Development and functional significance of private speech among attention-deficit hyperactivity disordered and normal boys

Task difficulty and private speech in typically developing and at-risk preschool children

Private speech is a cognitive tool to guide thinking and behavior, yet its regulatory use in atypical development remains equivocal. This study investigated the influence of task difficulty on private speech in preschool children with attention or language difficulties. Measures of private speech use, form and content were obtained while 52 typically developing and 25 developmentally at-risk three- to four-year-old children completed Duplo construction and card sort tasks, each comprising two levels of challenge. In line with previous research, developmentally at-risk children used less internalized private speech than typically developing peers. However, both typically developing and at-risk children demonstrated a similar regulatory private speech response to difficulty with no systematic evidence of group difference. This was captured by an increase in all utterances, reduced private speech internalization, and more frequent forethought and self-reflective content. Results support the hypothesis of delayed private speech internalization but not regulatory deviance in atypical development.

Executive Function and Attention Performance in Children with ADHD: Effects of Medication and Comparison with Typically Developing Children

The emerging literature reports that children with Attention-Deficit/Hyperactivity Disorder (ADHD) show deficits in executive functioning. To date, the combination of drug therapy with certain evidence-based non-medication interventions has been proven to be the most effective treatment for ADHD. There is a gap in the literature regarding comparing the executive functions (EF) of treatment naïve and medicated children with ADHD with both each other and typically developing children. Altogether, 50 treatment naïve and 50 medicated children with ADHD and 50 typically developing children between the ages of six and 12 were enrolled. The Mini International Neuropsychiatric Interview for Children and Adolescents (Mini Kid) and the Test of Attentional Performance for Children (KiTAP) measures were employed. Treatment naïve children with ADHD showed weaker performance on most executive function measures (12 out of 15) than either the medicated ADHD group or the controls. There were no significant differences between the medicated ADHD children and typically developing children in most KiTAP parameters (10 out of 15). Executive function impairments were observable in treatment naïve ADHD children, which draws attention to the importance of treating ADHD. Future studies should focus on the specific effects of stimulant medication on executive functions.

Shyness, Self-regulation, and Cognitive Problem Solving in Typically Developing 4-year-olds: A Pilot Study

Because shy children are at risk for poor academic achievement, it is important to examine factors that contribute to variability in the relation between individual differences in shyness and cognitive functioning before school entry. The authors examined whether on-task facilitative private speech-a proxy of self-regulation-moderated the association between individual differences in shyness and performance on an executive function (EF) task in 52 typically developing 4-year-olds. They found that private speech interacted with shyness to predict performance on the EF task in girls but not in boys. More specifically, shyness was inversely related to EF task performance when girls used low amounts of regulatory private speech, but was positively related to performance when girls used high amounts of regulatory private speech. These preliminary findings are discussed in the context of implications for shy children in educational settings.

Self-directed speech and self-regulation in childhood neurodevelopmental disorders: Current findings and future directions

Self-directed speech is considered an important developmental achievement as a self-regulatory mediator of thinking and behavior. Atypical self-directed speech is often implicated in the self-regulatory challenges characteristic of children with neurodevelopmental disorders. A growing body of evidence provides snapshots across age-levels and diagnoses, often presenting conflicting results. This systematic review is undertaken to impose clarity on the nature, extent, and self-regulatory implications of self-directed speech interruption in children with developmental language disorder (DLD), autism spectrum disorder (ASD), and attention deficit hyperactivity disorder (ADHD).A rigorous search process of relevant databases (i.e., PsychInfo, PubMed, CINAHL, ERIC) uncovered 19 relevant peer-reviewed articles that investigate self-directed speech in children with neurodevelopmental disorders. Consistent across the research, children with DLD, ASD, and ADHD present with differential development and use of self-directed speech.In its synthesis of findings, this systematic review clearly explicates the differential ontogenesis of self-directed speech in neurodevelopmental disorders and interprets the self-regulatory implications for children with DLD, ASD, and ADHD. Furthermore, the review spotlights important future research directions to better understand the mechanistic relationship between self-directed speech and self-regulation.

