controls using an auditory distractor described as a "very loud hooter". (90 dB). The extent of the deterioration in performance was not significantly greater for the ...
Journal o f Abnormal Child Psychology, Vol. 9, No. 2, 1981, pp. 179-189
The Effect of Appealing Distractors on the Performance of Hyperactive Children' Alice Radosh 2 Queens College, City University o f New York Rachel Gittelman ~ New York State Psychiatric Institute and Columbia University
The study investigated whether hyperactive children were more suceptible to appealing distractors than were normal children. Twenty hyperactive and 20 normal children performed arithmetic tasks under three levels of distraction: no distraction, low-appeal distraction, and high-appeal distraction. Hyperactive children were significantly more affected by both lowand high-appeal distractors than were the normal children.
Attentional problems have been stressed by clinicians as key symptoms of children with hyperkinetic reactions. The renaming of this disorder as "attention deficit disorder with hyperactivity" (American Psychiatric Association, 1980) reflects this concern. Yet experimental attempts have not documented that hyperactive children are more deleteriously affected by external stimuli than are normal children. Sykes, Douglas, Weiss, and Minde (1971) found that the presence of an auditory distractor did not produce a significant decrement in the performance of 40 hyperactive children compared with matched controls. Dykman, Wails, Suzuki, Ackerman, and Peters (1970) obtained latency scores for telegraph key pressing in 20 hyperactive boys and 34
Manuscript received in final form July 23, 1980. 'This report is based upon a dissertation submitted by A. Radosh in partial fulfillment of the Ph.D. degree. The valuable contributions of Dr. Tina Moreau and Dr. Daniel Caputo are gratefully acknowledged. The study was supported in part by NIMH grant MH 18579. 2Now at Brooklyn College, City University of New York. 3Address all correspondence to Rachel Gittelman, Director, Psychology Department, New York State Psychiatric Institute, 722 West 168th Street, New York, New York 10032. 179 0091-0627/81/0600-0179 $03.00/0 9 1981 Plenum Publishing Corporation
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controls using an auditory distractor described as a "very loud hooter" (90 dB). The extent of the deterioration in performance was not significantly greater for the hyperactive than for the control group. Studies using visual distractors, like those using auditory distractors, have failed to find differences between hyperactive and nonhyperactive children. Campbell, Douglas, and Morgenstern (1971) reported that a stimulus field containing background information that is intrusive or contradictory to the central task was not more disruptive to the performance of hyperactive children than to that of nonhyperactive children. Combining auditory and visual distractors, Bremer and Stern (1976) measured the head and eye movements of 15 hyperactive boys and 15 controls during a reading task. The hyperactive children looked toward the distractors significantly more often and for longer periods of time than did the controls. The above studies are based on a model that assumes that hyperactive children, compared to normals, are more vulnerable to external stimuli, that they orient more easily to irrelevant aspects of the environment, and that they are more easily distracted from tasks regardless of the nature of the distractors. Klein and Gittelman-Klein (1975) have suggested that the implication that any stimulus suffices to divert attention of hyperactive children, while consistent with unrefined clinical observation, may not be the appropriate behavioral model to the attentional deficits of hyperactive children. Instead, they posit that distractibility is, in part, exploratory behavior in the service of appetitive interests. Therefore, hyperactive children should be more distracted than normal children by stimuli that they view as potentially rewarding alternatives to an ongoing task. External stimuli, such as white noise, which offer little possibility of reward or even of interesting relief from a fatiguing or aversive task, should be no more distracting to hyperactive children than to normal children. This study was designed to examine whether the level of appeal of the external stimuli affects the extent of distractibility in hyperactive children. The general hypothesis was that appealing stimuli have a significantly more negative effect on the performance of hyperactive children than on the performance of nonhyperactive children.
METHOD
Subjects The sample of hyperactive children consisted of 20 boys who had been referred by their teachers for treatment at the Child Development
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Effect of Distractors
Clinic of the Long Island Jewish-Hillside Medical Center. The boys ranged in age from 7 to 10 years (mean = 109 months, SD = 10) with a mean IQ on the revised Wechsler (1974) Intelligence Scale for Children (WISC-R) of 106 (SD = 9.33, range 91 to 121). Only children whose arithmetic achievement scores were within 1 year of grade level on the Wide Range Achievement Test (Jastak & Jastak, 1965) were included in the study. Fifteen children were white, three black, and two Hispanic. To obtain controls, teachers were approached to submit the names of children who exhibited no signs of hyperactivity or other behavioral problems. Permission to test the children was obtained from parents. The control group consisted of 20 boys, ages 7 to 10 years (mean = 102 months, SD = 9). The mean verbal IQ for the control group was 107 (SD = 14.7, range -- 86 to 131). All control group children had arithmetic scores with 1 year o f grade level on the Wide Range Achievement Test (mean = 3.3, SD -- 4 months). Thirteen children were white, three were black, and four were Hispanic. The two groups did not differ in level of SES using the two-index criterion (occupation and education).
