IMPORTANCE Modern digital platforms are easily accessible and intensely stimulating; it is unknown whether frequent use of digital media may be associated with symptoms of attention-deficit/hyperactivity disorder (ADHD).OBJECTIVE To determine whether the frequency of using digital media among 15-and 16-year-olds without significant ADHD symptoms is associated with subsequent occurrence of ADHD symptoms during a 24-month follow-up.DESIGN, SETTING, AND PARTICIPANTS Longitudinal cohort of students in 10 Los Angeles County, California, high schools recruited through convenience sampling. Baseline and 6-, 12-, 18-, and 24-month follow-up surveys were administered from September 2014 (10th grade) to December 2016 (12th grade). Of 4100 eligible students, 3051 10th-graders (74%) were surveyed at the baseline assessment.EXPOSURES Self-reported use of 14 different modern digital media activities at a high-frequency rate over the preceding week was defined as many times a day (yes/no) and was summed in a cumulative index (range, 0-14).MAIN OUTCOMES AND MEASURES Self-rated frequency of 18 ADHD symptoms (never/rare, sometimes, often, very often) in the 6 months preceding the survey. The total numbers of 9 inattentive symptoms (range, 0-9) and 9 hyperactive-impulsive symptoms (range, 0-9) that students rated as experiencing often or very often were calculated. Students who had reported experiencing often or very often 6 or more symptoms in either category were classified as being ADHD symptom-positive. RESULTS Among the 2587 adolescents (63% eligible students; 54.4% girls; mean [SD] age 15.5 years [0.5 years]) who did not have significant symptoms of ADHD at baseline, the median follow-up was 22.6 months (interquartile range [IQR], months). The mean (SD) number of baseline digital media activities used at a high-frequency rate was 3.62 (3.30); 1398 students (54.1%) indicated high frequency of checking social media (95% CI, 52.1%-56.0%), which was the most common media activity. High-frequency engagement in each additional digital media activity at baseline was associated with a significantly higher odds of having symptoms of ADHD across follow-ups (OR, 1.11; 95% CI, 1.06-1.16). This association persisted after covariate adjustment (OR, 1.10; 95% CI, 1.05-1.15). The 495 students who reported no high-frequency media use at baseline had a 4.6% mean rate of having ADHD symptoms across follow-ups vs 9.5% among the 114 who reported 7 high-frequency activities (difference; 4.9%; 95% CI, 2.5%-7.3%) and vs 10.5% among the 51 students who reported 14 high-frequency activities (difference, 5.9%; 95% CI, 2.6%-9.2%).CONCLUSIONS AND RELEVANCE Among adolescents followed up over 2 years, there was a statistically significant but modest association between higher frequency of digital media use and subsequent symptoms of ADHD. Further research is needed to determine whether this association is causal.

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CONTEXT: Although children with attention-deficit/hyperactivity disorder (ADHD) are at elevated risk for comorbid psychopathology, the clinical correlates of ADHD in girls are far less understood relative to boys, despite ADHD being one of the most common childhood disorders in girls.OBJECTIVE: To meta-analytically summarize rates of comorbid internalizing (anxiety, depression) and externalizing (oppositional defiant disorder [ODD], conduct disorder [CD]) psychopathology among girls with and without ADHD.DATA SOURCES: Literature searches (PubMed, Google Scholar) identified published studies examining comorbid psychopathology in girls with and without ADHD. STUDY SELECTION:Eighteen studies (1997 participants) met inclusion criteria and had sufficient data for the meta-analysis. DATA EXTRACTION:Odds ratios for each comorbid disorder were calculated from available data. Demographic (eg, age, race/ethnicity) and study characteristics (eg, referral source, diagnostic method) were also coded. RESULTS:Compared with girls without ADHD, girls with ADHD were significantly more likely to meet Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for each comorbid disorder assessed. Relative odds were higher for externalizing (ODD: 5.6×; CD: 9.4×) relative to internalizing disorders (anxiety: 3.2×; depression: 4.2×). Meta-regression revealed larger effect sizes of ADHD on anxiety for studies using multiple diagnostic methods, featuring younger children, and including clinic-referred (versus communityreferred) girls; the effect of ADHD on ODD varied based on diagnostic informant. LIMITATIONS:Findings were derived from cross-sectional studies, precluding causal inferences.CONCLUSIONS: Girls with ADHD frequently exhibit comorbid externalizing and internalizing disorders. We discuss future research priorities and consider intervention implications for ADHD and comorbid psychopathology in girls. Ms Tung collected and coded studies for inclusion, supervised the acquisition of data, carried out the analyses, and drafted the initial manuscript; Dr Li conceptualized and designed the study, supervised the acquisition of data, assisted with interpretation of analyses, and critically reviewed and revised the manuscript; Ms Meza and Ms Jezior collected and coded the studies for inclusion, assisted with drafting the initial manuscript, and reviewed and revised the manuscript; Ms Kianmahd, Mr Hentschel, and Mr O'Neil collected and coded the studies for inclusion and reviewed and revised the manuscript; Dr Lee supervised the acquisition of data, assisted with interpretation of analyses, and critically reviewed and revised the manuscript; and all authors approved the fi nal manuscript as submitted.

