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Executive function (EF) impairments are heterogeneous in children with attention deficit/hyperactivity disorder (ADHD). Culture has a significant impact on EF development in typically developing (TD) children, yet its influence on EF impairments in those with ADHD remains understudied. This study aims to investigate the impact of cultural factors on EF impairments in children with ADHD through a cross-cultural comparison. To ensure a robust sample size, the study initially recruited a large participant pool of 690 children from China and Australia. We applied similar diagnostic criteria and used propensity score matching to align clinical representation. This approach resulted in a final sample of 198 children aged 7-12, including 102 children diagnosed with ADHD and 96 TD peers. The same neuropsychological testing battery was used to assess EF in terms of working memory (WM), inhibitory control (IC), and set shifting. Significant cultural effects were observed: Chinese children with ADHD showed lower performance in IC and WM compared to their TD peers, a pattern not seen in Australian children. A latent profile analysis revealed distinct EF profiles, highlighting a subgroup of Chinese children with severe EF impairments. This study advances cross-cultural ADHD research on EF by using a robust methodology, including consistent diagnostic and testing procedures, propensity score matching, and person-centered analysis. Our findings suggest that high-EF-expectation environments may have a negative effect on EF in children with ADHD, which provides insight into the underlying contributors to heterogeneous EF and underscores the need for culturally tailored ADHD interventions.

Across diverse populations, there is growing evidence that emotion regulation is central to healthy adaptation. Much is known about emotion regulation processes in typically developing populations, but comparatively very little is known about how these processes unfold in individuals with intellectual disability. This integrative review advances understanding of emotion regulation in intellectual disability within a clinical framework. We first synthesize research on affective and behavioral functioning across the heterogeneous intellectual disability population. We then apply the process model of emotion regulation to examine how differences in cognition, language, and executive functioning shape regulation capacities. Particular attention is given to the distinction between self-focused strategies used by individuals to regulate their own emotions, and other-focused, interpersonal strategies (i.e. caregiver-mediated support), which may play a particularly critical role for individuals with intellectual disability across the lifespan. Finally, we discuss implications for clinical practice, including interventions for promoting healthy emotion regulation in intellectual disability within the process model framework and recommendations for family-centered approaches. By integrating empirical evidence with a widely used theoretical model, this review establishes a foundation for conceptualizing emotion regulation in intellectual disability and for improving interventions that support emotional well-being in this underserved population.

This study aims to evaluate the clinical value of using QbCheck in routine Attention Deficit Hyperactive Disorder (ADHD) clinics by investigating longitudinal inter-domain relationships between objective neurocognitive outcomes of QbCheck and subjective clinical outcomes: ADHD core symptoms, impairment and quality of life (QoL). The study was conducted alongside the participants' standard pharmacological treatment for their ADHD. Thirty-four clinically diagnosed participants with ADHD completed baseline and follow-up neurocognitive assessments. Bayesian paired t-tests and bivariate correlations were used to examine changes over time and relationships between key variables. Bayesian analyses showed correlations between QbCheck and continuous performance test (CPT)-II for the same constructs, except for omission errors. In the test-retest results of QbCheck, measures remained stable, though moderate evidence supported changes in reaction time variability (BF10 = 5.57) and anecdotal evidence for commission errors (BF10 = 1.72). In measuring treatment effect, there was moderate to extreme evidence for reductions in self- and informant-rated ADHD symptoms and clinician-rated impairment severity. In contrast, informant-rated QoL showed weak evidence for a difference (BF10 = 1.81), and self-rated QoL showed no change (BF10 = 0.67). QbCheck showed moderate to extreme evidence for most changes, with weak evidence for reaction time (BF10 = 1.38), while CPT-II showed strong evidence for commission errors, weak evidence for response time variability, and no evidence for omission errors or reaction time. Weak evidence suggested moderate associations between QbCheck MicroEvent X and informant-rated ADHD symptom severity (BF10 = 2.40, r = 0.47) and CPT-II commission errors and self-rated ADHD symptom severity (BF10 = 2.44, r = 0.39). QbCheck is a valid tool for assessing neurocognitive changes in ADHD treatment but should not replace clinical outcome measures or be used as a proxy for behavioural assessments. Caution is needed when relying on a single outcome measure, emphasizing the need for multi-source assessments to capture the full impact of treatment.

