Attention deficit disorder-hyperactivity and academic failure: which comes first and what should be treated?

Mobility, educational, and social performance of children with learning problems in Taiwan: A 3-year follow-up study

AIM

This study evaluated the performance of children with learning problems in Taiwan by using the Taiwan Data Bank of Persons with Disability.

METHOD

We included 3854 children (2343 males, 1511 females; mean [SD] age 9y 11mo [2y 4mo]) with specific learning disorder (SLD), attention-deficit/hyperactivity disorder (ADHD), autism, epilepsy, or intellectual disabilities for analysis. We used the Functioning Scale of the Disability Evaluation System-Child version to investigate performance at follow-up for at least 3 years.

RESULTS

These participants demonstrated improvement across all the domains of the International Classification of Functioning, Health, and Disability including for mobility, learning, social participation, and daily living. The children with SLD (p=0.3) and epilepsy (p=0.442) did not demonstrate significant improvement in learning, whereas those with ADHD (p<0.001), autism (p<0.001), and intellectual disabilities (p<0.001) did. The children with epilepsy displayed the most impairment and least improvement.

INTERPRETATION

This cross-diagnostic study of learning problems indicated the children with autism or ADHD received more structural education. However, education strategies for those with SLD or epilepsy required improvement. Finally, SLD is possibly underdiagnosed in children, and children with epilepsy are affected in multiple aspects.

WHAT THIS PAPER ADDS

Specific learning disorder (SLD), ADHD, autism, epilepsy, and intellectual disability can cause learning problems in children. Children with ADHD and autism showed more improvement in academic performance. SLD has been neglected and underdiagnosed, resulting in poor improvement. Children with epilepsy have multiple impairments and exhibited minimal improvement.

Inattention, hyperactivity/impulsivity, and academic competence: Findings from three cohorts

BACKGROUND

Attention-deficit hyperactivity disorder (ADHD) is a risk for learning. Because ADHD commonly includes behaviours of inattention and behaviours of hyperactivity/impulsivity, how the two types of behaviours independently affect children's academic competence remains poorly understood.

AIMS

To investigate the impact of behaviours of inattention and behaviours of hyperactivity/impulsivity on Chinese students' academic competence.

SAMPLES

Parents of 167 preschoolers (Cohort 1), parents of 313 first graders (Cohort 2), and 1,003 high school students (Cohort 3).

METHODS

The ADHD-RS-IV Preschool version (Cohort 1), ADHD-RS-IV Home version (Cohort 2), and BASC-SRP (Cohort 3) were used to measure behaviours of inattention and hyperactivity/impulsivity. Academic competence was operationalized as school readiness (Cohort 1), math and language arts scores at two time points provided by school (Cohort 2), and self-reported academic performance (Cohort 3). Multiple regressions were performed to investigate the relationship between academic performance and behaviours of inattention alone (Step 1), and behaviours of hyperactivity/impulsivity alone (Step 2), and behaviours of inattention together with behaviours of hyperactivity/impulsivity (Step 3).

RESULTS

For each cohort, both types of behaviours were negatively correlated with academic competence. However, regression analyses showed that in Step 3, behaviours of hyperactivity/impulsivity either failed to predict academic competence or predicted better academic competence. Overall, behaviours of inattention alone accounted for a similar amount of variance in academic competence as did behaviours of inattention and hyperactivity/impulsivity combined.

CONCLUSIONS

Behaviours of inattention presented a risk for academic competence but the effect of behaviours of hyperactivity/impulsivity varied. Implications for instructional strategies for behaviours of inattention were discussed.

Do the Kinds of Achievement Errors Made by Students Diagnosed With ADHD Vary as a Function of Their Reading Ability?

A large body of research has documented the relationship between attention-deficit hyperactivity disorder (ADHD) and reading difficulties in children; however, there have been no studies to date that have examined errors made by students with ADHD and reading difficulties. The present study sought to determine whether the kinds of achievement errors made by students diagnosed with ADHD vary as a function of their reading ability. The participants in this study were 91 students in the ADHD clinical validity standardization sample of the Kaufman Test of Educational Achievement–Third Edition (KTEA-3), as well as a control group of 63 students selected from the larger standardization sample. Students with ADHD and reading difficulties demonstrated a statistically significant greater amount of errors across tests of academic achievement. Findings from the study are discussed within the context of past research, as well as implications for the field of school psychology and practitioners.

Boys' Disruptive Behaviour, School Adjustment, and Delinquency: The Montreal Prevention Experiment

The authors discuss interim goals for prevention programmes designed to reduce antisocial behaviour. They describe effects of one such programme in which kindergarten teachers identified their most disruptive boys, some of whom were randomly allocated to a two-year treatment programme. The programme provided assistance in family management to the parents and in social skills to the boys, who were between the ages of 7 and 9 years during the treatment programme. By the age of 12, as compared with their peers who were not assigned to the treatment group, boys in the treatment group were doing better in school and evidencing less antisocial behaviour.

