Elizabeth A. Schaughency

Dimensions and types of attention deficit disorder

Abstract DSM-III-R provides a unidimensional definition of attention deficit-hyperactivity disorder (ADHD), based on the assumption that inattention, impulsivity, and motor hyperactivity are unitary aspects of the same dimension. The definition of undifferentiated attention deficit disorder (UADD), however, contradicts this assumption by treating inattention as a separate dimension. The present study evaluated these assumptions empirically. A cluster analysis of three factors derived from factor analyses of teacher ratings of ADD symptoms and a broader list of ADD symptoms produced three distinct clusters: patients without ADD, those with both inattention and hyperactivity, and a group that exhibited inattention and sluggish tempo but not hyperactivity. The association was very strong between the empirically derived clusters and clinical DSM-III diagnoses of ADD with and without hyperactivity. These findings do not support the DSM-III-R unidimensional definition of ADHD.

Attention deficit disorder with and without hyperactivity: comparison of behavioral characteristics of clinic-referred children.

Using a reliable assessment procedure, 41 clinic outpatients, 6–13 years of age, were given a diagnosis of Attention Deficit Disorder with Hyperactivity (ADD/H), and 22 outpatients were diagnosed as having Attention Deficit Disorder without Hyperactivity (ADD/WO). Comparisons of measures involved in the diagnostic process showed that the ADD/H children were rated by teachers as being more impulsive. More importantly, comparisons of measures not used in the diagnoses showed that children with ADD/H were more likely to display a severe pattern of aggressive conduct disorder in spite of being younger at the time of assessment. In contrast, the ADD/WO group displayed a more sluggish cognitive tempo, was more likely to receive a codiagnosis of an anxiety or affective disorder, and tended to be rated as more anxious. The results were found not to be explainable by differences in age, intelligence, or socioeconomic status. These findings demonstrate that ADD/WO can be reliably diagnosed in a clinic sample and suggest that ADD/H and ADD/WO differ in important ways.

Are Attention Deficit Disorders with and without Hyperactivity Similar or Dissimilar Disorders

From a population of 625 children in grades 2–5, 10 children were identified as those with attention deficit disorder with hyperactivity (ADD/H) and 20 children were identified as those with attention deficit disorder without hyperactivity (ADD/WO). When compared with matched normal control children on a battery of teacher ratings, peer ratings, and self-report measures, markedly different patterns of characteristics were found for the two ADD groups. ADD/H children exhibited aggressive conduct disorders, bizarre behavior, were guiltless, very unpopular, and performed poorly in school. In contrast, ADD/WO children were found to be anxious, shy, socially withdrawn, moderately unpopular, and poor in sports and school performance. Both groups exhibited depression and poor self-concepts, but differed in the specific areas of low self-esteem. These different patterns suggest that ADD/ H and ADD/WO are dissimilar syndromes and perhaps should not be considered to be subtypes of the same disorder.

Teacher Ratings of Attention Problems in Children Experimentally Classified as Exhibiting Attention Deficit Disorder with and without Hyperactivity

From a total of 625 children, 30 children in grades 2–5 were experimentally classified as having Attention Deficit Disorder with Hyperactivity (ADD/H: N = 10) or Attention Deficit without Hyperactivity (ADD/WO: N = 20) using teacher ratings of behavior on the Revised Behavior Problem Checklist (RBPC). These groups were compared to normal control children ( N = 20) on each of the items that comprise the Attention Problem-Immaturity (API) factor of the RBPC. Both ADD groups were rated by teachers as exhibiting significantly greater attention problems than controls on 12 of the 16 items on the factor. However, the ADD/H children were rated as more irresponsible, sloppy, distractible, impulsive, less sluggish, more likely to answer without thinking, and faster in finishing assignments than the ADD/WO children. In addition, only the ADD/H group differed significantly from controls on ratings of impulsivity and anwering without thinking, and only the ADD/WO group differed from controls on ratings of sluggishness and drowsiness. A stepwise discriminant analysis showed that the two ADD groups could be accurately discriminated (average canonical r 2 = 0.83) by a combination of ratings of impulsivity, sluggishness, immaturity, sloppiness, slowness, and need for supervision. These results suggest that ADD/H and ADD/WO may exhibit dissimilar types of attention deficits. Journal of the American Academy of Child Psychiatry , 24, 5:613–616, 1985.

Effects of background anger, provocation, and methylphenidate on emotional arousal and aggressive responding in attention-deficit hyperactivity disordered boys with and without concurrent aggressiveness.

We investigated the effects of background anger, provocation, and methylphenidate on emotional, physiological, and behavioral responding in children with attentiondeficit hyperactivity disorder (ADHD) with and without concurrent aggression. Our study revealed that ADHD boys showed more emotional and physiological distress when exposed to an interaction in which an administrator chastised each boys favorite counselor, compared to a friendly interaction between the two adults. The background anger manipulation did not affect the aggressive behavior of the boys against an opponent in an aggressive game. High-aggressive (HA) ADHD boys were more likely to respond to provocation with aggression than low-aggressive (LA) ADHD boys, but only LA boys showed increased physiological reactivity with increasing provocation. Methylphenidate resulted in increased heart rates under all conditions and did not interact with any of the other findings.

