Psychosocial Treatments for Children with Attention Deficit/Hyperactivity Disorder

This article reviews studies examining the efficacy of behavioral interventions for the treatment of attention-deficit/hyperactivity disorder (ADHD). A specific emphasis is placed on evidence-based interventions that include parent training, classroom, academic, and peer interventions. Results indicate that school-aged children respond to behavioral interventions when they are appropriately implemented both at home and in the classroom setting. Combined treatments (behavioral management and stimulant medication) represent the gold standard in ADHD treatment and are often recommended as the first-line treatment option due to the many problems faced by children with ADHD. Diversity issues, although an important consideration in the treatment of ADHD, continue to remain an understudied area. Recommendations for future research are made pertaining to treatment sequencing with regard to behavior management as well as for subgroups of ADHD children who may respond best to specific treatments.     

The Relation of Story Structure Properties to Recall of Television Stories in Young Children with Attention-Deficit Hyperactivity Disorder and Nonreferred Peers

In this study, the authors examined memory for televised stories to gain insight into similarities and differences in story comprehension between young children with attention-deficit hyperactivity disorder (ADHD) and their typical peers. In particular, the authors investigated the extent to which 4- to 6-year-old children's free recall of story events is predicted by several structural properties of story events (number of causal connections, whether an event is on or off the story's causal chain, story-grammar category, and position in the story's hierarchical structure), whether differences exist between children with ADHD and nonreferred comparison children in their sensitivity to structural features of stories, and whether age differences in sensitivity to structural features are similar for both groups. For both groups, recall of story events was predicted by all four structural properties, but the effects of the two causal properties was stronger for comparison children than for children with ADHD. Further examination revealed that this difference was observed only when a competing activity was available during television viewing. These findings indicate that both groups of preschool children are able to benefit from causal structure when recalling television stories, but that children with ADHD lose this benefit when attention is divided. Consistent with previous findings for nonreferred children (P. W. van den Broek, E. P. Lorch, & R. Thurlow, 1996), in both diagnostic groups the effects of causal properties increased across age, and older children were more likely to include causally important protagonists' goals in their recalls than younger children.     

The Development of Selective Attention in Children With Attention Deficit Hyperactivity Disorder

The influence of age on a selective attention task was studied in a sample of children with and without Attention Deficit Hyperactivity Disorder (ADHD). The impact of methylphenidate (MPH) treatment on selective attention was also investigated in the children with ADHD. Two age groups of children with ADHD and two age groups of control children were tested using a timed computer task. The task consisted of identifying visual target stimuli under various distracter conditions. Distracters varied on the basis of modality (i.e., visual, auditory, or both) and task relevance (i.e., meaningful or irrelevant). Reaction times and accuracy were measured. Children with ADHD were less efficient on the selective attention task than were children without ADHD, and older children were more efficient than younger children in both groups. Children without ADHD were influenced more by the nature of distracters than were children with ADHD. For children with ADHD, MPH improved performance overall.     

国内注意缺陷/多动障碍儿童干预效果的元分析

对国内过去12年间的62项注意缺陷/多动障碍干预研究结果进行了元分析,结果显示：（1）国内现有的ADHD干预措施取得了显著的干预效果;（2）在不同干预措施中,药物治疗与行为疗法或认知行为疗法相结合具有最佳疗效,单独的药物治疗次之,单独的行为疗法或认知行为疗法效果较低;（3）在各种效果指标中,学业指标上的效果量是最大的,这一结果与国外已有的元分析研究发现不一致;（4）在各种效果信息来源中,来自客观观察的效果量最高,来自父母评价的效果量次之,来自教师评定的效果量最差。（5）各种干预措施在不同效果指标上有不同的表现。药物治疗对于学业和行为指标的效果最强烈,而认知行为疗法和脑电反馈疗法对认知指标的效果最明显。最后,结合干预措施的选择、效果指标的采用以及研究质量问题进行了讨论     

