Gabrielle Weiss

Psychiatric Status of Hyperactives as Adults: A Controlled Prospective 15-Year Follow-up of 63 Hyperactive Children

Sixty-three hyperactive adults aged 21–33 and 41 matched normal controls were evaluated for their psychiatric status by means of (a) psychiatric interviews and histories using the DSM-II diagnosis; (b) psychiatric interviews carried out “blind” as to which group the subject belonged, using the SADS-L diagnosis; and (c) by means of self-rating scales. Each subject was assigned a number on the Global Assessment Scale of the SADS which measures general overall functioning. Results indicated that about half of the probands continued to have mild to severely disabling continuing symptoms of the syndrome. A significant percentage (23%) of the hyperactive adults had an Antisocial Personality Disorder on both the modified SADS-L and the DSM-I diagnostic criteria. Schizophrenia and alcoholism or alcohol abuse was not found more commonly in the hyperactive group. There was evidence that the hyperactives had more overall psychopathology and functioned generally less well than did normal controls.

Hyperactivity in preschoolers and the effect of methylphenidate.

Observations of nursery behavior and tests of cognitive style and motor impulsivity were carried out with 28 hyperactive preschool children of normal intelligence and 26 matched control children. The hyperactive group was also observed and tested on methylphenidate and placebo. Methylphenidate was found to reduce hyperactivity at home, but it did not improve nursery behavior or psychological functioning. Unwanted side effects made the drug less useful at this age than in older hyperactive children.

Controlled prospective fifteen year follow-up of hyperactives as adults: Non-medical drug and alcohol use and anti-social behaviour.

This is a fifteen year prospective controlled study of the non-medical drug and alcohol use and antisocial behaviour of 61 hyperactives, and 41 matched control subjects, (mean age 25 years). The data was collected from detailed interviews with the subjects as well as computerized court records to verify subjects reports. Generally hyperactives did not differ significantly from controls on current drug and alcohol use and antisocial behaviour. However one sees trends of greater drug alcohol and antisocial involvement in the hyperactive group. All the subjects who have antisocial behaviour at 15 year follow-up (mean age 25) had early and persistent histories of antisocial behaviour beginning at initial assessment (mean age 8) or at 5 year follow-up (mean age 13). However many hyperactives do not continue their antisocial behaviour into adulthood (mean age 25). There thus appears to be a small subgroup of hyperactive subjects who have more negative outcomes with significantly greater social, emotional and psychological difficulties. It is this subgroup which we need to identify early and treat vigorously.

Hyperactives as young adults: self-esteem and social skills.

Eighteen pairs of young adult hyperactives and controls, matched for age, sex, IQ and socioeconomic class and education completed, were assessed on tests of social skills and self-esteem. Hyperactive subjects had significantly more difficulty than matched controls in social skills tests which involved direct oral responses than those involving written responses. This would suggest that the hyperactive young adults cognitively know what the most appropriate response would be from a number of possibilities, but have problems spontaneously producing such a response. Situations dealing with heterosocial and assertion situations were more difficult for hyperactives than job interview situations. Hyperactive young adults also scored significantly worse than matched controls on a number of self-esteem tests, thus supporting the findings of previous psychiatric assessments and the California Psychological Inventory. Finally, no significant correlations were found between the self-esteem and social skills tests. Possible explanations for the findings are discussed.

The hyperactive child at adolescence: Cognitive, emotional, and social functioning

In view of the paucity of detailed followup studies on hyperactive children, the performance of 15 adolescents diagnosed hyperactive 5 years previously was compared to that of a control group of equivalent age, sex, intelligence, and social class. Eleven cognitive tests measuring sustained attention, visual-motor and motor skills, abstraction, and reading ability, as well as three self-assessment tests examining selfesteem, activity level, social functioning, academic status, and career aspirations were administered. The hyperactives performed significantly worse than the controls on the sustained attention, visualmotor, and motor tasks, and on two of the four reading tests. They also gave themselves significantly lower ratings on some of the selfesteem and sociability items. It would appear that the hyperactives at adolescence still have attentional and stimulus-processing difficulties, which affect not only their academic performance but also their social functioning.

Hyperactives as Young Adults: School, Employer, and Self-Rating Scales Obtained During Ten-Year Follow-Up Evaluation.

A ten-year prospective follow-up of hyperactive adolescents and young adults indicates that they are rated as markedly inferior to normal controls by teachers but not by employers. On self-rating scales, they view themselves as inferior to controls on a personality test, but no different than controls on a psychopathology scale.

A two-year follow-up of hyperactive preschoolers.

Twenty hyperactive children and 21 controls, studied in a research nursery at age four, were followed up at six-and-a-half. Hyperactives were still reported to have more behavior problems. Those rated extremely active in the nursery requested more feedback and made more comments in interactions with their mothers, and also made more immature moral judgments; children rated only moderately active did not differ from controls on these measures.

Parent Training and Social Skills Training for Children with Attention-Deficit Hyperactivity Disorder: How can They be Combined for Greater Effectiveness?

Attention-deficit hyperactive disorder (ADHD) is a chronic and treatment-refractory syndrome affecting academic, social and emotional adjustment in children. Stimulant medication is the treatment of choice and is often paired with psychosocial treatment. However, no single treatment modality alleviates the symptoms or improves the negative peer status of these children in their social ecology over the long term. This article reviews two psychosocial treatments used for ADHD, parent training and social skills training and suggests ways that these two components may be combined for greater effectiveness by encouraging the parent to: 1. learn more about the importance of developing social competence and positive peer status; 2. use incidental teaching and self-evaluation strategies; 3. become strategic organizers of the childs social life; and 4. become case managers to facilitate more consistency between the significant adults in the childs social environment.

Two subgroups of hyperactives as adults: correlations of outcome.

This prospective study explored the association of continuing symptoms of the hyperactive syndrome with adult outcome. A fifteen year follow-up compared 61 hyperactive subjects and 41 matched controls. Outcome measures examined included continuing symptoms of the hyperactive syndrome, antisocial behaviour, substance use, and emotional difficulties. Two subgroups of the hyperactive population were identified. Those hyperactive subjects with moderate or severe continuing symptoms were characterized by significant emotional difficulties, alcohol use, and antisocial behaviour. By contrast, hyperactive subjects with none or only mild continuing symptoms at follow-up did not have other difficulties in psychosocial functioning, and were, in addition, similar to the control group in many respects. The importance of continuing symptoms in determining the adult outcome of children with a diagnosis of ADDH is discussed. Accordingly, the need for comprehensive early, and ongoing interventions is emphasized.

Continuities in maternal reports and child behaviors over time in hyperactive and comparison groups

Maternal reports, observations of nursery and elementary school behavior, and teacher ratings of problems were available for hyperactive and control children who had participated in a longitudinal study. This paper examines consistencies in maternal reports and child behaviors over time, and their relationship to teacher ratings in elementary school. Maternal reports of infant sleep difficulties were related to maternal ratings of hyperactivity at 41/2 and 61/2 years. Maternal ratings of activity at 41/2 were predictive of 61/2-year ratings of hyperactivity and conduct problems. In addition, behavior in a research nursery at 41/2 predicted teacher ratings of problems and classroom behavior in grade two. Hyperactive preschoolers who left the table most during structured activities were more often out-of-seat and off-task in school. Controls who were more aggressive in the nursery were more disruptive in the classroom. These data indicate continuities in both maternal reports and child behaviors.