Attention Deficits and Hyperactivity in Children

169 Pages·1993·10.132 MB·English

by  Stephen P. Hinshaw

Attention Deficits
and Hyperactivity
in Children
Developmental Clinical Psychology and
Psychiatry Series
Series Editor: Alan E. Kazdin, Yale University
Recent volumes in this series . . .
8: LIFE EVENTS AS STRESSORS IN 22: SUBSTANCE ABUSE IN CHILDREN
CHILDHOOD AND ADOLESCENCE AND ADOLESCENTS
by James H. Johnson by Steven P. Schinke, Gilbert J. Botvin, and
Mario A. Orlandi
9: CONDUCT DISORDERS IN
CHILDHOOD AND ADOLESCENCE 23: CHILD PSYCHIATRIC
by Alan E. Ka/.din EPIDEMIOLOGY
by Frank C. Verhulst and Hans M. Koot
10: CHILD ABUSE
by David A.Wolfe 24: EATING AND GROWTH
DISORDERS IN INFANTS
11 : PREVENTING MALADJUSTMENT
AND CHILDREN
FROM INFANCY THROUGH
by Joseph L. Woolston
ADOLESCENCE
by Annette U. Riekel and LaRuc Allen 25: NEUROLOGICAL BASIS OF
CHILDHOOD PSYCHOPATHOLOGY
12: TEMPERAMENT AND CHILD
by George W. Hynd and Stephen R. Hooper
PSYCHOPATHOLOGY
26: ADOLESCENT SEXUAL BEHAVIOR
by William T. Garrison and Felton J. Earls
AND CHILDBEARING
14: MARRIAGE, DIVORCE, AND
by Laurie Schwab Zabin and Sarah C. Hayward
CHILDREN'S ADJUSTMENT
27: EFFECTS OF PSYCHOTHERAPY
by Robert E. Fmery
WITH CHILDREN AND
15: AUTISM
ADOLESCENTS
by Laura Sehreibman by John R. Weis/, and Bahr Weiss
18: DELINQUENCY IN ADOLESCENCE 28: BEHAVIOR AND DEVELOPMENT
by Seoll W. Hcnggeler IN FRAGILE X SYNDROME
19: CHRONIC ILLNESS DURING by Elisabeth M. Dykens, Robert M. Hodapp,
CHILDHOOD AND ADOLESCENCE and James K Leckman
by William T. Garrison and 29: ATTENTION DEFICITS AND
Susan McQuiston
HYPERACTIVITY IN CHILDREN
20: ANXIETY DISORDERS IN by Stephen P Hinshaw
CHILDREN
30: LEARNING DISABILITIES
by Rachel G. Klein and Cynthia G. Last
by Byron P. Rourke and Jerel E. Del Dotlo
21 : CHILDREN OF BATTERED WOMEN
by Peter G. Jat'r'e, David A. Wolfe, and
Susan Kaye Wilson
Attention Deficits
and Hyperactivity
in Children
Stephen P. Hinshaw
Volume 29.
Developmental Clinical Psychology and Psychiatry
SAGE Publications
<§
International Educational and Professional Publisher
Thousand Oaks London New Delhi
Copyright © 1994 by Sage Publications, Inc.
All rights reserved. No part of this book may be reproduced or
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For information address:
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Printed in the United States of America
Library of Congress Cataloging-in-Publication Data
Hinshaw, Stephen P.
Attention deficits and hyperactivity in children / Stephen P.
Hinshaw.
p. cm. —(Developmental clinical psychology and psychiatry:
v. 29)
Includes bibliographical references and index.
ISBN 0-8039-5195-7. — ISBN 0-8039-5196-5 (pbk.)
1. Attention-deficit hyperactivity disorder. I. Title.
II. Series.
RJ506.H9H56 1994
618.92'8589—dc20 93-36735
94 95 96 97 10 9 8 7 6 5 4 3 2 1
Sage Production Editor: Diane S. Foster
CONTENTS
Series Editor's Introduction vii
Preface ix
1. Background Issues, Core Symptoms,
and Associated Features 1
Key Background Issues 3
Defining Features 12
Prevalence 12
Harmful Dysfunction? 15
Associated Features and Comorbidity 16
Progression Into Adolescence and Adulthood 18
Summary 19
2. Assessment and Diagnosis 22
Reliability and Validity 25
Cross-Informant Consistency in the Assessment of ADHD 28
Theoretical Framework for Assessment 29
Key Assessment Tools 31
Amalgamating Disparate Sources of Information 39
Summary 41
3. The Nature of the Disorder and Etiologic Hypotheses 43
Methodologie and Conceptual Issues 44
The Nature of ADHD: Underlying Mechanisms 45
Etiology 57
Summary 65
4. Subgroups and Comorbidity 67
Pervasive Versus Situational Hyperactivity 67
Attention Deficit Disorder With and Without Hyperactivity 70
Comorbid Aggression in Children With ADHD 74
Associated Learning Disabilities and Underachievement 76
Comorbid Anxiety Disorders and Depression 77
Girls With ADHD 79
Summary 81
5. Course, Developmental Progressions,
and Predictors of Outcome 84
Natural History of ADHD 84
Developmental Progressions and Predictors of Outcome 88
Which Factors Reliably Predict Long-Term Outcome
in Children With ADHD? 98
Summary 99
6. Intervention Strategies 101
Conceptual Underpinnings of Treatment 103
Pharmacologie Intervention for ADHD 105
Behavioral Intervention for ADHD 112
Treatment Combinations 118
NIMH Multimodal Treatment Study
for Children With ADHD 122
Final Thoughts 123
References 127
Index 147
About the Author 155
SERIES EDITOR'S INTRODUCTION
Interest in child and adolescent development and adjustment is by no
means new. Yet only recently has the study of youth benefited from
advances in both clinical and scientific research. Advances in the social
and biological sciences, the emergence of disciplines and subdisciplines
that focus exclusively on childhood and adolescence, and greater appre-
ciation of the impact of such influences as the family, peers, and school
have helped accelerate research on developmental psychopathology. Apart
from interest in the study of child development and adjustment for its
own sake, the need to address clinical problems of adulthood naturally
draws one to investigate precursors in childhood and adolescence.
Within a relatively brief period, the study of psychopathology among
