A computerized test of self-control predicts classroom behavior

We assessed choices on a computerized test of self-control (CTSC) for a group of children with features of attention deficit hyperactivity disorder (ADHD) and a group of controls. Thirty boys participated in the study. Fifteen of the children had been rated by their parents as hyperactive and inattentive, and 15 were age- and gender-matched controls in the same classroom. The children were observed in the classroom for three consecutive mornings, and data were collected on their activity levels and attention. The CTSC consisted of two tasks. In the delay condition, children chose to receive three rewards after a delay of 60 s or one reward immediately. In the task-difficulty condition, the children chose to complete a difficult math problem and receive three rewards or complete an easier problem for one reward. The children with ADHD features made more impulsive choices than their peers during both conditions, and these choices correlated with measures of their activity and attention in the classroom.     

Visual attention and academic performance in children with developmental disabilities and behavioural attention deficits

Despite well‐documented attention deficits in children with intellectual and developmental disabilities (IDD), distinctions across types of attention problems and their association with academic attainment has not been fully explored. This study examines visual attention capacities and inattentive/hyperactive behaviours in 77 children aged 4 to 11 years with IDD and elevated behavioural attention difficulties. Children with autism spectrum disorder (ASD; n = 23), Down syndrome (DS; n = 22), and non‐specific intellectual disability (NSID; n = 32) completed computerized visual search and vigilance paradigms. In addition, parents and teachers completed rating scales of inattention and hyperactivity. Concurrent associations between attention abilities and early literacy and numeracy skills were also examined. Children completed measures of receptive vocabulary, phonological abilities and cardinality skills. As expected, the results indicated that all groups had relatively comparable levels of inattentive/hyperactive behaviours as rated by parents and teachers. However, the extent of visual attention deficits varied as a result of group; namely children with DS had poorer visual search and vigilance abilities than children with ASD and NSID. Further, significant associations between visual attention difficulties and poorer literacy and numeracy skills were observed, regardless of group. Collectively the findings demonstrate that in children with IDD who present with homogenous behavioural attention difficulties, at the cognitive level, subtle profiles of attentional problems can be delineated.     

Parent stress and coping in relation to child ADHD severity and associated child disruptive behavior problems.

Examined parent role distress and coping in relation to childhood attention deficit hyperactivity disorder (ADHD) in mothers and fathers of 66 children age 7 to 11 (42 boys, 24 girls; mean age = 10.2). Parents of children with ADHD combined and inattentive subtypes expressed more role dissatisfaction than parents of control children. Parents of ADHD combined and inattentive type children did not differ significantly in levels of distress. For mothers, child inattention and oppositional-conduct problems but not hyperactivity contributed uniquely to role distress (dissatisfaction related to parenting or parenting performance). For fathers, parenting role distress was associated uniquely with child oppositional or aggressive behaviors but not with ADHD symptom severity. Parent coping by more use of positive reframing (thinking about problems as challenges that might be overcome) was associated with higher role satisfaction for both mothers and fathers. Community supports were associated with higher distress for mothers only.     

Hyperactive boys in their classroom: Assessment of teacher and peer perceptions,interactions, and classroom behaviors

Teacher ratings, peer perceptions, peer interactions, and classroom behaviors of 17 hyperactive and 17 active elementary school-age boys, nominated by their teachers, were compared using multivariate analyses and planned comparisons in order to better describe and assess hyperactivity in its most probable setting —the classroom. Hyperactive boys were found to be significantly different from actives on measures from all data sources in that they were perceived and interacted more negatively. Cluster analyses of teacher ratings of 90 hyperactives from a clinical sample and 17 hyperactives from the current sample were used to discriminate among different types of hyperactives. Four types were named anxious, conduct problem, inattentive, and low problem hyperactives. The fact that six conduct problem hyperactives were found to be more disruptive and have higher activity level ratings than six inattentive hyperactives, when observed in their classrooms, points to the need to study and treat hyperactives as heterogeneous groups.This study is based in part on a doctoral dissertation submitted to the Psychology Department, Indiana University, by the first author. Thanks are expressed to the students and teachers of the Monroe County School System who took part in the study. The authors also wish to thank Prof. Robert Sprague of the University of Illinois for providing the Conners Rating Scales on 90 hyperactive children.     

