Web Health Application for ADHD Monitoring (WHAAM): Context-Driven Framework

The Framework (FW) summarizes the experiences and vision of the WHAAM project partners, providing the basis for the development of the WHAAM app and online services. There are many approaches to the treatment of ADHD, with excellent resources available. This FW is a working tool based on partners' experiences, inspiring subsequent project activities. It is divided into three parts: part A explores general issues related to ADHD, focusing on key life contexts such as school, family, and social relationships. Each context is explored in terms of assessment, intervention and support. Part B delves into the relationship between ICT use and ADHD treatment. Finally, Part C briefly explains the main features of the WHAAM app, including functionality and interfaces. The WHAAM project considers the app and online service accessible via PC and mobile devices as a significant advancement in monitoring process management

ABSTRACT Lauren Hamilton: Evaluation of the Sexuality & Relationships Psycho-education Program for Adolescents with Intellectual and/or Developmental Disabilities and their Parents

The purpose of this DNP project is to evaluate an existing psycho-education program about sexuality and relationships for adolescents with intellectual and/or developmental disabilities and their parents. The clinical problem at the heart of this project is the need to address adolescent psychosexual development in the IDD population. This problem is based on the understanding that sexuality and relationships have an extensive impact on long-term holistic health and individuals with IDD confront unique challenges. Failure to satisfy psychosexual developmental needs results in increased risks and problems in the IDD population. Comprehensive sexuality education equips adolescents and their parents with the knowledge and skills to build the foundation for health and positive experiences in these areas of life. The Context, Input, Process, Product model guides the program evaluation & the alignment of DNP project goals. DNP project participants included the Sexuality & Relationships program director and co-facilitators. The program evaluation consisted of two outcome measures: an online survey and semi-structured interview, both conducted after the spring 2018 program series.Doctor of Nursing Practic

Disruptive Behavior Disorders

Disruptive behavior disorders (DBD) refer to a group of conditions that typically share difficulties in modulating aggressive conducts, self-control, and impulses, with resulting behaviors that constitute a threat to others’ safety and to social norms. Problematic issues with self-control associated with these disorders are commonly first observed in childhood, but may often persist into adolescence and adulthood, or pose a developmental risk for subsequent negative outcomes. The clinical management of DBD in childhood and adolescence has seen great advances in recent years, and research has also focused on identifying early signs, predictors, and risk factors, which may help clinicians to disentangle and subtype the heterogeneous manifestations of BDB. This has allowed significant progress to be made in defining specific developmental trajectories, targeted prevention programs, and timely treatment strategies. The principal aims of this Special Issue were thus to address three core features of DBD clinical management, the multidimensional assessment of callous–unemotional traits, empathic faults and emotional dysregulation, and the available treatment options. In this Special Issue, twelve relevant contributions, including ten original articles, one systematic review, and one study protocol, which provide novel insights for the assessment and treatment of DBD in clinical practice, have been collected by the editors

Factors Associated with Parental Treatment Attitudes and Information-Seeking Behaviors for Childhood ADHD

Abstract Background: Childhood ADHD is an impairing neurodevelopmental disorder with associated long-term negative outcomes in a variety of domains. Despite this, there is a significant delay to treatment and a low rate of lifetime treatment contact for individuals with ADHD. Barriers to child treatment include parental poor symptom recognition, attitudinal barriers, evaluative barriers, fear of stigma, and structural barriers. These barriers are important to consider in the context of the family system, as parents serve as gatekeepers to mental health treatment for their children. In addition, parents’ perceptions of the quality and type of their children’s symptoms may also inform their information-seeking behaviors and ultimately, treatment decisions. The current study aimed to examine (a) variables associated with treatment-seeking attitudes, (b) variables associated with information-seeking behaviors, and (c) the relationship between treatment-seeking attitudes and information-seeking behaviors in a non-treatment-seeking parent sample. Method: Data from 169 non-treatment-seeking parents were analyzed. All parents participated in an online study that assessed their perceptions of their own children’s symptoms, parenting self-efficacy, satisfaction with treatment providers for themselves and their child, knowledge about ADHD and treatment, symptom recognition, stigma towards ADHD, and treatment attitudes. Information-seeking behaviors were also measured. Results: Linear and logistic regressions analyzed the association between parental factors and treatment attitudes and information-seeking behavior, as well as the association between attitudes and information-seeking behavior. In these non-treatment-seeking parents, attitudes towards ADHD treatment were significantly associated with ADHD knowledge and misconceptions, causal attributions and understanding of ADHD, parenting self-efficacy, ADHD stigma, ADHD knowledge, and satisfaction with past providers. No hypothesized factors were significantly associated with information-seeking behavior. Attitudes towards treatment and information-seeking behavior were also not significantly associated with each other. Discussion: Parental knowledge and understanding of ADHD symptoms and treatment, low levels of ADHD stigma, and positive experiences with past medical providers for oneself and one’s child were the best predictors of holding positive attitudes about ADHD treatment. Significant relations between these factors and treatment attitudes and information-seeking behavior did not emerge, however, highlighting the need for additional research on factors associated with treatment attitudes as well as continued study of how best to enhance treatment attitudes

Social cognition, impulsivity, and emotion regulation factors in aggressive behavior among children with attention-deficit/hyperactivity disorder.

