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    Cynthia Hartung

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    Objective: Emerging adulthood (18–25 years) is a transitional and understudied developmental period. Yet, little is known about how specific symptoms of ADHD, as well as those from the related SCT domain, may differentially relate to one... more
    Objective: Emerging adulthood (18–25 years) is a transitional and understudied developmental period. Yet, little is known about how specific symptoms of ADHD, as well as those from the related SCT domain, may differentially relate to one another during this period, if there are differences based on biological sex, or how closely results will align with adulthood. Methods: We used network analysis techniques to explore the structure of ADHD and SCT symptoms within emerging adulthood, with additional comparisons between sexes as well as between emerging adulthood and adulthood. Using an online platform, 8,506 adults reported on their symptoms of ADHD and SCT. Results: Symptoms grouped together within their respective domains during emerging adulthood with no significant differences in overall network structure between sexes. Similarly, network structure appeared to be robust across emerging adulthood and adulthood. Conclusion: Such consistency supports a conceptualization of ADHD in e...
    ABSTRACT Evidence-based practice in psychology (EBPP) has long focused on treatment, but evidence-based psychological assessment (EBPA) is also crucial given the important role of accurate and reliable diagnostic practices in treatment... more
    ABSTRACT Evidence-based practice in psychology (EBPP) has long focused on treatment, but evidence-based psychological assessment (EBPA) is also crucial given the important role of accurate and reliable diagnostic practices in treatment planning. In terms of the diagnosis of attention-deficit/hyperactivity disorder (ADHD), EBPA practices are well-established for children, and more recently for adults, but for college students in particular there are special considerations that warrant attention. College students with symptoms of ADHD have some challenges that are unique, and thus the assessment and diagnosis of ADHD in these students is unique. The aim of this review is not to cover all EBPA strategies for diagnosing ADHD in emerging adult college students; rather, we will focus on the unique considerations at play in college ADHD assessment. These include (a) conceptual matters such as the appropriateness of the DSM-5 criteria for college students, the limitations of our understanding of ADHD this population because of a lack of diversity in research studies, and the issue of late-identified ADHD; and (b) practical matters, such as specific documentation needs, how to gather and interpret self- and other-report of symptoms, how to assess impairment, and alternate explanations for ADHD-like symptoms in college students.
    Attention-deficit/hyperactivity disorder (ADHD) is characterized by inattentive, hyperactive, and impulsive behaviors. Impairment in individuals diagnosed with ADHD is significant; one such domain of impairment is achieving a college... more
    Attention-deficit/hyperactivity disorder (ADHD) is characterized by inattentive, hyperactive, and impulsive behaviors. Impairment in individuals diagnosed with ADHD is significant; one such domain of impairment is achieving a college education. College students with ADHD tend to have lower grade point averages, take longer to graduate, and have higher dropout rates than individuals without ADHD. Those with ADHD may be inadequately prepared for college. College readiness can be broken into self-determination, academic skills, and daily living skills, all of which are possible areas of deficit for individuals with ADHD, given their common characteristics. In the current study, we examined differences in college readiness in undergraduates with and without ADHD. In general, students with ADHD were found to be less prepared for college than those without ADHD, and specific areas of unpreparedness were identified. The findings support the need for intervention for students with ADHD befo...
    OBJECTIVE College students with attention-deficit/hyperactivity disorder (ADHD) and/or a learning disorder (LD) are at higher risk for not attaining a bachelor's degree. The purpose is to identify the predictors of academic success in... more
    OBJECTIVE College students with attention-deficit/hyperactivity disorder (ADHD) and/or a learning disorder (LD) are at higher risk for not attaining a bachelor's degree. The purpose is to identify the predictors of academic success in college for students with ADHD and/or LD using a systematic review of the literature. Method: Academic Search Premier, Education Full Text, Education Source, Education Resources Information Center, Teacher Reference Center, PsycINFO, PsycArticles, and Primary Search and relevant journals were searched using PRISMA guidelines. Studies were screened based on the following inclusion criteria: college students with ADHD and/or LD, student characteristics as predictors, and GPA and/or retention as outcomes. Results: Twenty-one studies were included (20 quantitative studies and 1 randomized control trial). Academic regulation, academic self-efficacy, emotional regulation, ADHD symptoms, and academic and social integration predicted college success. Conclusion: Incorporating these components into interventions with students with ADHD and/or LD may enhance their success in college.
