Psychiatric and psychological morbidity as a function of adaptive disability in preschool children with aggressive and hyperactive-impulsive-inattentive behavior

Attention Deficit Hyperactivity Disorder in Preschool Children: A Cross-Sectional Study of Clinical Profile and Co-morbidity

Background:

Diagnosis of Attention Deficit Hyperactivity Disorder (ADHD) in preschool children is challenging and complicated owing to the presence of developmentally appropriate overactivity and a dynamic developmental/learning phase shaping their behaviour. We aimed to study the clinical profile and co-morbidity of ADHD in preschool children.

Methods:

Fifty consecutively presenting preschool children with ADHD were enrolled from our child guidance clinic (CGC) between January 2017 and December 2018. The diagnosis and assessment of comorbidities were based on the DSM-5 criteria and Vanderbilt teacher and parent rating scales. Relevant clinical and sociodemographic profiles were assessed and analyzed for association with ADHD subtypes and comorbidity.

Results:

Preschool children with ADHD constituted 8% of all patients visiting the CGC and one-fifth of all children with ADHD. Male:female ratio was 11.5:1. Hyperactive-impulsive was the commonest type, and oppositional defiant disorder (ODD) was the commonest comorbidity. Most children belonged to the lower-middle socioeconomic group. Language delay was observed in 20%. Median social quotient measured using the Vineland Social Maturity Scale was 83.

Conclusions:

Preschool children predominantly have the hyperactive impulsive type of ADHD. Isolated language delay was the predominant comorbid developmental disorder, and ODD was the predominant comorbid behavioural disorder. Addressing these issues would help in the appropriate management of these children.

Exploring demographic, medical, and developmental determinants of adaptive behaviour in children with hemiplegic cerebral palsy

Hemiplegic cerebral palsy (CP), the most common subtype, is characterized by high levels of mobility. Despite this, children with hemiplegic CP can face challenges functioning in and adapting to situations of everyday life. The purpose of this cross-sectional study (Hemi-NET database) was to identify factors associated with adaptive behaviour in 59 children with hemiplegic CP (ages 4-18; GMFCS I-IV). Using multivariate regression analyses, the relationship between demographic, medical, and developmental factors and adaptive behaviour (measured by the Adaptive Skills Composite score of the BASC-2) was explored. Results indicate that 34% of children had impaired adaptive skills. An autism diagnosis and lower communication functioning were significantly associated with poorer adaptive skills (R² = 0.42, F(4, 43) = 7.87, p < 0.001), while factors such as IQ scores and GMFCS level were not. The results contribute to the growing literature that suggests that clinicians and researchers need to look beyond motor functioning when working with individuals with CP.

A Double-Blind, Randomized Study of Extended-Release Molindone for Impulsive Aggression in ADHD

Objective: To evaluate efficacy and safety of SPN-810 (extended-release molindone) in a Phase-2b, randomized, double-blind, placebo-controlled, dose-ranging study of children (6-12 years) with ADHD and persistent impulsive aggression (IA). Method: After lead-in, children were randomized to (a) placebo (N = 31); (b) low-dose (N = 29, 12/18 mg/day); (c) medium-dose (N = 30, 24/36 mg/day); and (4) high-dose (N = 31, 36/54 mg/day) groups. Treatment included ~2.5-week titration, 3-week maintenance, and 1-week tapering/conversion, alongside existing monotherapy (stimulants/nonstimulants) and behavioral therapy. The primary endpoint was change in Retrospective-Modified Overt Aggression Scale (R-MOAS) score at end of study, with safety monitored. Results: A total of 95 (78.5%) children completed the study. Aggression (R-MOAS) improved with low and medium doses (low dose: p = .031; medium dose: p = .024; high dose: p = .740). The most common adverse events were headache (10.0%), sedation (8.9%), and increased appetite (7.8%). Conclusion: These results suggest SPN-810 may be effective in reducing residual IA behaviors in children with ADHD. Research is still needed to support the benefit-risk profile of SPN-810 in pediatric populations.

Diagnostic delay in ADHD: Duration of untreated illness and its socio-demographic and clinical predictors in a sample of adult outpatients

AIM

To investigate the Duration of Untreated Illness (DUI) and its socio-demographic and clinical predictors in a sample of adult ADHD outpatients.

METHODS

The DUI of 150 adult outpatients with a confirmed diagnosis of DSM-IV ADHD was calculated. Non-parametric tests were used to evaluate differences in DUI among subgroups and to build a correlation matrix. Subsequently, a multiple linear regression model was performed.

RESULTS

The median DUI was 17 years (interquartile range [IQR] = 14). DUI was longer in employed patients, those with a family history of ADHD, those with a history of major depressive disorder and those who had predominantly inattentive ADHD in childhood. The current age, age at administration of the first proper treatment and education level were correlated with DUI. Current age (63.3% of total variance), family history of ADHD and the presence of a predominantly inattentive type in childhood (together, 2.6% of total variance) were all predictors of DUI.

CONCLUSIONS

Information programmes for caregivers and training for health care professionals should be promoted to foster the early recognition of covert inattentive symptoms and shorten DUI.

Family and Maternal Characteristics of Children With Co-Occurring ADHD and Depression

Objective: This study examined differences between children with ADHD and comorbid depression (n = 26), ADHD only (n = 111), and a community control group (n = 130) on measures of family and maternal characteristics. Method: The present study utilized a large, community sample. Diagnoses required positive endorsements from multiple sources. ANOVAs and chi-square tests were conducted to determine group differences. Results: Compared with children with ADHD alone and community controls, mothers of depressed ADHD children reported decreased family cohesion, limited participation in social/recreational activities, increased maternal depressive symptoms, difficulty coping with parenting roles, and higher rates of bipolar and anxiety disorders. Mothers of children with ADHD (with or without comorbid depression) reported increased conflict, decreased cohesion, and poor maternal coping compared with community controls. Conclusion: Findings are consistent with prior literature suggesting that families of children with ADHD and depression demonstrate both similar and unique characteristics. Clinical implications are discussed.

Attentional Control Explains Covariation Between Symptoms of Attention-Deficit/Hyperactivity Disorder and Anxiety During Adolescence

Symptoms of attention-deficit/hyperactivity disorder (ADHD) and anxiety are common during adolescence and frequently co-occur. However, the genetic and environmental influences that underlie this co-occurrence are understudied. Using a large twin sample (N = 1,017), we examined cross-sectional genetic and environmental influences on ADHD and anxiety symptoms during childhood. We also explored whether these influences were shared with attentional control, a putative mechanism for symptom comorbidity. We found evidence for common genetic and nonshared environmental influences on the covariation among attentional control, ADHD, and anxiety symptoms, supporting the putative role of attentional control as a mechanism by which comorbid problems may develop. Genetic factors also accounted for symptom co-occurrence after controlling for covariation with attentional control, suggesting the presence of additional unmeasured mechanisms.

