Attention deficit hyperactivity disorder and executive dysfunction

To evaluate the relationship between attention deficit hyperactivity disorder (ADHD) and executive functioning (EF) a sample of ADHD children (N = 48) with above average IQs (median = 117.5) was administered a battery of standardized norm‐referenced tests sensitive to EF. Below average performance was found on the Wisconsin Card Sorting Test and continuous performance test (Test of Variables of Attention, TOVA) but not on Word Fluency or the Rey Complex Figure. Significant intraindividual discrepancies were found for a selected pair of content‐matched tests that differed in EF task demands. Pennington, Groisser, and Welsh's (1993) “double dissociation” of ADHD and reading disability (RD) was tested by examining the EF performance of ADHD with and without RD. No significant differences between ADHD/No‐RD and ADHD/RD were found on any of the EF measures.     

Attention deficit and hyperactivity disorder/learning disabilities (ADHD/LD): parental characterization and perception

Sixty-six parents of adolescents (mean age, 14.8 years), who attended special education classes and who were diagnosed as having attention deficit and hyperactivity disorder/learning disabilities (ADHD/LD), were interviewed. The comorbidity of the ADHD group included emotional lability and/or depression, 70%; oppositional defiant disorder (ODD), 67%; obsessive-compulsive disorder (OCD), 44%; addiction to buying, 44%; and aggressiveness, 62%. Twenty-one percent were either involved in the past or presently using drugs. Nine percent had attempted suicide. According to their parents, the main characteristic of these adolescents was low self-image. Parents enumerated five negative characteristics: impulsiveness; nervousness; angered easily ('short fused'); aggressiveness with cursing and outbursts; and impaired sociability with impoliteness.     

No objectively measured sleep disturbances in children with attention‐deficit/hyperactivity disorder

The main goal of this study was to gain more insight into sleep disturbances in children with attention‐deficit/hyperactivity disorder, using objective measures of sleep quality and quantity. The evidence for sleep problems in children with attention‐deficit/hyperactivity disorder thus far is inconsistent, which might be explained by confounding influences of comorbid internalizing and externalizing problems and low socio‐economic status. We therefore investigated the mediating and moderating role of these factors in the association between attention‐deficit/hyperactivity disorder and sleep problems. To control for the effects of stimulant medication use, all participants were tested free of medication. Sixty‐three children with attention‐deficit/hyperactivity disorder and 61 typically developing children, aged 6–13 years, participated. Sleep was monitored for one to three school nights using actigraphy. Parent and teacher questionnaires assessed symptoms of attention‐deficit/hyperactivity disorder, internalizing behaviour, oppositional defiant disorder and conduct disorder. Results showed no differences between the attention‐deficit/hyperactivity disorder and typically developing group in any sleep parameter. Within the attention‐deficit/hyperactivity disorder group, severity of attention‐deficit/hyperactivity disorder symptoms was not related to sleep quality or quantity. Moderation analyses in the attention‐deficit/hyperactivity disorder group showed an interaction effect between attention‐deficit/hyperactivity disorder symptoms and internalizing and externalizing behaviour on total sleep time, time in bed and average sleep bout duration. The results of our study suggest that having attention‐deficit/hyperactivity disorder is not a risk factor for sleep problems. Internalizing and externalizing behaviour moderate the association between attention‐deficit/hyperactivity disorder and sleep, indicating a complex interplay between psychiatric symptoms and sleep.     

Attention deficit hyperactivity disorder in teens and adults: they don't all outgrow it

Attention deficit hyperactivity disorder (ADHD) has been long recognized and well established in children, but its continuation into adulthood has only recently been supported by the research. ADHD symptoms and concerns typically appear differently in adults, but treatment options, conceptually at least, are similar to those used for children who have ADHD. This article introduces the issue of Journal of Clinical Psychology: In Session devoted to ADHD in teens and adults. It presents the prevalence and manifestations of the disorder and then reviews the subsequent articles on the comorbidity, evaluation, education, psychopharmacology, and psychosocial treatments of ADHD for teens and adults. The issue concludes with an article on neurobiofeedback, a relatively new treatment option.     

