The Association Between the Impact of COVID-19 and Internalizing Problems Among Children and Adolescents with ADHD: The Moderating Role of Parental Anxiety.

Previous research has identified an increase in internalizing problems during the COVID-19 pandemic in children and adolescents with attention-deficit/hyperactivity disorder (ADHD). Additionally, it has been observed that parents of children with ADHD had elevated levels of anxiety during the pandemic. The current study aimed to longitudinally assess whether the impact of COVID-19 was associated with internalizing problems in children and adolescents with ADHD during the middle (Time 1-Spring 2021 [T1]) and end (Time 2-Fall/Winter 2022 [T2]) of the pandemic, and whether parental anxiety moderated this relationship over time. Canadian parents of youth with ADHD (aged 3-18 years old) completed online questionnaires assessing their child's depression and anxiety symptoms, their own anxiety symptoms, and the pandemic's impact on their child, both at T1 (N = 278) and T2 (N = 89). The results indicated that the impact of COVID-19 on children at T1 was a unique predictor of child internalizing problems at T1 but not at T2. While parental anxiety did not moderate this association cross-sectionally, it was a significant moderator longitudinally. More specifically, low parental anxiety at T1 positively moderated the association between the COVID-19 impact on children at T1 and child internalizing problems at T2. The results highlight the importance of providing on-going psychological support for children and adolescents with ADHD and emphasize the need to aid parents in effectively supporting their children during the process of pandemic recovery.

A cohort study examining the association between children's symptoms of inattention and hyperactivity, internalizing symptoms, and mindful parenting during the COVID-19 pandemic.

Objectives: Increased mental health difficulties have been reported in Canadian children as a result of the COVID-19 pandemic, and emerging research suggests that children with high levels of symptoms of inattention and hyperactivity have been disproportionately impacted. Accordingly, the pandemic has impacted families as well. The purpose of this study was the following: (1) to examine whether children's symptoms of inattention and hyperactivity at the beginning of the 2020 and 2021 academic year were associated with mindful parenting at the end of the academic year and (2) to examine whether children's depressive and anxiety symptoms at the end of the year moderated this relationship. Methods: Parents of 114 young children in a large Canadian city participated in this study in the Winter of 2020 and the Spring of 2021. Parents completed several self-report scales used to measure children's mental health symptomatology and mindfulness in parenting. Results: Children's symptoms of inattention and hyperactivity were significantly, negatively associated with mindful parenting across the pandemic year, and children's depressive symptoms moderated this relationship. Specifically, when children's depressive symptoms were low or average it was found that higher symptoms of inattention and hyperactivity were associated with lower levels of mindful parenting. However, when children's depressive symptoms were high their symptoms of inattention and hyperactivity were not predictive of mindful parenting. Conclusions: Children's mental health, namely symptoms of inattention/hyperactivity and depression, are related to challenges in mindful parenting during COVID-19. These results may inform practitioners about which families require additional support during the pandemic.

ADHD Symptoms Increased During the Covid-19 Pandemic: A Meta-Analysis.

OBJECTIVE: Emerging research suggests that the Covid-19 pandemic has disproportionately and adversely affected children with Attention-Deficit/Hyperactivity Disorder (ADHD). The purpose of this meta-analysis is to consolidate the findings from studies that examined changes in ADHD symptoms from before to during the pandemic. METHOD: Database searches of PsycINFO, ERIC, PubMed, and ProQuest were used to identify relevant studies, theses, and dissertations. RESULTS: A total of 18 studies met specific inclusion criteria and were coded based on various study characteristics. Twelve studies examined ADHD symptoms longitudinally and six studies assessed ADHD symptoms retroactively and during the pandemic. Data from 6,491 participants from 10 countries were included. Results indicated that many children and/or their caregivers reported an increase in child ADHD symptoms during the Covid-19 pandemic. CONCLUSIONS: This review points to a global increase in ADHD symptoms and has implications for the prevalence and management of ADHD during the post-pandemic recovery.

The student-teacher relationship and ADHD symptomatology: A meta-analysis.

