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Controversy continues as to whether sluggish cognitive tempo (SCT) is a subtype of attention-deficit/hyperactivity disorder (ADHD) or a distinct disorder. This study examined differences between these disorders in demographics, executive functioning (EF), impairment, and prior professional diagnoses to address the issue. There were 1,800 children 6 to 17 years of age of both sexes from various U.S. ethnic backgrounds who were divided into four groups: (a) high SCT but not ADHD ("N" = 41), (b) high ADHD but not SCT ("N" = 95), (c) high in both SCT and ADHD ("N" = 61), and (d) the control group ("N" = 1,603). Besides providing demographics, parents completed scales assessing ADHD and SCT symptoms, EF deficits, and psychosocial impairment and reported their child's history of professional diagnoses. SCT symptoms formed two distinct but interrelated factors separate from those for ADHD. SCT differed from ADHD in demographics (age, sex ratio, parental education, income). ADHD was associated with more severe and pervasive EF deficits than SCT, whereas SCT was chiefly associated with mild deficits in Self-Organization. ADHD contributed far more variance to EF deficits than did SCT. Both disorders were impairing, but ADHD was more severely and pervasively so than SCT, especially in Home-School domains; SCT was most impairing in Community-Leisure domains. Different patterns of comorbidity were evident between SCT and ADHD. SCT showed less comorbidity and was particularly associated with depression. SCT may comprise a distinct disorder from ADHD but both may coexist in 39% to 59% of cases each. (Contains 4 tables.)

Objective: The present article reports on the discovery and translation of a chapter in a 1775 medical textbook by the German physician, Melchior Adam Weikard, which describes attention disorders. This article is believed to be the earliest reference to the syndrome that today is known as attention deficit hyperactivity disorder, or ADHD. Method: The authors briefly discuss previous efforts to identify the earliest description of ADHD thought to be the lectures of George Still in 1902 and subsequently, the medical textbook by the physician, Alexander Crichton, in 1798. Background is provided on Weikard followed by the English translation of his short chapter on attention deficits and the rationale for why it should be viewed as relevant to the history of ADHD. Results and Conclusions: The authors argue that Weikard's description in 1775 now deserves to be credited with providing the first description of attention disorders in the medical literature known to date. (Contains 12 notes.)

This study examined the latent structure and validity of inattention, hyperactivity-impulsivity, and sluggish cognitive tempo (SCT) symptomatology. We evaluated mother and teacher ratings of ADHD and SCT symptoms in 140 Puerto Rican children (55.7% males), ages 6 to 11 years, via factor and regression analyses. A three-factor model (inattention, hyperactivity-impulsivity, and SCT) provided the best fit for both sets of ratings. Inattention was the strongest correlate of lower scores on neuropsychological, achievement, and psychosocial measures. Externalizing problems were most strongly associated with hyperactivity-impulsivity, and internalizing problems were most strongly associated with parent-rated SCT and teacher-rated Inattention. SCT was not associated with executive function but was negatively associated with math. Inattention accounted for a disproportionate amount of ADHD-related impairment, which may explain the restricted discriminant validity of DSM-IV types. The distinct factors of hyperactivity-impulsivity and SCT had unique associations with impairing comorbidities and are roughly equivalent in predicting external correlates of ADHD-related impairment.

Experts recommend that clinicians evaluating adults for attention-deficit/hyperactivity disorder (ADHD) obtain information from others who know the patient well. The authors examined correspondence between the self- and other-ratings of ADHD symptoms and impairment using 3 groups of adults recruited on the basis of their severity of ADHD: ADHD diagnosis (n = 146), clinical controls self-referring for ADHD but not diagnosed (n = 97), and community controls (n = 109). The influences of diagnostic group, informant relationship, sex of participant, IQ, and comorbid anxiety and depression on self-informant disparities were also examined. Results indicated moderate to high agreement (0.59-0.80) between self and others on current functioning and slightly lower levels (0.53-0.75) between self- and parent-ratings of childhood functioning. Examination of difference scores between self- and other-ratings revealed small mean disparities (-0.1 to +5.0 points) but substantial variation (SDs = -2.4 to 8.9 points) for both current and childhood ratings. Clinic referrals not diagnosed with ADHD, particularly women, had higher disparities than was evident in the ADHD and community groups. Age, IQ, and education were not associated with disparities in most ratings. Higher anxiety, in contrast, was associated with greater disparities on all current and childhood measures of both ADHD and impairment. (Contains 4 tables.)

