Treatment effectiveness of combined medication/behavioural treatment with chinese ADHD children in routine practice

BACKGROUND: The effectiveness of a combined methylphenidate/behavioural treatment (BT) versus methylphenidate-only for Chinese children with Attention-Deficit/Hyperactivity Disorder (ADHD) was tested in routine clinical practice in Hong Kong. METHODS: A randomized group comparison design was adopted with two treatment conditions (methylphenidate-only; methylphenidate/BT), which lasted for 6 months. There were four assessment time points (pre-treatment, post-treatment, and 6-month and 12-month follow-ups), using the Strengths and Weaknesses of ADHD Symptoms and Normal Behaviours (SWAN) Rating Scale. Parental attitude toward different treatment options of ADHD was also assessed at pre-treatment and post-treatment. Participants included 90 Chinese ADHD children (mean age=8 years, SD=.95). RESULTS: The combination of BT and a low-dose methylphenidate was significantly more effective than methylphenidate-only in reducing ADHD and ODD symptoms at post-treatment. At follow-ups, the benefits of the combined treatment were maintained, while the methylphenidate-only group caught up in improvement in ADHD symptoms. Parents in both treatment conditions showed improved attitude toward medication after the 6-month treatment phase, while their attitude toward BT was positive all along. CONCLUSIONS: This study supported the added benefits of BT, on top of medication, for Chinese ADHD children in routine practice with treatments conducted by regular medical and paramedical staffs.     

Parental involvement in children's learning: Comparing parents of children with and without Attention-Deficit/Hyperactivity Disorder (ADHD)

The present study examined involvement in children's learning among parents of 101 children between 8 and 12 years of age (53 parents of children with ADHD, 48 parents of children without ADHD). Compared to parents of children without ADHD, parents of children with ADHD reported lower self-efficacy in their ability to help their children, felt less welcome and supported by their children's schools and teachers, and perceived less time and energy for involvement in their children's academic lives. Mothers of children with and without ADHD reported similar types and levels of involvement behaviors in the home. Fathers of children with ADHD reported being more disengaged from their children's learning and using more coercive and punitive interactions regarding their children's achievement compared to fathers of children without ADHD. These findings underscore the difficulties in parent-supported learning practices and home-school collaboration initiatives faced by parents of children with ADHD and educators alike. Implications for school psychology practice are discussed.     

Comorbid Problems in ADHD: Degree of Association,Shared Endophenotypes,and Formation of Distinct Subtypes. Implications for a Future <Emphasis Type="Italic">DSM</Emphasis>

We aimed to assess which comorbid problems (oppositional defiant behaviors, anxiety, autistic traits, motor coordination problems, and reading problems) were most associated with Attention-Deficit/Hyperactivity Disorder (ADHD); to determine whether these comorbid problems shared executive and motor problems on an endophenotype level with ADHD; and to determine whether executive functioning (EF)—and motor-endophenotypes supported the hypothesis that ADHD with comorbid problems is a qualitatively different phenotype than ADHD without comorbid problems. An EF—and a motor-endophenotype were formed based on nine neuropsychological tasks administered to 816 children from ADHD—and control-families. Additional data on comorbid problems were gathered using questionnaires. Results indicated that oppositional defiant behaviors appeared the most important comorbid problems of ADHD, followed by autistic traits, and than followed by motor coordination problems, anxiety, and reading problems. Both the EF—and motor-endophenotype were correlated and cross-correlated in siblings to autistic traits, motor coordination problems and reading problems, suggesting ADHD and these comorbid problems may possibly share familial/genetic EF and motor deficits. No such results were found for oppositional defiant behaviors and anxiety. ADHD in co-occurrence with comorbid problems may not be best seen as a distinct subtype of ADHD, but further research is warranted. Electronic supplementary material  The online version of this article (doi:) contains supplementary material, which is available to authorized users.     

Can Attention Deficit Hyperactivity Disorder and Fetal Alcohol Spectrum Disorder be differentiated by motor and balance deficits?

There is an ongoing debate regarding the diagnostic overlap between Attention Deficit Hyperactivity Disorder (ADHD) and Fetal Alcohol Spectrum Disorder (FASD). Differential diagnosis is important because of treatment implications. Children aged 7–10 years (47 ADHD, 30 FASD, 39 controls) participated. The Movement Assessment Battery for Children (M-ABC) and the Clinical Observations of Motor and Postural Skills (COMPS) were used. Force plate and electromyography data were collected during static balance and balance perturbation. On the M-ABC both children with ADHD and FASD had more motor problems than controls. The ADHD-Combined and the ADHD-Predominantly Inattentive subgroups were similarly affected in their fine motor skills. On the COMPS, the majority of children in both groups performed in the normal range, but for those children clinically affected, it was the children with ADHD who were more likely to be severely impaired. The children with ADHD were characterized by early onset latencies of the tibialis anterior muscles and increased amplitudes of the gastrocnemius muscles. Difficulty scaling muscle force reflecting medial cerebellar involvement may be the key problem in ADHD. Cerebellar involvement in the postural instability in FASD awaits further study.     

Teachers' Ratings of Attention-Deficit Hyperactivity Disorder and Decisions for Referral for Services in Taiwan

We examined the relationship between elementary teachers' perceptions and ratings of Attention-Deficit Hyperactivity Disorder (ADHD) symptoms of students and their referral decisions in public schools in Taiwan. One hundred and twenty-one homeroom teachers were randomly selected from six public elementary schools in Taipei County, Taiwan, to participate in the study. The study contained two groups of children, a random sample (n — 478) and a nominated sample (n = 219). Results of the discriminant analyses showed that Chinese teachers' ratings of ADHD could predict group membership as to whether a student had been or might be referred. This study found that, despite the fact that Chinese teachers believed children with scores two standard deviations above the mean had behavior problems, teachers decided not to refer those students. Teachers were more likely to refer children whose scores were three standard deviations above the mean.     

The Importance of Parental Attributions in Families of Children with Attention-Deficit/Hyperactivity and Disruptive Behavior Disorders

Presents a social-cognitive model outlining the role of parental attributions for child behavior in parent–child interactions. Examples of studies providing evidence for the basic model are presented, with particular reference to applications of the model in families of children with Attention-Deficit/Hyperactivity Disorder (ADHD) and/or oppositional defiant/conduct disordered behavior. Parent or child factors that may moderate the operation of links within the model are suggested, and evidence of such moderator effects is presented. The conceptualization and measurement of parental attributions also are discussed. The limitations of the model and existing evidence, as well as recommendations for future research in this area are presented throughout the paper. The paper concludes with a summary of the clinical implications of the model and research on parental attributions with regards to improving interventions for families of children with attentional and disruptive behavior problems.     

Construction and validation of Self-Efficacy Scale for early school-aged children

Self-efficacy beliefs play an important role in regulating a child's functioning and emotional well-being. The aims of our study were to construct the Polish Self-Efficacy Scale for Children (SESC) in early school age and to explore its factor structure and construct validity. A total of 402 children in the age range of 8 to 10 years took part in the study. An exploratory factor analysis of the SESC revealed four factors. The internal reliability of each scale score ranged from good to very good. Results show that self-efficacy beliefs for academic achievement, self-control and regulation of negative emotion are negatively correlated with inattention, hyperactivity–impulsivity, low emotional control and trait anxiety. It is concluded that the SESC is a promising measure for research concerning child development and psychopathology.