Trajectories of Loneliness During Adolescence Predict Subsequent Symptoms of Depression and Positive Wellbeing.

There is a need to identify the outcomes of changes in loneliness during adolescence, and to consider this within a multidimensional framework of loneliness. This study considered the effects of different trajectories of change in Isolation Loneliness and in Friendship Loneliness upon both positive wellbeing and symptoms of depression. To achieve this, 1782 (43% female; 12.92 years old at the start of the study, SD = 1.60) young people took part in a longitudinal study with four data points across 2 years. Four Isolation Loneliness trajectories and five Friendship Loneliness trajectories were identified. Youth who experienced low levels of Isolation Loneliness that subsequently increased appear to be at particular risk for poor outcomes. Similarly, initially high levels of Friendship Loneliness that decreased rapidly, or which began at a low level and only increased marginally, seem to also be a risk. Loneliness is a multi-dimensional construct and its development during adolescence impacts upon young people's depressive symptomatology and positive mental wellbeing.

A Short-Form Measure of Loneliness to Predict Depression Symptoms Among Adolescents.

The purpose of this study was to produce a short-form measure of loneliness and assesses its prediction of depressive symptoms relative to a comprehensive measure. Western Australian adolescents completed the Friendship Related Loneliness and Isolation subscales of the Perth Aloneness Scale (PALs) three times over 18 months (T 1 n = 1538; T 2, n = 1683; T 3, n = 1406). Items were reduced while preserving predictability. Follow-up confirmatory factor analyses and predictive models with the reduced and full PALs were then tested. A reduced six-item scale (PALs-6) preserved the two-factor structure of the PALs and showed strong prediction of very elevated depressive symptoms (Sensitivity = 0.70, Specificity = 0.78, AUC = 0.81); it was less successful in predicting future symptoms (Sensitivity = 0.67, Specificity = 0.64, AUC = 0.74). The PALs-6 provides a brief measure of adolescent loneliness for clinicians and researchers that also predicts very elevated levels of depression.

Longitudinal trajectories of mental health and loneliness for Australian adolescents with-or-without neurodevelopmental disorders: the impact of COVID-19 school lockdowns.

BACKGROUND: The impact of COVID-19 (SARS-CoV-2) pandemic school lockdowns on the mental health problems and feelings of loneliness of adolescents with neurodevelopmental disorders (NDDs) is hypothesized to be greater than that of their non-NDD peers. This two and a half year longitudinal study compared changes in the mental health and loneliness of Western Australian adolescents pre-COVID-19 (November 2018 and April 2019), immediately prior to COVID-19 school lockdowns (March 2020), and post schools reopening (July/August 2020). METHODS: An age-and-gender matched sample of 476 adolescents with-or-without NDDs completed online assessments for mental health and loneliness. RESULTS: Adolescents with NDDs reported elevated levels of adverse mental health across all four waves of data collection. These young people experienced little change in mental health problems and feelings of loneliness over time, and any increase during school lockdowns returned to, or fell below pre-COVID-19 levels once schools reopened. In comparison, adolescents without NDDs experienced significant increases from a low baseline in depression symptoms, externalizing symptoms, feelings of isolation, and having a positive attitude to being alone, and evidenced a significant decline in positive mental wellbeing. Quality of friendships were unaffected by COVID-19 school lockdowns for all adolescents regardless of NDD status. Of the adolescents with NDDs, those with Attention-Deficit/Hyperactivity Disorder reported a significant increase in positive mental wellbeing following school lockdowns. CONCLUSIONS: Adolescents with NDDs emerged relatively unscathed from COVID-19 school lockdowns and the short term impacts associated with these were not maintained over time. These findings should be considered in the context of this study's geographical location and the unpredictability of school lockdowns. Learning to live with school lockdowns into the future may be a critical element for further investigation in the context of interventions.

Adolescents' longitudinal trajectories of mental health and loneliness: The impact of COVID-19 school closures.

