Validity of the executive function theory of attention-deficit/hyperactivity disorder: a meta-analytic review.

This report builds on a highly valued predecessor, the 1994 Institute of Medicine (IOM) report entitled Reducing Risks for Mental Disorders: Frontiers for Preventive Intervention Research. That report provided the basis for understanding prevention science, elucidating its then-existing research base, and contemplating where it should go in the future. This report documents that an increasing number of mental, emotional, and behavioral problems in young people are in fact preventable. The proverbial ounce of prevention will indeed be worth a pound of cure: effectively applying the evidence-based prevention interventions at hand could potentially save billions of dollars in associated costs by avoiding or tempering these disorders in many individuals. Furthermore, devoting significantly greater resources to research on even more effective prevention and promotion efforts, and then reliably implementing the findings of such research, could substantially diminish the human and economic toll.

Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress and Possibilities

Objective To determine the empirical evidence for deficits in working memory (WM) processes in children and adolescents with attention-deficit/hyperactivity disorder (ADHD). Method Exploratory meta-analytic procedures were used to investigate whether children with ADHD exhibit WM impairments. Twenty-six empirical research studies published from 1997 to December, 2003 (subsequent to a previous review) met our inclusion criteria. WM measures were categorized according to both modality (verbal, spatial) and type of processing required (storage versus storage/manipulation). Results Children with ADHD exhibited deficits in multiple components of WM that were independent of comorbidity with language learning disorders and weaknesses in general intellectual ability. Overall effect sizes for spatial storage (effect size=0.85, CI=0.62 − 1.08) and spatial central executive WM (effect size=1.06, confidence interval=0.72-1.39) were greater than those obtained for verbal storage (effect size=0.47, confidence interval=0.36-0.59) and verbal central executive WM (effect size=0.43, confidence interval=0.24-0.62). Conclusion: Evidence of WM impairments in children with ADHD supports recent theoretical models implicating WM processes in ADHD. Future research is needed to more clearly delineate the nature, severity, and specificity of the impairments to ADHD.

A Meta-Analysis of Working Memory Impairments in Children With Attention-Deficit/Hyperactivity Disorder

Maturation of brain white matter pathways is an important factor in cognitive, behavioral, emotional and motor development during childhood and adolescence. In this study, we investigate white matter maturation as reflected by changes in anisotropy and white matter density with age. Thirty-four children and adolescents aged 6-19 years received diffusion-weighted magnetic resonance imaging scans. Among these, 30 children and adolescents also received high-resolution T1-weighed anatomical scans. A linear regression model was used to correlate fractional anisotropy (FA) values with age on a voxel-by-voxel basis. Within the regions that showed significant FA changes with age, a post hoc analysis was performed to investigate white matter density changes. With increasing age, FA values increased in prefrontal regions, in the internal capsule as well as in basal ganglia and thalamic pathways, the ventral visual pathways, and the corpus callosum. The posterior limb of the internal capsule, intrathalamic connections, and the corpus callosum showed the most significant overlaps between white matter density and FA changes with age. This study demonstrates that during childhood and adolescence, white matter anisotropy changes in brain regions that are important for attention, motor skills, cognitive ability, and memory. This typical developmental trajectory may be altered in individuals with disorders of development, cognition and behavior.

White Matter Development During Childhood and Adolescence: A Cross-sectional Diffusion Tensor Imaging Study

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Cognitive Therapy: Basics and Beyond

We examined 3 aspects of Barkley's (1997) recent model of Attention Deficit Hyperactivity Disorder (ADHD)--behavioral inhibition, self-regulation of motivation, and working memory utilizing 152 elementary school children ages 7 to 12. Seventy-six children with ADHD and 76 children without a psychiatric diagnosis completed the stop-signal task, a computerized Digit Span Task requiring concurrent storage and processing, and the Kaufman Brief Intelligence Test during a 1-hr testing session. Parent and teacher ratings were also obtained on the Conners Parent Rating Scale-Revised: Long Version (Conners, 1997), and the Conners Teacher Rating Scale-Revised: Long Version (Conners, 1997), respectively. Results indicated that children with ADHD had deficits in inhibitory control, working memory, and short-term memory relative to children without the disorder. Contrary to our prediction, the groups did not differ in their responsiveness to external reinforcement. In addition, children with and without ADHD had similar self-perceptions of their performances during the experimental session. Future directions for specifying childhood difficulties in inhibitory control and memory processes are discussed.

Behavioral inhibition, self-regulation of motivation, and working memory in children with Attention Deficit Hyperactivity Disorder

This article examines the prevalence and correlates of depression and trauma history in first-time mothers receiving home visitation. One hundred twenty-three mothers in a Healthy Families America (HFA) program completed measures of depression, trauma history, social support, sense of control, and child abuse risk. Number of completed home visits, number of uncompleted home visits, and total telephone contact time were documented for each participant over the first 6 months of enrollment. Nearly 30% of the mothers scored in the clinically significant range on the depression measure. Approximately 70% of the sample had experienced at least one violent trauma. Depression and violent trauma, but not nonviolent trauma, were related to greater child abuse risk and less maternal sense of control and social support. Violent traumas were related to greater interruptions in service delivery as reflected by more uncompleted home visits. After controlling for social support and sense of control, depression was associated with more telephone contact between mothers and home visitors. Mothers receiving home visitation exhibited a heightened incidence of depression and trauma history relative to the population at large. These constructs were related to social support and sense of control, both of which are targets of home visitation. Depression and trauma history may significantly influence the delivery and outcomes obtained from home visitation. © 2002 Wiley Periodicals, Inc.

Depression and trauma history in first‐time mothers receiving home visitation

Depression is frequently observed among young mothers who are low income who participate in home visitation programs that are focused on optimizing child development. Maternal depression can undermine such prevention programs, and mothers are faced with significant barriers to obtaining concurrent effective mental health treatment. This case study describes In-Home Cognitive Behavior Therapy (IH-CBT), an adapted treatment for depressed mothers in home visitation. IH-CBT provides an empirically based treatment in the home setting that is tightly integrated with ongoing home visitation. The treated mother presented with major depressive disorder in the postpartum period and poor attachment with her baby. After 15 sessions of IH-CBT, provided in conjunction with home visitation, significant improvement occurred in mood, self-sufficiency, and her relationship with her baby.

Jack Stevens

Papers

Behavioral inhibition, self-regulation of motivation, and working memory in children with Attention Deficit Hyperactivity Disorder

Depression and trauma history in first‐time mothers receiving home visitation

In-Home Cognitive Behavior Therapy for a Depressed Mother in a Home Visitation Program: