An evaluation of stimulant medication on the reinforcing effects of play

Although a vast literature has indicated that stimulant medications are effective for reducing inappropriate behavior in children with attention deficit hyperactivity disorder (ADHD), the effects of stimulant medication on ancillary behaviors (e.g., play) have yet to be investigated with the same rigor. We used a reinforcer assessment procedure to evaluate the effects of medication on the play and social behavior of 5 preschool children who had been diagnosed with ADHD. Conditions included (a) social reinforcement (i.e., playing with friends), (b) alone play, and (c) quiet time (i.e., resting). Results indicated that 1 of the 5 participants selected fewer social reinforcers and more nonsocial reinforcers (alone play or quiet time) while on medication. The findings indicate that the reinforcer assessment procedure may be a viable way to evaluate medication effects on an ongoing basis and to inform treatment decisions.     

Functional analysis and treatment of elopement for a child with attention deficit hyperactivity disorder

We conducted a functional analysis of elopement in an outdoor setting for a child with a diagnosis of attention deficit hyperactivity disorder. A subsequent treatment consisting of noncontingent attention and time-out was demonstrated to be effective in eliminating elopement. Modifications of functional analysis procedures associated with the occurrence of elopement in a natural setting are demonstrated.     

EFFECTS OF STIMULANT MEDICATION UNDER VARIED MOTIVATIONAL OPERATIONS

We evaluated the evocative effects of four conditions (high‐ and low‐preference activities, low and divided attention) and stimulant medication on the behavior of a 16‐year‐old boy with attention deficit hyperactivity disorder and moderate mental retardation. All behavior (activity engagement, activity changes, inappropriate touching, rude behaviors, and physical aggression) improved with stimulant medication in most conditions, but undesirable behaviors were not reduced to acceptable levels in all conditions. This finding suggests that stimulant medication may be a valuable adjunct to function‐based interventions.     

Testing the ability of children with attention deficit hyperactivity disorder to accurately report the effects of medication on their behavior

Children with attention deficit hyperactivity disorder (ADHD) are often treated with central nervous system stimulants, making the evaluation of medication effects an important topic for applied behavior analysts. Because assessment protocols emphasize informant reports and direct observations of child behavior, little is known about the extent to which children themselves can accurately report medication effects. Double-blind placebo-controlled procedures were used to examine whether 6 children with ADHD could recognize the effects of their medication. The children were given math worksheets to complete for 15 min during each of 14 sessions while on medication and placebo. Children completed a self-evaluation form at the end of each session, and ratings were compared to observed behavior and academic performance. Results indicated that 3 children were able to accurately report their medication status at levels greater than chance, whereas the accuracy of reports by all children was related to dosage level, differences in behavior, and the presence of adverse effects. The implications of these results for placebo-controlled research, self-monitoring of dosage levels, and accuracy training are discussed.     

ADHD儿童与正常儿童在视觉—动作方面的比较研究

10岁到13岁男性ADHD儿童在镶嵌图形、眼手协调、视力追踪和数字划销等视觉—动作实验上的分数显著低于同一年龄段的男性正常儿童,显示ADHD儿童的视觉—动作能力比正常儿童差.ADHD儿童与正常儿童相比,知觉方式的场独立性较弱,心理机能分化程度较低.ADHD儿童在长度估计实验上没有发现异常.     

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.     

Does the Conners' Continuous Performance Test Aid in ADHD Diagnosis?

The performance of clinic-referred children aged 6–11 (N = 100) was examined using the Conners' Continuous Performance Test (CPT) and measures of auditory attention (Auditory Continuous Performance Test; ACPT), phonological awareness, visual processing speed, and visual-motor competence. The Conners' CPT overall index was unrelated to measures of visual processing speed or visual-motor competence. Although the Conners' CPT converged with the ACPT, the latter demonstrated age and order effects. Significant variance in Conners' CPT parameters was predicted by phonological awareness measures, suggesting that Reading Disordered (RD) children could be false positives on the Conners' CPT. The Conners' CPT overall index, phonological awareness, and visual-motor measures were submitted to a 2×2 MANCOVA (ADHD vs. RD, covarying for age and socieoeconomic status): a main effect for RD status was found. Children with ADHD did not have higher Conners' CPT scores than did clinical controls; however, children with Reading Disorders did. Phonological measures distinguished RD children from ADHD children and other clinical controls. ADHD children who failed the Conners' CPT were rated by teachers as more hyperactive. Despite the strengths of the Conners' CPT, its utility for differential diagnosis of ADHD is questioned.     

