Applying the Theory of Planned Behavior (TPB) to the process of engagement in preventive parenting groups, we tested the ability of family and child measures to predict intent to enroll, enrollment, attendance, and quality of participation in PACE (Parenting Our Children to Excellence). PACE is a prevention trial testing the efficacy of a structured program to promote effective parenting and reduce risk of adverse child outcomes. Mothers of preschoolers (N = 451) from diverse ethnic and socioeconomic backgrounds participated at two sites. Results showed that mothers who stated their intent to enroll reported relatively few time constraints but high levels of stress, as did mothers who enrolled. The latter also experienced elevated levels of oppositional defiant child behaviors, indicating that the program reached families who stood to benefit from it. Attendance, which was also best predicted by few time constraints, was high (with 49% of mothers who enrolled attending 5 or more of 8 sessions). In turn, attendance predicted quality of participation (at 1 site only), with mothers attending more sessions participating more actively and enthusiastically. Ethnicity and, with a few exceptions, socioeconomic circumstances and site, were not significant predictors of intent, enrollment, or attendance. Results provide qualified support for the TPB and illustrate its relevance to preventive research and interventions.

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Objective We recently transitioned from in-person delivery of a brief behavioral parent intervention to telepsychology delivery to meet families’ needs during the COVID-19 pandemic. In this topical review, we describe how we used treatment fidelity as a guiding principle to orient adaptations for telepsychology, as well as preliminary findings and early lessons learned in this implementation. Methods: Using rapid-cycle quality improvement methods, we adapted a brief parent training group (Bootcamp for Attention-Deficit/Hyperactivity Disorder; BC-ADHD) to three groups of caregivers (i.e., 5–7 families) of school-aged children with ADHD (n = 20; 85% males). Families were from the following ethnic backgrounds: 75% White non-Hispanic, 15% White Hispanic, and 10% Black. Clinicians completed measures on their implementation experience. Observers completed measures on content/process fidelity and attendance. Caregivers completed measures on demographics, treatment satisfaction, and telepsychology experience. Results Telepsychology BC-ADHD can be implemented with comparably high levels of content and process fidelity and treatment satisfaction to in-person groups; and it appears to be feasible and acceptable to caregivers. Caregiver and clinician qualitative feedback revealed themes of appreciating the convenience of telepsychology, while experiencing some challenges in relating to others and sharing over video. Conclusions When treatment fidelity is used as a guiding tool, telepsychology parent training groups can be delivered with high fidelity and appear to be acceptable and feasible to caregivers and clinicians. Future research using larger and more diverse samples, multimethod and multi-informant measurement approaches, and controlled designs is needed to further assess the generalizability and efficacy of telepsychology parent training groups.

Attention deficit, hyperactivity disorder (ADHD) is familial and highly heritable. Several candidate genes involved in neurotransmission have been identified, however these confer minimal risk, suggesting that for the most part, ADHD is not caused by single common genetic variants. Advances in genotyping enabling investigation at the level of the genome have led to the discovery of rare structural variants suggesting that ADHD is a genomic disorder, with potentially thousands of variants, and common neuronal pathways disrupted by numerous rare variants resulting in similar ADHD phenotypes. Heritability studies in humans also indicate the importance of epigenetic factors, and animal studies are deciphering some of the processes that confer risk during gestation and throughout the post-natal period. These and future discoveries will lead to improved diagnosis, individualized treatment, cures, and prevention. These advances also highlight ethical and legal issues requiring management and interpretation of genetic data and ensuring privacy and protection from misuse.

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Epigenetics is the field of research that examines alterations in gene expression caused by mechanisms other than changes in DNA sequence. ADHD is highly heritable; however, epigenetics are considered relevant in potentially explaining the variance not accounted for by genetic influence. In this chapter, some of the well-known processes of epigenetics, such as chromosome organization, DNA methylation, and effects of transcriptional factors are reviewed along with studies examining the role of these processes in the pathophysiology of ADHD. Potential epigenetic factors conferring risk for ADHD at various developmental stages, such as alcohol, tobacco, toxins, medications, and psychosocial stressor are discussed. Animal studies investigating ADHD medications and changes in CNS Gene/Protein Expression are also explored since they provide insight into the neuronal pathways involved in ADHD pathophysiology. The current limited data suggest that identification of the epigenetic processes involved in ADHD is extremely important and may lead to potential interventions that may be applied to modify the expression of deleterious, as well as protective, genes.

Scientists and clinicians regularly use clinical screening tools for attention deficit/hyperactivity disorder (ADHD) to assess comorbidity without empirical evidence that these measures are valid in youth with autism spectrum disorder (ASD). We examined the prevalence of youth meeting ADHD criteria on the ADHD rating scale fourth edition (ADHD-RS-IV), the relationship of ADHD-RS-IV ratings with participant characteristics and behaviors, and its underlying factor structure in 386 7-17 year olds with ASD without intellectual disability. Expected parent prevalence rates, relationships with age and externalizing behaviors were observed, but confirmatory factor analyses revealed unsatisfactory fits for one-, two-, three-factor models. Exploratory analyses revealed several items cross-loading on multiple factors. Implications of screening ADHD in youth with ASD using current diagnostic criteria are discussed.