Predictors and Mechanisms of Resilience for High School Students with ADHD: A Prospective Longitudinal Study.

Attention-deficit/hyperactivity disorder (ADHD) has primarily been studied from a deficit-focused perspective. However, there are individuals with ADHD who exhibit resilience or a pattern of positive adaptation despite the risks associated with their diagnosis. The present study evaluated whether peer acceptance predicted resilience for adolescents with ADHD and if self-efficacy or a stress-is-enhancing mindset served as mechanisms of those relations. Participants included 113 comprehensively evaluated adolescents with ADHD (67% male) across three time-points (10th-12th grade). Mediation analyses revealed higher T1 peer acceptance significantly predicted higher resilience (ß = 0.24) 1.5-2 years later, with higher T2 self-efficacy (ß = 0.08) demonstrating a significant indirect effect of the association. A stress-is-enhancing mindset directly predicted resilience (ß = 0.15) but was not associated with peer acceptance nor mediated the association between peer acceptance and resilience. Present results are the first to provide longitudinal evidence for peer acceptance, self-efficacy, and a stress-is-enhancing mindset as important for promoting resilience among adolescents with ADHD.

Examining daily stimulant medication use and sleep in adolescents with ADHD.

Research has been inconclusive as to whether stimulant treatment causes or exacerbates sleep problems in adolescents with ADHD. This study examined sleep differences in adolescents with ADHD as a function of stimulant use. Participants were adolescents with ADHD (N = 159, ages 12-14). Parents reported on receipt of stimulant treatment (n = 92, 57.86%; n = 47 amphetamines, n = 45 methylphenidate). Adolescents wore actigraphs and completed daily diaries assessing sleep and daily use of stimulants for 2 weeks. Sleep parameters included daily-reported bedtime, sleep onset latency (SOL), sleep duration, daytime sleepiness, and difficulty waking the following morning; and actigraphy-measured sleep onset time, total time in bed, and sleep efficiency. We estimated between- and within-individual associations between stimulant medication use and sleep indices with all stimulants, after removing adolescents using sleep aids and weekend days, and as a function of stimulant type. Adolescent sleep did not differ between those receiving and not receiving stimulant treatment. Within individuals using stimulants, we largely observed no significant differences between medicated and unmedicated days, though findings were most often significant for school days only. Small effects were found indicating longer SOL, later sleep onset time, and more daytime sleepiness related to medication use. In contrast, there were slight improvements to sleep duration and sleep efficiency related to methylphenidate use, though methylphenidate was also associated with later sleep onset time and more daytime sleepiness. Given the inconsistent and small effects, findings suggest that stimulant medication may impact sleep, but does not appear to be a primary contributor to sleep problems in adolescents with ADHD.

Predictors of executive function trajectories in adolescents with and without ADHD: Links with academic outcomes.

Changes in executive function (EF) occur during adolescence with several factors (e.g., parenting styles, socioeconomic status) influencing the development of EF abilities. These changes are important as EF has been strongly linked with a range of outcomes including academic achievement, job performance, and social-emotional well-being. However, few studies have examined variability in EF trajectories during this critical developmental period, or trajectories in samples known to have specific impairments with EF, such as adolescents diagnosed with attention-deficit/hyperactivity disorder (ADHD). The present study examined differential trajectories of three domains of parent-rated EF in 302 adolescents (167 males; Mage = 13.17 years) with and without ADHD (53.6% with ADHD) from grade 8 to 10. The study also explored whether adolescent ADHD, parent ADHD, and parents' own EF predicted EF trajectories in addition to the longitudinal relation between trajectories and academic outcomes. Findings suggest that adolescence is marked by significant variability in EF development due to factors such as ADHD status, parent ADHD, and parent EF ability. Additionally, adolescents who displayed poor EF abilities throughout middle and high school had significantly lower grade point averages and poorer parent-, teacher-, and self-reported academic outcomes. Implications for interventions targeting EF deficits among adolescents with and without ADHD are discussed.

Impacts of COVID-19 on the school experience of children and adolescents with special educational needs and disabilities.

