Aaron J. Vaughn

Pilot Physical Activity Intervention Reduces Severity of ADHD Symptoms in Young Children

Objective: Physical activity associates with mental health and neurocognitive function, showing potential for addressing ADHD symptoms. As a preliminary assessment of this potential, the authors piloted a before-school physical activity intervention for young children. Method: Seventeen children (Grades K-3) exhibiting four or more hyperactivity/impulsivity symptoms on the Disruptive Behavior Disorders Rating Scale (Pelham, 2002) completed about 26 min of continuous moderate-to-vigorous physical activity daily over eight school weeks. The authors administered cognitive, motor, social, and behavioral functioning measures at pre- and postprogram, assessed response inhibition weekly, and coded negative behaviors daily. Results: Several measures showed significant or marginally significant change over time (effect size = 0.35-0.96) with additional measures showing meaningful effect size values (≥ 0.20). Response inhibition effects were most consistent. Most participants (64% to 71%) exhibited overall improvement according to postprogram parent, teacher, and program staff ratings. Conclusion: Physical activity shows promise for addressing ADHD symptoms in young children.

Evaluation of a school-based treatment program for young adolescents with ADHD.

OBJECTIVE This study compared 2 school-based training interventions for adolescents with attention deficit-hyperactivity disorder (ADHD): the Challenging Horizons Program-after school version (CHP-AS) and Challenging Horizons Program-mentoring version (CHP-M) with each other and with a community care (CC) condition. METHOD Participants were 326 students (sixth through eighth grade) diagnosed with ADHD. Interventions were conducted for 1 academic year. CHP-AS occurred twice weekly and included organization, social functioning, and academic study skills interventions. In CHP-M, students were paired with a mentor (e.g., teacher) who was trained by a consultant and delivered a subset of the CHP-AS interventions during school. No direct intervention was provided in CC. Participants were assessed at pretreatment, 4 occasions during the intervention year, posttreatment, and at a 6-month follow-up. RESULTS Intent-to-treatment analyses using hierarchical linear modeling to compare outcomes between the 3 conditions indicate participation in the CHP-AS intervention is associated with moderate effect size improvements in parent-rated organization and time-management skills, homework problems, and ADHD symptoms of inattention, and with small improvements in overall academic functioning and grade point average (GPA). These improvements were in comparison to CC and to CHP-M. Gains were sustained into the next school year and even increased in magnitude for several of the measures. CONCLUSIONS The CHP-AS program leads to significant benefits for adolescents with ADHD compared with the services provided in the CHP-M and CC. The persistence of improvements over time supports the use of training interventions that teach skills for adolescents.

Relation Between Outcomes on a Continuous Performance Test and ADHD Symptoms Over Time

This study examined the relationship between the developmental trajectories of neuropsychological functioning and ADHD symptomatology in a longitudinal sample of children ages 9 to 14. Participants and measures were derived from the Multimodal Treatment Study for ADHD including 534MTA participants and 254 normal controls. Despite improvement over time, MTA participants continued to receive higher ratings of ADHD symptomatology and exhibit greater difficulties across the majority of neuropsychological outcomes. No relations were found between improvements in neuropsychological functioning and ADHD symptomatology over time. Findings provide support for the persistence of neuropsychological functioning and ADHD symptomatology. Findings did not support the hypothesized relation between improvements in frontally-mediated neuropsychological functioning and ADHD symptomatology possibly due to the brief 1-year lag and limited assessment battery. Findings are discussed in relation to neuropsychological development including recommendations for future research.

Clinical Utility of the Vanderbilt ADHD Diagnostic Parent Rating Scale Comorbidity Screening Scales

Objective: To evaluate the clinical utility of the cutoff recommendations for the Vanderbilt ADHD Diagnostic Parent Rating Scale (VADPRS) comorbidity screening scales provided by the American Academy of Pediatrics/National Initiative for Childrens Healthcare Quality and to examine alternative cutoff strategies for identifying and ruling out disorders commonly comorbid with attention-deficit/hyperactivity disorder. Methods: A sample of 215 children (142 with attention-deficit/hyperactivity disorder), ages 7 to 11 years, participated in the study. Parents completed the VADPRS and were administered a diagnostic interview to establish diagnoses of oppositional defiant disorder (ODD), conduct disorder (CD), anxiety, and depression. The clinical utility of the VADPRS comorbidity screening scales were examined. Results: The recommended American Academy of Pediatrics/National Initiative for Childrens Healthcare Quality cutoff strategies did not have adequate clinical utility for identifying or ruling out comorbidities, with the exception of the VADPRS ODD cutoff strategy, which reached adequate levels for ruling out a diagnosis of ODD. An alternative cutoff approach using total sum scores was superior to the recommended cutoff strategies across all diagnoses in terms of ruling out a diagnosis, and this was particularly evident for anxiety/depression. Several individual items on the ODD and CD scales also had acceptable clinical utility for ruling in diagnoses. Conclusions: The VADPRS comorbidity screening scales may be helpful in determining which children likely do not meet diagnostic criteria for ODD, CD, anxiety, or depression. This study suggests that using a total sum score provides the greatest clinical utility for each of these comorbidities and demonstrates the need for further research examining the use of dimensional assessment strategies in diagnostic decision making.

Motor timing deficits in children with Attention-Deficit/Hyperactivity disorder.

Children with Attention-Deficit/Hyperactivity Disorder (ADHD) are thought to have fundamental deficits in the allocation of attention for information processing. Furthermore, it is believed that these children possess a fundamental difficulty in motoric timing, an assertion that has been explored recently in adults and children. In the present study we extend this recent work by fully exploring the classic Wing and Kristofferson (1973) analysis of timing with typically developing children (n=24) and children with ADHD (n=27). We provide clear evidence that not only do children with ADHD have an overall timing deficit, they also time less consistently when using a similar strategy to typically developing children. The use of the Wing and Kristofferson approach to timing, we argue, will result in the discovery of robust ADHD-related timing differences across a variety of situations.

