Fundamental Movement Skills and Children with Attention-Deficit Hyperactivity Disorder: Peer Comparisons and Stimulant Effects

The purpose of this study was to compare the fundamental movement skills of 22 children with attention-deficit hyperactivity disorder (ADHD), from 6 to 12 years of age, to gender- and age-matched peers without ADHD and assess the effects of stimulant medication on the movement skill performance of the children with ADHD. Repeated measures analyses revealed significant skill differences between children with and without ADHD (p ≤ 0.001). Results from the stimulant medication trials indicated no significant effect of medication on the movement skill patterns of children with ADHD. It is concluded that children with ADHD may be at risk for developmental delays in movement skill performance. Potential factors underlying the movement skill difficulties are discussed, with suggestions for future research.     

Sex Differences in Effectiveness of Extended-Release Stimulant Medication among Adolescents with Attention-Deficit/Hyperactivity Disorder

This study examined whether adolescent females with attention-deficit/hyperactivity disorder (ADHD) are differentially responsive than their male counterparts to extended-release stimulant medications. This investigation may bear special importance for an adolescent (as opposed to child) population, because hormonal and metabolism differences between sexes are most likely to emerge at this time. Male (n = 19) and female (n = 16) adolescents, ages 16–19 with ADHD, participated in a randomized, double-blind crossover study evaluating the effectiveness of osmotic-release methylphenidate, extended release amphetamine salts, placebo, and routine limited medication regimen. Medication efficacy was evaluated using ADHD symptom ratings from adolescent self-report and parent report, along with objective measures of inattention and hyperactivity/impulsivity during driving performance and neuropsychological tasks. Males and females were largely equivalent in impairment, and medication was similarly effective in reducing symptoms. No interactions were found between sex and medication on any measure of effectiveness or side effects. This finding suggests that the efficacy and tolerability of extended-release stimulant medications is equivalent for male and female adolescents with ADHD.     

The Predictive Power of Combined Neuropsychological Measures for Attention-Deficit/Hyperactivity Disorder in Children

The present study explores the predictive power of seven neuropsychological assessment tools used in combination in classifying children with attention-deficit/hyperactivity disorder (ADHD). Twenty-one ADHD boys and 22 community control children participated. Group differences were significant on the continuous performance test only; however, battery analysis did increase overall predictive power, which was moderate. This study highlights the difficulty in identifying consistent mean differences on tests of frontal/executive functioning across studies, as well as the need to assess the predictive validity of these tests in classifying children with ADHD. The study suggests that these tests may provide greater predictive validity when used in combination. Inconsistencies in the literature are discussed, with consideration of research methodology, the heterogeneity of the ADHD population, and comorbid diagnoses.     

Working Memory Mediates Increased Negative Affect and Suicidal Ideation in Childhood Attention-Deficit/Hyperactivity Disorder

Children with attention-deficit/hyperactivity disorder (ADHD) are at greater risk for suicidal ideation and suicide attempts compared to those without ADHD. Increased risk is at least partially attributable to a subset of children with ADHD and comorbid depression or disruptive behavior disorders; however, the early predictors and mechanisms driving increased risk are not well understood. Here, we investigate the contributions of two candidate mechanisms for increased suicidal ideation in children with ADHD: executive function and negative affect. 623 clinically well-characterized, community-recruited children classified by research criteria as ADHD (n = 388) or typically-developing controls (n = 253) participated. Parent-report on the Temperament in Middle Childhood Questionnaire provided a measure of negative affectivity. Children completed laboratory tasks to measure response inhibition and working memory. Suicidal ideation was evaluated by parent report during a semi-structured interview and child responses on the Children’s Depression Inventory. Compared to typically developing controls, children with ADHD had higher rates of suicidal ideation, more negative affect, slower stop signal reaction times, and weaker working memory. Statistical path-model analyses confirmed the hypothesis that weaker working memory in ADHD statistically mediated increased negative affect. Weaker working memory also mediated and increased suicidal ideation in these cross sectional data. Findings were not attributable to comorbid disruptive behavioral disorders. Poor response inhibition did not reliably mediate negative affect or suicidal ideation. Impairment in working memory is an important early risk factor for suicidal ideation in children with ADHD, and may help in identifying children for prevention and early intervention efforts.     

