The relative effects of classwide peer tutoring and peer coaching on the positive social behaviors of children with ADHD

This study investigates the effects of Classwide Peer Tutoring (CWPT) and peer coaching on the peer social behaviors of children with ADHD. A single-subject, multiple-baseline design is used with three elementary-school students in Grades 3 and 4. Following a baseline period, CWPT is implemented in each student's classroom. During the second intervention phase, CWPT is continued and peer coaching is added. Peer social behaviors are observed in both academic and social settings, with a primary focus on intervention effects on the latter setting. Results suggest that students participating in CWPT are actively and positively engaged with their peers while carrying out the CWPT program in the academic setting. However, when only CWPT is implemented, increases in positive peer social behaviors are not observed in social settings. The addition of peer coaching results in enhanced social behaviors during recess and lunch.     

The effect of reinforcement variables on inhibition in children with ADHD.

Behavioral inhibition, often cited as a central deficit in children with ADHD, has been shown to change in response to reinforcement. In this preliminary investigation, children with ADHD (n= 20) and matched controls (ages 7 to 12) completed a new version of the stop signal paradigm, the Fire Fighter Game, a measure of inhibition of a prepotent motor response, under three conditions: (1) no reinforcement; (2) immediate reinforcement; and (3) delayed reinforcement. In all conditions, the stop signal reaction time (SSRT) of children with ADHD was consistently longer than controls. Both groups improved significantly with reinforcement, and there was no strong evidence that immediate reinforcement was more effective than delayed reinforcement. However, it appeared that the reason for the changes in SSRT in response to reinforcement differed between the groups. Children in the control group responded faster on go trials, whereas children with ADHD improved their ability to inhibit responding with shorter stop delays. The relevance of these findings is discussed in terms of current theories of ADHD.     

Verbal fluency in children with ADHD: Strategy using and temporal properties

Verbal fluency tasks are commonly used in cognitive and developmental neuropsychology in assessing executive functions, language skills as well as divergent thinking. Twenty-two typically developing children and 22 children with ADHD between the ages of 8 and12 years were examined using verbal fluency tasks, prepotent response inhibition, and working memory tests. The clinical group showed impaired inhibitory and spatial working memory processes. We used different qualitative analyses of verbal fluency tasks to explore the lexical and executive strategies (word clustering and switching), and the temporal properties of the responses. Children with ADHD had a leeway in applying relevant lexical or executive strategies related to difficulties in strategy using. The reduced efficiency of children with ADHD in semantic fluency task is based on suboptimal shifting between word clusters and is related to the lack of ability of producing new clusters of items. The group difference appeared at the level of accessing and/or activating common words; however, the executive process of searching the lexicon extensively is intact.     

WISC-IV and WISC-III profiles in children with ADHD

Wechsler Intelligence Scale for Children, 3rd and 4th editions (WISC-III n = 586 and WISC-IV n = 118), profiles were compared for children with ADHD and normal intelligence. Mean Verbal Comprehension Index (VCI) and Perceptual Organization/Perceptual Reasoning Index (POI/PRI) scores were significantly higher than Freedom From Distractibility/Working Memory Index (FDI/WMI) and Processing Speed Index (PSI), and Symbol Search was higher than Coding. FDI/WMI and PSI scores were similar on both tests, but VCI and POI/PRI were higher on the WISC-IV than on the WISC-III. Therefore, index discrepancies were greater for the WISC-IV, suggesting that the WISC-IV might be better than the WISC-III in delineating the strengths and weaknesses of children with ADHD. All children in the WISC-IV sample scored lowest on WMI or PSI, whereas only 88% of the WISC-III children scored lowest on FDI or PSI. Thus, the WISC-IV may be more helpful in diagnosing ADHD than the WISC-III.     

Exploring the dynamics of design fluency in children with and without ADHD using artificial neural networks

The neuropsychology of attention deficit/hyperactivity disorder (ADHD) has been extensively studied, with a general focus on global performance measures of executive function. In this study, we compared how global (i.e., endpoint) versus process (i.e., dynamic) measures of performance may help characterize children with and without ADHD using a design fluency task as a case study. The secondary goal was to compare the sensitivity of standard versus connectionist statistical models to group differences in cognitive data. Thirty-four children diagnosed with ADHD and 37 children without ADHD aged 8–11 years old were tested on the Five-Point Test. The continuous process measure of performance, indexed as the number of produced designs at each consecutive 1 minute interval during 5 minutes, was analyzed against the discrete process measure, that is, the number of designs between first and last intervals and the standard global performance measure of total number of produced designs. Results show that the continuous process measure distinguished the two groups better than the two other measures. The detailed observation of production patterns revealed a decreasing linear trajectory in children without ADHD that contrasts with the flat, but fluctuating productivity pattern of children with ADHD. With regards to the second goal, results show that the connectionist and standard methods are equally sensitive to group differences for the three types of measures. This illustrates the utility of quantitative process measures together with the connectionist method in neuropsychological research and suggests great potential for a dynamical approach to cognition.     

Relationships between Hand Test variables and maladjustment in school children

Twenty-two Hand Test variables significantly differentiated a group of children referred to school psychologists for social and emotional maladjustment from a control group matched on age and sex. Eleven variables emerged from a subsequent stepwise discriminant analysis, resulting in a 80.85% hit rate. Results are interpreted as providing statistical support for the use of the Hand Test as a screening and/or ancillary projective technique in assessing school children.     

