Household task participation of children with and without attentional problems

Economic Burden and Service Utilization of Children With Attention-Deficit/Hyperactivity Disorder: A Systematic Review and Meta-Analysis

OBJECTIVES

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders in children. This study aims to systematically synthesize the literature on service utilization and costs for children with ADHD.

METHODS

The search included 9 databases for peer-reviewed primary studies in English from 2007 to 2023. Two independent reviewers conducted title/abstract and full-text screenings and quality assessment. Meta-analysis was conducted on direct medical costs.

RESULTS

Thirty-two studies were included. Children with ADHD have used more pharmaceuticals, mental health, and special education services than children without ADHD (counterparts). Nevertheless, one study found that children with ADHD were twice as likely to have unmet health needs than their counterparts. Annual health system costs per patient were highly varied and higher in children with ADHD ($722-$11 555) than their counterparts ($179-$3646). From a societal perspective, children with ADHD were associated with higher costs ($162-$18 340) than their counterparts ($0-2540). The overall weighted mean direct medical cost was $5319 for children with ADHD compared with $1152 for their counterparts when all studies with different sample sizes were considered together, with the difference being $4167. Limited literature on productivity losses associated with ADHD reported them as a substantial cost. ADHD in children had a "large" effect on the increment of direct medical costs.

CONCLUSIONS

ADHD was associated with increased service utilization and costs. However, unmet health needs or underuse among children with ADHD was also evident. Governments should endeavor to improve access to effective services for children with ADHD to mitigate the impact of ADHD.

How cognitive and behavioural body-functions of children with ADHD are linked to their participation and environmental supports?

BACKGROUND

Children with chronic conditions face participation restrictions and exclusions.

AIMS

To investigate how cognitive and behavioural body-functions are associated with 1) participation patterns and 2) environmental factors among children with attention deficit hyperactivity disorder (ADHD).

METHODS AND PROCEDURES

The study included 83 children with ADHD. Cognitive and behavioural body-functions were assessed with Conners' Parent Rating Scale-Revised Long-Version. The participation patterns of children were assessed with Participation and Environment Measure for Children and Youth (PEM-CY). Multiple regression analyses were used to examine the relationships between cognitive and behavioural body-functions and (1) participation patterns at home, school and community settings, and (2) environmental supports and barriers.

OUTCOME AND RESULTS

In home setting, inattention and ADHD index which determine ADHD children from typically developing peers, were the strongest factors, explaining 24.9 % of variance in activities that mothers wanted to change. In school setting, presence/level of oppositional behaviours had the strongest effect on environmental barriers, with variation of 29.8 %. In community setting, the strongest factor explaining environmental helpfulness was anxious/shy behaviours (16.1 %).

CONCLUSIONS AND IMPLICATIONS

When seeking to improve participation of children with ADHD both the cognitive and behavioural demands of chosen activities should be modified while creating environments that supports these challenges.

Community Participation, Supports and Barriers of Adolescents with and without Attention Deficit Hyperactivity Disorder

AIM

To compare participation patterns, environmental supports, and barriers to community activities in adolescents with and without attention deficit hyperactivity disorder (ADHD) in Turkey.

METHODS

Participants were 94 adolescents with ADHD and 109 adolescents without ADHD ages 13-17 years (mean age 14.6, S.D 1.49 years) Participation frequency, involvement rate, mothers who desired change, and environmental supports and barriers in a community setting were assessed with the Participation and Environment Measure for Children and Youth (PEM-CY).

RESULTS

Adolescents with ADHD participated 20.3% less frequently in socializing with peers in the community than adolescents without ADHD. With moderate to large effect sizes, the mean involvement rate in four community activities, including neighborhood outings, community events, socializing with peers in the community, and religious activities, was significantly lower for adolescents with ADHD than for adolescents without ADHD.

CONCLUSION

Adolescents with ADHD participate less frequently and are less involved in socializing with peers in the community. Almost half of all ADHD adolescents never participate in community events. It was seen that cognitive difficulties, sensory qualities, and safety may prevent adolescents with ADHD from socializing with peers in the community.

