Social judgment processes in hyperactive boys: Effects of methylphenidate and comparisons with normal peers

Although there is consensus that ADHD children have serious social problems, there is little understanding of the mechanisms underlying or accompanying such problems. To examine the possibility of atypical or faulty social reasoning, we presented ADHD and normal boys with a social perception task that entailed evaluating the behaviors of unknown peers. ADHD judges participated under both methylphenidate and placebo conditions, and on each occasion they evaluated an unfamiliar ADHD target in each medication state. In contrast to placebo, methylphenidate appeared to dampen overall response rates in ADHD judges, but there was no effect on sensitivity to medication-related differences. Regardless of their own medication state, ADHD judges identified more undesirable behaviors in peers on placebo than in those taking methylphenidate. Judges with the most serious behavior problems tended to identify the greatest number of negative behaviors in peers, especially when both judge and target were unmedicated. There were no effects of target medication status on detections of positive behaviors and few differences in detection patterns of ADHD versus normal judges. Discussion focused on the need to distinguish general regulatory from specific social-cognitive processes.This study was conducted at the Fernald Child Study Center, UCLA, and we very much appreciate the many contributions of Stephen P. Hinshaw, codirector of the program. We are also grateful to the resourceful and devoted staff and the energetic children who served as judges and targets.     

Perceptions of methylphenidate effects on hyperactive children's peer interactions

The behavioral constructs that emerge from observers' openended impressions of methylphenidate effects on the social behaviors of hyperactive children were examined. Ninety-six undergraduates observed videotapes of two different hyperactive target boys, each playing an interaction game with three peers. One target was taking methylphenidate and the other was taking placebo. The valence and content of observers' social perceptions were analyzed. Overall, more negative than positive behaviors were detected, a pattern more pronounced for the placebo than for the medication condition. Interestingly, placebo targets received negative evaluations for poorly controlled behaviors such as noncompliance, aggression, and disruption, but medicated targets received negative evaluations for social inhibition—passive and submissive behaviors. In contrast, the boys' medication state did not consistently influence observers' perceptions of positive social behaviors. Discussion focused on the extent and consequences of medicationrelated increases in social disengagement and on the ultimate impact of stimulant treatment on hyperactive children's social worlds.A preliminary report of this study was presented at the 1990 meeting of the Society for Research in Child and Adolescent Psychopathology, Costa Mesa, CA. We are grateful for the assistance of Pam Ajang, Keri Hom, and Scott Gutentag, and for support from the Fernald Child Study Center at UCLA.     

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.     

Social communication patterns of attention-deficit-disordered boys

This study was designed to compare the social communication patterns of attention-deficit-disordered (ADD) and normal boys. This was accomplished by employing a TV Talk Show social role-playing procedure in which the task required different strategies for the roles of host and guest. Groups of ADD and normal elementary-age boys were formed, and each boy was paired with a normal classmate. Measures of communication competence were coded from videotapes made of subject and partner social interactions while performing both roles. Results indicated that the ADD boys, in contrast to the control group, failed to modulate their social communication behaviors as task demands shifted. Additionally, the behavior of the ADD boys resulted in their normal partners' altering their response patterns in order to maintain the equilibrium in the dyadic interaction. These results suggest that the social behavior of ADD children is relatively independent of environmental requirements and may contribute to the inappropriate responding of others.     

Attention and distractibility during reading in hyperactive boys

Nonhyperactive and clinically defined hyperactive boys were administered reading tasks under quiet and distracting conditions. Hyperactive boys were less attentive to task relevant stimuli and more attentive to task irrelevant stimuli than their controls. Our results demonstrate that the previous findings of inattentiveness among hyperactive boys on laboratory tasks can be generalized to more typical school activities such as reading.     

