Longitudinal Relations Between ADHD Symptoms and Substance Use Across the Transition to College and Evaluation of Promotive and Protective Factors

The prevalence of substance use and related problems increases during adolescence and peaks in young adulthood with substantial increases during the transition from high school to college (Johnston et al., 2018). However, these increases are not universal for all students (White et al., 2006), and there is substantial variation in rates of substance use during the first year of college (Borasri et al., 2007; Frisher et al., 2007). It is important to identify the individual and environmental factors that serve as risk factors for substance use as well as factors that may promote or protect against use during the high school to college transition. This prospective longitudinal investigated the impact of risk, promotive, and protective factors on the substance use outcomes of 150 high school seniors transitioning to college. The prevalence of alcohol and marijuana use substantially increased from high school to the first semester of college. Results indicate that ADHD symptoms at the end of high school predicted residualized change in alcohol and marijuana use during the first semester of college (i.e., controlling for the autoregressive effect of use during college). For alcohol use (but not marijuana), ADHD symptoms continued to predict subsequent use across the first year of college (from fall to spring of the first year). Promotive models revealed that adaptive social perceptions predicted decreased alcohol and marijuana use, and academic motivation predicted decreased alcohol use, after controlling for the role of ADHD symptoms. Adaptive social perceptions about each substance was protective against future alcohol and marijuana use both before and after the transition to college demonstrated by significant interaction effect with ADHD symptoms, after controlling for the direct risk and promotive effects in the model. These interactions illustrated that adolescents with elevated ADHD symptoms who have high friend disapproval of substances may experience resilience with respect to substance use outcomes. Academic motivation demonstrated promotive (direct) effects for reducing the risk for alcohol use but protective effects were not found. Future research should seek to elucidate more specific mechanisms through which youth and adolescents with elevated ADHD are protected against the high risk for substance use problems

Adolescents with ADHD are at increased risk for COVID-19 vaccine hesitancy

Identifying factors that influence adolescent intentions for COVID-19 vaccination is essential for developing strategic interventions to increase uptake, particularly in subgroups of at-risk adolescents. Attention-deficit/hyperactivity disorder (ADHD) in adolescence is characterized by difficulties regulating attention and behavior, social impairment, and impulsive risk-taking behaviors, which may impact vaccine hesitancy and vaccine uptake. This study examined hesitancy toward COVID-19 vaccines among adolescents with and without ADHD, and explored how ADHD status interacted with malleable social mechanisms and other social determinants of health in predicting vaccine hesitancy. Participants were 196 U.S. adolescents (44.4% male), 45.6% diagnosed with ADHD. Adolescents reported their confidence and willingness toward COVID-19 vaccines from March to May 2021. Adolescents with ADHD reported greater hesitancy and less confidence in COVID-19 vaccine safety compared to adolescents without ADHD (p \u3c .01). Only 61.8% of adolescents with ADHD reported vaccine acceptance, compared to 81.3% of adolescents without ADHD. For all adolescents, those who identified as Black or Latinx and with lower family income had greater hesitancy and reduced confidence, whereas greater COVID-19 concerns, media use, and perceived negative impact on relationships was associated with greater vaccination willingness. Social contextual processes significantly interacted with ADHD status such that for adolescents without ADHD, concerns about COVID-19 were associated with increased confidence in vaccine safety. Being noncompliant with social distancing guidelines was associated with greater vaccine hesitancy, only for adolescents with ADHD. A concerted effort is needed to increase trust, confidence, and social relevance among adolescents, especially those with ADHD and from lower socio-economic backgrounds

Clinical Change Mechanisms in the Treatment of College Students With ADHD: Trajectories and Associations With Outcomes

The purpose of this study was to evaluate trajectories of response for the three theorized mechanisms of clinical change (knowledge, behavioral strategies, and adaptive thinking) associated with the Accessing Campus Connections and Empowering Student Success (ACCESS) intervention for college students with attention-deficit/hyperactivity disorder (ADHD) and their association with treatment outcomes. Participants included 250 college students comprehensively diagnosed with ADHD randomly assigned to ACCESS or to a delayed-treatment control who completed ratings at baseline, end of active treatment, and end of the maintenance phase of treatment (after two semesters). Growth mixture models (GMMs) were used to evaluate trajectories. Participants in ACCESS made significant gains in the use of behavioral strategies and trajectories were associated with large effect size improvements in measures of symptoms and functioning. Participants also made improvements in ADHD knowledge. However, only the knowledge trajectory with rapid improvement displayed significantly better outcomes. Only one trajectory group showed improvement in adaptive thinking with most ACCESS participants remaining stable across time. However, adaptive thinking trajectories were strongly related to both symptom and functional outcomes. ACCESS is associated with large gains in two of the three theorized clinical mechanisms of change, behavioral strategies and ADHD knowledge. Rapid improvement in behavioral strategies was associated with robust improvement in symptoms and functioning. Although improvements in the third mechanism, adaptive thinking, were small, they were strongly associated with outcomes demonstrating the importance of a cognitive-behavioral approach in treating college students with ADHD

Learning Disorder Confers Setting-Specific Treatment Resistance for Children with ADHD, Predominantly Inattentive Presentation