Attention deficit hyperactivity disorder in children and adolescents following traumatic brain injury

To better characterize pediatric psychopathology after neurological insult, secondary attention deficit hyperactivity disorder (SADHD)-or ADHD that develops after traumatic brain injury (TBI)-and its clinical and neuroimaging correlates were investigated. Outcome data were available for 118 children, ages 5 through 14 at the time of hospitalization following TBI (severe TBI n = 37; mild-moderate TBI n = 57) and orthopedic injury (n = 24). Standardized psychiatric, adaptive functioning, cognitive functioning, family functioning, and family psychiatric history assessments were conducted on all participants. Severity of injury and neuroimaging lesion assessments were conducted on TBI participants only. The diagnosis of SADHD was mutually exclusive with preinjury ADHD, which occurred in 13 of 94 TBI participants and 4 of 24 orthopedic injury participants. SADHD occurred in 13 of 34 eligible participants with severe TBI but resolved in 4 of 13 of these participants. SADHD also occurred in 1 of 8 eligible moderate TBI participants, only in the presence of preinjury ADHD traits and 3 of 39 of eligible mild TBI cases. SADHD occurred in 1 of 20 of eligible participants with orthopedic injury without any brain injury. SADHD was significantly associated with TBI severity recorded by categorical and dimensional measures, intellectual and adaptive functioning deficits, and personality change due to TBI, but not with lesion area or location. These results suggest that SADHD is a clinically important syndrome after severe TBI in children and adolescents.     

Attention deficit disorder with hyperactivity (ADDH): The contribution of catecholaminergic activity

An attention deficit disorder with hyperactivity in children (ADDH) is now recognized in most countries although diagnostic practices differ. Evidence is presented to show that the two cardinal symptoms of poor attentional performance and high motor activity may be functionally and causally separate. Both are temporarily relieved in a proportion of subjects that respond to psychostimulants. Beneficial treatment decreases noradrenergic metabolism and normalizes variable levels of dopaminergic metabolism. Parallels are drawn with other clinical syndromes arising from changed catecholaminergic activity and with behavioral interpretations of the result of damage to the dorsal noradrenergic bundle and dopaminergic A10 nucleus. Prognosis of ADDH subjects after treatment remains poor. There may be a further defect of neurotransmitter metabolism in the ADDH syndrome. Research strategies are suggested based on the neurobiological correlates of the cognitive style of ADDH subjects and septal function in the animal model of the hypertensive rat.     

Attention deficit hyperactivity disorder--a review.

The topic of attention deficit hyperactivity disorder (ADHD) is fascinating and controversial. A variety of stances have been taken by different clinicians, support groups, and the media. A nature/nurture argument has developed that may have a tendency to polarize views. This review aims to present research findings that inform the debate. It deals with symptomatology, aetiology, and prevalence, with assessment for diagnosis, management, and outcome. The importance of comprehensive management taking into consideration not just attention abilities but a range of other factors that have an impact upon them is stressed. Management should be pragmatic, multifaceted, and based around the establishment of good working relationships with family and school.     

Parent reports of sleep disturbances in stimulant-medicated children with attention-deficit hyperactivity disorder

In a study of the severity of sleep disturbances in children with attention-deficit hyperactivity disorder (ADHD) who are taking stimulant medication, parents of 20 children diagnosed as having ADHD and on medication, 20 unmedicated children with some other psychiatric diagnosis (OPD), and 20 nonclinical control children responded to a 40-question structured interview to report the frequency of their children's sleep disturbances occurring during a 1-month interval. Parents of children in the ADHD group reported significantly more problems than parents of children in the other groups on variables within all three categories of behaviors: (a) settling and going to sleep, (b) disruptions during sleep, and (c) morning activities. From 25% to 50% of these parents reported very frequent difficulties in their children settling and going to sleep. These findings indicate that monitoring sleep-related behaviors and providing adjunctive therapies for sleep-related disturbances would be beneficial for many families with ADHD children who are taking stimulant medication. © 1998 John Wiley & Sons, Inc. J Clin Psychol 54: 701–716, 1998.     

The role of sleep disturbances in attention deficit disorder symptoms: a case study

Identified a 10-year-old girl with ADD and a 5-year history of sleep difficulties. Sleep difficulties (delayed sleep phase insomnia) were corrected while performing blind assessments of behavioral symptoms. The intervention (chronotherapy combined with a behavior modification program) resulted in an increase of sleep from 7.2 to 9.2 hours per night. Pre/postintervention behavioral measures indicated significant improvement in positive interactions with peers, increased productivity on a timed arithmetic task, and significantly increased percentage of assigned seatwork completed. Four-month follow-up in the natural school setting indicated improvement in teacher ratings and classroom performance. Despite the persistence of ADD symptomatology, the improvement in sleep apparently contributed to a clinically significant reduction in ADD.     