Autonomic and behavioral effects of dextroamphetamine and placebo in normal and hyperactive prepubertal boys

The hypothesis is tested that the response to dextroamphetamine in terms of activity, attention, impulsivity, and autonomic activity is similar in normal (N) and hyperactive (H) children. Fourteen N and 15 H boys had skin conductance (SC), heart rate (HR), and finger temperature (ST) recorded during rest, presentation of eight 75- dB tones, and a reaction time (RT) procedure on three occasions: off drug (Day 1) and after ingestion (double-blind) of placebo and of .5 mg/kg dextroamphetamine. Both N and H groups showed drug effects, compared to placebo, of reduced motor activity and impulsivity, improved attention (RT), increased HR and HR slowing during RT foreperiods, and decreased ST. Both groups also had decreases in SC responsivity but in different parts of the test. Placebo compared to Day 1 produced increased activity and autonomic arousal but no change in RT. Stimulant drugs thus have similar behavioral and autonomic effects in both N and H boys, but the beneficial effects on behavior do not depend critically on increases in arousal.     

Effects of methylphenidate on kinematic aspects of handwriting in hyperactive boys

Poor handwriting in hyperactive children often contributes to academic failure. Beneficial effects of methylphenidate on the quality of handwriting have been shown. Using a digitizing tablet, the handwriting of 21 hyperactive boys was examined both during methylphenidate treatment and following withdrawal of the drug. Half of the hyperactive boys were tested first on methylphenidate and then following withdrawal of the drug and the remaining hyperactive boys were examined in the reverse order. Twenty-one control boys underwent the same examination. Velocity and acceleration of handwriting movements were measured. Furthermore, every writing specimen was independently rated by four examiners regarding the quality of handwriting. Following withdrawal of the drug, the quality of handwriting specimens of hyperactive boys was poorer than during treatment with methylphenidate. Statistical comparison of writing movements of hyperactive boys on and off methylphenidate revealed that the medication resulted in a deterioration in handwriting fluency. The results showed that following withdrawal of medication, hyperactive children did not differ from control boys in handwriting movements. The improvement in hyperactive behavior through methylphenidate was associated with increased legibility and greater accuracy of handwriting. The intention to write neatly may interfere with the fluent writing process.     

Peer popularity and peer communication patterns: Hyperactive versus active but normal boys

Classroom peer perceptions of 18 teacher-nominated hyperactive and 18 teacher-nominated active but normal elementary school-age boys, as revealed in two sociometric measures (Bower's Class Play, like-dislike nomination), were compared. Results indicated that hyperactives were significantly different from actives on all sociometric measures in that they were perceived more negatively. Peer communication patterns also were assessed. The communicative content, communicative quality, and attention to task instructions of hyperactive boys were compared to those of comparison boys. Limited support was found for the earlier finding that hyperactive boys were less likely than comparison boys to modulate behavior in response to changing external cues and to respond to subtle social learning opportunities. The communication task was found to be highly engaging for both groups of boys, and results suggest that hyperactive children may not lack the interpersonal skills necessary for referential communication, although they may be unable to use them consistently in all settings. The need to continue the study of peer relations of hyperactive children in naturalistic settings is stressed.     

Gender and Age Differences in Social Skills Among Children with ADHD: Peer Problems and Prosocial Behavior

Abstract

Gender differences in peer problems and prosocial behavior among children with attention-deficit hyperactivity disorder (ADHD) were examined. Parents and teachers rated social functioning on the Strengths and Difficulties Questionnaire (SDQ) among 592 children (age 5–10?years) with ADHD and among 215 children (age 6–10?years) in a community sample. Results in the clinical group revealed significant interaction effects where older boys showed fewer peer problems than younger boys, but older girls had similar peer problems as younger girls. Teachers reported less prosocial behavior among younger girls than older girls. No gender differences in social problems emerged for the nonclinical comparison group.     

Evaluative factors in social problem solving by aggressive boys

Components of social problem solving (problem definition, generation and prioritization of solutions, and generation and evaluation of consequences) were assessed in high aggressive and low aggressive boys from grades 2– 3 and 5–6. When compared with their low aggressive peers, high aggressive boys at both grade levels were more likely to (1) define social problems based on the perception that others were hostilely-motivated adversaries, (2) generate few consequences for exhibiting aggression, (3) choose a second-best solution that was rated as ineffective, and (4) evaluate their own affective reactions to self-generated consequences of aggression as wouldn't care or as not unhappy. In addition, within the group of aggressive boys, problem definition was found to be significantly related to both number of solutions generated and effectiveness of solutions that subjects chose as best and second-best. These findings are discussed in terms of early patterns of cognitive mediation that differentiate high aggressive children from their low aggressive peers.The authors would like to thank the staff of the Santa Barbara, City and County school districts for their cooperation.     

