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Biomedical subjects

H Abikoff

Publications and source records attributed to H Abikoff.

At least 19 recordsLinked to original sources
PubMed2001

The ecological validity of delay aversion and response inhibition as measures of impulsivity in AD/HD: a supplement to the NIMH multimodal treatment study of AD/HD.

Impulsivity is a primary symptom of the combined type of Attention Deficit/Hyperactivity Disorder (AD/HD). The Stop Signal Paradigm is premised upon a primary deficit in inhibitory control in AD/HD, whereas the Delay Aversion Hypothesis, by contrast, conceptualizes impulsivity in AD/HD, not as an inability to inhibit a response, but rather as a choice to avoid delay. This study compared the ecological validity of the Stop Signal Task (SST) and Choice-Delay Task (C-DT) measure of delay aversion, with respect to their relative utility in discriminating AD/HD children from normal control participants, and their correlations with classroom observations and with ratings of impulsivity and other core AD/HD symptoms on the Conners and SNAP-IV checklists. The tasks exhibited modest discriminant validity when used individually and excellent discriminant validity when used in combination. The C-DT correlated with teacher ratings of impulsivity, hyperactivity, and conduct problems, and with observations of gross motor activity, physical aggression, and an AD/HD composite score. The SST correlated with the observations only. These results suggest that delay aversion is associated with a broad range of AD/HD characteristics whereas inhibitory failure seems to tap a more discrete dimension of executive control.

Analysis of Variance↗
PubMed2001

Tailored psychosocial treatments for ADHD: the search for a good fit.

Commented on the article "What Does the MTA Study Tell Us About Effective Psychosocial Treatment for ADHD?" by Greene and Ablon (this issue). In this article, these authors note that the Multimodal Treatment Study (MTA) did not focus on or provide information about how to match treatment to the needs of the individual child. They contend that cognitive-behavioral treatment (CBT), which was not included in the MTA, can facilitate treatment tailoring if delivered appropriately. The authors offer several suggestions regarding how CBT can be structured to meet the needs of each child. This commentary points out that the MTA included psychosocial treatments with established rather than potential efficacy. Systematic studies are needed to determine whether the suggestions offered by Greene and Ablon have clinical utility. Matching treatment to the needs of individual patients remains the overarching goal of those interested in idiographic approaches to treatment. However, efforts to inform on treatment tailoring involve complex design and needs assessment methodologies. Several suggestions are offered regarding the technology of treatment tailoring. These include the use of goal attainment scaling to identify and evaluate individualized outcome measures and the use of hybrid efficacy-effectiveness designs to assess the impact of treatment preference on outcome.

Attention Deficit Disorder with Hyperactivity↗
PubMed1999

Stimulant medications.

OBJECTIVE: To review the short- and long-term safety and efficacy of stimulants for the treatment of children with attention-deficit/hyperactivity disorder (ADHD). METHOD: A Medline search was conducted for both randomized controlled trials and reviews to determine the efficacy and safety of stimulant drugs for treating children with ADHD. Information was obtained on adverse events associated with their use, including their impact on height and weight gain during childhood. Animal data were reviewed for information on tolerance, sensitization, and the impact of high-dose stimulant effects on neurons and on the development of hepatic tumors. Human data on dopamine transporter occupancy by stimulants were also included. RESULTS: Stimulant treatment studies show robust short-term efficacy and a good safety profile. Longer-term studies are few in number but have produced no conclusive evidence that careful therapeutic use of these medications is harmful. CONCLUSION: Current evidence indicates that stimulants show efficacy and safety in studies lasting up to 24 months.

Attention Deficit Disorder with Hyperactivity↗
PubMed1998

Factors influencing elementary school teachers' ratings of ADHD and ODD behaviors.

Examined factors that influence teachers' ratings of children with either attention deficit hyperactivity disorder (ADHD) or oppositional defiant disorder (ODD). 105 teachers watched 2 videotapes--1 depicting a normal child and the other a child with either ADHD or ODD--and rated each child using 2 different questionnaires. Results indicated that teachers accurately rated the child on the ADHD versus ODD tape as having significantly more inattention and hyperactivity but significantly less oppositionality. However, effect sizes indicated the presence of a unidirectional, negative halo effect of oppositional behaviors on ratings of hyperactivity and inattention. Teachers appeared less biased in their judgments when using a well-operationalized rating scale. Finally, knowledge, education, and experience with children with ADHD generally had no effect on the accuracy of teachers' ratings.

Adult↗
PubMed1997

Sleep problems of elementary school children. A community survey.

