To date there has been limited empirical exploration of the utility of behavior report form’s embedded symptom validity scales. The purpose of this study was to address this by examining the Conners - Third Edition (Conners 3) Parent Report Form’s ability to detect purposeful exaggeration of symptoms of inattention, hyperactivity, and impulsivity in an effort to obtain a diagnosis of Attention-Deficit/Hyperactivity Disorder (ADHD). This was accomplished by using a malingering simulation experimental design whereby a group of parents, whose children did not have a diagnosis of ADHD, were entreated to simulate symptoms of ADHD on the Conners 3. Their simulated reports were then compared to the responses of parents whose children had a diagnosis of ADHD, as well as to the Conners 3’s normative sample. Results indicate that simulators, provided with information easily obtained from the internet and minimal coaching, were largely able to fabricate profiles indicative of ADHD. Furthermore, they were able to accomplish this ADHD without raising concern regarding the validity of the report based upon the Conners 3’s embedded symptom validity scales. While simulators did produce significantly more severe symptom elevations compared to the ADHD comparison group, their profiles were not so extreme as to aid in discriminating over-reporting. The ramification of these findings in the context of the need for stand-alone symptom validity testing is discussed.

This study involves an examination of the neurocognitive correlates of subscales of the Conners' Rating Scale - Revised (CRS-R), an ADHD behavioral rating form, in both a child (n=72) and an adolescent (n=49) sample. While both behavioral rating forms and neuropsychological measures are commonly employed in pediatric clinical evaluations, these two forms of assessment do not generally converge as expected. The purpose of the current research was to examine and compare the abilities of intellectual, academic, attentional, and executive skills to account for variance in parent and teacher ratings of behavior across two pediatric age groups in a clinical setting. Additionally, the study compared the relationships between behavioral ratings and cognition in children versus adolescents. The study found parent and teacher ratings of cognitive problems and inattention to be better accounted for by general cognitive ability than by attention and executive skills in children. Conversely, ratings of child hyperactivity, as completed by both parents and teachers, were better explained by attention and executive skills. General cognitive and academic abilities best accounted for parent ratings of overall ADHD likelihood, whereas teacher ratings of ADHD likelihood were equally accounted for by general cognitive abilities and attentional and executive skills. Neither general cognitive and academic abilities nor attention and executive skills accounted for a significant proportion of the variance in the adolescent sample. Furthermore, results showed that the variance in parent and teacher ratings of behavior was significantly accounted for by neurocognitive test performance across ratings subscales for child, but not adolescent clients. Overall, the results suggest that ADHD behavioral rating form accuracy varies according to subscale, informant, and age group. In child clients, ADHD behavioral ratings converged with theoretically associated cognitive abilities for subscales assessing hyperactive, but not inattentive behaviors. Both parent and teacher informants appear to take children's overall cognitive and academic abilities into consideration more so than attentional and executive skills when rating inattentive behaviors. This suggests either rating form or informant inaccuracy in identifying specific problems in attention and organization. Parents, in particular, appear to be relatively poorer raters of child behavior than teachers as only teacher ratings of overall ADHD likelihood were accounted for by attentional and executive skills. Parent and teacher ratings of behavior appear to be of questionable accuracy across ADHD related behaviors in the assessment of adolescents. As behavioral ratings were not related to cognition in the 11-17-year-old sample, ADHD behavioral rating forms appear to demonstrate poor convergent validity in adolescents. The finding that ratings of behavior were significantly related to cognition in children, but not in adolescents, suggests the presence of age-dependent differences in the presentation of ADHD symptoms or the accuracy of assessment tools between children and adolescents. Clinicians are encouraged to use caution when interpreting ratings of adolescent ADHD behavior and ratings of child inattentive behavior, as these scales may often not assess their purported constructs.

Thesis (M.S.)--Auburn University, 2005. / Abstract. Includes bibliographical references.

Thesis (Ph. D.)--Auburn University, 2009. / Abstract. Vita. Includes bibliographical references (p. 68-75).

