Institutional care and iron deficiency increase ADHD symptomology and lower IQ 2.5–5 years post‐adoption

Increased ADHD symptomology and lower IQ have been reported in internationally adopted (IA) children compared to non‐adopted peers (Hostinar, Stellern, Schaefer, Carlson & Gunnar, 2012; Kreppner, O'Connor & Rutter, 2001). However, it is unclear whether these outcomes are due to institutional deprivation specifically or to co‐occurring micronutrient deficiencies that disrupt brain development (Fuglestad, Rao & Georgieff, 2008b). In this study, IA children were compared to children raised in their biological families to examine differences in ADHD symptomology and IQ 2.5–5 years post‐adoption and to assess the contributions of iron deficiency (ID) and duration of deprivation to these cognitive outcomes. ADHD symptoms (parent‐ and experimenter‐reported) and IQ were evaluated in 88 IA (M = 62.1 months, SD = 2.4) and 35 non‐adopted children (M = 61.4 months, SD = 1.6). IA children were assessed 29–64 months post‐adoption (M = 41.9 months, SD = 10.2). ID was assessed during the initial post‐adoption medical visit in 69 children, and children were classified into four groups by iron status, ranging from normal to ID anemia (most severe). IA children had greater ADHD symptomology, p < .01, and lower IQ, p = .001, than non‐adopted children. Within the IA group, children with more severe ID at adoption had greater ADHD symptomology, r(69) = 0.40, p = .001, and lower IQ, r(68) = −0.28, p < .05. Duration of institutional care was positively correlated with ADHD symptoms, r(86) = .28, p < .01, but not IQ, r(85) = −.08, p = .52. Longitudinal results indicate improvement in IQ from 12 months post‐adoption to age 5 for children with greater ID severity at adoption and longer duration of institutional care but no improvement in ADHD symptoms. These results signify continuing effects of early deprivation and ID on ADHD symptoms and IQ years after adoption. A video abstract of this article can be viewed at http://www.youtube.com/watch?v=vUFDAS3DD1c     

Can SMART Training Really Increase Intelligence? A Replication Study

A burgeoning research stream supports the efficacy of a novel behavior-analytic intervention, known as SMART training, in raising general intelligence by training a set of crucial cognitive skills, referred to as relational skills. A sample of Irish secondary school students (n?=?26) was divided into two IQ matched groups, with the experimental group receiving 12 weeks of SMART training delivered in bi-weekly 45-min sessions. WASI IQ assessments were administered at baseline and follow-up to all participants by blind testers. For each of the three WASI IQ indices and the four IQ subtests, significant follow-up rises were found for the experimental group only. Analyses of variance indicated a significant effect of training on Verbal IQ, Matrix Reasoning and Vocabulary scores. Results lend further support for the efficacy of the SMART training program in enhancing intellectual skills.     

The effect on the test behavior of children, as reflected in the I.Q. scores, when reinforced after each correct response

This experiment studied the effect on intelligence test scores of a probable reinforcer given for correct responses. Eleven pairs of 5- to 7-yr-old children were matched on the basis of a strong liking of candy, no physical problems associated with eating it, parent permission to receive and eat the candy, age, sex, and a revised Stanford-Binet Scale Form L IQ score. The control group was given the revised Stanford-Binet Scale Form M, as prescribed in the test manual. The experimental group was also given Form M according to the manual, except M&M candy was given for each plus or correct response. There was an appreciable, statistically significant difference between the resulting IQ test scores of the two groups.     

Visual short-term memory, response delay, and age

Recall and recognition memory performance of 12 young (M = 19 yr.) and 12 older (M = 72 yr.) females was studied in relation to response delay (5, 25, and 125 sec.) and stimulus complexity (6.1 and 13.7 bits of information). The subjects were matched on verbal IQ, visual acuity, and educational levels. Stimuli were abstract, black and white, 4 X 4 square matrices. Age-related decrements in memory performance were associated with stimulus complexity but not with response delay. Older subjects also reported experiencing encoding difficulties during the registration phase. The results were discussed with reference to the locus of age-related decrements in visual short-term memory.     

