The adolescent outcome of hyperactive children diagnosed by research criteria: I. An 8-year prospective follow-up study

The psychiatric outcome is reported for a large sample of hyperactive children (N = 123), meeting research diagnostic criteria, and normal control children (N = 66) followed prospectively over an 8-year period into adolescence. Over 80% of the hyperactives were attention deficit hyperactivity disorder (ADHD) and 60% had either oppositional defiant disorder and/or conduct disorder at outcome. Rates of antisocial acts were considerably higher among hyperactives than normals, as were cigarette and marijuana use and negative academic outcomes. The presence of conduct disorder accounted for much though not all of these outcomes. Family status of hyperactives was much less stable over time than in the normal subjects. The use of research criteria for diagnosing children as hyperactive identifies a pattern of behavioral symptoms that is highly stable over time and associated with considerably greater risk for family disturbance and negative academic and social outcomes in adolescence than has been previously reported.     

Does behavior therapy normalize the classroom behavior of hyperactive children?

This study evaluated the effectiveness of eight weeks of intensive behavioral treatment in normalizing the classroom behavior of 28 children with attention deficit disorder with hyperactivity (ADDH). Using blind classroom observers, treatment efficacy was examined for full normalization, partial normalization, and the rate of hyperactive children classified as being like normals. Evidence for normalization was scarce. With treatment, there was no significant change in the percentage of hyperactive children classified as normal. Some normalization gains were found at midtreatment but were not sustained. Attention, activity, and impulsivity, the primary features of ADDH, were not normalized. Aggression, however, was consistently and fully normalized. The modification of aggression does not appear to remedy hyperactive behaviors. The clinical meaningfulness of treatment was minimal; the hyperactive children remained deviant in many aspects of classroom conduct.     

The persistence of behavioural symptoms and symptom groups in children: A study of the stability of parental reported symptoms

The investigation assessed psychiatric symptoms in children at two time points and the persistence of symptom groups over an interval of 4 years. We studied 1128 children by using parental questionnaires (Rutter Scale A2) in both studies (mean age of the children was 8.5 years in Study 1 and 12.5 years in Study 2). There was a tendency for the frequency of symptoms to decrease over the 4-year period. Most of the symptoms reported in Study 1 were also found in Study 2. Sex differences were similar in both studies. Four factors were constructed out of the items on Rutter Scale A2, reflecting externalizing, hyperactive, internalizing, and poorly socialized behaviours. Externalizing, hyperactive, and internalizing behaviours were moderately persistent in the sample studied. The stability of externalizing and internalizing behaviour was high among deviant children. Hyperactivity was not persistent among deviant boys but highly persistent among deviant girls. Poorly socialized behaviour was not persistent in the sample studied, but girls scoring high in this factor in Study 1 scored high on the externalizing factor in Study 2.     

Reaction time, impulsivity, and attention in hyperactive children and controls: a video game technique

Maturation of sustained attention was studied in a group of 52 hyperactive elementary school children and 152 controls using a microcomputer-based test formatted to resemble a video game. In nonhyperactive children, both simple and complex reaction time decreased with age, as did variability of response time. Omission errors were extremely infrequent on simple reaction time and decreased with age on the more complex tasks. Commission errors had an inconsistent relationship with age. Hyperactive children were slower, more variable, and made more errors on all segments of the game than did controls. Both motor speed and calculated mental speed were slower in hyperactive children, with greater discrepancy for responses directed to the nondominant hand, suggesting that a selective right hemisphere deficit may be present in hyperactives. A summary score (number of individual game scores above the 95th percentile) of 4 or more detected 60% of hyperactive subjects with a false positive rate of 5%. Agreement with the Matching Familiar Figures Test was 75% in the hyperactive group.     

Genetic and neurobiological aspects of attention deficit hyperactive disorder: a review.

This paper reviews key studies that have addressed genetic and neurobiological aspects in attention deficit hyperactive disorder. Genetic studies can be divided into three distinct types: twin, adoption, and family studies. Evidence for a particular mode of inheritance and the possible specific genetic abnormalities are also explored. There is strong evidence of genetic involvement in this condition, although a clear-cut mode of inheritance and specific genetic abnormalities are yet to be determined. Neurobiological aspects such as the neuroanatomical and neurochemical evidence of various neurotransmitter system involvement is explored. Frontal lobe and dopamine and norepinephrine neurotransmitter systems appear to be involved in attention deficit hyperactive disorder.     

