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.     

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.     

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.     

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.     

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.     

Estimated prevalence of attention-deficit/ hyperactivity disorder symptoms among college freshmen: gender, race, and rater effects

Group differences and prevalence rates for attention-deficit/hyperactivity disorder (ADHD) symptoms in a matched sample of college freshmen (n = 956) and their parents (n = 956) were investigated for gender and race (African American and Caucasian) effects using current self-report and retrospective parent-report ratings. On self-report, compared to female students, male students displayed higher mean scores on subscales and lower rates for reporting symptom totals beyond DSM-IV thresholds for the three subtypes of ADHD. Mean differences in ADHD symptoms were not apparent for race. However, African American students displayed higher rates for reporting symptom totals beyond DSM-IV thresholds for all subtypes. On retrospective parent report, male students and Caucasian students displayed higher mean scores on all scales and higher rates for reporting symptom totals beyond DSM-IV thresholds for all subtypes. Prevalence rates varied by gender and race on self-report and parent report. Prevalence was examined based on combined data of self-report and parent report and using age-adjusted cutoff criteria. Findings and implications are discussed.     

Reading motivational differences among groups: Reading disability (RD), attention deficit hyperactivity disorder (ADHD), RD + ADHD,and typical comparison

This study assessed the reading motivation of 133 students at individual grade levels (2nd–5th), who were divided in subgroups with and without reading disabilities/difficulties (RD) and with and without attention deficit hyperactivity disorder (ADHD). Major findings were that students in the RD subgroup had lower reading motivation (intrinsic, extrinsic, and self-efficacy) and read less for enjoyment than the nondisability (ND) group; students in the combined group (ADHD + RD) showed these motivational deficits in earlier grade levels. However, students with ADHD did not differ from the ND group in reading motivation, and children with RD (with and without ADHD) were equivalent to ND in social motivation up to the 5th grade. Implications of these findings were (a) social reading is an instructional pathway for both groups of students with RD, (b) assessments of reading motivation, in addition to reading skill, may be important in assessing responses to intervention, and (c) motivational interventions should be implemented early before motivational responses become a motivational style.     

Differential effects of stimulant medication on reading performance of boys with hyperactivity with and without conduct disorder

Controversy surrounding stimulant medication, particularly its effects on reading performance, continues to obscure the issue of the use of this drug in classroom situations. The present study emphasized careful differential diagnosis, double-blind and placebo approaches, and curriculum-based dependent measures to address these concerns. Methylphenidate was administered to two groups of boys, ages 8 through 11. The two groups included 27 subjects meeting criteria for attention deficit-hyperactivity disorder but not conduct disorder, known as hyperactive disorder (HD), and 28 subjects meeting criteria for both diagnostic categories, known as hyperactive-aggressive (HA). Only four subjects in each group met a discrepancy criterion for learning disabilities (LD). Methylphenidate was administered to both groups at three levels of dosage, along with baseline and placebo conditions. Dependent measures involved both reading recognition and reading comprehension, equivalent across all conditions. No significant results were found for the group with HD in either reading recognition or comprehension, due largely to unusual placebo reactions. Results were generally in the direction predicted for the group with HA, but only significantly so in reading comprehension, and no dose effect was found on this variable. Implications for reading as a dependent measure of medication effects are discussed.     

Teachers' knowledge and misperceptions of Attention‐Deficit/hyperactivity disorder

The present study examined teachers' knowledge and misperceptions of ADHD within three specific content areas: symptoms/diagnosis, treatment, and general information (e.g., course, prevalence). One hundred and forty‐nine elementary school teachers completed the Knowledge of Attention Deficit Disorders Scale (KADDS), a new instrument designed to measure specific areas of knowledge about ADHD. Teachers' scores on the symptoms/diagnosis subscale of the KADDS were significantly greater than scores on both the treatment and general information subscales. Teacher self‐efficacy, prior exposure to an ADHD child, and years of teaching experience were all positively related to ADHD knowledge. Analysis of individual KADDS items was conducted to differentiate concepts that teachers did not know from those concepts that they believed incorrectly (i.e., misconceptions). © 2000 John Wiley & Sons, Inc.     

