The effect of conscious control on handwriting in children with attention deficit hyperactivity disorder

Two experiments were performed regarding the effect of conscious control on handwriting fluency in healthy adults and ADHD children. First, 26 healthy students were asked to write a sentence under different conditions. The results indicate that automated handwriting movements are independent from visual feedback. Second, the writing performance of 12 children with ADHD was examined on their usual medication with methylphenidate and under placebo. In comparison to placebo, medication with methylphenidate resulted in a reduced fluency of handwriting. Automated handwriting movements could be elicited in children with ADHD on medication. The results suggest that both visual and mental control of handwriting movements affect the automation of handwriting movements. Furthermore, a simple training procedure was designed and performed in a case study of a boy with ADHD.     

Brain dopamine and kinematics of graphomotor functions

Three experiments were performed in an attempt to achieve a better understanding of the effect of dopamine on handwriting. In the first experiment, kinematic aspects of handwriting movements were compared between healthy participants and patients with Parkinson's disease (PD) on their usual dopaminergic treatment and following withdrawal of dopaminergic medication. In the second experiment, the writing performance of healthy participants with a hyperechogenicity of the substantia nigra as detected by transcranial sonography (TCS) was compared with the performance of healthy participants with low echogenicity of the substantia nigra. The third experiment examined the effect of central dopamine reduction on kinematic aspects of handwriting movements in healthy adults using acute phenylalanine and tyrosine depletion (APTD). A digitising tablet was used for the assessment of handwriting movements. Participants were asked to perform a simple writing task. Movement time, distance, velocity, acceleration and measures of fluency of handwriting movements were measured. The kinematic analysis of handwriting movements revealed that alterations of central dopaminergic neurotransmission adversely affect movement execution during handwriting. In comparison to the automatic processing of handwriting movements displayed by control participants, participants with an altered dopaminergic neurotransmission shifted from an automatic to a controlled processing of movement execution. Central dopamine appears to be of particular importance with regard to the automatic execution of well-learned movements.     

Medication effects in the classroom: Three naturalistic indicators

Hyperactive and comparison boys participated in 5-week summer enrichment programs that included classroom activities and structured assessments of peer interaction patterns. During the 3rd and 4th weeks of these programs, a double-blind, methylphenidate-placebo crossover design was implemented within the hyperactive group. Three heterogeneous indicators of everyday behaviors were obtained: number of negative incidents noted by staff, quality of handwriting, and number of times the teacher called the boys' names aloud in the classroom. Medication effects emerged for each of these indicators. When hyperactive boys were taking placebos, they were involved in more negative incidents, their handwriting was poorer, and their names were called more frequently than when the boys were taking methylphenidate. Interrelationships among the measures suggest moderate cross-situational generality of medication responsiveness. Discussion focused on the bandwidth of medication effects and the need to examine the social ramifications of child treatments.This research was supported in part by NIMH grant 29475 and NIDA grant 01070. We gratefully acknowledge the participation of the data coders and the many summer school staff. Special thanks go to Mike Berlin, Barry E. Collins, and Sharon Dotemoto. Methylphenidate and placebo were supplied by Ciba-Geigy, Summit, New Jersey.     

Methylphenidate and cognitive therapy: A comparison of treatment approaches with hyperactive boys

This study of hyperactive boys evaluated the effects of three modes of treatment in relation to an untreated group. The treatments were administered over a 3-month period and included cognitive training, stimulant drug therapy (methylphenidate), and the two treatments combined. A follow-up assessment was conducted approximately 3 months after contact between the training staff and the child had ceased. Analyses of attentional deployment and cognitive style measures, tests of academic achievement, and behavioral ratings showed that only those children in the two medication treatment conditions demonstrated improvement in attentional deployment and behavioral ratings. In the cognitive therapy condition, there were changes only on measures of attentional deployment. The data did not provide evidence indicating that the combined medication and cognitive therapy condition was any more effective than that condition involving medication alone. Discussion provides future guidelines for evaluation of the relative effectiveness of stimulant drug therapy and other psychological treatment modalities.     

