Andrea L. Howard

Adolescent Substance Use in the Multimodal Treatment Study of Attention-Deficit/Hyperactivity Disorder (ADHD) (MTA) as a Function of Childhood ADHD, Random Assignment to Childhood Treatments, and Subsequent Medication

OBJECTIVE To determine long-term effects on substance use and substance use disorder (SUD), up to 8 years after childhood enrollment, of the randomly assigned 14-month treatments in the multisite Multimodal Treatment Study of Children with Attention-Deficit/Hyperactivity Disorder (MTA; n = 436); to test whether medication at follow-up, cumulative psychostimulant treatment over time, or both relate to substance use/SUD; and to compare substance use/SUD in the ADHD sample to the non-ADHD childhood classmate comparison group (n = 261). METHOD Mixed-effects regression models with planned contrasts were used for all tests except the important cumulative stimulant treatment question, for which propensity score matching analysis was used. RESULTS The originally randomized treatment groups did not differ significantly on substance use/SUD by the 8-year follow-up or earlier (mean age = 17 years). Neither medication at follow-up (mostly stimulants) nor cumulative stimulant treatment was associated with adolescent substance use/SUD. Substance use at all time points, including use of two or more substances and SUD, were each greater in the ADHD than in the non-ADHD samples, regardless of sex. CONCLUSIONS Medication for ADHD did not protect from, or contribute to, visible risk of substance use or SUD by adolescence, whether analyzed as randomized treatment assignment in childhood, as medication at follow-up, or as cumulative stimulant treatment over an 8-year follow-up from childhood. These results suggest the need to identify alternative or adjunctive adolescent-focused approaches to substance abuse prevention and treatment for boys and girls with ADHD, especially given their increased risk for use and abuse of multiple substances that is not improved with stimulant medication. Clinical trial registration information-Multimodal Treatment Study of Children With Attention Deficit and Hyperactivity Disorder (MTA); http://clinical trials.gov/; NCT00000388.

Functional adult outcomes 16 years after childhood diagnosis of Attention-Deficit/Hyperactivity Disorder:MTA results

OBJECTIVE To compare educational, occupational, legal, emotional, substance use disorder, and sexual behavior outcomes in young adults with persistent and desistent attention-deficit/hyperactivity disorder (ADHD) symptoms and a local normative comparison group (LNCG) in the Multimodal Treatment Study of Children with ADHD (MTA). METHOD Data were collected 12, 14, and 16 years postbaseline (mean age 24.7 years at 16 years postbaseline) from 476 participants with ADHD diagnosed at age 7 to 9 years, and 241 age- and sex-matched classmates. Probands were subgrouped on persistence versus desistence of DSM-5 symptom count. Orthogonal comparisons contrasted ADHD versus LNCG and symptom-persistent (50%) versus symptom-desistent (50%) subgroups. Functional outcomes were measured with standardized and demographic instruments. RESULTS Three patterns of functional outcomes emerged. Post-secondary education, times fired/quit a job, current income, receiving public assistance, and risky sexual behavior showed the most common pattern: the LNCG group fared best, symptom-persistent ADHD group worst, and symptom-desistent ADHD group between, with the largest effect sizes between LNCG and symptom-persistent ADHD. In the second pattern, seen with emotional outcomes (emotional lability, neuroticism, anxiety disorder, mood disorder) and substance use outcomes, the LNCG and symptom-desistent ADHD group did not differ, but both fared better than the symptom-persistent ADHD group. In the third pattern, noted with jail time (rare), alcohol use disorder (common), and number of jobs held, group differences were not significant. The ADHD group had 10 deaths compared to one death in the LNCG. CONCLUSION Adult functioning after childhood ADHD varies by domain and is generally worse when ADHD symptoms persist. It is important to identify factors and interventions that promote better functional outcomes.

