The association between parenting stress, depressed mood and informant agreement in ADHD and ODD

OBJECTIVE: In Attention Deficit Hyperactivity Disorder (ADHD) agreement between parents and teachers is often low. Parental depressed mood and parenting stress are considered to decrease informant agreement. This study examined informant agreement in children with ADHD and the association between parental depressed mood, parenting stress and agreement in the ratings of ADHD, ODD and CD symptoms. METHOD: 65 parents completed questionnaires on ADHD behavior of their child, parenting stress and depressed mood, teachers reported on ADHD behavior. RESULTS: Low agreement was found for hyperactive and moderate agreement for inattentive, ODD and CD symptoms. Stepwise regression analyses showed that parenting stress, and not parental depressed mood accounted for 12% of the variance in inattention symptoms disagreement, 14% of the variance in hyperactive symptoms disagreement and 9% in oppositional behavior disagreement. No significant predictors were found for CD disagreement. The found effect was independent of stimulant medication use. CONCLUSION: Parenting stress, but not parental depressed mood, was associated with the disagreement between parents and teachers on both ADHD and ODD symptoms. These results emphasize the importance of considering parenting stress in diagnosing ADHD and comorbid ODD.     

Prosocial behavior in hyperactive boys: Effects of stimulant medication and comparison with normal boys

To clarify the effects of stimulant medication on hyperactive (ADHD) children's prosocial as well as aversive behaviors toward peers, 19 hyperactive boys, aged 7–12, were observed as they acted as leaders for groups of 2–4 unfamiliar younger children. In a doubleblind crossover design, subjects were observed twice, once on placebo and again on a moderate (0.6 mg/kg) dose of methylphenidate (Ritalin). Thirteen comparison boys, without problems in attention and behavior, were also observed in the same leader roles. Relative to comparison boys, hyperactive boys on placebo were more socially engaged, used more aversive leadership techniques, and were rated as less likable by the younger children in their groups. Aversive social behaviors were the strongest predictors of being disliked by the younger children. No differences were found between comparison and unmedicated hyperactive boys for any aspect of prosocial behavior. Stimulant medication had a general dampening effect on social behavior, significantly reducing social engagement and increasing (mild) dysphoria relative to the placebo condition. The implications of these findings for understanding and treating the peer relationship difficulties of hyperactive children are discussed.This study was conducted at the Fernald Child Study Center, UCLA, and we very much appreciate the contributions of the many staff members of the program, especially those of Alice Huber-Dressler and Tracy Heller. We also are very grateful to staff and children of Corinne A. Seeds University Elementary School for their participation in this study.     

Young adult follow-up of hyperactive children: self-reported psychiatric disorders,comorbidity, and the role of childhood conduct problems and teen CD

We report on the psychiatric disorders present at young adult follow-up (Mean age 20–21 years; 13 + year follow-up) and the comorbidity among them for a large sample of hyperactive (H; N = 147) and community control (CC; N = 71) children. The H group had a significantly higher risk for any nondrug psychiatric disorders than the CC group (59% vs. 36%). More of the H group met criteria for ADHD (5%); major depressive disorder (26%); and histrionic (12%), antisocial (21%), passive–aggressive (18%), and borderline personality disorders (14%) at follow-up than the CC group. Severity of childhood conduct problems contributed to the risk for passive–aggressive, borderline, and antisocial personality disorders. But it only affected risk for antisocial personality after controlling for severity of teen conduct disorder (CD), which also contributed to the risk for these same 3 disorders. Examination for comorbidity among these disorders indicated that presence of either borderline or antisocial personality disorder significantly increased the risk for major depression and the other significant personality disorders. More of the hyperactive group had received various forms of mental health treatment during and since leaving high school than the control group. Results suggest that hyperactive children are at significant risk for at least 1 nondrug disorder in young adulthood, principally major depression and several personality disorders, and that this risk is largely mediated by severity of CD at adolescence.     

DSM-IV Attention Deficit Hyperactivity Disorder Symptoms: Agreement Between Informants in Prevalence and Factor Structure at Different Ages

The agreement between teachers’ and parents’ ratings of the prevalence of DSM-IV attention deficit hyperactivity disorder (ADHD) symptoms and the concordance of the factor structure of ADHD symptoms was analyzed in a sample of 653 Spanish schoolchildren aged 4 to 12 divided into two age groups. The prevalence of ADHD symptoms ranged between 0.66 and 16.73% and was higher when the rater was the teacher. Agreement between parents and teachers was low. Confirmatory factor analysis (CFA) shows a slightly better fit for the three-factor model (Inattention, Hyperactivity and Impulsivity) than for the two-factor model (Inattention and Hyperactivity–impulsivity), except for parents’ ratings in the sample of children under six. CFA using a multitrait–multimethod model (CFA-MTMM) shows similar results.     

