Association between parental depressive symptoms and impaired bonding with the infant.

Impaired bonding with the infant is associated with maternal postpartum depression but has not been investigated extensively in fathers. The primary study aim was to evaluate associations between maternal and paternal depressive symptoms and impaired bonding with their infant. A secondary aim was to determine the associations between parents' marital problems and impaired bonding with the infant. The study is part of a population-based cohort project (UPPSAT) in Uppsala, Sweden. The Edinburgh Postnatal Depression Scale (EPDS) at 6 weeks and 6 months postpartum and the Postpartum Bonding Questionnaire at 6 months postpartum were completed by 727 couples. The prevalence of impaired bonding was highest among couples in which both spouses had depressive symptoms. Impaired bonding was associated with higher EPDS scores in both mothers and fathers, as well as with experiencing a deteriorated marital relationship. The association between maternal and paternal impaired bonding and the mothers' and fathers' EPDS scores remained significant even after adjustment for relevant confounding factors. Depressive symptoms at 6 weeks postpartum are associated with impaired bonding with the infant at 6 months postpartum for both mothers and fathers. It is critical to screen for and prevent depressive symptoms in both parents during early parenthood.

[Poorer physician continuity after care choice for patients with diabetes. A comparison before and after introduction of hälsoval Skåne in Malmö]. / Sämre läkarkontinuitet efter vårdvalet för patienter med diabetes - En jämförelse före och efter införande av hälsoval Skåne i Malmö.

Continuity of care is one of the core values of family medicine and both patients and doctors consider it a vital aspect of the care of patients with chronic diseases. In 2009 a national health care reform was implemented in primary care in Sweden. This study compared the longitudinal continuity of care in primary care before and after this reform in 7121 adult diabetes patients living in Malmö. Our findings reveal that continuity of care decreased substantially after the reform. The decrease was independent of sex, type of diabetes, age and income. Both before and after the reform men had a significantly higher rate of continuity of care than women. The number of visits to GPs by diabetes patients decreased slightly each investigated year. This possibly illustrates the crowding out of diabetes patients, as earlier research showed an increased overall number of GP visits for the whole population in Skåne (the county where Malmö is situated) after the reform.

The role of parental education in the relation between ADHD symptoms and executive functions in children.

OBJECTIVE: Using a population-based sample of 9-year-old children, this study examined whether the relation between symptoms of ADHD and executive functions (EFs) depended on socioeconomic status (SES; indexed by parental education). METHOD: Parents and teachers rated the children's ADHD symptoms, and parents also indicated their educational level in a questionnaire. The children performed a comprehensive set of EF tasks. RESULTS: Whereas working memory was similarly related to ADHD symptoms in the lower and higher parental education group, the relations of inhibition and mental set-shifting with ADHD symptoms were generally stronger in the higher educational group, a pattern that was supported by several significant group differences in correlations. CONCLUSION: This suggests that the EF pathway in contemporary multiple pathway models of ADHD etiology may be particularly relevant in higher SES parts of the population.

A longitudinal examination of the developmental executive function hierarchy in children with externalizing behavior problems.

OBJECTIVE: Using a 4-year longitudinal design, we evaluated two hypotheses based on developmental executive function (EF) hierarchy accounts in a sample of children with externalizing problems. METHOD: The participants performed EF tasks when they were between 8 and 12 years (M = 9.93), and again approximately 4 years later when they were between 12 and 15 years (M = 13.36). RESULTS: Inhibition in middle childhood predicted working memory (WM) 4 years later. Further, deficits in inhibition and sustained attention were more prominent in middle rather than late childhood, whereas poor WM was salient throughout these periods. CONCLUSIONS: These findings support the hypotheses that EFs develop hierarchically and that EF deficits in ADHD are more prominent in actively developing EFs. They also emphasize ADHD as a developmental disorder.

Cognitive functioning and family risk factors in relation to symptom behaviors of ADHD and ODD in adolescents.

OBJECTIVE: In this study, the authors investigated whether ADHD and oppositional defiant disorder (ODD) behaviors share associations with problems in cognitive functioning and/or family risk factors in adolescence. This was done by examining independent as well as specific associations of cognitive functioning and family risk factors with ADHD and ODD behaviors. METHOD: A sample of 120 adolescents from the general population was assessed on various cognitive tasks. ADHD and ODD behaviors were measured through parental and teacher ratings based on Diagnostic and Statistical Manual of Mental Disorders (4th edition) criteria. Parents and adolescents provided information regarding measures of family risk factors. RESULTS: The results show that only cognitive functioning was associated with ADHD behaviors, and family risk factors were, independent of cognitive functioning, associated with ODD behaviors. CONCLUSION: These results suggest that cognitive performance bears a specific significance for ADHD behaviors, whereas family risk factors have specific importance for ODD behaviors.

Effects of symptoms of ADHD, ODD, and cognitive functioning on social acceptance and the positive illusory bias in children.