Naming Speed Performance and Stimulant Effects Indicate Effortful, Semantic Processing Deficits in Attention-Deficit/Hyperactivity Disorder

This study investigated rapid automatized naming and effects of stimulant medication in school-age children with attention-deficit/hyperactivity disorder (ADHD) with and without concurrent reading disorder (RD). Two ADHD groups (67 ADHD only; 21 ADHD + RD) and a control group of 27 healthy age-matched peers were compared on four variables: color naming speed, letter naming speed, phonologic decoding, and arithmetic computation. Discriminant function analysis (DFA) was conducted to predict group membership. The four variables loaded onto two discriminant functions with good specificity: phonologic decoding, letter naming speed, and arithmetic defined the first function; color naming speed defined the second function. Both ADHD groups were significantly slower in color naming than controls, but did not differ from one another. DFA correctly classified 96% of the control group, 91% of ADHD + RD, and 82% of ADHD only. A subset of children in the ADHD groups participated subsequently in an acute, randomized, placebo-controlled, crossover trial with three single doses (10, 25, 20 mg) of methylphenidate. Methylphenidate selectively improved color-naming speed but had no effect on the speed of naming letters or digits. These findings challenge the tenet that naming speed deficits are specific to RD and implicate naming speed deficits associated with effortful semantic processing in ADHD, which are improved but not normalized by stimulant medication.     

Memory in Early Onset Bipolar Disorder and Attention-Deficit/Hyperactivity Disorder: Similarities and Differences

Differentiating between early-onset bipolar disorder (BD) and attention-deficit/hyperactivity disorder (ADHD) can be difficult. Memory problems are commonly reported in BD, and forgetfulness is among the diagnostic criteria for ADHD. We compared children and adolescents with BD (n?=?23), ADHD combined type (ADHD-C; n?=?26), BD?+?ADHD-C (n?=?15), and 68 healthy controls on memory tests (Digit span, Children's Verbal Learning Test-II). Further analyses were performed on subgroups of BD (BD-I, BD-II/BD-NOS, with and without previous psychotic symptoms). All clinical groups demonstrated some problems with free recall, but the BD subgroup with a history of psychotic symptoms had a more pervasive problem that also included recognition and semantic clustering. The ADHD-C groups demonstrated the lowest performance on working memory. These data suggest that children and adolescents with BD and previously psychotic symptoms may have inefficient encoding of verbal material, whereas memory problems in ADHD-C appear more characterized by impaired free recall.     

Empathy and Social Perspective Taking in Children with Attention-Deficit/Hyperactivity Disorder

This study explored empathy and social perspective taking in 8 to 12 year old children with and without Attention-Deficit/Hyperactivity Disorder (ADHD). The sample comprised 92 children, 50 with a diagnosis of ADHD and 42 typically developing comparison children. Although children with ADHD were rated by their parents as less empathic than children without ADHD, this difference was accounted for by co-occurring oppositional and conduct problems among children in the ADHD sample. Children with ADHD used lower levels of social perspective taking coordination in their definition of problems, identification of feelings, and evaluation of outcomes than children without ADHD, and these differences persisted after the role of language abilities, intelligence and oppositional and conduct problems were taken into account. Girls were more empathic and had higher overall social perspective taking scores than boys. Implications for research and practice are discussed. This research was funded by the Social Sciences and Humanities Research Council (SSHRC).     

Effects of Stimulant Medication Treatment on Mothers' and Children's Attributions for the Behavior of Children with Attention Deficit Hyperactivity Disorder

Participants were 55 children with attention deficit hyperactivity disorder (ADHD) who were receiving ongoing treatment with stimulant medications and their mothers, and 31 children with ADHD who were beginning stimulant medication and their mothers. Mothers and children offered attributions for child behaviors that occurred when the child was medicated and not medicated. Mothers rated child compliance and prosocial behavior as more global and stable when the child was medicated and rated noncompliance, ADHD symptoms, and oppositional behavior as more externally caused, less global and stable, but more controllable by the child when the child was medicated. Children rated both their compliance and noncompliance as more controllable in the medicated condition. On a forced-choice measure, both mothers and children selected ability, effort, and task attributions for compliance more in the not-medicated condition, and pill-taking attributions more in the medicated condition. This was reversed for noncompliance, which was attributed more to effort, task, or ability in the medicated condition and more to not taking a pill in the not-medicated condition. The potential risks and benefits for parent–child interactions and children's self-perceptions of these medication-related differences in attributions are discussed.     