Teachers' and education students' perceptions of and reactions to children with and without the diagnostic label "ADHD"

Thirty-four elementary school teachers and 32 education students from Canada rated their reactions towards vignettes describing children who met attention-deficit/hyperactivity disorder (ADHD) symptom criteria that included or did not include the label “ADHD.” “ADHD”-labeled vignettes elicited greater perceptions of the child's impairment as well as more negative emotions and less confidence in the participants, although it also increased participants' willingness to implement treatment interventions. Ratings were similar to vignettes of boys versus girls; however, important differences in ratings between teachers and education students emerged and are discussed. Finally, we investigated the degree to which teachers' professional backgrounds influenced bias based on the label “ADHD.” Training specific to ADHD consistently predicted label bias, whereas teachers' experience working with children with ADHD did not.     

Parent–Adolescent Conflict in Teenagers with ADHD and ODD

Eighty-seven male teens (ages 12–18 years) with ADHD/ODD and their parents were compared to 32 male teens and their parents in a community control (CC) group on mother, father, and teen ratings of parent–teen conflict and communication quality, parental self-reports of psychological adjustment, and direct observations of parent–teen problem-solving interactions during a neutral and conflict discussion. Parents and teens in the ADHD/ODD group rated themselves as having significantly more issues involving parent–teen conflict, more anger during these conflict discussions, and more negative communication generally, and used more aggressive conflict tactics with each other than did parents and teens in the CC group. During a neutral discussion, only the ADHD/ODD teens demonstrated more negative behavior. During the conflict discussion, however, the mothers, fathers, and teens in the ADHD/ODD group displayed more negative behavior, and the mothers and teens showed less positive behavior than did participants in the CC group. Differences in conflicts related to sex of parent were evident on only a few measures. Both mother and father self-rated hostility contributed to the level of mother–teen conflict whereas father self-rated hostility and anxiety contributed to father–teen conflict beyond the contribution made by level of teen ODD and ADHD symptoms. Results replicated past studies of mother–child interactions in ADHD/ODD children, extended these results to teens with these disorders, showed that greater conflict also occurs in father–teen interactions, and found that degree of parental hostility, but not ADHD symptoms, further contributed to levels of parent–teen conflict beyond the contribution made by severity of teen ADHD and ODD symptoms.     

Trait mechanisms in youth with and without attention-deficit/hyperactivity disorder

Relations of temperament and personality traits within children and adolescents with ADHD and non-ADHD controls were examined. A two-process structure was hypothesized involving top-down effortful and bottom-up reactive response tendencies. Top-down processes were hypothesized to relate to inattentive ADHD symptoms, whereas bottom-up processes were hypothesized to relate to hyperactive–impulsive ADHD symptoms. Each hypothesis was tested in a sample of 179 children age 7–13 (113 boys; 107 ADHD) and then replicated in 184 adolescents age 14–17 (109 boys; 87 ADHD). All families completed a multistage diagnostic process. Youth completed laboratory measures of cognitive control, and parents completed trait ratings. Traits examined in the current study included effortful control, reactive control, resiliency, negative emotionality, neuroticism, extraversion, openness, agreeableness, and conscientiousness. Correlational relations among traits were inconclusive, but external correlations with cognitive tasks and ADHD symptoms were interpretable within the hypothesized two-process framework. Results provide partial support for a distinction between effortful and reactive traits and suggest this distinction is useful in relation to understanding ADHD.     

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.     

