Transdiagnostic considerations are critical to understanding childhood neurodevelopmental disorders.

Growing dissatisfaction with the current categorical diagnostic systems has led to a movement toward transdiagnostic dimensional approaches to assessment of childhood mental health disorders. We argue that a transdiagnostic approach is especially important and appropriate when screening for neurodevelopmental disorders during early childhood. In the early childhood years, symptoms often appear in the form of developmental delays that could portend a variety of different disorders. Early intervention at this point is critical, even though a final endpoint disorder is not yet apparent. Intervening early has the potential to grow the area of weakness, possibly correcting or at least ameliorating these delays. Early intervention requires a multidisciplinary approach integrating efforts across settings and providers that monitor the development of young children. We argue here that young children's language ability is central to the development of social cognition, and a prerequisite for adequate social functioning. Social deficits are defining features of a subset of neurodevelopmental disorders such as autism spectrum disorder and social (pragmatic) communication disorder. Critically, impairment in social functioning is common in additional neurodevelopmental disorders such as attention-deficit/hyperactivity disorder (ADHD), learning disorders, and even motor disorders. For this reason, we argue that, at the earliest sign of a possible neurodevelopmental disorder, children should be screened for language deficits prior to initiating a focused assessment for a specific type of neurodevelopmental disorder such as ADHD. Any detected language deficits should be considered in the design and implementation of the assessment, as well as the ultimate intervention plan.

Do Language-Related Cognitive Capacities Help Predict Adjustment in Children with Attention-Deficit/Hyperactivity Disorder?

The goal of this paper was to examine the role that language-related cognitive capacities (LRCC) might play in explaining adjustment of 7 to 12 year-old children (Mage = 9.24; SDage = 0.91) with and without ADHD. The sample was comprised of 178 children with ADHD and 86 typically-developing children (77.3% male; 81.4% White; 9.5% Black; 1.9% Hispanic; 0.8% Asian; 5.7% multiracial; 0.8% did not report race/ethnicity). Using simultaneous regression, we examined whether LRCC accounted for unique variance in achievement, attention problems, oppositional problems, conduct problems, and internalizing, over and above what standard covariates and ADHD diagnostic status could explain. Finally, we examined LRCC as a mediator of the relation between ADHD diagnostic status and these adjustment measures. Results indicated that LRCC significantly predicted 6 of 7 and partially mediated 5 of 7 measures, suggesting that language-related constructs warrant greater attention in diagnosis and treatment of ADHD.

Language Problems and ADHD Behaviors: Unique and Interactive Associations with School Readiness in a Socioeconomically Disadvantaged Preschool Sample.

This study examined the unique and interactive effects of receptive language ability and ADHD behaviors on six school readiness outcomes, over and above the effects of socioeconomic status, in 49 preschoolers (Mage = 3.98, SDage = .58; 53.06% female) recruited from Head Start-affiliated classrooms. Hierarchical regression analyses revealed unique positive associations between receptive language ability and cognitive and mathematics readiness, and unique negative associations between ADHD behaviors and social-emotional, physical, cognitive, and literacy readiness. Moderation analyses indicated that at higher, but not lower, levels of ADHD behaviors, lower receptive language ability was associated with lower social-emotional readiness. Results highlight that, when considered together, children's receptive language ability and ADHD behaviors vary in how they predict school readiness. Further, results provide preliminary evidence for ADHD behaviors as a risk factor in the association between receptive language deficits and social-emotional school readiness. Educational and clinical practice implications are discussed.

The Developmental Course of Teacher-Rated ADHD Symptom Levels in an Early Childhood Community Sample.

