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.     

Parenting cognitions and treatment beliefs as predictors of experience using behavioral parenting strategies in families of children with attention-deficit/hyperactivity disorder

We tested a model of mothers' parenting efficacy and attributions for child ADHD behaviors as predictors of experiences with behavioral treatment. The model proposed that mothers' beliefs regarding the acceptability and effectiveness of behavioral strategies would intervene between mothers' cognitions about parenting and child behavior and their treatment experiences. Participants were 101 mothers of 5- to 10-year-old children (82% male) with ADHD. Mothers reported their parenting efficacy and attributions for child behavior, and then received a single session of treatment teaching 2 behavior management strategies. Then, mothers reported their beliefs regarding the acceptability and effectiveness of these strategies. A follow-up phone interview 1 week later assessed mothers' experiences in using the behavioral strategies. The overall model fit the data. Attributions of child ADHD behavior as more pervasive, enduring, and within the child's control were related to seeing behavioral treatment as more acceptable, but neither attributions nor treatment acceptability predicted treatment experience. However, mothers with higher parenting efficacy viewed the behavioral strategies as more likely to be effective, and this pathway significantly predicted positive treatment experience. Implications for understanding the variables that contribute to parental decision-making and treatment participation for childhood ADHD are considered.     

The self-perceptions and attributions of attention deficit hyperactivity disordered and nonreferred boys

Compared the self perceptions and attributions of attention deficit hyperactivity disordered (ADHD) and control boys. The ADHD boys viewed themselves as no worse than control boys on self-perceived competence and global selfworth, especially when internalizing symptomatology was taken into account statistically through covariance analyses. In terms of attributions, the ADHD boys were more likely to take responsibility for social successes and less likely to take responsibility for social failures than the control boys. Although the ADHD boys scored significantly higher on the Children's Depression Inventory, this difference was no longer significant when items dealing with behavior, school, and social problems were excluded. The results are discussed in terms of their implications for understanding how the attributions and selfperceptions of ADHD boys may mediate their performance in challenging academic and social situations.An earlier version of this paper was presented at the 1992 Annual Meeting of the Society for Research in Child and Adolescent Psychopathology, Sarasota, Florida. The first author was supported in part by grants from the National Institute of Mental Health (MH47390 and MH48157) and the Clinical Research Center (MH30915). The second author was supported in part by grants from the National Institute on Alcohol Abuse and Alcoholism (AA06267), the National Institute on Drug Abuse (DA05605), and the National Institute of Mental Health (MH48157). The fourth author was supported by a grant from the College of Arts and Sciences of the University of Kentucky.     

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.     

PDD Symptoms in ADHD,an Independent Familial Trait?

The aims of this study were to investigate whether subtle PDD symptoms in the context of ADHD are transmitted in families independent of ADHD, and whether PDD symptom familiality is influenced by gender and age. The sample consisted of 256 sibling pairs with at least one child with ADHD and 147 healthy controls, aged 5–19 years. Children who fulfilled criteria for autistic disorder were excluded. The Children’s Social Behavior Questionnaire (CSBQ) was used to assess PDD symptoms. Probands, siblings, and controls were compared using analyses of variance. Sibling correlations were calculated for CSBQ scores after controlling for IQ, ADHD, and comorbid anxiety. In addition, we calculated cross-sibling cross-trait correlations. Both children with ADHD and their siblings had higher PDD levels than healthy controls. The sibling correlation was 0.28 for the CSBQ total scale, with the CSBQ stereotyped behavior subscale showing the strongest sibling correlation (r = 0.35). Sibling correlations remained similar in strength after controlling for IQ and ADHD, and were not confounded by comorbid anxiety. Sibling correlations were higher in female than in male probands. The social subscale showed stronger sibling correlations in elder than in younger sibling pairs. Cross-sibling cross-trait correlations for PDD and ADHD were weak and not-significant. The results confirm that children with ADHD have high levels of PDD symptoms, and further suggest that the familiality of subtle PDD symptoms in the context of ADHD is largely independent from ADHD familiality.     

Cuban Mothers' Schemas of ADHD: Development, Characteristics, and Help Seeking Behavior

Parents play a crucial role in the diagnosis and treatment of Attention-Deficit Hyperactivity Disorder (ADHD), one of the most prevalent developmental disorders of young children We report the findings of a qualitative study of Cuban-American mothers of 7 to 10 year old children with ADHD. Results suggest that mothers lacked a cultural model for ADHD and held a cultural model of normal child development which hampered their development of a schema of ADHD. Development of ADHD schemas were motivated by perplexity at their children's behavior and by the high value mothers ascribed to academic achievement. Although the schemas developed by the mothers were labeled as ADHD, their behavioral characterizations of their children, their attributions for the condition and for its causes, and their management strategies were not always in agreement with those of the biomedical model for the condition. However, once mothers classified their children's behavior as atypical, they actively sought assistance from the professional sector.     

