Intraindividual variability of sleep/wake patterns in adolescents with and without attention-deficit/hyperactivity disorder.

BACKGROUND: Prior studies examining the sleep of adolescents with and without attention-deficit/hyperactivity disorder (ADHD) have relied on mean values such as average sleep duration, which masks intraindividual variability (IIV). The objective was to investigate whether adolescents with ADHD have greater IIV of sleep/wake patterns than adolescents without ADHD using actigraphy and daily sleep diaries. METHOD: Adolescents (ages 13.17 ± 0.40 years; 45% female) with (n = 162) and without (n = 140) ADHD were recruited from middle schools at two sites. Participants wore actigraphs and completed sleep diaries for an average of 2 weeks. RESULTS: Multilevel models were conducted with sex, sleep medication use, ADHD medication use, number of days with data, and social jetlag controlled for in analyses. For actigraphy, adolescents with ADHD had greater variability for time in bed, sleep onset and offset, and wake after sleep onset than adolescents without ADHD. For sleep diary data, adolescents with ADHD had greater variability in bedtime, wake time, sleep duration, sleep onset latency, sleep quality, and night wakings than adolescents without ADHD. Social jetlag was a significant predictor of variability in sleep measures based on both actigraph and daily diaries; however, ADHD status was not associated with social jetlag. CONCLUSIONS: This is the first study to show that adolescents with ADHD have more variable sleep/wake patterns than their peers using both objective and subjective sleep measures. IIV of sleep/wake patterns may be important for clinicians to assess and monitor as part of treatment. Research is needed to understand the mechanisms underlying increased IIV of sleep/wake patterns in adolescents with ADHD and potential consequences for daytime functioning.

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.

A Longitudinal Study of the Relation Between Family Functioning and Preschool ADHD Symptoms.

The present study examined the bidirectional relation between family functioning and attention-deficit/hyperactivity disorder (ADHD) symptoms across the preschool years. Participants included 197 (110 boys) 3-year-old children (M = 44.14 months, SD = 3.43; 60% White) with and without behavior problems and their parents who took part in a 3-year longitudinal study. Parenting, parent psychopathology, life stress, and child symptoms were assessed annually from ages 3 to 6. Cross-lagged models provided evidence for both parent and child effects for mothers. In particular, greater maternal overreactive parenting and life stress were predictive of more child ADHD symptoms, and greater child ADHD symptoms significantly predicted greater maternal life stress and depressive symptoms and lower warmth, controlling for child oppositional defiant disorder and parent ADHD symtoms. Child effects were evident for fathers' depression and life stress, but these did not remain controlling for paternal ADHD symptoms. Findings suggest that targeting child ADHD symptoms, maternal overreactive parenting, and maternal stress each hold promise for attenuating the negative mutual influence of child ADHD symptoms and family functioning over time.

Reciprocal Relations Between Parenting Behaviors and Conduct Disorder Symptoms in Preschool Children.

Reciprocal relations between children's conduct disorder (CD) symptoms and parenting behaviors were examined across the preschool years. Participants were 199 children (M = 44.26 months, SD = 3.37; 92 girls) and their 199 mothers and 158 fathers. CD symptoms were assessed via structured interviews; parenting was assessed via observational and self-report measures. Fixed effects models were used to assess within-individual changes and traditional cross-lagged models were used to assess between-individual changes; comparisons by sex were also carried out. Increases in maternal overreactivity predicted increases in CD symptoms. During the later preschool years, decreases in maternal warmth predicted increases in CD symptoms and increases in CD symptoms predicted increases in paternal overreactivity. Reciprocal effects were found between girls' CD symptoms and paternal negative affect. Findings suggest maternal and paternal influence on the development of CD symptoms and suggest that CD symptoms influence fathers' parenting during the preschool years.

Biased self-perceived social competence and engagement in subtypes of aggression: Examination of peer rejection, social dominance goals, and sex of the child as moderators.

