The self-reference effect in attention deficit hyperactivity disorder.

The self-memory system depends on the prioritization and capture of self-relevant information, so may be disrupted by difficulties in attending to, encoding and retrieving self-relevant information. The current study compares memory for self-referenced and other-referenced items in children with ADHD and typically developing comparison groups matched for verbal and chronological age. Children aged 5-14 (N = 90) were presented with everyday objects alongside an own-face image (self-reference trials) or an unknown child's image (other-referenced trials). They were asked whether the child shown would like the object, before completing a surprise source memory test. In a second task, children performed, and watched another person perform, a series of actions before their memory for the actions was tested. A significant self-reference effect (SRE) was found in the typically developing children (i.e. both verbal and chronological age-matched comparison groups) for the first task, with significantly better memory for self-referenced than other-referenced objects. However, children with ADHD showed no SRE, suggesting a compromised ability to bind information with the cognitive self-concept. In the second task, all groups showed superior memory for actions carried out by the self, suggesting a preserved enactment effect in ADHD. Implications and applications for the self-memory system in ADHD are discussed.

"It's a learning curve throughout your entire life": Experiences and impact of FASD in adolescence explored in online photovoice research.

BACKGROUND: Research into the lived experience and disability of Fetal Alcohol Spectrum Disorder (FASD) is sparse in adolescence, despite its relevance to supports and life outcomes. AIMS: The study explored adolescents' lived experiences of FASD and access to support across home, school, and community. METHODS AND PROCEDURES: An online photovoice study was undertaken with eight young people (age 12-19, in education), integrating an Interpretative Phenomenological Analysis (IPA) approach. The research process comprised two individual interviews, group training, individual photo-taking, and group sessions for photo analysis/ dissemination. OUTCOMES AND RESULTS: Participant-led analysis of their photos identified how activities at home and in the community had functions of relaxation, sensory gratification, and enabled concentration. Researcher-led analysis found that young people identified with the disability of FASD through experiences at home and school. While they acknowledged the value of support and relationships, education was not always an inclusive experience. CONCLUSIONS AND IMPLICATIONS: Participatory online research allowed insight into the impact of FASD as a disability and underlines a consistent need for support in adolescence and the transition into adulthood. Young people with FASD require explicit support to develop their advocacy skills to improve educational outcomes.

Investigating the Mediating Role of Executive Function in the Relationship Between ADHD and DCD Symptoms and Depression in Adults.

This study was designed to test the effects of Attention Deficit Hyperactivity Disorder (ADHD) and Developmental Co-ordination Disorder (DCD) on depression levels and investigate the mediating role of executive function (EF) in adults. Adults with ADHD, DCD, and ADHD + DCD (N = 139) completed self-report measures of ADHD, DCD, depression, and EF. There were distinct profiles of EF across diagnostic groups, and higher depression symptoms in adults with ADHD + DCD than DCD alone. All EF domains were predicted by ADHD symptoms, and several by DCD symptoms. ADHD and DCD symptoms, and most EF domains, predicted depression symptoms. Overall EF difficulties fully mediated the relationships between ADHD/DCD and depression symptoms. Several specific EF domains relating to behavioural regulation and metacognition also showed full/partial mediating effects. The mediating role of EF difficulties between these neurodevelopmental conditions and depression symptoms has implications for their understanding and treatment, suggesting that targeting EF may be important for preventing co-occurring depression.

Illuminating the daily life experiences of adolescents with and without ADHD: protocol for an ecological momentary assessment study.

INTRODUCTION: Adolescents with attention-deficit/hyperactivity disorder (ADHD) are at elevated risk of a range of difficulties, among which emotion regulation, peer and co-occurring mental health problems are prominent challenges. To better support adolescents with ADHD, ecologically valid interventions that can be embedded in daily life to target the most proximal antecedents of these challenges are needed. Ecological momentary assessment (EMA) designs are ideally suited to meeting this need. METHODS AND ANALYSES: In the mental health in the moment ADHD study, we will use an EMA design to capture the daily life experiences of approximately 120 adolescents aged 11-14 years with a clinical diagnosis of ADHD and the same number of age-matched and gender-matched peers without a diagnosis of ADHD. We will combine this with comprehensive information gathered from online surveys. Analysing the data using techniques such as dynamic structural equation modelling, we will examine, among other research questions, the role of emotion regulation and peer problems in mediating the links between characteristics of ADHD and commonly co-occurring outcomes such as anxiety, depression and conduct problems. The results can help inform interventions to support improved peer functioning and emotion regulation for adolescents with ADHD. ETHICS AND DISSEMINATION: This study received a favourable ethical opinion through the National Health Service ethical review board and the University of Edinburgh PPLS Research Ethics panel. The results will be disseminated through journal publications, conferences and seminar presentations and to relevant stakeholders, such as those with ADHD, their families and clinicians.

