Abstract Attention deficit hyperactivity disorder (ADHD) and disruptive behavior disorder (DBD) are two very common and co-occurring psychiatric disorders among children and adolescents. They are among the leading reasons for clinical referrals to child and adolescent mental health facilities worldwide and have many unfavorable consequences with a high cost to society. In this thesis, the potential early risk factors associated with ADHD and/or DBD were examined, the current well-being of the adolescent with ADHD and/or DBD was evaluated and the later education and the psychiatric morbidity of the adolescent were researched. The study population in this thesis is based on a subsample of the Northern Finland Birth Cohort 1986 (NFBC 1986) containing 457 study subjects, of which 91 (19.9%) were diagnosed with ADHD, 44 (9.6%) with DBD, 72 (15.6%) with comorbid ADHD and DBD and 250 (54.7%) with neither of these disorders. Confirmatory factor analysis, Kaplan-Meier survival analysis, Kruskal-Wallis one-way analysis of variance and several regression analyses were carried out in the study. This thesis contains four original publications. The results in the first publication indicated that there are different risk factors in childhood associating with different behavioral problems in adolescence. The differences between behavioral problems were also visible in the results of the second publication, where those adolescents who were diagnosed with both ADHD and DBD had more severe conduct disorder symptoms and had increased risks for many psychiatric disorders. The results from the third publication suggested that those adolescents who were diagnosed with both ADHD and DBD fared worse in school at the end of ninth grade and were later less likely to achieve higher than basic education. Finally, the fourth publication showed that the adolescents diagnosed with DBD (both with and without ADHD) seemed to have an increased risk for admittance to the psychiatric inpatient hospital. This thesis underlines the differences between children and adolescents diagnosed with ADHD and/or DBD and emphasizes the role of comorbidity between these disorders as an indicator of poorer outcomes later in life. / Tiivistelmä Tarkkaavaisuus- ja ylivilkkaushäiriö (attention deficit hyperactivity disorder, ADHD) sekä käytös- ja uhmakkuushäiriöt (disruptive behavior disorder, DBD) ovat hyvin yleisiä – ja usein yhtä aikaa ilmeneviä – lasten ja nuorten psyykkisiä häiriöitä. Nämä häiriöt ovat hyvin usein syynä lasten ja nuorten psykiatristen terveyspalveluiden käyttöön. Niillä on myös todettu olevan useita epätoivottuja seurauksia, joiden hoitaminen puolestaan nostaa yhteiskunnan kuluja. Tämä väitöskirjatyö tutkii mahdollisia varhaisia riskitekijöitä, jotka assosioituivat ADHD- ja/tai DBD-häiriöiden kanssa, arvioi näillä häiriöillä diagnosoitujen nuorten sen hetkistä hyvinvointia ja tutkii näiden nuorten kouluttautumista sekä muuta psykiatrista sairastavuutta. Tutkimusaineisto koostuu Pohjois-Suomen syntymäkohortti 1986 (Northern Finland Birth Cohort 1986, NFBC 1986) -aineiston osaotoksesta, johon kuuluu 457 henkilöä. Osaotoksesta 91:llä (19,9 %) oli diagnosoitu ADHD, 44:llä (9,6 %) DBD ja 72:lla (15,6 %) komorbidi ADHD ja DBD. 250 henkilöllä (54,7 %) osaotoksesta ei ollut diagnosoitu kumpaakaan diagnoosia. Aineiston analysoinnissa käytettiin konfirmatorista faktorianalyysiä, Kaplan-Meierin elossaolomenetelmää, Kruskal-Wallisin yksisuuntaista varianssianalyysiä ja useita regressioanalyysejä. Tämä väitöskirja koostuu neljästä osajulkaisusta. Ensimmäisen osajulkaisun tulokset osoittivat, että eri riskitekijät lapsuudessa assosioituivat eri käytösongelmiin nuoruudessa. Eri käytösongelmien eroavaisuudet olivat myös nähtävillä toisessa osajulkaisussa: niillä nuorilla, joilla oli diagnosoitu komorbidi ADHD ja DBD, todettiin olevan vakavampia käytöshäiriöiden oireita sekä kohonnut riski useisiin muihin psykiatrisiin sairauksiin. Kolmannen osajulkaisun tulokset viittasivat näiden nuorien, jotka oli diagnosoitu komorbidillä ADHD:lla ja DBD:llä, pärjäävän huonommin koulussa ja valmistuvan muita todennäköisemmin vain peruskoulusta. Lopuksi neljännessä osajulkaisussa todettiin, että DBD diagnoosin nuorena saaneilla (riippumatta ADHD diagnoosista) näytti olevan kohonnut riski psykiatriseen osastohoitoon joutumiselle. Tämä väitöskirjatyö alleviivaa tarkkaavaisuus- ja ylivilkkaushäiriöllä sekä käytös- ja uhmakkuushäiriöillä diagnosoitujen lasten ja nuorten eroavaisuuksia ja korostaa kyseisten häiriöiden komorbidin ilmenemisen roolia huonon lopputuloksen ennustetekijänä myöhemmin nuoren elämässä.

