Journal of Attention Disorders最新文献

Objective: Accumulating evidence indicates high rates of major depressive disorder (MDD) in children and adolescents with ADHD. This systematic review and meta-analysis aimed to examine the rate of depression in children and adolescents with ADHD who are without intellectual disability (ID).

Method: A comprehensive search of six databases identified 20,745 studies. After screening based on inclusion and exclusion criteria, 24 studies were retained. A meta-analysis estimated the pooled depression rate in this population, and subgroup analyses examined differences based on sex, pubertal status, ADHD medication use, recruitment settings, depression assessment tools, informants, and risk of bias rating. Depression rates in children and adolescents with ADHD were compared with neurotypical peers in the retained case-control studies.

Results: Depression rates in children and adolescents with ADHD across the included studies ranged from 1.7% to 60%, with the meta-analysis estimating a pooled depression rate of 11.31% (95% CI [0.07, 0.16]). Subgroup analyses indicated significant differences by sex, with females showing higher rates than males. Differences were also noted by assessment methods, with the highest rates observed when both questionnaires and interviews were used. While other factors did not significantly affect rates, notable trends were identified and reported in the current article.

Conclusion: Depression is a common co-occurrent psychiatric condition in children and adolescents with ADHD, with rates observed in this review and meta-analysis being higher than those reported for neurotypical children and adolescents. This review underscores the importance of combining multiple assessment methods to capture a comprehensive picture of depression in this population, as well as ensuring balanced demographic representation. This review also suggests that further research should explore the depression developmental patterns in children and adolescents with ADHD and identify whether patterns are similar to the neurotypical population.

Objective: This study aims to determine the prevalence of Attention Deficit Hyperactivity Disorder (ADHD), considering both parents' and teachers' reports and clinical diagnosis, and to examine the relationship between ADHD prevalence and measurement tools, sex, age, and clinical presentations.

Method: This two-phase epidemiological study was conducted on 689 preschoolers aged 3 to 6 years in Kocaeli, Turkey. In the first phase, the Conners Rating Scale-Revised Long Form and the ADHD Rating Scale-IV Preschool Version were administered to teachers after parents. In the second phase, diagnostic evaluation was performed using DSM-5 ADHD criteria for children scoring above the 93rd percentile on any scale, according to either parent or teacher reports.

Results: The prevalence of ADHD was estimated to range from 2% to 12.6%, depending on the measurement method. The prevalence of ADHD diagnosis was 3.3%, with a male-to-female ratio of 1.9:1. The hyperactive-impulsive presentation (1.62%) was more common than the combined presentation (1.32%) and the inattentive presentation (0.44%).

Conclusion: Our findings are consistent with the literature, emphasizing the importance of ADHD screening in preschool children for early diagnosis. Measurement tools used in ADHD screening and parent-teacher responses should be evaluated carefully.

Objective: There is substantial evidence supporting the distinction between cognitive disengagement syndrome (CDS) and attention-deficit/hyperactivity disorder (ADHD), particularly from the inattentive subtype. However, despite proposed etiological and phenomenological similarities, the relationship between CDS and dissociation remains underexplored. This study investigates the relationship between CDS and dissociation and evaluates their combined impact on functional impairment while accounting for comorbid internalizing and externalizing problems in adolescents with ADHD.

Method: A total of 103 adolescents with ADHD (aged 11-17, M = 14.15, SD = 1.71) and their parents participated in this multicenter, cross-sectional study. ADHD diagnosis was established using the Best Estimate Clinical Diagnosis method. Standardized assessments included the Adolescent Dissociative Experiences Scale (A-DES) and the Revised Child Anxiety and Depression Scale-Child Version (RCADS-CV) for self-report, while parents completed the modified version of Sluggish Cognitive Tempo Scale (SCT-S), Strengths and Difficulties Questionnaire-Parent Form (SDQ-P), and Weiss Functional Impairment Rating Scale-Parent Report (WFIRS-P).

Results: No significant correlations were observed between the parent-reported CDS Modified Total and the adolescent-reported A-DES Total score (r = -.024, p = .811), or any of its subdomains, after controlling for anxiety symptoms. Regression analyses revealed that CDS Modified Total (β = .0121, p = .032), and A-DES Absorption & Imaginative Involvement (β = .0085, p = .042) were independent predictors of parent-reported functional impairment along with SDQ-P Emotional Symptoms (β = .0399, p = .040), SDQ-P Conduct Problems (β = .0752, p < .001), RCADS-CV Separation Anxiety Disorder (β = .0245, p = .017). The dominance analysis indicated that the parent-reported SDQ Conduct Problems subscale had the highest average R² contribution (M = 0.1625) while the parent-reported CDS Modified Total demonstrated the lowest average R² contribution across models (M = 0.0498).

Conclusion: The findings suggest that CDS and dissociation represent distinct constructs, at least when rated by different informants, and that both may have significant and independent contributions to functional impairment in adolescents with ADHD. These results highlight the need to consider a broader range of contributing factors beyond symptom severity alone for the effective management of ADHD.

