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.     

Learning disabilities and executive dysfunction in boys with attention-deficit/hyperactivity disorder

The effect of comorbid reading or arithmetic learning disabilities (LDs) on neuropsychological function in attention-deficit/hyperactivity disorder (ADHD) was studied. Participants were young males diagnosed with ADHD, with and without LD, and non-ADHD, non-LD male controls of similar age. LD was defined by combined regression-based and low-achievement classifications. Analyses adjusted for the effect of psychiatric comorbidity, age, and socioeconomic status on neuropsychological function. Children who had both ADHD and LD were significantly more impaired on both executive and nonexecutive functions than ADHD children without LD. Neuropsychological performance was most impaired in ADHD with combined arithmetic and reading disability. These data indicate that comorbid LD, especially arithmetic disability, significantly increases the severity of executive function impairment in ADHD.     

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.     

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.     

BAIAP2基因多态与儿童注意缺陷多动障碍共患学习困难的关联分析

目的:探讨脑特异性血管发生抑制剂1相关蛋白2(BAIAP2)基因多态与儿童注意缺陷多动障碍(ADHD)共患学习困难(LD)的关联。方法:选取符合美国精神障碍诊断与统计手册第4版(DSM-IV)诊断标准731例共患LD的ADHD儿童和957例健康对照,采用高通量实时荧光定量PCR方法检测基因型,探讨BAIAP2基因的9个单核苷酸多态性(SNPs)位点与共患LD的儿童ADHD的关联。结果:BAIAP2的SNP位点rs8079626/G(病例对照频率0.638 vs.0.604)和rs4969385/T(0.179 vs.0.150)与儿童ADHD共患LD关联,rs3934492/C(0.572 vs.0.532)和rs4969385/T(0.180 vs.0.142)与男性儿童ADHD共患LD关联,rs4969239/G(0.426 vs.0.329)和rs4969358/A(0.472 vs.0.389)与女性儿童ADHD共患LD关联(均P0.05);由rs4969239-rs4969358-rs6565531-rs8079626组成的单体型AAGG与共患LD的儿童ADHD共患LD(0.100 vs.0.065)和男性儿童ADHD共患LD(0.101 vs.0.065)关联(均P0.05)。结论:BAIAP2基因多态性可能与汉族儿童ADHD共患LD的病理机制有关,且这种作用机制可能存在性别差异。     

Additive effect of three noradrenergic genes (ADRA2A, ADRA2C, DBH) on attention-deficit hyperactivity disorder and learning disabilities in Tourette syndrome subjects

Halperin et al. (Halperin JM. Newcorn JH, Koda VH, Pick L, McKay KE, Knott P. Noradrenergic mechanisms in ADHD children with and without reading disabilities: a replication and extension. J Am Acad Child Adolesc Psychiatry 1997: 36: 1688 1696) reported a significant increase in plasma norepinephrine (NE) in attention-deficit hyperactivity disorder (ADHD) children with reading and other cognitive disabilities compared to ADHD children without learning disabilities (LD). We examined the hypothesis that ADHD + LD was associated with NE dysfunction at a molecular genetic level by testing for associations and additive effects between polymorphisms at three noradrenergic genes the adrenergic alpha2A receptor (ADRA2A), adrenergic alpha2C receptor (ADRA2C), and dopamine beta-hydroxylase (DBH) genes. A total of 336 subjects consisting of 274 individuals with Tourette syndrome (TS) and 62 normal controls were genotyped. Regression analysis showed a significant correlation between scores for ADHD, a history of LD, and poor grade-school academic performance that was greatest for the additive effect of all three genes. Combined, these three genes accounted for 3.5% of the variance of the ADHD score (p = 0.0005). There was a significant increase in the number of variant NE genes progressing from subjects without ADHD (A-) or learning disorders (LD-) to A + LD - to A - LD + to A + LD + (p = 0.0017), but no comparable effect for dopamine genes. These data support an association between NE genes and ADHD, especially in ADHD + LD subjects.     

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.     

Identifying students faking ADHD: Preliminary findings and strategies for detection.

