JCPP advances最新文献

Background: Executive function (EF) impairments are heterogeneous in children with attention deficit/hyperactivity disorder (ADHD). Culture has a significant impact on EF development in typically developing (TD) children, yet its influence on EF impairments in those with ADHD remains understudied. This study aims to investigate the impact of cultural factors on EF impairments in children with ADHD through a cross-cultural comparison.

Methods: To ensure a robust sample size, the study initially recruited a large participant pool of 690 children from China and Australia. We applied similar diagnostic criteria and used propensity score matching to align clinical representation. This approach resulted in a final sample of 198 children aged 7-12, including 102 children diagnosed with ADHD and 96 TD peers. The same neuropsychological testing battery was used to assess EF in terms of working memory (WM), inhibitory control (IC), and set shifting.

Results: Significant cultural effects were observed: Chinese children with ADHD showed lower performance in IC and WM compared to their TD peers, a pattern not seen in Australian children. A latent profile analysis revealed distinct EF profiles, highlighting a subgroup of Chinese children with severe EF impairments.

Conclusions: This study advances cross-cultural ADHD research on EF by using a robust methodology, including consistent diagnostic and testing procedures, propensity score matching, and person-centered analysis. Our findings suggest that high-EF-expectation environments may have a negative effect on EF in children with ADHD, which provides insight into the underlying contributors to heterogeneous EF and underscores the need for culturally tailored ADHD interventions.

Background: Parental attention deficit/hyperactivity disorder (ADHD) is associated with increased postpartum depressive symptoms and impaired daily functioning, potentially impacting early maternal-infant attachment (MIA).

Methods: 78 mothers, half with ADHD, were enrolled during pregnancy or postpartum. Participants completed questionnaires regarding social support, home chaos, postpartum depressive symptoms, and postnatal MIA. Pregnant participants (n = 45) also reported antenatal MIA. ANOVA compared mothers without ADHD (n = 44), mothers with ADHD (n = 21), and mothers with ADHD coparents (infants' fathers; n = 13), and Benjamini-Hochberg correction was applied to account for multiple testing. Multilevel linear regression examined predictors of MIA.

Results: Mothers with ADHD reported greater postpartum depressive symptoms and home chaos than mothers with ADHD coparents or those without parental ADHD; mothers with ADHD coparents reported the poorest overall MIA and quality of attachment and greatest hostility toward their infants (Benjamini-Hochberg false discovery rate q < 0.05). In the final model for MIA, postpartum depressive symptoms (B = -0.85, p < 0.001) and coparent ADHD (B = -4.70, p = 0.051) were associated with poorer MIA (R ²  = 0.40, p < 0.001). When examining MIA subscales, postpartum depressive symptoms were negatively correlated with subscales measuring quality of attachment and absence of hostility but not pleasure in mother-child interaction. When antenatal attachment was included, it (B = 0.65, p = 0.002), along with postpartum depressive symptoms (B = -0.60, p = 0.032), predicted postnatal MIA (R ²  = 0.50, p < 0.001).

Conclusions: Given parental ADHD (mother or father) was associated with increased maternal postpartum depressive symptoms and less optimal MIA in this study, additional support for families with ADHD in the perinatal period may improve maternal and infant mental health outcomes. Future work incorporating observational data and additional investigation of the coparenting relationship is needed to further clarify determinants of MIA in early childhood.

Background: Young children diagnosed with autism experience high rates of co-occurring anxiety, with uncertainty-related concerns commonly reported. This randomized controlled trial investigated an 8-week parent-mediated group anxiety intervention, "Coping with Uncertainty in Everyday Situations" (CUES-Junior©).

Methods: Parents of 4-7-year-old children diagnosed with autism and experiencing uncertainty-related anxiety were recruited. The primary outcome was change from baseline in blinded assessor ratings of child responses to uncertainty and impact on family, measured post-intervention and 2-month follow-up. Secondary outcomes were parent-reported child anxiety and intolerance of uncertainty (IU), parental IU and mental health, parenting sense of competence, along with intervention feasibility and acceptability.

