Edmund Sonuga-Barke’s research while affiliated with King's College London and other places

Introduction Early life exposure to adversity and stress has been shown to sensitize young people to later negative life events (LEs), leading to increased susceptibility to mental health problems. We explored this question by testing whether exposure to severe institutional deprivation moderated the effect of adolescent exposure to LE on early adult depression and anxiety. To test the specificity of these effects, we contrasted the effects on these outcomes with neuro-developmental problems (autism and disinhibited social engagement), known from previous studies to be associated with deprivation from early childhood. Methods Participants were 170 adoptees from the English and Romanian Adoptees study. Of these, 124 (66 females) grew up as infants and small children in severely depriving Romanian orphanages before being adopted into UK families before the age of 43 months. The remainder were UK adoptees (16 females) with no history of deprivation who were placed before the age of 6 months. For this analysis, data on emotional problems, autism, and disinhibited social engagement were used at both age 15 years and in early adulthood (23–25 years) using standardized questionnaire and interview measures. Exposure to independent, dependent, and peer-related LE was measured at age 15 years. Results In all models, there were continuities in all outcomes between adolescence and adulthood (ps < .05). Dependent LE had a main effect on emotional symptoms, with higher exposure to dependent LE predicting an increase in emotional symptoms between age 15 and young adulthood. For independent and dependent LE, there were no interactions between deprivation and LE. For peer-related LE, the interaction was significant for emotional problems, but not deprivation-specific problems (i.e., autism/disinhibited social engagement)—the group of individuals exposed to early extreme deprivation and elevated peer-related LE had elevated emotional problems. Discussion There was no evidence that early severe institutional deprivation increased susceptibility to depression and anxiety following exposure to independent or dependent LE in general. However, it appeared to sensitize adolescents to the effects of peer-related LE specifically. We discuss possible mechanisms by which difficulties in peer relations might influence the emergence of depression and anxiety to already vulnerable individuals.

Background Attention‐deficit/hyperactivity disorder (ADHD) is commonly attributed to neuro‐cognitive deficits of genetic and/or prenatal/perinatal environmental origins. Sonuga‐Barke proposed an alternative formulation, suggesting that ADHD behaviors are functional expressions of delay aversion—a strong motivational disposition to avoid or escape negative affective states evoked by delay. It is hypothesized that the strength of this disposition, though neuro‐biologically rooted, is exacerbated by early negative social interactions during waiting‐related encounters. This paper reports findings from an initial proof‐of‐concept study that specifically tests this hypothesis in a nonclinical sample. Methods Preschoolers (n = 112; mean age = 46.2 months) and their parents from London, UK, and Hong Kong participated in a longitudinal study. The Parent–Child Delay Frustration Task (PC‐DeFT) and two nonwaiting control tasks were administered at baseline. Children's performance, behavioral and emotional responses, and parents' reactions were observed. Teachers rated children's ADHD behaviors and delay aversion at baseline and follow‐up (12–18 months later). Results At baseline, children's maladaptive performance and parental negative reactions during the PC‐DeFT were correlated with each other and with teacher ratings of ADHD and delay aversion. Negative parental reactions during the PC‐DeFT at baseline predicted an increase in teacher‐rated ADHD behaviors at follow‐up, but similar associations were not observed for baseline parental responses in the nonwaiting tasks. The increase in child ADHD symptoms associated with negative parental reactions at baseline was statistically mediated by delay aversion. These longitudinal effects were consistent across the UK and HK samples. Conclusions The findings provide the first evidence that parent's negative reactions to preschooler's attempts to manage delay are associated with increases in ADHD behaviors overtime, and linked to delay aversion increases. They underscore the potential significance of the early social environment as a contributor to developmental trajectory of ADHD behaviors. Future studies with clinical samples over an extended time‐frame using a range of different aversive environments (i.e. difficult tasks to complete) are indicated.

