Gender differences in children with ADHD, ODD, and co-occurring ADHD/ODD identified in a school population

The prevalence of attention-deficit hyperactivity disorder and its associated factors among children in Ethiopia, 2024: a systematic review and meta-analysis

Introduction

Attention-deficit hyperactivity disorder (ADHD) is a neuropsychiatric condition that affects children. Its magnitude varies by area, ranging from 0.2% to 26.8%. Even though there is debate, culture and geographical location may have little or no influence on the epidemiology of ADHD worldwide. Despite this variation, debate over the national prevalence and location of ADHD is unknown in Ethiopia. Therefore, this study aimed to assess the pooled prevalence of ADHD and its contributing factors among children.

Methods

Electronic databases, including Google Scholar, PubMed, Scopus, EMBASE, Web of Science, ScienceDirect, and institutional repositories, were searched. The studies that covered the prevalence and/or risk factors of ADHD in children were included in the collection. The Joanna Briggs Institute quality rating tool was used to rate the quality of each study. The data were extracted using Microsoft Excel 2019, and the statistical analysis was performed using STATA 17.0. Using a random-effects model, we evaluated the combined prevalence of ADHD and associated factors. The Cochrane Q-test and I 2 test statistics were used to quantify the heterogeneity. Furthermore, publication bias was examined using funnel plot graphs and Egger's tests. A Galbraith plot was employed to illustrate outliers. Sensitivity analysis was also applied.

Result

This study included a total of six articles with 4,338 participants. The pooled prevalence estimate of ADHD was 8.81% [95% confidence interval (CI), 4.52-13.11; I 2 = 96.95%; P = 0.001]. Age 6-12 [adjusted odds ratio (AOR) = 3.51 (95% CI, 1.38-5.64), I 2 = 0%; P = 0.001], being male [AOR = 1.94 (95% CI, 1.09-2.79), I 2 = 0%; P = 0.001], and living with a single parent [AOR = 4.92 (95% CI, 1.24-861), I 2 = 0%; P = 0.001] were significant variables.

Conclusion and recommendation

One out of every 12 children in Ethiopia suffers from ADHD. Living with a single parent, being male, and being between the ages of 6 and 12 were risk factors for ADHD. A nationwide study with a large sample size may be required to ascertain the true impact of ADHD. It may be crucial to improve school health services to identify ADHD early and lessen its long-term effects.

Oppositional Defiant Disorder in Autism and ADHD

Our study compared oppositional defiant disorder (ODD) in children with autism to ADHD-Combined presentation and ADHD-Inattentive presentation. Mothers of 2,400 children 3-17 years old with autism and/or ADHD completed the Pediatric Behavior Scale. ADHD-Combined was most strongly associated with ODD, with an ODD prevalence of 53% in children with ADHD-Combined only. When autism was added to ADHD-Combined, prevalence increased to 62% and the ODD score increased significantly. Autism+ADHD-Inattentive, Autism Only, and ADHD-Inattentive Only had ODD prevalences of 28%, 24% and 14%. In each diagnostic group, ODD had the same two factors (irritable/angry and oppositional/defiant); demographic differences between children with and without ODD were few; and correlations between ODD and conduct problems were large, correlations with depression were medium, and correlations with anxiety were small. However, ODD scores differed significantly between groups (Autism+ADHD-Combined > ADHD-Combined Only > Autism+ADHD-Inattentive and Autism Only > ADHD-Inattentive Only). The irritable/angry ODD component was greater in Autism+ADHD-Combined than in ADHD-Combined Only, whereas the oppositional/defiant component did not differ between the two groups. Autism was a significant independent risk factor for ODD, particularly the irritable/angry ODD component, but ADHD-Combined was the strongest risk factor. Therefore, the high co-occurrence of ADHD-Combined in autism (80% in our study) largely explains the high prevalence of ODD in autism. ADHD-Combined, autism, and ODD are highly comorbid (55-90%). Clinicians should assess all three disorders in referred children and provide evidence-based interventions to improve current functioning and outcomes for children with these disorders and reduce family and caretaker stress.

An Open-Label Study of a Wearable Device Targeting ADHD, Executive Function, and Academic Performance

OBJECTIVE

This was an open-label pilot study to test the feasibility and preliminary efficacy of a wearable digital intervention developed to improve on-task behavior. This was an exploratory study to test for specificity of response on parent- and teacher-reported symptom outcomes in attention and hyperactive/impulsive symptoms, as well as domains of functional impairment, including school behavior and learning and executive function.

METHOD

Participants included 38 children aged 8-12 years with a parent-reported past diagnosis of ADHD. Following baseline ratings from parents (N = 38) and teachers (N = 26), participants wore the device to school for four weeks. Parent and teacher ratings of ADHD symptoms, executive function, and functional impairment were repeated at the end of the four-week intervention period.

RESULTS

Statistically significant improvement was seen in the total scores for all parent and nearly all teacher outcomes, with moderate effect size improvements in attention, organization and planning, self-monitoring, school functioning, and teacher-reported academic performance.

CONCLUSIONS

Preliminary evidence from this open-label pilot study suggests that having a child interact with a wearable device to self-monitor attention is feasible. This exploratory, open-label pilot study found real-world improvement in functional domains, including academic performance. Future research will require a blinded, randomized, controlled trial using an appropriate sham comparator to confirm these findings.

Novel Oppositional Defiant Disorder or Conduct Disorder 24 Months After Traumatic Brain Injury in Children and Adolescents

OBJECTIVE

The authors sought to identify predictive factors of new-onset or novel oppositional defiant disorder or conduct disorder assessed 24 months after traumatic brain injury (TBI).

METHODS

Children ages 5 to 14 years who had experienced TBI were recruited from consecutive hospital admissions. Soon after injury, participants were assessed for preinjury characteristics, including psychiatric disorders, socioeconomic status (SES), psychosocial adversity, and family function, and the presence and location of lesions were documented by MRI. Psychiatric outcomes, including novel oppositional defiant disorder or conduct disorder, were assessed 24 months after injury.

