Parenting Stress and Youth Symptoms Among Girls With and Without Attention-Deficit/Hyperactivity Disorder

Objective. To examine the aspects of parenting stress—parental distress and parental stress due to dysfunctional interactions—reported by mothers of girls with attention-deficit/hyperactivity disorder in both childhood and adolescence and to understand their associations with internalizing and externalizing symptoms in adolescence. Design. The diverse sample comprised 120 girls with attention-deficit/hyperactivity disorder and 81 age- and ethnicity-matched comparison girls, evaluated at ages 6–12 years and followed prospectively for 5 years. Basic demographics, oppositionality, childhood behavioral outcomes and symptoms, and key parenting practice were covaried in the analyses. Results. Longitudinally, parental distress during the participants’ childhood was positively associated with adolescent externalizing and internalizing behaviors, even when statistically controlling for parallel childhood behaviors. Parental stress due to dysfunctional interactions during adolescence was associated with contemporaneous adolescent depressive symptoms and externalizing behaviors, but parental distress was associated with only internalizing behaviors. With respect to moderation by diagnostic group, parental stress due to dysfunctional interactions (in childhood) was associated with adolescent internalizing symptoms only in girls with attention-deficit/hyperactivity disorder. However, associations between parental distress in childhood and internalizing behaviors were stronger in the comparison than the ADHD sample. Conclusions. Minimizing early dysfunctional interactions might reduce internalizing behaviors in girls with attention-deficit/hyperactivity disorder. Interventions targeting parental distress may be beneficial for girls, regardless of attention-deficit/hyperactivity disorder status.     

ADHD symptoms and the teacher–student relationship: a systematic literature review

This systematic review integrates the existing literature regarding relationships that students with attention-deficit/hyperactivity disorder (ADHD) have with their teachers, in mainstream inclusive primary, secondary and high school settings. Theoretical approaches and methodical choices were considered in understanding the literature and considering possible research areas. The methods used in the reviewed literature show that investigations in this research field have predominantly used quantitative surveys. Several theoretical approaches have been used, with attachment theory the most-prominent. The findings indicate students with ADHD generally feel less close to their teacher than do their non-ADHD peers, which agrees with the teachers’ perceptions. Thus, teachers experience less emotional closeness, less co-operation and more conflicts in their relations with their students with ADHD than with other students. Teachers’ rejection of ADHD students poses a risk factor for not only school failure, but also peer exclusion and rejection, leading to low self-esteem and loneliness.     

The acceptance and rejection of peers with ADHD and ASD in general secondary education

The authors focused on analyzing (a) peer acceptance and peer rejection of typically developing students, students with attention deficit hyperactivity disorder (ADHD), and students with autism spectrum disorder (ASD) in general secondary education; (b) attitudes of general secondary-aged students toward peers with ADHD and ASD; and (c) the relationship between peer acceptance/rejection and students' attitudes. A cross-sectional study was performed (n = 437 typically developing students, n = 28 students with ADHD/ASD; range = 12–15 years old). Students were asked to indicate with whom they prefer to hang out or preferably not want to hang out (peer acceptance and peer rejection). Attitudes were assessed using the Attitude Survey Toward Inclusive Education. Multilevel analysis showed significant differences between students with ADHD and ASD and typically developing peers on peer acceptance and higher on peer rejection. Second, typically developing peers showed neutral attitudes toward peers with ADHD or ASD. Third, the results showed that students' rejection and attitudes of peers significantly relate to each other.     

