The neurocognition of conduct disorder behaviors: specificity to physical aggression and theft after controlling for ADHD symptoms

There is growing evidence that among the different conduct disorder (CD) behaviors, physical aggression, but not theft, links to low neurocognitive abilities. Specifically, physical aggression has consistently been found to be negatively related to neurocognitive abilities, whereas theft has been shown to be either positively or not related to neurocognition. The specificity of these links needs further examination because attention deficit hyperactivity disorder (ADHD) links to both physical aggression and neurocognitive variation. The development of self-reported physical aggression and theft, from age 11 to 17 years, was studied in a prospective at-risk male cohort via a dual process latent growth curve model. Seven neurocognitive tests at age 20 were regressed on the growth parameters of physical aggression and theft. The links between neurocognition and the growth parameters of physical aggression and theft were adjusted for ADHD symptoms at ages 11 and 15 (parent, child and teacher reports). Results indicated that verbal abilities were negatively related to physical aggression while they were positively associated with theft. However, inductive reasoning was negatively associated with increases in theft across adolescence. Symptoms of ADHD accounted for part of the neurocognitive test links with physical aggression but did not account for the associations with theft. These differences emphasize the importance of examining specific CD behaviors to better understand their neurodevelopmental mechanisms. They also suggest that youth who engage in different levels of physical aggression or theft behaviors may require different preventive and corrective interventions.     

Book Review

Performance-based measures and ratings of executive functions were examined in a sample of adolescents with attention deficit/hyperactivity disorder (ADHD) and comparison controls. Performance-based measures of executive function included inhibition, working memory, set shifting, and planning, and ratings of these same executive functions were completed by parents and teachers. Adolescents with ADHD demonstrated lower executive function performance than controls and displayed elevated ratings on the executive function ratings by parents and teachers. Significant associations were obtained between the performance-based measures and the parent and teacher ratings, but each measure was not uniquely associated with its respective scale on the rating scales. When performance-based measures and ratings were examined as predictors of ADHD status, the parent and teacher ratings entered as significant predictors of ADHD status. Further commonality analyses indicated that performance-based measures accounted for little unique variance in predicting ADHD status and also displayed little overlap with the behavioral ratings. These findings highlight the diagnostic utility of behavioral ratings of executive function in predicting ADHD status; however, behavioral ratings should not be assumed to be a proxy for performance on measures of executive function in clinical practice.     

Prosocial foundations of children's academic achievement

The present longitudinal research demonstrates robust contributions of early prosocial behavior to children's developmental trajectories in academic and social domains. Both prosocial and aggressive behaviors in early childhood were tested as predictors of academic achievement and peer relations in adolescence 5 years later. Prosocialness included cooperating, helping, sharing, and consoling, and the measure of antisocial aspects included proneness to verbal and physical aggression. Prosocialness had a strong positive impact on later academic achievement and social preferences, but early aggression had no significant effect on either outcome. The conceptual model accounted for 35% of variance in later academic achievement, and 37% of variance in social preferences. Additional analysis revealed that early academic achievement did not contribute to later academic achievement after controlling for effects of early prosocialness. Possible mediating processes by which prosocialness may affect academic achievement and other socially desirable developmental outcomes are proposed.     

Agreement of adolescent ratings with mother ratings and teacher ratings of ADHD symptom groups: A correlated trait-correlated method minus one analysis

This study examined the level of agreement of adolescent ratings with mother ratings, and adolescent ratings with teacher ratings of the inattention (IA) and hyperactivity/impulsivity (HI) symptom groups of ADHD. A total of 214 adolescents provided self-ratings of IA and HI, and their IA and HI were also rated by their mothers and teachers. The correlated trait-correlated method minus one model was applied, with adolescent ratings as the reference method, and the other two ratings as the non-reference methods. The findings indicated no additional variance in adolescent ratings for IA and HI that could not be accounted by mother ratings of IA and HI, respectively. In contrast, there was additional variance in adolescent ratings for IA and HI that could was not accounted by teacher ratings of IA and HI, respectively. The findings suggest that when diagnosing ADHD in adolescents, their reports of their own ADHD behaviors are not needed when mother reports of such behaviors are used.     

