“Attention” is not a unitary brain process. Evidence from adult studies indicates that distinct neuroanatomical networks perform specific attentional operations and that these are vulnerable to selective damage. Accordingly, characterising attentional disorders requires the use of a variety of tasks that differentially challenge these systems. Here we describe a novel battery, the Test of Everyday Attention for Children (TEA-Ch), comprising nine subtests adapted from the adult literature. The performance of 293 healthy children between the ages of 6 and 16 is described together with the relationships to IQ, existing measures of attention, and scholastic attainment. This large normative sample also allows us to test the fit of the adult model of functionally separable attention systems to the observed patterns of variance in children's performance. A Structural Equation Modelling approach supports this view. A three-factor model of sustained and selective attention and higher-level “executive” control formed a good fit to the data, even in the youngest children. A single factor model was rejected.

There are behavioural and anatomical grounds to believe that Attention Deficit Disorder (ADD) is particularly associated with poor self-sustained attention and behavioural control. The TEA-Ch performance of 24 boys diagnosed with ADD presented here is consistent with this view. When performance levels on WISC-III subtests were taken into account, specific deficits in sustained attention were apparent while selective attention performance was within the normal range.

This study's aim was to estimate the prevalence and describe the clinical characteristics of Tourette syndrome (TS) in 13–14-year-old schoolchildren attending mainstream secondary schools. A three-stage ascertainment procedure was used to identify those who had TS. First, all 1012 Year 9 pupils were screened for tics using validated self-report questionnaires, which were completed by parents, teachers, and pupils. Data were available from at least one informant for 918 (90·7%) subjects. Tics were identified in 189 (18·7%) pupils. Second, families were contacted and a semistructured interview was carried out to determine whether they had TS. Finally, to ensure that the diagnosis of TS was correct, all those assessed as having TS were systematically assessed by an expert clinician in the field of TS.

Seven young people were identified as fulfilling the criteria for TS, giving a minimum prevalence rate amongst 13–14-year-olds of 0·76% (95% CI 0·31 to 1·57) and a more realistic estimate of 1·85% (95% CI 1·00 to 2·95). Behavioural problems, in particular hyperkinetic disorder, were frequently associated with the TS group. These findings lend further support to the contention that the prevalence of TS in the community has hitherto been underestimated, though the symptoms may be generally milder than cases of TS presenting to clinics. This study supports the need for vigilance for TS in school-age children in primary care and in educational settings, so that children with this potentially serious disorder can be identified and assessed and effective management packages can be formulated to address their needs, when necessary.

Families of 99 children with early-onset conduct problems, aged 4–8 years, were randomly assigned to a child training treatment group (CT) utilizing the Incredible Years Dinosaur Social Skills and Problem Solving Curriculum or a waiting-list control group (CON). Post-treatment CT children had significantly fewer externalizing problems at home, less aggression at school, more prosocial behavior with peers, and more positive conflict management strategies than CON children. Significantly more CT than CON children showed clinically significantly improvements on reports and independent observations of aggressive and noncompliant behavior. The differential treatment response was evaluated according to child comorbidity with attention deficit hyperactivity disorder (ADHD), parenting discipline practices, and family risk factors. The only risk factor related to failure to make improvements in child conduct problems after treatment was negative parenting (i.e., maternal critical statements and physical force). The long-term follow-up 1 year later indicated that most of the significant post-treatment changes were maintained.

This study examined patterns of comorbid/associated diagnoses and associated problems in a population sample of children with and without DSM-III-R attention-deficit hyperactivity disorder (ADHD). Half (N = 409) of a mainstream school population of Swedish 7-year-olds were clinically examined, and parents and teachers were interviewed and completed questionnaires. The children were followed up 2–4 years later. Eighty-seven per cent of children meeting full criteria for ADHD (N = 15) had one or more—and 67% at least two—comorbid diagnoses. The most common comorbidities were oppositional defiant disorder and developmental coordination disorder. Children with subthreshold ADHD (N = 42) also had very high rates of comorbid diagnoses (71% and 36%), whereas those without ADHD (N = 352) had much lower rates (17% and 3%). The rate of associated school adjustment, learning, and behaviour problems at follow-up was very high in the ADHD groups. We concluded that pure ADHD is rare even in a general population sample. Thus, studies reporting on ADHD cases without comorbidity probably refer to highly atypical samples. By and large, such studies cannot inform rational clinical decisions.

