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BACKGROUND: Children and adolescents with attention-deficit/hyperactivity disorder (ADHD) often experience difficulties with emotion regulation. Specific use of cognitive emotion regulation strategies may contribute to these challenges, albeit research in this area remain limited.

METHOD: Self-rated and task-specific use of adaptive and maladaptive cognitive emotion regulation strategies was assessed in children and adolescents with ADHD and typically developing controls (N=176, 10-17 years, 55.1% girls; subsample for self-rated use: N=94, 13-17 years, 61.7% girls). Self-rated use was measured with the short version of the Cognitive Emotion Regulation Questionnaire. Task-specific use was assessed by an experimental task involving viewing emotion-eliciting photos. Regression analyses were utilized to assess associations between ADHD and cognitive emotion regulation. Effects of sex and age were explored. Adjustments were made for co-occurring psychiatric symptoms.

RESULTS: ADHD was associated with lower self-rated (β =-0.21, p = .044) and task-specific (β =-0.09, p = .015) use of adaptive strategies, and greater use of self-rated maladaptive strategies (β =0.27, p = .010). No associations remained after adjusting for co-occurring psychiatric symptoms and multiple comparisons. Rather, depressive symptoms may contribute to the self-rated use of maladaptive strategies. Post-hoc analyses revealed that ADHD was robustly linked to less self-rated use of acceptance (β =-0.38, p = .005).

CONCLUSION: Lower use of self-rated acceptance may be characteristic for ADHD. Depressive symptoms may play a more vital role for maladaptive cognitive emotion regulation than ADHD. More studies are needed to explore the longitudinal relation between ADHD, emotion regulation and depression.

Background: Research has produced conflicting findings on whether ADHD is associated with financial debt. Moreover, as yet, there has been little research on this association in non-Western settings. To address this deficit, this cross-sectional study examined the association between ADHD symptoms and debt in the Japanese general population.

Methods: Data were used from an online sample of 3,717 adults aged >= 18 years old. A single-item question was used to assess debt. ADHD symptoms were measured with the Adult ADHD Self-Report Scale (ASRS) Screener. Information was also collected on demographic characteristics and mental health.

Results: In a fully adjusted logistic regression analysis, ADHD symptoms (as a continuous score) were significantly associated with debt in the total sample (OR: 1.04, 95%CI: 1.01-1.07). In sex-stratified analyses, ADHD symptoms were associated with debt in women (OR: 1.06, 95%CI: 1.01-1.10), while the association was of borderline statistical significance in men (OR: 1.04, 95%CI: 1.00-1.07, p = .053). When the analysis was stratified by age, ADHD symptoms were significantly associated with debt in adults aged 18 to 34 (OR: 1.10, 95%CI: 1.04-1.16) and 60 and above (OR: 1.09, 95%CI: 1.02-1.16) but not in those aged 35 to 59 (OR: 1.01, 95%CI: 0.97-1.05).

Conclusion: ADHD symptoms are associated with debt in Japanese adults. More research is needed to determine the causes and consequences of debt in adults with ADHD.

AIMS: The Alcohol Use Disorders Identification Test (AUDIT) is a widely used screening instrument for harmful alcohol use. Comorbidity between alcohol use disorders and other mental disorders is common, but there is a shortage of studies investigating AUDIT's diagnostic accuracy in young adult psychiatric patients. The aim of this study was to examine AUDIT's diagnostic accuracy and psychometric properties in young adult psychiatric outpatients.

METHODS: In data from two samples of young adults (18-25 years) from general psychiatric outpatient clinics in Sweden, recruited in 2002-2003 (n = 197) and 2012-2016 (n = 283) psychiatric diagnoses were assessed using the Structured Clinical Interview for DSM-IV, axis I disorders, clinical version (SCID-I-CV) or the Mini International Neuropsychiatric Interview (MINI 6.0). Internal consistency of AUDIT, sensitivity, specificity, positive and negative predictive values (PPV and NPV), receiver operator characteristic (ROC) curves, and area under the curve (AUC) were calculated.

RESULTS: The internal consistency of AUDIT was acceptable (Cronbach's alpha = 0.76). For the samples combined the optimal cut-off was 10, sensitivity 87% and specificity 82%, PPV 0.28 and NPV 0.99. For Sample 2002-2003, the optimal cut-off point was nine For Sample 2012-2016, the optimal cut-off point was 10. ROC curves are presented, with an AUC of 0.88 (95% CI= 0.81-0.95) for both samples combined, 81.1% for Sample 2002-2003 (95% CI = 0.63-0.99) and an AUC of 90.6% for Sample 2012-2016 (95% Cl = 0.85-0.96).

CONCLUSION: The full version of AUDIT is a reliable and valid screening instrument for alcohol use disorders, as shown in two samples of young adult psychiatric outpatients.

