Objective: Current studies examining the co-morbidity patterns of ADHD with internalizing disorders have reported inconsistent findings. Some studies have found that the inattentive subtype (ADHD-I) is more likely to be comorbid with internalizing disorders, while other studies found similar levels of comorbid internalizing disorders between the ADHD subtypes. Moreover, anxiety and depression were found to be comorbid in inattentive children high in sluggish cognitive tempo (SCT), characterized by features of sluggishness, drowsiness, and daydreaming. SCT has been postulated to be useful in discriminating a distinct inattentive subtype of ADHD-I with a different pattern of impairments. More recently, low levels of behavioral inhibition (BI)—manifested in the form of disinhibited behaviors—have also been implicated in the development of ADHD in children. The current study examines the relationships between ADHD and internalizing symptoms. The roles of SCT and BI in ADHD and internalizing symptoms are also investigated. Methods: The sample was comprised of 1,965 Hong Kong primary students between 8 and 14 years old and their parents/caregivers from 10 local schools. The children completed two self-report scales: the Revised Children Anxiety and Depression Scale (RCADS) and the Behavioral Inhibition System Scale (BISS). Their parents/caregivers completed three scales: the Attention Deficit Hyperactivity Disorder Rating Scale–IV (ADHDRS-IV), the Oppositional Defiant Disorder Scale (ODDS), and the Sluggish Cognitive Tempo Scale (SCTS). Using a psychometric approach, the relationships between the symptom clusters of ADHD (inattention and hyperactivity-impulsivity), anxiety, depression, SCT, and BI were systematically examined with correlation, regression, and factor analyses. A categorical approach was also used to classify children meeting the DSM symptom criteria to compare levels of internalizing symptoms among the three subtypes of ADHD: ADHD-I, ADHD-HI (hyperactive-impulsive), and ADHD-C (combined hyperactive and inattentive). An SCT cutoff score of 20 (the mean SCT rating among ADHD-I children) was used to further divide the ADHD-I into high- and low-SCT subgroups for planned between-group comparisons. Results: In the dimensional analyses, the inattention dimension of ADHD correlated slightly higher than the hyperactivity-impulsivity dimension with anxiety and depression as predicted. But the hyperactivity-impulsivity dimension was also significantly correlated with anxiety and depression, suggesting that hyperactive children were as likely as inattentive children to feel anxious and depressed. Regression analyses found that inattention was not predictive of anxiety and depression, while hyperactivity-impulsivity was marginally predictive of anxiety, but not depression. BI and SCT emerged as significant predictors of internalizing symptoms after controlling for age, gender, and ODD symptoms. There was evidence that SCT mediated the relationship between anxiety/depression and inattention symptoms. Using the categorical approach, between-group differences were found between the ADHD subtypes and the no-ADHD category. ADHD-I children were more anxious and depressed than children without ADHD. Differences in depressive symptoms were found between the ADHD subtypes. Children with ADHD-I had higher levels of depressive symptoms when compared to children with ADHD-HI and ADHD-C. Contrary to predictions, however, the high-SCT ADHD-I group and the low-SCT ADHD-I group did not differ in symptom levels for any anxiety disorders, major depressive disorder, or externalizing symptoms of ODD. Subtype differences in comorbid anxiety were found to be related to gender differences. The symptom levels of panic disorder were higher in females with ADHD-I, and the symptom levels of separation-anxiety disorder were higher for females with ADHD-C. Inattentive girls might present with higher levels of anxiety symptoms than boys. Conclusions: Consistent with previous studies, children with ADHD were more comorbid with anxiety and depression than children without ADHD. In addition, children with ADHD-I were more comorbid with depressive symptoms than children with ADHD-HI and ADHD-C. The higher ratings of depression in ADHD-I children appeared to be related to higher ratings of SCT found in this subtype. There was no difference in anxiety symptoms among the ADHD subtypes, but girls with clinical levels of inattention tend to experience a wider spectrum of anxiety disorders than boys. Contrary to previous research, the findings did not support the idea that SCT is useful in discriminating a distinct inattentive subtype, since this study found no comorbidity differences between the high-SCT ADHD-I and low-SCT ADHD-I groups. Despite the fact that the ADHD-I group had higher BI, there was no evidence that they had higher anxiety symptoms. Reasons for the lack of a direct relationship between BI and internalizing symptoms in ADHD are discussed. The complex roles of SCT and BI in ADHD symptoms and internalizing symptoms call for the need of further local investigation in both clinical and community samples. / published_or_final_version / Clinical Psychology / Doctoral / Doctor of Psychology

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This qualitative study describes teens' perceptions about AD/HD and medications. Roy's Adaptation Model's four modes of adaptation were the framework for this study. Data were collected through semi-structured interviews with 15 high school teens aged 14-17 with parent reported AD/HD. Findings of inductive analysis for modes: Physiologic (Medication), Medications are a hassle but they work; Role function, I do better in school when I take the meds; Interdependence, With meds things are better with my family and friends don't know I am any different; and Self-concept/group identity, I'm just an everyday teenager, pretty much. The composite main theme was: Meds help me. School nurses can use this knowledge to guide interventions for families and teens with AD/HD, healthcare providers, school teachers and staff, and communities in a multidisciplinary effort toward an adaptive educational experience compatible for teens.