Parental Attributions of the Causes of Their Children's Behavior

We investigated causal attributions parents made regarding their children's best and worst behavior while the children were taking methylphenidate (MPH) for Attention-Deficit Hyperactivity Disorder (ADHD). Twenty-six parents were surveyed each week for six weeks using the Parent Attribution Scale-Revised. This scale measures parents' attributions of the causes for their children's behavior when taking MPH to treat symptoms of ADHD. When attributing causes for best behavior, the parents rated their children's effort most often followed by their own effort and the positive medication effects. When attributing causes for worst behavior, the parents rated their children's lack of effort most often followed by inadequate medication effects and their own lack of effort. Our study suggests that parents rate effort most often when making attributions for their children's best and worst behavior. When making attributions for best behavior only, parents saw no difference between their own efforts and the effects of medication. When making attributions for worst behavior only, parents were more likely to blame their children's lack of effort and the ineffectiveness of medication more often than their own lack of effort.     

Neuropsychological functioning in nonreferred siblings of children with attention deficit/hyperactivity disorder

The goal of this study was to assess neuropsychological functioning in nonreferred siblings of children with attention deficit/hyperactivity disorder (ADHD). Participants were 156 siblings of ADHD probands with (N = 40) and without (N = 116) ADHD (according to criteria of the Diagnostic and Statistical Manual of Mental Disorders (3rd edition, revised; American Psychiatric Association, 1987) and 118 siblings of non-ADHD normal controls of similar age, IQ, and grade level. Information on attention, executive, and memory functions was obtained in a standardized manner without knowledge of clinical status. Compared with siblings of controls, siblings with ADHD were significantly impaired on the Stroop test and on verbal learning and memory. In contrast, siblings without ADHD were similar to controls on virtually all measures. These data suggest that some executive, attention, and verbal learning deficits are found in nonreferred individuals with ADHD but that neuropsychological deficits are unlikely to constitute an endophenotype to ADHD.     

An investigation into the psychosocial functioning of creative children: The impact of ADHD symptomatology

This study examined the relationship among creativity, ADHD symptomatology, temperament, and psychosocial functioning by comparing four groups of children aged 10–12 years: (1) 29 ADHD children without creativity, (2) 16 highly creative children displaying ADHD symptomatology, (3) 18 highly creative children without ADHD symptomatology, and (4) 30 normal controls. Children completed the TTCT, Child Depression Inventory, Revised Child Manifest Anxiety Scale, and Rosenberg Self‐Esteem Scale. Parents completed the Junior Temperament and Character Inventory, Family Environment Scale, and the parent version of the Kastan Children's Attributional Style Questionnaire. Parents completed the Conner's Rating Scales and Child Behavior Checklist, and teachers completed the Child Behaviour Checklist. Results showed that the presence of ADHD symptomatology in creative children was related to their temperamental characteristics, and parent reports of children's levels of anxiety and depression. However, family environment and mother's attributions did not appear to be related to the presence of ADHD symptomatology in creative children. These findings have implications for the development and management of creative children.     

An Investigation into the Relationship Among ADHD Symptomatology,Creativity, and Neuropsychological Functioning in Children

This paper examined the relationship between creativity and ADHD symptomatology. First, the presence of ADHD symptomatology within a creative sample was explored. Secondly, the relationship between cognitive functioning and ADHD symptomatology was examined by comparing four groups, aged 10–12 years: 1) 29 ADHD children without creativity, 2) 12 creative children with ADHD symptomatology, 3) 18 creative children without ADHD symptomatology, and 4) 30 controls. Creativity, intelligence, processing speed, reaction time, working memory, and inhibitory control were measured. Results showed that 40% of the creative children displayed clinically elevated levels of ADHD symptomatology, but none met full criteria for ADHD. With regard to cognitive functioning, both ADHD and creative children with ADHD symptoms had deficits in naming speed, processing speed, and reaction time. For all other cognitive measures the creative group with ADHD symptoms outperformed the ADHD group. These findings have implications for the development and management of creative children.     

An investigation into the relationship among ADHD symptomatology, creativity, and neuropsychological functioning in children.

This paper examined the relationship between creativity and ADHD symptomatology. First, the presence of ADHD symptomatology within a creative sample was explored. Secondly, the relationship between cognitive functioning and ADHD symptomatology was examined by comparing four groups, aged 10-12 years: 1) 29 ADHD children without creativity, 2) 12 creative children with ADHD symptomatology, 3) 18 creative children without ADHD symptomatology, and 4) 30 controls. Creativity, intelligence, processing speed, reaction time, working memory, and inhibitory control were measured. Results showed that 40% of the creative children displayed clinically elevated levels of ADHD symptomatology, but none met full criteria for ADHD. With regard to cognitive functioning, both ADHD and creative children with ADHD symptoms had deficits in naming speed, processing speed, and reaction time. For all other cognitive measures the creative group with ADHD symptoms outperformed the ADHD group. These findings have implications for the development and management of creative children.     

