Examining the associations between attention-deficit/hyperactivity disorder, sleep problems, and other mental health conditions in adolescents.

Adolescents with attention-deficit/hyperactivity disorder (ADHD) often experience greater sleep difficulties compared to those without. However, findings are mixed, and other mental health conditions are often overlooked. This study aimed to examine the relationship between sleep problems, ADHD, and other mental health conditions in a sample of adolescents. Data from 373 adolescents aged 10-19 years was used as part of the wider 'Healthy Brain Network' study, which targets children and adolescents experiencing mental health and neurodevelopmental difficulties. Mental health conditions were assessed via a comprehensive assessment. Sleep was measured by self- and parent-report, as well as via up to a month of actigraphy data. Actigraphy data were analysed using mixed-methods modelling, while subjective sleep data were analysed using multiple regression. Subjectively-reported sleep was generally worse in adolescents who had ADHD and other mental health conditions compared to those with ADHD but no other conditions. There were no associations between ADHD status and objective sleep measures or self-reported measures, but a significant association was found between ADHD status and parent-reported sleep difficulties, even when accounting for other conditions. Parent-reported sleep problems were associated not only with ADHD, but also with anxiety, depression, and externalising disorders. The strength of association between ADHD and sleep problems is potentially not as strong as previously thought when considering the role of other mental health conditions. Clinicians should consider the role of other mental health conditions when sleep problems are present, and vice versa. The study also highlights the importance of comprehensive, multi-informant assessment of mental health conditions, including sleep.

The influence of deliberate practice on skill performance in therapeutic practice: A systematic review of early studies.

OBJECTIVE: Deliberate practice (DP) is recommended as a new approach to facilitate the acquisition of discrete therapeutic skills, however, its implementation and effectiveness in psychotherapy remains unclear. METHOD: A systematic search on DP for therapeutic skills among psychotherapy trainees and psychotherapists yielded eleven studies for inclusion. Nine were randomized controlled studies (RCTs), including seven unique RCTs, and two were within-group studies. RESULTS: Risk of bias was assessed as "high" for one RCT, "some concerns" for the remaining RCTs, and "serious" for within-group studies. All RCTs found the DP group performed better than the control group. All studies involved efforts to improve performance based on learning objectives and iterative practice but varied in the source of expert guidance and feedback. The included studies provide limited insight into best practice for delivering DP. CONCLUSION: The results highlight the paucity of research in this field; however they offer insight into current applications of DP and provide preliminary empirical support DP for as a model for promoting the development of discrete therapeutic skills. Given the rapid dissemination of DP publications and manuals in psychotherapy, future research is strongly encouraged.

Parent and child mental health trajectories April 2020 to May 2021: Strict lockdown versus no lockdown in Australia.

OBJECTIVE: To control a second-wave COVID-19 outbreak, the state of Victoria in Australia experienced one of the world's first long and strict lockdowns over July-October 2020, while the rest of Australia experienced 'COVID-normal' with minimal restrictions. We (1) investigate trajectories of parent/child mental health outcomes in Victoria vs non-Victoria and (2) identify baseline demographic, individual and COVID-19-related factors associated with mental health trajectories. METHODS: Online community sample of 2004 Australian parents with rapid repeated assessment over 14 time-points over April 2020 to May 2021. Measures assessed parent mental health (Depression, Anxiety and Stress Scales-21), child depression symptoms (13-item Short Mood and Feelings Questionnaire) and child anxiety symptoms (four items from Brief Spence Children's Anxiety Scale). RESULTS: Mental health trajectories shadowed COVID-19 infection rates. Victorians reported a peak in mental health symptoms at the time of the second-wave lockdown compared to other states. Key baseline predictors, including parent and child loneliness (standardized regression coefficient [ß] = 0.09-0.46), parent/child diagnoses (ß = 0.07-0.21), couple conflict (ß = 0.07-0.18) and COVID-19 stressors, such as worry/concern about COVID-19, illness and loss of job (ß = 0.12-0.15), predicted elevated trajectories. Effects of predictors on parent and child mental health trajectories are illustrated in an online interactive app for readers (https://lingtax.shinyapps.io/CPAS_trend/). CONCLUSION: Our findings provide evidence of worse trajectories of parent and child mental health symptoms at a time coinciding with a second COVID-19 outbreak involving strict lockdown in Victoria, compared to non-locked states in Australia. We identified several baseline factors that may be useful in detecting high-risk families who are likely to require additional support early on in future lockdowns.