Inhibitory control in typically developing preschoolers: Relations among temperament, respiratory sinus arrhythmia, and behavior at age 4

Although inhibitory control (IC) is associated with children's positive adjustment, we know relatively little about factors underlying its development. We examined whether baseline and on-task respiratory sinus arrhythmia [(RSA); a physiological measure of self-regulation] and private speech (a behavioral measure of self-regulation) interacted to confer differences on directly observed IC in 52 typically developing 4-year olds. We found that baseline RSA moderated the association between private speech and IC, such that private speech positively predicted IC in children with relatively higher baseline RSA, but was unrelated to IC in children with relatively lower RSA. We also found that children with a concordant physiological-behavioral pattern (i.e., high RSA and high private speech; low RSA and low private speech) had higher IC, higher effortful control, and lower negative emotionality than those with a discordant physiological-behavioral pattern (i.e., high RSA and low private speech; low RSA and high private speech). Individual differences in physiological and behavioral self-regulation indices may represent distinct regulation pathways that interact to confer differences in IC during the preschool years.

Working memory and organizational skills problems in ADHD

BACKGROUND

This study tested model-driven predictions regarding working memory's role in the organizational problems associated with ADHD.

METHOD

Children aged 8-13 (M = 10.33, SD = 1.42) with and without ADHD (N = 103; 39 girls; 73% Caucasian/Non-Hispanic) were assessed on multiple, counterbalanced working memory tasks. Parents and teachers completed norm-referenced measures of organizational problems (Children's Organizational Skills Scale; COSS).

RESULTS

Results confirmed large magnitude working memory deficits (d = 1.24) and organizational problems in ADHD (d = 0.85). Bias-corrected, bootstrapped conditional effects models linked impaired working memory with greater parent- and teacher-reported inattention, hyperactivity/impulsivity, and organizational problems. Working memory predicted organization problems across all parent and teacher COSS subscales (R2  = .19-.23). Approximately 38%-57% of working memory's effect on organization problems was conveyed by working memory's association with inattentive behavior. Unique effects of working memory remained significant for both parent- and teacher-reported task planning, as well as for teacher-reported memory/materials management and overall organization problems. Attention problems uniquely predicted worse organizational skills. Hyperactivity was unrelated to parent-reported organizational skills, but predicted better teacher-reported task planning.

CONCLUSIONS

Children with ADHD exhibit multisetting, broad-based organizational impairment. These impaired organizational skills are attributable in part to performance deficits secondary to working memory dysfunction, both directly and indirectly via working memory's role in regulating attention. Impaired working memory in ADHD renders it extraordinarily difficult for these children to consistently anticipate, plan, enact, and maintain goal-directed actions.

Overdiagnosis and Medication for Attention-Deficit Hyperactivity Disorder in Children with Cleft: Diagnostic Examination and Follow-Up

Objective

To examine the diagnosis of attention-deficit hyperactivity disorder (ADHD) in children with cleft to determine whether language-learning characteristics are taken into account when making this diagnosis.

Design

Prospective examination of 177 consecutive patients. Objective behavioral ratings, cognitive assessments, and attention/impulsivity testing of 32 of the 177 children with nonsyndromic cleft lip and palate (CLP) who had previously been diagnosed as ADHD and were receiving medication were performed. the prospective 6- to 9-month follow-up examination was examined to determine the accuracy of prior and posttest diagnoses.

Setting

University hospital-based cleft palate clinic.

Main Outcome Measures

Pretest/posttest design to determine accuracy of DSM-IV psychiatric diagnosis.

Results and Conclusions

The results show that the proportion of children originally diagnosed with ADHD (18%) was significantly higher than posttest diagnosis of ADHD (6% p < .001). Also, the frequency of pretest diagnosis of learning disorder (LD; 31%) was significantly different from posttest diagnosis (66% p < .01). The overdiagnosis of ADHD and underdiagnosis of LD in this sample of children with nonsyndromic unilateral cleft lip and palate appears to be due to lack of language-learning assessment.

An exploration of sarcasm detection in children with Attention Deficit Hyperactivity Disorder

The present research explored the ability of children with ADHD to distinguish between sarcasm and sincerity. Twenty-two children with a clinical diagnosis of ADHD were compared with 22 age and verbal IQ matched typically developing children using the Social Inference-Minimal Test from The Awareness of Social Inference Test (TASIT, McDonald, Flanagan, & Rollins, 2002). This test assesses an individual's ability to interpret naturalistic social interactions containing sincerity, simple sarcasm and paradoxical sarcasm. Children with ADHD demonstrated specific deficits in comprehending paradoxical sarcasm and they performed significantly less accurately than the typically developing children. While there were no significant differences between the children with ADHD and the typically developing children in their ability to comprehend sarcasm based on the speaker's intentions and beliefs, the children with ADHD were found to be significantly less accurate when basing their decision on the feelings of the speaker, but also on what the speaker had said. Results are discussed in light of difficulties in their understanding of complex cues of social interactions, and non-literal language being symptomatic of children with a clinical diagnosis of ADHD. The importance of pragmatic language skills in their ability to detect social and emotional information is highlighted.

