Diagnosis Of Attention Deficit Disorder Research Articles

Psychosocial Adjustment and Educational Outcome in Adolescents with a Childhood Diagnosis of Attention Deficit Disorder

To conduct a retrospective follow-up study of psychosocial adjustment and educational outcome in adolescents with a childhood diagnosis of attention deficit disorder (ADD) and a group of clinical controls. Groups included male and female subjects aged 14 to 18 years at time of follow-up with childhood diagnosis of ADD (cases; n = 48) versus other neurodevelopmental disorders (clinical controls; n = 37). Cases were also subdivided based on the presence of conduct disorder (CD) at follow-up. All groups were compared on measures of academic performance, self-esteem, behavior, alcohol and substance use, and adaptive functioning. Cases had significantly lower academic performance and poorer social, emotional, and adaptive functioning than clinical controls. Cases with CD had significantly lower academic performance, greater externalizing behaviors and emotional difficulties, and lower adaptive functioning than cases without CD. Cases with CD fared worse than clinical controls on self-report measures of behavior, socialization skills, and alcohol and substance use. These academic and psychosocial problems in adolescents with a childhood diagnosis of ADD suggest potential long-term ramifications for vocational and psychological functioning into adulthood. In addition, the presence of CD in some of these cases during adolescence appears to further increase the risk for maladaptive outcome.

DSM-IV field trials for attention deficit hyperactivity disorder in children and adolescents.

Optimal diagnostic thresholds were determined for DSM-IV attention deficit hyperactivity disorder, and the psychometric properties were compared to alternative definitions. Structured diagnostic interviews of multiple informants for 380 clinic-referred youths aged 4-17 years were conducted. In addition, standardized clinicians' validation diagnoses of attention deficit disorder were obtained to assess agreement with clinical judgment. Measures of impairment were obtained to assess the accuracy of identifying youth with an impairing condition. Three subtypes of attention deficit hyperactivity disorder (predominantly inattentive, predominantly hyperactive-impulsive, and combined types) were distinguished on the basis of the degree of deviance on separate dimensions of inattention and hyperactivity-impulsivity. These three subtypes were found to differ in terms of types of impairment, age, and sex ratio, but not ethnicity. In terms of case identification of attention deficit hyperactivity disorder, DSM-IV was found to be very similar to DSM-III-R, except that DSM-IV identified more impaired girls and preschool children. These results support the decision to subdivide the heterogeneous category of DSM-III-R attention deficit hyperactivity disorder into three subtypes. The resulting DSM-IV definition appears to be somewhat less biased toward the symptom pattern typical of elementary school boys.

Are tests of frontal lobe functions useful in the diagnosis of attention deficit disorders?

Abstract Nine neuropsychological tests presumed to assess various frontal lobe functions in children were evaluated for their accuracy in classifying children as having attention deficit disorders (ADD) with (ADD+H) and without hyperactivity (ADD-H). Four groups of children were evaluated: ADD+H (n=12), ADD-H (n=12), non-ADD learning disabled (LD) children (n=11), and a normal community control group (n=12). Results indicated low levels of sensitivity for the ADD groups. Positive predictive power (PPP) for the diagnosis of ADD+H was poor for eight of the tests reaching levels exceeding 50% only for the CPT commission score. Combining both ADD groups resulted in a PPP that approached or exceeded reasonably acceptable levels (90% or higher) for two tests: the CPT scores and the F-A-S version of the Controlled Oral Word Association Test. This led to a marked reduction in negative predictive power for these same tests, however. Hence, abnormal scores on these two tests may be predictive of ADDs, though not of...

Diagnosis of Attention Deficit Disorders in DSM-IV: Scientific Basis and Implications for Education

The category of attention deficit hyperactivity disorder (ADHD) and its diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM) have undergone numerous revisions. The history of these revisions is briefly presented, followed by a summary of results of the Field Trials for the forthcoming fourth edition, the DSM-IV, regarding ADHD. The revised symptom list and empirical determination of symptom cutpoints resulted in increased reliability and predictive validity for educational impairment, as operationalized by measures of academic productivity and accuracy, for the new criteria. Three subtypes emerged, including a new subtype of predominantly hyperactive. The relevance, functions, and limitations of DSM-IV diagnosis for educational assessment of ADHD are discussed.