A qualitative examination of the motivations behind vegan, vegetarian, and omnivore diets in an Australian population.

There is a growing shift towards meat reducing diets, especially in Western nations, in the last decade. Whilst research has examined the potential motivations in adopting meat reducing diets, there are a limited number of studies which directly compare diet-related motivations across dietary groups, especially comparing meat reducing diet groups to omnivores. As such, it is unclear whether these dietary groups have distinctly different motivations for adopting their diets. This study aimed to examine the motivations that underlie people's dietary choices, and to compare these across three dietary groups; vegan, vegetarian, omnivore. A sample of 701 participants participated in the study (Mage = 30.09, SDage = 10.91). Participants were asked to self-describe the diet they follow and provide a written response as to why they choose to follow this diet. A content analysis indicated that the participants' motivations were similar across the three dietary groups. Similar reasons included health and environment, with the health reason common across all three groups. For vegan and vegetarians the most common was animal welfare. However, taste and enjoyment for diet was most common for omnivores. The overlap in responses across the dietary groups suggests that dietary motivations are similar across these three groups. Therefore, rather than simply employing motivations to encourage reduced meat diets, it may be better to develop more personalised interventions to achieve this.

Experiences and perspectives of self-compassion from young adult children of parents with mental illness.

INTRODUCTION: In adolescents and young adults, self-compassion has been positively associated with wellbeing and negatively associated with psychological distress. One population of youth who may draw particular benefit from self-compassion are those who have parents with mental illness. This qualitative study explored the perspectives and experiences of self-compassion among a group of young adult children of parents with mental illness. METHODS: A purposive sample of ten Australian emerging adults aged 18-25 years (3 men, 6 women and 1 non-binary person) participated in individual semi-structured telephone interviews. Interpretative Phenomenological Analysis was used to examine and interpret participants' experiences and perspectives of self-compassion. RESULTS: Participants described self-compassion as personally relevant and beneficial, although difficult to engage in. Some participants had learnt about, and actively practiced self-compassion, and offered advice for others. Conversely, others described self-compassion as difficult to practice and outlined barriers to self-compassion, from society and family life. Although participants identified common negative social conceptions of self-compassion, they articulated how self-compassion could be valuable for those who have parents with mental illness. CONCLUSIONS: Results indicate the perceived importance of self-compassion along with barriers and facilitators of self-compassion for young adults who have parents with a mental illness. Implications for clinical practice and suggestions for future research are presented.

Systematic review of meditation-based interventions for children with ADHD.

Meditation-based interventions such as mindfulness and yoga are commonly practiced in the general community to improve mental and physical health. Parents, teachers and healthcare providers are also increasingly using such interventions with children. This review examines the use of meditation-based interventions in the treatment of children with Attention-Deficit Hyperactivity Disorder (ADHD). Electronic databases searched included PsycINFO, Medline, CINAHL, and AMED. Inclusion criteria involved children (aged to 18 years) diagnosed with ADHD, delivery of a meditation-based intervention to children and/or parents, and publication in a peer-reviewed journal. Studies were identified and coded using standard criteria, risk of bias was assessed using Risk of Bias in Non-randomised Studies- of interventions (ROBINS-I), and effect sizes were calculated. A total of 16 studies were identified (8 that included children in treatment, and 8 that included combined parent-child treatment). Results indicated that risk of bias was high across studies. At this stage, no definitive conclusions can be offered regarding the utility of meditation-based interventions for children with ADHD and/or their parents, since the methodological quality of the studies reviewed is low. Future well designed research is needed to establish the efficacy of meditation-based interventions, including commonly used practices such as mindfulness, before recommendations can be made for children with ADHD and their families.

