Examining daily stimulant medication use and sleep in adolescents with ADHD.

Research has been inconclusive as to whether stimulant treatment causes or exacerbates sleep problems in adolescents with ADHD. This study examined sleep differences in adolescents with ADHD as a function of stimulant use. Participants were adolescents with ADHD (N = 159, ages 12-14). Parents reported on receipt of stimulant treatment (n = 92, 57.86%; n = 47 amphetamines, n = 45 methylphenidate). Adolescents wore actigraphs and completed daily diaries assessing sleep and daily use of stimulants for 2 weeks. Sleep parameters included daily-reported bedtime, sleep onset latency (SOL), sleep duration, daytime sleepiness, and difficulty waking the following morning; and actigraphy-measured sleep onset time, total time in bed, and sleep efficiency. We estimated between- and within-individual associations between stimulant medication use and sleep indices with all stimulants, after removing adolescents using sleep aids and weekend days, and as a function of stimulant type. Adolescent sleep did not differ between those receiving and not receiving stimulant treatment. Within individuals using stimulants, we largely observed no significant differences between medicated and unmedicated days, though findings were most often significant for school days only. Small effects were found indicating longer SOL, later sleep onset time, and more daytime sleepiness related to medication use. In contrast, there were slight improvements to sleep duration and sleep efficiency related to methylphenidate use, though methylphenidate was also associated with later sleep onset time and more daytime sleepiness. Given the inconsistent and small effects, findings suggest that stimulant medication may impact sleep, but does not appear to be a primary contributor to sleep problems in adolescents with ADHD.

Initial Results from a New College Substance Use Prevention Program Targeting Externalizing and Internalizing Traits.

Objective: College students engage in high rates of risky substance use. Standard college prevention strategies focus on providing feedback about current substance use behaviors and harm reduction strategies but do not address the underlying genetically-influenced risk factors impacting these behaviors. We created an online Personalized Feedback Program (PFP) for college students that targets genetically-influenced externalizing and internalizing risk pathways and provides personalized recommendations and campus resources. College students received personalized feedback on four risk domains (Sensation Seeking, Impulsivity, Extraversion, and Neuroticism). Methods: An open trial (n = 300) was conducted at a large public university in spring of 2021 to assess initial responses to the PFP and evaluate intentions related to future substance use and campus resource use. Results: 81% of students in the open trial reported they enjoyed the Personalized Feedback Program. Participants reported intending to use significantly more campus resources after completing the PFP. Among participants that drank, 39% reported they intended to decrease their alcohol consumption and 41% reported they intended to decrease the number of times they get drunk after completing the PFP; these intentions to reduce use after completing the PFP are higher than rates found in previous studies. Conclusion: Preliminary data indicate that the Personalized Feedback Program may be a complementary method to enhance current college substance use prevention programs.

Multi-method examination of cognitive disengagement syndrome and ADHD inattentive symptoms in relation to early adolescents' academic functioning.

Cognitive disengagement syndrome (CDS), previously referred to as sluggish cognitive tempo, is a set of symptoms characterized by excessive daydreaming, mental fogginess, and slowed behavior/thinking. Studies examining the association between CDS and academic functioning have reported mixed findings and have relied upon limited measures of CDS, broad ratings of academic impairment, and/or focused only on elementary-aged children. The current study examined the relationship between CDS and academic functioning in adolescents using a comprehensive, multi-informant, multi-method design. Participants were 302 adolescents (Mage = 13.17 years; 44.7% female; 81.8% White; 52% with ADHD) recruited in the fall of their 8th grade. Above and beyond ADHD inattentive symptoms, CDS symptoms were related to poorer homework performance, lower math fluency, and lower daily academic motivation across multiple informants, and teacher-reported CDS symptoms were related to lower grades. Findings were not moderated by ADHD diagnosis, suggesting that associations between CDS and academic outcomes do not differ for adolescents with and without ADHD. Findings demonstrate that CDS symptoms are uniquely associated with daily academic difficulties as well as global indices of academic performance. These findings have implications for assessing and monitoring CDS symptoms in interventions aiming to improve the academic functioning in adolescents with and without ADHD.

Predictors of executive function trajectories in adolescents with and without ADHD: Links with academic outcomes.

