Psychopathological Problems Research Articles

The Assessment of Alexithymia Across Positive and Negative Emotions: The Psychometric Properties of the Iranian Version of the Perth Alexithymia Questionnaire

Background: Construct of Alexithymia is important for understanding psychopathology that its assessment is of high interest as persons with difficulty in processing their emotions (either positive and negative) are more vulnerable to psychopathology problems. Objectives: The current study aimed to determine the psychometric properties of the Perth Alexithymia questionnaire (PAQ), and to describe appropriate measures for the field of clinical psychology and psychiatry. Methods: The Persian version of the PAQ was produced through forward translation, reconciliation, and back translation. The study population was all staff (soldiers) of the army force in Tehran, Iran, in 2018 - 2019. Two hundred and fifty four soldiers were selected by convenience sampling method. The following questionnaires were used to collect data: the PAQ, The Deliberate Self-Harm inventory (DSHI), Borderline Personality scale (STB), Cognitive Flexibility inventory (CFI), and Self-Compassion scale (SCS) short-form. The construct validity of the PAQ was evaluated using confirmatory factor analysis, divergent, and convergent validity. Internal Consistency and test-retest reliability (2 weeks’ interval) were applied to evaluate reliability. Data were analyzed using LISREL (version 8.8) and SSPS (version 22). Results: PAQ and its subscales were found as valid and reliable measures, with good internal consistency and good test-retest reliability. The PAQ showed good internal consistency (Cronbach’s α = 0.91). Concerning the convergent validity, PAQ and its subscales showed a significant positive correlation with self-report measures of DSHI and STB (P < 0.05). However, they were negatively correlated with Self-Compassion scale (SCS) short-form and CFI (P < 0.05), which demonstrated a good divergent validity. Moreover, while the results of this study support the five-factor models of the PAQ (RMSEA = 0.08, NFI = 0.94, CFI= 0.95), the two-factor model does not fit the data. Conclusions: The PAQ showed good validity and reliability and can be useful for evaluating Alexithymia in the army force samples. The PAQ can be considered promising as a measure in Alexithymia-related research and clinical settings.

Establishing Safety and Stability for Enhanced Treatment Engagement With the Unified Protocol: A Case Study

Despite the vast array of empirically validated treatments for psychopathological problems, interventions still require considerable client resources for engagement and success. For clients lacking safety and stability outside of therapy, numerous barriers to treatment can prevent improvement and lead to disengagement. In such cases, therapists can seek to understand clients’ difficulties with safety and stability. Developing both rapport and the client’s problem-solving abilities can instill a sense of agency, keeping clients in treatment for better outcomes overall. This case study describes the modified application of the Unified Protocol following safety planning and crisis management. “Mary,” a 23-year old female, presented to a training clinic with fluctuating mood episodes, trauma symptoms, and problem substance use; pre, post, and routinely collected session data with clinical report indicate symptom improvement and increased treatment engagement following client gains in safety, employment, and housing. This case illustrates the importance of the therapeutic alliance in establishing client safety to effectively deliver a transdiagnostic treatment to address core mechanisms underlying emotion dysregulation.

ADHD subtypes: Do they hold beyond core symptoms? A multilevel testing of an additive model

Attention Deficit Hyperactivity Disorder (ADHD) is characterized as a behavioral syndrome with core symptoms of inattention and/or hyperactivity/impulsivity that constitute, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), predominantly Inattentive and Hyperactive-Impulsive and a combined (additive) presentation that fulfills both criteria. The question remains if the pathophysiological background of both factors is also separate at levels of investigation beyond core symptoms. This would allow a clearer understanding and a more focused treatment approach even with tools derived from these levels. Hence, we assumed that an implicit additive diagnostic model also holds at the levels of associated psychopathology, neuropsychological performance and brain oscillations. We investigated this hypothesis using data of 61 boys (7–12 years old) with ADHD and 43 typically developing children. There were no significant differences in age and IQ between groups. Children were examined with Child Behavior Checklist (CBCL), the Integrated Visual and Auditory Test (IVA), and brain oscillations during eyes closed resting state. Inattention characteristics were associated with more pronounced internalizing problems, lower attention, and vigilance during IVA performance and at the Electroencephalography level with elevated Theta and diminished Beta power during eyes closed rest. In contrast, hyperactivity/impulsivity characteristics led to general psychopathology problems and showed at the neuropsychological level faster response speed and deficits in cognitive control and performance consistency, but were on the electroencephalography level without any deficits in EEG power. Considering differences in behavioral, neuropsychology, and electroencephalography levels in each subtype, separate clinical approaches should be recommended for them and an additive model for their combination.

