The spontaneously hypertensive rat (SHR) as an animal model of childhood hyperactivity (ADHD): changed reactivity to reinforcers and to psychomotor stimulants.

Childhood hyperactivity (attention-deficit hyperactivity disorder, ADHD) is a behavior disorder affecting 2-6% of grade-school children. The main symptoms are attention problems and hyperkinesis. The disorder is commonly treated with psychomotor stimulants, usually methylphenidate hydrochloride (ritalin) or d-amphetamine. Neither the cause of the disorder nor the basis of the effectiveness of the drug treatment is well understood. Differences in reinforcement processes have been implicated as part of the underlying problem. The main purpose of the present research was to investigate reinforcement processes and motor characteristics with and without stimulant medication in SHR, as an animal model of ADHD, and WKY controls, its normoactive progenitor strain. SHR behavior turned out to be more sensitive to immediate reinforcement and proportionately less sensitive to delayed reinforcement when compared to the behavior of WKY, as demonstrated by systematic changes in rates of responding throughout fixed-interval schedules of reinforcement of bar-presses by water. The psychomotor stimulants weakened the control by immediate reinforcers and strengthened the control by delayed reinforcers, with the effect of the drugs being more pronounced in WKY than in SHR. The results are consistent with clinical observations that ADHD children are less willing than others to accept "delayed gratification" and that methylphenidate increases the control of delayed reward over their behavior.     

A chart review study of the inattentive and combined types of ADHD

Studies of the clinical correlates of the subtypes of Attention-Deficit/Hyperactivity Disorder (ADHD) have identified differences in the representation of age, gender, prevalence, comorbidity, and treatment. We report retrospective chart review data detailing the clinical characteristics of the Inattentive (IA) and Combined (C) subtypes of ADHD in 143 cases of ADHD-IA and 133 cases of ADHD-C. The children with ADHD-IA were older, more likely to be female, and had more comorbid internalizing disorders and learning disabilities. Individuals in the ADHD-IA group were two to five times as likely to have a referral for speech and language problems. The children with ADHD-IA were rated as having less overall functional impairment, but did have difficulty with academic achievement. Children with ADHD-IA were less likely to be treated with stimulants. One eighth of the children with ADHD-IA still had significant symptoms of hyperactivity/impulsivity, but did not meet the DSM-IV threshold for diagnosis of ADHD-Combined Type. The ADHD-IA subtype includes children with no hyperactivity and children who still manifest clinically significant hyperactive symptomatology but do not meet DSM-IV criteria for Combined Type. ADHD-IA children are often seen as having speech and language problems, and are less likely to receive medication treatment, but respond to medical treatment with improvement both in attention and residual hyperactive/impulsive symptoms.     

Follow-up of children identified with and treated for a motor delay of nonspecifiable etiology

Forty-eight 7- to 8-year-old children who had been diagnosed prior to 48 months of age as being developmentally motor delayed and had received therapy for their delay were followed up and assessed for motor, intellectual, and psychological development as well as for self-perceived competence and school achievement. These children were found to be significantly inferior on all of these variables, except for self-competence, when compared with matched nondelayed controls. Those delayed children who had begun treatment prior to 24 months of age demonstrated significantly greater gains in motor function at follow-up, had significantly higher IQs, performed better at school, and participated in more peer-related activities than did the delayed children who began treatment after 24 months. This study supports the hypotheses that (1) young children diagnosed as being developmentally motor delayed demonstrate subsequent intellectual and psychological problems when in the primary grades and (2) that the age at onset of intervention therapy for the delay is significantly related to outcome (benefit of therapy).     

Methylphenidate and cognitive therapy: A comparison of treatment approaches with hyperactive boys

This study of hyperactive boys evaluated the effects of three modes of treatment in relation to an untreated group. The treatments were administered over a 3-month period and included cognitive training, stimulant drug therapy (methylphenidate), and the two treatments combined. A follow-up assessment was conducted approximately 3 months after contact between the training staff and the child had ceased. Analyses of attentional deployment and cognitive style measures, tests of academic achievement, and behavioral ratings showed that only those children in the two medication treatment conditions demonstrated improvement in attentional deployment and behavioral ratings. In the cognitive therapy condition, there were changes only on measures of attentional deployment. The data did not provide evidence indicating that the combined medication and cognitive therapy condition was any more effective than that condition involving medication alone. Discussion provides future guidelines for evaluation of the relative effectiveness of stimulant drug therapy and other psychological treatment modalities.     

