The hyperactive child at adolescence: cognitive, emotional, and social functioning

Review: Adult Outcome as Seen Through Controlled Prospective Follow-up Studies of Children With Attention-Deficit/Hyperactivity Disorder Followed Into Adulthood

OBJECTIVE

To describe adult outcome of people with attention-deficit/hyperactivity disorder (ADHD) diagnosed in childhood and its several key predictors via a review of 7 North American controlled prospective follow-up studies: Montreal, New York, Milwaukee, Pittsburgh, Massachusetts General Hospital (MGH), Berkeley, and 7-site Multimodal Treatment Study of Children With ADHD (MTA).

METHOD

All studies were prospective and followed children with a diagnosis of ADHD and an age- and gender-matched control group at regular intervals from childhood (6-12 years of age) through adolescence into adulthood (20-40 years of age), evaluating symptom and syndrome persistence, functional outcomes, and predictors of these outcomes.

RESULTS

The rates of ADHD syndrome persistence ranged from 5.7% to 77%, likely owing to varying diagnostic criteria and the source of information (self-report vs informant report) across the studies. However, all studies observed high rates of symptomatic persistence ranging from 60% to 86%. The 7 studies were largely consistent in finding that relative to control groups, research participants with childhood-diagnosed ADHD had significant impairments in the areas of educational functioning, occupational functioning, mental health, and physical health as well as higher rates of substance misuse, antisocial behavior, and unsafe driving. The most consistently observed predictors of functional outcomes included ADHD persistence and comorbidity, especially with disruptive behavior disorders.

CONCLUSION

Childhood ADHD has high rates of symptomatic persistence, which is associated with negative functional outcomes. Characteristics that predict these negative outcomes, such as comorbid disruptive behavior disorders, may be important targets for intervention.

Functional connectivity of the vigilant-attention network in children and adolescents with attention-deficit/hyperactivity disorder

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ADHD affects functional connectivity in a brain network for vigilant attention (VA).

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First evidence showing the VA network is intrinsically coupled in older children.

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ADHD patients showed less consistent network connectivity, forming 2 subnetworks.

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Lower network integrity in ADHD is due to both weaker and stronger connections.

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Aberrant connectivity between several regions is linked to ADHD symptomatology.

The ability to maintain attention to simple tasks (i.e., vigilant attention, VA) is often impaired in attention-deficit/hyperactivity disorder (ADHD), but the underlying pathophysiological mechanisms at the brain network level are not clear yet. We therefore investigated ADHD-related differences in resting-state functional connectivity within a meta-analytically defined brain network of 14 distinct regions subserving VA (comprising 91 connections in total), as well as the association of connectivity with markers of behavioural dysfunction in 17 children (age range: 9–14 years) with a diagnosis of ADHD and 21 age-matched neurotypical controls. Our analyses revealed selective, rather than global, differences in the intrinsic coupling between nodes of the VA-related brain network in children with ADHD, relative to controls. In particular, ADHD patients showed substantially diminished intrinsic coupling for 7 connections and increased coupling for 4 connections, with many differences involving connectivity with the anterior insula. Moreover, connectivity strength of several aberrant connections was found to be associated with core aspects of ADHD symptomatology, such as poor attention, difficulties with social functioning, and impaired cognitive control, attesting to the behavioural relevance of specific connectivity differences observed in the resting state.

ADHD and Emotion Dysregulation Among Children and Adolescents

Individuals with attention-deficit/hyperactivity disorder (ADHD) experience impairments in a number of functional domains. Although current evidence-based treatments for ADHD reduce symptoms and improve academic and behavioral functioning, they have minimal impact on social functioning or on risky behaviors (see Evans et al. in J Clin Child Adolesc Psychol, 43:527-551, 2014 for review). Preliminary evidence indicates that emotion dysregulation (ED) is associated with impairments across the developmental spectrum, such as social impairment and risky behaviors, and that its relative absence/presence is differentially associated with treatment response. It thus stands to reason that by incorporating a focus on ED in interventions targeting social impairment and risky behaviors, we may be able to increase the number of youth who respond to such interventions and decrease the prevalence or degree of these impairments and behaviors among youth and adults with ADHD. However, a number of questions remain unaddressed about the association between ADHD and ED, such as the portion of individuals with ADHD who experience ED, the extent to which ED is associated with the above impairments and behaviors, and whether or not ED is malleable. To begin addressing these questions, we summarize and critically evaluate the literature on the association between ADHD and ED and make recommendations for future basic, translational, and treatment outcome research.

