The effects of methylphenidate on various types of activity level and attention in hyperkinetic children

The effects of methylphenidate on a number of objective measures of activity level and attention were assessed on three repeated occasions in four types of settings: free play, movie viewing, testing, and restricted play periods. Subjects were 36 boys between 5 and 12 years of age and of average intelligence. Of these, 18 were diagnosed as hyperkinetic and participated in a double-blind drug-placebo crossover design. The remaining 18 boys, matched in age and IQ with the hyperkinetic children, served as a control group and received no drugs. Results indicated that compared to placebo, methylphenidate significantly reduced wrist, ankle, locomotor, and seat movement activity in the hyperkinetic children regardless of the type of setting in which the measures were taken. Relatively fewer significant drug effects were noted on the measures of concentration or attention. While concentration to reaction time, maze performance, and a movie viewing task improved during drug treatment, the length of attention to toys in free play was not significantly improved. Parental ratings of activity level were also improved by the drug. The hyperkinetic children were also observed to increase their level of task-irrelevant activity over time while control children remained relatively stable in activity over repeated assessment. Despite the positive drug effects, clinical observations suggested that methyl-phenidate may have reduced the interest of some children in their environment.     

Standardized playroom measures as indices of hyperactivity

A group of 16 children from a normal community population was compared with two groups of 16 children referred for clinical evaluation of hyperactivity. These three groups were matched on age, sex, and race. One of the clinic groups was matched with the community sample on IQ and social class as well, while the children in the other clinic group were mentally retarded and of somewhat lower social class. All children were observed in a standardized playroom for two 15-minute sessions, one under free play instructions and the other under instructions restricting activity and toy-changing behavior. The two groups of children referred for evaluation of hyperactivity had significantly higher playroom activity scores than controls under both instructional conditions and significantly higher toy-change scores under restrictive instructions. Parental ratings of activity were also significantly higher in both clinic groups than in the community group. The mentally retarded clinic sample did not differ from the other clinic sample on any of the measures of activity or toy switching.A preliminary version of this article was presented at the meeting of the American Psychological Association, Chicago, Illinois, August 30, 1975, as part of a Symposium on Hyperactive Children: Assessment, Treatment, and Outcome. This research was supported by U. S. Public Health Service, Maternal and Child Health Project No. 916 and by Grants HD-03110 and ES-01104.     

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.     

Stimulation seeking and hyperactive behavior in children with ADHD: a re-analysis

To examine the stimulation-seeking function of hyperactivity in children with ADHD, Antrop and colleagues analyzed the behavior of 30 hyperactive and 30 nonhyperactive children during a waiting situation, either with or without extra stimulation. The behavior was assessed by frequency measures. In their study it was hypothesized that children with ADHD would show a greater decrease in activity in the presence of stimulation than control children. Since confirmation for this hypothesis was only found for 2 of 25 target behaviors, the present re-analysis included other behavioral measures to assess two relationships: first, how hyperactivity varies under fixed time conditions, using measures of duration and intensity of behavior instead of frequency measures, and second, how the perceived duration of waiting time affects behavior. Analysis indicated that children with ADHD showed a greater decrease in behavior in the presence of stimulation for touching objects and movements of trunk, as reported. Further, children who underestimated the waiting period were more apt to seek additional stimulation in its absence than those who overestimated the waiting period.     

Variation in Social Facilitation of Eating Behavior in Puppies

Observations of the play behavior of same-sex, same-age dyads of preschool children were made during 10-minute play sessions. Each of the 48 children participated both with a familiar peer and with an unfamiliar peer. The hypothesis that both boys and girls would show more interaction with familiar peers than unfamiliar peers was supported for younger girls and older boys. Younger boys seemed little influenced by the familiarity of their play companion, while older girls showed more social interaction with unfamiliar peers. Results were compared with studies that used projective techniques, and it was suggested that the effects of peer familiarity may appear earlier in actual behavior than through these techniques.     

Gender differences on the Five to Fifteen questionnaire in a non‐referred sample with inattention and hyperactivity‐impulsivity and a clinic‐referred sample with hyperkinetic disorder

Lambek, R., Trillingsgaard, A., Kadesjö, B., Damm, D. & Thomsen, P. H. (2010). Gender differences on the Five to Fifteen questionnaire in a non‐referred sample with inattention and hyperactivity‐impulsivity and a clinic‐referred sample with hyperkinetic disorder. Scandinavian Journal of Psychology 51, 540–447. The aim of the present study was to examine gender differences in children with inattention, hyperactivity, and impulsivity on the Five to Fifteen (FTF) parent questionnaire. First, non‐referred girls (n = 43) and boys (n = 51) with problems of attention and hyperactivity‐impulsivity and then clinic‐referred girls (n = 35) and boys (n = 66) with hyperkinetic disorder (HKD) were compared on the FTF. Results suggested that non‐referred boys were more hyperactive‐impulsive than non‐referred girls, whereas clinic‐referred boys and girl with HKD were more similar than dissimilar on the FTF questionnaire. Secondly, it was examined whether the application of gender mixed norms versus gender specific norms would result in varying proportions of clinic‐referred children with HKD being identified as impaired on the subdomains of the FTF questionnaire. Based on results it was concluded that the use of a gender mixed normative sample may lead to overestimation of impairment in boys with HKD, but the type of sample applied to define impairment on the FTF should depend on the purpose for applying the questionnaire.     

