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Biomedical subjects

R A Barkley

Publications and source records attributed to R A Barkley.

At least 55 records · Page 3Linked to original sources
PubMed1991

Adolescents with ADHD: patterns of behavioral adjustment, academic functioning, and treatment utilization.

Adolescents with attention deficit hyperactivity disorder (ADHD) were compared with a control group on a comprehensive assessment battery. More ADHD teenagers had oppositional defiant disorder (68%) and conduct disorder (39%) and were rated as more impaired in social competence, behavioral and emotional adjustment, and school performance by parents and teachers than control teens. The ADHD youths, however, rated themselves as better adjusted than did their parents and teachers, differing only from controls in depressive symptoms and antisocial acts. Poorer performances in verbal learning and vigilance and greater ADHD behaviors during a math task also distinguished the ADHD from control teenagers.

Achievement↗
PubMed1991

The adolescent outcome of hyperactive children diagnosed by research criteria--III. Mother-child interactions, family conflicts and maternal psychopathology.

The present study reports the results of a prospective, 8-year follow-up study of 100 hyperactive and 60 normal children followed from childhood into adolescence. Ratings of child behavior problems and family conflicts as well as direct observations of mother-child interactions were taken in childhood and again at adolescent follow-up. At outcome, hyperactives continued to have more conduct and learning problems and to be more hyperactive, inattentive, and impulsive than controls. Hyperactives were also rated by their mothers as having more numerous and intense family conflicts than the normal controls, although the adolescents in both groups did not differ in their own ratings of these conflicts. Observations of mother-adolescent interactions at outcome found the hyperactive dyads displaying more negative and controlling behaviors and less positive and facilitating behaviors towards each other than in the normal dyads. These interaction patterns were significantly related to similar patterns in mother-child interactions observed 8 years earlier. Mothers of hyperactives also reported more personal psychological distress than normal mothers at outcome. Further analyses of subgroups of hyperactives at outcome, formed on the presence or absence of ADHD and oppositional defiant disorder (ODD), indicated that the presence of ODD accounted for most of the differences between hyperactives and normals on the interaction measures, ratings of home conflicts, and ratings of maternal psychological distress. Results suggest that the development and maintenance of ODD into adolescence in hyperactive children is strongly associated with aggression and negative parent-child interactions in childhood.

Achievement↗
PubMed1991

Stimulant medication and parent training therapies for attention deficit-hyperactivity disorder.

The present article provides a brief overview of the clinical use of two of the most commonly used and effective therapies for Attention Deficit-Hyperactivity Disorder (ADHD) in children: stimulant medication treatment and training parents in child behavior management skills. The clinical issues involved in the use of each treatment, as well as their limitations, are reviewed, along with evidence for their efficacy. It is concluded that ADHD is a developmental disorder of attention, impulse control, and regulation of activity level that requires multiple treatment methods, which must be applied over long time intervals if they are to produce an impact on the outcome of children with ADHD.

Attention Deficit Disorder with Hyperactivity↗
PubMed1991

Attention deficit disorder with and without hyperactivity: clinical response to three dose levels of methylphenidate.

The response of 23 children with attention deficit disorder (ADD) with hyperactivity (+H) and 17 children with ADD without hyperactivity (-H) to three doses of methylphenidate (5, 10, and 15 mg twice a day) was evaluated in a triple-blind, placebo-controlled cross-over design using parent and teacher ratings of behavior, laboratory tests of ADD symptoms, and behavioral observations during academic performance. Results indicated that the children with ADD+H were rated as having more pervasive behavioral problems at home and more pervasive and severe conduct problems at school than the children with ADD-H. Laboratory tests found the children with ADD+H to be impaired in behavioral inhibition and vigilance whereas children with ADD-H were more impaired in the consistent retrieval of verbally learned material Drug effects were noted on the parent and teacher ratings and on most laboratory measures, with all three doses typically producing significant changes but rarely differing among themselves in effectiveness. The groups were not found to differ significantly on any measures in their response to methylphenidate. However, more children with ADD-H were clinically judged as having either no clinical response (24%) or responding best to the low dose (35%) of medication. In contrast, most ADD+H (95%) children were judged to be positive responders and most were recommended to receive the moderate to high dose (71%).

Attention Deficit Disorder with Hyperactivity↗
PubMed1990

The adolescent outcome of hyperactive children diagnosed by research criteria: II. Academic, attentional, and neuropsychological status.

One hundred hyperactive children meeting research diagnostic criteria and 60 community control children were followed prospectively over an 8-year period into adolescence. Younger (12-14 years) and older (15-20 years) groups were tested on measures of academic skills, attention and impulse control, and select frontal lobe functions. At follow-up, hyperactive Ss demonstrated impaired academic achievement, impaired attention and impulse control, and greater off-task, restless, and vocal behavior during an academic task, compared with control Ss. The limited set of frontal lobe measures did not differentiate the groups. Age did not interact with group membership. However, several measures showed age-related declines in both groups. It is concluded that hyperactive children may remain chronically impaired in academic achievement, inattention, and behavioral disinhibition well into their late adolescent years.

