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Methylphenidate and Play Skills in Children with Intellectual Disability and ADHD

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Title: Methylphenidate and Play Skills in Children with Intellectual Disability and ADHD
Language: English
Authors: Handen, Benjamin L., Sagady, Amie E., McAuliffe-Bellin, Sarah
Source: Journal of Mental Health Research in Intellectual Disabilities. 2009 2(1):1-10.
Availability: Routledge. Available from: Taylor & Francis, Ltd. 325 Chestnut Street Suite 800, Philadelphia, PA 19106. Tel: 800-354-1420; Fax: 215-625-2940; Web site: http://www.tandf.co.uk/journals
Peer Reviewed: Y
Physical Description: PDF
Page Count: 10
Publication Date: 2009
Document Type: Journal Articles
Reports - Evaluative
Descriptors: Play, Mental Retardation, Drug Therapy, Children, Social Behavior, Aggression, Comparative Analysis, Hypothesis Testing, Attention Deficit Hyperactivity Disorder, Interpersonal Competence
DOI: 10.1080/19315860802598901
ISSN: 1931-5864
Abstract: Attention-deficit/hyperactivity disorder (ADHD) affects 9-12% of individuals with intellectual disability (ID). Although psychostimulant medication is often the primary treatment modality, little is known regarding the effects of such agents on social interactions and play in this population. Additionally, the role of ADHD symptoms in social and play deficits (beyond that accounted for by ID alone) is not well understood. The first aim of this study was to examine differences in play skills between children with ADHD and ID and non-ADHD/ID controls. The second aim was to determine what, if any, changes in social/play behavior would occur with the use of the stimulant, methylphenidate, among the participants with ADHD/ID. It was hypothesized that the ADHD/ID group would display significantly greater activity level, "rough" play, and more aggression than matched controls. Additionally, it was hypothesized that these deficits would evidence statistically significant improvement with pharmacologic treatment. This study replicates prior work conducted by the authors. (Contains 3 tables.)
Abstractor: As Provided
Number of References: 20
Entry Date: 2009
Accession Number: EJ866807
Database: ERIC
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  Value: <anid>AN0035884643;[5ew6]01mar.09;2019Feb28.12:30;v2.2.500</anid> <title id="AN0035884643-1">Methylphenidate and Play Skills in Children with Intellectual Disability and ADHD. </title> <p>Attention-deficit/hyperactivity disorder (ADHD) affects 9–12% of individuals with intellectual disability (ID). Although psychostimulant medication is often the primary treatment modality, little is known regarding the effects of such agents on social interactions and play in this population. Additionally, the role of ADHD symptoms in social and play deficits (beyond that accounted for by ID alone) is not well understood. The first aim of this study was to examine differences in play skills between children with ADHD and ID and non-ADHD/ID controls. The second aim was to determine what, if any, changes in social/play behavior would occur with the use of the stimulant, methylphenidate, among the participants with ADHD/ID. It was hypothesized that the ADHD/ID group would display significantly greater activity level, "rough" play, and more aggression than matched controls. Additionally, it was hypothesized that these deficits would evidence statistically significant improvement with pharmacologic treatment. This study replicates prior work conducted by the authors.</p> <p>Keywords: ADHD; intellectual disability; methylphenidate</p> <p>Attention-deficit/hyperactivity disorder (ADHD) affects 3–5% of typically developing school-age children and is characterized by overactivity, impulsivity, and inattention across multiple environments ([<reflink idref="bib3" id="ref1">3</reflink>]). Estimates of the rates of ADHD among children with intellectual disability (ID) are considerably higher. For example, [<reflink idref="bib6" id="ref2">6</reflink>]) recently conducted a large-scale survey of children with ID in Great Britain and found that 9–12% had symptoms suggestive of ADHD. Similarly, a study of the prevalence of psychiatric diagnoses among children with ID in Norway found 16% to have symptoms of hyperkinesia ([<reflink idref="bib20" id="ref3">20</reflink>]). The most common treatments for ADHD in both typically developing children and children with ID are stimulant medications ([<reflink idref="bib13" id="ref4">13</reflink>]).