The Separation of Between-person and Within-person Components of Individual Change Over Time: A Latent Curve Model with Structured Residuals

OBJECTIVE Although recent statistical and computational developments allow for the empirical testing of psychological theories in ways not previously possible, one particularly vexing challenge remains: how to optimally model the prospective, reciprocal relations between 2 constructs as they developmentally unfold over time. Several analytic methods currently exist that attempt to model these types of relations, and each approach is successful to varying degrees. However, none provide the unambiguous separation over time of between-person and within-person components of stability and change, components that are often hypothesized to exist in the psychological sciences. Our goal in this article is to propose and demonstrate a novel extension of the multivariate latent curve model to allow for the disaggregation of these effects. METHOD We begin with a review of the standard latent curve models and describe how these primarily capture between-person differences in change. We then extend this model to allow for regression structures among the time-specific residuals to capture within-person differences in change. RESULTS We demonstrate this model using an artificial data set generated to mimic the developmental relation between alcohol use and depressive symptomatology spanning 5 repeated measures. CONCLUSIONS We obtain a specificity of results from the proposed analytic strategy that is not available from other existing methodologies. We conclude with potential limitations of our approach and directions for future research.

Exploring or Floundering? The Meaning of Employment and Educational Fluctuations in Emerging Adulthood

Youth today spend years moving in and out of different education and employment statuses until they settle into stable employment. This 14-year Canadian longitudinal study reveals how month-to-month fluctuations in employment and educational statuses from age 19 to 25 predict employment success at age 32. Early employment instability was linked to lower income at age 32 and, among men, to lower occupational status and career satisfaction. However, for those who had made at least one career change, employment fluctuation had a positive effect on income and career satisfaction. Greater fluctuation in educational status was associated with higher occupational status at age 32. In general, labor market instability in the early 20smight best be described as floundering, while educational status changes more often reflect exploring.

A trifactor model for integrating ratings across multiple informants.

Psychologists often obtain ratings for target individuals from multiple informants such as parents or peers. In this article we propose a trifactor model for multiple informant data that separates target-level variability from informant-level variability and item-level variability. By leveraging item-level data, the trifactor model allows for examination of a single trait rated on a single target. In contrast to many psychometric models developed for multitrait-multimethod data, the trifactor model is predominantly a measurement model. It is used to evaluate item quality in scale development, test hypotheses about sources of target variability (e.g., sources of trait differences) versus informant variability (e.g., sources of rater bias), and generate integrative scores that are purged of the subjective biases of single informants.

College student affect and heavy drinking: Variable associations across days, semesters, and people.

This study tested associations between positive and negative affect and heavy drinking in 734 college students who completed daily diaries in 14-day bursts once per semester over 7 semesters (≤98 days per person). Three-level multilevel models tested whether affect and heavy drinking were linked across days, semesters, and persons. Higher daily, between-semester, and between-person positive affect were each associated with greater odds of heavy drinking on weekdays and on weekend days. A significant interaction with semester in college showed that the association between daily positive affect and heavy drinking on weekend days became stronger over time. That is, heavy drinking on a weekend day with higher positive affect was more likely in later years of college (OR = 2.93, Fall of 4th year), compared to earlier in college (OR = 1.80, Fall of 1st year). A similar interaction was found for between-semester positive affect and heavy drinking on weekdays. Higher daily negative affect was associated with a greater odds of heavy drinking on weekdays only for students who first began drinking in 7th grade or earlier (OR = 2.36). Results of this study highlight the importance of varied time spans in studying the etiology, consequences, and prevention of heavy drinking. Harm-reduction strategies that target positive affect-related drinking by encouraging protective behaviors during celebratory events may become increasingly important as students transition to later years of college. (PsycINFO Database Record

Worldview Accommodation: Selectively Modifying Committed Beliefs Provides Defense Against Worldview Threat

Although numerous studies have examined compensatory reactions to ideological threats such as derogation, relatively little research has focused on alternative forms of defense. One such alternative, termed accommodation, involves accepting and incorporating parts of the threatening information into existing belief-structures. The present research employs a terror management framework to assess the effects of worldview threat, death-thoughts, and trait self-esteem on worldview accommodation. Five studies demonstrate that accommodation entails selectively modifying only peripheral worldview beliefs, while retaining core beliefs. Study 1 demonstrates that accommodation increases as a function of death-thought accessibility (DTA) aroused by threat. Studies 2–5 show that self-esteem moderates the effects of threat on accommodation, such that people with low (but not high) self-esteem accommodate their worldview. Moreover, accommodation is found to reduce source derogation (Studies 1–3), fluid defensiveness (Study 4), and DTA (Study 5). Discussion focuses on implications for understanding various means of coping with worldview threats.

