Sleep disturbances in adolescents with symptoms of attention-deficit/hyperactivity disorder

We evaluated 32 nonmedicated male adolescents diagnosed with attention-deficit/hyperactivity disorder (ADHD) in childhood, 35 male adolescents similarly diagnosed who were receiving methylphenidate (MPH), and 77 control boys. Both ADHD groups completed self-report questionnaires assessing sleep disturbances; weekday and holiday sleep duration; and symptoms of ADHD, anxiety, and depression. Parents and teachers rated the severity of the participants' ADHD. The control group completed self-report questionnaires assessing sleep disturbances. We found that nonmedicated participants and controls did not differ in the severity of sleep disturbance. In contrast, the medicated participants demonstrated a significantly greater severity of sleep disturbance compared with the nonmedicated participants and reported elevated levels of symptoms of ADHD, anxiety, and depression. Specific analyses showed that depressive symptoms contributed significantly to the degree of sleep disturbance when controlling for ADHD diagnosis and MPH treatment. These findings suggest that among adolescents with ADHD symptoms, the severity of symptoms of depression may contribute to the degree of sleep disturbance in addition to the effect of their primary disorder and MPH treatment.     

Including students with attention-deficit/hyperactivity disorder in mainstream schools

Around 80% of pupils with attention deficit disorders are educated in mainstream schools. The difficulties relating to inattention, impulsivity and hyperactivity experienced by such pupils present mainstream educators with a unique set of challenges and opportunities. In this article, Neil Humphrey, Senior Lecturer in the Psychology of Education at the University of Manchester, presents and discusses key evidence-based strategies and approaches to facilitate the inclusion of pupils affected by attention deficit/hyperactivity disorder (AD/HD). These include the need to reframe AD/HD, to understand the role of medication, to minimise distractions, to provide predictability, structure and routine, and to apply cognitive and behavioural strategies.     

Ambivalent attitudes about teaching children with attention deficit/hyperactivity disorder (ADHD)

Drawing on attitude theories from social psychology, we conducted a survey of Australian pre-service (n = 327) and in-service (n = 127) teachers’ attitudes about teaching children with attention-deficit/hyperactivity disorder (ADHD). This paper reports a content analysis of beliefs, affect and behaviours towards teaching children with ADHD and quantitative analyses pertaining to attitudinal ambivalence – that is, where a teacher may simultaneously report negative and positive evaluations of teaching children with ADHD. While on average, overall or global attitudes were mildly positive for both cohorts, considerable ambivalence about teaching children with ADHD was commonly experienced. Participants reported ambivalent beliefs, affect and behaviours, as well as ambivalence between these attitude components. Paradoxically, participants who knew more about ADHD and held stronger positive global attitudes about teaching children with ADHD reported less ambivalent behaviours towards these children, but reported more ambivalent beliefs. The implications for teachers’ professional development and training are discussed.     

Knowledge and attitudes towards attention-deficit hyperactivity disorder (ADHD): a comparison of teachers and teaching assistants

ABSTRACT

Attention-deficit hyperactivity disorder (ADHD) rates in classrooms have increased considerably in recent years. Previous literature has acknowledged the significance of teachers’ knowledge and attitudes towards ADHD when making referral and intervention decisions. Using Mulholland, Cumming and Jung’s (2015) knowledge (SASK) and attitude (SASA) scales, ADHD training and perceived support were compared across public school teachers (n = 165) and teaching assistants (TAs) (n = 157) in the UK. Results indicated that teachers and TAs displayed adequate levels of knowledge, and TAs held better knowledge and more positive feelings towards ADHD than teachers. Training increased knowledge for TAs, but not for teachers, and training and support appeared important for both the teachers and TAs’ attitudes. Both teachers and TAs reported inadequate training and expressed a desire for further ADHD training, and a significant association was found between knowledge and attitudes for teachers only. The implications for these findings are discussed.     

