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BACKGROUND: Attention-deficit hyperactivity disorder (ADHD) is a pervasive disorder which affects many domains of a patient’s life. Studies show that even with treatment, the behavior of many children with ADHD will fail to normalize. This can cause stress, and impair academic, social, emotional, and familial aspects of the child’s life. This stress can affect also have a deep impact on the parents, or caregivers, of children with ADHD, including occurrence of depression, social isolation, self-blame, marital discontent, alcohol-related dysfunction. This paper aims to investigate whether the stress caused by a child’s ADHD diagnosis changes with socioeconomic factors, such as parental education or income level. The stress of ADHD on parents or caregivers can be further impacted with a comorbid disorder, and literature suggests a comorbid disorder may be the norm rather than the exception, with up to 50% of children with ADHD displaying comorbid externalizing disorders, such as Oppositional defiant disorder or Conduct disorder. METHOD: A literature search was done to find relevant articles about pediatric ADHD, parental and familial stress, and socioeconomic factors. History, etiology, diagnostic evaluation and comorbid disorders were also examined. RESULTS: Parental stress resulting from their child’s ADHD seems to be greater at lower levels of parental educational and income levels. Furthermore, socioeconomic factors, such as marital status, impacts this stress, where parents without a partner present have greater stress levels. Parental stress levels are also greater when ADHD is comorbid with an externalizing disorder. CONCLUSIONS: Parents with children with ADHD experience more stress, especially at lower income levels, and especially when comorbid with an externalizing disorder. These parents need more resources and social support and special care should be paid to their mental health as well.

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The self-esteem of children with Attention Deficit Disorder (ADD) and Attention Deficit Hyperactivity Disorder (ADHD) has been hypothesized to be low. These children receive frequent negative feedback from the important people in their lives for their hyperactive, impulsive and often intrusive behaviors and for frequent academic failures, which can result in low self-esteem. The research in this area however, reveals conflicting results. The purpose of this research study was to answer the question, "Is there a difference in self-esteem between elementary school children diagnosed with ADD/ADHD and their peers?" A comparative descriptive study design was used to compare the self-esteem scores on the Coopersmith Self-Esteem Inventory (SEI) of81 third- and fourth-grade students with (n = 7) and without (n = 74) a diagnosis of ADD or ADHD. Teacher ratings for each subject's self-esteem using the Behavioral Academic Self-Esteem Rating Scale (BASE) and parent ratings of their child's self-esteem as high, average or low were also compared. Using the demographic information provided by participants parents, there were no significant differences between groups by gender, ethnicity, parents' marital status, parent's level of education, parental employment, or number of children in the home, Jl. > .05. Parent ranking of the self-esteem of the children with ADD/ADHD was significantly lower than their peers, Jl_ = .013. Although no significant differences were found between groups on the SEI or the BASE total scores or subscales,12 > .05, the ADD/ADHD group did consistently rate themselves lower than their average classmate on the SEI. These findings are clinically significant in that studies of adolescents with a childhood diagnosis of ADD or ADHD consistently reveal low self-esteem by that age. These findings are similar to previous research with this age group. It is proposed that these children tend to answer defensively or offer inflated self-evaluations as a selfprotective mechanism. Advanced Practiced Nurses are often part of a collaborative team in the Family Practice, Pediatric, or Psychiatric office setting or in a school health setting which provide opportunities to identify indications of low self-esteem and to offer early appropriate interventions for the child, parents, teachers and significant others in the child's life, which may help to minimize the life long negative consequences associated with low self-esteem. Limitations of the study, and recommendations for future research are discussed.

The hypothesis testing behaviors of 50 boys with Attention-Deficit Hyperactivity Disorder (ADHD) were compared to those of 50 boys without ADHD. The two groups were randomly assigned to one of two feedback conditions: a) boys in the "instruction and rule" condition learned additional strategies to aid their performance on the Wisconsin Card Sorting Test (WCST); b) children in the "verbal only" condition learned no additional strategies. There were no significant group or condition differences between the boys on the primary dependent measures used. The results from the WCST were also evaluated according to five aspects of problem solving: (a) selective attention, (b) stimulus differentiation, (c) response generation, (d) response execution, and (e) responding appropriately to feedback. The study showed a tendency for the children with ADHD to respond according to a position or hypothesis set. Similarly, children in the "verbal only" condition tended to respond to feedback less appropriately than did children in the instruction and rule condition. These tendencies however, did not differentiate between the boys with ADHD and boys without ADHD.

The current study discussed the development and validation of the Checklist for Differential Diagnosis of Attentional Problems (CDDAP), a tool for use with adults seeking diagnosis and treatment of an Attention Deficit Hyperactivity Disorder. Normative data are provided on three subject groups (ADHD adults, controls, and adults with other psychiatric disorders). Convergent validity was established with the SCL-90, and criterion validity established through comparing scaled scores with final diagnoses. Overall, this measure was accurate at differentiating adults with ADHD from controls and adults with other psychiatric disorders. Results indicated that the CDDAP was also able to identify other psychiatric disorders with 71 to 92% accuracy, depending on the disorder.