Motor timing deficits in community and clinical boys with hyperactive behavior: the effect of methylphenidate on motor timing

In a previous paper we showed that community children with hyperactive behavior were more inconsistent than controls in the temporal organization of their motor output. In this study we investigated: (1) various aspects of motor timing processes in 13 clinically diagnosed boys with attention deficit hyperactivity disorder (ADHD) who were compared to 11 community boys with hyperactive behavior and to a control group and (2) the effect of methylphenidate on the motor timing processes in the clinical group with ADHD in a double blind, cross-over, medication-placebo design, including 4 weeks of medication. The clinical group with ADHD, like the community group with hyperactivity, showed greater variability in sensorimotor synchronization and in sensorimotor anticipation relative to controls. The clinical group was also impaired in time perception, which was spared in the community group with hyperactivity. The persistent, but not the acute dose, of methylphenidate reduced the variability of sensorimotor synchronization and anticipation, but had no effect on time perception. This study shows that motor timing functions are impaired in both clinical and community children with hyperactivity. It is the first study to show the effectiveness of persistent administration of methylphenidate on deficits in motor timing in ADHD children and extends the use of methylphenidate from the domain of attentional and inhibitory functions to the domain of executive motor timing.     

Attention and movement execution during handwriting

Two studies were performed in order to test the hypothesis that movement execution during handwriting in skilled writers is independent of attention. Study I examined the relationship between attentional functioning and kinematic aspects of handwriting movements in 24 adult participants. A digitizing tablet was used for the assessment of handwriting movements. Participants were asked to perform a simple writing task and various components of their attention were assessed. Correlation analysis indicated no significant relationship between attention functions and both kinematic aspects of handwriting movements and quality of handwriting. In Study II, 20 participants underwent total sleep deprivation (TSD) for 24h. While attention, as assessed with alertness and vigilance tasks, deteriorated during TSD, the execution of handwriting movements, as assessed with a digitizing tablet, improved markedly. The quality of handwriting was not affected by TSD. These findings may suggest an independence between attention and movement generation during handwriting.     

The Effects of Parent Training and Ritalin on the Parent-Child Interactions of Hyperactive Boys

Using a multiple baseline across subjects design, the present study assessed the effects of parent training alone and combined with methylphenidate on the social interactions of three mothers with their hyperactive boys. Two mothers received instruction in child behavior management while their sons remained off medication. Subsequently, these boys returned to medication to evaluate whether the drug further enhanced the effects of parent training. The third child received the drug treatment first and then remained on medication while his mother underwent the same parent training program. Results indicated that both treatments alone decreased the amount of commands given by the mother as well as parent ratings of deviant child behavior in the home, but produced variable improvements in child compliance to commands. More reliable improvements in child compliance to commands. More reliable improvements from each treatment occurred in the duration of compliance per command. the combination of treatments failed to produce any further improvements in mother-child interactions than that achieved by either treatment alone. Contrary to earlier research, only parent training resulted in increases in the mothers' use of positive attention following child compliance.     

Perceptions of methylphenidate effects on hyperactive children's peer interactions

The behavioral constructs that emerge from observers' openended impressions of methylphenidate effects on the social behaviors of hyperactive children were examined. Ninety-six undergraduates observed videotapes of two different hyperactive target boys, each playing an interaction game with three peers. One target was taking methylphenidate and the other was taking placebo. The valence and content of observers' social perceptions were analyzed. Overall, more negative than positive behaviors were detected, a pattern more pronounced for the placebo than for the medication condition. Interestingly, placebo targets received negative evaluations for poorly controlled behaviors such as noncompliance, aggression, and disruption, but medicated targets received negative evaluations for social inhibition—passive and submissive behaviors. In contrast, the boys' medication state did not consistently influence observers' perceptions of positive social behaviors. Discussion focused on the extent and consequences of medicationrelated increases in social disengagement and on the ultimate impact of stimulant treatment on hyperactive children's social worlds.A preliminary report of this study was presented at the 1990 meeting of the Society for Research in Child and Adolescent Psychopathology, Costa Mesa, CA. We are grateful for the assistance of Pam Ajang, Keri Hom, and Scott Gutentag, and for support from the Fernald Child Study Center at UCLA.     