This study expands on prior research suggesting that children who either over- or under-estimate their social competence relative to others' reports are more likely to be aggressive. Linear and curvilinear associations between biased social self-perceptions and forms (physical vs. relational) and functions (proactive vs. reactive) of aggression were tested along with three moderators (peer rejection, social dominance goals, and child sex). Children in the fifth through eight grade (N = 167) completed self-reports of perceived social competence and social dominance goals. Teachers completed ratings of children's social competence, peer rejection, and reactive and proactive physical and relational aggression. Bias in self-perceived social competence was quantified as the residual difference between child and teacher ratings of the child's social competence. There was a significant interaction between quadratic bias and peer rejection predicting reactive physical aggression; rejected children with a positive bias or a negative bias were highest in reactive physical aggression. The interaction between linear bias, social dominance goals, and the sex of the child was also significant when predicting proactive physical aggression. Among girls who highly valued social dominance, a positive bias predicted greater proactive physical aggression. Results are discussed in terms of implications for aggression theory and intervention. Aggr. Behav. 42:498-509, 2016. © 2016 Wiley Periodicals, Inc.

Longitudinal changes in individual symptoms across the preschool years in children with ADHD.

The present study examined trajectories of individual Diagnostic and Statistical Manual of Mental Disorders (4th ed.) symptoms of attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) across the preschool years in children with ADHD. It also evaluated whether preschool symptoms vary in their ability to discriminate children who later meet criteria for ADHD from typically developing children. ADHD and ODD symptoms were assessed annually in 75 ethnically diverse children (46 boys) who presented with behavior problems at age 3 and met criteria for ADHD 3 years later, and in 51 typically developing children (26 boys). Children with ADHD generally exhibited stable levels of hyperactivity/impulsivity but increases in several symptoms of inattention. Most ADHD symptoms showed at least fair utility in discriminating children with and without ADHD; however, 3 symptoms of inattention (carelessness, losing things, and forgetfulness) and 1 symptom of hyperactivity/impulsivity (blurting out answers) had relatively poor utility. These symptoms demonstrated only somewhat greater utility at age 4, but by the age of 5 were better able to classify children. Children with ADHD exhibited increases in several ODD symptoms, including symptoms related to negative affect. Although most symptoms of hyperactivity/impulsivity appear to extend well down to age 3, more developmentally appropriate symptoms of inattention may be required to develop more sensitive assessments for 3- and 4-year-old children.

Emotion Socialization Practices in Latina and European American Mothers of Preschoolers with Behavior Problems.

The present study examined mothers' emotion socialization of 3-year-old children with behavior problems, to determine whether emotion socialization practices, as well as the relation between these practices and child functioning, varied across ethnicities. Participants were 134 preschoolers with behavior problems. Mothers were European American (n = 96) and Latina American (n = 38; predominately Puerto Rican). Audiotaped mother-child interactions were coded for emotion socialization behaviors. Latina and European American mothers used similar emotion socialization practices on most dimensions. Latina mothers were more likely to minimize or not respond to their children's negative affect. However, this difference did not appear to have ramifications for children. This study provided evidence for both differences and similarities across ethnicities on emotion socialization practices.

The role of parent psychopathology in the development of preschool children with behavior problems.

The present study examined associations between early parental self-reported psychopathology symptoms and the later behavioral, emotional, and social functioning of preschool children with behavior problems. Mothers and fathers of preschoolers with behavior problems (N = 132; 55 girls, 77 boys) completed parent psychopathology questionnaires when children were 3 years old and completed measures of children's externalizing, internalizing, and social problems annually from age 3 to age 6. The sample included 61% European American, 16% Latino (predominantly Puerto Rican), 10% African American, and 13% multiethnic children. Every dimension of mothers' and fathers' psychopathology symptoms when children were 3 years old was associated with their own reports of children's externalizing and internalizing problems 3 years later. Several dimensions of maternal psychopathology symptoms at age 3 were associated with mother-reported social skills 3 years later. However, the relation between many dimensions of psychopathology symptoms and child outcome appears to be accounted for by co-occurring psychopathology symptoms. Only maternal attention-deficit hyperactivity disorder (ADHD) and Cluster A symptoms, and paternal ADHD and depression/anxiety symptoms emerged as unique predictors of child functioning. These findings suggest that most types of mothers' and fathers' self-reported psychopathology symptoms may play a role in the prognosis of behavioral, social, and emotional outcomes of preschoolers with behavior problems, but that co-occurring symptoms need to be considered.