Chronic hepatitis C virus infection and neurocognitive function in adult survivors of childhood cancer

BACKGROUND

Cancer survivors transfused with blood products before reliable screening for hepatitis C virus (HCV) are at risk for infection. This study examined the impact of HCV on neurocognitive function and health-related quality of life (HRQOL) among adult survivors of childhood cancer.

METHODS

Neurocognitive testing was conducted for 836 adult survivors of childhood cancer (mean age, 35 years [standard deviation, 7.4 years]; time since diagnosis, 29 years [standard deviation, 6.2 years]) who received blood products before universal HCV screening. No differences were observed between confirmed HCV-seropositive survivors (n = 79) and HCV-seronegative survivors (n = 757) in the primary diagnosis or neurotoxic therapies. Multivariate regression models were used to compare functional outcomes between seropositive and seronegative survivors.

RESULTS

Compared with seronegative survivors, seropositive survivors demonstrated lower performance on measures of attention (P < .001), processing speed (P = .008), long-term verbal memory (P = .01), and executive function (P = .001). After adjustments for sex, age at diagnosis, and treatment exposures, seropositive survivors had a higher prevalence of impairment in processing speed (prevalence ratio [PR], 1.3; 95% confidence interval [CI], 1.1-1.6) and executive functioning (PR, 1.3; 95% CI, 1.1-1.6). Differences were not associated with the treatment of HCV or the presence of liver cirrhosis. Seropositive survivors reported worse general HRQOL (PR, 1.6; 95% CI, 1.2-2.1), which was associated with the presence of liver cirrhosis (P = .001).

CONCLUSIONS

Survivors of childhood cancer with a history of HCV infection are at risk for neurocognitive impairment and reduced HRQOL beyond the known risks associated with neurotoxic cancer therapies. Cancer 2017;123:4498-505. © 2017 American Cancer Society.

Verbal Thinking and Inner Speech Use in Autism Spectrum Disorder

The extent to which cognition is verbally mediated in neurotypical individuals is the subject of debate in cognitive neuropsychology, as well as philosophy and psychology. Studying "verbal thinking" in developmental/neuropsychological disorders provides a valuable opportunity to inform theory building, as well as clinical practice. In this paper, we provide a comprehensive, critical review of such studies among individuals with autism spectrum disorder (ASD). ASD involves severe social-communication deficits and limitations in cognitive/behavioural flexibility. The prevailing view in the field is that neither cognition nor behaviour is mediated verbally in ASD, and that this contributes to diagnostic features. However, our review suggests that, on the contrary, most studies to date actually find that among people with ASD cognitive task performance is either a) mediated verbally in a typical fashion, or b) not mediated verbally, but at no obvious cost to overall task performance. Overall though, these studies have methodological limitations and thus clear-cut conclusions are not possible at this stage. The aim of the review is to take stock of existing empirical findings, as well as to help develop the directions for future research that will resolve the many outstanding issues in this field.

Private Speech in the Classroom: The Effects of Activity Type, Presence of Others, Classroom Context, and Mixed-age Grouping

This study addressed the question of how young children's spontaneous use of private speech in the kindergarten classroom varies as a function of contextual variables, such as type of activity, immediate presence of others, degree of teacher-given structure, and classroom age composition. Twenty children from two classrooms (one mixed-age, one same-age) were systematically observed in their regular kindergarten classroom during a period of four weeks, using a time-sampling procedure. Results from ANOVA, chi-square, and logistic regression analyses indicated that young children's use of private speech does vary systematically according to the immediate physical and social context. More specifically, children were found to use more self-regulatory language when they were: (1) engaged in goal-directed task activity, as compared to free play or other activities; (2) in a classroom context which provided an intermediate degree of teacher regulation, compared to contexts in which either very little or a great deal of external structure was present; and (3) with their younger classmates, compared to either their same-age or older peers. No differences in overall private speech usage were found between the mixed-age and same-age classes. Frequency of private speech did not vary significantly depending on whether children were alone, with other children, or with adults. Classroom contexts vary in the degree to which they promote self-direction. This study suggests that if one is interested in fostering young children's development of self-regulation or in observing children's use of private speech, the optimum context is one which provides an intermediate amount of structure and allows children to spontaneously engage in challenging goal-directed activity.

