Reducing Hyperactivity with a Feedback Actigraph: Initial Findings

Abstract

Schulman and colleagues demonstrated that classroom activity level can be reduced in hyperactive boys using activity-level feedback and positive reinforcement. This article reports preliminary results using a device that combines modern beeper and actigraphy technology for the purpose of measuring, monitoring, and modifying motor excess in children with confirmed diagnoses of Attention Deficit Hyperactivity Disorder (ADHD). Nine boys ranging in age from 8 to 9 years with the ADHD Combined Type wore prototype BuzzBee® feedback actigraphs during school periods and were reinforced for activity-level reductions in the context of a simple pre/post research design. The findings indicated that 7 of the 9 boys reduced their activity level from 20 to 47% of baseline levels while the activity levels of the two remaining boys increased from 2 to 7% of baseline levels. These changes were statistically significant and constitute a large effect.

Keywords

actigraphy ADHD biofeedback positive reinforcement

Get full access to this article

View all access options for this article.

References

Achenbach, T. M. , & Edelbrock, C. S. (1978). The classification of child psychopathology: A review and analysis of empirical efforts . Psychological Bulletin, 85, 1275-1301 .

American Psychiatric Association [APA] . (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author .

August, G. J. , Stewart, M. A. , & Holmes, C. S. (1983). A four-year follow-up of hyperactive boys with and without conduct disorder . British Journal of Psychiatry, 143, 192-198 .

Barkley, R. A. (1990). Attention deficit hyperactivity disorder: A handbook for diagnosis and treatment. New York: Guilford Press .

Barkley, R. A. (1997). Behavioral inhibition, sustained attention and executive functions: Constructing a unifying theory of ADHD . Psychological Bulletin, 121, 65-94 .

Barkley, R. A. , Fischer, M. , Edelbrock, C. S. , & Smallish, L. (1990). The adolescent outcome of hyperactive children diagnosed by research criteria: I. An 8-year prospective follow-up study . Journal of the American Academy of Child and Adolescent Psychiatry, 29, 546-557 .

Gittelman, R. , Mannuzza, S. , Shenker, R. , & Bonagura, N. (1985). Hyperactive boys almost grown up: 1. Psychiatric status . Archives of General Psychiatry, 42, 937-947 .

Hinshaw, S. P. (1987). On the distinction between attention deficit/hyperactivity and conduct problems/aggression in child psychopathology . Psychological Bulletin, 101, 443-463 .

Hinshaw, S. P. (1992). Externalizing behavior problems and academic underachievement in childhood and adolescence: Causal relationships and underlying mechanisms . Psychological Bulletin, 111, 127-155 .

10.

Hinshaw, S. P. (1994). Attention deficits and hyperactivity in children. London: SAGE Publications .

11.

Jensen, P. S. , Bhatara, V. S. , Vitello, B. , Hoagwood, K. , Fell, M. , & Burke, L. B. (1999). Psychoactive medication prescribing practices for US children: Gaps between research and clinical practice . Journal of the American Academy of Child and Adolescent Psychiatry, 38, 557-565 .

12.

Kamphaus, R. W. , & Frick, P. J. (1996). Clinical assessment of child and adolescent personality and behavior. Boston: Allyn and Bacon .

13.

Loney, J. , Whaley-Klahn, M. A. , Kosier, T. , & Conboy, J. (1983). Hyperactive boys and their brothers at 21: Predictors of aggressive and antisocial outcomes. In K. T. van Dusen , & S. A. Mednick (Eds.), Prospective studies of crime and delinquency (pp 181-206). Boston: Kluwer-Nijhoff .

14.

Mannuzza, S. , Klein, R. G. , & Addalli, K. A. (1991). Young adult mental status of hyperactive boys and their brothers: A prospective follow-up study . Journal of the American Academy of Child and Adolescent Psychiatry, 30, 743-751 .

15.

Milich, R. , Hartung, C. M. , Martin, C. A. , & Haigler, E. D. (1994). Behavioral disinhibition and underlying processes in adolescents with disruptive behavior disorders. In D. K. Routh (Ed.), Disruptive behavior disorders in childhood (pp. 109-139). New York: Plenum .

16.

MTA Co-operative Group . (1999). A 14-month randomized clinical trial of treatment strategies for Attention Deficit/Hyperactivity Disorder . Archives of General Psychiatry, 56, 1073-1086 .

17.

National Institutes of Health [NIH] . (2000). National Institutes of Health consensus development conference statement: Diagnosis and treatment of Attention Deficit/Hyperactivity Disorder (ADHD) . Journal of the American Academy of Child and Adolescent Psychiatry, 39, 182-193 .

18.

Pelham, W. E. , Burrows-MacLean, L. , Gnagy, E. M. , Fabiano, G. A. , Coles, E. K. , Tresco, K. E. , et al. (2005). Transdermal methylphenidale, behavioral, and combined treatment for children with ADHD . Experimental and Clinical Psychopharmacology, 13, 111-126 .

