Understanding health behaviors that modify the risk for obesity in ADHD.

OBJECTIVE: Research provides support for the associated risk of inadequate sleep duration, limited physical activity, and excessive media use in attention-deficit/hyperactivity disorder (ADHD) and obesity. The present study aims to (1) examine the association between ADHD and overweight or obese status (OW/OB); (2) comprehensively examine sleep duration, physical activity, and media use as potential moderators of OW/OB; and (3) examine the moderating effects of these health behaviors cross-sectionally by comparing medicated youth with ADHD, unmedicated youth with ADHD, and youth without ADHD. METHODS: Data were acquired from the 2018 and 2019 National Survey of Children's Health, a nationally representative survey of caregivers conducted across the United States. The current study used data for youth 11-17 years old with a final sample size of 26,644. Hours of sleep, physical activity, and media use per day were dichotomized based on national recommendation guidelines for each health behavior (i.e., either meeting or not meeting guidelines). RESULTS: The OW/OB prevalence rate was 7% greater among unmedicated youth with ADHD than among medicated youth with ADHD. Medicated youth with ADHD and peers without ADHD had similar OW/OB rates. Among medicated youth with ADHD, physical activity, sleep duration, and media use did not contribute to OW/OB risk after controlling for family poverty level. However, among unmedicated youth with ADHD, meeting sleep duration guidelines was linked to a lower OW/OB risk. CONCLUSION: Overall, findings suggest that clinical providers and parents may wish to prioritize improved sleep duration in the management of OW/OB risk in youth with ADHD.

Cognitive Disengagement Syndrome But Not ADHD Symptoms Increases Risk for Child Body Mass Index: Examination in a Sample of Clinically Referred Youth.

Given the substantial increase in pediatric obesity rates in recent decades, its long-term stability, and its pervasive negative outcomes, continuous efforts to identify factors that may place children at increased risk for overweight or obesity (OW/OB) are essential. As such, the primary aim of the present investigation was to examine the extent to which symptoms of Cognitive Disengagement Syndrome (CDS; i.e., Sluggish Cognitive Tempo) relates to child body mass index (BMI) independent of Attention-Deficit/Hyperactivity Disorder (ADHD). The study is the first to examine whether CDS subdomains of slowed thinking, hypoarousal, and daydreamy is associated with BMI. Analyses included data from 72 clinically-referred children (46 males, 26 females) aged 4-12 years old (M = 8.41, SD = 2.48). CDS and ADHD were assessed using standardized parent-report rating scales, and children's BMI was collected at the time of encounter. Bayesian hierarchical regression models revealed no evidence that overall CDS symptoms or ADHD symptoms (overall and subdomain) predicted child BMI. However, models did provide moderate evidence that hypoarousal and daydream subdomains jointly predicted BMI independent of ADHD (BF10 = 19.28-21.87). The present study suggests that CDS is a risk factor for obesity in young children and future research is needed to inform clinical interventions and to provide further understanding of the relatively nuanced association between CDS symptoms and obesity.

Self-esteem in children and adolescents with and without attention-deficit/hyperactivity disorder: A meta-analytic review.

Meta-analytic methods were used to examine global and domain-specific (i.e., academic, social, behavioral) self-esteem in children and adolescents with and without ADHD. Potential moderators of effect size heterogeneity were also examined via meta-regressions within a three-level approach. Findings from 49 aggregated global self-esteem effect sizes (ADHDN = 2500, TDN = 9448), 12 academic self-esteem effect sizes (ADHDN = 386, TDN = 315), 11 social self-esteem effect sizes (ADHDN = 258, TDN = 254), and 8 behavioral self-esteem effect sizes (ADHDN = 231, TDN = 211) suggest that children and adolescents with ADHD experience moderate global (ES = 0.46, p < .001), academic (ES = 0.60, p = .009), and social (ES = 0.67, p = .001) self-esteem impairments compared to children and adolescents without the disorder. The aggregated behavioral self-esteem effect size (ES = 0.20, p = .54), however, was not significant, and the global self-esteem effect size was markedly smaller compared to effect sizes for the academic and social domains. Further, examination of potential moderators of effect size heterogeneity indicated null effects for medication status, diagnostic complexity, informant, age, sex, comorbid psychopathology, and self-esteem dimension. Collectively, findings suggest that children and adolescents with ADHD do not hold a ubiquitous negative self-perception of difficulties across academic, social, and behavioral domains of functioning, and unexamined domains that are distal to ADHD may serve to bolster global self-esteem.

Social functioning in children with ADHD: an examination of inhibition, self-control, and working memory as potential mediators.

