Clinical distinction between cognitive disengagement syndrome and ADHD presentations in a nationally representative sample of Spanish children and adolescents.

BACKGROUND: This study sought to determine whether cognitive disengagement syndrome (CDS, formerly sluggish cognitive tempo) has different external correlates relative to ADHD-inattentive presentation (INP), ADHD-hyperactive/impulsive presentation (HIP), and ADHD-combined presentation (CP). METHODS: Parents of a nationally representative sample of 5,525 Spanish youth (ages: 5-16, 56.1% boys) completed measures of CDS, ADHD-inattention (IN), and ADHD-hyperactivity/impulsivity (HI) and other measures. Scores greater/less than the top 5% on CDS, ADHD-IN, and ADHD-HI were used to create control (n = 5,013, 90.73%), CDS-only (n = 131, 2.37%), ADHD-INP-only (n = 83, 1.50%), ADHD-HIP-only (n = 113, 2.05%), ADHD-CP-only (n = 48, 0.97%), CDS + ADHD-INP (n = 44, 0.80%), CDS + ADHD-HIP (n = 25, 0.45%), and CDS + ADHD-CP (n = 68, 1.23%) groups. RESULTS: Forty-nine percent of youth with clinically elevated CDS did not qualify for any ADHD presentation, whereas 64% of youth with clinically elevated ADHD did not qualify for CDS. The CDS-only group was higher than the ADHD-INP-only, ADHD-HIP-only, and ADHD-CP-only groups on anxiety, depression, somatization, daytime sleep-related impairment, nighttime sleep disturbance, and peer withdrawal, whereas the CDS-only and ADHD-INP-only groups did not differ on ODD (ADHD-HIP-only and ADHD-CP-only higher) and academic impairment (ADHD-CP-only higher than CDS-only and ADHD-HIP-only lower than CDS-only). The CDS-only group also had higher rates of anxiety, depression, and bipolar disorder diagnoses than the ADHD-only group. CONCLUSIONS: A distinction was found between CDS and each ADHD presentation, thus providing support for CDS as a syndrome that frequently co-occurs with yet is distinct from each ADHD presentation.

ADHD, chronotype, and circadian preference in a multi-site sample of college students.

Attention-deficit/hyperactivity disorder and an evening chronotype are both common among college students, and there is growing interest in understanding the possible link between attention-deficit/hyperactivity disorder and circadian function. However, mixed findings have been reported, and many of the existing studies have used small samples that were unable to examine chronotype across attention-deficit/hyperactivity disorder presentations. Participants were 4751 students (73% female; 80% White), aged 18-29 years (M = 19.28, SD = 1.50), from five universities who completed measures assessing attention-deficit/hyperactivity disorder, depressive and anxiety symptoms, as well as the Morningness-Eveningness Questionnaire to assess chronotype (categorical) and circadian preference (dimensional). Participants with either attention-deficit/hyperactivity disorder predominantly inattentive presentation or attention-deficit/hyperactivity disorder combined presentation had higher rates of being an evening type (47.2% and 41.5%, respectively) than participants without elevated attention-deficit/hyperactivity disorder (28.5%), and participants with attention-deficit/hyperactivity disorder predominantly inattentive presentation also had higher rates of being an evening type than participants with attention-deficit/hyperactivity disorder predominantly hyperactive-impulsive presentation (30.7%). Dimensional analyses indicated that attention-deficit/hyperactivity disorder inattentive symptoms were more strongly associated than hyperactive-impulsive symptoms with eveningness preference. Finally, greater eveningness preference strengthened the association between attention-deficit/hyperactivity disorder inattention and depressive symptoms but not anxiety symptoms. This is the largest study to document that college students with elevated attention-deficit/hyperactivity disorder symptoms are more likely to be evening types than other college students, and inattentive symptoms in particular are associated with later circadian preference.

A Multi-Method Examination of Peer Functioning in Children with and without Cognitive Disengagement Syndrome.

