Emotion Regulation and Organizational Skills in Children With ADHD Symptoms Are Associated With Behavioral Parent Training Adherence.

OBJECTIVE: Behavioral parent training (BPT) is a well-established treatment for ADHD; however, treatment response is variable. Consistency in parent skill use during BPT is known to influence child outcomes post-treatment, while less research has focused on specific child factors that may be impacting parent skill utilization during treatment. The current study examined associations between child organizational skills and emotion dysregulation (ED) with parent treatment adherence during BPT and post-treatment child impairment. METHOD: Parents of 72 children (Mage = 8.31) with ADHD symptoms and impairment participated in BPT which was embedded in a 12-week, multicomponent, school-based intervention for children delivered by school mental health clinicians. Outcomes included parent treatment adherence and child improvements in global impairment post-treatment. RESULTS: Greater pre-treatment child organizational problems were associated with less parent treatment adherence regardless of ADHD symptom severity. Worse pre-treatment child ED was associated with more impairment post-treatment regardless of ADHD symptom severity whereas the effects of child ED on parent treatment adherence were moderated by child ADHD symptom severity. CONCLUSION: The current study suggests that pre-treatment child ED and organizational difficulties impact parent treatment adherence to behavioral interventions targeting ADHD symptoms, potentially in unique ways, and should be considered in future BPT treatment studies.

Development of a Web-Based Training Platform for School Clinicians in Evidence-Based Practices for ADHD.

Lack of training for school clinicians in evidence-based practices (EBPs) contributes to underutilization of such services for youth with attention-deficit/hyperactivity disorder (ADHD). Advances in web-based technology and videoconferencing have allowed for expanded access to and optimization of training. We describe the development and outcomes of a novel web-based platform for training school clinicians to gain skills in EBPs for school-age youth with ADHD. The training platform is adapted from an empirically supported, in-person training for a school-home behavioral intervention (Collaborative Life Skills program) and includes skill modules for working with teachers, parents, and students. Training methods include web-accessed manuals/handouts, skill example video clips, automated progress monitoring tools, and consultation/in-session coaching via videoconferencing. We gathered stakeholder qualitative and quantitative feedback during discovery and design phases of the iterative development. We then evaluated the usability, acceptability, fidelity and clinician and student outcomes of the remote training program. Focus group themes and qualitative feedback identified clinician preferences for remote training features (e.g., interactive, brief, role-plays/coaching methods), video tools (recorded samples of skills and therapy sessions), and progress monitoring tools (e.g., clear, easy to use). Clinician usability ratings of the platform were high with most components rated as moderately to very useful/easy to use. Clinician ratings of usability, fidelity implementing the treatment, and their EBP knowledge and confidence following training were favorable. Student's outcomes were similar to those achieved in prior studies of clinician in-person training. Results support the promise of remote, web-based clinician training for the dissemination of evidence-based practices.

Improving Adherence to Behavioral Parent Training for ADHD Using Digital Health Tools.

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.

Early childhood depression, emotion regulation, episodic memory, and hippocampal development.

Depression in adults is associated with deficits in a number of cognitive domains, however it remains less clear how early in development theses deficits can be detected in early onset depression. There are several different hypotheses about the links between cognitive function and depression. For example, it has been argued that executive function deficits contribute to emotion regulation difficulties, which in turn increase risk for depression. Further, it has been suggested that some cognitive deficits, such as episodic memory, may reflect hippocampal abnormalities linked to both depression and episodic memory. We examined these questions in adolescents participating in a longitudinal study of preschool onset depression. We measured cognitive function at adolescence using the National Institutes of Health toolbox (vocabulary, processing speed, executive function, working memory and episodic memory), and examined relationships of cognitive deficits to depression, emotion regulation, life stress and adversity, as well as hippocampal volume trajectories over three imaging assessments starting at school age. Depression related deficits in episodic memory were found. Youths with either current and past depression showed episodic memory deficits even after controlling for other psychopathology and family income. Depression severity, emotion dysregulation, and life stress/adversity all predicted episodic memory impairment, as did smaller intercepts and slopes of hippocampal growth over time. Modest relationships of depression to hippocampal volume and strong relationships between emotion regulation and both episodic memory and hippocampal volume were found. These data are consistent with prior work in adults linking depression, episodic memory, emotion regulation, life stress/adversity, and hippocampal volume in adults and suggest similar relations are evident as early as adolescence when memory systems are under development. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Preschool Executive Function Predicts Childhood Resting-State Functional Connectivity and Attention-Deficit/Hyperactivity Disorder and Depression.

