26
|
Abstract
This study examined possible gender differences in children and adults with attention-deficit/hyperactivity disorder. Results indicated that adult self-ratings differed significantly by gender. Adult women reported fewer assets and more problems than did male counterparts, but there was no gender difference with respect to age at referral, intelligence quotient, indicators of neuropsychological performance, or parent or teacher ratings of behavior. Referral bias against girls is a possible reason for previously reported gender differences, so we interpreted our results in light of the participants' referral patterns. There was a nonsignificant trend for girls with relatively more severe ratings of hyperactivity, conduct disorder, or inattention to be referred earlier than were boys. Overall, our results suggest no evidence of cognitive or neuropsychological differences by gender in samples that are sensitive to behavioral deviance in girls (as evidenced by early referral), but adult women's self-perception is comparatively poorer than that of adult men.
Collapse
|
27
|
Conners CK, Wells KC, Parker JD, Sitarenios G, Diamond JM, Powell JW. A new self-report scale for assessment of adolescent psychopathology: factor structure, reliability, validity, and diagnostic sensitivity. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 1997; 25:487-97. [PMID: 9468109 DOI: 10.1023/a:1022637815797] [Citation(s) in RCA: 131] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
This paper describes four studies on self-reported problems in 2,243 adolescent males and females, 12 to 17 years of age. In Study 1, principal-axis factoring of 102 items covering 11 problem domains revealed six factors comprising 49.5% of the variance. Study 2 used confirmatory factor analysis of a 64-item reduced set on a new sample of 408 adolescents. Goodness-of-fit indicators suggested that the six-factor model had excellent fit to the data. Study 3 used data from the 2,157 adolescents used in the first two studies. Coefficient alphas ranged from .83 to .92. Median test-retest reliability for the six factors was .86. There was a consistent structure of the correlation matrix across age and gender. Study 4 was a study of criterion validity, using an additional sample of 86 children with attention-deficit hyperactivity disorder (ADHD). Sensitivity and specificity were high, with an overall diagnostic efficiency of 83%. This new self-report scale, the Conners/Wells Adolescent Self-Report of Symptoms (CASS), may provide a useful component of a multimodal assessment of adolescent psychopathology.
Collapse
|
28
|
Arnold LE, Abikoff HB, Cantwell DP, Conners CK, Elliott G, Greenhill LL, Hechtman L, Hinshaw SP, Hoza B, Jensen PS, Kraemer HC, March JS, Newcorn JH, Pelham WE, Richters JE, Schiller E, Severe JB, Swanson JM, Vereen D, Wells KC. National Institute of Mental Health Collaborative Multimodal Treatment Study of Children with ADHD (the MTA). Design challenges and choices. ARCHIVES OF GENERAL PSYCHIATRY 1997; 54:865-70. [PMID: 9294378 DOI: 10.1001/archpsyc.1997.01830210113015] [Citation(s) in RCA: 194] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The Collaborative Multimodal Treatment Study of Children with Attention Deficit Hyperactivity Disorder (ADHD), the MTA, is the first child multisite cooperative agreement treatment study of children conducted by the National Institute of Mental Health, Rockville, Md. It examines the long-term effectiveness of medication vs behavioral treatment vs both for treatment of ADHD and compares state-of-the-art treatment with routine community care. In a parallel-groups design, 576 children (age, 7-9 years) with ADHD (96 at each site) are thoroughly assessed and randomized to 4 conditions: (1) medication alone, (2) psychosocial treatment alone, (3) the combination of both, (4) or community comparison. The first 3 groups are treated for 14 months and all are reassessed periodically for 24 months. Designers met the following challenges: framing clinically relevant primary questions; defining the target population; choice, intensity, and integration and combination of treatments for fair comparisons; combining scientific controls and standardization with clinical flexibility; and implementing a controlled clinical trial in a nonclinical setting (school) controlled by others. Innovative solutions included extensive decision algorithms and manualized adaptations of treatments to specific needs.
