Psychological predictors of performance-based physical functioning among pediatric pain program participants.

PURPOSE: The purpose of the present study was to evaluate changes in performance-based physical functioning and investigate psychological predictors of physical functioning over time in pediatric patients with chronic pain who completed an interdisciplinary rehabilitation intensive outpatient program (IOP). METHODS: Participants (N = 55; mean age = 14.92 years; 12.7% male, 87.3% female; 83.6% White, 5.6% African-American/Black; 9.1% Latinx) completed baseline measures assessing pain intensity and modifiable psychological factors (i.e., pain catastrophizing, kinesiophobia, anxiety and depressive symptoms). Participants were administered performance-based assessments of physical functioning (i.e., physical endurance, high-level motor abilities) before and after IOP completion. RESULTS: Pain intensity was not significantly associated with physical functioning at either timepoint. There was significant improvement on measures of physical functioning after completion of the IOP when controlling for the effects of sex, race, and ethnicity. Depressive symptoms were associated with baseline physical endurance, ß = - .28, p = .047, while pain catastrophizing was associated with baseline gross motor abilities, ß = - .28, p = .032. CONCLUSION: Participation in an IOP led to significant improvement in physical endurance and high-level motor ability. Depressive symptoms and pain catastrophizing were associated with physical functioning at baseline but not post-program completion. Integration of pain psychology and physical therapy in an IOP can help address the interrelated psychological and physical factors impacting physical functioning to improve outcomes for children with chronic pain.

Pain Widespreadedness, and Not Primary Pain Location, is Associated With Comorbid Symptoms in Children With Chronic Pain.

OBJECTIVES: Pediatric chronic pain represents heterogeneous diagnoses; often, primary pain location informs research classifications and treatment. In contrast, recent research has highlighted the role of widespread pain and this perspective has been adopted in assessments in specialty pediatric pain clinics. The lack of direct comparison between these 2 methods of categorizing pediatric chronic pain may hinder the adoption of evidence-based practices across the spectrum of care. Therefore, this study aimed to compare whether primary pain location or pain widespreadedness is more informative for pain-related symptoms in pediatric chronic pain. METHODS: Youth (n=223) between the ages of 8 to 23 years (M=15.93, SD=2.11, 83% female) completed surveys upon intake at the pediatric chronic pain clinic. Free-text entries of primary pain location were coded into categories: headache, abdominal pain, and musculoskeletal pain. Additional domains assessed included widespread pain, pain interference, kinesiophobia, catastrophizing, anxiety, depression, sleep, and fatigue. RESULTS: Differences based on primary pain location only emerged for kinesiophobia, F(2150)=8.20, P<0.001, with the highest scores among those with musculoskeletal pain. In contrast, controlling for sex, age, and pain intensity, pain widespreadedness was associated with pain interference, pain catastrophizing, fatigue, anxiety, and depression (P<0.05). DISCUSSION: Pain widespreadedness was more consistently associated with pain-related outcomes among pediatric chronic pain patients than primary pain location, and body maps may be useful in determining a nociplastic pain mechanism to inform treatment. Improved assessment of pediatric pain mechanisms may help advance more precise treatment delivery.

Trajectories of Insomnia Symptoms From Childhood Through Young Adulthood.

