Classroom observations of students with and without ADHD: Differences across types of engagement

The current study examined the behaviors related to academic engagement exhibited by students with ADHD during instruction in math and reading. A total of 155 students (92 ADHD, 63 recruited controls) in grades 1 through 4 participated in the study. Results revealed that students with ADHD exhibited statistically significant lower rates of academic engagement and higher rates of off-task behaviors than recruited controls and randomly selected peer comparisons. Specifically, students with ADHD exhibited statistically significant lower rates of passive academic engagement (PET) than recruited controls and peer comparisons; however no group differences were found with regard to active engaged time (AET). In addition, students with ADHD exhibited lower rates of AET than PET, a finding observed among both recruited controls and randomly selected peer comparisons. Implications for research and practice are discussed.     

The direct way may not be the best way: Children with ADHD and their understanding of self-presentation in social interactions

Knowledge and use of self-presentational tactics is an important social skill. We examined understanding of the function of three different self-presentational tactics (self-promotion, ingratiation and blasting) in 11 8–12-year-old boys with attention-deficit/hyperactivity disorder (ADHD) and 11 matched comparison children. Children were given six different self-presentation stories, two for each one of the three different tactics. After each story, they were asked to evaluate the effects of the self-presentational tactic used. Children with ADHD rated self-promotion and blasting as more positive and more effective—and ingratiation as less positive and less effective—than children in the control group. This implicates that children with ADHD prefer simple and direct self-presentational strategies (like self-promotion), and, therefore, may not as easily understand more subtle strategies (like ingratiation). They also seem to be more inclined to use negatively connoted strategies (like blasting). We suggest that this limited understanding of self-presentational strategies in children with ADHD may explain some of their problems in social interactions. Therefore, social skill interventions in children with ADHD should incorporate elements focusing on use and understanding of different self-presentational strategies.     

Personality Characteristics Associated with Persistent ADHD in Late Adolescence

This study focused on the personality characteristics associated with Attention-deficit/Hyperactivity disorder (ADHD) in a longitudinal sample of youth, with a particular focus on differences between those with and without persisting ADHD symptoms. Participants with ADHD (n = 90) were initially evaluated when they were 7–11 years old, and re-assessed at 16–22 years of age. Matched control subjects (n = 80) were recruited at the time of the follow-up evaluation. At follow-up, the Kiddie-SADS-PL, a semi-structured psychiatric interview, and the NEO-PI, a self-report personality inventory, were administered. Data were analyzed using multivariate analyses of variance (MANOVA). Results indicate that childhood ADHD is associated with lower scores on the NEO Conscientiousness subscale in adolescents/young adults—irrespective of the degree of ADHD persistence. In contrast, ratings of Neuroticism and Agreeableness appear to be more closely linked to adolescent status; those with persisting symptoms only exhibited increased Neuroticism and decreased Agreeableness. These results suggest that ADHD, and the degree to which symptoms persist into adolescence, may be closely linked to personality structure.     

ADHD and Behavioral Inhibition: A Re-examination of the Stop-signal Task

The current study investigates two recently identified threats to the construct validity of behavioral inhibition as a core deficit of attention-deficit/hyperactivity disorder (ADHD) based on the stop-signal task: calculation of mean reaction time from go-trials presented adjacent to intermittent stop-trials, and non-reporting of the stop-signal delay metric. Children with ADHD (n = 12) and typically developing (TD) children (n = 11) were administered the standard stop-signal task and three variant stop-signal conditions. These included a no-tone condition administered without the presentation of an auditory tone; an ignore-tone condition that presented a neutral (i.e., not associated with stopping) auditory tone; and a second ignore-tone condition that presented a neutral auditory tone after the tone had been previously paired with stopping. Children with ADHD exhibited significantly slower and more variable reaction times to go-stimuli, and slower stop-signal reaction times relative to TD controls. Stop-signal delay was not significantly different between groups, and both groups’ go-trial reaction times slowed following meaningful tones. Collectively, these findings corroborate recent meta-analyses and indicate that previous findings of stop-signal performance deficits in ADHD reflect slower and more variable responding to visually presented stimuli and concurrent processing of a second stimulus, rather than deficits of motor behavioral inhibition.     

