Suicide is one of the leading causes of death among adolescents. With rates of suicide among rural youth nearly double those of urban youth, suicide among adolescents in rural areas is a major public health concern. School mental health programs, which provide mental health services to students in the context of the school, address many barriers to accessing mental health treatment in rural areas and may include efforts to address suicide prevention. Of critical importance in suicide prevention strategies for schools are methods for restricting access to lethal means and methods for facilitating student referral for risk assessment and management. In addition, there is a need to develop effective suicide crisis response protocols appropriate for the school setting. The Prevention of Escalating Adolescent Crisis Events (PEACE) protocol was developed and revised to create a thorough risk assessment process for mental health clinicians working in tandem with school personnel in educational contexts. The PEACE protocol was utilized for 78 crisis events that involved 58 students during the 2016 -2017 school year. During 2016 -2017, the PEACE protocol was revised to collect more detailed information on how students were referred for assessment and to directly track how crisis response and safety plans addressed access to lethal means. These results and the clinical implications of utilizing this protocol and the assessment findings to address school-based suicide prevention efforts are discussed.

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Objective: Adults often select romantic partners who behave like they do (i.e. assortative mating). However, little is known about whether assortative mating is common among adults with attention-deficit/hyperactivity disorder (ADHD) and whether it is related to associated problems. Method: About 94 adults without ADHD, 43 adults with childhood ADHD histories but without current symptoms or impairment (ADHD-Desist), 27 adults with childhood ADHD histories and elevated current symptoms and impairment (ADHD-Persist) rated their partners’ ADHD symptoms and their own associated problems (e.g., intimate partner violence, financial difficulties). Results: The ADHD-Persist group reported that their partners exhibited more ADHD symptoms than the ADHD-Desist group and those without ADHD. Adults in the ADHD-Persist group who had partners with elevated ADHD symptoms endorsed high intimate partner violence and financial difficulties. Conclusion: Assortative mating appears to be common among adults with ADHD, especially those with persistent symptoms, and to increase risk of additional problems.

Objective: Children with ADHD exhibit deficits in academic motivation compared to their peers. Yet conceptualizations of motivation according to prominent motivation theories connected to achievement have not been studied in college-bound youth with ADHD symptoms. Method: This study examined motivation according to these theories, differences in motivation by ADHD symptoms, and how the cross-sectional association between motivation and achievement varies by ADHD symptoms. The sample included 461 first-year college students retrospectively reporting their motivation and achievement in their last year of high school. Results: Results indicated differences in motivation by ADHD symptoms. Mastery achievement goal orientation was uniquely associated with achievement and exerted beneficial effects on achievement at moderate to high ADHD symptom levels. Conclusion: Motivation may operate differently in association with achievement for college-bound youth with ADHD symptoms compared to youth with no to low symptoms.

Objective: This study examined the role of academic, social, and family impairment in the pathway from externalizing psychopathology to depression among young adolescents with ADHD in a multiple mediation model. Method: The sample included adolescents with ADHD enrolled in an intervention trial. Parent ratings of externalizing psychopathology were measured at eligibility assessment, adolescent self-reported depressive symptoms were measured at eligibility and at the end of treatment, and parent-rated impairment was measured in the middle of treatment. A multiple mediation model was used to examine mediating effects of impairment types in the pathway from externalizing psychopathology to depression. Results: Parent-reported family impairment significantly mediated the association between externalizing psychopathology and depressive symptoms. Conclusions: Results suggest family impairment mediates the association between externalizing psychopathology and depressive symptoms beyond academic and social impairment for youth with ADHD. Findings implicate the importance of targeting family functioning during early adolescence to prevent depression.