Critique or Misrepresentation? A Reply to Timimi et al.

In rebuttal to Timimi et al., we show that their critique is not a form of reasonable scientific debate with informed, constructive criticism, but merely a misrepresentation of the existing scientific literature on ADHD apparently designed to convince the scientifically uninformed of its nonexistence and of the misuse of medications for its management. We show their argument to be based on faulty logic, selective citation, misreprensentation of individual studies, ignorance of the vast literature on ADHD, and innuendo that maligns the integrity of scientists studying the disorder. Our original International Consensus Statement on ADHD remains untarnished by this faux critique – indeed it was intended to refute just such unsupported and unsupportable criticism that often appears in the popular media.     

A RAPID METHOD FOR EVALUATING THE NECESSITY FOR BOTH A BEHAVIORAL INTERVENTION AND METHYLPHENIDATE

We examined the effects of a behavioral intervention and methylphenidate (MPH) on inappropriate behavior and sleep disturbance displayed by a 6-year-old boy who had been diagnosed with attention deficit hyperactivity disorder. Results showed that the behavioral intervention was effective in reducing inappropriate behaviors to near-zero levels regardless of the presence or absence of MPH.     

Comprehensive school-based behavioral assessment of the effects of methylphenidate.

Individualized assessments of the effects of three doses of methylphenidate (MPH) were conducted for 2 students with attention deficit hyperactivity disorder within each child's classroom using behavioral, academic, and social measures. A double-blind, placebo-controlled, multielement design was used to evaluate the results. Results suggested that at least one or more dosages of MPH were associated with some degree of improvement for both children in each area of functioning as compared to placebo. However, the degree of improvement at times varied substantially across dosage and area of functioning. Results suggest that MPH dosage and area of child functioning are critical assessment parameters and that controlled clinical trials are necessary to optimize the effectiveness of treatment with MPH for the individual child.     

Further evaluation of the accuracy of reinforcer surveys: a systematic replication

The present report evaluates the accuracy of a reinforcer survey by comparing the survey results to the results of subsequent reinforcer assessments for 20 children using a concurrent-operants arrangement to assess relative reinforcer preference. Total accuracy for the survey was determined to be approximately 57%. The results provide a systematic replication of Northup et al. (1996) with a much larger sample of children. A need for the development of more accurate and comprehensive reinforcer assessment methods for verbal children is discussed.     

Response efficiency during functional communication training: effects of effort on response allocation

An analogue functional analysis revealed that the problem behavior of a young child with developmental delays was maintained by positive reinforcement. A concurrent-schedule procedure was then used to vary the amount of effort required to emit mands. Results suggested that response effort can be an important variable when developing effective functional communication training programs.     

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.     

The Predictive Validity of Parent and Teacher Reports of ADHD Symptoms

The objectives were to evaluate the ability of the Inattention and Hyperactivity–Impulsivity factors of the ADHD Rating Scale-IV to differentiate children with ADHD from a control group and to discriminate children with different subtypes of ADHD. Also, we sought to determine optimal cutoff scores on the teacher and parent versions of this scale for making diagnostic decisions about ADHD. In a sample of 92 boys and girls 6 to 14 years of age referred to a regional ADHD program, we assessed ADHD diagnostic status using categorical and dimensional approaches as well as parent- and teacher-report measures. Logistic regression analyses showed that the Inattention and Hyperactivity–Impulsivity factors of the ADHD Rating Scale-IV were effective in discriminating children with ADHD from a control group and differentiating children with ADHD, Combined Type from ADHD, Inattentive Type. Although both teacher and parent ratings were significantly predictive of diagnostic status, teacher ratings made a stronger contribution to the prediction of subtype membership. Using symptom utility estimates, optimal cutoff scores on the Inattention and Hyperactivity–Impulsivity scales for predicting subtypes of ADHD were determined.     

