LIBRARY Michigan State University This is to certify that the thesis entitled GENDER DIFFERENCES IN HYPERACTIVE SCHOOL-AGE CHILDREN presented by Ann Elizabeth Wagner has been accepted towards fulfillment of the requirements for M.A. Psychology degree in mm. Major professor Wade Horn Date 11/17/86 0-7639 MS U is an Affirmative Action/Equal Opportunity Institution MSU LIBRARIES m \— RETURNING MATERIALS: Place in book drop to remove this checkout from your record. FINES will be charged if book is returned after the date stamped below. GENDER DIFFERENCES IN HYPERACTIVE SCHOOL-AGE CHILDREN BY Ann Elizabeth Wagner A THESIS Submitted to Michigan State University in partial fulfillment of the requirements for the degree of MASTER OF ARTS Department of Psychology 1987 ABSTRACT GENDER DIFFERENCES IN HYPERACTIVE SCHOOL-AGE CHILDREN BY Ann Elizabeth Wagner The present study investigated 79 cross-situa- tional hyperactive children and 38 normal-control chil- dren to determine whether there are gender differences in the expression of primary and secondary symptomatol- ogy, in levels of pre- and perinatal stress, and in degree of psychological disturbance in family members. Hyperactive boys exhibited a more impulsive cognitive style as measured by the Continuous Performance Test (CPT) . The male and female hyperactive groups were strikingly’ similar' on. 18 other"measures of overall severity of hyperactivity, primary symptomatology (impulsivity, short attention span, and overactivity), secondary symptomatology (learning problems, low self- control, low self-esteem, and external locus of con- trol) , and history variables (prenatal and perinatal stress and disturbance in family members). Gender dif- ferences in classroom behavior were found in the com- parison group but not in the hyperactive group. Ann Elizabeth Wagner Mothers of hyperactive children reported greater levels of prenatal stress than did mothers of control children. ACKNOWLEDGMENTS I would like to thank my committee chairman, Dr. Wade Horn, for challenging me to develop my ideas, for helping me to develop the skills needed to test them, and for his infectious enthusiasm for the project. Dr. Gary Stollak and Dr. Neal Schmitt also provided me with greatly appreciated suggestions and assistance. I also want to thank the members of the Child Behavior Project research team for their conceptual input and technical assistance. Nick Ialongo deserves extra thanks for his contributions at every level of the project. Finally; I would like to 'thank. my family and friends for encouraging me to undertake this endeavor in the first place. ii TABLE OF CONTENTS 2193 LIST OF TABLES O O O O O O O O O O O 0 iv Chapter 1- Statement of the Problem . . . . . 1 Chapter 2- Review of the Literature . . . . . 6 Prevalence . . . . . . . . . . 6 Primary Symptomatology . . . . . . . . 8 Secondary Symptomatology. . . . . . . . 12 EtiOIOgy O O O O O O O O O O O 16 Studies of Female Hyperactivity . . . . . 21 Chapter 3 - Method .. . . . . . . . . . 34 Subjects . . . . . . . . . . . . . 34 Measures . . . . . . . . . . . . . 35 Procedure .. . . . . . . . . . . . 44 Chapter 4 - Results . . . . . . . . . . 48 Severity of Hyperactivity . . . . . . . 52 Primary Symptomatology . . . . . . . . 54 Secondary Symptomatology. . . . . . . . 61 Pre- and Perinatal Influences . . . . . . 69 Chapter 5 - Discussion . . . . . . . . . 71 Summary and Future Directions for Research . 81 Appendices Appendix A - Instruments . . . . . . . 86 Appendix B - Public Service Announcements . 127 Appendix C - Consent Forms . . . . . . 130 Appendix D - Tables. . . . . . . . . 134 References . . . . . . . . . . . . . 139 iii 10 11 12 13 LIST OF TABLES Comparisons between male and female hyperactive subjects. . . . . . Demographics of hyperactive (N = 79) and control (N = 38) subjects. . . Means and standard deviations of square root transformations of all scores . F-statistics for measures of severity of hyperactivity . . . . . . . Significance of sex differences on measures of severity. . . . . . F-statistics for measures of impulsi- Vity O O O O I O O O O O 0 Significance of sex differences on measures of impulsivity. . . . . F-statistics for measures of inatten- tion I I O O O O O O O O O F-statistics for measures of over- activity. . . . . . . . . . Significance of sex differences on measures of overactivity . . . . F-statistics for measures of learning problems. . . . . . . . . . Significance of sex differences on measures of learning problems. . . F-statistics for measures of secondary symptomatology. . . . . . . . iv Page 47 49 50 53 53 55 56 59 60 6O 62 63 65 14 15 16 17 18 Significance of sex differences on measures of secondary symptomatology F-values for measures of pre- and peri- natal stress Correlations of using square Correlations of using square and genetic loading. . dependent variables root transformations . dependent variables root transformations . Means and standard deviations of depen- dent variables. . . . . . . . 66 70 134 135 136 Chapter 1 tateme t o P b1 m Hyperactivity is one of the most common childhood disorders with which clinicians are presented (Barkley, 1981b; Pries & Huessey, 1979; Ross, 1982). Estimates of prevalence appearing in the literature range from 1% to 20% of school-age children (Sandoval et al., 1980: O'Leary et al., 1984; Barkley, 1981a; Bosco 8 Robin, 1980). In a review of the literature, Barkley suggests that a "reasonable estimate" is that 4-5% of school-age children in the United States are hyperactive. This, he points out, is about one child in every classroom (Barkley, 1981b). Primary characteristics associated with hyperac- tivity are overactivity, attention deficits, and impul- sivity (Barkley, 1981b: Ross & Ross, 1982; Douglas, 1972; Preis & Huessey, 1979; Safer & Allen, 1976). Learning disabilities, conduct disorders, school fail- ure, and poor peer relationships are often associated with hyperactivity, as well (Barkley, 1981b; Safer & Allen, 1976; Ross & Ross, 1976). A number of studies have tried to correlate mea- sures of activity level, attention style and impulsiv- ity, but have found that the three constructs do not necessarily covary (Barkley, 1981a; Satterfield, 1975). Most authors agree that hyperactive children form a heterogeneous group, and some have attempted to define more homogeneous subgroups. Attempts have been made to differentiate between responders and nonresponders to stimulate drug treatment (Barkley, 1981a; Satterfield & Schell, 1984), and between hyperactive children with and without conduct disorders (August at al., 1983; Satterfield & Schell, 1984; Lahey et al., 1980). Another approach has been to focus on the attention deficits. DSM-III distinguishes between Attention Deficit Disorders with and without Hyperactivity. Some authors have suggested that groups of hyperactive chil- dren might be subdivided by components of attentional style, such as impulsivity, vigilance, signal detection and distractibility (Douglas, 1972; O'Dougherty et al., 1984; DeHaas & Young, 1984; Prinz et al.,l984). Still others Ihave distinguished "situational" hyperactives from "true" or "cross-situational" hyperactive children (Campbell et al., 1977). While each of these approaches makes intuitive sense, they all are in need of further study and validation. The incidence of hyperactivity is mmch higher in boys than in girls. Again, estimates vary, with reported ratios ranging from 3:1 to 9:1. In the review mentioned above, Barkley (1981b) reports that a "generally accepted" ratio is 6:1. A number of hypotheses have been suggested to explain this greater occurrence of hyperactivity among males. Cultural, environmental, developmental, genetic, and physiologi- cal influences have all been offered as possible expla- nations (Eme, 1979; Barkley; 1981a: Preis & Huessey, 1979). A number of authors have suggested that it might be valuable to investigate female hyperactive children as a subgroup (Henker & Whalen, 1980; Thorley, 1984; Barkley, 1981b; Ross & Ross, 1982). Because the number of hyperactive girls is so small, most researchers look at boys only, or at combined groups of hyperactive boys and girls. The few studies of hyperactive girls that can be found in the literature report a variety of characteristics which appear differently in hyperactive girls and hyperactive boys. Some authors have sug- gested that girls exhibit less impulsivity and fewer conduct problems (Kashani et al., 1979; deHaas & Young, 1984), less stability of behavior, greater achievement orientation, better peer relationships (Battle & Lacey, 1984) , and better overall adjustment (Prinz & Loney, 1974). It also has been suggested that girls are more likely to be referred for learning, speech or language difficulties, while boys are usually referred for con- duct disorders (Kashani et al., 1979), that the progno- sis may be better for females (Preis & Huessey, 1979), and that mothers may interact differently with male and female hyperactive children (Befera & Barkley, 1985). None of these studies have been replicated, and definitional and methodological idiosyncrasies make them difficult to compare. However, they do indicate that gender differences may exist in hyperactivity, and that the differences might be relevant to treatment goals and strategies. A look at female subgroups of hyperactive children might also provide clues to the causes of the disorder, particularly in relation to its higher incidence in males. Males are overrepresented in most types of childhood disturbances. Hypotheses which have been suggested in explanation include a lower tolerance level for deviation in males, and a greater constitu- tional vulnerability in males to a range of biological and physiological stressors (Eme, 1979: Barkley, 1981a: Preis & Huessey, 1979). There is a need for empirical testing of the relevance of these hypotheses to spe- cific disorders. Carefully controlled studies which compare the developmental histories and severity of disturbance in groups of male and female hyperactive children may be fruitful in this regard. The purpose of this study will be to compare a group of hyperactive girls with a group of hyperactive boys. Specifically, the study will try to determine (a) whether there are differences in the expression of the primary characteristics of hyperactivity: overac- tivity, attention deficits, and impulsivity; (b) whether there are differences in associated character- istics, such as conduct disorders, learning difficul- ties, self-control, self-esteem, and locus of control; (c) to test the hypothesis that adults have less toler- ance for male deviance by comparing severity of distur- bance in both groups: and (d) to determine whether there are differences in levels of pre- and peri-natal stress, as would be consistent with the hypothesis that males are more vulnerable to such stress. Chapter 2 Rev ew t e e tu EIQXQLEDQQ Estimates of the prevalence of hyperactivity vary. Lack of agreement about the definition of the disorder accounts for much of the discrepancy. In a review of the research, Barkley (1981a) has shown that the use of a single criterion results in an elevated prevalence estimate. For example, he cites a study by Trites (1979: cited in Barkley, 1981a) in which 14,038 chil- dren in Ottawa public schools were rated by teachers on the Conners Teacher Rating Scale. More than 14% of the children obtained scores at or above the cut-off score of 15 (2 standard deviations above the normal mean). Different observers may disagree about whether a child displays hyperactive behavior. Sandoval, Lambert, and Sassone (1980), in a random sample of 40 classrooms in San Francisco, compared ratings of hyper- active behavior by teachers, parents, and physicians. Almost 5% of the children were categorized as hyperac- tive by at least one of the adults. However, only 1.9% were designated by all three. Similarly, different assessment instruments can yield different results. Holborow, Berry, and Elkins (1984) compared prevalence ratings of hyperactivity using three different rating scales. They rated all of the children in grades 1-7 in six primary schools (N = 1,908) in Queensland, Australia, using the Conners' Parent-Teacher Questionnaire, the Queensland Scale, and an adapted form of the Pittsburgh Scale. The three instruments yielded prevalence rates of 5.6%, 7.5%, and 8.9%, respectively. The number of children rated as hyperactive on at least one scale was 12%. However, only 3.5% were identified as hyperactive on all three scales. Other sources of discrepancy include differences in cut-off scores used, and differences in sample popu- lations. Sprague, Cohen, and Werry (cited in Holborow et al., 1984) determined cut-off scores on the Conners' Questionnaire which are two standard deviations above the mean, using samples of children from three coun- tries. The cut-off scores were 15 for the American sample, 21 for the New Zealand sample, and 18 for the German sample. Trites (cited in Barkley, 1981a) found higher prevalence rates in poorer economic areas of Ottawa, with 25% of the children in those areas being rated as hyperactive using the Conners scale. Given the difficulty in comparing studies, Barkley (1981a) suggests that the best estimate of prevalence of hyper- activity in school-age children in the United States is between 3% and 5%. Wm Symptoms most commonly associated with hyperactiv- ity are overactivity, attention deficits, and poor impulse control (Barkley, 1981b: Ross & Ross, 1982; Douglas, 1972; Preis & Huessey, 1979; Safer & Allen, 1976). Hyperactive children appear to be more active, energetic, and restless than other children in many, but not all, situations (Barkley, 1981a). In general, the more restrictive the situation, the more restless- ness and task-irrelevant behavior occur. This is espe- cially apparent in classrooms, where activity is inhib- ited and concentration is required (Campbell et a1. , 1977: Klein, 1979; Prinz & Loney, 1974: Christie et al., 1934). Attentional difficulties in hyperactive children are well-documented (Barkley, 1981b: Ross & Ross, 1982: Douglas, 1972; Preis & Huessey, 1979; Safer & Allen, 1976) . Research consistently finds that hyperactive children have greater difficulty sustaining attention to task-relevant stimuli while inhibiting responses to non-relevant stimuli (Ross & Ross, 1982; Douglas, 1972; Ceci & Tishman, 1984; Brown & Wynne, 1984; McMahon, 1984). Distractibility has traditionally been associ- ated with hyperactivity (Barkley, 1981b) , but recent research suggests that hyperactive children may not be distracted more easily than other children by stimuli that are external to the performance task (McMahon, 1984: Prinz et al., 1984). It appears that attention is a multi—dimensional construct (Barkley, 1981b; Douglas, 1972) . Further research is needed to specify what aspects of attention are most problematic for hyperactive children. Douglas and her co-workers at the Montreal Chil- dren's Hospital conducted a series of investigations on attentional problems in hyperactive children. In one of the studies, Sykes (cited in Douglas, 1972) used a continuous performance task in which subjects had to respond to a particular stimulus (x preceded by A) every time it appeared on a screen over a fifteen- minute period. The test was administered in both visual and auditory form. Hyperactive children made two types of errors more often than non-hyperactive children. They failed to respond to the designated stimulus (errors of omission) and responded to incor- rect stimuli (errors of comission) more frequently than control subjects. In addition, the performance of hyperactive children deteriorated over time more than 10 the control subjects. The errors of omission and dete- rioration of performance can be interpreted as an inability to sustain attention, while the errors of comission seem to be failures to inhibit responses to irrelevant stimuli, or impulsivity. Campbell, Douglas, and Morganstern (1971) investi- gated problem-solving styles in hyperactive children, using a series of problem-solving tasks. The Matching Familiar Figures Test consists of sets of drawings of common objects. The child is asked to pick one of six drawings which matches the standard stimulus, and is scored for latency of first response and number of errors. The Children's Embedded Figures Test consists of simple figures imbedded in more complex designs, and the child is scored on the number of figures correctly located. The Color Distraction Test requires the child to ignore distracting stimuli while quickly naming the colors of objects. Campbell and her co-workers found that hyperactive children performed differently from other children on the Matching Familiar Figures Test and the Children's Embedded Figured Test, but not on the Color Distraction Test. On the MFFT, hyperactive children had shorter latencies and made more errors, reflecting an impulsive problem-solving style. They isolated fewer embedded figures on the CEFT, again) displaying an impulsive 11 style as well as a field-dependent approach to solving the problem. However, they did not appear to be any more distracted by external stimuli on the Color Dis- traction Test, nor was their performance hindered by interfering stimuli any more than the control subjects. As a result of these and other studies, Douglas (1972) concluded that hyperactive children had difficulty with sustaining attention and controlling impulses. They are unable to "stop, look, and listen". In a critique of the decision to focus on atten- tion rather than activity level in DSM-III, McMahon (1984) concluded that the evidence to date supports the idea that hyperactive children are less attentive and more impulsive than other children. On the other hand, attempts to measure gross motor activity have yielded inconsistent results. Other studies suggest that attention deficits and impulsivity are more stable over time than is activity level (August et al., 1983) and that they are more predictive of school failure than are ratings of activity level alone (Weithorn et al., 1984) . Prinz, Tarnowski, and Nay (1984) determined that inattention and impulsivity on laboratory tasks are consistent with attention deficits in the classroom. The performance of a group of boys with ADD with hyper- activity was compared to the performance of a normal 12 control group on a task similar to academic work (ANALOGUE). Distracting classroom-like stimuli were presented on a video monitor during the task. Perfor- mances of both groups were compared with teacher rat- ings of classroom behavior and performance on the Con- tinuous Performance Test (CPT). ANALOGUE discriminated ADDH children from the non- clinic control group. Its variables significantly cor- related with the CPT and teacher ratings of attentional classroom behavior. Consistent with the findings of Campbell, Douglas, and Morganstern (1971). ADDH chil- dren were not more distracted by the video monitor than the non-ADDH group. There is now a need to opera- tionalize the definition of attention deficit and investigate its implications for treatment (Prinz et al., 1984: Weithorn et al., 1984; McMahon, 1984). It has also been suggested that attentional style might help to discriminate between hyperactive and learning disabled children, with LD children being less impul- sive than both hyperactive and normal groups (Brown & Wynne, 1984), and might be useful in defining subgroups of’ hyperactive. children (August. et. al., 1983: O'Dougherty et al., 1984). Secondary Symptomatology Barkley (1981a) states that 60-80% of hyperactive children are likely to have learning disabilities, when 13 LD is defined as a significant deficit compared to expected grade level in one or more areas of academic achievement, despite normal IQ and educational opportu- nity. Several studies have partialled out the effects of the children's IQ and have still found that hyperac- tive children underachieve in all areas of academic performance (Barkley, 1981a). Hyperactive children exhibit a much higher rate of out-of—seat and off-task behavior' in ‘the.tclassroom (Barkley, 1981a: Klein & Young, 1979) than do normal children. Their learning difficulties and behavioral/attentional difficulties contribute to a higher than normal risk of school fail- ure. Hyperactive children are 2 to 3 times more likely than non-hyperactive peers to be retained at least once before middle or junior high school (Barkley, 1981a). A study by Weiss et al. (1971, cited in Ross, 1982) found that only 20% of the adolescent hyperactive sub- jects had made satisfactory academic adjustment. Ratings of children on factor-analytically derived conduct problem and hyperactivity scales are consis— tently correlated (Lahey, et al., 1980), and follow-up studies of hyperactive children have found that as many as 25% become delinquent (Satterfield & Schell, 1984). It has been suggested that aggression in hyperactive children is predictive of aggressive and delinquent 14 behavior in adolescence, while activity level is pre- dictive of academic achievement (Barkley, 1981a: August et al., 1983). August, Stewart and Holmes (1983) fol- lowed up a group of 34 "pure" (H) hyperactive boys, and a group of 42 hyperactive-unsocialized aggressive (H- USA) boys. The mean age at follow-up was 14.2. The H- USA group continued to have problems with attention and impulsivity, and were reported to be aggressive, non- compliant, egocentric, exhibiting antisocial behaviors and using alcohol. The H group continued to be inat- tentive and impulsive, but showed few aggressive and antisocial behaviors. Given the difficulties that hyperactive children often have with school performance and conduct disor- ders, it is not surprising that peer relationships are also jproblematic for"many of them (Barkley, 1981a; Ross, 1982). Waddell (1984) recruited 30 adolescents who had been diagnosed as hyperactive or hyperkinetic in early childhood. The 27 males and 3 females ranged in age from 13 to 18 (M = 14.5). These children were significantly less socialized, and had fewer interper- sonal interactions, than their non-hyperactive peers. In addition, they lacked self-discipline and confi- dence, and were less resourceful. They' were more 15 likely to describe themselves as inadequate; to be dis- satisfied with their behavior, morality, and relation- ships; and showed more evidence of pathology. It has also been suggested that hyperactive chil- dren are more likely to attribute life events to fac- tors beyond their control (external locus of control) than to their own influence (internal locus of control) (Linn 8 Hodge, 1982). It has been hypothesized that as children learn about the behavior-reinforcement contin- gencies that operate in their environments, they come to believe that they are able to have some control over the outcome of events. It has been shown that there is a gradual increase in internal locus of control in nor- mal children as they get older (Nowicki 8 Strickland, 1973). Children who are unable to attend to and learn from environmental contingencies because of attention deficits and impulsivity' may fail to maneuver the developmental process from external to internal locus of control (Cunningham 8 Barkley, 1978). It is apparent that some, but not all, hyperactive children have a poor prognosis for social adjustment. Associated characteristics such as learning difficulty and conduct disorders contribute to adjustment problems in some hyperactive children. An understanding of the interaction. between these (associated characteristics 16 and the primary symptoms of hyperactivity could lead to more effective treatment of children with the disorder. 