UT Southwestern School of Health Professions
Permanent URI for this collectionhttps://hdl.handle.net/2152.5/6691
Welcome to the UT Southwestern School of Health Profession’s electronic theses and dissertations (ETD) collection. (Note: The school was previously named the UT Southwestern School of Allied Health Sciences.)
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Print theses and dissertations from 1943 to 2004 are located in the Library's Special Collections and Archives (Room E3.314) and are available by appointment. (Note: Former students may request a digitized copy of their work by email, but other users may submit an Interlibrary Loan request.) For more information, contact archives@utsouthwestern.edu.
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Browsing UT Southwestern School of Health Professions by Subject "Attention Deficit Disorder with Hyperactivity"
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Item ADHD and Medical Correlates of Bullying of Pediatric Neurofibromatosis Patients(2016-08-25) Patel, Sarita; Holland, Alice A.; Faith, Melissa A.; Silver, Cheryl H.Neurofibromatosis Type 1 (NF1) is an autosomal dominant disorder that involves nervous system tumor growth, and it is one of the most frequently occurring genetic disorders. NF1 is a multisystem disease with a complex phenotype. Given the range in severity of presentation in NF1, research has shown that disease severity could impact children's social-emotional functioning. Physical deformities such as tumor growth often are associated with NF1, and as a result, children and adolescents with NF1 may be at greater risk for being victims of bullying by peers. Children with NF1 also tend to have higher rates of Attention-Deficit/Hyperactivity Disorder (ADHD) as compared to children without NF1 (Barton & North, 2004; Martin et al., 2012). Common issues experienced by children with ADHD, such as social immaturity and behavioral dysregulation, may put them at higher risk for both bullying and peer victimization (Wiener & Mak, 2009; Unnever & Cornell, 2003). Overall, the current study found that parentreported ADHD symptoms predicted parent-reported but not self-reported bullying. Furthermore, the current study found that parent-reported ADHD symptoms were more predictive of being bullied than provider-rated severity of physical deformity. Since the present study was the first to examine whether physical appearance and ADHD symptoms may be associated with bullying in children with NF1, the novel information gained from the study may be used to direct future research, educate parents and teachers, and inform the development of interventions specific to the NF1 population.Item ADHD Subtypes and the Convergent Validity of the Brief Three-Factor Approach and D-KEFS Color-Word Interference Test(2014-05-02) Oasay, Larry M. K.; Silver, Cheryl H.; Glasier, Paul; Stavinoha, Peter L.Deficits in executive functioning (EF) often translate to significant impairment in real-life situations. EF can be assessed by performance-based tests or through the use of behavior ratings; however, most research has found little to no associations between performance-based EF tests and parent ratings. ADHD is a neurodevelopmental disorder characterized by EF deficits, but some studies have found differences on EF measures between subtypes of ADHD. The first aim of this study is to examine the convergent validity between the D-KEFS CWIT, a performance-based EF task, and the recently revised three-factor BRIEF. The second aim of this study is to examine whether there are differences between ADHD-I and ADHD-HI/C subtypes on either of these EF measures. A sample of 49 children with ADHD, aged 6 to 12 years, were administered the D-KEFS CWIT and their parents were given the BRIEF to complete. No significant correlations between Condition 3 of the CWIT and the new Self-Monitor and Inhibit subdomains of the BRIEF were obtained, but the Shift subdomain of the BRIEF significantly correlated with Condition 3. Participants with ADHD-HI/C were rated by parents as having greater executive dysfunction compared to participants with ADHD-I. No significant differences between subtypes were observed on the CWIT after controlling for symptoms of inattention. It would be beneficial to continue developing EF measures with the goal of greater convergent validity between performance-based and informant-report measures. Also, more research should be conducted in identifying differences between ADHD subtypes in their EF profiles as it can potentially aid in improving evaluation and treatment of this disorder.Item Emotional Control and Reaction Time in Children with Internalizing Disorders and Attention-Deficit Hyperactivity Disorder(2016-12-16) Turner, Melissa Dawn; Wilkinson-Smith, Alison; Brewer-Mixon, Karen; Rose, LindseyBACKGROUND: Prior literature indicates that children with slower reaction times on neurocognitive attention measures are more likely to respond more slowly to stop signals in real world situations. Taking longer to respond may also suggest