Hello. We are The Association for Child and Adolescent Mental Health, or ACAMH for short. Hi. My name is Aja Murray, and I'm a lecturer in psychology at the University of Edinburgh, and I'm here with Lydia Speyer to talk about our recent paper in JCPP called "A symptom level perspective on reactive and proactive aggressive behaviours and ADHD symptoms in childhood." So the motivation for this paper is that we know from past research that ADHD symptoms are commonly associated with aggressive behaviours and that these aggressive behaviours are quite an important source of impairment for children. Often, in fact, it's what drives referral to mental health services. And that makes it quite important to understand what the links are between ADHD symptoms and aggression from the point of view of informing prevention and treatment for these aggressive behaviours among this group. However, we also know that ADHD symptoms and aggression are highly heterogeneous, and that makes it really important to take a symptom-level perspective and examine which symptoms of ADHD in particular are linked to which types of aggression in particular. So for example, within ADHD symptoms, we make a distinction between attention issues, such as having difficulty with concentrating for a long time, hyperactivity issues, such as having problems with remaining seated, and impulsivity issues, such as not thinking before acting or having difficulty with delaying gratification. On the other hand, we also make distinctions within aggression, and a really important distinction between different types of aggressive behaviours is that between proactive aggression, which is instrumental, emotionally cold aggressive behaviours, and reactive aggression, which is much more emotionally hot, impulsive, under-controlled forms of aggressive behaviour. There has been some speculation previously that different ADHD symptoms might be differentially related to different aspects of aggression. And if that's the case, and if we can identify these specific links, then that provides us with some information to essentially provide more refined targeting of treatments based on which specific ADHD symptoms are risk factors for which specific types of aggression. So that's the background of our paper, and I'll handover now to Lydia to explain a bit about the methodology and what we found in that paper. Thank you. So in this study, we used data from the Zurich Project on the Social Development from Childhood to Adulthood. So set processes with longitudinal cohort study that has been following the lives of around 1,500 children from age seven up until today. And in this specific study, we used data from the age 7, 9, and 11 waves of z-proso. And our aim was to investigate whether specific ADHD symptoms are particularly strongly connected to specific aggressive behaviours longitudinally. And our aim was really to identify potentially ADHD symptoms that would represent priority targets for the prevention of aggressive behaviours. So within z-proso, ADHD symptoms and aggressive behaviours measured using the social behaviour questionnaire, and that was completed by parents in the computer system interviews when children were age 7, 9, and 11. The SBQ measures children's psycho-social development in a number of different domains and, amongst others, includes five items on relating to symptoms of inattentiveness, four items relating to symptoms of hyperactivity and impulsivity, and then it also includes four items relating to proactive aggressive behaviours and three items relating to reactive aggressive behaviours. And those are all rated by parents on the five-point Likert scale. And once we had those individual items, we used those to build longitudinal symptom networks that met different ADHD symptoms onto aggressive behaviours over time. So the specific type of model we used was a graphic vector ordinal regression model. So this model is quite useful for these kind of analysis as it allows us to disentangle within-person effects from between-person effects. And so what we mean by within-person effects here is that we refer to how changes in ADHD symptoms relate to subsequent changes in aggressive behaviours within the same individual, whereas between-person effects refer to effects relating to between-person differences such as genetic predispositions or stable effects of the family environment that may be associated with both ADHD symptoms and aggressive behaviours. And this distinction is really important in the context of investigating interrelations between ADHD and aggressive behaviours, as most interventions are going to be targeted at the within-person level. So we used that kind of model to really get a clear distinction between those two effects. So results of our longitudinal model suggested, firstly, that aggressive behaviours and ADHD symptoms shared relatively strong temporal connections within the respective domains. So that means, for example, a specific ADHD symptom at time one was associated with increases in other ADHD symptoms over subsequent time points. And the same was true for aggressive behaviours. However, we also found that ADHD symptoms were linked to a number of different aggressive behaviours, and we found that the symptom child is inattentive had the strongest influence generally on aggressive behaviours over time. And then what we also found, that there were actually reciprocal relations between ADHD and aggressive symptoms, and those were actually particularly strong for proactive aggressive behaviours in addition to one reactive aggressive behaviour item. So those were associated with higher ADHD symptoms over time. So overall, one of the key findings from our study really is that inattentive symptoms shared reciprocal relations with both reactive and proactive aggression, which highlights that those symptoms may play a central role in the development of aggressive behaviours and may, in fact, even be exacerbated by engagement aggression. Now I'm going to handover to Aja to talk a bit more about what these findings mean. So the bi-directional relations that we found between inattention on both reactive and proactive aggression I think are interesting for several reasons. First, they point to some specific symptoms that might be of the highest priority for intervention when it comes to preventing multiple different types of aggressive behaviours, not just reactive aggression, but both reactive and proactive aggression. They also suggest that interestingly, targeting aggressive behaviours with intervention could actually potentially lead to improvements in ADHD symptoms as well as the reverse. And finally, they point to some potential mechanisms by which ADHD symptoms could engender risk for aggressive behaviour, and these could be explored in future research. So for example, the fact that inattention was so important in these links suggests that the aggression risk that we see in relation to ADHD symptoms might relate to difficulties in attending to and/or encoding social cues, which might mean that children with ADHD symptoms end up in more social situations that escalate to aggression. A key future direction, though, will be to examine whether using information about specific symptom links like the data showed us in this paper can help to improve the effectiveness of interventions, for example through better personalization to symptom profiles or equally to the prioritisation of specific symptoms as targets based on those that have got the strongest links to other symptoms and to key outcomes, such as aggression. So that's our paper in brief. You can read the full paper online in JCPP. Thank you very much. Find out more about becoming an ACAMH member. And to be part of the advancement of child and adolescent mental health, visit www.acamh.org.