Anxiety and depressive disorders in attention deficit disorder with hyperactivity: new findings.

The authors examined the discriminant validity of the diagnosis of attention deficit disorder with hyperactivity. They used standardized rating scales of life stresses and child and family functioning to assess psychosocial and family risk factors in 47 children who had the diagnosis of attention deficit disorder with hyperactivity, a matched group of 47 children in the community, and a matched group of 47 children seen in a psychiatric clinic. Children who had the diagnosis of attention deficit disorder and children in the psychiatric clinic reported significantly more depression and anxiety than did the children in the community; furthermore, children diagnosed as having attention deficit disorder with hyperactivity had more externalizing symptoms than did children in the psychiatric clinic. Children diagnosed as having attention deficit disorder with hyperactivity plus a comorbid anxiety or depressive disorder had higher levels of coexisting life stresses and parental symptoms than did children who had the single diagnosis of attention deficit disorder with hyperactivity. These results underscore the need for future studies to carefully assess children diagnosed as having attention deficit disorder with hyperactivity for concurrent psychiatric disorders as well as family and psychosocial stressors that may contribute to childhood symptoms. Such information is essential because different subtypes of attention deficit disorder with comorbid disorders may arise from different etiologic pathways, may require varying treatment options, and may foreshadow different eventual outcomes.

Are Attentional-Hyperactivity Deficits Unidimensional or Multidimensional Syndromes? Empirical Findings from a Community Survey

Factor analysis on teacher ratings of symptoms in a probability community sample of children aged 6 to 16 years ( N = 614) yielded two factors: Inattention and Hyperactivity-impulsivity. Subsequent cluster analyses on the scores of factorially derived scales for a subsample of 170 children with a diagnosis of attention deficit disorder with (ADDH) and without hyperactivity (ADDWO), or normals, resulted in five clusters that accounted for 88% of the variance. The existence of these clusters was confirmed using external validating criteria. The data support a bidimensional conceptualization of attention deficit disorder with hyperactivity, one dimension consisting of symptoms of inattention and another of symptoms of hyperactivity-impulsivity. The data also suggests that a condition very similar to the DSM-III-R description of undifferentiated attention-deficit disorder also exists as a distinct entity.

Methylphenidate Protocol: Feasibility in a Pediatric Practice

This report examines the feasibility of double blind individual trials of methylphenidate versus placebo in a general pediatric practice to assess benefit of this medication in the treatment of attention deficit disorder. Children presenting with the diagnosis of attention deficit disorder were enrolled in a three-week protocol. The first week was a baseline week during which teachers and parents completed the Connors rating scales. During the second and third weeks of each trial, placebo or methylphenidate was given for a week each in an unknown order to parents, teachers or the investigator. Respective Connors rating scales were also completed for each of these weeks. At the end of the third week, the three parent questionnaires and the three teacher questionnaires were returned to the investigator for scoring and disclosure about findings. During a pilot period, 53% of the trials were improperly completed. Reasons for this were addressed and with simple measures the rate of successful completion was raised to 83%. During the study phase, 43% of the children were found to be hyperactive but they did not benefit from medication. In six trials there was disagreement between teachers and parents. The completed trials and many of the incompleted trials were helpful in the assessment of the children with attention deficit disorder and their response to medication. It is felt that this approach is suitable for a private general pediatric practice.