33.19.1292 No specific etiology has been identified for hyperactivity. It is likely that there are multiple etiologies, and that the disturbance is the "final com- mon pathway". Pre- and perinatal disturbances have been investigated as possible contributing factors in hyperactivity. Unfortunately, research which has looked for evidence of pre- or peri-natal stress in the developmental histories of hyperactive children has not shown consistent results. In a review of research on perinatal influences on behavior and learning problems, Rubin and Balow (1979) report that retrospective data indicates that from 9.5% to 73% of hyperactive children show perinatal problems. They assume that the enormous range reflects unreliability of the data. Most inves- tigations of perinatal stress have been retrospective, and many have not used control groups. And here too, definitions of hyperactivity vary between studies. Summarizing findings from retrospective studies which used control groups, Rubin and Balow (1979) found a number of perinatal influences which have been associ- ated with hyperactivity, including prematurity, mater- nal toxemia of pregnancy, forceps delivery, unusually short labors, and unusually long labors. None of these 17 results have been replicated, however, and retrospec- tive studies by Stewart and colleagues, and by Werry and colleagues (cited in Rubin and Balow, 1979) found no significant differences between hyperactive and con- trol children. In a recent report, Hartsough and Lambert (1985) retrospectively investigated the developmental medical histories of a group of children who had been included in a prevalence study of hyperactivity. The 492 chil- dren were identified from a representative sample of 5,000 school-age children in the San Francisco Bay area. To be included in the hyperactive sample, chil- dren had to meet the following criteria: a) teacher and parent ratings of nonmedicated behavior on the Behavior and Temperament Survey in the top 15%; b) a. primary diagnosis of hyperactivity by a physician, and c) parental report of hyperactive behavior for two years or more. Parents were interviewed, including 30 questions related to medical issues. The authors caution that the data collection was retrospective, and the children were school-aged at the time of the interview. There- fore, unreliability of recall may affect the results, and caution should be used in interpreting them. Nev- ertheless, analysis of the data revealed twelve medical factors which discriminated between hyperactive and 18 control children. In order of relative magnitude, they were: a) presence of health problems in infancy, b) post-maturity of fetus, c) poor maternal health during pregnancy, d) first pregnancy for mother, e) presence of toxemia or eclampsia during pregnancy, f) young mother, g) poor coordination, h) long labor, i) four or more serious accidents in childhood, j) delay in bowel control, k) delay in talking, and 1) speech problems. The authors feel that their results indicate that medical factors have a small predispositional influence on later hyperactive behavior. In particular, health problems in infancy, fetal post-maturity, poor maternal health during pregnancy, being first-born, presence of toxemia in pregnancy, maternal youth, and long labor may be indications of risk. Similar findings from the Collaborative Perinatal Project (NCPP) , a prospective study of the National Institute of Neurological and Communicative Disorders and Stroke (NINCDS) have been reported by Nichols and Chen (1981). The purpose of the NCPP is to study the relationship between perinatal problems and neurologi- cal and cognitive deficits in infants and children. The total project population was a representative sam- ple of over 53,000 subjects, with data collected at twelve university medical centers between 1959 and 19 1965. Children were examined neonatally, and then periodically until the age of 9 years. Nichols and Chen (1981) looked specifically at Minimal Brain Dysfunction (MBD), which they defined as the extreme 8% of a distribution of learning disabili- ties, hyperkinesis, and neurological soft signs. The MBD cohort included 34,065 white and black children who were given examinations at age 7, while they were in first or second grade. Using scores from a number of behavioral, cognitive, and neuro-physiological mea- sures, the presence or absence of 26 MBD symptoms was assessed. A factor analysis of the results yielded three factors: learning difficulties (LD), hyperkinetic-impulsive behavior (HI), and neurological "soft signs" (NS). Variables loading most highly on the HI factor were hyperactivity, impulsivity, short attention span, and emotional lability. Of the MBD cohort, 7.9% (N = 2,356) scored in the extreme 8% on the HI factor, and composed the group of HI subjects. Using multivariate analyses, a number of variables were significantly correlated. ‘with hyperkinetic- impulsive behavior. The variables with the largest standardized coefficients included socioeconomic index score, lengths of maternal smoking, smoking during pregnancy, low fetal heart rate, low placental weight, 20 convulsions during pregnancy, and delayed motor devel- opment at one year. Smaller significant correlations were found for young maternal age, breech delivery, hospitalizations during pregnancy, and retardation in relatives. Small but significant correlations were found for three behavior ratings when infants were 8 months old: fast speed of response, short duration of response, and high activity level. Hyperactive chil- dren were more likely than controls to be first-horns or only children, and to come from homes in which the father was absent. Of particular interest to the pre- sent study, hyperactivity tended to run in families, and was particularly prevalent in relatives of "severe" (extreme 3% of the distribution) and female hyperac- tives. A polygenetic transmission of hyperactivity has been proposed (Preis 8 Huessey, 1979; Eme, 1979: Cantwell, 1975; Morrison 8 Stewart, 1973). This model predicts that siblings of more severely affected chil- dren will be at a greater risk themselves, since the severely affected child has more of the genes needed to produce the hyperactive symptoms. In addition, a poly- genetic model predicts that siblings of affected girls should be at higher risk because girls have a higher "threshold" and would also have to be more "genetically loaded" to produce the symptoms (Nichols 8 Chen, 1981). 21 The NCPP findings were consistent with a polygenetic transmission of hyperactivity. There was a highly sig- nificant (p < .001) risk to siblings of severe hyperactive-impulsive children, but none to siblings of children with less severe disturbances. Siblings of girls in the MBD cohort had greater risk than siblings of boys, although the difference did not reach signifi- cance. The above studies suggest the possibility that prenatal genetic, physical and environmental influences may contribute to the development of hyperactivity in childhood. How these biological and environmental influences interact is open to further investigation. Studies of Female Hyperactivity The conflicting data across studies is likely due to the heterogeneity of the groups of hyperactive chil- dren being investigated. Studies are appearing in the literature which look at specific subgroups of hyperac- tive children, including those with and without conduct disorders or delinquent behavior (Iahey et al., 1980: August et al., 1983: Satterfield 8 Schell, 1984): hyperactive girls (Battle 8 Lacey, 1972: Prinz 8 Loney, 1974: Kashani et. al., 1979: deHaas 8 Young, 1984: Befera 8 Barkley, 1985): those with and without learn- ing disabilities (Breen 8 Barkley, 1984): those with differential responses to medication (Satterfield, 22 1975); different attentional styles (O'Dougherty et al., 1984): and, retrospectively, by outcome (Hechtman et al., 1984). It seems that finding more homogeneous subgroups of children with hyperactive behavior is nec- essary for further clarification of the etiology of the disorder. A comparison of boys and girls with hyperac- tivity would be an important contribution to the liter- ature. Unfortunately, because of its relative rarity in females, few researchers have attempted to do this. In a review of the literature, Barkley (1981b) determined that the ratio of hyperactive boys to hyper- active girls is about 6:1. Social and cultural expla- nations have hypothesized that lower tolerance levels for boys than girls, and the difficulty of males living in a "feminine" environment may be reasons for greater referral rates for boys (Eme, 1979). In his review of the literature, Eme indicated that there is empirical support for the notion that adults have less tolerance for male deviance than for female deviance. Studies by Shepard et al., Chess and Thomas, Serbin and O'Leary (cited in Eme, 1979), and. Battle and. Lacey (1972) investigated reactions of parents and teachers to chil- dren with different levels of disturbance. Shepard, Oppenheim and Mitchell found that parental reaction, as opposed to severity of disturbance, determined whether a child was referred to a clinic. In addition, more 23 mothers of girls accepted their child's behavior as a temporary difficulty. Chess and Thomas found that mothers were less tolerant of distractibility in males than in females. Battle and Lacey (1972) investigated hyperactivity in 74 subjects drawn from the Fels Longitudinal Study. They reported that mothers of highly active boys were critical, disapproving, unaffectionate, and severe in their punishment. They did not find these maternal characteristics to a significant degree in mothers of highly active girls. Serbin and O'Leary (cited in Eme, 1979) found that disruptions by males in preschool classrooms were more likely to be reprimanded than sim- ilar disruptions caused by females. The reprimands were also more severe, louder, and more public. Eme speculates that mothers and teachers (apparently assum- ing that most teachers are female) may view the same behavior as more pathological in boys than in girls because adults feel less comfortable and competent with children of the opposite sex. Contradicting the hypothesis is a study by Walker, Bettes, and Ceci (1984) which looked at teachers' assumptions regarding male and female children's behav- ior problems. They presented a predominantly female (91 females and 9 males) group of preschool teachers with vignettes describing aggressive, hyperactive, and 24 withdrawn behavior in both boys and girls. The authors reported no bias in favor of either sex in the teach- ers' ratings of severity, outcome, or cause of the behavior problems. However, teachers did rate aggres- sion and hyperactivity in children of both sexes as more severe disorders, and as having worse prognoses than withdrawal. They were also more likely to agree with the statement, "This type of problem is best referred to a mental health professional" if the vignette depicted aggressive or hyperactive behavior. The authors concluded that the high referral rate for males is not due to biases against boys, but is a result of their exhibiting a higher incidence of aggression and hyperactivity, which are the behavior problems that teachers view as most serious. In a review of the literature on sex differences in childhood psychopathology, Eme (1979) reports that there is a preponderance of males with adjustment reac- tions, learning difficulties, psychosexual disorders, antisocial behavior, neurosis, and psychosis. In con- trast to the "annoyance level" theory is the hypothesis that males are more vulnerable to physical and psycho- logical stressors (Eme, 1979: Smith, 1983). In his review of sex differences, Eme summarizes evidence that males suffer more damage from pre-, peri-, and post- natal traumas: 25 . . . though the ratio of male and female conceptions is 130:100, the ratio is reduced to 105:100 at birth in the United States. (Males) suffer more abortions, miscarriages, prematurity, anoxia, and other birth compli- cations. They are also more likely than females to suffer serious defects as a result of prematurity or anoxia. During infancy 37% more males die, and throughout life males are afflicted by the major diseases. They are also more likely to suffer ill effects from malnutrition and radiation" (Eme, 1979, p. 577). Reasons commonly given for this greater male vul- nerability include maturational lags (Eme, 1979: Smith, 1983); slower growth of the brain's protective sheath in prenatal males (Smith, 1983): greater male suscepti- bility to sex-linked disease (Eme, 1979): and the ten- dency for males to have greater birth weights, larger heads, and to be first borns, all of which are associ- ated with increased risks of brain injury (Smith, 1983). Maturational lags of the male nervous system may make boys more vulnerable to prenatal and postnatal damage which leads to learning difficulties (Smith, 1983). Specifically, boys lag behind girls in the 26 development of brain regions responsible for attention and reading-related skills such as verbal expression, articulation, and perception of word order (Smith, 1983). Since as many as 80% of hyperactive children also have a learning disability (Safer 8 Allen, 1976), and both disorders have similar male:female ratios, (Smith, 1983), it is possible that they share a common vulnerability to CNS damage. If the greater number of hyperactive boys in clin- ical populations is due to a lower tolerance level for deviance in males, one would expect that hyperactive girls would have to exhibit greater behavior distur- bances than boys in order to be referred for treatment. Very few studies have looked specifically at hyperac- tive girls (Battle 8 Lacey, 1972: Prinz 8 Loney, 1974: Kashani et al., 1979: deHaas 8 Young,,1984: Befera 8 Barkley, 1985). Battle and Lacey (1972) examined motor activity in a group of subjects drawn from the Fels Longitudinal Study. The 31 females and 43 males were from predomi- nantly white, middle-class families. The 74 subjects came from 45 families. Each subject was given a hyper- activity rating from 1 to 7 by two raters. These rat- ings were made on the basis of narrative reports of home observations, and narrative accounts of nursery school and day camp behavior, all recorded 20 years 27 prior to the time in which the ratings were being made. Hyperactivity was defined as the degree to which the child's motor behavior was described in reports as impulsive, uninhibited, and uncontrolled, as well as the total amount of vigorous motor activity. Data were analyzed for three age periods: 0-3 years, 3-6 years, and 6-10 years. Mean hyperactivity scores were consis- tently higher for males, although significantly so only during the 6-10 age period. Male scores remained sta- ble, while girls' scores fluctuated throughout the ten years. Hyperactivity in boys correlated positively with mothers being more highly critical, disapproving, severe in their punishment, and lacking in affection and protectiveness. The mother variables were not cor- related with hyperactivity in girls. Hyperactive males showed less evidence of "general achievement striving", and a lack of approach toward intellectual tasks, than other males. In contrast, hyperactive girls showed greater' than average achievement orientation, espe- cially in the preschool years. There are obviously methodological problems with this study. The primary criteria for hyperactivity in this study was motor activity. As previously dis- cussed, more recent research indicates that difficulty in sustaining attention and controlling impulses are 28 more consistently associated with hyperactivity (Douglas, 1972: McMahon, 1984) and. are :more stable characteristics than motor activity (August, et al., 1983). The authors seem to interpret the findings as supportive of the "lower tolerance for males" hypothe- sis, but the methodological problems make any interpre- tation highly speculative. However, the study does suggest that there may be gender differences among hyperactive children. The next study of hyperactive girls to appear in the literature is by Prinz and Loney (1974) . The authors compared 12 hyperactive girls with 12 female controls, matched by IQ. The "hyperactive" subjects were determined by their inclusion in a "High Activity Level" category by their elementary art teacher. They were also rated on General Adjustment (1-3), Self- Esteem (0-5), and Impulse Control (0-5). All children had been given a group intelligence test during the same academic year. Comparing their results with an identical study previously conducted with male subjects (unpublished, cited in Prinz 8 Loney, 1974), the authors reported that a) intellectual functioning of male and female hyperactives dropped over time, b) self-esteem dropped in males, but not in females, and c) general adjustment compared to control groups was worse for males but not 29 for females. Again, the lack of a representative sam- ple, operational definitions, and objective measures makes the results difficult to interpret. Kashani, Chapel, Ellis, and Shekim (1979) reviewed the medical records of children seen in a Pediatric Developmental Evaluation Clinic over a three-year period. Twenty-eight girls were given a diagnosis of Hyperkinetic Reaction and matched with 28 hyperkinetic boys for SES, race, and age. The authors reported that there were no significant differences in severity of overactivity, short attention span, restlessness or distractibility. They did not report how these charac- teristics were measured, beyond "the review of complete medical records". The results of the study did suggest that the boys were more frequently referred for hyper- activity and behavioral disorders, while hyperkinetic girls were usually referred for learning disabilities, and speech and language problems. These findings are consistent with the hypothesis that boys are referred more often because they are more likely to engage in problematic behavior. The authors also found that enuresis, fearfulness, and emotional lability were more prevalent in the female hyperactive subjects. More psychopathology was found in the families of the female proband. This last finding is consistent with 30 the polygenetic theory of transmission discussed previ- ously. DeHaas and Young (1984) compared 24 hyperactive and 24 normal first- and second-grade girls. Hyperac- tive girls were selected by teachers using the DSM-III diagnostic criteria for Attention Deficit Disorder with Hyperactivity. All subjects were rated by teachers on the Conners' Teacher Rating Scale, and were adminis- tered a variety of cognitive measures. TRS profiles were compared with norms derived from studies of teacher-rated hyperactive boys and a cflinical popula- tion. The hyperactive girls had a similar TRS profile, but lower than the hyperactive males. They also scored lower than normal on items measuring gross motor skills on the Riley Motor Problems Inventory. On the Matching Familiar Figures Test, hyperactive girls made more errors than controls, indicating a shorter attention span. However, they did not differ in response latency, suggesting that they did not display the impulsive response style that is generally reported in studies with hyperactive boys. Befera and Barkley (1985) compared hyperactive and normal girls and boys on their mother-child interac- tions, family psychiatric status, and ratings on the Personality Inventory for Children (PIC). Criteria for 31 inclusion as hyperactive subjects included parent rat- ings on the Conners' Parent Questionnaire and the Werry-Weiss-Peters Activity Rating Scale that were two standard deviations above the mean. The hyperactive children were obtained from referrals to a child psy- chology clinic. Direct observations of parent-child interactions in a playroom revealed that hyperactive boys received more direction and praise than did hyperactive girls. The authors suggest that caution be used in the confi- dence placed in these findings until replications are done. They suggest that it is easy to understand that hyperactive children might need more encouragement to stay on—task, but add that this should apply to both male and female hyperactive children. Mothers completed a family history questionnaire in which they indicated the number of their own and their husbands' relatives with psychiatric problems and the type of problem they had. The hyperactive group had significantly more psychiatric disturbance in their relatives than did the normal group. However, within the hyperactive group males and females were comparable in the amount of familial disturbance. This finding does not support the polygenetic model discussed previ- ously. 