A comparison of behavioral and emotional functioning in children and adolescents with Autistic Disorder and PDD-NOS.

Behavioral symptomatology was compared in 26 children and adolescents with Autistic Disorder ("autism") and 25 children and adolescents with Pervasive Developmental Disorder, Not Otherwise Specified ("PDD-NOS"). Relative to individuals with PDD-NOS, those with autism had more symptoms of depression, social withdrawal, atypical behavior, and immature social skills--and fewer family problems. These differences remained even when group differences in intellectual ability were statistically controlled. No group differences emerged in somatization, anxiety, or hyperactivity. Findings suggest that although both groups demonstrate considerable evidence of behavioral and emotional problems, those with autism are at particularly high risk for comorbid behavioral and emotional disabilities.     

Surf therapy for improving child and adolescent mental health: A pilot randomised control trial

The aim of this pilot randomised control trial (RCT) was to test, 1) feasibility and acceptability of a surf therapy program to improve symptoms of mental ill-health among children and adolescents, and 2) the design and procedures of an evaluative study. This pilot RCT compared a 6-week mentor-supported surf therapy program with a wait list control group, in Australian children and adolescents aged 8–18yrs (M age = 11.28, SD = 2.34; 15 females), who were help seeking for issues relating to their mental health. Exclusion criteria included if an individual was actively suicidal or experiencing a psychotic episode or being unavailable for program dates. The primary outcome was the feasibility and acceptability of the intervention and study design assessed via 11 pre-defined criteria. A secondary outcome was to investigate the effectiveness signal of the intervention on child indicators of depression and anxiety, assessed via the Revised Children’s Anxiety and Depression Scale-Short Form and the Strengths and Difficulties Questionnaire. Random allocation was computer generated and while it was not possible to blind participants, researchers collecting assessments were blinded to group allocation. Thirty-six youth were randomised (intervention = 18; wait list controls = 18), representing an 84% participation rate among eligible youth. Of the 11 a priori feasibility and acceptability criteria, 4 of 5 relating to the intervention, and 4 of 6 addressing the study design were fully met, with the unmet factors guiding program revision. At the completion of the intervention, children and adolescents receiving the intervention reported reductions in symptoms of depression (ES = 0.57), anxiety (ES = 0.43), emotional problems, (ES = 0.79), peer problems (ES = 0.56), hyperactivity/inattention (ES = 0.28), and overall difficulties (ES = 0.64). These reductions were not sustained 6-weeks after completion of the intervention. Surf therapy is an acceptable and feasible intervention for addressing symptoms of mental ill-health among children and adolescents. Preliminary evidence suggests that surf therapy improves symptoms of mental ill-health in the short-term but that these improvements were not sustained after the intervention is ceased.     

The impact of stimulants on a clinical measure of attention in children with ADHD

The effect of stimulant medication on the attentional functioning of 23 children (8–12 yrs) with attention deficit/hyperactivity disorder (ADHD) was investigated. Significant main effects of medication and TEA-Ch subtests were found, however there was no significant interaction. Planned contrasts showed that stimulants improved performance on the sustained attention, but not the selective or divided attention, subtests. Similar to previous studies, the results indicate that stimulants improve sustained attention in children with ADHD. Significant effects of stimulants on selective and divided attention, however, were not as apparent. Therefore, care must be taken when using TEA-Ch subtests to assess performance change subsequent to stimulant administration.     

The impact of stimulants on a clinical measure of attention in children with ADHD.

The effect of stimulant medication on the attentional functioning of 23 children (8-12 yrs) with attention deficit/hyperactivity disorder (ADHD) was investigated. Significant main effects of medication and TEA-Ch subtests were found, however there was no significant interaction. Planned contrasts showed that stimulants improved performance on the sustained attention, but not the selective or divided attention, subtests. Similar to previous studies, the results indicate that stimulants improve sustained attention in children with ADHD. Significant effects of stimulants on selective and divided attention, however, were not as apparent. Therefore, care must be taken when using TEA-Ch subtests to assess performance change subsequent to stimulant administration.     