Effects of White Noise on Off-Task Behavior and Sleep for Elementary-Age Students with ADHD

Abstract

Children with ADHD were administered 75?dB of continuous white noise during independent seat work in the classroom and during bedtime in their homes. Compared to baseline all three students exhibited decreases in off-task behavior. Off-task behavior returned to original baseline levels when white noise was removed and decreased again when reintroduced in classrooms. White noise also decreased bedtime sleep latency and spontaneous night wakings at home. Both sleep latencies and night wakings increased during return-to-baseline conditions. Surprisingly, when white noise was reintroduced only in the classrooms sleep improved a second time. White noise in classrooms with or without simultaneous treatment during sleep at night resulted in lower levels of off-task classroom behavior as well as less disruptive sleep. Results were independent of whether children were on ADHD medication. Children, teachers, and parents all rated white noise favorably.     

Relating lab to life: Decrements in attention over time predict math productivity among children with ADHD

A child’s ability to sustain attention over time (AOT) is critical in attention-deficit/hyperactivity disorder (ADHD), yet no prior work has examined the extent to which a child’s decrement in AOT on laboratory tasks relates to clinically-relevant behavior. The goal of this study is to provide initial evidence for the criterion validity of laboratory assessments of AOT. A total of 20 children with ADHD (7–12 years of age) who were enrolled in a summer treatment program completed two lab attention tasks (a continuous performance task and a self-paced choice discrimination task) and math seatwork. Analyses focused on relations between attention task parameters and math productivity. Individual differences in overall attention (OA) measures (averaged across time) accounted for 23% of the variance in math productivity, supporting the criterion validity of lab measures of attention. The criterion validity was enhanced by consideration of changes in AOT. Performance on all laboratory attention measures deteriorated as time-on-task increased, and individual differences in the decrement in AOT accounted for 40% of the variance in math productivity. The only variable to uniquely predict math productivity was from the self-paced choice discrimination task. This study suggests that attention tasks in the lab do predict a clinically-relevant target behavior in children with ADHD, supporting their use as a means to study attention processes in a controlled environment. Furthermore, this prediction is improved when attention is examined as a function of time-on-task and when the attentional demands are consistent between lab and life contexts.     

Parent-Child Interaction Therapy for ADHD: A Conceptual Overview and Critical Literature Review

ABSTRACT

Attention-Deficit/Hyperactivity Disorder (ADHD), a chronic disorder beginning in childhood, is identifiable and diagnostically valid during the preschool years. Compared to school-aged children, preschoolers have not received as much attention in the literature. Parent-Child Interaction Therapy (PCIT) is an empirically-supported parent training program for young children with disruptive behaviors that may also be effective in treating ADHD. The purpose of the current article was to explore the theoretical rationale for utilizing PCIT with this population and to conduct a literature review of published PCIT treatment outcome studies that measured ADHD symptoms. The literature demonstrates that children with ADHD have been included in PCIT research and evidence suggests that PCIT may be effective for young children with ADHD. However, future research is needed to specifically examine the effects of PCIT on ADHD.     

Working Memory Deficits in Boys with Attention-deficit/Hyperactivity Disorder (ADHD): The Contribution of Central Executive and Subsystem Processes

The current study investigated contradictory findings from recent experimental and meta-analytic studies concerning working memory deficits in ADHD. Working memory refers to the cognitive ability to temporarily store and mentally manipulate limited amounts of information for use in guiding behavior. Phonological (verbal) and visuospatial (nonverbal) working memory were assessed across four memory load conditions in 23 boys (12 ADHD, 11 typically developing) using tasks based on Baddeley's (Working memory, thought, and action, Oxford University Press, New York, 2007) working memory model. The model posits separate phonological and visuospatial storage and rehearsal components that are controlled by a single attentional controller (CE: central executive). A latent variable approach was used to partial task performance related to three variables of interest: phonological buffer/rehearsal loop, visuospatial buffer/rehearsal loop, and the CE attentional controller. ADHD-related working memory deficits were apparent across all three cognitive systems--with the largest magnitude of deficits apparent in the CE--even after controlling for reading speed, nonverbal visual encoding, age, IQ, and SES.     