RESULTS

Of the children without preinjury oppositional defiant disorder, conduct disorder, or disruptive behavior disorder not otherwise specified who were recruited in this study, 165 were included in this sample; 95 of these children returned for the 24-month assessment. Multiple imputation was used to address attrition. The prevalence of novel oppositional defiant disorder or conduct disorder was 23.7 out of 165 (14%). In univariable analyses, novel oppositional defiant disorder or conduct disorder was significantly associated with psychosocial adversity (p=0.049) and frontal white matter lesions (p=0.016) and was marginally but not significantly associated with SES. In the final multipredictor model, frontal white matter lesions were significantly associated with novel oppositional defiant disorder or conduct disorder (p=0.021), and psychosocial adversity score was marginally but not significantly associated with the outcome. The odds ratio of novel oppositional defiant disorder or conduct disorder among the children with versus those without novel depressive disorder was significantly higher for girls than boys (p=0.025), and the odds ratio of novel oppositional defiant disorder or conduct disorder among the children with versus those without novel attention-deficit hyperactivity disorder (ADHD) was significantly higher for boys than girls (p=0.006).

CONCLUSION

Approximately 14% of children with TBI developed oppositional defiant disorder or conduct disorder. The risk for novel oppositional defiant disorder or conduct disorder can be understood from a biopsychosocial perspective. Sex differences were evident for comorbid novel depressive disorder and comorbid novel ADHD.

Psychopathic traits in the interpersonal context: Is the effect of psychopathic traits on prosocial behavior mediated by peer problems?

Psychopathic traits are often investigated within the individual, while most traits come to expression within the interpersonal context. Low social communion might even be an important overlooked core feature of psychopathy. This raises the question how psychopathic (i.e., Grandiose-Manipulative, Callous-Unemotional, and Irresponsible-Impulsive) traits affect the tendency to show prosocial behavior, and whether peer problems explain this relationship. Besides, the effects of gender on these subrelations are explored. In total, 541 community adolescents and emerging adults (26.4 % men; 16-25 years old, M_age = 21.7, SD_age = 2.50) completed questionnaires, measuring psychopathic traits, prosocial behavior, and peer problems. The relationship between psychopathic traits and prosocial behavior was investigated with three separate moderated mediation regression analyses (for Grandiose-Manipulative, Callous-Unemotional, and Impulsive-Irresponsible traits separately) including peer problems as mediator and gender as moderator. Significant direct negative effects of Grandiose-Manipulative and Callous-Unemotional traits on prosocial behavior were found, though not for Impulsive-Irresponsible traits. Peer problems did not mediate this relation and gender was no moderator. The significant moderation effect indicated that only for women a significant direct positive effect of Callous-Unemotional traits on peer problems was found, but not for men nor other psychopathic traits. More gender differences were found with men (vs. women) scoring significantly higher on all three psychopathic traits and lower on prosocial behavior. Implications of psychopathic traits within the interpersonal context are discussed and future research could further investigate how this relationship can be explained, for example by including different types of measures and other potential mediators (e.g., empathy).

Sex Differences in Neurodevelopmental Disorders: A Key Role for the Immune System

Sex differences are prominent defining features of neurodevelopmental disorders. Understanding the sex biases in these disorders can shed light on mechanisms leading to relative risk and resilience for the disorders, as well as more broadly advance our understanding of how sex differences may relate to brain development. The prevalence of neurodevelopmental disorders is increasing, and the two most common neurodevelopmental disorders, Autism Spectrum Disorder (ASD) and Attention-Deficit/Hyperactivity Disorder (ADHD) exhibit male-biases in prevalence rates and sex differences in symptomology. While the causes of neurodevelopmental disorders and their sex differences remain to be fully understood, increasing evidence suggests that the immune system plays a critical role in shaping development. In this chapter we discuss sex differences in prevalence and symptomology of ASD and ADHD, review sexual differentiation and immune regulation of neurodevelopment, and discuss findings from human and rodent studies of immune dysregulation and perinatal immune perturbation as they relate to potential mechanisms underlying neurodevelopmental disorders. This chapter will give an overview of how understanding sex differences in neuroimmune function in the context of neurodevelopmental disorders could lend insight into their etiologies and better treatment strategies.

Substance-Related Problems in Adolescents with ADHD-Diagnoses: The Importance of Self-Reported Conduct Problems

BACKGROUND

Attention-deficit/hyperactivity disorder (ADHD) is a known risk factor for substance-related problems (SRP) during adolescence, but the nature of this relationship and the importance of co-occurring conduct problems are not fully understood.

METHODS

Data stem from a linked dataset between a large population-based survey conducted in 2012 of Norwegian adolescents aged 16 to 19, and registry-based data from specialized child and adolescent mental health services (n = 9,411).

RESULTS

Adolescents with "ADHD + high conduct problems" had increased risk of SRP (odds ratios = 2.37-10.14). Adolescents with "ADHD only" had very similar risk of SRP as adolescents from the general population with low symptoms of conduct problems. Relative to boys, girls with "ADHD + high conduct problems" appeared to have somewhat higher risk for SRP.

CONCLUSION

The present study suggests that the risk for SRP among adolescent with ADHD is largely driven by co-existing conduct problems.

Reliability and Validity of the Korean Version of Disruptive Behavior Disorders Rating Scale, DSM-5 Version-Parent Form

OBJECTIVE

Disruptive behavior disorder (DBD) adversely impacts children and adolescents. However, a comprehensive and cost-effective scale to assess DBD is lacking in Korea. Therefore, this study translated the Disruptive Behavior Disorders Rating Scale (DBDRS) into Korean and analyzed its psychometric properties.

METHODS

Parents and primary caregivers of non-clinical (n=429) and clinical (n=28) children and adolescents aged 6-15 years were included in the analysis. Confirmatory factor analysis was conducted; further, concurrent validity and internal consistency were investigated using correlation analysis and Cronbach's alpha, respectively. Furthermore, discriminative capacity was estimated using receiver operating characteristic curve analysis.

RESULTS

The four-factor model of K-DBDRS showed good model fit indices and factor loadings, which supported the construct validity of the scale. Strong correlations between K-DBDRS and related measurements were observed, and a robust level of Cronbach's alpha was confirmed (0.891-0.933). The discriminative capacity of the scale was good, based on the area under the curve values (0.933-0.953).

CONCLUSION

This study indicated that the K-DBDRS is an appropriate screening tool for Korean children and adolescents. Thus, this scale can be applied in clinical and community settings to identify children and adolescents with disruptive behavior disorders.

Effect of relative age on childhood mental health: A cohort of 9,548,393 children and adolescents

BACKGROUND

The effect of relative age on the diagnoses of attention deficit hyperactivity disorder (ADHD), disruptive behavior disorder (DD), anxiety disorder, and depressive disorder and the prescription for ADHD and antidepressant medications remains unclear.