Assessment of Hyperactivity All the children in the hyperactive group had to be referred by their teachers because of behavior in the classroom consonant with the diagnosis of hyperactivity, such as not listening, moving about the classroom, not paying attention, requiring a great deal of supervision. The Conners Teacher Rating Scale (Conners, 1969) was used to quantify the teachers' observations. In order to be considered hyperactive, a child had to receive a minimum score of 1.8 out of a possible maximum of 3.0 on the Hyperactivity factor. The 20 boys in the patient group had a group mean of 2.4 (sd = .40) on this factor, indicating high levels of hyperactive behavior perceived by the teachers. In addition to the teachers' ratings, parents had to report that the child was hyperactive or had troublesome behavior problems at home, and had a history of such behavior since early childhood, i All children had been o f f medication at least 72 hours prior to the testing session.
Task The task consisted of eight arithmetic problems, dition, subtraction, and multiplication problems. devised corresponding to the second-, third-, and respectively. Each child was administered the set appropriate to his grade level (e.g., Grade 2 : 8 - 3, 7
which included adThree levels were fourth-grade level, of eight problems + 1; Grade 3 : 2 x
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4, 16 - 8; Grade 4 : 5 • 3, 17 - 9). The eight problems were randomized across 300 trials.
Distractors
A 2-inch border surrounded the arithmetic problems in which three types of distractors were presented: high appeal, low appeal, and no appeal. For the high-appeal condition, the test border was filled with cutouts of colorful magazine pictures of toys, comical animals, spacecraft, and other like objects. For the low-appeal condition, the border contained colorful pictures free of meaningful content, such as fragments of nonobjective abstract paintings. In the no-appeal condition, the white border remained blank. Two pilot studies were conducted to test whether the different stimulus conditions varied in level of appeal (for details see Radosh, 1980). Both hyperactive and nonhyperactive children considered the high-appeal picture more interesting than low-appeal and no-appeal displays.
Procedure
Each child was tested individually while seated at a small desk on which was placed a teaching machine and a four-button response box that had four numbers on it, one number being the correct answer to the problem displayed in the window of the teaching machine. The child was told that the arithmetic problems were going to be shown in the window of the teaching machine and was instructed to press the button with the right answer. The machine was programmed to present each problem for a maximum of 3 seconds. If the child made no response during the 3-second exposure, the next problem appeared automatically. If a child responded before 3 seconds had elapsed, the next problem appeared immediately after the response. Children were not told whether their responses were correct. In order to familiarize the child with the apparatus and task, an eight-trial pretest training session was given, without any' distractions. The 3-second interval was selected on the basis of a pilot study conducted to determine the rate of presentation, which precluded the possibility of obtaining only correct responses and which allowed for errors (for details, see Radosh, 1980). A total of 300 trials were administered to each child, 100 for each appeal level. The three types of distractors were presented in random order over the 300 trials.
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Table I. Mean Number of Errors on Arithmetic Task Under Three Levels o f Distraction Stimulus condition b'c Group a Hyperactive Nonhyperactive
No appeal
Low appeal
High appeal
39.20 (19.12) 32.25 (17.09)
43.60 (20.00) 31.30 06.26)
47.30 (21.40) 35.80 (18.03)
Between-groups F(1.38) = 4.38, p < . 0 5 Between-conditions F(2.76) = 23.72, p < .01 Groups x conditions F(2.76) = 5.34, p < .01 aN = 20 in each group. bl00 trials in each condition ( m a x i m u m error score = 100). cStandard deviations in parentheses.