Young children diagnosed with autism experience high rates of co-occurring anxiety, with uncertainty-related concerns commonly reported. This randomized controlled trial investigated an 8-week parent-mediated group anxiety intervention, "Coping with Uncertainty in Everyday Situations" (CUES-Junior©). Parents of 4-7-year-old children diagnosed with autism and experiencing uncertainty-related anxiety were recruited. The primary outcome was change from baseline in blinded assessor ratings of child responses to uncertainty and impact on family, measured post-intervention and 2-month follow-up. Secondary outcomes were parent-reported child anxiety and intolerance of uncertainty (IU), parental IU and mental health, parenting sense of competence, along with intervention feasibility and acceptability. Sixty-four children were randomized to CUES-Junior© (n = 33) or waitlist (n = 31); five families withdrew post-randomization. Immediately post-intervention, significantly more CUES-Junior© participants were rated as clinically improved from baseline in child responses to uncertainty (OR = 34.48; 95% CI = 1.72-690.04, p = 0.02) and in family impact (OR = 8.99; 95% CI = 1.52-53.05, p = 0.02) compared to waitlist. Significant improvements were also observed in parent-reported child IU and parenting satisfaction, favoring CUES-Junior©. At subsequent 2-month follow-up, CUES-Junior© participants showed sustained improvements in the impact of uncertainty on children, and parental ratings of child IU and anxiety, parenting sense of competence, and parental stress, compared to baseline. The program was feasible to administer and acceptable to parents. CUES-Junior© had an immediate treatment effect on child responses to uncertain situations and impact on families, with maintained improvements observed at follow-up. This novel mechanism-targeted and autism-informed program holds promise for addressing early uncertainty-related anxiety in young children diagnosed with autism.

The registered prevalence of autism has increased substantially over the past two decades, potentially impacting the co-occurrence of diagnosed intellectual disability (ID) in autism. Thus, the aim of this study was to investigate the proportion of ID in individuals with autism over two decades (2001-2020). Data for this study was retrieved for individuals born between 1988-2016 from Swedish population based national registers. A total of 3,045,819 individuals were eligible for inclusion in the current study, out of whom 81,286 had autism assigned 2001-2020. The annual proportion of ID in autism was calculated across year of autism diagnosis and the Cochrane Armitage trend tests were conducted. From 2001-2020 the prevalence of autism increased by 800%. Among those with autism, 13,403 also had an ID diagnosis, resulting in an overall proportion of ID in autism of 16.5%. The proportion of ID in autism decreased from 55.8% in 2001 to 6.7% in 2020, with a comparable decrease in females and males. A similar trend was discerned when limiting the sample to those diagnosed with autism before age 13 and 7 years. The results of this study indicate less congruity between the autism phenotype observed today and earlier conceptualizations of autism, which often included intellectual disability (ID). The findings suggest that changes in diagnostic criteria during this period contributed to a broadening of the ways in which individuals could meet criteria for autism, encompassing a wider range of cognitive abilities.

Exploring the similarities and differences of mental health-based service contact behaviours for children and young people (CYP) and associated characteristics will allow for distinct analysis of identified groups, and inform both current support pathways alongside more focussed targeted intervention strategies. Using data from the Mental Health of CYP in England Survey, 2017, we fitted latent class analysis models to identify classes of CYP based on the type of service contact they received. Analysis was stratified by educational stage (aged 5-10, 11-16 and 17-19 years) owing to different help-seeking pathways. For each educational stage, the four-class model was the best fit. Latent classes for children aged 5-10 years included, No Services, Community Services, Nonmedical Services, Contact all services. Children and young people reported different patterns of class membership by gender and ethnic group. Similar latent classes were identified for YP aged 11-16 years including: No Services, Nonmedical Services, Community Services, and Contact all services, however, stronger patterns of contact were found for nonmedical compared to community services. For those aged 17-19 years, classes included: No Services, Nonmedical Services, Specialised Services and Community and Health Services. Young people in the Specialist Service class had higher probabilities of being white/other compared to Black/Asian/Mixed/Other. CYP show different patterns of service contact across educational stages, with gender and ethnic disparities. Our findings could inform models of help, and support those designing and commissioning services to refocus and review where funding is best placed.