Relationship between ADHD and Central Auditory Processing Disorder

It is increasingly apparent that differential diagnosis of children with Attention-deficit Hyperactivity Disorder (ADHD) is, at best, difficult, with a majority of children identified as ADHD also diagnosed with co-occurring developmental learning disorders. Most notably, children with ADHD have been found to have a high prevalence of language problems. Research has further indicated that children with ADHD demonstrate significant difficulty on tasks used to assess central auditory processing skills and that these difficulties are ameliorated by the use of stimulant medication. Early findings raised the question of whether ADHD and Central Auditory Processing Disorder (CAPD) can be differentiated, or if they represent a singular disorder. Literature highlignting the similarity of psychoeducational and behavioral sequelae of children with CAPD and those with ADHD are presented. Studies of central auditory processing abilities in children diagnosed as having ADHD as well as a more recent study investigating the prevalence of ADHD in children diagnosed as CAPD are reviewed as well. Given the overlap in etiology and symptomatology of ADHD and auditory/linguistic disorders such as CAPD, the need for a collaborative effort on the part of professionals who work with these children (school psychologists, speech-language pathologists, audiologists) in diagnosis and intervention planning as well as other implications of this research are presented.

The Impact of Intensive Reading Intervention on Level of Attention in Middle School Students

The purpose of the study was to estimate the impact of reading intervention on ratings of student attention over time. We used extant data from a longitudinal randomized study of a response-based reading intervention to fit a multiple-indicator, multilevel growth model. The sample at randomization was 54% male, 18% limited English proficient, 85% eligible for free or reduced-price lunch, 58% African American, and 32% Hispanic. Reading ability was measured by using the Woodcock-Johnson III Tests of Achievement. Attention was measured by using the Strengths and Weaknesses of ADHD Symptoms and Normal Behavior Scale. Findings indicate that intensive, response-based reading intervention over 3 years improved reading achievement and behavioral attention in middle school struggling readers, with treatment directly affecting reading, which in turn influenced attention. In the business-as-usual condition, there was no relation between improved reading and attention. The results are consistent with a correlated liabilities model of comorbidity. The results do not align with the inattention-as-cause hypothesis, which predicts that reading intervention should not affect attention. The findings do not support, but do not necessarily preclude, the phenocopy hypothesis. The results are especially pertinent for older students who may be inattentive partly because of years of struggling with reading.

Effects of Methylphenidate on Attention Skills in Children With Attention Deficit/Hyperactivity Disorder

This study aimed to investigate the effects of methylphenidate on children with Attention Deficit Hyperactivity Disorder (ADHD). The study employed a conceptual framework of attention, consistent with contemporary theory, and including the following components: sustained attention, selective attention, divided attention, shifting attention, and speed of information processing. Fifteen children (12 boys and 3 girls) of normal intelligence, with a diagnosis of ADHD according to the DSM-IV criteria, and ranging in age from 8 to 11 years participated in the study. Children's attentional abilities were evaluated using the Test of Everyday Attention for Children (TEA-Ch: Manly, Roberston, Anderson, & Nimmo-Smith, 1999). A double-blind counterbalanced repeated-measures design approach was employed to tap on–off medication effects, and deviations from normal. Results showed that comparisons between on–off medication conditions generally detected few differences with respect to sustained and selective attention measures and simple processing speed. In contrast, for higher-level attention domains, including shifting and divided attention, children on medication demonstrated a speed–accuracy trade-off, exhibiting greater accuracy, but slower completion times. When data from the ADHD group were compared to controls a consistent pattern emerged, with children with ADHD in the medication condition being more accurate across all attention domains on all measures. While these children also tended to record slower completion times, group differences and effect sizes were of smaller magnitude. The findings of this study suggest a possible speed–accuracy trade-off effect for children with ADHD on medication.

Japanese version of home form of the ADHD-RS: an evaluation of its reliability and validity

Using the Japanese version of home form of the ADHD-RS, this survey attempted to compare the scores between the US and Japan and examined the correlates of ADHD-RS. We collected responses from parents or rearers of 5977 children (3119 males and 2858 females) in nursery, elementary, and lower-secondary schools. A confirmed factor analysis of ADHD-RS confirmed the two-factor solution (Inattentive and Hyperactive-Impulsive) same as previous studies. ADHD-RS scores were not related to IQ, but were negatively associated with standardized achievement test scores. Males showed stronger ADHD tendencies than did the females, and the scores ended to decline as the children grew older. Japanese children scored lower than did their US children in Hyperactive-Impulsive among all of the sex-age groups. Japanese version of home form of the ADHD-RS was developed with good reliability and validity. More researches of ADHD in Japanese children are required.

Japanese version of school form of the ADHD-RS: an evaluation of its reliability and validity

Using the Japanese version of school form of the ADHD-RS, this survey attempted to compare the scores between the US and Japan and examined the correlates of ADHD-RS. The classroom teachers of 7414 children (3842 males and 3572 females) evaluated all the children's behaviors. A confirmed factor analysis of ADHD-RS confirmed the two-factor solution (Inattentive and Hyperactive-Impulsive) same as previous studies. ADHD-RS scores were not related to IQ, but were associated with standardized achievement test scores. Males showed stronger ADHD tendencies than did the females, and the males tended to score lower as they grew older. Our comparison of the scores between the US and Japan found the Japanese children scored lower than did their US children. Japanese version of school form of the ADHD-RS with good reliability and validity was developed. More researches of ADHD in Japanese children are required.