a tendency to take longer to process emotional cues in real time, thus possibly resulting in vulnerability towards emotional dyscontrol. The present study examined differences between reaction time and the parental ratings of emotional control and internalizing symptomatology in three distinct pediatric populations: those with Attention-Deficit Hyperactivity Disorder (ADHD), those with internalizing disorders such as anxiety and depression, and those with comorbid ADHD and internalizing disorders. SUBJECTS: A sample of 64 children and adolescents who were patients at the Neuropsychology Service at Children's Medical Center Dallas Texas from November 2011 through July 2014 was derived. All patients received neuropsychological evaluations and were assessed for attentional and emotional disorders. METHOD: Approval for the study was obtained from the Institutional Review Board at UT Southwestern Medical Center. Data was obtained via examination of medical records. Reaction time was measured via the Conners' Continuous Performance Test II (CPT II) Overall Hit Reaction Time (RT) variable. Parent rating forms from the Behavior Rating Inventory of Executive Function (BRIEF) Emotional Control subscale (EC) and the Behavioral Assessment Scale for Children, Second Edition (BASC-2) Internalizing Problems Composite score (IP) were used as a measure of participants' emotional control capacity. A multivariate analysis of covariance (MANCOVA) was employed to assess for significant differences between all three groups for CPT II RT, BRIEF EC, and BASC-2 IP, controlling for age, education, sex, and race. RESULTS: The MANCOVA yielded a significant overall model for group [F (6, 26) = 6.89, p < .01], controlling for age (p = .08), education (p < .01), sex (p = .13), and race (p = .02). There was a significant main effect for CPT II RT [F (2) = 8.31, p < .01] and BASC-2 IP [F (2) = 3.96, p < .04], with respectable effect sizes (η2 = .56 and .35, respectively). There was a moderately significant main effect for BRIEF EC [F (2) = 3.65, p = .051] with a moderate effect size (η2 = .33). Post hoc analyses revealed significant differences between the internalizing disorder and comorbid groups (p = .048) for CPT II RT, with slower reaction times in the internalizing disorders than comorbid groups. Significant differences were also observed between the ADHD and internalizing disorders groups (p < .01) as well as between the ADHD and comorbid groups (p = .03) for BASC-2 IP, with greatest elevation in the internalizing disorders, followed by the comorbid and ADHD groups. There were significant differences between the ADHD and the internalizing disorder groups (p = .04) as well as between the ADHD and comorbid groups (p = .01) for BRIEF EC. Of note, mean CPT II RT performance was in the normal range across the groups. All other pairwise comparisons were nonsignificant. DISCUSSION: In this study we explored associations between cognitive inefficiency and emotional dysregulation in order to further our understanding of the ways in which emotional and executive functions are related. We focused on differences between groups of three specific populations (i.e., ADHD, internalizing disorders and comorbid ADHD and internalizing disorders). The co-occurrence of ADHD and internalizing disorders may have important implications for assessment and treatment. Results such as these could be useful in determining whether treating one type of internalizing symptomatology may improve the other, and can allow providers to make more informed decisions about how to better assist children with comorbid conditions.Item ImPACT™ Performance of High School Student Athletes with ADHD(2015-08-31) Gomez, Brooke Marie; Silver, Cheryl H.; Resch, Jacob; Cullum, C. MunroBACKGROUND: To date, two studies demonstrate that adolescents with ADHD tend to perform poorer on the Immediate Post-Concussion Assessment and Cognitive Test (ImPACT; Lovell, 2013) at baseline than do adolescents without ADHD at baseline (Elbin et al., 2013; Zuckerman, Lee, Odom, Solomon, & Sills, 2013). In an effort to replicate and extend these studies, the baseline and immediate post-concussion performance of high school athletes with and without ADHD were evaluated to identify potential differences between groups on the ImPACT’s domains. SUBJECTS: Student athletes were recruited from a private high school. Baseline testing was conducted biannually to establish pre-injury/baseline levels of individual participants. Thirty-eight students with ADHD and a matched control group of thirty-eight students without ADHD were used to test the first hypothesis. Twenty-three students with ADHD and a matched control group of twenty-three students without ADHD who sustained a concussion were used to test the second and third hypotheses. Additional analyses were performed on data from four student athletes with ADHD who sustained a concussion. METHOD: Data were used from a larger study conducted by a large public metropolitan university. Variables included demographic information and the ImPACT. All