Attention deficit disorder with hyperactivity: a critique

Neuropsychological evaluation of deficits in executive functioning for ADHD children with or without learning disabilities

This study investigates multiple aspects of executive functioning in children with attention deficit/hyperactivity disorder (ADHD). These areas include attentional components, impulsiveness, planning, and problem solving. The rationale of the study is based on neurophysiological studies that suggest frontal lobe dysfunction in ADHD. As frontal lobe functioning is related to abilities in executive control, ADHD is hypothesised to be associated with deficits in various areas of executive functioning. The specific effect of comorbidity of learning disability (LD) was also investigated. Eighty-three children with ADHD and 29 age-matched controls (age 7-13) participated in the study. A battery of neuropsychological tests was utilized to evaluate specific deficits in speed of processing, selective attention, switching attention, sustained attention, attentional capacity, impulsiveness, planning and problem solving. Findings indicated that children with ADHD have slower verbal responses and sustained attention deficit. Deficits in selective attention and attentional capacity observed were largely related to the presence of LD. No specific deficit associated with ADHD or the comorbidity of LD was identified in switching attention, impulsiveness, planning, and problem solving. These results revealed that ADHD is not associated with a general deficit in executive functioning. Instead, ADHD is related to a specific deficit in regulation for attentional resources. The importance of isolating the deficit related to LDs for examining the specific deficit associated with ADHD is highlighted. Results also emphasised the importance of isolating the effect of lower level of abilities (e.g., speed of processing) and the utilization of specific definition for the examination of executive functions.

Comorbidity in adults with attention-deficit/hyperactivity disorder

This paper describes the clinical manifestations of attention-deficit/hyperactivity disorder (ADHD) in adulthood, with particular emphasis placed on issues relating to comorbidity. Prospective and retrospective studies are reviewed to evaluate the degree to which adults with ADHD exhibit clinical features that mirror their childhood counterparts with analogous comorbid psychiatric (e.g., antisocial, mood, and anxiety) and/or cognitive (i.e., learning) disorders. We also address the question of whether comorbid disorders in adults represent independent diagnostic entities and whether the presence of psychiatric comorbidity varies as a function of ADHD subtype (i.e., inattentive, hyperactive-impulsive, combined, and residual). As is the case for ADHD in childhood, comorbidity is not uncommon among adults with ADHD. However, the reported prevalence of comorbid conditions among adults with ADHD varies considerably depending upon whether the research used a prospective or retrospective design.

Can parents accurately perceive hyperactivity in their child?

In all, 1872 children were recruited as part of a larger study concerning food additives and behaviours in preschool children. This figure represented 70% of the whole population of 3 1/4 -year-old children resident on the Isle of Wight, UK. Parents completed an assessment concerning their perceptions of their child's behaviour. The results of this assessment were compared with scores on two validated parental questionnaires, the Weiss Werry Peters (WWP) hyperactivity scale and the Emotionality, Activity and Sociability Temperament Questionnaire (EAS), which were used to assess hyperactivity. The accuracy of parents in perceiving hyperactivity in their children was found to be around 50% if the child was hyperactive, and 89% if the child was not hyperactive. The implications of these findings for services are discussed. Frequencies of potential risk groups for future Attention Deficit Hyperactivity Disorder (ADHD) and Conduct Disorder were also suggested.

Executive processing and attention deficit hyperactivity disorder: an application of the supervisory attentional system

Children with attention deficit hyperactivity disorder (ADHD) display many behaviors consistent with an underlying deficit in executive processes. This study examines Norman and Shallice's (1986) supervisory attentional system (SAS) as an approximation of executive functioning thought to be impaired in ADHD. Fifteen ADHD children were compared to a clinical control sample of learning disabled (LD) children and control children matched for age, gender, and IQ on a series of tasks designed to tap the functions of the SAS. The tasks assessed either the inhibition of a strongly triggered response (Star Counting Test, Hayling Sentence Completion Test, and the Random Generation Test) or impulsive responding in the absence of strong trigger-schema contingencies (Brixton Spatial Anticipation Test). Analyses revealed that the ADHD group was significantly impaired, in comparison to the LD and control groups, on tasks requiring the inhibition of a strongly triggered response. Further support for the fractionation of the SAS is provided by the differential performance of the groups on these tasks.