Social perspective-taking and teacher ratings of peer interaction in hyperactive boys

Hyperactive and matched control boys at two age levels were compared on teacher ratings of peer interaction and three measures of social perspective-taking. The teachers' ratings of peer interaction discriminated between the hyperactive children and their controls. In addition, a significant interaction effect indicated that teachers rated the older hyperactive group as more deviant with peers than both their younger hyperactive counterparts and their age-matched controls. In a structured laboratory setting, the hyperactive children did not differ from control children on the three measures of social perspective-taking. The perspective-taking measures did, however, show differences across age groups. Implications for treatment are examined.The research reported in this paper is based on master's thesis submitted to the Graduate Faculty of Arts and Sciences of the University of Pittsburgh by the first author. The authors are indebted to Dr. C. Keith Conners for his assistance in recruiting hyperactive subjects and to Drs. Alex Siegel and Carl Barenboim for their critical evaluations regarding this investigation. Appreciation is expressed to the staff, teachers, parents, and students of the Forest Grove Elementary School for their cooperation.     

Malleability of social impressions of hyperactive children

The role of adults' social cognitions in mediating judgments of hyperactive children's medicationrelated behavior change was explored. Two hundred eightyeight undergraduates observed two videotaped excerpts of a hyperactive target boy playing a group game with two peers. Each target was taking either methylphenidate (0.6 mg/kg) during both excerpts, placebo during both excerpts, methylphenidate first followed by placebo, or placebo first followed by methylphenidate. Adults' cumulative social evaluations of the child were assessed after they viewed both video segments. Results indicated that observers combined their perceptions of the two behavior samples into composite impressions using an equalweight averaging algorithm. Even for children whose behavior improved, adults' ratings of undercontrolled behaviors continued to meet or, in some cases exceed, research cutoff scores used to identify hyperactive children. The findings suggest that the actual behaviors of children with attentiondeficit hyperactivity disorder (ADHD) play a more influential role in shaping interpersonal impressions than do perceiver socialcognitive processes such as primacy, recency, or integration biases.This project was supported in part by a UC Regents' Dissertation fellowship to Douglas A. Granger while at the University of California at Irvine. We acknowledge Tom Crawford and Karen Rook for their helpful comments at formative stages of this project, and support from the UCLA Fernald Child Study Center and Program in Psychoneuroimmunology. We thank behavior observers Leslie Klein, Jeanne Tsai, and Dawn Rowland, and data managers Pam Ajang and Scott Gutentag. A preliminary report of this study was presented at the 1991 meeting of the Society for Research in Child Development, Seattle, WA.     

Span of apprehension in hyperactive boys

The spans of apprehension of hyperactive and normal boys were compared with a forced-choice letter-recognition task developed by Estes (1965). This task provides an estimate of the span which is relatively insensitive to either memory or motivational influences. The span size was the same for both groups when visual noise was absent. In the presence of noise, span size for the hyperactive boys decreased. Moreover, as the number of noise letters increased, the reduction in span size observed for the hyperactive boys increased. It is argued that this increasing reduction in span size represents a true deficit in attention.     

Sex-typed play in feminoid boys versus normal boys and girls

Procedures for assessing children's sex-typed play were developed which (a) examined children's continuous play in four sessions totaling 20 minutes rather than measuring only initial choice of a sex-typed toy, and (b) did not impose the stimulus-specific condition of requiring an adult experimenter to be present to administer the task. Play with masculine and feminine toys was observed for 120 normal children (60 boys, 60 girls) aged 3 yr.–8 yr., and 15 similarly aged boys diagnosed as having childhood gender disturbance. Significant differences were found in the sex-typed play of the two normal groups, but no age differences were observed. The amount of feminine play by the feminoid boys was found to be significantly greater than that of normal boys, but not significantly different from the predominantly feminine play patterns of the normal girls. The usefulness of such a measure for the clinical assessment of deviant sexrole development in young children is discussed.This study was supported by United States Public Health Service Research Grant #MH 21803-01A1, 02, 03 from the National Institute of Mental Health. The University Elementary School at UCLA is gratefully acknowledged for providing a normal subject population and laboratory facilities. The authors express their appreciation to Stanley Conrad, Roni Greenberg, Alfred Lauck, Benson Low, and Martin Magy for their assistance in data collection.     