Collapse
|
29
|
March JS, Parker JD, Sullivan K, Stallings P, Conners CK. The Multidimensional Anxiety Scale for Children (MASC): factor structure, reliability, and validity. J Am Acad Child Adolesc Psychiatry 1997; 36:554-65. [PMID: 9100431 DOI: 10.1097/00004583-199704000-00019] [Citation(s) in RCA: 1410] [Impact Index Per Article: 52.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To describe the history, factor structure, reliability, and validity of the Multidimensional Anxiety Scale for Children (MASC). METHOD In two separate school-based population studies, principal-components factor analysis was used, first, to test a theory-driven factor structure, and second, to develop an empirically derived factor structure for the MASC. In a separate study using a clinical population, test-retest reliability at 3 weeks and 3 months, interrater concordance, and convergent and divergent validity were examined. RESULTS The final version of the MASC consists of 39 items distributed across four major factors, three of which can be parsed into two subfactors each. Main and subfactors include (1) physical symptoms (tense/restless and somatic/autonomic), (2) social anxiety (humiliation/rejection and public performance fears), (3) harm avoidance (perfectionism and anxious coping), and (4) separation anxiety. The MASC factor structure, which presumably reflects the in the vivo structure of pediatric anxiety symptoms, is invariant across gender and age and shows excellent internal reliability. As expected, females show greater anxiety on all factors and subfactors than males. Three-week and 3-month test-retest reliability was satisfactory to excellent. Parent-child agreement was poor to fair. Concordance was greatest for easily observable symptom clusters and for mother-child over father-child or father-mother pairs. Shared variance with scales sampling symptom domains of interest was highest for anxiety, intermediate for depression, and lowest for externalizing symptoms, indicating adequate convergent and divergent validity. CONCLUSION The MASC is a promising self-report scale for assessing anxiety in children and adolescents.
Collapse
|
30
|
Greenhill LL, Abikoff HB, Arnold LE, Cantwell DP, Conners CK, Elliott G, Hechtman L, Hinshaw SP, Hoza B, Jensen PS, March JS, Newcorn J, Pelham WE, Severe JB, Swanson JM, Vitiello B, Wells K. Medication treatment strategies in the MTA Study: relevance to clinicians and researchers. J Am Acad Child Adolesc Psychiatry 1996; 35:1304-13. [PMID: 8885584 DOI: 10.1097/00004583-199610000-00017] [Citation(s) in RCA: 170] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Clinicians have difficulty applying drug research findings to clinical practice, because research protocols use methods different from those used in daily office practice settings. METHOD To design a medication protocol for a multisite clinical trial involving 576 children with attention-deficit hyperactivity disorder (ADHD) while maintaining relevance to clinical practice, investigators from the NIMH Collaborative Multisite Multimodal Treatment Study of Children with Attention-Deficit/Hyperactivity Disorder (MTA study) developed novel medication strategies. These were designed to work either in a monomodal or multimodal format and to ensure standard approaches are used across diverse sites. Each child randomized to medication (projected N = 288) is individually titrated to his or her "best" methylphenidate dose and has individual ADHD symptoms monitored. Decision rules were developed to guide "best dose" selection, dose changes, medication changes, the management of side effects, and integration with psychosocial treatments. CONCLUSIONS The MTA study uses a controlled method to standardize the identification of each child's "best" methylphenidate dose in a national, multisite cooperative treatment program. Although the titration protocol is complex, the study's individual dosing approach and algorithms for openly managing ADHD children's medication over time will be of interest to clinicians in office practice.
