Risk and protective factors for the development of ADHD symptoms in children and adolescents: Results of the longitudinal BELLA study

Background Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders in childhood worldwide, and causes significant impairments in overall functioning. In order to develop effective prevention and intervention programs, knowledge of the determinants that have an impact on the onset and development of ADHD symptoms is essential. So far, little is known about factors affecting ADHD symptoms in children and adolescents over time. Therefore, this study investigates potential psychosocial risk and protective factors for ADHD symptoms based on cross-sectional and longitudinal data of a German population-based study. Methods Data on children and adolescents (n = 1,384 aged 11 to 17 years) were collected at three measurement points (baseline, 1-year and 2-year follow-ups) covering a period of two years. We used latent growth modelling to investigate effects of parental mental health problems (risk factor) and self-efficacy, family climate and social support (protective factors) on symptoms of ADHD based on cross-sectional as well as longitudinal data. Sociodemographic factors, pre- and postnatal factors, and comorbid symptoms of internalizing and externalizing mental health problems were considered as covariates. Results At baseline, male gender, younger age, stronger aggressive behavior, and stronger parental mental health problems were related to more ADHD symptoms. Longitudinal analyses showed that female gender, migration status, increasing symptoms of generalized anxiety, increasing aggressive behavior and increasing parental mental health problems were associated with stronger increase of ADHD symptoms over time. However, improving family climate was related to decreasing ADHD symptoms over time. We further found moderator effects for social support. Conclusion The findings of the study provide important information concerning risk and protective factors in the context of ADHD. Hence, the results may be integrated into the planning and implementation of future prevention and early intervention strategies that target affected children and adolescents.Peer Reviewe

Socioeconomic status, stressful life situations and mental health problems in children and adolescents: Results of the German BELLA cohort-study

Aim Children and adolescents with low socioeconomic status (SES) suffer from mental health problems more often than their peers with high SES. The aim of the current study was to investigate the direct and interactive association between commonly used indicators of SES and the exposure to stressful life situations in relation to children’s mental health problems. Methods The prospective BELLA cohort study is the mental health module of the representative, population-based German National Health Interview and Examination Survey for children and adolescents (KiGGS). Sample data include 2,111 participants (aged 7–17 years at baseline) from the first three measurement points (2003–2006, 2004–2007 and 2005–2008). Hierarchical multiple linear regression models were conducted to analyze associations among the SES indicators household income, parental education and parental unemployment (assessed at baseline), number of stressful life situations (e.g., parental accident, mental illness or severe financial crises; 1- and 2-year follow-ups) and parent-reported mental health problems (Strength and Difficulties Questionnaire; 2-year follow-up). Results All indicators of SES separately predicted mental health problems in children and adolescents at the 2-year follow-up. Stressful life situations (between baseline and 2-year follow-up) and the interaction of parental education and the number of stressful life situations remained significant in predicting children’s mental health problems after adjustment for control variables. Thereby, children with higher educated parents showed fewer mental health problems in a stressful life situation. No moderating effect was found for household income and parental employment. Overall, the detected effect sizes were small. Mental health problems at baseline were the best predictor for mental health problems two years later. Conclusions Children and adolescents with a low SES suffer from multiple stressful life situations and are exposed to a higher risk of developing mental health problems. The findings suggest that the reduction of socioeconomic inequalities and interventions for families with low parental education might help to reduce children’s mental health problems.Peer Reviewe

The BELLA study – the mental health module of KIGGS Wave 2

The BELLA study is the module on mental health and health-related quality of life within the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). Baseline data collection took place together with KiGGS baseline data collection between 2003 and 2006. This article discusses the fourth follow-up of the BELLA study (BELLA Wave 4), which was surveyed between 2014 and 2017. The aims of the BELLA Wave 4 are to enable longitudinal analyses of health-related quality of life and mental health problems. Dynamic measurement instruments were used to enable a user-friendly and precise assessment of mental health among children, adolescents and young adults. The study’s participants were a sub-sample of around 3,500 KiGGS respondents aged 7 to 29 years. For the first time, in BELLA Wave 4 data were collected exclusively online. The BELLA study targeted both the parents of younger children (aged 7 to 13 years) and adolescents and young adults themselves (aged 11 years and above). Study instruments surveying mental health problems and the use of mental health care services were supplemented by a dynamic measurement tool in the form of a computer adaptive test (CAT) to record data on health-related quality of life