The Efficacy, Safety, and Practicality of Treatments for Adolescents with Attention-Deficit/Hyperactivity Disorder (ADHD)

Studies examining interventions for adolescents diagnosed with attention-deficit/hyperactivity disorder (ADHD) were reviewed to evaluate their efficacy. These efficacy findings were supplemented with a preliminary system for judging safety and practicality. Results suggest that the stimulant drug methylphenidate (MPH) is safe and well-established empirically, but has some problems with inconvenience and noncompliance. Preliminary research supports the efficacy, safety, and practicality of some psychotherapeutic interventions, including behavioral classroom interventions, note-taking training, and family therapy. Treatment with tricyclic antidepressants was judged to have minimal empirical support and debatable safety. Very little is known about long-term effectiveness of treatments, long-term compliance, or multimodal treatments for adolescents such as stimulants plus behavior therapy.     

Early Fathering as a Predictor of Later Psychosocial Functioning Among Preschool Children with Behavior Problems

The present study examined the role of early fathering in subsequent trajectories of social emotional and academic functioning of preschool children with behavior problems. Participants were 128 preschool-aged children (73 boys, 55 girls) with behavior problems whose biological fathers took part in a longitudinal study. Children were 3 years of age at the beginning of the study and were assessed annually for 3 years. Early paternal depressive symptoms predicted many aspects of children’s outcome 3 years later, including externalizing and internalizing problems, social skills deficits, and lower cognitive and academic functioning, and predicted changes in children’s externalizing, internalizing, and social problems across the preschool years. Paternal socioeconomic status (SES) also consistently predicted children’s later functioning across these domains. Furthermore, self-reported paternal attention-deficit hyperactivity disorder (ADHD) symptoms and laxness, as well as observed frequent commands were associated with later externalizing problems in children. Paternal depressive symptoms and laxness mediated the relation between paternal ADHD symptoms and child functioning. Results suggest that aspects of early father functioning play an important role in the psychosocial, cognitive, and academic development of preschool-aged children with behavior problems.     

Friendship Intimacy Exchange Buffers the Relation between ADHD Symptoms and Later Social Problems among Children Attending an After-School Care Program

The friendships of children displaying symptoms of attention-deficit/hyperactivity disorder (ADHD) have been understudied, particularly in comparison to the domain of peer rejection. This study tested whether friendship intimacy exchange buffers the prospective relation between ADHD symptoms and social problems 1 year later in a sample of children attending a community-based after-school program. Children (N?=?131; 53 % boys; 66 % African American) ranging from 5 to 13 years of age participated in this study. At baseline, children reported on friendship intimacy exchange with their identified best friend, and program staff rated children on ADHD symptoms and social problems. Staff ratings of children’s social problems were collected again 1 year later. Multiple regression analyses indicated that, after controlling for demographic variables and baseline social problems, friendship intimacy exchange significantly moderated the association between ADHD symptoms and social problems at the one-year follow-up. Specifically, the relation between ADHD and social problems was no longer significant for children reporting high levels of friendship intimacy exchange. This moderation was not further qualified by either child age or sex, although boys were more likely than girls to report low rates of friendship intimacy exchange. These findings indicate the importance of friendship intimacy for children displaying ADHD symptoms, who often experience significant peer problems. Friendship quality may be a promising target for prevention and intervention efforts in mitigating some of the long-term social problems associated with ADHD symptomatology, and future research is needed to extend these findings to other domains of friendship quality and clinical samples of children with ADHD.     

Psychiatric and Psychological Morbidity as a Function of Adaptive Disability in Preschool Children with Aggressive and Hyperactive-Impulsive-Inattentive Behavior

Children with high levels of aggressive-hyperactive-impulsive-inattentive behavior (AHII; n = 154) were subdivided into those with (n = 38) and without (n = 116) adaptive disability (+AD/–AD) defined as a discrepancy between expected versus actual adaptive functioning. They were compared to each other and a control group of 47 normal children. Both AHII groups were more likely to have attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder, and conduct disorder than control children; more symptoms of general psychopathology; greater social skills deficits; more parental problems; and lower levels of academic achievement skills. Compared to AHII – AD children, AHII + AD children had (1) more conduct disorder; (2) greater inattention and aggression symptoms; (3) more social problems, less academic competence, and poorer self-control at school; (4) more severe and pervasive behavior problems across multiple home and school settings; and (5) parents with poorer child management practices. Thus, adaptive disability has utility as a marker for more severe and pervasive impairments in AHII children.     

