Functional analysis and treatment of elopement for a child with attention deficit hyperactivity disorder

We conducted a functional analysis of elopement in an outdoor setting for a child with a diagnosis of attention deficit hyperactivity disorder. A subsequent treatment consisting of noncontingent attention and time-out was demonstrated to be effective in eliminating elopement. Modifications of functional analysis procedures associated with the occurrence of elopement in a natural setting are demonstrated.     

An evaluation of stimulant medication on the reinforcing effects of play

Although a vast literature has indicated that stimulant medications are effective for reducing inappropriate behavior in children with attention deficit hyperactivity disorder (ADHD), the effects of stimulant medication on ancillary behaviors (e.g., play) have yet to be investigated with the same rigor. We used a reinforcer assessment procedure to evaluate the effects of medication on the play and social behavior of 5 preschool children who had been diagnosed with ADHD. Conditions included (a) social reinforcement (i.e., playing with friends), (b) alone play, and (c) quiet time (i.e., resting). Results indicated that 1 of the 5 participants selected fewer social reinforcers and more nonsocial reinforcers (alone play or quiet time) while on medication. The findings indicate that the reinforcer assessment procedure may be a viable way to evaluate medication effects on an ongoing basis and to inform treatment decisions.     

Some effects of stimulant medication on response allocation: a double-blind analysis

Children who are diagnosed with attention deficit hyperactivity disorder (or who engage in behavior consistent with such a diagnosis) are often prescribed stimulant medications for hyperactive or inattentive behaviors. However, the mechanisms by which stimulant medications affect individuals' behavior are rarely evaluated. The purpose of the current study was to evaluate the effects of stimulant medication on response allocation when antecedents and consequences were held constant and equated. Results indicated that the presence of an amphetamine medication (Adderall) influenced response allocation across two concurrently available responses while all other stimulus conditions were held constant.     

THE DIFFERENTIAL EFFECTS OF TEACHER AND PEER ATTENTION ON THE DISRUPTIVE CLASSROOM BEHAVIOR OF THREE CHILDREN WITH A DIAGNOSIS OF ATTENTION DEFICIT HYPERACTIVITY DISORDER

We conducted functional analyses of classroom disruption during contingent teacher and peer attention conditions for 3 children with attention deficit hyperactivity disorder. Attention provided by peer confederates appeared to function as a distinct form of positive reinforcement for all 3 children.     

An evaluation of methylphenidate as a potential establishing operation for some common classroom reinforcers.

We conducted reinforcer assessments for 3 boys with a diagnosis of attention deficit hyperactivity disorder who alternately received either placebo or previously prescribed methylphenidate. Our purpose was to evaluate whether methylphenidate altered the relative reinforcing effectiveness of various stimuli that are often used in classroom-based behavioral treatment programs (e.g., activities, tangible items). Results showed clear differences for some stimuli between reinforcer assessments conducted when participants had received methylphenidate compared to placebo. Results suggest that methylphenidate might act as an establishing operation for some common classroom reinforcers. Implications for the development and evaluation of behavioral treatments are discussed.     

Direct assessment of the cognitive correlates of attention deficit disorders with and without hyperactivity

The cognitive functioning of children identified as attention deficit disorder with hyperactivity (ADD/H) was compared to that of children identified as attention deficit disorder without hyperactivity (ADD/WO). Based on information on symptoms supplied by teachers, 20 ADD/H and 15 ADD/ WO children were selected according to DSM-III criteria from a large elementaryschool learning disabilities and behavior disorders population. For comparison purposes, 16 normal children from regular classrooms were also selected. Children from all three groups were evaluated with a battery of cognitive tests. Intelligence test scores differentiated the two ADD groups, with the ADD/H children obtaining significantly lower Full Scale IQ scores than both ADD/WO and control children. In addition, ADD/H children obtained significantly lower Verbal IQ scores than ADD/WO children. Both ADD groups performed more poorly than controls on Spelling and Reading Achievement, and the ADD/WO group performed more poorly on Math Achievement. The two ADD groups took longer to complete six Stroop and rapid naming tasks than the control groups but did not differ among themselves. The ADD/WO group made more errors on a visual matching task than the controls, but neither ADD group differed from controls on the accuracy of the Stroop tasks, rapid naming tasks, measures of receptive and expressive language, visual-motor integration, or sustained visual attention. The differences between the two ADD groups were fewer than expected on the basis of previous research and are more global than specific.The assistance of John Junginger, Jason Walker, and Cynthia Jones at various stages of the project is gratefully acknowledged. Particular thanks are extended to the teachers and staff of Clarke County schools.     

