ADHD Assessment

Abstract

This study examined effects of negative versus positive symptom formats on the assessment and subsequent classification of ADHD in children in public schools. Symptoms associated with the disorder based on the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV) were presented to parents and teachers of referred children according to both types of formats. Informants were then asked to indicate whether the symptoms described the child's behavior over the last six months. Overall, the negatively phrased symptoms appeared to generate response bias which resulted in an increased percentage of children meeting the DSM-IV criteria for ADHD. Additionally, the decision reliability or classification agreement between the two formats was low, suggesting the possibility of confirmation bias in the assessment process. Implications for practice and future research are discussed.     

Preparing Families for Evidence-Based Treatment of ADHD: Development of Bootcamp for ADHD

Objective: Many families of children with attention-deficit/hyperactive disorder (ADHD) do not initiate evidence-based treatments (EBTs), placing these children at risk for poor outcomes. Bootcamp for ADHD (BC-ADHD) is a novel, four-session, group intervention designed to prepare parents as informed consumers to engage in multimodal EBTs for ADHD. This paper describes the theory of change and the development of BC-ADHD, outlines its components, and provides an initial proof of concept of the program. Method: Participants were 11 families of children with ADHD (ages 5–11; 55% male; 91% non-Hispanic; 55% White, 27% Black, 18% more than one race) who were the initial participants receiving BC-ADHD during a small-scale, randomized controlled trial. Parent-report outcome measures assessed parental empowerment, treatment preferences, affiliate stigma, intention to pursue treatment, and treatment initiation at baseline, posttreatment, and 6-week follow-up. Results: Parent engagement was high, as indicated by an 86% session attendance rate and high ratings of program satisfaction. Parents reported an increase in empowerment to access systems of care. Ratings of acceptability for behavior therapy increased at posttreatment and follow-up with minimal or no concerns about feasibility. The acceptability of medication was high at each assessment, although parents expressed increased concerns about stigma and adverse effects of medication at posttreatment and follow-up. Nonetheless, there was a marked increase in parental intention to use medication at posttreatment and follow-up. Accounting for ceiling effects, parents reported substantial increases in intention to use medication, behavioral parent training (BPT), and school services. Changes in treatment initiation were in the expected direction. Conclusions: BC-ADHD has the potential to promote family empowerment in seeking services and increase their intent to initiate EBTs, as well as actual initiation of these treatments.     

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.     

Rates of Subthreshold PTSD Among U.S. Military Veterans and Service Members: A Literature Review

The current study’s goal was to provide a comprehensive review of current subthreshold posttraumatic stress disorder (PTSD) rates among U.S. military veterans and service members. PubMed, PsycInfo, ProQuest, Web of Knowledge, Google Scholar, and any relevant articles’ reference lists identified studies of subthreshold PTSD in the U.S. military. Search terms included PTSD in combination with partial, subthreshold or sub-threshold, subsyndromal or sub-syndromal, subclinical or sub-clinical, and military or veteran. Sixteen articles met criteria for review. Current subthreshold PTSD rates ranged from 2.3% to 22.3%, with a weighted mean rate of 7.6%. Definitional variation within and across the “below threshold” terms produced some variability in rates reported. Few studies consistently reported on impairment and comorbidity in the subthreshold PTSD population. Variability of current subthreshold PTSD rates may be due to methodological issues such as sampling methods, sample sizes, and how below threshold PTSD was assessed and defined. Based on our findings, we provide a number of recommendations that can be used to inform future research of subthreshold PTSD among U.S. military veterans and service members. These recommendations include having a standardized term and definition, determining how to more properly assess subthreshold PTSD symptomatology, clarifying subthreshold PTSD diagnostic stability, and identifying appropriate sampling methods.     

Assessment of executive function in ADHD adolescents: contribution of performance tests and rating scales

This study aimed to analyze performance on measures of neuropsychological and behavioral executive functions (EF) in adolescents with attention deficit hyperactivity disorder (ADHD), and to evaluate the utility of performance-based tests for predicting scores on behavioral EF ratings. One hundred eighteen adolescents (75 ADHD and 43 controls) aged 12–16 years performed neuropsychological tests and completed a behavior rating scale of EF. The ADHD group presented significantly lower scores than controls on Full Scale IQ (FSIQ) and all indexes of the WISC-IV, except the verbal comprehension index (VCI). The ADHD group had significantly lower scores on performance-based tests of working memory, planning and inhibition, and on EF rating scales. Scores on the cognitive EF working memory, planning and flexibility modestly predicted performance on behavioral EF. The results suggest that the combined use of performance-based tests and rating scales provides valuable complementary information that can improve the assessment of executive domains in ADHD.     