data were stored on an encrypted computer or in a locked file cabinet. RESULTS: Independent samples t-tests revealed significant differences between athletes with ADHD and non-ADHD athletes at baseline on the Impulse Control (t (74) = 2.73, p < .01) and the Total Symptoms (t(74)= 2.63, p < .05) scores of the ImPACT. A multivariate analysis of variance (MANOVA) was conducted on data from two time periods. A statistically significant difference (F(6, 39) = 2.86, p = .02; Wilks’ ? = 0.694; ?2 = .31) in ImPACT performance was found between non-concussed athletes with ADHD tested at baseline and concussed athletes without ADHD tested within 72 hours of injury (M = 1.83 days). Further analysis using independent samples t-tests found that athletes with ADHD at baseline performed significantly better than concussed athletes without ADHD tested within 72 hours of injury, on the following composites: Verbal Memory (t(44)= 2.25, p < .05), Visual Motor Speed (t(44)= 2.33, p < .05), Reaction Time (t(44)= -3.42, p < .01), and Total Symptoms (t(44)= -3.52, p < .01). No significant between-group differences were found on the Visual Memory or Impulse Control composites of the ImPACT. DISCUSSION: These findings indicate that administration of the ImPACT to individuals with ADHD is appropriate. At baseline, both groups performed similarly on Verbal Memory, Visual Memory, Visual Motor Speed and Reaction Time. However, the overlap in ADHD and concussion profiles on Impulse Control and Visual Memory warrant caution in the clinical interpretation of the ImPACT profiles of individuals with ADHD. Nevertheless, these findings suggest that the overall use of normative data within an ADHD population is appropriate, and baseline testing has values for athletes with ADHD.Item Mild Traumatic Brain Injury Rehabilitation: A Model for ADHD Treatment(2016-11-18) Yates, Ashley Nicole; Silver, Cheryl H.; Brewer-Mixon, Karen; Fulbright, Richard L.Attention Deficit Hyperactivity Disorder (ADHD) is a condition that affects approximately 4.4% of adults in the U.S. (Kessler et al., 2006) and is most commonly treated with psychopharmacological interventions. More recently, non-pharmacological interventions have been developed for ADHD. Cognitive Behavioral Therapy (CBT) has emerged as an efficacious treatment for ADHD and typically consists of training compensatory strategies and the use of external aids. The aims of this thesis were to examine the similarities between ADHD and mild Traumatic Brain Injury (mTBI) as well as review treatment options for mTBI and discuss their possible usefulness in treating ADHD. Based on the literature reviewed, there were striking similarities of deficits between ADHD and mTBI, specifically in the executive functioning of both. It is hypothesized that treatment for mTBI could also be beneficial for ADHD. Currently, some of the techniques used to treat ADHD and mTBI overlap. However in, cognitive rehabilitation (CR) for TBI, there is more emphasis on remediation of deficits compared to treatment of ADHD. Also, cognitive tasks for mTBI are more often completed in a real-life setting or as close to a real-life setting as possible. At this time, the literature regarding cognitive rehabilitation specific to mTBI is somewhat limited because it continues to be a growing field of literature. However, CR in general may be a beneficial treatment for the executive functioning deficits that also commonly affect ADHD.Item Symptom Presentation in ADHD and Its Association with Inhibitory Control(2014-01-21) Loris, Colin Patrick; Silver, Cheryl H.; Stavinoha, Peter L.; Glasier, PaulAttention-Deficit/Hyperactivity Disorder (ADHD) has been associated with problems in executive functioning (EF). However, subtype difference in EF may exist between the inattentive type of ADHD and the hyperactive/impulsive and combined types of ADHD. As small number of studies, in fact, have found that inhibitory control is more strongly related to symptoms of inattention than symptoms of hyperactivity/impulsivity, suggesting that children with the inattentive type of ADHD may have more deficits in inhibition. The D-KEFS Color Word Interference Test (CWIT) was administered to 35 children, ages 8-17 years, diagnosed previously with ADHD, to examine possible differences in inhibition between a Predominantly Inattentive group and a Combined group (Predominantly Hyperactive-Impulsive and Combined types). Both ADHD group means on the CWIT were within normal limits. Results from a MANOVA showed no differences between groups on the CWIT, except for the word reading condition (Condition 2). Analysis of the CWIT and symptoms of inattention from the Conners Parent Rating Scale-Revised showed no significant relationship between performance on the CWIT and parent report of inattentive behaviors. Contrary to the hypotheses, this study did not provide evidence that children in the Predominantly Inattentive group display more deficits in inhibition than children in the Combined group, or that deficits in inhibition are related to inattentive behaviors.