APA Journal of Abnormal Psychology

Attention-deficit/hyperactivity disorder across development: Predictors, resilience, and future directions.

The goal of this Introduction to the Special Section is to synthesize recent conceptual, methodological, and developmental advances in the field of abnormal psychology and to highlight future directions for research that will catalyze innovations in our understanding of ADHD across development. (PsycINFO Database Record (c) 2016 APA, all rights reserved)

Early development of comorbidity between symptoms of attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD).

Attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) are among the most common childhood disorders and frequently co-occur. The present study sought to advance our understanding of how comorbidity between ADHD and ODD develops during the preschool years by testing a cross-lagged model that integrates 2 prominent models: the developmental precursor model and the correlated risk factors model. Participants were 199 children (107 boys) who took part in a longitudinal study of preschoolers with behavior problems. Parent reports of ADHD and ODD symptoms were collected annually from ages 3 to 6 and a family history interview was administered at age 3. In support of the developmental precursors model, ADHD symptoms predicted later argumentative/defiant symptoms. In support of the correlated risk factors model, family histories of ADHD and ODD/CD symptoms were correlated risk factors that uniquely predicted ADHD and anger/irritable symptoms in children. Results suggest that the correlated risk factors model may best explain the development of comorbidity between symptoms of ADHD and anger/irritability, whereas the developmental precursors model may better explain the development of comorbidity between symptoms of ADHD and argumentative/defiance. (PsycINFO Database Record (c) 2016 APA, all rights reserved)

Predictors of adolescent outcomes among 4–6-year-old children with attention-deficit/hyperactivity disorder.

Children who met Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-IV) criteria for attention-deficit/hyperactivity disorder (ADHD) with functional impairment in at least one setting at 4–6 years of age were followed prospectively through age 18 years. On average, the 125 children (107 boys) with ADHD at baseline improved over time, but still continued to exhibit more symptoms, functional impairment, and risky behavior through adolescence than demographically matched healthy comparison children. These findings support the predictive validity of the diagnosis of ADHD at younger ages by demonstrating that the symptoms and impairment are enduring. Nonetheless, there were marked variations in developmental outcomes. Among children with ADHD, higher numbers of inattention and hyperactivity-impulsivity symptoms and higher number of concurrent symptoms (oppositional, conduct disorder, anxiety, and depression) measured at baseline each predicted higher future levels of the same dimension of symptoms. In addition, higher baseline levels of inattention, oppositional, conduct disorder, and anxiety symptoms predicted greater future functional impairment. Among children with ADHD, girls and children from families with lower family incomes had relatively poorer outcomes. Although outcomes varied along a continuum, approximately 10% of the children with ADHD at 4–6 years could be classified as functioning in the normative range on multiple measures during 15–18 years. Although this finding awaits replication, lower levels of hyperactivity-impulsivity symptoms at 4–6 years predicted more normative functioning during adolescence. These findings suggest that ADHD identified in early childhood predicts an increased likelihood of functional impairment through adolescence for most, but not all, children. (PsycINFO Database Record (c) 2016 APA, all rights reserved)

Attention-deficit/hyperactivity disorder developmental trajectories related to parental expressed emotion.

In the transition from childhood to adolescence, attention-deficit/hyperactivity disorder (ADHD) developmental trajectories diverge. Family environment, as indexed by parental expressed emotion, may moderate these trajectories. 388 children with ADHD and 127 controls were assessed using multi-informant, multimethod diagnostic procedures at up to 3 time points 1 year apart in an accelerated longitudinal design spanning ages 7–13 years. Latent-class growth analysis was used to identify developmental trajectories for parent- and teacher-rated ADHD and oppositional-defiant disorder (ODD) symptoms within the ADHD sample. Parental expressed emotion, criticism, and emotional overinvolvement were coded from a 5-min speech sample at 2 time points, 1 year apart, for 208 of these children and compared among ADHD trajectory groups. Results: Parent-rated hyperactivity yielded a 4-class trajectory solution in latent-class growth analysis; teacher-rated inattention yielded a 3-trajectory solution. Teacher-rated ODD also yielded 3-trajectory solution. A parent-rated high persistent hyperactive group was more likely than the other ADHD groups to have parents with stable high criticism (34.6%, p < .001), with ODD symptoms controlled. A teacher-identified high ODD-worsening group was more likely to experience high criticism, particularly the initial time point; (87.5%, p < .001), with hyperactivity controlled. Parental criticism, an index of the family environment, is uniquely associated with divergent developmental trajectories among children with ADHD in addition to those associated with ODD symptoms. Lay summary: For many children, ADHD symptoms decrease as they transition to adolescence. Family environmental factors, such as parental criticism, may help explain for whom symptom remission is less likely. (PsycINFO Database Record (c) 2016 APA, all rights reserved)