Camouflaging has been proposed to have a detrimental effect on quality of life, yet previous research has not accounted sufficiently for potential confounding by genetic and shared environmental factors. The current study utilized a co-twin control design providing stringent control for a range of confounders to investigate the hypothesis that camouflaging autistic traits has a negative impact on quality of life. The sample included 140 individual twins from 42 monozygotic (MZ) and 28 dizygotic (DZ) twin-pairs, enriched for participants with neurodevelopmental conditions including 22 autistic participants. All twins provided self-reports of camouflaging and quality of life. Autistic participants and specifically autistic females displayed increased camouflaging behaviors compared to non-autistic participants. Across the sample, higher levels of camouflaging were associated with reduced quality of life, surviving adjustment for confounding effects of autistic traits, ADHD, sex, and age. Within DZ- as well as MZ-pairs, which provide the highest level of control for unmeasured confounders, twins who camouflaged more reported lower quality of life compared to their co-twins, consistent with a causal influence of camouflaging on quality of life. Our results strengthen previous claims purporting camouflaging behaviors as a risk factor for reduced quality of life.

Introduction Relational aggression (RA), characterized by behaviors aimed at inflicting social harm, is prevalent during adolescence and linked to adverse mental health outcomes. Although RA has been associated with internalizing and externalizing problems, less is known about its relationship with functional impairments (i.e., a reduced ability to perform daily roles) and sex and age differences. This study aimed to examine the associations between RA and mental health outcomes and functional impairment, and to test the effects of sex and age on these associations.Methods Data were used from a representative sample of 2,838 adolescents aged 13-17 years from Arkhangelsk, Russia. Participants completed validated self-report measures assessing RA, depressive symptoms, anxiety, somatic complaints, posttraumatic stress, conduct problems, alcohol use, and functional impairment. Multivariate path analyses were used to estimate associations between RA and all outcomes simultaneously, adjusting for sex, age, and a proxy measure of socioeconomic status (SES).Results RA was significantly associated with depressive symptoms, somatic complaints, posttraumatic stress, conduct problems, alcohol use, and functional impairment, but not anxiety after accounting for the substantial intercorrelations among symptom domains. Sex moderated these associations, with boys showing greater increases in internalizing symptoms and girls exhibiting higher conduct problems and alcohol use at higher levels of RA. Age and the SES proxy measure were also significant predictors of mental health outcomes. No RA-by-age interactions were observed.Discussion By modeling multiple outcomes simultaneously, this study provides novel evidence that RA is associated with a broad and distinctive pattern of psychosocial difficulties beyond general internalizing or externalizing distress. Findings suggest that RA is a clinically relevant marker of adolescent vulnerability with sex-specific correlates that may inform targeted prevention efforts.

Adolescents with attention-deficit/hyperactivity disorder (ADHD) often experience difficulties with emotion regulation, but treatment alternatives remain limited. This study investigates the feasibility and effectiveness of a newly developed psychological intervention aiming to increase emotion regulation skills in adolescent ADHD. A single-case experimental design with multiple baselines across participants was employed. Seven girls aged 13-17 years with ADHD completed the intervention. Outcomes of feasibility included attrition and retention rates, therapist-rated adherence, homework completion and engagement with the intervention material, as well as self- and caregiver ratings of client satisfaction and adverse outcomes. Primary outcomes of emotion dysregulation included weekly self- and caregiver ratings of the Difficulties in Emotion Regulation Scale Short Form during baseline, the intervention and a follow-up period of 2 weeks. Data was analyzed through descriptive statistics, visual inspection and effect size (Tau). The intervention was deemed feasible, although homework completion and engagement between sessions proved challenging. Six adolescents and caregivers reported lower emotion dysregulation after the intervention. However, six adolescent and four caregiver ratings demonstrated improvement before the intervention during baseline, complicating determination of intervention effects. Nevertheless, four participants showed a visual and/or statistical improvement from the intervention. Sensitivity analyses suggest that the intervention may have positive effects on emotional clarity.

Attention-deficit hyperactivity disorder (ADHD) presents challenges that both influence and are influenced by the child's environment. While non-pharmacological interventions exist for youth and parents, brief and accessible programmes that also engage the wider social network are lacking. This study evaluated the feasibility of the psychoeducational programme SKILLS for the child's Social Network (SKILLS-SN), focusing on implementation, acceptability, and preliminary outcomes. One hundred participants-including parents, grandparents, stepparents, and others in the child's network-attended the two-session intervention at two sites, online or in person. Following the intervention, demographic data and satisfaction ratings were collected. Participants also completed pre- and post-ratings of perceptions of the youth's ADHD, treatment, and challenges. Quantitative data were analyzed descriptively and with non-parametric tests; an open-ended response regarding opinions about SKILLS-SN was analyzed with qualitative content analysis. Attendance was high, with over 97% completing both sessions; 17% of participants were non-parents. Most rated SKILLS-SN as good or excellent, and 99% would recommend it to others. Increased knowledge about ADHD was most valued. No significant changes were observed in participants' attitudes towards ADHD or treatment. The qualitative analysis identified three themes: programme strengths (e.g., useful as basic training), suggestions for improvement (e.g., more discussion time), and experienced impact (e.g., increased knowledge). SKILLS-SN appears to be a feasible and acceptable brief psychoeducational programme for the child's social network. Future work should enhance participant interaction, broaden inclusion to school personnel and other key individuals, and further evaluate effectiveness and long-term outcomes.

