[show abstract][hide abstract] ABSTRACT: To examine the usefulness of temporal measures of motor activity during psychometric assessment on two different assessment days, 1 week apart with a scope to help the early identification of hyperactivity.
Actigraph measures at the ankle and the waist were compared on the first and the second days of psychometric assessment in a total of 169 children (93 children in ADHD group; 76 children in Non-ADHD group) aged 3 years and 4 years.
There was a significant interaction effect between group and time on the activity level at the waist. Although the activity level of the waist in the children with ADHD did not significantly differ between Day 1 and Day 2, the activity level of the children without ADHD declined significantly from Day 1 to 2. A total of 70% of children were correctly classified into ADHD or Non-ADHD groups based only on Day 2 waist activity data.
The temporal consistency of hyperactivity in young children with ADHD during psychometric assessment is confirmed, indicating that objective measures of motor activity at the waist over different days of psychometric assessment can provide additional information for the stability of hyperactivity.
Psychiatry and Clinical Neurosciences 02/2014; 68(2):120-126. · 2.04 Impact Factor
[show abstract][hide abstract] ABSTRACT: The relationship between obstructive sleep apnoea (OSA) and poorer neurobehavioural outcomes in school-age children is well established, but the relationship in obese children and adolescents, in whom OSA is more common, is not so well established. We aimed to investigate this relationship in 10-18-year-olds.
Thirty-one participants with a mean body mass index (BMI) of 32.3 ± 4.9 enrolled. BMI-for-age cut-offs were used to define obesity. Participants underwent polysomnography and were classified into OSA (apnoea-hypopnoea index (AHI) > 2 per hour) and non-OSA (AHI ≤ 2) groups. Intelligence, memory and learning, academic achievement, behaviour and executive functioning were assessed using the Wechsler Abbreviated Scale of Intelligence, Wide Range Assessment of Memory and Learning 2, Wechsler Individual Achievement Test II (WIAT-II), Behavioural Assessment System for Children 2 and Behaviour Rating Inventory of Executive Function, respectively.
Forty-eight per cent (15/31) were classified as having OSA, and 52% (16/31) as non-OSA. The obese cohort performed below the average of normative data on several neurobehavioural measures. WIAT-II maths scores were significantly lower (P = 0.034) in the OSA group than in the non-OSA group (means 84.5 vs. 94.6, respectively), losing significance after adjustment for IQ, age and gender. Self-reported school problems were significantly worse in the OSA group before and after multivariate adjustment (P = 0.010, Cohen's d = 1.02). No other significant differences were found.
Results suggest that OSA may increase risk for some poorer educational and behavioural outcomes. The findings are reasonably consistent with and add to the evidence base of the few studies that have explored this relationship.
Journal of Paediatrics and Child Health 10/2013; · 1.25 Impact Factor
[show abstract][hide abstract] ABSTRACT: Background
Attention-deficit/hyperactivity disorder (ADHD) has a range of aetiological origins which are associated with a number of disruptions in neuropsychological functioning. This study aimed to examine how low birth weight, a proxy measure for a range of environmental complications during gestation, predicted ADHD symptom severity in preschool-aged children indirectly via neuropsychological functioning. MethodsA total of 197 preschool-aged children were recruited as part of a larger longitudinal study. Two neuropsychological factors were derived from NEPSY domain scores. One, referred to as ‘Primary Neuropsychological Function,’ was loaded highly with Sensorimotor and Visuospatial scores. The other, termed ‘Higher-Order Function’ was loaded highly with Language and Memory domain scores. Executive functioning split evenly across the two. Analyses examined whether these neuropsychological factors allowed for an indirect association between birth weight and ADHD symptom severity. ResultsAs both factors were associated with symptom severity, only the Primary Neuropsychological Factor was associated with birth weight. Furthermore, birth weight was indirectly associated to symptom severity via this factor. Conclusions
These data indicate that birth weight is indirectly associated with ADHD severity via disruption of neuropsychological functions that are more primary in function as opposed to functions that play a higher-order role in utilising and integrating the primary functions.