INTRODUCTION: Longitudinal research examining the impact of coronavirus disease 2019 (COVID-19) school closures on the mental health of adolescents is scarce. Prolonged periods of physical and social isolation because of such restrictions may have impacted heavily on adolescents' mental health and loneliness. METHODS: The current study addresses a major gap by examining the impact of school closures on the mental health and loneliness of 785, 10- to 17-year-old Western Australian adolescents (mean age = 14.1, SD = 1.31), who were surveyed across four time points: twice before COVID-19, once as schools closed, and once post reopening of schools. Pre- and post-COVID-19 changes in mental health and loneliness were compared using linear mixed models. Random intercept cross-lagged panel models (RI-CLPMs) assessed temporal associations between loneliness, depression symptoms, and positive mental wellbeing. RESULTS: Compared with pre-COVID-19 symptom levels, there were significant increases in depression symptoms, internalizing and externalizing symptoms, and a significant decrease in positive mental wellbeing at different points over time. Symptom change over time differed according to gender and pre-COVID-19 symptom severity. Significant increases in positive attitudes towards being alone and feelings of isolation occurred at different points over time. Gender differences were evident. RI-CLPMs highlighted the predictive significance of friendship quality and having a negative attitude towards being alone over time in relation to depression symptoms. A positive or negative attitude towards being alone was predictive of positive mental wellbeing over time. CONCLUSION: Findings provide evidence that COVID-19-related school closures adversely affected adolescents' mental health and feelings of loneliness.

Measuring impostor phenomenon in healthcare simulation educators: a validation of the clance impostor phenomenon scale and leary impostorism scale.

BACKGROUND: Impostor phenomenon is a term used to describe feelings of intellectual and professional fraudulence. The Clance Impostor Phenomenon Scale and the Leary Impostorism Scale are two self-report measures used to determine whether an individual experiences impostor phenomenon. This study examined the psychometric properties of both measures in healthcare simulation educators. METHODS: The study sample comprised 148 educators, 114 (77%) females, 34 (23%) males, who completed an online version of each instrument. Exploratory factor analysis was used to examine the factor structure of the Clance Impostor Phenomenon Scale and the Leary Impostorism Scale. RESULTS: Exploratory factor analysis revealed that for both instruments a one-factor solution best fit the data, suggesting all items in both measures fit onto a single theoretical construct. Both instruments demonstrated high internal reliability, with the Cronbach's alpha for the Clance Impostor Phenomenon Scale being α = .96 and the Leary Impostorism Scale α = .95. CONCLUSIONS: This study suggests that impostor phenomenon as measured by the Clance Impostor Phenomenon Scale and the Leary Impostorism Scale is a unidimensional construct among healthcare simulation educators. With a growing interest in impostor phenomenon, the present findings will assist researchers to evaluate the phenomenon in healthcare settings.

Loneliness in adolescence: a Rasch analysis of the Perth A-loneness scale.

PURPOSE: The psychometric properties of the Perth A-loneness Scale (PALs) have been extensively validated using classical test theory, but to date no studies have applied a Rasch analysis. The purpose of this study was to validate the PALs four subscales, using Rasch analysis. METHODS: Responses from 1484 adolescents (58% female, mean age = 12.8 years), 131 of whom had a diagnosed neurodevelopmental disorder, from 10 Western Australian secondary schools were included in the Rasch analysis. Overall fit, individual item fit, local response dependence, dimensionality, operation of response categories, and differential item functioning (DIF) were examined. RESULTS: The Rasch analysis supported the factor structure of the PALs. A reasonable to high reliability was obtained for each of the subscales. Participants did not distinguish consistently between the higher categories 'very often' and 'always' on three of the subscales. No item showed Differential Item Functioning (DIF) for neurodevelopmental disorder status and age. One item on each of the Positive and Negative Attitude to Aloneness subscales showed DIF for gender. CONCLUSION: The results support the interval scale measurement properties of the PALs and provide clinicians and researchers with a measure to assess adolescent loneliness, a construct strongly associated with a constellation of mental health problems.

A latent growth curve model to estimate electronic screen use patterns amongst adolescents aged 10 to 17 years.

BACKGROUND: High quality, longitudinal data describing young people's screen use across a number of distinct forms of screen activity is missing from the literature. This study tracked multiple screen use activities (passive screen use, gaming, social networking, web searching) amongst 10- to 17-year-old adolescents across 24 months. METHODS: This study tracked the screen use of 1948 Australian students in Grade 5 (n = 636), Grade 7 (n = 672), and Grade 9 (n = 640) for 24 months. At approximately six-month intervals, students reported their total screen time as well as time spent on social networking, passive screen use, gaming, and web use. Patterns of screen use were determined using latent growth curve modelling. RESULTS: In the Grades 7 and 9 cohorts, girls generally reported more screen use than boys (by approximately one hour a day), though all cohorts of boys reported more gaming. The different forms of screen use were remarkably stable, though specific cohorts showed change for certain forms of screen activity. CONCLUSION: These results highlight the diverse nature of adolescent screen use and emphasise the need to consider both grade and sex in future research and policy.

