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To evaluate the relative efficacy of two reading programs with and without adjunctive stimulant medication for children with attention-deficit/hyperactivity disorder and comorbid reading disorder (ADHD+RD). Sixty-five children (7-11 years in age) were assigned randomly to one of three intensive remedial academic programs (phonologically or strategy-based reading instruction, or general academic strategy and social skills training) in combination with either immediate-release methylphenidate or placebo. Multiple-blind procedures were used for medication/placebo, given twice daily. Children received 35 hours of instruction in 10 weeks, taught by a trained teacher in a separate school classroom, in small matched groups of 2 to 3. Children's behavior and reading abilities were assessed before and after intervention. Stimulant medication produced expected beneficial effects on hyperactive/impulsive behavioral symptoms (reported by classroom teachers) but none on reading. Children receiving a reading program showed greater gains than controls on multiple standardized measures of reading and related skills (regardless of medication status). Small sample sizes precluded interpretation of possible potentiating effects of stimulant medication on reading skills taught in particular reading programs. Intensive reading instruction, regardless of treatment with stimulant medication, may be efficacious in improving reading problems in children with ADHD+RD and warrants further investigation in a large-scale study.

Background: A body of literature has emerged that links inattentive symptoms of attention deficit hyperactivity disorder (ADHD) to poor academic achievement. Major variation across studies renders conclusions about this relationship complex. Purpose: This review will provide a qualitative synthesis of these studies that (1) use community samples and (2) examine inattention as a separate dimension from hyperactivity/impulsivity. The aim of this review is to ascertain whether the relationship documented between inattention and academic outcomes in ADHD also holds for the dimensional trait of inattention as manifest in non-clinical community samples of children and adolescents, taking into consideration both academic achievement and academic performance across age. Design and methods: A comprehensive search was carried out using two databases. The PRISMA guidelines were used to report the search steps. The QUIPS tool was used to rate the quality of studies, followed by a best evidence synthesis to summarise these results. Results: Out of 1748 citations found, 27 articles met the specific inclusion criteria. Results point to a strong effect according to the best evidence synthesis: 7 studies that have low risk of bias found that teacher-rated inattention is significantly predicative of poor academic achievement in community samples of children. Conclusions: This review provides support for a consistent, negative relationship between classroom inattention as reported by teachers and both standardised academic test achievement and classroom performance outcomes for children in preschool (moderate evidence), elementary school and longitudinally from elementary to high school. The average relationship was stronger when classroom performance was measured, as compared to standardised achievement. However, the quantitative strength of relationship has not been confirmed with a meta-analysis due to heterogeneity and too few high-quality studies identified. Variance across the studies in terms of the strength of association suggests that other unexamined factors (e.g. cognitive function or motivation) may be contributing to this relationship. Implications for educators and clinicians who work within the school setting are discussed.

To better understand the nature of impairment resulting from attention-deficit/hyperactivity disorder (ADHD) for students in a post-secondary education (PSE) setting, the authors analyzed the symptoms and associated impairment of 135 students with a diagnosis of ADHD who were recruited via Student Disability Services in Canadian post-secondary institutions. The authors (a) developed a novel semistructured telephone interview based on the 6-item "Adult ADHD Self-Report Scale Screener-Telephone Interview With Probes" (ASRS-TIPS) to elicit students' descriptions of their behavior for each symptom they endorsed, (b) administered standardized tests of executive functioning (EF) and academic fluency, and (c) obtained self-reports of grade point averages (GPAs), EF, cognitive failures, psychopathology, distress, and resilience. Qualitative analysis of the ASRS-TIPS revealed significant impairment relating to symptoms of ADHD in the PSE setting. Students reported clinically significant symptoms of ADHD, psychological distress, and impairment in EF (67%, severe range) and cognitive failure (62%, atypical range) in everyday life. By contrast, their GPAs and standardized scores of EF and academic fluency were in the average range. Standardized scores and GPAs did not capture the impairment that participants experienced in their PSE settings. The ASRS-TIPS may provide a useful tool to help document how these students' symptoms impair functioning in the PSE setting.

