Community violence exposure (CVE) is associated with numerous psychosocial outcomes among youth. Although linear, cumulative effects models have typically been used to describe these relations, ...emerging evidence suggests the presence of curvilinear associations that may represent a pattern of emotional desensitization among youth exposed to chronic community violence. This study uses longitudinal data to investigate relations between CVE and both internalizing and externalizing symptoms among 3,480 youth ages 3 to 12 at baseline and 9 to 18 at outcome. Results support desensitization models, as evidenced by longitudinal quadratic associations between Wave 2 CVE and Wave 3 anxiety/depressive symptoms, alongside cross-sectional linear associations between Wave 3 CVE and Wave 3 aggression. Neither age nor gender moderated the associations between CVE and well-being.
It is estimated that childhood attention deficit hyperactivity disorder (ADHD) remits by adulthood in approximately 50% of cases; however, this conclusion is typically based on single endpoints, ...failing to consider longitudinal patterns of ADHD expression. The authors investigated the extent to which children with ADHD experience recovery and variable patterns of remission by adulthood.
Children with ADHD (N=558) in the Multimodal Treatment Study of ADHD (MTA) underwent eight assessments over follow-ups ranging from 2 years (mean age, 10.44 years) to 16 years (mean age, 25.12 years) after baseline. The authors identified participants with fully remitted, partially remitted, and persistent ADHD at each time point on the basis of parent, teacher, and self-reports of ADHD symptoms and impairment, treatment utilization, and substance use and mental disorders. Longitudinal patterns of remission and persistence were identified that considered context and timing.
Approximately 30% of children with ADHD experienced full remission at some point during the follow-up period; however, a majority of them (60%) experienced recurrence of ADHD after the initial period of remission. Only 9.1% of the sample demonstrated recovery (sustained remission) by study endpoint, and only 10.8% demonstrated stable ADHD persistence across study time points. Most participants with ADHD (63.8%) had fluctuating periods of remission and recurrence over time.
The MTA findings challenge the notion that approximately 50% of children with ADHD outgrow the disorder by adulthood. Most cases demonstrated fluctuating symptoms between childhood and young adulthood. Although intermittent periods of remission can be expected in most cases, 90% of children with ADHD in MTA continued to experience residual symptoms into young adulthood.
A plethora of research on the psychological consequences of community violence exposure among youth has conceptualized and measured community violence as a single, homogenous construct that ...indiscriminately gives rise to a wide range of outcomes. However, it is increasingly recognized that community violence exposure is comprised of many disparate characteristics. Thus, a more dimensional theoretical approach to the study of community violence exposure is proposed; such an approach will more precisely clarify how community violence exposure is differentially associated with specific outcomes. In particular, the dimensions of type, severity, physical proximity, relational proximity (familiarity with the persons involved), and chronicity of community violence exposure are suggested as potential moderating factors that may each, individually and in interaction, differentially impact youths' well-being. In order to account for greater contextual complexity in children's experiences of community violence, several recommendations for new methodological approaches and research directions are proposed and discussed. Such a theoretical shift is critical to advance our understanding of the processes underlying the links between community violence exposure and youth outcomes, as well as to inform more targeted and effective interventions for youth exposed to community violence.
In their recent examination of the Monitoring the Future (MTF) data, McCabe et al. (Journal of Child Psychology and Psychiatry, 2023) address the complex, longstanding, and clinically valuable ...questions of whether and how stimulant medication treatment for adolescents with ADHD relates to their risk for substance use. Here, we expand on the authors' interpretations of their nuanced findings of increased risk for illicit stimulant use and non‐prescribed stimulant medication use for youth with later age of medication treatment initiation and shorter treatment duration. We particularly focus on highlighting tangible clinical implications, and we recommend ways future research can build on the authors' findings to further clarify this important issue.
Aims
This study examines whether the relational proximity to the victim or perpetrator of witnessed community violence is associated with youth symptoms.
Methods
Data come from the Longitudinal ...Studies of Child Abuse and Neglect, a national high‐risk sample. The sample included 12‐year‐old youth (N = 720) who had witnessed violence in their lifetimes. Ordinary least squares (OLS) regressions tested whether relationship proximity differentiated youth functioning (social competency, withdrawal, anxiety/depression, delinquency, and aggression), and whether gender moderated these effects.
Results
Witnessing violence toward a parent was associated with greater withdrawal, delinquency, and aggression symptoms. Witnessing violence perpetrated by a stranger was associated with lower social competency, higher anxiety/depression, and higher delinquency. Two perpetrator associations differed by gender.
Conclusion
Findings suggest important differences in outcomes based on relational proximity to victims and perpetrators. The particularly widespread associations between witnessing violence against a parent and youth functioning underscore the importance of targeting interventions toward youth with parent victims.
Adolescents and young adults without childhood attention deficit hyperactivity disorder (ADHD) often present to clinics seeking stimulant medication for late-onset ADHD symptoms. Recent birth-cohort ...studies support the notion of late-onset ADHD, but these investigations are limited by relying on screening instruments to assess ADHD, not considering alternative causes of symptoms, or failing to obtain complete psychiatric histories. The authors address these limitations by examining psychiatric assessments administered longitudinally to the local normative comparison group of the Multimodal Treatment Study of ADHD.
Individuals without childhood ADHD (N=239) were administered eight assessments from comparison baseline (mean age=9.89 years) to young adulthood (mean age=24.40 years). Diagnostic procedures utilized parent, teacher, and self-reports of ADHD symptoms, impairment, substance use, and other mental disorders, with consideration of symptom context and timing.