Treatment Sensitivity of a Brief Rating Scale for Attention-Deficit Hyperactivity Disorder (ADHD) Symptoms

This study examined the treatment sensitivity of the ADHD Questionnaire (ADHD-Q), which is a brief rating scale for measuring symptoms of inattention, hyperactivity, and impulsivity in children. Parent, teacher, and child self-report data of the ADHD-Q were obtained for 17 clinically referred children with ADHD on the three occasions: (1) during the regular intake assessment, (2) just before the start of the stimulant medication (i.e., methylphenidate) intervention, and (3) four weeks after the start of the medication intervention. Results showed that ADHD-Q scores remained fairly stable in the period prior to the intervention, but then showed a substantial decline after the stimulant medication had been administered. Clearly, this finding supports the treatment sensitivity of the ADHD-Q.     

Parent-Child Interaction Therapy for Children Born Premature: A Case Study and Illustration of Vagal Tone as a Physiological Measure of Treatment Outcome

Evidence-based psychosocial interventions for externalizing behavior problems in children born premature have not been reported in the literature. This single-case study describes Parent-Child Interaction Therapy (PCIT) with a 23-month-old child born at 29 weeks gestation weighing 1,020 grams, who presented with significant externalizing behavior problems. Treatment outcome was assessed using standard measures of maternal and child functioning and observational measures of the parent-child interaction, as well as a physiological measure of heart rate variability (i.e., vagal tone) used to assess parasympathetic control in the child. Maternal reports of child behavior problems and their own stress and depressive symptoms decreased after treatment. Behavioral observations demonstrated improved parenting practices and child compliance, and vagal tone showed comparable increases as well. Results suggest that PCIT is a promising psychosocial intervention for children born premature with externalizing behavior problems, and that vagal tone may be a useful measure of treatment outcome.     

Maternal Over-Control Moderates the Association Between Early Childhood Behavioral Inhibition and Adolescent Social Anxiety Symptoms

Behavioral inhibition (BI) and maternal over-control are early risk factors for later childhood internalizing problems, particularly social anxiety disorder (SAD). Consistently high BI across childhood appears to confer risk for the onset of SAD by adolescence. However, no prior studies have prospectively examined observed maternal over-control as a risk factor for adolescent social anxiety (SA) among children initially selected for BI. The present prospective longitudinal study examines the direct and indirect relations between these early risk factors and adolescent SA symptoms and SAD, using a multi-method approach. The sample consisted of 176 participants initially recruited as infants and assessed for temperamental reactivity to novel stimuli at age 4?months. BI was measured via observations and parent-report across multiple assessments between the ages of 14?months and 7?years. Maternal over-control was assessed observationally during parent–child interaction tasks at 7?years. Adolescents (ages 14–17?years) and parents provided independent reports of adolescent SA symptoms. Results indicated that higher maternal over-control at 7?years predicted higher SA symptoms and lifetime rates of SAD during adolescence. Additionally, there was a significant interaction between consistently high BI and maternal over-control, such that patterns of consistently high BI predicted higher adolescent SA symptoms in the presence of high maternal over-control. High BI across childhood was not significantly associated with adolescent SA symptoms when children experienced low maternal over-control. These findings have the potential to inform prevention and early intervention programs by indentifying particularly at-risk youth and specific targets of treatment.     

PILLS OR SKILLS FOR HYPERACTIVE CHILDREN

The controversial nature of drug treatment of hyperactivity, the incidence and sequelae of hyperactivity, and problems of differential diagnosis of hyperactivity versus aggression were discussed. The effects of psychostimulant medication and behavior therapy on hyperactive children were reviewed with regard to effects on their social and academic behavior. Both treatments have resulted in clear short-term changes in social behavior but neither long-term academic nor long-term social effects have been shown with either treatment. Short-term effects on academic behavior have resulted from behavioral interventions but not from psychostimulants. However, the interventions have been too brief to allow one to draw unequivocal conclusions about the clinical efficacy of behavioral treatments. Although there have been long-term evaluations of psychostimulant therapy, there have not been any evaluations of long-term behavioral treatment programs for hyperactive children. Given the salutary short-term effects of behavior therapy with hyperactive children, extended clinical trials of behavior therapy need to be conducted. Finally, specific directions are suggested for future research.     

