Relational and physical aggression in preschool-age children: Associations with teacher, parent, sibling, and peer relationship quality.

Early childhood relationships with teachers, parents, siblings, and peers are foundational factors for later social functioning. High rates of childhood aggression have been associated with negative developmental consequences, however, the associations between child aggression on the quality of these formative relationships have not been studied extensively. In a sample of young children attending preschool (N = 114, Mage = 46.27 months, SD = 9.94, 40% girls), this study investigated associations between early childhood relational and physical aggression and the quality of concurrent teacher-child and parent-child closeness and conflict, sibling relationship quality, and positive peer interactions and peer rejection. Early childhood relational and physical aggression was associated with negative teacher-child relationships, and this was true for boys and girls. Differential patterns of prediction were found for relational and physical aggression on the other relationship variables. Relational aggression strongly predicted more positive peer interactions, whereas physical aggression predicted fewer positive peer interactions and greater peer rejection. Early childhood relational aggression predicted higher levels of teacher-child closeness, whereas physical aggression predicted lower levels of teacher-child closeness and fewer positive sibling interactions. These findings challenge common perceptions that aggression is negatively associated with relationship quality. Notably, relational aggression relative to physical aggression may be associated with some favorable relationship outcomes. We did not find support for an additive model of aggression whereby children who were both relationally and physically aggressive (co-morbid) were at higher risk for negative relationship quality. Implications of these findings for future research and prevention and intervention are discussed.

Normative Beliefs and Aggression: The Mediating Roles of Empathy and Anger.

This study examined a two-mediator model with both empathy and anger as mediators in the association between children's normative beliefs about aggression and forms (relational and physical) and functions (reactive and proactive) of aggressive behavior. Ninety-eight children (54% males, Mage=46.21months, SD = 8.84months) reported their approval of relationally and physically aggressive behaviors depicted in iconic (animation) and enactive (toy figurines) hypothetical scenarios. Children's aggression, empathy and anger were measured using teacher reports. No main effects of normative beliefs about aggression on the corresponding aggressive behavior were found. Normative beliefs about aggression were negatively associated with empathy and empathy was significantly associated with relational aggression, suggesting that developing social emotional processes mediate the relation between social cognitions and aggression. Anger was associated with aggression, but not normative beliefs about aggression. The findings provide support for the distinction between subtypes of aggressive behavior in young children and the developing social-cognitive and affective processes that influence these behaviors.

Anger-irritability as a mediator of attention deficit hyperactivity disorder risk for adolescent alcohol use and the contribution of coping skills.

BACKGROUND: Research on susceptibility to alcohol use disorder within the attention deficit/hyperactivity disorder (ADHD) population has begun to expand examination of putative moderators and mediators in order to develop effective treatments. Specific dysregulated emotions have been separately associated with ADHD and with alcohol use difficulties. The current study is the first to conjointly study these variables by testing anger-irritability as a mediator of ADHD risk for adolescent alcohol use. METHODS: Frequency of binge drinking, drunkenness, and alcohol problems were examined for 142 children with ADHD followed into adolescence and compared to 100 demographically similar youth without ADHD. Parent-rated anger-irritability was tested as a mediator. Behavioral and cognitive coping skills, which are key clinical treatment targets, were studied as moderators of these associations. RESULTS: Childhood ADHD was positively associated with anger-irritability and the drinking outcomes in adolescence. Anger-irritability mediated the association between ADHD and alcohol use problems, but not binge drinking or drunkenness. Behavioral and cognitive, but not avoidant, coping played a moderating role, but only of the association between childhood ADHD and anger-irritability. CONCLUSIONS: Active coping strategies by adolescents with ADHD may reduce the vulnerability to alcohol problems through a reduction of negative emotions. Future research on additional mediators and treatments that target these skills is encouraged.

ADHD and Marijuana-Use Expectancies in Young Adulthood.