Developmental and etiological characteristics of children with sexual behavior problems: treatment implications

OBJECTIVE

Baseline data are reported on the demographics, psychological adjustment, victimization, and perpetration histories of 127 6- to 12-year-old children who have engaged in developmentally unexpected sexual behaviors. Information regarding the children's caregivers, and their extended families, is also presented. Data were collected during intake of the families into a longitudinal treatment outcome study.

METHOD

A comprehensive battery of psychometric devices and a structured interview were completed with 127 children with sexual behavior problems and their primary caregivers at intake to a treatment outcome study.

RESULTS

More than half of the children engaging in developmentally unexpected sexual behaviors had been abused both sexually and physically by more than two different perpetrators. One-third of the people who had maltreated these children were less than 18 years old. These children had acted out against an average of two other children. High levels of distress in the children and their caregivers were evident across a number of psychometric and historical variables.

CONCLUSION

Children with sexual behavior problems exhibited a number of functional impairments commonly associated with maltreatment, including learning and psychiatric disorders. Their caregivers and families manifested several characteristics that deter children's recovery from maltreatment, including an impaired attachment between parent and child. The scope of the children's problems requires that treatment extend beyond the therapist's office to include schools and other agencies or individuals with whom the child and families have regular contact.

Latent class and factor analysis of DSM-IV ADHD: a twin study of female adolescents

OBJECTIVE

In an attempt to validate the current DSM-IV criteria for attention-deficit/hyperactivity disorder (ADHD) in females and to determine whether symptoms are continuously distributed or categorically discrete, the authors performed factor and latent class analysis on ADHD symptom data from a large general population of adolescent female twins (1,629 pairs).

METHOD

A structured diagnostic assessment of DSM-IV ADHD was completed with at least one parent of 1,629 pairs by telephone. ADHD symptoms from 1,549 pairs were subjected to latent class and factor analysis.

RESULTS

Latent class and factor analyses were consistent with the presence of separate continuous domains of inattention (ATT), hyperactivity-impulsivity (H-I), and combined ATT with H-I problems. Severe latent classes corresponding to the predominantly inattentive, predominantly hyperactive-impulsive, and combined types were identified with lifetime prevalence estimates of 4.0%, 2.2%, and 3.7%, respectively. Membership in the severe ATT class predicted academic problems, family problems, and referral to health care providers. Membership in the H-I and combined classes also predicted impaired social relationships.

CONCLUSIONS

These results suggest that DSM-IV ADHD subtypes can be thought of as existing on separate continua of inattention, hyperactivity-impulsivity, and combined type problems. Membership in any of there severe ADHD latent classes did not preclude academic excellence, but it was associated with different types of impairment and health care-seeking behavior. These data have implications in the areas of diagnosis, classification, treatment, and research.

Is there a comorbid relationship between hyperactivity and emotional psychopathology?

Some of the early literature implied that emotional disorders were almost incompatible with hyperactivity in childhood. The paper addresses this issue using a large epidemiological data base--of two cohorts of 7- & 8-year-old and 11- & 12-year-old children from the North of England. There are two themes, first, the paper reports on the prevalence of emotional symptoms and disorder among hyperactive children. Second, it explores co-occurrence of hyperactivity and emotional psychopathology according to whether the hyperactivity is situational or pervasive and according to the age of the child. Hyperactivity proved to have an association with emotional symptoms and disorder at both ages but the links with disorder were most prominent among the older children. Among our high risk or maladjusted samples the strongest links were with home-based situational hyperactivity. However, among the general population cohort, emotional disorder proved to be a function of pervasiveness of hyperactivity and older age.

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.

Attention deficit hyperactivity disorder: perceptions, practice and politics

Some of the issues related to the doubts and complexities involved in the diagnosis and treatment of attention deficit hyperactivity disorder (ADHD) are reviewed. While some writers claim that it is clear that all children presenting with ADHD should be treated by pharmacological means, there are associated risks and politics. However, in the absence of well established and research-supported alternative understandings of the aetiology and treatment of the disorder, many practitioners feel unable to offer a useful service. Resulting frustrations have led some parents to form their own support networks, which make strong demands for increased services. More creative and innovative therapeutic interventions focusing on the broader impact of ADHD must be developed to deal with this disorder.

