Paediatrics (RCH) - Theses
Permanent URI for this collection
Search Results
1 - 1 of 1
-
ItemExamination of key clinical, biological, psychological and social factors associated with post-pubertal anxiety in young people diagnosed with Attention Deficit Hyperactivity Disorder (ADHD)( 2019)Introduction: ADHD and anxiety are two common developmental mental health conditions that co-occur in 25% to 33% of young people with ADHD. There are associated functional impairments in these disorders across clinical, biological (e.g., working memory, IQ scores and blood pressure), psychological (e.g., language, emotion regulation and academic achievement) and social (e.g., social competence and positive illusory bias) domains, which may be more severe or ameliorated when they co-occur. It is important to understand and recognise these impairing associations of ADHD and post-pubertal anxiety across developmental stages in order to target them early with appropriate and effective therapy interventions. To date there are relatively few longitudinal datasets examining key risk factors associated with these comorbid conditions and more research is needed to investigate how post-pubertal anxiety influences the different domains of life of young people with ADHD (all presentations) from childhood through to adolescence. Methods: This thesis presents a three-year blinded follow-up evaluation of children with ADHD from pre- through to post-puberty, investigating those with and without post-puberty anxiety. At baseline, relevant demographic, clinical, and functional (biological, psychological and social) information was collected from clinically referred pre-pubertal participants with ADHD (all presentations) (N=419). After the pre-pubertal baseline assessment (Tanner stage 1) all participants were followed up three years later (Tanner stage 3-5). Given that 25% of the sample were not able to be re-assessed (N=104), 118 young people were recruited with ADHD and post-pubertal anxiety [84 (71%) treated with stimulant medication or atomoxetine] and 72 young people were recruited with ADHD alone (anxiety absent) [53 (74%) treated with stimulant medication or atomoxetine], both based on parent and the child report of anxiety. Due to subclinical anxiety features, 125 young people were precluded from the study. Groups were compared for clinical (ADHD- all presentations-, ODD/CD, anxiety and depressive disorders), biological (verbal/non-verbal IQ, verbal/spatial working memory and blood pressure (systolic & diastolic - postural), psychological (language, academic achievement, emotional regulation and emotional negativity/lability), and social (social competence and positive illusory bias) characteristics. Results: There was an increased total score in the parental self-report of their total tmental health symptoms in the group of young people with ADHD and post-pubertal anxiety. However, all the significant group differences remained when the parental self- report of their total symptoms was entered as a covariate. In the clinical domain, MDD, DD (DSM-5 persistent depressive disorder equivalent) and GAD significantly predicted ADHD and post-pubertal anxiety group membership. In the psychological domain, young people with ADHD and post-pubertal anxiety had a better performance in the spatial working memory task (e.g., a lower between search error total score and a better spatial working memory strategy score). This group of young people manifested worse emotion regulation abilities and increased emotional lability/negativity in comparison with the ADHD alone group. In contrast, positive illusory bias was ameliorated in young people with child defined ADHD and post- pubertal anxiety on the teacher minus child delinquent behaviour subscale of the Child Behaviour Checklist but there was an increased level of positive illusory bias in young people with parent defined ADHD and post-pubertal anxiety on the parent minus child anxious/depressed and thought problems subscales of the Child Behaviour Checklist. Discussion: The findings outlined in this thesis suggest post-pubertal anxiety in the ADHD population needs to be effectively managed through preserving the potential benefits of a better spatial working memory performance and a more realistic self- appraisal related to post-pubertal anxiety along with optimal management of the deleterious impairments of ADHD (all presentations), anxiety and depression. In addition, these results emphasise the necessity of recognising the differences and similarities between parent-reported child anxiety and child-reported anxiety through successive developmental stages. Future clinical and research directions are discussed.