Effects of methylphenidate (Ritalin) on selective attention in hyperactive children

This study investigated the effect of methylphenidate (Ritalin) on the selective attention of hyperactive children designated as favorable or adverse responders to stimulant medication. Using a type II incidental learning paradigm, it was found that children in the drug condition recalled more central and less incidental stimuli than those children in the placebo condition. While no differential effects on recall were found for responder type, methylphenidate did affect the spontaneous overt labeling of central stimuli by the favorable responder group. Results were interpreted in terms of the role of methylphenidate in narrowing the focus of attention. Implications for the classification of hyperactive children as favorable and adverse responders were also discussed.This paper is based on a master's thesis completed by the first author in the Department of Psychology, University of Guelph, under the supervision of the second author. The authors wish to thank J. Thomas Dalby for his assistance in the conducting of this experiment.     

BEHAVIORAL AND STIMULANT TREATMENT OF HYPERACTIVE CHILDREN: A THERAPY STUDY WITH METHYLPHENIDATE PROBES IN A WITHIN-SUBJECT DESIGN

Eight hyperactive children were treated with a behavioral intervention focusing on teacher and parent training over a period of 5 months. Three times, before therapy and after 3 weeks and 13 weeks of intervention, children received methylphenidate during 3-week probe periods. Each week in a probe they received either a placebo, .25 mg/kg, or .75 mg/kg methylphenidate. Classroom observations of on-task behavior suggested that effectiveness of the behavioral intervention was between that of the two dosages of medication before therapy. Both dosages resulted in higher levels of on-task behavior when administered after 13 weeks of behavioral intervention than when administered before therapy. Teacher rating data showed equivalent effects of therapy and the low dosage of methylphenidate alone but a stronger effect of the high dose alone; only the high dose resulted in improved behavior after 13 weeks of behavioral intervention. As a group, only when they received the high dose of methylphenidate after 13 weeks of behavioral intervention did children reach the level of appropriate behavior shown by nonhyperactive controls. However, this level was also reached by two children with the low dose and by one child without medication, and it was not reached by one child. The results suggest that the combination of psychostimulant medication and behavior therapy may be more effective in the short-term than either treatment alone for hyperactive children in school settings. In addition, parent ratings and clinic observation of parent-child interactions suggested that children had improved in the home setting, highlighting the importance of behavioral parent training in the treatment of hyperactivity.     

Prosocial behavior in hyperactive boys: Effects of stimulant medication and comparison with normal boys

To clarify the effects of stimulant medication on hyperactive (ADHD) children's prosocial as well as aversive behaviors toward peers, 19 hyperactive boys, aged 7–12, were observed as they acted as leaders for groups of 2–4 unfamiliar younger children. In a doubleblind crossover design, subjects were observed twice, once on placebo and again on a moderate (0.6 mg/kg) dose of methylphenidate (Ritalin). Thirteen comparison boys, without problems in attention and behavior, were also observed in the same leader roles. Relative to comparison boys, hyperactive boys on placebo were more socially engaged, used more aversive leadership techniques, and were rated as less likable by the younger children in their groups. Aversive social behaviors were the strongest predictors of being disliked by the younger children. No differences were found between comparison and unmedicated hyperactive boys for any aspect of prosocial behavior. Stimulant medication had a general dampening effect on social behavior, significantly reducing social engagement and increasing (mild) dysphoria relative to the placebo condition. The implications of these findings for understanding and treating the peer relationship difficulties of hyperactive children are discussed.This study was conducted at the Fernald Child Study Center, UCLA, and we very much appreciate the contributions of the many staff members of the program, especially those of Alice Huber-Dressler and Tracy Heller. We also are very grateful to staff and children of Corinne A. Seeds University Elementary School for their participation in this study.     

