The Effect of Physical Activity on Children With ADHD: A Quantitative Review of the Literature

Research on the effects of physical activity on children with attention deficit hyperactivity disorder is promising, yet no attempt has been made to integrate current findings using meta-analytic techniques. Using a meta-regression, the present study examined the effectives of physical activity for children with attention deficit hyperactivity disorder on a number of cognitive, behavioral, and emotional outcomes. From 20 empirical studies, 164 effect sizes quantifying the effectiveness of physical activity for children with attention deficit hyperactivity disorder were extracted from 22 independent samples. Results indicated an overall moderate-to-large effect for physical activity on children with attention deficit hyperactivity disorder, with a significant effect for emotion/mood. Limitations of the study, future directions, and implications for school professionals are discussed.     

Does attention-deficit/hyperactivity disorder have a dimensional latent structure? A taxometric analysis

An understanding of the latent structure of attention-deficit/hyperactivity disorder (ADHD) is essential for developing causal models of this disorder. Although some researchers have presumed that ADHD is dimensional and others have assumed that it is taxonic, there has been relatively little research directly examining the latent structure of ADHD. The authors conducted a set of taxometric analyses using data from the NICHD Study of Early Child Care and Youth Development (ns between 667 and 1,078). The results revealed a dimensional latent structure across a variety of different analyses and sets of indicators for inattention, hyperactivity/impulsivity, and ADHD. Furthermore, analyses of correlations with associated features indicated that dimensional models demonstrated stronger validity coefficients with these criterion measures than dichotomous models. These findings jibe with recent research on the genetic basis of ADHD and with contemporary models of ADHD.     

Understanding the Covariation Among Childhood Externalizing Symptoms: Genetic and Environmental Influences on Conduct Disorder,Attention Deficit Hyperactivity Disorder,and Oppositional Defiant Disorder Symptoms

Conduct disorder (CD), attention deficit hyperactivity disorder (ADHD), and oppositional defiant disorder (ODD) are common childhood externalizing disorders that frequently co-occur. However, the causes of their comorbidity are not well understood. To address that question, we analyzed data from > 600 Finnish twin pairs, who completed standardized interviews at age 14. Behavior genetic methods were used to examine how genetic/environmental factors contribute to each disorders symptoms and to their covariation. We found significant genetic effects on each disorder with only modest evidence of shared environmental influences. Our data suggest the comorbidity among CD, ADHD, and ODD is primarily explained by shared genetic influences; however, each disorder was also under unique genetic influence, supporting the distinction of each disorder.     

Diagnostic Stability of ADHD in a Community Sample of School-Aged Children Screened for Disruptive Behavior

A large school-based sample of children in Grades 1, 2, 3, and 4 were screened for disruptive behavior and subsequently assessed over a 5-year period for DSM-III-R symptoms of attention deficit hyperactivity disorder (ADHD) and other externalizing and internalizing behavior disorders. Parents completed structured diagnostic interviews in Years 1, 4, and 5, and teachers completed Behavioral Assessment for Children—Teacher Rating Scales behavioral ratings annually. For parent-derived diagnostic data, both inattention and hyperactivity/impulsivity symptom groups declined from Year 1 to Year 4, with hyperactivity showing more significant decline. For teacher-rated behavioral dimensions, the Attention Problems scale declined from Year 1 to Year 3 and stabilized thereafter. The Hyperactivity scale showed stability during the first 3 years before declining in Year 4. Of those children diagnosed with ADHD in Year 1, 69% still met criteria for ADHD in either Year 4 or 5. Persisters were more likely to exhibit coexisting conduct disorder in Year 1 and oppositional defiant disorder in Years 1, 4, and 5. Parents of persisters reported more psychosocial adversity on measures of parenting and marital satisfaction.     

