The Effects of Stimulant Medication and Training on Sports Competence Among Children With ADHD

The current study examined the relative efficacy of behavioral sports training, medication, and their combination in improving sports competence among youth with attention deficit/hyperactivity disorder (ADHD). Participants were 73 youth (74% male; 81% Hispanic) between the ages of 5 and 12 diagnosed with Diagnostic and Statistical Manual of Mental Disorders (4th ed.) ADHD enrolled in a Summer Treatment Program (STP). The study consisted of a 2 (medication: methylphenidate, placebo) × 2 (sports training: instruction and practice, recreational play) between-groups design and was conducted over a 3-week period during the STP. Sports training was conducted with a novel sport, badminton, to limit previous sport knowledge and to differentiate it from concurrent sports training that occurred within the STP. Objective and subjective measures of sports skills, knowledge, and behavior were collected. Results indicated that, relative to recreational play, brief sports training improved observed and counselor-rated measures of sports competence including sports skills, knowledge, game awareness, effort, frustration, and enjoyment. During sports training, medication incrementally improved children’s observed rule following behavior and counselor-rated sportsmanship relative to placebo. In the absence of sports training, medication improved behavior, effort, and sport knowledge. Training in sports skills and rules produced the largest magnitude effects on sports-related outcomes. Therefore, skills training, rather than medication alone, should be used in conjunction with behavioral intervention to teach sports to youth with ADHD. It is recommended that medication be used only as an adjunct to highly structured sports skills training for youth who display high rates of negative behavior during sports activities.     

The Impact of Late-Afternoon Stimulant Dosing for Children With ADHD on Parent and Parent-Child Domains

Examined the impact of late-afternoon stimulant dosing on parent and parent-child domains. Twenty-one children with attention deficit hyperactivity disorder (ADHD) participated in a double-blind, placebo-controlled medication assessment comparing varying doses of methylphenidate (MPH) and Adderall in the context of an intensive treatment program. Children received varying doses of stimulant medication, including active medication or placebo at 3:30 p.m. daily. Parent ratings of their mood, pleasantness of parent-child interactions, and perceived parenting effectiveness and successfulness were obtained each evening. Effective medication doses had a beneficial impact on parent-child domains (e.g., parent-child interactions) but did not significantly affect non-child-related parent variables (e.g., negative affect [NA]). Findings suggested that doses with beneficial effects lasting into the evening improved parent reports of the pleasantness of parent-child interactions but were insufficient to produce positive changes in parent functioning.     

Development of a Multimethod Clinical Protocol for Assessing Stimulant Drug Response in Children With Attention Deficit Disorder

We developed a protocol for clinical assessment of stimulant drug response in children with attention deficit disorders (ADD) and used a triple-blind, placebo-controlled crossover design to assess the effects of two doses of Ritalin (.3 mg/kg and .5 mg/kg BID) and a placebo. The 1-hr assessment battery, administered at the end of each 1-week drug condition, consisted of parent and teacher ratings of ADD behaviors, problem settings, drug side effects, laboratory tests of vigilance and impulse control, and clinic playroom observations of ADD behaviors during academic performance. Twenty-three of twenty-eight 5- to 12-year-olds completed the entire study. Results demonstrated that most measures in the protocol were sensitive to both doses of medication. Eighty percent of the children were judged positive responders to medication. This quantitative, objective protocol for the clinical evaluation of stimulant drug response is feasible and cost-effective. It should represent a substantial improvement over the use of subjective impressions now commonplace in clinical practice.     

Neuropsychological Evaluation of Deficits in Executive Functioning for ADHD Children With or Without Learning Disabilities

This study investigates multiple aspects of executive functioning in children with attention deficit/hyperactivity disorder (ADHD). These areas include attentional components, impulsiveness, planning, and problem solving. The rationale of the study is based on neurophysiological studies that suggest frontal lobe dysfunction in ADHD. As frontal lobe functioning is related to abilities in executive control, ADHD is hypothesised to be associated with deficits in various areas of executive functioning. The specific effect of comorbidity of learning disability (LD) was also investigated. Eighty-three children with ADHD and 29 age-matched controls (age 7-13) participated in the study. A battery of neuropsychological tests was utilized to evaluate specific deficits in speed of processing, selective attention, switching attention, sustained attention, attentional capacity, impulsiveness, planning and problem solving. Findings indicated that children with ADHD have slower verbal responses and sustained attention deficit. Deficits in selective attention and attentional capacity observed were largely related to the presence of LD. No specific deficit associated with ADHD or the comorbidity of LD was identified in switching attention, impulsiveness, planning, and problem solving. These results revealed that ADHD is not associated with a general deficit in executive functioning. Instead, ADHD is related to a specific deficit in regulation for attentional resources. The importance of isolating the deficit related to LDs for examining the specific deficit associated with ADHD is highlighted. Results also emphasised the importance of isolating the effect of lower level of abilities (e.g., speed of processing) and the utilization of specific definition for the examination of executive functions.     