Medication effects in the classroom: Three naturalistic indicators

Hyperactive and comparison boys participated in 5-week summer enrichment programs that included classroom activities and structured assessments of peer interaction patterns. During the 3rd and 4th weeks of these programs, a double-blind, methylphenidate-placebo crossover design was implemented within the hyperactive group. Three heterogeneous indicators of everyday behaviors were obtained: number of negative incidents noted by staff, quality of handwriting, and number of times the teacher called the boys' names aloud in the classroom. Medication effects emerged for each of these indicators. When hyperactive boys were taking placebos, they were involved in more negative incidents, their handwriting was poorer, and their names were called more frequently than when the boys were taking methylphenidate. Interrelationships among the measures suggest moderate cross-situational generality of medication responsiveness. Discussion focused on the bandwidth of medication effects and the need to examine the social ramifications of child treatments.This research was supported in part by NIMH grant 29475 and NIDA grant 01070. We gratefully acknowledge the participation of the data coders and the many summer school staff. Special thanks go to Mike Berlin, Barry E. Collins, and Sharon Dotemoto. Methylphenidate and placebo were supplied by Ciba-Geigy, Summit, New Jersey.     

Self-control in hyperactive boys in anger-inducing situations: Effects of cognitive-behavioral training and of methylphenidate

The effects of cognitive-behavioral intervention and methylphenidate on anger control in hyperactive boys were investigated in two studies. The anger-inducing stimuli in both studies involved verbal provocation from peers. Study 1 assessed a brief intervention using self-control strategies, while Study 2 employed a longer training period and a control intervention that focused on enhancement of empathy. Both studies included methylphenidate versus placebo comparisons. Methylphenidate reduced the intensity of the hyperactive boys' behavior but did not significantly increase either global or specific measures of self-control. Cognitive-behavioral treatment, when compared to control training, was more successful in enhancing both general self-control and the use of specific coping strategies. There was no advantage for the combination of methylphenidate plus cognitive-behavioral intervention. Implications for intervention to ameliorate the social and interpersonal difficulties of hyperactive children are discussed.Major support for this study was provided by NIDA grant 01070. This research was also facilitated by a grant from the Spencer Foundation. The many training staff and raters, too numerous to mention individually here, are deserving of our special thanks. We also appreciate the cooperation of Marion Jacobs and the staff of the UCLA Psychology Clinic, where the first study was held, and of Howard Adelman and the staff of Fernald School, where the second study was housed; the clinical and administrative skills of Stephen Alkus, who organized the intervention program for the first study; the talents and diligence of David Neswald, who coordinated much of the videotape scoring; and the ever-present contributions of Doris Finck, who also edited and dubbed the video segments. Medication and placebos were supplied by CIBA-Geigy.     

Attention styles and peer relationships of hyperactive and normal boys and girls

Attention skills of hyperactive and normal boys and girls and behavioral ratings by teachers were investigated. Peer perceptions were obtained using a sociometric measure. Results supported previous research that found attentional deficits in hyperactive children. Results also suggested that hyperactive girls, as well as hyperactive boys, have difficulty with peer relationships. Hyperactive boys and girls displayed different patterns of problem behavior, although both groups displayed more problems than normal boys and girls. Specifically, the hyperactive girls displayed more conduct problem behavior than normal girls, but less than hyperactive boys. Because of the disruptive behavior problems they present, hyperactive boys may be identified earlier than are hyperactive girls.Portions of this paper were presented at the 56th annual meeting of the Midwestern Psychological Association, Chicago, 1984. Thanks are expressed to the students and teachers of the Eastwood Local Schools who took part in the study.The author wishes to thank the Department of Psychology and the Faculty Research Committee at Bowling Green State University, Bowling Green, Ohio, for their support of this study.     