A Vygotskian critique of self-instructional training

Self-instructional training, a widely used intervention for treating the learning and behavioral difficulties of impulsive, attention deficit-hyperactivity disordered, and learning disabled children, has repeatedly failed to promote self-control or improve academic performance. In light of this failure, we critically examine four assumptions underlying self-instructional training: (a) children with learning and behavior problems show a lack and/or deficient use of self-regulatory private speech; (b) modeling of self-verbalizations will increase children's spontaneous production of private speech; (c) speech and action are intrinsically coordinated; and (d) internalization refers to subvocalization of private speech. We argue that self-instructional training interventions need to be thoroughly grounded in Soviet developmental theory of verbal self-regulation and in systematic research on the social origins and development of children's private speech. A new research agenda is suggested.

Academic performance in ADHD when controlled for comorbid learning disorders, family income, and parental education in Brazil

OBJECTIVE

Scholastic achievement in a nonclinical sample of ADHD children and adolescents was evaluated taking into consideration variables such as comorbid learning disorders, family income, and parental education which may also be associated with poor academic performance.

METHOD

After screening for ADHD in 396 students, the authors compared academic performance of 26 ADHD individuals and 31 controls paired for gender, age, and intelligence level considering both mathematics and Portuguese language scores. Learning disorders were investigated and the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV ) criteria were met using structured interviews.

RESULTS

The prevalence of academic underachievement was 2.98 times higher in students with ADHD, the most frequent subtype being predominantly inattentive. Parental educational level, family income, and comorbid learning disorders could not explain the discrepancies between ADHD students and controls.

CONCLUSIONS

ADHD seems to be associated with poor academic performance even in the absence of comorbid learning disorders, lower family income, and parental educational level.

Conduct disorder and antisocial behavior: Some thoughts about processes

“Whether we form habits of one kind or of another from our very youth…makes a very great difference, or rather all the difference,” claimed Aristotle, wrestling with notions of conduct disorder (CD) and antisocial behavior two thousand years ago (Bk. II, chap. 1). As I respond to the invitation of John Richters and Dante Cicchetti to reflect on “where research on antisocial behavior has been, is now, and is going,” I think about the implications of Aristotle's claim. On the one hand, Aristotle points to the training received during childhood as key to understanding subsequent misbehavior. On the other, he believed that individuals must be responsible for their behavior and that, therefore, they must be able to make choices regarding how to act.

Why are hyperactivity and academic achievement related?

Although a negative association between hyperactivity and academic achievement is well documented, little is known about the genetic and/or environmental mechanisms responsible for the association. The present study explored links between parent and teacher ratings of hyperactive behavior problems and teacher-assessed achievement in a sample of 1,876 twin pairs (mean age 7.04 years). The results did not differ across rater, nor were there significant differences between males or females or for twins in the same or different classrooms. Hyperactivity was significantly correlated with achievement. Multivariate model-fitting analyses revealed significant genetic and nonshared environmental covariance between the two phenotypes. In addition, bivariate heritabilities were substantial, indicating that the phenotypic correlations between hyperactivity and achievement were largely mediated by genetic influences.

Cognitive functioning in children with and without Attention-deficit/Hyperactivity Disorder with and without comorbid learning disabilities

This study attempted to determine whether children with the combined subtype of attention-deficit/hyperactivity disorder (ADHD) have impairments in cognitive functioning and motor skills. The specific effect of the comorbidity of learning disabilities (LD) was also investigated. A battery of cognitive tests was administered to 26 children with a clinical diagnosis of ADHD-combined subtype (ADHD/C), to 24 children with ADHD/C with a comorbid diagnosis of LD (ADHD/C+LD), and to 102 participants without disabilities, all between ages 7 and 10. The testing battery consisted of tasks assessing memory, visuospatial and verbal abilities, and fine motor skills. In general, the test results of children with ADHD/C were poorer than those of the control group but better than the results of children with a combined ADHD/C+LD diagnosis (with the exception of motor skills). The predictive accuracy of the testing battery tasks in children with ADHD/C and ADHD/C+LD was examined. The results of a standard procedure of discriminant function analyses revealed that the measures correctly classified 73.6% of the children.

Learning disabilities in juvenile offenders

The article briefly reviews the literature on the association between learning disabilities and conduct problems across correctional communities and clinical settings. It first reviews the literature on the prevalence of learning deficiencies among criminal offenders. It then discusses a number of relevant points from studies of the association between low academic achievement and conduct problems in nonincarcerated population samples. Third, it discusses studies of postrelease academic profiles of juvenile offenders. The article closes with a comment on possible future directions of the research linking reduced levels of academic achievement and delinquency.

