Beyond Ritalin: The importance of therapeutic work with parents and children diagnosed ADD/ADHD

It is estimated that as many as 5 million children in America are being medicated with psycho-stimulants for Attention Deficit Disorder (ADD) and/or Attention Deficit/Hyperactivity Disorder (ADHD). Parents frequently seek psychotherapy for their child up to one and a half years after medication has been tried due to a high degree of symptom recidivism. The parents should be engaged in the therapeutic work, if at all possible. An intricate web begins to unfold as the current parent-child relationship resonates with the parents' relationship with their own parents, siblings and childhood experiences. Working with the parents is essential if one is going to know anything about the cross-generational dynamics involved and if real and helpful change is going to occur. Conscious and unconscious parent—child dynamics of hyperactive behaviour in children are discussed. A clinical case illustration is described. Alternatives to medicating children are also described.     

Psychosocial intervention follow-up in children with ADHD: effects on academic, emotional and social functioning

The aim of this investigation was to analyze the maintenance of the effects, one year after its conclusion, of an intervention that integrated three coordinated programs, implemented with 27 children with ADHD, aged between 7 and 10 years, their parents and teachers. The intervention lasted 10 weeks and included behavior-modification and cognitive-behavioral techniques, academic adaptations and social skills. We evaluated the effects on academic, emotional and social adjustment from the information provided by parents, teachers and classmates. The results confirm the maintenance in the follow-up evaluation of the improvements experienced after the treatment, especially in the academic and social areas, in which these children displayed the greatest difficulties.     

Evaluation of sensorimotor training in children with ADHD

Reduced ability to regulate motor behavior seems to be an essential aspect of Attention-Deficit Hyperactivity Disorder (ADHD) and may reflect deficits in behavioral response inhibition. In this respect, pragmatic clinical experience over the last two decades, in daily practice, training of motor control has played an important role within multimodal treatment approaches, although an adequate proof of its efficacy is still lacking. Therefore, to examine the efficacy of sensorimotor training, 12 children with ADHD (two groups of six) were treated with both sensorimotor training and (as control) cognitive behavioral training using a within-subject cross-over design. Each treatment had a duration of 4 months (20 sessions), yielding a total of 40 sessions for the completed cross-over design. Results showed that Sensorimotor Training improved sensorimotor coordination slightly, while Cognitive Behavioral Training ameliorated cognitive impulse control. Hyperactivity and anxious-depressive/aggressive behavior were markedly reduced by Sensorimotor Training but not by Cognitive Behavioral Training. In conclusion, a combined treatment may be recommended since compensation and regulation of inhibitory deficits in ADHD come into play within the framework of both kinds of training.     

Perceptions of sexual harassment in an academic context

This study assessed the influence of two subject variables, gender and gender role, and one contextual variable, power of the harasser, on perceptions of sexual harassment in an academic context. Fifty-one white males and 73 white females evaluated a series of vignettes depicting a range of behavioral interactions. When the harasser was a higher power individual, vignettes were more likely to be viewed as examples of sexual harassment, male characters were perceived more negatively, and female characters were perceived more favorably. Female respondents rated the male characters less favorably than did the male respondents, although there were no gender differences in the number of vignettes interpreted as sexual harassment. Subtle differences in the way males and females interpret harassment behaviors are examined and discussed.Portions of this paper were presented at the meeting of the Eastern Psychological Association, Boston, Massachusetts, April 1992.     

Child and familial pathways to academic achievement and behavioral adjustment: a prospective six-year study of children with and without ADHD

This longitudinal study examined familial and child predictors of academic achievement and behavioral adjustment. Participants included 115 children with ADHD and 59 normative comparisons. Data analyses spanned three assessment waves from elementary- through secondary-school grades. We evaluated the degree to which child and familial factors present during middle school mediated relationships between childhood ADHD, subsequent academic achievement, and behavioral adjustment during high school. We found that emotional and behavioral well-being of ADHD children during middle school mediated relations between childhood ADHD and adverse academic and behavioral outcomes during high school. In addition, familial factors in middle school years predicted the behavioral adjustment of children in both the ADHD and non-ADHD groups. Academic achievement during high school was strongly associated with previous achievement levels. Our results provide support for tailoring preventive interventions to the unique needs of children with ADHD and their parents at various stages of adolescent development.     

