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Self-Regulation in Childhood: Developmental Mechanisms and Relations to ADHD Symptoms
Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology. Uppsala University.
2019 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Self-regulation is a multi-faceted construct that concerns goal-directed behaviors, which aid individuals in everyday life and in achieving long-term goals. Self-regulation in believed to progress in a hierarchical fashion, in that simple cognitive functions are integrated into more complex functions across development. Attention-deficit/hyperactivity disorder (ADHD) is a heterogeneous childhood-onset disorder, characterized by deficits in various aspects of self-regulation, including core symptoms of inattention and hyperactivity/impulsivity, and comorbidity with externalizing disorders such as oppositional defiant disorder (ODD). The last decade has seen a shift from simple etiological models towards more complex ones, which stress multiple pathways to the disorder. In addition, there is an ongoing search for early markers of the condition, which will increase our understanding, enable early detection, intervention, and perhaps even prevention of the full disorder. Cognitive regulation, aspects of temperament (i.e. negative affect, surgency, and effortful control), and parenting are three areas of importance for self-regulation in general and of ADHD symptoms in particular. Grounded in these three constructs, informed by the hierarchical model of self-regulation development, and a multiple pathway perspective on ADHD, the present thesis aimed to map development of self-regulation, with a special focus on inattention and hyperactivity/impulsivity. Four studies were conducted based on three samples, ranging from infancy to 12 years, including both typically developing children and children diagnosed with ADHD. Study I found that early sustained attention predicted later cognitive regulation, providing support for the hierarchical model of self-regulation development. In addition, maternal sensitivity contributed to higher levels of emotion regulation whereas surgency contributed to lower levels of emotion regulation. Study II gained support for a multiple pathway perspective on ADHD, in that higher temperamental regulation and maternal sensitivity contributed to lower levels of inattention and hyperactivity/impulsivity, and higher surgency contributed to higher levels of hyperactivity/impulsivity. Study III replicated findings from Study II and confirmed early temperament markers of later inattention and hyperactivity/impulsivity, and that early cognitive regulation was a poor predictor of later symptoms. Study IV proposed contributions of multiple regulatory functions to ADHD symptoms and elevated negative affect in ODD. The latter was moderated by parental support, which seemed to be a protective factor for children with high levels of negative affect. In all, the findings point to the importance of both intrinsic and extrinsic factors in the development of self-regulation, which seems to progress in a hierarchical fashion. Aspects of temperament rather than cognitive regulation seem to be valid early markers of later inattention and hyperactivity/impulsivity. Multiple pathways to ADHD symptoms are proposed, with contributions of maternal sensitivity and temperament early in development and different regulatory functions in school-aged children. In addition, elevated negative affect in combination with low parental support seem to be characteristic of ODD rather than of core symptoms of ADHD. The thesis contributes to the complexity and heterogeneity of ADHD and that ADHD is best viewed as a developmental disorder, in that the influence of various regulatory factors change over time.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2019. , p. 77
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Social Sciences, ISSN 1652-9030 ; 167
National Category
Psychology
Research subject
Psychology
Identifiers
URN: urn:nbn:se:uu:diva-380106ISBN: 978-91-513-0614-8 (print)OAI: oai:DiVA.org:uu-380106DiVA, id: diva2:1299282
Public defence
2019-05-17, Humanistiska teatern, Thunbergsvägen 3, Uppsala, 10:15 (English)
Opponent
Supervisors
Available from: 2019-04-25 Created: 2019-03-26 Last updated: 2019-06-17
List of papers
1. The role of sustained attention, maternal sensitivity, and infant temperament in the development of early self-regulation
Open this publication in new window or tab >>The role of sustained attention, maternal sensitivity, and infant temperament in the development of early self-regulation
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2018 (English)In: British Journal of Psychology, ISSN 0007-1269, E-ISSN 2044-8295, Vol. 109, no 2, p. 277-298Article in journal (Refereed) Published
Abstract [en]