Anxiety, concerns and COVID-19: Cross-country perspectives from families and individuals with neurodevelopmental conditions.

Background: The COVID-19 pandemic had a major impact on the mental health and well-being of children with neurodevelopmental conditions (NDCs) and of their families worldwide. However, there is insufficient evidence to understand how different factors (e.g., individual, family, country, children) have impacted on anxiety levels of families and their children with NDCs developed over time. Methods: We used data from a global survey assessing the experience of 8043 families and their children with NDCs (mean of age (m) = 13.18 years, 37% female) and their typically developing siblings (m = 12.9 years, 45% female) in combination with data from the European Centre for Disease Prevention and Control, the University of Oxford, and the Central Intelligence Agency (CIA) World Factbook, to create a multilevel data set. Using stepwise multilevel modelling, we generated child-, family- and country-related factors that may have contributed to the anxiety levels of children with NDCs, their siblings if they had any, and their parents. All data were reported by parents. Results: Our results suggest that parental anxiety was best explained by family-related factors such as concerns about COVID-19 and illness. Children's anxiety was best explained by child-related factors such as children's concerns about loss of routine, family conflict, and safety in general, as well as concerns about COVID-19. In addition, anxiety levels were linked to the presence of pre-existing anxiety conditions for both children with NDCs and their parents. Conclusions: The present study shows that across the globe there was a raise in anxiety levels for both parents and their children with NDCs because of COVID-19 and that country-level factors had little or no impact on explaining differences in this increase, once family and child factors were considered. Our findings also highlight that certain groups of children with NDCs were at higher risk for anxiety than others and had specific concerns. Together, these results show that anxiety of families and their children with NDCs during the COVID-19 pandemic were predicted by very specific concerns and worries which inform the development of future toolkits and policy. Future studies should investigate how country factors can play a protective role during future crises.

The Prevalence of Attention Deficit/Hyperactivity Disorder Symptoms in Children and Adolescents With Autism Spectrum Disorder Without Intellectual Disability: A Systematic Review.

OBJECTIVE: ADHD commonly co-occurs with ASD without ID in young people. It has been difficult to obtain accurate prevalence estimates of ADHD in this population, as a dual-diagnosis was not permitted until DSM-V. We systematically reviewed the literature on the prevalence of ADHD symptoms in young people with ASD without ID. METHOD: 9,050 articles were identified through six databases. Articles were reviewed against inclusion and exclusion criteria and 23 studies were included. RESULTS: ADHD symptom prevalence varied from 2.6% to 95.5%. We discuss these findings according to the ADHD assessment measure, informant, diagnostic criteria, risk of bias rating and recruitment pool. CONCLUSION: ADHD symptoms are common in young people with ASD without ID, but there is substantial variance in study reporting. Future studies should recruit participants from community sources, provide information on key sociodemographic sample characteristics and assess ADHD with standardized diagnostic criteria, using both parent/carer and teacher report.

Lived experiences of depression in autistic children and adolescents: A qualitative study on child and parent perspectives.

BACKGROUND: Depression is highly prevalent in autistic children and adolescents. Despite this, little is known about the nature of the autistic child's subjective experience of depression and the impact of depression on their lives. METHODS: We therefore conducted a qualitative study using thematic analysis with 7 autistic children and adolescents and their parents to identify common themes and individual differences. All children had previously experienced at least one depressive episode. RESULTS: Six main themes were identified: (1) Autism related experiences; (2) Difficulties with peer relationships; (3) Co-occurring relationships between anxiety and depression; (4) Impactful pessimism and anhedonia; (5) Impactful difficulties with focus and concentration and (6) Feelings of irritability, including aggressive behaviours. Parent's accounts of their children's experience of depression mirrored the child's perspective. Novel findings included reports of depression related restriction of diet variety and masking of mental health difficulties. Children and parents linked being autistic and developing depression, referring to the difficulties of being autistic in a complex, neurotypical world. CONCLUSIONS: These results highlight key challenges that autistic children and their families experience, calling for increased awareness of the impact of depression on autistic young people.