Objective: Reports estimate at least one child in every general education classroom in the U.S. has ADHD. Thus, teachers should enter the classroom with an accurate working knowledge of ADHD and the skills to respond effectively to support the development of these students. The present study tested the following research questions (RQs): (RQ1) How knowledgeable are preservice teachers about ADHD? (RQ2) What are pre-service teachers' naturalistic responses to students with ADHD? Are pre-service teachers' (RQ3) knowledge of ADHD, (RQ4) stress, and (RQ5) mindfulness skills associated with three types of responses to working with students with ADHD: evaluation of social/behavioral problems, emotional distress, and investment in treatment and classroom practices? (RQ6) Does mindfulness moderate the association between stress and teachers' responses to students with ADHD?

Method: Participants were 101 education majors in a teacher education program at a large Southeastern university in the United States. Multivariate regressions were employed to assess RQs 3-6.

Results: Pre-service teachers correctly answered 52% of items (SD = 0.15) measuring knowledge of ADHD. There were no significant associations between knowledge of ADHD, stress, and mindfulness skills and pre-service teachers' responses to students with ADHD, nor did mindfulness moderate the association between stress and outcomes. However, pre-service teachers with previous experience teaching students with ADHD perceived students' behavioral challenges as more serious than those without experience.

Conclusion: Results indicated that pre-service teachers lacked comprehensive knowledge of ADHD but responded to students with ADHD in a supportive manner. Notably, these findings indicate that teachers entering the workforce within the next two years are willing to implement supportive practices for students with ADHD. Implications for research and practice are discussed.

Objectives: There is a need to examine the utility of objective measures of attention-deficit/hyperactivity disorder (ADHD) symptoms in children. Objective measures of ADHD symptoms, such as physical activity, may provide a more nuanced assessment of behavior that can be used to augment traditional cross-informant ratings of ADHD symptoms by parents and teachers. The most widely used and researched technique for objectively capturing children's physical activity is accelerometry (i.e., the use of small devices that measure gravitational acceleration). The current study examined the unique and interactive effects of mean levels of physical activity (physical activity volume) and intra-individual variability in physical activity (physical activity variability), as measured by accelerometry, on teacher-reported ADHD symptoms (hyperactivity/impulsivity and inattention examined separately).

Method: One hundred seventy-six early elementary school students (M_age = 6.83, SD = 0.96, 53% male) from four midwestern schools and four northeastern schools were included. All were participants in a before-school intervention study involving physical activity or a sedentary classroom program. Data were collected using accelerometry during the intervention period and ADHD symptoms were reported by teachers following the intervention. Multiple regression models were used to examine the unique and interactive effects of physical activity volume and physical activity variability on ADHD symptoms.

Results: Results demonstrated that physical activity volume was positively associated with hyperactive/impulsive symptoms, whereas physical activity variability was negatively associated with hyperactive/impulsive and inattentive symptoms. Additionally, when both physical activity variables were in the same model, only physical activity variability uniquely predicted ADHD symptoms after accounting for physical activity volume. Specifically, higher physical activity variability was linked with lower hyperactive/impulsive and inattentive symptoms.

Conclusion: Objective measures of physical activity volume and physical activity variability may enhance our understanding of physical activity patterns as they relate to ADHD symptoms. Future research should continue to investigate the usability of objective measures of physical activity, and especially physical activity variability, as a screener to identify children at risk for ADHD.

Objective: Around 70% of adolescents with ADHD experience sleep and/or homework problems. Both impairments have been previously associated with neuropsychological deficits but have not been simultaneously examined in adolescents with ADHD and clinical sleep problems. Therefore, this study investigated how sleep problems are associated with homework problems and how parent-rated behavioral indicators of neuropsychological functioning are part of this association in adolescents with ADHD.

Method: Parental ratings of homework problems (HPC) and behavioral indicators of neuropsychological functioning (CAMEL) of adolescents with ADHD and comorbid sleep problems (ADHD/sleep; n = 53), adolescents with ADHD only (n = 24), and neurotypical adolescents (NT; n = 53) were collected. Homework problems and behavioral indicators of neuropsychological functioning were compared between the three groups. A path analysis was performed to investigate whether the behavioral indicators of neuropsychological functioning are part of the relation between sleep problems in ADHD and homework problems.

Results: We found no differences for either homework problems or behavioral indicators of neuropsychological functioning between the ADHD/sleep and ADHD only groups, except for a small significant difference in arousal regulation, but both ADHD groups showed more homework problems and behavioral indicators of weaker neuropsychological functioning compared to the NT group. Behavioral indicators of weaker neuropsychological functioning were related to the increased homework problems experienced in the ADHD/sleep and ADHD only groups compared to NT.

Conclusion: In adolescents with ADHD, sleep problems were not associated with more homework problems by weaker behavioral indicators of neuropsychological functioning. However, regardless of sleep problems, the behavioral indicators of neuropsychological functioning relate to the homework problems in adolescents with ADHD.