This study investigated infant predictors of early cognitive and emotional self-regulation from an intrinsic and caregiving environmental perspective. Sustained attention, reactive aspects of infant temperament, and maternal sensitivity were assessed at 10months (n=124) and early self-regulation (including executive functions, EF, and emotion regulation) was assessed at 18months. The results indicated that sustained attention predicted early EF, which provide empirical support for the hierarchical framework of EF development, advocating early attention as a foundation for the development of cognitive self-regulation. Maternal sensitivity and surgency predicted emotion regulation, in that infants of sensitive mothers showed more regulatory behaviours and a longer latency to distress, whereas high levels of surgency predicted low emotion regulation, suggesting both the caregiving environment and temperament as important in the development of self-regulation. Interaction effects suggested high sustained attention to be a protective factor for children of insensitive mothers, in relation to emotion regulation. In addition, high levels of maternal sensitivity seemed to foster development of emotion regulation among children with low to medium levels of sustained attention and/or surgency. In all, our findings point to the importance of both intrinsic and extrinsic factors in infant development of self-regulation.

Place, publisher, year, edition, pages
WILEY, 2018
Keywords
emotion regulation, executive functions, infant temperament, maternal sensitivity, self-regulation, sustained attention
National Category
Psychology (excluding Applied Psychology)
Identifiers
urn:nbn:se:uu:diva-352572 (URN)10.1111/bjop.12266 (DOI)000429702400007 ()28895129 (PubMedID)
Funder
Swedish Research Council, 421-2012-1222
Available from: 2018-08-07 Created: 2018-08-07 Last updated: 2019-03-26Bibliographically approved
2. Can reactivity and regulation in infancy predict inattentive and hyperactive/impulsive behavior in 3-year-olds?
Open this publication in new window or tab >>Can reactivity and regulation in infancy predict inattentive and hyperactive/impulsive behavior in 3-year-olds?
2019 (English)In: Development and psychopathology (Print), ISSN 0954-5794, E-ISSN 1469-2198, Vol. 31, no 2, p. 619-629Article in journal (Refereed) Published
Abstract [en]

A need to identify early infant markers of later occurring inattentive and hyperactive/impulsive behaviors has come to the fore in the current attention-deficit/hyperactivity disorder literature. The purpose of such studies is to identify driving mechanisms that could enable early detection of attention-deficit/hyperactivity disorder liability and thus facilitate early intervention. Here we study independent and interactive effects of cognitive regulation (inhibition and sustained attention), temperament (reactive and regulatory aspects), and maternal sensitivity (as external regulation) in a sample of 112 typically developing 10-month-old infants (59 boys, 52.7%), in relation to inattentive and hyperactive/impulsive behavior at 3 years. The results showed that infant temperamental regulation and maternal sensitivity made independent contributions to both inattention and hyperactivity/impulsivity, in that higher levels of temperamental regulation and maternal sensitivity were related to less inattentive and hyperactive/impulsive behavior. In addition, the temperamental factor positive affectivity/surgency made a significant contribution to later hyperactivity/impulsivity, in that higher levels of positive affectivity/surgency were related to more hyperactive/impulsive behavior. No interaction effects were found. Our findings suggest temperament and parental regulation as potential and independent markers of later inattentive and hyperactive/impulsive behavior.

National Category
Psychology
Identifiers
urn:nbn:se:uu:diva-348127 (URN)10.1017/S0954579418000160 (DOI)000466341900017 ()29606186 (PubMedID)
Funder
Swedish Research Council, 421-2012-1222
Available from: 2018-04-10 Created: 2018-04-10 Last updated: 2019-06-24Bibliographically approved
3. Temperament and Cognitive Regulation During the First 3 Years of Life as Predictors of Inattention and Hyperactivity/Impulsivity at 6 Years
Open this publication in new window or tab >>Temperament and Cognitive Regulation During the First 3 Years of Life as Predictors of Inattention and Hyperactivity/Impulsivity at 6 Years
2019 (English)In: Journal of Attention Disorders, ISSN 1087-0547, E-ISSN 1557-1246, Vol. 23, no 11, p. 1291-1302Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: With a wish to identify early markers of inattention and hyperactivity/impulsivity, we examined effects of temperament and cognitive regulation, during the first 3 years of life, on later inattentive and hyperactive/impulsive behavior.