Importance Neurofeedback has been proposed for the treatment of attention-deficit/hyperactivity disorder (ADHD) but the efficacy of this intervention remains unclear. Objective To conduct a meta-analysis of randomized clinical trials (RCTs) using probably blinded (ie, rated by individuals probably or certainly unaware of treatment allocation) or neuropsychological outcomes to test the efficacy of neurofeedback as a treatment for ADHD in terms of core symptom reduction and improved neuropsychological outcomes. Data Sources PubMed (MEDLINE), Ovid (PsycInfo, MEDLINE, Embase + Embase Classic), and Web of Science, as well as the reference lists of eligible records and relevant systematic reviews, were searched until July 25, 2023, with no language limits. Study Selection Parallel-arm RCTs investigating neurofeedback in participants of any age with a clinical ADHD or hyperkinetic syndrome diagnosis were included. Data Extraction and Synthesis Standardized mean differences (SMDs) with Hedges g correction were pooled in random effects meta-analyses for all eligible outcomes. Main Outcomes and Measures The primary outcome was ADHD total symptom severity assessed at the first postintervention time point, focusing on reports by individuals judged probably or certainly unaware of treatment allocation (probably blinded). Secondary outcomes were inattention and/or hyperactivity-impulsivity symptoms and neuropsychological outcomes postintervention and at a longer-term follow-up (ie, after the last follow-up time point). RCTs were assessed with the Cochrane risk of bias tool version 2.0. Results A total of 38 RCTs (2472 participants aged 5 to 40 years) were included. Probably blinded reports of ADHD total symptoms showed no significant improvement with neurofeedback (k = 20; n = 1214; SMD, 0.04; 95% CI, −0.10 to 0.18). A small significant improvement was seen when analyses were restricted to RCTs using established standard protocols (k = 9; n = 681; SMD, 0.21; 95% CI, 0.02 to 0.40). Results remained similar with adults excluded or when analyses were restricted to RCTs where cortical learning or self-regulation was established. Of the 5 neuropsychological outcomes analyzed, a significant but small improvement was observed only for processing speed (k = 15; n = 909; SMD, 0.35; 95% CI, 0.01 to 0.69). Heterogeneity was generally low to moderate. Conclusions and Relevance Overall, neurofeedback did not appear to meaningfully benefit individuals with ADHD, clinically or neuropsychologically, at the group level. Future studies seeking to identify individuals with ADHD who may benefit from neurofeedback could focus on using standard neurofeedback protocols, measuring processing speed, and leveraging advances in precision medicine, including neuroimaging technology.

Background There is a growing expectation that neurodivergent young people, such as those with diagnoses of attention‐deficit/hyperactivity disorder (ADHD) and/or autism, should play a central role in shaping research on neurodevelopmental conditions. However, currently, their involvement is typically limited to arms‐length advice. To address this, the Regulating Emotions‐Strengthening Adolescent Resilience (RE‐STAR) programme has co‐developed a framework for deepening the involvement of neurodivergent participants in translational research. Here we apply this to build, implement and evaluate a new approach to participatory qualitative research. Methods Development – Building on the track record of successful collaboration between RE‐STAR academic researchers (ARs) and its Youth Researcher Panel (Y‐RP), a cycle of meetings was convened to co‐develop a collaborative protocol for the participatory approach. Implementation – ARs and Y‐RPers applied the general protocol to study a specific topic. This involved co‐designing and co‐delivering an interview schedule to study the emotional experiences of 12 adolescents with diagnoses of ADHD and/or autism and then co‐analysing the interviews. Evaluation – ARs, Y‐RPers and interviewees shared their reflections on the participatory approach and its implementation, during interviews (N = 36) and short open‐ended surveys (N = 22). Results Development ‐ The protocol for the participatory approach gave detailed advice on how to engage Y‐RP members (or equivalent) in the co‐design, co‐delivery and co‐analysis of interviews. Implementation ‐ The approach was successfully implemented by ARs and Y‐RPers working together to co‐design an interview to study the emotional lives of adolescents with diagnoses of ADHD and/or autism, co‐deliver it and then co‐analyse the interview scripts. Evaluation ‐ The implementation experience of the Y‐RP, ARs and interviewees was characterised by common themes relating to (a) adapting research methods and making practical adjustments; (b) taking on new roles, adding value to research and (c) valuing neurodivergent characteristics. Conclusions This new RE‐STAR protocol proved feasible to implement in a way that was generally perceived, from multiple perspectives, to add depth and authenticity to research into the experiences of neurodivergent young people.

Background: 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 the two competing accounts for why this is the case. The first established notion is that depression risk associated with ADHD and/or autism is due to associated deficits in emotional processing and control (DEPAC). The second new perspective is that it is due to 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 DEPAC 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, stress sensitivity, resilience and alexithymia) will also be conducted. Methods: A sample of 600 adolescents aged 11 to 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, DEPAC, EB, self-esteem, rumination, stress sensitivity, interpersonal 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 will also be collected as covariates. Results: The pathways between ADHD/autism and depression, along with their mediators and moderators, will be analysed using structural equation modelling.Conclusion: 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.