Suicide risk factors across suicidal ideators, single suicide attempters, and multiple suicide attempters

Few studies have compared the three suicidality groups—suicidal ideators (SIs), single suicide attempters (SSAs), and multiple suicide attempters (MSAs)—in relation to the suicidal process. This cross-sectional study investigated trends and differences in suicide risk factors across suicidality groups. Using the baseline data of the Korean Cohort for the Model Predicting a Suicide and Suicide-related Behavior, we analyzed trends (Jonckheere-Terpstra or Mantel-Haenszel χ2 test) and differences (analysis of covariance or logistic regression) in sociodemographic and clinical factors, psychiatric diagnoses, as well as clinical rating scores on psychopathology (suicidal ideation, depressive symptoms, anxiety symptoms, and problem drinking), trait impulsiveness, and stress across suicidality groups. Across suicidality groups comprising 193 SIs, 207 SSAs, and 376 MSAs, we observed a decreasing trend in age and increasing trends in history of early trauma, familial histories of suicide attempts and suicide, most diagnoses and psychopathologies (suicidal ideation, anxiety symptoms, and problem drinking), trait impulsiveness, and stress—with MSAs more likely to have histories of early trauma and familial suicide, almost uniformly higher proportions of diagnoses, and higher psychopathology rating scores. Overall, increasing trends in suicide risk factors were found across all suicidality groups. Notably, MSAs presented greater proportions of most psychiatric diagnoses and higher degrees of most psychopathologies, motor impulsiveness, and stress, indicating they were at more severe clinical states and were closer to suicide. Mental health professionals should ascertain the number of suicide attempts to identify MSAs, implement more thorough evaluations, and employ additional measures for reducing motor impulsiveness.

Parental Psychopathology and Oppositional Defiant Problems in Emerging Adults: Moderated Mediation by Temperament and Gender.

Previous studies have indicated that prenatal maternal depressive symptoms predicted toddler temperament, which led to childhood irritability, an important component to ODD problems. In addition, children with ODD problems continue to have difficulties as they transition into emerging adulthood. The current study examined whether present-day emerging adult temperament mediated the relationship between perceived parental psychopathology (e.g., depressive, anxiety, and antisocial problems) and emerging adult ODD problems (e.g., affective and behavioral components). Further, emerging adult and parent gender was examined as a moderator (i.e., moderated mediation). The current study asked a sample of 973 emerging adults to report upon the psychological problems of their parents as well as their own temperament and ODD problems. Negative affect and effortful control mediated the relationship between maternal anxiety problems and female affective and behavioral ODD problems. Similarly, effortful control mediated the relationship between paternal antisocial problems and male behavioral ODD problems. Significant indirect effects occurred for the mother-daughter and father-son dyads only, suggesting moderated mediation by child and parent gender. Thus, temperament may be one process which explains the relationship between parental psychopathology and emerging adult ODD problems, and this process differed by parent and child gender.

The Mediating Effect of Difficulties in Emotion Regulation on the Relationship Between Childhood Emotional Trauma, Psychopathology and Interpersonal Problems: With a Focus on the Distinct Paths of Emotional Abuse and Emotional Neglect

The Mediating Effect of Difficulties in Emotion Regulation on the Relationship Between Childhood Emotional Trauma, Psychopathology and Interpersonal Problems: With a Focus on the Distinct Paths of Emotional Abuse and Emotional Neglect

