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.     

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.     

Strategies for Counselors Working With High School Students With Attention‐Deficit/Hyperactivity Disorder

Researchers agree early intervention is crucial to prevent academic underachievement and negative effects on the lives of children, adolescents, and adults affected by attention‐deficit/hyperactivity disorder (ADHD). If counselors, particularly high school counselors, address the needs of students with ADHD, these students may attain their potential and enter into the workplace or postsecondary education. The authors provide counselors with strategies to identify interpersonal, academic, vocational, and life issues that may affect students with ADHD and to help teachers and parents prepare students with ADHD for the transition from high school to postsecondary education or the work environment.     

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.     

Interference Control in Children with Attention Deficit/Hyperactivity Disorder

The view that Attention Deficit/Hyperactivity Disorder (ADHD) is associated with a diminished ability to control interfference is controversial and based exclusively on results of (verbal)-visual interference tasks, primarily the Stroop Color Word task. The present study compares medication-naïve children with ADHD (n?=?35 and n?=?51 in Experiments 1 and 2, respectively) with normal controls (n?=?26 and n?=?32, respectively) on two interference tasks to assess interference control in both the auditory and the visual modality: an Auditory Stroop task and a Simon task. Both groups showed reliable but equal degrees of interference on both tasks, suggesting that children with ADHD do not differ from normal controls in their ability to control interference in either modality.     

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.     

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.     

注意缺陷多动障碍儿童的表征搜索

为探索ADHD儿童在时间维度上的视觉选择性注意的基本机制,揭示其表征搜索能力是否存在缺陷,研究采用RSVP范式,通过实验材料(字母和数字)和呈现方式操作两种搜索方式:序列搜索和平行搜索,比较ADHD儿童(18名)和控制组儿童(17名)的成绩差异。结果发现:①在平行搜索和序列搜索条件下,ADHD儿童的成绩均低于正常控制组;②比较平行搜索和序列搜索条件下的成绩变化,以及由低难度到高难度上成绩的变化,无论是正确率还是反应时均发现ADHD儿童和正常儿童具有相同的成绩变化模式。结论认为ADHD儿童在视觉选择性注意的基本搜索机制上并不存在明显缺陷。     

Family Correlates of Comorbid Anxiety Disorders in Children with Attention Deficit/Hyperactivity Disorder

This study evaluated parental anxiety and parenting practices associated with comorbid Anxiety Disorders among children with Attention Deficit/Hyperactivity Disorder. Clinic-referred families (n=143) were diagnosed using DSM criteria. Parents and children completed measures of parenting practices. Comorbid anxiety in children was significantly associated with maternal anxiety, overprotectiveness, and a lack of positive parenting. The relative odds of comorbid anxiety appeared to be especially high when all three factors were present. These findings are consistent with theory linking those three family factors to the development of anxiety in all children. Implications for adjunctive treatment of anxiety that is comorbid with ADHD are discussed.     

Conditional Associative Learning of Spatial and Object Information in Children with Attention Deficit/Hyperactivity Disorder

The present study assessed frontostriatal mediated memory functions in children with ADHD (N = 12) and healthy control participants (N = 12) using two tests of conditional associative learning (i.e., object and spatial) that shared similar stimulus-response association structures but that differed in terms of the demands placed upon strategic processes. Children with ADHD displayed normal performance on the object learning task but were impaired on the spatial learning task that placed greater demands on internally derived strategic processes. Secondary analyses further indicated that this strategic processing impairment cannot be attributed specifically to perseverative or working memory errors but rather appears to be related to a more general inability to maintain a high degree of consistency in responding across trials. Although the results of this study must be interpreted in light of the small sample sizes, they suggest that ADHD does not produce a basic deficit in acquiring stimulus-response associations previously shown to be associated with basal ganglia dysfunction. Rather, these findings suggest that the impaired conditional associative learning performance of children with ADHD is attributable to deficits in strategic processes previously been found to be dependent upon the integrity of the prefrontal cortex.     

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.     

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.     