Motor correlates of ADHD: contribution of reading disability and oppositional defiant disorder

This study investigated whether the likelihood of motor impairment in children with attention-deficit/hyperactivity disorder (ADHD) increases with the presence of other disorders, and whether the co-occurring diagnoses of reading disability (RD) and oppositional defiant disorder (ODD) account for the motor deficits seen in ADHD. A total of 291 children (218 boys, 73 girls) participated. Six groups of children were compared: ADHD only (n = 29); RD only (n = 63); ADHD and RD (n = 47); ADHD and ODD (n = 19); ADHD, RD, and ODD (n = 21); and typically developing control children (n = 112). Motor skills were assessed with the Bruininks-Oseretsky Test of Motor Proficiency and the Beery Test of Visual-Motor Integration. We found that the motor skills of the ADHD-only group did not differ from the typical control group. Furthermore, motor impairment in ADHD increased as a function of co-occurring disorders, and the presence of RD rather than ADHD predicted motor impairment.     

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.     

Peer Status in Boys With and Without Attention-Deficit Hyperactivity Disorder: Predictions from Overt and Covert Antisocial Behavior, Social Isolation, and Authoritative Parenting Beliefs

Because of the centrality of peer relationship difficulties for children with attentiondeficit hyperactivity disorder (ADHD), we investigated behavioral (overt and covert antisocial activity), internalizing (self-reports and observed social isolation), and familial (authoritative, authoritarian, and permissive parenting beliefs) predictors of peer sociometric nominations among previously unfamiliar, ethnically diverse ADHD ( N=73 ) and comparison ( N=60 ) boys, aged 6–12 years. Authoritative maternal parenting beliefs and negatively weighted social isolation explained significant variance in positive peer regard; aggression, covert behavior, and authoritative parenting beliefs were the independent predictors of both negative peer status and peer social preference. We extended such predictions with statistical control of (1) child cognitive variables, (2) maternal psychopathology, and (3) ADHD boys, but authoritative parenting beliefs were stronger predictors in ADHD than in comparison youth. We discuss family-peer linkages regarding peer competence.     

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.     

Clinical features of survivors of sexual abuse with major depression.

OBJECTIVE: This study examined differences in rates of trauma-related disorders between patients with histories of childhood sexual abuse and those without such histories in a sample of depressed outpatients. Another aim of this study was to determine whether childhood sexual abuse is associated with recent suicidal attempts, affect dysregulation and duration of index depressive episode, independent of posttraumatic stress disorder and borderline personality disorder. METHOD: Subjects were 235 treatment-seeking outpatients with major depression. Structured interviews were administered to assess for Axis I and Axis II disorders, childhood sexual abuse, and various clinical features. RESULTS: Patients with sexual abuse compared to those without sexual abuse histories had higher rates of comorbidity, primarily borderline personality disorder, posttraumatic stress disorder and multiple Axis I diagnoses. Childhood sexual abuse status was linked to a longer duration of the index depressive episode, independent of borderline personality disorder and/or posttraumatic stress disorder. However, childhood sexual abuse status was not independently related to affect dysregulation and suicidal attempts. CONCLUSION: The findings suggest that patients with histories of sexual abuse represent a subgroup of depressed patients who are at especially high risk for psychiatric morbidity and a prolonged episode of depression.     

The relationship of teacher-rated social skills deficits and ADHD characteristics among kindergarten-age children

Research findings regarding the relationship of social skills deficits and behavioral characteristics associated with attention-deficit hyperactivity disorder (ADHD) among kindergarten-age children are presented. The Preschool and Kindergarten Behavior Scales (PKBS) were utilized to identify the social skills attributes of young children with significant ADHD characteristics. An ADHD target group (N = 95) was constructed by selecting participants from a large nationwide sample who were rated by their teachers as being in the highest 5% on the PKBS Attention Problems/Overactive subscale. A matched non-ADHD comparison group (by gender and age) of 95 children was developed through a randomized block procedure using the same nationwide sample. The ADHD group was rated as having significantly poorer social skills than the comparison group, and could be classified with a very high degree of accuracy based on discriminant function analysis of their social skills scores. Although exhibiting comparative deficits in all social skill areas, the ADHD participants were especially lacking in social cooperation skills: the ability to follow rules, structure, and important social expectations of both children and adults. Children who were rated high in ADHD characteristics were between five and six times more likely than the comparison children to be rated as having significant deficits in social skills. Implications of these findings for assessment and treatment of young children are discussed. © 1998 John Wiley & Sons, Inc.     