Behavioral Treatment for the Social-Emotional Difficulties of Preadolescent and Adolescent Girls with ADHD.

Girls with attention-deficit/hyperactivity disorder (ADHD) are at high risk for peer difficulties that often persist into adolescence and adulthood and portend risk for additional difficulties, such as depression, anxiety, and borderline personality disorder. However, very little research has examined interventions that address the widespread peer difficulties of girls with ADHD. This paper describes two open trials of behavior therapy aimed at addressing their social-emotional difficulties. The first trial includes 33 preadolescent girls (ages 7-11) with ADHD enrolled in an eight-week treatment and the second trial includes 22 adolescent girls (ages 12-16) with ADHD enrolled in a 12-week treatment. Measures of treatment feasibility and acceptability and measures of social functioning and psychopathology were collected in both trials. High levels of treatment feasibility and acceptability were reported in both the preadolescent and adolescent trial. In addition, improvements were reported in areas of social functioning and reductions in psychopathology, although the magnitude and specific areas of improvement differed somewhat in the preadolescent versus adolescent group. These preliminary findings provide a first step towards addressing the widespread social-emotional difficulties of girls with ADHD and offer insight into continuing efforts to address their treatment needs.

Sleepy, sluggish, worried, or down? The distinction between self-reported sluggish cognitive tempo, daytime sleepiness, and internalizing symptoms in youth with attention-deficit/hyperactivity disorder.

Sluggish cognitive tempo (SCT) consists of symptoms of slowness, sluggishness, daydreaming, and low motivation. SCT has been linked to attention-deficit/hyperactivity disorder (ADHD), internalizing symptoms, and daytime sleepiness. Although there is clear evidence that SCT and ADHD symptoms are distinct constructs, the distinction between SCT, anxiety/depression, and daytime sleepiness is less clear. Prior research has largely relied upon parent-report to evaluate potential overlap between SCT, sleep, and anxiety/depression, despite best practice suggesting that self-report should be used to assess internalizing symptoms. The present study used adolescent self-report to evaluate whether SCT was distinct from daytime sleepiness, anxiety, and depression. Participants were 285 middle school students comprehensively diagnosed with ADHD. Ten confirmatory factor analyses were conducted: four 1-factor models, three 2-factor models, one 3-factor model, one 4-factor model, and a higher order model. Results showed that SCT was indeed distinct from all tested constructs, with the four-factor model including self-report of SCT, anxiety, depression, and daytime sleepiness meeting adequate model fit criteria. All models including SCT as its own factor had improved model fit over models with SCT in a combined factor with another construct. Implications for the assessment and treatment of SCT are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Evaluation of the Interplay Between Homework Motivation and Sluggish Cognitive Tempo in Youth With ADHD: Associations With Homework Performance.

Objective: This study evaluated which Sluggish Cognitive Tempo (SCT) factors (i.e., Slow, Sleepy, Daydreamer) are most strongly associated with homework motivation, and whether homework motivation mediates the path between SCT and academic impairment. Method: Participants were 285 middle school students (boys 209) in Grades 6 to 8 (ages 10-15 years) who were comprehensively diagnosed with ADHD. Results: Parent- and self-report of SCT Slow behaviors predicted homework motivation above and beyond symptoms of ADHD, oppositional defiant disorder (ODD), anxiety, depression, and intelligence. The mediation models tested were multi-informant and cross-rater (parent-report of SCT to self-report of motivation to teacher-report of homework problems), and suggest that low motivation may help explain the associations between SCT and functional impairment. Conclusion: SCT and motivation are significantly associated constructs. Clinically, youth with ADHD and comorbid SCT may be more likely to present with low motivation, placing them at risk for academic failure. The manuscript discusses potential clinical implications of these findings.

