ADHD, chronotype, and circadian preference in a multi-site sample of college students.

Attention-deficit/hyperactivity disorder and an evening chronotype are both common among college students, and there is growing interest in understanding the possible link between attention-deficit/hyperactivity disorder and circadian function. However, mixed findings have been reported, and many of the existing studies have used small samples that were unable to examine chronotype across attention-deficit/hyperactivity disorder presentations. Participants were 4751 students (73% female; 80% White), aged 18-29 years (M = 19.28, SD = 1.50), from five universities who completed measures assessing attention-deficit/hyperactivity disorder, depressive and anxiety symptoms, as well as the Morningness-Eveningness Questionnaire to assess chronotype (categorical) and circadian preference (dimensional). Participants with either attention-deficit/hyperactivity disorder predominantly inattentive presentation or attention-deficit/hyperactivity disorder combined presentation had higher rates of being an evening type (47.2% and 41.5%, respectively) than participants without elevated attention-deficit/hyperactivity disorder (28.5%), and participants with attention-deficit/hyperactivity disorder predominantly inattentive presentation also had higher rates of being an evening type than participants with attention-deficit/hyperactivity disorder predominantly hyperactive-impulsive presentation (30.7%). Dimensional analyses indicated that attention-deficit/hyperactivity disorder inattentive symptoms were more strongly associated than hyperactive-impulsive symptoms with eveningness preference. Finally, greater eveningness preference strengthened the association between attention-deficit/hyperactivity disorder inattention and depressive symptoms but not anxiety symptoms. This is the largest study to document that college students with elevated attention-deficit/hyperactivity disorder symptoms are more likely to be evening types than other college students, and inattentive symptoms in particular are associated with later circadian preference.

A Prospective Study of Co-Rumination in Parent-Adolescent Conversations Several Years After a Devastating Tornado.

OBJECTIVE: This study examined the association between youth post-disaster stress responses and co-rumination in conversations with a parent several years after a devastating tornado. METHOD: Adolescents (N = 200) drawn from an ongoing study for aggressive youth (ages 13 to 17; 80% African American) and their parents experienced an EF-4 tornado in 2011 and then provided joint recollections about their tornado experiences approximately 5 years later. Recollections were coded for the four components of co-rumination: rehashing problems, dwelling on negative affect, mutual encouragement of problem talk, and speculating about problems. Parent-rated post-traumatic stress symptoms (PTSS) and youth resting respiratory sinus arrhythmia (RSA) were measured approximately 6-months and 1-year post-tornado, respectively. RESULTS: Results indicated that co-rumination could be identified, and reliably measured, in the tornado conversations. Resting RSA moderated the association between post-disaster PTSS and the co-rumination component dwelling on negative affect, such that youth PTSS was associated with higher levels of dwelling on negative affect but only at lower levels of resting RSA (an index of physiological dysregulation). There was no association between youth PTSS and dwelling on negative affect at high resting RSA (an index of better physiological regulation). Youth PTSS and resting RSA were unrelated to the other three co-rumination components. No gender differences were found. CONCLUSIONS: Results provide preliminary evidence establishing the co-rumination coding scheme in a sample of disaster-exposed parents and adolescents. Results also indicated that PTSS and resting RSA are important youth-level factors that relate to how parents and adolescents discuss their disaster experiences even years post-exposure.

Sluggish Cognitive Tempo in Autism Spectrum Disorder, ADHD, and Their Comorbidity: Implications for Impairment.