Dietary factors and hyperactivity: a failure to replicate

Recent research suggests that sucrose consumption may be a factor in children's hyperactivity. Yet, the manner in which hyperactive behavior was assessed confounded hyperactivity and aggression, thereby reducing the conceptual validity of the findings. In addition, accepting a probability level of 0.06 as significant with 36 correlations, and using grams rather than portions as an index of food consumption might have contributed to a Type I error. When these three issues were addressed in the present study, no significant relationships emerged between sucrose consumption and hyperactivity or aggression assessed as separate dimensions. The age of the hyperactive children in this sample (M = 9.15 years) contrasted with that of the original research (M = 6 years 2 months) and this may contribute to the differential results. Suggestions for further research are outlined, and the need to separate hyperactive children according to whether they receive stimulant medication or not, and assess attention deficit disorders in addition to behavioral components of hyperactivity are stressed.     

Promoting socioemotional competence in primary school classrooms: Intervention effects of the EMOscope

The aim of the study was to determine the effectiveness of a brief, teacher-led intervention (EMOscope) developed to promote children’s socioemotional competence. Our sample consisted of 339 Polish pupils and their 16 teachers from 16 third grade classrooms. Teachers in the experimental condition (8 teachers) were trained to deliver the EMOscope intervention. Data were collected at pre-test and post-test. Performance tests were administered to measure children’s social understanding and emotional awareness. Furthermore, peer ratings were used to measure children’s cooperative behaviour and teachers’ reported on children’s prosocial behaviour, hyperactivity, emotional problems, conduct problems, and peer problems. Multilevel regression analysis revealed that children in the experimental condition improved significantly on emotional self- and other-awareness and on social understanding. Moreover, they decreased in teacher-rated hyperactivity, conduct problems, and total difficulties. No effects were found, however, on teacher-rated prosocial behaviour, emotional problems, peer problems, and peer-rated cooperative behaviour.     

Treatment of children with ADHD: psychopedagogical program at school versus psychostimulant medication

This study examined the impact of medication management compared to a psycho-educational program on parent and teacher ratings of children with combined type ADHD. The study lasted 14 weeks and included 50 children. 17 children took medication, 17 received psycho-educational intervention, and 16 children were assigned to the control group. The measures used were the IOWA Conners Scale, the School Problem Inventory, the Abbreviated Conners, and the DSM-IV Inattention-Disorganization and Hyperactivity-Impulsivity rating scales. Regarding teacher ratings, improvements were observed on: a) inattention and school problems in the medication group versus the control group; and b) hyperactivity symptoms in the psycho-pedagogical group versus the control and medication groups. Regarding to parent ratings, improvements were observed on: a)inattention in the psycho-pedagogical group versus the control and medication groups; and b) hyperactivity symptoms in the psycho-pedagogical group versus the control and the medication groups.     

Children with behaviour problems: the influence of social competence and social relations on problem stability,school achievement and peer acceptance across the first six years of school

The aims of the present study were to investigate the role for problematic children of the child's social competence, teacher relations and behaviour with peers for later problem persistence, school performance and peer acceptance, in terms of moderating (protective and exacerbating) and independent effects. Groups of children with externalizing (n=26) and internalizing (n=25) problems and a non‐problematic group (n=44) were followed from grade 1–6. Teachers rated behaviour problems and social competence in the first, third and sixth grades, the teacher–child relationship in third grade, and school achievement in sixth grade. Behaviour with peers was assessed in observations in later elementary school. Peer acceptance was assessed through peer nominations in sixth grade. Both problem groups had lower social competence, school achievement and peer acceptance in sixth grade than the non‐problematic group. There were moderating and independent effects of social competence, teacher and peer relations on outcomes, but these applied mainly to children with internalizing problems. Copyright © 2006 John Wiley & Sons, Ltd.