Lawrence J. Lewandowski

Symptoms versus Impairment: The Case for Respecting "DSM-IV"'s Criterion D.

Diagnosing ADHD based primarily on symptom reports assumes that the number/frequency of symptoms is tied closely to the impairment imposed on an individual’s functioning. That presumed linkage encourages diagnosis more by Diagnostic and Statistical Manual of Mental Disorders (4th ed.) style symptom lists than well-defined, psychometrically sound assessments of impairment. The current study correlated measures reflecting each construct in four separate, large-scale ADHD research samples. Average correlation between symptoms and impairment accounted for less than 10% of variance. Symptoms never predicted more than 25% of the variance in impairment. When an ADHD group was formed according to a measure of current symptoms, the sample size shrunk by 77% when a criterion-based measure of impairment was added. The partial unlinking of symptoms and impairment has implications for decisions about the diagnostic process, research criteria for participant inclusion, prevalence estimates, gender ratios, evaluation of treatment effects, service delivery, and many other issues.

Symptoms of ADHD and Academic Concerns in College Students With and Without ADHD Diagnoses

Objective: Previous research has found ADHD symptoms to be common in the general population but has not compared endorsement of symptoms between ADHD and non-ADHD groups. This study examines self-reported ADHD symptoms and academic complaints in college students. Method: Students without (n = 496) and with ADHD (n = 38) completed a questionnaire covering the 18 ADHD symptoms in the Diagnostic and Statistical Manual of Mental Disorders and academic and test-taking concerns. Results and Conclusion: Students with ADHD diagnoses reported significantly more ADHD symptoms and academic concerns, but none of the 18 symptoms or 6 concerns proved to be both sensitive and specific to ADHD. Poor specificity of symptoms and academic complaints casts doubt on the utility of this self-reported information in diagnosis, particularly if used alone and without regard to severity or extent of impairment. (J. of Att. Dis. 2008; 12(2) 156-161)

Gifted Students With Learning Disabilities: Who Are They?

More than 20 years ago, psychologists first described gifted students with learning disabilities (LD). In the past decade, several sets of identification criteria have been proposed for this population. Many of the suggested assessment practices are unsupported by research in psychoeducational assessment, and some have been directly contradicted by recent research. We argue that an uncritical acceptance of the concept of concomitant giftedness and LD has led to unsound identification procedures and to interventions that are not targeted properly. Specific recommendations for future research and implications for current clinical practice are discussed.

The Role of Impairment in the Diagnosis of ADHD.

Objective: Current diagnostic criteria for ADHD require the consideration of impairment in making a diagnosis, although clinical and research definitions of ADHD rely more heavily on reported symptoms. This study explored the relationship between impairment and symptoms, variables predictive of impairment, and variation in ADHD identification when impairment criteria are added to symptom criteria. Method: ADHD symptoms and impairment were assessed using archival parent and teacher rating scale data. Results: The results indicated that (a) single impairment measures alone and a global impairment index were, at best, only moderately correlated with symptom reports; (b) predictor variables accounted for a small percentage of the variance in impairment; and (c) the number of children meeting criteria for ADHD diagnosis varied dramatically when impairment measures were considered. Conclusion: Symptoms and impairment are related yet distinct constructs that should be measured independently to determine the presence of ADHD. (J. of Att. Dis. 2008; 11(5) 529-537)

The LD Label for Relatively Well-Functioning Students: A Critical Analysis

The number of students identified since the mid-1970s as having learning disabilities has produced a corresponding increase in the population of such individuals in postsecondary programs. The Americans with Disabilities Act, along with Section 504 of the Vocational Rehabilitation Act of 1973, provide the basis for civil rights for students in higher education. These laws protect individuals who have a substantial limitation in a major life activity when compared with the general population. A disparity between the legal definition and the clinical definition of learning disabilities, which can encompass those identified on the basis of academic underachievement relative to intellectual potential, has stimulated debate about the fairest, most appropriate standard for declaring a student functionally impaired. Extending services to individuals without significant academic impairment may tax or even deplete scarce resources for others in greater needs, distort the normal processes by which individuals select careers, and diminish the credibility of the diagnosis itself.