OBJECTIVE: Cognitive disengagement syndrome (CDS) includes excessive daydreaming, mental confusion, and hypoactive behaviors that are distinct from attention-deficit/hyperactivity disorder inattentive (ADHD-IN) symptoms. A growing number of studies indicate that CDS symptoms may be associated with ratings of social withdrawal. However, it is important to examine this association in children specifically recruited for the presence or absence of CDS, and to incorporate multiple methods including direct observations of peer interactions. The current study builds on previous research by recruiting children with and without clinically elevated CDS symptoms and using a multi-method, multi-informant design including recess observations and parent, teacher, and child rating scales. METHOD: Participants were 207 children in grades 2-5 (63.3% male), including 103 with CDS and 104 without CDS, closely matched on grade and sex. RESULTS: Controlling for family income, medication status, internalizing symptoms, and ADHD-IN severity, children with CDS were observed during recess to spend more time alone or engaging in parallel play, as well as less time involved in direct social interactions, than children without CDS. Children with CDS were also rated by teachers as being more asocial, shy, and socially disinterested than children without CDS. Although children with and without CDS did not differ on parent- or self-report ratings of shyness or social disinterest, children with CDS rated themselves as lonelier than children without CDS. CONCLUSIONS: Findings indicate that children with CDS have a distinct profile of peer functioning and point to the potential importance of targeting withdrawal in interventions for youth with elevated CDS symptoms.

Examining cognitive disengagement syndrome in a psychiatric outpatient sample: Psychometric support and associations with internalizing symptoms and sleep problems.

OBJECTIVE: The internal (structural) and external validity of a self-report measure of cognitive disengagement syndrome (CDS, formerly sluggish cognitive tempo) relative to a self-report measure of attention-deficit/hyperactivity disorder-inattention (ADHD-IN) was evaluated with adults from university outpatient psychiatric clinics in Turkey. METHODS: A total of 274 outpatients (75.9% women; ages 18-64 years; Mage = 31.06; SDage = 10.84; 50.4% anxiety disorders; 41.6% depressive disorders; 2.9% ADHD; 1.5% sleep disorders; 0.7% eating disorders; 2.9% no mental disorder) completed self-report measures of CDS, ADHD-IN, ADHD-hyperactivity/impulsivity (HI), sleep problems, depression, and stress. RESULTS: All 15 CDS symptoms measured by the Adult Concentration Inventory (ACI) showed convergent (moderate to high loadings on the CDS factor) and discriminant (loading close to zero on the ADHD-IN factor) validity. CDS also showed stronger first-order and unique associations than ADHD-IN with sleep problems, depression, anxiety, and stress, whereas ADHD-IN showed stronger first-order and unique associations than CDS with ADHD-HI. CONCLUSION: This is the first study to provide support for the scores from this 15 item self-report measure of CDS by the ACI in a clinical sample of adults, with findings consistent with previous studies examining parent and teacher rating scale measures with the same 15 CDS symptoms. These findings provide additional support for usefulness of these 15 CDS symptoms as measured by the ACI to study CDS across various cultures.

Cognitive Disengagement Syndrome Symptoms from Early Childhood to Adolescence in a Nationally Representative Spanish Sample.

OBJECTIVE: The identification of a common set of symptoms for assessing cognitive disengagement syndrome (CDS, formerly sluggish cognitive tempo) for early childhood (ages 5-8), middle childhood (ages 9-12), and adolescence (ages 13-16) is needed to advance research on the developmental psychopathology of CDS (i.e. a common symptom set with comparable internal and external validity for each age group). METHOD: Parents of a nationally representative sample of 5,525 Spanish children and adolescents (ages 5 to 16, 56.1% boys) completed measures of CDS, attention-deficit/hyperactivity disorder-inattention (ADHD-IN), and other measures. RESULTS: First, the 15 CDS symptoms showed convergent and discriminant validity relative to the ADHD-IN symptoms within each age group. Second, CDS showed stronger first-order and unique associations than ADHD-IN with anxiety, depression, somatization, daytime sleep-related impairment, and nighttime sleep disturbance, whereas ADHD-IN showed stronger first-order and unique associations than CDS with ADHD-hyperactivity/impulsivity, oppositional defiant disorder, and academic impairment. Third, CDS showed stronger first-order and unique associations than ADHD-IN with a history of having an anxiety, depression, or bipolar disorder diagnosis, whereas ADHD-IN showed stronger first-order and unique associations with having an ADHD diagnosis. CONCLUSIONS: The identification of a common set of CDS symptoms spanning early childhood to adolescence allows for the advancement of research on CDS, with a particular need now for longitudinal studies and examination of CDS with other functional outcomes and across other cultural contexts.