Adapting to the surface: A comparison of handwriting measures when writing on a tablet computer and on paper

Our study addresses the following research questions: Are there differences between handwriting movements on paper and on a tablet computer? Can experienced writers, such as most adults, adapt their graphomotor execution during writing to a rather unfamiliar surface for instance a tablet computer?We examined the handwriting performance of adults in three tasks with different complexity: (a) graphomotor abilities, (b) visuomotor abilities and (c) handwriting. Each participant performed each task twice, once on paper and once on a tablet computer with a pen.We tested 25 participants by measuring their writing duration, in air time, number of pen lifts, writing velocity and number of inversions in velocity. The data were analyzed using linear mixed-effects modeling with repeated measures.Our results reveal differences between writing on paper and on a tablet computer which were partly task-dependent. Our findings also show that participants were able to adapt their graphomotor execution to the smoother surface of the tablet computer during the tasks.     

Use of a task-oriented self-instruction method to support children in primary school with poor handwriting quality and speed

Two studies were conducted to investigate the effect of a task-specific self-instruction intervention to improve handwriting ability of children with poor handwriting quality in schools for regular education (Study 1) and children with poor handwriting quality in schools for special education (Study 2). Study 1 showed that children with poor handwriting quality who received handwriting intervention on an individual basis for three months improved on average more on quality of writing than control children without handwriting problems who did not receive intervention. In contrast, the control group improved more in speed of writing after the intervention period. At an individual level, three out of the seven children with poor handwriting quality before intervention were not classified as such anymore after the intervention period. Study 2 showed that after six months of intervention in a group setting children with poor handwriting quality improved their quality of writing more so than children with poor handwriting quality who had not received intervention. On speed of handwriting no significant group differences emerged. We conclude that the task-oriented self-instruction method applied in this study seems to improve especially the quality of handwriting, not speed, of children initially identified as having poor handwriting quality.     

Psychoactive drug effects in a hyperactive child: A case study analysis of behavior change and teacher attention

The effects of methylphenidate on the behavior and teacher interactions of a 9-year-old hyperactive female were analyzed. Observations of the subject's task-related and disruptive behaviors and of interactions between the subject and her classroom teacher were made when the subject received the active drug and an inert placebo. Teacher's ratings of the subject's classroom behavior and measures of her academic performance were also obtained. Results showed that when the subject was receiving methylphenidate she engaged in task-related activities a greater percent of the time, had a higher percent of teacher interactions that were instructional in quality, and received lower behavior ratings by the teacher than when she was receiving a placebo. The results suggest that the use of medication may enable the hyperactive child to profit both behaviorally and academically.     

Efficacy of an explicit handwriting program

The aim of this study was to investigate the effects of an explicit handwriting program introduced during the first grade of elementary school. Grade 1 children (N=23) with an age range of 6.1 to 7.4 yr. (15 girls, 8 boys) were administered an additional handwriting program of two weekly sessions of 45 min. over six weeks. Another group of 19 Grade 1 children (11 girls, 8 boys) received only the regular handwriting program of one weekly session. The Concise Assessment Scale for Children's Handwriting was administered to measure the changes in quality and speed of handwriting. The children given the explicit program showed better quality and speed of handwriting than did the control group. Their handwriting was more regular, with fewer ambiguous letters and fewer incorrect relative heights.     

Aggression in boys with attention deficit-hyperactivity disorder: Methylphenidate effects on naturalistically observed aggression,response to provocation,and social information processing

High and low-aggressive boys with attention deficit-hyperactivity disorder (ADHD) were compared and the effects of methylphenidate were examined on measures from three domains of aggression: (1) directly observed verbal and nonverbal aggressive behaviors exhibited in the context of a day treatment program, (2) aggressive responding when provoked during a laboratory task, and (3) social information processing patterns exhibited on tasks designed to tap the putative cognitive components of aggression. The high-aggressive (HA) and low-aggressive (LA) subgroups differed significantly on observational measures of aggression and on the laboratory provocation task, but the HA group showed more deviant cognitions on only one of the numerous measures of social information processing. Regarding medication effects on the direct observation measures, methylphenidate decreased aggression for both subgroups. On the laboratory provocation task, methylphenidate had only minimal effects. Significant drug effects were obtained on only two recall social information processing measures.     

