Symptom centrality and infrequency of endorsement identify adolescent depression symptoms more strongly associated with life satisfaction.

Although depression symptoms are often treated as interchangeable, some symptoms may relate to adolescent life satisfaction more strongly than others. To assess this premise, we first conducted a network analysis on the Mood and Feelings Questionnaire (MFQ) in a large (N = 1,059), cross-sectional sample of community adolescents (age M = 14.72 ± 1.79). The most central symptoms of adolescent depression, as indexed by strength, were self-hatred, loneliness, sadness, and worthlessness while the least frequently endorsed symptoms were self-hatred, anhedonia, feeling like a bad person, and feeling unloved. Moreover, the more central a depression symptom was in the network (i.e., higher strength), the more variance it shared with life satisfaction (r = 0.59, 95% CI: 0.27, 0.76). How frequently a symptom was endorsed was negatively associated with the variance symptoms shared with life satisfaction (r = -0.48, 95% CI: -0.63, -0.21). Cross-validated, prediction focused models found central symptoms were expected to predict more out of fold variance in life satisfaction than peripheral symptoms and frequently endorsed symptoms, but not the least frequently endorsed symptoms. These findings show certain depression symptoms may be more strongly associated with life satisfaction in adolescence and these symptoms can be identified by multiple symptom-level metrics. Limitations include use of cross-sectional data and utilizing a community sample. Better understanding which symptoms of depression share more variance with important outcomes like life satisfaction could help us develop a more fine-grained understanding of adolescent depression.

Factors predicting the development of psychopathology among first responders: A prospective, longitudinal study.

Objective: Previous research has shown that first responders exhibit elevated rates of psychopathology. Factors predicting the development of this psychopathology, however, remain understudied. This study longitudinally examined predictors of posttraumatic stress disorder (PTSD), depression, and anxiety symptoms in first responders. Method: Participants included 135 emergency medical service (EMS) providers. Multiple linear regressions were used to model predictors of change in PTSD, depression, and anxiety symptomatology from baseline to 3-month follow-up. Baseline levels of social support, sleep, emotional stability, and perceived stress were examined as potential predictors. Results: Results revealed that (a) increases in PTSD symptoms, (b) increases in depression symptoms, and (c) increases in anxiety symptoms at 3-month follow-up were each predicted by worse sleep and lower social support at baseline. In particular, the sleep subscale of disturbed sleep and the social support subscale of appraisal appeared to be driving these effects. Conclusion: These results highlight the importance of social support and sleep hygiene in protecting against increases in psychopathology symptoms in EMS providers, and set the stage for future interventions to target sleep disturbances and encourage deeper social connections in order to foster resilience in first responders. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Validity of DSM-IV attention deficit/hyperactivity disorder symptom dimensions and subtypes.

Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) criteria for attention deficit/hyperactivity disorder (ADHD) specify two dimensions of inattention and hyperactivity-impulsivity symptoms that are used to define three nominal subtypes: predominantly hyperactive-impulsive type (ADHD-H), predominantly inattentive type (ADHD-I), and combined type (ADHD-C). To aid decision making for DSM-5 and other future diagnostic systems, a comprehensive literature review and meta-analysis of 546 studies was completed to evaluate the validity of the DSM-IV model of ADHD. Results indicated that DSM-IV criteria identify individuals with significant and persistent impairment in social, academic, occupational, and adaptive functioning when intelligence, demographic factors, and concurrent psychopathology are controlled. Available data overwhelmingly support the concurrent, predictive, and discriminant validity of the distinction between inattention and hyperactivity-impulsivity symptoms, and indicate that nearly all differences among the nominal subtypes are consistent with the relative levels of inattention and hyperactivity-impulsivity symptoms that define the subtypes. In contrast, the DSM-IV subtype model is compromised by weak evidence for the validity of ADHD-H after first grade, minimal support for the distinction between ADHD-I and ADHD-C in studies of etiological influences, academic and cognitive functioning, and treatment response, and the marked longitudinal instability of all three subtypes. Overall, we conclude that the DSM-IV ADHD subtypes provide a convenient clinical shorthand to describe the functional and behavioral correlates of current levels of inattention and hyperactivity-impulsivity symptoms, but do not identify discrete subgroups with sufficient long-term stability to justify the classification of distinct forms of the disorder. Empirical support is stronger for an alternative model that would replace the subtypes with dimensional modifiers that reflect the number of inattention and hyperactivity-impulsivity symptoms at the time of assessment. (PsycINFO Database Record (c) 2012 APA, all rights reserved).

Categorical and Dimensional Definitions and Evaluations of Symptoms of ADHD: History of the SNAP and the SWAN Rating Scales.