Children with attention-deficit/hyperactivity disorder (ADHD) typically experience significant academic and social impairments, including problem behaviors in the classroom. Existing research suggests students who present with ADHD symptoms are more likely to have relationships with their teachers that are low in closeness and high in conflict. However, research about the quality of relationships between teachers and students with ADHD symptoms remains quantitatively un-synthesized. The present meta-analysis quantitatively describes the overall quality of student-teacher relationships for children who present with ADHD symptoms according to the relational dimensions of closeness and conflict. Database searches of PsycInfo, ERIC, and ProQuest (theses and dissertations) were conducted to collect a sample of 27 quantitative studies for statistical analyses. A total of 47 effect sizes (N = 17,236) were included in the analyses. Results confirm the trends seen in the literature. Children with symptoms of ADHD tended to have relationships with their teachers that were low in closeness (r = -0.170) and high in conflict (r = 0.414). Additionally, eight moderator analyses were conducted (i.e., grade level, informant types, informant consistency, sample type, reported comorbidity, gender, and ADHD presentation) to assess their effect on the link between ADHD symptoms and student-teacher relationship quality. The results of this meta-analysis provide insight into the quality of relationships that students who exhibit ADHD symptoms form with their teachers also may inform intervention programs that aim to best support students.

The Impact of Internalizing Symptoms on Impairment for Children With ADHD: A Strength-Based Perspective.

BACKGROUND/PURPOSE: This study aims to investigate the influence of internalizing symptoms on functional impairment for children with ADHD, and whether child strengths and parenting strengths have moderating effects on this relationship. METHODS: Participants included 209 children with ADHD and their caregivers seeking mental health services between the ages of 5 and 11 years. To examine the moderating effects of parenting and child strengths, ordinary least squares regression models were tested using the PROCESS macro for SPSS (v3.5). RESULTS: Results suggest that levels of internalizing symptoms influence functional impairment in children with ADHD. Child strengths moderate the relationship between internalizing symptoms and functional impairment when internalizing symptoms are medium to high. CONCLUSION: Findings from this study demonstrate that facilitating child strengths can help moderate functional impairment for children who experience ADHD and internalizing symptoms.

The effectiveness and acceptability of formal versus informal mindfulness among university students with and without recent nonsuicidal self-injury: Protocol for an online, parallel-group, randomized controlled trial.

BACKGROUND: Mindfulness-based programming comprising both formal (FM) and informal (IM) mindfulness practice is increasingly offered to university students. However, difficulties with emotion regulation, self-criticism, and a potentially complex relationship with their body may undermine the benefits of FM for students with a history of nonsuicidal self-injury (NSSI), given its requirement of sustained attention on thoughts, emotions, and bodily sensations. IM may be better tolerated by these students. This protocol describes a randomized controlled trial comparing a brief FM practice, a brief IM practice, and an active control task in university students with and without recent NSSI. METHODS: Recruitment began in November 2022. An online, parallel-group, single-blind, randomized controlled trial will compare a 10-min, single-session FM practice, a 10-min, single session IM practice, and a 10-min, single session active control task in university students with and without recent NSSI. Outcomes will be assessed immediately pre-intervention and within five minutes post-intervention. The primary outcome will be state mindfulness. Secondary outcomes will be state stress, state well-being, and acceptability. Students with a history of NSSI are expected to report (i) greater improvements in state mindfulness, stress, and well-being, and (ii) greater acceptability in the IM condition, relative to the FM and control conditions. This distinction is not expected to occur in the no-NSSI comparison group. CONCLUSION: This trial is the first to parse out the impacts of FM versus IM practice among university students with and without a history of self-injury. Findings will be relevant to academic and clinical audiences within university settings.

Event Perception and Social Skills in Undergraduates with ADHD Symptoms.

BACKGROUND: Event perception provides a promising, novel approach for investigating underlying cognitive mechanisms of the social impairment associated with symptoms of ADHD. AIMS: The goal of this study was to establish the relationship among event perception, symptoms of ADHD, and social skills. METHODOLOGY: Eighty-three undergraduates were recruited from the University of Ottawa first year psychology courses (38 with ADHD, 45 without ADHD). They performed an event perception task and completed self-report questionnaires assessing social functioning and symptoms of ADHD (The Social Skills-Improvement System and the Conner's CBRS-SR). RESULTS: Bootstrapping mediation analyses revealed that symptoms of inattention and hyperactivity mediated the relationship between event perception and social skills. A model with predictor and mediator reversed was also tested, and was not significant, providing strength to the directionality of the relationships. Results highlight the applicability of event perception to understanding the association between social impairment and symptoms of ADHD.

Examining daily parent involvement in caregivers of children with ADHD using electronic diaries.

