Rick Ostrander

Potential cognitive, parenting, and developmental mediators of the relationship between ADHD and depression.

The authors investigated the role of parent behavior management and locus of control in mediating the relationships between ADHD (attention-deficit/hyperactivity disorder) and depression in a community sample of 232 children with ADHD and 130 community controls. Results supported the hypothesized path models to depression for older and younger subjects. For older subjects (10 years and older), a cognitive variable, locus of control, partially mediated the relationships between ADHD and parent management and depression. In addition, parent management partially mediated the relationships of ADHD with locus of control and depression. For the younger group (under 8 years old), however, locus of control did not mediate the effects of parent management and ADHD on depression. Consistent with developmental theories, only an environment variable, parent management, explained the relationship between ADHD and depression for this younger group. For children 8-9 years old, both locus of control and parent management partially mediated the ADHD-depression relationship; however, similar to the younger children, locus of control did not mediate the parent management-depression relationships. Implications for designing interventions and prevention strategies for children with ADHD are discussed.

Effects of a school-based cognitive-behavioral intervention for ADHD children

Two variations of school-based cognitive-behavioral training (CBT) program were compared to each other and to a waiting-list control condition in the treatment of children with attention-deficit hyperactivity disorder (ADHD). The experimental interventions included a multicomponent condition that provided coordinated training programs for parents, teachers, and children and a teacher-only condition that offered training for classroom teachers only. Evaluation of outcome occurred at pre-intervention, post-intervention and at 6-week followup periods. Depedent measures included classroom behavior observations, teacher ratings of child behavior, child self-report, and teacher ratings of adjustment. The multicomponent CBT condition was significantly better than the other conditions at improving observed off-task/disruptive behavior at post-test. This improvement was maintained at followup, although treatment condition differences were no longer significant. There were no treatment condition differences on any other measures at postintervention or followup. It was concluded that the intervention had minimal short-term effects on the ADHD children. The results are discussed within the context of several methodological limitations of the study which serve as proposals for continued research in this area.

Multimethod assessment of psychopathology among DSM-IV subtypes of children with attention-deficit/hyperactivity disorder: self-, parent, and teacher reports.

Using data based on self-, parent, and teacher reports, we assessed various aspects of psychopathology in a large sample of control children and those with ADHD. Confirmatory factor analysis was employed to extract response bias from latent constructs of aggression, anxiety, attention problems, depression, conduct disorder, and hyperactivity. These latent constructs were then entered into logistic regression equations to predict membership in control versus ADHD groups, and to discriminate between ADHD subtypes. Results of the regression equations showed that higher levels of attention problems and aggression were the best predictors of membership in the ADHD group relative to controls. Logistic regression also indicated that a higher degree of aggression was the only significant predictor of membership in the ADHD-Combined group compared to the ADHD-Inattentive group. However, when comorbid diagnoses of Oppositional Defiant Disorder and Conduct Disorder were controlled for in the logistic regression, greater hyperactivity rather than aggression was the sole variable with which to distinguish the ADHD-Combined from the ADHD-Inattentive subtype. Results are discussed in the context of the DSM-IV ADHD nosology and the role of instrument and source bias in the diagnosis of ADHD.

ATTENTION DEFICIT HYPERACTIVITY DISORDER: An Epidemiological Screening Method

Multistage identification, an epidemiological screening method of diagnostic assessment, was used to identify attention-deficit hyperactivity disorder (ADHD) in 1,490 elementary-school students. Children diagnosed with ADHD exhibited more impairment on adjustment measures and were more likely to have coexisting disruptive behavior disorders than were children diagnosed as subclinical non-ADHD.

Improvements in visual attention in deaf infants and toddlers after cochlear implantation

The aims of this study were to examine the development of visual attention in deaf and hearing infants and toddlers, and assess whether improvements in visual attention were observed in the deaf sample after 12 months of cochlear implantation. A novel puppet task, based on a measure of attention developed with normally hearing infants, was administered to 88 deaf and 42 normal-hearing children at three time points: baseline, six and 12 months post-implantation for the deaf sample. At baseline, deaf children demonstrated significantly more inattentive looks during the puppet skits than hearing children, and these looks were of longer duration, confirming the results of prior studies which have documented deficits in visual attention in deaf children. Longitudinal analyses showed significant decreases in the frequency of inattentive looks for both groups, with a significant decrease in the duration of inattentive looks only for the cochlear implant group. The largest decrease in duration of off-task looks occurred at six months post-implantation, indicating that improvements occurred rapidly after restoration of auditory input. These results provided support for the ‘division of labor’ hypothesis which suggests that deaf children with no access or limited access to sound must monitor their environment visually, making it difficult for them to focus and attend to specific tasks. Cochlear implantation appeared to alter the developmental trajectory of visual attention in a positive manner. The clinical implications of visual attention for the development of early language, reading and social skills are discussed.

Developmental and symptom specificity of hopelessness, cognitive errors, and attributional bias among clinic-referred youth.

The present study examined the unique and interactive relationships between age and indices of psychopathology (i.e., anxiety, aggression, and depression), with three types of maladaptive cognitions: hopelessness, negative cognitive errors, and attributional bias. Some negative cognitions were not unique to depression and were associated with broader psychopathology. Developmental considerations also influenced some negative cognitions or qualified the association between negative cognitions and depression.

