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IntroductionAlthough psychotic behaviors can be difficult to assess in children, early identification of children at high risk for the emergence of psychotic symptoms may facilitate the prevention of related disorders. Psychotic-like experiences (PLEs), or subthreshold thought and perceptual disturbances, could be early manifestations of psychosis that may predict a future diagnosis of a psychosis-related disorder or nonspecific correlates of a wide range of psychological problems. Additional research is needed regarding how PLEs map onto dimensions of psychopathology in children.MethodsIn the present study, we examined the association between PLEs and general and specific dimensions of psychological problems in a sample of 10,692 children from the Adolescent Brain Cognitive Development Study (ABCD Study).ResultsThe results of this study showed that self-reported PLEs were associated with a general psychopathology factor and an ADHD factor, which were defined in hierarchical models of parent-rated psychological problems.DiscussionThese findings suggest that PLEs are broadly associated with a wide range of psychological problems through the general psychopathology factor even before psychotic disorders typically manifest. This study supports the need for longitudinal analyses of future waves of the ABCD Study to determine if PLEs can detect children at high risk for serious psychological problems in adulthood.

Abstract Background Children referred for attention-deficit/hyperactivity disorder (ADHD) often present with a broader pattern of conduct problems including oppositionality and defiance. This combination can be extremely stressful to parents, lower parents’ self-esteem and negatively impact family life. The National Institute for Health and Care Excellence (NICE) recommends that families receive support as soon as possible after their referral. However, as clinical services are overstretched, and traditional in-person parenting intervention programmes are expensive, families often must wait times a long time prior to receiving this vital input. To address this, we have created a digital parenting programme called STEPS. It is delivered as a mobile phone app providing a set of tools and resources that can be easily accessed at parents’ convenience. This study aims to evaluate the clinical and cost-effectiveness of STEPS in supporting parents of children with high levels of hyperactivity/impulsivity, inattention and conduct problems, who are waiting to be assessed by specialist children’s clinical services. Methods Online Parent Training for The Initial Management of ADHD referrals (OPTIMA) is a two-arm superiority parallel randomised controlled trial with an internal pilot study. We aim to recruit 352 parents and their children, who have been accepted onto a waitlist in Child and Adolescent Mental Health Services or similar child health services. Parents who consent will be randomised 1:1 to either the STEPS or wait-as-usual (WAU) group. The trial will be conducted remotely (online and telephone) with measures taken at baseline and 3, 6, 9 and 12 months post-randomisation. The primary objective is to evaluate whether STEPS reduces the severity of children’s oppositional and defiant behaviour, as rated by parents, measured at 3 months post-randomisation compared to WAU. Discussion Digital solutions, such as mobile phone apps, have potential for delivering psychological support for parents of children with clinical-level needs in a timely and inexpensive manner. This trial will provide data on the clinical and cost-effectiveness of the STEPS app, which could support the implementation of this scalable parenting intervention programme into standard clinical care and, ultimately, improve the outcomes for families of children referred to specialist child and adolescent health services. Trial registration ISRCTN 16523503. Prospectively registered on 18 November 2021. https://www.isrctn.com/ISRCTN16523503

Separate studies with clinical and community‐based samples have identified an association between symptoms of attention‐deficit hyperactivity disorder (ADHD) and inhibitory control deficits and ADHD and weak effortful control. We tested whether differences in effortful control explained the associations between ADHD symptoms and inhibitory control deficits, controlling for conduct problems. In a community sample, parents rated ADHD symptoms, conduct problems, effortful control, surgency and negative affect in 77 4‐7‐year‐olds (47 girls), who performed an inhibitory control task. ADHD symptoms, deficient inhibitory control and low effortful control were correlated. Controlling for conduct problems, path analysis showed the ADHD symptoms – inhibitory control link was mediated statistically by effortful control. This focuses attention on cognitive‐energetic factors associated with ADHD‐related executive deficits. [ABSTRACT FROM AUTHOR]

Background: Attention deficit hyperactivity disorder (ADHD) has in several studies been linked to substance use, including cannabis use. However, crucial gaps remain regarding how to understand this association. Analyzing the association between ADHD and substance use is complicated because of a pronounced overlap between ADHD, conduct problems, and traits such as sensation-seeking. Objectives: Using data from a large and nationally representative study among Swedish adolescents, this study explored the role of conduct problems, but also of sensation-seeking, in accounting for the association between ADHD and cannabis use. Results: There was a notable association between ADHD and cannabis use that was attenuated when conduct problems were controlled for. The association between cannabis use and conduct problems, in turn, was attenuated when sensation-seeking was controlled for. Individuals with both ADHD and conduct problems were more likely to have used cannabis than individuals with ADHD only, but not compared with individuals with conduct problems only. Conclusions: Whereas conduct problems largely explain the link between ADHD and cannabis use, sensation-seeking seems to account for the association between conduct problems and cannabis use. [ABSTRACT FROM AUTHOR]

Background: Children referred for attention-deficit/hyperactivity disorder (ADHD) often present with a broader pattern of conduct problems including oppositionality and defiance. This combination can be extremely stressful to parents, lower parents’ self-esteem and negatively impact family life. The National Institute for Health and Care Excellence (NICE) recommends that families receive support as soon as possible after their referral. However, as clinical services are overstretched, and traditional in-person parenting intervention programmes are expensive, families often must wait times a long time prior to receiving this vital input. To address this, we have created a digital parenting programme called STEPS. It is delivered as a mobile phone app providing a set of tools and resources that can be easily accessed at parents’ convenience. This study aims to evaluate the clinical and cost-effectiveness of STEPS in supporting parents of children with high levels of hyperactivity/impulsivity, inattention and conduct problems, who are waiting to be assessed by specialist children’s clinical services. Methods: Online Parent Training for The Initial Management of ADHD referrals (OPTIMA) is a two-arm superiority parallel randomised controlled trial with an internal pilot study. We aim to recruit 352 parents and their children, who have been accepted onto a waitlist in Child and Adolescent Mental Health Services or similar child health services. Parents who consent will be randomised 1:1 to either the STEPS or wait-as-usual (WAU) group. The trial will be conducted remotely (online and telephone) with measures taken at baseline and 3, 6, 9 and 12 months post-randomisation. The primary objective is to evaluate whether STEPS reduces the severity of children’s oppositional and defiant behaviour, as rated by parents, measured at 3 months post-randomisation compared to WAU. Discussion: Digital solutions, such as mobile phone apps, have potential for delivering psychological support for parents of children with clinical-level needs in a timely and inexpensive manner. This trial will provide data on the clinical and cost-effectiveness of the STEPS app, which could support the implementation of this scalable parenting intervention programme into standard clinical care and, ultimately, improve the outcomes for families of children referred to specialist child and adolescent health services. Trial registration: ISRCTN 16523503. Prospectively registered on 18 November 2021. [ABSTRACT FROM AUTHOR]

