Stephen Hinshaw
University of California, Berkeley, Psychology, Faculty Member
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Research Interests: Clinical Psychology, Developmental Psychology, Individuality, Consulting, Comorbidity, and 15 moreExecutive Function, Language Processing, Humans, Child, Effect size, Child Abuse, Female, Attention Deficit Disorder, Discriminant function analysis, Learning Disorders, High Sensitivity, Cross Sectional Studies, Attention deficit disorder with hyperactivity, Attention deficit hyperactivity disorder, and Child behavior disorders
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Research Interests: Psychology, Mental Health, Narrative, Silence, Courage, and 3 moreMedicine, Mental Illness, and Honesty
Research Interests: Psychology, Clinical Psychology, Cognition, Social Interaction, Adolescent, and 13 moreMedicine, Social behavior, Humans, Child, Behavior Therapy, Male, Psychological Intervention, Social Behavior, Methylphenidate, Combined Modality Therapy, Attention deficit disorder with hyperactivity, Outcome measure, and reinforcement psychology
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We examined developmental trajectories of attention‐deficit/hyperactivity disorder (ADHD) symptoms, standardized achievement, and school performance for adolescents with and without ADHD who did and did not enroll in postsecondary... more
We examined developmental trajectories of attention‐deficit/hyperactivity disorder (ADHD) symptoms, standardized achievement, and school performance for adolescents with and without ADHD who did and did not enroll in postsecondary education (PSE; N = 749; 79% boys; 63% White, 17% non‐Hispanic Black, 10% Hispanic, and 10% other ethnicities). In a multisite study (recruitment based in New York, North Carolina, Pennsylvania, California, and Quebec), participants were originally enrolled between 1994 and 1998 at ages 7 to 9.9 and followed up through 2012 (Mage = 25 at final follow‐up). Adolescents who eventually enrolled in PSE had less severe symptoms, but differences were modest and trajectories were similar over time. For all adolescents, standardized achievement trajectories declined up to two thirds of a standard deviation from ages 9 to 17. By the end of high school, the average GPA of adolescents with ADHD was three quarters of a point higher for those who eventually enrolled in ...
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We investigated initial engagement in oral sex and sexual intercourse, as well as number of sexual partners, among a prospectively followed sample of adolescent girls with and without a thorough childhood diagnosis of attention-deficit... more
We investigated initial engagement in oral sex and sexual intercourse, as well as number of sexual partners, among a prospectively followed sample of adolescent girls with and without a thorough childhood diagnosis of attention-deficit hyperactivity disorder (ADHD). Participants were adolescent girls (ages 12–19) followed longitudinally as part of a study of ADHD in females. A diverse sample of 140 girls with clinician-diagnosed ADHD (47 Inattentive, 93 Combined) and 88 age- and ethnicity-matched comparison girls were initially recruited and invited to partake in research summer programs. We utilized data on initial engagement in oral sex, sexual intercourse, and number of sexual partners, collected during follow-up interviews conducted 5 and 10 years after baseline participation. Girls with a childhood diagnosis of ADHD engaged in oral sex at a significantly younger age and reported nearly twice as many oral sex partners than their typically developing peers. Post-hoc tests revealed that group differences were driven largely by girls with the combined presentation of ADHD (i.e., those with childhood histories of both inattention and hyperactivity/impulsivity). No significant differences emerged with respect to age of initial sexual intercourse or number of male sexual intercourse partners. In sum, adolescent girls with ADHD, particularly those with the combined presentation, were more likely to engage in oral sexual activity at a young age and with a greater number of both male and female partners. Findings highlight the need for longitudinal research that quantifies and distinguishes between various forms of sexual behavior and later reproductive and mental health outcomes.
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We examine the impacts of childhood adversity on adult outcomes for women with and without childhood ADHD using an ethnically diverse sample of 140 participants with ADHD (Mage = 9.7) and 88 age- and ethnicity-matched comparison... more
We examine the impacts of childhood adversity on adult outcomes for women with and without childhood ADHD using an ethnically diverse sample of 140 participants with ADHD (Mage = 9.7) and 88 age- and ethnicity-matched comparison participants (Mage = 9.4). At adult follow- up, the sample included 211 of the original 228 participants (92.6% retention; Mage = 25.6). We used inclusive latent class analysis to identify profiles of childhood adversity; class membership was subsequently used in regression models to predict adult outcomes and ADHD persistence status. Key findings were as follows: (1) Four childhood adversity profiles emerged (Low Exposure, Familial Dysfunction, Maltreatment, Pervasive Exposure); (2) Compared with women with Low Exposure profile, those with Familial Dysfunction had significantly higher internalizing outcomes, whereas those in the Maltreatment and the Pervasive Exposure profiles were associated with lower global functioning and higher internalizing and externalizing behaviors; (3) Women with childhood ADHD in the Maltreatment profile were significantly more likely than those in the other profiles to show persistent ADHD in adulthood. Findings provide useful information about women who could be targeted for intervention; we discuss limitations and the need to investigate the confluence of neurodevelopmental conditions, like ADHD, and exposure to adverse child events.