Perceived Social Acceptance and Peer Status Differentially Predict Adjustment in Youth With and Without ADHD

Objective: This study extends previous research and examined if the longitudinal relation between self-perceived social acceptance and changes in adjustment was moderated by peer status and ADHD diagnosis. Method: A sample of children with ADHD and a normative comparison group (age 8-13 years) were assessed at baseline and one-year follow-up. Self-perceived social acceptance, peer status, and three areas of adjustment (depression symptoms, aggression/conduct problems, and social skills) were measured. Results: Moderation was found when predicting depression symptoms and aggression/conduct problems. Specifically, in children with ADHD only, higher perceived social acceptance protected against increases in depression symptoms for those with lower peer preference, but predicted greater aggression/conduct problems for those with higher peer preference. There was not evidence of significant moderation for predicting social skills; instead non-ADHD status, greater peer preference, and greater self-perceived social acceptance were each predictive of greater social skills. Conclusion: Results highlight the complex association between positive social self-perceptions and adjustment for children with ADHD and caution against a universal assumption that high self-perceptions are adaptive.

Does Sluggish Cognitive Tempo Fit Within a Bi-Factor Model of ADHD?

Objective: Studies demonstrate sluggish cognitive tempo (SCT) symptoms to be distinct from inattentive and hyperactive-impulsive dimensions of ADHD. No study has examined SCT within a bi-factor model of ADHD, whereby SCT may form a specific factor distinct from inattention and hyperactivity/impulsivity while still fitting within a general ADHD factor, which was the purpose of the current study. Method: A total of 168 children were recruited from an ADHD clinic. Most (92%) met diagnostic criteria for ADHD. Parents and teachers completed measures of ADHD and SCT. Results: Although SCT symptoms were strongly associated with inattention, they loaded onto a factor independent of ADHD g. Results were consistent across parent and teacher ratings. Conclusion: SCT is structurally distinct from inattention as well as from the general ADHD latent symptom structure. Findings support a growing body of research suggesting SCT to be distinct and separate from ADHD.

Predictors of Response and Mechanisms of Change in an Organizational Skills Intervention for Students with ADHD.

The purpose of the study was to evaluate predictors of response and mechanisms of change for the Homework, Organization, and Planning Skills (HOPS) intervention for middle school students with Attention-Deficit/Hyperactivity Disorder (ADHD). Twenty-three middle school students with ADHD (grades 6–8) received the HOPS intervention implemented by school mental health providers and made significant improvements in parent-rated materials organization and planning skills, impairment due to organizational skills problems, and homework problems. Predictors of response examined included demographic and child characteristics, such as gender, ethnicity, intelligence, ADHD and ODD symptom severity, and ADHD medication use. Mechanisms of change examined included the therapeutic alliance and adoption of the organization and planning skills taught during the HOPS intervention. Participant implementation of the HOPS binder materials organization system and the therapeutic alliance as rated by the student significantly predicted post-intervention outcomes after controlling for pre-intervention severity. Adoption of the binder materials organization system predicted parent-rated improvements in organization, planning, and homework problems above and beyond the impact of the therapeutic alliance. These findings demonstrate the importance of teaching students with ADHD to use a structured binder organization system for organizing and filing homework and classwork materials and for transferring work to and from school.

Clinical Utility of the Vanderbilt ADHD Rating Scale for Ruling Out Comorbid Learning Disorders

OBJECTIVE: The goal was to examine the clinical utility of using the Vanderbilt Attention-Deficit/Hyperactivity Disorder (ADHD) Rating Scale (VARS) to determine when to refer children with ADHD for learningdisorder (LD) evaluations. METHODS: A total of 128 stimulant-naive children with ADHD, 7 to 11 years of age, were included in the study. The parents and teachers of 128 children with diagnosed ADHD completed the VARS. The reading, numerical operations, and spelling subtests from the Wechsler Individual Achievement Test, Second Edition, were used to identify children with a comorbid LD. We examined the predictive validity and clinical utility of the VARS performance items for ruling in/out the presence of a comorbid LD. RESULTS: Thirty-eight percent of the samples met the criteria for a comorbid LD. A cutoff score of 7.5 for the sum of the VARS parent and teacher reading items had excellent clinical utility for ruling out both reading and spelling LDs. Cutoff scores of 4 for the VARS teacher reading and writing items had excellent utility for ruling out comorbid reading and spelling LDs, respectively. None of the VARS performance items effectively identified or ruled out math LDs. CONCLUSION: The VARS performance items should be used with an interview about school functioning and a review of school records to rule out the presence of a comorbid reading or spelling LD for children with diagnosed ADHD.

Effects of an 8-Session Behavioral Parent Training Group for Parents of Children With ADHD on Child Impairment and Parenting Confidence

Objective: This study examined the feasibility and effectiveness of a behavioral parent training (BPT) group intervention implemented in an outpatient mental health setting in reducing child impairments and increasing parenting confidence in managing child behavior. Method: Parents of 241 children with ADHD participated in the eight-session parent group program, completing the Impairment Rating Scale (IRS) and a measure of parenting confidence at the first and last session. Results: Parents reported improvements in child behavior across all domains of the IRS, with the largest improvements in terms of overall impairment, parent–child relationship, and impact of child behavior on the family. Parents also reported increased confidence in managing their child’s behavior. Conclusion: These findings suggest that brief BPT group programs administered to a diverse range of attendees in a typical outpatient setting result in improvements in functional impairments comparable with those produced in controlled studies, as well as improved parenting confidence.