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Alarachi A, Merrifield C, Rowa K, McCabe RE. Are We Measuring ADHD or Anxiety? Examining the Factor Structure and Discriminant Validity of the Adult ADHD Self-Report Scale in an Adult Anxiety Disorder Population. Assessment 2024; 31:1508-1524. [PMID: 38288573 PMCID: PMC11409565 DOI: 10.1177/10731911231225190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2024]
Abstract
Adults with clinical anxiety have significant symptom overlap and above average rates of attention-deficit/hyperactivity disorder (ADHD). Despite this, ADHD remains a vastly under-detected disorder among this population, indicating the need for a screener with well-understood symptom dimensions and good discriminant validity. The current study compared competing models of ADHD as well as discriminant properties of self-reported ADHD symptoms as measured by the Adult ADHD Self-Report Scale (ASRS-v1.1) in 618 adults with clinical anxiety. A three-factor correlated model of Inattention, Impulsivity, and Hyperactivity, with the movement of one item, talks excessively, to a factor of Impulsivity from Hyperactivity fit better than the one-factor, two-factor, and traditional three-factor models of ADHD. Discriminant properties of the screener were fair to good against measures of clinical anxiety and distress; however, some items within the Hyperactivity factor (e.g., difficulty relaxing; feeling driven by a motor) loaded more strongly onto factors of clinical anxiety than ADHD when measures were pooled together. These results suggest that clinicians making differential diagnoses between adult ADHD and anxiety or related disorders should look for evidence of ADHD beyond the overlapping symptoms, particularly for those within the Hyperactivity factor.
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Affiliation(s)
- Arij Alarachi
- Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, Ontario, Canada
- Department of Psychology, Neuroscience, & Behaviour, McMaster University, Hamilton, Ontario, Canada
| | - Colleen Merrifield
- Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, Ontario, Canada
- Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Karen Rowa
- Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, Ontario, Canada
- Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Randi E McCabe
- Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, Ontario, Canada
- Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
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Sutherland Charvis JM, Vergara-Lopez C, Hernandez Valencia EM, Fernandez ME, Rozum W, Lopez-Vergara HI. A proof-of-concept study testing the factor structure of the Stop Signal Task: overlap with substance use and mental health symptoms. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2024; 50:462-470. [PMID: 38557256 DOI: 10.1080/00952990.2024.2316599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 02/04/2024] [Indexed: 04/04/2024]
Abstract
Background: Research utilizing experimental tasks usually does not report estimates of internal reliability of measurement. However, modern measurement theories conceptualize reliability as sample dependent indicating that reliability should be empirically demonstrated in the samples used to make inferences.Objectives: Test whether confirmatory factor analytic (CFA) estimates of reliability can be applied to a commonly used task measuring response inhibition (the Stop Signal Task) to predict substance use (alcohol and cannabis) and mental health symptoms.Methods: Thirty-seven participants between the ages of 18-20 (72% female; 16% Asian, 3% Native American, 11% Black or African American, 59% White; 32% Latino/a/x) were recruited via social media advertisement and attended a laboratory visit. The Stop Signal Reaction Time (SSRT) was calculated as the outcome for three experimental blocks and used as indicators in a CFA.Results: CFA suggests the task yields reliable scores; factor loadings were statistically significant (p < .05) and substantial (standardized loadings ranged from .74 to .94). However, reliability increased across experimental blocks and error was non-trivial (ranging from 50% to 12% of the variance). The inhibition factor predicted higher maximum number of drinks consumed (β = .37, p < .05), higher frequency of cannabis use (β = .39, p < .05), and more cannabis use occasions within using days (β = .40, p < .05), as well as facets of mental health (anxious/depression, attention, and anxiety problems; all p's < .05).Conclusion: Results support the utility of CFA to test for reliability of measurement, with the ability to inhibit dominant responses serving as a transdiagnostic correlate of substance use and mental health problems.