</p> <p>During the past 10 to 15 years, there have been a number of well-controlled studies examining the safety and efficacy of stimulant medications among the ADHD/ID population. Overall, rates of stimulant response have been found to be somewhat lower than among typically developing children with ADHD. Whereas response rates for typically developing children are around 77% ([<reflink idref="bib9" id="ref5">9</reflink>]), response rates among children with ID range from 45–65% ([<reflink idref="bib2" id="ref6">2</reflink>]). Gains have been noted on global ratings of ADHD symptoms ([<reflink idref="bib1" id="ref7">1</reflink>]; [<reflink idref="bib10" id="ref8">10</reflink>]; [<reflink idref="bib11" id="ref9">11</reflink>]), direct observation of classroom behavior, social interactions ([<reflink idref="bib10" id="ref10">10</reflink>]; [<reflink idref="bib11" id="ref11">11</reflink>]), and neuropsychological assessment of attention and learning ([<reflink idref="bib18" id="ref12">18</reflink>]). In addition, children with ID appear to be at greater risk for adverse events than typically developing peers ([<reflink idref="bib12" id="ref13">12</reflink>]).</p> <p>Observation of children with ADHD/ID has found them to be significantly more vocal and to change toys significantly more often during independent play in comparison with a matched group of children with ID but no ADHD symptoms ([<reflink idref="bib16" id="ref14">16</reflink>]). Similarly, children with ADHD/ID were found to be significantly more fidgety, off-task, and active in comparison with non-ADHD/ID controls during direct observations of group classroom instruction and independent work ([<reflink idref="bib15" id="ref15">15</reflink>]). In a study examining the efficacy of methylphenidate in treating ADHD in children with ID, significant improvement on measures of play intensity, negative behavior, and global ratings of appropriate social interactions were noted during group play situations ([<reflink idref="bib10" id="ref16">10</reflink>]). However, the sample size in this study was small (<emph>n</emph> = 12) and the findings were not replicated in a subsequent study involving 14 children with the same diagnoses ([<reflink idref="bib11" id="ref17">11</reflink>]). The purpose of the current study was to replicate our prior studies by examining play behavior in a larger group of children with ADHD/ID (Study 1). In particular, we sought to delineate further deficit areas through comparison with a group of non-ADHD/ID controls on a range of measures during a group play situation. We hypothesized that the ADHD/ID group would display significantly greater activity level, "rough" play, and aggression than matched controls. The second aspect of the study was to reexamine the effects of methylphenidate on play behavior among children with ADHD/ID (Study 2). It was hypothesized that these deficits would evidence statistically significant improvement with pharmacologic treatment.</p> <hd id="AN0035884643-2">METHODS</hd> <p>Forty children with moderate ID to borderline intellectual functioning (IQ scores 44 to 77, <emph>M</emph>= 64) served as participants. Children ranged in age from 6 to 13 years (<emph>M</emph>= 9–10 years). Twenty-three of the children were also diagnosed with ADHD, based upon a score of 15 points or more on <emph>both</emph> the Parent and Teacher Conners Hyperactivity Index ([<reflink idref="bib7" id="ref18">7</reflink>]). The remaining 17 children served as controls, based upon a score of 10 points or less on <emph>both</emph> the Parent and Teacher Conners Hyperactivity Index. Exclusionary criteria for both the ADHD/ID and ID control groups included autism, pervasive developmental disorder (PDD), or significant motor impairment (based upon prior assessment by a developmental pediatrician or child psychiatrist). However, no standardized assessment tools were utilized to rule out a possible autism/PDD diagnosis. Table 1 documents the specific demographic variables of the ADHD/ID and ID control groups. No significant group differences were noted on variables such as age, gender, socioeconomic status (SES), or IQ based upon a chi-square or Fisher's Exact Test. All participants were in a 6-week Saturday Education Program. Program sessions ran from 9:00 a.m. to 3:00 p.m.</p> <p>TABLE 1 Participant Demographics</p> <p> <ephtml> <table><thead valign="bottom"><tr><td /><td>ADHD/ID (<italic>N</italic> = 23)</td><td>ID controls (<italic>N</italic> = 17)</td></tr></thead><tbody><tr><td>Age</td><td><italic>M</italic>: 8 years 6 months (<italic>SD</italic>: 23 months)</td><td><italic>M</italic>: 9 years 7 months (<italic>SD</italic>: 26 months)</td></tr><tr><td>Gender</td><td>12 boys, 11 girls</td><td>7 boys, 10 girls</td></tr><tr><td>IQ</td><td><italic>M</italic>: 64.1 (<italic>SD</italic>: 9.4)</td><td><italic>M</italic>: 63.8 (<italic>SD</italic>: 8.9)</td></tr><tr><td>Race</td><td>16 White, 7 African American</td><td>13 White, 4 African American</td></tr><tr><td>SES</td><td>Level 1:  0%</td><td>Level 1:  6%</td></tr><tr><td>Level 2: 30.4%</td><td>Level 2: 17.5%</td></tr><tr><td>Level 3: 30.4%</td><td>Level 3: 17.5%</td></tr><tr><td>Level 4: 17.4%</td><td>Level 4: 47%</td></tr><tr><td>Level 5: 21.7%</td><td>Level 5: 12%</td></tr><tr><td><italic>Note:</italic> ADHD = Attention deficit/hyperactivity disorder; ID = intellectual disability.