Individual and developmental differences in eyewitness recall and suggestibility in children with intellectual disabilities

This study examined two key issues: (1) whether there were developmental improvements in eyewitness memory performance for children with intellectual disabilities (ID); and (2) whether standardised measures of cognitive ability and suggestibility would relate to eyewitness recall and suggestibility. Children with ID and age‐matched controls (ages 8/9 and 12 years) watched a video of a crime and were asked a range of open‐ended and specific questions about the event in a subsequent interview. Free recall increased between the two age levels for children with and without ID, but at a faster rate for those without ID. For other question types, differences in performance between children with and without ID were far more marked than age differences. Standardised measures of interrogative suggestibility (Gudjonsson Suggestibility Scale, GSS), verbal IQ, non‐verbal IQ, mental age and speed of information processing were related to eyewitness performance. In particular, higher eyewitness recall scores (free recall, non‐leading specific questions) were related to higher scores on the standardised GSS free recall measure; and higher eyewitness suggestibility scores were related to higher scores on the standardised GSS suggestibility measures. Mental age was a better predictor of performance on a range of eyewitness memory question types than verbal or non‐verbal IQ; and speed of information processing showed some relationships with eyewitness performance. Copyright © 2006 John Wiley & Sons, Ltd.     

The effects of sex steroids on spatial performance: a review and an experimental clinical investigation

Males typically surpass females in spatial performance, an outcome that may be linked to testosterone and estrogen. The authors (a) review physiological mechanisms, developmental periods, and past empirical work relevant to sex steroids' effects on human spatial performance and (b) report an experimental study of the role of actively circulating sex steroids in adolescents being treated for delayed puberty (N = 55; mean age = 13.70 years). Sex steroids (simulating early, middle, and late puberty) and placebos were given alternately over 21 months and spatial tests were given every 3 months. Spatial performance showed traditional sex differences but did not vary with levels of actively circulating sex steroids.     

Validity of psychologists' identification of EMR students in the perspective of the California decertification experience

The Diana (Diana v. State Board of Education, Note 1) and the Larry P. (Larry P. v. Riles, Note 2) litigations led to decertification of thousands of California EMR students and their return to the regular program. Allegations, including those of biased testing, went largely uncontested in order that change in special education could result from court mandate, but the allegations left the psychologists in a libeled state. A study of cumulative records and psychologists files in 12 representative districts permitted a comparison of the EMR placement of those later decertified (D) with matched nondecertified (EMR). Other than a small mean difference in IQ at placement, nothing was found to support various allegations. Records showed no systematic differences betweeen D and EMR groups in pre-EMR reasons for referral nor in teacher marks, discnfirming beliefs in referral of higher functioning students for deportment rather than for academic failure. Districts permitted a mean of at least two years in regular placement before assessment, attesting to class failure rather than IQ as the initial and necessary basis for EMR identification (no D-EMR difference in this either). The data permit a conclusion that the work of the school psychologists in the EMR placement was professionally competent, given the guidelines in effect at the time.     