Selective mutism (SM) is a childhood disorder characterized by failure to speak in social situations, despite there being an expectation to speak and the capacity to do so. There has been a focus on elucidating the differences between SM and anxiety disorder (ANX) in the recent literature. Although children with SM exhibit more symptoms at school than at home, the assessment of SM typically does not involve teacher reports. There is also a lack of research to help us better understand how to best support students with SM in the classroom, and linking assessment to intervention. The "Teacher Telephone Interview: Selective Mutism and Anxiety in the School Setting" (TTI-SM) was developed by a group of researchers across three large children's hospitals in Canada, within specialized ANXs Clinics, with the goal of addressing several of these diagnostic and treatment issues. Child participants (ages 6-11) were referred for SM (n = 19) or ANX (n = 10). Findings revealed that the SM subscale of the TTI-SM has acceptable psychometric properties. Scores on the SM subscale between the two groups of children were statistically significant t(29) = -3.67, p < 0.001, ?[superscript2] = 0.33, suggesting that the SM subscale was able to distinguish between children with SM and ANX. Given the promising findings, and possible uses of this tool for assessment and intervention, the TTI-SM warrants further research. The role of the teacher in the assessment of children with SM and anxiety disorders, and future directions are discussed.

The Strengths and Difficulties Questionnaire (SDQ) is a 25-item screening measure for emotional and behavioral problems in children and adolescents aged 4 to 16. Structural equation modeling was used to test the five-factor structure of teacher and parent ratings on the British version of the SDQ in a community sample of 501 Canadian children aged 6 to 9 years. The five-factor model fit the data well for both teacher and parent ratings. In addition, the SDQ demonstrated acceptable reliability based on internal consistency coefficients and inter-rater agreement. The findings provide preliminary support for the reliability and validity of the British version of the parent and teacher SDQ in a sample of early elementary school Canadian children.

Meta-analyses were conducted to examine findings on the association between parenting stress and ADHD. Predictors comprising child, parent, and contextual factors, and methodological and demographic moderators of the relationship between parenting stress and ADHD, were examined. Findings from 22 published and 22 unpublished studies were included. Results confirmed that parents of children with ADHD experience more parenting stress than parents of nonclinical controls and that severity of ADHD symptoms was associated with parenting stress. Child co-occurring conduct problems and parental depressive symptomatology predicted parenting stress. Parents of children with ADHD experienced no more parenting stress than parents of other clinically referred children. Little difference in parenting stress was found between mothers and fathers, but child gender was a significant moderator of parenting stress, with lower stress levels in samples with higher proportions of girls. (Contains 2 tables and 3 notes.)

DSM-5, the fifth edition of the American Psychiatric Association's "Diagnostic and Statistical Manual of Mental Disorders," was published in May 2013, amidst a storm of controversy. This article focuses on changes made to the diagnostic criteria for Specific Learning Disorders (SLD). Primary criticisms of the changes in the SLD concern the aggregation of the DSM-IV subtypes into one overarching category, the failure to codify Dyslexia as a distinct type of SLD, and the inclusion of response to intervention as one component of the criteria. This article first summarizes the historical perspectives on SLD. Next, the changes made to the diagnostic criteria are presented, followed by a discussion of the rationale and evidence on which the changes were based. It concludes with a discussion of the possible impact on clinical practice, research and policy. [DSM-5, the fifth edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, was published in May 2013, amidst a storm of controversy. This article focuses on changes made to the diagnostic criteria for Specific Learning Disorders (SLD). Primary criticisms of the changes in the SLD concern the aggregation of the DSM-IV subtypes into one overarching category, the failure to codify Dyslexia as a distinct type of SLD, and the inclusion of response to intervention as one component of the criteria. This article first summarizes the historical perspectives on SLD. Next, the changes made to the diagnostic criteria are presented, followed by a discussion of the rationale and evidence on which the changes were based. It concludes with a discussion of the possible impact on clinical practice, research and policy. [This article is based on the Cruickshank Memorial Lecture presented by Dr. Tannock at The International Academy for Research on Learning Disabilities, Boston, May 2013.]

Objective: To examine the factor structure of attention-deficit/hyperactivity disorder (ADHD) in a clinical sample of 1,373 children and adolescents with ADHD and their 1,772 unselected siblings recruited from different countries across a large age range. Hierarchical and correlated factor analytic models were compared separately in the ADHD and sibling samples, across three different instruments and across parent and teacher informants. Specific consideration was given to factorial invariance analyses across different ages and different countries in the ADHD sample. Method: A sample of children and adolescents between 5 and 17 years of age with ADHD and their unselected siblings was assessed. Participants were recruited from seven European countries and Israel. ADHD symptom data came from a clinical interview with parents Parental Account of Childhood Symptoms and questionnaires from parents and teachers (Conners Parent and Teacher). Results: A hierarchical general factor model with two specific factors best represented the structure of ADHD in both the ADHD and unselected sibling groups, and across informants and instruments. The model was robust and invariant with regard to age differences in the ADHD sample. The model was not strongly invariant across different national groups in the ADHD sample, likely reflecting severity differences across the different centers and not any substantial difference in the clinical presentation of ADHD. Conclusions: The results replicate previous studies of a model with a unitary ADHD component and separable specific traits of inattention and hyperactivity/impulsivity. The unique contribution of this study was finding support for this model across a large developmental and multinational/multicultural sample and its invariance across ages.