AIM

To clarify the impact of relative age in a school year with the diagnoses of ADHD, DD, anxiety disorder, and depressive disorder and the prescription for ADHD and antidepressant medications.

METHODS

The annual cutoff birthdate for entry to school in Taiwan is August 31. The Taiwan National Health Insurance Research Database was used to enroll 9,548,393 children and adolescents aged 3-17 years during the study period (September 1, 2001, to August 31, 2011). The Poisson regression model was performed to examine the likelihood of receiving diagnoses of ADHD, DD, anxiety disorder, and depressive disorder, as well as the prescription of ADHD and antidepressant medications among children born in August (the youngest) and September (the oldest).

RESULTS

Both boys and girls born in August had a higher risk of being diagnosed as having ADHD (odds ratio [OR] = boys: 1.65, girls: 1.80), DD (1.29, 1.45), anxiety disorder (1.49, 1.33), and depressive disorder (1.10, 1.10). Furthermore, children born in August were more likely to be prescribed ADHD medication (1.71, 1.72) and antidepressants (1.18, 1.09) compared with those born in September.

DISCUSSION

Relative age, as an indicator of neurocognitive maturity, is a critical factor for the likelihood of being diagnosed as having ADHD, DD, anxiety disorder, and depressive disorder among children and adolescents.

Lifetime evolution of ADHD treatment

Attention-deficit hyperactivity disorder (ADHD), has been traditionally considered a neurodevelopmental disorder affecting children and adolescents characterized by inattention, hyperactivity, disruptive behavior, and impulsivity. Although still debated, it is evident that ADHD is also present in adulthood, but this diagnosis is rarely carried out, mainly for the frequent comorbidity with other psychiatric and/or substance abuse disorders. Given the need to shed more light on the pharmacological treatment of ADHD, we performed a naturalistic review to review and comment on the available literature of ADHD treatment across the lifespan. Indeed, stimulants are endowed of a prompt efficacy and safety, whilst non-stimulants, although requiring some weeks to be fully effective, are useful when a substance abuse history is detected. In any case, the pharmacological management of ADHD appears to be still largely influenced by the individual experience of the clinicians. Further longitudinal studies with a careful and detailed characterization of participants across different phases of the lifespan are also required to provide relevant confirmations (or denials) regarding pharmacological treatments amongst the different age groups.

Attention-Deficit/Hyperactivity Disorder Symptom Dimensions Differentially Predict Adolescent Peer Problems: Findings From Two Longitudinal Studies

Introduction: Previous findings that inattention (IA) and hyperactive/impulsive (HI) symptoms predict later peer problems have been mixed. Utilizing two culturally diverse samples with shared methodologies, we assessed the predictive power of dimensionally measured childhood IA and HI symptoms regarding adolescent peer relationships.

Methods: A US-based, clinical sample of 228 girls with and without childhood diagnosed attention-deficit/hyperactivity disorder (ADHD; M age = 9.5) was assessed and followed 5 years later. A Norwegian, population-based sample of 3,467 children (53% girls; M age = 8.3) was assessed and followed approximately 4 years later. Both investigations used parent and teacher reports of ADHD symptoms and peer relations. Multivariate regression analyses examined the independent contributions of IA and HI symptoms to later peer problems, adjusting for baseline childhood peer problems. We also examined childhood sex as a potential moderator within the Norwegian sample.

Results: Higher levels of childhood HI symptoms, but not IA symptoms, independently predicted adolescent peer problems in the all-female clinical sample. Conversely, higher levels of IA symptoms, but not HI symptoms, independently predicted preadolescent peer problems in the mixed-sex population sample. Results did not differ between informants (parent vs. teacher). Associations between ADHD symptom dimensions and peer problems within the Norwegian sample were not moderated by child sex.

Discussion: Differential associations between childhood hyperactive/impulsive and inattention symptoms and adolescent peer problems were found across two diverse samples using a shared methodology. Potential explanations for different findings in the clinical vs. population samples include symptom severity as well as age, sex, and cultural factors. We discuss implications for future research, including the importance of dimensional measures of ADHD-related symptoms and the need for shared methodologies across clinical and normative samples.

Teacher reports of ADHD symptoms in Italian children at the end of first grade

Objective:

To determine the prevalence of teacher-rated ADHD symptoms in Italian first-graders.

Method:

1891 first-graders aged 6.6–7.4 years were evaluated using a 34-item DSM-IV-referenced ADHD teacher rating questionnaire which included all the 18 DSM-IV ADHD diagnostic criteria, some Oppositional-Defiant Disorder (ODD), Conduct Disorder (CD), depression and anxiety symptoms, and questions about the child's social and scholastic impairment.

Results:

Criteria for ADHD were met in 7.1% (n = 135) of the subjects (10.4% males and 3.8% females), 3.5% with the Inattentive subtype, 2.3% with the Hyperactive/Impulsive subtype and 1.3% with a Combined subtype. Internalizing (depression and/or anxiety) symptoms were reported in 25.9% of the subjects with ADHD symptoms, 17% showed externalizing symptoms (ODD or CD), and 12.6% showed both. Comorbid symptoms were 10 times more frequent than in subjects without ADHD symptoms. Inattentive subtype and scholastic impairment were more frequent in females, Hyperactive/Impulsive subtype and social impairment were more frequent in males.

Conclusions:

Even though the real prevalence of ADHD in first graders is presumably lower than that found in the present study, this screening procedure might allow detecting those children who could benefit from referral for more comprehensive assessments.

ADHD and ODD Symptoms in Toddlers: Common and Specific Associations with Temperament Dimensions

The aim of this work was to study the relationship between temperament and signs of psychopathology in typically developing toddlers. More specifically, Attentional Deficit Hyperactivity Disorder (ADHD) and Oppositional Defiant Disorder (ODD) symptoms were analyzed in connection with fine-grained temperament dimensions. The sample was composed of 65 toddlers aged between 18 and 35 months. Bivariate correlations showed that higher levels of negative emotionality and approach tendencies, and lower levels of inhibitory control, were related to more ADHD and ODD manifestations. Bivariate correlations also indicated unique associations: lower levels of soothability were associated with higher ODD symptoms, whereas lower attentional focusing and low-intensity pleasure were related with higher ADHD symptoms. Additionally, regression and path analysis models indicated that ADHD was predominantly associated with attentional focusing and motor activation whereas ODD was most closely related to frustration. Our findings highlight the relevance of studying early correlates of psychopathological manifestations to identify children who could benefit from prevention and early intervention programs.