Cognition and maths in children with Attention-Deficit/Hyperactivity disorder with and without co-occurring movement difficulties.

BACKGROUND: Movement difficulties are common in ADHD, however, the implications of their co-occurrences on cognitive and maths performance is unknown. AIMS: This study set out to examine whether cognitive and maths performance of children with high ADHD symptoms differs depending on the co-occurrence of movement difficulties given evidence that weaker visuospatial processing, known to be important for maths performance, differentiates ADHD and DCD. We also aimed to examine whether relationships between cognition and maths in ADHD differs depending on co-occurring movement difficulties. METHODS: Participants were 43 drug naïve children between 6 and 12 years old (M = 101.53 months SD = 19.58). The ADHD-only group (n = 18) included children with high ADHD scores, and those in the ADHD+DCD group (n = 25) concurrently had high movement difficulty scores. All completed executive function and memory, including 2 visuo-spatial memory tasks from the CANTAB battery and Mathematics Problem Solving, Numeracy, and Maths Fluency tasks from the WIAT-III and specific factual, conceptual, and procedural maths component tasks. RESULTS: Children in the ADHD+DCD group scored significantly lower on visuospatial working memory (WM) capacity, than those in the ADHD-only group. Both groups were comparable on all other cognitive assessments of executive functions, memory, and processing speed. The groups did not differ in their maths attainment scores, nor on more specific maths skills. Comparison of the correlations between cognitive processes and maths revealed that the association between visuospatial WM updating and procedural skill efficiency was stronger for the ADHD-only group. Moreover, associations between visuospatial WM and maths problem solving attainment were stronger in the ADHD+DCD group. CONCLUSIONS: Despite similarities in maths performance, children with ADHD+DCD could be distinguished by lower visuospatial WM. Differential associations with some of the maths domain implicate recruitment of different cognitive processes for some aspects of maths. This distinction can be particularly useful for conceptualising cognitive characteristics of different clinical groups and understanding cognitive pathways of maths difficulties. Implications for interventions are discussed.

Understanding and Supporting Attention Deficit Hyperactivity Disorder (ADHD) in the Primary School Classroom: Perspectives of Children with ADHD and their Teachers.

Children with Attention Deficit Hyperactivity Disorder (ADHD) are more at risk for academic underachievement compared to their typically developing peers. Understanding their greatest strengths and challenges at school, and how these can be supported, is vital in order to develop focused classroom interventions. Ten primary school pupils with ADHD (aged 6-11 years) and their teachers (N = 6) took part in semi-structured interviews that focused on (1) ADHD knowledge, (2) the child's strengths and challenges at school, and (3) strategies in place to support challenges. Thematic analysis was used to analyse the interview transcripts and three key themes were identified; classroom-general versus individual-specific strategies, heterogeneity of strategies, and the role of peers. Implications relating to educational practice and future research are discussed.

Friendships in Children with Williams Syndrome: Parent and Child Perspectives.

Although children with Williams syndrome (WS) are strongly socially motivated, many have friendship difficulties. The parents of 21 children with WS and 20 of the children themselves participated in a semi-structured interview about the children's friendships. Parents reported that their child had difficulties sustaining friendships and low levels of interaction with peers. Barriers to friendships included difficulties with play and self-regulating behaviour. However, there was within-group variability, with a small number of children reported to have strong friendships. While parents reported friendship challenges, all of the children named at least one friend, and most said that they had never felt excluded by their peers. Future research is needed to determine optimal ways to support children with WS in their friendships.

Stimulant and non-stimulant drug therapy for people with attention deficit hyperactivity disorder and epilepsy.

