Inhibition and working memory in young preschool children with symptoms of ADHD and/or oppositional-defiant disorder

Background: Early symptoms of attention deficit/hyperactivity disorder (ADHD) and oppositional-defiant disorder (ODD) are associated with deficits in cognitive self-regulatory processes or executive functions (EF)s. However, the hypothesis that neurocognitive deficits underlying the two disorders are already evident during early preschool years still has limited empirical support. The present study investigated associations between symptoms of ADHD and/or ODD and two core EFs, inhibition and working memory, in a large nonclinical sample of 3-year old children. Method: Participants were 1045 children (554 boys, age 37–47 months), recruited from the population based Norwegian Mother and Child Cohort Study (MoBa). Relations between behavioral symptoms and measures of inhibition and working memory were studied both categorically and dimensionally. Results: Children with co-occurring symptoms of ADHD and ODD performed at a significantly lower level than typically developing children in 4 out of 5 EF measures. Symptoms of ADHD, both alone and in combination with ODD, were associated with reduced performance on tests of inhibition in the group comparisons. Dimensional analyses showed that performance within both EF domains contributed to variance primarily in ADHD symptom load. The associations between test results and behavioral symptoms remained significant after gender and verbal skills had been controlled. Conclusion: Young preschoolers show the same pattern of relations between EF and behavioral symptoms of ADHD and/or ODD as previously described in older children diagnosed with ADHD and/or ODD. Effect sizes were generally small, indicating that measures of EF have limited clinical utility at this stage in development.     

Voluntary parents to multiple children with special needs: A profile

A sample of 18 women and men who accompanied their foster or adopted children with severe developmental disabilities to a medical appointment at Henry Ford's Multidisciplinary Care Clinic during the one-year period and who reported during that appointment that they currently had residing with them at least three foster or adopted children with special needs are described in the context of their parental role vis-a-vis these children. Results of the study are presented through use of a six-part organizational scheme: demographic and social traits of the parents and their focal children (the children being seen at the Clinic that day), the focal children in family context, life satisfactions of the parents, foster or adoption motives (whichever applied), foster or adoption satisfactions, and parental sentiments regarding the children as a group.     

Winnicott's children: The holding environment and therapeutic communication in brief and non-intensive work

This paper discusses brief and non-intensive work using a Winnicottian framework for understanding the processes involved. The importance of play, communication and interpretation are considered within the careful establishment of a unique holding environment for each patient. Parallels are drawn with ordinary development and care of the infant and young child. Two clinical examples are given to illustrate these concepts. The first describes the treatment of parents and children following the accidental death of the youngest child, and the second describes time-limited work with a sexually abused and abusing teenage boy. The value of providing a range of psychoanalytic treatments to meet the range of needs of patients is discussed. The importance of conceptualizing such treatments in ways that do not imply that they are ‘diluted’ psychoanalysis is also stressed, particularly with a view to the increasing pressure on therapists to offer help to as many children as possible within limited treatment time.     

成人注意缺陷多动障碍诊断与心理治疗的研究进展

注意缺陷多动障碍（ADHD）是指一种以注意缺陷、多动、冲动的行为表现为主要特征的精神病理障碍。对儿童注意缺陷多动障碍的研究有了长足的进步,但对成人注意缺陷多动障碍的研究相对较少。本文阐明了国际上对成人注意缺陷多动障碍的诊断与心理治疗的研究进展,希望引起国内临床心理学家、精神病学家和心理咨询师等的充分重视。     

The psychotherapy of parenthood: towards a formulation and valuation of concurrent work with parents

This paper explores the process and value of concurrent work with parents when their child is being treated in individual psychotherapy. The position taken is that psychoanalytic understanding generally and the specific formulations presented in this paper have a broader applicability in other aspects and approaches in child and adolescent mental health practice. The central issues are the interweaving of knowledge of family processes, child development and psychopathology, and the uses that can be made of an understanding of transference and countertransference. A particular formulation is presented in relation to aspects of the work that constitute ‘child guidance’ and those that may be considered as ‘psychotherapeutic’ in relation to parental psychopathology. We have coined the term ‘the psychotherapy of parenthood’ to give this work the status it deserves and to define a boundary within which to explore the areas and levels of this complex work. Some practice and training implications are considered.     

