Methylphenidate slows reactions of children with attention deficit disorder during and after an error

A Sternberg memory search task was administered under placebo and methylphenidate to 42 children with cross-situational attention deficit disorder (ADD), 31 children with cross-situational ADD plus oppositional features, and 25 patients with marginal ADD. Overall, stimulant medication enhanced accuracy and speed. In addition, patients reacted faster on correct responses not preceded by an error than on errors (especially false alarms) or on correct responses following an error. The slowness during error reactions may reflect decreased confidence or confusion during stimulus classification. This uncertainty may also lead subjects to respond with greater caution, hence more slowly, on correct responses following errors. Notably, methylphenidate increased the slowing of reactions on error trials as well as on correct reactions following an error. Stimulant medication may augment subjects' persistence when they are uncertain or confused, thereby heightening caution and promoting accuracy on succeeding trials. Consistent with previous reports of the generality of enhancement of performance by stimulant medication, the impact of methylphenidate was comparable for the three subtypes of ADD studied.Jaine Strauss is at Macalester College.This research was supported by National Institute of Mental Health Grants MH32103 and MH38118. We thank Rachel Avery, Christine Carriuolo, Lawrence Ota, the late Helen Pollock, and the University of Rochester's Strong Memorial Hospital Pharmacy for their assistance.     

Direct assessment of the cognitive correlates of attention deficit disorders with and without hyperactivity

The cognitive functioning of children identified as attention deficit disorder with hyperactivity (ADD/H) was compared to that of children identified as attention deficit disorder without hyperactivity (ADD/WO). Based on information on symptoms supplied by teachers, 20 ADD/H and 15 ADD/ WO children were selected according to DSM-III criteria from a large elementaryschool learning disabilities and behavior disorders population. For comparison purposes, 16 normal children from regular classrooms were also selected. Children from all three groups were evaluated with a battery of cognitive tests. Intelligence test scores differentiated the two ADD groups, with the ADD/H children obtaining significantly lower Full Scale IQ scores than both ADD/WO and control children. In addition, ADD/H children obtained significantly lower Verbal IQ scores than ADD/WO children. Both ADD groups performed more poorly than controls on Spelling and Reading Achievement, and the ADD/WO group performed more poorly on Math Achievement. The two ADD groups took longer to complete six Stroop and rapid naming tasks than the control groups but did not differ among themselves. The ADD/WO group made more errors on a visual matching task than the controls, but neither ADD group differed from controls on the accuracy of the Stroop tasks, rapid naming tasks, measures of receptive and expressive language, visual-motor integration, or sustained visual attention. The differences between the two ADD groups were fewer than expected on the basis of previous research and are more global than specific.The assistance of John Junginger, Jason Walker, and Cynthia Jones at various stages of the project is gratefully acknowledged. Particular thanks are extended to the teachers and staff of Clarke County schools.     

The specificity of the effects of stimulant medication on classroom learning-related measures of cognitive processing for Attention Deficit Disorder children

There appear to be beneficial effects of stimulant medication on daily classroom measures of cognitive functioning for Attention Deficit Disorder (ADD) children, but the specificity and origin of such effects is unclear. Consistent with previous results, 0.3 mg/kg methylphenidate improved ADD children's performance on a classroom reading comprehension measure. Using the Posner letting-matching task and four additional measures of phonological processing, we attempted to isolate the effects of methylphenidate to parameter estimates of (a) selective attention, (b) the basic cognitive process of retrieving name codes from permanent memory, and (c) a constant term that represented nonspecific aspects of information processing. Responses to the letter-matching stimuli were faster and more accurate with medication compared to placebo. The improvement in performance was isolated to the parameter estimate that reflected nonspecific aspects of information processing. A lack of medication effect on the other measures of phonological processing supported the Posner task findings in indicating that methylphenidate appears to exert beneficial effects on academic processing through general rather than specific aspects of information processing.     