BACKGROUND: Attention Deficit Hyperactivity Disorder (ADHD) can co-occur in up to 40% of people with epilepsy. There is debate about the efficacy and tolerability of stimulant and non-stimulant drugs used to treat people with ADHD and co-occurring epilepsy. OBJECTIVES: To assess the effect of stimulant and non-stimulant drugs on children and adults with ADHD and co-occurring epilepsy in terms of seizure frequency and drug withdrawal rates (primary objectives), as well as seizure severity, ADHD symptoms, cognitive state, general behaviour, quality of life, and adverse effects profile (secondary objectives). SEARCH METHODS: We searched the following databases on 12 October 2020: Cochrane Register of Studies (CRS Web), MEDLINE (Ovid, 1946 to 9 October 2020), CINAHL Plus (EBSCOhost, 1937 onwards). There were no language restrictions. CRS Web includes randomised or quasi-randomised controlled trials from PubMed, Embase, ClinicalTrials.gov, the World Health Organization International Clinical Trials Registry Platform (ICTRP), the Cochrane Central Register of Controlled Trials (CENTRAL), and the Specialised Registers of Cochrane Review Groups including Epilepsy.  SELECTION CRITERIA: We included randomised controlled trials of stimulant and non-stimulant drugs for people of any age, gender or ethnicity with ADHD and co-occurring epilepsy. DATA COLLECTION AND ANALYSIS: We selected articles and extracted data according to predefined criteria. We conducted primary analysis on an intention-to-treat basis. We presented outcomes as risk ratios (RRs) with 95% confidence intervals (CIs), except for individual adverse effects where we quoted 99% CIs. We conducted best- and worst-case sensitivity analyses to deal with missing data. We carried out a risk of bias assessment for each included study using the Cochrane risk of bias tool and assessed the overall certainty of evidence using the GRADE approach. MAIN RESULTS: We identified two studies that matched our inclusion criteria: a USA study compared different doses of the stimulant drug osmotic-release oral system methylphenidate (OROS-MPH) with a placebo in 33 children (mean age 10.5 ± 3.0 years), and an Iranian study compared the non-stimulant drug omega-3 taken in conjunction with risperidone and usual anti-seizure medication (ASM) with risperidone and ASM only in 61 children (mean age 9.24 ± 0.15 years). All children were diagnosed with epilepsy and ADHD according to International League Against Epilepsy and Diagnostic and Statistical Manual of Mental Disorders, fourth edition, criteria, respectively. We assessed both studies to be at low risk of detection and reporting biases, but assessments varied from low to high risk of bias for all other domains. OROS-MPH No participant taking OROS-MPH experienced significant worsening of epilepsy, defined as: 1. a doubling of the highest 14-day or highest two-day seizure rate observed during the 12 months before the trial; 2. a generalised tonic-clonic seizure if none had been experienced in the previous two years; or 3. a clinically meaningful intensification in seizure duration or severity (33 participants, 1 study; low-certainty evidence). However, higher doses of OROS-MPH predicted an increased daily risk of a seizure (P < 0.001; 33 participants, 1 study; low-certainty evidence). OROS-MPH had a larger proportion of participants receiving 'much improved' or 'very much improved' scores for ADHD symptoms on the Clinical Global Impressions for ADHD-Improvement tool (33 participants, 1 study; low-certainty evidence). OROS-MPH also had a larger proportion of people withdrawing from treatment (RR 2.80; 95% CI 1.14 to 6.89; 33 participants, 1 study; moderate-certainty evidence). Omega-3 Omega-3 with risperidone and ASM were associated with a reduction in mean seizure frequency by 6.6 seizures per month (95% CI 4.24 to 8.96; 56 participants, 1 study; low-certainty evidence) and an increase in the proportion of people achieving 50% or greater reduction in monthly seizure frequency (RR 2.79, 95% CI 0.84 to 9.24; 56 participants, 1 study; low-certainty evidence) compared to people on risperidone and ASM alone. Omega-3 with risperidone and ASM also had a smaller proportion of people withdrawing from treatment (RR 0.65, 95% CI 0.12 to 3.59; 61 participants, 1 study; low-certainty evidence) but a larger proportion of people experiencing adverse drug events (RR 1.40, 95% CI 0.44 to 4.42; 56 participants, 1 study; low-certainty evidence) compared to people on risperidone and ASM alone. AUTHORS' CONCLUSIONS: In children with a dual-diagnosis of epilepsy and ADHD, there is some evidence that use of the stimulant drug OROS-MPH is not associated with significant worsening of epilepsy, but higher doses of it may be associated with increased daily risk of seizures; the evidence is of low-certainty. OROS-MPH is also associated with improvement in ADHD symptoms. However, this treatment was also associated with a large proportion of treatment withdrawal compared to placebo. In relation to the non-stimulant drug omega-3, there is some evidence for reduction in seizure frequency in children who are also on risperidone and ASM, compared to children who are on risperidone and ASM alone. Evidence is inconclusive whether omega-3 increases or decreases the risk of adverse drug events. We identified only two studies - one each for OROS-MPH and omega-3 - with low to high risk of bias. We assessed the overall certainty of evidence for the outcomes of both OROS-MPH and omega-3 as low to moderate. More studies are needed. Future studies should include: 1. adult participants; 2. a wider variety of stimulant and non-stimulant drugs, such as amphetamines and atomoxetine, respectively; and 3. additional important outcomes, such as seizure-related hospitalisations and quality of life. Clusters of studies which assess the same drug - and those that build upon the evidence base presented in this review on OROS-MPH and omega-3 - are needed to allow for meta-analysis of outcomes.