BACKGROUND: Measures of executive function (EF), such as the Behavior Rating Inventory of Executive Function, distinguish children with attention-deficit/hyperactivity disorder (ADHD) from control subjects, but less work has examined relationships to depression or brain network organization. This study examined whether early childhood EF predicted new onset or worsening of ADHD and/or depression and examined how early childhood EF related to functional connectivity of brain networks at school age. METHODS: Participants included 247 children who were enrolled at 3 to 6 years of age from a prospective study of emotion development. The Behavior Rating Inventory of Executive Function Global Executive Composite score was used as the measure of EF in early childhood to predict ADHD and depression diagnoses and symptoms across school age. Resting-state functional magnetic resonance imaging network analyses examined global efficiency in the frontoparietal, cingulo-opercular, salience, and default mode networks and six "hub" seed regions selected to examine between-network connectivity. RESULTS: Early childhood EF predicted new onset and worsening of ADHD and depression symptoms across school age. Greater EF deficits in preschool predicted increased global efficiency in the salience network and altered connectivity with four regions for the dorsal anterior cingulate cortex hub and one region with the insula hub at school age. This altered connectivity was related to increasing ADHD and depression symptoms. CONCLUSIONS: Early executive deficits may be an early common liability for risk of developing ADHD and/or depression and were associated with altered functional connectivity in networks and hub regions relevant to executive processes. Future work could help clarify whether specific EF deficits are implicated in the development of both disorders.

Overlapping and Distinct Cognitive Impairments in Attention-Deficit/Hyperactivity and Autism Spectrum Disorder without Intellectual Disability.

Attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) are commonly comorbid, share genetic liability, and often exhibit overlapping cognitive impairments. Clarification of shared and distinct cognitive effects while considering comorbid symptoms across disorders has been lacking. In the current study, children ages 7-15 years assigned to three diagnostic groups:ADHD (n = 509), ASD (n = 97), and controls (n = 301) completed measures spanning the cognitive domains of attention/arousal, working memory, set-shifting, inhibition, and response variability. Specific processes contributing to response variability were examined using a drift diffusion model, which separately quantified drift rate (i.e., efficiency of information processing), boundary separation (i.e., speed-accuracy trade-offs), and non-decision time. Children with ADHD and ASD were impaired on attention/arousal, processing speed, working memory, and response inhibition, but did not differ from controls on measures of delayed reward discounting, set-shifting, or interference control. Overall, impairments in the ASD group were not attributable to ADHD symptoms using either continuous symptom measures or latent categorical grouping approaches. Similarly, impairments in the ADHD group were not attributable to ASD symptoms. When specific RT parameters were considered, children with ADHD and ASD shared impairments in drift rate. However, children with ASD were uniquely characterized by a wider boundary separation. Findings suggest a combination of overlapping and unique patterns of cognitive impairment for children with ASD as compared to those with ADHD, particularly when the processes underlying reaction time measures are considered separately.

Omega-3 fatty acid and ADHD: blood level analysis and meta-analytic extension of supplementation trials.