Background: Attention-deficit/hyperactivity disorder (ADHD) is a known risk factor for substance-related problems (SRP) during adolescence, but the nature of this relationship and the importance of co-occurring conduct problems are not fully understood. Methods: Data stem from a linked dataset between a large population-based survey conducted in 2012 of Norwegian adolescents aged 16 to 19, and registry-based data from specialized child and adolescent mental health services (n = 9,411). Results: Adolescents with "ADHD + high conduct problems" had increased risk of SRP (odds ratios = 2.37–10.14). Adolescents with "ADHD only" had very similar risk of SRP as adolescents from the general population with low symptoms of conduct problems. Relative to boys, girls with "ADHD + high conduct problems" appeared to have somewhat higher risk for SRP. Conclusion: The present study suggests that the risk for SRP among adolescent with ADHD is largely driven by co-existing conduct problems. [ABSTRACT FROM AUTHOR]

Research on the association between callous–unemotional (CU) traits and intelligence yielded contradictory results. Moreover, several previous studies focused on global intelligence scores or verbal vs. nonverbal/performance abilities usually evaluated with short/abbreviated instruments. The current study builds on these previous works and explores the link between CU traits and intelligence using the full version of the Wechsler Intelligence Scale for Children—4th Edition (WISC-IV), which provides four different verbal and nonverbal abilities scores. This guarantees a more detailed evaluation of children's intelligence and its relation to CU traits. The sample included children (N = 149; age 6–14 years old) with severe behavioral problems. Clinicians administered the WISC-IV, and parents completed questionnaires evaluating the child's externalizing problems and CU traits. Findings showed that CU traits were associated with lower verbal comprehension scores after also controlling for gender, age, externalizing problems, and the other WISC-IV indexes. In addition, CU traits and externalizing problems did not interact in predicting the WISC-IV indexes, and there were no significant differences in the WISC-IV indexes between children with CU traits and high vs. low externalizing problems. The current study suggests the relevance of assessing and addressing verbal abilities in children with behavioral problems and CU traits. [ABSTRACT FROM AUTHOR]

Abstract Background In the UK, children with high levels of hyperactivity, impulsivity and inattention referred to clinical services with possible attention-deficit/hyperactivity disorder (ADHD) often wait a long time for specialist diagnostic assessment. Parent training (PT) has the potential to support parents during this difficult period, especially regarding the management of challenging and disruptive behaviours that often accompany ADHD. However, traditional face-to-face PT is costly and difficult to organise in a timely way. We have created a low-cost, easily accessible PT programme delivered via a phone app, Structured E-Parenting Support (STEPS), to address this problem. The overall OPTIMA programme will evaluate the efficacy and cost-effectiveness of STEPS as a way of helping parents manage their children behaviour while on the waitlist. To ensure the timely and efficient evaluation of STEPS in OPTIMA, we have worked with children’s health services to implement a remote strategy for recruitment, screening and assessment of recently referred families. Part of this strategy is incorporated into routine clinical practice and part is OPTIMA specific. Here, we present the protocol for Phase 1 of OPTIMA—a study of the feasibility of this remote strategy, as a basis for a large-scale STEPS randomised controlled trial (RCT). Methods This is a single arm observational feasibility study. Participants will be parents of up to 100 children aged 5-11 years with high levels of hyperactivity/impulsivity, inattention and challenging behaviour who are waiting for assessment in one of five UK child and adolescent mental health or behavioural services. Recruitment, consenting and data collection will occur remotely. The primary outcome will be the rate at which the families, who meet inclusion criteria, agree in principle to take part in a full STEPS RCT. Secondary outcomes include acceptability of remote consenting and online data collection procedures; the feasibility of collecting teacher data remotely within the required timeframe, and technical difficulties with completing online questionnaires. All parents in the study will receive access to STEPS. Discussion Establishing the feasibility of our remote recruitment, consenting and assessment strategy is a pre-requisite for the full trial of OPTIMA. It can also provide a model for future trials conducted remotely.

Exposure to adverse childhood experiences (ACEs) is a significant public health issue for youth. However, traumatic brain injury (TBI) has been almost entirely overlooked in the ACEs and health outcomes literature, which has largely focused on the significant mental and behavioral health impact of ACEs. The goal the current study is to examine the association between ACEs and TBI among a nationally representative sample of adolescents in the United States and the extent to which ADHD and conduct problems inform this association. To assess this relationship, we use a sample of 42,204 adolescents (ages 12–17 years) in the United States whose caregivers were surveyed during the three most recent cohorts (2016–2018) of the National Survey of Children's Health (NSCH). The results revealed a dose–response relationship between ACEs and TBI, even after accounting for an array of confounding variables. Findings also indicated that associations were of a greater magnitude among youth who are not sports-involved. Supplemental mediation analyses showed that ADHD and conduct problems attenuated associations between ACE exposure and TBI, but only in the absence of youth sports involvement. Given that both ACEs and TBI carry long-term consequences for health and well-being, the findings from this study draw attention to the need for early intervention and prevention programming (e.g. home visiting) that can reduce the prevalence of ACEs and a history of TBI among adolescents. [ABSTRACT FROM AUTHOR]

