(PS4-10) Social-Contextual Resilience Promotive Factors and Sex Differences in Relation to Lower Co-occurring Internalizing Symptoms in Youth with ADHD

Youth with ADHD face heightened risks for experiencing co-occurring internalizing symptoms of anxiety and depression, leading to compounded negative effects and impairment. Social-contextual factors, such as school connectedness, friend support, and social skills such as leadership (Harmelen et al., 2016; Perren & Alsaker, 2009) have proven protective against internalizing symptoms, though there is some evidence these present differently by sex (Rueger et al., 2016). A gap in the literature remains in identifying resilience factors that promote lower internalizing symptoms among youth with ADHD. Further, there is a need to examine sex differences, which may be crucial to develop interventions that mitigate risk of comorbidity and enhance wellbeing. A community-based sample of 151 fifth graders (Mage=10.65; 46.4% female; 3.3% Asian, 14.6% Black, 62.9% White, 13.9% Multiracial, 4.7% Other; 16.6% Hispanic/Latino) were diagnosed with ADHD based on a semi-structured diagnostic interview with the child’s caregiver and teacher ratings. Regression analyses examined whether child-rated school connectedness, child-rated friend support, and parent-rated leadership were associated with child- and parent-rated anxiety and depressive symptoms, controlling for sex. Interaction terms with each resilience promoting factor by sex were also examined to explore whether sex moderated these associations.

School connectedness and leadership were significantly associated with child-rated anxiety (βs=-.25-.28, p< .05) and parent-reported anxiety (βs=-.29-.32, p< .02), such that youth with higher school connectedness and leadership skills experienced lower anxiety. Child sex moderated the association between school connectedness and parent-reported anxiety (β=.36, p=.006) such that school connectedness buffered against anxiety for boys (b=-4.87, p=.01), not girls (b=3.33, p=.12). There was also a significant sex by friend support interaction with child-reported anxiety (β=-.28, p=.036) such that higher friend support was associated with lower anxiety for girls (b=-3.18, p=.005), not boys (b=.17, p=.88). In models predicting depressive symptoms, school connectedness was associated with child-rated depression (β=-.33, p=.013), and both school connectedness and leadership skills were associated with parent-reported depression (βs=-.28-.32, p< .03), such that youth with higher school connectedness and leadership experienced lower depression. Sex did not moderate any of the associations with depressive symptoms.

Findings demonstrate the importance of building interventions targeting malleable social-contextual factors–particularly school connectedness and leadership–among all youth with ADHD to protect against co-occurring internalizing symptoms. The moderating effect of sex on resilience promoters and anxiety suggests stronger need for targeting school connectedness for boys, and friend support for girls with ADHD. Additional research should further explore mechanisms behind these sex differences and build from present findings to inform approaches targeting resilience against the development of internalizing as children with ADHD transition to adolescence when these symptoms often magnify.