Functional Impairment In Adolescents Research Articles

Functional Impairments and Related Factors in Adolescents with Attention Deficit Hyperactivity Disorder During the COVID-19 Normalization Stage.

Attention deficit hyperactivity disorder is a disorder associated with significant functional impairments that can have important consequences for the individual and the society. Those with attention deficit hyperactivity disorder were reported to be more vulnerable in the face of difficulties and experience more psychological problems during the coronavirus disease 2019 pandemic. It was shown that the psychological problems experienced during the pandemic could persist during the normalization stage. We aimed to assess functional impairment in adolescents with attention deficit hyperactivity disorder and the related factors during the normalization stage which involved the initiation of fully face-to-face schooling practices. This is a cross-sectional study including attention deficit hyperactivity disorder (n = 52) and a healthy control group (n = 52). Functional impairment was assessed using the Weiss functional impairment rating scale self and parent forms. We also examined the factors associated with functional impairment (internalizing-externalizing problems, parenting strategies, and perceived expressed emotion). Adolescents with attention deficit hyperactivity disorder had higher functional impairment scores on Weiss functional impairment rating scale self and parent in all sub-domains and total. Weiss functional impairment rating scale self and parent total mean score had a positive correlation with negative parenting and externalizing-internalizing scores and a negative correlation with the positive parenting score. Weiss functional impairment rating scale-self total mean score was positively correlated with negative parenting and externalizing-internalizing scores and perceived expressed emotion scores. Our results suggest that the effects of the pandemic on children's functioning may persist in the normalization stage. For a comprehensive evaluation and effective intervention, it is important that comorbid symptoms, parenting strategies, and the perceived family climate are evaluated from the perspectives of both the parent and the adolescent.

Executive function measured by BRIEF in adolescents diagnosed and treated for ADHD: problem profiles and agreement between informants

ABSTRACT Executive functional deficits (EFDs) play an important role in functional impairment in adolescents with attention deficit/hyperactivity disorder (ADHD). More knowledge of executive function (EF) profiles and informant discrepancies will guide clinicians and provide tailored treatment advice. The objectives of this study were to use teacher, parent, and self-reported EF ratings to describe (a) problem profiles and (b) the correlation and agreement between informants. This study included 100 adolescents aged 14–18 years with ADHD still experiencing clinically impairing symptoms despite standard treatment including medication. EFs were measured using the Behavior Rating Inventory of Executive Function (BRIEF). Agreement between informants was quantified using Pearson correlation and informant discrepancies were analyzed using paired samples t-test. Overall, the results indicated considerable EFDs in the study population. Correlation and agreement varied between the informants. Agreement was highest between adolescents and their parents, especially for female participants, and lowest between male participants and their teachers. Teachers reported the highest level of EFDs, whereas adolescents generally self-reported EFDs at a lower level than both parents and teachers. Identifying and tailoring treatment for EFDs might improve future prognosis for adolescents with ADHD, however, self-awareness of these difficulties is a challenge that needs to be considered when planning interventions.

Associated predictors of functional impairment among adolescents with ADHD\u2014a cross-sectional study

BackgroundAttention-deficit/hyperactivity disorder (ADHD) in adolescence is associated with functional impairment in several domains of life. To enable development of interventions that more effectively target functional impairment in this age group, the associations between clinical characteristics and impairment need to be clarified. The aim of this study was to investigate the associations between ADHD and functional impairment, if they varied by sex, and the potential impact of comorbid psychiatric symptoms on the associations.MethodsThis was a cross-sectional study including adolescents with ADHD (n = 164) and a reference group of adolescents without ADHD (n = 106). Self-ratings and parental ratings of functional impairment in different life domains were used as outcomes in all analyses. Differences between groups were investigated with comparative analyses. General linear models (GLMs) were used to explore associations between ADHD symptoms and functional impairment in adolescents with ADHD, while adjusting for of comorbid symptoms, sex, and medication.ResultsAdolescents with ADHD displayed higher levels of functional impairment than peers without ADHD, and girls with ADHD rated higher impairment than their male counterparts. The combined ADHD presentation was associated with the highest levels of self-reported impairment, while parental ratings indicated comparable levels of overall impairment across presentations. In the adjusted GLMs, symptoms of inattention were strongly associated with self- and parent-rated impairment in school, but symptoms of hyperactivity/impulsivity were not, whereas symptoms of both inattention and hyperactivity/impulsivity were modestly associated with self-rated impairment with friends. Further, both emotional and conduct problems were associated with impairment in daily life.ConclusionsOur results suggest that attention difficulties, in particular, seem to impair academic functioning in adolescents with ADHD, and interventions targeting such difficulties are warranted. In addition, comorbid symptoms need to be assessed and treated, and self-reports of functioning should be included in research and clinical practice involving adolescents.

