Behaviour problems and social competence deficits associated with symptoms of attention-deficit/hyperactivity disorder: effects of age and gender.

BACKGROUND: Previous research has shown that children with high levels of attention-deficit/hyperactivity disorder (ADHD) symptoms often have a wide variety of associated behaviour problems. However, relatively little is known regarding to what extent these associated behaviour problems are present to the same degree in younger as well as older children and in girls as well as in boys. METHODS: This study used parent ratings to examine effects of age and gender on behaviour problems, social competence, negative impact on everyday life, and family burden among pre-school and school-aged children high in ADHD symptoms (n=60) and comparison children (n=499). RESULTS: With regard to age, the pre-school children did not differ from the school-aged children on any of the different types of problem behaviour or with regard to social competence. The interactions between age and group were not significant. The behaviour problems of older children did, however, have more negative impact on the child's daily life and induced higher levels of family burden compared with problems of younger children, especially among children with high levels of ADHD symptoms. Boys were more severely affected than girls with regard to ADHD symptom severity, most associated problem behaviours, as well as negative impact and family burden. Significant interactions of ADHD symptoms and gender were also found, which indicated that gender differences were primarily found among children with high levels of ADHD symptoms. CONCLUSIONS: Children with high levels of ADHD symptoms have many associated behaviour problems, even in pre-school years, and boys with high levels of ADHD symptoms are more severely affected compared with girls.

Social competence and behavioural problems in children with hearing impairment.

The focus in this study is on social competence and behavioural problems in a group (n=57) of hearing-impaired 7- to 12-year-old children. Results were related to hearing status, school placement, and gender. Parent and teacher questionnaires were used to measure two aspects of social competence, prosocial orientation and social initiative, and three aspects of behavioural problems, externalizing, internalizing, and concentration problems. A sample of 214 normally-hearing children was used as a comparison group. Overall, the results showed only minor differences between the two groups, with the exception that the hearing-impaired children showed less social initiative in parent ratings. There were no relationships between social functioning and hearing status or school placement (mainstream vs. special classes for hearing-impaired children) nor any clear pattern of gender differences. These findings indicate that hearing-impaired children in Sweden fare well. The results are discussed in terms of the need for longitudinal studies and possible interventions targeted at social behaviours.

Measurement of two social competence aspects in middle childhood.

The psychometric properties of a rating measure for parents and teachers for social competence, conceptualized as social skills and behaviors, were studied. The rating measure was constructed from factor analyses on 4 samples of school-age children. Factor analyses identified 2 moderately correlated competence aspects, valid for both sexes and for children from varying socioeconomic backgrounds. The first factor, Prosocial Orientation, captured a style promoting positive social interactions; the second factor, Social Initiative, described initiative as opposed to withdrawal in social situations. Scales based on the 2 factors showed reliability in internal consistency and stability across 1 year, validity in interrater agreement concurrently and across 1 year, correspondence with observed peer behavior, and the capacity to discriminate between children of different peer status.

Characteristics of school children who are choosy eaters.

Choosiness, manifested in refusal of foods, eating little, and disinterest in food, was studied with regard to prevalence, stability, sociodemographic characteristics, health problems, weight, and associated problem behaviors in a sample of 240 Swedish primary school children. Questionnaires were used, and data on sociodemographic variables, health problems, weight, and height were collected from child health-care and school health records. Choosiness was present in one third of the children, but only 8% showed choosy behavior both at home and in school. The choosy children had no more health problems than others, nor were they significantly thinner. Choosiness was not related to gender, social class, or ethnic background. The choosy children had modestly elevated levels of externalizing, hyperactive, and internalizing behavior. The choosy children with a history of refusal to eat in infancy or preschool age had more pronounced choosy behavior and had more problem behaviors than the other choosy children. Choosiness can not easily be categorized within an eating disorders or main problem syndromes of childhood frame of reference.

Children with early refusal to eat: follow-up during primary school.

