David L. Rabiner

Early Attention Problems and Children’s Reading Achievement: A Longitudinal Investigation

OBJECTIVES To determine whether attention problems predict the development of reading difficulties and examine whether screening for attention problems could be of practical value in identifying children at risk for reading underachievement. METHOD Three hundred eighty-seven children were monitored from kindergarten through fifth grade. Standardized assessments of attention problems and reading achievement were conducted at multiple time points. RESULTS Attention problems predicted reading achievement even after controlling for prior reading achievement, IQ, and other behavioral difficulties. Inattentive first graders with normal reading scores after kindergarten were at risk for poor reading outcomes. CONCLUSIONS Attention problems play an important role in the development of reading difficulties for some children, and screening for attention problems may help identify children at risk for reading difficulties.

Motives and Perceived Consequences of Nonmedical ADHD Medication Use by College Students Are Students Treating Themselves for Attention Problems

Objective: This study examines why college students without a prescription take ADHD medication, what they perceive the consequences of this to be, and whether attention problems are associated with this behavior. Method: More than 3,400 undergraduates attending one public and one private university in the southeastern United States completed a Web-based survey. Results: Nonmedical ADHD medication use in the prior 6 months was reported by 5.4% of respondents and was positively associated with self-reported attention difficulties. Enhancing the ability to study was the most frequent motive reported; nonacademic motives were less common. Students perceived nonmedical use to be beneficial despite frequent reports of adverse reactions. Conclusion: Students without prescriptions use ADHD medication primarily to enhance academic performance and may do so to ameliorate attention problems that they experience as undermining their academic success. The academic, social, and biomedical consequences of illicit ADHD medication use among college students should be researched further. (J. of Att. Dis. 2009; 13(3) 259-270)

The Misuse and Diversion of Prescribed ADHD Medications by College Students

Objective: This study assesses the misuse and diversion of prescribed attention-deficit/hyperactivity disorder (ADHD) medications. Method: One hundred fifteen students, attending two universities, with prescriptions for ADHD medications completed a Web survey in spring 2007. Results: Eighty-nine of 115 students (69%) used their ADHD medications as prescribed, whereas 36 (31%) had misused during college by taking larger or more frequent doses than prescribed or by using someone else’s medication. Nine students (8%) reported intranasal use during the previous 6 months, and 30 (26%) had diverted medications to peers. Misuse was associated with impulsivity and with other substance use. Enhancing the ability to study outside of class was students’ primary motive for misuse, but nonacademic reasons were also reported. Students who misused ADHD medications generally felt that doing so was helpful. Conclusions: Although most students use their ADHD medication as prescribed, misuse and diversion is not uncommon. Because enhancing academic performance was the primary motive for misuse, the results raise questions about whether undergraduates with ADHD perceive their treatment as adequate and the extent to which physicians and students communicate about issues related to medication adjustments. (J. of Att. Dis. 2009; 13(2) 144-153)

A Randomized Trial of Two Promising Computer-Based Interventions for Students with Attention Difficulties.

Few studies have examined whether attention can be improved with training, even though attention difficulties adversely affect academic achievement. The present study was a randomized-controlled trial evaluating the impact of Computerized Attention Training (CAT) and Computer Assisted Instruction (CAI) on attention and academic performance in 77 inattentive first graders. Students receiving either intervention were more likely than controls to show a moderate decline in teacher rated attention problems in first grade. Students receiving CAI also showed gains in reading fluency and in teacher ratings of academic performance. Intervention effects for attention were absent by second grade largely because attention problems declined in all groups. However, post hoc analyses indicated potential longer-term benefits for children with 6 or more inattentive symptoms at baseline. Persistent attention problems were associated with poorer academic performance in multiple domains. Results provide initial evidence that CAT and CAI can improve children’s attention in the classroom - and support additional studies to determine whether more clinically significant benefits are attainable.