OBJECTIVES: Insomnia symptoms are transdiagnostic to physical and mental health disorders. Given the lack of population-based cohorts with objective sleep measures and long-term follow-ups, little is known about the chronicity of childhood insomnia symptoms. We determined the developmental trajectories of insomnia symptoms, their evolution into adult insomnia, and the role of objective sleep duration in the transition to adulthood. METHODS: A total of 502 children (median 9 years old, 71.7% response rate) were studied 7.4 years later as adolescents (median 16 years old) and 15 years later as adults (median 24 years old). Insomnia symptoms were ascertained as moderate-to-severe difficulties initiating and/or maintaining sleep via parent- or self reports at all 3 time points, adult insomnia via self-report in young adulthood, and objective short-sleep duration via polysomnography in childhood and adolescence. RESULTS: Among children with insomnia symptoms, the most frequent trajectory was persistence (43.3%), followed by remission (26.9% since childhood, 11.2% since adolescence) and a waxing-and-waning pattern (18.6%). Among children with normal sleep, the most frequent trajectory was persistence (48.1%), followed by developing insomnia symptoms (15.2% since adolescence, 20.7% in adulthood) and a waxing-and-waning pattern (16.0%). The odds of insomnia symptoms worsening into adult insomnia (22.0% of children, 20.8% of adolescents) were 2.6-fold and 5.5-fold among short-sleeping children and adolescents, respectively. CONCLUSIONS: Early sleep interventions are a health priority because pediatricians should not expect insomnia symptoms to developmentally remit in a high proportion of children. Objective sleep measures may be clinically useful in adolescence, a critical period for the adverse prognosis of the insomnia with short-sleep duration phenotype.

Behavioral, neurocognitive, polysomnographic and cardiometabolic profiles associated with obstructive sleep apnea in adolescents with ADHD.

BACKGROUND: A high comorbidity between attention-deficit/hyperactivity disorder (ADHD) and obstructive sleep apnea (OSA) as well as similar impairments across neurobehavioral outcomes has been described in children. However, there is a paucity of research examining the comorbidity of these two disorders in adolescents. This study examined the association of OSA with sleep, neurobehavioral, and cardiometabolic outcomes in adolescents with ADHD from the general population. METHODS: 421 adolescents (16.9 ± 2.3 years, 53.9% male) underwent 9-hr polysomnography, neurobehavioral, and physical evaluation. ADHD was ascertained by a parent-or-self-report of a lifetime diagnosis/treatment of ADHD. OSA was defined as an apnea hypopnea index of ≥2 events/hour. Groups of controls (n = 208), OSA-alone (n = 115), ADHD-alone (n = 54), and ADHD+OSA (n = 44) were studied. Multivariable-adjusted general linear models tested group differences in PSG parameters, neurobehavioral, and cardiometabolic outcomes after controlling for sex, race/ethnicity, age, and/or body mass index percentile. RESULTS: The ADHD+OSA group had significantly longer sleep onset latency, shorter total sleep time, lower sleep efficiency, and higher percent of stage 1 sleep, as compared with all other groups, however, these differences were diminished by excluding adolescents on psychoactive medication. The ADHD-alone group showed significantly higher periodic limb movements than controls. The ADHD+OSA and ADHD-alone groups did not significantly differ on any measure of neurocognitive or behavioral functioning. The ADHD+OSA and OSA-alone groups showed significantly worse cardiometabolic and inflammatory biomarkers when compared to controls or the ADHD-alone, but did not significantly differ between each other. CONCLUSIONS: Adolescents with a diagnosis ADHD+OSA showed phenotypic risk factors for OSA (i.e., overweight/obesity, visceral adiposity, metabolic syndrome, and inflammation) but not worse neurobehavioral outcomes when compared with ADHD-alone. While comorbidity is possible, these data support that adolescents with a suspicion of ADHD should be screened for OSA, before a diagnosis is reached and psychoactive medication initiated.

Sleep disturbance and pain in U.S. adults over 50: evidence for reciprocal, longitudinal effects.