Early Cortisol and Inflammatory Responses to Parental Cancer and Their Impact on Functional Impairment in Youth.

Purpose: Chronic stress is associated with increased risk for maladaptive psychological responses during childhood, adolescence, and young adulthood. Adults exposed to chronic stress during childhood exhibit dysregulation of hypothalamic-pituitary-adrenal (HPA) axis activity and inflammation. There are no studies examining the impact of stress on biological stress responses and functional impairment in adolescents and young adults early after the onset of a stressor. Methods: The sample consisted of 59 offspring, aged 11–25 years, 33 of parents diagnosed with cancer and 26 controls from families with no cancer or severe chronic illness in parents or siblings. Cancer patients and their families were recruited within an average of 62 days (SD = 35.9) and followed at 6 and 9 months later. Functional impairment was assessed and hair cortisol concentrations (HCC), salivary cortisol, and inflammatory markers were measured. Mixed regression analyses were conducted. Results: The stress group showed higher functional impairment (β = −5.5, 95% CI (−10.4, −0.06), p = 0.03, d= −0.40) and HCC (β = 10.5, 95% CI (−5.5, −0.50), p < 0.001, d = 1.43). However, HCC were reduced over time in the stress group (β= −0.3, 95% CI (−0.04, −0.01), p < 0.001, d = −1.08). Higher total cortisol output was associated with increased functional impairment over time (β = −3.0, 95% CI (−5.5, −0.5), p = 0.02, d = −0.60). Conclusions: Parental cancer is associated with early increase in cortisol, which was associated with increased functional impairment in offspring. Clinicians need to assess and monitor psychiatric symptoms and functioning in these offspring early on following parental cancer diagnosis.

Psychometric properties of the Weiss Functional Impairment Rating Scale parent and self-reports in a Norwegian clinical sample of adolescents treated for ADHD

Objective To analyze the psychometric properties of the Norwegian version of the Weiss Functional Impairment Rating Scale parent and self-reports (WFIRS-P and WFIRS-S) in adolescents with ADHD. Methods 102 clinically referred patients, of which 86% were enrolled in an ongoing RCT program (Clinical trials NCT02937142), were diagnosed with ADHD according to the Diagnostic and Statistical Manual of Mental Disorders version IV (DSM-IV). The conceptual framework of the WFIRS-P and the WFIRS-S was evaluated using confirmatory factor analysis (CFA), reliability was estimated using Cronbach’s alpha, convergent and divergent validity was assessed using correlations with the Children’s Global Assessment Scale (C-GAS) and the ADHD Rating Scale-IV (ADHD-RS-IV). Results CFA supported the original factor structure of the questionnaires, both a first-order and a second-order model revealed acceptable model fit. Internal consistency was satisfactory across domains. The parent-adolescent agreement was moderate. The correlations between the C-GAS and the total scores of the WFIRS-P and WFIRS-S were low to moderate (r = –0.29 to −0.38). The ADHD-RS-IV correlated moderately (r = 0.49) with WFIRS-P, the correlation with WFIRS-S was weak (r = 0.28) supporting divergent validity. In multiple regression analyses, the ADHD-RS total score was the strongest predictor of the total score in both the WFIRS questionnaires, with internalizing disorder showing an additional small contribution. Age, gender and full-scale IQ gave no additional contribution in explaining the variance. Conclusions The findings support the use of the Norwegian version of the WFIRS-S and the WFIRS-P in the evaluation of functional impairment in adolescents with ADHD.