Objective: Emotional impulsiveness (EI) may be a central feature of attention-deficit/hyperactivity disorder (ADHD) contributing impairment beyond the two ADHD dimensions of inattention and hyperactivity-impulsivity. Method: We evaluated EI in hyperactive (N = 135) and control (N = 75) children followed to adulthood (mean age 27 years). The hyperactive cases were subdivided into those individuals whose ADHD persisted (ADHD-P) and did not persist (ADHD-NP) to adulthood. We examined the additional contribution of EI apart from ADHD symptoms to global ratings of impairment in 10 major life activities, adverse occupational and educational outcomes, criminal and driving outcomes, and money management difficulties at ages 21 and 27. Results: The ADHD-P group reported more EI symptoms than either the ADHD-NP or community control groups. EI uniquely contributed to seven of 10 major life domains and to overall impairment beyond ADHD symptoms. Severity of EI uniquely contributed to numerous impairments in occupational, educational, criminal, driving, and financial outcomes beyond ADHD symptoms. Conclusions: EI is as much a component of ADHD as are its two traditional dimensions and is associated with impairments beyond those contributed by the two traditional dimensions. (Contains 1 figure and 4 tables.)

Objective: There is a high risk of vehicular crashes, traffic citations, and poorer driving performance in adults with ADHD. This pilot study examines the value of a new nonstimulant (atomoxetine) for improving the driving performance of adults with ADHD. Method: Atomoxetine (1.2 mg/kg daily for 3 weeks) and a placebo are studied on 18 adults with ADHD (M age = 37 years) using ratings of ADHD symptoms, impairment, and safe driving behavior; a virtual reality driving simulator; and ratings of simulator performance. Results: Atomoxetine improves self-ratings of ADHD symptoms, impairments, safe driving behavior, and simulator driving performance. No effects of atomoxetine are evident on others' ratings of driving behavior or on the simulator. Practice effects on the simulator may have obscured those drug effects. Conclusion: The authors find a mixed pattern of results such that atomoxetine warrants further study for its effects on driving in this high-risk population. (Contains 3 tables.)

In this article, the author considers some issues concerning future research into school-based assessment and management of attention deficit hyperactivity disorder (ADHD). He focuses on a few issues of some relevance to school interventions for children and teens with ADHD. He features three articles that found that less intensive interventions were nearly as good if not equivalent to more intensive ones and that the positive implications that flow there from is worthy of notice and follow-up. Recent findings that ADHD in parents can significantly interfere with parent training and probably other interventions for ADHD deserves note among those studying school interventions. Although much has been done in the last 30 years to improve one's knowledge of how to manage ADHD in the school setting, the author points out that there is still much work to be done to improve the status quo for children and teens with ADHD.

This study reports on the leisure time, financial, gambling, and social activities of a large sample of children with hyperactivity (H group, N = 149) and children who served as a control group (CC group, N = 72) from the Southeastern Wisconsin (Milwaukee) region tracked for 13-15 years to young adulthood (ages 19--25, M = 20 years). Participant interviews were used to gather information on the amount of time they spent in various leisure activities, the amount of their monthly earnings and the proportion they spent on various expenses, and their gambling activities and amounts they expended in those activities. The results revealed that the H group spent significantly more hours engaged in watching television, listening to music, socialising on the telephone, and engaging in their hobbies relative to the control group. While the H group at this early stage of adulthood was earning more monthly income, no differences were found in the proportion of that income being spent on various categories of monthly expenditures except that the CC group paid a larger percentage of their income to credit card bills. This difference probably stems from more of the CC group having credit cards than the H group. Few group differences emerged in the specific kinds of gambling activities examined. Few group differences were evident in the closeness of family relationships as children, or currently, or in the number of social or dating relationships they enjoyed in high school or currently. The H group, however, had a lower quality of current dating relationships, fewer current close friends, more trouble keeping friends, and were more likely to argue with friends than those in the CC group. Findings also revealed that more of the H group had experienced going without food or shelter (homelessness) due to a lack of money since leaving high school, intimating that a subset of the H group may be having greater problems with adult self-sufficiency than those in the CC group. (Contains 5 tables.)