Collapse
|
31
|
Conners CK, Casat CD, Gualtieri CT, Weller E, Reader M, Reiss A, Weller RA, Khayrallah M, Ascher J. Bupropion hydrochloride in attention deficit disorder with hyperactivity. J Am Acad Child Adolesc Psychiatry 1996; 35:1314-21. [PMID: 8885585 DOI: 10.1097/00004583-199610000-00018] [Citation(s) in RCA: 166] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE This is a multisite, double-blind, placebo-controlled trial to determine the safety and efficacy of bupropion in the treatment of children with attention deficit disorder with hyperactivity (ADDH). METHOD In a four-center, double-blind comparison of bupropion (n = 72) and placebo (n = 37), children aged 6 to 12 years meeting DSM-III criteria for ADDH were randomized to receive bupropion 3 to 6 mg/kg per day or placebo, administered twice daily, at 7 A.M. and 7 P.M. Measures of efficacy included the Conners Parent and Teacher Questionnaires (93-item, 39-item, and 10 item), Clinical Global Impressions Scales of Severity and Improvement, the Sternberg Short-Term Memory Task, and the Continuous Performance Test. Screen and posttreatment physical examinations, electrocardiograms, electroencephalograms, and clinical laboratory evaluations were performed. Height, weight, and vital signs were measured and adverse experiences were assessed weekly. RESULTS A significant treatment effect, apparent as early as day 3, was present for both conduct problems and hyperactivity on the Conners 10-item and 39-item teacher's checklist, and at day 28 for conduct problems and restless-impulsive behavior on the 93-item parent questionnaire. Findings were of smaller magnitude for parent ratings than teacher ratings. Significant treatment effects were present on both the Continuous Performance Test and memory retrieval test. Effect sizes of bupropion/placebo differences for teacher and parent ratings in this study were somewhat smaller than for standard stimulant drugs used to treat ADDH. Bupropion appeared to be well tolerated in most children. Dermatological reactions were twice as frequent in the drug group as the placebo group, with four reactions involving rash and urticaria that were serious enough to require discontinuation of medication. CONCLUSIONS Bupropion may be a useful addition to available treatments for ADDH. Comparative trials with such standard drugs as methylphenidate are warranted to determine the relative clinical merits of bupropion.
Collapse
|
32
|
Levin ED, Conners CK, Sparrow E, Hinton SC, Erhardt D, Meck WH, Rose JE, March J. Nicotine effects on adults with attention-deficit/hyperactivity disorder. Psychopharmacology (Berl) 1996; 123:55-63. [PMID: 8741955 DOI: 10.1007/bf02246281] [Citation(s) in RCA: 267] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Several lines of evidence suggest that nicotine may be useful in treating the symptoms of Attention-Deficit/Hyperactivity Disorder (ADHD). The current study was an acute, placebo-controlled double-blind experiment to determine whether nicotine might be useful as an alternative treatment of adults with ADHD symptomatology. Six smokers and 11 nonsmokers who were outpatient referrals for ADHD were diagnosed by DSM-IV criteria. Measures of treatment effect included the Clinical Global Impressions (CGI) scale, Hopkins' symptom check list (SCL-90-R), the Profile of Mood States (POMS), Conners' computerized Continuous Performance Test (CPT), the Stroop test, and an interval-timing task. The smokers underwent overnight deprivation from smoking and were given a 21 mg/day nicotine skin patch for 4.5 h during a morning session. The nonsmokers were given a 7 mg/day nicotine skin patch for 4.5 h during a morning session. Active and placebo patches were given in a counter-balanced order approximately 1 week apart. Nicotine caused a significant overall nicotine-induced improvement on the CGI. This effect was significant when only the nonsmokers were considered, which indicated that it was not due merely to withdrawal relief. Nicotine caused significantly increased vigor as measured by the POMS test. Nicotine caused an overall significant reduction in reaction time (RT) on the CPT, as well as, with the smokers, a significant reduction in another index of inattention, variability in reaction time over trial blocks. Nicotine improved accuracy of time estimation and lowered variability of time-estimation response curves. Because improvements occurred among nonsmokers, the nicotine effect appears not to be merely a relief of withdrawal symptoms. It is concluded that nicotine deserves further clinical trials with ADHD.
