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.     

Teacher attributions for children's attention‐deficit/hyperactivity disorder behaviors predict experiences with children and with classroom behavioral management in a summer program practicum

Elementary school teachers often implement classroom behavioral management systems to address student misbehavior. Common problems targeted by these systems are the inattentive, hyperactive, and impulsive behaviors characteristic of attention‐deficit/hyperactivity disorder (ADHD). This study examined teachers' attributions for why children display ADHD behaviors, and how such attributions affect their experiences with children in the context of interventions to manage these behaviors. Participants were 32 preservice teachers undertaking a practicum in a summer program for 137 children (Grades 1–3), some of whom had ADHD. Teachers were trained to implement classroom‐wide behavioral management. Teachers' attributions for children's ADHD behaviors were assessed using a vignette measure, before teachers had met their students or begun training on intervention techniques. When controlling for attributions regarding oppositional behavior, teachers' initial attributions for ADHD behaviors as less internal/controllable predicted children reporting more positive relationships with that teacher during the summer program. Teachers' initial attributions for ADHD behaviors as less stable predicted teachers' greater satisfaction with the intervention techniques during the summer program and their greater attunement to children's social networks. Cognitions about the causes of children's ADHD behaviors held by preservice teachers may relate to their subsequent experiences with children in the context of implementing classroom behavioral management.     

Longitudinal Study of Reading Disability and Attention-Deficit/Hyperactivity Disorder: Implications for Education

ABSTRACT— The majority of children who receive special education services meet criteria for reading disability (RD) or attention-deficit/hyperactivity disorder (ADHD), but additional research is needed to understand the long-term academic outcome of children in these groups. Individuals with RD only ( N = 71), ADHD only ( N = 66), both RD and ADHD ( N = 51), or neither disorder ( N = 118) were identified through the ongoing Colorado Learning Disabilities Research Center twin study and retested 5 years later. Results of the follow-up testing indicated that, in addition to ongoing reading difficulties, individuals with RD exhibited higher rates of academic difficulties, depression, and adolescent-onset conduct disorder. Initial ADHD status was associated with academic and social difficulties and elevated rates of nearly all comorbid disorders 5 years later. The group with comorbid RD and ADHD had more stable reading deficits than the group with RD without ADHD and exhibited greater impairment than groups with either disorder alone on outcome measures of academic functioning and social difficulties. These results suggest that individuals with both RD and ADHD are at increased risk for negative outcomes as adolescents and young adults and that when RD and ADHD co-occur, interventions should be provided for both disorders.     

Association of maternal developmental disorder traits with child mistreatment: A prospective study in Japan

Maternal mental disorders are known risk factors for child mistreatment. However, little is known about the involvement of maternal developmental disorder traits. The aim of this study was to examine maternal traits related to Pervasive Developmental Disorder (PDD) and Attention Deficit Hyperactivity Disorder (ADHD), and their possible association with child mistreatment. Maternal PDD and ADHD were assessed through a self-administered questionnaire (N = 846) during mid-pregnancy using the Pervasive Developmental Disorders Autism Society Japan Rating Scale (PARS) and Adult ADHD Self-Report Scale (ASRS). The mothers completed another questionnaire on child mistreatment when the offspring was approximately 18 months of age. The associations between maternal PDD and ADHD traits and child mistreatment score were analyzed using linear regression models adjusted for covariates. Mothers who exhibited stronger PDD traits showed significantly higher child mistreatment score, even after adjustment for maternal characteristics at baseline and ADHD traits. At the same time, ADHD traits were significantly associated with child mistreatment after adjustment of covariates, although the association became non-significant after adjustment of PDD traits. Mothers who showed PDD and ADHD traits during pregnancy were more likely to mistreat their children. It is essential to educate mothers with such traits with appropriate, easy-to-follow childcare instructions, preferably in simple language combined with pictorial aids.     

Mothers' use of cognitive state verbs in picture-book reading and the development of children's understanding of mind: a longitudinal study

Mothers read stories to their children (N=41) aged between 3.3 years and 5.11 years old, and children then completed two false-belief tasks. One year later, mothers read a story to 37 of those children who were also given four tasks to assess their advanced understanding of mental states. Mothers' early use of cognitive verbs in picture-book reading correlated with their children's later understanding of mental states. Some pragmatic aspects of maternal input correlated with children's later outcomes. Two different factors in mothers' cognitive discourse were identified, suggesting a zone of proximal development in children's understanding of mental states.     