Attention deficit/hyperactivity disorder-predominantly inattentive presentation (ADHD-I) and specific learning disorder (SLD) are commonly co-occurring conditions. Despite the considerable diagnostic overlap, the effect of SLD comorbidity on outcomes of behavioral interventions for ADHD-I remains critically understudied. The current study examines the effect of reading or math SLD comorbidity in 35 children with comorbid ADHD-I+SLD and 39 children with ADHD-I only following a behavioral treatment integrated across home and school (Child Life and Attention Skills [CLAS]). Pre- and posttreatment outcome measures included teacher-rated inattention, organizational deficits, and study skills and parent-rated inattention, organizational deficits, and homework problems. A similar pattern emerged across all teacher-rated measures: Children with ADHD-I and comorbid ADHD-I+SLD did not differ significantly at baseline, but between-group differences were evident following the CLAS intervention. Specifically, children with ADHD-I and comorbid ADHD-I+SLD improved on teacher-rated measures following the CLAS intervention, but children with ADHD-I only experienced greater improvement relative to those with a comorbid SLD. No significant interactions were observed on parent-rated measures-all children improved following the CLAS intervention on parent-rated measures, regardless of SLD status. The current results reveal that children with ADHD-I+SLD comorbidity benefit significantly from multimodal behavioral interventions, although improvements in the school setting are attenuated significantly. A treatment-resistant fraction of inattention was identified only in the SLD group, implying that this fraction is related to SLD and becomes apparent only when behavioral intervention for ADHD is administered

Impacts of COVID-19 quarantine and isolation on adolescent social functioning

This review discusses research conducted globally between March 2020 and March 2023 examining the impact of the COVID-19 pandemic on adolescent social functioning, including their lifestyle, extracurricular activities, family environment, peer environment, and social skills. Research highlights the widespread impact, with largely negative effects. However, a handful of studies support improved quality of relationships for some young people. Study findings underscore the importance of technology for fostering social communication and connectedness during periods of isolation and quarantine. Most studies specifically examining social skills were cross-sectional and conducted in clinical populations, such as autistic or socially anxious youth. As such, it is critical that ongoing research examines the long-term social impacts of the COVID-19 pandemic, and ways to promote meaningful social connectedness via virtual interactions

Impacts of COVID-19 on the school experience of children and adolescents with special educational needs and disabilities

This review of research conducted between March 2020-April 2023 summarizes the impact of COVID-19 on the learning and school experiences of children and adolescents with special educational needs and dis/abilities (SENDs) including youth with neurodevelopmental disorders, learning differences, intellectual, developmental, and other disabilities. This research highlights the far-reaching consequences of COVID-19, with the most detrimental effects experienced by students of color, those from under-resourced communities, and those with multiple marginalized identities, whose struggles with systemic inequities have been amplified by the pandemic. To date, most studies have been cross-sectional and utilized qualitative methods. Future research should examine long-term impacts and ways to promote growth in learning and social-emotional functioning among students with SENDs

Rumination as a Mechanism of the Longitudinal Association Between COVID-19-Related Stress and Internalizing Symptoms in Adolescents

The current prospective longitudinal study evaluated brooding rumination as an intervening mechanism of the association between COVID-19-related stress and internalizing symptoms during the first year of the pandemic. Attention-deficit/hyperactivity disorder (ADHD) status and adolescent sex were tested as moderators of the indirect effect. Adolescents with and without ADHD (N = 238; M age = 16.74) completed rating scales of COVID-19 stress and both adolescents and parents completed ratings scales of internalizing symptoms in May/June 2020 (T1). In October/November 2020 (T2), adolescents reported on their brooding rumination. Adolescents and parents reported on internalizing symptoms again in March/April 2021 (T3). Covariates included participant characteristics and baseline symptoms. T1 self-reported COVID-19-related stress was associated with increased T3 self-reported anxiety (ab = 0.10), self-reported depression (ab = 0.07), and parent-reported depression (ab = 0.09) via T2 brooding rumination. The indirect effect did not differ for adolescents with and without ADHD or for female and male adolescents. Brooding rumination may be one mechanism to target to promote the mental health adjustment of adolescents during periods of high stress of the COVID-19 pandemic and future stressors

Improving Adherence to Behavioral Parent Training for ADHD Using Digital Health Tools.

Behavioral Parent Training (BPT) is a well-established treatment for school-age children with ADHD but lack of parent adherence to prescribed parenting strategies limits treatment gains. Digital Health (dHealth) tools can be leveraged to target barriers to parent adherence but existing tools for parenting interventions are limited. New efforts to develop a dHealth tool to target adherence barriers including limited skill competence, EF processes, and low motivation/negative attitudes, are presented and recommendations for future technology-enhanced treatments are provided

COVID-19 Resulted in Lower Grades for Male High School Students and Students With ADHD

OBJECTIVE: Researchers have speculated that the COVID-19 pandemic may expand the academic performance gap experienced by at-risk students. We examined learning experiences during the 2020 to 2021 school year and the impact the pandemic has had on high school student grade point average (GPA), including predictors of change in GPA from 2019-2020 to 2020-2021. METHOD: Participants were 238 adolescents (55.5% male), 49.6% with attention-deficit/hyperactivity disorder (ADHD), in the United States. Adolescents reported on their GPAs via online surveys. RESULTS: GPA significantly decreased on average from 2019-2020 to 2020-2021 school year. ADHD status and biological sex significantly moderated change-students with ADHD and male students reported decreased GPA, whereas students without ADHD and female students\u27 GPA did not change. Low income and Black/Latinx students had lower GPAs in both school years. CONCLUSION: It is imperative that additional supports be provided for at-risk students to help them catch up on missed learning during the pandemic