19.

Pennington, B. F. , & Ozonoff, S. (1996). Executive functions and developmental psychopathology . Journal of Child Psychology and Psychiatry, 37, 51-87 .

20.

Porrino, L. J. , Rapoport, J. L. , Behar, D. , Ismond, D. R. , & Bunney, W. E., Jr. (1983). A naturalistic assessment of the motor activity of hyperactive boys II: Stimulant drug effects . Archives of General Psychiatry, 40, 688-693 .

21.

Porrino, L. J. , Rapoport, J. L. , Behar, D. , Sceery, W. , Ismond, D. R. , & Bunney, W. E., Jr. (1983). A naturalistic assessment of the motor activity of hyperactive boys I: Comparison with normal controls . Archives of General Psychiatry, 40, 681-687 .

22.

Rapaport, J. L. , Buchsbaum, M. S. , Zahn, T. P. , Weingartner, H. , Ludlow, C. , & Mikkesen, E. J. (1978). Dextroamphetamine: Cognitive and behavioral effects in normal prepubertal boys . Science, 199, 560-563 .

23.

Safer, D. J. , Zito, J. M. , & Fine, E. M. (1996). Increased methylphenidate usage for attention deficit disorder in the 1990s . Pediatrics, 98, 1084-1088

24.

Schachar, R. J. , Tannock, R. , Marriott, M. , & Logan, G. (1995). Deficient inhibitory control in attention deficit hyperactivity disorder . Journal of Abnormal Child Psychology, 23, 411-437 .

25.

Schulman, J. L. , Stevens, T. M. , & Kupst, M. J. (1977). The Biomotometer: A new device for the measurement and remediation of hyperactivity . Child Development, 48, 1152-1154 .

26.

Schulman, J. L. , Stevens, T. M. , Suran, B. G. , Kupst, M. J. , & Naughton, M. J. (1978). Modification of activity level through biofeedback and operant conditioning . Journal of Applied Behavior Analysis, 11, 145-152 .

27.

Schulman, J. L. , Suran, B. G. , Stevens, T. M. , & Kupst, M. J. (1979). Instructions, feedback, and reinforcement in reducing activity levels in the classroom . Journal of Applied Behavior Analysis, 12, 441-447 .

28.

Shaffer, D. , Fisher, P. , Lucas, C. P. , Dulcan, M. K. , & Schwab-Stone, M. E. (2000). NIMH Diagnostic Interview Schedule for Children Version IV (NIMH DISC-IV): Description, differences from previous versions, and reliability of some common diagnoses . Journal of the American Academy of Child and Adolescent Psychiatry, 39, 28-38 .

29.

Swanson, J. M. , Gupta, S. , Williams, L. , Agler, D. , Lerner, M. , & Wigla, S. (2002). Efficacy of a new pattern of delivery of methylphenidate for the treatment of ADHD: Effects on activity level in the classroom and on the playground . Journal of the American Academy of Child and Adolescent Psychiatry, 41, 1306-1314 .

30.

Tannock, R. , & Schachar, R. (1996). Executive dysfunction as an underlying mechanism of behavior and language problems in attention deficit hyperactivity disorder. In J. H. Beitchman , N. J. Cohen , M. M. Konstantareas , & R. Tannock (Eds.), Language, learning and behavior disorders: Developmental, biological, and clinical perspectives (pp. 128-155). New York: Cambridge University Press .

31.

Taylor, E. (1994). Syndromes of attention deficit and overactivity. In R. M. Taylor & E. Hersov (Eds.), Child and adolescent psychiatry: Modern approaches (pp. 285-307). Oxford: Blackwell .

32.

Taylor, E. , Chadwick, O. , Heptinstall, E. , & Danckaerts, M. (1996). Hyperactivity and conduct problems as risk factors for adolescent development . Journal of the American Academy of Child and Adolescent Psychiatry, 35, 1213-1226 .

33.

Thorley, G. (1984). Clinical characteristics and outcome of hyperactive children. Unpublished PhD thesis, University of London, UK.

34.

Tryon, W. W. (1991). Activity measurement in psychology and medicine. New York: Plenum Press .

35.

Tryon, W. W. (2005). The reliability and validity of two ambulatory monitoring actigraphs . Behavior Research Methods Instruments & Computers, 37, 492-497 .

36.

Tryon, W. W. , & Williams, R. (1996). Fully proportional actigraphy: A new instrument . Behavior Research Methods Instruments & Computers, 28, 392-403 .

37.

Zito, J. M. , Safer, D. J. , dosReis, S. , Gardner, J. F. , Boles, M. , & Lynch, F. (2000). Trends in the prescribing of psychostimulant medications to preschoolers . Journal of the American Medical Association, 283, 1025-1033 .