Self-reported ADHD and adjustment in college: cross-sectional and longitudinal findings.

Objective: To examine the association between self-reported ADHD and college adjustment. Participants: Study 1 included nearly 3400 undergraduates attending a public and private university. Study 2 included 846 students who participated during freshman and sophomore year. Method: Students completed a web-based survey that assessed diagnostic status and adjustment in multiple domains. Results: Relative to other students, those with self-reported ADHD had lower GPAs and reported more academic concerns, depressive symptoms, social concerns, emotional instability, and substance use. Overall, however, most were making satisfactory adjustments in these domains. Benefits of medication treatment were not found. Freshman year ADHD predicted lower GPA, increased academic concerns and alcohol use, and smoking initiation. Conclusion: Students with ADHD struggled relative to peers but most were adjusting reasonably well across multiple domains. Future research should move beyond the use of self-reported diagnosis and more carefully examine the impact of medication treatment in this population. (J. of Att. Dis. 2009; 13(3) 297-309)

Studying the Epidemiology of Attention-Deficit Hyperactivity Disorder: Screening Method and Pilot Results

Objective: As part of a larger epidemiologic study of risk factors for attention-deficit hyperactivity disorder (ADHD), this pilot study combined parent and teacher information to estimate ADHD prevalence among elementary school children in a North Carolina county. The methods developed for this study and the pitfalls we encountered illustrate the challenges involved in conducting population-based studies of ADHD. Methods: We employed 2-stage screening using DSM-IV criteria. Teachers completed behaviour-rating scales for all children. We then administered a structured telephone interview to parents of potential cases. We screened 362 of 424 (85%) children in grades 1 to 5 in 4 schools. Results: According to parent reports, 43 children (12%) had previously been diagnosed with ADHD by a health professional. Thirty-four children (9%) were taking ADHD medication. Forty-six children (12.7%) met study case criteria for ADHD, based on combined teacher and parent reports. Of the 46 cases, 18 (39%) had not been previously identified. Eight previously diagnosed children, however, did not meet case criteria. After we adjusted for nonresponse, the estimated prevalence was 16% (95%CI, 12% to 20%). Conclusions: These data suggest that the DSM-IV prevalence of ADHD has been substantially underestimated, although the true prevalence in this population may be less than the 16% estimated here. Population-based studies of ADHD are feasible and may provide important information about practice and treatment patterns in community settings, as well as a broader understanding of the etiology and life course of this common disorder.

The Impact of Tutoring on Early Reading Achievement for Children With and Without Attention Problems

This study examined whether the benefits of reading tutoring in first grade were moderated by childrens level of attention problems. Participants were 581 children from the intervention and control samples of Fast Track, a longitudinal multisite investigation of the development and prevention of conduct problems. Standardized reading achievement measures were administered after kindergarten and 1st grade, and teacher ratings of attention problems were obtained during 1st grade. During 1st grade, intervention participants received three 30-min tutoring sessions per week to promote the development of initial reading skills. Results replicated prior findings that attention problems predict reduced 1st grade reading achievement, even after controlling for IQ and earlier reading ability. Intervention was associated with modest reading achievement benefits for inattentive children without early reading difficulties, and substantial benefits for children with early reading difficulties who were not inattentive. It had no discernible impact, however, for children who were both inattentive and poor early readers. Results underscore the need to develop effective academic interventions for inattentive children, particularly for those with co-occurring reading difficulties.

The Ecological Effects of Universal and Selective Violence Prevention Programs for Middle School Students: A Randomized Trial.

