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Objective To describe adult outcome of people with attention-deficit/hyperactivity disorder (ADHD) diagnosed in childhood and its several key predictors via a review of 7 North American controlled prospective follow-up studies: Montreal, New York, Milwaukee, Pittsburgh, Massachusetts General Hospital (MGH), Berkeley, and 7-site Multimodal Treatment Study of Children With ADHD (MTA). Method All studies were prospective and followed children with a diagnosis of ADHD and an age- and gender-matched control group at regular intervals from childhood (6–12 years of age) through adolescence into adulthood (20–40 years of age), evaluating symptom and syndrome persistence, functional outcomes, and predictors of these outcomes. Results The rates of ADHD syndrome persistence ranged from 5.7% to 77%, likely owing to varying diagnostic criteria and the source of information (self-report vs informant report) across the studies. However, all studies observed high rates of symptomatic persistence ranging from 60% to 86%. The 7 studies were largely consistent in finding that relative to control groups, research participants with childhood-diagnosed ADHD had significant impairments in the areas of educational functioning, occupational functioning, mental health, and physical health as well as higher rates of substance misuse, antisocial behavior, and unsafe driving. The most consistently observed predictors of functional outcomes included ADHD persistence and comorbidity, especially with disruptive behavior disorders. Conclusion Childhood ADHD has high rates of symptomatic persistence, which is associated with negative functional outcomes. Characteristics that predict these negative outcomes, such as comorbid disruptive behavior disorders, may be important targets for intervention.

OBJECTIVE: It is estimated that childhood ADHD remits by adulthood in approximately 50% of cases; however, this conclusion is typically based on single endpoints, failing to consider longitudinal patterns of ADHD expression. We investigated the extent to which children with ADHD experience recovery and variable patterns of remission by adulthood. METHOD: Children with ADHD (N=558) in the Multimodal Treatment Study of ADHD (MTA) were administered eight assessments from 2-year (M age=10.44) to 16-year follow-up (M age=25.12). We identified participants with fully remitted, partially remitted, and persistent ADHD at each timepoint based on parent, teacher, and self-reports of ADHD symptoms and impairment, treatment utilization, and substance use and mental disorders. Longitudinal patterns of remission and persistence were identified that considered context and timing. RESULTS: Approximately 30% of children with ADHD experienced full remission at some point during the 14-year follow-up period; however, a majority (60% of these) experienced recurrence of ADHD after the initial period of remission. Only 9.1% of the sample demonstrated recovery (sustained remission) by study endpoint and only 10.8% demonstrated stable ADHD persistence across study timepoints. Instead, most participants with ADHD (63.8%) had fluctuating periods of remission and recurrence over time. CONCLUSIONS: The MTA findings challenge the notion that approximately 50% of children with ADHD outgrow the disorder by adulthood. Most cases demonstrated fluctuating symptoms between childhood and young adulthood. Although intermittent periods of remission can be expected in most cases, 90% of children with ADHD continued to struggle with residual ADHD through young adulthood. Clinical Trial Number: NCT00000388, Multimodal Treatment Study of Children with Attention Deficit and Hyperactivity Disorder (MTA). https://clinicaltrials.gov/ct2/show/NCT00000388

Objective: We examine the outcomes associated with childhood adversity for women with and without carefully diagnosed childhood ADHD, via an ethnically diverse sample of 140 participants with ADHD (Mage = 9.7) and 88 age- and ethnicity-matched comparisons (Mage = 9.4). At adult follow-up, we retained 211 of the original 228 participants (92.6%; Mage = 25.6). Method: We used latent class analysis to identify patterns of childhood adversity and examine their association with adult global functioning and psychopathology. Results: Key findings: (1) Four childhood adversity classes emerged (Low Exposure, Familial Dysfunction, Emotional Maltreatment, Pervasive Exposure); (2) Childhood ADHD predicted membership in the Emotional Maltreatment class; and (3) Childhood adversity classes were differently associated with adult outcomes, such that women in both the Emotional Maltreatment and Pervasive Exposure groups experienced significantly higher internalizing and externalizing symptoms and reported significantly lower global functioning than those in the Low Exposure group. Furthermore, compared to those in the Emotional Maltreatment group, women with the Familial Dysfunction group had lower externalizing symptoms, whereas women in the Pervasive Exposure class had lower global functioning and higher internalizing symptoms. Conclusions: Findings provide information about women who could be targeted for intervention in terms of ADHD symptoms plus types of adverse experiences in childhood. Beyond limitations, we discuss the need to investigate the confluence of neurodevelopmental conditions and adverse child events with respect to maladaptive outcomes.

We examine the outcomes associated with childhood adversity for women with and without carefully diagnosed childhood ADHD, via an ethnically diverse sample of 140 participants with ADHD (M

Attention-deficit/hyperactivity disorder (ADHD) is associated with self-harm during adolescence and young adulthood, especially among females. Yet little is known about the developmental trajectories or childhood predictors/moderators of self-harm in women with and without childhood histories of ADHD. We characterized lifetime risk for nonsuicidal self-injury (NSSI), suicidal ideation (SI), and suicide attempts (SA), comparing female participants with (n= 140) and without (n= 88) childhood ADHD. We examined theory-informed childhood predictors and moderators of lifetime risk via baseline measures from childhood. First, regarding developmental patterns, most females with positive histories of lifetime self-harm engaged in such behaviors in adolescence yet desisted by adulthood. Females with positive histories of self-harm by late adolescence emanated largely from the ADHD-C group. Second, we found that predictors of NSSI were early externalizing symptoms, overall executive functioning, and father's negative parenting; predictors of SI were adverse childhood experiences and low self-esteem; and predictors of SA were early externalizing symptoms, adverse childhood experiences, and low self-esteem. Third, receiver operating characteristics analyses helped to ascertain interactive sets of predictors. Findings indicate that pathways to self-harm are multifaceted for females with ADHD. Understanding early childhood predictors and moderators of self-harm can inform both risk assessment and intervention strategies.

Behavioral Parent Training (BPT) is a well-established treatment for school-age children with ADHD but lack of parent adherence to prescribed parenting strategies limits treatment gains. Digital Health (dHealth) tools can be leveraged to target barriers to parent adherence but existing tools for parenting interventions are limited. New efforts to develop a dHealth tool to target adherence barriers including limited skill competence, EF processes, and low motivation/negative attitudes, are presented and recommendations for future technology-enhanced treatments are provided.