Psychometric and Normative Information on the Child and Adolescent Behavior Inventory in a Nationally Representative Sample of United States Children.

OBJECTIVE: Psychometric and normative information is provided for the Sluggish Cognitive Tempo, Attention Deficit/Hyperactivity Disorder (ADHD) Inattention, ADHD Hyperactivity/Impulsivity, Oppositional Defiant Disorder, Callous-Unemotional Behaviors (Limited Prosocial Emotions specifier), Anxiety, Depression, Social Impairment, Friendship Difficulties, and Academic Impairment Scales of the Child and Adolescent Behavior Inventory (CABI) with a nationally representative sample of U.S. children. METHOD: Mothers of 2,056 kindergarten to sixth-grade children (M ± SDage = 8.49 ± 2.15 years; 49% girls) completed the CABI, and 307 randomly selected mothers completed the CABI again 4 weeks later. RESULTS: The 10-factor model (one factor for each CABI scale) provided a close fit for the total sample as well as for boys and girls separately. Each scale showed invariance of like-item loadings and thresholds for boys and girls across a 4-week interval with excellent test-retest factor correlations and no significant factor mean changes. Normative information (T-scores) is provided for the 10 scales separately for boys and girls, with test information functions supporting the use of the scales for screening purposes. CONCLUSION: The normative information on the CABI provides support for the use of the 10 scales to inform the clinical care of individual children, with the positive psychometric properties of the scores providing additional support for the use of the scales for research. Copies of the scale and norms are available for free to clinicians and researchers.

Multisource Longitudinal Network and Latent Variable Model Analyses of ADHD Symptoms in Children.

Objective: Multisource longitudinal network analysis was used to determine if between-child and within-child variance of attention-deficit/hyperactivity disorder (ADHD) symptoms provided unique findings of ADHD relative to latent variable model (LVM) analyses.Method: Mothers and fathers of 802 Spanish first-grade children (54% boys) provided ratings of ADHD symptoms at two time points six weeks apart (assessment 1: 723 mothers and 603 fathers; assessment 2: 667 mothers and 584 fathers). Network and latent variable models were applied to the ratings.Results: Inattention, hyperactivity, and mixed hyperactive/impulsive symptom communities occurred for the within- and between-children's symptom networks with the results being consistent across mothers and fathers, especially for the between-children's symptom networks. LVM analyses identified three factors with the same symptoms on each factor as in the symptom communities. These models also showed invariance across mothers and fathers as well as assessments.Conclusions: Longitudinal networks provided several useful insights for ADHD, including centrality symptoms that differed across between- and within-child levels. However, many findings were also largely consistent with the LVM analyses. Future studies should use novel methods (e.g., intensive longitudinal measurement) and analytic tools to determine if more unique theoretical and clinical findings emerge when applying network analysis to longitudinally measured ADHD symptoms.

Sluggish Cognitive Tempo and ADHD Symptoms in a Nationally Representative Sample of U.S. Children: Differentiation Using Categorical and Dimensional Approaches.

A nationally representative sample of U.S. children was used to determine the empirical and clinical differentiation of sluggish cognitive tempo (SCT) and attention-deficit/hyperactivity disorder (ADHD) symptoms using both categorical and dimensional approaches. Mothers of children (N = 2,056, M± SDage = 8.49 ± 2.15 years, 49.3% girls) completed measures of SCT, ADHD, oppositional defiant disorder (ODD), anxiety, depression, sleep difficulties, daily life executive functioning, conflicted shyness, friendship difficulties, and social and academic impairment. Scores greater than the top 5% on SCT and ADHD measures were used to create SCT-only (n = 53, 2.58%), ADHD-only (n = 93, 4.52%), SCT+ADHD (n = 49, 2.38%), and comparison (n = 1,861, 90.52%) groups. Fifty-two percent of the SCT group did not qualify for the ADHD group, whereas 65% of the ADHD group did not qualify for the SCT group. The SCT-only group had higher levels of anxiety, depression, conflicted shyness, and sleep difficulties than the ADHD-only group. In contrast, the ADHD-only group had greater executive functioning deficits and higher ODD than the SCT-only group. SCT-only and ADHD-only groups showed similar levels of friendship, social, and academic impairment. Similar findings emerged when using structural regression analyses to determine the unique clinical correlates of SCT and ADHD dimensions. This is only the second study to examine the distinction of clinically-elevated SCT from ADHD in a national sample of children and extends previous findings to a broader array of functional outcomes. Normative information on the SCT scale also provides a validated rating scale to advance research and clinical care.