Several studies have found a relationship between attention-deficit hyperactivity disorder (ADHD) and substance use, primarily in the context of co-occurring conduct disorder (CD). However, very few have examined the associations between the individual dimensions of ADHD (hyperactivity-impulsivity and inattention) and substance use, even though these dimensions reflect distinct symptom groupings, both by clinical definition (DSM-IV, American Psychiatric Association, 1994) and through empirical demonstration (Lahey et al., 1988; McBurnett et al., 1999). This longitudinal study examines the relationship between dimensions of ADHD (as described by DSM) and substance use, accounting for other psychopathology and factors potentially related to substance use. Participants were 177 clinic-referred boys (initially between ages 7 and 12) followed up over nine annual phases until all participants had reached age 15. Annual assessment included structured clinical interviews with parent and child and self-report questionnaires of substance use, as well as questionnaires related to family factors and parenting behaviors. Seventy-eight per cent of participants reported use of tobacco, alcohol, marijuana, or other illicit drugs during adolescence, with 51% reporting any tobacco use. The inclusion of CD rendered all bivariate relationships with the full diagnosis of ADHD nonsignificant. However, adolescent inattention, considered independently, was associated with a 2·2 times greater risk for concurrent tobacco use, even after controlling for CD. Even when other factors, selected based on their associations with tobacco use in adolescence, were included in a regression model (concurrent adolescent CD odds ratio [OR] = 6·08), duration of tobacco use by age 12 (OR = 5·11), poor parental communication in childhood (OR = 2·9), African-American ethnicity (inversely predictive; OR = 0·15), inattention (OR = 2·3) remained significantly associated with tobacco use in early adolescence. These findings highlight the importance of considering the risks for comorbid substance use separately by individual dimensions of ADHD.

The phenotypic and genetic interrelationships underlying ADHD symptomatology assessed by various instruments were examined on a sample of 735 male and 819 female same-sex twin pairs, aged 8 to 16 years, participating in the first phase of the Virginia Twin Study of Adolescent Behavioral Development (VTSABD). Multivariate analyses were applied to parental and teacher ratings from an investigator-based interview, the CAPA, and three questionnaires (the CBCL and the Rutter Parent and Teacher Scales). Results from patterns of intercorrelations and factor analyses of maternal measures suggested that at the phenotypic level, these assessed the same underlying behavioural construct, which differed from other emotional and behavioural constructs. However, genetic analyses showed that in addition to a common factor underlying the expression of ADHD as assessed across the range of measures, additional genetic factors were identified that were method- and rater-specific. The findings suggest that although the investigator-based interview and the behavioural checklists tap similar aspects of ADHD behaviour, there is additional rater-specific variance.

In this study the factorial validity and the reliability of DSM-IV related ADHD symptom ratings made by care professionals working in residential treatment centres were determined in a sample of 412 residential youngsters. Three concurrent models of the ADHD disorder were investigated, a one-factor model comprising all 18 symptoms, a two-factor model with the Inattention and Hyperactivity/Impulsivity symptoms, respectively, combined and a three-factor model comprising Inattention, Hyperactivity, and Impulsivity symptoms, respectively. An analysis of the covariance structure shows acceptable fits for both the two-and the three-factor models, slightly favouring the three-factor model. The internal consistencies, the test-retest reliabilities, and the inter-rater reliabilities turned out to be good to excellent for all scales based on each of the three concurrent models.

