June 2023 Children and young adolescents with ADHD - can we predict from baseline child emotional features?

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This month, our journal club article explored whether internalizing disorder trajectories, in children and young adolescents with ADHD, can be predicted from baseline child emotional features, executive functioning and/or the family environment. 

The importance of this research and main research question 

It is known that the clinical course of ADHD is heterogenous. Comorbid internalising disorders (anxiety and depression) in ADHD are associated with worse outcomes. If potentially modifiable risk factors for the development of these disorders can be identified, this may facilitate prevention, early identification and/or intervention.  

What are the key findings and discussion points of this article? 

The present study identified three internalising disorder trajectories: high, stable anxiety and/or depression; low-risk for anxiety and/or depression; and increasing anxiety and/or depression.  

For anxiety, elevated sadness, fear and parental criticism were associated with an increased probability of the child being in the high, stable or increasing anxiety trajectories over the low-risk anxiety trajectory. For depression, elevated irritability and self-blame for parental conflict were associated with an increased probability of the child being in the high, stable depression trajectory over the low-risk depression trajectory. Higher working memory was associated with an increased probability of the child being in the increasing depression trajectory over the high, stable trajectory.  

These findings suggest that emotional features, executive functioning and/or the family environment represent potentially modifiable risk factors for emerging internalising disorders in ADHD in late childhood and adolescence.  

The findings of this study raised the following discussion points during the Journal Club meeting: 

  • The absence of a “decreasing” trajectory characteristic of recovery. 
  • Parental criticism as a “two-way street” between parent perceptions and wellbeing, and child ADHD symptoms, which are often the source of criticism. Interventions could be designed to improve one or both of these factors.  
  • The importance of clarity around which participants are included in which analyses when reporting key findings. 

Similar research occurring at the Melbourne Children’s Campus 

The Calm Kids project aims to understand whether treating anxiety in children with ADHD improves child anxiety, as well as broader child and family functioning. The intervention to treat anxiety includes, over the course of 10 sessions, teaching children and parents what anxiety is, what causes anxiety, and what children and parents can do to lessen anxiety. The research team for the Calm Kids project is based in the Centre for Community Child Health, and the project is led by Dr Emma Sciberras. More information on the can be found here: https://www.mcri.edu.au/research/projects/calm-kids-study  

Next month’s paper 

We warmly encourage you to send suggestions for next month’s paper to our team at cmhs@mcri.edu.au 

Where possible, please select open access articles so that we may share the paper with all interested parties, increasing access to valuable scientific literature.  

We are happy to review and present the paper but also encourage you to do so if you wish. 


Acknowledgement of Country

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At Mental Health Central we acknowledge the traditional custodians of the land on which we live, gather and work. We recognise their continuing connection to land, water and community. We pay respect to Elders past, present and emerging.

We acknowledge all people with a lived or living experience of mental ill-health and recovery. At the Campus, we particularly acknowledge children, young people, families, carers, and supporters. We recognise their vital contribution and value the courage of those who share this unique perspective for the purpose of learning and growing together to achieve better outcomes for the Campus, staff, sector, and all people of lived experience.


Proudly supported by The Royal Children’s Hospital Foundation