An earlier version of this article was originally submitted for publication in early 2000 to introduce a new dimensional of concept of Attention Deficit Hyperactivity Disorder (ADHD) provided by the Strengths and Weaknesses of ADHD-symptoms and Normal-behavior (SWAN) rating scale. The SWAN was developed to correct some obvious deficiencies of the Swanson, Nolan and Pelham (SNAP) rating scale that was based on the categorical concept of ADHD. The first submission was not accepted for publication, so a draft of the article was posted on a website (www.ADHD.net). The SWAN scale was published as a table in a review article (Swanson et al, 2001) to make it available to those interested in this dimensional approach to assessment of ADHD. Despite its relative inaccessibility, the SWAN has been used in several genetic studies of ADHD (e.g., Hay, Bennett, Levy, Sergeant, & Swanson, 2005; Cornish et al, 2005) and has been translated into several languages for European studies of ADHD (e.g., Lubke et al, 2006; Polderman et al, 2010) and into Spanish for studies in the United States (e.g., Lakes, Swanson, & Riggs, 2011; Kudo et al., this issue). Recently, invitations to include the SWAN in the PhenX Toolkit (www.phenx.org) for genomic studies (Hamilton et al, 2011) and to describe thedimensional approach of the SWAN for discussion of diagnostic (Swanson, Wigal, & Lakes, 2009) and ethical (Swanson, Wigal, Lakes, &Volkow, 2011) issues has convinced us that the unpublished article is still relevant after more than a decade, so it is presented here with some minor updates. We use examples (a) to document some consequences (e.g., over-identification of extreme cases) of using statistical cutoffs based on the assumption for a distribution of SNAP ratings that is highly skewed and (b) to show how the SWAN corrects the skewness of the SNAP by rewording the items on the scale and using a wider range of rating alternatives, which corrects the tendency to over-identify extreme cases.

Task demands interact with the single and combined effects of medication and contingencies on children with ADHD.

OBJECTIVE: To investigate single and combined effects of stimulant medication and contingencies on the performance of ADHD children with tasks involving different cognitive demands. METHOD: Children diagnosed with ADHD participated in a within-subjects design. At two separate sessions, children on either medication or placebo (administered in a double-blind fashion) completed two tasks, a match-to-sample task and a stop-signal task, under three conditions (reward, response cost, and no contingency) in a counterbalanced order. RESULTS: Contingencies and medication administered singly improved performance on both tasks. For the match-to-sample task, the combination of medication and contingencies was more efficacious than either alone. For the stop-signal task, the combination of medication and reward was no more effective than either alone; however, medication and response cost combined was more effective than either treatment alone. CONCLUSION: Results suggest that both medication and contingencies improve task performance. The findings suggest that task demands interact with single and combined treatment effects.

Performance on a neurocognitive measure of alerting differentiates ADHD combined and inattentive subtypes: a preliminary report.

The performance of 16 attention-deficit hyperactivity disorder (ADHD)/C, 26 ADHD/IA, and 24 control children was compared using a computer reaction time task designed to measure the effects of Posner's orienting, conflict and alerting attentional systems. No group differences in orienting or conflict were found. In contrast, children with ADHD/IA showed stronger alerting effects than those with ADHD/C, as indicated by relatively greater performance benefits following a warning cue. Although neither ADHD group differed significantly from controls on alerting, effect size comparisons indicated that children with ADHD/IA showed a somewhat larger (d=.57) and children with ADHD/C a somewhat smaller (d=.44) alerting effect relative to control children. The results are among the first to document unique patterns of attentional capacity for ADHD subtypes.

Rejection sensitivity and social outcomes of young adult men with ADHD.

OBJECTIVE: Attention-Deficit/Hyperactivity Disorder (ADHD) has been consistently linked to social maladjustment. This study investigated whether elevated rejection sensitivity (RS) could contribute to the relational problems that adults with ADHD encounter. METHOD: Undergraduate men in ADHD-Combined Type (ADHD-C; n = 31), ADHD-Primarily Inattentive Type (ADHD-IA; n = 22), and nondiagnosed control (NC; n = 25) groups completed questionnaires concerning RS, relational history, current relationships, and self-esteem. RESULTS: The hypothesis that those with ADHD would have elevated RS (versus NC peers) was not supported. However, low RS predicted divergent outcomes across groups. Furthermore, ADHD-IA men reported more negative relational outcomes than their ADHD-C peers, although both groups reported lower general self-esteem than controls. CONCLUSION: Perhaps the positive illusory bias associated with childhood ADHD could buffer RS development. Findings provide evidence of ADHD-related impairment in adult relationships, further differentiate the principal ADHD subtypes, and extend the RS literature to this clinical population.

