Carol K. Whalen

The ADHD Spectrum and Everyday Life: Experience Sampling of Adolescent Moods, Activities, Smoking, and Drinking

Using an experience sampling methodology, the everyday lives of 153 adolescents with low, middle, or high levels of attention-deficit/hyperactivity disorder (ADHD) characteristics as assessed by either parent or teen were examined. Twice each hour, across two 4-day recording intervals, participants in a longitudinal study of stress and health risks logged their behaviors, moods, and social contexts. Those with high, in contrast to low, ADHD symptom levels recorded more negative and fewer positive moods, lower alertness, more entertaining activities relative to achievement-oriented pursuits, more time with friends and less time with family, and more tobacco and alcohol use. Fewer associations emerged with parent-defined than with teen-defined subgroups, although the differences in alertness, peer and family contexts, entertainment versus achievement activities, and substance use were consistent across sources. Even at subclinical levels, ADHD characteristics were associated with behavioral patterns and contexts that may promote peer deviancy training, unhealthy lifestyle behaviors, and vulnerability to nicotine dependence.

Causal Attributions of Hyperactive Children and Motivational Assumptions of Two Behavior-Change Approaches: Evidence for an Interactionist Position.

BUGENTAL, DAPHNE BLUNT; WHALEN, CAROL K.; and HENKER, BARBARA. Causal Attributions of Hyperactive Children and Motivational Assumptions of Two Behavior-Change Approaches: Evidence for an Interactionist Position. CHILD DEVELOPMENT, 1977, 48, 874-884. Childrens causal-attribution systems were predicted to act as mediators of the differential effectiveness of 2 behavior-change programs. Hyperactive boys were tutored individually for 2 months in a classroom setting; half were instructed in self-controlling speech, and half were given contingent social reinforcement. Within each treatment group, half of the children were taking methylphenidate (Ritalin), and half were unmedicated. 2 dependent measures were used: (a) qualitative-error scores on the Porteus Mazes and (b) the Conners Abbreviated Teacher Rating Scale. Measures were obtained for each childs attributions of personal causation for academic success and failure. Significant interactions were found between interventions and (a) child attributions and (b) medication status. The self-control intervention produced significantly greater error reduction on the mazes for (a) children with high perceived personal causality and (b) nonmedicated children. The social-reinforcement intervention produced trends toward greater error reduction for (a) children with low perceived personal causality and (b) medicated children. No significant differences were found on teacher ratings. The efficacy of perfecting the match between the childs attributional system and the attributional assumptions implicit in an intervention approach is discussed.

Anxiety, Affect, and Activity in Teenagers: Monitoring Daily Life With Electronic Diaries

OBJECTIVE The everyday experiences of a community sample of adolescents differing in anxiety level were compared by means of electronic diaries. METHOD One hundred fifty-five ninth-grade adolescents completed electronic diaries every 30 minutes for two 4-day intervals, reporting their moods, activities, social settings, dietary intake, smoking, and alcohol use. Teenagers were stratified into low-, middle-, or high-anxiety groups on the basis of diary ratings and, separately, questionnaire scores. RESULTS High-anxiety teenagers, compared with low-anxiety teenagers, expressed higher levels not only of anxiety and stress but also of anger, sadness, and fatigue, along with lower levels of happiness and well-being. They reported fewer conversations and less recreational activity relative to achievement-oriented pursuits, stronger eating and smoking urges, and more tobacco use. There were few gender differences. Despite a tendency to spend less time with peers, high-anxiety teenagers were more likely to show reduced anxiety when in the company of friends. Sharper differentiations among anxiety subgroups emerged when stratification was based on diary reports rather than on questionnaire scores. CONCLUSION Even when anxiety problems fall below diagnostic thresholds, the daily lives of anxious adolescents differ meaningfully from those of their peers in affective, behavioral, and contextual domains.

Social Impact of Stimulant Treatment for Hyperactive Children

Most children diagnosed with ADHD have extensive and enduring problems in the social arena. Despite its limitations, the standard stimulant treatment regimen for children with ADHD is a useful therapeutic modality as well as an heuristic tool for increasing our understanding of both optimal and problematic interpersonal functioning. This article explores the social impact of stimulant treatment, delineating documented improvements, identifying elusive domains and puzzling patterns, and highlighting unintended and potentially undesirable outcomes. Medication-related changes in the behaviors and perceptions of the diagnosed childs adult caretakers are distinguished from those observed in peers, and the need to enhance our understanding of peer cultures is underscored. We present new findings on the effects of stimulant treatment on social cognition and affect, and then discuss the critical need to map the attributional sequelae of any treatment approach. The final sections explore contemporary controversies and improved strategies for balancing the costs, risks, and benefits of stimulant treatment in the service of enhancing interpersonal competence, satisfaction, and harmony.

