Controversy abounds regarding the symptom dimensions of attention problems, impulsivity, and hyperactivity, developmentally extreme and impairing levels of which compose the diagnostic category of ...attention deficit hyperactivity disorder (ADHD). I highlight causal factors, underlying mechanisms, developmental trajectories, and female manifestations of ADHD, integrating the psychobiological underpinnings of this syndrome with contextual factors related to its clinical presentation, impairments, and soaring increases in diagnosed prevalence. Indeed, despite strong heritability, ADHD is expressed via transactional patterns of influence linked to family-, school-, peer-, neighborhood-, and policy-related factors. Moreover, intervention strategies must take into account both pharmacologic and behavioral modalities if the goal is to enhance competencies, rather than symptom reduction per se. A comprehensive understanding of ADHD mandates multiple levels of analysis-spanning genes, neurotransmission, brain pathways, individual skill levels, family socialization, peer relationships, and educational and cultural forces-which must be integrated and synthesized to surpass reductionist accounts, reduce stigma, and maximize the impact of prevention- and intervention-related efforts.
Research on the precursors of borderline personality disorder (BPD) reveals numerous child and adolescent risk factors, with impulsivity and trauma among the most salient. Yet few prospective ...longitudinal studies have examined pathways to BPD, particularly with inclusion of multiple risk domains.
We examined theory-informed predictors of young-adult BPD (a) diagnosis and (b) dimensional features from childhood and late adolescence via a diverse (47% non-white) sample of females with (n = 140) and without (n = 88) carefully diagnosed childhood attention-deficit hyperactivity disorder (ADHD).
After adjustment for key covariates, low levels of objectively measured executive functioning in childhood predicted young adult BPD diagnostic status, as did a cumulative history of childhood adverse experiences/trauma. Additionally, both childhood hyperactivity/impulsivity and childhood adverse experiences/trauma predicted young adult BPD dimensional features. Regarding late-adolescent predictors, no significant predictors emerged regarding BPD diagnosis, but internalizing and externalizing symptoms were each significant predictors of BPD dimensional features. Exploratory moderator analyses revealed that predictions to BPD dimensional features from low executive functioning were heightened in the presence of low socioeconomic status.
Given our sample size, caution is needed when drawing implications. Possible future directions include focus on preventive interventions in populations with enhanced risk for BPD, particularly those focused on improving executive functioning skills and reducing risk for trauma (and its manifestations). Replication is required, as are sensitive measures of early emotional invalidation and extensions to male samples.
Individuals with mental illness receive harsh stigmatization, resulting in decreased life opportunities and a loss of independent functioning over and above the impairments related to mental ...disorders themselves. We begin our review with a multidisciplinary discussion of mechanisms underlying the strong propensity to devalue individuals displaying both deviant behavior and the label of mental illness. Featured is the high potential for internalization of negative perceptions on the part of those with mental disorders-i.e., self-stigmatization. We next focus on several issues of conceptual and practical relevance: (a) stigma against less severe forms of mental disorder; (b) the role of perceptions of dangerousness related to mental illness; (c) reconciliation of behavioral research with investigations of explicit and implicit attitudes; (d) evolutionary models and their testability; (e) attributional accounts of the causes of mental illness, especially to personal control versus biogenetic factors; and (f) developmental trends regarding stigma processes. We conclude with a brief review of multilevel efforts to overcome mental illness stigma, spanning policy and legislation, alterations in media depictions, changed attitudes and practices among mental health professionals, contact and empathy enhancement, and family and individual treatment.
Hinshaw discusses the stigmatization surrounding mental illness, particularly in child patients and their families. He focuses on the negative developmental effects of stigma and presents suggestions ...for interventions that may help reduce them.
Now over 10 years old, the Research Domain Criteria (RDoC) has gained impressive traction in the adult psychopathology literature, but enthusiasm among child and adolescent psychopathologists lags ...somewhat behind. We consider possible reasons why RDoC has not been embraced fully in the child and adolescent literatures. We emphasize common, interrelated, and sometimes outdated assumptions that impede scientific progress that RDoC could facilitate. Traditionally, child and adolescent psychopathologists have used behavioral syndromes as gold standards against which biological markers are validated, even though behavioral syndromes are often measured with less precision; sought to identify large main effects of single biological functions on single behavioral syndromes, thereby ignoring (even if implicitly) the overwhelming etiological complexity of psychopathology; expected 1:1 correspondencies between biological functions and behaviors, despite evidence that core biological systems subserving behavior are functionally interdependent (i.e., modulate one another); and failed to consider neurobiological mechanisms of homotypic and heterotypic comorbidity and continuity. Using examples from our work, we show how a developmental, RDoC-informed approach to externalizing behavior enriches our understanding of psychopathology. We also provide an agenda for future research, which includes calls to (1) adopt neural-systems-first approaches over disorder-first approaches when studying psychopathology, (2) eschew biological reductionism by integrating environmental risk mediators into our etiopathophysiological models, (3) integrate neural vulnerabilities into the empirical latent structure of psychopathology, and (4) replace null hypothesis significance testing with computational approaches that accommodate etiological complexity by evaluating functional dependencies among RDoC constructs, including positive valence systems (approach), negative valence systems (avoidance), and arousal/regulatory systems (self-regulation).
