Sam Goldstein

The comorbidity of Pervasive Developmental Disorder and Attention Deficit Hyperactivity Disorder: results of a retrospective chart review.

Objective: To determine if a sample of children meeting diagnostic criteria for a Pervasive Developmental Disorder (PDD) display symptoms and impairment related to Attention Deficit Hyperactivity Disorder (ADHD) sufficient to warrant a comorbid diagnosis of ADHD. Further, do children with PDD displaying such symptoms demonstrate more impairment in daily life activities than those children only having PDD? Method: A retrospective chart review was conducted on children (N = 57) diagnosed with the PDDs of Autism or PDD-Not Otherwise Specified (PDD-NOS), or ADHD. Comparative analysis of questionnaire and neuropsychological test data was completed to determine the severity of ADHD-like symptoms presenting among children with PDD. Results: From the pool of subjects having PDD with sufficient data (N = 27), 7 or 26% met DSM-IV criteria for the combined type of ADHD. Nine or 33% met diagnostic criteria for the Inattentive Type of ADHD and 11 or 41% did not demonstrate a significant number of ADHD symptoms to warrant a comorbid diagnosis of ADHD. Results indicate that a subgroup of children with PDD displaying significant ADHD-like symptoms may in fact have ADHD thus warranting a comorbid diagnosis of ADHD. Current data did not suggest children with PDD and the combined type of ADHD demonstrated significantly more impairment in daily life functioning than those children only having PDD. However, this appeared likely the result of small sample size. The data, however, does indicate such children experience more difficulties in daily situations as rated by parents and teachers. Conclusion: These findings reinforce clinical observations indicating that some children with PDD may also experience an independent comorbid condition of ADHD, suggesting that a comorbid diagnosis of ADHD with PDD be considered in such cases. If further findings are replicated, the current exclusionary DSM-IV-TR criteria of making such a comorbid diagnosis should be re-considered.

Performance of Children with Attention Deficit Hyperactivity Disorder and Anxiety/Depression on the WISC-III and Cognitive Assessment System (CAS)

The purpose of this study was to examine differences in cognitive performance between samples of children diagnosed with ADHD, anxiety and/or depression, and the normative groups on two tests of ability. Matched samples of 25 children diagnosed with Attention Deficit Hyperactivity Disorder were contrasted with 25 children diagnosed with anxiety/depression. Both groups were also compared to the normative values for the Wechsler Intelligence Scale for Children, Third Edition (WISC-III) and tests of Planning, Attention, Simultaneous, and Successive cognitive processes from the Cognitive Assessment System (CAS). Children with ADHD had lower Planning scores than those with anxiety/depression (6.5 points; effect size of 0.6) and lower Planning scores than the standardization sample (12.7 points; effect size of 0.9). No significant difference was found between children with ADHD, children with anxiety and depression, and the matched clinical sample on the WISC-III. The findings are commensurate with other studies, suggesting that Wechsler scores differentiated the samples minimally but CAS scores appear sensitive to the cognitive processing difficulties experienced by children with ADHD.

Why Study Resilience

The study of resilience traces its roots back a scant 50 years. Early on, the field of study was not extensive and the number of researchers devoting their careers to the examination of this phenomenon was fairly small. The field, as Michael Rutter noted in 1987, reflected not so much a search for factual phenomena but “for the developmental and situational mechanisms involved in protective processes” (p. 2). The interest was and is not just on what factors insulate and protect, but how they went about exerting their influence. Resilience studies were reserved for high-risk populations with a particular focus on those youth demonstrating resilience or the ability to overcome the emotional, developmental, economic, and environmental challenges they faced growing up (Rutter, 1987).

Handbook of executive functioning

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Introduction: A History of Executive Functioning as a Theoretical and Clinical Construct

Executive function (EF) has come to be an umbrella term used for a diversity of hypothesized cognitive processes, including planning, working memory, attention, inhibition, self-monitoring, self-regulation, and initiation carried out by prefrontal areas of the frontal lobes.