Parental Reflective Functioning in Mothers and Fathers of Children With ADHD: Issues Regarding Assessment and Implications for Intervention

Parental factors contribute to ADHD, partly in an etiological way and partly as moderators and mediators of child outcomes and treatment effects. An important aspect of parenting seems to be parental reflective functioning (PRF), defined as the parent's capacity to reflect upon his own and his child's internal mental experience. The studies on parenting factors linked to ADHD have not extensively investigated the role of PRF. Recent findings on interventions have begun to consider mentalization to promote empathy and emotion regulation in parents, but empirical studies assessing PRF are still scarce. The aim of this cross-sectional study was to compare specific familial and parental functioning characteristic between parents of children with attention deficit/hyperactivity disorder (ADHD) and parents of controls without ADHD. A clinical sample of 41 children with ADHD aged 8–11 years and their parents was compared with a matched, non-clinical sample of 40 children. Three aspects of parental functioning were investigated: parental symptomatology, parental alliances and PRF; children's differences in strength and difficulty profiles were also assessed. The results showed that families of children with ADHD had lower socioeconomic status, and both mothers and fathers of the same families reported higher scores for depression and lower PRF than did the control group; only mothers showed lower parental alliance. Logistic regression highlighted the fact that several of these familial and parental factors contributed to the increased risk of belonging to the clinical group, specifically both mothers' and fathers' depressive symptoms and lower PRF. These data represent new findings with potentially meaningful clinical implications for both assessment and intervention.

Parental Stress and Parental Self-Efficacy as Mediators of the Association Between Children's ADHD and Marital Satisfaction

Parents of children with ADHD often experience low marital satisfaction, since the child's increased susceptibility to maladjustment can affect family dynamics as a whole.

OBJECTIVES

To explore this association by examining parental stress and parental self-efficacy as two possible mediators.

METHOD

Totally, 182 Israeli parents of children in the first to ninth grades (63 parents of children with ADHD and 119 without) completed parental self-efficacy, marital satisfaction, and parental stress questionnaires.

RESULTS

As expected, parents of children with ADHD reported higher parental stress, and lower self-efficacy and marital satisfaction than non-ADHD parents. The association between ADHD parents and marital satisfaction was fully explained by parental stress and self-efficacy, suggesting that personal characteristics and situation appraisal are tapped when facing strain and hardship.

CONCLUSION

These findings provide a window of hope for an otherwise deterministic view of the ADHD-marital dissolution relationship and propose individual and familial interventions that may minimize these damaging effects.

Child/Adolescent's ADHD and Parenting Stress: The Mediating Role of Family Impact and Conduct Problems

Objective: The demands of parenting are usually associated with some stress, and elevated levels of stress may affect the parent-child relationships and parenting practices. This is especially the case of families where children have special needs conditions or disorders, like Attention Deficit Hyperactivity Disorder (ADHD). Method: This study examined parenting stress among mothers of children and adolescents with ADHD. The sample comprised 126 mothers of girls (36; 29%) and boys (90; 71%) aged 6-17 years old. Results: Mothers reported their own stress levels as well as the children and adolescents' variables (severity of their ADHD symptoms, conduct, and emotional problems) and family-contextual variables (negative impact on family's social life, impact on couple relationship, and perceived social support). Hierarchical multiple regression showed that (a) negative impact on social life and conduct problems were the strongest predictors of mother's stress. Bootstrap mediation analyses revealed that (b) the association between child and adolescent's ADHD and parenting stress was mediated by children's conduct problems and by negative impact on family's social life, and not by children's emotional problems nor by mother's perceived social support. The mediation analysis also suggested (c) a pathway from child/adolescent's ADHD through children's conduct problems and then through their negative impact on family's social life to mother's parenting stress. Conclusion: These results suggest that both child/adolescent's and family factors should be considered in the designing of interventions for reducing parenting stress in families of children and adolescents with ADHD.

[The interparental relationship in families with children with ADHD: Interactions between couple distress and child's symptoms]

The interparental relationship in families with children with ADHD: Interactions between couple distress and child's symptoms Abstract. The impact of the family in the development and maintenance of childhood ADHD is well established. However, previous research in this field focused largely on parenting and the quality of the parent-child relationship, whereas the role of the interparental relationship has been neglected. This review summarizes the current state of research on the interactions between a couple distress and their child's ADHD and discusses interparental conflict as a risk factor for the development of ADHS-related symptoms. Based on the present knowledge, an integrative model is postulated that assumes an interaction of genetic vulnerability for childhood ADHD and a couple distress. It depicts how distress in the interparental relationship may both directly and indirectly affect the etiology, maintenance, and/or amplification of childhood ADHD-related symptoms, which in turn affect the interparental relationship. The review highlights the significance of relationship distress prevention programs for couples to prevent adjustment problems in children, and the adequate consideration of couple conflict in diagnostics and therapy among families with children with ADHD.

CATEGORICAL DIAGNOSIS OF EXTREME HYPERACTIVITY, IMPULSIVITY, AND INATTENTION IN VERY YOUNG CHILDREN

Severe hyperactivity and impulsivity are common reasons for referral to infant mental health services. Past versions of ZERO TO THREE's () diagnostic nosology, the Diagnostic Classification of Mental and Developmental Disorders in Infancy and Early Childhood (DC:0-3), did not address this clinical issue because it had been addressed in other nosologies. These general diagnostic nosologies describe attention deficit hyperactivity disorder (ADHD), but with little attention to developmentally specific aspects of the diagnosis in very young children. Categorical diagnosis related to hyperactivity and impulsivity in very young children warrants careful review of existing literature. Explicit attention must be paid to ensure that categorical diagnoses serve to describe syndromes that cause significant impairment to the family to allow children and families to access effective supports and ensure that behaviors typical of the developmental level are not described as pathologic. This article reviews proposed diagnostic criteria for ADHD and overactivity disorder of toddlerhood as well as the rationale for the criteria and evidence supporting validity and reliability of the diagnoses in very young children. Clinical implications also are presented.