Background: Iron deficiency (ID) is the most prevalent nutritional deficiency in the world. In children, both inadequate iron and fatty acid (FA) status have been found to have an effect on cognitive and behavioural function, including physical activity behaviour and attention deficit hyperactivity disorder (ADHD)–related behaviour. Aim: To investigate the effects of supplementation with iron and omega–3 fatty acids (n–3 FAs), alone and in combination, on spontaneous motor activity and ADHD–related behaviour in iron deficient primary school children in KwaZulu–Natal. An additional aim was to evaluate the use of the Actical accelerometer as a tool to assess physical activity behaviour. Methods: The study design was a 2x2 factorial, randomized, double–blind and placebo–controlled trial. Iron deficient school children aged six to ten years with or without mild anaemia were included in the study (n = 321). Subjects were randomly assigned to receive one of the following supplement combinations: (1) 420mg docosahexaenoic acid (DHA)/80 mg eicosapentaenoic acid (EPA) + 50mg of iron as ferrous sulphate (Fe); (2) 420mg DHA/80mg EPA + placebo; (3) 50mg of Fe + placebo; (4) placebo + placebo. Supplements were provided four times a week for a duration of 8.5 months (excluding school holidays). Physical activity of a subgroup of subjects (n=98) was recorded on four random school days at baseline, midpoint and endpoint (12 days in total) during three different time periods namely class time 1 (08h00-10h30), break time (10h30–11h00) and class time 2 (11h00–12h00). Classroom behaviour of study subjects was assessed by teachers at baseline and endpoint using the Conners’ Teacher Rating Scale–Revised: Short Forms (CTRS). Iron status indicators and red blood cell (RBC) FA composition were measured at baseline and endpoint. Treatment effects were assessed for activity and CTRS scores. Furthermore, the relationship between activity, CTRS scores and iron/FA status indicators was determined using bivariate correlation and multivariate linear regression analysis. Results: Overall activity of all subjects varied over time from baseline and midpoint to endpoint. A significant cycle x age interaction (P = 0.005) as well as a significant cycle x time period x gender interaction (P = 0.036) was observed on overall activity. There were no significant interactions of cycle or time period with treatment. However, there was a significant main effect of DHA/EPA supplementation for lower class time 1 activity at endpoint (P = 0.014). Biological markers indicating better or poorer iron status were positively and negatively associated with activity at break time, respectively. Subjects in the group receiving both iron and DHA/EPA supplements showed a significant improvement from baseline to endpoint on the cognitive problems/inattention subscale (P = 0.005) of the CTRS. Hyperactivity scores increased iv significantly from baseline to endpoint in all groups (P = 0.006). DHA (r = –.203; P = 0.040) and EPA (r = –.199; P = 0.044) content of RBC were negatively associated with activity at class time 1. No significant associations were observed between activity and CTRS scores at baseline. At endpoint, class time 1 activity was positively associated with all CTRS subscale scores except for the cognitive problems subscale, which only bordered significance (correlation, P = 0.051; regression, P = 0.073). Conclusions: These findings suggest that n–3 FA supplementation may have an influence on ADHD–related behaviour during class time. During school break time when subjects were allowed to move around freely, iron status was positively associated with spontaneous motor activity. Furthermore, the accelerometer might be a useful complimentary tool for assessing both classroom and break time activity behaviour in school children. / Thesis (M.Sc. (Nutrition))--North-West University, Potchefstroom Campus, 2012.

Background: Iron deficiency (ID) is the most prevalent nutritional deficiency in the world. In children, both inadequate iron and fatty acid (FA) status have been found to have an effect on cognitive and behavioural function, including physical activity behaviour and attention deficit hyperactivity disorder (ADHD)–related behaviour. Aim: To investigate the effects of supplementation with iron and omega–3 fatty acids (n–3 FAs), alone and in combination, on spontaneous motor activity and ADHD–related behaviour in iron deficient primary school children in KwaZulu–Natal. An additional aim was to evaluate the use of the Actical accelerometer as a tool to assess physical activity behaviour. Methods: The study design was a 2x2 factorial, randomized, double–blind and placebo–controlled trial. Iron deficient school children aged six to ten years with or without mild anaemia were included in the study (n = 321). Subjects were randomly assigned to receive one of the following supplement combinations: (1) 420mg docosahexaenoic acid (DHA)/80 mg eicosapentaenoic acid (EPA) + 50mg of iron as ferrous sulphate (Fe); (2) 420mg DHA/80mg EPA + placebo; (3) 50mg of Fe + placebo; (4) placebo + placebo. Supplements were provided four times a week for a duration of 8.5 months (excluding school holidays). Physical activity of a subgroup of subjects (n=98) was recorded on four random school days at baseline, midpoint and endpoint (12 days in total) during three different time periods namely class time 1 (08h00-10h30), break time (10h30–11h00) and class time 2 (11h00–12h00). Classroom behaviour of study subjects was assessed by teachers at baseline and endpoint using the Conners’ Teacher Rating Scale–Revised: Short Forms (CTRS). Iron status indicators and red blood cell (RBC) FA composition were measured at baseline and endpoint. Treatment effects were assessed for activity and CTRS scores. Furthermore, the relationship between activity, CTRS scores and iron/FA status indicators was determined using bivariate correlation and multivariate linear regression analysis. Results: Overall activity of all subjects varied over time from baseline and midpoint to endpoint. A significant cycle x age interaction (P = 0.005) as well as a significant cycle x time period x gender interaction (P = 0.036) was observed on overall activity. There were no significant interactions of cycle or time period with treatment. However, there was a significant main effect of DHA/EPA supplementation for lower class time 1 activity at endpoint (P = 0.014). Biological markers indicating better or poorer iron status were positively and negatively associated with activity at break time, respectively. Subjects in the group receiving both iron and DHA/EPA supplements showed a significant improvement from baseline to endpoint on the cognitive problems/inattention subscale (P = 0.005) of the CTRS. Hyperactivity scores increased iv significantly from baseline to endpoint in all groups (P = 0.006). DHA (r = –.203; P = 0.040) and EPA (r = –.199; P = 0.044) content of RBC were negatively associated with activity at class time 1. No significant associations were observed between activity and CTRS scores at baseline. At endpoint, class time 1 activity was positively associated with all CTRS subscale scores except for the cognitive problems subscale, which only bordered significance (correlation, P = 0.051; regression, P = 0.073). Conclusions: These findings suggest that n–3 FA supplementation may have an influence on ADHD–related behaviour during class time. During school break time when subjects were allowed to move around freely, iron status was positively associated with spontaneous motor activity. Furthermore, the accelerometer might be a useful complimentary tool for assessing both classroom and break time activity behaviour in school children. / Thesis (M.Sc. (Nutrition))--North-West University, Potchefstroom Campus, 2012.