Implicit Motor Sequence Learning in Children With Learning Disabilities: Deficits Limited to a Subgroup With Low Perceptual Organization

This study tested whether deficiencies in implicit motor sequence learning occurred exclusively in a subgroup of children with learning disabilities (LD). An experimental motor sequence task showed that LD children with low Perceptual Organization did not learn the sequence through implicit training, whereas they improved considerably after a few explicit test trials. In contrast, children with low Freedom From Distractibility (or sequencing) experienced the same benefit from implicit training as the control children. These results suggest that training motor skills (e.g., writing) should be adapted to suit the visuospatial abilities of a child with LD.     

Treatment Adherence Among Low-Income Children With Asthma

Objective: To investigate the adherence behaviors (MDI use,MDI/spacer technique, appointment attendance, smoking in thehome) of low-income, urban, primarily African American childrenwith asthma. Method: Participants were 55 children ages 6 to 17 with moderateto severe asthma. Adherence to MDI anti-inflammatory agentswas estimated primarily from canister weight at the follow-upappointment. Results: The mean use of MDI medication was 44%; of prescribeduse, with 27% of subjects demonstrating MDI/spacer techniquelikely to prevent drug delivery. Almost half reported that householdmembers smoked cigarettes, and 21% missed scheduled follow–upappointments. Conclusions: These findings have implications for how cliniciansshould assess and improve adherence.     

Attentional But Not Pre-Attentive Neural Measures of Auditory Discrimination Are Atypical in Children With Developmental Language Disorder

We examined neural indices of pre-attentive phonological and attentional auditory discrimination in children with developmental language disorder (DLD, n = 23) and typically developing (n = 16) peers from a geographically isolated Russian-speaking population with an elevated prevalence of DLD. Pre-attentive phonological MMN components were robust and did not differ in two groups. Children with DLD showed attenuated P3 and atypically distributed P2 components in the attentional auditory discrimination task; P2 and P3 amplitudes were linked to working memory capacity, development of complex syntax, and vocabulary. The results corroborate findings of reduced processing capacity in DLD and support a multifactorial view of the disorder.     

罗夏测验攻击变量在学龄期儿童中应用的效度研究

目的:在国内学龄期儿童样本中检验罗夏测验攻击变量的效度.方法:用Achenbach儿童行为量表和Conners教师问卷对湖南某地一小学311名同学进行筛选,筛选出攻击高分组(N=33)与低分组(N=35),对这两组学生进行罗夏测验,回收有效数据,得到最后的高分组(N=30)和低分组(N=30).结果:罗夏测验7个变量的Pearson相关均在0.96之上, P<0.01;Kappa系数均在0.83以上.对儿童攻击行为的测量贡献最大的是攻击性运动(AG)与攻击性内容(AgC).AgC与外显攻击行为呈正相关(r=0.32,P<0.05),AG与外显攻击行为呈负相关(r=-0.27,P<0.05).结论:罗夏攻击变量对儿童的攻击行为的测量有一定价值,特别是攻击性运动与攻击性内容这两个变量.     

Stimulant Effects on Persistence of Motor Performance of Hyperactive Children

The effect of stimulant medication (methylphenidate) on thepersistence of the maze-tracking performance of 24 hyperactivechildren was assessed in drug and placebo conditions using adouble-blind design. There was no significant difference inerrors (overshooting the maze boundaries) in the initial alleysof the maze. However, while on placebo, patients seemed unableto persist in their performance starting from the midpoint ofthe task through to its completion and made significantly moreerrors over this section of alleys in the unmedicated statethan when on drug. These results suggest that while hyperactivechildren may be capable of giving adequate attention to a taskin its beginning stages, they cannot sustain attention as thetask progresses. Stimulant medication is effective in helpingthem to maintain their attention when it would otherwise beginto falter.     