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Interpersonal difficulties are among the most severe aspects of attention-deficit hyperactivity disorder (ADHD) children’s psychopathology. Although stimulant medication and behavior modification procedures reduce disruptive and... more
Interpersonal difficulties are among the most severe aspects of attention-deficit hyperactivity disorder (ADHD) children’s psychopathology. Although stimulant medication and behavior modification procedures reduce disruptive and aggressive behavior problems and enhance peer status, no intervention to date—alone or in combination with other treatments—has produced sufficient or lasting gains for the social problems of these children. In addition, despite successes with socially rejected youngsters and with aggressive children, intervention designed to teach important problem solving, mediational, and social skills has fared poorly with ADHD populations. To remedy this situation, better understanding of the cognitive, motivational, and behavioral contributions to ADHD children’s peer rejection as well as better integration of social skills treatments with both contingency management and medication interventions, is required. At stake is prevention of the negative long-term outcomes that are characteristic of children with ADHD.
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We examined developmental trajectories of attention‐deficit/hyperactivity disorder (ADHD) symptoms, standardized achievement, and school performance for adolescents with and without ADHD who did and did not enroll in postsecondary... more
We examined developmental trajectories of attention‐deficit/hyperactivity disorder (ADHD) symptoms, standardized achievement, and school performance for adolescents with and without ADHD who did and did not enroll in postsecondary education (PSE; N = 749; 79% boys; 63% White, 17% non‐Hispanic Black, 10% Hispanic, and 10% other ethnicities). In a multisite study (recruitment based in New York, North Carolina, Pennsylvania, California, and Quebec), participants were originally enrolled between 1994 and 1998 at ages 7 to 9.9 and followed up through 2012 (Mage = 25 at final follow‐up). Adolescents who eventually enrolled in PSE had less severe symptoms, but differences were modest and trajectories were similar over time. For all adolescents, standardized achievement trajectories declined up to two thirds of a standard deviation from ages 9 to 17. By the end of high school, the average GPA of adolescents with ADHD was three quarters of a point higher for those who eventually enrolled in PSE compared to those who did not. Overall, school performance mattered more than academic achievement for understanding eventual enrollment of adolescents with ADHD.
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What is Behavior Therapy? Behavior therapy is the only form of treatment besides medication that researchers have found to be consistently helpful for children and adolescents with ADHD. It can be effective as a substitute for or... more
What is Behavior Therapy? Behavior therapy is the only form of treatment besides medication that researchers have found to be consistently helpful for children and adolescents with ADHD. It can be effective as a substitute for or supplement to medication. Which type of the...
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What Does ADHD Look Like in the Earliest Years of Life? No one ever said it was easy to raise toddlers and preschoolers under the best of circumstances. Most parents quickly understand why the third year of life is known as the Terrible... more
What Does ADHD Look Like in the Earliest Years of Life? No one ever said it was easy to raise toddlers and preschoolers under the best of circumstances. Most parents quickly understand why the third year of life is known as the Terrible Twos....
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What Do We Know About the Value of Daily Exercise? The evidence is solid and plentiful on this question: Regular, intense physical exercise is good for everyone’s brain and particularly helpful for the brains of people with ADHD.... more
What Do We Know About the Value of Daily Exercise? The evidence is solid and plentiful on this question: Regular, intense physical exercise is good for everyone’s brain and particularly helpful for the brains of people with ADHD. Scientists have known the basic truth...