Symptoms of attention-deficit hyperactivity disorder (ADHD) and home learning environment (HLE): findings from a longitudinal study

The concept of “Home Learning Environment” (HLE) covers activities in a family providing intellectual stimulation for a child, such as reading to him or her or visiting libraries. Numerous studies have shown an association between HLE and children's cognitive development. In this longitudinal study, we focus on HLE as a predictor for children's behavioral development, namely, for later symptoms of attention-deficit hyperactivity disorder (ADHD), controlling for relevant aspects like socioeconomic status (SES), or television viewing behavior. We analyzed the development of ADHD symptoms from kindergarten to the end of grade 2 and possible associations with HLE, SES, and television exposure, using a German community sample (N?=?924). Results indicated that ADHD symptoms were negatively and significantly correlated to HLE for all five measurement points as well as to SES (except T4) and to television exposure for T1 to T4. Observing later development, only early HLE but not SES or television exposure served as a significant predictor for ADHD symptoms at school, when age, sex, and ADHD symptoms in kindergarten were controlled for. A structural equation model showed that HLE acted as a mediator between SES and later ADHD symptoms. Our results highlight the importance of the concept of home learning environment also for children's behavioral development. As a consequence, parents should be supported in offering their children a more favorable learning environment.     

Learning disabilities and risk-taking behavior in adolescents: a comparison of those with and without comorbid attention-deficit/hyperactivity disorder

Risk-taking behavior includes alcohol and drug use, delinquency, acts of aggression, sexual activity, and so on. Many studies have explored the relationship between adolescents and risk-taking behavior; however, only a few studies have examined this link in adolescents with learning disabilities (LD) or attention-deficit/hyperactivity disorder (ADHD). The purpose of the present study was to address that limitation by comparing the risk-taking behavior of adolescents with LD (n=230), with comorbid LD/ADHD (n=92), and without LD or ADHD (n=322) on their substance use, engagement in major and minor delinquency, acts of aggression, sexual activity, and gambling activities. The study also investigated whether psychosocial variables (e.g., well-being) may act as mediating variables that help explain between-group differences. Results suggest that it is a combination of the LD and the secondary psychosocial characteristics that explains why adolescents with LD and comorbid LD/ADHD more frequently engage in some risk-taking behavior.     

EEG analysis of children with attention-deficit/hyperactivity disorder and comorbid reading disabilities

This study investigated electroencephalographic differences between two groups of children with attention-deficit/hyperactivity disorder, combined type, with reading disabilities (ADHD + RD) or without (ADHD) and typical control participants. Twenty participants were included in each group. All participants were between the ages of 8 and 12 years, and groups were matched on age and gender. The electroencephalographic (EEG) was recorded during an eyes-closed resting condition from 21 monopolar derivations, which were clustered into nine regions for analysis. The EEGs were Fourier-transformed to provide absolute and relative power estimates for the delta, theta, alpha, and beta bands. Ratio coefficients were also calculated for the theta/alpha and theta/beta ratios. Compared with controls, the clinical groups demonstrated the increased slow-wave and reduced fast-wave activity commonly reported in the ADHD literature. The ADHD + RD group had more relative theta, less relative alpha, and a higher theta/alpha ratio than the ADHD group. A number of hemispheric differences were also found in the delta and alpha bands. These results suggested that some of the EEG divergences found in the ADHD + RD group represent an electrophysiological component associated with the reading disability that is independent of the EEG divergences found in ADHD.     

Evidence for unexpected weaknesses in learning in children with attention-deficit/hyperactivity disorder without reading disabilities

This study examined the mechanisms underlying verbal learning in children with and without attention-deficit/hyperactivity disorder (ADHD), none of whom had reading disabilities. Children with ADHD were compared to typically developing children on both process and product scores from the California Verbal Learning Test for Children. The findings indicated that children with ADHD initially learned the same number of words as controls but showed weaknesses recalling the words after delays, suggesting that children with ADHD are less efficient learners. Regardless of ADHD status, boys and girls performed differently. Boys used semantic clustering less frequently and recalled fewer words from the middle region of the list than girls; girls also outperformed boys in terms of overall performance, despite lower verbal IQ scores. These findings show that children with ADHD can exhibit unexpected weaknesses in learning even without a formal learning disability. Gender differences in verbal learning are also illustrated.     

