Self-control game interventions for attention-deficit hyperactivity disorder.

Compared the effects of self-control training, using cognitive-behavioral game play (CB) and biofeedback game play (BF), on the behaviors of 58 male and 5 female 8–12 yr olds with Full Scale IQ of 90 or higher on the Wechsler Intelligence Scale for Children--Revised (WISC--R) and diagnosed with attention deficit hyperactivity disorder (ADHD). The experimental groups were compared to a control game group (GC), which received no self-control training. A 3?×?3 (treatment?×?time) factorial design with repeated measures, using IQ as a covariate, and multiple outcome criteria was employed comparing the groups. Findings support the hypothesis that self-control training by BF reduces a child's perception of his or her self-control problems, but the same does not generalize to parental report of self-control or behavioral measures. Hyperactivity, one of the cardinal symptoms of ADHD, was significantly decreased in GC. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An update on the diagnosis and treatment of attention-deficit/hyperactivity disorder in children.

What are the most appropriate empirically supported diagnostic and treatment approaches to children with attention-deficit/hyperactivity disorder (ADHD)? This article summarizes the nomenclature, prevalence and course, comorbidity, etiology, assessment, and federal laws associated with ADHD. The authors then review clinical research and consensus guidelines for the treatment of ADHD, including the largest randomized treatment study completed on ADHD (MTA Cooperative Group, 1999a). The empirical evidence supports either a behavioral-psychosocial or a combined behavioral-psychosocial and medication intervention in the treatment of children with ADHD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive inhibition and working memory in attention-deficit/hyperactivity disorder.

Studies of cognitive control in attention-deficit/hyperactivity disorder (ADHD) have emphasized the ability to suppress motor responses (i.e., behavioral inhibition) rather than the ability to actively suppress prepotent mental representations (i.e., cognitive inhibition). Further, working memory deficits are suspected in ADHD, yet their distinction from cognitive inhibition is unclear. Two hundred and eighty-eight adolescent and adult participants, 115 of whom met criteria for ADHD and 173 of whom were for non-ADHD comparison, completed a sentence processing task that required the suppression of an incorrect interpretation and a working memory task. The results failed to support cognitive inhibition problems in ADHD. Moreover, the ability to reanalyze sentences with a temporary misinterpretation was at least partially related to working memory performance. The results challenge a unitary inhibition problem in ADHD and suggest inhibition problems do not extend to cognitive suppression in this age range. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Planning ability in adults with attention-deficit/hyperactivity disorder.

Planning ability was investigated in 26 patients diagnosed with attention-deficit/hyperactivity disorder in adulthood and in 27 control participants, with groups matched for age, predicted IQ, and social class. They were tested using the 3-dimensional computerized Tower of London Test (Morris, Ahmed, Syed, & Toone, 1993; Morris, Rushe, Woodruffe, & Murray, 1995), which measures planning latencies as well as accuracy, with problems increasing in graded difficulty. For the control group, planning latencies increased systematically with task difficulty, with the participants slowing their initial responses to ensure accuracy. For those with attention-deficit/hyperactivity disorder, there was no increase in planning time and a corresponding diminution in accuracy on the most difficult problems. This pattern of impairment is interpreted as resulting from failure to inhibit responses when confronted with problem solving, leading to reduced planning activity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Parenting in mothers with and without attention-deficit/ hyperactivity disorder.

The authors examined the impact of maternal attention-deficit/hyperactivity disorder (ADHD) on parenting behaviors. Sixty mothers between the ages of 31 and 50 with (n = 30) and without (n = 30) ADHD and their 8- to 14-year-old children with ADHD completed self-report and laboratory measures of monitoring of child behavior, consistency in parenting, and parenting problem-solving abilities. These parenting behaviors were selected because of their established links to the development of child behavior problems. As predicted, mothers with ADHD were found to be poorer at monitoring child behavior and less consistent disciplinarians compared with mothers without ADHD. There was some evidence to support the prediction that mothers with ADHD were less effective at problem solving about childrearing issues than control mothers. The differences between the 2 groups of mothers persisted after child oppositional and conduct-disordered behavior were controlled. These results indicate that parenting is an area of functioning that requires more attention in adult ADHD research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Validity of DSM-IV attention-deficit/hyperactivity disorder for younger children