Negative Halo Effects in Parent Ratings of ADHD and ODD

Parent ratings of ADHD and ODD symptoms depicted in written vignettes were examined for negative halo effects. Participants were 82 parents of children ages 6–12. Both unidirectional and bidirectional halo effects were found but to a lesser extent than in similar studies with teacher and college student raters. Specifically, parents were more likely to: (a) rate a child as inattentive in the presence of hyperactivity symptoms; (b) more likely to rate a child as oppositional in the presence of inattention and hyperactivity symptoms; and (c) more likely to rate a child as inattentive and hyperactive in the presence of oppositionality symptoms. Several specific symptoms were also found to be particularly susceptible to halo effects. Results suggest that parents may be more discerning raters of disruptive behavior disorders than teachers or college students and less prone to negative halo effects. Implications for clinical practice and future research directions are discussed.     

Evaluating the endophenotype model of ADHD neuropsychological deficit: results for parents and siblings of children with ADHD combined and inattentive subtypes

Neurogenetic models predict neuropsychological weaknesses in the relatives of children with attention-deficit/ hyperactivity disorder (ADHD). The authors examined executive and regulatory measures in 386 relatives (307 parents, 79 siblings) of children with ADHD combined type, ADHD inattentive type, and controls. Predicted deficits were seen on trailmaking (relatives of ADHD combined type only), stop-signal reaction times (relatives of girls only), and response variability (mothers only) but not on naming or output speed. Effects generally held, even with relatives' ADHD status controlled. A neuropsychologically impaired subgroup of children with ADHD had relatives with clear neuropsychological weaknesses. The authors conclude that a neurogenetic model of ADHD etiology is supportable only for a subset of executive functions and that neuropsychological heterogeneity warrants more examination in ADHD.     

The Role of Maternal and Child ADHD Symptoms in Shaping Interpersonal Relationships

The current study investigated the influence of maternal ADHD symptoms on: (a) mothers’ own social functioning; (b) their child’s social functioning; and (c) parent–child interactions following a lab-based playgroup involving children and their peers. Participants were 103 biological mothers of children ages 6–10. Approximately half of the children had ADHD, and the remainder were comparison youth. After statistical control of children’s ADHD diagnostic status and mothers’ educational attainment, mothers’ own inattentive ADHD symptoms predicted poorer self-reported social skills. Children with ADHD were reported to have more social problems by parents and teachers, as well as received fewer positive sociometric nominations from playgroup peers relative to children without ADHD. After control of child ADHD status, higher maternal inattention and hyperactivity/impulsivity each predicted children having more parent-reported social problems; maternal inattention predicted children receiving more negative sociometric nominations from playgroup peers. There were interactions between maternal ADHD symptoms and children’s ADHD diagnostic status in predicting some child behaviors and parent–child relationship measures. Specifically, maternal inattention was associated with decreased prosocial behavior for children without ADHD, but did not influence the prosocial behavior of children with ADHD. Maternal inattention was associated with mothers’ decreased corrective feedback and, at a trend level, decreased irritability toward their children with ADHD, but there was no relationship between maternal inattention and maternal behaviors for children without ADHD. A similar pattern was observed for maternal hyperactivity/impulsivity and mothers’ observed irritability towards their children. Treatment implications of findings are discussed.     

