Reciprocal relations between dimensions of attention-deficit/hyperactivity and anxiety disorders from preschool age to adolescence: sex differences in a birth cohort sample.

BACKGROUND: Symptoms of anxiety and attention-deficit/hyperactivity disorder (ADHD) are prospectively related from childhood to adolescence. However, whether the two dimensions of ADHD-inattention and hyperactivity-impulsivity-are differentially related to anxiety and whether there are developmental and sex/gender differences in these relations are unknown. METHODS: Two birth cohorts of Norwegian children were assessed biennially from ages 4 to 16 (N = 1,077; 49% girls) with diagnostic parent interviews used to assess symptoms of anxiety and ADHD. Data were analyzed using a random intercept cross-lagged panel model, adjusting for all unobserved time-invariant confounding effects. RESULTS: In girls, increased inattention, but not hyperactivity-impulsivity, predicted increased anxiety 2 years later across all time-points and increased anxiety at ages 12 and 14 predicted increased inattention but not hyperactivity-impulsivity. In boys, increased hyperactivity-impulsivity at ages 6 and 8, but not increased inattention, predicted increased anxiety 2 years later, whereas increased anxiety did not predict increased inattention or hyperactivity-impulsivity. CONCLUSIONS: The two ADHD dimensions were differentially related to anxiety, and the relations were sex-specific. In girls, inattention may be involved in the development of anxiety throughout childhood and adolescence and anxiety may contribute to girls developing more inattention beginning in early adolescence. In boys, hyperactivity-impulsivity may be involved in the development of anxiety during the early school years. Effective treatment of inattention symptoms in girls may reduce anxiety risk at all time-points, while addressing anxiety may decrease inattention during adolescence. Similarly, treating hyperactivity-impulsivity may reduce anxiety risk in boys during late childhood (at ages 8-10).

Sex, Gender, and Sexual Orientation in Psychological Research: Exploring Data Trends & Researcher Opinions.

Psychology researchers have historically neglected variables related to sex, gender, and sexual orientation, leading to the erasure of sex, gender, and sexual orientation in research, which limits the generalizability of psychological findings. We argue that these important variables need to be considered more consistently by researchers across psychology subdisciplines. In Study 1 we found that 15.1% of a large MTurk sample (i.e., 8500+) identified as a sexual or gender minority (SGM; e.g., lesbian, gay, bisexual, transgender, queer [LGBTQ+]). In addition, data from Study 1 showed that our youngest cohort (i.e., aged 18-25 years) reported significantly higher rates of LGBTQ+ identification (22.7%) than our oldest cohort (i.e., 65-84 years; 1.3%), suggesting that endorsement of these idnetities is increasing. Next, in Study 2 we found that psychology researchers (N = 135) tended to rate expansive sex, gender, and sexual orientation demographic variables as important in general, but were much less likely to report actually using these variables in their own studies. Moreover, younger faculty and faculty who identified as women rated these variables as more important than their colleagues. Based on our findings, we conclude that psychology researchers should use expansive sex, gender, and sexual orientation items in their studies, report these demographic variables consistently, and analyze their data by these important variables when possible. Because a substantial and growing proportion of individuals identify as LGBTQ+, and because SGM identity is related to additional life stressors, it is imperative to better understand these individuals. Various resources are offered and challenges are discussed.

Transitioning to college with ADHD: a qualitative examination of parental support and the renegotiation of the parent-child relationship.

Objective: In the transition to college, students with Attention-Deficit/Hyperactivity Disorder (ADHD) often face difficulties. Parental support may aid in the successful adjustment to college, and a strong parent-child relationship (PCR) may optimize the balance between autonomy and support necessary during this transition. Method: Few studies have examined this; therefore, a qualitative study using Interpretative Phenomenological Analysis (IPA) was conducted. First- and second-year college students with ADHD participated in open-ended, one-on-one interviews (N = 11; 64% women, 91% White). Results: The two broad categories of findings included Parental Support and the Renegotiation of the Parent-Child Relationship. Participants described feeling supported by their parents in the progress toward their short- and long-term goals. Students described this support as helpful when they managed or initiated the contact, but as unhelpful when the parent was perceived as over involved. They described a strong PCR in this transition as helpful to their adjustment and enjoyed the renegotiation of the PCR in terms of their own increased autonomy and responsibility. Many additional themes and sub-themes are described herein. Conclusion: Optimal levels of involvement and support from parents in the context of a strong PCR is beneficial for adjustment to college for those with ADHD. We discuss the clinical implications of our findings, such as therapists helping families transition to college, and working with college students with ADHD on an adaptive renegotiation of the PCR in their transition to adulthood.

