The diagnosis of children with Attention Deficit Hyperactivity Disorder (ADHD) has increased over the last few years in Australia. ADHD is currently understood largely through a medical perspective, and in that context, the treatment recommended is stimulant medication. ADHD is a mental health label given to children who exhibit challenging behaviour. These children are diagnosed according to the categories stated in the Diagnostic Statistical Manual (DSM) – IV. To date, there is no medical test children can undertake to show that they ‘have’ ADHD. This research focuses on an alternative view of ADHD. Focussing upon families’ experience of ADHD, and the medicalisation of children’s behaviour, it argues that behaviour is socially influenced and constructed. It is because insufficient attention has been given to the family experience and the social implications of ADHD, that the child is often seen as ‘the problem’. The gap in our understanding of ADHD is situated in our understanding of the broader social context. To challenge this I will explore perceptions of the ‘good child’, ‘good mothers’ and the social consequences of inappropriate behaviour. Each family was interviewed five times every three months over a two-year period. Their stories and experiences are presented in this thesis.

Children and young people with ADHD often experience social difficulties, which are associated with poor psychological, behavioural, and academic outcomes. As yet, underlying mechanisms of poor social functioning are unknown. The social functioning of fifty-two children (M = 14.13 years) who had been diagnosed with ADHD four years previously and their matched controls were assessed using several measures: the ratings of parents/guardians and teachers, and children's self-reports; a conversation task; the Otago Social Dilemma Test. Analyses were conducted for the whole sample plus a Socially-Impaired subgroup (clinically significant social problems), and a Persistent-ADHD subgroup (continued to meet DSM-IV ADHD criteria). First we compared the social functioning of children in the ADHD group with that of children in the control group by analysing the questionnaire responses of parents/guardians, teachers, and children's self-reports. Children in the ADHD group and Socially-Impaired sub-group were rated as experiencing more social problems and having fewer social skills than control children, across all informants. Children also estimated their own popularity, and despite experiencing social difficulties, no differences in children's popularity ratings were observed between children in the ADHD group and control group. Given that children in the ADHD group showed social difficulties, we investigated whether these deficits were driven by children's conversation skills. Children engaged in a 15-minute conversation with an adult confederate. The frequency of conversation skills were coded and analysed. Across all groups, ADHD children asked more questions, were less likely to offer extended information in response to a question, and were more likely to make at least one unco-operative statement. The number of extended verbal responses accounted for a significant amount of the variance in participants' social skills. Overall, however, the conversations of children with and without ADHD were remarkably similar. It appears, therefore, that it may be language style that influences social difficulties. Next we investigated a second mechanism that might account for social difficulties observed in children with ADHD; social problem solving skills. Children completed the Otago Social Dilemma Test, which involved viewing vignettes of social dilemmas and generating possible solutions to these problems. Children in the ADHD group provided poorer descriptions and showed less understanding of the problems portrayed. Although the ADHD participants were able to generate a similar number of solutions to the social problems as the children in the Control group, they made poorer decisions about what was the 'best solution'. ADHD participants' choice for best solution significantly added to a model of their social problems, even after IQ and severity of inattentive symptoms had been added. Taken together, the present study supports research showing that children with ADHD experience social difficulties, but they may lack insight into the effect of their behaviour on their status among peers. Children's conversation and their problem solving abilities may be factors influencing poor social functioning. Interventions that focus on teaching children to recognise social cues and generate appropriate solutions to social dilemmas may be beneficial.

<p>The aim of this thesis was to explore the prevalence of parentally experienced infant sleep problems, with special interest in severe problems, in a total community sample of 2 518 infants aged between 6 and 18 months. Factors associated with severe sleep problems were sought. Parents reported 16 % of the infants to have difficulties in falling asleep at night, and 30 % to have frequent night waking. Severe sleep problems were associated with frequent night meals, psychosocial problems in the family, exhaustion and depression in the mother, and parental stress. An association with infant difficultness, high activity and problematic behaviour was also found. </p><p>In a five-year prospective study a group of children fulfilling specific criteria for severe sleep problems in infancy (N=27) was followed after an interventional sleep programme and compared with a control group regarding sleep characteristics, behaviour and development. One month after an interdisciplinary treatment programme, combining behavioural technique with family work, the average number of times the case babies woke up had diminished from 6.0 to 1.8 times per night. A 92 % rate of improvement was reported.</p><p>The changes were stable over time. Comparisons with the controls during five years revealed no significant group difference in sleep characteristics. Concerning behaviour and development, however, there were significant differences. At the age of 5.5 years, seven of the children in the former sleep problem group met the criteria for the diagnosis of attention-deficit/hyperactivity disorder. No control child qualified for the diagnosis.</p>