Der Zusammenhang zwischen Lese-, Rechtschreib- und Verhaltensschwierigkeiten

Zusammenfassung. Um den Zusammenhang zwischen Lese-Rechtschreibschwierigkeiten und emotionalen sowie Verhaltensproblemen zu klären, wurde eine Längsschnittstudie vom Kindergarten bis zum Ende der vierten Grundschulklasse durchgeführt (n = 219). In jährlichem Abstand wurde der Leistungsstand im Lesen und Rechtschreiben erfasst und eine Befragung zum Sozialverhalten durchgeführt. Zudem wurden Verhaltenseinschätzungen seitens der Kindergärtnerin, Lehrerin, Eltern und Mitschüler erhoben. Kinder mit Verhaltensschwierigkeiten zeigten bereits im Kindergarten häufiger auffälliges Verhalten, Kinder mit LRS-Schwierigkeiten in der Schule waren durch Defizite in den Vorläuferfertigkeiten gekennzeichnet. Von Anfang an bestand ein mäßiger Zusammenhang zwischen den Bereichen, der etwa in gleicher Größe über die Jahre erhalten blieb. Bei jährlicher Testung und Verhaltensbeurteilung nahm die Stabilität sowohl der Verhaltens - als auch der Lese-Rechtschreibprobleme über die Jahre zu. Beim Vergleich der Einschätzungen der Kindergärtnerin und der Klassenlehrerin bzw. eines Verhaltensratings der anderen Kinder wurde deutlich, dass die sozialen Anpassungsschwierigkeiten der Schüler mit Leserechtschreibschwierigkeiten in der vierten Klasse im Vergleich zum Kindergarten deutlich zugenommen hatten. Dies betraf allerdings nicht die Einschätzung von Hyperaktivität und Aufmerksamkeitsstörung und auch nicht jene von aggressivem und störendem Verhalten, sondern zurückgezogenes Verhalten und Viktimisierung durch Mitschüler.

Delinquency, hyperactivity, and phonological awareness: a comparison of adolescents with ODD and ADHD

The incidence of reading disabilities in children with attention deficit hyperactivity disorder (ADHD) has been found at a higher proportion than would be expected by chance. This study explored the relationship between reading problems-comprehension and phonological awareness, and externalizing behaviors-hyperactivity (ADHD), and oppositional defiant disorder (ODD). One hundred boys from Central Texas area alternative education schools between the ages of 11 and 15 were grouped by categories: ADHD-Combined Type (ADHD:C), ODD only, a combination of ADHD:C and ODD, and children without either ADHD or ODD. Results indicated that there were no significant differences among the four groups in terms of reading skills. However, findings suggest a significant negative linear relationship between hyperactivity and reading skills. Application of these findings is 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.

ADHD and reading disability in male adults: is there a connection?

The present study examined the comorbidity between attention-deficit/hyperactivity disorder (ADHD) and reading disability (RD) in male adults. Participants were 120 men, of whom 24 were classified as having ADHD. The basis for the diagnosis was two self-report scales validated by interviews and background data. An extensive battery was used to assess phonological abilities and various aspects of reading skills. No differences were obtained between adults with and without ADHD on measures of either phonological processing skills or word decoding, indicating a low comorbidity with RD. This finding was valid even when different criteria were used to diagnose RD. However, the two groups differed in reading comprehension, with individuals with ADHD performing poorly in tests of reading comprehension. These results are compatible with the view that reading comprehension involves many of the higher cognitive control functions assumed to be impaired in ADHD. However, these attentional control functions are not critical to word recognition, which is determined by a more encapsulated phonological processing module. The pattern of associations between ADHD and RD observed in the present study is explained with reference to the differential attentional demands of the two aspects of reading.

Fronto-central dysfunctions in reading disability depend on subtype: guessers but not spellers

The goal of this study was to test the hypothesis that the inhibitory deficits previously found in children with the guessing subtype of dyslexia (who read fast and inaccurately) can be attributed to dysfunctions in the fronto-central brain areas. For this purpose, the electrocortical correlates of the inhibition mechanism were assessed in a stop task that was adapted for event-related brain potential recording. It was found that in children with the spelling subtype of dyslexia (who read slowly and accurately) and normal readers, a positive component with a fronto-central scalp distribution was related to processes engaged in the inhibition of a response. Guessers did not show this "inhibition P300." Analyses of the lateralized readiness potential (LRP) data suggested that response inhibition in spellers depended (at least in part) on their ability to inhibit the central activation of the response. In guessers, the association between response inhibition and inhibition of activity in the central motor structures was found to be weaker. It was concluded that the inhibitory deficits in guessers can be attributed to dysfunctions in the fronto-central brain structures involved in selective motor inhibition (indicated by the LRP data) and nonselective motor inhibition (indicated by the P300 data). It was suggested that there may be an association between guessers and attention deficit hyperactivity disorder children in that both clinical groups may suffer from the same type of deficits in executive functioning.

The long-term significance of teacher-rated hyperactivity and reading ability in childhood: findings from two longitudinal studies

BACKGROUND

The aims of this study were twofold: first, to examine behavioural and academic outcomes of children with hyperactivity, using data from two longitudinal studies; and second, to examine comparable psychosocial outcomes for children with early reading difficulties.

METHODS

Measures of teacher-rated persistent hyperactivity, and reading ability obtained during early primary school were available for children from the Australian Temperament Project and the Dunedin Multidisciplinary Health and Development Study. Both samples were followed up to assess behavioural and academic outcomes during the adolescent and early adult years. Family background, antisocial behaviour and literacy were controlled in the first set of analyses to examine the influence of early hyperactivity.