Objective: Sluggish Cognitive Tempo (SCT), characterized by lethargy and daydreaming, has most commonly been studied in community samples and in youth with Attention-Deficit/Hyperactivity Disorder (ADHD). Despite shared neurodevelopmental symptoms with ADHD, few studies have investigated SCT in Autism Spectrum Disorders (ASD). The current study investigated SCT symptoms in youth with ASD, ADHD, and comorbid ASD+ADHD to explore the relations between SCT and global and social impairment.Method: Caregivers of children and adolescents (n = 98; ages 6-17) diagnosed with ADHD (n = 46), ASD (n = 28), or ASD+ADHD (n = 24) completed measures of social impairment, SCT, and demographic variables.Results: All three clinical groups demonstrated comparable levels of SCT. Diagnosis and SCT independently contributed to parent-rated social impairment, while SCT and IQ, but not diagnosis, contributed to clinician-rated global functioning. Specifically, having comorbid ASD+ADHD, but not an ASD or ADHD diagnosis alone, significantly predicted greater social impairment.Conclusion: These results extend previous literature investigating SCT in ASD and provide evidence to suggest that SCT is associated with social and global impairment above and beyond the impairment associated with ADHD and/or ASD. These results may have implications for clinical assessment and treatment of ASD and ADHD.

Increased Working Memory Load in a Dual-Task Design Impairs Nonverbal Social Encoding in Children with High and Low Attention-Deficit/Hyperactivity Disorder Symptoms.

Children with attention-deficit/hyperactivity disorder (ADHD) are known to have difficulty with peer relations, though the mechanisms by which these children struggle with interpersonal relationships are not well known. The current study examined the relation between working memory (WM) and the encoding of nonverbal social cues using a dual-task paradigm tested in children with High and Low ADHD symptoms. A total of 40 children were recruited (20 High ADHD; 20 Low ADHD) and completed computerized tasks of social encoding and WM in both single- and dual-task conditions. A series of repeated measures mixed-model ANOVAs revealed that both children with High ADHD and Low ADHD performed significantly worse during the dual-task condition compared to the single task conditions. Also, children with High ADHD had significantly lower performance than Low ADHD children on task-based social encoding and WM. This study supports the role of WM in nonverbal social encoding in children.

Family environment moderates the relation of sluggish cognitive tempo to attention-deficit/hyperactivity disorder inattention and depression.

OBJECTIVES: The current study investigated whether a maladaptive family environment would moderate the strength of the relations of sluggish cognitive tempo (SCT) to attention-deficit/hyperactivity disorder inattention (ADHD-IN) and to depressive symptoms in a large sample of college students. METHODS: Participants (n = 3,172), between the ages of 18-29 (M ± SDage = 19.24 ± 1.52; 69.8% women; 80.4% White) and enrolled in five universities in the United States completed self-report measures of symptomatology, interparental conflict, and family expressiveness of emotions. RESULTS: A negative emotional climate strengthened relations of SCT with ADHD-IN and depressive symptoms. Moreover, the lack of a positive emotional climate strengthened the co-occurrence of SCT with depressive symptoms, though not with ADHD-IN. CONCLUSIONS: The current study is the first to demonstrate that the family environment moderates the association between SCT and co-occurring symptomatology in young adults.

Factor Structure and Criterion Validity of the Five Cs Model of Positive Youth Development in a Multi-University Sample of College Students.

There is growing recognition that clinical and developmental outcomes will be optimized by interventions that harness strengths in addition to ameliorating deficits. Although empirically-supported methods for identifying strengths are available for children and adolescents, this framework has yet to be applied to emerging adulthood. This study evaluates the nature of the Five Cs model of Positive Youth Development (PYD) - character, confidence, competence, connection, and caring - in a sample of emerging adults from six universities (N = 4654; 70% female; 81% White). Historically, PYD has been modeled as either separate correlated factors or a second-order factor structure. More recently, the bifactor model has been recommended to determine the degree to which PYD is unidimensional versus multidimensional. The present study examined the multidimensionality of PYD by comparing the model fit of a one-factor, five-correlated factor model, and second-order factor structure with a bifactor model and found support for the bifactor model with evidence of invariance across sex. Criterion validity was also assessed using three criterion measures particularly relevant for adjustment during emerging adulthood: anxiety, depressive symptoms, and emotion regulation difficulties. PYD and the residual Cs tended to correlate negatively with indicators of maladaptive development. Future directions including applications of the PYD framework as a measure of thriving across emerging adulthood are discussed.