UNLABELLED: Interest in the value of omega-3 (n-3) fatty acid supplementation for treatment of ADHD remains high. No prior meta-analysis has examined whether ADHD is associated with alterations in blood lipid levels and meta-analyses of supplementation have reached conflicting conclusions. METHODS: We report two new meta-analyses. Study 1 examined blood levels of omega-3 fatty acids in relation to ADHD. Study 2 examined a larger sample of randomized intervention trials than previously reported. RESULTS: Study 1 included 9 studies (n=586) and found lower overall blood levels of n-3 in individuals with ADHD versus controls (g=0.42, 95% CI=0.26-0.59; p<.001). Study 2 included 16 studies (n=1408) and found that n-3 supplementation improved ADHD composite symptoms; using the best available rating and reporter (g=0.26, 95% CI=0.15-0.37; p<.001). Supplementation showed reliable effects on hyperactivity by parent and teacher report, but reliable effects for inattention only by parent report. CONCLUSIONS: Omega-3 levels are reduced in children with ADHD. Dietary supplementation appears to create modest improvements in symptoms. There is sufficient evidence to consider omega-3 fatty acids as a possible supplement to established therapies. However it remains unclear whether such intervention should be confined to children with below normal blood levels.

Structural and functional connectivity of the human brain in autism spectrum disorders and attention-deficit/hyperactivity disorder: A rich club-organization study.

Attention-deficit/hyperactive disorder (ADHD) and autism spectrum disorders (ASD) are two of the most common and vexing neurodevelopmental disorders among children. Although the two disorders share many behavioral and neuropsychological characteristics, most MRI studies examine only one of the disorders at a time. Using graph theory combined with structural and functional connectivity, we examined the large-scale network organization among three groups of children: a group with ADHD (8-12 years, n = 20), a group with ASD (7-13 years, n = 16), and typically developing controls (TD) (8-12 years, n = 20). We apply the concept of the rich-club organization, whereby central, highly connected hub regions are also highly connected to themselves. We examine the brain into two different network domains: (1) inside a rich-club network phenomena and (2) outside a rich-club network phenomena. The ASD and ADHD groups had markedly different patterns of rich club and non rich-club connections in both functional and structural data. The ASD group exhibited higher connectivity in structural and functional networks but only inside the rich-club networks. These findings were replicated using the autism brain imaging data exchange dataset with ASD (n = 85) and TD (n = 101). The ADHD group exhibited a lower generalized fractional anisotropy and functional connectivity inside the rich-club networks, but a higher number of axonal fibers and correlation coefficient values outside the rich club. Despite some shared biological features and frequent comorbity, these data suggest ADHD and ASD exhibit distinct large-scale connectivity patterns in middle childhood.

Shared familial transmission of autism spectrum and attention-deficit/hyperactivity disorders.

BACKGROUND: To determine whether familial transmission is shared between autism spectrum disorders and attention-deficit/hyperactivity disorder, we assessed the prevalence, rates of comorbidity, and familial transmission of both disorders in a large population-based sample of children during a recent 7 year period. METHODS: Study participants included all children born to parents with the Kaiser Permanente Northwest (KPNW) Health Plan between 1 January 1998 and 31 December 2004 (n = 35,073). Children and mothers with physician-identified autism spectrum disorders (ASD) and/or attention-deficit/hyperactivity disorder (ADHD) were identified via electronic medical records maintained for all KPNW members. RESULTS: Among children aged 6-12 years, prevalence was 2.0% for ADHD and 0.8% for ASD; within those groups, 0.2% of the full sample (19% of the ASD sample and 9.6% of the ADHD sample) had co-occurring ASD and ADHD, when all children were included. When mothers had a diagnosis of ADHD, first born offspring were at 6-fold risk of ADHD alone (OR = 5.02, p < .0001) and at 2.5-fold risk of ASD alone (OR = 2.52, p < .01). Results were not accounted for by maternal age, child gestational age, child gender, and child race. CONCLUSIONS: Autism spectrum disorders shares familial transmission with ADHD. ADHD and ASD have a partially overlapping diathesis.