32 Comparisons of mother reports on the PIC revealed that hyperactive boys were rated as more emotionally labile (psychosis scale) than hyperactive girls. In addition, the mothers of hyperactive boys had a higher F scale, which the authors interpret as meaning that they were more concerned about their children than were the mothers of hyperactive girls. These studies have yielded some interesting results. It appears that both male and female hyperac- tive children share the primary symptoms of overactiv- ity and short attention span, but there is some evi- dence that suggests that girls may have better impulse control than boys. In addition, there may be differ- ences in related problems, with girls having more learning difficulty but fewer conduct disorders. The results of these studies do not support the hypothesis that boys are more often referred for behavioral disor- ders because adults have a lower tolerance for male disturbance. Rather, they suggest that there are dif- ferences in the kinds of behavior disturbance pre- sented, and that boys may be more likely to have the types of behavioral disturbances that will be consid- ered problematic by their parents and teachers. The findings of a higher incidence of psychopathology in relatives of hyperactive females and poorer gross motor 33 skills are consistent with the polygenetic theory dis- cussed earlier. This theory would suggest that boys are more vulnerable to genetic disturbances that would contribute to the development of the hyperactive symp- toms. Girls would show greater evidence of pre- and perinatal stress, and/or greater genetic loading to produce the same symptoms. Investigating girls as a subgroup of hyperactive children might produce valuable information. There is a need for further research uti- lizing a direct comparison of males and females, matched normal controls, operational definitions, and objective measures. Developmental histories, as well as symptomatology, should be addressed. Chapter 3 m W Hyperactive subjects were 79 school-age children who were assessed for the Child Behavior Project, a treatment program for hyperactive children at Michigan State University's Psychological Clinic. Criteria for inclusion in the present study are: (1) age between 7 and 11 years: (2) meet the criteria for DSM-III diagno- sis of Attention Deficit Disorder with Hyperactivity: (3) score of 15 or more (two or more standard devia- tions above published means) on the Hyperactivity Index of the Conners Parent Questionnaire and a score of 15 or more on the Hyperactivity Index of the Conners Teacher Rating Scale: (4) the absence of gross physical impairments, intellectual deficits or psychosis in either the child or parents: and (5) the child was not receiving medication for control of his or her hyperac- tivity. On the basis of these criteria, 60 hyperactive males and 19 hyperactive females were included in the study. A group of 38 control subjects (23 male, 15 female) were matched for IQ, grade level, and age. 34 35 eas es The following measures were administered prior to enrollment in the program, and before treatment was initiated: Revised Conners Parent and Teacher Rating Scales. These parent and teacher behavior rating scales (see Appendix A) were developed to identify hyperactive children and evaluate treatment effectiveness. They have been shown to discriminate between hyperactive and normal children. They have been factor analyzed with stable factor structures across studies (Goyette et al., 1978: Conners, 1973). Items on the parent ques- tionnaire load on five factors: Conduct Problem, Learning Problem, Psychosomatic, Impulsive-Hyperactive, and Anxiety. Test-retest. reliabilities of ‘the questionnaires range from .70 to .90 (Goyette et al., 1978: Conners, 1973). An Abbreviated Parent-Teacher Questionnaire has also been prepared (Conners, 1973) which consists of 10 overlapping parent and teacher items. Werry et a1. (1975) have reported satisfactory correlations (.94 and .92) between the abbreviated questionnaire and the hyperactivity factor on the long parent and teacher questionnaires. Mother-father and parent-teacher cor- relations have been found to be acceptable (.55 and .49, respectively) (Goyette et al., 1978). 36 A cut-off score of 15 was used to determine eligi- bility for the program. The score of 15 is two stan- dard deviations above the mean, according to normative data reported by Sprague, Cohen and Werry (1974). erso ' ve to o h’ --Rev se . The Personality Inventory for Children-~Revised (Wirt et al., 1977) (see Appendix A) is a multidimensional per- sonality instrument designed to provide screening information for children ages 6 to 16. The 600- and 280-item versions consist of true-false statements, such as "my child has many friends", that are filled out by a parent or other primary caretaker. Three validity scales, an Adjustment Scale, and 12 clinical scales can be plotted on a profile graph, and raw scores are converted to T-scores. The 12 clinical scales are Achievement, Intellectual Screening, Devel- opment, Somatic Concern, Depression, Family Relations, Delinquency, Withdrawal, Anxiety, Psychosis, Hyperac- tivity, and Social Skills. The PIC-R was standardized on 2,390 children with equal numbers of boys and girls in the standardization sample. Continuous Performaaca Test (gm) . The CPT (see Appendix A) is a measure of sustained attention that has been shown to differentiate hyperactive from normal children (Sykes et al., 1972). The test consists of a series of letters presented on a computer monitor at 37 short intervals. The subject is asked to press a but- ton on an attached paddle when a particular letter or series of letters occurs. In order to respond cor- rectly to the signals, the subject must maintain con- tinuous vigilance. Errors of comission (responding to a nonsignal stimulus) are indicative of impulsivity, while errors of omission (failure to respond to an appropriate stimulus) are indicative of a failure to sustain attention. In this way the test is thought to be useful for tapping the major symptoms of impulsivity and short attention span. W The Match- ing Familiar Figures Test (Kagan, 1965) (see Appendix A) consists of pictures of common objects and animals. The child is shown a stimulus picture and six similar ones, and is asked to choose from the six the one that is identical to the stimulus picture. The latency to the child's first response and number of errors are recorded. Children with an impulsive cognitive style have shorter latencies and more errors than children with reflective cognitive styles. Stability of the MFF was tested with 104 children at a one-year interval. Correlations for latencies on the first and second administrations were high for both boys and girls (mean = .62). Response latencies were also highly correlated to response latencies on other 38 visual matching tasks (median = .64). Number of errors on the MFF was correlated with response latency (median = -.63) but showed only a low negative correlation with verbal performance on the WISC (median = -.28) (Hagan, 1965). These results suggest that the IMFF is an adequate measure of an impulsive cognitive style. uhre'ss -otolScae e. The Humphrey's Self-Control Scale (Humphrey, 1982) (see Appendix A) consists of 11 items which can be adminis- tered individually or in a group. Items such as "When someone pushes me I fight them" and "It's hard to wait for something I want" are presented orally by the exam- iner, and the child responds "Yes" or "No". Factor analysis of the scale revealed three factors: Inter- personal Self-Control, Personal Self-Control, and Self- Evaluation. The reported test-retest reliability ranged from .56 to .63 for the factors, and was .71 for the total score. The ratings correlated moderately with observa- tions of task-relevant and task-irrelevant classroom behavior (.59 and .61), and with frustration tolerance and acting out problems (.39 and .49) as determined by a teacher rating scale of children's behavior. Relia- bility and validity appear to be sufficient when groups of children (N = 10), but not individuals, are the units of analysis, suggesting that it is an appropriate 39 measure of group differences in children's perceived self-control (Humphrey, 1982). s- ' d ' e - . The Piers-Harris Children's Self-Concept Scale (Piers 8 Harris, 1984) (see Appendix A) is a self-report measure designed to aid in the assessment of self-control in children. and adolescents. Items. on the. scale are scored in either a positive or negative direction. A. high score on this measure suggests a positive self- evaluation, while a low score suggests a negative self- evaluation. During administration of the Piers-Harris children are read 80 statements that tell how some people feel about themselves, and are asked to indicate whether each statement applies to them by using "yes" or "no" responses. The resultant data are compiled into three summary scores said to reflect an overall assessment of self-concept: a total raw score, a percentile score, and an overall stanine score. The Piers-Harris also provides six "cluster scales": Behavior, Intellectual and School Status, Physical Appearance and Attributes, Anxiety, Popularity, and Happiness and Satisfaction. The test-retest reliability of the Piers-Harris has been assessed in a number of studies with both nor- mal and "special" populations. The reliability coeffi- cients have ranged from .42 (with an interval of eight 40 months) to .96 (with an interval of one month). Tests of internal consistency using responses of children from normative samples in the third through sixth grades ranged from .89 to .92. Significant correla- tions between scores on the Piers-Harris and results of teacher and peer ratings, scores on other self-concept measures, and other behavioral measures including locus of control and cognitive style, have been found for samples of both girls and boys across a broad age range (Piers 8 Harris, 1984). Nowicki—Strigkland 1&cus 9f Conrrol Sgala. The Nowicki-Strickland Locus of Control Scale (see Appendix A) is a measure consisting of 40 questions, such as "Are you often blamed for things that aren't your fault?" and "Do you often feel that whether you do your homework has much to do with what grades you get?" that are answered either "yes" or "no". In the present study, the questions were asked orally by the examiner, and the subjects responded verbally. The test can also be given to children to read themselves and respond by making a mark in the appropriate place beside each question. Children who attribute events to circum- stances outside of their control are said to have an external locus of control. Those who attribute events to their own behavior are said to have an internal locus of control. 41 Reported estimates of internal consistency, mea- sured by the split-half method, range from .63 to .74. Test-retest reliabilities range from .63 to .71. Scale scores in male populations have been found to correlate significantly with socioeconomic status and school achievement. The same correlations do not reach sig- nificance with female groups. Studies of the scale's relation to other measures of self-control have resulted in correlations ranging from .31 to .61. These moderate correlations suggest that the Nowicki- Strickland scale is an appropriate measure of locus of control in children. eab ctu e Vo abula T st-R v's P - . The PPVT-R (see Appendix A) is an individually-adminis- tered, norm-referenced, wide-range test of receptive vocabulary. Each item has four simple, black—and-white illustrations arranged in multiple-choice format. Sub- jects select the picture they consider to best illus- trate the meaning of a stimulus word which is presented orally by the examiner. The test yields a raw score that can be converted to age-referenced norms. Tests of internal consistency have resulted in split-half reliability coefficients ranging from .61 to .86, and. test-retest. coefficients from .52 ‘to .90. 42 Numerous studies have been done to assess the relation- ship between the PPVT-R and tests of general intelli- gence. The PPVT-R correlates satisfactorily with the full scale scores of the WISC—R (median = .64) and the WAIS (median = .72). Overall correlations with intel- ligence tests range from .46 to .72. Although the cor- relations vary, they are generally satisfactory, sug— gesting that the PPVT-R is an appropriate screening measure of scholastic ability (Dunn 8 Dunn, 1981). Wide Range Aghievamenr Iagt-Bavigad (WRAI-B). The WRAT-R (see Appendix A) is designed to assess a child's skill in basic academic coding tasks. Subtests include Reading (recognizing and naming letters, and pronounc- ing words out of context): Spelling (copying marks resembling letters, writing their name, and writing single words to dictation): and Arithmetic (counting, reading number symbols, solving oral problems, and per- forming written computations). The test yields stan- dard scores and grade ratings. Tests of internal consistency have resulted in correlations in the high .80's and .90's for all three subtests. Test-retest reliability coefficients range from .94 to .97. Several studies have assessed the relationship between the WRAT-R and other achievement tests, and report correlations in the .60's, .70's, and .80's (Jastak 8 Wilkinson, 1984). 43 Developmentai History Quesriganaira. The Develop- mental History Questionnaire (Horn, unpublished) (see Appendix A) is administered in a structured intake interview with the parent(s). It includes questions about the child's achievement of developmental mile- stones, illnesses, and physical or behavioral problems. Problems during pregnancy or birth are assessed, as well as psychological and medical problems in other family members. A Prenatal Score was derived using 11 items that referred to problems experienced during pregnancy. This score included items such as "Did the child's mother have any illnesses or complications while carry- ing the child; Did the mother smoke tobacco during pregnancy: Did the mother drink alcohol during this pregnancy?" The Perinatal Score was derived from 11 questions regarding complications experienced during delivery of the child. These items included "Was the baby term or premature: the length and weight of the infant; Type of delivery: Did this baby have difficulty starting to breathe?" a i1 '5 o ues 'o a' e. The Family History Questionnaire (see Appendix A) is administered to one or both parents in a structured interview. Questions about medical or psychological disorders in family mem- bers are included. A general Family Disturbance score 44 was derived by adding up the number of psychological and medical disorders reported by the parent. PM The 79 hyperactive subjects were selected from children whose parents contacted the MSU Psychological Clinic because of the child's behavior problems in the home and/or at school. Many had been referred by physicians or other professionals in the community, and some parents had seen a public service announcement about the program on television. A copy of an informa- tional letter which had been sent to physicians and local agencies, and the public service announcement, can be found in Appendix B. Initial contact with the parents was made by tele- phone to explain the project and to determine whether the program was appropriate for the child. If the clinician did not feel that the child could benefit from the program, referrals were made to other ser- vices. If the child appeared to be eligible, and the family felt that the program could be beneficial, an appointment was made for a full assessment. Each child was seen at the Psychological Clinic for a 2- to 3-hour session during which a series of measures, including the ones being used in this study, were individually administered by a research assistant. The parent questionnaires had been mailed to the parent 45 when the appointment was made, and were returned on the day of the assessment. If the child was eligible for the treatment program on the basis of the assessment, his or her teacher was contacted and asked if he or she would be willing to fill out a behavior questionnaire. The questionnaires were mailed to the child's school, filled out by the teacher, and returned in a self- addressed, stamped envelope. Of the 180 children assessed, 79 met the criteria outlined above, and were included in the present study. Control subjects were recruited through local health care facilities, a local school, and word of mouth. via the families participating' in the study. Criteria for inclusion were: (1) the child was between the ages of 7 and 11: (2) the absence of gross physical impairments, intellectual deficits or psychoses in either the child or parent(s): and (3) the parent does not feel that the child has a behavior problem. Par- ents of all qualifying subjects signed consent forms (see Appendix C), thereby allowing their children to participate in the study, and permitting the researchers to contact the children's teachers. The controls were administered the same battery of tests by research assistants who were blind to the fact that they were normal controls. The parents and teachers also filled out and returned the questionnaires. The 46 families received a stipend at the completion of the assessment procedures. The present study used only measures taken during the pre-treatment assessment procedure, and parent and teacher ratings of children's pre-treatment behavior. These instruments and the constructs they measure are presented in Table 1. Table l ison o-tw-‘ 47 ha-- .c 'v- s . e s MW Prediction Lereeau Severity of Hyp Impulsivity Inattention Overactivity Learning Prob Conduct Prob Self-Control Self—Concept Social Skills Locus of Control Pre- and Peri- Natal Stress Genetic Loading Ms=Fs Ms>Fs Fs>Ms Ms>Fs Fs>Ms Ms>Fs Fs>Ms Fs>Ms Fs>Ms Ms>Fs Fs>Ms Fs>Ms Conners PQ Conners TQ PIC:Hyperactive CPT:Comission (B and BX Trials) MFF:Errors MFFzResponse Latency Conners' PQ: Impulsivity CPT:Omission Conners' PQ: Inattention Conners' TQ: Inattention Conners' PQ: Overactivity Conners' TQ: Overactivity PPVT-R WRAT-R:Reading, Spelling, Arithmetic PIC:Achievement PIC:Intellectual Screening PIC:Development PIC:Delinquency PIC:Undisciplined/ Poor Self-Concept Humphreys Piers-Harris PIC:Social Skills Nowicki-Strickland Developmental History Family History Chapter 4 Resume Univariate t-tests were computed in order to assess the comparability of the hyperactive (N = 79) and control (N 38) groups on important demographic variables. The results of these analyses are pre- sented in Table 2, and indicate that the differences between the groups in age, IQ, grade, and family income did not reach statistical significance. Subjects were then broken down into four groups: hyperactive males (N = 60), hyperactive females (N = 19), control males (N 23), and control females (N = 15). Examination of the individual distributions of each of the dependent variables, however, revealed that a number of variables had extremely skewed distribu- tions. Consequently, all variables were transformed using a square root transformation in order to normal- ize each distribution. All subsequent analyses were performed on these transformed scores. Means and stan- dard deviations of the transformed scores are presented in Table 3. Correlations between transformed scores 48 49 Table 2 WW (I: = 791W aa) subjacrs. Significance Issuable me _E_ —_Q.f—'i Age in months Hyperactives 106.33 Controls 111.40 -l.32 .190 IQa Hyperactives 53.65 Controls 62.75 -1.33 .187 Grade Hyperactives 2.88 Controls 3.40 -l.53 .130 Incomeb Hyperactives 2.49 Controls 3.00 - .99 .326 Note: df = 87 for all r-statistics. aPercentile scores from the PPVT-R are used as a rough estimate of intelligence. bIncome levels as reported on the PIC-R: 1=over 35,000: 2=30,000-35,000: 3=25,000-29,999: 4=20,000-24,999: 5=15,000-19,999: 6=10,000-14,999: 7=5,000=9,999: 8=below 5,000. Table 3 Means and standard deviations of square root 50 transformations of all scores. Conners ' PQ: Conners' TQ: PIC-Rza‘ Hyperactivigy Hyperactivity Hyperactivity x' 5.0. x 5.0. 7 5.0. HM 4.65 .40 4.59 .39 8.50 .84 HF 4.66 .45 4.48 .54 8.63 1.09 NM 1.89 1.05 2.27 1.20 7.05 .55 NP 1.55 .84 1.50 .97 6.99 .60 CPT MFF:Errors MFF:Latency Comission (Bl Comission (BX) )‘t 5.0. it 5.0. i 5.0. :‘t 5.0. HM 3.59 .84 3.31 1.21 2.64 1.30 3.19 2.02 HF 3.46 .98 3.25 .88 1.78 1.35 1.97 1.94 NM 2.78 .71 3.47 .75 1.96 1.15 1.95 1.99 NF 2.57 1.04 4.27 1.66 1.08 .78 1.10 .84 Conners' PQ:Impulsivity Conners' TQ:Igpulsivity X S.D. X S.D. HM 3.42 .49 3.52 .36 H? 3.54 .46 3.40 .52 NM 1.30 .95 1.78 .92 NP 1.09 .76 .91 .74 Conners' PQ:Overactivity Conners' TQ:Overactiviry X S.D. X S.D. HM 2.14 .35 2.13 .31 HF 2.07 .41 2.09 .41 NM .62 .68 .88 .80 NF .32 .56 .41 .63 CPT: CPT: Conners' PQ: Conners' TQ: Omission (B) Omission (BX) Inattention Inattention i 5.0. x 5.0. :‘c 5.0. )‘t 5.0. HM 1.37 1.14 2.52 1.23 2.24 .31 1.20 .32 HF 1.10 1.03 2.77 1.46 2.16 .35 1.98 .40 NM .81 .71 1.45 1.36 .72 .74 .81 .74 NF .36 .52 1.88 l.03~ .72 .67 .67 .49 Note: HM - hyperactive males (N - 60): HF - hyperactive females (N - 19). NM - normal males (N - 23): NF - normal females (N - 15). Table 3 (Continued) 51 WRAT-R: WRAT-R HEAT-R PPVT-R Reading 4§pelling Arithmetic it 5.0. it 5.0. :‘t 5.0. SE 5.0. HM 10.26 .51 9.59 .91 9.36 .77 9.51 .66 HF 10.20 .54 9.99 .82 9.92 .70 9.73 .70 NM 10.63 .71 10.39 .77 10.00 .72 9.94 .78 NF 10.20 1.05 10.35 .67 10.26 .62 10.14 .71 RIC-R:a PIC-R:ll Intellectual PIC-R:n Achievement Screening Development x' 5.0. )‘t 5.0. x 5.0. HM 7.98 .77 7.86 1.33 7.77 .78 HF 8.13 .94 7.58 1.56 7.97 .81 NM 6.51 .59 6.92 .70 6.52 .59 NF 6.87 .72 7.16 .60 6.80 .66 pic-as‘ Pic-nz‘ Humphrey' s Undisciplined Delinquency Self-Control Y 5.0. i 5.0. i 5.0. HM 8.74 .77 8.39 .86 2.17 .47 HF 9.29 .98 8.96 .95 2.39 .55 NM 6.87 .52 7.04 .60 2.58 .45 NF 6.82 .49 6.79 .37 2.43 .39 Nowicki- Piers-Harris PIC-Ra Strickland Self-Concept Social Skills Locus of Control )1 5.0. )‘t 5.0. i 5.0. HM 7.40 .89 8.18 .92 4.58 .46 HF 7.45 .92 8.28 .82 4.61 .46 NM 8.04 .61 6.88 .74 4.90 .57 NF 7.80 .44 6.73 .68 4.96 .52 Developmental Developmental Family History: History: History: Prenatal Perinatal Total Score it 5.0. i 5.0. r“: 5.0. HM 2.10 .92 1.75 .70 2.44 2.04 HF 2.04 .83 1.64 1.03 1.72 2.04 NM 1.59 .91 1.41 .74 2.31 1.50 NF 1.52 .86 1.53 .58 1.82 1.48 alT-scores are reported for PIC-R scale scores. 52 are presented in Appendix D. Means and standard devia- tions of the variables before transformation are pre- sented in Appendix D. Sevariry of Hyparacriviry The hypothesis that male and female hyperactive subjects would be equivalent in the severity of the disorder was tested by computing a 2 x 2 ANOVA (diagnosis x sex) using the Conners' Parent and Teacher Questionnaires and the Hyperactive subscale of the PIC- R as dependent variables. These results are presented in Tables 4 and 5. As predicted, the differences in severity of the disorder between the hyperactive male and hyperactive female subjects did not reach statisti- cal significance. As would be expected, there were significant main effects for diagnosis on all three measures, with the hyperactive subjects scoring higher than the control subjects on the Conners' Parent Ques- tionnaire F(1,113) = 455.4, p < .0001; the Conners' Teacher Questionnaire F(1,113) = 299.4, p < .0001: and on the Hyperactive subscale of the PIC-R F(1,113) -= 79.9, p < .0001. A significant main effect for sex was found on the Hyperactivity index of the Conners' Teacher Questionnaire F(1,113) = 8.4, p < .01. Uni- variate t-tests revealed that the significant sex dif- ference was primarily within the control group, where 53 Table 4 E-sraristics for measures or severity 9f nyparagtivity. Conners' PQ: Conners' TQ: PIC-R:a wwwa Sex 1.40 8.25** .06 Diagnosis 455.39**** 299.37**** 79.94**** Sex by Diagnosis 1.73 4.57 .32 Error (.07) (.08) (.09) Nara: df = 1,113 for all F-statistics. Scores are square root transformations. aT-scores are reported for PIC-R scale scores. *9 < .05. **p < .01. ***p < .001. ****Q < .0001. Table 5 Significance of ser differences an neasnras or savariry. Hyperactives Controls (df = 771 LQ£_E_1§1 Conners' TQ:Hyperactivity i .99 2.08* Note: Scores are square root transformations. 