Differences in feedback- and inhibition-related neural activity in adult ADHD

The objective of this study was to examine response inhibition- and feedback-related neural activity in adults with attention deficit hyperactivity disorder (ADHD) using event-related functional MRI. Sixteen male adults with ADHD and 13 healthy/normal controls participated in this study and performed a modified Go/NoGo task. Behaviourally, attention and inhibition problems in the ADHD group were observed; no feedback-related differences between the groups were detected. The neuroimaging data showed that the ADHD group displayed more activation in the inferior frontal gyrus and putamen during response inhibition. During feedback-related processes, the ADHD group displayed less activation in the inferior frontal/orbitofrontal cortex, hippocampus/nucleus accumbens, and caudate nucleus, but more activity in the inferior frontal gyrus. These results indicate that at least two distinguishable underlying brain networks related to response inhibition and feedback are altered in adults with ADHD.     

Default mode network connectivity and social dysfunction in children with Attention Deficit/Hyperactivity Disorder

ObjectiveAttention Deficit/Hyperactivity Disorder (ADHD) negatively affects social functioning; however, its neurological underpinnings remain unclear. Altered Default Mode Network (DMN) connectivity may contribute to social dysfunction in ADHD. We investigated whether DMN's dynamic functional connectivity (dFC) alterations were associated with social dysfunction in individuals with ADHD.MethodsResting-state fMRI was used to examine DMN subsystems (dorsal medial prefrontal cortex (dMPFC), medial temporal lobe (MTL)) and the midline core in 40 male ADHD patients (7-10 years) and 45 healthy controls (HCs). Connectivity correlations with symptoms and demographic data were assessed. Group-based analyses compared rsFC between groups with two-sample t-tests and post-hoc analyses.ResultsSocial dysfunction in ADHD patients was related to reduced DMN connectivity, specifically in the MTL subsystem and the midline core. ADHD patients showed decreased dFC between parahippocampal cortex (PHC) and left superior frontal gyrus, and between ventral medial prefrontal cortex (vMPFC) and right middle frontal gyrus compared to HCs (MTL subsystem). Additionally, decreased dFC between posterior cingulate cortex (PCC), anterior medial prefrontal cortex (aMPFC), and right angular gyrus (midline core) was observed in ADHD patients relative to HCs. No abnormal connectivity was found within the dMPFC.ConclusionPreliminary findings suggest that DMN connectional abnormalities may contribute to social dysfunction in ADHD, providing insights into the disorder's neurobiology and pathophysiology.     

Risky Decision Making in Substance Dependent Adolescents with a Disruptive Behavior Disorder

Of all psychiatric disorders, the disruptive behavior disorders (DBDs) are the most likely to predispose to substance dependence (SD). One possible underlying mechanism for this increased vulnerability is risky decision making. The aim of this study was to examine decision making in DBD adolescents with and without SD. Twenty-five DBD adolescents (19 males) with SD (DBD+SD), 28 DBD adolescents (23 males) without SD (DBD-SD) and 99 healthy controls (72 males) were included in the study. DBD adolescents with co-morbid attention deficit/ hyperactivity disorder (ADHD) were excluded. Risky decision making was investigated by assessing the number of disadvantageous choices in the Iowa gambling task. DBD+SD made significantly more risky choices than healthy controls and DBD-SD. Healthy controls and DBD-SD did not differ on risky decision making. These results suggest that risky decision making is a vulnerability factor for the development of SD in a subgroup of adolescents with DBD without ADHD.     

Relationship between reaction time variability and motor skill development in ADHD

Slower and more variable reaction times to computerized tasks have been documented in children diagnosed with attention deficit/hyperactivity disorder (ADHD). Recent research supports a role for attentional lapses in generating abnormally variable and slow responses. However, given the association between ADHD and impairments in motor control, we hypothesized that slower or more variable reaction times might also correlate with motor development. The aim of this case-control study was to explore the relationship between motor function, reaction speed and variability, and ADHD. After comprehensive educational and clinical assessments, motor skill development was evaluated in 35 children ages 9 to 14 (19 with ADHD) using the Physical and Neurological Examination for Subtle Signs (PANESS) test battery. Finger-sequencing speed and variability were quantified with goniometers. Reaction times were measured with 20 trials each of computerized simple and choice (binary) tasks. Compared to healthy controls, children with ADHD had slower and more variable reaction times, and these findings correlated with impaired motor development (PANESS) and slow and variable finger sequencing (goniometers). Further studies of motor development in ADHD may identify factors influencing speed and variability of reaction times.     

