BEHAVIORAL HISTORY OF ATTENTION DEFICIT DISORDER

Behavioral History of Attention Deficit Disorder and the Natural Course of the Attention Deficit Disorder Syndrome: A longitudinal study of the long-term outcome of attention deficit disorderrelated behavior.

Debra Franckowiak and Heather Walen-Frederick

Walden University January 16, 2011

Abstract A longitudinal study encompassing 15-years, studied 369 second grade children from non-urban areas where they were classified as displaying or not displaying behaviors commonly associated with attention deficit disorder. Further data was collected in fourth and fifth grades. Subsequent evaluations in ninth and twelfth grades involved school performance and finally, interviews were conducted 3 years post high school graduation. The results from this study indicated that it is possible to identify children who display behaviors associated with attention deficit disorder as early as 2nd grade. Overall, these children perform more poorly than their counter parts in ninth and 12th grades in both academic achievement and social adjustment. Additionally, the identified children continue to have similar issues in early adulthood.

Behavioral History of Attention Deficit Disorder and the Natural Course of the Attention Deficit Disorder Syndrome: A longitudinal study of the long-term outcome of attention deficit disorderrelated behavior.

Attention deficit disorder (ADD) has been one of the earliest developmental disorders to be identified and measured. In order to determine the symptoms and behavioral manifestations (hypersensitivity to neurological causes and limited attention span to disruptive behaviors) of ADD have been adequately quantified and managed for some years now (Rasmussen & Gillberg, 2000). In the past, what was known of this condition was limited to the clinical and psychological. This study delineates the natural course of the attention deficit disorder syndrome by assessing ADD- like behaviors among schoolchildren when they were in second, fourth, and fifth grade utilizing a behavioral questionnaire that was developed by Howell, Hussy, and Hassuk (1985) in a similar study. Further follow up was conducted three years post highschool graduation utilizing a 174-item protocol (Howell, C., Huessy, H., & Hassuk, B. Fifteenyear follow-up of a behavioral history of attention deficit disorder, 1985). The intent of this report is to determine whether ADD-like behaviors as identified by instructors is related to the students academic performance and experiences in school.

Method Participants

Participants were 216 students (54% boys, 46% girls) from one of 18 schools in northwestern Vermont. The schools were chosen in such a way to produce a reasonable cross section of rural schools within 40 miles of Burlington, VT. Age at first assessment, family background, racial/ethnic identity and other background variables were not assessed. Procedure All participants were part of a larger study conducted by Howell, Huessy, and Hassuk (1985). The original study began with 501 children in the second grade and consisted of six stages of data collection: 2nd grade, 4th grade, 5th grade, 9th grade, 12th grade, and 3 years post graduation. The first three assessments were collected via the childs current teacher, the second two assessments were collected via school records and the final assessment was an extensive interview. Due to normal attrition, the sample size was reduced to 352 children by the end of the fifth grade. The present study utilizes data collected during all six collection periods and includes only those for whom complete data is available (N = 216). Measures Gender. The gender of the child was collected via a questionnaire completed by the childs second grade teacher. Grade repetition. Whether or not the child repeated a grade during high school was assessed via school records at the end of the 12th grade. English level. The level of English class the child was enrolled in was assessed via the school record in the ninth grade. The three categories were: remedial, general and college preparatory. English grade. The grade the child received in English during the ninth grade was assessed via school records. Grades were: A, B, C, D, or F.

Social adjustment problems. Whether or not the child exhibited any social adjustment problems in the ninth grade was assessed via school records. A child was considered to have a social adjustment problem if there were at least two notations in the record of infractions like disruptive classroom behavior, truancy, or setting fires in trash cans. High school dropout status. Whether or not the participant dropped out before completing high school was obtained from the interview conducted approximately three years post high school graduation. ADD-like behavior score. ADD-like behavior score is the average of three scores obtained during the second, fourth and fifth grades. Each childs current teacher was asked to complete the form. The diagnostic instrument was a 21-item questionnaire that tapped behavioral components commonly associated with ADD. Teachers rated each child on a scale from 1 (low behavior) to 5 (high behavior), where 3 indicated an average level of behavior. For each of the three assessments, the 21 items were summed to obtain a total score. The score used in the present study reflect an average of these three assessments. Howell et al. (1985) reported high reliability (Cronbachs alpha ranged from .93.96 across the three assessments), and good validity for the measure. Intelligence quotient (IQ). IQ was assessed via a group administered Intelligence Test. Grade point average (GPA). Overall high school GPA was collected from school records at the end of the 12th grade. GPA was calculated using the following scale: A=4, B=3, C=2, D=1, F=0.

