College during COVID-19: The pandemic's effect on college adjustment in first year students with ADHD.

Objective: The current study aims to compare college adjustment and the effects of the COVID-19 pandemic on first-year students with and without ADHD. Participants: Two cohorts (pre-pandemic, during the pandemic) of first-year, undergraduate college students (N = 3,006; Mage=18.32) were recruited from a multisite research consortium across several universities. Methods: First-year participants self-reported on ADHD diagnosis and symptoms, functional impairments, and experiences transitioning to college. Results: First-year college students with and without ADHD reported significantly greater academic, daily living, and overall functional impairments during the pandemic compared to pre-pandemic. Compared to college students without ADHD, college students with ADHD reported greater functional impairment, more difficulty adjusting to the academic demands of college, and were less likely to feel valued at their institution. Conclusions: First-year college students with and without ADHD experienced greater difficulties navigating the transition to college during the pandemic. Psychosocial and academic supports to help students transition to college are needed.

Predictors of Autism Spectrum Disorder and ADHD: Results from the National Survey of Children's Health.

BACKGROUND: Autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) are two of the most common neurodevelopmental disorders with comorbidity rates of up to 70%. Population-based studies show differential rates of ADHD and ASD diagnosis based on sociodemographic variables. However, no studies to date have examined the role of sociodemographic factors on the likelihood of receiving an ADHD, ASD, or comorbid ASD + ADHD diagnosis in a large, nationally representative sample. OBJECTIVE: This study aims to examine the impact of sociodemographic factors on the odds of experiencing ASD-only, ADHD-only, or both diagnoses for children in the United States. METHODS: Using a mixed effects multinomial logistic modeling approach and data from the 2016-2018 National Survey of Children's Health, we estimated the association between sociodemographic variables and the log odds of being in each diagnostic group. RESULTS: Sociodemographic variables were differentially related to the three diagnostic groups: ASD-only, ADHD-only, and ASD + ADHD. Compared to girls, boys experienced higher odds of all three diagnosis categories. White children had higher odds of having an ADHD-only or ASD + ADHD diagnosis compared to non-Hispanic (NH) Black, NH multiple/other race, and Hispanic children. Odds ratios for levels of parent education, household income, and birth characteristics showed varying trends across diagnostic groups. CONCLUSIONS: Overall, our findings point to unique sets of risk factors differentially associated ASD and ADHD, with lower income standing out as an important factor associated with receiving a diagnosis of ASD + ADHD.

Factor Structure of the Teacher Strengths and Difficulties Questionnaire in a Large Community-Based Sample: An Investigation of Alternative Measurement Models.

The Strengths and Difficulties Questionnaire (SDQ) is a screening measure commonly used to assess behavioral and emotional symptoms and strengths among children and adolescents. However, despite its frequent use, its underlying factor structure remains an important area of inquiry. Whereas the original five-factor structure has often been supported through exploratory factor analysis, results from confirmatory analyses continue to yield mixed results. We analyzed data from youth in Grades K through 12 from a large epidemiologic study in the Southeastern United States. Teacher-report SDQ data were used to test three confirmatory factor models by school level (i.e., elementary [Grades K-5] and secondary [Grades 6-12]): The original five-factor model, a three-factor model, and a bifactor model. Model fit indices and reliability measures supported the original five-factor model as the preferred model when using the teacher-reported SDQ with both elementary and secondary school children. Implications for using the SDQ in applied research and predictive modeling are discussed.

The Utility of the Behavior Assessment System for Children-2 Behavioral and Emotional Screening System and Strengths and Difficulties Questionnaire in Predicting Mental Disorders in the Project to Learn About Youth-Mental Health.

