Recent studies report a fluctuating course of attention-deficit/ hyperactivity disorder (ADHD) across development characterized by intermittent periods of remission and recurrence. In the Multimodal Treatment of ADHD (MTA) study, we investigated fluctuating ADHD including clinical expression over time, childhood predictors, and between- and within-person associations with factors hypothesized as relevant to remission and recurrence.
Objective To test whether adolescents' perceived ADHD symptoms may improve while monitoring them throughout the day.Method In a sample of 90 adolescents (Mage = 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.Results 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.Conclusions 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.
The rates of suicidal ideation and completed suicide among adolescents have become increasingly alarming in recent years. Epidemiological studies indicate that a large portion of adolescents suffer from chronic pain, which research supports as a risk factor for suicidal ideation and behaviors. Further, psychological factors may account for the associations between chronic pain and suicidality. The current study sought to fill gaps in the literature on chronic pain and suicidality in adolescents, by examining whether depression mediates the links between various chronic amplified pain symptoms and suicidal ideation. Retrospective medical record reviews were conducted of 453 adolescents ages 11-17 (M = 14.34, SD = 1.83), who presented to a tertiary pain clinic and received a diagnosis of amplified pain. Prior to their initial appointment, participants completed measures assessing pain symptoms, disability, depression, and suicidality. We found pain duration was significantly related to suicidal ideation, however, this association was mediated by depressive symptoms. These results highlight the need for early screening and intervention for depressive symptoms among adolescents suffering from amplified pain. Clinical recommendations for mental health and medical providers are discussed. (PsycINFO Database Record
Abstract Background Although individuals with histories of childhood attention‐deficit/hyperactivity disorder (ADHD) report more alcohol‐related problems in adulthood than those without ADHD, it is unknown whether there are group differences in certain types of alcohol problems. We tested whether the nature of alcohol problems differed for individuals with and without childhood ADHD, as well as adulthood‐persistent ADHD, to facilitate a personalized medicine approach for alcohol problems in this high‐risk group. Methods Data were drawn from a prospective, observational study. Children diagnosed with ADHD and demographically similar individuals without childhood ADHD were followed prospectively through young adulthood ( N = 453; 87.6% male). ADHD symptom persistence was assessed using self‐reports and parent reports. Alcohol problems and heavy drinking were assessed repeatedly from 18–30 years old to construct lifetime measures. Results Full‐sample confirmatory factor analyses identified 5 alcohol problem “types:” interpersonal problems/risky behaviors, occupational/academic impairment, impaired control/treatment seeking, tolerance/withdrawal, and drinking to blackout. Latent class analyses of items within each type yielded the best fit for 3‐class solutions for all sets of items except blackout drinking, for which 2 classes emerged. Children with ADHD were more likely than those without ADHD to belong to high‐risk latent classes for interpersonal problems/risky behaviors, occupational/academic problems, and impaired control (the high‐risk class that indexed treatment‐seeking behavior). These effects were driven by individuals whose ADHD symptoms persisted into adulthood. Few group differences emerged for tolerance/withdrawal and blackout drinking, except that individuals with only childhood ADHD (no persistence) were more likely to belong to the low ‐ risk groups than those with adulthood‐persistent ADHD and without ADHD. Conclusions Individuals with ADHD histories whose symptoms persist into adulthood may be more likely to experience socially oriented alcohol problems and impaired control/treatment seeking than individuals without an ADHD history and those with childhood ADHD only. Tailored alcohol prevention and treatment programs may benefit this high‐risk population.