Social Functioning in Youth with Attention-Deficit/Hyperactivity Disorder and Sluggish Cognitive Tempo.

The current review summarizes the research to date on social functioning for youth with attention-deficit/hyperactivity disorder (ADHD) with a focus on three key domains: peer rejection, friendship, and social information processing. The review extends past reviews by examining the research to date on how the presence of sluggish cognitive tempo (SCT) symptoms, a common correlate of ADHD, affects the social presentation of youth with ADHD. Overall, youth with ADHD show significant difficulty with peer rejection, forming and maintaining friendships, and abnormalities in how they process and respond to social information. Further, the presence of SCT symptoms results in great social withdrawal and isolation. Future studies are needed to better understand the social difficulties of youth with ADHD, particularly using experimental approaches that can manipulate and isolate mechanisms within the social information processing model. In addition, novel intervention approaches are needed to more effectively ameliorate the social difficulties of youth with ADHD and those with co-occurring SCT symptoms.

Evidence-Based Assessment of ADHD in Youth Using a Receiver Operating Characteristic Approach.

Guidelines exist for the assessment of attention deficit/hyperactivity disorder (ADHD), but they are often unclear as to how a clinician should consider multiple informants, methods, and co-occurring symptoms to reach an overall diagnostic probability for an individual patient. The current study used receiver operating characteristic analyses and evidence-based medicine methods to evaluate the Achenbach System of Empirically Based Assessment measures and the Conners' Continuous Performance Test for ADHD diagnosis in youth. Children (n = 379) and their parent(s) presented at an outpatient clinic for a psychoeducational assessment. Analyses examined the diagnostic efficiency and utility of study measures for predicting a best-estimate ADHD diagnosis. The Child Behavior Checklist Attention Problems construct, Teacher Report Form Attention Problems construct, and Hit Reaction Time Standard Error showed adequate diagnostic efficiency and unique contributions to the prediction of ADHD, Combined Type diagnosis. None of these measures showed good diagnostic efficiency or utility for the prediction of ADHD, Predominantly Inattentive Type. Child anxiety did not moderate the relations between predictors and ADHD diagnosis. Both the Child Behavior Checklist and Teacher Report Form Attention Problems constructs can discriminate youth with ADHD, Combined Type from other clinic-referred youth. Although Hit Reaction Time Standard Error also showed diagnostic utility, the decision to include a computerized measure should consider time and expense and be utilized in cases where diagnostic probability is unclear. Finally, anxiety may be associated with elevated attention problems, but it does not appear that anxiety affects diagnostic cutoffs for ADHD.

Parent Management Training and Collaborative & Proactive Solutions: A Randomized Control Trial for Oppositional Youth.

This study examined the efficacy of Collaborative & Proactive Solutions (CPS) in treating oppositional defiant disorder (ODD) in youth by comparing this novel treatment to Parent Management Training (PMT), a well-established treatment, and a waitlist control (WLC) group. One hundred thirty-four youth (ages 7-14, 61.9% male, 83.6% White) who fulfilled Diagnostic and Statistical Manual of Mental Disorders (4th ed.) criteria for ODD were randomized to CPS, PMT, or WLC groups. ODD was assessed with semistructured diagnostic interviews, clinical global severity and improvement ratings, and parent report measures. Assessments were completed pretreatment, posttreatment, and at 6 months following treatment. Responder and remitter analyses were undertaken using intent-to-treat mixed-models analyses. Chronological age, gender, and socioeconomic status as well as the presence of comorbid attention deficit/hyperactivity and anxiety disorders were examined as predictors of treatment outcome. Both treatment conditions were superior to the WLC condition but did not differ from one another in either our responder or remitter analyses. Approximately 50% of youth in both active treatments were diagnosis free and were judged to be much or very much improved at posttreatment, compared to 0% in the waitlist condition. Younger age and presence of an anxiety disorder predicted better treatment outcomes for both PMT and CPS. Treatment gains were maintained at 6-month follow-up. CPS proved to be equivalent to PMT and can be considered an evidence-based, alternative treatment for youth with ODD and their families.