Results Descriptive Statistics Descriptive statistics for the variables used in this study are in Tables 1 & 2

Table 1 School experiences of participants (n=216) Repeated a grade Yes No Social adjustment problems Yes No High school drop out Yes No 9 Grade English Level prep General Remedial 9 Grade English Grade
th th

Frequency 20 196 25 191 20 196 College 29 154 33 28 82 78 25 3

Percent 9.3 90.7 11.6 88.4 9.3 90.7 13.4 71.3 15.3 13 38 36 11.6 1.4

A B C D F

The data presented in this table represents the experiences of the participants in school identified during their 9th grade data gathering. The data in the table indicates that 9.3% of the students were asked to repeat a grade while 11.6% of the students indicated that they have had social adjustment problems and 9.3% did not complete high school. This table also presents the 9th grade students' English proficiency level along with the letter grades in English class. English proficiency was categorized as performing in the college preparatory, general, or remedial ranking of which 71.3% of the students were categorized as proficient in the general

level of English. English letter grades ranged from A to F, wherein the majority of the participants had a grade of B (38%), or a grade of C (36.1%).

Table 2 Mean and Standard Deviation of ADD-like scores, IQ and GPA (n=216) Mean ADD-like behavior scores (mean of 3) IQ Score GPA (in 9th grade)
52.8480 102.3542 2.4386

Standard Deviation
10.45221 12.55762 .84507

Minimum 24.67 55 .25

Maximum 76.67 137 4

Table 2 presents the mean and standard deviation of the scores of the participants on the ADD-like behavior questionnaire. The data utilized was the mean of the three years that the questionnaire was administered (2nd, 4th, & 5th grade). As the table illustrates, the mean ADDlike scores of the group was 52.85 with a standard deviation of 10.45, likewise; the maximum ADD-like behavior score was 76.67 while the minimum was 24.67. The IQ scores were determined during the ninth grade of which the mean IQ is 102.35 with a standard deviation of 12.55 and the highest IQ score was 137 while the lowest was 55. The grade point average of the participants during their 9th grade experience was also surveyed. The table shows that the mean GPA for this group was 2.438 with a standard deviation of .845, the highest GPA achieved by a student was 4.0, and the lowest GPA obtained by a student was 0.25.

Behavioral History of Attention Deficit Disorder

Results for t Test Table 3. T-Test result between gender, social adjustment, dropping-out and ADD-like behavior scores (n=216) Gende Social Adjustment r ADD-like behavior scores (t) 2 95% Confidence interval *p>.05 The research question answered was Does ADD-like behaviors cause social adjustment difficulties along with a higher percentage of drop-out rates and is there a difference in ADD-like scores between genders? The hypothesis tested was: Ho: p = 0 Ha: p 0 The assumption for the t-test was that observations are independent and that the tested variables will not contribute to the ADD-like behaviors or that the ADD-like behaviors cause social adjustment problems or dropping-out. The t-test was used because the variables are Franckowiak, D. 4.33 6.84 4.23 *5.19 5.235 3.748 Dropping-out

Behavioral History of Attention Deficit Disorder single factor difference questions and are dichotomous. The results indicate that ADD-like behavior was significantly related to gender (p>4.33). The analysis of the gender means (averages) indicated that males (56.08) had a greater mean, which indicates that males had

higher ADD-like scores on the survey than females. Social adjustment and dropping-out of high school was not caused by ADD-like behavior, therefore for the hypothesis related to gender we reject the null hypothesis, and for social adjustment difficulties and the likelihood of droppingout hypothesis, we accept the null-hypothesis. Results for Analysis of Variance (ANOVA) Table 4. Analysis of Variance of ADD-like behaviors and English Proficiency Level and Grade ADD-like behavior scores Sig. p>.05 9th Grade English proficiency level 1.46 .024 9th Grade English Letter Grade 1.50 .017

The research question answered was Is English proficiency level and the letter grade achieved in the 9th grade related to ADD-like behaviors? The hypothesis tested was: Ho: p = 0 Ha: p 0 The assumption for the ANOVA was that ADD-like behaviors would not affect the English proficiency level and letter grades in English class in the 9th grade. The one-way ANOVA was used because the variables are made up of an interval scale and the question involves two variables with several categories and one dependent variable. The results indicate that at 0.05 alpha proficiency, level had .024 significance and English grades had a significance of 0.17. The significance levels of both categories are statistically significant which leads to the Franckowiak, D.

