Attention deficit hyperactivity disorder (ADHD) comprises a deficit in behavioral inhibition. A theoretical model is constructed that links inhibition to 4 executive neuropsychological functions that appear to depend on it for their effective execution: (a) working memory, (b) self-regulation of affect-motivation-arousal, (c) internalization of speech, and (d) reconstitution (behavioral analysis and synthesis). Extended to ADHD, the model predicts that ADHD should be associated with secondary impairments in these 4 executive abilities and the motor control they afford. The author reviews evidence for each of these domains of functioning and finds it to be strongest for deficits in behavioral inhibition, working memory, regulation of motivation, and motor control in those with ADHD. Although the model is promising as a potential theory of self-control and ADHD, far more research is required to evaluate its merits and the many predictions it makes about ADHD.

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Behavioral inhibition, sustained attention, and executive functions: Constructing a unifying theory of ADHD.

This study examined the persistence of attention-deficit/hyperactivity disorder (ADHD) into young adulthood using hyperactive (N = 147) and community control (N = 71) children evaluated at ages 19-25 years. ADHD was rare in both groups (5% vs. 0%) based on self-report but was substantially higher using parent reports (46% vs. 1.4%). Using a developmentally referenced criterion (+2 SD), prevalence remained low for self-reports (12% vs. 10%) but rose further for parent reports (66% vs. 8%). Parent reports were more strongly associated with major life activities than were self-reports. Recollections of childhood ADHD showed moderate correlations with actual parent ratings collected in childd hood, which suggests some validity for such recollections. The authors conclude that previous follow-up studies that relied on self-reports might have substantially underestimated the persistence of ADHD into adulthood.

The persistence of attention-deficit/hyperactivity disorder into young adulthood as a function of reporting source and definition of disorder.

Systematic study of abnormal repetitive behaviors in autism has been lacking despite the diagnostic significance of such behavior The occurrence of specific topographies of repetitive behaviors as well as their severity was assessed in individuals with mental retardation with and without autism The occurrence of each behavior category, except dyskinesias, was higher in the autism group and autistic subjects exhibited a significantly greater number of topographies of stereotypy and compulsions Both groups had significant patterns of repetitive behavior co-occurrence Autistic subjects had significantly greater severity ratings for compulsions, stereotypy, and self-injury Repetitive behavior severity also predicted severity of autism Although abnormal repetition is not specific to autism, an elevated pattern of occurrence and severity appears to characterize the disorder

Varieties of repetitive behavior in autism: comparisons to mental retardation.

Objective The authors report the adaptive functioning of hyperactive and control children in southeastern Wisconsin (Milwaukee) followed to young adulthood. Method Interviews with participants concerning major life activities were collected between 1992 and 1996 and used along with employer ratings and high school records at the young adult follow-up (mean = 20 years, range 19-25) for this large sample of hyperactive (H; n = 149) and community control (CC; n = 72) children initially seen in 1978-1980 and studied for at least 13 years. Age, duration of follow-up, and IQ were statistically controlled as needed. Results The H group had significantly lower educational performance and attainment, with 32% failing to complete high school. H group members had been fired from more jobs and manifested greater employer-rated attention-deficit/hyperactivity disorder and oppositional defiant disorder symptoms and lower job performance than the CC group. Socially, the H group had fewer close friends, more trouble keeping friends, and more social problems as rated by parents. Far more H than CC group members had become parents (38% versus 4%) and had been treated for sexually transmitted disease (16% versus 4%). Severity of lifetime conduct disorder was predictive of several of the most salient outcomes (failure to graduate, earlier sexual intercourse, early parenthood) whereas attention-deficit/hyperactivity disorder and oppositional defiant disorder at work were predictive of job performance and risk of being fired. Conclusions These findings corroborate prior research and go further in identifying sexual activity and early parenthood as additional problematic domains of adaptive functioning at adulthood.