Impulsive Aggression as a Comorbidity of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents

OBJECTIVE

This article examines the characteristics of impulsive aggression (IA) as a comorbidity in children and adolescents with attention-deficit/hyperactivity disorder (ADHD), focusing on its incidence, impact on ADHD outcomes, need for timely intervention, and limitations of current treatment practices.

METHODS

Relevant literature was retrieved with electronic searches in PubMed and PsycINFO using the search strategy of "ADHD OR attention deficit hyperactivity disorder" AND "impulsive aggression OR reactive aggression OR hostile aggression OR overt aggression" AND "pediatric OR childhood OR children OR pre-adolescent OR adolescent" with separate searches using review OR clinical trial as search limits. Key articles published before the 2007 Expert Consensus Report on IA were identified using citation analysis.

RESULTS

More than 50% of preadolescents with ADHD combined subtype reportedly display clinically significant aggression, with impulsive aggression being the predominant subtype. Impulsive aggression is strongly predictive of a highly unfavorable developmental trajectory characterized by the potential for persistent ADHD, increasing psychosocial burden, accumulating comorbidities, serious lifelong functional deficits across a broad range of domains, delinquency/criminality, and adult antisocial behavior. Impulsive aggression, which triggers peer rejection and a vicious cycle of escalating dysfunction, may be a key factor in unfavorable psychosocial outcomes attributed to ADHD. Because severe aggressive behavior does not remit in many children when treated with primary ADHD therapy (i.e., stimulants and behavioral therapy), a common practice is to add medication of a different class to specifically target aggressive behavior.

CONCLUSIONS

Impulsive aggression in children and adolescents with ADHD is a serious clinical and public health problem. Although adjunctive therapy with an aggression-targeted agent is widely recommended when aggressive behaviors do not remit with primary ADHD therapy, empirical evidence does not currently support the use of any specific agent. Randomized controlled trials are needed to identify aggression-targeted agents with favorable benefit-risk profiles.

Factors Influencing Time Lag Between Initial Parental Concern and First Visit to Child Psychiatric Services Among ADHD Children in Japan

The aim of this study was to examine the factors associated with a time lag between initial parental concern about ADHD symptoms and the first visit to a hospital in Japan that offers child psychiatric services. We investigated the demographic characteristic, symptoms, diagnosis, and healthcare system factors including duration between initial parental concern about symptoms and the first visit to a hospital (N = 387). The mean time lag between initial parental concern and the first visit to a hospital was 2.6 years. Risk factors for a longer time lag include the young age of a child, behavioral problems of the child, lower maternal education, difficulty in determining appropriate medical institution, referral route, and the distance from home to the hospital. A more established connection between a hospital with child psychiatric services and other health institutions is recommended for earlier referral to an appropriate hospital.

Child impact on family functioning: a multivariate analysis in multiplex families with children and mothers both affected by attention-deficit/hyperactivity disorder (ADHD)

ADHD seriously impacts family functioning, even the more in families with simultaneous parental and child ADHD. The aim of the study was to examine associations between family impact of child ADHD and child, mother and family characteristics in multiplex families with children and mothers both affected by ADHD. One hundred and forty-four mother-child pairs were assessed (children: mean age 9.4 ± 1.7 years, 73.6 % male). Family impact of child ADHD was rated by mothers using the Family Impact Questionnaire (FIQ). Multiple linear regression analyses were performed with child and maternal psychopathology and basic family characteristics such as employment, partnership status and number of children as predictors and FIQ subscores as criteria. Rates of variance explained by family variables were 49 % for negative feelings towards the child, 37 % for impact on partnership, 31 % for impact on social life and 27 % for impact on finances (p < .001, respectively). Pearson correlations with family impact were especially strong for child externalizing symptoms, maternal ADHD and co-morbid symptoms of the mother. The strongest independent predictor was oppositional defiant child behaviour. In ADHD multiplex families, mothers' perception of the impact of an ADHD child on its family can be explained to a substantial degree by child psychopathology, maternal psychopathology and basic family characteristics. Although a cross-sectional design does not allow for causal interpretations, the findings of this study offer important targets for the treatment of ADHD in a family context pointing to the need for assessing and treating parental mental health and co-morbid symptoms besides ADHD core symptoms.

To ID or not to ID? Changes in classification rates of intellectual disability using DSM-5

The Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5) diagnostic criteria for intellectual disability (ID) include a change to the definition of adaptive impairment. New criteria require impairment in one adaptive domain rather than two or more skill areas. The authors examined the diagnostic implications of using a popular adaptive skill inventory, the Adaptive Behavior Assessment System-Second Edition, with 884 clinically referred children (ages 6-16). One hundred sixty-six children met DSM-IV-TR criteria for ID; significantly fewer (n  =  151, p  =  .001) met ID criteria under DSM-5 (9% decrease). Implementation of DSM-5 criteria for ID may substantively change the rate of ID diagnosis. These findings highlight the need for a combination of psychometric assessment and clinical judgment when implementing the adaptive deficits component of the DSM-5 criteria for ID diagnosis.

Stress among parents of children with attention deficit hyperactivity disorder, a Malaysian experience

INTRODUCTION

Attention deficit hyperactivity disorder (ADHD) is a chronic debilitating illness with onset in early childhood. The objective of this study was to look at the impact of children with ADHD on their parents.

METHODS

All parents with children diagnosed as having ADHD attending the Psychiatry Adolescent and Child Unit, University Malaya were included in this study. Their parenting stress was assessed using the Parent Stress Index.

RESULTS

A total of 95 parents participated in the study. The proportion of parents who reported significant stress in this study was much higher than in most studies (n = 69, 73%). Significant correlation was found between the severity of the child's disorder (Children's Global Assessment Scale [CGAS] score) and the parents' stress level (OR 0.16, 95% CI 0.05-0.51). Mothers were significantly more stressed than fathers (OR 0.16, 95% CI 0.05-0.51) and non-Malay parents more stressed than the Malay parents (OR 3.92, 95% CI 1.29-11.94). Parents with children older than 12 years of age were six times more stressed than parents with children younger than 12 years old (OR 6.47, 95% CI 1.55-27.01). Stressed parents acknowledged that having a child with ADHD was their biggest worry.

DISCUSSION

Stress has marked consequences on any person and has important bearings on their mental health. Stress among parents needs be looked into when treating children with ADHD.

