ADHD is complex neurodevelopmental disorder that causes considerable individual and social difficulties, creating significant parental stress. This study aimed to examine the indirect associations between parental stress and child irritability through two sequential parenting mechanisms: experiential avoidance and negative parent-child relationship, within a sample of school-aged children with ADHD (ages 6-12). Using a two-wave longitudinal serial path analysis based on parent-reported data collected at two time points 1-month apart (Time 1 and Time 2), the study investigated whether early parental stress predicted subsequent child irritability via its influence on experiential avoidance and the quality of the parent-child relationship. Findings supported the hypothesized model. More precisely, higher parental stress was associated with greater experiential avoidance, which in turn predicted more negative parent-child relationship, ultimately resulting in elevated child irritability. Longitudinal serial mediation effects confirmed that all Time 1 variables significantly predicted corresponding Time 2 outcomes across the proposed sequential pathway. Notably, the model explained 41.1% of the variance in child irritability at Time 2, underscoring how stress-related disruptions in experiential avoidance and parent-child relationship can affect child irritability even over a short period of time. Taken together, these findings provide empirical support for a stress-driven sequence of parental mechanisms through which parental stress may contribute to child irritability in ADHD. In this context, interventions targeting parental experiential avoidance and improving the quality of parent-child relationship may help mitigate the early development of irritability in children with ADHD. Clinical implications are discussed.
Aim: This study aimed to provide a representative indication of the accessibility of both adult and child ADHD assessments in Australia for psychologists, psychiatrists, and paediatricians. Accessibility was considered in terms of clinician availability, wait times for an initial session, initial session costs, and total assessment costs across Australian states and territories, remoteness areas, and socioeconomic ranges.
Methods: Using a secret shopper design, researchers posed as potential consumers seeking an ADHD assessment for themselves and/or their child. A total of 736 clinicians were contacted via telephone between May and August 2024.
Results: Fifty-nine percent of clinicians responded, and 49.8% of respondents were available to book an ADHD assessment. The average wait times for psychologists, psychiatrists, and paediatricians were 7, 16, and 31 weeks, respectively (Mdn = 3, 15, and 26; IQR = 7, 16, and 31). The average initial session costs and estimated total assessment costs were $266 and $1,622 for psychologists (Mdn = 250 and 1,625; IQR = 57 and 929), $748 and $1,163 for psychiatrists (Mdn = 750 and 1,086; IQR = 340 and 555), and $500 and $598 for paediatricians (Mdn = 495 and 585; IQR = 123 and 739).
Conclusion: This study identified substantial barriers to ADHD assessment accessibility in Australia. Low clinician availability, long wait times, and high costs for assessments are all factors contributing to healthcare access inequality. Policy changes and investment, as well as further research into contributing factors, are needed to improve availability and accessibility.
Objective: Attention-deficit/hyperactivity disorder (ADHD) is associated not only with cognitive impairments but also with deficits in social cognitive abilities, including empathy. Although attention and empathy have been individually studied in children with ADHD, the link between performance-based attention measures and empathy remains underexplored. Thus, this study examined the relationship between attention performance and empathy in children diagnosed with ADHD.
Method: The sample included 53 children aged 7 to 12, consisting of 27 children diagnosed with ADHD and 26 typically developing control group. All participants were recruited from educational and clinical settings. Attention was measured using a computer-based Go/No-Go task, and empathy was assessed using the Reading the Mind in the Eyes Test (RMET). ADHD symptom severity was assessed using the Turgay DSM-IV-Based Disruptive Behavior Disorders Rating Scale (T-DSM-IV-S).
Results: Children with ADHD made significantly more omission errors and scored lower on RMET than typically developing group. Significant negative correlations were found between RMET total score and omission errors and inattention scores. Regression analyses further supported these associations by indicating that attention-related variables significantly predicted empathy performance.
Conclusion: Attention performance is closely associated with empathy in children with ADHD. These findings underscore the need for early and integrative interventions targeting both attentional and socio-cognitive dimensions in children with ADHD.