54 non-hyperactive females had lower Conners Teacher Ques- tionnaire scores compared to non—hyperactive males. Gender differences within the hyperactive group on this measure did not attain statistical significance. Diag- nosis x sex interaction did not achieve statistical significant on any of these measures. ima S tomatolo A series of 2 x 2 ANOVAs (diagnosis x sex)lwas used to test the hypothesis that male and female hyper- active subjects would differ in their manifestation of primary symptoms of the disorder. The hypothesis that male hyperactive subjects would be more impulsive than female hyperactive subjects was tested using number of errors and response latency on the MFF, errors of comission on the CPT, and the Impulsivity items from the Conners' Parent and Teacher Questionnaires (Tables 6 and 7). Hyperactive subjects compared to non-hyper- active subjects scored significantly higher on the following measures of impulsivity: MFF errors F(1,113) = 21.5, p < .0001: CPT errors of comission (B trials) F(1,113) = 7.2, {>‘< .01: CRT errors of comission (BX trials) F(1,113) = 6.9, p < .01: Impulsivity items on Conners' PQ F(1,113) = 285.6, (p < .0001: and Impulsivity on Conners' TQ F(1,113) = 292.1, p < .0001. 55 Table 6 -s s ' s u CPT: CPT: MFF: MFF: Comission Comission to s latency (B) 182:1 Sex .89 2.42 11.25** 6.61* Diagnosis 21.53**** 6.28* 7.15** 6.88** Sex x Diag .05 3.39 .00 .20 Error (.09) (.12) (.13) (.20) Conners' PQ: Conners' TQ: Impuiaiviry Impulsiyiry Sex .11**** 16.10*** Diagnosis 285.64**** 292.06**** Sex x Diag 1.56 8.89** Error (.07) (.06) N222: df = 1,113 for all F-statistics. square root transformations. *9 < .05. **p < .01. ***p < .001. ****p < .0001. Scores are 56 Table 7 n 'cance o sex ' eren s o easu es o impulsivity. Hyperactives Controls (a: = 77) l§f_s_3§l CPT:Comission (B) i 2.50* 2.59* CPT:Comissiosn (BX) i 2.30* 1.57 Conners' TQ:Impulsivity i 1.20 3.06** Note: Scores are square root transformations. *9 < .05. **p < .01. ***Q < .001. ****2 < .0001. 57 Response latency on the MFF was significantly lower in the hyperactive group F(1,113) = 6.3, p < .05. Male subjects scored significantly higher on three measures of impulsivity; CPT errors of comission (B trials) F(1,113) = 11.3, p < .01: CPT errors of comis- sion (BX trials) F(1,113) = 6.6, p < .05: and Impulsiv— ity items on the Conners' TQ F(1,113) = 16.1, p < .001, when the hyperactive and control groups are combined, Univariate t-tests revealed significant sex differences within the hyperactive group on CPT errors of comission (B trials) t = 2.50, p < .05, and CPT errors of comis- sion (BX trials) 1'. = 2.30, p < .05, with hyperactive boys making more errors of comission than hyperactive girls. A diagnosis x sex interaction was found on the Impulsivity items of the Conners' TQ: F(1,113) = 8.9, p < .01. Univariate t-tests revealed that the sex dif- ference on the Conners' Teacher Questionnaire was a result of control males scoring significantly higher than control females on that measure r = 3.06, p < .01. Male and female hyperactives scores were not signifi- cantly different on that measure of impulsivity. The hypothesis that female hyperactive subjects would be more inattentive than males was tested using errors of omission on the CPT and Inattention items from the Conners' Parent and Teacher Questionnaires as dependent variables. These results are presented in 58 Table 8. There were no significant differences between the male and female hyperactive subjects on these measures. The hyperactive group scored significantly higher than the control group on all measures of inattention: CPT errors of omission (B trials) F(1,113) = 9.5, p < .01: CPT errors of omission (BX trials) F(1,113) = 13.3, p < .001: Inattention items on Conners' PQ F(1,113) = 212.2, p < .0001: and Inattention items on Conners' TQ F = (1,113) 161.6, p < .0001. Diagnosis x sex interaction did not achieve statistical significance on these measures of inattention. It was also hypothesized that male hyperactive subjects would be more overactive than the female hyperactives. This hypothesis was tested using the Overactivity items from the Conners' Parent and Teacher Questionnaires as dependent variables (Tables 9 and 10). Again, there were no significant differences between the male and female hyperactive subjects on the measures of overactivity. Hyperactive subjects scored significantly higher than control subjects on both mea- sures of overactivity: Overactivity items on Conners' PQ F(1,113) = 271.6, p < .0001: and Overactivity items on Conners' TQ F(1,113) = 190.5, p < .0001. The Over- activity items on the Conners' TQ yielded main effects for sex F(1,113) = 5.8, p < .05, and a diagnosis x sex 59 Table 8 E-starisrics for neasuras of inartantion. CPT: CPT: Omission Omission Conners' PQ: Conners' TQ: (Bl (BX) Inarrention Inarranrian Sex 2.86 1.60 .14 .73 Diagnosis 9.54** 13.25*** 212.24**** 161.62**** Sex x Diag .18 .12 .16 .37 Error (.11) (.14) (.05) (.05) Nota: df = 1,113 for all F-statistics. Scores are square root transformations. .05. .01. .001. .0001. I- ”- IO AAAA 60 Table 9 - ta '5 cs o eas es 0 ove ac 'v't . Conners' PQ: Conners' TQ: Qveragtiviry Qveractivity Sex 3.66 5.79* Diagnosis 27l.62**** 190.49**** Sex x Diag 1.26 4.22* Error (.05) (.05) Nate: df = 1,113 for all F-statistics. Scores are square root transformations. *9 < .05. **p < .01. ***p < .001. ****p < .0001. Table 10 Significance of sex dirferences on measures gf gveragtivity Hyperactives Controls df = 77) (df.§“1§l Conners' TQ:Overactivity i .42 1.93* Nara: Scores are square root transformations. *9 < .05. **p < .01. ***g < .001. ****p < .0001. 61 interaction F(1,113) = 4.2, p < .05. However, univari- ate t-tests revealed significant sex differences only within the control group 1 = 1.93, p < .05 when the groups were analyzed separately. Teachers rated con- trol males as more overactive than control females on this measure. Secon a tom to A series of 2 x 2 ANOVAs (diagnosis x sex) was used to test the hypothesis that there would be gender differences in the manifestation of secondary symptoma- tology associated with hyperactivity. To test the hypothesis that female hyperactive subjects would have greater learning difficulties, standard scores on the PPVT-R, standard scores on the WRAT-R subscales (Reading, Spelling and Arithmetic), and T-scores on the Cognitive subscales (Achievement, Intellectual Screen- ing, and Development) of the PIC-R were used as depen- dent variables. The results of these analyses are pre- sented in Tables 11 and 12. As the F-test results in Tables 11 and 12 indi- cate, the hyperactive and normal control groups were comparable on the PPVTéR. However, the control group scored significantly better on the Intellectual Screen- ing factor of the PIC-R F(1,113) = 7.3, p < .01, and on all of the measures of academic achievement: WRAT-R Reading F(1,113) = 10.6, p < .01: WRAT-R Spelling 62 Table 11 E-starisrics ior neasnras or iearning proniams. WRAT-R: WRAT-R: WRAT-R: 22212.3 R___ugeadi Arithmetic Snelliriq Sex 3.32 1.03 1.94 6.85* Diagnosis 1.75 10.59** 7.96** 9.93* Sex x Diag 2.00 1.63 .01 .96 Error (.07) (.09) (.07) (.08) PIC-R:a PIC-R:a Intellectual PIC-R:a Achierement Ming.— Wt Sex 2.63 .01 2.44 Diagnosis 74.27**** 7.28** 63.21**** Sex x Diag .48 1.08 .06 Error (.08) (.13) (.08) EELS: df = 1,113 for all F-statistics. Scores are square root transformations. aT-scores are reported for PIC-R scale scores. *9 < .05. **p < .01. ***p < .001. ****Q < .0001. 63 Table 12 Significance of sex differences on mea5ures of iaarning roblems Hyperactives Controls df = 77) d = WRAT-R:Spelling i -2 .82** -1. 12 Note: Scores are square root transformations. *p < .05. **Q < .01. ***p < .001. ****p < .0001. 64 F(1,113) = 9.9, p < .05; WRAT-R Arithmetic F(1,113) = 8.0, p < .01; and PIC-R Achievement F(1,113) = 74.3, p < .0001. Hyperactive subjects also had significantly higher T-scores on the PIC-R Development subscale F(1,113) = 63.2, p < .0001, indicating greater difficulty in the areas of physical development and school performance. When hyperactive and control groups were combined, there was a significant main effect for sex on the Spelling subtest of the WRAT-R F(1,113) = 6.9, p < .05. Univariate t-tests revealed that hyperactive girls scored significantly higher on this test r = -2.82, p < .01, when analyzed separately. Univariate t-tests did not reveal sex differences on this test in the control group. Diagnosis x sex interaction did not achieve statistical significance on any of these measures of learning problems. The hypothesis that male hyperactive subjects would exhibit greater conduct disorders than the female hyperactives was tested using the Factor 1 (Undisciplined/Poor Self-Concept) and Delinquency sub- scale scores from the PIC-R as dependent variables (Tables 13 and 14). A significant sex x diagnosis interaction was found on the Delinquency subscale F(1,113) = 6.2, p < .05, when the hyperactive and con- trol groups were analyzed together. Univariate t-tests 65 Table 13 E-stariarigs for meaauras of sacondary synprgmatology. PIC-R:a PIC-R:a Hymphreys' Undisciniineg Qelingnancy Seif-Qontrgl Sex 2.56 .91 .11 Diagnosis 192.57**** ll3.02**** 5.12* Sex x Diag 3.61 6.15* 3.30 Error (.08) (.08) (.05) Nowicki- Strickland Piers-Harris PIC-R:a Locus of Self-Concept Sociai Skilia gonrrgi Sex .00 .03 .01 Diagnosis 12.09*** 63.43**** 7.47** Sex x Diag .06 .50 .46 Error (.09) (.09) (.05) Nara: df = 1,113 for all F-statistics. Scores are square root transformations. aT-scores are reported for PIC-R scale scores. *2 < **B < ***E < ****B < .05. .01. .001. .0001. 66 Table 14 Significance of sex girrerenges on measures or segondary synptomatoiogy. Hyperactives Controls (df = 77) (df = 36) PIC-R:De1inquency :3 -2.46* 1.46 note: Scores are square root transformations. aT-scores are reported for PIC-R scale scores. *9 < .05. **9 < .01. ***9 < .001. ****9 < .0001. 67 revealed that hyperactive girls scored significantly higher than hyperactive boys on this measure r = -2.46, p < .05. When analyzed separately, there were no sig- nificant sex differences within the control group. Both measures of conduct problems indicated signifi- cantly more severe problems in the hyperactive group than in the normal control group: the Undisci- plined/Poor Self-Concept factor of the PIC-R F(1,113) = 192.6, p < .0001: and the Delinquency subscale of the PIC-R F(1,113) = 113.0, p < .0001. Main effects for sex did not reach statistical significance. It was hypothesized that female hyperactive sub- jects would exhibit greater self-control than the male hyperactive subjects. Analysis of variance, using scores from the Humphrey's Self-Control Scale for Chil- dren as dependent measures, was used to test this hypothesis. Table 13 illustrates that the difference between the male and female hyperactive groups did not achieve statistical significance. Hyperactive subjects reported significantly lower self-control scores than the control subjects F(1,113) = 5.1, p < .05. Main effects for sex and diagnosis x sex did not achieve significance. To test the hypothesis that male hyperactive sub- jects would have poorer self-concepts than female hyperactives, the Piers-Harris Self-Concept Scale was 68 used as the dependent variable in the analysis of vari- ance. The male and female hyperactive groups did not differ significantly on this variable (see Table 13). Normal control subjects had a significantly higher mean self-concept score than the hyperactive group F(1,113) = 12.1, p < .001. Main effects for sex and diagnosis x sex interaction did not achieve statistical signifi- cance. Analysis of variance, using the Social Skills sub- scale of the PIC-R as the dependent variable, was used to test the hypothesis that female hyperactive subjects would have better social skills than male hyperactive subjects. Again, the difference between the male and female hyperactive subjects did not achieve signifi- cance on this measure (see Table 13). The normal con- trol group scored significantly better than the hyper- active group on this measure of social skills F(1,113) = 63.4, p < .0001. There were no significant main effects for sex or diagnosis x sex interaction. The hypothesis that male hyperactive subjects would have a more external locus of control than female hyperactive subjects was tested using the Nowicki- Strickland Locus of Control Scale as the dependent variable. . The difference between male and female hyperactive subjects on this measure was not signifi- cant (see Table 13) . The normal control group had a 69 significantly more internal locus of control than the hyperactive group F(1,113) = 7.5, p < .01. Main effects for sex and diagnosis x sex interaction did not achieve significance. e- an e n t e c s It was hypothesized that female hyperactive sub- jects would show greater evidence of pre- and perinatal stress, and a greater amount of family disturbance. To test this hypothesis, a series of 2 x 2 ANOVAs (diagnosis x sex) was conducted, using the Prenatal and Perinatal scores from the Developmental History Ques- tionnaire, and the Total score from the Family History Questionnaire as dependent variables. The results of these analyses are presented in Table 15. The male and female hyperactive groups did not differ significantly on any of these measures. There was a significant main effect for diagnosis in level of prenatal stress, with mothers of hyperactive children reporting higher levels of stress than mothers of control subjects F(1,113) = 7.4, p < .01. There were no significant differences between the hyperactive and normal control groups in level of perinatal stress or degree of disturbance in family members. Main effects for sex and diagnosis x sex interaction did not achieve statistical signifi- cance on these measures. 70 Table 15 'V ues or meas es 0 ' an e nat S r SS d generic ioading. Family Dev. History: Dev. History: History: Brenatai Perinaral T t core Sex .12 .00 2.32 Diagnosis 7.42** 9.66 .00 Sex x Diag .00 1.89 .08 Error (.09) (.08) (.20) Nora: df = 1,113 for all F-statistics. Scores are square root transformations. *9 < .05. **9 < .01. “*9 < .001. ****9 < .0001. Chapter 5 piggussion The major purpose of this study was to investigate the possibility of gender differences in a group of cross-situational hyperactive children. Few of the predicted differences were found. The major exception to the lack of differences between male and female hyperactive subjects was that the hypothesis that hyperactive males would be more impulsive than hyperac- tive females received partial support. Gender differ- ences within the hyperactive group were also found on one measure of behavior disorders, and on one measure of learning problems, but in both instances the differ- ences were not in the predicted direction. With these exceptions, the male and female hyperactive groups in this study were strikingly similar on all of the mea- sures of primary symptomatology (impulsivity, short attention span and overactivity) , secondary symptoma- tology (learning problems, conduct disorders, poor social skills, low self-control, low self-esteem, and external locus of control), and history variables (prenatal and perinatal stressors, and disturbance in family members). 71 72 Previous studies (Battle 8 Lacey, 1972: Kashani, Chapel, Ellis 8 Shekim, 1979: deHaas 8 Young, 1984: Befera 8 Barkley, 1985) have suggested that while the overall severity of hyperactivity is similar in boys and girls, the profile of symptoms may differ. Specif- ically, the research has suggested that although the overall severity of hyperactivity is similar in male and female hyperactive children, males may be more overactive and impulsive while females may have greater attention deficits. The present study supported the idea that the severity of hyperactivity is similar in hyperactive boys and girls. However, as measured by parent and teacher reports, the hyperactive males and females exhibited similar degrees of behavioral impul- sivity, inattention, and overactivity. The sex differ- ences that were found in non-hyperactive children's classroom behavior (boys were more impulsive and active) were not evident in the hyperactive group. Gender differences were found on the CPT (B and BX trials), suggesting that hyperactive boys may be more cognitively impulsive than hyperactive girls. However, similar differences in cognitive style were not sug- gested by the MFF. It is possible that the CPT is a more sensitive measure of cognitive impulsivity. The fact that similar differences occurred in both trials of the CPT lends credence to this possibility. On the 73 other hand, the differences were marginally signifi- cant, and replication is needed before this finding can be interpreted with confidence. In any evident, if hyperactive males are in fact more impulsive than hyperactive females, it does not seem to translate into more impulsive behavioral disturbance as measured by parent, teacher, or self reports. Previous research (Kashani et al., 1979) has also suggested that conduct disorders may be more prevalent in hyperactive boys, and learning disabilities more prevalent among hyperactive girls (Kashani et al. , 1979). Again, this study failed to find the expected sex differences on most measures of these associated characteristics. Nor did it find the expected gender differences in self-control, self-concept, social skills, or locus of control among hyperactive subjects. Hyperactive girls were rated by their mothers as significantly more delinquent than were hyperactive boys. Because this difference was marginally signifi- cant, and because a previous study (Befera 8 Barkley, 1985) failed to find such a difference, it is likely that this study's finding is a result of Type 1 error. The finding that hyperactive boys did more poorly than hyperactive girls on the spelling achievement test is also contradictory to the prediction that the girls would exhibit greater learning difficulties. It is 74 possible that the poorer performance of the boys is due to greater cognitive impulsivity, but one would then expect to find similar deficits in the other achieve- ment tests. Until replicated, this finding should also be interpreted with caution. The inconsistencies in the present findings when compared to those of previous studies may be due to differences in selection criteria. Barkley (1981b) has discussed the need for the use of standardized measures in assessing and selecting hyperactive subjects for research purposes. Yet, other than the present study, only two studies investigating gender differences in hyperactive samples used such measures (deHaas 8 Young, 1984: Befera 8 Barkley, 1985), and one of these (deHaas 8 Young, 1984) compared the female hyperactive group to published norms for male hyperactives, rather than mak- ing a direct comparison. Of the remaining studies of gender differences in hyperactive children, two of the studies used clinic-referred hyperactive subjects (Kashani et al., 1970: Befera 8 Barkley, 1985), one study retrospectively rated subjects from a longitudi- nal study (Battle 8 Lacey, 1972), and two used teacher- nominated children from normal classrooms (Prinz 8 Loney, 1974: dehaas 8 Young, 1984). Of the studies which made direct comparisons between male and female hyperactive subjects, those 'which used standardized 75 measures to diagnose subjects did not find gender dif- ferences. The studies which found sex differences used less well-operationalized criteria for inclusion. The study by Befera and Barkley (1985) used crite- ria for inclusion that are similar to those of the pre- sent study. Both studies used clinic-referred subjects which met the DSM III criteria for Attention Deficit Disorder with Hyperactivity, and scored at least two standard deviations above the mean on the Hyperactivity Index of the Conners Parent Questionnaire. The Befera and Barkley (1985) study found no gender differences on 15 of 16 subscales of the Personality Inventory for Children. They did find that the male hyperactive group had significantly higher scores on the Psychosis subscale of the PIC-R. A mean score of T = 75.5 on that scale is not indicative of true psychosis (which requires a T-score greater than 115) , but probably reflects emotional lability. Since the present study did not include the Psychosis subscale, that particular finding remains to be replicated. Another reason for the discrepancy between the results of the present study and the results of prior studies may be related to the requirement for perva- siveness of hyperactive symptomatology in the present sample which was not a requirement for inclusion in previous studies. It has been demonstrated that only a 76 small percent of children who are described as hyperac- tive in at least one setting present the same types of behavior difficulties across settings (Schachar, Rutter 8 Smith, 1981). Schachar and his colleagues (1981) found. that these "pervasive" or "cross-situational" hyperactive children differed from other behaviorally disturbed children on behavioral and cognitive mea- sures, while the "situational" hyperactive children did not. The group of non-pervasive hyperactive children appear to be a more heterogeneous group of children with more diverse characteristics. The present study included only subjects who dis- played hyperactive behavior both in the home and at school, and who had a history of early onset and per- sistence of hyperactive symptoms. Furthermore, the behavioral disorder could not be secondary to other gross physical, intellectual or psychological impair- ments. The results indicate that this group of cross- situational hyperactive children does in fact differ significantly from the group of normal children on most behavioral, academic, and historical measures. These findings are consistent with the idea that these chil- dren present a distinct syndrome of behavioral and cog- nitive difficulties and that Attention Deficit Disorder 77 with Hyperactivity is an appropriate diagnostic cate- gory for children who present these symptoms across situations. None of the studies which have reported gender differences in hyperactive children attempted to deter- mine the pervasiveness of the disorder in the subjects (Battle 8 Lacey, 1972; Prinz 8 Loney, 1974: Kashani et al., 1979; deHaas 8 Young, 1984). It may be that the absence of gender differences in this study is due to the requirement for cross-situational hyperactivity which was not a requirement for inclusion in prior studies. However, the other study that did not find gender differences in symptomatology (Befera 8 Barkley, 1985) relied on parent report only. like the present study, Befera and Barkley did require that their sub- jects score at least two standard deviations above the mean on the Conners Parent Questionnaire. It is possi- ble that many children who score this high on the rat- ing scale would exhibit the same