Mark C. Edwards

The role of the family in the assessment of attention deficit hyperactivity disorder

Abstract The family plays an essential and primary role in the assessment of Attention Deficit Hyperactivity Disorder (ADHD) in children. This article seeks to provide the clinician with an understanding of the families of children with ADHD and how the functioning of the family might impact the outcome of assessment. It does so by discussing the role of the family in the assessment process within the context of current standards of practice, examining the characteristics and functioning of families of children with ADHD, and reviewing the issues in the use of parents and children as informants in the assessment of ADHD. With the latter, the factors which influence parent report, the reliability of parents and children as informants, and the correspondence of parents, children, and other informants are discussed.

Effect of methylphenidate on time perception in children with attention-deficit/hyperactivity disorder.

The effects of methylphenidate (MPH) on performance of a time-production task were studied in 17 children with attention-deficit/hyperactivity disorder who participated in 1 test session on and 1 off MPH. Participants held a response lever down for at least 10 but no longer than 14 s. Administration of MPH had no effect on the number of correct responses or on the mean duration of lever holds. MPH administration significantly decreased timing response variability, increased holds of 10- to 11-s duration, and decreased lever holds of extremely short durations. These results indicate that administration of MPH resulted in more precise timing performance without changing the mean duration of lever holds, suggesting an enhancement in working memory.

Matching treatment with recurrent abdominal pain symptoms: An evaluation of dietary fiber and relaxation treatments

We evaluated whether symptoms of recurrent abdominal pain in children provide a basis for treatment selection. Subjects were assigned to dietary fiber or relaxation treatments based upon whether they presented with symptoms of constipation. Elven subjects were treated in a combined multiple baseline and A-B or A-B-C design. As a control, some subjects recived the alternative treatment first. All four subjects with symptoms of constipation showed reductions in the number of stomachaches during the dietary fiber treatment. Of the seven subjects without symptoms of constipation, one showed reductions in stomachaches during the relaxation treatment, three showed some minimal reduction that was difficult to attribute to the relaxation treatment, two responded to the dietary fiber treatment, and one spontaneously improved during baseline. Results support the effectiveness of a dietary fiber treatment for children with symptoms of constipation. Minimal support was obtained for the effectiveness of a relaxation treatment for children without symptoms of constipation. Implications, limitations, and directions for future research are discussed.

Stimulant medication improves recognition memory in children diagnosed with attention-deficit/hyperactivity disorder.

The effect of stimulant medication on recognition memory was examined in 18 children with attention-deficit/hyperactivity disorder (ADHD). Recognition memory was assessed using a delayed matching-to-sample task at 6 delays ranging from 1 to 32 s. Each child was tested on 2 separate occasions, once 60 to 90 min after taking stimulant medication and the other at least 18 hr after taking medication. Children performed significantly better on medication than off. Stimulant administration significantly increased accuracy and the number of nickel reinforcers earned. Decreases in observing response latency and correct choice response latency occurred after taking stimulant medication. The results indicate that stimulant medication improved recognition memory for children with ADHD.

The Relation of Harsh and Permissive Discipline with Child Disruptive Behaviors: Does Child Gender Make a Difference in an At-Risk Sample?

The role of parenting in child disruptive behaviors has received substantial support; however, the findings as to differential effects of specific parenting behaviors (e.g., discipline) on boys’ and girls’ disruptive behavior problems have not been consistent. The current study examined the individual, unique, and interactive relation of two types of ineffective discipline (i.e., harsh & permissive) with child disruptive behavior for at-risk boys and girls separately. Participants were 160 parents with 3- to 6-year-old at-risk children (47.5% girls). Findings revealed that higher levels of harsh discipline were related to more intense disruptive behavior of both boys and girls, whereas higher levels of permissive discipline were related to more intense disruptive behavior of only boys. Additionally, results indicated that harsh and permissive discipline did not interact to predict child disruptive behavior problems. Clinical implications and directions for future research are discussed.

Effect of methylphenidate on motivation in children with attention-deficit/hyperactivity disorder.

