Effects of Compliance to a Training Intervention for High School Students with ADHD.

OBJECTIVE: We evaluated the effects of treatment compliance with the Challenging Horizons Program (CHP) for high school aged adolescents with attention-deficit hyperactivity disorder (ADHD). METHOD: Participants were 185 high school aged adolescents (65% non-Hispanic White; 79% male) with a diagnosis of ADHD who were randomly assigned to either CHP or community control. Outcomes included parent-rated academic functioning, parent- and self-rated social-emotional functioning, and GPA. The complier average causal effect (CACE) was estimated using propensity-weighted models for youth engaging in ≥ 30 CHP individual sessions (15-20 min) across the academic year. RESULTS: Most (78%) CHP participants engaged in≥30 CHP sessions. CACE analyses using latent growth curve modeling revealed significant treatment effects among treatment compliers across ratings of academic and social outcomes relative to similar control participants. For most outcomes, CACE estimates were larger than those found in intent-to-treat analyses, especially at 6-months follow-up. CONCLUSIONS: Compliance with 30 or more individual CHP sessions appeared to be an attainable threshold associated with incremental gains across several academic and social outcomes. Effects of compliance were amplified at 6-months follow-up, supporting the hypothesized theory of change of training interventions. Future work should focus on facilitators of treatment engagement and feasibility of the CHP as delivered by high school personnel.

Impairment's Role in the Pathway From Externalizing Psychopathology to Depressive Symptoms in Adolescents With ADHD.

OBJECTIVE: This study examined the role of academic, social, and family impairment in the pathway from externalizing psychopathology to depression among young adolescents with ADHD in a multiple mediation model. METHOD: The sample included adolescents with ADHD enrolled in an intervention trial. Parent ratings of externalizing psychopathology were measured at eligibility assessment, adolescent self-reported depressive symptoms were measured at eligibility and at the end of treatment, and parent-rated impairment was measured in the middle of treatment. A multiple mediation model was used to examine mediating effects of impairment types in the pathway from externalizing psychopathology to depression. RESULTS: Parent-reported family impairment significantly mediated the association between externalizing psychopathology and depressive symptoms. CONCLUSIONS: Results suggest family impairment mediates the association between externalizing psychopathology and depressive symptoms beyond academic and social impairment for youth with ADHD. Findings implicate the importance of targeting family functioning during early adolescence to prevent depression.

COVID-19 Impact Battery: Development and Validation.

In addition to impacting the physical health of millions of Americans, the novel-coronavirus (COVID-19) pandemic is a significant psychological stressor due to both the threat of the illness itself and the mitigation strategies used to contain the spread. To facilitate understanding of the impact of COVID-19, validated measures are needed. Using a stepwise procedure in line with best-practice measurement procedures, the current report summarizes the procedures employed to create the COVID-19 Impact Battery (CIB). Two independent samples recruited via Amazon Mechanical Turk (N = 175, N = 642) and a third community sample (N = 259) were used for reliability and validity testing. Validation procedures yielded a battery consisting of three scales assessing COVID-19 related behaviors, worry, and disability. The behaviors scale contains three subscales assessing stockpiling, cleaning, and avoidance. The worry subscale also contains three subscales assessing health, financial and catastrophic concerns. In addition, we created a short version of the battery (CIB-S) to allow for more flexibility in data collection. In summary, we have provided reliability and validity information for the CIB and CIB-S, demonstrating that these measures can facilitate evaluation of the broad impact of COVID-19 on mental health functioning.

Lonely, anxious, and uncertain: Critical risk factors for suicidal desire during the COVID-19 pandemic.

Public health measures enacted early in response to the COVID-19 pandemic resulted in unprecedented physical isolation. Social isolation, or the objective experience of being alone, and loneliness, the subjective feeling of being lonely, are both implicated in suicidal ideation. Anxiety sensitivity (i.e., fear of somatic anxiety) and intolerance of uncertainty (distress due to uncertainty), may also be heightened in response to the pandemic increasing risk for suicidal ideation in response to social isolation and loneliness. The direct and interactive relations loneliness, anxiety sensitivity, and intolerance of uncertainty shared with suicidal ideation were examined using structural equation modeling across two samples. Sample 1 comprised 635 people (M age = 38.52, SD = 10.00; 49.0% female) recruited using Mechanical Turk in May 2020. Sample 2 comprised 435 people (M age = 34.92, SD = 14.98; 76.2% female) recruited from faculty, staff, and students at a midwestern university in June 2020. Loneliness and anxiety sensitivity were positively, uniquely associated with suicidal ideation across samples. Results of this study were cross-sectional and included only self-report measures. These findings highlight loneliness and anxiety sensitivity as important correlates of suicidal ideation. Modular treatments should be employed to target these mechanisms to reduce COVID-19-related suicidal ideation.

