Effects of Reward and Response Cost on Response Inhibition in AD/HD, Disruptive, Anxious, and Normal Children

In previous research, children with attention deficit/hyperactivity disorder (AD/HD) have demonstrated impaired response inhibition on the stop paradigm. In this study we examined whether this impairment in fact reflects a motivational deficit. Four groups of children (age range 7–13 years) participated in the study: 14 AD/HD children, 21 normal controls, 14 disruptive children, and 14 anxious children. The psychopathological groups were recruited from special educational services and mental health outpatient clinics. Parent, teacher, and child questionnaires were used to select children with pervasive disorders. Normal controls attended regular classes and scored low on all questionnaires. Children were tested once with reward contingencies and once with response cost contingencies in a randomized cross-over design. We hypothesized that if a motivational deficit underlies poor response inhibition in AD/HD children, this deficit will be remedied by response contingencies. Despite the presence of response contingencies, AD/HD children showed poor response inhibition compared with normal controls. Findings argue against a motivational explanation for the response inhibition deficit in AD/HD children     

Parent stress and coping in relation to child ADHD severity and associated child disruptive behavior problems.

Examined parent role distress and coping in relation to childhood attention deficit hyperactivity disorder (ADHD) in mothers and fathers of 66 children age 7 to 11 (42 boys, 24 girls; mean age = 10.2). Parents of children with ADHD combined and inattentive subtypes expressed more role dissatisfaction than parents of control children. Parents of ADHD combined and inattentive type children did not differ significantly in levels of distress. For mothers, child inattention and oppositional-conduct problems but not hyperactivity contributed uniquely to role distress (dissatisfaction related to parenting or parenting performance). For fathers, parenting role distress was associated uniquely with child oppositional or aggressive behaviors but not with ADHD symptom severity. Parent coping by more use of positive reframing (thinking about problems as challenges that might be overcome) was associated with higher role satisfaction for both mothers and fathers. Community supports were associated with higher distress for mothers only.     

Executive functions in kindergarteners with high levels of disruptive behaviours

Executive function (EF) deficits have yet to be demonstrated convincingly in children with disruptive behaviour disorders (DBD), as only a few studies have reported these. The presence of EF weaknesses in children with DBD has often been contested on account of the high comorbidity between DBD and attention‐deficit/hyperactivity disorder (ADHD) and of methodological shortcomings regarding EF measures. Against this background, the link between EF and disruptive behaviours in kindergarteners was investigated using a carefully selected battery of EF measures. Three groups of kindergarteners were compared: (1) a group combining high levels of disruptive behaviours and ADHD symptoms (COMB); (2) a group presenting high levels of disruptive/aggressive behaviours and low levels of ADHD symptoms (AGG); and (3) a normative group (NOR). Children in the COMB and AGG groups presented weaker inhibition capacities compared with normative peers. Also, only the COMB group showed weaker working memory capacities compared with the NOR group. Results support the idea that preschool children with DBD have weaker inhibition capacities and that this weakness could be common to both ADHD and DBD.     

Buffers of peer rejection among girls with and without ADHD: the role of popularity with adults and goal-directed solitary play

We investigated a risk-resilience model in 91 girls with ADHD and 58 age- and ethnicity-equated comparison girls, who participated in all-female naturalistic summer research camps. The hypothesized risk factor was peer rejection (assessed via sociometric nominations), with criterion measures including multiinformant composites of aggressive behavior and anxious/depressed symptoms. The two hypothesized protective factors were the girls' popularity with adult staff (assessed via staff ratings) and objective observations of goal-directed solitary play. Peer rejection was related to higher levels of aggressive behavior and depressed/anxious behavior, confirming its status as a risk factor. Next, for all girls, popularity with adults predicted lower levels of aggression and goal-directed solitary play predicted lower levels of anxiety/depression. Whereas popularity with adults was most protective among the peer-accepted subgroup, solitary play was most protective among the peer-rejected subgroup. Diagnostic status (ADHD versus comparison) moderated the findings such that engaging in meaningful solitary play was a stronger predictor of lower levels of anxious/depressed behavior in girls with ADHD than in comparison girls. We discuss the need for replication in prospective research and implications for research and intervention regarding the social functioning of peer-rejected children, particularly those with behavior disorders.     

