Novel Measures of Response Performance and Inhibition in Children with ADHD

Fifteen children with ADHD aged 8 to 12 years and age and gender matched controls performed two different stopping tasks to examine response performance and inhibition and their respective moment-to-moment variability. One task was the well-established stop-signal task, while the other was a novel tracking task where the children tracked a spaceship on the screen until an alarm indicated they should stop. Although performance was discrete in the stop signal task and continuous in the tracking task, in both tasks latencies to the stop signal were significantly slowed in children with ADHD. Go performance and variability did not significantly differ between ADHD and control children in either task. Importantly, stopping latency in the novel spaceship tracking task also was more variable in children with ADHD. As stopping variability cannot be measured using the standard stop signal task, the new task offers compelling support for the heretofore untested prediction that stopping is both slowed and more variable in children with ADHD. The results support a response inhibition impairment in ADHD, whilst limiting the extent of an intra-trial variability deficit.

Hot and Cool Aspects of Cognitive Control in Children with ADHD: Decision-Making and Inhibition

This study investigated hot and cool aspects of cognitive control in children with Attention Deficit Hyperactivity Disorder (ADHD). The study aimed to: (1) replicate the postulated response inhibition deficit of children with ADHD; (2) explore whether children with ADHD choose disadvantageously in a decision-making task and to explore the mechanisms underlying the expected response pattern; and (3) study whether performance on a combination of hot and cool executive control measures has predictive value for an ADHD diagnosis. The sample consisted of 20 children with ADHD and 22 normal developing children (NC, 8 to 12 years) matched on age, FSIQ, and gender. Two paradigms have been applied: (1) the stop signal paradigm, and (2) the adapted children's version of the IOWA Gambling task. There were no group differences for both paradigms. Both groups chose in a reward-oriented manner and seemed to develop the ability to take future consequences into account in making decisions. Moreover, feedback resulted in direct behavioral changes. Children with ADHD did not have a specific response inhibition deficit or a decision-making deficit.     

Neuropsychological deficits in preschool as predictors of ADHD symptoms and academic achievement in late adolescence

High levels of ADHD symptoms are related to severe negative outcomes, which underscore the importance of identifying early markers of these behavior problems. The main aim of the present study was therefore to investigate whether neuropsychological deficits in preschool are related to later ADHD symptoms and academic achievement, over and above the influence of early ADHD symptom levels. The present study is unique because it includes a broader range of predictors compared to previous studies and the participants are followed over time for as long as 13 years (i.e., ages 5–18 years). Preschool data included measures of executive functioning and reaction time variability as well as emotional reactivity and emotion regulation of both positive and negative emotions. When controlling for early ADHD symptom levels, working memory, reaction time variability, and regulation of happiness/exuberance were significantly related to inattention whereas regulation of happiness/exuberance and anger reactivity were significantly related to hyperactivity/impulsivity. Furthermore, working memory and reaction time variability in preschool were significantly related to academic achievement in late adolescence beyond the influence of early ADHD symptoms. These findings could suggest that it is possible to screen for early neuropsychological deficits and thereby identify children who are at risk of negative outcomes. Furthermore, our results suggest that interventions need to look beyond executive functioning deficits in ADHD and also target the role of emotional functioning and reaction time variability. The importance of including both the positive and negative aspects of emotional functioning and distinguishing between emotion regulation and emotional reactivity was also demonstrated.     

Parent Ratings of ADHD Symptoms: Differential Symptom Functioning Across Malaysian Malay and Chinese Children

This study examined differential symptom functioning (DSF) in ADHD symptoms across Malay and Chinese children in Malaysia. Malay (N=571) and Chinese (N=254) parents completed the Disruptive Behavior Rating Scale, which lists the DSM-IV ADHD symptoms. DSF was examined using the multiple indicators multiple causes (MIMIC) structural equation modeling procedure. Although DSF was found for a single inattention (IA) symptom and three hyperactivity-impulsivity (HI) symptoms, all these differences had low effect sizes. Controlling for these DSF, Chinese children had higher IA and HI latent factor scores. However the effect sizes were small. Together, these findings suggest adequate support for invariance of the ADHD symptoms across these ethno-cultural groups. The implications of the findings for cross-cultural invariance of the ADHD symptoms are discussed.     