An Exploration of Parent-Youth Agreement on Functional Impairment in Adolescents Utilizing Outpatient Mental Health Services.

Parent-youth agreement on the youth’s functional impairment may have important implications for mental health service utilization, assessment, therapy goal development, and treatment engagement for adolescents. The present study examines parent-youth agreement on their perceptions of youth functional impairment in a predominantly racial/ethnic minority sample of adolescents utilizing outpatient mental health services. Parent and youth functional impairment ratings were compared, and agreement was estimated in multiple ways. On average, parents indicated higher levels of youth functional impairment compared to youth in their overall scores, and when differences existed between parents and youth at the functioning domain and item level. Although there was similarity in the proportion of parents and youth who reported total impairment above the clinical cut-off, actual agreement between parent-youth pairs was only slight. There appeared to be substantial variation in agreement levels when identifying problems in functional impairment at the domain and item levels, and some areas of strong consensus were identified. These findings highlight the need to consider parent-youth agreement in perceptions of functional impairment and the complexities that may underlie this agreement.

Psychometric Properties of the Persian Version of the Weiss Functional Impairment Rating Scale–Self-Report Form in Iranian Adolescents

Objective: The Weiss Functional Impairment Rating Scale–Self-Report Form (WFIRS-S) was developed as a measure of functional impairment in adolescents and adults with ADHD. This study reports the psychometric properties of the Persian version of the WFIRS-S in a sample of normal Iranian adolescents. Method: Internal consistency and factor structure of the WFIRS-S were tested on a sample of 386 students (Grades 7-12). The test-retest reliability and the convergent validity of the WFIRS-S were evaluated by using two different subsamples including 50 and 100 students, respectively. Results: The Cronbach’s alpha values were between .72 and .94 for the WFIRS-S subdomains and total scale. The test-retest reliability was .80 for the total scale. The WFIRS-S subdomains had moderate to high significant correlations with the Pediatric Quality of Life total scale. Conclusion: The Persian version of the WFIRS-S has acceptable psychometric properties and could be used as a functional impairment assessment for adolescents.

Social learning pathways in the relation between parental chronic pain and daily pain severity and functional impairment in adolescents with functional abdominal pain.

Having a parent with chronic pain (CP) may confer greater risk of persistence of CP from childhood into young adulthood. Social learning, such as parental modeling and reinforcement, represents one plausible mechanism for the transmission of risk of CP from parents to offspring. Based on a 7-day pain diary in 154 pediatric patients with functional abdominal CP, we tested a model in which parental CP predicted adolescents' daily average CP severity and functional impairment (distal outcomes) via parental modeling of pain behaviors and parental reinforcement of adolescent's pain behaviors (mediators) and adolescents' cognitive appraisals of pain threat (proximal outcome representing adolescents' encoding of parents' behaviors). Results indicated significant indirect pathways from parental CP status to adolescent average daily pain severity (b = 0.18, SE = 0.08, 95% confidence interval: 0.04-0.31, P = 0.03) and functional impairment (b = 0.08, SE = 0.04, 95% confidence interval: 0.02-0.15, P = 0.03) over the 7-day diary period via adolescents' observations of parent pain behaviors and adolescent pain threat appraisal. The indirect pathway through parental reinforcing responses to adolescents' pain did not reach significance for either adolescent pain severity or functional impairment. Identifying mechanisms of increased risk of pain and functional impairment in children of parents with CP ultimately could lead to targeted interventions aimed at improving functioning and quality of life in families with CP. Parental modeling of pain behaviors represents a potentially promising target for family-based interventions to ameliorate pediatric CP.

Disruptive Mood Dysregulation Disorder at Ages 13-18: Results from the National Comorbidity Survey-Adolescent Supplement.