Approximately 95% of individuals who initially screened positive on symptom checklists were excluded from late-onset ADHD diagnosis. Among individuals with impairing late-onset ADHD symptoms, the most common reason for diagnostic exclusion was symptoms or impairment occurring exclusively in the context of heavy substance use. Most late-onset cases displayed onset in adolescence and an adolescence-limited presentation. There was no evidence for adult-onset ADHD independent of a complex psychiatric history.
Individuals seeking treatment for late-onset ADHD may be valid cases; however, more commonly, symptoms represent nonimpairing cognitive fluctuations, a comorbid disorder, or the cognitive effects of substance use. False positive late-onset ADHD cases are common without careful assessment. Clinicians should carefully assess impairment, psychiatric history, and substance use before treating potential late-onset cases.
Low‐income, urban adolescents are exposed to extremely high rates of witnessing and being victimized by community violence. Such violence exposure presents serious implications for youth's ...development and psychological well‐being. In a sample of 223 ninth‐grade Latino adolescents, we examine: (1) what types of after‐school activity participation increase or reduce adolescents' risk for violence exposure and (2) the role of the cultural value of familismo in moderating the impact of violence exposure on adolescents' psychological well‐being. Our results indicate that spending unstructured leisure time with peers and participating in non‐school sports and non‐school clubs were associated with higher levels of community violence exposure, whereas adhering to the cultural value of familismo was associated with lower levels of violence exposure. Additionally, familismo moderated the positive association between violence exposure and depressive symptoms, but not posttraumatic stress disorder symptoms. Implications of these results are discussed.
Objective: Longitudinal observational data pose a challenge for causal inference when the exposure of interest varies over time alongside time-dependent confounders, which often occurs in trauma ...research. We describe marginal structural models (MSMs) using inverse probability weighting as a useful solution under several assumptions that are well-suited to estimating causal effects in trauma research. Method: We illustrate the application of MSMs by estimating the joint effects of community violence exposure across time on youths' internalizing and externalizing symptoms. Our sample included 4,327 youth (50% female, 50% male; 1.4% Asian American or Pacific Islander, 34.7% Black, 46.9% Hispanic, .8% Native American, 14.3%, White, 1.5%, Other race/ethnicity; Mage at baseline = 8.62, range = 3-15) from the Project on Human Development in Chicago Neighborhoods. Results: Wave 3 internalizing symptoms increased linearly with increases in Wave 2 and Wave 3 community violence exposure, whereas effects on externalizing symptoms were quadratic for Wave 2 community violence exposure and linear for Wave 3. These results fail to provide support for the desensitization model of community violence exposure. Conclusion: MSMs are a useful tool for researchers who rely on longitudinal observational data to estimate causal effects of time-varying exposures, as is often the case in the study of psychological trauma.
Clinical Impact Statement
Marginal structural models allow researchers to test the causal effect of trauma exposure over time even when exposed individuals are different from those who are not exposed, under certain assumptions. This approach can be especially useful for informing whether an intervention that prevents or imposes exposure would have an impact.
To test whether adolescents' perceived ADHD symptoms may improve while monitoring them throughout the day.
In a sample of 90 adolescents (M
age
= 14.7; 66% boys, 34% girls; 76.7% White, 13.3% Black ...or African American, 8.9% more than one race, 1.1% "other") treated for ADHD by their pediatricians, this study examined: (1) whether self-rated ADHD symptoms decreased across 17 days of 4 times daily ecological momentary assessment (EMA) of symptoms and (2) whether completing versus missing an EMA survey was associated with lower self-rated ADHD symptoms in the subsequent hours.
Multilevel regression analyses showed that, on average, adolescents' perceived ADHD symptoms (inattention, hyperactivity, impulsivity, and total across domains) decreased across 17 days of EMA. Within person, symptoms were lower following completed versus missed EMA surveys. Significant moderating effects showed that the effect of completing the prior EMA survey weakened across the day and over the course of the 17 days.
This study is the first to document acute improvements in self-rated ADHD symptoms using EMA in adolescents' naturalistic environments. Symptom monitoring throughout the day may help adolescents improve their day-to-day ADHD, at least acutely, and holds promise as one component of mobile-health ADHD interventions.
Background
Inconsistent findings exist regarding long‐term substance use (SU) risk for children diagnosed with attention‐deficit/hyperactivity disorder (ADHD). The observational follow‐up of the ...Multimodal Treatment Study of Children with ADHD (MTA) provides an opportunity to assess long‐term outcomes in a large, diverse sample.
Methods
Five hundred forty‐seven children, mean age 8.5, diagnosed with DSM‐IV combined‐type ADHD and 258 classmates without ADHD (local normative comparison group; LNCG) completed the Substance Use Questionnaire up to eight times from mean age 10 to mean age 25.
Results
In adulthood, weekly marijuana use (32.8% ADHD vs. 21.3% LNCG) and daily cigarette smoking (35.9% vs. 17.5%) were more prevalent in the ADHD group than the LNCG. The cumulative record also revealed more early substance users in adolescence for ADHD (57.9%) than LNCG (41.9%), including younger first use of alcohol, cigarettes, marijuana, and illicit drugs. Alcohol and nonmarijuana illicit drug use escalated slightly faster in the ADHD group in early adolescence. Early SU predicted quicker SU escalation and more SU in adulthood for both groups.
Conclusions
Frequent SU for young adults with childhood ADHD is accompanied by greater initial exposure at a young age and slightly faster progression. Early SU prevention and screening is critical before escalation to intractable levels.
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