OBJECTIVE: To examine the relationship between sleep disturbance and pain over a 14-year period. METHODS: This study used data from the 2002-2016 waves of the Health and Retirement Study (HRS), an observational study of U.S. adults over age 50 (n = 17,756). Sleep disturbance was measured via four items (assessing difficulty falling asleep, staying asleep, and waking up too early as well as restedness) and pain via two items assessing the presence and degree of pain. Analyses consisted of path analysis; more specifically, random intercept cross-lagged panel modeling (RI-CLPM) was used to examine how pain and sleep disturbance predict one another over two-year intervals after accounting for the trait-like nature of both factors. RESULTS: There was evidence of reciprocal effects between sleep disturbance and pain across some, but not all, intervals. Moreover, the latent variables representing the trait-like nature of sleep disturbance and pain both showed significant variance (p < 0.001), indicating stable differences between persons in sleep and pain. These trait-like characteristics were strongly associated (ß = 0.51, p < 0.001). The findings remained after adjusting the model for baseline age, self-reported health, partner status, depression, years of education, and sex. CONCLUSION: Sleep disturbance and pain are stable experiences. Moreover, there was some evidence that sleep disturbance and pain are bidirectionally linked across time among adults over 50, whereby across some intervals deviations in one's typical level of sleep disturbance predicted corresponding deviations in one's typical level of pain and vice versa. Clinically, this comorbidity and potential longitudinal bidirectionality underscore the importance of evidence-based interventions that target both sleep and pain among older individuals. Further studies should replicate these findings by collecting validated and/or objective sleep and pain measures on a more frequent basis.

The Hypersomnia Severity Index: reliability, construct, and criterion validity in a clinical sample of patients with sleep disorders.

STUDY OBJECTIVES: The Hypersomnia Severity Index (HSI) was designed to assess the severity and impairment of hypersomnolence and has been validated in persons with psychiatric disorders. Little is known about its psychometric properties in clinical samples of patients with sleep disorders. METHODS: One hundred fifty-eight patients (aged 44.1 ± 16.4 years, 29.1% male, 19.6% racial/ethnic minority) evaluated at the Behavioral Sleep Medicine program of the Penn State Health Sleep Research and Treatment Center completed the HSI and other patient-reported outcomes. We examined the HSI's reliability and factorial, construct, and criterion validity. RESULTS: The HSI showed satisfactory internal consistency (α = 0.79). A 2-factor structure, reflecting symptoms (HSI-S) and impairment, explained 56.2% of the variance. Convergent validity with the Epworth Sleepiness Scale was optimal (r = .65) but greater for HSI-S (r = .69) than for impairment (r = .39). Divergent validity was optimal for HSI-S against unrelated measures of sleep effort, reactivity, and incompatible behaviors (r ≤ .02). Construct validity showed higher scores in patients with central disorders of hypersomnolence and lower scores in patients with chronic insomnia disorder compared to those with other sleep disorders; however, these divergent scores were primarily driven by HSI-S rather than impairment. Criterion validity showed that an HSI-S cutoff score ≥ 8 provided the best balance in sensitivity/specificity (0.82/0.78) to identify central disorders of hypersomnolence (area under the curve, 0.85). CONCLUSIONS: The HSI shows satisfactory indices of reliability and validity in a clinical patient sample. Its construct and criterion validity are supported by its divergent association with other patient-reported outcomes and central disorders of hypersomnolence vs chronic insomnia disorder diagnoses and the adequate sensitivity/specificity of its HSI-S cutoff score to reliably identify central disorders of hypersomnolence. CITATION: Fernandez-Mendoza J, Puzino K, Amatrudo G, et al. The Hypersomnia Severity Index: reliability, construct, and criterion validity in a clinical sample with sleep disorders. J Clin Sleep Med. 2021;17(11):2249-2256.

Peer Victimization and Poor Academic Outcomes in Adolescents With ADHD: What Individual Factors Predict Risk?

Objective: Examine individual factors associated with peer victimization (PV) in adolescents with attention-deficit/hyperactivity disorder (ADHD) and to examine the association between PV and educational outcomes. Method: Participants were 121 adolescents (Mage = 13.62, SD = 1.03; 89% boys) with diagnosed ADHD. Using path analysis, we tested whether general adolescent factors (ADHD symptoms, comorbid autism spectrum disorder, cognitive and social functioning, and age) were associated with experiences of PV, and associations between PV and academic outcomes. Results: Deficits in working memory (WM) and peer relationship problems were weakly and moderately associated with PV, respectively. PV was in turn was associated with adolescents' attitudes about school, academic competence, and academic achievement. Conclusion: Adolescents with poor social skills and/or WM difficulties who have ADHD may be particularly vulnerable to being victimized by peers. Failure to identify and manage PV during early adolescence may be connected to poor educational outcomes.