Observation of children with attention‐deficit hyperactivity (ADHD) problems in three natural classroom contexts

Background. Observation studies of students with attention‐deficit hyperactivity disorder (ADHD) problems in natural classroom situations are costly and relatively rare. Aims. The study enquired how teacher ratings are anchored in actual student classroom behaviours, and how the behaviour of children with ADHD problems differs from their classmates. The authors attempted to broaden the usual focus on disruptive and inattentive behaviours to elucidate the role of various on‐task behaviours, as well as considering differences between classroom contexts. Sample. DSM‐III‐R criteria were used in conjunction with a teacher rating scale to select a sample of 55 students with ADHD problems, and 55 matched controls from a population of 569 primary school students. Method. Students were observed in their natural classrooms using the Munich Observation of Attention Inventory (MAI; Helmke, 1988 ). Correlations between teacher reports and observation codes were computed, and systematic differences between students with ADHD problems and controls in different classroom contexts were examined using a generalized linear mixed model (GLMM). Results. Global teacher reports showed moderate to strong correlations with observed student behaviours. Expected on‐task behaviour demonstrated the strongest relationship (r >?.70) with teacher reports. As hypothesized, the children with ADHD were more disruptive and inattentive than their matched peers. They were also less often inconspicuous on‐task as expected by their teachers. However, their behaviour was assigned to two other on‐task categories more often than their peers, and this raised their total on‐task behaviour to over 66%. Situational differences were found for all codes as well, which mostly affected all students in a similar way, not just students with ADHD. Conclusions. ADHD related behaviours are pervasive across the classroom situations coded. Teachers appear to distinguish between desirable and undesirable on‐task behaviours. Nevertheless, assisting students with ADHD problems requires shaping both. Future studies need to include more differentiated codes for various types of on‐task behaviours and also need to code the lesson context concurrently.     

A comparison of objective measures of activity and distractibility in hyperactive and nonhyperactive children

In a 15-minute free-play and a 5-minute test session, 13 measures of activity, distractibility, and parental ratings of activity were obtained on three groups of children, consisting of 16 boys referred to a psychological services center for evaluation of possible hyperactivity, 16 referred to that same center for problems other than hyperactivity, and 20 obtained from the local community. Subjects were boys with average intelligence between the ages of 4 and 12 years. Results indicated that the multiple measures of activity and distractibility had significant but relatively low order correlations among themselves. These relationships varied as a function of the subject group. However, there was no sonsistent relationship between the measures of activity and distractibility. The pattern of relationships obtained suggested that both activity level and distractibility are not homogeneous, unidimensional constructs. Results also indicated that boys referred for hyperactivity displayed greater wrist activity in free play, tended to display greater ankle activity in free play, had significantly correlated wrist and ankle activity, and were rated by their parents as more active than other children. This pattern suggested a global restlessness in children referred for hyperactivity that distinguishes them from other children.     

Processing Speed Weakness in Children and Adolescents with Non-Hyperactive but Inattentive ADHD (ADD)

DSM-IV-TR defines ADHD-Predominantly Inattentive as allowing up to five symptoms of hyperactivity/impulsivity, while theories of the inattentive type usually assume a group that is hypoactive and characterized by processing speed and cognitive interference deficits. In a community-recruited sample of 572 children and adolescents, a pure inattentive subtype of ADHD (ADD) was defined as those who met DSM-IV-TR criteria for ADHD-PI but had two or fewer hyperactive/impulsive symptoms. Processing and output speeds of those with ADD were compared to those identified with DSM-IV-TR ADHD combined type and non-ADHD controls. These results were then contrasted with those found when DSM-IV-TR defined ADHD-PI was compared with ADHD-C and controls. Processing and output speed were assessed with the Trailmaking A and B and the Stroop Naming Tests. Cognitive interference control was assessed with the interference score from the Stroop Task. Slower cognitive interference speed was found in the ADD vs. ADHD-C and controls comparisons, but not the ADHD-PI versus ADHD-C and controls comparisons. On output speed measures, ADD exhibited the slowest performance, significantly different from controls and the effect size for the set-shifting speed contrast (Trailmaking B) was double that of the ADHD-PI vs. control comparison. ADHD-Inattentive type as defined by the DSM-IV-TR is a heterogeneous condition with a meaningful proportion of those affected exhibiting virtually no hyperactive/impulsive symptoms. This subgroup may represent a distinct inattentive condition characterized by poor cognitive interference control and slow processing or output speed.     