Effects of sugar ingestion expectancies on mother-child interactions

This study tested the hypothesis that commonly reported negative effects of sugar on children's behavior may be due to parental expectancies. A challenge study design was employed, in which thirty-five 5- to 7-year-old boys reported by their mothers to be behaviorally sugar sensitive, and their mothers, were randomly assigned to experimental and control groups. In the experimental group, mothers were told their children had received a large dose of sugar, whereas in the control condition mothers were told their sons received a placebo; all children actually received the placebo (aspartame). Mothers and sons were videotaped while interacting together and each mother was then questioned about the interaction. Mothers in the sugar expectancy condition rated their children as significantly more hyperactive. Behavioral observations revealed these mothers exercised more control by maintaining physical closeness, as well as showing trends to criticize, look at, and talk to their sons more than did control mothers. For several variables, the expectancy effect was stronger for cognitively rigid mothers.A portion of this research was presented at the 100th Annual Convention of the American Psychological Association, Washington, DC, August 1992.This research was supported by the Jesse G. Harris Memorial Dissertation Scholarship, and is part of the first author's doctoral dissertation at the University of Kentucky. Special thanks go to Monica Harris for her support and conceptual guidance at the outset of this project.     

Methylphenidate in hyperactive children: Differential effects of dose on academic,learning, and social behavior

Methylphenidate (Ritalin) has been shown to have differential effects on hyperactive children's behavior as a function of dose level. In the present investigation, a triple-blind, placebo-control, within-subject (crossover) experimental design was employed in which 12 hyperactive boys between 6 and 10 years received three different dosages of methylphenidate (5, 10, and 15 mg) in a randomly assigned sequence. Dosage effects were assessed on clinic(PAL-Paired Associates Learning test) and school-(percent on task, teacher ratings, work completion rates, and accuracy) related behaviors. For 10 of the children, classified as responders to medication by the PAL using the criteria of Swanson, Kinsbourne, and colleagues, a series of ANCOVAs with repeated measures showed significant dosage effects on teacher ratings (p 01), percent on task (p 01), academic accuracy (p 05), and assignment completion rates (p 05). PAL performance was also significantly enhanced (p 01) after optimal dose levels were considered. Subsequent trend analysis showed a significant positive linear relationship between dose and each of the dependent variables. A comparison of fixed-dose and miligram-per-kilogram plots showed that children's performance across the different dosages were clearly individualistic and task-specific, even when similar body weights were compared. The implications of using clinic-based testing to determine optimal medication responsivity were discussed.We would like to express our sincere appreciation to the following pediatricians for their valuable assistance: W. H. McDermott, D. J. Chronley, R. B. Trivett, F. J. Jehle, P. M. Small, and F. T. Leong. Grateful acknowledgement is also extended to the two anonymous reviewers whose comments contributed to the content of this paper, and to the undergraduate and graduate student members of the Children's Learning Clinic.     

Short-term serial recall in ADDH,normal, and reading-disabled boys

Short-term retention of verbal items of span and subspan length was examined in hyperactive (ADDH), normal and non-ADDH reading-disabled boys. Performance of ADDH and normal boys did not differ on three measures of verbal serial recall. Thus, it appears that the cognitive deficits of ADDH children cannot be attributed to deficient retention of stimuli. In contrast, reading-disabled (RD) boys performed significantly more poorly than both normal and ADDH boys when required to recall verbal items following filled delay intervals in which the children were required to perform a competing verbal activity. The results suggest that verbal encoding of RD children is particularly vulnerable to interference from other verbal stimuli. ADDH and RD children may represent subsamples of children demonstrating academic difficulties, with each group showing a characteristic pattern of cognitive deficits.This article is based on a doctoral dissertation submitted to the Faculty of Graduate Studies and Research of McGill University. Special thanks are due to Rhonda Amsel for her help and advice.