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Affiliation(s)
| | - Chrystal Vergara-Lopez
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI, USA
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA
| | | | | | - William Rozum
- Department of Psychology, The University of Rhode Island, Kingston, RI, USA
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Kofler MJ, Groves NB, Chan ESM, Marsh CL, Cole AM, Gaye F, Cibrian E, Tatsuki MO, Singh LJ. Working memory and inhibitory control deficits in children with ADHD: an experimental evaluation of competing model predictions. Front Psychiatry 2024; 15:1277583. [PMID: 38779551 PMCID: PMC11110569 DOI: 10.3389/fpsyt.2024.1277583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 03/07/2024] [Indexed: 05/25/2024] Open
Abstract
Introduction Children with ADHD demonstrate difficulties on many different neuropsychological tests. However, it remains unclear whether this pattern reflects a large number of distinct deficits or a small number of deficit(s) that broadly impact test performance. The current study is among the first experiments to systematically manipulate demands on both working memory and inhibition, with implications for competing conceptual models of ADHD pathogenesis. Method A clinically evaluated, carefully phenotyped sample of 110 children with ADHD, anxiety disorders, or co-occurring ADHD+anxiety (Mage=10.35, 44 girls; 69% White Not Hispanic/Latino) completed a counterbalanced, double dissociation experiment, with two tasks each per inhibition (low vs. high) x working memory (low vs. high) condition. Results Bayesian and frequentist models converged in indicating that both manipulations successfully increased demands on their target executive function (BF10>5.33x108, p<.001). Importantly, occupying children's limited capacity working memory system produced slower response times and reduced accuracy on inhibition tasks (BF10>317.42, p<.001, d=0.67-1.53). It also appeared to differentially reduce inhibition (and non-inhibition) accuracy for children with ADHD relative to children with anxiety (BF10=2.03, p=.02, d=0.50). In contrast, there was strong evidence against models that view working memory deficits as secondary outcomes of underlying inhibition deficits in ADHD (BF01=18.52, p=.85). Discussion This pattern indicates that working memory broadly affects children's ability to inhibit prepotent tendencies and maintain fast/accurate performance, and may explain the errors that children with ADHD make on inhibition tests. These findings are broadly consistent with models describing working memory as a causal mechanism that gives rise to secondary impairments. In contrast, these findings provide evidence against models that view disinhibition as a cause of working memory difficulties or view working memory as a non-causal correlate or epiphenomenon in ADHD.
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Affiliation(s)
- Michael J. Kofler
- Department of Psychology, Florida State University, Tallahassee, FL, United States
| | - Nicole B. Groves
- Department of Psychiatry, Seattle Children’s Hospital, Seattle, WA, United States
| | - Elizabeth S. M. Chan
- Graduate School of Applied and Professional Psychology, Rutgers University, New Brunswick, NJ, United States
| | - Carolyn L. Marsh
- Department of Psychology, Florida State University, Tallahassee, FL, United States
| | - Alissa M. Cole
- Department of Psychology, Florida State University, Tallahassee, FL, United States
| | - Fatou Gaye
- Department of Psychology, Florida State University, Tallahassee, FL, United States
| | - Enrique Cibrian
- Department of Psychology, Florida State University, Tallahassee, FL, United States
| | - Miho O. Tatsuki
- Department of Psychology, Florida State University, Tallahassee, FL, United States
| | - Leah J. Singh
- Department of Psychology, Florida State University, Tallahassee, FL, United States
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Marsh CL, Harmon SL, Cho S, Chan ESM, Gaye F, DeGeorge L, Black KE, Irwin Harper LN, Kofler MJ. Does Anxiety Systematically Bias Estimates of Executive Functioning Deficits in Pediatric Attention-Deficit/Hyperactivity Disorder? Res Child Adolesc Psychopathol 2024; 52:773-787. [PMID: 38157122 PMCID: PMC11216413 DOI: 10.1007/s10802-023-01152-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2023] [Indexed: 01/03/2024]
Abstract
Growing evidence suggests that childhood ADHD is associated with larger impairments in working memory relative to inhibition. However, most studies have not considered the role of co-occurring anxiety on these estimates - a potentially significant confound given prior evidence that anxiety may increase working memory difficulties but decrease inhibition difficulties for these children. The current study extends prior work to examine the extent to which co-occurring anxiety may be systematically affecting recent estimates of the magnitude of working memory/inhibitory control deficits in ADHD. The carefully-phenotyped sample included 197 children with ADHD and 142 children without ADHD between the ages of 8 and 13 years (N = 339; Mage = 10.31, SD = 1.39; 144 female participants). Results demonstrated that ADHD diagnosis predicted small impairments in inhibitory control (d = 0.31) and large impairments in working memory (d = 0.99). However, child trait anxiety assessed dimensionally across multiple informants (child, parent, teacher) did not uniquely predict either executive function, nor did it moderate estimates of ADHD-related working memory/inhibition deficits. When evaluating anxiety categorically and controlling for ADHD, anxiety diagnosis predicted slightly better working memory (d = 0.19) but not inhibitory control for clinically evaluated children generally. Findings from the current study indicate that trait anxiety, measured dimensionally or categorically, does not differentially affect estimates of executive dysfunction in pediatric ADHD. Further, results suggest that trait anxiety is generally not associated with executive dysfunction above and beyond the impact of co-occurring ADHD. Future research is needed to further assess the role of anxiety in ADHD behavioral symptomatology, neurocognitive functioning, and mechanisms underlying these relations.