Identification of Early Child and Family Risk Factors for Aggressive Victim Status in First Grade

This prospective investigation sought to discriminate children who were both aggressive towards and victimized by peers in the first grade, from those who were only aggressive, only victimized, or neither (i.e., socially adjusted), using early child and family risk factors. Two hundred thirty-eight children, their mothers, and teachers participated in a longitudinal study since birth. All three aggressor/victim subgroups showed greater temperamental dysregulation than the socially adjusted children, but only aggressive victims had significantly poorer social perception skills. Aggressive victims were distinguished from aggressors by greater exposure to maternal depression and from victims by lower levels of early inhibition, but they shared the experiences of negative family emotional expressiveness with aggressors and greater mother-child negativity with victims. The identification of early risk factors is crucial to prevention and early intervention efforts that have the potential to attenuate the long term emotional, social, and academic problems associated with aggressive victim status.     

Measuring Symptoms and Functioning of Youth with ADHD in Middle Schools

The identification of reliable and valid means for evaluating the effectiveness of school-based treatments and completing diagnostic evaluations of middle school aged students are needed. The present study examined the inter-rater agreement of teacher ratings and the relationship between ratings and observational data in a middle school setting. The data are interpreted in the context of differences between a secondary and elementary school setting. Teacher ratings and observational data were collected regularly over the course of two academic years for middle school students diagnosed with ADHD. The results indicate low rates of inter-rater agreement as well as low rates of agreement between teachers and observational data, and between observational data collected in different classrooms. Inter-rater agreement was lowest in late fall and gradually increased over the second half of the year. Implications for conducting treatment outcome evaluations of school-based treatment programs and diagnostic evaluations are discussed.     

Anxiety Symptoms as Predictors of Nursing Home Placement in Patients with Alzheimer's Disease

Anxiety symptoms are fairly common among patients with Alzheimer's Disease (AD). Such symptoms are likely to make patient care more problematic and, therefore, increase the risk of nursing home placement. Anxiety symptoms were evaluated on the basis of physician examinations, in conjunction with caregiver interviews, in 372 community-dwelling AD patients. Patients received annual follow-up for 1–12 years (M = 4.4). Patients who exhibited anxiety symptoms at baseline assessment were significantly more likely to enter nursing homes, regardless of initial cognitive status or other risks for institutionalization. There was a 15% increase in risk for each point on a 0–5 scale. This study supports the hypothesis that anxiety symptoms increase the risk of nursing home placement in patients with AD. Consequently, there is a need for better understanding of the causes of anxiety in AD and for the development of effective methods of assessment and treatment.     

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.     

Parenting and Friendship Quality as Predictors of Internalizing and Externalizing Symptoms in Early Adolescence

Research indicates both parents and peers influence child and adolescent adjustment outcomes. Moreover, friendship quality has been found to buffer the influence of parenting on adolescent adjustment, particularly externalizing symptoms. Little to no research, however, has longitudinally examined whether friendship quality moderates the relation between parenting and adolescent internalizing symptoms. Accordingly, our study examines friendship quality as a moderator of the relation between parenting (positive parenting, poor parental monitoring, inconsistent discipline, parental involvement) and adolescent internalizing and externalizing symptoms over one year’s time. The sample included 65 early adolescents (67% male), ages 10–13 at initial assessment. Friendship quality buffered the effect of positive parenting on internalizing symptoms over time. However, no moderating effects for externalizing symptoms were found. Implications and further directions are discussed.     