problematic behavior at school as they do at home. This is speculative, however, and further comparisons of situational and cross-situatiohal hyperactive children is needed to determine if this is the case. The question of gender differences in this popula- tion has important theoretical implications. It has been suggested that the high referral rate of boys for 78 behavioral problems might be due to a greater tolerance for' those behaviors in girls (Eme, 1979: Battle 8 Lacey, 1972) . If adults had greater tolerance for behavioral disturbances in girls, then girls would have to exhibit more severe disturbance than males in order to be referred to a clinic. One would then expect that in this clinic-referred group of hyperactive children, the girls would exhibit more severe symptoms than the boys. In actuality, the mean hyperactivity scores of the male and female hyperactive subjects were almost identical. These findings support the alternative explanation suggested by Walker, Bettes and Ceci (1984) that the high referral rate for boys with behavior problems is not due to biases against males, but is a result of their exhibiting a higher incidence of behav- iors such as hyperactivity, which adults view as seri- ous problems. It has also been suggested that the higher inci- dence of hyperactivity in males may be related to etio- logical factors. One suggestion is that hyperactivity is the result of neurological damage caused by prenatal or perinatal stress. Since males' central nervous sys- tems are slower to develop than are those of females, males would presumably’ be more vulnerable to such stress. If this were the case, females would have to 79 suffer"more pre-» and. perinatal stress in. order to develop the same symptoms. The results of the present study do not support this hypothesis. While mothers of male and female hyperactives combined reported more stress during preg- nancy and birth than mothers of normal controls, moth- ers of hyperactive females reported similar levels of stress compared to mothers of hyperactive males. How- ever, the questionnaire which was the source of this study's data is retrospective self-report questionnaire filled out by the mother at the time of enrollment in the program. Therefore, the mother has to recall preg- nancy and birth events which happened at least seven years earlier. Such retrospectively attained data has been shown to be somewhat unreliable (Evans 8 Nelson, 1977) . Further investigation of pre- and perinatal stressors using prospective data is needed. Another etiological model that has relevance to gender differences is the polygenetic transmission model (Preis 8 Huessey, 1979: Eme, 1979; Cantwell, 1975; Morrison 8 Stewart, 1973: Nichols 8 Chen, 1981). This model predicts that siblings of hyperactive girls should be at higher risk for having the disorder because girls have a higher "threshold" and would also have to be more "genetically loaded" to produce the symptoms. There is some supportive research for this 80 model (Nichols 8 Chen, 1981: Befera 8 Barkley, 1985), but it remains highly inferential. The present study's findings do not support the polygenetic model. There was no significant difference in the degree of familial psychological disturbance between the male and female hyperactive groups. Nor was there a significant difference in the degree of disturbance between the hyperactive and control groups. Again, the data on family psychological disturbance was taken from a questionnaire filled out by one or both parents (usually the mother) during the intake inter- view. This data is also subject to unreliability of recall. The retrospective manner in which this type of data is usually collected probably contributes to the discrepancy of findings. The data from the present study supports the hypothesis that hyperactivity may result from prenatal or perinatal stress. For some reason, males seem to be more vulnerable to such stress, although the reasons for this vulnerability remain unclear. Investigations into etiological factors such as prenatal stress, birth complications, and genetic influences will probably remain inconclusive and contradictory until they are carried out longitudinally. 81 umma a d t r ’rec ’o s or ese c The results of this study supported the hypothesis that the severity of hyperactivity would be similar in male and female hyperactive subjects. There is some support for the prediction that hyperactive boys have a more impulsive cognitive style than do hyperactive girls. However, they failed to show the expected gen- der differences in behavioral manifestations of primary and secondary symptomatology of hyperactivity. The expected differences in pre- and perinatal stress, and in degree of psychological disturbance in family mem- bers were not found either. The present study looked at a group of clinic- referred children who exhibit the behaviors associated with. Attention Deficit Disorder ‘with Hyperactivity, both in the home and at school. In contrast, prior studies have defined their hyperactive samples in a way which makes it unclear whether the symptoms are of a. pervasive or situational nature. There is evidence that pervasively hyperactive children present symptoms that are distinctly different from children who display the same behavioral symptoms in only one setting. Hence, it is possible that the gender differences which have been previously reported were found using situa- tional hyperactive subjects rather than pervasively hyperactive subjects. Unfortunately, the present study 82 does not address that question. A 2 (male, female) x 3 (pervasive, situational, non-hyperactive) design would give useful information in that regard. It would also allow one to compare the overall hyperactivity scores of the pervasive and situational groups to determine whether children with more severe symptoms are more likely to present the same behavioral disturbances across situations. Similar questions could also be addressed in children with Attention Deficit Disorder without Hyperactivity. In addition, there are a number of ways in which measurement of the dependent variables could be improved. This study used individual items from the Hyperactivity Index of the Conners Parent and Teacher Questionnaires to measure the behavioral manifestations of overactivity, impulsiveness and attention deficits. This measure has only ten items, which greatly restricts the range of scores a subject can receive on any of the three constructs. Use of a more extensive assessment of those behaviors would be useful. For example, the SNAP is an l8-item parent report question- naire that is specifically designed to assess these behaviors (Pelham et al., 1981). The retrospective nature of the developmental and family history data collected in this study makes its reliability suspect. The use of medical records would 83 be a more objective and accurate measure of stress experienced during pregnancy and birth. Questions about etiological variables will best be answered using longitudinal research methods. Barkley (1981b) has suggested following a group of hyperactive subjects into adulthood and investigating their offspring. This type of study would give the most accurate and unbiased information about stress in early development and about familial disturbance. In conclusion, the absence of gender differences in this group of clinic-referred, cross-situational hyperactive children has important implications for the assessment and treatment of these children. Further investigation and replication is needed. The question of etiology remains inconclusive, and will probably be best addressed with data from longitudinal research. Further investigations of differences between pervasive and situational hyperactivity, as well as between ADD and ADD-H are warranted. In order for comparisons to be made between studies, future research should include clearly defined diagnostic criteria, including the use of standardized measures such as the Conners Question- naires to determine the pervasiveness of the disorder. 84 Appendices 85 Appendix A Instruments 86 Conners' Parent Questionnaire _%‘ - ®®®®®®®®®q ' @ooooooooo It” ©0®®®®©®®© “ii?!"“ilemm‘? mm...” W” :2: maria.‘2.:‘:.:‘.92:.§2:§.b:;‘.:::°;::a.2°:.:'r “WWW stir-n“ “3.1”?"5 ma: :3 machines: “5“ ”WWW a:m:*.::";.::":.:;::::.’a:.ra‘ctm'his. .... ”mm“ the examle before beginning. . ®®®®®®®®®© Definition of the Four Scale Points: ©0®®®®©®®® 93:85:? him mwwww §::::i§§l*luc‘lc" mmwmm . @®®®®®®®®® Emle: Doesn’t clean up his/her roan........................ 9099990099 By filling in space 11this person answered that his/her child doesn‘t clean up his/her roan “Just a little.‘ 9099099096) ®®®®®®®®©® 1. Disturbs other children. .................................. @QQQQQQOQG 2. Restless or overactive................... ........ . ..... ... ®®®®®®©O®® 3. m.mr outbursts. explosive and unpredictable ......... @o@®®©©®®® 4. lnattentive. easily distracted.............. ...... . ....... @QQQQQQGQQ 5. Constantly fidgeting; restless in the 'squimy' sense..... @QQQQQQQQQ 6. Excitable. iwulsive... ..... .............................. @®@®®®®®®© 7. Demands mist be met imediately: easily frustrated ...... .. @o®®®®®®®® 3. cm: often and easily.................. ........ @ooooooooo 9. gillsttgnfiggh things he/she starts: short............... ®O®®®®®G®® 10. Hood changes quickly and drastically.............. ...... .. ©®®®®©®O®® ®®®®®®®®®® ®Q©O®®®O®® @OQQGGOOQG OOGOGGGOGO OOGOGQOOGO noonomoo.- 87 Conners' Teacher Questionnaire Using the scale defined below. please darken in the numbered circle 0000000000 on the right that best describes this child in terns of the problems listed below. PLEASE USE THE ENCLOSED PENCIL ONLY. OOOOOOOOOQ 0 - HOT AT ALL 1 I- JUST A LITTLE 2 - PRETTY "JG! 3 - VERY illCli 0000000000 1. Restless in the 'squirny' sense......................:.......... 0000000000 2. flakes inappropriate noises Man he shouldn't... ........ . ........ 0000000000 3. Depends mist be met innediately.............. ...... . ...... ..... 0000000000 4. Acts 'saart' (imudent or sassy)............... ............ 0000000000 5. Temper outbursts and unpredictable behavior............ ....... .. 0000000000 6. Overly sensitive to criticism........ ..... .. 0000000000 7. Distractibility or attention span a problem... ...... ..... 0000000000 8. Disturbs other children............ ..... ... 0000000000 9. Daydreams... ...... ......... ..... ................................ 0000000000 10. Pout: and sulks... ...... . ..... ........................' ..... ..... 0000000000 11.. liood changes quickly and drastically............................ 0000000000 12. Quarrelsome ...... _....................... ......... . ....... . ...... 0000000000 13. Submissive attitude toward authority .................... ........ 0000000000 14. Restless. always 'up and on the go.“..... ........ . ....... ...... 0000000000 15. Excitable. impulsive ..... . ..... 0000000000 16. Excessive demands for teacher's attention... ....... ..... .. 0000000000 17. Appears to be unaccepted by group................. ........... 0000000000 18. Appears to be easily led by other children.......... ........... . 0000000000 19. .‘to sense of fair play......... ..... .......... ..... ..... 0000000000 20. Appears to lack leadership.............................. ....... . 0000000000 21. Fails to finish things that he starts........... ...... . ..... 0000000000 2.2. Childish and imture........................................... 0000000000 23. Denies mistakes or blames others ..... ..... ......... . ........... . 0000000000 ‘24. Does not get along well with other children..... ................ 0000000000 25. Uncooperative with classmates....................... ............ 0000000000 26. Easily frustrated in efforts.................. .......... . ..... .. 0000000000 27. Uncooperative with teacher.... ....... ..... . ............. . 0000000000 28. Diff‘cu‘ty in 1..ming....... ..... ......O.‘ OOOOOOOOOOOOOOOOOOOOO homeommn o 88 Peabody Picture Vocabulary Test—Revised INDMDUAL TEST RECORD ' by LLOYD M. DUNN l- LEOTA M. DUNN NAME .-_-_-__ _._-_ .-.- ..-.-- - . SEX: M F M Mi ne‘er-eel ml HOME . HOME ADDRESS -. ---_._- __ - ._ _. -. PHONE GRADE SCHOOL... - -... .-- PLACEMENT .-.. nee-wen . creole-In TEACHER-.. ._ --. _ - _. EXAMINER _ town LANGUAGE OF THE HOME: E] Standard English; D Other - cmwmuwdivs-MWI Date 3. Age Data ... ..., Notice to Users Date oi The PPVT-R is not mended ior ieehng ........ uee in snuebons when twin-un- o“. oi lasting legislation smalesihei birth mes oi iesi nems and correct """"" me be «memo io sub- Chronoiogioei ' .perents.onhegenecaipub-. age .......... he Such aecioeurewy 'meke m m n 'IiihenumbetdoeyseeoeecsiSJwemm m, uiure tome loo (eeePen I oithe Manual) Reason '0' Testing (may include reienal soutce and person Iuihpnzv'ig test”; Minimum“; Mutual Dunn IeWNWMDWem-sm Milieu-overly meens moummm ' WW. 0"!er WWI 89 o I ...:z......xa.m a I .Nv ........ 3.605 D I A“. ........ gun a I a. ......... 9...... Q I 8. ......... 39.. D I ... ....... 322. O I AN. ..... 0.9323 0 I S ..... 528 a I i .......... a...» D I a. ..... 2.32.6 c I 51.55.68... G I ... ........ .38.. D I a. ........ 5.5.. O I a. ......... ..:.... o I fluv ........ EEG .v I ... .......... .8. D I a. ........ 85.... c I an. ...... 93a: 4 I .... 3.28885 D II .......!..5oa=..2 O I a. ..... 2.389.. 0 I a. .......... ..:... c I .v. ...... 93.5.3 D I a. ....... 8.33 c I ... ......... .32. d I a. ......... 89. U I :... ......... E...» O I Anv ........ :55 o I AN- ........ ‘8“— a II any ......... .uoa. D in ... : 2...... C ...II 8. ..... 3.288 0 I ... ......... 3...... D I a. ....... uses... 2 on an on nu as .5 On. 00 so no. no 3 an an mm mm. an 3 5' av NV 0' mv vv 1 O I a. ...... .839.» n. o I ... ..... .3282 we a. -I ... ......... :5. .v D II 8. ..... 228.3 9 . c I a. ........ as)... on 4 I ... ..... 9.33.8 8 D I a. ....... 9.33 S O I A—' ....... .3953 8 o I ... ........ 3...... an a a I .v. ....... 05.3.. 3 D I a. ......... ..8: 8 c I a. ...... 822.... «a d I ... .......... .8: .n D I ANV ......... E- on I O I ANv ......... g:- Q“ o I ... ..... 9.20.9.» on alizzzzoaan a D I ... .......... .8. on c I ... ......... 2.8 ...... 4 I .n. ....... 9.38.. cm D I 3.22.3582: 8 O I ... .......... ..8 w... o I 3 ........ 9:8. .w c I a. ........... .2 on e D I a. ...... 28.8.. m. c I ... ......... 8:... ... q I A”. ........ >20 NF B I ... ....... 552.. ... O I ... ...... 83...... n. . o I ... ........ :33 I a I a. ..... 3.82.9. a. 9 I ... ......... 85. u. c I .n. ......... :5... .. q I A'v ......... “E”— OF t I.- llele '- tel II...“ D I A. v .......... 80 O I An' ........... .3- o I an .......... ..B a I A'v ........ 01‘s 9 I .n v ........ -§ c I AN. ........ 538.— q I “av .......... E D I Ah. ......... 22 O I A'v .......... 03 veal. 2.92.8250: ..5' 5 3: .I j .ufl.~..z.. .82an an a c418... .awrrcowm .SQeaueizezil ne :..“... :41 ...-93:31.5 .053. no. .5132 0‘ .0 . :33 A .1. . up \- mam: emu» 2.. acts-.55.... :..-8. :73... 8.8.... ..:..-e .22.: 5.8. ..:.-...... its... 593...... ...?e-: 395.3... 8.93.}. ... 53... E to. 5.1.8 .u. i... 8.3 5.3-. .....b. ...-8 no: beet.- <00 On: .0... Dbl-Cg 0! clue I... I: :sazi-g 1i §3§.o§.awzmm< 02¢ mim: hawk T 2...... Obtained Test Scores mom “my... . - 5:: ma Rawecore ........ Q auwwmm strum " 3:; (item page 6) . .__‘ i Standard score ‘7‘" [ .qgfiv ........ WWW-PH '(MTgt‘Append’xA) ,_ 0 as an as an a to 75 an : Percentleranlt.... , - H;.,,_;,; (”affable 3. W! A) , 5 10 Shrine .......... g. ; , (MINING am: A) - - l 2 . EXTREMELY MODERATELv Ageequivaient..- Lowsoone Lowsoone- (iromTable «was A) Data from Other Tests Test Date PPVT-R FORM M Observations Bnetty describe the subject's test behewor. such as interest in task. quickness oi response. signs oi perseveratton. wont habits. etc: 91 E SCORE CONFIDENCE BAND ”a “a . Themededanaprovidesaoonhdenoebvidnerengeoiaooresmehch “"0 m ”a...” tilesibiectstruesoorescanbeexpectedtoialeatimesntoo (Thesebend an. .7: man values arebasedonamedian standarderroioimeasurmntlSEMwi :7enihthebandieidthsmaoeincieasi lyasymnieiricaltoeerdtheeiitiemes all}: Save ‘6 g i: :33: z : Dilation?" nubmothemeeMSee anloitheMenualandtheTechnical a .0 "9‘2. ,0 . or more precise veiues and a newssionoi oiSEM continence g . ‘25,,“ ,2 2 bands AtaoaeetheManualiondiscussionoihovitocalouiatethetruesooie 7 7 ”5‘” u o oonhdenoebendioiiheegemvelent 1 1 _l l l 'YY'jij'V"Y‘VVYT'YYYVIYIY'IYVIVI' l i 155 m us no us 150 is tau 1 l J l L rrjvvfiV'TY—TT"YT—VTfifi—ijYWrTY'YV‘VV‘VVIYVV 85 so 95 1m 1% 110 ii WM ' : : '.....: .‘c “' :: :{crrr§ 4. : ‘ : is zozsmaioiisiossaoa'siofsaoas so is as 1‘ J J J l l 1 I I fl . I I a 4 s s 1 a a 5 LOW I HIGH MOOERATELY EXTREMELY - AVERAGE SCORE HIGH SCORE | HIGH SCORE Periormanoe Evaluation This standardized test provides an estimate only oi this lflleldUa' s hearing vocabulary in Standard English as compared with a cross- -section oi U S A. persons oi the same age Do you believe the periormance oi this subiect represents iairty herorhis true ability in this area? -. Yes No it not. cite reasons such as rapport problems poortesting situation. hearing or vision loss. visual- peroeptual disorder. test too easy ortoo hard (automatic basal or ceiling used). etc Recommendations -._ .—- —_.o -—- g. - - -- _—.—-..-...-— ——-— ---- - .-. - ..- --- ——. -—— .-i.__; - ...... 92 II PERSONALITY INVENTORY FOR CHILDREN ADMINISTRATION BOOKLET by ROBERT D. WIRT, PhD. PHILIP D. SEAT. PhD. WILLIAM E. BROEN. Jr.. PhD. Published by WBTERN PSYCHOLOGICAL SERVICES ‘1 rususi-ius mo bisnieuton : 12031 WILSHIIE IOULEVAID L05 ANGLES. CALIFOINIA suns A DIVISION OF MANSON WESTERN CORPORATION 0:7' This inventory consists oi statements about children and family re- lationships. DIRECTIONS: First fill in the iniormation requested on the answer sheet: then read each of the statements in this booklet and decide whether his true or talse as applied to your child. Sam 0, mm L00k at the example oi the answer sheet shown at the right. In the example the mother decided T F that statement 25 was true as applied to her child 25. I : : and statement 26 was false as applied to her child. 25 i I I l It a statement is TRUE or MOSTLY TRUE. as applied to your child. use a pencil to blacken between the lines at the column headed YT (Yes or True column. See 25 in the example). It a statement is FALSE or NOT USUALLY TRUE. as applied to your child. blacken between the lines at the column headed NF (No or False column. See 26 in the example). In marking your answers on the answer sheet. be sure that the number or the statement agrees with the number on the answer sheet. Make your marks heavy and black. Erase completely any answer you wish to Change. Do not make any marks on this booklet. W-iSZA W! isnothSTEi-IN PSYCHOLOGICAL SERVICES ”bummunmanmmmmamWJm Asmara“ izoisetae WnUSA 93 DO NOT MAKE ANY MARKS ON THIS BOOKLET 2. Mychildlearnedtowalkbeforcbe(she)wassia yearsold. My child seems average or above average in intel- lipncc. . Mychildissmallforhisagc. . Sometimeslthink l'm tooeasywith'thc child. My child never talks to strangers. . Mychildtendstopityhimflnr) self. . My child often plays with a group of children. . Mychildusuallykissesmebeforegoingtoschool or to play. . Mychildhardlyeversmiles. . Othersalways listen when mychildspeaks. . Mychildlnshitaschoolofficialueacheretco. Several times my child had complaints. but the doctor could find nothing wrong. . Otherchildrcnoftengetmadatmychild. . Usually my child kisses his (her) parents before going tobed. . Mychildhardlyeverneedspunishment. My child thinks others are against him or her for racial or religious reasons. . My child worries about things that usually only adults worry about . Mychildwasablue baby. .loftenwondcrifmychildisloncly. .Usuallymychildtakesthingsinstride. . Mychildhasmanyfriends. My child is troubled by constant coughing. . Mychildislikelytotaksremarksthewrongway. . Little thing upset my child. 3l. 32. 33. 35. 38. 39. 4|. 42. 43. 45. 47. . My child keeps thoughts to him (her) self. . Mychild sometimes thinksbeorsheissorneone else. . Oftenmychildhastogotobedwithacold. . As a younger child. it was impossible to get my childtotakcanap. . lthasbecnalongtimcsinccourfamilyhasgone out together. . At one time my child was unconscious with an injury to his (her) head. My child‘s manners sometimes embarrass me. My child has never mentioned his (her) heart racing or pounding. My child seldom gets a restful sleep. . My child often tries to show off. My child is always humming to him (her) self. . Mychildhashadtohavedrugstorelax. . Mychildhasusuallybecnaquietchild. At times my child has seriofil'y' hurt others. Mychildhasncvcrhadcrampsinthelegs. --—- . Mychildhashadaseverecascofoneormoreof the following measles. mumps. encephalitis (sleep-‘ ing sickness). chicken pox. scarlet fever. whooping cough. meningitis. Mychild hasagoodsenseofhurnor. At times my child yells out for no reason. Mychildsometimessessthingsthataren’tthere. .Asachild.mychildhitotherchildrsnonthehead with sharp toys. My child often complains of being hungry. My child is worried about sin. Stuttering has been a problem for my child. GO ON TO THE NEXT PAGE 49. SI. 52. 53. 55. 57. $8. 59. 61. 62. 63. . My child will beg until I give in. The child's father has been fired from his job several times. . Other children don't seem to listen to or notice my child much. My child is fairly helpful in doing chores around the house. My child is rather unattractive. My child is liable to scream if disturbed. . My child sometimes undresses outside. My child hardly ever kisses me. . My child has little self-confidence. Certain foods make my child ill. My child has no special talents. Our family seems to enjoy each Other more than most families. . My child usually undresses him (her) self for bed. l often wish my child would be more friendly. My child broods some. My child could do better in school if he (she) tried. . My child can comb his (her) own hair. . My child never mam» cuddled. . At times my child gets so excited you can‘t under- stand his (or her) talk. . Often my child destroys other children‘s toys. . The child's father seems jealous of the child. . My child is usually rejected by other children. . My child seems to enjoy destroying thing. . Attimesmychildpullsouthis(her)hair. My child usually comes when called. . Now and then my child writes letters to friends. . lam afraid’my child might be going insane. 94 75. 76. 77. 78. 87. 