注意缺陷多动障碍儿童的表征搜索

为探索ADHD儿童在时间维度上的视觉选择性注意的基本机制,揭示其表征搜索能力是否存在缺陷,研究采用RSVP范式,通过实验材料(字母和数字)和呈现方式操作两种搜索方式:序列搜索和平行搜索,比较ADHD儿童(18名)和控制组儿童(17名)的成绩差异。结果发现:①在平行搜索和序列搜索条件下,ADHD儿童的成绩均低于正常控制组;②比较平行搜索和序列搜索条件下的成绩变化,以及由低难度到高难度上成绩的变化,无论是正确率还是反应时均发现ADHD儿童和正常儿童具有相同的成绩变化模式。结论认为ADHD儿童在视觉选择性注意的基本搜索机制上并不存在明显缺陷。     

Children with Attention Deficit Hyperactivity Disorder

ABSTRACT

It is estimated that there have been over 4,000 articles in the literature on the subject of attentional problems, addressing its etiology, epidemiology, assessment, diagnosis, and treatment. This article reviews recent and relevant literature with an eye toward functional conclusions and linkages between assessment and intervention. The article concludes by providing a problem-solving model that integrates parent or teachers' referral concerns, reasons for these concerns, assessment methods, and intervention strategies. In the end, four definitive conclusions are drawn, and the importance of multimodal strategies that collaboratively involve home, school, and community settings is emphasized.     

错误意识判断对ADHD儿童错误觉察的影响特点

将GO/NO-GO任务范式和错误意识判断范式相结合,对21名ADHD儿童,27名正常儿童,在错误监控中的错误觉察水平进行考察,结果表明:1)ADHD儿童能够正常觉察到自己的错误反应;2)错误意识判断任务诱发出ADHD儿童的错误延迟效应,这种作用,既是因为该任务能够刺激ADHD儿童的有意觉察,又因为该任务无形中增加了GO/NO-GO任务中的刺激间隔时间。该结果表明,增加刺激间隔时间,可能会促使ADHD儿童改变错误后的反应策略,对错误反应进行错误调节,提高其错误监控水平。     

Interference Control in Children with Attention Deficit/Hyperactivity Disorder

The view that Attention Deficit/Hyperactivity Disorder (ADHD) is associated with a diminished ability to control interfference is controversial and based exclusively on results of (verbal)-visual interference tasks, primarily the Stroop Color Word task. The present study compares medication-naïve children with ADHD (n?=?35 and n?=?51 in Experiments 1 and 2, respectively) with normal controls (n?=?26 and n?=?32, respectively) on two interference tasks to assess interference control in both the auditory and the visual modality: an Auditory Stroop task and a Simon task. Both groups showed reliable but equal degrees of interference on both tasks, suggesting that children with ADHD do not differ from normal controls in their ability to control interference in either modality.     

反馈对注意缺损多动障碍儿童错误监控能力的影响

研究选取了注意缺损多动障碍(ADHD)儿童39名,正常儿童40名,采用两项选择任务,考察在无反馈和有反馈的情况下,ADHD儿童的错误监控能力是否存在缺损。结果发现,(1)无论是否提供反馈,与正常儿童相比,ADHD儿童的错误察觉能力正常,但是错误更正能力落后,这可能是由于ADHD儿童动作调节控制能力落后导致的;(2)反馈提高了ADHD儿童和正常儿童的认知加工速度,但同时降低了他们的警醒水平,导致错误监控能力下降。     

Task Switching and Attention Deficit Hyperactivity Disorder

The main goal of the present set of studies was to examine the efficiency of executive control processes and, more specifically, the control processes involved in task set inhibition and preparation to perform a new task in attention deficit hyperactivity disorder (ADHD) and non-ADHD children. This was accomplished by having ADHD children, both on and off medication, and non-ADHD children perform the task-switching paradigm, which involves the performance of two simple tasks. In nonswitch trials, an individual task is performed repeatedly for a number of trials. In switch trials, subjects must rapidly and accurately switch from one task to the other, either in a predictable or unpredictable sequence. Switch costs are calculated by subtracting performance on the nonswitch trials from performance on the switch trials. These costs are assumed to reflect the executive control processes required for the coordination of multiple tasks. ADHD children showed substantially larger switch costs than non-ADHD children. However, when on medication, the ADHD children's switch performance was equivalent to control children. In addition, medication was observed to improve the ADHD children's ability to inhibit inappropriate responses. These data are discussed in terms of models of ADHD and cognition.     

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.     