Validity of Sluggish Cognitive Tempo in Turkish Children and Adolescents.

The internal and external validity of sluggish cognitive tempo (SCT) relative to attention-deficit/hyperactivity disorder-inattention (ADHD-IN) was evaluated with Turkish children and adolescents. Parents completed the SCT, ADHD-IN, ADHD-hyperactivity/impulsivity (HI), oppositional defiant disorder (ODD), callous-unemotional (CU), anxiety, depression, social impairment, and academic impairment scales of the Child and Adolescent Behavior Inventory (CABI) on 1015 Turkish children and adolescents (56% girls; ages 6-15 years; Mage = 10.05, SDage = 2.32), including 762 recruited from the community and 253 recruited from outpatient psychiatric clinics. SCT symptoms demonstrated excellent internal validity with the ADHD-IN symptoms. SCT symptoms also showed invariance across boys and girls as well as across community and clinical samples. SCT showed stronger first-order and unique associations than ADHD-IN with anxiety and depression whereas ADHD-IN showed stronger first-order and unique associations than SCT with ADHD-HI, ODD, and academic impairment. SCT and ADHD-IN showed equal associations with CU behaviors and social impairment. The current study is the first to support the validity of CABI SCT scores with Turkish children and adolescents and also replicates the findings from similar studies with children from South Korea, Spain, and United States. These findings thus further strengthen the transcultural validity of CABI SCT scale scores.

Patient experiences of fertility clinic closure during the COVID-19 pandemic: appraisals, coping and emotions.