Achievement↗
PubMed1990

Comprehensive evaluation of attention deficit disorder with and without hyperactivity as defined by research criteria.

Children with attention deficit disorder with hyperactivity (ADD+H; N = 48) were compared with those without hyperactivity (ADD-H; N = 42), as well as with learning disabled and control children, on an extensive battery of interviews, behavior ratings, tests, and direct observations. ADD+H children had more externalizing and internalizing symptoms by parent and teacher report, were more off task during vigilance testing, and had more substance abuse, ADD+H, and aggression among their relatives than did the other groups. ADD-H children were more day-dreamy and lethargic by teacher report, more impaired in perceptual-motor speed, and had more anxiety disorders among their relatives than did ADD+H children. Results indicate that these 2 types of ADD may be separate, distinct childhood disorders rather than subtypes of a common attention deficit.

Achievement↗
PubMed1990

The adolescent outcome of hyperactive children diagnosed by research criteria: I. An 8-year prospective follow-up study.

The psychiatric outcome is reported for a large sample of hyperactive children (N = 123), meeting research diagnostic criteria, and normal control children (N = 66) followed prospectively over an 8-year period into adolescence. Over 80% of the hyperactives were attention deficit hyperactivity disorder (ADHD) and 60% had either oppositional defiant disorder and/or conduct disorder at outcome. Rates of antisocial acts were considerably higher among hyperactives than normals, as were cigarette and marijuana use and negative academic outcomes. The presence of conduct disorder accounted for much though not all of these outcomes. Family status of hyperactives was much less stable over time than in the normal subjects. The use of research criteria for diagnosing children as hyperactive identifies a pattern of behavioral symptoms that is highly stable over time and associated with considerably greater risk for family disturbance and negative academic and social outcomes in adolescence than has been previously reported.

Adolescent↗
PubMed1990

The DSM-III-R field trial of disruptive behavior disorders.

The members of the DSM-III-R Advisory Committee responsible for the diagnostic criteria for the disruptive behavior disorders (attention deficit hyperactivity disorder, oppositional defiant disorder, and conduct disorder) were able to reach agreement on potential items to be included in the final diagnostic criteria. However, there was considerable disagreement about the relative utility of different items for the three disorders and no agreement on how many items should be required from a final list of discriminating items to establish each of the diagnoses. This article describes the method and results of a national field trial of the proposed criteria. Using as a standard the diagnosis of these disorders made by expert clinicians with experience with these disorders, the diagnostic criteria that were finally included in DSM-III-R demonstrated high sensitivity, specificity, and internal consistency.

Attention Deficit Disorder with Hyperactivity↗
PubMed1990

Side effects of methylphenidate in children with attention deficit hyperactivity disorder: a systemic, placebo-controlled evaluation.

The frequency and severity of 17 side effects presumably associated with stimulant medication were assessed during a rigorous, triple-blind, placebo-controlled, crossover evaluation of methylphenidate, 0.3 and 0.5 mg/kg twice a day, in 83 children with attention deficit hyperactivity disorder. Side effects were rated by parents and teachers at the end of each weekly drug condition. Three children (3.6%) had side effects that were sufficiently serious to warrant immediate discontinuation of medication. Parent ratings indicated that only the side effects of decreased appetite, insomnia, stomachaches, and headaches increased significantly in frequency and severity during the two active medication doses as compared with the placebo condition. Fewer than half of the children experienced these side effects and among those who did, ratings of mean severity remained in the mild range. Teacher ratings showed little change over drug conditions, except on ratings of staring, sadness, and anxiety, which declined with increasing dose of medication. Parent ratings indicated that only the side effects of decreased appetite, insomnia, stomachaches, and headaches increased significantly in frequency and severity during the two active medication doses as compared with the placebo condition. Fewer than half of the children experienced these side effects and among those who did, ratings of mean severity remained in the mild range. Teacher ratings showed little change over drug conditions, except on ratings of staring, sadness, and anxiety, which declined with increasing dose of medication. Surprisingly, a high frequency of these behavior side effects were reported during the placebo condition. Stimulant medication within this therapeutic range, therefore, results in few, generally mild side effects.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

A critique of current diagnostic criteria for attention deficit hyperactivity disorder: clinical and research implications.