"Disruptive mood dysregulation disorder" (DMDD) has been introduced into the Diagnostic and Statistical Manual of Mental Disorders, 5th ed. but the utility of this new label and the clinical correlates of the children it describes are yet to be determined. A proxy for the DMDD diagnosis was extracted from the National Comorbidity Survey - Adolescent Supplement (NCS-A) data on 6483 adolescents (51.4% female) including Composite International Diagnostic Interview (CIDI) diagnoses and measures of impaired functioning from the Sheehan Disability Scale. Cross tabulations and logistic regression were used to assess for prevalence and comorbidity. A total of 310 (5.26%) adolescents met the criteria for DMDD when diagnostic hierarchy and frequency of outbursts were not considered. At the low end of prevalence estimation, only nine adolescents (0.12%) met the most stringent proxy diagnosis, and they also met criteria for a number of comorbid disorders and functional impairment. The rates of comorbidity and functional impairment in adolescents with bipolar disorder were the same, irrespective of their meeting criteria for DMDD. The DMDD diagnosis captures a small group of adolescents with multiple other psychiatric and neurologic conditions. The specificity of this diagnostic label, therefore, at least in adolescents, remains an open question.

Group Therapy for Adolescents With Attention-Deficit/Hyperactivity Disorder: A Randomized Controlled Trial

To determine the efficacy of group cognitive-behavioral therapy (CBT) on adolescents with attention-deficit/hyperactivity disorder (ADHD) who were in pharmacological treatment but still had persistent symptoms. We conducted a multicenter, randomized, rater-blinded, controlled trial between April 2012 and May 2014 in a cohort of 119 adolescents (15-21 years of age). Participants were randomly assigned to 12 manualized group CBT sessions (n= 45) or a waiting list control group (n= 44). Primary outcomes were assessed by a blinded evaluator (ADHD Rating Scale [ADHD-RS], Clinical Global Impression Scale for Severity [CGI-S], Global Assessment of Functioning [GAF]) before and after treatment, as well as by self-report and parent informant ratings. Of the initial 119 participants enrolled, 89 completed treatment. A mixed-effects model analysis revealed that participants who were assigned to the group CBT sessions experienced significantly reduced ADHD symptoms compared to the control group (ADHD-RS Adolescent:-7.46, 95% CI=-9.56 to-5.36, p< .001, d=7.5; ADHD-RS Parents:-9.11, 95% CI=-11.48 to-6.75, p< .001, d= 8.38; CGI-S Self-Report:-0.68, 95% CI=-0.98 to-0.39, p< .001, d= 3.75; CGI-S Clinician:-0.79, 95% CI=-0.95 to-0.62, p< .001; d=7.71). Functional impairment decreased significantly inthe CBT group according to parents (Weiss Functional Impairment Scale-4.02, 95% CI=-7.76 to-0.29, p< .05, d= 2.29) and according to the blinded evaluator (GAF:-7.58, 95% CI=-9.1 to-6.05, p< .001, d= 7.51). Group CBT associated with pharmacological treatment is an efficacious intervention for reducing ADHD symptoms and functional impairment in adolescents. Clinical trial registration information-CBT Group for Adolescents With ADHD: a Randomized Controlled Trial; http://clinicaltrials.gov/; NCT02172183.

Functional impairment in adolescents and young adults with emerging mood disorders.