Children with Attention-Deficit/Hyperactivity Disorder (ADHD) exhibit greater levels of aggressive behavior than their typically developing peers, often resulting in impairment in social and family functioning. Aggressive behavior is often differentiated into two functions: reactive, or “hot-blooded” and proactive, or “cold-blooded” aggression. Prior research has identified several factors contributing to aggressive behavior within a general population, including emotion dysregulation, negative urgency, social information processing (SIP), and parenting behaviors. A paucity of research has examined these factors within an ADHD population. Thus, the present study aimed to examine social, emotional, behavioral, and cognitive factors associated with aggression among children with ADHD. Specifically, the present study investigated the independent and combined roles of emotion dysregulation and negative urgency in reactive aggression as well as the independent and interactive roles of SIP and parenting behaviors in proactive aggression. Participants included 28 children with ADHD and their parents. Participants, their parents, and their teachers completed questionnaires to assess emotion dysregulation, negative urgency, aggressive behavior, and parenting behaviors. Parents completed a diagnostic interview to confirm ADHD diagnostic status. Children completed one task to assess aggression and responded to social vignettes to assess social information processing. Of note, the data collection was prematurely discontinued due to the emergence of the COVID-19 pandemic; therefore, results of the present study should be interpreted with caution due to low power. Hypothesis 1 was partially supported, such that emotion dysregulation significantly estimated reactive aggression regardless of reporter. Further, negative urgency significantly estimated reactive aggression when reported by parents, but not by teachers. Contrary to hypothesis 2, SIP did not significantly estimate proactive aggression, and no interaction between SIP and parenting behaviors was observed. However, inconsistent discipline did significantly estimate proactive aggression suggesting learning history and environment play an important role in proactive aggression. Finally, contrary to hypothesis 3, no indirect effect of emotion dysregulation on reactive aggression through negative urgency were observed; however, these results are inconclusive due to low power. Findings of the present results have significant implications for the way in which aggression is conceptualized, as well as clinical implications for the treatment of aggressive behavior among children with ADHD

Understanding And Improving Adhd Symptom Recall: An Investigation of Temperament And Childhood Symptom Recall Over Time

Background: ADHD is characterized by a high prevalence, functional impairment across the lifespan, negative long-term consequences, and a heterogeneous etiology, rendering it of significant public health import. Despite this, there is still a significant delay to treatment as well as low rate of lifetime treatment contact in the ADHD population, which may potentially increase the associated personal and public health burdens. Due to this delay to treatment and requirement of symptom onset before the age of 12, adults seeking ADHD assessments provide a challenge to clinicians to determine if symptoms were present in childhood. The current study investigated the consistency of retrospective parental and self-recall of childhood symptoms and explored potential avenues for improving assessment of symptoms of ADHD in childhood. Method: Participants were recruited from an outpatient mental health clinic and a developmental research program. Data were collected from 50 parents and 40 children (Time 2 age M=13.63; SD=3.09; range 6.87 - 20.50). who had previously completed a measure of ADHD symptoms (Time 1 age M=9.48; SD=2.65; range 5.44 - 14.92). Participants completed a retrospective recall of previous child ADHD symptoms using the same symptom measure they completed earlier. Participants also completed measures of child current ADHD symptoms and associated impairment, and a retrospective report of child temperament. Results: Repeated measures ANCOVAs were conducted to assess the difference between retrospective recall and past symptom reports. Results suggested that Time 1 childhood symptoms of ADHD were significantly higher than Time 2 retrospective reports. ADHD diagnostic status only affected self-report of childhood hyperactivity/impulsivity symptoms, such that youth with ADHD demonstrated more consistent report of hyperactivity/impulsivity over time. Multiple linear regressions suggested that Time 2 symptoms of ADHD were the most significant factor in predicting Time 1 childhood symptoms for parent report and child report of attention problems. Linear regressions assessed the relationship between retrospective recall of Time 1 temperament traits and past, current, and retrospective reports of ADHD symptoms. Parent reported child reward dependence, novelty-seeking, and self-directedness temperament traits were associated with parent report of childhood ADHD symptoms. Self-reported novelty-seeking, persistence, reward dependence, and self-directedness were the most significant temperament correlates with parent report of childhood ADHD symptoms. Discussion: Results were consistent with previous research and suggested that parents and youth tend to underreport previous symptom levels of inattention and hyperactivity/impulsivity. Higher parent reported reward dependence was associated with lower inattention and hyperactivity/impulsivity in childhood. Higher novelty-seeking was associated with both inattention and hyperactivity/impulsivity in childhood. Lower parent reported self-directedness was associated with higher parent reported hyperactivity/impulsivity. Regarding self-report, higher novelty-seeking was associated with childhood inattention and hyperactivity/impulsivity. Further, higher self-directedness and reward dependence were associated with childhood hyperactivity. Finally, higher self-reported persistence was associated with higher inattention in childhood. These results provide preliminary data suggesting that assessing child temperament, specifically related to motivational processes and reward seeking may aid ADHD diagnostic processes