Collapse
|
33
|
Pillsbury HC, Grose JH, Coleman WL, Conners CK, Hall JW. Binaural function in children with attention-deficit hyperactivity disorder. ARCHIVES OF OTOLARYNGOLOGY--HEAD & NECK SURGERY 1995; 121:1345-50. [PMID: 7488361 DOI: 10.1001/archotol.1995.01890120005001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To evaluate the basic binaural function of children with attention-deficit hyperactivity disorder (ADHD). DESIGN Case-control study. Measures of binaural function were compared for children with and without ADHD. SUBJECTS Forty-two children; 26 had ADHD and 16 were normal controls. INTERVENTIONS None. RESULTS For detection tasks, no differences were seen between children with ADHD and controls. For speech recognition tasks, the younger children with ADHD did not perform as well as the controls. CONCLUSIONS Younger children with ADHD might have a reduced processing efficiency for signal recognition in certain types of noise, but not for signal detection.
Collapse
|
34
|
Richters JE, Arnold LE, Jensen PS, Abikoff H, Conners CK, Greenhill LL, Hechtman L, Hinshaw SP, Pelham WE, Swanson JM. NIMH collaborative multisite multimodal treatment study of children with ADHD: I. Background and rationale. J Am Acad Child Adolesc Psychiatry 1995; 34:987-1000. [PMID: 7665456 DOI: 10.1097/00004583-199508000-00008] [Citation(s) in RCA: 189] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE The National Institute of Mental Health's recently initiated 5-year, multisite, multimodal treatment study of children with attention-deficit hyperactivity disorder (MTA) is the first major clinical trial in its history focused on a childhood mental disorder. This article reviews the major scientific and clinical bases for initiating the MTA. METHOD A selective review of the literature is presented in the service of describing the estimated prevalence of ADHD among children and adolescents, its core clinical features, evidence concerning psychopharmacological and psychosocial treatment effects, and related research issues and trends leading to the development of the MTA. RESULTS Despite decades of treatment research and clinical practice, there is an insufficient basis for answering the following manifold question: under what circumstances and with what child characteristics (comorbid conditions, gender, family history, home environment, age, nutritional/metabolic status, etc.) do which treatments or combinations of treatment (stimulants, behavior therapy, parent training, school-based intervention) have what impacts (improvement, stasis, deterioration) on what domains of child functioning (cognitive, academic, behavioral, neurophysiological, neuropsychological, peer relations, family relations), for how long (short versus long term), to what extent (effect sizes, normal versus pathological range), and why (processes underlying change)? CONCLUSIONS The important scientific, clinical, and public health issues nested within this manifold question provide both the impetus and scaffolding for the MTA.
Collapse
|
35
|
Shaffer D, Schwab-Stone M, Fisher P, Cohen P, Piacentini J, Davies M, Conners CK, Regier D. The Diagnostic Interview Schedule for Children-Revised Version (DISC-R): I. Preparation, field testing, interrater reliability, and acceptability. J Am Acad Child Adolesc Psychiatry 1993; 32:643-50. [PMID: 8496128 DOI: 10.1097/00004583-199305000-00023] [Citation(s) in RCA: 370] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To describe the history and assessment strategies used to investigate and revise the Diagnostic Interview Schedule for Children (DISC), a highly structured interview form used by lay interviewers to elicit diagnostic criteria for the common psychiatric disorders of childhood and adolescence. METHOD Revision was based on clinical and community data that identified unreliable and undiscriminating items in an earlier version of the instrument (DISC-1). A field study was carried out with 74 parent-child pairs. Interrater reliability and acceptability to patients was high. Accompanying papers describe the test-retest and construct validity of the instrument. CONCLUSIONS Taken together, the findings suggest that the DISC is an acceptable, brief, inexpensive, and convenient instrument for ascertaining a comprehensive range of child and adolescent diagnoses whose methodological properties are comparable with other child diagnostic instruments.
