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Predicting Flourishing in ADHD Youth: Positive Childhood Experiences and Mood Disturbances in Context of Adversity

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Title: Predicting Flourishing in ADHD Youth: Positive Childhood Experiences and Mood Disturbances in Context of Adversity
Language: English
Authors: Patricia Bianca Torres (ORCID 0009-0007-1010-040X), Daniel Andre Ignacio (ORCID 0000-0002-1045-8328), Nathan M. Griffith, Jessica Emick (ORCID 0000-0001-6762-8706)
Source: Journal of Attention Disorders. 2026 30(4):476-492.
Availability: SAGE Publications. 2455 Teller Road, Thousand Oaks, CA 91320. Tel: 800-818-7243; Tel: 805-499-9774; Fax: 800-583-2665; e-mail: journals@sagepub.com; Web site: https://sagepub.com
Peer Reviewed: Y
Page Count: 17
Publication Date: 2026
Document Type: Journal Articles
Reports - Research
Descriptors: Attention Deficit Hyperactivity Disorder, Predictor Variables, Well Being, Resilience (Psychology), Children, Adolescents, Individual Characteristics, Intervention, Trauma, Early Experience, Anxiety, Depression (Psychology), Mental Disorders
DOI: 10.1177/10870547251375513
ISSN: 1087-0547
1557-1246
Abstract: Background: In response to the increasing prevalence of ADHD, efforts have focused on understanding methods to optimize psychosocial, emotional, and behavioral well-being, defined as flourishing. Mood disturbances, environmental vulnerabilities, and Adverse Childhood Experiences (ACEs) are risk factors for not flourishing. There is limited research on protective relational factors, as measured by Positive Childhood Experiences (PCEs), as facilitators of flourishing in children with ADHD and comorbid mood disturbances. Method: Using a nationally representative sample of 4,847 children, aged 6 to 17 years-old, currently diagnosed with ADHD, hierarchical binary logistic regression examined whether the number of PCEs present for children with and without mood disturbances could significantly predict who was flourishing or not. The initial model included demographics, ADHD treatment-related variables, and the number of ACEs encountered. Results: After controlling for covariates, the odds of flourishing measured by the Child Flourishing Index (CFI) for children with ADHD were 7.31 [4.51, 11.86] times greater for those with 6 to 7 PCEs compared to peers with 0 to 2 PCEs, and 3.37 [2.24, 5.06] times greater for those with 3 to 5 PCEs relative to peers with 0 to 2 PCEs. Furthermore, parents who reported their children had neither current anxiety nor depression were 2.92 [1.87, 4.55] times more likely to flourish than children currently reported to have both anxiety and depression. These associations were consistent regardless of the level of ACEs. Conclusions: Our findings suggest that more PCEs and the absence of mood disturbance may attenuate the influence of ACEs on healthy adjustment for children with ADHD. Encouraging resilience in families, connecting with caregivers, and community volunteering were the most predictive positive childhood experiences of flourishing in this national sample of youth with ADHD and comorbid mood disturbance. Current results also provide guidance for future research on PCEs measurement, screening for comorbidities, and clinical intervention in neurodiverse samples.
Abstractor: As Provided
Entry Date: 2026
Accession Number: EJ1500115
Database: ERIC
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  Value: <anid>AN0192008566;gs001apr.26;2026Mar05.05:44;v2.2.500</anid> <title id="AN0192008566-1">Predicting Flourishing in ADHD Youth: Positive Childhood Experiences and Mood Disturbances in Context of Adversity </title> <p>Background: In response to the increasing prevalence of ADHD, efforts have focused on understanding methods to optimize psychosocial, emotional, and behavioral well-being, defined as flourishing. Mood disturbances, environmental vulnerabilities, and Adverse Childhood Experiences (ACEs) are risk factors for not flourishing. There is limited research on protective relational factors, as measured by Positive Childhood Experiences (PCEs), as facilitators of flourishing in children with ADHD and comorbid mood disturbances. Method: Using a nationally representative sample of 4,847 children, aged 6 to 17 years-old, currently diagnosed with ADHD, hierarchical binary logistic regression examined whether the number of PCEs present for children with and without mood disturbances could significantly predict who was flourishing or not. The initial model included demographics, ADHD treatment-related variables, and the number of ACEs encountered. Results: After controlling for covariates, the odds of flourishing measured by the Child Flourishing Index (CFI) for children with ADHD were 7.31 [4.51, 11.86] times greater for those with 6 to 7 PCEs compared to peers with 0 to 2 PCEs, and 3.37 [2.24, 5.06] times greater for those with 3 to 5 PCEs relative to peers with 0 to 2 PCEs. Furthermore, parents who reported their children had neither current anxiety nor depression were 2.92 [1.87, 4.55] times more likely to flourish than children currently reported to have both anxiety and depression. These associations were consistent regardless of the level of ACEs. Conclusions: Our findings suggest that more PCEs and the absence of mood disturbance may attenuate the influence of ACEs on healthy adjustment for children with ADHD. Encouraging resilience in families, connecting with caregivers, and community volunteering were the most predictive positive childhood experiences of flourishing in this national sample of youth with ADHD and comorbid mood disturbance. Current results also provide guidance for future research on PCEs measurement, screening for comorbidities, and clinical intervention in neurodiverse samples.</p> <p>Keywords: ADHD; pediatric flourishing; mood disorders; positive childhood experiences; adverse childhood experiences</p> <hd id="AN0192008566-2">Introduction</hd> <p>The prevalence of children who currently have ADHD in the United States increased from 6 million in 2019 ([<reflink idref="bib11" id="ref1">11</reflink>]) to 7 million in 2022, according to the National Survey of Children's Health (NSCH; [<reflink idref="bib27" id="ref2">27</reflink>]). ADHD is a condition characterized by difficulties in attention, impulsivity, and hyperactivity that can be a significant stressor for children and their families ([<reflink idref="bib84" id="ref3">84</reflink>]). Those who cope effectively with adversity, as opposed to those who struggle, have been suggested to be supported by protective family and community systems ([<reflink idref="bib44" id="ref4">44</reflink>]). Indeed, families experiencing caregiving challenges related to children with special needs related to chronic conditions are at increased risk for adverse circumstances ([<reflink idref="bib23" id="ref5">23</reflink>]). "Complex ADHD" is defined as this neurodevelopmental condition accompanied by additional complicating factors (e.g., behavioral disturbances and mental health conditions) that make diagnosis and treatment more challenging ([<reflink idref="bib5" id="ref6">5</reflink>]). In 2022 NSCH data, [<reflink idref="bib27" id="ref7">27</reflink>] estimated that 77.9% of children with ADHD had at least one co-occurring mood disturbance (e.g., anxiety and depression). The increased total number of children currently diagnosed with ADHD underscores the importance of identifying protective mechanisms to buffer against risk factors and enhance adaptive outcomes ([<reflink idref="bib20" id="ref8">20</reflink>]).</p> <hd id="AN0192008566-3">Risk Factors</hd> <p>While a number of factors are known to impact developmental outcomes, a study reviewing the impacts of symptom severity of ADHD with comorbid anxiety revealed that those with comorbidity had higher emotional lability and negativity, as well as poorer emotional regulation abilities in comparison to those with ADHD alone ([<reflink idref="bib2" id="ref9">2</reflink>]). In context, children with ADHD and both anxiety and depression were found to be 10 times more likely to have poorer academic performance than those with ADHD and no comorbidity ([<reflink idref="bib26" id="ref10">26</reflink>]). Lower levels of early educational attainment may then further exacerbate the cycle of adversity and its consequences over time as families with low levels of education have also been identified as a risk factor for toxic stress ([<reflink idref="bib50" id="ref11">50</reflink>]), which is defined as prolonged activation of the nervous system's stress response due to chronic adversity and is associated with negative consequences for emotional regulation, cognitive development, and overall health ([<reflink idref="bib77" id="ref12">77</reflink>]). Conversely, performing well in school is considered to be protective for families against the occurrence of early childhood adversity ([<reflink idref="bib43" id="ref13">43</reflink>]). Treatment guidelines have recently been added by the Society of Developmental and Behavioral Pediatrics to encourage screening of ADHD and comorbidities ([<reflink idref="bib35" id="ref14">35</reflink>]) to reduce the likelihood of dysfunctional outcomes across various domains: behavioral (e.g., outbursts; [<reflink idref="bib42" id="ref15">42</reflink>]), social (e.g., familial relationships; [<reflink idref="bib83" id="ref16">83</reflink>]), and academic performance ([<reflink idref="bib3" id="ref17">3</reflink>]).