Developmental Changes in Attention and Comprehension Among Children With Attention Deficit Hyperactivity Disorder

Changes in visual attention and story comprehension for children (N = 132) with attention deficit hyperactivity disorder (ADHD) and comparison peers were examined. Between the ages of 7 and 9 (Phase 1) and approximately 21 months later (Phase 2), children viewed 2 televised stories: 1 in the presence of toys and 1 in their absence. Both groups of children showed developmental increases in visual attention and stable group differences over time. Deficits in comprehension among children with ADHD, however, increased over time. Whereas comparison children’s recall of factual and causal information increased over time in both viewing conditions, children with ADHD showed no developmental improvement in recall of factual information in the toys‐present condition and no improvement in recall of causal relations in either viewing condition.     

Parental self-confidence, parenting styles, and corporal punishment in families of ADHD children in Iran

OBJECTIVE: This study examines the relationship between parental self-confidence, warmth, and involvement, and corporal punishment in families of children with attention deficit/hyperactivity disorder (ADHD). METHOD: The diagnosis of ADHD was established through clinical interviews with the parents, children, and teachers, according the criteria in DSM-IV-TR. This diagnosis was also established by having the parents complete the Conners' Parent Rating Scale, and the teachers complete the Conners' Teacher Rating Scale. Two groups of Iranian parents, one group with children who have ADHD (N=130) and a control group (N=120), completed questionnaires measuring parental self-confidence and parenting styles. RESULTS: Parents of children with ADHD were found to have lower self-confidence and less warmth and involvement with their children, and used corporal punishment significantly more than the parents of control children. CONCLUSIONS: The study provides strong evidence that children with ADHD are at considerable risk of abuse by their parents. Rather than focusing only on the child's ADHD, treatment may also need to address the parents' functioning.     

Parent-, teacher-, and self-rated motivational styles in ADHD subtypes

The motivational styles of 25 children with attention-deficit/hyperactivity disorder, combined type (ADHD/C), 13 children with ADHD, inattentive type (ADHD/IA), and 25 nondiagnosed controls (NC) were compared using parent, teacher, and self-ratings. Both ADHD subtypes demonstrated motivational impairment characterized by a preference for easy work, less enjoyment of learning, less persistence, and a greater reliance on external than on internal standards to judge their performance relative to NC. Some motivational style differences between ADHD subtypes were also revealed, with the ADHD/C group more motivated by competitiveness and a desire to be perceived as superior to others and the ADHD/IA group less uncooperative and possibly more passive in their learning styles. When IQ was statistically controlled, these results were generally unchanged. The contributing role of motivational deficits to the generally poor academic functioning of children with ADHD is discussed, along with potential intervention implications of the divergent motivational styles of different ADHD subtypes.     

Assessing ADHD Symptoms in Preschool Children: Use of the ADHD Symptoms Rating Scale

Attention-Deficit Hyperactivity Disorder (ADHD) is a common childhood disorder that is typically diagnosed during the school years, although features of the disorder can be identified in early childhood. As more children enter into preschool programs, there are increasing opportunities for professionals to identify and treat ADHD prior to school entry. This may increase the likelihood that children will have successful academic and social experiences. Unfortunately, diagnosing ADHD in preschoolers is difficult, in part because few assessment instruments are designed and validated for this age group. The purpose of this study was to examine the psychometric and normative properties of the ADHD-Symptoms Rating Scale (ADHD-SRS) in preschool children. Results shed light on normative levels of ADHD behaviors in preschool children and suggest that preschoolers may present with a somewhat different symptom pattern than school-age children. Further, findings reveal that parents are more likely to endorse ADHD symptoms in their children than are teachers. Given this disparity, the current data emphasize the need for cross-informant assessment in the preschool population.     

Agreement and Stability of Teacher Rating Scales for Assessing ADHD in Preschoolers

This study investigated the agreement and stability of 3 teacher rating Scales used to assess ADHD in preschool children: the ADHD Rating Scale, the Child Attention Profile (CAP), and the Conners' Teacher Rating Scale-28 (CTRS-28). A sample of suburban children (n = 60) was observed and rated by their teachers and assistant teachers at preschool level (Time 1) and 4 years later at the elementary school level (Time 2). Agreement among the rating scales and interrater agreement between teacher and assistant teacher ratings yielded noticeably stronger correlations at Time 2 than at Time 1. Over the 4-year interval of the study, there was a significant change in the number of children identified as potential ADHD risks. It is probable there were a high number of false-positive indications in the preschool ADHD screenings. It is also possible that immature behavior of preschool children may mimic ADHD behavior at the elementary school level.     

