Adults With Attention‐Deficit/Hyperactivity Disorder: Assessment and Treatment Strategies

Attention‐deficit/hyperactivity disorder (ADHD) among adults is characterized by inattentiveness and impulsivity. This article provides counselors with information about the etiology, assessment, and treatment of adult ADHD. The identification of the genetic and neurological features of ADHD has led to improvements in evaluation and treatment. Assessment of ADHD requires knowledge of the defining characteristics, subtypes, comorbid features, and functional aspects of ADHD. Effective treatments include both medical management and counseling to address psychosocial deficits.     

Diagnosis and Treatment of Children and Adolescents With Attention‐Deficit/Hyperactivity Disorder

Attention‐deficit/hyperactive disorder (ADHD) has been estimated to affect between 3% and 5% of school‐age children. The disorder frequently has a profound effect on a child's personal, social and academic development and is a risk factor in the development of other comorbid disorders. Diagnostic criteria and methods for identification of ADHD will be presented. Major intervention strategies appropriate for school and community settings are outlined. Because ADHD is 1 of the most common reasons for referral in both school and community agencies, it is important that clinicians be prepared to provide accurate diagnosis and intervention recommendations.     

Group Narrative Therapy for Women With Attention‐Deficit/Hyperactivity Disorder

Women with attention‐deficit/hyperactivity disorder (ADHD) often struggle with the developmental challenges of adulthood and ADHD‐related problems. The authors provide specific clinical interventions from a narrative‐based group approach to help women with ADHD understand their symptoms, create strength‐based narratives, and apply these narratives to the developmental tasks of early adulthood.     

Processing Speed in Children With Attention Deficit/Hyperactivity Disorder,Inattentive Type

Attention Deficit/Hyperactivity Disorder (ADHD) is among the most common and most often reconceptualized neurobehavioral disorders of childhood. In the most recent DSM-IV, a primarily inattentive subtype of ADHD (AD) has again been identified. This study explores the neuropsychological profile of this group of children. Eighty-two children referred for school-related problems participated. Twenty-five met criteria for AD; 52 met criteria for reading disability (RD); 9 were comorbid for RD and AD. AD children performed poorly on measures of information processing speed. Children with comorbid AD/RD were distinguishable from those with RD on speed of processing measures only. Vulnerability to information processing load may be at the root of many of the behavioral manifestations of AD.     

Strategies for Counselors Working With High School Students With Attention‐Deficit/Hyperactivity Disorder

Researchers agree early intervention is crucial to prevent academic underachievement and negative effects on the lives of children, adolescents, and adults affected by attention‐deficit/hyperactivity disorder (ADHD). If counselors, particularly high school counselors, address the needs of students with ADHD, these students may attain their potential and enter into the workplace or postsecondary education. The authors provide counselors with strategies to identify interpersonal, academic, vocational, and life issues that may affect students with ADHD and to help teachers and parents prepare students with ADHD for the transition from high school to postsecondary education or the work environment.     

Accumulated reinforcers increase academic responding and suppress problem behavior for students with Attention‐Deficit Hyperactivity Disorder

We compared rates of academic responses and problem behavior during mathematics with distributed and accumulated reinforcer arrangements for 3 students with Attention‐Deficit Hyperactivity Disorder who engaged in chronic, severe problem behavior. All 3 students engaged in more academic responding and less problem behavior when reinforcers accumulated throughout the session, relative to conditions in which reinforcers were distributed throughout the session or withheld completely. We then conducted concurrent‐chain analyses to evaluate student preference for the reinforcer arrangements. Two students preferred distributed reinforcers, even though this arrangement continued to produce problem behavior. One student preferred accumulated reinforcers. Our data replicate previous findings regarding the efficacy of accumulated‐reinforcer arrangements, but suggest that students do not always prefer the most efficacious reinforcer arrangement.     

Individual Differences in Training Gains and Transfer Measures: An Investigation of Training Curves in Children with Attention‐Deficit/Hyperactivity Disorder

Currently, evidence for the beneficial effects of working memory (WM) training on transfer measures in children with attention‐deficit/hyperactivity disorder (ADHD) is inconsistent. Although there is accumulating evidence for the role of individual differences in training and transfer gains of cognitive training, this area has been left unexplored for children with ADHD. In the current study, an advanced latent growth curve model analysis was used to investigate the individual differences in learning curves (training gains) of WM training tasks within a new cognitive intervention ‘Paying Attention in Class’. It was investigated whether certain baseline variables (age, intelligence quotient, externalizing behaviour problems and presence of learning disability) predicted the learning curves and how these individual learning curves influenced near‐transfer and far‐transfer measures. A total of 164 children diagnosed with ADHD, between the age of 8 and 12 years old, followed this new Paying Attention in Class intervention. WM (near‐transfer) and academic performance (far‐transfer) measures were assessed before treatment and directly after treatment. Results showed that individual differences at the start of training were predicted by age and intelligence quotient, but the individual differences in learning curves were not predicted by any of the baseline variables. Both for the verbal and the visuospatial WM training, children with larger training gains (i.e. steeper training curves) showed larger benefits on the near untrained transfer measures. These effects were absent for the far‐transfer measures. Current study shows that training WM is quite complex and has its limitations for children with ADHD. Nonetheless, it highlights that training and transfer gains are affected by many different factors and warrants the need of a more in‐depth investigation of individual differences in future studies.Copyright © 2017 John Wiley & Sons, Ltd.     