Distractibility and hypersensitivity

The present paper reports on the development of a modified problem checklist for use in normal samples of elementary school children. The two factors, Hypersensitivity and Distractibility, replicated over male and female samples. Hypersensitivity showed a significant grade effect, with a decrease between the first and second grade for both boys and girls. In contrast, boys scored higher than girls on Distractibility and there were no grade differences. Convergent validitiy data from peer judgments, in-class activity level, physical fitness measures, standardized achievement scores, and a comparison with another teacher judgment are presented. In addition, three Behavioral Problem Checklist (Quay & Peterson, 1967) dimensions, Conduct Problem, Personality Problem, and Inadequacy--Immaturity, were developed and their relationships to the independent measures, as well as to the new dimensions, are presented. The pattern of correlations of Distractibility was quite similar for boys and girls, with both being rated as Mean-Noisy by their peers. The findings for Hypersensitivity were somewhat weaker. Distractibility and Conduct Problem scores reflected a similar pattern of correlations with other variables; in a like manner, Hypersensitivity and Personality Problem scores reflected a similar pattern of correlations with other variables. Distractibility was related to an increased activity level and Hypersensitivity was related to a decreased activity level in young boys. The total number of behavior problems was related to a decrease in activity level for young girls. Older Distractible and Hypersensitive girls showed different patterns of activity level. It is proposed that problem behavior is more complex for older children and that Distractibility may be less influenced by the usual socialization process of school than is Hypersensitivity and may have some congenital antecedents.     

Peer interactions of normal and attention-deficit-disordered boys during free-play,cooperative task,and simulated classroom situations

Groups of 30 ADD-H boys and 90 normal boys were divided into 30 mixed dyads composed of a normal and an ADD-H boy, and 30 normal dyads composed of 2 normal boys. Dyads were videotaped interacting in 15-minute free-play, 15-minute cooperative task, and 15-minute simulated classroom settings. Mixed dyads engaged in more controlling interaction than normal dyads in both free-play and simulated classroom settings. In the simulated classroom, mixed dyads completed fewer math problems and were less compliant with the commands of peers. ADD-H children spent less simulated classroom time on task and scored lower on drawing tasks than normal peers. Older dyads proved less controlling, more compliant with peer commands, more inclined to play and work independently, less active, and more likely to remain on task during the cooperative task and simulated classroom settings. Results suggest that the ADD-H child prompts a more controlling, less cooperative pattern of responses from normal peers.     

Hyperactivity in boys with attention deficit/hyperactivity disorder (ADHD): The association between deficient behavioral inhibition,attentional processes,and objectively measured activity

Contemporary models of ADHD hypothesize that hyperactivity reflects a byproduct of inhibition deficits. The current study investigated the relationship between children's motor activity and behavioral inhibition by experimentally manipulating demands placed on the limited-resource inhibition system. Twenty-two boys (ADHD = 11, TD = 11) between the ages of 8 and 12 years completed a conventional stop-signal task, two choice-task variants (no-tone, ignore-tone), and control tasks while their motor activity was measured objectively by actigraphs placed on their nondominant wrist and ankles. All children exhibited significantly higher activity rates under all three experimental tasks relative to control conditions, and children with ADHD moved significantly more than typically developing children across conditions. No differences in activity level were observed between the inhibition and noninhibition experimental tasks for either group, indicating that activity level was primarily associated with basic attentional rather than behavioral inhibition processes.     

Hyperactivity in boys with attention deficit/hyperactivity disorder (ADHD): the association between deficient behavioral inhibition, attentional processes, and objectively measured activity

Contemporary models of ADHD hypothesize that hyperactivity reflects a byproduct of inhibition deficits. The current study investigated the relationship between children's motor activity and behavioral inhibition by experimentally manipulating demands placed on the limited-resource inhibition system. Twenty-two boys (ADHD = 11, TD = 11) between the ages of 8 and 12 years completed a conventional stop-signal task, two choice-task variants (no-tone, ignore-tone), and control tasks while their motor activity was measured objectively by actigraphs placed on their nondominant wrist and ankles. All children exhibited significantly higher activity rates under all three experimental tasks relative to control conditions, and children with ADHD moved significantly more than typically developing children across conditions. No differences in activity level were observed between the inhibition and noninhibition experimental tasks for either group, indicating that activity level was primarily associated with basic attentional rather than behavioral inhibition processes.     

