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Attention-deficit/hyperactivity disorder (ADHD) is a chronic neurodevelopmental disorder defined by pervasive symptoms of inattention, hyperactivity, and impulsivity. Furthermore, children with ADHD show marked deficits in executive functioning (EF) such as attention, effortful control, and behavior, and are more likely to have poor self-regulatory skills. Current evidence-based interventions for children with ADHD include behavioral treatment (BT), psychopharmacological treatment, and their combination. Many other interventions are often used conjunction with or in lieu of evidence-based treatments for ADHD. One such example is the use of mindfulness-based interventions which have been shown to improve attention, reduce maladaptive behaviors, and increase self-regulatory abilities among children in general education settings. The current study is the first to evaluate the effect of mindfulness intervention in combination with BT on behavior, task-based executive functioning (EF), and mindful awareness in elementary-aged children with ADHD (N = 58). The study took place in a controlled analogue summer program setting (STP) in which children were randomized to receive either the mindfulness intervention in conjunction with BT or to a BT active control condition. Children completed a variety of EF cognitive tasks at baseline and post-treatment. Child behavioral responses were measured as teacher and staff-recorded frequencies of observed behavior. In addition, parent-reported and child self-reported measures on mindful awareness were collected. Overall, there were no beneficial incremental effects of mindfulness when used in combination with intensive BT with regard to observed child behavior, attention and inhibitory control, or mindful awareness. [ABSTRACT FROM AUTHOR]

The conceptual overlap between mind-wandering and attention-deficit/hyperactivity disorder (ADHD)-related impairments is considerable, yet little experimental research examining this overlap among children is available. The current study aims to experimentally manipulate mind-wandering among children with and without ADHD and examine effects on task performance. Participants were 59 children with ADHD and 55 age-matched controls. Participants completed a novel mind-wandering sustained attention to response task (SART) that included non-self-referential and self-referential stimuli to experimentally increase self-referential mind-wandering, reflected by increases in reaction time variability (RTV) following self-referential stimuli. The ADHD group participated in a classroom study with analogue conditions aimed at encouraging self-referential future-oriented thinking (free play/movie before and after class work) compared to a control condition (newscast) and a cross-over methylphenidate trial. The significant interaction between ADHD status and self-referential stimuli on SART performance indicated that self-referential stimuli led to greater RTV among children with ADHD (within-subject d = 1.29) but not among controls. Methylphenidate significantly reduced RTV among youth with ADHD across self-referential (d = 1.07) and non-self-referential conditions (d = 0.72). In the ADHD classroom study, the significant interaction between mind-wandering condition and methylphenidate indicated that methylphenidate led to higher work completion (ds > 5.00), and the free-play mind-wandering condition had more consistent detrimental effects on productivity (ds ≥ 1.25) than the movie mind-wandering condition. This study is the first to manipulate mind-wandering and assess effects among children with ADHD using a behavioral task. Results provide evidence that children with ADHD are uniquely susceptible to mind-wandering interference. [ABSTRACT FROM AUTHOR]

Objective: Evaluate whether stimulant medication improves acquisition of academic material in children with attention deficit hyperactivity disorder (ADHD) receiving small-group, content-area instruction in a classroom setting. Method: Participants were 173 children between the ages of 7 and 12 years old (77% male, 86% Hispanic) who met Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for ADHD and were participating in a therapeutic summer camp. The design was a triple-masked, within-subject, AB/BA crossover trial. Children completed two consecutive phases of daily, 25-min instruction in both (a) subject-area content (science, social studies) and (b) vocabulary. Each phase was a standard instructional unit lasting for 3 weeks. Teachers and aides taught the material to small groups in a summer classroom setting. Each child was randomized to be medicated with daily osmotic-release oral system methylphenidate (OROS-MPH) during either the first or second of the instructional phases, receiving placebo during the other. Results: Medication had large, salutary, statistically significant effects on children's academic seatwork productivity and classroom behavior on every single day of the instructional period. However, there was no detectable effect of medication on learning the material taught during instruction: Children learned the same amount of subject-area and vocabulary content whether they were taking OROS-MPH or placebo during the instructional period. Conclusions: Acute effects of OROS-MPH on daily academic seatwork productivity and classroom behavior did not translate into improved learning of new academic material taught via small-group, evidence-based instruction. What is the public health significance of this article?: In this controlled study, there was no detectable impact of extended-release methylphenidate on the learning of units of academic material taught via small-group, evidence-based instruction. Methylphenidate improved seatwork productivity and classroom behavior, as in many previous studies, but these benefits did not translate into improved learning of academic material. [ABSTRACT FROM AUTHOR]

Variability in working memory (WM) task selection likely contributes to heterogeneity in effect size estimates of deficiencies in youth with attention-deficit/hyperactivity disorder (ADHD). This has resulted in the development of brief, easy to administer assessments such as the NIH List Sorting Working Memory (LSWM) task from the NIH Cognitive Toolbox in hopes of standardizing measurement of this construct. Unfortunately, substantial questions persist regarding the specific constructs being evaluated by this task (e.g., visuospatial [VS] or phonological [PH] WM) as well as the ability of this task to detect WM deficits in previously identified impaired groups (e.g., ADHD). The current study examines the extent to which the LSWM task is associated with VS and PHWM performance as well as symptoms of ADHD. Additionally, we examined the magnitude of differences between ADHD and Typically Developing (TD) youth on this task relative to empirically derived WM tasks utilized in the past. Forty-six children (25 ADHD, 21 TD) completed multiple WM tasks. The LSWM task was moderately associated with PHWM and demonstrated relatively weaker associations with VSWM. Symptoms of inattention and hyperactivity/impulsivity were unrelated to the LSWM task; whereas tasks assessing PH and VSWM were moderately associated with inattention and weakly associated with hyperactivity (VSWM only). No significant between-group differences in performance emerged on the LSWM task; however, significant large-magnitude group differences were observed on both the PH and VSWM tasks. These findings suggest that the LSWM task may lack the ability to detect WM difficulties in youth with ADHD. [ABSTRACT FROM AUTHOR]

