Although numerous terms have been used to describe Attention-Deficit Hyperactivity Disorder (ADHD) during the past several decades, it has continued to be conceptualized from a biological or neurological perspective. Consequently, much research has accumulated investigating possible biological and neurological causes, developing better diagnostic criteria, and accumulating medication protocols. Despite voluminous amounts of research, little consensus has been reached as to the best way to define and diagnose ADHD. Consequently, it becomes difficult to generate and test hypotheses related to the etiology, characteristics, and treatment of this disorder. One problem relates to how ADHD is conceptualized. In approaching ADHD as a psychiatric condition, assessment usually focuses on improving diagnostic precision. Similarly, most treatment research has dealt with the use of psychopharmacological agents, such as Ritalin. Yet, there are many ways to conceptualize “disorders.” We begin this article by suggesting that ADHD has become reified as a result of social and cultural factors. We present an alternative conceptualization based on a functional approach to the assessment and treatment of ADHD. Based on this functional approach, we present a model for classifying performance problems that can be used to guide the selection of appropriate intervention techniques.
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References
1.
AbikoffH. (1992). Cognitive training in ADHD children: Less to it than meets the eye. In ShaywitzS.E., & ShaywitzB.A. (Eds.), Attention deficit disorder comes of age (pp. 261–272). Austin, TX: Pro-Ed.
2.
AchenbachT. M. (1980). DSM-III in light of empirical research on the classification of child psychopathology.Journal of the American Academy of Child Psychiatry, 19, 395–412.
3.
American Psychiatric Association. (1980). Diagnostic and statistical manual of mental disorder (3rd ed.). Washington, DC: Author.
4.
American Psychiatric Association. (1987). Diagnostic and statistical manual of mental disorder (3rd ed. rev). Washington, DC: Author.
5.
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorder (4th ed.). Washington, DC: Author.
6.
AtkinsM.S., & PelhamW.E. (1992). School-based assessment of attention deficit-hyperactivity disorder. In ShaywitzS.E., & ShaywitzB.A. (Eds.), Attention deficit disorder comes of age (pp. 69–88), Austin, TX: Pro-Ed.
7.
BanduraA. (1977). Social learning theory.Englewood Cliffs, NJ: Prentice-Hall.
8.
BanduraA. (1978). The self system in reciprocal determinism.American Psychologist, 33, 344–358.
9.
BarkerR.G. (1968). Ecological psychology: Concepts and methods for studying the environment of human behavior.Palo Alto, CA: Stanford University Press.
10.
BarkleyR. A. (1990). Attention deficit hyperactivity disorder: A handbook for diagnosis and treatment.New York: Guilford Press.
11.
BeckS., ForehandR., NeeperR., & BaskinC. (1982). A comparison of two analogue strategies for assessing children's social skills.Journal of Consulting and Clinical Psychology, 50, 596–597.
12.
BijouS.W., PetersonR.F., & AultM.H. (1968). A Method to integrate descriptive and experimental field studies at the level of data and empirical concepts.Journal of Applied Behavior Analysis, 1, 175–191.
CampbellS.B. (1990). Behavior problems in preschool children: Clinical and developmental issues.New York: Guilford.
15.
CarlsonC.L., LaheyB.B., FrameC.L., WalkerJ., & HyndG.W. (1987). Sociometric status of clinic-referred children with attention deficit disorders with and without hyperactivity.Journal of Abnormal Child Psychology, 15, 537–547.
16.
ClementsS.D., & PetersJ.E. (1962). Minimal brain dysfunction in the school-age child.Archives of General Psychiatry, 6, 185–197.
17.
CullinanD., EpsteinM.H., & LloydJ.W. (1983). Behavior disorders of children and adolescents.Englewood Cliffs, NJ: Prentice-Hall.
18.
DodgeK.A. (1989). Problems in social relationships. In MashE.J., & BarkleyR.A. (Eds.), Treatment of childhood disorders (pp. 222–244). New York: Guilford.
19.
DouglasV.I. (1983). Attention and cognitive problems. In RutterM. (Ed.), Developmental neuropsychiatry (pp. 280–329). New York: Guilford.
20.
DraegerS., PriorM., & SansonA. (1986). Visual and auditory attention performance in hyperactive children: Competence or compliance.Journal of Abnormal Child Psychology, 14, 411–424.
