In-person victimization, cyber victimization, and polyvictimization in relation to internalizing symptoms and self-esteem in adolescents with attention-deficit/hyperactivity disorder.

BACKGROUND: There is mixed evidence for whether in-person victimization and cyber victimization are differentially linked to internalizing symptoms and self-esteem among adolescents with attention-deficit/hyperactivity disorder (ADHD). The goals of the present study were to (1) evaluate in-person victimization and cyber victimization in relation to internalizing symptoms (i.e., anxiety and depression) and self-esteem and (2) examine differences in internalizing symptoms and self-esteem between in-person victimization, cyber victimization, and polyvictimization (i.e., both in-person victimization and cyber victimization). METHODS: Participants were 78 adolescents (ages 13-17 years) diagnosed with ADHD who completed ratings of in-person victimization, cyber victimization, anxiety, depression, and self-esteem. Parents completed ratings of their adolescent's anxiety and depression. RESULTS: Adolescents with ADHD reported experiencing higher rates of in-person victimization (64%) than cyber victimization (23%) in the last 30 days. In addition, 22% reported that they experienced polyvictimization. In-person victimization was associated with higher adolescent-reported anxiety symptoms, whereas cyber victimization was associated with higher parent-reported depressive symptoms; both were associated with lower adolescent-reported self-esteem. Adolescents who reported polyvictimization reported the highest anxiety and depressive symptoms and the lowest self-esteem. CONCLUSIONS: Approximately one quarter of adolescents with ADHD report experiencing polyvictimization in the past month. Findings indicate that in-person victimization and cyber victimization are each uniquely associated with lower self-esteem and differentially associated with co-occurring internalizing symptoms among adolescents with ADHD. Polyvictimization is especially linked to higher internalizing symptoms and lower self-esteem. Longitudinal studies are needed to better understand the directionality of these associations.

Regional variation in quality of life in patients with a Fontan circulation: A multinational perspective.

BACKGROUND: Impaired quality of life (QOL) is associated with congenital heart disease (CHD) and country of residence; however, few studies have compared QOL in patients with differing complexities of CHD across regional populations. The current study examined regional variation in QOL outcomes in a large multinational sample of patients with a Fontan relative to patients with atrial septal defects (ASDs) and ventricular septal defects (VSDs). METHODS: From the Assessment of Patterns of Patient-Reported Outcomes in Adults with Congenital Heart disease-International Study (APPROACH-IS), 405 patients (163 Fontan and 242 ASD/VSD) across Asia, Europe, and North America provided consent for access to their medical records and completed a survey evaluating QOL (0 to 100 linear analog scale). Primary CHD diagnosis, disease complexity, surgical history, and documented history of mood and anxiety disorders were recorded. Differences in QOL, medical complications, and mood and anxiety disorders between Fontan and ASD/VSD patients, and across geographic regions, were examined using analysis of covariance. Hierarchical regression analyses were conducted to identify variables associated with the QOL ratings. RESULTS: Patients with a Fontan reported significantly lower QOL, and greater medical complications and mood and anxiety disorders relative to patients with ASD/VSD. Inpatient cardiac admissions, mood disorders, and anxiety disorders were associated with lower QOL among patients with a Fontan, and mood disorders were associated with lower QOL among patients with ASD/VSD. Regional differences for QOL were not observed in patients with a Fontan; however, significant differences were identified in patients with ASD/VSD. CONCLUSIONS: Regional variation of QOL is commonplace in adults with CHD; however, it appears affected by greater disease burden. Among patients with a Fontan, regional variation of QOL is lost. Specific attempts to screen for QOL and mood and anxiety disorders among CHD patients may improve the care of patients with the greatest disease burden.

Effect of methylphenidate on functional controllability: a preliminary study in medication-naïve children with ADHD.

Methylphenidate (MPH) is the recommended first-line treatment for attention-deficit/hyperactivity disorder (ADHD). While MPH's mechanism of action as a dopamine and noradrenaline transporter blocker is well known, how this translates to ADHD-related symptom mitigation is still unclear. As functional connectivity is reliably altered in ADHD, with recent literature indicating dysfunctional connectivity dynamics as well, one possible mechanism is through altering brain network dynamics. In a double-blind, placebo-controlled MPH crossover trial, 19 medication-naïve children with ADHD underwent two functional MRI scanning sessions (one on MPH and one on placebo) that included a resting state scan and two inhibitory control tasks; 27 typically developing (TD) children completed the same protocol without medication. Network control theory, which quantifies how brain activity reacts to system inputs based on underlying connectivity, was used to assess differences in average and modal functional controllability during rest and both tasks between TD children and children with ADHD (on and off MPH) and between children with ADHD on and off MPH. Children with ADHD on placebo exhibited higher average controllability and lower modal controllability of attention, reward, and somatomotor networks than TD children. Children with ADHD on MPH were statistically indistinguishable from TD children on almost all controllability metrics. These findings suggest that MPH may stabilize functional network dynamics in children with ADHD, both reducing reactivity of brain organization and making it easier to achieve brain states necessary for cognitively demanding tasks.