Inattentive behaviour is associated with poor working memory and slow processing speed in very pre‐term children in middle childhood

Background. Problem behaviour is common following pre‐term birth, but the underlying nature of these difficulties is not well known. Aims. We sought to establish the mechanisms underpinning behavioural difficulties in very pre‐term (VPT) children in middle childhood by comparing their performance to that of term born peers on tasks of working memory, inhibition, and processing speed, and relating these to parent and teacher assessments of their behaviour. Particular focus was given to inattention and overactive/impulsive behaviour, as these behaviours have been associated with different neuropsychological problems in term children. Samples. A group of VPT children (gestational age < 31 weeks, N= 56) aged 9–10 years and term controls (N= 22) participated in the study. Method. Children were assessed with measures of working memory, inhibition, and processing speed. Parents and teachers reported behavioural problems using the Strengths and Difficulties Questionnaire and two additional scales measuring overactive/impulsive behaviour and inattention. Results. Results revealed increased rates of problem behaviour in VPT compared to term children for parent‐rated total difficulties, hyperactivity, emotional problems, peer problems, prosocial behaviour, overactive/impulsive behaviour, and parent‐ and teacher‐rated inattention. Processing speed and working memory, but not inhibition, were significantly related to inattentive and overactive/impulsive behaviour. Conclusions. The increased rates of inattention and overactive/impulsive behaviour in VPT children may be explained by impairment in processing speed and working memory. Expected links between overactive/impulsive behaviour and inhibitory control were not identified, suggesting the nature of such difficulties may be different in VPT compared to term children.     

Training parents of hyperactive children in child management: A comparative outcome study

Parents of 44 hyperactive children were assigned to either a behavior modification group (PAT), a communications group (PET), or a delayed-treatment control group. Parents in the treatment groups participated in 9-week training workshops. Parents and their children were assessed before and after the workshops on measures that included ratings of hyperactivity and severity of problems, a daily checklist of problem occurrence, parental attitudes, and direct observations in a laboratory situation. Both treatment methods were more effective than a no-treatment control condition in reducing hyperactivity ratings, problem severity ratings, and daily problem occurrence. Additionally, parents receiving behavior modification training rated their children as more improved than did PET parents, were more willing to recommend the program to a friend, felt the program was more applicable to them, and were less likely to drop out of the program. Nine-month follow-up assessments indicated that treatment parents continued to view their children's behavior more positively than did control group parents. Results are discussed with respect to the implications that an educational approach to teaching child management can be an effective means of reducing behavioral problems in children, that methods differing in theoretical background and actual skills taught may result in similar outcomes, and that a "psychological," as opposed to a medical, approach to the treatment of hyperactive children can have considerable merit.     

Hard-to-manage preschool boys: Family context and the stability of externalizing behavior

Preschool boys identified by their teachers as active, inattentive, and impulsive (N=42) were compared with matched classroom controls (N=43) and with parentidentified problem boys (N=27) on measures of family functioning often associated with children's problem behaviors, including family history of psychopalhology, stressful life events, and family composition. Teacher-identified and parent-identified problem boys did not differ on measures of family adversity, and both groups came from less well functioning families than comparison boys. Mothers of problem boys, regardless of referral source, were more negative and controlling toward their sons when observed in a compliance task. Children's problem behaviors were moderately stable over a oneyear follow-up period; initial symptom levels, maternal self-reported depression, and negative maternal control predicted follow-up ratings of externalizing problems.Thanks are expressed to Clea Angell, Clare Flanagan, Julie Hunt, Patricia Huszar, Andrea Lurier, Sarah McAuliffe, Jasmine Sardessai, and Teri Sobolik for help with data collection, coding, and analysis. We are grateful to the staff of the many preschools in the Pittsburgh area who facilitated our work. Special appreciation is expressed to the children and parents who participated in this study.Portions of these data were presented at the Rochester Symposium on Developmental Psychopathology, Rochester, New York, October 1988, and at the Society for Research in Child and Adolescent Psychopathology, Costa Mesa, California, February, 1990. This work was supported by grant R0I MH32735 from the National Institute of Mental Health to Dr. Campbell.     