Young Adult Outcome of Hyperactive Children: Adaptive Functioning in Major Life Activities

In this review, we consider the nature and possible developmental functions of physical activity play, defined as a playful context combined with a dimension of physical vigor. We distinguish 3 kinds of physical activity play, with consecutive age peaks: rhythmic stereotypies peaking in infancy, exercise play peaking during the preschool years, and rough-and-tumble play peaking in middle childhood. Gender differences (greater prevalence in males) characterize the latter 2 forms. Function is considered in terms of beneficial immediate and deferred consequences in physical, cognitive, and social domains. Whereas most theories assume that children's play has deferred benefits, we suggest that forms of physical activity play serve primarily immediate developmental functions. Rhythmic stereotypies in infancy are hypothesized to improve control of specific motor patterns. Exercise play is hypothesized to function primarily for strength and endurance training; less clear evidence exists for possible benefits for fat reduction and thermoregulation. In addition, there may be cognitive benefits of exercise play that we hypothesize to be largely incidental to its playful or physical nature. Rough-and-tumble play has a distinctive social component; we hypothesize that it serves primarily dominance functions; evidence for benefits to fighting skills or to emotional coding are more equivocal. Further research is indicated, given the potentially important implications for children's education, health, and development.

Physical Activity Play: The Nature and Function of a Neglected Aspect of Play.

Development of Activity Level in Children.

A combined informant questionnaire and interview survey of self-injurious behavior (SIB) at a large state facility for the retarded was conducted independently three times over a 3-year period. Prevalence consistently was about 10% of the population. SIB cases tended to be younger and institutionalized longer than the rest of the population. Severe cases had a longer history of chronic SIB. SIB cases had more seizure disorders, severe language handicaps, visual impairments, and severe or profound retardation than the rest of the population. They appeared to fulfill most of the Rutter (1966) criteria for autism. But unlike the severely autistic, there was little relation of sex to incidence of SIB. Over 90% of SIB cases changed status over 3 years, suggesting that SIB was amenable to behavior modification in most cases (94%). Psychotropic behavior control medications helped in some intervention programs (52%). SIB remitted spontaneously in 27% of SIB cases where there had been no behavioral or drug intervention.

Prevalence of self-injurious behaviors in a large state facility for the retarded: a three-year follow-up study.

Part I: The Foundation. Development of Psychopathology. Assessment to Intervention. Part II: Managing Common Problems. Eating Problems. Toileting: Training, Enuresis, Encopresis. Habits and Tics. Sleep. Sexuality and Sexual Problems. Fears and Anxieties. Depression. Disruptive Behavior. Attention-Deficit/Hyperactivity Disorder. Siblings. Divorce. Bereavement. Appendices: A. Description of Assessment Instruments. B. Assessment Instruments.

Assessment and Treatment of Childhood Problems: A Clinician's Guide

Investigated the sexual knowledge of 130 children between the ages of 2 and 7 years. Significant age differences were found for all areas of knowledge (gender, sexual and nonsexual body parts and functions, sexual behavior, pregnancy, and abuse prevention). Younger children generally knew less than older ones. None of the children demonstrated much understanding of adult sexual behavior. Lower-class children had less knowledge than middle- and upper-class children in the areas of sexual body parts, pregnancy, and abuse prevention. Lower-class parents reported more restrictive attitudes toward sexuality, had done less sex education with their children, and reported that their children had less sexual experience.

Age and Social-Class Differences in Children's Knowledge of Sexuality

A group of 16 children from a normal community population was compared with two groups of 16 children referred for clinical evaluation of hyperactivity These three groups were matched on age, sex, and race One of the clinic groups was matched with the community sample on IQ and social class as well, while the children in the other clinic group were mentally retarded and of somewhat lower social class All children were observed in a standardized playroom for two 15-minute sessions, one under free play instructions and the other under instructions restricting activity and toy-changing behavior The two groups of children referred for evaluation of hyperactivity had significantly higher playroom activity scores than controls under both instructional conditions and significantly higher toy-change scores under restrictive instructions Parental ratings of activity were also significantly higher in both clinic groups than in the community group The mentally retarded clinic sample did not differ from the other clinic sample on any of the measures of activity or toy switching

Carolyn S. Schroeder

Papers

Development of Activity Level in Children.

Prevalence of self-injurious behaviors in a large state facility for the retarded: a three-year follow-up study.

Assessment and Treatment of Childhood Problems: A Clinician's Guide

Age and Social-Class Differences in Children's Knowledge of Sexuality

Standardized Playroom Measures as Indices of Hyperactivity.