Primary Versus Secondary Diagnosis of Generalized Anxiety Disorder in Youth: Is the Distinction an Important One?

Examine whether children with a primary diagnosis of generalized anxiety disorder (GAD) differ from children with a secondary diagnosis of GAD on clinician, parent, teacher, and youth-report measures. Based on consensus diagnoses, 64 youth referred to a general outpatient assessment clinic were categorized as having either a primary or secondary diagnosis of GAD. A semi-structured diagnostic interview was used to guide diagnostic decisions and assign primary versus secondary diagnostic status. We predicted that youth with a primary GAD diagnosis would present with greater anxiety symptomatology and symptom impairment on a variety of anxiety-related measures than youth with a secondary GAD diagnosis. Contrary to our hypotheses, no differences were found between those with primary versus secondary GAD diagnoses on measures of symptom severity and clinical impairment, comorbid diagnoses, or youth and teacher-report measures. Our findings have potential implications for the current practice of requiring primary anxiety diagnostic status as an inclusion criterion in clinical research and treatment outcome studies. Assuming our findings are confirmed in larger samples and with other anxiety disorders, future clinical trials and basic psychopathology research might not exclude youth based on absence of a particular anxiety disorder as the primary disorder but rather include individuals for whom that anxiety disorder is secondary as well.

The importance of executive functioning for social skills in college students: a relative weights analysis.

STATEMENT OF RELEVANCE: Social interaction is one of the most important things that humans do on a day-to-day basis, impacting both mental and physical wellness. College is a particularly important period where social interaction becomes increasingly important as well as complex. While there is no currently agreed upon cognitive basis of social interaction, the executive function (EF) system is believed to play a central role. The current study provides further evidence of the role of the EF system across different social skills in addition to highlighting the complexity of these relationships.

ADHD and dangerous driving in emerging adults: The moderating role of family climate for road safety.

Dangerous driving accounts for 95% of driving fatalities among emerging adults. Emerging adult drivers exhibiting symptoms of Attention-Deficit/Hyperactivity Disorder (ADHD) are at greater risk for motor vehicle crashes and engaging in unsafe driving practices; however, not all individuals with ADHD symptoms exhibit such risk. Several studies have found that drivers' perceptions of their family's values and priorities related to driving practices predict driving outcomes among emerging adults; these factors have not been examined in the context of ADHD symptomology. We examined family climate for road safety as a moderator of ADHD symptoms and dangerous driving behaviors in a sample of college students. A total of 4,392 participants completed surveys measuring self-reported ADHD symptoms, dangerous driving behavior, and family climate for road safety. Results indicated that higher levels of parental feedback weakened the relation between ADHD symptoms and aggressive driving; higher levels of parental monitoring strengthened this relationship. Higher levels of parental monitoring strengthened the association between ADHD symptoms and negative emotion while driving. When participants perceived their parents as having high levels of noncommitment to road safety, the association between ADHD symptoms and self-reported risky driving increased. Higher levels of open communication about unsafe driving attenuated the relation between ADHD and risky driving. Overall, some but not all components of family climate for road safety appear to affect the relation between ADHD symptoms and dangerous driving in the expected direction.

Barkley Deficits in Executive Functioning Scale (BDEFS): Validation in a Large Multisite College Sample.

Despite the importance of daily life executive functioning (EF) for college students' success, few measures exist that have been validated in college students specifically. This study examined the factor structure of the Barkley Deficits in Executive Functioning Scale (BDEFS) in college students. Participants were 1,311 students (ages 18-28 years, 65% female) from five universities in the United States. Additionally, the study examined invariance across sex, age, and attention-deficit/hyperactivity disorder symptoms. Exploratory structural equation modeling provided strong support for the BDEFS five-factor structure though some items had high cross-loadings on multiple factors. Findings generally supported invariance across sex and age; however, loadings, thresholds, and factor means differed based on attention-deficit/hyperactivity disorder symptoms. Stronger support for invariance across sex emerged for a reduced item version that eliminated cross-loading items. Overall, findings provide support for the validity and utility of the BDEFS in college students.