Use of digital console game for children with attention deficit hyperactivity disorder

ADHD or ADD （Attention Deficit/Hyperactivity Disorder） is one of the most frequently diagnosed mental and behavioral disorders of children. Children with ADHD are characterized by poor attention and distractibility and/or hyperactive and impulsive behaviors. Although there is no ＂cure＂ for ADHD, there are accepted treatments that specifically target its symptoms. The most common standard treatments include medication, psychological or behavioral modification, and educational approaches. However, more and more parents began to worry about the side effects of medication. For this reason, this study proposed a new treatment by using digital console games to assist children who suffer from ADD to improve their attention condition. With the advantages of gaming apparatus, this study intends to improve the effect of behavioral intervention and cognitive remediation therapy for ADD children.     

Developmental co‐ordination disorder (DCD) in adolescents and adults in further and higher education

Few studies have looked at the strengths and weaknesses and needs of students with developmenal co‐ordination disorder (DCD). This paper describes a cohort of 93 UK students currently studying at further or higher education and who have reported motor difficulties present since childhood. The study group consisted of 21 reporting to have DCD only, 38 with DCD plus another diagnosis (a combination of any of the following: dyslexia, attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), learning difficulties); 23 subjects reporting dyslexia only, and 11 students who have not been formally diagnosed. The aim of this study was to first ascertain the similarities and differences between the students in the type of support received in childhood and while at university. The second goal was to examine the reported strengths and difficulties and see how they vary for each subgroup. The DCD group reported higher levels of motor‐related difficulties such as handwriting and also executive functioning difficulties. They also had higher levels of professional support given in childhood and were also more likely to be living at home with parents compared with the dyslexia group. Despite different types of difficulties reported in the DCD group, the range of student support given across all groups was similar. Significantly more of the dyslexia group were reported to be in receipt of disability student allowance than the DCD group. The DCD and other disorders group were seen to be an intermediary group in most of the areas studied.     

高水平示范性师范大学建设(笔谈)--新时代师范大学的发展向度

我国举办着世界最大规模的教育体系,基础教育阶段就有2.4亿学生,谁来教这些学生,谁又来培养教师,这是我国教育体系承载的重大使命。逐渐地,我国形成了以师范院校为主、综合性大学参与的开放的教师教育体系。应该说,这是改革的产物,是进步的结果。但是在复杂因素影响特别是有关评价导向下,这个体系出现了一些目标外结果,突出表现为师范院校实质性综合化,综合性大学象征性参与。高质量教师供给成为各方共同关注的紧迫课题。改革中出现的问题还得用改革的办法来解决。于是,师范院校追逐着教师教育模式的理想,学术界凝练出师范院校“再师范化”和教师教育学科化的思想,国家提出了建设高水平示范性师范大学的构想。本期专题围绕新时代如何建好师范院校,更好发挥师范院校主体作用进行讨论,以深化相关研究。     

Development and testing of a direct observation code training protocol for elementary aged students with attention deficit/hyperactivity disorder

Observational measures can add objective data to both research and clinical evaluations of children’s behavior in the classroom. However, they pose challenges for training and attaining high levels of interrater reliability between observers. The Behavioral Observation of Students in Schools (BOSS) is a commonly used school-based observation instrument that is well adapted to measure symptoms of attention deficit/hyperactivity disorder (ADHD) in the classroom setting. Reliable use of the BOSS for clinical or research purposes requires training to reach reliable standards (kappa?≥?0.80). The current study conducted training observations in one suburban and one urban elementary school in the Greater Boston area. To enhance interrater reliability and reduce training time, supplemental guidelines, including 30 additional rules to follow, were developed over two consecutive school years. The complete protocol was then used for training in the third school year. To reach sufficient interrater reliability (kappa?≥?0.80) during training, 45 training observations were required in the first year while, in the third year, only 17 observations were required. High interrater reliability was sustained after training across all three school years, accumulating a total of 1,001 post-training observations. It is estimated that clinicians or researchers following this proposed protocol, who are naive to the BOSS, will require approximately 30 training observations to reach proficient reliability. We believe this protocol will make the BOSS more accessible for clinical and research usage, and the procedures used to obtain high interrater reliability using the BOSS are broadly applicable to a variety of observational measures.     