Results: Sixty-four children were randomized to CUES-Junior© (n = 33) or waitlist (n = 31); five families withdrew post-randomization. Immediately post-intervention, significantly more CUES-Junior© participants were rated as clinically improved from baseline in child responses to uncertainty (OR = 34.48; 95% CI = 1.72-690.04, p = 0.02) and in family impact (OR = 8.99; 95% CI = 1.52-53.05, p = 0.02) compared to waitlist. Significant improvements were also observed in parent-reported child IU and parenting satisfaction, favoring CUES-Junior©. At subsequent 2-month follow-up, CUES-Junior© participants showed sustained improvements in the impact of uncertainty on children, and parental ratings of child IU and anxiety, parenting sense of competence, and parental stress, compared to baseline. The program was feasible to administer and acceptable to parents.

Conclusions: CUES-Junior© had an immediate treatment effect on child responses to uncertain situations and impact on families, with maintained improvements observed at follow-up. This novel mechanism-targeted and autism-informed program holds promise for addressing early uncertainty-related anxiety in young children diagnosed with autism.

Background: Significant intimate partner aggression (IPA) has been found to negatively impact outcomes of children, such as increased conduct problems (CP). However, it is unclear if forms of IPA that are less severe (e.g., shoving, pushing or yelling) have no, little, or substantial impact on child CP, which would indicate that the intensity (i.e., dosage) of IPA matters. In addition, it is unknown if the impact of IPA on child CP depends on the reporter (mother vs. partner) and on variables such as maternal depression and parenting.

Methods: We investigated the impact of IPA (both mother- and partner-reported), assessed during pregnancy and 9 months postpartum, on child CP at ages 2, 4.5, and 8 years. We also tested both the potential mediating role of maternal depression and moderating role of maternal warmth, reflecting risk and protective factors, respectively. Using longitudinal data from the Growing Up in New Zealand study, we tested path models with 5298 children.

Results: IPA predicted greater child CP for both mother- and partner-reported IPA, but at different age. Maternal depression partly mediated this effect, which was not moderated by maternal warmth.

Conclusion: These findings underscore the importance of exposure to IPA on child development and provides evidence for that impact on behaviour independent of the effects of maternal depression. Positive parenting like maternal warmth seems not to buffer those negative effects.

Background: This study aims to evaluate the clinical value of using QbCheck in routine Attention Deficit Hyperactive Disorder (ADHD) clinics by investigating longitudinal inter-domain relationships between objective neurocognitive outcomes of QbCheck and subjective clinical outcomes: ADHD core symptoms, impairment and quality of life (QoL).

Method: The study was conducted alongside the participants' standard pharmacological treatment for their ADHD. Thirty-four clinically diagnosed participants with ADHD completed baseline and follow-up neurocognitive assessments. Bayesian paired t-tests and bivariate correlations were used to examine changes over time and relationships between key variables.

Results: Bayesian analyses showed correlations between QbCheck and continuous performance test (CPT)-II for the same constructs, except for omission errors. In the test-retest results of QbCheck, measures remained stable, though moderate evidence supported changes in reaction time variability (BF₁₀ = 5.57) and anecdotal evidence for commission errors (BF₁₀ = 1.72). In measuring treatment effect, there was moderate to extreme evidence for reductions in self- and informant-rated ADHD symptoms and clinician-rated impairment severity. In contrast, informant-rated QoL showed weak evidence for a difference (BF₁₀ = 1.81), and self-rated QoL showed no change (BF₁₀ = 0.67). QbCheck showed moderate to extreme evidence for most changes, with weak evidence for reaction time (BF₁₀ = 1.38), while CPT-II showed strong evidence for commission errors, weak evidence for response time variability, and no evidence for omission errors or reaction time. Weak evidence suggested moderate associations between QbCheck MicroEvent X and informant-rated ADHD symptom severity (BF₁₀ = 2.40, r = 0.47) and CPT-II commission errors and self-rated ADHD symptom severity (BF₁₀ = 2.44, r = 0.39).