Objective: The authors report the adaptive functioning of hyperactive and control children in southeastern Wisconsin (Milwaukee) followed to young adulthood. Method: Interviews with participants concerning major life activities were collected between 1992 and 1996 and used along with employer ratings and high school records at the young adult follow-up (mean = 20 years, range 19-25) for this large sample of hyperactive (H; n = 149) and community control (CC; n = 72) children initially seen in 1978-1980 and studied for at least 13 years. Age, duration of follow-up, and IQ were statistically controlled as needed. Results: The H group had significantly lower educational performance and attainment, with 32% failing to complete high school. H group members had been fired from more jobs and manifested greater employer-rated attention-deficit/hyperactivity disorder and oppositional defiant disorder symptoms and lower job performance than the CC group. Socially, the H group had fewer close friends, more trouble keeping friends, and more social problems as rated by parents. Far more H than CC group members had become parents (38% versus 4%) and had been treated for sexually transmitted disease (16% versus 4%). Severity of lifetime conduct disorder was predictive of several of the most salient outcomes (failure to graduate, earlier sexual intercourse, early parenthood) whereas attention-deficit/hyperactivity disorder and oppositional defiant disorder at work were predictive of job performance and risk of being fired. Conclusions: These findings corroborate prior research and go further in identifying sexual activity and early parenthood as additional problematic domains of adaptive functioning at adulthood. (Contains 5 tables.)

In his lectures published in 1902, George Still described 43 children in his clinical practice who had serious problems with sustained attention and self-regulation. George Still certainly did not use the current terminology for this disorder, but many historians of attention deficit hyperactivity disorder (ADHD) have inferred that the children he described in his series of three published lectures to the Royal College of Physicians would likely have qualified for the current disorder of ADHD combined type, among other disorders. Still believed these children displayed a major "defect in moral control" that was relatively chronic in most cases. To Still, the moral control of behavior meant "the control of action in conformity with the idea of the good of all." Still concluded that a defect in moral control could arise as a function of three distinct impairments: (a) a defect of "cognitive relation to the environment," (b) a defect of "moral consciousness," and (c) a defect in "inhibitory volition." In this article, the author provides his views on Still's contentions. He contends that Still cannot be faulted for not recommending interventions for children with attention problems. Special educational services were unheard of in Still's time. The author wants to applaud Still's efforts for his careful observations and thoughtfully reasoned conclusions about his clinical cases that would prove to be a historical beginning not only to the field of ADHD but also to the study of child psychopathology more generally.

Diagnosing ADHD based primarily on symptom reports assumes that the number/frequency of symptoms is tied closely to the impairment imposed on an individual's functioning. That presumed linkage encourages diagnosis more by "Diagnostic and Statistical Manual of Mental Disorders" (4th ed.) style symptom lists than well-defined, psychometrically sound assessments of impairment. The current study correlated measures reflecting each construct in four separate, large-scale ADHD research samples. Average correlation between symptoms and impairment accounted for less than 10% of variance. Symptoms never predicted more than 25% of the variance in impairment. When an ADHD group was formed according to a measure of current symptoms, the sample size shrunk by 77% when a criterion-based measure of impairment was added. The partial unlinking of symptoms and impairment has implications for decisions about the diagnostic process, research criteria for participant inclusion, prevalence estimates, gender ratios, evaluation of treatment effects, service delivery, and many other issues. (Contains 6 tables.)

Research on children with ADHD indicates an association with inaccuracy of self-appraisal. This study examines the accuracy of self-evaluations in clinic-referred adults diagnosed with ADHD. Self-assessments and performance measures of driving in naturalistic settings and on a virtual-reality driving simulator are used to assess accuracy of self-evaluations. The group diagnosed with ADHD (n= 44) has a higher rate of collisions, speeding tickets, and total driving citations in their driving history; report less use of safe driving behaviors in naturalistic settings; and use fewer safe driving behaviors in the simulator than the community comparison group (n= 44). Despite poorer performance, adults with ADHD provide similar driving self-assessments, thereby overestimating in naturalistic settings to a greater degree than the comparison group. These findings extend research in children with ADHD to an adult sample in an important domain of functioning and may relate to findings of executive deficits associated with ADHD. (Contains 5 tables and 2 notes.)