ADHD and Psychological Need Fulfillment in College Students.

OBJECTIVE: Self-determination theory suggests that the satisfaction and frustration of basic psychological needs-autonomy, competence, relatedness-are uniquely associated with overall well-being. Undergraduates with attention-deficit/hyperactivity disorder (ADHD) experience more academic-related impairment and are less likely to graduate. Thus, well-being is important to understand and aim to improve in these students. METHOD: Students at four universities (N = 2,197) completed a survey and reported previous diagnoses, ADHD symptoms, and psychological need satisfaction and frustration. Group differences were explored via t-tests; associations were explored via structural equation modeling. RESULTS: The ADHD group reported lower satisfaction and higher frustration across all psychological needs. Inattention and hyperactivity/impulsivity were uniquely associated with aspects of need fulfillment beyond the impact of comorbid symptoms. Sex differences emerged such that women with ADHD had the lowest overall need satisfaction. CONCLUSIONS: Addressing need fulfillment, both satisfaction and frustration, in interventions with undergraduates with clinical/subclinical levels of ADHD may optimize treatment effectiveness.

Parent Intention to Enroll in an Online Intervention to Enhance Health Behavior Change among Youth Treated with Psychotropic Medication Who Are Overweight or Obese: An Elicitation Study.

Youth who are prescribed psychotropic medication are disproportionally affected by overweight/obesity (OW/OB), yet few interventions have been tailored to their needs. To develop new interventions, it is important to address the needs, preferences, and intentions of target users. Qualitative methods within the theory of planned behavior (TPB) framework were used in this study to identify salient beliefs which may influence attitudes associated with parents' intentions to participate in a future online intervention designed to develop behavioral health coaching skills among parents and guardians. Twenty parents and guardians of youth with OW/OB who were taking psychotropic medications, and were eligible for the study, were recruited through TurkPrime. Parents and guardians identified key salient beliefs consistent with the theory of planned behavior including behavioral beliefs (e.g., access and convenience), normative beliefs (e.g., family), and control beliefs (e.g., cost) that may influence their decision to enroll in a future, parent-oriented intervention. The results of this study suggest important salient beliefs which may be included in future research, as well as specific preferences which may be used to guide the development of a future intervention. Future work should focus on the creation of a salient belief quantitative measure and assess the relationships of these beliefs to attitudinal constructs and behaviors.

Feasibility and Acceptability of an Internet-Based Intervention for Young Adults with ADHD.

Internet-based interventions (IBIs) to treat psychological disorders are available, but accessibility to these to treat attention-deficit/hyperactivity disorder (ADHD) in young adult populations is quite limited. The current study examined the feasibility of a proposed IBI for ADHD and participant perceptions regarding treatment acceptability and credibility, and outcome expectancy. Participants (N = 235; aged 18-35) with a prior ADHD diagnosis were recruited through Amazon's Mechanical Turk (MTurk) and were provided with a proposed IBI and explanatory outlines of treatment module content. Participants in the cross-sectional study were randomly assigned to either a tailored (i.e., targeted content modules), minimal (i.e., presented overall fewer and non-targeted modules), or full (i.e., all possible modules) condition. Results demonstrated moderate IBI acceptability among participants in the tailored and full conditions. The majority of participants preferred IBI over face-to-face (F2F) treatment, and most individuals who preferred F2F treatment also considered an IBI to be an acceptable treatment modality. Lack of significant mean differences between the tailored and full conditions on several of the main outcomes of interest (e.g., perceptions of acceptability) suggests that implementation of either method of treatment could prove effective. Differences based on treatment length and relevance, and biological sex were also explored. Implications, limitations, and future directions are discussed. Supplementary Information: The online version contains supplementary material available at 10.1007/s41347-022-00256-4.