Limited research has examined the associations between child ADHD symptoms and parent involvement and has generally relied on the use of parents' retrospective reports of parent involvement and ADHD symptoms. Using daily reports, the current study explored the pathways between child ADHD symptoms and home-based parental involvement beliefs and behaviors. Data were collected daily from 26 parent participants over a 2-week period for a total of 315 time points. Daily surveys asked parents to report on child ADHD symptoms, parental self-efficacy, parental time/energy, and home-based involvement quality. Results indicated that parental self-efficacy mediated the association between children's inattentive symptoms and parental home-based involvement quality. Children's hyperactive/impulsive symptoms moderated the association between parental time/energy and parental home-based involvement quality. These results suggest that parental self-efficacy is an important factor in explaining how children's inattention is associated with parental quality of home-based involvement. In addition, the association between parental time/energy and home-based involvement quality was lower when parents perceived their child to have higher levels of symptoms.

Event Segmentation Deficits in ADHD.

Event segmentation is the automatic cognitive process of chunking ongoing information into meaningful events. Event segmentation theory (EST) proposes that event segmentation is a grouping process fundamental to normal, everyday perceptual processing, taking a central role in attention and action control. The neurocognitive deficits observed among individuals with ADHD overlap those involved in event segmentation, but to date no research has examined event segmentation in the context of ADHD. Objective: The goal of this study was to document the event segmentation deficits of individuals with ADHD. Method: Seventy-five undergraduates with ADHD and seventy-nine without ADHD performed an event segmentation task. Results: Results revealed that undergraduates with ADHD identify significantly more large events. Conclusion: These findingssuggest explicit disturbances in the event model and updating system among those with ADHD. Future research directions include further elucidating these deficits with more varied stimuli and establishing associations with functional impairments.

Parents' and teachers' ratings of family engagement: Congruence and prediction of outcomes.

This study examined parent-teacher agreement regarding three forms of family engagement in kindergarten: home-school communication, school-based involvement, and parent-teacher trust, as well as whether parent-teacher agreement predicted children's behavioral and academic outcomes. Parent and teacher ratings of parent engagement and child internalizing and externalizing behavior were obtained for a sample of kindergarten students (N = 122). Academic outcomes were directly assessed. Parents and teachers showed high levels of agreement in their perceptions of home-school communication, school-based involvement, and parent-teacher trust. Parents' educational background moderated the level of agreement for school-based involvement between parents and teachers. Parents and teachers reported higher levels of involvement for parents with higher educational levels; however, the differences in involvement levels were greater between parents from higher and lower educational backgrounds when using teacher ratings versus parent ratings. Positive associations between parents' and teachers' ratings of all engagement types were small to moderate. Higher levels of parent-teacher trust predicted lower levels of parent and teacher-reported externalizing behavior. Discrepancies in parents' and teachers' ratings of school-based involvement predicted lower internalizing symptoms for children. Findings replicated research suggesting positive associations between parental engagement and children's behavioral/academic functioning, while also expanding the limited understanding of how parent-teacher agreement regarding family engagement predict outcomes. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The Effectiveness of Daily Behavior Report Cards for Children With ADHD: A Meta-Analysis.

Objective: This meta-analysis examined group-design studies investigating the effectiveness of Daily Behavior Report Cards (DBRC) as a school-based intervention to manage the classroom behavior of students with ADHD. Methods: A search of three article databases (PsycINFO, ERIC and Medline) identified seven group design evaluations of DBRC interventions. This meta-analysis included a total of 272 participants, with an average age of 7.9 years old. Three of the studies compared a control group to a treatment group with randomized group assignment, one study compared a control group to three treatment groups, two studies compared pre-and post-treatment scores in the same group, and one study compared pre-and post-treatment results of two intervention groups without random assignment. Dependent measures for these studies were teacher ratings (n = 5) and systematic direct observation of student academic and social behaviour (n = 2). Standardized mean differences (Hedge's g) were calculated to obtain a pooled effect size using fixed effects. Results: DBRCs were associated with reductions teacher-rated ADHD symptoms, with a Hedge's g of 0.36 (95% CI: 0.12-0.60, z=2.93, p ≤ .005) with low heterogeneity (Q-value: 2.40, I2 = 0.00). This result excluded two studies that used observational coding instead of standardized tests to evaluate the effects of the intervention. A moderator analysis indicated that the effect size for systematic direct observation was large (Hedge's G = 1.05[95% CI: 0.66-1.44, z=5.25, p ≤ .00]), with very high heterogeneity (Q-value: 46.34, I2: 93.53). A second moderator analysis found differences in the effects of DBRCs for comorbid externalizing symptoms with an overall effect size of 0.34 (95%CI: -0.04-0.72, z=1.76 p =0.08) with high heterogeneity (Q-value: 3.98, I2: 74.85). Conclusions: DBRCs effectively reduce the frequency and severity of ADHD symptoms in classroom settings. Additionally, they have a significant effect on co-occuring externalizing behaviors. It appears that systematic direct observation may be a more sensitive measure of treatment effects compared to teacher ratings of ADHD symptoms.

