The Effects of Instructions on Mothers’ Ratings of Child Attention-Deficit/Hyperactivity Disorder Symptoms

We examined whether instructional materials describing how to rate child ADHD symptoms would improve the accuracy of mothers’ ratings of ADHD symptoms presented in standard child behavior stimuli, and whether instructions would be equally effective across a range of maternal depressive symptoms and family incomes. A community sample of 100 mothers with 5 to 12 year old sons were randomly assigned to either receive or not receive the instructions. All mothers watched standard video recordings of boys displaying nonproblem behavior, ADHD symptoms, ADHD plus oppositional behaviors, or ADHD plus anxious behaviors, and then rated the ADHD symptoms of the boys in the videos. These ratings were compared to ratings of the boys’ ADHD symptoms made by objective coders. Results indicated an interaction such that the instructional materials improved the agreement between mothers’ and coders’ ratings, but only for mothers at lower family income levels. The instructional materials improved all mothers’ open-ended responses regarding knowledge of ADHD. All mothers rated more ADHD symptoms in boys with comorbid oppositional or anxious behaviors, and this effect was not reduced by the instructional materials. The potential utility of these instructions to improve the accuracy of ratings of child ADHD symptoms is explored.     

Impact of Sluggish Cognitive Tempo and Attention-Deficit/Hyperactivity Disorder Symptoms on Adults’ Quality of Life

The symptoms of Attention-Deficit/Hyperactivity Disorder (ADHD) have been linked to dysfunction in numerous life domains for both children and adults. As such, it is likely that individuals with these and other related symptoms (e.g., sluggish cognitive tempo, SCT) may also experience impaired quality of life. The current study examines the association between ADHD and SCT symptoms and quality of life (QOL) in a community sample of adults. Quality of life data collected from 983 participants (M age = 45.6 years) were analyzed primarily through a series of hierarchical multiple regressions employing SCT and ADHD symptom clusters, demographic, and anxiety and depression scale variables as predictors. Results generally supported the hypothesis that ADHD and SCT symptoms would negatively associate with QOL. Amongst the indicators, inattention and SCT emerged as the strongest predictors of low QOL. These findings underscore the negative impact of ADHD symptoms in adulthood, the independent contribution of SCT, and the importance of considering QOL in prospective research and intervention.     

The Relation Between Maternal Symptoms of Attention-Deficit/Hyperactivity Disorder and Mother–Infant Interaction

The relationship between maternal symptoms of attention-deficit/hyperactivity disorder (ADHD) and specific maternal behaviors was examined in a community sample of 40 mothers of infants aged 3–8 months. It was hypothesized that maternal ADHD symptoms would be related to lower levels of maternal sensitivity, and higher levels of maternal intrusiveness and negative regard. Mothers and their infants were observed and video-recorded in their homes while interacting in a feeding, play, and task situation. A series of hierarchical regressions partially supported the hypothesized relations: Of the specific maternal ADHD symptoms, maternal inattentive symptoms significantly predicted maternal insensitivity, intrusiveness, and negative regard above and beyond maternal symptoms of anxiety and maternal ratings of infant activity. These findings suggest that mothers reporting ADHD symptoms, particularly the inattentive cluster of symptoms, may experience difficulties in interactions with their infants. Early interventions that address these difficulties may be warranted to facilitate development and reduce the likelihood of adverse outcomes in children of mothers with symptoms of ADHD.     

The Effects of Incentives on Visual–Spatial Working Memory in Children with Attention-deficit/Hyperactivity Disorder

Working memory is one of several putative core neurocognitive processes in attention-deficit/hyperactivity disorder (ADHD). The present work seeks to determine whether visual–spatial working memory is sensitive to motivational incentives, a laboratory analogue of behavioral treatment. Participants were 21 children (ages 7–10) with a diagnosis of ADHD-combined type. Participants completed a computerized spatial span task designed to assess storage of visual–spatial information (forward span) and manipulation of the stored information (backward span). The spatial span task was completed twice on the same day, once with a performance-based incentive (trial-wise feedback and points redeemable for prizes) and once without incentives. Participants performed significantly better on the backward span when rewarded for correct responses, compared to the no incentive condition. However, incentives had no effect on performance during the forward span. These findings may suggest the use of motivational incentives improved manipulation, but not storage, of visual–spatial information among children with ADHD. Possible explanations for the differential incentive effects are discussed, including the possibility that incentives prevented a vigilance decrement as task difficulty and time on task increased.     