When conducting psychological evaluations, clinicians typically assume that the subject being evaluated is putting forth maximal effort and is not exaggerating or magnifying symptom complaints. While the field of neuropsychology has identified that factors, such as effort and motivation, can significantly interfere with correct interpretation of self-reported symptoms and test scores, evaluation methods for other psychological conditions, such as attention deficit hyperactivity disorder (ADHD) have not addressed effort and motivation as potential factors influencing accurate diagnosis. In analyzing the performance of students simulating ADHD, and comparing it to performance of both non-ADHD and genuine ADHD students, this study clearly demonstrated that the symptoms of ADHD are easily fabricated, and that simulators would be indistinguishable from those with true ADHD. In addition, students motivated to feign ADHD could easily perform poorly on tests of reading and processing speed, thus allowing them access to academic accommodations. Implications of these findings are discussed.     

Attitude and knowledge of attention deficit hyperactivity disorder and learning disability among high school teachers

The aims of the study were to investigate teachers’ knowledge and attitudes towards attention deficit hyperactivity disorder (ADHD) and learning disabilities (LD). Forty-six high school teachers were interviewed in this regard. The 46 teachers were divided into two groups: 25 teachers taught at an academic school (School 1); and 21 teachers taught at special education school (School 2) and dealt with ADHD/LD cases regularly. General knowledge about ADHD (71%) and about LD (74%) was relatively low among both groups. Thirteen percent of all teachers considered LD to be the result of parental attitudes, namely ‘spoiling’ the children. The score for attitude and understanding of ADHD children was relatively low (72.5%) for both groups, whereas Group B teachers scored higher regarding LD cases. Almost 40% considered that ADHD children should be rebuked and/or punished in a manner similar to non-ADHD kids. Regarding long-term outcome, 45.7% of the teachers expected ADHD children to experience multiple difficulties in family life during adulthood. In relation to LD cases, the overall scoring for positive attitude was 75%. However, this score was higher for Group B teachers. Three-quarters of the teachers favored increasing peer awareness and comprehension as to the problems LD kids encounter at school. Ninety-five percent believed LD patients should enjoy a more lenient school education. There was no correlation between teachers, knowledge of ADHD and LD and their attitude. The main sources for this knowledge were: specialized textbooks, continuous education, TV shows, journals and newspapers, and medical personnel.     

Language-based cognitive functioning in parents of offspring with ADHD comorbid for Tourette syndrome or learning disabilities

The parents of children diagnosed with attention deficit hyperactivity disorder (ADHD) were examined for characteristics symptomatic of 2 comorbidities (Co) within their offspring with ADHD: Tourette syndrome (TS) and language-based learning disabilities (LD). A 2 ×2 multivariate analysis of variance design was used; the parents were divided according to whether the offspring with ADHD had TS (Co-TS) or not (No Co-TS) and whether offspring had LD (Co-LD) or not (No Co-LD). Parents (86 mothers and 70 fathers) were administered the short form of the Wechsler Adult Intelligence Scale-Revised (WAIS-R; Wechsler, 1981), subtests of the Woodcock-Johnson Cognitive and Achievement Batteries (Woodcock & Johnson, 1989), and word fluency (semantic and letter; Benton & Hamsher, 1989; Wiig & Semel, 1987). The fathers of offspring with Co-TS were more likely to be diagnosed with LD and had lower WAIS-R Vocabulary, Arithmetic, and Picture Arrangement scores. In addition, when the WAIS-R full scale IQ was used as a covariate, these fathers had lower Woodcock-Johnson Oral Vocabulary, Spelling, and Reading scores (as measured by Letter-Word Identification). The mothers of children with Co-TS had lower WAIS-R Vocabulary scores. Parents of the children with No Co-TS showed a higher proportion of error patterns on the word fluency tasks involving repetitions and rule breaks. The findings show that it was the parents of the children with Co-TS, not the parents of the children with Co-LD, who showed language-based learning problems. In separate discriminant analyses for the fathers and mothers, when the aforementioned significant parental measures were used as predictors, 81% of offspring with Co-TS were correctly classified as having a diagnosis of TS, solely on the basis of characteristics in their parents.     