Innovations and recent trends in the treatment of ADHD

Initiatives to develop better-tolerated, more efficacious pharmacological agents with improved drug delivery systems have driven recent research in attention-deficit hyperactivity disorder (ADHD). While stimulants are the primary pharmacotherapy for ADHD, these drugs have a limited duration of action and a subset of patients will either fail to respond to these medications or have side effects that preclude their use. The development of atomoxetine, the first nonstimulant approved for ADHD, has been followed by additional innovative research, such as the methylphenidate transdermal system, modafinil, NRP-104 and cholinergic agents. This review highlights some of the recent trends in ADHD treatment and the current status of promising treatment options that may help to shape the future of ADHD treatment.

More than intelligence: distinct cognitive/behavioral clusters linked to adaptive dysfunction in children

Impairments in adaptive functioning are frequently associated with intellectual disability (ID); however, adaptive dysfunction can be seen in many individuals with a variety of neurological conditions without ID. The extent to which other variables may be associated with adaptive dysfunction is unclear. In a mixed clinical sample of children (n = 348) consecutively referred for neuropsychological evaluation, the majority were rated as showing weak adaptive skills (ABAS-II, >1 SD below the mean; 71%), with a substantial proportion evidencing frank impairment (>2 SD below the mean, 45%). We examined patterns of scores on measures of intelligence (WISC-IV) and behavioral/affective dysregulation (BRIEF and BASC-2). Using hierarchical cluster analysis, a four cluster model yielded the most appropriate fit and adaptive functioning was subsequently examined across clusters. As expected, adaptive functioning was most intact in the cluster characterized by average IQ and minimal behavioral dysregulation. Other clusters were marked by adaptive dysfunction and distinguished by sub-average intellectual functioning and varying behavioral/emotional dysregulation. In contrast to traditional views associating low IQ with adaptive dysfunction, adaptive impairment was comparable between the cluster characterized by low intelligence and the cluster with average intelligence but significant behavioral dysregulation. These data suggest that adaptive functioning should be considered across various cognitive/behavioral conditions.

Understanding Discipline in Families of Children with Attention-Deficit/Hyperactivity Disorder: A Structural Equation Model

One hundred and fifty-five mothers of children with attention deficit/hyperactivity disorder (ADHD) completed a semi-structured interview, the Parenting Stress Index Questionnaire (Abidin, 1990), to evaluate parenting stress. The Parenting Scale (Arnold, O'Leary, Wolff & Acker, 1993) was also administered to measure dysfunctional discipline strategies. Structural equation modeling was used to test a model in which the independent variables were the Child's Characteristics and the Socio-Educational Status of his or her family; intermediate variables were Parenting Stress concerning the Child Domain and concerning the Parent Domain; and the dependent variable was Parental Discipline. The results confirm our hypotheses. Interventions in these families should therefore incorporate a component focused on Parenting Stress (in both the Child Domain and the Parent Domain), as a determinant of Parental Discipline.

Effects of attentional/ hyperactive and oppositional/ aggressive problem behaviour at 14 months and 21 months on parenting stress

BACKGROUND

  To evaluate effects of attentional/ hyperactive (Att/Hi) and oppositional/ aggressive (Opp/Agg) behaviours of children at 14 and 21 months of age on parenting stress at 21 months.

METHOD

  107 children from the general population with low, intermediate, and high levels of disruptive behaviours at 14 months, as evaluated by parents on a 55-item checklist, participated. Parents completed the Child Behaviour Checklist 1.5-5 and the Dutch version of Parenting Stress Index (NOSI) at 21 months. Effects of problem behaviours were examined in a 2 (Att/Hi and Opp/Agg) by 2 (not high versus high) by 2 (14 and 21 months) multivariate design with parental stress as dependent variable.

RESULTS

  Oppositional/ aggressive behaviour at 14 months had a strong main effect on parenting stress, but not at 21 months. There was a significant interaction between parenting stress and Att/Hi behaviour at 14 and 21 months, indicating that increase in these behaviours over time was associated with parenting stress. Both Opp/Agg behaviour and an interaction between Att/Hi behaviour and parenting stress contributed to maternal role restriction and social isolation. Oppositional/ aggressive behaviour led to higher scores for parental competence and depression, whereas Att/Hi behaviour led to lower scores for attachment.

CONCLUSIONS

  Early Opp/Agg and Att/Hi behaviour had differential effects on parenting stress at 21 months. The increase in parenting stress associated with early Opp/Agg behaviour may be linked to overall feelings of parental competence, whereas the course of Att/Hi behaviour may be associated with increased demands on parent-child interactions and attachment. Our results have implications for development of early intervention programmes.

Having a Co-Twin With Attention-Deficit Hyperactivity Disorder

Attention-deficit hyperactivity disorder (ADHD) is a common childhood disorder which occurs more often in twins than singletons. This article focuses on the psychosocial consequences of having a co-twin with ADHD. Specifically, the level of anxiety (generalized and separation) in non-ADHD children who have a co-twin with ADHD is examined using data from the Australian Twin ADHD Project (ATAP). Parental report data on 501 dizygotic (DZ) twin pairs aged 6 to 15 and their siblings were used to examine (i) anxiety symptoms in twin pairs discordant for ADHD, (ii) how the effects of an ADHD twin on their co-twin and siblings are related to the type of ADHD, and (iii) whether the effects are greater for the nonaffected twin than nontwin siblings. Results show that anxiety was high in co-twins of children with the combined subtype of ADHD, with increased symptoms of both generalized and separation anxiety. Inattentive ADHD had smaller effects, which were confined to generalized anxiety and were specific to the co-twin rather than other siblings. These results have clinical implications in managing the entire multiple birth family where one twin has ADHD, and also has implications for genetic analysis in modeling the relationship of ADHD to internalizing disorders.

Associations between mothers' and children's secure base scripts in ADHD and community cohorts

This study explored the relation between mothers' and their children's secure base scripts in two samples of school-aged children: a community sample (N = 29; mean age 8.9) and a sample of children diagnosed with ADHD (N = 50; mean age 8.9). Using the Attachment Script Representation Task, mothers and children were asked to construct narratives using word prompt outlines. In addition, mothers and children completed questionnaires focusing on symptoms. The results revealed that while the link between mothers' and children's scriptedness was significant in the community, no significant association was found in the ADHD sample. In the ADHD group, maternal reports of children's symptoms were negatively linked to children's secure-base scriptedness. Implications of these findings for theory and intervention are discussed.