Collapse
|
36
|
Conners CK. Methodology of antidepressant drug trials for treating depression in adolescents. J Child Adolesc Psychopharmacol 1992; 2:11-22. [PMID: 19630618 DOI: 10.1089/cap.1992.2.11] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
ABSTRACT Despite the sophistication of the currently available studies on antidepressant treatment of adolescent depression, various methodological problems limit the conclusions that can be drawn. It is difficult to evaluate trends across the available studies because of differences in definitions of treatment response, therapeutic response and placebo response rates, symptomatic subtypes of depression, comorbidity, drugs studied, and study designs that limit the statistical power to detect treatment effects. Some fundamental issues concern the sample selection and reliability of the measurement instruments, as well as the assumption that efficacy of antidepressants in adults is easy to demonstrate. None of the studies now available carefully examine behavioral, social, or academic variables that clinicians commonly use to assess antidepressant effects in adolescents. Before concluding that antidepressants are less effective in treating depression in adolescents than in adults, these methodological issues need further study. The main problem is not merely the small number of studies or low number of subjects. Until the validity of the diagnostic construct of depression in adolescents is better developed, or until more homogeneous samples of patients can be defined, it is pointless to encourage further attempts to assess antidepressant efficacy using the past methodologies.
Collapse
|
37
|
Grundfast KM, Berkowitz RG, Conners CK, Belman P. Complete evaluation of the child identified as a poor listener. Int J Pediatr Otorhinolaryngol 1991; 21:65-78. [PMID: 1709922 DOI: 10.1016/0165-5876(91)90061-f] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
With increasing awareness among educators of the importance of early identification of hearing impairment, growing numbers of children are being referred for evaluation when a teacher or day care supervisor perceives that a child is having difficulty listening. Some children who manifest difficulty listening in a pre-school play group or the classroom may have conductive or sensorineural hearing loss, while others have normal hearing with an underlying and yet-to-be-detected behavioral or psychoeducational disorder. This report presents suggestions for evaluation of the child referred for difficulty listening. The otologist should consider that a child may have an attention deficit disorder when results of initial audiologic assessment indicate there is no hearing loss or when the degree of hearing loss appears to be small in relation to the degree of inattentiveness that has been observed. The features of Attention-deficit Hyperactivity Disorder (ADHD) and Specific Developmental Disorder (SDD) are described, and illustrative case studies are presented. Clues to diagnosis are provided and a distinction between overlapping disorders is made.
Collapse
|
38
|
Achenbach TM, Conners CK, Quay HC, Verhulst FC, Howell CT. Replication of empirically derived syndromes as a basis for taxonomy of child/adolescent psychopathology. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 1989; 17:299-323. [PMID: 2754115 DOI: 10.1007/bf00917401] [Citation(s) in RCA: 139] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
To advance the empirical identification of child/adolescent syndromes, principal components analyses were performed on four sets of parents' ratings of 8,194 6- to 16-year-olds referred to American and Dutch mental health services. The following syndromes replicated well for both sexes at ages 6-16: Aggressive, Anxious/Depressed, Attention Problems, Delinquent, Somatic Complaints, and Withdrawn. For both age ranges, a syndrome designated as Socially Inept replicated well among boys, and one designated as Mean replicated well among girls. Evidence was also found for a Schizoid syndrome in all sex/age groups and a Sex Problems syndrome among girls at ages 6-11. Syndrome scores discriminated well between nationwide normative and clinical samples. The replicated syndromes contribute to the empirical basis for a taxonomy of the kinds of disorders commonly seen between the ages of 6 and 16.