Reactive and proactive aggression as meaningful distinctions at the variable and person level in primary school-aged children.

Reactive and proactive aggression is a dichotomous classification of aggression in adults and children. This distinction has been supported by a number of variable-based and factor analytic studies. Due to high inter-correlations, however, the reactive-proactive aggression distinction may not be entirely useful for understanding how group or individual aggressive behavior varies in children and adolescents. Drawing on a sample of primary school-aged children (N = 242) aged 7-12 years, this study sought to determine whether reactive and proactive aggression could be distinguished at the variable-level and the person-level in children. Exploratory Factor Analysis of data from an aggression instrument measuring both functions and forms of aggression, found a two-factor construct of aggression constituted by a reactive and proactive aggression factor. A person-based analysis was then conducted after classifying children according to the presence of reactive and/or proactive aggression. Discriminant function analysis was used to discern whether classifications on the basis of aggression function produced meaningful distinctions in terms of antisocial traits and emotional valence and intensity measures. Two functions were identified which distinguished children with different combinations of reactive and proactive aggression. Reactive-only aggressive children were defined primarily by high levels of impulsivity, while proactive-only children were defined primarily by higher levels of antisocial traits. Children high in both types of aggression exhibited both the presence of antisocial traits and impulsivity. Contrary to recent findings, this suggests that differences in aggression functions remain meaningful at the person level in children. Implications for interventions are discussed.

Reciprocal Relationships between Trajectories of Depressive Symptoms and Screen Media Use during Adolescence.

Adolescents are constantly connected with each other and the digital landscape through a myriad of screen media devices. Unprecedented access to the wider world and hence a variety of activities, particularly since the introduction of mobile technology, has given rise to questions regarding the impact of this changing media environment on the mental health of young people. Depressive symptoms are one of the most common disabling health issues in adolescence and although research has examined associations between screen use and symptoms of depression, longitudinal investigations are rare and fewer still consider trajectories of change in symptoms. Given the plethora of devices and normalisation of their use, understanding potential longitudinal associations with mental health is crucial. A sample of 1,749 (47% female) adolescents (10-17 years) participated in six waves of data collection over two years. Symptoms of depression, time spent on screens, and on separate screen activities (social networking, gaming, web browsing, TV/passive) were self-reported. Latent growth curve modelling revealed three trajectories of depressive symptoms (low-stable, high-decreasing, and low-increasing) and there were important differences across these groups on screen use. Some small, positive associations were evident between depressive symptoms and later screen use, and between screen use and later depressive symptoms. However, a Random Intercept Cross Lagged Panel Model revealed no consistent support for a longitudinal association. The study highlights the importance of considering differential trajectories of depressive symptoms and specific forms of screen activity to understand these relationships.

Development of the Adolescent Preoccupation with Screens Scale.

BACKGROUND: Although public health concerns have been raised regarding the detrimental health effects of increasing rates of electronic screen use among adolescents, such effects have been small. Instruments currently available tend to be lengthy, have a clinical research focus, and assess young people's screen use on specific screen-based activities (e.g., TV, computer, or internet). None appear to address screen use across a broad range of screens, including mobile devices and screen-based activities. The objective was to develop a new and short self-report scale for investigating adolescents' screen use across all screens and screen-based activities in non-clinical settings. METHODS: The Adolescent Preoccupation with Screens Scale (APSS) was developed over a three stage process. First, a review of the current literature and existing instruments was undertaken and suitable items identified. Second, the draft APSS was piloted with adolescents and item affectivity and discrimination indices were calculated. Third, a cross sectional school based online survey of 1967 Australian adolescents in grades 5 (10 years old), 7 (13 years) and 9 (15 years) from 25 randomly selected schools was conducted. RESULTS: Factor Analysis on a sub-sample of the data (n = 782) and Confirmatory Factor Analysis on the remaining sub-sample (n = 1185), supported a two-factor model. The first factor reflects adolescents' mood management with screen use, and the second reflects a behavioural preoccupation. The measure demonstrated strong invariance across sex and across Grades 5, 7, and 9. Both factors displayed good internal consistency (α = .91 and .87, respectively). Sex and grade differences on both scales were investigated and boys in Grade 5 reported higher levels of both mood management and behavioural preoccupation with screens. There were no sex differences on mood management in Grades 7 and 9, but girls reported higher behavioural preoccupation in both these later grades. CONCLUSION: The APSS provides researchers with a new, brief and robust measure of potentially problematic screen use across a wide array of screens, including mobile devices, so readily accessed during adolescence.