Parenting Stress and Childhood Psychopathology: An Examination of Specificity to Internalizing and Externalizing Symptoms

The purpose of this study was to examine if specificity exists between three factors of parenting stress (i.e., parental distress, parent–child (PC) dysfunctional interactions, and difficult child) and childhood internalizing and externalizing symptoms. The incremental validity of parenting stress beyond parental psychopathology was also examined. The sample was drawn from families of children aged 5–17 (N = 300), who sought treatment for their child from a community mental health clinic. Results indicated that the PC dysfunctional interactions factor showed specificity to internalizing symptoms when controlling for parental psychopathology. Parental distress did not show specificity or incremental validity and the difficult child factor was associated with both internalizing and externalizing symptoms when controlling for parental psychopathology. The influence of age, gender, and ethnicity on these associations is also presented, and findings are discussed in terms of how the results add to understanding the specific relations between parenting stress and child and adolescent symptoms.     

两种亚型ADHD儿童的促进和抑制加工

采用图片Stroop任务,对两种亚型ADHD儿童的促进和抑制加工进行了研究。结果发现,不论在反应时还是错误率上,ADHD儿童和正常儿童在促进效应上的表现模式相似,但ADHD儿童在错误率上比正常儿童表现出更大的抑制效应,混合型ADHD儿童的抑制效应更大于注意缺陷型儿童。由于ADHD儿童仅选择性地在抑制加工上受损,而促进加工正常,这一结果提示,促进和抑制可能是具有不同机制的、分离的加工过程。     

Early Adolescent Growth in Depression and Conduct Problem Symptoms as Predictors of Later Substance Use Impairment

Most studies of adolescent substance use and psychological comorbidity have examined the contributions of conduct problems and depressive symptoms measured only at particular points-in-time. Yet, during adolescence, risk factors such as conduct problems and depression exist within a developmental context, and vary over time. Though internalizing and comorbid pathways to substance use have been theorized (Hussong et al. Psychology of Addictive Behaviors 25:390-404, 2011), the degree to which developmental increases in depressive symptoms and conduct problems elevate risk for substance use impairment among adolescents, in either an additive or potentially a synergistic fashion, is unclear. Using a school-based sample of 521 adolescents, we tested additive and synergistic influences of changes in depressive symptoms and conduct problems from 6th to 9th grade using parallel process growth curve modeling with latent interactions in the prediction of late adolescent (12th grade) substance use impairment, while examining gender as a moderator. We found that the interaction between growth in depression and conduct disorder symptoms uniquely predicted later substance use problems, in addition to main effects of each, across boys and girls. Results indicated that adolescents whose parents reported increases in both depression and conduct disorder symptoms from 6th to 9th grade reported the most substance use-related impairment in 12th grade. The current study demonstrates that patterns of depression and conduct problems (e.g., growth vs. decreasing) are likely more important than the static levels at any particular point-in-time in relation to substance use risk.     

Assessment of executive function in ADHD adolescents: contribution of performance tests and rating scales

This study aimed to analyze performance on measures of neuropsychological and behavioral executive functions (EF) in adolescents with attention deficit hyperactivity disorder (ADHD), and to evaluate the utility of performance-based tests for predicting scores on behavioral EF ratings. One hundred eighteen adolescents (75 ADHD and 43 controls) aged 12–16 years performed neuropsychological tests and completed a behavior rating scale of EF. The ADHD group presented significantly lower scores than controls on Full Scale IQ (FSIQ) and all indexes of the WISC-IV, except the verbal comprehension index (VCI). The ADHD group had significantly lower scores on performance-based tests of working memory, planning and inhibition, and on EF rating scales. Scores on the cognitive EF working memory, planning and flexibility modestly predicted performance on behavioral EF. The results suggest that the combined use of performance-based tests and rating scales provides valuable complementary information that can improve the assessment of executive domains in ADHD.     

Signs and the process of interpretation: sign as an object and as a process

Historically the words representation and symbol have had overlapping meanings, meanings that usually disregard the role played by the interpreter. Peirce’s theory of signs accounts for these meanings and also for the role of the interpreter. His theory draws attention to the static and dynamic nature of signs. Sign interpretation can be viewed as a continuous dynamic and evolving process. The static and dynamic nature of signs helps us understand the teaching–learning activity as a process of interpretation on the part of teacher and students. The paper attempts to explain the classroom interpretation process on the part of the actors involved using the Peircean theory of signs.     

