Validity of the diagnostic category of attention deficit disorder without hyperactivity: a review of the literature

The validity of the diagnostic category of Attention Deficit Disorder Without Hyperactivity (ADD/WO) has been the subject of debate since it was first introduced in DSM-III. The differentiation of two syndromes of ADD is supported by factor analytic studies that indicate two dimensions of maladjustment: (1) inattention and disorganization, and (2) motor hyperactivity and impulsive responding. Cluster analyses of these two dimensions have yielded two profiles of deviance that correspond to the DSM-III subtypes. Furthermore, clinic-referred children who meet DSM-III criteria for ADD/WO have been shown to exhibit less serious conduct problems, are less impulsive, are more likely to be characterized as sluggish and drowsy, are less rejected by peers but more socially withdrawn, and are more likely to exhibit depressed mood and symptoms of anxiety disorder than children with Attention Deficit Disorder with Hyperactivity (ADD/H).     

Perceived family functioning, marital status, and depression in parents of boys with attention deficit disorder

The present study examined the perceptions of parents of children with attention deficit disorder with hyperactivity (ADD/H) regarding their family environment and depression in comparison with a clinical and a nondisabled control group. Parents of children with ADD/H perceived their family environment as less supportive and more stressful than did either the clinical or the nondisabled controls. Specifically, ADD/H parents viewed their families as having lower levels of interpersonal relationships than did either of the control groups. Ratings of depression for each of the parent groups indicated a greater frequency of depressive symptomatology among the parents of children with ADD/H. In addition, more parents of ADD/H children were separated or divorced. Correlation coefficients computed for the entire sample suggest differences between mothers' and fathers' depression and differences in their perceptions of the family. Recommendations are made for future research as well as the development of treatment programs to incorporate work with the parents of children with ADD/H.     

Occurrence and pattern of impaired reading and written language in children with attention deficit disorders

The purpose of this study was to investigate the occurrence and severity of reading, spelling, and written language impairment in children clinically referred for Attention Deficit Hyperactivity Disorder (ADHD). Specific questions involved 1) whether ADD subgroups with and without hyperactivity differ in reading, spelling, and written language achievement, 2) whether age and gender interact with ADD sub-group class to affect reading/written language achievement, and 3) whether prevalence of impaired reading/written language in these subgroups is consistent with previous reports in heterogeneous samples. Subjects were 115 ADD children aged 6-12 who were subclassified as ADD + H(72 percent) and ADD - H(28 percent) by objective teacher ratings. Dependent measures included tests of single word recognition and vocabulary, word attack, contextual comprehension, written spelling, written sentence construction, and writing fluency, in addition to a structured behavioral observation, during which aspects of inattention and motor activity were coded. A large fraction of this sample met public school LD criteria (54 percent), and achievement on most measures was globally poorer than the respective test normative groups. The ADD + H subgroup showed significantly poorer word attack skills, while the subgroups did not significantly differ from each other on other reading/written language measures. However, 17 percent of the total ADD sample were ≥ 1.5 SD below the mean in total reading achievement, and 29 percent were ≥ 1.5 SD below the mean on measures of written spelling/language. Gender X age interactions, indicating poorer performance in the middle age group of females, were likely related to lower IQ.     

Attention deficit disorder and specific reading disability: separate but often overlapping disorders

Within a large (N = 182) heterogeneous sample of clinic-referred children with DSM-III-diagnosed attention deficit disorder (ADD), three behavioral subgroups were identified via cluster analysis of teacher ratings: 40% of the children had ADD with hyperactivity (ADDH), 30% had ADD with hyperactivity and aggressivity (ADDHA), and 31% had ADD without hyperactivity or aggressivity. Proportionally more girls were in the ADD-only subgroup. Over half the sample (n = 94) were poor readers, with 82 meeting discrepancy criteria for specific reading disability (RD). Proportionately more boys than girls met the RD criteria (9.2:1.0), whereas the sex ratio of males to females for the whole sample was 5.1 to 1.0. Focusing just on white males, the three behavioral subgroups were significantly different on convergent validity measures, such as other teacher ratings, parent ratings, and interview-elicited ratings of externalizing behavior, but were not different on such divergent validity measures as IQ and achievement scores, self-ratings, and laboratory performance tasks. Boys in the ADD sample who did not meet criteria for RD had significantly higher IQs than those who did, but subgroups with and without RD still differed significantly on WRAT-R reading and spelling scores with IQ covaried out. Both groups with and without RD could be differentiated from a control group on laboratory measures of sustained attention and impulse control. Methylphenidate benefited all subgroups equally, whether RD or not, and whether given a low (0.3 mg/kg) or high (0.6 mg/kg) dose.     