STUDY QUESTION: What are appraisals, coping strategies and emotional reactions of patients to coronavirus disease 2019 (COVID-19) fertility clinic closures? SUMMARY ANSWER: Clinic closure was appraised as stressful due to uncertainty and threat to the attainability of the parenthood goal but patients were able to cope using strategies that fit the uncertainty of the situation. WHAT IS KNOWN ALREADY: Psychological research on COVID-19 suggests that people are more anxious than historical norms and moderately to extremely upset about fertility treatment cancellation owing to COVID-19. STUDY DESIGN, SIZE, DURATION: The study was of cross-sectional design, comprising a mixed-methods, English language, anonymous, online survey posted from April 9 to 21 to social media. Eligibility criteria were being affected by COVID-19 fertility clinic closure, 18 years of age or older and able to complete the survey in English. In total, 946 people clicked on the survey link, 76 did not consent, 420 started but did not complete the survey and 450 completed (48% completion, 446 women, four men). PARTICIPANTS/MATERIALS, SETTING, METHODS: Overall 74.7% (n = 336) of respondents were residents in the UK with an average age of 33.6 years (SD = 4.4) and average years trying to conceive, 3.5 years (SD = 2.22). The survey comprised quantitative questions about the intensity of cognitive appraisals and emotions about clinic closure, and ability to cope with clinic closure. Open-text questions covered their understanding of COVID-19 and its effect on reproductive health and fertility plans, concerns and perceived benefits of clinic closure, and knowledge about closure. Sociodemographic information was collected. Descriptive and inferential statistics were used on quantitative data. Thematic qualitative analysis (inductive coding) was performed on the textual data from each question. Deductive coding grouped themes from each question into meta-themes related to cognitive stress and coping theory. MAIN RESULTS AND THE ROLE OF CHANCE: Most patients (81.6%, n = 367) had tests or treatments postponed, with these being self (41.3%, n = 186) or publicly (46.4%, n = 209) funded. Patients appraised fertility clinic closure as having potential for a more negative than positive impact on their lives, and to be very or extremely uncontrollable and stressful (P ≤ 0.001). Most reported a slight to moderate ability to cope with closure. Data saturation was achieved with all open-text questions, with 33 broad themes identified and four meta-themes linked to components of the cognitive stress and coping theory. First, participants understood clinic closure was precautionary due to unknown effects of COVID-19 but some felt clinic closure was unfair relative to advice about getting pregnant given to the public. Second, closure was appraised as a threat to attainability of the parenthood goal largely due to uncertainty of the situation (e.g. re-opening, effect of delay) and intensification of pre-existing hardships of fertility problems (e.g. long time waiting for treatment, history of failed treatment). Third, closure taxed personal coping resources but most were able to cope using thought-management (e.g. distraction, focusing on positives), getting mentally and physically fit for next treatments, strengthening their social network, and keeping up-to-date. Finally, participants reported more negative than positive emotions (P ≤ 0.001) and, almost all participants reported stress, worry and frustration at the situation, while some expressed anger and resentment at the unfairness of the situation. Overall, 11.8% were not at all able to cope, with reports of intense feelings of hopelessness and deteriorating well-being and mental health. LIMITATIONS, REASONS FOR CAUTION: The survey captures patient reactions at a specific point in time, during lockdown and before clinics announced re-opening. Participants were self-selected (e.g. UK residents, women, 48% starting but not completing the survey), which may affect generalisability. WIDER IMPLICATIONS OF THE FINDINGS: Fertility stakeholders (e.g. clinics, patient support groups, regulators, professional societies) need to work together to address the great uncertainty from COVID-19. This goal can be met proactively by setting up transparent processes for COVID-19 eventualities and signposting to information and coping resources. Future psychological research priorities should be on identifying patients at risk of distress with standardised measures and developing digital technologies appropriate for the realities of fertility care under COVID-19. STUDY FUNDING/COMPETING INTEREST(S): University funded research. Outside of the submitted work, Prof. J.B. reports personal fees from Merck KGaA, Merck AB, Theramex, Ferring Pharmaceuticals A/S; grants from Merck Serono Ltd; and that she is co-developer of the Fertility Quality of Life (FertiQoL) and MediEmo apps. Outside of the submitted work, Dr R.M. reports personal or consultancy fees from Manchester Fertility, Gedeon Richter, Ferring and Merck. Outside of the submitted work, Dr S.G. reports consultancy fees from Ferring Pharmaceuticals A/S, Access Fertility and SONA-Pharm LLC, and grants from Merck Serono Ltd. The other authors declare no conflicts of interest. TRIAL REGISTRATION NUMBER: N/A.

Longitudinal associations of callous-unemotional and oppositional defiant behaviors over a three-year interval for Spanish children.

The objective was to determine the longitudinal associations between callous-unemotional (CU) and oppositional defiant (OD) behaviors from the first to fourth grades for Spanish children. Four possible outcomes were evaluated: (a) CU behaviors in the first grade predict increases in OD behaviors in the fourth grade, controlling for OD behaviors in the first grade; (b) OD behaviors in the first grade predict increases in CU behaviors in the fourth grade, controlling for CU behaviors in the first grade; (c) both unique effects are significant; and (d) neither unique effect is significant. A longitudinal panel model with two latent variables (CU and OD behaviors), three sources (mothers, fathers, teachers), and two occasions (spring of the first and fourth grades) was used to evaluate the four possibilities among 758 (54% boys) first grade and 469 (53% boys) fourth grade Spanish children. For mother-, father-, and teacher-reports, OD behaviors in the first grade predicted increases in CU behaviors in the fourth grade, after controlling for CU behaviors in the first grade, whereas CU behaviors in the first grade did not predict increases in OD behaviors in the fourth grade, after controlling for OD behaviors in the first grade. OD behaviors thus conferred independent vulnerability to increases in CU behaviors 3 years later among young children.

Are Sluggish Cognitive Tempo, ADHD, and Oppositional Defiant Disorder Trait- or State-Like Constructs from Prekindergarten to Fourth Grade?