OBJECTIVE: This study examined trajectories of inattention and hyperactivity/impulsivity symptom levels across one preschool year and explored variation in trajectories by age, sex, and end-of-year impairment. METHOD: Participants were 261 preschoolers (87% Head Start; 59% Caucasian; 53% boys; Mage = 3.97 years). Teachers rated ADHD symptom levels four times throughout one academic year. RESULTS: Results showed a course of increasing inattention that decelerated over time and steadily increasing hyperactivity/impulsivity. Group-based finite mixture modeling revealed three trajectories of inattention: stable low (57%), change (32%), and stable high (11%), as well as three trajectories of hyperactivity/impulsivity: stable low (63%), increasing (26%), and stable high (11%). Compared to children with increasing or changing symptoms levels, children with stable high levels were more impaired and children with stable low symptom levels were less impaired. CONCLUSION: Findings suggest a "wait and see" approach to treatment may miss an important opportunity for early intervention.

Meeting a Physical Activity Guideline in Preschool and School Readiness: A Program Evaluation.

This study evaluates if the Kiddie Children and Teachers on the Move physical activity (PA) program improves the proportion of days meeting the Institute of Medicine (IOM) PA guideline, and whether meeting the guideline is correlated with improvement in school readiness. Thirteen Head Start-affiliated pre-kindergarten classrooms participated in this study. Minutes per hour of moderate-to-vigorous physical activity (MVPA) and proportion of days meeting the IOM PA guideline were examined across three types of intervention days: days during a non-intervention period, non-program days during the intervention period, and program days during the intervention period. Children displayed increasingly more MVPA and a greater proportion of days meeting the IOM guideline from non-intervention days to non-program days, and from non-program days to program days. Proportion of days meeting the guideline significantly predicted improvement in school readiness in five of six domains. Examination of program fidelity indicated the program was run with high fidelity.

Moderate-to-vigorous physical activity and processing speed: predicting adaptive change in ADHD levels and related impairments in preschoolers.

BACKGROUND: Preschool ADHD symptoms have predictive utility for later presence of ADHD diagnoses (Harvey, Youngwirth, Thakar, & Errazuriz, 2009, Journal of Consulting and Clinical Psychology, 77, 349; Lahey et al., 2004, American Journal of Psychiatry, 161(11), 2014), yet some level of inattention, hyperactivity, and impulsivity are present even in typically developing preschoolers. Physical activity (PA) is known to have a broad spectrum of positive effects on the brain in school-age typically developing children (Centers for Disease Control and Prevention, 2010, The association between school based physical activity, including physical education, and academic performance. Atlanta, GA: U.S. Department of Health and Human Services), including functions impaired by ADHD (Halperin, Berwid, & O'Neill, 2014, Child and Adolescent Psychiatric Clinics of North America, 23, 899), yet links between PA and ADHD levels and impairments have rarely been studied in either typically developing or at-risk preschool children. Importantly, impaired processing speed (PS), though not a symptom of ADHD, is a robust neuropsychological correlate (Willcutt & Bidwell, 2011, Treating attention deficit hyperactivity disorder: Assessment and intervention in developmental context. Kingston, NJ: Civic Research Institute) that may indicate additional risk for ADHD. Hence, we examined whether baseline PS moderates the association between preschoolers' PA, specifically moderate-to-vigorous PA (MVPA), and changes in ADHD levels and related behaviors. METHOD: Eighty-five preschoolers (49.4% female; Mage  = 4.14, SDage  = .64) were drawn from a larger study of the effects of the Kiddie Children and Teachers (CATs) on the Move PA program on school readiness. The sample was largely Head Start eligible (68.2%) and ethnically diverse. Hierarchical regressions were utilized to examine links between MVPA, averaged over a school year, and changes in inattention (IA), hyperactivity/impulsivity (HI), oppositional behaviors, moodiness, and peer functioning, and whether these associations varied based on baseline PS. RESULTS: Results indicated that for IA, HI, and peer functioning, higher amounts of MVPA were associated with greater adaptive change for those with lower (but not higher) levels of PS. CONCLUSIONS: Preschool MVPA may be a viable method of reducing ADHD levels and impairments for those with lower PS.

Factors Relating to the Presence and Modifiability of Self-Perceptual Bias Among Children with ADHD.