METHOD: Temperament and cognitive regulation were assessed at 12, 18, 24, and 36 months in 66 typically developing children. Teachers rated inattention and hyperactivity/impulsivity at 6 years.

RESULTS: Temperamental activity at all studied time points was predictive of later hyperactive/impulsive behavior, thus appearing as a stable marker thereof. Activity at 12 months was also predictive of inattention, whereas temperamental persistence was correlated with inattention and hyperactivity/impulsivity, but with no independent contributions. No significant relations between cognitive regulation and the outcome measures were found.

CONCLUSION: Our findings add to the scarce literature proposing that markers of inattentive and hyperactive/impulsive behavior in early school age can be found within the first years of life, using parental ratings of child temperament.

Place, publisher, year, edition, pages
Sage Publications, 2019
Keywords
cognitive regulation, early markers, hyperactivity/impulsivity, inattention, temperament
National Category
Applied Psychology
Identifiers
urn:nbn:se:uu:diva-367226 (URN)10.1177/1087054718804342 (DOI)000481493400008 ()30296881 (PubMedID)
Funder
Swedish Research Council, 421-2012-1222
Available from: 2018-11-29 Created: 2018-11-29 Last updated: 2019-10-03Bibliographically approved
4. A Multi-Factorial Perspecitve on ADHD and ODD in School-Aged Children: What is the Role of Cognitive Regulation, Temperament, and Parental Support?
Open this publication in new window or tab >>A Multi-Factorial Perspecitve on ADHD and ODD in School-Aged Children: What is the Role of Cognitive Regulation, Temperament, and Parental Support?
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Introduction: It is well established that attention-deficit/hyperactivity disorder (ADHD) is a disorder of self-regulation. As such, ADHD is associated with disturbed cognitive regulation, extreme temperament traits, and deficient extrinsic regulation such as parenting. Despite these associations, cognitive regulation, temperament, and parenting have not previously been examined simultaneously in relation to ADHD symptoms in school-aged children. To bridge this gap of knowledge, we examined effects of these important aspects of self-regulation on symptoms of inattention, hyperactivity/impulsivity, and comorbid symptoms of oppositional defiant disorder (ODD) in children with and without a diagnosis of ADHD. Method: The sample consisted of 77 children aged 8-12 years (~40% had a diagnosis of ADHD). Cognitive regulation (i.e. complex inhibition and working memory) was assessed during a lab visit and parental ratings were used for measures of temperament (negative affect, surgency, and effortful control) and parental support. Parents and teachers rated ADHD and ODD symptoms in the child. Informed by a dimensional perspective on ADHD, continuous analyses were performed. Results: Working memory contributed independently to inattention (β = -.19, p < .05). Effortful control contributed independently to inattention and hyperactivity/impulsivity (βs = -.50 and -.49, ps < .01). Negative affect contributed to ODD as moderated by parental support (β = .58, p < .01). Specifically, for children who received lower levels of parental support there was a significant positive association between negative affect and ODD symptoms. Conclusions: The results propose that both cognitive regulation and effortful control influence ADHD symptoms. Moreover, different factors seem to be involved in ADHD and ODD, with regulatory deficits specifically related to ADHD symptoms, and elevated negative affect specifically related to ODD symptoms. Interestingly, parenting moderated the relationship between negative affect and ODD symptoms, with a suggested protective effect of high parental support for children with high levels of negative affect.

Keywords
ADHD, ODD, executive functions, temperament, parenting
National Category
Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:uu:diva-380103 (URN)
Funder
Sven Jerring Foundation, 2017/29
Available from: 2019-03-26 Created: 2019-03-26 Last updated: 2019-03-26

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