The association between dog walking, physical activity and owner's perceptions of safety: cross-sectional evidence from the US and Australia.

BACKGROUND: We examined the relationship between dog walking and physical activity within and between four US cities and Australia and investigated if dog walking is associated with higher perceived safety in US and Australian cities. METHODS: Dog owners (n = 1113) in the Pet Connections Study completed a cross-sectional survey. Data were collected across four study sites; three in the US (San Diego, Nashville, Portland) and a fourth in Australia (Perth). Physical activity, local walking, dog walking, and individual and community perceptions of safety were analysed for dog walkers and non-dog walkers for each study site. Between-city comparisons were examined for dog walkers. RESULTS: Across all study sites, dog walkers walked with their dog 5-6 times/week for a total of 93-109 min/week and achieved ≥30mins of physical activity on more days/week and walked in their neighbourhood more often/week, compared with non-dog walkers (all p ≤ 0.01). Compared with Perth, significantly fewer dog walkers walked in their local park in the three US study sites. San Diego dog walkers walked more often in their neighborhood/week compared with Perth dog walkers (all p ≤ 0.05). In Portland, dog walkers perceived significantly more neighborhood problems and in Nashville dog walkers perceived a significantly higher level of neighborhood natural surveillance (i.e., 'eyes on the street'), compared with non-dog walkers (both p ≤ 0.05). Among dog walkers, females were more likely than males to feel safer walking with their dog in their neighborhood (OR = 2.49; 95 % CI = 1.76, 3.53). Compared with dog walkers in Perth, dog walkers from each of the US study sites felt safer in their neighborhood and perceived there was more neighborhood surveillance (all p ≤ 0.001). CONCLUSION: This multi-site international study provides further support for the potential for dog walking to increase levels of daily physical activity. Walking with a dog may be a mechanism for increasing perceptions of neighborhood safety and getting to know the neighborhood, however significant between-country differences exist. Further international research is required to understand the drivers for these between-country differences. Community based programs and policies aimed at improving safety and social connectedness should consider the wider community benefits of dog walking and include strategies for supporting more dog walking.

Virtually impossible: limiting Australian children and adolescents daily screen based media use.

BACKGROUND: Paediatric recommendations to limit children's and adolescents' screen based media use (SBMU) to less than two hours per day appear to have gone unheeded. Given the associated adverse physical and mental health outcomes of SBMU it is understandable that concern is growing worldwide. However, because the majority of studies measuring SBMU have focused on TV viewing, computer use, video game playing, or a combination of these the true extent of total SBMU (including non-sedentary hand held devices) and time spent on specific screen activities remains relatively unknown. This study assesses the amount of time Australian children and adolescents spend on all types of screens and specific screen activities. METHODS: We administered an online instrument specifically developed to gather data on all types of SBMU and SBMU activities to 2,620 (1373 males and 1247 females) 8 to 16 year olds from 25 Australian government and non-government primary and secondary schools. RESULTS: We found that 45% of 8 year olds to 80% of 16 year olds exceeded the recommended < 2 hours per day for SBMU. A series of hierarchical linear models demonstrated different relationships between the degree to which total SBMU and SBMU on specific activities (TV viewing, Gaming, Social Networking, and Web Use) exceeded the < 2 hours recommendation in relation to sex and age. CONCLUSIONS: Current paediatric recommendations pertaining to SBMU may no longer be tenable because screen based media are central in the everyday lives of children and adolescents. In any reappraisal of SBMU exposure times, researchers, educators and health professionals need to take cognizance of the extent to which SBMU differs across specific screen activity, sex, and age.

Comorbidities of Attention Deficit Hyperactivity Disorder: Pregnancy Risk Factors and Parent Mental Health.