Past research raises concerns about whether the presence of self-perceptual biases among children with attention-deficit/hyperactivity disorder (ADHD) interferes with accurate assessment and/or diminishes treatment response. Yet, it remains unclear whether self-perceptual bias is a construct that can be modified. The current study examines individual differences in how children with ADHD (n = 178) display and modify their self-perceptions of competence in the presence of an external motivator for self-perceptual accuracy. Participants were grouped based on the presence and modifiability of their self-perceptual biases across three experimental conditions. Results demonstrate that the presence and modifiability of participants' self-perceptual biases across conditions was associated with adjustment (i.e., externalizing and internalizing problems) and cognitive functioning. Findings suggest multiple factors may be associated with self-perceptual bias (e.g., self-protection and cognitive impairment), and that these factors may differ across children. Implications for intervention, including whether assessment and treatment can be improved, are discussed.

Distinct Methods for Assessing Compliance With a Physical Activity Guideline for Children in Preschools.

BACKGROUND: According to the US Institute of Medicine guideline, preschool-aged children should participate in ≥15 minutes of physical activity (PA) per hour or 3 hours per day over 12 hours. Examinations of PA guideline compliance to date averaged time spent in PA over several days; however, children could exceed the guideline on some days and not on others. Therefore, this cross-sectional study examined PA guideline compliance in preschool children based on number of minutes per hour (average method) and percentage of days the guideline was met (everyday method). METHODS: PA was measured by accelerometry during the preschool day for up to 10 days in 177 children (59.3% males, Mage = 4.23). Minutes per hour and percentage of time in light, moderate to vigorous, and total PAs were calculated. Percentage of days in compliance was determined by number of days in compliance (defined as the child active on average ≥15 min/h) divided by total accelerometer days. RESULTS: Children engaged in PA, on average, 17.01 minutes per hour, suggesting that on average, children are meeting the guideline. However, children were only in compliance with the PA guideline 62.41% of assessment days. CONCLUSIONS: Findings demonstrate the importance of examining compliance with both the average and everyday methods to more accurately portray level of Institute of Medicine PA guideline compliance.

Does a social self-perceptual bias mask internalizing symptoms in children with attention-deficit/hyperactivity disorder?

BACKGROUND: Children with attention-deficit/hyperactivity disorder (ADHD) often present with additional psychiatric conditions. Comorbidity is associated with poorer long-term outcomes, highlighting the need for effective assessment and intervention. However, self-perceptual biases may mask the presence of symptoms for a subgroup of children with ADHD. This study examined the role of social self-perceptual biases in children with ADHD versus control children on self-reports of loneliness, and depressive and anxious symptoms. METHODS: The research question was examined in two samples. Sample 1 consisted of 7.7-12.8-year-old boys with ADHD (n = 199) and control boys (n = 74); Sample 2 consisted of 7.7-11.4-year-old boys and girls with ADHD (n = 178) and control children (n = 86). Across samples, children reported social competence and symptoms of anxiety and depression. Child-reported loneliness was examined in Sample 1. A social competence discrepancy score (difference between self-report and teacher-report) was used as an indicator of social self-perceptual bias. RESULTS: Hierarchical multiple regression analyses tested social self-perceptual bias as a suppressor variable. The magnitude of the associations between ADHD and self-reported feelings of depression, anxiety and loneliness was greater when social self-perceptual bias was included in models as compared to models that did not include social self-perceptual bias (ΔR2 s range = 0.04-0.19). CONCLUSIONS: Findings across both samples suggest that social self-perceptual biases may mask internalizing symptom severity on self-reports for individuals who overestimate their social competence. More research is needed to determine the best approach to assessing internalizing problems among children with ADHD.

Social Costs for Wannabes: Moderating Effects of Popularity and Gender on the Links between Popularity Goals and Negative Peer Experiences.