Objective measurement of hyperactivity and attentional problems in ADHD

OBJECTIVE

To precisely describe movement abnormalities in seated children with attention-deficit hyperactivity disorder (ADHD) while they were engaged in a continuous performance task (CPT).

METHOD

Diagnoses were made by using structured interviews (Schedule for Affective Disorders and Schizophrenia for School-Age Children-Epidemiologic Version) and DSM-IV criteria. Movement patterns of 18 boys with ADHD (9.3 +/- 2.4 years) and 11 normal controls (8.6 +/- 1.8 years) were recorded using an infrared motion analysis system that tracked the position of four markers 50 times per second to a resolution of 0.04 mm.

RESULTS

Boys with ADHD moved their head 2.3 times more often than normal children (p < .002), moved 3.4 times as far (p < .01), covered a 3.8-fold greater area (p < .001), and had a more linear and less complex movement pattern (p < .00004). They responded more slowly and with greater variability on the CPT. Complexity of head movement and variability in response latency significantly correlated with teacher ratings. A predefined composite of movement and attention discriminated 16 of 18 patients from 11 of 11 controls.

CONCLUSIONS

The relative inability of boys with ADHD to sit still can be objectively verified, and "fidgeting" appears to consist of more frequent, larger amplitude, whole body movements.

Deficient inhibitory control in attention deficit hyperactivity disorder

The purpose of this study was to examine two executive control processes--response inhibition and re-engagement of responses after inhibition in children with attention deficit hyperactivity disorder (ADHD). Thirty-three children with ADHD and 22 normal control children of similar age (7 to 11 years) and mean IQ (107) were tested with the change paradigm. ADHD subgroups were defined by the context in which the ADHD symptoms predominated (in the home only; at school only; and in both, i.e., pervasive ADHD). Children with marked oppositional defiant or conduct disorder were excluded. Children with ADHD exhibited deficits in inhibitory control and in response re-engagement. Deficits were greatest in pervasive ADHD and, to a lesser extent, in those with ADHD limited to the school context. ADHD limited to the home context showed the least deficit. These results replicate an earlier study that found deficient inhibitory control in pervasive ADHD and demonstrate that the deficit in ADHD involves a second aspect of executive control.

Attentional difficulties in hyperactive and conduct-disordered children: a processing deficit

A random population sample of 1479 Chinese boys from Hong Kong was screened and diagnosed in a two-stage epidemiological study. Four groups, age 7-8, were distinguished: (1) a pure hyperactive group (HA), (2) a mixed hyperactive/conduct-disordered group (HA+CD), (3) a pure conduct-disordered group (CD), and (4) a normal control group (N). On a visual search task, only the HA children showed a specific processing deficit in performance. This confirms the diagnostic value of such a deficit for hyperactivity, differentiating it from conduct disorder. The failure to find a similar deficit in the HA+CD group raises questions concerning the clinical identity of these children. Each group showed a performance decrement over time in the visual search task but the decrement did not differ between the four groups. This observation is not congruent with the reports of a short attention span in hyperactive children; explanations of this apparent contradiction are considered.

Effects of experimenter and mother presence on the attentional performance and activity of hyperactive boys

The attentional performance, activity, and off-task behavior of hyperactive boys with and without conduct problems and normal boys were compared on a cancellation task under three conditions: when performing the task alone, with mother present, and with experimenter present. Results indicated that both the hyperactive groups achieved poorer attentional scores than normal subjects in the alone and mother present conditions, but improved in the experimenter present condition. The performance of the hyperactive boys with conduct problems was particularly affected by this condition. The activity and off-task behavior scores of both the hyperactive groups were higher than controls in all conditions, although the hyperactive boys with conduct problems decreased in off-task behavior when the experimenter was present. Attention and behavior scores were not significantly correlated. The implications of these findings for assessment of hyperactivity, and the role of noncompliance in the attentional behavior of hyperactive children, are discussed.

Mother-child interactions and noncompliance in hyperactive boys with and without conduct problems

Mother-child interaction, and parent ratings of child noncompliance and defiance among hyperactive boys with conduct problems (H/CP), hyperactive boys without conduct problems (H), and normal boys (N) were compared. Results indicated more negative mother-child interactions and more noncompliance in the H/CP group than in the other two groups. The H group was more noncompliant than normal children, but these groups showed no differences in defiance, nor in the behaviour of mothers. The implications of these findings in relation to the development of conduct problems in hyperactive children, treatment and research are discussed.