This review of research conducted between March 2020-April 2023 summarizes the impact of COVID-19 on the learning and school experiences of children and adolescents with special educational needs and dis/abilities (SENDs) including youth with neurodevelopmental disorders, learning differences, intellectual, developmental, and other disabilities. This research highlights the far-reaching consequences of COVID-19, with the most detrimental effects experienced by students of color, those from under-resourced communities, and those with multiple marginalized identities, whose struggles with systemic inequities have been amplified by the pandemic. To date, most studies have been cross-sectional and utilized qualitative methods. Future research should examine long-term impacts and ways to promote growth in learning and social-emotional functioning among students with SENDs.

Impacts of COVID-19 quarantine and isolation on adolescent social functioning.

This review discusses research conducted globally between March 2020 and March 2023 examining the impact of the COVID-19 pandemic on adolescent social functioning, including their lifestyle, extracurricular activities, family environment, peer environment, and social skills. Research highlights the widespread impact, with largely negative effects. However, a handful of studies support improved quality of relationships for some young people. Study findings underscore the importance of technology for fostering social communication and connectedness during periods of isolation and quarantine. Most studies specifically examining social skills were cross-sectional and conducted in clinical populations, such as autistic or socially anxious youth. As such, it is critical that ongoing research examines the long-term social impacts of the COVID-19 pandemic, and ways to promote meaningful social connectedness via virtual interactions.

Prospective examination of psychological trauma among adolescents during the COVID-19 pandemic.

OBJECTIVE: This longitudinal study investigated the predictors of and changes in psychological trauma during the COVID-19 pandemic. METHOD: Participants included 236 adolescents (130 males; Mage = 16.74 years in spring 2020; 49.6% diagnosed with attention-deficit hyperactivity disorder; 16.1% diagnosed with an anxiety or depressive disorder) in the United States who completed online questionnaires at four timepoints (spring 2020, summer 2020, fall 2020, spring 2021). RESULTS: Repeated measures ANOVA showed that psychological trauma was highest during stay-at-home orders in spring 2020, and decreased for a majority of adolescents by the summer of 2020. However, ~20% of adolescents exhibited moderate-to-clinical levels of psychological trauma at each timepoint. Four groups were identified based on the presence of psychological trauma symptoms: (a) resilient group (normal range across all timepoints; 60.6%); (b) moderate fluctuating group (moderate range at 1 or more timepoints; 18.2%); (c) severe fluctuating group (clinical range at 1 or more timepoints; 14.0%); and (d) chronic psychological trauma group (moderate or clinical range across all timepoints; 7.2%). Females, adolescents with preexisting internalizing disorders, and participants whose families were most impacted by the pandemic were more susceptible to experiencing psychological trauma symptoms. CONCLUSIONS: Findings highlight at-risk populations and suggest that the COVID-19 pandemic resulted in psychological trauma symptoms for approximately 20% of adolescents at some point during the first year of the pandemic. There is critical need to provide mental health services to adolescents, such as through school-based services, to reduce the negative long-term psychological impact of the pandemic. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Longitudinal Change in Adolescent Depression and Anxiety Symptoms from before to during the COVID-19 Pandemic.

This study aimed to examine changes in depression and anxiety symptoms from before to during the first 6 months of the COVID-19 pandemic in a sample of 1,339 adolescents (9-18 years old, 59% female) from three countries. We also examined if age, race/ethnicity, disease burden, or strictness of government restrictions moderated change in symptoms. Data from 12 longitudinal studies (10 U.S., 1 Netherlands, 1 Peru) were combined. Linear mixed effect models showed that depression, but not anxiety, symptoms increased significantly (median increase = 28%). The most negative mental health impacts were reported by multiracial adolescents and those under 'lockdown' restrictions. Policy makers need to consider these impacts by investing in ways to support adolescents' mental health during the pandemic.

Understanding the association between spirituality and mental health outcomes in adolescents in two non-Western countries: Exploring self-control as a potential mediator.