The clinical utility of behavior rating scales: Comments on the diagnostic assessment of ADHD

Responding to Reid and Maag's critique of behavior rating scales in assessing ADHD, published in a previous issue of the Journal of School Psychology, we provided specific recommendations for improving the accuracy of diagnostic decisions using rating scales and affirmed the importance of these procedures in the assessment of ADHD. Strategies for managing the error intrinsic to the use of diagnostic measures, specifically behavior rating scales, were outlined. A multiple stage procedure, involving one or more levels of screening prior to conducting a diagnostic assessment, was recommended as a strategy to increase diagnostic accuracy in a time- and cost-efficient manner.     

Associations of Lifetime Depression with Trauma Exposure,Other Environmental Adversities,and Impairment in Adolescents with ADHD

Depression is a common, potentially devastating comorbidity in youth with attention-deficit/hyperactivity disorders (ADHD). Various environmental adversities are well-described as correlates of depression in general pediatric populations, but not in youth with ADHD. In 104 adolescents with ADHD, we examined potential environmental correlates of lifetime depression, including trauma exposure, recent negative life events and current parent-child conflict, along with current and past ADHD severity and current impairment. Controlling for demographic variables, comorbid disorders, and ADHD severity, we noted significant associations between lifetime depression and environmental adversities, including victimization trauma, parent-child conflict, and behaviorally-independent negative life events. Current impairment but not ADHD severity was also highly associated with lifetime depression, controlling for the same covariates. Findings from this preliminary, cross-sectional study suggest that environmental adversities and impairment in youth with ADHD should also be targeted along with the ADHD when contemplating strategies to treat or prevent comorbid depression.     

Working memory and behavioral inhibition in children with attention-deficit/hyperactivity disorder (ADHD): an examination of varied central executive demands,construct overlap,and task impurity

The stop-signal paradigm is the premier metric of behavioral inhibition in contemporary attention-deficit/hyperactivity disorder (ADHD) research. The stop-signal paradigm’s choice-reaction time component, however, arguably places greater demands on working memory processes (e.g., controlled-focused attention) relative to alternative inhibition metrics (i.e., go/no-go (GNG) tasks), and consequently obscures conclusions about inhibition and working memory deficits in affected children. The current study, therefore, aimed to determine whether shared variance between stop-signal behavioral inhibition and working memory performance in children with ADHD reflects overlap between the working memory and inhibition constructs or insufficient specificity of the stop-signal paradigm. Fifty-five children (8–12 years) with and without ADHD were administered established phonological (PH) and visuospatial (VS) working memory measures, as well as stop-signal and GNG tasks that vary with respect to demands on controlled-focused attention. Although working memory and GNG performance each uniquely predicted children’s inattention, stop-signal task performance was not a significant predictor of unique variance in inattention, above and beyond variance associated with working memory. Collectively, these findings suggest that performance on the stop-signal task, compared to the GNG task, is confounded by greater demands associated with working memory and consequently reflects an impure estimate of the inhibition construct.     

Behind the wheels with autism and ADHD: Brain networks involved in driving hazard detection

Driving is a cognitively challenging task, and many individuals with autism spectrum disorder (ASD) or with attention-deficit/hyperactivity disorder (ADHD) struggle to drive safely and effectively. Previous evidence suggests that core neuropsychological deficits in executive functioning (EF) and theory of mind (ToM) may impact driving in ASD and ADHD. This functional magnetic resonance imaging (fMRI) study compares the brain mechanisms underlying ToM and EF during a hazard perception driving task. Forty-six licensed drivers (14 ASD, 17 ADHD, 15 typically developing (TD)), ages 16–27 years, viewed a driving scenario in the MRI scanner and were instructed to respond to driving hazards that were either “social” (contained a human component such as a pedestrian) or “nonsocial” (physical objects such as a barrel). All groups of participants recruited regions part of the “social brain” (anterior insula, angular gyrus, right middle occipital gyrus, right cuneus/precuneus, and right inferior frontal gyrus) when processing social hazards, and regions associated with motor planning and object recognition (postcentral gyrus, precentral gyrus, and supplementary motor area) when processing nonsocial hazards. While there were no group differences in brain activation during the driving task, years licensed was predictive of greater prefrontal and temporal activation to social hazards in all participants. Findings of the current study suggest that high-functioning ASD and ADHD licensed drivers may be utilizing similar cognitive resources as TD controls for decisions related to driving-related hazard detection.     