Acute Effects of Physical Exercise on Cognitive and Psychological Functioning in College Students with Attention-Deficit/Hyperactivity Disorder.

We sought to elucidate the acute effects of high-intensity interval training (HIIT) among college students with and without attention-deficit/hyperactivity disorder (ADHD). Participants were age- and sex-matched across ADHD (n = 18) and non-ADHD groups (n = 18) and both groups completed baseline (non-HIIT) and experimental sessions (HIIT). We examined within- and between-subject effects on a continuous performance task (CPT) and self-reported ADHD and internalizing symptomatology. We found that the degree of improvement on ADHD and depressive symptomatology, as well as processing speed and response variability following HIIT was significantly greater for the ADHD group than the comparison group. Further investigations such as randomized controlled trials focusing on the chronic effects of sustained HIIT interventions are needed to substantiate the potential feasibility and efficacy of HIIT as an intervention. HIIT may be a useful adjunct to psychosocial and/or pharmacological treatments for college students with ADHD because it: (a) yields immediate, acute improvements in executive functioning, ADHD, and mood; (b) promotes improved physical and mental health; (c) poses a relatively low risk of deleterious effects in apparently healthy college students. Even with the need for additional research, current data suggest a single, brief, high-intensity bout of aerobic exercise can yield immediate significant short-term improvements. These improvements may enhance functioning and improve outcomes for college students with ADHD.

Promoting academic success in college students with ADHD and LD: A systematic literature review to identify intervention targets.

Objective: College students with attention-deficit/hyperactivity disorder (ADHD) and/or a learning disorder (LD) are at higher risk for not attaining a bachelor's degree. The purpose is to identify the predictors of academic success in college for students with ADHD and/or LD using a systematic review of the literature. Method: Academic Search Premier, Education Full Text, Education Source, Education Resources Information Center, Teacher Reference Center, PsycINFO, PsycArticles, and Primary Search and relevant journals were searched using PRISMA guidelines. Studies were screened based on the following inclusion criteria: college students with ADHD and/or LD, student characteristics as predictors, and GPA and/or retention as outcomes. Results: Twenty-one studies were included (20 quantitative studies and 1 randomized control trial). Academic regulation, academic self-efficacy, emotional regulation, ADHD symptoms, and academic and social integration predicted college success. Conclusion: Incorporating these components into interventions with students with ADHD and/or LD may enhance their success in college.

Networks of ADHD and SCT Symptoms in Emerging Adulthood.

OBJECTIVE: Emerging adulthood (18-25 years) is a transitional and understudied developmental period. Yet, little is known about how specific symptoms of ADHD, as well as those from the related SCT domain, may differentially relate to one another during this period, if there are differences based on biological sex, or how closely results will align with adulthood. METHODS: We used network analysis techniques to explore the structure of ADHD and SCT symptoms within emerging adulthood, with additional comparisons between sexes as well as between emerging adulthood and adulthood. Using an online platform, 8,506 adults reported on their symptoms of ADHD and SCT. RESULTS: Symptoms grouped together within their respective domains during emerging adulthood with no significant differences in overall network structure between sexes. Similarly, network structure appeared to be robust across emerging adulthood and adulthood. CONCLUSION: Such consistency supports a conceptualization of ADHD in emerging adulthood as similar to adulthood.

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 World Federation of ADHD International Consensus Statement: 208 Evidence-based conclusions about the disorder.

BACKGROUND: Misconceptions about ADHD stigmatize affected people, reduce credibility of providers, and prevent/delay treatment. To challenge misconceptions, we curated findings with strong evidence base. METHODS: We reviewed studies with more than 2000 participants or meta-analyses from five or more studies or 2000 or more participants. We excluded meta-analyses that did not assess publication bias, except for meta-analyses of prevalence. For network meta-analyses we required comparison adjusted funnel plots. We excluded treatment studies with waiting-list or treatment as usual controls. From this literature, we extracted evidence-based assertions about the disorder. RESULTS: We generated 208 empirically supported statements about ADHD. The status of the included statements as empirically supported is approved by 80 authors from 27 countries and 6 continents. The contents of the manuscript are endorsed by 366 people who have read this document and agree with its contents. CONCLUSIONS: Many findings in ADHD are supported by meta-analysis. These allow for firm statements about the nature, course, outcome causes, and treatments for disorders that are useful for reducing misconceptions and stigma.