    Abstract The present study investigated whether academic, social, emotional, and behavioral factors mediated disparities in teachers' identification of boys and girls from different racial/ethnic backgrounds in need of family-based... more
    Abstract The present study investigated whether academic, social, emotional, and behavioral factors mediated disparities in teachers' identification of boys and girls from different racial/ethnic backgrounds in need of family-based prevention services. Teachers (n = 157) from regular education classrooms at 17 public elementary schools anonymously nominated the boy (n = 157) and girl (n = 156) in their class most in need of services. An age- and grade-matched boy (n = 158) and girl (n = 156) were randomly selected from the same classrooms, resulting in a total of 627 students (Mean age = 8.37; 62% White, 8% Black, 8% Latina/o, 13% Asian-American, 9% mixed/other). Teachers rated students' aggressive behavior and depressive, generalized anxiety, inattentive, oppositional defiant, and conduct symptoms. Mediation models were tested accounting for clustering of students within classrooms. Black students were more likely to be nominated than all other groups, and Latina/o and White students were more likely to be nominated than Asian-American students. Racial/ethnic disparities were largely accounted for by inattentive symptoms and externalizing problems for boys and girls. However, Black students were still more likely to be nominated than White or Asian-American students. Consultation could prepare teachers to accurately identify and manage variations in problematic behaviors among students from diverse racial/ethnic backgrounds.
    ABSTRACT The developmental transition between adolescence to emerging adulthood (ages 18–25) is a critical juncture—particularly for individuals with attention-deficit/hyperactivity disorder (ADHD). However, there are no known published... more
    ABSTRACT The developmental transition between adolescence to emerging adulthood (ages 18–25) is a critical juncture—particularly for individuals with attention-deficit/hyperactivity disorder (ADHD). However, there are no known published studies on treatments for ADHD that aim to improve the transition from adolescence to emerging adulthood. We sought to facilitate future transition intervention research and provide empirically-supported treatment principles and corresponding targets for clinicians with this manuscript. We review two key areas of research to inform transition planning interventions for adolescents with ADHD: (a) domains of impairment (e.g., occupational, social) within the developmental context of the transition to emerging adulthood and (b) existing treatment research on interventions for adolescents and adults with ADHD. After evaluating and synthesizing these areas of research, we highlight and discuss targets for treatment that are promising for addressing the unique needs of adolescents with ADHD transitioning to emerging adulthood. We also discuss treatment modalities which may be particularly suited for ADHD within this developmental context. Many treatment elements were indicated, ranging from empirically-supported focuses on compensatory skills (e.g., organization, time management, planning [OTMP]) to more theoretically relevant techniques, such as health and lifestyle behaviors (e.g., physical exercise). Further, certain treatment modalities, such as parent-teen collaborative models and group-based approaches, seemed particularly suited for adolescents with ADHD transitioning to emerging adulthood. Limitations of existing research on the transition to emerging adulthood for those diagnosed with ADHD and areas for future research are discussed in greater detail.
    Parent ratings of ADHD and ODD symptoms depicted in written vignettes were examined for negative halo effects. Participants were 82 parents of children ages 6–12. Both unidirectional and bidirectional halo effects were found but to a... more
    Parent ratings of ADHD and ODD symptoms depicted in written vignettes were examined for negative halo effects. Participants were 82 parents of children ages 6–12. Both unidirectional and bidirectional halo effects were found but to a lesser extent than in similar studies with teacher and college student raters. Specifically, parents were more likely to: (a) rate a child as inattentive in the presence of hyperactivity symptoms; (b) more likely to rate a child as oppositional in the presence of inattention and hyperactivity symptoms; and (c) more likely to rate a child as inattentive and hyperactive in the presence of oppositionality symptoms. Several specific symptoms were also found to be particularly susceptible to halo effects. Results suggest that parents may be more discerning raters of disruptive behavior disorders than teachers or college students and less prone to negative halo effects. Implications for clinical practice and future research directions are discussed.