This study tested the predictions of three different theories of hyperactivity: response inhibition deficit, working memory impairment, and delay aversion. A sample of 51 pervasively hyperactive children and 119 control children, identified by screening a general population sample of 1316 twin pairs, were assessed on tests relating to each of these theories. The hyperactive group performed worse than the control group on the delay aversion measure and some of the working memory tasks. Controlling for IQ removed the significant group differences on the working memory measures, however. There were no significant group differences on the inhibition variables derived from the stop task. However, there was evidence of a pattern of responding on the stop task that was strongly characteristic of hyperactivity: hyperactive children were variable in their speed, generally slow and inaccurate in responding. This pattern of responses may indicate a nonoptimal effort/activation state. Hyperactive girls were indistinguishable from hyperactive boys in their performance on the tasks.

This study investigated the association between reading disability (RD) and internalizing and externalizing psychopathology in a large community sample of twins with (N = 209) and without RD (N = 192). The primary goals were to clarify the relation between RD and comorbid psychopathology, to test for gender differences in the behavioral correlates of RD, and to test if common familial influences contributed to the association between RD and other disorders. Results indicated that individuals with RD exhibited significantly higher rates of all internalizing and externalizing disorders than individuals without RD. However, logistic regression analyses indicated that RD was not significantly associated with symptoms of aggression, delinquency, oppositional defiant disorder, or conduct disorder after controlling for the significant relation between RD and ADHD. In contrast, relations between RD and symptoms of anxiety and depression remained significant even after controlling for comorbid ADHD, suggesting that internalizing difficulties may be specifically associated with RD. Analyses of gender differences indicated that the significant relation between RD and internalizing symptoms was largely restricted to girls, whereas the association between RD and externalizing psychopathology was stronger for boys. Finally, preliminary etiological analyses suggested that common familial factors predispose both probands with RD and their non-RD siblings to exhibit externalizing behaviors, whereas elevations of internalizing symptomatology are restricted to individuals with RD.

This study is a prospective, longitudinal attempt to explore behavioral self-regulation, private speech, and speech-action coordination in a sample of behaviorally at-risk preschool children. Preschoolers (N = 72) were classified at age 3 years into a behaviorally at-risk group or a comparison group on the basis of preschool teacher behavioral ratings. Children were videotaped on four different occasions across the span of almost 2 years as they completed problem-solving tasks, and private speech, task performance, executive functioning, and speech-action coordination were analyzed. Children identified 2 years earlier as being hard to manage were at risk for continued behavior problems at elementary school entry. Behaviorally at-risk children consistently used more spontaneous private speech than comparison children across all observations. Both groups of children demonstrated a pattern of increasing silence with task success over time. No group differences were observed in children's speech-action coordination at age 5 years. Intraindividual developmental changes in private speech for both groups were associated with task performance, speech-action coordination, and executive functioning at age 5, but not with teacher- and parent-reported problem behavior.

Over the past 10 years, innovations in physics and computer science have promoted magnetic resonance imaging (MRI) as an essential tool for investigating the biological substrates of psychiatric disorders. Requiring no radiation exposure, MRI is now the preferred imaging technique for pediatric populations. However, the rapid technical advances in MRI pulse sequences, data processing, and analysis have made it increasingly complex for clinicians to compare and critically evaluate MRI research studies. This paper selectively reviews MRI research on five psychiatric conditions occurring in childhood or adolescence: ADHD, autism, childhood-onset schizophrenia, Tourette syndrome, and early-onset depression. The selection of papers reviewed was based on four criteria: the originality of the idea underlying the paper, the quality of the sample and methodologies used, the presence of controversial findings in the paper, and whether the paper was a clear illustration of specific methodological strengths or weaknesses. The two goals of this review paper are to update clinicians on morphometric brain imaging in child psychiatry and the methodological issues pertaining to image acquisition and analysis, and to promote critical reading of future MRI studies.