OBJECTIVE: To examine the effects of symptoms of ADHD and ODD and cognitive functioning on social acceptance and positive bias in children. METHOD: The sample consisted of 86 children (49 girls) between 7 and 13 years old, recruited to reflect a wide range of ADHD symptoms. Parents and teachers reported on ADHD and ODD symptoms and social acceptance. Children reported on social acceptance and were given tasks measuring working memory, inhibition and reaction-time variability. A discrepancy score between child and adult reports of social acceptance was used as a measure of positive bias. RESULTS: Inattention independently explained variance in social acceptance. The cognitive factors were related to social acceptance and the positive bias, but not beyond the ADHD and ODD symptoms. CONCLUSION: It is primarily disruptive behavior that contributes to external reports of children's social acceptance.

Behavioral and ERP indices of response conflict in Stroop and flanker tasks.

We investigated effects of different proportions of incongruent trials on behavioral and event-related potential (ERP) interference measures associated with response conflict in the Stroop and flanker task. From the literature, we hypothesized that response conflict is greater when incongruent trials are rare compared to when incongruent trials are frequent. In support, the behavioral results on both tasks and the ERP results on the Stroop task (N450) showed that interference effects were significantly larger when incongruent trials were rare than frequent. In contrast, the ERP results on the flanker task N200 showed a larger interference effect when incongruent trials were frequent than rare. Because results for the flanker N200 were opposite to behavioral effects and theoretical predictions, our findings challenge the notion of the flanker N200 as a valid index of response conflict.

The relation between working memory components and ADHD symptoms from a developmental perspective.

The objective was to examine the relations between attention deficit hyperactivity disorder (ADHD) symptoms and four working memory (WM) components (short-term memory and central executive in verbal and visuospatial domains) in 284 6-16-year-old children from the general population. The results showed that verbal and visuospatial short-term memory and verbal central executive uniquely contributed to inattention symptoms. Age interacted with verbal short-term memory in predicting inattention, with the relation being stronger in older children. These findings support the notion of ADHD as a developmental disorder, with changes in associated neuropsychological deficits across time. The results further indicate ADHD-related deficits in several specific WM components.

Developmental change in the relation between simple and complex spans: a meta-analysis.

In the present meta-analysis the effects of developmental level on the correlation between simple and complex span tasks were investigated. Simple span-complex span correlation coefficients presented in 52 independent samples (7,060 participants) were regressed on a variable representing mean age of sample (range: 4.96-22.80 years), using analyses adapted for meta-analytic purposes. The results showed strong positive relations between mean age of sample and simple span-complex span correlation coefficients, suggesting that the relation between simple and complex span tasks became stronger with increasing age. These results could not be accounted for by study-related differences in measurement reliability, restricted range, or sample size. A new theoretical account explaining these findings is outlined.

Intellectual deficits in children with ADHD beyond central executive and non-executive functions.

This study aimed to specify the deficit in intellectual ability in children with attention deficit hyperactivity disorder (ADHD), by studying the mediating role of impairments in central executive function (EF)-related components (working memory, inhibition, sustained attention) and non-EFs (short-term memory and processing speed). Two hundred and thirty children aged 8-11 years from a population-based sample were assigned to either the ADHD group, the clinical comparison group, or the normal comparison group. The results showed that children with ADHD had poorer fluid and crystallized intelligence, relative to both comparison groups. Further, regarding fluid intelligence, these deficits were not fully mediated by, but rather went beyond, poorer functioning on the studied EF-related components and non-EFs. We tentatively interpret these fluid deficits in children with ADHD as representing deficiencies in a general intellectual resource reflecting executive attentional processes. Concerning crystallized ability, in contrast, the deficit signified impairment in the studied cognitive functions, as indicated by the significant full mediation effect.

Motor response inhibition and execution in the stop-signal task: development and relation to ADHD behaviors.

The main aim of this study was to investigate the developmental course of motor response inhibition and execution as measured by the stop-signal task in a population-based sample of 525 4- to 12-year-olds. A further aspiration of the study was to enhance the limited knowledge on how the various stop-signal measures relate to ADHD behaviors in a normal sample. We also wanted to contribute to the theoretical understanding of the various stop-signal measures by examining the relations between the stop-signal measures and performance on tasks reflecting other aspects of response inhibition and execution. Our results showed that the ability to inhibit as well as to execute a motor response as measured by the stop-signal task improved with age during childhood. Of specific interest are the findings suggesting that this task captures the development of motor response inhibition in the late preschool years (age 5 years). Both of the inhibition measures derived from the stop-signal task (i.e., SSRT and probability of inhibition) related significantly to teacher ratings of inattention as well as to performance on tasks tapping other aspects of inhibition. The data provided by this study have thus contributed to the scarce knowledge on early development of motor response inhibition, as well as suggested that the stop-signal task may be a valuable tool for capturing deficient motor response inhibition in ADHD behaviors in normal samples.