RESULTS The mean numbers of errors made by the hyperactive and nonhyperactive children in the three distraction conditions are presented in Table I. The numbers of errors were analyzed using a two-way factorial design; the two factors were group membership (hyperactive vs. nonhyperactive) and distraction condition (high, low, and no appeal). Analyses of simple (noninteractional) effects such as differences of mean scores between groups or conditions were conducted using the Newman-Keuls procedure. Two-tailed tests were applied to all probability levels. No significant difference between groups across conditions was obtained, F(1,38) = 2.98, p = .09. Significant differences across conditions, F(2,76) = 23.66, p < .001, and a significant groups by conditions interaction, F(2,76) = 4.98, p < .01, were obtained (Table II). The significant group by condition interaction indicates that the pattern of the error rate across the three conditions (no appeal, low appeal, and high appeal) differed significantly between the hyperactive and control groups. Figure 1 depicts the groups by condition interaction. The Newman-Keuls multiple-comparisons procedure was applied to identify the significant pairwise differences between treatment conditions. The difference between pairwise means, Wr, which had to be met or exceeded in order for differences between a pair of treatment means to be considered significant at the .05 level was 2.90. The hyperactive children made significantly more errors in the highappeal than in the low-appeal condition (47.30 vs. 43.60). In addition, the
Radosh and Gitteiman
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Table If. Analysis of Variance of Error Scores of Hyperactive and Nonhyperactive Children on Arithmetic Task Main effect
Sum of squares
df
Mean square
F
Groups a Error term Conditions Error term Groups • conditions
3050.21 38892.78 702.05 1125.57 147.72
1 38 2 76 2
4236.41 966.94 351.10 14.80 79.03
2.980
aN bp Cp dp
23.66 a 4.98 c
= 40. = .09. < .01. < .001.
hyperactive children made significantly more errors in the low-appeal than in the no-appeal condition (43.69 vs. 39.20). The nonhyperactive children also made significantly more errors in the high-appeal than in the low-appeal condition (35.80 vs. 31.30). The high-appeal condition had significantly more errors than the no-appeal condition in the nonhyperactive group (35.80 vs. 32.25). There was no sigrificant difference in the number of errors between the low-appeal and the no-appeal condition in this group (31.30 vs. 32.25). The pairwise differences between the stimulus conditions are presented in Table III.
5O nr
o
tY
48 46
a: 4 4 W u_ 4 2 o 40 w rn
38
:~
36 34
z
m
m
m
./ m
B
Z 9~
32
~
gO
m
I
1
I
NO APPEAL
LOW APPEAL
HIGH APPEAL
STIMULUS CONDITION Fig. | . Mean n u m b e r of errors made by hyperactive and nonhyperactive children in each appeal condition.
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185
Table 1II. Differences in Mean Error Scores: Comparison Between Conditions a Stimulus condition comparisons
Group ~ Hyperactive Nonhyperactive
Low appeal VS. no appeal
High appeal VS. no appeal
High appeal VS. low appeal
4.40 c -.45
3.70 c 4.00 c
8.10 c 3.55 c
a W r (Newman-Keuls) = 2.90.
~N = 20 in each group. cSignificant at .05 level.
The difference between groups, with all conditions combined, was analyzed to permit pairwise comparisons between the two groups in each treatment condition. The Newman-Keuls procedure yielded a Wr of 20.46. The pairwise differences between the hyperactive and nonhyperactive groups are presented in Table IV. No pairwise differences between group means met or exceeded 20.46, indicating nonsignificant differences between groups within conditions. Error scores on the arithmetic task were analyzed to determine whether the high-appeal stimuli had disrupted the performance of hyperactive children significantly more than the performance of nonhyperactive children. The hyperactive children had a significantly greater difference in errors between the high-appeal stimulus condition and the no-appeal stimulus condition than did the nonhyperactive children (means, 47.30 and 39.20 vs. 35.80 and 32.25, t(38) = 2.29, p < .03). Error scores were analyzed to determine whether the difference in error rate between the high- and low-appeal conditions differed significantly between the hyperactive and nonhyperactive children. The mean group difference in error scores between high and low appeal was 3.7 for the hyperactive children and 4.5 for the nonhyperactive children. Although both the hyperactive and nonhyperactive children made significantly more errors in the presence of high-appeal stimuli, the extent of this deterioration was Table IV. Difference in Mean Error Scores: Group Contrasts a Stimulus condition Group comparison Hyperactive vs. nonhyperactive
No appeal
Low appeal
High appeal
6.95
12.30
11.50
a W r (Newman-Keuls) = 20.46. No significant differences.