The Ecological Validity of Delay Aversion and Response Inhibition as Measures of Impulsivity in AD/HD: A Supplement to the NIMH Multimodal Treatment Study of AD/HD

Impulsivity is a primary symptom of the combined type of Attention Deficit/Hyperactivity Disorder (AD/HD). The Stop Signal Paradigm is premised upon a primary deficit in inhibitory control in AD/HD, whereas the Delay Aversion Hypothesis, by contrast, conceptualizes impulsivity in AD/HD, not as an inability to inhibit a response, but rather as a choice to avoid delay. This study compared the ecological validity of the Stop Signal Task (SST) and Choice-Delay Task (C-DT) measure of delay aversion, with respect to their relative utility in discriminating AD/HD children from normal control participants, and their correlations with classroom observations and with ratings of impulsivity and other core AD/HD symptoms on the Conners and SNAP-IV checklists. The tasks exhibited modest discriminant validity when used individually and excellent discriminant validity when used in combination. The C-DT correlated with teacher ratings of impulsivity, hyperactivity, and conduct problems, and with observations of gross motor activity, physical aggression, and an AD/HD composite score. The SST correlated with the observations only. These results suggest that delay aversion is associated with a broad range of AD/HD characteristics whereas inhibitory failure seems to tap a more discrete dimension of executive control     

Inhibition of return in children and adolescents

Inhibition of return (IOR), slowed responding to targets at a cued location after attention is removed from this location, has been shown to occur both in adults and in infants. To explore suggestion that the timecourse of IOR depends on factors that might affect the efficiency with which attention is removed from the cued location, we compared the performance of young children (5-10-year-olds, N=49, M=8 years, 4 months) to older children and adolescents (11-17-year-olds, N=61, M=14 years) in single and double cue procedures. Cue-target interval was varied to measure the timecourse of IOR in this within-subjects localization task. Whereas no IOR was found in the young group unless a double cue procedure was used, in the older group, we found IOR at all intervals with the double cue procedure and the typical crossover pattern, with early facilitation followed by inhibition in the single cue procedure.     

Treatment, Age, and Time-Related Predictors of Behavioral Outcome in Pediatric Brain Tumor Survivors

The research has shown that children surviving cancer are at risk for long-term emotional and behavioral problems secondary to the cumulative effects of cranial irradiation and chemotherapy. The purpose of this study was to investigate the emotional and behavioral outcome of children diagnosed with brain tumor and treated with cranial irradiation and chemotherapy by looking at the association between treatment, time, age, and cognitive-related variables on externalizing and internalizing behaviors at 3 years posttreatment. Fifty-four brain tumor survivors were administered a neuropsychological test battery, whereas the parents filled out the CBCL and Conners' Parent Rating Scale. The results indicate that chemotherapy treatment with vincristine, cytoxan, cisplantinum, and/or VP16 was related to poorer internalizing and externalizing behavioral outcome, especially attention, social withdrawal, and anxious–depressive symptomatology. Age at time of diagnosis or treatment, time since discontinuation of treatment, type and/or total dose of radiation therapy was not significantly correlated with any of the behavioral outcome scales. Verbal memory and learning deficits accounted for a significant portion of the variance in social withdrawal, whereas lower scores in overall intellectual functioning and verbal fluency was related to disturbances in attention, inhibition, and social functioning. The findings suggest that children treated with 1 or a combination of any of the aforementioned chemotherapy agents who exhibit declines in intellectual functioning and memory are at increased risk for long-term behavioral problems 3 years after treatment cessation. These findings support the importance for early psychotherapeutic and supportive intervention services immediately after treatment cessation, with the goal of circumventing these potentially debilitating emotional problems.     