21.
ElliottS.N., GreshamF.M., & HefferR.W. (1987). Social-skills interventions: Research findings and training techniques. In MaherC.A., & ZinsJ.E. (Eds.), Psychoeducational interventions in the schools (pp. 141–159). New York: Pergamon.
FrickP.J., & LaheyB.B. (1991). The nature and characteristics of attention-deficit hyperactivity disorder.School Psychology Review, 20, 163–173.
24.
GableR.A., HendricksonJ.M., WarrenS.F., EvansW.H., & EvansS.S. (1988). The promise and pitfalls of an ecological perspective on children's behavioral disorders. In RutherfordR.B.Jr., & MaagJ. W. (Eds.), Severe behavior disorders of children and youth (Vol. 11, pp. 156–166). Reston, VA: Council for Children with Behavioral Disorders.
25.
GoodmanG., & PoillionM.J. (1992). ADD: Acronym for any dysfunction or difficulty.Journal of Special Education, 26, 37–56.
26.
GordonM. (1991). ADHD/hyperactivity: A consumer's guide.Dewitt, NY: GSI Publications.
27.
GreenwoodC.R., & CartaJ.J. (1987). An ecobehavioral interaction analysis of instruction within special education.Focus on Exceptional Children, 19(9), 1–12.
28.
GreshamF.M. (1985). Utility of cognitive-behavioral procedures for social skills training with children: A critical review.Journal of Abnormal Child Psychology, 13, 411–423.
29.
GreshamF.M., & ElliottS.N. (1984). Assessment and classification of children's social skills: A review of methods and issues.School Psychology Review, 13, 292–301.
30.
HamlettK.W., PellegriniD.S., & ConnersC.K. (1987). An investigation of executive processes in the problem-solving of attention deficit disorder-hyperactive children.Journal of Pediatric Psychology, 12, 227–240.
31.
HarrisK.R. (1985). Conceptual, methodological, and clinical issues in cognitive-behavioral assessment.Journal of Abnormal Child Psychology, 13, 373–390.
32.
HinshawS. P. (1987). On the distinction between attentional deficits/hyperactivity and conduct problems/aggression in child psychopathology.Psychological Bulletin, 101, 443–463.
33.
HowellK.W. (1978). Evaluation of behavior disorders. In RutherfordR.B.Jr., & PrietoA.G. (Eds.), Severe behavior disorders of children and youth (Vol. 1, pp. 116–125). Reston, VA: Council for Children with Behavioral Disorders.
34.
HowellK.W. (1985). A task-analytic approach to social behavior.Remedial and Special Education, 6(2), 24–30.
KanferF.H., & Gaelick-BuysL. (1991). Self-management methods. In KanferF.H., & GoldsteinA.P. (Eds.), Helping people change (4th ed., pp. 305–360). New York: Pergamon.
40.
KaslowN.J., & RehmL.P. (1991). Childhood depression. In MorrisR.J., & KratochwillT.R. (Eds.), The practice of child therapy (2nd ed., pp. 27–51). New York: Pergamon.
KinsbourneM. (1977). The mechanism of hyperactivity. In BlauM., RapinI., & KinsbourneM. (Eds.), Topics in child neurology (pp. 289–307). New York: Spectrum.
45.
KoriathU., GualtieriM. D., Van BourgondienM. E., QuadeD., & WerryJ. S. (1985). Construct validity of clinical diagnosis in pediatric psychiatry: Relationship among measures.Journal of the American Academy of Child Psychiatry, 24, 429–436.
46.
KupersmidtJ.B., CoieJ.D., & DodgeK.A. (1990). The role of poor peer relationships in the development of disorder. In AsherS.R., & CoieJ.D. (Eds.), Peer rejection in childhood (pp. 274–305)., New York: Cambridge University Press.
47.
LaheyB.B., SchaughencyE.A., FrameC.L., & StraussC.C. (1985). Teacher ratings of attention problems in children experimentally classified as exhibiting attention deficit disorders with and without hyperactivity.Journal of the American Academy of Child and Adolescent Psychiatry, 24, 613–616.
48.
LaheyB.B., SchaughencyE.A., HyndG., CarlsonC.L., & NievesN. (1987). Attention deficit disorder with and without hyperactivity: Comparison of behavioral characteristics of clinic-referred children.Journal of the American Academy of Child and Adolescent Psychiatry, 26, 718–723.