Natural history of insomnia symptoms in the transition from childhood to adolescence: population rates, health disparities, and risk factors.

STUDY OBJECTIVES: To determine the sociodemographic, behavioral, and clinical risk factors associated with the persistence, remission, and incidence of insomnia symptoms in the transition from childhood to adolescence. METHODS: The Penn State Child Cohort is a random, population-based sample of 700 children (5-12 years at baseline), of whom 421 were followed-up as adolescents (12-23 years at follow-up). Subjects underwent polysomnography, clinical history, physical exam, and parent- and self-reported scales at baseline and follow-up. Insomnia symptoms were defined as a parent- or self-report of difficulty falling and/or staying asleep. RESULTS: The 421 subjects with baseline (Mage = 8.8 years) and follow-up (Mage = 17 years) data were 53.9% male and 21.9% racial/ethnic minorities. The persistence of childhood insomnia symptoms (CIS) was 56% (95% CI = 46.5-65.4), with only 30.3% (95% CI = 21.5-39.0) fully remitting. The incidence of adolescent insomnia symptoms was 31.1% (95% CI = 25.9-36.3). Female sex, racial/ethnic minority, and low socioeconomic status as well as psychiatric/behavioral or neurological disorders, obesity, smoking, and evening chronotype were associated with a higher persistence or incidence of insomnia symptoms. CONCLUSIONS: CIS are highly persistent, with full remission occurring in only a third of children in the transition to adolescence. Sex-, racial/ethnic-, and socioeconomic-related disparities in insomnia occur as early as childhood, while different mental/physical health and lifestyle/circadian risk factors play a key role in the chronicity of CIS versus their incidence in adolescence. CIS should not be expected to developmentally remit and should become a focus of integrated pediatric/behavioral health strategies.

Integrating Tobacco Prevention Skills into an Evidence-Based Intervention for Adolescents with ADHD: Results from a Pilot Efficacy Randomized Controlled Trial.

Adolescents with attention-deficit/hyperactivity disorder (ADHD) are at high risk for tobacco use, but tobacco use prevention strategies are not regularly incorporated into evidence-based ADHD interventions. We conducted a pilot randomized-controlled trial to determine the feasibility of integrating tobacco use prevention skills into a behavioral treatment for ADHD and to provide preliminary efficacy data comparing a combined (ADHD + tobacco) intervention (N = 40) to an ADHD only intervention (N = 23) on tobacco risk outcomes. Sixty-three adolescents (72% male; 13-17 years) with ADHD and their caregivers were randomly assigned to condition and families were masked to condition. Parent and adolescent ratings were collected at baseline, immediate post-intervention, and at 3- and 9-month follow-up assessments. The combined intervention was (1) implemented with high fidelity (94%), (2) well received by parents and adolescents as evidenced by high levels of treatment attendance (82%) and satisfaction with the intervention, and (3) associated with parent- and adolescent-reported reductions in tobacco use risk. Relative to the ADHD intervention, the combined intervention buffered against increases in tobacco risk, including reduced intentions to smoke and maladaptive social normative beliefs, and increased parental control, family cohesion, and family communication about substance use. Effect sizes at post-treatment were in the small to moderate range. Overall, this study provides preliminary support for a parent-adolescent behavioral treatment supplemented with family-based tobacco prevention strategies. This approach targets families already in treatment for ADHD, reducing barriers that occur when families attend multi-session prevention programs in addition to ADHD treatment.

A Review of Pediatric Nonpharmacological Sleep Interventions: Effects on Sleep, Secondary Outcomes, and Populations With Co-occurring Mental Health Conditions.