Mindfulness and attention deficit hyperactivity disorder

Attention deficit hyperactivity disorder (ADHD) is a disorder characterized by attentional difficulties. Mindfulness is a receptive attention to present experience. Both ADHD and mindfulness are associated with attention and personality. This study tests whether individuals with ADHD have lower mindfulness scores than controls and, if true, whether personality contributes to these differences. One hundred and five adults (half with ADHD) were assessed for mindfulness, using the Kentucky Inventory of Mindfulness Skills, and personality, using the Tridimensional Character Inventory. Individuals with ADHD report themselves as less mindful than non‐ADHD controls and more novelty‐seeking, less self‐directed, and more self‐transcendent. Mindfulness is negatively associated with ADHD and positively associated with self‐directedness and self‐transcendence. Analyses of subscales of mindfulness suggest that ADHD is associated most with the “Acting in Awareness” dimension, perhaps because of shared items reflecting attentional variability. The current findings support that a large portion of variability in trait mindfulness can be explained by ADHD status and personality traits of self‐directedness and self‐transcendence. It further suggests that interventions that increase mindfulness might improve symptoms of ADHD and increase self‐directedness and/or self‐transcendence. © 2009 Wiley Periodicals, Inc. J Clin Psychol 65: 1–12, 2009.     

Diversity and attention deficit hyperactivity disorder

Attention Deficit Hyperactivity Disorder (ADHD) is a debilitating disorder which affects children and adults in this country and around the world. Diversity variables such as ethnicity, age, gender, and socioeconomic status have been relatively neglected in ADHD research. Additionally, these variables have not traditionally been incorporated into clinical assessment, diagnosis, or intervention strategies. A review of the existing literature regarding diversity issues and ADHD was conducted, including a review of international findings. Implications for clinicians and researchers are incorporated. © 1998 John Wiley & Sons, Inc. J Clin Psychol 54: 415–426, 1998.     

The sleep phenotypes of attention deficit hyperactivity disorder: the role of arousal during sleep and implications for treatment

About 25-50% of children and adolescents with attention-deficit hyperactivity disorder (ADHD) experience sleep problems. An appropriate assessment and treatment of such problems might improve the quality of life in such patients and reduce both the severity of ADHD and the impairment it causes. According to data in the literature and to the overall complexity of the interaction between ADHD and sleep, five sleep phenotypes may be identified in ADHD: (i) a sleep phenotype characterized mainly by a hypo-arousal state, resembling narcolepsy, which may be considered a "primary" form of ADHD (i.e. without the interference of other sleep disorders); (ii) a phenotype associated with delayed sleep onset latency and with a higher risk of bipolar disorder; (iii) a phenotype associated with sleep disordered breathing (SDB); (iv) another phenotype related to restless legs syndrome (RLS) and/or periodic limb movements; (v) lastly, a phenotype related to epilepsy/or EEG interictal discharges. Each sleep phenotype is characterized by peculiar sleep alterations expressed by either an increased or decreased level of arousal during sleep that have important treatment implications. Treatment with stimulants is recommended above all in the primary form of ADHD, whereas treatment of the main sleep disorders or of co-morbidities (i.e. bipolar disorders and epilepsy) is preferred in the other sleep phenotypes. All the sleep phenotypes, except the primary form of ADHD and those related to focal benign epilepsy or focal EEG discharges, are associated with an increased level of arousal during sleep. Recent studies have demonstrated that both an increase and a decrease in arousal are ascribable to executive dysfunctions controlled by prefrontal cortical regions (the main cortical areas implicated in the pathogenesis of ADHD), and that the arousal system, which may be hyperactivated or hypoactivated depending on the form of ADHD/sleep phenotype.     

Attention deficit and hyperactivity disorder (ADHD) and learning disabilities (LD): adolescents perspective

Three hundred and eight pupils in the age group 12-18 years were interviewed and examined. They had been diagnosed as having attention deficit and hyperactivity disorder (ADHD) and learning disabilities (LD), and were attending a high school devoted to special education. Their classification into subgroups was as follows: ADHD - inattentive (I) = 22.1%, ADHD - hyperactivity/impulsivity (HI) = 12.3% and combined = 42.2%. Only 25% of them were treated by methylphenidate (Ritalin). Ninety-four percent of them were diagnosed with comorbidity of 'learning disabilities'. Thirty-four percent of them reported being severely stressed when going to school and sitting in class. Their complaints were: tiredness and excessive needs to sleep, frequent quarrelling with close friends, feeling different from other classmates and having low self-esteem (SE). They complaint that their parents don't understand them. Things that irritated them the most were being lied to and coercion by others. The authors suggest to consider ADHD/LD as neurobehavioral disability. It is mandatory to prepare them for adult life with proper social skills and a suitable occupation.