49.
LaheyB.B., StraussC.C., & FrameC.L. (1984). Are attention deficit disorders with and without hyperactivity similar or dissimilar disorders?Journal of the American Academy of Child and Adolescent Psychiatry, 23, 302–309.
50.
LandauS., & MilichR. (1988). Social communication patterns of attention-deficit-disordered boys.Journal of Abnormal Child Psychology, 16, 69–81.
51.
LandauS., & MooreL.A. (1991). Social skill deficits in children with attention-deficit hyperactivity disorder.School Psychology Review, 20, 235–251.
52.
LochmanJ.E., & LampronL.B. (1986). Situational social problem-solving skills and self-esteem of aggressive and nonaggressive boys.Journal of Abnormal Child Psychology, 14, 605–617.
53.
LukS. (1985). Direct observations studies of hyperactive behaviors.Journal of the American Academy of Child Psychiatry, 24, 338–344.
54.
MaagJ.W. (1989). Assessment in social skills training: Methodological and conceptual issues for research and practice.Remedial and Special Education, 10(4), 6–17.
55.
MaagJ.W. (1990). Social skills training in schools.Special Services in the Schools, 6, 1–19.
56.
MaagJ.W. (1992). Integrating consultation into social skills training: Implications for practice.Journal of Educational and Psychological Consultation, 3, 233–258.
57.
MaagJ.W., & FornessS.R. (1991). Depression in children and adolescents: Identification, assessment, and treatment.Focus on Exceptional Children, 24(1), 1–19.
58.
McBurnettK., LaheyB.B., & PfiffnerL.J. (1993). Diagnosis of attention deficit disorders in DSMIV: Scientific basis and implications for education.Exceptional Children, 60, 108–117.
59.
McConnellS.R. (1987). Entrapment effects and the generalization and maintenance of social skills training for elementary school students with behavioral disorders.Behavioral Disorders, 12, 252–263.
60.
McKnightD.L., NelsonR.O., HayesS.C., & JarrettR.B. (1984). Importance of treating individually assessed response classes in the amelioration of depression.Behavior Therapy, 15, 315–335.
MeichenbaumD., & ButlerL. (1980). Cognitive ethology: Assessing the streams of cognition and emotion. In BlanksteinK., PlinerP., & PolivyJ. (Eds.), Assessment and modification of emotional behavior (Vol. 6, pp. 1–53). New York: Plenum.
63.
MilichR., & LandauS. (1982). Socialization and peer relations in hyperactive children. In GadowK.D., & BialerI. (Eds.), Advances in learning and behavioral disabilities (Vol. 1, pp. 283–339). Greenwich, CT: JAI Press.
64.
MilichR., LandauS., KilbyG., & WhittenP. (1982). Preschool peers perceptions of the behavior of hyperactive and aggressive children.Journal of Abnormal Child Psychology, 10, 497–510.
65.
MilichR., LoneyJ., & LandauS. (1982). The independent dimensions of hyperactivity and aggression: A validation with playroom observation data.Journal of Abnormal Psychology, 91, 183–198.
66.
NeelR.S., & CessnaK.K. (1990). Maybe this behavior does make sense. In RutherfordR.B.Jr., & DiGangiS.A. (Eds.), Severe behavior disorders of children and youth (Vol. 13, pp. 18–22). Reston, VA: Council for Children with Behavioral Disorders.
67.
NoblitG.W., PaulJ.L., & SchlechtyP. (1991). The social and cultural construction of emotional disturbance. In PaulJ.L., & EpanchinB.C. (Eds.), Educating emotionally disturbed children and youth: Theories and practices for teachers (pp. 218–242). New York: Merrill.
68.
ParkerJ.G., & AsherS.R. (1987). Peer relations and later personal adjustment: Are low-accepted children at risk?Psychological Bulletin, 102, 357–389.
69.
PelhamW.E., & BenderM.E. (1982). Peer relationships in hyperactive children: Description and treatment. In GadowK.D., & BialerI. (Eds.), Advances in learning and behavioral disabilities (Vol. 1, pp. 365–436). Greenwich, CT: JAI Press.
70.