慢性抽动障碍儿童行为问题的对照研究

目的:比较伴与不伴注意缺陷多动障碍(ADHD)的慢性抽动障碍(CTD)儿童和ADHD以及正常对照儿童行为问题的差异。方法:对伴与不伴ADHD的CTD儿童和ADHD以及正常对照儿童采用儿童行为量表(CBCL)进行对比分析。结果:CTD ADHD组和ADHD组儿童总的行为问题发生率、CBCL多数因子分及行为问题总分与单纯CTD组和对照组比较,差异有统计学意义(P﹤0.05),而单纯CTD组和对照组两组间只有强迫、多动、攻击因子分和行为问题总分有统计学差异(P﹤0.05)。结论:伴有ADHD的CTD儿童与ADHD儿童相似,存在较高的行为问题发生率和较多的行为问题,提示伴有的ADHD是CTD儿童行为问题的主要来源。     

中医结合心理矫正疗法治疗儿童多动症的效果观察

目的:对中医结合心理矫正疗法在儿童多动症治疗中的临床运用效果进行分析与观察。方法:选取我院2014年2月至2015年2月所收治的84例儿童多动症患者作为观察的对象,按随机数字表法均分成联合组与对照组,对照组予以心理矫正疗法,在此基础之上,对联合组患者再予以中医(益肾健脑汤)治疗,且观察与比较两组患者的临床治疗效果。结果:联合组患者治疗后的总有效率(97.62%)比对照组(80.95%)高,经Ridit分析两组比较差异显著(U=2.514,P0.05);联合组治疗后PSQ评分各指标比对照组低,有统计学意义(P0.05);联合组治疗后的中医症候积分小于对照组,差异有统计学意义(t=-6.883,P0.05)。结论:对儿童多动症患者予以中医联合心理矫正法加以治疗,疗效确切,值得在临床上大力推行与运用。     

Psychosocial treatments for ADHD in teens and adults: a practice-friendly review

Although stimulant medication is a cornerstone of treatment for attention deficit hyperactivity disorder (ADHD), numerous nonpharmacological treatments can be employed in combination with medication to assist in the lifelong management of the disorder. A multimodal treatment combining psychoeducation, medication, psychotherapy, compensatory behavioral/self-management skills, technological tools and devices, coaching, advocacy, and reasonable school or workplace accommodations is probably the most comprehensive and effective. This article describes a variety of psychosocial treatments that are commonly used for adolescents and adults suffering from ADHD.     

Keeping Families Together (Book)

Compared 2 groups of children with attention deficit hyperactivity disorder, predominantly inattentive type (ADHD/IA)-those with high scores on a composite measure of sluggish cognitive tempo (SCT) and those without-using a large, school-based sample of children for which previous comparisons between ADHD subtypes have been reported. Although the 2 groups did not differ on level of attention or learning problems, high-SCT ADHD/IA children were rated by teachers as showing less externalizing behavior and higher levels of unhappiness, anxiety/depression, withdrawn behavior, and social dysfunction. Thus, SCT identifies a more homogeneous subgroup of ADHD/IA children who are, relative to the entire Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV]; American Psychiatric Association [APA], 1994) diagnosed ADHD/IA group, more similar to those classified in previous research as "attention deficit disorder without hyperactivity." These results support a reconsideration of SCT symptoms as a component of diagnostic criteria for a category of nonhyperactive attention deficit disorder.     

Attention deficit and learning disabilities (ADHD/LD) among high school pupils in Holon (Israel)

Five hundred forty-three students participated in the study. The prevalence of ADHD according to criteria of DSM-4 among them was 15.2%, including three subgroups: ADHD (inattentive)- 9.7%, combined- 4.5%, and ADHD-hyperactivity-impulsivity (HI)- 1%. The prevalence of learning disability (LD) was 17.6%. The gender ratio in both groups (ADHD and LD) was equal. These pupils had lower academic achievements with lower marks. The prevalence of ADHD/LD found in the present study in Israel is in a higher range of those reported in the literature. We should remember that ADHD/LD is a neuro-behavioral disability and these children and adolescents need an early educational correcting program at home and at school.     

Knowledge and attitudes of high school pupils towards peers' attention deficit and learning disabilities

The purpose of this study was to investigate pupils' knowledge and attitudes in the areas of attention deficit and hyperactivity (ADHD) and learning disabilities (LD). One hundred and four high school pupils in Holon (Israel) were interviewed and anonymously completed a questionnaire on these conditions. Pupils' knowledge on the topic of ADHD was low (62%); they showed a better knowledge about LD (75%). They showed a partially tolerant attitude (62.7%) towards pupils suffering from ADHD; on the other hand, they had a somewhat more positive and perceptive attitude (74.1%) towards peers diagnosed as learning disabled. Pupils' attitudes became more perceptive with increasing age. There was no correlation between pupils' knowledge and attitude. Pupils had learned about these two handicapped conditions from various sources; TV (66.3%), newspapers (63.5%) and school (53.8%), while physicians and nurses occupied the 5th and last place. Information about these two disabilities (ADHD and LD) should be added to the curriculum and be taught by qualified specialists, as there is an obvious statistically deficient knowledge in these areas.     

