Biomedical subjects

William E Pelham

Publications and source records attributed to William E Pelham.

At least 19 recordsLinked to original sources

PubMed2007

Association of dopamine transporter genotype with disruptive behavior disorders in an eight-year longitudinal study of children and adolescents.

Associations between dopamine transporter (DAT1) variable number tandem repeats (VNTR), genotypes, and disruptive behavior were examined in an 8-year longitudinal study of children (n = 183). Half of the children met criteria for attention-deficit/hyperactivity disorder (ADHD) at 4-6 years and half were non-referred comparison children. Consistent with several studies, the non-additive association for the 10-repeat allele was significant for hyperactivity-impulsivity (HI) symptoms. However, consistent with other studies, exploratory analyses of the non-additive association of the 9-repeat allele of DAT1 with HI and oppositional defiant disorder (ODD) symptoms also were significant. The inconsistent association between DAT1 and child behavior problems in this and other samples may reflect joint influence of the 10-repeat and 9-repeat alleles.

Adolescent↗

PubMed2007

Tympanostomy tubes and developmental outcomes at 9 to 11 years of age.

BACKGROUND: Developmental impairments in children have been attributed to persistent middle-ear effusion in their early years of life. Previously, we reported that among children younger than 3 years of age with persistent middle-ear effusion, prompt as compared with delayed insertion of tympanostomy tubes did not result in improved cognitive, language, speech, or psychosocial development at 3, 4, or 6 years of age. However, other important components of development could not be assessed until the children were older. METHODS: We enrolled 6350 infants soon after birth and evaluated them regularly for middle-ear effusion. Before 3 years of age, 429 children with persistent effusion were randomly assigned to undergo the insertion of tympanostomy tubes either promptly or up to 9 months later if effusion persisted. We assessed literacy, attention, social skills, and academic achievement in 391 of these children at 9 to 11 years of age. RESULTS: Mean (+/-SD) scores on 48 developmental measures in the group of children who were assigned to undergo early insertion of tympanostomy tubes did not differ significantly from the scores in the group that was assigned to undergo delayed insertion. These measures included the Passage Comprehension subtest of the Woodcock Reading Mastery Tests (mean score, 98+/-12 in the early-treatment group and 99+/-12 in the delayed-treatment group); the Spelling, Writing Samples, and Calculation subtests of the Woodcock-Johnson III Tests of Achievement (96+/-13 and 97+/-16; 104+/-14 and 105+/-15; and 99+/-13 and 99+/-13, respectively); and inattention ratings on visual and auditory continuous performance tests. CONCLUSIONS: In otherwise healthy young children who have persistent middle-ear effusion, as defined in our study, prompt insertion of tympanostomy tubes does not improve developmental outcomes up to 9 to 11 years of age. (ClinicalTrials.gov number, NCT00365092 [ClinicalTrials.gov].).

Child↗

PubMed2007

Maternal depression and early positive parenting predict future conduct problems in young children with attention-deficit/hyperactivity disorder.

Children with attention-deficit/hyperactivity disorder (ADHD) are at risk for adverse outcomes such as substance abuse and criminality, particularly if they develop conduct problems. Little is known about early predictors of the developmental course of conduct problems among children with ADHD, however. Parental psychopathology and parenting were assessed in 108 children who first met Diagnostic and Statistical Manual of Mental Disorders (4th ed.) criteria for ADHD at 4-7 years old. When demographic variables and baseline ADHD and conduct problems were controlled, maternal depression predicted conduct problems 2-8 years following the initial assessment, whereas positive parenting during the structured parent- child interaction task predicted fewer future conduct problems. These findings suggest that maternal depression is a risk factor, whereas early positive parenting is a protective factor, for the developmental course of conduct problems among children with ADHD.

Adaptation, Psychological↗

PubMed2006

Self-handicapping prior to academic-oriented tasks in children with attention deficit/hyperactivity disorder (ADHD): medication effects and comparisons with controls.

