Adults With Attention‐Deficit/Hyperactivity Disorder: Assessment and Treatment Strategies

Attention‐deficit/hyperactivity disorder (ADHD) among adults is characterized by inattentiveness and impulsivity. This article provides counselors with information about the etiology, assessment, and treatment of adult ADHD. The identification of the genetic and neurological features of ADHD has led to improvements in evaluation and treatment. Assessment of ADHD requires knowledge of the defining characteristics, subtypes, comorbid features, and functional aspects of ADHD. Effective treatments include both medical management and counseling to address psychosocial deficits.     

Group Narrative Therapy for Women With Attention‐Deficit/Hyperactivity Disorder

Women with attention‐deficit/hyperactivity disorder (ADHD) often struggle with the developmental challenges of adulthood and ADHD‐related problems. The authors provide specific clinical interventions from a narrative‐based group approach to help women with ADHD understand their symptoms, create strength‐based narratives, and apply these narratives to the developmental tasks of early adulthood.     

Diagnosis and Treatment of Children and Adolescents With Attention‐Deficit/Hyperactivity Disorder

Attention‐deficit/hyperactive disorder (ADHD) has been estimated to affect between 3% and 5% of school‐age children. The disorder frequently has a profound effect on a child's personal, social and academic development and is a risk factor in the development of other comorbid disorders. Diagnostic criteria and methods for identification of ADHD will be presented. Major intervention strategies appropriate for school and community settings are outlined. Because ADHD is 1 of the most common reasons for referral in both school and community agencies, it is important that clinicians be prepared to provide accurate diagnosis and intervention recommendations.     

Five Frameworks for Increasing Understanding and Effective Treatment of Attention‐Deficit/Hyperactivity Disorder: Predominately Inattentive Type

The article presents 5 interrelated frameworks for counselors seeking to obtain a greater understanding of factors that play a pivotal role in attention‐deficit/hyperactivity disorder (ADHD). Special attention is devoted to cases in which the predominant characteristic is inattentiveness. The 5 frameworks examined are organicity, internalizing dimension, co‐occurring conditions, personality structure, and neurocounseling. Generating new perspectives for counseling practitioners should optimize counseling or treatment outcomes for clients with this multifaceted disorder.     

Accumulated reinforcers increase academic responding and suppress problem behavior for students with Attention‐Deficit Hyperactivity Disorder

We compared rates of academic responses and problem behavior during mathematics with distributed and accumulated reinforcer arrangements for 3 students with Attention‐Deficit Hyperactivity Disorder who engaged in chronic, severe problem behavior. All 3 students engaged in more academic responding and less problem behavior when reinforcers accumulated throughout the session, relative to conditions in which reinforcers were distributed throughout the session or withheld completely. We then conducted concurrent‐chain analyses to evaluate student preference for the reinforcer arrangements. Two students preferred distributed reinforcers, even though this arrangement continued to produce problem behavior. One student preferred accumulated reinforcers. Our data replicate previous findings regarding the efficacy of accumulated‐reinforcer arrangements, but suggest that students do not always prefer the most efficacious reinforcer arrangement.     

Exemplary Counseling Strategies for Developmental Transitions of Young Women With Attention Deficit/Hyperactivity Disorder

This article is intended to provide rehabilitation, career, and mental health counselors with an understanding of how attentional impairments are manifested in young women and how professional counselors may help them most effectively. Treatment guidelines and recommendations are presented for working with these young women through the developmental transition years of adolescence and young adulthood.     

Individual Differences in Training Gains and Transfer Measures: An Investigation of Training Curves in Children with Attention‐Deficit/Hyperactivity Disorder

Currently, evidence for the beneficial effects of working memory (WM) training on transfer measures in children with attention‐deficit/hyperactivity disorder (ADHD) is inconsistent. Although there is accumulating evidence for the role of individual differences in training and transfer gains of cognitive training, this area has been left unexplored for children with ADHD. In the current study, an advanced latent growth curve model analysis was used to investigate the individual differences in learning curves (training gains) of WM training tasks within a new cognitive intervention ‘Paying Attention in Class’. It was investigated whether certain baseline variables (age, intelligence quotient, externalizing behaviour problems and presence of learning disability) predicted the learning curves and how these individual learning curves influenced near‐transfer and far‐transfer measures. A total of 164 children diagnosed with ADHD, between the age of 8 and 12 years old, followed this new Paying Attention in Class intervention. WM (near‐transfer) and academic performance (far‐transfer) measures were assessed before treatment and directly after treatment. Results showed that individual differences at the start of training were predicted by age and intelligence quotient, but the individual differences in learning curves were not predicted by any of the baseline variables. Both for the verbal and the visuospatial WM training, children with larger training gains (i.e. steeper training curves) showed larger benefits on the near untrained transfer measures. These effects were absent for the far‐transfer measures. Current study shows that training WM is quite complex and has its limitations for children with ADHD. Nonetheless, it highlights that training and transfer gains are affected by many different factors and warrants the need of a more in‐depth investigation of individual differences in future studies.Copyright © 2017 John Wiley & Sons, Ltd.     