88. My child sweats very little. My child seems to delight in smashing thing. My child is over-confident in most thing. My child has trouble making decisions. . My child has had convulsions. . Thunder and lightning bother my child. . The school says my child needs help in getting along with other children. Lately my child has shown interest in religion. . My child loves to hug and kiss. . My child often gets up at night. . Most of my child's friends are younger than he (she) is. . Eating is no problem for my child. Others think my child is “easygoing“. Sometimes i think my child's memory has been lost. . There is a lot of swearing at our house. . l have found out my child has had sex play with the opposite sex. . Mychildnevertakestheleadinthings. My child often asks if 1 love him (her). . Myehildlirstsatupbeforehe(she)wasoneyearold. . My-child would probably take blame rather than lie. . My child changes moods quickly. . Other children look up to my child as a leader. . My child could ride a tricycle by age five years. . My child takes criticism easily. . My child sometimes gets angry. . My child often jumps into thing without thinking. . My child sometimes hears thing others don‘t hear. My child sometimes swears at me. GO ON TO THE NEXT PAGE 0“ IOJ. . My child frequently complains of being hot even ")5. 112. H3. H4. ”5. H6. H7. H8. “9. l 24. 125. [26. 127. My child is not worried about disease. on cold days. My child's behavior often makes others angry. . My child seems bored with school. . The child‘s parents are now separated or divorced. . Mychildgetsexhaustcdsoeasily. . My child belong to a gang. . Mychildplaysamusicalinstrument. . My child often expresses dislike for teachers. My child tends to talk faster than he (she) can think. I can't get my child to do his (her) school lessons. My child stays close to me when we go out. Often my child goes about wringing his(her) hands. My child is sometimes cruel to animals. Recently my child has complained of eye trouble. My child likes to build thing from clay or sand. The child's parents have broken up thdr marriage several times. . Sometimesmy child runserrands for me. . Othersthinkmychildistalented. Mychildisafraidofanimals. . My child frequently has gas on the stomach (sour stomach). My child is good at lying his (her) way out of trouble. My child often carries a cloth or doll for comfort. The child's parents sometimes forbid the child to play with certain other children. Sometimes my child gets so excited he (she) can't sleepatnight. . It is not too unlikely that my child will stay in the house for days at a time. 95 130. l3l. l32. l33. ”2. M3. M4. 145. I46. I47. I48. I49. l5l. l52. [53. 155. . My child shows a lot of affection for a pet. My child usually gets up without being called. My child has had brief periods of time when he(she) seems unaware of everything that is going on. My child often cheats other children in deals. The child's parents have to keep after him (her) to do his (her) chores. . My child is good at leading games and thing. . My child is more nervous than most children. . My child's feeling are hurt easily. . My child usually runs rather than walks. My child sometimes irritates others with practical jokes. . My child never played peek-a-boo. . My child never wonies about what others think. . Sometimes my child earns extra money by doing small jobs around the neighborhood. The child's parents try to be as permissive as pos- sible. My child likes to dress like older children. Usually my child eats all the food on his (her) plate. My child is different than most children. Achild hasa right todisagree withhis(her) parents. Others have remarked how polite my child is. My child has original ideas. At one time my child had speech difficulties. . My child usually completes something once it is started. My child is afraid of dying. My child carries a weapon (knife. club. etc.). Pestering others is a problem with my child. . MychildbelievesinGod. Mychildcancutthing withscissorsaswellascan others ofhis(her)age. GO ON TO THE NEXT PAGE 156. l58. I39. I60. I6I. I62. l feel I am very close to my child. . Mychildhasneverbeenelectedtoanofficeina club or school. My child doesn't seem to care for fun. My clu'ld often talks about how strong he (or she) is. At times my child has hit and kicked me. My child sometimm feeh thing that aren‘t there. Mistakes are often made by my child just because of hurrying. . My child worries about hurting others. . My child doesn‘t seem to care to be with others. . My child cents to enjoy talking about nightmares. . Others have told me I baby my child. . My child has difficulty doing thing with his (her) hands. . . Several times my child has performed in front of a group. . Several times my child has asked if he (she) were adopted. .Oftenmychildwillsleepmostofthedayona holiday. . Othersthinkmychildismean. My child often stays in his (her) room for hours. . My child seems to know everyone in the neigh- borhood. . My child can cry one minute and laugh the next. . At times my child scratches his (her) face until it bleeds. . Voices sometimes tell my child to do thing. . Often my child talks back to me. . My child has never had any paralysis. . My child would never take advantage of others. . My child will take the blame for others. 96 I81. I82. I83. I84. I85. I86. I87. I88. I89. I”. I9I. I92. I93. I94. I95. é §§§§§ My child has to be coaxed or threatened before he (she) will eat. My child has had an operation on M's (her) head. My child's allowance is his (her) own to spend. My child usually blames others for any trouble. Mychildhasmorethanthreebowelmovements aday. My child can be left home alone without danger. Starting school was very difficult for my child. My child jumps from one thing to another. My child is always talking about the future. My child has been in trouble for attacking others. My child seldom breaks rules. How toraisethe childhasneverbeenaproblem atourhouse. My child belong to a club. Severaltimesmychildhasthreatenedtokillhim (her) self. My child usually doesn‘t trust others. Mychildseemstooseriousminded. . Mychildhasmorefriendsthanmostchildren. . My child cries if left home alone. . Often my child goes to the toilet outside the house. . Strength impresses my child. . My child often hits younger children. My child has many friends of the opposite sex. . Often my child does thing before thinking. My child seems unhappy about our home life. . When my child gets mad. watch out. My child seems shy with the opposite sex. My CW never really forgives anyone. . My child really has no real friend. GO ON TO THE NEXT PAGE 209. 210. 21 I. 212. 213. 214. 215. 2I6. 217. 218. 219. 539$ 59.9 9559\5 E 232. My child often tells jokes. My child often tattles (tells) on others. My child has never been away from home at night. Mychild isashappyasever. Others often remark how moody my child is. We often argue about who is the boss at our house. My child could walk downstairs alone by age five years. Sometimes mychild willgo intoarage. My child often complains that others don't under- stand him (her). My child has to be prevented from eating and drink- ing too much. The trouble with my child is a ‘chip on the shoul- der.‘ . Mychildhasveryfewfriends. . Mychildlovestomakefunofothers. My child likes to play active games and sports. . Others often remark how relaxed my child is. Sometimes I worry about my child's lack of concern for other's feeling. Blushing is a problem for my child. . Nothing seems to scare my child. My child can wash him (her) self as well as other children his (her) age. . Often my child is afraid of little thing. Often my child smashes thing when angry. My child doesn't seem to be interested in practical thing. . Ihaveoftenbeenembarrassedbymychild‘ssassi- My child tends to see how much he (she) can get away with. . Others think my child is a ‘cry baby”. 97 235. 236. 237. 238. 239. 240. 241 . 242. 243. 244. 245. 246. 247. 248. 249. 25 I. 252. 253. fifiE‘E 259. . My child can't seem to keep attention on anything. My child has never been in trouble because of sex behavior. ' My child almost never argues. My child gives in too easily. Playing with match: is a problem with my child. My child often disobeys me. The child's mother frequently has crying spells. My chifl cries when scolded. My child is better than average at sports. Falling down is a problem for my child. The child's parents are not active in community affairs. My child likes to show off. My child sometimeschews on his(her) lips until thsyaresore. My child has never been spanked. My child loves to rock back and forth when sitting down. Mychildisagoodloser. . My child loves to stay over night ata friend's house My child usually plays with older children. The child‘s father changes jobs frequently. My child has a weight problem. . School has been easy for my child. . Others have said my child has a lot of “personality“. . Sometimes mychildwetsthebed. . My child goes to bed on time without complaining. . My child belong to Boy Scouts. Girl Scouts or some younger branch of these organizations. ‘Sparetherod.s_poilthechild"isatruesaying. . My child can‘t sit still in school because of ner- vousness. GO ON TO THE NEXT PAGE 261 . 262. 263. 264. 265. 266. . 267. 268. 269. 270. 27 I . 272. 274. 275. 276. 278. 28 I. 282. 283. 285. 286. My child has older brothers or sisters. I do not approve of most of my child's friends. My child vomits frequently after meals. Constipation has never been a problem for my child. My child tells of having the same dream over and over. . My child likes to “boss“ others around. Reading has been a problem for my child. I sometimes ‘blow up“ at the child. My child doesn't seem to have any fear. Parents should be strict with their children. My child is very jealous of others. Five minutes or less is about all my child will ever sit at one time. . Mychildisoftenrestless. We seldom argue about religion at our house. A scolding is enough to make my child behave. My child seldom misses school because of illness. . Frequently my child looks under the bed before going to bed. We frequently argue about money matters at our house. . My child often talks about the DeviL . Often my child sing around the house. My child sometimes disobeys his (her) parents. My child tends to doubt everything others say. Usually my childs leg or arms are swinging. . Several times my child has been in trouble for stealing. My child seldom complains of stomach aches. Neither parent has ever been mentally ill. . My child takes sleeping pills to get to sleep. 98 288. 289. 291. 292. 293. 295. 296. 297. 298. 300. 30 I. 302. 303. 305. 306. 307. 310. 31!. 3I2. 313. My child has never failed a grade in school. If my child can't run thing. he (she) won't play. . The child‘s parents can't seem to live within their Others have remarked about my child's unusual imagination. I have heard my child swear at others. The child's parents are often out socially. . My child is in a special class in school (for slow learners). At times my child has to be held down because of excitement. Others think my child has a ‘know it all“ attitude. My child usually plays alone. My child won't go into the bedroom without some- one else there. . Several times my child took money from home without permission. Our family attends Church together. My child often talks to him (her) self. Affection is frequently shown in our home. My child loves to work with numbers. . Usually my child sees good in everybody. My child often talks about religion. My child sometimes mts too many sweets. My child has never been in trouble with the police. . My child often bring friends home. . My child could feed him (her) self fairly well by age five years. My child seldom visits a doctor. My child‘s favorite stories are fairy tales or nursery rhymes. The child‘s father doesn‘t understand the child. Nakedness embarrasses my child. GO ON TO THE NEXT PAGE 314. 315. 3I6. 317. 318. 319. 320. 32I. 322. 323. 324. 325. 326. 327. 328. 329. 330. 331. 332. 333. 334. 335. 336. 337. 338. 339. Dizzy spells are no problem with my child. My child usually falls right to sleep once in bed. My child learned to count thing by age six years. The child‘s father drinks too much. I have several times found my child nnsturbating (playing with self sexually.). My child could print his (her) first name by age six years. My child tends to brag My child doesn‘t seem to learn from mistakes. My child would rather be with adults than with children his (her) own age. My child can‘t seem to wait for things like other children do. My child tends to be pretty stubborn. My child rarely gets excited. My child often asks questions about sex. My child gets spanked abdut once a day. My child seldom talks. My child is constantly moving about. My child is very critical of others. My child seldom gets into mischief. My child always does his (her) homework on time. Sometimes during the night my child will crawl in bed with me. My child often vomits when getting a headache. My child is usually a leader in groups. Sometimes my child lies to avoid embarrassment or punishment. l have a terrible time getting my child to take a bath. Car sickness is a problem with my child. I always worry about my child having an accident when he (she) is out. 99 340. 34I. 342. 343. 345. 347. 349. 350. 351. 352. 353. 354. 355. 356. 357. 358. 359. 360. 361. 362. 363. 365. Other children makc fun of my child's different ideas. Our whole family seldom gets to eat together. My child usually stays neat and clean. Reading is my child‘s favorite pasttime. . My child loves excitement. My child is often ashamed of the family. . Often my child plays to hard. The child‘s father usually makes the important decisions at our house. . ‘Bad days“ are frequent with my child. My child often visits art museums or attends con- certs. My child insists on keeping the light on while sleeping. My child could be trusted to walk upstairs alone before he (she) was four years old. My child seems to prefer adults to children. Sometimes my child‘s muscles twitch. Much of my child‘s time is taken up with art or music. My child sometimes smears self and walls after going to the toilet. Punishment is usually given by the child's father. My child never stays out too late at night. My child seldom if ever has dizzy spells. Chewing fingernails is a problem for my child. My child is dependent on others. An interruption is likely to get my child angry. A lot of my child‘s suggestions as well as actions are very impractical. During the past few years we have moved often. . My child worries about talking to others. My child never sleep walks. co ON TO THE mime 366. ' 367. 368. 369. 370. 371. 372. 373. 374. 375. 376. 377. 378. 379. 380. 38 I . 382. 383. 384. 385. 386. 387. 388. e 100 My child first talked before he (she) was two years old. My child gets common colds more often than most children. My child will usually admit being wrong. The child‘s parents disagree a lot about rearing the child. School teachers complain that my child can‘t sit still. Oftenmychildlockshimself(herself)inthebed- room. My child has some bad habits. Several times my child has spoken ofa lump in his (her) throat. ‘Head in the clouds" describes my child. We often have friends in for a social evening. My child often wakes up screaming. My child drools when eating. My child has been with me since he(she) was born. Often my child will laugh for no apparent reason. My child frequently has nightmares. My child is often the center of attention. My child almost never acts selfishly. My child sometimes skips school. My child is usually in good spirits. The child's parents are active in church. My child seems fearful of blood. My child is not as strong as most children. My child seems more clumsy than other children his (her) an. Others have remarked how self confident my child is in a group. . Others often remark how sensible my child is. . The child‘s father seldom helps around the house. 392. 393. 394. 395. 396. 397. 398. 399. 401. 402. 403. 405. §§ §§ 410. 4”. 412. 413. 414. 415. 4I6. 4I7. My child loves to play in water. Arguing is my childs biggest downfall. My child seems to understand everyth'ng that is said. My child will do anything on a dare. Mychildalwaysseemsto haveacold. At times my child just keeps on spinning around. Sometimes the child‘s father will go away for days after an argument. Sometimes my child gets so nervous his (her) hands shake. . Skin rash has been a problem with my child. I have often found my child playing in the toilet. The child‘s father sometimes gets drunk and mean. My child often plays sports. . My child sometimes becomes envious of the poses. sions or good fortune of others. Shyness is my child‘s biggest trouble. . My child often talks in rhymes. . The child‘s mother makes most of the important decisions in the home. . My child will do anything for a laugh. . My child is a healthy child. My child thinks others are ploting against him (or her.) My child has difficulty holding his (her) head up. Usually my child gets along well with others. The child‘s parents do not get along with the neighbors. My child seems eager to please others. My child seems to have no shame. Usually my child plays inside. The child‘s father seldom misses work. GO ON TO THE NEXT PAGE 418. 419. 420. 42 I . 422. 423. 424. 425. 426. 427. 428. 429. 430. 43 l . 432. 433. 434. 435. 436. 437. 438. 439. 441. 442. 443. 101 My child gets lost easily. My child has the habit of pickinghis (her) nose until it bleeds. My child has had asthma attacks. My child is put to bed early if he (she) disturbs the rest of the family. Often my child takes walks alone. My child often has headaches. ' Thechild‘s parents haveset firm rulesthatmustbe obeyed. Often my child will wander about aimlessly. My child seems to get along with everyone. My child is easily embarrassed. My child is very popular with other children. My child gets confused easily. The child‘s father dislikes his present job. My child is almost always smiling. My child has more accidents resulting in cuts. bruises. and broken bones than other children. Several time my child has threatened to run away. At times my child has difficulty breathing. There is always a lot of argument at our dinner table. Others don‘t understand my child. My child plays with friends who are often in trouble. My child seldom has nose bleeds. My child often talks of loving someone much older. . Parents should teach their children who is boss. My child has never been expelled from school. Sometimes my child acts like a clown. My child loses most friends because of his (or her) temper. . Ourhouseisalwaysinamess. 445. 446 447 448. 449 450. 451. 452. 453. 454. 455. 457. 458. 459. 461. 462. 463. 465. 461. ii 470. 47 I . My child whines a lot. . My child is thy with children his (her) own age. . My child doesn‘t seem to feel pain like others. My child was difficult to toilet train. . My child wants a lot of attention when sick. My child saves most of his (her) spending money. The child‘s mother or father have never been di- vorced. My child can count change when buying something. Winning a game seems more important than the fun of playing to my child. , The child's mother strongly dislikes housework. My child has never run away from home. My child needs laxitives. My child shows unusual talent. A mother‘s place is in the home. Speaking up is no problem for my child. . I had an espem’ally difficult time with temper tan- trums in my child at an early age. My child worries a lot about physical health. My child can tell the time fairly well. Sometimes my child comes home with torn clothes. . Sharing thing has been no problem for my child. Many times my child has become violent. . The child‘s parents always discuss important mat- ters before making a decision. I have a problem stopping my child from eating everything. . The child‘s mother can‘t stand to stay home all day. . Murder and crime stories seem to be my child‘s favorites. My child'insists on polished shoes. Mychildcantakeabathby him(her)self. GO ON TO THE NEXT PAGE 472. 473. 474. 475. 476. 477. 478. 479. 481. 482. 483. 485. 487. 490. 49 I . 492. 493. 494. 495. 496. 497. My child smokes at home. Recently my child has complained of chest pains. Tb child‘s father frequently ‘blows up“ at the child. My child see strange thing. My child is shy with adults. Before going to sleep my child needs a teddy bear or doll in bed. Frequently my child argue with others. I have heard that my child drinks alcohoL .Thereisseldomaneedtocorrectorcriticizemy child. My child is rather absent-minded. Others have remarked how pale my child looks. My child bite his (her) fingernails or toenails. . The child‘s father is home almost every evening. My child repeats numbers and letters over and over. . My child is always telling lies. Recently the child‘s parents have argued with the school officials. . When talking my child often jumps from one topic to another. . By the age of five years. my child could dress him (her) self except for tying thing. My child most always tells me where he (she) is going to play. The child's parents seldom visit the school. My child boasts about being sent to the principal in school. My child never has fainting spells. My child is crabby most of the time. My child spends over fifteen minutes at a time combing his (her) hair. Music Iesons have to be forced on my child. The child‘s father is too strict with the child. 102 498. 499. 501. 502. 503. 505. 507. 510. 51 I. 5l2. 513. 514. 5l5. 5l6. 517. 518. 519. 520. 521 . 522. 523. 524. My child has as much pep and energy as most children. Recently the school has sent home notes about my child‘s bad behavior. . A parent should try to treat a child as an equal. My child often has unusual ideas. My child will never clean his (or her) room. Sometimes my child will put off doing a chore. . My child is able to keep out of everyday dangers. My child often talks about death. . My child usually does just what you tell him (her) notto do. My child has frequently been hospitalized. . My child likes parties. . My child always shows affection to me. The child‘s father gets along fine with the child. Sex seems to concern my child more than Others. My child is usually rested after a good sleep. My child Ins been difficult to manage. Children should be seen and not heard. Hardly a day goes by when my child doesn‘t get into a fight. My child often sits and reads the dictionary. Others say our family is close. Working puale is one of my child‘s favorite hobbies. Most of my child‘s time is taken up watching tele- vision. Frequently my child has a high fever. Sometime my child‘s room is mesy. I have seen my child laugh when others get hurt. My child often talks of flying off into space. Sometime my child irritate me. GO ON TO THE NEXT PAGE 525. 526. 527. 528. 529. 530. 531. 532. 533. 534. 535. 536. 537. 538. 539. 541. 542. 543. 545. 547. 549. 550. 