Children and adolescents with chronic pain: parental factors, functioning, and neurodevelopmental comorbidity

Background: Pediatric chronic pain affects between 11 and 38% of all children. Although pain may result from injury or disease, the cause of chronic pain is commonly unclear. The interaction between biological, psychological, and social aspects has been emphasized as key to the understanding of the chronic pain experience, as well as risk and resilience factors. Pediatric chronic pain may result in significant impairment affecting both child and family functioning, and addressing family factors such as parental distress and protective behaviors, are generally considered important to pediatric chronic pain management. However, there is still a need to identify resilience factors that can be targeted in parental support programs, and to develop and evaluate effective parent support interventions. The complexity of the pain experience in pediatric chronic pain is well known with a large number of patients suffering from co-occurring disorders such as depression or insomnia. However, despite a considerable number of clinical observations suggesting an elevated prevalence of attention-deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) among children with chronic pain, and similarities in terms of clinical correlates, the empirical support has been scarce. More research on the co-occurrence of pediatric chronic pain, ADHD, and ASD, including relationships with functioning, is therefore warranted. Purpose and aims: The purpose of the present research project was to identify and assess parental and child factors of importance for functioning and treatment effects in pediatric chronic pain. More specifically, the aims of the project were to: validate an instrument for parental psychological flexibility (Study I); evaluate the effects of a brief parental ACTintervention on parent outcomes (Study II); assess the prevalence of clinically significant traits and symptoms of ASD and ADHD in children, and relations to pain- and demographic variables (Study III); and, to explore the relationships between traits and symptoms of ASD and ADHD, functioning, and health-related quality of life (HRQoL) (Study IV). Methods: In Study 1, utilizing a cross-sectional design, the Parent Psychological Flexibility Questionnaire (PPFQ) was translated and psychometrically evaluated in a sample of parents (n=263) of children with chronic pain using principal component analysis (PCA), correlation and regression analyses, and analysis of internal consistency. In Study II, the effects of individual and group ACT-interventions for adolescents (n=48) with chronic pain, and a brief support program for their parents (n=28), were evaluated using a randomized (group/individual) uncontrolled pilot design and non-parametric analyses of differences between groups and over time. In Study III, the prevalence of clinically significant ASD-traits and ADHD-symptoms was evaluated in a descriptive cross-sectional study on children with chronic pain (n=146) and their parents (n=146). Differences in painand demographic variables between children below and above cutoff for clinically significant traits and symptoms of ADHD or ASD were also assessed. Study IV, using the same sample as Study III, examined the relationships between ASD-traits and ADHDsymptoms, functioning (depression and pain interference), and HRQoL in correlation- and regression analyses and with independent t-tests, and assessed the indirect effects of insomnia and psychological inflexibility on the relationships between ASD-traits or ADHD-symptoms as predictors and functioning and HRQoL as dependents. Results: In Study 1, results supported a three-factor solution for the PPFQ with 10 items (PPFQ-10), showing good internal consistency and explaining a significant amount of variance in the criteria variables anxiety (29%) and depression (35.6%). In Study II, significant improvements in parental pain reactivity and psychological flexibility were found with clinically significant changes in the direction of better functioning for 54-76% of parents, with no differences between individual and group formats. In Study III, 13.7% of the sample presented with clinically significant ASD-traits and 19.9% of the sample presented with clinically significant ADHD-symptoms. The combined prevalence of clinically significant ASD/ADHD-traits and symptoms was 26%. Children with clinically significant ASD-traits were more likely to be girls and clinically significant ADHDsymptoms showed no gender differences. In Study IV, children with clinically significant ASD-traits and ADHD-symptoms presented with significantly higher levels of depressive symptoms and pain interference, and significantly lower HRQoL, compared to the rest of the sample. ASD-traits and ADHD-symptoms explained a significant amount of variance in pain interference and depressive symptoms, as well as in HRQoL. Psychological inflexibility was shown to mediate the influence of both ADHD-symptoms and ASD-traits, and insomnia the effect of ADHD-symptoms, on depression, pain interference, and HRQoL. Conclusions: Although tentative, the results suggests the utility of addressing parental psychological flexibility in relation to pediatric chronic pain. However, more research is warranted and future studies should e.g. evaluate the predictive utility of the PPFQ for child treatment outcomes, and evaluate if parental support programs that increase parental psychological flexibility also have positive effects on the children. Also, the results provide empirical support regarding elevated levels of clinically significant ADHD-symptoms and ASD-traits in pediatric chronic pain, and illustrate significant relationships between such traits and symptoms and functioning in children. Children with debilitating chronic pain, particularly girls, may be at risk for having a comorbid, and possibly undetected highfunctioning neurodevelopmental disorder. Results thus suggest the utility of screening for neurodevelopmental disorders in children with chronic pain, and may indicate insomnia, and psychological flexibility as potential treatment targets to improve functioning and HRQoL. The results also warrant further research to e.g. validate these findings in larger studies, evaluate the utility of tailored interventions, and examine the shared neuropathophysiology of chronic pain and neurodevelopmental disorders, including dopamine function and sensory abnormalities