Teachers' screening for attention deficit/hyperactivity disorder: comparing multinational samples on teacher ratings of ADHD

This study evaluates a measurement model for Attention Deficit/Hyperactivity Disorder (ADHD). The DSM-IV divides 18 symptoms into two groups, inattentive and hyperactive/impulsive. Elementary school teachers rated 21,161 children in 4 locations: Spain, Germany, urban US, and suburban US. Confirmatory factor analysis suggested that the 2-factor model (inattention, hyperactivity/impulsivity) shows the best fit. A third factor, impulsivity, was too slight to stand-alone. Children with academic performance problems were distinguished by inattention, but children with behavior problems typically had elevations in inattention, hyperactivity, and impulsivity. Between-site differences were statistically significant, but so small that we conclude that same measurement model fits all 4 samples in 2 continents.     

Behavioral Characteristics of DSM-IV ADHD Subtypes in a School-Based Population

From an ethnically diverse sample of 2,744 school children, 221 attention deficit hyperactivity disorder (ADHD) [123 (4.5%) predominantly inattentive (IA), 47 (1.7%) predominantly hyperactive/impulsive (HI), and 51 (1.9%) combined type (C)] were identified using teacher ratings on a Diagnostic and Statistical Manual of Mental Disorders (4th ed.) (DSM-IV) symptom checklist. Subjects were compared to 221 controls on teacher ratings of behavioral, academic, and social functioning. The results revealed relatively independent areas of impairment for each diagnostic group. The IA children were impaired in all areas, but were rated as displaying more appropriate behavior and fewer externalizing problems than HI or C children. The HI group displayed externalizing and social problems, but was rated as no different than controls in learning or internalizing problems. The C group demonstrated severe and pervasive difficulties across domains. These findings support the validity of the DSM-IV ADHD subtypes; all ADHD groups demonstrated impairment relative to controls, but show different patterns of behavioral characteristics.     

Parent-Child Interactions Among Low-Income Mexican American Parents and Preschoolers: Do Clinic-Referred Families Differ From Nonreferred Families?

This study compared low-income Mexican American parents of young children referred for behavior problems to their nonreferred counterparts on an observational measure of parent-child interactions. Referred Mexican American parents demonstrated more negative behaviors than their nonreferred counterparts in both nondirective and highly directive situations. However, no differences were found at moderate levels of directiveness. The most and least directive situations in the Dyadic Parent-Child Interaction Coding System best differentiated referred from nonreferred Mexican American families, and families differed more in their negative behaviors than positive behaviors. Many of the parenting behaviors that have been found to differ between referred and nonreferred Caucasian families were also observed to differ between their Mexican American counterparts.     

Early parent-child relations and family functioning of preschool boys with pervasive hyperactivity

This study examined the quality of parent–child relationships and family functioning of preschool children with early onset hyperactivity by comparing a community sample of 33 pervasively hyperactive preschool boys with a comparison sample of 34 boys. Mothers and children were assessed at home on a range of interview, parent questionnaire, and observational measures of parenting and family functioning. Results of the study showed that higher rates of reported lax disciplinary practices, less efficient parental coping, lower rates of father–child communication, and less synchronous mother–child interactions were significantly associated with hyperactivity following statistical adjustment for the effects of conduct problems and other confounding factors. The best parenting predictor of hyperactivity was maternal coping. The present findings suggest that the way in which parents interact with their preschool children may make a unique contribution to the development and ongoing behavioral difficulties experienced by children with pervasive hyperactivity. Findings also highlight the importance of considering the role of fathers in the behavioral development of boys with early tendencies to hyperactive and distractible behavior problems.     