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Irritability is common in Attention-Deficit Hyperactivity Disorder (ADHD), but little is known about whether irritability predicts the course of ADHD symptoms over time. Adolescence is a dynamic period of emotional development as well as... more
Irritability is common in Attention-Deficit Hyperactivity Disorder (ADHD), but little is known about whether irritability predicts the course of ADHD symptoms over time. Adolescence is a dynamic period of emotional development as well as shifts in ADHD symptoms; an important goal is to identify youth at risk of increasing or persisting symptoms. We examined irritability as a longitudinal predictor of change in adolescents’ ADHD symptoms, as well as how this link may differ in females versus males. The sample included 108 youth (72 males) age 12–16 years (M = 14.21 years, SD = 1.44 years), 62 of whom met criteria for ADHD. Approximately 18 months later, 80 participants (48 males) were followed up at Time 2. A dimensional approach was used to examine changes over time in parent-reported inattentive and hyperactive/impulsive symptoms. Longitudinal path analysis revealed that irritability at Time 1 predicted higher relative hyperactive/impulsive symptoms at Time 2 after controlling for age and longitudinal stability in all variables. A multiple-group analysis examining moderation by sex/gender revealed that this association was significant only for females. These results suggest that irritability may play a key role in the persistence and worsening of hyperactive/impulsive symptoms across adolescence for females, with potential implications for the diagnosis and treatment of females with ADHD.
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ADHD is a worldwide phenomenon of considerable importance, having generated major controversy throughout its history. In this chapter we emphasize the confluence of biological vulnerabilities and contextual influences essential for its... more
ADHD is a worldwide phenomenon of considerable importance, having generated major controversy throughout its history. In this chapter we emphasize the confluence of biological vulnerabilities and contextual influences essential for its manifestations. We also provide information on the sharp rises in both diagnosed prevalence and rates of medication treatment in recent years, providing a case example from the US pertaining to the influences of educational policies as one trigger of such increases. We conclude with commentary on the need for integrative and integrated perspectives on both the origins of ADHD and evidence-based treatments. Even though ADHD has important heritable and biological roots, its symptoms and impairments are amplified or diminished in homes and schools, and multimodal treatments are optimal for enhancing competence. Moreover, societal context and policy clearly shape diagnostic trends. We emphasize the need for integrative perspectives on ADHD, as reductionistic viewpoints polarize essential dialogue.
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Objective: We examined the predictive relation between childhood-diagnosed ADHD and trajectories of body mass index (BMI) from childhood to adulthood in an all-female sample, accounting for socioeconomic status (SES), childhood... more
Objective: We examined the predictive relation between childhood-diagnosed ADHD and trajectories of body mass index (BMI) from childhood to adulthood in an all-female sample, accounting for socioeconomic status (SES), childhood comorbidities (e.g., depression/anxiety), and stimulant usage. Childhood executive functioning (i.e., planning, sustained attention, and response inhibition) was also evaluated as a possible predictor of BMI trajectories.Method: We utilized longitudinal data from a full sample of 140 girls diagnosed with ADHD in childhood and 88 comparison girls matched on age and ethnicity. Girls were 6-12 years old at the first assessment and followed prospectively for 16 years. Data were collected on their BMI and stimulant medication usage across four evaluation waves. Using latent growth curve modeling, we evaluated the BMI trajectories of girls with ADHD and the comparison sample from childhood to adulthood.Results: Although there was no significant difference in initial childhood BMI, girls with ADHD increased in BMI at a significantly faster rate than comparison girls across development, even when adjusting for covariates. Significant differences in BMI first emerged in adolescence; by adulthood, 40.2% of the ADHD sample met criteria for obesity versus 15.4% of the comparison sample. When covarying ADHD diagnosis, executive functioning measures were not significantly predictive of BMI increase. Adjusting for stimulant medication usage within the ADHD sample did not alter core findings.Conclusions: We discuss health-related implications for girls with ADHD, potential underlying mechanisms, and how our findings may inform both ADHD and obesity interventions.
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Objective: Individuals with late-onset symptoms of attention-deficit/hyperactivity disorder (ADHD) are presenting to providers at increasing rates. Recent birth-cohort studies reveal evidence for late-onset ADHD, but conclusions are... more
Objective: Individuals with late-onset symptoms of attention-deficit/hyperactivity disorder (ADHD) are presenting to providers at increasing rates. Recent birth-cohort studies reveal evidence for late-onset ADHD, but conclusions are challenged by measurement methods as well as presence of participant impairment and psychiatric comorbidities. We examined the occurrence of late-onset ADHD in a small but thoroughly investigated group of diverse (47% white) women followed from childhood to adulthood. Method: From a larger, 16-year longitudinal study, a subsample of young women without childhood ADHD (N = 87) was assessed at four time points between childhood and adulthood via a multimethod, multiinformant approach. We used a stepped diagnostic procedure to identify those who initially met symptom criteria for ADHD after childhood and then evaluated them for remaining DSM ADHD diagnostic criteria, including impairment, cross-situational symptoms, and comorbid diagnoses. Results: Of 87 participants, 17 met ADHD symptom criteria after childhood. Fifteen showed no evidence of childhood onset, 10 showed clear evidence of impairment, and nine had cross-situational symptoms. Of these nine, all but one showed clinically significant co-occurring or preexisting psychiatric diagnoses and/or substance use that might account for ADHD symptoms. Conclusions: Although 19.5% of women from our subsample without childhood ADHD met symptom criteria for ADHD during adolescence/adulthood, only one showed the needed combination of impairment and cross-situational symptoms without significant co-occurring mental health problems. It is possible that uncomplicated cases of adult ADHD do arise, yet we find little supporting evidence herein.
