published_or_final_version / abstract / toc / Educational Psychology / Master / Master of Social Sciences

published_or_final_version / abstract / toc / Psychology / Master / Master of Philosophy

published_or_final_version / abstract / Japanese Studies / Master / Master of Philosophy

published_or_final_version / Social Work and Social Administration / Master / Master of Social Sciences

published_or_final_version / Social Work / Master / Master of Social Sciences

Objective: Current studies examining the co-morbidity patterns of ADHD with internalizing disorders have reported inconsistent findings. Some studies have found that the inattentive subtype (ADHD-I) is more likely to be comorbid with internalizing disorders, while other studies found similar levels of comorbid internalizing disorders between the ADHD subtypes. Moreover, anxiety and depression were found to be comorbid in inattentive children high in sluggish cognitive tempo (SCT), characterized by features of sluggishness, drowsiness, and daydreaming. SCT has been postulated to be useful in discriminating a distinct inattentive subtype of ADHD-I with a different pattern of impairments. More recently, low levels of behavioral inhibition (BI)—manifested in the form of disinhibited behaviors—have also been implicated in the development of ADHD in children. The current study examines the relationships between ADHD and internalizing symptoms. The roles of SCT and BI in ADHD and internalizing symptoms are also investigated. Methods: The sample was comprised of 1,965 Hong Kong primary students between 8 and 14 years old and their parents/caregivers from 10 local schools. The children completed two self-report scales: the Revised Children Anxiety and Depression Scale (RCADS) and the Behavioral Inhibition System Scale (BISS). Their parents/caregivers completed three scales: the Attention Deficit Hyperactivity Disorder Rating Scale–IV (ADHDRS-IV), the Oppositional Defiant Disorder Scale (ODDS), and the Sluggish Cognitive Tempo Scale (SCTS). Using a psychometric approach, the relationships between the symptom clusters of ADHD (inattention and hyperactivity-impulsivity), anxiety, depression, SCT, and BI were systematically examined with correlation, regression, and factor analyses. A categorical approach was also used to classify children meeting the DSM symptom criteria to compare levels of internalizing symptoms among the three subtypes of ADHD: ADHD-I, ADHD-HI (hyperactive-impulsive), and ADHD-C (combined hyperactive and inattentive). An SCT cutoff score of 20 (the mean SCT rating among ADHD-I children) was used to further divide the ADHD-I into high- and low-SCT subgroups for planned between-group comparisons. Results: In the dimensional analyses, the inattention dimension of ADHD correlated slightly higher than the hyperactivity-impulsivity dimension with anxiety and depression as predicted. But the hyperactivity-impulsivity dimension was also significantly correlated with anxiety and depression, suggesting that hyperactive children were as likely as inattentive children to feel anxious and depressed. Regression analyses found that inattention was not predictive of anxiety and depression, while hyperactivity-impulsivity was marginally predictive of anxiety, but not depression. BI and SCT emerged as significant predictors of internalizing symptoms after controlling for age, gender, and ODD symptoms. There was evidence that SCT mediated the relationship between anxiety/depression and inattention symptoms. Using the categorical approach, between-group differences were found between the ADHD subtypes and the no-ADHD category. ADHD-I children were more anxious and depressed than children without ADHD. Differences in depressive symptoms were found between the ADHD subtypes. Children with ADHD-I had higher levels of depressive symptoms when compared to children with ADHD-HI and ADHD-C. Contrary to predictions, however, the high-SCT ADHD-I group and the low-SCT ADHD-I group did not differ in symptom levels for any anxiety disorders, major depressive disorder, or externalizing symptoms of ODD. Subtype differences in comorbid anxiety were found to be related to gender differences. The symptom levels of panic disorder were higher in females with ADHD-I, and the symptom levels of separation-anxiety disorder were higher for females with ADHD-C. Inattentive girls might present with higher levels of anxiety symptoms than boys. Conclusions: Consistent with previous studies, children with ADHD were more comorbid with anxiety and depression than children without ADHD. In addition, children with ADHD-I were more comorbid with depressive symptoms than children with ADHD-HI and ADHD-C. The higher ratings of depression in ADHD-I children appeared to be related to higher ratings of SCT found in this subtype. There was no difference in anxiety symptoms among the ADHD subtypes, but girls with clinical levels of inattention tend to experience a wider spectrum of anxiety disorders than boys. Contrary to previous research, the findings did not support the idea that SCT is useful in discriminating a distinct inattentive subtype, since this study found no comorbidity differences between the high-SCT ADHD-I and low-SCT ADHD-I groups. Despite the fact that the ADHD-I group had higher BI, there was no evidence that they had higher anxiety symptoms. Reasons for the lack of a direct relationship between BI and internalizing symptoms in ADHD are discussed. The complex roles of SCT and BI in ADHD symptoms and internalizing symptoms call for the need of further local investigation in both clinical and community samples. / published_or_final_version / Clinical Psychology / Doctoral / Doctor of Psychology

Background: The problem of poverty in Hong Kong is worsening, particularly the disparity between the rich and poor. Although much of the public concern about this problem has concentrated on the physical development of children, the effect of disparity between the rich and poor on their psychological well-being remains relatively underexplored. A review of the literature revealed that most studies on the psychological effect of disparity between the rich and poor have been conducted in Western countries only. This study aimed to bridge this gap. Its objectives were (1) to compare the self-esteem, depressive symptoms and quality of life (QoL) of children from low- and high-income families, (2) to identify the socioeconomic and demographic characteristics affecting the psychological well-being of children, (3) to compare the livelihoods of children from low- and high-income families, and (4) to examine the effectiveness of adventure-based programme in promoting the psychological well-being of children living in poverty. Methods: This study consisted of a survey study and a pilot RCT. The survey study was conducted in 12 primary schools from the three highest and the three lowest median household income districts. A total of 1,725 children were recruited, with 898 from low-income families and 827 from high-income families. The self-esteem, depressive symptoms and QoL of them were assessed and compared. Additional 42 children were chosen to have semi-structured interviews. As for the pilot RCT, it was conducted in two primary schools in Kwai Chung Estate. A total of 120 children were recruited, of whom 56 were randomly assigned to the experimental group to receive adventure-based programme and 64 to the control group to have placebo programme. Results: For the survey study, the results showed that the children from low-income families scored significantly lower on self-esteem and QoL, and higher on depressive symptoms than the children from high-income families. Moreover, the disparity between the rich and poor was found to have the greatest impact on children's self-esteem. Regression analyses showed that housing type made the largest contribution to children's self-esteem, depressive symptoms and QoL. Additionally, the daily lives of children from low-income families were seriously affected in terms of living environment, physical health, social lives and ability to function at school. Concerning the pilot RCT, mixed between-within subjects ANOVA showed that the children in experimental group scored significantly lower on depressive symptoms and higher self-esteem than those in control group. However, such a significant effect was not found on QoL. Conclusion: The survey study provides further evidence that disparity between the rich and poor has a negative effect on children's psychological well-being. Additionally, the pilot RCT demonstrated the effectiveness of adventure-based programme in promoting the psychological well-being of children living in poverty. Implications for practice: It is vital for healthcare professionals to develop and implement appropriate interventions that promote the psychological well-being of this vulnerable group. Moreover, healthcare professionals should go beyond their normal roles to build multidisciplinary partnerships with schools and the community to promote psychological well-being among children living in poverty. / published_or_final_version / Nursing Studies / Master / Master of Philosophy

published_or_final_version / abstract / toc / Education / Master / Master of Education

published_or_final_version / abstract / toc / Education / Master / Master of Education

published_or_final_version / Education / Master / Master of Education