Processing Speed Deficits in Attention Deficit/Hyperactivity Disorder and Reading Disability

The goal of the current study was to test whether deficits in processing speed (PS) may be a shared cognitive risk factor in reading disability (RD) and Attention Deficit/Hyperactivity Disorder (ADHD), which are known to be comorbid. Literature on ADHD and RD suggests that deficits on tasks with a speeded component are seen in both of these disorders individually. The current study examined a wide range of speeded tasks in RD, ADHD, comorbid RD+ADHD, and a control group to test whether RD and ADHD have similar profiles of PS deficits, and whether these deficits are shared by the two disorders. The results suggest that a general PS deficit exists in both clinical groups compared to controls, although children with RD demonstrate greater PS deficits than children with ADHD. Two tests (underadditivity and partial correlations) were conducted to test whether these PS deficits are shared. Since we found that PS deficits were underadditive in the comorbid group and that partialling PS reduced the correlation between RD and ADHD, it appears that PS is a shared cognitive risk factor that may help explain the comorbidity of these two disorders.     

Response inhibition in children with and without ADHD after traumatic brain injury

Children with attention‐deficit hyperactivity disorder (ADHD) and traumatic brain injury (TBI) show deficient response inhibition. ADHD itself is a common consequence of TBI, known as secondary ADHD (S‐ADHD). Similarity in inhibitory control in children with TBI, S‐ADHD, and ADHD would implicate impaired frontal‐striatal systems; however, it is first necessary to delineate similarities and differences in inhibitory control in these conditions. We compared performance of children with ADHD and those with TBI without pre‐injury ADHD on a stop signal, response inhibition task. Participants were 274 children aged 6–14 years. There were 92 children with ADHD, 103 children with TBI, and 79 typically developing children who served as controls. Among the TBI participants, injury severity ranged from mild to severe. Children with ADHD and TBI showed deficient inhibition. The deficit in children with ADHD was as great as or greater than that in children with TBI, regardless of degree of TBI severity or the presence of S‐ADHD. The finding indicates that TBI results in deficient inhibition regardless of the development of S‐ADHD.     

Working memory interference control deficit in children referred by teachers for ADHD symptoms.

It has been hypothesised that children with Attention Deficit/Hyperactivity Disorder (ADHD) present memory problems, including working memory deficits. This research is aimed at finding clearer evidence of a working memory deficit in these children. In the first study 22 children that had been referred by teachers as having ADHD symptoms were compared with a control group. Their performance on a listening span test, drawn up by De Beni, Palladino, Pazzaglia, and Cornoldi (1998), was investigated. In this task the subjects were asked to select the names of animals in word strings and to remember the last word in each string. In a second study, 34 children with ADHD symptoms and 50 control children were presented with a visuospatial working memory task mirroring the verbal task used in Study 1. In both studies, the children with ADHD symptoms had difficulty in remembering the last item in the string and had a higher number of intrusions when memorising items that were not in the final position. The results were interpreted that children with ADHD symptoms have working memory problems because they are not capable of suppressing information that initially has to be processed, and subsequently excluded from memory. This particular difficulty can be interpreted as an inhibitory processing deficit. The implications of the results in understanding learning difficulties in children with ADHD are discussed.     

Underlying processes in the poor response inhibition of children with Attention-Deficit/Hyperactivity Disorder

This study evaluated the effects of reward, punishment, and reward + punishment on the impulsive responses of ADHD children. The impulsive responses of ADHD and normal control boys (30 per group) were compared during performance of a go/no-go task, administered under reward-only, punishment-only, and reward + punishment conditions. When differences in aggression, anxiety, and IQ between these groups were controlled for, results indicated that the impulsivity levels of the ADHD group were higher than the control group in all three reinforcement conditions. Also, the ADHD group was more impulsive in the reward + punishment condition, compared to the reward-only and punishment-only conditions, and there was no difference between the reward-only and punishment-only conditions. The control groups showed no difference across the three reinforcement conditions. These findings raise the possibility that the poor response inhibition of ADHD children may be related to both a generalized inhibitory deficit and a response modulation deficit.     

Measuring Parental Treatment Adherence in a Multimodal Treatment Program for Children with ADHD: A Preliminary Investigation

This study evaluated the clinical significance of measuring between session parental adherence on child and parent outcomes for 51 children (age 4 to 8.5 years) with attention deficit/hyperactivity disorder (ADHD) in a multimodal group training program. Three group treatment conditions: (a) child-only treatment (C1), (c) child and parent training (C2), and (c) C2 + Parent Adherence Measure [PAM (C3)] were compared to assess the clinical significance of measuring parental adherence on child behavioral problems, socialization skills, and parental efficacy. Parents administered the PAM (C3) displayed, in general, better outcomes on child and parent measures than the other two conditions. Results suggest that a multimodal group training program for young children with ADHD is favorable to child group training only. This study offers preliminary support for the clinical utility of measuring parental adherence in a child ADHD multimodal group training program.     