ANTECEDENTES: El trastorno por déficit de atención e hiperactividad (TDAH) puede concurrir en hasta el 40% de las personas con epilepsia. Existe un debate sobre la eficacia y la tolerabilidad de los fármacos estimulantes y no estimulantes utilizados para tratar a las personas con TDAH y epilepsia concurrente. OBJETIVOS: Evaluar el efecto de los fármacos estimulantes y no estimulantes en niños y adultos con TDAH y epilepsia concurrente, en cuanto a la frecuencia de las crisis epilépticas y las tasas de retiro del fármaco (objetivos principales), así como la gravedad de las crisis epilépticas, los síntomas del TDAH, el estado cognitivo, el comportamiento general, la calidad de vida y el perfil de efectos adversos (objetivos secundarios). MÉTODOS DE BÚSQUEDA: El 12 de octubre de 2020 se realizaron búsquedas en las siguientes bases de datos: Registro Cochrane de Estudios (CRS Web), MEDLINE (Ovid, 1946 hasta el 9 de octubre de 2020), CINAHL Plus (EBSCOhost, 1937 en adelante). No hubo restricciones de idioma. El CRS Web incluye ensayos controlados aleatorizados o cuasialeatorizados de PubMed, Embase, ClinicalTrials.gov, la Plataforma de registros internacionales de ensayos clínicos (ICTRP) de la Organización Mundial de la Salud, el Registro Cochrane central de ensayos controlados (Cochrane Central Register of Controlled Trials; CENTRAL) y los registros especializados de los Grupos Cochrane de Revisión, incluido el de Epilepsia. CRITERIOS DE SELECCIÓN: Se incluyeron ensayos controlados aleatorizados de fármacos estimulantes y no estimulantes para personas de cualquier edad, sexo o etnia con TDAH y epilepsia concurrente. OBTENCIÓN Y ANÁLISIS DE LOS DATOS: Se seleccionaron los artículos y se extrajeron los datos según criterios predefinidos. El análisis principal se realizó por intención de tratar. Los desenlaces se presentaron como razones de riesgos (RR) con intervalos de confianza (IC) del 95%, excepto en el caso de los efectos adversos individuales, en los que se citaron los IC del 99%. Se realizaron análisis de sensibilidad en el mejor y peor de los casos para lidiar con los datos faltantes. Se realizó una evaluación del riesgo de sesgo para cada estudio incluido mediante la herramienta Cochrane de riesgo de sesgo y la certeza general de la evidencia se evaluó mediante el método GRADE. RESULTADOS PRINCIPALES: Se identificaron dos estudios que cumplieron con los criterios de inclusión: un estudio de EE.UU. comparó diferentes dosis del fármaco estimulante metilfenidato con un sistema oral de liberación osmótica (OROS­MPH) con un placebo en 33 niños (media de edad 10,5 ± 3,0 años), y un estudio iraní comparó el fármaco no estimulante omega­3 tomado junto con la risperidona y la medicación anticonvulsiva (MAC) habitual con la risperidona y la MAH solamente en 61 niños (media de edad 9,24 ± 0,15 años). Todos los niños tenían un diagnóstico de epilepsia y TDAH según los criterios de la International League Against Epilepsy y del Diagnostic and Statistical Manual of Mental Disorders, cuarta edición, respectivamente. Se consideró que ambos estudios tenían un riesgo de sesgo de detección y de notificación bajos, pero las evaluaciones variaron de riesgo de sesgo bajo a alto en todos los demás dominios. OROS­MPH Ningún participante de los que recibieron OROS­MPH presentó un empeoramiento significativo de la epilepsia, definido como: 1. una duplicación de la tasa más alta de convulsiones en 14 días o en dos días, observada durante los 12 meses anteriores al ensayo; 2. una convulsión tónico­clónica generalizada si no se había experimentado ninguna en los dos años anteriores; o 3. una intensificación clínicamente significativa de la duración o la gravedad de las convulsiones (33 participantes, un estudio; evidencia de certeza baja). Sin embargo, las dosis más altas de OROS­MPH predijeron un mayor riesgo diario de presentar una convulsión (p < 0,001; 33 participantes, un estudio; evidencia de certeza baja). Con el OROS­MPH hubo una mayor proporción de participantes que recibieron puntuaciones de "mucha mejoría" o "muchísima mejoría" en los síntomas del TDAH según la herramienta Clinical Global Impressions for ADHD­Improvement (33 participantes, un estudio; evidencia de certeza baja). Con el OROS­MPH también hubo una mayor proporción de personas que se retiraron del tratamiento (RR 2,80; IC del 95%: 1,14 a 6,89; 33 participantes, un estudio; evidencia de certeza moderada). Omega­3 El omega­3 con la risperidona y la MAC se asociaron con una reducción de la frecuencia media de las crisis epilépticas en 6,6 crisis epilépticas por mes (IC del 95%: 4,24 a 8,96; 56 participantes, un estudio; evidencia de certeza baja) y un aumento de la proporción de personas que lograron una reducción del 50% o más en la frecuencia mensual de las crisis epilépticas (RR: 2,79; IC del 95%: 0,84 a 9,24; 56 participantes, un estudio; evidencia de certeza baja) en comparación con las personas que recibieron risperidona y MAC solamente. Con el omega­3 con risperidona y MAC también hubo una menor proporción de personas que se retiraron del tratamiento (RR 0,65; IC del 95%: 0,12 a 3,59; 61 participantes, un estudio; evidencia de certeza baja), pero una mayor proporción de personas que presentaron eventos adversos al fármaco (RR 1,40; IC del 95%: 0,44 a 4,42; 56 participantes, un estudio; evidencia de certeza baja) en comparación con las personas que recibieron risperidona y MAC solamente. CONCLUSIONES DE LOS AUTORES: En los niños con un doble diagnóstico de epilepsia y TDAH, hay alguna evidencia de que el uso del fármaco estimulante OROS­MPH no se asocia con un empeoramiento significativo de la epilepsia, pero las dosis más altas podrían estar asociadas con un mayor riesgo diario de crisis epilépticas; la evidencia es de certeza baja. OROS­MPH también se asocia con una mejoría de los síntomas del TDAH. Sin embargo, este tratamiento también se asoció con una gran proporción de retiro del tratamiento en comparación con el placebo. En relación con el fármaco no estimulante omega­3, existe alguna evidencia de una reducción de la frecuencia de las convulsiones en los niños que también recibieron risperidona y MAC, en comparación con los niños que sólo recibieron risperidona y MAC. La evidencia no es concluyentes en cuanto a si los omega­3 aumentan o disminuyen el riesgo de experimentar efectos adversos de los medicamentos. Sólo se identificaron dos estudios (uno con OROS­MPH y otro con omega­3) con un riesgo de sesgo bajo a alto. La certeza general de la evidencia para los desenlaces de OROS­MPH y omega­3 se consideró baja a moderada. Se necesitan más estudios. Los estudios futuros deberían incluir: 1. participantes adultos; 2. una mayor variedad de fármacos estimulantes y no estimulantes, como las anfetaminas y la atomoxetina, respectivamente; y 3. desenlaces adicionales importantes, como las hospitalizaciones relacionadas con las convulsiones y la calidad de vida. Se necesitan grupos de estudios que evalúen el mismo fármaco (y estén desarrollados sobre evidencia presentada en esta revisión acerca de OROS­MPH y omega­3) para poder realizar un metanálisis de los desenlaces.