OBJECTIVE: This study examined mean level differences in marijuana expectancies and the differential associations between expectancies and marijuana use for individuals with and without a history of Attention-Deficit/Hyperactivity Disorder (ADHD). BACKGROUND: Substance-use expectancies are a widely studied risk factor for alcohol and other drug use. The relations between marijuana-use expectancies and self-reported marijuana use have not been examined in young adults with ADHD, a population shown to be at risk for marijuana use. METHOD: Participants were 306 (190 ADHD and 116 non-ADHD) young adults (M age = 20.06, SD = 2.03) from the Pittsburgh ADHD Longitudinal Study (PALS) who provided data about marijuana use and marijuana-use expectancies. RESULTS: Individuals in the ADHD group reported lower levels of social enhancement, tension reduction, and cognitive and behavioral-impairment expectancies compared to individuals in the non-ADHD group. Positive and negative marijuana-use expectancies were associated with marijuana use frequency in the whole sample and statistically significant ADHD group by expectancy interactions were found. Sexual-enhancement expectancies were more strongly associated with marijuana use frequency among individuals with ADHD histories while cognitive behavioral-impairment expectancies were more strongly associated with marijuana use frequency among individuals without ADHD. CONCLUSIONS: Marijuana-use expectancies may be acquired, and operate differently, for individuals with and without ADHD histories. Although future research is needed to test this speculation, these differences may be associated with ADHD-related difficulties in higher order cognitive processes that affect the encoding and utilization of expectations regarding marijuana's effects.

The roles of extraversion and neuroticism in the relationship between childhood adversity and adolescent substance misuse.

Although the influences of extraversion and neuroticism on the relationship between childhood adversity and substance misuse have been considered in adults, they are not yet clear and have not been examined among adolescent samples. This study sought to investigate the relationship between childhood adversity and adolescent substance misuse, alongside the influences of extraversion and neuroticism, using data from a longitudinal birth cohort study. Statistical analyses were performed on a longitudinal dataset provided by the Christchurch Health and Development Study (CHDS). After controlling for confounds, childhood adversity was a significant predictor of substance use disorder symptoms in adolescence. Moderation analyses showed that experiences of childhood adversity were most strongly associated with adolescent substance use disorder symptoms at higher levels of extraversion and at higher levels of neuroticism. Among adolescents who have experienced childhood adversity, extraversion and neuroticism may be risk factors for substance use disorder. By encouraging professionals to target adolescent substance misuse intervention and prevention approaches towards those who have experienced childhood adversity and are high in extraversion and/or neuroticism, these findings may help to diminish the prevalence of adolescent substance misuse and improve the health of adolescents.

Delinquency, aggression, and attention-related problem behaviors differentially predict adolescent substance use in individuals diagnosed with ADHD.

OBJECTIVE: To measure the degree to which childhood and adolescent ratings of aggression, attention, and delinquency are related to adolescent substance use outcomes in youth diagnosed with attention-deficit/hyperactivity disorder (ADHD). BACKGROUND: Childhood externalizing disorders have been shown to predict adolescent maladaptive substance use, but few studies have examined the differential predictive utility of two distinct dimensions of externalizing behavior: aggression and delinquency. METHODS: Ninety-seven clinically referred children with ADHD initially took part in this research protocol when they were on average 9.05 years of age, and were seen again on average 9.30 years later. Participants' parents were administered the Child Behavior Checklist (CBCL) at baseline and follow-up, and youth completed the Youth Self Report (YSR) in adolescence. At follow-up, substance use severity and diagnosis were assessed using semi-structured psychiatric interviews administered separately to parents and adolescents. Linear and binary logistic regressions were used to determine the association of CBCL- and YSR-rated attention problems, aggression, and delinquency to adolescent substance use. RESULTS: Childhood and adolescent delinquency, but not aggression, as rated by parents and youths, predicted adolescent substance use disorders and substance use severity (all p < .05). After accounting for the associations of delinquency and aggression with adolescent substance use, ratings of attention problems in childhood and adolescence were negatively associated with substance use outcome. CONCLUSIONS: Children with ADHD who exhibit high rates of delinquency are at risk for later substance use and may require targeted prevention, intervention, and follow-up services.

Stimulant Diversion Risk Among College Students Treated for ADHD: Primary Care Provider Prevention Training.

OBJECTIVE: To address increasing rates of stimulant misuse in college students, this study developed an evidence-based, brief clinical practice intervention for primary care providers (PCPs) to reduce stimulant medication diversion among young adults with attention-deficit/hyperactivity disorder (ADHD). METHODS: College students (N-114; 18-25 years; 68% attending universities; 24% attending community college) treated for ADHD with a stimulant and their PCPs across six practices participated in this initial, uncontrolled study of pre- to post-intervention change. An educational workshop providing strategies aimed at reducing stimulant diversion was developed and delivered to providers and staff across all practices (50% pediatric; 50% family medicine). Patients and providers completed baseline and post intervention surveys. RESULTS: Diversion was relatively infrequent, 16.7% at baseline and 14.9% post-intervention, respectively. Statistically significant decreases from baseline to post-intervention were found for three diversion risk factors: (1) number of times approached to divert, (2) intent to share, sell, or trade stimulants, and (3) disclosure of stimulant use. Providers and staff reported mostly high satisfaction with the training. CONCLUSIONS: This study provides initial evidence for a PCP-delivered intervention to reduce stimulant diversion. Research is needed on the efficacy of targeting college students directly, working with pharmacies and student health centers, and preventing misuse among teenagers.

