. RESULTS: For ratings of symptom severity, the ADHD-LNCG comparison was statistically significant for the parent/self-report average (0.51 ± 0.04, p < .0001, d = 1.11), documenting symptom persistence, and for the parent/self-report difference (0.21 ± 0.04, p < .0001, d = .60), documenting source discrepancy, but the comparisons of naturalistic subgroups reflecting medication effects were not significant. For adult height, the ADHD group was 1.29 ± 0.55 cm shorter than the LNCG (p < .01, d = .21), and the comparisons of the naturalistic subgroups were significant: the treated group with the Consistent or Inconsistent pattern was 2.55 ± 0.73 cm shorter than the subgroup with the Negligible pattern (p < .0005, d = .42), and within the treated group, the subgroup with the Consistent pattern was 2.36 ± 1.13 cm shorter than the subgroup with the Inconsistent pattern (p < .04, d = .38). CONCLUSIONS: In the MTA follow-up into adulthood, the ADHD group showed symptom persistence compared to local norms from the LNCG. Within naturalistic subgroups of ADHD cases, extended use of medication was associated with suppression of adult height but not with reduction of symptom severity.