Non-pharmacological interventions for attention-deficit hyperactivity disorder in children and adolescents.

Attention-deficit hyperactivity disorder (ADHD) affects approximately 5% of children and adolescents globally and is associated with negative life outcomes and socioeconomic costs. First-generation ADHD treatments were predominantly pharmacological; however, increased understanding of biological, psychological, and environmental factors contributing to ADHD has expanded non-pharmacological treatment possibilities. This Review provides an updated evaluation of the efficacy and safety of non-pharmacological treatments for paediatric ADHD, discussing the quality and level of evidence for nine intervention categories. Unlike medication, no non-pharmacological treatments showed a consistent strong effect on ADHD symptoms. When considering broad outcomes (eg, impairment, caregiver stress, and behavioural improvement), multicomponent (cognitive) behaviour therapy joined medication as a primary ADHD treatment. With respect to secondary treatments, polyunsaturated fatty acids showed a consistent modest effect on ADHD symptoms when taken for at least 3 months. Additionally, mindfulness and multinutrient supplementation with four or more ingredients showed modest efficacy on non-symptom outcomes. All other non-pharmacological treatments were safe; clinicians might tolerate their use but should educate families of childrenand adolescents with ADHD on the disadvantages, including costs, burden to the service user, absence of proven efficacy relative to other treatments, and delay of proven treatment.

Impact of stress and parenting on respiratory sinus arrythmia trajectories in early adolescence.

The effects of stress and parenting on 1-year trajectories of physiological emotion regulation capacity among adolescents were examined. Consistent with the vulnerability-stress and allostatic load models, stress (chronic family and marital) was hypothesized to be associated with less favorable trajectories of basal respiratory sinus arrhythmia (RSA) over 1 year. This relationship was further hypothesized to be moderated by parenting practices (warmth, neglect, and rejection) and adolescent sex. Participants included 150 adolescents (51.3% female), 11-15 years of age (M = 13.04, SD = 0.89). Basal RSA and stress were assessed four times across 1 year. Results indicated a significant decrease in RSA over the course of 1 year (ß = -0.15, p = .010). Warm parenting style was associated with lower RSA in environments of low marital stress and was also related with higher RSA in environments of high marital stress (ß = 0.86, p = .021). Rejecting parenting styles were associated with higher RSA in environments of low family stress and lower RSA in environments of high family stress (ß = -0.60, p = .014). These findings may be explained by the Yerkes-Dodson law of optimal stress, suggesting that sufficient environmental challenge is needed to catalyze regulatory development.

Distress Tolerance as a Mechanism Linking Violence Exposure to Problematic Alcohol use in Adolescence.

Adolescents exposed to violence are at elevated risk of developing most forms of psychopathology, including depression, anxiety, and alcohol abuse. Prior research has identified emotional reactivity and difficulties with emotion regulation as core mechanisms linking violence exposure with psychopathology. Scant research has examined behavioral responses to distress as a mechanism in this association. This study examined the association of violence exposure with distress tolerance-the ability to persist in the face of distress-and whether lower distress tolerance linked violence exposure with subsequent increases in depression, anxiety, and alcohol abuse problems during adolescence. Data were collected prospectively in a sample of 287 adolescents aged 16-17 (44.3% male; 40.8% White). At Time 1, participants provided self-report of demographics, violence exposure, and psychopathology, and completed a behavioral measure of distress tolerance, the Paced Auditory Serial Addition Task. Four months later, participants (n = 237) repeated the psychopathology assessments. Violence exposure was associated with lower distress tolerance (ß = -.21 p = .009), and elevated concurrent psychopathology (ß = .16-.45, p = .001-.004). Low distress tolerance was prospectively associated with greater likelihood of abusing alcohol over time (OR = .63, p = .021), and mediated the association between violence exposure and greater levels (ß = .02, 95% CI [.001, .063]) and likelihood (OR = .03, 95% CI [.006, .065]) of alcohol use over time. In contrast, low distress tolerance was not associated concurrently or prospectively with internalizing symptoms. Results persisted after controlling for socio-economic status. Findings suggest that distress tolerance is shaped by early experiences of threat and plays a role in the association between violence exposure and development of problematic alcohol use in adolescence.