The North American Perspective On Attention Deficit Hyperactivity Disorder

The purpose of the present paper is to (1) provide an overview of the nature of attention-deficit hyperactivity disorder (ADHD) as it seems to be viewed by North American clinicians and clinical scientists; (2) describe its diagnostic criteria as they are applied in that region; (3) discuss the prevalence of ADHD in the region; and (4) briefly present a new theoretical model of the authors emerging from that North American perspective. Some of the critical issues related to these matters will be raised along the way. Given the thousands of scientific papers on this topic, however, an overview of these various topics is all that space here can afford. Readers wishing a more thorough treatment of these topics as well as those pertaining to history, developmental courses, associated risks, assessment, and treatments for ADHD are directed to other writings by the author (Barkley, 1990).

Inner Speech: Development, Cognitive Functions, Phenomenology, and Neurobiology

Inner speech-also known as covert speech or verbal thinking-has been implicated in theories of cognitive development, speech monitoring, executive function, and psychopathology. Despite a growing body of knowledge on its phenomenology, development, and function, approaches to the scientific study of inner speech have remained diffuse and largely unintegrated. This review examines prominent theoretical approaches to inner speech and methodological challenges in its study, before reviewing current evidence on inner speech in children and adults from both typical and atypical populations. We conclude by considering prospects for an integrated cognitive science of inner speech, and present a multicomponent model of the phenomenon informed by developmental, cognitive, and psycholinguistic considerations. Despite its variability among individuals and across the life span, inner speech appears to perform significant functions in human cognition, which in some cases reflect its developmental origins and its sharing of resources with other cognitive processes.

Associations between private speech, behavioral self-regulation, and cognitive abilities

We examined the associations between 5-year-old children’s private speech, behavioural self-regulation, and cognitive abilities. Behavioural self-regulation was assessed using parental and preschool teacher questionnaires. Cognitive abilities (i.e., language, inhibition, planning and fluency, and memory) were assessed with neurocognitive tests, and the effectiveness of private speech (i.e., whether the child performs better when using speech than when not using speech) with the Hammer Task. About 43% of the children used private speech spontaneously, and about 76% performed better on the Hammer Task when they used speech. Associations between behavioural self-regulation and speech effectiveness were few, but all cognitive scores were significantly associated with the speech effectiveness score, i.e., the poorer the child’s neurocognitive test performance was, the more he/she benefited from using speech. The findings lend support to the relevance of children’s cognitive abilities when seeking understanding on the development, use, and effectiveness of private speech.

Pragmatic deficits and social impairment in children with ADHD

BACKGROUND

Impaired social functioning has been well documented in individuals with attention-deficit/hyperactivity disorder (ADHD). Existing treatments for ADHD are effective for managing core symptoms, but have limited effectiveness at improving social skills, suggesting that social deficits in ADHD may not be directly related to core symptoms of the disorder. Language problems are also common in ADHD, with accumulating evidence of pragmatic language difficulties. Pragmatic deficits are associated with social impairment in several neurodevelopmental disorders. This study systematically examined pragmatic language functioning in children with ADHD and whether social impairment in ADHD is mediated by pragmatic deficits.

METHOD

Sixty-three children (28 ADHD; 35 typically developing), ages 7-11 years, underwent a comprehensive assessment of pragmatic language, including parent ratings, standardized tests, and a narrative task. Parents also rated children's social skills on the Social Skills Improvement System.

RESULTS

Children with ADHD had poorer pragmatic language skills relative to peers across all measures, even after controlling for general language abilities. Furthermore, pragmatic abilities as measured by parent ratings, mediated the relation between ADHD and social skills.

CONCLUSIONS

Pragmatic language skills are impaired in many children with ADHD and may partially account for high rates of social impairment. Implications for treatment and possible prevention of social problems in children with ADHD are discussed.

Individual differences in children's private speech: the role of imaginary companions

Relations between children's imaginary companion status and their engagement in private speech during free play were investigated in a socially diverse sample of 5-year-olds (N=148). Controlling for socioeconomic status, receptive verbal ability, total number of utterances, and duration of observation, there was a main effect of imaginary companion status on type of private speech. Children who had imaginary companions were more likely to engage in covert private speech compared with their peers who did not have imaginary companions. These results suggest that the private speech of children with imaginary companions is more internalized than that of their peers who do not have imaginary companions and that social engagement with imaginary beings may fulfill a similar role to social engagement with real-life partners in the developmental progression of private speech.

Signed soliloquy: visible private speech

Talking to oneself can be silent (inner speech) or vocalized for others to hear (private speech, or soliloquy). We investigated these two types of self-communication in 28 deaf signers and 28 hearing adults. With a questionnaire specifically developed for this study, we established the visible analog of vocalized private speech in deaf signers. "Signed soliloquy" is employed regularly and valued as an integral part of everyday functioning. Deaf signers were also found to engage in inner speech, which appeared to have a mostly affirmative character. Together, the findings demonstrate a significantly more frequent use of both inner and private speech in the deaf sample. They underscore the benefits of self-talk in general and provide the first-ever description of an intriguing phenomenon in deaf signers' self-communication, that is, signed soliloquy.