Abstract Background Early to middle adolescence is a critical period of development for mental health issues. Illuminating sex/gender differences in mental health trajectories in this period is important for targeting screening and preventive interventions; however, evidence to date on the extent and nature of sex/gender differences in common mental health issue trajectories in this period has produced mixed findings. There is a particular gap in our knowledge of sex/gender differences in the joint trajectories of commonly co‐occurring mental health issues in adolescence, given the strong tendency for mental health issues to co‐occur. Method We applied sex/gender‐stratified latent class growth analysis to an age‐heterogeneous cohort (age 10–15) derived from the population‐representative UK Household Longitudinal Study. We explored sex/gender differences in attention deficit hyperactivity disorder (ADHD) symptoms, internalizing problems, and conduct problems individually and jointly. Results We found indications of sex/gender differences in a number of areas. There were fewer classes in the optimal model to describe the heterogeneity in internalizing problems and conduct problems trajectories in males and females respectively. Further, for ADHD, affected males were more likely to enter adolescence with already elevated symptoms whereas affected female trajectories were characterized by an escalation of symptoms during adolescence. Conclusions There are sex/gender differences in the levels and trajectories of specific mental health symptoms in early to middle adolescence; however, in both males and females there is a strong tendency for multiple issues to co‐occur.

Background: In the UK, children with high levels of hyperactivity, impulsivity and inattention referred to clinical services with possible attention-deficit/hyperactivity disorder (ADHD) often wait a long time for specialist diagnostic assessment. Parent training (PT) has the potential to support parents during this difficult period, especially regarding the management of challenging and disruptive behaviours that often accompany ADHD. However, traditional face-to-face PT is costly and difficult to organise in a timely way. We have created a low-cost, easily accessible PT programme delivered via a phone app, Structured E-Parenting Support (STEPS), to address this problem. The overall OPTIMA programme will evaluate the efficacy and cost-effectiveness of STEPS as a way of helping parents manage their children behaviour while on the waitlist. To ensure the timely and efficient evaluation of STEPS in OPTIMA, we have worked with children's health services to implement a remote strategy for recruitment, screening and assessment of recently referred families. Part of this strategy is incorporated into routine clinical practice and part is OPTIMA specific. Here, we present the protocol for Phase 1 of OPTIMA—a study of the feasibility of this remote strategy, as a basis for a large-scale STEPS randomised controlled trial (RCT). Methods: This is a single arm observational feasibility study. Participants will be parents of up to 100 children aged 5-11 years with high levels of hyperactivity/impulsivity, inattention and challenging behaviour who are waiting for assessment in one of five UK child and adolescent mental health or behavioural services. Recruitment, consenting and data collection will occur remotely. The primary outcome will be the rate at which the families, who meet inclusion criteria, agree in principle to take part in a full STEPS RCT. Secondary outcomes include acceptability of remote consenting and online data collection procedures; the feasibility of collecting teacher data remotely within the required timeframe, and technical difficulties with completing online questionnaires. All parents in the study will receive access to STEPS. Discussion: Establishing the feasibility of our remote recruitment, consenting and assessment strategy is a pre-requisite for the full trial of OPTIMA. It can also provide a model for future trials conducted remotely. [ABSTRACT FROM AUTHOR]

Research on the association between callous–unemotional (CU) traits and intelligence yielded contradictory results. Moreover, several previous studies focused on global intelligence scores or verbal vs. nonverbal/performance abilities usually evaluated with short/abbreviated instruments. The current study builds on these previous works and explores the link between CU traits and intelligence using the full version of the Wechsler Intelligence Scale for Children—4th Edition (WISC-IV), which provides four different verbal and nonverbal abilities scores. This guarantees a more detailed evaluation of children’s intelligence and its relation to CU traits. The sample included children (N = 149; age 6–14 years old) with severe behavioral problems. Clinicians administered the WISC-IV, and parents completed questionnaires evaluating the child’s externalizing problems and CU traits. Findings showed that CU traits were associated with lower verbal comprehension scores after also controlling for gender, age, externalizing problems, and the other WISC-IV indexes. In addition, CU traits and externalizing problems did not interact in predicting the WISC-IV indexes, and there were no significant differences in the WISC-IV indexes between children with CU traits and high vs. low externalizing problems. The current study suggests the relevance of assessing and addressing verbal abilities in children with behavioral problems and CU traits.

Many autistic young people exhibit co‐occurring behavior difficulties, characterized by conduct problems and oppositional behavior. However, the causes of these co‐occurring difficulties are not well understood. Impairments in theory of mind (ToM) are often reported in autistic individuals and have been linked to conduct problems in nonautistic individuals. Whether an association between ToM ability and conduct problems exists in autistic populations, whether this association is similar between individuals who are autistic versus nonautistic, and whether these associations are specific to conduct problems (as opposed to other domains of psychopathology) remains unclear. ToM ability was assessed using the Frith–Happé Triangles task in a pooled sample of autistic (N = 128; mean age 14.78 years) and nonautistic youth (N = 50; mean age 15.48 years), along with parent‐rated psychiatric symptoms of conduct problems, hyperactivity/inattention and emotional problems. Analyses tested ToM ability between autistic versus nonautistic participants, and compared associations between ToM performance and conduct problems between the two groups. Where no significant group differences in associations were found, the pooled association between ToM and conduct problems was estimated in the combined sample. Results showed no evidence of moderation in associations by diagnostic status, and an association between poorer ToM ability and higher levels of conduct problems, hyperactivity/inattention and emotional problems across the total sample. However, these associations became nonsignificant when adjusting for verbal IQ. Results provide support for theoretical models of co‐occurring psychopathology in autistic populations, and suggest targets for intervention for conduct problems in autistic youth. Lay Summary Many young people with autism spectrum disorder show co‐occurring behavior problems, but the causes of these are not well understood. This paper found an association between difficulties recognizing what others think and intend (so‐called "theory of mind") in a simple animated task, and emotional and behavioral problems in autistic and nonautistic young people. However, a substantial part of this association was explained by individual differences in verbal ability. These findings may have implications for intervention efforts to improve young people's mental health. [ABSTRACT FROM AUTHOR]