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.     

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.     

Factor structures of Taiwanese teachers' ratings of ADHD: a comparison with U.S. studies

The purpose of this study was to compare factor structures from Taiwanese teachers' ratings with diagnostic definitions of attention-deficit/hyperactivity disorder (ADHD) as described in the DSM-III-R, DSM-IV, and ICD-10; to examine how factor structures of Taiwanese teachers' ratings of ADHD symptoms compare with factor structures reported in research using school-based American participants; and to examine gender differences. One hundred and twenty-one homeroom teachers from six public elementary schools in Taipei County, Taiwan, rated two boys and two girls randomly selected from their homerooms using the ADHD checklist. Findings from this study support the concurrent validity of the DSM-IV ADHD factor structures of hyperactivity-impulsivity and inattention. Comparability of these findings with school-based U.S. studies suggests the cross-cultural congruency of behaviors associated with ADHD.     

ADHD and dyscalculia: Evidence for independent familial transmission

The familial relationship between dyscalculia and attention-deficit/hyperactivity disorder (ADHD) was assessed. We conducted a familial risk analysis using probands with and without ADHD of both genders and their first-degree relatives. Participants were assessed with structured diagnostic interviews and a cognitive test battery. We found elevated rates of ADHD in relatives of both ADHD proband groups, regardless of dyscalculia status, and elevated rates of dyscalculia in relatives of probands with dyscalculia, irrespective of ADHD status. There was no evidence for cosegregation or assortative mating. Our findings support the hypothesis that ADHD and dyscalculia are independently transmitted in families and are etiologically distinct. These results reinforce the current nosological approach to these disorders and underscore the need for separate identification and treatment strategies for children with both conditions.     

Home literacy,television viewing,fidgeting and ADHD in young children

Factors related to parent ratings of young children’s (mean age = 3.72, range = 3–6) fidgeting and reports of attention-deficit hyperactivity disorder (ADHD) were examined in a nationally representative sample of US families via the National Household Education Surveys. In structural equation models, the number of television hours viewed daily was associated with more fidgeting (a sign of hyperactivity), which, in turn, was related to ADHD, when controlling for race/ethnicity, SES, family structure, autism, emotional disturbance and gender. The home literacy environment (shared reading, children’s books and library visits) was negatively associated with both fidgeting and hours of television. Home literacy was indirectly negatively related with ADHD via fidgeting. Boys and children with autism fidgeted more frequently, where as children from two-parent families were less likely to have ADHD. Overworked parents allowed more television viewing than other parents. The implications for future studies involving television viewing, home literacy, attention and hyperactivity are discussed.     

The ADHD spectrum and everyday life: experience sampling of adolescent moods, activities, smoking, and drinking

Using an experience sampling methodology, the everyday lives of 153 adolescents with low, middle, or high levels of attention-deficit/hyperactivity disorder (ADHD) characteristics as assessed by either parent or teen were examined. Twice each hour, across two 4-day recording intervals, participants in a longitudinal study of stress and health risks logged their behaviors, moods, and social contexts. Those with high, in contrast to low, ADHD symptom levels recorded more negative and fewer positive moods, lower alertness, more entertaining activities relative to achievement-oriented pursuits, more time with friends and less time with family, and more tobacco and alcohol use. Fewer associations emerged with parent-defined than with teen-defined subgroups, although the differences in alertness, peer and family contexts, entertainment versus achievement activities, and substance use were consistent across sources. Even at subclinical levels, ADHD characteristics were associated with behavioral patterns and contexts that may promote peer deviancy training, unhealthy lifestyle behaviors, and vulnerability to nicotine dependence.     