</p> <hd id="AN0192008566-4">Adverse Childhood Experiences</hd> <p>Adverse Childhood Experiences (ACEs) refer to traumatic and prolonged stressful events or circumstances that children endure prior to the age of 18 years that have been associated with a range of negative behavioral, psychological, and developmental consequences ([<reflink idref="bib38" id="ref18">38</reflink>]). For example, results from a latent class analysis using 2018 NSCH data examining the association between ACEs and behavioral problems and depression in adolescents with ADHD, aged 11 to 17 years old, demonstrated that those who endorsed having high-risk ACEs (i.e., parental/guardian incarceration and witnessing domestic violence) had a higher likelihood of behavioral issues and depression ([<reflink idref="bib82" id="ref19">82</reflink>]). Other studies suggest that children with ADHD have more ACE exposure than children without ADHD ([<reflink idref="bib15" id="ref20">15</reflink>]) and that those with 4 or more ACEs have higher odds of being diagnosed with moderate to severe ADHD than those who had experienced fewer than 4 ACES ([<reflink idref="bib24" id="ref21">24</reflink>]). The temporal relationship between ADHD and ACEs has received bidirectional support, which highlights this complexity.</p> <hd id="AN0192008566-5">Protective Factors</hd> <p>Identifying protective factors for children with ADHD is an important clinical target considering the heightened risk reported for adverse adult outcomes, such as legal trouble and substance use ([<reflink idref="bib36" id="ref22">36</reflink>]; [<reflink idref="bib48" id="ref23">48</reflink>]). In general, lower nurturance in childhood is associated with maladaptive outcomes in adulthood, such as greater poverty ([<reflink idref="bib66" id="ref24">66</reflink>]), higher job-related stress ([<reflink idref="bib49" id="ref25">49</reflink>]), and poorer overall health and resilience ([<reflink idref="bib32" id="ref26">32</reflink>]), suggesting psychosocial vulnerability may be attenuated by positive mechanisms like perceived social support ([<reflink idref="bib4" id="ref27">4</reflink>]; [<reflink idref="bib63" id="ref28">63</reflink>]; [<reflink idref="bib79" id="ref29">79</reflink>]). Research has suggested that individuals with ADHD tend to have lesser degrees of self-control and increased emotional dysregulation ([<reflink idref="bib81" id="ref30">81</reflink>]). A longitudinal study over 2 years revealed that family climate was associated with decreases in ADHD symptoms with high social support as a significant moderator ([<reflink idref="bib101" id="ref31">101</reflink>]). For example, a supportive family environment that emphasizes structure and positive reinforcement can be essential in managing the sequela of ADHD. According to [<reflink idref="bib88" id="ref32">88</reflink>], family resilience is comprised of four components: communication, problem-solving, emotional support, and cohesion. Healthy communication helps families address problems and resolve difficult conflicts collaboratively and non-defensively, rather than becoming overwhelmed or disengaged. In the 2016 to 2017 NSCH, typically developing children of parents who endorsed low parental aggravation (positive parenting behavior) were over six times more likely to be flourishing than children of parents who endorsed high levels of parental aggravation (e.g., bothered by their child, angry with their child; [<reflink idref="bib52" id="ref33">52</reflink>]). In another study reviewing data on children with ADHD from the 2016 to 2017 NSCH, family cohesion and community support were also shown to positively influence clinical, academic, and social outcomes ([<reflink idref="bib30" id="ref34">30</reflink>]), which corroborate findings for neurotypical children that socioeconomic and family factors are critical in overall health outcomes (C. D. [<reflink idref="bib7" id="ref35">7</reflink>]; [<reflink idref="bib45" id="ref36">45</reflink>]; [<reflink idref="bib69" id="ref37">69</reflink>]).</p> <p>Youth with positive peer networks are protective against ACEs ([<reflink idref="bib45" id="ref38">45</reflink>]), which further supports the proposed psychosocial mechanism underlying the development of resilience. A review of 176 studies supports protective relationship factors as a mechanism for the development of resilience in neurodivergent populations ([<reflink idref="bib12" id="ref39">12</reflink>]). Furthermore, another review of 21 cross-sectional and longitudinal studies examining resilience in children suggested that family cohesion, positive parenting behaviors, and social acceptance may counteract the deleterious effects of adversity on adaptive outcomes in children with ADHD ([<reflink idref="bib31" id="ref40">31</reflink>]). With the shift to focus on promoting protective mechanisms, researchers have acknowledged the significance of studying systemic approaches to bolster relational and community health among various populations and outcomes in a manner that extends beyond the absence of disorder or mitigation of risk factors ([<reflink idref="bib46" id="ref41">46</reflink>]; [<reflink idref="bib76" id="ref42">76</reflink>]; [<reflink idref="bib86" id="ref43">86</reflink>]; [<reflink idref="bib95" id="ref44">95</reflink>]; [<reflink idref="bib96" id="ref45">96</reflink>]).</p> <hd id="AN0192008566-6">Positive Childhood Experiences</hd> <p>In the recent decades, a growing body of literature has focused on studying the association of more adaptive and benevolent experiences with maladaptive outcomes (C. [<reflink idref="bib9" id="ref46">9</reflink>]; [<reflink idref="bib47" id="ref47">47</reflink>]; [<reflink idref="bib67" id="ref48">67</reflink>]; [<reflink idref="bib69" id="ref49">69</reflink>]). Supportive home, school, and community environments have been proposed to serve as safeguards against childhood adversity and suboptimal mental health ([<reflink idref="bib76" id="ref50">76</reflink>]). The Healthy Outcomes from Positive Experiences (HOPE) framework was designed to promote child and parent health where the healthy parent-child relationship, accompanied by the interplay of community and social support, helps achieve optimal child health outcomes ([<reflink idref="bib76" id="ref51">76</reflink>]). The HOPE framework emphasizes four domains of PCEs: the presence of supportive and nurturing relationships, an ability to develop and learn in safe and protective environments, opportunities for constructive social connectedness, and the enhancement of socioemotional competencies.</p> <p>Positive childhood experiences (PCEs) refer to the events, activities, and situations that enhance a child's life and promote successful mental and physical health outcomes in a dose-dependent fashion ([<reflink idref="bib69" id="ref52">69</reflink>]; [<reflink idref="bib80" id="ref53">80</reflink>]; [<reflink idref="bib100" id="ref54">100</reflink>]; [<reflink idref="bib103" id="ref55">103</reflink>]). While there is not a single defining measure for PCEs, there have been efforts to develop measures of key concepts, including safe, nurturing, and supportive environments (C. [<reflink idref="bib8" id="ref56">8</reflink>]; [<reflink idref="bib25" id="ref57">25</reflink>]; [<reflink idref="bib34" id="ref58">34</reflink>]; [<reflink idref="bib45" id="ref59">45</reflink>]; [<reflink idref="bib71" id="ref60">71</reflink>]; [<reflink idref="bib73" id="ref61">73</reflink>]; [<reflink idref="bib99" id="ref62">99</reflink>]). The 2022 NSCH dataset includes seven items from the Child and Youth Resilience Measure-12 (CYRM-12), an internally consistent inventory (α =.84; [<reflink idref="bib60" id="ref63">60</reflink>]), to measure PCEs (C. [<reflink idref="bib8" id="ref64">8</reflink>]; [<reflink idref="bib74" id="ref65">74</reflink>]; [<reflink idref="bib102" id="ref66">102</reflink>]). Empirical evidence revealed heterogeneity in the measurement of PCEs citing multiple instruments with different specific items, such as the Protective and Compensatory Experiences scale ([<reflink idref="bib67" id="ref67">67</reflink>]) and the Benevolent Childhood Experience scale ([<reflink idref="bib69" id="ref68">69</reflink>]) in addition to the CYRM-12, which limits interpretation and direct comparability of research findings ([<reflink idref="bib73" id="ref69">73</reflink>]).</p> <p>Nonetheless, in a sample of pandemic-era youth with ACEs, having 6 or more PCEs was associated with better mental health and well-being than those with and without ACEs ([<reflink idref="bib74" id="ref70">74</reflink>]); moreover, PCEs significantly moderated the relationship between ACEs and depression. Their findings were consistent with a systematic review of PCEs and adult outcomes, where higher levels of PCEs were incrementally associated with more favorable outcomes including mental health and psychosocial functioning ([<reflink idref="bib47" id="ref71">47</reflink>]); the authors suggested that PCEs directly promote positive outcomes, rather than solely moderating the effects of adversity. Recent literature has, however, illustrated potential mechanisms underlying PCEs and positive outcomes such as flourishing. A study reviewing the impact of PCEs on those with ADHD found that higher PCEs indirectly related to improved emotion regulation through increased social support, specifically through self-esteem, belonging, and social connection ([<reflink idref="bib62" id="ref72">62</reflink>]). Hence, there is a clear need for additional research to substantiate what specific factors may promote positive outcomes for individuals with ADHD in the context of adversity.