Knowledge of attention deficit hyperactivity disorder (ADHD) and attitudes toward teaching children with ADHD: THE role of teaching experience

Knowledge of attention deficit hyperactivity disorder (ADHD) and attitudes toward teaching children with ADHD are compared across stages of Australian teachers' careers. Relative to pre‐service teachers with (n = 218) and without (n = 109) teaching experience, in‐service teachers (n = 127) show more overall knowledge of ADHD, more knowledge of characteristics and treatments for ADHD, and higher perceived knowledge. In‐service teachers reported less favorable emotion about teaching children with ADHD than did pre‐service teachers without experience and more favorable behaviors than pre‐service teachers with experience. Groups did not differ in knowledge of causes of ADHD, overall attitudes, stereotypical beliefs, and beliefs about teaching children with ADHD. Identification of knowledge gaps and ambivalent attitudes will guide pre‐service and in‐service training courses. © 2012 Wiley Periodicals, Inc.     

Objectivity of boys with attention-deficit/hyperactivity disorder (adhd) and their mothers when responding to a caricatured portrayal of adhd

In a recent theoretical model of Attention-Deficit/Hyperactivity Disorder (ADHD) it is proposed that a core deficit in response inhibition affects, among other things, an individual's objectivity in their reaction to events. In the context of this, the ability of boys diagnosed with ADHD objectively to differentiate their own behaviour from that of a caricatured portrayal of ADHD by Bart Simpson was examined. Four segments, each lasting 10–15 seconds, depicting ADHD related behaviours were isolated from a television episode of The Simpsons and shown in random order to 39 boys diagnosed with ADHD, their mothers, and two paediatricians. After watching each segment, the boys were asked to show how similar they believed their behaviours were to those exhibited by Bart Simpson by simultaneously placing two figures (one a replica of Bart and another representing themselves) on a chequer board. Mothers were subsequently administered the same procedure to indicate how they viewed their sons' behaviour in relation to Bart's. The distance measured between the two figures was representative of their levels of objectivity compared to a benchmark level set by the two paediatricians using the same chequer board procedure. While the results overall indicate that boys with ADHD and their mothers are able to make distinctions between caricatured and typical ADHD behaviours, the results are mediated by both ADHD subtype and the specific ADHD behaviour portrayed in the video segment.     

Children with attention-deficit/hyperactivity disorder: A review of the literature on social skills deficits

Social interactions between children with Attention-Deficit/Hyperactivity Disorder (AD/HD) and their teachers, peers, and parents are discussed. The extent to which these interactions may be termed problematic may depend on the social skills deficits displayed by this population. Although the general trend in the liternature has been to examine and describe children with deficient social skills, changing the focus to children with AD/HD who are not experiencing these difficulties may prove beneficial. A review of the previous literature is discussed, as well as suggestions for practice and future research needs.     

Preschool twin study of the relation between attention-deficit/hyperactivity disorder and prereading skills

Numerous studies have examined the etiology of the association between reading difficulties and attention-deficit hyperactivity disorder (ADHD) in school-age children, but little is known about the relation between prereading skills and ADHD behaviors prior to the beginning of formal reading instruction. A population-based sample of 809 pairs of preschool twins completed an extensive battery of prereading measures, and the parent of each twin completed an ADHD rating scale. Phenotypic analyses revealed small but significant correlations between DSM-IV inattention ratings and six prereading composite measures, whereas hyperactivity–impulsivity symptoms were not independently associated with any of the prereading scores. Multivariate twin analyses indicated that virtually all of the phenotypic correlation between inattention and prereading performance is attributable to common genetic influences, consistent with results obtained in studies of older twins. Although additional research is needed to test alternative causal models in children younger than five years old, these results are most consistent with the hypothesis that reading difficulties and inattention symptoms are attributable to common genetic influences.     