Examined self-handicapping prior to academic-oriented tasks in children with and without ADHD and examined whether stimulant medication influenced self-handicapping. Participants were 61 children ages 6 to 13, including 22 children with ADHD tested after taking a placebo, 21 children with ADHD tested after taking stimulant medication, and 18 non-ADHD controls. Participants completed three measures of self handicapping and also completed self-evaluations of their performance. Results showed greater self handicapping and more positive self-evaluations in children with ADHD than in controls regardless of medication condition. Findings suggest children with ADHD may use self handicapping to ameliorate the effects of experiencing high rates of academic failure.

Adolescent↗

PubMed2006

Cognitive-behavioral depression treatment for mothers of children with attention-deficit/hyperactivity disorder.

An adaptation of the Coping With Depression Course (CWDC) was evaluated in mothers of children with attention-deficit/hyperactivity disorder (ADHD), a population at risk for depression. Mothers were randomly assigned to receive the CWDC either immediately following an intensive summer treatment program targeting their child's behavior or after a wait-list period. Measures of maternal functioning, cognitions about child behavior, parent-child and marital relationship quality, child behavior, and ADHD-related family impairment were obtained at pretreatment, posttreatment, and 5-month follow-up. The CWDC resulted in improvements in maternal depressive symptoms, maternal self-esteem, child-related cognitions, and family impairment at posttreatment compared to a wait-list control group that were maintained at follow-up. Findings suggest that the CWDC is a promising intervention for mothers of children with ADHD, particularly those with current depressive symptomatology.

Adult↗

PubMed2006

Treatment-related changes in objectively measured parenting behaviors in the multimodal treatment study of children with attention-deficit/hyperactivity disorder.

The present study examined treatment outcomes for objectively measured parenting behavior in the Multimodal Treatment Study of Children with Attention-Deficit/Hyperactivity Disorder (ADHD). Five hundred seventy-nine ethnically and socioeconomically diverse children with ADHD-combined type (ages 7.0-9.9 years) and their parent(s) were recruited at 6 sites in the United States and Canada and randomly assigned to 1 of 4 treatment groups for 14 months of active intervention: medication management (MedMgt), intensive behavior therapy, combination of the 2 (Comb), or a community-treated comparison (CC). Baseline and posttreatment laboratory observations of parent-child interactions were coded by observers blind to treatment condition. Comb produced significantly greater improvements in constructive parenting than did MedMgt or CC, with effect sizes approaching medium for these contrasts. Treatment effects on child behaviors were not significant. The authors discuss the importance of changes in parenting behavior for families of children with ADHD and the need for reliable and objective measures in evaluating treatment outcome.

Adult↗

PubMed2006

Assessing medication effects in the MTA study using neuropsychological outcomes.

BACKGROUND: While studies have increasingly investigated deficits in reaction time (RT) and RT variability in children with attention deficit/hyperactivity disorder (ADHD), few studies have examined the effects of stimulant medication on these important neuropsychological outcome measures. METHODS: 316 children who participated in the Multimodal Treatment Study of Children with ADHD (MTA) completed the Conners' Continuous Performance Test (CPT) at the 24-month assessment point. Outcome measures included standard CPT outcomes (e.g., errors of commission, mean hit reaction time (RT)) and RT indicators derived from an Ex-Gaussian distributional model (i.e., mu, sigma, and tau). RESULTS: Analyses revealed significant effects of medication across all neuropsychological outcome measures. Results on the Ex-Gaussian outcome measures revealed that stimulant medication slows RT and reduces RT variability. CONCLUSIONS: This demonstrates the importance of including analytic strategies that can accurately model the actual distributional pattern, including the positive skew. Further, the results of the study relate to several theoretical models of ADHD.

Amphetamine↗

PubMed2006

Predictive validity of ICD-10 hyperkinetic disorder relative to DSM-IV attention-deficit/hyperactivity disorder among younger children.