    The present study examined the relation between self-regulated learning (SRL) strategies and ADHD and sluggish cognitive tempo (SCT) symptomatology. Participants were 303 college students, aged 18 to 25 ( M = 20.04, SD = 1.45), from a... more
    The present study examined the relation between self-regulated learning (SRL) strategies and ADHD and sluggish cognitive tempo (SCT) symptomatology. Participants were 303 college students, aged 18 to 25 ( M = 20.04, SD = 1.45), from a Midwestern university who completed the Barkley Adult ADHD Rating Scale-IV (BAARS-IV), and a shortened, generalized version of the Motivated Strategies for Learning Questionnaire (MSLQ). Among college students, inattention symptomatology was consistently predictive of deficits in use of value, expectancy, and self-regulation strategies, while SCT symptomatology was only predictive of deficits in the use of self-regulation strategies. This study is the first to examine the relation between SCT symptomatology and SRL strategy use in college students. The findings revealed that SRL strategy use differs between college students exhibiting ADHD or SCT symptomatology. Remediation focusing on these deficits would likely increase academic achievement. Clinical...
    The current study examines psychometric properties of the Weiss Functional Impairment Rating Scale (WFIRS), a measure of adult ADHD-related impairment. It is a self-report questionnaire that provides a metric of overall life impairment... more
    The current study examines psychometric properties of the Weiss Functional Impairment Rating Scale (WFIRS), a measure of adult ADHD-related impairment. It is a self-report questionnaire that provides a metric of overall life impairment and domain-specific dysfunction. Using data from a large (N = 2,093), multi-institution sample of college students and including a subsample of collateral informants (n = 262), a series of analyses were conducted. The WFIRS demonstrated robust internal reliability, cross-informant agreement on par or superior to other measures of ADHD symptomatology and impairment, and concurrent validity. The WFIRS was not shown to be uniquely associated with ADHD, as internalizing symptoms also associated with the total and domain scores. The use of the WFIRS in identifying ADHD-related impairment in emerging adults appears to be psychometrically supported, and will prove useful to clinicians and researchers.
    Although the research is clear that boys with ADHD have higher symptomatology and impairment than girls with ADHD, for adults the research is mixed. Some studies suggest no sex differences, whereas others suggest that women might have... more
    Although the research is clear that boys with ADHD have higher symptomatology and impairment than girls with ADHD, for adults the research is mixed. Some studies suggest no sex differences, whereas others suggest that women might have higher symptomatology and impairment. The present study examined sex differences in ADHD symptomatology and impairment, and the possible role of claimed and behavioral self-handicapping as an explanation for any differences. Claimed self-handicapping (CSH) involves reports of performance-inhibiting conditions, whereas behavioral self-handicapping (BSH) involves reporting more objective, intentional acts that could undermine performance. College students (N = 699) completed an online study. Sex differences were found for hyperactivity such that women reported higher levels, but not for inattention or impairment. The test of the indirect effect of sex through CSH was significant, suggesting that higher levels of CSH in women were associated with elevated ADHD symptoms and impairment. The test of the indirect effect of sex through BSH was also significant, suggesting that higher levels of BSH in men are associated with elevated symptoms of ADHD and impairment. These data extend the literature by suggesting that self-handicapping might at least partially explain differential self-reporting of ADHD symptoms and impairment in emerging adults across the sexes.
    Approximately 5% of adults have ADHD. Despite recommendations regarding the diagnosis of emerging adults, there is not a strong consensus regarding the ideal method for diagnosing ADHD in both emerging and mature adults. We were... more
    Approximately 5% of adults have ADHD. Despite recommendations regarding the diagnosis of emerging adults, there is not a strong consensus regarding the ideal method for diagnosing ADHD in both emerging and mature adults. We were interested in determining whether a threshold of four, five, or six ADHD symptoms would be associated with significantly different levels of functional impairment and be more or less indicative of a potential ADHD diagnosis. We examined the relation between functional impairment and these ADHD symptom thresholds in 2,577 college students. Our findings suggest that none of these symptom thresholds are differentially better at predicting functional impairment. The Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) threshold of five symptoms for ages 17 years and older is not necessarily predictive of ADHD-related impairment in college students and may not be preferable to other thresholds. Options for resolving this diagnostic dilemma are d...
