Academic Motivation Deficits in Adolescents with ADHD and Associations with Academic Functioning

Effects of Background Music on Attentional Networks of Children With and Without Attention Deficit/Hyperactivity Disorder: Case Control Experimental Study

BACKGROUND

To sustain performance during a task that requires attention may be a challenge for children with attention deficit/hyperactivity disorder (ADHD), which strongly influences motivation for tasks and has been connected to the level of arousal.

OBJECTIVE

This study aimed to analyze the effect of musical stimulus on attentional performance in children with ADHD and typically developing children.

METHODS

A total of 76 boys (34 with ADHD and 42 typically developing) performed the Attention Network Test (ANT) for children under 2 experimental conditions (with and without music). Four attentional measures were extracted from the ANT. We tested the effect of the experimental condition and its interaction with the group using repeated measures ANOVA.

RESULTS

We found no significant main effects or interactions for the reaction times of the alerting, orienting, and conflict attentional networks of the ANT (all P>.05). Regarding ANT errors, we found a significant main effect for music, with a moderate effect size (F1,72=9.83; P=.03; ηp2=0.06) but the condition×group interaction was not significant (F1,72=1.79; P=.18). Participants made fewer errors when listening to music compared to the control condition.

CONCLUSIONS

Music seems not to interfere in the attentional network in children and adolescents. Perhaps background music affects motivation. Future studies will be needed to validate this.

TRIAL REGISTRATION

ReBEC.gov U1111-12589039; https://ensaiosclinicos.gov.br/rg/RBR-8s22sh8.

Later ("evening") circadian preference is associated with poorer executive, academic, and attentional functioning in adolescents with and without ADHD

BACKGROUND

Adolescents vary considerably in their circadian phase preference; those with greater "eveningness" (also known as "night owls") have later bedtimes, wake times, and peak arousal compared to those with greater "morningness." Prior research suggests that (a) greater eveningness is associated with worse academic, executive, and attentional functioning; and (b) adolescents with attention-deficit/hyperactivity disorder (ADHD) tend to be high in eveningness and to have deficits in these school-related constructs. However, few studies have examined circadian preference alongside two potential confounds-sleep duration and sleep quality-as predictors of daytime functioning, or whether the strength of associations differs across adolescents with and without ADHD.

METHODS

Participants were 302 adolescents (Mage = 13.17 years; 44.7% female; 81.8% White); approximately half (52%) had ADHD. A multi-method, multi-informant design was used. Specifically, adolescents reported on their circadian preference, school night sleep duration, and sleep quality. Adolescents provided ratings of their academic motivation (intrinsic, extrinsic, and amotivation) and were administered standardized achievement tests in reading and math. Adolescents and parents completed ratings of daily life executive functioning (behavioral, emotion, and cognitive regulation), and they and teachers also provided ratings of ADHD inattentive symptoms.

RESULTS

Above and beyond sleep duration, sleep quality, and covariates (sex, family income, pubertal development, medication use), greater eveningness was uniquely associated with poorer academic, executive, and attentional functioning across most measures. Sleep quality was uniquely associated with a handful of outcomes, and sleep duration was not significantly uniquely associated with any outcome in the regression analyses. ADHD status did not moderate effects.

CONCLUSIONS

This study provides compelling evidence that poorer academic, executive, and attentional functioning are more closely associated with greater eveningness than with sleep duration or quality in adolescents. Findings suggest that targeting circadian preference may be important to reduce these problems in adolescents, especially in clinical samples such as ADHD for whom academic, executive, and attentional difficulties are exceptionally common.