Behavioral History of Attention Deficit Disorder rejection of the null hypothesis and acceptance of the alternative hypothesis. This means that ADD-like behaviors were affecting the level of English proficiency and the letter grades of the students during the 9th grade. The analysis of the mean squares revealed that between groups (.343) in the English proficiency level was higher than the within groups (.234). These imply that ADD-like behavior was found to have an effect between categories. For the English letter grades, the mean squares of between groups (.996) was higher than the within groups (.661). This again showed that ADD-like behavior was present between categories of English letter grades. Table 5 Post hoc Analysis of ANOVA test of English proficiency and grade N
English proficiency

Type 1 43.06

Type 2

College Prep General Remedial

29 154

53.80

33 56.97 Means for groups in homogeneous subsets are displayed. a. Uses Harmonic Mean Sample Size = 42.088. b. The group sizes are unequal. The harmonic mean of the group sizes is used. Type I error levels are not guaranteed. c. Type 1/Type 2 Error Seriousness Ratio = 100. English grade A B C D 28 82 78 25 46.23 50.05 54.60 54.60 62.52 64.44

F 3 Means for groups in homogeneous subsets are displayed. a. Uses Harmonic Mean Sample Size = 11.519.

Franckowiak, D.

Behavioral History of Attention Deficit Disorder b. The group sizes are unequal. The harmonic mean of the group sizes is used. Type I error levels are not guaranteed. c. Type 1/Type 2 Error Seriousness Ratio = 100.

Results for Correlation Table 6 Pearson moment correlation r of ADD-like behavior scores and IQ scores and GPA (n=216) IQ score ADD-like behavior scores **-.629 **-.542 9th Grade GPA

** Correlation is significant at the 0.01 level (2-tailed) The research question answered was Is there any relationship between ADD-like scores, IQ scores, and GPA? The hypothesis tested was:

Ho: p = 0 Ha: p 0

The assumption for the correlation was that variables were not related and that ADD-like behavior scores exist independently from IQ scores and GPA. The correlation coefficient between ADD-like scores and IQ (-.629) is significant, which means that there is indeed a relationship between ADD-like scores and IQ scores, but since the coefficient is negative, it means that as the ADD-like scores increase, the IQ scores decrease. For the correlation coefficient of ADD-like scores and GPA (-.542), the correlation is significant at 0.01 alpha. The Franckowiak, D.

Behavioral History of Attention Deficit Disorder

mean that there is a relationship between the two variables and the negative sign indicates that as the ADD-like scores increase, the GPA decreases.

Discussion The findings of this study found that ADD-like behavior does not contribute to social adjustment problems or affect the incidences dropping out of high school. Despite this conclusion, a study completed by Rasmussen & Gilberg (2000) concluded that there is sufficient data to indicate that ADD-like behavior does contribute to social adjustment problems (Rasmussen & Gillberg, 2000). The Howell et.al, study also concluded that ADD-like behavior is found to be related to gender, wherein males had higher ADD-like scores than females. It was also found that ADD-like behavior was related to the English proficiency level and letter grades in English. The statistical relationship is probably because ADD-like behaviors include impatience, fidgeting, or not being able to focus quickly on a task (Pariseau, Fabiano, Massetti, Hart, & Pelham, 2010). The results also revealed that there is a negative relationship between ADD-like behavior scores and IQ scores and GPA; this implied that those who had higher IQ scores and GPAs had lower ADD-like behavior scores. Over-all, this study found that ADDlike behaviors identified in a students elementary years by teachers did not actually cause students to have social adjustment difficulties nor did the ADD-like behaviors make the students drop-out of high school, but instead it did contribute to the students English proficiency level and the letter grade in English. It should be noted however, that there are numerous studies, which do, indicated that ADD-like behavior does contribute to social adjustment problems (Rasmussen & Gillberg, 2000). Franckowiak, D.

Behavioral History of Attention Deficit Disorder References Howell, C., Huessy, H., & Hassuk, B. (1985). Fifteen-year follow-up of a behavioral history of attention deficit disorder [Entire issue]. Pediatrics, 76 Pariseau, M. E., Fabiano, G. A., Massetti, G. M., Hart, K. C., & Pelham, W. R. (2010). Extended time on academic assignments: Does increased time lead to improved performance for children with attention-deficit/hyperactivity disorder? . School Psychology Quarterly, 25(4), 236-248. doi: 10.1037/a0022045

Rasmussen, P. & Gillberg, C. (2000). Natural outcome of ADHD with developmental coordination disorder at age 22 years: A controlled, longitudinal, community-based study []. Journal of the American Academy of Child & Adolescent Psychiatry, 39(11), 14241431.