Parental involvement in children's learning: Comparing parents of children with and without Attention-Deficit/Hyperactivity Disorder (ADHD)

The present study examined involvement in children's learning among parents of 101 children between 8 and 12 years of age (53 parents of children with ADHD, 48 parents of children without ADHD). Compared to parents of children without ADHD, parents of children with ADHD reported lower self-efficacy in their ability to help their children, felt less welcome and supported by their children's schools and teachers, and perceived less time and energy for involvement in their children's academic lives. Mothers of children with and without ADHD reported similar types and levels of involvement behaviors in the home. Fathers of children with ADHD reported being more disengaged from their children's learning and using more coercive and punitive interactions regarding their children's achievement compared to fathers of children without ADHD. These findings underscore the difficulties in parent-supported learning practices and home-school collaboration initiatives faced by parents of children with ADHD and educators alike. Implications for school psychology practice are discussed.     

注意缺陷多动障碍儿童教育康复线上模式的构建

注意缺陷多动障碍(简称ADHD)是一种常见的儿童神经发育性障碍。当前用于儿童ADHD的传统(线下)教育康复模式存在缺少学业实效、教师低参与、学校管理经验不足以及遇到特殊情况(如疫情)无法服务等问题。本研究在脑电生物反馈认知训练的基础上, 以解决问题和循证研究为设计思路, 为中国ADHD患儿构建教育康复线上模式并进行初步应用。本研究分为3个子研究：研究1采用访谈法和问卷调查法对中国儿童ADHD教育康复的现状调查并分析患儿及关键相关人(家长和教师)需求; 研究2采用随机对照单盲试验(干预组和对照组各为50人), 评价基于脑电生物反馈认知训练(NCT)的教育康复线上模式的有效性; 研究3采用一个更大被试样本量(每组n = 100)的(家长为中介人干预组/教师为中介人干预组/对照组)×(诊断组/亚诊断组)随机对照研究评价由干预中介人(家长或教师)参与的线上模式的有效性, 以及一个纵向质性研究发现关键相关人对于线上模式的接受情况。研究旨在为中国ADHD患儿提供一个有效且好用的教育康复形式。     

Processing Speed Weakness in Children and Adolescents with Non-Hyperactive but Inattentive ADHD (ADD)

DSM-IV-TR defines ADHD-Predominantly Inattentive as allowing up to five symptoms of hyperactivity/impulsivity, while theories of the inattentive type usually assume a group that is hypoactive and characterized by processing speed and cognitive interference deficits. In a community-recruited sample of 572 children and adolescents, a pure inattentive subtype of ADHD (ADD) was defined as those who met DSM-IV-TR criteria for ADHD-PI but had two or fewer hyperactive/impulsive symptoms. Processing and output speeds of those with ADD were compared to those identified with DSM-IV-TR ADHD combined type and non-ADHD controls. These results were then contrasted with those found when DSM-IV-TR defined ADHD-PI was compared with ADHD-C and controls. Processing and output speed were assessed with the Trailmaking A and B and the Stroop Naming Tests. Cognitive interference control was assessed with the interference score from the Stroop Task. Slower cognitive interference speed was found in the ADD vs. ADHD-C and controls comparisons, but not the ADHD-PI versus ADHD-C and controls comparisons. On output speed measures, ADD exhibited the slowest performance, significantly different from controls and the effect size for the set-shifting speed contrast (Trailmaking B) was double that of the ADHD-PI vs. control comparison. ADHD-Inattentive type as defined by the DSM-IV-TR is a heterogeneous condition with a meaningful proportion of those affected exhibiting virtually no hyperactive/impulsive symptoms. This subgroup may represent a distinct inattentive condition characterized by poor cognitive interference control and slow processing or output speed.     

The Oedipus complex as observed in work with couples and their children

In work with couples where there is a child referred to a Child and Adolescent Mental Health Service, there are opportunities to observe and to work with unresolved Oedipal issues brought by the parents to the task of creating a family. These conflicts can be seen enacted by the child or children, either internally or externally. Examples are given from five cases: the first two from brief family work where the children are under five and the difficulties are to some extent resolved. The next two demonstrate more intractable problems of psychopathology where the parental Oedipal conflicts are handed down to the next generation, and the paper concludes with an example of couple work in relation to individual therapy with a child, where despite the pressure of considerable pathology in the parents' backgrounds there is a will to integration and progress is made.     