Relationship between symptoms of attention-deficit/hyperactivity disorder and family functioning: a community-based study

This study examined the relationship between family functioning and attention-deficit/hyperactivity disorder (ADHD) symptoms in an Australian community-based sample. Children were screened for ADHD in their second year of formal schooling. Two hundred and two (202) primary caregivers completed validated measures of family quality of life (QoL), parent mental health, parenting styles and parental relationship quality. Compared with controls, parents of children screening positive for ADHD reported poorer family QoL in the domains of emotional impact (mean difference [MD] -20.1; 95% CI -38.2 to -1.9, p = 0.03) and impact on family activities (MD -17.2; 95% CI -27.9 to -6.5, p = 0.002), less parental warmth (MD -3.4; 95% CI -6.0 to -0.9, p = 0.01) and higher parental depression (MD 6.8; 95% CI 1.8 to 11.7, p = 0.009) and anxiety (MD 6.2; 95% CI 1.7 to 10.6, p = 0.008) after adjusting for socio-demographic characteristics and child conduct symptoms. Parents of children screening positive for ADHD reported higher stress (MD 4.5; 95% CI 1.2 to 7.1, p = 0.007) and more inconsistent (MD 3.0; 95% CI 1.2 to 4.8, p = 0.002) and hostile (MD = 2.2; 95% CI 1.0 to 3.4, p = 0.001) parenting after adjusting for socio-demographic factors only. No difference in parental relationship quality and parental inductive reasoning was identified.

CONCLUSION

These findings suggest a strong association between poor family functioning and ADHD symptoms and carry implications for comprehensive ADHD management and the importance of seeing the child within the family context.

Advancing our knowledge of ADHD in Latino children: psychometric and cultural properties of Spanish-versions of parental/family functioning measures

The lack of available Spanish versions of assessment measures contributes to insufficient research and underutilization of mental health services for Latino children with Attention-Deficit/Hyperactivity Disorder (ADHD). Thus, the goal of the current study was to examine the psychometric and cultural properties of several Spanish versions of parental/family functioning measures commonly used in comprehensive ADHD assessments (i.e., the Parenting Sense of Competence Scale, Alabama Parenting Questionnaire, and Confusion, Hubbub, and Order Scale). Participants included 68 Spanish-speaking, Latino parents in Southeast Wisconsin. In general, the Spanish translations of the measures demonstrated good reliability and validity. Furthermore, the psychometrically-sound measures were significantly related to acculturation as predicted, suggesting that the scales are not only psychometrically valid, but also culturally valid for use with Spanish-speaking, Latino families.

Predictors of stress-related growth in parents of children with ADHD

This study was designed to investigate stress-related growth in 71 parents of children with ADHD, compared with 80 parents of non-clinical children. Adopting Tedeschi and Calhoun's (2004) theoretical framework for predicting personal growth, the study investigated the contribution of emotional intelligence (individual characteristics), social support (environmental factors), parental self-efficacy and perceptions of parenting as a challenge vs. a threat (cognitive processing). Results indicated that emotional intelligence was the main predictor of stress-related growth, particularly for parents of ADHD children, emphasizing that this personal trait is especially relevant to coping with on-going parental strain; whereas social support made a greater contribution to growth for the control group than for parents of children with ADHD. Path analysis confirmed our research model, suggesting that parents' sense of competence and of parenthood as a challenge vs. a threat mediates between emotional intelligence and social support on the one hand, and growth on the other.

The health and psychosocial functioning of caregivers of children with neurodevelopmental disorders

PURPOSE

Children with neurodevelopmental disorders (Neuro) pose complex parenting challenges, particularly if the condition co-occurs with behaviour problems. Such challenges are likely to impact caregiver health and well-being. This study explores the extent to which caregivers of children with both 'Neuro' and behaviour problems differ in their physical and psychosocial outcomes from caregivers of children with either condition or neither condition.

METHOD

The first wave of data collected in the National Longitudinal Survey of Children and Youth in Canada (1994) was used to identify four groups of caregivers of 4 to 11-year-old children: caregivers of children with a 'Neuro' disorder and externalising behaviour problems (Both; n=414), caregivers of children with a 'Neuro' disorder only (Neuro Only; n=750), caregivers of children with an externalising behaviour problem only (Ext Only; n=1067), and caregivers of children with neither health condition (Neither; n=7236).

RESULTS

Caregivers in the 'Both' group were least likely to report excellent or very good health, and more frequently reported chronic conditions such as asthma, arthritis, back problems, migraine headaches, and limitations in activities as compared to the 'Neither' group. This group also exhibited higher depression scores, experienced more problematic family functioning, and reported lower social support than the 'Neither' group. Scores for caregivers in the 'Ext Only' and 'Neuro Only' groups tended to lie between the 'Both' and 'Neither' group scores and often did not differ from one another.

CONCLUSIONS

Caregivers of children with both neurodevelopmental disorders and behaviour problems exhibited a greater number of health and psychosocial problems. While addressing children's behaviour problems, health care professionals should also consider caregiver physical and psychosocial health as this may also have an impact on children's well-being.

The health and psychosocial functioning of caregivers of children with neurodevelopmental disorders

PURPOSE

Children with neurodevelopmental disorders (Neuro) pose complex parenting challenges, particularly if the condition co-occurs with behaviour problems. Such challenges are likely to impact caregiver health and well-being. This study explores the extent to which caregivers of children with both Neuro and behaviour problems differ in their physical and psychosocial outcomes from caregivers of children with either condition or neither condition.

METHOD

The first wave of data collected in the National Longitudinal Survey of Children and Youth in Canada (1994) was used to identify four groups of caregivers of 4- to 11-year-old children: caregivers of children with a Neuro disorder and externalizing behaviour problems (Both; n = 414), caregivers of children with a Neuro disorder only (Neuro Only; n = 750), caregivers of children with an externalizing behaviour problem only (Ext Only; n = 1067), and caregivers of children with neither health condition (Neither; n = 7236).

RESULTS

Caregivers in the Both group were least likely to report excellent or very good health, and more frequently reported chronic conditions such as asthma, arthritis, back problems, migraine headaches, and limitations in activities as compared to the Neither group. This group also exhibited higher depression scores, experienced more problematic family functioning and reported lower social support than the Neither group. Scores for caregivers in the Ext Only and Neuro Only groups tended to lie between the Both and Neither group scores and often did not differ from one another.

CONCLUSIONS

Caregivers of children with both neurodevelopmental disorders and behaviour problems exhibited a greater number of health and psychosocial problems. While addressing children's behaviour problems, health care professionals should also consider caregiver physical and psychosocial health, as this may also have an impact on children's well-being.