Family Interactions in Children With and Without ADHD

We used global ratings to compare the family (parent[s]-child) interactions of 51 clinic-referred children with ADHD and 32 non problem children. Children and parent(s) were videotaped while engaging in problem solving and game playing activities. Independent coders, blind to children's diagnostic status, rated the interactions using measures designed to assess interaction competence and quality. Significant group differences emerged between the ADHD and control groups during problem solving on the interaction quality measures of Warmth, Engagement and Communication. Comparisons of the interactions of families of children with ADHD, with (ADHD W) and without (ADHD W/O) comorbid disruptive behavior disorders, were non significant, although increased symptomology was associated with reduced Warmth and Engagement during problem solving. Irrespective of group membership family interactions were more positive during game playing versus problem solving.     

Innovations in Assessing ADHD: Development, Psychometric Properties, and Factor Structure of the ADHD Symptoms Rating Scale (ADHD-SRS)

This research involved the development of a behavior rating scale designed to measure ADHD and the investigation of the scale's psychometric properties and factor structure. This scale, the ADHD Symptoms Rating Scale (ADHD-SRS), was developed for the assessment of ADHD in the school-age (K–12) population. Participants were 1006 children and adolescents (in grades K–12) who were rated by their parents and/or teachers. The results indicate that the ADHD-SRS possesses strong internal consistency reliability and test–retest reliability and moderate cross-informant reliability. The data also suggest that the ADHD-SRS has strong content validity. Convergent validity of this instrument was also high, as demonstrated by correlations with three previously validated behavior rating scales. Significant age and gender differences in ADHD symptoms were found with both the parent and teacher respondent populations. Finally, the factor analysis of the ADHD-SRS suggested a two factor oblique rotation as the best fit for both the parent and the teacher data. After a visual inspection of the items which loaded on each factor, Factor 1 was named Hyperactive-Impulsive and Factor 2 was named Inattention. These two factors, along with the items which loaded on each factor, appear to be remarkably similar to the two categories listed in the DSM-IV for ADHD. Directions for future research, as well as clinical implications and limitations of the research are discussed.     

Assessment of cognitive domains during treatment with OROS methylphenidate in adolescents with ADHD

Aim: To psychometrically assess cognitive domains in adolescents with ADHD during long-term open treatment with robust dosing of extended-release methylphenidate (OROS MPH).

Methods: Data were derived from a prospective clinical study of adolescent ADHD, employing the Cambridge Neuropsychological Test Automated Battery (CANTAB), before and after up to one year of treatment with OROS MPH. In the absence of placebo control, a similar age and gender group of youth without ADHD served as comparators.

Results: During the course of treatment with OROS MPH, ADHD youth’s performance significantly improved across multiple CANTAB tasks, including spatial working memory, rapid visual processing, verbal recognition memory, set shifting, and inhibition/vigilance. ADHD subjects’ scores in several CANTAB tasks, including spatial working memory, planning, and set shifting, were significantly more impaired at baseline compared to the non-ADHD comparison group; these significant differences were no longer seen at endpoint.

Conclusions: Statistically significant improvements in multiple cognitive domains were observed in a sample of adolescents with ADHD over the course of 12 months of robust treatment with extended-release methylphenidate. Rigorous, monitored stimulant treatment may be associated with objectively determined cognitive benefits; however, practice effects in this open trial cannot be ruled out. Further study on this important topic is warranted.     

Assessing Stress in Families of Children with ADHD: Preliminary Development of the Disruptive Behavior Stress Inventory (DBSI)

This paper describes the initial development of the Disruptive Behavior Stress Inventory (DBSI). This 40-item measure, which provides indices of the number of stressors experienced during the past 6 months and the rated stressfulness of these events, is designed to assess behavior-related family stress experienced by families of children with attention-deficit/hyperactivity disorder (ADHD). Findings provide strong support for the internal consistency of the DBSI and suggest adequate test-retest reliability. Support for the validity of the measure is suggested by findings that DBSI stress indices differentiate between parents of children with ADHD and those with no history of this disorder. Additional support is provided by findings that scores on the DBSI also differentiate between parents of children with ADHD, combined type and parents of children with ADHD, inattentive type. It is suggested that this measure may provide useful clinical information regarding stress levels in families of children with ADHD and that it may be of potential value as an ADHD treatment outcome measure.     