Insomnia during the COVID-19 pandemic: the role of depression and COVID-19-related risk factors.

The COVID-19 pandemic has resulted in dramatic changes to sleep patterns and higher prevalence of insomnia, which threaten overall mental and physical health. We examined whether safety behaviors in response to COVID-19, worry in response to COVID-19, and depression predicted insomnia, with age, race, and sex as covariates. A community sample from the United States (n = 321, Mage = 40.02, SD = 10.54; 53.6% female) recruited using online crowdsourcing completed self-report measures in May of 2020 and again three months later. At baseline, our model accounted for 68.1% of the variance in insomnia, with depression as the only significant predictor (ß = .70, p < .001). In the longitudinal analyses, only baseline insomnia symptoms predicted 3-month follow-up insomnia symptoms (ß = .70, p < .001; 67.1% of variance). Of note, COVID-19 worry and some COVID-19 safety behaviors were related to 3-month follow-up safety behaviors, but not insomnia. Our findings demonstrated that depression is an important factor to consider for concurrent insomnia symptoms. Our results have implications regarding the development of interventions for insomnia during the COVID-19 pandemic and suggest that clinicians should consider depression when assessing for and treating insomnia symptoms.

The Difficulties in Emotion Regulation Scale-Parent Report: A Psychometric Investigation Examining Adolescents With and Without ADHD.

Emotion dysregulation is associated with attention deficit/hyperactivity disorder (ADHD) and confers risk for behavior problems and functional impairment; however, there is little guidance on best practices for measurement in adolescents. We developed a parent-report version of the Difficulties in Emotion Regulation Scale (DERS-P). Evidence of reliability and validity was evaluated in a large community online sample (Study 1: n = 978; Mage = 13.52 years; SD = 1.93) and in two samples of adolescents with ADHD (Study 2, Sample 1: n = 78; Mage = 12.12 years, SD = 0.91; Sample 2: n = 206; Mage = 15.35 years; SD = 0.85). A four-factor solution of the DERS-P was obtained in Study 1 and confirmed in Study 2, with factors demonstrating acceptable internal consistency. The community sample was generally rated as less dysregulated than the ADHD samples. Support was obtained for convergent, concurrent, and incremental validity evidence. These findings provide preliminary evidence for the DERS-P as a psychometrically sound parent-report measure of emotion dysregulation in 11- to 17-year-old adolescents.

Examination of the Structure and Measurement of Inattentive, Hyperactive, and Impulsive Behaviors from Preschool to Grade 4.

Attention Deficit/Hyperactivity Disorder (ADHD) is a complex and heterogeneous disorder consisting of inattentive and hyperactive/impulsive behaviors. Although, the multidimensionality of ADHD is widely accepted, questions remain regarding the extent to which the components of this disorder are overlapping or distinct. Further, although the same measures are generally used to assess inattentive, hyperactive, and impulsive behaviors across childhood, it has been argued that the structure and measurement of inattentive, hyperactive, and impulsive behaviors may be susceptible to developmental influences. The purpose of this study was to examine the factor structure and measurement invariance of inattentive and hyperactive/impulsive behaviors in a large group of children (N = 10,047) ranging in grade level from preschool to grade 4. A bifactor model with a general factor and two specific factors of inattention and hyperactivity/impulsivity fit the data best. This finding held across all groups and all grade levels. In general, the bifactor model demonstrated measurement invariance from kindergarten through grade 4 but not for preschool. Implications for the understanding and measurement of inattentive, hyperactive, and impulsive behaviors across early and middle childhood are discussed.

The Influences of Multiple Informants' Ratings of Inattention on Preschoolers' Emergent Literacy Skills Growth.

