Developmental hyperactivity

On the positive association between candy and fruit gum consumption and hyperactivity in children and adolescents with ADHD

Objective: The purpose of the present study was the analysis of the association between consumption of candy and fruit gums, diagnosis of attention deficit hyperactivity disorder (ADHD), and behavioural problems. Methods: In total, 1,187 children and adolescents of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) were analyzed. Results: It was observed that children and adolescents with ADHD as compared to healthy controls (HC) reported to consume more frequently and higher amounts of candy and fruit gums and that hyperactivity was associated with frequent candy and fruit gum consumption. Conclusions: Because with the present design no conclusions on causality or directionality of the found associations could be drawn, results are discussed quite broadly in the light of several previously published interpretations, also to serve as a generator for further research. One more innovative speculation is that children and adolescents with ADHD may consume more frequently candy and fruit gums in order i) to compensate for their higher needs of energy resulting from hyperactive behaviour and/or ii) to compensate for the ADHD-typical deficits in the "reward cascade".

Psychometric Screening for Attention Deficit Disorder in a Clinical Setting

There is growing dissatisfaction with the DSM-III definition of Attention Deficit Disorder (ADD) and considerable debate among researchers as to whether ADD is a distinct disorder. Additionally, clinicians have relied on nonobjective behavioral observation to diagnose ADD. The present study attempted to find commonly used tests that could discriminate between an ADD sample and a control group with no DSM-III diagnosis. Subjects were 88 children, 7 to 10 years of age, who had received a battery of psychological tests. Discriminant analysis confirmed that hypothesized attention tests from the WISC-R, ITPA, Detroit, plus the GFW Auditory Selective Attention Test, significantly differentiated between the two groups and classified 74% of the cases correctly. It was concluded that use of these tests might add objective evidence to ADD screening and that the overall results lent support to ADD as a valid diagnostic classification.

Hyperactivity in Attention-Deficit/Hyperactivity Disorder (ADHD): Impairing Deficit or Compensatory Behavior?

Excess gross motor activity (hyperactivity) is considered a core diagnostic feature of childhood ADHD that impedes learning. This view has been challenged, however, by recent models that conceptualize excess motor activity as a compensatory mechanism that facilitates neurocognitive functioning in children with ADHD. The current study investigated competing model predictions regarding activity level's relation with working memory (WM) performance and attention in boys aged 8-12 years (M = 9.64, SD = 1.26) with ADHD (n = 29) and typically developing children (TD; n = 23). Children's phonological WM and attentive behavior were objectively assessed during four counterbalanced WM tasks administered across four separate sessions. These data were then sequenced hierarchically based on behavioral observations of each child's gross motor activity during each task. Analysis of the relations among intra-individual changes in observed activity level, attention, and performance revealed that higher rates of activity level predicted significantly better, but not normalized WM performance for children with ADHD. Conversely, higher rates of activity level predicted somewhat lower WM performance for TD children. Variations in movement did not predict changes in attention for either group. At the individual level, children with ADHD and TD children were more likely to be classified as reliably Improved and Deteriorated, respectively, when comparing their WM performance at their highest versus lowest observed activity level. These findings appear most consistent with models ascribing a functional role to hyperactivity in ADHD, with implications for selecting behavioral treatment targets to avoid overcorrecting gross motor activity during academic tasks that rely on phonological WM.

Is hyperactivity ubiquitous in ADHD or dependent on environmental demands? Evidence from meta-analysis

Hyperactivity, or excess gross motor activity, is considered a core and ubiquitous characteristic of ADHD. Alternate models question this premise, and propose that hyperactive behavior reflects, to a large extent, purposeful behavior to cope with environmental demands that interact with underlying neurobiological vulnerabilities. The present review critically evaluates the ubiquity and environmental modifiability of hyperactivity in ADHD through meta-analysis of 63 studies of mechanically measured activity level in children, adolescents, and adults with ADHD relative to typically developing groups. Random effects models corrected for publication bias confirmed elevated gross motor activity in ADHD (d=0.86); surprisingly, neither participant age (child vs. adult) nor the proportion of each ADHD sample diagnosed with the inattentive subtype/presentation moderated this effect. In contrast, activity level assessed during high cognitive load conditions in general (d=1.14) and high executive functioning demands in particular (d=1.39) revealed significantly higher effect sizes than activity level during low cognitive load (d=0.36) and in-class schoolwork (d=0.50) settings. Low stimulation environments, more rigorous diagnostic practices, actigraph measurement of movement frequency and intensity, and ADHD samples that included fewer females were also associated with larger effects. Overall, the results are inconsistent with DSM-5 and ADHD models that a) describe hyperactivity as ubiquitous behavior, b) predict a developmental decline in hyperactivity, or c) differentiate subtypes/presentations according to perceived differences in hyperactive behavior. Instead, results suggest that the presence and magnitude of hyperactive behavior in ADHD may be influenced to a considerable extent by environmental factors in general, and cognitive/executive functioning demands in particular.