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no greater for the hyperactive children than for the nonhyperactive children (t = .21, n.s.). A t test of difference scores comparing the performance of hyperactive and nonhyperactive children on the extent of deterioration between the low-appeal and the no-appeal condition was significant (t(38) = 2.85, p < .01), indicating that the hyperactive children made significantly more errors on the low-appeal than on the no-appeal task compared with the normal children.
DISCUSSION The results of the present study support the hypothesis that highly appealing distractors, compared to neutral conditions, are significantly more distracting to hyperactive children than to nonhyperactive children. These findings are consistent with Douglas's (1972) view that hyperactive children are less disrupted by outside distractors than the literature would suggest but that they can be "led astray" by stimuli that are "highly attractive" to them. This study was designed with the intention of distinguishing between the effects of high-appeal and low-appeal distractors. Although hyperactive children made significantly more arithmetic errors in the presence of high-appeal stimuli than in the presence of low-appeal stimuli, this was also the case for the nonhyperactive children. The lack of difference between the hyperactive and nonhyperactive children in the degree to which highly appealing distractors affected performance compared with only somewhat appealing (low-appeal) distractors was due to a significantly deleterious effect of the low-appeal condition on the performance of hyperactive children. The design of the present study does not rule out the possibility that the low-appeal stimuli were distracting to hyperactive children due to a contamination of the low-appeal stimuli by the high-appeal stimuli. Since the three appeal conditions were randomly distributed, each trial could be bordered by amusing magazine pictures, colored abstract art fragments, or blank paper. Only the blank border could be perceived instantly as not being highly interesting. The art fragments might require a very brief period of time to determine that they offered no interesting alternative to the task. This could have interfered with performance on the timed arithmetic task. If hyperactive children are more likely than nonhyperactive children to turn to external stimuli in an attempt to find an interesting alternative to an ongoing task, then it is possible that they would scan colorful low-appeal stimuli longer than would nonhyperactive children.
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A second possible explanation for the distracting impact of the lowappeal stimuli in the hyperactive children is the possibility that there is a distractor-task interaction and that, as the task becomes more difficult, the level of stimulus appeal necessary to produce distractibility declines. With the exception of Bremer and Stern (1976), who used a reading task, investigators have used nonacademic tasks. It is possible that the uniformly negative results of the earlier studies are the result of the use of lowappeal stimuli in conjunction with undemanding, nonaversive tasks. In contrast, in this study, the arithmetic problems, presented rapidly, provided a challenging task for young children, and one that many of the children found aversive. If, as has been suggested by Klein and GittelmanKlein (1975), distractibility in hyperactive children is in part a response to mental effort and therefore mental fatigue, then there would be reason to expect that hyperactive children required to perform a task as difficult as the one in the present study might be distracted by low-appeal stimuli. The extent to which task difficulty affected the hyperactive children in the presence of low-appeal stimuli cannot be assessed since only one level of task difficulty was used. The issues concerning the role of task difficulty and the effect of the level of stimulus appeal on distractibility are of major importance to educators. The belief that hyperactive children have an attentional disorder manifested by an impaired ability to ignore irrelevant, external stimuli has been common since the work of Strauss and his colleagues (Strauss, 1939; Strauss & Lehtinen, 1947; Strauss & Werner, 1943). This assumption, although previously unsupported by empirical studies, is generally accepted (Johnson & Prinz, 1976). The importance of reducing distraction within the classroom has been stressed by numerous authors, many of whom have conducted classroom studies aimed at determining the optimal conditions for the teaching of hyperactive children (Bateman, 1973; Cruickshank, Bentzen, Ratzburg & Tannhauser, 1961; Cruickshank, Junkala, & Paul, 1968; Johnson & Prinz, 1976; Patterson, 1965; Rost & Charles, 1967). If hyperactive children have difficulty screening out environmental distractors and maintaining attention to the task, then isolating the children in booths or removing all potential distractors should result in improved classroom performance. Very little has changed since 1973 when Somerville, Warnberg, and Bost reviewed the literature on the use of isolation booths and concluded that there was no study that clearly indicated that minimizing external stimulation had a beneficial effect on task performance. The failure of classroom studies to show that the absence of external stimulation improves performance, and the failure of most studies to show that the presence of external stimulation disrupts performance, has led some authors to question the premise of the "stimulation-as-distractor"
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model presented by Strauss and his co-workers (Carter & Diaz, 1971; Hallahan & Kaufman, 1976; Zentall, Zentall, & Barack, 1978). The present study, rather than rejecting the stimulation-as-distractor model, has critically examined the earlier studies and found them to be inadequate tests of the model. The results of the present study support the hypothesis that distracting stimuli have an adverse effect on the performance of hyperactive children.