</p> <hd id="AN0192008566-7">Flourishing</hd> <p>Flourishing will be used as the outcome measure in the current study. With the shift from a disease perspective towards the study of positive and protective factors for children, the concept of flourishing has been a focus of recent research ([<reflink idref="bib37" id="ref73">37</reflink>]; [<reflink idref="bib87" id="ref74">87</reflink>]). The Early Relational Health framework builds from infant and early childhood mental health studies by corroborating the need to shift from disease prevention to a focus on promoting optimal development ([<reflink idref="bib97" id="ref75">97</reflink>]). Flourishing refers to the positive psychology concept of overall well-being that emphasizes an optimal range of functioning indicating personal growth and development ([<reflink idref="bib19" id="ref76">19</reflink>]; [<reflink idref="bib40" id="ref77">40</reflink>]) and self-esteem ([<reflink idref="bib1" id="ref78">1</reflink>]; C. D. [<reflink idref="bib9" id="ref79">9</reflink>]), where individuals "feel good about their lives in which they are functioning well" (C. L. [<reflink idref="bib55" id="ref80">55</reflink>], p. 101). The NSCH has since incorporated the key components of flourishing through the inclusion of the Child Flourishing Index (CFI; Children and Adolescent Health Measurement Initiative: NSCH, 2018). Research on flourishing as an outcome suggests that children with chronic illness (i.e., type-I diabetes) may have higher rates of flourishing if there are greater levels of family connection and support ([<reflink idref="bib93" id="ref81">93</reflink>], [<reflink idref="bib94" id="ref82">94</reflink>]). These findings corroborate the finding that children who have a better relationship with their parents have lower rates of depression and greater flourishing ([<reflink idref="bib53" id="ref83">53</reflink>]; [<reflink idref="bib91" id="ref84">91</reflink>]). Various national cross-sectional studies studying children's health have further concluded that family resilience and connection (e.g., promotion of stable, safe, and nurturing relationships; [<reflink idref="bib92" id="ref85">92</reflink>]; [<reflink idref="bib96" id="ref86">96</reflink>]) are associated with greater levels of flourishing ([<reflink idref="bib9" id="ref87">9</reflink>]; [<reflink idref="bib29" id="ref88">29</reflink>]; [<reflink idref="bib52" id="ref89">52</reflink>]; [<reflink idref="bib61" id="ref90">61</reflink>]; [<reflink idref="bib90" id="ref91">90</reflink>]). It is notable that the development of relational support and safety can be provided by others in the child's community (e.g., teachers, clinicians, coaches, neighbors, and relatives; [<reflink idref="bib39" id="ref92">39</reflink>]). However, research on flourishing in ADHD populations is limited.</p> <p>Currently available literature examining mental well-being outcomes in adult ADHD populations found that those with comorbid depression, anxiety, and chronic pain may have lesser degrees of complete mental health (CMH; Fuller-Thompson et al., 2022). The CMH framework is similar to flourishing, however, it focuses specifically on the absence of mental illness, substance dependence, and suicidality, in addition to the presence of happiness/life satisfaction, and social/psychological well-being (C. L. M. [<reflink idref="bib56" id="ref93">56</reflink>]). The one study examining pediatric ADHD utilized the 2022 NSCH to evaluate the relationship between the degree of PCEs and flourishing as stratified by increasing incidences of ACEs ([<reflink idref="bib102" id="ref94">102</reflink>]). Their study revealed that when considering PCEs as a predictor for flourishing, the odds of flourishing for children with 6 to 7 PCEs were 2.45 times higher than children with 3 to 5 PCEs, and that rates of flourishing in children with 0 to 2 PCEs were 1.39 times lower than those with 3 to 5 PCEs ([<reflink idref="bib102" id="ref95">102</reflink>]); these findings were consistent regardless of the number of ACEs present. When evaluating the seven PCEs included in their study, having a "connected caregiver," amongst other safe and supportive community experiences, was the strongest PCE associated with flourishing. However, there is still limited research on understanding how PCEs promote flourishing for children with ADHD and comorbid mood disturbance ([<reflink idref="bib16" id="ref96">16</reflink>]; [<reflink idref="bib87" id="ref97">87</reflink>]).</p> <hd id="AN0192008566-8">Objectives and Aims</hd> <p>The objective of the present study was to separately examine how ACEs, PCEs, and comorbid mood disturbances (i.e., anxiety or depression, anxiety and depression, neither) collectively predict flourishing in the present ADHD sample of youth, aged 6 to 17 years, using a two-block logistic regression model. Firstly, it was hypothesized that more instances of the 10-item ACEs ([<reflink idref="bib102" id="ref98">102</reflink>]) would significantly predict lower rates of flourishing, as measured by the 3-item Childhood Flourishing Index (CFI), after accounting for the other variables included in the first block (e.g., demographic and treatment factors). Secondly, it was hypothesized that more of the 7-item PCEs (C. [<reflink idref="bib8" id="ref99">8</reflink>]) endorsed would significantly predict greater flourishing over and above ACEs, demographic, and treatment variables in the first block. Thirdly, the nature of comorbid mood disturbances (i.e., depression or anxiety, both, neither) was hypothesized to be a significant second block predictor over and above the variables in the first block. Overall, PCEs, even in the presence of comorbid mood disturbances, were expected to attenuate the influence of adverse experiences. As a post-hoc analysis, the influence of each of the seven PCE items (i.e., guided mentor, resilient family, supportive community, safe community, after-school activities, community volunteering, and connected caregiver) was assessed individually, as opposed to aggregate groups. It was hypothesized that flourishing would be associated with having a connected caregiver and a resilient family.</p> <hd id="AN0192008566-9">Method</hd> <p>The study used cross-sectional data from the 2022 NSCH, a nationally representative sample of American children collected by the United States Census Bureau and funded by the United States Health Resources and Services Administration (HRSA). The Census Bureau randomly selected households across the United States with at least one child aged 0 to 17 years for data collection ([<reflink idref="bib17" id="ref100">17</reflink>]). Researchers gathered data through online and mailed surveys completed by parents. As in previous versions, the 2022 NSCH applied non-response sampling weights to account for the complex survey design and adjust for potential bias due to non-response. The full dataset is publicly available.</p> <hd id="AN0192008566-10">Participants</hd> <p>The 2022 NSCH included 54,103 children aged 0 to 17 years, and this study focused on caregivers who reported that their children currently had ADHD. The study sample was limited to children aged 6 to 17 years (<emph>M</emph> = 12.37, <emph>SD</emph> = 3.28) who were currently diagnosed with ADHD (<emph>N</emph> = 4,847). Researchers determined ADHD status based on parents' responses to the question, "Does this child have current or lifelong health conditions?" The response options were "Do not have condition," "Ever told, but do not currently have condition," and "Currently have condition." Only children whose parents selected "Currently have condition" for ADHD were included. The study excluded 371 children who had missing PCE or CFI data. The final sample consisted of 2,886 males (64.5%) and 1,590 females (35.5%). Researchers conducted weighted tests of independence to assess significant associations between inclusion or exclusion from the main study sample (Table 1).</p> <p>Table 1. Differences in Demographic Characteristics and Treatment Variables Between ADHD Children Included (n = 4,476) and Excluded (n = 371) in This Study, 2022 NSCH in the United States.</p> <p>Graph</p> <p> <ephtml> <table><colgroup><col align="left" /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /></colgroup><thead><tr><th align="center">Variable</th><th align="center">Included sample</th><th align="center">Excluded sample</th><th align="center">Statistic</th><th align="center"><italic>p</italic></th></tr></thead><tbody><tr><td>Age in years: <italic>M</italic> (<italic>SD</italic>)</td><td>12.34 (3.27)</td><td>12.66 (3.35)</td><td><italic>t</italic> = 1.79</td><td>.074</td></tr><tr><td>Sex: <italic>n</italic> (%)</td><td /><td /><td>χ2 = 0.04</td><td>.866</td></tr><tr><td> Male</td><td>2,886 (64.5)</td><td>241 (65.0)</td><td /><td /></tr><tr><td> Female</td><td>1,590 (35.5)</td><td>130 (35.0)</td><td /><td /></tr><tr><td>Race, ethnicity: <italic>n</italic> (%)</td><td /><td /><td>χ2 = 20.09</td><td><.001</td></tr><tr><td> White, non-Hispanic</td><td>3,203 (71.6)</td><td>232 (62.5)</td><td /><td /></tr><tr><td> Hispanic</td><td>566 (12.6)</td><td>55 (14.8)</td><td /><td /></tr><tr><td> Black, non-Hispanic</td><td>252 (5.6)</td><td>39 (10.5)</td><td /><td /></tr><tr><td> Multi-racial, non-Hispanic</td><td>455 (10.2)</td><td>45 (12.1)</td><td /><td /></tr><tr><td>FPL: <italic>n</italic> (%)</td><td /><td /><td>χ2 = 6.40</td><td>.094</td></tr><tr><td> 0–199% FPL</td><td>1,455 (32.5)</td><td>138 (37.2)</td><td /><td /></tr><tr><td> 200–299% FPL</td><td>753 (16.8)</td><td>60 (16.2)</td><td /><td /></tr><tr><td> 300–399% FPL</td><td>569 (12.7)</td><td>33 (8.9)</td><td /><td /></tr><tr><td> ≥400% FPL</td><td>1,699 (38.0)</td><td>140 (37.7)</td><td /><td /></tr><tr><td>Health insurance: <italic>n</italic> (%)</td><td /><td /><td>χ2 = 3.85</td><td>.055</td></tr><tr><td> Adequate/continuous insurance in past year</td><td>2,806 (62.8)</td><td>208 (57.6)</td><td /><td /></tr><tr><td> Inadequate insurance and/or gap in past year</td><td>1,661 (37.2)</td><td>153 (42.4)</td><td /><td /></tr><tr><td>Special education (IFSP, IEP): <italic>n</italic> (%)</td><td /><td /><td>χ2 = 0.16</td><td>.706</td></tr><tr><td> Yes</td><td>1,876 (41.9)</td><td>151 (40.7)</td><td /><td /></tr><tr><td> No</td><td>461 (10.3)</td><td>40 (10.8)</td><td /><td /></tr><tr><td>Severity of ADHD: <italic>n</italic> (%)</td><td /><td /><td>χ2 = 11.45</td><td>.003</td></tr><tr><td> Mild</td><td>1,809 (40.4)</td><td>154 (41.5)</td><td /><td /></tr><tr><td> Moderate</td><td>2,147 (48.0)</td><td>149 (40.2)</td><td /><td /></tr><tr><td> Severe</td><td>487 (10.9)</td><td>58 (15.6)</td><td /><td /></tr><tr><td>Current ADHD medication: <italic>n</italic> (%)</td><td /><td /><td>χ2 = 0.32</td><td>.581</td></tr><tr><td> Yes</td><td>2,622 (58.6)</td><td>210 (56.6)</td><td /><td /></tr><tr><td> No</td><td>1,831 (40.9)</td><td>156 (42.0)</td><td /><td /></tr><tr><td>ADHD Behavioral treatment: <italic>n</italic> (%)</td><td /><td /><td>χ2 = 4.43</td><td>.038</td></tr><tr><td> Yes</td><td>2,121 (47.5)</td><td>153 (41.8)</td><td /><td /></tr><tr><td> No</td><td>2,343 (52.5)</td><td>213 (58.2)</td><td /><td /></tr><tr><td>General health status: <italic>n</italic> (%)</td><td /><td /><td>χ2 = 4.52</td><td>.104</td></tr><tr><td> Excellent or very good</td><td>3,596 (80.6)</td><td>283 (76.9)</td><td /><td /></tr><tr><td> Good</td><td>710 (15.9)</td><td>74 (20.1)</td><td /><td /></tr><tr><td> Fair or poor</td><td>156 (3.5)</td><td>11 (3.0)</td><td /><td /></tr></tbody></table> </ephtml> </p> <p>1 <emph>Note</emph>. FPL = federal poverty level; ADD = Attention Deficit Disorder; IFS<emph>p</emph> = individualized family service plan; IEP = individualized education plan.