Meditation therapies for attention-deficit/hyperactivity disorder (ADHD)

BACKGROUND

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common developmental disorders experienced in childhood and can persist into adulthood. The disorder has early onset and is characterized by a combination of overactive, poorly modulated behavior with marked inattention. In the long term it can impair academic performance, vocational success and social-emotional development. Meditation is increasingly used for psychological conditions and could be used as a tool for attentional training in the ADHD population.

OBJECTIVES

To assess the effectiveness of meditation therapies as a treatment for ADHD.

SEARCH STRATEGY

Our extensive search included: CENTRAL, MEDLINE, EMBASE, CINAHL, ERIC, PsycINFO, C2-SPECTR, dissertation abstracts, LILACS, Virtual Health Library (VHL) in BIREME, Complementary and Alternative Medicine specific databases, HSTAT, Informit, JST, Thai Psychiatric databases and ISI Proceedings, plus grey literature and trial registries from inception to January 2010.

SELECTION CRITERIA

Randomized controlled trials that investigated the efficacy of meditation therapy in children or adults diagnosed with ADHD.

DATA COLLECTION AND ANALYSIS

Two authors extracted data independently using a pre-designed data extraction form. We contacted study authors for additional information required. We analyzed data using mean difference (MD) to calculate the treatment effect. The results are presented in tables, figures and narrative form.

MAIN RESULTS

Four studies, including 83 participants, are included in this review. Two studies used mantra meditation while the other two used yoga compared with drugs, relaxation training, non-specific exercises and standard treatment control. Design limitations caused high risk of bias across the studies. Only one out of four studies provided data appropriate for analysis. For this study there was no statistically significant difference between the meditation therapy group and the drug therapy group on the teacher rating ADHD scale (MD -2.72, 95% CI -8.49 to 3.05, 15 patients). Likewise, there was no statistically significant difference between the meditation therapy group and the standard therapy group on the teacher rating ADHD scale (MD -0.52, 95% CI -5.88 to 4.84, 17 patients). There was also no statistically significant difference between the meditation therapy group and the standard therapy group in the distraction test (MD -8.34, 95% CI -107.05 to 90.37, 17 patients).

AUTHORS' CONCLUSIONS

As a result of the limited number of included studies, the small sample sizes and the high risk of bias, we are unable to draw any conclusions regarding the effectiveness of meditation therapy for ADHD. The adverse effects of meditation have not been reported. More trials are needed.

Hyperactivity in boys with attention-deficit/hyperactivity disorder (ADHD): a ubiquitous core symptom or manifestation of working memory deficits?

Hyperactivity is currently considered a core and ubiquitous feature of attention-deficit/hyperactivity disorder (ADHD); however, an alternative model challenges this premise and hypothesizes a functional relationship between working memory (WM) and activity level. The current study investigated whether children's activity level is functionally related to WM demands associated with the domain-general central executive and subsidiary storage/rehearsal components using tasks based on Baddeley's (Working memory, thought, and action. New York: Oxford University Press 2007) WM model. Activity level was objectively measured 16 times per second using wrist- and ankle-worn actigraphs while 23 boys between 8 and 12 years of age completed control tasks and visuospatial/phonological WM tasks of increasing memory demands. All children exhibited significantly higher activity rates under all WM relative to control conditions, and children with ADHD (n = 12) moved significantly more than typically developing children (n = 11) under all conditions. Activity level in all children was associated with central executive but not storage/rehearsal functioning, and higher activity rates exhibited by children with ADHD under control conditions were fully attenuated by removing variance directly related to central executive processes.