The present paper critiques the current diagnostic criteria from the DSM-III-R and the draft criteria proposed for the ICD-10 for attention deficit hyperactivity disorder (ADHD). Improvements made in the criteria over earlier editions are discussed along with continuing limitations in these approaches to clinical diagnosis. The issue of whether ADHD constitutes an actual syndrome is also reviewed. It is concluded that despite contradictory evidence for covariation of the symptoms, the disorder meets other important conditions for syndrome definition and should continue to be viewed as such. The variability of symptoms across settings and parameters which may affect this variability are briefly noted as is the impact of this symptom instability on establishing diagnostic criteria. A number of suggestions for revision of these criteria are provided that can be incorporated into current clinical and research practices to improve the rigor and discriminative validity of the criteria for ADHD. The implications of these revisions for clinical diagnosis are also discussed.

Adolescent↗
PubMed1989

The response of aggressive and nonaggressive ADHD children to two doses of methylphenidate.

Differences between 37 aggressive and 37 nonaggressive children with attention deficit hyperactivity disorder (ADHD) were evaluated as was their response to two doses of methylphenidate (0.3 and 0.5 mg/kg) using a multimethod battery of behavior ratings, laboratory tests, and direct observations. Aggressive ADHD children differed little from nonaggressive ADHD children except that nonaggressives displayed more problems with inattentiveness at school than aggressives while mothers of aggressives reported more symptoms of psychopathology in themselves than mothers of nonaggressives. In their drug responding, aggressives and nonaggressives were quite similar. The few exceptions were on measures of conduct, on which the aggressives were initially rated as more extreme and subsequently showed the greater degree of improvement from medication than nonaggressives. Results replicated those of a previous study and further indicate that aggressive and nonaggressive ADHD children share a common disorder of ADHD but aggressives have more impaired family situations.

Adolescent↗
PubMed1989

Hyperactive girls and boys: stimulant drug effects on mother-child interactions.

Two doses of Ritalin (0.15 mg/kg and 0.35 mg/kg BID) were evaluated for their differential effects on the mother-child interactions of hyperactive girls and boys. The effects of Ritalin on these interactions were similar for both sexes. During task performance, the children increased their duration of compliance to the tasks. Mothers responded with decreased commands and control over compliance, while increasing their level of more general, non-directive interactions and passive observation of their children. The findings are consistent with previous studies of stimulant drug effects on the social interactions of hyperactive children.

Attention Deficit Disorder with Hyperactivity↗
PubMed1985

Effects of age on the mother-child interactions of ADD-H and normal boys.

The interactions of 60 ADD-H boys with their mothers were compared to those of 60 normal boys during both free-play and task situations. Both groups were equally subdivided into five age levels (years 5, 6, 7, 8, and 9). In free play, ADD-H boys played more independently of and were more negative toward their mothers, while their mothers gave more commands and initiated fewer interactions than normal mother-child dyads. There were no effects of age in this setting. During the task setting, ADD-H boys were less compliant, sustained their compliance for shorter time periods, and were more negative and off task than the normal boys. Mothers of ADD-H boys gave more commands, were more negative, initiated fewer interactions, and responded with greater control over both compliance and off-task behavior than did normal mothers. Several age effects were noted suggesting that older boys in both groups were more compliant while their mothers gave fewer commands and controlled their compliance less than the mother-child dyads of younger boys. While the interactions of ADD-H boys appear to improve with age, the boys continue to display a developmental lag in social behavior that is more evident with increasing situational demands.

Age Factors↗
PubMed1985

Developmental changes in the mother-child interactions of hyperactive boys: effects of two dose levels of Ritalin.

The mother-child interactions of 60 hyperactive children subdivided equally into five age levels (years 5, 6, 7, 8 and 9) were studied during free play and task periods in a double-blind drug-placebo evaluation of two dose levels of Ritalin (0.3 and 0.7 mg/kg bid.) on these interactions. No effects for age or drug condition were found during free play. In contrast, age effects were significant in the task period with the children increasing their compliance and sustained attention with age. In response, mothers decreased their direction and control while increasing their passive observation of the children. Several drug effects were found during the task period, indicating that only the high dose of Ritalin produced improvements in child compliance. However, both doses resulted in decreases in mothers' controlling reactions to the child's compliance and off-task behavior as well as in ratings of home behavior problems. Drug effects were essentially the same across all five age levels. The interaction patterns of hyperactive children are similar to those found in younger normal children in previous research, apparently reflecting a chronic lag in this pattern in hyperactive children that may be improved with stimulant medication.

Adult↗
PubMed1985

Hyperactive and normal girls and boys: mother-child interaction, parent psychiatric status and child psychopathology.

This study compared hyperactive and normal girls and boys on their mother-child interactions, family psychiatric status and ratings on the Personality Inventory for Children (PIC). Hyperactive children were less compliant and more negative, and their mothers responded more negatively to their compliance than mothers of normal children. Mothers of hyperactive children reported more depression, marital discord and psychiatric problems in their relatives, and rated their children more deviant on 15 of 16 PIC scales than normal children. Hyperactive boys received more direction and praise, and had greater maternal concern about their adjustment than hyperactive girls or normal children.

Adult↗