ADHD symptoms,academic achievement,self‐perception of academic competence and future orientation: A longitudinal study

In the investigation of the effect of attention deficit hyperactivity disorder (ADHD) symptoms on school careers there is a need to study the role of adolescent and childhood ADHD symptoms and academic achievement, and to incorporate measures that include the individual's perspective. Our aim was to gain an overview of the long‐term development of school careers in relation to ADHD symptoms. We studied associations between ADHD symptoms and academic achievement at different time‐points and future orientation at the end of high school, and assessed the role of self‐perceptions of academic competence in these associations. Participants were 192 children (47% girls) with a range of ADHD symptoms taken from a community sample. Collecting data at three time points, in 6th, 11th and 12th grade we tested a structural equation model. Results showed that ADHD symptoms in 6th grade negatively affected academic achievement concurrently and longitudinally. ADHD symptoms in 11th grade negatively affected concurrent academic achievement and academic self‐perception and future orientation in 12th grade. Academic achievement had a positive influence on academic self‐perception and future orientation. Given the other factors, self‐perception of academic competence did not contribute to outcomes. We concluded that early ADHD symptoms may cast long shadows on young people's academic progress. This happens mainly by way of stability in symptoms and relations to early low academic achievement.     

注意缺陷多动障碍-发展性阅读障碍共患儿童的干预效果及其内在机理

注意缺陷多动障碍和发展性阅读障碍是两类常见的儿童神经发育障碍, 二者共患率高达25%~48%。共患问题不仅使儿童自身面临着严重的认知、行为和心理损害, 还给家庭、学校和社会带来了沉重的负担, 对共患儿童的干预是极为必要且重要的。以共患病理机制假说为基础, 可将既往共患儿童的干预研究划分为以下两大类：(1)基于表型假说的干预方案, 如药物干预、阅读干预以及二者联合干预, 相应方案干预效果的迁移性和稳定性均有待深入考究; (2)基于共同缺陷假说的干预方案, 如针对核心共同认知缺陷之一的加工速度问题的干预已初显成效, 但相关研究较少, 干预效果需更多研究进一步系统性地考察。最后就共患儿童的干预方案现状进行了反思和展望。     

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.     

Trajectories and Predictors of Response to the Challenging Horizons Program for Adolescents With ADHD

The Challenging Horizons After School Program is one of the only psychosocial interventions developed specifically for adolescents with attention-deficit/hyperactivity disorder (ADHD) that has demonstrated efficacy in multiple randomized controlled trials. To date, however, all research with the intervention has evaluated outcomes at the group level, and it is unclear whether all adolescents respond similarly, or if the intervention is particularly well suited for certain adolescents with ADHD. This type of information is needed to guide stakeholders in making informed choices as part of dissemination and implementation efforts. The purpose of this study was to evaluate trajectories of response to intervention for a large sample of middle-school age adolescents with ADHD (grades 6–8) who received the after-school intervention (N = 112). An additional goal of the study was to evaluate potential predictors of response trajectories, focusing on determining what factors best distinguished between intervention responders and nonresponders. Latent trajectory analyses consistently revealed four or five distinct classes. Depending on the outcome, between 16% and 46% of participants made large improvements, moving into the normal range of functioning, and between 26% and 65% of participants made small or negligible improvements. Multivariate predictor analyses revealed that a strong counselor/adolescent working alliance rated from the adolescent perspective and lower levels of parenting stress and parent-adolescent conflict consistently predicted an increased likelihood of intervention response. Implications of these findings for disseminating the after school intervention and for further intervention development are discussed.     