Clinical Effects of Methylphenidate and Thioridazine in Intellectually Subaverage Children

Thirty children with subaverage IQs and psychiatric diagnoses of attention deficit disorder and/or conduct disorder took part in a double-blind study of placebo, methylphenidate, and thioridazine, which were given for 3 weeks each. The results showed a consistent and highly significant effect of methylphenidate in reducing teacher ratings of problem behavior. Parent ratings showed no behavioral effects for the group as a whole. An attentional model of stimulant drug response was used to divide subjects according to a cognitive maturity domain presumed to reflect selective attention. When divided according to breadth of attention, mental age, and IQ level, higher functioning subjects were found to show a generally favorable response to methylphenidate on both teacher and parent rating scales, whereas children of low functional level typically showed an adverse or indifferent response. The present data suggest that mental age and IQ may be important determinants of drug response; below a given level, there was a greatly reduced likelihood of responding positively. Clinical response to thioridazine was substantially less than the response to methylphenidate, with significant improvements confined to conduct and hyperactivity problems on teacher ratings.

Conditional Probabilities of Child Interview Symptoms in the Diagnosis of Attention Deficit Disorder

Based upon the standardized interviews of 76 clinic-referred boys, children's reports of behaviors suggestive of attention deficit disorder (ADD) were examined to determine which symptoms were most efficient predictors of an ADD diagnosis. Unlike previous research that has focused exclusively upon the use of sensitivity and specificity rates, this investigation also employed the conditional probability rates of positive and negative predictive power to establish the diagnostic utility of symptoms. As such, this study attempted to establish the diagnostic efficiency of some of the child-reported symptoms and describes a new method to examine any criteria set that is to be used for classification purposes. Results indicated that the optimal child-reported predictors of an ADD diagnosis were not those symptoms typically considered hallmark indicators of the disorder. In addition, no symptom was found to be an efficient exclusion criterion for diagnosis. These findings are discussed in terms of the role of the child as informant for the diagnosis of children's behavior disorders and the need for multisource assessment.

A family-genetic study of girls with DSM-III attention deficit disorder

The authors evaluated family-genetic risk factors in girls with attention deficit disorder and compared these results to findings in the authors' previous study of boys with attention deficit disorder. Twenty-one girls with attention deficit disorder and 20 normal comparison girls were consecutively ascertained from a pool of existing and new referrals from a pediatric psychopharmacology unit and a medical pediatric unit of the same urban hospital. First-degree relatives of the attention deficit disordered girls (N = 69) and of the normal girls (N = 71) were also assessed. Both groups of girls and their relatives were evaluated on the basis of structured diagnostic interviews conducted by raters who were blind to the clinical status of the probands. The relatives of the girls with attention deficit disorder had higher risks for attention deficit disorder, antisocial disorders, major depression, and anxiety disorders. The higher risk for attention deficit disorder could not be accounted for by gender or generation of relative, age of proband, social class, or family intactness. These findings are highly consistent with the findings in the authors' previous study of boys with attention deficit disorder, which was conducted with identical methods. This study provides further support for the validity of the diagnosis of attention deficit disorder in girls and suggests that the genders share a common biological substrate.

Individual and Combined Effects of Attention Deficits and Learning Disabilities on Computerized ADHD Assessment

The widespread use of computerized assessments in the diagnosis of attention deficit disorders (ADD/ADD-H) necessitates identification of factors that influence performance on these instruments. The individual and combined influence of two factors, attention deficits (determined by DSM-III) and learning disabilities (LD), on computerized ADHD assessment was evaluated in a clinic population of 253 children referred because of problems with attention or concentration, high activity levels, or poor academic achievement. Intelligence scores, levels of academic achievement, DSM-III diagnoses, parent and teacher rating scale data, and the presence of LDs were recorded. In ADD subjects, 66% also had one or more identified LD. In children without ADD, 64% were diagnosed as LD. Analyses of both summary scores (age-adjusted percentiles) and separate trial (raw) scores of a computerized assessment device indicated main effects for ADD/ADD-H on the continuous performance task (CPT) number correct and number of commissions. No main effect for LD was found. Delay task (DRL) results were not as clear; ADD effects were significant when raw scores, but not percentile scores, were used. It appears the computerized CPT task is influenced by ADD/ADD-H and is not affected independently by LD; however, age and IQmust be considered in such assessment. The delay task might not be as clinically useful.

