Co-occurrence of child and adolescent neurodevelopmental and mental health conditions is the rule rather than the exception, yet translating this insight into shared frameworks and clinical practice remains challenging. In this Editorial, we are pleased to introduce the 26 papers included in the 2026 Special Issue of JCPP Advances. This Special Issue aimed to advance our understanding of transdiagnostic mechanisms, dimensions, and practices in child and adolescent mental health, and includes original articles, reviews, commentaries, and an editorial perspective. Collectively, these articles illustrate three main 'transdiagnostic' conceptualisations; (i) mechanistic approaches identifying shared biological, cognitive, or affective processes across diagnostic boundaries; (ii) dimensional approaches mapping symptom covariance onto hierarchical structures such as the general 'p' factor and internalising, externalising, and neurodevelopmental spectra; and (iii) developmental, clinical-staging approaches treating early, non-specific features as precursors to a broad range of later outcomes. Methodologically, the current Special Issue highlights both the opportunities and limitations of large existing datasets, multi-informant assessment, and neuroimaging and genomic approaches, while underscoring the persistent difficulty of modelling transdiagnostic dimensions developmentally. Importantly, while translation into routine clinical care remains limited, the field is now well positioned to test the clinical utility and effectiveness of transdiagnostic dimensional assessments and interventions in routine care.
Background:Decades of youth psychotherapy research have demonstrated the efficacy of cognitive behavioral therapy (CBT) on targeted symptoms using standardized, retrospective clinician-, child-, and parent-report. Advancements in digital technologies can be leveraged to capture granular symptom change in patients' natural environments. While CBT is tailored to treat specific diagnosis-perpetuating mechanisms, it remains unknown whether such effects may carry over to non-targeted symptoms, which could have important treatment implications. Methods:We examined targeted and non-targeted symptom change in two separate exposure-based CBT trials: one trial for anxiety (n = 92) and one for irritability (n = 39). Youth in both trials completed ecological momentary assessment (EMA) pre-, mid-, and post-treatment; n = 57 healthy volunteer youth completed EMA at matching time intervals. Each EMA interval lasted for 7 days (3 prompts/day). We used multilevel modeling to examine changes in symptoms across time (e.g., pre, mid, post). Results:We observed frustration to decrease over time in both youth with anxiety (non-targeted symptom) and irritability (targeted symptom). We observed anger to decrease in youth with irritability only (targeted symptom), and worry did not change significantly over time in either group. Healthy volunteer youth showed low, stable levels of symptoms across time. Conclusion:Findings highlight frustration as a potential key transdiagnostic symptom; frustration improves in both youth with clinical anxiety and with irritability over the course of exposure-based CBT. Demonstrating specificity, anger in youth seeking treatment for irritability, but not anxiety, improved over time. While additional research is needed to better understand measurement of in vivo worry, results support using EMA to monitor symptom change during CBT.
Background:Although the neural underpinnings of anxiety have been investigated, most research has been confined to adolescence and adulthood, with less of a focus on the early childhood period. Little is known about the role of anticipatory fear processing early childhood, which is a sensitive period for anxiety development. Free-viewing paradigms provide a useful method for investigating brain activation during fear anticipation because they present stimuli in a manner that mirrors the participant's natural environment. Methods:One hundred and fifty-nine, high-risk children (M = 5.93 years; SD = 1.16) (54% female) watched an episode of a children's animated program that relied on anticipatory fear for the main plot line. Parents rated children on anxiety symptoms. Data was analyzed using both general linear modeling (GLM) and independent components analysis (ICA) to determine task-dependent regional and network response to positively and negatively-valenced time-series in the episode. Results:GLM analyses identified significant positive regional activation in the dorsomedial prefrontal cortex, middle temporal gyrus, and thalamus that fluctuated during the negative timecourse as a function of anxiety symptoms. Furthermore, ICA analyses revealed diminished network connectivity between (1) the anterior cingulate and raphe nuclei and (2) the right temporoparietal junction, left superior parietal lobule, and lingual gyri as a function of anxiety symptoms. Conclusion:Our findings point to fractured communication between emotion and sociocognitive processing regions as a function of increased anxiety in early childhood. The findings of this study can point to neural mechanisms present in early anxiety symptomatology before the traditionally defined onset.