Too Connected to Being Connected? Adolescents' Social Media Emotional Investment Moderates the Association between Cybervictimization and Internalizing Symptoms.

This study examined whether the association between cybervictimization and internalizing symptoms was moderated by adolescents' emotional connectedness to their social media. Participants were 288 adolescents (54.9% male participants) with (n = 151) and without (n = 137) attention-deficit/hyperactivity disorder (ADHD) between the ages of 13 and 15 years (M = 14.09, SD = 0.36). Adolescents reported on social integration and emotional connection (SIEC) to social media and parents reported on their impression of their adolescent's SIEC to social media. Adolescents also reported on cybervictimization experiences and internalizing symptoms. Adolescents with ADHD had higher cybervictimization scores than adolescents without ADHD and were also more likely to report multiple experiences of cybervictimization over the past month. Emotional investment in social media moderated the relations between cybervictimization and internalizing symptoms such that cybervictimization was associated with higher anxiety and depression symptoms at higher levels of emotional investment in social media. Results were consistent across both parent and adolescent report of social integration and emotional connection to social media. These findings indicate that cybervictimization may be associated with negative outcomes specifically among adolescents with a strong emotional connection to their social media use.

Comorbid Internalizing and Externalizing Disorders Predict Lability of Negative Emotions Among Children With ADHD.

Objective: A subset of children with ADHD experience more frequent, sudden, and intense shifts toward negative emotions. The current study utilized ecological momentary assessment (EMA) to provide a valid assessment of the impact of comorbid internalizing and externalizing disorders on negative emotional lability (EL) among children with ADHD. Method: Parents of 58, 8- to 12-year-old children with ADHD were administered a diagnostic interview to assess for ADHD and for the presence of comorbid disorders. Parents completed EMA-based ratings of their child's negative emotions three times daily for a total of 28 days. Results: Children with a comorbid internalizing disorder or children with comorbid oppositional defiant disorder (ODD) experienced significantly greater EMA-derived negative EL than children without comorbid disorders over time. Children with multiple comorbidities experienced greater EL than children with single comorbidities. Conclusion: Overall, this study suggested that both comorbid ODD and comorbid internalizing disorders contribute to negative EL among children with ADHD.

Convergent Neural Correlates of Empathy and Anxiety During Socioemotional Processing.

Empathy is characterized by the ability to understand and share an emotional experience with another person and is closely tied to compassion and concern for others. Consequently, this increased emotional awareness and sensitivity may also be related to increased anxiety. Taken from another perspective, higher general anxiety may translate into increased concern for others, or concern for how one's actions might affect others, and therefore may be linked to increased empathy. Furthermore, self-reflection is positively related to perspective-taking and empathic concern, while rumination is closely tied to anxiety, thus providing an additional connecting point between empathy and anxiety through enhanced internally generated thought. While previous literature suggests a relationship between empathy and anxiety, this has yet to be empirically studied using neuroimaging tools aimed at investigating the underlying neural correlates that may support these convergent responses. We therefore conducted an functional magnetic resonance imaging (fMRI) study (N = 49) in which participants viewed fearful and neutral human faces and rated how the faces made them feel, to promote introspection. Participants also completed questionnaires assessing empathy Toronto Empathy Questionnaire (TEQ), trait anxiety State Trait Anxiety Inventory (STAI), worry Penn State Worry Questionnaire (PSWQ) and rumination Ruminative Responses Scale (RRS). Behaviorally, empathy positively correlated with worry, worry and rumination positively correlated with anxiety, and significant indirect relationships were found between empathy and anxiety through worry and rumination. Using the neuroimaging face processing task as a backdrop on which the neurobiological mechanisms of empathy and anxiety may interact, regressions of questionnaires with brain activations revealed that empathy related to activation in the temporoparietal junction (TPJ), anxiety related to bilateral insula activation, and worry related to medial prefrontal cortex (mPFC) activation, while rumination showed increased engagement of all three aforementioned regions. Functional connectivity (FC) analyses showed increased communication between the left amygdala and insula related to higher empathy, worry and rumination. Finally, whole-brain analysis using median split groups from questionnaires revealed that the lower halves of anxiety, worry and rumination exhibited increased activation in top-down attentional networks. In sum, empathy, worry and rumination related to enhanced bottom-up processing, while worry, rumination and anxiety exhibited decreased top-down attentional control, suggesting an indirect relationship between empathy and anxiety through the ruminative tendencies of worry.