Comparatively little is known about the associations between loneliness and anger and aggression in adolescence. This study examined whether anger and aggression are elevated in lonely adolescents. Data were analyzed from 2838 Russian school students (mean age 14.89). Loneliness was assessed with a single-item measure. Information was collected on physical and verbal aggression, relational aggression, anger rumination and trait anger using scale measures. In a full path analysis, higher loneliness was positively associated with all forms of anger and aggression. After adjustment for depressive symptoms and peer victimization, the associations became either non-significant (trait anger, relational aggression) or negative (physical and verbal aggression). In contrast, although the strength of the association was reduced, anger rumination remained significantly associated with loneliness. These findings indicate that the relationships between loneliness, anger, and aggression are complex in Russian adolescents, with depressive symptoms and peer victimization influencing these associations.

BACKGROUND: Challenges in adaptive or daily functioning are inherent to diagnostic criteria for neurodevelopmental conditions (NDCs). However, less is known regarding the influence of factors that may confound the association between NDCs and adaptive functioning. Therefore, we examined the associations between different NDCs and adaptive functioning while adjusting for co-occurring conditions, genetics, and shared environment.

METHODS: We used a co-twin control study design in a sample of Swedish twins (N = 314, age range 8-21 years), including both monozygotic (MZ) and dizygotic (DZ) twins. Adaptive function was assessed using the parent-rated Adaptive Behavior Assessment System, second edition. A generalized estimating equations (GEE) model was fitted, using NDC diagnoses of Autism Spectrum Disorder, Attention-Deficit/Hyperactivity Disorder (ADHD), and Intellectual Disability (ID), as well as other psychiatric conditions, as exposure and adaptive functioning as the outcome. The model was first fitted across twin pairs and subsequently within the twin pairs, thus adjusting for genetic and shared environmental influences. Interaction effects of age and sex by different NDCs on adaptive functioning were assessed.

RESULTS: All forms of NDCs were independently associated with challenges in adaptive function across pairs. The co-occurrence of multiple NDCs was associated with adaptive functioning, with a greater number of NDCs being associated with more functioning challenges. Higher age was associated with more challenges in adaptive functioning among autistic individuals. In the within-pair models, the association remained for autism and ID, but the association between ADHD and adaptive functioning was lost in the MZ sub-sample when adjusting fully for all genetic factors.

CONCLUSIONS: NDCs are associated with challenges in adaptive function, even when adjusting for other psychiatric conditions, stressing the importance of adequate community support. Findings indicate the importance of non-shared environmental factors for understanding the challenges in adaptive function experienced by individuals with autism and ID and genetic factors for individuals with ADHD.

BackgroundEmotional difficulties are common in attention-deficit/hyperactivity disorder (ADHD), but previous research lack specificity regarding how reactivity and regulation of distinct emotions relate to categorical (diagnostic) and dimensional (trait-level) ADHD, while also clarifying sex- and age-related patterns. Considering co-occurring psychiatric traits is important due to the transdiagnostic nature of emotional challenges.

MethodThis cross-sectional study included two samples: a diagnostic cohort (N = 104, 10–17 years, 56.7% females) consisting of participants with an ADHD diagnosis (n = 56) and typically developing controls (n = 48), and a cohort referred to a first visit to a specialist psychiatric unit (N = 85, 13–18 years, 78.8% females) for which a dimensional measure of ADHD was used. Linear regressions were used to assess associations between ADHD and self- and caregiver-rated reactivity (frequency/intensity) and regulation (by oneself or with the help of others) of four different emotions (sadness, fear, anger and exuberance) using the Emotion Questionnaire. Effects of sex were explored. Adjustments were made for age and co-occurring psychiatric traits (anxiety, depression, conduct problems and autism) within the referred cohort. Findings were validated through caregiver ratings for the diagnostic cohort (N=103) and the referred cohort (N=212).

ResultsDiagnostic and trait-level ADHD were robustly linked to reactivity and a limited ability to regulate (i.e., dysregulation) anger. Diagnostic ADHD was also related to dysregulation of exuberance and fear, and higher levels of sadness and fear reactivity. Trait-level ADHD was, in addition to anger, associated with elevated reactivity and dysregulation of exuberance, adjusting for co-occurring psychiatric symptoms. No interaction effects of sex by ADHD were identified.

ConclusionAnger may be particularly relevant for ADHD. Reactivity and dysregulation of exuberance may also be important for ADHD, although further research is needed to clarify the relation between ADHD and positive emotions. Potential effects of sex and co-occurring psychiatric traits are discussed.