Sluggish cognitive tempo predicts a different pattern of impairment in the attention deficit hyperactivity disorder, predominantly inattentive type.

Compared 2 groups of children with attention deficit hyperactivity disorder, predominantly inattentive type (ADHD/IA)--those with high scores on a composite measure of sluggish cognitive tempo (SCT) and those without--using a large, school-based sample of children for which previous comparisons between ADHD subtypes have been reported. Although the 2 groups did not differ on level of attention or learning problems, high-SCT ADHD/IA children were rated by teachers as showing less externalizing behavior and higher levels of unhappiness, anxiety/depression, withdrawn behavior, and social dysfunction. Thus, SCT identifies a more homogeneous subgroup of ADHD/IA children who are, relative to the entire Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV]; American Psychiatric Association [APA], 1994) diagnosed ADHD/IA group, more similar to those classified in previous research as "attention deficit disorder without hyperactivity." These results support a reconsideration of SCT symptoms as a component of diagnostic criteria for a category of nonhyperactive attention deficit disorder.

Parent-, teacher-, and self-rated motivational styles in ADHD subtypes.

The motivational styles of 25 children with attention-deficit/hyperactivity disorder, combined type (ADHD/C), 13 children with ADHD, inattentive type (ADHD/IA), and 25 nondiagnosed controls (NC) were compared using parent, teacher, and self-ratings. Both ADHD subtypes demonstrated motivational impairment characterized by a preference for easy work, less enjoyment of learning, less persistence, and a greater reliance on external than on internal standards to judge their performance relative to NC. Some motivational style differences between ADHD subtypes were also revealed, with the ADHD/C group more motivated by competitiveness and a desire to be perceived as superior to others and the ADHD/IA group less uncooperative and possibly more passive in their learning styles. When IQ was statistically controlled, these results were generally unchanged. The contributing role of motivational deficits to the generally poor academic functioning of children with ADHD is discussed, along with potential intervention implications of the divergent motivational styles of different ADHD subtypes.

Responsiveness of children with attention deficit-hyperactivity disorder to reward and response cost: differential impact on performance and motivation.

Using a within-subject design and both high- and low-interest tasks, this study examined the effects of reward (R), response cost (RC), and no contingency (NR) on performance and motivation of 22 children with attention deficit-hyperactivity disorder (ADHD) and 22 controls. Dependent variables included performance measures, self-rated performance and motivation, and a new measure of behavioral motivation based on a 2-min postcontingency task. Both contingencies benefited some aspects of the performance of ADHD children; relative to R, RC showed stronger effects but at the expense of decreased self-rated motivation on the low-interest task. The performance of controls did not differ across tasks, whereas ADHD children performed relatively better on the high-interest task. Neither contingency decreased motivation measures relative to NR for either group. For ADHD children, motivational effects appeared to be influenced by self-perceptions of performance.

Cognitive factors differentiating attention deficit-hyperactivity disorder with and without a comorbid mood disorder.

Mood disorders and attention deficit-hyperactivity disorder (ADHD) co-occur in 20-30% of children and adolescents diagnosed in both epidemiological and clinical studies, but little information is available regarding cognitive factors that may be relevant to the expression of co-occurring mood disorders and ADHD. This study examined whether ADHD with and without a comorbid mood disorder could be differentiated on the basis of cognitive factors associated with prominent theories of depression. Children meeting diagnostic criteria for ADHD (n = 14) or ADHD and a comorbid mood disorder (n = 27) were assessed on a variety of cognitive indices. Children in the comorbid group reported more negative views of themselves and a more depressogenic attributional style. Cognitive disturbances associated with A. T. Beck's (1967) cognitive model and attributional style theories of depression differentiate ADHD children with significant mood pathology.

Separate and combined effects of methylphenidate and behavior modification on boys with attention deficit-hyperactivity disorder in the classroom.

This study evaluated the separate and combined effects of behavior modification and 2 doses of methylphenidate (MPH; 0.3 and 0.6 mg/kg) compared with baseline (no behavior modification and a placebo) on the classroom behavior and academic performance of 31 ADHD (attention deficit-hyperactivity disorder) boys attending a summer treatment program. Results revealed significant effects of both interventions, with the mean effect size of medication being more than twice as great as that of behavior modification. Relatively small incremental value was gained by the higher dose of medication or the addition of behavior modification, compared with the effects of the low dose of MPH. In contrast, the addition of either dose of MPH resulted in improvement beyond the effects of behavior modification alone. These group effects reflected those obtained in analyses of individual differences. Furthermore, comparisons of individual responsiveness showed that boys who responded to one treatment also responded to the other.