Functional-Performance Deficits in Volunteers With Functional Ankle Instability

Context: Although functional-performance tests are dynamic measures used to assess general lower body function, studies investigating these tests for ankle instability have yielded conflicting results.Objective: To determine if a relationship exists between a measure of functional ankle instability and deficits in functional performance.Design: A case-control study correlating subject performance on a set of lower extremity functional-performance tests with a measure of ankle instability.Setting: University athletic training research laboratory.Patients or Other Participants: We recruited 60 participants (43 females, 17 males, age = 22.4 +/- 4.9 years, height = 169.9 +/- 9.7 cm, mass = 72.6 +/- 16.3 kg; 42 injured, 18 uninjured) to participate in the study. Six questions were used to determine if functional ankle instability was present in each participant. A point was added for each yes response to produce an index that represents a continuous variable of functional ankle instability.Main Outcome Measure(s): Four unilateral hopping tests were used in this study: figure-of-8 hop, side hop, up-down hop, and single hop. For the first 3 tests, the total time was recorded with a handheld stopwatch to the nearest 0.01 second; for the single hop-for-distance test, the distance was recorded to the nearest 0.01 m. Correlations were computed with the functional ankle instability index and each of the 4 functional-performance tests.Results: No relationship was revealed between the functional ankle instability index and single hop for distance or up-down hop, with r values of -.008 and .245, respectively. A significant relationship was found between the functional ankle instability index and the side hop (r = .35, P 相似文献   

儿童注意网络的发展特点

Posner和Petersen在大量研究的基础上,把注意看作包括警觉、定向和执行网络的认知系统。注意网络测验(ANT)范式可以独立测量3个子网络的效能。通过概述当前国内外有关儿童注意网络的发展研究,结果发现,总体来看,注意网络模型中的3个子系统有着截然不同的发展成熟路径,7岁之前是儿童注意网络发展的关键时期。警觉和定向网络的发展主要集中在婴儿期和童年早期,直至童年晚期发展成熟;而执行网络的发展则比较缓慢,自1岁末开始萌芽直至进入青春期。未来应将研究对象扩展到特殊儿童,且儿童注意网络的发展特点,即警觉、定向和执行控制网络是否存在交互关系,有待于进一步的探究。     

Watch Out for the Beast: Fear Information and Attentional Bias in Children

Although valenced information about novel animals changes the implicit and explicit fear beliefs of children (Field & Lawson, 2003), how it might lead to anxiety is unknown. One possibility, based on cognitive models of anxiety, is that fear information creates attentional biases similar to those seen in anxiety disorders. Children between 7 and 9 years old were given positive information about 1 novel animal, negative information about another, and no information about the 3rd. A pictorial dot-probe task was used, immediately or with a 24-hr delay, to test for attentional biases to the different animals. The results replicated the finding that fear information changes children's fear beliefs. Regardless of whether there was a delay, children acquired an attentional bias in the left visual field toward the animal about which they held negative beliefs compared to the control animal. These results imply a possible way in which fear information might contribute to acquired fear.     

Developmental Trajectory of Motor Deficits in Preschool Children with ADHD

Motor deficits persisting into childhood (>7 years) are associated with increased executive and cognitive dysfunction, likely due to parallel neural circuitry. This study assessed the longitudinal trajectory of motor deficits in preschool children with ADHD, compared to typically developing (TD) children, in order to identify individuals at risk for anomalous neurological development. Participants included 47 children (21 ADHD, 26 TD) ages 4-7 years who participated in three visits (V1, V2, V3), each one year apart (V1=48-71 months, V2=60-83 months, V3=72-95 months). Motor variables assessed included speed (finger tapping and sequencing), total overflow, and axial movements from the Revised Physical and Neurological Examination for Subtle Signs (PANESS). Effects for group, visit, and group-by-visit interaction were examined. There were significant effects for group (favoring TD) for finger tapping speed and total axial movements, visit (performance improving with age for all 4 variables), and a significant group-by-visit interaction for finger tapping speed. Motor speed (repetitive finger tapping) and quality of axial movements are sensitive markers of anomalous motor development associated with ADHD in children as young as 4 years. Conversely, motor overflow and finger sequencing speed may be less sensitive in preschool, due to ongoing wide variations in attainment of these milestones.     

Cognitive Event-Related Brain Potentials in Children with Attention and Reading Deficits

ERPs were recorded from four groups of children: reading disabled, attentional deficit disorder with and without hyperactivity, and normal controls. Subjects pressed a button to a low probability nonsense syllable (target, p= .168) and ignored all other events, which included a high probability nonsense syllable (nontarget, p= .664) and either low probability (category, p= .168) symbols (Block 1) or 3-letter words (Block 2). The amplitudes of several late ERP components and the latency of the P3 component were examined. The overall amplitude of P3 was significantly smaller in all clinical groups than in controls, but the difference in P3 amplitude between targets and nontargets was smaller only in the two attentional deficit groups. Reading disabled children had smaller P3 and Pc components to words than to symbols, while controls had equivalent values. The N2 component had a different scalp distribution for words and symbols, but did not differentiate reading disabled children from controls. P3 latency was significantly longer in the three clinical groups than in controls, but only the attentional deficit groups showed an increase in P3 latency across blocks of the task. The results are discussed within the framework of recent cognitive models dealing with attentional processes.     