Patterns of language impairment and behaviour in boys excluded from school

Background. High levels of behaviour problems are found in children with language impairments, but less is known about the level and nature of language impairment in children with severe behavioural problems. In particular, previous data suggest that at primary age, receptive impairments are more closely related to behaviour problems, whereas expressive language has a closer link at a later age. Aims. The study assessed expressive and receptive language problems in boys excluded from primary and secondary schools, to investigate the extent of impairment, the pattern of relations between age, receptive and expressive language, and relations with different aspects of behaviour. Sample. Nineteen boys (8–16 years of age) who had been excluded from school and 19 non‐excluded controls matched for age and school participated. Method. The sample was given assessments of: receptive language from the British Picture Vocabulary Scale (BPVS), and Wechsler Objective Language Dimensions (WOLD); expressive‐language evaluations from the Wechsler Intelligence Scale for Children (WISC); auditory working memory evaluations from the Clinical Evaluation of Language Fundamentals (CELF); verbal reasoning (from the WISC); and non‐verbal IQ assessments Raven's matrices. Teachers completed behaviour ratings using the Strengths and Difficulties Questionnaire (SDQ). Results. Excluded boys were significantly poorer than controls on expressive measures but similar on receptive language and non‐verbal IQ. Boys excluded from primary school were poorer than controls on auditory working memory. Expressive problems were linked with high levels of emotional symptoms. Conclusion. Many of the excluded boys had previously unidentified language problems, supporting the need for early recognition and assessment of language in boys with behaviour problems. Expressive problems in particular may be a risk factor.     

Influence of breastfeeding and iron status on mental and psychomotor development during the first year of life.

Breastfeeding (BF) confers numerous benefits on the developing infant in both the short and the long term including psychological development, but there are multiple other factors that must be taken into account when these relationships are studied. To analyse how breastfeeding during the first 4 months of life affects infant mental and psychomotor development (MPD) at 6 and 12 months in a group of healthy infants from a Mediterranean Spanish city considering many important potential confounds. This is a longitudinal study conducted on infants from birth until the age of 12 months. A total of 154 healthy infants were evaluated by Paediatric Unit of Sant Joan University Hospital in Reus, Spain. Type of feeding, clinical history, anthropometry, iron status and mental and psychomotor development were assessed and analysed. At 4 months, 24% of infants received BF and 26% received mixed feeding (MF). Multiple Linear Regression models were applied adjusting for potential prenatal, perinatal and postnatal confounds showing that infants who received BF for at least four months presented higher psychomotor development index (PDI) at 6 and at 12 months of age. Also, gestational age and BMI at 6 m were associated positively with PDI at 6 m, and haemoglobin levels at 12 m and birth height were associated with PDI and MDI at 12 m (respectively).In conclusion, after the adjustment of important potential confounds, BF during at least four months and adequate infant iron status are related to better psychomotor development during the first year. No associations were found between BF and mental development.     

Effects of restricting first graders' TV-viewing on leisure time use,IQ change,and cognitive style

Middle-class 6-year-olds matched for sex, age, pretest WPPSI IQ, and TV-viewing time were blindly assigned to a restricted TV-viewing group or an unrestricted group. Restricted parents halved subjects' previous TV-viewing rates and interacted 20 min./day with subjects for a 6-week period. Unrestricted TV parents provided similar interactions but did not limit viewing. Results tentatively suggest that TV restriction enhanced Performance IQ, reading time, and reflective Matching Familiar Figures scores.     

Impairment of a motor skill in children with spina bifida cystica and hydrocephalus: an exploratory study.

Twenty 7-10 year old children with spina bifida cystica and hydrocephalus and 20 normals matched for age, sex and IQ were compared on a 12-trial target task, first used by Connolly, Brown & Bassett (1968). Analysis of the results, in which particular attention was paid to statistical method and to ways of analysing individual differences, showed a significant impairment in dotting speed in the spina bifida group, although both groups improved with practice. In a second experiment immediately following the first, visual monitoring of this task was restricted. The spina bifida children were initially more affected than the controls but able to recover. The findings are discussed in relation to neurological abnormalities in the spina bifida group.     

HUMAN FIGURE DRAWINGS BY NORMAL AND PHYSICALLY HANDICAPPED CHILDREN: DRAW-A-PERSON TEST

N ielsen , H elle H. Human figure drawings by normal and physically handicapped children. Scand. J. Psychol ., 1961, 2 , 129–138.—Cerebral palsied children (spastic hemiplegia and paraplegia) were compared with normal children on nineteen formal variables of Draw-a-Person Test. Contrary to prediction, no differences were found between the experimental and matched control group, but one variable (Extremities lacking) was scored more frequently on hemiplegic than on paraplegic children. A comparison of the two groups showed that a significantly larger number of spastic drawings than normal drawings had a Goodenough IQ that was more than 10 points lower than their Binet IQ. A clinical psychologist, with much experience of figure drawings, sorted the drawings better than chance, only informed about age and IQ of the subject.     