We examined the predictive utility of the Behavior Assessment System for Children-2 Behavioral and Emotional Screening System (BASC-2-BESS) and Strengths and Difficulties Questionnaire (SDQ) in identifying students with a mental disorder. Data were collected in a two-stage study over 34 months with kindergarten-12th grade (K-12) students (aged 5-19 years) in four U.S. school districts. In Stage 1, teachers completed the BASC-2-BESS and the SDQ. In Stage 2, parents of 1,054 children completed a structured diagnostic interview to determine presence of a mental disorder. Results suggest that teacher versions of the BASC-2-BESS and SDQ have modest utility in identifying children meeting criteria for a mental disorder based on parent report. Area Under the Curve (AUC) statistics representing prediction of any externalizing disorder (.73 for both measures) were higher than the AUCs predicting any internalizing disorder (.58 for both measures). Findings can inform the use of teacher report in mental health screening, specifically the selection of measures when implementing screening procedures.

A Scoping Review of Factors Associated With Emotional Dysregulation in Adults With ADHD.

OBJECTIVE: Emotion dysregulation is frequently seen in adults with ADHD and is associated with many adverse outcomes. We conducted a scoping review of factors associated with emotion dysregulation in adults with ADHD. METHOD: PubMed and PsycInfo (EBSCO) were searched. Articles were included if they measured ADHD, emotional dysregulation or some aspect of emotional dysregulation, and at least one other construct. Studies examining physiological underpinnings as well as clinical trials examining the effect of ADHD medications on emotional dysregulation were excluded because recent reviews have already examined these topics. RESULTS: Thirty-five studies were included in the review. Factors such as biological sex, comorbidities, attachment style, using certain emotional regulation strategies, and ADHD subtype tend to be related to emotion dysregulation. CONCLUSION: Clinicians working with adults with ADHD can collect information on these factors to better understand risk for emotion dysregulation, and emotion regulation skills may be one area for intervention.

County-Level Prevalence Estimates of Autism Spectrum Disorder in Children in the United States.

Prevalence estimates of autism spectrum disorder (ASD) point to geographic and socioeconomic disparities in identification and diagnosis. Estimating national prevalence rates can limit understanding of local disparities, especially in rural areas where disproportionately higher rates of poverty and decreased healthcare access exist. Using a small area estimation approach from the 2016-2018 National Survey of Children's Health (N = 70,913), we identified geographic differences in ASD prevalence, ranging from 4.38% in the Mid-Atlantic to 2.71% in the West South-Central region. Cluster analyses revealed "hot spots" in parts of the Southeast, East coast, and Northeast. This geographic clustering of prevalence estimates suggests that local or state-level differences in policies, service accessibility, and sociodemographics may play an important role in identification and diagnosis of ASD.County-Level Prevalence Estimates of Autism Spectrum Disorder in Children in the United States.

County-level prevalence estimates of ADHD in children in the United States.

PURPOSE: Attention-deficit/hyperactivity disorder (ADHD) is a common childhood disorder often characterized by long-term impairments in family, academic, and social settings. Measuring the prevalence of ADHD is important as treatment options increase around the U.S. Prevalence data helps inform decisions by care providers, policymakers, and public health officials about allocating resources for ADHD. In addition, measuring geographic variation in prevalence estimates can facilitate hypothesis generation for future analytic work. Most U.S. studies of ADHD prevalence among children focus on national or demographic group rates. METHODS: Using a small area estimation approach and data from the 2016 to 2018 National Survey of Children's Health, we estimated childhood ADHD prevalence estimates at the census regional division, state, and county levels. The sample included approximately 70,000 children aged 5-17 years. RESULTS: The national ADHD rate was estimated to be 12.9% (95% Confidence Interval: 11.5%, 14.4%). Counties in the West South Central, East South Central, New England, and South Atlantic divisions had higher estimated rates of childhood ADHD (55.1%, 53.6%, 49.3%, and 46.2% of the counties had rates of 16% or greater, respectively) compared to counties in the Mountain, Mid Atlantic, West North Central, Pacific, and East North Central divisions (2.1%, 4%, 5.8%, 6.9%, and 11.7% of the counties had rates of 16% or greater, respectively). CONCLUSIONS: These local-level rates are useful for decision-makers to target programs and direct sufficient ADHD resources based on communities' needs.

Household Food Insecurity and Fear of Hypoglycemia in Adolescents and Young Adults With Diabetes and Parents of Youth With Diabetes.