The boundaries of attention deficit disorder

This report examines distinctions and interrelationships among attention deficit disorder (ADD) and two closely related conditions: learning disability (LD) and oppositional/conduct (O/C) disorder. To evaluate our hypothesis that some of the difficulty in resolving the relationship between ADD and, particularly, O/C may reflect the consequences of selective referral patterns, we studied groups of children diagnosed as ADD from different referral sources. Results suggest that referral bias does exist and that children referred to mental health settings differ from those referred to pediatricians, child neurologists, or psychologists. Because of the nature of the subjects referred to mental health services, nonrepresentative associations may emerge. Rather than being considered as prototypical of all children with attention disorder, children referred to mental health facilities may represent simply an extreme of the continuum of ADD. Evidence suggests that many children with ADD will be represented by those referred primarily for attentional deficits and learning problems, rather than those with inattention, hyperactivity, or aggression referred for child psychiatric evaluation.     

Taxonomic separation of attention deficit disorders and developmental reading disorders

This investigation compared the behavior ratings and psychometric profiles of children with attention deficit disorders (ADD) and children with developmental reading disorders (DRD). ADD children showed no qualitative reading or spelling problems, although they were slightly behind expected levels of academic achievement. DRD children were significantly more impaired in academic attainment and showed evidence of qualitative disturbances in reading and spelling. DRD subjects did not differ from control subjects on ratings of hyperactivity, which was one of the defining variables of the ADD group. This evidence is interpreted as adding to a growing testimony that indicates that ADD and DRD are distinctly separate groups of disorders.     

Attention deficit disorders: characteristics,assessment, and interventions

ABSTRACT

In the United States, there is an increasing prevalence of children who are diagnosed with an attention deficit disorder (ADD). The essential features of ADD are developmentally inappropriate degrees of inattention, impulsivity, and motor hyperactivity. The rate of prevalence could differ in other countries depending on the definition of the condition. This article will review related research in the United States about ADD which will include the following topics: differential diagnosis and assessment, treatment, interventions, and parent training. The overlap of ADD with other handicaps will be described as well as assessment techniques such as interviews, rating scales, and observations. Studies of the efficacy of medication, educational interventions, cognitive‐behavioral strategies, and parent training are reviewed. In the conclusion, suggestions for further research are outlined which may further assist youngsters with ADD to adjust at school, in the home, and in the community.     

Development of mental attention in gifted and mainstream children: the role of mental capacity, inhibition, and speed of processing

The study examined performance of 6- to 11-year-old children, from gifted and mainstream academic programs, on measures of mental-attentional capacity, cognitive inhibition, and speed of processing. In comparison with mainstream peers, gifted children scored higher on measures of mental-attentional capacity, responded more quickly on speeded tasks of varying complexity, and were better able to resist interference in tasks requiring effortful inhibition. There was no group difference on a task requiring automatic inhibition. Comparisons between older and younger children yielded similar results. Correlations between inhibition tasks suggest that inhibition is multidimensional in nature, and its application may be affected by task demands. Measures of efficiency of inhibition and speed of processing did not explain age or group differences on a complex intellective measure of mental-attentional capacity.     

Arithmetic disabilities and ADD subtypes: implications for DSM-IV

This study investigated whether specific academic deficits were associated with attention-deficit disorder (ADD) subtypes. Twenty students (ages 8-12) with attention-deficit disorder with hyperactivity (ADD/H) were compared to 20 students with attention-deficit disorder without hyperactivity (ADD/noH). Group differences were compared using a MANCOVA, and paired t tests were used to compare within-group differences. Dependent variables for the within-group differences were four achievement subtest scores from the Woodcock-Johnson Psycho-Educational Battery-Revised: Letter-Word Identification, Passage Comprehension, Calculation, and Applied Problems. Consistent with much of the previous research, no significant between-group differences were found on the achievement measures. Significant differences did, however, appear in the six within-group comparisons, all involving lower performance on the Math Calculations subtest. For students with ADD/H, only one comparison (with Math Applied Problems) reached significance. Students with ADD/noH, however, had significantly lower scores on the Calculation subtest compared to all of the other achievement subtests. These results provided additional support for the hypothesis that inattention exerts a specific and deleterious effect on the acquisition of arithmetic computation skills. These findings have important implications for the diagnosis and treatment of ADHD as conceptualized in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association, 1994), because they suggest that students with ADHD-Predominantly Inattentive Type may be at increased risk for arithmetic calculation deficits.     