Youth in early adolescence are highly concerned with being popular in the peer group, but the desire to be popular can have maladaptive consequences for individuals. In fact, qualitative work suggests that youth with high popularity goals who are nonetheless unpopular have negative experiences with their peers. However, little quantitative work has examined this possibility. The purpose of the current study was to examine if popularity goals were linked with physical (e.g., being hit) and relational (e.g., being excluded) victimization and peer rejection, particularly for individuals who strived for popularity but were viewed by their peers as unpopular. Late elementary and early middle school participants (N = 205; 54% female) completed self-reports of popularity goals and peer nominations of popularity and peer rejection. Teachers reported on students' experiences of relational and physical victimization. Peer nominated popularity and gender were moderators of the association between popularity goals and negative peer experiences. Consistent with hypotheses, girls who were unpopular but wanted to be popular were more likely to experience peer rejection and relational victimization. Unexpectedly, boys who were unpopular but did not desire to be popular were more likely to be rejected and relationally victimized. The findings suggest that intervention and prevention programs may benefit from addressing the social status goals of low status youth in a gender-specific manner.

Aerobic Fitness and Inhibition in Young Children: Moderating Roles of ADHD Status and Age.

We examined the relation between aerobic fitness and inhibition in young children with and without attention deficit hyperactivity disorder (ADHD)-risk status. Participants (91 ADHD risk, 107 typically developing, Mage = 6.83, 53.5% male, 68.2% Caucasian) completed an assessment of aerobic fitness and a flanker task requiring variable amounts of inhibitory control. Aerobic fitness was positively associated with inhibition. When inhibitory control demands were largest, the relation varied as a function of ADHD-risk status such that the link between aerobic fitness and inhibition was significant only for children with ADHD risk. The relation between aerobic fitness, status, and inhibition was further moderated by age for interference control. Specifically, the positive relation between aerobic fitness and interference control was only significant for younger children with ADHD risk. A fitness-cognition link appears in young childhood that seems particularly salient for those in the earliest school years with ADHD risk. The findings extend work on typically developing children and suggest that exploring aerobic fitness interventions to address executive function impairments in children at risk for ADHD is warranted.

Exploration of the Factor Structure of ADHD in Adolescence through Self, Parent, and Teacher Reports of Symptomatology.

Factor analytic studies of attention-deficit/hyperactivity disorder (ADHD) in children and adults have shown that second-order and bifactor models better represent ADHD symptoms than two- or three-factor models, yet there is far less evidence for a bestfitting model of ADHD in adolescence. Thus, the current study examined the factor structure of ADHD in adolescence and further evaluated the external validity of the best fitting model. Participants were 588 adolescents (22 % female; 366 with a childhood ADHD diagnosis; mean age 15.9 years) from the 8-year assessment of the Multimodal Treatment Study of Children with ADHD (MTA). ADHD symptoms were assessed via adolescent self-report, parent report, and teacher report on the SNAP-IV scale. Potential factor structures for the 18 symptoms of ADHD were tested for each informant, which included traditional one-factor, two-factor, and three-factor models of ADHD, as well as second-order factor (specific factors loading onto general factor) and bifactor (items loading onto both specific and general factors) models. Unique associations between external criteria and the identified factors of each informant's best fitting model were examined. Although several of the proposed models exhibited good fit, the second-order two-factor model best accounted for ADHD in adolescence according to self-report and parent report, and the second-order three-factor model was optimal according to teacher report. Several key measurement issues emerged for the hierarchical bifactor models, such as numerous Heywood cases and out-of-bound parameter estimates, which rendered them unfit as optimal representations of ADHD in adolescence. These findings and the implications of the best fitting model of ADHD in adolescence suggest that a possible reorganization of this disorder may eventually aid clinicians in the accurate diagnosis of ADHD in adolescents.

Using Physical Activity to Manage ADHD Symptoms:The State of the Evidence.

This article summarizes the evidence for management of attention-deficit/hyperactivity disorder (ADHD) using chronic aerobic physical activity (PA). Known studies comparing chronic aerobic PA to at least one control group are listed; uncontrolled studies and studies of non-aerobic PA are not considered. Key challenges to conducting chronic PA studies with children and youth with ADHD are summarized. After condensing information from widely varying studies, measures, and research designs, conclusions are stated in broad brush stroke terms. Preliminary evidence supports PA as beneficial for ADHD symptoms, executive function, and motor abilities. Social, emotional, and behavioral outcomes also may benefit. The preliminary state of the evidence supports PA as an adjunctive treatment for ADHD at this time, but the body and sophistication of the research to date is insufficient at present to support PA as a stand-alone treatment. Critical directions for future research are discussed.