Between 30 and 60% of adults with unipolar or bipolar disorders exhibit impairments across multiple domains. However, little is known about impaired functioning in youth with mood disorders. To examine the prevalence of objective, subjective and observer-rated disability in a large, representative sample of young people with a primary mood disorder. Individuals aged 16-25 years presenting to youth mental health services for the first time with a primary mood disorder participated in a systematic diagnostic and clinical assessment. Impairment was assessed using objective (unemployment or disability payments), observer- (Social and Occupational Functioning Assessment Scale; SOFAS) and self-rated measures (role functioning according to the Brief Disability Questionnaire). Of 1241 participants (83% unipolar; 56% female), at least 30% were functionally impaired on the objective, self-rated and/or observer-rated measures, with 16% impaired according to all three criteria. Even when current distress levels were taken into account, daily use of cannabis and/or nicotine were significantly associated with impairment, with odds ratios (OR) ranging from about 1.5 to 3.0. Comorbid anxiety disorders were related to lower SOFAS scores (OR = 2-5). Levels of disability were significant, even in those presenting for mental healthcare for the first time. Functional impairment did not differ between unipolar and bipolar cases, but some evidence suggested that females with bipolar disorder were particularly disabled. The prevalence of comorbid disorders (50%) and polysubstance use (28%) and their association with disability indicate that more meaningful indicators of mood episode outcomes should focus on functional rather than symptom-specific measures. The association between functioning and nicotine use requires further exploration.

Somatisation and functional impairment in adolescents: longitudinal link with mothers’ reactions

Adolescents' somatisation (i.e., the psychological tendency to experience and report multiple physical complaints for which no definite medical cause can be found; SOM) and functional impairment (i.e., all bothersome aftermath of somatisation; FI) were studied in relation to mothers' protection, encouraging/monitoring, and minimisation of physical functional complaints. Besides main effects, interaction effects with other child and parenting characteristics were examined. A total of 990 adolescents and their mothers filled out questionnaires when the adolescents were respectively 12-13 (T1) and 13-14 (T2) years old. At T1, there was a significant relation between mothers' higher amounts of minimisation and adolescents' higher levels of SOM. Further, the link between mothers' higher levels of T1 minimisation and adolescents' higher amounts of T1 FI was significant, but not for adolescents with high levels of depressive mood. Longitudinal analyses revealed that mothers' reactions did not significantly predict adolescents' SOM/FI, nor did adolescents' SOM/FI significantly predict mothers' reactions. Practical implications are discussed.

Popularity, Funding for Health-Effect Research and Cell-Phone Addiction

Cell phones are convenient and increasingly more intuitive to operate. They come in hip, fanciful little packages with a growing range of extra features that deliver music, video, messaging, and Internet capabilities. Children have them, and some grownups are hooked by them. Adolescents and young adults are obsessed with and possibly addicted to the cell phone. The question of whether the brains of children are more susceptible to the radio-frequency fields emitted by cell phones than are those of adults remains open, and cannot be easily answered based on existing scientific knowledge. Obsessive, problematic, or excessive cell-phone use and functional impairment in adolescents have been observed worldwide.

Depression and school functioning in adolescents with chronic pain: the mediating role of pain-related catastrophizing

Psychological distress, particularly depression, has been consistently linked to functional impairment in adolescents with chronic pain. Although there is a general consensus that depression in adolescents is associated with poorer overall functioning, particularly in school, the manner in which it influences the overall outcome is still unknown. There is reason to believe that the way in which adolescents perceive and cope with their pain mediates the relationship between depression and overall functioning.

Family factors, emotional functioning, and functional impairment in juvenile fibromyalgia syndrome

Family factors and emotional functioning can play an important role in the ability of adolescents with juvenile primary fibromyalgia syndrome (JPFS) to cope with their condition and function in their everyday lives. The primary objectives of this study were to determine 1) whether adolescents with JPFS and their caregivers differed from healthy age-matched comparison peers and their caregivers in terms of emotional distress and functional impairment; 2) whether there were any differences in the family environment of adolescents with JPFS compared with healthy comparison peers; and 3) which individual-, caregiver-, and family-level variables were associated with functional impairment in adolescents with JPFS. Participants were 47 adolescents with JPFS recruited from a pediatric rheumatology clinic and 46 comparison peers without chronic illness matched for age, sex, and race. Participants and their caregivers (all mothers) completed a battery of standardized measures administered in their homes. Adolescents with JPFS had greater internalizing and externalizing symptoms than healthy comparison peers. Mothers of adolescents with JPFS reported twice as many pain conditions and significantly greater depressive symptoms than mothers of comparison peers. The JPFS group also had poorer overall family functioning and more conflicted family relationships. In adolescents with JPFS, maternal pain history was associated with significantly higher functional impairment. Increased distress and chronic pain are evident in families of adolescents with JPFS, and family relationships are also impacted. Implications for child functional impairment and the need for inclusion of caregivers in treatment are discussed.

