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1.  Heavy Alcohol Use in Early Adulthood as a Function of Childhood ADHD: Developmentally-Specific Mediation by Social Impairment and Delinquency 
Frequent heavy drinking in early adulthood, particularly prior to age 21, is associated with multiple health and legal consequences including continued problems with drinking later into adulthood. Children with Attention-Deficit/Hyperactivity Disorder (ADHD) are at risk of alcohol use disorder in adulthood, but little is known about their frequency of underage drinking as young adults or about mediational pathways that might contribute to this risky outcome. The current study used data from the Pittsburgh ADHD Longitudinal Study (PALS) to test social impairment and delinquency pathways from childhood ADHD to heavy drinking in early adulthood for individuals with (n=148) and without (n=117) childhood ADHD. Although ADHD did not predict heavy drinking, indirect mediating effects in opposing directions were found. A delinquency pathway from childhood ADHD to increased heavy drinking included adolescent and subsequently adult delinquent behavior. A social impairment pathway from childhood ADHD to decreased heavy drinking included adolescent, but not adult, social impairment. These findings help to explain the heterogeneity of results for alcohol use among individuals with ADHD and suggest that common ADHD-related impairments may operate differently from each other and distinctly across developmental periods.
PMCID: PMC4068123  PMID: 24611838
2.  Longitudinal Disparities of Hazardous Drinking between Sexual Minority and Heterosexual Individuals from Adolescence to Young Adulthood 
Sexual minority (lesbian and gay, bisexual, mostly heterosexual) individuals are at an increased risk for hazardous drinking than heterosexual individuals, but little is known about the nature of the disparities as adolescents reach adulthood. We used four waves of a nationally representative data set, the National Longitudinal Study of Adolescent Health (Add Health), to examine disparities of hazardous drinking outcomes between sexual minority and heterosexual men and women from adolescence to young adulthood. Participants were 14 to 18 years old at the first assessment (N = 12,379; 53% female) and 27 to 31 years old at the fourth assessment. At the fourth assessment, 13% self-identified as sexual minority individuals, 16% were Hispanic, and 36% were of minority race, including primarily African Americans (60%) and Asian Americans (18%). There were clear hazardous drinking disparities between sexual minority individuals and heterosexual individuals over time. During adolescence, sexual minority individuals, particularly females, reported higher levels of hazardous drinking. As study participants reached adulthood, the magnitude of the hazardous drinking disparities increased among sexual minorities, sexual minority men in particular. Additional research is needed to better understand the developmental mechanisms that underlie the emerging sexual orientation related disparities of hazardous drinking in young adulthood.
PMCID: PMC4109154  PMID: 23325141
bisexual; gay; lesbian; longitudinal; hazardous drinking; alcohol
3.  Childhood ADHD and Growth in Adolescent Alcohol Use: The Roles of Functional Impairments, ADHD Symptom Persistence, and Parental Knowledge 
Journal of abnormal psychology  2012;121(4):922-935.
Research on the relation between childhood Attention-Deficit/Hyperactivity Disorder (ADHD) and adolescent alcohol use has found mixed results. Studies are needed that operationalize alcohol use in developmentally appropriate ways and that test theoretically plausible moderators and mediators in a longitudinal framework. The current study tested childhood ADHD as a predictor of alcohol use frequency at age 17, and age-related increases in alcohol use frequency, through adolescence for 163 adolescents with ADHD diagnosed in childhood and 120 adolescents without ADHD histories. Childhood ADHD did not predict either alcohol outcome. However, parental knowledge of the teen’s friendships, activities, and whereabouts moderated the association such that childhood ADHD predicted alcohol use frequency at age 17 when parental knowledge was below median levels for the sample. Mediational pathways that explained this risk included social impairment, persistence of ADHD symptoms, grade point average, and delinquency. Social impairment was positively associated with alcohol use frequency through delinquency; it was negatively associated with alcohol use frequency as a direct effect independent of delinquency. These nuanced moderated-mediation findings help to explain previously inconsistent results for the ADHD-adolescent alcohol use association. The findings also imply that future research and intervention efforts should focus on ADHD-related social and academic impairments as well as symptom persistence and parenting efforts.
PMCID: PMC4128089  PMID: 22845650
ADHD; attention deficit; alcohol; adolescence; parenting
4.  Trajectories of Depressive Symptoms and Suicidality among Heterosexual and Sexual Minority Youth 
Journal of youth and adolescence  2013;42(8):1243-1256.