Sleep problems are common in school-age children and linked to numerous negative outcomes. Sleep disturbances are particularly common in children with mental health disorders, such as attention-deficit/hyperactivity disorder, depression, and anxiety. Despite frequent use of nonpharmacological pediatric sleep interventions to treat common sleep problems, there is a paucity of research on whether these interventions are effective. Further, it is unclear whether by targeting sleep, these interventions lead to broader improvements in the domains of functioning that are commonly affected by poor sleep. The present review includes 20 studies that evaluated nonpharmacological sleep treatments for school-aged youth, including 5 studies specifically focused on youth with externalizing or internalizing problems. Multimodal approaches consisting of psychoeducation and sleep hygiene in combination with other components were effective at treating insomnia and general sleep problems in typically developing samples. The addition of behavioral parent training to sleep interventions was effective for youth with externalizing problems, whereas incorporating cognitive strategies into sleep interventions for youth with internalizing problems was found to be ineffective. A variety of secondary outcomes were examined, with the strongest support emerging for improvement in anxiety and behavioral problems. Implications for clinical practice and future research directions are discussed.

Training Executive, Attention, and Motor Skills (TEAMS): a Preliminary Randomized Clinical Trial of Preschool Youth with ADHD.

This preliminary randomized controlled trial compared Training Executive, Attention and Motor Skills (TEAMS), a played-based intervention for preschool children with attention-deficit/hyperactivity disorder (ADHD), to an active comparison intervention consisting of parent education and support (ClinicalTrials.gov Identifier: NCT01462032). The primary aims were to gauge preliminary efficacy and assist in further development of TEAMS. Four- and 5-year-old children with ADHD were randomly assigned to receive TEAMS (N = 26) or the comparison intervention (N = 26) with blinded assessments by parents, teachers and clinicians ascertained pretreatment, post-treatment, and 1- and 3-months post-treatment. Changes in ADHD severity, impairment, parenting factors, and neuropsychological functioning over time as a function of treatment condition were assessed using the PROC MIXED procedure in SAS. Across most measures, significant main effects for Time emerged; both treatments were associated with reduced ADHD symptoms that persisted for three months post-treatment. There were no significant Treatment effects or Time x Treatment interactions on symptom and impairment measures, suggesting that the magnitude of improvement did not differ between the two interventions. However, significant correlations emerged between the magnitude of behavioral change, as assessed by parents and clinicians, and the amount of time families engaged in TEAMS-related activities during treatment. Across a wide array of parenting and neuropsychological measures, there were few significant group differences over time. TEAMS and other psychosocial interventions appear to provide similar levels of benefit. Play-based interventions like TEAMS represent a potentially viable alternative/addition to current ADHD treatments, particularly for young children, but more research and further development of techniques are necessary.

Sleep and daytime sleepiness in adolescents with and without ADHD: differences across ratings, daily diary, and actigraphy.

BACKGROUND: Children with attention-deficit/hyperactivity disorder (ADHD) experience greater sleep problems than their peers. Although adolescence is generally a developmental period characterized by insufficient sleep, few studies have used a multi-informant, multi-method design, to examine whether sleep differs in adolescents with and without ADHD. METHODS: Targeted recruitment was used to enroll an approximately equal number of eighth-grade adolescents (mean age = 13 years) with (n = 162) and without ADHD (n = 140). Adolescents and parents completed global ratings of sleep problems; adolescents, parents, and teachers completed ratings of daytime sleepiness. Adolescents wore actigraphs and completed a daily sleep diary for approximately 2 weeks. RESULTS: Adolescents with ADHD were more likely than adolescents without ADHD to obtain insufficient sleep on school days (per diary) and weekends (per diary and actigraphy). Adolescents with ADHD were also more likely to report falling asleep in class and to have stayed up all night at least twice in the previous 2 weeks (14% and 5% reported all-nighters for ADHD and comparison, respectively). In regression analyses controlling for a number of variables known to impact sleep (e.g. pubertal development, sex, medication use, having an externalizing, anxiety, or depression diagnosis), ADHD remained associated with shorter diary and actigraphy school night sleep duration, adolescent- and parent-reported daytime sleepiness, and parent-reported difficulties initiating and maintaining sleep and total sleep disturbance. Controlling for other variables, the odds of being classified with clinically elevated parent-reported sleep disturbance were 6.20 times greater for adolescents with ADHD. CONCLUSIONS: Findings provide some of the clearest evidence yet that adolescents with ADHD experience more sleep problems and sleepiness than their peers without ADHD. It may be especially important to assess for sleep problems in adolescents with ADHD and to evaluate whether existing sleep interventions are effective, or can be optimized, for use in adolescents with ADHD who also have sleep problems.