The development of working memory in normally achieving and subtypes of learning disabled children

Working memory has been proposed as an important component of reading and arithmetic skills. The development of working memory was studied in normally achieving and subtypes of learning disabled children. The performance of reading disabled (RD), arithmetic disabled (ARITHD), and attentional deficit disordered (ADD) children, age 7-13, was compared to normal achievers (NA) on 2 working memory tasks, 1 involving sentences and the other involving counting. There was a significant growth of working memory as a function of age. In addition, the RD children had significantly lower scores on both tasks. The ARITHD children had significantly lower scores only on the Working Memory--Counting task, and the ADD group had scores similar to the normally achieving children except at the youngest age level in the Working Memory--Sentences task. Thus, a reading disability appears to involve a generalized deficit in working memory. Children with an arithmetic disability do not have a generalized language deficit but have a specific working memory deficit in relation to processing numerical information. As children with ADD did not have deficits in these tasks, working memory may not have significant attentional components. An important component of the development of reading and computational arithmetic skills appears to be the growth of working memory for language and numerical information.     

Type A behavior in normal and hyperactive children: multisource evidence of overlapping constructs

1 goal was to identify correlates of the Type A "coronary-prone" Behavior Pattern (TABP) in children. A second was to examine the overlap between hyperactivity and TABP. In Study 1, a diverse set of measures reliably distinguished boys classified as Type A versus Type B on the basis of the MYTH, a teacher rating scale. The MYTH Competition subscale was related to perceived leadership, athleticism, and--when age and IQ were partialed out--to task attention in the classroom. The Impatience-Aggression subscale showed a different and more extensive configuration of correlates, including staff and peer assessments of problematic behaviors as well as classroom observations of noisemaking, verbalization, and social (particularly negative) contact. Hyperactive boys received higher Type A scores than did their comparison peers, a difference attributable to higher scores on the Impatience-Aggression subscale. Study 2, a partial replication conducted with a different group of hyperactive children, yielded a similar configuration of correlates. Discussion focused on the implications of the overlap between TABP and hyperactivity and, more generally, the heterogeneity of children designated Type A.     

Comparison of deficits in cognitive and motor skills among children with dyslexia

There is a growing body of evidence that children with dyslexia have problems not just in reading but in a range of skills including several unrelated to reading. In an attempt to compare the severity and incidence of deficits across these varied domains, children with dyslexia (mean ages 8, 12, and 16 years), and control groups of normally achieving children matched for IQ and for age or reading age, were tested on a range of primitive (basic) skills. The children with dyslexia performed significantly worse than the same-age controls on most tasks, and significantly worse even than the reading-age controls on phoneme segmentation, picture naming speed, word tachistoscopic word recognition, speeded bead threading and some balance tasks. The overall performance of the children with dyslexia is interpreted as showing less complete automatization than normal.     

Using the WISC-R to identify Attentional Deficit Disorder

The purpose of the present research was to test the utility of the Wechsler Intelligence Scale for Children-Revised (WISC-R) subscales in differentiating between children with Attentional Dificit Disorder (ADD) and children with other problems. Twenty-four children with ADD and a control group of 19 children with behavioral/emotional disorders were identified on the basis of historical background and intake interview. The results indicated that scores on three WISC-R subscales—Arithmetic, Digit Span, and Coding—were significantly lower among the ADD group. The practical implications of the findings are discussed.     

Selective attention deficits in poor readers? Dichotic listening, speeded classification, and auditory and visual central and incidental learning tasks

Poor readers (PRs) and controls (i.e., normal readers) from the second, fourth, and sixth grades were compared on four tasks chosen to measure the development of selective attention. The PRs performed more poorly than controls on the central but not on the incidental portion of an auditory memory task. The differences on the central task were interpreted as a function of group differences in mnemonic skills rather than selective attention. There were no group differences on either central or incidental portions of a visual memory task. In a speeded classification task, PRs exhibited a slower rate of information processing, measured in bits of information transmitted per second, than controls, but this difference in rate was not affected by distraction. On a dichotic listening task, PRs performed more poorly than controls under a variety of conditions in which the presence of distraction, the rate of information presentation, and attended ear were manipulated; the pattern of differences obtained, however, was not readily interpretable as a function of greater distractibility on the part of PRs than controls. As a whole, the results did not support the hypothesis that PRs show deficits in selective attention relative to age-matched normal readers. In addition, correlations computed among indices of selectivity (residualized gain scores) derived from the four tasks were uniformly low, suggesting that the four tasks did not measure the same cognitive construct. The implications for the study of reading disabilities and for the construct of selective attention in developmental studies are discussed.     

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.     

Using emotional intelligence in an EFL integrated writing assessment

The use of integrated writing tasks instead of traditional impromptu writing-only tasks is gaining ground in the teaching and assessment of EFL/ESL writing. Source text as the distinct feature of the integrated writing and the concern to improve its quality for the enhanced students' engagement has been a fertile line of inquiry. In this regard, the present study used a body of 67 Iranian intermediate EFL learners in three modalities: emotionalized reading-to-write (ERW) group which received emotionally-loaded source texts along with the emotional activities based on Goleman's Emotional Intelligence framework, reading-to-write (RW) group which developed their essays based on the texts with no focus on their emotional content and a writing-only (WO) group as the control group which followed the traditional writing procedure. The findings showed that ERW group outperformed RW group on the integrated writing tasks. In addition, ERW group performed better than the RW and WO on the overall independent writing task. Furthermore, the emotional intelligence of the students in the ERW group improved more than that of the RW and WO groups in the study. The study discusses that the emotional content of the source text followed by the emotionalized activities would significantly enhance the learners’ engagement with the source text in the reading-to-write tasks and consequently improve their writing. The implications and suggestions for further research are next discussed.     