Our study examined the risk of maternal smoking and alcohol consumption in pregnancy associated with child comorbidity in a community sample of children diagnosed with attention deficit hyperactivity disorder (ADHD). We used a cross sectional community retrospective questionnaire of 321 children diagnosed with ADHD. Our results suggest that maternal smoking increased the risk of oppositional defiant behavior (ODB) in children with ADHD twofold (OR 2.27; CI 1.29-4.11). Maternal alcohol consumption increased the risk although not significantly for ADHD child comorbid ODB, anxiety disorder and depression. Parent mental health significantly impacted on child comorbidity. Our study suggests that smoking in pregnancy is associated with comorbid ODB, independent of parent mental health, family history of ADHD and socioeconomic factors. Parent mental health is independently associated with comorbid ODB, anxiety disorder and depression.

Child attention deficit hyperactive disorder co morbidities on family stress: effect of medication.

We examined the degree of parental and child mental health in a community sample of children diagnosed with Attention Deficit Hyperactive Disorder and the effect on family stress prior to and during treatment using a community retrospective questionnaire study. In total 358 questionnaires were returned for analysis where 92 % of children had at least one co-morbid condition and mental health conditions in parents was common. Overall, the Family Strain Index was significantly reduced after commencement of medication (p < 0.0001), but remained higher in families where the children had either externalizing disorders or autism spectrum disorder.

Conceptualising loneliness in adolescents: development and validation of a self-report instrument.

This paper reports the development and psychometric evaluations of a multidimensional model of loneliness in Australian adolescents. In the first study a new instrument was designed and administered to 1,074 adolescents (ages 10-18 years, M = 13.01). An exploratory factor analysis from data supplied by 694 of these participants yielded a 4-factor structure (friendship, isolation, negative attitude to solitude, and positive attitude to solitude). Competing measurement models were then evaluated using confirmatory factor analysis with data from the remaining 380 participants; strong support was demonstrated for the conceptual model. Significant main effects were evident for geographical location (rural remote/urban), age and sex. In a second study, involving 235 Australian adolescents (ages 10.0-16 years, M = 13.8) the superiority of the first-order model represented by four correlated factors was confirmed. The findings have clinical and practical implications for professional groups represented by child and adolescent psychiatry, pediatric and clinical psychology services, researchers, and educators. Specifically, the new self-report instrument identifies adolescents who are at risk of loneliness and its associated adverse outcomes and in doing has the potential to offer new insights into prevention and intervention.

Mindfulness-based interventions for preadolescent children: A comprehensive meta-analysis.

Among the many social and emotional learning (SEL) interventions available, mindfulness-based interventions (MBIs) have become increasingly popular, particularly for preadolescent children who were once thought to not possess the metacognitive abilities or cognitive resources to benefit from such training. Although previous research syntheses indicate that MBIs show promise in promoting positive outcomes across a range of domains, the effectiveness of MBIs for preadolescent children may be masked by the effects of older children who have comprised the majority of samples in past meta-analyses. Hence, to better understand the impact of mindfulness-based training on preadolescent children (ages 6-12 years), the present study reviewed treatment effect estimates across a range of outcomes, including mindfulness, attention, metacognition and cognitive flexibility, emotional and behavioral regulation, academic achievement and school functioning, positive emotion and self-appraisal, negative emotion and subjective distress, externalizing problems, internalizing problems, social competence and prosocial behavior, and physical health. Thirty-two studies (nparticipants = 3640) were identified and included in a random-effects meta-analyses. The results from multiple meta-analytical analyses conducted in the present study suggest that preadolescents have experienced significant benefits across attention, emotional and behavioral regulation, positive emotion and self-appraisal, and social competence and prosocial behavior (g = 0.19 to 0.39). However, the overall effect was deemed small (g = 0.34). Due to the lack of comparison studies with SEL interventions, it remains unclear whether MBIs are as effective as traditional approaches in promoting healthy development and academic achievement for preadolescent children. Additionally, results from the present meta-analysis suggest various recommendations for future studies to ensure a continued growth in understanding how MBIs can be used with children.

Game on: do children absorb sports sponsorship messages?