Assessment of Stimulant Response in ADHD Children Using a Refined Multimethod Clinical Protocol

Describes a rigorous multimethod protocol for evaluating individual children's response to stimulant medication in the clinical setting. This protocol represents a refinement of previously reported methods (Barkley, Fischer, Newby, & Breen, 1988) with a large sample of clinic-referred children (N = 161) with Attention Deficit Hyperactivity Disorder (ADHD). Children complete 1 week each on a low dose of Ritalin (.2 mg/kg bid–i.e., twice daily), a higher dosage of Ritalin (.4 mg/kg bid), and a lactose placebo. Medication sequence is randomized and double blind. Each week, multiple questionnaire ratings by parents and teachers are obtained, and 30 min of in-clinic testing is conducted. Our data indicate a statistically significant medication response on most measures, as well as a significant difference between the low and moderate doses on some measures.     

Peer-Assessed Outcomes in the Multimodal Treatment Study of Children With Attention Deficit Hyperactivity Disorder

Peer-assessed outcomes were examined at the end of treatment (14 months after study entry) for 285 children (226 boys, 59 girls) with attention deficit hyperactivity disorder (ADHD) who were rated by their classmates (2,232 classmates total) using peer sociometric procedures. All children with ADHD were participants in the Multimodal Treatment Study of Children with ADHD (MTA). Treatment groups were compared using the orthogonal treatment contrasts that accounted for the largest amount of variance in prior MTA outcome analyses: Medication Management + Combined Treatment versus Behavior Therapy + Community Care; Medication Management versus Combined Treatment; Behavior Therapy versus Community Care. There was little evidence of superiority of any of the treatments for the peer-assessed outcomes studied, although the limited evidence that emerged favored treatments involving medication management. Post hoc analyses were used to examine whether any of the four treatment groups yielded normalized peer relationships relative to randomly selected-classmates. Results indicated that children from all groups remained significantly impaired in their peer relationships.     

孟鲁司特钠联合酮替芬治疗小儿支气管炎的临床效果分析

目的 分析孟鲁司特钠联合酮替芬治疗小儿支气管炎的临床疗效。方法 随机选取我院2014年10月~2017年2月收治的200例支气管炎患儿,随机分为观察组和对照组各100例。对照组给予静脉使用抗生素加口服丙卡特罗和氨溴索雾化吸入治疗,观察组在对照组基础上给予口服孟鲁司特钠联合酮替芬治疗,比较两组患儿临床治疗效果和恢复情况。结果 在治疗的总有效率上比较,观察组比对照组明显更高（P＜0.05）;在咳嗽消失时间及肺部喘鸣音消失时间上比较,观察组比对照组明显更短（P＜0.05）;两组在不良反应发生率上比较无明显差异（P＞0.05）。结论 孟鲁司特钠联合酮替芬治疗小儿支气管炎效果确切,能有效改善患儿临床症状,促进患儿恢复,且安全性高,值得推广使用。     

Memory Deficits in Aged Cebus Monkeys and Facilitation With Central Cholinomimetics

Cebus monkeys of 3 different age groups were trained to perform an automated behavioral task (delayed response), intended to measure recent memory ability. In in initial study, the aged monkeys (18 years and older) exhibit prprogressively greater performance impairments (relative to young monkeys) as they were required to remember the location of a visual stimulus for increasingly longer durations (0 to 20 sec). This deficits replicated previously published results from aged Rhesus monkeys and appeared similar to the primary memory deficits reported in elderly humans and demented patients. In subsequent studies, the effects of three different cholinomimetics were evaluated for their ability to improve the aged monkey's performance on this task. Each monkey was tested under several acute doses of the cholinergic precursor, choline, the anticholinesterase, physostigmine, and the cholinergic muscarinic receptor agonist, arecoline. The results revealed clear differences in the ability of these drugs to improve performance on this task. Choline exerted no apparent effects in the aged monkeys at any dose tested. Physostigmine clearly enhanced performance in certain aged monkeys, but the optimal dose varied dramatically between subjects, replicating previously published results with aged Rhesus monkeys and humans. Arecoline produced clear improvement within a restricted dose range, with little variation in optimal dose between subjects. In addition to demonstrating differences in the effects of different cholinomimetics on memory performance in aged primates, these data also suggest a possible rationale for future investigations. Assuming that each of these drugs primarily affected cholinergic function in the manner conventionally attributed, these data suggest that, within the cholinergic system, the more directly one stimulates the receptor, the more one might expect robust and consistent effects on memory performance in aged subjects.