BACKGROUND: Little is known about the predictive validity of hyperkinetic disorder (HKD) as defined by the Diagnostic Criteria for Research for mental and behavioral disorders of the tenth edition of the International Classification of Diseases (ICD-10; World Health Organization, 1993), particularly when the diagnosis is given to younger children. METHODS: The predictive validity of HKD was evaluated over a 6-year period and compared to the predictive validity of DSM-IV attention-deficit/hyperactivity disorder (ADHD) in 95 4-6-year-old children who met full criteria for at least ADHD and 122 demographically-matched nonreferred comparison children. Diagnoses were based on structured assessments of both parents and teachers. RESULTS: All children who met full criteria for HKD also met full DSM-IV criteria for ADHD, but only 26% of ADHD children met criteria for HKD. Children who met criteria for HKD (N = 24), children who would have met criteria for HKD but were excluded from the diagnosis because they concurrently met criteria for an anxiety disorder or depression (N = 16), and the remaining children who met DSM-IV criteria for ADHD (N = 55) all exhibited significantly more symptoms of ADHD and greater social and academic impairment during years 2-7 than nonreferred comparison children. Unlike the two other diagnostic groups, however, children who met strict criteria for HKD were not more likely than comparison children to be injured unintentionally or to be placed in special education. CONCLUSIONS: Both ICD-10 HKD and DSM-IV ADHD exhibit predictive validity over 6 years, but ICD-10 HKD appears to under-identify children with persistent ADHD symptoms and related impairment. Children who met criteria for DSM-IV ADHD but not HKD exhibited at least as much functional impairment over time as hyperkinetic children.

Attention Deficit Disorder with Hyperactivity↗

PubMed2006

A practical measure of impairment: psychometric properties of the impairment rating scale in samples of children with attention deficit hyperactivity disorder and two school-based samples.

Assessing impairment is an explicit component of current psychiatric diagnostic systems. A brief parent and teacher rating scale for assessing impairment was developed and studied using attention deficit hyperactivity disorder (ADHD) as an exemplar disorder. The psychometric properties of the Impairment Rating Scale (IRS) were measured in 4 samples. Two included ADHD and matched comparison children and the other 2 a school sample. Overall, IRS ratings exhibited very good temporal stability. They correlated with other impairment ratings and behavioral measures and displayed evidence of convergent and discriminant validity. The IRS was highly effective in discriminating between children with and without ADHD. Evidence that the parent and teacher IRS accounted for unique variance beyond ratings of ADHD symptoms is also presented. The scale is brief, practical, and in the public domain. The results of the studies and implications for the assessment of impairment are discussed.

Attention Deficit Disorder with Hyperactivity↗

PubMed2006

Childhood ADHD predicts risky sexual behavior in young adulthood.

This study compared young adults (ages 18 to 26) with and without childhood attention deficit hyperactivity disorder (ADHD) on self-reported risky sexual behaviors. Participants were 175 men with childhood ADHD and 111 demographically similar men without ADHD in the Pittsburgh ADHD Longitudinal Study (PALS). Childhood ADHD predicted earlier initiation of sexual activity and intercourse, more sexual partners, more casual sex, and more partner pregnancies. Although childhood conduct problems did contribute significantly to risky sexual behaviors among participants with ADHD, there was also an independent contribution of ADHD, suggesting that the characteristic deficits of the disorder or other associated features may be useful childhood markers of later vulnerability.

Adolescent↗

PubMed2006

A factor analytic approach to distinguish pure and co-occurring dimensions of proactive and reactive aggression.

This study used a confirmatory factor model to distinguish pure and co-occurring dimensions of proactive and reactive aggression, and examined the relation between parenting variables and these dimensions of aggression in a sample of 100 children (9 to 12 years of age; 69 boys). Confirmatory factor analysis (CFA) supported 3 dimensions of proactive and reactive aggression: pure proactive, pure reactive, and their co-occurrence. Parenting variables differentially related to the pure and co-occurring dimensions of aggression. Findings indicate that CFA provides a promising approach for conceptualizing aggression on a continuum and allows researchers to distinguish pure and co-occurring dimensions of proactive and reactive aggression.

Aggression↗

PubMed2005

Coping skills and parent support mediate the association between childhood attention-deficit/hyperactivity disorder and adolescent cigarette use.

OBJECTIVE: To examine mediators of the association between childhood attention-deficit/hyperactivity disorder (ADHD) and adolescent cigarette use. METHOD: Participants were 142 adolescents diagnosed with ADHD in childhood and 100 adolescents without ADHD. RESULTS: Among probands, cigarette smoking was more frequent, adaptive coping skills (behavioral and cognitive) were fewer, and parental support was lower. Coping and support partially mediated the ADHD association with smoking. Persistence of ADHD and adolescent conduct disorder were also important. CONCLUSIONS: Vulnerability to smoking among probands may be partly due to fewer problem-solving resources. Coping skill deficits and parent-child communication may be important treatment targets for smoking prevention.