551. Often my child tells fantastic stories. The child‘s father is hardly ever home. My child is seldom short of breath. Sometimes I don‘t understand what my child means. My child usually feels sorry when he (or she) has hurt others. My child is usually afraid to meet new people. My child almom never needs punishing or scolding. My child speaks of him (her) self as stupid or dumb. My child could eat with a fork before age four years. Often my child complains of blurring (blurred vision). There is a lot of tension in our home. My child needs protection from every day dangers. My child has a terrible temper. My child daydreams quite a bit. It is necessary for the child‘s mother to work outside the home. . Several times my child has threatened to kill others. The child‘s father spends very little time with the child. My child refuse to do anything around the house. My child usually stays mad a long time. . My child needs help when going to the toilet. My child is adopted. . My child runs around the house naked. My child always insists on wearing clean clothes. . My child respects the property of others. My child seldom has back pains. Frequently my child will put his (her) hands over his (her) ears. The child‘s father has very little patience with the child. 103 552. 553. 554. 555. 556. 557. 558. 559. 561. 562. 564. 565. 567. 568. 569. 570. 57 I . .33 575. 576. 577. My child wants to sit in the bath tub for hours. The child‘s father has held the same job for the last five years (or since marriage). I have no trouble getting my child to bed at night. My child often speaks of being smarter titan others. My child love to read about murder and other crime. My child didn‘t have colic as an infant. My child learned to drink from a cup by age three years. The child‘s parents frequently quarrel. . Often my child sets goals that are too high. My child‘s headache usually start with a pain in the back of the neck. Everything has to be perfect or my child isn‘t sat- . The child‘s parents belong to several clubs or com- munity groups. My child gets pneumonia almost every year. Spanking doesn‘t seem to affect my child. . Lately my child has had diarrhea a lot. My child was a "planned" child. My child tallts a lot about his (her) size or weight. My child tends to repeat everything (parroting). My child has never had face twitching. My child was completely toilet trained by three years of age. My child often will cry for no apparent reason. Both parents enjoy children. . My child seldom talks about sickness. My child tends to swallow food without chewing it. Mychildwillworryalotbeforestartingsome- thingnew. My child is afraid of strangers. GO ON TO THE NEXT PAGE 578. 579. 580. 581. §§§§§§§ ii 104 Mychildhastroubleswallowing. Mychildhaddificultybreathingatbirth. Mychildshowsalot of interest-in fire. Mychildusuallylooksatthebrightsideofthing. Mychildisafraidofthedark. Ourmarriagehasbeenveryunstable(shaky). Mymmflywn(h¢)mouthopen. Mychildof’tenhascryingspells. Mychildohentalksaboutthefuture. Mychildneverseemstohaveagoal. Sometimes my child gets hot all over without reason. . Nothingseemstogetmychildupset. I2 . Delivery ofmychild waswithinstrumenu . Often my child will lick his(her)fip._,..- Mychildseemstiredmostofthethn.‘ . Mychildrefusedorcouldn‘tsuckasaam I. ,. Mychildisexcaptionallyneatandcleaa.~ Othershaveremarkedhowsmartmychild-is. Mychildtakesillnseharderthanmostchildren. Mychildwasaprematureorover-duebaby. Moneyseemstobemychild'sblggestinter-et'. Mychildgohsondatewiththeoppositesex. Usually my child will sleep all night without awakening. 105 Continuous Performance Tesr (CPT) Name of. Child Nettle of Tester Date of Testing RESULTS: (a) ”X” Trials: Total Correct Responses : thruster of Errors of Comnission: thsrber of Errors of Omnission : Total Ntsrber of Errors : (b) "BX" Trials: Total Correct Responses : lumber of Errors of Corrrnission: Ntrnber of Errors of Omnission : note]. thsnber of Errors : 106 MATCHING FAHILIAR FIGURES Answer Sheet Set l-F Note: First two items are practice ' Response latency to Sequence of responses first response I tern l. house....l 2. scissors....6 3. phone....3 4. beer....l 5. tree....2 6. Ieaf....6 7. cat....3 8. dress....5 9. giraffe....4 lO. lamp....5 ll. boat....2 12. cowboy....4 107 ;~ 07%- 0000000000 0000000000 Instructions: "Now I am going to read to you sigma more 0000000009 tt t.Ag1n. fth willbtruo and ;o: :1; :newar‘gg.”;:m: will-not be :rua 6f yozfnd no” 0000000000 youwsllanawer_. Anewareva :1 if me a hard to decide. [tam-sheen answer: glfo‘tlhr'rtlatmarnt 1:: 0000000000 generall llk ' , er ' if th is ll .... ...? .:.:°:.. .3... .: :.::::':::....§'“"' ’ “‘ oopooooooo l‘laad each from to the child. If the child answers m. 0000000000 111 in the circle umh r d "O" t th ht hand 1d f the page. If the chlldflrtawers 5.33. £1111; the c1:cl:,° 0000000006 mimbered "l" at the right h nd side of th e. Ha k ONLY ONE mimbered circle for one; item and do $2.3m an; “QMOOOOOOOOOO DO NOT USE A mom PEN. If you change yo mind. your first mark completely. Please do not mal: any “:2“ 0000000000 marks on tha sheet. 0000000000 Definition 3; fl IE Scale Points 0000000000 iififigs 0000000000 0000000000 1. If someone bothers me when I'm busy, I ignore ........... 0000000000 him or her. 2. when the teacher is busy I talk with my friends ......... 0000000000 3. When someone pushes me I fight them ..................... 0000000000 4. I think about other things while I work ................. 0000000000 5. It' hard ke wh f 1 d ........... having, funfo ep working on my r. en a are 0000000000 6. It's hard to wait for something I want .................. 0000000000 7. I make msstakas because I work too fast ................. 0000000000 8. I know when I'm doing something wrong without ........... 0000000000 someone telling no. 9. If my work to too hard I switch to something else ....... 0000000000 IO. After I do something it's hard to tell what will ........ 0000000000 happen next. ll. It's hard for me to finish my work if I don't like it... 0000000000 0000000000 0000000000 0000000000 0000000000 0000000000 -('\(.‘-‘\r‘-V“v‘-“v‘(’ A ’.9999900990 0999909000 0000000000 0000000000 0000000000 0000000000 0000000000 0000000000 0000000000 0000000000 0000000000 0000000000 0000000000 0000000000 0000000000 0000000000 ‘9999999999 9909000999 0900909999 9999990009 9999990099 9999999099 9999999090 9999099000 9999900909 0999900900 _9999099099 9999900999 9999099999 naammmmmma ..... 18. ..... 19. ..... 20. ..... 21. ..... 22. ..... 23. ..... 26. ..... 25. ..... 26. ..... 27. ..... 28. ..... 29. ..... 30. ..... 31. ..... 32. ..... 33. ..... 36. ..... 35. ..... 36. ..... 37. ..... 38. ..... 39. ..... 60. ..... 61. ..... 62. ..... 63. ..... 66. 108 Definition 2; :50 Two Scale Points I usually want ny own way. I am good at making things with ny hands H give up easily I am good in ny school work H do many bad things I can draw well H an good in music H behave badly at hone H am slow in finishing my school work I am an important member of ny class I an nervous I have pretty eyes I can give a good report in front of the class In school I an a dreaner I pick on my brother(s) and sistc:(s) My friends like ny ideas I often get into trouble I an obedient at home I am lucky I worry a lot My parents expect too much of me I like being the way I am I feel left out of things I have nice hair 0-. often volunteer in school I wish I were different .1 sleep well at night 65. 67. 68. 69. 51. 53. 56. 55. 56. 57. 58. 59. 60. 61. 62. 63. 66. 65. 66. 67. 68. 69. 70. 71. 109 1 ..... NO I hate school .......................................... I am among the last to be chosen for games ............. I am sick a lot ........................................ I am often mean to other people ........................ Hy classmates in school think I have good ideas ........ I am unhappy ............................................ I have many friends .................................... ¢ I am cheerful .......................................... I am dumb about most things ............................ I am good looking ...................................... . I have lots of pep ..................................... 4 I get into a lot of fights ............................. I am popular with boys ................................. . People pick on me ...................................... . Hy family is disappointed in me ........................ . I have a pleasant face ................................. . Hhen I try to make something. everything seems to go.... wrong I am picked on at home ................................. . I am a leader in games and sports ....................... I am clumsy ............................................. In games and sports. I watch instead of play ............ I forget what I learn .................................. J I an easy to get along with ............................ . I lose my temper easily ................................. I am popular with girls ................................ . I am a good reader ..................................... 4 I would rather work alone than with a group ............ . 0000000000 0000000000 0000000000 0000000000 0000000000 0000000000 0000000000 0000000000 0000000000 0000000000 0000000000 0000000000 0000000000 0000000000 0000000000 0000000000 0000000000 0000000000 0000000000 0000000000 0000000000 0000000000 0000000000 0000000000 0000000000 0000000000 0000000000 0000000000 110 . sad ‘7~1'lm'”“'.w‘w." ple... '."‘°~"‘ ' '.. ' ‘ 49,- di Nowicki-Strickland Locus of Control Instructions: " I am going to read to you sons more statements. Some of then are true of you and so you will answer 13;. Some are not true of you and so you will answer no. Answer every question even if some are hard to decide. lamamber. answer 23; if the statement is generally like you. or no if the statement is generally not like you. there are no right or wrong answers. Only you can tell us how you feel about things. so we hope you will answer the way you really feel inside." lead each item to the child. If the child answers 13;. fill in the circle numbered "0" at the right hand side of the page. If the child answers _ng, fill in the circle numbered "1" at the right hand side of the page. Mark ONLY ONE numbered circle for each item and do not dkip any items. DO NOT USE A DALLPOINT PEN. If you change your mind. erase your first nark completely. Please do not make any extra marks on the sheet. Definition _gf_ t_h; 32 Scale P_o___ints O .....123 1 .....HO 1. Do you believe that most problems will solve.... ....... themselves if you just don't fool with them? 2. Do you believe that you can stop yourself ............ ..... from catching a cold? 3. Are some kids Just born lucky?........... ........ ......... 6. Most of time do you feel that getting.... ........ ......... good grades means a great deal to you? 5. Are you often blamed for things that..... ............. .... just aren't your fault? 6. Do you believe that if somebody studies .............. ..... hard enough he or she can pass any subject? 7. Do you feel that most of the time it doesn't..... ......... pay to try hard because things never turn out right anyway? 8. Do you feel that if things start out well in the.......... morning that it's going to be a good day no matter what you do? 9. Do you feel that most of the time parents ................. listen to what their children have to say? 10. Do you believe that wishing can make good things ..... ..... happen? 11. When you get punished does it usually seen ................ its for no good reason at all? 12. Host of the time do you find it hard to change a.......... friend's (mind) opinion? 13. Do you think that cheering more than luck helps ........... a team to win? 16. Do you feel that it's nearly impossible to change ......... your parent's mind about anything? 15. Do you believe that your parents should allow you ......... to make most of your own decisions? 0000000000 0000000900 0000000000 0000000000 0000000000 0000000000 0000000000 0000000000 0000000000 0000000000 0000000000 0000000000 0000000000 0000000000 0000000000 0000000000 0000000000 0000000000 0000000000 0000000000 0000000000 0000000000 0000000000 0000000000 0000000000 0000000000 00000000 00000000 0000000 0 0000000 Char-‘00,“ ‘K A\ V fl ‘1 A- V “KM CUB A ) A '0606656560 'ooooooeooo 0000000000 0000000000 0000000000 0000000000 0000000000 0000000000 0000000000 0000000000 0000000000 0000000000 0000000000 0000000000 I®o®®©®®o©® ‘®o®©@@®®®© '®o©®®®oo®® —®o@®®®®o®® 0000000000 0000000000 0000000000 0000000000 0000000000 0000000000 0000000000 0000000000 0000000000 0000000000 0000000000 AAA- ..... 111 . g e e m e . 16. Do you feel that when you do something wrong there's very little you can do to make it right? 17. Do you believe that most kids are just born good at sports? . 18. Are most of the other kids your age stronger than you are? 19. Do you feel that one of the best ways to handle most problems is just not to think about them? 20. Do you feel that you have a lot of choice in deciding who your friends are? 21. If you find a four leaf clover do you believe that it might bring you good luck? 22. Do you often feel that whether you do your homework has ' much to do with what kind of grades you get? ..... 23. Do you feel that when a kid your age decides to hit you. there's little you can do to stop hin or her? 25. Have you ever had a good luck charm? 23. Do you believe that whether or not people like you depends on how you act? 26. Hill your parents usually help you if you ask them to? 27. Have you felt that when people were'mean to you it was usually for no reason at all? 28. host of the time, do you feel that you can change what might happen tomorrow by what you do today? 29. Do you believe that when bad things are going to happen they just are going to happen no matter what you try to do to stop them? 30. Do you think that kids can get their own way if they just keep trying? 31. Most of the time do you find it useless to try to get your own way at home? 32. Do you feel that when good things happen they happen becsuse of hard work? 33. Do you feel that when somebody your age wants to be your enemy there's little you can do to change matters? 36. Do you feel that it's easy to get friends to do what you want them to? 35. Do you usually feel that you have little to say about what you get to eat at home? 36. Do you feel that when someone doesn't like you there's little you can do about it? 37. Do you usually feel that it's almost useless to try in school because most other children are just plain smarter than you are? 112 ASTAKI“ ASSESSMENT y fiy \ 1m ammuw R fl? SYSTEMS .-- WIDE QANGE ACHIEVEMENT TEST Joseph F Josiah. Sidney VI. leou. Seven Jeslae Name --' ———"" " ' "“‘— S" M F feet lesuts: a: 2:: ..:....“ ”:...- Dale Blnn Dale Age _. _. Reaom9 School__--._.. ___ -_ _._ ...-__. Grade—___— Soellmg __,__ -_ ,, .. ._ _ .fielened Dy . ... ._ Exammer . , -, _,_,-____ _ Amnmellc - __,, ___.-.- _— P-sc 1 -- Spelling. Level I a Level II «A..- l— EAR—65?": v "I + /\ gar A DELLEVEC'UE l Name 31 Q 15 32 2 17 33 3 . la 34 .' 19 ‘ 3S 5. A 36 5 2 37 7 22 - 38 8 237 39 9 24 40 10 25 4 . 3,. :2 12 " 43 13 28 4’- 14 29 45 ‘5 3O ‘5 Level I. flew Scores (RS) and Grade Raunqs (GR) Level ll. Raw Scores (RS) and Grade Ratlnqs (GB) in 22:: --——-°="-'=&:2-—“! "'2 :—————-’—‘- cm-.. .. . . . - 7. ' ...... - '- ' 'f .. . ‘.f‘ .. :. ' :. :. :2 "" w .. ,1; 5‘55 ILL INYEQPQEVIVW‘NS ON SHINOARO SCOQES FACES '6 '0 ‘2 0‘ MANUA- 113 LEVEL l-SPELLING ‘ AGES: 5-11 y... a C u ' 4 V I M I ~ ' ' I I V LEVEL l—SPELLING LIST AND PRONUNCIATION GUIDE Lgo .................. Childrengouoschnol ........................... go Les: ................. Theeerhufur ................................. ks: S.in .................. Weereinthsroonl ............................. In «boy ................. Thsboyplaysbell .............................. boi land ................. Dillardhobplsynogether ....................... Ind twill ................ Theym'llwaitforyou .......................... ' VB Intake ................ Shscennlmksadress ........................... milk thin ................. Theysawlu‘mintown ......................... hlnl 9.ssy ................. Ssyitsiowlly ................................... sl 10.nn ................. Mothervillcuruiscske ......................... km 11.nook ................ Wecookourovndinner ........................ kbok 12. fight ................ The light is bright .............................. lit llrnusr ................ Wemdoourwork .......................... must 14.dress ................ Thedressfitsvell ...... dds IS. reach ............... He couldn't reoch the ball ...................... rich 16. order ............... The csptsin'sorderwas obeyed .................. br’dlr l7.wstch ............... Myemehisfam ............................... wdch Ilenter ............... Enterthisvsy .......................... . ...... ln’tlr ”grown ..' ............ Potatoesaregrowainthefield ............ . ...... gron 20.nature ............... Thestudyofwursisinxeresting ................. nl'cbtr 21. explain .............. Explain how it happened ....................... sksplln’ 22.edge ................ Hesatonthssdgsollhscheir .................. ii 23.kitchen .............. Oinlu'rchsnissnlafl ........................... klch'tn 24.surprise ............. Hernsynrrpriseyou ........................... sirprir’ 211‘qu ............... Therendtolyourworkisgood... .............. rlrnlt' 26. advice ............... My edvioewasiorgotten ........................ ldvis’ 27.purchase ............ Wedidnotpurchnsethsear .................... phr’chls 28.brief .......... . ...... lreesivedabrl’elnote ......................... buff 21m .............. Succesrrnakespeoplehappy .................... snksis’ 30. reasonable ........... His requestwesressonebleandjust .............. rez'nlb‘l 31. imaginary ........... He toldusanimoginorystory ................... mariner! 32. ocaapy .............. We occupy a srnall apartment ................... bk’upi 33.:harscter ............ Herfinschoroctervespraised ................... klr’lkllr Stanciery ........... ...Everysocieryhasruies ......................... and 35. oficial .............. Anofioiel invitationcamlstodsy ................. offsh’ll 36.noogniee ............ Hedidnotreoogniseme ....................... rik'bgniz 37. familiar ............. We are lemma with the news .................. {Irn‘lryu ”continue-ion .......... Theoommissionrsponediouienuyor ............ kbnlIsh’nn 39.bene6cia1 ........... Goodfoodisbawfia'sltoheshh ....... ‘ .......... blnlfish’ll 40. appropriation ........ Congress made an appropriation {orschools ....... lpropd'l’shln sl. enthusiasm .......... People showed mm for the hero ........... hmn'du'm 42. cnncixeorcrincise ...ltisessytocririeireothers ...................... Whiz 43.prejudics ........... Pniwdicsishernfultopeopie .................. prij’bbds 44. belligerent .......... The soidierwasbelligerem and brave ............ blfli’irlnt sioccurrence .......... Wariseu-agicosewrrenes ...................... bklr’lns 33' 114 Pages Reading. Level I A R 2 H I Q S E B O .4: Two letters in name m A B 0 S E R T H P l U Z Q 5 cat see red to big work book est was him how u then open letter jar deep even spell awake block size as weather should lip finger tray felt stalk cliff lame struck at approve plot huge quality sour imply humidity urge as bulk exhaust abuse collapse glutton clarify n recession threshold horizon residence participate quarantine u luxurious rescinded emphasis aeronautic intrigue repugnant s: putative . endeavor heresy discretionary persevere anomaly u rudimentary miscreant usurp novice audacious mitosis we seismograph spurious idiosyncrasy itinerary pseudonym aborigines luu LNG! l. as gs as on s on as on as no es gun as on es on a! ge a! gun as gs ass-Scoreslnsl o "'I srs‘u u nu an .s aslsaulsasvlrz ts'stzgi s: u warm mung-lam l :1 1? I} 3 :1 3 l3 3: 3;: I: 3.: ii 33 9 3 i3 1 3 l; 3 ii 3 :3 3 no 12 "In" an L. nu «solsruluu rs to use so so a D: I: so a lo 31 Is an 2.5 so at . as a: _ s1 ss ’6 H I: I! Id 94 “(HAWALFORNOIIS s ’2 u “'23 ll .12 2.0 u 2,. so 3,: l so u l as 6.0 l r: :2 as I: es ss I '3 '5 K) g 2‘ l2 . 33 2' , ‘2 II ' 5‘ 33 IO ‘5 ‘ II I? - 'I ’3 I? I. '7 9.I 7PdllIld:25LJ 3422.027 5:3..6al‘rcsalrsnlssISSsssr seslnesauluzz:uz~lgau 5249 rlss‘sovs:ssss ssss ' so l-' ' let ‘2 Reading. Level II Two letters in name m A B O S E R T H P l U 2 Q (m u milk city in tree animal himself between chin split form n grunt stretch theory contagious grieve toughen aboard triumph u contemporary escape eliminate tranquillity conspiracy image ethics 60 deny rancid humiliate bibliography unanimous predatory alcove .1 scald mosaic municipal decisive contemptuous deteriorate stratagem a benign desolate protuberance prevalence regime lrascible peculiarity u pugilist enigmatic predilection covetousness soliloquixe longevity abysmal as ingratiating oligarchy coercion vehemence sepulcher emaciated evanescence 1: centrifugal subtlety beatify succinct regicidal schism ebullience s: misogyny beneficent desuetude egregious heinous internecine synecdoche u Level It. Rate Scores (85) and Grade nettngucfl) 74 H2 is I!) 7‘ "3 I2 I3 0‘ II '0 O I? '0 I II ‘0 3 s7 balsa 77 SI II a: sslsl rs so so “I 7 '3'“ 23.2' ”are u as s. as es s: an!» s: 22 Jane as 3‘ SI :3 16,30 an)? 57 (3| I H vs 2‘ “I s lsl-s rs ‘.lm ‘7’17 zf'Jl 37 3| IIlJI 59. as so as s! s: so." loslrr nr 09 "I“Ue.-° as H Is! "I 29'.‘ Hi I: to w ~--‘ 4.. 'l v..- leb.‘ 3LT '0?" “01" SIEflWALFOINOIflS 'I" ‘-‘ l’l '9 )0./-‘ u: l. 52'40 b.” :- ’.l:~r. “is? $6.“ I37“? I20!" .. ' s- 'I' ’ -.- .2 «glen s~l :. _. ... do. ..4 97" la’,ep v7:|.g .. . . on ’ "‘ q?.:o- I! OIII GI IIGIIS BI RIGIII GIII CI '8 GI II 0' IIBIII OI II 6.] '3 I27 115 WIDE RANGE ACHIEVEMENT TEST usnx Page 2. Arlthrnetlc. Level I ’ on'P'" ......OOOOOOIOO- H! L‘ 9 9 3 3 Fingers 8 lingers. 9 or 6? 42 or 28" 3 pennies. spend 1?____. 3 o s apples?____. 9 marbles. lose 3" . .‘O WrittenPsrt 32 6 5 24 4:2: 23 29 75 M=— *_2 -_3 No L? -_H :.8 4—1-__ I! 452 i - - 1 hr.= mm. 137 $62.04 3' sl—ssa' r245 6‘—2= ~5.30 — 1 1 . T’?'___ 41 15 7 5 823 s _ T‘— 7'T‘__ :96 3% ':'°‘35‘ e2; 2 %Yd.= in. 1.: =1- : MUltlDly‘ 7.9 6 7 yr. = mo. - 5 275384 2 _ -1; 30.8 T ' i? _.3_ 2% 602. : Wnicn vs more? Find the average or wme as a percent 1 u Tor? 24. 18. 21. 26. 17 ’ 4‘_x3L : 7: yo I 3 Ans Ans. Write as decrmal %_%= %x%x-;-: ,- 20'Iool120:____ _ — ?- Change to lamiliar 8.2 l 6 2.7 O 3 numerals: 52: (-5)(*9)= MCXLII= $300al4%'lslor7nw. Y’l9'37l‘55 A68. y: thcovanSI uuuummmuuumm sndcrsdelsllngsmfl) 0 mg 5 runs NH: ".3: was 29:30 Jslas «one sows rats: on» ‘05 ‘..: s solupg..gv:l;n:3 2532339 s1|J¢Si'HIJ 4? ’ll” ’OlSI'O. .:~s- - a: -: .. ~- ~.. s: 3: :7;- a: a: 2: s: w seine so so 'I;O‘¢ H7 3‘6 I 5‘ I! ‘.l ' {E " .l. ‘-‘. _ I. .33 33 ‘3: 3' s: ‘3 ‘9 .v- ‘.. S: 9., 6 ...'| s «r '- »-- .- . -- w u .' 3° H .‘s 4' u- .. u " s.‘ In M 7.;0 s. .. " ‘. r. . .‘c ‘1‘. I see MANUAL roe mus l § -- - . --- — - -———-—. -. — .— 2. 