OBJECTIVE: To examine the prevalence, co-occurrence, and correlates of sleep problems among elementary school children. DESIGN: Survey. SETTING: General community. PARTICIPANTS: The parents of 987 children aged 5 to 12 years completed an anonymous survey distributed in their children's schools. MAIN OUTCOME MEASURES: The survey form asked about background characteristics, children's sleep environment, sleep habits, adult interventions, sleep history, and specific sleep problems. RESULTS: Bedtime resistance was the most prevalent sleep problem (27%). Sleep-onset delays (11.3%), night waking (6.5%), morning wake-up problems (17%), and fatigue complaints (17%) were also common. Among children with sleep-onset problems, 80% displayed bedtime resistance, while 34% of bedtime resisters had onset problems. Onset problems correlated with more fears, night waking, psychiatric and medical conditions, the need for reassurance and caregiver proximity, and history of sleep problems. Bedtime resistance was associated with an inconsistent bedtime and falling asleep away from bed. Those who display delayed sleep onset and bedtime resistance also wake later, suggesting that sleep-phase delays may maintain these problems. CONCLUSIONS: The results confirm bedtime resistance as parents principal sleep-related complaint for this age group but reveal a subgroup more prone to insomnia, night waking, and anxiety-related features. Phase delay findings suggest the importance of limits around wake-up time as well as bedtime. The results highlight the importance of distinctly evaluating bedtime resistance, sleep onset, sleep maintenance, waking, and emotional adjustment.

Child↗
PubMed1997

Clinical efficacy of methylphenidate in conduct disorder with and without attention deficit hyperactivity disorder.

BACKGROUND: Stimulants are not considered appropriate for the treatment of children with conduct disorders (CDs). The postulated differences in stimulant effect between children with attention deficit hyperactivity disorder (ADHD) and CD led to the hypothesis that methylphenidate hydrochloride, which is effective in ADHD, would not significantly improve symptoms of CD. METHODS: We randomly assigned 84 children with CD, between the ages of 6 and 15 years, to receive methylphenidate hydrochloride (up to 60 mg/d) or placebo for 5 weeks. Behavior was evaluated by parent, teacher, and clinician reports and by direct classroom observations. Two thirds of the children also met criteria for ADHD. RESULTS: Contrary to prediction, ratings of antisocial behaviors specific to CD were significantly reduced by methylphenidate treatment. The magnitude of methylphenidate effect indicated meaningful clinical benefit. Partialling out severity of ADHD did not alter the significant superiority of methylphenidate on CD ratings specifically (P < .001). CONCLUSIONS: Methylphenidate has short-term positive effects on children and adolescents with CD. Key aspects of antisocial adjustment appear to be treatment responsive. This effect was independent of severity of the children's initial ADHD symptoms.

Adolescent↗
PubMed1997

Hospitalizing the suicidal adolescent: decision-making criteria of psychiatric residents.

OBJECTIVE: The primary purpose of this research is to investigate the criteria used by general psychiatric residents in determining the appropriateness of hospitalization. METHOD: A questionnaire containing 64 vignettes describing adolescent suicide attempts was completed by a sample of 33 residents from a general psychiatry training program. Six variables known to relate to lethality of attempt were systematically varied within the vignettes: gender, depression, conduct disorder/substance abuse, previous attempts, suicidal relative, and family supports. Respondents were asked to judge the appropriateness of hospitalization for each vignette. RESULTS: Hospitalization preference was significantly predicted by all risk factors except for gender, with the presence of depression emerging as the most important predictor of hospitalization. Residents recommended hospitalization more frequently than did experienced child and adolescent clinicians. In comparison with experienced clinicians, residents placed more importance on depression, and less importance on conduct disorder/substance abuse, in making decisions to hospitalize. CONCLUSIONS: Although psychiatric residents use known risk factors for adolescent suicide in assessing need for hospitalization, there was clear support for further training initiatives for psychiatric residents concerning the assessment of suicidal adolescents.

Adolescent↗
PubMed1996

The effects of auditory stimulation on the arithmetic performance of children with ADHD and nondisabled children.

This study evaluated the impact of extra-task stimulation on the academic task performance of children with attention-deficit/hyperactivity disorder (ADHD). Twenty boys with ADHD and 20 nondisabled boys worked on an arithmetic task during high stimulation (music), low stimulation (speech), and no stimulation (silence). The music "distractors" were individualized for each child, and the arithmetic problems were at each child's ability level. A significant Group x Condition interaction was found for number of correct answers. Specifically, the nondisabled youngsters performed similarly under all three auditory conditions. In contrast, the children with ADHD did significantly better under the music condition than speech or silence conditions. However, a significant Group x Order interaction indicated that arithmetic performance was enhanced only for those children with ADHD who received music as the first condition. The facilitative effects of salient auditory stimulation on the arithmetic performance of the children with ADHD provide some support for the underarousal/optimal stimulation theory of ADHD.