Substance use, substance abuse, and LD among adolescents with a childhood history of ADHD

A clinic-referred sample of 109 children with attention-deficit/hyperactivity disorder (ADHD) was followed into adolescence for the ascertainment of alcohol and other drug use and abuse. Learning disability (reading or math) in childhood was examined as a predictor of adolescent substance use and substance use disorder for alcohol and marijuana. No statistically significant group differences for children with LD versus those without LD emerged even after using different methods to compute LD. IQ/achievement discrepancy scores were similarly not predictive of later use or abuse. However, children with ADHD who had higher IQs and higher levels of academic achievement in childhood were more likely to try cigarettes, to smoke daily, and to have their first drink of alcohol or first cigarette at an early age. Children with ADHD who had higher reading achievement scores were less likely to have later alcohol use disorder. Although these findings are necessarily preliminary, due to the small number of children interviewed, the pattern of results suggests that level of cognitive functioning--rather than discrepancy between IQ and achievement--is important for the prediction of later substance use and abuse, at least in this clinic-referred sample of children with ADHD. Further, different mechanisms of risk related to cognitive functioning may be operating for experimentation with legal drugs such as alcohol and tobacco, regular cigarette smoking, and problematic alcohol use.     

Attention deficit disorder with and without hyperactivity: reaction time and speed of cognitive processing

This study addressed the issue as to whether children reliably diagnosed as attention deficit disordered with hyperactivity (ADD/H) and without hyperactivity (ADD/WO) differed significantly from each other and a clinic control (CC) population on speed and efficiency of cognitive processing. From an outpatient clinic population, 43 ADD/H and 22 ADD/WO children were examined. An analysis of mean reaction time and speeded classification task performance revealed significant group effects on both mean reaction time and on a measure of within-subject variability. ADD/H children performed significantly more slowly and variably than the CC children on several of the speeded classification tasks. However, the ADD/WO group was not distinguished on any measure. Thus, while children may be reliably diagnosed as ADD/H or ADD/WO using behavioral measures, it would appear that they cannot be distinguished on these neurocognitive tasks. Issues related to childhood psychopathology and the neuropsychological basis of ADD/H are discussed.     

Morningness/eveningness and school performance among Spanish adolescents: Further evidence

Adolescents shift their time of day preferences from morning to evening during puberty when school schedule becomes earlier. Given that a better performance is obtained when individuals are tested at times that are in synchrony with their chronotype, and optimal sleep duration is positively associated with academic performance, evening-types may obtain worse school performance because of both morning school schedule and a decrease of total sleep time. A group of 1133 adolescents (aged 12–16) participated in this study. School performance was evaluated using subjective level of achievement and self-reported grades measures. Controlling for total sleep time, more evening oriented young adolescents (12–14 years) performed significantly worse in school achievement. Girls among 15–16 years performed significantly better than boys. These results have important implications for intervention and prevention programs during school years.     

Childhood maltreatment and conduct disorder: Independent predictors of criminal outcomes in ADHD youth

ObjectiveChildren with attention-deficit/hyperactivity disorder (ADHD) are at heightened risk for maltreatment in childhood and criminality as they enter into adolescence and early adulthood. Here, we investigated the effect of moderate to severe childhood maltreatment on later criminality among adolescents/young adults diagnosed with ADHD in childhood while accounting for the contributions of other known risk factors such as early conduct disorder (CD).MethodsEighty-eight participants from a longitudinal study of children diagnosed with ADHD and screened for comorbid disorders at age 7–11 years were assessed for maltreatment histories at the time of the 10-year adolescent follow-up. Detailed juvenile and adult criminal records were obtained from the New York State Division of Criminal Justice Services approximately 3-years after commencement of the follow-up study. We used regression analyses to determine predictors of adolescent/young adult criminal behavior.ResultsModerate to severe childhood maltreatment increased the risk of adolescent/young adult arrest over and above the risk associated with childhood CD, while both childhood maltreatment and childhood CD significantly increased the risk of recidivism. ADHD youth classified as maltreated were three and a half times more likely to be arrested when compared to ADHD youth without a maltreatment classification.ConclusionWe established maltreatment as a risk factor for criminality in ADHD youth and demonstrated that this relationship was independent of the contributions of CD, and established risk factor for antisocial behavior in this population. The findings highlight the need for maltreatment screening in children with ADHD in order to identify those at heightened risk for criminal activity, and target treatment to improve outcome in this high-risk group of children.