Laura D. Eddy

Attention-Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment (4th ed.)

The existent literature on attention deficit/hyperactivity disorder (ADHD) is enormous, and books that adequately take on the review of its full scope are few. This newly released revision represents a significant update and expansion from its previous edition that, along with prior iterations, has served as just such a comprehensive primer. Broadly, this reference documents the state of the science regarding the nature of ADHDandmethods for assessment of and intervention with affected children, adolescents, and adults. The book is rich in its coverage of etiological theory and the impact that ADHD has on individuals across domains and development. The two most notable changes in this edition are the breadth of topics addressed and the wider panel of contributors that Barkley enlists to lend their related expertise (52, as compared to 21 in the prior edition). Mirroring the field, greater emphasis is notably put on: (a) increasingly supported core dysfunctions associated with ADHD (e.g., emotional dysregulation, executive dysfunction); (b) the manifestation, assessment, and treatment of ADHD in the adult population; (c) and novel and refined means and targets of intervention (e.g., in social skills training, dietary management, executive functioning training, driving risk intervention, couples counseling). Barkley also takes the opportunity to delineate the case for recognizing a distinct disorder of attention, namely concentration deficit disorder, which has largely been researched as sluggish cognitive tempo in the past. The diverse chapters in the book find similarity in their effective empirical and critical approach and a format of concluding with a useful “key clinical points” section. In fact, many (e.g., social skills training for youth, driving risk intervention for teens, cognitive-behavioral therapies for adults) read like a sort of “how to” guide that while necessarily lacking detailed session-to-session protocols, provide critical guidance for clinicians and researchers alike. Another potentially helpful feature of the book is that chapters are more narrowly focused, such that a reader with interests in a specific topic will have to search less for appropriate information. This is especially true with regards to topics related to adult ADHD, which now is focused on in 11 chapters where previously there were just four. While it may be unfair to single out specific topics within this compendium that are particularly meritorious, several highlights include (a) Amori Mikami’s case for new social skills training approaches that focus on parents and teachers instead of children themselves, (b) Mary Solanto’s focused treatment of executive dysfunction in adults with ADHD, (c) Laura Knouse’s excellent review of cognitive-behavioral approaches to treating ADHD in adults, and (d) Barkley’s own reviews of the history and potential etiological underpinnings of the disorder. Overall, we conclude that this reference is a musthave for practitioners, researchers, and graduate students with a professional interest in ADHD, incorporating approximately the last decade’s advances to its previous editions comprehensive treatment of the history and nature of this disorder. We predict that you will find yourself reaching for it time and time again, and greatly appreciate having its wealth of information at your fingertips.

Overcoming the research-to-practice gap: A randomized trial with two brief homework and organization interventions for students with ADHD as implemented by school mental health providers.

Objective: To evaluate the effectiveness of 2 brief school-based interventions targeting the homework problems of adolescents with attention-deficit/hyperactivity disorder (ADHD)—the Homework, Organization, and Planning Skills (HOPS) intervention and the Completing Homework by Improving Efficiency and Focus (CHIEF) intervention, as implemented by school mental health providers during the school day. A secondary goal was to use moderator analyses to identify student characteristics that may differentially predict intervention response. Method: Two-hundred and eighty middle school students with ADHD were randomized to the HOPS or CHIEF interventions or to waitlist, and parent and teacher ratings were collected pre, post, and at a 6-month follow-up. Results: Both interventions were implemented with fidelity by school mental health providers. Participants were pulled from elective periods and sessions averaged less than 20 min. Participants in HOPS and CHIEF demonstrated significantly greater improvements in comparison with waitlist on parent ratings of homework problems and organizational skills and effect sizes were large. HOPS participants also demonstrated moderate effect size improvements on materials management and organized action behaviors according to teachers. HOPS participants made significantly greater improvements in parent- and teacher-rated use of organized actions in comparison with CHIEF, but not on measures of homework problems. Moderation analyses revealed that participants with more severe psychopathology and behavioral dysregulation did significantly better with the HOPS intervention as compared to the CHIEF intervention. Conclusions: Brief school-based interventions implemented by school providers can be effective. This type of service delivery model may facilitate overcoming the oft cited research-to-practice gap.

Writing Abilities Longitudinally Predict Academic Outcomes of Adolescents with ADHD.

Students with attention-deficit/hyperactivity disorder (ADHD) often experience a host of negative academic outcomes, and deficits in reading and mathematics abilities contribute to these academic impairments. Students with ADHD may also have difficulties with written expression, but there has been minimal research in this area and it is not clear whether written expression abilities uniquely contribute to the academic functioning of students with ADHD. The current study included a sample of 104 middle school students diagnosed with ADHD (Grades 6-8). Participants were followed longitudinally to evaluate whether written expression abilities at baseline predicted student grade point average (GPA) and parent ratings of academic impairment 18 months later, after controlling for reading ability and additional relevant covariates. Written expression abilities longitudinally predicted both academic outcomes above and beyond ADHD and oppositional defiant disorder symptoms, medication use, reading ability, and baseline values of GPA and parent-rated academic impairment. Follow-up analyses revealed that no single aspect of written expression was demonstrably more impactful on academic outcomes than the others, suggesting that writing as an entire process should be the focus of intervention. (PsycINFO Database Record

Longitudinal Evaluation of the Cognitive-Behavioral Model of ADHD in a Sample of College Students With ADHD.