Listening comprehension and working memory are impaired in attention-deficit hyperactivity disorder irrespective of language impairment

This study investigated listening comprehension and working memory abilities in children with attention-deficit hyperactivity disorder (ADHD), presenting with and without language impairments (LI). A 4-group design classified a community sample (n = 77) of boys aged 9–12 into ADHD, ADHD + LI, LI, and Normal groups. Children completed tests of basic language and cognitive skills, verbal and spatial working memory, and passage-level listening comprehension. Multivariate analyses and post hoc comparisons indicated that ADHD children who did not have co-occurring LI comprehended factual information from spoken passages as well as normal children, but were poorer at comprehending inferences and monitoring comprehension of instructions. ADHD children did not differ from normal children in verbal span, but showed significantly poorer verbal working memory, spatial span, and spatial working memory. The ADHD + LI and LI groups were most impaired in listening comprehension and working memory performance, but did not differ from each other. Listening comprehension skills were significantly correlated with both verbal and spatial working memory, and parent–teacher ratings of inattention and hyperactivity/impulsivity. Findings that children with ADHD but no LI showed subtle higher-level listening comprehension deficits have implications for both current diagnostic practices and conceptualizations of ADHD.     

Reliable Ratings or Reading Tea Leaves: Can Parent,Teacher, and Clinician Behavioral Ratings of Preschoolers Predict ADHD at Age Six?

To assess the relative ability of parent, teacher, and clinician behavioral ratings of preschoolers to predict ADHD severity and diagnosis at 6 years of age. Hyperactive/inattentive preschoolers [N?=?104, 75 % boys, Mean (SD) age?=?4.37 (0.47) years] were followed over 2 years (mean?=?26.44 months, SD?=?5.66). At baseline (BL), parents and teachers completed the ADHD-RS-IV and clinicians completed the Behavioral Rating Inventory for Children following a psychological testing session. At age 6, [Mean (SD) age?=?6.62 (0.35) years], parents were interviewed with the K-SADS-PL; teachers completed the ADHD-RS-IV; and laboratory measures of hyperactivity, impulsivity, and inattention were obtained from children. Hierarchical logistic and linear regression analyses examined which combination of BL ratings best predicted 6-year-old ADHD diagnosis and severity, respectively. At age 6, 56 (53.8 %) children met DSM-IV criteria for a diagnosis of ADHD. BL ratings from parent/teacher/clinician, parent/teacher and parent/clinician combinations significantly predicted children who had an ADHD diagnosis at age 6. Parent and clinician, but not teacher, behavior ratings were significant independent predictors of ADHD diagnosis and severity at 6-years-old. However, only clinician reports of preschoolers’ behaviors predicted laboratory measures of over-activity and inattention at follow-up. Cross-situationality is important for a diagnosis of ADHD during the preschool years. Among parents, teachers and clinicians, positive endorsements from all three informants, parent/teacher or parent/clinician appear to have prognostic value. Clinicians’ ratings of preschoolers’ inattention, impulsivity and hyperactivity are valid sources of information for predicting ADHD diagnosis and severity over time.     

Effects of amphetamine on vigilance performance in normal and hyperactive children

Deficient sustained attention is a symptom of hyperactivity that can be improved by stimulant medication. Recently, amphetamine has been shown to increase detections during a vigilance task in both normal and hyperactive boys. The present study applied signal detection analysis to the vigilance performance of 15 hyperactive and 14 normal boys divided into two age groups (6–9 and 10–12). A computerized continuous performance test was administered under amphetamine and placebo. Overall group comparisons indicated that perceptual sensitivity or d was higher for the normal boys and the older groups, and analysis of drug treatments showed that amphetamine significantly increased d. Interactions between drugs and age groups demonstrated that amphetamine affected the younger boys to a significantly greater degree than the older children for both d and response bias or . It is notable that the results were essentially parallel for both normal and hyperactive children.     

Preparing Families for Evidence-Based Treatment of ADHD: Development of Bootcamp for ADHD

Objective: Many families of children with attention-deficit/hyperactive disorder (ADHD) do not initiate evidence-based treatments (EBTs), placing these children at risk for poor outcomes. Bootcamp for ADHD (BC-ADHD) is a novel, four-session, group intervention designed to prepare parents as informed consumers to engage in multimodal EBTs for ADHD. This paper describes the theory of change and the development of BC-ADHD, outlines its components, and provides an initial proof of concept of the program. Method: Participants were 11 families of children with ADHD (ages 5–11; 55% male; 91% non-Hispanic; 55% White, 27% Black, 18% more than one race) who were the initial participants receiving BC-ADHD during a small-scale, randomized controlled trial. Parent-report outcome measures assessed parental empowerment, treatment preferences, affiliate stigma, intention to pursue treatment, and treatment initiation at baseline, posttreatment, and 6-week follow-up. Results: Parent engagement was high, as indicated by an 86% session attendance rate and high ratings of program satisfaction. Parents reported an increase in empowerment to access systems of care. Ratings of acceptability for behavior therapy increased at posttreatment and follow-up with minimal or no concerns about feasibility. The acceptability of medication was high at each assessment, although parents expressed increased concerns about stigma and adverse effects of medication at posttreatment and follow-up. Nonetheless, there was a marked increase in parental intention to use medication at posttreatment and follow-up. Accounting for ceiling effects, parents reported substantial increases in intention to use medication, behavioral parent training (BPT), and school services. Changes in treatment initiation were in the expected direction. Conclusions: BC-ADHD has the potential to promote family empowerment in seeking services and increase their intent to initiate EBTs, as well as actual initiation of these treatments.     