Children with conduct problems often present with a range of complex needs and many factors have the potential to complicate the delivery of evidence-based interventions for conduct problems. Little, however, is known about how to optimise the delivery of such interventions for complex cases, and there has been a lack of consensus regarding the features that reflect case complexity in treating child conduct problems. The aims of this study were to examine practitioner perceptions of the factors that contribute to case complexity in child conduct problems, and perceptions of the therapist competencies necessitated by distinct features of case complexity when delivering these interventions. Practitioners (n = 49) with expertise in evidence-based parenting interventions for conduct problems were recruited from nine countries. Using the Delphi method, participant consensus was established across multiple rounds of consultation and feedback with the expert panel. Experts reached consensus on a model comprising seven distinct drivers of case complexity among children with conduct problems, spanning child-related factors, caregiver-related factors, and broader ecological factors. Consensus was also reached regarding 16 therapist competencies of key importance to distinct drivers of case complexity, thereby validating the conceptualisation of these drivers. These findings represent a novel consensus-based practitioner perspective on the complex needs of children with conduct problems, and offer researchers and practitioners a common language for communicating information about case complexity. This perspective has the potential to inform clinical research, practice, and training, to better meet these complex client needs.

Depression levels increase dramatically during adolescence in the general population. This effect is exacerbated in adolescents with a diagnosis of attention-deficit/hyperactivity disorder (ADHD), autism, or both. Here we detail the protocol for the My Emotions and Me Over Time (MEMO) study, a 12-month longitudinal study with the primary aim to compare two competing hypotheses for why this is the case. The first, established hypothesis is that depression risk associated with ADHD and/or autism is mediated by emotion regulation deficits (ERD). The second and new perspective is that it is mediated by the experience of elevated emotional burden (EB) created by (i) greater exposure to upsetting events and encounters, which are (ii) experienced more intensely. Cross-lagged path models will test the relative importance of the ERD and EB pathways to the relationship between autism and ADHD traits and depression symptoms. Exploratory analyses examining secondary mediators (i.e., self-esteem) and moderators (rumination, resilience and alexithymia) will also be conducted. A sample of 600 adolescents aged 11-16 years, enriched for the presence of autism and ADHD diagnosed cases, and their parent/guardian will be recruited via schools, local NHS (South London and Maudsley) and ADHD and autism charities. Measures of ADHD, autism and depression, ERD, EB, self-esteem, rumination, resilience and alexithymia will be completed at baseline, 6 months and/or 12 months by parents and/or participants. Background factors such as age, sex, cognitive abilities and socioeconomic status as well as service use and medication status will also be collected. The pathways between ADHD/autism and depression, along with their mediators and moderators, will be analysed using structural equation modelling. The findings from MEMO will feed into the other studies within the RE-STAR programme to support the development of an intervention to reduce ADHD and/or autism-related depression risk in adolescence.