Developmental progression to early adult binge drinking and marijuana use from worsening versus stable trajectories of adolescent attention deficit/hyperactivity disorder and delinquency

AIMS To examine the association between developmental trajectories of inattention, hyperactivity-impulsivity and delinquency through childhood and adolescence (ages 8-16 years) and subsequent binge drinking and marijuana use in early adulthood (age 21 years). DESIGN Prospective naturalistic follow-up of children with attention deficit/hyperactivity disorder (ADHD) previously enrolled in a randomized controlled trial (RCT). Treatment-phase assessments occurred at 3, 9 and 14 months after randomization; follow-up assessments occurred at 24 months, 36 months, and 6, 8 and 12 years after randomization. SETTING Secondary analysis of data from the Multimodal Treatment Study of ADHD (MTA), a multi-site RCT comparing the effects of careful medication management, intensive behavior therapy, their combination, and referral to usual community care. PARTICIPANTS A total of 579 children with DSM-IV ADHD combined type, aged 7.0 and 9.9 years at baseline (mean = 8.5, SD = 0.80). MEASUREMENTS Ratings of inattention, hyperactivity-impulsivity and delinquency were collected from multiple informants at baseline and through the 8-year follow-up. Self-reports of binge drinking and marijuana use were collected at the 12-year follow-up (mean age 21 years). FINDINGS Trajectories of worsening inattention symptoms and delinquency (and less apparent improvement in hyperactivity-impulsivity) were associated with higher rates of early adult binge drinking and marijuana use, compared with trajectories of stable or improving symptoms and delinquency (of 24 comparisons, all P-values <0.05), even when symptom levels in stable trajectories were high. CONCLUSIONS Worsening inattention symptoms and delinquency during adolescence are were associated with higher levels of early adult substance use; this pattern may reflect a developmental course of vulnerability to elevated substance use in early adulthood.

Developmental progression to early adult binge drinking and marijuana use from worsening versus stable trajectories of adolescent ADHD and delinquency

AIMS To examine the association between developmental trajectories of inattention, hyperactivity-impulsivity and delinquency through childhood and adolescence (ages 8-16 years) and subsequent binge drinking and marijuana use in early adulthood (age 21 years). DESIGN Prospective naturalistic follow-up of children with attention deficit/hyperactivity disorder (ADHD) previously enrolled in a randomized controlled trial (RCT). Treatment-phase assessments occurred at 3, 9 and 14 months after randomization; follow-up assessments occurred at 24 months, 36 months, and 6, 8 and 12 years after randomization. SETTING Secondary analysis of data from the Multimodal Treatment Study of ADHD (MTA), a multi-site RCT comparing the effects of careful medication management, intensive behavior therapy, their combination, and referral to usual community care. PARTICIPANTS A total of 579 children with DSM-IV ADHD combined type, aged 7.0 and 9.9 years at baseline (mean = 8.5, SD = 0.80). MEASUREMENTS Ratings of inattention, hyperactivity-impulsivity and delinquency were collected from multiple informants at baseline and through the 8-year follow-up. Self-reports of binge drinking and marijuana use were collected at the 12-year follow-up (mean age 21 years). FINDINGS Trajectories of worsening inattention symptoms and delinquency (and less apparent improvement in hyperactivity-impulsivity) were associated with higher rates of early adult binge drinking and marijuana use, compared with trajectories of stable or improving symptoms and delinquency (of 24 comparisons, all P-values <0.05), even when symptom levels in stable trajectories were high. CONCLUSIONS Worsening inattention symptoms and delinquency during adolescence are were associated with higher levels of early adult substance use; this pattern may reflect a developmental course of vulnerability to elevated substance use in early adulthood.

Leveraging Time-Varying Covariates to Test Within- and Between-Person Effects and Interactions in the Multilevel Linear Model

Multilevel linear modeling (MLM) is a powerful and well-defined tool often used to evaluate time-varying associations between two or more variables measured in longitudinal studies. Such variables carry information about stable, between-person differences as well as information about within-person variability. For emerging adults, this variability figures prominently across a variety of developmental domains. A single variable measured on repeated occasions can be easily summarized into two new variables that represent the unique within- and between-person sources of information contained in the original variable. Well-known procedures for statistically disaggregating time-varying predictors in an MLM are straightforward but often not accessible to a nontechnical readership. Using SAS syntax, this tutorial provides step-by-step instructions to recode a single repeated-measures variable into separate between- and within-person predictor variables. Strategies are suggested for testing and interpreting main effects and interactions in the MLM, drawing on a daily diary example of first-year, first-time college-attending emerging adults.