</p> <hd id="AN0192008566-11">Measures</hd> <p></p> <hd id="AN0192008566-12">Childhood Flourishing Index (CFI)</hd> <p>The NSCH included three items to assess flourishing among children. The Child Flourishing Index (CFI) is a three-item, empirically supported construct (C. D. [<reflink idref="bib9" id="ref101">9</reflink>]) based on responses from parents and caregivers of children aged 6 to 17 years. The three indicators of flourishing were how well each item described the child on a 4-point scale: "shows interest and curiosity in learning new things," "works to finish tasks he or she starts," and "stays calm and in control when faced with a challenge." The response options were "always," "usually," "sometimes," and "never." Only responses of "always" received a score of 1, while all other responses were scored as 0. The scores for the three items were summed, yielding a total score ranging from 0 to 3. The CFI demonstrated acceptable internal consistency (α =.67) and had loadings onto a single factor that explained 62.5% of the variance (C. D. [<reflink idref="bib9" id="ref102">9</reflink>]). Furthermore, C. D. [<reflink idref="bib9" id="ref103">9</reflink>] showed strong convergent validity of the CFI with school engagement—defined as completing all required homework and effortful academic performance—among children who endorsed all three CFI items (89.4%) and those who endorsed two CFI items (73.6%), compared to children who endorsed zero or one item (33.2%). In the present sample, the three-item CFI scale showed strong internal consistency for both children without ADHD (α =.91) and children diagnosed with ADHD (α =.87). For the present study, a binary flourishing indicator from the NSCH dataset, considering only children with a total score of 3 (C. D. [<reflink idref="bib9" id="ref104">9</reflink>]), was used.</p> <hd id="AN0192008566-13">Positive Childhood Experiences (PCEs)</hd> <p>The present study used the 7-item measure of PCEs from the NSCH (C. [<reflink idref="bib8" id="ref105">8</reflink>]), which showed good internal consistency (α =.77) in a separate population-based sample of adults (C. D. [<reflink idref="bib9" id="ref106">9</reflink>]). In the current sample, both children without ADHD (α =.92) and those with current ADHD (α =.91) showed high internal consistency. Three items were answered with "yes" or "no" and scored as "1" or "0." These items asked caregivers whether, in the past 12 months, their child had a supportive and guiding mentor, participated in after-school activities (e.g., clubs and organizations), and volunteered in the community. The remaining four PCE items were rated on a 4-point Likert scale, measuring family resilience, a supportive community, a safe community, and the acquisition of socio-emotional competencies. After scoring each individual PCE item, researchers summed the scores to create a total score ranging from 0 to 7 experiences endorsed. For a full description of the scoring convention for the 7-item PCEs scale, see the supplementary material in [<reflink idref="bib102" id="ref107">102</reflink>]. Participants were then stratified into three groups based on their total scores: those who endorsed 0 to 2 PCEs, 3 to 5 PCEs, and 6 to 7 PCEs.</p> <hd id="AN0192008566-14">Adverse Childhood Experiences</hd> <p>The NSCH identified adverse childhood experiences (ACEs) by assessing the occurrence of 10 types of experiences (NSCH-ACEs). One of these experiences involved insufficient income to cover basic needs, measured by the question: "Since this child was born, how often has it been very hard to cover the basics, like food or housing, on your family's income?" Participants responded on a four-level Likert scale: "never," "rarely," "somewhat often," and "very often." Those who answered "somewhat often" or "very often" were considered to have experienced this ACE. The remaining nine ACEs were assessed with questions such as, "To the best of your knowledge, has this child EVER experienced any of the following... parent or guardian divorced or separated; parent or guardian died; parent or guardian served time in jail; saw or heard parents or adults slap, hit, kick, punch one another in the home; was a victim of violence or witnessed violence in his or her neighborhood; lived with anyone who was mentally ill, suicidal, or severely depressed; lived with anyone who had a problem with alcohol or drugs; treated or judged unfairly because of his or her race or ethnic group or treated or judged unfairly because of his or her sexual orientation or gender identity; and treated or judged unfairly because of a health condition or disability." The total number of adverse events was calculated as a sum score ranging from 0 to 10, and participants were categorized into groups based on their total ACEs: those who experienced 0 ACEs ("none"), 1 to 3 ACEs, and 4 or more ACEs ([<reflink idref="bib102" id="ref108">102</reflink>])</p> <p>There are at least 14 ACEs screeners that have unknown or inadequate psychometric properties (C. D. [<reflink idref="bib10" id="ref109">10</reflink>]; [<reflink idref="bib64" id="ref110">64</reflink>]). [<reflink idref="bib57" id="ref111">57</reflink>] recently conducted a systematic review of ACEs screeners and found similar results for the measures used in the four NSCH studies they reviewed. The 2017 evaluation of the NSCH-ACEs did not report temporal stability, test-retest reliability, or internal consistency properties (C. D. [<reflink idref="bib10" id="ref112">10</reflink>]). In the present sample, the NSCH-ACEs measure demonstrated good internal consistency for children with current ADHD (α =.71) and was acceptable for research purposes for children without ADHD (α =.66).</p> <hd id="AN0192008566-15">Mood Disturbance</hd> <p>Mood disturbance was comprised of three groups: children and adolescents with neither depression or anxiety, with depression or with anxiety, and with both depression and anxiety ("plus"). Participants answered the question, "Does your child currently have anxiety problems?" with response options: "does not have condition," "ever told, but does not currently have condition," and "currently has condition." Participants who selected "currently has condition" for anxiety were classified as having anxiety. A similar question was asked for depression: "Does your child currently have depression?" with the same response options. Participants who selected "currently has condition" for depression were classified as having depression. Those who selected "currently has condition" for both anxiety and depression were placed in the "plus" group. Participants who denied the presence of either depression or anxiety were classified as "neither."</p> <hd id="AN0192008566-16">Covariates</hd> <p>A block of demographic variables was included in the model to control for its influence on ACEs, mood disturbance, and PCEs when predicting flourishing. The variables included age, sex, race, ethnicity, federal poverty level (FPL), health insurance, special education plan, general health status, and ADHD-related variables (i.e., severity, medication, and behavioral treatment). The NSCH defined FPL based on responses to the survey about family income, which included wages/salary, self-employment, interest, social security, supplemental security income (SSI), other income sources such as VA benefits, unemployment compensation, child support, and alimony. Income was then coded into four categories: 0% to 199%, 200% to 299%, 300% to 399%, and 400% FPL or greater. Special education was defined by responses to the question, "Has this child EVER had a special education or early intervention plan?" with answers of "yes" or "no." General health status was determined by responses to the question, "In general, how would you describe this child's health?" with options of "excellent," "very good," "good," "fair," or "poor." The 5-item Likert scale was collapsed into three categories: excellent/very good, good, and fair/poor. ADHD severity was defined based on responses to the question, "Has a doctor or other health care provider EVER told you that this child has Attention Deficit Disorder or Attention-Deficit/Hyperactivity Disorder (ADD or ADHD)? If yes, does this child CURRENTLY have the condition? If yes, is it: mild, moderate, or severe?" ADHD medication and behavioral treatment were defined by responses to the questions: "Is this child CURRENTLY taking medication for ADD or ADHD?" and "At any time DURING THE PAST 12 MONTHS, did this child receive behavioral treatment for ADD or ADHD, such as training or an intervention that you or this child received to help with their behavior?"