Precursors of hyperactivity and aggression

OBJECTIVE

This study investigated the early characteristics of children who at 8 years old were hyperactive, aggressive, or both, to clarify the etiology of these disorders.

METHOD

Prospective data from infancy to 8 years on children who were hyperactive (N = 65), aggressive (N = 57), or both (N = 60) at 8 years were compared with those on a normal comparison group (N = 70). Variables included ratings of temperament, behavior, school performance, and socioeconomic and life stress indices.

RESULTS

The two aggressive groups, particularly the hyperactive-aggressive group, were more difficult in temperament and behavior from infancy and had less optimal environments. In contrast, the "pure" hyperactive group showed more problems than did the comparison group only from 3 to 4 years on. All three clinical groups had poorer academic performance than did the controls.

CONCLUSIONS

The findings are consistent with a transactional model of development in which aggression (with or without hyperactivity) emerges when difficultness in infancy interacts with a stressed environment. Hyperactivity, when unassociated with aggression, may emerge later from poor self-regulation when faced with societal, especially school, demands. The pattern of group differences found suggest that risk indicators for specific patterns of later maladjustment may be identifiable for early intervention.

Discriminant validity of attention-deficit hyperactivity disorder

OBJECTIVE

The primary purpose of this study was to assess the discriminant validity of attention-deficit hyperactivity disorder (ADHD) relative to well-defined groups of children with other psychiatric disorders.

METHOD

Clinic-referred patients diagnosed as having ADHD without any other comorbid diagnosis (N = 13), were compared with patients with only anxiety disorders (N = 20), disruptive disorders other than ADHD (N = 15), and nonreferred controls (N = 18) on measures of cognitive and academic functioning, as well as on objective measures of attention, impulse control, and activity level.

RESULTS

All three patient groups were found to have cognitive and academic achievement difficulties relative to controls. However, the ADHD group was found to be inattentive and impulsive relative to the other patient groups and the nonreferred controls. Objective measurement of activity level distinguished the ADHD group from controls but not from the other two patient groups.

CONCLUSIONS

These data support the diagnostic validity of a small subgroup of ADHD children (i.e., those without comorbid diagnoses) and demonstrates, that as a group, these children can be distinguished from patients with anxiety as well as other disruptive disorders on objective test measures.

The Boston Teacher Questionnaire. 3. A reassessment

The prevalence of different types of dysfunction in school was assessed with the Boston Teacher Questionnaire, completed for 1923 children born 8 years earlier in a university-affiliated maternity hospital. Cluster analyses of 15 items on the questionnaire resulted in six two-item clusters and one three-item cluster that were identical for girls and boys. We identified children as having a syndrome if they possessed all features of the cluster-defined syndrome. The most prevalent syndrome, consisting of both daydreaming and distractibility items, occurred in 18.5% of boys and 11.5% of girls. Boys were also more likely than girls to be identified as having the reading syndrome (11.6% and 7.7%, respectively), the hyperactivity/impulsivity syndrome (6.1% and 1.5%), and the syndrome characterized by frustration intolerance and peer problems (9.5% and 4.0%). The prevalences of the remaining three syndromes were similar in both sexes (arithmetic, 11.3% and 10.3%; difficulty following instructions, 5.1% and 4.7%; and the tasks syndrome [characterized by impersistence/dependence/inflexibility], 5.5% and 5.4%). More than 40% of boys and girls with one syndrome also had another. The lower prevalences in this sample than in an earlier-born sample assessed with the same instrument were confined to boys. Reasons for this temporal decrease in one sex only remain obscure. Girls with the reading syndrome were 10 times more likely, and boys with the reading syndrome were five times more likely, than their peers to receive special services and to have repeated a grade.

The effect of delay on hyperactive and non-hyperactive children's response times: a research note

Twenty-four hyperactive and 55 non-hyperactive children made a button press after the disappearance of a stimulus presented for either 1, 15 or 30 sec. Hyperactive children's responses were generally slower than those of non-hyperactive children and increased with length of pre-response delay, while non-hyperactive children's response time remained the same across all presentation levels. The results are interpreted as giving support to accounts that stress the role of pre-response delay, rather than time on task per se, as an important determinant of hyperactive children's attentional performance.