There is strong evidence that inattention is a correlate of reading-related skills; however, less research has examined the unique and longitudinal relations between multiple informants' ratings of inattention and the development of early reading skills across the preschool year. This study used latent growth curve analysis to examine whether ratings of inattention, completed by multiple informants, were unique predictors of emergent literacy development in preschoolers. Participants included 284 preschool children. ADHD-rating scales were completed by three different informants (i.e., classroom teachers, project teachers, and examiners) and measures of emergent literacy skills, a measure of working memory, and a measure of non-verbal cognitive ability were completed by the preschoolers. Each informant's rating of inattention uniquely predicted children's initial emergent literacy skills, but only the ratings of inattention made by project teachers were uniquely associated with growth in emergent literacy skills over the course of the preschool year.

Agreement Among Traditional and RTI-based Definitions of Reading-Related Learning Disability with Preschool Children.

To investigate approaches for identifying young children who may be at risk for later reading-related learning disabilities, this study compared the use of four contemporary methods of indexing learning disability (LD) with older children (i.e., IQ-achievement discrepancy, low achievement, low growth, and dual-discrepancy) to determine risk status with a large sample of 1,011 preschoolers. These children were classified as at risk or not using each method across three early-literacy skills (i.e., language, phonological awareness, print knowledge) and at three levels of severity (i.e., 5th, 10th, 25th percentiles). Chance-corrected affected-status agreement (CCASA) indicated poor agreement among methods with rates of agreement generally decreasing with greater levels of severity for both single- and two-measure classification, and agreement rates were lower for two-measure classification than for single-measure classification. These low rates of agreement between conventional methods of identifying children at risk for LD represent a significant impediment for identification and intervention for young children considered at-risk.

Inhibitory Control of Spanish-Speaking Language-Minority Preschool Children: Measurement and Association With Language, Literacy, and Math Skills.

Children's self-regulation, including components of executive function such as inhibitory control, is related concurrently and longitudinally with elementary school children's reading and math abilities. Although several recent studies have examined links between preschool children's self-regulation or executive function and their academic skill development, few included large numbers of Spanish-speaking language-minority children. Among the fastest growing segments of the U.S. school-age population, many of these children are at significant risk of academic difficulties. We examined the relations between inhibitory control and academic skills in a sample containing a large number of Spanish-speaking preschoolers. Overall, the children demonstrated substantial academic risk based on preschool-entry vocabulary scores in the below-average range. Children completed assessments of language, literacy, and math skills in English and Spanish, when appropriate, at the start and end of their preschool year, along with a measure of inhibitory control, the Head-Toes-Knees-Shoulders task, which was administered at the start of the preschool year in the child's dominant conversational language. Scores on this last measure were lower for children for whom it was administered in Spanish. For both English and Spanish outcomes, those scores were significantly and uniquely associated with higher scores on measures of phonological awareness and math skills but not vocabulary or print knowledge skills.

Examining the predictive relations between two aspects of self-regulation and growth in preschool children's early literacy skills.

There is strong evidence that self-regulatory processes are linked to early academic skills, both concurrently and longitudinally. The majority of extant longitudinal studies, however, have been conducted using autoregressive techniques that may not accurately model change across time. The purpose of this study was to examine the unique associations between 2 components of self-regulation, attention and executive functioning (EF), and growth in early literacy skills over the preschool year using latent-growth-curve analysis. The sample included 1,082 preschool children (mean age = 55.0 months, SD = 3.73). Children completed measures of vocabulary, syntax, phonological awareness, print knowledge, cognitive ability, and self-regulation, and children's classroom teachers completed a behavior rating measure. To examine the independent relations of the self-regulatory skills and cognitive ability with children's initial early literacy skills and growth across the preschool year, growth models in which the intercept and slope were simultaneously regressed on each of the predictor variables were examined. Because of the significant relation between intercept and slope for most outcomes, slope was regressed on intercept in the models to allow a determination of direct and indirect effects of the predictors on growth in children's language and literacy skills across the preschool year. In general, both teacher-rated inattention and directly measured EF were uniquely associated with initial skills level; however, only teacher-rated inattention uniquely predicted growth in early literacy skills. These findings suggest that teacher ratings of inattention may measure an aspect of self-regulation that is particularly associated with the acquisition of academic skills in early childhood. (PsycINFO Database Record

Executive function of Spanish-speaking language-minority preschoolers: Structure and relations with early literacy skills and behavioral outcomes.