A Comparison of Urge Intensity and the Probability of Tic Completion During Tic Freely and Tic Suppression Conditions.

Tic-suppression-based treatments (TSBTs) represent a safe and effective treatment option for Chronic Tic Disorders (CTDs). Prior research has demonstrated that treatment naive youths with CTDs have the capacity to safely and effectively suppress tics for prolonged periods. It remains unclear how tic suppression is achieved. The current study principally examines how effective suppression is achieved and preliminary correlates of the ability to suppress tics. Twelve youths, ages 10 to 17 years, with moderate-to-marked CTDs participated in an alternating sequence of tic freely and reinforced tic suppression conditions during which urge intensity and tic frequency were frequently assessed. Probability of tics occurring was half as likely following high-intensity urges during tic suppression (31%) in contrast to low-intensity urges during tic freely conditions (60%). Age was not associated with ability to suppress. Intelligence indices were associated with or trended toward greater ability to suppress tics. Attention difficulties were not associated with ability to suppress but were associated with tic severity. In contrast to our “selective suppression” hypothesis, we found participants equally capable of suppressing their tics regardless of urge intensity during reinforced tic suppression. Tic suppression was achieved with an “across-the-board” effort to resist urges. Preliminary data suggest that ability to suppress may be associated with general cognitive variables rather than age, tic severity, urge severity, and attention. Treatment naive youths appear to possess a capacity for robust tic suppression. TSBTs may bolster these capacities and/or enable their broader implementation, resulting in symptom improvement.

Electric charge requirements of pediatric cochlear implant recipients enrolled in the childhood development after cochlear implantation study

Objective: To evaluate mapping characteristics of children with cochlear implants who are enrolled in the Childhood Development After Cochlear Implantation (CDACI) multicenter study. Study Design: Longitudinal evaluation during 24 months of speech processor maps of children with cochlear implants prospectively enrolled in the study. Setting: Six tertiary referral centers. Subjects: One hundred eighty-eight children enrolled in the CDACI study who were 5 years old or younger at the time of enrollment. Of these children, 184 received unilateral implants, and 4 received simultaneous bilateral implants. Intervention: Children attended regular mapping sessions at their implant clinic as part of the study protocol. Maps were examined for each subject at 4 different time intervals: at device activation and 6, 12, and 24 months postactivation. Main Outcome Measures: Mean C/M levels (in charge per phase) were compared for 4 different time intervals, for 3 different devices, for 6 different implant centers, and for children with normal and abnormal cochleae. Results: All 3 types of implant devices demonstrate significant increases in C/M levels between device activation and the 24-month appointment. Significant differences in mean C/M levels were noted between devices. Children with cochlear anomalies demonstrate significantly greater C/M levels than children with normal cochleae. Conclusion: The CDACI study has enabled us to evaluate the mapping characteristics of pediatric patients who use 3 different devices and were implanted at a variety of implant centers. Analysis of such data enables us to better understand the mapping characteristics of children with cochlear implants.

Patterned changes in urge ratings with tic suppression in youth with chronic tic disorders

BACKGROUND Premonitory urges are central to emerging behavioral models of chronic tic disorders (CTD). Urge reduction has been proposed as a behavioral explanation for tic maintenance and exacerbation as well as the efficacy of behavioral treatments. Prior investigations have produced inconsistent findings despite common methodologies. The current study evaluated the possibility that data aggregation obscures distinct and meaningful patterns of change in urge ratings when tics are freely expressed versus suppressed. METHOD Participants (n = 12) included children with moderate-to-marked tic severity and noticeable premonitory urges. Tic frequencies and urge ratings were obtained at 15 s and 10-s intervals, respectively, across an alternating sequence of 10-min tic freely and 40-min tic suppression conditions. Patterns were established using a two step approach. RESULTS Five distinct patterns of urge rating change emerged, suggesting data aggregation may obscure meaningful patterns in the urge-tic relationship when tics are completed versus suppressed. LIMITATIONS Eligibility criteria may have unintentionally excluded younger affected children and included older participants with more severe tic disorders than commonly seen. Additional research with less stringent eligibility criteria and a larger sample size will help validate the results. CONCLUSIONS The relationship between urges and tics is much more complex than previously theorized. Investigations that rely on global assessments of urge and tic severity and/or assume uniformity when aggregating participant data may obscure meaningful differences in the urge-tic relationship. Future investigations should examine the possibility that individual differences and/or developmental considerations modulate the functional urge-tic relationship.

Anger Regulation and Social Acceptance in Early Adolescence: Associations with Gender and Ethnicity.

Anger regulation among adolescents is important to investigate given theoretical and empirical support for its critical association with peer relationships. This study examined two aspects of anger regulation (i.e., inhibition, dysregulation) using self-report and peer-nominations and their associations with social acceptance among 163 Black and White adolescents ( X ¯ = 13.87 years). We explored gender and ethnicity differences in anger regulation predicting peer acceptance. Self-reports and peer-nominations of anger regulation were significantly correlated. Within-gender ethnicity differences in anger regulation were found: White girls reported higher levels of anger inhibition than Black girls, and Black girls reported higher levels of anger dysregulation than White girls. For all adolescents, self-reports and nominations of anger inhibition were associated with higher levels of social acceptance, whereas nominations of anger dysregulation predicted lower social acceptance. The results indicate the importance of considering gender and ethnicity in adolescents’ anger management within peer contexts.