The aim of this thesis was to explore the prevalence of parentally experienced infant sleep problems, with special interest in severe problems, in a total community sample of 2 518 infants aged between 6 and 18 months. Factors associated with severe sleep problems were sought. Parents reported 16 % of the infants to have difficulties in falling asleep at night, and 30 % to have frequent night waking. Severe sleep problems were associated with frequent night meals, psychosocial problems in the family, exhaustion and depression in the mother, and parental stress. An association with infant difficultness, high activity and problematic behaviour was also found. In a five-year prospective study a group of children fulfilling specific criteria for severe sleep problems in infancy (N=27) was followed after an interventional sleep programme and compared with a control group regarding sleep characteristics, behaviour and development. One month after an interdisciplinary treatment programme, combining behavioural technique with family work, the average number of times the case babies woke up had diminished from 6.0 to 1.8 times per night. A 92 % rate of improvement was reported. The changes were stable over time. Comparisons with the controls during five years revealed no significant group difference in sleep characteristics. Concerning behaviour and development, however, there were significant differences. At the age of 5.5 years, seven of the children in the former sleep problem group met the criteria for the diagnosis of attention-deficit/hyperactivity disorder. No control child qualified for the diagnosis.

In recent decades a growing number of individuals in preschool, middle childhood and adolescence have been diagnosed with ADHD. Accompanying increasing rates of diagnoses is an increase in the use of stimulant medication in preschool populations, a practice not approved by the Food and Drug Administration. This paper reviews the current literature pertaining the social and developmental consequences of ADHD, its effect on the child and family, treatment strategies with and without the use of stimulants, and cultural and diagnostic trends which may be contributing to the rising number of diagnoses. A review of the literature suggests that there is a dire need for further empirical research into the use of stimulant medications in preschoolers, and a number of cultural factors unique to the United States have contributed to increasing rates of ADHD diagnosis.

Attention deficit/hyperactivity disorder (ADHD) is a common disease with a worldwide prevalence of 5% on preschool children. It has been reported that ADHD patients have volume variant in partial brain regions. Futhermore, functional magnetic resonance imaging have also been used to detect function variant possibility in particular brain regions. In the last decade, some researchers used diffusion MR imaging to investigate the abnormality of neural fibers in disease involved with central nervous system. In general, the diffusion anisotropy of white matter in both ADHD patients and healthy subjects can be estimated seperately to undergo inter-subject comparison. While previous studies often used the popular ICBM brain template (MNI152), this study applied a self-made template of Taiwan adolescents as the common space of image normailization. In this work, group comparison of diffusion fractional anisotropy was performing by using two methods, TBSS and VBM. Both manners found a decreased FA in white matter of ADHD subjects compared with normal control group. However, regions detected by different methods showed low reproducibility. The areas of significant difference include inferior longitudinal fasciculus¡Binternal capsule¡Bexternal capsule¡Bsuperior longitudinal fasciculus¡Boptic radiation¡Bsuperior frontal¡Bsuperior region of corona radiata¡Bcorticospinal tract¡Bposterior region of corona radiata / superior longitudinal fasciculus¡Bsuperior fronto-occipital fasciculus¡Banterior region of corona radiata¡Bgenu of corpus callosum nerve fibers.