Very Low Birthweight: A Long-term Developmental Impairment?

Research with very low birthweight (VLBW) infants (≤isoog) may be broadly categorised into product and process studies. Recent product-oriented outcome studies are reviewed from the perspective of whether VLBW infants born since 1975 (when intensive care methods became relatively stabilised in effectiveness) show behavioural problems, intellectual impairment, linguistic or social deficits.

Process studies examining cognitive, social and contextual variables, differentiating VLBW and normal birthweight infants, and thought to compromise long-term outcome are then discussed.

It is argued, in the light of the conflicting evidence, that future studies need to: (1) exert greater control over the medical and psychological variables confounded with low birthweight, including the variable of social class; (2) study outcome from a life-span perspective, examining the possibility of an intergenerational cycle for at least some families; and; (3) incorporate both systems-oriented and transactional models into their designs, for the purpose not only of predicting outcome, but also ultimately for providing the most appropriate types of support for these infants.

Social and emotional impairment in children and adolescents with ADHD and the impact on quality of life

This review provides an overview as to how the social and emotional impairments involved in Attention-Deficit/Hyperactivity Disorder affect the quality of life of patients and their families. A model of three categories into which the emotional difficulties fall, and how they impair quality of life, is also presented.

Treatment of a 7-Year-Old Hyperactive Boy with Educational Problems

A 7-year-old hyperactive boy with multiple problems was treated using a combination of interventions, applied sequentially over 14 months. The first phase of treatment was participation in a drug trial (placebo, then drug) and this was followed by cognitive-behavioural training designed to teach strategies with which to approach academic work. Teacher and parent behaviour ratings showed improvement over the drug trial period and educational gains were made during the cognitive-behavioural training, both in the area specifically taught and other academic subjects. The problems choosing appropriate targets and of disentangling the effects of different treatment components are discussed.

Separable/integral classification by hyperactive and normal children

This research tested the hypothesis that information-processing deficits associated with hyperactivity implicate a self-regulatory dysfunction. Hyperactive and control children were compared on nonspeeded classification tasks. In Studies 1 and 2, children classified sets of either three (triads) or four (tetrads) stimuli. The stimuli varied simultaneously on size and brightness or on length and density. They could be classified analytically (separably) on the basis of identical values for one dimension and holistically (integrally) on the basis of overall similarity. Control children made an equal number of dimensional classifications for triads and for tetrads. As predicted, however, hyperactive children made fewer dimensional classifications for tetrads, suggesting that they apparently resorted to less effortful holistic responding under the increased processing load. In an unexpected finding in Study 1, older hyperactive children appeared to behave like younger controls, making more dimensional classifications when size, rather than brightness, was the shared dimension. Study 3 explored the possibility that hyperactive children lagged behind the controls in their responding to the shared dimensions. Three age groups of normal children (mean ages: 5, 8, and 11 years) and adults were asked to classify stimuli that varied on size and brightness. Consistent with the lag hypothesis, normal preschoolers behaved like the young hyperactive children in Study 1, classifying equally on the basis of size and brightness. The discussion focuses on the contribution of processing load and stimulus salience to the cognitive deficits of hyperactive children.

Neuropsychological functioning of girls with attention-deficit/hyperactivity disorder followed prospectively into adolescence: evidence for continuing deficits?

The current study prospectively followed girls with attention-deficit/hyperactivity disorder (ADHD), along with a matched comparison sample, 5 years after childhood neuropsychological assessments. Follow-up neuropsychological measures emphasized attentional skills, executive functions, and language abilities. Paralleling childhood findings, the childhood-diagnosed ADHD group displayed moderate to large deficits in executive/attentional performance as well as in rapid naming relative to the comparison group at follow up (M-sub(age) 14.2 years). ADHD-inattentive versus ADHD-combined contrasts were nonsignificant and of negligible effect size, even when a refined, sluggish cognitive tempo subgroup of the inattentive type was examined. Although ADHD versus comparison group differences largely withstood statistical control of baseline demographics and comorbidities, control of childhood IQ reduced executive function differences to nonsignificance. Yet when the subset of girls meeting diagnostic criteria for ADHD in adolescence was compared with the remainder of the participants, neuropsychological deficits emerged even with full statistical control. Overall, childhood ADHD in girls portends neuropsychological and executive deficits that persist for at least 5 years.