Cooccurrence of problems in activity level, attention, psychosocial adjustment, reading and writing in children with developmental coordination disorder

The purpose of this paper was to investigate the cooccurrence of problems in activity level, attention, reading, writing and psychosocial adjustment of children with developmental coordination disorder (DCD). A parent-report questionnaire, the Developmental Coordination Disorder Questionnaire - Chinese version (DCDQ-C), was used to screen first to third graders from 13 mainstream schools in Taipei. Two standardized motor tests were then administered to those who scored below 10% on the DCDQ-C. Tests of activity level, attention, reading, writing and psychosocial adjustment were then administered to this sample. Thirty-eight children identified as DCD, 32 as suspect for DCD and 82 as normal comparison were included in the final sample. Multivariate analysis of variance comparing the three groups (DCD, suspect DCD, and comparison) revealed that both children with DCD and suspect for DCD obtained significantly poorer scores on measures of attention and reading, and were more hyperactive than comparison children. Children with DCD and suspect for DCD were also reported to have more internalizing and social problems than children without motor problems. No significant differences, however, were noted between children with different degree of motor coordination problems (categorized as DCD and suspect for DCD) on any measure. Furthermore, a high percentage of children in both the DCD and suspect groups fell in the clinical range of attention, activity level and psychosocial adjustment problems. The results revealed a high risk for these problems in nonreferred children with motor coordination problems. The high percentage of clinical range behavioral problems warrants attention of clinicians who work with children with motor coordination difficulties to the need to promote early identification and referral.

Seeking help for attention deficit hyperactivity disorder in developing countries: A study of parental explanatory models in Goa, India

This qualitative study analyzes the explanatory models employed by parents whose children have been diagnosed with attention deficit hyperactivity disorder (ADHD) and the ways in which these explanatory models change as they seek help for their child's problem. In-depth interviews were conducted with 24 parents recruited from a list of children who had been diagnosed with ADHD at a community-based child development center (CDC) in Goa, India. The most frequent reasons for consulting the CDC were educational difficulties. Despite having received an ADHD diagnosis and reporting significant adverse impact of the child's behavior, most parents were reluctant to accept the biomedical explanatory model or even consider their child's difficulties as an illness. Instead, parents most commonly attributed causality to psychological models, learning and memory difficulties, and to models which emphasized either the volitional or non-volitional nature of the problem, or to attribute blame of self or spouse. Interventions most commonly used were educational and religious; consultation with the CDC was the last resort for many parents. We conclude that cultural attitudes towards mental illness significantly affect parental perception and behavior in response to interventions by biomedical practitioners for child mental health problems in developing countries.

Relationship between motor proficiency, attention, impulse, and activity in children with ADHD

The aim of this study was to investigate the relationship between motor performance, attention deficit, impulsiveness, and hyperactivity in children with attention-deficit--hyperactivity disorder (ADHD). Participants were 42 school-aged children with ADHD (36 males, 6 females; mean age 8 years 2 months, SD 1 year 2 months; range 6 years to 11 years), and 42 age- and sex-matched children without ADHD (mean age 8 years 3 months, SD 1 year 1 month; range 6 years to 11 years). Motor abilities were assessed with the Bruininks-Oseretsky Test of Motor Proficiency. Attention and impulse control were measured with the Gordon Diagnostic System, and assessment of activity level was based on two Activity Level Rating Scales that were completed by parents and teachers. Analysis by t-test revealed a significant difference between children with and without ADHD in fine and gross motor skills, impulse control, and attention. Stepwise regression indicated that attention, impulse control, and parent ratings of activity level were the three best predictors of gross motor skills for children with ADHD, accounting for 55.9% of the variance. Attention and impulse control were the two best predictors of fine motor skills, accounting for 45.7% of the variance. Attention and impulse control were consistently found to be important predictors of both fine and gross motor skills in children with ADHD. However, the fact that activity level was a predictor for gross motor proficiency but not for fine motor tasks suggests that different behavioral processes are involved in fine and gross motor performance to different extents.