Young children's executive function (EF) is increasingly recognized as an important construct associated with development in cognitive and socioemotional domains. To date, however, few studies have examined EF in populations of language-minority children. In this study, 241 Spanish-speaking language-minority preschoolers who ranged in age from 38 to 69 months (M=54.23 months, SD=6.17) completed three tasks designed to measure inhibitory control (IC) and four tasks designed to measure working memory (WM). Children completed assessments of their vocabulary skills, early literacy skills, and behavioral self-regulation in both English and Spanish, and their classroom teachers completed three behavior rating measures. Children were classified as more proficient in English or Spanish based on their scores on the vocabulary measures, and all IC and WM measures were administered in the children's more proficient language. Results of confirmatory factor analyses supported a two-factor model of EF for both groups of children as well as strong measurement and structural invariance across groups. Children's EF was substantially related to the language, early literacy, and behavioral self-regulation measures as well as teacher ratings of inattention and hyperactivity/impulsivity. For children with more proficient English, EF was associated with skills in both English and Spanish; however, for children with more proficient Spanish, EF was associated primarily with skills in Spanish. These results provide evidence of strong correspondence for EF measured in Spanish-speaking language-minority preschoolers and monolingual preschoolers, and they identify a potential key factor that can enhance understanding of development in this population of children.

Relations between response trajectories on the continuous performance test and teacher-rated problem behaviors in preschoolers.

Although both the continuous performance test (CPT) and behavior rating scales are used in both practice and research to assess inattentive and hyperactive/impulsive behaviors, the correlations between performance on the CPT and teachers' ratings are typically only small-to-moderate. This study examined trajectories of performance on a low target-frequency visual CPT in a sample of preschool children and how these trajectories were associated with teacher-ratings of problem behaviors (i.e., inattention, hyperactivity/impulsivity [H/I], and oppositional/defiant behavior). Participants included 399 preschool children (mean age = 56 months; 49.4% female; 73.7% White/Caucasian). An attention deficit/hyperactivity disorder (ADHD) rating scale was completed by teachers, and the CPT was completed by the preschoolers. Results showed that children's performance across 4 temporal blocks on the CPT was not stable across the duration of the task, with error rates generally increasing from initial to later blocks. The predictive relations of teacher-rated problem behaviors to performance trajectories on the CPT were examined using growth curve models. Higher rates of teacher-reported inattention and H/I were uniquely associated with higher rates of initial omission errors and initial commission errors, respectively. Higher rates of teacher-reported overall problem behaviors were associated with increasing rates of omission but not commission errors during the CPT; however, the relation was not specific to 1 type of problem behavior. The results of this study indicate that the pattern of errors on the CPT in preschool samples is complex and may be determined by multiple behavioral factors. These findings have implications for the interpretation of CPT performance in young children.

Relations between inhibitory control and the development of academic skills in preschool and kindergarten: a meta-analysis.

Although there is evidence that young children's inhibitory control (IC) is related to their academic skills, the nature of this relation and the role of potential moderators of it are not well understood. In this meta-analytic study, we summarized results from 75 peer-reviewed studies of preschool and kindergarten children (14,424 children; 32-80 months old [M = 54.71 months; SD = 9.70]) across a wide range of socioeconomic status. The mean effect size (r) across studies was .27 (95% confidence interval [.24, .29]), indicating a moderate and statistically significant association between self-regulation and academic skills. The association between IC and academic skills was moderated by type of IC behavior task (i.e., hot vs. cool behavior task), by method of assessing IC (i.e., behavior task vs. parent report), and by academic subject (i.e., literacy vs. math), but not by other methods of assessing IC (i.e., behavior task vs. teacher report, parent report vs. teacher report) or by grade (i.e., preschool vs. kindergarten). The results of this meta-analysis suggest that there are preferred methods for assessing IC (i.e., cool behavior tasks, teacher reports) that should be considered when examining the relations between IC and academic skills in young children. (PsycINFO Database Record (c) 2014 APA, all rights reserved).