People do change their beliefs about conspiracy theories-but not often.

Recent research has produced a significant body of knowledge about the antecedents and consequences of individual differences in belief in conspiracy theories. What is less clear, however, is the extent to which individuals' beliefs in conspiracy theories vary over time (i.e., within-person variation). In this descriptive and exploratory study, we therefore aimed to describe within-person variability in belief in conspiracy theories. We collected data from 498 Australians and New Zealanders using an online longitudinal survey, with data collected at monthly intervals over 6 months (March to September 2021). Our measure of conspiracy theories included items describing ten conspiracy theories with responses on a 5-point Likert scale. While there was substantial between-person variance, there was much less within-person variance (intraclass r = 0.91). This suggests that beliefs in conspiracy theories were highly stable in our sample. This stability implies that longitudinal studies testing hypotheses about the causes and consequences of belief in conspiracy theories may require large samples of participants and time points to achieve adequate power. It also implies that explanations of belief in conspiracy theories need to accommodate the observation that beliefs in such theories vary much more between people than within people.

Can temporal self-regulation theory and its constructs predict medication adherence? A systematic review and meta-analysis.

The relationships between temporal self-regulation theory (TST) constructs (intention, behavioural prepotency and self-regulatory capacity) and medication adherence should be established before further applying the theory to adherence. Searches of PsychINFO, Medline, EMBASE, CINAHL and Web of Science were conducted in 2019 (updated November 2021). Studies had to be original quantitative research, assessed the relationship between one of the constructs and adherence in one illness, and used an adult population. The risk of bias was assessed using the NHLBI Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Three meta-analyses were conducted using R. Moderation analyses were also conducted. A total of 57 articles (60 studies) with 13,995 participants were included, with 7 studies included in more than one analysis. Results identified significant correlations between intention (r = .369, [95% CI: .25, .48]), behavioural prepotency (r = .332, [95% CI: .18, .48]), self-regulatory capacity (r = .213, [95% CI: .10, .32]) and adherence. There was some evidence of publication bias and no significant moderators. No studies explored the interactions in the theory, so whilst the constructs adequately predict adherence, future research should apply the theory to adherence in a specific illness to assess these relationships. Pre-registered on Prospero: CRD42019141395.

Associations Between ADHD, Sleep Problems, and Mental Health Symptoms in Adolescents.

OBJECTIVE: This study examined associations between objective and subjective sleep parameters, and mental health symptoms (internalizing symptoms, externalizing symptoms, and irritability) and whether these relationships differed for adolescents with and without ADHD. METHOD: Participants were 373 adolescents aged 10 to 19 years (M = 13.21, SD = 2.37). Sleep was measured both via actigraphy and self- and parent-report scales. Mental health symptoms were measured via a range of validated measures. RESULTS: Few relationships were detected when examining actigraphy variables. Subjective sleep parameters were associated with almost all mental health variables. Some relationships were moderated by ADHD status, generally consistent with stronger relationships between subjective sleep quality and mental health in the non-ADHD group. CONCLUSION: Sleep problems, particularly subjective difficulties, are associated with a range of mental health outcomes, regardless of the presence of ADHD. Sleep problems may be a beneficial intervention target for adolescents experiencing mental health issues.

The prevalence of probable mental health disorders among hospital healthcare workers during COVID-19: A systematic review and meta-analysis.

