Attention deficit-hyperactivity disorder in adolescence: Critical assessment parameters

Longitudinal Examination of Sexual Risk Behavior in College Students With and Without Attention-Deficit/Hyperactivity Disorder

The present study sought to identify differences in the rates and predictors of risky sexual behavior among college students with and without attention-deficit hyperactivity disorder (ADHD). Current ADHD diagnosis, medication status among those with ADHD, executive functioning, substance use, comorbid anxiety, comorbid depression, and gender were identified as potential predictors of increased risky sexual behavior. Multiple group latent growth curve modeling was used to estimate trajectories of risky sexual behavior across four years of college among college students with ADHD (nmedicated = 99, nunmedicated = 105) and a comparison group (n = 217) recruited from colleges throughout the eastern United States (M age = 18.23 years, 53% female, 70% White). First-year college students with ADHD reported significantly higher rates of sexual risk behavior than their peers without ADHD, with no significant differences found based on medication status. Students with ADHD who were taking medication for ADHD reported significant decreases in risky sexual behavior over time. Among college students with ADHD, anxiety was related to increased current risky sexual behavior in the medicated group, while depression was predictive of decreased future risky sexual behavior in the unmedicated group. Alcohol and cannabis use were significantly associated with increased mean levels of risky sexual behavior across all three groups, and cannabis use was associated with decreased future risky sexual behavior within the comparison group. Executive functioning deficits and male gender were predictive of risky sexual behavior within the comparison group. The results demonstrate that college students with ADHD, regardless of medication status, are at an increased likelihood of engaging in risky sexual behavior.

Perceived family resources based on number of members with ADHD

OBJECTIVE

This study examines how the number of family members with ADHD affects other family members' perceived resources.

METHOD

A total of 40 adolescents diagnosed with ADHD and their mothers, fathers, and adolescent siblings living in the household participated. Hierarchical linear modeling was used to analyze family-level data from a total of 130 participants.

RESULTS

Mothers reported more resources when only the target adolescent had ADHD and more nonsupportive factors when more than one member of the family had ADHD. Fathers reported more supportive factors when only one member of the family had ADHD.

CONCLUSION

Parents reported greater resources and strengths when only one adolescent family member had ADHD; however, family members had varying viewpoints. The ADHD Family Scale examined issues specific to ADHD, compared with general family stress and resource scales, and may be a useful tool for examining the impact of ADHD on all members of a family.

Nonmedical prescription stimulant use among a sample of college students: relationship with psychological variables

OBJECTIVE

To further investigate use and potential misuse of prescription stimulants (e.g., Ritalin, Adderall, Concerta) among a sample of college students and to explore the relationship between psychological variables and nonmedical stimulant use.

METHOD

The sample consisted of 390 college students (71.6% female, 28.4% male). Participants were asked to complete five questionnaires concerning demographic information, prescription stimulant use, internal restlessness, sensation seeking, and psychological distress.

RESULTS

The study findings revealed that, regarding nonprescribed stimulants, 7.5% reported use within the past 30 days; 60% reported knowing students who misused stimulants; and 50% agreed or strongly agreed that prescription stimulants were "easy to get on this campus." Findings further revealed a relationship between stimulant use and degree of psychological distress and internal restlessness.

CONCLUSIONS

Continued research regarding psychological variables, specific group membership (e.g., fraternity, sorority, athletics), and stimulant acquisition is suggested. Effective prevention and education efforts are needed to help address the nonmedical use of prescription stimulants on college campuses.

Utility of the Bender Visual-Motor Gestalt Test-Second Edition in the assessment of attention-deficit/hyperactivity disorder

This study examined the use of the Bender Visual-Motor Gestalt Test-Second Edition (BGT-II) with children diagnosed with Attention-Deficit/Hyperactivity Disorder (ADHD). Previous research has examined the relationship of ADHD and visual-motor functioning based on overall developmental scores or specific emotional indicators. Although several studies have examined the relationship of the previous edition of the BGT-II and ADHD symptoms, psychometric issues associated with the original edition limit the validity of the results. The current study examined the utility of the BGT-II in the assessment of behaviors associated with ADHD. A group of 62 subjects diagnosed with ADHD (M=11 yr., 5 mo.; 45 male, 17 female) was compared to a control group of 62 subjects randomly selected from the BGT-II standardization data (M=11 yr., 6 mo; 33 male, 29 female). Several hypotheses were made regarding how areas of deficit, e.g., self-regulation, planning, working memory, and motor control, were expected to manifest in BGT-II performance. With IQ controlled, subjects with ADHD performed more poorly on the BGT-II than subjects with no known disorders; however, the effect size was small (eta(p)=.07). Emotional indicators intended to assess symptoms of ADHD did not demonstrate diagnostic utility.

ADHD in college students

OBJECTIVE

According to the American Psychiatric Association, 3% to 7% of the school-age population has ADHD and many children continue to display significant symptoms throughout adolescences and adulthood. Relative to the childhood literature, less is known about ADHD in adults, especially college students with ADHD. The principle purpose of this review articles is to summarize the major research findings concerning ADHD in the college student population with regard to prevalence of symptoms, neuropsychological and psychological functioning. Overall, findings suggest that college students with ADHD are at greater risk for academic and psychological difficulties, and they perform similar to non-ADHD controls on many neuropsychological tasks. These findings are preliminary, however, and are tempered by the small number of studies that have been conducted as well as the methodological limitations of these studies.

CONCLUSION

Future research using larger sample sizes, rigorous assessment criteria, and a longitudinal design is needed to better understand the psychological, academic, and neuropsychological functioning of college students with ADHD. Studies are also needed to elucidate the effects of pharmacological and nonpharmacological effects of treatment on the functioning of college students with this disorder.