Background: Physical activity (PA) during adolescence is associated with a wide range of health benefits, including lower levels of internalizing and externalizing problems. Although the association between PA and mental health has been established, there are few prospective studies investigating if the association between PA and internalizing/externalizing symptoms remains after adjustment for the baseline occurrence of such symptoms, and those exploring any sex-specific pattern of the association.Methods: Swedish adolescents (N = 1428; mean age = 14.38 years) were assessed and followed up 3 years later. Self-reported data were collected for PA (recoded as low, moderate and high levels), internalizing (depression and anxiety) and externalizing (attention-deficit/hyperactivity disorder and disruptive behaviours) symptoms. A full path analysis was used to determine the main and interaction effects of PA and sex on internalizing/externalizing symptoms 3 years later, adjusting for these symptoms at baseline.Results: Higher levels of PA were correlated with lower internalizing/externalizing symptoms. In the full path analysis, PA during early adolescence predicted lower levels of depressive symptoms, but not anxiety or externalizing problems, 3 years later. A sex-specific effect of PA on depressive symptoms was found, wherein boys, but not girls, with high levels of PA showed reduced symptoms.Limitations: Including parental ratings, diagnostic assessments and objective measures of PA would have provided additional information to the study.Conclusions: Low levels of PA during early adolescence are a unique predictor for the development of depressive symptoms among boys. PA should be considered when discussing prevention and treatment for depression in adolescents. [ABSTRACT FROM AUTHOR]

Objective: The aim was to explore mediators of change in parent training (PT) for 3- to 8-year-old children with ADHD difficulties. Method: Parents of 64 children received PT with Incredible Years® and assessed child ADHD symptoms and conduct problems and their parenting strategies, parental self-efficacy, and therapeutic alliance before, during, and after PT. Product-of-coefficients mediation analyses in multilevel models were applied, and causal relations between mediators and outcome were investigated in time-lagged analyses. Results: Increased parental self-efficacy and reduced negative parenting statistically mediated reductions in ADHD and conduct problems in the product-of-coefficient analyses. However, time-lagged analyses were unable to detect a causal relation between prior change in mediators and subsequent child symptom reduction. There was limited evidence of therapeutic alliance as mediator of child symptom reduction or change in parenting variables. Conclusion: Parental self-efficacy and reductions in negative parenting may mediate change in PT, but more fine-grained time-lagged analyses are needed to establish causality. [ABSTRACT FROM AUTHOR]

Objective: To test the previously suggested hypothesis that those with comorbid ADHD and Conduct Disorder (CD) diagnoses differ from other antisocially involved youth in terms of higher rates of violent behavior, impulsiveness, and psychopathic traits. Method: Three hundred eighty juvenile incarcerated delinquents from Northern Russia were assessed by means of semi-structured psychiatric interview and by student and teacher self-reports. Results: The study has demonstrated higher rates of psychiatric disorders and of comorbidity, as well as more complicated substance abuse and disruptive behaviors in those with combined ADHD-CD diagnosis, as compared with CD only, ADHD only, and no CD no ADHD groups. The results regarding psychopathic traits were inconclusive. Conclusion: The group with combined ADHD-CD diagnosis is more severely disturbed, both as concerns psychiatric comorbidity and more severe aggressive and disruptive behaviors. However, there is only limited evidence supporting a higher prevalence of psychopathic traits in this group. [ABSTRACT FROM AUTHOR]

• Factors that influence student–teacher relationships for children with ADHD are unknown. • Compared to peers children with ADHD experience poorer student–teacher relationships. • Within the ADHD group, boys and children with conduct problems had poor quality teacher relationships. • Prosocial skills may foster better student–teacher relationships for all children. The relationships children form with their teachers in early childhood are known to be important in the context of their ongoing learning and development. This study investigated student–teacher relationship quality (STRQ) in grade one students with (n = 177) and without (n = 208) attention-deficit/hyperactivity disorder (ADHD). We also examined whether a range of child and teacher factors were associated with STRQ. Children (M = 7.3 years; SD = 0.4) were recruited through 43 schools and screened for ADHD using parent and teacher screening questionnaires (Conners 3 ADHD index). ADHD cases were confirmed using the diagnostic interview schedule for children version IV. STRQ was rated by teachers using the student–teacher relationship scale — short form. Results showed that children with ADHD experienced poorer STRQ compared to children without ADHD (Cohen's d = 1.11). STRQ was associated with child sex, medication use, ADHD subtype, cognitive/academic functioning and behavior, teacher experience, and self-efficacy, and parent education and socio-economic status. After controlling for school and teacher clustering, children's prosocial behavior and teacher years of experience were positively associated with STRQ in both groups. In children with ADHD, conduct problems and child sex (boys) predicted poorer teacher relationship quality. For children without ADHD, higher socio-economic status was associated with better STRQ. Targeting modifiable factors associated with STRQ for children with and without ADHD and their teachers may be one way of improving school outcomes for at-risk children. Promoting prosocial behavior in classrooms may benefit STRQ for all children. [ABSTRACT FROM AUTHOR]

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The purpose of the current study was to examine the relationship between multiple forms of behavioral and trait impulsivity and the externalizing symptoms of Attention-Deficit Hyperactivity Disorder (ADHD), conduct problems (CP), and callous-unemotional (CU) traits. Participants were 182 elementary school age children (142 boys and 40 girls) ranging in age from 5.6 to 12.5 years, recruited through a university-based ADHD clinic. Data showed that symptoms of ADHD were characterized by playing fewer trials on the Reward Dominance task, UPPS Urgency, and UPPS lack of perseverance. Symptoms of conduct problems were characterized by playing fewer trials on the Reward Dominance task and UPPS urgency. In contrast, callous-unemotional traits were characterized by only UPPS urgency and not by performance on either of the behavioral tasks. These results indicate some convergence in terms of trait impulsivity across externalizing syndromes, as well as divergence in terms of behavioral impulsivity and perseverance on tasks. The implications of these findings are discussed with particular emphasis on the importance of different facets of impulsivity characterizing different childhood externalizing syndromes. [ABSTRACT FROM AUTHOR]