Neurobehavioral follow-up of children exposed to selective serotonin reuptake inhibitors in utero.

BACKGROUND: Systematic data regarding long-term neurobehavioral effects of maternal antidepressant use during pregnancy are sparse. The aim of this study was to evaluate the impact of gestational exposure to antidepressants on later neurodevelopmental function. METHODS: This study describes a cohort of mother-child dyads (44 mothers, 54 children) in which maternal depressive symptoms and medication exposures were prospectively collected across pregnancy and the postpartum period. Children age 6 to 17 were assessed using validated instruments across domains of childhood behavior and executive memory and functioning. RESULTS: No associations were found between maternal use of selective serotonin reuptake inhibitors (SSRIs) during pregnancy and atypical neurodevelopment of children. Borderline clinical or clinical ranges of internalizing symptoms were associated with exposure to a higher maternal depressive symptom burden during pregnancy compared with those in the normal range. Compared with age- and sex-matched controls, the SSRI-exposed group showed superior performance on executive function tasks; findings did not demonstrate elevated risk for abnormal neurodevelopment in children age 6 to 17 exposed to SSRIs in utero. Deviations from the norm were instead associated with higher in utero exposure to maternal depression burden. CONCLUSIONS: This study highlights the need for rigorous studies of long-term outcomes after fetal antidepressant exposure.