</td></tr></tbody></table> </ephtml> </p> <hd id="AN0035884643-3">Procedure</hd> <p>Measures for both Study 1 and Study 2 were collected during 22-minute play sessions that were held as part of the Saturday Education Program. Four to 5 children were placed together in a 17 x 22-foot playroom observation period. Prior to the child entering the room, a set of 12 toys was arranged in a circle in the center of the room. Five toys were chosen to be particularly appealing to boys (e.g., He-Men characters, GI Joe characters, Rock'em Sock'em Robots, a bo-bo doll, and a pinball game), three toys were chosen to be appealing to girls (e.g., Barbie Dolls, a makeup vanity, and pompoms), and four toys were chosen to be particularly appealing to both genders (e.g., Play-Doh, an electronic flute, crayons with coloring books, and a Waterfuls toy; [<reflink idref="bib14" id="ref19">14</reflink>]). A teacher sat the group down and briefly reviewed the playroom rules (e.g., no hitting, remain in the room) and then remained seated in the room by the door (reading a magazine) during the play session.</p> <p>Participant behavior was coded live by three trained research assistants from behind a one-way mirror. In addition, sessions were videotaped in the event coding questions arose. Coding involved a 10-second observe/5-second record system, with coders shifting their observation of participants every 2.5 minutes so that a sample of behavior was taken from the beginning, middle, and end of the session for each participant. Coders were unaware of group membership and were blind to medication dosing. The following section describes the definitions that were used to record behavior. The first five categories ("Withdrawn" through "Rule Violation") were mutually exclusive.</p> <hd id="AN0035884643-4">Withdrawn</hd> <p>This was defined as sitting or standing alone and not engaging with either play materials or peers. This included periods when the observed child might have been watching others play (as long as the child was not engaged in an activity). The child needed to maintain this behavior for the entire interval in order to be coded as "Withdrawn."</p> <hd id="AN0035884643-5">Solitary</hd> <p>This was defined as playing with toys alone. The child could not engage in any verbal or physical activity with others during the entire interval in order to be coded as "Solitary."</p> <hd id="AN0035884643-6">Interactive</hd> <p>This was defined as exhibiting prosocial behavior toward one or more peers (not adults). Examples included asking for help or assistance from a peer, laughing with another peer (but not at an adult), or offering a greeting to another peer. Any instance of interactive behavior (even for only 1–2 seconds) could result in a child being coded using this category (unless the child was coded as either "Rough and Tumble" or "Rule Violation").</p> <hd id="AN0035884643-7">Rough and tumble</hd> <p>This was defined as engaging in vigorous physical play with other peers. Examples included running, skipping, chasing other peers, and wrestling with peers.</p> <hd id="AN0035884643-8">Rule violation</hd> <p>This was coded when a child displayed negative affect, aggressive behavior, or was noncompliant to prescribed rules. Examples included leaving the room, climbing on tables, turning out the lights, and refusing to comply with adult requests either verbally or by physical action. A coding of "Rule Violation" took precedence over the preceding four coding categories.</p> <hd id="AN0035884643-9">Intensity</hd> <p>This was coded when a child exhibited a high level of physical energy or affect (positive or negative) while interacting with peers or objects during play group. Examples included gross motor movements such as running, jumping, skipping, having tantrums, pounding, slapping, and hitting. Intensity was always coded with "Rough and Tumble."</p> <p>At the end of all playgroup sessions, the coder completed a global rating for each child that was intended to record the child's overall behavior during play. Global ratings were scaled on a Likert scale from 0 to 4. Each child was rated for the following:</p> <hd id="AN0035884643-10">Activity intensity level</hd> <p>This was a rating of the overall level of physical activity or intensity during play. The range was from 0 (<emph>was not at all active</emph>) to 4 (<emph>was extremely active</emph>).</p> <hd id="AN0035884643-11">Sociability</hd> <p>This was a rating of the overall level of social interaction with peers during play. The range was from 0 (<emph>readily interacted or initiated interactions</emph>) to 4 (<emph>was unresponsive to social overtures</emph>).</p> <hd id="AN0035884643-12">Aggression</hd> <p>This was a rating of the overall level of antisocial of inappropriate interaction with peers or teacher during play. The range was from 0 (<emph>interactions were prosocial</emph>) to 4 (<emph>most interactions were antisocial toward peers</emph>).