Background:Exposure to stressors during early childhood has been linked to irritability and subsequent mental health problems; however, little work has examined the unique and combined effects of distinct stress exposures on trajectories of childhood irritability or adolescent mental health symptoms. Methods:Six components of family stress were assessed via maternal report at child age 5. Irritability was measured longitudinally at ages 7, 9, and 11. Adolescents self-reported on anxiety, depression, and externalizing symptoms at age 13-20. Latent growth mixture modeling examined classes of irritability. Bayesian kernel machine regression (BKMR) examined unique and shared effects of stress components on class assignment and to continuously measured irritability at individual age points (N = 472). Causal mediation tested if irritability mediated any stress-related mental health problems. Results:Latent growth mixture modeling identified high and low irritability classes. A positive joint mixture effect of stressors on irritability was detected, with additive contributions from intimate partner violence, material hardship, perceived stress, and maternal demoralization. Intimate partner violence independently predicted high irritability over time and irritability at age 7, and maternal perceived stress independently predicted irritability at age 11. Neither childhood irritability nor early stress predicted self-reported adolescent mental health symptoms. Conclusion:Early exposure to familial stressors are risk markers for childhood irritability. Interventions targeting intimate partner violence and co-occurring stressors could help mitigate persistent irritability, a well-known public health concern related to children's development.
Background:The American Academy of Pediatrics and the American Academy of Child and Adolescent Psychiatry have declared a National State of Emergency in Children's Mental Health, calling for improved approaches to address youth mental health. We sought to leverage the first child psychiatry division-wide measurement-based care initiative to advance understanding of how both psychopathology and social-emotional skills are related among youth patients, as these associations are rarely examined together. In doing so, our objective was to provide an empirical basis for integrative approaches that target psychopathology, while also leveraging social-emotional strengths. Methods:Youth patients receiving a continuum of psychiatric services, from intensive outpatient to short-term residential programs (N = 926; ages 11-24; 58% Cis-Female; 84.6% White), completed self-report measures of psychopathology and social-emotional skills. Latent profile analyses were conducted to identify distinct profiles within the sample. Results:Seven profiles were identified. Profiles with overlapping syndromes were differentiated by highly distinct patterns of socio-emotional strengths and challenges. Conclusion:Social-emotional skills assessment provides unique information beyond syndrome severity and can be used to create personalized subgroups of clinical patients. We observed many youth with similar syndromes report markedly different patterns of social-emotional skills. We emphasize the clinical utility of integrating strengths- and resilience-based frameworks into psychiatric assessment and treatment planning-supporting the shift beyond treatment models focused solely on reducing symptoms and skills deficits, toward more personalized approaches that also leverage youths' existing capacities for growth and recovery.
Background:Best practices in diagnosing autism spectrum disorder require an expert diagnostician to integrate multiple sources of information, including direct observations, interviews, and rating scales completed by knowledgeable informants. Machine learning methods are well-positioned to integrate disparate information sources to improve classification. This study sought to evaluate whether a machine learning algorithm could support appropriately weighting multiple sources of diagnostically relevant information. Methods:Telehealth diagnostic assessments were conducted for 639 toddlers (age mean = 30.4, SD = 4.3 months; 29.7% female) already receiving early intervention (EI). The Toddler Autism Symptom Interview (TASI) and the TELE-ASD-PEDS (TAP) were completed during separate visits. Each child's caregivers and usual EI providers asynchronously completed rating scales of autistic characteristics developed for this study. Calibration and validation data subsets were created using a 2:1 split. The optimal algorithm was developed using elastic net regularized regression in the calibration dataset, which was then evaluated in the validation dataset. Statistical fairness criteria evaluated whether the proposed algorithm functioned similarly across multiple protected group statuses. Results:The prevalence of autism in the sample was 80.4%. The algorithm developed in the calibration dataset included both the caregiver- and EI provider-completed rating scales, four items from the TASI, and six items from the TAP. Model performance was high in both the calibration and validation samples (sensitivity >0.90; specificity >0.75; kappa >0.60), but statistical fairness criteria varied. False positives were relatively rare, but were more common in advantaged groups, which may suggest systematic under-classification by the algorithm in minoritized groups. Conclusion:Diagnostic practices for autism require integrating multiple sources of information. Machine learning can support diagnosticians in this effort, as demonstrated here utilizing multiple rating scales, the TASI, and the TAP. However, there is a risk for bias when using machine learning and as such, no algorithm should replace expert clinical judgment.