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.     

Assessment of ADHD symptoms: comment on Gomez et al. (2003)

R. Gomez, G. L. Burns, J. A. Walsh, and M. A. de Moura (2003) examined the degree to which parent and teacher ratings of attention-deficit/hyperactivity disorder (ADHD) symptoms are accounted for by trait, source, and error variance. The importance and limitations of Gomez et al.'s findings are discussed in the context of clinical and research assessments of children suspected of having ADHD. Gomez et al.'s findings make clear that multimethod and multisource assessment protocols should be used in diagnosing children with this disorder. Further, clinicians and researchers must avoid relying too heavily on 1 source of data when evaluating the severity and frequency of ADHD symptoms.     

The importance of narcissism in predicting proactive and reactive aggression in moderately to highly aggressive children

The present study examined the importance of psychopathy-linked narcissism in predicting proactive and reactive aggression and conduct problems in a group of 160 moderately to highly aggressive children (mean age of 10 years, 9 months). Children's self-report of self-esteem and parent and teacher report of dimensions of psychopathy [narcissism, callous-unemotional (CU) traits, and impulsivity], proactive and reactive aggression, and conduct problems were collected. Composites of parent and teacher ratings of children's behavior were used. Consistent with the study's hypotheses, narcissism predicted unique variance in both proactive and reactive aggression, even when controlling for other dimensions of psychopathy, demographic variables associated with narcissism, and the alternative subtype of aggression. As hypothesized, impulsivity was significantly associated with only reactive aggression. CU traits were not related to proactive or reactive aggression once the control variables were entered. All dimensions of psychopathy predicted unique variance in conduct problems. Consistent with prediction, narcissism was not significantly related to general self-esteem, providing support that narcissism and self-esteem are different constructs. Furthermore, narcissism and self-esteem related differentially to proactive aggression, reactive aggression, and conduct problems. Furthermore, narcissism but not self-esteem accounted for unique variance in aggression and conduct problems. The importance of narcissism in the prediction of aggressive behaviors and clinical implications are discussed.     

A preliminary investigation of reaction time variability in relation to social functioning in children evaluated for ADHD

Reaction time variability (RTV) is a ubiquitous phenomenon in Attention-Deficit/Hyperactivity Disorder (ADHD). Few studies have examined RTV in relation to functional outcomes such as social impairment in children with ADHD. In this exploratory study, we investigated whether RTV is associated with social functioning in children at risk for ADHD. Specifically, we explored the association between RTV (tau derived from correct go trials of a Stop-Signal task) and social functioning in 198 children ages 7–12 years referred for an ADHD evaluation. Social functioning measures included child and/or parent ratings of social competence, aggression, social problems, and impairment in relationships. In regression analyses that also included Oppositional Defiant Disorder symptoms and sex, higher RTV was significantly associated with lower ratings of social competence, and higher proactive/reactive aggression ratings on the child self-report measures. RTV was not significantly associated with parent report of social functioning or relationship impairment. This study provides preliminary evidence that RTV may be associated with social functioning in children at risk for ADHD. We propose that lapses of attention affecting cognitive control may also negatively impact social information processing thereby affecting social functioning. Replication is warranted and longitudinal studies are needed to investigate whether RTV predicts social dysfunction in ADHD.     