We examine the impacts of childhood adversity on adult outcomes for women with and without childhood ADHD using an ethnically diverse sample of 140 participants with ADHD (Mage = 9.7) and 88 age- and ethnicity-matched comparison participants (Mage = 9.4). At adult follow- up, the sample included 211 of the original 228 participants (92.6% retention; Mage = 25.6). We used inclusive latent class analysis to identify profiles of childhood adversity; class membership was subsequently used in regression models to predict adult outcomes and ADHD persistence status. Key findings were as follows: (1) Four childhood adversity profiles emerged (Low Exposure, Familial Dysfunction, Maltreatment, Pervasive Exposure); (2) Compared with women with Low Exposure profile, those with Familial Dysfunction had significantly higher internalizing outcomes, whereas those in the Maltreatment and the Pervasive Exposure profiles were associated with lower global functioning and higher internalizing and externalizing behaviors; (3) Women with childhood ADHD in the Maltreatment profile were significantly more likely than those in the other profiles to show persistent ADHD in adulthood. Findings provide useful information about women who could be targeted for intervention; we discuss limitations and the need to investigate the confluence of neurodevelopmental conditions, like ADHD, and exposure to adverse child events.

Objective: Recent studies suggest attention-deficit/hyperactivity disorder (ADHD) may emerge post-childhood. We integrate qualitative methods to systematically characterize contextual factors that may (a) delay identification of ADHD in childhood and (b) inform why ADHD symptoms emerge post-childhood. Method: Suspected late-onset ADHD cases from the local normative comparison group of the Multimodal Treatment Study of ADHD completed a qualitative interview (14 young adults and 7 caregivers). Interviews were qualitatively analyzed. Results: We identified five themes. Three themes may attenuate or delay identification of childhood ADHD: external factors (e.g., supportive adults), internal factors (e.g., strong intellectual functioning), and other factors (e.g., dismissive attitudes toward ADHD). Two themes may accompany an increase in ADHD symptoms post-childhood: external factors (e.g., increased external demands) and internal factors (e.g., perceived stress). Conclusion: Clinicians should probe these factors in suspected late-onset cases to address (a) whether, how, and to what extent ADHD was attenuated in childhood and (b) why symptoms emerge post-childhood.

We aimed to identify adolescent mediators of the significant and sizable link between childhood attention deficit/hyperactivity disorder (ADHD) and later unplanned pregnancy in our prospectively followed, all-female sample. Participants included an ethnically diverse (47% non-White) sample of women with (n =140) and without (n =88) childhood ADHD who were assessed 4 times across childhood, adolescence, and adulthood. Potential mediators were measured via self, parent, and teacher report on questionnaires and interviews and by objective testing. We tested 5 early adolescent variables in three domains (personality, behavioral, and academic) as components of serial mediation pathways from (a) childhood ADHD status to (b) the early adolescent putative mediator to (c) risky sexual behavior in late adolescence and finally to (d) unplanned pregnancy by early adulthood. Of these, academic achievement (indirect effect=.1339, SE =.0721), 95% confidence interval (CI) [.0350, .3225] and substance use frequency (indirect effect=.0211, SE =.0167), 95% CI [.0013, .0711] operated through late-adolescent risky sexual behavior to explain rates of unplanned pregnancy, even adjusting for the effects of age, IQ, and family socioeconomic status (SES). When these 2 indirect effects were entered simultaneously, only the pathway from childhood ADHD to low academic achievement to higher rates of risky sexual behavior to unplanned pregnancy was significant (indirect effect=.0295, SE =.0145), 95% CI [.0056, .0620]. We discuss the significance of these early adolescent mediators, particularly academic engagement, as potential intervention targets intended to reduce rates of later unplanned pregnancies among female individuals with ADHD.

Some mothers of children with attention-deficit/hyperactivity disorder (ADHD) present with maladaptive personality profiles (high neuroticism, low conscientiousness). The moderating effect of maternal personality traits on treatment outcomes for childhood ADHD has not been examined. We evaluate whether maternal neuroticism and conscientiousness moderated response in the Multimodal Treatment Study of Children with ADHD. This is one of the first studies of this type. In a randomized controlled trial (RCT), 579 children aged 7–10 (M = 8.5); 19.7% female; 60.8% White with combined-type ADHD were randomly assigned to systematic medication management (MedMgt) alone, comprehensive multicomponent behavioral treatment (Beh), their combination (Comb), or community comparison treatment-as-usual (CC). Latent class analysis and linear mixed effects models included 437 children whose biological mothers completed the NEO Five-Factor Inventory at baseline. A 3-class solution demonstrated best fit for the NEO: MN&MC = moderate neuroticism and conscientiousness (n = 284); HN&LC = high neuroticism, low conscientiousness (n = 83); LN&HC = low neuroticism, high conscientiousness (n = 70). Per parent-reported symptoms, children of mothers with HN&LC, but not LN&HC, had a significantly better response to Beh than to CC; children of mothers with MN&MC and LN&HC, but not HN&LC, responded better to Comb&MedMgt than to Beh&CC. Per teacher-reported symptoms, children of mothers with HN&LC, but not LN&HC, responded significantly better to Comb than to MedMgt. Children of mothers with high neuroticism and low conscientiousness benefited more from behavioral treatments (Beh vs. CC; Comb vs. MedMgt) than other children. Evaluation of maternal personality may aid in treatment selection for children with ADHD, though additional research on this topic is needed.

Neuropsychological functioning underlies behavioral symptoms of attention-deficit/hyperactivity disorder (ADHD). Children with all forms of ADHD are vulnerable to working memory deficits and children presenting with the inattentive form of ADHD (ADHD-I) appear particularly vulnerable to processing speed deficits. As ADHD-I is the most common form of ADHD presented by children in community settings, it is important to consider how treatment interventions for children with ADHD-I may be affected by deficits in processing speed and working memory. We utilize data collected from 199 children with ADHD-I, aged 7 to 11 years, who participated in a randomized clinical trial of a psychosocial-behavioral intervention. Our aims are first to determine whether processing speed or working memory predict treatment outcomes in ADHD-I symptom severity, and second whether they moderate treatment effects on ADHD-I symptom severity. Results of linear regression analyses reveal that baseline processing speed significantly predicts posttreatment ADHD-I symptom severity when controlling for baseline ADHD-I symptom severity, such that better processing speed is associated with greater symptom improvement. However, predictive effects of working memory and moderation effects of both working memory and processing speed are not supported in the present study. We discuss study limitations and implications of the relation between processing speed and treatment benefits from psychosocial treatments for children with ADHD-I.