    While youth with emotional and behavioral disorders experience increased rates of obesity, few obesity interventions exist that are tailored to their needs. Qualitative methods were employed to elucidate obesity management practices in... more
    While youth with emotional and behavioral disorders experience increased rates of obesity, few obesity interventions exist that are tailored to their needs. Qualitative methods were employed to elucidate obesity management practices in this population. In all, 56 participants (i.e. 21 youths with emotional and behavioral disorders, 20 caregivers of youth with emotional and behavioral disorders, and 15 mental health providers) were recruited from community mental health centers. Participants completed a demographic form and semi-structured interview regarding obesity-related behaviors. Barriers (e.g. psychiatric symptoms) and facilitators (e.g. social support) to obesity management were identified. These results highlight preferred intervention components for this unique population.
    We sought to elucidate the effects of an organization, time management, and planning (OTMP) skills training intervention for college students reporting elevated levels of ADHD symptomatology and academic impairment. Undergraduate... more
    We sought to elucidate the effects of an organization, time management, and planning (OTMP) skills training intervention for college students reporting elevated levels of ADHD symptomatology and academic impairment. Undergraduate participants enrolled in either the intervention (n = 22) or comparison (n = 15) condition in exchange for psychology course credit. Those in the intervention condition attended three weekly group meetings designed to improve organizational skills. Treatment effectiveness was evaluated by comparing pre- and postmeasurements of academic impairment, inattention, hyperactivity/impulsivity, and OTMP skills utilization. Intervention group participants improved significantly on ratings of inattention, hyperactivity/impulsivity, and academic impairment, relative to the comparison group. Intervention group participants also improved in their use of OTMP skills, relative to their baseline ratings. This study suggests an organizational skills intervention has the pot...
    We assessed the predictive validity of attention-deficit=hyperactivity disorder (ADHD) in 20 girls and 98 boys who met the Diagnostic and Statistical Manual for Mental Disorders (4th ed., American Psychiatric ssociation, 1994) criteria... more
    We assessed the predictive validity of attention-deficit=hyperactivity disorder (ADHD) in 20 girls and 98 boys who met the Diagnostic and Statistical Manual for Mental Disorders (4th ed., American Psychiatric ssociation, 1994) criteria for ADHD at 4 to 6 years of age compared to 24 female and 102 male comparison children. Over the next 8 years, both girls and boys who met criteria for ADHD in Year 1 exhibited more ADHD symptoms and impairment than same-sex comparison children. Effect sizes were consistently large, ndicating that the diagnosis of ADHD at 4 to 6 years of age has predictive validity for both sexes. Both girls and boys with ADHD in Year 1 also exhibited higher levels of symptoms of conduct disorder, major epression, and anxiety disorders in early adolescence than same-sex comparison children, controlling levels of the same symptoms in Year 1. This indicates both substantial homotypic and heterotypic continuity for ADHD in both sexes, but significant interactions with ti...
    Despite the commonality of attention-deficit/hyperactivity disorder (ADHD), the diagnostic criteria are based largely on research with European American boys. Much less research is available regarding the prevalence of ADHD in other... more
    Despite the commonality of attention-deficit/hyperactivity disorder (ADHD), the diagnostic criteria are based largely on research with European American boys. Much less research is available regarding the prevalence of ADHD in other groups, specifically American Indian/Alaska Native (AI/AN) children. Moreover, research on sex differences in ADHD has typically not included AI/AN children. The current study examined parent- and teacher-reported ADHD symptoms in 72 AI children from one region in the Southern U.S., with a focus on sex differences. Data showed that AI children may have more pronounced sex differences in ADHD symptomology than is found in studies with primarily European American children. Implications, limitations, and future directions are discussed.
