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Objective: This study examined trajectories of inattention and hyperactivity/impulsivity symptom levels across one preschool year and explored variation in trajectories by age, sex, and end-of-year impairment. Method: Participants were 261 preschoolers (87% Head Start; 59% Caucasian; 53% boys; Mage = 3.97 years). Teachers rated ADHD symptom levels four times throughout one academic year. Results: Results showed a course of increasing inattention that decelerated over time and steadily increasing hyperactivity/impulsivity. Group-based finite mixture modeling revealed three trajectories of inattention: stable low (57%), change (32%), and stable high (11%), as well as three trajectories of hyperactivity/impulsivity: stable low (63%), increasing (26%), and stable high (11%). Compared to children with increasing or changing symptoms levels, children with stable high levels were more impaired and children with stable low symptom levels were less impaired. Conclusion: Findings suggest a “wait and see” approach to treatment may miss an important opportunity for early intervention.

Peer problems are common among children with emotional and behavioral disorders (EBD). However, the extent to which children’s peer functioning varies across settings is unknown, as is the incremental power of peer functioning in different settings in predicting subsequent psychopathology. Participants were 57 children with Attention-Deficit/Hyperactivity Disorder (ADHD) who had peer sociometric nominations collected in general education classrooms and a Summer Treatment Program (STP) with all-EBD peers. Significant, small-to-medium correlations existed between nomination rates across settings. Lower rates of STP positive nominations and higher rates of STP negative nominations (but not classroom nominations) predicted exacerbated self-reported depression and antisocial behavior 1 year later. Lower rates of STP positive nominations, but higher rates of classroom positive nominations, predicted increased self-reported depression 2 years later. For children with high rates of classroom positive nominations, higher rates of STP positive nominations predicted reduced parent-reported internalizing behavior 1 year later. For children with low rates of classroom negative nominations, higher rates of STP negative nominations predicted increased teacher-reported externalizing behavior 1 year later and self-reported depression 2 years later. Results suggest that sociometric nominations collected within an EBD peer group may have stronger predictive power for later adjustment than nominations collected in a mainstream classroom.

The current study examined the incremental utility of rating scales, a structured diagnostic interview, and multiple informants in a comprehensive assessment of attention-deficit/hyperactivity disorder (ADHD). The sample included 185 children with ADHD ( Mage = 9.22, SD = 0.95) and 82 children without ADHD ( Mage = 9.24, SD = 0.88). Logistic regressions were used to examine the incremental contribution of each method within an assessment of ADHD. Results indicated that information collected from a structured diagnostic interview was unable to significantly improve a prediction model including parent and teacher ratings (Block χ2 = 0.91, ρ = .64). Teacher ratings on symptom-based scales resulted in significant model improvement beyond parent ratings alone (Block χ2 = 48.47, ρ < .001). Exploratory analyses indicated that using behavioral rating scales correctly classified all participants by diagnosis. Clinical implications are highlighted, and future research directions are discussed.

Objective: Physical activity associates with mental health and neurocognitive function, showing potential for addressing ADHD symptoms. As a preliminary assessment of this potential, the authors piloted a before-school physical activity intervention for young children. Method: Seventeen children (Grades K-3) exhibiting four or more hyperactivity/impulsivity symptoms on the Disruptive Behavior Disorders Rating Scale (Pelham, 2002) completed about 26 min of continuous moderate-to-vigorous physical activity daily over eight school weeks. The authors administered cognitive, motor, social, and behavioral functioning measures at pre- and postprogram, assessed response inhibition weekly, and coded negative behaviors daily. Results: Several measures showed significant or marginally significant change over time (effect size = 0.35-0.96) with additional measures showing meaningful effect size values (≥ 0.20). Response inhibition effects were most consistent. Most participants (64% to 71%) exhibited overall improvement according to postprogram parent, teacher, and program staff ratings. Conclusion: Physical activity shows promise for addressing ADHD symptoms in young children.

Mothers and fathers often disagree in their ratings of child behavior, as evidenced clinically and as supported by a substantial literature examining parental agreement on broadband rating scales. The present study examined mother—father agreement on Diagnostic and Statistical Manual—based symptom-specific ratings of Attention-Deficit/Hyperactivity Disorder (ADHD), as compared to agreement on broadband ratings of externalizing behavior. Based on mother and father ratings of 324 children who participated in the Multimodal Treatment Study of Children with ADHD (MTA), parental agreement was computed and patterns of disagreement examined. Mother—father ratings were significantly correlated; however, a clear pattern of higher ratings by mothers was present. Agreement on attention-deficit/hyperactivity disorder symptom-specific ratings was significantly lower than that for broadband externalizing behaviors and oppositional defiant disorder symptoms. Of several moderator variables tested, parental stress was the only one that predicted the discrepancy in ratings. Disagreement between parents is clinically significant and may pose complications to the diagnostic process.

ObjectivePast research suggests that many children with behavior problems display overly positive self-views (“positive illusions”); some researchers have hypothesized that these positive illusions may prevent these children from improving their behavior. This research investigates positive illusions in the behavioral domain as a moderator and mediator of the relation between ADHD status and behavior in a summer program setting.MethodBoys with ADHD and comparison boys rated their own behavioral competence; discrepancies between these self-ratings and the reports of boys’ teachers served as an index of behavioral positive illusions. Dependent variables were derived from a behavioral point system that provided specific data about boys’ positive and negative behaviors and from counselor ratings of behavior.Results/ConclusionHierarchical multiple regression analyses revealed no evidence supporting a moderational association, although ADHD status and behavioral positive illusions were additive predictors of the dependent variables. Post hoc analyses revealed a pattern of mediational effects that were strongest for dependent variables assessing conduct problem behaviors. (J. of Att. Dis. 2008; 12(3) 227-238)