Decision Making with Uncertain Reinforcement in Children with Attention Deficit/Hyperactivity Disorder (ADHD)

Reward-related processes are impaired in children with ADHD. Whether these deficits can be ascribed to an aversion to delay or to an altered responsiveness to magnitude, frequency, valence, or the probability of rewards still needs to be explored. In the present study, children with ADHD and normal controls aged 7 to 10 years performed a simple probabilistic discounting task. They had to choose between alternatives where the magnitude of rewards was inversely related to the probability of outcomes. As a result, children with ADHD opted more frequently for less likely but larger rewards than normal controls. Shifts of the response category after positive or negative feedback, however, occurred as often in children with ADHD as in control children. In children with ADHD, the frequency of risky choices was correlated with neuropsychological measures of response time variability but unrelated to measures of inhibitory control. It is concluded that the tendency to select less likely but larger rewards possibly represents a separate facet of dysfunctional reward processing, independent of delay aversion or altered responsiveness to feedback.     

Attention Deficit/Hyperactivity Disorder in Adults with Sleep Apnea

AAttention deficit hyperactivity disorder (ADHD) is a common childhood illness. In some patients, this illness may persist into adulthood and an association between ADHD and Obstructive Sleep Apnea (OSA) has been found in childhood. However, it is unclear how OSA and ADHD coincide in adulthood. Therefore, to explore the relationship between OSA and adult ADHD the current investigation utilized a clinically-based cross-sectional survey. Subjects consisted of 81 treatment-naïve OSA patients and 32 controls. Measures included each patient completed a questionnaire regarding sleep, Adult ADHD scale. Clinical information, body mass index, 36-item Short Form Health Survey (SF-36), Epworth Sleepiness Scale (ESS), Hospital Anxiety and Depression Scale, and polysomnography.The subjects with Apnea-Hypopnea Index (AHI) ≥ 5 events/h were defined as patients with OSA. The control group was accepted as individuals with AHI > 0 events/h. The prevalence of adult ADHD was not different between the patients with OSA and the control group [(7.4 % (6/75) vs. 6.3 % (2/30), p = 0.8, respectively]. OSA patients with ADHD, as compared with those without, had higher anxiety scores and poorer physical component scores of quality of life and higher ESS scores. ADHD scores in patients with OSA were associated with anxiety and depression scores and SF36 physical and mental component scores in bivariate analyses. Thus, in our sample ADHD was not a frequent illness in adult patients with OSA. However, in patients with OSA and ADHD higher levels of anxiety and daytime sleepiness and poorer quality of life was found.     

An Evaluation of Occupational Behavior in Individuals with and without Attention Deficit/Hyperactivity Disorder

Attention deficit/hyperactivity disorder (ADHD) is now conceptualized as a life-course persistent disorder, including impairments in the occupational functional domains. Occupational impairment is one of the considerations in contemporary diagnostic criteria for ADHD. This study compares the workplace behavior of 26 young adults without ADHD to 24 young adults with ADHD in a simulated pizza restaurant and delivery setting on a job application completion task, in a job interview, and on job performance tasks. Results indicated that there were significant differences in masked ratings of job interview performance, favoring the performance of individuals without ADHD. No significant differences were obtained for job applications and job performance. Results suggest that job interviewing skills may be an important area to address for individuals with ADHD entering the workforce.     

Teacher Ratings of Attention Deficit Hyperactivity Disorder Symptoms in Hispanic Children

This study compared teacher's ratings of attention deficit hyperactivity disorder in groups of nonreferred Hispanic and non-Hispanic White children via the Teacher Report Form, the Attention Deficit Hyperactivity Disorder Scales—IV, and the Conners Abbreviated Teacher Rating Scale. A total of 61 non-Hispanic White teachers completed behavior ratings of 61 Hispanic and non-Hispanic White children between 6 and 11 years old. Significant differences were found between boys and girls, with girls showing fewer behavior problems and fewer hyperactive/inattentive symptoms compared to boys. In addition, Hispanics scored similar or lower than non-Hispanic Whites on multiple subscales measuring symptomatology related to attention deficit hyperactivity disorder and overall behavioral disorders. In no instance did Hispanic children score as more pathological than non-Hispanic White children. The need to consider the rater's ethnicity is discussed, and findings are explained in terms of childhood socialization patterns that might help to discern the behavior displayed by Hispanic children in classroom settings.     

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.     

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。