AFRIKAANS: In hierdie navorsing is deur aksienavorsing ondersoek ingestel na strategieë wat vir opvoeders bruikbaar is in die hantering van leerders met emosionele en gedragsbehoeftes binne die opset van insluitende onderwys. Leerders in Suid-Afrikaanse skole en klaskamers openbaar ʼn wye verskeidenheid emosionele en gedragsbehoeftes, en hierdie behoeftes word as een van die vernaamste knelpunte deur alle belanghebbendes in die land se onderwys uitgesonder. Anders as in die verlede word daar nou van opvoeders verwag om die primêre hulpverleners te wees van leerders met behoeftes in die konteks van die insluitende klaskamer. In die lig hiervan benodig opvoeders bemagtiging om die leerders te hanteer deur ’n verskeidenheid strategieë te kan gebruik. Die navorsing het deur verskeie fases verloop waar die aanvanklike behoeftes van die opvoeders bepaal is, asook die stand van sake voor die intervensie. Op grond hiervan is ʼn implementeringsprogram saamgestel wat gefokus het op die ontwikkeling van strategieë vir opvoeders van die twee skole, die toepassing daarvan in hul klasse/skool en die effek wat dit op die klasse/skool gehad het. Die implementering is op verskeie sistemiese vlakke gemoniteer – deur die opvoeders in hul eie klasse, maar ook deur eksterne waarnemers en die navorser. Gedurende die fases is die intervensie voortdurend aangepas namate nuwe behoeftes bekend geraak het. Die deelnemers het ook insette gelewer ten opsigte van strategieë en hoe dit aangepas kon word. Nuwe gemeenskaplike kennis van strategieë het tydens die intervensie ontstaan. Na afloop van die program het opvoeders die strategieë vir die hantering van leerders met emosionele en gedragsbehoeftes kwantitatief beoordeel, op grond van die bruikbaarheid daarvan in die skool- en klasopset. Uit my bevindinge het dit geblyk dat opvoeders bemagtiging benodig om met leerders met emosionele en gedragsbehoeftes te werk. Die indiensopleidings-program waaraan 47 opvoeders van twee skole deelgeneem het, het daartoe bygedra dat die opvoeders se ingesteldheid teenoor leerders verander het. Na die opleiding was hulle bekend met meer strategieë om leerdergedrag te hanteer en het ‘n gevoel van sukses beleef in die klas, wat bygedra het tot ‘n positiewe belewenis van die klassituasie. Van die strategieë wat as die bruikbaarste beoordeel is, het gehandel oor klaskamerpraktyke en strategieë om taakgerigtheid te bevorder. Ander strategieë het aspekte rondom skoolbestuur en ondersteuning aan ouers ingesluit. Enkele opvoeders het ook meer gevorderde strategieë, soos kognitiewe en gedragstegnieke gebruik. Opvoeders het positiewe reaksie aangemeld van leerders waar die strategieë toegepas is. Hierdie studie is deur ‘n proses van aksienavorsing uitgevoer en kwalitatiewe en kwantitatiewe navorsingsmetodes is gebruik. Die resultate is van toepassing binne hierdie bepaalde konteks. Volgens die navorser kan hierdie opleidingsprogram aangepas word om aan die behoefte vir indiensopleiding vir opvoeders te voorsien. Opleiding kan moontlik fokus op ʼn kleiner aantal strategieë wat deeglik ingeoefen en vasgelê kan word. Dit is verkieslik dat al die personeel van ‘n skool, insluitend die skoolbestuurspan, aan die opleiding moet deelneem om dit ‘n skoolontwikkelingsprojek te maak. Deur twee skole op verskillende vlakke van implementering saam op te lei, kan opvoeders mekaar stimuleer en kan die toepassing van idees bevorder word. ENGLISH: Learners who exhibit emotional and behavioural needs (e.g. ADHD and depression conduct disorder) seem to present a major challenge for educators in the inclusive mainstream class and educators feel that they are not adequately prepared and trained for these challenges. Action research was chosen as research method. The purpose of this research was to useful strategies which educators could implement in supporting and managing these learners, in the inclusive classroom environment. Learners with emotional and behavioural needs exhibit a wide variety of behaviours at school. In the inclusive education environment educators are expected to be the primary supporters of learners with needs. Although this expectation exists, up till now educators have received little