Internet Addiction and Cognitive Behavioral Therapy

Internet addiction has become a social and public health problem especially among adolescents and adults. The purpose of this chapter is to describe the Internet addiction and discuss the process of treating Internet addiction by using cognitive behavioral therapy for Internet addiction model (CBT-IA). Among the Internet addiction, I have elected to focus on the studies regarding definition, prevalence, risk factors, negatives consequences, and treatment modalities with focus on CBT-IA. In contrast, research on the CBT-IA is still in its early stages. Till now, there is no clear definition for Internet addiction, and these definitions are based on assessment tools that are developed by researchers. There was a variance in the prevalence of Internet addiction among adolescents and adults, which might be related to many factors including assessment instruments and cultural factors. There are many risk factors for Internet addiction that involve socio-demographic, social, psychological factors, and Internet use practices. Many negative consequences result from Internet addiction such as social withdrawal, lack of relationships with families and peers, and psychological problems including depression and anxiety. The CBT-IA is the most effective treatment for Internet addiction. The CBT-IA model is a comprehensive approach, which can be divided into three phases: behavior modification, cognitive restructuring, and harm reduction therapy (HRT)

Academic underachievement and mental disorders in adolescence: Assessment and treatment

Academic underachievement affects many adolescents and is defined as a notable discrepancy between actual and expected achievement, given the student's cognitive ability level. A significant percentage of adolescents suffer from both academic underachievement and mental disorders, putting them at risk for negative psychosocial development. However, there are few treatments available focussing on these adolescents. The present doctoral thesis evaluated the efficacy of the treatment program "SELBST – achievement problems" in a randomised controlled trial (RCT). Furthermore, the added benefit of a specifically designed smartphone app to improve therapy transfer was investigated. Methods: The psychometric properties of the primary outcome, the Academic Problems Checklist, were analysed. A clinically referred sample of n = 60 adolescents aged 11-18 years was randomised into either the experimental group, receiving weekly cognitive behavioural therapy based on the "SELBST – achievement problems" treatment manual including a therapy smartphone app or into the control group, receiving treatment as usual. Results: The revised version of the Academic Problems Checklist consists of a 17-item, semi�structured clinical interview for adolescents, parents, and teachers. The analysis of the psychometric properties of the APC showed it is a short, reliable, and valid instrument for assessing academic underachievement of adolescents with mental disorders using a multi�informant approach. The RCT showed for both groups clinically relevant improvements on the primary outcome of academic underachievement. For the teacher-rated academic underachievement, a statistical superiority of the treatment group compared to the control group was found during the follow-up phase. The treatment group showed significant improvements regarding their grade point average compared to the control group. Statistical superiority of the treatment group was found for the individual problemlist measuring individual academic underachievement problems with large effects in the adolescent and parent rating. Mental health problems improved in both groups, however, there was no statistical superiority of either group. These effects remained largely stable during the follow-up period. The smartphone app was well accepted by the adolescents, however, it showed no statistically significant additional benefit compared to the standard SELBST-treatment. Conclusion: In summary, improvements were found for academic underachievement and mental problems. The treatment satisfaction was high, but the smartphone app provided no significant additional benefit. The study's limitations included the small sample size, the substantial dropout rate in the experimental group, and the technical challenges encountered implementing a smartphone ap

Chapter 3 Research Methods

The main research question for this thesis is: How can the complex field of mental health problems among adolescents in Vietnam be understood and addressed with sustainable and accessible developments at the school-level