Empirical knowledge on what specific aspects of mental health are associated with spirituality is limited, and explanations for the mechanisms underlying this association is scarce. Furthermore, there is limited research on this association among individuals from non-Christian religious backgrounds and non-Western countries. The current study examined relations between spirituality and aspects of mental health in 1,544 adolescents from diverse religious backgrounds in two Eastern countries, India and the United Arab Emirates (UAE). Additionally, we examined mediating and moderating factors. Adolescents (58% female) ages 11-15 years completed a questionnaire on aspects of their mental health, spirituality, and self-control abilities. Results showed that spirituality had a significant positive association with life satisfaction and a significant negative association with internalizing problems, but a non-significant relation with externalizing problems, controlling for age, gender, and socioeconomic status. Self-control completely mediated the association between spirituality and life satisfaction, and this mediational relation was only present for adolescents from the UAE. Results support prior research suggesting positive associations between spirituality and adaptive mental health outcomes and extend these findings to adolescents from diverse religious backgrounds in non-Western countries. These findings have important clinical and policy implications for supporting the role of spirituality in an adolescent's life.

Systematic Review and Meta-analysis: Pharmacological and Nonpharmacological Interventions for Persistent Nonepisodic Irritability.

OBJECTIVE: This meta-analysis examined the efficacy of available pharmacological and nonpharmacological interventions for irritability among youth with autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), disruptive behavior disorders (DBD), disruptive mood dysregulation disorder (DMDD), and/or severe mood dysregulation (SMD). METHOD: Literature searches were conducted in October 2020, resulting in 564 abstracts being reviewed to identify relevant papers, with 387 articles being reviewed in full. A random effects model was used for the meta-analysis, with subgroup meta-regressions run to assess effects of study design, intervention type, medication class, and clinical population. RESULTS: A total of 101 studies were included (80 pharmacological, 13 nonpharmacological, 8 combined). Despite high heterogeneity in effects (I2 = 94.3%), pooled posttreatment effect size for decreasing irritability was large (Hedges' g = 1.62). Large effects were found for pharmacological (g = 1.85) and nonpharmacological (g = 1.11) interventions; moderate effects were found for combined interventions relative to monotherapy interventions (g = 0.69). Antipsychotic medications provided the largest effect for reducing irritability relative to all other medication classes and nonpharmacological interventions. A large effect was found for youth with ASD (g = 1.89), whereas a medium effect was found for youth with ADHD/DMDD/DBD/SMD (g = 0.64). CONCLUSION: This meta-analysis provides a comprehensive review of interventions targeting persistent nonepisodic irritability among youth with various psychiatric disorders. Strong evidence was found for medium-to-large effects across study design, intervention type, and clinical populations, with the largest effects for pharmacological interventions, particularly antipsychotic medications and combined pharmacological interventions, and interventions for youth with ASD.

Community belongingness during COVID-19 predicts anxiety and depression treatment change in college students.

OBJECTIVE: Community belongingness has been shown to be related to mental health outcomes in college students; however, little work has evaluated whether community belongingness impacts treatment change, especially during the COVID-19 pandemic, when social isolation and mental health concerns are exacerbated. Accordingly, the current study evaluated community belongingness as a predictor of treatment change for anxiety and depression in a university counseling center. METHOD: Participants included 516 young adults with clinical levels of anxiety or depression who attended at least two individual therapy sessions at a university counseling center during fall 2020. Participants completed broad measures of psychosocial functioning at each session. RESULTS: Paired-samples t-tests indicated that students demonstrated significant decreases in anxiety and depression after just one session. Linear stepwise regressions revealed that community belongingness was a significant predictor of symptom improvement for both anxiety and depression. CONCLUSION: These results suggest improving community belongingness on college campuses may be a way to buffer mental health and improve treatment outcomes for students seeking psychological services. Specific clinical and educational recommendations for ways to improve community belongingness are discussed.

Rumination as a Mechanism of the Longitudinal Association Between COVID-19-Related Stress and Internalizing Symptoms in Adolescents.

