Background
This longitudinal study examined growth trajectories of academic motivation in youth with and without attention‐deficit/hyperactivity disorder (ADHD) across the important developmental ...transition from middle school to high school, and associations with academic success. Consistent with self‐determination theory (SDT) of motivation, trajectories of amotivation, extrinsic motivation, and intrinsic motivation were modeled.
Methods
The study included a robust multi‐method, multi‐source assessment of academic outcomes, including homework performance ratings; reading and mathematics standardized test scores; and grade point average (GPA) obtained from school records. Participants included 302 adolescents (ages 12–14; Mage = 13.20) in eighth grade who were specifically recruited so that approximately half (n = 162) were diagnosed with ADHD and 140 adolescents comprising a comparison sample without ADHD. The sample was predominantly White (81.80%), with 7.90% identifying as bi/multiracial, 5.30% identifying as Black/African American, 4.60% identifying as Asian, and 0.30% identifying as Indigenous/Alaskan.
Results
Adolescents with ADHD had worse academic motivation at all timepoints. Growth curve analyses indicated the academic motivation of adolescents without ADHD decreased at faster rates across the transition to high school compared to adolescents with ADHD. However, for adolescents with ADHD, amotivation, extrinsic motivation, and intrinsic motivation each predicted GPA, with higher extrinsic and intrinsic motivation also predicting better homework performance and different aspects of math performance, whereas for youth without ADHD, only amotivation and extrinsic motivation predicted GPA.
Conclusions
Intervention and school policy implications are discussed, including the importance of fostering autonomy and internal motivation, and consideration of whether current ADHD interventions primarily foster extrinsic motivation.
Background
Sluggish cognitive tempo (SCT) is a construct that includes symptoms of slowness, excessive daydreaming, and drowsiness. SCT is often comorbid with attention‐deficit/hyperactivity disorder ...(ADHD), and SCT symptoms are associated with significant academic impairment above the influence of ADHD. Despite the overlap between ADHD and SCT and associated impairments, no studies have evaluated how evidence‐based psychosocial interventions for adolescents with ADHD impact symptoms of SCT.
Methods
This study examined whether SCT symptoms improved in a sample of 274 young adolescents with ADHD who were randomly assigned to an organizational skills intervention, homework completion intervention, or to a waitlist control. SCT intervention response was evaluated broadly in all participants and, specifically, for participants in the clinical range for SCT symptom severity at baseline. Change in ADHD symptoms of inattention, executive functioning, and motivation were examined as potential predictors of improvement in SCT.
Results
The two intervention groups were collapsed together for analyses because there were no significant differences in change in SCT symptoms. Multilevel modeling results indicate that parent‐reported SCT symptoms significantly decreased when comparing the intervention group to waitlist control (d = .410). For adolescents with parent‐reported clinical levels of SCT, the decrease in symptoms was more pronounced (d = .517). Self‐reported SCT symptoms produced null results, though effect size calculations showed small improvement for the full sample (d = .313) and for the high‐SCT group (d = .384). Change in behavior regulation executive functioning (d = .247), metacognitive executive functioning (d = .346), and inattention (d = .230) predicted change in parent‐reported SCT symptoms.
Conclusions
Although not specifically designed to decrease SCT symptoms, the ADHD interventions evaluated in this study resulted in significant improvements in parent‐reported SCT with small to moderate effect sizes. Clinical implications and future directions are discussed, including development of interventions for adolescents with high levels of SCT.
Fasting and negative urgency (the disposition to act rashly when distressed) are risk factors for binge eating. It may be that each influences the other over time to predict binge eating.
This study ...tested whether (1) fasting predicts binge eating through negative urgency, and (2) negative urgency predicts binge eating through fasting.
Path analysis and mediation tests were used to investigate objectives in n = 302 college women assessed three times over eight months. We controlled for each variable at the previous time point, and concurrent negative affect and body mass index at each time point.
Time 1 (T1) fasting predicted elevated negative urgency three months later at Time 2 (T2) and T2 negative urgency predicted increases in binge eating five months later at Time 3 (T3). T2 negative urgency mediated the relationship between T1 fasting and T3 binge eating. T1 negative urgency predicted increases in T2 fasting, which then predicted increases in T3 binge eating. T2 fasting mediated the relationship between T1 negative urgency and T3 binge eating.
Findings suggest fasting and negative urgency transact to predict binge eating among college women. Interventions targeting negative urgency may prevent or reduce both fasting and binge eating.
The aim of this work was 2-fold: (1) to evaluate current knowledge and identify key directions in the study of sluggish cognitive tempo (SCT); and (2) to arrive at a consensus change in terminology ...for the construct that reflects the current science and may be more acceptable to researchers, clinicians, caregivers, and patients.