Age of Onset of ADHD in a Sample of Elementary School Students

Examined the age of onset of ADHD symptoms and subtypes using parent ratings of a large sample of elementary school students. Results showed: (1) in children with ADHD-combined type, hyperactive-impulsive symptoms emerged at younger ages than inattention symptoms; (2) about one-fifth of children who met symptom count and impairment criteria for ADHD did not meet the age of onset criterion; (3) Children who did not meet the age of onset criterion consisted primarily of children with inattention problems; and (4) children who did not meet the age of onset criterion had more impaired parent-child relationships, self-esteem, family functioning, and higher overall impairment ratings than children who did meet the criterion. These results raise questions about the validity of the age of onset criterion for ADHD as formulated in DSM-IV.     

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.     

Written expression in boys with ADHD: The mediating roles of working memory and oral expression

The written expression difficulties experienced by children with ADHD are widely recognized; however, scant empirical evidence exists concerning the cognitive mechanisms and processes underlying these deficiencies. The current study investigated the independent and potentially interactive contributions of two developmentally antecedent cognitive processes – viz., working memory (WM) and oral expression – hypothesized to influence written expression ability in boys. Thirty-three boys with ADHD-Combined Presentation and 27 neurotypical (NT) boys 8–12 years of age were administered standardized measures of oral and written expression, and multiple counterbalanced tasks to assess WM central executive (CE) processes, WM phonological short-term memory (PH STM), and WM visuospatial short-term memory (VS STM). Bias-corrected bootstrapped mediation analyses revealed a significant mediation effect, wherein the independent and interactive effects of PH STM and oral expression collectively explained 76% of the diagnostic status to written expression relation. The implications of the obtained results for clinical practice suggest that children with ADHD may benefit by incorporating a blended approach that simultaneously strengthens PH STM capacity and oral expression abilities as antecedents to engaging in writing-related activities.     

Parenting Behavior and Cognitions in a Community Sample of Mothers with and without Symptoms of Attention-deficit/Hyperactivity Disorder

Although attention-deficit/hyperactivity disorder (ADHD) in adults has recently emerged as an important area of research, little attention has been given to the family functioning of women with ADHD, particularly in their role as mothers. We examined parenting self-esteem, locus of control, and disciplinary styles in a community sample of mothers with varying levels of ADHD symptoms. Women with high levels of ADHD symptoms reported more occupational and psychiatric problems than women with lower levels of ADHD symptoms. They also reported lower parenting self-esteem, a more external parenting locus of control, and less effective disciplinary styles. The findings suggest that women with ADHD symptoms may face a number of difficulties within the parenting domain.     

Internal Validity of the Disruptive Behavior Disorder Symptoms: Implications from Parent Ratings for a Dimensional Approach to Symptom Validity

A dimensional approach was used to evaluate the internal validity of the DSM-III-R ADHD-inattention, ADHD-hyperactivity/impulsivity, oppositional defiant disorder (ODD), and conduct disorder (CD) symptoms (i.e., whether a symptom has a stronger correlation with its own dimension than the other three). Parents rated 4,019 children between the ages of 2 and 19 on these symptoms. The results showed that 5 of the 6 inattention symptoms, 3 of the 4 hyperactivity symptoms, 1 of the 4 impulsivity symptoms, 6 of the 9 oppositional defiant disorder symptoms, and 8 of the 11 CD symptoms had significant internal validity. Confirmatory factor analysis (CFA) found support for inattention, hyperactivity/impulsivity, oppositional defiant, and conduct disorder dimensions. Multiple-group CFA also found support for factor pattern and loading invariance across gender. The implications of these results as well as the merits of the dimensional approach to symptom validity are discussed in the context of the DSM-IV changes in ADHD, ODD, and CD.     