Social Skills Mediate the Association of ADHD and Depression in Preadolescents

Childhood attention-deficit/hyperactivity disorder (ADHD) is a replicated risk factor for depression, but the explanatory factors underlying this association have not been reliably identified. Given that social skills (i.e., cooperation, assertion, responsibility, self-control) are sensitive to early ADHD and predict later depression, we tested whether individual differences in social skills individually and collectively mediated predictions of depressive symptoms from early ADHD symptoms. In an ethnically diverse (50 % non-Caucasian) sample of 232 children with (n = 124) and without ADHD (n = 108) followed prospectively for two years (aged 5–10 at Wave 1; 7–12 at Wave 2), we gathered multi-informant (i.e., parent, teacher) and multi-method (e.g., rating scale, structured interview) assessment of key constructs. Using a multiple mediation framework with bootstrapping and statistical control of sex, Wave 1 depression, Wave 1 oppositional defiant disorder (ODD), Wave 1 anxiety, and Wave 2 ADHD symptoms, an independent mediation effect emerged for parent-rated self-control in the prediction of Wave 2 depression (parent-rated) from Wave 1 ADHD symptoms (combined parent and teacher ratings). Teacher-rated social skills at Wave 1 also collectively mediated this association, with teacher-rated assertion emerging as a unique mediator. We discuss the role of social skills in emergent depression among youth with ADHD and consider implications for prevention and intervention.     

Comparing Four Methods of Integrating Parent and Teacher Symptom Ratings of Attention-deficit/hyperactivity Disorder (ADHD)

Although parents and teachers are valid informants in the assessment of childhood attention-deficit/hyperactivity disorder (ADHD), there is relatively little systematic research on how these ratings should be optimally combined. We compared four methods of ADHD assessment to determine how well they identified impaired children: (1) parent only, (2) teacher only, (3) parent or teacher (‘or rule’), and (4) parent and teacher (‘and rule’). We obtained parent and teacher ratings of ADHD from the Disruptive Behavior Disorder Rating Scale on 232 5- to 10-year-old children (69% male; 47% Caucasian) with (n = 121) and without (n = 111) ADHD. We used receiver operating characteristic curves (ROC) and seemingly unrelated regression analyses (SUR) to evaluate how accurately each method identified categorically- and dimensionally-defined measures of functional impairment. Parent ratings of ADHD optimally identified globally impaired children based on categorical and dimensional measures. However, teacher ratings of ADHD most accurately identified children who were negatively regarded by peers using categorical, but not dimensional, measures. No ADHD assessment method effectively identified children with academic difficulties. Although multiple informants are valuable in the assessment of ADHD, no single method was consistently superior in identifying impaired children across domains. We consider alternative assessment strategies in ADHD as well as other potential factors that may contribute to modest agreement among informants.     

Verbal Working Memory as a Longitudinal Mechanism of Vocabulary Problems in Preschoolers with ADHD

Elucidation of early potential risk factors of Attention-Deficit/Hyperactivity Disorder (ADHD) is important to allow for early identification of ADHD and targeted early intervention for children with ADHD. Delayed language skills, particularly poor vocabulary, is an early-developing potential risk factor that is thought to be involved in developmental pathways to ADHD; however, mechanisms explaining the relationship between poor vocabulary skills and ADHD symptoms are unclear and warrant investigation. The present study examines the relationship between poor vocabulary skills and ADHD symptoms by testing cognitive mechanisms, namely verbal working memory (WM), that might account for this link. Participants were 109 young children between the ages of three and six and their primary caregivers. Diagnostic information on ADHD symptoms was available from parents and teachers/daycare providers via standardized rating forms. Vocabulary skills and WM were measured through child performance on laboratory tasks. Mediation analyses found poor verbal working memory significantly partially explained the vocabulary-ADHD association for both parent and teacher-rated ADHD symptoms. Further, effects of verbal WM on the association between poor vocabulary and increased ADHD symptoms largely held at one-year follow-up. Development of early interventions targeting verbal WM may be a promising new direction for early ADHD intervention work.     

Can Executive Functions Explain the Relationship Between Attention Deficit Hyperactivity Disorder and Social Adjustment?