OBJECTIVES: The mental health impacts of the COVID-19 pandemic continue to be documented worldwide with systematic reviews playing a pivotal role. Here we present updated findings from our systematic review and meta-analysis on the mental health impacts among hospital healthcare workers during COVID-19. METHODS: We searched MEDLINE, CINAHL, PsycINFO, Embase and Web Of Science Core Collection between 1st January 2000 to 17th February 2022 for studies using validated methods and reporting on the prevalence of diagnosed or probable mental health disorders in hospital healthcare workers during the COVID-19 pandemic. A meta-analysis of proportions and odds ratio was performed using a random effects model. Heterogeneity was investigated using test of subgroup differences and 95 % prediction intervals. RESULTS: The meta-analysis included 401 studies, representing 458,754 participants across 58 countries. Pooled prevalence of depression was 28.5 % (95 % CI: 26.3-30.7), anxiety was 28.7 % (95 % CI: 26.5-31.0), PTSD was 25.5 % (95 % CI: 22.5-28.5), alcohol and substance use disorder was 25.3 % (95 % CI: 13.3-39.6) and insomnia was 24.4 % (95 % CI: 19.4-29.9). Prevalence rates were stratified by physicians, nurses, allied health, support staff and healthcare students, which varied considerably. There were significantly higher odds of probable mental health disorders in women, those working in high-risk units and those providing direct care. LIMITATIONS: Majority of studies used self-report measures which reflected probable mental health disorders rather than actual diagnosis. CONCLUSIONS: These updated findings have enhanced our understanding of at-risk groups working in hospitals. Targeted support and research towards these differences in mental health risks are recommended to mitigate any long-term consequences.

Key predictors of psychological distress and wellbeing in Australian frontline healthcare workers during COVID-19 (Omicron wave).

Introduction: The COVID-19 pandemic has led to significant challenges for frontline healthcare workers' (FHW), raising many mental health and wellbeing concerns for this cohort. To facilitate identification of risk and protective factors to inform treatment and interventions, this study investigated key predictors of psychological distress and subjective wellbeing in FHWs. Methods: During the Omicron wave of the COVID-19 pandemic (January 2022), Victorian (Australia) doctors, nurses, allied health and non-medical staff from Emergency Departments, Intensive Care units, Aged Care, Hospital In The Home, and COVID Wards completed a cross-sectional survey consisting of the Kessler 6 item (Psychological Distress), Personal Wellbeing Index (Subjective Wellbeing), Coronavirus Health Impact Survey tool (COVID-19 related factors) and occupational factors. Multivariable linear regressions were used to evaluate unadjusted and adjusted associations. Relative weight analysis was used to compare and identify key predictors. Results: Out of 167 participants, 18.1% screened positive for a probable mental illness and a further 15.3% screened positive for low wellbeing. Key risk factors for greater psychological distress included COVID infection worries, relationship stress and younger age. For both psychological distress and lower wellbeing, health status and supervisor support were key protective factors, while infection risks were key risk factors. Only positive changes in relationship quality was protective of lower wellbeing. Conclusion: This study highlights the significance of social determinants and individual level factors alongside work related factors, in influencing FHWs' mental health and wellbeing during public health crises, such as the COVID-19 pandemic. Findings suggest that future interventions and supports should take a more holistic approach that considers work, social and individual level factors when supporting FHWs' mental health and wellbeing.

The impact of structured self-monitoring of blood glucose on clinical, behavioral, and psychosocial outcomes among adults with non-insulin-treated type 2 diabetes: a systematic review and meta-analysis.

Background: Self-monitoring of blood glucose (SMBG) is considered of little clinical benefit for adults with non-insulin-treated type 2 diabetes, but no comprehensive review of a structured approach to SMBG has been published to date. Purpose: To conduct a systematic review and meta-analysis of the impact of sSMBG on HbA1c, treatment modifications, behavioral and psychosocial outcomes, and; examine the moderating effects of sSMBG protocol characteristics on HbA1c. Data sources: Four databases searched (November 2020; updated: February 2022). Study selection: Inclusion criteria: non-randomized and randomized controlled trials (RCTs) and prospective observational studies; reporting effect of sSMBG on stated outcomes; among adults (≥18 years) with non-insulin-treated type 2 diabetes. Studies excluded if involving children or people with insulin-treated or other forms of diabetes. Data extraction and analysis: Outcome data extracted, and risk of bias/quality assessed independently by two researchers. Meta-analysis was conducted for RCTs, and moderators explored (HbA1c only). Data synthesis: From 2,078 abstracts, k=23 studies were included (N=5,372). Risk of bias was evident and study quality was low. Outcomes assessed included: HbA1c (k=23), treatment modification (k=16), psychosocial/behavioral outcomes (k=12). Meta-analysis revealed a significant mean difference favoring sSMBG in HbA1c (-0·29%, 95% CI: -0·46 to -0·11, k=13) and diabetes self-efficacy (0.17%, 95% CI: 0.01 to 0.33, k=2). Meta-analysis revealed no significant moderating effects by protocol characteristics. Limitations: Findings limited by heterogeneity in study designs, intervention characteristics, and psychosocial assessments. Conclusion: A small positive effect of sSMBG on HbA1c and diabetes self-efficacy was observed. Narrative synthesis of sSMBG intervention characteristics may guide future implementation. PROSPERO registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020208857, identifier CRD42020208857.