Temperament, executive control, and attention-deficit/hyperactivity disorder across early development.

Research examining factors linking early temperament and later attention-deficit/ hyperactivity disorder (ADHD) is limited by cross-sectional approaches and having the same informant rate both temperament and psychopathology. The authors used multiinformant/multimethod longitudinal data to test the hypothesis that negative emotionality during preschool is positively associated with ADHD symptom severity in middle childhood, but developing executive control mediates this relation. Children (N = 161) with and without ADHD were evaluated 3 times: parent and teacher temperament ratings and NEPSY visual attention at ages 3–4 years; Wechsler Intelligence Scale for Children-4th edition Working Memory Index and NEPSY Response Set at age 6 years; and ADHD symptoms using the Kiddie-SADS at age 7 years. Parent and teacher ratings of preschoolers’ temperament were combined to form an anger/frustration composite. Similarly, an executive functioning composite was derived from age 6 measures. Bootstrapping was used to determine whether age 6 executive functioning mediated the relation between early anger/frustration and later ADHD symptom severity, while controlling for early executive functioning. Preschoolers’ anger/frustration was significantly associated with later ADHD symptoms, with this relation partially mediated by age 6 executive functioning. Developing executive control mediates the relation between early anger/frustration and later ADHD symptom severity, suggesting that anger/frustration influences ADHD symptom severity through its impact on developing executive control. Early interventions targeting the harmful influences of negative emotionality or enhancing executive functioning may diminish later ADHD severity. (PsycINFO Database Record (c) 2016 APA, all rights reserved)

Developmental trajectories of clinically significant attention-deficit/hyperactivity disorder (ADHD) symptoms from grade 3 through 12 in a high-risk sample: Predictors and outcomes.

Developmental trajectories of clinically significant attention-deficit/hyperactivity (ADHD) symptoms were explored in a sample of 413 children identified as high risk because of elevated kindergarten conduct problems. Symptoms of inattention and hyperactivity-impulsivity were modeled simultaneously in a longitudinal latent class analyses, using parent reports collected in Grades 3, 6, 9, and 12. Three developmental trajectories emerged: (1) low levels of inattention and hyperactivity (low), (2) initially high but then declining symptoms (declining), and (3) continuously high symptoms that featured hyperactivity in childhood and early adolescence and inattention in adolescence (high). Multinomial logistic regressions examined child characteristics and family risk factors as predictors of ADHD trajectories. Relative to the low class, children in the high and declining classes displayed similar elevations of inattention and hyperactivity in early childhood. The high class was distinguished from the declining class by higher rates of aggression and hyperactivity at school and emotion dysregulation at home. In contrast, the declining class displayed more social isolation at home and school, relative to the low class. Families of children in both high and declining trajectory classes experienced elevated life stressors, and parents of children in the high class were also more inconsistent in their discipline practices relative to the low class. By late adolescence, children in the high class were significantly more antisocial than those in the low class, with higher rates of arrests, school dropout, and unemployment, whereas children in the declining class did not differ from those in the low trajectory class. The developmental and clinical implications of these findings are discussed. (PsycINFO Database Record (c) 2016 APA, all rights reserved)

Childhood conduct problems and young adult outcomes among women with childhood attention-deficit/hyperactivity disorder (ADHD).