This study examined the ability of executive functions (EF) to account for the relationship between Attention Deficit Hyperactivity Disorder (ADHD) status and social adjustment as indexed by parent and teacher report and by performance on a standardized observational “chat room” task. Children with the Combined subtype (ADHD-C; n = 23), the Primarily Inattentive Subtype (ADHD-I; n = 33), and non-ADHD controls (n = 36) participated. EF did not mediate the relationship between ADHD status and parent or teacher report of social adjustment. EF accounted for about 40–50% of the variance between ADHD status and the ability of children to detect subtle verbal cues as well as memory for the conversation in the chat room task, but did not mediate the relationship between ADHD and the number of prosocial, hostile, or on-topic statements that were made. Results are consistent with other recent reports, and suggest that the role of EF deficits in the production of social skill deficits in ADHD may not be as prominent as is typically assumed. The implications for the development of intervention programs designed to target core cognitive etiologic factors are discussed.     

Predicting the Early Developmental Course of Symptoms of Attention Deficit Hyperactivity Disorder

Data from the National Institute of Child Health and Human Development Study of Early Child Care were examined to test whether: attention deficit/hyperactivity disorder (ADHD) symptoms remain stable from 54 months through early elementary school; behavioral inhibition and attention deficits assessed at 54 months predict ADHD symptoms in elementary school, even after controlling for their temporal stability; and early behavioral inhibition and attention deficits moderate the longitudinal stability in ADHD symptoms. Data were examined using continuous and categorical measures of symptoms. Modest stability in ADHD symptoms from 54 months to third grade was found. Measures of inhibition and inattention predicted later teacher ratings uniquely, but no evidence was found for moderation. Measures of preschool behavioral inhibition also predicted “persistently at risk status” defined by elevated teacher ratings over time. Results are discussed in terms of executive and motivational facets of inhibition that may be related to early signs of ADHD.     

Multimethod Psychoeducational Intervention for Preschool Children with Disruptive Behavior: Two-Year Post-Treatment Follow-up

This paper describes the 2-year post-treatment follow-up of preschool children identified as having high levels of disruptive behavior at kindergarten entry. They were assigned to four treatment conditions: A no-treatment group, parent-training only, treatment classroom only, and the combination of parent training with the treatment classroom. Interventions lasted the entire kindergarten academic year. Initial post-treatment results reported previously indicated no effects for the parent-training program but some efficacy for the classroom intervention program. For this report, the disruptive behavior (DB) children were subdivided into those who did (n = 74) and did not (n = 77) receive the treatment classroom. Two-year post-treatment follow-up results indicated no differences between the classroom treated and untreated DB groups. These groups also failed to differ in the percentage of children using available treatments across the follow-up period. The DB children in both groups had significantly more symptoms of ADHD and ODD than a community control group (N = 47) at follow-up. They also received higher ratings of externalizing problems on the parent Child Behavior Checklist, more severe ratings of behavior problems at home, and ratings of more pervasive behavior problems at school, and had poorer academic skills. Results suggested that early intervention classrooms for DB children may not produce enduring effects once treatment is withdrawn, and that better approaches are needed for identifying those DB children at greatest risk for later maladjustment.     

Behavior problems and peer rejection in preschool boys and girls

The authors tested the hypothesis that deviant behaviors within a preschool peer group would be linked with peer rejection, irrespective of child gender. Seventy-six children, aged 3 to 5 years, participated. Teachers rated children's behavior on the Child Adaptive Behavior Inventory, and children provided sociometric ratings. For a subsample of children (n = 47), observers coded aggressive, noncompliant, and withdrawn behavior using a time-sampling system. For both boys and girls, noncompliance, hyperactivity, and social withdrawal were associated with peer rejection; overt aggression was associated with peer rejection for boys, but not for girls. Analysis revealed that approximately half of the variance in sociometric and teacher ratings of peer rejection was accounted for by aggression and social withdrawal for both boys and girls. The results suggest that the association between behavior problems and peer rejection emerges at a very early age.     

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.     