    This study examines the clinical utility of behavior ratings made by nonclinician examiners during assessments of preschool children with Attention-Deficit/Hyperactivity Disorder (AD/HD). Matched samples of children with (n = 127) and... more
    This study examines the clinical utility of behavior ratings made by nonclinician examiners during assessments of preschool children with Attention-Deficit/Hyperactivity Disorder (AD/HD). Matched samples of children with (n = 127) and without (n = 125) AD/HD were utilized to test the internal, convergent, concurrent, and incremental validity of ratings completed by examiners on the Hillside Behavior Rating Scale (HBRS). Results indicated that HBRS ratings were internally consistent, possessed sufficient interrater reliability, and were significantly associated with parent and teacher reports of AD/HD when controlling for age, gender, intelligence, and symptoms of other psychopathology. HBRS ratings also were significantly associated with other measures of functioning, and provided a significant increment in the prediction of impairment over parent and teacher report alone. These findings suggest that behavioral ratings during testing provide a unique source of clinical information t...
    ABSTRACT Disruptive behaviors in adolescents can be grouped broadly into four categories: (1) inattention, (2) hyperactivity and impulsivity, (3) oppositionality and defiance, and (4) conduct problems and antisocial behaviors including... more
    ABSTRACT Disruptive behaviors in adolescents can be grouped broadly into four categories: (1) inattention, (2) hyperactivity and impulsivity, (3) oppositionality and defiance, and (4) conduct problems and antisocial behaviors including aggression. Some of these behaviors at low levels are normative at certain ages. However, these behaviors are considered problematic when the individual experiences impairment due to the chronic nature of the symptoms. Both typical and problematic manifestations of disruptive behaviors are discussed. Further, the developmental progression and known sex differences in disruptive behaviors are elucidated. Finally, causes of and treatments for disruptive behavior disorders are presented.
    EJ823233 - Effects of a Social Skills Intervention Administered in Mixed Diagnostic Groups for Children with Peer Relationship Problems.
    ABSTRACT This article describes a manualized social skills intervention for children with peer relationship problems developed by Milich and colleagues (Milich et al., 199510. Milich , R. , Hartung , C. M. , Gallen , R. T. , Manolis , M.... more
    ABSTRACT This article describes a manualized social skills intervention for children with peer relationship problems developed by Milich and colleagues (Milich et al., 199510. Milich , R. , Hartung , C. M. , Gallen , R. T. , Manolis , M. B. , Diener , M. B. and Scambler , D. J. 1995 . Jesse G. Harris Psychological Services Center social skills and problem-solving training program manual , University of Kentucky . Unpublished manuscript View all references, 200411. Milich , R. , Hartung , C. M. , Gallen , R. T. , Manolis , M. B. , Diener , M. B. and Scambler , D. J. 2004 . Jesse G. Harris Psychological Services Center social skills and problem-solving training program manual , University of Kentucky & Oklahoma State University . Unpublished manuscript View all references). The program includes deficits-based components and problem-solving/anger-management components. This intervention is meant to be delivered in a group format over 8 sessions. It was designed for children ages 7 to 13 years and 2 treatment efficacy studies have been conducted with this age group (Antshel & Remer, 20032. Antshel , K. M. and Remer , R. 2003 . Social skills training in children with attention deficit hyperactivity disorder: A randomized-controlled clinical trial . Journal of Clinical Child and Adolescent Psychology , 32 : 153 – 165 . [Taylor & Francis Online], [PubMed], [Web of Science ®], [CSA]View all references; Lefler et al., 20089. Lefler , E. K. , Hartung , C. M. , Scambler , D. J. , Page , M. , Sullivan , M. Isenberg , J. 2008 . NHSA Dialog: A Research-to-Practice Journal for the Early Intervention Field View all references). The program has also been adapted for use with younger children in a Head Start setting, but treatment outcome research with this age group has not yet been completed. This article addresses 3 issues. First, an introduction to social skills interventions is presented. Second, the Milich et al. social skills program is described. Third, our recommendations for adapting the Milich et al. intervention for younger children is detailed as well as our clinical experience in using the intervention in Head Start.