Supporting Japanese Mothers of Children with ADHD: Cultural Adaptation of the New Forest Parent Training Programme

International practice guidelines recommend medication and behavioral intervention as evidenced‐based treatments for attention deficit hyperactivity disorder (ADHD). Currently in Japan, the availability of non‐pharmacological interventions for ADHD is limited. We report the results of a pilot and a proof‐of‐concept study for a new behavioral intervention for Japanese mothers of children with ADHD. The pilot study delivered a standard six‐session behavioral intervention and two parent‐support sessions. Participants approved the group format and requested additional support to change parenting practices and behavioral strategies targeting ADHD symptoms. For the proof‐of‐concept study, the intervention was revised to include five sessions of pre‐intervention support followed by six sessions of the New Forest Parent Training Programme (NFPP), an evidence‐based intervention for ADHD. The revised intervention, NFPP‐Japan, was associated with reductions in the mothers’ reports of children's ADHD symptoms and aggression, more effective parenting practices, and reduced parenting stress. The pilot and proof‐of‐concept studies indicate that it is possible to successfully modify Western behavioral interventions for Japanese mothers and to justify a randomized controlled trial evaluation of the NFPP‐Japan, which is currently underway.     

A web-based intervention for elementary school teachers of students with attention-deficit/hyperactivity disorder (ADHD)

The goal of the present study was to determine whether a web-based medium is an effective tool for supporting knowledge, attitude, and behavior change in teachers of elementary school children with attention-deficit/hyperactivity disorder (ADHD). Nineteen teachers from Nova Scotia, Canada completed a 7-week intervention that consisted of presentations, web links, and discussion board activities related to different aspects of ADHD. Teachers' knowledge positively changed from pre- to post-intervention (p = .03), as did teachers' attitudes related to perceived control in their classrooms (p = .001) and competence in teaching (p < .0001). The study demonstrated that a web-based medium is a useful tool for knowledge creation and translation and has potential as a means of providing professional development to teachers about ADHD.     

Developmental Context and Treatment Principles for ADHD Among College Students

Attention-deficit/hyperactivity disorder (ADHD) affects between 2 and 8?% of college students. ADHD is associated with impaired academic, psychological, and social functioning, and with a wide array of negative outcomes including lower GPAs, graduation rates, and self-reported quality of life. The college environment often brings decreased external structure and increased availability of immediate rewards, presenting added demands for behavioral self-regulation—an area in which students with ADHD are already vulnerable. Despite the significant impact of ADHD in college and the unique challenges presented by the college context, virtually no treatment development research has been conducted with this population. In order to provide a framework to guide intervention development, this comprehensive review integrates research from three key domains that inform treatment for college students with ADHD: (1) functional impairment associated with ADHD among college students, (2) etiology of ADHD and the developmental context for ADHD among emerging adults (age 18–24), and (3) treatment outcome research for ADHD among adolescents and adults. A detailed set of proposed treatment targets and intervention principles are identified, and key challenges associated with treatment development in this population are discussed.     

Combining Parent and Teacher Training for Early ADHD: A Randomized Study of Effectiveness

Parent training (PT) has been documented as an effective intervention for early ADHD based on parental assessment, but documentation of transfer of its results outside the family context has been limited. Due to the cross-contextual impairments typically caused by ADHD, it has been proposed that PT in combination with an intervention in kindergarten or school based on systematic teacher training (TT) would be better suited. The objective of this study was to evaluate the effectiveness of a combination of PT and TT in a community sample of children with early ADHD problems. Families of 64 3-8-year old children were randomized to either PT alone with “The Incredible Years” PT or to a combined PT?+?TT intervention. Moderate to large pre-post effect sizes on mother-reported outcomes were revealed in both groups, in line with those generally reported in the literature on PT interventions for early ADHD. With an n of 64, the current study was powered to detect superiority of the PT?+?TT intervention if the difference was of a moderate effect size (Cohen’s d?=?0.5). There were no statistically significant differences between the two groups on any of the outcome measures as rated by parents or teachers. In conclusion, the study did not provide support for the combined PT?+?TT intervention for early ADHD problems as a superior intervention in comparison with PT alone.     