This study investigated the effects of the encoding strategy episodic future thinking on prospective memory performance (i.e., remembering to execute intended actions in the future) in individuals with a diagnosis of Attention Deficit Hyperactivity Disorder (ADHD) by community providers. Individuals with ADHD often have difficulties to plan and execute delayed intentions in everyday life; thus, they show reduced prospective memory performance. Several studies indicate that engaging in episodic future thinking (i.e., mentally imagining executing the planned activity) during intention formation can improve prospective memory performance in typically developing populations in lab-based settings. To assess the execution of everyday intentions, we requested participants to perform the diary task. Thirty-two adults with ADHD and 31 controls were allocated to an episodic future thinking encoding condition and 31 adults with ADHD and 33 controls to a standard encoding condition. Analyses of variance revealed significant main effects of group and of encoding condition. Overall, controls remembered to execute more intentions than individuals with ADHD. Across groups, episodic future thinking increased the realization of intentions as compared to the standard encoding condition; however, this effect was no longer significant when verbal ability was statistically controlled. There was no significant interaction effect. This study replicates earlier findings of reduced intention execution in ADHD and provides preliminary support for episodic future thinking as a strategy to enhance PM in daily life, though its effects may depend on verbal ability, warranting further research.
Objectives: Attention-deficit/hyperactivity disorder (ADHD) and post-traumatic stress disorder (PTSD) often co-occur in youth, complicating the clinical presentation. However, little is known about how PTSD influences treatment selection or outcomes in youth with ADHD. This study examined prescribing patterns and clinical outcomes among youth with ADHD, with and without comorbid PTSD.
Methods: This retrospective cohort study used electronic health record data from the TriNetX Research Network, including over 714,000 youth (ages 6-18) diagnosed with ADHD (F90), of whom 30,341 (4.25%) also had comorbid PTSD (F43.1). Outcomes included treatment trends, emergency visits, hospitalizations, and subsequent antipsychotic or mood stabilizer prescriptions. Relative risks (RR), hazard ratios (HR), and 95% confidence intervals were calculated using propensity score matching and Cox proportional hazards models adjusted for sociodemographic and psychiatric variables.
Results: Among youth with ADHD, those with comorbid PTSD were older, had more psychiatric comorbidities, and were more likely to receive non-stimulants (RR 1.54, 95% CI [1.51, 1.57]), antidepressants, antipsychotics, mood stabilizers (RRs 1.29-1.70), and psychotherapy (RR 1.55, 95% CI [1.51, 1.60]). Methylphenidate prescriptions were slightly lower (RR 0.97, 95% CI [0.95, 0.99]), while amphetamine use remained stable. Among youth with ADHD and PTSD, CNS stimulants were associated with the most favorable outcomes across all clinical measures, including hospitalizations, emergency visits, and subsequent antipsychotic and mood stabilizer use (aHRs 0.52-0.74), compared with non-stimulants and antidepressants.
Conclusions: Youth with ADHD and PTSD are clinically complex and receive broader treatment interventions. Clinicians appear to de-prioritize stimulants after PTSD diagnosis, despite evidence of superior clinical outcomes. Findings underscore the need for prospective studies and evidence-based treatment guidelines for this high-risk population.
Background: Prior work reports a relative age effect (RAE), in which children are more likely to be diagnosed with Attention-Deficit/Hyperactivity Disorder (ADHD) if they are relatively younger than their classmates. Yet work reporting a RAE in ADHD diagnosis has analyzed relatively dated samples, has not examined moderation across sociodemographic characteristics, and has largely not examined the RAE in longitudinal analyses. We examined whether entering kindergarten as a relatively younger student increased the likelihood being diagnosed with ADHD across elementary school. We also examined moderation by race and ethnicity, biological sex, socioeconomic status, and home language.
Methods: We analyzed data from the Early Childhood Longitudinal Study-Kindergarten Cohort (ECLS-K: 2011; N = 11,410), a nationally representative cohort. Logistic regression models estimated relations between children's relative age and both grade-specific and cumulative ADHD diagnoses during elementary school. Discrete-time event history logit regression models examined the timing of ADHD diagnosis from kindergarten through fifth grade. Interaction terms assessed moderation by sociodemographic characteristics.
Results: We generally failed to observe evidence of a RAE, either cumulatively or within specific grades. Discrete-time event models indicated no significant relations between relative age and timing of ADHD diagnosis. Moderation analyses identified isolated interactions, indicating the possibility of a specific RAE for Black children and those from non-English-speaking homes in select grades. However, these predicted effects were not consistently observed and did not survive correction for multiple comparisons.
Conclusions: In contrast to prior work analyzing older datasets, we failed to observe a RAE in U.S. elementary schools. Our finding suggest that relatively younger children attending U.S. elementary schools are not at increased likelihood for ADHD diagnosis.