RESULTS

There were strong linear relationships between early hyperactivity and later adverse outcomes. Adjustment for other childhood variables suggested that early hyperactivity was associated with continuing school difficulties, problems with attention and poor reading in adolescence. Early reading difficulties, after controlling for early hyperactivity, predicted continuing reading problems in high school and leaving school with no qualifications.

CONCLUSIONS

The findings suggest that there are dual pathways from early inattentive behaviours to later inattention and reading problems, and from early reading difficulties to substantial impairments in later academic outcomes.

Separating genuine cases of reading disability from reading deficits caused by predominantly inattentive ADHD behavior

Conventional methods of differentiating reading disability (RD) caused by deficits in decoding skills or comprehension from poor reading performance caused by inconsistent attention associated with attention-deficit/hyperactivity disorder (ADHD) have produced equivocal results. This study presents a model of differential diagnosis of attentional problems and RD that differs from these conventional approaches. The new diagnostic procedure uses intraindividual differences seen in the performance of at-risk learners on tasks related to reading that vary in their sensitivity to the sustained attention required for successful performance. The hypothesis is that children with inconsistent attention would perform more poorly on tests that require sustained attention, such as listening comprehension, than on tests that are more tolerant of inattention, such as reading comprehension. Such differences would not be seen in the test scores of children who have only RD, because their performance is determined more by the difficulty level of the reading tests than by the degree of sensitivity of the task to attention. The validity of this new model was evaluated by determining the capability of the differences seen in the scores of tests that differ in their sensitivity to sustained attention to predict the degree of inconsistency in sustained attention as measured by a continuous performance test. The data obtained from 39 children who are at risk for RD suggest that this is a viable model.

Diagnosis and management of children with attention deficit hyperactivity disorder

Attention deficit hyperactivity disorder (ADHD) is one of the most prevalent childhood psychiatric disorder which is characterized by three core symptoms of inattention, hyperactivity and impulsivity. It is estimated that 5% to 10% of school aged children suffer from this disorder. This disorder is more common in boys than girls. Comorbidity is a major problem and is present in as many as two thirds of children with ADHD. A multiple modality approach to treatment which combines pharmacotherapy, psycho education, behaviour therapy, environmental changes and social skills training is recommended. The outcome of ADHD is variable and unless properly treated in early years may predispose the child to serious psychopathology in adulthood.

Boys with reading disabilities and/or ADHD: distinctions in early childhood

We examined distinctions in the early childhood characteristics of boys with reading disabilities (RD) and/or attention-deficit/ hyperactivity disorder (ADHD). A four-group mixed design consisting of boys identified at age 11 with reading disabilities only (RD only; n = 46), reading disabilities and ADHD (RD/ADHD; n = 16), ADHD only (n = 20), and a comparison group (n = 281) was utilized. Differences on receptive and expressive language and temperament for ages 3 and 5 were investigated. Analyses indicated that the boys from the RD-only group performed worse on measures of receptive and expressive language. The results also indicated that boys from the RD/ADHD groups consistently performed worse on measures of receptive language and exhibited more behaviors indicative of an undercontrolled temperament. In summary, we suggest that reading disabilities and ADHD represent moderately unique disorders that frequently co-occur and are characterized by distinct developmental pathways.

A comparison of the cognitive deficits in reading disability and attention-deficit/hyperactivity disorder

This study used a nonreferred sample of twins to contrast the performance of individuals with reading disability (RD; n = 93), attention-deficit/hyperactivity disorder (ADHD; n = 52), RD and ADHD (n = 48), and neither RD nor ADHD (n = 121) on measures of phoneme awareness (PA) and executive functioning (EF). Exploratory factor analysis of the EF measures yielded underlying factors of working memory, inhibition, and set shifting. Results revealed that ADHD was associated with inhibition deficits, whereas RD was associated with significant deficits on measures of PA and verbal working memory. The RD + ADHD group was most impaired on virtually all measures, providing evidence against the phenocopy hypothesis as an explanation for comorbidity between RD and ADHD.

How children with neurofibromatosis type 1 differ from "typical" learning disabled clinic attenders: nonverbal learning disabilities revisited

To further investigate cognitive deficits in children with Neurofibromatosis Type 1 (NF-1), children with NF-1 were compared to typical learning disabled clinic attenders (LD-clinic), all of whom had reading disabilities, as well as to a group with no disabilities (NoDx). Results indicated that both the NF-1 group and LD-clinic group had reading and reading-related deficits when compared to the NoDx group; however, the NF-1 group was more globally language impaired than the LD-clinic group. In addition, the NF-1 group scored significantly lower than the LD-clinic group, but not the NoDx group, on the visuospatial measures, thus confirming that children with NF-1 have visuospatial deficits not typical of a general LD-clinic population. The NF-1 group was not impaired in comparison to the NoDx group on certain language and visuospatial tasks that were previously found to be deficits in sibling pairwise matched designs; thus, the importance of considering genetic and familial context when studying the impact of genetic disorders on cognition was demonstrated.