Behavioral problems in preadolescence: Does gender matter?

Behavioral problems in children are increasingly acknowledged as a global issue in mental health. Preadolescence is the transitory phase of development that links childhood and adolescence, and the presence of behavioral problems in this phase could be detrimental to children's present and future. This study aimed to describe the epidemiology of "behavioral problems" in preadolescents aged 11 to 12 years and to examine their distribution by socioeconomic status and children's characteristics while developing an in-depth understanding of the role of gender as a risk factor for such problems. A school-based, cross-sectional study was conducted in Karachi, Pakistan. Participants were selected from a middle-class, coeducational school chain. Sociodemographic questionnaires and an officially adapted version of Youth Self Report Form, which is child- and adolescent-reported version of Child Behavior Checklist, were used to collect data from children. The prevalence of Overall Behavioral Problems was 28.6%. From Broadband Scales, the relative prevalence of internalizing problems was about 52% higher than that of externalizing problems. Among the Narrowband Scales, somatic complaints were the most prevalent (23.2%). Male children significantly had higher odds for being at risk of Overall Behavioral problems, internalizing problems, and co-occurring behavioral issues, as compared to female children. The study concludes that the prevalence of overall behavioral problems is at the higher end of the global range. Male children are more at risk for overall behavioral problems, and contrary to previous studies, they are significantly more at risk of internalizing problems. Our study is the first to report the risk of co-occurrence of multiple issues with respect to gender, and adds that male children are significantly at risk of multiple co-occurring behavioral problems. Our study highlights the need for an in-depth understanding of cultural, sociopolitical conditions for actionable and gender-sensitive interventions for preadolescents.

Trajectories of Verbal and Physical Peer Victimization Among Children with Comorbid Oppositional Defiant Problems, Conduct Problems and Hyperactive-Attention Problems

The high levels of comorbidity between oppositional/conduct problems and hyperactivity/attention problems underscore the need for assessing how vulnerability for peer victimization is shaped by overlap among these behavior problems. Children (mean age 8.39, SD = 0.93) participating in a longitudinal study of the development of conduct problems (N = 744; 348 girls) in Quebec, Canada, were evaluated by their teachers regarding experiences of peer verbal and physical victimization every year for 6 years. Parent and teacher ratings of clinically significant oppositional/conduct problems, and hyperactivity/attention problems, as well as cormorbid opposition defiant/conduct problems and hyperactivity/attention problems were regressed onto trajectories of verbal and physical victimization. While behavior problems (both alone and together) were associated with higher levels of verbal and physical victimization, some variation was observed across rater and type of victimization. Ultimately, these findings suggest the importance of adapting programming for reducing victimization to children with oppositional and conduct problems.

Demographic Differences in Disruptive Mood Dysregulation Disorder Symptoms in ADHD, Autism, and General Population Samples

OBJECTIVE

Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) disruptive mood dysregulation disorder (DMDD) is a controversial new diagnosis. No studies have investigated DMDD symptoms (irritable-angry mood and temper outbursts) and demographics in general population and psychiatric samples.

METHOD

Maternal ratings of DMDD symptoms and diagnoses, age, gender, IQ, race, and parent occupation were analyzed in general population ( n = 665, 6-12 years) and psychiatric samples ( n = 2,256, 2-16 years).

RESULTS

Percentage of school-age children with DMDD symptoms were 9% general population, 12% ADHD-I, 39% ADHD-C, and 43% autism. Male, nonprofessional parent, and autism with IQ > 80 were associated with increasing DMDD symptoms, but demographics together explained only 2% to 3% of the DMDD score variance.

CONCLUSION

Demographics contributed little to the presence of DMDD symptoms in all groups, whereas oppositional defiant disorder (ODD) explained most of the variance. Almost all children with DMDD symptoms had ODD suggesting that DMDD may not be distinct from ODD.

Peer relationships and prosocial behaviour differences across disruptive behaviours

It is unclear if impairments in social functioning and peer relationships significantly differ across common developmental conditions such as attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), conduct disorder (CD), and associated callous-unemotional traits (CU traits). The current study explored sex differences and symptoms of parent- and teacher-reported psychopathology on peer relationships and prosocial behaviour in a sample of 147 referred children and adolescents (aged 5-17 years; 120 m). The results showed that increases in parent-reported ADHD Inattentive symptoms and teacher-reported ADHD Hyperactive-Impulsive symptoms, CD, ODD, and CU traits were significantly associated with peer relationship problems across sex. At the same time, teacher-reported symptoms of ODD and both parent- and teacher-reported CU traits were related to difficulties with prosocial behaviour, for both boys and girls, with sex explaining additional variance. Overall, our findings show a differential association of the most common disruptive behaviours to deficits in peer relationships and prosocial behaviour. Moreover, they highlight that different perspectives of behaviour from parents and teachers should be taken into account when assessing social outcomes in disruptive behaviours. Given the questionable separation of conduct problem-related constructs, our findings not only point out the different contribution of those aspects in explaining peer relationships and prosocial behaviour, but furthermore the variance from different informants about those aspects of conduct problems.

ADHD and Gender: subjective experiences of children in Chile

Abstract Although research on ADHD has tended to ignore gender differentials, recent contributions produced mainly from epidemiology have revealed that this diagnostic category seems to be strongly related to gender. However, these contributions seem to limit their scope to the study of the symptoms as well as cognitive, affective and social functioning of children, leaving aside subjective aspects associated with the ADHD practices of diagnosis and treatment. Thus, this article aims to explore how the gender dimension crosses the subjective experience of children diagnosed with ADHD. Based on open interviews conducted with children between the ages of 7 and 13, we show general trends that articulate gender and characteristics associated with the ADHD diagnosis, while at the same time, with children’s experiences that dislocate such trends. The findings were grouped according to four emerging axes: (1) locations, (2) abilities, (3) approches, (4) interactions. Thus, we will show how the experience of boys and girls is multiple in relation to the diagnosis and it is not possible to be reduced to a gender binary perspective.

What Predicts a Good Adolescent to Adult Transition in ADHD? The Role of Self-Reported Resilience

OBJECTIVE

ADHD is a disorder associated with impairment and comorbid psychiatric problems in young adulthood; therefore, factors that may imply a more favorable outcome among adolescents with ADHD are of interest.

METHOD

This study used a longitudinal design to assess whether adolescent personal resilience characteristics during adolescence protected against psychosocial impairment, depression, and anxiety 3 years later. Self-reported protective factors were used as baseline measures in the assessment of 190 clinically referred adolescents with ADHD. A semi-structured diagnostic interview was performed at the follow-up.