Parent-based Diagnosis of Attention Deficit Disorder Predicts a Diagnosis Based on Teacher Report

The literature evaluating agreement between parent and teacher reports on symptoms of attention deficit disorder (ADD) has repeatedly shown only modest correlations between these two sources of information. A more relevant statistic to this clinical issue, however, is the positive predictive power, the conditional probability that diagnostic criteria will be met by teacher's report if that diagnosis has been made based on parental report. In a population of 43 children (ages 4 to 17) satisfying clinical criteria for DSM-III ADD, parents and teachers independently completed them module on ADD derived from the Diagnostic Interview for Children and Adolescents. Although correlations for individual symptoms were low to moderate, there was a 90% probability that the teacher report would result in a positive diagnosis given a positive parent diagnosis, indicating a very high probability that, in clinically referred children, a clinical diagnosis of ADD based on parent report will be corroborated by a teacher report.

Sustained attention in normal and in reading-disabled youngsters with and without ADDH

Three groups of children-one normal, one reading-disabled, and one reading-disabled with an additional diagnosis of attention deficit disorder with hyperactivity (ADDH)-were administered the Continuous Performance Test and compared on correct detections and three types of commission errors. All three groups showed a decline in sustained attention over the course of the task but not differentially according to diagnostic group. When younger and older subgroups were compared, the reading-disabled children were found to make significantly more correct detections with increased age, but not when the reading disability was accompanied by ADDH. The latter group of children also were differentiated by a type of commission error, previously associated with impulsive responding, that remained prominent in the older subgroup of dually diagnosed children. Reading-disabled children were differentiated by a second type of commission error which possibly was associated with inattention or short-term memory deficit and which diminished with age.

Juvenile Delinquency and Attention Deficit Disorder: Boys' Developmental Trajectories from Age 3 to Age 15

This article describes a longitudinal analysis of the behavior of a birth cohort of 435 boys. 4 groups were defined at age 13 on the basis of both self-reported delinquent behavior and professional diagnosis of Attention Deficit Disorder: ADD + delinquent, ADD only, delinquent only, and nondisordered. Biennial correlates of delinquency (antisocial behavior problems, verbal intelligence, reading difficulty, and family adversity) were traced across childhood. The ADD + delinquent boys consistently fared the worst on the assessments of family adversity, verbal intelligence, and reading. Their antisocial behavior began before school age, escalated at school entry, and persisted into adolescence. The ADD-only boys had normal family, intelligence, and reading scores, and showed only mild antisocial behavior in middle childhood. The delinquent-only boys showed no early risk from family, low intelligence, or reading deficit, and remained relatively free of conduct problems until they initiated delinquency at age 13. Persistence of criminal offending beyond adolescence is predicted for the ADD + delinquent boys.

Comparative effectiveness of carbamazepine and propranolol for rage outbursts

Eighty patients (randomly assigned in 51 cases) with diverse diagnoses, were prescribed propranolol or carbamazepine for temper outbursts. Results suggested that both medications were beneficial. The diagnosis of attention deficit disorder predicted preferential response to propranolol, and a diagnosis of intermittent explosive disorder predicted preferential response to carbamazepine. Results, however, were not entirely consistent and require confirmation.

Disorders of Attention and Activity Level in a Referral Population

Of 614 children referred for an evaluation of hyperactivity and inattention, the 422 (68.7%) who qualified for a diagnosis of attention deficit disorder (ADD) were compared with the 192 (31.3%) who did not. The children with ADD had significantly higher full-scale IQ scores, verbal scores, and parental educational levels. They also had a significantly higher incidence of specific learning disabilities (73.7%). The absence of hyperactivity in children with ADD further exaggerated the differences in learning disability between the two groups. Cognitive limitation, severe parental psychopathology, and child neglect/abuse were significantly higher in the group without ADD. The two groups did not differ in the incidence of parental or child depressive symptomatology, motor diagnoses, language disorders, conduct disorders, and psychosomatic complaints. That only 29 children in whom ADD was absent (4.7% of all referrals) had been given a trial of stimulant medication does not support the presence of a major abuse of such drugs in the community.