Congenital correlates of distractibility

The present research reports correlations between ratings of distractibility and minor physical anomalies and gross motor incoordination. For an original and two replication samples of preschool children, there were significant average weighted correlations between distractibility and both minor physical anomalies and gross motor incordination for boys. Also, the magnitude of the correlation between distractibility and the congenital characteristics was significantly higher for boys. Although neither parental rejection nor parental restrictiveness was related to boys' distractibility, parental rejection was marginally related to girls' distractibility.     

Structural complexity and the quality of stepfather-stepchild relationships

This research examined the effects of structural complexity and sex of stepchild on the quality of stepfather-stepchild relationships. Sixteen simple stepfather families (the wife had custody of a child from a previous marriage, but the stepfather has no biological children) and 16 complex stepfather families (the wife had custody of a child from a previous marriage, and the stepfather was a noncustodial biological parent) with half of each type (N = 8) having a male and half having a female, 9-12-year-old target child participated in a multimethod-multimeasure assessment of the stepfather-stepchild relationship. Families were recruited from marriage license records, and data collection was accomplished in a single three-and-a-half-hour home visit. Dependent variables included: (a) questionnaire measures of love and detachment relationship dimensions independently obtained from parents, stepparents, and (step)children, and (b) proportions of positive and negative stepparent and stepchild communication behaviors derived from videotaped interaction tasks. Findings revealed that simple and complex stepfather families did not differ on any questionnaire or behavioral measures. Girls, however, engaged in a lower proportion of positive verbal and greater proportion of negative problem-solving behaviors toward their stepfathers than boys did. Stepfathers did not differ on proportions of communication behaviors emitted toward boys and girls. No sex-of-child differences were obtained on the questionnaire measures. Directions for future research on structural complexity and stepfather families are discussed.     

Israeli kindergarten children's gender constancy for others' counter‐stereotypic toy play and appearance: the role of sibling gender and relative age

To test divergent theoretical predictions as to the impact of having a younger or older, same‐sex sibling or opposite‐sex sibling on other gender constancy, Israeli kindergarten children in two‐child families responded to a gender constancy task in which a male and female picture target engaged in counter‐stereotypic toy play and adopted counter‐stereotypic appearance. Children were also asked whether the target child could change sex at will and to explain the difference between boys and girls. Relative age of sibling, both independently and in interaction with participant sex, was associated with greater gender constancy in the face of counter‐stereotypic toy play. Relative age of sibling and sibling sex was independently associated with greater gender constancy in the face of counter‐stereotypic appearance. In both cases, children with a younger sibling evidenced greater gender constancy. Boys, especially ones with a male sibling, referred most explicitly to target's birth sex in accounting for his or her being unable to change sex at will. Genital and anatomical differences between boys and girls were cited more often by children who referred explicitly to target's birth sex and had a younger sibling. The results were discussed in the context of theories of gender development and the socialization of gender within the family. Copyright © 2008 John Wiley & Sons, Ltd.     

Teacher Ratings of Hyperactivity, Inattention, and Conduct Problems in Preschoolers

Age and sex norms of classroom behavior in preschoolers were established on a standard measure, the Revised Conners Teacher Rating Scale, and the utility of this measure for assessing problem behavior in preschoolers was examined. Teachers provided ratings for 455 nonreferred preschoolers. In addition, ratings were obtained for 12 clinically referred preschoolers diagnosed with attention deficit hyperactivity disorder. The Conduct Problems, Inattention, and Hyperactivity subscales, as well as the Hyperactivity Index, were found to have good internal reliability and were related to each other in predictable ways. Normative data are presented by age and sex. Age was inversely related to scores for the Conduct Problems subscale, the Hyperactivity subscale and the Index. Sex was a significant predictor of subscale scores, with boys receiving higher scores than girls. Subscale scores and nearly all item scores were highly significantly different between clinically referred and nonreferred preschoolers. The results provide a standard upon which to evaluate preschool-aged children in clinical and research settings.     

Peer-based differences among boys with ADHD

Examined the peer interactions and peer acceptance of three groups of boys ages 8 to 11 1/2 years: attention deficit hyperactivity disorder (ADHD), predominantly inattentive type; ADHD, combined type; and nonclinical controls (N = 45). Peer nominations were obtained from each boy's classroom. Newly acquainted peers consisting of boys from each of the 3 groups were observed for 3 play sessions, after which peer nominations were obtained. Both ADHD groups were more likely than nonclinical controls to receive lower social preference scores from peers in the classroom but not in the play groups. In both settings, boys from the predominantly inattentive group were more likely to be nominated as very shy, whereas boys from the combined type group were more likely to be nominated for starting fights and arguments. Observations of the play group showed that boys from the predominantly inattentive group displayed a marked pattern of social withdrawal. The findings suggest that the peer rejection experienced by these 2 groups may result from very different social behavior patterns.     