Do Wechsler intelligence scales predict academic achievement in children with ADHD or autism? A systematic review and meta-analysis

Intelligence tests predict academic achievement in typically developed children, however if this is the case also in children with attention-deficit/hyperactivity disorder (ADHD) and/or autism spectrum disorder (ASD) is not clear. This systematic review and meta-analysis examined if Wechsler intelligence scales predict academic achievement and/or grades in children, ages 6-16 years, with ADHD and/or ASD. We searched the databases PubMed, PsycINFO and Education Research Complete for studies published between 2000 and 2023. We used the Newcastle-Ottawa Scale to assess risk of bias. Narrative synthesis and meta-analysis were performed. Twelve studies (ADHD n = 1,834, ASD n = 176) were included in the review, and six samples (ADHD n = 1,112) of those were included in the meta-analyses. The results of the meta-analyses showed moderate overall weighted correlations between IQ and word reading, written language, and mathematics respectively. Similarly, the overall weighted correlations between processing speed and the aforementioned domains of academic achievement were moderate. Meta-analysis with additional Wechsler scales composite scores could not be conducted. In the narrative synthesis, Full Scale IQ was associated with academic achievement in both ADHD and ASD, and grades in ADHD. The limited number of ASD participants and the heterogeneity of the samples need to be considered when interpreting results. Generally, the results indicate that Wechsler scales are valuable in predicting academic achievement in children with ADHD or ASD. Motivation and other factors related with academic achievement need to be further explored in these groups.

Examining the Use of VR as a Study Aid for University Students with ADHD

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental condition characterized by patterns of inattention and impulsivity, which lead to difficulties maintaining concentration and motivation while completing academic tasks. University settings, characterized by a high student-to-staff ratio, make treatments relying on human monitoring challenging. One potential replacement is Virtual Reality (VR) technology, which has shown potential to enhance learning outcomes and promote flow experience. In this study, we investigate the usage of VR with 27 university students with ADHD in an effort to improve their performance in ctableompleting homework, including an exploration of automated feedback via a technology probe. Quantitative results show significant increases in concentration, motivation, and effort levels during these VR sessions and qualitative data offers insight into considerations like comfort and deployment. Together, the results suggest that VR can be a valuable tool in leveling the playing field for university students with ADHD.

Examining daily stimulant medication use and sleep in adolescents with ADHD

Research has been inconclusive as to whether stimulant treatment causes or exacerbates sleep problems in adolescents with ADHD. This study examined sleep differences in adolescents with ADHD as a function of stimulant use. Participants were adolescents with ADHD (N = 159, ages 12-14). Parents reported on receipt of stimulant treatment (n = 92, 57.86%; n = 47 amphetamines, n = 45 methylphenidate). Adolescents wore actigraphs and completed daily diaries assessing sleep and daily use of stimulants for 2 weeks. Sleep parameters included daily-reported bedtime, sleep onset latency (SOL), sleep duration, daytime sleepiness, and difficulty waking the following morning; and actigraphy-measured sleep onset time, total time in bed, and sleep efficiency. We estimated between- and within-individual associations between stimulant medication use and sleep indices with all stimulants, after removing adolescents using sleep aids and weekend days, and as a function of stimulant type. Adolescent sleep did not differ between those receiving and not receiving stimulant treatment. Within individuals using stimulants, we largely observed no significant differences between medicated and unmedicated days, though findings were most often significant for school days only. Small effects were found indicating longer SOL, later sleep onset time, and more daytime sleepiness related to medication use. In contrast, there were slight improvements to sleep duration and sleep efficiency related to methylphenidate use, though methylphenidate was also associated with later sleep onset time and more daytime sleepiness. Given the inconsistent and small effects, findings suggest that stimulant medication may impact sleep, but does not appear to be a primary contributor to sleep problems in adolescents with ADHD.

Longitudinal associations between academic competence-building and depression symptoms in early adolescence

The longitudinal associations between academic competence-building and depression symptoms were investigated among 741 early adolescents in Singapore. Extending from past studies on academic achievement and depression, the current research tested two competing hypotheses - the academic incompetence hypothesis versus the adjustment erosion hypothesis using a 3-wave longitudinal study over an academic year. The former hypothesis suggests that prior deficits in academic competence-building lead to subsequent depression symptoms, whereas the latter posits that previous depression leads to subsequent deficits in competence-building. Longitudinal associations between a higher-order competence-building factor (operationalized using multiple constituent motivational variables) and depression were examined using a random intercept cross-lagged panel model. Results indicated that within-individual decreases in competence-building prospectively predicted subsequent within-individual increases in depression symptoms, but the opposite effect was not observed. Within-individual fluctuations in competence-building also predicted end-of-year grades and teacher-reported adjustment problems. Overall, the current findings were consistent with the academic incompetence hypothesis, suggesting that interventions aimed at sustaining academic competence-building could offer protection against the worsening of depression. These results clarified the within-individual developmental dynamics between academic competence-building and depression symptoms in adolescents over time.