Acoustic Stimulation↗
PubMed1995

The New York Teacher Rating Scale for disruptive and antisocial behavior.

OBJECTIVE: A teacher rating scale designed to reflect current diagnostic descriptors of oppositional defiant disorder and conduct disorder was developed and standardized. METHOD: Teacher ratings were obtained for 1,258 1st-through 10th-grade children from two school districts in New York and for 81 clinically referred children with conduct disorder. RESULTS: Three factors relevant to oppositional defiant disorder and conduct disorder were generated: defiance, physical aggression, and delinquent aggression. A fourth factor reflects peer problems. Internal consistency, test-retest reliability, and interrater reliability are documented using a population and a conduct disorder sample. The validity of the factors is supported by the factors' ability to discriminate between children in the general population and those with conduct disorders, by correlations with global impairment items, and by expected sex differences. CONCLUSION: The scale has utility for assessing symptoms of conduct disorder in school settings.

Adolescent↗
PubMed1995

Hospitalizing the suicidal adolescent: an empirical investigation of decision-making criteria.

OBJECTIVE: The primary purpose of this research is to investigate the criteria used by child and adolescent clinicians in determining the appropriateness of hospitalization for suicidal adolescents. METHOD: A questionnaire containing 64 vignettes describing adolescent suicide attempters was completed by a sample of 36 child and adolescent clinicians. Six variables known to relate to lethality of attempt were systematically varied within the vignettes: gender, depression, conduct disorder/substance abuse, previous attempts, suicidal relative, and family supports. Respondents were asked to judge the appropriateness of hospitalization for each vignette. RESULTS: Hospitalization preference was found to be inversely related to professional experience and was significantly predicted by all risk factors except gender. Configural cue utilization added substantially to the efficacy of a linear model in predicting preference to hospitalize. CONCLUSIONS: Experienced clinicians use known risk factors for adolescent suicide in making recommendations to hospitalize, but results also suggest ongoing needs for education and training in adolescent suicidality.

Adolescent↗
PubMed1995

NIMH collaborative multisite multimodal treatment study of children with ADHD: I. Background and rationale.

OBJECTIVE: The National Institute of Mental Health's recently initiated 5-year, multisite, multimodal treatment study of children with attention-deficit hyperactivity disorder (MTA) is the first major clinical trial in its history focused on a childhood mental disorder. This article reviews the major scientific and clinical bases for initiating the MTA. METHOD: A selective review of the literature is presented in the service of describing the estimated prevalence of ADHD among children and adolescents, its core clinical features, evidence concerning psychopharmacological and psychosocial treatment effects, and related research issues and trends leading to the development of the MTA. RESULTS: Despite decades of treatment research and clinical practice, there is an insufficient basis for answering the following manifold question: under what circumstances and with what child characteristics (comorbid conditions, gender, family history, home environment, age, nutritional/metabolic status, etc.) do which treatments or combinations of treatment (stimulants, behavior therapy, parent training, school-based intervention) have what impacts (improvement, stasis, deterioration) on what domains of child functioning (cognitive, academic, behavioral, neurophysiological, neuropsychological, peer relations, family relations), for how long (short versus long term), to what extent (effect sizes, normal versus pathological range), and why (processes underlying change)? CONCLUSIONS: The important scientific, clinical, and public health issues nested within this manifold question provide both the impetus and scaffolding for the MTA.

Adolescent↗
PubMed1995

Spatial orienting and focused attention in attention deficit hyperactivity disorder.

Seventeen children with attention deficit disorder (ADHD) and 10 normal controls performed two tasks while event-related potentials were recorded. ADHD subjects took part in two more sessions under methylphenidate (MP) or placebo. In the spatial orienting task, invalidly cued targets elicited a longer reaction time (RT) and a P3 that was longer in latency and greater in amplitude than did validly cued targets. Performance was similar for both groups, but the early portion of P3 (300-400 ms) was lower in amplitude for invalidly cued targets in ADHD subjects. MP increased accuracy without affecting RT and shortened P3 peak latency and increased the amplitude of its early portion. In the focused attention task, accuracy was greater for controls and MP, but there were no RT differences. Attended stimuli elicited greater amplitude P1, N1, and P3 than did nonattended stimuli, but these measures were unaffected by diagnosis or medication.

Attention↗
PubMed1995

Effects of late-afternoon methylphenidate administration on behavior and sleep in attention-deficit hyperactivity disorder.