The Children’s Attention-Deficit Hyperactivity Disorder Telemental Health Treatment Study: Caregiver Outcomes

The Children’s Attention-deficit Hyperactivity Disorder (ADHD) Telemental Health Treatment Study (CATTS) tested the hypotheses that children and caregivers who received guideline-based treatment delivered through a hybrid telehealth service delivery model would experience greater improvements in outcomes than children and caregivers receiving treatment via a comparison delivery model. Here, we present caregiver outcomes. 88 primary care providers (PCPs) in seven geographically underserved communities referred 223 children (ages 5.5 ? 12.9 years) to the randomized controlled trial. Over 22 weeks, children randomized to the CATTS service delivery model received six sessions of telepsychiatry and six sessions of caregiver behavior management training provided in person by community therapists who were trained and supervised remotely. Children randomized to the comparison Augmented Primary Care (APC) service model received management in primary care augmented by a single telepsychiatry consultation. Caregiver outcomes included changes in distress, as measured by the Patient Health Questionnaire (PHQ-9), Parenting Stress Index (PSI), Caregiver Strain Questionnaire (CSQ) and Family Empowerment Scale (FES). Caregivers completed five assessments. Multilevel mixed effects regression modeling tested for differences between the two service delivery models in caregiver outcomes from baseline to 25 weeks. Compared to caregivers of children in the APC model, caregivers of children in the CATTS service model showed statistically significantly greater improvements on the PHQ-9 (β?=?-1.41, 95 % CI?=?[?2.74, ?0.08], p?<?.05), PSI (β?=??4.59, 95 % CI?=?[?7.87, ? 1.31], p?<?.001), CSQ (β?=??5.41, 95 % CI?=?[? 8.58, ?2.24], p?<?.001) and FES (β?=?6.69, 95 % CI?=?[2.32, 11.06], p?<?.01). Improvement in child ADHD symptoms mediated improved caregiver scores on the PSI and CSQ. Improvement in child ODD behaviors mediated caregiver CSQ scores. The CATTS trial supports the effectiveness of a hybrid telehealth service delivery model for reducing distress in caregivers of children with ADHD and suggests a mechanism through which the service model affected caregiver distress.     

Can Motivation Normalize Working Memory and Task Persistence in Children with Attention-Deficit/Hyperactivity Disorder? The Effects of Money and Computer-Gaming

Visual-spatial Working Memory (WM) is the most impaired executive function in children with Attention-Deficit/Hyperactivity Disorder (ADHD). Some suggest that deficits in executive functioning are caused by motivational deficits. However, there are no studies that investigate the effects of motivation on the visual-spatial WM of children with- and without ADHD. Studies examining this in executive functions other than WM, show inconsistent results. These inconsistencies may be related to differences in the reinforcement used. The effects of different reinforcers on WM performance were investigated in 30 children with ADHD and 31 non-ADHD controls. A visual-spatial WM task was administered in four reinforcement conditions: Feedback-only, 1 euro, 10 euros, and a computer-game version of the task. In the Feedback-only condition, children with ADHD performed worse on the WM measure than controls. Although incentives significantly improved the WM performance of children with ADHD, even the strongest incentives (10 euros and Gaming) were unable to normalize their performance. Feedback-only provided sufficient reinforcement for controls to reach optimal performance, while children with ADHD required extra reinforcement. Only children with ADHD showed a decrease in performance over time. Importantly, the strongest incentives (10 euros and Gaming) normalized persistence of performance in these children, whereas 1 euro had no such effect. Both executive and motivational deficits give rise to visual-spatial WM deficits in ADHD. Problems with task-persistence in ADHD result from motivational deficits. In ADHD-reinforcement studies and clinical practice (e.g., assessment), reinforcement intensity can be a confounding factor and should be taken into account. Gaming can be a cost-effective way to maximize performance in ADHD.     

Test-Retest Measurement Invariance of Clinic Referred Children’s ADHD Symptoms

This study examined the test-retest measurement invariance of ratings of the ADHD symptoms. Mothers of a group of 217 clinic-referred children (boys?=?169, girls?=?49; age range?=?7 to 17 years) completed ratings of the ADHD symptoms presented in a modified version of the Strengths and Weaknesses of ADHD-Symptoms and Normal Behavior Scale (SWAN-M) twice, 12 months apart. Confirmatory factor analysis (CFA) of their ratings at both time points provided more support for the bifactor model of ADHD [orthogonal general and specific factors for inattention (IA) and hyperactivity/impulsivity (HI) symptoms] over the 2-factor oblique model (factors for inattention IA and HI symptoms). For the bifactor model, measurement invariance testing using multiple-group CFA indicated support for configural and full scalar test-retest invariance when the chi-square difference test was applied. For metric invariance, all but one symptom showed invariance. When the differences in approximate fit indices were applied, there was support for full measurement invariance (configural, metric and scalar). The findings indicate that observed scores (based on maternal ratings of the SWAM-M), twelve months apart, are comparable as they have the same measurement properties. Several practical, theoretical, research and clinical implications of the findings are discussed.     