WISC-IV and WISC-III profiles in children with ADHD

Wechsler Intelligence Scale for Children, 3rd and 4th editions (WISC-III n = 586 and WISC-IV n = 118), profiles were compared for children with ADHD and normal intelligence. Mean Verbal Comprehension Index (VCI) and Perceptual Organization/Perceptual Reasoning Index (POI/PRI) scores were significantly higher than Freedom From Distractibility/Working Memory Index (FDI/WMI) and Processing Speed Index (PSI), and Symbol Search was higher than Coding. FDI/WMI and PSI scores were similar on both tests, but VCI and POI/PRI were higher on the WISC-IV than on the WISC-III. Therefore, index discrepancies were greater for the WISC-IV, suggesting that the WISC-IV might be better than the WISC-III in delineating the strengths and weaknesses of children with ADHD. All children in the WISC-IV sample scored lowest on WMI or PSI, whereas only 88% of the WISC-III children scored lowest on FDI or PSI. Thus, the WISC-IV may be more helpful in diagnosing ADHD than the WISC-III.     

Complex prospective memory in children with ADHD.

The ability to remember intentions (prospective memory) is fundamental to the organization of goal-directed actions in everyday life. Successful prospective remembering involves forming, retaining, initiating, and executing an intention. Although previous research has demonstrated prospective memory impairments in children with attention deficit/hyperactivity disorder (ADHD), this has largely focused on the intention initiation and execution stages. In this study, we investigate the performance of 20 children with ADHD and 20 matched controls at each of the four stages of prospective memory, using a computer multitask paradigm. Results suggest that children with ADHD may demonstrate difficulties forming delayed intentions, as indicated by impulsive planning, and that this may have further implications for the retention and implementation of these delayed intentions. While children with ADHD showed comparable multitask switching, this appeared to be at the expense of intention execution as they made more performance errors than controls. Implications for day-to-day functioning are discussed.     

Reduced ADHD symptoms in adults with ADHD after structured skills training group: results from a randomized controlled trial

Objective

Feasibility, acceptability, and efficacy of a Dialectical Behavioral Therapy (DBT) -based method developed in Germany were evaluated in a Swedish outpatient psychiatric context.

Method

Fifty-one adults with ADHD on stable medical treatment or on no medication were randomized to the DBT-based skills training (n = 26) or a parallel loosely structured discussion group (n = 25). Self-rating scales were administered before randomization and after the treatment.

Results

Feasibility and participant satisfaction were good in both groups while skills training was perceived as more logical and effective for ADHD-related problems. The analyses of the individuals who completed the treatment and remained stable with regard to medication (n = 19 in skills training; n = 18 in control group) showed a significant reduction in ADHD symptoms in the skills training group, but not in the control group. No reduction of comorbidity was observed in any of the groups.

Conclusions

The treatment was feasible in an outpatient psychiatric context, well tolerated, and significantly reduced ADHD symptoms in on-treatment individuals who remained stable regarding medication status.     

Cumulative risk,teacher-child closeness,executive function and early academic skills in kindergarten children

We tested the role of teacher-child closeness in moderating the associations between early childhood adversity, measured as a cumulative risk index, and child outcomes during the kindergarten year. Using the ECLSK:11, a national dataset of kindergarteners in the 2010–11 academic year, we examined three dimensions of executive function (cognitive flexibility, inhibitory control, working memory), as well as early reading and math scores, as key skills that facilitate the transition to school. Cumulative risk was negatively associated with all outcomes, and teacher-child closeness was positively associated with all outcomes. Teacher-child closeness moderated the relation between cumulative risk and working memory and cumulative risk and reading scores in a protective manner, but not cognitive flexibility, inhibitory control, or math scores. Implications for research in early childhood adversity and education are discussed.