Changes in caregiver strain over time in young adolescents with ADHD: the role of oppositional and delinquent behavior

OBJECTIVE

The objectives of this study were to identify the relationships between caregiver strain among parents of young adolescents with ADHD and child characteristics during a 1-year period.

METHOD

Parents of 52 middle-school-aged youth with ADHD participated in this study and completed two evaluations 1 year apart.

RESULTS

Ratings of oppositional and delinquent behavior best predicted levels of caregiver strain, and change over time did not significantly add to the equation. Patterns of change in caregiver strain indicated important individual differences.

CONCLUSION

Oppositional, delinquent behavior was the best predictor of caregiver strain and suggests that preventing and treating these child behavior problems should be a high priority when working with young adolescents with ADHD. Given the variability in parent responses to changes in oppositional and delinquent behavior, it may also be important to address personal coping strategies for parents of youth exhibiting high rates of these behaviors.

Teacher reports of peer aggression in preschool: its relationship to DSM-IV externalizing symptoms

OBJECTIVE

to establish the prevalence and associations of peer aggression as manifested in preschool children, in community-based populations and to study links with DSM-IV externalizing diagnoses.

METHOD

Subjects were 1104 children, 3-to-5-year-olds attending rural and urban pre-schools classes. Teachers completed the Peer Conflict Scale (PCS) to inform about direct physical and verbal aggression, object aggression and symbolic aggression and the questionnaire on psychopathology ECI-4.

RESULTS

6.6% (n=73) had at least one positive item on the PCS. This percentage dropped to 2.6% (n=29) if we take into account a minimum of three positive items. Physical direct aggression was the more prevalent type of aggressive behavior, followed by verbal aggression, object aggression and symbolic aggression. Significant differences by gender and age were found. Peer aggression was associated with male gender from three years of age. Physical, object and verbal aggressive behavior was linked with externalizing disorders. This association was very strong with oppositional disorder.

CONCLUSIONS

The present research with a Spanish population confirms the existence of peer aggression in preschoolers and the gender differences. Our chief contribution is about the age of emergence of sex differences and gender differences in different types of peer aggression.

Acute atomoxetine treatment of younger and older children with ADHD: a meta-analysis of tolerability and efficacy

BACKGROUND

Atomoxetine is FDA-approved as a treatment of attention-deficit/hyperactivity disorder (ADHD) in patients aged 6 years to adult. Among pediatric clinical trials of atomoxetine to date, six with a randomized, double-blind, placebo-controlled design were used in this meta-analysis. The purpose of this article is to describe and compare the treatment response and tolerability of atomoxetine between younger children (6-7 years) and older children (8-12 years) with ADHD, as reported in these six acute treatment trials.

METHODS

Data from six clinical trials of 6-9 weeks duration were pooled, yielding 280 subjects, ages 6-7 years, and 860 subjects, ages 8-12 years with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV)-diagnosed ADHD. Efficacy was analyzed using the ADHD Rating Scale-IV (ADHD-RS), Conners' Parent Rating Scale-revised (CPRS-R:S), and the Clinical Global Impression of ADHD Severity (CGI-ADHD-S).

RESULTS

Atomoxetine was superior to placebo in both age categories for mean (SD) change in ADHD-RS total, total T, and subscale scores; 3 CPRS-R:S subscales; and CGI-ADHD-S from baseline. Although there were no significant treatment differentials between the age groups for these efficacy measures, the age groups themselves, regardless of treatment, were significantly different for ADHD-RS total (younger: ATX = -14.2 [13.8], PBO = -4.6 [10.4]; older: ATX = -15.4 [13.2], PBO = -7.3 [12.0]; p = .001), total T (younger: ATX = -15.2 [14.8], PBO = -4.9 [11.2]; older: ATX = -16.4 [14.6], PBO = -7.9 [13.1]; p = .003), and subscale scores (Inattentive: younger: ATX = -7.2 [7.5], PBO = -2.4 [5.7]; older: ATX = -8.0 [7.4], PBO = -3.9 [6.7]; p = .043; Hyperactive/Impulsive: younger: ATX = -7.0 [7.2], PBO = -2.1 [5.4]; older: ATX = -7.3 [7.0], PBO = -3.4 [6.3]; p < .001), as well as the CGI-ADHD-S score (younger: ATX = -1.2 [1.3], PBO = -0.5 [0.9]; older: ATX = -1.4 [1.3], PBO = -0.7 [1.1]; p = .010). Although few subjects discontinued from either age group due to adverse events, a significant treatment-by-age-group interaction was observed for abdominal pain (younger: ATX = 19%, PBO = 6%; older: ATX = 15%, PBO = 13%; p = .044), vomiting (younger: ATX = 14%, PBO = 2%; older: ATX = 9%, PBO = 6%; p = .053), cough (younger: ATX = 10%, PBO = 6%; older: ATX = 3%, PBO = 9%; p = .007), and pyrexia (younger: ATX = 5%, PBO = 2%; older: ATX = 3%, PBO = 5%; p = .058).

CONCLUSION

Atomoxetine is an effective and generally well-tolerated treatment of ADHD in both younger and older children as assessed by three recognized measures of symptoms in six controlled clinical trials.

TRIAL REGISTRATION

Not Applicable.

Assessing the efficacy of treatments for ADHD : overview of methodological issues

Attention-deficit hyperactivity disorder (ADHD) is a common and impairing psychiatric condition that affects significant numbers of children, adolescents and adults. Clinicians in a variety of practice settings (hospital, outpatient, residential, research) strive to diagnose, treat and monitor ADHD in an efficient and evidence-based manner. Tools that facilitate the gathering and interpretation of information from a variety of sources can effectively augment a diagnostic assessment, and can also be useful for longitudinal monitoring. Multiple assessment tools are available, with varying degrees of psychometric validity, clinical utility and overall feasibility (time and cost). This review provides an overview of several available ADHD rating scales and continuous performance tests, and offers a discussion of potential strengths and weaknesses of the instruments. While these tools do not in and of themselves make a diagnosis of ADHD, they can certainly assist in the diagnostic assessment, be crucial in assessing the efficacy of medications in clinical trials, and be a useful adjunct in the clinical management of ADHD.