Cognitive effects of psychostimulant medication in hyperactive children

Hyperactive and normal children were given a test of selective attention (Stroop test) and a neurocognitive test sensitive to a functional deficit of prefrontal cortex (Wisconsin Card Sorting Test). Hyperactive children showed significant deficits on both measures. After a year of psychostimulant medication, the hyperactive children all showed clinical and neurocognitive improvement, but continued to show a selective attention deficit compared with normal children. The results indicate a dissociation between the cognitive processes measured by the Wisconsin test and selective attention as measured by the Stroop, and that the selective attention deficit is more resistant to psychostimulant intervention.     

Attention deficit hyperactivity disorder and sensory modulation disorder: a comparison of behavior and physiology

Children with attention deficit hyperactivity disorder (ADHD) are impulsive, inattentive and hyperactive, while children with sensory modulation disorder (SMD), one subtype of Sensory Processing Disorder, have difficulty responding adaptively to daily sensory experiences. ADHD and SMD are often difficult to distinguish. To differentiate these disorders in children, clinical ADHD, SMD, and dual diagnoses were assessed. All groups had significantly more sensory, attention, activity, impulsivity, and emotional difficulties than typical children, but with distinct profiles. Inattention was greater in ADHD compared to SMD. Dual diagnoses had more sensory-related behaviors than ADHD and more attentional difficulties than SMD. SMD had more sensory issues, somatic complaints, anxiety/depression, and difficulty adapting than ADHD. SMD had greater physiological/electrodermal reactivity to sensory stimuli than ADHD and typical controls. Parent-report measures identifying sensory, attentional, hyperactive, and impulsive difficulties varied in agreement with clinician's diagnoses. Evidence suggests ADHD and SMD are distinct diagnoses.     

A twelve-year follow-up of preschool hyperactive children

Two percent (N = 21) of a large sample of preschool children were identified as "pervasively hyperactive." Compared with nonhyperactive preschoolers, these children more often came from families with high levels of adversity, and they showed poorer language skills. Over a 12-year follow-up period, the hyperactive preschoolers continued to show poorer cognitive skills, lower levels of reading ability, disruptive and inattentive behaviors at home and at school, and higher rates of DSM-III disorder in preadolescence and adolescence. By age 15, only one-quarter of this group were identified as having met "recovery" criteria. The findings point to the long-term adverse consequences of preschool hyperactivity and indicate the need for intervention with this type of disorder.     

Comorbidity in hyperactive children: Issues related to selection bias,gender, severity,and internalizing symptoms

Parental behavior ratings of hyperactive boys and girls aged 6–11 years seen for evaluation in a general outpatient child psychiatry clinic and in a specialty “attention deficit disorder” (ADD) program were analyzed. The pattern of comorbidity in the two groups showed no significant differences. Most of the associated internalizing and externalizing behavioral scales in hyperactive boys and in hyperactive girls were elevated and in clinical ranges except for the “somatic complaints” scale. Comorbidity in both hyperactive boys and girls was related to the severity of the hyperactivity itself.     

ADHD-like hyperactivity, with no attention deficit, in adult rats after repeated hypoxia during the equivalent of extreme prematurity

The most common behavioural disorder seen in children and adolescents born extremely prematurely is attention deficit hyperactivity disorder (ADHD). The hyperactive/impulsive sub-type of ADHD or the inattentive sub-type or the hyperactive/impulsive/inattentive sub-type can be evident. These sub-types of ADHD can persist into adulthood. The aim of this study was to investigate the relevance of a new immature rat model of repeated hypoxic exposure to these behavioural characteristics of extreme prematurity. More specifically, this study aimed to measure ADHD-like hyperactivity in response to delayed reward, and inattention, in repeated hypoxic versus repeated normoxic rats. Sprague-Dawley rats were exposed to either repeated hypoxia or repeated normoxia during postnatal days (PN) 1-3. The rat brain during PN1-3 is generally considered to be developmentally equivalent to the human brain during extreme prematurity. The rats were then behaviourally tested at 16 months-of-age on a multiple component fixed interval-extinction test. This test detects ADHD-like hyperactivity in response to delayed reward, as well as inattention. It was found that the repeated hypoxic rats exhibited ADHD-like hyperactivity in response to delayed reward, but no attention deficit, when compared to repeated normoxic rats. These findings provide a new animal model to investigate the biological mechanisms and treatment of ADHD-like hyperactivity due to repeated hypoxia during the equivalent of extreme prematurity.     

