Psychosocial effects in parents and children 12 years after newborn genetic screening for type 1 diabetes.

Little is known about the psychosocial consequences of testing newborns for genetic susceptibility to multifactorial diseases. This study reports quantitative psychosocial evaluations of parents and children 12 years after screening for type 1 diabetes (T1D). Two parent-child cohorts participated: children at increased genetic risk of T1D and children at low genetic risk. T1D risk status was determined at birth as part of a prospective study investigating potential environmental triggers of autoimmunity. Parent measures included ratings of children's emotional, behavioural and social functioning (Child Behaviour Checklist) and parenting style (Alabama Parenting Questionnaire). Child self-concept was assessed using the self-description questionnaire (SDQ1). Statistical analyses were conducted to test for differences between the groups. Twelve years after testing there was no evidence that knowledge of a child's increased genetic risk of T1D adversely affected parental ratings of their child's emotional, behavioural or social functioning, or impacted upon parenting style. There was no adverse effect upon the child's assessment of their self-concept. This study provides important preliminary data concerning longer-term psychosocial effects of incorporating tests for genetic risk of complex disorders into NBS panels. While it is reassuring that no significant adverse effects have been detected, more data will be required to adequately inform policy.

Preschool self regulation predicts later mental health and educational achievement in very preterm and typically developing children.

OBJECTIVE: To examine the extent to which preschool emotional and behavioral regulatory difficulties were associated with an increased risk of later mental health and educational problems. Of particular interest was whether early regulatory abilities contributed to later risk once baseline child behavioral adjustment and cognitive function were taken into account. METHOD: Data were drawn from a prospective longitudinal study of 223 children born very preterm (VPT; <32 weeks gestation, n = 110) and full term (37-40 weeks gestation). At corrected ages 2 and 4 years, children's regulatory abilities were assessed using (1) direct observation of child behavior, (2) a modified version of the Emotion Regulation Checklist, and (3) tester ratings of child behavior during neuropsychological testing. At age 9 years, mental health and educational achievement were assessed using the Development and Well-being Assessment interview and the Woodcock Johnson-III Tests of Achievement. RESULTS: VPT-born children had poorer emotional and behavioral regulation across all measures and time points. They also had higher rates of DSM-IV mental health disorder and educational delay at age 9. Across both study groups, poorer self regulation was associated with an increased risk of ADHD, conduct disorder, anxiety disorders and any disorder net of preschool child behavior problems and social risk. In contrast, only associations between early regulation and later language and any educational delay remained significant after adjustment for preschool cognitive functioning and family social risk. CONCLUSION: Early assessment of regulation in addition to behavioral screening may improve the early identification of preschool children at mental health risk.

The interplay among temperament, neuropsychological abilities, and global functioning in young hyperactive/inattentive children.

Cognition and emotion have been shown to interact and influence psychological functioning. However, to date these interactions have only been examined cross-sectionally among inattentive and/or hyperactive/impulsive children. This study investigated the moderating effects of neuropsychological functioning at age 3-4 years on the relation between negative emotionality at age 3-4 years and global functioning 1 year later, at age 4-5 years. Hyperactive/inattentive (H/I; n = 114) preschoolers entered the study (BL: baseline) and were seen again 1 year later (F1). Children's BL scores on a neuropsychological test (NEPSY) and their temperament as rated by parents (Child Behavior Questionnaire) and teachers (Temperament Assessment Battery for Children-Revised) were obtained, as were clinicians' ratings of their global functioning (Children's Global Assessment Scale) at F1. Hierarchical linear regression analyses revealed that BL temperament variables accounted for significant variance in F1 Global Functioning. Significant interactions indicated that higher Verbal Executive abilities were associated with better child functioning when parent-rated Effortful Control was high, but not when Effortful Control was low. Additionally, high levels of Nonverbal Executive skills were associated with higher child global functioning when both parent- and teacher-rated negative affect was low, but not when negative affect was high.

Enhancing Neurobehavioral Gains with the Aid of Games and Exercise (ENGAGE): Initial open trial of a novel early intervention fostering the development of preschoolers' self-regulation.

Poor self-regulation during the preschool years predicts a wide array of adverse adult outcomes and, as such, is an important treatment target. We assessed the efficacy of a novel early intervention aimed at fostering the development of preschoolers' self-regulation. Enhancing Neurobehavioral Gains with the Aid of Games and Exercise (ENGAGE) involves parents and children playing a wide range of games targeting self-regulation on a daily basis over a 5-week period. Twenty-five New Zealand families, in whom parents identified their children as difficult to manage, took part in this study. Parent hyperactivity, aggression, and attention problems ratings on the BASC-2 were used to assess improvements in behavioral self-regulation, and subtests of the Stanford Binet-5 and NEPSY-2 were used to assess improvements in cognitive control. Improvements in parent-rated hyperactivity, aggression, and attention problems were maintained throughout the 12-month follow-up. In addition, improvements were found in two neurocognitive areas associated with self-regulation. While more rigorous randomized controlled trials are necessary, ENGAGE shows promise as a novel intervention for developing self-regulation in at-risk preschoolers.