Conclusion: QbCheck is a valid tool for assessing neurocognitive changes in ADHD treatment but should not replace clinical outcome measures or be used as a proxy for behavioural assessments. Caution is needed when relying on a single outcome measure, emphasizing the need for multi-source assessments to capture the full impact of treatment.

Background: Health anxiety (HA) is characterized by impairing worry about being or becoming seriously ill. This cross-sectional study aimed to explore psychological and behavioral correlates of HA compared to other anxiety phenomena in adolescents, that is, with respect to depression, physical symptoms, bodily dissatisfaction, health-related quality of life (HRQoL) and healthcare utilization.

Methods: This study was pre-registered at https://doi.org/10.17605/OSF.IO/YNBJG. We employed data from the 16/17-year follow-up (N = 2438, 16/17 years old) from the general population-based Copenhagen Child Cohort 2000. Health anxiety, anxiety, depression, physical symptoms, bodily dissatisfaction, and HRQoL were assessed using self-report questionnaires, and linked to register data on healthcare utilization. Latent profile and latent class analyses were applied to explore if specific HA related profiles/classes could be detected. These analyses did not support the idea of HA being independent of other anxieties. Instead, four groups were created based on levels of HA and anxiety symptoms. Differences between the four groups regarding the various health-related aspects were examined using relevant statistics.

Results: The four groups were: no anxieties (N = 1822; 74.7%), high other anxiety (N = 364; 14.9%), high HA (N = 111; 4.6%), and both high HA and other anxiety (N = 141; 5.8%). The high HA group reported fewer depressive symptoms, more physical symptoms, and higher healthcare utilization than those with high other anxiety. Compared to those without anxieties, both HA groups had worse scores on all psychological and behavioral correlates. Adolescents with both high HA and other anxiety symptoms reported most depressive and physical symptoms, highest bodily dissatisfaction, the lowest HRQoL and the highest healthcare utilization.

Conclusion: HA symptoms often co-occur with additional anxiety symptoms but is specifically associated with significantly higher healthcare utilization, highlighting the importance of early recognition and intervention in youth to reduce its clinical impact.

Background: Exploring the similarities and differences of mental health-based service contact behaviours for children and young people (CYP) and associated characteristics will allow for distinct analysis of identified groups, and inform both current support pathways alongside more focussed targeted intervention strategies.

Methods: Using data from the Mental Health of CYP in England Survey, 2017, we fitted latent class analysis models to identify classes of CYP based on the type of service contact they received. Analysis was stratified by educational stage (aged 5-10, 11-16 and 17-19 years) owing to different help-seeking pathways.

Results: For each educational stage, the four-class model was the best fit. Latent classes for children aged 5-10 years included, No Services, Community Services, Nonmedical Services, Contact all services. Children and young people reported different patterns of class membership by gender and ethnic group. Similar latent classes were identified for YP aged 11-16 years including: No Services, Nonmedical Services, Community Services, and Contact all services, however, stronger patterns of contact were found for nonmedical compared to community services. For those aged 17-19 years, classes included: No Services, Nonmedical Services, Specialised Services and Community and Health Services. Young people in the Specialist Service class had higher probabilities of being white/other compared to Black/Asian/Mixed/Other.

Conclusion: CYP show different patterns of service contact across educational stages, with gender and ethnic disparities. Our findings could inform models of help, and support those designing and commissioning services to refocus and review where funding is best placed.