Methylphenidate and cognitive therapy with add children: A methodological reconsideration

The present doubleblind study examined the effects of methylphenidate, cognitive therapy, and their combination in attention deficitdisordered (ADD) children. Four treatment groups were compared on measures of attentional deployment and cognitive style, tests of academic achievement, and behavioral rating scales. In contrast to a previous study conducted in this laboratory, children in this study were not receiving medication during posttesting. Results were interpreted to suggest that measurable effects of stimulant medication dissipate rapidly upon discontinuation of pharmacotherapy. The combination of methylphenidate and cognitive therapy was not found to be any more efficacious than either of the treatments studied alone. Discussion suggests that medication status at follow-up is an essential feature of research design.This research was supported in full by U.S. Public Health Service Grant No. MH 37-628 from the National Institute of Mental Health, Psychopharmacology Branch, and by Biomedical Research Award No. RR 0715807 from the National Institutes of Health, each awarded to R. T. Brown. Placebo and methylphenidate were supplied by CIBA-GEIGY, Summit, New Jersey. The authors are grateful to Dr. Rute Medenis and the entire staff at the University of Illinois Pediatrics Clinic for their valuable assistance and kind support throughout the project. The authors would also like to thank Avery L. Spunt, R.Ph., College of Pharmacy, University of Illinois, for his assistance in packaging the medication and monitoring compliance; Arthur I. Neyhus, Ph.D., Coordinator of Child Study Facility, University of Illinois at Chicago, for his assistance in evaluation; and J. Scott Allen, Jimmy Bruce, Robert Miller, Michael Mazius, and Steven Orenczuk, for their assistance in training of the children.The contributions of these authors are equal.     

The effects of methylphenidate on levels of processing and laterality in children with attention deficit disorder

Effects of stimulant medication (methylphenidate) on levels (feature, name, semantic) of word processing by the left and right hemisphere were assessed in 31 attention- deficit- disordered children. In a double-blind procedure, same- different decisions were made to tachistoscopically presented word pairs under medication and placebo. Analysis of manual response times failed to show any negative effects of medication. Feature decisions were faster than name decisions, which were faster than semantic decisions. Methylphenidate induced a right visual field advantage (left hemisphere) for the name decision, which was interpreted as a normalization effect. The results suggest that (1) methylphenidate may selectively improve the phonological level of word processing and (2) methylphenidate's favorable therapeutic effect is produced through inhibition of excessive right hemisphere activity in response to task demands that engage the left hemisphere.This research is based in part upon a doctoral thesis completed by the first author in the Department of Education, University of Toronto. The authors thank Dr. William Logan and Dr. Wendy Roberts of the Hospital for Sick Children for permitting testing of patients in the Child Development Clinic. This research was supported in part by a doctoral fellowship from the Social Sciences and Humanities Research Council to the first author.     

Agreement of parent and teacher rating scales with comprehensive clinical assessments of attention deficit disorder with hyperactivity

Forty-one clinic-referred children were given the DSM-III diagnosis of attention deficit disorder with hyperactivity (ADD/H) based on structured diagnostic interviews of the child and mother and on two teacher and two parent rating scales. The degree of agreement between diagnostic classification of ADD/H based solely on criterion scores on each rating scale and classification based on the comprehensive clinical assessments that included use of the same rating scaleswas assessed by comparing the ratings of the 41 children with ADD/H to those of 47 clinic-referred children given other diagnoses or no diagnosis. The accuracy of classification was highly similar across scales. Increasing the cutoff score increased the acing true positives. Using the point of intersection of these two curves to choose the optimal cutoff scores resulted in 70–75% accurate classification and 25–30% misclassification of children given clinical diagnoses of ADD/H. This rate of misclassification suggests that rating scales alone should not be used to classify ADD/H for most clinical and research purposes, especially because the method of comparison used in this study favored finding a high degree of correspondence.     