</p> <p>Study 1 utilized data from the first play session attended by each participant (either Session 1 or 2 of the Saturday program) and included both ADHD and control participants. Any ADHD participants who were currently prescribed stimulant medication had their medication discontinued for the week prior to the observation. Study 2 utilized observational data from the ADHD participants only, collected during Sessions 3–5 (with Session 6 serving as a makeup session). The ADHD participants were involved in a double-blind, placebo-controlled, crossover study with 0.3mg/kg and 0.6 mg/kg doses of methylphenidate (MPH). Participants were randomized into one of six drug-placebo orders: (<reflink idref="bib1" id="ref20">1</reflink>) placebo,.3 mg/kg,.6 mg/kg; (<reflink idref="bib2" id="ref21">2</reflink>) placebo,.6 mg/kg,.3 mg/kg; (<reflink idref="bib3" id="ref22">3</reflink>).3 mg/kg, placebo,.6 mg/kg; (<reflink idref="bib4" id="ref23">4</reflink>).3 mg/kg,.6 mg/kg, placebo; (<reflink idref="bib5" id="ref24">5</reflink>).6 mg/kg, placebo,.3 mg/kg; or (<reflink idref="bib6" id="ref25">6</reflink>).6 mg/kg,.3 mg/kg, placebo. MPH doses were given twice daily during Weeks 3 to 5, the first with breakfast and the second with lunch.</p> <p>Parents gave participants the Saturday-morning MPH dose at 8:15 a.m., as confirmed by project staff. Program personnel gave the Saturday-lunch MPH dose and dependent measures were taken between 9:15 a.m. and 11:15 a.m. and between 12:45 p.m. and 2:45 p.m. (during the peak 2 hours of medication effectiveness). Parents were asked to return all prescription bottles, including any unused pills. In order to answer questions and to ensure compliance with the protocol, both teachers and parents were contacted weekly.</p> <hd id="AN0035884643-13">Reliability</hd> <p>Interrater reliability was calculated on 20% of observation intervals, based upon the percentage agreement across coders. Agreement ranged from 86.4% to 100% for the first five categories (using summarized data by observation date) and 93.0% to 99.0% for the coding of "intensity." Interrater reliability was also calculated for the three global ratings across three raters (interclass correlation (ICC) =.84,.73, and.75 for Activity Intensity Level, Sociability, and Aggression, respectively).</p> <hd id="AN0035884643-14">Data Analysis</hd> <p>For both studies, percentile data were transformed using an arcsine-square root transformation; numeric data were transformed using a square root transformation. All variables were on a continuous scale of measurement. Study 1 data were analyzed using independent <emph>t</emph> tests to compare ADHD/ID and ID control group data. Study 2 data were analyzed using univariate repeated-measures Analysis of Variance (ANOVA) among the three MPH conditions. When Mauchly's W spericity test results were violated, either the Geisser-Greenhouse correction or multivariate ANOVA test was used. Data were missing for 3 participants in at least one drug condition due the appearance of side effects (and the need to discontinue a particular dose). Therefore, a second analysis was conducted using the last observation carried forward technique to impute missing data where, for each participant, values were replaced by the last observed value of that variable. Data in this article are presented using this technique.</p> <hd id="AN0035884643-15">RESULTS</hd> <p></p> <hd id="AN0035884643-16">Study 1</hd> <p>Table 2 provides the means and standard deviations for the nine dependent variables. Four of the nine variables evidenced significant differences between the control and ADHD groups (Rule Violation, Play Intensity, Global Activity Intensity, and Global Aggression). In all four cases, the ADHD group was found to exhibit greater deficits.</p> <p>TABLE 2 Means and Standard Deviations for Social/Play Behaviors and Global Ratings</p> <p> <ephtml> <table><thead valign="bottom"><tr><td>Dependent measures</td><td>ADHD/ID (<italic>n</italic> = 23) <italic>M</italic> (<italic>SD</italic>)</td><td>Controls (<italic>n</italic> = 17) <italic>M</italic> (<italic>SD</italic>)</td><td><italic>p</italic> value</td></tr></thead><tbody><tr><td>Social/Play</td><td /><td /><td /></tr><tr><td> Withdrawn</td><td char=".">0.09 (0.42)</td><td char=".">1.3 (4.2)</td><td char=".">0.209</td></tr><tr><td> Solitary</td><td char=".">51.9 (20.3)</td><td char=".">53.4 (21.0)</td><td char=".">0.881</td></tr><tr><td> Interactive</td><td char=".">44.3 (18.6)</td><td char=".">44.4 (21.5)</td><td char=".">0.797</td></tr><tr><td> Rough & Tumble</td><td char=".">2.3 (5.0)</td><td char=".">0.47 (0.88)</td><td char=".">0.192</td></tr><tr><td> Rule Violation</td><td char=".">2.4 (2.8)</td><td char=".">0.41 (1.3)</td><td char="."><bold>0.002</bold></td></tr><tr><td> Intensity</td><td char=".">27.2 (22.9)</td><td char=".">11.6 (16.2)</td><td char="."><bold>0.009</bold></td></tr><tr><td>Global ratings</td><td /><td /><td /></tr><tr><td> Activity Intensity</td><td char=".">2.3 (0.94)</td><td char=".">1.9 (0.88)</td><td char="."