Objective: The study examined executive function deficits (EFD) in school-age children (7 to 14 years) with ADHD. Method: A clinical sample of children diagnosed with ADHD (n = 49) was compared to a population sample (n = 196) on eight executive function (EF) measures. Then, the prevalence of EFD in clinical and non-clinical children was examined at the individual level according to three methods previously applied to define EFD, and a fourth method was included to control for the effect of age on performance. Results: Children with ADHD were significantly more impaired on measures of EF than children without ADHD at the group level. However, only about 50% of children with ADHD were found to have EFD at the individual level, and results appeared relatively robust across methods applied to define EFD. Conclusion: As a group, children with ADHD displayed more problems on neuropsychological measures of EF than non-clinical children; at the individual level, there appeared to be heterogeneity in EF impairment. (Contains 4 tables.)

The present study examined general and special education teachers' self-reported level of in-service training in attention-deficit hyperactivity disorder (ADHD), a common childhood mental health disorder, and the relationship between teachers' level of training in ADHD and their reported use of a range of recommended instructional and behavior management approaches for students exhibiting behavior problems. The analyses revealed that the majority of general education teachers (76%), and almost half (41%) of the special education teachers, reported having no or brief in-service training in ADHD. General education teachers with moderate to extensive in-service training in ADHD reported significantly greater use of the recommended approaches (as indicated by their scores on the Instructional and Behavior Management Survey) than general educators with little or no training in ADHD. Implications for research and practice are discussed.

Objective: The study investigates behavioural, academic, cognitive, and motivational aspects of functioning in school-age children with attention-deficit/hyperactivity disorder (ADHD) with and without an executive function deficit (EFD). Method: Children with ADHD - EFD (n = 22) and children with ADHD + EFD (n = 26) were compared on aspects of ADHD behaviour, school functioning, general cognitive ability, intra-individual response variability, affective decision-making, and delay aversion. Results: Children with ADHD - EFD and children with ADHD + EFD were comparable in terms of ADHD symptomatology and school functioning. However, children with ADHD + EFD had significantly lower IQ and more intra-individual response variability than no EFD counterparts. Children with ADHD alone appeared more delay averse on the C-DT task than children with ADHD + EFD. Conclusions: Some children with ADHD were primarily characterised by problems with executive functions and variability others by problems with delay aversion supporting multiple pathway models of ADHD. Given the exploratory nature of the study, results are in need of replication.

Slowed speed of processing and impaired rapid temporal processing (RTP) have been proposed to underlie specific language impairment (SLI), but it is not clear that these dysfunctions are unique to SLI. We considered the contribution of attention-deficit/hyperactivity disorder (ADHD), which frequently co-occurs with language impairments, to performances on processing tasks. School-aged children who had SLI without concurrent ADHD (n = 14), ADHD without concurrent SLI (n = 14), and typical development (TD, n = 28) performed two nonverbal speeded tasks and one auditory RTP task. RTP impairments were found in many children with SLI and ADHD, and some children with TD. Children with ADHD demonstrated slower processing speed than children with SLI or TD. Overall, findings questioned the uniqueness of these processing dysfunctions to language impairments and the validity of the behavioural paradigms traditionally used to estimate processing dysfunctions. Accounts of SLI should be further scrutinized by considering the influence of other disorders. Learning outcomes: Readers will (1) become familiar with areas of overlap between SLI and ADHD, (2) understand some of the confounds associated with behavioural measures of processing speed in children, and (3) recognize the value in testing models of language disorders by including participants with other types of disorders. (Contains 1 figure and 2 tables.)

Using data from 123 children (aged 6-12 years) referred consecutively to a pediatric neuropsychiatry clinic by community physicians for assessment of Attention-Deficit/Hyperactivity Disorder (ADHD) and related problems, we investigated the effects of informant (parent, teacher), tool (interview, rating scale), and method for combining symptom reports ("and," "or" algorithms), on the diagnosis of ADHD and its subtypes. Results indicated that as many as 50% of cases were reclassified from one subtype to another, depending on whether information was derived from one or two informants, a semistructured clinical interview and/or rating scale, and the algorithm used to combine informant reports. We conclude that the diagnosis of "DSM-IV" ADHD subtypes is capricious in that it is influenced by clinicians' decisions regarding informants, instrumentation, and method for aggregating information across informants and instruments. (Contains 6 tables.)