Working Memory and Motor Activity: A Comparison Across Attention-Deficit/Hyperactivity Disorder,Generalized Anxiety Disorder,and Healthy Control Groups

Converging findings from recent research suggest a functional relationship between attention-deficit/hyperactivity disorder (ADHD)-related hyperactivity and demands on working memory (WM) in both children and adults. Excessive motor activity such as restlessness and fidgeting are not pathognomonic symptoms of ADHD, however, and are often associated with other diagnoses such as generalized anxiety disorder (GAD). Further, previous research indicates that anticipatory processing associated with anxiety can directly interfere with storage and rehearsal processes of WM. The topographical similarity of excessive motor activity seen in both ADHD and anxiety disorders, as well as similar WM deficits, may indicate a common relationship between WM deficits and increased motor activity. The relationship between objectively measured motor activity (actigraphy) and PH and visuospatial WM demands in adults with ADHD (n = 21), adults with GAD (n = 21), and healthy control adults (n = 20) was examined. Although all groups exhibited significant increases in activity from control to WM conditions, the ADHD group exhibited a disproportionate increase in activity, while activity exhibited by the GAD and healthy control groups was not different. Findings indicate that ADHD-related hyperactivity is uniquely related to WM demands, and appear to suggest that adults with GAD are no more active relative to healthy control adults during a cognitively demanding laboratory task.     

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。     

Peer Rejection and Friendships in Children with Attention-Deficit/Hyperactivity Disorder: Contributions to Long-Term Outcomes

Even after evidence-based treatment, Attention-Deficit/Hyperactivity Disorder (ADHD) is associated with poor long-term outcomes. These outcomes may be partly explained by difficulties in peer functioning, which are common among children with ADHD and which do not respond optimally to standard ADHD treatments. We examined whether peer rejection and lack of dyadic friendships experienced by children with ADHD after treatment contribute to long-term emotional and behavioral problems and global impairment, and whether having a reciprocal friend buffers the negative effects of peer rejection. Children with Combined type ADHD (N?=?300) enrolled in the Multimodal Treatment Study of Children with ADHD (MTA) were followed for 8 years. Peer rejection and dyadic friendships were measured with sociometric assessments after the active treatment period (14 or 24 months after baseline; M ages 9.7 and 10.5 years, respectively). Outcomes included delinquency, depression, anxiety, substance use, and general impairment at 6 and 8 years after baseline (Mean ages 14.9 and 16.8 years, respectively). With inclusion of key covariates, including demographics, symptoms of ADHD, ODD, and CD, and level of the outcome variable at 24 months, peer rejection predicted cigarette smoking, delinquency, anxiety, and global impairment at 6 years and global impairment at 8 years after baseline. Having a reciprocal friend was not, however, uniquely predictive of any outcomes and did not reduce the negative effects of peer rejection. Evaluating and addressing peer rejection in treatment planning may be necessary to improve long-term outcomes in children with ADHD.     

Anxiety and Depression Symptoms in Children with Asperger Syndrome Compared with Attention-Deficit/Hyperactivity Disorder and Depressive Disorder

The objective of this study was to examine (a) anxiety and depression symptoms in children with Asperger syndrome (AS) compared to children with attention-deficit/hyperactivity disorder (ADHD) and children with depressive disorder; (b) parental anxiety and depressive symptoms in the three groups; and (c) the association between the anxiety and depression symptoms of children and their parents. The emotional and behavioral problems of 56 children with AS (48 boys, 8 girls, mean age, 9.39 ± 2.01 years) were compared with 56 ADHD children and 56 depressive disorder children, matched for age and sex. Their parents’ anxiety and depression symptoms were also compared. Trait-anxiety and internalizing problems in AS children were higher than those in ADHD children and as high as those in depressive disorder children (F = 8.83, p < 0.001 and F = 8.21, p < 0.001). Parents’ anxiety and depression symptoms did not differ among the three groups, but correlations between maternal anxiety and depression and children’s emotional and behavioral problems were most prominent in the AS group. We suggest that the assessment and treatment of children with AS should involve detailed assessment, possible concomitant treatment for comorbid anxiety and depression, and parental education about the effect of parental emotional states on children.     