><bold>0.047</bold></td></tr><tr><td> Sociability</td><td char=".">3.4 (0.61)</td><td char=".">3.2 (0.71)</td><td char=".">0.411</td></tr><tr><td> Aggression</td><td char=".">0.90 (0.70)</td><td char=".">0.41 (0.36)</td><td char="."><bold>0.020</bold></td></tr><tr><td><italic>Note:</italic> ADHD = attention deficit/hyperactivity disorder; ID = intellectual disability.</td></tr><tr><td>Bolded items were deemed significant.</td></tr></tbody></table> </ephtml> </p> <hd id="AN0035884643-17">Study 2</hd> <p>Table 3 provides the means and standard deviations for the nine dependent variables across placebo, 0.3 mg/kg, and 0.6 mg/kg conditions. Significant treatment differences were noted for the variables "Withdrawn," "Intensity," "Activity Intensity (global rating)," and Sociability (global rating) when comparing MPH with placebo. Although participants were significantly more withdrawn while on medication (in comparison with placebo), the subsequent post hoc paired comparisons were not significant. All other group differences indicated significant decreases in ADHD symptoms, with post hoc comparisons indicating that only the higher 0.6 mg/kg dose was found to be significantly improved in comparison with placebo for three of the four variables.</p> <p>TABLE 3 Means and Standard Deviations of Social/Play Behavior and Global Ratings Across Drug Conditions</p> <p> <ephtml> <table><thead valign="bottom"><tr><td>Dependent measures</td><td>Placebo <italic>M</italic> (<italic>SD</italic>)</td><td>.3 mg/kg/dose <italic>M</italic> (<italic>SD</italic>)</td><td>.6 mg/kg/dose <italic>M</italic> (<italic>SD</italic>)</td><td><italic>p</italic> value</td></tr></thead><tbody><tr><td>Social/Play</td><td /><td /><td /><td /></tr><tr><td>Withdrawn</td><td char=".">0.3 (0.8)</td><td char=".">2.4 (3.9)</td><td char=".">3.7 (13.1)</td><td char="."><bold>0.028</bold></td></tr><tr><td>Solitary</td><td char=".">44.6 (25.3)</td><td char=".">46.0 (29.3)</td><td char=".">48.6 (26.5)</td><td char=".">0.790</td></tr><tr><td>Interactive</td><td char=".">45.1 (21.9)</td><td char=".">44.0 (29.3)</td><td char=".">43.0 (25.0)</td><td char=".">0.947</td></tr><tr><td>Rough & Tumble</td><td char=".">4.9 (9.4)</td><td char=".">4.3 (1.4)</td><td char=".">1.3(5.5)</td><td char=".">0.112</td></tr><tr><td>Rule Violation</td><td char=".">5.1 (10.8)</td><td char=".">3.6 (6.8)</td><td char=".">3.5 (5.5)</td><td char=".">0.619</td></tr><tr><td>Intensity</td><td char=".">34.5 (29.5)</td><td char=".">27.7 (30.4)</td><td char=".">22.0 (24.1)</td><td char="."><bold>0.0011</bold><xref ref-type="fn" rid="TFN3001" /></td></tr><tr><td>Global ratings</td><td /><td /><td /><td /></tr><tr><td>Activity Intensity</td><td char=".">2.5 (0.9)</td><td char=".">2.1 (1.0)</td><td char=".">2.0 (1.0)</td><td char="."><bold>0.039</bold><xref ref-type="fn" rid="TFN3001" /></td></tr><tr><td>Sociability</td><td char=".">3.4 (0.8)</td><td char=".">3.2 (0.8)</td><td char=".">3.2 (0.8)</td><td char="."><bold>0.027</bold><xref ref-type="fn" rid="TFN3001" /></td></tr><tr><td>Aggression</td><td char=".">1.1 (1.0)</td><td char=".">1.1 (1.0)</td><td char=".">1.0 (0.7)</td><td char=".">0.637</td></tr><tr><td><ext-link id="TFN3001" /><sup>a</sup>Significant difference was found between placebo and.6 mg/kg of methylphenidate (MPH).</td></tr><tr><td>Bolded items were deemed significant.</td></tr></tbody></table> </ephtml> </p> <hd id="AN0035884643-18">DISCUSSION</hd> <p>In this article we sought to examine differences in play and social behavior between children with ID alone and a group dually diagnosed with ID and ADHD. In addition, we examined possible gains in play and social behavior with the use of MPH through a double-blind, placebo-controlled study involving those children with both ID and ADHD. As was hypothesized, significant differences in play were noted between ADHD and control participants. The ADHD group was rated as being more active, engaging in higher rates of "intense" play, and having greater need for teacher intervention (due to the breaking of rules). This is consistent with much of the literature on typically developing children, where children with ADHD tend to be more disruptive, controlling, and active (e.g., [<reflink idref="bib4" id="ref26">4</reflink>]; [<reflink idref="bib19" id="ref27">19</reflink>]). Conversely, no group differences were found on measures assessing the amount of time ID controls and ADHD/ID children engaged in solitary versus interactive play, a finding also consistent with the literature on typically developing children with ADHD (e.g., [<reflink idref="bib5" id="ref28">5</reflink>]). It is possible that although children with ADHD/ID are more inattentive and active than ID controls, these deficits do not negatively impact a child's level of interest in peer interactions. In fact, prior research in typically developing children with ADHD has found that children with ADHD may actually be more interactive than same-age peers ([<reflink idref="bib19" id="ref29">19</reflink>]). However, the quality of those interactions remains problematic.