Prevalence of attention-deficit hyperactivity disorders in students. Comparison between DSM-IV and neuropsychological criteria

Attention-deficit hyperactivity disorder (ADHD) is a common childhood condition, recognized as an important social-medical problem. The syndrome is characterized by motor system, perception, cognition and behavioral disturbances, compromising the learning of children with adequate intellectual potential. To investigate its prevalence in first grade pupils 484 children with DSM-IV diagnostic criteria and neuropsychological criteria were examined. The prevalence of ADHD was 18% when the diagnosis was made using DSM-IV criteria; 3.5% when neuropsychological criteria was used, including, in addition to behavioral and psychometric aspects, a discrepancy in the evolutionary neurological examination, and 3.9% when motor persistence was taken into account. The prevalence of ADHD was higher among older children (92.4 months) only when DSM-IV criteria were used. We conclude that the use of DSM-IV criteria probably overestimates the prevalence of ADHD, since it detects another behavioral disorders. In this context, they may be useful as screening, since they have adequate pre-testing performance.

[Use of amitriptyline in attention deficit hyperactivity disorder]

We studied the action of amitriptyline (AMI) in the attention deficit hyperactivity disorder (ADHD). Twenty-five children who came to consultation for ADHD were analyzed, in two groups: the group which used AMI (n = 18) at 1.6 mg/kg/day and the group which used placebo (n = 7). Both groups were submitted to two assessments in a 30 days interval, which consisted of the evolutive neurological evolution examination (ENE) and the WISC scale subtests on numbers, drawings to be completed and the code. The results showed that the AMI produced an improvement in performance in the motor persistence tests.

Accomplishments during young adulthood of children originally diagnosed with minimal cerebral dysfunction: a ten-year follow-up study

To gather data about the adult accomplishments of persons diagnosed with minimal cerebral dysfunction this retrospective study evaluated 57 subjects at ten-year follow-up. Two-thirds of the subjects graduated from high school with an average of 11.8 years of education. Factors correlating with educational outcome included intelligence quotient, age at initial evaluation, and parental socioeconomic status. Adult accomplishments appear related to intelligence and to the presence of family or behavior problems.

Contributing factors in the manifestation of aggression in preschoolers with hyperactivity

This study examined family characteristics of preschoolers with hyperactivity. We assessed child-rearing practices, maternal depression, marital conflict, and social support. Sixty-three preschool boys were placed in a hyperactivity-aggressive, hyperactive, aggressive or comparison group based on behavioral ratings. Parents were given questionnaires, mothers were interviewed, and children were administered the Woodcock-Johnson Psycho-Educational Battery and were observed playing. Compared to preschoolers with hyperactivity, preschoolers with hyperactivity plus aggression had families with (a) more restrictive fathers, (b) siblings who retaliated aggressively, and (c) mothers who reported more physical aggression directed to their partners and more verbal aggression received. Follow-forward aggression ratings were predicted by initial child manageability and maternal depression, perceived support, and low income.

Individuation-Attachment and Suicide Trajectory: A Developmental Guide FOR the Clinician

This article applies a two-axis model of human development to the problem of suicide trajectory. The two-axis approach represents a fundamental shift in the way Eriksonian stages are viewed. Typical interpretations of Erikson suggest healthy development is achieved by resolving each stage crisis horizontally in favor of the syntonic as opposed to the dystonic ego quality. A two-axis view proposes that an organism begins each stage at the negative or dystonic position in reaction to the stage-initiating life event and must move ahead vertically to achieve the positive syntonic quality and the attaining of a stage-specific syntonic equilibrium.

We are suggesting that successful development involves not the avoidance of the negative or dystonic ego qualities at each stage but the very plunging into each of them as the natural sequela of the preceding life event. Successful development involves working through a stage vertically to attain the respective stage-specific positive or syntonic ego position, followed by forward regression to the next advanced stage. The logic of this developmental axis is simply that the loosening of one's defenses (i.e., greater permeability of walls) should occur in conjunction with the strengthening of one's ego (i.e., greater definition of boundaries).

Incongruent resolution of the individuation-attachment dilemma results in “enmeshment” (attachment to the external world without individuation), or in “disengagement” (remaining detached even after becoming sufficiently individuated). Extreme distress can result from the attempt to simultaneously apply enmeshed and disengaged styles to cope with the overwhelming challenges of the new life stage, creating a potentially suicidal level of stress.