Information processing deficits in children with attention-deficit/hyperactivity disorder, inattentive type, and children with reading disability

We examined the information processing capabilities of children diagnosed with the inattentive subtype of attention-deficit/hyperactivity disorder (ADHD) who had been characterized as having a sluggish cognitive tempo. Children referred for school-related problems (n = 81) and nonreferred community controls (n = 149) participated. Of the referred children, 24 met criteria for ADHD, 42 met criteria for reading disability (RD), and 9 of these were comorbid for RD and ADHD. Children with ADHD differed from those without ADHD on a visual search task but not on an auditory processing task; the reverse was true for children with RD. Decomposition of the visual search task into component operations demonstrated that children in the ADHD group had a slow processing rate that was not attributable to inattention. The children with ADHD were not globally poor at information processing or inattentive, but they demonstrated diminished speed of visual processing.     

Cognitive profiling in Chinese developmental dyslexia with attention-deficit/hyperactivity disorders

The cognitive profiles of children with Developmental Reading Disorder (RD) and Attention-Deficit/Hyperactivity Disorders (ADHD) have been extensively studied in alphabetic language communities. Deficits in phonological processing and rapid naming have been implicated as core features of RD although whether the latter is a deficit specific to RD remains controversial. Similar research aiming to explore the cognitive profiles of children with both RD and ADHD in non-alphabetic language communities is limited. The specificity of rapid naming deficit to RD among Chinese has yet to be studied. In the first study, 43 Chinese children with confirmed diagnoses of RD + ADHD were assessed on their cognitive abilities in relating to reading. In the second study, the specificity deficit hypothesis of rapid naming to RD but not ADHD was examined. A digit naming test was administered to the RD + ADHD group (43 subjects) and an ADHD only group (49 subjects). In regard to cognitive profiling, rapid naming and orthographic knowledge were found to be the most common deficits among the Chinese RD + ADHD group. This co-morbid group was also found to have a significant deficit performance on the rapid naming task than the ADHD only group. The present findings support the double dissociation hypothesis in cognitive deficit between RD and ADHD. The results of both studies are discussed with reference to the findings of the Western counterparts.     

Linkages between child abuse and attention-deficit/hyperactivity disorder in girls: behavioral and social correlates

OBJECTIVE: The objectives of this study were to examine whether girls with attention-deficit/hyperactivity disorder (ADHD) are at increased risk of having histories of abuse and to assess whether the presence of an abuse history may constitute a distinct subgroup of youth with ADHD. METHOD: We examined rates and correlates of child abuse in an ethnically and socioeconomically diverse sample of girls with attention-deficit/hyperactivity disorder (ADHD; n=140) and a matched comparison sample of girls without ADHD (n=88), all aged 6-12 years. A thorough chart review reliably established documented rates of physical and sexual abuse in both samples. RESULTS: There were significantly higher rates of abuse for girls with ADHD (14.3%) than for the comparison sample (4.5%), with most of the abuse found in girls with the Combined as opposed to the Inattentive type. Higher rates of externalizing behaviors (including objective observations in a research summer camp) and peer rejection (indexed through peer sociometric nominations) characterized the subgroup of girls with ADHD with abuse histories compared to the subgroup without such histories, with moderate to large effect sizes. Subgroup differences regarding internalizing problems and cognitive deficits did not emerge. Findings regarding peer rejection were explained, in part, by higher rates of observed aggressive behavior in the abused subgroup. CONCLUSIONS: The findings raise important questions about the possible etiologic and/or exacerbating role of abusive trauma in a subgroup of children with ADHD.     

Comorbidity of reading disability and attention-deficit/hyperactivity disorder: differences by gender and subtype

This study used a community sample of 494 twins with a reading disability (223 girls, 271 boys) and 373 twins without a reading disability (189 girls, 184 boys) to assess the relation between reading disability (RD) and attention-deficit/hyperactivity disorder (ADHD). Symptoms of DSM-III and DSM-IV ADHD were classified into symptoms of inattention and symptoms of hyperactivity-impulsivity (H/I). Results indicated that individuals with RD were more likely than individuals without RD to meet criteria for ADHD and that the association between RD and ADHD was stronger for symptoms of inattention than for symptoms of H/I. Parents and teachers reported similar rates of ADHD, suggesting that ADHD symptoms were pervasive across settings and were not solely attributable to academic frustration. Analyses of possible gender differences revealed that RD was significantly associated with inattention in both girls and boys but associated with H/I only in boys. This difference may provide a partial explanation for the discrepancy between the gender ratio obtained in referred (approximately 4 boys to 1 girl) and nonreferred (1.2 to 1.5 boys to 1 girl) samples of individuals with RD. Specifically, the hyperactive and impulsive behaviors exhibited by boys with RD may be more disruptive than the inattentive behaviors exhibited by girls and may therefore precipitate more frequent referrals for clinical attention.     