The objective was to determine the proportion of trait (consistency across occasions) and occasion-specific variance in sluggish cognitive tempo (SCT), attention deficit/hyperactivity disorder (ADHD)-inattention (IN), ADHD-hyperactivity/impulsivity (HI), and oppositional defiant disorder (ODD) symptom ratings. A single trait factor-multiple state factors model was applied to parent ratings of SCT, ADHD-IN, ADHD-HI, and ODD symptoms for 978 children (50% female) across prekindergarten (M = 4.90 years), kindergarten (M = 6.27 years), 1st-grade (M = 7.42 years), 2nd-grade (M = 8.45 years), and 4th-grade (M = 10.45 years) assessments. For the prekindergarten assessment, SCT, ADHD-IN, ADHD-HI, and ODD contained more occasion-specific than trait variance (54%, 64%, 56%, and 55% occasion-specific variance, respectively). In contrast, SCT, ADHD-IN, ADHD-HI, and ODD contained more trait than occasion-specific variance for the kindergarten through 4th-grade assessments (62%-72%, 65%-68%, 71%-75%, and 60%-69% trait variance, respectively). SCT, ADHD-IN, ADHD-HI, and ODD are slightly to moderately more state-like than trait-like during the prekindergarten developmental period but are more stable traits than fluctuating states from kindergarten to 4th grade. Findings indicate that, particularly after children start formal schooling, these psychopathology dimensions are primarily stable traits; implications for assessment are discussed.

Measurement of single- and double-escape HPGe efficiency ratios for 60Co.

As a by-product of another measurement, ratios of the single-escape (SE) and double-escape (DE) efficiencies relative to the full-energy-peak efficiency (FE) have been measured for two HPGe detectors for 60Co. For a 2.5-cm-thick 95 cm3 crystal the results were SE/FE = 0.000 48 ± 0.000 20 and 0.003 25 ± 0.000 24 for 1173 and 1332 keV gamma-rays, respectively, and DE/FE = 0.000 90 ± 0.000 17 and 0.003 41 ± 0.000 11 for 1173 and 1332 keV, respectively. For a 3.0-cm-thick 84 cm3 crystal the results were SE/FE = 0.000 67 ± 0.000 32 and 0.003 79 ± 0.000 27 for 1173 and 1332 keV respectively, and DE/FE = 0.001 05 ± 0.000 28 and 0.004 29 ± 0.000 16 for 1173 and 1332 keV, respectively. These measurements may be of relevance in connection with Monte Carlo calculations of HPGe detector efficiencies, and may also suggest a path towards improved atomic cross-section measurements.

Optimal Items for Assessing Sluggish Cognitive Tempo in Children Across Mother, Father, and Teacher Ratings.

A recent meta-analysis identified optimal items for assessing sluggish cognitive tempo (SCT) as distinct from attention deficit/hyperactivity disorder inattention (ADHD-IN), and a preliminary study with teacher ratings of children in the United States found strong support for the convergent and discriminant validity of 15 SCT items. The current study evaluated whether the same 15 SCT items demonstrated convergent and discriminant validity from ADHD-IN in a large, community-based sample of children in Spain, and whether validity results were replicated across mother, father, and teacher ratings. Mothers, fathers, and teachers completed measures of SCT, ADHD-IN, ADHD-hyperactivity/impulsivity, oppositional defiant disorder, limited prosocial emotions, anxiety, depression, shyness, peer rejection, social impairment, and academic impairment on 2,142 Spanish children (49.49% girls; ages 8-13). The 15 SCT symptoms demonstrated convergent validity along with discriminant validity with ADHD-IN across all three informants. The SCT symptom ratings also showed measurement invariance across the informants. In addition, SCT and ADHD-IN factors had different and unique associations with the other symptom and impairment factors. The 15 SCT symptoms identified in this study-consistent across mother, father, and teacher ratings-appear appropriate to serve as a standard symptom set for assessing SCT in children. Use of a common set of symptoms in future studies will advance our understanding of the SCT construct, including its etiology and developmental progression, associations with ADHD and other psychopathologies, links to impairment, and implications for clinical intervention.

Family environment moderates the relation of sluggish cognitive tempo to attention-deficit/hyperactivity disorder inattention and depression.