ADHD and reading disabilities: a cluster analytic approach for distinguishing subgroups

Data suggest that children with reading disability (RD) and non-RD children with attention-deficit/hyperactivity disorder (ADHD) may comprise distinct subgroups. Research has been hampered by variance in definitional criteria, which results in the study of different subgroups of children. Using cluster analysis, this study empirically divided children with ADHD (N = 54), based on their Full Scale IQ (FSIQ) and reading ability. Four distinct subgroups emerged in which cognitive, behavioral, and neurochemical function was compared. Cluster 1 was of average FSIQ and reading scores; Cluster 2 was of average FSIQ but showed impairment in reading; Cluster 3 had high FSIQ and reading scores; and Cluster 4 had low scores in both domains. The groups had different patterns of cognitive, behavioral, and neurochemical function, as determined by discrepancies in Verbal-Performance IQ, academic achievement scores, parent aggression ratings, and a measure of noradrenergic function. These distinctions are discussed with regard to etiology, treatment, and long-term outcome.

Etiology of inattention and hyperactivity/impulsivity in a community sample of twins with learning difficulties

A community sample of 373 8 to 18 year-old twin pairs in which at least one twin in each pair exhibited a history of learning difficulties was utilized to examine the etiology of inattention and hyperactivity/impulsivity (hyp/imp). Symptoms of attention-deficit/hyperactivity disorder (ADHD) were assessed by the DSM-III Diagnostic Interview for Children and Adolescents. Inattention and hyp/imp composite scores were created based on results of a factor analysis. Results indicated that extreme ADHD scores were almost entirely attributable to genetic influences across several increasingly extreme diagnostic cutoff scores. Extreme inattention scores were also highly heritable whether or not the proband exhibited extreme hyp/imp. In contrast, the heritability of extreme hyp/imp increased as a linear function of the number of inattention symptoms exhibited by the proband. This finding suggests that extreme hyp/imp may be attributable to different etiological influences in individuals with and without extreme inattention. If this result can be replicated in other samples, it would provide evidence that the hyp/imp symptoms exhibited by individuals with Combined Type ADHD and Predominantly Hyp/Imp Type ADHD may be attributable to different etiological influences.

Comorbidity of reading disability and attention-deficit/hyperactivity disorder: differences by gender and subtype

This study used a community sample of 494 twins with a reading disability (223 girls, 271 boys) and 373 twins without a reading disability (189 girls, 184 boys) to assess the relation between reading disability (RD) and attention-deficit/hyperactivity disorder (ADHD). Symptoms of DSM-III and DSM-IV ADHD were classified into symptoms of inattention and symptoms of hyperactivity-impulsivity (H/I). Results indicated that individuals with RD were more likely than individuals without RD to meet criteria for ADHD and that the association between RD and ADHD was stronger for symptoms of inattention than for symptoms of H/I. Parents and teachers reported similar rates of ADHD, suggesting that ADHD symptoms were pervasive across settings and were not solely attributable to academic frustration. Analyses of possible gender differences revealed that RD was significantly associated with inattention in both girls and boys but associated with H/I only in boys. This difference may provide a partial explanation for the discrepancy between the gender ratio obtained in referred (approximately 4 boys to 1 girl) and nonreferred (1.2 to 1.5 boys to 1 girl) samples of individuals with RD. Specifically, the hyperactive and impulsive behaviors exhibited by boys with RD may be more disruptive than the inattentive behaviors exhibited by girls and may therefore precipitate more frequent referrals for clinical attention.

Findings on disruptive behavior disorders from the first decade of the Developmental Trends Study

The paper summarizes the first decade of the Developmental Trends Study, a prospective longitudinal study of 177 boys. Initially, they were referred to mental health clinics in Pennsylvania (Pittsburgh), and Georgia (Athens and Atlanta). Since 1987, the boys, their parents, and their teachers have been followed up almost annually. The study is unique because the cooperation rate of participants has remained very high over the years, psychiatric diagnoses were derived from structured interviews (especially disruptive behavior disorders), and many risk factors were measured over the years. The present paper summarizes key findings on the development of disruptive behavior, especially Oppositional Defiant Disorder, Conduct Disorder, and Attention Deficit-Hyperactivity Disorder. The paper also highlights results on risk factors and comorbid conditions of disruptive behaviors.

Comorbidity of learning and attention disorders. Separate but equal

Children with learning and attention disorders commonly present with symptoms of both types of disorders. In many children, this co-occurrence represents comorbid disorders that are separate but overlapping. Because of comorbidity, the presence of one disorder signals the need to evaluate for the other disorders. Evaluation and treatment approaches must address both disorders when present.

Attention deficits and clumsiness in Swedish 7-year-old children

A population study of 409 seven-year-old children in a middle-sized Swedish town was performed. All children were examined by the same doctor and evaluated by means of parent interview, motor examinations, and teacher reports on behaviour in the classroom. Follow-up was carried out 8 months later. The rate of severe problems in the fields of attention deficit-hyperactivity disorder (ADHD), developmental coordination disorder (DCD), and deficits in attention, motor control, and perception (DAMP) (the combination of ADHD and DCD) was 6.1%, with boys being affected more frequently than girls. There was considerable overlap between ADHD and DCD, with about half of each diagnostic group also meeting criteria for the other diagnosis. Attention deficits at diagnosis strongly predicted attention deficits at follow-up. If parents had noted attention deficits in the home setting, then teachers almost always independently agreed that there were similar problems in the classroom. However, the reverse did not always apply. Clumsiness also showed striking stability over time. The diagnosis of DAMP, particularly severe DAMP, had a stronger association with classroom dysfunction and with high Conners scores than did diagnoses of ADHD or DCD. It is concluded that DAMP may be a clinically valid diagnostic construct.