Children with disruptive behavior disorders (DBD) and callous-unemotional traits (CU; i.e., lack of guilt, uncaring) are at risk for a variety of negative trajectories (Frick & White, 2008), and frequently exhibit poorer response-to-treatment than children without CU traits (Haas et al., 2010; Hawes & Dadds, 2005). The current single-case design study describes the process of developing individualized modifications of a Daily Report Card intervention for a nine-year, eleven-month-old boy receiving treatment for disruptive behavior and CU traits in the context of a highly controlled, well-staffed Summer Treatment Program setting. After the child showed an initial non-response to the standard components of the behavior modification program, several treatment adaptations were attempted to maximize treatment response. During the 8-week program, one strategy emerged as superior in which the child was not told which target behaviors were being evaluated until immediately before the reward was given ("mystery" Daily Report Card targets). Results are discussed in the context of ways in which treatment can be maximized for children with both DBD and co-occurring CU traits. Our findings suggest that clinicians who are working with children who initially demonstrate an insufficient response to treatment should consider using iterative, data-driven treatment planning and progress monitoring strategies. [ABSTRACT FROM AUTHOR]

Abstract: Although adolescents with attention-deficit/hyperactivity disorder (ADHD) experience serious life impairment (Molina et al., 2009; Wolraich et al., 2005), very few effective psychosocial interventions exist to treat this population (Pelham & Fabiano, 2008; Smith, Waschbusch, Willoughby, & Evans, 2000). Intensive child-directed interventions are an important component in the treatment of childhood ADHD (Pelham et al., 2005), yet no study exists that fully evaluates an intensive adolescent-directed intervention. The current investigation is a pilot study of 19 adolescents with ADHD (age range: 11-16) who participated in an 8-week intensive Summer Treatment Program–Adolescent (STP-A) during the summer of 2009. The program was developed to address specific difficulties associated with ADHD in adolescence. As such, the program was designed to be ecologically valid, age appropriate, and parent-involved. Results suggest that almost all adolescents who attended the STP-A benefitted from the program according to parent, self, and staff ratings and objective measures. These ratings also indicated that participants showed moderate improvement in each of the 6 domains targeted by treatment (i.e., conduct problems, adult-directed defiance, social functioning, inattention/disorganization, mood/well-being, and academic skills). All parents indicated that both they and their children benefitted from the program and all but 1 parent indicated that the STP-A was more effective than the treatments they had utilized in the past. A case example is presented to illustrate typical improvement patterns during the STP-A. Discussion addresses the role of the STP-A in the treatment of ADHD in adolescence. [Copyright &y& Elsevier]

As part of the behavioral treatment in the Multimodal Treatment Study of Children with ADHD (MTA9), children participated in an intensive summer treatment program (STP). This study examined the differences between 57 children in the combined treatment (Comb) group, who were medicated, and 60 children in the behavioral treatment (Beh) group, who were unmedicated throughout the STP. Comb children were significantly better than Beh on 5 measures: rule following, good sportsmanship, peer negative nominations, and STP teacher posttreatment ratings of inattention/overactivity. Groups did not differ on any of the other 30 measures, and responded similarly to the STP over time. Comparisons to normative data revealed that Comb children were more likely to fall within the normative range on 6 measures. The differences between these results and the main MTA results, in which Comb was always superior to Beh, are discussed in terms of the relative intensity of combined treatments. The implications for future studies of pharmacological and behavioral treatment for ADHD are discussed. [ABSTRACT FROM AUTHOR]

Current evidence-based, school-based interventions for children with attention deficit hyperactivity disorder (ADHD) include academic intervention, behavioral classroom management, and psychopharmacological intervention. However, some approaches that are commonly used have not been studied in controlled evaluations. The current study is the first rigorous evaluation of the effect of occupational therapy (OT) weighted vests and stability balls on classroom behavior and academic productivity in elementary-age children with ADHD (N = 64). The effect of psychostimulant medication and its combination with each of the OT interventions on classroom outcomes was also examined. The study consisted of a 2 (medication: methylphenidate, placebo) × 3 (OT intervention: stability ball, weighted vest, control) within-subjects design and was conducted over a 6-week period in a weekday, 60-min summer classroom. OT intervention was randomized daily within a medication crossover design. Overall, results indicated that medication but not weighted vest nor stability ball interventions resulted in improvement in two key areas of functioning in school settings: following classroom rules and academic productivity. [ABSTRACT FROM AUTHOR]

Children with attention deficit hyperactivity disorder (ADHD) make up a considerable proportion of students who receive special education services in schools. The present study aimed to enhance the outcomes of students with ADHD in special education settings by using a daily report card (DRC). Thirty-three children with ADHD in special education placements were randomly assigned to an intervention condition wherein behavioral consultants worked with the teacher and parent to construct and implement a DRC based on the child's individualized education plan goals and objectives. These children were compared to 30 children in a business as usual control condition. Results indicated positive effects of the DRC on observations of classroom functioning, individualized education plan goal attainment, and teacher ratings of academic productivity and disruptive behavior in the classroom. Further, a greater percentage of children with ADHD in the DRC group were normalized on measures of disruptive behavior and impairment. The intervention did not result in incremental improvement in academic achievement, teacher ratings of ADHD symptoms or impairment, or the student-teacher relationship. The implications of these results for working with children with ADHD in special education settings are discussed. [ABSTRACT FROM AUTHOR]