REFERENCES American Psychiatric Association. Diagnostic and statistical manual of mental disorders (3rd ed.). Washington, D.C., 1980. Bateman, B. D. Educational implications of minimal brain dysfunction. In F. F. de la Cruz, B. H. Fox, & R. H. Roberts (Eds.), Minimal brain dysfunction. New York: New York Academy of Sciences, 1973. Bremer, D. A., & Stern, J. A. Attention and distractibility during reading in hyperactive boys. Journal of Abnormal ChiM Psychology, 1976, 4, 381-387. Campbell, S. B., Douglas, V. I., & Morgenstern, G. Cognitive styles in hyperactive children and the effect of methylphenidate. Child Psychology, 1971, 12, 55-67. Carter, J. L., & Diaz, A. Effects of visual and auditory background on reading test performance. Exceptional Children, 1971, 38, 43-50. Conners, C. K. A teacher rating scale for use in drug studies with children. American Journal of Psychiatry, 1969, 126, 884-888. Cruickshank, W. M., Bentzen, F. A., Ratzburg, F. H., & Tannhauser, M. T. A teaching method for brain injured and hyperactive children: A demonstration pilot study. Syracuse: Syracuse University Press, 1961. Cruickshank, W. M., Junkala, J. B., & Paul, J. L. The preparation of teachers of brain injured children. Syracuse: Syracuse University Press, 1968. Douglas, V. I. Stop, look and listen: the problem of sustained attention and impulse control in hyperactive and normal children. Canadian Journal of Behavioral Science, 1972, 4, 259-282. Dykman, R., Walls, R. C., Suzuki, T., Ackerman, P. T., & Peters, J. E. Children with learning disabilities: Condition differentiation and the effect of distraction. American Journal of Orthopsychiatry, 1970, 40, 766-782. Hallahan, D. P., & Kaufman, J. M. Introduction to learning disabilities. Englewood Cliffs, New Jersey: Prentice-Hall, 1976. Jastak, J. F. & Jastak, S. R. The Wide Range Achievement Test, Revised edition. Wilmington, Del: Wilmington Guidance Associates, 1965. Johnson, C. F., & Prinz, R. Hyperactivity is in the eyes of the beholder. Clinical Pediatrics, 1976, 15, 222-238. Klein, D. F., & Gittelman-Klein, R. Problems in the diagnosis of minimal brain dysfunction and hyperkinetic syndrome. International Journal of Mental Health, 1975, 4, 45-60. Patterson, G. R. An application of conditioning techniques to the control of a hyperactive child. In L. P. UUmann & L. Krasner (Eds.), Case studies in behavior modification. New York: Holt, Rinehart & Winston, 1965. Radosh, A. The effects of visual distractors on the performance of hyperactive children on an arithmetic task. Unpublished doctoral disseration, City University of New York, 1980. Rost, K. F., & Charles, Q. C. Academic achievement of brain injured and hyperactive children in isolation. Exceptional Children, 1967, 34, 125-126. Somerville, J. W., Warnberg, L. S., & Bost, D. E. Effects of cubicles versus increased stimulation on task performance by first grade males perceived as distractible or nondistractible Journal of Special Education, 1973, 7, 169-185.
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Strauss, A. A. Typology in mental deficiency. Proceedings of the American Association of Mental Deficiency, 1939, 44, 84-90. Strauss, A. A., & Lehtinen, L. Psychopathology and education of the brain-injured child. New York: Grune and Stratton, 1947. Strauss, A. A., & Werner, J. Comparative psychopathology of the brain-injured child and the traumatic brain-injured adult. American Journal of Psychiatry, 1943, 99, 835-838. Sykes, D. H., Douglas, V. I., Weiss, G., & Minde, K. K. Attention in hyperactive children and the effect of methylphenidate. Journal of Child Psychology and Psychiatry, 1971, 12, 129-139. Wechsler, D. Wechsler intelligence scale for children--revised. New York: Psychological Corporation, 1974. Zentall, S. S., Zentall, T. R., & Barack, R. R. Distraction as a function of within-task stimulation for hyperactive and normal children. Journal of Learning Disabilities, 1978, 11, 13-21.