A randomized trial examining the effects of aerobic physical activity on attention-deficit/hyperactivity disorder symptoms in young children.

The goal of this study was to compare the effects of before school physical activity (PA) and sedentary classroom-based (SC) interventions on the symptoms, behavior, moodiness, and peer functioning of young children (M age = 6.83) at risk for attention-deficit/hyperactivity disorder (ADHD-risk; n = 94) and typically developing children (TD; n = 108). Children were randomly assigned to either PA or SC and participated in the assigned intervention 31 min per day, each school day, over the course of 12 weeks. Parent and teacher ratings of ADHD symptoms (inattention, hyperactivity/impulsivity), oppositional behavior, moodiness, behavior toward peers, and reputation with peers, were used as dependent variables. Primary analyses indicate that the PA intervention was more effective than the SC intervention at reducing inattention and moodiness in the home context. Less conservative follow-up analyses within ADHD status and intervention groups suggest that a PA intervention may reduce impairment associated with ADHD-risk in both home and school domains; interpretive caution is warranted, however, given the liberal approach to these analyses. Unexpectedly, these findings also indicate the potential utility of a before school SC intervention as a tool for managing ADHD symptoms. Inclusion of a no treatment control group in future studies will enable further understanding of PA as an alternative management strategy for ADHD symptoms.

Negative peer status and relational victimization in children and adolescents: the role of stress physiology.

The purpose of the current investigation was to determine the unique associations between two subtypes of low peer status, peer rejection and unpopularity, and changes in relational victimization over time. This study also investigated if these associations were moderated by sympathetic nervous system (SNS) and parasympathetic nervous system (PNS) reactivity to peer stress. Sixty-one girls attending (M(age) = 11.91 years, SD = 1.62; predominantly Caucasian) a residential summer camp were followed across 1 calendar year. Participants' skin conductance and respiratory sinus arrhythmia were assessed during a laboratory stress protocol. Peer rejection and unpopularity were measured using peer nomination techniques and counselors reported on relational victimization. Both unpopularity and rejection were associated with increased relational victimization over time among girls who exhibited reciprocal SNS activation (i.e., high SNS reactivity coupled with PNS withdrawal). Rejection was also associated with subsequent victimization among girls exhibiting reciprocal PNS activation (i.e., low SNS reactivity, PNS activation). Findings underscore the biosocial interactions between low peer status and physiological reactivity in the prediction of peer maltreatment over time.

Biased self-perceptions of social competence and engagement in physical and relational aggression: the moderating role of peer status and sex.

This study sought to expand on prior research suggesting that children low in peer status who either over- or underestimate their social competence relative to others' reports are more likely to be aggressive (White and Kistner [2011]. Journal of Abnormal Child Psychology, 39, 645-656). The curvilinear associations between social competence bias and two forms of aggression (physical and relational) were examined in a sample of 4th through 6th graders (n = 183); moderation by both sex and peer status (peer preference and popularity) also were tested. Social competence bias was operationally defined as the residual difference between child and teacher ratings of the child's social competence. Aggression and peer status were measured using peer nomination procedures. There was a significant curvilinear association between social competence bias and physical aggression moderated by both types of peer status. For low peer status children greater underestimation and overestimation of social competence was associated with higher physical aggression. The curvilinear association between social competence bias and relational aggression was moderated by both peer status and sex. Popular boys had higher rates of relational aggression when they had accurate, rather than biased, self-perceptions of social competence. However, for very highly preferred girls, a more extreme positive bias was associated with an exponential increase in relational aggression. Results are discussed in terms of implications for aggression theory and intervention.

Working memory and social functioning in children.