Highlights in this issue

Many countries have closed schools and kindergartens to minimise COVID-19, but the role that children play in transmitting the virus is unclear. Ludvigsson carried out a systematic review and concluded that children were unlikely to be the main drivers of the pandemic.1 de Niet et al2 comment on the same topic. Snapiri et al3 present a group of paediatric patients who were diagnosed with appendicitis at a later stage, due to fear of the pandemic, and report higher complications than the same period in 2019. Mastnak4 suggest in a perspective paper that some of the psychopathological problems related to the pandemic could be prevented with music therapy. Haward et al5 express concerns about assumptions that extremely premature babies are less deserving of ventilator care than adults during the pandemic. The authors also describe other unrecognised areas in paediatric ethics that require our immediate attention. There are two different indications where body position has had a great impact on active medical practice. One of them is infants and sudden infant death syndrome, which favours the supine position, and the other is adult patients with acute lung insufficiency, which favours the prone position. This is covered by three papers in this issue. Poets et al6 studied oxygenation and intermittent hypoxia in supine versus prone positions in very preterm infants and Lindahl7 comments on the findings. Lindahl also looks at how some centres have started treating adult COVID-19 patients with rapidly deteriorating lung function in the prone position. His mini-review reports that this has led to considerable improvement in oxygenation in some cases and provides some insights into the mechanisms behind this that could also be relevant for paediatric medicine.8 Kivistö et al explored trends in asthma medication dispensed to children and adolescents aged 0-19 years in Finland and Sweden from 2006 to 2017.9 The authors report that inhaled corticosteroids were 1.5 times more likely to be dispensed for children aged 0-4 years in Sweden than Finland. The prevalence of short-acting β2-adrenergic receptor agonists increased in both countries, particularly in Finland. The accompanying editorial by Wennergren10 discusses why trends in asthma medication and hospitalisation differ for children in Finland and Sweden. Readers may also be interested in the paper by Bigman,11 which reports that exclusive breastfeeding for the first 3 months of life may reduce the risk of respiratory allergies and some asthma in children when they reach 6 years of age. Examining the placentas of sick newborn infants may help to personalise their neonatal care. De Angelis et al studied sick newborn infants who were transferred from smaller neonatal care centres to the neonatal intensive care unit at a children's hospital in Genoa, Italy. They found that placentas were seldom transferred with the infants for pathological examination.12 The authors attribute this finding to insufficient understanding of the importance of placental pathology in smaller neonatal care centres, as well as suboptimal routines for storing and handling placentas. They propose steps that could overcome these barriers. Papadogiannakis comments on the paper.13 Figures 1, 3: istockphoto.com, 2: Lindahl et al, 4: Alamy

Emotion Regulation Strategies as Mediators of the Relationship Between Internalizing Psychopathology and Sleep-Wake Problems During the Transition to Early Adolescence: A Longitudinal Study

Internalizing psychopathology, including depression and anxiety, has been associated with sleep-wake problems among youth. Although transdiagnostic theories of psychopathology posit that emotion dysregulation explains many of the symptoms associated with internalizing psychopathology, examination of regulatory mechanisms underlying this association is limited, particularly during the transition to early adolescence when risk for affective dysregulation and sleep-wake problems is heightened. Using a longitudinal design with a youth community sample ( N = 278), the current study found a positive, indirect effect of internalizing psychopathology ([Formula: see text]age = 9.84) on later sleep-wake problems ([Formula: see text]age = 14.53) via higher levels of a more maladaptive emotion regulation strategy (i.e., expressive suppression), with no evidence of an indirect effect of a more adaptive strategy (i.e., cognitive reappraisal; [Formula: see text]age = 12.02). Findings have important clinical implications for targeting the reduction of maladaptive emotion regulation strategies, such as expressive suppression, in order to address sleep problems among youth with internalizing psychopathology.

Reintegration of ex-Military Personnel with Civil Life - A social Issue and Big Challenge: An Empirical Study

Every year a large number of individuals have to quit different military services: army, navy, air force etc. for different reasons all over the world. Among all the reasons, medical discharge is the most unacceptable one. After forced departure from the service, these personnel face several problems as they go through a difficult and sensitive time in their life. Starting from post-traumatic stress disorder (PTSD), they go through different mental, psychological, social and psychopathological problems. Further, people look at them in a different way when they come to know that the person had to resign from military services. Moreover, the behavior and attitude of the family members and relatives make the situation worse. Ex-military personnel of this category suffer from depression. However, the person can be turned into a positive and effective power of the society by proper support from the surroundings as the person can use the learning from his/her experience in other occupations as well. The paper draws attention towards this social problem. The benefits of the research will have an impact on the ex-military community of forced departure, as this problem has not been addressed properly in broader context before.