Children with attention-deficit/hyperactivity disorder (ADHD) experience a host of social problems, in addition to significant impairments in behavioral inhibition, working memory, and self-control. Behavioral inhibition and working memory difficulties have been linked with social functioning deficits, but to date, most studies have examined these neurocognitive problems either in isolation or as an aggregate measure in relation to social problems, and none has considered the role of self-control. Thus, it remains unclear whether all of these executive functions are linked with social problems or if the link can be more parsimoniously explained by construct overlap. Fifty-eight children with ADHD and 63 typically developing (TD) children completed tests assessing self-control, behavioral inhibition, and working memory; parents and teachers rated children's social functioning. Examination of potential indirect effects with the bootstrapping procedure indicated that working memory mediated the relation between group membership (ADHD, TD) and child social functioning based on teacher but not parent ratings. Behavioral inhibition and self-control did not have direct relations with either parent- or teacher-rated social functioning. These findings point to important differences regarding how executive functioning difficulties manifest at school compared to home, as well as the specific executive function components that predict ADHD-related social difficulties.

Phonological working memory in children with and without ADHD: A systematic evaluation of recall errors.

OBJECTIVE: Phonological working memory impairments associated with attention-deficit/hyperactivity disorder (ADHD) have garnered interest due to reliable evidence of moderate- to large-magnitude between-group (ADHD vs. control) effects, as well their association with a wide range of secondary impairments. However, previous studies are methodologically limited in their ability to identify potential underlying mechanistic processes. This study aimed to examine converging and diverging patterns of omission, intrusion, and transposition errors to parse-specific mechanistic processes that contribute to ADHD-related phonological working memory deficits. METHOD: Fifty-four children with ADHD (45 males, nine females) and 65 typically developing (TD; 50 males, 15 females) children aged 8-12 (M = 9.62, SD = 1.52) years completed a computer-based phonological working memory task that aurally presented a random series of jumbled numbers and one letter. Children were instructed to verbally respond by stating the numbers from least to greatest, followed by the letter. Children's incorrect responses were coded as errors of omission, intrusion errors, or transposition errors. RESULTS: Results indicated a significant moderate-magnitude between-group difference in total omission and transposition errors, and a significant small-magnitude between-group difference in total intrusion errors. An examination of specific error types supported evidence of ADHD-related deficits in reordering and updating central executive processes. CONCLUSION: Collectively, these findings contribute to a more precise understanding of underlying mechanistic processes in ADHD-related working memory deficits and hold potential to inform the development of novel working memory metrics and working memory-based interventions for ADHD. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Feature Binding and Working Memory in Children with ADHD: Evidence of Episodic Buffer Impairment.

Previous examinations of working memory impairments in children with attention-deficit/hyperactivity disorder (ADHD) have predominantly focused on discreet visuospatial and phonological subsystem processes, as well as the domain-general central executive. The episodic buffer component of working memory, a neurocognitive process that allows for temporary storage and maintenance of bound episodes/features of information, is understudied in ADHD and initial findings have been equivocal. Heterogeneity in previous findings may reflect between-study methodological variability, floor effects unrelated to episodic buffer processes (i.e., excessive central executive demands), and limitations associated with previous investigations' use of novel paradigms. This study examined ADHD-related episodic buffer processing via an established paradigm (Allen et al., 2006) in well-defined groups of children with attention-deficit/hyperactivity disorder (ADHD) and typically developing peers (TD). Seventy-one children (ADHD n = 34, TD n = 37) aged 8-12 years (M = 9.81, SD = 1.50; 32% female) completed two conditions of a computerized working memory task that presented single feature stimuli (color and shape), and a third condition that presented dual-feature stimuli (color/shape binding). Overall, the ADHD group exhibited a large-magnitude deficit during the color/shape binding condition (d = .77), and both groups evinced worse performance accuracy in the color/shape binding condition compared to the single feature color and shape conditions. Collectively, these findings appear to provide evidence that children with ADHD exhibit large magnitude episodic buffer deficits that are not attributable to visuospatial subsystem or domain-general central executive processes.

Visuospatial working memory in attention-deficit/hyperactivity disorder: Characterizing path length and path crossings as mechanisms of impairment.