Background:Evidence on the relationship of autism spectrum disorder (ASD) to overweight/obesity and underweight is mixed. Moreover, it is unclear how this relationship changes with age. Methods:We carried out a systematic review (SR) with meta-analysis on the association between ASD and obesity, overweight and underweight across the life span. The study was based on a pre-registered protocol (PROSPERO: CRD42024524084). Web of Science and PubMed were searched until the 8th of April 2025. We assessed the quality of the included studies with the Newcastle-Ottawa scales (NOS). Results:A total of 9075 records were screened, of which 64 studies reporting data on obesity, overweight and/or underweight on ASD and controls general participants were included in the SR and 62 meta-analyzed. We found a significant association between ASD and obesity (OR = 1.93; CI = 1.70-2.19; i 2 = 99.02%), ASD and overweight (OR = 1.73; CI = 1.43-2.09; i 2 = 95.44%) but, at the group level, not ASD and underweight (OR = 1.22; CI = 0.91-1.64; i 2 = 78.37%). There was a statistically significant association between ASD and underweight in adolescents (OR = 1.32; CI = 1.12-1.56) and adults (OR = 2.14; CI = 1.5-3.04). The score on the Newcastle-Ottawa Scale showed that, overall, studies had a medium risk of bias (median = 6, range 1-10). Conclusion:Individuals with ASD have an elevated risk of being obese or overweight, and, in adolescents and adults, of underweight. Our study may contribute to the development and implementation of targeted prevention and intervention strategies, aimed at enhancing the physical well-being of individuals with ASD and their caregivers, ultimately improving their quality of life.
Background:Infant sleep is multidimensional, with sleep habits and sleep problems often co-occurring and changing rapidly during early life. Evidence links infant sleep with later neurodevelopmental and behavioral outcomes, yet few studies have examined overall sleep patterns, their changes over time, and outcomes across multiple preschool domains. We examined associations of sleep patterns at 6 and 12 months and their transitions with preschool neurodevelopmental and behavioral outcomes. Methods:This prospective cohort study included 1707 children from the Shanghai Birth Cohort. Infant sleep at 6 and 12 months was assessed using the Brief Infant Sleep Questionnaire. Sleep patterns were identified at each time point using latent class analysis based on multiple sleep indicators, and children with sleep data at both ages were classified into transition groups. At age 4, outcomes were assessed using the Strengths and Difficulties Questionnaire (SDQ), Social Responsiveness Scale-Short Form (SRS-SF), and Behavior Rating Inventory of Executive Function-Preschool Version (BRIEF-P). Multivariable linear regression estimated associations. Results:At 6 and 12 months, 66.02% and 69.18% of infants were classified as having a good sleep pattern. Among children with sleep data at both time points, 51.57% had consistently good sleep, 16.68% improved, 14.44% deteriorated, and 17.31% had consistently poor sleep. Poor sleep at 6 months was associated with higher SDQ Total Difficulties scores. Poor sleep at 12 months was associated with higher SDQ Total Difficulties, SRS-SF Total, and BRIEF-P Global Executive Composite scores. Consistently poor sleep from 6 to 12 months was associated with less favorable outcomes than consistently good sleep. Conclusion:Poorer infant sleep patterns, especially at 12 months and when persistent from 6 to 12 months, were associated with less favorable preschool neurodevelopmental and behavioral outcomes. These findings support infant sleep patterns as an early-life factor relevant to developmental research and monitoring.