Neuropsychological studies of late onset and subthreshold diagnoses of adult attention-deficit/hyperactivity disorder

BACKGROUND

Diagnosing attention-deficit/hyperactivity disorder (ADHD) in adults is difficult when the diagnostician cannot establish an onset prior to the DSM-IV criterion of age 7 or if the number of symptoms recalled does not achieve the DSM-IV threshold for diagnosis. Because neuropsychological deficits are associated with ADHD, we addressed the validity of the DSM-IV age at onset and symptom threshold criteria by using neuropsychological test scores as external validators.

METHODS

We compared four groups of adults: 1) full ADHD subjects met all DSM-IV criteria for childhood-onset ADHD; 2) late-onset ADHD subjects met all criteria except the age at onset criterion; 3) subthreshold ADHD subjects did not meet full symptom criteria; and 4) non-ADHD subjects did not meet any of the above criteria.

RESULTS

Late-onset and full ADHD subjects had similar patterns of neuropsychological dysfunction. By comparison, subthreshold ADHD subjects showed few neuropsychological differences with non-ADHD subjects.

CONCLUSIONS

Our results showing similar neuropsychological underpinning in subjects with late-onset ADHD suggest that the DSM-IV age at onset criterion may be too stringent. Our data also suggest that ADHD subjects who failed to ever meet the DSM-IV threshold for diagnosis have a milder form of the disorder.

Attention-deficit/hyperactivity disorder among adolescents: a review of the diagnosis, treatment, and clinical implications

Attention-deficit/hyperactivity disorder (ADHD) is the most common mental disorder in childhood, and primary care clinicians provide a major component of the care for children with ADHD. However, because of limited available evidence, the American Academy of Pediatrics guidelines did not include adolescents and young adults. Contrary to previous beliefs, it has become clear that, in most cases, ADHD does not resolve once children enter puberty. This article reviews the current evidence about the diagnosis and treatment of adolescents and young adults with ADHD and describes how the information informs practice. It describes some of the unique characteristics observed among adolescents, as well as how the core symptoms change with maturity. The diagnostic process is discussed, as well as approaches to the care of adolescents to improve adherences. Both psychosocial and pharmacologic interventions are reviewed, and there is a discussion of these patients' transition into young adulthood. The article also indicates that research is needed to identify the unique adolescent characteristics of ADHD and effective psychosocial and pharmacologic treatments.

Adjustment, social skills, and self-esteem in college students with symptoms of ADHD

Many studies of ADHD have shown that the problems associated with the disorder continue into adolescence and beyond for 10% to 60% of patients. The present study assesses several aspects of college adjustment, social skills, and self-esteem in a nonreferred sample of college students meeting criteria for a Diagnostic and Statistical Manual of Mental Disorders (4th ed.) diagnosis of ADHD. Twenty-one undergraduate students with symptoms of ADHD are compared to 20 students without significant ADHD symptoms, who match the ADHD students on age, gender, and grade point average. Students with ADHD symptoms show decreased functioning in several areas of college adjustment as well as lower levels of self-reported social skills and self-esteem. The results also suggest that the relation between ADHD and college adjustment is partially mediated by self-reported levels of self-esteem.

Gender effects on attention-deficit/hyperactivity disorder in adults, revisited

BACKGROUND

This study reexamined gender differences in a large sample of adults with attention-deficit/hyperactivity disorder (ADHD).

METHODS

We assessed the effects of ADHD, gender, and their interaction on rates of psychiatric comorbidity and cognitive functioning in 219 adults with ADHD who were referred to an outpatient psychiatric clinic over the last 7 years compared with 215 control subjects group-matched to control subjects on age and gender, and ascertained from ongoing family genetic case control adults with ADHD.

RESULTS

There was no evidence that gender moderated the association between ADHD and other psychiatric disorders. Attention-deficit/hyperactivity disorder was associated with cognitive deficits and higher rates of major depression, anxiety, substance use disorders, and antisocial personality disorder.

