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.     

The biopsychosocial-spiritual health of active duty women

ABSTRACT

Women have been an active part of the military since the beginning of American history, holding various roles in the military for centuries. The purpose of this review is to explore the literature pertaining to the biopsychosocial and spiritual health of active duty women. These comparisons help to highlight factors that are most unique to women who are serving in our active duty armed forces. The current review revealed that while active duty women and men report similar levels of resiliency, and women may be no more susceptible to the negative effects of combat than men, there is evidence that active duty women experience higher levels of posttraumatic stress due to physical and sexual trauma in the military aside from combat exposure. Findings suggest that further research is needed to better understand the unique challenges of women in the military in order to create service delivery models that support the BPSS health of women in order to maintain mission readiness and retain women in the military.     

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.     

Therapeutic response to Cognitive Processing Therapy in White and Black female veterans with military sexual trauma-related PTSD

Cognitive Processing Therapy (CPT) is an evidence-based treatment (EBT) for posttraumatic stress disorder (PTSD) which has been validated for female veterans with military-related PTSD. Existing trials have enrolled predominantly White veterans with some studies documenting higher rates of early termination from EBTs among Black females when compared to White females. Data from a previously published randomized clinical trial were used to evaluate the effectiveness of CPT for Black female veterans with military sexual trauma (MST)-related PTSD. Reductions in PTSD symptom severity, number of sessions attended, and early termination rates were compared between Black (n = 20) and White (n = 16) female veterans. A hierarchical linear modeling approach was used, with PTSD symptom severity over the course of treatment and follow-up entered as a level-1 variable and race (Black or White) entered as a level-2 predictor. Piecewise growth curves analyses revealed that both Black and White female veterans experienced significant reductions in PTSD symptom severity over the course of treatment and gains were maintained up to 6 months post-treatment. Race was not found to be a significant predictor of change in the slope of PTSD symptom severity over the course of CPT treatment. Additionally, number of sessions attended and rates of early termination did not significantly differ based on race. Results suggest that CPT was a well-tolerated and effective psychotherapeutic treatment for this sample regardless of racial self-identification.     

Multimethod Assessment of Psychopathology Among DSM-IV Subtypes of Children With Attention-Deficit/Hyperactivity Disorder: Self-, Parent, and Teacher Reports

Using data based on self-, parent, and teacher reports, we assessed various aspects of psychopathology in a large sample of control children and those with ADHD. Confirmatory factor analysis was employed to extract response bias from latent constructs of aggression, anxiety, attention problems, depression, conduct disorder, and hyperactivity. These latent constructs were then entered into logistic regression equations to predict membership in control versus ADHD groups, and to discriminate between ADHD subtypes. Results of the regression equations showed that higher levels of attention problems and aggression were the best predictors of membership in the ADHD group relative to controls. Logistic regression also indicated that a higher degree of aggression was the only significant predictor of membership in the ADHD-Combined group compared to the ADHD-Inattentive group. However, when comorbid diagnoses of Oppositional Defiant Disorder and Conduct Disorder were controlled for in the logistic regression, greater hyperactivity rather than aggression was the sole variable with which to distinguish the ADHD-Combined from the ADHD-Inattentive subtype. Results are discussed in the context of the DSM-IV ADHD nosology and the role of instrument and source bias in the diagnosis of 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.     

Classroom-based functional and adjunctive assessments: proactive approaches to intervention selection for adolescents with attention deficit hyperactivity disorder.

The present investigation evaluated the utility of classroom-based functional and adjunctive assessments of problem behaviors for 2 adolescents who met diagnostic criteria for attention deficit hyperactivity disorder (ADHD) and comorbid oppositional defiant disorder (ODD). For children with ADHD-ODD, environmental classroom variables, when systematically manipulated by teachers, were related to the occurrence and nonoccurrence of problem behaviors. Classroom interventions derived from information that was obtained during functional and adjunctive assessments and from subsequent analyses resulted in substantial reductions in problem behaviors. Teacher and student consumer satisfaction ratings indicated that the interventions were effective and feasible in the classroom setting.     

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.     

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 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.     

国内注意缺陷/多动障碍儿童干预效果的元分析

对国内过去12年间的62项注意缺陷/多动障碍干预研究结果进行了元分析,结果显示：（1）国内现有的ADHD干预措施取得了显著的干预效果;（2）在不同干预措施中,药物治疗与行为疗法或认知行为疗法相结合具有最佳疗效,单独的药物治疗次之,单独的行为疗法或认知行为疗法效果较低;（3）在各种效果指标中,学业指标上的效果量是最大的,这一结果与国外已有的元分析研究发现不一致;（4）在各种效果信息来源中,来自客观观察的效果量最高,来自父母评价的效果量次之,来自教师评定的效果量最差。（5）各种干预措施在不同效果指标上有不同的表现。药物治疗对于学业和行为指标的效果最强烈,而认知行为疗法和脑电反馈疗法对认知指标的效果最明显。最后,结合干预措施的选择、效果指标的采用以及研究质量问题进行了讨论     

儿童前瞻记忆研究述评

前瞻记忆是指对未来某一时刻完成某项或某些活动的记忆。该文主要从儿童前瞻记忆的实验范式,儿童前瞻记忆与回溯记忆的关系,注意缺陷-多动障碍（Attention- Deficit Hyperactivity Disorder,ADHD）儿童的前瞻记忆以及儿童前瞻记忆影响因素的研究等几个方面对该领域的研究加以综述分析,并对其发展趋势和前景作以预测     

两亚型注意缺陷多动障碍(ADHD)儿童的内隐注意定向

研究探讨注意缺陷障碍儿童与正常儿童之间,混合型与注意缺陷型ADHD儿童之间在内源与外源注意定向功能的差异。ADHD儿童及与之匹配的正常儿童对照组分别参与了两个实验,实验一采用了内源性内隐注意定向任务,实验二采用了外源性内隐注意定向任务。研究表明：（1）ADHD儿童与正常儿童相比,在注意定向过程（注意解除、转移与施加）上有一定缺陷。（2）ADHD儿童注意定向网络功能有缺陷,与反应水平上动作准备有关的注意功能可能受损。（3）两种亚类型儿童注意定向功能缺陷模式不同。在内原定向上,混合型与注意缺陷型相比较,混合型ADHD儿童表现为有较强的反应冲动性;注意缺陷型儿童,主要表现为注意加工过程比较缓慢,注意更易涣散。在外源定向上,混合型儿童在反应的运动准备及运动控制方面的缺陷要大于注意缺陷型儿童     

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。