High Prevalence of Dysgraphia in Elementary Through High School Students With ADHD and Autism.

OBJECTIVE: Prevalence of dysgraphia by age across all grade levels was determined in students with ADHD or autism. METHOD: Referred children with normal intelligence and ADHD-Combined, ADHD-Inattentive, or autism ( N = 1,034) were administered the Developmental Test of Visual-Motor Integration (VMI) and Wechsler Intelligence Scale for Children (WISC). RESULTS: VMI and WISC Coding scores were significantly lower than IQ and the normal mean of 100 for all diagnoses. More than half (59%) had dysgraphia, and 92% had a weakness in graphomotor ability relative to other abilities. Dysgraphia prevalence did not differ between diagnostic or age groups (6-7 years, 56%; 8-10 years, 60%; and 11-16 years, 61%). CONCLUSION: Dysgraphia is common at all ages in children and adolescents with ADHD and autism. Accommodations and strategies for addressing this problem are discussed.

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).

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.

Longitudinal Associations of Parental Emotion Socialization and Children's Emotion Regulation: The Moderating Role of ADHD Symptomatology.

Theory and research suggest that parents' reactions to children's emotions play a critical role in teaching children effective emotion regulation (ER) skills, but no studies have directly examined the role that parent emotion socialization plays in the development of ER in children with ADHD. Gaining insight into the causes of impaired ER, particularly in youth with ADHD who are known to have poor ER, has important theoretical and translational significance. The present study is the first to longitudinally examine whether emotion socialization predicts later physiological and adult-reported measures of ER in children with and without ADHD. It also sought to determine if these relations are moderated by ADHD symptoms. Participants were 61 children (31 girls, 30 boys; M = 10.67 years, SD = 1.28) with and without clinically significant ADHD symptoms. At Time 1, parent reports of emotion socialization and parent- and teacher-report of child ADHD symptoms were collected. At Time 2, child ER measures were collected based on parent- and teacher-report and physiological reactivity during an impossible puzzle and a social rejection task. Physiological measures included respiratory sinus arrhythmia and skin conductance level (SCL). Supportive parenting practices were associated with better parent-rated emotion regulation skills for all children and greater SCL reactivity for children with high ADHD symptoms. Non-supportive parenting reactions were associated with greater adult-rated emotional lability for children with high ADHD symptoms. Results highlight the importance of considering multiple aspects of ER, including physiological manifestations. Findings suggest that parents' use of adaptive emotion socialization practices may serve as a protective factor for children's ER development and may be particularly critical for youth with ADHD. Our findings support the use of interventions addressing parent emotion socialization to help foster better ER in children.

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

Are Elevations in ADHD Symptoms Associated with Physiological Reactivity and Emotion Dysregulation in Children?

The present study examined whether children with elevated attention-deficit/hyperactivity disorder (ADHD) symptoms display a unique pattern of emotion dysregulation as indexed by both parent report and physiological reactivity during experiences of failure. A sample of 61 children (9 to 13 years; M = 11.62, SD = 1.29; 48 % male) with and without clinical elevations in ADHD symptoms participated. Parent and teacher report of ADHD and oppositional defiant disorder (ODD) symptoms and parent report of internalizing problems were collected. Parents also provided ratings of children's emotional negativity/lability and emotion regulation. Children's physiological reactivity, based on changes in respiratory sinus arrhythmia (RSA) and skin conductance level (SCL), were assessed while they completed a manipulated social rejection task and impossible puzzle task. Regression analyses indicated that ADHD symptoms were associated with higher parent-rated emotional negativity/lability and with blunted RSA withdrawal in response to social rejection; these effects were not accounted for by co-occurring ODD symptoms or internalizing problems. ODD symptoms also were uniquely associated with parent ratings of poor emotion regulation. Internalizing problems were uniquely associated with emotional negativity/lability, poor emotion regulation, and increased SCL activity in response to social rejection. Results suggest that there may be a pattern of emotion dysregulation that is specific to ADHD symptomatology. The importance of contextual factors when examining physiological reactivity to stress in youth with ADHD is discussed.