RESULTS

In a group of youth with ADHD, personal resilience characteristics were associated with better psychosocial functioning in young adulthood, and less depression and anxiety.

CONCLUSION

Although further research is needed, these results indicate that personal resilience characteristics may be protective factors in the transitional period from adolescence to early adulthood.

Influence of Disruptive Behavior Disorders on Academic Performance and School Functions of Youths with Attention-Deficit/Hyperactivity Disorder

Childhood attention-deficit/hyperactivity disorder (ADHD) and comorbid oppositional defiant disorder/conduct disorder (ODD/CD) are associated with negative school outcomes. The study aimed to examine the impact of ADHD and ODD/CD on various school functions. 395 youths with ADHD (244 with ADHD + ODD/CD and 151 with ADHD only) and 156 controls received semi-structured psychiatric interviews. School functions were assessed and compared between each group with a multiple-level model. The results showed that youths with ADHD had poorer performance across different domains of school functioning. Youths with ADHD + ODD/CD had more behavioral problems but similar academic performance than those with ADHD only. The multiple linear regression models revealed that ADHD impaired academic performance while ODD/CD aggravated behavioral problems. Our findings imply that comorbid ODD/CD may specifically contribute to social difficulties in youths with ADHD. Measures of early detection and intervention for ODD/CD should be conducted to prevent adverse outcomes.

Social Functioning in Children With or At Risk for Attention Deficit/Hyperactivity Disorder: A Meta-Analytic Review

Considerable work has demonstrated significant impairment in social functioning for children with attention deficit/hyperactivity disorder (ADHD). The social functioning profiles of children with ADHD are marked by impairments across diverse domains as they tend to experience greater rates of peer rejection, have lower levels of social skills, and have impaired social cognitions. The purpose of this study was to (a) quantitatively examine the association between ADHD and deficits across several domains of social functioning (peer functioning, social skills, social information processing), (b) examine differences in the magnitude of such associations, and (c) examine the effect of potential moderators. A meta-analysis of 109 studies (n = 104,813) revealed that children with ADHD have the most impairment within the peer functioning domain (weighted effect size [ES] r = .33) followed by significantly smaller effects within the social skills (weighted ES r = .27) and social information-processing domains (weighted ES r = .27). When examining potential moderators, results revealed that the association between ADHD and deficits within the social skills domain was weaker among studies that controlled for co-occurring conduct problems (CP). Studies that utilized sociometric and teacher reports of peer status reported the largest effects within the peer functioning domain. In addition, studies that utilized the "gold standard" approach to diagnosing ADHD documented the largest effects within both the social skills and peer functioning domains. Last, studies utilizing younger samples revealed the largest effects for deficits within the peer functioning domain. Theoretical and clinical implications are discussed.

Reduced inattention and hyperactivity and improved cognition after marine oil extract (PCSO-524®) supplementation in children and adolescents with clinical and subclinical symptoms of attention-deficit hyperactivity disorder (ADHD): a randomised, double-blind, placebo-controlled trial

INTRODUCTION

This study investigated the effects of a marine oil extract (PCSO-524®) on inattention, hyperactivity, mood and cognition in children and adolescents. PCSO-524® is a standardised lipid extract of the New Zealand green-lipped mussel and is an inflammatory modulator that inhibits the 5'-lipoxygenase and cyclooxygenase pathways and decreases concentrations of the pro-inflammatory arachidonic acid (AA).

METHODS

PCSO-524® or a matched placebo was administered for 14 weeks to 144 participants (123 males/21 females; mean age 8.7 years) with high hyperactivity and inattention in a randomised, double-blind, placebo-controlled study. The primary outcome was the Conners Parent Rating Scale assessing parental reports of behavioural problems. Secondary outcomes assessed changes in cognition and mood.

RESULTS

The results of the present study did not support the hypothesis that PCSO-524® improves parental reports of hyperactivity, inattention and impulsivity in children ages 6 to 14 years over placebo. Repeated measures ANOVA on post hoc subsample analysis indicated significant improvements in hyperactivity (p = 0.04), attention (p = 0.02), learning (p = 0.05) and probability of ADHD (p = 0.04) with a medium to large average effect size (d = 0.65) in those children who did not meet criteria for combined hyperactivity and inattention. Furthermore, significant improvements in the PCSO-524® group were indicated in a whole sample repeated measures ANCOVA on recognition memory between baseline and week 8 over placebo (p = 0.02, d = 0.56); this difference was not sustained at week 14.

CONCLUSIONS

The results presented indicate that PCSO-524® may be beneficial in reducing levels of hyperactivity and inattention in a population of children with clinical and subclinical symptoms of ADHD.

Problematic Peer Functioning in Girls with ADHD: A Systematic Literature Review

Objective

Children with attention deficit hyperactivity disorder (ADHD) experience many peer interaction problems and are at risk of peer rejection and victimisation. Although many studies have investigated problematic peer functioning in children with ADHD, this research has predominantly focused on boys and studies investigating girls are scant. Those studies that did examine girls, often used a male comparison sample, disregarding the inherent gender differences between girls and boys. Previous studies have highlighted this limitation and recommended the need for comparisons between ADHD females and typical females, in order to elucidate the picture of female ADHD with regards to problematic peer functioning. The aim of this literature review was to gain insight into peer functioning difficulties in school-aged girls with ADHD.

Methods

PsychINFO, PubMed, and Web of Knowledge were searched for relevant literature comparing school-aged girls with ADHD to typically developing girls (TDs) in relation to peer functioning. The peer relationship domains were grouped into ‘friendship’, ‘peer status’, ‘social skills/competence’, and ‘peer victimisation and bullying’. In total, thirteen studies were included in the review.

Results

All of the thirteen studies included reported that girls with ADHD, compared to TD girls, demonstrated increased difficulties in the domains of friendship, peer interaction, social skills and functioning, peer victimization and externalising behaviour. Studies consistently showed small to medium effects for lower rates of friendship participation and stability in girls with ADHD relative to TD girls. Higher levels of peer rejection with small to large effect sizes were reported in all studies, which were predicted by girls’ conduct problems. Peer rejection in turn predicted poor social adjustment and a host of problem behaviours. Very high levels of peer victimisation were present in girls with ADHD with large effect sizes. Further, very high levels of social impairment and social skills deficits, with large effect sizes, were found across all studies. Levels of pro-social behaviour varied across studies, but were mostly lower in girls with ADHD, with small to large effect sizes. Overall, social disability was significantly higher among girls with ADHD than among TD girls.