Sleep, Internalizing Problems, and Social Withdrawal: Unique Associations in Clinic-Referred Youth With Elevated Sluggish Cognitive Tempo Symptoms.

Objective: We compared clinic-referred youth with ADHD + sluggish cognitive tempo (SCT; n = 34), ADHD Only (n = 108), and SCT Only (n = 22) on demographics, co-occurring symptomatology, comorbid diagnoses, and social functioning. Method: In total, 164 youth (age = 6-17 years, M = 9.97) and their parent(s) presented to an outpatient clinic for a psychoeducational assessment. Between-group analyses and regressions were used to examine study variables. Results: SCT groups were older and exhibited more parent-reported internalizing problems, externalizing problems, sleep problems, and social withdrawal on the Child Behavior Checklist. No significant differences emerged between groups on the Teacher Report Form. Regression analyses involving multiple covariates revealed that SCT symptoms were uniquely related to social withdrawal but not general social problems. Conclusion: Based on parent report, SCT symptoms have a unique relationship with internalizing problems, sleep problems, and social withdrawal. Future research should explore correlates of SCT in youth using multiple informants.

Disentangling the effects of attentional difficulties on fears of social evaluation and social anxiety symptoms: Unique interactions with sluggish cognitive tempo.

Although fears of negative and positive social evaluation are hallmark cognitive features of social anxiety, attentional difficulties may exacerbate the relation between fears of social evaluation and social anxiety. Thus, the goal of the current study was to test whether two different types of self-reported attentional difficulties, specifically sluggish cognitive tempo (SCT) and attention-deficit/hyperactivity disorder (ADHD) inattention symptoms, moderate the relation between fears of social evaluation and social anxiety. Participants (N = 4756; Mage = 19.28 years; 72.7% female) enrolled in five universities across the United States completed self-report measures of fears of negative and positive evaluation and psychopathology symptoms. Results indicated a significant two-way interaction of fear of negative evaluation and SCT in relation to social anxiety symptoms, as well as a significant two-way interaction of fear of positive evaluation and SCT in relation to social anxiety symptoms. In both instances, the associations between fears of negative and positive evaluation in relation to social anxiety became increasingly stronger at higher levels of SCT. Conversely, the interactions between fears of negative and positive evaluation with ADHD inattentive symptoms were non-significant. These results are the first to report that self-reported SCT, but not ADHD inattentive symptoms, exacerbate the relation between fears of social evaluation and social anxiety, and suggest that attentional difficulties characteristic of SCT may prolong engagement in fears.

Co-reminiscing with a caregiver about a devastating tornado: Association with adolescent anxiety symptoms.

This study explores the association between caregivers' style of co-reminiscing with their adolescents about an EF4 tornado and youth anxiety symptoms several years following the disaster. Caregiver reward of their children's emotional expression, defined as attending to and validating emotionally salient content, is generally associated with adaptive youth psychosocial outcomes. However, caregiver reward of youth recollections that are centered around the youth's negative emotional expression could be an indicator that both caregivers and adolescents are engaged in co-rumination regarding negative emotional experiences. This process may contribute to relatively higher levels of anxiety over time. Adolescents (N = 169) drawn from an ongoing study for aggressive youth (ages 12 to 17; 82% African American) provided individual recollections about their experiences during a devastating tornado 4 to 5 years following the disaster. Caregivers and youth then co-reminisced about their tornado-related experiences. Individual youth recollections were coded for negative personal impact and use of negative emotion words; caregiver-adolescent conversations were coded for caregiver reward of negative emotional expression. Youth who noted more negative personal impacts and used more negative emotion words were higher in parent-rated youth anxiety, and these associations were moderated by caregiver reward of negative emotional expression. The associations between youth recollection qualities and anxiety emerged only when caregivers exhibited high levels of reward of negative emotional expression. These patterns were generally stronger for girls compared to boys. Findings suggest that excessively discussing and rehashing negative experiences, especially several years after the disaster, may be a risk factor for anxiety among disaster-exposed adolescents. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

An EEG Study of Children With and Without ADHD Symptoms: Between-Group Differences and Associations With Sluggish Cognitive Tempo Symptoms.