</p> <p>The use of MPH resulted in significant improvement on some of the measures where play deficits were noted (e.g., direct observation of play intensity and global ratings of activity). In three of the four measures where improvement was noted, the higher (0.6 mg/kg) dose led to the only statistically significant gains (although improvement did appear in the desired direction during the 0.3 mg/kg condition). Gains in social and play behaviors with the use of MPH are consistent with some of our prior findings ([<reflink idref="bib10" id="ref30">10</reflink>]). Although the results of a subsequent replication of that study ([<reflink idref="bib11" id="ref31">11</reflink>]) failed to find statistically significant MPH effects, this may have been due to the relatively small sample (as changes on these same play measures decreased considerably when comparing placebo with the 0.6 mg/kg MPH dose). Interestingly, although some gains on a number of play behaviors were noted, no changes in the relative amounts of interactive/solitary play were found. This has not always been the case in the literature on typically developing children with ADHD, where some reports have found increased passivity and social disengagement with MPH, even at relatively low doses (e.g.,.15 mg/kg and.3 mg/kg; [<reflink idref="bib5" id="ref32">5</reflink>]; [<reflink idref="bib8" id="ref33">8</reflink>]).</p> <p>MPH appears to "normalize" some social and play functioning among children dually diagnosed with ID and ADHD. For two of the four variables where significant group differences were noted during the first study (Intensity and Activity Intensity global rating), improvement with MPH was noted. Yet, it is also likely that these two ratings overlapped considerably, with one being a global assessment and the other being a direct observation measure. Prior research in medication-induced changes in play and social interactions among typically developing children with ADHD also found similar results. For example, [<reflink idref="bib17" id="ref34">17</reflink>] found significantly decreased rates of conduct problems (e.g., lying, aggression), negative verbalizations, and negative peer interactions during naturalistic observations at a summer camp setting with the use of a 0.3 mg/kg dose of MPH. However, despite decreases in maladaptive behavior, MPH has not necessarily led to an increase in appropriate social behavior (e.g., [<reflink idref="bib8" id="ref35">8</reflink>]).</p> <p>There are some limitations to the current findings. Despite significant differences between groups, these differences were limited to less than 50% of those variables assessed. Conversely, global measures consistently documented significant group differences. An important clinical implication of this study is that although stimulants may decrease the overall "intensity" and "roughness" of play in children with ADHD/ID, the level of interactive play and global ratings of "sociability" remain unchanged. Consequently, teachers, clinicians, and families will need to combine the use of stimulant medication with the teaching of appropriate interactive play skills if deficits in this area are to be adequately addressed.</p> <ref id="AN0035884643-19"> <title> REFERENCES </title> <blist> <bibl id="bib1" idref="ref7" type="bt">1</bibl> <bibtext> Aman, M. G., Buican, B. and Arnold, L. E.2003. Methylphenidate treatment in children with low IQ and ADHD: Analysis of three aggregated studies. Journal of Child and Adolescent Psychopharmacology, 13: 27–38.</bibtext> </blist> <blist> <bibl id="bib2" idref="ref6" type="bt">2</bibl> <bibtext> Aman, M. G., Collier-Crespin, A. and Lindsay, R. L.2000. Pharmacotherapy of disorders in mental retardation. European Child and Adolescent Psychiatry, 9(Suppl. 1): 198–107.</bibtext> </blist> <blist> <bibl id="bib3" idref="ref1" type="bt">3</bibl> <bibtext> American Psychiatric Association. 2000. Diagnostic and statistical manual of mental disordersText Revision, 4th, Washington, DC: Author.</bibtext> </blist> <blist> <bibl id="bib4" idref="ref23" type="bt">4</bibl> <bibtext> Cunningham, C. E. and Siegel, L. S.1987. Peer interactions of normal and attention-deficit hyperactivity disordered boys during free-play, cooperative task, and simulated classroom situations. Journal of Abnormal Child Psychology, 15: 247–268.</bibtext> </blist> <blist> <bibl id="bib5" idref="ref24" type="bt">5</bibl> <bibtext> Cunningham, C. E., Siegel, L. S. and Offord, D. R.1991. A dose-response analysis of the effects of methylphenidate on the peer interactions and simulated classroom performance of ADD children with and without conduct problems. Journal of Child Psychology and Psychiatry, 32: 439–452.</bibtext> </blist> <blist> <bibl id="bib6" idref="ref2" type="bt">6</bibl> <bibtext> Emerson, E.2003. Prevalence of psychiatric disorders in children and adolescents with and without intellectual disability. Journal of Intellectual Disability Research, 47: 51–58.