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Affiliation(s)
- Carolyn L Marsh
- Florida State University, Department of Psychology, 1107 W. Call Street, Tallahassee, FL, 32306-4301, USA
| | - Sherelle L Harmon
- Florida State University, Department of Psychology, 1107 W. Call Street, Tallahassee, FL, 32306-4301, USA
| | - Sooyun Cho
- Florida State University, Department of Psychology, 1107 W. Call Street, Tallahassee, FL, 32306-4301, USA
| | - Elizabeth S M Chan
- Rutgers University, Graduate School of Applied and Professional Psychology, Piscataway, NJ, USA
| | - Fatou Gaye
- Florida State University, Department of Psychology, 1107 W. Call Street, Tallahassee, FL, 32306-4301, USA
| | - Lauren DeGeorge
- Florida State University, Department of Psychology, 1107 W. Call Street, Tallahassee, FL, 32306-4301, USA
| | - Katie E Black
- Florida State University, Department of Psychology, 1107 W. Call Street, Tallahassee, FL, 32306-4301, USA
| | - Lauren N Irwin Harper
- Johns Hopkins All Children's Hospital, Center for Behavioral Health, St. Petersburg, FL, USA
| | - Michael J Kofler
- Florida State University, Department of Psychology, 1107 W. Call Street, Tallahassee, FL, 32306-4301, USA.
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Anning KL, Langley K, Hobson C, De Sonneville L, Van Goozen SHM. Inattention symptom severity and cognitive processes in children at risk of ADHD: the moderating role of separation anxiety. Child Neuropsychol 2024; 30:264-288. [PMID: 36960813 DOI: 10.1080/09297049.2023.2190964] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 02/24/2023] [Indexed: 03/25/2023]
Abstract
Impairments in cognitive processes and their associations with dimensional measures of inattention, hyperactivity-impulsivity and anxiety were examined in children at risk of Attention-Deficit Hyperactivity Disorder. Children referred by teachers for exhibiting ADHD-type problems (n = 116; 43 meeting full diagnostic criteria for ADHD; 4-8 years) completed computerized tasks measuring episodic memory, response inhibition, visuomotor control and sustained attention, while parents were interviewed (DAWBA) to assess ADHD and anxiety symptoms. Of the 116 children assessed, 72% exhibited impaired cognitive processes; 47% had impaired visuomotor control, 37% impaired response inhibition, and 35% had impaired episodic memory. Correlational and hierarchical regression analyses using our final analytic sample (i.e., children who completed all cognitive tasks and a vocabulary assessment, n = 114) showed that poorer task performance and greater within-subject variability were significantly associated with more severe inattention symptoms but not with hyperactivity-impulsivity severity. Symptoms of separation anxiety, which were reported in over half of the sample, moderated associations between inattention and episodic memory, and between inattention and inhibition. Only children without separation anxiety showed significant correlations between ADHD symptoms and poor performance. However, separation anxiety had no moderating effect on associations between inattention and visuomotor control or sustaining attention. Children exhibiting signs of ADHD show impairments across a range of cognitive tasks. Further research to improve our understanding of these processes may be useful in the development of early interventions. Our results suggest that separation anxiety should be taken into account when considering interventions to address emerging neuropsychological deficits associated with this disorder.