A 6-year follow-up of behavior and activity disorders in the Taiwan Yu-cheng children

OBJECTIVES

The relationship of behavior and activity levels to the interval between outbreak and year of birth and to age of children is explored in Taiwanese children exposed in utero to heat-degraded polychlorinated biphenyls (PCBs)--the Yu-cheng children. Additionally, the relationship of the scores to chemical, physical, and cognitive findings is described.

METHODS

With Rutter's Child Behavior Scale A and a modified Werry-Weiss-Peters Activity Scale, 118 Yu-chen children and matched controls were followed biannually from 1985 to 1991.

RESULTS

At each year, the Yu-cheng children scored 7% to 43% worse (mean = 23%) than control children on the Rutter scale. At any fixed age, the Yu-cheng children scored 11% to 63% (mean = 28%) worse. The effect for children born later did not differ from that for those born earlier; neither was there any improvement as the children aged. A similar but weaker picture was seen for the activity score. These behavioral findings were not related to physical or cognitive findings or to serum PCB levels.

CONCLUSIONS

In utero exposure to heat-degraded PCBs appears to cause mildly disordered behavior and increased activity level; the effect persists over time and is similar in children born up to 6 years after the mothers were exposed.

Mathematical performance and behavior of children with hyperactivity with and without coexisting aggression

An analysis was made of a basic skill deficit and collateral behavior that could differentiate youth with hyperactivity from children with both hyperactivity and aggression. A total of 92 boys (with hyperactivity, with hyperactivity and aggression, and without disorders) were assessed for their timed performance and accuracy of computer-generated math operations. Response time differences documented between disordered and nondisordered groups, and between the diagnostic groups, were not explained by the group differences that were also observed in behavior or motor response speed (typing). Conclusions derived from these findings, and from prior work, indicated that speed of addition may be a marker of academic and social dysfunction. The overall importance of this assessment is related to the potential sensitivity of math fluency data for assessment and treatment monitoring.

Relative efficacy of ritalin and biofeedback treatments in the management of hyperactivity

This study examined the efficacy of biofeedback and Ritalin treatments on hyperactivity as reflected by muscular electrical activity and as observed by teachers and parents. Eighteen male subjects between the ages of 10 and 13 were assigned to three groups, matched by age, IQ, and race. One group received 10 biofeedback sessions, another received Ritalin, and the third group controlled for nonspecific treatment effects. EMG readings, the Conners Teacher Rating Scale, the Werry-Weiss-Peters Scale, and the Zukow Parent Rating Scale were used to measure treatment efficacy. Results indicated that biofeedback-assisted relaxation significantly reduced muscle tension levels, whereas neither Ritalin nor personal attention produced significant change. On teacher ratings of hyperactivity, significant improvement was made by all three groups. Parent ratings on the Zukow scale indicated significant improvement by subjects in all groups. On the Werry-Weiss-Peters scale, the biofeedback and control groups made significant improvements in hyperactivity.

Hypnopolygraphic alterations in Attention Deficit Disorder (ADD) children

The sleep pattern of 13 prepubertal children, nonmedicated, rigourously diagnosed as Attention Deficit Disorder (ADD) was recorded for two consecutive nights. Analyses of sleep pattern variables revealed a marked reduction of sleep onset latency (p less than .01), a great number of nocturnal awakenings (p less than .01), and a high increase of Delta sleep percentage (p less than .01) for the ADD children compared to normals. In addition, the two subtypes of the disorder--ADD with hyperactivity (ADD/H) and ADD without hyperactivity (ADD/WO) or ADD undifferentiated--showed distinct hypnopolygraphic correlates. Those ADD/H children had a greater sleep fragmentation and a lesser degree of sleep efficiency. These findings would support the hypothesis that ADD is related to a deficient control of arousal level and, on the other hand, suggest that ADD/H and ADD/WO are different clinical entities.

Child outcome following mid-trimester amniocentesis: development, behaviour, and physical status at age 4 years

Four-year-old children whose mothers had mid-trimester amniocentesis (n = 88) were compared with children whose mothers chose not to have the procedure (n = 46). Intelligence, visual-motor-perceptual skills, language, behaviour, social competence, temperament, physical growth, hearing, and middle-ear function were measured using standardized procedures. Health histories were obtained by maternal report. The results suggest that the wide range of developmental and behavioural variables studied is not influenced by removal of amniotic fluid in the mid-trimester. However, mothers who had amniocentesis were more likely to report a history of ear infections in their child (P = 0.04). In support of this finding were the results of audiological assessment which demonstrated a trend toward a higher rate of bilateral middle-ear impedance abnormalities in children whose mothers had amniocentesis (P = 0.06). Further study of the upper respiratory system is recommended to explore potential long-term sequelae of mid-trimester amniocentesis.