学校正念干预的应用与特点

“学校正念干预”(School-Based Mindfulness Intervention)是将正念理论及技术应用到教育领域而形成的非医疗健康干预新策略。一方面,学校正念干预能有效帮助学生改善身心行为问题,提高认知能力;另一方面,它能够增强教师压力管理能力和幸福感。总的来说,学校正念干预是以“大健康”为目标、以“非评判接纳”为视角、以校园为干预情境、以传统学校项目为基础的校园非医疗健康干预,是学校心理健康工作者、学校专业社工可采取的策略。未来研究应注重其成效评估和测量、理论机制及应用问题的研究。     

Bending the Curve: A Community-Based Behavioral Parent Training Model to Address ADHD-Related Concerns in the Voluntary Sector in Denmark

Limited access to evidence-based behavioral parent training (BPT) for addressing attention deficit/hyperactivity disorder (ADHD) has been a growing concern internationally. Models to improve access to BPT are needed, particularly those that can be readily implemented in community settings and that leverage the potential workforce to increase capacity to deliver BPT. The purpose of this study was to evaluate a BPT model which included oft-used content, methods, processes of BPT (common-elements), non-professionally delivered (task-shifted/shared) BPT intervention, and an efficient ancillary support system (training, fidelity, and supervision methods) for families of youth with parental concerns about ADHD. In a randomized controlled trial of 161 families of children (79% male; mean age 7.04 [1.55]), the Caring in Chaos (CiC) BPT model, delivered by community volunteers across 12 community-based sites in Denmark, was compared to a wait-list control condition on key child and parent outcomes at immediate post-treatment and 4-month follow-up assessment points. Results suggested that the CiC model led to significantly greater improvement in parenting behavior, parenting sense of competence, child functional impairment, parental stress and parental depressive symptoms compared to the wait list condition at immediate post-treatment, with maintenance of gains in most of these areas at follow-up assessment. No effect of intervention was found on ADHD symptoms. The results of this study suggest that developing efficient BPT intervention models, such as the CiC model, can result in readily implemented interventions by a variety of individuals in community settings. Such models are necessary to bend the curve on addressing unmet needs of families of youth with concerns about ADHD.     

Intervention response among preschoolers with ADHD: The role of emotion understanding

Emotion recognition/understanding (ERU), which is the ability to correctly identify emotional states in others as well as one's self, plays a key role in children's social-emotional development and is often targeted in early intervention programs. Yet the extent to which young children's ERU predicts their intervention response remains unclear. The current study examined the extent to which initial levels of ERU and changes in ERU predicted intervention response to a multimodal early intervention program (Summer Treatment Program for Pre-Kindergarteners; STP-PreK). Participants included 230 young children (M_age = 4.90, 80.0% male) with attention-deficit/hyperactivity disorder (ADHD) who participated in the 8-week STP-PreK. Children's ERU was measured via a standardized behavioral task. Similarly, standardized measures of academic achievement (Woodcock-Johnson-IV), executive functioning (Head-Toes-Knees-Shoulders-Task), and social-emotional functioning (Challenging Situation Task) were obtained pre- and post-intervention. Parents and teachers also reported on children's behavioral functioning pre- and post-intervention. Children with better initial ERU made greater improvements in academic, executive functioning (EF), and social-emotional domains, along with decreases in inattention symptom severity. However, pre-intervention levels of ERU were not associated with improvements in parent/teacher report of hyperactivity, oppositional defiant disorder, and overall behavioral impairment. Lastly, changes in ERU only predicted improvement in EF, but not any other school readiness outcomes. We provide preliminary evidence that initial levels of ERU predict intervention response across school readiness domains in a sample of preschoolers with ADHD.     