Sexual minority youth report higher rates of depression and suicidality than do heterosexual youth. Little is known, however, about whether these disparities continue as youth transition into young adulthood. The primary goals of this study were to describe and compare trajectories of adolescent depressive symptoms and suicidality among sexual minority and heterosexual youth, examine differences in depressive symptoms and suicidality trajectories across sexual orientation subgroups, and determine whether there are gender differences in these longitudinal disparities. Four waves of data from the National Longitudinal Study of Adolescent Health were analyzed using latent curve modeling (N = 12,379; 53% female). Results showed that the rates of depressive symptoms and suicidality in early adolescence were higher among sexual minority youth than among heterosexual youth, and that these disparities persisted over time as participants transitioned into young adulthood. Consistent with previous cross-sectional studies, the observed longitudinal disparities were largest for females and for bisexually-identified youth. Sexual minority youth may benefit from childhood and early adolescent prevention and intervention programs.
PMCID: PMC3744095  PMID: 23784511
sexual minority youth; lesbian; gay; and bisexual youth; sexual orientation; depressive symptoms; suicidality; trajectories; latent growth curve modeling
5.  Dimensions of callousness in early childhood: Links to problem behavior and family intervention effectiveness 
Development and psychopathology  2013;25(2):347-363.
This study examined dimensions of callous behaviors in early childhood and the role of these behaviors in the development of conduct problems, as well as responsiveness to a family-centered preventative intervention. Caregiver reports of callous behaviors were examined using exploratory and confirmatory factor analysis. Problem behavior was examined using within- and cross-informant reports of these behaviors. Parenting was measured using observational methods within the context of a randomized control trial of the Family Check-Up with a sample of 731 ethnically diverse boys and girls (followed from age 2 to 4) at high risk for later conduct problems. Results demonstrated that a measure of deceitful-callous (D-C) behaviors had acceptable factor loadings and internal consistency at ages 3 and 4. D-C behaviors at age 3 predicted problem behavior concurrently and longitudinally within and across informant. However, D-C behaviors did not reduce the effectiveness of the family preventative intervention. These findings have implications for our understanding of behaviors that may precede later callous-unemotional traits and for our understanding of the development and prevention of early starting conduct problems.
PMCID: PMC3641705  PMID: 23627949
Externalizing; Callous-Unemotional Traits; Conduct Problems; Early Childhood; Intervention
6.  Young Adult Educational and Vocational Outcomes of Children Diagnosed with ADHD 
Decreased success at work and educational attainment by adulthood are of concern for children with ADHD given their widely documented academic difficulties; however there are few studies that have examined this empirically and even fewer that have studied predictors and individual variability of these outcomes. The current study compares young adults with and without a childhood diagnosis of ADHD on educational and occupational outcomes and the predictors of these outcomes. Participants were from the Pittsburgh ADHD Longitudinal Study (PALS), a prospective study with yearly data collection. Significant group differences were found for nearly all variables such that educational and occupational attainment was lower for adults with compared to adults without histories of childhood ADHD. Despite the mean difference, educational functioning was wide-ranging. High school academic achievement significantly predicted enrollment in post-high school education and academic and disciplinary problems mediated the relationship between childhood ADHD and post-high school education. Interestingly, ADHD diagnosis and disciplinary problems negatively predicted occupational status while enrollment in post-high school education was a positive predictor. Job loss was positively predicted by a higher rate of academic problems and diagnosis of ADHD. This study supports the need for interventions that target the child and adolescent predictors of later educational and occupational outcomes in addition to continuing treatment of ADHD in young adulthood targeting developmentally appropriate milestones, such as completing post-high school education and gaining and maintaining stable employment.
PMCID: PMC3505256  PMID: 22752720
ADHD; young adult; education; employment; longitudinal outcomes
7.  Risk of Intimate Partner Violence among Young Adult Males with Childhood ADHD 
Journal of Attention Disorders  2011;16(5):373-383.
Research has clearly documented the social dysfunction of youth with attention-deficit hyperactivity disorder (ADHD). However, little is known about the interpersonal relationships of adults diagnosed with ADHD in childhood, including rates of intimate partner violence (IPV).
Using data from the Pittsburgh ADHD Longitudinal Study, analyses compared the level of IPV (verbal aggression, violence) reported by young adult (18-25 year-old) males with childhood ADHD (n=125) to reports by demographically-similar males without ADHD histories (n=88).
Males with childhood ADHD, especially those with conduct problems persisting from childhood, were more likely to be verbally aggressive and violent with romantic partners than males without histories of ADHD or conduct problems.