Adolescents with childhood ADHD and comorbid disruptive behavior disorders: aggression, anger, and hostility.

UNLABELLED: This study examined the self-reported expression of overt aggressive behaviors and covert emotional and cognitive processes in adolescents diagnosed with ADHD and comorbid disruptive behavior disorders (DBDs) during childhood. METHODS: Participants were a clinically referred sample of 85 individuals diagnosed with ADHD, initially recruited in the early to mid 1990s when they were 7-11 years of age. At that time, 44 (52%) met criteria for a comorbid diagnosis of ODD and an additional 22 (26%) met criteria for a comorbid diagnosis of CD. Approximately 10 years later, these youth, along with an age-matched comparison sample (n=83), were re-evaluated to assess a wide array of outcomes including physical and verbal aggression, anger, and hostility. RESULTS: Individuals diagnosed with ADHD + CD in childhood reported elevated levels of physical aggression when compared to Controls and the ADHD-only group. Individuals diagnosed with ADHD + ODD had elevated levels of verbal aggression compared to Controls. Additionally, both comorbid groups experienced significantly greater amounts of anger, but not hostility, as compared to Controls. Importantly, the persistence of ADHD symptoms into adolescence accounted for most group differences in verbal aggression and anger at follow-up, but not physical aggression, which was accounted for by childhood CD. CONCLUSION: Adolescents diagnosed with ADHD and comorbid disruptive behavior disorders during childhood report high levels of aggression associated with increased emotionality in the form of anger, but not hostile cognitions. These findings suggest that in addition to inattention and hyperactivity/impulsivity, emotional dysregulation may be an important component of ADHD, particularly as it presents in adolescence.

Childhood maltreatment and conduct disorder: independent predictors of adolescent substance use disorders in youth with attention deficit/hyperactivity disorder.

Children with attention deficit/hyperactivity disorder (ADHD) are at heightened risk for maltreatment and later substance use disorders (SUDs). We investigated the relationship of childhood maltreatment and other risk factors to SUDs among adolescents diagnosed with ADHD in childhood. Eighty adolescents diagnosed with ADHD when they were 7 to 11 years old were screened for histories of childhood maltreatment, and SUD diagnoses were formulated in accordance with the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders. Lifetime history of problematic substance use was obtained for each parent at baseline. Childhood maltreatment predicted SUD outcome over and above that accounted for by childhood conduct disorder and problematic parental substance use, two potent predictors of adolescent SUDs.

The indirect effects of childhood attention deficit hyperactivity disorder on alcohol problems in adulthood through unique facets of impulsivity.

BACKGROUND AND AIMS: Research has not studied unique impulsivity dimensions as prospective links between childhood attention deficit hyperactivity disorder (ADHD) and alcohol problems. We examined the association between childhood ADHD, five facets of impulsivity and alcohol problems in adulthood and the indirect effects of childhood ADHD-to-impulsivity-to-alcohol problems. DESIGN, SETTING AND PARTICIPANTS: Participants were from a longitudinal study (n = 289, meanage  = 28.67) of individuals with (n = 170) and without (n = 119) childhood ADHD. The ADHD sample, as part of an ADHD summer treatment program, was diagnosed initially in childhood (1987-96, Pittsburgh, PA, USA) via structured parent interview and standardized parent/teacher ratings. The ADHD sample and demographically similar individuals without ADHD (living in the greater Pittsburgh area) were recruited to participate in the Pittsburgh ADHD Longitudinal Study (PALS) between 1999 and 2003. MEASUREMENTS: Self-reported impulsivity (UPPS-P) and alcohol-related problems were assessed in adulthood (2011-14). FINDINGS: Adults with, compared with those without, childhood ADHD had more alcohol problems (ß = 0.34, P < 0.05) and higher levels of negative urgency, positive urgency, lack of perseverance and lack of planning (ßs = 0.24-0.31, Ps < 0.001). Impulsivity facets (except sensation-seeking) were related to number of alcohol problems (ßs = 0.34-0.61, Ps < 0.05). Negative (ß = 0.26, P < 0.01) and positive (ß = 0.27, P < 0.01) urgency mediated the association between childhood ADHD and number of adult alcohol problems. CONCLUSIONS: Elevated levels of emotional impulsivity (negative/positive urgency) may place children with attention deficit hyperactivity disorder at increased risk for alcohol problems in adulthood.

