Children with Attention Deficit Hyperactivity Disorder

ABSTRACT

It is estimated that there have been over 4,000 articles in the literature on the subject of attentional problems, addressing its etiology, epidemiology, assessment, diagnosis, and treatment. This article reviews recent and relevant literature with an eye toward functional conclusions and linkages between assessment and intervention. The article concludes by providing a problem-solving model that integrates parent or teachers' referral concerns, reasons for these concerns, assessment methods, and intervention strategies. In the end, four definitive conclusions are drawn, and the importance of multimodal strategies that collaboratively involve home, school, and community settings is emphasized.     

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.     

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。     

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.     

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.     

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.     

Task Switching and Attention Deficit Hyperactivity Disorder

The main goal of the present set of studies was to examine the efficiency of executive control processes and, more specifically, the control processes involved in task set inhibition and preparation to perform a new task in attention deficit hyperactivity disorder (ADHD) and non-ADHD children. This was accomplished by having ADHD children, both on and off medication, and non-ADHD children perform the task-switching paradigm, which involves the performance of two simple tasks. In nonswitch trials, an individual task is performed repeatedly for a number of trials. In switch trials, subjects must rapidly and accurately switch from one task to the other, either in a predictable or unpredictable sequence. Switch costs are calculated by subtracting performance on the nonswitch trials from performance on the switch trials. These costs are assumed to reflect the executive control processes required for the coordination of multiple tasks. ADHD children showed substantially larger switch costs than non-ADHD children. However, when on medication, the ADHD children's switch performance was equivalent to control children. In addition, medication was observed to improve the ADHD children's ability to inhibit inappropriate responses. These data are discussed in terms of models of ADHD and cognition.     

Psychological functioning in siblings of children with Attention Deficit Hyperactivity Disorder

We examined psychological functioning in siblings of children with Attention Deficit Hyperactivity Disorder (ADHD). Siblings of children diagnosed with ADHD (n = 45) between the ages of 9 and 13 and a control group (n = 46) within the same age range composed of siblings of children with no diagnosed disorders completed measures of psychological functioning. A significant multivariate difference was observed on these measures across groups. Post hoc investigation of the univariate means revealed one significant group difference, which occurred on a measure of Trait Anger. This finding suggests that future research on family members of children with ADHD may be warranted.     

Processing Speed Deficits in Attention Deficit/Hyperactivity Disorder and Reading Disability

The goal of the current study was to test whether deficits in processing speed (PS) may be a shared cognitive risk factor in reading disability (RD) and Attention Deficit/Hyperactivity Disorder (ADHD), which are known to be comorbid. Literature on ADHD and RD suggests that deficits on tasks with a speeded component are seen in both of these disorders individually. The current study examined a wide range of speeded tasks in RD, ADHD, comorbid RD+ADHD, and a control group to test whether RD and ADHD have similar profiles of PS deficits, and whether these deficits are shared by the two disorders. The results suggest that a general PS deficit exists in both clinical groups compared to controls, although children with RD demonstrate greater PS deficits than children with ADHD. Two tests (underadditivity and partial correlations) were conducted to test whether these PS deficits are shared. Since we found that PS deficits were underadditive in the comorbid group and that partialling PS reduced the correlation between RD and ADHD, it appears that PS is a shared cognitive risk factor that may help explain the comorbidity of these two disorders.     

工作记忆负荷对注意缺陷多动障碍儿童过滤新异分心刺激能力的影响*

关于启动工作记忆负荷的强度与过滤分心刺激这两种认知资源的关系一直存在争论;并且对ADHD儿童来说,新异的分心刺激是提高了唤醒水平,还是干扰了任务进程也一直存在争论。本研究选取了ADHD儿童32名,正常儿童35名。采用视听跨通道oddball任务,通过操作视觉任务工作记忆负荷的高低,以及分心刺激与目标刺激之间的时间间隔,探讨不同工作记忆负荷对 ADHD 儿童过滤新异分心刺激能力的影响。结果发现：(1)在低工作记忆负荷条件下,分心刺激对两组儿童都起到了唤醒作用;在高工作记忆负荷条件下,分心刺激影响了两组儿童对任务本身的加工过程,使其判断的精确性下降。但是 ADHD 儿童受到的影响更大,表明其过滤分心刺激的能力落后。(2)当分心刺激与目标刺激同时出现时, ADHD儿童受到的干扰最大;但随着二者时间间隔的延长,并没有出现间隔越长干扰效应越小的趋势。在本研究条件下,得出以下结论：(1)两组儿童对跨通道新异分心刺激的过滤受到目标任务的工作记忆负荷强度的影响。(2)适度延长分心刺激与目标刺激之间的时间间隔可能会帮助ADHD的注意回归。     