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Page 49. 2 Childhood Attention-Deficit Hyperactivity Disorder: Pharmacological Treatments Laurence L. Greenhill Rebecca E. Ford More than 180 placebo-controlled investigations demonstrate that psychostimulantsthe meth ...
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Mental health stigma is arguably the fundamental issue in the entire mental health field, including developmental psychopathology, given its impact on every participant in the enterprise: scientists, clinicians, social theorists,... more
Mental health stigma is arguably the fundamental issue in the entire mental health field, including developmental psychopathology, given its impact on every participant in the enterprise: scientists, clinicians, social theorists, policymakers, and those contending with mental disorder as well as their many associates. This chapter synthesizes core findings in mental health stigma research and articulates strategies to strengthen its explanatory and applied reach. Specifically, topics include theoretical perspectives on stigma (including social psychological and evolutionary approaches), historical accounts, empirical and cultural evidence for stigma, intersecting developmental themes, future research directions, and strategies to overcome mental health stigma. The chapter includes an integrative theoretical model, incorporating the vantage point of the social perceiver (the person doing the stigmatizing) and the target (the experiencer) of that stigma. It is concluded that although stigma processes may be universal—given evidence that stigma is pancultural and even evolutionarily wired into the mind/brain as an “us” versus “them” module—it can nevertheless be meaningfully reduced. Stigma reduction efforts must consist of multilevel interventions that leverage psychological, family, community, and policy factors. Keywords: discrimination; evolutionary; contact; social cognition; attribution; prejudice; mental health stigma
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Now over 10 years old, the Research Domain Criteria (RDoC) has gained impressive traction in the adult psychopathology literature, but enthusiasm among child and adolescent psychopathologists lags somewhat behind. We consider possible... more
Now over 10 years old, the Research Domain Criteria (RDoC) has gained impressive traction in the adult psychopathology literature, but enthusiasm among child and adolescent psychopathologists lags somewhat behind. We consider possible reasons why RDoC has not been embraced fully in the child and adolescent literatures. We emphasize common, interrelated, and sometimes outdated assumptions that impede scientific progress that RDoC could facilitate. Traditionally, child and adolescent psychopathologists have used behavioral syndromes as gold standards against which biological markers are validated, even though behavioral syndromes are often measured with less precision; sought to identify large main effects of single biological functions on single behavioral syndromes, thereby ignoring (even if implicitly) the overwhelming etiological complexity of psychopathology; expected 1:1 correspondencies between biological functions and behaviors, despite evidence that core biological systems subserving behavior are functionally interdependent (i.e., modulate one another); and failed to consider neurobiological mechanisms of homotypic and heterotypic comorbidity and continuity. Using examples from our work, we show how a developmental, RDoC-informed approach to externalizing behavior enriches our understanding of psychopathology. We also provide an agenda for future research, which includes calls to (1) adopt neural-systems-first approaches over disorder-first approaches when studying psychopathology, (2) eschew biological reductionism by integrating environmental risk mediators into our etiopathophysiological models, (3) integrate neural vulnerabilities into the empirical latent structure of psychopathology, and (4) replace null hypothesis significance testing with computational approaches that accommodate etiological complexity by evaluating functional dependencies among RDoC constructs, including positive valence systems (approach), negative valence systems (avoidance), and arousal/regulatory systems (self-regulation).
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How Many US Children and Adults are Taking Medication for ADHD? In 2015, more than two-thirds of US children and adolescents diagnosed with ADHD were taking medication. By the most recent estimates, that works out to be close to 4 million... more
How Many US Children and Adults are Taking Medication for ADHD? In 2015, more than two-thirds of US children and adolescents diagnosed with ADHD were taking medication. By the most recent estimates, that works out to be close to 4 million youth. The vast...
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How Do ADHD Rates Vary Between Males and Females? An enduring myth about ADHD is that it affects only or mainly boys. For much of the twentieth century, five to as many as 10 boys for every girl were diagnosed with the disorder. More...
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What is the Most Common Cause of ADHD? (Spoiler Alert: It Runs in Families) ADHD can be caused by one or more of several different factors that we’ll list and explain in this chapter. But by far the single most common way to get...