Twenty-five children, previously investigated at 3-12 months of age for refusal to eat for at least four weeks with no apparent medical cause, have been followed-up prospectively with respect to feeding characteristics, general behaviour, somatic health and growth. In the present study, 18 of these children, still resident in Uppsala, were reinvestigated during the primary school period. Comparisons were made with 240 classmates. Information was obtained from school health records and from questionnaires completed by teachers and parents concerning the children's current eating behaviour and general behaviour. Compared with the controls, the children who refused to eat at an early age presented more eating problems both at home (p < 0.01) and at school (p < 0.01), but were not different with respect to general behaviour, somatic health or growth. We conclude that children with previous periods of refusal to eat continue to show problematic eating behaviour, not only at home but also at school.

New morbidity-problems and peer relations in a sample of Swedish primary school children: a follow-up from the first to the third grade.

The stability in the new morbidity-problem domains motor skills, reading/writing ability, behavioral-psychological-social function and concentration ability in school, and the stability of peer status and peer preferences as well as relationships between peer status and problems among boys and girls was studied in a sample of 81 Swedish primary school children. The children were rated by teachers and made peer nominations six months after school start, and in the third grade. There was considerable stability in problems, while the stability in peer status was modest. There were marked gender differences. Boys in contrast to girls improved in motor skills from the first to the third grade, and boys had more concentration problems and multiple problems than girls in both grades 1 and 3. In the first grade low peer acceptance in boys was accompanied by low motor skills. In the third grade, low peer acceptance in boys was accompanied by deficient concentration ability and externalizing problems. For girls, few relationships between low peer acceptance and problems emerged Various explanations for these findings are discussed.

Health examination of preschool children in relation to school adjustment in grade I.

The results of a collaborative study on health examination in preschool children, using data from child health care, preschool establishments and a teacher evaluation carried out six months after the start of school were compared. The analysis showed that many children with difficulties in motor function, behaviour and/or learning in grade 1 had been identified at the health examination. The results emphasize the value of collaboration between preschool establishments, child health care centres and schools for identification of children at risk of developing early adjustment problems.

Teacher rated problems and school ability tests in relation to preschool problems and parents' health information at school start. A study of first-graders.

The reliability of assessments at four and six years of age in identifying teacher rated problems in behaviour, concentration, motor skill and school achievement was investigated in a study of first-graders. Relationships between preschool data and school ability tests, and between parents' information at school start and teacher ratings were also studied. Problems noted in preschool and school were often present in more than one area. Multiple problems at four and six years were strong predictors of later school problems, but preschool assessments of separate areas could not in general predict problems in corresponding areas in school. However, cross situational concentration deficits at the age of six did reliably identify concentration problems in the first grade, at the age of seven.

School health services as prescribed and practised--do they correspond?

The purpose of this study was to elucidate the correspondence between officially prescribed objectives of the school health service and the actual practice. The health and contacts with the school health service during one school year of 383 children from two school management areas in Uppsala were studied through school health records and interviews with the school nurse. The results showed that the children's physical health and development were followed up continuously and were carefully documented. Their psychosocial status was well known by a nurse familiar with the area but documented only to a minor extent. There was a relationship between psychosocial problems, male sex and low social class. Children with psychosocial problems did not visit the school health clinic to any major extent. The official objective to promote psychosocial health did not seem to correspond to existing programmes and routines.

School adjustment, school performance and peer relations among first-graders in a Swedish suburban area.

A study of 95 first-graders in one school management area used teacher ratings of problems and sociometric ratings to assess school adjustment and peer relations; 14% of the children had difficulties in reading/writing, motor skill, concentration and psychosocial function. Behavioural problems did not generally coincide with poor scholastic performance, but a small group (6.3%) exhibited problems in both reading/writing, concentration, gross and fine motor skill and psychosocial functions. Sociometric results showed only moderate agreement with teacher ratings. Extremely popular boys had no teacher-rated problems, but children with teacher-rated problems did not to any high degree tend to be isolated. Poor gross motor skill did distinguish isolated boys from others, a relationship that was not evident among the girls. The need to study the validity of teacher ratings as well as the prognostic value of school adjustment in first grade was stressed.