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

Abstract

Objective 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. Methods 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. Results 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. Conclusion 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.

Multimodal Neuroimaging of Suicidal Thoughts and Behaviors in a U.S. Population-Based Sample of School-Age Children

“…Next, we sought to identify associations between suicidal thoughts and behaviors and brain morphometry, functional connectivity at rest, and functional measures during three tasks. Specifically, we examine neural correlates of processes that have been implicated with suicidal behavior in clinical and at-risk samples of youth, named reward processing (30)(31)(32)(33) with the Monetary Incentive Delay task (34), inhibitory control (35,36) with the Stop Signal Task (37), and working memory and affective processing (38)(39)(40)(41) with an emotional version of the N-back task (42). We tested for differences in these measures using a traditional null hypothesis significance test, and complemented our analyses with Equivalence testing (26) to examine whether observed effect size were large enough to be considered meaningful based on a prespecified benchmark.…”

Investigating cognitive control and cognitive emotion regulation in Iranian depressed women with suicidal ideation or suicide attempts

“…Working memory is conceptualized as the system responsible for the maintenance and manipulation of information within short periods of time and is influential in affecting other executive functions, such as decision‐making (Braver et al, 2009; Cowan, 2008; McCabe et al, 2010; Swann et al, 2005; Xiu et al, 2018). A recent study showed that working memory was a cognitive mediator of the relationship between ADHD and suicidal ideation in children (Bauer et al, 2018). Response inhibition is the second component.…”

Correlations between Quality of Life, School Bullying, and Suicide in Adolescents with Attention-Deficit Hyperactivity Disorder

“…In a long-term observation, adolescents with ADHD were at a higher risk of suicidality and repeated suicide attempts in adulthood with or without a psychiatric disorder comorbidity [14,15]. Although psychological problems concurrent with ADHD, such as depressive symptoms, specific anxiety disorders, dysthymia symptoms [13,16,17], weak cognitive function [18], and family dysfunction [13], are commonly reported as being involved in the mechanisms of suicide, a pooled data analysis of suicidality and ADHD demonstrated that ADHD is an independent risk factor for suicidality [12].…”