Verbal fluency in children with ADHD: Strategy using and temporal properties

Verbal fluency tasks are commonly used in cognitive and developmental neuropsychology in assessing executive functions, language skills as well as divergent thinking. Twenty-two typically developing children and 22 children with ADHD between the ages of 8 and12 years were examined using verbal fluency tasks, prepotent response inhibition, and working memory tests. The clinical group showed impaired inhibitory and spatial working memory processes. We used different qualitative analyses of verbal fluency tasks to explore the lexical and executive strategies (word clustering and switching), and the temporal properties of the responses. Children with ADHD had a leeway in applying relevant lexical or executive strategies related to difficulties in strategy using. The reduced efficiency of children with ADHD in semantic fluency task is based on suboptimal shifting between word clusters and is related to the lack of ability of producing new clusters of items. The group difference appeared at the level of accessing and/or activating common words; however, the executive process of searching the lexicon extensively is intact.     

Parents' estimations of their own intelligence and that of their children: a comparison between English and Icelandic parents

In this study, 158 parents (79 fathers and 79 mothers) with a mean age of 38.3 yrs (SD = 8.2), estimated their own, and their children's, overall intelligence as well as their children's score on the 12 intelligence scales from the Wechsler's Intelligence Scale for Children (WISC-III). The sample included English (n = 122) and Icelandic parents (n = 36), and a comparison between them showed few differences except that Icelandic parents' estimates were lower than English parents' estimates. The results showed fathers estimated their own overall intelligence higher than mothers estimated theirs and sons were estimated higher than daughters on overall intelligence. Two factors (verbal, performance) of intelligence were identified through factor analysis of the ratings of the 12 WISC subscale score estimates. A hierarchical regression showed that these two factors explained most of the variance in the estimation of the child's overall intelligence; however, gender of child and parents' self-estimated own overall intelligence added incremental variance.     

Risky decision-making in children with and without ADHD: A prospective study

Learning from past decisions can enhance successful decision-making. It is unclear whether difficulties in learning from experience may contribute to risky decision-making, which may be altered among individuals with attention-deficit/hyperactivity disorder (ADHD). This study follows 192 children with and without ADHD aged 5 to 10 years for approximately 2.5 years and examines their risky decision-making using the Balloon Emotional Learning Task (BELT), a computerized assessment of sequential risky decision-making in which participants pump up a series of virtual balloons for points. The BELT contains three task conditions: one with a variable explosion point, one with a stable and early explosion point, and one with a stable and late explosion point. These conditions may be learned via experience on the task. Contrary to expectations, ADHD status was not found to be related to greater risk-taking on the BELT, and among younger children ADHD status is in fact associated with reduced risk-taking. In addition, the typically-developing children without ADHD showed significant learning-related gains on both stable task conditions. However, the children with ADHD demonstrated learning on the condition with a stable and early explosion point, but not on the condition with the stable and late explosion point, in which more pumps are required before learning when the balloon will explode. Learning during decision-making may be more difficult for children with ADHD. Because adapting to changing environmental demands requires the use of feedback to guide future behavior, negative outcomes associated with childhood ADHD may partially reflect difficulties in learning from experience.     

Comorbidity of Attention Deficit Hyperactive Disorder (ADHD) and major depression in primary school children

The study investigated comorbid Attention-Deficit/Hyperactivity Disorder (ADHD) and depression in a sample of rural primary school children in Limpopo Province, South Africa. A total of 320 learners participated in this study of whom 160 learners had teacher and parent identified ADHD symptoms (females?=?50%; age range 6–14 years). All the learners took the Beck Depression Youth Inventory, second edition. Data were analysed applying ANOVA to investigate the possible differences between and within age, gender, and ADHD subtype group differences in depression symptomatology. Results indicated no statistically significant differences in the scores on the depression scale between the children with ADHD as identified by parents and teachers and the comparison group peers.     