Environmental exposures, psychosocial stressors and nutrition are all potentially important influences that may impact health outcomes directly or via interactions with the genome or epigenome over generations. While there have been clear successes in large-scale human genetic studies in recent decades, there is still a substantial amount of missing heritability to be elucidated for complex childhood disorders. Mounting evidence, primarily in animals, suggests environmental exposures may generate or perpetuate altered health outcomes across one or more generations. One putative mechanism for these environmental health effects is via altered epigenetic regulation. This review highlights the current epidemiologic literature and supporting animal studies that describe intergenerational and transgenerational health effects of environmental exposures. Both maternal and paternal exposures and transmission patterns are considered, with attention paid to the attendant ethical, legal and social implications.

Although there are likely to be multiple mechanisms underlying parent attention-deficit/hyperactivity disorder (ADHD) symptoms as a key risk factor for offspring ADHD, potential explanatory factors have yet to be reliably identified. Given that parent ADHD symptoms independently predict parenting behavior and child ADHD symptoms, we tested whether individual differences in multiple dimensions of positive and negative parenting behavior (i.e., corporal punishment, inconsistent discipline, positive parenting behavior, observed negative talk, and observed praise) mediated the association between parental and offspring ADHD. We used a prospective design that featured predictors (i.e., parent ADHD symptoms) and mediators (i.e., parenting behavior) that temporally preceded the outcome (i.e., offspring ADHD symptoms). Using a well-characterized sample of 120 children with and without ADHD (ages 5–10 at Wave 1, 7–12 at Wave 2) and their biological parents, we examined multimethod (i.e., observed, self-report) measures of positive and negative parenting behavior as simultaneous mediators of the association of Wave 1 parent and Wave 2 offspring ADHD symptoms. Using a multiple mediation framework, consisting of rigorous bootstrapping procedures and controlling for parent depression, child’s baseline ADHD and oppositional defiant disorder, and child’s age, corporal punishment significantly and uniquely mediated the association of Wave 1 parent ADHD symptoms and Wave 2 offspring ADHD. We consider the role of parenting behavior in the intergenerational transmission of ADHD as well as implications of these findings for the intervention and prevention of childhood ADHD.

Although multiple dimensions of negative parenting behavior are associated with childhood conduct problems (CP), there is relatively little research on whether the association is equally robust in boys and girls. To improve the specificity of current models of negative parenting and offspring CP, we explored the potential moderating role of child sex in a sample of 179 5- to 10-year-old ethnically diverse boys and girls with and without attention-deficit/hyperactivity disorder (ADHD) who were assessed using multiple methods (i.e., rating scales, semistructured interviews) and informants (i.e., parents, teachers). Controlling for children's age, race-ethnicity, and ADHD diagnostic status (i.e., ADHD vs. non-ADHD), inconsistent discipline was positively associated with offspring aggression and rule-breaking behavior, whereas harsh punishment was positively associated with aggression, rule-breaking behavior, and oppositional defiant disorder symptoms. Furthermore, child sex significantly moderated the association of inconsistent discipline and aggression and rule-breaking behavior, such that inconsistent discipline was positively associated with CP for boys, but not for girls. Given the centrality of negative parenting to theories of and efficacious interventions for aggression and CP, we discuss these findings within a developmental psychopathology framework and consider their implications for intervention.

Social skills are traditionally viewed as acquired through social environments including parenting. However, biopsychosocial models highlight the importance of genetic influences and gene-environment interactions (GϫEs) in child development. Extant GϫE investigations often fail to account for developmental changes in the phenotype or rigorously assess the social environment using observational measures. The present study prospectively assessed 110 children (44.5% female) and their parents to explore biologically plausible independent and interactive associations of the serotonin transporter-linked polymorphic region (5-HTTLPR) and observed positive and negative parenting in prediction of (a) initial levels of social skills at school entry (age 6 years) and (b) developmental changes in social skills across the early school years (ages 6 -9 years). Overall, the SS (vs. SL/LL) 5-HTTLPR genotype inversely predicted social skills across all domains, although parenting behavior moderated these associations wherein putative GϫE effects differed by developmental timing and social skills domain. Positive parenting positively predicted concurrent (age 6) overall social skills for children with SL/LL genotypes, but not the SS genotype. However, for the SS group only, age 6 positive parenting positively predicted prospective growth in social responsibility, although negative parenting positively predicted growth in social cooperation. Findings suggest that 5-HTTLPR may signal differential sensitivities to parenting styles and patterns of social development, which may help to inform targeted intervention approaches to enhance person-environment fit.

Although negative parenting behavior and peer status are independently associated with childhood conduct problems (e.g., oppositional defiant disorder (ODD)), relatively little is known about their interplay, particularly in relation to differentiated measures of positive and negative peer regard. To improve the specificity of the association of negative parenting behavior and peer factors with ODD, we explored the potential interaction of parenting and peer status in a sample of 169 five-to ten-year-old ethnically diverse children with and without attention-deficit/hyperactivity disorder (ADHD) assessed using multiple measures (i.e., rating scales, interview) and informants (i.e., parents, teachers). Controlling for children's age, sex, number of ADHD symptoms, and parents' race-ethnicity, peer acceptance inversely predicted and inconsistent discipline, harsh punishment, and peer rejection were each positively associated with ODD symptom severity. Interactive influences were also evident such that inconsistent discipline and harsh punishment each predicted elevated ODD but only among children experiencing low peer acceptance or high peer rejection. These findings suggest that supportive environments, including peer acceptance, may protect children from negative outcomes associated with inconsistent discipline and harsh punishment. Findings are integrated with theories of social support, and we additionally consider implications for intervention and prevention.