CONCLUSIONS

Attention-deficit/hyperactivity disorder in adults is associated with psychiatric and cognitive impairment in both genders. These results bear striking similarities to findings reported in pediatric samples, supporting the validity of ADHD and stressing the importance of identifying and treating the disorder in adulthood.

Big five dimensions and ADHD symptoms: links between personality traits and clinical symptoms

Attention-deficit/hyperactivity disorder (ADHD) in adulthood is conceptualized as originating in childhood. Despite considerable theoretical interest, little is known about how ADHD symptoms relate to normal personality traits in adults. In 6 studies, the Big Five personality dimensions were related to ADHD symptoms that adults both recalled from childhood and reported concurrently (total N = 1,620). Substantial effects emerged that were replicated across samples. First, the ADHD symptom cluster of inattention-disorganization was substantially related to low Conscientiousness and, to a lesser extent, Neuroticism. Second, ADHD symptom clusters of hyperactivity-impulsivity and oppositional childhood and adult behaviors were associated with low Agreeableness. Results were replicated with self-reports and observer reports of personality in community and clinical samples. Findings support theoretical connections between personality traits and ADHD symptoms.

Experienced emotion and affect recognition in adult attention-deficit hyperactivity disorder

Emotional competence and deficits that may disrupt interpersonal interactions were evaluated in 28 adults with attention-deficit hyperactivity disorder (ADHD) and 28 demographically equivalent controls. Participants completed tasks assessing affect recognition and experienced emotional intensity. Adults with ADHD performed worse in affect recognition than did adults without the disorder; however, the impairment was unrelated to gross perceptual processes, fundamental abilities in facial recognition, or attentional aspects of affect perception. Moreover, intensity of experienced emotion moderated affect recognition: Among controls, experienced emotion facilitated affect recognition. Among adults with ADHD, who reported significantly greater intensity, experienced emotion was inversely related to affect recognition. Results are consistent with theories of ADHD as a deficit in behavioral inhibition; yet, results may merely reflect a constellation of deficits associated with the disorder.

Continuous performance tests are sensitive to ADHD in adults but lack specificity. A review and critique for differential diagnosis

Historically, the focus for Attention Deficit Hyperactivity Disorder (ADHD) has been on children, with considerable research and many opinions available in this area. More recently, the focus has been expanded to include ADHD in adults. Assessment of ADHD in adults is complicated by the high rate of co-occurring disorders as well as symptom overlap with a number of disorders. One popular family of measures for the assessment of attention and executive control is the continuous performance test (CPT). A review of the available research on CPTs reveals that they are quite sensitive to CNS dysfunction. This is both a strength and a limitation of CPTs in that multiple disorders can result in impaired performance on a CPT. The high sensitivity of CPTs is further complicated by the multiple variations of CPTs available, some of which may be more sensitive or demonstrate better specificity to ADHD in adults than others. If CPTs are to be used clinically, further research will be needed to answer the questions raised by this review.

Long-term follow-up of children with mental retardation/borderline intellectual functioning and ADHD

Fifty-two children (ages 7 to 14 years) with moderate retardation to borderline intellectual functioning were recontacted 12 to 65 months following participation in a double-blind, placebo-controlled trial of methylphenidate (MPH). Sixty-nine percent of subjects continued to be prescribed medication for behavior control at follow-up. While 72% of the sample evidenced improvement, over two-thirds continued to be rated at or above the 98th percentile on the Hyperactivity Index of the Parent Conners. In fact, 22% of subjects had received inpatient psychiatric treatment between the time of the initial MPH trial and follow-up. Finally, subjects with high initial ratings on the Parent Conners Conduct Problems scale were more likely to be suspended from school or receive inpatient psychiatric treatment than subjects with low initial ratings. The results suggested that children with ADHD and mental retardation of borderline intellectual functioning continued to exhibit significant symptoms associated with attention deficit hyperactivity disorder (ADHD) at follow-up and that early conduct problems were predictive of continuing behavioral difficulties.

Hyperactivity and conduct problems as risk factors for adolescent development

OBJECTIVE

To clarify the developmental risk associated with hyperactive behavior, especially the relationship between hyperactive and conduct problems, in a longitudinal epidemiological design.