Reintegration of ex-Military Personnel with Civil Life- A social Issue and Big Challenge: An Empirical Study

Every year a large number of individuals have to quit different military services: army, navy, air force etc. for different reasons all over the world. Among all the reasons, medical discharge is the most unacceptable one. After forced departure from the service, these personnel face several problems as they go through a difficult and sensitive time in their life. Starting from post-traumatic stress disorder (PTSD), they go through different mental, psychological, social and psychopathological problems. Further, people look at them in a different way when they come to know that the person had to resign from military services. Moreover, the behavior and attitude of the family members and relatives make the situation worse. Ex-military personnel of this category suffer from depression. However, the person can be turned into a positive and effective power of the society by proper support from the surroundings as the person can use the learning from his/her experience in other occupations as well. The paper draws attention towards this social problem. The benefits of the research will have an impact on the ex-military community of forced departure, as this problem has not been addressed properly in broader context before.

Psychopathological problems related to the COVID-19 pandemic and possible prevention with music therapy.

The author has no conflicts of interest to declare.

대학생의 아동기 ADHD의 지속 및 감소와 성인기 ADHD의 발현에 따른 유병률과 부적응: 실행기능 결함, 심리적 부적응 및 대인관계 문제를 중심으로

본 연구에서는 대학생의 아동기 ADHD 증상의 변화와 성인기 ADHD 증상에 따른 네 집단(지속, 감소, 발현, 정상 집단) 간 실행기능 결함, 심리적 부적응 및 대인관계 문제의 차이를 검증하고자 하였다. 이를 위해 지역사회의 1,082명의 남녀 대학생(남 445명, 여 637명)을 대상으로 아동기 ADHD 증상(Childhood Symptom Scale), 성인기 ADHD 증상(Current Symptom Scale, K-AADHDS), 실행기능 결함(KBDEFS), 심리적 부적응(SCL-90-R), 대인관계 문제(KIIP-SC)에 대한 자기보고 평가를 실시하였다.<BR>연구결과, DSM-5의 진단기준에 따라 ADHD 집단을 선별한 결과 대학생 집단에서 아동기 ADHD의 유병률은 7.3% (79명)로 나타났고, 성인기 ADHD의 유병률은 6.2% (67명)로 나타났다. 아동기 ADHD 증상의 변화에 따른 아동기 증상지속 및 감소집단, 성인기의 늦은 발현집단 및 정상집단 간 차이를 검증한 결과, 아동기 ADHD의 지속집단이 실행기능에서 가장 큰 결함을 나타냈고, 발현집단의 실행기능 결함이 감소집단 보다 유의하게 높았고, 정상집단의 실행기능 결함이 유의하게 가장 낮았다. 또한 지속집단과 발현집단의 대인관계 문제와 심리적 부적응 점수가 감소집단과 정상집단보다 유의하게 높았다.

The development and initial tests for the psychometric properties of the COVID-19 Phobia Scale (C19P-S)

Researchers predict that the negative effects of the novel coronavirus 2019 (COVID-19) pandemic will continue . These negative effects are not solely limited to psycho-pathological problems. Serious physiological, social, and economical difficulties due to COVID-19 have already been observed in various nations. In this study, we suggest a new type of specific phobia, which may be categorized under DSM-V 300.29. The current study developed a self-report instrument whose items address the specific phobia diagnosis criteria of the DSM-V and tested its initial psychometric properties. Results show that the scale has initial evidence of construct, convergent, and discriminant validity, and internal consistency reliability. The scale should be further tested; however, the COVID-19 Phobia Scale (C19P-S) items provide support for assessing the levels of phobia reactions among a wide range of age groups.

When is Psychotherapy Brief? Considering Sociodemographic Factors, Problem Complexity, and Problem Type in U.S. Adolescents