Objective Individuals with late-onset symptoms of attention-deficit/hyperactivity disorder (ADHD) are presenting to providers at increasing rates. Recent birth-cohort studies reveal evidence for late-onset ADHD, but conclusions are challenged by measurement methods as well as presence of participant impairment and psychiatric comorbidities. We examined the occurrence of late-onset ADHD in a small but thoroughly investigated group of diverse (47% white) women followed from childhood to adulthood. Method From a larger, 16-year longitudinal study, a subsample of young women without childhood ADHD (N = 87) was assessed at four time points between childhood and adulthood via a multimethod, multiinformant approach. We used a stepped diagnostic procedure to identify those who initially met symptom criteria for ADHD after childhood and then evaluated them for remaining DSM ADHD diagnostic criteria, including impairment, cross-situational symptoms, and comorbid diagnoses. Results Of 87 participants, 17 met ADHD symptom criteria after childhood. Fifteen showed no evidence of childhood onset, 10 showed clear evidence of impairment, and nine had cross-situational symptoms. Of these nine, all but one showed clinically significant co-occurring or preexisting psychiatric diagnoses and/or substance use that might account for ADHD symptoms. Conclusions Although 19.5% of women from our subsample without childhood ADHD met symptom criteria for ADHD during adolescence/adulthood, only one showed the needed combination of impairment and cross-situational symptoms without significant co-occurring mental health problems. It is possible that uncomplicated cases of adult ADHD do arise, yet we find little supporting evidence herein. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Using a sample of 228 females with and without childhood attention-deficit/hyperactivity disorder followed prospectively across 16 years, we measured childhood neurocognitive vulnerability via executive dysfunction using teacher-reported cognitive and learning problems. We then ascertained relations between dimensionally measured internalizing and externalizing psychopathology during adulthood and showed that childhood neurocognitive vulnerability reliably predicted such associated psychopathology. We identified six serial mediation pathways from childhood neurocognitive vulnerability to adult psychopathology through three early- and late-adolescent domains: individual (self-control and delay of gratification), peer (rejection/conflict and acceptance/friendship), and school (academic performance and school failure). The serial indirect effects occurred for the pathways from childhood neurocognitive vulnerability through early-adolescent academic performance, to late-adolescent school failure, to adult associated psychopathology, and from neurocognitive vulnerability through adolescent self-control and then the ability to delay gratification, to adult psychopathology. Furthermore, these indirect effects, plus two others, were moderated by parental distress during childhood and early adolescence, such that under conditions of high distress, the serial indirect effects were weaker than when parental distress was low. We discuss the potential importance of behavioral self-regulation and educational success for later psychological functioning, especially among girls, as well as implications for ontogenic process models of psychopathology.

Objective To examine whether girls with attention deficit/hyperactivity disorder (ADHD) demonstrate positive illusory self-perceptions during adolescence and young adulthood. Methods We tested, across a 5-year longitudinal span, whether self-perceptions versus external-source ratings were more strongly predictive of young adulthood impairment and depressive symptoms. Participants included an ethnically diverse sample of 140 girls with ADHD and 88 comparison girls, aged 11–18 years (M = 14.2) at adolescent and 19–24 years (M = 19.6) at young adult assessment. Results Although girls with ADHD rated themselves more positively than indicated by external ratings, their self-reports still did not differ significantly from external ratings in both scholastic competence and social adjustment domains. Comparison girls, on the other hand, rated themselves significantly less positively than indicated by external ratings in social adjustment. Positive discrepancy scores in adolescence did not significantly predict depressive symptoms in young adulthood and vice versa. Crucially, measures of actual competence in adolescence were more strongly associated with young adulthood impairments than were inaccurate self-perceptions for girls with ADHD. Conclusions Our findings continue to challenge the existence of a positive illusory bias among girls with ADHD, including any association of such bias with key indicators of impairment.

This chapter describes the long-term outcomes in the Multimodal Treatment study of ADHD (MTA), which began in 1994 and ended in 2014. First, we provide a short history of the origin of the MTA. Second, we review the design as a 14-month randomized clinical trial and the transition to a long-term follow-up. Third, we present findings from 12 key publications describing outcomes in four stages of the MTA from childhood to adulthood. Fourth, we discuss how the final adult assessments of the MTA address critical issues about symptomatic persistence of ADHD, functional outcomes outside the parental home, and cost-benefit analyses of residual effects of treatment with medication.

The goal of the study was to examine baseline characteristics-child gender, IQ, age, internalizing problems, symptoms of hyperactivity/impulsivity (HI), oppositional defiant disorder, and sluggish cognitive tempo, and parent income, education, attention deficit/hyperactivity disorder (ADHD) severity, and anxiety/depression (A/D)-associated with response to behavioral treatments for ADHD, predominantly inattentive type. We employed data from 148 children (M=8.7years), 58% male, and 57% Caucasian in a randomized clinical trial. Positive treatment response was defined as (a) 5 or fewer inattentive symptoms and (b) a decrease of at least 3 inattentive symptoms from baseline to posttreatment. Child HI, parental A/D, and child IQ were associated with positive response, as follows: Child HI had a main effect in which it was negatively associated with treatment response (36% with 2 or more HI symptoms were positive responders vs. 59% of those with 1 or no symptoms) that was qualified by parental A/D and child IQ. When children had 2 or more symptoms of HI and higher parental A/D, positive response rate was low at 25%; when children had 2 or more symptoms of HI, low parental A/D, and an IQ of 105 or higher, positive response rate was 85%. Furthermore, the group with the poorest response rate (25%) had parents who self-reported greater ADHD severity, and the group with a relatively good rate of positive response (59%) had the lowest number of oppositional defiant disorder symptoms. Likelihood of positive response to our behavioral treatment for ADHD-I is dependent on child and parent factors.