Relations between Parenting Stress,Parenting Style,and Child Executive Functioning for Children with ADHD or Autism

Relations among parenting stress, parenting style, and child executive functioning for children with disabilities are not easily teased apart. The current study explored these relations among 82 children and adolescents age 7–18: 21 with attention deficit/hyperactivity disorder, 33 with autism spectrum disorder, and 28 typically developing. Results indicated that children with attention deficit/hyperactivity disorder or autism spectrum disorder had more executive functioning deficits, and their parents reported more parenting stress and a greater use of permissive parenting, compared to typically developing children. In general, increased parenting stress was associated with greater use of authoritarian and permissive parenting styles, as well as more problems with behavior regulation for children. Authoritarian and permissive parenting styles were associated with poorer child executive functioning. Child diagnostic group (attention deficit/hyperactivity disorder, autism spectrum disorder, typically developing) moderated relations between parent stress and child functioning, and between parenting style and child functioning. Implications for intervention with families of children with disabilities are discussed.     

Structure and Etiology of Co-occurring Internalizing and Externalizing Disorders in Adolescents

Several studies suggest that a two-factor model positing internalizing and externalizing factors explains the interrelationships among psychiatric disorders. However, it is unclear whether the covariation between internalizing and externalizing disorders is due to common genetic or environmental influences. We examined whether a model positing two latent factors, internalizing and externalizing, explained the interrelationships among six psychiatric disorders (major depressive disorder, generalized anxiety disorder, separation anxiety disorder, attention-deficit/hyperactivity disorder, oppositional defiant disorder, and conduct disorder) in adolescents, and whether there are common genetic and environmental influences on internalizing and externalizing latent factors. Multivariate behavior genetic analyses of data from 1162 twin pairs and 426 siblings ascertained from the general population via the Colorado Center for Antisocial Drug Dependence (CADD) were conducted. We found support for a model positing two latent factors (internalizing and externalizing). These factors were moderately heritable and influenced by significant common genetic and nonshared environmental influences. These findings suggest that co-occurrence of internalizing and externalizing psychopathology in adolescents results from both genetic and environmental influences.     

Relationships among compulsive hoarding, trauma, and attention-deficit/hyperactivity disorder

The current study investigated aspects of post-traumatic stress disorder and attention deficit/ hyperactivity disorder (ADHD) among hoarders. Compared to a sample of 36 controls, hoarders (n=26) reported a significantly greater number of different types of trauma, more frequent traumatic experiences, more symptoms of inattention, hyperactivity, and greater comfort derived from possessions. These findings are consistent with previous reports of extensive comorbidity associated with hoarding behaviors, and may reflect the potential usefulness of assessing PTSD and ADHD symptoms at the outset of hoarding treatments, as well as considering alternative pharmacological interventions.     

Neurobiological models of attention-deficit/hyperactivity disorder: a brief review of the empirical evidence

Attention-deficit/hyperactivity disorder (ADHD) is a psychiatric disorder characterized by inattention, impulsivity, and overactivity that begins in childhood. While considerable research has focused on the neurobiological substrates of this disorder, the specific nature of the brain dysfunction in ADHD has remained elusive. However, early data from pharmacological treatment studies, as well as from basic research in animals and humans, initially led several investigators to develop neurobiological models of ADHD. These models of ADHD and more recent evidence from neuropsychological, neuroimaging, neurochemical, and genetic research are briefly reviewed. While not completely consistent, the empirical data suggest that dysfunction in prefrontal-striatal neural circuits, as well as in brain stem catecholamine systems that innervate these circuits, may underlie the executive function deficits in ADHD.     

成人注意缺陷多动障碍在内外源冲突时的表现:眼动的证据

在注意定向与维持上,注意缺陷多动障碍(ADHD)个体更容易受到外部刺激的干扰而导致目标任务加工进程受阻,表现出了注意定向反应的缺陷,但导致任务失败的原因是由于对突然出现的外部无关刺激的过度兴奋还是对内源性目标刺激的持续维持能力减弱,尚不清楚。研究采用反向眼跳范式、记忆导向眼跳范式和视觉导向眼跳范式,来探索成人ADHD内外源注意定向反应的情况,以及当二者发生冲突时,成人ADHD失败的可能机制。结果发现,在反向眼跳任务上,成人注意缺陷多动障碍组错误率更高,并且差异性显著。但在记忆导向眼跳任务中,成人注意缺陷多动障碍组与正常组的差异不显著。在视觉导向眼跳任务中,成人注意缺陷多动障碍组的正确眼跳潜伏期比正常组要短,且二者之间的差异显著。这说明,在内外源刺激反应的冲突导致的情境中,成人注意缺陷多动障碍的反应明显落后于正常个体,这种缺陷并非由于其维持内源性注意产生定向反应落后所导致的,而是与其外源注意定向反应过强有关。     