Temperamental negative affect, emotion-specific regulation, and concurrent internalizing and externalizing pathology among children with ADHD.

Children with attention-deficit/hyperactivity disorder (ADHD) experience high rates of temperamental negative affect and comorbid internalizing and externalizing pathology. The current study explored the role of emotion-specific regulation in accounting for the link between temperamental negative affect and psychopathology among children with ADHD. Forty parents of children ages 8-11 (N =29 males, N =11 females) completed measures of child temperament, emotion-specific dysregulation (i.e., anger dysregulation, sadness dysregulation), and psychopathology. Children completed a measure of emotion-specific dysregulation. Results revealed that anger dysregulation fully statistically accounted for the relationship between temperamental negative affect and concurrent externalizing problems. Sadness dysregulation did not account for the relationship between temperamental negative affect and internalizing problems. These novel findings implicate the robust role of anger dysregulation in explaining the link between temperamental negative affect and concurrent externalizing pathology. The results of this study have significant implications for the treatment of emotionally driven externalizing behavior among children with ADHD.

Intolerance of uncertainty in children with attention-deficit/hyperactivity disorder.

Intolerance of uncertainty (IU) has often been studied in the context of internalizing disorders, but no studies to our knowledge have explored the relation between IU and externalizing disorders. Given the proposed link between IU and emotion regulation, the current study sought to examine levels of IU in an externalizing clinical population with known emotion regulation difficulties-attention-deficit/hyperactivity disorder (ADHD). IU levels in this population were compared to a clinical population known to experience elevated levels of IU. Participants in present study were ninety-three children (36 anxiety disorder, 28 ADHD, 29 unaffected children) ages 7-13, who completed the Intolerance of Uncertainty Scale-Short Version (IUS). Responses on the IUS were converted to total IU, prospective IU, and inhibitory IU. A linear mixed model analysis of covariance was conducted while controlling for age, sex, and ADHD medications. A significant interaction was observed between diagnostic status and IU scale. Planned contrasts indicated that children with anxiety disorders and ADHD reported significantly higher levels of IU relative to unaffected children, and children with ADHD reported comparable levels of inhibitory IU relative to children with anxiety disorders. The current results contribute to a growing literature on the link between IU and psychopathology. IU appears to be a transdiagnostic construct present among children with internalizing and externalizing disorders, and may be broadly associated with emotion regulation deficits rather than specific disorder symptoms.

Relation between internalizing behaviors, externalizing behaviors, and peer victimization among children with and without ADHD.

The current study explored the concurrent and longitudinal association between internalizing behaviors, externalizing behaviors, and peer victimization among children with and without ADHD. Eighty children (42 ADHD, 38 non-ADHD) ages 8-12 participated in the present study conducted over a 6-month period. During the baseline session, parents completed a structured diagnostic interview and the Vanderbilt ADHD Parent Rating Scale to determine whether their child met criteria for ADHD, and the Child Behavior Checklist (CBCL) to assess their child's internalizing and externalizing behaviors; children completed the Perception of Peer Support Scale (PPSS) to assess experiences of peer victimization. At the 6-month follow-up session, parents completed the CBCL and children completed the PPSS. Concurrently, internalizing behaviors were associated with peer victimization among children with and without ADHD; ADHD moderated this relation, such that internalizing behaviors were more strongly related to peer victimization among children with ADHD. Longitudinally, internalizing behaviors at baseline predicted peer victimization at 6-month follow-up; however, further analyses demonstrated there was a covarying change in internalizing behaviors and peer victimization. These findings suggest internalizing behaviors are related to peer victimization concurrently, and over time, and are associated with increased risk for peer victimization in the presence of ADHD. Additionally, internalizing behaviors and peer victimization appear to share a dynamic relationship; that is, decreases in internalizing behaviors predict similar decreases in peer victimization. No significant relations were observed between externalizing behaviors and peer victimization. Implications and limitations are discussed.

How do children with and without ADHD talk about frustration?: Use of a novel emotion narrative recall task.

Children with attention-deficit/hyperactivity disorder (ADHD) experience difficulties related to emotional reactivity and regulation. The current study examines differences in the emotional reactivity and regulation of children with and without ADHD in the context of their real-life experiences of negative emotion using a novel ecologically valid methodology. Eighty-three 8-12-year-old children (46 ADHD, 38 non-ADHD) participated in the study. Children completed the negative emotion narrative recall task, a novel task whereby children provided a narrative recall of a real-life event where they experienced negative emotion. ANCOVA indicated children with ADHD recalled significantly more overall frustration and intense frustration than children without ADHD. Children with ADHD exhibiting more negative emotional reactivity while recalling negative emotions than children without ADHD. The current study suggests that children with ADHD are uniquely impacted by negative emotional experiences and represents an important step in understanding the emotional reactivity and regulation of children with ADHD.