Early parent-child relations and family functioning of preschool boys with pervasive hyperactivity

This study examined the quality of parent–child relationships and family functioning of preschool children with early onset hyperactivity by comparing a community sample of 33 pervasively hyperactive preschool boys with a comparison sample of 34 boys. Mothers and children were assessed at home on a range of interview, parent questionnaire, and observational measures of parenting and family functioning. Results of the study showed that higher rates of reported lax disciplinary practices, less efficient parental coping, lower rates of father–child communication, and less synchronous mother–child interactions were significantly associated with hyperactivity following statistical adjustment for the effects of conduct problems and other confounding factors. The best parenting predictor of hyperactivity was maternal coping. The present findings suggest that the way in which parents interact with their preschool children may make a unique contribution to the development and ongoing behavioral difficulties experienced by children with pervasive hyperactivity. Findings also highlight the importance of considering the role of fathers in the behavioral development of boys with early tendencies to hyperactive and distractible behavior problems.     

Gender differences in severity of writing and reading disabilities

Gender differences in mean level of reading and writing skills were examined in 122 children (80 boys and 42 girls) and 200 adults (115 fathers and 85 mothers) who showed behavioral markers of dyslexia in a family genetics study. Gender differences were found in writing and replicated prior results for typically developing children: Boys and men were more impaired in handwriting and composing than were girls and women, but men, who were more impaired in those writing skills, were also more impaired in spelling than women. Men were more impaired than women in accuracy and rate of reading passages orally, but boys were not more impaired than girls on any of the reading measures. Males were consistently more impaired than females in orthographic skills, which may be the source of gender differences in writing, but not motor skills. Population-based studies that report gender differences in reading in children with dyslexia may be confounding reading and writing disorders—the latter being the true source of gender differences in both children and adults with dyslexia.     

The normalizing effects of methylphenidate on the classroom behavior of ADDH children

This study examined whether methylphenidate normalizes the behavior of hyperactive children (ADDH). Twenty-eight ADDH children were treated for 8 weeks with a mean dose of 41.5 mg/d of methylphenidate. Their classroom behavior and that of normal children was recorded by observers who were blind to diagnosis and treatment. Before treatment, all measures significantly differentiated the ADDH and normal children. After treatment, the two groups were indistinguishable on measures of gross and minor motor movement, noncompliance, interference, and overall hyperactivity. ADDH children were significantly improved on measures of attention but continued to be significantly less attentive. In many ways, the ADDH children were not only improved but indistinguishable from their normal peers.This paper was supported by NIMH grants 30822 and 18579. We gratefully acknowledge the assistance of Beth Landa, Ph.D., who performed the statistical analyses.     

The effects of methylphenidate on various types of activity level and attention in hyperkinetic children

The effects of methylphenidate on a number of objective measures of activity level and attention were assessed on three repeated occasions in four types of settings: free play, movie viewing, testing, and restricted play periods. Subjects were 36 boys between 5 and 12 years of age and of average intelligence. Of these, 18 were diagnosed as hyperkinetic and participated in a double-blind drug-placebo crossover design. The remaining 18 boys, matched in age and IQ with the hyperkinetic children, served as a control group and received no drugs. Results indicated that compared to placebo, methylphenidate significantly reduced wrist, ankle, locomotor, and seat movement activity in the hyperkinetic children regardless of the type of setting in which the measures were taken. Relatively fewer significant drug effects were noted on the measures of concentration or attention. While concentration to reaction time, maze performance, and a movie viewing task improved during drug treatment, the length of attention to toys in free play was not significantly improved. Parental ratings of activity level were also improved by the drug. The hyperkinetic children were also observed to increase their level of task-irrelevant activity over time while control children remained relatively stable in activity over repeated assessment. Despite the positive drug effects, clinical observations suggested that methyl-phenidate may have reduced the interest of some children in their environment.