The Relationships among Verbal Skills of Primary School Students with Specific Learning Disabilities and a Typically Developing Comparison Group

The relationships among verbal skills of primary school students with learning disabilities and a typically developing comparison group were studied and compared with written tasks carried out in Estonian classrooms. Word defining, categorising/justifying, guessing, and memorising tasks were used. The participants were 251 students in Grades 2–4; of these, 163 were described as achieving normally and were in regular education classrooms, and 88 were diagnosed as having specific learning disabilities and attended special schools or classes for students with specific learning disabilities. Except for performance on the memorising tasks by grade, all the scores were better in upper grades. Children with learning disabilities performed less well than the children in the typically developing comparison group on all the tests. Associations between the results of various tests were stronger in the typically developing comparison group than in the group of children with learning disabilities.     

Changes in self-concept and academic skills during a multimodal summer camp program

The impact of a six-week multimodal summer camp program on the self-concept and reading/writing skills of a group of dyslexic students (n=42) was assessed. Campers ranged in age from 9 to 14 years (mean=11 years, 5 months) and came from public, private, and specialized private schools serving students with learning disability (LD). Twenty-six percent of the sample had a comorbid diagnoses of attention deficit disorder (ADD) and 11 percent had attention deficit hyperactivity disorder (ADHD). Campers improved significantly in phonetic reading and spelling skills, but not in sight word vocabulary or reading speed. Campers also exhibited significant improvements in self-concept, both on a general level and in the specific areas of reading and overall academic competence. The kinds of changes observed on the more general measures of self-concept, however, were not the same for the various groups of campers. Campers from regular private schools and from public schools typically experienced greater gains in general self-concept than did campers from LD private schools. Campers with diagnosed comorbid disorders typically realized little or no gains, whereas campers without ADD or ADHD displayed significant improvement in general self-concept.     

An intervention approach for children with teacher- and parent-identified attentional difficulties

Using a multimodal and multi-informant method for diagnosis, we selected 33 children by teacher and parent nomination for attention and work completion problems that met DSM-IV criteria for attention-deficit/hyperactivity disorder (ADHD). Of the 33 children in this group, 21 participated in the initial intervention, and 12 were placed in an ADHD control group and received the intervention after pre- and posttesting. A similarly selected group of 21 children without difficulties in attention and work completion served as a control group. Each child was assessed on pre- and posttest measures of visual and auditory attention. After an 18-week intervention period that included attention and problem-solving training, all children in the intervention and control groups were retested on visual and auditory tasks. Children in both ADHD groups showed significantly poorer initial performance on the visual attention task. Whereas the ADHD intervention group showed commensurate performance to the nondisabled control group after training, the ADHD control group did not show significant improvement over the same period. Auditory attention was poorer compared to the control group for both ADHD groups initially and improved only for the ADHD intervention group. These findings are discussed as a possible intervention for children with difficulties in strategy selection in a classroom setting.     

Neural Systems for Rapid Automatized Naming in Skilled Readers: Unraveling the RAN-Reading Relationship

The majority of children and adults with reading disabilities exhibit pronounced difficulties on naming-speed measures such as tests of rapid automatized naming (RAN). RAN tasks require speeded naming of serially presented stimuli and share key characteristics with reading, but different versions of the RAN task vary in their sensitivity: The RAN letters task successfully predicts reading ability, whereas the RAN objects task does not reliably predict reading after kindergarten. In this study we used functional magnetic resonance imaging to evaluate the neural substrates that may underlie performance on these tasks. In two scans during the same test session, adult, average readers covertly rapidly named objects or letters or passively viewed a fixation matrix of plus signs. For both rapid naming tasks compared with fixation, activation was found in neural areas associated with eye movement control and attention as well as in a network of structures previously implicated in reading tasks. This reading network included inferior frontal cortex, temporo-parietal areas, and the ventral visual stream. Whereas the inferior frontal areas of the network were similarly activated for both letters and objects, activation in the posterior areas varied by task. The letters task caused greater activation in the angular gyrus, superior parietal lobule, and medial extrastriate areas, whereas object naming only preferentially activated an area of the fusiform gyrus. These results confirm that RAN tasks recruit a network of neural structures also involved in more complex reading tasks and suggest that the RAN letters task specifically pinpoints key components of this network.