Relationship between reaction time variability and motor skill development in ADHD

Slower and more variable reaction times to computerized tasks have been documented in children diagnosed with attention deficit/hyperactivity disorder (ADHD). Recent research supports a role for attentional lapses in generating abnormally variable and slow responses. However, given the association between ADHD and impairments in motor control, we hypothesized that slower or more variable reaction times might also correlate with motor development. The aim of this case-control study was to explore the relationship between motor function, reaction speed and variability, and ADHD. After comprehensive educational and clinical assessments, motor skill development was evaluated in 35 children ages 9 to 14 (19 with ADHD) using the Physical and Neurological Examination for Subtle Signs (PANESS) test battery. Finger-sequencing speed and variability were quantified with goniometers. Reaction times were measured with 20 trials each of computerized simple and choice (binary) tasks. Compared to healthy controls, children with ADHD had slower and more variable reaction times, and these findings correlated with impaired motor development (PANESS) and slow and variable finger sequencing (goniometers). Further studies of motor development in ADHD may identify factors influencing speed and variability of reaction times.     

Evidence for specificity of ERP abnormalities during response inhibition in ADHD children: A comparison with reading disorder children without ADHD

Executive function and working memory deficits are not only present in ADHD, but also in reading disorder (RD). Here, high-density ERPs were recorded during the Stop Signal Task in 53 children and adolescents: An ADHD-combined type group, a group with RD, and a healthy control group. The ADHD-C group displayed unique abnormalities of the frontal N200. Both healthy controls and RD groups showed a success-related right frontal N200 modulation, which was absent in the ADHD group. Second, for Success Inhibition trials, the ADHD-C had smaller right frontal N200 waves relative to healthy controls, while the RD group did not. In contrast, NoGo-P3 abnormalities were present both in the ADHD-C and RD groups. Impaired early response inhibition mechanisms, indexed by the frontal N200, appear to be limited to ADHD-C. In contrast, deficits in later cognitive control and error monitoring mechanisms, indexed by the NoGo-P3, appear to be present in both conditions.     

The attributions of children with Attention-Deficit/ Hyperactivity Disorder for their problem behaviors

This study investigated the attributions children with ADHD make about their most problematic symptoms. Children were interviewed to determine the degree to which they felt their behavior was controllable, stable, global, and stigmatizing; and about the locus of the cause of their behavior. Participants were 16 children with ADHD (10 boys, 6 girls), and 16 children without ADHD (9 boys, 7 girls), ages 7 to 13. The present study demonstrated that children with ADHD viewed their most problematic behaviors as less within their control and more global across situations than children without ADHD. Children with ADHD were more likely than children without ADHD to view their most problematic behavior as always having been present, but were no more likely to view their most problematic behavior as persisting into the future. No significant group differences emerged on the locus of causality dimension. With regards to stigmatization, girls without ADHD reported that their behaviors can bother their teachers, parents, and peers, whereas girls and boys with ADHD did not perceive their behavior as bothersome.     

Verbal fluency over time as a measure of automatic and controlled processing in children with ADHD

The performance of ADHD children on semantic category fluency (SCF) versus initial letter fluency (ILF) tasks was examined. For each participant, word production was recorded for each 15-s time slice on each task. Performance on both fluency tasks was compared to test the hypothesis that children with ADHD are characterized by a performance deficit on the ILF task because performance on this task is less automated than performance on the SCF. Children classified with ADHD (N = 20) were compared to children with other psychopathology (N = 118) and healthy controls (N = 130). Results indicated that the groups could not be differentiated by the total number of words produced in 60 s in either fluency task. As hypothesized, a significant interaction of group by productivity over time by type of fluency task was found: ADHD children had more problems finding words in the first 15 s of the IFL than did children in the other two groups, and as compared with their performance on the SCF. Results were taken to indicate that children with ADHD symptoms show a delay in the development of automating skills for processing abstract verbal information.     

The Importance of Parental Attributions in Families of Children with Attention-Deficit/Hyperactivity and Disruptive Behavior Disorders

Presents a social-cognitive model outlining the role of parental attributions for child behavior in parent–child interactions. Examples of studies providing evidence for the basic model are presented, with particular reference to applications of the model in families of children with Attention-Deficit/Hyperactivity Disorder (ADHD) and/or oppositional defiant/conduct disordered behavior. Parent or child factors that may moderate the operation of links within the model are suggested, and evidence of such moderator effects is presented. The conceptualization and measurement of parental attributions also are discussed. The limitations of the model and existing evidence, as well as recommendations for future research in this area are presented throughout the paper. The paper concludes with a summary of the clinical implications of the model and research on parental attributions with regards to improving interventions for families of children with attentional and disruptive behavior problems.