Predictors of Parent-Reported Attention-Deficit/Hyperactivity Disorder in Children Aged 6–7 years: A National Longitudinal Study

This study examined the prenatal, postnatal and demographic predictors of parent-reported attention-deficit/hyperactivity disorder (ADHD) in an Australian population-based sample. Participants were families participating in the Longitudinal Study of Australian Children. There were approximately even numbers of males (51%) and females (49%) in the sample. Predictors of parent-reported ADHD status at Wave 2 (children aged 6–7 years) which were measured at Wave 1 (children aged 4–5 years) included cigarette smoking and alcohol use during pregnancy (prenatal factors); maternal postnatal depression, intensive care at birth, birth weight, and gestation (postnatal factors); and child gender, primary caregiver education, income, family composition, and maternal age at childbirth (socio-demographic factors). We found that male gender, cigarette smoking during pregnancy, and maternal postnatal depression were the only significant predictors (at the 5% level) of ADHD in the adjusted analysis (N = 3,474). Our results are consistent with previous findings that male gender and cigarette smoking during pregnancy are risk factors for ADHD. In addition, we found that postnatal depression was predictive of parent-reported ADHD.     

Treating Parents with Attention-Deficit/Hyperactivity Disorder: The Effects of Behavioral Parent Training and Acute Stimulant Medication Treatment on Parent–Child Interactions

This multiple baseline study evaluated the efficacy of behavioral parent training (BPT) for 12 parents (M age?=?39.17 years; 91 % mothers) and their children (ages 6–12; 83 % boys) both with Attention-Deficit/Hyperactivity Disorder (ADHD), and also explored the acute effect of stimulant medication for parents before and after BPT. Parents rated their own and their children’s symptoms and impairment and were stabilized on optimally dosed medication. Then, parents discontinued medication and were randomly assigned to a 3, 4, or 5 week baseline (BL), during which they provided twice-weekly ratings of their impairment, parenting, and their child’s behavior. Following BL, parents and their children completed two laboratory tasks, once on their optimally dosed medication and once on a placebo to assess observable effects of medication on parent–child behavior, and they completed additional assessments of family functioning. Parents then completed eight BPT sessions, during which they were unmedicated. Twice-weekly ratings of parent and child behavior were collected during BPT and additional ratings were collected upon completing BPT. Two more parent–child tasks with and without parent medication were conducted upon BPT completion to assess the observable effects of BPT and BPT plus medication. Ten (83.33 %) parents completed the trial. Improvements in parent and child behavior were observed, and parents reported improved child behavior with BPT. Few benefits of BPT emerged through parent reports of parent functioning, with the exception of inconsistent discipline, and no medication or interaction effects emerged. These results, although preliminary, suggest that some parents with ADHD benefit from BPT. While pharmacological treatment is the most common intervention for adults with ADHD, further examination of psychosocial treatments for adults is needed.     

African-American Teenagers’ Stories of Attention Deficit/Hyperactivity Disorder

Cultural differences in illness perceptions and treatment access of teens with attention deficit/hyperactivity disorder (ADHD) are evident yet under studied. The purpose of this qualitative paper is to explore how African-American teenagers describe and narrate stories about their lives with ADHD. Data were gathered from four African-American teens in the Southern United States through a qualitative experience sampling method, and stories were analyzed using narrative analysis framed within the context of African-American rhetorical traditions. We argue that the study of teen-constructed narratives and culturally-situated talk are tools that can improve communication between healthcare providers and teens by illuminating the ways teens construct their personalized realities of ADHD.     

African American Children’s Depressive Symptoms: The Prospective Effects of Neighborhood Disorder, Stressful Life Events, and Parenting

The prospective effects of observed neighborhood disorder, stressful life events, and parents’ engagement in inductive reasoning on adolescents’ depressive symptoms were examined using data collected from 777 African American families. Multilevel analyses revealed that stressful life events experienced at age 11 predicted depressive symptoms at age 13. Furthermore, a significant interaction between neighborhood disorder and parents’ engagement in inductive reasoning was found, indicating that parental use of inductive reasoning was a protective factor for depressive symptoms particularly for youths living in highly disordered neighborhoods. The importance of examining correlates of depressive symptoms from a contextual framework, focusing on individuals, families, and neighborhood contexts, is emphasized.     