注意缺陷多动障碍儿童教育康复线上模式的构建

注意缺陷多动障碍(简称ADHD)是一种常见的儿童神经发育性障碍。当前用于儿童ADHD的传统(线下)教育康复模式存在缺少学业实效、教师低参与、学校管理经验不足以及遇到特殊情况(如疫情)无法服务等问题。本研究在脑电生物反馈认知训练的基础上, 以解决问题和循证研究为设计思路, 为中国ADHD患儿构建教育康复线上模式并进行初步应用。本研究分为3个子研究：研究1采用访谈法和问卷调查法对中国儿童ADHD教育康复的现状调查并分析患儿及关键相关人(家长和教师)需求; 研究2采用随机对照单盲试验(干预组和对照组各为50人), 评价基于脑电生物反馈认知训练(NCT)的教育康复线上模式的有效性; 研究3采用一个更大被试样本量(每组n = 100)的(家长为中介人干预组/教师为中介人干预组/对照组)×(诊断组/亚诊断组)随机对照研究评价由干预中介人(家长或教师)参与的线上模式的有效性, 以及一个纵向质性研究发现关键相关人对于线上模式的接受情况。研究旨在为中国ADHD患儿提供一个有效且好用的教育康复形式。     

Developmental relations between ADHD symptoms and bullying perpetration and victimization in adolescence

It has previously been hypothesized that individuals with elevated attention deficit hyperactivity disorder (ADHD) symptoms are at greater risk of bullying perpetration and victimization. Using autoregressive latent trajectory models with structured residuals (ALT‐SR) and four waves (ages 11, 13, 15, and 17) of longitudinal data from the normative z‐proso study (n = 1526, 52% male), we evaluated the developmental relations between ADHD and bullying using both self‐ and teacher‐reported ADHD symptom data. Analyses suggested that ADHD symptoms primarily increase the risk of bullying perpetration, with a within‐person effect of ADHD symptoms on bullying perpetration symptoms identified across ages 13–15 (β = .13) and ages 15–17 (β = .19) based on self‐reported ADHD symptoms and a similar effect identified across ages 11–13 (β = .24) and 13–15 (β = .29) based on teacher‐reported inattention symptoms. There were also some indications of reciprocal effects and effects involving victimization that merit further exploration in future research. Results imply that the content of bullying intervention and prevention programs should take account of ADHD symptoms to ensure that those with elevated symptoms can benefit as much as their typically developing peers. This will involve addressing bullying perpetration that may reflect impulsive/reactive aggression and impaired social skills rather than instrumental aggression. Further, programs should go beyond classical curriculum/classroom‐based delivery to ensure that individuals with elevated ADHD symptoms can be successfully engaged.     

Preschoolers at risk for attention-deficit hyperactivity disorder and oppositional defiant disorder: family,parenting, and behavioral correlates

This community study assigned 129 4-year-olds to groups at risk for attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), both ADHD and ODD, or no problems. Mothers of children at risk for ODD reported more family dysfunction, felt less competent as parents, suggested fewer solutions to child behavior problems, demonstrated a less assertive approach to child management, and reported more child internalizing problems than did mothers of children not elevated on ODD symptoms. Mothers of children at risk for ADHD reported higher personal depression scores than did those of the non-ADHD subgroup. Children at risk for ADHD evidenced the most difficulties in school where teachers reported more social behavior, classroom management, and internalizing problems relative to other children not at risk for ADHD. When solving child management problems, mothers of children in all groups suggested twice as many controlling/negative management strategies as positive/preventive strategies. In addition, faced with oppositional and conduct problems, mothers of children in all groups increased controlling/negative suggestions and decreased positive/preventive suggestions. Mothers of girls at risk for ADHD, ODD, and ADHD/ODD gave more rewards per positive behavior than did mothers of boys.     

Attention deficit hyperactivity disorder (ADHD): An affect‐processing and thought disorder?