The early caregiver-child relationship and attention-deficit disorder with hyperactivity in kindergarten: a prospective study

Newborn status, ratings of temperament, and heretofore neglected experiential (parenting) antecedents of hyperactivity were evaluated in a prospective, longitudinal investigation. The experiential variables were derived from a developmental theory of arousal modulation in the early years. Patterns of maternal intrusive care, seductive behavior, and overstimulation were assessed at 6 months, 2 years, and 3 1/2 years, respectively. 2 of these 3 variables significantly predicted hyperactivity in kindergarten at age 5 or 6, as determined by clinically validated ratings made by teachers. Of the 38 early child variables, which included neonatal behavioral assessments and ratings of activity level by parents and observers on many occasions during the first 2 1/2 years, only the motor maturity factor from 2 composited Brazelton exams yielded a significant relation. In addition, a measure of distractibility at 42 months was predictive of hyperactivity. Although other child measures may prove to be more powerful than those we tested, it will remain the case that prospective data are a critical arbiter of etiological factors in hyperactivity. Such data have important implications for both diagnosis and treatment.     

The diagnosis of attention deficit hyperactivity disorder (ADHD) in community mental health centers: Where and when

The high degree of coexistence of attentional disorders, such as Attention Deficit Hyperactivity Disorder (ADHD), with a number of other disorders continues to pose diagnostic problems and to highlight a continuing need to differentiate better between overlapping diagnoses. The purpose of this study was to assess the extent to which this type of diagnostic confusion continues to exist in referrals for assessment of ADHD to community mental health centers. Using referrals to a specialized ADHD Clinic of our center, 92 children with a previous diagnosis of ADHD were provided comprehensive evaluations, addressing cognitive, intellectual, personality, academic, social, behavioral, developmental, and medical concerns. After comprehensive evaluation and careful review of the results, only 22% of our sample were given a primary diagnosis of ADHD and only 37% a secondary diagnosis of ADHD. Substantial numbers of children were diagnosed instead with primary anxiety and mood disorders. Reasons for this discrepancy are discussed.     

Postsecondary attention-deficit/hyperactivity disorder and deliberate practice: Study time,study quality,and self-perceptions

The current study examined study habits of postsecondary students with attention-deficit/hyperactivity disorder (ADHD) through the theoretical context of deliberate practice. The responses of participants with and without ADHD were compared on a survey of study time, study quality, and self-perceptions of study habits, as well as a measure of test anxiety. Groups were equivalent on reports of study time and time spent in other activities, percentage of classes they attend, use of conducive study environments, and planning of studying. Despite similar study behaviors, ADHD participants were more likely to feel unprepared for tests, reported significantly higher test anxiety, and had lower grade point averages. Regardless of ADHD status, the majority of study participants were not implementing deliberate practice behaviors, with the exception of class attendance, and study times fell far below recommended levels. Findings provided evidence that emulating the study behaviors of peers is not sufficient for students with ADHD to experience similar outcomes.     

Visualisation to support children with attention-deficit/hyperactivity disorder learning to solve mathematical word problems: A randomised controlled trial

This randomised controlled trial experimental study compared the effectiveness of using two different types of visualisation – self-constructed visualisation (SCV) and passively received visualisation (PRV) – to help children with attention-deficit/hyperactivity disorder (ADHD) solve mathematical word problems. While SCV refers to drawings that children create to help solve given word problems, PRV refers to pre-made images that accompany word problems. Twenty children with ADHD in Kuwait, aged nine to 11 years, were randomly assigned to either the SCV or PRV group, where they were taught to use either SCV or PRV to solve word problems across 20 daily one-to-one sessions. The results showed that regardless of the visualisation type, children's word problem-solving ability significantly improved. Children with ADHD should thus be encouraged to use visualisation to help make the word problem-solving process more accessible to them.