OBJECTIVE: Little is known about the validity of the diagnosis of attention-deficit/hyperactivity disorder (ADHD) in young children. Moreover, the results of the DSM-IV field trials raised concerns that inclusion of the new predominantly hyperactive-impulsive type of ADHD in DSM-IV might increase the likelihood of the diagnosis being given to active but unimpaired preschool and primary school children. METHOD: The validity of DSM-IV criteria for each subtype of ADHD was evaluated in 126 children, aged 4 through 6 years, and 126 matched comparison children. Probands and controls were classified by using structured diagnostic interviews of the parent and a DSM-IV checklist completed by the teacher. RESULTS: Children who met DSM-IV criteria for each subtype of ADHD according to parent and teacher reports differed consistently from controls on a wide range of measures of social and academic impairment, even when other types of psychopathology and other potential confounds were controlled. CONCLUSIONS: When diagnosed by means of a structured diagnostic protocol, all three DSM-IV subtypes of ADHD are valid for 4- through 6-year-old children in the sense of identifying children with lower mean scores on measures of adaptive functioning that are independently associated with ADHD.     

Discriminant validity of the Behavior Rating Inventory of Executive Function Parent Form for children with attention-deficit/hyperactivity disorder.

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder, with concomitant executive function deficits often being the focus of empirical and clinical investigation. This study explored the validity of the Behavior Rating Inventory of Executive Function Parent Form (BRIEF; Gioia, Isquith, Guy, & Kenworthy, 2000) for children with ADHD and a matched control sample. Fifty-eight children with ADHD (69% with comorbidity) and 58 matched controls were found to exhibit statistically (p     

The latent structure of attention-deficit/hyperactivity disorder in a clinic-referred sample.

The question of whether attention-deficit/hyperactivity disorder (ADHD) represents a continuum of attentional and executive dysfunction or a natural category has yet to be extensively investigated. Subjective report and neuropsychological data from 437 individuals referred for neuropsychological evaluation were analyzed using latent class and taxometric analyses (mean above minus below a cut [MAMBAC], maximum eigenvalue [MAXEIG], and latent mode [LMODE]). Results indicated no significant evidence for a taxonic representation of ADHD across multiple procedures and indicator sets. Similarly, there was no evidence that ADHD subtypes represent a qualitative distinction. These findings may suggest that current diagnostic conceptualizations are inadequate for accurately identifying and characterizing individuals with problems related to attention and executive dysfunction. Alternatively, the null findings may have resulted from inadequate indicator selection. A dimensional model may better facilitate accurate identification of individuals at risk for functional impairment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Correspondence between DSM-III-R and DSM-IV attention-deficit/hyperactivity disorder

OBJECTIVE: To evaluate the correspondence between DSM-III-R and DSM-IV definitions of attention-deficit/hyperactivity disorder (ADHD) in clinically referred children. Results of the field trials led to the hypothesis that there would be a strong correspondence between DSM-III-R and DSM-IV subtypes. METHOD: The sample consisted of all children and adolescents consecutively referred to a pediatric psychopharmacology clinic (N = 405). Children were comprehensively evaluated with structured diagnostic interviews assessing both DSM-III-R and DSM-IV ADHD. DSM-III-R symptoms were used to approximate DSM-IV subtypes. Kappa statistics and conditional probabilities were used to examine the correspondence between DSM-III-R and DSM-IV ADHD. RESULTS: Ninety-three percent of children who received a DSM-III-R diagnosis of ADHD also received a DSM-IV ADHD diagnosis. The kappa coefficient assessing the agreement between DSM-III-R and DSM-IV ADHD was .73 (z = 14.6, p < .0001). The kappa coefficient assessing the agreement between the DSM-III-R-approximated subtypes and the actual DSM-IV subtypes was .71 (z = 15, p < .0001). CONCLUSION: These results confirm previous findings and indicate that the change from DSM-III-R to DSM-IV results in minimal changes in case identification and provides support for diagnostic continuity between the two classification systems.     

Predicting attention-deficit/hyperactivity disorder and oppositional defiant disorder from preschool diagnostic assessments.

The present study examined the power of measures of early preschool behavior to predict later diagnoses of attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD)/conduct disorder (CD). Participants were 168 children with behavior problems at age 3 who underwent a multimethod assessment of ADHD and ODD symptoms and were followed annually for 3 years. Fifty-eight percent of 3-year-old children with behavior problems met criteria for ADHD and/or ODD/CD 3 years later. Using a diagnostic interview and rating scales at age 3, the authors could accurately predict later diagnostic status for 3/4 of children for ADHD and for 2/3 of children for ODD/CD. Predictive power of the best models did not increase significantly at age 4 and age 5 compared with age 3. Results provide support for the validity of early diagnoses of ADHD, although caution is needed in making diagnoses because a significant minority of children with early hyperactivity and inattention do outgrow their problems. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Contraction of time in attention-deficit hyperactivity disorder.