Some issues and Instruments for the Assessment of Attention-Deficit Hyperactivity Disorder in Puerto Rican Children

Found that teachers' ratings of a representative sample of 961 Puerto Rican 5- to 13-year-olds suggested an inordinately high number of students qualifying for a diagnosis of attention deficit disorder with hyperactivity (ADDH) or attention-deficit hyperactivity disorder (ADHD). There is a need to take into consideration sociocultural issues and the use of appropriate norms in this diagnosis. We describe two instruments that have been standardized for Puerto Rican children, the Inventario de Comportamiento Escolar (the School Behavior Inventory, a teacher rating Scale) and the Gordon Diagnostic System (a laboratory measure of inattention), and we present data and guidelines that could prove useful in assessing and diagnosing ADDH or ADHD in Puerto Rican children.

Dose-Response Effects of Methylphenidate on Academic Performance and Overt Behavior in Hyperactive Children

In the present study, the effects of 0.3 mg/kg and 1.0 mg/kg of methylphenidate on the overt behavior and academic functioning of 12 children with an established diagnosis of attention deficit disorder with hyperactivity were evaluated. A double-blind, placebo-control, within-subject (crossover) design was used, in which each child was tested four times in each drug condition. Drug conditions were alternated on a bidaily basis and each child received two different drug conditions each day. The academic tasks were designed for evaluation of the relationship between task complexity and dose. Whereas overt behavior improved with increasing dose, academic functioning was improved with methylphenidate, but did not vary with either dose or task complexity. Also, investigated were potential carryover effects of a morning dose of methylphenidate on performance in the afternoon. Behavioral and academic improvements produced by a dose of 0.3 mg/kg in the morning were no longer evident in the afternoon, but a morning dose of 1.0 mg/kg produced behavioral improvements that were clinically and statistically discernible in the afternoon, although the academic improvements had dissipated.

Effects of event rate and display time on sustained attention in hyperactive, normal, and control children.

Two experiments were conducted to determine whether hyperactive boys have a unique deficit in sustained attention. Groups with DSM-III diagnoses of attention deficit disorder (ADDH), conduct disorder (CD), ADDH + CD, and learning disorder were compared with normal controls on the Continuous Performance Task. In Experiment 1, stimulus presentation rate (stimulus onset asynchrony, SOA) and display time were varied to manipulate attentional demand, and speed and accuracy of performance were measured. The ADDH group was uniquely affected, with less accurate performance at the fastest and slowest SOA. To distinguish the effects of time on task and SOA, the duration of each SOA condition was held constant in Experiment 2. The poorer performance of the ADDH group at the fastest SOA was no longer evident. This finding indicates that the deficit of sustained attention in boys who have ADDH is associated with a greater susceptibility to refractory effects, which is influenced by practice.

Diagnosis and treatment of attention deficit disorder in two general hospital clinics.

In two clinics in military general hospitals, the charts of all children with a presumptive diagnosis of attention deficit disorder who were prescribed psychostimulants (N = 68) were audited to assess the quality of the primary physicians' evaluation and treatment. The audit instrument, constructed by a multidisciplinary team, indicated high interrater reliabilities, high face and concurrent validity, and moderate internal consistency. The audit found that only 51.5 percent of the children being treated with psychostimulants met the audit criteria for attention deficit disorder. A school intervention plan was documented in only 16.2 percent of the cases, and a psychotherapy intervention in only 19.1 percent; low rates were also found for other treatment and follow-up criteria. Overall, the assessment, the follow-up care, and the overall quality of care were found to be inadequate or less than adequate in about two-thirds of the cases.