The current prospective longitudinal study evaluated brooding rumination as an intervening mechanism of the association between COVID-19-related stress and internalizing symptoms during the first year of the pandemic. Attention-deficit/hyperactivity disorder (ADHD) status and adolescent sex were tested as moderators of the indirect effect. Adolescents with and without ADHD (N = 238; M age = 16.74) completed rating scales of COVID-19 stress and both adolescents and parents completed ratings scales of internalizing symptoms in May/June 2020 (T1). In October/November 2020 (T2), adolescents reported on their brooding rumination. Adolescents and parents reported on internalizing symptoms again in March/April 2021 (T3). Covariates included participant characteristics and baseline symptoms. T1 self-reported COVID-19-related stress was associated with increased T3 self-reported anxiety (ab = 0.10), self-reported depression (ab = 0.07), and parent-reported depression (ab = 0.09) via T2 brooding rumination. The indirect effect did not differ for adolescents with and without ADHD or for female and male adolescents. Brooding rumination may be one mechanism to target to promote the mental health adjustment of adolescents during periods of high stress of the COVID-19 pandemic and future stressors.

When daily challenges become too much during COVID-19: Implications of family and work demands for work-life balance among parents of children with special needs.

Working parents of children with special needs (i.e., emotional, behavioral, and/or learning difficulties) face recurrent stressors that can make balancing work and family demands difficult. This strain has been magnified during the COVID-19 pandemic, as these parents often need to take on greater responsibility in supporting their children's remote learning, while still meeting their own job-related responsibilities. Accordingly, working parents of special needs children may be particularly vulnerable to adverse outcomes stemming from pandemic-induced changes to work (e.g., teleworking) and education (e.g., remote instruction). We sought to understand how daily family and work challenges influence satisfaction with work-life balance (WLB) in this priority population, with an emphasis on contextualizing this process through chronic job stress perceptions. Conducting a 10-day daily diary study in a sample of 47 working parents of special needs children during fall 2020, we observed family challenges to deplete positive affect from day-to-day, which undermined satisfaction with work-life balance. Furthermore, detrimental influences of daily family and work challenges on positive affect were magnified under chronic job stress, yielding diminished WLB satisfaction for more chronically stressed employees. We discuss how these findings can be harnessed to support particularly vulnerable employees during the COVID-19 pandemic and other chronic stress circumstances, while also drawing attention to how the pandemic may be exacerbating work-life inequities that some employees face. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Adolescents with ADHD are at increased risk for COVID-19 vaccine hesitancy.

Identifying factors that influence adolescent intentions for COVID-19 vaccination is essential for developing strategic interventions to increase uptake, particularly in subgroups of at-risk adolescents. Attention-deficit/hyperactivity disorder (ADHD) in adolescence is characterized by difficulties regulating attention and behavior, social impairment, and impulsive risk-taking behaviors, which may impact vaccine hesitancy and vaccine uptake. This study examined hesitancy toward COVID-19 vaccines among adolescents with and without ADHD, and explored how ADHD status interacted with malleable social mechanisms and other social determinants of health in predicting vaccine hesitancy. Participants were 196 U.S. adolescents (44.4% male), 45.6% diagnosed with ADHD. Adolescents reported their confidence and willingness toward COVID-19 vaccines from March to May 2021. Adolescents with ADHD reported greater hesitancy and less confidence in COVID-19 vaccine safety compared to adolescents without ADHD (p < .01). Only 61.8% of adolescents with ADHD reported vaccine acceptance, compared to 81.3% of adolescents without ADHD. For all adolescents, those who identified as Black or Latinx and with lower family income had greater hesitancy and reduced confidence, whereas greater COVID-19 concerns, media use, and perceived negative impact on relationships was associated with greater vaccination willingness. Social contextual processes significantly interacted with ADHD status such that for adolescents without ADHD, concerns about COVID-19 were associated with increased confidence in vaccine safety. Being noncompliant with social distancing guidelines was associated with greater vaccine hesitancy, only for adolescents with ADHD. A concerted effort is needed to increase trust, confidence, and social relevance among adolescents, especially those with ADHD and from lower socio-economic backgrounds.