Research is needed to replicate these findings, to explore potential mechanisms, and to develop effective interventions for romantic relationship discord among young adults with ADHD histories, especially those with persistent conduct problems.
PMCID: PMC3272093  PMID: 22044962
8.  Attention-Deficit Hyperactivity Disorder Moderates the Life Stress Pathway to Alcohol Problems in Children of Alcoholics 
Parent alcoholism is a well-established risk factor for the development of pathological alcohol involvement in youth, and life stress is considered to be one of the central mechanisms of the parent alcoholism effect; however, little is known about the moderators of the life stress pathway. Attention-deficit hyperactivity disorder (ADHD) has also been shown to predict pathological alcohol involvement, however, little is known about whether or not ADHD interacts with parent alcoholism to increase offspring risk. The goals of this study were to examine stressful life events as mediators of the relationship between parent alcoholism and adolescent pathological alcohol involvement, and to examine whether or not this mediated pathway was stronger for adolescents with ADHD than for adolescents without ADHD.
Participants were 142 adolescents with a childhood ADHD diagnosis (probands) and 100 demographically matched control adolescents without childhood ADHD. Probands, controls, and at least 1 parent were interviewed about drinking behavior; probands and controls were interviewed about negative life events.
A moderated mediation paradigm was used to test the hypotheses using ordinary least squares regression. Results showed that the relationships between parent alcoholism and 2 of the stress variables (“family” stress and “peer” stress) were significant for probands only, and that stress in the probands mediated the parent alcoholism effect on offspring alcohol involvement.
These results provide preliminary support for the hypothesis that offspring characteristics might moderate the life stress pathway to alcoholism, and indicate that ADHD may serve to facilitate the transmission of pathological alcohol use from parent to child.
PMCID: PMC3649116  PMID: 17374035
Parent Alcoholism; ADHD; Stress; Adolescence; Mediation
9.  Motorsports Involvement among Adolescents and Young Adults with Childhood ADHD 
Though children with attention-deficit/hyperactivity disorder (ADHD) are at risk for impulsive, health-endangering behavior, few studies have examined non-substance use-related risk-taking behaviors. This study examined whether adolescents and young adults with ADHD histories were more likely than those without ADHD histories to report frequent engagement in motorsports, a collection of risky driving-related activities associated with elevated rates of physical injury. Path analyses tested whether persistent impulsivity, comorbid conduct disorder or antisocial personality disorder (CD/ASP), and heavy alcohol use mediated this association. Analyses also explored whether frequent motorsporting was associated with unsafe and alcohol-influenced driving.
Two-hundred and twenty-one adolescent and young adult males (16–25 years-old) diagnosed with ADHD in childhood and 139 demographically-similar males without ADHD histories reported their motorsports involvement. Persistent impulsivity, CD/ASP, heavy drinking, and hazardous driving were also measured in adolescence/young adulthood1
Adolescents and young adults with ADHD histories were more likely to report frequent motorsports involvement than those without childhood ADHD. Impulsivity, CD/ASP and heavy drinking partially mediated this association, such that individuals with ADHD histories, who had persistent impulsivity or CD/ASP diagnoses, were more likely to engage in heavy drinking, which was positively associated with frequent motorsporting. Motorsports involvement was associated with more unsafe and alcohol-influenced driving, and this association was more often found among those with, than without, ADHD histories.
Adolescents and young adults with ADHD histories, especially those with persisting impulsivity, comorbid CD/ASP and heavy drinking tendencies, are more likely to engage in motorsports, which may heighten risk of injury.
PMCID: PMC3587661  PMID: 23347139
10.  Substance Use and Delinquency among Adolescents with Childhood ADHD: The Protective Role of Parenting 
Several domains of parenting have been identified as important for adolescent well-being. Whether these same domains are equally beneficial for adolescents with ADHD histories remains an empirical and clinically important question. This study examined whether parental knowledge of their teen’s activities and whereabouts, consistency, support, and parent-adolescent conflict are associated with substance use and delinquency similarly for adolescents with and without a diagnosis of ADHD in childhood. A sample of 242 adolescents, 142 diagnosed with ADHD in childhood and prospectively followed into adolescence, and 100 without ADHD in childhood, were the focus of study. The relations between adolescent-reported outcomes (i.e. substance use and delinquency) and parenting behaviors were tested using latent variable modeling to determine both the effects of general (common) and specific (unique) parenting behaviors for participants with and without a history of ADHD. Adolescents’ report of parental knowledge was a significant correlate of delinquency and substance use above and beyond other parenting variables and the variance in common across the parenting variables. More knowledge was associated with less delinquency and substance use for all participants, but parental knowledge was more strongly associated with alcohol use for adolescents with versus without childhood ADHD. These correlational findings suggest that, despite the increased difficulty of parenting youths with ADHD histories, actions taken by parents and youth to increase parental awareness may provide some protection against behavioral transgressions known to be elevated in this population.