Why are beliefs in different conspiracy theories positively correlated across individuals? Testing monological network versus unidimensional factor model explanations.

A substantial minority of the public express belief in conspiracy theories. A robust phenomenon in this area is that people who believe one conspiracy theory are more likely to believe in others. But the reason for this "positive manifold" of belief in conspiracy theories is unclear. One possibility is that a single underlying latent factor (e.g. "conspiracism") causes variation in belief in specific conspiracy theories. Another possibility is that beliefs in various conspiracy theories support one another in a mutually reinforcing network of beliefs (the "monological belief system" theory). While the monological theory has been influential in the literature, the fact that it can be operationalised as a statistical network model has not previously been recognised. In this study, we therefore tested both the unidimensional factor model and a network model. Participants were 1553 American adults recruited via Prolific. Belief in conspiracies was measured using an adapted version of the Belief in Conspiracy Theories Inventory. The fit of the two competing models was evaluated both by using van Bork et al.'s (Psychometrika, 83, 2018, 443, Multivariate Behavioral Research, 56, 2019, 175) method for testing network versus unidimensional factor models, as well as by evaluating goodness of fit to the sample covariance matrix. In both cases, evaluation of fit according to our pre-registered inferential criteria favoured the network model.

The interteacher reliability of assessments of adolescents.

Teachers are uniquely placed to comment on the psychosocial functioning of their students. In particular, teacher report of symptoms and functional impairment is crucial in a diagnostic assessment of Attention-deficit Hyperactivity Disorder (ADHD). For adolescents, however, schooling structures and other factors can influence the reliability of teacher reports. Clarity is needed for both clinicians and researchers regarding the interteacher reliability across different domains in the assessment of adolescents. This study investigated interrater reliability of teacher reports of adolescents using data from the 72-month follow-up of the National Institute of Mental Health (NIMH) Collaborative Multisite Multimodal Treatment Study of Children with ADHD (MTA) when participants were 13-15.9 years old. For adolescents with a history of ADHD (MTA; N = 177-210), and a normative comparison group (Local Normative Control Group [LNCG]; N = 100-125), intraclass correlations (ICC) were examined between Math and English teacher reports of ADHD symptoms, externalizing behavior, scholastic competence, and social functioning. Results indicate poor to moderate reliability in the assessment of adolescents with a history of ADHD for core ADHD symptoms, social functioning and scholastic competence, and moderate to good reliability of externalizing behavior. Interteacher reliability was better for the normative comparison group in all domains except social functioning, which was also poor to moderate. Clinicians and researchers should be aware of potential inconsistencies in teacher reports and where possible collect multiple teacher reports to maximize reliability. Further implications for research and clinical practice are explored. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The impact of different responses to negative body talk on body satisfaction, shame, and future negative body talk likelihood: A UK sample.

A recent online experiment found that, following a negative body talk induction task, receiving a response of ignoring the comment, compared with reassuring, reciprocating, and challenging, led to worse body satisfaction and socio-emotional outcomes for Australian women. The current online study aimed to replicate and extend this study by examining the effects of these four negative body talk responses on body satisfaction, shame, and future negative body talk likelihood in UK-based women. Participants (N = 156, Mage = 25.29, SDage = 5.64, rangeage = 18-40) recalled a scenario in which they engaged in negative body talk and were randomly assigned to receive one of four responses. Contrary to hypotheses, there were no significant differences in body satisfaction, shame, or future negative body talk likelihood across the four groups. Preferred negative body talk response data were mixed, with challenge and reassurance responses preferred at comparable rates, and just under a quarter of participants preferring a response outside of the original four. Possible explanations, including that the responses used in the original Australasian study may not perfectly correspond with UK women's experiences of social interactions and heterogeneous motivations for engaging in negative body talk necessitate more nuanced and sophisticated responses, are explored.