International Early Childhood Resources from Educational Research Abstracts (ERA)

The aim was to examine cross-cultural variation in linguistic responsiveness to young children in 10 English-speaking mother–child dyads and 10 Italian-speaking mother– child dyads. All 20 children were late talkers who possessed delays in expressive vocabulary development but age-appropriate cognitive and receptive language skills. Dyads were filmed in 15 minute free play contexts, which were transcribed and coded for measures of maternal linguistic input (e.g. rate, MLU, labels, expansions) and child language productivity (e.g. utterances, different words used). The results revealed that the Italian mothers used more utterances, spoke more quickly and used a more diverse vocabulary than the Canadian mothers. The Italian children mirrored their mothers and also used more utterances and a more diverse vocabulary than the Canadian children. Mothers in both groups used similar percentages of responsive labels and expansions. However, Italian mothers responded to fewer of their children's vocalisations, using a smaller percentage of imitations and interpretations than the Canadian mothers. Correlations between maternal input and children's language productivity revealed that contingent language measures (e.g. imitations, interpretations, expansions) were related to high levels of productivity in children in both cultural groups. The results support the use of language interventions based on increasing maternal responsiveness for these children at the one-word stage of language development. They also point to differences that may be culturally based. For example, Italian mothers use faster rates of interaction and appear to have higher expectations for their children's verbal participation in interaction. This is reflected in higher rates of language production from their children, even though children in both cultural groups have similar vocabulary sizes.     

Private speech in children with ADHD and their typically developing peers during problem-solving and inhibition tasks

This study compared private speech of children with ADHD and normal controls during problem solving and inhibition tasks. Thirty-two children (16 children with ADHD and 16 matched controls) aged 6–11 years participated. Consistent with previous studies, children with ADHD produced more task-irrelevant and task-relevant external private speech than control children during problem-solving tasks, but did not differ in their use of task-relevant internal private speech. During the inhibition/attention task (Continuous Performance Test-II), children with ADHD produced more task-relevant external and more task-relevant internal private speech, suggesting that they may have employed a less mature strategy to aid in self-regulation. The educational implications of the current study are that there should be an increased awareness of the developmental nature and functional significance of private speech and how private speech usage may differ in children with ADHD.     

Maternal Emotions During Mother-Toddler Interaction: Parenting in Affective Context

Objective. This study explored the emotional experiences of mothers in interacting with their 2-year-old children and examined interrelations among maternal emotion, family distress, and observations of parenting sensitivity. Design. Sixty mothers and their 2-year-old children were observed interacting during both enjoyable (free play) and challenging (waiting) interaction tasks, and mothers provided self-report information about their emotional experiences during each task. Mothers also completed self-report measures to assess family distress. Results. Mothers experienced and expressed a range of positive and negative emotions during interactions with their toddlers, however, mothers' expressed (observed) and experienced (self-reported) emotions were generally uncorrelated. Mothers reported experiencing more positive emotion during interactions characterized by less child negativity and less negative emotion during interactions characterized by child expressions of positive emotion. Mothers' self-reported emotional experiences during interactions with their children moderated the associations between family distress (as reported by mothers) and sensitive parenting behaviors (as observed during parent-child interaction). Conclusions. Findings support a conceptualization of parenting as multiply determined by child, parent, and family contextual factors, with emotion serving an integral role. Results are also discussed with regard to parenting emotion as a potential target for intervention in distressed families.     

Task performance and response to frustration in children with attention deficit hyperactivity disorder

The present study examined performance on an arithmetic task of increasing difficulty and a frustrating puzzle task for children with ADHD and comparison children. Emotional competence also was investigated in the two groups. Sixty‐four children, 21 previously diagnosed with ADHD, participated. Performance on the arithmetic task was measured in terms of completion and accuracy. Children with ADHD had similar rates of accuracy for all levels of difficulty, but completed fewer problems. Performance on the puzzle task was measured both through completion and persistence. Although children with ADHD persisted for a similar amount of time compared to children without ADHD, they were more likely to quit the task before completion. Children with ADHD also were more likely to report that they became frustrated with the task. Furthermore, they tended to report that in general, they become more frustrated than other children. With regard to emotional competence, children with ADHD did not differ from the comparison children on their reported understanding of their own emotions or attention to emotions; however, children with ADHD reported that they engage in less mood repair. © 2006 Wiley Periodicals, Inc. Psychol Schs 43: 377–386, 2006.     

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.     