PlatzmanK.A., StoyM.R., BrownR.Y., Coles,CD., SmithI.E., & FalekA. (1992). Review of observational methods in attention deficit hyperactivity disorder (ADHD): Implications for diagnosis.School Psychology Quarterly, 7, 155–177.
71.
PriorM., & SansonA. (1986). Attention deficit disorder with hyperactivity: A critique.Journal of Child Psychology and Psychiatry, 27, 307–319.
72.
RamirezS.Z., KratochwillT.R., & MorrisR.J. (1987). Childhood anxiety disorders. In MichelsonL., & AscherL.M. (Eds.), Anxiety and stress disorders: Cognitive-behavioral assessment and treatment (pp. 149–175). New York: Guilford.
73.
ReidR. (1993). Implementing self-monitoring interventions in the classroom: Lessons from research. In RutherfordR.B.Jr., & MathurS.R. (Eds.), Severe behavior disorders of children and youth (Vol. 16, pp. 43–54). Reston, VA: Council for Children with Behavioral Disorders.
74.
ReidR., & KatsiyannisA. (in press). ADHD and Section 504.Remedial and Special Education.
75.
ReidR., MaagJ.W., & VasaS.F. (1994). Attention deficit hyperactivity disorder as a disability category: A critique.Exceptional Children, 60, 198–214.
76.
ReidR., VasaS.F., MaagJ.W., & WrightC. (1994). An analysis of teachers’ perceptions of attention-deficit hyperactivity disorder.Journal of Research and Development in Education, 27, 195–202.
77.
RenshawP.D., & AsherS.R. (1982). Social competence and peer status: The distinction between goals and strategies. In RubinK.W., & RossH.S. (Eds.), Peer relationships and social skills in children (pp. 375–395). New York: Springer-Verlag.
78.
RhodesW. (1970). A community participation analysis of emotional disturbance.Exceptional Children, 36, 309–314.
79.
RichardsonJ.G. (1980). Historical change in school classification.Educational Research Quarterly, 5, 50–62.
80.
RutterM. (1983). Introduction: Concepts of brain dysfunction syndromes. In RutterM. (Ed.), Developmental neuropsychology (pp. 1–11). New York: Guilford.
81.
SalendS.J., & MeddaughD. (1985). Using a peer-mediated extinction procedure to decrease obscene language.The Pointer, 30(1), 8–11.
82.
SassoG.M., & ReimersT.M. (1988). Assessing the functional properties of behavior: Implications and applications for the classroom.Focus on Autistic Behavior, 3, 1–15.
83.
SchaughencyE.A., & RothlindJ. (1991). Assessment and classification of attention deficit hyperactivity disorders.School Psychology Review, 20, 187–202.
84.
SegalZ.V., & ShawB.F. (1988). Cognitive assessment. In DobsonK.S. (Ed.), Handbook of cognitive-behavioral therapies (pp. 39–81). New York: Guilford.
85.
ShaywitzS. E., & ShaywitzB. A. (1988). Attention deficit disorder: Current perspectives. In KavanaghJ. G., & TrussT. J.Jr. (Eds.), Learning disabilities: Proceedings of the national conference (pp. 369–523) Parkton, MD: New York Press.
86.
ShoresR.E. (1988). Highlighting analysis in applied behavior analysis: Designing and analyzing single subject research. In RutherfordR.B.Jr., & MaagJ.W. (Eds.), Severe behavior disorders of children and youth (Vol. 11, pp. 144–155). Reston, VA: Council for Children with Behavioral Disorders.
87.
ShureM.B., & SpivackG. (1972). Means-ends thinking, adjustment and social class among elementary school-age children.Journal of Consulting and Clinical Psychology, 38, 348–353.
88.
SkinnerB.F. (1953). Science and human behavior.New York: Macmillan.
89.
SkinnerB.F. (1987). Whatever happened to psychology as the science of behavior?American Psychologist, 42, 780–786.
90.
SleeterC.E. (1986). Learning disabilities: The social construction of a special education category.Exceptional Children, 53, 46–54.
91.
SnowR.E., & FarrM.J. (1984). Aptitude, learning, and instruction, Vol. 3: Cognitive and affective process analysis.Hillsdale, NJ: Lawrence Erlbaum.
92.
StraussA.A., & LehtinenL.E. (1947). Psychopathology and education of the brain-injured child.New York: Guilford.
93.