Conclusion

Congruous evidence was found for peer functioning difficulties in the peer relationship domains of friendship, peer status, social skills/competence, and peer victimisation and bullying in girls with ADHD.

Cognitive-Behavioral Therapy for a 9-Year-Old Girl With Disruptive Mood Dysregulation Disorder

Disruptive mood dysregulation disorder (DMDD) is a relatively new diagnosis in the field of childhood onset disorders. Characterized by both behavior and mood disruption, DMDD is a purportedly unique clinical presentation with few relevant treatment studies to date. The current case study presents the application of cognitive-behavioral therapy (CBT) for anger and aggression in a 9-year-old girl with DMDD, co-occurring attention deficit hyperactivity disorder (ADHD), and a history of unspecified anxiety disorder. At the time of intake evaluation, she demonstrated three to four temper outbursts and two to three episodes of aggressive behavior per week, in addition to prolonged displays of non-episodic irritability lasting hours or days at a time. A total of 12 CBT sessions were conducted over 12 weeks and 5 follow-up booster sessions were completed over a subsequent 3-month period. Irritability-related material was specially designed to target the DMDD clinical presentation. Post-treatment and 3-month follow-up assessments, including independent evaluation, demonstrated significant decreases in the target symptoms of anger, aggression, and irritability. Although the complexities of diagnosing and treating DMDD warrant extensive research inquiry, the current case study suggests CBT for anger and aggression as a viable treatment for affected youth.

Analyzing Digit Span Components for Assessment of Attention Processes

The Digit Span (DS) subtest of the Wechsler Intelligence Scale for Children-Third Edition (WISC-III) is thought to be a measure of attention, concentration, sequencing, number facility, and auditory short-term memory. An optional WISC-III subtest and part of the Freedom from Distractibility (FD) factor, DS assesses several cognitive constructs, yet its utility in differential diagnosis has been questioned because poor DS or FD performance has been inconsistently associated with attention processes. In this study of 195 children referred for comprehensive neuropsychological evaluations, Digits Forward (DF) and Digits Backward (DB) component scores were found to be differentially predictive of attention, executive function, and behavior rating measures. Results suggest that DB is associated with attention and executive function processes, not the short-term rote auditory memory processes tapped by DF.

Social Representations of Attention Deficit/Hyperactivity Disorder, 1988–1997

Considerable debate has arisen regarding many aspects of attention deficit/hyperactivity disorder (ADHD), including the existence, diagnosis and prevalence of the disorder, the use of medications in treating young children for the disorder, and the long-term side-effects of the medications. A fundamental catalyst in this debate involves the numerous and diverse social representations of ADHD: the differing ways of perceiving what ADHD is, whom it affects, and the most appropriate treatments. This paper presents a discussion of social representations theory and its previous applications to the study of mental illness, connecting this theory with research in media framing. Quantitative and qualitative content analyses of print media representations of ADHD over a ten-year period are presented. Using results from the media analysis, we examine different processes through which these representations might influence perceptions of individuals experiencing ADHD-related symptoms, particularly as these perceptions relate to mental health treatment decisions.

ADHD symptoms and peer relations of children in a community sample: Examining associated problems, self-perceptions, and gender differences

This study examined children's peer relations in relation to gender, symptoms of attention-deficit/ hyperactivity disorder (ADHD), associated behaviour problems, prosociality, and self-perceptions, in a community sample. Six hundred and thirty-five 12-year-old children (314 girls) provided peer nominations and rated feelings of loneliness and self-perceptions regarding global self-worth and behavioural conduct. We obtained teacher ratings of ADHD symptoms, conduct and internalising problems, and prosociality. ADHD symptoms, conduct problems, internalising problems, and low levels of prosociality were all related to higher levels of peer dislike. Despite ADHD symptoms being related to more peer dislike, children with high levels of ADHD symptoms did not report more feelings of loneliness. The self-perceptions of children with high levels of ADHD were not related to peer dislike. Although high levels of ADHD symptoms were not related to peer dislike in girls, peers tolerated higher levels of ADHD symptoms among boys than among girls, providing support for the “gender appropriateness hypothesis” regarding the impact and influence of ADHD symptomatology upon the peer relations of children within a community sample.

Subtypes of exposure to intimate partner violence within a Canadian child welfare sample: associated risks and child maladjustment

Children exposed to intimate partner violence (IPV) are at increased risk of experiencing behavioral difficulties including externalizing and internalizing problems. While there is mounting evidence about mental health problems in children exposed to IPV, most of the research to date focuses on IPV exposure as a unitary, homogeneous construct. The purpose of this study was to examine the association between subtypes of IPV exposure on child functioning and presence of harm within a child welfare sample. Given the evidence of the "double whammy" effect, co-occurring IPV exposure was also examined. Using data from the Canadian Incidence Study of Reported Child Abuse and Neglect - 2008 (n=2,184) we examined whether specific IPV exposure subtypes or their co-occurrence resulted in a greater risk of child maladjustment. Information was obtained from child welfare workers' reports. Caregiver and household risk factors were also examined. Co-occurring IPV exposure resulted in the greatest risk for reported child maladjustment. Exposure to emotional IPV and direct physical IPV were significantly associated with increased risk of internalizing problems and presence of harm. Caregiver mental health and lack of social support emerged as significant risk factors for behavior problems. This study adds to the evidence that exposure to subtypes of IPV may be differentially related to child functioning. Given that risk factors and child functioning is part of the decision-making framework for case worker referrals, this study provides important preliminary evidence about how the child welfare system operates in practice with respect to sub-types of exposure to IPV. These findings suggest that intervening with children exposed to different types of IPV may require a tailored approach.