Intervening to improve communication between parents, teachers, and primary care providers of children with ADHD or at high risk for ADHD

This study examines interventions designed to improve communication between individuals who take care of children with ADHD. A teacher rating of 6,171 elementary school children identifies 1,573 children with ADHD or with high risk for ADHD. Parent interviews and information from teachers are collected on 243 children who are randomized into treatment and control conditions and followed for 39 months. The interventions consisted of group workshops and single one-on-one tutorials with parents, teachers, and providers about the evaluation and treatment of ADHD that stressed the need for communication between the three parties. There are few significant effects on communication that are short lived. Results suggest that the interventions are insufficient to cause significant increase in communication. Future attempts to improve parent-teacher-provider coordination should be continuing rather than single-session interventions.     

Evaluation of sensorimotor training in children with ADHD

Reduced ability to regulate motor behavior seems to be an essential aspect of Attention-Deficit Hyperactivity Disorder (ADHD) and may reflect deficits in behavioral response inhibition. In this respect, pragmatic clinical experience over the last two decades, in daily practice, training of motor control has played an important role within multimodal treatment approaches, although an adequate proof of its efficacy is still lacking. Therefore, to examine the efficacy of sensorimotor training, 12 children with ADHD (two groups of six) were treated with both sensorimotor training and (as control) cognitive behavioral training using a within-subject cross-over design. Each treatment had a duration of 4 months (20 sessions), yielding a total of 40 sessions for the completed cross-over design. Results showed that Sensorimotor Training improved sensorimotor coordination slightly, while Cognitive Behavioral Training ameliorated cognitive impulse control. Hyperactivity and anxious-depressive/aggressive behavior were markedly reduced by Sensorimotor Training but not by Cognitive Behavioral Training. In conclusion, a combined treatment may be recommended since compensation and regulation of inhibitory deficits in ADHD come into play within the framework of both kinds of training.     

Classroom behavior and children with mental retardation: Comparison of children with and without ADHD

Thirty-four children (ages 6–12 years) with moderate to borderline mental retardation were studied in a laboratory classroom setting to determine whether children identified as having attention deficit hyperactivity disorder on the basis of Conners Questionnaires differed in classroom behavior. Half of the children scored 15 or greater on both the Parent and Teacher Conners; the remaining children scored 11 or less. All were participants in a Saturday Education Program serving children with mental retardation. Direct observation of the laboratory classroom documented significant differences between groups on measures of on-task behavior and fidgetiness, especially during situations where little direct teacher feedback or supervision was available. Saturday Education Program staff, while blind as to group designation, rated the two groups as differing significantly on all scales of two standardized behavior problem checklists. Checklists by parents and teachers appear to be valid measures of classroom behavior of children with moderate to borderline mental retardation.This research was supported by a grant to the first author from the National Institutes of Child Health and Human Development, U.S. Department of Health and Human Services, grant No. 1R29HD26186-01A1. The authors gratefully acknowledge the assistance of the staff of Children's Hospital of Pittsburgh's Saturday Education Program: Nancy Hall, Aimee Hart, Phyllis Loeffler, Robin Nelson, Christina Poljak, Kelley Sacco, Sarah Stewart, and Mary Zuberbuehler.     

Complex prospective memory in children with ADHD.

The ability to remember intentions (prospective memory) is fundamental to the organization of goal-directed actions in everyday life. Successful prospective remembering involves forming, retaining, initiating, and executing an intention. Although previous research has demonstrated prospective memory impairments in children with attention deficit/hyperactivity disorder (ADHD), this has largely focused on the intention initiation and execution stages. In this study, we investigate the performance of 20 children with ADHD and 20 matched controls at each of the four stages of prospective memory, using a computer multitask paradigm. Results suggest that children with ADHD may demonstrate difficulties forming delayed intentions, as indicated by impulsive planning, and that this may have further implications for the retention and implementation of these delayed intentions. While children with ADHD showed comparable multitask switching, this appeared to be at the expense of intention execution as they made more performance errors than controls. Implications for day-to-day functioning are discussed.     

Sleep disturbance and neuropsychological function in young children with ADHD

Sleep disturbance, common among children with ADHD, can contribute to cognitive and behavioral dysfunction. It is therefore challenging to determine whether neurobehavioral dysfunction should be attributed to ADHD symptoms, sleep disturbance, or both. The present study examined parent-reported sleep problems (Children’s Sleep Habits Questionnaire) and their relationship to neuropsychological function in 64 children, aged 4–7 years, with and without ADHD. Compared to typically developing controls, children with ADHD were reported by parents to have significantly greater sleep disturbance—including sleep onset delay, sleep anxiety, night awakenings, and daytime sleepiness—(all p ≤ .01), and significantly poorer performance on tasks of attention, executive control, processing speed, and working memory (all p < .01). Within the ADHD group, total parent-reported sleep disturbance was significantly associated with deficits in attention and executive control skills (all p ≤ .01); however, significant group differences (relative to controls) on these measures remained (p < .01) even after controlling for total sleep disturbance. While sleep problems are common among young children with ADHD, these findings suggest that inattention and executive dysfunction appear to be attributable to symptoms of ADHD rather than to sleep disturbance. The relationships among sleep, ADHD symptoms, and neurobehavioral function in older children may show different patterns as a function of the chronicity of disordered sleep.