Attention styles of hyperactive and normal girls

Behavioral characteristics and cognitive skills of teacher-identified hyperactive (n=24) and normally active (n=24) first- and second-grade girls were investigated. Teachers rated subjects on the Conners Teacher Rating Scale (TRS). Subjects were given several tasks measuring attentional styles and motor skills. Results suggested that hyperactive girls, like hyperactive boys, have short attention spans and poor concentration when compared with normals. Unlike hyperactive boys, hyperactive girls did not show an impulsive response style, and presented few conduct problems to their teachers. TRS profile patterns of the hyperactive girls were similar to those of hyperactive boys, but cutoff scores currently used for males may not be applicable to females. A direct comparison of hyperactive females and males is advocated.This study is based on a doctoral dissertation submitted to the Department of Psychology, Indiana University, by the first author. Thanks are expressed to the students and teachers of the Monroe County Community School Corporation who took part in the study.     

Hyperactive boys in their classroom: Assessment of teacher and peer perceptions,interactions, and classroom behaviors

Teacher ratings, peer perceptions, peer interactions, and classroom behaviors of 17 hyperactive and 17 active elementary school-age boys, nominated by their teachers, were compared using multivariate analyses and planned comparisons in order to better describe and assess hyperactivity in its most probable setting —the classroom. Hyperactive boys were found to be significantly different from actives on measures from all data sources in that they were perceived and interacted more negatively. Cluster analyses of teacher ratings of 90 hyperactives from a clinical sample and 17 hyperactives from the current sample were used to discriminate among different types of hyperactives. Four types were named anxious, conduct problem, inattentive, and low problem hyperactives. The fact that six conduct problem hyperactives were found to be more disruptive and have higher activity level ratings than six inattentive hyperactives, when observed in their classrooms, points to the need to study and treat hyperactives as heterogeneous groups.This study is based in part on a doctoral dissertation submitted to the Psychology Department, Indiana University, by the first author. Thanks are expressed to the students and teachers of the Monroe County School System who took part in the study. The authors also wish to thank Prof. Robert Sprague of the University of Illinois for providing the Conners Rating Scales on 90 hyperactive children.     

Agreement Between Parent and Teacher Ratings of Disruptive Behavior Disorders in Children with Clinically Diagnosed ADHD

This study investigated the agreement between parent and teacher ratings of DSM-IV symptoms of Attention Deficit Hyperactivity Disorder (ADHD) and related disorders: Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD). A sample of 55 children in the age range of 6–12 years with clinically diagnosed ADHD participated in the study. Parents and teachers were asked to complete the Disruptive Behavior Disorder Rating Scale (DBDRS; W. E., Pelham, E. M., Gnagy, K. E., Greenslade, & R. Milich, 1992). No association was found between parent and teacher ratings of inattention and hyperactivity/impulsivity. However, moderate to high levels of agreement were obtained for ratings of symptoms that characterized ODD and CD. The observed low levels of agreement between parent and teacher ratings of ADHD symptoms may be attributed to different perceptions of the problem behavior by parents and teachers, medication effects, or the situation specificity of children's behavior. It is recommended that the diagnostic criterion of symptom pervasiveness for the diagnosis of ADHD be operationalized more clearly.     