The reticular-activating hypofrontality model of acute exercise (RAH) predicts exercise-induced hypoactivity in frontal cortex which mediates executive function. Connors Continuous Performance Test (CCPT) was used to investigate changes in executive function during- and post treadmill running in healthy volunteers (n=30, 15 male). In a randomized order, subjects performed the CCPT at rest, during low- (LI; 63% maximal heart rate; MHR) and moderate intensity (MI; 75% MHR). Separately, subjects then performed isocalorifically matched exercise bouts of LI, MI and high intensity interval training (HIT) consisting of 4x4 min with 90% MHR and 3 min recovery at 60-70% MHR. Repeated measures ANOVAs revealed main effects of exercise intensity for reaction time RT during- (p≤0.001) and post exercise (p≤0.0001). Subsequent analyses showed an overall increase of RT during exercise compared to rest (p≤0.005). RT decreased significantly from rest to post exercise levels in an exercise intensity dependent, linear fashion (p≤0.0001). Commission errors showed a non significant linear trend to increase both during (p=0.057), and post exercise (p=0.052) as a function of intensity. In a follow up study, we sought to relate observed exercise effects to frontal cortex activity through the use of transcranial direct current stimulation (tDCS) (n=4) and transcranial magnetic stimulation (TMS) over the dorsolateral prefrontal cortex (DLPFC). Prior to TMS stimulation cortical excitability was estimated post running through motor-evoked potentials (MEP) elicited from the primary motor cortex (M1) induced by single burst TMS and measured in the first dorsal interosseous (FDI) muscle using electromyography. At rest, inhibitory cathodal tDCS with left DLPFC cathode and right supraorbital anode led to improved reaction time and increased amount of commission errors, whereas anodal stimulatory tDCS in the immediate post exercise period was unable to recover the post exercise effect. Continuous theta burst stimulation over the left DLPFC post running further impaired inhibitory control and facilitated reaction time. Different findings during- and after- exercise suggests that potential contributing mechanisms such as computational and metabolic factors may be differentially active during these respective conditions. Furthermore, the fact that an inhibitory TMS protocol pronounced the post running effects even more and that we were able to mimic the reported RAH effects at rest with inhibitory frontal tDCS, but observed different patterns during exercise, suggests that the latter state cannot be fully explained by reducing activity in the left frontal cortex alone. Failure to modify the after exercise effect with stimulatory tDCS also supports an interplay of different factors and might emphasize the strong, robust effects of exercise that cannot simply be attenuated by current application. Increases in MEP post running for 35min paired with the observed performance decrements imply an excited state of M1 and might serve as an explanatory cross-link to central fatigue suggesting that a hypofrontal state might enhance the motor cortical drive to activate muscles.

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common behavioural disturbances in school children. The aims of this thesis were to explore the association of ADHD with recurrent health complaints and bullying behaviour in children in grade four, and to evaluate whether it is possible to predict ADHD in grade four by screening before or at school entry. Cohort study in a population of 577 fourth graders (10-year-olds) in Sigtuna, a municipality in Stockholm County. All children were screened for attention and behaviour problems by parents and teachers in fourth grade. In a second step children with high scores underwent further clinical and cognitive assessments. Information about health complaints and bullying was collected from the children themselves in a classroom questionnaire. Hypotheses were tested in multivariate analyses with adjustment for sex and parental education. Screening with developmental indicators and Conners scale from routine child health services was performed. Sensitivity, specificity and positive predictive value for being diagnosed with ADHD in fourth grade was calculated. Recurrent abdominal pain, sleeping problems, and tiredness were associated with ADHD (adjusted relative risks: 2.2 [1.4-3.4], 1.7 [1.1-2.7], and 2.7 [1.7-4.1] respectively). ADHD was associated with bullying others students (adjusted odds ratios; 3.8 [95% C.I.: 2.0-7.2]) as well as being bullied (often 10.8 [4.0-29.0] and sometimes 2.9 [1.5-5.7]). The predictive value of developmental deviations for ADHD was no more than 20% and 50% when combining a Conner score of at least 10 from both parents and teachers. This thesis demonstrates a connection between ADHD in one as well as two settings (home and school), health complaints, and bullying in school children. Treatment strategies for ADHD need to include an effective evaluation and treatment of health complaints and effective interventions for bullying. Evaluation of ADHD should be considered in children with recurrent health complaints and in children involved in bullying. Screening does not identify children who are diagnosed with ADHD in grade four with a high degree of selectivity. It may be more important for schools to have an effective strategy for identifying and dealing with children who develop ADHD when these problems evolve, rather than before school entry.