Predictors and Trajectories of Response to the Homework, Organization, and Planning Skills (HOPS) Intervention for Adolescents With ADHD.

The goal of the present study was to evaluate the relative importance of adolescent and parent skills acquired during participation in the Homework, Organization, and Planning Skills (HOPS) intervention in predicting intervention response. A sample of 111 middle school students with attention-deficit/hyperactivity disorder (66% male; Mage = 11.99, SD = 1.05) received the HOPS intervention, which includes 16 brief sessions with the adolescent and two parent meetings. Each session, school mental health providers completed checklists measuring students' acquisition of homework recording, materials organization, and time management skills. Parents provided information on whether they monitored and used contingencies to reinforce skills use at home. Outcome measures included parent and teacher ratings of homework problems and organizational/time management skills postintervention. Grade point average and assignment completion were also evaluated as objective outcomes. Regressions found accurate homework recording and time management to be unique predictors of parent-reported homework and organizational skills outcomes. Growth mixture models examining organizational skills trajectories throughout the intervention significantly predicted parent- and teacher-reported outcomes, GPA, and assignment completion; homework recording trajectories predicted parent-reported outcomes and GPA. Sixty-eight percent of participants displayed high acquisition of organization and homework recording skills. Parent-reported use of monitoring and contingencies to support adolescent skills implementation was not associated with outcomes. Results highlight the importance of examining individual differences in school-based intervention studies targeting organization, time management, and planning. Importantly, for a school-based adolescent-focused intervention, improvement in outcomes does not appear to be dependent upon parent skills implementation.

Featured Article: Technology Use and Sleep in Adolescents With and Without Attention-Deficit/Hyperactivity Disorder.

OBJECTIVES: This study used a multi-informant approach to examine differences in types and rates of technology used by adolescents with and without attention-deficit/hyperactivity disorder (ADHD), associations between technology use and sleep/daytime sleepiness, and whether technology use was differentially related to sleep/daytime sleepiness in adolescents with and without ADHD. METHODS: Eighth graders with (n = 162) and without (n = 140) ADHD were recruited. Adolescents completed questionnaires assessing time spent using technology, sleep-wake problems, school-night time in bed, and daytime sleepiness. Parents and teachers reported on adolescents' technology use and daytime sleepiness, respectively. RESULTS: Adolescents with ADHD had significantly greater total technology, television/movie viewing, video game, and phone/video chatting use than adolescents without ADHD. Adolescents with ADHD engaged in twice as much daily video game use compared to those without ADHD (61 vs. 31 min). Controlling for medication use, ADHD status, pubertal development, sex, and internalizing symptoms, greater parent- and adolescent-reported technology use was associated with more sleep-wake problems and less time in bed. ADHD status did not moderate the relations between technology use and these sleep parameters. In contrast, ADHD status moderated the association between parent-reported technology use and teacher-reported daytime sleepiness, such that this association was significant only for adolescents with ADHD. CONCLUSIONS: Technology use, although more prevalent in adolescents with ADHD, is linked with more sleep problems and reduced school-night sleep duration regardless of ADHD status. Technology use is associated with teacher-rated daytime sleepiness only in adolescents with ADHD. Clinicians should consider technology usage when assessing and treating sleep problems.

Brief homework intervention for adolescents with ADHD: Trajectories and predictors of response.