Background:Behavioral parent training (BPT) is an evidence-based intervention for children with attention-deficit/hyperactivity disorder (ADHD); however, evidence from low- and middle-income Asian countries remains scarce. This randomized controlled trial evaluated a culturally adapted blended BPT program for Vietnamese parents of elementary school-aged children with ADHD. Methods:Eighty-six parents of children (6-11 years) with a clinician-confirmed DSM-5 diagnosis of ADHD were randomized to a blended BPT program (n = 43) or treatment as usual plus psychoeducational materials (n = 43). The intervention comprised six weekly 2-h online group sessions, each followed within the same week by a 1-h individual home-based support session, and 12 weekly support telephone calls across a 3-month maintenance period. Parenting skills (Parenting Skills Assessment Scale), parent-rated child ADHD symptoms (Vanderbilt ADHD Diagnostic Parent Rating Scale), and parenting stress were assessed at baseline (T1), post-intervention (T2), and 3-month follow-up (T3). The analyses included 80 participants with complete data (intervention, n = 37; control, n = 43). Results:Parenting skills improved substantially in the intervention group relative to the control group (group × time interaction: F (2, 156) = 20.75, p < .001, partial η 2 = 0.21; baseline-adjusted between-group d = 1.28 at follow-up). Parent-rated ADHD symptoms decreased significantly within the intervention group (T1→T3: -4.14 points, p < .001), but the baseline-adjusted between-group differences were small and not statistically significant (T2: p = .057; T3: p = .075; adjusted d ≈ 0.28-0.30). Parenting stress declined similarly in both groups. Exploratory mediation analyses indicated a significant indirect effect on follow-up ADHD symptoms through improved parenting skills (ab = -1.86, 95% bootstrap CI [-4.01, -0.37]). Conclusion:The culturally adapted blended BPT program was feasible and produced large, sustained improvements in parenting skills among Vietnamese parents. The effects on parent-rated ADHD symptoms were small and require confirmation in adequately powered trials. Trial registration:Thai Clinical Trials Registry, TCTR20260212003 (retrospectively registered on February 12, 2026). Registration number: TCTR20260212003. Available at: https://www.thaiclinicaltrials.org/show/TCTR20260212003.
Background:There is a critical lack of reliable, high-quality epidemiological data on mental health and/or social and emotional wellbeing (SEWB) outcomes for First Nations children, partly, due to the limited availability of culturally valid assessment tools. This review aims to assess the cultural validity of mental health and SEWB assessment tools used with First Nations children aged 4-12 years in Australia, and identify gaps, strengths, and opportunities for reform that enhance cultural safety, and self-determination in assessment practices. Methods:A systematic search of five electronic databases (Web of Science, PubMed, PsycINFO, Informit, and CINAHL) identified English-language studies (1980-2025) assessing mental health or SEWB in Aboriginal and/or Torres Strait Islander children aged 4-12 years. Data on assessment tools were extracted and their cultural validity analysed using the First Nations Cultural Validity Assessment Tool. Tools were classified, as bespoke, culturally adapted or generic, using the CBSPATSISP definitions. Results:This review examined the cultural validity across 10 studies, including 11 unique tools and 16 assessments of cultural validity. Three tools were bespoke, eight culturally adapted, and five generic. Over three quarters of tools used to assess SEWB or mental health in First Nations children had poor or limited cultural validity. Two bespoke SEWB tools were identified, although none specifically targeted mental health. Conclusion:Culturally valid assessment tools for First Nations children remain limited, with research predominantly relying on inappropriate measures. Improving the measurement of mental health and SEWB outcomes requires a shift towards First Nations-led, co-designed tools grounded in Indigenous knowledges, strengths, and cultural frameworks. The evidence base was limited by reliance on published academic sources, which may have missed community-used assessment tools, a focus on cultural validity rather than broader study quality, and limited psychometric reporting for some First Nations-specific measures. Trial Registration:PROSPERO (CRD42024542866). 13 May 2024. www.crd.york.ac.uk/PROSPERO/view/CRD42024542866.