[Formula: see text]The relationship between cognition and mathematics in children with attention-deficit/hyperactivity disorder: a systematic review.

Cognitive processes play an imperative role in children's mathematics learning. Difficulties in cognitive functioning are a core feature of Attention Deficit Hyperactivity Disorder (ADHD) in children, who also tend to show lower levels of mathematics attainment than their typically developing peers. This review (registration number: CRD42020169708) sought to aggregate findings from studies assessing the relationship between cognition and mathematics in children with a clinical ADHD diagnosis aged 4-12 years. A total of 11,799 studies published between 1992 and August 2020 were screened for eligibility using various database (PsycINFO, PubMed, SCOPUS, EMBASE, ERIC, Web of Science, and additional sources), from which four studies met inclusion criteria. A narrative synthesis was conducted on the correlations between mathematics and cognitive domains, including an evaluation of the risk of bias within the studies. Across four studies meeting inclusion criteria, memory, inhibitory control, and processing speed were assessed. The results showed a positive association between cognition and mathematics performance in this population. The strength of associations across these studies varied as a function of the cognitive domain in question, means by which mathematics performance was assessed, as well as whether confounding factors such as age and IQ were controlled for. Collectively, this review demonstrates a lack of research in this area and points to various methodological considerations for identifying the association between cognition and mathematics performance in ADHD.

Editorial: Evidence Concerning Dose-Dependent Effects of Stimulants on Neurocognitive Function in Children With Attention-Deficit/Hyperactivity Disorder.

The question of how stimulants affect cognitive function in children with attention-deficit/hyperactivity disorder (ADHD) is a challenging one that has been investigated across many studies. Part of the challenge lies in the difficulty of examining the range of cognitive functions that are now evidenced as areas of difficulty within a single study. A lack of studies examining the long-term effects of medication has also challenged advancement of knowledge in this area. When the available research is integrated, what is the conclusion regarding effects of stimulants on neurocognitive function?

A systematic review of the rates of depression in autistic children and adolescents without intellectual disability.

OBJECTIVES: Increasing evidence suggests that major depressive disorder (MDD) is highly prevalent in autism spectrum disorder (ASD). The current study is a systematic review of rates of depression in autistic children and adolescents, without intellectual disability. DESIGN: Adhering to PRISMA guidelines, a total of 14,557 studies were identified through five databases (MEDLINE, EMBASE, Cinahl, ERIC, PsycINFO, and Web of Science). METHODS: Articles were screened for inclusion and exclusion criteria and 10% double coded at each stage. Nineteen studies met criteria and were retained in the review. RESULT: The reported rates of depression in autistic children and adolescents varied from 0% to 83.3%. We discuss these findings in relation to method of report (self/informant, interview/questionnaire), recruitment status (clinical/community recruited), and age (pre-pubertal/adolescent). CONCLUSION: Rates of depression vary considerably across studies and do not show a particular pattern in relation to methodology, or age. Our research joins a crucial call to action from the research community for future research to improve the identification of depression in autism, which in turn will aid our understanding of the potentially different characterization and manifestation of depression in autism, to ultimately improve assessment and treatment of depression in autistic children and adolescents. PRACTITIONER POINTS: Rates of depression in autistic children and adolescents vary and do not show a particular pattern in relation to methodology or age. Our research joins the call to action from the research community for future research to improve the identification of depression in autistic children and adolescents, which in turn will aid understanding of depression in autism, and ultimately improve assessment and treatment of depression in autistic children and young people. The development of new measures of depression, specifically designed with, and for, children and adolescents with autism, is warranted.

Relationships between cognition and literacy in children with attention-deficit/hyperactivity disorder: A systematic review and meta-analysis.

Evidence suggests that cognitive and literacy difficulties are common for children with Attention-Deficit/Hyperactivity Disorder (ADHD). The current systematic review and meta-analysis investigated the relationship between cognition and literacy in children with ADHD. Ten thousand and thirty-eight articles were screened against the inclusion criteria and six eligible studies were retained for final review. Where two or more studies used comparable measures of cognition and literacy, a meta-analysis of the relationship between these measures was undertaken. A narrative synthesis of all included studies was also completed. There were medium effect sizes between working memory and aspects of reading, and small effect sizes between processing speed and reading. Inhibition and attention had differential relationships with aspects of literacy with varying effect sizes. This systematic review demonstrates differential relationships between aspects of literacy and cognition in children with ADHD. Further examination of these relationships is warranted to support intervention development.