ABSTRACT Objective: When psychotherapy is brief (1–2 sessions), “early dropout” – defined as premature treatment discontinuation due to financial or structural barriers – is a commonly assumed cause. However, there are several possible reasons why treatment may be brief, including youth-level factors such as psychopathology complexity or problem type. Better characterizing whether factors beyond financial and structural barriers predict adolescents’ receipt of briefer (versus longer-term) treatment may guide efforts to retain specific youth in longer-term services – and disseminate intentionally brief interventions to youth potentially positioned to benefit. Method: Using data from the 2017 SAMHSA National Survey on Drug Use and Health, we examined whether sociodemographic disadvantage (minority race, low-income, government assistance), perceived problem type, and psychopathology complexity (1 versus multiple problem types) related to psychotherapy length (1–2 versus 3-24+ sessions) among adolescents receiving outpatient psychotherapy (N = 1,601; ages 12–17; 60.59% white; 64.50% female). Results: Among adolescents beginning outpatient psychotherapy, 23.36% ended treatment after 1–2 sessions. Psychopathology complexity predicted greater likelihood of receiving >2 sessions, after adjusting for specific problem type (χ2 = 75.14, p < .001, OR = 1.80). Further, although certain problem types (e.g., depression, anxiety, and anger control) were associated with increased likelihood of greater treatment length, these findings did not hold after accounting for psychopathology complexity. No sociodemographic factors significantly predicted treatment length. Conclusions: Structural and financial barriers alone may not explain when and why youth psychotherapy is brief. Additional factors, such as psychopathology complexity, may be important and potentially primary contributors to treatment duration among youth who access outpatient services. Future research may examine whether youth with less comorbidity differentially benefit from intentionally brief interventions, along with strategies for retaining youth who might benefit from longer-term care – such as those with multiple co-occurring problems – in treatment.

Using the Body When There Are No Words for Feelings: Alexithymia and Somatization in Self-Harming Adolescents.

The present case-control study aimed to investigate the relationship between alexithymia and somatic complaints in the psychopathological setting of non-suicidal self-injury (NSSI). A clinical sample of 134 adolescents (115 females; 85.5%) from 12 to 18 years old engaging in NSSI was compared with a control group of 243 high-school students (157 females; 64.6%) from 13 to 18 years old. Data were collected using two questionnaires: The Youth Self-Report 11–18 and the 20 Toronto Alexithymia Scale. In both cases and controls, the presence of somatization and alexithymia was associated with more severe psychopathological problems. Analyses were conducted to explore the association between somatic disorders and alexithymia. In the clinical group, somatic complaints were reported by 95.9% of alexithymic individuals, whereas only 44.3% of alexithymic adolescents reported somatic complaints. A one-way relationship emerged between somatization and alexithymia: while alexithymia would seem to be a factor associated with self-injury, somatic disorders were strongly associated with alexithymia, but not necessarily with self-injury. Among the self-harming adolescents, those with both alexithymia and somatization had a more severe psychopathological picture than the individuals with alexithymia but no somatization. This would suggest that, in the setting of NSSI, greater difficulty with identifying feelings is associated with somatization, and alexithymia would be an attribute common to self-harming behavior and somatization, both of which are characterized by the body being used to express psychological and emotional problems. Future research could further investigate alexithymia in self-harming individuals, in relation to any presence or absence of somatic disorders, with longitudinal assessments on any differences in their manifestation of self-injury and its psychopathological correlates.

Cybervictimization, Depression Suicidal Ideation, and Addictive Behavior toward Social Media

An addictive behavior is considered to exist when there is excessive use, loss of control and tolerance, and withdrawal symptoms which cause negative repercussions in everyday life and become a concern where other psychopathological problems may manifest. The objective of this study was to develop an explanatory model of cybervictimization, depression, suicidal ideation and addictive behavior toward social media. Instruments that measured these variables were applied to a total sample of 406 university students. A significant correlation was found between addictive behavior toward social media, cybervictimization, depression, and suicidal ideation. The model explained that cybervictimization and depression can lead to two outcomes: an addictive behavior toward social media, or suicidal thoughts. These results contribute to a better understanding of current phenomenon such as cybervictimization and addictive behavior toward social media with respect to depression and suicidal ideation. A deeper investigation is recommended to create preventive and intervention programs for healthy Internet usage for young people.

Aircraft Pilots and Psychophysical health and Safety

In the last ten years, there have been several accidents, some of them very serious due to airplane pilots showing psychological or psychopathological problems or obvious signs of distress. In this article, starting from the 24 March 2015 catastrophe, flight GWI18G operated by German wings with an airbus A320, carrying 150 people on board crashed into the foothills of the French Alps, offers various possibilities for evaluation and prevention. The proposals of the British Psychology Society for 2020 are also mentioned and the current possibilities of evaluation and verification are described, both psychological, medical and psychophysiological for an adequate prevention and cure.

Does the Psychopathology of the Parents Predict the Developmental-Emotional Problems of the Toddlers?