Franckowiak, D.

Behavioral History of Attention Deficit Disorder Appendix SPSS Syntax and Output Files for the Final Project

Descriptive Statistics DESCRIPTIVES VARIABLES=ADDSC IQ GPA /STATISTICS=MEAN STDDEV MIN MAX .

FREQUENCIES VARIABLES=ENGL ENGG /ORDER= ANALYSIS .

FREQUENCIES VARIABLES=GENDER REPEAT SOCPROB DROPOUT /ORDER= ANALYSIS .

t-Test T-TEST GROUPS = GENDER(1 2) /MISSING = ANALYSIS /VARIABLES = ADDSC /CRITERIA = CI(.95) . Franckowiak, D.

Behavioral History of Attention Deficit Disorder

T-TEST GROUPS = SOCPROB(1 0) /MISSING = ANALYSIS /VARIABLES = ADDSC /CRITERIA = CI(.95) .

T-TEST GROUPS = DROPOUT(1 0) /MISSING = ANALYSIS /VARIABLES = ADDSC /CRITERIA = CI(.95) .

ANOVA ONEWAY ENGL BY ADDSC /MISSING ANALYSIS .

ONEWAY ENGG BY ADDSC /MISSING ANALYSIS. ONEWAY Franckowiak, D.

Behavioral History of Attention Deficit Disorder ADDSC BY ENGL /MISSING ANALYSIS /POSTHOC = WALLER(100) ALPHA(.05).

ONEWAY ADDSC BY ENGG /MISSING ANALYSIS /POSTHOC = WALLER(100) ALPHA(.05).

Correlation CORRELATIONS /VARIABLES=ADDSC IQ /PRINT=TWOTAIL NOSIG /MISSING=PAIRWISE .

CORRELATIONS /VARIABLES=ADDSC GPA /PRINT=TWOTAIL NOSIG /MISSING=PAIRWISE .

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Appendix B SPSS Output Tables Descriptive Statistics Appendix B SPSS Output Tables Descriptive Statistics Table 1 Mean and Standard Deviation for ADD-like behavior, IQ and GPA scores
N ADD-like behavior score (mean of 3) IQ Score GPA in 9th Grade Valid N (listwise) 216 216 216 216 Minimum 24.67 55.00 .25 Maximum 76.67 137.00 4.00 Mean 52.8480 102.3542 2.4386 Std. Deviation 10.45221 12.55762 .84507

Table 2 Frequency Distribution of 9th Grade English Level and English Grade
9th Grade English Level Cumulative Percent 13.4 84.7 100.0

Valid

College Prep General Remedial Total

Frequency 29 154 33 216

Percent 13.4 71.3 15.3 100.0

Valid Percent 13.4 71.3 15.3 100.0

9th Grade English Grade Cumulative Percent 1.4 13.0 49.1 87.0 100.0

Valid

F D C B A Total

Frequency 3 25 78 82 28 216

Percent 1.4 11.6 36.1 38.0 13.0 100.0

Valid Percent 1.4 11.6 36.1 38.0 13.0 100.0

Table 3 Frequency Distribution of Gender Franckowiak, D.

Behavioral History of Attention Deficit Disorder

Frequency 116 100 216 Percent 53.7 46.3 100.0 Valid Percent 53.7 46.3 100.0 Cumulative Percent 53.7 100.0

11

Valid

Male Female Total

Table 4 Frequency Distribution of Student Responses to Schooling Experience Questions

Repeated Grade? Cumulative Percent 90.7 100.0

Valid

No Yes Total

Frequency 196 20 216

Percent 90.7 9.3 100.0

Valid Percent 90.7 9.3 100.0

Social Adjustment Problems in 9th Grade? Cumulative Percent 88.4 100.0

Valid

No Yes Total

Frequency 191 25 216

Percent 88.4 11.6 100.0

Valid Percent 88.4 11.6 100.0

Dropped out of High School? Cumulative Percent 90.7 100.0

Valid

No Yes Total

Frequency 196 20 216

Percent 90.7 9.3 100.0

Valid Percent 90.7 9.3 100.0

Appendix C Franckowiak, D.