Parents' role in early adolescent self-injury: An application of self-determination theory.

OBJECTIVE: We applied self-determination theory to examine a model whereby perceived parental autonomy support directly and indirectly affects nonsuicidal self-injury (NSSI) through difficulties in emotion regulation. METHOD: 639 participants (53% female) with a mean age of 13.38 years (SD = 0.51) completed the How I Deal with Stress Questionnaire as a screener for NSSI, the Perceptions of Parents Scale, and the Difficulties in emotion Regulation Scale. Participants who indicated having ever hurt themselves on purpose without the intent to die (n = 116, 66% female) were classified in the NSSI lifetime group. RESULTS: A mediation analysis with bootstrapping procedure revealed that adolescents who reported their parents as being less supportive of their need for autonomy were more likely to have engaged in NSSI. Further, this relationship was partially mediated by emotion regulation. CONCLUSION: Adolescents who do not perceive autonomy support from their parents, have more difficulties regulating their emotions, and may turn to NSSI as a means to cope. Clinical implications of the findings suggest involving the family, and specifically, targeting parental autonomy support may be beneficial when working with young adolescents who self-injure. (PsycINFO Database Record

A decade of viral mutations and associated drug resistance in a population of HIV-1+ Puerto Ricans: 2002-2011.

Puerto Rico has one of the highest rates of HIV/AIDS seen for any US state or territory, and antiretroviral therapy has been a mainstay of efforts to mitigate the HIV/AIDS public health burden on the island. We studied the evolutionary dynamics of HIV-1 mutation and antiretroviral drug resistance in Puerto Rico by monitoring the population frequency of resistance-associated mutations from 2002 to 2011. Whole blood samples from 4,475 patients were analyzed using the TRUGENE HIV-1 Genotyping Kit and OpenGene DNA Sequencing System in the Immunoretrovirus Research Laboratory at Universidad Central del Caribe. Results show that 64.0% of female and 62.9% of male patients had HIV-1 mutations that confer resistance to at least one antiretroviral medication. L63P and M184V were the dominant mutations observed for the protease (PRO) and reverse transcriptase (RT) encoding genes, respectively. Specific resistance mutations, along with their associated drug resistance profiles, can be seen to form temporal clusters that reveal a steadily changing landscape of resistance trends over time. Both women and men showed resistance mutations for an average of 4.8 drugs over the 10-year period, further underscoring the strong selective pressure exerted by antiretrovirals along with the rapid adaptive response of HIV. Nevertheless, both female and male patients showed a precipitous decrease for overall drug resistance, and for PRO mutations in particular, over the entire course of the study, with the most rapid decrease in frequency seen after 2006. The reduced HIV-1 mutation and drug resistance trends that we observed are consistent with previous reports from multi-year studies conducted around the world. Reduced resistance can be attributed to the use of more efficacious antiretroviral drug therapy, including the introduction of multi-drug combination therapies, which limited the ability of the virus to mount rapid adaptive responses to antiretroviral selection pressure.

Understanding the relationship between inattention and early literacy trajectories in kindergarten.

