Background
Children with attention‐deficit/hyperactivity disorder (ADHD) experience greater sleep problems than their peers. Although adolescence is generally a developmental period characterized by ...insufficient sleep, few studies have used a multi‐informant, multi‐method design, to examine whether sleep differs in adolescents with and without ADHD.
Methods
Targeted recruitment was used to enroll an approximately equal number of eighth‐grade adolescents (mean age = 13 years) with (n = 162) and without ADHD (n = 140). Adolescents and parents completed global ratings of sleep problems; adolescents, parents, and teachers completed ratings of daytime sleepiness. Adolescents wore actigraphs and completed a daily sleep diary for approximately 2 weeks.
Results
Adolescents with ADHD were more likely than adolescents without ADHD to obtain insufficient sleep on school days (per diary) and weekends (per diary and actigraphy). Adolescents with ADHD were also more likely to report falling asleep in class and to have stayed up all night at least twice in the previous 2 weeks (14% and 5% reported all‐nighters for ADHD and comparison, respectively). In regression analyses controlling for a number of variables known to impact sleep (e.g. pubertal development, sex, medication use, having an externalizing, anxiety, or depression diagnosis), ADHD remained associated with shorter diary and actigraphy school night sleep duration, adolescent‐ and parent‐reported daytime sleepiness, and parent‐reported difficulties initiating and maintaining sleep and total sleep disturbance. Controlling for other variables, the odds of being classified with clinically elevated parent‐reported sleep disturbance were 6.20 times greater for adolescents with ADHD.
Conclusions
Findings provide some of the clearest evidence yet that adolescents with ADHD experience more sleep problems and sleepiness than their peers without ADHD. It may be especially important to assess for sleep problems in adolescents with ADHD and to evaluate whether existing sleep interventions are effective, or can be optimized, for use in adolescents with ADHD who also have sleep problems.
Objective
Limited research incorporates an intersectional approach when evaluating disordered eating behaviors among those holding minoritized social positions, such as lesbian, gay, bisexual, queer, ...questioning, and/or transgender/gender diverse (LGBTQ) adolescents. The current study assessed stigma experiences from peers at school, self‐esteem, LGBTQ pride, and overlapping social positions as they relate to disordered eating behaviors among LGBTQ adolescents.
Method
Participants included 11,083 adolescents (Mage = 15.6, SD = 1.3; 34.8% transgender/gender diverse) from a large national survey study of LGBTQ adolescents from 2017. Exhaustive Chi‐square Automatic Interaction Detection analysis was used to identify bias‐based bullying experiences (i.e., weight‐based, identity‐based), self‐esteem, LGBTQ pride, and overlapping social positions (i.e., gender identity, sexual identity, race/ethnicity, body mass index (BMI) percentile) associated with the highest prevalence of unhealthy weight control behaviors, extreme unhealthy weight control behaviors, and past year binge eating.
Results
Adolescents in the 28 identified groups with a high prevalence of disordered eating behavior held at least one structurally marginalized social position (e.g., high BMI), bias‐based bullying experience, low self‐esteem, or low LGBTQ pride in addition to being LGBTQ. Weight‐based bullying was a salient risk‐factor for disordered eating across social positions. Among adolescents with the same social positions, levels of self‐esteem, LGBTQ pride, but no bias‐based bullying experience, prevalence estimates of disordered eating were, on average, 23% lower.
Discussion
LGBTQ adolescents with multiple marginalized social positions and related factors engage in disproportionately high prevalence disordered eating. Findings underscore the importance of addressing intersecting experiences of stigma to reduce disordered eating and promote health equity among adolescents.
Public significance
Multiply marginalized LGBTQ adolescents, most of whom also reported experiencing bias‐based bullying from peers at school, reported disproportionately high prevalence disordered eating. In comparison groups of adolescents with no bias‐based bullying experience, prevalence of disordered eating was, on average, 24% lower. Findings underscore the importance of addressing intersecting experiences of stigma to reduce disordered eating and promote health equity among adolescents.