Previous research shows that, compared to children without ADHD, children with ADHD have worse socio-emotional outcomes and more experience of socio-economic disadvantage. In this study, we explored if and how the increased emotional and behavioural difficulties faced by children with ADHD may be accounted for by their more disadvantaged socio-economic circumstances. Our study, using data from 180 children (149 boys) with ADHD from the Millennium Cohort Study, had two aims. First, to examine the role of socio-economic disadvantage in the trajectories of emotional and conduct problems in children with ADHD at ages 3, 5, 7 and 11 years. Second, to explore the roles of the home environment (household chaos) and parenting (quality of emotional support, quality of the parent-child relationship and harsh parental discipline) in mediating any associations between socio-economic disadvantage and child emotional and conduct problems. Using growth curve models, we found that socio-economic disadvantage was associated with emotional and conduct problems but neither the home environment nor parenting attenuated this association. Lower quality of the parent-child relationship and harsher discipline were associated with more conduct problems. It appears that socio-economic disadvantage and parenting contribute independently to the prediction of comorbid psychopathology in children with ADHD. [ABSTRACT FROM AUTHOR]

This study examined the extent to which positive and negative parenting relates to conduct problems (CP) and callous-unemotional (CU) traits among 172 adolescents (72 % males; Mage = 16.91 years, SD = .67) with attention-deficit/hyperactivity disorder and whether CU traits moderate the link between parenting and CP. Mothers reported on their adolescents' CP, CU traits, and their own parenting practices. Maternal behaviors were observed during a problem-solving communication task. Parents who engaged in more positive parenting (self-reported and observed) reported their adolescents as having lower levels of CU traits. No effect was found for negative parenting. Moderation analyses indicated that lower levels of positive maternal behavior was only associated with higher CP in the presence of higher levels of CU traits. Negative parenting was positively related to CP regardless of CU traits. Positive parenting, irrespective of measurement approach, uniquely relates to adolescents' CU traits while both positive and negative parenting relate to CP. [ABSTRACT FROM AUTHOR]

Background: Attention deficit hyperactivity disorder (ADHD) is characterized by symptoms of inattention, excessive motor activity and impulsivity detected mostly during childhood. These traits are known to be controlled by monoamine neurotransmitters, chiefly dopamine, serotonin and norepinephrine. Monoamine oxidase A (MAOA) and B (MAOB), two isoenzymes bound to the outer membrane of mitochondria, are involved in the degradation of monoamines and were explored for association with ADHD in different ethnic groups. In the present study, few exonic as well as intronic MAOB variants were analyzed in ADHD probands (N = 150) and ethnically matched controls (N = 150) recruited following the Diagnostic and Statistical Manual for Mental Disorders-4th edition (DSM-IV). Appropriate scales were used for measuring the behavioural attributes. Gene variants were analyzed by amplification of target sites followed by DNA sequencing and data obtained were analyzed by population based statistical methods. Results: Out of 34 variants present in the analyzed sites, only seven functional variants, rs4824562, rs56220155, rs2283728, rs2283727, rs3027441, rs6324 and rs3027440, were found to be polymorphic. rs2283728 ‘C’ (P = 3.45e-006) and rs3027440 ‘T’ (P = 0.02) alleles showed higher frequencies in ADHD probands as compared to controls. rs56220155 ‘A’ (P = 0.04) allele and ‘GA’ (P = 0.04) genotype showed higher frequencies in the male and female ADHD probands respectively as compared to sex-matched controls. Analysis of pairwise linkage disequilibrium revealed striking differences between probands and controls. Haplotype analysis revealed significantly higher occurrence of different haplotypes in the ADHD probands while some haplotypes were detected in the controls only. Higher scores for conduct problems were found to be associated with rs56220155 ‘A’ (P = 0.05) allele in the male ADHD probands. Multifactor dimensionality reduction analysis showed independent as well as interactive effects of polymorphic variants which were more robust in the male probands. Conclusions: Since all the polymorphic variants analyzed were functional, it may be inferred that MAOB gene variants are contributing to the etiology of ADHD in the Indo-Caucasoid population from eastern India which merits further in depth analysis. [ABSTRACT FROM AUTHOR]

Background The onset of hyperactivity/impulsivity and attention problems ( HAP) is typically younger than that of conduct problems ( CP), and some research supports a directional relation wherein HAP precedes CP. Studies have tested this theory using between-person and between-group comparisons, with conflicting results. In contrast, prior research has not examined the effects of within-person fluctuations in HAP on CP. Method This study tested the hypothesis that within-person variation in HAP would positively predict subsequent within-person variation in CP, in two population samples of youth ( N = 620) who participated in identical methods of assessment over the course of 30 months. Three-level, hierarchical models were used to test for within-person, longitudinal associations between HAP and CP, as well as moderating effects of between-person and between-family demographics. Results We found a small but significant association in the expected direction for older youth, but the opposite effect in younger and non-Caucasian youth. These results were replicated across both samples. Conclusions The process by which early HAP relates to later CP may vary by age and racial identity. [ABSTRACT FROM AUTHOR]

Objective: We evaluated the effectiveness of 4 parent-training programs for children with externalizing problems. We tested the effectiveness of 3 behavioral programs (Comet, Cope, and Incredible Years) and 1 nonbehavioral program (Connect) in reducing child behavior problems and attention-deficit/ hyperactivity disorder (ADHD) symptoms, in improving positive parenting and parenting competence, and in decreasing negative parenting and parents' stress and depressive symptoms. Method: This national study was designed as a randomized-controlled effectiveness trial (RCT). The treatments were carried out in 30 clinical and community-based practices. Parents of 908 children (ages 3-12 years) were randomly assigned to 1 of 2 parent training programs available at each practice, or to a wait-list condition, where parents had sought help from regular services. Before and after treatment, parents rated child behavior problems and parenting strategies. Results: At posttreatment, children whose parents had received interventions showed a strong decrease in child conduct problems and a moderate to strong decrease in ADHD symptoms. About half of parents whose children scored over the 95th percentile on the behavior measures (Eyberg Child Behavior Inventory, Swanson, Nolan, and Pelham Rating Scale), a clinically meaningful cutoff, reported that their children were no longer above the cutoff after the intervention. Parents showed considerably less negative behaviors toward their children at posttest compared with pretest; they increased in parental competence, and decreased in both stress and depressive symptoms. Overall, the behavioral programs were more effective than the nonbehavioral program. Conclusions: The results support the general efficacy of parent training in a short-term perspective. [ABSTRACT FROM AUTHOR]