Biological predictors and co-morbidity of attention deficit and hyperactivity disorder in extremely low birthweight infants at school

OBJECTIVE

To examine biological predictors and co-morbidity of Attention Deficit Hyperactivity Disorder (ADHD) and associated academic and social impairment in a cohort of extremely low birthweight of (ELBW) children attending school.

METHODOLOGY

Eight seven (70%) of 125 ELBW children born between 1977 and 1986 were followed prospectively. Neonatal and biological data including cranial ultrasound for 62% of children, formal developmental assessment at 4 or 6 years of age, teacher and parent ADHD questionnaire, parental rating of health status and social impairment and school teacher rating of academic performance was recorded.

RESULTS

Apart from grades 3 or 4 intraventricular haemorrhage in a minority of children, there was no evidence to suggest an association between ADHD and perinatal adversity in ELBW children. Social impairment, academic difficulty and atopic symptoms were significantly related to ADHD.

CONCLUSIONS

Extremely low birthweight children presenting with symptoms of ADHD are likely to suffer social and learning impairment and these, rather than perinatal risk factors, should be the focus of clinical attention.

Academic underachievement in ADHD subtypes

Although a relationship between attention-deficit/hyperactivity disorder (ADHD) and academic underachievement has been widely reported, the nature of this relationship has not been specified. The present investigation addresses this relationship directly by comparing 24 students (20 males and 4 females) with ADHD and 20 students (15 males and 5 females) with attention-deficit disorder without hyperactivity (ADD/noH) referred to a university-based diagnostic clinic for comprehensive neuropsychological assessment. The students ranged in age from 6 years 0 months to 12 years 10 months. Consistent with previous reports, this study found that math achievement test scores for students with ADD/noH were significantly lower than those for students with ADHD. These findings support previous research suggesting the ADD/noH may represent a distinct ADD subtype. It is hypothesized that inattention interferes with students' ability to master abstract symbol systems, especially in the acquisition of basic arithmetic skills in the primary grades.

Early reading difficulties and later conduct problems

The relationships between early reading difficulties and later conduct problems were examined in a birth cohort of New Zealand children studied from the point of school entry to the age of 16. Children with early reading difficulties had increased rates of conduct problems up to the age of 16 years. These associations depended on context, being more evident for boys and tending to reduce with increasing age. However, the associations between early reading difficulties and later conduct problems were explained by the fact that children with early reading difficulties tended to be characterised by a number of disadvantageous features (and notably early-onset conduct problems) that were present before the onset of reading difficulties. When the associations between reading difficulties and conduct problems were adjusted for confounding factors there were no statistically significant associations between reading difficulties and conduct problems. These results were found to hold for various age and gender subgroups of the sample, for measures of reading difficulties defined in different ways, and for a wide range of outcome variables. It is concluded that, when due allowance is made for potentially confounding factors (and notably early conduct problems) and for factors correlated with these problems, it is unlikely that reading difficulties in early childhood are related to later conduct problems.

Inattention-hyperactivity and reading achievement in children from low-income families: a longitudinal model

This study examined how preschool inattention-hyperactivity is related to elementary school reading achievement. Prereading skills were hypothesized to be a link between them. This link was explored using longitudinal data on 105 low-socioeconomic-status (SES) children's inattentive-hyperactive behavior and prereading skills in Head Start and in kindergarten and their inattentive-hyperactive behavior and reading skills in first grade. A model of this relationship was tested using structural equation modeling. The results failed to show a significant path between inattention-hyperactivity and prereading skills at both the Head Star and kindergarten levels. A significant path was found between first grade inattention-hyperactivity and reading skills, confirming that the strong relationship between inattention-hyperactivity and poor reading achievement commonly found in children from other SES levels was also significant in this low-SES sample. Strong relationships were found between prereading skills and reading skills, as well as among hyperactivity levels at the three grades. The issue of the direction of the path of influence between attention-behavior and reading achievement is addressed briefly; however, the results indicate that further longitudinal work is necessary to resolve this issue.

The overlap of attention deficit hyperactivity disorder with other common mental disorders

OBJECTIVE

The literature on the overlap (co-morbidity) of attention deficit hyperactivity disorder (ADHD) with conduct disorder, specific learning disability, and anxiety disorders was reviewed to examine: (i) the evidence for ADHD being a syndrome distinct from the other conditions; and (ii) the evidence for co-morbid patterns representing meaningful subtypes of ADHD.

METHODOLOGY

Narrative review of the literature.

CONCLUSIONS

Conduct disorder is distinguished from ADHD by prognosis, patterns of association and familial aggregation. Pure' disorders are uncommon, however, and there is little evidence to support a distinct co-morbid subtype. There are few data that reliably distinguish ADHD from specific learning disabilities, but there are weaknesses in research to date. A specific ADHD+learning disabled subtype may exist, but as yet the implications for treatment are not known. Attention deficit hyperactivity disorder is distinguished from anxiety by symptom discrimination, factor analysis, patterns of association, familial aggregation and treatment response. There is evidence for a distinct ADHD+anxiety subtype.