Family Correlates of Comorbid Anxiety Disorders in Children with Attention Deficit/Hyperactivity Disorder

This study evaluated parental anxiety and parenting practices associated with comorbid Anxiety Disorders among children with Attention Deficit/Hyperactivity Disorder. Clinic-referred families (n=143) were diagnosed using DSM criteria. Parents and children completed measures of parenting practices. Comorbid anxiety in children was significantly associated with maternal anxiety, overprotectiveness, and a lack of positive parenting. The relative odds of comorbid anxiety appeared to be especially high when all three factors were present. These findings are consistent with theory linking those three family factors to the development of anxiety in all children. Implications for adjunctive treatment of anxiety that is comorbid with ADHD are discussed.     

工作记忆负荷对注意缺陷多动障碍儿童过滤新异分心刺激能力的影响*

关于启动工作记忆负荷的强度与过滤分心刺激这两种认知资源的关系一直存在争论;并且对ADHD儿童来说,新异的分心刺激是提高了唤醒水平,还是干扰了任务进程也一直存在争论。本研究选取了ADHD儿童32名,正常儿童35名。采用视听跨通道oddball任务,通过操作视觉任务工作记忆负荷的高低,以及分心刺激与目标刺激之间的时间间隔,探讨不同工作记忆负荷对 ADHD 儿童过滤新异分心刺激能力的影响。结果发现：(1)在低工作记忆负荷条件下,分心刺激对两组儿童都起到了唤醒作用;在高工作记忆负荷条件下,分心刺激影响了两组儿童对任务本身的加工过程,使其判断的精确性下降。但是 ADHD 儿童受到的影响更大,表明其过滤分心刺激的能力落后。(2)当分心刺激与目标刺激同时出现时, ADHD儿童受到的干扰最大;但随着二者时间间隔的延长,并没有出现间隔越长干扰效应越小的趋势。在本研究条件下,得出以下结论：(1)两组儿童对跨通道新异分心刺激的过滤受到目标任务的工作记忆负荷强度的影响。(2)适度延长分心刺激与目标刺激之间的时间间隔可能会帮助ADHD的注意回归。     

Methodological Issues in the Assessment of Medication Effects in Children Diagnosed with Attention Deficit Hyperactivity Disorder (ADHD)

Attention deficit hyperactivity disorder (ADHD) is one of the most commonly diagnosed disorders in school-aged children and is usually treated with stimulant medications, including methylphenidate (MPH; Ritalin®, Ritalin-LA®, Concerta®, Metadate®, or Focalin®) and other drug compounds (e.g., Adderall®, Adderall-XR®, or Dexedrine). Assessment of school behavior and performance is a critical component in determining the safety and efficacy of these medications. This paper reviews methodological issues in assessing drug effects in school settings by considering features of the independent variable (the medication), the dependent variables (the endpoints selected for assessment), and the design (the structure of the assessment). In addition, we consider recent conceptual advances in understanding the behavioral mechanisms of action of drugs used to treat ADHD that may influence the structure and interpretation of medication assessments.     

不同特征维度下ADHD儿童的任务切换特点

本研究采用双向刺激设置,通过操纵两实验的特征维度,以考察任务维度对ADHD儿童任务切换的影响。结果发现,在两个实验中,相对于正常组儿童,ADHD儿童在任务切换上都表现出缺损。当注意维度相同时,ADHD儿童在固定顺序上的切换损耗大于随机顺序,但在跨维度任务中,ADHD儿童在固定顺序上的切换损耗则小于随机顺序,这与正常儿童的表现模式不一致。该结果表明,工作记忆会对ADHD儿童产生影响,但这取决于任务的特征维度是否一致。     

Psychological functioning in siblings of children with Attention Deficit Hyperactivity Disorder

We examined psychological functioning in siblings of children with Attention Deficit Hyperactivity Disorder (ADHD). Siblings of children diagnosed with ADHD (n = 45) between the ages of 9 and 13 and a control group (n = 46) within the same age range composed of siblings of children with no diagnosed disorders completed measures of psychological functioning. A significant multivariate difference was observed on these measures across groups. Post hoc investigation of the univariate means revealed one significant group difference, which occurred on a measure of Trait Anger. This finding suggests that future research on family members of children with ADHD may be warranted.     