Attention deficit hyperactivity disorder in preschool children

Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder with a childhood onset of symptoms and impairment. Although it is most frequently identified during elementary school years, epidemiologic data suggest that the onset of ADHD frequently occurs earlier, with presentation as young as 3 years of age. Early identification, however, allows consideration of appropriate interventions. Many data are available on safe and efficacious treatment options for school-aged children who have ADHD; however, little is known about the use of these modalities in preschoolers and, ultimately, the long-term effects of early treatment. Recognition of the preschool presentation of ADHD, appropriate differential diagnosis, and identification of comorbid conditions, and a developmental perspective on the course and potential outcomes of the disorder may guide treatment planning. Newly available data on the safety and efficacy of pharmacotherapy and psychosocial intervention for preschoolers who have ADHD may help clinicians make treatment decisions for these young children and their families.

Do maternal attention-deficit/hyperactivity disorder symptoms exacerbate or ameliorate the negative effect of child attention-deficit/hyperactivity disorder symptoms on parenting?

The impact of similarity in parent and child characteristics on the quality of parenting is underresearched. The current study examined the interaction between mother and child attention-deficit/hyperactivity disorder (ADHD) symptoms on parenting. Two hypotheses were tested: the similarity-fit hypothesis, which predicted that parent and child similarity will improve parenting, and the similarity-misfit hypothesis, which predicted the opposite. Study 1 examined the associations between maternal and child ADHD symptoms and child-specific rearing attitudes of 95 mothers with school-aged children. In Study 2 this analysis was extended to more objective observer-rated mother–child interaction and maternal expressed emotion in 192 mothers of preschool children. Child ADHD symptoms were associated with negative maternal comments and maternal ADHD symptoms with negative expressed emotion. In both studies maternal ADHD symptoms appeared to ameliorate the effects of child ADHD symptoms on negative parenting. Parental response to children with high ADHD symptoms was more positive and affectionate when the mother also had high ADHD symptoms. The results support the similarity-fit hypothesis and highlight the importance of considering both child and maternal ADHD symptoms in studies of parenting.

A pilot study of atomoxetine in young children with attention-deficit/hyperactivity disorder

OBJECTIVE

The purpose of this study was to assess the effectiveness and tolerability of atomoxetine during acute treatment of attention-deficit/hyperactivity disorder (ADHD) in 5 and 6 year olds.

METHOD

Twenty two children (male n = 19, 86%) with ADHD were treated with atomoxetine for 8 weeks in a three-site, open-label pilot study. Dosing was flexible, with titration to a maximum of 1.8 mg/kg per day. Parent education on behavior management was provided as part of each pharmacotherapy visit.

RESULTS

Subjects demonstrated a mean decrease of 20.68 points (SD = 12.80, p < 0.001)) on the ADHD Rating Scale-IV (ADHD-IV-RS) total score, 10.18 (SD = 7.48, p < 0.001) on the inattentive subscale and 10.50 (SD = 7.04, p < 0.001) on the hyperactive/impulsive subscale. Clinical Global Impression-Severity (CGI-S) was improved in 82% of the children (95% CI, 66-98%) and Children's Global Assessment (CGAS) scores improved 18.91 points on average (SD = 12.20, p < 0.001). The mean final dose of atomoxetine was 1.25 mg/kg per day (SD = 0.35 mg/kg per day). Mood lability was the most commonly reported adverse event (n = 12, 54.5%). Eleven subjects (50%) reported decreased appetite and a mean weight loss of 1.04 kg (SD = 0.80 kg) (p < 0.001) was observed for the group. Vital sign changes were mild and not clinically significant. There were no discontinuations due to adverse events or lack of efficacy.

CONCLUSION

Atomoxetine was generally effective for reducing core ADHD symptoms in the 5 and 6 year olds in this open-label study.

Interventions to address the academic impairment of children and adolescents with ADHD

There exists a strong link between ADHD and academic underachievement. Both the core behavioral symptoms of ADHD and associated executive functioning deficits likely contribute to academic impairment. Current evidence-based approaches to the treatment of ADHD (i.e., stimulant medication, clinical behavior therapy and classroom behavioral interventions) have demonstrated a robust impact on behavioral variables such as attention and disruptive behavior within classroom analogue settings; however, their efficacy in improving academic outcomes is much less clear. Although surprisingly few treatment outcome studies of ADHD have attempted to incorporate interventions that specifically target academic outcomes, the studies that are available suggest that these interventions may be beneficial. The state of the treatment literature for addressing academic impairment in children and adolescents with ADHD will be reviewed herein, as well as limitations of current research, and directions for future research.

Conflitos conjugais e familiares e presença de transtorno de déficit de atenção e hiperatividade (TDAH) na prole: revisão sistemática

O transtorno do déficit de atenção e hiperatividade (TDAH) é um dos transtornos neurobiológicos com maior prevalência na infância e pode implicar dificuldades no funcionamento conjugal dos pais das crianças afetadas, bem como sofrer influência do mesmo. OBJETIVO: Realizar uma revisão sistemática acerca dos aspectos conjugais em famílias de crianças com TDAH, relacionando-os com outras variáveis, como a presença de comorbidades, aspectos socioeconômicos e saúde mental dos pais. MÉTODOS: Revisão sistemática de literatura por meio do PubMed entre os anos de 1996 e 2006, utilizando os termos "ADD", "ADHD", "Attention-Deficit Hyperactivity Disorder", "Attention-Deficit", "marital conflict" e "family". RESULTADOS: Dezesseis estudos dentre 628 publicações iniciais e 55 artigos posteriormente incluídos pelas referências bibliográficas foram avaliados. O relacionamento conjugal aparece comprometido em grande parte da literatura, principalmente nos pais daquelas crianças que apresentam distúrbio desafiador e de oposição (DDO) ou distúrbio de conduta comórbidos. Contudo, resultados opostos também são encontrados em diversas pesquisas. CONCLUSÕES: Os resultados de pesquisas referentes ao funcionamento conjugal de pais destas crianças são heterogêneos. É preciso que sejam feitos estudos longitudinais, que possam esclarecer o impacto do transtorno nos conflitos conjugais de pais de portadores, bem como a influência destes últimos na expressão clínica do transtorno.