Attention-deficit hyperactivity disorder (ADHD) has been associated with anomalies in dopamine systems. Recent advances in the understanding of the core cognitive deficits in ADHD suggest that dopamine dysfunction might be expressed through shortened time scales in reward-based learning. Here this perspective is extended by the conjecture that temporal span in working memory systems might generally be shortened. As a test of this conjecture the authors focus on the implicit memory system involved in rhythmic movement, assessing the minimum tempo at which rhythmic feeling can be sustained in adults with diagnosed ADHD and in a control group of normal adults. The authors found that people with ADHD do in fact have a rhythm cut-off that is faster in tempo than those without ADHD. This finding is consistent with the idea that impaired dopamine dynamics have systemic consequences for cognitive function, essentially recalibrating the clock that sets the time scale for the subjective experience of temporal events. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sources of covariation among attention-deficit/hyperactivity disorder, oppositional defiant disorder, and conduct disorder: The importance of shared environment.

Research has documented high levels of covariation among childhood externalizing disorders, but the etiology of this covariation is unclear. To unravel the sources of covariation among attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and conduct disorder (CD), the authors studied 11-year-old twins (N/&=/&1,506) from the Minnesota Twin Family Study. Symptom counts for each of these disorders were obtained from interviews administered to the twins and their mothers. A model was fit that allowed the parsing of genetic, shared environmental (factors that make family members similar to each other), and nonshared environmental (factors that make family members different from each other) contributions to covariation. The results revealed that although each disorder was influenced by genetic and environmental factors, a single shared environmental factor made the largest contribution to the covariation among ADHD, ODD, and CD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Eating pathology among adolescent girls with attention-deficit/hyperactivity disorder.

The authors investigated prospectively assessed eating pathology (body image dissatisfaction and bulimia nervosa symptoms) among an ethnically and socioeconomically diverse sample of adolescent girls with attention-deficit/hyperactivity disorder--combined type (ADHD--C; n=93), ADHD--inattentive type (ADHD--I; n=47), and a comparison group (n=88). The sample, initially ages 6-12 years, participated in a 5-year longitudinal study (92% retention rate). After statistical control of relevant covariates, girls with ADHD--C at baseline showed more eating pathology at follow-up than did comparison girls; girls with ADHD--I were intermediate between these two groups. Baseline impulsivity symptoms, as opposed to hyperactivity and inattention, best predicted adolescent eating pathology. With statistical control of ADHD, baseline peer rejection and parent- child relationship problems also predicted adolescent eating pathology. The association between punitive parenting in childhood and pathological eating behaviors in adolescence was stronger for girls with ADHD than for comparison girls. Results are discussed in terms of the expansion of longitudinal research on ADHD to include female-relevant domains of impairment, such as eating pathology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Autonomic correlates of attention-deficit/hyperactivity disorder and oppositional defiant disorder in preschool children.

Numerous studies have revealed autonomic underarousal in conduct-disordered adolescents and antisocial adults. It is unknown, however, whether similar autonomic markers are present in at-risk preschoolers. In this study, the authors compared autonomic profiles of 4- to 6-year-old children with attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD; n = 18) with those of age-matched controls (n = 20). Children with ADHD and ODD exhibited fewer electrodermal responses and lengthened cardiac preejection periods at baseline and during reward. Although group differences were not found in baseline respiratory sinus arrhythmia, heart rate changes among ADHD and ODD participants were mediated exclusively by parasympathetic withdrawal, with no independent sympathetic contribution. Heart rate changes among controls were mediated by both autonomic branches. These results suggest that at-risk preschoolers are autonomically similar to older externalizing children. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinical and treatment characteristics of children with attention-deficit/hyperactivity disorder in psychiatric practice

OBJECTIVE: To capture information about the clinical characteristics of, and treatments for, children with attention-deficit/hyperactivity disorder (ADHD) in psychiatric practice. METHOD: A mailed, self-administered questionnaire was sent to 81 practicing psychiatrists for them to complete on the next three consecutive patients aged 14 years and younger with ADHD seen during the 12-day study period. Information collected included the sociodemographic, clinical, and treatment characteristics of sampled patients. RESULTS: Patients in the study were predominantly white (85%), male (78%), and between 10 and 14 years old (58%). The most common ADHD subtype was combined/predominantly hyperactive (86%); 31% had no other comorbidity. Ninety-seven percent were receiving medications, with 49% receiving two or more. The single most common medication reported was methylphenidate (51% of patients) followed by clonidine (20%). Psychotropics other than psychostimulants were used in a majority of patients (55%). CONCLUSIONS: Psychiatrists, and child and adolescent psychiatrists in particular, see a more severely impaired and complex group of patients than would be expected of primary care providers. The treatment patterns of psychiatrists for these patients do not reflect the simpler treatments usually studied in clinical trials.     