The purpose of this study was to examine the relationship between inattention, academic enabling behaviors (i.e., motivation, engagement, and interpersonal skills), and early literacy outcomes. Kindergarten students (N = 181; 55.2% male; 62% white) from two research sites (Southeastern U.S. and Eastern Canada) were assessed using the Letter Naming and Letter Sound Fluency AIMSweb Tests of Early Literacy (Shinn & Shinn, 2012) at three points across the school year. Their teachers provided information on the level of attention-deficit/hyperactivity disorder symptoms (ADHD Symptom Checklist-4; Gadow & Sprafkin, 2008) and academic enabling behaviors (Academic Competence Evaluation Scales; DiPerna & Elliott, 2000). Structural equation modeling (SEM) was used to determine predictors of initial level and growth in early literacy. Specifically, a series of models were tested to determine if a multidimensional model of academic enablers (AEs) mediated the relationship. Engagement predicted students' initial levels of early literacy, suggesting that this is an important mediator to consider between inattention and early literacy skills. Motivation related positively to engagement. Inattention also predicted both motivation and interpersonal skills in the negative direction. These findings suggest that AEs play an important role in the relationship between inattention and early literacy. AEs provide malleable targets for intervention and should be considered when developing intervention for youth at risk for academic failure. (PsycINFO Database Record

Friendship Characteristics of Children With ADHD.

OBJECTIVE: This study explored the friendship characteristics of 8 to 12 year old children with and without Attention-Deficit/Hyperactivity Disorder (ADHD). Friendship characteristics included number of nominated and corroborated friends, duration of friendships, amount of contact with friends, and the proportion of friends with learning and behavioral problems. METHOD: The sample comprised 92 children, 50 with a diagnosis of ADHD and 42 comparison children. RESULT: While children with ADHD did not differ from comparison children in the number of friends they nominated, parents and teachers of children with ADHD were less likely to corroborate that these friendships existed. The friendships of children with ADHD were also shorter in duration. While children with ADHD were indistinguishable from comparison children with regards to the amount of telephone contact with friends, they spent less time with friends outside of school than comparison children. Children with ADHD had a higher proportion of friends with learning and behavior problems. CONCLUSION: While children with ADHD differ from comparison children in the above friendship characteristics, it is promising that they still fall within the average range for the number of corroborated friendships and they demonstrate adequate stability in their friendships.

Longitudinal relations among inattention, working memory, and academic achievement: testing mediation and the moderating role of gender.

Introduction. Behavioral inattention, working memory (WM), and academic achievement share significant variance, but the direction of relationships across development is unknown. The aim of the present study was to determine whether WM mediates the pathway between inattentive behaviour and subsequent academic outcomes. Methods. 204 students from grades 1-4 (49.5% female) were recruited from elementary schools. Participants received assessments of WM and achievement at baseline and one year later. WM measures included a visual-spatial storage task and auditory-verbal storage and manipulation tasks. Teachers completed the SWAN behaviour rating scale both years. Mediation analysis with PROCESS (Hayes, 2013) was used to determine mediation pathways. Results. Teacher-rated inattention indirectly influenced math addition fluency, subtraction fluency and calculation scores through its effect on visual-spatial WM, only for boys. There was a direct relationship between inattention and math outcomes one year later for girls and boys. Children who displayed better attention had higher WM scores, and children with higher WM scores had stronger scores on math outcomes. Bias-corrected bootstrap confidence intervals for the indirect effects were entirely below zero for boys, for the three math outcomes. WM did not mediate the direct relationship between inattention and reading scores. Discussion. Findings identify inattention and WM as longitudinal predictors for math addition and subtraction fluency and math calculation outcomes one year later, with visual-spatial WM as a significant mediator for boys. Results highlight the close relationship between inattention and WM and their importance in the development of math skills.

Age-related changes in visual and auditory sustained attention in preschool-aged children.

OBJECTIVE: The development of sustained attention in the preschool years is not yet fully understood. Delineating age-related changes of attentional proficiencies and deficiencies is important for understanding atypical developmental trajectories, specifically in neurodevelopmental disorders that are characterized by attentional difficulties. The objective of the current study was to develop preschool-appropriate measures for assessing sustained attention and to chart developmental changes in attention in early childhood. METHOD: Using adapted computerized paradigms, the present study investigated age-related changes in visual and auditory sustained attention in seventy typically developing children aged 3 to 6 years. RESULTS: The results indicated that similar age-related gains in performance emerged across both visual and auditory attention tasks. CONCLUSION: The findings suggest that the adapted measures developed in this study are sensitive enough to capture developmental variations in attention performance.

The Boy from Fez: A tale of five charities, and the global community, joining hands.

A case study in global cooperation between multiple charities and cardiac centers helped to save a 8-year-old Moroccan boy suffering a case of Laubry-Pezzi syndrome with severe aortic regurgitation and ventricular septal defect. His recuperation was aided by the support of communities in both Morocco and Qatar.