Children with language impairment (LI) have been shown to be at risk for reading disability (RD) and behavior disorder (BD). Previous research has not determined the specific pattern of these conditions associated with LI. This study sought to determine if the behavior disorder and reading problems represented different outcomes or if these conditions occurred together when found with LI. A group of 581 second-grade children, including 164 children with LI, were examined for spoken language, reading, and behavior disorder. The data for each of these areas were examined as dimensional traits and as clinical categorical traits.

Reading and spoken language were found to be strongly correlated (r = .68); RD was found in 52% of the children with LI and in only 9% of the controls. Scores of parent ratings for BD were also significantly correlated with spoken language scores (r = .29). Clinical levels of BD were found in 29% of the children with LI and 19% of the controls. An examination of the co-occurrence of clinical levels of BD, RD, and LI showed BD in children with LI to be conditioned by the child's reading status. The data indicated that whereas RD was directly associated with BD, the association of LI with BD required the mediation of RD.

Although young children with conduct disorder (CD) are suspected of having verbal and executive function deficits, most studies that investigated this hypothesis did not control for attention deficit hyperactivity disorder (ADHD). Furthermore, relatively little is known about the interaction between cognitive deficits and familial factors in explaining the onset and persistence of CD in children. The participants in this study were 57 children with CD and 35 controls aged 7 to 12 years. At 1-year follow-up, 41 of the participants with CD were reassessed. Children with CD were found to be significantly impaired in four of five executive function measures after ADHD symptoms and socioeconomic status (SES) were controlled. Executive function test performance, number of ADHD symptoms, and familial characteristics (SES, parental punishment) together correctly classified 90% of the participants. Only the number of ADHD symptoms was found to significantly improve prediction of CD 1 year later beyond that afforded by number of CD symptoms a year earlier. Findings indicate that children with CD and ADHD symptoms are especially at risk for persistent antisocial behaviour. Results also highlight the importance of treatment programs that cover both cognitive and familial aspects associated with CD.

Annual screenings of preschool children at kindergarten registration identified 158 children having high levels of aggressive, hyperactive, impulsive, and inattentive behavior. These “disruptive” children were randomly assigned to four treatment conditions lasting the kindergarten school year: no treatment, parent training only, full-day treatment classroom only, and the combination of parent training with the classroom treatment. Results showed that parent training produced no significant treatment effects, probably owing largely to poor attendance. The classroom treatment produced improvement in multiple domains: parent ratings of adaptive behavior, teacher ratings of attention, aggression, self-control, and social skills, as well as direct observations of externalizing behavior in the classroom. Neither treatment improved academic achievement skills or parent ratings of home behavior problems, nor were effects evident on any lab measures of attention, impulse control, or mother–child interactions. It is concluded that when parent training is offered at school registration to parents of disruptive children identified through a brief school registration screening, it may not be a useful approach to treating the home and community behavioral problems of such children. The kindergarten classroom intervention was far more effective in reducing the perceived behavioral problems and impaired social skills of these children. Even so, most treatment effects were specific to the school environment and did not affect achievement skills. These findings must be viewed as tentative until follow-up evaluations can be done to determine the long-term outcomes of these interventions.

Thirty hyperactive and 30 non-hyperactive children were confronted with a delay, consisting of a waiting situation of 15 minutes, either with or without extra stimulation provided by the presentation of a videotape. The behaviour of the child during the waiting period was videotaped and later coded by two naive observers. In line with theories that emphasise the stimulation-seeking function of hyperactive behaviours, such as the optimal stimulation account and the delay aversion theory, a group by stimulation effect was hypothesised. For two categories of activity this was found, with ADHD children displaying more activity than non-ADHD children in the no-stimulation but not in the stimulation condition. These data provide support for the stimulation-seeking function of certain features of ADHD hyperactivity.