An emerging body of mental health research provides evidence that callous-unemotional (CU) traits explain significant and meaningful variance among children with disruptive behavior disorders. However, the classroom behavior of students with CU traits has not yet been adequately studied. This study examined this issue using teacher-recorded classroom rule violations (RVs). Participants were 648 children (346 boys; M age = 8.14) from 28 classrooms (kindergarten-sixth grade) distributed across three schools participating in a schoolwide behavioral intervention. Teachers completed rating scales approximately 4 to 6 weeks after the start of the school year, prior to initiating the schoolwide intervention. After completing ratings, teachers recorded daily frequency counts of RVs for each student in their classroom for the remainder of the school year. Growth curve modeling analyses indicated that (a) CU traits were associated with elevated rates of RVs at the start of the school year even after taking attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder/conduct disorder (ODD/CD) into account and (b) CU traits were associated with a significant decrease in rates of RVs across the school year. CU traits appear to explain significant and important variance in classroom RVs among elementary school age students. [ABSTRACT FROM AUTHOR]

Children and adolescents with attention-deficit/hyperactivity disorder (ADHD) experience high rates of sleep problems and are also at increased risk for experiencing comorbid mental health problems. This study provides an initial examination of the 1-year prospective association between sleep problems and comorbid symptoms in youth diagnosed with ADHD. Participants were 81 young adolescents (75 % male) carefully diagnosed with ADHD and their parents. Parents completed measures of their child's sleep problems and ADHD symptoms, oppositional defiant disorder (ODD) symptoms, and general externalizing behavior problems at baseline ( M = 12.2) and externalizing behaviors were assessed again 1 year later. Adolescents completed measures of anxiety and depression at both time-points. Medication use was not associated with sleep problems or comorbid psychopathology symptoms. Regression analyses indicated that, above and beyond demographic characteristics, ADHD symptom severity, and initial levels of comorbidity, sleep problems significantly predicted greater ODD symptoms, general externalizing behavior problems, and depressive symptoms 1 year later. Sleep problems were not concurrently or prospectively associated with anxiety. Although this study precludes making causal inferences, it does nonetheless provide initial evidence of sleep problems predicting later comorbid externalizing behaviors and depression symptoms in youth with ADHD. Additional research is needed with larger samples and multiple time-points to further examine the interrelations of sleep problems and comorbidity. [ABSTRACT FROM AUTHOR]

In this study, we aimed to replicate Stattin and Kerr's (2000) study on parental monitoring and adolescents' deviant behavior, to extend their findings to ADHD symptoms, and to examine the longitudinal predictors (8–18 years) of parental knowledge and child disclosure. Results showed that conduct problems were primarily associated with parental knowledge and child disclosure, but not with parental solicitation and control. A similar pattern was observed for ADHD symptoms. However, while the relations for conduct problems were generally independent of ADHD symptoms, the relations for ADHD symptoms were primarily non-significant after controlling for conduct problems. Moreover, early behavior problems, but not insecure/disorganized attachment, were associated with parental knowledge and child disclosure in adolescence. In conclusion, child disclosure is primarily associated with deviant behavior rather than ADHD, and early child problem behavior is a more important predictor of child disclosure (implicating reciprocal relations between these two constructs) than is insecure/disorganized attachment. [ABSTRACT FROM AUTHOR]

Previous research demonstrates that ADHD symptoms are related to increased risky sexual behavior. Distress intolerance (DIT) has also been linked to risk behavior and may also be related to increased risky sexual behavior. Thus, we evaluated the degree to which DIT moderated the link between ADHD symptoms and number of casual and monogamous sexual partners. Participants were undergraduate psychology students ( N = 660; 30 % male; M = 20.23, SD = 1.40; 47 % European American) who completed an online assessment. Hierarchical multiple regression revealed that several DIT constructs, specifically tolerance, appraisal, and regulation, moderated the link between ADHD symptoms and casual sex partners. Only regulation moderated the association between ADHD symptoms and monogamous sex partners. Results suggest that difficulty managing distress moderates the link between ADHD symptoms and number of sexual partners. These results have important implications for prevention and intervention program development. [ABSTRACT FROM AUTHOR]

Justice sensitivity captures individual differences in the frequency with which injustice is perceived and the intensity of emotional, cognitive, and behavioral reactions to it. Persons with ADHD have been reported to show high justice sensitivity, and a recent study provided evidence for this notion in an adult sample. In 1,235 German 10-to 19-year olds, we measured ADHD symptoms, justice sensitivity from the victim, observer, and perpetrator perspective, the frequency of perceptions of injustice, anxious and angry rejection sensitivity, depressive symptoms, conduct problems, and self-esteem. Participants with ADHD symptoms reported significantly higher victim justice sensitivity, more perceptions of injustice, and higher anxious and angry rejection sensitivity, but significantly lower perpetrator justice sensitivity than controls. In latent path analyses, justice sensitivity as well as rejection sensitivity partially mediated the link between ADHD symptoms and comorbid problems when considered simultaneously. Thus, both justice sensitivity and rejection sensitivity may contribute to explaining the emergence and maintenance of problems typically associated with ADHD symptoms, and should therefore be considered in ADHD therapy. [ABSTRACT FROM AUTHOR]

