Designing an iPad App to Monitor and Improve Classroom Behavior for Children with ADHD: iSelfControl Feasibility and Pilot Studies.

Children with Attention Deficit/Hyperactivity Disorder (ADHD) receive approximately 80% of instruction in the general education classroom, where individualized behavioral management strategies may be difficult for teachers to consistently deliver. Mobile device apps provide promising platforms to manage behavior. This pilot study evaluated the utility of a web-based application (iSelfControl) designed to support classroom behavior management. iSelfControl prompted students every 'Center' (30-minutes) to self-evaluate using a universal token-economy classroom management system focused on compliance, productivity, and positive relationships. Simultaneously, the teacher evaluated each student on a separate iPad. Using Multi Level Modeling, we examined 13 days of data gathered from implementation with 5th grade students (N = 12) at a school for children with ADHD and related executive function difficulties. First, an unconditional growth model evaluated the overall amount of change in aggregated scores over time as well as the degree of systematic variation in scores within and across teacher-student dyads. Second, separate intercepts and slopes were estimated for teacher and student to estimate degree of congruency between trajectories. Finally, differences between teacher and student scores were tested at each time-point in separate models to examine unique 'Center' effects. 51% of the total variance in scores was attributed to differences between dyads. Trajectories of student and teacher scores remained relatively stable across seven time-points each day and did not statistically differ from each other. On any given day, students tended to evaluate their behaviors more positively (entered higher scores for themselves) compared to corresponding teacher scores. In summary, iSelfControl provides a platform for self and teacher evaluation that is an important adjunct to conventional classroom management strategies. The application captured teacher/student discrepancies and significant variations across the day. Future research with a larger, clinically diagnosed sample in multiple classrooms is needed to assess generalizability to a wider variety of classroom settings.

Canine-assisted therapy for children with ADHD: preliminary findings from the positive assertive cooperative kids study.

OBJECTIVE: The objective of this study was to provide preliminary findings from an ongoing randomized clinical trial using a canine-assisted intervention (CAI) for 24 children with ADHD. METHOD: Project Positive Assertive Cooperative Kids (P.A.C.K.) was designed to study a 12-week cognitive-behavioral intervention delivered with or without CAI. Children were randomly assigned to group therapy with or without CAI. Parents of children in both groups simultaneously participated in weekly parent group therapy sessions. RESULTS: Across both treatment groups, parents reported improvements in children's social skills, prosocial behaviors, and problematic behaviors. In both groups, the severity of ADHD symptoms declined during the course of treatment; however, children who received the CAI model exhibited greater reductions in the severity of ADHD symptoms than did children who received cognitive-behavioral therapy without CAI. CONCLUSION: Results suggest that CAI offers a novel therapeutic strategy that may enhance cognitive-behavioral interventions for children with ADHD.

Exercise: applications to childhood ADHD.

ADHD is the most common neurobehavioral disorder of childhood, presenting with pervasive and impairing symptoms of inattention, hyperactivity, impulsivity, or a combination. The leading hypothesis of the underlying physiology of this disorder of inattention and/or hyperactivity-impulsivity is based on catecholamine dysfunction. Pharmacotherapy research indicates that psychostimulants, which are catecholamine agonists, show the greatest efficacy for treating the core symptoms of ADHD. Exercise affects the same dopaminergic and noradrenergic systems that stimulant medications target and is a stressor, which elicits measurable physiological changes. The magnitude of these peripheral alterations is posited as a potential biomarker of ADHD. The hypothesis that exercise training alters the underlying physiology present in ADHD and other medical conditions as well as conceptual issues behind its potential clinical utility is reviewed.

The Healthy for Life Taekwondo Pilot Study: A Preliminary Evaluation of Effects on Executive Function and BMI, Feasibility, and Acceptability.

There is growing consensus that exercise improves cognitive functioning, but research is needed to identify exercise interventions that optimize effects on cognition. The objective of this pilot study was to evaluate Taekwondo implemented in public middle school physical education (PE). Two classes were randomly assigned to either: five sessions per week of PE or three sessions of PE and two sessions of Taekwondo. In PE sessions, evidence-based curriculum to address the Presidential Core Fitness Guidelines and California Physical Fitness Tests was implemented. Taekwondo sessions included traditional techniques and forms taught in an environment emphasizing respect and self-control. Sixty students were evaluated at baseline and during the last week of the intervention (nine months later). Differences in mean residualized change scores for parent-rated inhibitory behavioral control yielded a significant, large effect size (d =.95, p =.00), reflecting greater improvement among Taekwondo students. Results from an executive function computer-administered task revealed greater accuracy on the congruent trial (d = 2.00, p = .02) for Taekwondo students. Differences in mean residualized change scores for BMI z scores yielded a moderate, non-significant effect size (d = - .51, p = .16). The majority of Taekwondo students reported positive perceptions of Taekwondo and perceived self-improvement in self-control and physical fitness. Results suggest that Taekwondo is an exercise program that improves cognitive functioning and is both feasible and acceptable to implement in a public school setting.

Atomoxetine versus stimulants in the community treatment of children with ADHD: an electronic diary study.

OBJECTIVE: To compare the morning and afternoon/evening functioning of children with ADHD treated in the community with either atomoxetine or long-acting stimulants and reported to be doing well. METHOD: 109 8- to 12-year-olds and their mothers participated in one of three groups: stimulants (STIM, N = 26), atomoxetine (ATMX, N = 25), or comparison (COMP, N = 58). Mothers completed morning and evening electronic diaries installed on personal digital assistants throughout an entire week, rating the child's behaviors and moods as well as their own moods and perceptions. RESULTS: There was no evidence that ongoing pharmacotherapy fully normalized the behaviors of children with ADHD: Mothers in both ADHD groups reported higher rates of child inattention, hyperactivity/impulsivity, oppositionality, and negative affect and lower levels of parenting efficacy and positive affect than did COMP mothers. Although the behavioral profiles were generally comparable for the STIM and ATMX groups, there were indications of better functioning in the ATMX group during mornings only. CONCLUSION: Children treated in the community with either STIM or ATMX appear to have similar behavioral profiles, suggesting that medication decisions be guided by other factors such as comorbid disorders, child and parent preferences, and effects on nontargeted behaviors and moods.

ADHD and anger contexts: electronic diary mood reports from mothers and children.

OBJECTIVE: Using electronic diaries (eDiaries), this study examined temporal links between child and maternal anger, as well as positive mood and perceived stress, in children with attention-deficit/hyperactivity disorder (ADHD) versus comparison peers. METHODS: Across 7 days, half-hourly eDiaries were completed independently by mothers and their 8-12-year-old children (51 receiving medication for ADHD and 58 comparison peers). RESULTS: Cross-informant analyses revealed systematic patterns of negative maternal moods in relation to child anger in both groups along with evidence of slower recovery in the ADHD group. Analogously, for both groups, children's anger reports increased and good-mood reports decreased in relation to maternal anger, whereas elevated stress in relation to maternal anger was restricted to children with ADHD. CONCLUSIONS: The findings indicate that a negative affective climate is more likely to persist in ADHD than in comparison families. They also affirm the utility of child as well as parent eDiary reports and suggest that children may be willing to report low positive mood when reluctant to report negative mood. The promise of incorporating real-time data on mood patterning into tailored treatments for children with ADHD and their families is discussed.