ADHD Symptoms and Sex Moderate the Relation Between Protective Behavioral Strategies and Alcohol Use Among Treatment-Mandated College Students.

College students with attention deficit/hyperactivity disorder are likely to engage in alcohol use and experience alcohol-related problems. Use of protective behavioral strategies is related to fewer alcohol-related consequences. However, this association has not been sufficiently examined in relation to attention deficit/hyperactivity disorder symptoms, which could alter the likelihood of utilizing protective behavioral strategies. This study examined whether attention deficit/hyperactivity disorder symptoms moderate the relationship between protective behavioral strategies and alcohol use, and whether this differs by sex. Participants were 125 treatment-mandated college students (58.6% male; Mage = 19.50 years) who completed measures of attention deficit/hyperactivity disorder symptoms, protective behavioral strategies, and past-2-week drinking. There was a significant 3-way interaction such that drinking was highest when protective behavioral strategy use was low and hyperactivity/impulsivity symptoms were high, but only for women. There was also a significant protective behavioral strategy by inattention interaction, as students with high inattention and low protective behavioral strategy use consumed the most drinks. Interventions to enhance use of protective behavioral strategies may effectively decrease alcohol use for college students with attention deficit/hyperactivity disorder symptoms, particularly women.

College Readiness: Differences Between First-Year Undergraduates With and Without ADHD.

Attention-deficit/hyperactivity disorder (ADHD) is characterized by inattentive, hyperactive, and impulsive behaviors. Impairment in individuals diagnosed with ADHD is significant; one such domain of impairment is achieving a college education. College students with ADHD tend to have lower grade point averages, take longer to graduate, and have higher dropout rates than individuals without ADHD. Those with ADHD may be inadequately prepared for college. College readiness can be broken into self-determination, academic skills, and daily living skills, all of which are possible areas of deficit for individuals with ADHD, given their common characteristics. In the current study, we examined differences in college readiness in undergraduates with and without ADHD. In general, students with ADHD were found to be less prepared for college than those without ADHD, and specific areas of unpreparedness were identified. The findings support the need for intervention for students with ADHD before or early in their college careers. Further research on specific skill deficits and ameliorative steps is needed.

Psychometric Properties of the Weiss Functional Impairment Rating Scale: Evidence for Utility in Research, Assessment, and Treatment of ADHD in Emerging Adults.

Objective: The current study examines psychometric properties of the Weiss Functional Impairment Rating Scale (WFIRS), a measure of adult ADHD-related impairment. It is a self-report questionnaire that provides a metric of overall life impairment and domain-specific dysfunction. Method: Using data from a large (N = 2,093), multi-institution sample of college students and including a subsample of collateral informants (n = 262), a series of analyses were conducted. Results: The WFIRS demonstrated robust internal reliability, cross-informant agreement on par or superior to other measures of ADHD symptomatology and impairment, and concurrent validity. The WFIRS was not shown to be uniquely associated with ADHD, as internalizing symptoms also associated with the total and domain scores. Conclusion: The use of the WFIRS in identifying ADHD-related impairment in emerging adults appears to be psychometrically supported, and will prove useful to clinicians and researchers.

Sex and gender in psychopathology: DSM-5 and beyond.