PMCID: PMC3355197  PMID: 22329747
11.  Investigating Ethnic Differences in Adolescent Alcohol Use and Peer Norms Using Semi-Continuous Latent Growth Models 
Aims: To investigate whether ethnic differences in vulnerability to peer norms supportive of alcohol use is a viable, partial explanation for the ethnic differences in reported prevalence and amount of alcohol use during high school. Methods: Survey data from a sample of 680 adolescents from Project STAR (Students Taught Awareness and Resistance) of the Midwestern Prevention Project were used. Hypotheses were tested using sequential, semi-continuous growth curve models. Results: Relative to Black adolescents, White adolescents reported greater peer alcohol use during middle school and were much more likely to consume alcohol during high school. General peer norms in seventh grade and middle school growth in alcohol use norms among close friends was predictive of a greater propensity to consume alcohol in ninth grade among White adolescents. Conclusion: Lower peer norms for alcohol use among Black adolescents might better account for differences between Black and White adolescents than the possibility that White adolescents are more vulnerable to peer norms.
PMCID: PMC3156885  PMID: 21478496
12.  Citalopram Improves Metabolic Risk Factors Among High Hostile Adults: Results of a Placebo-Controlled Intervention 
Psychoneuroendocrinology  2011;36(7):1070-1079.
Hostility is associated with a number of metabolic risk factors for cardiovascular disease, including waist-hip ratio, glucose, and triglycerides. Along with hostility, many of these measures have also been shown to be associated with reduced central serotonergic function. We have previously reported that a citalopram intervention was successful in reducing hostility by self-report assessment (Kamarck, et al., 2009). Here we examine the effects of this serotonergic intervention on metabolic risk factors in the same sample. 159 healthy adults with elevated hostility scores were randomized to citalopram or placebo for a 2-month period. Citalopram favorably changed metabolic risk factors, including waist circumference (p = .003), glucose (p=.02), HDL cholesterol (p= .04), triglycerides (p=.03), insulin sensitivity (p = .045) and diastolic blood pressure by automated assessment (p = .0021). All of these metabolic changes were significantly mediated by treatment-related changes in body mass index (in most cases, p < .01). In addition, the changes in blood glucose were significantly mediated by treatment-related changes in hostility (p < .05). Mechanisms accounting for these associations remain to be explored.
PMCID: PMC3118402  PMID: 21306829
hostility; citalopram; metabolic syndrome; randomized clinical trial; ssri; glucose
13.  Behavioral Control in At-Risk Toddlers: The Influence of the Family Check-up 
This study examines the role of one component of emotion regulation, behavioral control, in the growth of children’s early behavior problems by examining whether increases in parental positive behavior support brought about by a family-centered intervention were associated with greater child behavioral control, and whether greater behavioral control at age 3 mediated the association between improvements in aspects of positive behavior support from ages 2 to 3 and decreases in growth of behavior problems from ages 2 to 4. The sample included 713 at-risk children (50% female) and their primary caregivers (50% European American, 28% African American, 13% biracial, 9% other) who were randomly assigned to the intervention or control group. Children had a mean age of 29.91 months at the initial assessment. Data were collected through home visits at child ages 2 to 4, which involved questionnaires for primary caregivers and structured and unstructured play activities for children with primary and alternative caregivers and siblings. Results indicated that the intervention improved parental positive behavior support and reduced growth of child behavior problems. One dimension of positive behavior support, proactive parenting, was modestly associated with behavioral control at age 3, which in turn was significantly associated with growth in behavior problems from ages 2 to 4, with greater behavioral control related to lower levels of growth in behavior problems. Results provide support for the notion that proactive parenting is an important factor in the development of children’s behavioral control and that behavioral control plays an important role in the growth of behavior problems.
PMCID: PMC3409090  PMID: 22494145
14.  Adolescent Dispositions for Antisocial Behavior in Context: The Roles of Neighborhood Dangerousness and Parental Knowledge 
Journal of abnormal psychology  2009;118(3):564-575.