In the present study, we sought to examine response trajectories to brief (11-week) school-based homework interventions and factors that may help schools predict responses. Participants included 222 middle-school students (72% boys; Mage = 12.00 years, SD = 1.02) who had been diagnosed with attention-deficit/hyperactivity disorder (ADHD) and had received either a contingency-management or skills-based intervention for homework problems. Both interventions included 16 20-min student meetings with a school counselor and two parent meetings. Trajectories of response for ratings of homework problems and assignment completion were examined from baseline to a 6-month follow-up using growth-mixture models. Baseline variables routinely measured in school settings, including grade-point average (GPA), math and reading achievement, and externalizing and internalizing symptoms, were examined as predictors of treatment-response trajectories. The majority of students (68-81%) showed positive treatment response across outcomes. However, trajectories of students who did not respond to intervention were identified for each outcome. Baseline GPA significantly predicted trajectories for all outcomes and achievement scores significantly predicted trajectories of teacher-reported homework performance and parent-reported homework problems, such that youth with relatively higher baseline GPAs and achievement were most likely to respond. In contrast, neither externalizing nor internalizing symptoms were significant predictors of response trajectories. Schools can use GPA and academic-achievement data to determine whether brief school-based interventions for homework problems are likely to succeed. Students with ADHD who display severe academic impairment (i.e., GPA lower than 2.0 at baseline) may benefit from a more long-term, intensive intervention. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Attention-Deficit/Hyperactivity Disorder Symptoms, Depression Risk, and Quality of Life in Black Pregnant Women.

BACKGROUND: Experiencing mental health difficulties during pregnancy predicts a variety of quality-of-life (QoL) outcomes for Black women. However, one area of prenatal mental health remains underresearched: attention-deficit/hyperactivity disorder (ADHD). Given the impairments reported by adults with significant symptoms of ADHD and the linkages between depression and ADHD in nonpregnant samples, the current study aimed to examine the relationships among ADHD symptoms, depression, and QoL in Black pregnant women. MATERIALS AND METHODS: Participants for this study were 116 pregnant Black women aged 18-43 years (mean age = 27.14, standard deviation = 5.67) presenting to an urban women's health clinic. We investigated associations among maternal ADHD symptoms, risk of maternal depression, and different aspects of QoL, including relationships, life outlook, and life productivity. RESULTS: Linear hierarchical regressions were performed to investigate the ability of maternal depression risk to mediate the relationship between maternal ADHD symptoms and QoL. Moderate to large negative correlations were found between maternal ADHD symptoms, depression risk, and quality of life (p's ≤ 0.001). Furthermore, maternal depression risk either partially or fully explained the relationship between ADHD symptoms and the different QoL variables. CONCLUSIONS: This study illustrates that symptoms of both ADHD and depression are important clinical considerations for Black women during pregnancy. As significant ADHD symptoms can lead to the development of depression, future research should investigate the temporal relationship between depression and QoL in pregnant women diagnosed with ADHD, as well as study whether ADHD treatment results in improvements in depressive symptoms.

The importance of therapeutic processes in school-based psychosocial treatment of homework problems in adolescents with ADHD.

OBJECTIVE: To evaluate the importance of therapeutic processes in two brief school-based psychosocial treatments targeting homework problems in adolescents with attention-deficit/hyperactivity disorder (ADHD) as delivered by school mental health professionals. METHOD: A sample of 222 middle school students (72% male; Mage = 12.00 years, SD = 1.02) diagnosed with ADHD was randomized to receive either a contingency-management or a skills-based treatment for homework problems. Both treatments included 16 individual sessions (20-min each) and 2 parent/family meetings. Adolescents and school mental health professionals reported on the working alliance in the middle of the treatment; professionals rated adolescent involvement at each of the 16 sessions, parent involvement during both parent meetings, and parent commitment to carry out the established homework plan. Attendance at parent meetings was also recorded. RESULTS: Therapeutic processes predicted objective, parent-reported, and teacher-reported academic outcomes. Parent engagement was particularly important for the contingency-based treatment, whereas working alliance and adolescent involvement were most important for the skills-based treatment. CONCLUSIONS: Therapeutic processes such as developing a strong working alliance and engaging parents and students are key elements of treatment delivery and receipt in school-based mental health programming and should be explicitly trained and monitored. (PsycINFO Database Record

Longitudinal Evaluation of the Cognitive-Behavioral Model of ADHD in a Sample of College Students With ADHD.