Behavioral History of Attention Deficit Disorder SPSS Output Tables- Inferential Statistics Table 1.A t-test of ADD-like scores for male and female students
Group Statistics Std. Error Mean .92862 .97221

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ADD-like behavior score (mean of 3)

Gender Male Female

N 116 100

Mean 56.0862 49.0917

Std. Deviation 10.00158 9.72213

t-test Results
Independent Samples Test Levene's Test for Equality of Variances t-test for Equality of Means 95% Confidence Interval of the Difference Lower Upper 4.33889 4.34426 9.65019 9.64482

F ADD-like behavior score (mean of 3) Equal variances assumed Equal variances not assumed .261

Sig. .610

t 5.192 5.203

df 214 210.915

Sig. (2-tailed) .000 .000

Mean Difference 6.99454 6.99454

Std. Error Difference 1.34729 1.34445

Table 1B t-test of ADD-like behavior score and social adjustment problems

Group Statistics Social Adjustment Problems in 9th Grade? Yes No Std. Error Mean 1.42422 .73500

N 25 191

ADD-like behavior score (mean of 3) t-test Results

Mean 62.5600 51.5768

Std. Deviation 7.12112 10.15789

Independent Samples Test Levene's Test for Equality of Variances t-test for Equality of Means 95% Confidence Interval of the Difference Lower Upper 6.84795 7.73912 15.11847 14.22730

F ADD-like behavior score (mean of 3) Equal variances assumed Equal variances not assumed 3.559

Sig. .061

t 5.235 6.853

df 214 38.144

Sig. (2-tailed) .000 .000

Mean Difference 10.98321 10.98321

Std. Error Difference 2.09793 1.60270

Table 1C t-test of ADD-like behavior and High school drop out Franckowiak, D.

Behavioral History of Attention Deficit Disorder

Group Statistics Dropped out of High School? Yes No Std. Error Mean 1.60085 .74245

13

N 20 196

ADD-like behavior score (mean of 3)

Mean 60.9500 52.0213

Std. Deviation 7.15924 10.39424

t-test Result
Independent Samples Test Levene's Test for Equality of Variances t-test for Equality of Means 95% Confidence Interval of the Difference Lower Upper 4.23293 5.31361 13.62455 12.54387

F ADD-like behavior score (mean of 3) Equal variances assumed Equal variances not assumed 3.228

Sig. .074

t 3.748 5.060

df 214 27.927

Sig. (2-tailed) .000 .000

Mean Difference 8.92874 8.92874

Std. Error Difference 2.38231 1.76464

Table 2A One Way ANOVA of ADD-like Score and 9th Grade English Level
9th Grade English Level Sum of Squares 36.669 25.257 61.926 df 107 108 215 Mean Square .343 .234 F 1.465 Sig. .024

Between Groups Within Groups Total

Waller-Duncan N 9th Grade English Level College Prep General Remedial 1 29 154 Subset for alpha = .05 2 43.0690 1 53.8052

33 56.9747 Means for groups in homogeneous subsets are displayed. a Uses Harmonic Mean Sample Size = 42.088. b The group sizes are unequal. The harmonic mean of the group sizes is used. Type I error levels are not guaranteed. c Type 1/Type 2 Error Seriousness Ratio = 100.

Franckowiak, D.

Behavioral History of Attention Deficit Disorder Table 2B One-Way ANOVA of ADD-like Behavior and 9th Grade English Grade
9th Grade English Grade Sum of Squares 106.572 71.424 177.995 df 107 108 215 Mean Square .996 .661 F 1.506 Sig. .017

14

Between Groups Within Groups Total

Waller-Duncan N 9th Grade English Level College Prep General Remedial 1 29 154 Subset for alpha = .05 2 43.0690 1 53.8052

33 56.9747 Means for groups in homogeneous subsets are displayed. a Uses Harmonic Mean Sample Size = 42.088. b The group sizes are unequal. The harmonic mean of the group sizes is used. Type I error levels are not guaranteed. c Type 1/Type 2 Error Seriousness Ratio = 100.

Table 3A Pearson Moment Correlation between ADD-like behavior score and IQ

Correlations ADD-like behavior score (mean of 3) 1 216 -.629(**) .000 216 216

ADD-like behavior score (mean of 3) IQ Score

Pearson Correlation Sig. (2-tailed) N Pearson Correlation Sig. (2-tailed) N

IQ Score -.629(**) .000 216 1

** Correlation is significant at the 0.01 level (2-tailed).

Franckowiak, D.

Behavioral History of Attention Deficit Disorder Table 3B Pearson Moment Correlation of ADD-like behavior score and GPA
Correlations ADD-like behavior score (mean of 3) 1 216 -.542(**) .000 216 216

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ADD-like behavior score (mean of 3) GPA in 9th Grade

Pearson Correlation Sig. (2-tailed) N Pearson Correlation Sig. (2-tailed) N

GPA in 9th Grade -.542(**) .000 216 1

** Correlation is significant at the 0.01 level (2-tailed).

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