This study compared Hispanic children (ages 7 to 11) with combined type (CT, n = 33) and inattentive type (IT, n = 21) attention deficit hyperactivity disorder (ADHD) and a control group (n = 25) on time-estimation and time-reproduction tasks. The ADHD groups showed larger errors in time reproduction but not in time estimation than the control group, and the groups did not differ from each other on their performance on this task. Individual differences could not be accounted for by oppositional-defiance ratings and low math or reading scores. Although various measures of executive functioning did not make significant unique contributions to time estimation performance, those of interference control and nonverbal working memory did so to the time-reproduction task. Findings suggest that ADHD is associated with a specific impairment in the capacity to reproduce rather than estimate time durations and that this may be related to the children's deficits in inhibition and working memory.

Background: Hyperactive/ADHD children are believed to be a greater risk for adolescent and young adult antisocial activity and drug use/abuse, particularly that subset having comorbid conduct problems/disorder. Method: We report on the lifetime antisocial activities and illegal drug use self-reported at young adult follow-up (mean age 20-21 years; 13+ year follow-up) for a large sample of hyperactive (H; N = 147) and community control (CC; N = 73) children. Parent reports of childhood hyperactivity and conduct problems at study entry, parent and self-reports of ADHD and conduct disorder at adolescence, and parent reports of ADHD at young adulthood are examined for their contribution to antisocial behavior and drug use at adulthood. Results: More of the H group committed a variety of antisocial acts and had been arrested for doing so (corroborated through official arrest records) than did the CC group. The H group also committed a higher frequency of property theft, disorderly conduct, assault with fists, carrying a concealed weapon, and illegal drug possession, as well as more arrests. These activities reduced to two dimensions corresponding to predatory-overt and drug-related antisocial conduct. The H group differed from the CC group only on the latter dimension. Childhood, adolescent, and adult ADHD predicted higher drug-related activities, as did childhood conduct problems. The H group with conduct disorder (CD) reported greater use of most substances than did the H only or CC groups, who did not differ from each other. Severity of teen ADHD and especially lifetime CD predicted use of hard drugs while just lifetime CD predicted marijuana/LSD use. Teen drug use seemed to potentiate increased drug-related antisocial activities beyond the contribution made by teen CD. Conclusions: Hyperactive children are at greater risk for antisocial activities and arrests by young adulthood that appear to be principally associated with illegal drug possession, use, and sale. The having CD, however, appear to engage in greater and more diverse substance use.

This article summarizes the literature on attention deficit disorders (both with and without hyperactivity), diagnostic criteria, the disorder's prevalence, developmental course, and proposed etiologies. A conceptual framework for designing a comprehensive assessment battery is presented with specific attention to the relationship between attention deficits and language disorders. (Author/DB)

Randomized adolescents with attention-deficit hyperactivity disorder to 8-10 sessions of behavior management training (n=20), problem-solving and communication training (n=21), or structural family therapy (n=20). All treatments resulted in significant reductions in negative communication, conflicts, and anger during conflicts and improved ratings of school adjustment, reduced internalizing and externalizing symptoms, and decreased maternal depressive symptoms. (Author/NB)

Compared 48 children with attention deficit disorder with hyperactivity (ADD+H), with 42 without hyperactivity, and with learning-disabled and control children. ADD+H children had more externalizing and internalizing symptoms, were more off task during testing, and had more family substance abuse, ADD+H, and aggression. Results suggest two types of ADD may be separate childhood disorders. (Author/NB)

The discussion of the Blau (1936) article continues the welcome tradition established in this journal in acquainting readers with historically important articles in the history of ADHD. That history began with efforts to understand the functions of the brain likely to be impaired from injury to various brain regions and especially the frontal lobes (Bianchi, 1895). As the author has noted in previous commentaries accompanying other historical pieces, efforts to understand ADHD actually began as attempts to understand the psychological sequelae of various forms of brain injury. Among these early clinical studies, almost all of which were descriptions of series of clinical cases evaluated by the various authors, this article by Blau (1936) stands out as significant due to its focus on children who had sustained various forms of traumatic brain injury. In this commentary, the author discusses Blau's remarkable summation of observations on the behavior of children with traumatic brain injuries.