Long-term course of ADHD symptoms from childhood to early adulthood in a community sample

Comparatively little information is available from population-based studies on subgroup trajectories of attention-deficit/hyperactivity disorder (ADHD) core symptoms of inattention and hyperactivity-impulsivity (particularly as defined by DSM-IV and ICD-10). Recent report of a subgroup with high and increasing inattention symptoms across development requires replication. To identify the different trajectory subgroups for inattention, hyperactivity-impulsivity and total symptoms of ADHD in children and adolescents aged 7-19 years. Eleven birth cohorts from 2,593 families with children and adolescents who had parent ratings for the outcome measures of inattention, hyperactivity-impulsivity or total symptoms were considered. Data were analysed using an accelerated longitudinal design and growth mixture modelling was applied to detect subgroups. For all three outcome measures, three trajectories with low (78.3-83.3 %), moderate (13.4-18.8 %) and high (2.8-3.2 %) symptom levels were detected. Course within these subgroups was largely comparable across outcome domains. In general, a decrease in symptoms with age was observed in all severity subgroups, although the developmental course was stable for the high subgroups of inattention and total symptoms. About 3 % of children in a community-based sample follow a course with a high level of ADHD symptoms. In this high trajectory group, hyperactivity-impulsivity symptoms decrease with age from 7 to 19 years, whilst inattention and total symptoms are stable. There was no evidence for an increase in symptoms across childhood/adolescence in any of the severity groups

The Global Index of the Conners Scales - Psychometric Properties and Norm Values for a Parent- and a Self-Report German Version Among Adolescents

Attention deficit/hyperactivity disorders (ADHD) among children and adolescents are frequent, and ADHD in childhood or adolescence often predicts mental health problems in adulthood. The Global Index of the well-established Conners Scales is used in clinical routine and research to screen for symptoms of ADHD and additional mental health problems in children and adolescents. The present study offers a psychometric analysis and provides norm values for a parent- and a self-report German version of the Global Index based on data of adolescents from the general population (aged 13 - 17 years; N = 967). Results showed good internal consistency and acceptable to good convergent validity for the Global Index as well as for its subscale Restless-Impulsive for both versions, but results for the scale Emotional Lability were not satisfactory. Moreover, the factor structure of the Global Index needs further investigation and the three-item subscale Emotional Lability should be interpreted with caution. Findings of this study should not be generalized for children and adolescents outside the investigated age rage

Risk and resource factors of antisocial behaviour in children and adolescents: results of the longitudinal BELLA study

Antisocial behaviour is a common phenomenon in childhood and adolescence. Information on psychosocial risk and resource factors for antisocial behaviour are important for planning targeted prevention and early intervention programs. The current study explores risk and resource factors of antisocial behaviour in children and adolescents based on population-based longitudinal data.We analysed longitudinal data from the German BELLA study (n = 1145; 11 to 17 year-olds) measured at three measurement points covering two years. Latent growth analysis, linear regression models and structural equation modelling were used to explore cross-sectional and longitudinal data. Based on baseline data, we found that stronger self-efficacy and worse family climate were each related to stronger antisocial behaviour. Longitudinal data revealed that more severe parental mental health problems, worse family climate at baseline, deteriorating family climate over time, and more social support were each associated with increasing antisocial behaviour over time. We further found a moderating effect for family climate.Our study provides important exploratory results on psychosocial risk, resource and protective factors in the context of antisocial behaviour in children and adolescents, which need confirmation by future research. Our exploratory results point in the direction that family-based interventions for antisocial behavior in children and adolescents may benefit from considering the family climate