Retrospective Report of Academic Motivation Among College Students With Elevated ADHD Symptoms

OBJECTIVE

Children with ADHD exhibit deficits in academic motivation compared to their peers. Yet conceptualizations of motivation according to prominent motivation theories connected to achievement have not been studied in college-bound youth with ADHD symptoms.

METHOD

This study examined motivation according to these theories, differences in motivation by ADHD symptoms, and how the cross-sectional association between motivation and achievement varies by ADHD symptoms. The sample included 461 first-year college students retrospectively reporting their motivation and achievement in their last year of high school.

RESULTS

Results indicated differences in motivation by ADHD symptoms. Mastery achievement goal orientation was uniquely associated with achievement and exerted beneficial effects on achievement at moderate to high ADHD symptom levels.

CONCLUSION

Motivation may operate differently in association with achievement for college-bound youth with ADHD symptoms compared to youth with no to low symptoms.

Attention-Deficit/Hyperactivity Disorder and Academic Functioning: Reading, Writing, and Math Abilities in a Community Sample of Youth with and without ADHD

Previous studies have shown that Attention-Deficit/Hyperactivity disorder (ADHD) is marked by impairments in academic functioning in reading, writing, and mathematics. Yet, virtually no studies have examined academic functioning in terms of both basic skills (e.g., word recognition, handwriting/spelling, arithmetic calculations) and more complex advanced skills (e.g., reading comprehension, writing composition, and mathematical problem-solving) within the same sample. In the present study, 518 children with ADHD were compared to a control group of 851 children without ADHD (ages 8-18) and assessed on a comprehensive battery of reading, writing, and math assessments. It was hypothesized that ADHD diagnostic status would uniquely predict performance on advanced skill measures even after controlling for performance on basic skills in that academic domain. ADHD status was associated with worse performance across all academic tests. Results also indicated that ADHD independently predicted performance for measures of writing composition and one measure of reading comprehension, even after controlling for performance on basic skills in those domains. However, ADHD did not independently predict mathematical problem-solving performance. These findings add to the literature on ADHD and academic functioning and indicate that inattention may weaken skills necessary for effective reading comprehension and writing composition.

ADHD and Psychological Need Fulfillment in College Students

OBJECTIVE

Self-determination theory suggests that the satisfaction and frustration of basic psychological needs-autonomy, competence, relatedness-are uniquely associated with overall well-being. Undergraduates with attention-deficit/hyperactivity disorder (ADHD) experience more academic-related impairment and are less likely to graduate. Thus, well-being is important to understand and aim to improve in these students.

METHOD

Students at four universities (N = 2,197) completed a survey and reported previous diagnoses, ADHD symptoms, and psychological need satisfaction and frustration. Group differences were explored via t-tests; associations were explored via structural equation modeling.

RESULTS

The ADHD group reported lower satisfaction and higher frustration across all psychological needs. Inattention and hyperactivity/impulsivity were uniquely associated with aspects of need fulfillment beyond the impact of comorbid symptoms. Sex differences emerged such that women with ADHD had the lowest overall need satisfaction.

CONCLUSIONS

Addressing need fulfillment, both satisfaction and frustration, in interventions with undergraduates with clinical/subclinical levels of ADHD may optimize treatment effectiveness.

