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Does Actigraphy Differentiate ADHD Subtypes in a Clinical Research Setting?

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ABSTRACT

Objective

To compare subtypes of attention-deficit/hyperactivity disorder (ADHD) (predominantly inattentive and combined types) and a comparison group on an objective measure of activity level (actigraphy).

Method

Actigraphs were worn by 64 children (49 boys, 15 girls) during a full-day clinical diagnostic assessment; 20 subjects had a diagnosis of ADHD predominantly inattentive type, 22 had ADHD combined type, and 22 were non-ADHD controls. Mean actigraph scores were calculated for two 2-hour intervals, comprising, respectively, a psychometric evaluation in the morning and the completion of a speech and language assessment and research measures in the afternoon.

Results

There were no significant group differences in activity level in the morning session. During the afternoon session, children with ADHD were significantly more active than controls, but there were no differences between ADHD subtypes.

Conclusions

These data partially support specifications in the DSM-IV regarding hyperactivity in ADHD; however, they also indicate that situational and/or temporal factors may affect the degree to which hyperactivity is expressed. Furthermore, the findings contradict specifications in the DSM-IV that suggest that children with ADHD combined type should be more hyperactive than children with ADHD predominantly inattentive type.

Section snippets

Participants

Participants included 64 children (49 boys, 15 girls) ranging in age from 7 to 12 years (mean = 9.17, SD = 1.40). They were selected from a pool of 201 children referred for psychiatric and psychoeducational assessment of learning or behavioral disorders to the outpatient clinic of the Department of Psychiatry at an urban pediatric hospital. Sample sizes for the ADHD-I and control groups were determined by the availability of valid actigraph data; such data were available for 20 children who

Actigraph Scores by ADHD Status

Using a 2 (testing session) by 3 (group status) repeated-measures design in which the ADHD factor was partitioned into orthogonal contrasts, we determined that the main effects of group status and testing session on overall activity were nonsignificant. However, there was a significant interaction indicating increased activity among children with ADHD and decreased activity among control participants in the afternoon testing session. The details of this analysis are reported in Table 2.

In view

DISCUSSION

The results of this study are only partially consistent with expectations based on the definition of ADHD specified in the DSM-IV. In line with previous research involving actigraphy, children with ADHD were found to have higher levels of objectively measured activity than children not affected by the disorder, but only in the afternoon portion of the clinical diagnostic assessment. Furthermore, although DSM-IV criteria would lead clinicians to believe that children with ADHD-I should not

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    This research was supported by NIH grant RO1-HUD30174 awarded to Dr. Tannock. The authors thank Penny Corkum, Min-Na Hockenberry, Shameela Hoosen-Shakeel, and Victor Mota for their assistance. They also thank the anonymous reviewers for their helpful comments on an earlier version of this manuscript.

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