视听整合持续测试的诊断价值

目的探讨视听整合持续测试（IVA-CPT）在儿童注意缺陷多动障碍（attention deficit hyperactivity disorder ADHD）辅助诊断中的评估价值。方法应用IVA-CPT操作评估软件对一组符合DSM-诊断标准的多动症儿童和一些正常儿童进行测试。结果根据DSM-诊断标准,76例ADHD患儿经IVA-CPT测试,结果异常,符合临床诊断的有69例,敏感度为90.79%;40例正常儿童中结果有异常的5例,特异度为87.5%;假阴性率为9.11%;假阳性率为12.5%。结论IVA-CPT是客观、标准、高精确度的持续性操作测试,在ADHD诊断中有较理想的辅助诊断意义,值得推广应用。     

成人ADHD患者静息脑电及其与生态执行功能的相关性

目的:探究成人注意缺陷多动障碍(ADHD)患者的脑电特征及其与生态执行功能的关系。方法:选取成人ADHD患者33例及正常对照30例,用执行功能行为评定量表成人版(BRIEF-A)评估生态执行功能,并记录静息态脑电,分析不同频段脑电的绝对功率,探讨其与执行功能缺陷的相关性。结果:与正常对照相比,ADHD患者BRIEF-A各因子得分及其全脑θ波及中央区β绝对功率均高于对照组(均P<0.01);ADHD患者的工作记忆评分与其双侧额叶θ波绝对功率呈正相关(r=0.43、0.49,均P<0.05),情感控制评分与双侧中央区β波绝对功率呈正相关(r=0.43、0.49,均P<0.05)。结论:成人ADHD患者生态执行功能存在缺陷,其额叶θ波及中央区-顶叶β波功率增高可能分别参与其工作记忆缺陷及情感控制不良的神经病理学机制。     

Polymorphism of the serotonin-2A receptor gene (HTR2A) associated with childhood attention deficit hyperactivity disorder (ADHD) in adult women with seasonal affective disorder

INTRODUCTION: Several lines of research point to a possible overlap between seasonal affective disorder (SAD) and attention deficit hyperactivity disorder (ADHD), particularly in females. There is also emerging evidence that variation of the 5-HT2A receptor gene (HTR2A) contributes to both SAD and ADHD. The current study investigated whether variation in HTR2A was associated with symptoms of childhood ADHD in adult women with SAD. METHOD: Sixty-six women with SAD were administered the Wender-Utah Rating Scale (WURS), which retrospectively assesses childhood ADHD, as part of an ongoing genetic study of SAD. WURS scores were compared across the three genotypic groups defined by the T102C polymorphism of HT2RA. RESULTS: Analysis of variance indicated a significant difference in mean 25-item WURS scores across the three genotypic groups (p = 0.035). Post-hoc tests revealed that the C/C genotypic group had a significantly higher mean score than both the T/T group and T/C group. Based on previously established WURS criteria, 38% of subjects with the C/C genotype, and none with the T/T genotype, had scores consistent with childhood ADHD. LIMITATIONS: The current sample size is small, and childhood ADHD diagnoses were based on retrospective recall. CONCLUSION: These preliminary results suggest a possible association between variation in HTR2A, childhood ADHD, and the later development of SAD in women.     

Executive processing and attention deficit hyperactivity disorder: an application of the supervisory attentional system

Children with attention deficit hyperactivity disorder (ADHD) display many behaviors consistent with an underlying deficit in executive processes. This study examines Norman and Shallice's (1986) supervisory attentional system (SAS) as an approximation of executive functioning thought to be impaired in ADHD. Fifteen ADHD children were compared to a clinical control sample of learning disabled (LD) children and control children matched for age, gender, and IQ on a series of tasks designed to tap the functions of the SAS. The tasks assessed either the inhibition of a strongly triggered response (Star Counting Test, Hayling Sentence Completion Test, and the Random Generation Test) or impulsive responding in the absence of strong trigger-schema contingencies (Brixton Spatial Anticipation Test). Analyses revealed that the ADHD group was significantly impaired, in comparison to the LD and control groups, on tasks requiring the inhibition of a strongly triggered response. Further support for the fractionation of the SAS is provided by the differential performance of the groups on these tasks.