The Role of Intellectual Processes in the DSM-V Diagnosis of ADHD

In May 1968, the American Psychiatric Association published the second edition of its Diagnostic and Statistical Manual of Mental Disorders (DSM-II). Under the category of behavior disorders of childhood and adolescence, a condition referred to as hyperkinetic reaction of childhood (or adolescence) was described as a problem “characterized by over activity, restlessness, distractibility and short attention span, especially in young children; the behavior usually diminishes in adolescence” (American Psychiatric Association, 1968, p. 50). The manual noted that these conditions “are more stable, internalized and resistant to treatment than transient situational disturbances but less so than psychoses, neuroses and personality disorders” (p. 50). Beyond these guidelines, this manual provided little in the way of normative comparisons, statistical analyses, or methods of data collection. It was assumed that the diagnosis was made based on the characteristics described and/or observed by parents, teachers, and the diagnostician. Thirty-two years later, the text revision of the fourth edition (DSM-IV-TR) of the diagnostic and statistical manual of the American Psychiatric Association (2000) was published. In the interim, the diagnostic manual grew from 134 to 943 pages. The diagnosis of hyperkinetic reaction of childhood evolved and is now referred to as ADHD. The original description of eight lines grew to a set of diagnostic criteria and accompanying descriptions filling 8 pages. Yet the diagnostic process remained unchanged—ADHD is evaluated on the basis of the correspondence of behavioral characteristics described by parents and DSM criteria. The essential feature of ADHD is currently described as a “persistent pattern of inattention and/or hyperactivity-impulsivity that is more frequently displayed and more severe than is typically observed in individuals at a comparable level of development” (American Psychiatric Association, 2000, p. 85). The current diagnostic criteria contain five parts (A through E). Part A contains the often-cited 18 diagnostic symptoms; Part B requires that symptoms must cause impairment before age 7; Part C that impairment must be present in two or more settings; Part D that there is clear evidence “of clinically significant impairment in social, academic or occupational function” (American Psychiatric Association, 2000, p. 93); and finally, Part E requires that symptoms should not occur exclusively during the course of other conditions or be better accounted for by other mental disorders. One of those conditions mentioned, pervasive developmental disorder, has already been found to frequently be comorbid rather than a rule out for ADHD (Frazier et al., 2001; Goldstein & Schwebach, 2004). ADHD grew from a simple description to a set of diagnostic criteria based on an effort to provide empirical, statistically valid and reliable descriptors (McBurnett et al., 1999). Though a citation is made in the DSM-IV-TR that those with ADHD may demonstrate variability in IQ, the diagnostic criteria continue to reflect behavioral rather than cognitive manifestations. The quest to provide a cognitive profile for ADHD using traditional, general ability measures employing verbal and nonverbal tests or a variety of neuropsychological measures has been generally unsuccessful. However, we believe careful consideration should be given to the emerging research relative to cognitive processes. Cognitive processes could be incorporated into the DSM-V diagnostic criteria for ADHD. As the DSM-V will not be published until at least 2012, there is more than sufficient time to begin an organized course of research toward this end.

Coaching as a treatment for ADHD.

Ten years ago, psychiatrist Ned Hallowell (1995) authored a brief article based on his clinical experiences titled “Coaching: An Adjunct to the Treatment of ADHD.” In this article, Hallowell described frustration stemming from his inability to provide the daily support his patients with ADHD required to functionally negotiate life. Hallowell concluded that the daily lives of individuals with ADHD were dramatically enhanced beyond the benefits derived from medication or psychotherapy when a trained professional was available on a regular basis to provide guidance and consultation. Hallowell wrote,

Review of the Asperger Syndrome Diagnostic Scale.

The Aspergers Syndrome Diagnostic Scale (2001) was reviewed to determine its reliability, validity, and clinical utility in the diagnostic process for pervasive developmental disorder, specifically Aspergers syndrome. Concerns were raised about validity of the instrument, population upon which the instrument was normed, capability of the instrument to provide accurate differential diagnoses, and properties of the scale. The measure was determined to hold promise as a research tool, but there appears to be little evidence that it can distinguish among the various types of pervasive developmental disorder or diagnosis Asperger syndrome specifically.

The Power of Mindsets: Nurturing Engagement, Motivation, and Resilience in Students

In this chapter, three interrelated concepts—student engagement, motivation, and resilience—are examined through the lens of “mindsets.” Mindsets are assumptions that we possess about ourselves and others that guide our behavior. The mindset that educators hold about the factors that contribute to student engagement, motivation, and resilience determines their expectations, teaching practices, and relationships with students. We identify the key components of these three concepts, highlighting those that overlap. We distinguish between extrinsic and intrinsic motivation and the ways in which the latter is more closely attuned with student engagement and resilience than the former. We encourage the ongoing discussion of mindsets at staff meetings so that teachers become increasingly aware of the mindset of engaged, motivated learners and consider how to nurture this mindset in the classroom. We offer many strategies to facilitate the enrichment of this mindset in all students.

Continuity of ADHD in Adulthood: Hypothesis and Theory Meet Reality

This chapter deals with the hypothesis and continuity of Attention Deficit Hyperactivity Disorder (ADHD) in adulthood. The hypothesis concerning the continuity of ADHD into the adult years has become reality. Current theory for the etiology of ADHD is consistent with a lifetime presentation, reflecting developmental rather than a pathological difference between affected individuals and the general population. The consequences of living with the burden of a significantly disabling condition that reflects limited self-control, results in problems for an adult ADHD suffer. The condition serves as a risk factor, limiting their potential for academic and vocational achievement, as well as acting as a catalyst for comorbid psychiatric and life problems. This chapter concludes that much work remains to be done to understand the developmental course, risk, and protective factors involved in the adult outcome of ADHD, clinicians must increasingly turn their research and clinical attention to the care and treatment of affected adults.