Changes in executive function (EF) occur during adolescence with several factors (e.g., parenting styles, socioeconomic status) influencing the development of EF abilities. These changes are important as EF has been strongly linked with a range of outcomes including academic achievement, job performance, and social-emotional well-being. However, few studies have examined variability in EF trajectories during this critical developmental period, or trajectories in samples known to have specific impairments with EF, such as adolescents diagnosed with attention-deficit/hyperactivity disorder (ADHD). The present study examined differential trajectories of three domains of parent-rated EF in 302 adolescents (167 males; Mage = 13.17 years) with and without ADHD (53.6% with ADHD) from grade 8 to 10. The study also explored whether adolescent ADHD, parent ADHD, and parents' own EF predicted EF trajectories in addition to the longitudinal relation between trajectories and academic outcomes. Findings suggest that adolescence is marked by significant variability in EF development due to factors such as ADHD status, parent ADHD, and parent EF ability. Additionally, adolescents who displayed poor EF abilities throughout middle and high school had significantly lower grade point averages and poorer parent-, teacher-, and self-reported academic outcomes. Implications for interventions targeting EF deficits among adolescents with and without ADHD are discussed.

Bridging the gap between genetic epidemiological research and prevention: A randomized control trial of a novel personalized feedback program for alcohol and cannabis use.

BACKGROUND: Risky substance use among college students is widespread and associated with numerous negative consequences. We created an online Personalized Feedback Program (PFP) for college students that targets genetically influenced risk pathways for substance use and provides feedback on four risk domains (Sensation Seeking, Impulsivity, Extraversion, and Neuroticism) along with individualized recommendations and campus resources. METHODS: A pilot randomized controlled trial was conducted to evaluate the effects of the PFP on alcohol and cannabis use. First-year college students were randomized to one of four groups: (1) control, (2) PFP, (3) computer-delivered brief motivational intervention (BMI), and (4) combined group that included both the PFP and BMI (PFP+BMI). Students completed a baseline survey (n=251) that assessed alcohol and cannabis use and program satisfaction. Two follow-up surveys were administered at 30-days and 3-months post-intervention to evaluate longitudinal effects on substance use. RESULTS: Participants reported high satisfaction with the PFP. There were no significant effects of intervention group on alcohol use at the follow-up timepoints, though trends were in the expected direction with participants in the PFP group showing decreased odds of alcohol use. There were significant reductions in cannabis use in the PFP group as compared to other groups. CONCLUSIONS: The PFP was met with high satisfaction and had a positive impact on reducing cannabis use. With cannabis use at a historic high among college-aged adults, further research evaluating the effects of the PFP is warranted.

Clinical Change Mechanisms in the Treatment of College Students With ADHD: Trajectories and Associations With Outcomes.

The purpose of this study was to evaluate trajectories of response for the three theorized mechanisms of clinical change (knowledge, behavioral strategies, and adaptive thinking) associated with the Accessing Campus Connections and Empowering Student Success (ACCESS) intervention for college students with attention-deficit/hyperactivity disorder (ADHD) and their association with treatment outcomes. Participants included 250 college students comprehensively diagnosed with ADHD randomly assigned to ACCESS or to a delayed-treatment control who completed ratings at baseline, end of active treatment, and end of the maintenance phase of treatment (after two semesters). Growth mixture models (GMMs) were used to evaluate trajectories. Participants in ACCESS made significant gains in the use of behavioral strategies and trajectories were associated with large effect size improvements in measures of symptoms and functioning. Participants also made improvements in ADHD knowledge. However, only the knowledge trajectory with rapid improvement displayed significantly better outcomes. Only one trajectory group showed improvement in adaptive thinking with most ACCESS participants remaining stable across time. However, adaptive thinking trajectories were strongly related to both symptom and functional outcomes. ACCESS is associated with large gains in two of the three theorized clinical mechanisms of change, behavioral strategies and ADHD knowledge. Rapid improvement in behavioral strategies was associated with robust improvement in symptoms and functioning. Although improvements in the third mechanism, adaptive thinking, were small, they were strongly associated with outcomes demonstrating the importance of a cognitive-behavioral approach in treating college students with ADHD.

Impairment's Role in the Pathway From Externalizing Psychopathology to Depressive Symptoms in Adolescents With ADHD.

OBJECTIVE: This study examined the role of academic, social, and family impairment in the pathway from externalizing psychopathology to depression among young adolescents with ADHD in a multiple mediation model. METHOD: The sample included adolescents with ADHD enrolled in an intervention trial. Parent ratings of externalizing psychopathology were measured at eligibility assessment, adolescent self-reported depressive symptoms were measured at eligibility and at the end of treatment, and parent-rated impairment was measured in the middle of treatment. A multiple mediation model was used to examine mediating effects of impairment types in the pathway from externalizing psychopathology to depression. RESULTS: Parent-reported family impairment significantly mediated the association between externalizing psychopathology and depressive symptoms. CONCLUSIONS: Results suggest family impairment mediates the association between externalizing psychopathology and depressive symptoms beyond academic and social impairment for youth with ADHD. Findings implicate the importance of targeting family functioning during early adolescence to prevent depression.

Physical and Extracurricular Activity in Adolescents With and Without ADHD: Examining Group Differences and the Role of Cognitive Disengagement Syndrome Symptoms.

OBJECTIVE: This study examined extracurricular and physical activity related to ADHD (diagnosis and symptoms) and cognitive disengagement syndrome (CDS) symptoms. METHODS: Participants were 302 adolescents (ages 12-14) with and without ADHD and primary caregivers. ADHD diagnosis was determined with parent interview. Questionnaires provided information on parent-reported demographic characteristics, ADHD symptoms, and extracurricular activity involvement; and adolescent-reported ADHD and CDS symptoms and indices of physical activity. RESULTS: Although ADHD diagnosis and symptom dimensions were correlated with less extracurricular and physical activity involvement, CDS symptoms were most often independently associated with these outcomes. Females and adolescents from lower income homes also often had less involvement in extracurricular and physical activity. CONCLUSIONS: Findings point to the need for more research in this area, careful assessment of risk factors (i.e., CDS symptoms, economic burden), and interventions that address inactivity in adolescents with ADHD, including those that address inequity related to income and sex.

Prospective association between evening circadian preference and academic functioning in adolescents: the role of daytime sleepiness.

BACKGROUND: There is growing evidence for the role of circadian factors in adolescents' sleep and academic adjustment, with greater evening preference being linked to poorer academic functioning. However, studies have yet to evaluate this association prospectively in adolescence, nor have studies examined daytime sleepiness as a putative mechanism linking evening preference to poor academic functioning. The current study used a multi-informant design to test the prospective association of evening circadian preference, daytime sleepiness, and academic functioning (e.g., global academic impairment and grades) across 2 years in adolescence. As evening circadian preference, sleepiness, and academic problems are elevated in adolescents with ADHD, we used a sample enriched for adolescents with ADHD and explored whether ADHD moderated effects. METHOD: Participants were 302 adolescents (Mage = 13.17 years; 44.7% female; 81.8% White; 52% with ADHD). In the fall of eighth grade, adolescents reported on their circadian preference, and in the fall of ninth grade, adolescents and parents completed ratings of daytime sleepiness. In the middle of 10th grade, parents and teachers reported on adolescents' academic impairment and at the end of 10th grade, adolescents' grade point average (GPA) was obtained from school records. RESULTS: Above and beyond covariates (e.g., adolescent sex, ADHD status, medication, sleep duration) and baseline academic impairment, greater self-reported evening preference in 8th grade predicted increased parent ratings of academic impairment in 10th grade indirectly via adolescent and parent ratings of daytime sleepiness in 9th grade. Furthermore, evening preference in 8th grade predicted greater teacher ratings of academic impairment and lower average GPA in 10th grade via parent ratings of daytime sleepiness in 9th grade, controlling for covariates and baseline GPA. ADHD status did not moderate indirect effects. CONCLUSION: Findings underscore daytime sleepiness as a possible intervening mechanism linking evening preference to poor academic functioning across adolescence. Intervention studies are needed to evaluate whether targeting circadian preference and sleepiness improves academic functioning in adolescents.

Prospective examination of psychological trauma among adolescents during the COVID-19 pandemic.