or no training on how to support learners with needs. The research process conducted in this study followed different phases. Firstly, a needs analysis was conducted to determine the current state of affairs, the needs of educators, and strategies currently in use. Information that became evident through the needs analysis and literature research prescribed the format and aspects to be included in the initial intervention programme. During the execution of this programme, current strategies were adapted and new ones developed. Needs that came to the fore during the implementation were recognised and incorporated. The implementation was monitored on different levels, for example by teachers who implemented the strategies in their classrooms and provided feedback, by the researcher, and also by external observers. The focus was not only on the strategies, but also on processes. Changes that were observed in the different systems were assessed. During the final step of the implementation phase, educators, based on their practical experience, were required to rate the usefulness of all the different strategies that were either part of the initial presentation or were generated during the course of implementation. The qualitative as well as quantitative findings indicated that the educators became more capable of supporting these learners and implemented a wide variety of strategies. Classroom management strategies and strategies to support task behaviour were found to be the most helpful. Educators also gained more than merely knowledge. Changes in the relationship between educators and these learners were noticeable and they became aware of feelings of personal achievement and competency. Changes also occurred at other systemic levels, such as in the learners, the school, the community and even in the broader education system. This study was undertaken on a small group of educators in a particular context. Whilst the findings cannot be generalised, it is suggested that this programme may also be beneficial for educators to support learners with emotional and behavioural needs in other environments. / Thesis (DPhil)--University of Pretoria, 2010. / Psychology / unrestricted

In this study the impact of a board game as parent guidance strategy to reinforce Cognitive Control Therapy (CCT) in the home environment of a child with ADHD was explored. The influence of such a board game, based on the principles of CCT, on multiple contexts of the child’s existence - therapeutic and family contexts - was also investigated. There were two reasons for involving the parents in therapy. Firstly, children with an attention problem are situated within contexts and the effect of ADHD can permeate to the home and school environments. Secondly, for Cognitive Control Therapy (CCT) to be successful, it needs to be sustained by frequent repetition. It was hypothesized that sustainability of the effect of CCT should rise substantially after introduction of the board game, as the child and the parent can reinforce the principles of CCT by using it, even without being able to attend a session. The board game was designed by using the principles for game development as articulated by Dodge. A case study was then conducted by using a mixed methods approach, where quantitative and qualitative data were obtained. Data collection strategies consisted of quantitative methods in the form of the Cognitive Control battery (pre and post test), and the Copeland Symptoms checklist. Qualitative strategies included parental feedback, qualitative data during therapy sessions (observations and therapeutic notes) and a semi-structured interview with the mother. Data was collected before, after and during the intervention. The intervention consisted of individual therapy with the participant, parent guidance and parallel implementation of the designed board game by the parents with the child-participant. The quantitative data (from the CCB and the Copeland Symptoms Checklist) from the post test indicated that sensitivity towards distractions remains a concern, and that parental implementation of a board game (incorporating elements of CCT) with a child can possibly have a slightly negative effect on cognitive control functioning. However, the scope of this case study does not allow direct correlations to be drawn between the parental input and the child’s cognitive control