The Impact of ADHD on Maternal Quality of Life

Childhood attention-deficit/hyperactivity disorder (ADHD) is associated with substantial burden to caregiver quality of life (QoL). However, a paucity of work has focused on quantifying QoL among caregivers of adolescents with a history of ADHD. The purpose of the current study was (1) to quantify maternal QoL in a sample of mothers of adolescents with and without childhood ADHD; and (2) to examine predictors (i.e., parent and child characteristics and behavior) associated with maternal QoL. Participants included mothers of adolescents with (N = 110) and without ADHD (N = 90) ranging in age from 13 to 18 (M = 16.09, 92% male). The Quality Adjusted Life-Year (QALY) was used to calculate maternal QoL using two health domains (i.e., anxiety/depression and disruption in daily activities) commonly impacted by raising youth with ADHD. QALYs are valued monetarily to estimate disease burden. Mothers of adolescents with childhood ADHD experienced significantly worse QoL relative to mothers in the comparison group. Maternal depression, as well as adolescent age, ADHD status, and discipline problems significantly predicted lower levels of maternal QALY health status index, with ADHD being the strongest predictor. This is equal to a reduction in 1.96 QALYs when summed over the course of a child's lifetime and is associated with a loss of $98,000 to $196,000. Results of the investigation help to further elucidate the health impacts incurred by families of adolescents with ADHD and have important public health implications. Further, parental QoL should be considered when conceptualizing the financial and negative health impact of ADHD.

The significance of limited prosocial emotions among externalizing disorders in children

Limited Prosocial Emotion (LPE) specifier of conduct disorder (CD) includes lack of remorse or guilt, callousness/lack of empathy, unconcern about performance, and shallow/deficient affect. Given the relatively recent inclusion of the LPE specifier in the Diagnostic and Statistical Manual, fundamental information is still unknown about LPE, such as how common the different domains are, how much they overlap with one another, whether they predict unique variance from each other, and the potential for the LPE specifier as a transdiagnostic facet of externalizing problems. Caregivers (n = 1,50) of children (M_age = 8.42, SD = 2.31) completed a questionnaire assessing individual LPE domains and measures of externalizing symptoms. Results showed that LPE specifier domains were highly related but separable. All LPEs were uniquely associated with oppositional defiant disorder (ODD), CD, and overall impairment after controlling for other LPE items, child sex, and ADHD symptoms. Being unconcerned about performance, emotionally manipulative, and having shallow/deficient affect were uniquely associated with ADHD while controlling for ODD and CD symptomatology. Our findings fit with the historical conceptualization of LPE as a unidimensional construct and contributes to the growing evidence of the potential utility of assessing LPE across externalizing disorders in children. Future research should look to replicate and extend our findings in clinical samples of youth.

Fluid Attention in Education: Conceptual and Neurobiological Framework

Attention is indispensable to our learning, performance, relationships, health, and daily life, and yet laboratory studies of attention have only scratched the surface of these lived varieties of attention. In this article, we begin with William James' theory of derived involuntary attention, which has largely been ignored in laboratory research. We then show that there is a gap in our attention vocabulary and the theory that underpins it, which depend on an incomplete voluntary/involuntary dichotomy. The negative effects of this dichotomy stretch beyond laboratory research to clinical diagnosis, influencing how we understand so-called attention deficits. To fill the gap between voluntary and involuntary, we introduce a third kind of attention—fluid attention (also called postvoluntary attention), which is goal-directed and selective, like voluntary attention, but also effortless and drawn to its source, like involuntary attention. Fluid attention is a rediscovery of James' derived involuntary attention. A distinguishing feature of fluid attention is its motivational component, which, we show, neurophysiologically also reveals a gap in the neurocognitive literature on attention. Recognizing fluid attention as fundamentally motivational allows ADHD to be redefined as a motivational rather than an attentional deficit, which we go on to show has significant implications for both special and regular education.