Variation in latent social profiles of adolescent ADHD and related clinical features.

Social impairment is a hallmark of Attention-deficit/hyperactivity disorder (ADHD), but the extent of variation in adolescent social strengths and weaknesses is unclear. We compared teacher-reported characteristics of social functioning in adolescents with a history of ADHD (N = 340), and without ADHD (N = 182) from the NIMH Collaborative Multisite Multimodal Treatment Study of Children with ADHD (MTA) at 72-month follow-up (13 - 15.9 years-old). Latent profile analysis of teacher-reported cooperation, assertion and self-control on the Social Skills Rating System (SSRS), was used to identify "social profiles". Their associations with clinical features were explored. Significant differences in social functioning were identified between adolescents with a history of ADHD, and without ADHD (ES = 0.54 - 0.77). Four distinct social profiles were identified in adolescents with a history of ADHD: unskilled (N = 24, 7%), low average (N = 144, 42%), average (N = 141, 41%), and skilled (N = 31, 9%). Profiles with worse social functioning (low average, unskilled) displayed more symptoms of inattention, hyperactivity/impulsivity, oppositionality, depression, global impairment, and were less liked, more rejected and ignored by peers than average and skilled. Social profile membership was not associated with sex, anxiety symptoms, or remittance / persistence of ADHD. Social functioning in adolescents with a history of ADHD is variable, and associated with worse symptomology, global functioning, and peer relationships, irrespective of persistence or remittance of ADHD. Group level summaries of social difficulties in ADHD may be inadequate given nearly half of adolescents with a history of ADHD presented with average or skilled social profiles.

Interventions for Adolescents With ADHD to Improve Peer Social Functioning: A Systematic Review and Meta-Analysis.

Objective: Peer social functioning difficulties characteristic of ADHD persist into adolescence, but the efficacy of interventions for this age group remains unclear. Method: A systematic search of nonpharmacological interventions for adolescents with ADHD (10-18 years) identified 11 trials addressing social functioning, of which eight were included in meta-analyses. Results: Random effects meta-analyses of four randomized trials found no differences in social functioning between treatment and control groups by parent- (g = -0.08 [-0.34, 0.19], k = 4, N = 354) or teacher-report (g = 0.17 [-0.06, 0.40], k = 3, N = 301). Meta-analyses of nonrandomized studies indicated participants' social functioning improved from baseline to postintervention by parent-report, but not teacher- or self-report. All trials had a high risk of bias. Conclusion: These results highlight the paucity of research in this age group. There is little evidence that current interventions improve peer social functioning. Clearer conceptualizations of developmentally relevant targets for remediation may yield more efficacious social interventions.

Associations between conspiracism and the rejection of scientific innovations.

Public opinion regarding scientific developments such as genetically modified food can be mixed. We suggest such science-based technological innovations are rejected by some because they are perceived to be advanced as part of a conspiracy. In nationally representative samples (Australia n = 1011; New Zealand n = 754), we report the associations between five conspiracism facets and anti-science attitudes. Results indicate broad public opposition to genetically modified food and use of nuclear power, but more acceptance of renewable power, potable recycled water, 5G networks, and childhood vaccinations. There were small to moderate associations between the rejection of scientific innovations and conspiracism. Multivariate models estimating unique associations of conspiracism facets with anti-science attitudes suggested several novel and important relationships, particularly for childhood vaccination, genetically modified food, and 5G networks. We discuss the importance of examining factors such as conspiracism in understanding what may motivate and sustain rejection of scientific evidence-based claims about socially contentious technological innovations.

Associations between sleep, daytime sleepiness and functional outcomes in adolescents with ADHD.