Sex and gender differences in psychopathology have been understudied, yet identifying and understanding variability by sex and gender is important for the development of comprehensive etiological models as well as effective assessment and treatment of psychopathology in all persons. In the current article, we discuss the importance of sex and gender in psychopathology research, review terminology used when examining these constructs, and present multiple explanations for differential prevalence rates. Next, we review articles from psychopathology journals and conclude that researchers more often include both males and females than they did two decades ago, but still do not consistently analyze by sex or gender. We also provide an update of male-to-female ratios as presented in the DSM-5 and conduct a systematic review of the literature for selected disorders. We conclude that the DSM-5 presentation of sex or gender ratios is not systematic. Finally, we provide suggestions for the next DSM task force, researchers, journal editors, and funding agencies. These recommendations focus on more consistently and systematically considering sex and gender in all aspects of psychopathology research. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

ADHD and SCT Symptomatology in Relation to College Students' Use of Self-Regulated Learning Strategies.

Objective: The present study examined the relation between self-regulated learning (SRL) strategies and ADHD and sluggish cognitive tempo (SCT) symptomatology. Method: Participants were 303 college students, aged 18 to 25 (M = 20.04, SD = 1.45), from a Midwestern university who completed the Barkley Adult ADHD Rating Scale-IV (BAARS-IV), and a shortened, generalized version of the Motivated Strategies for Learning Questionnaire (MSLQ). Results: Among college students, inattention symptomatology was consistently predictive of deficits in use of value, expectancy, and self-regulation strategies, while SCT symptomatology was only predictive of deficits in the use of self-regulation strategies. Conclusion: This study is the first to examine the relation between SCT symptomatology and SRL strategy use in college students. The findings revealed that SRL strategy use differs between college students exhibiting ADHD or SCT symptomatology. Remediation focusing on these deficits would likely increase academic achievement. Clinical implications, limitations, and suggestions for future research are discussed.

DSM-5 and Other Symptom Thresholds for ADHD: Which Is the Best Predictor of Impairment in College Students?

OBJECTIVE: Approximately 5% of adults have ADHD. Despite recommendations regarding the diagnosis of emerging adults, there is not a strong consensus regarding the ideal method for diagnosing ADHD in both emerging and mature adults. We were interested in determining whether a threshold of four, five, or six ADHD symptoms would be associated with significantly different levels of functional impairment and be more or less indicative of a potential ADHD diagnosis. METHOD: We examined the relation between functional impairment and these ADHD symptom thresholds in 2,577 college students. RESULTS: Our findings suggest that none of these symptom thresholds are differentially better at predicting functional impairment. CONCLUSION: The Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) threshold of five symptoms for ages 17 years and older is not necessarily predictive of ADHD-related impairment in college students and may not be preferable to other thresholds. Options for resolving this diagnostic dilemma are discussed.

Efficacy of an Organizational Skills Intervention for College Students With ADHD Symptomatology and Academic Difficulties.

OBJECTIVE: We sought to elucidate the effects of an organization, time management, and planning (OTMP) skills training intervention for college students reporting elevated levels of ADHD symptomatology and academic impairment. METHOD: Undergraduate participants enrolled in either the intervention ( n = 22) or comparison ( n = 15) condition in exchange for psychology course credit. Those in the intervention condition attended three weekly group meetings designed to improve organizational skills. Treatment effectiveness was evaluated by comparing pre- and postmeasurements of academic impairment, inattention, hyperactivity/impulsivity, and OTMP skills utilization. RESULTS: Intervention group participants improved significantly on ratings of inattention, hyperactivity/impulsivity, and academic impairment, relative to the comparison group. Intervention group participants also improved in their use of OTMP skills, relative to their baseline ratings. CONCLUSION: This study suggests an organizational skills intervention has the potential to ameliorating ADHD symptomatology and academic impairment among college students.

Barriers and facilitators of obesity management in families of youth with emotional and behavioral disorders.

While youth with emotional and behavioral disorders experience increased rates of obesity, few obesity interventions exist that are tailored to their needs. Qualitative methods were employed to elucidate obesity management practices in this population. In all, 56 participants (i.e. 21 youths with emotional and behavioral disorders, 20 caregivers of youth with emotional and behavioral disorders, and 15 mental health providers) were recruited from community mental health centers. Participants completed a demographic form and semi-structured interview regarding obesity-related behaviors. Barriers (e.g. psychiatric symptoms) and facilitators (e.g. social support) to obesity management were identified. These results highlight preferred intervention components for this unique population.