Differing opinions among the disciplines involved in the diagnosis and treatment of children with attention-deficit/hyperactivity disorder (ADHD) have left parents navigating in a maze of divergent languages, explanations, and treatment recommendations. This quantitative research study addressed the question of whether a parent training program was an effective treatment for families of children with ADHD residing in a rural community. Although this community-based study did not demonstrate statistically significant outcome measures, it did reveal some interesting side effects. The limitations and the clinical significance of the findings of the study are examined for future research purposes. In particular, the implications for social work practice with families of children with ADHD residing in rural communities are explored from an ecological perspective.

This thesis was designed to investigate differences in aggression between girls with and without attention-deficit/hyperactivity disorder (ADHD). Forty girls with ADHD and 43 girls without ADHD aged 9- to 12- years and their mothers and teachers participated. A multiassessment methodology was used to investigate these differences, employing mothers' reports, teachers' reports, and a laboratory aggression analogue task (a computer game involving simulated girls in other rooms). The results indicated that mothers and teachers saw girls with ADHD as having much higher levels of all types of aggression assessed, including overt, relational, proactive, and reactive aggression, than girls in the control group. On the lab task, girls with ADHD used a strategy that involved more threatening and bragging comments, and social exclusions of their co-players. Expected differences on some of the lab task measures did not emerge. Also, according to mothers, teachers, and the results from the lab task, girls with ADHD were significantly less prosocial than girls in the control group. Where significant group differences had been found, follow-up tests generally indicated that girls with ADHD and comorbid oppositional-defiant disorder (ODD) were more aggressive than girls in the control group, with girls with ADHD but not ODD falling in between. In sum, these results indicate substantial cause for concern for the concurrent and future psychosocial well-being of girls with ADHD.

Within pediatric mental health, of the only 25% of children with emotional and behavioral disorders that receive mental health services many receive treatments and interventions that are not based upon evidence. The question remains how to support mental health clinicians to utilize the evidence we have regarding the treatment of pediatric mental health disorders. Research findings consistently demonstrate that there are a variety of successful interventions which can be effective in changing clinical behaviors. However, further research is required to develop and validate a coherent theoretical framework of health professional behavioral change to better inform the choice of interventions. This study applied theory-driven approaches to predict pediatric mental health clinician behavior in the utilization of evidence-based practice. A national web based survey of pediatric outpatient mental health clinicians (N=154) applying the Theory of Planned Behavior and Operant Learning Theory (Habit and Reinforcement) was conducted. The clinical behaviors of interest were: 1) Recommendation of medication consultation/prescription for the treatment of ADHD; 2) Recommendation of parent training regarding child behavior management; and 3) Utilization of evidence-based group therapy with the specific objective of reducing wait lists. Behavioral intention, a theoretically derived measure, was the main outcome measure. Habit uniquely accounted for 61%, 20% and 25% of the variance, respectively in the three behaviors of interest (parent management, medication, and group treatment for waitlist management). Attitude uniquely contributed a further 5% of the variance in intention in medication consultation/prescription while Reinforcement uniquely explained an additional 10% of the intention to use group treatment. Habit is the single greatest predictor of pediatric mental health clinician behavioral intention in the utilization of evidence-based practice. Habit describes why clinicians are engaging in a behavior (it is what they’ve always done), but the other theoretical predictors tell us something about how to change this habit.

Bakalauro darbe nagrinėjamos aktyvumo ir dėmesio sutrikimą turinčių mokinių bendravimo problemos. Bakalauro darbo tikslas - išnagrinėti aktyvumo ir dėmesio sutrikimą turinčių mokinių bendravimo problemas patiriamas mokykloje. Anketinės apklausos metodu tirta mokinių nuomonė apie mokyklą ir savijautą joje, buvo siekiama išanalizuoti mokinių bendravimo problemas. Apklausiant pedagogus, siekta nustatyti pedagogų reakcijas į nepageidaujamą mokinių elgesį, jų tarpusavio bendravimo su aktyvumo ir dėmesio sutrikimų turinčių vaikų ypatumus, efektyviausias nepageidaujamo elgesio valdymo priemones.Tyrimo metu nustatyta, jog aktyvumo ir dėmesio sutrikimų turintys mokiniai nesijaučia turintys didelių bendravimo problemų. Bendravimą su mokytojais jie vertina teigiamai, labiausiai jie nerimauja, kai reikia pradėti pokalbį ar išsakyti savo nuomonę, nes mano, kad jų niekas nesupranta. Bendraudami su bendraklasiais, jie jaučia kitų mokinių nenorą bendrauti ir mano, jog su jais sutaria tik kai aktyvumo ir dėmesio sutrikimą turinčių mokinių elgesys būna geras. Daţniausia mokinių nesutarimų su bendraamţiais prieţastis yra patyčios. Dauguma mokytojų neturi neigiamo poţiūrio į aktyvumo ir dėmesio sutrikimų turinčius mokinius. Bendravimo su mokiniais, turinčiais aktyvumo ir dėmesio sutrikimą, nesklandumus mokytojai sprendţia pozityviomis priemonėmis, o efektyviausios, mokytojų teigimu, elgesio valdymo priemonės – pokalbiai su tokiais mokiniais ir nuolatinis mokinių uţimtumas. / In the bachelor work were analysed pupil with attention deficit hyperactivity disorder communication problems having at school. Work purpose – to find out pupils with attention deficit hyperactivity disorder communication problems at school. The biggest part of schoolteachers do not have negative view to pupils with attention deficit hyperactivity disorder. Because of pupils negative behaviour, shoolteachers solve communication problems by positive methods. Most effective methods of behaviour control – conversations and full employment.

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