Verbal Mediation of Problem Solving in Pre-Primary and Junior Primary School Children

Human ontogeny entails the construction and use of semiotic mediational means to regulate psychological functions intrapersonally and interpersonally. In the Vygotskyan school of thought, speech is regarded as both a mediatory tool and a mediated higher mental function and, as such, is considered central to the development of children's cognition. Grounded in Vygotsky's work on speech as an instrument of thought, this study examined the dynamics of verbal mediation of children's problem solving with specific focus on the use of social, private and inner speech. The study investigated the incidence and semantic composition of speech produced during problem solving and delineated the age related changes of the semantic profile of private speech in relation to social speech and inner speech. A total of 120 children, aged from 5 years, 6 months to 9 years, 5 months, with equal distribution of boys and girls, completed the Raven's Coloured Progressive Matrices. The participants within the four age groups were of different ethnic origin but all spoke English as their first language. The results indicated that children relied extensively on all three types of speech and that the semantic content of both social and private speech was primarily task-oriented. Unlike social speech, private speech presented with a dual, cognition-centred and emotions-centred semantic profile, in which complex age-related changes, as shown by a one-way MANCOVA, permeated children's verbal denotations of salient task-related dynamics. Importantly, significations of emotional processes featured consistently in the content composition of private speech and showed a steady age-related occurrence. It was concluded that verbal mediation of children's problem solving is multimodal, multifocal and multidirectional.

The dual loop model: its relation to language and other modalities

The current neurobiological consensus of a general dual loop system scaffolding human and primate brains gives evidence that the dorsal and ventral connections subserve similar functions, independent of the modality and species. However, most current commentators agree that although bees dance and chimpanzees grunt, these systems of communication differ qualitatively from human language. So why is language unique to humans? We discuss anatomical differences between humans and other animals, the meaning of lesion studies in patients, the role of inner speech, and compare functional imaging studies in language with other modalities in respect to the dual loop model. These aspects might be helpful for understanding what kind of biological system the language faculty is, and how it relates to other systems in our own species and others.

Self-directed speech affects visual search performance

People often talk to themselves, yet very little is known about the functions of this self-directed speech. We explore effects of self-directed speech on visual processing by using a visual search task. According to the label feedback hypothesis (Lupyan, 2007a), verbal labels can change ongoing perceptual processing-for example, actually hearing "chair" compared to simply thinking about a chair can temporarily make the visual system a better "chair detector". Participants searched for common objects, while being sometimes asked to speak the target's name aloud. Speaking facilitated search, particularly when there was a strong association between the name and the visual target. As the discrepancy between the name and the target increased, speaking began to impair performance. Together, these results speak to the power of words to modulate ongoing visual processing.

Memory for object locations in boys with and without ADHD

OBJECTIVE

To determine whether 7- to 12-year-old boys with ADHD, relative to non-ADHD age-mates, exhibit greater difficulty learning and remembering object locations. The second purpose was to examine the functional utility of mnemonic strategies, specifically speech-to-self, used by boys with and without ADHD.

METHOD

Boys with and without ADHD were videotaped while completing a well-established, laboratory-based object location learning and memory task.

RESULTS

Boys with ADHD evinced a deficit while learning the location of objects and employed less sophisticated forms of private speech during the memory task.

CONCLUSION

These findings reveal details about the utility of private speech during spatial working memory performance and further a theoretical understanding of ADHD. (J. of Att. Dis. 2010; 13(5) 505-515).

Extraneous bodily movements and irrelevant vocalizations by dyslexic and non-dyslexic boys during calculation tasks

Thirty dyslexic boys, aged between 9 and 15 years, and 30 age-matched controls were tested on a series of sums involving division, subtraction and addition. During the testing a record was kept of any bodily movements or verbal utterances (vocalizations) irrelevant to the task in hand. It was found that the dyslexics produced many more extraneous bodily movements and many more irrelevant vocalizations than did the controls. Possible reasons for these findings are tentatively suggested.