The impact of parental multiple sclerosis on the adjustment of children and adolescents

Thirty-one parents with multiple sclerosis (MS) participated in a study to investigate the adjustment of their children, 24 boys and 24 girls aged 4 to 16 years. The majority of parents believed that their illness had an effect on their children. The perception of parents regarding their children's problems in the areas of emotions, concentration, behavior, or social interactions indicated that the children were at three times greater risk than the general community of developing psychological problems. In contrast, actual symptom scores reported by parents revealed that, although these children were at greater risk than the general community of developing peer problems, little difference was found on hyperactivity, emotional symptoms, conduct problems, or total difficulties. Parental negative affect predicted both parental reports of peer problems and perceptions that the parents' illness had an effect on their children. Parental relationship satisfaction and family income did not predict parental reports of children's level of adjustment. These results indicate that children of parents with MS demonstrate more difficulties in how they relate to others, the distress they experience, and how they manage their lives, rather than revealing higher levels of symptoms. Since the data were based on parental reports of their children's problems, the results may also be due to negative affect among the parents.     

Effects of the EXAT neuropsychological multilevel intervention on behavior problems in children with executive function deficits

This is a clinical intervention study of children with executive function (EF ) deficits. A neuropsychological multimodal group intervention called EXAT (rehabilitation of EX ecutive function and AT tention) was developed at the Psychology Clinic of the University of Tampere. Based on the principles of neuropsychological rehabilitation and behavioral modification, EXAT combines child group training, parent training, and teacher consultations. The aims of this study were to investigate behavior problems before and after the intervention in children attending EXAT and in controls, and to compare intervention effects in hyperactive, inattentive, and EF subgroups based on the primary deficit described in the referral. The participants were 86 children (6–12 years) with a mean IQ of 91.4 attending EXAT and 45 controls. The participants’ parents and teachers completed the Conners’ Rating Scales‐Revised. In addition, the Strengths and Difficulties Questionnaire was completed by the parents attending EXAT . The parents reported statistically significant decreases with medium effect sizes for the CPRS ‐R subscales for impulsivity, hyperactivity, and oppositional behavior. In the controls within the same time interval, there was increase in restless and impulsive behavior, and a decrease in total problems. The teachers reported positive changes after the intervention in ADHD symptoms and anxiousness/shyness, but the effects sizes were small. The intervention effects were larger in the hyperactive subgroup. Positive intervention effects were related to a younger age, lower IQ , and simultaneous learning support. In conclusion, EXAT – a structured multilevel group intervention – has positive effects on children's behavior regulation skills by decreasing impulsivity and restless behavior.     

Parent characteristics and parent-child interactions in families of nonproblem children and ADHD children with higher and lower levels of oppositional-defiant behavior

This study examined parent-child interactions and parent characteristics in families of nonproblem children and attention deficit hyperactivity disorder (ADHD) children with lower (ADHD-LOD) and higher (ADHD-HOD) levels of oppositional-defiant behavior. Families of ADHD children were recruited from a parent training program. Observed and parent-reported child behavior problems were highest in the ADHD-HOD group. Observed parent behavior revealed few differences, but daily reports indicated that parents in both ADHD groups used more negative-reactive and fewer positive parenting strategies than control parents. Maternal psychological functioning differed between the ADHD and nonproblem groups, but not between the two ADHD groups. Fathers of ADHD-HOD children reported more psychological disturbance than controls. Parenting self-esteem was lowest in the ADHD-HOD group and highest in the nonproblem group. The results support the LOD and HOD distinction, but also suggest that, although certain difficulties are more common in the families of ADHD-HOD children, families of ADHD-LOD children also differ from controls on a number of dimensions.This research was supported by grants from the Medical Research Council of Canada and the British Columbia Health Research Foundation. Appreciation is extended to Josie Geller, Kim Behrenz, Susan Greaves, and Sonia Pietzsch who assisted with data collection and coding, and to the families who generously gave their time to participate in the research. Thanks also to two anonymous reviewers for their comments.