The long-term impact of the COVID-19 pandemic on children with ADHD in terms of participation, support, and barriers at home

PURPOSE

The purpose of this study was to compare the long-term impact of the COVID-19 pandemic on participation, support, and barriers at home in children with attention deficit hyperactivity disorder (ADHD) and without ADHD.

DESIGN AND METHODS

This study included a total of 227 participants with a mean age of 11.93 ± 2.96 years, comprising 116 children and adolescents with ADHD and 111 without ADHD. The parents or primary caregivers of all the children completed the Participation and Environment Measure for Children and Youth (PEM-CY), which was used to assess participation and environmental factors in the home. The Student's t-test was used to compare numeric data and Chi-square test to categorical data between children and adolescents with ADHD and those without ADHD in all three settings.

RESULTS

The children with ADHD were determined to play computer and video games significantly more than children without ADHD (p < 0.001). The mean frequency of participation in arts, crafts, music, hobbies (p < 0.001), school preparation (<0.0001), and homework (<0.003) was significantly higher in children without ADHD. A moderate effect size (ϕ = 0.42) was determined in respect of cognitive demands making it more difficult for children with ADHD to participate in home activities than children without ADHD.

CONCLUSIONS

Children with ADHD were negatively affected in terms of participating in home activities than their typically developing peers. In addition, cognitive demands prevented their participation and involvement in the home environment while cognitive demands were a support for non-ADHD children.

PRACTICAL IMPLICATIONS

A highlight of this research was the comprehensive investigation of the long-term effect of the COVID-19 pandemic on participation in all activities at home, in addition to the support and barriers in the home environment for children with ADHD compared to typically developing peers.

Impact of Medication on Performance of Household Chores by Children with ADHD

OBJECTIVE

To investigate associations between ADHD medication and household chore performance by children with ADHD.

METHODS

A parent questionnaire collected information about the adequacy and quality of their child's performance of two self-care and six family-care chores. Parent perceptions of ADHD medication effect duration were used to identify children with after-school medication benefits (ASMB). Mann-Whitney U tests compared children with and without ASMB across measures of chore performance.

RESULTS

A total of 565 parents of children with ADHD that regularly take medication completed the questionnaire. Children with ASMB were more likely to meet parental expectations for five of eight household chores and were more likely to be able to independently complete both self-care and family-care chores than those without ASMB. No differences were noted regarding their need for reminders or assistance with chores.

CONCLUSION

Improvement in chore performance may be an additional consideration with respect to medication selection for children with ADHD.

Metacognition Mediates the Effect of Social Communication and Internalizing Behaviors on Self-management of Daily Life Tasks for Diploma-Track Autistic Youth

Social communication and executive functioning challenges as well as co-occurring anxiety/depression may make acquiring the skills needed to manage daily life tasks difficult for diploma-track autistic youth, thus limiting their participation in adult roles. This study describes the associations between executive function, social communication skills, and internalizing behaviors on task management in academically capable autistic adolescents (n = 46) using multiple regression with mediator analysis. The three predictors and youth age explained a moderate amount of variance in task management. Metacognition mediated the effect of social communication skills and internalizing behaviors on task management. Relations between underlying factors that influence self-management of daily life tasks are complex, supporting the need for multifaceted assessment and intervention approaches for academically capable autistic youth.

Preparation for Adulthood: Shifting Responsibility for Management of Daily Tasks From Parents to Their Children

Importance: Limited research has described the timing of acquisition of the broad range of skills required for the transition to adulthood.

Objective: To describe the timing of the shift of responsibility for daily tasks from parent to child.

Design: This study used an existing data set of parent responses to 49 items in the Responsibility domain of the Pediatric Evaluation of Disability Inventory Computer Adaptive Tests.

Participants: A U.S. nationally representative sample of 2,205 typically developing children and youth ages 0 to 20 yr.

Outcomes and Measures: Descriptive analyses focused on two ages: (1) starting age (when >50% of parents reported their child was taking at least some responsibility for a task) and (2) full responsibility age (when >50% of parents reported their child was taking full responsibility for the task).