Background: This systematic review aimed to assess the current evidence on the efficacy and safety of Atomoxetine in common clinical attention-deficit hyperactivity disorder (ADHD) symptoms in the context of autism spectrum disorder (ASD) for children and adolescents. Some of these common clinical symptoms of ADHD in the context of ASD include core symptoms of ASD, ADHD, depression, anxiety, mood instability/irritability, and cognitive symptoms.

Methods: Major medical literature were searched for randomized controlled trials (RCTs), open-label trials, and other relevant studies or clinical trials reporting on pediatric (age <18 years) patients with ASD treated with Atomoxetine for any reason. Databases were searched January of 2024 and include PubMed, Google Scholar, Web of Science, Scopus, PsycINFO, and Embase. Exclusion criteria were unpublished data and multiple reports from the same data set.

Results: A total of 100 abstracts were screened, and 16 clinical trials were selected for inclusion. Out of these 16 clinical trials there were two RCTs (n = 128 and 97), four open-label trials (n = 24, 12, 12, and 16), eight extension studies (n = 128, 97, 88, 97, 97, 117, 128, and 94), one observational study (n = 4), and one crossover study (n = 16). Meta-analysis was not performed due to a lack of homogeneity in the two RCTs. There were limited studies available with a need for more high-power studies. In the current studies, most suggested that Atomoxetine was well tolerated and safe in pediatric patients with ASD. In fact, Atomoxetine response rates were found to be similar to those of methylphenidate in ASD studies, while inducing fewer adverse events and tolerated better.

Conclusion: Further trials are warranted to make conclusive recommendations on Atomoxetine for improvement of common clinical symptoms of ADHD in the ASD pediatric population. Given limited approved therapies for common clinical symptoms of ASD in children and adolescents, Atomoxetine could be used as a safe off-label option due to a favorable tolerability profile and minimal adverse effects.

Pharmacoepidemiology studies are an important complement to Randomized Clinical trials, but such studies face several challenges, such as confounding and selective reporting. How to best address confounding has been discussed in detail for many years. More recent discussions have highlighted the value of pharmacoepidemiology studies based on pre-registered protocols. This is an important step to address problems related to selective reporting and to enhance transparency and reproducibility. In this editorial perspective, we discuss the value of pre-registered protocols in pharmacoepidemiology.

Background: Genetic risk factors, impulsivity, and exposure to painful and provocative events (PPEs) have each been linked with risk for suicide attempt (SA). However, the degree to which genetic associations with SA are mediated by dimensions of impulsivity and PPEs remains unexplored, particularly in early adolescence.

Methods: Participants were 6402 individuals (52.0% male, 48.0% female, 72.3% European ancestry, 27.7% African ancestry, mean age at baseline = 9.47 years, SD = 0.51 years) from the Adolescent Brain Cognitive Development (ABCD) Study. Genetic liability for SA was measured using polygenic scores and family history density scores. Multiple dimensions of impulsivity were assessed using self-report measures and laboratory tasks, and potential PPEs included injuries, traumatic events, non-suicidal self-injury, and operations. A series of mediation models was specified to evaluate whether genetic associations with SA risk were mediated by impulsivity and PPE exposure. Separate models were tested in adolescents of European and African ancestry. Sex, age, socioeconomic factors, and depressive symptoms were included as covariates.

Results: Genetic liability for SA was largely unrelated to impulsivity, PPE exposure, and SA risk ( $\left|\beta \right|$  = 0.00-0.34). In addition, there was little support for the hypothesis that more impulsive individuals are more likely to experience PPEs, with the exception that urgency and low conscientiousness were significantly related to non-suicidal self-injury ( $\left|\beta \right|$  = 0.09-0.19). Several dimensions of impulsivity and two PPEs (non-suicidal self-injury and traumatic events) were related to increased risk for SA ( $\left|\beta \right|$  = 0.32-0.76).

Conclusions: Impulsivity and PPEs each contribute to risk for SA. However, there is little support for the hypothesis that genetic influences on SA are mediated by impulsivity and PPE exposure in early adolescence.