OBJECTIVE: The primary aim of this study was to evaluate longitudinal pathways to impairment as outlined in the cognitive-behavioral model of ADHD in a sample of 59 college students diagnosed with ADHD. METHOD: Serial mediation models were used to test whether underachievement, defined as prior year GPA, would longitudinally predict self-reported impairment at the end of the next school year, through negative self-concept and associated changes in symptoms of anxiety and depression, while controlling for baseline impairment and changes in ADHD symptoms. RESULTS: Findings supported the cognitive-behavioral model of ADHD. The association between prior year GPA and overall impairment at the end of the year was fully mediated through self-concept and symptoms of depression. CONCLUSION: These results help explain why impairment often persists even when ADHD symptoms remit and suggests that internalizing symptoms may be an important target for intervention in college students with ADHD.

Factor structure and predictive validity of a homework motivation measure for use with middle school students with attention-deficit/hyperactivity disorder (ADHD).

Many students with attention-deficit/hyperactivity disorder (ADHD) exhibit deficits in motivation to pursue long-term goals. Students with ADHD have particular difficulty with motivation to complete homework-related tasks and often fail to complete assignments. Although these problems are common and may impact academic performance, no homework-motivation measures have been validated for use with students with ADHD. The primary goal of the present study was to evaluate the factor structure and predictive validity of a homework-motivation measure based upon the expectancy-value theory of achievement motivation. A sample of 285 middle school students with ADHD completed the measure, and confirmatory factor analysis was used to evaluate the proposed factor structure and associations with parent and teacher ratings of homework performance. A 2-factor structure emerged, and model fit was excellent. Further, student-rated ability-expectancy beliefs demonstrated significant associations with parent-rated homework problems and performance and with teacher-rated homework performance and percentage of assignments turned in above and beyond ADHD symptoms. Future directions for studying the importance of motivation in students with ADHD are provided, with particular attention to the role that reward sensitivity may play in motivation. (PsycINFO Database Record

Is the Positive Bias an ADHD Phenomenon? Reexamining the Positive Bias and its Correlates in a Heterogeneous Sample of Children.

The goals of this study were to (a) evaluate the presence of the positive bias (PB) in elementary-school-aged children with and without ADHD when PB is defined at the individual level through latent profile analysis and (b) examine the extent to which several correlates (i.e., social functioning, aggression, depression, and anxiety) are associated with the PB. Participants were 233 youth (30% female; 8 to 10 years of age), 51% of whom met criteria for ADHD. During an individual evaluation, children and parents completed a battery of questionnaires to assess child competence, depression, anxiety, and aggression. Children also participated in a novel group session with same-sex unfamiliar peers (half of the group was comprised of children with ADHD) to engage in group problem-solving tasks and free play activities. After the group session, peers and staff completed ratings of each child's behavior (e.g., likeability, rule following). The best fitting LPA model for parent and self-ratings of competence revealed four profiles: High Competence/Self-Aware; Variable Competence/Self-Aware; Low Competence/Self-Aware; and Low Competence/PB, in which the PB was present across domains. Only 10% of youth showed a PB and youth with ADHD were no more likely to display the PB than their non-ADHD peers with similar levels of low competence. Lastly, the Low Competence/Self-Aware profile demonstrated higher levels of anxiety and depression than the Low Competence/PB profile; the profiles did not differ on aggression or peer or staff ratings of social/behavioral functioning. Implications for understanding the PB in children with and without ADHD are discussed.