The Effects of Thematic Importance on Story Recall among Children with Attention Deficit Hyperactivity Disorder and Comparison Children

This study examined the recall of televised stories for younger (4-6 years) and older (7-9 years) children with and without attention deficit hyperactivity disorder (ADHD) under two different viewing conditions (toys present/toys absent). Each child watched two Rugrats television programs, once with toys present and once with toys absent. Immediately after viewing a program, the child completed a free recall of the observed story. Comparison children's recall increased more than ADHD children's as importance level increased, and comparison children recalled more information overall than children with ADHD. When toys were present, children with ADHD retold less coherent stories than comparison children, as indexed by smaller correlations between the story units recalled and the order of these units in the story. In summary, children with ADHD demonstrated multiple difficulties in story comprehension. These findings add to our understanding of the differences in higher-order cognitive processing abilities between children with ADHD and comparison children, and suggest important areas of focus in designing more effective academic interventions for children with ADHD.     

Effects of Stimulant Medication Treatment on Mothers' and Children's Attributions for the Behavior of Children with Attention Deficit Hyperactivity Disorder

Participants were 55 children with attention deficit hyperactivity disorder (ADHD) who were receiving ongoing treatment with stimulant medications and their mothers, and 31 children with ADHD who were beginning stimulant medication and their mothers. Mothers and children offered attributions for child behaviors that occurred when the child was medicated and not medicated. Mothers rated child compliance and prosocial behavior as more global and stable when the child was medicated and rated noncompliance, ADHD symptoms, and oppositional behavior as more externally caused, less global and stable, but more controllable by the child when the child was medicated. Children rated both their compliance and noncompliance as more controllable in the medicated condition. On a forced-choice measure, both mothers and children selected ability, effort, and task attributions for compliance more in the not-medicated condition, and pill-taking attributions more in the medicated condition. This was reversed for noncompliance, which was attributed more to effort, task, or ability in the medicated condition and more to not taking a pill in the not-medicated condition. The potential risks and benefits for parent–child interactions and children's self-perceptions of these medication-related differences in attributions are discussed.     

Multimodal Treatments for Childhood Attention-deficit/Hyperactivity Disorder: Interpreting Outcomes in the Context of Study Designs

The goal of this article was to outline issues critical to evaluating the literature on incremental benefit of multiple effective treatments used together, vs. a single effective treatment, for childhood ADHD. These issues include: (1) sequencing and dosage of treatments being combined and compared; (2) difficulty drawing valid conclusions about individual components of treatment when treatment packages are employed; (3) differing results emerging from measurement tools that purportedly measure the same domain; and (4) the resultant difficulty in reaching a summary conclusion when multiple outcome measures yielding conflicting results are used. The implications of these issues for the design and conduct of future studies are discussed, and recommendations are made for future research.     

Attention Deficit Hyperactivity Disorder in Adults: Implications for Theories of Diagnosis

The diagnosis of attention deficit hyperactivity disorder (ADHD) in adults has been a source of controversy, with some prominent researchers questioning its very existence and others suggesting it is an urgent clinical problem. This article reviews five domains of data addressing the validity of adult ADHD: clinical correlates, family history, treatment response, laboratory studies, and long-term outcome. It then shows how the debate over adult ADHD reflects a clash of theoretical paradigms and concludes by suggesting ways in which psychological science can collect the data needed to clarify the validity of adult ADHD.     