Differentiation of motor activity of normally active and hyperactive boys in schools: some preliminary results

All non-task-related body movements during school hours were listed in 11 normally active and 12 hyperactive boys. The mean number of movements was 48 +/- 7 per 45 minutes in the normal actives and 79 +/- 16 per 45 minutes in the hyperactives. The rather monotonous increment and decrement of motor activity during the 4-hr registration period was noticed only in hyperactive boys. These results could be a consequence of a circadian rhythm, as there was independence of type of school hours and of teacher personality. The cyclical level of activity in hyperactive boys was sometimes in the range of the normal actives.

Communication disturbances and hyperactive/conduct-disturbed behavior

This study examines mother-child communication as one factor in the development of conduct-disturbed/hyperactive boys. Three groups of school-age children were compared: a group including conduct-disturbed/hyperactive boys who had a significant insult in their perinatal/developmental history; a group of conduct-disturbed/hyperactive boys in whom no insult could be found; and a group of normally active/non-conduct-disturbed/hyperactive boys. It was hypothesized that disturbed communication between mother and son would be found in boys who were conduct-disturbed/hyperactive, whether or not there was a probable organic cause for their dysfunction, and this hypothesis was confirmed. In addition, it was found that the communication patterns in children who had a probable organic etiology for their disturbance were different from those found in the group lacking an organic etiology. However, both of these groups exhibited communication patterns that were more disturbed than the communication from mother to son in the normally active, non-conduct-disturbed group.

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.

Plasma free tryptophan concentration in autistic children

The plasma free and total tryptophan (TRP) and blood serotonin levels in autistic children were examined simultaneously in order to establish a relationship between these parameters and the pathophysiology of infantile autism. The subjects were 37 autistic children, 28 normal adults and 12 normal children. Quantitative evaluation of the global severity, hyperkinetic behavior and intellectual function was performed by means of the Children's Psychiatric Rating Scale (CPRS-1), the Werry-Weiss-Peters Activity Scale (WWPAS) and the Developmental Quotient (DQ), respectively. The mean total TRP level in autistic children was not significantly different from those in normal children and adults. The mean plasma free TRP level in autistic children was significantly higher than those in normal children and adults. A significant positive correlation was found between the plasma free TRP level and CPRS-1 or WWPAS score in autistic children. Moreover, there tended to be a negative correlation between the plasma free TRP level and DQ. These findings suggest the presence of some defect in the metabolic system for TRP-serotonin in the brain of autistic children.

Plasma free tryptophan concentration in children with attention deficit disorder

In order to examine the serotonin metabolism in children with attention deficit disorder (ADD), plasma tryptophan, which is the precursor of serotonin, was measured in 10 children with ADD and 12 normal children. The mean plasma total tryptophan level in the children with ADD was not significantly different from that of the normal children. The mean plasma free tryptophan level in the children with ADD was significantly higher than that in the normal children. There tended to be a positive correlation between the plasma free tryptophan level and the Werry-Weiss-Peters Activity Scale in children with ADD. In other words, the more severe the hyperactivity of ADD, the higher the plasma free tryptophan level. The mean ratio of plasma free to total tryptophan levels in the children with ADD was significantly higher than that in the normal children, which means that the children with ADD showed a high amount of free tryptophan in the total tryptophan level. These results suggest that there might be some disturbance in the tryptophan-serotonin metabolism in the brain of a child with ADD.

Dietary factors and hyperactivity: a failure to replicate

Recent research suggests that sucrose consumption may be a factor in children's hyperactivity. Yet, the manner in which hyperactive behavior was assessed confounded hyperactivity and aggression, thereby reducing the conceptual validity of the findings. In addition, accepting a probability level of 0.06 as significant with 36 correlations, and using grams rather than portions as an index of food consumption might have contributed to a Type I error. When these three issues were addressed in the present study, no significant relationships emerged between sucrose consumption and hyperactivity or aggression assessed as separate dimensions. The age of the hyperactive children in this sample (M = 9.15 years) contrasted with that of the original research (M = 6 years 2 months) and this may contribute to the differential results. Suggestions for further research are outlined, and the need to separate hyperactive children according to whether they receive stimulant medication or not, and assess attention deficit disorders in addition to behavioral components of hyperactivity are stressed.