Aim of the present study was to evaluate executive functions (EF) such as inhibition, planning, working memory, set-shifting in children with Attention Deficit / Hyperactivity Disorder (ADHD) via comparison of three ADHD subtype groups (ADHD-I, ADHD-C and ADHD-Comorbid) and a normal control group. Participants consist of 147 children. Total of 111 children were assigned into the ADHD groups of the study. Thirty seven children (5 girl and 32 boys) were assigned into the ADHD-Inattentive group, thirty seven children (6 girls and 31 boys) were assigned into the ADHD-Combined group / and thirty seven children (4 girls and 33 boys) were classified as ADHD-Comorbide group (ADHD-C with Oppositional Defiant Disorder consists of 4 girls and 31 boys, and/or Conduct Disorders consists of 2 boys). Thirty six children (6 girls and 30 boys / age range: 7- 12) were assigned as control group by matching with the ADHD groups according to the WISC-R Full Scale IQ score, sex and age. Conner&rsquo / s Parental and Teacher Rating Scales, Child Behavior Check List and Wechsler Intelligence Scale Revised, Tower of London Test, Wisconsin Card Sorting Test, Stroop Color Word Test, Cancellation Task, Trail Making Test, California Verbal List Test for Children, Verbal Fluency Test, Continuous Performance Test, Go-No-Go Task and Bender-Gestalt Test were used for the assessment of children. The data were analyzed by one-way within subject ANOVA for all dependent variables measured by the assessment tools. Additionally discriminant function analyses were conducted to determine the variables that differentiate the three ADHD groups and control group. Outcome of study indicated that subjects in ADHD-Comorbid group had more severe Executive Function (EF) deficits than subjects in ADHD-I and ADHD-C group. The findings were discussed in the light of the literature.

Attention deficit hyperactivity disorder (ADHD) is a neurobehavior developmental disorder that affects around 7.5% of Taiwan children. With the use of magnetic resonance imaging , many results have been reported that ADHD patients have volume atrophy in gray matter and dysfunction in couples of cortical regions. In recent years, diffusion MR imaging with diffusion-sensitizing gradients has been used to investigate the abnormality of neural fibers in disease involved with central nervous system. In this study, the anisotropy of white matter in both ADHD patients and age-matched healthy subjects was estimated using diffusion tensor imaging to undergo inter-subject comparison. In this work, a significant decrease (FWE-corrected p-value <0.05) of FA values has been found in white matter of adolescents diagnosed as ADHD patients, compared with normal controls group. The areas that confirmed by two different algorithms of inter-subject comparison are mainly diffused on white matter region, including middle cerebellar peduncle, left inferior longitudinal fasciculus, internal capsule, left optic radiation, external capsule, splenium of the corpus callosum, superior longitudinal fasciculus, superior frontal and parietal-occipital nerve fibers.

This study examined the impact of working memory deficits (WMD) on the academic achievement of adolescents with ADHD. Adolescents (n=79) aged 13 to 17 years with a clinical diagnosis of ADHD were subtyped into those with and without WMD based on impairment in at least two measures, and then compared on their academic achievement and clinical profile. Results indicated that adolescents with ADHD plus WMD (23%) manifest significantly lower academic achievement than those with adequate WM. By contrast, there were no group differences in psychiatric comorbidity, severity of ADHD symptoms and psychological adjustment. We also found a unique contribution of WM to academic achievement over and above that of other clinical features. These findings suggest that WMD compromise the educational attainment of a subgroup of individuals with ADHD. Individuals with ADHD should be screened for WMD to prevent academic failure and WM should be considered as a treatment target.

The purpose of this study was to investigate which factors contributed to stress in parents of children diagnosed with Attention-Deficit/Hyperactivity Disorder (ADHD). The influence of the parents' gender on these stress factors as well as the way in which parents conceptualised extreme stress/burnout were also explored. This study focused on parents whose children have been diagnosed with this disorder and attend the grade two classes at this special school. Thirty seven parents completed a survey questionnaire and semi-structured interviews were conducted with 10 of these parents. The researcher was able to determine which specific factors contributed to these parents' stress relating to parenting their ADHD child and also explored parents' conceptions of stress. The data was quantitatively and qualitatively analysed. The semistructured interviews explored the parents' subjective stress experiences with their ADHD children and encouraged possible solutions from parents. Gender differences were also explored. The responses to the interviews were qualitatively analysed. The results of this study have indicated that generally, parents perceive extreme stress/burnout in terms of physical and emotional symptoms. The factors contributing to extreme stress appeared to be associated with social problems of ADHD children, their inappropriate behaviours and school-related problems. Many possible solutions were offered by parents but they also indicated the need for support and understanding from significant others, such as spouses, teachers, family members, doctors and therapists. Parents of ADHD children in this study indicated that one's gender does play an important role regarding how a person copes with stress, with mothers generally experiencing far more stress than fathers. / Thesis (M.Ed.)-University of KwaZulu-Natal, 2005.