This study examined an ecological perspective on the development of antisocial behavior during adolescence, examining direct, additive, and interactive effects of child and both parenting and community factors in relation to youth problem behavior. To address this goal, early adolescent dispositional qualities were examined as predictors of boys' antisocial behavior within the context of parents' knowledge of adolescent activities and neighborhood dangerousness. Antisocial behavior was examined using a multi-method latent construct that included self-reported delinquency, symptoms of conduct disorder, and court petitions in a sample of 289 boys from lower socioeconomic status backgrounds who were followed longitudinally from early childhood through adolescence. Results demonstrated direct and additive findings for child prosociality, daring, and negative emotionality that were qualified by interactions between daring and neighborhood dangerousness, and between prosociality and parental knowledge. The findings have implications for preventive intervention approaches that address the interplay of dispositional and contextual factors to prevent delinquent behavior in adolescence.
PMCID: PMC2846381  PMID: 19685953
15.  Investigation of Mediational Processes Using Parallel Process Latent Growth Curve Modeling 
This study investigated a method to evaluate mediational processes using latent growth curve modeling. The mediator and the outcome measured across multiple time points were viewed as 2 separate parallel processes. The mediational process was defined as the independent variable influencing the growth of the mediator, which, in turn, affected the growth of the outcome. To illustrate modeling procedures, empirical data from a longitudinal drug prevention program, Adolescents Training and Learning to Avoid Steroids, were used. The program effects on the growth of the mediator and the growth of the outcome were examined first in a 2-group structural equation model. The mediational process was then modeled and tested in a parallel process latent growth curve model by relating the prevention program condition, the growth rate factor of the mediator, and the growth rate factor of the outcome.
PMCID: PMC2821108  PMID: 20157639
16.  Gay-related Development, Early Abuse and Adult Health Outcomes Among Gay Males 
AIDS and behavior  2007;12(6):891-902.
This study examined relationships between timing of gay-related developmental milestones, early abuse, and emergence of poor health outcomes in adulthood among 1,383 gay/bisexual men in the Urban Men’s Health Study. Latent Profile Analysis grouped participants as developing early, middle or late based on the achievement of four phenomena including age of first awareness of same-sex sexual attractions and disclosure of sexual orientation. Participants who developed early were more likely, compared to others, to experience forced sex and gay-related harassment before adulthood. They were more likely to be HIV seropositive and experience gay-related victimization, partner abuse and depression during adulthood. Early forced-sex, gay-related harassment and physical abuse were associated with several negative health outcomes in adulthood including HIV infection, partner abuse, and depression. This analysis suggests that the experience of homophobic attacks against young gay/bisexual male youth helps to explain heightened rates of serious health problems among adult gay men.
PMCID: PMC2680076  PMID: 17990094
HIV; Homosexuality; Abuse; Psychosexual development
17.  Polymorphisms in the CRP gene moderate an association between depressive symptoms and circulating levels of C Reactive Protein 
Brain, behavior, and immunity  2009;24(1):160-167.
Although many studies have found psychological depression associated with higher circulating levels of C-reactive protein (CRP), not all findings are consistent. Since DNA sequence variation in the CRP gene has also been shown to predict plasma CRP levels, we hypothesized that plasma CRP may covary with depressive symptomatology as a function of allelic variation in the CRP gene. We tested this hypothesis in 868 healthy community volunteers of European ancestry. Depressive symptomatology was measured using the Center for Epidemiological Studies – Depression (CESD) scale, and plasma CRP was assayed from whole blood. Three polymorphisms [rs1417938 (A/T), rs1800947 (C/G) and rs1205 (C/T)] were genotyped and three-locus haplotypes were generated. Regression models adjusting for demographic and lifestyle-related covariates showed no direct association of CESD depression scores with CRP. In regression models adjusting for age, gender, education, smoking status and statin use, one CRP haplotype (T-G-C) was associated with CRP level (p = 0.014) and a second haplotype (A-G-T) showed marginal association (p=0.064 respectively). Neither haplotype was related to depressive symptoms. However, plasma CRP was predicted by the interaction of A-G-T haplotype with depressive symptomatology (p = 0.009). Higher CESD scores were associated positively with CRP levels among individuals with the A-G-T haplotype (p = 0.004). In secondary analyses, body mass index was found to partially account for the moderating effects of the A-G-T haplotype on the association of depression with circulating CRP. In conclusion, we found that haplotypic variation in the CRP locus moderates an association of depressive symptoms with circulating CRP, which is partially mediated by BMI.
PMCID: PMC3074460  PMID: 19796676
CRP; depression; inflammation; genotypes; haplotypes; interaction

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