Background Recent studies have linked attention-deficit/hyperactivity disorder ( ADHD) to elevated rates of risky sexual behavior ( RSB) in adult samples. The current study tested whether ADHD symptoms were associated with RSB among adolescents, and examined comorbid conduct problems and problematic substance use as joint mediators of this association. Methods ADHD symptoms, conduct problems (oppositional defiant disorder/conduct disorder symptoms), problematic alcohol use (alcohol use disorder symptoms, alcohol use frequency), problematic marijuana use (marijuana use disorder symptoms, marijuana use frequency), and RSB were assessed among an ethnically diverse cross-sectional sample of adolescents ( N = 115; mean age = 14.9 years) involved in the juvenile justice system. Results Bootstrapped mediation models revealed an initial association between ADHD symptoms and RSB that was accounted for fully by the influence of problematic alcohol and marijuana use, but not conduct problems. A follow-up multiple groups mediation analysis demonstrated that the relationship between ADHD symptoms and RSB emerged only among youth with clinically elevated conduct problems, and that problematic marijuana use fully accounted for this relationship. Hyperactive/impulsive, but not inattentive, symptoms were related to RSB, although the pattern of indirect effects was consistent with the multiple groups analysis. Conclusions The association between ADHD and adolescent RSB is restricted to youth with elevated comorbid conduct problems and reflects the contributions of comorbid marijuana use problems, and to a lesser extent alcohol use problems. Early identification and treatment of these comorbid conditions may be important for the prevention of negative sexual health outcomes among youth with ADHD. [ABSTRACT FROM AUTHOR]

Background Maternal psychopathology robustly predicts poor developmental and treatment outcomes for children with attention-deficit/hyperactivity disorder ( ADHD). Despite the high heritability of ADHD, few studies have examined associations between paternal ADHD symptoms and child adjustment, and none have also considered degree of paternal involvement in childrearing. Identification of modifiable risk factors for child conduct problems is particularly important in this population given the serious adverse outcomes resulting from this comorbidity. Methods This cross-sectional study examined the extent to which paternal involvement in childrearing moderated the association between paternal ADHD symptoms and child conduct problems among 37 children with ADHD and their biological fathers. Results Neither paternal ADHD symptoms nor involvement was independently associated with child conduct problems. However, the interaction between paternal ADHD symptoms and involvement was significant, such that paternal ADHD symptoms were positively associated with child conduct problems only when fathers were highly involved in childrearing. Conclusions The presence of adult ADHD symptoms may determine whether father involvement in childrearing has a positive or detrimental influence on comorbid child conduct problems. [ABSTRACT FROM AUTHOR]

This prospective 2-year longitudinal study tested whether inattentive and hyperactive/impulsive symptom dimensions predicted future peer problems, when accounting for concurrent conduct problems and prosocial skills. A community sample of 492 children (49 % female) who ranged in age from 6 to 10 years ( M = 8.6, SD = .93) was recruited. Teacher reports of children's inattention, and hyperactivity/impulsivity symptoms, conduct problems, prosocial skills and peer problems were collected in two consecutive school years. Elevated inattention and hyperactivity/impulsivity in Year-1 predicted greater peer problems in Year-2. Conduct problems in the first and second years of the study were associated with more peer problems, and explained a portion of the relationship between inattention and hyperactivity/impulsivity with peer problems. However, prosocial skills were associated with fewer peer problems in children with elevated inattention and hyperactivity/impulsivity. Inattention and hyperactivity/impulsivity have negative effects on children's peer functioning after 1-year, but concurrent conduct problems and prosocial skills have important and opposing impacts on these associations. [ABSTRACT FROM AUTHOR]

The article focuses on a study which examines the impact of perceived peer tolerance and perceived peer use in mediating the risk of attention-deficit hyperactivity disorder (ADHD) and conduct problems (CP) on substance use for college students. Topics discussed include association of ADHD with alcohol, marijuana, and illicit drug use, analysis of ADHD symptoms in childhood and adulthood, and need to assess peer perceptions in avoidance and reduction of substance use more accurately.

Children with attention-deficit/hyperactivity disorder (ADHD) are impaired in social adaptation and display deficits in social competence. Deficient emotion recognition has been discussed to underlie these social problems. However, comorbid conduct problems have not been considered in the majority of studies conducted so far, and the influence of medication on emotion recognition has rarely been studied. Here, emotion recognition performance was assessed in children with ADHD without medication compared with children with ADHD under stimulant medication and a matched control group. In order to rule out confounding by externalizing symptoms, children with comorbid conduct problems were excluded. Video clips with neutral faces developing a basic emotion (happiness, sadness, disgust, fear and anger) were presented in order to assess emotion recognition. Results indicated between-group differences neither concerning the number of correctly identified emotions nor concerning reaction times and their standard deviations. Thus, we suggest that ADHD per se is not associated with deficits in emotion recognition. [ABSTRACT FROM AUTHOR]

Background: Research examining mental health in violence-affected youth in representative samples is rare. Using data from the nationally representative German Health Interview and Examination Survey for Children and Adolescents (KiGGS) this study reports on gender-specific prevalence rates and associations of a broad range of internalizing and externalizing mental health problems: emotional problems, conduct problems, ADHD, disordered eating, somatic pain and substance use in youth variously affected by violence. While internalizing is generally more common in girls and externalizing in boys, observations of prior non-normative studies suggest reverse associations once an individual is affected by violence. The occurrence of such "gender cross-over effects" is therefore examined in a representative sample. Methods: The sample consisted of 6,813 adolescents aged 11 to 17 from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS): Applying multivariate logistic regression analyses, associations between each type of violence history and mental health indicator were determined for perpetrators, victims, and perpetrating victims of youth violence. Moderating effects of gender were examined by using product term interaction. Results: Victim status was associated primarily with internalizing problems, while perpetrators were more prone to externalizing problems. Perpetrating victims stood out with respect to the number and strength of risk associations with all investigated mental health indicators. However, the risk profiles of all violence-affected youth included both internalizing and externalizing mental health problems. Gender cross-over effects were found for girls and boys: despite lower overall prevalence, girls affected by violence were at far higher risk for conduct problems and illicit drug use; by contrast, somatic pain, although generally lower in males, was positively associated with perpetrator status and perpetrating victim status in boys. All violence-affected youth exhibited significantly higher rates of cumulative mental health problems. Conclusions: The results highlight the importance of violence for the mental health of youth. They reveal a particular vulnerability as a function of gender. Implications for policy making, clinical practice and research are discussed. [ABSTRACT FROM AUTHOR]

The article focuses on a study related to the evaluation of relationship between attention-deficit hyperactivity disorder (ADHD) and over-the-counter (OTC) stimulants. As per the study, undergraduate students between 18 to 25 years of age were recruited for assessment. The study mentions that an online survey was performed to evaluate several symptoms including ADHD, conduct-problem (CP) and sensation seeking (SS). The study concludes that college students show increase risk of OTC stimulant.