Adaptation, Psychological↗

PubMed2005

Instability of the DSM-IV Subtypes of ADHD from preschool through elementary school.

CONTEXT: The DSM-IV definition of attention-deficit/hyperactivity disorder (ADHD) distinguished 3 subtypes that had not been extensively studied. OBJECTIVE: To determine whether the ADHD subtypes are stable enough over time to be valid. DESIGN: Longitudinal study with a greater-than 89% retention rate in 7 assessments over 8 years. SETTING: Outpatient clinics. PARTICIPANTS: Volunteer sample of 118 4- to 6-year-olds who met DSM-IV criteria for ADHD, including impairment in 2 settings in at least 1 assessment. MAIN OUTCOME MEASURE: Meeting DSM-IV criteria for the subtypes of ADHD during years 2 through 8. RESULTS: The number of children who met criteria for ADHD declined over time, but most persisted. Children who met criteria for the combined subtype (CT, n = 83) met criteria for ADHD in more subsequent assessments than children in the predominantly hyperactive-impulsive subtype (HT, n = 23). Thirty-one (37%) of 83 CT children and 6 (50%) of 12 children in the predominantly inattentive subtype (IT) met criteria for a different subtype at least twice in the next 6 assessments. Children of the HT subtype were even more likely to shift to a different subtype over time, with HT children who persisted in ADHD mostly shifting to CT in later assessments. The subtypes exhibited consistently different mean levels of hyperactive-impulsive symptoms during years 2 through 8 that corresponded with their initial subtype classifications, but initial subtype differences in inattention symptoms diminished in later years. CONCLUSIONS: In younger children, the CT and IT may be stable enough to segregate groups for research, but they seem too unstable for use in the clinical assessment of individual children. Children rarely remain in the HT classification over time; rather, they sometimes desist from ADHD but mostly shift to CT in later years. Using continuous ratings of hyperactivity-impulsivity symptoms as a diagnostic qualifier should be considered as an alternative to classifying nominal subtypes of ADHD in DSM-V.

Attention Deficit Disorder with Hyperactivity↗

PubMed2005

What aspects of peer relationships are impaired in children with attention-deficit/hyperactivity disorder?

Participants included 165 children with attention-deficit/hyperactivity disorder (ADHD; 130 boys, 35 girls) and their 1,298 same-sex classmates (1,026 boys, 272 girls) who served as raters. For each child with ADHD, a child of the same sex was randomly selected from the same classroom to serve as a comparison child, which yielded 165 dyads. Consistent with predictions, contrasted with the comparison children, those with ADHD were lower on social preference, higher on social impact, less well liked, and more often in the rejected social status category; they also had fewer dyadic friends. When liking ratings that children made versus received were examined, children with ADHD had less positive imbalance and greater negative imbalance relative to comparison children. Analyses that considered the types of peers who chose children with ADHD as friends or nonfriends demonstrated that children with ADHD were nominated as nonfriends by children of higher social preference and who were better liked by others.

Attention Deficit Disorder with Hyperactivity↗

PubMed2005

Transdermal methylphenidate, behavioral, and combined treatment for children with ADHD.

Stimulant medication and behavioral treatments are evidence-based for children with attention-deficit/hyperactivity disorder, but the combination of the 2 treatments has been understudied. In this investigation, methylphenidate (MPH) was crossed with 2 levels of behavior modification (BMOD) in a summer treatment program. Twenty-seven children with attention-deficit/hyperactivity disorder, aged 6-12, participated. Children received placebo and 3 doses of transdermal MPH (12.5 cm(2), 25.0 cm(2), and 37.5 cm(2)). BMOD was implemented on alternating weeks. Both treatments produced large and significant effects. Combined treatment was superior to either treatment alone. The effects of transdermal MPH were comparable to those found in this setting in previous studies with multiple stimulant medications and formulations. Consistent with other research, low doses of MPH--even lower than in previous studies--yielded enhanced effects in combination with behavior modification.