Parent and teacher SNAP-IV ratings of attention deficit hyperactivity disorder symptoms: psychometric properties and normative ratings from a school district sample

To examine Swanson, Nolan, and Pelham-IV (SNAP-IV) psychometric properties, parent (N = 1,613) and teacher (N = 1,205) data were collected from a random elementary school student sample in a longitudinal attention deficit hyperactivity disorder (ADHD) detection study. SNAP-IV reliability was acceptable. Factor structure indicated two ADHD factors and an oppositional defiant disorder (ODD) factor. Parent and teacher scores varied by gender and poverty status (d = .49-.56) but not age; only teacher scores varied by race (d = .25-.55). Screening and diagnostic utility was evaluated with likelihood ratios (LRs) and posttest probabilities. Parent SNAP-IV scores above 1.2 increased probability of concern (LR > 10) and above 1.8, of ADHD diagnosis (LR > 3). Teacher hyperactivity/impulsivity scores above 1.2 and inattention scores above 1.8 increased probabilities of concern only (LR = 4.2 and >5, respectively). Higher teacher scores for African American children and race differences in measurement models require future study.     

Pragmatic aspects of communication and language comprehension in groups of children differentiated by teacher ratings of inattention and hyperactivity

Children with attention‐deficit hyperactivity disorder (ADHD) experience pragmatic language deficits, but it is not known whether these difficulties are primarily associated with high levels of inattention, hyperactivity, or both. We investigated pragmatic aspects of communication and language comprehension in relation to poor attention and/or high hyperactivity in a nondiagnosed population of 7‐ to 11‐year olds. Classroom teachers rated their pupils' attention and hyperactivity/impulsivity on the ADD‐H Comprehensive Teacher Rating scale (ACTeRS). Three groups were formed: children with poor attention and low hyperactivity (poor attention group), children with good attention and high hyperactivity (high hyperactivity group), and children with both poor attention and high hyperactivity (poor attention/high hyperactivity group). Their performance was compared with that of same‐age controls in two studies: Study 1 (N = 94) investigated the comprehension of figurative language in and out of context and Study 2 (N = 100) investigated the pragmatic aspects of communication using the Children's Communication Checklist – Second Edition. Two groups, the poor attention and the poor attention/high hyperactivity groups, were impaired in both their comprehension of figurative language and their communication skills. The high hyperactivity group was impaired in their comprehension of figurative language but they did not exhibit communication impairments. The findings extend work with clinical populations of children with ADHD: even in a nondiagnosed sample of children, poor attention and elevated levels of hyperactivity are associated with pragmatic language weaknesses.     

Disinhibitory psychopathology in male adolescents: discriminating conduct disorder from attention-deficit/hyperactivity disorder through concurrent assessment of multiple autonomic states.

T. P. Beauchaine recently proposed a model of autonomic nervous system functioning that predicts divergent patterns of psychophysiological responding across disorders of disinhibition. This model was tested by comparing groups of male adolescents with attention-deficit/hyperactivity disorder (ADHD) and attention-deficit/hyperactivity disorder plus conduct disorder (CD/ADHD) with controls while performing a repetitive motor task in which rewards were administered and removed across trials. Participants then watched a videotaped peer conflict. Electrodermal responding (EDR), cardiac pre-ejection period (PEP), and respiratory sinus arrhythmia (RSA) were monitored. Compared with controls, the ADHD and CD/ADHD participants exhibited reduced EDR. The CD/ADHD group was differentiated from the ADHD and control groups on PEP and from the control group on RSA. Findings are discussed in terms of the motivational and regulational systems indexed. Implications for understanding rates of comorbidity between CD and ADHD are considered.     