Time-of-day matters in text learning and recall: Evening lessons are advantageous for adults with ADHD though not for typical peers

Motor skill (“how-to” knowledge) consolidation is enhanced when individuals with ADHD practice at evening. We tested, in adults with and without ADHD, whether evening lessons are advantageous for recalling texts (declarative memory). Participants (N = 40) listened to and read narrative texts in morning and evening lessons (crossover study). Recall was tested immediately post-lesson and 24 h and 8–10 days later. Recall tended to decrease over time but independently of ADHD status or the time-of-day of the lesson. Nevertheless, typical participants showed a morning advantage immediately post-lesson and in later recall, correlated with stronger morning chronotype. In contrast, participants with ADHD benefited more from evening lessons; nearer their preferred time-of-day. In adults with ADHD long-term declarative memory was no less durable than in typical adults after both morning and evening lessons, but a mismatch with their preferred diurnal “on-peak” time can lead to less effective engagement in learning during morning lessons.     

Mother-child planning and child compliance

This study investigated child compliance and maternal instruction during planning. Based on the Child Behavior Checklist and free-play observations, 40 mothers and their 4- to 5-year-old children were assigned to a group with children who behaved within the normal range of compliance ( n = 20) or a group with children with high rates of noncompliance for this age ( n = 20). Mothers in the noncompliant group provided more low-level, directive, and negative instruction; requested more compliance; and shared less task responsibility with children. Mothers in both groups responded to child compliance by increasing or maintaining the level of instruction. Results are discussed in relation to the role of child compliance in regulating opportunities for cognitive development in social context.     

Academic underachievement among children with epilepsy: proportion exceeding psychometric criteria for learning disability and associated risk factors

This study assessed rates of learning disabilities (LD) by several psychometric definitions in children with epilepsy and identified risk factors. Participants (N = 173, ages 8-15 years) completed IQ screening, academic achievement testing, and structured interviews. Children with significant head injury, chronic physical conditions, or mental retardation were excluded. Using an IQ-achievement discrepancy definition, 48% exceeded the cutoff for LD in at least one academic area; using low-achievement definitions, 41% to 62% exceeded cutoffs in at least one academic area. Younger children with generalized nonabsence seizures were at increased risk for math LD using the IQ-achievement discrepancy definition; age of seizure onset and attention-deficit/hyperactivity disorder (ADHD) were risk factors for reading and math LD using low-achievement definitions. Writing was the most common domain affected, but neither ADHD nor seizure variables reliably identified children at risk for writing LD. Although children with earlier seizure onset, generalized nonabsence seizures, and comorbid ADHD appear to be at increased risk for some types of LD by some definitions, these findings largely suggest that all children with epilepsy should be considered vulnerable to LD. A diagnosis of epilepsy (even with controlled seizures and less severe seizure types) should provide sufficient cause to screen school-age children for LD and comorbid 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.     

Traumatic and stressful events in early childhood: can treatment help those at highest risk?

Objective

This study involves a reanalysis of data from a randomized controlled trial to examine whether child-parent psychotherapy (CPP), an empirically based treatment focusing on the parent-child relationship as the vehicle for child improvement, is efficacious for children who experienced multiple traumatic and stressful life events (TSEs).

Methods

Participants comprised 75 preschool-aged children and their mothers referred to treatment following the child's exposure to domestic violence. Dyads were randomly assigned to CPP or to a comparison group that received monthly case management plus referrals to community services and were assessed at intake, posttest, and 6-month follow-up. Treatment effectiveness was examined by level of child TSE risk exposure (<4 risks versus 4+ TSEs).

Results

For children in the 4+ risk group, those who received CPP showed significantly greater improvements in PTSD and depression symptoms, PTSD diagnosis, number of co-occurring diagnoses, and behavior problems compared to those in the comparison group. CPP children with <4 risks showed greater improvements in symptoms of PTSD than those in the comparison group. Mothers of children with 4+ TSEs in the CPP group showed greater reductions in symptoms of PTSD and depression than those randomized to the comparison condition. Analyses of 6-month follow-up data suggest improvements were maintained for the high risk group.

Conclusions

The data provide evidence that CPP is effective in improving outcomes for children who experienced four or more TSEs and had positive effects for their mothers as well.

Practice implications

Numerous studies show that exposure to childhood trauma and adversity has negative consequences for later physical and mental health, but few interventions have been specifically evaluated to determine their effectiveness for children who experienced multiple TSEs. The findings suggest that including the parent as an integral participant in the child's treatment may be particularly effective in the treatment of young children exposed to multiple risks.