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Affiliation(s)
- Kate L Anning
- School of Psychology, Cardiff University, Cardiff, UK
| | - Kate Langley
- School of Psychology, Cardiff University, Cardiff, UK
| | | | - Leo De Sonneville
- Department of Clinical Neurodevelopmental Studies, Leiden University, Leiden, The Netherlands
| | - Stephanie H M Van Goozen
- School of Psychology, Cardiff University, Cardiff, UK
- Department of Clinical Neurodevelopmental Studies, Leiden University, Leiden, The Netherlands
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Marsh CL, Groves NB, Mehra LM, Black KE, Irwin Harper LN, Meyer A, Kofler MJ. The relation between executive functions, error-related brain activity, and ADHD symptoms in clinically evaluated school-aged children. Child Neuropsychol 2023; 29:1362-1387. [PMID: 36644833 PMCID: PMC10349902 DOI: 10.1080/09297049.2023.2166029] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 01/03/2023] [Indexed: 01/17/2023]
Abstract
Two event-related potentials (ERPs) elicited following errors, the error-related negativity (ERN) and error positivity (Pe), have been proposed to reflect cognitive control, though the specific processes remain debated. Few studies have examined the ERN and Pe's relations with individual differences in cognitive control/executive functioning using well-validated tests administered separately from the inhibition tasks used to elicit the ERN/Pe. Additionally, neurocognitive tests of executive functions tend to strongly predict ADHD symptoms, but the extent to which task-based and EEG-based estimates of executive functioning/cognitive control account for the same variance in ADHD symptoms remains unclear. The current study addressed these limitations by examining relations between the ERN/Pe and three core executive functions (working memory, inhibitory control, set shifting) in a clinically-evaluated sample of 53 children ages 8-12 (Mage = 10.36, SD = 1.42; 77.4% White/Non-Hispanic; 16 girls) with and without ADHD. Results demonstrated that neither the ERN nor Pe were related to overall cognitive control/executive functioning, or to working memory or set shifting specifically (all 95%CIs include 0.0). In contrast, a larger Pe was associated with better-developed inhibitory control (β=-.35, 95%CI excludes 0.0), but did not capture aspects of inhibitory control that are important for predicting ADHD symptoms. Neither the ERN nor Pe predicted ADHD symptoms (95%CIs include 0.0). Results were generally robust to control for age, sex, SES, ADHD symptom cluster, and anxiety, and emphasize the need for caution when interpreting the ERN/Pe as indices of broad-based cognitive control/executive functioning, as well as using the ERN/Pe to examine cognitive processes contributing to ADHD symptomatology.
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Miyauchi M, Matsuura N, Mukai K, Hashimoto T, Ogino S, Yamanishi K, Yamada H, Hayashida K, Matsunaga H. A prospective investigation of impacts of comorbid attention deficit hyperactivity disorder (ADHD) on clinical features and long-term treatment response in adult patients with obsessive-compulsive disorder (OCD). Compr Psychiatry 2023; 125:152401. [PMID: 37454485 DOI: 10.1016/j.comppsych.2023.152401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 05/13/2023] [Accepted: 07/10/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND A close association between obsessive-compulsive disorder (OCD) and attention-deficit/hyperactivity disorder (ADHD) in children and adolescents has been investigated in previous studies. However, few studies examined the relationship between lifetime comorbidity of ADHD and OCD in adults. Therefore, we sought to investigate the clinical and psychopathological features related to comorbid ADHD in Japanese adult patients with OCD. METHODS We assessed lifetime comorbidity of ADHD in 93 adult Japanese patients with OCD. Additionally, we used the Japanese version of Conners' Adult ADHD Rating Scales to assess the characteristics and severity of ADHD in each participant. According to the results, we excluded OCD patients that did not have ADHD but who exhibited elevated levels of ADHD traits. We compared OCD patients with ADHD (ADHD+ group) and those without ADHD or its trait (ADHD- group) in terms of background profiles and clinical features, such as OCD symptomatology and psychometric test results. Additionally, the 6-month treatment outcome was compared prospectively between groups. RESULTS Of the 93 OCD participants, the prevalence of lifetime comorbidity of ADHD was estimated as 16.1%. Compared with the ADHD- group, participants in the ADHD+ group had an earlier age of onset of OCD, higher frequencies of hoarding symptoms, higher levels of depressive and anxiety symptoms and lower quality of life, more elevated levels of impulsivity, and higher rates of substance or behavioral addiction and major depression. Finally, the mean improvement rate on the Yale-Brown Obsessive Compulsive Scale after 6 months of standardized OCD treatment in the ADHD+ group (16.1%) was significantly lower than that in the ADHD- group (44.6%). CONCLUSION The lifetime comorbidity of ADHD is likely to exert a significant effect on clinical features and treatment outcome in adult patients with OCD. It is important to consider that underlying ADHD pathology may function as a facilitator for increased severity of global clinical features and treatment refractory conditions in OCD patients. Further studies are required to examine treatment strategies for such patients.
