George J. DuPaul

Frontal lobe functions in attention deficit disorder with and without hyperactivity: A review and research report

We review 22 neuropsychological studies of frontal lobe functions in children with attention deficit disorder with and without hyperactivity (ADD/+H,ADD/-H). Some measures presumed to assess frontal lobe dysfunctions were not reliably sensitive to the deficits occurring in either form of ADD. Tests of response inhibition more reliably distinguished ADD/+H from normal children. Where impairments were found on other tests between ADD and normal subjects, they were highly inconsistent across studies and seemed strongly related to age of the subjects and possibly to the version of the test employed. Other methodological differences across studies further contributed to the discrepant reports. The co-morbidity of other disorders, such as learning disabilities (LD) and conduct problems, with ADD may be an additional confounding factor in some, though not all, of these studies. In a separate study, children with ADD/+H (n=12) were then compared on frontal lobe tests to three other groups: ADD/-H (n=12), LD but no ADD (n=11),and normal children (n=12) statistically covarying for differences in conduct problems across groups. Most measures did not distinguish among these groups. Both ADD groups made more omission errors on a Continuous Performance Test (CPT) than the normal group. All three clinical groups performed more poorly on the word and interference portions of the Stroop Test. Thus, while both types of ADD share some apparent similarities in deficits on a few frontal lobe tests in this study, the totality of existing findings suggests an additional problem with perceptual-motor speed and processing in the ADD/-H group.

Comprehensive evaluation of attention deficit disorder with and without hyperactivity as defined by research criteria.

Children with attention deficit disorder with hyperactivity (ADD+H; N = 48) were compared with those without hyperactivity (ADD-H; N = 42), as well as with learning disabled and control children, on an extensive battery of interviews, behavior ratings, tests, and direct observations. ADD+H children had more externalizing and internalizing symptoms by parent and teacher report, were more off task during vigilance testing, and had more substance abuse, ADD+H, and aggression among their relatives than did the other groups. ADD-H children were more day-dreamy and lethargic by teacher report, more impaired in perceptual-motor speed, and had more anxiety disorders among their relatives than did ADD+H children. Results indicate that these 2 types of ADD may be separate, distinct childhood disorders rather than subtypes of a common attention deficit.

Parenting stress among families of children with Attention Deficit Hyperactivity Disorder

Prior research has shown that parenting stress levels can be quite high among families of children with attention deficit hyperactivity disorder (ADHD). This study investigated the degree to which such stress was related not only to the childs ADHD, but also to various other child, parent, and family-environment circumstances. Multimethod assessments were conducted on 104 clinic-referred children with ADHD. Data collected from these subjects were entered into hierarchical multiple-regression analyses, utilizing the Parenting Stress Index as the criterion. The results showed that child and parent characteristics accounted for a substantial portion of the variance in overall parenting stress. The childs oppositional-defiant behavior and maternal psychopathology were especially potent predictors. The severity of the childs ADHD, the childs health status, and maternal health status also emerged as significant predictors. These findings are discussed in terms of their impact upon the clinical management of children with ADHD.

Response of children with ADHD to methylphenidate: interaction with internalizing symptoms.

OBJECTIVEnThe purpose of this study was to examine differences in methylphenidate (MPH) response between groups of children with attention-deficit hyperactivity disorder (ADHD) who exhibited varying degrees of internalizing symptoms.nnnMETHODnA sample of 40 children with ADHD was subdivided into three groups based on the severity of comorbid internalizing symptoms. Differential effects of three doses of MPH (5 mg, 10 mg, 15 mg) were evaluated in a double-blind, placebo-controlled fashion using multiple outcome measures across home, school, and clinic settings.nnnRESULTSnChildren with ADHD and comorbid internalizing symptoms were significantly less likely to respond positively to MPH than were their noninternalizing counterparts according to teacher ratings and behavioral observations during a clinic-based academic task.nnnCONCLUSIONSnChildren who exhibit comorbid symptoms of ADHD and internalizing disorder are less likely to respond to MPH in classroom settings and on academic tasks. A significant minority of children with comorbid conditions may be at a higher risk for an adverse medication response relative to patients with ADHD who are not exhibiting internalizing symptoms. Further research is necessary to delineate the characteristics of possible adverse responders.

Attention deficit-hyperactivity disorder in adolescence: Critical assessment parameters

Abstract The nature of Attention Deficit—Hyperactivity Disorder (ADHD) and its behavioral correlates in adolescence are briefly described. An assessment protocol for evaluating this disorder among teenagers is proposed, including parent and adolescent interviews, rating scales (completed by parent, teachers, and teenagers), laboratory tasks, and direct observation techniques. The advantages and limitations of each of these are delineated to explicate the inherent complexities encountered when evaluating ADHD in adolescents. Multiple methods obtained across sources, caregivers, and settings are recommended for use in assessing ADHD with the adolescent population.

Diagnosis and assessment of attention deficit-hyperactivity disorder in children

Abstract This article provides an overview of Attention Deficit-Hyperactivity Disorder (AD-HD) in children and its behavioral correlates, emphasizing clinical issues in assessment. Diagnostic criteria for AD-HD that are presented in DSM-III-R are briefly reviewed as are additional guidelines used in making the diagnosis. A clinical assessment protocol for evaluating this disorder among children is proposed that includes parent, teacher, and child interviews, standardized parent and teacher behavior rating scales, laboratory test measures, and direct observational procedures. A multimethod assessment protocol that utilizes sources of information obtained from different settings and informants is advocated because of the inherent complexities encountered when evaluating AD-HD. The importance of differential diagnosis and the need to assess for coexisting behavioral, learning, or emotional problems is emphasized. A clinical case is presented to illustrate the diagnostic and assessment process in evaluating children for AD-HD.