Methylphenidate response in aggressive and nonaggressive ADHD children: distinctions on laboratory measures of symptoms

Response to a single, 5-mg dose of methylphenidate was compared in aggressive and nonaggressive attention-deficit hyperactivity disorder (ADHD) children using objective measures of inattention, impulsivity, and activity level. After medication, both ADHD groups had a significant decrease in inattention, whereas impulsivity remained unchanged. Activity level decreased only in the nonaggressive ADHD group. Unmedicated normal controls showed no change on any measure. These results support the hypothesis that aggressive and nonaggressive ADHD children have somewhat different underlying determinants for some of their symptoms. In addition, they suggest that inattention, impulsivity, and overactivity may be mediated by partially distinct neural mechanisms.

The relationship between inattentiveness in the classroom and reading achievement (Part A): methodological issues

Conclusions drawn from recent reviews of research concerned with relationships between child behavior disorders and learning difficulties highlight major methodological and analytical problems that have plagued empirical research in the field. This paper (Part A) identifies and discusses some of these problems, including those associated with the design and use of psychometric instruments, cutoff scores, and statistical modeling techniques. The paper provides a contextual rationale for the choice of methods and statistical models used in a large explanatory study of the relationship between inattentiveness in the classroom and reading achievement, reported in Part B.

Comorbidity for disruptive behavior disorders in psychiatrically hospitalized children

A variety of instruments were used to compare six groups of inpatient children: pure attention deficit disorder with hyperactivity (ADDH), pure conduct disorder (CD), pure oppositional defiant disorder (OD), ADDH + CD, and ADDH + OD, and a clinical control group who had no DBD diagnosis. Children with ADDH and CD or OD exhibited a greater degree of psychopathology. Children with CD and OD were more similar than different, indicating that perhaps a continuum of pathology exists between these diagnostic classifications.

The utility of a DSM-III-R-based checklist in screening child psychiatric patients

The Stony Brook Child Psychiatric Checklist, a parent completed rating instrument based on DSM-III-R, was used as part of a psychiatric inpatient admission evaluation. Data were collected on 63 5- to 13-year-old children. Checklist endorsements were compared with the same parent's responses to the Kiddie-Schedule for Affective Disorders and Schizophrenia for School-aged Children-Epidemiologic Version structured interview for the most frequently occurring disorders. Sensitivity scores ranged from 0.69 to 0.93. Results suggest the checklist can be useful in alerting the clinician to diagnostic areas warranting further pursuit.

Hyperactivity and parental psychopathology

The association of child hyperactivity and parental psychopathology was explored by establishing lifetime DSM-III diagnoses and histories of childhood hyperactivity among the parents of boys, aged 7-11 yrs, in five diagnostic groups: attention deficit disorder with hyperactivity (ADDH), conduct disorder (CD), ADDH + CD, emotional disorder (ED) and no disorder (NC). These groups were differentiated by a family history of parental psychopathology or childhood hyperactivity. ADDH + CD, CD and ED groups all had significantly higher rates of parental psychopathology than the ADDH and NC groups, for which rates were similar. Significantly more boys in the ADDH, CD and ADDH + CD groups had family histories of parental childhood hyperactivity than did boys in the ED and NC groups.

ADDH and conduct disorder: degree of diagnostic overlap and differences among correlates

The objective of this paper was to determine the degree of diagnostic overlap between attention deficit disorder with hyperactivity (ADDH) and conduct disorder (CD) and to see whether ADDH children show a different pattern of demographic, familial, and developmental correlates compared to CD children. The sample for this study consisted of 2,697 4- to 16-year-olds who participated in the Ontario Child Health Study. In terms of diagnostic overlap, ADDH and CD occurred together more often than by chance alone, particularly among girls. Pure groups of ADDH and CD children differed in a variety of ways. In general, ADDH children were younger and had experienced more developmental delays and less psychosocial disadvantage than the CD children. No differences were found with respect to associated impairments, a measure of severity. Children with both ADDH and CD (a mixed group) appeared to represent a true hybrid disorder rather than one diagnosis or the other. These findings support the validity of ADDH compared to CD, at least in terms of the pattern of correlates.