Chelation therapy in children as treatment of sequelae in severe lead toxicity

Certain children who experience a toxic lead episode requiring hospitalization in infancy or early childhood will manifest central nervous system dysfunctions, including hyperactivity, as sequelae of this experience. In this study, findings indicate that persistent, higher-than-normal lead levels, dating back to the time of the initial toxicity, may well be a mechanism underlying some of these sequelae. Consequently, some part of these sequelae may be preventable and/or treatable.

Preliminary support for the oral administration of valine, isoleucine and leucine for phenylketonuria

Recent behavioral data have demonstrated the importance of maintaining low phenylalanine concentrations beyond early childhood in patients with phenylketonuria, which can be a difficult task, particularly during adolescence. Administration of certain large neutral amino-acids (valine, isoleucine, leucine--VIL) appears to reduce phenylalanine concentrations in the cerebrospinal fluid of humans and in the brain of rats. The present study compared neuropsychological test-performance of six patients with phenylketonuria during periods of VIL administration and periods when this supplement was not given. Although individual responses to VIL were variable, there was an over-all improvement of about 1 1/2 SD in neuropsychological test performance during VIL treatment. Abstract reasoning and tactile motor problem-solving increased more than pure motor performance.

The adolescent outcome of hyperactive girls

The adolescent outcome of a complete cohort of 12 girls diagnosed hyperactive in childhood is compared with that of 24 hyperactive boys and 24 male control subjects matched for age and social class. The lifetime psychiatric history of parents was also assessed. No significant difference between the rate of mental disorder in adolescent hyperactive boys and girls was found. Also, the rate of lifetime adult psychiatric diagnosis in the parent groups did not differ significantly.

Modification of inattentive classroom behavior. Hyperactive children's use of self-recording with teacher guidance

Three hyperactive children participated in a training program designed to teach them how to self-record their behavior in a regular classroom. Subsequently, in the regular classroom, each child was signaled when to record his behavior at intervals of time that were convenient for the teacher. Signaled self-recording produced reductions in inattentive and inappropriate classroom behavior, and increased on-task behavior for all of the children. By using such procedures in the actual classroom setting, it was possible to circumvent generalization difficulties that have been reported in previous studies attempting to modify classroom behavior by using training procedures in a laboratory setting.

Hyperactivity in children: evidence for differences between parents' and teachers' perceptions of predominant features

The behavior of 34 hyperactive children was rated by their parents and teachers. The relationships between behavior rating scores and the actual behavior of the children in the classroom were examined. Parents' ratings correlated significantly with children's frequency of inattention in the classroom, while teachers' ratings were correlated with out-of-seat behavior. Results are discussed in terms of parents' and teachers' sensitivity to and awareness of different features of hyperactivity in children.

Schedule-induced behavior in hyperactive children

A schedule-induced behavior paradigm was used to investigate the activity patterns of hyperactive children in a standardized situation. In Experiment I, 10 hyperactive and 10 normal control children matched for age, sex, and IQ were observed under conditions of baseline and schedule. Measures of a number of categorized activities were taken on a time-sampling basis. Hyperactive children were more active than controls in baseline and did not respond to the schedule, unlike the controls who became significantly more active in schedule conditions. In Experiment II, 12 hyperactive and 6 normal children were again subjected to the same experimental paradigm, but in two of the four experimental sessions the stimulant drug methylphenidate was administered in an attempt to reduce the amount of baseline activity. Results were substantially similar to those of Experiment I, with hyperactive children more active than controls in baseline and insensitive to the schedule. There was no overall effect of drug administration on the behavior of either group. There were some rate-dependent effects of both drug and schedule conditions.