</p> <hd id="AN0192008566-17">Statistical Analysis</hd> <p>Analyses were completed using IBM SPSS 29. Hierarchical binary logistic regression was used to evaluate a model for predicting the binary flourishing variable ("always" to all three items of CFI or not) to determine whether PCEs added significant incremental predictive utility over demographic variables ([<reflink idref="bib85" id="ref113">85</reflink>]). Many of these demographic variables have been separately correlated with ACEs in typically developing samples. Previous research has identified high rates of poverty ([<reflink idref="bib59" id="ref114">59</reflink>]), high unemployment rates ([<reflink idref="bib65" id="ref115">65</reflink>]), food insecurity ([<reflink idref="bib18" id="ref116">18</reflink>]), and high levels of social disorder ([<reflink idref="bib41" id="ref117">41</reflink>]) as risk factors for ACEs. Conversely, access to mental health services or medical care ([<reflink idref="bib33" id="ref118">33</reflink>]), stable housing (Sege et al., 2017), and nurturing childcare or safe after-school programs ([<reflink idref="bib6" id="ref119">6</reflink>]) have been proposed as protective factors against early childhood adversity.</p> <p>The first block in the regression model included significant demographic and treatment-related predictors (i.e., age, poverty level, health insurance status, special education plan, ADHD behavioral treatment, ADHD severity, children's overall health status) and the degree of ACEs. These covariates were included to account for multiple social determinants of health (SDoH) and other factors associated with toxic stress, helping to assess the relationships between ACEs, PCEs, mood disorders, and flourishing in the current sample of youth with ADHD. The second block included current mood disturbances (i.e., anxiety or depression, anxiety and depression, neither) and the degree of PCEs (i.e., 0–2, 3–5, and 6–7). Before conducting the primary analysis, we evaluated the associations between the categorical variables of interest (i.e., flourishing, mood disturbance, degree of PCEs, and degree of ACEs).</p> <hd id="AN0192008566-18">Results</hd> <p>Chi-square analyses showed significant associations between the categorical variables of interest and flourishing: mood disturbance (χ<sups>2</sups> = 182.07, <emph>p</emph> <.001), degree of PCEs (χ<sups>2</sups> = 294.12, <emph>p</emph> <.001), and degree of ACEs (χ<sups>2</sups> = 18.76, <emph>p</emph> <.001). Specifically, a higher proportion of children with neither anxiety nor depression were flourishing (31.8%) as compared to children with either current anxiety or depression (17.4%) and children with currently comorbid anxiety and depression (11.5%). A higher proportion of children who experienced 6 to 7 PCEs were flourishing (44.8%) as compared to children who only experienced 3 to 5 PCEs (24.4%), as well as children with 0 to 2 PCEs (7.9%). Among children who had not experienced any ACEs, a higher proportion were flourishing (27.7%) compared to those who had experienced 1 to 3 ACEs (25.9%) or 4 or more ACEs (16.7%).</p> <p>The Durbin-Watson statistic confirmed the independence of observations, with a value of 2.03, indicating no serial correlation. To assess multicollinearity, we examined conservative Spearman ρ correlations and collinearity statistics (VIF, tolerance). Among the 13 predictors, no correlations exceeded ±0.267, VIF was less than 1.35, and tolerance values were greater than 0.742. We calculated Mahalanobis' distance and identified four multivariate outliers (α =.001), but these outliers did not impact the results and were retained for all analyses. The total sample size of children aged 6 to 17 years old, who reported having ADHD in the 2022 NSCH dataset and who had complete data on CFI and PCEs, was 4,476. This sample size was sufficient for the 13 explanatory variables (344 participants per explanatory variable). As a result, we deemed the assumptions to be within acceptable levels (Tabachnick & Fidell, 2001). The Hosmer and Lemeshow test confirmed the fit of predicted probabilities to the observed binary outcomes for both Model 1 (χ²(<reflink idref="bib8" id="ref120">8</reflink>) = 11.91, <emph>p</emph> = 0.155) and Model 2 (full; χ²(<reflink idref="bib8" id="ref121">8</reflink>) = 2.93, <emph>p</emph> =.939).</p> <p>We entered the predictors in a hierarchical manner to separately assess the contributions of mood disturbance and PCEs, distinct from covariates and ACEs. In Model 1, we found that age (<emph>p</emph> =.042), adequate insurance (<emph>p</emph> <.001), receiving behavioral ADHD treatment (<emph>p</emph> =.001), parent-endorsed ADHD severity (<emph>p</emph> <.001), and parent-endorsed health status of their child (<emph>p</emph> =.005) were significant demographic predictors of flourishing. Additionally, the number of ACEs a child had experienced significantly predicted whether they flourished (<emph>p</emph> <.001). Children who had not experienced any ACEs (OR = 2.33, 95% CI [1.54, 3.53], <emph>p</emph> <.001) or only 1 to 3 ACEs (OR = 1.49, 95% CI [1.01, 2.21], <emph>p</emph> =.046) were more likely to flourish than those who had experienced 4 or more ACEs.</p> <p>In Model 2, we found that several covariates were significantly associated with flourishing, including age (<emph>p</emph> =.013), income relative to the Federal Poverty Level (FPL; <emph>p</emph> =.003), health insurance coverage (<emph>p</emph> =.002), current special education plan (<emph>p</emph> <.001), receiving ADHD behavioral treatment (<emph>p</emph> =.023), parent-endorsed ADHD severity (<emph>p</emph> =.001), and parent-endorsed health status of their child (<emph>p</emph> =.043). For the full model, see Table 2. Children reported to currently have both anxiety and depression (Mood Disturbances Plus) significantly predicted whether they were flourishing (<emph>p</emph> <.001). Parents who did not report anxiety or depression in their children were 2.92 [1.87, 4.55] times more likely to report their children were flourishing than parents who endorsed co-morbid anxiety and depression. Additionally, children reported to have either anxiety or depression were 1.79 [1.13, 2.86] times more likely to be flourishing than those reported to have both anxiety and depression. The presence of PCEs in a child's life also significantly predicted flourishing (<emph>p</emph> <.001), and we separated this predictor into three groups based on prior empirical convention ([<reflink idref="bib102" id="ref122">102</reflink>]). After controlling for covariates, children with ADHD who had experienced 3 to 5 PCEs were 3.37 [2.24, 5.06] times more likely to be flourishing than those with 0 to 2 PCEs (<emph>p</emph> <.001). Similarly, children who had experienced 6 to 7 PCEs were 7.31 [4.51, 11.86] times more likely to be flourishing than children with 0 to 2 PCEs (<emph>p</emph> <.001). Once mental health status (<emph>p</emph> <.001) and PCEs (<emph>p</emph> <.001) were included in the model, groupings based on the degree of ACEs no longer significantly predicted flourishing (<emph>p</emph> =.097).</p> <p>Table 2. Results of Logistic Regression with Child Flourishing Index as Outcome (Full Model).</p> <p>Graph</p> <p> <ephtml> <table><colgroup><col align="left" /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /></colgroup><thead><tr><th align="center">Variable (reference category)</th><th align="center"><italic>b</italic></th><th align="center"><italic>SE</italic></th><th align="center">Wald</th><th align="center"><italic>p</italic></th><th align="center"><italic>OR</italic></th><th align="center">95% CI [lower, upper]</th></tr></thead><tbody><tr><td>Age (6–17)</td><td>.05</td><td>.02</td><td>6.23</td><td>.013</td><td>1.05</td><td>[1.01, 1.10]</td></tr><tr><td>Sex (male)</td><td /><td /><td>.001</td><td>.975</td><td /><td /></tr><tr><td> Female</td><td>.01</td><td>.14</td><td /><td /><td>1.00</td><td>[0.77, 1.32]</td></tr><tr><td>Race/ethnicity (White, non-Hispanic)</td><td /><td /><td>2.77</td><td>.428</td><td /><td /></tr><tr><td> Hispanic</td><td>.18</td><td>.19</td><td>.94</td><td>.331</td><td>1.20</td><td>[0.83, 1.73]</td></tr><tr><td> Black, non-Hispanic</td><td>.07</td><td>.26</td><td>.07</td><td>.799</td><td>1.07</td><td>[0.64, 1.78]</td></tr><tr><td> Multi-racial, non-Hispanic</td><td>.32</td><td>.21</td><td>2.23</td><td>.135</td><td>1.37</td><td>[0.91, 2.07]</td></tr><tr><td>Poverty level (400% FPL or greater)</td><td /><td /><td>8.54</td><td>.036</td><td /><td /></tr><tr><td> 0–99% FPL</td><td>.47</td><td>.16</td><td>8.54</td><td>.003</td><td>1.61</td><td>[1.17, 2.20]</td></tr><tr><td> 100–199% FPL</td><td>.24</td><td>.19</td><td>1.61</td><td>.205</td><td>1.27</td><td>[0.88, 1.82]</td></tr><tr><td> 200–399% FPL</td><td>.21</td><td>.20</td><td>1.10</td><td>.295</td><td>1.23</td><td>[0.84, 1.82]</td></tr><tr><td>Health coverage (inadequate/coverage gap)</td><td /><td /><td>9.97</td><td>.002</td><td /><td /></tr><tr><td> Adequate/continuous insurance in past year</td><td>.43</td><td>.14</td><td /><td /><td>1.54</td><td>[1.18, 2.01]</td></tr><tr><td>Special education plan (none)</td><td /><td /><td>11.75</td><td><.001</td><td /><td /></tr><tr><td> Current plan</td><td>.49</td><td>.14</td><td /><td /><td>1.63</td><td>[1.23, 2.16]</td></tr><tr><td>ADHD severity (severe)</td><td /><td /><td>33.62</td><td><.001</td><td /><td /></tr><tr><td> Mild</td><td>.81</td><td>.25</td><td>10.48</td><td>.001</td><td>2.24</td><td>[1.38, 3.66]</td></tr><tr><td> Moderate</td><td>.06</td><td>.24</td><td>.06</td><td>.811</td><td>1.06</td><td>[0.66, 1.71]</td></tr><tr><td>ADHD medication (no)</td><td>.17</td><td>.13</td><td>1.76</td><td>.185</td><td>1.19</td><td>[0.92, 1.54]</td></tr><tr><td>Behavioral ADHD treatment (none)</td><td /><td /><td>5.17</td><td>.023</td><td /><td /></tr><tr><td> Current</td><td>.30</td><td>.13</td><td /><td /><td>1.35</td><td>[1.04, 1.76]</td></tr><tr><td>Child's general health (fair or poor)</td><td /><td /><td>11.25</td><td>.004</td><td /><td /></tr><tr><td> Excellent or very good</td><td>1.11</td><td>.55</td><td>4.08</td><td>.043</td><td>3.04</td><td>[1.03, 8.96]</td></tr><tr><td> Good</td><td>.52</td><td>.58</td><td>.82</td><td>.365</td><td>1.69</td><td>[0.54, 5.24]</td></tr><tr><td>ACEs (≥4)</td><td /><td /><td>4.67</td><td>.097</td><td /><td /></tr><tr><td> 1–3</td><td>.37</td><td>.22</td><td>2.75</td><td>.097</td><td>1.45</td><td>[0.94, 2.24]</td></tr><tr><td> None</td><td>.11</td><td>.21</td><td>.26</td><td>.610</td><td>1.11</td><td>[0.74, 1.68]</td></tr><tr><td>Mood disturbances (plus)</td><td /><td /><td>26.56</td><td><.001</td><td /><td /></tr><tr><td> Neither</td><td>1.07</td><td>.23</td><td>22.41</td><td><.001</td><td>2.92</td><td>[1.87, 4.55]</td></tr><tr><td> Anxiety or depression</td><td>.58</td><td>.24</td><td>6.04</td><td>.014</td><td>1.79</td><td>[1.13, 2.86]</td></tr><tr><td>PCEs grouping (0–2)</td><td /><td /><td>65.10</td><td><.001</td><td /><td /></tr><tr><td> 3–5 PCEs</td><td>1.22</td><td>.21</td><td>34.43</td><td><.001</td><td>3.37</td><td>[2.25, 5.06]</td></tr><tr><td> 6–7 PCEs</td><td>1.99</td><td>.25</td><td>65.01</td><td><.001</td><td>7.31</td><td>[4.51, 11.86]</td></tr></tbody></table> </ephtml> </p> <hd id="AN0192008566-19">Post Hoc Analysis</hd> <p>To further assess the degree of PCEs as a significant predictor of flourishing in children currently diagnosed with ADHD, we applied the same model using item-level responses as predictors, rather than PCE groupings. This approach allowed us to evaluate the individual contributions of each experience, providing more specific guidance on measuring PCEs in a neurodiverse population (Table 3). We found that only three of the seven experiences significantly predicted flourishing. Children who participated in community service or volunteer work were 1.39 [1.05, 1.84] times more likely to flourish than those who did not. Children who had a connected caregiver to discuss important matters and share ideas were 2.86 [2.22, 3.68] times more likely to flourish than those without such a connection. Additionally, children with resilient families—those who discussed openly, maintained collaboration, or stayed hopeful when facing problems—were 3.02 [1.87, 4.85] times more likely to flourish than children without these family characteristics.</p> <p>Table 3. Results of Logistic Regression With Item-level PCEs and CFI as the Outcome.</p> <p>Graph</p> <p> <ephtml> <table><colgroup><col align="left" /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /></colgroup><thead><tr><th align="center">Variable (reference category)</th><th align="center"><italic>B</italic></th><th align="center"><italic>SE</italic></th><th align="center">Wald</th><th align="center"><italic>p</italic></th><th align="center"><italic>OR</italic></th><th align="center">95% CI [lower, upper]</th></tr></thead><tbody><tr><td>Age (6–17)</td><td>.06</td><td>.02</td><td>7.50</td><td>.006</td><td>1.06</td><td>[1.02, 1.11]</td></tr><tr><td>Sex (Male)</td><td /><td /><td>.10</td><td>.758</td><td /><td /></tr><tr><td> Female</td><td>.04</td><td>.14</td><td /><td /><td>1.04</td><td>[0.79, 1.38]</td></tr><tr><td>Race/ethnicity (White, non-Hispanic)</td><td /><td /><td>2.56</td><td>.464</td><td /><td /></tr><tr><td> Hispanic</td><td>.15</td><td>.19</td><td>.60</td><td>.440</td><td>1.16</td><td>[0.80, 1.69]</td></tr><tr><td> Black, non-Hispanic</td><td>.04</td><td>.27</td><td>.02</td><td>.877</td><td>1.04</td><td>[0.620, 1.76]</td></tr><tr><td> Multi-racial, non-Hispanic</td><td>.33</td><td>.22</td><td>2.29</td><td>.131</td><td>1.39</td><td>[0.91, 2.11]</td></tr><tr><td>Poverty level (400% FPL or greater)</td><td /><td /><td>5.35</td><td>.148</td><td /><td /></tr><tr><td> 0–99% FPL</td><td>.39</td><td>.17</td><td>5.33</td><td>.021</td><td>1.47</td><td>[1.06, 2.04]</td></tr><tr><td> 100–199% FPL</td><td>.20</td><td>.19</td><td>1.10</td><td>.295</td><td>1.22</td><td>[0.84, 1.77]</td></tr><tr><td> 200–399% FPL</td><td>.15</td><td>.20</td><td>.53</td><td>.467</td><td>1.16</td><td>[0.78, 1.72]</td></tr><tr><td>Health coverage (inadequate/coverage gap)</td><td /><td /><td>9.03</td><td>.003</td><td /><td /></tr><tr><td> Adequate/continuous insurance in past year</td><td>.42</td><td>.14</td><td /><td /><td>1.52</td><td>[1.16, 2.01]</td></tr><tr><td>Special education plan (none)</td><td /><td /><td>11.19</td><td><.001</td><td /><td /></tr><tr><td> Current plan</td><td>.49</td><td>.15</td><td /><td /><td>1.64</td><td>[1.23, 2.18]</td></tr><tr><td>ADHD severity (severe)</td><td /><td /><td>34.13</td><td><.001</td><td /><td /></tr><tr><td> Mild</td><td>.81</td><td>.25</td><td>10.22</td><td>.001</td><td>2.25</td><td>[1.37, 3.70]</td></tr><tr><td> Moderate</td><td>.04</td><td>.25</td><td>.02</td><td>.885</td><td>1.04</td><td>[0.64, 1.68]</td></tr><tr><td>ADHD medication (no)</td><td>.21</td><td>.13</td><td>2.34</td><td>.126</td><td>1.23</td><td>[0.94, 1.60]</td></tr><tr><td>Behavioral ADHD treatment (none)</td><td /><td /><td>3.87</td><td>.049</td><td /><td /></tr><tr><td> Current</td><td>.27</td><td>.14</td><td /><td /><td>1.31</td><td>[1.00, 1.71]</td></tr><tr><td>Child's general health (fair or poor)</td><td /><td /><td>8.80</td><td>.012</td><td /><td /></tr><tr><td> Excellent or very good</td><td>1.15</td><td>.56</td><td>4.16</td><td>.041</td><td>3.15</td><td>[1.05, 9.46]</td></tr><tr><td> Good</td><td>.66</td><td>.59</td><td>1.24</td><td>.265</td><td>1.93</td><td>[0.61, 6.12]</td></tr><tr><td>ACEs (≥4)</td><td /><td /><td>3.38</td><td>.185</td><td /><td /></tr><tr><td> 1–3</td><td>.34</td><td>.23</td><td>2.25</td><td>.133</td><td>1.40</td><td>[0.90, 2.19]</td></tr><tr><td> None</td><td>.12</td><td>.21</td><td>.31</td><td>.577</td><td>1.13</td><td>[0.74, 1.71]</td></tr><tr><td>Mood disturbances (plus)</td><td /><td /><td>26.93</td><td><.001</td><td /><td /></tr><tr><td> Neither</td><td>1.09</td><td>.23</td><td>22.44</td><td><.001</td><td>2.97</td><td>[1.89, 4.65]</td></tr><tr><td> Anxiety or depression</td><td>.57</td><td>.24</td><td>5.67</td><td>.017</td><td>1.78</td><td>[1.11, 2.85]</td></tr><tr><td colspan="7">PCEs (item-level)</td></tr><tr><td> Guided mentor (no)</td><td>-.02</td><td>.24</td><td>.01</td><td>.950</td><td>.99</td><td>[0.62, 1.57]</td></tr><tr><td> Resilient family (no)</td><td>1.10</td><td>.24</td><td>20.70</td><td><001</td><td>3.02</td><td>[1.87, 4.85]</td></tr><tr><td> Supportive community (no)</td><td>.07</td><td>.15</td><td>.21</td><td>.646</td><td>1.07</td><td>[0.80, 1.44]</td></tr><tr><td> Safe community (no)</td><td>.30</td><td>.16</td><td>3.56</td><td>.059</td><td>1.36</td><td>[0.99, 1.86]</td></tr><tr><td> After-school activities (no)</td><td>.01</td><td>.18</td><td>.01</td><td>.953</td><td>1.01</td><td>[0.71, 1.45]</td></tr><tr><td> Community volunteering (no)</td><td>.33</td><td>.14</td><td>5.31</td><td>.021</td><td>1.39</td><td>[1.05, 1.84]</td></tr><tr><td> Connected caregiver (no)</td><td>1.05</td><td>.13</td><td>66.48</td><td><.001</td><td>2.86</td><td>[2.22, 3.68]</td></tr></tbody></table> </ephtml> </p> <hd id="AN0192008566-20">Discussion</hd> <p>This study of a national dataset examined how the presence of PCEs (e.g., resilient family and connected caregiver) and comorbid mental health conditions (e.g., anxiety and depression) predicted rates of flourishing in a pediatric ADHD sample. Our first hypothesis was supported in that more ACEs significantly predicted lower rates of flourishing after accounting for other covariates. The results from our initial model are consistent with previous literature that revealed significantly decreased odds of flourishing in children who experienced 4 or more ACEs relative to children who experienced 1 to 3 ACEs and to those who have not experienced any ACEs ([<reflink idref="bib29" id="ref123">29</reflink>]). Previous literature has suggested that having 4 or more ACE exposures is associated with increased odds of having depression, anxiety, and ADHD ([<reflink idref="bib13" id="ref124">13</reflink>]) as well as a myriad of health conditions ([<reflink idref="bib89" id="ref125">89</reflink>]). However, in the current study, having 4 or more ACEs no longer significantly predicted flourishing once mood disturbance and degree of PCEs were considered. Overall, our findings suggest that more PCEs and the absence of mood disturbance may indeed attenuate the negative impact of ACEs.</p> <p>Our results supported the second hypothesis, such that having more PCEs significantly and incrementally predicted the degree to which children with ADHD were flourishing, after considering covariates, ACEs, and comorbid mood disturbances. Furthermore, PCEs significantly predicted flourishing in a dose-dependent fashion such that children who endorsed 6 to 7 PCEs were more likely to be flourishing than children with 3 to 5 PCEs, who were then more likely to be flourishing than children with 0 to 2 PCEs. Our third hypothesis was also supported in that children who reported to currently have both comorbid anxiety and depression also significantly predicted lower rates of flourishing; those with neither current anxiety nor current depression were almost three times more likely to be flourishing than children currently experiencing both comorbid anxiety and depression. The post-hoc analysis partially supported our last hypothesis in that only three specific positive experiences significantly predicted flourishing in the current sample: resilient family (yes = 81%), connected caregiver (yes = 43%), and community volunteering (yes = 29.9%). Based on the literature presented on PCEs, we had hypothesized supportive relationships with caregivers and nurturing family practices to be strong predictors, but did not expect community volunteering. There are likely reciprocal nurturing relationships being formed within themselves and others (e.g., staff and other volunteers) in these opportunities ([<reflink idref="bib58" id="ref126">58</reflink>]). In the final model, having stable and adequate health insurance, access to special education services, provision of behavioral ADHD treatments, milder ADHD severity, and better overall health status were all associated with greater likelihood of flourishing.