The effects of methylphenidate (MPH) on motivation were examined using a progressive ratio (PR) task in children who were prescribed MPH for the treatment of ADHD. Twenty-one children, 7 to 12 years of age, completed two test sessions, one under the effects of medication and one not. During each session, children pressed a lever to earn nickel reinforcers, where the first press resulted in a reinforcer and 10 additional presses were required for each subsequent reinforcer. Children on MPH had a significantly higher breakpoint than when off medication. This MPH-associated increase in the breakpoint manifested as a significant decrease in the interresponse times (IRT). Further, MPH administration resulted in a significant decrease in IRT variability. In contrast, MPH administration had no significant effects on the means and variability of postreinforcement pause duration. These results suggest that MPH increased motivation in children being treated for ADHD. Further, the inability of MPH to significantly reduce postreinforcement pause duration while simultaneously decreasing IRTs suggests that while MPH may increase motivation to perform an ongoing task, it may have little effect on the initiation of that task.

Test of Time Agreeing about Disagreements: A Personal Reflection on Achenbach, McConaughy, and Howell (1987)

Whether behavior is determined mainly by situational factors or by more stable personality characteristics has been a classic debate in the social sciences. The question of the situational specificity of behavior has important implications for the assessment of children and adolescents. Because children function in multiple settings, clinicians are faced with the task of integrating information obtained from multiple informants from different settings, as well as their own clinical observations and impressions, and making clinical judgments based on this information. This process is challenging when information from different sources is not in agreement. Clinical decision-making and, ultimately, the accuracy of clinical judgments, will be influenced by how clinicians handle such discrepancies. With clinical accuracy being the chief concern in assessment, the debate about the stability vs situational specificity of behavior is an important one. The article by Achenbach, McConaughy, and Howell (1987) entitled ‘Child/Adolescent Behavioral and Emotional Problems: Implications of Cross-Informant Correlations for Situational Specificity’ has made an important contribution to the classic debate and leads to some practical recommendations for assessing children.

The Unidimensionality and Reliability of the Preschool and Kindergarten Behavior Scales

The unidimensionality and reliability of the Preschool and Kindergarten Behavior Scales (PKBS) for assessing child behavior with at-risk children was examined using a sample of 1,679 2- to 6-year-old children from nine Starting Early Starting Smart study sites. The unidimensionality of the eight PKBS scales was assessed using confirmatory factor analysis for the full sample, and the comparability (invariance) of the scales was examined across gender and Black and White racial groups. The results supported the unidimensionality of six of the eight scales using the full sample. The unidimensionality of the scales varied across gender and racial subgroups. Four of the eight PKBS scales were shown to be comparable across gender subgroups, and three of the eight scales were shown to be comparable across racial subgroups. The reliability of measurements derived from the PKBS was sufficient for using the PKBS as a measure of group performance for young at-risk children.

Parent Training Interventions

Parent training involves teaching parents and primary caregivers how to address and intervene with their children’s problem behaviors. These types of interventions have gained increasing popularity over the past several decades. Additionally, they have a strong evidence base supporting positive outcomes for both parents’ and children’s behavior, from different theoretical orientations, and across a number of populations and problems. Several behavioral parent training programs have been developed that teach a number of different skills including attending, rewarding, giving effective instructions, ignoring, and time-out. This chapter discusses and reviews many of these parent training programs and their supporting evidence. Current and anticipated trends such as the increasing use of technology in parent training and the dissemination of parent training programs to different countries and cultures are also discussed. Overall, while the field of parent training and its future looks bright, more work is needed to better understand what specific variables contribute to the effectiveness of parent training programs and what works best for whom.

Estimates of the validity and utility of unstructured clinical observations of children in the assessment of ADHD.

The purpose of this prospective study was to examine the validity and diagnostic utility of unstructured clinic observations of attention deficit hyperactivity disorder (ADHD) behaviors in children. Results showed observations to be related to behavioral ratings of parents but not of teachers. The relationship between observations and parent ratings was stronger for hyperactive-impulsive than inattentive behaviors. The level of agreement between observations and classification of ADHD significantly exceeded chance levels only for parent measures of hyperactivity-impulsivity. Only parent measures predicted a diagnosis of ADHD at a rate that was significantly better than chance. Clinic observations were found to have consistently higher positive predictive power than negative predictive power. Clinical implications are discussed.