This systematic review aimed to assess the current evidence on the efficacy and safety of Atomoxetine in common clinical attention-deficit hyperactivity disorder (ADHD) symptoms in the context of autism spectrum disorder (ASD) for children and adolescents. Some of these common clinical symptoms of ADHD in the context of ASD include core symptoms of ASD, ADHD, depression, anxiety, mood instability/irritability, and cognitive symptoms. Major medical literature were searched for randomized controlled trials (RCTs), open-label trials, and other relevant studies or clinical trials reporting on pediatric (age <18&#xa0;years) patients with ASD treated with Atomoxetine for any reason. Databases were searched January of 2024 and include PubMed, Google Scholar, Web of Science, Scopus, PsycINFO, and Embase. Exclusion criteria were unpublished data and multiple reports from the same data set. A total of 100 abstracts were screened, and 16 clinical trials were selected for inclusion. Out of these 16 clinical trials there were two RCTs (n&#xa0;=&#xa0;128 and 97), four open-label trials (n&#xa0;=&#xa0;24, 12, 12, and 16), eight extension studies (n&#xa0;=&#xa0;128, 97, 88, 97, 97, 117, 128, and 94), one observational study (n&#xa0;=&#xa0;4), and one crossover study (n&#xa0;=&#xa0;16). Meta-analysis was not performed due to a lack of homogeneity in the two RCTs. There were limited studies available with a need for more high-power studies. In the current studies, most suggested that Atomoxetine was well tolerated and safe in pediatric patients with ASD. In fact, Atomoxetine response rates were found to be similar to those of methylphenidate in ASD studies, while inducing fewer adverse events and tolerated better. Further trials are warranted to make conclusive recommendations on Atomoxetine for improvement of common clinical symptoms of ADHD in the ASD pediatric population. Given limited approved therapies for common clinical symptoms of ASD in children and adolescents, Atomoxetine could be used as a safe off-label option due to a favorable tolerability profile and minimal adverse effects.

In middle childhood (ages 6-12), children with attention-deficit/hyperactivity disorder (ADHD) symptoms often experience emotion dysregulation (ED), anger, and social difficulties, including peer problems and maladaptive conflict resolution. Parenting plays a critical role in shaping emotional development; however, how parenting practices interact with ADHD symptoms to influence ED, anger, and social functioning remains underexplored, particularly across cross-national contexts. This study examined these dynamics using longitudinal data from two population-based cohorts in the UK and Zurich. Data was drawn from two longitudinal cohorts: the UK Millennium Cohort Study (MCS; n&#xa0;=&#xa0;3147-30,135) and the Zurich Project on Social Development from Childhood to Adulthood (z-proso; n&#xa0;=&#xa0;1179-1360). In the MCS sample, we ran cross-sectional moderation models to examine whether ADHD symptoms moderated the association between withdrawn/harsh parenting practices and emotion dysregulation, at ages 5 and 7, respectively (H1). The MCS sample also examined whether ADHD symptoms at age 7 moderated the association between withdrawn/harsh parenting practices at age 5 and peer relationship problems at age 11, longitudinally (H2). In the z-proso sample, we ran cross-sectional moderation models to examine whether ADHD symptoms moderated the association between negative/positive parenting and anger, at age 9 (H3). The z-proso sample additionally focused on whether anger at 9 mediates the association between age 7 negative/positive parenting and conflict coping strategies (aggressive/competent) at age 11, longitudinally (H4) Multiple linear regression, moderation, and mediation analyses were performed, adjusting for demographic covariates, such as gender, income (MCS), socio-economic status (z-proso), maternal education (MCS), ethnicity (MCS), and parents' migration background (z-proso). In the MCS, cross-sectionally at age 7, a statistically significant negative interaction was observed, indicating that the association between withdrawn parenting and ED was stronger at lower levels of ADHD symptoms and weakened as ADHD symptoms increased, suggesting that parenting had a greater influence on emotional outcomes when ADHD symptoms were less pronounced. Longitudinally, ADHD symptoms at age 7 amplified the effects of withdrawn parenting at age 5 on peer problems at age 11, highlighting the compounding risk of elevated ADHD symptoms and early parenting challenges on later social functioning. In z-proso, cross-sectionally at age 9, ADHD symptoms did not moderate the effects of positive or negative parenting on anger. Longitudinally, anger at age 9 mediated the association between ADHD symptoms at age 7 and both aggressive and competent conflict coping at age 11, identifying emotional reactivity as a key developmental mechanism linking early ADHD symptoms to later behavioural adjustment. Findings across both cohorts showed that parenting practices and ADHD symptoms interact to influence emotion dysregulation, anger, and social difficulties in middle childhood. Anger emerged as a distinct emotional process, reinforcing its unique role in social challenges. The results highlight the need for culturally sensitive interventions that address both parenting and emotion regulation to improve outcomes for children with ADHD symptoms.