METHOD

A follow-up study of children who were identified, by parent and teacher ratings in a large community survey of 6- and 7-year-olds, as showing pervasive hyperactivity or conduct problems or the comorbid mixture of both problems or neither problem. They were later investigated, at the age of 16 to 18 years, with detailed interview techniques as well as parental and self-report ratings and cognitive tests.

RESULTS

Hyperactivity was a risk factor for later development, even allowing for the coexistence of conduct problems. Its sequelae included a high likelihood of psychiatric diagnosis, persisting hyperactivity, violence and other antisocial behaviors, and social and peer problems.

CONCLUSIONS

The results suggested a developmental pathway through which hyperactivity raised the likelihood of impaired social adjustment, including the development of psychiatric disorders, independently of the existence of conduct problems.

Distractibility in hyperactive and conduct-disordered children

Hyperactive children are often said to be inattentive and distractible. However, the results from a number of experimental studies are equivocal. To examine this discrepancy, a Chinese version of the Stroop Test was devised. Four groups of subjects recruited from a community sample of 1479 Chinese boys living in Hong Kong took part in the investigation. These were: (1) a pure hyperactive (HA) group; (2) a mixed hyperactive/conduct-disordered (HA + CD) group; (3) a pure conduct-disordered (CD) group; and (4) a normal (N) control group. The results revealed that HA children were more markedly affected by the introduction of distracting stimuli. This distractibility was probably a function of both stimulus potency and the random order in which stimuli were presented. The specificity of a greater distractibility to HA children indicates its diagnostic value with regard to hyperactivity. The failure to find a similar deficit in HA + CD children raises questions about the clinical identity of this mixed diagnostic group.

Is the Continuous Performance Task useful in research with ADHD children? Comments on a review

A recent review of the Continuous Performance Task (CPT) as a research tool by Corkum and Siegel, Journal of Child Psychology and Psychiatry, 34, 1217-1239, 1993, is criticized for insufficient covering of the relevant literature, disregard of the question of differentiation among clinical groups, and inadequacy of explanations of Attention-Deficit-Hyperactivity Disorder (ADHD) in terms of arousal, activation, and effort. An attention-deficit in ADHD children cannot be inferred from poor performance on a CPT. Impaired performance is anything but specific to ADHD children and is caused by a host of variables among which "attention" probably plays a minor role.

Attentional difficulties in hyperactive and conduct-disordered children: a processing deficit

A random population sample of 1479 Chinese boys from Hong Kong was screened and diagnosed in a two-stage epidemiological study. Four groups, age 7-8, were distinguished: (1) a pure hyperactive group (HA), (2) a mixed hyperactive/conduct-disordered group (HA+CD), (3) a pure conduct-disordered group (CD), and (4) a normal control group (N). On a visual search task, only the HA children showed a specific processing deficit in performance. This confirms the diagnostic value of such a deficit for hyperactivity, differentiating it from conduct disorder. The failure to find a similar deficit in the HA+CD group raises questions concerning the clinical identity of these children. Each group showed a performance decrement over time in the visual search task but the decrement did not differ between the four groups. This observation is not congruent with the reports of a short attention span in hyperactive children; explanations of this apparent contradiction are considered.

Gender differences in a sample of adults with attention deficit hyperactivity disorder

Although originally conceptualized as a childhood disorder, attention deficit hyperactivity disorder (ADHD) may also be an adult disorder. However, despite increasing media attention to adult ADHD, its validity has only recently been studied in a systematic fashion. The overrepresentation of females in adult samples in comparison to pediatric samples of ADHD raises additional questions about the validity of this disorder in adults. The goal of this article is to explore whether ADHD is a valid clinical entity in female subjects and whether it is expressed differently in male and female adults. To this end, we examined the clinical, cognitive, and functional characteristics of 128 referred adult ADHD cases of both sexes. Each subject had a clinical diagnosis of childhood-onset ADHD confirmed by structured interview. The male and female ADHD adults were similar to one another but more disturbed and impaired than non-ADHD adult control subjects. Compared with normal control females, ADHD women had higher rates of major depression, anxiety disorders, and conduct disorder; and more evidence of school failure and cognitive impairment. The consistency of these findings in both genders further supports the validity of the diagnosis of ADHD in adults. Our results stress the viability and importance of identification of female subjects with ADHD. The underidentification and undertreatment of females with ADHD may have substantial mental health and educational implications, suggesting that research is needed to develop a better understanding of clinical indicators of ADHD in females.