多动症儿童教育方式研究

本文选取35名多动症儿童为被试,采用《康纳多动症评分量表》对经医学确诊的多动症儿童进行可疑程度分析。采用姚树桥、龚耀先编制的《儿童适应行为评定量表》对被试的社会适应行为进行评量。结果表明:多动症儿童在不同程度上存在适应行为问题,特别是在社会责任方面的水平较低,从年龄发展来看多动症儿童在小学三、四年级时适应水平最低。据此提出教育训练的重点和教育建议。     

Types of sexual transference and countertransference in psychotherapeutic work with children and adolescents

The question of normal sexuality begins to arise in the treatment of severely sexually abused or sexually offending patients. The author suggests that it is an interesting and delicate moment during the process of recovery when less perverse, more normal sexuality appears mixed with, or even disguised by, the more habitual perverse fantasies. Writers in the adult field have drawn distinctions between perverse, eroticized and normal erotic transferences, and between Oedipal and post-Oedipal sexuality. Some have also distinguished between countertransferences in the analyst of an erotised versus a normal erotic nature. The paper discusses whether these distinctions could have any relevance for child patients. Freud and Klein have taught us much about the child's sexuality in relation to his interest in and attraction to his parents as sexual beings. But can we also detect some origins in earlier experiences in infancy of the child's later capacity to feel himself a sexual being capable of being wanted by an other? How might such a feeling of sexual self-worth differ from narcissism and from sexualised exhibitionism? The paper asks how therapists might deal with such problems and such possibly healthy developments.     

Observed classroom behavior of children with ADHD: relationship to gender and comorbidity

Examined hypothesized gender and comorbidity differences in the observed classroom behavior of children with attention deficit hyperactivity disorder (ADHD). The behavior of 403 boys and 99 girls with ADHD, ages 7–10, was compared (a) to observed, sex-specific classroom behavior norms, (b) by sex, and (c) by comorbid subgroups. Boys and girls with ADHD deviated significantly from classroom norms on 15/16 and 13/16 categories, respectively. Compared to comparison girls, girls with ADHD had relatively high rates of verbal aggression to children. Boys with ADHD engaged in more rule-breaking and externalizing behaviors than did girls with ADHD, but the sexes did not differ on more neutral, unobtrusive behaviors. The sex differences are consistent with notions of why girls with ADHD are identified and referred later than boys. Contrary to hypothesis, the presence of comorbid anxiety disorder (ANX) was not associated with behavioral suppression; yet, as hypothesized, children with a comorbid disruptive behavior disorder (DBD) had higher rates of rule-breaking, and impulsive and aggressive behavior, than did children with ADHD alone and those with ADHD+ANX. Elevated rates of ADHD behaviors were also observed in children with comorbid DBD, indicating that these behaviors are truly present and suggesting that reports of higher ADHD ratings in this subgroup are not simply a consequence of negative halo effects and rater biases.     

Interventions to Address the Academic Impairment of Children and Adolescents with ADHD

There exists a strong link between ADHD and academic underachievement. Both the core behavioral symptoms of ADHD and associated executive functioning deficits likely contribute to academic impairment. Current evidence-based approaches to the treatment of ADHD (i.e., stimulant medication, clinical behavior therapy and classroom behavioral interventions) have demonstrated a robust impact on behavioral variables such as attention and disruptive behavior within classroom analogue settings; however, their efficacy in improving academic outcomes is much less clear. Although surprisingly few treatment outcome studies of ADHD have attempted to incorporate interventions that specifically target academic outcomes, the studies that are available suggest that these interventions may be beneficial. The state of the treatment literature for addressing academic impairment in children and adolescents with ADHD will be reviewed herein, as well as limitations of current research, and directions for future research.     

Divorce mediation: the impact of mediation on the psychological well‐being of children and parents

This study evaluated levels of psychological distress experienced by children (aged 4–16) and parents at the beginning of and one month after mediation for child‐related disputes. In contrast to previous research, this study employed both child‐ and parent‐reports of child outcome. Mediation was associated with reductions in child‐reported, though not parent‐reported, child psychological distress and with reductions in parent‐reports of their own psychological distress. The negotiation of successful agreements in mediation was not related to improved psychological well‐being of family members. The difficulties encountered (i.e. small numbers, low response rate) render the results tentative. Implications of the findings for future research are discussed. Copyright © 1999 John Wiley & Sons, Ltd.     

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.