We examined the longitudinal associations between prenatal tobacco smoke exposure (PSE) and attention-deficit hyperactivity disorder (ADHD) symptom domains in adolescence and young adulthood. A sample of girls with ADHD combined presentation (N=93), ADHD predominantly inattentive presentation (N=47), and matched comparisons (N= 88) was assessed prospectively. Symptoms of hyperactivity/impulsivity (HI), inattention (IA), and oppositionality (oppositional defiant disorder) were measured via multiple informants 5 (M age =14 years; retention rate =92%) and 10 years (M age =20 years; retention rate =95%) following childhood ascertainment. PSE was captured via maternal self-report. We used linear regressions to examine the prediction from PSE to both HI and IA in adolescence and early adulthood after stringent control of relevant confounding variables. PSE significantly predicted HI during adolescence and young adulthood across multiple informants but did not predict IA at either wave. Symptoms of HI may have partial etiological independence from IA symptoms.

Objective:To evaluate participants’ perceptions about frequent use and reasons for substance use (SU) in the qualitative interview study, an add-on to the multimodal treatment study of ADHD (MTA). Method: Using the longitudinal MTA database, 39 ADHD cases and 19 peers with Persistent SU, and 86 ADHD cases and 39 peers without Persistent SU were identified and recruited. In adulthood, an open-ended interview was administered, and SU excerpts were indexed and classified to create subtopics (frequent use and reasons for use of alcohol, marijuana, and other drugs). Results: For marijuana, the Persistent compared with Nonpersistent SU group had a significantly higher percentage of participants describing frequent use and giving reasons for use, and the ADHD group compared with the group of peers had a significantly higher percentage giving “stability” as a reason for use. Conclusion: Motivations for persistent marijuana use may differ for adults with and without a history of ADHD.

We performed a 10-year prospective follow-up of a childhood-ascertained (6-12 years), ethnically and socioeconomically diverse sample of girls with attention-deficit/hyperactivity disorder (ADHD; N = 140: combined type [ADHD-C] n = 93; inattentive type [ADHD-I] n = 47) plus a matched comparison group (N = 88). Girls were recruited from schools, mental health centers, pediatric practices, and via advertisements; extensive evaluations confirmed ADHD versus comparison status.Ten-year outcomes (age range 17-24 years; retention rate = 95%) included symptoms (ADHD, externalizing, internalizing), substance use, eating pathology, self-perceptions, functional impairment (global, academic, service utilization), self-harm (suicide attempts, self-injury), and driving behavior.Participants with childhood-diagnosed ADHD continued to display higher rates of ADHD and comorbid symptoms, showed more serious impairment (both global and specific), and had higher rates of suicide attempts and self-injury than the comparison sample, with effect sizes from medium to very large; yet the groups did not differ significantly in terms of eating pathology, substance use, or driving behavior. ADHD-C and ADHD-I types rarely differed significantly, except for suicide attempts and self-injury, which were highly concentrated in ADHD-C. Domains of externalizing behavior, global impairment, service utilization, and self-harm (self-injury and suicide attempts) survived stringent control of crucial childhood covariates (age, demographics, comorbidities, IQ).Girls with childhood ADHD maintain marked impairment by early adulthood, spreading from symptoms to risk for serious self-harm. Our future research addresses the viability of different diagnostic conceptions of adult ADHD and their linkages with core life impairments.

We describe the initiation and evolution of the Berkeley Girls with ADHD Longitudinal Study, an ongoing prospective, longitudinal study of 140 girls diagnosed with ADHD when they were children during the late 1990s, as well as 88 matched comparison girls. Study rationale, design, procedures, recruitment strategy, and measures are described in detail. Primary psychosocial and neuropsychological findings during childhood, adolescence, and adulthood are summarized. Our initial findings regarding predictors of outcome are presented. Results are discussed in light of the existing literature regarding long-term outcome among children with ADHD. Overall, during childhood, adolescence, and young adulthood, in almost every psychosocial and neuropsychological domain we investigated, females with ADHD show sizable disadvantages and deficits relative to females without ADHD. Our findings affirm the public health significance of ADHD in girls, given the likelihood of persisting symptoms and (especially) impairment in crucial domains over the long-term.

We examined the longitudinal associations between prenatal tobacco smoke exposure (PSE) and attention-deficit hyperactivity disorder (ADHD) symptom domains in adolescence and young adulthood. A sample of girls with ADHD combined presentation (N=93), ADHD predominantly inattentive presentation (N=47), and matched comparisons (N= 88) was assessed prospectively. Symptoms of hyperactivity/impulsivity (HI), inattention (IA), and oppositionality (oppositional defiant disorder) were measured via multiple informants 5 (M age =14 years; retention rate =92%) and 10 years (M age =20 years; retention rate =95%) following childhood ascertainment. PSE was captured via maternal self-report. We used linear regressions to examine the prediction from PSE to both HI and IA in adolescence and early adulthood after stringent control of relevant confounding variables. PSE significantly predicted HI during adolescence and young adulthood across multiple informants but did not predict IA at either wave. Symptoms of HI may have partial etiological independence from IA symptoms.

Objective Longitudinal studies of children diagnosed with ADHD report widely ranging ADHD persistence rates in adulthood (5–75%). This study documents how information source (parent vs. self-report), method (rating scale vs. interview), and symptom threshold (DSM vs. norm-based) influence reported ADHD persistence rates in adulthood. Method Five hundred seventy-nine children were diagnosed with DSM-IV ADHD-Combined Type at baseline (ages 7.0–9.9 years) 289 classmates served as a local normative comparison group (LNCG), 476 and 241 of whom respectively were evaluated in adulthood (Mean Age = 24.7). Parent and self-reports of symptoms and impairment on rating scales and structured interviews were used to investigate ADHD persistence in adulthood. Results Persistence rates were higher when using parent rather than self-reports, structured interviews rather than rating scales (for self-report but not parent report), and a norm-based (NB) threshold of 4 symptoms rather than DSM criteria. Receiver-Operating Characteristics (ROC) analyses revealed that sensitivity and specificity were optimized by combining parent and self-reports on a rating scale and applying a NB threshold. Conclusion The interview format optimizes young adult self-reporting when parent reports are not available. However, the combination of parent and self-reports from rating scales, using an ‘or’ rule and a NB threshold optimized the balance between sensitivity and specificity. With this definition, 60% of the ADHD group demonstrated symptom persistence and 41% met both symptom and impairment criteria in adulthood.