functioning. It does point to the possibility of heeding caution when implementing a board game to reinforce CCT principles by a parent. Conversely, the findings from the study also indicated that family relations improved. Five qualitative insights emerged: i) increased ability to distinguish between relevant versus irrelevant information in the participant; ii) increase in organizational thought in the therapeutic situation and at home; iii) improved communication between parent and child, resulting in improved skills to maintain discipline; iv) improved interaction among family members; and v) transfer of skills to the mother. The study found that the greatest contribution of the board game appears to be the improvement experienced in the family context – probably as a result of increased interaction among family members and attention focused on the problem. / Dissertation (MEd (Educational Psychology))--University of Pretoria, 2007. / Educational Psychology / MEd / unrestricted

Made available in DSpace on 2017-06-01T18:09:00Z (GMT). No. of bitstreams: 1 michelle_calheiros_lima.pdf: 441041 bytes, checksum: aaadacf9c6445eec2a1ff5aaf643d62b (MD5) Previous issue date: 2016-04-01 / The psychiatry classifies the aspects of psychopathology by the Diagnostic and Statistical Manual of Mental Disorders. This Manual, throughout its history, passes through many changes and variety versions. The object of this research is making a critical analysis about the ADHD diagnosis, as described by the psychiatry taking as reference the psychoanalysis. The choice of psychoanalysis as guiding element of this critical reading is due to the importance of consider the unique history and the singularity as inherent to the subject, while seek to listen and offer the word for each one. This paper have these specific purposes: discuss how the signs and symptoms evidence helped on the reflection about the ADHD diagnosis; demonstrate the psychoanalytical understanding of the subjective dimension and the psychic apparatus; present the parallelism among the modifications on social and production of new subjective symptoms. To achieve this proposal we have opted to use the DSM-V, in the most recent edition, as well as Manual para Diagnóstico e Tratamento do Transtorno de Deficit de Atenção/Hiperatividade TDA/H , third edition. However, consider the social in its consumer ideology, crossed by modifications at the symbolic law is fundamental for the research, after all, the postulates of post-modernity ignore the subjectivity, exalt all kinds of excess, contributing to erase the limits. The questioning about ADHD diagnosis mode is justified because it is served by merely statistical methodology and the lack of an etiology for referred disorder. As well as, the disregard of the subject singularity and his submission to unconscious processes that seeks satisfaction, because the mental organization and pulsional economy are individual and unique. It is know that the organizer potential of certain pulsional resignation, of joy restriction that impose sacrifice and creates unease, however it is fundamental and structuring for the subject. This is a research with theoretical character, that use as method the critical analysis of ADHD, according to presented in DSM-V, under viewpoint of psychoanalysis. It seeks to offer other achievable reading to think the ADHD. / A psiquiatria classifica os aspectos da psicopatologia por meio do manual diagnóstico e Estatístico de Transtornos Mentais. Este manual ao longo de sua história, passou por muitas modificações e variadas versões. O objetivo da presente pesquisa é fazer uma análise crítica do diagnóstico de TDA/H, conforme descrito pelo manual tomando como referência a psicanálise. A escolha da psicanálise como elemento norteador dessa leitura crítica deve-se à importância dada pela mesma à história individual e a singularidade como inerentes ao sujeito, ao buscar ouvir e ofertar a palavra a cada um. Este trabalho tem como objetivos específicos: discutir como as evidências dos sinais e sintomas ajudaram na reflexão sobre o diagnóstico do TDA/H; demonstrar a compreensão psicanalítica da dimensão subjetiva e do aparelho psíquico; apresentar o paralelismo entre as modificações no social e a produção de novos sintomas subjetivos. Para realizar essa proposta optamos por utilizar o DSM-V, em sua edição mais recente, assim como o Manual para