Umbrella reviews, or overviews of reviews, synthesize information using systematic reviews (SRs) as their unit of analysis. Although a formal guideline exists for reporting umbrella reviews of healthcare interventions (i.e. Preferred Reporting Items for Overviews of Reviews [PRIOR]), no formal guideline exists for conducting and/or reporting umbrella reviews of observational studies that examine epidemiological associations. To review the existing guidance on conducting and/or reporting umbrella reviews of observational studies on epidemiological associations, as part of the process of developing a formal reporting guideline. We reviewed the scoping review conducted in the context of PRIOR development and identified documents through forward citation search in PubMed, Scopus, and manual search in Google Scholar, Google Search up to December 22, 2024. Documents, regardless of format, were included if they provided guidance for conducting and/or reporting umbrella reviews of observational studies (including meta-research studies of their features). Title/abstract screening and data extraction were performed independently and in duplicate and summarized narratively by stages of the umbrella review process. The search retrieved 4491 unique records, with 96 full texts assessed and eight documents included. These documents, published between 2014 and 2023, offered guidance across seven topic areas, but overall guidance on conducting and/or reporting is limited. These areas include the answerable questions, prerequisite considerations, the scope of umbrella reviews, searching for SRs, primary data collection, analysis, presentation, and assessing the certainty/quality of the body of evidence. There is a need for dedicated, practical, and evidence-based formal reporting guidelines for umbrella reviews of observational studies on epidemiological associations. This review lays the groundwork for developing the PRIOR-extension for such studies: the Preferred Reporting Items for Umbrella Reviews of Cross-sectional, Case-control, and Cohort Studies.

Pregnancy complications have been associated with offspring autism spectrum disorders (ASD). There has also been increasing evidence for multigenerational risk factors of ASD. In a multigenerational California birth cohort of 1,740,379 mother-child pairs, we investigated pregnancy complications when the grandmother was pregnant with the mother's generation and their associations with ASD in grandchildren. We estimated odds ratios (ORs) and 95% CIs using logistic regression. The odds of ASD in grandchildren were higher among grandmothers who experienced pregnancy hypertensive disorders (OR, 1.23; 95% CI, 1.12-1.36) or infections (OR, 1.14; 95% CI, 1.01-1.28) compared to grandmothers who did not have the respective condition in pregnancy. The odds of ASD in grandchildren were also higher among mothers born prematurely (OR, 1.06; 95% CI, 1.02-1.11) compared to mothers born at term and elevated among mothers born with low birth weight (OR, 1.05; 95% CI, 1.00-1.11) compared to mothers with normal birth weight. ASD risk in grandchildren is higher among grandmothers who experienced hypertensive disorders or infections when pregnant with their daughters. Future studies are needed to explore the biologic underpinnings of possible multigenerational mechanisms.

Externalising behaviours are among the most common childhood mental health problems and have been linked to numerous adverse psychosocial outcomes including antisocial behaviour and depression. Parental negativity (PNeg) and child behaviours have been shown to mutually influence each other, leading to coercive cycles of negative behaviour over time. Interrupting these negative cycles is a common target for clinical intervention but little is known about what factors moderate these cycles over time in the general population. Using data on 9943 families from The Avon Longitudinal Study of Parents and Children across ages 4, 7 and 8, we explored the reciprocal associations between PNeg and externalising behaviour and tested whether they differed as a function of high versus low parent-reported interpersonal social support and neighbourhood social cohesion. Using random-intercept cross-lagged panel models, we found bidirectional associations between PNeg and child externalising behaviour across ages 7 to 8 (&#x3b2;s&#xa0;=&#xa0;0.13-0.15) but not ages 4 to 7 (&#x3b2;s&#xa0;=&#xa0;0.01-0.03). Moreover, we did not find evidence of moderation of any of the cross-lagged paths by social support or neighbourhood cohesion. Parent-reported interpersonal social support and neighbourhood social cohesion do not appear to play a role in interrupting negative parent-child interaction cycles in the general population.

