Continuities in maternal reports and child behaviors over time in hyperactive and comparison groups

Childhood Physical Health and Attention Deficit/Hyperactivity Disorder: A Systematic Review and Meta-Analysis of Modifiable Factors

Although neurobiologic and genetic factors figure prominently in the development of attention deficit/hyperactivity disorder (ADHD), adverse physical health experiences and conditions encountered during childhood may also play a role. Poor health is known to impact the developing brain with potential lifelong implications for behavioral issues. In attempt to better understand the relationship between childhood physical health and the onset and presence of ADHD symptoms, we summarized international peer-reviewed articles documenting relationships between a select group of childhood diseases or health events (e.g., illnesses, injuries, syndromes) and subsequent ADHD outcomes among children ages 0-17 years. Drawing on a larger two-phase systematic review, 57 longitudinal or retrospective observational studies (1978-2021) of childhood allergies, asthma, eczema, head injury, infection, or sleep problems and later ADHD diagnosis or symptomatology were identified and subjected to meta-analysis. Significant associations were documented between childhood head injuries, infections, and sleep problems with both dichotomous and continuous measures of ADHD, and between allergies with dichotomous measures of ADHD. We did not observe significant associations between asthma or eczema with ADHD outcomes. Heterogeneity detected for multiple associations, primarily among continuously measured outcomes, underscores the potential value of future subgroup analyses and individual studies. Collectively, these findings shed light on the importance of physical health in understanding childhood ADHD. Possible etiologic links between physical health factors and ADHD are discussed, as are implications for prevention efforts by providers, systems, and communities.

Quantifying ADHD classroom inattentiveness, its moderators, and variability: a meta-analytic review

BACKGROUND

Most classroom observation studies have documented significant deficiencies in the classroom attention of children with attention-deficit/hyperactivity disorder (ADHD) compared to their typically developing peers. The magnitude of these differences, however, varies considerably and may be influenced by contextual, sampling, diagnostic, and observational differences.

METHODS

Meta-analysis of 23 between-group classroom observation studies using weighted regression, publication bias, goodness of fit, best case, and original metric analyses.

RESULTS

Across studies, a large effect size (ES = .73) was found prior to consideration of potential moderators. Weighted regression, best case, and original metric estimation indicate that this effect may be an underestimation of the classroom visual attention deficits of children with ADHD. Several methodological factors-classroom environment, sample characteristics, diagnostic procedures, and observational coding schema-differentially affect observed rates of classroom attentive behavior for children with ADHD and typically developing children. After accounting for these factors, children with ADHD were on-task approximately 75% of the time compared to 88% for their classroom peers (ES = 1.40). Children with ADHD were also more variable in their attentive behavior across studies.

CONCLUSIONS

The present study confirmed that children with ADHD exhibit deficient and more variable visual attending to required stimuli in classroom settings and provided an aggregate estimation of the magnitude of these deficits at the group level. It also demonstrated the impact of situational, sampling, diagnostic, and observational variables on observed rates of on-task behavior.

Agreement between teachers' ratings and observations of hyperactivity, inattentiveness, and defiance

The relationship of directly observed classroom behavior and teacher ratings on questionnaires with a judgemental (Conners Teacher Rating Scale) or operational format was examined for 33 boys aged 6 years 5 months to 7 years 7 months. Results showed a high degree of association between observed and rated behavior. This association did not vary with the format of the rating scales but did vary with the nature of the behavior being rated. Defiance was more reliably rated than hyperactivity or inattentiveness. Several behaviors exerted a halo effect on ratings of hyperactivity, inattentiveness, and behavior problems. In particular, defiance toward a teacher increased the likelihood that a child would be rated as hyperactive or inattentive regardless of his observed level of activity or attentiveness. These results support the validity of behavior rating scales as screening measures for hyperactivity, inattentiveness, and defiance and indicate that a child's defiance and disobedience are significant causes of misclassification.

Classification of children's behavior problems: clinical and quantitative approaches

Children diagnosed Conduct Disorder, Attention Deficit Disorder, or Anxiety Disorder by DSM-III criteria were compared to contrast groups of Physically Disabled and Normal children using the Conners Teacher Rating Scale (CTRS). Discriminant function analyses of the CTRS ratings yielded accurate classification (67% correct) only when Conduct was combined with Attention Deficit and Normals were combined with Physically Disabled. The teacher raters seemed to be describing the children as behaviorally disordered with and without hyperactivity. The data also suggest that Attention Deficit Disorder is part of a broader Conduct Problems dimension.

Behavioral dimensions in fourth-, fifth-, and sixth-grade students as rated by teachers

The St. Francis Boys' Homes early intervention program for inadequately coping fourth-, fifth-, and sixth-grade students depends upon school teachers' nominations and employs their descriptions of pupil characteristics. In the interest of behavioral science, as well as the potential screening-in, selective placement, predictor purpose, and clinical gain within the tailored treatment program, the teachers completed a 99-item, favorable and unfavorable item description of 852 youths who were participating for 45 days in "Passport for Adventure." This large array of items yielded 14 first-order and four second-order factors, many of which have been found in the extensive literature. These measures of 14 first-order factors obtained through ratings by numerous teachers in 122 school settings demonstrated the wide span of the usual teacher's perception of youths in a formative period of their lives. It included interpersonal and intrapersonal descriptors. Most prior studies entered analysis with a low number of items and therefore could describe only a few simpler dimensions and could name them with less certainty. In addition, the factor analysis was sometimes unrealistically orthogonal and not finally hand rotated for clearest simple structure. This study gives a more comprehensive understanding of what teachers can and do perceive within and among their students, made manifest by a more extensive sampling of behavior.

Correspondence of teacher ratings and direct observations of classroom behavior of psychiatric inpatient children

The present investigation examined the correspondence of teacher ratings and direct observations of classroom behavior. Teachers, extraclass raters, and observers completed standard rating scales and/or measures of overt classroom behaviors of psychiatric inpatient children (N = 32). The study assessed if the correspondence between ratings and direct observations was influenced by who evaluates the child (teachers, raters) and the assessment format (general ratings, discrete behaviors). The results indicated that (1) measures from different assessors correlated in the low to moderate range, (2) data from extraclass raters corresponded more closely with direct observations than with data from teachers, (3) teacher and rater estimates of overt child behavior did not correlate more highly with direct observations than did standard rating scales, and (4) teachers and raters viewed child behavior as more appropriate than direct observations indicated. Measures from teachers, raters, and observers readily distinguished attention deficit disorder children with hyperactivity from their peers. However, teacher evaluations delineated these children more sharply than other assessors.