Objective: To investigate working memory (WM), academic achievement, and their relationship in university students with attention-deficit/hyperactivity disorder (ADHD). Method: Participants were university students with previously confirmed diagnoses of ADHD (n = 16) and normal control (NC) students (n = 30). Participants completed 3 auditory--verbal WM measures, 2 visual--spatial WM measures, and 1 control executive function task. Also, they self-reported grade point averages (GPAs) based on university courses. Results: The ADHD group displayed significant weaknesses on auditory--verbal WM tasks and 1 visual--spatial task. They also showed a nonsignificant trend for lower GPAs. Within the entire sample, there was a significant relationship between GPA and auditory--verbal WM. Conclusion: WM impairments are evident in a subgroup of the ADHD population attending university. WM abilities are linked with, and thus may compromise, academic attainment. Parents and physicians are advised to counsel university-bound students with ADHD to contact the university accessibility services to provide them with academic guidance. (Contains 2 tables.)

Objective: To investigate the effects of methylphenidate (MPH) on components of working memory (WM) in children with ADHD and determine whether MPH produces differential effects on WM in children with comorbid anxiety (ANX). Method: Participants were a clinical sample of 130 children with ADHD, aged 6 to 12 years old (32% comorbid ANX). Each child participated in an acute randomized, double-blind, placebo-controlled, crossover trial with single challenges of three MPH doses. Four WM measures were used that varied in processing demands (storage versus manipulation of information) and modality (auditory-verbal; visual-spatial). Results: MPH improved auditory-verbal manipulation but only in the non-ANX children with ADHD. It had no effect on auditory-verbal storage of information. Also, MPH improved the ability to manipulate visual-spatial information in both ADHD groups, but beneficial effects on visual-spatial storage were evident only in children without comorbid ANX. Conclusions: Findings provide insight into potential mechanisms underlying individual differences in treatment response in ADHD, which may facilitate more targeted treatments. (Contains 3 tables.)

Objectives: To determine whether oral language, working memory, and social anxiety differentiate children with selective mutism (SM), children with anxiety disorders (ANX), and normal controls (NCs) and explore predictors of mutism severity. Method: Children ages 6 to 10 years with SM (n = 44) were compared with children with ANX (n = 28) and NCs (n = 19) of similar age on standardized measures of language, nonverbal working memory, and social anxiety. Variables correlating with mutism severity were entered in stepwise regressions to determine predictors of mute behavior in SM. Results: Children with SM scored significantly lower on standardized language measures than children with ANX and NCs and showed greater visual memory deficits and social anxiety relative to these two groups. Age and receptive grammar ability predicted less severe mutism, whereas social anxiety predicted more severe mutism. These factors accounted for 38% of the variance in mutism severity. Conclusions: Social anxiety and language deficits are evident in SM, may predict mutism severity, and should be evaluated in clinical assessment. Replication is indicated, as are further studies of cognition and of intervention in SM, using large, diverse samples. (Contains 3 tables.)

Attention-deficit/hyperactivity disorder (ADHD) is associated with unexplained impairments on speeded naming of coloured stimuli. These deficits may reflect hypofunctioning retinal dopaminergic mechanisms impairing particularly blue-yellow colour discrimination. Colour perception and rapid colour naming ability were investigated in 14 children with ADHD and 13 healthy peers matched for age, gender, and IQ, using the Farnsworth-Munsell 100 Hue Test (FMT) and the Stroop-Colour-Word test. Children with ADHD committed more errors on the FMT, particularly on discrimination of colours along the blue-yellow axis, and were slower on Stroop subtests involving colour naming. However, the latter deficit was accounted for similarly by blue-yellow and red-green discrimination abilities. Blue-yellow colour perception problems in ADHD contribute to but do not fully explain the observed slowed colour naming.

Time perception performance was systematically investigated in adolescents with and without attention-deficit/hyperactivity disorder (ADHD). Specifically, the effects of manipulating modality (auditory and visual) and length of duration (200 and 1000 ms) were examined. Forty-six adolescents with ADHD and 44 controls were administered four duration discrimination tasks and two control tasks, and a set of standardized measures. Participants with ADHD had higher thresholds than controls on all of the duration discrimination tasks, with the largest effect size obtained on the visual 1000 ms duration discrimination task. No group differences were observed on the control tasks. Visual-spatial memory was found to be a significant predictor of visual and auditory duration discrimination at longer intervals (1000 ms) in the ADHD sample, whereas auditory verbal working memory predicted auditory discrimination at longer intervals (1000 ms) in the control sample. These group differences suggest impairments in basic timing mechanisms in ADHD.