The use of self-help interventions for parents of children with behaviour problems is becoming more prevalent. This review critically evaluated the evidence supporting the efficacy of such programmes for children with behaviour problems. Using a systematic literature search, two modes of delivery were evaluated, namely bibliotherapy and multimedia. Programmes that included minimal therapist support were also included. Overall, there is good evidence supporting the efficacy of self-help programmes in improving child behaviour, over the short and longer term. Self-help programmes led to outcomes similar to those achieved with more intensive therapist input. Including minimal levels of therapist support in addition to self-help materials enhances child and parent outcomes. Parents view self-help favourably but significantly less so than programmes including some form of therapist input. The future directions for self-help parent programmes include the need for longer-term follow-ups, the identification of moderators of outcome and economic evaluations of self-help programmes. [ABSTRACT FROM AUTHOR]

Objective: Symptoms of attention deficit hyperactivity disorder (ADHD) have been previously shown to be related with dopamine and noradrenaline dysfunction. Iron is the main cofactor of the tyrosine hydroxylase enzyme, the rate-limiting protein in dopamine synthesis. We aimed to investigate the association between iron/ferritin serum levels/subtypes and behavioral symptoms of ADHD. Methods: Fifty-eight children diagnosed with ADHD according to DSM-IV criteria in Samsun Ondokuz Mayis University Medical Faculty, Child Psychiatry outpatient clinic, were included in this study. Serum iron and ferritin levels in the participants were measured. The parents of the participants completed the Disruptive Behaviors Rating Scale-Parent Version (DBRS-PV). Results: There was no significant difference in serum iron and ferritin levels between the ADHD subtypes (p<0.05). We found a statistically significant negative correlation between the scores of DBRS-PV conduct problems and ferritin levels (r=-0.38, p<0.05). In further analysis, when participants age, gender, parental education level, ferritin and iron levels were taken into consideration, ferritin level was found the most powerful predictor of conduct score. Conclusion: This study revealed that serum ferritin level is significantly correlated with severity of conduct problems in children with ADHD. Especially in children with ADHD with low serum iron and ferritin levels, iron treatment would have beneficial effects on conduct problems comorbid with ADHD. [ABSTRACT FROM AUTHOR]

The current study examines the role of callous/unemotional (CU) traits in response to treatment among children with conduct problems (CP) and attention-deficit/hyperactivity disorder (ADHD). Fifty-four children with CP/ADHD and 16 controls (age = 9.48, SD = 1.58) took part in a summer treatment and research program. Simple correlations showed that CU and CP were associated with a number of treatment outcome measures. When examined together in regression analyses, CU and CP were uniquely associated with three treatment outcomes each (CU-improvement in social skills and problem solving, negative behaviors in time-out; CP-time-outs per day, peer ratings, peer dislike). The implications for these findings with regard to treatment response in children with CP/ADHD with and without CU traits are explored. [ABSTRACT FROM AUTHOR]

ention-deficit/hyperactivity disorder (ADHD) is a common child and adolescent disorder that is associated with negative outcomes (e.g., emotional and behavioral problems, substance use) and is often comorbid with Conduct Problems (CP). Research findings are mixed as to whether youth with ADHD alone or comorbid ADHD/CP suffer from low self-esteem. Research has also shown links between low self-esteem and ADHD (alone and with CP) with substance use; yet, no research has examined the links between self-esteem and substance use in adolescents with ADHD and CP. The current study examined the relation between ADHD with and without comorbid CP and self-esteem, and whether self-esteem moderated the relation between ADHD and ADHD/CP with substance use among adolescents. We hypothesized that adolescents with comorbid ADHD/CP would experience lower self-esteem than adolescents with ADHD alone or with neither disorder and that self-esteem would moderate the association between ADHD, CP, and substance use. Participants were 62 adolescents who completed the laboratory-based study with a parent. Results suggested that adolescents with comorbid ADHD and CP had significantly lower self-esteem than adolescents with ADHD alone or neither disorder. Self-esteem was not significantly different for adolescents with ADHD alone versus those in the control group. There was one marginally significant interaction between ADHD and self-esteem predicting substance use, such that individuals with comorbid ADHD/CP who also had low self-esteem tended to use more substances. Results have implications for treatments that target adolescents with ADHD and comorbid CP, as these adolescents are at risk for many deleterious outcomes. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Low-income, urban, ethnic minority children have higher rates of asthma, more severe symptoms, and more management issues, as well as high risk for academic and behavior problems. This study focused on asthma reported in young children who resided in a family emergency homeless shelter. Asthma rates were considered along with their relation to hospitalization and emergency department use and behavior that is important for school success, including cognitive function, conduct, and academic functioning. METHODS: A total of 104 children (age 4.0-7.5 years) and parents were recruited while residing in an urban emergency homeless shelter for families. Children had no previously identified developmental delays and spoke English proficiently. Parents reported whether the child experienced asthma, as well as emergency department use and hospitalization. Parents and teachers completed measures of child inattention/hyperactivity and behavior problems. Cognitive function of children was directly assessed. RESULTS: Asthma was reported for 27.9% of children, ∼3 times the national average. Children with asthma had been hospitalized more often, showed higher levels of inattention/hyperactivity and behavior problems, and evidenced lower academic functioning. CONCLUSIONS: Young children in homeless family emergency shelters have high rates of asthma and related problems that could lead to higher hospitalization rates, more behavioral problems, and lower academic functioning at school. Screening and treatment of children who stay in emergency family shelters may be particularly important for reducing risks associated with asthma in highly mobile, low-income families. [ABSTRACT FROM AUTHOR]