Deficient inhibitory control in attention deficit hyperactivity disorder

The purpose of this study was to examine two executive control processes — response inhibition and re-engagement of responses after inhibition in children with attention deficit hyperactivity disorder (ADHD). Thirty-three children with ADHD and 22 normal control children of similar age (7 to 11 years) and mean IQ (107) were tested with the change paradigm. ADHD subgroups were defined by the context in which the ADHD symptoms predominated (in the home only; at school only; and in both, i.e., pervasive ADHD). Children with marked oppositional defiant or conduct disorder were excluded. Children with ADHD exhibited deficits in inhibitory control and in response re-engagement. Deficits were greatest in pervasive ADHD and, to a lesser extent, in those with ADHD limited to the school context. ADHD limited to the home context showed the least deficit. These results replicate an earlier study that found deficient inhibitory control in pervasive ADHD and demonstrate that the deficit in ADHD involves a second aspect of executive control.We are grateful to Anne Rhodes and Isobelle Williams for their assistance in the conduct of this research. This research was supported by grants from Health and Welfare Canada and the Medical Research Council of Canada. This paper was prepared with the assistance of Medical Publications, The Hospital for Sick Children, Toronto, Ontario.     

The influence of developmental coordination disorder and attention deficits on associated movements in children

The relationship between associated movements (AMs) and level of motor performance is not well understood. In this study we investigated whether children with developmental coordination disorder (DCD), with (n = 10) and without (n = 10) attention deficit hyperactivity disorder (ADHD), and a control group (n = 10), differed in the severity of AMs. A total AM severity score was obtained for each child by rating their performance on AM tasks. Both groups with motor difficulties had significantly more severe AMs than the control group. A significant correlation was found between level of motor performance and total AM scores (r = -.62). Our results suggest that level of motor performance should be considered in future research attempting to understand individual differences in severity of AMs as a function of motor, learning, and behavioural disorders.     

Confirmatory factor analysis of the behavior rating inventory of executive function in a neuro-pediatric sample and its application to mental disorders

The construct validity of the 9-scale version of the Behavior Rating Inventory of Executive Function (BRIEF) parent form was examined in a clinical sample of children and adolescents with neurological and neurodevelopmental disorders (N = 281). Confirmatory factor analysis supported a three-factor model separating the inhibitory behavioral control dimension from the emotional control and metacognitive problem-solving dimensions. The Metacognitive factor was also related to a diagnosis of attention deficit/hyperactivity disorder (ADHD) after controlling for age, gender, IQ, adaptive functioning, and a conventional behavioral rating scale, which included inattention-hyperactivity symptoms. The Emotional Regulation factor was related to a diagnosis of oppositional defiant disorder. Correlational analyses indicated that child comorbid emotional and behavioral problems may exacerbate parental BRIEF reporting. Accordingly, when assessing executive function among children with neurological and neurodevelopmental disorders, the BRIEF should be complemented with assessments of mental health problems.     

Multiple family therapy for Chinese families of children with attention deficit hyperactivity disorder (ADHD): treatment efficacy from the children’s perspective and their subjective experiences

This paper reports the results of our study that assessed the treatment efficacy of multiple family therapy (MFT) from the perspective of participating Chinese children with attention deficit hyperactivity disorder (ADHD) and identified their subjective experiences. Forty‐three children with ADHD in the experimental group (EG) completed a forty‐two‐hour MFT, whilst forty‐five children with ADHD in the control group (CG) had attended two writing classes scheduled three months apart that were similar to those of the MFT. Data from the outcome study were gathered using standardized questionnaires and data from the qualitative study were drawn from thirteen children with ADHD who had completed the MFT and attended the focus group interviews (n = 5) or individual interviews (n = 8) conducted in the post‐treatment phase. The results of the Paired sample t‐test and MANOVA indicated no significant changes on the scores for the four measures adopted (perception of competence, hopefulness, parent‐child relationship and perceived social support) in the pre‐ and post‐treatment for the EG and the CG. Five themes emerged from the narratives of children with ADHD, which revealed the children’s subjective experiences with the MFT: (a) full of fun; (b) building friendships through common experiences; (c) a happy family time; (d) safe space; and (e) positive parental responses and communications.     