Collapse
|
39
|
Blouin AG, Conners CK, Seidel WT, Blouin J. The independence of hyperactivity from conduct disorder: methodological considerations. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 1989; 34:279-82. [PMID: 2736472 DOI: 10.1177/070674378903400403] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
It has been claimed that the childhood behavioural factors "hyperactivity" and "conduct disorder" are highly correlated. The fact that hyperactive symptoms load heavily on the conduct disorder factor has also been used to support the notion that hyperactivity is not an independent behavioural dimension. The present study employs a large sample of combined clinic and normal children to demonstrate that both of these observations are artifacts of methodological technique. When factor score coefficients are used to interpret factors, the hyperactive symptoms do not load on the conduct disorder factor. If factor scores are defined by the use of unit weights, as in previous studies, then the intercorrelation between the hyperactive and conduct disorder factors is high. The use of factor score coefficients to define factors, on the other hand, produces uncorrelated factors. The results support the idea that hyperactivity and conduct disorder are independent behavioural dimensions.
Collapse
|
40
|
Bock GH, Conners CK, Ruley J, Samango-Sprouse CA, Conry JA, Weiss I, Eng G, Johnson EL, David CT. Disturbances of brain maturation and neurodevelopment during chronic renal failure in infancy. J Pediatr 1989; 114:231-8. [PMID: 2464681 DOI: 10.1016/s0022-3476(89)80788-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Fifteen infants with moderate to severe congenital renal disease were prospectively studied by serial renal, neurodevelopmental, neurophysiologic, and anthropometric assessments. The observation period ranged from 3 to 25 months (mean = 10.9). Eight patients maintained a Mental Development Index (MDI) above the 16th percentile (greater than -1 SD) and comprised group 1. Of the remaining seven patients (group 2), three had an MDI less than 16th percentile when first studied and four had serial decreases of the MDI to less than 16th percentile. Although motor development was more delayed in group 2 at study entry, there were no significant changes of motor performance levels for either group during the study period. Group 2 patients had smaller length (p less than 0.05) and head circumference (p less than 0.05) standard deviation scores in comparison with group 1, and they had higher serum creatinine values (mean = 3.8 vs 1.3 mg/dl, respectively; p less than 0.01). By spectral electroencephalography, the expected progressive increase of the frequency of cerebral cortical background activity with age was demonstrated in group 1 but was not seen in group 2 (multivariate analysis of variance p less than 0.03). This increase of faster-frequency activity was primarily manifested in the left cerebral hemisphere of group 1 patients (p less than 0.01), a finding that was also absent in group 2. The frequent occurrence of neurodevelopmental abnormalities in infants with renal failure is possibly a consequence of impaired dominant hemispheric maturation in the first several years of life, which is clinically manifested as deterioration of cognitive function.
Collapse
|
41
|
Conners CK, Reader M, Reiss A, Caldwell J, Caldwell L, Adesman A, Mayer L, Berg M, Clymer R, Erwin R. The effects of piracetam upon visual event-related potentials in dyslexic children. Psychophysiology 1987; 24:513-21. [PMID: 3685231 DOI: 10.1111/j.1469-8986.1987.tb00328.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
|
42
|
Wilsher CR, Bennett D, Chase CH, Conners CK, DiIanni M, Feagans L, Hanvik LJ, Helfgott E, Koplewicz H, Overby P. Piracetam and dyslexia: effects on reading tests. J Clin Psychopharmacol 1987; 7:230-7. [PMID: 3305591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Previous research has suggested that dyslexics treated with piracetam have shown improvements in reading skills, verbal memory and verbal conceptualizing ability, feature analysis, and processing of letter-like stimuli. Two hundred twenty-five dyslexic children between the ages of 7 years 6 months and 12 years 11 months whose reading skills were significantly below their intellectual capacity were enrolled in a multicenter, 36-week, double-blind, placebo-controlled study. Children of below average intelligence, with abnormal findings on audiologic, ophthalmologic, neurologic, psychiatric, and physical examinations, who were emotionally disturbed or educationally deprived and who had recently been treated with psychoactive medication were excluded from the trial. Piracetam was well tolerated, with no serious adverse clinical or laboratory effects reported. Piracetam-treated children showed significant improvements in reading ability (Gray Oral Reading Test) and reading comprehension (Gilmore Oral Reading Test). Treatment effects were evident after 12 weeks and were sustained for the total period (36 weeks).