OBJECTIVE: To evaluate the relation between household food insecurity (HFI) and fear of hypoglycemia among young adults with type 1 and type 2 diabetes and adolescents with type 1 diabetes and their parents. RESEARCH DESIGN AND METHODS: We analyzed cross-sectional data of 1,676 young adults with youth-onset diabetes (84% type 1, 16% type 2) and 568 adolescents (<18 years old; mean age 15.1 years) with type 1 diabetes from the SEARCH for Diabetes in Youth study. Adult participants and parents of adolescent participants completed the U.S. Household Food Security Survey Module. Adults, adolescents, and parents of adolescents completed the Hypoglycemia Fear Survey, where answers range from 1 to 4. The outcomes were mean score for fear of hypoglycemia and the behavior and worry subscale scores. Linear regression models identified associations between HFI and fear of hypoglycemia scores. RESULTS: Adults with type 1 diabetes experiencing HFI had higher fear of hypoglycemia scores (0.22 units higher for behavior, 0.55 units for worry, 0.40 units for total; all P < 0.0001) than those without HFI. No differences by HFI status were found for adolescents with type 1 diabetes. Parents of adolescents reporting HFI had a 0.18 unit higher worry score than those not reporting HFI (P < 0.05). Adults with type 2 diabetes experiencing HFI had higher fear of hypoglycemia scores (0.19 units higher for behavior, 0.35 units for worry, 0.28 units for total; all P < 0.05) than those in food secure households. CONCLUSIONS: Screening for HFI and fear of hypoglycemia among people with diabetes can help providers tailor diabetes education for those who have HFI and therefore fear hypoglycemia.

Surveillance of ADHD Among Children in the United States: Validity and Reliability of Parent Report of Provider Diagnosis.

OBJECTIVE: To evaluate the appropriateness of parent-reported diagnosis of ADHD as a surveillance tool. METHOD: We assessed agreement over time and concordance of parent-reported diagnosis against Diagnostic and Statistical Manual (DSM)-based criteria. We compared concordance of diagnosis and DSM-based criteria by child characteristics, including treatment. RESULTS: Among parents who reported their child had ADHD, 95.7% reported it again 2 years later. Comparing diagnosis with DSM-based criteria, specificity and negative predictive value were high, sensitivity was moderate, and positive predictive value was low. Most children with an ADHD diagnosis who did not meet DSM-based criteria met sub-threshold criteria or took medication for ADHD. Concordance differed by child characteristics and treatment. CONCLUSION: Parent-reported diagnosed ADHD is reliable over time. Although differences in parent-reported diagnosis and DSM-based criteria were noted, these may reflect children with milder symptoms or treated ADHD. Parent-report of child ADHD ever diagnosis may be a good single-item indicator for prevalence.

Stability of mental disorder prevalence estimates among school-aged children and adolescents: findings from the community-based project to learn about youth-mental health (PLAY-MH) and replication-PLAY-MH (Re-PLAY-MH), 2014-2017.

PURPOSE: This study evaluated the stability over time of prevalence estimates of mental disorders among school-aged children from the same community. METHODS: We compared screening status and weighted prevalence of selected mental disorders from the two-stage school-based South Carolina Project to Learn About Youth-Mental Health (Time 1) and its replication study (Time 2) conducted between 2014 and 2017. During stage 1, two teacher screeners were used to group students into high or low risk for a mental disorder. During stage 2, parents of selected students completed a structured diagnostic interview to assess whether their child met criteria for specific disorders. RESULTS: For stage 1, 19.9% of students screened as high risk for a mental disorder at Time 2 compared to 17.8% at Time 1. Among students included at both timepoints, 9.1% screened as high risk at both timepoints while screening status changed for 20.7%. The overall prevalence of included mental disorders was approximately 18% at both time points There were no differences (P-values >.05) in prevalence of individual mental disorders between Time 1 (range:0.3%-6.7%) and Time 2 (range:1.2%-7.7%). CONCLUSIONS: Study findings demonstrate that similar methodology yielded similar prevalence estimates of mental disorders and can inform community-level planning for improving mental health in children.