Poor Mental Health in Caregivers of Children with Attention-Deficit/Hyperactivity Disorder and Its Relationships with Caregivers' Difficulties in Managing the Children's Behaviors and Worsened Psychological Symptoms during the COVID-19 Pandemic

The coronavirus disease 2019 (COVID-19) pandemic has thrown out a challenge to caregivers of children with attention-deficit/hyperactivity disorder (ADHD). The present study examined the factors related to the poor general mental health state of the caregivers of children with ADHD during the COVID-19 pandemic, including (1) difficulties of caregivers in asking their child to adopt protective behaviors against COVID-19, (2) difficulties of caregivers in managing the child’s daily performance, and (3) worsened psychological symptoms in children. In total, 161 caregivers completed an online questionnaire to provide data regarding their general mental health state and difficulties in asking their child with ADHD to adopt protective behaviors against COVID-19 and in managing the child’s after-school learning, sleep routine, and internet use, as well as worsened psychological symptoms. The results of multivariate logistic regression analysis demonstrated that caregivers’ difficulties in managing ADHD children’s self-protective behaviors and after-school learning and the children’s worsened emotional symptoms were significantly associated with poor caregiver general mental health state. An intervention that enhances the mental health of caregivers of children with ADHD during the COVID-19 pandemic by addressing their difficulties in managing the children’s behaviors and psychological problems is warranted.

The Effects of Choice on the Reading Comprehension and Enjoyment of Children with Severe Inattention and no Attentional Difficulties

It has been proposed that enhancing motivation supports the learning of children with Attention Deficit Hyperactivity Disorder (ADHD). Less is known if inattentive children with no ADHD diagnosis may similarly benefit, when being motivated to engage in an academic task. Using a repeated-measures design, this study investigated the effects of text choice as an intrinsic motivator on the reading comprehension and enjoyment of Year 4 children attending mainstream primary schools (N = 92; aged 8–9 years; 48 boys); comparing those with no attentional difficulties and severe inattention. We hypothesized that 1) choice would increase reading comprehension and enjoyment 2) choice would increase the reading comprehension and enjoyment of children both with severe inattention and no attentional difficulties 3) choice effects would be significantly greater for children with severe inattention than those with no attentional difficulties. Children participated in a reading intervention that included a Choice (experimental) and a No Choice (control) condition. Child inattention was measured via a Virtual Reality Continuous Performance Task (Omission errors, Reaction Time Variability) and Teacher Ratings. Choice significantly increased reading comprehension, but not enjoyment compared with no choice. Choice improved the reading comprehension of children with both severe inattention and no attentional difficulties. Choice did not benefit the reading of severely inattentive children more than that of children with no attentional difficulties. These findings underline the educational benefits of choice for young readers both with severe inattention and no attentional difficulties, which are further discussed drawing on existing theory and research.

Remote Learning During COVID-19: Examining School Practices, Service Continuation, and Difficulties for Adolescents With and Without Attention-Deficit/Hyperactivity Disorder

PURPOSE

This study examined remote learning practices and difficulties during initial stay-at-home orders during the COVID-19 pandemic in adolescents with and without attention-deficit/hyperactivity disorder (ADHD).

METHODS

Participants were 238 adolescents (132 males; 118 with ADHD) aged 15.64-17.99 years and their parents. Adolescents and parents completed questionnaires in May/June 2020 when in-person schools were closed in the U.S.

RESULTS

Twenty-two percent of families incurred financial costs to support remote learning, and only 59% of school-based services received before COVID-19 continued during COVID-19 remote learning. Adolescents with ADHD had fewer routines and more remote learning difficulties than adolescents without ADHD. Parents of adolescents with ADHD had less confidence in managing remote learning and more difficulties in supporting home learning and home-school communication. Thirty-one percent of parents of adolescents with ADHD with an Individualized Education Program (IEP) or receiving academic accommodations (504 Plan) reported remote learning to be very challenging, compared with 18% of parents of adolescents with ADHD without an IEP/504 Plan, and only 4% of parents of adolescents with neither ADHD nor an IEP/504 Plan. Fewer adolescent routines, higher negative affect, and more difficulty concentrating because of COVID-19 were each associated with greater adolescent remote learning difficulties only in adolescents with ADHD.

CONCLUSIONS

This study provides initial findings of the nature and impact of remote learning during the COVID-19 pandemic. It is imperative for schools and communities to provide the necessary supports to adolescents, particularly those with mental health and/or learning difficulties, and to their parents.