Collapse
|
43
|
Hamlett KW, Pellegrini DS, Conners CK. An investigation of executive processes in the problem-solving of attention deficit disorder-hyperactive children. J Pediatr Psychol 1987; 12:227-40. [PMID: 2886575 DOI: 10.1093/jpepsy/12.2.227] [Citation(s) in RCA: 53] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
|
44
|
Conners CK, Blouin AG, Winglee M, Lougee L, O'Donnell D, Smith A. Piracetam and event-related potentials in dyslexic males. Int J Psychophysiol 1986; 4:19-27. [PMID: 3522507 DOI: 10.1016/0167-8760(86)90047-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The effect of piracetam on visual event-related potentials (ERP) was investigated in a double-blind placebo-controlled study. Eight- to 12-year-old dyslexic males were randomly assigned to 3.3 g/day of piracetam or matching placebo in two divided doses over a 12-week period. Children performed a vigilance task in which they pressed a key when two alphabetic letters or shapes occurred in sequence. ERPs to letters and shapes, for active and passive responses, were recorded at the vertex and left and right parietal areas of the scalp. Performance measures included letter- and form-hits, misses, commission errors and reaction times. Piracetam increased the amplitude of a late positive component (believed to correspond to P300) at the vertex for letter-hits. Piracetam also increased the latency of this component in both hemispheres, but only for active responses (letter-hits) in the left hemisphere and passive responses (correct rejections and misses) in the right hemisphere. Although piracetam did not significantly affect performance, reaction time to letter-hits was significantly correlated with the latency of the P300 component, suggesting that letters created increased effort or attentional demand on the subjects compared with forms. An early ERP component (P225) also showed increased amplitude to piracetam in both hemispheres and effects were limited to form-hits. These effects were thought to possibly reflect slow negative potentials arising from stimulus anticipation in the CNV-like paradigm. In view of the small sample size, the results were cautiously interpreted as indicating a facilitation of verbal processing mechanisms responsible for analyzing the verbal significance of visual stimuli.
Collapse
|
45
|
Schwab EK, Conners CK. Nutrient-behavior research with children: methods, considerations, and evaluation. JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 1986; 86:319-24. [PMID: 3512667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Diet-behavior research with children formerly focused on effects of diet regimens, as with additive-free diets for hyperactivity. However, an important new area of investigation includes studies of the immediate effects of individual nutrients, such as sugar, on the behavior and cognition of children. Studies of this type use methods from a variety of disciplines. Competence in the fields of nutrition, behavior, neurochemistry, and metabolism is required to perform the studies. Important components of nutrient-behavior studies include the study hypothesis and subject description (including recruitment and selection). Aspects of the food challenge to consider are challenge formulation, dosage, carrier, background dietary variables, and challenge administration schedule. Dependent measures that are used frequently in the studies include observations of behavior, rating scales, activity monitoring, biochemical measures, laboratory tests of performance and attention, tests of cognitive function, and measures of mood. Familiarity with each of the components and use of specific evaluation guidelines will enable nutrition professionals to critically evaluate the studies.