Diagnosis and Treatment of Adults With Attention Deficit Hyperactivity Disorder

It is estimated that between 30% and 50% of children diagnosed with attention deficit hyperactivity disorder (ADHD) will continue to exhibit symptomatology that is disruptive throughout their adult lives. Identification and diagnosis of adult ADHD, as well as primary and secondary characteristics and comorbid disorders, are discussed in this article. Counseling strategies are suggested to help clinicians treat adults with ADHD, such as educating the client about the disorder and providing training in attention management techniques, self-management skills, interpersonal and social skills, stress and time management, anger management, and problem-solving skills. Clinicians are encouraged to prepare themselves for understanding, identifying, diagnosing, and treating the adult population with ADHD.     

Processing Speed in Children With Attention Deficit/Hyperactivity Disorder,Inattentive Type

Attention Deficit/Hyperactivity Disorder (ADHD) is among the most common and most often reconceptualized neurobehavioral disorders of childhood. In the most recent DSM-IV, a primarily inattentive subtype of ADHD (AD) has again been identified. This study explores the neuropsychological profile of this group of children. Eighty-two children referred for school-related problems participated. Twenty-five met criteria for AD; 52 met criteria for reading disability (RD); 9 were comorbid for RD and AD. AD children performed poorly on measures of information processing speed. Children with comorbid AD/RD were distinguishable from those with RD on speed of processing measures only. Vulnerability to information processing load may be at the root of many of the behavioral manifestations of AD.     

Psychosocial Treatments for Children with Attention Deficit/Hyperactivity Disorder

This article reviews studies examining the efficacy of behavioral interventions for the treatment of attention-deficit/hyperactivity disorder (ADHD). A specific emphasis is placed on evidence-based interventions that include parent training, classroom, academic, and peer interventions. Results indicate that school-aged children respond to behavioral interventions when they are appropriately implemented both at home and in the classroom setting. Combined treatments (behavioral management and stimulant medication) represent the gold standard in ADHD treatment and are often recommended as the first-line treatment option due to the many problems faced by children with ADHD. Diversity issues, although an important consideration in the treatment of ADHD, continue to remain an understudied area. Recommendations for future research are made pertaining to treatment sequencing with regard to behavior management as well as for subgroups of ADHD children who may respond best to specific treatments.     

Working With Immigrant Students in Schools: The Role of School Counselors in Building Cross‐Cultural Bridges

School counselors are poised to play a significant role within comprehensive school counseling programs in addressing the needs of immigrant children in schools. The authors describe how school counselors can have a positive impact on the adjustment of immigrant students by building cross‐cultural bridges through the use of cross‐cultural simulations and activities. Los consejeros escolares se encuentran en una buena posición para jugar un papel significativo dentro de los programas exhaustivos de consejería escolar que tratan las necesidades de los niños inmigrantes en las escuelas. Los autores describen cómo los consejeros escolares pueden tener un impacto positivo en la adaptación de los alumnos inmigrantes por medio de la construcción de puentes interculturales a través del uso de simulaciones y actividades interculturales.     

Assessing Culturally Different Students for Attention Deficit Hyperactivity Disorder Using Behavior Rating Scales

Behavior rating scales are commonly used in the assessment of attention deficit-hyperactivity disorder (ADHD). However, there is little information available concerning the extent to which scales are valid with culturally different students. This study explored the use of the ADHD-IV Rating Scale School Version with male Caucasian (CA) and African American (AA) students from ages 5 to 18 years. Teachers rated AA students higher on all symptoms across all age groups. LISREL analysis indicated that scale does not perform identically across groups. This was supported by the results of multidimensional scaling with suggested that there is a different relation between items across groups. Implications for research and practice are discussed.     