Emotion regulation (ER) is the ability to monitor, evaluate, and modify one’s emotional responses to be appropriate for environmental demands. Poor ER has been considered a transdiagnostic risk ...factor for a range of internalizing and externalizing disorders and overall decreased well-being in adolescents. A range of evidence-based interventions exist which may improve ER. However, much of the intervention research to date does not include a measure of ER to assess change pre and post treatment, with limited information about the efficacy of these interventions in youth across a range of sample types. There is a clear need for a comprehensive review of the literature examining ER-focused interventions in adolescents with a wide range of presenting disorders. A literature search was originally conducted in January 2020 and an updated search was conducted in February 2021 which elicited 1245 articles, of which 605 were duplicates and were removed. Abstracts of the remaining 640 articles were screened with 121 articles being reviewed in full. Of note, 16 additional articles were identified through references and other sources during this process and were also included in the full review. Of the 137 articles reviewed in full, 41 studies were ultimately included in the present review. The present paper provides a descriptive review of intervention approaches and findings from community prevention programs, programs for war-affected youth, programs for clinical populations, and programs for incarcerated and delinquent adolescents. The overall pooled effect was significantly different from zero based on the pre/post effects Hedge’s
g
= 0.29, 95% CI (0.22, 0.36) and the intervention/control effects Hedge’s
g
= 0.19, 95% CI (0.06–0.32). Although neither sex nor age significantly accounted for heterogeneity in effect sizes, there were significant findings for population type (clinical vs. community), with community samples having significantly lower effect sizes on average. Impacts of the different ER measures used and significant methodological variability (e.g., use of control groups, length of intervention) across included studies are discussed. Implications and suggestions for future research are reviewed, specifically, that additional understanding of moderators of effects are needed and that measures used to assess change in ER, both dysregulation and adaptive skill use, may need to more directly align with the intervention’s focus and the strategies taught as part of the intervention.
This meta-analysis examined the efficacy of available pharmacological and nonpharmacological interventions for irritability among youth with autism spectrum disorder (ASD), ...attention-deficit/hyperactivity disorder (ADHD), disruptive behavior disorders (DBD), disruptive mood dysregulation disorder (DMDD), and/or severe mood dysregulation (SMD).
Literature searches were conducted in October 2020, resulting in 564 abstracts being reviewed to identify relevant papers, with 387 articles being reviewed in full. A random effects model was used for the meta-analysis, with subgroup meta-regressions run to assess effects of study design, intervention type, medication class, and clinical population.
A total of 101 studies were included (80 pharmacological, 13 nonpharmacological, 8 combined). Despite high heterogeneity in effects (I
= 94.3%), pooled posttreatment effect size for decreasing irritability was large (Hedges' g = 1.62). Large effects were found for pharmacological (g = 1.85) and nonpharmacological (g = 1.11) interventions; moderate effects were found for combined interventions relative to monotherapy interventions (g = 0.69). Antipsychotic medications provided the largest effect for reducing irritability relative to all other medication classes and nonpharmacological interventions. A large effect was found for youth with ASD (g = 1.89), whereas a medium effect was found for youth with ADHD/DMDD/DBD/SMD (g = 0.64).
This meta-analysis provides a comprehensive review of interventions targeting persistent nonepisodic irritability among youth with various psychiatric disorders. Strong evidence was found for medium-to-large effects across study design, intervention type, and clinical populations, with the largest effects for pharmacological interventions, particularly antipsychotic medications and combined pharmacological interventions, and interventions for youth with ASD.
Objective. The present study evaluated the prevalence of past suicidal ideation (SI), plan, and attempt in college students with ADHD (N = 102) compared to a matched control (N = 102). Predictors of ...SI, plan, and attempts, were examined. Participants. Study participants were first year college students at a large Southeastern university who completed measures during August or September of 2014 or January of 2015. Methods. Measures were completed by first year students via an online survey. Results. Prevalence rates for SI and related behaviors were higher among the ADHD group than the matched control, with suicide attempts rates four times higher in the ADHD group (13.7% vs. 2.9%). Results showed that ADHD predicted rates of SI and suicide attempt accounting for depression and key demographic variables. Conclusions. Findings have implications for suicide risk assessments conducted with college students with ADHD.
Deficits in executive function (EFDs) are thought to be the mechanisms that underlie a diagnosis of Attention Deficit Hyperactivity Disorder (ADHD). However, prior research has indicated that EFDs ...are not uniform throughout the ADHD population and it is not clear what factors lead to individual variability in EF abilities. The current study was conducted to (a) elucidate the possible presence of unique patterns in EFDs and (b) identify potential risk factors for clinically significant EFDs. A sample of 256 young adolescents were comprehensively assessed and diagnosed with ADHD, and parents completed the Behavior Rating Inventory of Executive Function (BRIEF). Latent profile analysis (LPA) was conducted to elicit individual-level patterns of ratings across the eight clinical scales of the BRIEF. Chi-square analyses and regression models were also conducted to determine whether ADHD presentation, gender, or comorbid psychopathology was associated with the profiles elicited in the LPA. LPA results demonstrated a consistent trend in relative EF strengths and weaknesses, with patterns differing primarily in the intensity of deficits. Females with ADHD and adolescents with ADHD Combined Presentation or comorbid Oppositional Defiant Disorder exhibited more severe patterns of EFDs based upon group comparisons and regression models. ADHD may be associated with a consistent pattern of relative strengths and weaknesses in EF, although several important factors appear associated with an increased risk of more severe EFDs. These findings carry important clinical implications for the assessment of ADHD in adolescence.