Impact of anxiety and depression on functional impairment in adolescents with asthma

Objective This study aimed to assess the association of anxiety and depression with psychosocial and asthma-related functional impairment in a large-population-based sample of adolescents with asthma. Method The sample consisted of 767 youths ages 11 to 17 with a documented diagnosis of, and active treatment for, asthma. Telephone interviews were completed with each youth and one parent to assess asthma-related symptoms and self-report of psychosocial and asthma-related functional status. Structured diagnostic interviews (Computerized Diagnostic Interview Schedule for Children) were administered to determine psychiatric diagnoses. Weighted multiple linear regression models were employed to identify variables that were independently and significantly associated with levels of functioning. Results One hundred twenty-five youths (16.2%) met DSM-IV criteria for one or more anxiety and depressive disorders in the last 12 months. After controlling for demographic variables, greater severity of self-reported depressive and anxiety symptoms and presence of one or more DSM-IV anxiety or depressive diagnosis were associated with psychosocial and asthma-related functional status. The mental health factors were more strongly associated with measures of asthma and psychological functional outcomes than the modified Health Plan Employer Data and Information Set asthma risk measure. Conclusions Increased awareness of the need to assess and effectively treat psychiatric symptoms in youth with asthma may reduce the functional burden associated with asthma.

Cross-Sectional and Prospective Relationships between Physical Morbidity and Depression in Older Adolescents

To examine cross-sectional and prospective associations between major depressive disorder (MDD), physical morbidity (disease and injury), health-related reductions in activities, and functional impairment in adolescents. Data on depression and health-related variables were available for a sample of 1,410 adolescents (aged 14 to 18 years) at point of entry into the study and approximately 1 year later. Girls were more likely to have been treated for a disease and to have a health-related reduction in activities, whereas boys were more likely to have been treated for an injury. The expected cross-sectional associations were found between disease, reductions in activities, functional impairment, and depression, but the association between injury and depression was not significant. Prospective analyses suggest that functional impairment and disease are risk factors for future MDD and that MDD is a risk factor for future functional impairment and disease. The robust prospective associations between MDD and functional impairment suggest that the impact of disease on depression is particularly strong when it disrupts important behavior patterns. Clinically, the results emphasize the importance of assessing health-related variables in depressed adolescents and of assessing depression in those with functional impairment or disease.

27 A PROSPECTIVE STUDY OF ADOLESCENT CHEST PAIN

We prospectively studied patients presenting at a university adolescent clinic with a primary complaint of chest pain to determine the prevalence, etiology, perception and functional impact of chest pain (n=73) and to compare demographic and behavioral characteristics with 2 control groups: adolescents with abdominal pain (n=100) and adolescents making visits for reasons other than pain (n=100). While 35% of all adolescent patients claimed to have had chest pain in the past year, 13% made clinic visits for this symptom. The etiologies were: idiopathic 41%, musculoskeletal 32%, hyperventilation 18%. Breast, GI,pulmonary, cardiac and psychiatric problems accounted for 9%. Despite the paucity of significant pathology, 49% feared a heart attack or other serious cardiac problem and 12% suspected cancer; 71% believed adolescents are susceptible to heart attacks. Forty one percent missed school for chest pain. Chest pain was more likely to bring males to the clinic than control group symptoms. No group differences were noted for family structure or functioning, general health, school performance or drug usage. Pain groups were no more likely to have other pain problems (headache, backache) than the non-pain controls. Pain groups missed more school, but were no more likely to have repeated a grade. The results indicate chest pain is a prevalent problem of benign etiology causing considerable concern and functional impairment in adolescents. It does not generally represent a proxy for underlying family dysfunction or a pain-prone patient.