Neural Activity and Emotion Socialization as Predictors of Later Emotion Regulation Difficulties in Children With and Without Hyperactivity/Impulsivity.

OBJECTIVE: This study examined emotion socialization and neural activity during frustration as predictors of emotion regulation (ER) difficulties, and the interplay of emotion socialization and neural activity, in children with and without hyperactivity/impulsivity (H/I). METHOD: At Time 1, neural activity (P1, N2, P3) during a frustration task, H/I symptoms, and emotion socialization were assessed in 68 children (aged 4-7 years old). At Time 2 (1.5-2 years later), child-report, maternal-report, and observation measures of ER difficulties were assessed. RESULTS: H/I symptoms moderated the relation between predictors and ER difficulties; there were significant relations for children with high, but not low, levels of H/I. Further, as emotion socialization quality increased, relations between event-related potentials and later ER difficulties became weaker. CONCLUSION: The processes underlying ER difficulties differ for children with H/I symptoms. High quality emotion socialization may have a protective effect for children whose neural patterns indicate risk for later ER difficulties.

Corrigendum: A Mini-Review of Pharmacological and Psychosocial Interventions for Reducing Irritability Among Youth With ADHD.

[This corrects the article DOI: 10.3389/fpsyt.2022.794044.].

A preliminary examination of key strategies, challenges, and benefits of remote learning expressed by parents during the COVID-19 pandemic.

Among the many impacts of the Coronavirus disease (COVID-19) pandemic, one of the most dramatic was the immediate closure of in-person schooling in March/April 2020 when parents were faced with much greater responsibility in supporting their children's learning. Despite this, few studies have examined parents' own perspectives of this experience. The aims of this preliminary study were to (a) identify challenges, benefits, and useful strategies related to remote learning and (b) examine differences in findings across two countries, between parents of youth with and without attention-deficit/hyperactivity disorder (ADHD), and between parents of children and adolescents. To address these aims, parent responses to open-ended questions on the Home Adjustment to COVID-19 Scale (HACS; Becker, Breaux, et al., 2020) were examined across three studies conducted in the United States and Australia (N = 606, children: 68.5% male, ages 6-17 years). The challenges most frequently expressed by parents included the child's difficulty staying on task (23.8% of parents), lack of motivation (18.3%), remote learning factors (17.8%), and lack of social interaction (14.4%). The most frequently expressed strategy related to using routines and schedules (58.2%) and the biggest benefit was more family time (20.3%). Findings were largely consistent across countries, ADHD status, and age, with a few notable group differences. Given that the most common challenges involved child- (e.g., difficulties with staying on task and motivation), parent- (e.g., balancing remote learning with work responsibilities), and school- (e.g., remote instruction difficulties) related factors, there is a need for improved support across these systems going forward. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

A Mini-Review of Pharmacological and Psychosocial Interventions for Reducing Irritability Among Youth With ADHD.

Approximately a third of children and adolescents with attention-deficit/hyperactivity disorder (ADHD) experience significant irritability; despite this, no study has reviewed whether interventions for youth with ADHD can improve irritability. This mini review sought to address this gap in the literature by discussing existing pharmacological and psychosocial interventions for irritability among children and adolescents with ADHD. A literature search was conducted in April 2021, with a total of 12 intervention articles identified (six pharmacological, one psychosocial, five combined). Studies were excluded if they did not involve an intervention, a measure of irritability, or the population was not youth with ADHD. Of these articles, two were with an ADHD only sample; seven included ADHD with comorbid disruptive behavior, disruptive mood dysregulation disorder (DMDD), or severe mood dysregulation (SMD); and three included ADHD with comorbid autism spectrum disorder (ASD). Findings suggest that central nervous system stimulants used alone or in combination with behavior therapy are effective at reducing irritability in youth with ADHD only or comorbid ADHD and DMDD/SMD. Less evidence was found for the efficacy of guanfacine and atomoxetine for youth with ADHD only or comorbid ADHD and ASD. Parent training alone or in combination with atomoxetine was found to be effective at reducing irritability in youth with comorbid ADHD and ASD. Future research assessing the efficacy of other psychosocial interventions, particularly cognitive behavioral therapy is necessary, as are randomized trials assessing intervention sequencing and intensity among youth with ADHD. Researchers are advised to utilize well-validated measures of irritability in future research.