</bibtext> </blist> <blist> <bibl id="bib7" idref="ref18" type="bt">7</bibl> <bibtext> Goyette, C. H., Conners, C. K. and Ulrich, R. F.1978. Normative data on revised Conners Parent and Teacher Rating Scales. Journal of Abnormal Child Psychology, 6: 221–236.</bibtext> </blist> <blist> <bibl id="bib8" idref="ref33" type="bt">8</bibl> <bibtext> Granger, D. A., Whalen, C. K. and Henker, B.1993. Perceptions of methylphenidate effects on hyperactive children's peer interactions. Journal of Abnormal Child Psychology, 21: 535–549.</bibtext> </blist> <blist> <bibl id="bib9" idref="ref5" type="bt">9</bibl> <bibtext> Greenhill, L. L., Swanson, J. M., Vitiello, B., Davies, M., Clevenger, W., Wu, M. and al, et. 2001. Impairment and deportment responses to different methylphenidate doses in children with ADHD: The MTA titration trial. Journal of the American Academy of Child & Adolescent Psychiatry, 40: 180–187.</bibtext> </blist> <blist> <bibtext> Handen, B. L., Breaux, A. M., Gosling, A., Ploof, D. and Feldman, H.1990. Efficacy of methylphenidate among mentally retarded children with Attention Deficit Hyperactivity Disorder. Pediatrics, 86: 922–930.</bibtext> </blist> <blist> <bibtext> Handen, B. L., Breaux, A. M., Janosky, J., McAuliffe, S., Feldman and Gosling, A. 1992. Effects and non-effects of methylphenidate in children with mental retardation and ADHD. Journal of the American Academy of Child and Adolescent Psychiatry, 31: 455–461.</bibtext> </blist> <blist> <bibtext> Handen, B. L., Feldman, H., Gosling, A., Breaux, A. M. and McAuliffe, S.1991. Adverse side effects of Ritalin among mentally retarded children with ADHD. Journal of the American Academy of Child and Adolescent Psychiatry, 30: 241–245.</bibtext> </blist> <blist> <bibtext> Handen, B. and Gilchrist, R.2006. Psychopharmacology in children and adolescents with mental retardation. Journal of Child Psychology and Psychiatry and Allied Disciplines, 47: 871–882.</bibtext> </blist> <blist> <bibtext> Handen, B. L., McAuliffe, S., Janosky, J., Breaux, A. M. and Feldman, H.1995. Methylphenidate in children with mental retardation and ADHD: Effects on independent play and academic functioning. Journal of Developmental and Physical Disabilities, 7: 91–103.</bibtext> </blist> <blist> <bibtext> Handen, B. L., McAuliffe, S., Janosky, J., Feldman, H. and Breaux, A. M.1994. Classroom behavior and children with mental retardation: Comparison of children with and without ADHD. Journal of Abnormal Child Psychology, 22: 267–280.</bibtext> </blist> <blist> <bibtext> Handen, B. L., McAuliffe, S., Janosky, J., Feldman, H. and Breaux, A. M.1998. A playroom observation procedure to assess children with mental retardation and ADHD. Journal of Abnormal Child Psychology, 26: 269–277.</bibtext> </blist> <blist> <bibtext> Murphy, D., Pelham, W. E. and Lang, A.1992. Aggression in boys with attention deficit-hyperactivity disorder: Methylphenidate effects on naturalistically observed aggression, response to provocation, and social information processing. Journal of Abnormal Child Psychology, 20: 451–466.</bibtext> </blist> <blist> <bibtext> Pearson, D., Santos, D., Casat, C., Lane, D., Jerger, S., Roache, J. and al, et. 2004. Treatment effects of methylphenidate on cognitive functioning in children with mental retardation and ADHD. Journal of the American Academy of Child and Adolescent Psychiatry, 43: 677–685.</bibtext> </blist> <blist> <bibtext> Pelham, W. E. and Bender, M. E.1982. "Peer relationships in hyperactive children: Description and treatment". In Advances in learning and behavioral disabilities: A research annual, Edited by: Gadow, K. and Bialer, I.Vol. 1, 365–436. Greenwich, CT: JAI Press.</bibtext> </blist> <blist> <bibtext> Stromme, P. and Diseth, T. H.2000. Prevalence of psychiatric diagnoses in children with mental retardation: Data from a population-based study. Developmental Medicine & Child Neurology, 42: 266–270.</bibtext> </blist> </ref> <aug> <p>By BenjaminL. Handen; AmieE. Sagady and Sarah McAuliffe-Bellin</p> <p>Reported by Author; Author; Author</p> </aug> <nolink nlid="nl1" bibid="bib20" firstref="ref3"></nolink> <nolink nlid="nl2" bibid="bib13" firstref="ref4"></nolink> <nolink nlid="nl3" bibid="bib10" firstref="ref8"></nolink> <nolink nlid="nl4" bibid="bib11" firstref="ref9"></nolink> <nolink nlid="nl5" bibid="bib18" firstref="ref12"></nolink> <nolink nlid="nl6" bibid="bib12" firstref="ref13"></nolink> <nolink nlid="nl7" bibid="bib16" firstref="ref14"></nolink> <nolink nlid="nl8" bibid="bib15" firstref="ref15"></nolink> <nolink nlid="nl9" bibid="bib14" firstref="ref19"></nolink> <nolink nlid="nl10" bibid="bib19" firstref="ref27"></nolink> <nolink nlid="nl11" bibid="bib17" firstref="ref34"></nolink>
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  Data: Methylphenidate and Play Skills in Children with Intellectual Disability and ADHD