EEG Differences Between the Combined and Inattentive Types of Attention-Deficit/Hyperactivity Disorder in Girls: A Further Investigation

This study further investigated electroencephalogram (EEG) differences between girls with the Combined and Inattentive types of attention-deficit/hyperactivity disorder (AD/HD). We selected subjects with widely separated scores on hyperactivity-impulsivity symptoms to behaviorally exaggerate diagnostic group differences. Twenty girls with AD/HD Combined type, 20 girls with AD/HD Inattentive type, and 20 controls (aged 7-12 years) had an eyes-closed resting EEG recorded from 19 electrodes. The EEG was fast Fourier transformed, and estimates for total power, absolute and relative power in the delta, theta, alpha, and beta frequency bands, and the theta/beta ratio were calculated and analyzed in 9 scalp regions. Girls of the Combined type, compared with girls of the Inattentive type, had elevated midline total power, elevated temporal absolute alpha activity, elevated posterior absolute beta activity, reduced right hemisphere relative delta and reduced left hemisphere relative alpha activity, and reduced theta/beta ratio in the left hemisphere. Although topographic differences were again found between the AD/HD types, significant global differences remain elusive in the EEGs of girls with the Combined and Inattentive types. Despite creating behaviorally exaggerated AD/HD type groups, girls' EEG activity failed to replicate differences found previously in mixed-sex groups. The EEG profiles of AD/HD types in girls are markedly different from those found in boys. This reinforces the notion that it is no longer appropriate to apply the male-based literature to all AD/HD groups; rather, the use of single-sex subject groups is necessary in EEG research of AD/HD.

Distinguishing among disruptive behaviors to help predict high school graduation: does gender matter?

This study examined unique predictive associations of aggressive and hyperactive-inattentive behaviors in elementary school with high school graduation. The current study also investigated whether these associations were moderated by gender. At Time 1, 745 children in the 3rd through 5th grades completed peer ratings on their classmates' disruptive behaviors. At Time 2, school records were reviewed to determine whether students graduated within four years of entering high school. Results showed that gender and hyperactivity-inattention are uniquely associated with high school graduation, but childhood aggression is not. Results also indicated that gender moderated associations between hyperactivity-inattention and graduation. Among boys, hyperactive-inattentive behaviors were not significantly associated with graduation, above and beyond aggression. In contrast, among girls, hyperactive-inattentive behaviors in childhood were significantly associated with graduation even after controlling for aggression. These findings suggest that in middle childhood, hyperactive-inattentive behaviors may be a more meaningful predictor of high school graduation than other forms of early disruptive behavior (e.g., aggression), especially for girls. Such findings could have significant implications for prevention and intervention programs designed to target children at risk for dropping out of school.

The comorbidity of ADHD and autism spectrum disorder

ADHD and autism spectrum disorder are common psychiatric comorbidities to each another. In addition, there is behavioral, biological and neuropsychological overlap between the two disorders. There are also several important differences between autism spectrum disorder and ADHD. Treatment strategies for the comorbid condition will also be reviewed. Future areas of research and clinical need will be discussed.

Longitudinal associations between preschool psychopathology and school-age peer functioning

The current study examined the effects of preschool psychopathology on peer functioning around school entry. Children (N = 211) were assessed at ages 3 and 6. A semi-structured diagnostic interview, the Preschool Age Psychiatric Assessment, was administered to a parent at both time points to assess psychopathology. The peer functioning constructs examined at age 6 included child popularity, socially inappropriate behavior, and conflicted shyness. Simultaneous multiple regressions revealed that age 3 anxiety disorder diagnosis was the only unique diagnostic predictor of age 6 socially inappropriate behavior and conflicted shyness, with age 3 anxiety dimensional scores uniquely predicting all three peer constructs. Age 3 anxiety disorder had direct effects on both socially inappropriate behavior and conflicted shyness, which were not mediated by concurrent anxiety disorder at age 6. Thus, preschool anxiety disorders may have enduring effects on child peer relationships in the early school-age years. Possible explanations and implications are explored.

Acculturation, social self-control, and substance use among Hispanic adolescents

It is unclear how acculturation is related to self-control characteristics and whether part of the effect of acculturation on Hispanic adolescents' substance use behavior is mediated through lower self-control. We tested social self-control, peer substance use, and baseline substance use as mediators of the effect of Hispanic (predominantly Mexican or Mexican American) adolescents' level of U.S. acculturation on their substance use behavior 1 year later. In addition, we tested gender as a possible moderator of the pathways involved in the mediation model. Participants included 1,040 self-identified Hispanic/Latino adolescents (M = 14.7; SD = 0.90; 89% Mexican/Mexican American) recruited from nine public high schools. Acculturation was measured in terms of adolescents' extent of English language use in general, at home, with friends, and their use of the English-language entertainment media. Analyses were conducted using structural equation modeling and controlled for potential confounders such as age and parental education. Results indicated a statistically significant three-path mediation in which poor social self-control and peer substance use mediated the effects of acculturation on prospective substance use. Paths in the mediation model were not found to differ by gender. Our findings suggest that acculturation may influence adolescents' self-control characteristics related to interpersonal functioning, which may in turn influence their affiliation with substance-using friends and substance use behavior. Implications of the findings are discussed in terms of future research and prevention programming.

The association of ADHD and depression: mediation by peer problems and parent-child difficulties in two complementary samples

Children with attention-deficit/hyperactivity disorder (ADHD) are at increased risk for the development of depression, with evidence that peer and academic difficulties mediate predictions of later depression from ADHD. In the present study, we hypothesized that parent-child relationship difficulties may be an additional potential mediator of this association. Academic, peer, and parent-child functioning were tested as mediators of the association of attention problems and depression in two distinctly different yet complementary samples. Study 1 was a cross-sectional sample of 5- to 10-year-old children (N = 230) with and without ADHD. Study 2 was a prospective longitudinal sample of 472 youth, followed prospectively from birth to age 20 years, at risk for depression. Despite differences in age, measures, and designs, both studies implicated peer and parent-child problems as unique mediators of depressive symptoms, whereas academic difficulties did not uniquely mediate the ADHD-depression association. Furthermore, inattention symptoms, but not hyperactivity, predicted depressive symptoms via the disruption of interpersonal functioning. The inclusion of oppositional defiant disorder into models impacted results and supported its independent role in parent-child problems. Implications include support for interventions that target interpersonal competence, which may effectively reduce the risk of depression among children with ADHD.

Psychoticism and Disruptive Behavior can be also Good Predictors of School Achievement

The relations of Gf (Standard Progressive Matrices Raven), Gc (verbal scale of Wechsler Intelligence Scale for Children-Third Version), personality dimensions (Eysenck Personality Questionnaire-Junior Version), and disruptive behavior (TDAH scale) with school achievement (measured by TDE test and PISA test) were investigated. Two samples of students (total N = 534) representing a broad range of socioeconomic status (SES) participated in this study. Path models were conducted. The results demonstrated that (1) in both samples no sex differences related to school achievement were found; (2) in the first sample, after controlling for age and SES differences, Gf and psychoticism predicted (.38 and −.13, respectively) school achievement (measured by TDE test); (3) in the second sample, after controlling for SES differences to which additional measures were administered, Gf and Gc positively predicted (.22 and .40, respectively) school achievement (measured by PISA test). In addition, psychoticism and disruptive behavior also predicted school performance (−.14 and −.28, respectively). Some theoretical and practical implications are discussed.