Associations between birth weight and attention-deficit/hyperactivity disorder symptom severity: indirect effects via primary neuropsychological functions.

BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) has a range of aetiological origins which are associated with a number of disruptions in neuropsychological functioning. This study aimed to examine how low birth weight, a proxy measure for a range of environmental complications during gestation, predicted ADHD symptom severity in preschool-aged children indirectly via neuropsychological functioning. METHODS: A total of 197 preschool-aged children were recruited as part of a larger longitudinal study. Two neuropsychological factors were derived from NEPSY domain scores. One, referred to as 'Primary Neuropsychological Function,' was loaded highly with Sensorimotor and Visuospatial scores. The other, termed 'Higher-Order Function' was loaded highly with Language and Memory domain scores. Executive functioning split evenly across the two. Analyses examined whether these neuropsychological factors allowed for an indirect association between birth weight and ADHD symptom severity. RESULTS: As both factors were associated with symptom severity, only the Primary Neuropsychological Factor was associated with birth weight. Furthermore, birth weight was indirectly associated to symptom severity via this factor. CONCLUSIONS: These data indicate that birth weight is indirectly associated with ADHD severity via disruption of neuropsychological functions that are more primary in function as opposed to functions that play a higher-order role in utilising and integrating the primary functions.

One-week temporal stability of hyperactivity in preschoolers with ADHD during psychometric assessment.

AIM: To examine the usefulness of temporal measures of motor activity during psychometric assessment on two different assessment days, 1 week apart with a scope to help the early identification of hyperactivity. METHODS: Actigraph measures at the ankle and the waist were compared on the first and the second days of psychometric assessment in a total of 169 children (93 children in ADHD group; 76 children in Non-ADHD group) aged 3 years and 4 years. RESULTS: There was a significant interaction effect between group and time on the activity level at the waist. Although the activity level of the waist in the children with ADHD did not significantly differ between Day 1 and Day 2, the activity level of the children without ADHD declined significantly from Day 1 to 2. A total of 70% of children were correctly classified into ADHD or Non-ADHD groups based only on Day 2 waist activity data. CONCLUSION: The temporal consistency of hyperactivity in young children with ADHD during psychometric assessment is confirmed, indicating that objective measures of motor activity at the waist over different days of psychometric assessment can provide additional information for the stability of hyperactivity.

Are cognitive control and stimulus-driven processes differentially linked to inattention and hyperactivity in preschoolers?

Temperament and attention-deficit/hyperactivity disorder (ADHD) are both typically viewed as biologically based behavioural constructs. There is substantial overlap between ADHD symptoms and specific temperamental traits, such as effortful control, especially in young children. Recent work by Martel and colleagues ( 2009 , 2011 ) suggests that cognitive control temperamental processes are more closely related to inattention symptoms, whereas stimulus-driven temperamental processes are linked to hyperactivity-impulsivity. The present study tested a model of temperament and ADHD symptoms in typically developing preschoolers and those at risk for ADHD using structural equation modelling. Data were from larger study on ADHD in a short-term longitudinal sample with parent/teacher reports and neurocognitive testing. Participants included 214 preschool children (72.9% male) from diverse ethnic/racial backgrounds and a wide range of socioeconomic status from a large metropolitan center. Cognitive control processes, such as effortful control, but not stimulus-driven processes, are related to inattention and hyperactivity. In contrast, stimulus-driven processes, such as emotional reactivity, were related only to hyperactivity symptoms longitudinally. These results suggest that early temperament behaviours and cognitive processes may be indicators of later childhood behavioural difficulties with lasting consequences.

Training executive, attention, and motor skills: a proof-of-concept study in preschool children With ADHD.

OBJECTIVE: To examine whether cognitive enhancement can be delivered through play to preschoolers with ADHD and whether it would affect severity of ADHD symptoms. METHOD: Twenty-nine 4- and 5-year-old children and their parents participated in separate group sessions (3-5 children/group). Child groups were introduced games designed to enhance inhibitory control, working memory, attention, visuospatial abilities, planning, and motor skills. Parent groups were encouraged playing these games with their children at least 30 to 45 min/day and taught strategies for scaffolding difficulty levels and dealing with obstacles to daily playing. RESULTS: Parent ratings and session attendance indicated considerable satisfaction with the program. Parent (p < .001) and teacher (p = .003) ratings on the ADHD-Rating Scale-IV (ADHD-RS-IV) indicated significant improvement in ADHD severity from pre- to post-treatment, which persisted 3 months later. CONCLUSION: This play-based intervention for preschoolers with ADHD is readily implemented at home. Preliminary evidence suggests efficacy beyond the termination of active treatment.

Examining the interplay among negative emotionality, cognitive functioning, and attention deficit/hyperactivity disorder symptom severity.