Evaluation and management of attention-deficit hyperactivity disorder

Attention-deficit hyperactivity disorder is the most common pediatric psychiatric disorder, involving one of every 20 children. It is often a disabling condition and is frequently accompanied by high levels of frustration and comorbidity. Diagnosis of attention-deficit hyperactivity disorder requires a detailed history from the family and use of rating scales to collect observations from two or more settings. Effective treatment, including behavior management, appropriate educational placement and stimulant medication, will improve academic performance and behavior in most patients. Armed with an organized approach and a broad general knowledge of stimulant therapy, the family physician can effectively evaluate and coordinate the initial therapy for many of these troubled children within the office setting. Children in whom initial management fails or for whom the diagnosis is unclear or complicated should be referred to appropriate mental health professionals.     

Magnetic resonance imaging correlates of attention-deficit/hyperactivity disorder in children.

This study compared magnetic resonance imaging size differences in several brain regions and neurocognitive function in a group of male and female children with attention-deficit/hyperactivity disorder (ADHD) with no comorbid learning disorders with a normal control group of children. The ADHD group demonstrated smaller total brain, superior prefrontal, and right superior prefrontal volumes, as well as significantly smaller areas for cerebellar lobules I-V and VIII-X, total corpus callosum area, and splenium. No group differences were observed for the inferior prefrontal, caudate, or cerebellar volumes, or for the area of cerebellar lobules VI-VII. In the ADHD group but not in the control group, greater right superior prefrontal volume predicted poorer performance on a test of sustained attention. Patterns of brain abnormality did not differ in male and female children with ADHD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Set shifting in a rodent model of attention-deficit/hyperactivity disorder.

Two experiments compared spontaneously hypertensive rats (SHRs; a rodent model of attention-deficit/hyperactivity disorder) and Wistar rats (a normoactive control strain), on the acquisition of a set-shifting strategy. In Experiment 1, SHRs and Wistar rats were equivalent in trials to criterion to learn a brightness or a texture discrimination but SHRs were faster than Wistar rats in shifting to the opposite discrimination when there was 1 or 2 days between the initial discrimination and the shift. In Experiment 2, SHRs and Wistar rats were equivalent in shifting when the shift between discriminations occurred immediately after a criterion had been met in the first discrimination. The results are discussed in terms of a failure of SHRs to store or retrieve an initial discrimination and/or latent inhibition over a delay, leading to faster acquisition of a set-shift. This failure in storage or retrieval may be the result of a hypoactive dopamine system in the prefrontal cortex and nucleus accumbens shell as well as abnormalities in entorhinal cortex in SHRs. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Aspects of social and emotional competence in adult attention-deficit/hyperactivity disorder.

Social and emotional competence were evaluated using self-report and behavioral measures in adults with attention-deficit/hyperactivity disorder (ADHD) and controls. Adults with ADHD viewed themselves as less socially competent but more sensitive toward violations of social norms than controls. Films depicting emotional interactions were used to assess linguistic properties of free recall and perceived emotional intensity. Although adults with ADHD used more words to describe the scenes, they used fewer emotion-related words, despite rating the emotions depicted as more intense than did controls. In contrast, no group differences for words depicting social or cognitive processes were observed. Overall, adults with ADHD appear more aware of their problems in social versus emotional skills. Findings may have implications for improving the psychosocial functioning of these adults. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Stroop interference and attention-deficit/hyperactivity disorder: A review and meta-analysis.

Previous reviews and meta-analyses that addressed abnormal Stroop interference in attention-deficit/hyperactivity disorder (ADHD) yielded mixed results. The authors of the present study argue that the inconsistencies may reflect the problematic nature of 2 frequently used methods to quantify Stroop interference-the difference score and Golden's method (C. J. Golden, 1978). Golden's method correction for base-word reading is inadequate, and the difference score is sensitive to the nature of the outcome variable. The latter can be remedied with a ratio score. Contrasting previous meta-analyses, this meta-analysis covers all age groups and all Stroop test variants, and it excludes studies using the Golden quantification method. Mean effect sizes for interference in ADHD as quantified by difference scores relative to control scores were 0.24 across all studies but 1.11 for time-per-item studies; outcome variable was a significant moderator variable, reflecting the sensitivity of the difference score to this variable. Consistency analysis of ratio scores across 19 studies reveals more interference for the ADHD groups relative to the control groups. It is concluded that interference control is consistently compromised in individuals with ADHD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)