Parent Emotion Socialization and Positive Emotions in Child and Adolescent Clinical Samples: A Systematic Review and Call to Action.

The majority of the emotion socialization behaviors (ESB) literature has focused on community samples and socialization of negative emotions. However, it is becoming increasingly apparent that ESB are also critical in setting the foundations for the healthy development of positive emotions, with implications for developmental psychopathology. We conducted a systematic review of research examining parent ESB and youth positive emotions in clinical child and adolescent samples. A literature search was conducted in March 2021, resulting in 563 abstracts being reviewed. Two reviewers independently screened the titles and abstracts to identify relevant papers, with 53 articles being reviewed in full. Seven articles (four cross-sectional and correlational, three intervention) were included in the current review, of which one was with an internalizing sample, three were with an externalizing sample, and three were with a neurodevelopmental disorder sample. Results varied regarding the role of parent ESB in youth positive emotions across clinical populations. In correlational studies, minimal evidence was found for the association between parent ESB and youth positive emotions, but across the three intervention studies, there was evidence that both parent ESB and children's positive emotions can be improved through intervention. We present a preliminary model of relations between youth psychopathology, parent ESB, and child positive emotions, with consideration of potential moderators of links between ESB and positive emotions. Finally, we discuss limitations of the existing body of research, and offer specific recommendations for future research directions.

Interactive Effects of Parent Emotion Socialization and Child Physiological Reactivity in Predicting Adolescent Borderline Personality Disorder Features.

Theories suggest that a transaction between child biological vulnerability and parent emotion socialization underlies the development of borderline personality disorder (BPD) features. Yet, few studies have examined the interaction between these factors prospectively in at-risk samples. Consequently, this study tested whether parental reactions to children's negative emotions moderated the effect of the child's physiological reactivity to stress in predicting adolescent BPD features in a sample of youth with and without clinical elevations in attention deficit/hyperactivity disorder (ADHD). Participants were 61 children (52% female) and parents (90% mothers). When children were 9-13 years old, their physiological reactivity to a social stressor was assessed based on respiratory sinus arrhythmia (RSA) and skin conductance level (SCL) reactivity; parents also reported on their supportive and non-supportive reactions to their child's negative emotions. Children were followed-up four to five years later at ages 14-18 years old and their BPD features were assessed based on parent and adolescent report. Significant interactions between children's SCL reactivity and parental reactions to children's negative emotions were found in predicting adolescent BPD features. Children with low SCL reactivity to social stress and parents high in supportive/low in non-supportive reactions were lowest in adolescent BPD features. However, greater SCL reactivity predicted greater adolescent BPD features specifically when the parent was high in support or low in non-support. Childhood ADHD symptoms also significantly predicted greater adolescent BPD features. Findings suggest that children with different patterns of SCL reactivity may respond differently to parental reactions to their emotions.

COVID-19 Resulted in Lower Grades for Male High School Students and Students With ADHD.

OBJECTIVE: Researchers have speculated that the COVID-19 pandemic may expand the academic performance gap experienced by at-risk students. We examined learning experiences during the 2020 to 2021 school year and the impact the pandemic has had on high school student grade point average (GPA), including predictors of change in GPA from 2019-2020 to 2020-2021. METHOD: Participants were 238 adolescents (55.5% male), 49.6% with attention-deficit/hyperactivity disorder (ADHD), in the United States. Adolescents reported on their GPAs via online surveys. RESULTS: GPA significantly decreased on average from 2019-2020 to 2020-2021 school year. ADHD status and biological sex significantly moderated change-students with ADHD and male students reported decreased GPA, whereas students without ADHD and female students' GPA did not change. Low income and Black/Latinx students had lower GPAs in both school years. CONCLUSION: It is imperative that additional supports be provided for at-risk students to help them catch up on missed learning during the pandemic.