注意缺陷多动障碍-发展性阅读障碍共患儿童的干预效果及其内在机理

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

Training Children to Make Accurate Self-Evaluations: Effects on Behavior and the Quality of Self-Ratings

Research has shown that self-evaluation can have positive effects on children's behavior and academic performance. Components of self-evaluation that have not been fully examined include the accuracy and sensitivity of students' ratings before and after training, as well as the effects of accuracy training on performance. Four students exhibiting behavior consistent with Attention Deficit Hyperactivity Disorder (ADHD) participated in the study. The students' behavior during academic activities and accuracy of self-evaluations were examined before and after accuracy training in comparison to direct observations of behavior. None of the students accurately rated his behavior prior to training. Self-evaluation alone decreased disruptive behavior for only one student, whereas self-evaluation plus accuracy training decreased the disruptive behavior of all four students. Once accuracy training was withdrawn, the level of disruptive behavior increased for three of the four students. Implications of these results for the quality and utility of self-evaluation measures and the role of accuracy training in self-evaluation effects are discussed.     

Depression and Self-Esteem in Boys with Attention-Deficit/Hyperactivity Disorder: Associations with Comorbid Aggression and Explanatory Attributional Mechanisms

It was tested whether boys with attention-deficit/hyperactivity disorder (ADHD), subgrouped by aggressive status, would show higher rates of depressive symptomatology and lower levels of self-esteem than would comparison boys and, in a subsample, explored attributional mechanisms that may be related to such internalizing features. Study 1 utilized 114 boys with ADHD (all prior recipients of stimulant medication) and 87 comparison boys, aged 7–12 years. Aggressive boys with ADHD reported more symptoms of depression than did nonaggressive boys with ADHD, who, in turn, reported more depression than did comparison boys. Effect sizes were moderate to large and did not vary with a depression rating scale uncontaminated by ADHD-related items. For self-esteem, the most pronounced effect was that aggressive boys with ADHD showed lower levels than did nonaggressive ADHD or comparison boys; effects were again moderate to large. Study 2 participants were a subsample of boys with ADHD from Study 1 (N = 27). We probed causal attributions in ADHD-related domains through responses to hypothetical vignettes, in which the protagonist's medication status (medicated, not medicated) was crossed with type of outcome (good, bad). Medication-related attributions were frequent. In describing the protagonist's success in relation to medication treatment, the sample showed significant associations between (a) medication-related attributions and (b) increased depressive symptomatology as well as decreased self-esteem. We discuss attributional processes that may help to explain the variation in internalizing symptoms among children with ADHD.     

Selective inhibition in children with attention-deficit hyperactivity disorder off and on stimulant medication

Selective inhibition requires discrimination between auditory signals and is assessed using a modification of the stop-signal task. Selective inhibition was assessed in a group of 59 clinic-referred, DSM-IV-diagnosed children with attention-deficit hyperactivity disorder (ADHD) and compared to that of a community sample of 59 children. Methylphenidate (MPH) effects on selective inhibition were assessed in a subset of the ADHD sample that participated in an acute, randomized, placebo-controlled, crossover trial with 3 fixed doses of MPH. Children with ADHD performed more poorly than controls on the majority of selective stop-signal task parameters: they exhibited more anticipatory (invalid) responses, with less accurate and more variable responses on the response execution task, as well as a slower selective inhibition process. MPH improved speed of both inhibition and response execution processes; it also reduced variability of response execution and decreased nonselective inhibition. On the one hand, findings are consistent with purported inhibition deficit in ADHD, but on the other hand, suggest that neither the impairment itself, nor MPH effects, were restricted to inhibition.     

A COMPARISON OF REINFORCER ASSESSMENT METHODS: THE UTILITY OF VERBAL AND PICTORIAL CHOICE PROCEDURES

We compared three methods of stimulus preference assessment for verbal children and specifically evaluated the utility of a verbal choice procedure for assessing relative reinforcer value. Using a token system, relative preference for five categories of reinforcers, representing 15 different stimuli, was assessed by three methods: a reinforcer survey, a verbal stimulus-choice questionnaire, and a pictorial stimulus-choice procedure. Results showed that the verbal and pictorial stimulus-choice assessments accurately identified high- and low-preference categories for 3 of 4 participants. Survey results alone often rated multiple categories as high preference, were less likely to identify low-preference categories, and were less likely to correspond with the results of a reinforcer assessment.