Examination of Verbal Memory and Recall Time in Children With Attention Deficit Hyperactivity Disorder

In this study 22 7- to 11-year-old children diagnosed with attention deficit hyperactivity disorder (ADHD) and 44 age-matched controls recruited from the same classrooms were given a 4-item delayed serial recall task using numbers or phrases. Although both groups showed similar recall accuracy rates, ADHD children required significantly longer times to retrieve and articulate their answers than children from the control group, regardless of age. The findings are discussed in relation to theories of executive function deficits in ADHD.     

Evidence-Based Assessment of Attention Deficit Hyperactivity Disorder in Children and Adolescents

This article examines evidence-based assessment practices for attention deficit hyperactivity disorder (ADHD). The nature, symptoms, associated features, and comorbidity of ADHD are briefly described, followed by a selective review of the literature on the reliability and validity of ADHD assessment methods. It is concluded that symptom rating scales based on the Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV]; American Psychiatric Association, 1994), empirically and rationally derived ADHD rating scales, structured interviews, global impairment measures, and behavioral observations are evidence-based ADHD assessment methods. The most efficient assessment method is obtaining information through parent and teacher rating scales; both parent and teacher ratings are needed for clinical purposes. Brief, non-DSM based rating scales are highly correlated with DSM scales but are much more efficient and just as effective at diagnosing ADHD. No incremental validity or utility is conferred by structured interviews when parent and teacher ratings are utilized. Observational procedures are empirically valid but not practical for clinical use. However, individualized assessments of specific target behaviors approximate observations and have both validity and treatment utility. Measures of impairment that report functioning in key domains (peer, family, school) as well as globally have more treatment utility than nonspecific global measures of impairment. DSM diagnosis per se has not been demonstrated to have treatment utility, so the diagnostic phase of assessment should be completed with minimal time and expense so that resources can be focused on other aspects of assessment, particularly treatment planning. We argue that the main focus of assessment should be on target behavior selection, contextual factors, functional analyses, treatment planning, and outcome monitoring.     

Executive Function Profile of Children With Attention Deficit Hyperactivity Disorder

We explored the neuropsychological profile for executive functions of children with attention deficit hyperactivity disorder (ADHD) to assess whether problems associated with the two most cited relevant processes-inhibition and attentional problems-were the core of any executive function difficulty. A battery of executive function tests was administered to 31 children with a clinical diagnosis of ADHD and to 33 normal control participants, all aged between 7 and 12. The executive function battery encompassed a number of tasks, selected because each had multiple measures: a sustained attention reaction time task, a related vigilance task, an adaptation of the Hayling Sentence Completion Test, an adaptation of the Brixton Spatial Rule Attainment Test, a Letter Fluency task, a number Stroop task, and an "n-back" working memory task. The overall pattern of the results fit well with those obtained in previous studies as far as abnormalities of the ADHD group in the domain of inhibitory processes, attentional functions, and executive functions. The children with ADHD, although performing well on baseline tasks, performed more poorly than the controls on all the experimental tasks with one borderline exception: Letter Fluency, where the children with ADHD showed a very different pattern than most adult frontal lobe subgroups. However, there was no specific impairment on measures of inhibitory processes. In addition, strategy generation and use were severely affected in the ADHD group. Particular findings fitted well with disorders of a high-level effort system and of a monitoring system.     