Frontal lobe functions in attention deficit disorder with and without hyperactivity: A review and research report

We review 22 neuropsychological studies of frontal lobe functions in children with attention deficit disorder with and without hyperactivity (ADD/+H,ADD/-H). Some measures presumed to assess frontal lobe dysfunctions were not reliably sensitive to the deficits occurring in either form of ADD. Tests of response inhibition more reliably distinguished ADD/+H from normal children. Where impairments were found on other tests between ADD and normal subjects, they were highly inconsistent across studies and seemed strongly related to age of the subjects and possibly to the version of the test employed. Other methodological differences across studies further contributed to the discrepant reports. The co-morbidity of other disorders, such as learning disabilities (LD) and conduct problems, with ADD may be an additional confounding factor in some, though not all, of these studies. In a separate study, children with ADD/+H (n=12) were then compared on frontal lobe tests to three other groups: ADD/-H (n=12), LD but no ADD (n=11),and normal children (n=12) statistically covarying for differences in conduct problems across groups. Most measures did not distinguish among these groups. Both ADD groups made more omission errors on a Continuous Performance Test (CPT) than the normal group. All three clinical groups performed more poorly on the word and interference portions of the Stroop Test. Thus, while both types of ADD share some apparent similarities in deficits on a few frontal lobe tests in this study, the totality of existing findings suggests an additional problem with perceptual-motor speed and processing in the ADD/-H group.This research was supported by NIMH grant MH41464 and by funds from the Department of Psychiatry, University of Massachusetts Medical Center. The authors are grateful to Judy Tessier and Ellen Mintz-Lennick for their assistance with some of the data collection and scoring. The comments of Virginia Douglas on an earlier draft of this paper are greatly appreciated.     

Effortful processing deficits in children with reading and/or attention disorders

Three groups of educationally troublesome boys were contrasted with adequate students on several tasks tapping effortful processing. The nonhyperactive reading disabled (RD) group differed both from controls and two attention deficit disorder (ADD) groups, one with and one without hyperactivity (H), on aspects of a memory task involving acoustic and semantic associations. All three clinical groups differed from controls in memory for low-imagery as opposed to high-imagery words and in computational efficiency. A stepwise regression analysis to predict reading grade level showed age and WISC-R IQ to account for 38% of the variance with an additional 28% explained by the effortful task variables (multiple R = .83). It is theorized here that attentional disorder impedes automatization of number facts; and, inasmuch as RD children receive adverse attention ratings, even if not considered hyperactive, they, as well as ADD and H/ADD boys, exhibit this deficiency.     

A comparison of objective classroom measures and teacher ratings of attention deficit disorder

Children identified as Attention Deficit Disorder (ADD) on the basis of teacher ratings using the SNAP Rating Scale were compared to non- ADD children on objective classroom measures including observations of classroom behavior, examination of the organization of children's desks, and scoring of daily academic work. Analyses provided some support for the ability of the objective measures to differentiate between teacheridentified ADD and non-ADD children, though there was considerable overlap on the distributions of most variables between groups. Six measures chosen by a discriminant analysis combined to predict teacher ratings in 83% of the cases. The inclusion of academic, observational, and desk measures in the discriminant function indicates the importance of a multivariate assessment of this construct.Portions of this paper were presented as part of a symposium, W. Pelham (Chair),Identification and diagnosis of children with attention deficit disorder/hyperactivity, at the meeting of the American Psychological Association, Washington, D.C., August 1982. We thank the director, Dr. Edward Vertuno, and the teachers and staff of the Florida State University Developmental Research School for their cooperation and efforts throughout this study. In addition, we wish to thank our observers, Susan Friedan and Stephanie Martinez, whose patience, intelligence, and dedicated effort made this study possible; Denise Gammonsly, for work on the development of the Desk Checks, and Dr. Janet Belew, whose contributions during the early phase of this research are gratefully acknowledged.     