The Delinquency Outcomes of Boys with ADHD with and Without Comorbidity

This study examined the association between childhood ADHD and juvenile delinquency by examining data from the Pittsburgh ADHD Longitudinal Study (PALS), a follow-up study of individuals diagnosed with ADHD in childhood (ages 5–12) and recontacted in adolescence and young adulthood for yearly follow-up (age at first follow-up interview M = 17.26, SD = 3.17). Participants were 288 males with childhood ADHD and 209 demographically similar males without ADHD who were recruited into the follow-up study. Delinquency information gathered yearly during the second through eighth follow-up provided a comprehensive history of juvenile delinquency for all participants. Four childhood diagnostic groups [ADHD-only (N = 47), ADHD + ODD (N = 135), ADHD + CD (N = 106), and comparison (N = 209)] were used to examine group differences on delinquency outcomes. Analyses were conducted across three dimensions of delinquency (i.e., severity, age of initiation, and variety). Individuals with childhood ADHD + CD displayed significantly worse delinquency outcomes than the other three groups, across almost all indices of offending. When compared to comparison participants, boys with ADHD-only and ADHD + ODD in childhood displayed earlier ages of delinquency initiation, a greater variety of offending, and higher prevalence of severe delinquency. These findings suggest that although childhood ADHD + CD creates the greatest risk for delinquency, boys with ADHD-only and ADHD + ODD also appear at a higher risk for later offending. The patterns of offending that emerged from the PALS are discussed in the context of the relationship between ADHD, comorbidity, and delinquency.     

Parent Ratings of Attention-Deficit/Hyperactivity Disorder Symptoms: Factor Structure and Normative Data

Changes in the diagnostic criteria for attention-deficit/hyperactivity disorder (ADHD) have necessitated the creation of new measures for clinical assessment. The factor structure of a parent rating scale containing the 18 symptoms of ADHD was examined in this study. Factor analyses and assessment of differences in ADHD ratings across sex, age, and ethnic group were conducted using a sample of 4666 participants ranging in age from 4 to 20 years old who attended kindergarten through 12th grade in 22 school districts across the United States. Two factors (Inattention and Hyperactivity–Impulsivity) were derived and normative data for a nationally representative sample are presented. A higher frequency of ADHD symptoms was found for boys, younger children, and African-American participants. Potential uses of this scale in clinical practice and research are discussed.     

Innovations in Assessing ADHD: Development, Psychometric Properties, and Factor Structure of the ADHD Symptoms Rating Scale (ADHD-SRS)

This research involved the development of a behavior rating scale designed to measure ADHD and the investigation of the scale's psychometric properties and factor structure. This scale, the ADHD Symptoms Rating Scale (ADHD-SRS), was developed for the assessment of ADHD in the school-age (K–12) population. Participants were 1006 children and adolescents (in grades K–12) who were rated by their parents and/or teachers. The results indicate that the ADHD-SRS possesses strong internal consistency reliability and test–retest reliability and moderate cross-informant reliability. The data also suggest that the ADHD-SRS has strong content validity. Convergent validity of this instrument was also high, as demonstrated by correlations with three previously validated behavior rating scales. Significant age and gender differences in ADHD symptoms were found with both the parent and teacher respondent populations. Finally, the factor analysis of the ADHD-SRS suggested a two factor oblique rotation as the best fit for both the parent and the teacher data. After a visual inspection of the items which loaded on each factor, Factor 1 was named Hyperactive-Impulsive and Factor 2 was named Inattention. These two factors, along with the items which loaded on each factor, appear to be remarkably similar to the two categories listed in the DSM-IV for ADHD. Directions for future research, as well as clinical implications and limitations of the research are discussed.     

Confirmatory factor analysis of parents' and teachers' ratings of DSM-IV symptoms of attention deficit hyperactivity disorder in a Spanish sample

Confirmatory factor analysis examined the factor structure of DSM IV Attention Deficit Hyperactivity Disorder symptoms and analyzed the differences in informants' ratings of ADHD symptoms by children's age and sex. A sample of 1,018 Spanish school children, 574 girls and 444 boys, ages 4 to 12 years, was rated by teachers and parents. Confirmatory factor analysis showed a similar fit for the three-factor model of Inattention, Hyperactivity, and Impulsivity (teachers: CFI = .976, RMR = .041, % of total variance = 83.2; parents: CFI = .969, RMR = .037, % of total variance = 82.7) and for the two-factor model of Inattention and Hyperactivity Impulsivity (teachers: CFI = .958, RMR = .044, % of total variance = 79.3; parents: CFI = .961, RMR = .038, % of total variance, 79.9). The two-factor model was selected as a parsi monious representation of the teachers' and parents' ratings of ADHD symptoms. Analyses of variance indicated significant differences in teachers' and parents' mean ratings across sex and school grades of children.