Journal of Child Psychology and Psychiatry 10/2013; · 5.42 Impact Factor
[show abstract][hide abstract] ABSTRACT: Temperament and attention-deficit/hyperactivity disorder (ADHD) are both typically viewed as biologically based behavioural constructs. There is substantial overlap between ADHD symptoms and specific temperamental traits, such as effortful control, especially in young children. Recent work by Martel and colleagues ( 2009 , 2011 ) suggests that cognitive control temperamental processes are more closely related to inattention symptoms, whereas stimulus-driven temperamental processes are linked to hyperactivity-impulsivity. The present study tested a model of temperament and ADHD symptoms in typically developing preschoolers and those at risk for ADHD using structural equation modelling. Data were from larger study on ADHD in a short-term longitudinal sample with parent/teacher reports and neurocognitive testing. Participants included 214 preschool children (72.9% male) from diverse ethnic/racial backgrounds and a wide range of socioeconomic status from a large metropolitan center. Cognitive control processes, such as effortful control, but not stimulus-driven processes, are related to inattention and hyperactivity. In contrast, stimulus-driven processes, such as emotional reactivity, were related only to hyperactivity symptoms longitudinally. These results suggest that early temperament behaviours and cognitive processes may be indicators of later childhood behavioural difficulties with lasting consequences.
[show abstract][hide abstract] ABSTRACT: BACKGROUND: The current study aimed to examine the changes following a sleep hygiene intervention on sleep hygiene practices, sleep quality, and daytime symptoms in youth. METHODS: Participants aged 10--18 years with self-identified sleep problems completed our age-appropriate F.E.R.R.E.T (an acronym for the categories of Food, Emotions, Routine, Restrict, Environment and Timing) sleep hygiene programme; each category has three simple rules to encourage good sleep. Participants (and parents as appropriate) completed the Adolescent Sleep Hygiene Scale (ASHS), Pittsburgh Sleep Quality Index (PSQI), Sleep Disturbances Scale for Children (SDSC), Pediatric Daytime Sleepiness Scale (PDSS), and wore Actical(R) monitors twice before (1 and 2 weeks) and three times after (6, 12 and 20 weeks) the intervention. Anthropometric data were collected two weeks before and 20 weeks post-intervention. RESULTS: Thirty-three youths (mean age 12.9 years; M/F = 0.8) enrolled, and retention was 100%. ASHS scores significantly improved (p = 0.005) from a baseline mean (SD) of 4.70 (0.41) to 4.95 (0.31) post-intervention, as did PSQI scores [7.47 (2.43) to 4.47 (2.37); p < 0.001] and SDSC scores [53.4 (9.0) to 39.2 (9.2); p < 0.001]. PDSS scores improved from a baseline of 16.5 (6.0) to 11.3 (6.0) post- intervention (p < 0.001). BMI z-scores with a baseline of 0.79 (1.18) decreased significantly (p = 0.001) post-intervention to 0.66 (1.19). Despite these improvements, sleep duration as estimated by Actical accelerometry did not change. There was however a significant decrease in daytime sedentary/light energy expenditure. CONCLUSIONS: Our findings suggest the F.E.R.R.E.T sleep hygiene education programme might be effective in improving sleep in children and adolescents. However because this was a before and after study and a pilot study with several limitations, the findings need to be addressed with caution, and would need to be replicated within a randomised controlled trial to prove efficacy.Trial registration: Australian New Zealand Clinical Trials Registry: ACTRN12612000649819.