OBJECTIVE: This longitudinal study investigated the predictors of and changes in psychological trauma during the COVID-19 pandemic. METHOD: Participants included 236 adolescents (130 males; Mage = 16.74 years in spring 2020; 49.6% diagnosed with attention-deficit hyperactivity disorder; 16.1% diagnosed with an anxiety or depressive disorder) in the United States who completed online questionnaires at four timepoints (spring 2020, summer 2020, fall 2020, spring 2021). RESULTS: Repeated measures ANOVA showed that psychological trauma was highest during stay-at-home orders in spring 2020, and decreased for a majority of adolescents by the summer of 2020. However, ~20% of adolescents exhibited moderate-to-clinical levels of psychological trauma at each timepoint. Four groups were identified based on the presence of psychological trauma symptoms: (a) resilient group (normal range across all timepoints; 60.6%); (b) moderate fluctuating group (moderate range at 1 or more timepoints; 18.2%); (c) severe fluctuating group (clinical range at 1 or more timepoints; 14.0%); and (d) chronic psychological trauma group (moderate or clinical range across all timepoints; 7.2%). Females, adolescents with preexisting internalizing disorders, and participants whose families were most impacted by the pandemic were more susceptible to experiencing psychological trauma symptoms. CONCLUSIONS: Findings highlight at-risk populations and suggest that the COVID-19 pandemic resulted in psychological trauma symptoms for approximately 20% of adolescents at some point during the first year of the pandemic. There is critical need to provide mental health services to adolescents, such as through school-based services, to reduce the negative long-term psychological impact of the pandemic. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Longitudinal Change in Adolescent Depression and Anxiety Symptoms from before to during the COVID-19 Pandemic.

This study aimed to examine changes in depression and anxiety symptoms from before to during the first 6 months of the COVID-19 pandemic in a sample of 1,339 adolescents (9-18 years old, 59% female) from three countries. We also examined if age, race/ethnicity, disease burden, or strictness of government restrictions moderated change in symptoms. Data from 12 longitudinal studies (10 U.S., 1 Netherlands, 1 Peru) were combined. Linear mixed effect models showed that depression, but not anxiety, symptoms increased significantly (median increase = 28%). The most negative mental health impacts were reported by multiracial adolescents and those under 'lockdown' restrictions. Policy makers need to consider these impacts by investing in ways to support adolescents' mental health during the pandemic.

Cost-Effectiveness of a Training Intervention for Adolescents with ADHD.

OBJECTIVE: The aim of this study was to examine the costs and cost-effectiveness of a school-based training intervention delivered at varying levels of intensity with adolescents with attention-deficit/hyperactivity disorder (ADHD). Costs were examined in relation to post-treatment and 6-month follow-up effects of the Challenging Horizons Program (CHP), a training intervention for adolescents with ADHD. METHOD: A total of 326 middle-school students (71% male; 77% White) with ADHD were randomized to an after-school version of the CHP (CHP-AS), a less-intensive mentoring version (CHP-M), or routine community care. Detailed time logs were maintained throughout the study and were used to estimate costs associated with each condition. Student grade point average (GPA) and parent-rated ADHD symptoms and organization skills were collected at post-treatment and 6-month follow-up. RESULTS: The cost analysis revealed that CHP-AS was more costly per student than CHP-M, both in terms of overall costs and direct expenses to the school. However, CHP-AS was less costly per hour of intervention provided to the youth than CHP-M. Incremental cost-effectiveness ratios revealed that CHP-M may be the more cost-effective option for post-treatment effects, yet CHP-AS may be the more cost-effective option in the long term for sustained gains in organization skills and GPA. CONCLUSIONS: This study provides stakeholders important information to make decisions regarding allocation of finite monetary resources to meet their prioritized goals.

Rumination as a Mechanism of the Longitudinal Association Between COVID-19-Related Stress and Internalizing Symptoms in Adolescents.

