ABSTRACT

The relation between sustained attention in the laboratory and behaviors exhibited in naturalistic settings among children with Attention Deficit/Hyperactivity Disorder (ADHD) remains unclear. Additionally, research on stimulant medication effects in these areas and their association with one another remains scarce. Twenty-one children with ADHD and 21 children without ADHD completed a novel continuous performance test (CPT) involving high cognitive demands (e.g., visual search). Participants with ADHD also attended a Summer Treatment Program and received three doses of stimulant medication (placebo, low, and high). Their behavior in classroom and peer settings was observed and recorded, and they completed the CPT in each medication condition. The CPT measures of bias and sensitivity were used in analyses. Results indicated that children with ADHD had impaired overall performance and worse bias during the second half of the task compared to controls. Methylphenidate improved both naturalistic behavior and overall CPT performance but did not specifically improve the sustained attention deficit. Despite improvements in overall CPT performance, medication-related improvement in CPT performance did not mediate medication-related improvement in observed behavior in classroom or recreational settings. As such, our findings suggest that although children with ADHD do demonstrate a sustained attention deficit, salutary psychostimulant effects on CPT performance are not indicative of, or causally linked to, psychostimulant effects on presenting problems in naturalistic settings.

摘要

注意缺陷/多动症（ADHD）儿童的实验室持续关注与自然环境中表现出的行为之间的关系尚不清楚。另外，关于在这些区域中兴奋药物作用及其相互关联的研究仍然很少。21名患有ADHD的儿童和21名非ADHD的儿童完成了一项涉及持续高认知需求（例如视觉搜索）的新型持续表现测试（CPT）。患有多动症的参与者还参加了夏季治疗计划，并接受了三剂刺激性药物（安慰剂，低和高）。观察并记录他们在教室和同伴环境中的行为，并在每种用药情况下完成CPT。在分析中使用了CPT偏倚和敏感性度量。结果表明，与对照组相比，多动症儿童在任务的后半段期间总体表现受损，偏见更严重。哌醋甲酯改善了自然行为和整体CPT性能，但并没有特别改善持续的注意力缺陷。尽管总体CPT性能有所改善，但与药物相关的CPT性能改善并未在教室或娱乐场所中观察到与药物相关的改善行为。因此，我们的研究结果表明，尽管患有ADHD的儿童确实表现出持续的注意力缺陷，但对CPT表现的有益的精神刺激作用并不表示在自然环境中出现问题时精神刺激作用或与之有因果关系。