The relationship of hyperactivity to moderately elevated lead levels

Controversy exists with respect to whether moderately elevated lead levels are toxic in certain children with various central nervous system dysfunctions. One way of addressing this controversy is to remove the lead; if the condition is ameliorated a presumption of toxicity becomes reasonable. Such a strategy is reported herein. Children with an operationally defined central nervous system dysfunction (hyperactivity) and moderately elevated lead levels were treated with a lead chelating agent in a random allocation double blind treatment regimen. The finding of statistically significant and obvious behavioral improvement reported by three separate evaluators (i.e., parent, teacher, and treating physician) of the child suggests that the presumption of a toxic relationship between moderately elevated lead levels and hyperactivity is supported.

Evidence for an independent syndrome of hyperactivity

It has recently been suggested that hyperactivity and an aggressive conduct disorder cannot exist independently in children. The results of a factor analysis of the Conners Teacher Rating Scales of over 9000 children provided preliminary evidence to the contrary; a hyperactivity factor emerged as explaining the greatest proportion of the variance. Because of the large size of our data-set, it was deemed necessary to investigate the heuristic value of this finding. Using norms calculated on composite factor scores, a contingency analysis was performed to determine the proportions of children who were above a two-standard deviation criterion of deviance on all factors and combinations of factors. The use of different degrees of statistical control produced prevalence estimates comparable to those reported in the literature. These findings raise the possibility that studies reporting different prevalences of hyperactivity may, in fact, be exercising different degrees of conservatism in classification. Also, when the extent of overlap along each of our factor dimensions was examined, a group of children who appeared to be hyperactive but not conduct-disordered emerged. These findings provide evidence for an independent syndrome of hyperactivity in a sample of Canadian children.

Stimulus-seeking behavior in hyperactive and nonhyperactive children

Auditory and visual stimulus-seeking behavior was measured in hyperactive and nonhyperactive youngsters. The design controlled for motor activity level. The results indicate that hyperactive children preferred auditory stimulation more than the control children. There were no differences in stimulus-seeking preferences in the visual modality. The groups did not differ in motor activity. It was concluded that abnormally high needs for stimulation are important in hyperactivity.

Physiotherapy in the treatment of hyperkinetic children

The hyperkinetic syndrome is a feature of present times. This paper gives a brief survey of literature concerning the problem together with some details about causes, treatments, and methods of assessing the quantity and quality of the excessive movement. Although physiotherapists cannot treat the basic causes, they may give assistance by assessing the nature of the excessive movement and explaining this to teachers and parents, as well as helping with any co-existing clumsiness.

ties"ties"

The diagnostic category of learning disabilities is a heterogeneous one, but few empirical attempts have been made to distinguish subgroups. Recent research, however, suggests that it may be meaningful to discriminate between "hyperactive" and "nonhyperactive" learning-disabled children. In the present study, 21 learning-disabled children identified as "hyperactive" through teacher nominations and ratings were compared to 15 learning-disabled children identified as "nonhyperactive" in the same manner. The two groups differed on rated behavior, birth order, amount of prescribed stimulant medication, amount of psychosocial stress, and Verbal, Performance, and Full Scale WISC-R IQ scores. They did not differ, however, on several demographic variables, the number of perinatal complications, reading achievement, and a number of tonic and phasic measures of autonomic activity. These findings support the distinction between "hyperactive" and "nonhyperactive" subgroups of learning-disabled children, but suggest that the two subgroups may have a similar biological substrate.

Non-specificity of motor hyperactivity as a diagnostic criterion

The relationship between motor hyperactivity and childhood depression was investigated in a group of 178 children referred for evaluation of school problems. 60% (n = 107) of the children fulfilled the modified Feighner criteria for primary childhood depression. 44% (n = 78) of the children had motor hyperactivity and 75% (n = 59) of these also showed depression. Terminal insomnia, somatic complaints, self-deprecation, episodic loss of interest in school and usual activities, social withdrawal, and preoccupation with death and dying were the symptoms which significantly differentiated depressed from non-depressed children.

Biological factors in childhood hyperkinesis: a review of genetic and biochemical hypotheses

Reviewed research related to prevailing hypotheses with regard to the influence of genetic and biochemical factors in childhood hyperkinesis. Studies focused on establishing the influence of genetic factors are methodologically weak but consistently suggest that genetic transmission is a plausible, if incomplete, explanation in some cases. Studies that involve attempts to understand the underlying biochemical mechanisms of hyperactivity by studying the relationships among behavior patterns, psychophysiological measures, and variations in monamine levels have been disappointing.