    Objective: Behavior disorders are more prevalent among boys than girls, but the etiology of this difference is unclear. Studies have not tested for sex bias in ratings as a contributing factor to the differential sex prevalence rates.... more
    Objective: Behavior disorders are more prevalent among boys than girls, but the etiology of this difference is unclear. Studies have not tested for sex bias in ratings as a contributing factor to the differential sex prevalence rates. However, there are several studies showing “negative halo effects” in ratings of boys (i.e., the presence of one type of behavior artificially inflating ratings of another behavior). These findings have only been extended to girls in one recent study. The current study is designed to test for sex difference in (a) ratings of boys and girls who exhibit the same degree of disruptive behavior and (b) negative halo effects. Method: Two hundred and thirty-nine college students participated. Sex differences in ratings are not found. Nonetheless, bidirectional negative halo effects are found for boys and girls (i.e., the presence of oppositionality artificially increased ratings of inattention and hyperactivity; the presence of inattention and hyperactivity a...
    Numerous rating scales have been designed to assess bullying and victimization; however, the psychometric properties of these measures have been understudied. As a result, the accuracy of evaluations that determine the effectiveness of... more
    Numerous rating scales have been designed to assess bullying and victimization; however, the psychometric properties of these measures have been understudied. As a result, the accuracy of evaluations that determine the effectiveness of bullying policies or prevention programs is uncertain. The current study was designed to (a) compare the psychometric properties of two commonly-used student self-report measures of bullying and
    ... Jami Bartgisa, David G. Thomasb,*, Elizabeth K. Leflerb and Cynthia M. Hartungc a Indian Health Care Resource Center of Tulsa, Tulsa, OK, USA ... the ability to selectively attend to stimuli (Enns & Akhtar, 1989; Enns... more
    ... Jami Bartgisa, David G. Thomasb,*, Elizabeth K. Leflerb and Cynthia M. Hartungc a Indian Health Care Resource Center of Tulsa, Tulsa, OK, USA ... the ability to selectively attend to stimuli (Enns & Akhtar, 1989; Enns & Cameron, 1987; Hedrick & Kunze, 1974; Maccoby & Konrad ...
    ... Jami Bartgisa, David G. Thomasb,*, Elizabeth K. Leflerb and Cynthia M. Hartungc a Indian Health Care Resource Center of Tulsa, Tulsa, OK, USA ... the ability to selectively attend to stimuli (Enns & Akhtar, 1989; Enns... more
    ... Jami Bartgisa, David G. Thomasb,*, Elizabeth K. Leflerb and Cynthia M. Hartungc a Indian Health Care Resource Center of Tulsa, Tulsa, OK, USA ... the ability to selectively attend to stimuli (Enns & Akhtar, 1989; Enns & Cameron, 1987; Hedrick & Kunze, 1974; Maccoby & Konrad ...
    EJ629405 - Parent Training Programs for Young Children with Behavior Problems.
    EJ823233 - Effects of a Social Skills Intervention Administered in Mixed Diagnostic Groups for Children with Peer Relationship Problems.
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    Objective: Behavior disorders are more prevalent among boys than girls, but the etiology of this difference is unclear. Studies have not tested for sex bias in ratings as a contributing factor to the differential sex prevalence rates.... more
    Objective: Behavior disorders are more prevalent among boys than girls, but the etiology of this difference is unclear. Studies have not tested for sex bias in ratings as a contributing factor to the differential sex prevalence rates. However, there are several studies showing “negative halo effects” in ratings of boys (i.e., the presence of one type of behavior artificially inflating ratings of another behavior). These findings have only been extended to girls in one recent study. The current study is designed to test for sex difference in (a) ratings of boys and girls who exhibit the same degree of disruptive behavior and (b) negative halo effects. Method: Two hundred and thirty-nine college students participated. Sex differences in ratings are not found. Nonetheless, bidirectional negative halo effects are found for boys and girls (i.e., the presence of oppositionality artificially increased ratings of inattention and hyperactivity; the presence of inattention and hyperactivity artificially increased oppositionality).

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