Developmental progression to early adult binge drinking and marijuana use from worsening versus stable trajectories of adolescent attention deficit/hyperactivity disorder and delinquency.

AIMS: To examine the association between developmental trajectories of inattention, hyperactivity-impulsivity and delinquency through childhood and adolescence (ages 8-16 years) and subsequent binge drinking and marijuana use in early adulthood (age 21 years). DESIGN: Prospective naturalistic follow-up of children with attention deficit/hyperactivity disorder (ADHD) previously enrolled in a randomized controlled trial (RCT). Treatment-phase assessments occurred at 3, 9 and 14 months after randomization; follow-up assessments occurred at 24 months, 36 months, and 6, 8 and 12 years after randomization. SETTING: Secondary analysis of data from the Multimodal Treatment Study of ADHD (MTA), a multi-site RCT comparing the effects of careful medication management, intensive behavior therapy, their combination, and referral to usual community care. PARTICIPANTS: A total of 579 children with DSM-IV ADHD combined type, aged 7.0 and 9.9 years at baseline (mean = 8.5, SD = 0.80). MEASUREMENTS: Ratings of inattention, hyperactivity-impulsivity and delinquency were collected from multiple informants at baseline and through the 8-year follow-up. Self-reports of binge drinking and marijuana use were collected at the 12-year follow-up (mean age 21 years). FINDINGS: Trajectories of worsening inattention symptoms and delinquency (and less apparent improvement in hyperactivity-impulsivity) were associated with higher rates of early adult binge drinking and marijuana use, compared with trajectories of stable or improving symptoms and delinquency (of 24 comparisons, all P-values <0.05), even when symptom levels in stable trajectories were high. CONCLUSIONS: Worsening inattention symptoms and delinquency during adolescence are were associated with higher levels of early adult substance use; this pattern may reflect a developmental course of vulnerability to elevated substance use in early adulthood.

The effect of childhood conduct disorder and cognitive functioning on adolescent substance use.

OBJECTIVE: To assess the impact of childhood conduct disorder (CD) and intelligence quotient (IQ) on later substance use in adolescence. METHODS: Neuropsychological and structured diagnostic evaluations were initially administered to 32 children with disruptive behavior disorder when they were 7-11 years of age. They were then re-evaluated on average 6.7 years later using an array of interviews and rating scales with a focus on substance use. RESULTS: Early CD and IQ scores together accounted for a significant proportion of the variance in later substance use (R2=.248). In addition, there was a significant CD and Verbal IQ interaction (R2=.164) such that high Verbal IQ was linked to increased substance use in adolescents who had childhood CD. CONCLUSION: These data indicate that the presence of conduct disorder may interact with high Verbal IQ during childhood in such a way as to predict later adolescent substance use in disruptive behavior disorder populations.

Differential associations between alcohol expectancies and adolescent alcohol use as a function of childhood ADHD.

OBJECTIVE: Individuals with attention-deficit/hyperactivity disorder (ADHD) are at increased risk for experiencing alcohol-related problems. However, previous research has not examined alcohol expectancies, a widely studied risk factor for alcohol use, in this population. The current study examined mean differences in alcohol expectancies for adolescents with and without a history of childhood ADHD. The differential association between alcohol expectancies and alcohol use 1 year later as a function of ADHD status was also examined. METHOD: Two hundred and eighty-six adolescents ages 11-17 (ADHD: n = 165; non-ADHD: n = 121) reported their alcohol expectancies and alcohol use over a 1-year period as part of the Pittsburgh ADHD Longitudinal Study. RESULTS: Individuals with a history of ADHD had lower mean levels of alcohol expectancies compared with individuals without ADHD. Specifically, at Time 1, individuals with ADHD reported lower levels of sociability, cognitive and behavioral impairment, and liquid courage expectancies than individuals without ADHD. Further, the association between negative alcohol expectancies at Time 1 and alcohol use at Time 2 differed for individuals with and without a history of ADHD. CONCLUSIONS: These findings highlight the possibility that individuals with a history of ADHD may rely less on explicit cognitions, such as alcohol expectancies, when making decisions to drink alcohol. This is consistent with the dual process model of alcohol cognitions that has posited that individuals with decreased executive control may rely more on implicit cognitions about alcohol.