Self-reported inattention, impulsivity, and hyperactivity at ages 15 and 18 years in the general population.

OBJECTIVE Prevalence, impact, and continuity of self-reported attention deficit disorder (ADD) symptomology from ages 15 to 18 years were examined in a longitudinal study of a New Zealand birth cohort. METHOD At age 15, prevalence of ADD symptomology was estimated, with no gender differences found in self-reported symptomology. Four adolescents (0.5%) met full DSM-III criteria for ADD. Adolescents scoring higher than 1.5 SD above the sample mean on total ADD symptom score were identified as having high levels of ADD symptomology. RESULTS Male and female adolescents reporting ADD symptomology with (6% of males; 4% of females) and without history of behavior disorder (6% of males; 7% of females) did not differ in inattention and impulsivity, received more diagnoses other than ADD, and experienced more adverse educational and social outcomes at 15 and 18 years than did the nonADD group. CONCLUSIONS Findings pertaining to the ADD with history group were consistent with previous research on the outcome of hyperactive children, whereas the ADD without history group may be reflecting the onset of other pathology in adolescence. Results suggest adolescent self-report of attentional difficulties may be a clinically significant marker of adjustment difficulties for both males and females, but additional information likely is needed for accurate diagnosis.

Lateralized control of eye movements in attention deficit hyperactivity disorder

How does a complex syndrome that involves abnormalities in impulse control and sustained attention influence simple oculomotor responses to visual stimuli? We found that normal children, like adults, were faster in moving their eyes in directions controlled by the right cerebral hemisphere under conditions where there was no warning of the impending target. ADHD children did not show this asymmetry. We speculate that this result reflects a deficit in the vigilance network that serves to maintain the alert state.

Attentional control systems and the Attention Deficit Disorders (ADD)

Abstract This article focuses on neuropsychological hypotheses regarding self-regulation, with a special emphasis on those which would provide for the behaviorally differentiated subtypes of Attention Deficit Disorder (ADD) with and without hyperactivity. Specifically, this article (1) reviews the history and current status of the diagnostic category of ADD, particularly with regard to this Subtyping distinction, (2) discusses various neurological structures and biochemical systems believed involved in the regulation of attention and impulse control, (3) presents an integrative neuropsychological model of attention control which would allow for these subtypes of ADD, and (4) relates this model to clinical findings in children and adolescents with these disorders. It is concluded that the literature in this area of childhood psychopathology is consistent with the notion that these subtypes of ADD exist and that they may well be related to associated deficiencies in neurotransmitter systems involving dopamine and norepinephrine. Further, there may be interactions involving these subtypes and lateralized and anterior-posterior regulatory-attentional systems.

Neuropsychological test performance and the attention deficit disorders: Clinical utility of the Luria-Nebraska Neuropsychological Battery--Children's Revision.

The Luria-Nebraska Neuropsychological Battery-Childrens Revision (LNNB-CR) was administered to 54 clinic-referred children aged 8-12 years. Children reliably diagnosed as attention deficit disorder with hyperactivity were compared with children diagnosed as attention deficit disorder without hyperactivity and with a clinic control group diagnosed with internalizing disorders. Both attention deficit disorder groups were lower than the control group in verbal and Full Scale IQ scores but did not differ from one another. The groups did not differ significantly on any of the LNNB-CR clinical scales, on the right or left hemisphere scores, or on the pathognomonic score using analyses of variance or analyses of covariance with both Full Scale IQ and age as covariates. These findings failed to support the hypothesis that attention deficit disorder, either with or without hyperactivity, is associated with neuropsychological dysfunction as measured by the LNNB-CR.

Correlates of sociometric status in school children in Buenos Aires

Teacher ratings on Spanish translations of the Comprehensive Behavior Rating Scale for Children and peer nominations were obtained for 110 school children (42 boys and 68 girls) in grades 2– 5 at a public elementary school in Buenos Aires. Nominations of “likes best” were negatively correlated with language processing deficits, attention problems, and sluggish tempo as rated by both teachers and peers, and positively correlated with teacher ratings of social competence, for both boys and girls. The reverse pattern was found for nominations of “likes least.” Children were assigned to sociometric status groups of popular (n=27), rejected (n=28), neglected (n=7) controversial (n=11), and average (n=37) based on number of LL and LB nominations. Rejected and popular children could be differentiated by teacher and peer ratings of linguistic information processing deficits, inattention, and sluggish tempo. Behavioral characteristics of motor hyperactivity, impulsivity, and aggression were significantly associated with being male but did not differ by sociometric status group.