A Vygotskian critique of self-instructional training

Self-instructional training, a widely used intervention for treating the learning and behavioral difficulties of impulsive, attention deficit-hyperactivity disordered, and learning disabled children, has repeatedly failed to promote self-control or improve academic performance. In light of this failure, we critically examine four assumptions underlying self-instructional training: (a) children with learning and behavior problems show a lack and/or deficient use of self-regulatory private speech; (b) modeling of self-verbalizations will increase children's spontaneous production of private speech; (c) speech and action are intrinsically coordinated; and (d) internalization refers to subvocalization of private speech. We argue that self-instructional training interventions need to be thoroughly grounded in Soviet developmental theory of verbal self-regulation and in systematic research on the social origins and development of children's private speech. A new research agenda is suggested.

Issues of taxonomy and comorbidity in the development of conduct disorder

A developmental approach to the classification of antisocial behavior is necessary for two reasons. First, although the continuity of antisocial behavior is strong for many individuals, the topography of antisocial behavior changes during the course of development. Second, antisocial behavior apparently develops in at least two separate pathways — child-onset versus adolescent-onset — that differ markedly regarding types of antisocial behavior displayed, persistence, and perhaps etiology. The development of antisocial behavior must also be understood within the context of co-occurring disorders and conditions. Comorbid attention-deficit hyperactivity disorder appears to be associated with greater aggression and a worse prognosis, and comorbid academic underachievement is also associated with a negative course. Emerging evidence also suggests that comorbid anxiety disorder is associated with level of aggression, but the direction of the correlation appears to differ at different ages. In all, full understanding of conduct disorder requires developmentally sensitive classification as well as consideration of comorbid conditions.

Private speech and strategy-use patterns: bidirectional comparisons of children with and without mathematical difficulties in a developmental perspective

The present study examines private speech and strategy-use patterns for solving simple number fact problems in addition. The progressive differentiation by grade between children's levels of private speech internalization--including silence--was investigated and related to children's developmental patterns for subcategories of strategy-use internalization. Comparisons were made between 67 children with math difficulties (MD) and 67 children without MD from Grade 2 to Grade 7 in primary schools. Two separate laboratory investigations were performed for each child to examine private speech and strategy-use internalization. Analysis was based on private speech category differences, strategy-use differences, and differences in the occurrence of private speech-strategy-use combinations. Children without MD showed a grade-determined shift from less to more internalized private speech and from the use of backup strategies to retrieval strategies. In contrast, the private speech and the strategy-use internalization of children with MD, reflected in inaudible private speech and backup strategy use, seemed to converge at earlier developmental levels. The development of children with MD seemed almost to stop at the inaudible private speech-backup strategy combination level. The silence-retrieval strategy combination level was the primary alternative for typical math achievers. In all, the characteristics of the development curves of the children with MD were consistent with a developmental difference and not with a developmental delay model. Implications for intervention and future research methodology are discussed.

Private Speech and Executive Functioning among High-Functioning Children with Autistic Spectrum Disorders

Private speech used by high-functioning children with autistic spectrum disorders (ASD) (n = 33) during two executive functioning tasks was compared to that of typically developing children (n = 28), and children with ADHD (n = 21). Children with ASD were as likely as others to talk to themselves and their speech was similarly relevant and likely to appear in moments of task difficulty. Unlike others, children with ASD were more likely to get items correct when they were talking than when they were silent. Group differences in performance were observed when children were silent but not when children were talking. Findings suggest that autistic children talk to themselves in relevant ways during problem-solving and that such speech is helpful in normalizing their executive performance relative to controls.

Performance and private speech of children with attention-deficit/hyperactivity disorder while taking the Tower of Hanoi test: effects of depth of search, diagnostic subtype, and methylphenidate

We administered the Tower of Hanoi to demographically comparable samples of control participants (n = 34) and children with the Combined (n = 22) and Inattentive subtypes (n = 19) of Attention-Deficit/Hyperactivity Disorder (ADHD). Controls excelled over children with the Inattentive subtype, who outperformed patients with the Combined subtype. These results replicated findings of greater executive deficits in the Combined than in the Inattentive type of ADHD. Double-blind administration of methylphenidate improved task performance only for patients with the Inattentive subtype. In a drug-free Baseline session, children with both subtypes of ADHD made more private verbalizations than controls, particularly when failing puzzles. In later sessions, regardless of drug condition, the inattentive sample exhibited a smaller increase in self-regulatory utterances under failure. In contrast, the combined sample decreased self-regulatory verbalizations under failure only under methylphenidate. The results support some differences between the two subtypes of ADHD in executive functioning and in their response to stimulant therapy.