The stability of dimensions of behavior in ADHD and normal children over an 8-year followup

The present study reports on standardized behavioral ratings received by a large sample of hyperactive children meeting research diagnostic criteria (n = 108) and a community control sample of normal children (n = 61) who were followed prospectively over 8 years into adolescence. On some parent-report measures both groups declined in the severity of their behavior problems across time, while on other measures only the hyperactive group declined, but the hyperactives always remained more deviant than the controls at followup. The hyperactives and controls also differed on most teacher and self-report ratings at followup. The greatest degree of agreement between raters at adolescence was between parent and youth ratings. These results are consistent with previous research demonstrating more deviant scores for hyperactive children than controls on various rating scales at adolescent followup. They also are consistent with research showing significant longitudinal continuity of both internalizing and externalizing behavioral pathology.

Attention deficit hyperactivity disorder and the frontal lobe syndrome

The usefulness of frontal lobe (FL) dysfunction as a conceptual model for Attention Deficit Hyperactivity Disorder (ADHD) was investigated. Twenty-four ADHD and 24 normal control (NC) children were tested using two batteries of tasks. The first was sensitive to FL deficits in motor control and problem solving skills. The second consisted of memory tasks sensitive to temporal lobe dysfunction. ADHD children differed significantly from NCs on measures of FL function, but not on tests of temporal lobe functions. Where norms were available for normal children on the same FL tests, ADHDs performed like 6- to 7-year-olds, despite their mean age of 10 years and minimum age of 8 years. The differential performance of ADHDs on tasks sensitive to FL and temporal lobe dysfunction supports the hypothesis that ADHD deficits are analogous to FL dysfunction and demonstrates that the children's deficits do not reflect generalized cognitive impairment.

Study strategies and story recall in attention deficit disorder and reading disability

The role of metacognition and executive processes in mediating use of study skills was examined in groups of attention deficit disorder with hyperactivity (ADD-H), normal, and non-ADD-H reading-disabled (RD) boys, matched on age and verbal IQ. On a story recall task, ADD-H boys did not differ from normals in their immediate gist recall of a story or in their recall following a study period. RD boys demonstrated inferior recall in both conditions. Study skills of the ADD-H boys were poorer than those of normal boys on all measures. They spent less time studying, expended less effort, and employed more superficial strategies. However, their poor strategies did not appear to reflect a lack of metacognitive awareness. Results are discussed in terms of the impact of motivational variables in modulating strategy use in ADD-H boys and the impact of verbal processing problems in reading disabilities. Implications for treatment and the relationship between ADD-H and RD are discussed.

Methylphenidate speeds evaluation processes of attention deficit disorder adolescents during a continuous performance test

Forty-six Attention Deficit Disorder (ADD) adolescents took a Continuous Performance Test (CPT) under placebo and methylphenidate (35.33 mg/day). The task required pressing one button for targets (p = .133), and another button for nontargets. Subjects displayed a strong bias to make the more frequent negative response before completely evaluating stimuli. Consistent with this assumption, subjects responded faster (by an average of 87 ms) to nontargets than to targets. Methylphenidate increased accuracy and speeded reaction times (RTs) to targets. The drug also increased the amplitude of the P3b component of the event-related potential for nontargets and shortened the latency of P3b for both targets and nontargets. These results suggest increased capacity allocation to and faster evaluation of task stimuli. Finally, the stimulant lengthened relative motor processing time (RT-P3b latency) for nontargets, a finding implying that response processing was accomplished with the benefit of earlier completion of evaluation processes for these stimuli.

Long-term outcome of hyperactive children: a review

Reports of adolescent outcome in attention deficit hyperactivity disorder have uniformly indicated high rates of behavioral problems including cognitive impairment. Dysfunction is markedly reduced in adulthood, but the pattern of outcome remains unchanged except for failure to document cognitive deficits. In adulthood, dysfunction is characterized by antisocial personality and substance (nonalcohol) use disorders. These are in turn associated with criminality. The little existing information on girls with attention deficit hyperactivity disorder does not suggest a worse outcome than for boys. Attempts to identify the children most likely to have a poor outcome have been largely unsuccessful.