Family Correlates of Oppositional and Conduct Disorders in Children With Attention Deficit/Hyperactivity Disorder

Comorbidities among children with ADHD are key determinants of treatment response, course, and outcome. This study sought to separate family factors (parental psychopathology and parenting practices) associated with comorbid Oppositional Defiant Disorder (ODD) from those associated with Conduct Disorder (CD) among children with Attention Deficit/Hyperactivity Disorder. Clinic-referred families (n = 149) were diagnosed using DSM-IV criteria. Parents completed measures of parenting practices. Comorbid ODD and CD were significantly associated with maternal negative/ineffective discipline. Comorbid CD, but not ODD, was significantly associated with lack of maternal warmth and involvement, paternal negative/ineffective discipline, and with paternal Antisocial Personality Disorder (APD). However, the risk of CD posed by parenting appeared concentrated among children without a father having APD. While consistent discipline appears important for addressing comorbid ODD and CD, paternal psychopathology and the quality of the relationship between mother and child may pose risk specifically for comorbid CD. Efforts to prevent and/or treat CD should consider not only provision of structure and prudent discipline, but also the affective qualities of the relationship between the primary caretaker and child.     

Occupational Therapy Interventions for Children with Attention Deficit Hyperactivity Disorder: A Systematic Review

This systematic review examined evidence published 2005–2015 for occupational therapy interventions for children with Attention Deficit Hyperactivity Disorder (ADHD). We identified 590 abstracts with 17 full-text articles eligible for review. Fourteen articles were included in the final analysis with two level I studies, two level II studies, eight level III studies, and two level IV studies. Occupational therapy interventions focused on play, sensory, motor, and cognitive skills. While the interventions yielded good results, there were limitations in study design, interventions, and outcome measures. Future research should include larger sample size, randomization, control groups, and interventions that can be replicated.     

Very Low Birth Weight and Attention Deficit/Hyperactivity Disorder

It is well recognized that reaction time performance of term-born children with a normal birth weight (NBW > 2500 g) who fulfill the DSM-IV criteria for attention deficit/hyperactivity disorder (ADHD) in the primary school age is sensitive for the presentation rate of stimuli. They have been found to perform more poorly in conditions of relatively slow event rates as compared with fast event rates. The purpose of the current study was to explore whether reaction time performance of children with very low birth weight (VLBW < 1500 g) with or without ADHD showed the same sensitivity for the factor presentation rate of stimuli compared to children with a normal birth weight plus ADHD. To this end, reaction time performance of four groups of children was compared on a Go/No-Go test with a fast presentation rate of 1 second and a slow presentation rate of 6 seconds. Groups were: children with VLBW plus ADHD, children with VLBW only, children born full term with normal birth weight (NBW >2500 g) plus ADHD, and children born full term without ADHD (the control group). Findings indicated that, compared to the non-ADHD groups, the groups with ADHD (NBW and VLBW) showed a more dramatic decline in their reaction time performance in the slow condition: a state regulation deficit. In addition, both groups showed a response inhibition deficit. No difference was found in reaction time performance between the groups of children with VLBW only and the control group.     

Restraint and Cancellation: Multiple Inhibition Deficits in Attention Deficit Hyperactivity Disorder

We used variations of the stop signal task to study two components of motor response inhibition—the ability to withhold a strong response tendency (restraint) and the ability to cancel an ongoing action (cancellation)—in children with a diagnosis of attention deficit hyperactivity disorder (ADHD) and in non-ADHD controls of similar age (ages 7–14 years). The goal was to determine if restraint and cancellation were related and if both were deficient in ADHD. The stop signal task involved a choice reaction time task (go task) which required a rapid response. The demand for inhibitory control was invoked through the presentation of a stop signal on a subset of go trials which required that the ongoing response be suspended. The stop signal was presented either concurrently with the go signal (restraint version) or after a variable delay (cancellation version). In Study 1, we compared ADHD and control children on the cancellation version of the stop task; in Study 2, we compared ADHD and controls on the restraint version. In Study 3, a subset of ADHD and control participants completed both tasks so that we could examine convergence of these dimensions of inhibition. Compared to control participants, ADHD participants showed a deficit both in the ability to cancel and to restrain a speeded motor response. Performance on the restraint version was significantly correlated with performance on the cancellation version in controls, but not in ADHD participants. We conclude that ADHD is associated with deficits in both restraint and cancellation subcomponents of inhibition.