Extended Time Accommodations and the Mathematics Performance of Students With and Without ADHD

Test accommodations such as extended time are presumed to reduce the impact of a disability, while not affecting test scores of the general population. This study examined the effects of an extended time (time and one-half) accommodation on the mathematics performance of fifth-to seventh-grade students with and without attention deficit hyperactivity disorder (ADHD). The results did not support the differential boost hypothesis in that the ADHD group did not make more gains than the control group with extended time. However, the ADHD group did demonstrate lower processing speed, math fluency, and achievement. These findings suggest that, although students with ADHD tend to work with less overall efficiency in terms of processing speed and task fluency, they do not benefit significantly more than nondisabled students when given extended time on a speed-based math task. Implications for future research and accommodations policies are discussed.

Extended Time as a Testing Accommodation for Students with Reading Disabilities: Does a Rising Tide Lift All Ships?.

Testing accommodations have become a common component of services for students with disabilities at all levels of education. This study examined the effect of a common testing accommodation—extended time—on the reading comprehension test performance of high school students. Sixty-four students, half of whom had learning disabilities (LDs) in the area of reading, were given the Nelson Denny Reading Comprehension subtest under various time conditions. Nondisabled students benefited more from the extended time than students with LDs did. However, extended time did allow students with LDs to attempt as many questions as their nondisabled peers did under standard time conditions. Implications for future research, as well as policy in this area are discussed.

Test-Taking Skills in College Students With and Without ADHD

College students with attention deficit hyperactivity disorder (ADHD) often request and receive extended time to complete high-stakes exams and classroom tests. This study examined the performances and behaviors of college students on computerized simulations of high-stakes exams. Thirty-five college students with ADHD were compared to 185 typical peers on measures of reading decoding, speed, vocabulary, comprehension, test strategies, time management, and test anxiety. Results indicated no differences between students with and without ADHD on various reading (decoding, speed, vocabulary, and comprehension) and test-taking variables (time utilization, navigation style, or strategy use), yet significant differences were present regarding their perceptions of, and anxiety during, test taking. It appears that students with ADHD perform similarly to peers on timed reading tests, although they think they perform less well and worry more about their performance.

NEURODEVELOPMENTAL OUTCOME OF PRESCHOOL CHILDREN BORN PRETERM WITH AND WITHOUT INTRACRANIAL HEMORRHAGE

Thirty‐five children who had been born preterm with and without intracranial hemorrhage and weighing ≤1500g were followed prospectively to assess neurodevelopmental outcome. The 13 children with hemorrhage were inferior to the 22 without hemorrhage in terms of birthweight, Apgar scores, health complications at and after birth, neurological integrity at age five and several scales of the McCarthy Scales of Childrens Abilities. The hemorrhage group performed significantly below the standardized mean on each of the McCarthy scales, whereas the group without hemorrhage performed below the mean only in Quantitative and Memory scores. The Bayley scales at one year were not clinically sensitive to hemorrhage, but were predictive of McCarthy General Cognitive Index scores at age five. A greater proportion of children with hemorrhage have had educational difficulties and have been included in alternative school programs. Preterm, very low‐birthweight children, and particularly those with intracranial hemorrhage, are at high risk for motor, perceptual and cognitive defects which underlie learning difficulties.

SUBTLE SPEECH AND MOTOR DEFICITS OF CHILDREN WITH CONGENITAL ‘ HYPOTHYROID TREATED EARLY

This study surveyed the development and functioning of a group of 16 children with congenital hypothyroidism who had been followed closely since treatment was instituted at an average age of 15‐6 days. This group of early‐treated young children had no deficits in cognitive or adaptive functioning. Some isolated motor deficits were found, although results of the Finger‐tapping and Marching subtests of the Reitan‐Indiana battery did not replicate the New England Congenital Hypothyroid Collaborative (1985) finding of impaired performance. Speech deficits were documented in some. Congenitally hypothyroid children with delayed neonatal bone‐age performed more poorly on most measures than those whose bone‐age had been normal at birth.