This study reports the findings of a multisite randomized trial evaluating the separate and combined effects of 2 school-based approaches to reduce violence among early adolescents. A total of 37 schools at 4 sites were randomized to 4 conditions: (1) a universal intervention that involved implementing a student curriculum and teacher training with 6th-grade students and teachers, (2) a selective intervention in which a family intervention was implemented with a subset of 6th-grade students exhibiting high levels of aggression and social influence, (3) a combined intervention condition, and (4) a no-intervention control condition. Analyses of multiple waves of data from 2 cohorts of students at each school (N = 5,581) within the grade targeted by the interventions revealed a complex pattern. There was some evidence to suggest that the universal intervention was associated with increases in aggression and reductions in victimization; however, these effects were moderated by preintervention risk. In contrast, the selective intervention was associated with decreases in aggression but no changes in victimization. These findings have important implications for efforts to develop effective violence prevention programs.

The multisite violence prevention project: impact of a universal school-based violence prevention program on social-cognitive outcomes.

This study evaluated the impact of a universal school-based violence prevention program on social-cognitive factors associated with aggression and nonviolent behavior in early adolescence. The effects of the universal intervention were evaluated within the context of a design in which two cohorts of students at 37 schools from four sites (N = 5,581) were randomized to four conditions: (a) a universal intervention that involved implementing a student curriculum and teacher training with sixth grade students and teachers; (b) a selective intervention in which a family intervention was implemented with a subset of sixth grade students exhibiting high levels of aggression and social influence; (c) a combined intervention condition; and (d) a no-intervention control condition. Short-term and long-term (i.e., 2-year post-intervention) universal intervention effects on social-cognitive factors targeted by the intervention varied as a function of students’ pre-intervention level of risk. High-risk students benefited from the intervention in terms of decreases in beliefs and attitudes supporting aggression, and increases in self-efficacy, beliefs and attitudes supporting nonviolent behavior. Effects on low-risk students were in the opposite direction. The differential pattern of intervention effects for low- and high-risk students may account for the absence of main effects in many previous evaluations of universal interventions for middle school youth. These findings have important research and policy implications for efforts to develop effective violence prevention programs.This study evaluated the impact of a universal school-based violence prevention program on social-cognitive factors associated with aggression and nonviolent behavior in early adolescence. The effects of the universal intervention were evaluated within the context of a design in which two cohorts of students at 37 schools from four sites (N = 5,581) were randomized to four conditions: (a) a universal intervention that involved implementing a student curriculum and teacher training with sixth grade students and teachers; (b) a selective intervention in which a family intervention was implemented with a subset of sixth grade students exhibiting high levels of aggression and social influence; (c) a combined intervention condition; and (d) a no-intervention control condition. Short-term and long-term (i.e., 2-year post-intervention) universal intervention effects on social-cognitive factors targeted by the intervention varied as a function of students’ pre-intervention level of risk. High-risk students benefited from the intervention in terms of decreases in beliefs and attitudes supporting aggression, and increases in self-efficacy, beliefs and attitudes supporting nonviolent behavior. Effects on low-risk students were in the opposite direction. The differential pattern of intervention effects for low- and high-risk students may account for the absence of main effects in many previous evaluations of universal interventions for middle school youth. These findings have important research and policy implications for efforts to develop effective violence prevention programs.

Predictors of Nonmedical ADHD Medication Use by College Students.

Objective: To identify the predictors of nonmedical ADHD medication use by college students. Participants: A total of 843 undergraduates attending one public or one private university in southeastern United States. Method: Students completed a Web-based survey inquiring about ADHD medication use during the first semester freshman of their year and a second time during the second semester of their sophomore year. Results: A total of 45 participants (5.3%) reported the onset of nonmedical ADHD use between the two survey administrations. The majority of these students were high substance users as freshman. Attention difficulties also predicted the onset of nonmedical use, especially in the absence of excessive substance use. Compared with other nonmedical users of ADHD medication, those reporting attention difficulties had lower GPAs, greater academic concerns, and higher levels of depressive symptoms. Conclusion: Attention difficulties contribute to the onset of nonmedical ADHD medication use in a significant minority of nonmedical users. These students may begin using ADHD medication to address attention problems they experience as undermining their academic success. (J. of Att. Dis. 2010; 13(6) 640-648)