Behavior at 10 and 13 years of age for children with low birth weight

This study was based on data from a longitudinal research program. The cohort consisted of 874 normal children in an entire school grade in a Swedish community. The aim of the study was to investigate the relation between birth weight and behavior at school, for all children and for each sex separately. The results identified specific aspects of behaviour disorder significantly related to low birth weight (LBW) for children at the age of 10 but not at the age of 13. When the sexes were separated, there were no relations between birth weight and deviant behaviour for boys of low birth weight as compared to boys of normal birth weight, while girls of low birth weight showed specific behavioural disorders at age 10 as compared to girls of normal birth weight. For girls reared in families of low parental socioeconomic status, aggressiveness and motor restlessness at age 10 but not at age 13 was also present. Further analyses showed that girls born small-for-gestational age showed lack of school motivation and concentration difficulties both at age 10 and age 13.

Treatment of attentional and hyperactivity problems in children with sympathomimetic drugs: a comprehensive review

Issues concerning sympathomimetic drug treatment of children with attentional problems and hyperactivity are considered in light of cumulative and current research. These issues concern the atypical or "paradoxical" drug response of such children, predictability of drug response from neurological or biochemical assessments, and, especially, long-term outcome or effectiveness of sympathomimetic medication. Short-term drug effects on behavior and performance are well documented. However, follow-up studies that exist presently suggest little long-term impact of sympathomimetic drugs on school achievement, peer relationships, or behavior problems in adolescence. Questions remain concerning development of tolerance in children, ways to define subgroups of disordered children who may respond uniquely to stimulants, the efficacy of medication in combination with other treatments, and possible long-term negative consequences of medication.

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

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

A controlled trial of methylphenidate in black adolescents. Attentional, behavioral, and physiological effects

The short-term effects of methylphenidate were examined on behavioral, laboratory, academic, and physiological measures in 11 black male adolescents diagnosed as having attention deficit disorder (ADD). In a double-blind, crossover design with randomized order, the subjects received placebo and each of three methylphenidate doses (0.15 mg/kg, 0.30 mg/kg, and 0.50 mg/kg) for a period of 2 weeks per medication dosage. Significant drug effects were found for the majority of measures. In general, the higher doses resulted in the most beneficial response in behavioral, academic, and laboratory measures of attention and impulsivity. However, a significant linear increase occurred in diastolic blood pressure. The results suggest that methylphenidate is an effective adjunct to the treatment of ADD in adolescents.

Attention and impulsivity characteristics of the biological and adoptive parents of hyperactive and normal control children

On tests comparing 176 biological and adoptive parents of hyperactive and normal control children, biological parents of hyperactives evidenced more attentional difficulties, slower mean reaction times, and fewer correct recognitions than did the other parents. They showed no significant differences in impulsivity. A familial association between childhood hyperactivity and attentional deficits in the biological parents was suggested, as was the persistence of attentional difficulties as compared to impulse control problems.

Attention deficit disorder with hyperactivity: a critique

The DSM III category of Attention Deficit Disorder with Hyperactivity is considered within a framework of Rutter's (1977) outline of criteria for adequacy of psychiatry classification. Discussion of problems with the operationalization and definition of 'attention deficit' and the difficulty of using this rubric in distinguishing between ADDH and other related childhood disorders, along with the consequent failure to meet other important criteria, leads to the conclusion that the concept needs re-appraisal.

Effects of color stimulation and information on the copying performance of attention-problem adolescents

The optimal stimulation theory proposes that hyperactive children are less tolerant of lower levels of arousal than nonhyperactive children and should thus derive greater gains from stimulation added to repetitive copying tasks than do comparisons. To test this hypothesis, 16 adolescents, rating high on attention and behavior problems, were matched on the basis of age and poor handwriting performance to 16 controls. Matched pairs were randomly assigned to treatment order (high-stimulation colored letters followed in 2 weeks by low-stimulation black letters or the reverse order) and to level of information (color added to difficult letter parts or added to randomly selected letters), counterbalanced for treatment order and level of information within each order. Errors and activity were subjected to a mixed-design analysis of covariance, with IQ the covariate. The major findings indicated that attention-problem adolescents performed better with high-stimulation task stimuli than with low, relative to the opposite performance pattern of controls. Different responding was significant for experimental but not for control children.