Parental psychopathology has been defined in respect of psychopathological development in early childhood. This study aimed to investigate the effects of parental psychopathologies on social and emotional problems in the age range of 1-3 years and to determine children at risk. The study data were obtained from the 2009 Early Childhood Mental Health Profile taking population distribution into consideration with the properties representing Turkey. The primary caregiver of the child completed the Psychiatric Evaluation Form for 1-3 years, the Brief Infant-Toddler Social Emotional Assessment (BITSEA), the Ages and Stages Questionnaire (ASQ), and the Brief Symptom Inventory (BSI) for themselves. Machine learning models used for prediction. The performance of prediction models was evaluated with the ten-fold cross-validation method. Area Under Curve (AUC) values were calculated with Receiver Operating Characteristic (ROC) curves to evaluate the performance of each model. The evaluation was made of the data of 2775 children, comprising 1507 (54.3%) males and 1268 (45.7%) females with a mean age of 26.19±9.11 months (range, 10-48 months). A total of 106 children were identified as at risk, as they were above the clinical cut-off point (1.5 standard deviations) of the BITSEA points and below the cut-off points of any one of the developmental areas of the ASQ. Modeling was applied to the data of these 106 children. The Support Vector Machines (SVM) model was selected for prediction with the automatically optimized highest AUC value. Weighting for the SVM algorithm showed mothers' BSI scores, fathers' education and health problems, duration of breastfeeding, unplanned pregnancy are significant for predicting BITSEA-problem scores in the model. To be able to understand the complex relationship with parental psychopathology and behavioral problems, machine learning methods were used successfully in this study. Further studies with more massive data sets, more extended follow-up periods, and stronger algorithms will be able to identify risk groups earlier and allow early interventions to be implemented.

Chapter 9 - Intellectual disability

Intellectual disability (ID) or intellectual developmental disability (IDD) is one of the commonest neurodevelopmental disabilities worldwide and is known to affect 2% of the population of France or just over a million people. It is marked by a reduced ability to reason and understand abstract or complex information, which heavily restricts school learning and limits the individual's ability to adapt to daily life, including their transition to adulthood. Intellectual handicap or mental handicap results from an interaction between the individual vulnerability of a person with ID and their ecosystem, in other words, their family, and cultural and institutional environment, which can be a barrier or a facilitator. Identifying a child with an unusual developmental trajectory requires professionals to have a good understanding of psychomotor development. ID may be isolated but is very often intertwined with other neurodevelopmental disorders, including autism, motor or sensory difficulties (hearing, vision), serious sleep and eating disorders, and medical conditions such as epilepsy, as well as a wide variety of psychopathologic problems, including anxiety, depression, and emotional regulation disorders. There are many causes of ID. More than half of all cases are genetic in origin, and there are several hundreds of rare diseases about which little is known so far. The use of new genetic techniques (high-throughput sequencing) should reduce the number of people who are undiagnosed and give way to a comprehensive diagnostic approach based on clinical practice. A regular multidimensional evaluation of cognitive, educational, socioemotional, and adaptive skills throughout life provides a better understanding of how individuals with ID function and will contribute toward the planning of more appropriate strategies for learning, care, and support, leading to a better quality of life and participation in society.

The role of ADHD symptoms in the relationship between academic achievement and psychopathological symptoms

BackgroundPrevious research results suggest that ADHD symptoms explain the relationship between specific learning disability and externalising psychopathology and between math disability and anxiety, but not between reading disability and anxiety. For depression, previous results are mixed. AimsThe current study aims to clarify this role of ADHD symptoms in the relationship between various areas of academic achievement (reading, writing, and math skills) and psychopathological symptoms (anxiety, depression, and conduct disorder). Methods and proceduresWe used linear regressions based on data from a general population sample (N = 3014) collected using online assessment of 3rd and 4th grade students in Germany, which included measures of academic achievement and parent-reported psychopathological symptoms. Outcomes and resultsADHD symptoms completely account for the relationship between reading/writing achievement and anxiety and between writing/math achievement and conduct problems. The negative relationship between academic achievement and depression was strongest for children with average or high ADHD symptom scores. Conclusions and implicationsADHD symptoms play an important role in explaining the relationship between academic achievement and psychopathological symptoms in elementary school children. The nature and size of this role depend on the exact constructs under study. We discuss implications for the support of children with learning problems, ADHD, and/or psychopathological problems.