Diagnóstico e Tratamento do Transtorno de Déficit de Atenção/Hiperatividade TDA/H, terceira edição. Considerar o social e sua ideologia consumista, atravessado por mudanças na lei simbólica é fundamental para a pesquisa, uma vez que, os postulados da pós-modernidade desconsideram a subjetividade, exaltam todos os tipos de excesso e contribuem para o apagamento do limite. O questionamento sobre o modo diagnóstico do TDA/H justifica-se em virtude de se servir de uma metodologia meramente estatística e da falta de uma etiologia para o referido transtorno. Assim como, a desconsideração da singularidade do sujeito e sua submissão a processos inconscientes que buscam satisfação, uma vez que a organização mental e a economia pulsional são particulares e únicas. Sabe-se do potencial organizador de certa renúncia pulsional, da restrição de gozo que impõe sacrifícios e gera algum mal-estar, mas que é fundamental e estruturante para sujeito. Esta é uma pesquisa de caráter teórico, que utiliza a análise crítica para pensar o diagnóstico de TDA/H, conforme descrito pelo DSM-V sob a ótica da psicanálise. Busca-se oferecer outra leitura possível para pensar o TDA/H.

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The process of controlling executive and motor behaviours is central to one’s ability to self-regulate and accomplish day-to-day goals across the lifespan. Executive and motor control share a set of underlying neural substrates that support a common set of processes, including planning, sequencing and monitoring of behaviour. They share a bidirectional relationship, such that gains or deficits in one area can have profound effects on the other. This doctoral dissertation examines the interplay between executive and motor control at three distinct stages of life and in the context of neurological conditions whose clinical manifestations shed additional light on the nature of the constructs. Central to each investigation is the methodological theme of intraindividual variability, as a means of leveraging valuable data within-persons. Chapter 2 examines executive and motor control in typically developing children and children with attention-deficit/hyperactivity disorder (ADHD). Findings suggest that dysregulation of motor processes accounts for hyperactive symptoms in ADHD and detracts from higher-order executive control. Chapter 3 examines the impact of mild traumatic brain injury (mTBI) in young adult varsity athletes, who routinely practice executive motor control by virtue of their level of play. Findings suggest that the impacts of mTBI are discernible through a dampened electrophysiological response during computerized tests of higher order executive functioning, and may not outweigh the otherwise myriad health benefits of athletic engagement. Chapter 4 examines the impact of dementia on executive motor control during gait dual-tasking in older adults. Findings suggest that the consistency of performance across multiple indicators of gait is sensitive to dementia, and that engagement in cognitive and social lifestyle behaviours is protective against likelihood of both dementia and mild cognitive impairment (MCI) classification. On mass, these findings highlight the importance of assessing executive motor control to understand the pathophysiology of neurological conditions. The potential benefits that may generalize from one area to the other offer unique opportunities for preventative and rehabilitative efforts. / Graduate

Thesis (M.A. (Psychology)) -- University of Limpopo, 2016. / Background: ADHD is a neurodevelopmental disorder affecting 3 – 7% of school age children. The core symptoms of ADHD, hyperactivity, impulsiveness and inattentiveness often cause problems in many aspects of life, including interpersonal relationships. The problems associated with the disorder may also lead to poor self-esteem. Objective: To assess the impact of attention-deficit/hyperactivity disorder (ADHD) symptoms on interpersonal skills and self-esteem in a non-referred sample of primary school children meeting criteria for a diagnosis of ADHD. Method: Eighty-two children with ADHD (6 – 13 years) were selected using a convenient sample screened from primary schools in the Limpopo Province and were compared to 82 children without significant ADHD symptoms, who match the ADHD children on age and gender. The children were screened and diagnosed using the