Assessment of impulsivity and the development of self-control in students with attention deficit hyperactivity disorder.

We examined a combined approach of manipulating reinforcer dimensions and delay fading to promote the development of self‐control with 3 students diagnosed with attention deficit hyperactivity disorder. First, we administered a brief computer‐based assessment to determine the relative influence of reinforcer rate (R), reinforcer quality (Q), reinforcer immediacy (I), and effort (E) on the students' choices between concurrently presented math problems. During each session, one of these dimensions was placed in direct competition with another dimension (e.g., RvI involving math problem alternatives associated with high‐rate delayed reinforcement vs. low‐rate immediate reinforcement), with all possible pairs of dimensions presented across the six assessment conditions (RvQ, RvI, RvE, QvI, QvE, IvE). The assessment revealed that the choices of all 3 students were most influenced by immediacy of reinforcement, reflecting impulsivity. We then implemented a self‐control training procedure in which reinforcer immediacy competed with another influential dimension (RvI or QvI), and the delay associated with the higher rate or quality reinforcer alternative was progressively increased. The students allocated the majority of their time to the math problem alternatives yielding more frequent (high‐rate) or preferred (high‐quality) reinforcement despite delays of up to 24 hr. Subsequent readministration of portions of the assessment showed that self‐control transferred across untrained dimensions of reinforcement.     

Evaluation of pharmacological treatment of impulsivity in children with attention deficit hyperactivity disorder

We used an assessment that involved competing reinforcer dimensions in a concurrent-schedules arrangement to examine the effects of stimulant medication on impulsivity (i.e., sensitivity of choices to reinforcer immediacy relative to rate, quality, and effort) with 4 students with attention deficit hyperactivity disorder. The assessments were administered in the context of a double-blind, placebo-controlled, counterbalanced reversal design. Reinforcer immediacy was the most influential dimension for 3 of the students and the second most influential dimension for 1 of the students across placebo and medication conditions; medication did not affect these sensitivities.     

Behavioral assessment of impulsivity: a comparison of children with and without attention deficit hyperactivity disorder

We conducted a brief computer-based assessment involving choices of concurrently presented arithmetic problems associated with competing reinforcer dimensions to assess impulsivity (choices controlled primarily by reinforcer immediacy) as well as the relative influence of other dimensions (reinforcer rate, quality, and response effort), with 58 children. Results were compared for children with attention deficit hyperactivity disorder (ADHD) who were and were not receiving medication, and with typically developing children without ADHD. Within-subject and between-groups analyses of the ordinal influence of each of the reinforcer dimensions were conducted using both time- and response-allocation measures. In general, the choices of children with ADHD were most influenced by reinforcer immediacy and quality and least by rate and effort, suggesting impulsivity. The choices of children in the non-ADHD group were most influenced by reinforcer quality, and the influence of immediacy relative to the other dimensions was not statistically significant. Results are discussed with respect to the implications for assessment and treatment of ADHD.     

Noncontingent peer attention as treatment for disruptive classroom behavior

A functional analysis isolated peer attention as the primary maintaining variable for disruptive behavior displayed by a student with attention deficit hyperactivity disorder. Using a brief reversal design, noncontingent reinforcement was then shown to reduce disruptive behavior relative to the peer attention condition. Implications for assessing behavior disorders in mainstream school settings are discussed.     

An investigation of differential reinforcement of alternative behavior without extinction

We manipulated relative reinforcement for problem behavior and appropriate behavior using differential reinforcement of alternative behavior (DRA) without an extinction component. Seven children with developmental disabilities participated. We manipulated duration (Experiment 1), quality (Experiment 2), delay (Experiment 3), or a combination of each (Experiment 4), such that reinforcement favored appropriate behavior rather than problem behavior even though problem behavior still produced reinforcement. Results of Experiments 1 to 3 showed that behavior was often sensitive to manipulations of duration, quality, and delay in isolation, but the largest and most consistent behavior change was observed when several dimensions of reinforcement were combined to favor appropriate behavior (Experiment 4). Results suggest strategies for reducing problem behavior and increasing appropriate behavior without extinction.     

Temporal discounting: basic research and the analysis of socially important behavior

Recent basic research on human temporal discounting is reviewed to illustrate procedures, summarize key findings, and draw parallels with both nonhuman animal research and conceptual writings on self-control. Lessons derived from this research are then applied to the challenge of analyzing socially important behaviors such as drug abuse, eating and exercise, and impulsiveness associated with attention deficit hyperactivity disorder. Attending to the broader temporal context in which behavior occurs may aid in the analysis of socially important behavior. Applying this perspective to the study of behavior in natural environments also highlights the importance of combining methodological flexibility with conceptual rigor to promote the extension of applied behavior analysis to a broader array of socially important behaviors.     

An evaluation of methylphenidate as a potential establishing operation for some common classroom reinforcers.

We conducted reinforcer assessments for 3 boys with a diagnosis of attention deficit hyperactivity disorder who alternately received either placebo or previously prescribed methylphenidate. Our purpose was to evaluate whether methylphenidate altered the relative reinforcing effectiveness of various stimuli that are often used in classroom-based behavioral treatment programs (e.g., activities, tangible items). Results showed clear differences for some stimuli between reinforcer assessments conducted when participants had received methylphenidate compared to placebo. Results suggest that methylphenidate might act as an establishing operation for some common classroom reinforcers. Implications for the development and evaluation of behavioral treatments are discussed.     