Central auditory processing ability in children with ADHD with and without learning disabilities

A few studies have shown more central auditory processing deficits in children with attention-deficit/hyperactivity disorder (ADHD) than in nondisabled children. Because these studies failed to screen participants with ADHD for learning disabilities (LD), it is not clear whether these deficits are correlates of ADHD or LD or both. In the present study, the central auditory processing ability of children with ADHD, ADHD with LD, and no disabilities was examined. Results indicated lower central auditory processing ability, and significant correlations between reading and ADHD symptoms and reading and central auditory processing ability in the ADHD with LD group compared with the other two groups. These findings suggest that central auditory processing deficits are more likely to be associated with LD than ADHD.     

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.     

Overexcitabilities and ADHD in the Gifted: An Examination

Gifted children and adolescents can display behavioral characteristics similar to those exhibited by children and adolescents who have been diagnosed with attention-deficit hyperactivity disorder (ADHD), leading to potential issues with misdiagnosis. The overlapping characteristics between giftedness and ADHD are often seen as anecdotal or to only exist in theory, such as that explained by Dabrowski's theory of positive disintegration and his notion of overexcitabilities. There is a paucity of empirical data to support this perceived relationship between ADHD and overexcitabilities. This study provides empirical support for a relationship between ADHD and overexcitabilities within a sample of gifted adolescents. Implications are discussed.     

Self-report of ADHD symptoms in university students: cross-gender and cross-national prevalence

Little research has examined the structure and prevalence of attention-deficit/hyperactivity disorder (ADHD) symptoms in university students, including whether symptom structure conforms to the bidimensional (i.e., inattention and hyperactivity-impulsivity) conceptualization of the Diagnostic and Statistical Manual of Mental Disorders (DSMV-IV; American Psychiatric Association, 1994) and whether self-reported symptoms vary across gender and country. A sample of 1,209 university students from three countries (Italy, New Zealand, and the United States) completed a 24-item self-report measure (the Young Adult Rating Scale) tapping ADHD symptomatology. Factor analyses within the U.S. and New Zealand samples supported a bidimensional symptom structure, whereas weaker support for this conceptualization was provided by the Italian sample. Participants did not vary significantly by gender in symptom report; however, Italian students reported significantly more inattention and hyperactivity-impulsivity symptoms than students from the United States, and students from New Zealand reported more inattention symptoms than students from the United States. The prevalence of self-reported ADHD symptoms beyond DSM-IV thresholds for diagnosis ranged from 0% (Italian women) to 8.1% (New Zealand men). The implications of these results for the use of DSM-IV criteria in identifying university students with ADHD are discussed.     

Clinical importance of parent ratings of everyday cognitive abilities in children with learning and attention problems

This study addressed two issues: first, whether parental reports contribute information over and above a standardized psychometric assessment, and second, whether parental reports of everyday cognitive functioning might be useful in distinguishing between children with reading disabilities (RD), attention-deficit/hyperactivity disorder (ADHD), and combined ADHD + RD. Parent-reported information on 159 children with learning or attention problems was obtained using a questionnaire called the Parent Ratings of Everyday Cognitive and Academic Abilities (PRECAA). Psychometric information used for comparison included the Woodcock-Johnson Psychoeducational Battery-Revised, the Bruininks-Oseretsky Test of Motor Proficiency-Short Form, the Vocabulary and Block Design subtests of the Wechsler Intelligence Scale for Children, 3rd edition, and the Developmental Test of Visual-Motor Integration. The PRECAA was found to be sensitive to group differences between children with RD and children with ADHD and combined ADHD + RD. Its inclusion resulted in a significant increase in the number of children correctly classified compared to the use of psychometric measures alone. The PRECAA correctly classified more children (66%) than did the standard psychometric measures (50%). In fact, a very high percentage of children with ADHD (81%) were correctly classified using the PRECAA. These findings suggest that the PRECAA may be a useful aid to clinicians in the identification of children with learning and attention problems.