Objective: Five studies have demonstrated the effectiveness of atomoxetine compared with placebo in reducing symptoms of attention-deficit/hyperactivity disorder (ADHD) based on parent reports. The primary objective of this clinical trial was to assess the efficacy of once-daily atomoxetine compared with placebo using teacher reports. Method: One hundred fifty-three patients aged 8-12 years were randomly assigned to receive once-daily atomoxetine or placebo in a 2:1 ratio for 7 weeks. ADHD symptoms at school were primarily assessed by baseline-to-endpoint change on the Attention-Deficit/Hyperactivity Disorder Rating Scale-IV-Teacher Version: Investigator administered and scored (ADHDRS-IV-Teacher:Inv) as rated by investigators using teacher reports. Results: ADHDRS-IV-Teacher:Inv total scores were significantly lower for children treated with atomoxetine compared with those treated with placebo (p = .001). Similar results were observed for the inattentive (p = .016) and hyperactive/impulsive (p is less than .001) ADHDRS-IV-Teacher:Inv subscales, the clinician-rated Clinical Global Impressions severity scale (p = .001), the Conners Global Index-Teacher scale (p = .008), and the Conners Parent Rating Scale-Revised: Short Form ADHD Index T-Score (p is less than .001). Discontinuations due to adverse events were low in both groups (atomoxetine 5.9%, placebo 0%, p = .096). Conclusions: This study extends previous results based on parent reports showing that once-daily administration of atomoxetine is safe and effective in improving ADHD symptoms in children and demonstrates that outcomes at school are similar when symptoms are reported by teachers.

Reading comprehension is a very complex task that requires different cognitive processes and reading abilities over the life span. There are fewer studies of reading comprehension relative to investigations of word reading abilities. Reading comprehension difficulties, however, have been identified in two common and frequently overlapping childhood disorders: reading disability (RD) and attention-deficit/hyperactivity disorder (ADHD). The nature of reading comprehension difficulties in these groups remains unclear. The performance of four groups of adolescents (RD, ADHD, comorbid ADHD and RD, and normal controls) was compared on reading comprehension tasks as well as on reading rate and accuracy tasks. Adolescents with RD showed difficulties across most reading tasks, although their comprehension scores were average. Adolescents with ADHD exhibited adequate single word reading abilities. Subtle difficulties were observed, however, on measures of text reading rate and accuracy as well as on silent reading comprehension, but scores remained in the average range. The comorbid group demonstrated similar difficulties to the RD group on word reading accuracy and on reading rate but experienced problems on only silent reading comprehension. Implications for reading interventions are outlined, as well as the clinical relevance for diagnosis. (Contains 2 tables.)

Objective: To investigate the effect of methylphenidate (MPH) on visual-spatial memory, as measured by subtests of the Cambridge Neuropsychological Testing Automated Battery (CANTAB), in children with attention-deficit/hyperactivity disorder (ADHD). Visual-spatial memory is a core component of working memory that has been shown to be impaired in ADHD, irrespective of comorbid reading and/or language problems. Method: A clinic-referred sample of school-age children with a confirmed DSM-IV diagnosis of ADHD (n = 26) completed tests of visual-spatial memory, planning ability, and recognition memory in an acute, randomized, placebo-controlled, crossover trial with three single fixed doses of MPH. MPH effects on right-handed and left-handed motor control were also assessed. Results: MPH significantly improved performance on a self-ordered, updating visual-spatial working memory task and on maintenance of visual-spatial information but had no effects on measures of visual-spatial planning ability or recognition memory. Also, MPH significantly improved left-handed motor control. Conclusions: Beneficial effects of MPH on visual-spatial processing in ADHD are selective and restricted to visual-spatial memory.

Describes results of recent research that finds ADHD is predominately a cognitive disorder rather than a behavior disorder. Draws implications for instruction of ADHD students based on answers to three key questions. (Contains 11 references.) (PKP)

This study found that fathers of 20 preschool children with developmental delays and language impairment used more response control and topic control than mothers. Both parents reported low levels of child-related and parenting stress. Fathers used greater control with developmentally less mature children; mothers used greater control with children who were less involved in interaction. (Author/JDD)

Evaluation of the interactive intervention model with mothers and young children (n=32) with developmental delays found that treatment mothers became more responsive and less directive and provided clearer linguistic models. Treatment children increased their use of vocal turns but did not make significantly greater improvement in overall communicative and linguistic abilities than the control group. (DB)