OBJECTIVE: A growing body of research provides reliable evidence of moderate to large magnitude deficits in the visuospatial (VS) working memory (WM) of children with attention-deficit/hyperactivity disorder (ADHD), relative to typically developing (TD) children. Studies of ADHD-related Visuo-spatial Working Memory (VS-WM) functioning most often present sequential presentations of VS stimuli and examine general performance characteristics. Only a few studies have examined the effects of varying VS-WM task parameters on performance in children with ADHD, despite evidence from basic-cognitive research that indicates methodological heterogeneity in VS-WM task parameters yields significant performance variability that is associated with underlying mechanistic processes. This study is the first to examine the effect of the task parameters path characteristics and path crossings on performance in children with ADHD and TD children. METHOD: School-aged children with ADHD (n = 50) and TD children (n = 59) completed a VS-WM task that varied by path lengths and path crossings. RESULTS: Multilevel analyses indicated a negative effect of relatively long paths on VS-WM performance of both TD children and children with ADHD, and a negative effect of increasing path crossings that appears to be unique to TD children and dependent on path length. CONCLUSIONS: Overall, findings appear to suggest that school-aged children engage in dynamic rehearsal of VS information (i.e., mental rehearsal of path sequences), rather than static rehearsal (i.e., rehearsal of a gestalt). Moreover, ADHD-related VS-WM deficits are most likely to yield real-world impairments when information is presented with relatively long path lengths. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Emotion Regulation and Children With Attention-Deficit/Hyperactivity Disorder: The Effect of Varying Phonological Working Memory Demands.

Objective: Findings from extant studies of the relationship between ADHD-related emotion regulation and working memory deficits have been equivocal, and their correlational designs preclude inferences about the functional relationship between working memory demands and emotion regulation. This study aimed to experimentally examine the functional relationship between varying working memory demands and ADHD-related emotion regulation deficits. Method: Overt emotion regulation behaviors were coded while children with and without ADHD completed experimental tasks that manipulated low and high working memory demands. Results: Compared with typically developing children, children with ADHD exhibited large-magnitude overall emotion expression deficits, disproportionately greater self-criticism during high working memory conditions, and disproportionately greater positive emotion expression during low working memory demand conditions. Conclusion: These findings suggest that working memory demands are functionally related to emotion regulation deficits exhibited by children with ADHD and may explicate variability of emotion regulation difficulties related to environmental demands.

Attention-deficit/hyperactivity disorder and risk-taking: A three-level meta-analytic review of behavioral, self-report, and virtual reality metrics.

Meta-analytic methods were used to examine ADHD-related risk-taking in children and adults, and to compare the magnitude of risk taking across behavioral, self-report, and virtual reality metrics. Potential moderators of effect size heterogeneity were also examined via a three-level multi-level approach and a hybrid meta-analytic/systematic review approach. Aggregated effect sizes obtained from 56 behavioral-task studies (82 effect sizes; ADHDN = 2577; TDN = 2606), 51 self-report studies (130 effect sizes; ADHDN = 18,641; TDN = 113,163), and 8 virtual reality studies (16 effect sizes; ADHDN = 382; TDN = 436) suggest that children and adults with ADHD exhibit moderately more risk-taking compared to children and adults without the disorder. Notably, the aggregated effect size obtained from virtual reality simulations (Hedges', g = 0.43) was 30-40% larger than effect sizes obtained from self-report and behavioral task metrics (Hedges' g = 0.31 and 0.27), respectively. Suboptimal Decision Making was the only significant moderator identified via multi-level modeling; however, comparison of subgroup effect sizes revealed potential moderating effects of ADHD presentation and trial-by-trial feedback on behavioral tasks. Collectively, findings suggest that ADHD is reliably associated with small to moderate magnitude greater risk-taking behavior and virtual reality simulations appear be the most sensitive currently available metric.

Working memory and behavioral inhibition in children with attention-deficit/hyperactivity disorder (ADHD): an examination of varied central executive demands, construct overlap, and task impurity.

The stop-signal paradigm is the premier metric of behavioral inhibition in contemporary attention-deficit/hyperactivity disorder (ADHD) research. The stop-signal paradigm's choice-reaction time component, however, arguably places greater demands on working memory processes (e.g., controlled-focused attention) relative to alternative inhibition metrics (i.e., go/no-go (GNG) tasks), and consequently obscures conclusions about inhibition and working memory deficits in affected children. The current study, therefore, aimed to determine whether shared variance between stop-signal behavioral inhibition and working memory performance in children with ADHD reflects overlap between the working memory and inhibition constructs or insufficient specificity of the stop-signal paradigm. Fifty-five children (8-12 years) with and without ADHD were administered established phonological (PH) and visuospatial (VS) working memory measures, as well as stop-signal and GNG tasks that vary with respect to demands on controlled-focused attention. Although working memory and GNG performance each uniquely predicted children's inattention, stop-signal task performance was not a significant predictor of unique variance in inattention, above and beyond variance associated with working memory. Collectively, these findings suggest that performance on the stop-signal task, compared to the GNG task, is confounded by greater demands associated with working memory and consequently reflects an impure estimate of the inhibition construct.