OBJECTIVES: The current study investigated whether a maladaptive family environment would moderate the strength of the relations of sluggish cognitive tempo (SCT) to attention-deficit/hyperactivity disorder inattention (ADHD-IN) and to depressive symptoms in a large sample of college students. METHODS: Participants (n = 3,172), between the ages of 18-29 (M ± SDage = 19.24 ± 1.52; 69.8% women; 80.4% White) and enrolled in five universities in the United States completed self-report measures of symptomatology, interparental conflict, and family expressiveness of emotions. RESULTS: A negative emotional climate strengthened relations of SCT with ADHD-IN and depressive symptoms. Moreover, the lack of a positive emotional climate strengthened the co-occurrence of SCT with depressive symptoms, though not with ADHD-IN. CONCLUSIONS: The current study is the first to demonstrate that the family environment moderates the association between SCT and co-occurring symptomatology in young adults.

Factor Structure and Criterion Validity of the Five Cs Model of Positive Youth Development in a Multi-University Sample of College Students.

There is growing recognition that clinical and developmental outcomes will be optimized by interventions that harness strengths in addition to ameliorating deficits. Although empirically-supported methods for identifying strengths are available for children and adolescents, this framework has yet to be applied to emerging adulthood. This study evaluates the nature of the Five Cs model of Positive Youth Development (PYD) - character, confidence, competence, connection, and caring - in a sample of emerging adults from six universities (N = 4654; 70% female; 81% White). Historically, PYD has been modeled as either separate correlated factors or a second-order factor structure. More recently, the bifactor model has been recommended to determine the degree to which PYD is unidimensional versus multidimensional. The present study examined the multidimensionality of PYD by comparing the model fit of a one-factor, five-correlated factor model, and second-order factor structure with a bifactor model and found support for the bifactor model with evidence of invariance across sex. Criterion validity was also assessed using three criterion measures particularly relevant for adjustment during emerging adulthood: anxiety, depressive symptoms, and emotion regulation difficulties. PYD and the residual Cs tended to correlate negatively with indicators of maladaptive development. Future directions including applications of the PYD framework as a measure of thriving across emerging adulthood are discussed.

Invariance of parent ratings of attention deficit hyperactivity disorder symptoms for children with and without intellectual disability.

BACKGROUND: Although attention deficit hyperactivity disorder (ADHD) is considered a valid diagnosis for children with intellectual disability, no studies have evaluated the invariance of ADHD symptom ratings across children with and without intellectual disability. METHOD: Parents completed ratings on the ADHD symptoms for 189 children with intellectual disability and for 474 children without intellectual disability. Differential item functioning analysis was used to determine the equivalence of the ADHD symptoms across the two groups. RESULTS: The symptoms loses things, talks too much, and blurts out answers showed significant bias against children with intellectual disability. The prevalence of ADHD in children with intellectual disability was 18% (according to the symptom criterion), and 7.4% when the academic and/or social impairment criterion was also considered. CONCLUSIONS: Most of the ADHD symptoms can be valid for the assessment of ADHD in children with mild and moderate intellectual disability. ADHD symptoms may be used in further studies to establish base rates of the disorder in the intellectual disability population.

Differential impact of trait sluggish cognitive tempo and ADHD inattention in early childhood on adolescent functioning.

BACKGROUND: Sluggish cognitive tempo (SCT) is distinct from attention-deficit/hyperactivity disorder inattention (ADHD-IN) and concurrently associated with a range of impairment domains. However, few longitudinal studies have examined SCT as a longitudinal predictor of adjustment. Studies to date have all used a relatively short longitudinal time span (6 months to 2 years) and only rating scale measures of adjustment. Using a prospective, multi-method design, this study examined whether SCT and ADHD-IN were differentially associated with functioning over a 10-year period between preschool and the end of ninth grade. METHODS: Latent state-trait modeling determined the trait variance (i.e. consistency across occasions) of SCT and ADHD-IN across four measurement points (preschool and the end of kindergarten, first grade, and second grade) in a large population-based longitudinal sample (N = 976). Regression analyses were used to examine trait SCT and ADHD-IN factors in early childhood as predictors of functioning at the end of ninth grade (i.e. parent ratings of psychopathology and social/academic functioning, reading and mathematics academic achievement scores, processing speed and working memory). RESULTS: Both SCT and ADHD-IN contained more trait variance (Ms = 65% and 61%, respectively) than occasion-specific variance (Ms = 35% and 39%) in early childhood, with trait variance increasing as children progressed from preschool through early elementary school. In regression analyses: (a) SCT significantly predicted greater withdrawal and anxiety/depression whereas ADHD-IN did not uniquely predict these internalizing domains; (b) ADHD-IN uniquely predicted more externalizing behaviors whereas SCT uniquely predicted fewer externalizing behaviors; (c) SCT uniquely predicted shyness whereas both SCT and ADHD-IN uniquely predicted global social difficulties; and (d) ADHD-IN uniquely predicted poorer math achievement and slower processing speed whereas SCT more consistently predicted poorer reading achievement. CONCLUSIONS: Findings of this study - from the longest prospective sample to date - provide the clearest evidence yet that SCT and ADHD-IN often differ when it comes to the functional outcomes they predict.