</p> <p>We replicated and extended Zhang et al.'s (2024) study by evaluating how comorbid mood disturbance affected rates of flourishing in the presence of PCEs for children with ADHD. Our findings corroborate [<reflink idref="bib26" id="ref127">26</reflink>], who also revealed significantly poorer academic performance, an important component of well-being, in children with ADHD and comorbid anxiety and depression. Prior research on the benefits of PCEs on mental health outcomes has suggested moderation effects on the relationship of ACEs to depression ([<reflink idref="bib74" id="ref128">74</reflink>]) and ACEs to anxiety ([<reflink idref="bib72" id="ref129">72</reflink>]). These negative implications further highlight the need for protective factors and, in consideration of finite resources. Our results add to this literature base by considering the role of individual PCEs on adaptive outcomes.</p> <p>The main analysis supported an overall greater likelihood of flourishing with an increasing degree of PCEs, regardless of which specific items were endorsed. Among the seven PCEs, only the presence of "family resilience" (C. D. [<reflink idref="bib9" id="ref130">9</reflink>]; [<reflink idref="bib52" id="ref131">52</reflink>]), a "connected caregiver" ([<reflink idref="bib75" id="ref132">75</reflink>]; [<reflink idref="bib102" id="ref133">102</reflink>]), and "community volunteering" ([<reflink idref="bib58" id="ref134">58</reflink>]) were shown to significantly enhance the odds of flourishing in children with ADHD and comorbid mood disturbance. Consistent with previous studies, having a resilient family and connected caregivers showed the greatest odds of flourishing ([<reflink idref="bib25" id="ref135">25</reflink>]). Prior convention grouped PCEs by the number of positive events (i.e., 0–2, 3–5, and 6–7; [<reflink idref="bib102" id="ref136">102</reflink>]), however, upon disaggregating the groups, our results revealed a quantitative difference between the seven items that may translate to qualitative differences for these specific positive experiences in youth with ADHD. The current results support focusing on increasing the frequency of these 3 PCEs, specifically, when evaluating flourishing outcomes in neurodiverse samples, which may guide future research designed to further understand interpersonal protective factors. Connecting with caregivers (yes = 43%) and community volunteering (yes = 29.9%), relative to engagement in family practices of resilience (yes = 81%), represent activities of greater potential improvement.</p> <hd id="AN0192008566-21">Strengths and Limitations</hd> <p>The current study's findings should also be considered with the following limitations. The data from the NSCH is limited to the collection of parent/caregiver - reported surveys and does not include children's self-report data. Furthermore, the mood disturbances and ADHD diagnoses are caregiver-reported, so future research should consider using more rigorous methods such as structured clinical interviews or neuropsychological evaluations. Similarly, flourishing and PCEs were measured based on caregiver-endorsements of only a few specific domains. Future research may want to consider using more comprehensive assessments of optimal well-being that include self-reports of health-related quality of life, values, and objective indicators of personally meaningful living. Only seven healthy circumstances created the PCEs scale used in the current study, and while a couple items had multiple components, there are many other culturally dependent ways that children experience positivity. For example, a child can feel connected to their caregiver in ways other than open communication. Nonetheless, these constructs serve as initial frameworks for future research to undertake scalable efforts with more comprehensive assessments and objective operational definitions. However, the current study specifies the measurement of PCEs that future research may want to emphasize.</p> <p>While the comorbid mood disturbances were endorsed as "currently have," "do not have," or "had in the past but not currently," the cross-sectional nature of this study limits any causal inference or inference of temporal ordering. Children with ADHD and no currently comorbid mood disturbance may be more likely to flourish, or it is also possible that children with ADHD who are flourishing may be less likely to develop co-occurring mood disturbance; hence, future studies should utilize longitudinal designs to determine causation.</p> <p>There are many additional comorbidities that may be negatively impacting capacity for optimal well-being that were not fully evaluated here that should be considered in future research. For this initial study, we only considered mood disorders. Future studies may want to consider incorporating additional developmental disorders (e.g., intellectual disability, autism spectrum disorder, fetal alcohol spectrum disorder, and Down syndrome) or medical conditions (diabetes, epilepsy, headache, and concussion). Additionally, it may be important to consider learning disabilities, neighborhood disparities, or specific family dynamics.</p> <p>It is important to recognize that our sample's participants were majority white, male, had adequate and continued insurance in the past year, were at or above 400% FLP, had excellent or very good health status, and were enrolled in a special education program. While the dataset was nationally representative, it is important to acknowledge the systemic challenges faced by children and their families in getting accurate diagnosis and treatment. Diagnostic labels are provided by healthcare professionals; therefore, healthcare accessibility may be impacting which children receive a diagnosis, which may be influenced by situational and systemic inequalities (e.g., socioeconomic status and resources; [<reflink idref="bib51" id="ref137">51</reflink>]). Future studies would benefit from incorporating more diverse populations and including other social drivers of health, such as parental/caregiver education, marital and mental health status.</p> <p>This study had several strengths. Though there is extant literature discussing the positive implications of PCEs on pediatric health outcomes in various populations, there has been limited research on the effect of PCEs specifically in those with ADHD and comorbid conditions, in the context of ACEs. Another strength is that our study utilizes a large nationally representative sample that helps to increase the generalizability of our findings. Moreover, the publicly available dataset allows future researchers to continue to replicate and expand on our results to assist in preventative pediatric healthcare efforts.</p> <hd id="AN0192008566-22">Implications</hd> <p>The current findings inform applications for researchers and clinicians in providing more comprehensive and specialized care for children with ADHD. First, the results highlight the need to expand mental health screening specifically for anxiety and depression in children with ADHD. Their caregivers and families should be educated about the potential risk of these comorbid conditions ([<reflink idref="bib98" id="ref138">98</reflink>]). Ideally, integrating emotional, developmental, or behavioral screening into primary care settings on regular basis increases mental health service utilization and navigation by enhancing collaboration in a location where children and families are being regularly seen. Current practice guidelines for Complex ADHD suggest at least screening annually for common comorbid conditions ([<reflink idref="bib5" id="ref139">5</reflink>]).</p> <p>The current study demonstrated that interventions that target children with ADHD may also benefit from incorporating the promotion of protective factors. In an effort to empower the communities that support a child, evidence-based interventions are necessary. For example, interventions that target co-regulation by offering psychoeducation for adults in the home and within the community are needed to teach effective ways to model self-regulation and recognize when to be responsive to children's emotions and needs ([<reflink idref="bib68" id="ref140">68</reflink>]). A recent meta-analysis of nine studies in English and Spanish on 280 young children with ADHD revealed the effectiveness of Parent-Child Interaction Therapy (PCIT) with medium to large effect sizes on reducing ADHD symptoms (<emph>g</emph> = 0.90), problematic child behavior (<emph>g</emph> = 0.44), and parental stress (<emph>g</emph> = 0.82; [<reflink idref="bib70" id="ref141">70</reflink>]). A recent systematic review and meta-analysis examining parenting and family risk factors for children with ADHD suggested that sensitivity and warmth in parenting interactions were associated with reduced symptoms ([<reflink idref="bib21" id="ref142">21</reflink>]). Current treatment guidelines also recommend parent-training in behavioral management as an effective treatment for youth with ADHD ([<reflink idref="bib22" id="ref143">22</reflink>]; [<reflink idref="bib35" id="ref144">35</reflink>]).</p> <p>Our study highlights how interventions must also take into account broader contextual factors outside of the home setting. For example, treatment adherence outside of the home (e.g., after-school and community) can become problematic as children age into adolescents, which has been suggested as a high-risk period for discontinuation of ADHD medications ([<reflink idref="bib14" id="ref145">14</reflink>]) and disengagement from behavioral treatments due to low compliance of techniques and skills, low teacher monitoring of skill application, and beliefs of ineffectiveness ([<reflink idref="bib78" id="ref146">78</reflink>]). Furthermore, [<reflink idref="bib20" id="ref147">20</reflink>] revealed increasing rates of children who do not receive treatment from 2016 (23%) to 2022 (30.1%). Various barriers may account for these rates, and future studies should continue to identify the disparities influencing non-treatment in underserved communities, such as access to quality mental healthcare ([<reflink idref="bib54" id="ref148">54</reflink>]; [<reflink idref="bib74" id="ref149">74</reflink>]). Clinicians have utilized the Child Opportunity Index (COI) 3.0, which is a census-level indicator of 44 measures across three subdomains of socioeconomic, environmental quality, and educational opportunities within a neighborhood ([<reflink idref="bib28" id="ref150">28</reflink>]) to understand the community-level risk and protective factors of where children with neurodiversity live ([<reflink idref="bib51" id="ref151">51</reflink>]). Altogether, our results are consistent with other studies that urge the addition of strength-based initiatives comprising of methods to increase PCEs to buffer the negative effects of adversity in children with ADHD.