Methodological Issues in the Assessment of Medication Effects in Children Diagnosed with Attention Deficit Hyperactivity Disorder (ADHD)

Attention deficit hyperactivity disorder (ADHD) is one of the most commonly diagnosed disorders in school-aged children and is usually treated with stimulant medications, including methylphenidate (MPH; Ritalin®, Ritalin-LA®, Concerta®, Metadate®, or Focalin®) and other drug compounds (e.g., Adderall®, Adderall-XR®, or Dexedrine). Assessment of school behavior and performance is a critical component in determining the safety and efficacy of these medications. This paper reviews methodological issues in assessing drug effects in school settings by considering features of the independent variable (the medication), the dependent variables (the endpoints selected for assessment), and the design (the structure of the assessment). In addition, we consider recent conceptual advances in understanding the behavioral mechanisms of action of drugs used to treat ADHD that may influence the structure and interpretation of medication assessments.     

Restraint and Cancellation: Multiple Inhibition Deficits in Attention Deficit Hyperactivity Disorder

We used variations of the stop signal task to study two components of motor response inhibition—the ability to withhold a strong response tendency (restraint) and the ability to cancel an ongoing action (cancellation)—in children with a diagnosis of attention deficit hyperactivity disorder (ADHD) and in non-ADHD controls of similar age (ages 7–14 years). The goal was to determine if restraint and cancellation were related and if both were deficient in ADHD. The stop signal task involved a choice reaction time task (go task) which required a rapid response. The demand for inhibitory control was invoked through the presentation of a stop signal on a subset of go trials which required that the ongoing response be suspended. The stop signal was presented either concurrently with the go signal (restraint version) or after a variable delay (cancellation version). In Study 1, we compared ADHD and control children on the cancellation version of the stop task; in Study 2, we compared ADHD and controls on the restraint version. In Study 3, a subset of ADHD and control participants completed both tasks so that we could examine convergence of these dimensions of inhibition. Compared to control participants, ADHD participants showed a deficit both in the ability to cancel and to restrain a speeded motor response. Performance on the restraint version was significantly correlated with performance on the cancellation version in controls, but not in ADHD participants. We conclude that ADHD is associated with deficits in both restraint and cancellation subcomponents of inhibition.     

Self-Handicapping Prior to Academic-Oriented Tasks in Children with Attention Deficit/Hyperactivity Disorder (ADHD): Medication Effects and Comparisons with Controls

Examined self-handicapping prior to academic-oriented tasks in children with and without ADHD and examined whether stimulant medication influenced self-handicapping. Participants were 61 children ages 6 to 13, including 22 children with ADHD tested after taking a placebo, 21 children with ADHD tested after taking stimulant medication, and 18 non-ADHD controls. Participants completed three measures of self handicapping and also completed self-evaluations of their performance. Results showed greater self handicapping and more positive self-evaluations in children with ADHD than in controls regardless of medication condition. Findings suggest children with ADHD may use self handicapping to ameliorate the effects of experiencing high rates of academic failure.     

Inhibition and Attention Deficit Hyperactivity Disorder

This paper updates the author's earlier hypothesis that Attention Deficit Hyperactivity Disorder (ADHD) reflects underactivity in Gray's Behavioral Inhibition System. Five areas of research are reviewed: (1) studies using the stop-signal task, (2) studies of errors of commission, (3) a study of inhibition indexed by eye movements, (4) a neuroimaging study of the corpus callosum, and (5) a study on the prediction of response to methylphenidate. Data from the many different dependent variables in these studies are interpreted as supporting disinhibition as a core deficit in ADHD.     

Psychological therapy for adults with Attention Deficit Hyperactivity Disorder

In the liteature, the clinical management of adults with Attention Deficit Hyperactivity Disorder has focused almost exclusively on stimulant medication. Yet psychological therapy may be a useful adjunct to stimulant medication. Pharmacotherapy is generally reported to be efficacious and, as such, treated individuals are likely to be more receptive to psychological intervention. The aim of this paper is to consider how an individual may best be supported by psychological therapy. It is recommended that a structured pragmatic, psychoeducative approach is the most appropriate. The development of specific self-management skills is discussed within a cognitive behavioural framework. Family, marital and group therapies are also discussed.