Cognition and emotion, traditionally thought of as largely distinct, have recently begun to be conceptualized as dynamically linked processes that interact to influence functioning. This study investigated the moderating effects of cognitive functioning on the relationship between negative emotionality and attention deficit/hyperactivity disorder (ADHD) symptom severity. A total of 216 (140 hyperactive/inattentive; 76 typically developing) preschoolers aged 3-4 years were administered a neuropsychological test battery (i.e., NEPSY). To avoid method bias, child negative emotionality was rated by teachers (Temperament Assessment Battery for Children-Revised), and parents rated symptom severity on the ADHD Rating Scale (ADHD-RS-IV). Hierarchical Linear Regression analyses revealed that both negative emotionality and Perceptual-Motor & Executive Functions accounted for significant unique variance in ADHD symptom severity. Significant interactions indicated that when negative emotionality is low, but not high, neuropsychological functioning accounts for significant variability in ADHD symptoms, with lower functioning predicting more symptoms. Emotional and neuropsychological functioning, both individually and in combination, play a significant role in the expression of ADHD symptom severity.

The influences of environmental enrichment, cognitive enhancement, and physical exercise on brain development: can we alter the developmental trajectory of ADHD?

Attention-deficit/Hyperactivity Disorder (ADHD) is characterized by a pervasive pattern of developmentally inappropriate inattentive, impulsive and hyperactive behaviors that typically begin during the preschool years and often persist into adulthood. The most effective and widely used treatments for ADHD are medication and behavior modification. These empirically-supported interventions are generally successful in reducing ADHD symptoms, but treatment effects are rarely maintained beyond the active intervention. Because ADHD is now generally thought of as a chronic disorder that is often present well into adolescence and early adulthood, the need for continued treatment throughout the lifetime is both costly and problematic for a number of logistical reasons. Therefore, it would be highly beneficial if treatments would have lasting effects that remain after the intervention is terminated. This review examines the burgeoning literature on the underlying neural determinants of ADHD along with research demonstrating powerful influences of environmental factors on brain development and functioning. Based upon these largely distinct scientific literatures, we propose an approach that employs directed play and physical exercise to promote brain growth which, in turn, could lead to the development of potentially more enduring treatments for the disorder.

Mother-child dyadic synchrony is associated with better functioning in hyperactive/inattentive preschool children.

BACKGROUND: Hyperactive/inattentive (HI) behaviors are common in preschoolers, but they result in functional impairment and attention deficit/hyperactivity disorder (ADHD) diagnoses in only some children. We examined whether the quality of mother-child interaction accounts for variance in level of functioning among preschool children with elevated ADHD symptoms. METHOD: Parent and teacher ADHD-RS ratings were used to assess 126 HI preschoolers, and clinician Children's Global Assessment Scale (CGAS) ratings were used to quantify level of functioning. Mother-child interactions during a 5-minute free-play and a 5-minute structured task were coded for child, parent and dyadic behaviors. RESULTS: Partial correlations, controlling for symptom severity and IQ, revealed child and dyad factors that were related to children's functioning. Regression analyses revealed that low dyadic synchrony accounted for additional unique variance in children's functioning, above and beyond the influence of symptom severity and IQ. CONCLUSIONS: Dyadic synchrony between mother and child plays a role in the functioning of preschool children displaying elevated symptoms of hyperactivity/inattention, and may represent a potential area for intervention that is not generally addressed in most parent management training programs.

Moderating effects of neurocognitive abilities on the relationship between temperament and global functioning.

Clear links between temperament, psychopathology, and neuropsychological functioning exist; however the interrelations among temperament and neuropsychology, and their impact on functioning in typically developing children is not as well understood. This study examined the degree to which neuropsychological functioning, as measured by the NEPSY, moderates the impact of temperament on global functioning, as measured by the Children's Global Assessment Scale (CGAS), in 74 typically developing preschoolers. Temperament was assessed via parent ratings on the Children's Behavior Questionnaire (CBQ) and teacher ratings on the Temperament Assessment Battery for Children--Revised (TABC-R). Moderation analyses revealed significant interactions between verbal-executive skills and both child emotionality and lack of task persistence in predicting global functioning. The interaction patterns were mostly consistent across measures and indicated that when lower neurocognitive scores were coupled with higher levels of expressed negative emotions and more difficulties in task persistence, global functioning was at its lowest. In contrast better neurocognitive functioning mitigated the impact of high expressed emotions on global functioning. These findings support past literature and indicate that emotional and cognitive functioning interact to effect young children's global functioning.

The impact of impairment criteria on rates of ADHD diagnoses in preschoolers.

Behaviors characteristic of ADHD are common among preschool children, and as such, their clinical significance is oftentimes difficult to ascertain. Thus a focus on impairment is essential in determining the clinical significance of these behaviors. In order to explore the impact of impairment criteria on rates of diagnoses in inattentive/hyperactive children aged 36 through 60-months-old, we first developed, and psychometrically evaluated, the Children's Problem Checklist (CPC) which was designed to assess psychosocial impairment associated with ADHD in a community sample of preschoolers (n = 394), and found its reliability and validity to be acceptable. We then examined the impact of the inclusion of various CPC-determined impairment criteria, over and above symptom criteria measured by the ADHD-RS-IV, using various cut points ranging from the 75th to 90th percentile of our community sample. This reduced the number of children meeting criteria for ADHD by 46-77%. These findings are discussed in terms of the importance of using impairment criteria, rather than just severity of inattention, impulsivity and hyperactivity, when diagnosing ADHD in preschool children.