Differences in cognitive control in children and adolescents with combined and inattentive subtypes of ADHD

The aim of the present study was to investigate the ability of children with attention deficit/hyperactivity disorder-combined subtype (ADHD-C) and predominantly inattentive subtype (ADHD-PI) to direct their attention and to exert cognitive control in a forced attention dichotic listening (DL) task. Twenty-nine, medication-naive participants with ADHD-C, 42 with ADHD-PI, and 40 matched healthy controls (HC) between 9 and 16 years were assessed. In the DL task, two different auditory stimuli (syllables) are presented simultaneously, one in each ear. The participants are asked to report the syllable they hear on each trial with no instruction on focus of attention or to explicitly focus attention and to report either the right- or left-ear syllable. The DL procedure is presumed to reflect different cognitive processes: perception (nonforced condition/NF), attention (forced-right condition/FR), and cognitive control (forced-left condition/FL). As expected, all three groups had normal perception and attention. The children and adolescents with ADHD-PI showed a significant right-ear advantage also during the FL condition, while the children and adolescents in the ADHD-C group showed a no-ear advantage and the HC showed a significant left-ear advantage in the FL condition. This suggests that the ADHD subtypes differ in degree of cognitive control impairment. Our results may have implications for further conceptualization, diagnostics, and treatment of ADHD subtypes.     

Buffers of peer rejection among girls with and without ADHD: the role of popularity with adults and goal-directed solitary play

We investigated a risk-resilience model in 91 girls with ADHD and 58 age- and ethnicity-equated comparison girls, who participated in all-female naturalistic summer research camps. The hypothesized risk factor was peer rejection (assessed via sociometric nominations), with criterion measures including multiinformant composites of aggressive behavior and anxious/depressed symptoms. The two hypothesized protective factors were the girls' popularity with adult staff (assessed via staff ratings) and objective observations of goal-directed solitary play. Peer rejection was related to higher levels of aggressive behavior and depressed/anxious behavior, confirming its status as a risk factor. Next, for all girls, popularity with adults predicted lower levels of aggression and goal-directed solitary play predicted lower levels of anxiety/depression. Whereas popularity with adults was most protective among the peer-accepted subgroup, solitary play was most protective among the peer-rejected subgroup. Diagnostic status (ADHD versus comparison) moderated the findings such that engaging in meaningful solitary play was a stronger predictor of lower levels of anxious/depressed behavior in girls with ADHD than in comparison girls. We discuss the need for replication in prospective research and implications for research and intervention regarding the social functioning of peer-rejected children, particularly those with behavior disorders.     

Enhanced Brief Motivational Intervention for College Student Drinkers With ADHD: Goal-Directed Activation as a Mechanism of Change

College students with attention-deficit/hyperactivity disorder (ADHD) are at risk for alcohol-related problems and disorders relative to their typically developing peers. Despite risk, the optimal therapeutic approach for reducing problem alcohol use in students with ADHD, and mechanisms of change underlying treatment effects in this population, are largely unknown. The current study evaluated putative mechanisms of change in a randomized controlled trial of two harm reduction interventions for college student drinkers with ADHD (N = 113; 49% male): brief motivational intervention plus supportive counseling (BMI + SC) versus brief motivational intervention plus behavioral activation (BMI + BA). Results showed that participants in the BMI + BA condition engaged in more goal-directed activation and less avoidant behavior over the course of treatment compared to those in the BMI + SC condition, in turn predicting reductions in alcohol-related negative consequences. Effects were more robust 1 month following intervention, and diminished by 3 months. Sensitivity analyses revealed a significant indirect effect of treatment condition on alcohol-related negative consequence via reductions in avoidance over treatment. Post hoc moderated mediations showed that BMI + BA engaged target mechanisms more robustly for students with more severe ADHD and depressive symptoms compared to BMI + SC. These findings support the application of BMI + BA intervention, particularly in targeting goal-directed activation and avoidance/rumination in at-risk student drinkers with ADHD.