This study is the first to provide direct observations of dyadic interactions with friends for preschool-aged disruptive children. Forty preschoolers (mean age 52 months) rated by parents as “hard to manage” on Goodman's (1997) Strengths and Difficulties Questionnaire (SDQ), as well as 40 control children (matched for age, gender, school, and ethnic background) were filmed for 20 minutes on two occasions playing with a teacher-nominated best friend. The videos were transcribed and coded for antisocial behaviour, displays of negative emotion, and empathic/prosocial responses to friend's distress. Individual differences in social behaviour were considered in relation to false-belief performance, affective perspective taking, and executive function skills (planning and inhibitory control). Compared with controls, the hard-to-manage group showed significantly higher rates of both antisocial behaviour and displays of negative emotion, as well as significantly lower rates of emphatic/prosocial responses. Across both groups combined, frequencies of angry and antisocial behaviours were related to poor executive control. Mental-state understanding was not significantly correlated with antisocial behaviour, emotion display, or empathy, suggesting that the interpersonal problems of young disruptive children owe more to failure of behavioural regulation than to problems in social understanding per se. However, given the relatively low power of the study, these findings require replication with a larger sample.

This study examined the role of ADHD in the association between physical aggression and two types of executive functions. Boys received a cognitive-neuropsychological test battery over the ages of 13, 14, and 15 years. Diagnostic Interview Schedule for Children (DISC 2.25) data were collected from the boys and one parent between ages 14 and 16, and an IQ estimate was obtained at age 15. Three groups, differing in stability and level of physical aggression since kindergarten, were formed: Stable Aggressive, Unstable Aggressive, and Non-aggressive. Composite scores of validated executive function tests of working memory representing subjective ordering and conditional association learning were formed. A MANCOVA (N=149) using ADHD status, teacher-rated negative emotionality, general memory abilities, and IQ as covariates was performed on the two composite scores. ADHD and teacher-rated emotionality did not provide significant adjustment to the dependent variables. Number of ADHD symptoms was negatively associated only with general memory and IQ. General memory contributed significantly to adjusting for conditional association test scores. Group differences indicated lower conditional association scores for Unstable Aggressive boys relative to the other groups. Both IQ and general memory abilities interacted with subjective ordering within the groups. Specifically, Stable Aggressive boys performed poorly on this measure and did not benefit from increases in IQ whereas Nonaggressive boys performed best and were not disadvantaged by lower general memory abilities. This suggests a relationship exists between aspects of working memory and a history of physical aggression regardless of ADHD and IQ.

The recognition and drug treatment of hyperkinetic disorder have been increasing in the U.K. during the late 1990s, but are still at a low rate by comparison with many other countries. This article will describe some clinical conclusions, taken mostly from recent research, that should be relevant to clinicians in countries such as the U.K., where there is little current use of the diagnosis of Attention Deficit or stimulant drug treatments. It includes some practical recommendations for therapy that go beyond the evidence base; but space does not allow full protocols, and more detailed guidelines for European practitioners are available elsewhere (Taylor et al., 1998). The recommendations are not necessarily appropriate for other cultural settings, and should not be taken to apply to countries where stimulant drugs are unavailable or where they are widely used in primary care.

This study reconsiders the relationship of childhood Attention Deficit/Hyperactivity Disorder (ADHD) and childhood conduct problems with adult criminal activity by clarifying the role of the cardinal behaviors associated with the DSM-IV ADHD subtypes (inattention and hyperactivity/impulsivity). Since their childhood (average age 9 years), 230 male and 75 female subjects have been followed prospectively and were interviewed as young adults (average age 26 at follow-up). Early childhood behavior ratings by parents and teachers were examined to determine the role of conduct problems, hyperactivity-impulsivity, and inattention in predicting adult criminal involvement as measured by both official arrest records and self-report. Results show that both hyperactivity-impulsivity and early conduct problems independently, as well as jointly, predict a greater likelihood of having an arrest record for males, but not for females. For male subjects with 10 or more self-reported crimes, both early conduct problems and hyperactivity-impulsivity were significant predictors, both alone and in combination. Therefore, it appears that predominantly the symptoms of hyperactivity-impulsivity, but not inattention, contribute to the risk for criminal involvement over and above the risk associated with early conduct problems alone.