OBJECTIVE/BACKGROUND: Adolescents with attention-deficit/hyperactivity disorder (ADHD) experience greater difficulties in the domains of sleep, daytime sleepiness, and functioning compared to their peers. However, the relationship between these domains has not been fully elucidated. This study aimed to examine the relationship between sleep problems (including daytime sleepiness), ADHD severity, and functional outcomes (irritability, sluggish cognitive tempo, homework difficulties, and substance use) in a sample of adolescents with ADHD. PATIENTS/METHODS: Eighty-two adolescents (13-17 years) and their families participated in the study. Sleep was measured by both adolescent and parent-report. Adolescent irritability and sluggish cognitive tempo were reported by both adolescents and parents, while other variables were reported by a single reporter (homework difficulties - parent; ADHD severity - parent; substance use - adolescent). Analyses controlled for demographic factors and internalising and externalising comorbidities. RESULTS: A weak relationship was found between adolescent-reported sleep problems and daytime sleepiness, which became non-significant in adjusted analyses (ß = -0.19, p = 0.115). In adjusted analyses, there was an association between adolescent-reported sleep problems and adolescent-reported irritability (ß = -0.27, p = 0.023) as well as between adolescent-reported daytime sleepiness and parent-reported sluggish cognitive tempo (ß = 0.28, p = 0.033). In adjusted analyses, parent-reported adolescent sleep problems were associated with ADHD severity (ß = 0.54, p = <0.001), parent-reported sluggish cognitive tempo (ß = 0.64, p = <0.001), both reporters of irritability (parent-report: ß = 0.32, p = 0.004; adolescent-report: ß = 0.29, p = 0.022), and homework problems (ß = 0.37, p = 0.003). Parent-reported daytime sleepiness was associated with parent-reported sluggish cognitive tempo (ß = 0.34, p = 0.024). CONCLUSIONS: This study demonstrates the importance of a holistic assessment of adolescents with ADHD, not only focusing on symptomatology but also on sleep problems and functional outcomes. The importance of multi-informant assessment of sleep problems is also reinforced.

Study Protocol for the COVID-19 Pandemic Adjustment Survey (CPAS): A Longitudinal Study of Australian Parents of a Child 0-18 Years.

BACKGROUND: The COVID-19 pandemic presents significant risks to the mental health and wellbeing of Australian families. Employment and economic uncertainty, chronic stress, anxiety, and social isolation are likely to have negative impacts on parent mental health, couple and family relationships, as well as child health and development. OBJECTIVE: This study aims to: (1) provide timely information on the mental health impacts of the emerging COVID-19 crisis in a close to representative sample of Australian parents and children (0-18 years), (2) identify adults and families most at risk of poor mental health outcomes, and (3) identify factors to target through clinical and public health intervention to reduce risk. Specifically, this study will investigate the extent to which the COVID-19 pandemic is associated with increased risk for parents' mental health, lower well-being, loneliness, and alcohol use; parent-parent and parent-child relationships (both verbal and physical); and child and adolescent mental health problems. METHODS: The study aims to recruit a close to representative sample of at least 2,000 adults aged 18 years and over living in Australia who are parents of a child 0-4 years (early childhood, N = 400), 5-12 years (primary school N = 800), and 13-18 years (secondary school, N = 800). The design will be a longitudinal cohort study using an online recruitment methodology. Participants will be invited to complete an online baseline self-report survey (20 min) followed by a series of shorter online surveys (10 min) scheduled every 2 weeks for the duration of the COVID-19 pandemic (i.e., estimated to be 14 surveys over 6 months). RESULTS: The study will employ post stratification weights to address differences between the final sample and the national population in geographic communities across Australia. Associations will be analyzed using multilevel modeling with time-variant and time-invariant predictors of change in trajectory over the testing period. CONCLUSIONS: This study will provide timely information on the mental health impacts of the COVID-19 crisis on parents and children in Australia; identify communities, parents, families, and children most at risk of poor outcomes; and identify potential factors to address in clinical and public health interventions to reduce risk.