The relative effects of classwide peer tutoring and peer coaching on the positive social behaviors of children with ADHD

This study investigates the effects of Classwide Peer Tutoring (CWPT) and peer coaching on the peer social behaviors of children with ADHD. A single-subject, multiple-baseline design is used with three elementary-school students in Grades 3 and 4. Following a baseline period, CWPT is implemented in each student's classroom. During the second intervention phase, CWPT is continued and peer coaching is added. Peer social behaviors are observed in both academic and social settings, with a primary focus on intervention effects on the latter setting. Results suggest that students participating in CWPT are actively and positively engaged with their peers while carrying out the CWPT program in the academic setting. However, when only CWPT is implemented, increases in positive peer social behaviors are not observed in social settings. The addition of peer coaching results in enhanced social behaviors during recess and lunch.

The internal restlessness scale: performance of college students with and without ADHD

Attention-deficit/hyperactivity disorder (ADHD) was previously believed to be a disorder of childhood, with symptoms attenuating at the onset of puberty. Follow-up studies, however, suggest that the majority of children with ADHD continue to manifest symptoms into adulthood. Although the inattention components associated with ADHD persist into adulthood, the nature of the hyperactivity component is less well understood. For example, according to criteria established by the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, hyperactivity in adolescents and adults may be limited to subjective feelings of restlessness. Recent studies with adults with ADHD have also reported that mental restlessness is commonly reported by individuals with the disorder. To better understand this characteristic of ADHD, the Internal Restlessness Scale (IRS) was developed. The results of the IRS suggest that (a) college students with ADHD report significantly higher ratings of internal restlessness than college students without ADHD, and (b) the IRS appears to have adequate test-retest reliability and a four-factor structure. Implications and suggestions for future research are discussed.

The Assessment of Hyperactivity and Attention (AHA): development and preliminary validation of a brief self-assessment of adult ADHD

A brief self-rating scale, the Assessment of Hyperactivity and Attention (AHA), was developed and validated using a "gold standard" DSM-based semi-structured interview. The sample consisted of 101 smokers (74% male, 73% Caucasian)-38.6% with no DSM-IV ADHD diagnosis, 10.9% with a childhood diagnosis only, and 50.5% with an adult diagnosis (requiring childhood diagnosis as well). The mean age SD was 33.7 9.7; participants smoked a mean of 19.0 5.6 cigarettes/day. Results indicate that the AHA has utility as a screening tool and as a self-report assessment of ADHD with sensitivity of .80, specificity of .60, positive predictive power of .67, negative predictive power of .75, kappa of .40, odds ratio of 6.15, and an area under the curve (receiver operating characteristic analysis) of .79. Given the high rate of ADHD among smokers, the AHA may be useful in identifying smokers who may need more in-depth clinical evaluation for attentional problems.

Factors influencing elementary school teachers' ratings of ADHD and ODD behaviors

Examined factors that influence teachers' ratings of children with either attention deficit hyperactivity disorder (ADHD) or oppositional defiant disorder (ODD). 105 teachers watched 2 videotapes--1 depicting a normal child and the other a child with either ADHD or ODD--and rated each child using 2 different questionnaires. Results indicated that teachers accurately rated the child on the ADHD versus ODD tape as having significantly more inattention and hyperactivity but significantly less oppositionality. However, effect sizes indicated the presence of a unidirectional, negative halo effect of oppositional behaviors on ratings of hyperactivity and inattention. Teachers appeared less biased in their judgments when using a well-operationalized rating scale. Finally, knowledge, education, and experience with children with ADHD generally had no effect on the accuracy of teachers' ratings.

The Adolescent Behavior Checklist: development and initial psychometric properties of a self-report measure for adolescents with ADHD

Developed and provided initial psychometric properties on an adolescent, self-report questionnaire for attention deficit hyperactivity disorder (ADHD). The Adolescent Behavior Checklist (ABC) consists of 44 items that measure ADHD core symptoms and associated difficulties (e.g., conduct problems, academic problems, and social deficits). A total of 909 adolescents between the ages of 11 and 17 served as the standardization sample. Results indicated that the ABC was internally consistent. Principal components analysis revealed six factors for the ABC: Conduct Problems, Impulsivity/Hyperactivity, Poor Work Habits, Inattention, Emotional Lability, and Social Problems. Significant gender and race differences were obtained for some ABC factor scores, and initial standardization data were established based on this information. Initial convergent and divergent validity of the ABC was supported by the correlations obtained between factor scores and the subscale scores on the Child Behavior Checklist and Youth Self-Report. Using an additional sample of 81 adolescents, the stability of ABC scores across a 2-week interval was found to be satisfactory. Initial evidence for discriminant validity was established by comparing ABC scores for a sample of adolescents diagnosed with ADHD to the normative sample.

Attention deficits in school-aged children and adolescents. Current issues and practice

Attention deficits in school-aged children and adolescents pose unique diagnostic and management challenges for the practitioner. While this symptom reflects a heterogeneous spectrum of disorders with varying etiologies, clinical manifestation, treatment needs, and outcomes, there are sufficient common attributes to enable identification and treatment. Accurate diagnosis relies on synthesis of information from history, rating scales, direct observations, and psychometric testing. Close attention must be paid to potential underlying or associated medical, processing, emotional, and psychosocial problems. Multimodal treatment is essential with close collaboration between the child, parents, and professionals. While there is a risk of negative outcomes if the symptoms are left unattended, many of these children also harbor strengths that need to be identified and nurtured.