Mental Disorders,Comorbidity, and Pre‐enlistment Suicidal Behavior Among New Soldiers in the U.S. Army: Results from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS)

We examined the associations between mental disorders and suicidal behavior (ideation, plans, and attempts) among new soldiers using data from the New Soldier Study (NSS) component of the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS; N = 38,507). Most new soldiers with a pre‐enlistment history of suicide attempt reported a prior mental disorder (59.0%). Each disorder examined was associated with increased odds of suicidal behavior (ORs = 2.6–8.6). Only PTSD and disorders characterized by irritability and impulsive/aggressive behavior (i.e., bipolar disorder, conduct disorder, oppositional defiant disorder, and attention‐deficit/hyperactivity disorder) predicted unplanned attempts among ideators. Mental disorders are important predictors of pre‐enlistment suicidal behavior among new soldiers and should figure prominently in suicide screening and prevention efforts.     

Test of Alternative Hypotheses Explaining the Comorbidity Between Attention-Deficit/Hyperactivity Disorder and Conduct Disorder

There is significant comorbidity between attention-deficit/hyperactivity disorder (ADHD) and conduct disorder (CD). The conclusions of studies that examined the causes of comorbidity between ADHD and CD conflict, with some researchers finding support for the three independent disorders model and others finding support for the correlated risk factors model. We tested these models and eleven alternative hypotheses using the same analytical approach. The participants were 110 monozygotic twin pairs and 181 dizygotic twin pairs recruited from the Colorado Learning Disabilities Research Center Twin Study. The three independent disorders model did not fit the data, whereas the correlated risk factors model fit the data well. Several other comorbidity models fit the data as well as or better than the correlated risk factors model. The results suggest that correlated risk factors are a better explanation for the comorbidity between ADHD and CD than a third, independent ADHD+CD subtype.     

Item response theory analyses of adult self-ratings of the ADHD symptoms in the Current Symptoms Scale

The graded response model, which is based on item response theory, was used to evaluate the psychometric properties of adult self-ratings (N = 852) of the attention deficit/hyperactivity disorder inattention, hyperactivity, and impulsivity symptoms presented in the Current Symptoms Scale. This scale has four ordered response categories. The results for the discrimination parameters showed that all symptoms were generally good for discriminating their respective latent traits. For virtually all symptoms, their threshold values showed that they were especially good at representing the appropriate traits from around the mean trait level onward. The item information function values for most symptoms indicated reasonable reliability from approximately the mean trait level onward. All these findings are new and extend existing psychometric information for adult self-ratings of the attention deficit/hyperactivity disorder symptoms in the Current Symptoms Scale.     

Birth Weight and Childhood Psychopathology in the ABCD Cohort: Association is Strongest for Attention Problems and is Moderated by Sex

Research on Child and Adolescent Psychopathology - Many studies have shown low birth weight is associated with psychopathology later in life, particularly attention-deficit/hyperactivity disorder...     

Confirming the Factor Structure of Attention Deficit Hyperactivity Disorder Symptoms in Adult, Nonclinical Samples

Three separate models have been proposed to describe the factor structure of attention deficit hyperactivity disorder (ADHD) in the past 20 years. The Diagnostic and Statistical Manual of Mental Disorders-III (DSM-III, 1980) proposed 3 separate factors of inattention, hyperactivity, and impulsivity. The DSM-III-R (1987) proposed a single factor. The DSM-IV (1994) described the disorder as having 2 factors: hyperactivity/impulsivity and inattention. The following 2 studies employed confirmatory factor analysis to compare each of these models and 3 alternative models. University students completed questionnaires that assessed each of the 18 symptoms listed in the DSM-IV for ADHD. The 3-factor model fit the data significantly better than each of the other models in both studies. These findings suggest that a 3-factor model of inattention, hyperactivity, and impulsivity describes adult ADHD symptoms better than current alternatives.     

Comorbidity in compulsive hoarding: a case report

A 56-year-old male presented with compulsive hoarding along with attention-deficit/hyperactivity disorder and schizotypal personality disorder. Hoarding has been described as difficult to treat both pharmacologically and behaviorally, and this patient's comorbid conditions also contributed to his overall impairment. The patient's treatment regimen of fluvoxamine, amphetamine salts, and risperidone, along with behavioral therapy, has helped with hoarding behaviors, motivation, procrastination, and increased socialization. Hoarding may be a unique subtype of obsessive-compulsive disorder with poorer prognosis and distinct neuroanatomic dysfunction. Augmentation with stimulants may provide benefits in aspects of hoarding such as procrastination, especially in patients with comorbid attention-deficit hyperactivity disorder.