An international Work Group was convened that, in early 2021, compiled an online archive of all research studies on SCT and summarized the current state of knowledge, noted methodological issues, and highlighted future directions, and met virtually on 10 occasions in 2021 to discuss these topics and terminology.
Major progress has been made over the last decade in advancing our understanding of SCT across the following domains of inquiry: construct measurement and stability; genetic, environmental, pathophysiologic, and neuropsychological correlates; comorbid conditions; functional impairments; and psychosocial and medication interventions. Findings across these domains are summarized, and potential avenues to pursue in the next generation of SCT-related research are proposed. Following repeated discussions on terminology, the Work Group selected “cognitive disengagement syndrome” (CDS) to replace “SCT” as the name for this construct. This term was deemed to best satisfy considerations that should apply when selecting terms for a condition or syndrome, as it does not overlap with established terms for other constructs, is not offensive, and reflects the current state of the science.
It is evident that CDS (SCT) has reached the threshold of recognition as a distinct syndrome. Much work remains to further clarify its nature (eg, transdiagnostic factor, separate disorder, diagnostic specifier), etiologies, demographic factors, relations to other psychopathologies, and linkages to specific domains of functional impairment. Investigators are needed with interests and expertise spanning basic, clinical, and translational research to advance our understanding and to improve the lives of individuals with this unique syndrome.
Adolescents with Sluggish Cognitive Tempo (SCT) exhibit symptoms of slowness, mental confusion, excessive daydreaming, low motivation, and drowsiness/sleepiness. Although many symptoms of SCT reflect ...internalizing states, no study has evaluated the clinical utility of self-report of SCT in an attention-deficit/hyperactivity disorder (ADHD) sample. Furthermore, it remains unclear whether SCT is best conceptualized as a unidimensional or multidimensional construct. In a sample of 262 adolescents comprehensively diagnosed with ADHD, the present study used adolescent- and parent reports of SCT to evaluate the predictive utility of a general SCT factor from a bifactor modeling approach compared the utility of three specific SCT factors (slow, sleepy, and daydreamer) for predicting academic impairment and internalizing psychopathology. Overall, a multidimensional framework of SCT was supported, with the three SCT factors differentially predicting impairment and in one case (school grades), predicting impairment when the general factor did not. Consistent with prior research, SCT slow behaviors appear to be most strongly associated with impairment, predicting both academic impairment and internalizing psychopathology. Parent report of SCT was most useful for predicting academic functioning, whereas youth self-report was important for predicting anxiety and depression. Implications of the findings for the assessment and potential treatment of SCT are discussed.
This study aims to characterize the growth in condition-related knowledge in youth with spina bifida (SB), identify neurocognitive predictors of growth, and examine associations between growth in ...knowledge and subsequent levels of medical self-management skills.
Participants were recruited from a larger longitudinal study involving 140 youth with SB and caregivers, who completed questionnaires and interviews every 2 years over 8 years. The current study included the youth report of condition-related knowledge and medical self-management skills. Youth attention and executive functioning were assessed via parent and teacher reports and performance-based assessment. Latent growth curves were conducted in Mplus Version 8 (Múthen, L. K., & Múthen, B. O. 1998. Mplus User's Guide. Eighth. Muthén & Muthén) to examine change over time in youth-reported condition-related knowledge. Neurocognitive variables were included as predictors of growth in knowledge and regression analyses were used to predict medical self-management skills from growth in condition-related knowledge.
Youth condition-related knowledge increased linearly. Better youth performance on working memory and attention performance-based tasks predicted a higher intercept for condition-related knowledge at T1, but not slope. Teacher and parent reports of inattention and executive dysfunction were not consistent predictors of intercept and growth. Slope of condition-related knowledge was not predictive of subsequent youth self-management skills.
Youth with SB gain condition-related knowledge over time. However, executive dysfunction and inattention may impede gains in condition-related knowledge. Thus, executive functioning supports, attention-related interventions, and psychoeducation may support condition-related knowledge gains and later medical self-management skills, but further research assessing family and cultural factors is needed.
Objective
The primary goal of this study was to examine the factor structure of a spina bifida (SB) medical responsibilities measure and a medical regimen skills scale across time in families of ...youth with SB.
Method
One-hundred and forty youth with SB and their parents were assessed in both childhood/adolescence and adolescence/young adulthood. The Sharing of SB Medical Responsibilities Scale (SOSBMR) includes 34 items for which participants indicate who is responsible for each task. The SB Independence Survey (SBIS) is composed of 50 SB-specific medical skills items in yes-no format. Confirmatory factor analyses (CFA) were conducted to examine the factor structure of the SOSBMR and SBIS in childhood and adolescence (ages 8–15) and in adolescence/young adulthood (AYA; ages 16–25).