Results: The process of shifting responsibility for daily life tasks from parent to child typically occurred over a long period. Many task items had an interval of 5 yr from starting age to full responsibility age; the longest interval was 15 yr. Youth began assuming responsibility for more complex tasks and tasks that involved more risk at ages 10 to 15.

Conclusions and Relevance: Results can serve as a reference for the timing of the transition to greater self-management of daily life tasks across childhood and adolescence. Timing of responsibility shifts may reflect a combination of development of underlying capacities and social transitions. Executive functioning may be especially relevant for management of the more complex tasks required in daily life in adulthood.

What This Article Adds: The transfer of responsibility for managing tasks of daily life from parents to children often extends over a period of many years. Clinicians may find the results helpful when discussing the future with parents of young people with disabilities and other chronic conditions and the tasks that their children must learn to manage for independent living as an adult.

Participation Profile of Children and Youth, Aged 6-14, with and without ADHD, and the Impact of Environmental Factors

BACKGROUND

Children and youth with attention deficit hyperactivity disorder (ADHD) may experience difficulties in participation, but few studies examine their participation and the environmental factors affecting participation. This study explored the participation and the environmental factors of children and youth, with and without attention deficit hyperactivity disorder (ADHD), in the following three settings: home, school, and community.

MATERIALS AND METHODS

Parents of 65 participants aged 6-14 (M = 9.91, SD = 1.87) with and without ADHD completed the Participation and Environment Measure for Children and Youth (PEM-CY) questionnaire, which evaluates participation and environmental factors, along with demographic and screening questionnaires.

RESULTS

The ADHD group (n = 31) scored significantly lower than the non-ADHD group (n = 34) in "frequency" at home, "involvement", and overall environmental support in all settings, with parents expressing a greater desire to change their child's home and community participation. For the ADHD group, a relationship was found between environmental support and involvement in all three settings.

CONCLUSIONS

The findings demonstrated differences in the participation of children and youth with ADHD across different settings, compared to those without ADHD, and confirmed the effect of environmental factors on participation, especially involvement. It is essential to consider participation measures and environmental factors when designing interventions for children and youth with ADHD.

Fractal fluctuations in exploratory movements predict differences in dynamic touch capabilities between children with Attention-Deficit Hyperactivity Disorder and typical development

Children with Attention-Deficit Hyperactivity Disorder (ADHD) struggle to perform a host of daily activities. Many of these involve forceful interaction with objects and thus implicate dynamic touch. Therefore, deficits in dynamic touch could underlie functional difficulties presented by ADHD children. We investigated whether performance on a dynamic touch task (length perception by wielding) differ between children with ADHD and age-matched controls. We further examined whether this difference could be explained by fractal temporal correlations (wielding dynamics). Forty-two children (ADHD: 21; typically developing: 21) wielded unseen wooden rods and reported their perceived length in the form of magnitude productions. The rods varied in the magnitude of the first principal moment of inertia (I₁). Three-dimensional displacements of hand and rod positions were submitted to Detrended Fluctuation Analysis to estimate trial-by-trial temporal correlations. Children with ADHD reported shorter length for rods with higher I₁ than their typically developing peers, indicative of reduced sensitivity to mechanical information supporting dynamic touch. Importantly, temporal correlations in wielding dynamics moderated children’s usage of I_1. This finding points to a role of exploratory movements in perceptual deficits presented by children with ADHD and, thus, should be considered a new potential target for interventions.

Children's Participation in Household Tasks: Caregiver Importance and Satisfaction

Attribution of importance and satisfaction with performance are key dimensions contributing to engagement in occupations. This study explored caregiver satisfaction with and importance attributed to the participation of their children and adolescents in household tasks. Participants included 109 caregivers of children and adolescents of both sexes, aged 6 to 14 years, from various socioeconomic levels. They were interviewed with two questions of the Children Helping Out: Responsibilities, Expectations and Supports (CHORES), with ratings of importance and satisfaction on Likert-type scales, and asked to explain their ratings. We examined the association between the two dimensions. Results showed no correlation between caregivers' ratings of satisfaction and importance (r_s = .04; p = .699). The majority of caregivers evaluated their children's participation in domestic care as very important, explaining in terms of the need for children's autonomy in adulthood. Caregivers' satisfaction was attributed to children's attitudes. The expressed ideal of children's future autonomy by caregivers is not converted to current engagement in household task.