THE DIFFERENTIAL EFFECTS OF TEACHER AND PEER ATTENTION ON THE DISRUPTIVE CLASSROOM BEHAVIOR OF THREE CHILDREN WITH A DIAGNOSIS OF ATTENTION DEFICIT HYPERACTIVITY DISORDER

We conducted functional analyses of classroom disruption during contingent teacher and peer attention conditions for 3 children with attention deficit hyperactivity disorder. Attention provided by peer confederates appeared to function as a distinct form of positive reinforcement for all 3 children.     

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.     

Effects of modeling versus instructions on sensitivity to reinforcement schedules

This study examined the effects of modeling versus instructions on the choices of 3 typically developing children and 3 children with attention deficit hyperactivity disorder (ADHD) whose academic responding showed insensitivity to reinforcement schedules. During baseline, students chose between successively presented pairs of mathematics problems associated with different variable-interval schedules of reinforcement. After responding proved insensitive to the schedules, sessions were preceded by either instructions or modeling, counterbalanced across students in a multiple baseline design across subjects. During the instruction condition, students were told how to distribute responding to earn the most reinforcers. During the modeling condition, students observed the experimenter performing the task while describing her distribution of responding to obtain the most reinforcers. Once responding approximated obtained reinforcement under either condition, the schedules of reinforcement were changed, and neither instruction nor modeling was provided. Both instruction and modeling interventions quickly produced patterns of response allocation that approximated obtained rates of reinforcement, but responding established with modeling was more sensitive to subsequent changes in the reinforcement schedules than responding established with instructions. Results were similar for students with and without ADHD.     

A confirmatory factor analysis on the DSM-IV ADHD and ODD symptoms: what is the best model for the organization of these symptoms?

Confirmatory factor analysis (CFA) was used to evaluate five different models for the organization of the DSM-IV ADHD and oppositional defiant disorder (ODD) symptoms (Model 1: a single factor model; Model 2: an ADHD and ODD two factor model; Model 3a: an inattention (INA), hyperactivity/impulsivity (HYP/IMP), and ODD three factor model; Model 3b: an INA, HYP/IMP, and ODD three factor model where the three IMP symptoms cross-load on the ODD factor; Model 4: an INA, HYP, IMP, and ODD four factor model). To evaluate these models, maternal ratings of ADHD and ODD symptoms were obtained at outpatient pediatric clinics on 742 children not in treatment and 91 children in treatment for ADHD. Model 3a resulted in a good fit as well as a significantly better fit than Model 2. Model 3a was also equivalent across treatment status, gender, and age groupings for the most part. Though Models 3b and 4 provided a statistically better fit than Model 3a, the improvement in fit was small and other model selection criteria argued against these more complex models.     

A Preliminary Study of ADHD Symptoms and Correlates: Do Abused Children Differ from Nonabused Children?

In this pilot study, differences in inattention, impulsivity, and hyperactivity as well as demographic factors were investigated in a community sample of 8- through 11-year-olds, approximately half of whom had experienced child abuse or neglect. Parents completed the Attention Deficit Hyperactivity Disorder Test, the SNAP-IV, the Brief Betrayal Trauma Survey – Parent version, and additional questions. Abused children had more severe impulsivity and inattention, but not hyperactivity, symptoms. Abused boys and girls had a similar age of onset of symptoms, whereas nonabused girls had a much later age of onset than nonabused boys. ADHD is a significant problem among maltreated children. These data support large scale studies investigating possible differences in etiology, presentation, and treatment.     

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.     

A preliminary analysis of instructional control in the maintenance of appropriate behavior

This bridge study evaluated the effects of contingency-specifying instructions (CSIs) and incomplete instructions (IIs) in terms of establishing instructional control of appropriate behavior. Results suggested that instructional control and maintenance were achieved with CSIs but not with IIs. Results are discussed in terms of the potential use of instructional control in the maintenance of appropriate behavior for children with attention deficit hyperactivity disorder.     

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.     

A procedure to teach self-control to children with attention deficit hyperactivity disorder

This study examined the use of a progressive delay procedure combined with verbal mediation to teach self-control to children with attention deficit disorder. Results showed that when participants were initially given the choice between an immediate smaller reinforcer and a larger delayed reinforcer, all participants chose the smaller reinforcer. When slight delays to obtain a larger reinforcer were instated in conjunction with intervening verbal activity, all participants demonstrated self-control regardless of the content of the verbal activity.     

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.     

内侧前额皮层-伏隔核环路在决策冲动中的作用：基于动物模型的研究

注意缺陷多动障碍(attentiondeficit/hyperactivitydisorder,ADHD)行为控制不足与决策冲动密切相关,后者受内侧前额皮层(medial prefrontal cortex, mPFC)与伏隔核(nucleus accumbens, NAc)调节。为调查ADHD决策冲动与m PFC-NAc间功能耦合的关系,研究采用ADHD模型SHR (spontaneously hypertensive rat, SHR)大鼠,结合延迟折扣任务和在体电生理,研究发现,与对照Wistar (WIS)大鼠相比, SHR大鼠对延迟大奖赏的选择百分比降低; WIS大鼠m PFC-NAc的Theta频段相干值表现为延迟选择时显著大于立即选择时、首次选择时大于连续选择时、转换试次时大于连续试次时,而SHR大鼠在上述条件均低于WIS大鼠。回归分析发现m PFC-NAc的相干差值与延迟大奖赏选择率显著正相关。结果表明m PFC-NAc间功能联系减弱是ADHD决策冲动缺陷的重要环路基础,该缺陷与其深度信息加工以及策略转换能力受损有关,扩展了ADHD决策冲动的认知和神经机制的认识。