Results
One- and seven-factor CFAs were compared for both measures. For the SBIS, both mother- and father-report were used in childhood; self-report was employed for AYA. For the SOSBMR, only self-report was used for both age groups. Across each rater and time point, the seven-factor models of the SBIS and SOSBMR had adequate to excellent fit and reliability, indicating the ability to use each subscale. In addition, each of the corresponding subscales on the SOSBMR and SBIS were associated with each other across raters and time, showing good concurrent and predictive validity.
Conclusions
From childhood to young adulthood, the subscales of the SOSBMR can be used to examine responsibility across multiple medical tasks and the SBIS can be used to assess medical regimen skills and mastery in young people with SB.
Abstract
Objective
This study examined bidirectional associations between mother- and father-reported medical responsibility and medical skill mastery in youth with spina bifida (SB).
Methods
...Participants were 140 youth with SB and their parents who participated in three waves of a longitudinal study across four years (ages 8–15 years at Time 1). Mother- and father-report of both medical responsibility and medical skill mastery were used, and age and estimated intelligence quotient were included as covariates, in cross-lagged models.
Results
The cross-lagged model provided evidence for significant bidirectional associations between mother-reported medical responsibility and skill mastery across time (root mean square error of approximation=0.09, comparative fix index=0.97). These paths showed that higher levels of child responsibility predicted an increase in skill mastery and that higher levels of mastery predicted an increase in child responsibility across time. Moreover, based on mother-report, sharing of responsibility had stronger effects on increases in skill mastery (Time 1 to Time 2 β=.25, Time 2 to Time 3 β=.27) than skill mastery had on increases in child responsibility (Time 1 to Time 2 β=.08, Time 2 to Time 3 β=.07). The only significant cross-lagged path for father-report was from Time 1 skill mastery to Time 2 responsibility (β=.34).
Conclusions
Mothers perceive a bidirectional relationship between responsibility and skill mastery across time, whereas fathers appear to mainly consider how skills might affect a subsequent increase in responsibility sharing. Thus, it is important to consider both parents’ perspectives when working to increase medical autonomy in youth with SB.
Sluggish cognitive tempo (SCT) consists of symptoms of slowness, sluggishness, daydreaming, and low motivation. SCT has been linked to attention-deficit/hyperactivity disorder (ADHD), internalizing ...symptoms, and daytime sleepiness. Although there is clear evidence that SCT and ADHD symptoms are distinct constructs, the distinction between SCT, anxiety/depression, and daytime sleepiness is less clear. Prior research has largely relied upon parent-report to evaluate potential overlap between SCT, sleep, and anxiety/depression, despite best practice suggesting that self-report should be used to assess internalizing symptoms. The present study used adolescent self-report to evaluate whether SCT was distinct from daytime sleepiness, anxiety, and depression. Participants were 285 middle school students comprehensively diagnosed with ADHD. Ten confirmatory factor analyses were conducted: four 1-factor models, three 2-factor models, one 3-factor model, one 4-factor model, and a higher order model. Results showed that SCT was indeed distinct from all tested constructs, with the four-factor model including self-report of SCT, anxiety, depression, and daytime sleepiness meeting adequate model fit criteria. All models including SCT as its own factor had improved model fit over models with SCT in a combined factor with another construct. Implications for the assessment and treatment of SCT are discussed.
Public Significance Statement
Although the construct of sluggish cognitive tempo (SCT) includes symptoms of low motivation, apathy, and sluggishness, it is empirically distinct in youth with ADHD from other constructs with similar clinical characteristics, including anxiety, depression, and daytime sleepiness.
Preeminent theories of attention-deficit/hyperactivity disorder (ADHD) suggest that motivation deficits are core underlying features of the disorder. However, it is currently unclear whether ...empirical evidence supports the assertion that significant group (ADHD v. comparison) differences in motivation exist or that problems with motivation contribute to the functional impairments that youth with ADHD experience. Accordingly, this review focused on evaluating and summarizing the empirical literature on the presence of motivation deficits and their association with functional outcomes in samples of youth with ADHD. Twenty studies met the review inclusion criteria. Results support the assertion that youth with ADHD have lower academic-related motivation in comparison to their peers and that motivation plays an important role in academic outcomes, with the strongest evidence to date for reading achievement. However, the available evidence is limited, and few existing studies are aligned with the much larger theoretical and empirical motivation literature in typically developing youth. Given preliminary evidence that motivation plays a role in the academic impairments of youth with ADHD, the review concludes with a discussion of whether current ADHD interventions adequately target motivation and highlights important future directions.
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