Introduction The impact of digital activity on adolescent mental health has been difficult to assess because of methodological limitations and a lack of strong theory. Dynamic Interplay of Online Risk and Resilience in Adolescence (DIORA) is a longitudinal study designed to address these core limitations and tease apart the reciprocal influences linking digital activity and depression symptoms (hereafter ‘depression’) over 12 months in middle adolescence. This study will examine whether negative affective and cognitive reactions evoked by risky digital activities increase depression. It will additionally examine whether protective characteristics (eg, self-efficacy) moderate the associations between digital activity and depression. DIORA will also explore the reverse pathways between digital activity and depression, namely whether depression exacerbates negative affective and cognitive reactions and, in turn, increase risky digital activities or, further, whether risks can be mitigated through active management of digital activity and/or reactions that it evokes. Finally, the study will examine whether the effects of digital activity observed for depression contrast with those observed for well-being. Methods and analysis This is a prospective observational study with three assessment points: baseline (T1), 6 months (T2) and 12 months (T3). We aim to recruit a minimum of 276 adolescents aged between 13 and 14 years from secondary schools in the UK and 1 parent/caregiver/guardian (hereafter, ‘parent’) for each adolescent. Study questionnaires will be completed online. We will fit a range of models to examine the direct and indirect associations among digital activity, the reactions it evokes, depression and wellbeing, and individual and contextual mediators and moderators drawing on the structural equation modelling framework. Ethics and dissemination The study was approved by the London School of Economics and Political Science Research Ethics Committee, reference number 249287. The results will be published in peer-reviewed scientific journals and disseminated through presentations, posters and blogs.

Qualitative research is notable by its relative absence from the translational science studies in the field of child mental health and neurodevelopmental conditions in general, and the Journal of Child Psychology & Psychiatry in particular. In this editorial, I argue for a pragmatic integration of qualitative and quantitative methods to speed up the development of new and more effective interventions. I give practical examples of the benefits of qualitative methods at specific points across the discovery – development – implementation translational cycle.

Objective: The Attention-Deficit/Hyperactivity Disorder Rating Scale-IV (ADHD-RS-IV) assesses ADHD symptoms in children and adolescents. The original United States norms comprise percentiles. Yet, no Nordic percentile norms exist, and only T-scores, which (often falsely) assume normally distributed data, are currently available. Here, we for the first time provide Danish percentile norms for children aged 6–9 based on parent/caregiver-reports, and illustrate the potential consequences of T-scores when derived based on the expected skewed distribution of an ADHD scale in the population. Materials and methods: The sample comprised 1895 Danish schoolchildren (879 girls and 1016 boys) in 1st, 2nd, or 3rd grade from the general population. Their parents/caregivers completed the ADHD-RS-IV. Sex and age differences were investigated, percentiles were derived based on the observed score distributions, and for comparison, T-scores > 70 were estimated, which are expected to identify the top 2.3% under the assumption of normality. Results: Boys were rated to have higher ADHD-RS-IV scores than girls except on the impulsivity score. No age effects were found on the majority of scores. Sex-stratified and unisex percentiles (80, 90, 93, 98) were reported. The distribution of ADHD-RS-IV scores were highly skewed. T-score cutoffs identified a significantly higher proportion of and about twice as many children as having elevated ADHD symptoms than expected (4.3–5.2% vs. 2.3%). Conclusions: ADHD-RS-IV (parent/caregiver-report) percentile norms for young Danish schoolchildren are now available for future reference. The use of percentiles is considered appropriate given the skewed score distribution and since T-scores appear to over-identify children as having clinically elevated ADHD symptoms.

Introduction This paper describes an innovative Framework for Remotely Enabled Co-Design with Young people (FREDY), which details an adaptable four-stage process for generating design concepts with children and other key stakeholders in a naturalistic and inclusive way. Methods Recommendations from existing patient engagement and design methodologies were combined to provide research teams with procedures to capture and analyse end-user requirements rapidly. Resulting insights were applied through iterative design cycles to achieve accelerated and user-driven innovation. Results Applying this framework with neurodiverse children within the context of healthcare, shows how creative design methods can give rise to new opportunities for co-creating across diverse geographies, abilities, and backgrounds as well as strengthen co-designer approval of the co-design process and resulting product. Discussion We summarise key learnings and principles for fostering trust and sustaining participation with remote activities, and facilitating stakeholder design input through continuous collaboration, as well as highlight the potential benefits and challenges of utilising FREDY with neurotypical populations.