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Working Memory Mediates Increased Negative Affect and Suicidal Ideation in Childhood Attention-Deficit/Hyperactivity Disorder

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Abstract

Children with attention-deficit/hyperactivity disorder (ADHD) are at greater risk for suicidal ideation and suicide attempts compared to those without ADHD. Increased risk is at least partially attributable to a subset of children with ADHD and comorbid depression or disruptive behavior disorders; however, the early predictors and mechanisms driving increased risk are not well understood. Here, we investigate the contributions of two candidate mechanisms for increased suicidal ideation in children with ADHD: executive function and negative affect. 623 clinically well-characterized, community-recruited children classified by research criteria as ADHD (n = 388) or typically-developing controls (n = 253) participated. Parent-report on the Temperament in Middle Childhood Questionnaire provided a measure of negative affectivity. Children completed laboratory tasks to measure response inhibition and working memory. Suicidal ideation was evaluated by parent report during a semi-structured interview and child responses on the Children’s Depression Inventory. Compared to typically developing controls, children with ADHD had higher rates of suicidal ideation, more negative affect, slower stop signal reaction times, and weaker working memory. Statistical path-model analyses confirmed the hypothesis that weaker working memory in ADHD statistically mediated increased negative affect. Weaker working memory also mediated and increased suicidal ideation in these cross sectional data. Findings were not attributable to comorbid disruptive behavioral disorders. Poor response inhibition did not reliably mediate negative affect or suicidal ideation. Impairment in working memory is an important early risk factor for suicidal ideation in children with ADHD, and may help in identifying children for prevention and early intervention efforts.

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Acknowledgements

We thank Elisabeth Nousen and Andrew Bontemps with data collection and preparation. We gratefully acknowledge the participants and their caregivers, as well as the graduate students, staff, and research assistants whose remarkable dedication has made this research possible.

Funding

This work was supported by NIMH R37–59105 (PI: Nigg).

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Authors and Affiliations

  1. University of Southern Mississippi, 118 College Drive #5025, Hattiesburg, MS, 39406, USA

    Brian W. Bauer

  2. Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Multnomah Pavilion, Suite 1513, UHN-80R1, Portland, OR, 97239, USA

    Hanna C. Gustafsson, Joel Nigg & Sarah L. Karalunas

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  1. Brian W. Bauer
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  2. Hanna C. Gustafsson
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  3. Joel Nigg
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  4. Sarah L. Karalunas
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Correspondence to Brian W. Bauer.

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Brian Bauer, Hanna Gustafsson, Joel Nigg, and Sarah Karalunas declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Bauer, B.W., Gustafsson, H.C., Nigg, J. et al. Working Memory Mediates Increased Negative Affect and Suicidal Ideation in Childhood Attention-Deficit/Hyperactivity Disorder. J Psychopathol Behav Assess 40, 180–193 (2018). https://doi.org/10.1007/s10862-017-9635-5

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