Is there evidence for neural compensation in attention deficit hyperactivity disorder? A review of the functional neuroimaging literature

This article reviews evidence for the presence of a compensatory, alternative, neural system and its possible link to associated processing strategies in children and adults with attention deficit hyperactivity disorder (ADHD). The article presents findings on a region by region basis that suggests ADHD should be characterized not only by neural hypo-activity, as it is commonly thought but neural hyperactivity as well, in regions of the brain that may relate to compensatory brain and behavioral functioning. In this context studies from the functional neuroimaging literature are reviewed. We hypothesize that impaired prefrontal (PFC) and anterior cingulate (ACC) cortex function in ADHD reduces the ability to optimally recruit subsidiary brain regions and strategies to perform cognitive tasks. The authors conclude that healthy individuals can recruit brain regions using visual, spatial or verbal rehearsal for tasks as needed. In contrast, individuals with ADHD may be less able to engage higher order executive systems to flexibly recruit brain regions to match given task demands. This may result in greater reliance on neuroanatomy that is associated with visual, spatial, and motoric processing rather than verbal strategies. The authors speculate that this impaired flexibility in recruiting brain regions and associated strategies limits adaptation to new cognitive demands as they present and may require more effortful processing.

Boys with ADHD in social interaction with a nonfamiliar adult: an observational study

OBJECTIVE

To clarify the nature of social interaction deficits in boys with attention-deficit hyperactivity disorder (ADHD).

METHOD

Twenty Dutch hyperactive boys and 19 peer controls were observed using an ethological method during social interaction with a nonfamiliar adult (a student). Social behavior was operationalized in terms of the duration and frequency of visual and verbal behavior elements and scored during a conversation and a play segment.

RESULTS

During the conversation segment, the boy with ADHD and the student were less socially involved in each other. During the play segment, boys with ADHD talked to themselves more and seemed to direct their attention to the student more than control boys did. The students praised the boys with ADHD more frequently and asked them more questions about their play activities than the control boys.

CONCLUSIONS

Boys with ADHD demonstrate poor social attention during conversation and elicit structure-providing behavior in nonfamiliar adults. It is postulated that poor self-regulatory mechanisms may mediate their social problems.

ADHD outside the laboratory: boys' executive function performance on tasks in videogame play and on a visit to the zoo

One current theory of attention-deficit/hyperactivity disorder (ADHD) proposes that a primary deficit in behavioral inhibition gives rise to secondary deficits in 4 executive functions and motor control. To date, empirical support for this model is based primarily on laboratory-based cognitive methods. This study assessed behavioral inhibition and executive functioning in children with ADHD in 2 real-life contexts: videogames (motor-skill target game, cognitively demanding adventure game) and an outing at the zoo (route tasks). Participants were a community sample of 57 boys diagnosed with ADHD (20 inattentive, 37 combined type) and 57 normally developing control boys, matched individually for age and nonverbal IQ. Operationally defined measures of behavioral inhibition and specific executive functions were derived from these activities and assessed under contrasting conditions of low or high working memory and distractor loads. There were no group differences in basic motor skills on the target game, nor in terms of the ability to inhibit a prepotent or ongoing response in the adventure videogame. However, boys with ADHD exhibited more self-talk, more effortful response preparation, and completed fewer challenges in the latter videogame. Also, they manifested inhibition deficits in terms of interference control during the route task at the zoo and took longer to complete the tasks. Typically, these differences were greatest under conditions of high working memory and distractor loads. Findings from this study suggest that cognitive difficulties in ADHD may be context dependent and that ADHD is associated with deficits in some but not all aspects of behavioral inhibition.

Evolutionary recasting: ADHD, mania and its variants

This paper reviews clinical observations and evolutionary theory in relation to attention deficit hyperactivity disorder (ADHD) on the one hand and mania and its variants on the other. Both groups of disorders resemble each other in regard to high levels of motor activity, perhaps occurring together more often than not, and are confounded in most existing research. Making distinctions requires isolating the contribution of activity level from other characteristics such as those of flawed executive functions for ADHD or grandiosity and lapses in reciprocity for mania. High activity level is an asset throughout nature except in extreme intensities or when it amplifies the characteristics of psychopathology. Fitness, social displays, and behavioral adaptations for survival are clues to some aspects of hypomania and ADHD. While hypomania can be a competitive advantage in certain niches, it appears there can be few opportunities for ADHD to do so. Indeed, the impulsiveness seen in ADHD is probably the outcome of flaws in executive functions rather than being the cause of them. Neither lapses in executive functions nor in reciprocity are apt to be domain general but may interact sharply with each person's repertoire of psychological adaptations. The author submits that a theoretical orientation as outlined here would not only help in better understanding the disorders under consideration, but could be useful in providing new directions to treatment decisions.