Adolescents who have had an acquired brain injury (ABI) commonly experience depression. Brief Behavioural Activation (Brief BA) is a successful, values-based intervention for managing depression in neurotypical adolescents. This study investigated the effectiveness of Brief BA, using a single-case experimental design, with adolescents experiencing depression following ABI. Five adolescents, one male and four female, aged 14-17&#xa0;years and with ABI, completed a 6-week course of Brief BA. The primary outcome measures were mean daily activity scores out of 10 for 'achievement', 'closeness' and 'enjoyment' (mean achievement, closeness and enjoyment scores; MACES). MACES were collected daily for 9&#xa0;weeks, comprising at least 2&#xa0;weeks at baseline and at least 6&#xa0;weeks during the intervention. Secondary outcome measures of depression, quality of life (QoL), and participation were collected once at baseline, immediately post-treatment, and at a 4-week follow-up. Two participants showed a significant increase in enjoyment scores and one participant showed a significant increase in closeness scores. No other significant differences were noted for MACES. All participants reported significant reliable improvement in depression scores at their follow-up sessions, with three showing clinically significant improvement. Three participants reported reliable improvement in QoL. All parents reported reliable improvement in participants' depression and QoL scores. No significant changes were noted for participation scores. The significant changes in closeness and enjoyment scores following intervention suggest Brief BA may encourage positive behavioural change for adolescents with depression following ABI. Discussions explore the potential role of insight through linking valued activities with mood and positive reinforcement, leading to an improvement on depression and QoL outcomes. Charities and services providing low-intensity interventions might want to consider trialling Brief BA for this population. Future research suggestions, such as investigating Brief BA for depression linked with more diverse neurological conditions, are discussed.

Understanding attention deficit/hyperactivity disorder (ADHD) medication patterns is crucial for optimizing treatment outcomes. There are limited data on racial, ethnic, gender and socioeconomic treatment differences across longitudinal national samples. Secondary data analysis of baseline through 3rd-year follow-up (2016-2020) data from the Adolescent Brain Cognitive Development Study (ABCD) (N&#xa0;=&#xa0;11,875). Data were collected from 21 US sites, to reflect national demographic diversity. Complete case panel included 9708 children aged 9/10 at baseline and 12/13 at 3rd-year follow up. Sociodemographic factors (sex, race, ethnicity, household income), ADHD medication use (stimulants and non-stimulants), and ADHD severity were examined. By the 3rd-year follow-up, 13% of children used ADHD medications. Females were more likely to never have received medications compared to males (92% vs. 82%, odds ratio [OR] 2.34, 95% confidence interval [CI] 2.05-2.67, p&#xa0;<&#xa0;0.001). Females exhibited lower mean ADHD severity scores, though the difference diminished over time. Asian (95% vs. 87%, OR 2.83, 95% CI 1.41-5.38, p&#xa0;<&#xa0;0.001) and Hispanic children (90% vs. 86%, OR 1.39, 95% CI 1.17-1.64, p&#xa0;<&#xa0;0.001) were more likely to have never received medications compared to White and non-Hispanic children. Black children were more likely to discontinue medications (9% vs. 5%, OR 1.84, 95% CI 1.45-2.33, p&#xa0;<&#xa0;0.001) compared to White children, although this was not significant after adjusting for sociodemographic factors. Children in lower income households were more likely to have clinically significant ADHD but less likely to receive and remain on medications compared to those from higher income households. Significant differences exist in ADHD medication use patterns among US children based on sex, race, ethnicity, and socioeconomic status. Addressing these differences is essential to ensure equitable access to treatment.