Parental management of inappropriate hyperactivity in a young retarded child

This paper describes a procedure used by parents to eliminate inappropriate hyperactive behavior at mealtime and after meals, using a multiple baseline procedure and contingent attention and time-out. Parents were taught to record inappropriate behaviors during mealtime and a half hour following, and were trained to give positive attention to appropriate behaviors while ignoring inappropriate behaviors; following mealtime a time-out procedure was employed when any one of several inappropriate behaviors occured. Inappropriate behaviors decreased sharply and remained at a low rate for approximately 5 weeks thereafter. These procedures demonstrate the use of training parents to utilize an effective home management program.     

The effects of methylphenidate on the mother-child interactions of hyperactive children.

Twenty hyperactive boys were observed while interacting with their mothers during a free play and task period on each of three occasions (no drug, drug, placebo). A triple-blind, drug-placebo crossover design was used to study the effects of methylphenidate on these interactions. A complex objective coding system was used to score the children's responses to various maternal behaviors as well as the mother's responses to a variety of children's behaviors. Results indicated that these children were more compliant with maternal commands during drug treatment. In response, mothers displayed increased attention to compliance while reducing their directiveness toward the boys. However, the hyperactive boys receiving methylphenidate initiated fewer social interactions and tended to show greater nonresponding. Thus, methylphenidate may improve the compliance of hyperactive children but tends to decrease their sociability.     

The Prospective Links Between Hyperactive/Impulsive,Inattentive, and Oppositional-Defiant Behaviors in Childhood and Antisocial Behavior in Adolescence: The Moderating Influence of Gender and the Parent–Child Relationship Quality

We prospectively investigated the effect of child hyperactive/impulsive, inattentive, and oppositional/defiant behaviors on the development of youth antisocial behaviors, and the moderating influence of gender and the parent–child relationship quality in a normative sample. Participants (N = 673, 50 % girls) were assessed at 10 years of age (parent reports) and at age 15 (parent and adolescent reports). Using latent change models, we found that initial levels of, as well as increases in, hyperactivity/impulsivity and oppositional behaviors and initial levels of inattention behaviors predicted youth antisocial behaviors. The increase in oppositional behaviors was predictive of youth antisocial behaviors in girls only. Child hyperactive/impulsive behaviors predicted youth antisocial behaviors only in children for whom the quality of the parent–child relationship deteriorated from childhood to adolescence. Thus, both initial levels of and increases in disruptive behaviors as well as gender are important for understanding the development of antisocial behaviors in adolescence. We received partial support for the hypothesized, moderating role of a high-quality parent–child relationship.     

Heterogeneity in the pharmacodynamics of two long-acting methylphenidate formulations for children with attention deficit/hyperactivity disorder

Objectives  

To use growth mixture modelling (GMM) to identify subgroups of children with attention deficit hyperactive disorder (ADHD) who have different pharmacodynamic profiles in response to extended release methylphenidate as assessed in a laboratory classroom setting.     

Associations of the Behavioral Assessment and Research System (BARS) neurobehavioral outcomes with attention problems in children living near coal ash storage sites

Environmental exposures have been linked to childhood problems with overactivity, attention, and impulse control, and an increased risk of attention deficit hyperactivity disorder (ADHD) diagnosis. Two approaches to identify these types of exposure-related neurobehavioral problems include the use of computerized tests, such as the Behavioral Assessment and Research System (BARS), as well as the use of behavior rating scales. To assess comparability of these two types of measures, we analyzed data from 281 children aged 6 to 14 years enrolled in a 5-year research study investigating coal ash exposure and neurobehavioral health. All children lived in proximity of coal ash storage sites. We administered six computer tests from the BARS and obtained behavior measures from the parent-completed Child Behavior Checklist (CBCL) ADHD DSM oriented scale. BARS test performance was associated with age indicating that the tests could be used to evaluate neurodevelopmental changes over time or across a wide age range. Tests within the BARS including Continuous Performance (CPT) false alarm (standardized estimate 1.57, 95% confidence interval (CI) (0.67, 2.48), adjusted p = 0.006), Selective Attention (SAT) wrong count (standardized estimate 2.8, 95% CI (1.17, 4.44), adjusted p = 0.006), and SAT proportion correct (standardized estimate -2.45, 95% CI (-4.01, -0.88), adjusted p = 0.01) were associated with attention and impulse control problems on the CBCL after adjustment for multiple comparisons. Findings support that the BARS can contribute to research on environmental exposures by assessing subclinical behaviors related to ADHD such as sustained attention, impulse control, response inhibition, associative learning, and short-term memory. Future research can examine relationships of these BARS measures with biomarkers of neurotoxic exposures related to living near coal ash storage sites to better identify the potential risk for ADHD-related behaviors among children living near coal ash storage sites.     