Objective: To ascertain adult outcomes in 10 domains reflecting symptomatology (internalizing, externalizing, self-injury, substance use), attainment (education, employment), and impairment (health, ...social, driving, overall) as a function of both childhood diagnosis of attention-deficit/hyperactivity disorder (ADHD) and persistence of ADHD symptoms across time. Method: We prospectively followed 140 grade-school-aged girls with rigorously diagnosed childhood ADHD and 88 age- and ethnicity-matched comparison girls for 16 years. Outcome measures were obtained via self- and parent-report questionnaires, interviews, and objective tests. Results: Childhood ADHD, whether it remitted or persisted, was a pernicious risk factor for a limited number of poor outcomes, including low educational attainment, unplanned pregnancy, body mass index (BMI), and clinician-rated impairment. Childhood ADHD that persisted over time, whether completely or partially, was associated with a number of additional detrimental outcomes in the externalizing, internalizing, self-injury, occupational, social, and overall impairment domains. Finally, in this all-female sample, ADHD was not associated with objective measures of employment, substance use, or driving outcomes. Conclusions: We discuss the considerable impairments accruing from both childhood-limited and adult-persisting ADHD, with major implications for the health and well-being of females with this neurodevelopmental disorder.
What is the public health significance of this article?
Although a minority of girls no longer meet symptom criteria for ADHD in adulthood, they still show substantial educational underachievement over time, as well as increased body mass index and much greater likelihood of at least 1 unplanned pregnancy. Among girls, childhood ADHD that persists into adulthood is associated with these educational and health problems (increased body mass index and unplanned pregnancy) as well as substantially increased risk for internalizing problems (e.g., anxiety and depression), externalizing problems (e.g., aggression and defiance), self-injury, and occupational impairment. On average, however, girls with childhood ADHD are not at increased risk for later substance use problems, at least in the present sample.
Attention‐deficit/hyperactivity disorder (ADHD) – and its underlying behavioral dimensions of inattention and hyperactivity–impulsivity – have been understudied in females. We first cover the ...conceptual issues of prevalence, diagnostic practices, diversity, comorbidity, and causal factors, plus forces limiting awareness of ADHD in females. After a narrative review of cross‐sectional and longitudinal findings, we conclude the following. (a) Girls meet diagnostic criteria for ADHD at just under half the rates of boys, a ratio that becomes much closer to equal by adulthood. (b) Girls and women with ADHD show a predominance of inattention and associated internalizing problems; boys and men display greater levels of hyperactive–impulsive symptoms and associated externalizing problems. (c) Sex differences in ADHD symptoms and related outcomes depend heavily on the clinical versus nonreferred nature of the samples under investigation. (d) Females with ADHD experience, on average, serious impairments, with a particularly heightened risk for problems in close relationships and engagement in self‐harm. (e) Clinicians may overlook symptoms and impairments in females because of less overt (but still impairing) symptom manifestations in girls and women and their frequent adoption of compensatory strategies. Our review of predictors and mediators of adult outcomes highlights (a) the potential for heterotypically continuous pathways in females with childhood ADHD and (b) developmental progressions to self‐harm, intimate partner violence, unplanned pregnancy, and comorbid psychopathology. Focusing on ADHD in females is necessary to characterize causal and maintaining mechanisms with accuracy and to foster responsive interventions, as highlighted in our closing list of clinical implications and research priorities.
Children with Attention Deficit Hyperactivity Disorder (ADHD) have prominent deficits in sustained attention that manifest as elevated intra-individual response variability and poor decision-making. ...Influential neurocognitive models have linked attentional fluctuations to aberrant brain dynamics, but these models have not been tested with computationally rigorous procedures. Here we use a Research Domain Criteria approach, drift-diffusion modeling of behavior, and a novel Bayesian Switching Dynamic System unsupervised learning algorithm, with ultrafast temporal resolution (490 ms) whole-brain task-fMRI data, to investigate latent brain state dynamics of salience, frontoparietal, and default mode networks and their relation to response variability, latent decision-making processes, and inattention. Our analyses revealed that occurrence of a task-optimal latent brain state predicted decreased intra-individual response variability and increased evidence accumulation related to decision-making. In contrast, occurrence and dwell time of a non-optimal latent brain state predicted inattention symptoms and furthermore, in a categorical analysis, distinguished children with ADHD from controls. Importantly, functional connectivity between salience and frontoparietal networks predicted rate of evidence accumulation to a decision threshold, whereas functional connectivity between salience and default mode networks predicted inattention. Taken together, our computational modeling reveals dissociable latent brain state features underlying response variability, impaired decision-making, and inattentional symptoms common to ADHD. Our findings provide novel insights into the neurobiology of attention deficits in children.
Children whose parents exhibit criminal behavior (CB) appear to have an increased risk of displaying CB themselves. We conducted a systematic review and pooled results from 23 samples in 25 ...publications (including 3,423,483 children) in this meta-analysis of intergenerational transmission of CB. On average, children with criminal parents were at significantly higher risk for CB compared with children without criminal parents (pooled OR=2.4). Studies taking into account covariates also showed increased risk for CB (pooled OR=1.8). Transmission was strongest from mothers to daughters, followed by mothers to sons, fathers to daughters, and fathers to sons. Moreover, transmission appeared stronger for cohorts born after 1981. When we examined methodological quality and other characteristics of studies, response rates, sample size, or use of official records vs. self- or other-reports of parental CB did not moderate outcomes. However, we found stronger transmission for samples that used convenience or case-control sampling, and in studies in which parental CB clearly preceded offspring CB. We discuss mechanisms underlying intergenerational transmission, including social learning, criminogenic environments, biological proneness, and criminal justice bias. Finally, we consider limitations and directions for future research as well as policy implications for breaking the cycle of intergenerational crime.
•This meta-analysis synthesized results for around 3 million children.•Risk for criminal behavior is roughly 2.4 times higher for kids with criminal parents.•Studies considering covariates show the risk to be about 1.8 times higher.•Transmission was strongest from mothers to daughters, lowest for fathers to sons.•Transmission appeared stronger for cohorts born after 1981.
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