Impulsive choice, as measured in a delay discounting paradigm, remains stable after chronic heroin administration.

Heroin addicts display poorer impulse control than non-addicts, however it is not known if high impulsivity is a function of chronic heroin intake or a pre-disposing vulnerability for heroin addiction. Using animal models, relatively few studies have examined changes in impulsive choice as a function of chronic drug. The objective of this study was to measure alterations in impulsive choice through a delay discounting paradigm, as a function of chronic heroin administration. Animals were trained on a series of delay discounting sessions. Each session contained 5 blocks of trials. Blocks started with 2 forced, followed by 6 free choice trials. Pressing one lever resulted in the delivery of a small immediate (1 food pellet) reward and another lever in a large delayed (5 pellets) reward. Sessions consisted of the 3 ascending delay sequences in seconds. On the terminal sequence (0, 10, 20, 40, and 60s) animals exhibited a reversal of reward choice pattern of responding that allowed for the calculation of an indifference point (IP). After animals showed stable IPs they were treated with either heroin or saline for 12 days. Three days after the last injection animals were again placed in operant chambers and experienced the terminal delay discounting sequence at which time IPs were reassessed. Heroin-treated animals exhibited significant progressive increases in locomotor activity. Groups did not differ in IPs or performance across delay conditions during either before or after chronic treatment periods. These results indicate that chronic heroin intake does not impact later impulsive responding for natural (food) reward.

The impact of conduct disorder and stimulant medication on later substance use in an ethnically diverse sample of individuals with attention-deficit/hyperactivity disorder in childhood.

OBJECTIVE: To examine late adolescent substance use outcomes in relation to childhood conduct disorder (CD) and psychostimulant treatment in urban youth found to have attention-deficit/hyperactivity disorder (ADHD) in childhood. METHODS: Ninety-seven adolescents, evaluated during childhood, were seen for follow-up on average 9.30 (SD = 1.65) years later along with a well-matched never-ADHD control group. Stimulant treatment history was coded: Never (n = 28), up to 1 year (n = 19), 1 to 5 years (n = 28), and greater than 5 years (n = 22). Substance use at outcome was coded dimensionally for severity (frequency × intensity) and categorically for substance use disorders (SUDs). RESULTS: Individuals with ADHD+CD in childhood had significantly higher rates of SUD and substance use severity than those with childhood ADHD and controls. The ADHD and control groups did not differ significantly. Among those with childhood ADHD, there were no significant differences in SUD status or substance use severity as a function of medication history. CONCLUSIONS: Within an ethnically diverse urban sample, the increased rate of substance use associated with ADHD was fully accounted for by the presence of CD. These results extend previous findings indicating little impact of psychostimulant treatment on later substance use to an ethnically diverse urban sample and to individuals who received treatment for up to 12 years.

Childhood attention-deficit/hyperactivity disorder and the emergence of personality disorders in adolescence: a prospective follow-up study.

OBJECTIVES: Adults with attention-deficit/hyperactivity disorder (ADHD) experience considerable functional impairment. However, the extent to which comorbid Axis II personality disorders contribute to their difficulties and whether such comorbidities are associated with the childhood condition or the persistence of ADHD into adulthood remain unclear. METHOD: This study examined the presence of personality disorders in a longitudinal sample of 96 adolescents diagnosed with ADHD when they were 7 through 11 years old, as compared to a matched, never ADHD-diagnosed, control group (N = 85). Participants were between 16 and 26 years old at follow-up. On the basis of a psychiatric interview, the ADHD group was subdivided into those with and without persistent ADHD. Axis II symptoms were assessed by using the Structured Clinical Interview for DSM-IV Axis II Personality Disorders. Data were analyzed using logistic regression, and odds ratios (ORs) were generated. The study was conducted from 1994 through 1997. RESULTS: Individuals diagnosed with childhood ADHD are at increased risk for personality disorders in late adolescence, specifically borderline (OR = 13.16), antisocial (OR = 3.03), avoidant (OR = 9.77), and narcissistic (OR = 8.69) personality disorders. Those with persistent ADHD were at higher risk for antisocial (OR = 5.26) and paranoid (OR = 8.47) personality disorders but not the other personality disorders when compared to those in whom ADHD remitted. CONCLUSION: Results suggest that ADHD portends risk for adult personality disorders, but the risk is not uniform across disorders, nor is it uniformly related to child or adult diagnostic status.