Sheltered homeless children: their eligibility and unmet need for special education evaluations

OBJECTIVES

This study described the proportion of sheltered homeless children in Los Angeles, Calif, who were eligible for special education evaluations because of a probable behavioral disorder, learning disability, or mental retardation, and to explore their level of unmet need for special education services.

METHODS

This was a cross-sectional study of 118 parents and 169 children aged 6 through 12 years living in 18 emergency homeless family shelters in Los Angeles County, California. Parents and children were interviewed with standardized mental health and academic skill measures in English and Spanish.

RESULTS

Almost half (45%) of the children met criteria for a special education evaluation, yet less than one quarter (22%) had ever received special education testing or placement. The main point of contact for children with behavioral disorders and learning problems was the general health care sector.

CONCLUSIONS

School-aged sheltered homeless children have a high level of unmet need for special education evaluations, the first step toward accessing special education programs. Interventions for homeless children should include integration of services across special education, general health care, and housing service sectors.

Attention Deficit Hyperactivity Disorder (ADHD): Selected review of causes, comorbidity and treatment

A limited review of the causes, comorbidity, diagnosis and treatment is offered to emphasize the difficulties in diagnosing and treating Attention Deficit Hyperactivity Disorder and Hyperkinetic Disorder. Some of the difficulties include controversies about the existence of a separate disorder, the changes in symptoms with age, the short-lived improvement on medication and the claims of unsubstantiated treatments. This selected review should help the reader to consider recent findings in the aetiology, diagnosis and treatment of ADHD.

Management of children prescribed psychostimulant medication for attention deficit hyperactivity disorder in the Hunter region of NSW

OBJECTIVE

To examine local procedures for assessment of attention deficit hyperactivity disorder (ADHD) and its management with psychostimulant medication and to compare these with published practice guidelines.

DESIGN

Retrospective postal survey.

PARTICIPANTS

Parents of children living in the Hunter region of New South Wales first prescribed psychostimulants between 1992 and 1994.

MAIN OUTCOME MEASURES

Procedures for diagnostic assessment, treatment monitoring and continuing management.

RESULTS

788 parents (60%) responded. Diagnostic assessment procedures complied with published guidelines for about 70%, and detection of comorbid conditions was consistent with community prevalence estimates. There was systematic assessment of treatment response with questionnaires in only a third. Some children with academic or behavioural problems (19%-24% and 32%, respectively), almost 50% with emotional problems and 63% with motor problems were not receiving treatment for these difficulties. Modal interval for review was six months. Trials off medication were most commonly during school holidays, contrary to recommendations of the New South Wales Health Department. Most parents reported considerable improvement in their children's quality of life with medication.

CONCLUSIONS

Problems comorbid with ADHD are detected often. Areas of deficiency in management of ADHD include the low rate of contact with schools for diagnostic assessment and determining treatment efficacy, poor support for comorbid problems, infrequent review, and inadequate methods for determining need to continue treatment.

Behavioral distinctions in children with reading disabilities and/or ADHD

OBJECTIVE

To investigate behavioral distinctions between children with reading disabilities (RD) and attention-deficit hyperactivity disorder (ADHD).

METHOD

A four-group mixed design consisting of children with reading disabilities only (RD only), reading disabilities and ADHD (RD/ADHD), ADHD only, and a comparison group was used. Differences between parent reports, from age 5 to 15 years, and teacher reports, from age 5 to 13 years, were examined on measures of hyperactive and antisocial behaviors.

RESULTS

The analyses indicated that, at home, children from the ADHD only and RD/ADHD groups exhibited significantly more hyperactive behaviors than children from the RD only and comparison groups. At school, children from the RD only, ADHD only, and RD/ADHD groups typically exhibited significantly more hyperactive and antisocial behaviors than children from the comparison group. With regard to antisocial behaviors, children from the RD/ADHD group exhibited significantly more antisocial behaviors than children from any other group.

CONCLUSIONS

The results of the study indicate that children from these groups may exhibit either a "pervasive" or "situational" presentation of behavioral problems, a finding which suggests that in conducting an evaluation of ADHD it is important to obtain both parent and teacher reports of problem behaviors.

An examination of youth with attention-deficit/hyperactivity disorder and language learning disabilities: a clinical study

This study examined the performance of 96 youth hospitalized at an acute-care psychiatric hospital on a battery of language measures. The participants were separated into four groups: (a) participants with language learning disabilities (LLD; n = 14), (b) participants with attention-deficit/hyperactivity disorder (ADHD; n = 26), (c) participants with both ADHD and LLD (ADHD/LLD; n = 18), (d) participants with neither ADHD nor LLD (Neither; n = 38). Participants with ADHD/LLD performed significantly more poorly than did the ADHD group or the Neither group on measures of phonology and syntax, but not semantics. However, participants with ADHD/LLD did not significantly differ from participants with LLD on a majority of language-based measures. This finding suggests that participants with ADHD/LLD have profiles more similar to those of participants with LLD than participants with ADHD. Educational implications for instruction for students with ADHD/LLD are presented.