注意缺陷多动障碍儿童执行功能和工作记忆特点的初步探讨

目的:探讨我国注意缺陷多动障碍(ADHD)儿童的执行功能和工作记忆特征.方法:采用修订版威斯康星卡片分类测验(WCST)和韦氏记忆量表(WMS)中代表工作记忆的分测验,对汉族57例ADHD儿童和63例正常儿童进行测试.结果:①ADHD儿童在WCST中的持续性错误数(RPE)、总错误数.(RE)、持续性反应数(RP)、完成总应答数(BA)均多于对照组儿童(26.8±10.9/22.8±10.4、57.6±18.1/49.3±18.6、30.4±13.9/25.5±12.7、127.6±1.8/122.9±11.0,P=0.040、0.015、0.046、0.001),而完成分类数(CC)、正确应答数百分比(RCP)、概念化水平(RFP)均少于对照组儿童(2.9±1.5/3.8±1.8、55.0±14.0/60.5±13.4、40.8±17.6/47.8±17.7,P=0.003、0.028、0.033);②ADHD组顺背、倒背数字,数字广度、听故事理解、数字量表、积累量表得分低于对照组(7.5±1.3/8.0±1.3、4.3±1.2/4.9±1.7、11.7±1.9/13.5±2.8、6.4±3.1/8.8±3.3、9.1±2.7/10.8±3.6、9.2±3.1/11.0±2.5,P=0.025、0.029、0.001、01000、0.011、0.002);③控制年龄后,ADHD组的故事理解粗分、理解量表分、听看故事分均与WCST的总错误数、非持续性错误呈负相关(r=-0.32～-0.43,P<0.05),与完成分类数、正确应答数、正确应答数百分比、概念化水平呈正相关(r=0.32～0.39,P<0.05).结论:ADHD儿童存在执行功能、工作记忆等神经心理学功能缺陷,ADHD儿童的语音信息工作记忆存在缺陷;ADHD儿童的WCST成绩差与工作记忆能力缺陷有关.     

Attention Deficit Hyperactivity Disorder and Enuresis in Children and Adolescents

The incidences of comorbid disorders and the status of neuropsychological executive functions were evaluated in two groups of patients aged 5–14 years: patients with attention deficit hyperactivity disorder (ADHD) in combination with enuresis (53 patients) and ADHD without enuresis (71 patients). Most cases of enuresis among patients of group 1 (50 of 53) had primary nocturnal enuresis. This group showed a significant increase in the total number of cases of comorbidity with such disorders as oppositional-defiant behavioral disorder, anxiety disorders, ticks, and encopresis, seen in 77.7% of cases as compared with 60.6% in group 2. The presence of enuresis in patients with ADHD was associated with a significant increase in the incidence of anxiety disorders (54.7% as compared with 39.4%). In addition, at age 5–9 years, patients with ADHD with enuresis had a tendency to a higher frequency of oppositional-defiant behavioral disorder and encopresis; those aged 10–14 years showed an increase in the proportion with obsessive-compulsive disorder and tics as compared with patients with ADHD without enuresis. Assessment of measures of executive functions using the Wisconsin card sorting test revealed no differences between patients of the two groups.     

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.     

Evidence-Based Psychosocial Treatments for Children and Adolescents With Attention Deficit/Hyperactivity Disorder

The purpose of this research was to update the series of articles on evidence-based treatment for children and adolescents with attention deficit/hyperactivity disorder that have appeared in this journal (Evans, Owens & Bunford, 2014; Pelham & Fabiano, 2008; Pelham, Wheeler, & Chronis, 1998). We completed a systematic review of the literature published between 2012 and 2016 to establish levels of evidence for psychosocial treatments for these youth. We identified articles using criteria established by the Society of Clinical Child and Adolescent Psychology using keyword searches of abstracts and titles. Articles were classified according to a modified version of the Division 12 task force guidelines that was used in other reviews in this series. The results revealed that findings are becoming increasingly nuanced with variations in levels of evidence related to ages of the children and characteristics of the specific treatment. In addition, we focused our critique on generalization of treatment effects across settings and time and on sample diversity (with regard to ethnicity and levels of parent education) in relation to the population. Children of parents with higher levels of education than average appear to be overrepresented in the literature. Implications for future treatment development and evaluation and for dissemination research are discussed.     

Parenting Stress and the Child With Attention Deficit Hyperactivity Disorder

Presents a critical review of research concerning the stress of parenting a child with attention deficit hyperactivity disorder (ADHD). Four lines of research have been pursued. First, studies demonstrate increased stress reported by parents of hyperactive children. Second, studies of parental psychopathology suggest that for some parents such disturbance is independent of the child's pathology and reflects a genetic substrate for the same and related disorders. Third, ADHD is associated with increased parental marital discord. Fourth, research regarding parent-child interaction patterns suggests a child-to-adult direction of effect more than the reverse. Directions for future research are recommended.     