Effects of event rate and display time on sustained attention in hyperactive, normal, and control children

Two experiments were conducted to determine whether hyperactive boys have a unique deficit in sustained attention. Groups with DSM-III diagnoses of attention deficit disorder (ADDH), conduct disorder (CD), ADDH + CD, and learning disorder were compared with normal controls on the Continuous Performance Task. In Experiment 1, stimulus presentation rate (stimulus onset asynchrony, SOA) and display time were varied to manipulate attentional demand, and speed and accuracy of performance were measured. The ADDH group was uniquely affected, with less accurate performance at the fastest and slowest SOA. To distinguish the effects of time on task and SOA, the duration of each SOA condition was held constant in Experiment 2. The poorer performance of the ADDH group at the fastest SOA was no longer evident. This finding indicates that the deficit of sustained attention in boys who have ADDH is associated with a greater susceptibility to refractory effects, which is influenced by practice.

A comparison of 13-year-old boys with attention deficit and/or reading disorder on neuropsychological measures

This study compared 13-year-old boys with attention deficit disorder (ADD) and/or reading disability (RD), and controls with neither disorder on a battery of verbal and nonverbal neuropsychological measures. The aim was to examine whether ADD was associated with a qualitatively distinct pattern of deficits compared with RD. None of the measures differentiated the boys with ADD-only from the controls; the only deficit associated with ADD was slightly lower IQ. RD, on the other hand, was associated with deficits in memory and verbal skills.

Behavior therapy with children and adolescents: a twenty-year overview

A twenty-year overview of behavior therapy with children and adolescents is presented. The various techniques and their application to relevant major DSM-III-R categories are critically discussed. It is concluded that behavior therapy has made great progress and has proven applications in child and adolescent disorders but that its precise roles, comparative efficacy, and complementarity to other forms of psychotherapy and other treatments remain to be demonstrated. Much uncertainty stems from the relatively poor state of research in other forms of psychotherapy.

DSM-III-R: too much too soon?

Some of the more important changes carried out in the recently published revision of the DSM-III classification (DSM-III-R) are described, and an assessment is made on whether a revision of this nature was necessary and whether it achieved its aims. Since a large number of disorders have been modified in one way or another and since empirical evidence for many of the changes is lacking, the author concludes that DSM-III-R, rather than illuminating the field, is likely to cause confusion and frustration in the minds of clinicians, researchers and administrators, and that in fact DSM-III-R is a new classification, a DSM-IV in disguise.

Differences in attention control between 'clinic-observable' and 'reported' hyperactivity: a preliminary report

A series of attention tests were administered to two groups of hyperactive children and a control group of normal children. The first group of hyperactive children had both 'reported' hyperactivity (defined as having hyperactive behaviour reported at school and home) and 'clinic-observable' hyperactivity (defined as having hyperactive behaviour readily observable in a clinic interview). The second group had only 'reported' hyperactivity. The results of attention testing indicated that the children with both 'reported' and 'clinic-observable' hyperactivity had significant attentional difficulties in comparison with children with 'reported' hyperactivity as well as with the normal controls. On the other hand, the children with 'reported' hyperactivity had less evidence of attentional problems when compared to the normal children. Hence; the differentiation into 'reported' and 'clinic-observable' hyperactivity was of theoretical importance as clinic behaviour was a significant diagnostic marker in predicting performance in attention tests. The results of this study suggest the presence of different types of attention deficits in 'reported' and 'clinic-observable' hyperactivity respectively as well as heterogeneity in hyperactive children.

Visual and auditory attention performance in hyperactive children: competence or compliance

The effect of self-control and compliance on the attentional performance of hyperactive children was assessed. Visual and auditory attention tasks were presented in conditions in which the experimenter was either absent and therefore not imposing external control, or present and therefore imposing some degree of control. There was no difference in performance between hyperactives and controls when the experimenter was present, but the hyperactives' performance showed a greater deterioration than controls when the experimenter was absent. The amount of movement displayed during the tasks was greater for hyperactives and increased more for this group during experimenter-absent conditions. The results support the contention that noncompliance is a major contributor to the poor performance of hyperactive children, which can be seen as an "application" deficit rather than an "ability" deficit. These findings have relevance for the current debate on the association between hyperactivity and conduct disorder, and from an applied perspective they serve to stress the importance of situational contributors to the problem behaviors of hyperactive children.