Objective: Attention Deficit/Hyperactivity Disorder (ADHD) is a chronic and impairing neurodevelopmental disorder diagnosed in approximately 2% to 4% of preschool-age children and 9% of all children. Behavioral parent training (BPT) and high-quality education are effective treatments for young children with ADHD; however, poor rates of treatment access and participation limit the reach of BPTs to rural and underserved communities. In this study, we tested the newly developed Rural Outreach and ADHD Research-Early Childhood (ROAR-EC) program, a clinician-led, 7-session education and parent training program designed for delivery over telemedicine.
Method: We conducted a pilot RCT to assess the feasibility, acceptability, engagement of mechanism, and exploratory group × time effects of the ROAR-EC program compared to a control group in a sample of 44 children diagnosed with ADHD from a predominantly rural area (ages 3-7; Mage = 4.8; 62% male; 96% White; 89% non-Hispanic/Latinx). Families were randomized into either ROAR-EC or treatment as usual through developmental pediatrics and followed for 24 weeks. Assessed were metrics of feasibility, acceptability, parenting practices, caregiver empowerment, disruptive behaviors, and ADHD symptoms.
Results: Results indicated that ROAR-EC was feasible to implement and acceptable to caregivers. Repeated measures ANOVAs found significant group × time interaction effects in favor of the treatment group compared to control for family empowerment, parenting practices, total behavior problems, impairment, and inattentive symptoms.
Conclusions: This study demonstrated the promise of brief telemedicine programs as feasible, acceptable, and likely beneficial alternatives to traditional BPTs for young children with ADHD in rural and low-resource areas.
Background: ADHD has been characterised by excessive mind wandering (MW), or thoughts unrelated to the task at hand, with recent findings indicating that ADHD is specifically associated with more unintentional, but not intentional, MW. These two types of MW are also differentially associated with affective well-being. Most existing studies in ADHD, however, mainly rely on retrospective reports of MW tendencies, which are susceptible to memory-related errors and biases. Further, most studies categorise participants based on overall levels of ADHD, instead of accounting for the spectrum and dimensional heterogeneity of ADHD, including inattention and hyperactivity symptom dimensions. Our study aimed to address the knowledge gap regarding the relationship between different types of MW and affective well-being, across different symptom dimensions of ADHD.
Methods: We used ecological momentary assessment to capture participants' momentary attention state (on-task, intentional MW, or unintentional MW) and affective valence, six times daily for 7 days. Using linear mixed-effects modelling to account for inter-individual variance, we tested whether inattention and hyperactivity symptom dimensions of ADHD differentially moderate the relationship between attention states and affective valence.
Results: We found that higher levels of inattention symptoms predicted more negative affect during intentional MW compared to on-task attention; in contrast, higher levels of hyperactivity symptoms predicted more positive affect during intentional MW compared to on-task attention.
Discussion: Together, our results indicate that intentional MW moderates opposing effects of inattention and hyperactivity ADHD symptoms on affective valence. Our findings suggest that intentional MW - and not just unintentional MW - may also play a role in affective or behavioural outcomes associated with ADHD symptomatology, and highlight the importance of considering the heterogeneity of ADHD symptomatology, as well as the distinction between intentional and unintentional MW, in future ADHD research.
Objective: Attention-deficit/hyperactivity disorder (ADHD) has been shown to increase the risk of young adults perpetrating and being victims of intimate partner violence (IPV). However, research has yet to examine the IPV experiences of both dyad members where one or both partners has ADHD, and how those experiences differ from couples including partners without ADHD.
Methods: 41 "ADHD couples" (m age = 22.7 years), where one (n = 33) or both (n = 8) dyad members had ADHD, and 28 "Non-ADHD couples" (m age = 23.4 years), where both dyad members did not have ADHD, participated. Both partners reported on the frequency they perpetrated and were victims of psychological and physical IPV.
Results: Both partners in ADHD couples reported perpetrating more psychological and physical IPV than dyad members in Non-ADHD couples. Partners in ADHD couples also reported being victims of IPV more than partners in Non-ADHD couples.
Conclusions: The risk of IPV perpetration in young adult couples with ADHD appears to be a two-way street. Research is needed to examine possible explanations for this pattern of reciprocal IPV, including mutual ADHD symptoms and related behavior (e.g., alcohol intoxication).
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