Objective: To review and provide details about the primary and secondary findings from the Multimodal Treatment study of ADHD (MTA) published during the past decade as three sets of articles. Method: In the second of a two part article, we provide additional background and detail required by the complexity of the MTA to address confusion and controversy about the findings outlined in part I (the Executive Summary). Results: We present details about the gold standard used to produce scientific evidence, the randomized clinical trial (RCT), which we applied to evaluate the long-term effects of two well-established unimodal treatments, Medication Management (MedMGT) and behavior therapy (Beh), the multimodal combination (Comb), and treatment “as usual” in the community (CC). For each of the first three assessment points defined by RCT methods and included in intent-to-treat analyses, we discuss our definition of evidence from the MTA, interpretation of the serial presentations of findings at each assessment point with a different definition of long-term varying from weeks to years, and qualification of the interim conclusions about long-term effects of treatments for ADHD based on many exploratory analyses described in additional published articles. Conclusions: Using a question and answer format, we discuss the possible clinical relevance of the MTA and present some practical suggestions based on current knowledge and uncertainties facing families, clinicians, and investigators regarding the long-term use of stimulant medication and behavioral therapy in the treatment of children with ADHD. (J. of Att. Dis. 2008; 12(1) 15-43)

Objective: Children with ADHD experience peer problems that may place them at risk for adverse outcomes. Using a short-term longitudinal design, this study links specific behaviors to peer functioning in groups of previously unfamiliar children with ADHD. Method: The participants were 268 children with ADHD who took part in an intensive summer treatment program. The program used a comprehensive behavioral point system that yielded observational data for 12 behavioral categories. These behavioral categories were used to predict peer acceptance, rejection, and liking assessed at three times during the program. Results: Following activity rules, helping, whining, and attention emerged as best predictors of initial peer status. Subsequent helping behaviors and activity rule following predicted changes in peer status, but their contributions were small. Conclusion: The results indicate that increasing helping and rule- following behaviors may improve peer functioning of children with ADHD in similar settings. (J. of Att. Dis. 2007; 10(4) 359-371)

In this study, the authors examined the association between childhood attention-deficit/hyperactivity disorder (ADHD) and anxiety and mood disorders in adolescence.They compared a group of 142 adolescents ages 13 to 18 years with a history of ADHD in childhood to group of 100 community-recruited adolescents without ADHD.The two groups did not differ in rates of anxiety and mood disorders in adolescence.Within the ADHD group, however, anxiety and mood disorders in adolescence were predicted by childhood externalizing disorder symptoms and social problems but not by childhood internalizing disorder symptoms.The current findings provided little evidence of an overall increased risk for anxiety and mood disorders in adolescents who had childhoodADHD.Children with ADHD who have more severe externalizing symptoms and social problems in childhood may be at elevated risk for certain internalizing disorders.

The associations between measures of friendship and popularity derived from nomination and rating scales procedures were studied with a sample of school-age and early adolescent boys and girls. Confirmatory factor analyses and comparisons of the correlations among these measures showed that each of these techniques can provide parallel measures of popularity (i.e. sociometric preference) and friendship (i.e. whether the child is participating in a mutual friendship). These findings are discussed in regard to measurement issues in the study of friendship and popularity.

The Friendship Qualities Scale is a theoretically grounded, multidimensional measurement instrument to assess the quality of children's and early adolescents' relationships with their best friends according to five conceptually meaningful aspects of the friendship relation. These dimensions are companionship, conflict, help/aid, security and closeness. A confirmatory factor analysis, used to evaluate the factor structure of this instrument, demonstrated that these scales represented distinct, but related, domains of friendship. Assessments of reliability indicated the high level of internal consistency within each dimension. The validity of the scale was indicated by the observation of higher ratings for (a) mutual friends than for non-mutual friends, and (b) for stable friends than for non-stable friends. These findings are discussed according to the theoretical and practical issues related to the measurement of friendship quality.

Within the context of two case studies, the effects of two doses of methylphenidate (MPH) and behavioral interventions of varying potency are examined independently and jointly. Whereas studies of dose effects of MPH exist in the current literature, studies of different "doses" of behavior therapy-that is, interventions that vary in potency--are rare. This article uses a within-subjects design to demonstrate the importance of examining different doses of both types of treatments in determining the maximally effective treatment for a given child. The importance of considering individual differences is emphasized throughout this article as response to treatment among Attention-Deficit Hyperactivity Disorder children is quite variable. Case 1 illustrates the importance of evaluating medication response within the context of differing doses of behavior therapy; Case 2 demonstrates that difficult-to-manage cases are sometimes manageable using potent doses of both treatments simultaneously.

Stability and change in early adolescents' friendship conceptions were examined in a one-year longitudinal study. Once during sixth grade, and again during seventh grade, 99 girls and 98 boys were asked to rate 14 items according to how important each item was for friendship. These items were grouped according to the results of a factor analysis into three clusters referred to as Commonality, Help/Support, and Intimacy. A multivariate analysis of variance, followed by planned comparisons and simple effects tests, revealed: (a) a decrese over time in the importance ascribed to the Commonality cluster; (b) a decrease over time in the boys' ratings on the Help/Support cluster, but no change in the girls' ratings on this cluster; (c) no change over time in the ratings on the Intimacy cluster; (d) higher ratings from the girls than the boys for the Intimacy and Help/Support clusters, with the differences on the Help/Support cluster becoming larger over time; and (e) relatively higher ratings for the Help/Support cluster than for the Intimacy or Commonality clusters. The correlations computed between respective clusters across the one year interval indicate a moderate degree of stability in early adolescents' friendship conceptions. These results are discussed in light of previous research on children's friendship conceptions and in regard to the social experiences of boys and girls during early adolescence.