Trait and State Variance in Multi-Informant Assessments of ADHD and Academic Impairment in Spanish First-Grade Children.

OBJECTIVE: We examined the stable trait and variable state components of ADHD-inattention (IN), ADHD-hyperactivity/impulsivity (HI), and academic impairment (AI) dimensions using mothers', fathers', primary and secondary teachers' ratings of children's behavior at home and school. We also examined between-informant agreement with regard to trait and state components. METHOD: Mothers, fathers, primary and secondary teachers rated HI, IN, and AI in N = 758 Spanish first grade children (55% boys) over three measurement occasions across 12 months. RESULTS: Latent state-trait analyses revealed that mothers', fathers', and primary teachers' (but not secondary teachers') ratings reflected more trait variance for ADHD-HI (M = 73%), ADHD-IN (M = 74%), and AI (M = 76%) than occasion-specific variance (M = 27%, M = 26%, and M = 24%, respectively). Fathers' ratings shared a meaningful level of trait variance with mothers' ratings of ADHD-HI and ADHD-IN (range 78% to 82%), whereas primary and secondary teachers' ratings shared lower levels of trait variance with mothers' ratings (range 41% to 63%). The trait components of fathers', primary teachers', and secondary teachers' ratings of AI showed high levels of convergence with mothers' ratings (88%, 70%, and 59% respectively). CONCLUSIONS: ADHD symptom reports reflect both trait (48 to 86%) and state (14 to 53%) variance components. The lower amount of shared variability between home and school suggests the setting-specificity of trait and state components of ADHD symptoms. Our findings indicate that ADHD symptom reports may reflect context-specific traits, suggesting the importance of differentiating and targeting ADHD behaviors across different settings.

Toward Establishing the Transcultural Validity of Sluggish Cognitive Tempo: Evidence From a Sample of South Korean Children.

All sluggish cognitive tempo (SCT) research has been conducted in North America and Western Europe, with the addition of 1 study in Chile. Our objective was to determine the internal and external validity of 9 SCT and 9 Diagnostic and Statistical Manual of Mental Disorders (5th ed.) attention deficit/hyperactivity disorder inattention (ADHD-IN) symptoms in South Korean children. Mothers, fathers, and teachers rated SCT, ADHD-IN, ADHD hyperactivity/impulsivity (HI), oppositional defiant disorder (ODD), anxiety, depression, academic impairment, and social impairment in 1st- to 6th-grade children (6-13 years of age) from South Korea (Sample 1: mothers rated 885 children and fathers rated 646 children; 941 unique children, 54% girls; Sample 2: 99 teachers rated 297 children, 44% girls). The SCT and ADHD-IN symptoms showed convergent validity (substantial loadings on their respective factors) and discriminant validity (loadings near zero on the alternative factor) across all three raters. Although ADHD-IN showed a positive relationship with ADHD-HI and ODD even after controlling for SCT across all three raters, SCT was nonsignificantly (mothers and fathers) or negatively (teachers) related to ADHD-HI and ODD after controlling for ADHD-IN. Higher SCT scores predicted higher anxiety, depression, academic impairment (teachers only), and social impairment (teachers only) even after controlling for ADHD-IN, whereas higher ADHD-IN scores predicted higher anxiety (mothers and fathers only), depression, academic impairment, and social impairment after controlling for SCT. The study provides initial evidence for the internal and external validity of SCT relative to ADHD-IN in South Korean children, thereby providing the first evidence for SCT's validity in Asian children.