Social identities and mental well-being in autistic adults.

LAY ABSTRACT: Social identities are groups that we are part of and influence how we think about ourselves. However, up until now there has been little examination of the groups that autistic people may belong to, and how these groups may influence their mental health. This survey-based study investigated whether autistic adults answer questions about social groups in a similar way to non-autistic non-autistic adults, including the types and number of social groups they may belong to, and whether these are associated with depression, anxiety and positive traits of mental well-being. In total, 184 autistic adults completed an online survey with questionnaires about their demographics, social groups and mental health. The results found that autistic adults reported on their social groups similarly to non-autistic people. There was a variety in the types and numbers of groups that autistic adults identified with. Some participants reported having no groups that they identified with, whereas others reported up to four groups. These included other autistic people, their family, friends, work colleagues and activity clubs among others. Autistic adults who felt connected with more groups reported better mental well-being. Feelings of connection to other autistic people and the family were also associated with better mental well-being. These results show that it is important for autistic people to be given opportunity to be part of groups that are meaningful to them, as this may be beneficial for their mental health.

Peer Relationships in Children with Williams Syndrome: Parent and Teacher Insights.

Although children with Williams syndrome (WS) are reported to show a strong motivation towards social interaction, evidence suggests many experience difficulties with peer relations. Less is known regarding the characteristics of such difficulties. Parents and teachers of 21 children with WS (7- to 16 years) completed questionnaires measuring aspects of social functioning and peer interactions. Parents and teachers reported that children with WS demonstrated significantly greater peer problems than population norms, including difficulties sustaining friendships and increased social exclusion. More substantial social functioning difficulties were associated with greater peer relation problems. The study provides multi-informant evidence of peer relationship difficulties in children with WS that require further consideration within the broader WS social phenotype.

An ecological momentary assessment study of the role of emotional dysregulation in co-occurring ADHD and internalising symptoms in adulthood.

Previous ecological momentary assessment (EMA) research in children has suggested that emotional dysregulation problems are commonly associated with ADHD symptoms and may help explain their relatively strong co-occurrence with anxiety and depression (collectively referred to as 'internalising problems'); however, this has yet to be replicated for adults. In this study, we used data from a n=260 longitudinal cohort and EMA study, to evaluate the hypothesis that emotional dysregulation mediates the association between ADHD symptoms and internalising problems in emerging adulthood. Emotional dysregulation was based on affect data collected in near real time and in ecological context over a 14-day period, providing a measure of emotional lability in the context of participants' daily lives. Cross-sectional mediation was tested using structural equation modelling. Emotional lability significantly mediated the association between ADHD symptoms and internalising problems. Results suggest that interventions that address the emotional dysregulation aspects of ADHD are likely to be beneficial for preventing and managing secondary internalising symptoms.

Developmental changes in executive functions during adolescence: A study of inhibition, shifting, and working memory.

The development of executive functions (EFs) has primarily been studied among younger children, despite research suggesting that particular aspects of EFs continue to develop throughout adolescence and into adulthood. This study investigated whether EFs continue to develop during the later stages of adolescence: three related, yet separable EF components - inhibition, shifting, and working memory - were examined in a cross-sectional sample of 347 adolescents (aged 14-18 years). After adjusting for covariates, age was found to be a significant predictor of pupils' performance on the inhibition but not the shifting or working memory tasks, suggesting different developmental trajectories for the three EF components. Controlling for non-executive processes implicated in performing the inhibition and working memory tasks had the most pronounced effect on the relationship between performance on those tasks and age. Finally, socioeconomic status was a significant predictor of performance on all tasks. Implications for research and practice are discussed. Statement of contribution What is already known on this subject? Brain regions associated with EFs continue to mature throughout adolescence, implying ongoing development of EFs. Behavioural studies demonstrate that certain EFs have not yet reached their adult levels in early adolescence. What the present study adds Changes in inhibition, but not shifting or working memory task performance, are evident among older adolescents. Lower-order processes tapped by EF tasks act as confounds in the relationship between age and task performance. Socioeconomic status is a significant predictor of adolescents' performance on EF tasks.