[show abstract][hide abstract] ABSTRACT: Objective: To examine whether cognitive enhancement can be delivered through play to preschoolers with ADHD and whether it would affect severity of ADHD symptoms. Method: Twenty-nine 4- and 5-year-old children and their parents participated in separate group sessions (3-5 children/group). Child groups were introduced games designed to enhance inhibitory control, working memory, attention, visuospatial abilities, planning, and motor skills. Parent groups were encouraged playing these games with their children at least 30 to 45 min/day and taught strategies for scaffolding difficulty levels and dealing with obstacles to daily playing. Results: Parent ratings and session attendance indicated considerable satisfaction with the program. Parent (p < .001) and teacher (p = .003) ratings on the ADHD-Rating Scale-IV (ADHD-RS-IV) indicated significant improvement in ADHD severity from pre- to post-treatment, which persisted 3 months later. Conclusion: This play-based intervention for preschoolers with ADHD is readily implemented at home. Preliminary evidence suggests efficacy beyond the termination of active treatment. (J. of Att. Dis. 2012; XX(X) 1-XX).
Journal of Attention Disorders 03/2012; · 2.16 Impact Factor
[show abstract][hide abstract] ABSTRACT: Cognition and emotion, traditionally thought of as largely distinct, have recently begun to be conceptualized as dynamically linked processes that interact to influence functioning. This study investigated the moderating effects of cognitive functioning on the relationship between negative emotionality and attention deficit/hyperactivity disorder (ADHD) symptom severity. A total of 216 (140 hyperactive/inattentive; 76 typically developing) preschoolers aged 3-4 years were administered a neuropsychological test battery (i.e., NEPSY). To avoid method bias, child negative emotionality was rated by teachers (Temperament Assessment Battery for Children-Revised), and parents rated symptom severity on the ADHD Rating Scale (ADHD-RS-IV). Hierarchical Linear Regression analyses revealed that both negative emotionality and Perceptual-Motor & Executive Functions accounted for significant unique variance in ADHD symptom severity. Significant interactions indicated that when negative emotionality is low, but not high, neuropsychological functioning accounts for significant variability in ADHD symptoms, with lower functioning predicting more symptoms. Emotional and neuropsychological functioning, both individually and in combination, play a significant role in the expression of ADHD symptom severity. (JINS, 2011, 17, 1-9).
Journal of the International Neuropsychological Society 04/2011; · 2.70 Impact Factor
[show abstract][hide abstract] ABSTRACT: Individuals diagnosed with Attention-Deficit/Hyperactivity Disorder (ADHD) present with a wide array of cognitive and behavioral deficiencies. Over the past few decades, researchers have proposed a variety of theoretical models to account for and to better characterize this highly heterogeneous disorder. This paper reviews the recent literature on the neural and neurocognitive determinants of ADHD and emphasizes the importance of conceptualizing the disorder within a developmental framework. Implications for treatment are discussed.
Journal of Infant Child and Adolescent Psychotherapy 01/2011; 10(1):13-31.
[show abstract][hide abstract] ABSTRACT: Attention-deficit/Hyperactivity Disorder (ADHD) is characterized by a pervasive pattern of developmentally inappropriate inattentive, impulsive and hyperactive behaviors that typically begin during the preschool years and often persist into adulthood. The most effective and widely used treatments for ADHD are medication and behavior modification. These empirically-supported interventions are generally successful in reducing ADHD symptoms, but treatment effects are rarely maintained beyond the active intervention. Because ADHD is now generally thought of as a chronic disorder that is often present well into adolescence and early adulthood, the need for continued treatment throughout the lifetime is both costly and problematic for a number of logistical reasons. Therefore, it would be highly beneficial if treatments would have lasting effects that remain after the intervention is terminated. This review examines the burgeoning literature on the underlying neural determinants of ADHD along with research demonstrating powerful influences of environmental factors on brain development and functioning. Based upon these largely distinct scientific literatures, we propose an approach that employs directed play and physical exercise to promote brain growth which, in turn, could lead to the development of potentially more enduring treatments for the disorder.
[show abstract][hide abstract] ABSTRACT: Hyperactive/inattentive (HI) behaviors are common in preschoolers, but they result in functional impairment and attention deficit/hyperactivity disorder (ADHD) diagnoses in only some children. We examined whether the quality of mother-child interaction accounts for variance in level of functioning among preschool children with elevated ADHD symptoms.