Anxiety as a Predictor and Outcome Variable in the Multimodal Treatment Study of Children with ADHD (MTA)

Initial moderator analyses in the Multimodal Treatment Study of Children with ADHD (MTA) suggested that child anxiety ascertained by parent report on the Diagnostic Interview Schedule for Children 2.3 (DISC Anxiety) differentially moderated the outcome of treatment. Left unanswered were questions regarding the nature of DISC Anxiety, the impact of comorbid conduct problems on the moderating effect of DISC Anxiety, and the clinical significance of DISC Anxiety as a moderator of treatment outcome. Thirty-three percent of MTA subjects met DSM-III-R criteria for an anxiety disorder excluding simple phobias. Of these, two-thirds also met DSM-III-R criteria for comorbid oppositional-defiant or conduct disorder whereas one-third did not, yielding an odds ratio of approximately two for DISC Anxiety, given conduct problems. In this context, exploratory analyses of baseline data suggest that DISC Anxiety may reflect parental attributions regarding child negative affectivity and associated behavior problems (unlike fearfulness), particularly in the area of social interactions, another core component of anxiety that is more typically associated with phobic symptoms. Analyses using hierarchical linear modeling (HLM) indicate that the moderating effect of DISC Anxiety continues to favor the inclusion of psychosocial treatment for anxious ADHD children irrespective of the presence or absence of comorbid conduct problems. This effect, which is clinically meaningful, is confined primarily to parent-reported outcomes involving disruptive behavior, internalizing symptoms, and inattention; and is generally stronger for combined than unimodal treatment. Contravening earlier studies, no adverse effect of anxiety on medication response for core ADHD or other outcomes in anxious or nonanxious ADHD children was demonstrated. When treating ADHD, it is important to search for comorbid anxiety and negative affectivity and to adjust treatment strategies accordingly.     

System-of-Care Practice Review Scores as Predictors of Behavioral Symptomatology and Functional Impairment

The longitudinal comparison study of the national evaluation of the Comprehensive Community Mental Health Services for Children and Their Families Program assesses factors in service delivery systems that may shape the impact of systems of care. We evaluated the extent to which services embodying the principles of a system of care, as measured by the System-of-Care Practice Review (SOCPR), affect clinical outcomes for children being served in federally-funded systems of care and matched comparison communities. The participants included 75 children and families selected for participation in the SOCPR. Results indicated that experience of services embodying system-of-care principles at a high level was associated with lower symptom and impairment scores one year after entry into services. Children in systems of care were rated to have experienced high levels of system-of-care principles implemented within their services, and their symptom severity and functional impairment did not vary as a function of their experiences. Children in matched comparison communities had more variable rated experiences of system-of-care principles within their services, and their symptom severity and functional impairment decreased as their experiences of the principles increased.     

Psychometric properties of the Conners-3 and Conners Early Childhood Indexes in a Spanish school population

Ba#ckground/Obje#ctive: To examine the psychometric properties of the Conners 3 ADHD Index (Conners 3 AI) and the Conners Early Children Global Index (Conners ECGI) parents’ form (PF) and teachers’ form (TF) in Spanish schoolers. Method: Two-phase cross-sectional study. In the first phase, information was gathered from teachers (n = 1,796) and parents (n = 882) of 4-5 and 10-11 year-old children. In the second phase (n = 196), children at risk of ADHD and controls were individually assessed. Results: The results confirmed the two-factor structure of the Conners 3 ADHD Index, which contains hyperactive-impulsive and inattentive symptoms, and the two-factor structure of the Conners ECGI PF, consisting of emotional lability and restless-impulsive symptoms. In contrast with the original version, the Conners ECGI TF presented an additional inattentive factor. Moderate-to-high rates of evidence of convergent validity with Child Behavior Checklist and Kiddie-Schedule for Affective Disorders & Schizophrenia, and evidence of external validity (academic achievement) were found. Scores were significantly higher in boys than in girls, for both indexes. Raw scores corresponding to clinical T-scores were higher than the original version. Conclusions: The Conners indexes may be considered reliable and valid instruments for detecting ADHD symptoms in Spanish populations.