A multinational observational investigation of illness perceptions and quality of life among patients with a Fontan circulation.

OBJECTIVE: First, to compare QOL and illness perceptions between patients with a Fontan circulation and patients with anatomically simple defects (ie, atrial septal defects [ASD] or ventricular septal defects [VSD]). Second, to explore illness perceptions as a mediator of the association between congenital heart disease (CHD) diagnosis and QOL. DESIGN: Cross-sectional observational study. SETTING: Twenty-four cardiology centers from 15 countries across five continents. PATIENTS: Four hundred thirty-five adult patients with congenital heart disease (177 Fontan and 258 ASD/VSD) ages 18-83 years. OUTCOME MEASURES: QOL and illness perceptions were assessed by the Satisfaction With Life Scale and the Brief Illness Perceptions Questionnaire, respectively. RESULTS: Patients with a Fontan circulation reported lower QOL (Wald Z = -3.59, p = <.001) and more negative perceptions of their CHD (Wald Z = -7.66, p < .001) compared with patients with ASD/VSD. After controlling for demographics, anxiety, depressive symptoms, and New York Heart Association functional class, path analyses revealed a significant mediation model, αß = 0.15, p = .002, 95% CI = 0.06-0.25, such that CHD diagnosis was indirectly related to QOL through illness perceptions. CONCLUSIONS: The Fontan sample's more negative perceptions of CHD were likely a reflection of life with a more complex defect. Illness perceptions appear to account for unique differences in QOL between groups of varying CHD complexity. Psychosocial screening and interventions may be important treatment components for patients with CHD, particularly those with Fontan circulations.

Reduced lateral prefrontal cortical volume is associated with performance on the modified Iowa Gambling Task: A surface based morphometric analysis of previously deployed veterans.

Post-traumatic stress disorder (PTSD) and mild traumatic brain injury (mTBI) are two of the most common consequences of combat deployment. Estimates of comorbidity of PTSD and mTBI are as high as 42% in combat exposed Operation Enduring Freedom, Operation Iraqi Freedom and Operation New Dawn (OEF/OIF/OND) Veterans. Combat deployed Veterans with PTSD and/or mTBI exhibit deficits in classic executive function (EF) tasks. Similarly, the extant neuroimaging literature consistently indicates abnormalities of the ventromedial prefrontal cortex (vmPFC) and amygdala/hippocampal complex in these individuals. While studies examining deficits in classical EF constructs and aberrant neural circuitry have been widely replicated, it is surprising that little research examining reward processing and decision-making has been conducted in these individuals, specifically, because the vmPFC has long been implicated in underlying such processes. Therefore, the current study employed the modified Iowa Gambling Task (mIGT) and structural neuroimaging to assess whether behavioral measures related to reward processing and decision-making were compromised and related to cortical morphometric features of OEF/OIF/OND Veterans with PTSD, mTBI, or co-occurring PTSD/mTBI. Results indicated that gray matter morphometry in the lateral prefrontal cortex (lPFC) predicted performance on the mIGT among all three groups and was significantly reduced, as compared to the control group.

The association of emotional lability and emotional and behavioral difficulties among children with and without ADHD.

Children with ADHD often demonstrate a pattern of emotional lability characterized by sudden and intense shifts in affect. Emotional lability has been linked to emotional and behavioral problems in children with and without ADHD, but few studies have examined emotional lability over time. This study examined the effects of emotional lability over time on the behavioral and emotional difficulties of children with and without ADHD using an ecological momentary assessment (EMA) methodology. One hundred and two children aged 8-12 years (56 with ADHD and 46 without ADHD) and their parents completed baseline measures of the children's behavioral and emotional difficulties. Parents then completed a 28-day 3-times daily EMA assessment protocol to rate their child's emotional lability. Results suggested that emotional lability was associated with internalizing and/or externalizing diagnoses independent of ADHD diagnostic status, but was not directly associated with ADHD. Hierarchical regression analyses supported ADHD diagnostic status as a moderator of the association of greater EMA-derived emotional lability with children's behavioral difficulties, such that greater emotional lability was associated with greater behavioral difficulties among children with ADHD but not among children without ADHD. Results indicated that greater emotional lability was directly linked with greater emotional difficulties and that this relation was not moderated by ADHD diagnostic status. Overall, this study suggested that emotional lability is related to emotional difficulties independent of ADHD, but is differentially related to behavioral difficulties among children with and without ADHD.