Objective To compare educational, occupational, legal, emotional, substance use disorder, and sexual behavior outcomes in young adults with persistent and desistent attention-deficit/hyperactivity disorder (ADHD) symptoms and a local normative comparison group (LNCG) in the Multimodal Treatment Study of Children with ADHD (MTA). Method Data were collected 12, 14, and 16 years postbaseline (mean age 24.7 years at 16 years postbaseline) from 476 participants with ADHD diagnosed at age 7 to 9 years, and 241 age- and sex-matched classmates. Probands were subgrouped on persistence versus desistence of DSM-5 symptom count. Orthogonal comparisons contrasted ADHD versus LNCG and symptom-persistent (50%) versus symptom-desistent (50%) subgroups. Functional outcomes were measured with standardized and demographic instruments. Results Three patterns of functional outcomes emerged. Post−secondary education, times fired/quit a job, current income, receiving public assistance, and risky sexual behavior showed the most common pattern: the LNCG group fared best, symptom-persistent ADHD group worst, and symptom-desistent ADHD group between, with the largest effect sizes between LNCG and symptom-persistent ADHD. In the second pattern, seen with emotional outcomes (emotional lability, neuroticism, anxiety disorder, mood disorder) and substance use outcomes, the LNCG and symptom-desistent ADHD group did not differ, but both fared better than the symptom-persistent ADHD group. In the third pattern, noted with jail time (rare), alcohol use disorder (common), and number of jobs held, group differences were not significant. The ADHD group had 10 deaths compared to one death in the LNCG. Conclusion Adult functioning after childhood ADHD varies by domain and is generally worse when ADHD symptoms persist. It is important to identify factors and interventions that promote better functional outcomes.

We tested whether conduct problems predicted young adult functioning and psychiatric symptoms among women diagnosed with attention-deficit/hyperactivity disorder (ADHD) during childhood, in the context of 3 potential adolescent mediators: internalizing problems, peer rejection, and school failure and disciplinary problems. We controlled for childhood ADHD severity, IQ, and demographic factors, and in the mediational tests, for adolescent conduct problems. Data came from 140 participants in the Berkeley Girls With ADHD Longitudinal Study. We used bootstrapping methods to assess indirect effects (mediators). Both childhood, F(1, 118) change = 9.00, p = .003, R2 change = .069, and adolescent, F(1, 109) change = 10.41, p = .002, R2 change = .083, conduct problems were associated with worse overall functioning during young adulthood, controlling for initial ADHD severity, child IQ, and demographics. Results were similar when predicting psychiatric symptoms. Adolescent school failure and disciplinary problems mediated the relations between childhood conduct problems and both young adult functioning and externalizing problems; adolescent internalizing problems and peer conflict mediated the relation between childhood conduct problems and young adult internalizing problems. As is true for boys, childhood and adolescent conduct problems are associated with poor adult outcomes among girls with ADHD, with school failure and disciplinary problems, internalizing problems, and peer conflict functioning as mediators of these relations.

Attention-deficit/hyperactivity disorder (ADHD) is associated with interpersonal dysfunction during childhood and adolescence, yet little is known about the romantic relationships of young women with childhood ADHD. In the present study, we draw from a longitudinal sample of girls followed prospectively into young adulthood, comparing those with (n = 114) and without (n = 79; comparisons) childhood ADHD in terms of their risk for physical victimization by an intimate partner (physical IPV; e.g., slapping, punching) by 17–24 years of age. We examined ADHD both diagnostically and dimensionally, at the same time establishing reliable indicators of young adult physical IPV. Externalizing and internalizing problems, and academic achievement during adolescence, were tested as potential mediators. Overall, participants with a childhood diagnosis of ADHD experienced more physical IPV than did comparisons (30.7 % vs. 6.3 %). In parallel, IPV was associated with higher levels of childhood ADHD symptomatology (d = 0.73). Young women with persistent ADHD stood the highest risk of experiencing IPV (37.3 %), followed by those with transient ADHD (19.0 %) and those never-diagnosed (5.9 %). Academic achievement measured during adolescence was a significant partial mediator of the childhood ADHD symptomatology-young adult IPV relationship, even with control of sociodemographic, psychiatric, and cognitive factors, including childhood reading and math disorders. Findings indicate that in young women, childhood ADHD is a specific and important predictor of physically violent victimization in their intimate relationships. This vulnerable population requires IPV prevention and intervention, with academic empowerment as a key target.

It has been claimed that excessively positive self-perceptions of competence are a key risk factor for concurrent and subsequent impairments in youth with attention-deficit/ hyperactivity disorder (ADHD). We examined whether girls with ADHD demonstrate positive illusory self-perceptions in scholastic competence, social acceptance, and behavioral conduct domains. We then tested, across a five-year longitudinal span, whether (a) such self-perceptions versus (b) the constituent informant ratings or test scores were more strongly predictive of adolescent impairment and positive adjustment. Participants included an ethnically diverse sample of 140 girls with ADHD and 88 comparison girls, aged 6-12 at baseline (M = 9.0, SD = 1.7). Girls with ADHD rated themselves as more positive than indicated by external ratings, but these self-reports were still in a negative direction (comparison girls rated themselves as less positive than these indicators). ADHD subtypes were not related to discrepancy scores. Higher rates of depression symptoms were associated with attenuated discrepancy scores. Crucially, measures of actual competence were more strongly associated with adolescent impairment and positive adjustment than were "illusory" self-perceptions for girls with ADHD. Our findings challenge the view that, at least in girls with ADHD, overly positive and "illusory" appraisals of competence are strongly associated with future impairment and adjustment. The key psychometric point is that, in difference or discrepancy scores, the individual components of such scores should be separately examined.

SYNOPSIS Objective . The authors investigated the effects of preschool patterns of parental authority on adolescent competence and emotional health and differentiated between confrontive and coercive power-assertive practices which accounted partially for differential long-term effects of the preschool patterns. Design . Participants were 87 families initially studied when children were preschool students, with outcomes assessed during early adolescence. Families were drawn from Baumrind's Family Socialization and Developmental Competence longitudinal program of research. The authors used comprehensive observational and interview data to test hypotheses relating preschool power-assertive practices and patterns of parental authority to the children's attributes as adolescents. Person-centered analyses contrasted adolescent attributes associated with 7 preschool patterns of parental authority. The authors used variable-centered analyses to investigate the differential effects of 5 coercive power-assertive p...

Employing data from 140 prospectively followed girls with attention-deficit/hyperactivity disorder (ADHD) and 88 age- and ethnicity-matched comparison girls, we adopted a person-centered analytic approach to assess rates of adolescent positive adjustment (PA) across six domains: ADHD symptoms, externalizing symptoms, internalizing symptoms, social skills, peer acceptance, and school achievement. During adolescence, between 19.8% and 61.1% of the girls with childhood ADHD met criteria for PA when the six domains were considered independently. A total of 16.4% of the ADHD sample showed PA in at least five of six domains, versus 86.4% of the comparison girls. Results were similar when PA was examined excluding the ADHD symptom domain. Most girls did not “grow out of” the symptoms and impairments related to their ADHD.