PEER TUTORING FOR CHILDREN WITH ATTENTION DEFICIT HYPERACTIVITY DISORDER: EFFECTS ON CLASSROOM BEHAVIOR AND ACADEMIC PERFORMANCE

We investigated the effects of classwide peer tutoring (CWPT) on the classroom behavior and academic performance of students with attention deficit hyperactivity disorder (ADHD). Typical instructional activities were contrasted with CWPT for 18 children with ADHD and 10 peer comparison students attending first- through fifth-grade general education classes. CWPT led to increases in active engagement in academic tasks along with reductions in off-task behavior for most participants. Of students with ADHD, 50% exhibited improvements in academic performance in math or spelling during CWPT conditions, as measured by a treatment success index. Participating teachers and students reported a high level of satisfaction with intervention procedures. Our results suggest that peer tutoring appears to be an effective strategy for addressing the academic and behavioral difficulties associated with ADHD in general education settings.     

THE INFLUENCE OF MOTIVATING OPERATIONS ON GENERALIZATION PROBES OF SPECIFIC MANDS BY CHILDREN WITH AUTISM

We investigated the influence of motivating operations on the generalization of newly taught mands across settings and communication partners for 3 children with autism. Two conditions were implemented prior to generalization probes. In the first condition, participants were given access to a preferred item until they rejected the item (i.e., abolishing operation). In the second condition, the item was not available to participants prior to generalization probes (i.e., establishing operation). The effects of these conditions on the generalization of newly taught mands were evaluated in a multielement design. Results indicated differentiated responding during generalization probes in which more manding with the target mand was observed following the presession no‐access condition than in the presession access condition. These results support the consideration of motivating operations when assessing generalization of target mands to various untrained contexts.     

ADHD儿童与正常儿童在视觉—动作方面的比较研究

10岁到13岁男性ADHD儿童在镶嵌图形、眼手协调、视力追踪和数字划销等视觉—动作实验上的分数显著低于同一年龄段的男性正常儿童,显示ADHD儿童的视觉—动作能力比正常儿童差.ADHD儿童与正常儿童相比,知觉方式的场独立性较弱,心理机能分化程度较低.ADHD儿童在长度估计实验上没有发现异常.     

Critique or Misrepresentation? A Reply to Timimi et al.

In rebuttal to Timimi et al., we show that their critique is not a form of reasonable scientific debate with informed, constructive criticism, but merely a misrepresentation of the existing scientific literature on ADHD apparently designed to convince the scientifically uninformed of its nonexistence and of the misuse of medications for its management. We show their argument to be based on faulty logic, selective citation, misreprensentation of individual studies, ignorance of the vast literature on ADHD, and innuendo that maligns the integrity of scientists studying the disorder. Our original International Consensus Statement on ADHD remains untarnished by this faux critique – indeed it was intended to refute just such unsupported and unsupportable criticism that often appears in the popular media.     

A SOCIAL ECOLOGY OF HYPERACTIVE BOYS: MEDICATION EFFECTS IN STRUCTURED CLASSROOM ENVIRONMENTS

Hyperactive boys on methlyphenidate (Ritalin), hyperactive boys on placebo, and comparison boys were observed in quasi-naturalistic classroom settings. Ambient stimulation (quiet versus noisy conditions) and source of regulation (self-paced versus other-paced activities) were varied in a 2 × 2 design. Compared to their peers, hyperactive boys on placebo showed lower rates of task attention and higher rates of gross motor movement, regular and negative verbalization, noise-making, physical contact, social initiation, disruption, and acts that were perceived as energetic, inappropriate, or unexpected. Self-paced activities resulted in increased rates of verbalization, social initiation, and high-energy episodes. High ambient noise levels reduced task attention and increased the rates of many other behaviors including verbalization, physical contact, gross motor movement, and high-energy acts. Medication-by-situation interactions emerged for both classroom dimensions, with hyperactive boys on placebo being readily distinguishable from their peers under some classroom conditions and indistinguishable under other conditions. Moderate relationships were found between teacher ratings and many individual behavior categories. Discussion focused on (a) the merits and limitations of a social ecological research perspective, and (b) the implications of these findings for the design of intervention strategies.     