7-10岁学龄儿童ADHD筛查研究

用SDQ（家长版）对上海10所小学二至四年级学生进行测查,以探求被试的ADHD症状表现,锁定ADHD高风险儿童。结果：（1）男生ADHD得分偏高（p<.01）,但女生在红橙两个级别内的百分数均高于男生;（2）9岁被试的ADHD得分分布最分散,占男生ADHD红色级别的比例最大,在女生ADHD得分中均值最大;（3）红橙两个级别为高风险级别。结论：（1）9岁是ADHD症状表现最严重的年龄;（2）女生具有更高的ADHD风险;（3）ADHD高风险被试晒出率：男生14.4%,女生17.4%。     

ADHD and Judgments of Impulsivity in Rule Violations

Abstract

Participants with ADHD (n?=?45) and participants without ADHD (n?=?130, total n?=?175) judged hypothetical moral and conventional rule violations that varied the impulsivity of the act, the ADHD diagnosis, and the gender of the actor in order to examine (1) social reasoning about impulsiveness and (2) whether participants infer impulsiveness from the characteristics of the actor, including gender and ADHD-status. Moral violations were judged more negatively than conventional violations, even when they were impulsive. The characteristics of the actor influenced judgments in that participants judged boys’ behavior as more acceptable, as having less control, and as deserving of less punishment compared to girls. In addition, actors who were described as having ADHD were judged overall more positively. Participants with ADHD judged that all actors should receive similar punishment, regardless of the actor’s ADHD diagnosis, while participants without ADHD judged actors with ADHD should receive less punishment than those without.     

Well-being and Coping of Student Veterans Readjusting into Academia: A Pilot Survey

This study explored student veterans coping with transitions to postsecondary education. An instrument using a Tailored Survey Design and an Adult Transitioning Framework was developed to collect coping responses of 13 veterans with deployment experience transitioning to postsecondary education. Results indicated 38% reported difficulty managing finances, 93% utilized military training to manage stressors, and 38% sought environmental supports provided by the university. Findings suggest previous military experiences can be incorporated into occupations supporting individual coping skill development for the transition to postsecondary education. Further research is needed to understand barriers and facilitators of student veteran engagement in university resources.     

激活水平对两亚型ADHD儿童反应执行与抑制能力的影响

研究选取了混合型ADHD儿童14名,注意缺陷型ADHD儿童16名以及正常儿童18名,考察了在不同激活水平下,两亚型ADHD儿童之间,及其与正常儿童之间的反应执行能力与抑制能力的异同。采用传统的go/no-go任务,并将刺激间的时间间隔设置为1秒、4秒、8秒三种条件,分别对应高、中、低三种激活水平。结果发现,(1)与正常儿童相比,ADHD儿童的反应执行能力更容易受到激活水平的影响,且两亚型ADHD儿童受到的影响模式基本一致。具体而言:在高激活水平下,ADHD儿童与正常儿童差异最小;在中、低激活水平下,ADHD儿童与正常儿童差异增大,表明ADHD儿童状态调节能力落后。(2)两亚型ADHD儿童的功能缺损模式不同,混合型儿童在状态调节和反应抑制两方面都存在缺损,且其反应抑制缺陷不受激活水平影响;注意缺陷型儿童仅在状态调节方面受损。     

Clinical and Administrative Insights From Delivering Massed Trauma-Focused Therapy to Service Members and Veterans

Despite strong evidence of their effectiveness in reducing symptoms of posttraumatic stress disorder (PTSD), prolonged exposure therapy (PE) and cognitive processing therapy (CPT) remain challenging for some service members and veterans to access and complete. Delivering PE and CPT in time-condensed or “massed” formats may reduce barriers to receiving care. PE and CPT have now been implemented across a range of tempos (e.g., multiple sessions per day across 1 week, one session per day for 3 weeks) and to multiple target populations, in a variety of contexts from individual therapy alone to full intensive outpatient programs. A massed format of treatment delivery has advantages for both patients and providers, including quicker time to recovery, less opportunity for avoidance, and improved treatment completion rates. The time-limited nature of massed treatment also creates accompanying challenges, such as less time to practice homework and greater impact when factors delay or disrupt progress. This paper discusses lessons learned from providers across diverse settings who are experienced in both delivering massed PE and CPT and managing such programs, primarily with military populations.     