Household task demands for quiet and focused behavior facilitate performance by ADHD youth

ABSTRACT This study evaluated the associations among symptoms of attention-deficit/hyperactivity disorder (ADHD) and of oppositional defiant disorder (ODD) in children and adolescents’ performance in household tasks and assistance provided by caregivers. Parents of children from 6 to 14 years old with ADHD (n = 67) were interviewed with the Children Helping Out: Responsibilities, Expectations, and Supports (CHORES) instrument. Significant correlations were found between symptoms of ODD and assistance in self-care tasks (r = −0.31; p = 0.01); symptoms of hyperactivity correlated with assistance in self-care (r = −0.30, p = 0.01); and family-care (r = −0.25, p = 0.04) tasks. Age was directly associated with the number of tasks performed by children and inversely related to the assistance provided by caregivers. A greater number of ODD symptoms resulted in more household assistance from caregivers. Characteristics of ODD symptoms, such as disobedience and hostility in the face of authority, may limit these children in accessing household tasks by their own initiative, requiring assistance from caregivers.

Predictive Factors of Household Task Participation in Brazilian Children and Adolescents

Home environment is an important setting for child participation. This study investigated the participation of Brazilian children and adolescents in household self-care (SC) and family-care (FC) tasks. Interviews were conducted with 109 caregivers of children and adolescents ages 6 to 14 years residing in Belo Horizonte (Brazil). Multiple regression models revealed that a greater number of FC tasks were performed by children and adolescents (R2 = .23) from families who did not have a housekeeper and those in which the mothers did not work outside of the home; children and adolescents from this subgroup also received less assistance from the caregivers (R2 = .21) and showed greater independence in task performance (R2 = .20). On average, Brazilian children and adolescents participate in about half of the SC and 25% the FC household tasks. Factors related to family structure and child's age were associated with task performance, caregiver assistance, and child and adolescent independence in household tasks.

Internal Structure of the Children Helping Out: Responsibilities, Expectations, and Supports (CHORES) Measure

The purpose of this study was to examine the internal structure of the Children Helping Out: Responsibilities, Expectations, and Supports (CHORES), an assessment of household task participation for children. Rasch analysis was used to examine patterns of item response and scale structure with data collected from caregivers of 132 children and youth ages 6–14 yr with and without disabling conditions. Internal consistency was strong for the total measure and the subscales. The items in both subscales fit the measurement model, and the item difficulty order matched the expected pattern from harder to easier household task performance and degree of caregiver assistance. The sample distribution in the hierarchical continuum showed that younger participants and those with physical disabilities tended to score lower. Some inconsistencies in rating scale use suggest a need for further clarification of the scoring criteria for measurement coherence.

Household task participation of children and adolescents with cerebral palsy, Down syndrome and typical development

This cross-sectional study compared patterns of household task participation (e.g., performance, assistance and independence) of youth with cerebral palsy (CP), Down syndrome (DS) and typical development (TD). Parents of 75 children and adolescents were interviewed to report on their youths' active engagement in daily self-care and family-care tasks, using the children helping out: responsibilities, expectations and supports (CHORES) questionnaire. Groups were equivalent in age (mean=9.3 years; SD=2.2 years), sex (male=39; female=36), respondent education, presence of maid, and number of siblings at home, but differed on child cognitive function and family socioeconomic status, with the DS and the CP groups scoring lower than the TD group but not different from each other. ANOVA revealed group differences on CHORES performance of self-care tasks (p=0.004), on total participation score (p=0.04) and on assistance scores (p<0.02). Post hoc comparisons showed that TD group scored higher than CP and DS groups on performance and assistance in self-care tasks and total assistance; TD and CP groups were similar on total performance and assistance in family-care tasks. The groups also differed on independence indices; the TD index was greater than the CP and DS, and the CP index was greater than the DS. Parents from the three groups did not differ on ratings of importance regarding their children's household participation (p=0.416). In spite of observed differences, children and adolescents with CP and DS are actively engaged in daily self-care and family-care tasks; their participation at home is not prevented by the presence of their disabilities.