This study extends previous research and examines whether working memory (WM) is associated with multiple measures of concurrent social functioning (peer rejection, overall social competence, relational aggression, physical aggression, and conflict resolutions skills) in typically developing fourth- and fifth-grade children (N=116). Poor central executive WM was associated with both broad social impairments (peer rejection and poor overall social competence) and specific social impairments (physical aggression, relational aggression, and impaired conflict resolution skills); poor verbal storage was associated only with greater peer rejection, and spatial storage was not associated with any measures of social impairment. Analyses also examined whether specific impairments in aggressive behavior and conflict resolution skills mediated the association between central executive and broad measures of social functioning. Greater physical aggression and impaired conflict resolution skills were both significant mediators; relational aggression was not. Implications for theory and future research are discussed.

The role of coparents in African American single-mother families: the indirect effect of coparent identity on youth psychosocial adjustment.

The majority (67%) of African American youth live in single-parent households, a shift in the family structure that has been linked to increased risk for both internalizing and externalizing problem behaviors. Although the majority of single mothers endorse the assistance of another adult or family member in child rearing, relatively little is known about who is engaged in this nonmarital coparenting role (i.e., grandmother, father/social father, aunt, and female family friend) and how it relates to coparenting quality, maternal parenting, and youth psychosocial outcomes (i.e., internalizing and externalizing problems). This question, which is critical to the advancement of family focused programming for youth in these families, is addressed in this study. The participants examined in the current study were 159 African American single-mother child dyads. Adolescents' maternal grandmothers constituted the largest proportion of coparents in the sample (37.2%), followed by the mothers' female family friends (22.5%), adolescents' maternal aunts (12.7%), and adolescents' fathers/social fathers (11%). Differences emerged among groups of coparents in support and conflict with the mother. Specifically, grandmothers, aunts, and female family friends provided significantly more instrumental support than fathers. Furthermore, grandmothers and fathers had more conflict with the mother, both generally and specifically in front of the child, than aunts or female family friends. In turn, these differences were associated directly and indirectly through maternal parenting with internalizing and externalizing problems. Clinical implications and future directions are discussed.

Pilot physical activity intervention reduces severity of ADHD symptoms in young children.

OBJECTIVE: Physical activity associates with mental health and neurocognitive function, showing potential for addressing ADHD symptoms. As a preliminary assessment of this potential, the authors piloted a before-school physical activity intervention for young children. METHOD: Seventeen children (Grades K-3) exhibiting four or more hyperactivity/impulsivity symptoms on the Disruptive Behavior Disorders Rating Scale (Pelham, 2002) completed about 26 min of continuous moderate-to-vigorous physical activity daily over eight school weeks. The authors administered cognitive, motor, social, and behavioral functioning measures at pre- and postprogram, assessed response inhibition weekly, and coded negative behaviors daily. RESULTS: Several measures showed significant or marginally significant change over time (effect size = 0.35-0.96) with additional measures showing meaningful effect size values (≥ 0.20). Response inhibition effects were most consistent. Most participants (64% to 71%) exhibited overall improvement according to postprogram parent, teacher, and program staff ratings. CONCLUSION: Physical activity shows promise for addressing ADHD symptoms in young children.

The protective role of teacher preference for at-risk children's social status.

Aggressive behaviors have been associated with social costs (e.g., rejection) and benefits (e.g., popularity) in previous studies. The current study sought to examine the moderating effect of teacher preference on the association between distinct forms of aggressive behavior (i.e., physical aggression and relational aggression) and social status (i.e., rejection and popularity), and to explore whether these associations differed for boys and girls. Fourth and fifth grade students (N = 193) completed peer nomination procedures to assess rejection and aggressive behavior and teachers provided self-reports of their preferences for their students. Findings indicated that relationally aggressive girls were more likely to be popular with their peers when their teachers also liked them. In addition, both relationally and physically aggressive girls were less likely to be rejected by their peers when their teachers liked them. Although physical aggression was most strongly associated with rejection among boys whose teachers liked them, relational aggression predicted popularity among boys whose teachers disliked them. Results suggest that teacher preferences may be a particularly important factor contributing to both physically and relationally aggressive children's social status (e.g., rejection and popularity), especially for girls.