Objective: We examined differences between those with and without ADHD symptoms on resting state electroencephalography (EEG) indices and unique relations with sluggish cognitive tempo (SCT) symptoms. Method: Children with ADHD symptoms (n = 21) and healthy controls (n = 20) were assessed using rating scales, a neuropsychological task measuring sustained attention and inhibitory control, and EEG activity during a resting state period. Between-group, correlational, and regression analyses were conducted. Results: Large differences (particularly for theta/beta ratio in frontal and frontocentral regions) were found on EEG measures between those with and without ADHD symptoms. While ADHD and SCT symptoms both related to sustained attention on a computerized task, only ADHD symptoms were related to frontal and frontocentral theta/beta ratio. Conclusion: Results support the conclusion that ADHD symptoms are strongly associated with theta/beta ratio in frontal and frontocentral regions. Future studies should explore unique neurophysiological correlates of SCT.

Factor structure of the family climate for road safety scale in emerging adults in the United States.

The Family Climate for Road Safety Scale (FCRSS) was developed to measure parenting behaviors specific to the driving context. The original validation study found a scale structure composed of seven factors. However, this structure has not been consistently replicated. Two- and six-factor structures have also been identified. Further, this measure has not been validated in the U.S. and has not been subjected to measurement invariance testing to determine the factor structure's suitability across sex. Additionally, its ability to predict the driving style of emerging adults with varied driving experience has not been directly examined. The current study utilized exploratory and confirmatory factor analytic procedures to identify the factor structure of the FCRSS in a sample of emerging adults in the U.S. The sample consisted of 4392 students recruited from six universities. The sample was predominantly female (68.8 %), and was 83.5 % White, 6.1 % Black or African American, 5.1 % Asian American, 4.6 % biracial or multiracial, 0.4 % American Indian or Alaskan Native, and 0.2 % Pacific Islander or Hawaiian. Results indicated that a five-factor model of the FCRSS provided the best fit to the data compared to one-, two-, six-, and seven-factor models. The five factors identified for the model were: Noncommitment, Monitoring, Feedback, Communication, and Modeling. Further, invariance testing revealed that the five-factor model fit equally well for males and females. Some factors of the FCRSS predicted driving outcomes and driving styles in the expected directions. These findings have implications for family/parenting-based driving interventions for adolescents and young adults.

Sluggish cognitive tempo and positive valence systems: Unique relations with greater reward valuation but less willingness to work.

BACKGROUND: Research has started conceptualizing sluggish cognitive tempo (SCT) within the Research Domain Criteria (RDoC), but no study has tested SCT symptomatology in relation to the positive valence systems. METHODS: Participants (N = 4,679; 18-29 years; M = 19.08, SD = 1.36; 69% female; 80.9% White) enrolled in six universities in the United States completed self-reported measures of positive valence systems, SCT, and psychopathology dimensions. RESULTS: SCT symptoms were uniquely associated with greater reward valuation and expectancy of reward, but less willingness to work for reward. SCT symptoms were not uniquely related to initial and sustained response to reward. Conversely, depressive symptoms remained uniquely associated with greater reward valuation but less expectancy, willingness to work, initial, and sustained response to reward. LIMITATIONS: The present study included a relatively homogenous sample of college-age students, solely relied on self-report measures of the positive valence systems, and analyses were conducted cross-sectionally. CONCLUSIONS: Findings demonstrated that SCT has unique relations with various components of the positive valence system while controlling for commonly co-occurring psychopathology dimensions. Future research should continue investigating relations between SCT and positive valence systems to understand whether these domains may be targets for prevention and intervention.