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.     

The Use of Stimulant Medication and Behavioral Interventions for the Treatment of Attention Deficit Hyperactivity Disorder: A Survey of Parents’ Knowledge, Attitudes, and Experiences

We examined parents’ knowledge, attitudes, and information sources regarding Attention-Deficit/Hyperactivity Disorder (ADHD), including treatment with stimulant medication and behavioral interventions. Responses from parents with a child diagnosed with ADHD and parents without a child diagnosed with ADHD were also compared. Participants consisted of 146 parents of elementary age children from Wisconsin. The surveyed parents were aware of issues surrounding ADHD and the use of stimulant medication, but there were several areas where they possessed inaccurate or incomplete factual information. Parents who had a child diagnosed with ADHD rated the effects of stimulant medication more positively and side effects as less severe than other parents. They also rated behavioral interventions as less effective on all questions. Implications of the study are discussed.     

Treatment Sensitivity of a Brief Rating Scale for Attention-Deficit Hyperactivity Disorder (ADHD) Symptoms

This study examined the treatment sensitivity of the ADHD Questionnaire (ADHD-Q), which is a brief rating scale for measuring symptoms of inattention, hyperactivity, and impulsivity in children. Parent, teacher, and child self-report data of the ADHD-Q were obtained for 17 clinically referred children with ADHD on the three occasions: (1) during the regular intake assessment, (2) just before the start of the stimulant medication (i.e., methylphenidate) intervention, and (3) four weeks after the start of the medication intervention. Results showed that ADHD-Q scores remained fairly stable in the period prior to the intervention, but then showed a substantial decline after the stimulant medication had been administered. Clearly, this finding supports the treatment sensitivity of the ADHD-Q.     

两种亚型ADHD儿童的促进和抑制加工

采用图片Stroop任务,对两种亚型ADHD儿童的促进和抑制加工进行了研究。结果发现,不论在反应时还是错误率上,ADHD儿童和正常儿童在促进效应上的表现模式相似,但ADHD儿童在错误率上比正常儿童表现出更大的抑制效应,混合型ADHD儿童的抑制效应更大于注意缺陷型儿童。由于ADHD儿童仅选择性地在抑制加工上受损,而促进加工正常,这一结果提示,促进和抑制可能是具有不同机制的、分离的加工过程。     

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.     

Pediatrician/Psychologist Collaboration: Opportunities for Clinical Child Psychologists

In the United States, pediatricians prescribe the majority of medications used to treat children with psychological disorders, such as ADHD. However, because pediatricians have limited background in psychology or psychiatry, opportunities exist for properly trained clinical child psychologists to assist pediatricians in assessing and treating youngsters with psychological disorders. Psychologists with additional training in psychopharmacology can make even greater contributions by helping pediatricians select and monitor appropriate medications. This paper reviews models of consultation that are especially relevant to psychologists who seek to expand their practice by consulting with pediatricians. Consultant-centered models seem most appropriate in private practice settings, but institutionally employed psychologists have opportunities to also utilize some system-centered approaches. Examples of methods in which pediatric clinical psychologists and child psychologists with psychopharmacology training can assist pediatricians in treating a child with ADHD are discussed.     

Adrenocortical Functioning in Boys with Attention-Deficit/Hyperactivity Disorder: Examining Subtypes of ADHD and Associated Comorbid Conditions

Disruptions to hypothalamic-pituitary-adrenal (HPA) axis function have been associated with varying forms of psychopathology in children. Studies suggesting children with ADHD have blunted HPA function have been complicated by the prevalence of comorbid diagnoses and heterogeneity of ADHD. The goals of this research were to assess the relations between waking and stress–response salivary cortisol levels and comorbid disruptive behavior (DBD) and anxiety (AnxD) disorders and problems in boys with ADHD, and to examine whether cortisol levels varied across ADHD subtypes. One hundred seventy elementary school-age boys with ADHD provided salivary cortisol at waking and in reaction to venipuncture. Parent reports were used to assess boys’ psychiatric diagnoses and severity of behavioral problems. Boys’ comorbid AnxD and anxiety problems were associated with greater cortisol reactivity, whereas boys’ comorbid DBD and oppositional problems predicted diminished adrenocortical activity. Reactive cortisol increases were greatest in boys with ADHD and comorbid AnxD, but without DBD. ADHD subtypes were not differentially associated with waking, pre-stress baseline, or reactive cortisol levels. However, comorbid DBD predicted decreased cortisol reactivity in boys with inattentive and hyperactive subtypes of ADHD, but not in boys with combined subtype of ADHD. The results clarify previous patterns of distinct and divergent dysregulations of HPA function associated with boys’ varying kinds of psychopathology.

Assessing ADHD-related Family Stressors with the Disruptive Behavior Stress Inventory (DBSI): A Replication and Extension

The Disruptive Behavior Stress Inventory (DBSI) was developed to provide information related to the occurrence and severity of stressors that result from having a child with ADHD. Data provided in the initial 2002 study by Johnson and Reader (Journal of Clinical Psychology in Medical Settings, 9, 51–62) provided good preliminary support for the reliability of the DBSI, as well the ability of the scale scores to differentiate primary caregivers of children with and without a history of ADHD. The present study was an attempt to replicate major findings of the 2002 study using an additional larger sample and extend it by conducting item-level analyses to determine the degree to which individual DBSI items differentiate primary caregivers of children with and without a history of ADHD. Results provided additional support for the reliability and validity of the DBSI by replicating major findings from the 2002 study and further suggesting that a large majority of the 40 items individually differentiate between primary caregivers of children with and without a history of ADHD.     

奖惩对注意缺陷多动障碍儿童情感决策的影响

采用简化版儿童赌博任务,其中操纵了奖励和惩罚的强度,探察两种亚型（注意缺陷型和混合型）ADHD儿童的情感决策能力,同时采集儿童在任务中的皮肤电活动以探析ADHD儿童在情感决策中的生理机制。结果发现,在不同的奖惩强度下,ADHD儿童情感决策模式不同,在即刻奖励条件下,ADHD儿童情感决策的能力明显弱于正常对照组儿童,倾向于不利选择,所产生的预测性皮电振幅也明显低于正常对照组;在即刻惩罚条件下,ADHD儿童的情感决策能力未见异常。两种亚型ADHD儿童的表现模式相似。上述结果证明,ADHD儿童仅存在对奖励的异常敏感性,并确实影响了其决策能力,而其回避惩罚的能力正常。两种亚型ADHD儿童存在的问题相似