We tested whether conduct problems predicted young adult functioning and psychiatric symptoms among women diagnosed with attention-deficit/hyperactivity disorder (ADHD) during childhood, in the context of 3 potential adolescent mediators: internalizing problems, peer rejection, and school failure and disciplinary problems. We controlled for childhood ADHD severity, IQ, and demographic factors, and in the mediational tests, for adolescent conduct problems. Data came from 140 participants in the Berkeley Girls With ADHD Longitudinal Study. We used bootstrapping methods to assess indirect effects (mediators). Both childhood, F(1, 118) change = 9.00, p = .003, R2 change = .069, and adolescent, F(1, 109) change = 10.41, p = .002, R2 change = .083, conduct problems were associated with worse overall functioning during young adulthood, controlling for initial ADHD severity, child IQ, and demographics. Results were similar when predicting psychiatric symptoms. Adolescent school failure and disciplinary problems mediated the relations between childhood conduct problems and both young adult functioning and externalizing problems; adolescent internalizing problems and peer conflict mediated the relation between childhood conduct problems and young adult internalizing problems. As is true for boys, childhood and adolescent conduct problems are associated with poor adult outcomes among girls with ADHD, with school failure and disciplinary problems, internalizing problems, and peer conflict functioning as mediators of these relations. (PsycINFO Database Record (c) 2016 APA, all rights reserved)

Progression of impairment in adolescents with attention-deficit/hyperactivity disorder through the transition out of high school: Contributions of parent involvement and college attendance.

Long-term, prospective follow-up studies of children diagnosed with attention-deficit/hyperactivity disorder (ADHD) show that symptoms tend to decline with age, but impairments in daily life functioning often persist into adulthood. We examined the developmental progression of impairments before and after the transition out of high school in relation to parent involvement during adolescence, parent support during adulthood, and college attendance, using 8 waves of data from the prospective 16-year follow-up of the Multimodal Treatment of ADHD (MTA) study. Participants were 548 proband children diagnosed with Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM–IV; American Psychiatric Association, 2000) ADHD Combined Type and 258 age- and sex-matched comparison children (Local Normative Comparison Group; LNCG) randomly sampled from probands’ schools. Impairment was assessed consistently by parent report from childhood through adulthood. Results showed that impairment worsens over time both before and after the transition to adulthood for those with ADHD histories, in contrast to non-ADHD peers, whose impairments remained stably low over time. However, impairment stabilized after leaving high school for young adults with ADHD histories who attended college. Involved parenting in adolescence was associated with less impairment overall. Attending college was associated with a stable post-high school trajectory of impairment regardless of parents’ involvement during adolescence, but young adults with histories of involved parenting and who attended college were the least impaired overall. (PsycINFO Database Record (c) 2016 APA, all rights reserved)

Recent longitudinal studies of childhood attention-deficit/hyperactivity disorder: Important themes and questions for further research.

What we can see from the studies included here are that most cases of attention-deficit/hyperactivity disorder (ADHD) persist from the preschool years into elementary school and on into adolescence, although trajectories vary considerably across individuals. Several studies here identified a small set of unique developmental trajectories for the symptoms of ADHD. All in all, the longitudinal studies of ADHD included here have greatly advanced our understanding of the developmental course and outcomes associated with childhood ADHD. (PsycINFO Database Record (c) 2016 APA, all rights reserved)

Examining whether offspring psychopathology influences illness course in mothers with recurrent depression using a high-risk longitudinal sample.

Depression is known to be influenced by psychosocial stressors. For mothers with recurrent depressive illness, the presence of psychopathology in their children may have important effects on their own mental health. Although the impact of maternal depression on child mental health is well-established, no study to date, as far as we are aware, has examined the extent to which offspring psychopathology influences the course of depression in mothers with a history of recurrent depressive illness, what types of child psychopathology impact maternal mental health, or whether risks vary by child gender. Aims were to (a) Use a longitudinal design to examine whether adolescent psychopathology (depression, disruptive behavior disorder; DBD) predicts recurrence of a depressive episode and depression symptom course in women with a history of recurrent depression; and (b) To test if observed effects vary by child gender. 299 mothers with recurrent major depressive disorder and their adolescent offspring were assessed on 2 occasions, 29 months apart. Maternal depression and offspring psychopathology were assessed using semistructured interview measures. Cross-generational links across time were assessed using structural equation modeling. Analyses were adjusted for past severity of maternal depression. Offspring depression symptoms but not DBD symptoms at baseline predicted future episode recurrence in mothers. Depression symptoms in daughters (β = .16, p = .039) but not sons (β = −.07, p = .461), predicted an increase in maternal depression symptoms across time. Psychopathology in daughters is associated with long-term depressive symptoms in women (mothers) with a history of recurrent depression. Findings highlight the importance of careful assessment and management of mental health problems in adolescents for more effective management of maternal depression. This study suggests that offspring symptoms of depression may be important for the recurrence of maternal depression episodes. Girls’ symptoms of depression may be a particularly important psychosocial stressor for the development of depressive symptoms in mothers with a history of recurrent depression. (PsycINFO Database Record (c) 2016 APA, all rights reserved)