The current prospective longitudinal study evaluated brooding rumination as an intervening mechanism of the association between COVID-19-related stress and internalizing symptoms during the first year of the pandemic. Attention-deficit/hyperactivity disorder (ADHD) status and adolescent sex were tested as moderators of the indirect effect. Adolescents with and without ADHD (N = 238; M age = 16.74) completed rating scales of COVID-19 stress and both adolescents and parents completed ratings scales of internalizing symptoms in May/June 2020 (T1). In October/November 2020 (T2), adolescents reported on their brooding rumination. Adolescents and parents reported on internalizing symptoms again in March/April 2021 (T3). Covariates included participant characteristics and baseline symptoms. T1 self-reported COVID-19-related stress was associated with increased T3 self-reported anxiety (ab = 0.10), self-reported depression (ab = 0.07), and parent-reported depression (ab = 0.09) via T2 brooding rumination. The indirect effect did not differ for adolescents with and without ADHD or for female and male adolescents. Brooding rumination may be one mechanism to target to promote the mental health adjustment of adolescents during periods of high stress of the COVID-19 pandemic and future stressors.

Adolescents with ADHD are at increased risk for COVID-19 vaccine hesitancy.

Identifying factors that influence adolescent intentions for COVID-19 vaccination is essential for developing strategic interventions to increase uptake, particularly in subgroups of at-risk adolescents. Attention-deficit/hyperactivity disorder (ADHD) in adolescence is characterized by difficulties regulating attention and behavior, social impairment, and impulsive risk-taking behaviors, which may impact vaccine hesitancy and vaccine uptake. This study examined hesitancy toward COVID-19 vaccines among adolescents with and without ADHD, and explored how ADHD status interacted with malleable social mechanisms and other social determinants of health in predicting vaccine hesitancy. Participants were 196 U.S. adolescents (44.4% male), 45.6% diagnosed with ADHD. Adolescents reported their confidence and willingness toward COVID-19 vaccines from March to May 2021. Adolescents with ADHD reported greater hesitancy and less confidence in COVID-19 vaccine safety compared to adolescents without ADHD (p < .01). Only 61.8% of adolescents with ADHD reported vaccine acceptance, compared to 81.3% of adolescents without ADHD. For all adolescents, those who identified as Black or Latinx and with lower family income had greater hesitancy and reduced confidence, whereas greater COVID-19 concerns, media use, and perceived negative impact on relationships was associated with greater vaccination willingness. Social contextual processes significantly interacted with ADHD status such that for adolescents without ADHD, concerns about COVID-19 were associated with increased confidence in vaccine safety. Being noncompliant with social distancing guidelines was associated with greater vaccine hesitancy, only for adolescents with ADHD. A concerted effort is needed to increase trust, confidence, and social relevance among adolescents, especially those with ADHD and from lower socio-economic backgrounds.

Longitudinal Association of Sluggish Cognitive Tempo with Depression in Adolescents and the Possible Role of Peer Victimization.

It is unknown whether sluggish cognitive tempo (SCT) is prospectively associated with depression in adolescence, and possible processes linking SCT to depression remain unexamined. Using a longitudinal study with three timepoints over a two-year period, the current study tested the indirect effects of SCT on depression via peer victimization, specifically physical, relational, and verbal victimization. Participants were 302 adolescents (Mage = 13.17 years; 44.7% female participants; 81.8% White; 52% with ADHD). In the fall of 8th grade, adolescents and parents completed measures of adolescents' SCT and ADHD symptoms. Adolescents completed a measure of peer victimization in spring of 8th grade and a measure of depressive symptoms in 10th grade. Models examining indirect effects were conducted with and without control of baseline ADHD and/or depressive symptoms. Across analyses, adolescent and parent ratings of SCT symptoms uniquely predicted greater depressive symptoms two years later when controlling for adolescent sex, study site, and either 8th grade depressive or ADHD symptoms. Further, adolescents' self-reported 8th grade SCT symptoms predicted 10th grade depressive symptoms via verbal victimization when controlling for 8th grade ADHD symptoms, but not in analyses incorporating 8th grade depressive symptoms. Findings underscore the predictive association of SCT on depressive symptoms, the possible role of adverse peer relationships as a mechanism linking SCT to depression, and the importance of considering ADHD and depressive symptoms in research on longitudinal correlates of SCT.

A preliminary examination of key strategies, challenges, and benefits of remote learning expressed by parents during the COVID-19 pandemic.

