Assessing self-control training in children with attention deficit hyperactivity disorder.

Abstract

It is believed that 3 to 5% of children in the United States meet the current diagnostic criteria for attention deficit hyperactivity disorder (ADHD), making it one of the most prevalent disorders in the school-age population (American Psychiatric Association, 2000). A diagnosis of ADHD requires the person to display the disorder's symptoms before the age of 7 and impairments must be manifested in two or more settings (e.g., neighborhood, home, school). Additionally, diagnosed ADHD symptoms must cause significant impairments in academic, social, and occupational functioning, which are not better accounted for by any other disorder. Children and adults who have ADHD display certain degrees of overactivity, impulsivity, and inattention in various situations (Root and Resnick, 2003). Neef, Mace, and Shade (1993) operationally defined impulsivity in basic and applied behavioral research as choices between concurrently available response alternatives that produce smaller reinforcers rather than larger delayed reinforcers. Conversely, self-control is defined as choices that yield relatively greater gains at a later point in time. ADHD, like other disruptive behavior disorders of childhood, is connected with low self-control skills (Strayhorn, 2002). Impulsivity is related to self-control deficiencies, which often involve a failure to think about the consequences of actions. Barkley (1997) suggests that children with ADHD tend to be less able to delay gratification and resist temptations and that the essential concern in ADHD is a deficit involving response inhibition. Neef et al. (2005) showed that the choices of children with ADHD are principally influenced by reinforcer immediacy and quality and least by rate and effort. Previous studies that attempted to increase self-control focused on two types of interventions. The first involved interventions that progressively increased the delay to a larger reinforcer (Dixon & Holcomb, 2000). These authors presented a choice between an immediate smaller reinforcer and a larger delayed reinforcer to two groups of dually diagnosed adults. They showed that this progressive delay increased self-control among the participants. The second type of intervention used to increase self-control extends the previous method of Dixon and Cummings (2001). It involves requiring the participant to be engaged in an activity during his or her wait time. Children were more successful in working for delayed rewards when they were asked to direct their attention away from the intervention (Strayhorn, 2002). Binder, Dixon, and Ghezzi (2000) suggested that the type of activity that the participants engage in was not critical to their ability to demonstrate self-control. The mere requirement of an intervening activity is as effective in decreasing impulsivity as requiring a rule describing the contingencies. Neef et al. (2001) showed that a combination of progressive wait times and concurrent activities in increasing self-control can produce transfer across untrained reinforcer dimensions. However, they do not provide information on the generalizability of self-control trainings or the effects in the participants' typical environments. The purpose of the present study was to assess the selfcontrol training procedures of progressive delays and progressive delays combined with a concurrent activity in the participants' typical environments. Method Participants All participants were African American males residing in therapeutic foster care. Richard (11 years old) and Bob (10) lived in urban areas of Philadelphia, PA, while Vincent (14) resided in a suburban area just outside of Philadelphia. Richard took Straterra (40 mg/day) for hyperactivity. Vincent and Bob were medication free during the course of the study. Settings All experimental sessions were conducted at the participants' homes or in a recreational area located directly outside the home. …