From anxious youth to depressed adolescents: Prospective prediction of 2-year depression symptoms via attentional bias measures.

Anxious youth are at heightened risk for subsequent development of depression; however, little is known regarding which anxious youth are at the highest prospective risk. Biased attentional patterns (e.g., vigilance and avoidance of negative cues) are implicated as key mechanisms in both anxiety and depression. Aberrant attentional patterns may disrupt opportunities to effectively engage with, and learn from, threatening aspects of the environment during development and/or treatment, compounding risk over time. Sixty-seven anxious youth (ages 9–14; 36 female) completed a dot-probe task to assess baseline attentional patterns provoked by fearful–neutral face pairs. The time course of attentional patterns both during and after threat was assessed via eye-tracking and pupilometry. Self-reported depressive and anxiety symptoms were assessed 2 years after the conclusion of a larger psychotherapy treatment trial. Eye-tracking patterns indicating threat avoidance predicted greater 2-year depression scores, over and above baseline and posttreatment symptoms. Sustained, postthreat pupillary avoidance (reflecting preferential neural engagement with the neutral relative to the previously threatening location) predicted additional variance in depression scores, suggesting sustained avoidance in the wake of threat further exacerbated risk. Identical eye-tracking and pupil indices were not predictive of anxiety at 2 years. These biobehavioral markers imply that avoidant attentional processing in the context of anxiety may be a gateway to depression across a key maturational window. Excessive avoidance of threat could interfere with acquisition of adaptive emotion regulation skills during development, culminating in the broad behavioral deactivation that typifies depression. Prevention efforts explicitly targeting avoidant attentional patterns may be warranted. (PsycINFO Database Record (c) 2016 APA, all rights reserved)

Inhibition of vicariously learned fear in children using positive modeling and prior exposure.

One of the challenges to conditioning models of fear acquisition is to explain how different individuals can experience similar learning events and only some of them subsequently develop fear. Understanding factors moderating the impact of learning events on fear acquisition is key to understanding the etiology and prevention of fear in childhood. This study investigates these moderators in the context of vicarious (observational) learning. Two experiments tested predictions that the acquisition or inhibition of fear via vicarious learning is driven by associative learning mechanisms similar to direct conditioning. In Experiment 1, 3 groups of children aged 7 to 9 years received 1 of 3 inhibitive information interventions—psychoeducation, factual information, or no information (control)—prior to taking part in a vicarious fear learning procedure. In Experiment 2, 3 groups of children aged 7 to 10 years received 1 of 3 observational learning interventions—positive modeling (immunization), observational familiarity (latent inhibition), or no prevention (control)—before vicarious fear learning. Results indicated that observationally delivered manipulations inhibited vicarious fear learning, while preventions presented via written information did not. These findings confirm that vicarious learning shares some of the characteristics of direct conditioning and can explain why not all individuals will develop fear following a vicarious learning event. They also suggest that the modality of inhibitive learning is important and should match the fear learning pathway for increased chances of inhibition. Finally, the results demonstrate that positive modeling is likely to be a particularly effective method for preventing fear-related observational learning in children. (PsycINFO Database Record (c) 2016 APA, all rights reserved)

Modulation of hyperactive error signals in obsessive–compulsive disorder by dual-task demands.