注意缺陷多动障碍儿童认知功能的对照研究

目的：探讨注意缺陷多动障碍各亚型的认知功能。方法：对113名8—12岁注意缺陷多动障碍男童与83名正常儿童采用威斯康星卡片分类测验进行对照研究。结果：ADHD各型儿童的分类次数和概括力水平均低于对照组，并以混合型最低，而注意冲动型与混合型的持续性反应与持续性错误均明显高于对照组。在控制智力因素后，仍存在显著性差异。在ADHD各亚型间，以混合型最明显，其次为注意障碍型，三型之间除非持续性错误外。主要指标比较无显著性差异。结论：ADHD儿童存在认知功能损害，且不同亚型之间的损害程度不同。     

Story Comprehension and the Impact of Studying on Recall in Children With Attention Deficit Hyperactivity Disorder

This study examined the impact of studying on story comprehension and recall among children with attention deficit hyperactivity disorder (ADHD). Participants in the study were 36 children with ADHD and 43 nonreferred comparison children ages 7 to 11. The participants listened to 1 of 2 folktales and recalled the story both before and after studying a written version of the story for up to 10 min. The stories had been divided into individual events, and each event was coded for the number of causal connections it had to other story events. Each event was presented on a separate page of the study booklet so that time spent on each event could be recorded. All of the transcribed recalls were coded for which story events the participant correctly recalled. For both groups, recall increased as the number of causal connections increased, but the effect of the number of causal connections on recall was stronger for comparison children than for children with ADHD. The results revealed no group differences in studying behavior. However, when recall before studying was included as a predictor of recall after studying, studying was found to be more effective for higher IQ comparison children than for higher IQ children with ADHD, especially at the highest levels of causal connections. The results offer important leads for the development of academic interventions that are specific to the story-comprehension deficits of children with ADHD.     

共患对立违抗性障碍的注意缺陷多动障碍儿童的认知特点研究

目的:探讨共患对立违抗性障碍(ODD)的注意缺陷多动障碍(ADHD)儿童的认知功能特点.方法:以单纯ADHD ODD、单纯ADHD和正常儿童各36例(性别、年龄与ADHD亚型组间匹配)为研究对象,采用龚耀先修订的韦氏儿童智力量表、韦氏记忆量表、数字划消、Stroop测验和瑞文标准推理测验对其智力、记忆力、注意力水平及执行功能进行评定.结果:两病例组的常识、类同、译码、言语智商、操作智商、全量表智商、A因子、C因子、经历定向、心智、再生、触觉、长时记忆、短时记忆、记忆商、瑞文标准推理测验标准分、Stroop测验A完成时间、C完成时间和总完成时间的测验成绩与正常对照组的差异具有显著性,两病例组间差异无显著性;正常组数字划消测验总分有显著高于两病例组(F＝2.521,P＝0.093)及平均失误率显著低于两病例组的趋势(χ2＝5.150,P＝0.076);ADHD组和正常对照组在算术、数字广度、积木、B因子、Stroop测验B完成时间和D完成时间上的差异具有显著性;ADHD ODD组的瑞文标准推理测验标准分有优于ADHD组的趋势(Z=-1.674,P=0.094).结论:伴或不伴ODD的ADHD儿童有着相似的认知模式,如扩大样本量,可能发现共患病组在某些认知功能上与纯ADHD组的差异.     

Overt and Relational Aggression in Girls With Attention Deficit Hyperactivity Disorder

We employed a multi-informant approach to examine attention deficit hyperactivity disorder (ADHD) subtype differences, as well as ADHD versus comparison group differences, in overt aggression, relational aggression, and peer regard related to such aggression. Participants included 228 girls (ages 6 to 12 years) diagnosed with either ADHD-Combined (ADHD-C; n = 93), ADHD-Inattentive (ADHD-I; n = 47), or nondiagnosed comparisons (n = 88) who attended research-based summer camp programs. Girls with ADHD-C exhibited higher rates of overt and relational aggression than did girls with ADHD-I, who in turn exhibited higher rates than comparison girls. For the ADHD-C subgroup, aggressive behavior was associated with both negative peer regard and lack of positive peer regard; for the ADHD-I subgroup, aggressive behavior was related to negative peer regard but not to positive peer regard. Controlling for subtype, relational aggression contributed incremental variance in peer regard over and above overt aggression, but effects for the latter were stronger. We discuss the importance of overt versus relational aggression for girls with ADHD as well as disparities in findings according to informant sources.     