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  Data: <searchLink fieldCode="AR" term="%22Handen%2C+Benjamin+L%2E%22">Handen, Benjamin L.</searchLink><br /><searchLink fieldCode="AR" term="%22Sagady%2C+Amie+E%2E%22">Sagady, Amie E.</searchLink><br /><searchLink fieldCode="AR" term="%22McAuliffe-Bellin%2C+Sarah%22">McAuliffe-Bellin, Sarah</searchLink>
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  Data: <searchLink fieldCode="SO" term="%22Journal+of+Mental+Health+Research+in+Intellectual+Disabilities%22"><i>Journal of Mental Health Research in Intellectual Disabilities</i></searchLink>. 2009 2(1):1-10.
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  Data: Routledge. Available from: Taylor & Francis, Ltd. 325 Chestnut Street Suite 800, Philadelphia, PA 19106. Tel: 800-354-1420; Fax: 215-625-2940; Web site: http://www.tandf.co.uk/journals
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  Data: 10
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  Data: 2009
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  Data: Journal Articles<br />Reports - Evaluative
– Name: Subject
  Label: Descriptors
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  Data: <searchLink fieldCode="DE" term="%22Play%22">Play</searchLink><br /><searchLink fieldCode="DE" term="%22Mental+Retardation%22">Mental Retardation</searchLink><br /><searchLink fieldCode="DE" term="%22Drug+Therapy%22">Drug Therapy</searchLink><br /><searchLink fieldCode="DE" term="%22Children%22">Children</searchLink><br /><searchLink fieldCode="DE" term="%22Social+Behavior%22">Social Behavior</searchLink><br /><searchLink fieldCode="DE" term="%22Aggression%22">Aggression</searchLink><br /><searchLink fieldCode="DE" term="%22Comparative+Analysis%22">Comparative Analysis</searchLink><br /><searchLink fieldCode="DE" term="%22Hypothesis+Testing%22">Hypothesis Testing</searchLink><br /><searchLink fieldCode="DE" term="%22Attention+Deficit+Hyperactivity+Disorder%22">Attention Deficit Hyperactivity Disorder</searchLink><br /><searchLink fieldCode="DE" term="%22Interpersonal+Competence%22">Interpersonal Competence</searchLink>
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  Data: 10.1080/19315860802598901
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  Data: 1931-5864
– Name: Abstract
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  Group: Ab
  Data: Attention-deficit/hyperactivity disorder (ADHD) affects 9-12% of individuals with intellectual disability (ID). Although psychostimulant medication is often the primary treatment modality, little is known regarding the effects of such agents on social interactions and play in this population. Additionally, the role of ADHD symptoms in social and play deficits (beyond that accounted for by ID alone) is not well understood. The first aim of this study was to examine differences in play skills between children with ADHD and ID and non-ADHD/ID controls. The second aim was to determine what, if any, changes in social/play behavior would occur with the use of the stimulant, methylphenidate, among the participants with ADHD/ID. It was hypothesized that the ADHD/ID group would display significantly greater activity level, "rough" play, and more aggression than matched controls. Additionally, it was hypothesized that these deficits would evidence statistically significant improvement with pharmacologic treatment. This study replicates prior work conducted by the authors. (Contains 3 tables.)
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  Data: 2009
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      – Text: English
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        PageCount: 10
        StartPage: 1
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      – SubjectFull: Play
        Type: general
      – SubjectFull: Mental Retardation
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      – SubjectFull: Drug Therapy
        Type: general
      – SubjectFull: Children
        Type: general
      – SubjectFull: Social Behavior
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      – SubjectFull: Aggression
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      – SubjectFull: Comparative Analysis
        Type: general
      – SubjectFull: Hypothesis Testing
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      – SubjectFull: Attention Deficit Hyperactivity Disorder
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      – SubjectFull: Interpersonal Competence
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      – TitleFull: Methylphenidate and Play Skills in Children with Intellectual Disability and ADHD
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            NameFull: Sagady, Amie E.
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            NameFull: McAuliffe-Bellin, Sarah
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            – TitleFull: Journal of Mental Health Research in Intellectual Disabilities
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