Background:Attention-deficit/hyperactivity disorder (ADHD) and language/reading difficulties frequently co-occur. The extent of shared genetic architecture remains incompletely defined. We investigated genome-wide overlap between ADHD and four core skills: word reading, nonword reading, spelling, and phoneme awareness. Methods:We integrated genome-wide association study (GWAS) summary statistics from the Psychiatric Genomics Consortium for ADHD (38,691 cases; 186,843 controls) and from the GenLang Consortium for language-related traits (n = 13,633-33,959). We performed linkage disequilibrium score regression (LDSC) to estimate genetic correlations and stratified LDSC to identify enriched genomic annotations. Cross-trait meta-analyses were conducted using MTAG and CPASSOC to identify cross-trait association signals. Mendelian randomization (MR) was applied to assess potential directional relationships. Results:Genome-wide genetic correlations were negative and significant between ADHD and each reading- and language-related trait (word reading rg = -0.35, p = 1.35 × 10-16; nonword reading rg = -0.28, p = 2.15 × 10-9; spelling rg = -0.38, p = 1.03 × 10-15; phoneme awareness rg = -0.28, p = 2.64 × 10-6). Partitioned heritability analysis using S-LDSC showed significant enrichment after Benjamini-Hochberg false discovery rate correction (BH-FDR), concentrated in conserved or constrained annotations such as Genomic Evolutionary Rate Profiling and phastCons. Cross-trait analyses (MTAG and CPASSOC) identified loci associated with ADHD and each skill, 6 for word reading, 7 for spelling, 7 for phoneme awareness, and 4 suggestive loci for nonword reading (dual-method p < 5 × 10-6); several map near neurodevelopmental genes including DCC, MEF2C, and ST3GAL3. Bidirectional MR findings were consistent with a potential directional contribution of ADHD genetic liability to poorer reading/language performance, with no clear evidence supporting the reverse direction under standard MR assumptions. Conclusion:ADHD and language/reading abilities share a substantial polygenic overlap with convergent signals in neuronal regulatory annotations. These genome-wide findings support a transdiagnostic framework linking attention and literacy-related skills, while indicating that causal and clinical interpretations should remain cautious given the modest effect sizes and limited variance captured by current GWAS resources.
Background:Children and adolescents with attention-deficit hyperactivity disorder (ADHD) exhibit higher physical activity (PA) levels than peers without ADHD. It remains unclear how this association evolves across developmental stages and differs between sexes. This study explores associations between ADHD symptoms and PA levels in childhood and adolescence, focusing on sex differences. Methods:Data from the Millennium Cohort Study at ages 7 (n = 14,043), 11 (n = 13,469), 14 (n = 11,872) and 17 (n = 10,757) were included. Moderate-to-vigorous PA (MVPA) was objectively measured using accelerometers at ages 7 and 14, and PA by parent- and self-reporting at ages 7, 11 and 14. ADHD symptoms were assessed by the ADHD subscale of the Strengths and Difficulties Questionnaire (SDQ) at all ages. Multiple linear regressions and mixed-effects regression models estimated associations between PA and SDQ ADHD scores adjusting for confounders. Results:MVPA was associated with higher SDQ ADHD scores at age 7 (b = 0.009, p < 0.001) and, to a lesser extent, age 14 (b = 0.004, p = 0.004). MVPA and SDQ ADHD scores were associated among males at ages 7 (b = 0.008, p = 0.001) and 14 (b = 0.004, p = 0.007), but among girls at age 7 only (b = 0.011, p < 0.001). Age 7 MVPA was associated with higher ADHD symptoms at ages 11 (b = 0.004, p = 0.003) and 17 (b = 0.004, p = 0.031), however age 14 MVPA was not associated with ADHD symptoms at age 17. Higher reported PA levels at ages 7, 11 and 14 were associated with lower SDQ ADHD scores. Conclusion:Young people with higher objectively-measured PA levels exhibited higher ADHD symptoms, although this association was stronger in males. By adolescence, PA and SDQ ADHD scores were less strongly associated, and no longer significantly associated among adolescent females. Subjectively-measured PA showed the inverse association with ADHD symptoms, emphasising the importance of mode of PA measurement.
Background:Young children with emerging mental health problems and neurodevelopmental differences often do not receive the support they need early in life, and if they do receive support, it may not be appropriately targeted towards their individual needs. The Neurodevelopment Assessment Unit (NDAU) was established to meet this need, offering an innovative method for evaluating young children through developmental profiling guided by the NIMH Research Domain Criteria (RDoC). Methods:Children (4-7 years) identified as experiencing social, emotional, and/or cognitive difficulties by education practitioners were referred to the NDAU to complete a comprehensive battery of assessments. We present an overview of the first cohort of children (N = 486) who were referred between September 2017 and January 2023. We first provide an overview of children's performance on constructs within the Cognitive Systems and Systems for Social Processes domains of the RDoC. As an exploratory analysis, we used latent profile analysis to identify subgroups of children with similar patterns of performance on assessments within these domains. Results:Children demonstrated most difficulties with recognition of negative emotions (81.6% below average in at least one negative emotion), understanding mental states (51.4% below average), and sustained attention (47.6% below average). Next, we identified three distinct subgroups of children, each defined by unique patterns of performance across Cognitive Systems and Social Processing domains. Conclusion:These findings highlight the NDAU as a promising model for dimensional assessment and underscore the importance of investigating variability and heterogeneity in the neuropsychological profiles of young children with emerging difficulties.