Mother–Son Interactions in Families of Boys With Attention-Deficit/Hyperactivity Disorder With and Without Oppositional Behavior

Parenting responsiveness and over-reactivity were assessed among 25 mothers of 7–9-year-old sons with Attention-Deficit/Hyperactivity Disorder (ADHD) and oppositional behavior (Oppositional Defiant, OD), 24 mothers of sons with ADHD only, and 38 mothers of nonproblem sons. Responsiveness was observed during mother–son play and clean-up interactions and over-reactivity was assessed using self-reports of parenting in discipline situations. Mothers of sons with ADHD/OD were less responsive and more over-reactive than mothers of nonproblem sons, and mothers of sons with ADHD only did not differ from the other groups. Mothers of sons with ADHD/OD reported more hostility than mothers of nonproblem sons, and controlling for maternal hostility eliminated the significant group differences in responsiveness during clean-up and in over-reactivity. Controlling for the childs ADHD subtype did not alter the pattern of results. The implications for addressing responsiveness and over-reactivity as components of parent-mediated behavioral treatments for ADHD are considered.     

Mother–Child Agreement on Reports of Internalizing Symptoms Among Children Referred for Evaluation of ADHD

The effects of maternal (bias), child (age, severity of behavior problems), and measurement characteristics (similarity of parent and child measures; types of internalizing symptoms) on mother–child agreement on reports of children's internalizing symptoms were examined for 65 children referred for evaluation of ADHD. Agreement was low and did not improve when parents and children completed parallel measures. Mothers and children were more likely to agree on severity of internalizing symptoms rated as behavioral than those rated as ideational. The majority of discordant reports were of the type that mothers, but not children, reported clinically elevated symptoms. This type of discordance appeared to be a function of maternal negative bias rather than underreporting of symptoms by children.     

Hyperactivity in Boys with Attention-Deficit/Hyperactivity Disorder (ADHD): A Ubiquitous Core Symptom or Manifestation of Working Memory Deficits?

Hyperactivity is currently considered a core and ubiquitous feature of attention-deficit/hyperactivity disorder (ADHD); however, an alternative model challenges this premise and hypothesizes a functional relationship between working memory (WM) and activity level. The current study investigated whether children’s activity level is functionally related to WM demands associated with the domain-general central executive and subsidiary storage/rehearsal components using tasks based on Baddeley’s (Working memory, thought, and action. New York: Oxford University Press 2007) WM model. Activity level was objectively measured 16 times per second using wrist- and ankle-worn actigraphs while 23 boys between 8 and 12 years of age completed control tasks and visuospatial/phonological WM tasks of increasing memory demands. All children exhibited significantly higher activity rates under all WM relative to control conditions, and children with ADHD (n = 12) moved significantly more than typically developing children (n = 11) under all conditions. Activity level in all children was associated with central executive but not storage/rehearsal functioning, and higher activity rates exhibited by children with ADHD under control conditions were fully attenuated by removing variance directly related to central executive processes.

Effects of Prenatal and Postbirth Intimate Partner Violence on Preschool-Age Children’s Dissociative Symptoms

Studies on the effects of intimate partner violence (IPV) on children have typically focused on IPV to which children were exposed after their birth. However, research has also demonstrated the effect of prenatal IPV on children’s psychological functioning, although this has not yet been studied with respect to dissociation. In this study, we examined the association between prenatal and postbirth IPV and dissociative symptoms among preschool-age children using a Bayesian approach to multiple regression. Results indicated that prenatal IPV predicts child dissociative symptoms over and above postbirth IPV and other negative life events that the child has experienced. These results provide further evidence for the role prenatal IPV plays in the development of child psychopathology and suggest directions for future research and intervention.     

The Effects of Parental Labor Migration on Children’s Mental Health in Rural China

Applied Research in Quality of Life - Utilizing data from the China Education Panel Survey, we investigated the effects of parental migration and its duration on children’s mental health in...     

The Long-term Effects of Early Paternal Presence on Children’s Behavior

A father’s presence in the family is important for promoting adaptive behavioral functioning in children. It is unknown however, if there is a critical time during infancy and childhood for such paternal presence and involvement to affect behaviour. Using data from the Auckland Birthweight Collaborative (ABC) study, we examined the amount of paternal presence children experienced through their first 11 years of life (measured as fathers’ time spent in the same household as their children) and its effect on their behavioral outcomes at 11 years of age. After controlling for potential confounds, children who whose fathers were minimally present (left between 0 and 3.5 years of age) were twice as likely to report clinically significant behavioural difficulties as those whose fathers were present throughout childhood. Those whose fathers were present for early childhood (left between 3.5 and 7 years of age) exhibited no significant differences in their behaviour at 11 years of age when compared to their peers whose fathers remained present. Mothers reported no significant changes in their children’s behavior. Findings suggested that paternal presence early in a child’s life might be most important with regard to promoting adaptive behavioural functioning as they age.     

Examining Children’s Problem Behaviors and Mothers’ Dating for Mothers’ Depressive Symptoms Following Divorce

Journal of Child and Family Studies - Although divorce is typically stressful for mothers, the formation of post-divorce dating relationships can help to ease this stress. Unfortunately, research...