Parent emotion socialization and pre-adolescent's social and emotional adjustment: Moderating effects of autonomic nervous system reactivity.

This study examined whether measures of children's autonomic nervous system (ANS) reactivity to social stress moderated the effect of parent emotion socialization on children's social and emotional adjustment. Sixty-one children (9-13 years) completed a peer rejection task while their respiratory sinus arrhythmia reactivity (RSA-R) and skin conductance level reactivity (SCL-R) were assessed. Parents' report of supportive and non-supportive reactions to their child's negative emotions served as measures of emotion socialization. Measures of children's social and emotional adjustment included: teacher-rated peer rejection, aggression, and prosocial behavior and parent-rated aggressive/dysregulated behavior and emotion regulation skills. Measures of children's ANS reactivity moderated the effect of parent emotion socialization on children's adjustment. Supportive responses were more protective for children evidencing RSA augmentation whereas non-supportive responses were more detrimental for children evidencing low SCL-R. Thus children's ANS reactivity during social stress may represent a biological vulnerability that influences sensitivity to parent emotion socialization.

Mediators and Moderators of the Relation between Parental ADHD Symptomatology and the Early Development of Child ADHD and ODD Symptoms.

The present study examined mediators and moderators of the relation between parental ADHD symptomatology and the development of child attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) symptoms across the preschool years. Participants included 258 (138 boys) 3-year-old children (M = 44.13 months, SD = 3.39) with and without behavior problems and their parents who took part in a 3-year longitudinal study. Maternal ADHD symptoms predicted later ADHD symptoms in children, controlling for early child symptomatology. Both family history of ADHD and paternal comorbid psychopathology predicted later child ADHD and ODD symptoms, but they did not account for the association between maternal and child ADHD symptoms. Although paternal ADHD symptoms were associated with age 3 child ADHD symptoms, they did not significantly predict later child ADHD symptoms controlling for early symptomatology. Family adversity moderated the relation between maternal ADHD and child ADHD symptoms, such that the relation between maternal and child ADHD symptoms was stronger for families with less adversity. Maternal overreactive parenting mediated the relation between maternal ADHD symptoms and later child ADHD and ODD symptoms. Our findings suggest that targeting paternal comorbid psychopathology and maternal parenting holds promise for attenuating the effects of parental ADHD on children's ADHD.

The Nature of Social Positive Illusory Bias: Reflection of Social Impairment, Self-Protective Motivation, or Poor Executive Functioning?

The present study examined if a social positive illusory bias (PIB) is: a) simply a reflection of low adult-rated social acceptance, b) evident when children's perceived social acceptance is measured implicitly, and c) directly relates to impaired executive functioning (EF). Participants were 8 to 12 year-old children (N = 120; 55 boys and 65 girls) with and without clinical symptoms of attention-deficit/hyperactivity disorder (ADHD). Ratings of the child's social acceptance were obtained from an adult and the child using the Self-Perception Profile for Children (Harter 2012); social bias was calculated as the discrepancy between standardized adult- and child-ratings. Children also completed a reaction time measure to assess implicit perceptions of social acceptance and a battery of EF measures. Depression symptoms were assessed based on parent report. Group comparisons were focused on the presence or absence of social PIB rather than on ADHD diagnostic status. Relative to non-PIB children, those with a social PIB were significantly higher in self-reported social acceptance, but significantly lower on adult reports and implicit perceived social acceptance; these children also were significantly higher in depression symptoms. EF impairments were indirectly related to social PIB as a function of adult-rated social impairment. Results suggest that social PIB is not merely a reflection of low adult-ratings of social acceptance. However, the high explicit self-reports of social acceptance in children with a social PIB are not fully consistent with their implicit self-perceptions of social acceptance. Results are discussed in light of the self-protective and cognitive deficits hypotheses regarding the nature of social PIB.