Efficacy of Strattera in Children and Adolescents with Attention Deficit Hyperactivity Disorder

Children and adolescents (25 boys, nine girls, aged from six to 17 years) with attention deficit hyperactivity disorder (ADHD) were treated with Strattera at the optimal dose of 1.2 mg/day in out-patient conditions. After use of Strattera for three months, assessment of treatment efficacy demonstrated marked and moderate clinical effects in 78.1% of patients. Psychologists’ assessment indicated that 80% of children showed improvements in the volume and rate of switching of attention and almost 60% showed improvements in measures of the stability of attention. EEG studies showed decreases in the “index of slowing” in 70.2% of patients. Strattera was found to have good safety and tolerance in the treatment of children and adolescents with ADHD.     

注意缺陷多动障碍临床亚型持续性注意力的比较

目的：比较注意缺陷多动障碍不同临床亚型儿童持续性注意力的差异。方法：符合DSM—Ⅳ注意缺陷多动障碍的90名儿童，分为注意缺陷为主型（ADHD—PI；44例）、多动-冲动为主型（ADHD—HI；14例）、混合型（ADHD—CT；36例），对3组患儿进行视听整合持续性操作测试，对视觉和听觉持续性注意力进行组间比较。结果：混合型和注意缺陷为主型的持续性注意力低于多动-冲动型，差异有统计学意义。结论：持续性注意力的损害以混合型最重，多动-冲动为主型最轻。     

Time Estimation and Performance on Reproduction Tasks in Subtypes of Children With Attention Deficit Hyperactivity Disorder

This study compared Hispanic children (ages 7 to 11) with combined type (CT, n = 33) and inattentive type (IT, n = 21) attention deficit hyperactivity disorder (ADHD) and a control group (n = 25) on time-estimation and time-reproduction tasks. The ADHD groups showed larger errors in time reproduction but not in time estimation than the control group, and the groups did not differ from each other on their performance on this task. Individual differences could not be accounted for by oppositional-defiance ratings and low math or reading scores. Although various measures of executive functioning did not make significant unique contributions to time estimation performance, those of interference control and nonverbal working memory did so to the time-reproduction task. Findings suggest that ADHD is associated with a specific impairment in the capacity to reproduce rather than estimate time durations and that this may be related to the children's deficits in inhibition and working memory.     

Social Skills Training in Children With Attention Deficit Hyperactivity Disorder: A Randomized-Controlled Clinical Trial

Evaluated efficacy of social skills training (SST) on children with 2 subtypes of attention deficit hyperactivity disorder (ADHD). Participants were 120 children (30 girls, 90 boys), ages 8 to 12 with ADHD-Inattentive type (ADHD-I; n = 59) or Combined type (ADHD-C; n = 61). The children were randomly assigned within diagnosis subtype to the treatment condition (8 weeks of SST) or the no-intervention control condition. SST led to greater improvements in both parent- and child-perceived assertion skills in the children with ADHD, yet did not affect the other domains of social competence. Diagnostically heterogeneous groups led to greater improvements on parent-report of their child's cooperation and assertion abilities as well as children's report of their own empathy skills. Diagnostically homogeneous groups led to greater decreases in externalizing behaviors at posttreatment but not at follow-up. Children with comorbid oppositional defiant disorder (ODD) did not benefit as much from the intervention. Children with ADHD-I improved in assertion skills more than children with ADHD-C, yet the 2 diagnostic entities did not differ in improvement levels across all other social skills.     

Sensitivity to Reward Frequency in Boys With Attention Deficit Hyperactivity Disorder

Compared the sensitivity of boys with and without attention deficit hyperactivity disorder (ADHD) to differences in reward frequency. Fifteen boys with ADHD as diagnosed in the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev.; American Psychiatric Association, 1987) and a matched control group completed a signal-detection task in which correct identification of 1 stimulus was rewarded 3 times as often as correct identification of the other. Boys in the ADHD group completed the task twice, on and off medication. Group differences emerged in response bias toward the more frequently rewarded alternative. Boys in the control group showed a stable pattern of response bias, irrespective of which alternative they were last rewarded on. Boys in the ADHD group showed different patterns of response bias following rewards on the 2 alternatives. These results suggest children with ADHD were more sensitive to individual instances of reward compared with controls, whose response bias is governed more by their reinforcement history. Methylphenidate improved discriminability and reduced sensitivity to individual instances of reward in the boys with ADHD.     

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 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.