The Reinforcing Effects of Nicotine and Stimulant Medication in the Everyday Lives of Adult Smokers with ADHD: A Preliminary Examination

Whereas the smoking prevalence rates in the general population are declining, rates among people diagnosed with attention-deficit/hyperactivity disorder (ADHD) continue to be elevated. Previous research has shown that nicotine may improve attention and mood, suggesting that nicotine may help ameliorate the attentional and emotional problems associated with ADHD. The present study examined the effects of nicotine with and without stimulant medication on ADHD symptoms, moods, and arousal in the everyday lives of smokers with ADHD. A total of 10 smokers with ADHD who were being treated with stimulant medication were asked to abstain from smoking while participating in the study. Participants underwent four conditions in randomized order: (a) Nicotine patch+stimulant medication, (b) nicotine patch only, (c) placebo patch+stimulant medication, and (d) placebo patch only. Each condition continued for 2 days, during which self-reports of ADHD symptoms and moods were obtained using electronic diaries. Lightweight ambulatory monitors recorded cardiovascular activity at each diary entry. Smoking abstinence was verified by expired carbon monoxide and salivary cotinine analysis. Results showed that nicotine patches and stimulant medication alone and in combination reduced difficulty concentrating and core ADHD symptoms compared with placebo patch only. Borderline improvement in impatience and self-control was seen with nicotine patch administration primarily on day 1. Nicotine patches also tended to elevate systolic and diastolic blood pressure compared with placebo patch during day 2. The findings suggest that smokers with ADHD experience nicotine-related reductions in ADHD symptoms during their everyday lives.

Optimism in children's judgments of health and environmental risks

Although optimistic bias has been well documented for adults, little is known about how children view their own risks vis-à-vis those of their peers. Two studies of 6th graders examined optimism and the degree of differentiation in perceived risks across diverse health, lifestyle, and environmental problems. The findings revealed perceptions of relative invulnerability and highly differentiated risk assessments. The strongest levels of optimism emerged for controllable and stigmatizing events such as illicit drugs, smoking, and AIDS. The effects of gender, assessment context, and methodological variations were minimal. Discussion focused on the implications for health-promoting interventions with school-age children, the need for developmental information about risk perception processes, and the difficulty of distinguishing realistic from biased optimism.

Tobacco use across the formative years: A road map to developmental vulnerabilities

Different vulnerabilities are launched or play a more active role at different developmental stages and different ages. Furthermore, the interplay between developmental and biological, psychosocial, and environmental vulnerabilities is expected to differ across stages of smoking. This article focuses on the intersection of vulnerability associated with adolescence with tobacco-use vulnerability resulting from biological, psychological, and environmental characteristics of an adolescent. Recommendations include the following: (a) Effectively treat childhood and adolescent behavioral and emotional disorders that place adolescents at risk; (b) target programs toward specific high-risk subgroups; (c) incorporate training in self-control, affect regulation, and healthy coping strategies into educational programs and extracurricular activities; (d) encourage youth to develop healthy sources of success and satisfaction; (e) encourage communities and states to launch environmental, policy, and regulatory initiatives to protect youth from tobacco; (f) consider bold initiatives that will require fundamental changes in public attitudes, including monetary rewards for nonsmoking, heightened penalties for facilitating and engaging in underage smoking, and government subsidies for substitute pharmacological agents.

Parent-adolescent dialogues about AIDS

Little is known about the socialization of compassion, intimacy, sexuality, and risk management within family contexts. In this study, the authors observed parents and young adolescents (N = 140 dyads) in Grades 6-8 during structured communication tasks focused on AIDS. Communication styles were compared across gender pairings, and their relations with AIDS-related knowledge, worry, and stigmatizing attitudes were examined. Parents were more mutual with daughters and more directive toward sons. Girls were more mutual and expressive than boys, whereas boys were more withdrawn. Father-son dyads were particularly distinctive. Student stigmatizing attitudes were associated with low levels of both positive engagement in students and support from parents during the interaction. Discussion focused on family relations during early adolescence and implications for family involvement in AIDS prevention efforts.

Effects of Transdermal Nicotine on Symptoms, Moods, and Cardiovascular Activity in the Everyday Lives of Smokers and Nonsmokers With Attention-Deficit/Hyperactivity Disorder

The aim of the study was to test the self-medication hypothesis by examining the effects of nicotine in the everyday lives of smokers and nonsmokers with attention-deficit/hyperactivity disorder (ADHD). Fifty-two adults with ADHD (25 abstinent smokers and 27 nonsmokers) participated in a double-blind placebo controlled study with one nicotine patch condition and one placebo patch condition in counterbalanced order. Each condition continued for two consecutive days in which patches were administered each morning. The effects of nicotine on ADHD symptoms, moods, and side effects were assessed with electronic diaries. Cardiovascular activity was recorded with ambulatory blood pressure monitors and physical activity was monitored with actigraphs. Nicotine reduced reports of ADHD symptoms by 8% and negative moods by 9%, independent of smoking status. In addition, nicotine increased cardiovascular activity during the first 3 to 6 hours after nicotine patch administration. The results support the self-medication hypothesis for nicotine in adults with ADHD and suggest that smoking cessation and prevention efforts for individuals with ADHD will need to address both the symptom reducing and mood enhancing effects of nicotine.

Messages of medication: Effects of actual versus informed medication status on hyperactive boys' expectancies and self-evaluations.

After 15 boys with attention-deficit hyperactivity disorder (ADHD) were informed that they had taken either medication or placebo, they completed computer tasks, self-assessments, and causal judgments. The boys predicted better performance when told they were on medication versus placebo. For self-evaluations, medication status and information interacted, with boys actually taking placebo rating themselves more positively when told they had taken medication versus placebo. These effects were more apparent following failure than success. Both ADHD and comparison boys overestimated future classroom performance, with the former more unrealistic. Discussion focused on difficulties in assessing childrens causal reasoning and the need to monitor emanative effects of pharmacotherapy on self-cognitions.