Department of Psychiatry, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA.
J Abnorm Child Psychol. 2020 Dec;48(12):1543-1553. doi: 10.1007/s10802-020-00695-8.
Research on attention-deficit/hyperactivity disorder (ADHD) points to the possibility that contextual factors (e.g., time of day, school vs. home) may be related to symptoms and impairment. This prior research has relied on laboratory-based or retrospective, global approaches which has limited ecological validity. The present study substantively contributes to the extant literature by examining adolescents' ADHD symptoms in the real world across the day on both school and non-school days to test whether symptoms worsened throughout the day and were higher on school days relative to non-school days. As part of a larger study, 83 adolescents taking stimulant medication for ADHD (M = 14.7, 66% identified as boys/men, 78% White) completed a 17-day ecological momentary assessment protocol that included wake-up and bedtime reports and two reports in the afternoon and evening. These assessments asked about ADHD symptoms and stimulant medication usage since the last report. Hypotheses were tested using multilevel modeling. Accounting for demographic covariates and medication usage, ADHD symptoms worsened quadratically, peaking by the afternoon report and subsequently declining, across school days but not non-school days. Mean-level ADHD symptoms were also worse on school days relative to non-school days. Results did not differ across gender. In conclusion, our study is the first to examine important environmental factors (school, time of day) in real time in relation to level of naturalistically occurring ADHD symptoms. Our findings highlight the importance of advancing treatments to support adolescents with ADHD on school days and in the afternoon.
研究注意力缺陷多动障碍（ADHD）表明，环境因素（例如，一天中的时间、学校与家庭）可能与症状和损伤有关。先前的研究依赖于基于实验室或回顾性的、整体的方法，这限制了其生态有效性。本研究通过在学校日和非学校日全天实地考察青少年的 ADHD 症状，检验症状是否在一天中逐渐恶化，以及在学校日是否比非学校日更严重，从而为现有文献做出了实质性贡献。作为一项更大研究的一部分，83 名服用兴奋剂治疗 ADHD 的青少年（M=14.7，66%为男性/男性，78%为白人）完成了为期 17 天的生态瞬时评估方案，其中包括起床和就寝报告，以及下午和晚上的两份报告。这些评估询问了自上次报告以来的 ADHD 症状和兴奋剂药物使用情况。使用多层次建模检验了假设。在考虑人口统计学协变量和药物使用的情况下，ADHD 症状呈二次方恶化，在学校日的下午报告中达到峰值，随后下降，但在非学校日没有这种情况。在学校日，ADHD 症状的平均水平也比非学校日更差。结果在性别方面没有差异。总之，我们的研究首次实时考察了与自然发生的 ADHD 症状水平相关的重要环境因素（学校、时间）。我们的发现强调了为支持 ADHD 青少年在学校日和下午提供治疗的重要性。