To estimate the prevalence of being well-adjusted in adolescence, boys and girls with (n = 96) and without (n = 126) attention-deficit/hyperactivity disorder (ADHD) were assessed seven times in eight years starting when they were 4-6 years of age. Symptoms of ADHD, ODD/CD, and depression/anxiety in addition to social skills and social preference were gathered using multiple methods and informants. Being well-adjusted was defined by surpassing thresholds in at least four of the five domains. At the 7- and 8-year follow-up, when youth were 11-14 years old, probands were significantly less likely to be well-adjusted relative to age- and ethnicity-matched control children. Only a minority of children with ADHD was well-adjusted in adolescence when emotional, behavioral, and social domains were considered simultaneously. Even when their ADHD symptoms improved over time, most probands exhibited significant impairment 7-8 years after their initial assessment.

Chapter 4 discusses the experiences and eventual death of the contributor’s sister from years of substance and alcohol abuse, eating disorder, and depression.

Self-harm (suicidal ideation and attempts; non-suicidal self-injuries behavior) peaks in adolescence and early-adulthood, with rates higher for women than men. Young women with childhood psychiatric diagnoses appear to be at particular risk, yet more remains to be learned about the key predictors or mediators of self-harm outcomes. Our aims were to examine, with respect to self-harm-related outcomes in early adulthood, the predictive validity of childhood response inhibition, a cardinal trait of attention-deficit hyperactivity disorder (ADHD), as well as the potential mediating effects of social preference and peer victimization, ascertained in early adolescence. Participants were an ethnically and socioeconomically diverse sample of 228 girls with and without ADHD, an enriched sample for deficits in response inhibition. Childhood response inhibition (RI) predicted young-adult suicide ideation (SI), suicide attempts (SA), and non-suicidal self-injury (NSSI), over and above full-scale IQ, mother's education, household income, and age. Importantly, teacher-rated social preference in adolescence was a partial mediator of the RI-SI/SA linkages; self-reported peer victimization in adolescence emerged as a significant partial mediator of the RI-NSSI linkage. We discuss implications for conceptual models of self-harm and for needed clinical services designed to detect and reduce self-harm.

We examined whether maltreatment experienced in childhood and/or adolescence prospectively predicts young adult functioning in a diverse and well-characterized sample of females with childhood-diagnosed attention-deficit/hyperactivity disorder (N = 140). Participants were part of a longitudinal study and carefully evaluated in childhood, adolescence, and young adulthood (Mage = 9.6, 14.3, and 19.7 years, respectively), with high retention rates across time. A thorough review of multisource data reliably established maltreatment status for each participant (Mκ = 0.78). Thirty-two (22.9%) participants experienced at least one maltreatment type (physical abuse, sexual abuse, or neglect). Criterion variables included a broad array of young adult measures of functioning gleaned from multiple-source, multiple-informant instruments. With stringent statistical control of demographic, prenatal, and family status characteristics as well as baseline levels of the criterion variable in question, maltreated participants were significantly more impaired than nonmaltreated participants with respect to self-harm (suicide attempts), internalizing symptomatology (anxiety and depression), eating disorder symptomatology, and well-being (lower overall self-worth). Effect sizes were medium. Comprising the first longitudinal evidence linking maltreatment with key young adult life impairments among a carefully diagnosed and followed sample of females with attention-deficit/hyperactivity disorder, these findings underscore the clinical importance of trauma experiences within this population.

The present study examined treatment outcomes for objectively measured parenting behavior in the Multimodal Treatment Study of Children with Attention-Deficit/Hyperactivity Disorder (ADHD). Five hundred seventy-nine ethnically and socioeconomically diverse children with ADHD-combined type (ages 7.0-9.9 years) and their parent(s) were recruited at 6 sites in the United States and Canada and randomly assigned to 1 of 4 treatment groups for 14 months of active intervention: medication management (MedMgt), intensive behavior therapy, combination of the 2 (Comb), or a community-treated comparison (CC). Baseline and posttreatment laboratory observations of parent-child interactions were coded by observers blind to treatment condition. Comb produced significantly greater improvements in constructive parenting than did MedMgt or CC, with effect sizes approaching medium for these contrasts. Treatment effects on child behaviors were not significant. The authors discuss the importance of changes in parenting behavior for families of children with ADHD and the need for reliable and objective measures in evaluating treatment outcome.

Hierarchical linear modeling was used to examine 2 facets of externalizing behavior: its level at age 6 and its rate of change from age 2 to 6 among 299 boys from low-income families. As for age-6 level of externalizing behavior, maternal depressive symptoms, maternal acceptance of child behavior, parental conflict, and the interaction between maternal acceptance and maternal depressive symptoms were each uniquely associated with this outcome. Regarding the interaction, maternal acceptance was associated with externalizing behavior primarily when maternal depressive symptoms were low, and maternal depressive symptoms were related to externalizing behavior only when maternal acceptance was high. Externalizing behavior gradually decreased between ages 2 and 6; interactions between infant negative emotionality and maternal depressive symptoms and between parental conflict and maternal acceptance were associated with rate of change. Plots suggested a protective effect of low infant negative emotionality when maternal depressive symptoms were high and a larger effect of maternal acceptance when parental conflict was low compared to when it was high. Results add to a small but growing literature regarding predictors of continuity and change in early child externalizing behavior.