Special characteristics of retarded children rated as severely hyperactive

Summary Ninety-four pairs of retarded children, in one of whom hyperactivity was rated as no problem and in the other as a severe problem, were matched for age and year of examination. The findings indicated a higher incidence of central nervous system damage and/or dysfunction in the hyperactive children than in those who were not hyperactive.Of six cases of hemiplegia, all were in the hyperactive group as were seven of eight cases of diplegia. A significantly larger portion of the hyperactive group had a history of convulsive seizures, and significantly more had a residual speech defect.The hyperactive children had lower social quotients than those not hyperactive, and a greater number of them were not yet completely toilet trained for both bowel and bladder control.The hyperactive children showed a significantly higher incidence of destructiveness, of withdrawal, of assaultiveness, and of overanxiousness and fearfulness than those not hyperactive. Possible relations of these behaviors were discussed.Severe hyperactivity affects quite unfavorably the prognosis for the behavioral adjustment of a retarded child.The authors wish to thank the Interagency Case Information Service for making available the data on which this study is based.     

Association Between Colonic Symptoms and Inattention/Hyperactivity in British Children

Background: Functional faecal retention and attention deficit hyperactivity disorder (ADHD) are common in childhood. There is some evidence, mostly from clinical samples, of an association between them. Methods: The association between parental reports of inattention/hyperactivity and colonic symptoms in children between four and ten years of age was examined using the Health Survey for England 2000. Results: Boys were about twice as likely to be rated by their parents as inattentive/hyperactive if they had colon symptoms. Conclusions: This study adds to existing evidence associating bowel function and behavioural symptoms, especially in boys. Given the high prevalence of gastrointestinal symptoms in general, and the increasing personal and societal impact of childhood behavioural problems, further exploration of the relationship is warranted, with particular attention to causal pathways.     

Prediction of early-onset deviant peer group affiliation: a 12-year longitudinal study

CONTEXT: Deviant peer group involvement is strongly related to onset, aggravation, and persistence of conduct problems during adolescence. OBJECTIVE: To identify early childhood behavioral profiles that predict early-onset deviant peer group involvement. DESIGN: A 12-year longitudinal study of behavioral development. SETTING: Fifty-three inner-city elementary schools in a large Canadian city. PARTICIPANTS: A total of 1037 boys in kindergarten from low socioeconomic neighborhoods. MAIN OUTCOME MEASURES: Annual self-reported deviant peer group involvement from 11 to 17 years of age. RESULTS: Kindergarten boys were at highest risk of following an early adolescence trajectory of deviant peer group affiliation if they were hyperactive, fearless, and low on prosocial behaviors but much less at risk if they scored high on only 2 of these dimensions. Family adversity had no main effect but substantially increased the risk of following an early adolescence trajectory of deviant peer group affiliation for boys with a profile of hyperactivity, fearlessness, and low prosocial behaviors. CONCLUSIONS: Kindergarten boys from low socioeconomic areas who are hyperactive, fearless, infrequently prosocial, and raised in adverse family environments are at much heightened risk of engaging in deviant peer groups early in their development. Boys at high risk can be identified as early as kindergarten and should be targeted for preventive intervention.     

Attention deficit disorder and pathological gambling

To examine the possibility that pathological gambling is related to the deficits in impulse control associated with attention deficit disorder, 14 pathological gamblers and 16 controls were administered questionnaires concerning their childhood behaviors. These self-reports indicated a strong correlation between pathological gambling and childhood behaviors related to attention deficit disorder.     

Platelet MAO and measures of attention and impulsivity in boys with attention deficit disorder and hyperactivity

Platelet monoamine oxidase (MAO) activity was studied in 22 boys diagnosed as having attention deficit disorder with hyperactivity and 12 healthy control boys admitted to a clinical research center and placed on a diet low in monoamines. The hyperactive boys had lower platelet MAO activity than controls, and MAO activity was related to performance on the Matching Familiar Figures Test (MFF) and the Continuous Performance Test (CPT), which yield scores sensitive to impulsivity and inattention. Furthermore, it was negatively related, in hyperactive boys only, to two tests of reading and spelling achievement. Administration of d-amphetamine and placebo in a double-blind crossover design did not significantly raise MAO levels above baseline and was minimally related to improved performance on the MFF and CPT.