Forms of Aggression and Peer Victimization During Early Childhood: A Short-term Longitudinal Study

A multi-informant and multi-measure short-term longitudinal study of the association between subtypes of aggression and peer victimization was conducted in an early childhood sample (M = 44.36 months; SD = 11.07; N = 120). Observational and teacher report measures demonstrated appropriate reliability and validity as well as stability across an academic year. Concurrent associations revealed that observed relational aggression was uniquely associated with teacher reported relational victimization and observed physical aggression was uniquely associated with teacher reported physical victimization. Prospective findings indicated that observed relational aggression predicted increases in teacher reported relational victimization for girls only, controlling for the variance associated with physical aggression, prosocial behavior, physical victimization, and gender. Peer rejection partially mediated the association between observed relational aggression at time 1 and teacher reported relational victimization at time 2. Ways in which these and other prospective findings extend the extant literature are discussed.     

Efficacy of Adderall for Attention-Deficit/Hyperactivity Disorder: a meta-analysis

Stimulant medication has, for many years, been the pharmacological treatment of choice for children and adults with Attention-Deficit/Hyperactivity Disorder (ADHD). Several studies have shown Adderall , to be efficacious for measures of inattention, hyperactivity-impulsivity, aggression, disruptive behavior, and academic productivity. Although these studies provide useful information for clinicians treating ADHD children and adults, the variability in efficacy among the different types of measures used within each study has not been comprehensively examined. Thus, to provide a clearer picture of what conclusions can be drawn from these studies, we performed a meta-analysis. Data from the six available studies of standard release Adderall show it to be efficacious for symptoms of inattention, hyperactivity-impulsivity, and aggression, as well as global ratings. Its efficacy was significant for clinician, parent, and teacher ratings, and for both fixed- and best-dose designs.     

Executive Functioning and Engagement in Physical and Relational Aggression among Children with ADHD

Although evidence suggests that executive functioning (EF) impairments are implicated in physically aggressive behavior (e.g., hitting) these cognitive impairments have rarely been examined with regard to relational aggression (e.g., gossip, systematic exclusion). Studies also have not examined if EF impairments underlie the expression of aggression in children with attention-deficit/hyperactivity disorder (ADHD) and if child gender moderates risk. Children with and without clinical elevations in ADHD symptoms (N = 124; ages 8–12 years; 48 % male) completed a battery of EF tests. Parent and teacher report of ADHD and oppositional defiant disorder (ODD) symptoms and teacher report of engagement in physical and relational aggression were collected. Models tested the unique association of EF abilities with physical and relational aggression and the indirect effect through the expression of ADHD or ODD behaviors; child gender was also tested as a moderator. EF impairment was uniquely associated with physical aggression, but better EF ability was associated with relational aggression. For boys, poor EF also was indirectly associated with greater physical aggression through the expression of ADHD behaviors. However, ADHD symptoms were unrelated to relational aggression. ODD symptoms also predicted physical aggression for boys but relational aggression for girls. Results suggest that there are multiple and distinct factors associated with engagement in physical and relational aggression and that better EF may actually promote relational aggression. Established models of physical aggression should not be assumed to map on to explanations of relational aggression.     

Retrospective ratings of ADHD symptoms made at young adulthood by clinic-referred boys with ADHD-related problems, their brothers without ADHD, and control participants

Retrospective childhood attention-deficit/hyperactivity disorder (ADHD) symptoms are required to diagnosis adult ADHD, but the validity of self-rated symptoms across time is questionable. Here, boys with ADHD-related problems, their brothers without ADHD, and former schoolmates rated themselves during young adulthood for ages 9, 14, and 19. Brothers rated probands retrospectively at the same ages. The young adults referred as children for ADHD (a) acknowledged childhood symptoms; (b) described improvement over time; (c) did not differ from brothers or controls on most self-ratings of young adult symptoms; (d) rated themselves as more symptomatic at age 9, but less symptomatic at age 19, than their brothers rated them; and (e) agreed only to some degree with brothers' ratings of probands' aggression (median correlation = .22). Probands' ratings showed limited agreement with judges' symptom ratings (median correlation = .16) and young adult follow-up examiners' ratings (median correlation = .14). These findings are not accounted for solely by changes in informants, nor by the course of ADHD psychopathology. They suggest some stability but limited internal consistency and validity for retrospective ADHD ratings by probands and brothers.