Oculomotor atypicalities in Developmental Coordination Disorder

Children with Developmental Coordination Disorder (DCD) fail to acquire adequate motor skill, yet surprisingly little is known about the oculomotor system in DCD. Successful completion of motor tasks is supported by accurate visual feedback. The purpose of this study was to determine whether any oculomotor differences can distinguish between children with and without a motor impairment. Using eye tracking technology, visual fixation, smooth pursuit, and pro‐ and anti‐saccade performance were assessed in 77 children that formed three groups: children with DCD (aged 7–10), chronologically age (CA) matched peers, and a motor‐match (MM) group (aged 4–7). Pursuit gain and response preparation in the pro‐ and anti‐saccade tasks were comparable across groups. Compared to age controls, children with DCD had deficits in maintaining engagement in the fixation and pursuit tasks, and made more anti‐saccade errors. The two typically developing groups performed similarly, except on the fast speed smooth pursuit and antisaccade tasks, where the CA group outperformed the younger MM group. The findings suggest that children with DCD have problems with saccadic inhibition and maintaining attention on a visual target. Developmental patterns were evident in the typically developing groups, suggesting that the pursuit system and cognitive control develop with age. This study adds to the literature by being the first to systematically identify specific oculomotor differences between children with and without a motor impairment. Further examination of oculomotor control may help to identify underlying processes contributing to DCD. A video abstract of this article can be viewed at: https://youtu.be/NinXa2KlB4M . [Correction added on 27 January 2017, after first online publication: The video abstract link was added.]     

Gender-related assessment of childhood play

Parent-report based scales for the assessment of sex-dimorphic behavior are an important tool in research on psychosexual differentiation and its disorders. This paper presents the factor analysis and corresponding scale development for the slightly expanded Child Game Participation Questionnaire (Bates & Bentler, 1973), based on the parents of a demographically diverse school sample of 355 girls and 333 boys aged 6 to 10 years. Evidence supporting each of three theoretical positions in gender assessment — unidimensional bipolar, two-dimensional unipolar, and multidimensional — was provided. Effect sizes were unusually large for gender, but small for age, socioeconomic level, and race/ethnicity.This research was supported in part by a NICHD postdoctoral fellowship (NRSA HD06726; sponsor: Dr. Meyer-Bahlburg) awarded to Dr. Sandberg, by grants to Dr. Ehrhardt and Dr. Meyer-Bahlburg from the Spencer Foundation, the William T. Grant Foundation, the Ford Foundation, and NIMH (center grant 2-P50-MH43520, Anke A. Ehrhardt, Ph.D., Principal Investigator), and by the NIMH Clinical Research Center grant MH-30906.We thank the children and parents who participated in the study. Dr. Jacob Cohen consulted on statistical matters. Ms. Patricia Connolly provided word processing services. A portion of this work was presented as a poster at the XIth Biennial Meeting of the International Society for the Study of Behavioral Development, Minneapolis, Minnesota, July 3–7, 1991 (Abstracts, p. 285).     

Sociometric status of clinic-referred children with Attention Deficit Disorders with and without Hyperactivity

Peer sociometric nominations of clinic-referred children given the diagnosis of Attention) Deficit Disorder with Hyperactivity (ADD/H) or Attention Deficit Disorder without Hyperactivity (ADD/WO) were compared to one another and to those of normal control children. Only children with ADD diagnoses in the absence of other major diagnoses were included. Both children with ADD/H (n=16) and ADD/WO (n=11) received significantly fewer liked most nominations, more liked least nominations, and lower social preference scores than normal control (n=45) children. These results confirm previous findings of social deficits in children with ADD/H, even when codiagnoses are excluded. In addition, they support the validity of the diagnostic category of ADD/WO by demonstrating that the ADD/WO behavior pattern is apparently psychopathological in being associated with peer unpopularity after codiagnoses are excluded. When larger groups including all codiagnoses (primarily Conduct Disorder) of children with ADD/H (n=36) and ADD/WO (n=20) were compared, identical patterns of peer unpopularity were found, except that children with ADD/H also were significantly more likely to be nominated as a child who fights most.     

Separate verbal memory and naming deficits in attention deficit disorder and reading disability

In this study, verbal memory and naming abilities were investigated in reading disabled (RD) and control children who were characterized according to the presence or absence of attention deficit disorder (ADD). Results indicate that deficits in learning and memory for recently acquired information occur as a function of ADD rather than RD while deficits in naming are specific to RD rather than ADD. We conclude that ADD is a major source of additional and separate cognitive morbidity in RD children.     