Community-Clinic-Based Parent Intervention Addressing Noncompliance in Children With Attention-Deficit/Hyperactivity Disorder

The current study tested whether an abbreviated version of Defiant Children (Barkley, 1987), an efficacious parent training program to address the behavioral noncompliance often associated with disruptive behavior disorders, could be implemented successfully within a community mental health clinic setting by master's-level therapists. Ethnically and socioeconomically diverse parents of 16 children (ages 4 to 12 years old) completed a 6-session active treatment group emphasizing the use of differential attending skills, effective time-out strategies, and a structured reinforcement schedule to increase child compliance. Pre- and posttreatment measures of attention-deficit/hyperactivity disorder (ADHD), oppositional-defiant disorder (ODD), and conduct disorder (CD) symptom level were administered, as well as a measure tapping the contextual breadth (i.e., number of settings) and severity of disruptive behaviors. Parent satisfaction with the treatment was also assessed. Analyses indicated large treatment effects on all measures except CD behavior. Results are discussed in the context of implementing empirically supported therapies in settings where “treatment as usual” is the norm.     

Personality Mediation of Genetic Effects on Attention-Deficit/Hyperactivity Disorder

Personality traits may be viable candidates for mediators of the relationship between genetic risk and ADHD. Participants were 578 children (331 boys; 320 children with ADHD) between the ages of six and 18. Parents and teachers completed a comprehensive, multi-stage diagnostic procedure to assess ADHD and comorbid disorders. Mother completed the California Q-Sort to assess child Big Five personality traits. Children provided buccal samples of DNA which were assayed for selected markers on DRD4, DAT1, and ADRA2A. An additive genetic risk composite was associated with ADHD symptoms and maladaptive personality traits; maladaptive personality traits were associated with ADHD symptoms. Low conscientiousness and high neuroticism partially mediated the relationship between genetic risk and ADHD symptoms. Mediation effects for conscientiousness were specific to inattentive symptoms; effects for neuroticism generalized to all disruptive behaviors. High neuroticism and low conscientiousness may be useful as early markers for children at risk for ADHD.     

Attention-Deficit Hyperactivity Disorder: The Medicalization of Misbehavior

During the past decade, there has been an increase in the diagnosis and treatment of Attention-Deficit Hyperactivity Disorder (ADHD). This syndrome, typically diagnosed in childhood, is characterized by inattention, hyperactive motor behavior, and distractibility. Current prevalence rates obtained in various countries generally exceed the 3–5% reported by DSM-IV. Reasons for increased ADHD prevalence include changes in diagnostic standards, overlap between ADHD and other externalizing disorders, nonspecific behavioral criteria, and the rapid effects of stimulant medication on cognitive functioning. However, social, cultural, and economic factors may also contribute to increased diagnosis. ADHD has become a common topic in the lay media. Popular discussions of ADHD may serve as a metaphoric expression of social anxieties, particularly with respect to children. At the same time, ADHD has rapidly become incorporated into a medical model, with emphasis on pharmacological treatment. Reductions in mental health and educational services, as well as economic pressures of managed care, may also contribute to medicalization of behavioral problems. Collaboration between psychologists and primary care physicians can lead to more accurate diagnosis and appropriate treatment of ADHD and related disorders.     

Methylphenidate in treatment of adults with Attention-Deficit/Hyperactivity Disorder

Attention-Deficit/Hyperactivity Disorder (ADHD) can persist into adulthood with a continuation of the pattern of childhood psychopathology, cognition and functioning. Adult comorbidities include substance use disorders, antisocial personality disorder, anxiety, and depression. Studies have shown that as in children, methylphenidate treatment for adults can lead to a robust, dose-dependent improvement in ADHD symptoms. Future research is needed to evaluate the safety and efficacy of long-term treatment with methylphenidate (MPH).