Feasibility & Preliminary Efficacy of Structured Programming and a Parent Intervention to Mitigate Accelerated Summer BMI Gain: A pilot study.

BackgroundThis study assessed initial feasibility and preliminary efficacy of providing children a free summer day camp and a parent intervention to improve self-regulation and mitigate accelerated summer BMI gain.MethodsThis pilot 2x2 factorial randomized control trial used a mixed methods design to evaluate providing children a free summer day camp (SCV), a parent intervention (PI), and the combination of these two strategies (SCV + PI) to mitigate accelerated summer body mass index (BMI) gain. Feasibility (i.e., recruitment capability, retention, compliance, treatment fidelity, acceptability) was examined using means, standard deviations, and percentages for relevant variables. Changes in BMI were estimated using intent-to-treat and post-hoc dose response analyses via multilevel mixed effects regressions.ResultsA total of 89 families participated, with 24 participants randomized to the PI group, 21 randomized to the SCV group, 23 randomized to the SCV + PI group, and 21 randomized to the control. Parents and children found the summer program acceptable but attendance at the summer program and engagement in the PI were low due to COVID-19 and lack of transportation. Intent-to-treat analyses showed no statistically significant difference between groups in summer BMI gain. Post-hoc dose response analyses showed that for each day (0 to 29) of summer programming children attended they gained - 0.009 (95CI= -0.018, -0.001) less in BMI z-score.ConclusionsEngagement in both the SCV and PI was not ideal and was likely due to COVID-19 and lack of transportation. Providing children with structured summer programming to mitigate accelerated summer BMI gain may be an effective strategy. Thus, a larger trial may be warranted, but more work is needed to ensure children attend the programming.Trial registration: The trial reported herein was prospectively registered at clinicaltrials.gov. Trial #:NCT04608188.

Unique considerations in the assessment of ADHD in college students.

Evidence-based practice in psychology (EBPP) has long focused on treatment, but evidence-based psychological assessment (EBPA) is also crucial given the important role of accurate and reliable diagnostic practices in treatment planning. In terms of the diagnosis of attention-deficit/hyperactivity disorder (ADHD), EBPA practices are well-established for children, and more recently for adults, but for college students in particular there are special considerations that warrant attention. College students with symptoms of ADHD have some challenges that are unique, and thus the assessment and diagnosis of ADHD in these students is unique. The aim of this review is not to cover all EBPA strategies for diagnosing ADHD in emerging adult college students; rather, we will focus on the unique considerations at play in college ADHD assessment. These include (a) conceptual matters such as the appropriateness of the DSM-5 criteria for college students, the limitations of our understanding of ADHD this population because of a lack of diversity in research studies, and the issue of late-identified ADHD; and (b) practical matters, such as specific documentation needs, how to gather and interpret self- and other-report of symptoms, how to assess impairment, and alternate explanations for ADHD-like symptoms in college students.

Relations among protective behavioral strategies, biological sex, and ADHD symptoms on alcohol use and related problems: Who benefits most, and from what type of strategy?

Attention-deficit/hyperactivity disorder (ADHD) symptoms among college students are associated with high rates of alcohol use and alcohol-related consequences. Use of protective behavioral strategies (PBS) is generally related to lower levels of alcohol use and problems; however, it is unclear how effectively students with ADHD symptoms can implement PBS, and whether certain types of PBS use may yield better outcomes. This study examined relations between PBS type and ADHD symptoms on both alcohol use and consequences, and whether these relations varied by biological sex. Participants were 875 college student drinkers from three universities who completed measures of ADHD symptoms, PBS, past-month alcohol use, and alcohol-related consequences. There were significant moderation effects of ADHD symptoms, such that the relation between PBS use and alcohol use was more pronounced for students high in inattention, and the relation between PBS use and alcohol-related consequences was more pronounced for students high in either inattention or hyperactivity/impulsivity symptoms. These relations were found for both manner of drinking and stopping/limiting drinking PBS, and they tended to be strongest for male students. There were no significant interaction effects that included serious harm reduction PBS; for all students, increased use of this type of PBS was associated with fewer problems. These results suggest that PBS are likely effective for students with ADHD symptoms. Interventions that provide explicit instruction in employing PBS, particularly related to manner of drinking and stopping/limiting drinking strategies, are recommended for students with ADHD symptoms.