Objectives: Children with ADHD obtain lower scores than their peers on standardized language measures but less is known about their conversational language skills. We tested the ability of children with and without ADHD to monitor and repair their language during a conversation (social discourse) with a young adult.

Methods: Forty-nine 9- to 14-year-old children previously diagnosed with ADHD (17 in partial remission) and an age and sex-matched sample of typically developing (TD) children engaged in a conversation with a young adult. Their conversations were recorded, transcribed, and coded for structural and pragmatic language use. Language error and correction rates were compared across the two groups, for the whole sample and for those meeting full criteria for ADHD.

Results: The ADHD group made significantly more structural language errors, specifically morphosyntactic mistakes and word repetitions. In their pragmatic language use, children with ADHD were more likely to make unrelated utterances and were less successful in repairing dysfluent responses. The adult conversational partners made more attempts to keep TD participants engaged in conversation and rated them as more likable.

Conclusions: Subtle differences were identified in the structural and pragmatic language use of children with and without ADHD during social discourse. Conversation partners were more engaged in their interactions with TD children and appeared to experience these interactions more positively. The language skills of children with ADHD, including their conversation skills, should be monitored and considered as targets for intervention.

Objective: Although treatment research has relied upon group-based methods to understand treatment response, these methods often are unable to detect intraindividual changes in behavior. Single case designs using time series analyses, in contrast, may be ideal for examining intraindividual variability in treatment response over time. The current proof-of-concept study applies time series analysis to four youth with attention-deficit/hyperactivity disorder in a behavioral treatment program to characterize how their behavior changes over time.

Method: Objective behavioral data was collected on a moment-by-moment basis while the youth attended an intensive afterschool treatment program implemented throughout the academic year. Desirable and undesirable behaviors were summed for each day, and trends were fit to the data.

Results: The most parsimonious trend was linear for most children, for both undesirable and desirable behaviors; however, variability in behavioral response limited the ability of time series analysis to optimally characterize behavioral change. Further, a seasonal analysis revealed differences in response to intervention depending on the day of the week. Notably, decreases in both desirable and undesirable behavior were observed closer to the week's most salient reinforcer.

Conclusion: These findings provide a proof-of-concept for implementing time series analysis for clinical scientists intending to utilize moment-by-moment data collection.

Objective: Students with ADHD are often provided with an extended testing time accommodation due to various skill deficits. However, little empirical work has examined the ways in which students use their extra time, if at all, and how use relates to overall performance. Further understanding of how students use this accommodation in practice can help to inform accommodation decision-making procedures so that students with disabilities recieve the appropiate support to be able to demonstrate their underlying knowledge and skills on tests.

Method: The current study utilized the National Assessment of Educational Progress (NAEP) 2017 eighth-grade process data to examine the use and nonuse of extended time accommodations among students with ADHD as well as among comparison groups.

Results: Less than half of students with ADHD who were eligible for an extended time accommodation used it. Access to the accommodation, rather than actual use, corresponded to higher rates of test completion. Those students who spent more time on the final five items of the test performed better overall when compared to their peers.

Conclusion: Findings raise questions about the underlying needs of students with ADHD during testing and whether mere access to extended time sufficiently addresses those needs. Additional critical analysis of the provision and use of extended time for students with attention problems appears warranted. Implications for future research and practice are offered.

Background: Many children with attention-deficit/hyperactivity disorder (ADHD) demonstrate impairment in social skills. However, ADHD rarely occurs in isolation, with approximately one-third of children with ADHD having one additional disorder, and another third having two or three comorbidities. Few studies have considered the global and specific patterns of social skill performance based on comorbidity status.

Method: Using a large dataset containing 1400 carefully phenotyped children with ADHD (ages 7-12; 28% girls) in the United States and Canada, we characterized social skill deficit profiles associated with the presence of internalizing comorbidity (depression and/or anxiety), externalizing comorbidity (oppositional defiant or conduct disorder), and both internalizing + externalizing comorbidities. All children had parent and teacher ratings of social skills on a consistent measure, and we took a nuanced approach that considered both global social skills and specific subdomains of skills.

Results: Parent ratings indicated main and interaction effects of each comorbidity on lower social skill performance in a varied pattern. Both comorbidities were associated with poorer global social skills, responsibility, and self-control. In addition, internalizing was associated with poorer assertion, while externalizing was associated with poorer communication, cooperation, and empathy. Interaction effects suggested that the impact of externalizing overshadowed internalizing for poor responsibility and self-control; however, internalizing comorbidity attenuated the negative association between externalizing comorbidity and empathy. On teacher ratings, only externalizing comorbidity was associated with poorer global social skills, communication, cooperation, assertion, responsibility, empathy, and self-control. In addition, girls and younger children tended to have poorer global social skills (using a gender-normed standard score), while girls and older children showed better specific social skills (using a raw, not gender-normed score).

Conclusion: Children with ADHD and these comorbidities had poorer social skills relative to children with ADHD only, as perceived by parents and teachers. There also may be different social skill profiles depending on the comorbid condition and informant. These findings may inform more personalized social skill interventions for children with ADHD.