SwansonJ.M., McBurnettK., WigalT., PfiffnerL.J., LernerM.A., WilliamsL., ChristianD.L., TarnmL., WillcuttE., CrowleyK., ClevengerW., KhouzamN., WooC., CrinellaF.M., & FisherT.D. (1993). Effect of stimulant medication on children with attention deficit disorder: A “review of reviews.”Exceptional Children,60, 154–162.
94.
TantJ.L., & DouglasV.I. (1982). Problem solving in hyperactive, normal, and reading-disabled boys.Journal of Abnormal Child Psychology, 10, 285–306.
95.
TaylorE. (1989). On the epidemiology of hyperactivity. In SagnoldenT., & ArcherT. (Eds.), Attention deficit disorder: Clinical and Basic Research (pp. 31–52) Hillsdale NJ: Lawrence Erlbaum.
96.
TrowerF., YardleyK., BryantB.M., & ShawP. (1978). The treatment of social failure: A comparison of anxiety-reduction and skills-acquisition procedures on two social problems.Behavior Modification, 2, 41–60.
97.
UllmanD.G., BarkleyR.A., & BrownH.W. (1978). The behavioral symptoms of hyperkinetic children who successfully responded to stimulant drug treatment.American Journal of Orthopsychiatry, 48, 425–437.
98.
VoelkerS.L., CarterR.A., SpragueD.J., GdowskiC.L., & LacharD. (1989). Developmental trends in memory and metamemory in children with attention deficit disorder.Journal of Pediatric Psychology, 14, 75–88.
99.
WakefieldJ.C. (1992). The concept of mental disorders: On the boundary between biological facts and social values.American Psychologist, 47, 373–388.
100.
WallanderJ.L., & HubertN.C. (1985). Long-term prognosis for children with attention deficit disorder with hyperactivity (ADD/H). In LaheyB.B., & KazdinA.E. (Eds.), Advances in clinical child psychology (Vol. 8, pp. 114–147). New York: Plenum.
101.
WeinbergW.A., & BrumbackR.A. (1992). The myth of attention deficit-hyperactivity disorder: Symptoms resulting from multiple causes.Journal of Child Neurology, 7, 431–445.
102.
WhalenC. K. (1989). Attention deficit and hyperactivity disorders. In OllendickT. H., & HersenM. (Eds.), Handbook of Child Psychopathology (2nd ed., pp. 131–169). New York: Plenum.
103.
WhalenC.K., & HenkerB. (1985). The social worlds of hyperactive children.Clinical Psychology Review, 5, 1–32.
104.
WhalenC.K., & HenkerB. (1992). Social impact of stimulant treatment for hyperactive children. In ShaywitzS.E., & ShaywitzB.A. (Eds.), Attention deficit disorder comes of age (pp. 323–348), Austin, TX: Pro-Ed.
105.
WhalenC.K., HenkerB., CollinsB.E., McAuliffeS., & VauxA. (1979). Peer interaction in a structured communication task: Comparisons of normal and hyperactive boys and of methylphenidate (Ritalin) and placebo effects.Child Development, 50, 388–401.
106.
WolraichM. L., LindgrenS., StromquistA., MilichR., DavisC., & WatsonD. (1990). Stimulant medication use by primary care physicians in the treatment of attention deficit hyperactivity disorder.Pediatrics, 86, 95–101.
107.
YoungK.R., SmithD.J., WestR.P., & MorganD.P. (1987). A peer-mediated program for teaching self-management strategies to adolescents. In BraatenS., RutherfordR.B.Jr., & MaagJ.W. (Eds.), Programming for adolescents with behavioral disorders (Vol. 3, pp. 34–47). Reston, VA: Council for Children with Behavioral Disorders.
108.
YsseldykeJ.E., AlgozzineB.A., & ThurlowM.L. (1992). Critical issues in special education (2nd ed.). Boston: Houghton Mifflin.
109.
ZentallS.S. (1985). A context for hyperactivity. In GadowK.D., & BialerI. (Eds.), Advances in learning and behavioral disabilities (Vol. 4, pp. 273–343). Greenwich, CT: JAI Press.
110.
ZentallS.S., & MeyerM.J. (1987). Self-regulation of stimulation for ADHD children during reading and vigilance task performance.Journal of Abnormal Child Psychology, 15, 519–536.