Detecting differences in activities of daily living between children with and without mild disabilities

OBJECTIVE

We evaluated whether the Assessment of Motor and Process Skills (AMPS) measures are valid for detecting differences in activities of daily living (ADL) ability among children with and without mild disabilities.

METHOD

Retrospective data from the AMPS database were analyzed using many-facet Rasch analyses and forced regression analyses to evaluate for significant group differences.

RESULTS

Regression analyses of data for 10,998 children ages 4-15 who met the inclusion criteria revealed significant Age × Group interaction effects (B ≥ 0.23, T ≥ 6.20, p ≤ .001). Post hoc t tests revealed significant group differences in ADL ability at all ages beyond age 4. ADL process ability effect sizes were moderate to large at all ages, and ADL motor ability was mostly moderate to large at ages 6 or older.

CONCLUSION

These findings support the validity of the AMPS measures when used to identify ADL problems among children with mild disabilities.

Household Task Participation of Children With and Without Physical Disability

We examined household task participation patterns of 46 children and youth with and without physical disability (PD) and explored the effects of age on roles of and expectations for these children in household task participation. Children with PD did not differ significantly from those without PD in the number of household tasks they performed; however, they did require more assistance than those without PD. In both groups, younger children performed significantly fewer household tasks and required significantly more help than older children. These findings further support the discriminant validity of the Children Helping Out: Responsibilities, Expectations, and Supports (Dunn, 2004) measure of household task participation and its use with adolescents. Assessing such participation would help caregivers and practitioners more successfully prepare children and youths with PD for independent living. Considering the roles and opportunities for social participation inherent in many household tasks will contribute to the usefulness of examining such participation.

Motor ability and adaptive function in children with attention deficit hyperactivity disorder

Attention deficit hyperactivity disorder (ADHD) is a common neuropsychiatric disorder. Previous studies have reported that children with ADHD exhibit deficits of adaptive function and insufficient motor ability. The objective of this study was to investigate the association between adaptive function and motor ability in children with ADHD compared with a group of normal children. The study group included 25 children with ADHD (19 boys and 6 girls), aged from 4.6 years to 8.6 years (mean±standard deviation, 6.5±1.2). A group of 24 children without ADHD (normal children) were selected to match the children with ADHD on age and gender. The Movement Assessment Battery for Children, which includes three subtests, was used to assess the motor ability of the children of both groups. The Chinese version of Adaptive Behavior Scales, which consists of 12 life domains, was used to assess adaptive function of the children with ADHD. Compared with the normal children, children with ADHD exhibited poorer motor ability on all the three subtests of motor assessment. In the ADHD group, nine (36%) children had significant motor impairments and seven (28%) were borderline cases. A total of 10 (40%) children with ADHD had definite adaptive problems in one or more adaptive domains. With statistically controlling of IQ for the ADHD group, those children with impaired motor ability had significantly poorer behaviors in the adaptive domain of home living (p=0.035). Moreover, children with ADHD who had severely impaired manual dexterity performed worse than the control group in the adaptive domains of home living (r=-0.47, p=0.018), socialization (r=-0.49, p=0.013), and self-direction (r=-0.41, p=0.040). In addition, children with poorer ball skills had worse home living behavior (r=-0.56, p=0.003). Children who had more impaired balance exhibited poorer performance in social behavior (r=-0.41, p=0.040). This study found significant correlation between motor ability and adaptive function in children with ADHD, especially in their adaptive domains of home living, socialization, and self-direction. In clinical settings, identification of motor difficulties may have important implications for the understanding of relative factors in effective management of the adaptive dysfunction in children with ADHD.