Commenting on an historically significant article by A. T. Childers ("Hyper-Activity in Children Having Behavior Disorders," "American Journal of Orthopsychiatry," 5:227-243 1935), Barkley states that it is evident that the Childers' article deserves a place of importance in the history of ADHD, as much of what Childers found to be associated with hyperactivity in children has since been substantiated in thousands of scientific studies. Although some of Childers' observations proved incorrect, this is understandable given the larger professional context in which he practiced at the time, and the exceptionally limited scientific methods available for evaluating his samples with regard to their psychological, psychiatric, neurological, and genetic features. Overall, it can be said that the work done by Childers resulted in a legacy of substantial information about hyperactivity in children, much of which is still applicable today.

Observed the mother-child interactions of three age groups of hyperactive children (N=54) during free play and task settings using two dose levels of Ritalin. Results indicated that the interactions of hyperactive boys with their mothers improve with age, and that Ritalin produces further improvements regardless of age examined. (LLL)

Mother/child interactions of 60 hyperactive children 5, 6, 7, 8 and 9 years of age were studied during free play and task periods. Significant age effects and several drug effects were found in the task period. Drug effects were essentially the same across all five age levels. (Author/RH)

Hyperactive children were less compliant and more negative than were nonhyperactive controls, and their mothers responded more negatively to their compliance than mothers of nonhyperactive children. Mothers of hyperactive children reported more psychological difficulties in relatives and rated their children as more deviant than nonhyperactive children. Differential treatment of boys was found. (Author/RH)

The nature of behavioral deficiencies in children with Attention Deficit Disorders are briefly described. The use of group parent training is recommended as the most cost-effective method for helping parents. Steps involved in implementing such a program and a case example are provided. (Author/DB)

Groups of 20 normal and 20 hyperactive boys ranging in age from 6 to 12 years were observed interacting with their mothers in 15-minute free-play and 15-minute structured-task situations. (JMB)

Research is reviewed on the effects of stimulant drugs on the classroom behavior and academic achievement of hyperactive children. Results indicate that stimulant drugs do not appreciably improve academic achievement, but are effective in improving attention span, on-task behavior, activity level, and disruptive behavior. (Author/MH)

The effectiveness of a package of self-control procedures in a classroom with six hyperactive boys ages 7 to 10 was investigated. Results indicated that the self-control package was effective in improving misbehavior and attention to tasks during the individual seat work but not during group instruction. (Author)

Results of the study involving 14 hyperactive boys (5-12 years old) indicated that activity and attention span are affected by methylphenidate even in highly stimulating, informal settings. (Author/SBH)

Verbal interactions of 18 hyperactive boys (8 to 11 years old) with their mothers during 15-minute free play and task periods were studied and compared to interactions of 18 normal boys with their mothers. Both hyperactive boys and their mothers were found to use significantly more utterances in free play than normal mother-child dyads. (Author/SEW)

Dr. Goldstein continues the laudable practice of reprinting articles of historical significance in the history of ADHD with this selective reprinting of material from the original article by Maurice Laufer, Eric Denhoff, and Gerald Solomons on hyperkinetic impulsive disorder (HID) in children. This article on HID is among the first articles to distinguish a group of children who were seriously hyperactive and impulsive yet who did not have evidence by history of significant brain injury. It also signaled a return to focusing on child behavioral disorders in 1957 after a hiatus in which two World Wars preoccupied the general population and medical professionals alike. In this article, all of the major symptom dimensions that would go on to characterize both minimal brain dysfunction and eventually ADHD were noted, including short attention span, variability of behavior and work performance, impulsiveness, and emotional dysregulation. The authors recommended a combination of treatment approaches, including amphetamine, counseling of the parents, and psychotherapy for the child--a treatment package only modestly different from that recommended today. The exception is that psychotherapy has not proven to be of much value for management of the disorder. Nevertheless, use of ADHD medications, parent training, and school interventions would be considered the mainstay of modern treatment for children with ADHD. From an historical perspective, this article was also of considerable significance because it argued for a time-limited course of the disorder that was most likely to be outgrown by adolescence. It is this article that established the clinical opinion at the time that HID would be "overcome by the operation of normal maturational processes" typically by adolescence. That opinion turned out to be incorrect as many children with HID (ADHD) have since been found to have a quite persistent disorder into adulthood, although perhaps 14% to 35% may eventually recover from it by their late 20s.