Parent and teacher ADHD-RS ratings were used to assess 126 HI preschoolers, and clinician Children's Global Assessment Scale (CGAS) ratings were used to quantify level of functioning. Mother-child interactions during a 5-minute free-play and a 5-minute structured task were coded for child, parent and dyadic behaviors.
Partial correlations, controlling for symptom severity and IQ, revealed child and dyad factors that were related to children's functioning. Regression analyses revealed that low dyadic synchrony accounted for additional unique variance in children's functioning, above and beyond the influence of symptom severity and IQ.
Dyadic synchrony between mother and child plays a role in the functioning of preschool children displaying elevated symptoms of hyperactivity/inattention, and may represent a potential area for intervention that is not generally addressed in most parent management training programs.
Journal of Child Psychology and Psychiatry 03/2010; 51(9):1058-66. · 5.42 Impact Factor
[show abstract][hide abstract] ABSTRACT: Clear links between temperament, psychopathology, and neuropsychological functioning exist; however the interrelations among temperament and neuropsychology, and their impact on functioning in typically developing children is not as well understood. This study examined the degree to which neuropsychological functioning, as measured by the NEPSY, moderates the impact of temperament on global functioning, as measured by the Children's Global Assessment Scale (CGAS), in 74 typically developing preschoolers. Temperament was assessed via parent ratings on the Children's Behavior Questionnaire (CBQ) and teacher ratings on the Temperament Assessment Battery for Children--Revised (TABC-R). Moderation analyses revealed significant interactions between verbal-executive skills and both child emotionality and lack of task persistence in predicting global functioning. The interaction patterns were mostly consistent across measures and indicated that when lower neurocognitive scores were coupled with higher levels of expressed negative emotions and more difficulties in task persistence, global functioning was at its lowest. In contrast better neurocognitive functioning mitigated the impact of high expressed emotions on global functioning. These findings support past literature and indicate that emotional and cognitive functioning interact to effect young children's global functioning.
[show abstract][hide abstract] ABSTRACT: To ascertain the psychometric properties and clinical utility of the Behavioral Rating Inventory for Children (BRIC), a novel clinician inventory for preschoolers.
Completion of the BRIC for 214 preschoolers follows 2 evaluation sessions, generally separated by less than 2 weeks. Items are submitted to a Principal Components Analysis (PCA) with Varimax rotation. Test-retest reliability and validity relative to other measures are assessed.
PCA yields a 2-factor solution representing a "Symptom Triad" and a "Mood/Sociability Factor." Test-retest reliability of the triad and factor are .78 (p <.001) and .55 (p < .001), respectively. Correlations between parent and teacher ratings of ADHD-related behaviors and the Symptom Triad range from .39-.47 (all p <.001); similar correlations are found with laboratory measures of activity level (r = .35-.49, all p <.001).
The Symptom Triad of the BRIC appears to be a reliable and valid tool that may assist researchers and clinicians in studying and diagnosing ADHD in preschoolers, particularly in cases where teacher ratings are unavailable. J. of Att. Dis. 2010; 13(5) 479-488.
Journal of Attention Disorders 04/2009; 13(5):479-88. · 2.16 Impact Factor
[show abstract][hide abstract] ABSTRACT: Behaviors characteristic of ADHD are common among preschool children, and as such, their clinical significance is oftentimes difficult to ascertain. Thus a focus on impairment is essential in determining the clinical significance of these behaviors. In order to explore the impact of impairment criteria on rates of diagnoses in inattentive/hyperactive children aged 36 through 60-months-old, we first developed, and psychometrically evaluated, the Children's Problem Checklist (CPC) which was designed to assess psychosocial impairment associated with ADHD in a community sample of preschoolers (n = 394), and found its reliability and validity to be acceptable. We then examined the impact of the inclusion of various CPC-determined impairment criteria, over and above symptom criteria measured by the ADHD-RS-IV, using various cut points ranging from the 75th to 90th percentile of our community sample. This reduced the number of children meeting criteria for ADHD by 46-77%. These findings are discussed in terms of the importance of using impairment criteria, rather than just severity of inattention, impulsivity and hyperactivity, when diagnosing ADHD in preschool children.