Processing Speed Predicts Behavioral Treatment Outcomes in Children with Attention-Deficit/Hyperactivity Disorder Predominantly Inattentive Type

Neuropsychological functioning underlies behavioral symptoms of attention-deficit/hyperactivity disorder (ADHD). Children with all forms of ADHD are vulnerable to working memory deficits and children presenting with the inattentive form of ADHD (ADHD-I) appear particularly vulnerable to processing speed deficits. As ADHD-I is the most common form of ADHD presented by children in community settings, it is important to consider how treatment interventions for children with ADHD-I may be affected by deficits in processing speed and working memory. We utilize data collected from 199 children with ADHD-I, aged 7 to 11 years, who participated in a randomized clinical trial of a psychosocial-behavioral intervention. Our aims are first to determine whether processing speed or working memory predict treatment outcomes in ADHD-I symptom severity, and second whether they moderate treatment effects on ADHD-I symptom severity. Results of linear regression analyses reveal that baseline processing speed significantly predicts posttreatment ADHD-I symptom severity when controlling for baseline ADHD-I symptom severity, such that better processing speed is associated with greater symptom improvement. However, predictive effects of working memory and moderation effects of both working memory and processing speed are not supported in the present study. We discuss study limitations and implications of the relation between processing speed and treatment benefits from psychosocial treatments for children with ADHD-I.     

Diagnosis and Treatment of Adults With Attention Deficit Hyperactivity Disorder

It is estimated that between 30% and 50% of children diagnosed with attention deficit hyperactivity disorder (ADHD) will continue to exhibit symptomatology that is disruptive throughout their adult lives. Identification and diagnosis of adult ADHD, as well as primary and secondary characteristics and comorbid disorders, are discussed in this article. Counseling strategies are suggested to help clinicians treat adults with ADHD, such as educating the client about the disorder and providing training in attention management techniques, self-management skills, interpersonal and social skills, stress and time management, anger management, and problem-solving skills. Clinicians are encouraged to prepare themselves for understanding, identifying, diagnosing, and treating the adult population with ADHD.     

注意缺陷多动障碍的研究与治疗

注意缺陷多动障碍（ADHD）的发病群体多为5岁以后的儿童,主要临床表现是多动、冲动,注意力无法集中,对一项任务不能够有规划进行下去,而且脾气暴躁、易怒。近年来,心理学界、神经科学界和教育学界等对ADHD的研究取得了很多进展。本文概括性地介绍了ADHD病症的基本特征,目前对于患者脑机制损害的研究,并从药理学和行为学等方面讨论了ADHD的治疗方法和手段。     

The Association of Neurofibromatosis Type 1 and Attention Deficit Hyperactivity Disorder

Some research and clinical observations have linked Neurofibromatosis Type 1 (NF-1) and Attention Deficit Hyperactivity Disorder (ADHD). In order to investigate whether ADHD is part of the phenotype of NF-1 or is a separate, unrelated disorder within families, we compared the ADHD status of children affected with NF-1 to that of their unaffected-NF-1 siblings and to that of their biological parents. Results of matched-pair analyses were calculated and revealed a significant with-in pair discordance, when comparing children with NF-1 and their siblings and when comparing children with NF-1 and their biological parents (in families with a sporadic, non-familial NF-1 child). These findings suggest that ADHD may occur as a component of the NF-1 phenotype.     

Response Style Differences in the Inattentive and Combined Subtypes of Attention-Deficit/Hyperactivity Disorder

This study examined potential differences between the inattentive and combined ADHD subtypes using laboratory tasks assessing behavioral inhibitory processes. Seventy-five children completed two tasks of behavioral inhibition believed to isolate different processes: the cued reaction time task (CRT), a basic inhibition task, and the go/no-go task (GNG), a complex inhibition task that incorporates motivational contingencies. Three groups of participants were identified, including ADHD/Inattentive (n = 17), ADHD/Combined (n = 37), and comparison (n = 21). Results indicated that rather than showing behavioral inhibition deficits, the ADHD/I children appeared overly inhibited, as evidenced by slower reaction times across the two tasks and significantly higher errors of omission in the GNG task. Additionally, the ADHD/I children did not demonstrate cue dependency effects on the CRT task, suggesting that they were failing to incorporate relevant information before making a response. The sluggish and inhibited performance of the ADHD/I group challenges the idea that it is a subtype of ADHD.     