注意缺陷多动障碍的研究与治疗

注意缺陷多动障碍（ADHD）的发病群体多为5岁以后的儿童,主要临床表现是多动、冲动,注意力无法集中,对一项任务不能够有规划进行下去,而且脾气暴躁、易怒。近年来,心理学界、神经科学界和教育学界等对ADHD的研究取得了很多进展。本文概括性地介绍了ADHD病症的基本特征,目前对于患者脑机制损害的研究,并从药理学和行为学等方面讨论了ADHD的治疗方法和手段。     

Evidence for an Error Monitoring Deficit in Attention Deficit Hyperactivity Disorder

We studied error monitoring in ADHD and control children in a task requiring inhibition of a motor response. The extent of slowing following successful (stopped) and failed (nonstopped) inhibition was compared across groups. We also measured the time required to inhibit a response (stop signal reaction time, SSRT). Compared to controls, ADHD participants slowed less following nonstopped responses. Slowing did not vary with comorbid reading, oppositional, conduct or anxiety disorder, sex or ADHD subtype. Slowing after nonstopped responses was marginally, although significantly correlated with total ADHD symptoms and with age. ADHD participants had significantly longer SSRT than controls, but SSRT was not significantly correlated with slowing. The apparent deficit in error monitoring in ADHD and its independence from the inhibition deficit observed in ADHD has implications for executive control models of ADHD, performance problems associated with the disorder and for component theories of executive control.     

Establishing a Link Between Attention Deficit Disorder/Attention Deficit Hyperactivity Disorder and Childhood Physical Abuse

Attention deficit disorder and attention deficit/hyperactivity disorders (ADD/ADHD) are found in approximately 5% to 10% of school-aged children. This study examined whether childhood physical abuse was associated with ADD/ADHD. Data were derived from a population-based sample of 13,054 adults from the 2005 Canadian Community Health Survey. We used logistical regression analysis in 2 models, both of which had ADD/ADHD as the criterion variable. There were 7 times higher odds of ADD/ADHD among those who reported they had been abused after controlling for several potential mediating factors, including age, race, gender, and 3 other types of adverse childhood experiences (parental divorce, parental addictions, and long-term parental unemployment) in comparison to those who were not abused. The results of this analysis show a strong link between childhood abuse and ADD/ADHD, an association that requires further study.     

Family Correlates of Oppositional and Conduct Disorders in Children With Attention Deficit/Hyperactivity Disorder

Comorbidities among children with ADHD are key determinants of treatment response, course, and outcome. This study sought to separate family factors (parental psychopathology and parenting practices) associated with comorbid Oppositional Defiant Disorder (ODD) from those associated with Conduct Disorder (CD) among children with Attention Deficit/Hyperactivity Disorder. Clinic-referred families (n = 149) were diagnosed using DSM-IV criteria. Parents completed measures of parenting practices. Comorbid ODD and CD were significantly associated with maternal negative/ineffective discipline. Comorbid CD, but not ODD, was significantly associated with lack of maternal warmth and involvement, paternal negative/ineffective discipline, and with paternal Antisocial Personality Disorder (APD). However, the risk of CD posed by parenting appeared concentrated among children without a father having APD. While consistent discipline appears important for addressing comorbid ODD and CD, paternal psychopathology and the quality of the relationship between mother and child may pose risk specifically for comorbid CD. Efforts to prevent and/or treat CD should consider not only provision of structure and prudent discipline, but also the affective qualities of the relationship between the primary caretaker and child.     

The Development of Selective Attention in Children With Attention Deficit Hyperactivity Disorder

The influence of age on a selective attention task was studied in a sample of children with and without Attention Deficit Hyperactivity Disorder (ADHD). The impact of methylphenidate (MPH) treatment on selective attention was also investigated in the children with ADHD. Two age groups of children with ADHD and two age groups of control children were tested using a timed computer task. The task consisted of identifying visual target stimuli under various distracter conditions. Distracters varied on the basis of modality (i.e., visual, auditory, or both) and task relevance (i.e., meaningful or irrelevant). Reaction times and accuracy were measured. Children with ADHD were less efficient on the selective attention task than were children without ADHD, and older children were more efficient than younger children in both groups. Children without ADHD were influenced more by the nature of distracters than were children with ADHD. For children with ADHD, MPH improved performance overall.     

Lack of Inhibition: A Motivational Deficit in Children With Attention Deficit/Hyperactivity Disorder and Children With Traumatic Brain Injury*

Recent research has demonstrated that both brain-injured children and children with attention deficit/hyperactivity disorder (ADHD) suffer from response inhibition deficits. To investigate whether these deficits can be influenced by motivational factors, the stop-signal task was performed with and without reward contingencies for successful inhibition. Three groups of children between 8 and 12 years of age, participated in the study: 31 children with ADHD, 37 with traumatic brain injuries (TBI), and 26 normal controls. Results indicated that, although all groups showed comparable learning effects, reward contingencies had different effects on the groups. Whereas the performance of children with ADHD under reward contingencies were brought up to the performance level of normal controls, rewards were found less effective at improving response inhibition in children with TBI. The results further support a motivational/energetic explanation of the inhibitory deficit in children with ADHD, and of a primary response inhibition deficit due to structural brain damage in children with TBI.