Among the many impacts of the Coronavirus disease (COVID-19) pandemic, one of the most dramatic was the immediate closure of in-person schooling in March/April 2020 when parents were faced with much greater responsibility in supporting their children's learning. Despite this, few studies have examined parents' own perspectives of this experience. The aims of this preliminary study were to (a) identify challenges, benefits, and useful strategies related to remote learning and (b) examine differences in findings across two countries, between parents of youth with and without attention-deficit/hyperactivity disorder (ADHD), and between parents of children and adolescents. To address these aims, parent responses to open-ended questions on the Home Adjustment to COVID-19 Scale (HACS; Becker, Breaux, et al., 2020) were examined across three studies conducted in the United States and Australia (N = 606, children: 68.5% male, ages 6-17 years). The challenges most frequently expressed by parents included the child's difficulty staying on task (23.8% of parents), lack of motivation (18.3%), remote learning factors (17.8%), and lack of social interaction (14.4%). The most frequently expressed strategy related to using routines and schedules (58.2%) and the biggest benefit was more family time (20.3%). Findings were largely consistent across countries, ADHD status, and age, with a few notable group differences. Given that the most common challenges involved child- (e.g., difficulties with staying on task and motivation), parent- (e.g., balancing remote learning with work responsibilities), and school- (e.g., remote instruction difficulties) related factors, there is a need for improved support across these systems going forward. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Dispositional mindfulness moderates the relation between brooding rumination and sleep problems in adolescents.

OBJECTIVES/BACKGROUND: This study examined whether dispositional mindfulness moderates the association between brooding rumination and sleep problems in adolescents with and without attention-deficit/hyperactivity disorder (ADHD). PARTICIPANTS/METHODS: Participants were 137 adolescents (ages 13-15 years; 64% male). Approximately half (47.4%; n = 65) were diagnosed with ADHD. Adolescents provided ratings of their dispositional mindfulness and brooding rumination. Both adolescents and parents provided ratings of adolescents' sleep problems. RESULTS: In analyses controlling for sex, race, study site, and group (ADHD vs. comparison), brooding rumination was associated with more adolescent- and parent-reported sleep problems only at low levels of dispositional mindfulness. This effect did not differ for adolescents with or without ADHD and was also unchanged when controlling for internalizing psychopathology symptoms. CONCLUSIONS: Our findings showed that dispositional mindfulness might buffer against the negative impact of brooding rumination on adolescent sleep. These findings may have important clinical implications and underscore the potential benefit of including mindfulness and other cognitive-behavioral approaches when treating sleep problems in adolescents.

A multi-method examination of sluggish cognitive tempo in relation to adolescent sleep, daytime sleepiness, and circadian preference.

BACKGROUND: The field's understanding of the association between sluggish cognitive tempo (SCT) and sleep is severely limited by the lack of multi-method and multi-informant research designs that move beyond global ratings, often focused on a limited number of sleep-related domains, such as daytime sleepiness. The current study begins to address these limitations by using actigraphy, daily sleep diary, and self- and parent-report global ratings of sleep in adolescents, a developmental period marked by changes in SCT, sleep, and circadian function. As SCT and sleep are also associated with ADHD symptoms, we tested these associations in a sample of adolescents with and without ADHD. METHODS: Adolescents (N = 302; M age = 13.17 years, 44.7% female) with (n = 162) and without ADHD (n = 140) and parents completed global ratings of sleep and daytime sleepiness, and adolescents completed a measure of circadian preference. Adolescents also wore actigraphs for approximately two weeks, during which daily diaries were completed. RESULTS: Above and beyond demographic characteristics (i.e., sex, race, and family income), pubertal development, medication use, and ADHD group status, adolescents' self-reported SCT symptoms were uniquely associated with shorter sleep duration and later sleep onset per both actigraphy and daily diary. SCT symptoms were also uniquely associated with longer sleep onset latency and poorer overall sleep (per daily diary), more sleep/wake problems and daytime sleepiness (per adolescent rating), more difficulties initiating and maintaining sleep (per parent rating), and later eveningness preference (per adolescent rating). Nearly all significant effects remained in sensitivity analyses controlling for adolescent- or parent-reported ADHD symptom dimensions. CONCLUSIONS: Findings provide the strongest evidence to date for SCT being uniquely linked to poorer sleep, greater daytime sleepiness, and a later evening circadian preference across subjective and objective measures. Longitudinal studies are needed to evaluate predictive and bidirectional associations.