A RAPID METHOD FOR EVALUATING THE NECESSITY FOR BOTH A BEHAVIORAL INTERVENTION AND METHYLPHENIDATE

We examined the effects of a behavioral intervention and methylphenidate (MPH) on inappropriate behavior and sleep disturbance displayed by a 6-year-old boy who had been diagnosed with attention deficit hyperactivity disorder. Results showed that the behavioral intervention was effective in reducing inappropriate behaviors to near-zero levels regardless of the presence or absence of MPH.     

A COMPARISON OF REINFORCER ASSESSMENT METHODS: THE UTILITY OF VERBAL AND PICTORIAL CHOICE PROCEDURES

We compared three methods of stimulus preference assessment for verbal children and specifically evaluated the utility of a verbal choice procedure for assessing relative reinforcer value. Using a token system, relative preference for five categories of reinforcers, representing 15 different stimuli, was assessed by three methods: a reinforcer survey, a verbal stimulus-choice questionnaire, and a pictorial stimulus-choice procedure. Results showed that the verbal and pictorial stimulus-choice assessments accurately identified high- and low-preference categories for 3 of 4 participants. Survey results alone often rated multiple categories as high preference, were less likely to identify low-preference categories, and were less likely to correspond with the results of a reinforcer assessment.     

Agreement of parent and teacher rating scales with comprehensive clinical assessments of attention deficit disorder with hyperactivity

Forty-one clinic-referred children were given the DSM-III diagnosis of attention deficit disorder with hyperactivity (ADD/H) based on structured diagnostic interviews of the child and mother and on two teacher and two parent rating scales. The degree of agreement between diagnostic classification of ADD/H based solely on criterion scores on each rating scale and classification based on the comprehensive clinical assessments that included use of the same rating scaleswas assessed by comparing the ratings of the 41 children with ADD/H to those of 47 clinic-referred children given other diagnoses or no diagnosis. The accuracy of classification was highly similar across scales. Increasing the cutoff score increased the acing true positives. Using the point of intersection of these two curves to choose the optimal cutoff scores resulted in 70–75% accurate classification and 25–30% misclassification of children given clinical diagnoses of ADD/H. This rate of misclassification suggests that rating scales alone should not be used to classify ADD/H for most clinical and research purposes, especially because the method of comparison used in this study favored finding a high degree of correspondence.     

The Predictive Validity of Parent and Teacher Reports of ADHD Symptoms

The objectives were to evaluate the ability of the Inattention and Hyperactivity–Impulsivity factors of the ADHD Rating Scale-IV to differentiate children with ADHD from a control group and to discriminate children with different subtypes of ADHD. Also, we sought to determine optimal cutoff scores on the teacher and parent versions of this scale for making diagnostic decisions about ADHD. In a sample of 92 boys and girls 6 to 14 years of age referred to a regional ADHD program, we assessed ADHD diagnostic status using categorical and dimensional approaches as well as parent- and teacher-report measures. Logistic regression analyses showed that the Inattention and Hyperactivity–Impulsivity factors of the ADHD Rating Scale-IV were effective in discriminating children with ADHD from a control group and differentiating children with ADHD, Combined Type from ADHD, Inattentive Type. Although both teacher and parent ratings were significantly predictive of diagnostic status, teacher ratings made a stronger contribution to the prediction of subtype membership. Using symptom utility estimates, optimal cutoff scores on the Inattention and Hyperactivity–Impulsivity scales for predicting subtypes of ADHD were determined.     

Do Executive Function Deficits Differentiate Between Adolescents with ADHD and Oppositional Defiant/Conduct Disorder? A Neuropsychological Study Using the Six Elements Test and Hayling Sentence Completion Test

Two neuropsychological measures of executive functions—Six Elements Tests (SET) and Hayling Sentence Completion Test (HSCT)—were administered to 110 adolescents, aged 12–15 years. Participants comprised four groups: Attention Deficit Hyperactivity Disorder (ADHD) only (n = 35), ADHD and Oppositional Defiant Disorder/Conduct Disorder (ODD/CD) (n = 38), ODD/CD only (n = 11), and a normal community control group (n = 26). Results indicated that adolescents with ADHD performed significantly worse on both the SET and HSCT than those without ADHD, whether or not they also had ODD/CD. The adolescents with ADHD and with comorbid ADHD and ODD/CD were significantly more impaired in their ability to generate strategies and to monitor their ongoing behavior compared with age-matched controls and adolescents with ODD/CD only. It is argued that among adolescents with clinically significant levels of externalizing behavior problems, executive function deficits are specific to those with ADHD. The findings support the sensitivity of these two relatively new tests of executive functions and their ecological validity in tapping into everyday situations, which are potentially problematic for individuals with ADHD.     