Background:Individuals with a parental history of anxiety disorders are at risk of developing an anxiety disorder. Prior studies have focused on the transmission of specific anxiety disorders across generations (i.e., disorder-specific transmission), often overlooking the possibility that a general tendency to develop various forms of anxiety might be passed from parents to offspring (i.e., transdiagnostic transmission). Our study aimed to investigate whether (a) anxiety disorders are transmitted intergenerationally through disorder-specific or transdiagnostic pathways and (b) different parental transdiagnostic factors differentially predict the offspring's anxiety and the onset of childhood anxiety disorders. Methods:Data were drawn from a subset of participants within a multigenerational family study, focusing specifically on 211 parents (generation 2; G2) and 253 children (generation 3; G3) from families where the first-generation probands either had a diagnosis of moderate/severe major depressive disorder or no lifetime psychiatric disorders. Structural equation modeling was employed to test transdiagnostic and disorder-specific pathways of anxiety transmission, and to compare different G2 transdiagnostic factors in predicting the G3 anxiety factor. Survival analysis was used to examine how different G2 factors predicted the onset of childhood anxiety disorders in G3. Results:The results indicated that parents transmit general vulnerabilities for developing various forms of anxiety disorders to their offspring (βs = 0.337-0.412, ps = 0.012-0.040), rather than vulnerabilities for specific types of anxiety disorders. Different parental transdiagnostic factors (internalizing, anxiety, and distress) significantly and similarly predicted both the offspring anxiety factor (βs = 0.400-0.469, ps = 0.006 to < 0.001) and the onset age of childhood anxiety disorders (HRs = 2.11-2.71, ps < 0.05). Conclusion:These results underscore the importance of considering transdiagnostic factors in understanding the intergenerational transmission of anxiety. Targeting these broad underlying vulnerabilities may enhance the effectiveness of interventions and prevention strategies. Future research should further explore potential transdiagnostic genetic, neurobiological, and environmental mechanisms involved in intergenerational anxiety transmission.
Background A general psychopathology "p-factor" captures shared variation across psychiatric disorder categories and is associated with dysfunctions in cognitive control. Alterations in resting-state functional connectivity (RSFC) of cognitive and attentional networks have been associated concurrently with the p-factor in youth samples. However, we do not yet know whether these RSFC alterations prospectively relate to change in the p-factor over time during the transition to adolescence, when many forms of disorder onset or worsen.Methods We examined whether baseline RSFC was prospectively related to the trajectory of p-factor scores over three years in 9344 preadolescents (age 9-10 at baseline) from the Adolescent Brain Cognitive Development Adolescent Brain Cognitive DevelopmentSM (ABCD) study. Using longitudinal multilevel modeling, we tested whether baseline within- and between-network RSFC of the default mode (DMN), frontoparietal (FPN), salience (SN), cingulo-opercular (CON), and ventral and dorsal attention (VAN and DAN) networks were related to the intercept (between-person differences) and slope (within-person rate of change) of p-factor scores over four ABCD study waves (3-year timeframe).Results There was a significant nonlinear, quadratic trajectory of p-factor scores over wave. Lower within-DMN and within-DAN connectivity and greater DMN-DAN, DMN-CON, and VAN-CON connectivity were associated with higher between-person levels of p-factor scores, which persisted over time. Greater VAN-DAN and SN-CON connectivity and lower DMN-VAN connectivity were prospectively associated with steeper within-person rates of quadratic change in p-factor scores over time.Conclusion These novel results identify specific alterations in RSFC within and between core networks involved in self-referential processing, bottom-up and town-down attention, salience, and cognitive control that might contribute to general psychopathology development in early adolescence. Children with aberrant connectivity between the DMN and VAN, SN and CON, and VAN and DAN networks may be vulnerable to increases in general psychopathology during the transition to adolescence.