Achievement attributions and depressive symptoms in attention deficit-disordered and normal children

Depressive symptoms and achievement attributions were examined in attention deficit-disordered (ADD) and normal schoolchildren. The findings indicate that the ADD children acknowledged having more depressive symptoms and displayed more external attributions both for positive and for negative achievement. In addition, correlations reveal that the normal children's achievement attributions became more internal with age, whereas the ADD children became more external for negative events. The patterns of the relationships among measures are discussed.     

Psychosocial correlates of learning disability subtypes in children with tourette's syndrome

Children with different types of learning disabilities are thought to be at risk for specific profiles of behavior problems. This study sought to determine if learning disabilities are related to behavioral adjustment specifically in children with Tourette's syndrome (TS). We examined the Child Behavior Checklist (CBC) profiles of 61 children with TS who were between the ages of 6 and 18 years. The children were classified into one of three subtypes of learning disabilities or a nondisabled control group, based on performance on the Wide Range Achievement Test-Revised. Children with learning disabilities displayed higher scale elevations on the CBC than did controls, but not after controlling for the presence of attention deficit disorder. The results are inconsistent with previous research on the behavioral adjustment of subtypes of learning disabilities. Thus, the expression of learning disabilities may be idiosyncratic in children with discrete neuropsychiatric disorders such as TS.     

Pragmatic aspects of communication and language comprehension in groups of children differentiated by teacher ratings of inattention and hyperactivity

Children with attention‐deficit hyperactivity disorder (ADHD) experience pragmatic language deficits, but it is not known whether these difficulties are primarily associated with high levels of inattention, hyperactivity, or both. We investigated pragmatic aspects of communication and language comprehension in relation to poor attention and/or high hyperactivity in a nondiagnosed population of 7‐ to 11‐year olds. Classroom teachers rated their pupils' attention and hyperactivity/impulsivity on the ADD‐H Comprehensive Teacher Rating scale (ACTeRS). Three groups were formed: children with poor attention and low hyperactivity (poor attention group), children with good attention and high hyperactivity (high hyperactivity group), and children with both poor attention and high hyperactivity (poor attention/high hyperactivity group). Their performance was compared with that of same‐age controls in two studies: Study 1 (N = 94) investigated the comprehension of figurative language in and out of context and Study 2 (N = 100) investigated the pragmatic aspects of communication using the Children's Communication Checklist – Second Edition. Two groups, the poor attention and the poor attention/high hyperactivity groups, were impaired in both their comprehension of figurative language and their communication skills. The high hyperactivity group was impaired in their comprehension of figurative language but they did not exhibit communication impairments. The findings extend work with clinical populations of children with ADHD: even in a nondiagnosed sample of children, poor attention and elevated levels of hyperactivity are associated with pragmatic language weaknesses.     

Effects of event rate and display time on sustained attention in hyperactive,normal, and control children

Two experiments were conducted to determine whether hyperactive boys have a unique deficit in sustained attention. Groups with DSM-III diagnoses of attention deficit disorder (ADDH), conduct disorder (CD), ADDH+CD, and learning disorder were compared with normal controls on the Continuous Performance Task. In Experiment 1, stimulus presentation rate (stimulus onset asynchrony, SOA) and display time were varied to manipulate attentional demand, and speed and accuracy of performance were measured. The ADDH group was uniquely affected, with less accurate performance at the fastest and slowest SOA. To distinguish the effects of time on task and SOA, the duration of each SOA condition was held constant in Experiment 2. The poorer performance of the ADDH group at the fastest SOA was no longer evident. This finding indicates that the deficit of sustained attention in boys who have ADDH is associated with a greater susceptibility to refractory effects, which is influenced by practice.This research was supported by the Ontario Mental Health and Ruth Schwartz Foundations through a graduate fellowship awarded to P. Chee and a research grant to R. Schachar, G. Logan, and R. Wachsmuth. Dr. Schachar was also supported by the Canadian Psychiatric Research Foundation. This article is based, in part, on a doctoral dissertation submitted by the first author to the Ontario Institute for Studies in Education. The authors thank Dr. John Lovering and the staff of the Departments of Psychiatry and Psychology, The Hospital for Sick Children, for their cooperation in the conduct of this study. This paper was prepared with the assistance of the Medical Publications Department, The Hospital for Sick Children, Toronto.     