国内注意缺陷/多动障碍儿童干预效果的元分析

对国内过去12年间的62项注意缺陷/多动障碍干预研究结果进行了元分析,结果显示：（1）国内现有的ADHD干预措施取得了显著的干预效果;（2）在不同干预措施中,药物治疗与行为疗法或认知行为疗法相结合具有最佳疗效,单独的药物治疗次之,单独的行为疗法或认知行为疗法效果较低;（3）在各种效果指标中,学业指标上的效果量是最大的,这一结果与国外已有的元分析研究发现不一致;（4）在各种效果信息来源中,来自客观观察的效果量最高,来自父母评价的效果量次之,来自教师评定的效果量最差。（5）各种干预措施在不同效果指标上有不同的表现。药物治疗对于学业和行为指标的效果最强烈,而认知行为疗法和脑电反馈疗法对认知指标的效果最明显。最后,结合干预措施的选择、效果指标的采用以及研究质量问题进行了讨论     

Attention Deficit Hyperactivity Disorder in Adults: Implications for Theories of Diagnosis

The diagnosis of attention deficit hyperactivity disorder (ADHD) in adults has been a source of controversy, with some prominent researchers questioning its very existence and others suggesting it is an urgent clinical problem. This article reviews five domains of data addressing the validity of adult ADHD: clinical correlates, family history, treatment response, laboratory studies, and long-term outcome. It then shows how the debate over adult ADHD reflects a clash of theoretical paradigms and concludes by suggesting ways in which psychological science can collect the data needed to clarify the validity of adult ADHD.     

Dimensions and Correlates of Attention Deficit/Hyperactivity Disorder and Sluggish Cognitive Tempo

The present study examined Sluggish Cognitive Tempo (SCT) in relation to ADHD symptoms, clinical diagnosis, and multiple aspects of adjustment in a clinical sample. Parent and teacher reports were gathered for 322 children and adolescents evaluated for behavioral, emotional, and/or learning problems at a university clinic. Confirmatory factor analyses (CFA) supported the presence of three separate, but correlated factors (SCT, inattention, and hyperactivity/impulsivity) in both parent and teacher ratings. As expected, SCT symptoms were greatest in youth with ADHD Inattentive type, but were also found in non-ADHD clinical groups. SCT symptoms were related to inattention, internalizing, and social problems across both parent and teacher informants; for parent reports, SCT was also related to more externalizing problems. Findings support the statistical validity of the SCT construct, but its clinical utility is still unclear.     

Treatment Efficacy of Multiple Family Therapy for Chinese Families of Children with Attention Deficit Hyperactivity Disorder

The treatment efficacy of multiple family therapy (MFT) for Chinese families of children with attention deficit hyperactivity disorder (ADHD) has not been studied in the past. In this paper, the effect of MFT on different aspects of the lives of the parents in the experimental group (n = 61) was compared with the effect of only the psychoeducational talks on parents in the control group (n = 53). The results of a MANOVA have shown that by the time they reached the posttreatment phase, the parents who had completed the full 42 hours of the MFT program perceived their children's ADHD symptoms as being less serious and less pathological than they had originally thought compared to the parents in the control group. The effect of MFT on parent–child relationships, parenting stress, parental efficacy, hope, and perceived social support was statistically insignificant. Contributions and limitations of our study are discussed.     

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.     

Exemplary Counseling Strategies for Developmental Transitions of Young Women With Attention Deficit/Hyperactivity Disorder

This article is intended to provide rehabilitation, career, and mental health counselors with an understanding of how attentional impairments are manifested in young women and how professional counselors may help them most effectively. Treatment guidelines and recommendations are presented for working with these young women through the developmental transition years of adolescence and young adulthood.     

Family Correlates of Oppositional and Conduct Disorders in Children With Attention Deficit/Hyperactivity Disorder

Comorbidities among children with ADHD are key determinants of treatment response, course, and outcome. This study sought to separate family factors (parental psychopathology and parenting practices) associated with comorbid Oppositional Defiant Disorder (ODD) from those associated with Conduct Disorder (CD) among children with Attention Deficit/Hyperactivity Disorder. Clinic-referred families (n = 149) were diagnosed using DSM-IV criteria. Parents completed measures of parenting practices. Comorbid ODD and CD were significantly associated with maternal negative/ineffective discipline. Comorbid CD, but not ODD, was significantly associated with lack of maternal warmth and involvement, paternal negative/ineffective discipline, and with paternal Antisocial Personality Disorder (APD). However, the risk of CD posed by parenting appeared concentrated among children without a father having APD. While consistent discipline appears important for addressing comorbid ODD and CD, paternal psychopathology and the quality of the relationship between mother and child may pose risk specifically for comorbid CD. Efforts to prevent and/or treat CD should consider not only provision of structure and prudent discipline, but also the affective qualities of the relationship between the primary caretaker and child.