Background:Sex differences in the frequency and timing of attention-deficit/hyperactivity disorder (ADHD) diagnosis exist. While there are multiple known individual and wider consequences for young females with delayed or undiagnosed ADHD, little is known about mental health service utilisation (HSU) impacts. Methods:A national population-based cohort of females aged 18-24 years between July 1, 2021, to June 30, 2022, in Aotearoa New Zealand was established. ADHD-index, intellectual disability (ID)-index and age at index were derived using established algorithms. Four mental and two non-mental health variables capturing HSU interactions between July 1, 2022, to June 30, 2024 were derived and analyzed for ADHD-index participants. Unadjusted and adjusted modified Poisson regression models were utilised and reported. All analyses were stratified by ID-index. Results:Overall, 212,385 females were included, of whom 5244 (2.5%) had ADHD-index. Of those ADHD-indexed, 486 were also ID-indexed. For females ADHD-indexed, 1638 (31.2%) were indexed at age < 12 years, 1575 (30.0%) at age 12-17 years, and 2031 (38.7%) at age 18-24 years. While different patterns emerged between females with and without ID, those with later ADHD diagnosis were associated with higher rates of psychotropic pharmaceutical dispensing, psychiatric inpatient stays, and non-psychiatric hospitalisations compared to those with early diagnosis. For example, in the adjusted analysis comparing females without ID-index who were ADHD-indexed at age 12-17 years to their counterparts indexed at age < 12 years, the estimated incident rate ratio of psychiatric inpatient stay was 2.07 (95% CI 1.20-3.58). Conclusion:Later ADHD diagnosis among a national cohort of young adult females was common. A later diagnosis was associated with increased mental and non-mental HSU compared to those with earlier diagnosis. Earlier detection of ADHD in females may mitigate their personal burden and reduce subsequent service use.
Background:This objective of this study was to use ecological momentary assessment (EMA) to investigate the relationships of momentary loneliness with body dissatisfaction and dysregulated eating in a diverse sample of adolescents as well as trait peer teasing as a moderator of associations. Methods:Seventy-four adolescents aged 13-17 completed a baseline measure of peer teasing and a 10-day EMA protocol, reporting momentary feelings of loneliness, affect, body dissatisfaction, and eating behaviors. Mixed models were used to examine within- and between-subject associations of loneliness with dysregulated eating and body dissatisfaction, including trait peer teasing as a moderator. Results:Models revealed that elevated momentary loneliness was significantly associated with higher concurrent body dissatisfaction (Estimate = 0.13, SE = 0.02, p < 0.001). Peer teasing moderated this relationship (Estimate = 0.12, SE = 0.03, p < 0.001), with stronger associations between momentary loneliness and concurrent body dissatisfaction among adolescents who experienced more teasing. Momentary loneliness was not significantly associated with subsequent dysregulated eating (LOCE: Estimate = -0.002, SE = 0.02, p = 0.90; Overeating: Estimate = -0.02, SE = 0.03, p = 0.48). Conclusion:These findings highlight the acute relationship between loneliness and greater body dissatisfaction and emphasize the importance of targeting loneliness and peer teasing in ED prevention and intervention efforts. The effect of acute loneliness on dysregulated eating may be more complex, necessitating future research clarifying this association. Preventions for EDs that focus on increasing meaningful social connection may be useful for reducing body dissatisfaction.
Background:Contemporary classification systems differ in their conceptualization of ADHD as either an externalizing or neurodevelopmental condition, with both perspectives promoting the common cause model as an explanation of ADHD's comorbidity. An alternative theory, dynamic mutualism, proposes that ADHD's comorbidity emerges through reciprocal interactions among symptoms over time, as opposed to a common cause. Methods:We tested the common cause and the dynamic mutualism theories in explaining the associations between aspects of ADHD (i.e., ADHD, inattention, hyperactivity/impulsivity, cognitive disengagement) and the neurodevelopmental and externalizing spectra across four waves of the Adolescent Brain Cognitive Development (ABCD) Study data (n = 11,878 youths aged 9-10 at baseline; 48% female). Results:Results largely supported the common cause theory in explaining the developmental links between ADHD and both the externalizing and neurodevelopmental spectra. Findings varied across ADHD subdimensions, although not substantially, with hyperactivity/impulsivity more closely linked to the externalizing spectrum and cognitive disengagement more closely linked to the neurodevelopmental spectrum. Conclusion:ADHD is best conceptualized as a disorder that bridges both the externalizing and neurodevelopmental domains, rather than fitting exclusively within either category. Given the assessment structure of the ABCD Study, there was more support for the common cause model compared with dynamic mutualism.