Story Comprehension in Children with ADHD

A wealth of research is available examining children's story comprehension. However, little attention has been directed toward understanding the story comprehension of children with attention deficit hyperactivity disorder (ADHD). The present paper attempts to integrate the developmental literature on children's story comprehension with the little that is known about the story comprehension processes of children with ADHD. This review is guided by a network model of story representation that emphasizes the structure of causal and enabling relations between story events. Examination of the available studies indicates that children with ADHD lag behind their peers in their understanding of causal relations, and that their attentional problems may contribute to difficulties in understanding factual information in the preschool years and causally related information in the elementary years. Some evidence also is presented suggesting that children with ADHD are less effective in taking advantage of story structure features in guiding their recall of story events. Suggestions for future research are offered that would elaborate our knowledge of the developmental progression in the processing of complex information by children with ADHD.     

Virtual-reality-based attention assessment of ADHD: ClinicaVR: Classroom-CPT versus a traditional continuous performance test

Virtual-reality-based assessment may be a good alternative to classical or computerized neuropsychological assessment due to increased ecological validity. ClinicaVR: Classroom-CPT (VC) is a neuropsychological test embedded in virtual reality that is designed to assess attention deficits in children with attention deficit hyperactivity disorder (ADHD) or other conditions associated with impaired attention. The present study aimed to (1) investigate the diagnostic validity of VC in comparison to a traditional continuous performance test (CPT), (2) explore the task difficulty of VC, (3) address the effect of distractors on the performance of ADHD participants and typically-developing (TD) controls, and (4) compare the two measures on cognitive absorption. A total of 33 children diagnosed with ADHD and 42 TD children, aged between 7 and 13 years, participated in the study and were tested with a traditional CPT or with VC, along with several cognitive measures and an adapted version of the Cognitive Absorption Scale. A mixed multivariate analysis of covariance (MANCOVA) revealed that the children with ADHD performed worse on correct responses had more commissions and omissions errors than the TD children, as well as slower target reaction times . The results showed significant differences between performance in the virtual environment and the traditional computerized one, with longer reaction times in virtual reality. The data analysis highlighted the negative influence of auditory distractors on attention performance in the case of the children with ADHD, but not for the TD children. Finally, the two measures did not differ on the cognitive absorption perceived by the children.     

注意缺损多动障碍量表的编制

 本研究在综合国内外有关儿童行为问题的测量问卷的基础上,编制了适合我国小学生特点的《儿童注意缺损多动障碍量表》。经过预测后的修订,组成正式量表。共计34个题目,施测于5所普通小学1-6年级的433名被试。因素分析结果验证了本量表五个因子的存在,即:注意力缺损、多动、冲动、唤醒不足、角色管理失控行为,从而验证了最初的结构预想。本研究着重考察了该量表的信度和效度:其中总量表与各分量表的同质性信度在.9202-.9448之间,总量表的再测信度为.8902。对量表结构效度和实证效度的检验也取得了令人满意的结果。     

Familial Aggregation of ADHD Characteristics

Patterns of familial aggregation of ADHD symptoms in parents of ADHD and non-ADHD children were examined. Within the ADHD sample, symptom aggregation was examined as a function of biological relationship, parent and child gender, and children's comorbid diagnoses. Participants consisted of parents of 579 children with ADHD, Combined Type participating in the multimodal treatment study of children with ADHD and parents of 288 normal control participants. Adult symptoms of ADHD were measured by both self-report and report of a significant other. Results indicated that the parents of children with ADHD had higher ratings of inattention/cognitive problems, hyperactivity/restlessness, impulsivity/emotional lability, and lower self-concept than parents of children without ADHD on both self-report and other-report ratings. Within the ADHD sample of children, other-report ratings of inattention/cognitive problems and impulsivity/emotional lability were higher for biological parents compared to nonbiological parents whereas self-ratings were not related to biological status. These findings support previous research documenting familial aggregation of ADHD and appear to strengthen the hypothesis that there is a genetic contribution to ADHD.