Administration, Cutaneous↗

PubMed2005

Stimulant medication effects in a summer treatment program among young children with attention-deficit/hyperactivity disorder.

OBJECTIVE: This study examined the effectiveness of stimulant medication on multiple domains of functioning in 36 young (5 to 6 years old) children diagnosed with attention-deficit/hyperactivity disorder (ADHD). METHOD: Five- and 6-year-old children attending a summer treatment program between 1987 and 1997 underwent a randomized clinical assessment of the effect of two doses of methylphenidate (0.3 mg/kg versus 0.6 mg/kg) and placebo on social behavior and academic performance. RESULTS: Methylphenidate had an effect on all four social behaviors and improved two of the three areas of academic functioning. Dose effects were present for three of the seven dependent measures. Individual analyses indicated a therapeutic response rate between 39% and 100% across dependent measures. Furthermore, individual analyses of response indicated that across several important dependent measures, 39% to 98% of children showed little incremental improvement with the higher dose compared with the lower dose of stimulant medication. CONCLUSIONS: Stimulant medication is an effective treatment for young children diagnosed with ADHD; however, multiple domains of functioning must be assessed to determine the most effective dose for young children with ADHD.

Attention Deficit Disorder with Hyperactivity↗

PubMed2005

A dose-ranging study of a methylphenidate transdermal system in children with ADHD.

OBJECTIVE: This was a multicenter, double-blind, randomized, dose-ranging study of a methylphenidate (MPH) transdermal system (MTS). Medication (placebo, 0.45, 0.9, and 1.8 mg/h) was crossed with application time (6 a.m., 7 a.m.) to evaluate MTS efficacy and influence of exposure time on morning effects. METHOD: The study took place in a summer treatment program (STP) at three sites, with 36 children aged 7-12 years with attention-deficit/hyperactivity disorder. Each treatment was administered for 1 day in random order, for a total of 8 days. Behavioral and academic measures were taken as well as patch wear characteristics and side effects. RESULTS: Evaluable participant data were analyzed in a series of dose x application time multivariate analyses of variance. All MTS conditions were significantly different from placebo across measures. Time of application had no significant effect on daily behavior, and effects of application time on morning behavior were inconclusive. Consistent with previous results in this setting, the highest dose produced limited incremental benefit compared with the mid-range dose. The wear characteristics of the MTS were acceptable, and the formulation was well tolerated. CONCLUSIONS: The MTS produced significant effects that were similar to those previously reported with comparable MPH doses. There does not appear to be a substantial effect of application time on total daily functioning in this setting; further controlled time-course studies will be necessary to evaluate the question of morning onset fully.

Administration, Cutaneous↗

PubMed2005

Cost-effectiveness of ADHD treatments: findings from the multimodal treatment study of children with ADHD.

OBJECTIVE: Attention deficit hyperactivity disorder (ADHD) is a costly public health problem. To the authors' knowledge, this is the first study on the cost-effectiveness of the major forms of ADHD treatments used in NIMH's Multimodal Treatment Study of Children With ADHD (MTA Study). METHOD: Five hundred seventy-nine children with ADHD, combined type, ages 7 to 9.9, were assigned to 14 months of medication management, behavioral treatment, both combined, or community care. Services were tallied throughout the study, including medication, health care visits, behavioral treatments, and rental costs. Provider specialty, total time, and number of visits with providers were used to calculate costs, adjusted to FY 2000 dollars with the consumer price index. RESULTS: Treatment costs varied fourfold, with medication management being the least expensive, followed by behavioral treatment, and then combined treatment. Lower costs of medication treatment were found in the community care group, reflecting the less intensive (and less effective) nature of community-delivered treatment. Medical management was more effective but more costly than community care and more cost-effective than combination treatment and behavioral treatment alone. Under some conditions, combination treatment (medical management and psychotherapy) were somewhat more cost-effective, as demonstrated by lower costs per additional child "normalized" among children with multiple comorbid disorders. CONCLUSIONS: Medical management treatment, although not as effective as combined medical management and behavioral treatment, is likely to be more cost-effective in routine treatment for children with ADHD, particularly those without comorbid disorders. For some children with comorbid disorders, it may be cost-effective to provide combination treatment.

Attention Deficit Disorder with Hyperactivity↗