Background:Attention-deficit/hyperactivity disorder (ADHD) symptoms are associated with adverse health outcomes; this may be partially due to unhealthy lifestyle factors such as low physical activity (PA) and high sedentary behavior (SED). However, this association remains unclear. ADHD and PA have a medium-to-high heritability; therefore, genetically informed studies are warranted. This study aimed to increase the understanding of the association between ADHD symptoms and time spent in PA and SED in children. Additionally, we aimed to determine whether sex, symptom type, and genetics influence this association. This could guide the design of health promotion and preventive interventions. Methods:This cross-sectional twin study included 9-year-old children from the Swedish Twin Registry born from 2011 to 2015 who had complete data on ADHD symptoms and accelerometry. ADHD symptoms were assessed through a parental-report questionnaire. Inattention and hyperactivity/impulsivity symptoms were analyzed together and separately. Triaxial accelerometry measured the average time (minutes) spent in SED, light physical activity (LPA), and moderate-to-vigorous physical activity (MVPA). Linear generalized estimating equations regression models were used to assess the association in the full cohort and stratified by sex. Within-twin pair analyses were performed separately for dizygotic and monozygotic twins. Regression coefficients and 95% confidence intervals (CI) were calculated. Results:1966 children (52.8% girls) were included. In the full cohort, ADHD symptoms were significantly associated with less time in SED (β = -0.32; 95% CI -0.59, -0.06) and more time in MVPA (β = 0.30; 95% CI 0.12, 0.47). These associations were primarily driven by hyperactivity/impulsivity symptoms and were significant only in girls. The associations remained in dizygotic twins but became non-significant among monozygotic twins. Conclusion:Our findings suggest that in girls, higher hyperactivity/impulsivity symptoms are associated with higher PA levels. Associations were largely explained by shared familial factors, including genetics. Longitudinal studies are needed to corroborate these results.
Background:Multiple dimensions of parenting-including hostility, conflict, and warmth-are associated with an array of mental disorders in youth. We tested two possible explanations for these associations: Parenting may shape a shared liability to experience many forms of psychopathology ("shared-liability" hypothesis), or parenting may shape unique liabilities to externalizing and internalizing psychopathology ("unique-liability" hypothesis). Methods:Participants were from the Early Growth and Development Study (EGDS; N = 561 adoptive families) and the Michigan Twin Neurogenetics Study (MTwiNS; N = 354 twin families). In EGDS, we measured parental hostility and warmth at child age 27 months. In MTwiNS, we measured parent-child conflict and parental involvement at child mean age 8.1 years. We extracted shared and unique liabilities from child-psychopathology data using structural equation models. We tested whether parenting longitudinally predicted psychopathology, and to what extent associations between parenting and children's externalizing and internalizing psychopathology liabilities were explained by associations with a general psychopathology liability ("p"). We addressed genetic confounding by testing associations of adoptive parents' parenting with psychopathology in their genetically unrelated children, and by using a twin-difference design. Results:Across ages and cohorts, parenting characterized by hostility and conflict was associated with greater p, consistent with the shared-liability hypothesis. Also consistent, parental warmth was associated with lower p in middle and late childhood in EGDS participants, though parental involvement was not associated with p in adolescent MTwiNS participants. There was limited support for the unique-liability hypothesis; only one association (with externalizing psychopathology) remained after accounting for p. In childhood, but not adolescence, findings remained after accounting for genetic confounding. Conclusion:Parenting behaviors, particularly hostility and conflict, are associated with children's broad vulnerability to psychopathology, and these associations are evident in childhood even after controlling for genetic influences. These findings support parenting interventions as a means to reduce children's liability to diverse mental-health problems.