Objective: The primary aim of this study was to evaluate longitudinal pathways to impairment as outlined in the cognitive-behavioral model of ADHD in a sample of 59 college students diagnosed with ADHD. Method: Serial mediation models were used to test whether underachievement, defined as prior year GPA, would longitudinally predict self-reported impairment at the end of the next school year, through negative self-concept and associated changes in symptoms of anxiety and depression, while controlling for baseline impairment and changes in ADHD symptoms. Results: Findings supported the cognitive-behavioral model of ADHD. The association between prior year GPA and overall impairment at the end of the year was fully mediated through self-concept and symptoms of depression. Conclusion: These results help explain why impairment often persists even when ADHD symptoms remit and suggests that internalizing symptoms may be an important target for intervention in college students with ADHD.

Longitudinal evaluation of the importance of homework assignment completion for the academic performance of middle school students with ADHD.

The primary goal of this study was to longitudinally evaluate the homework assignment completion patterns of middle school age adolescents with ADHD, their associations with academic performance, and malleable predictors of homework assignment completion. Analyses were conducted on a sample of 104 middle school students comprehensively diagnosed with ADHD and followed for 18 months. Multiple teachers for each student provided information about the percentage of homework assignments turned in at five separate time points and school grades were collected quarterly. Results showed that agreement between teachers with respect to students assignment completion was high, with an intraclass correlation of .879 at baseline. Students with ADHD were turning in an average of 12% fewer assignments each academic quarter in comparison to teacher-reported classroom averages. Regression analyses revealed a robust association between the percentage of assignments turned in at baseline and school grades 18 months later, even after controlling for baseline grades, achievement (reading and math), intelligence, family income, and race. Cross-lag analyses demonstrated that the association between assignment completion and grades was reciprocal, with assignment completion negatively impacting grades and low grades in turn being associated with decreased future homework completion. Parent ratings of homework materials management abilities at baseline significantly predicted the percentage of assignments turned in as reported by teachers 18 months later. These findings demonstrate that homework assignment completion problems are persistent across time and an important intervention target for adolescents with ADHD.

Alcohol Use Longitudinally Predicts Adjustment and Impairment in College Students With ADHD: The Role of Executive Functions

The primary aim of this study was to evaluate whether alcohol consumption longitudinally predicts the adjustment, overall functioning, and grade point average (GPA) of college students with ADHD and to determine whether self-report of executive functioning (EF) mediates these relationships. Sixty-two college students comprehensively diagnosed with ADHD completed ratings at the beginning and end of the school year. Regression analyses revealed that alcohol consumption rated at the beginning of the year significantly predicted self-report of adjustment and overall impairment at the end of the year, above and beyond ADHD symptoms and baseline levels of adjustment/impairment but did not predict GPA. Exploratory multiple mediator analyses suggest that alcohol use impacts impairment primarily through EF deficits in self-motivation. EF deficits in the motivation to refrain from pursuing immediately rewarding behaviors in order to work toward long-term goals appear to be particularly important in understanding why college students with ADHD who consume alcohol have a higher likelihood of experiencing significant negative outcomes. The implications of these findings for the prevention of the negative functional outcomes often experienced by college students with ADHD are discussed. (PsycINFO Database Record

Factor Structure and Predictive Validity of a Homework Motivation Measure for Use With Middle School Students With Attention-Deficit/Hyperactivity Disorder (ADHD).

Many students with attention-deficit/hyperactivity disorder (ADHD) exhibit deficits in motivation to pursue long-term goals. Students with ADHD have particular difficulty with motivation to complete homework-related tasks and often fail to complete assignments. Although these problems are common and may impact academic performance, no homework-motivation measures have been validated for use with students with ADHD. The primary goal of the present study was to evaluate the factor structure and predictive validity of a homework-motivation measure based upon the expectancy–value theory of achievement motivation. A sample of 285 middle school students with ADHD completed the measure, and confirmatory factor analysis was used to evaluate the proposed factor structure and associations with parent and teacher ratings of homework performance. A 2-factor structure emerged, and model fit was excellent. Further, student-rated ability–expectancy beliefs demonstrated significant associations with parent-rated homework problems and performance and with teacher-rated homework performance and percentage of assignments turned in above and beyond ADHD symptoms. Future directions for studying the importance of motivation in students with ADHD are provided, with particular attention to the role that reward sensitivity may play in motivation.

Using Bug-in-the-Ear Technology to Facilitate Trainees’ Use of Behavior Management Strategies During Child Assessments

ABSTRACT Many clinicians provide psychoeducational assessments to children with a variety of mental health concerns; however, the literature is sparse with regard to training clinicians to provide assessments with this population. This brief report describes the use of an innovative training model desired to increase trainee competencies in the use of behavior management strategies during child psychoeducational assessments, a common training activity for clinical psychology graduate students. Bug-in-the-ear (BITE) technology, although utilized for training in other fields, is not regularly used for clinical training by clinical psychology doctoral programs. Child psychoeducational assessments provide a unique training opportunity to utilize BITE technology to provide live supervision to trainees while helping to ensure that an accurate representation of the child’s ability is obtained and not obstructed by the presence of disruptive or other maladaptive behaviors. A model for using BITE to improve trainee use of child behavior management and ways to measure outcomes are presented. In addition, an example trainee case is discussed. BITE-facilitated supervision represents a creative and efficient method to improve trainee use of behavior management strategies during child assessments and should be considered by graduate programs training students to conduct child psychoeducational assessments.