Time perception and reproduction in young adults with attention deficit hyperactivity disorder

Adults with attention deficit hyperactivity disorder (ADHD; n = 104) were compared with a control group (n = 64) on time estimation and reproduction tasks. Results were unaffected by ADHD subtype or gender. The ADHD group provided larger time estimations than the control group, particularly at long intervals. This became nonsignificant after controlling for IQ. The ADHD group made shorter reproductions than did the control group (15- and 60-s intervals) and greater reproduction errors (12-, 45-, 60-s durations). These differences remained after controlling for IQ and comorbid oppositional defiant disorder, depression, and anxiety. Only the level of anxiety contributed to errors (at 12-s duration) beyond the level of ADHD. Results extended findings on time perception in ADHD children to adults and ruled out comorbidity as the basis of the errors.

Executive functioning and olfactory identification in young adults with attention deficit-hyperactivity disorder

Young adults with attention deficit-hyperactivity disorder (ADHD; N = 105) were compared with a control group (N = 64) on 14 measures of executive function and olfactory identification using a 2 (group) X 2 (sex) design. The ADHD group performed significantly worse on 11 measures. No Group X Sex interaction was found on any measures. No differences were found in the ADHD group as a function of ADHD subtype or comorbid oppositional defiant disorder. Comorbid depression influenced the results of only 1 test (Digit Symbol). After IQ was controlled for, some group differences in verbal working memory, attention, and odor identification were no longer significant, whereas those in inhibition, interference control, nonverbal working memory, and other facets of attention remained so. Executive function deficits found in childhood ADHD exist in young adults with ADHD and are largely not influenced by comorbidity but may be partly a function of low intelligence.

Preschoolers classified as having attention-deficit hyperactivity disorder (ADHD): DSM-IV symptom endorsement pattern

In the present study, 50 preschoolers were formally and independently classified using both the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) and third edition-revised (DSM-III-R) criteria for attention-deficit hyperactivity disorder (ADHD). The sample consisted of 25 preschoolers classified as having ADHD and 25 typically developing preschoolers for comparison; the sample was matched on gender, age, and socioeconomic status. All 50 preschoolers were without neurologic or neurodevelopmental disorders, oppositional defiant disorder, or language delay. There were four key findings: first, of the 25 preschoolers with ADHD, DSM-IV classification was as follows: hyperactive-impulsivity type (68%), combined type (28%), and inattentive type (4%). Second, the DSM-IV profiles showed that several symptoms were either infrequently endorsed by parents, reflecting limited applicability to preschoolers with ADHD, or frequently endorsed by parents of typically developing preschoolers, thus reducing their diagnostic value. Third, of the 25 preschoolers classified as having ADHD using DSM-IV criteria, 16% would not have been classified as having ADHD using the DSM-III-R criteria. The DSM-IV criteria therefore appear to be more lenient than the DSM-III-R criteria for this age group. Fourth, two symptoms that were not included in the DSM-IV, but were part of the DSM-III-R, were found to have clinical value for differentiating preschoolers with ADHD from their typically developing peers.

Attentional skills following traumatic brain injury in childhood: a componential analysis

Recent research has documented residual deficits in attention following traumatic brain injury in childhood. The present study aimed to investigate whether such deficits are global, or affect specific components of attention differentially. Four attentional domains were examined using a newly developed test of attention, the Test of Everyday Attention for Children: sustained attention, focussed attention, divided attention, and response inhibition. Eighteen children with a history of traumatic brain injury, aged between 8 and 14 years, and 18 non-injured matched controls participated in the study. Results indicated that attentional skills may be differentially impaired after TBI, with children who have sustained moderate-to-severe TBI exhibiting significant deficits for sustained and divided attention, and response inhibition, but relatively intact focussed attention.

Neuropsychological and cognitive psychophysiological substrates of impulsive aggression

The purpose of this study was to test whether subjects who commit impulsive vs non-impulsive aggression differ on measurements of personality, neuropsychology, and cognitive psychophysiology, and whether these differences can yield information regarding the etiology of impulsive aggression. Subjects were two groups of prison inmates, distinguished by their committal of impulsive or nonimpulsive aggression, and matched noninmate controls. All inmates met DSM III-R criteria for an antisocial personality disorder but for no other disorder. Impulsiveness, anger, and peak P300 latencies did not differ between the inmate groups, but verbal symbol decoding and peak P300 amplitudes did. Impulsiveness and verbal skills were inversely correlated. Impulsiveness was inversely correlated with, and verbal skills positively correlated with P300 amplitudes. The results indicate that aggression is not homogenous, even among antisocial persons, and that impulsive aggression is related to neuropsychological and cognitive psychophysiological measures of information processing beyond those factors related to criminality alone.

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

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