10. Address o: Physician: ll. Date of child's last physical area: 12. ”ans at school child attends: 13. Address of school: 116 Develoaental Hi s tori Child’s sane Sea ot Child (circle one): male tenale a. Caucasian b. Black c. Asian :1. Chicano/Kimmie e. native Merican £. Other: Date at Birth: Place at Birth: Bone Address: MIMI: Parents ' llanes: Business Phone: Chad's Physician‘s Name: School Intonation 1s. Olild's grade in school: 1!». Child's classroon teacher: 16. lane of principal: 11137 17. Is your child enrolled in any special program at school? (please circle all appropriate choices) a. b. c. d. e. t. none counseling tutoring speech therapy reading other (specity): 18. Is your child currently receiVing any special help outside at school? (please circle all appropriate choices) a. b. c. d. e. t. none counseling tutoring speech therapy remedial reading other (specity) = 19. I: answer to question Ola is yes, please specity namn or the agency or person providing the treatment and the address below: mans: ADDaISS: Pregnancy Histogy 20. Did the child's mother have any illnesses or complications while carrying the child? (circle one) yes 21. It answer to 821 is yes. please circle below: rash intection marked swelling or hands & test measles toxemia very putty tace diabetes headaches abdominal pains dizzy spells high blood pressure convulsions blurring vision other (speciry: ) 18 ya 22. Did the child's mother have a special diet during pregnancy? yes no 23. I: yes to :22. please circle below salt :r low calorie other: (circle one) 2:. Did mother take any medications or drugs during pregnancy? (please yes no 25. I: yes to 326. please speciiy below: Started the medication was taxen to... oonth c: Name or drug control nausea? in which orecnancv control :luid retention? control diet or weight? help you sleep? help you stay awake? help relieve nervousness or anxiety? help relieve depression? help control all gies? other? (please specity) 26. Did mother smoke tobacco during this pregnancy? (circle) 27. 2: yes. circl the month(s) in which smoking ocurred: l 2 3 l 5 6 7 I 9 28. Did mother drink alcohol during this pregnancy? (circle) 29. :: yes. circle the month(s) in which drinking occurred: 1 2 3 4 S I 7 I 9 yes yes ’...-1.) :or how 1::- l . 119 30. Did mother take aspirin-containing drugs during this pregnancy? yes no 3l. It yes. circle the month(s) in which aspirin-taking occurred: 1 2 3 I 5 6 7 I 9 32. Did mother drink cottee during this pregnancy? (circle) yes no 33. If yes. circle the month(s) in which cottee was taken: 1 2 3 I 5 6 7 I 9 36. Did mother have severe emotional stress prior to this pregnancy? yes no 35. Did mother have severe emotional stress during this pregnancy? yes no 36. Did mother have severe emotional stress site: this pregnancy? Y's no 37. was mother exposed to r-ray shortly betore or during this pregnancy? yes no 38. It yes, in which month(s) was mother exposed to s-ray? 1 2 3 4 5 6 7 I 9 Birth of Child 39. was baby term or premature? (circle one) term premature 40. Birth weight or baby: s1. Length or baby at birth: 62. has any medication given to mother during labor or delivery? yes no 43. It yes. please circle below: local anesthesia (e.g. caudal. spinal. saddleblock) general anesthesia (e.g. ether, nitrous oxide) pain pills (e.g. demerol. codeine) other (please specity: ) 1J2() so. Type or delivery (please circle): normal torceps caesarean it. Has labor/delivery abnormal in any way? (circle one) yes no 1! yes. please explain: :6. How long was the labor with this child? hours 47. was labor spontaneous or induced? spontaneous induced to. Did this baby have ditticulty starting to breathe? yes no 1: yes. please circle all that apply: use ot incubator jaundice (yellowing of skin) repiratory problems . convulsions heart problems other Growth and Develgggent l9. were there any ditticulties during the baby's first month at home? yes no so. 1: yes. please indicate which one(s) or the tollowing: excessive crying teeding problems unusual muscle activities other 51. ,Please indicate age when your child began pertorming the behaviors listed below: Snilod Laughed Cut tirst tooth Set by selt Said tirst word Crawled Stood alone 1J2]. balk-d by salt Pd 8.1! lumber or words (appronimately) by age 2 Talked in sentences Able to hold crayon or pencil Toilet trained tor day time Totally toilet trained Dressed selr :1“ M 33”.! Child's health 52. Child's blight: inches 53. Child's weight: upounds 54. Please circle the tollowing medications it used by your child currently or recently: lone Ritalin. dexedrine. amphetamines (or other similar drugs) Phenobarbital. tranquilzers Iron Dilantin 55. how many tiles has your child been hospitalized? ' times 56. Please list all hospitalizations. including child's age at hospitalization. how long the child was hospitalized. and the reason tor the hospitalization: 1122 . 57. Did the child ever have any operations? (please cirle) yes no It yes. please specify: 58. has your child ever been in any accidents resulting in serious injury? yes no 1: yes. please speciry: 59. “hat is tho highest fever your child has had? 60. Has this child ever had (or currently have) any or the tollowing diseases? (please circle all that apply): - meningitis encephalitis asthma diabetes heart disease heart murmer cystic fibrosis epilepsy seizures hydrocephalus cerebral palsy brain tumor leukemia anemia arthritis bone disease muscle disease kidney problems tuberculosis cancer measles mumps chicken pox 61. Does your child have any allergies? (please circle) yes no It yes. please specity: 62. has your child had (or currently have) any medical problems which you think might be related to your present concerns? (please circle) yes no If yes. please specity: 123 Family Background: Please list all siblings or other children currently living in the home: gag 523 Grade in School Mother's occupation Pather's occupation Current marital status (please circle which apply): a. b. c. d. e. t. g. married. living together in the home married. living apart separated divorced widowed single other: Current tamily income: . In cases where the tamily will participate in the child and parent groups. as well as receiving a medication or placebo pill. these groups will be conducted in the evenings trom 6:00-7:30 at the MSU CLINICAL CENTER. Please indicate below any evening between 6:00-7:30 that you could £23 come to the CLINICAL We Monday Tuesday Hednesday Thursday 124 How did you rind out about this program? (circle all that apply) a. radio announcement b. TV announcement c. newspaper article d. community newsletter e. school newsletter t. tamily physician or pediatrician g. school teacher or other school personnel h. tamily physician or pediatrician i. other (please specifiy) q 125 Family History Is there anyone else in your larnily who has had a problem similar to your child's? Here any members oi the lernily (lather. mother. brother. sister. aunt. uncle. grandparents. cousins) oswiensed any ol the lollowing? lllness Alcoholism Allergies Astlvne’l'ley lever Ilindness’Eyo problems Center or Leukemia Oeelness Depression Diabetes Epilepsy Heart disease Kidney problems Learning problems Mental retardation Muscular dystrophy Schisophrenia Speech problems Stillbirth or early childhood death Suicide Thyroid disease Tuberculosis Other: Family Member Which side ol the lowly? Father's side Mother's side 126 Appendix B Public Service Announcements 127 MICHIGAN STATE UNIVERSITY bmwrnmwrowrmmnouxw murbuommi~xxuwun-immsuu October 30, 1904 James R. Rawlinson, H.0. 1201 Oakland Lansing, HI 40915 Dear Dr. Rawlinson, The hichigan State University Psychological Clinic and Clinical Center are Jointly otsering a program to help families with children with chronic inattention and impulsivity problems. especially those diagnosed attention deticit disordered. it is called the Child fighavigr Prgyggg. He would like to solicit your help in reserring patients to this program. You may reier any of your patients to the proJect who meet the following criteria: 1. chronic inattention and/or impulsivity problems at school or in the home 2. age between 7 and 11 years 3. the child is ngt mentally retarded The treatment program incorporates the sollowing widely used clinical treatment components: 1. a series ot parent groups in which techniques tor managing children with behavioral problems are discussed and applied 2. a series o4 child groups in which techniques for self-control and problem-solving are taught and practiced 3. psychostimvlant therapy These three components of the program run concurrently, and last about 12 weeks. All o4 the children given the medication will be monTTbred by Dr. John H. Pascoe, H.0., Director oi the Child Health Care Clinic in the College oi Human Medicine within the Clinical Center at Michigan State University, as well as other Board certitied pediatricians. The cost oi the program is a one-time tee of only s50.00, which can be waived if it presents a hardship for any tamily. we are currently accepting reterrals {or the next series of groups which will begin in the Uinter. A representative ot the thlg fighavigr Prgjggg will call your osiice in the next week to set up a brass appointment to provide more intormation and answer any questions in person. In the meantime. you may obtain further information or initiate a retsrral by calling either 0r. Uade F. Horn at 355-9564 or Dr. John H. Pascoe at 353-3002. He hope that you will consider the interventions available through the thlg fighgvig: Prgyggt as a possible adJunctive service to those tamilies in your practice who are having chronic inattention and impulsivity problems with their school-aged children. Sincerely. Uade F. Horn. Ph.0. John N. Pascoe, H.0.,H.P.H. Proiect Co-Director ProJect Co-Oirector 128 MICHIGAN STATE UNIVERSITY mom 0. ”VOW? MST LANSING IW - “"17 MY IRWICII ”WHO Does your child have behavior problems at home or at school? Does your child have trouble sitting still, paying attention, or following directions? Does your child behave impulsively or have temper outbursts? If your child has any of these behavior problems and is between the ages of 7 and 11. a new program called the ghilg fighavigr Prgiggt may be able to help. Call the Hichigan State University Psychology Clinic at 355-9564 for further information. That’s 335-9564. 129 Appendix C Consent Forms 130 MICHIGAN STATE UNIVERSITY ”Am u ”VOW? us? mac ”‘3“ - ‘..-fl" WV MK" WNW Informed Consent I. the parent (or legal guardian) of agree to have him/her and myself participate in the oiild Behavior Pro'ect. a clinical evaluation program examining the effectiveness of a calmly—b sedication (Ritalin) - for chronic inattention problem adninistered with or without a family therapy program for families with children experiencing chronic inattention and inpulse control problems in the hon: and/or at school. l waderstand that a lottery will be conducted to randomly assign my child and myself to one of a nutber of different coubinations of these treatment approaches- I further understand that some children may benefit more than others through their participation in this project. and a guarantee has been made that my child's difficulties or other fanily problsis will be aired through participation in this progrma. lbre specifically. I understand that participation in this project will involve: (ll periodic assessmmts of my child at the m0 Psychological Clinic. including one assesmnent prior to treatment. one assessment just after treatment has ended, and one assessment at four to six months following the end of treatment. this clinic assessment will involve approximately 2 hours of psychological testing with my child and a 20 minute observation of my child and myself interacting in a playroom setting: (2) periodic questionnaires about myself and my fmnily, to be completed by me once before treami'ent. once just after treatment has ended, and once four to six months following the end of treacnent. If my family is chosen to participate in the group treaciient sessions. I will also complete some additional questionnaires at several points during the treat-dent . (3) a lottery process to determine whether my child will receive medication for managmnent of attentional problens. or an inactive (placebo) pill. A board eligible or board certified pediatrician at the H50 Clinical Center will monitor the adainistration of the medication to my child, including a minimun of one clinic visit per month at the F50 Clinical Center throughout the course of the study; (4) a lottery process to determine whether my child and myself will participate in 12 weekly, Z-hour group treatment sessions for my child and myself; and (5) periodic observations of my family during the evening meal time. one to be couplecai prior to treatment. one to he conpleted just after treatment has ended, and one to be completed at four to six months following the end of treatment: I understand that my child should not participate in this study if he/she is allergic to Ritalin: has marked anxiety, tension or agitation; glaucoma: high blood pressure: depression: mocor tics. or a family history of tics. 1L3]. Should my child and myself be assigned to the child and parent group treatment sessions. I further understand that the parent groups will involve instruction in child aunagenent techniques and the child groups will involve instruction in self-control and problen solving techniques. These groups will be co-lead by advanced graduate students in the child and family clinical psychology training program under the supervision of Dr. wade F. Horn. a fully licensed clinical mychologist and assistant professor in the Departsnnc of Psychology at Hichigan State University. I understand that in order to supervise the group leaders. each of the tr'eaoiient groups will be either videotaped or audiotaped. ‘I‘hese recordings will be used for supervision of the group co-leaders and will be erased at the end of the trestle-lit program. Mther. I give my consem for representatives of the Guild Behavior Project to contact the school my child attends so that an assessent of my childechool behavior can be made through the use of periodic teacher questionnaires. I further understand that at the time of these school contacts. the representative of the Guild Behavior Project may discuss ways of best managing my diild's school behavior thh the classroom teacher. I mderstand that participation in this progrma is carpletely voluntary. and that my child‘s assent for participation will also be sought. I further understand that I will be asked to pay a one-time fee of $56.00 to cover aduinistrative costs. and all physician and medication costs. However. I understand that if this fee presents an undue hardship. it can be waived. free to decline entrance into the program. and I say withdraw myconsent to participate at any time during the program. I understand that I may discontinue participation at any time without jeopardizing current or future treatment at IGU's Clinical Center. I understand that possible side effects of Ritalin include: (1) changes in appetite; (2) insomnia; (3) abdominal pain: (4) changes in blood pressure and heart rate: and (S) hypersensitivity reactions. I further understand that in the unlikely event of serious side effects resulting from taking the nedication. Michigan State University. its agents. and mployees will assune the responsibility as required by law. 'nreatment for serious side effects is available where die side effects are incurred during the treaonent progrmn. I have been advised that I should look toward my own health imurance progrua for payment of said medical expenses. I understand that all questionnaires and other assessnent data are confidential. After the questionnaires have been checked for completeness. I mderstand that my nave will be renoved. and I will be identified only by a code nunber in order to ensure confidentiality. Any reports of this program which are made will be presented only as group averages. and neither myself nor my fanily will be identified in any way. I have read this consent form. and all my questions have been answered. I also understand that if I have any further questions I may contact either John H. Pascoe. H.D.. (SSS-2721) or Wade E“. Horn. Ph.D. (3353-6640). I freely and voluntarily choose'to participate. I understand that I may withdraw at any time. I have not been promised any reward. inducenent. or payment to participate. I have been told that ample opportunity is available to me now and later to obtain information about this study. 1 also acknowledge that 1 have received a copy of this consent form. In Slqnature Date Witness Date 132 MICHIGAN STATE UNIVERSITY bombemocowoy WW-W-“IIIT WYMCHWG Consent Form for School Contact 1, the parent (or legal guardian) of agree to allow members of the Child Behavior Project from Michigan State University‘s Psychological Clinic to contact the school my child attends in order to ask my child‘s classroom teacher to complete a questionnaire regarding my child's classroom behavior. My child currently attends the school named below: The name of my child's classroom teacher is: Signature of parent (or legal guardian) witness Date Date 133 Appendix D Tables 134 Table 16 Correlations of de endent variables usin s uare root transformations. l 2 3 t 5 6 7 a 9 lo I. em-a - 2. Age .01 - 3. Grade .07 .93" - 0. Income .00 .03 .05 - 5. Conners' Po: Hyper. -.ll -.00 -.08 .07 - 6. Conners' To: BYPCZ. -012 '.03 '.05 .01 08". - 7. PIC-R: Hyper. -.12 -.02 -.01 .00 .67" .62" - 0. I??:£rrora -.31" -.34" -.36" -.ll .37" .37“ .25“ - 9. Irrxnatency .23" .15' .16' .00 -.20' -.l7' -.12 -.60" - 10. CPT: Comission D -.03 -.20' -.23" -.02 .20' .28" .23.. .20" -.10' - ll. CPT: Comission ax -.lo -.19' -.26" -.04 .29“ .31" .22 .34" -.24" .50" 12. CPT: Omission D -.12 -.36" -.39" -.Ol .22" .23" .20' .39" -.20' .45" 13. CPT: Omission ax -.29fl —.5l" -.55" -.OS .27" .26" .14 .42" -.00 .21' 14. IRAr-R: Reading .30" .09 .27" .08 -.30" o.37" -.19' -.26" .07 -.ll 15. IIAT-R: Arithmetic .26" -.10 .06 0.03 -.26" -.JD" -.lS -.24" .00 -.ll 16. IRAT-R: Spelling .32.. :06 .25" .05 -.30°' -.:1-- -.10' -.27" .05 -.lS' l7. PIC-R: Achievement -.34" -.l6' -.20° .05 .60" .56" .47" .34" -.08 .23" 18. PIC-R: Intellectual -.30" .l6' .Ol -.00 .15' .22" .15 .12 .03 .12 19. PIC-R: Development -.40" -.12 -.20' .07 .570. .54.. .40" .37.. -.00 .13- 20. Humphrey's Self-Control .22" -.l7' -.13 -.14 -.30" -.29“ -.25" -.lo .07 -.20' 21. N-S Locus of Control .23“. .23" .20" -.12 -.25" -.26" -.22" -.31" .33'° -.05 22. Piers-Harris Self-Concept .ll -.12 -.12 -.l7' -.37" -.35" -.Jl" -.14 .03 -.ls 23. PIC—R: Undisciplined -.ll -.02 .00 -.02 .01" .75" .00" .29" -.l$' .12 24. PIC-R: Delinquency -.00 .01 .03 .05 .7l" .66“ .63" .21' -.08 -.Ol 25. PIC-R: Social Skills -.ll .l3 .13 .06 .66" .59" .63" .15 -.07 .15 26. Dev. History Prenatal .06 .00 .09 -.Ol .27" .27" .21' .08 .Ol -.02 27. Dev. History: ' Perinatal -.Ol -.06 -.04 .01 .ll .16' .09 .09 -.03 .12 20. Family Distory .05 -.12 -.20' -.13 .00 .Ol .03 -.03 .06 .06 Note: Scores are square root transformations. ' 2 < -05. " p < .01. 135 Table 17 Correlations of do endent variables usin are root transformations. 11 12 13 1c 15 l6 17 la 19 20 1. PPVT-R -.10 -.12 3.29" .30" .26" .32" -.34" -.30" -.60" .22" 2. Age -.19 -.36" -.51" .08 -.10 .06 -.l6' .16. -.12 -.17' 3. Grade -.26" -.39" -.55" .27" .06 .25“ -.20' .01 -.20' -.13 4. Income -.04 -.01 -.05 .08 —.03 .05 .05 -.08 .07 -.l£ 5. Conners' PQ: Hyper. .29" .22" .27“ -.30" -.26" -.30" .60 .15' .57" -.30" 6. Conners' To: Hyper. .31" .23“ .26" -.37" -.36" -.£l" .56" .22" .54" -.29" 7. PIC-R: Hyper .22“ .20' .14 -.l9' -.15 -.16' .47" .15 .40" -.25" 0. Hr?:zrrors .34" .39" .62" o.26" -.26" -.27'° .34“ .12 .37" -.10 9. HFP:Latency -.2A" -.20' -.08 .07 .08 .05 -.08 .03 -.08 .07 10. CPT: Comission H .58" .65" .21' -.ll -.11 -.15' .23" .12 .18. -.20' 11. CPT: Comission BX - .44" .29" -.27" -.22" -.32" .26" .17' .26" -.27" 12. CPT: Omission D - .55" —.l7' -.24" -.2¢" .26" .13 .29" -.08 13. CPT: Omission ax - -.36" -.35" -.39" .39" .18' .62" -.09 14. "RAT—R Reading - .60" .90" -.50" -.55" c.48" .19' 15. “RAT-R: Arithmetic - .62" -.60" -.43" -.44" .31" 16. HRAI-R: Spelling - -.53" -.55" -.53°' .19. Achievement - .65" .91" -.24°' 18. PIC-R: Intellectual - .SS" -.15 19. PIC-R: Development - -.23" 20. Hymphery's Self-Control - 21. N-S Locus of Control - 22. Piers-Harris Self-Concept .38" - 23. PIC-R: Undisciplined -.25" -.36" - 26; PIC-R: Delinquency -.22" -.36" .06 -- 25. PIC-R: Social Skills -.25" -.61" .75" .63" - 26. Dev. History: Prenatal -.06 -.16' .29" .20' .26" - 27. Dev. History: - Perinatal .02 .01 .06 .07 .06 .51 - 28. Family History -.05 -.10' .03 .02 -.03 .26" .19' - Note: Scores are square root transformations. ' 2 < .05. .. 2 < .01. Table 18 136 Means and standard deviations of dependent variables. _ PPVT-R Age Grade Incoge SE S.D. i 5.0. i S.D. i S.D. HM 105.5 10.4 106.0 14.9 2.8 1.2 2.9 2.1 HP 104.4 11.0 105.0 16.8 2.8 1.6 3.0 2.2 NH 113.5 15.4 110.7 15.3 3.2 1.3 2.8 2.3 NF 104.9 20.1 107.8 16.1 3.1 1.6 3.2 2.4 Conners' PQ: Conners' TQ: PIC-R:a Hyperactivity Hyperactivitygi Hyperactivity MFF:Errors i S.D. i S.D. i S.D. i S.D. an 21.8 3.7 21.3 3.7 72.8 14.0 13.6 6.0 HP 22.0 4.1 20.4 5.1 75.6 18.2 12.9 6.9 NM 4.7 4.0 6.5 6.2 50.0 7.9 8.2 3.8 NF 3.1 2.7 3.1 2.8 49.2 8.2 7.6 . 5.5 MFF: CPT: CPT: CPT: ggtency Comission B Comission sx Omission B i S.D. i S.D. i S.D. ii S.D. HM 12.2 9.4 8.6 8.1 14.2 17.3 3.2 4.5 HP 11.3 6.3 4.9 7.7 7.5 14.3 2.2 2.8 NM 12.6 5.5 5.1 5.6 7.6 18.3 1.1 1.2 NP 20.8 15.5 1.7 1.6 1.9 2.0 .4 .6 CPT: “RAT-R “RAT-R ”RAT-R Omission Bx Reading Arithmetic Spelling x S.D. x S.D. x S.D. X S.D. HM 7.9 7.0 92.7 17.0 90.9 12.3 88.2 14.1 HP 9 7 9.0 100.5 16.6 95.2 13.9 98.8 14.3 NM 3.9 5.7 108.6 16.1 99.4 15.5 100.5 14.4 NF 4.5 4.6 107.5 13.4 103.2 14.1 105.5 12.7 Table 18 (Continued) 1237’ PIC-Ra pic-n“ pic-Ra Humphrey's Achievement Intellectual Development Self-Control i S.D. i S.D. i 5.0. i S.D. HM 63.2 11.5 61.1 20.0 59.7 11.7 5.0 2.0 HP 67.0 16.1 54.9 17.6 63.2 12.6 6.0 2.5 NM 42.7 7.7 48.4 9.4 42.9 7.6 6.9 2.0 NP 47.7 10.5 51.7 8.7 46.6 9.1 6.1 1.9 Nowicki- Strickland Piers-Harris PIC-R:a PIC-H:g Locus of Control Self-Concept Undisciplined Delinquency- i S.D. x S.D. x 5.0. i S.D. HM 22.2 4.3 55.6 12.4 77.0 13.4 71.2 14.2 HP 21.4 4.3 56.3 13.0 87.2 17.3 81.2 16.7 NM 24.3 5.5 64.9 9.4 47.5 7.4 49.9 8.7 NP 24.9 5.3 64.1 7.0 46.8 7.0 46.2 5.2 Developmental Developmental Family PIC-Ra History: History: History: Social Skills Prenatal Perinatal Total I S.D. i S.D. X S.D. I S.D. HM 67.8 14.8 5.2 3.5 3.6 2.3 15.4 9.2 HP 69.2 13.6 4.8 2 6 3.7 3.3 14.6 3.7 NM 47.9 10.4 3.3 2.7 2.5 1.9 9.6 6.1 NP 45.7 9.4 3.0 2.7 2.7 2.1 8.0 4.3 *T-scores are reported for PIC-R scale scores. Note: HM I hyperactive males (N I 60); HF I hyperactive females (H I 19), NM I normal males (N I 23), NF I normal females (N I 15). 138 References 139 References August, G. J., Stewart, M. A., 8 Holmes, C. S. (1983). A four-year follow-up of hyperactive boys with and without conduct disorders. t s o s - ehie;;y, 143, 192-198. Barkley, R. A. (1981a). Hyperactivity. In E. J. Mash & L. G. Terdal (Eds.), ehav' a assessme 0 childhood disorders (pp. 127-184). New York: Guil- ford Press. Barkley, R. A. 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