Disruptive Behaviour Disorders rating scale (DBD). They were assessed on two instruments: The PHSF (Personal, Home, Self and Formal) relations questionnaire was used for the measurement of interpersonal relationship while self-esteem was measured using the self-concept inventory of the Beck Self-Concept Inventory for youths [BSCI-Y]. The scores obtained on the two scales were compared for significant differences between the ADHD group and the non-ADHD comparisons as a possible function of gender. Results: Children with ADHD scored significantly higher (p < 0.001) on the scale that measured problems with interpersonal relationships (PHSF) than the non-ADHD comparison group. There was no effect of gender. The measurement instrument for self esteem (BSCI-Y) indicated that the children with ADHD had higher self-esteem than their non-ADHD comparisons (p < 0.001). Gender did not affect the difference between the groups. Conclusion: The findings indicated that children, who are inattentive, impulsive and over active, which are symptoms of ADHD, will have poorer interpersonal relationships than children without the disorder. Findings from the result of the measurement of self-esteem indicated that children with ADHD could have higher self-esteem than children without ADHD. The latter is in contrast with findings of most studies and may be ascribed to an unrealistic self-concept because of the young age of the participants or possible cultural factors.

Background. Attention-deficit/hyperactivity disorder (ADHD) is one of the most prevalent neuropsychiatric disorders in childhood. Besides inattention and hyperactivity, impulsivity is the third core symptom leading to diverse and serious problems. However, the neuronal mechanisms underlying impulsivity in ADHD are still not fully understood. This is all the more the case when patients with the ADHD combined subtype (ADHD-C) are considered who are characterized by both symptoms of inattention and hyperactivity/impulsivity. Method. Combining high-density electroencephalography (EEG) recordings with source localization analyses, we examined what information processing stages are dysfunctional in ADHD-C (n = 20) compared with controls (n = 18). Results. Patients with ADHD-C made more impulsive errors in a Go/No-go task than healthy controls. Neurophysiologically, different subprocesses from perceptual gating to attentional selection, resource allocation and response selection processes are altered in this patient group. Perceptual gating, stimulus-driven attention selection and resource allocation processes were more pronounced in ADHD-C, are related to activation differences in parieto-occipital networks and suggest attentional filtering deficits. However, only response selection processes, associated with medial prefrontal networks, predicted impulsive errors in ADHD-C. Conclusions. Although the clinical picture of ADHD-C is complex and a multitude of processing steps are altered, only a subset of processes seems to directly modulate impulsive behaviour. The present findings improve the understanding of mechanisms underlying impulsivity in patients with ADHD-C and might help to refine treatment algorithms focusing on impulsivity.

This paper explores whether librarians have the tools to fulfil the requirements of the library law concerning patrons with ADHD and if there are any obstacles for librarians regarding this work; this is made possible by a survey sent to 38 libraries, resulting in 138 respondents. For data processing, evaluation and discussion, the study used a theoretical framework based on Säljö’s theory of the necessity of tools for human understanding and development, along with requirements listed by the Health and Human Services Department and IFLA for successfully working with people with ADHD. The results show that librarians do not have the required tools to work with patrons with ADHD and that the primary obstacles hindering them are a lack of knowledge, as well as the existence of misunderstandings regarding ADHD and the work with patrons with this diagnosis. The primary cause of these issues is an inadequate legal framework, which impacts all aspects connected to this work, from the education of librarians to their work with individual patrons within the daily operation of the libraries, adding to the stress that librarians are already experiencing in relation to their occupation.