BEHAVIORAL AND STIMULANT TREATMENT OF HYPERACTIVE CHILDREN: A THERAPY STUDY WITH METHYLPHENIDATE PROBES IN A WITHIN-SUBJECT DESIGN

Eight hyperactive children were treated with a behavioral intervention focusing on teacher and parent training over a period of 5 months. Three times, before therapy and after 3 weeks and 13 weeks of intervention, children received methylphenidate during 3-week probe periods. Each week in a probe they received either a placebo, .25 mg/kg, or .75 mg/kg methylphenidate. Classroom observations of on-task behavior suggested that effectiveness of the behavioral intervention was between that of the two dosages of medication before therapy. Both dosages resulted in higher levels of on-task behavior when administered after 13 weeks of behavioral intervention than when administered before therapy. Teacher rating data showed equivalent effects of therapy and the low dosage of methylphenidate alone but a stronger effect of the high dose alone; only the high dose resulted in improved behavior after 13 weeks of behavioral intervention. As a group, only when they received the high dose of methylphenidate after 13 weeks of behavioral intervention did children reach the level of appropriate behavior shown by nonhyperactive controls. However, this level was also reached by two children with the low dose and by one child without medication, and it was not reached by one child. The results suggest that the combination of psychostimulant medication and behavior therapy may be more effective in the short-term than either treatment alone for hyperactive children in school settings. In addition, parent ratings and clinic observation of parent-child interactions suggested that children had improved in the home setting, highlighting the importance of behavioral parent training in the treatment of hyperactivity.     

A PRELIMINARY COMPARISON OF REINFORCER ASSESSMENT METHODS FOR CHILDREN WITH ATTENTION DEFICIT HYPERACTIVITY DISORDER

We evaluated the relative treatment utility of a verbal forced-choice questionnaire, child nomination, and direct observation for identifying the most potent reinforcers for children with attention deficit hyperactivity disorder. Results demonstrated that all three methods were more likely to disagree than to agree, that a forced-choice format may enhance verbal reinforcer assessment, and that further development and evaluation of verbal reinforcer-assessment methods are needed.     

Depression and Self-Esteem in Boys with Attention-Deficit/Hyperactivity Disorder: Associations with Comorbid Aggression and Explanatory Attributional Mechanisms

It was tested whether boys with attention-deficit/hyperactivity disorder (ADHD), subgrouped by aggressive status, would show higher rates of depressive symptomatology and lower levels of self-esteem than would comparison boys and, in a subsample, explored attributional mechanisms that may be related to such internalizing features. Study 1 utilized 114 boys with ADHD (all prior recipients of stimulant medication) and 87 comparison boys, aged 7–12 years. Aggressive boys with ADHD reported more symptoms of depression than did nonaggressive boys with ADHD, who, in turn, reported more depression than did comparison boys. Effect sizes were moderate to large and did not vary with a depression rating scale uncontaminated by ADHD-related items. For self-esteem, the most pronounced effect was that aggressive boys with ADHD showed lower levels than did nonaggressive ADHD or comparison boys; effects were again moderate to large. Study 2 participants were a subsample of boys with ADHD from Study 1 (N = 27). We probed causal attributions in ADHD-related domains through responses to hypothetical vignettes, in which the protagonist's medication status (medicated, not medicated) was crossed with type of outcome (good, bad). Medication-related attributions were frequent. In describing the protagonist's success in relation to medication treatment, the sample showed significant associations between (a) medication-related attributions and (b) increased depressive symptomatology as well as decreased self-esteem. We discuss attributional processes that may help to explain the variation in internalizing symptoms among children with ADHD.     

DEVELOPING FLUENCY AND ENDURANCE IN A CHILD DIAGNOSED WITH ATTENTION DEFICIT HYPERACTIVITY DISORDER

We examined the effect of a teaching method on skill fluency and on‐task endurance of a 9‐year‐old boy who had been diagnosed with attention deficit hyperactivity disorder. An academic task that occurred at low fluency during 10‐min baseline sessions was taught to fluency. When responding was not yet fluent, brief reversals to baseline showed that the learner's rate of responding decreased and that he did not spend entire sessions on task. However, once a fluency goal had been reached, responding remained fluent and he remained on task in the third reversal condition.