Oppositional defiant disorder symptoms in relation to psychopathic traits and aggression among psychiatrically hospitalized children: ADHD symptoms as a potential moderator

Oppositional defiant disorder (ODD) is associated with elevated rates of psychopathic traits and aggression. However, it remains unclear if attention-deficit/hyperactivity disorder (ADHD) symptoms exacerbate these relations, particularly in samples of children who are severely clinically distressed. The purpose of the present study was to test ADHD symptoms as a potential moderator of the relations of ODD symptoms to psychopathic traits (i.e., callous-unemotional [CU] traits, narcissism) and to aggressive subtypes (i.e., proactive, reactive aggression) in a large sample of children in an acute psychiatric inpatient facility (n = 699; ages 6-12). Multiple regression analyses indicated that, after controlling for child demographic variables, ADHD symptoms marginally exacerbated the relation between ODD symptoms and CU traits. Both ODD and ADHD symptoms had an additive, but not a multiplicative effect, in predicting narcissism. In addition, for a subset of the full sample for whom data were available (n =351), ADHD symptoms exacerbated the relation between ODD symptoms and both reactive and proactive aggression. These results suggest that ADHD symptoms tend to have a negative effect on the relation between ODD symptoms and markers of antisociality among children receiving acute psychiatric care.

Development of the Juvenile Justice Anger Management Treatment for Girls

Female juvenile offenders exhibit high levels of anger, relational aggression, and physical aggression, but the population has long been ignored in research and practice. No anger management treatments have been developed specifically for this population, and no established anger management treatments are empirically supported for use with delinquent girls. Thus, to alleviate anger and reduce the frequency and severity of aggressive behaviors in this underserved population, we developed the gender-specific, Juvenile Justice Anger Management (JJAM) Treatment for Girls. This cognitive-behavioral intervention was adapted from the Coping Power Program (Lochman & Wells, 2002), a school-based anger management treatment for younger children that has established efficacy and effectiveness findings with its target populations. This paper describes how the content of JJAM was developed to meet the unique needs of adolescent girls in residential juvenile justice placements. It also traces the process of developing a manualized treatment and the steps taken to enhance efficacy and clinical utility. An overview of the treatment, a session-by-session outline, an example session activity, and an example homework assignment are provided. A randomized controlled trial is currently being conducted to evaluate the efficacy of the JJAM Treatment for Girls.

Lesen, Schreiben, Rechnen – gibt es Unterschiede zwischen den Geschlechtern?

Geschlechtsunterschiede werden bei kognitiven Leistungen kontrovers diskutiert. Dies gilt auch für die Kulturtechniken Lesen, Schreiben und Rechnen. Hier unterscheiden sich Mädchen und Jungen teilweise hinsichtlich ihrer schulischen Fertigkeiten, was das Thema der vorliegenden narrativen Überblicksarbeit darstellt. Im mathematischen Bereich erlernen Jungen im Grundschulalter das Stellenwertsystem der mehrstelligen Zahlen früher als Mädchen. Eventuell hängt dies mit besseren räumlichen Fähigkeiten der Jungen zusammen. Im Jugendalter finden sich Leistungsunterschiede zu Gunsten der Jungen bei komplexen Textaufgaben. Im internationalen Vergleich sind diesbezügliche Geschlechtsunterschiede in jenen Ländern höher, in denen eine geringere Gleichstellung zwischen Frauen und Männern herrscht. Das Lesen und Schreiben baut hingegen auf sprachlichen Vorläuferfertigkeiten auf. Hier gibt es Hinweise darauf, dass sich Mädchen schneller entwickeln. Unterschiede werden aber vorwiegend bei jungen Kindern gefunden und werden mit zunehmendem Alter geringer. Im höheren Schulalter sind im Bereich Lesen und Schreiben meist keine Unterschiede mehr zwischen den Geschlechtern nachweisbar. Für die Diagnosen einer Lese-Rechtschreibstörung (LRS) oder Rechenstörung (Dyskalkulie) gibt es hingegen deutliche Unterschiede. Bei Jungen wird die LRS deutlich häufiger erkannt. Im Gegensatz zu den meisten anderen Entwicklungsstörungen scheinen Mädchen tendenziell öfter von einer spezifischen Rechenstörung (Dyskalkulie) betroffen zu sein, wohingegen Jungen mindestens so häufig wie Mädchen Rechenprobleme in Kombination mit anderen kognitiven Störungen aufweisen. Sowohl bei der LRS als auch bei der Dyskalkulie scheinen Umweltfaktoren mit dafür verantwortlich, dass Jungen relativ gesehen häufiger identifiziert werden als Mädchen.

A randomized trial of a classroom intervention to increase peers' social inclusion of children with attention-deficit/hyperactivity disorder

OBJECTIVE

Interventions for peer problems among children with attention-deficit/hyperactivity disorder (ADHD) typically focus on improving these children's behaviors. This study tested the proposition that an adjunctive component encouraging the peer group to be socially inclusive of children with ADHD would augment the efficacy of traditional interventions.

METHOD

Two interventions were compared: contingency management training (COMET), a traditional behavioral management treatment to improve socially competent behavior in children with ADHD, and Making Socially Accepting Inclusive Classrooms (MOSAIC), a novel treatment that supplemented behavioral management for children with ADHD with procedures training peers to be socially inclusive. Children ages 6.8-9.8 (24 with ADHD; 113 typically developing [TD]) attended a summer day program grouped into same-age, same-sex classrooms with previously unacquainted peers. Children with ADHD received both COMET and MOSAIC with a repeated measures crossover design. TD children provided sociometric information about the children with ADHD.

RESULTS

Whereas the level of behavior problems displayed by children with ADHD did not differ across treatment conditions, children with ADHD displayed improved sociometric preference and more reciprocated friendships, and received more positive messages from peers, when they were in MOSAIC relative to COMET. However, the beneficial effects of MOSAIC over COMET predominantly occurred for boys relative to girls.

CONCLUSIONS

Data support the concept that adjunctive procedures to increase the inclusiveness of the peer group may ameliorate peer problems among children with ADHD, and suggest the potential utility of modifying MOSAIC to be delivered in regular classroom settings.