children and adolescents has proliferated considerably. Several different
professional journals, annual book series, and handbooks devoted entirely
to the study of children and adolescents and their adjustment document the
proliferation of work in the field. Nevertheless, there is a paucity of re-
source material that presents information in an authoritative, system-
atic, and disseminable fashion. There is a need within the field to convey
the latest developments and to represent different disciplines, concep-
tual views, and approaches to the topics of childhood and adolescent
adjustment and maladjustment.
The Sage Series Developmental Clinical Psychology and Psychiatry
is designed to serve uniquely several needs of the field. The series encom-
passes individual monographs prepared by experts in the fields of clinical
child psychology, child psychiatry, child development, and related dis-
ciplines. The primary focus is on developmental psychopathology, which
in this volume refers here to the diagnosis, assessment, treatment, and
prevention of problems that arise in the period from infancy through
adolescence. A working assumption of the Series is that understanding,
Vll
Vlll ATTENTION DEFICITS AND HYPERACTIVITY
identifying, and treating problems of youth must draw on multiple
disciplines and diverse views within a given discipline.
The task for individual contributors is to present the latest theory and
research on various topics including specific types of dysfunction, diag-
nostic and treatment approaches, and special problem areas that affect
adjustment. Core topics within clinical work are addressed by the series.
Authors are asked to bridge potential theory, research, and clinical practice
and to outline the current status and future directions. The goals of the
series and the tasks presented to individual contributors are demanding.
We have been extremely fortunate in recruiting leaders in the fields who
have been able to translate their recognized scholarship and expertise
into highly readable works on contemporary topics.
The present monograph, prepared by Dr. Stephen Hinshaw, focuses
on attention deficits and hyperactivity in children. The topic has received
a great deal of attention in research and is commonly encountered by
parents, teachers, and therapists in everyday life. In many ways, atten-
tion deficits and hyperactivity serve as a showcase for many advances
as well as challenges before researchers and practitioners in the mental
health professions. In this book, Dr. Hinshaw masterfully presents advan-
ces and challenges in diverse areas including diagnosis, assessment, etiol-
ogy, and intervention. The developmental course of the attention deficits
is traced, with an effort to identify promising and needed interventions
to improve current practice. The book is enriched by the fact that the
author's own work has played an important role in elaborating key
features of attention deficits. Overall, the monograph provides a com-
prehensive yet concise presentation of attention deficits, current advan-
ces, and sources of controversy that currently guide both clinical re-
search and practice.
Alan E. Kazdin, Ph.D.
PREFACE
The amount of literature that has been published in recent years regard-
ing the constellation of behavioral and cognitive problems commonly
known as hyperactivity, attention deficit disorder, or attention-deficit
hyperactivity disorder (ADHD) is nothing short of staggering. Supple-
menting the countless journal articles that appear each year, a number
of books on the topic have appeared within the past decade, including
a provocative monograph (Conners & Wells, 1986) in this very series
on Developmental Clinical Psychology and Psychiatry. Attempting to
synthesize findings from this vast and often confusing array of infor-
mation is both daunting and challenging.
Furthermore, misinformation abounds in the field. Public and even
professional understanding of children with clinically significant atten-
tion problems and overactivity is limited by outdated notions, subopti-
mal assessment strategies, nonreplicated scientific findings, and pervasive
tendencies to pursue narrow, unidimensional perspectives in both scholar-
ship and intervention. Regarding the latter point, such prior terms as
minimal brain dysfunction for many years ascribed causation exclusive-
ly to neural mechanisms, whereas other paradigms looked solely toward
deviant parent-child interaction as the key etiologic factor. Notions of com-
plex causal pathways in which psychobiologic risk factors, problematic
family functioning, and wider system influences might combine to shape
problems in attention regulation, activity level modulation, and response
inhibition have been slow to gain acceptance.
My chief goals for this book are as follows: (a) to provide sufficient
background information regarding basic clinical, conceptual, diagnos-
tic, etiologic, and treatment-related issues so that readers are conversant
with major themes; and (b) to illuminate and critically evaluate several
key debates and core questions that have confronted the field for many
years and that still merit close consideration. Such questions include the
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