Responses of low-IQ students on the learning awareness questionnaire compared to students matched on mental and chronological age

Learning awareness, including semantic content, response strategy, processing strategy, summarization, and memory in the classroom, were examined in students with mental retardation. From urban schools in Japan special high school students with average IQ of 60 (n = 40) and students with normal intellectual capacity matched on mental (n = 40) and chronological age (n = 40) were administered a 16-item Learning Awareness Questionnaire. Students of low IQ on the Tanaka-Binet test obtained lower scores on semantic content and memory strategies than chronological or mental age-matched controls, but not on response and processing. Scores indicated that students of low IQ may be equally aware of learning processes related to response and processing strategies.     

Effects of IQ on Executive Function Measures in Children with ADHD

The present study compared children with Attention-Deficit Hyperactivity Disorder (ADHD) and controls on a selected set of clinical measures of executive function (EF). A total of 92 children (51 ADHD, 41 control), ages 6-16, completed measures chosen from a larger neuropsychological battery to illustrate diverse components of the EF construct (planning, inhibitory control, response preparation, memory search). The selected measures were moderately correlated with one another, and moderately correlated with IQ. After controlling for age, sex, presence of learning disability (LD), ADHD, and IQ test version, Full Scale IQ was significantly related to four of the five selected EF measures. A second analysis showed group differences on the EF measures at different IQ levels. After covarying for age, there was a significant multivariate effect for IQ level (average, high average, superior) and a significant multivariate interaction between group (ADHD vs. control) and IQ level. Three of the five selected EF measures showed significant univariate group effects (controls performing better than ADHD) at the average IQ level; however, there were no significant group differences between children with ADHD and controls at high average or superior IQ levels. These results suggest that clinical measures of EF may differ among children with ADHD and controls at average IQ levels, but there is poorer discriminatory power for these measures among children with above average IQ.     

What does the public think of placebo use? The Canadian experience

Part of the National Placebo Initiative in Canada included public consultations, based on the belief that the views of the public should inform Canadian policy development on what constitutes appropriate placebo use. Public consultations took place nationally in 2003. A deliberative dialogue approach was used, or a structured discussion format designed to facilitate the consideration of complex issues and build consensus. The placebo debate was characterized as having 3 distinct approaches and each were explored. The first approach “Maximize Patient Protection” identified the need for experts to determine appropriate placebo use and that placebos should only be allowed under very restricted conditions. The second approach “Maximize Medical Knowledge” identified that placebos give essential information about the safety and efficacy of new drugs, and are appropriate when the rights, safety and well-being of research participants are ensured. The third approach “Maximize Patient Autonomy” identified that the current system of regulating placebo use is paternalistic and that patients should be able to define what is in their best interests and have more leeway to determine for themselves if they wish to participate in a placebo-controlled trial. Advantages and disadvantages of each approach were considered and feedback on what constitutes appropriate placebo use was sought. The major findings were that: PCTs were considered a valuable and acceptable part of advancing medical knowledge; research using placebos must be valid and justifiable; a patient-centred approach needs to be fostered; patient autonomy (choice) should be a first consideration and take clear precedence in trials of low to medium risk; patient protection (or health) may need to “trump” patient autonomy at higher levels of risk and/or patient vulnerability; placebos are not a violation of the duty of care as duty of care is best met by identifying a choice for patients, whenever a choice is available. These consultations clearly were not designed to produce conclusive evidence, but rather to provide some useful insights into what the public may think about placebo use; additional studies are indicated. Funding for the public consultations was provided by Health Canada and the Canadian Institutes of Health Research. An earlier version of this paper was presented at an international conference, “Placebo: Its Action and Place in Health Research Today,” held in Warsaw, Poland on 12–13 April, 2003.     

Effects of IQ on executive function measures in children with ADHD.

The present study compared children with Attention-Deficit Hyperactivity Disorder (ADHD) and controls on a selected set of clinical measures of executive function (EF). A total of 92 children (51 ADHD, 41 control), ages 6-16, completed measures chosen from a larger neuropsychological battery to illustrate diverse components of the EF construct (planning, inhibitory control, response preparation, memory search). The selected measures were moderately correlated with one another, and moderately correlated with IQ. After controlling for age, sex, presence of learning disability (LD), ADHD, and IQ test version, Full Scale IQ was significantly related to four of the five selected EF measures. A second analysis showed group differences on the EF measures at different IQ levels. After covarying for age, there was a significant multivariate effect for IQ level (average, high average, superior) and a significant multivariate interaction between group (ADHD vs. control) and IQ level. Three of the five selected EF measures showed significant univariate group effects (controls performing better than ADHD) at the average IQ level; however, there were no significant group differences between children with ADHD and controls at high average or superior IQ levels. These results suggest that clinical measures of EF may differ among children with ADHD and controls at average IQ levels, but there is poorer discriminatory power for these measures among children with above average IQ.     

Understanding boundary extension: Normalization and extension errors in picture memory among adults and boys with and without Asperger's syndrome

Boundary extension is the tendency for people to “remember” information that fell outside a picture's boundaries. We used a novel test of boundary extension to provide absolute estimates of the magnitude of extension errors and of the degree to which people are influenced by the way a picture is presented at the time of testing. Participants were shown photographs on a computer and subsequently allowed to adjust their magnification to match the size they remembered. The test produced reliable boundary extension of around 11% in adults and large influences of initial test size. In a second experiment we tested boys diagnosed with Asperger's syndrome and matched controls. Both groups demonstrated boundary extension comparable to that observed in adults but greater effects of initial test size. High performance IQ in Asperger's was linked with high levels of boundary extension, while for the matched control group the opposite pattern was obtained.     

Understanding boundary extension: Normalization and extension errors in picture memory among adults and boys with and without Asperger's syndrome

Boundary extension is the tendency for people to “remember” information that fell outside a picture's boundaries. We used a novel test of boundary extension to provide absolute estimates of the magnitude of extension errors and of the degree to which people are influenced by the way a picture is presented at the time of testing. Participants were shown photographs on a computer and subsequently allowed to adjust their magnification to match the size they remembered. The test produced reliable boundary extension of around 11% in adults and large influences of initial test size. In a second experiment we tested boys diagnosed with Asperger's syndrome and matched controls. Both groups demonstrated boundary extension comparable to that observed in adults but greater effects of initial test size. High performance IQ in Asperger's was linked with high levels of boundary extension, while for the matched control group the opposite pattern was obtained.     

Stress in Mothers with Intellectual Disabilities

Both low parental IQ and stress have been shown to be associated with parenting difficulties and adverse child outcomes. We examined stress in parents with low IQ as a potential contributor to their documented parenting problems. Eighty-two mothers with intellectual disabilities (IQ < 80; labelled as having mental retardation) were given the Parenting Stress Index and they were found to be enduring very high levels of overall stress (95th percentile), stress related to child characteristics (95th percentile), and stress related to other life experiences (90th percentile) as compared to the normative test group. We divided the 82 mothers with intellectual disabilities into three groups depending on the age of their children. The mothers with school-age children reported significantly higher stress than parents of infant/toddler and preschool children. A hierarchical regression analysis revealed that child age and living in a crowded environment were significant predictors of parenting stress. The results confirm that mothers with intellectual disabilities experience extreme stress that, together with other factors, may hinder adequate parenting.