A rating measure of ADHD-related neuropsychological impairment in children and adolescents: Data from the Cognition and Motivation in Everyday Life (CAMEL) Scale from population and clinical samples

Child neurocognitive functioning influences the effectiveness of specific techniques in behavioral teacher training for ADHD: Moderator analyses from a randomized controlled microtrial

Background

Childhood attention-deficit/hyperactivity disorder (ADHD) is associated with several neurocognitive impairments. Whether these impairments influence the effectiveness of techniques that are commonly used in behavioral teacher training for ADHD has not been investigated so far.

Method

In this microtrial, teachers of 90 children with ADHD symptoms (6-12 years) were randomly assigned to a short intervention consisting of either antecedent-based (stimulus-control) techniques or consequent-based (contingency management) techniques, or to a waitlist control condition. Primary outcome was the daily assessment of individually selected problem behavior, assessed pre- and post-intervention. Potential neurocognitive moderators of treatment effect included teacher ratings of cognitive control, reward, and punishment sensitivity, and measures derived from computerized neurocognitive tasks, including attentional lapses, interference control, visuospatial working memory, and emotional functioning. Intervention condition by moderator interactions were assessed in separate multilevel mixed models.

Results

Lapses of attention, working memory, and emotional functioning interacted with intervention effectiveness. Antecedent-based techniques were effective independent of these neurocognitive functions; consequent-based techniques were (more) effective when these functions were more impaired. The effectiveness of techniques was neither related to interference control nor to teacher-rated neurocognitive functioning.

Conclusions

This study showed that child neurocognitive functioning influences the effectiveness of behavioral teacher techniques for children with ADHD symptoms. Findings suggest that antecedent-based techniques may be effective for all children, while consequent-based techniques have added value particularly for children who suffer from low visuospatial working memory, low emotional functioning, and/or large numbers of attentional lapses.

Measuring individual differences in task-related motivation in children and adolescents: Development and validation of a new self-report measure

OBJECTIVES

Task characteristics can alter motivation. Understanding how individuals respond to these characteristics is important in understanding how to adapt tasks to increase engagement of individuals with mental health problems. We describe the development of a self-report questionnaire quantifying individual differences in task-related motivation-The Child and Adolescent Motivational Profile (CHAMP). We explore the association with externalizing/internalizing problems.

METHODS

A 64-item prototype scale was designed to measure how children and adolescents perceive the motivational significance of a range of task characteristics (n = 688; age range: 8-16 years). Parents completed the "Strengths and Difficulties Questionnaire" measuring externalizing and internalizing problems (Van Widenfelt, Goedhart, Treffers & Goodman, 2003).

RESULTS

Exploratory factor analysis identified eight distinct task characteristics that affected motivation: (a) requiring focus, (b) predictable, (c) marked/graded, (d) rewarded, (e) socially evaluated, (f) cognitively challenging, (g) competitive, and (h) collaborative. A 32-item scale based on these factors was constructed. Internal consistency of each factor was high (Cronbach's alpha: .79-.91), and test-retest reliability was acceptable (SBC = .43-.65). Externalizing and internalizing problems were associated with a distinct motivational profile.

CONCLUSION

These results highlight the multidimensional nature of children and adolescents' task-related motivation for tasks and the differential links to internalizing and externalizing problems.

A novel unstructured performance-based task of executive function in children with attention-deficit/hyperactivity disorder

OBJECTIVE

Executive functions (EFs) have been assessed with performance-based measures and rating scales. Research has shown a lack of association between these two methods. One factor that might contribute to this difference is the structure provided on performance-based measures that is not provided on rating scales. This study examined the role of structure on self-directed task completion, an aspect of EF, using a novel unstructured performance-based task (UPT).

METHOD

Children aged 8-12 years (38 attention-deficit/hyperactivity disorder, ADHD; 42 typically developing) and their caregivers participated. We compared performance on the UPT, performance-based measures of EF (Stroop test and Trail-Making Test), and a rating scale to assess EF (Barkley Deficits in Executive Functioning Scale-Children and Adolescents, BDEFS-CA).

RESULTS

Group differences were found across all measures. Significant associations emerged between the UPT and Stroop test, Trail-Making Test, and BDEFS-CA, but no significant associations were found between the Stroop test or Trail-Making Test and the BDEFS-CA. In regression analyses, performance-based tasks and the rating scale both uniquely predicted UPT performance. The UPT was a significant predictor of group status when entered with performance-based tasks, but the UPT did not enter as a significant predictor when entered with the rating scale.

CONCLUSION

The UPT is a promising measure to assess self-directed task completion in children with ADHD.

Differences in Perceived Mental Effort Required and Discomfort during a Working Memory Task between Individuals At-risk And Not At-risk for ADHD

Objective: The avoidance of mental effort is a symptom criterion for Attention-Deficit/Hyperactivity Disorder (ADHD), but the experience of mental effort has received relatively little attention in the empirical study of individuals at-risk for ADHD. We explored a novel method to assess the experience of effort and discomfort during a working memory task in a sample of young adults at-risk and not at-risk for ADHD.

Method: A sample of 235 undergraduate students (Mean age = 21.02, 86 males) were included in this study. Based on an ADHD-screener (ASRS), 136 participants met criteria for the ADHD-risk group and 99 were in the non-ADHD risk group.

Results: Individuals at-risk for ADHD reported higher mental effort and discomfort than individuals not at-risk for ADHD, even when performance on the working memory task was comparable or statistically controlled. Mental effort required and discomfort were more strongly correlated for at-risk compared to not at-risk participants. Individuals at-risk for ADHD displayed a stronger correlation between mental effort required and actual accuracy, but individuals not at-risk for ADHD displayed a stronger association between perceived accuracy and actual accuracy for the hardest experimental conditions. The most intense moment of effort required predicted retrospective discomfort ratings of the task in the ADHD-risk group, but not in the non-risk group.

Conclusion: The subjective experience of in the moment mental effort is an important and viable construct that should be more carefully defined and measured. In particular, the experience of effort required (or how taxing a task is) differentiated between individuals at-risk and individuals not at-risk for ADHD in the present study. Whereas previous ADHD research has explored effort exerted, the present work demonstrated that investigating the experience of being mentally taxed might provide a productive line of investigation that could be used to advance our understanding of the cognitive and affective mechanisms underlying the regulation of effort in individuals at-risk of ADHD.