The Factor Structure and Gender Invariance of ADHD Symptoms in College Students.

Previous studies examining the factor structure of attention-deficit/hyperactivity disorder (ADHD) symptoms in adults using self-report measures have shown mixed results, supporting two-, three-, and bifactor solutions. The current study further investigated the structure of ADHD symptoms in adults using the Current Symptoms Scale and rigorous model evaluation in a sample of 892 college students. Confirmatory factor analysis was used to analyze and compare five-factor structures; a single-factor model, a two-factor model, a three-factor model, and two bifactor models. A single-factor model with correlated residuals best fit the data. Factor correlations with nearly all related constructs (i.e., symptoms of oppositional defiant disorder, depression, impairment, previous ADHD diagnosis, grades, and substance use) were significant in the expected directions and the model was invariant across gender. These findings contribute to a growing body of work suggesting a unidimensional factor may best represent ADHD symptoms in adults. Implications are discussed.

Revisiting the Effect of Varying the Number of Response Alternatives in Clinical Assessment: Evidence From Measuring ADHD Symptoms.

This study illustrated the effect of varying the number of response alternatives in clinical assessment using a within-participant, repeated-measures approach. Participants reported the presence of current attention-deficit/hyperactivity disorder symptoms using both a binary and a polytomous (4-point) rating scale across two counterbalanced administrations of the Current Symptoms Scale (CSS). Psychometric properties of the CSS were examined using (a) self-reported binary, (b) self-reported 4-point ratings obtained from each administration of the CSS, and (c) artificially dichotomized responses derived from observed 4-point ratings. Under the same ordinal factor analysis model, results indicated that the number of response alternatives affected item parameter estimates, standard errors, goodness of fit indices, individuals' test scores, and reliability of the test scores. With fewer response alternatives, the precision of the measurement decreased, and the power of using the goodness-of-fit indices to detect model misfit decreased. These findings add to recent research advocating for the inclusion of a large number of response alternatives in the development of clinical assessments and further suggest that researchers should be cautious about reducing the number of response categories in data analysis.

Community-Based Prevalence of Externalizing and Internalizing Disorders among School-Aged Children and Adolescents in Four Geographically Dispersed School Districts in the United States.

The Project to Learn About Youth-Mental Health (PLAY-MH; 2014-2018) is a school-based, two-stage study designed to estimate the prevalence of selected mental disorders among K-12 students in four U.S.-based sites (Colorado, Florida, Ohio, and South Carolina). In Stage 1, teachers completed validated screeners to determine student risk status for externalizing or internalizing problems or tics; the percentage of students identified as being at high risk ranged from 17.8% to 34.4%. In Stage 2, parents completed a structured diagnostic interview to determine whether their child met criteria for fourteen externalizing or internalizing disorders; weighted prevalence estimates of meeting criteria for any disorder were similar in three sites (14.8%-17.8%) and higher in Ohio (33.3%). PLAY-MH produced point-in-time estimates of mental disorders in K-12 students, which may be used to supplement estimates from other modes of mental disorder surveillance and inform mental health screening and healthcare and educational services.

Food insecurity, childhood hunger and caregiver life experiences among households with children in South Carolina, USA.