Effect of comorbid developmental dyslexia on oculomotor behavior in children with developmental coordination disorder: A study with the Developmental Eye Movement test

Studies have suggested a dysfunction in oculomotor skills in children with developmental coordination disorder (DCD). It has been proposed that the Developmental Eye Movement (DEM) test is useful in testing the dyslexics' (DD) oculomotor behavior during reading, in a simple and indirect manner. The present study aimed at exploring the oculomotor behavior in children with DCD as assessed with the DEM test. We thus compared children with DCD to children with DD and to children with both DCD and DD in order to investigate the specificity of the oculomotor difficulties, as measured by the DEM test. Results showed that 1) children with DCD presented mild atypical performance at the DEM test (error z-score only), 2) children with DD presented particularly poor performance at the DEM test, and 3) the co-morbid condition (DCD + DD) did not add to the severity of atypical performance at the DEM test. In sum, children with DCD were the less affected according to the DEM test, and children with DD (isolated or comorbid) presented the most atypical performance. Results at the DEM test did not allow to highlight clear oculomotor atypicalities in DCD. We thus concluded that more research using eye-tracking techniques is needed to explore the nature of oculomotor atypicalities in DCD children, to distinguish DD and DCD oculomotor behavior, and to understand the profile of children with dual diagnosis.     

A cognitive tool to diagnose predominantly inattentive ADHD behavior

Poor performance on tests of reading comprehension could be the result of weak word-recognition skills, inconsistent attention (ADD), or a combination of the two. Identifying the source of the reading disability (RD) reliably has been difficult because inconsistent attention interferes with reading and weak word recognition skill makes attention wander. The situation is further complicated by the fact that there are no objective diagnostic tests for ADD (Breggin, 1998; Diller, 1998). We proposed a new model of differential diagnosis of ADHD-I/RD and field-tested its utility in two studies. The new diagnostic procedure utilizes intra-individual differences seen in the performance of at-risk learners on tasks related to reading that vary in the degree of sustained attention required for successful performance. The hypothesis is that children whose attention is inconsistent would perform more poorly on tests such as listening comprehension, which require sustained attention, than on tests such as reading comprehension, which are more tolerant of inattention. Such differences will not be seen in the test scores of children who have only a reading disability because their performance on reading tests is determined more by the difficulty level of the tests than by the sensitivity of the tests to attention. The validity of this new model was evaluated by determining the relationship between differences seen in the scores of tests that differ in their attention requirement and the degree of inconsistency in sustained attention as measured by Conners' CPT. The results of the two studies indicate this to be a viable approach. The results of the second study are presented in this report.     

Good moments in Rational-Emotive Therapy: Some unique features of this approach

Two independent teams of judges used a general category system of good moments and an RET category system of good moments, respectively, in assessing all client statements in two audiotaped sessions conducted by Dr. Albert Ellis. A comparison of the findings from using the two category systems identified four unique features of RET. The features involved (a) unique RET good moments given by the RET literature; (b) additional general categories of good moments that are also obtained by RET; (c) unique RET methods of obtaining insight-understanding; and (d) unique RET methods of promoting behavior change.Wayne P. Nadler, Irit Sterner, and Eran A. Talitman are members of the psychotherapy research team, School of Psychology, University of Ottawa. Patricia A. Gervaize, Ph.D., is clinical research psychologist, Ottawa Civic Hospital and School of Medicine, University of Ottawa, as well as a member of the psychotherapy research team, University of Ottawa.