In the literature on child and adolescent psychoanalysis attention deficit hyperactivity disorder (ADHD) is described as complex syndrome with wide‐ranging psychodynamic features. Broadly speaking, the disorder is divided into three categories: 1. a disorder in early object relations leading to the development of a maniform defence organization in which object‐loss anxieties and depressed affects are not worked through via symbolization but are organized in a body‐near manner; 2. a triangulation disorder in which the cathexis of the paternal position is not stable; structures providing little support alternate with excessive arousal, affect regulation is restricted; 3. current emotional stress or a traumatic experience. I suggest taking a fresh look at ADHD from a psychoanalytic vantage point. With respect to the phenomenology of the disorder, the conflict–dynamic approach should be supplemented by a perspective regarding deficits in α‐function as constitutive for ADHD. These deficits cause affect‐processing and thought disorders compensated for (though not fully) by the symptomatology. At a secondary level, a vicious circle develops through the mutual reinforcement of defective processing of sense data and affects into potential thought content, on the one hand, and secondary, largely narcissistic defence processes on the other. These considerations have major relevance for the improved understanding of ADHD and for psychoanalytic technique.     

A Review of Factors that Promote Resilience in Youth with ADHD and ADHD Symptoms

The vast majority of research on youth with ADHD has focused on risk factors and describing the types of impairment individuals with ADHD experience. However, functional outcomes associated with ADHD are heterogeneous, and although many youth with ADHD experience significant negative outcomes (e.g., school dropout), some are successful in multiple domains of functioning (e.g., pursue and graduate college). There is a growing body of literature supporting the existence of factors that protect youth with ADHD from experiencing negative outcomes, but there is no published synthesis of this literature. Accordingly, the goals of this review are to conceptualize risk–resilience in the context of ADHD using a developmental psychopathology framework and to systematically review and critique evidence for promotive and protective factors in the context of ADHD. The literature search focused specifically on resilience in the context of ADHD symptoms or an ADHD diagnosis and identified 21 studies, including clinic, school, and community samples. Findings of promotive and/or protective factors are summarized across individual, family, and social–community systems. Overall, we know very little of the buffering processes for these youth, given that the study of promotive and protective factors in ADHD is in its infancy. The strongest evidence to date was found for social- and family-level systems. Specifically, multiple longitudinal studies support social acceptance as a protective factor, buffering against negative outcomes such as poor academic performance and comorbid depressive symptoms for youth with ADHD. There was also compelling evidence supporting positive parenting as a promotive factor. In terms of individual-level factors, positive or modest self-perceptions of competence were identified as a promotive factor in multiple studies. Future directions for research that will catalyze the study of resilience with ADHD are provided, and the potential for targeting protective mechanisms with intervention and prevention is discussed.     

ADHD Correlates, Comorbidity, and Impairment in Community and Treated Samples of Children and Adolescents

Patterns of correlates, comorbidity and impairment associated with attention-deficit hyperactivity disorder (ADHD) in children and youth were examined in representative samples from the community and from treatment facilities serving medically indigent youth in Puerto Rico. Information from caretakers and youths was obtained using the Diagnostic Interview Schedule for Children, (version IV), measures of global impairment, and a battery of potential correlates. In the community (N = 1,896) and the treated samples (N = 763), 7.5 and 26.2% of the children, respectively, met criteria for DSM-IV ADHD in the previous year. Although the prevalence rates and degree of impairment differed, the general patterns of correlates, comorbidity and impairment were similar in both populations. The exceptions were associated with conduct disorder, anxiety, impairment in the ADHD comorbid group, and age factors that appeared to be related to selection into treatment.     

A Multivariate Predictive Study of Staff OTR Job Satisfaction

Abstract

This paper is a discussion of the experience of adult attention deficit hyperactivity disorder (ADHD). While much is known about the diagnosis and treatment of childhood ADHD, therapists may be less familiar with the clinical signs of adult ADHD and fail to detect and address such deficits in patients. Adult ADHD often affects all occupational domains-work/school, family life, social relationships, and self-organization-often without the person's awareness of the condition. When people with ADHD do not receive a formal diagnosis until adulthood, deficits in the above occupational domains may be severe. The first half of this paper describes (a) clinical presentation; (b) classification; prevalence, adult course, and comorbid conditions; (c) biologic factors; and (d) pharmacologic treatment. The latter half discusses occupational therapy intervention and describes a case study involving a college student.