Collapse
|
46
|
Di Ianni M, Wilsher CR, Blank MS, Conners CK, Chase CH, Funkenstein HH, Helfgott E, Holmes JM, Lougee L, Maletta GJ. The effects of piracetam in children with dyslexia. J Clin Psychopharmacol 1985; 5:272-8. [PMID: 3900148 DOI: 10.1097/00004714-198510000-00004] [Citation(s) in RCA: 37] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Following previous research which suggests that piracetam improves performance on tasks associated with the left hemisphere, a 12-week, double-blind, placebo-controlled study of developmental dyslexics was conducted. Six study sites treated 257 dyslexic boys between the ages of 8 and 13 years who were significantly below their potential in reading performance. Children were of at least normal intelligence, had normal findings on audiologic, ophthalmologic, neurologic, and physical examination, and were neither educationally deprived nor emotionally disturbed. Piracetam was found to be well tolerated in this study population. Children treated with piracetam showed improvements in reading speed. No other effects on reading were observed. In addition, improvement in auditory sequential short-term memory was observed in those piracetam-treated patients who showed relatively poor memory at baseline. It is suggested that longer term treatment with piracetam may result in additional improvements.
Collapse
|
47
|
Chatoor I, Schaefer S, Dickson L, Egan J, Conners CK, Leong N. Pediatric assessment of non-organic failure to thrive. Pediatr Ann 1984; 13:844, 847-8, 850. [PMID: 6514431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
|
48
|
Feinstein C, Blouin AG, Egan J, Conners CK. Depressive symptomatology in a child psychiatric outpatient population: correlations with diagnosis. Compr Psychiatry 1984; 25:379-91. [PMID: 6467918 DOI: 10.1016/0010-440x(84)90073-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
|
49
|
Delamater AM, Conners CK, Wells KC. A comparison of staff training procedures. Behavioral applications in the child psychiatric inpatient setting. Behav Modif 1984; 8:39-58. [PMID: 6477388 DOI: 10.1177/01454455840081003] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The present study sought to determine the most efficient means of staff management by comparing three training procedures: (1) in-service training, using Brown and Presbie's (1974) Behavior Modification Skills, (2) direct feedback of actual staff performance, and (3) role-playing, involving instruction, modeling, behavioral rehearsal, feedback, and reinforcement with an experienced behavior therapist. Direct naturalistic observational procedures were used to obtain behavioral data to eight staff members' (nurses and aides) interactions with children on an inpatient psychiatric unit. The phases of the study, which spanned twenty-one weeks, included: baseline 1, in-service training, in-service plus direct feedback (administered sequentially across subjects), baseline 2, and role-playing. Results indicated that (1) the in-service training had little effect on staff behavior, (2) direct feedback in some cases resulted in increased frequency of appropriate staff responding, including greater use of positivereinforcement and vocalizations, but these gains were not maintained across time, and (3) the greatest gains in staff behavior occurred as a result of role-playing. These results are discussed in terms of both the specific advantages anddisadvantages of each of the training procedures, and the practicality and political issues involved.
Collapse
|
50
|
Horn WF, Chatoor I, Conners CK. Additive effects of dexedrine and self-control training. A multiple assessment. Behav Modif 1983; 7:383-402. [PMID: 6679303 DOI: 10.1177/01454455830073006] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The present study reports the use of a single-case experimental design in examining the additive effects of psychostimulant medication (Dexedrine) and self-control training with a 9-year-old psychiatric inpatient diagnosed as hyperactive. Over a 10-week period, Dexedrine was systematically applied and withdrawn during the absence and presence of self-control procedures. Dependent measures included direct behavioral observation, teacher ratings of hyperactivity, laboratory tests of cognitive performance, and academic achievement measures. Results demonstrated that a combination of Dexedrine and self-control training was more effective than either Dexedrine alone or self-control training plus placebo in (1) increasing on-task behavior in the classroom (as measured by direct classroom observations) and (2) decreasing the teacher's reports of hyperactivity and distractability. Results also demonstrated that Dexedrine, but not self-control training, was effective in increasing attention and decreasing impulsive responding as measured by the Continuous Performance Test. However, only direct reinforcement for correct responses was found to improve (1) performance on measures of spelling and math performance and (2) performance on the Matching Familiar Figures Test. Implications for treatment of children with attention deficit disorders are discussed.
Collapse
|