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Background: Behavioural interventions, including parent training, have been recommended for use with children and adolescents with attention- deficit/hyperactivity disorder (ADHD), however specific guidance for their implementation based on the best available evidence is currently lacking. Here a group of specialist clinicians and researchers provide practitioners and policy-makers with evidence-based, expert guidance on the use of behavioural interventions for ADHD. Methods: The review used a question and answer format organized around four themes: treatment benefits, therapeutic content and delivery, treatment indications and contraindications and relationship to other non-pharmacological treatments. Specific questions were designed to address key issues of clinical concern based on expert interpretation of the evidence with precedence given to meta-analyses of trials although when necessary other evidence was also considered. Results: Parent training reduces ADHD symptoms according to reports of parents engaged in the delivery of the intervention and who were not blind to treatment allocation. These reports have not to date been corroborated by blinded raters There is however evidence from probably blinded measures that these interventions benefit parenting practices and improve conduct problems (a common comorbidity and source of impairment) in the context of ADHD. Positive results have also been found in relation to parental knowledge, children’s emotional, social and academic functioning. Generic as well as specialised ADHD parent training approaches - delivered either individually or in groups - have value. High quality training and supervision of therapists and practice with the child may improve outcomes but further evidence is required. Evidence for who benefits the most from behavioural interventions is scant. There is no evidence that behavioural treatment should be limited to parents with parenting difficulties or children with conduct problems. Adjunctive treatment for parental depression may be valuable. Conclusion: Behavioural interventions have an important role to play in the comprehensive treatment of ADHD but their role in the management of core ADHD symptoms is much less clear and requires further study using trials with well-blinded outcomes. More research is required to understand how to optimise treatment effectiveness either in general or for individual patients and their barriers to treatment uptake and engagement. In terms of selecting which intervention formats to use it seems important to acknowledge and respond to parental treatment preferences.

Background Irritability and the new DSM-5 diagnostic category of Disruptive Mood Dysregulation Disorder (DMDD) have been conceptualised as related to mood disorder. Irritability is common in Attention Deficit Hyperactivity Disorder (ADHD) but little is known about its association with depression risk in this group. This study aims to establish levels of irritability and prevalence of DMDD in a clinical sample of children with ADHD, and examine their association with anxiety, depression and family history of depression. Methods The sample consisted of 696 children (mean age 10.9 years) with a diagnosis of ADHD, recruited from UK child psychiatry and paediatric clinics. Parents completed the Child and Adolescent Psychiatric Assessment, a semi-structured diagnostic interview, about their child. This was used to establish prevalence of DMDD, anxiety disorder and depressive disorder, as well as obtain symptom scores for irritability, anxiety and depression. Questionnaires assessed current parental depression, and family history of depression. Result Irritability was common, with 91% endorsing at least one irritable symptom. 3-month DMDD prevalence was 31%. Children with higher levels of irritability or DMDD were more likely to have comorbid symptoms of anxiety, depression and a family history of depression. Limitations Results are based on a clinical sample, so may not be generalizable to children with ADHD in the general population. Conclusions Irritability and DMDD were common, and were associated with markers of depression liability. Longitudinal studies are needed to examine the association between irritability and depression in youth with ADHD as they get older.

Objective: The purpose of this study was to examine whether persisting hyperactivity into adulthood was associated with impaired family, friendship, and partner relationships or poor coping skills in everyday life. Method: A 20-year community-based follow-up of 6- to 7-year-old boys showing pervasive hyperactivity (n = 40) and unaffected controls (n = 25) was conducted. At age 27 years, participants were assessed with detailed interview techniques as well as self-report ratings. Results: ADHD in adulthood was associated with problems in intimate relationships and negotiation skills. Antisocial behavior did not influence the association, but remitting childhood hyperactivity was not associated with social relationship difficulties in adulthood. Conclusion: In an untreated, community-based sample of hyperactive children, the risk for unsatisfactory social relationships is largely confined to those patients who still show ADHD in adulthood. The majority of patients who experience childhood hyperactivity have positive social relationships in adulthood.

Maternal depression in the peri-natal period is associated with increased risk for young adult depression in offspring. This study explored mediation of these links via trajectories of child conduct and emotional problems (Strengths and Difficulties Questionnaire) from ages 4-16 years old in data from the Avon Longitudinal Study of Parents and Children cohort (n = 13373). Through gender-specific structural equation models, a composite measure of exposure to early maternal depression (Edinburgh Postnatal Depression Scale), predicted young adult depression at age 18 (Revised Clinical Interview Schedule - distal outcome). Mediational effects were then estimated by testing which parts of joint piecewise latent trajectory models for child/adolescent conduct and emotional problems were associated with both exposure and distal outcome. For girls, only conduct problems in early childhood were consistently indicated to mediate effects of early maternal depression on risk of young adulthood depression. Some evidence for a pathway via changing levels of childhood and adolescent emotional difficulties was also suggested. For boys, by contrast, the differing models gave less consistent findings providing some evidence for a small time-specific indirect effect via early childhood conduct problems. In addition to its practice implications the current methodological application offers considerable potential in exploratory longitudinal developmental mediation studies. © 2016 The Authors International Journal of Methods in Psychiatric Research Published by John Wiley & Sons Ltd.