</p> <hd id="AN0192008566-23">Conclusion</hd> <p>The current study supports the integration of a developmental systems approach in trauma-informed care of children with ADHD. Clinicians should focus on the interactions between the individual and their environment, incorporate psychosocial and educational components that recognize resilience and adaptation are built over time, and consider long-term development of neurodiversity, not just immediate symptom relief. In the Multimodal Treatment Study of ADHD, the diagnostic trajectory of 558 children was studied longitudinally with eight assessments for up to 16 years after baseline to reveal that recovery or remission in a vast majority of participants (63.8%) was non-linear; sustaining remission of ADHD symptoms, or diagnostic persistence, was uncommon and progressing fluidly between asymptomatic, symptomatic, and syndromic phases over time was the most observed pattern ([<reflink idref="bib78" id="ref152">78</reflink>]). The heterogeneous trajectory of ADHD symptoms underscores how the condition may manifest depending on the variability in environmental support across settings, relationship dynamics, and life stages. 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Child Development Perspectives, 7, 215–220.</bibtext> </blist> </ref> <ref id="AN0192008566-25"> <title> Footnotes </title> <blist> <bibtext> Patricia Bianca Torres</bibtext> </blist> <blist> <bibtext>Graph</bibtext> </blist> <blist> <bibtext>https://orcid.org/0009-0007-1010-040X Daniel Andre Ignacio</bibtext> </blist> <blist> <bibtext>Graph</bibtext> </blist> <blist> <bibtext>https://orcid.org/0000-0002-1045-8328 Jessica Emick</bibtext> </blist> <blist> <bibtext>Graph https://orcid.org/0000-0001-6762-8706</bibtext> </blist> <blist> <bibtext> The authors received no financial support for the research, authorship, and/or publication of this article.</bibtext> </blist> <blist> <bibtext> The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.</bibtext> </blist> </ref> <aug> <p>By Patricia Bianca Torres; Daniel Andre Ignacio; Nathan M. 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  Label: Title
  Group: Ti
  Data: Predicting Flourishing in ADHD Youth: Positive Childhood Experiences and Mood Disturbances in Context of Adversity
– Name: Language
  Label: Language
  Group: Lang
  Data: English
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Patricia+Bianca+Torres%22">Patricia Bianca Torres</searchLink> (ORCID <externalLink term="https://orcid.org/0009-0007-1010-040X">0009-0007-1010-040X</externalLink>)<br /><searchLink fieldCode="AR" term="%22Daniel+Andre+Ignacio%22">Daniel Andre Ignacio</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0002-1045-8328">0000-0002-1045-8328</externalLink>)<br /><searchLink fieldCode="AR" term="%22Nathan+M%2E+Griffith%22">Nathan M. Griffith</searchLink><br /><searchLink fieldCode="AR" term="%22Jessica+Emick%22">Jessica Emick</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0001-6762-8706">0000-0001-6762-8706</externalLink>)
– Name: TitleSource
  Label: Source
  Group: Src
  Data: <searchLink fieldCode="SO" term="%22Journal+of+Attention+Disorders%22"><i>Journal of Attention Disorders</i></searchLink>. 2026 30(4):476-492.
– Name: Avail
  Label: Availability
  Group: Avail
  Data: SAGE Publications. 2455 Teller Road, Thousand Oaks, CA 91320. Tel: 800-818-7243; Tel: 805-499-9774; Fax: 800-583-2665; e-mail: journals@sagepub.com; Web site: https://sagepub.com
– Name: PeerReviewed
  Label: Peer Reviewed
  Group: SrcInfo
  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 17
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2026
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Research
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Attention+Deficit+Hyperactivity+Disorder%22">Attention Deficit Hyperactivity Disorder</searchLink><br /><searchLink fieldCode="DE" term="%22Predictor+Variables%22">Predictor Variables</searchLink><br /><searchLink fieldCode="DE" term="%22Well+Being%22">Well Being</searchLink><br /><searchLink fieldCode="DE" term="%22Resilience+%28Psychology%29%22">Resilience (Psychology)</searchLink><br /><searchLink fieldCode="DE" term="%22Children%22">Children</searchLink><br /><searchLink fieldCode="DE" term="%22Adolescents%22">Adolescents</searchLink><br /><searchLink fieldCode="DE" term="%22Individual+Characteristics%22">Individual Characteristics</searchLink><br /><searchLink fieldCode="DE" term="%22Intervention%22">Intervention</searchLink><br /><searchLink fieldCode="DE" term="%22Trauma%22">Trauma</searchLink><br /><searchLink fieldCode="DE" term="%22Early+Experience%22">Early Experience</searchLink><br /><searchLink fieldCode="DE" term="%22Anxiety%22">Anxiety</searchLink><br /><searchLink fieldCode="DE" term="%22Depression+%28Psychology%29%22">Depression (Psychology)</searchLink><br /><searchLink fieldCode="DE" term="%22Mental+Disorders%22">Mental Disorders</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1177/10870547251375513
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 1087-0547<br />1557-1246
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Background: In response to the increasing prevalence of ADHD, efforts have focused on understanding methods to optimize psychosocial, emotional, and behavioral well-being, defined as flourishing. Mood disturbances, environmental vulnerabilities, and Adverse Childhood Experiences (ACEs) are risk factors for not flourishing. There is limited research on protective relational factors, as measured by Positive Childhood Experiences (PCEs), as facilitators of flourishing in children with ADHD and comorbid mood disturbances. Method: Using a nationally representative sample of 4,847 children, aged 6 to 17 years-old, currently diagnosed with ADHD, hierarchical binary logistic regression examined whether the number of PCEs present for children with and without mood disturbances could significantly predict who was flourishing or not. The initial model included demographics, ADHD treatment-related variables, and the number of ACEs encountered. Results: After controlling for covariates, the odds of flourishing measured by the Child Flourishing Index (CFI) for children with ADHD were 7.31 [4.51, 11.86] times greater for those with 6 to 7 PCEs compared to peers with 0 to 2 PCEs, and 3.37 [2.24, 5.06] times greater for those with 3 to 5 PCEs relative to peers with 0 to 2 PCEs. Furthermore, parents who reported their children had neither current anxiety nor depression were 2.92 [1.87, 4.55] times more likely to flourish than children currently reported to have both anxiety and depression. These associations were consistent regardless of the level of ACEs. Conclusions: Our findings suggest that more PCEs and the absence of mood disturbance may attenuate the influence of ACEs on healthy adjustment for children with ADHD. Encouraging resilience in families, connecting with caregivers, and community volunteering were the most predictive positive childhood experiences of flourishing in this national sample of youth with ADHD and comorbid mood disturbance. Current results also provide guidance for future research on PCEs measurement, screening for comorbidities, and clinical intervention in neurodiverse samples.
– Name: AbstractInfo
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  Data: As Provided
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2026
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ1500115
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1500115
RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1177/10870547251375513
    Languages:
      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 17
        StartPage: 476
    Subjects:
      – SubjectFull: Attention Deficit Hyperactivity Disorder
        Type: general
      – SubjectFull: Predictor Variables
        Type: general
      – SubjectFull: Well Being
        Type: general
      – SubjectFull: Resilience (Psychology)
        Type: general
      – SubjectFull: Children
        Type: general
      – SubjectFull: Adolescents
        Type: general
      – SubjectFull: Individual Characteristics
        Type: general
      – SubjectFull: Intervention
        Type: general
      – SubjectFull: Trauma
        Type: general
      – SubjectFull: Early Experience
        Type: general
      – SubjectFull: Anxiety
        Type: general
      – SubjectFull: Depression (Psychology)
        Type: general
      – SubjectFull: Mental Disorders
        Type: general
    Titles:
      – TitleFull: Predicting Flourishing in ADHD Youth: Positive Childhood Experiences and Mood Disturbances in Context of Adversity
        Type: main
  BibRelationships:
    HasContributorRelationships:
      – PersonEntity:
          Name:
            NameFull: Patricia Bianca Torres
      – PersonEntity:
          Name:
            NameFull: Daniel Andre Ignacio
      – PersonEntity:
          Name:
            NameFull: Nathan M. Griffith
      – PersonEntity:
          Name:
            NameFull: Jessica Emick
    IsPartOfRelationships:
      – BibEntity:
          Dates:
            – D: 01
              M: 04
              Type: published
              Y: 2026
          Identifiers:
            – Type: issn-print
              Value: 1087-0547
            – Type: issn-electronic
              Value: 1557-1246
          Numbering:
            – Type: volume
              Value: 30
            – Type: issue
              Value: 4
          Titles:
            – TitleFull: Journal of Attention Disorders
              Type: main
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