The relational structure of psychological symptoms and disorders is of crucial importance to mechanistic and causal research. Methodologically, factor analytic approaches (latent variable modeling) ...and network analyses are two dominant approaches. Amidst some debate about their relative merits, use of both methods simultaneously in the same data set has rarely been reported in child or adolescent psychopathology. A second issue is that the nosological structure can be enriched by inclusion of transdiagnostic constructs, such as neurocognition (e.g., executive functions and other processes). These cut across traditional diagnostic boundaries and are rarely included even though they can help map the mechanistic architecture of psychopathology. Using a sample enriched for ADHD (n = 498 youth ages 6 to 17 years; M = 10.8 years, SD = 2.3 years, 55% male), both approaches were used in two ways: (a) to model symptom structure and (b) to model seven neurocognitive domains hypothesized as important transdiagnostic features in ADHD and associated disorders. The structure of psychopathology domains was similar across statistical approaches with internalizing, externalizing, and neurocognitive performance clusters. Neurocognition remained a distinct domain according to both methods, showing small to moderate associations with internalizing and externalizing domains in latent variable models and high connectivity in network analyses. Overall, the latent variable and network approaches yielded more convergent than discriminant findings, suggesting that both may be complementary tools for evaluating the utility of transdiagnostic constructs for psychopathology research.
To date, only three studies have examined the role of emotion socialization in the emotional functioning of youth with neurodevelopmental disorders. As such, this review article with pilot data ...sought to provide a call to action and first step in addressing this limited research body. Pilot data was collected with 18 adolescents (Mage = 13.5, SD = 1.6; 70% male) with a neurodevelopmental disorder and their primary caregiver. All adolescents were diagnosed with attention-deficit/hyperactivity disorder and displayed a range of comorbid disorders: autism spectrum disorder (27.8%), anxiety (66.7%), depression (44.4%), and disruptive behavior disorders (50%). Adolescents and caregivers completed a conflict discussion task while physiological, observational, and self-report measures of emotion socialization and emotional functioning were measured. Observed supportive parent emotion socialization behaviors were significantly associated with more observed adaptive emotion regulation strategies, and decreased observed and adolescent-reported negative affect, whereas non-supportive emotion socialization behaviors were associated with more observed negative affect and less observed adaptive emotion regulation strategies. Our pilot findings support growing research suggesting that adaptive parent emotion socialization practices can help foster less negative emotionality and better emotion regulation in youth with neurodevelopment disorders. We make a call to action for more emotion socialization research focused on youth with neurodevelopmental disorders, and propose four important directions for future research: 1) Research examining emotion socialization behaviors during daily life, 2) Understanding the nuanced role of emotion socialization practices, 3) Considering diversity in emotion socialization practices with clinical populations, and 4) Longitudinal and intervention research studies.
Gender and sexual orientation diverse (GSD) individuals are at risk for negative social and psychological outcomes due to repeated marginalization. Identifying malleable individual factors to target ...in treatment may help buffer against societal risks. Latent profile analysis (LPA) explored associations between self-regulation, adverse, and resilience outcomes with personal identity among (n = 155) GSD adults. LPA showed three self-regulation profiles (high, medium, and low) which were associated with differences in social support, anxiety, and depression. Descriptive statistics of associations between intersectional identities and profiles are presented. Self-regulation may be an important indicator of risk and be used to promote resilience among GSD adults.
Arab, Middle Eastern, and North African (Arab/MENA) individuals are regularly unaccounted for in research because they are conflated with the racial category "White." The systematic ...underrepresentation of Arab/MENA individuals in research persists, despite the fact that Arab/MENA individuals experience stigma, discrimination, and structural barriers that separate them from their White peers and contribute to disparities in mental health and well-being (Awad et al., 2021). Further, the lack of widespread inclusion of an Arab/MENA racial category has created assumptions about the generalizability of psychological constructs, measures, and treatments for Arab/MENA people, despite well-known cultural differences. The present study explored the validity of a widely used emotion regulation measure, the Difficulties in Emotion Regulation Scale-18, in an Arab/MENA emerging adult sample (Mage = 21.8, SD = 3.02), invariance across sex assigned at birth, differences in latent scores for religious identity, and associations with mental health and well-being. Results support the original six-factor model and are invariant across males and females. The implications of these findings for supporting assessment and treatment of Arab/MENA individuals, and the importance of including Arab/MENA as a racial category in research, are discussed.
Public Significance Statement
Arab and Middle Eastern Americans are incorrectly categorized as "White" despite the higher rates of structural discrimination and barriers these individuals face. The lack of research on this group yields the inability to understand if current psychological measures adequately capture Arab/Middle Eastern individuals' functioning. This article evaluated a widely used emotion regulation measure in Arab/Middle Eastern Americans and its associations with mental health and well-being.
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