阅读障碍与注意缺陷多动障碍儿童的语言加工和反应抑制

阅读障碍与注意缺陷多动障碍(ADHD)高度共病,以往研究结果显示两种障碍在语言加工、执行功能等领域的缺陷既相似又不同。本研究采用语音意识测验、快速命名测验、语素意识测验和停止信号任务,以及阅读广度测验,分别考察四组被试（阅读障碍组、ADHD组、双重障碍组、正常控制组）的基础语言加工、反应抑制和言语工作记忆能力,结果发现：阅读障碍组和双重障碍组在语言加工任务上的成绩均显著差于ADHD组和正常组;ADHD组和双重障碍组在停止信号任务上的成绩显著差于阅读障碍组和正常组;所有障碍组在阅读广度测验上的成绩显著差于正常组。表明阅读障碍的特异性缺陷体现在语言加工过程上,而注意缺陷多动障碍的特异性缺陷体现在反应抑制上。这对于今后单一障碍的研究及临床诊断和干预具有重要的参考价值。     

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.     

Anxious children and their parents: what do they expect?

Assigned 73 children, ages 7 to 14, to 1 of 3 groups (anxious, clinical control, and nonclinical control) according to their diagnostic status. Within the anxious group, children were assigned to 1 of 2 further groups on the basis of self-reported parental anxiety--either the child anxiety only group or the child + parent anxiety group. All children completed an experimental task (giving a brief talk in front of a video camera), which was the focus for a series of structured family discussions between the child and his or her parents. The aims of the study were to measure and compare across groups (a) the evaluations of children and their parents regarding the child's predicted anxiety and skill level and (b) the effect of the family discussion on children's expectations. Results indicated that, prior to the family discussion, anxious children's expectations of their future performance did not differ from those of control children. Similarly, there were no differences in children's expectations between the child anxiety group and the child + parent anxiety group. Second, compared to mothers in the child anxiety group, mothers in the child + parent anxiety group expected that their children would be more anxious and more likely to choose an avoidant problem solution (but not less skilled). Finally, the family discussion was found to produce no changes in anxious children's expectations of their future performance. The implications of these findings are discussed.     

Transcranial magnetic stimulation in child psychiatry: disturbed motor system excitability in hypermotoric syndromes

Normal development and dysfunctions of motor system excitability can be investigated in vivo by means of single‐ and paired‐pulse transcranial magnetic stimulation (TMS). While different TMS‐parameters show different developmental time courses between 8 and 16 years of age, distinct dysfunctional patterns of motor system excitability can be demonstrated in child psychiatric disorders with hypermotoric behavior: in tic disorder, a shortened cortical silent period can be stated providing evidence for deficient inhibitory mechanisms within the sensorimotor loop, probably primarily at the level of the basal ganglia. In attention deficit hyperactivity disorder (ADHD), a decreased intracortical inhibition indicates deficient inhibitory mechanisms within the motor cortex (but enhancement of intracortical inhibition after oral intake of 10 mg methylphenidate). In children with comorbid ADHD and tic disorder, the findings of a reduced intracortical inhibition as well as a shortened cortical silent period provide evidence for additive effects at the level of motor system excitability. Thus, TMS allows us to obtain substantial insight into both the normal development and the neurobiological basis of hypermotoric syndromes in child psychiatry.     

Confirmation of an Inhibitory Control Deficit in Attention-Deficit/Hyperactivity Disorder

The objective of this study was to determine whether deficient inhibitory control distinguishes children with a diagnosis of attention-deficit/hyperactivity (ADHD) disorder, conduct disorder (CD), and comorbid ADHD + CD from normally developing children. Participants were rigorously diagnosed children (age 7 to 12 years) with ADHD (N = 72), CD (N = 13) or ADHD + CD (N = 47) and 33 control children (NC). We studied inhibitory control using the stop-signal paradigm, a laboratory task that assessed the ability to inhibit an ongoing action. The ADHD group had significantly impaired inhibitory control compared to NC, CD, and ADHD + CD children. These results indicate that children with ADHD have deficient inhibition as measured in the stop-signal paradigm and that ADHD occurring in the presence of ADHD + CD may represent a phenocopy of CD rather than a variant of ADHD.     

RD,ADHD, and their comorbidity from a dual route perspective

In order to achieve further insight into the comorbidity of reading disorder (RD) and attention deficit/hyperactivity disorder (ADHD), lexical processing and rapid naming were studied in RD and ADHD. The Dual Route Cascaded model postulates that lexical processing contains two parallel processes: lexical route processing and sublexical route processing. An orthographic decision task and a phonological decision task were used to measure lexical and sublexical route processing, respectively. In addition, a rapid naming task was used to compare 27 children with RD, 18 children with ADHD, 20 children with ADHD+RD, and 29 controls. RD and ADHD shared impairments in accuracy of orthographic and phonological decision making as well as in rapid naming, which suggest that RD and ADHD may be overlapping disorders that share deficits in both lexical route and sublexical route processing. RD was dissociated from ADHD by being slower in both orthographical and phonological decision making that indicates unique deficits in RD on lexical and sublexical speed.