Auditory processing measures: correlation with neuropsychological measures of attention, memory, and behavior.

It has been suggested that measures of auditory processing (AP) are sensitive measures of attention resulting in the high comorbidity of auditory processing disorder (APD) and attention deficit/hyperactivity disorder (ADHD). Others have found that selected AP measures share significant variance with memory tasks. The current study investigated the relation between AP measures and various neuropsychological measures presumed to measure attention and memory in 36 children with a mean age of 7.78 years (SD=1.61) referred to an outpatient facility. Results indicate that AP measures significantly correlated with each other as well as with some measures of attention, memory, and behavior ratings. Results suggest that although AP measures include elements of both attention and memory, these measures also appear to assess processes not tapped by other measures of attention and memory. The correlation of AP measures with parent-and teacher-rated withdrawal, parent-rated somatization, conduct, and depression, as well as teacher-rated attention, anxiety, learning problems, social skills, and leadership suggest that auditory processing problems may manifest in myriad behaviors across settings. Implications for practice and future research are presented.     

Auditory Processing Measures: Correlation with Neuropsychological Measures of Attention,Memory, and Behavior

It has been suggested that measures of auditory processing (AP) are sensitive measures of attention resulting in the high comorbidity of auditory processing disorder (APD) and attention deficit/hyperactivity disorder (ADHD). Others have found that selected AP measures share significant variance with memory tasks. The current study investigated the relation between AP measures and various neuropsychological measures presumed to measure attention and memory in 36 children with a mean age of 7.78 years (SD = 1.61) referred to an outpatient facility. Results indicate that AP measures significantly correlated with each other as well as with some measures of attention, memory, and behavior ratings. Results suggest that although AP measures include elements of both attention and memory, these measures also appear to assess processes not tapped by other measures of attention and memory. The correlation of AP measures with parent-and teacher-rated withdrawal, parent-rated somatization, conduct, and depression, as well as teacher-rated attention, anxiety, learning problems, social skills, and leadership suggest that auditory processing problems may manifest in myriad behaviors across settings. Implications for practice and future research are presented.     

A multidimensional assessment of parent-identified behavior problem toddlers

Sixty-eight 2-and 3-year-olds (46 parent-referred, 22 controls) participating in an identification, assessment, and follow-up study of hyperactivity and related behavior problems were evaluated on parent-report, observational, and cognitive measures. Referred youngsters were described by both parents as more active, inattentive, difficult to discipline, and aggressive with peers than were controls. Mothers of referred children also reported a more difficult infancy period. Laboratory assessments confirmed parental reports of current problems. Referred children shifted activities more during free play, were more active and inattentive during structured tasks, and made more impulsive responses on a delay task than did controls. Discriminant function analysis indicated that parental ratings of activity paired with laboratory measures of sustained attention and impulsivity correctly classified 88% of the sample. These data suggest that the core symptoms of hyperactivity can be identified in very young children, although their prognostic significance remains to be determined.This research was supported by Grant No. R01 MH 32735 from the National Institute of Mental Health to the first author. Thanks are due to the parents and children who participated so enthusiastically in this study. The dedication of Patricia Cluss is gratefully acknowledged. Mady Fingeret, Frank McKee, Jenny Palermo, Susan Riley, Elizabeth Schaughency, Sheree Thomas, and Russell Walters are also thanked for their help in data collection.     

A Playroom Observation Procedure to Assess Children with Mental Retardation and ADHD

Forty-two children (ages 6 to 12 years old) with moderate mental retardation to borderline intellectual functioning were studied in a laboratory playroom setting to determine whether children identified as ADHD (attention deficit hyperactivity disorder) or controls differed on activity and attentional measures. Children with ADHD were further divided into ADHD + conduct problems (ADHD + CD) and ADHD-only subgroups (with an ADHD-combined group comprising children of both subgroups). An interval recording system was used to code observations of independent play and a restricted academic task. Results indicated that the ADHD-combined group was significantly more vocal and engaged in a significantly greater number of toy changes than controls during independent play. Significant group differences were also noted during the restricted academic task, with the ADHD-combined and ADHD + CD groups more off-task and engaging in a greater number of toy touches than controls. Discriminant analyses found independent play measures to predict group membership in 70 percent of cases (ADHD-combined vs. controls), but in only 64 percent of cases using measures from the restricted academic task. No significant findings resulted when the ADHD subjects were further divided into two subgroups. Despite some inconsistent findings, such laboratory-based observations may be of value in the diagnosis of ADHD in children with moderate mental retardation to borderline intellectual functioning.