The Relationship between Attention Problems, Internalizing Symptoms and Quality of Life in Youth Receiving Outpatient Services

Attention problems, internalizing problems and quality of life (QOL) were investigated to understand the possible mediating and moderating role of internalizing problems on the relationship between attention problems and QOL. Extant literature provides theoretical explanations for the influence emotional distress has on reducing QOL in individuals with attention problems; however, empirical examination of the explanations is lacking. Parents of 590 children and adolescents ages 8 to 18 years who were treated at one of two outpatient clinics completed a norm referenced broadband behavior rating scale and a QOL scale. Using Baron and Kenny (1986) model, the possible mediating effect of internalizing problems was examined. Results indicated that study variables were moderately correlated (range = -.26 to -.51; p < .05). Regression analysis indicated a significant indirect effect ( b = -.26; p < .01), combined with a nonsignificant direct effect, thereby suggesting full mediation of internalizing problems on the relationship between attention problems and QOL. Moderation analysis indicated a significant interaction effect between attention problems and internalizing problems; however, the main effect of internalizing problems was the strongest predictor of QOL across levels of attention problems. Implications for future research and for practice are discussed. Future research directions include examining the stability of results across self-report measures and demographic variables. The results have clinical implications for treatment: Methods aimed at interrupting the development of internalizing problems in individuals with attention problems are identified and discussed.