OBJECTIVE: It is likely that there are substantial subconscious effects of organizations' efforts to associate their products with sport via sponsorships, but most research methods are unable to capture these effects. The present study employed a novel projective technique to explore children's implicit associations between popular sports and a range of sports sponsors. DESIGN: Children participated in an activity using magnets bearing the logos of numerous sports and sponsors. They were invited to arrange the magnets on a whiteboard without being advised that the activity related to sponsorship. SETTING: Perth, Western Australia. SUBJECTS: Children (n 164) aged 5­12 years. RESULTS: Three-quarters (76 %) of the children aligned at least one correct sponsor magnet with the relevant sport. Just over half the children (54 %) correctly matched the most popular sport (an Australian Football League team) with its relevant sponsor (a fast-food chain). CONCLUSIONS: Given the unstructured nature of the projective task, the results provide some support for the argument that sports sponsorship can effectively reach child audiences. This is of concern given the current extent of sponsorship by alcohol and fast-food companies.

Interpersonal and affective dimensions of psychopathic traits in adolescents: development and validation of a self-report instrument.

We report the development and psychometric evaluations of a self-report instrument designed to screen for psychopathic traits among mainstream community adolescents. Tests of item functioning were initially conducted with 26 adolescents. In a second study the new instrument was administered to 150 high school adolescents, 73 of who had school records of suspension for antisocial behavior. Exploratory factor analysis yielded a 4-factor structure (Impulsivity α = 0.73, Self-Centredness α = 0.70, Callous-Unemotional α = 0.69, and Manipulativeness α = 0.83). In a third study involving 328 high school adolescents, 130 with records of suspension for antisocial behavior, competing measurement models were evaluated using confirmatory factor analysis. The superiority of a measurement model represented by four correlated factors was supported, and this model was invariant across gender and age. The findings provide researchers and clinicians with a psychometrically strong, self-report instrument and a greater understanding of psychopathic traits in mainstream adolescents.

Goal setting and self-efficacy among delinquent, at-risk and not at-risk adolescents.

Setting clear achievable goals that enhance self-efficacy and reputational status directs the energies of adolescents into socially conforming or non-conforming activities. This present study investigates the characteristics and relationships between goal setting and self-efficacy among a matched sample of 88 delinquent (18 % female), 97 at-risk (20 % female), and 95 not at-risk adolescents (20 % female). Four hypotheses related to this were tested. Findings revealed that delinquent adolescents reported fewest goals, set fewer challenging goals, had a lower commitment to their goals, and reported lower levels of academic and self-regulatory efficacy than those in the at-risk and not at-risk groups. Discriminant function analysis indicated that adolescents who reported high delinquency goals and low educational and interpersonal goals were likely to belong to the delinquent group, while adolescents who reported high educational and interpersonal goals and low delinquency goals were likely to belong to the not at-risk group. The at-risk and not at-risk groups could not be differentiated. A multinomial logistic regression also revealed that adolescents were more likely to belong to the delinquent group if they reported lower self-regulatory efficacy and lower goal commitment. These findings have important implications for the development of prevention and intervention programs, particularly for those on a trajectory to delinquency. Specifically, programs should focus on assisting adolescents to develop clear self-set achievable goals and support them through the process of attaining them, particularly if the trajectory towards delinquency is to be addressed.

Differences between DSM-5-TR and ICD-11 revisions of attention deficit/hyperactivity disorder: A commentary on implications and opportunities.

Current ICD-11 descriptions for attention deficit hyperactivity disorder (ADHD) were recently published online, in the same year as the DSM-5-TR (text revised edition) was released. In this commentary, we compare and contrast the DSM-5/DSM-5-TR and ICD-11 diagnostic criteria, summarize important differences, and underscore their clinical and research implications. Overall, three major differences emerge: (1) The number of diagnostic criteria for inattention (IA), hyperactivity (HY) and impulsivity (IM) symptoms (i.e., DSM-5-TR has nine IA and nine HY/IM symptoms, whereas ICD-11 has 11 IA and 11 HY/IM sym-ptoms); (2) the clarity and standardization of diagnostic thresholds (i.e., the diagnostic thresholds for symptom count in IA and HY/IM domains are explicitly specified in DSM-5-TR, whereas in ICD-11 they are not); and (3) the partitioning of HY and IM symptoms into sub-dimensions (i.e., difference in partitioning HY and IM symptom domains relates to the differences between the current and previous editions of DSM and ICD, and this has important research implications). Currently, no ICD-11 based ADHD rating scales exist and while this absence represents an obstacle for respective research and clinical practice, it also presents opportunities for research development. This article highlights these challenges, possible remedies and novel research opportunities.