Background: Rates of suicide attempts and nonsuicidal self-injury [(NSSI); e.g., cutting, burning] peak in adolescence and early adulthood; females and individuals with psychiatric symptoms and diagnoses appear to be at particular risk. Hinshaw et al. [Journal of Consulting and Clinical Psychology, (2012), 80, 1041] reported that young women with histories of childhood ADHD diagnoses reported higher rates of suicide attempts and NSSI than nondiagnosed, comparison women. Methods: Via analyses of an ongoing longitudinal investigation, our aims are to examine, with respect to both aspects of self-harmful behavior, (a) ADHD subtype differences and effects of diagnostic persistence (vs. transient and nondiagnosed classifications) and (b) potential mediating effects of impulsivity and comorbid psychopathology, ascertained during adolescence. Results: Young adult women with a childhood diagnosis of ADHD-Combined type were at highest risk for suicide attempts as well as the most varied and severe forms of NSSI compared with those with ADHD-Inattentive type and those in the comparison group; participants with a persistent ADHD diagnosis were at higher risk than those with a transient diagnosis or those never meeting criteria for ADHD. Mediator analyses revealed that, during adolescence, an objective measure of impulsivity plus comorbid externalizing symptoms were simultaneous, partial mediators of the childhood ADHD-young adult NSSI linkage. Adolescent internalizing symptoms emerged as a partial mediator of the childhood ADHD-young adult suicide attempt linkage. Conclusions: ADHD in females, especially when featuring childhood impulsivity and especially with persistent symptomatology, carries high risk for self-harm. Psychiatric comorbidity and response inhibition are important mediators of this clinically important longitudinal association. We discuss limitations and implications for prevention and intervention. Keywords: Attention-deficit/hyperactivity disorder, self-harm, self-injury, adulthood, comorbidity.

To elucidate processes underlying therapeutic change in a large-scale randomized clinical trial, we examined whether alterations in self-reported parenting practices were associated with the effects of behavioral, medication, or combination treatments on teacher-reported outcomes (disruptive behavior, social skills, internalizing symptoms) in children with attention-deficit hyperactivity disorder (ADHD). Participants were 579 children with Combined-type ADHD, aged 7-9.9 years, in the Multimodal Treatment Study of Children with ADHD (MTA). We uncovered 2 second-order factors of parenting practices, entitled Positive Involvement and Negative/Ineffective Discipline. Although Positive Involvement was not associated with amelioration of the school-based outcome measures, reductions in Negative/Ineffective Discipline mediated improvement in children's social skills at school. For families showing the greatest reductions in Negative/Ineffective Discipline, effects of combined medication plus behavioral treatment were pronounced in relation to regular community care. Furthermore, only in combination treatment (and not in behavioral treatment alone) was decreased Negative/Ineffective Discipline associated with reduction in children's disruptive behavior at school. Here, children in families receiving combination treatment who showed the greatest reductions in Negative/Ineffective Discipline had teacher-reported disruptive behavior that was essentially normalized. Overall, the success of combination treatment for important school-related outcomes appears related to reductions in negative and ineffective parenting practices at home; we discuss problems in interpreting the temporal sequencing of such process-outcome linkages and the means by which multimodal treatment may be mediated by psychosocial processes related to parenting.

Factors associated with school behavioral competence at 72 months were investigated in a sample of at-risk boys followed longitudinally from 18 months. Boys were at risk for developing behavior problems due to early exposure to sociodemographic and family-environmental stressors associated with low-income urban living. Research findings: Of child protective factors investigated, main effects were found for intelligence, mother-reported emotionality and sociability, and observed likability in relation to teacher-reported behavior problems, and results were generally consistent across type of risk. In only one instance did the effect of a protective factor depend on the level of risk. Furthermore, a cumulative measure of protective factors was strongly predictive of child behavior problems and was a better predictor than cumulative risk measures. Observed infant emotionality, child physical attractiveness, and children's self-perceptions of being pro-social or aggressive and fearless were essentially unrela...

The aim of this investigation was to examine the role of social relationships in the home as predictors of social functioning in the first years of school. Longitudinal data gathered on 156 children from urban, low-income families were used to examine the unique contributions of mother-child attachment classification at ages 1 and 2 years, the child's relationship with another adult caregiver, the child's closeness to a sibling, and the child's status in the family relative to siblings between ages 3 and 4 years, to teacher reports of their own relationship to the child and the child's social skills in the classroom and peer relations. The role of family-based relationships as possible protective factors for children at social or demographic risk for problems in school was also tested. Results indicate that quality of different family relationships provides relatively independent and complementary information about early social functioning in school, with more limited evidence for compensatory or protecti...

Researchers have begun to develop models that explain the processes by which interparental conflict impacts children's adjustment. The present study tested a model based on emotional security theory. The longitudinal relations among interparental conflict, boys' reactions to conflict, and internalizing and externalizing problems were examined in a sample of 129 mother-son dyads from low-income, 2-parent families from the time sons were age 2 to 5. Results indicated that children exposed to interparental conflict were more likely to have concurrent and later behavior problems and that patterns of interparental conflict across time made unique contributions in predicting later problems. Children's emotional reactivity in response to conflict had no direct relation to interparental conflict and only modest relations to behavior problems. However, interparental conflict and reactivity factors interacted to predict behavior problems at ages 3 1/2 and 5. Thus, some support was demonstrated for emotional reactivity as a moderator in the development of young children's behavior problems.

Comorbid psychiatric conditions often complicate the treatment of childhood obsessive-compulsive disorder (OCD). Behavioral treatment of OCD using exposure plus response prevention for a boy with disruptive behavior disorders and two previous unsuccessful medication trials is described. Treatment was adapted to his developmental level, his mother was highly involved in treatment, and a contingency management program contained his disruptive behavior so that he could participate in therapy. Posttreatment and 2- and 6-month follow-up measures indicated marked improvement in OCD symptoms. The possibility of successful behavioral treatment of OCD in medication-free children with disruptive behavior problems is highlighted.

Relations between infant irritability and maternal responsiveness at 12 and18 months were investigated in low-income mother-infant dyads. Emphasis was placed on whether results varied according to measurement strategies, infant gender, or level of maternal social support and satisfaction with that support. Irritability was measured separately through observation and maternal report, responsiveness was measured observationally, and maternal social support and satisfaction were self-reported via questionnaire. Concurrent relations between irritability and responsiveness were, in general, negative and were larger when irritability was measured observationally rather than by maternal report. Correlations were similar across gender. No longitudinal relations were found between irritability and responsiveness. Amount of maternal social support was weakly related to responsiveness and to responses to infant irritability, and the nature of these relations was unexpected. Irritability-responsiveness relations varied as a function of measurement strategies, which may in part explain mixed findings in the empirical literature.

The present study examined pathways leading to early externalizing problems from age 1 to 3 1/2 in a design that took advantage of our knowledge of normative progression and normative socialization as well as findings from research on risk. A sample of 130 low-income participants was followed longitudinally from 12 to 42 months using observational measures of developmentally salient parenting and child disruptive behavior to predict early externalizing problems. Results are best accommodated by concepts such as transformation and transaction from developmental psychology. For boys, both child and parent variables predicted later externalizing. For girls and boys, the interaction between child noncompliance and maternal rejection was significant.