OBJECTIVE: This study evaluated the effects on behavior and sleep of methylphenidate (MPH) administered at 4 PM to children with attention-deficit hyperactivity disorder (ADHD). METHODOLOGY: Twelve children admitted to a child psychiatric inpatient service with ADHD participated in a double-blind, crossover study in which they received a 4 PM dose of either 15 mg of MPH, 10 mg of MPH, or a placebo in random order for 12 consecutive days. Ratings of behavior, including ADHD symptoms, pertaining to the period from dose administration until sleep onset, were supplied nightly by hospital staff. Sleep latency and sleep adequacy were also assessed for each night. RESULTS: MPH resulted in markedly improved behavioral control compared with placebo; there was no difference between 15-mg and 10-mg MPH doses. MPH did not alter sleep latencies observed with the placebo. Children were more often rated as less tired on awakening after nights that they received 10 mg of MPH compared with 15 mg of MPH and the placebo. Weight loss was apparent among 83% of the patients, but dinner intake did not vary with third-dose condition. CONCLUSIONS: Morning and noon administration of stimulants to children with ADHD is a near-universal practice, but many clinicians avoid a third, late-afternoon administration for fear of inducing insomnia. This study's findings show that children with ADHD derive substantial symptom reduction from MPH administered in late afternoon, with no untoward effects on sleep. Therefore, three-times-a-day dosing should be considered for those children exhibiting ADHD symptoms in the evening. Adverse effects on sleep latency were not apparent in the sample overall. Nonetheless, monitoring for possible aggravation of sleep problems and weight loss remains sound treatment practice.

Attention Deficit Disorder with Hyperactivity↗
PubMed1994

Children's behavioral adaptation early in psychiatric hospitalization.

Behavioral patterns over time were assessed during the first 24 days of hospitalization for 98 child psychiatric inpatients. Staff completed daily behavioral monitoring and ratings. Patients were categorized as improved, unchanged or deteriorated during this time. Thirty-four percent of patients initially exhibited well-controlled behavior, but then significantly worsened after a period averaging 6.8 days. This result empirically supports the "honeymoon" phenomenon. Other patients showed either improvement during the initial period (15%), no change (30%), or could not be reliably classified (21%). Therefore, many child inpatients show rapid symptom stabilization after admission, but a large number then worsen. Clinical, scientific and administrative implications of these results are discussed.

Adaptation, Psychological↗
PubMed1993

Teachers' ratings of disruptive behaviors: the influence of halo effects.

This study evaluated the accuracy of teachers' ratings and examined whether these ratings are influenced by halo effects. One hundred thirty-nine elementary school teachers viewed videotapes of what they believed were children in regular fourth-grade classrooms. In fact, the children were actors who followed prepared scripts that depicted a child engaging in behaviors characteristic of an attention-deficit hyperactivity disorder (ADHD), an oppositional defiant disorder or a normal youngster. The findings provide support for a bias that was unidirectional in nature. Specifically, teachers rated hyperactive behaviors accurately when the child behaved like an ADHD youngster. However, ratings of hyperactivity and of ADHD symptomatic behaviors were spuriously inflated when behaviors associated with oppositional defiant disorder occurred. In contrast, teachers rated oppositional and conduct problem behaviors accurately, regardless of the presence of hyperactive behaviors. The implications of these findings regarding diagnostic practices and rating scale formats are discussed.

Adult↗
PubMed1992

Attention-deficit hyperactivity and conduct disorder: comorbidity and implications for treatment.

The distinguishing and overlapping features of attention-deficit hyperactivity disorder (ADHD) and conduct disorder (CD) are discussed. Conclusions regarding comorbidity, treatment efficacy, and long-term outcome can be influenced by several factors, including diagnostic procedures and sample characteristics. The need to distinguish between referred and non-referred samples is particularly crucial when considering treatment and comorbidity issues. The efficacy of psychosocial and pharmacological treatments in ADHD and CD children is reviewed as are the few studies of psychostimulant medication in co-morbid youngsters. Suggestions regarding treatment planning and recommendations for treatment and research are described.

Adolescent↗
PubMed1991

Cognitive training in ADHD children: less to it than meets the eye.

This article reviews cognitive training studies that have been carried out with children with attention deficit-hyperactivity disorder (ADHD) during the past decade. The efficacy of cognitive training as a single intervention and as an adjunct to stimulant treatment is discussed. The impact of training on the cognitive, academic, and behavioral functioning of youngsters with ADHD is summarized. Although this treatment modality is inherently appealing, there is little empirical support for its clinical utility with children with hyperactivity.

Attention Deficit Disorder with Hyperactivity↗