This Swedish nationwide cohort study used large-scale data to investigate the associations between bipolar disorder and somatic disorders and whether these risks differ by subtype, sex, or exposure to compulsory care. 61,071 individuals diagnosed with bipolar disorder in inpatient (from 1973) or outpatient care (from 2001) care were compared with the general population without bipolar disorder. The cohort included individuals born in 1932 or later, with follow-up from 1973 to 2020. Cox regression models estimated associations with a range of somatic conditions, including cardiovascular, endocrine, neurological, and infectious diseases. Subtype-specific analyses were conducted in individuals with type 1 (n&#x2009;=&#x2009;8,352) or type 2 (n&#x2009;=&#x2009;9,674), and in those with a history of compulsory care (n&#x2009;=&#x2009;6,748). Bipolar disorder was associated with significantly increased risks for most examined somatic conditions. The highest hazard ratios (HRs) were observed for sleep disorders (HR 3.79; 95% CI, 3.71-3.87) and dementias (HR 4.32; 95% CI, 3.82-4.79). Type 2 diabetes risk was elevated, while no association was found for type 1 diabetes. Most risks were comparable across bipolar subtypes, though certain conditions-such as migraine and fibromyalgia-were more strongly associated with type 2. Individuals with a history of compulsory psychiatric care showed elevated risks for several conditions. Regardless of sex or subtype, bipolar disorder is associated with substantially higher lifetime risks of a broad range of somatic conditions. Integrated psychiatric and somatic health care may help reduce morbidity and improve outcomes.

[This corrects the article DOI: 10.1002/jcv2.12295.].

Family research in child and adolescent mental health has often been framed as if influence runs mainly from adults to children. Bj&#xf8;rndal et&#xa0;al. provide a timely corrective. Using longitudinal network models that separate within-person from between-person associations, they show that adolescent mental health difficulties and family dynamics are interrelated over time, and that emotional symptoms may precede later hyperactivity/inattention and sibling problems. Their findings also point to reinforcing loops within the family system, particularly between low family support and negative feelings towards the family. This matters because family members are not merely environmental exposures; they are genetically correlated social environments, and children can shape parental and sibling dynamics as well as be shaped by them. Distinguishing between variables with stronger outgoing and ingoing influence may help refine which intervention hypotheses should be prioritized, and which should be discarded or treated more cautiously.

Genetic risk factors, impulsivity, and exposure to painful and provocative events (PPEs) have each been linked with risk for suicide attempt (SA). However, the degree to which genetic associations with SA are mediated by dimensions of impulsivity and PPEs remains unexplored, particularly in early adolescence. Participants were 6402 individuals (52.0% male, 48.0% female, 72.3% European ancestry, 27.7% African ancestry, mean age at baseline&#xa0;=&#xa0;9.47&#xa0;years, SD&#xa0;=&#xa0;0.51&#xa0;years) from the Adolescent Brain Cognitive Development (ABCD) Study. Genetic liability for SA was measured using polygenic scores and family history density scores. Multiple dimensions of impulsivity were assessed using self-report measures and laboratory tasks, and potential PPEs included injuries, traumatic events, non-suicidal self-injury, and operations. A series of mediation models was specified to evaluate whether genetic associations with SA risk were mediated by impulsivity and PPE exposure. Separate models were tested in adolescents of European and African ancestry. Sex, age, socioeconomic factors, and depressive symptoms were included as covariates. Genetic liability for SA was largely unrelated to impulsivity, PPE exposure, and SA risk ( | &#x3b2; | &#xa0;=&#xa0;0.00-0.34). In addition, there was little support for the hypothesis that more impulsive individuals are more likely to experience PPEs, with the exception that urgency and low conscientiousness were significantly related to non-suicidal self-injury ( | &#x3b2; | &#xa0;=&#xa0;0.09-0.19). Several dimensions of impulsivity and two PPEs (non-suicidal self-injury and traumatic events) were related to increased risk for SA ( | &#x3b2; | &#xa0;=&#xa0;0.32-0.76). Impulsivity and PPEs each contribute to risk for SA. However, there is little support for the hypothesis that genetic influences on SA are mediated by impulsivity and PPE exposure in early adolescence.