Brain correlates of performance-monitoring have been shown to be hyperactive in patients with obsessive–compulsive disorder (OCD), indexed by enhanced amplitudes of the error-related negativity (ERN) in the event-related potential (ERP). This hyperactivity was found to be temporally stable, independent of symptom remission, and could not be further increased by punishing committed errors. The current study examined whether the ERN in OCD is generally insensitive to modulatory influences or can be decreased by manipulation of task demands. Twenty-two OCD patients and 22 control participants performed a flanker task alone or with a concurrent n-back task to manipulate attentional resource allocation. Response-related ERP data were examined. OCD patients showed enhanced ERN-amplitudes in the standard flanker (ηp2 = .13). In both groups a significant decrease in ERN was found under dual-task conditions (ηp2 = .72) that was larger in the OCD group (ηp2 = .14), resulting in a nonsignificant ERN group difference in dual-task conditions. The current study replicated enhanced performance-monitoring in OCD as indexed by higher ERN-amplitudes. Importantly, it further showed a larger ERN-reduction with dual-task demands in patients compared to healthy participants. These results suggest that overactive performance-monitoring was normalized in patients with OCD by experimental conditions. Changing the attentional focus appears to be an effective strategy in modifying hyperactive error-signals in OCD and might be a target for innovative interventions. (PsycINFO Database Record (c) 2016 APA, all rights reserved)

Vocal expression in schizophrenia: Less than meets the ear.

Abnormalities in nonverbal communication are a hallmark of schizophrenia. Results from studies using symptom rating scales suggest that these abnormalities are profound (i.e., 3–5 SDs) and occur across virtually every channel of vocal expression. Computerized acoustic analytic technologies, used to overcome practical and psychometric limitations with symptom rating scales, have found much more benign and isolated abnormalities. To better understand vocal deficits in schizophrenia and to advance acoustic analytic technologies for clinical and research applications, we examined archived speech samples from 5 separate studies, each using different speaking tasks (patient N = 309; control N = 117). We sought to: (a) use Principal Component Analysis (PCA) to identify independent vocal expression measures from a large set of variables, (b) quantify how patients with schizophrenia are abnormal with respect to these variables, (c) evaluate the impact of demographic and contextual factors (e.g., study site, speaking task), and (d) examine the relationship between clinically—rated psychiatric symptoms and vocal variables. PCA identified 7 independent markers of vocal expression. Most of these vocal variables varied considerably as a function of context and many were associated with demographic factors. After controlling for context and demographics, there were no meaningful differences in vocal expression between patients and controls. Within patients, vocal variables were associated with a range of psychiatric symptoms—though only pause length was significantly associated with clinically rated negative symptoms. The discussion centers on explaining the apparent discordance between clinical and computerized speech measures. (PsycINFO Database Record (c) 2016 APA, all rights reserved)

Using social outcomes to inform decision-making in schizophrenia: Relationships with symptoms and functioning.

The outcomes of the decisions we make can be used to inform subsequent choices and behavior. We investigated whether and how people with and without schizophrenia use positive and negative social outcomes and emotional displays to inform decisions to place trust in social partners. We also investigated the impact of reversals in social partners’ behavior on decisions to trust. Thirty-two people with schizophrenia and 29 control participants completed a task in which they decided how much trust to place in social partners’ showing either a dynamic emotional (smiling, scowling) or neutral display. Interactions were predetermined to result in positive (trust reciprocated) or negative (trust abused) outcomes, and we modeled changes in trust decisions over the course of repeated interactions. Compared to controls, people with schizophrenia were less sensitive to positive social outcomes in that they placed less trust in trustworthy social partners during initial interactions. By contrast, people with schizophrenia were more sensitive to negative social outcomes during initial interactions with untrustworthy social partners, placing less trust in these partners compared to controls. People with schizophrenia did not differ from controls in detecting social partner behavior reversals from trustworthy to untrustworthy; however, they had difficulties detecting reversals from untrustworthy to trustworthy. Importantly, decisions to trust were associated with real-world social functioning. We discuss the implications of these findings for understanding social engagement among people with schizophrenia and the development of psychosocial interventions for social functioning. (PsycINFO Database Record (c) 2016 APA, all rights reserved)

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