Measuring socioemotional functioning in a national birth cohort study

An accumulating body of research suggests that the capacities children acquire that prepare them for learning in formal educational settings are multilevel and complex with multiple contributing factors that begin in infancy. A new U.S. longitudinal study, the Early Childhood Longitudinal Study, Birth Cohort (ECLS-B), is designed to enable researchers to examine how an array of children's capacities and skills function individually and jointly to promote or hinder the acquisition of school readiness. The ECLS-B follows a nationally representative sample of 10,688 children born in the U.S. in 2001. Baseline data on the children and their families were collected at 9 months of age with follow-up at ages 2, 4, and kindergarten entry. Information on study children's socioemotional development is derived from several sources: videotaped mother-child interactions, parent interviews, and field staff observations. Because attachment is such an important indicator of children's socioemotional development during the toddler period, the study devoted considerable resources to designing an attachment measure. The Toddler Attachment Sort-45 (TAS-45) was designed to meet the need for a simple yet valid measure that did not require extensive training for field staff to administer easily. The TAS-45 generates the classical attachment categories and security and dependency scores.

Examining Subtypes of Behavior Problems Among 3-Year-Old Children, Part III: Investigating Differences in Parenting Practices and Parenting Stress

This study examined parenting of mothers and fathers of 3-year-old children who were classified as hyperactive (HYP), hyperactive and oppositional defiant (HYP/OD), and non-problem based on mothers' reports of behavior. Parents of children with HYP/OD were less warm, showed more negative affect, and more laxness than parents of non-problem children; however, contrary to prediction, they did not differ significantly from parents of children in the HYP group. Compared to mothers of non-problem children, mothers of children in the HYP/OD group reported significantly more parenting stress across all domains, whereas mothers of children in the HYP group only reported elevated levels of stress associated with having a difficult child. Theoretical and treatment implications are discussed.

Parental schemata in the management of children with attention deficit-hyperactivity disorder

The authors describe the management schemata held by parents of children diagnosed with attention deficit-hyperactivity disorder (ADHD). They conducted semistructured interviews with 10 mothers of children who had ADHD and used interpretative, phenomenological analysis on the interview transcriptions to identify the schemata that guided the parents' management practices. The predominant schemata were the perceived difference of children with ADHD, parental aspirations, the necessity of medication, psychological management, parental authority, role of the father, mothering concept, and community support. The authors discuss these schemata in the context of the current controversy as to whether ADHDis best regarded as a medical or a developmental disorder. They conclude that the parents' schemata conformed to current child-raising theory, but as a consequence, the parents might not consider social factors involved in the development of ADHD sufficiently. The authors suggest that this restricted perspective limits the parents' options for managing the condition.

Parenting Practices of Mothers of Children with ADHD: The Role of Maternal and Child Factors

BACKGROUND

  We examined the relationships among child behavioural and demographic characteristics and parent characteristics in understanding the effectiveness of parenting practices used by mothers of children diagnosed with ADHD.

METHOD

  One hundred and fifty Australian mothers of children diagnosed with ADHD were interviewed and asked to assess the severity of their child's disruptive behaviour, their own parenting sense of competence, perceptions of social isolation and parenting practices. The hypothesis was that severity of child disruptive behaviour, higher child age, 'only' child status, lower parental sense of competence and greater social isolation would be associated with the use of less effective parenting practices.

RESULTS

  The regression analysis indicated that the combination of these variables was significantly associated with parenting practices, accounting for 32% of the variance. Unique contributions were evident for severity of overall behavioural disturbance and parental sense of competence.

CONCLUSIONS

  Theoretical and clinical implications are discussed together with methodological limitations of the study.

Adaptive functioning and behaviour problems in relation to level of education in children and adolescents with intellectual disability

BACKGROUND

The interrelationship between adaptive functioning, behaviour problems and level of special education was studied in 186 children with IQs ranging from 61 to 70. The objective was to increase the insight into the contribution of adaptive functioning and general and autistic behaviour problems to the level of education in children with intellectual disability (ID).

METHODS

Children from two levels of special education in the Netherlands were compared with respect to adaptive functioning [Vineland Adaptive Behavior Scales (VABS)], general behaviour problems [Child Behavior Checklist (CBCL)] and autistic behaviour problems [Autism Behavior Checklist (ABC)]. The effect of behaviour problems on adaptive functioning, and the causal relationships between behaviour problems, adaptive functioning and level of education were investigated.

RESULTS

Children in schools for mild learning problems had higher VABS scores, and lower CBCL and ABC scores. The ABC had a significant effect on the total age equivalent of the VABS in schools for severe learning problems, the CBCL in schools for mild learning problems. A direct effect of the ABC and CBCL total scores on the VABS age equivalent was found, together with a direct effect of the VABS age equivalent on level of education and therefore an indirect effect of ABC and CBCL on level of education.

CONCLUSIONS

In the children with the highest level of mild ID, adaptive functioning seems to be the most important factor that directly influences the level of education that a child attends. Autistic and general behaviour problems directly influence the level of adaptive functioning. Especially, autistic problems seem to have such a restrictive effect on the level of adaptive functioning that children do not reach the level of education that would be expected based on IQ. Clinical implications are discussed.

The impact of preschool inattention, hyperactivity, and impulsivity on social and academic development: a review

The literature on the prevalence and stability of preschool problems of inattention, hyperactivity, and impulsivity suggests a number of links to early literacy skills and broader school achievement. Developmental considerations in the assessment of preschool ADHD are reviewed in this paper, along with evidence for the stability of symptoms over time and the relationship between early symptoms of ADHD and elementary school achievement. Emphasis is placed on describing the nature of the connection between preschool ADHD symptoms and academic achievement, as few studies to date have focused specifically on that relationship. Several explanations for the relationship between preschool ADHD symptoms and achievement are analyzed, including an explanation that focuses on the relationship between inattention, hyperactivity, and impulsivity and the acquisition of emergent literacy and language skills. Finally, the evidence for four models that have been proposed to account for the link between behavior and learning is reviewed and critically analyzed. Suggestions are made for future research that might resolve important questions only partially addressed in studies to date.

Attention deficit and hyperactivity disorder/learning disabilities (ADHD/LD): parental characterization and perception

Sixty-six parents of adolescents (mean age, 14.8 years), who attended special education classes and who were diagnosed as having attention deficit and hyperactivity disorder/learning disabilities (ADHD/LD), were interviewed. The comorbidity of the ADHD group included emotional lability and/or depression, 70%; oppositional defiant disorder (ODD), 67%; obsessive-compulsive disorder (OCD), 44%; addiction to buying, 44%; and aggressiveness, 62%. Twenty-one percent were either involved in the past or presently using drugs. Nine percent had attempted suicide. According to their parents, the main characteristic of these adolescents was low self-image. Parents enumerated five negative characteristics: impulsiveness; nervousness; angered easily ('short fused'); aggressiveness with cursing and outbursts; and impaired sociability with impoliteness.