Among two large, independent samples of girls with attention-deficit/hyperactivity disorder (ADHD), we examined associations between specific (maternal gestational smoking and drug use, early labor, low birth weight, and infant breathing problems at birth) and cumulative prenatal and perinatal risk factors and psychiatric comorbidity during childhood. Data from the (a) Multimodal Treatment Study of Children with ADHD, a randomized clinical trial with 579 children aged 7 to 9.9 years with combined-type ADHD, and the (b) Berkeley Girls ADHD Longitudinal Sample, a naturalistic study of 140 girls with ADHD (93 combined-type and 47 inattentive-type) who were first seen when they were 6 to 12 years old, were analyzed separately. In each sample, perinatal risk factors were assessed retrospectively by maternal report, and current childhood psychiatric comorbidity was assessed using maternal report on the Diagnostic Interview Schedule for Children. Consistent findings across these two studies show that infant breathing problems, early labor, and total perinatal problems predicted childhood comorbid depression but not comorbid anxiety or externalizing disorders. These associations remained significant, in both samples, with control of family socioeconomic status (SES) and maternal symptoms of ADHD and depression. Results attenuated slightly with control of the number of child comorbidities plus SES and maternal symptoms. Accumulating evidence suggests that perinatal risk factors are important precursors of childhood psychiatric comorbidity and that the association between these risk factors and detrimental psychiatric outcomes cannot be explained by maternal psychiatric symptoms or SES during childhood.

This study examined risk factors from infancy associated with the development of preschool disruptive behavior problems across child, parent, and sociodemographic domains. Risk factors that consistently were associated with the prediction of disruptive behavior at age 5 years included disorganized attachment classification at 12 months, and maternal personality risk and child-rearing disagreements during the second year. In addition, infants with disorganized attachment status at 12 months whose mothers perceived them as difficult in the second year showed significantly higher aggressive problems at age 5 years than those with only one of the two risk factors present. When pathways leading to clinically elevated aggression at age 5 were explored, infant disorganized attachment status, maternal personality risk, and child-rearing disagreements demonstrated equivalent predictive validity as child aggression assessed at age 3 years.

The vast parenting literature has shown differences in parenting practices across different ethnicities. However, parenting practices of parents of children with Attention-Deficit/Hyperactivity Disorder (ADHD) have primarily been studied in Caucasian middle-class families. Given that modifying parenting practices is often a primary target for psychosocial intervention for children with ADHD, ethnic differences in parenting may moderate treatment outcomes. Utilizing observations of 567 children with ADHD (ages 7–9) and their caregivers collected during the Multimodal Treatment Study of ADHD (MTA), the present study examined ethnic differences in observed parenting and child behavior at baseline and the moderating effects of ethnicity on the relationship between treatment and parenting and child behavior. The four MTA treatments were medication management, behavior therapy, combined medication management + behavior therapy, and community care. Baseline results indicated that both parenting practices and child behavior differed by ethnicity. However, ethnicity did not moderate the relationship between treatment and parenting and child behavior. Hence, children from different ethnicities did not differentially benefit from one treatment over another on observed ratings of parenting or child behavior. Implications for clinical care and future research are discussed.

The authors performed 5-year prospective follow-up (retention rate = 92%) with an ethnically diverse sample of girls, aged 11-18 years, who had been diagnosed in childhood with attention-deficit/ hyperactivity disorder (ADHD; N = 140) and a matched comparison group (N = 88). Hyperactive-impulsive symptoms were more likely to abate than inattentive symptoms. Across multiple domains of symptoms and functional impairment, girls with ADHD continued to display deficits of moderate to large effect size in relation to the comparison girls, but few differences emerged between the inattentive versus combined types. Follow-up effects withstood statistical control of crucial covariates for most outcomes, meaning that there were specific effects of childhood ADHD on follow-up status; in other instances, baseline disruptive disorders accounted for adolescent effects. For outcomes identical at baseline and follow-up, girls with ADHD showed more improvement across time than comparison girls (except for math achievement). Overall, ADHD in girls portends continuing impairment 5 years after childhood ascertainment.

Hierarchical linear modeling was used to examine 2 facets of externalizing behavior: its level at age 6 and its rate of change from age 2 to 6 among 299 boys from low-income families. As for age-6 level of externalizing behavior, maternal depressive symptoms, maternal acceptance of child behavior, parental conflict, and the interaction between maternal acceptance and maternal depressive symptoms were each uniquely associated with this outcome. Regarding the interaction, maternal acceptance was associated with externalizing behavior primarily when maternal depressive symptoms were low, and maternal depressive symptoms were related to externalizing behavior only when maternal acceptance was high. Externalizing behavior gradually decreased between ages 2 and 6; interactions between infant negative emotionality and maternal depressive symptoms and between parental conflict and maternal acceptance were associated with rate of change. Plots suggested a protective effect of low infant negative emotionality when maternal depressive symptoms were high and a larger effect of maternal acceptance when parental conflict was low compared to when it was high. Results add to a small but growing literature regarding predictors of continuity and change in early child externalizing behavior.

Childhood poverty appears to be an enduring and entrenched problem, resistant to most social and economic policies intended to lift families above the poverty line. Although rates of poverty among families of pre–school-age children initially declined during the 1960s, when antipoverty programs directed at children and families were initiated, rates rose throughout the 1970s and 1980s and leveled off in the 1990s, with the consequence that young children continue to experience poverty at alarmingly high rates. In fact, in 1999 about one in five infants and preschool-age children in the United States lived in families whose incomes fell below the poverty threshold (U.S. Census Bureau, 2000a). Poverty is considered a pervasive and nonspecific stressor, rather than a bounded one, because it negatively affects many aspects of individual and family functioning; yet at the same time, many impoverished children are positively adjusted (Garmezy, 1991; Luthar, 1999; Werner & Smith, 1992). How is it that some children are vulnerable to the effects of poverty, whereas others demonstrate positive adjustment (i.e., resilience)? Attempts to answer this question are at the core of this chapter. Our primary objective is twofold: to summarize findings from relevant literatures regarding factors associated with better or worse adjustment among young impoverished children, and to showcase one effort toward the identification of such factors using data from the Pitt Mother and Child Project, a longitudinal study of adjustment and psychopathology among young boys from low-income families.