Up to 40% of youth with ASD also suffer from anxiety and this comorbidity is linked with significant functional impairment. However, the mechanisms of this overlap are poorly understood. We investigated the interplay between ASD traits and anxiety during reward processing, known to be affected in ASD, in a community sample of 1472 adolescents (mean age=14.4 years) who performed a modified monetary incentive delay task as part of the Imagen project. Blood-oxygen-level dependent (BOLD) responses to reward anticipation and feedback were compared using a 2x2 ANOVA (ASD traits: low/high, anxiety symptoms: low/high), controlling for plausible covariates. Additionally, we used a longitudinal design to assess whether neural responses during reward processing predicted anxiety at two-year follow-up. High ASD traits were associated with reduced BOLD responses in dorsal prefrontal regions during reward anticipation and negative feedback. Participants with high anxiety symptoms showed increased lateral prefrontal responses during anticipation, but decreased responses following feedback. Interaction effects revealed that youth with combined ASD traits and anxiety, relative to other youth, showed high right insula activation when anticipating reward, and low right-sided caudate, putamen, medial and lateral prefrontal activations during negative feedback (all clusters pFWE

Ineffective decision-making is a major source of everyday functional impairment and reduced quality of life for young people with mental disorders. However, very little is known about what distinguishes decision-making by individuals with different disorders or the neuropsychological processes or brain systems underlying these. This is the focus of the current review. We first propose a neuro-economic model of the decision-making process with separate stages for: the pre-choice evaluation of expected utility of future options, choice execution and post-choice management, the appraisal of outcome against expectation and the updating of value estimates to guide future decisions. According to the proposed model, decision-making is mediated by neuropsychological processes operating within three domains: (i) self-referential processes involved in autobiographical reflection on past, and prospection about future, experiences; (ii) executive functions, such as working memory, inhibition and planning that regulate the implementation of decisions; and (iii) processes involved in value estimation and outcome appraisal and learning. These processes are underpinned by the interplay of multiple brain networks, especially medial and lateralised cortical components of the default mode network, dorsal cortico-striatal circuits controlling higher-order cognitive and behavioural control, and ventral fronto-striatal circuits, connecting to brain regions implicated in emotion processing, that control valuation and learning processes. Based on clinical insights and considering each of the decision- making stages in turn, we outline disorder-specific hypotheses about impaired decision-making in four childhood disorders: attention-deficit/hyperactivity disorder (ADHD), conduct disorder (CD), depression, and anxiety. We hypothesize that decision-making in ADHD is deficient (i.e., inefficient, insufficiently reflective, and inconsistent) and impulsive (biased towards immediate over delayed alternatives). In CD, it is reckless and insensitive to negative consequences. In depression, it is disengaged, perseverative and pessimistic, while in anxiety it is hesitant, risk-averse and self-deprecating. A survey of current empirical indications related to these disorder-specific hypotheses highlights the limited and fragmentary nature of the evidence base and illustrates the need for a major research initiative in decision-making in childhood disorders. The final section highlights a number of important additional general themes that need to be considered in future research.

This study examines the extent to which children's positive attributes are distinct from psychopathology. We also investigate whether positive attributes change or "buffer" the impact of low intelligence and high psychopathology on negative educational outcomes.METHOD:In a community sample of 2,240 children (6-14 years of age), we investigated associations among positive attributes, psychopathology, intelligence, and negative educational outcomes. Negative educational outcomes were operationalized as learning problems and poor academic performance. We tested the discriminant validity of psychopathology versus positive attributes using confirmatory factor analysis (CFA) and propensity score matching analysis (PSM), and used generalized estimating equations (GEE) models to test main effects and interactions among predictors of educational outcomes.RESULTS:According to both CFA and PSM, positive attributes and psychiatric symptoms were distinct constructs. Positive attributes were associated with lower levels of negative educational outcomes, independent of intelligence and psychopathology. Positive attributes buffer the negative effects of lower intelligence on learning problems, and higher psychopathology on poor academic performance.CONCLUSION:Children's positive attributes are associated with lower levels of negative school outcomes. Positive attributes act both independently and by modifying the negative effects of low intelligence and high psychiatric symptoms on educational outcomes. Subsequent research should test interventions designed to foster the development of positive attributes in children at high risk for educational problems.