OBJECTIVE: We explored how positive and negative life experiences of caregivers are associated with household food insecurity. DESIGN: The Midlands Family Study (MFS) was a cross-sectional study with three levels of household food security: food secure, food insecure without child hunger and food insecure with child hunger. Ordinal logistic regression analysis was used for analyses of negative and positive life experiences (number, impact, type) associated with food insecurity. SETTING: An eight-county region in South Carolina, USA, in 2012-2013. PARTICIPANTS: Caregivers (n 511) in households with children. RESULTS: Caregivers who reported greater numbers of negative life experiences and greater perceived impact had increased odds of household food insecurity and reporting their children experienced hunger. Each additional negative life experience count of the caregiver was associated with a 16 % greater odds of food insecurity without child hunger and a 28 % greater odds of child hunger. Each one-unit increase in the negative impact score (e.g. a worsening) was associated with 8 % higher odds of food insecurity without child hunger and 12 % higher odds of child hunger. Negative work experiences or financial instability had the strongest association (OR = 1·8; 95 % CI 1·5, 2·2) with child hunger. Positive life experiences were generally not associated with food security status, with one exception: for each unit increase in the number of positive experiences involving family and other relationships, the odds of child hunger decreased by 22 %. CONCLUSIONS: More research is needed to understand approaches to build resilience against negative life experiences and strengthen positive familial, community and social relationships.

Stand-Alone Social Skills Training for Youth with ADHD: A Systematic Review.

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common childhood disorders, and its symptoms and impairment in multiple domains begin in childhood and can extend into adulthood as well. Many youth with ADHD experience impairment in the social domain, including social skills deficits and difficulties in peer relationships. Social skills interventions, or social skills training (SST), have been developed to target social impairment and improve the social skills and functioning of youth with ADHD. Previous reviews of SST for youth with ADHD have provided mixed conclusions, with many including comprehensive, multilevel interventions for ADHD and none examining stand-alone SST for ADHD in a systematic way. The present review addresses this gap in the literature by providing the first known comprehensive, systematic review of SST alone, along with ratings of methodological rigor for each evaluation of stand-alone SST. The present review provides insight into the strengths and weaknesses in the existing SST literature, and provides suggestions for improvement and future directions for SST. An outline of "specific ingredients" and characteristics of effective SST are also presented, with the goal of providing both researchers and clinicians guidance for creating and implementing effective SST for youth with ADHD.

Life Satisfaction in Adolescents with Autism Spectrum Disorder.

We provided evidence regarding the reliability and validity of measures of assets and life satisfaction (LS) for adolescents with autism spectrum disorder (ASD). We identified levels of LS within this population, compared these levels to those of typically developing adolescents, and described the relation between assets and LS. Forty-six adolescents with ASD and their caregivers completed questionnaires assessing LS and assets. Preliminary support was provided for the internal consistency reliability and validity of these measures in adolescents with ASD. Youth with ASD reported moderate to high levels of LS; these were lower than those of typically developing peers. Age moderated the relation between self-reported LS and some assets. Implications were discussed within the context of Schalock's (J Disabil Policy Stud 14:204-215, 2004) emerging disability paradigm.

Is ADHD, independent of ODD, associated with whether and why college students misuse stimulant medication?

Although previous research suggests that undergraduates with untreated or undertreated attention-deficit/hyperactivity disorder (ADHD) symptoms may have academic motives for stimulant medication misuse, no previous work has examined the relation of ADHD symptoms, controlling for comorbid oppositional defiant disorder (ODD), to misuse, or has explored how these symptoms are differentially related to motives for misuse. Among a sample of 900 students from one public university, the current study first tested whether increased ADHD symptomology (using the Current Symptoms Scale, CSS) was associated with an increased likelihood of misusing stimulant medication, controlling for comorbid ODD. We then examined whether those with increased ADHD symptomology were more likely to report academic motives for misuse. The prevalence rate of misuse in the past year was 22%. Participants who met symptom count criteria for ADHD (controlling for comorbid ODD) were 2.90 times more likely to misuse stimulant medication than those who did not. Among misusers, those who met ADHD criteria were also 2.80 times more likely to report academic motives for misuse. These results support that stimulant medication misuse is likely driven, in part, by inadequate or absent care for the executive functioning impairments associated with ADHD. Therefore, a greater focus on assessment and treatment of college students with ADHD symptoms is warranted. (PsycINFO Database Record (c) 2018 APA, all rights reserved).