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Affiliation(s)
- Masahiro Miyauchi
- Department of Neuropsychiatry, Hyogo College of Medicine, Nishinomiya, Japan
| | - Naomi Matsuura
- Graduate School of Education, Mie University, Mie, Japan
| | - Keiichiro Mukai
- Department of Neuropsychiatry, Hyogo College of Medicine, Nishinomiya, Japan
| | - Takuya Hashimoto
- Department of Neuropsychiatry, Hyogo College of Medicine, Nishinomiya, Japan
| | - Shun Ogino
- Department of Neuropsychiatry, Hyogo College of Medicine, Nishinomiya, Japan
| | - Kyosuke Yamanishi
- Department of Neuropsychiatry, Hyogo College of Medicine, Nishinomiya, Japan
| | - Hisashi Yamada
- Department of Neuropsychiatry, Hyogo College of Medicine, Nishinomiya, Japan
| | - Kazuhisa Hayashida
- Department of Neuropsychiatry, Hyogo College of Medicine, Nishinomiya, Japan
| | - Hisato Matsunaga
- Department of Neuropsychiatry, Hyogo College of Medicine, Nishinomiya, Japan.
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Morales-Hidalgo P, Voltas-Moreso N, Hernández-Martínez C, Canals-Sans J. Emotional problems in preschool and school-aged children with neurodevelopmental disorders in Spain: EPINED epidemiological project. RESEARCH IN DEVELOPMENTAL DISABILITIES 2023; 135:104454. [PMID: 36804709 DOI: 10.1016/j.ridd.2023.104454] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 12/09/2022] [Accepted: 02/03/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Children with neurodevelopmental disorders (NDD) are often at risk of developing emotional problems. AIMS AND METHODS The co-occurrence of anxiety and depression with ASD and/or ADHD was determined by exploring the association with children's clinical and neuropsychological functioning and their parent's mental health. To this end, we assessed 295 preschoolers (PRE; 4-5 years old) and 486 school-aged children (SCH; 10-11 years old) in Tarragona, Spain. NDD diagnoses were based on DSM-5. Emotional problems were assessed using Achenbach's scales. RESULTS Emotional problems (PRE: 36%-78%; SCH: 32%-81%) were more common and more severe in participants with NDD than in controls and children in the ASD + ADHD school-aged group were the most affected. In ADHD, emotional problems were associated with more severe symptoms of attention deficit (PRE) and hyperactivity/impulsivity (SCH). In ASD + ADHD, emotional problems showed a trend of association with more severe ASD repetitive behaviours and impaired working memory, whereas in ASD were associated with greater overall ASD severity. CONCLUSIONS AND IMPLICATIONS Children with NDD are vulnerable to emotional problems, which become more prevalent and interfering with age. Early detection and intervention aimed at tackling emotional problems can improve NDD prognosis.
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Affiliation(s)
- Paula Morales-Hidalgo
- Research Group on Nutrition and Mental Health (NUTRISAM), Research Center for Behavioral Assessment (CRAMC), Department of Psychology, University Rovira i Virgili, Tarragona, Spain; Psychology and Education Studies, Universitat Oberta de Catalunya (UOC), Barcelona, Spain; Interdisciplinary Research Network for the PROmotion of Mental Health and Wellness EMocional in Young People (Red PROEM), Spain
| | - Núria Voltas-Moreso
- Research Group on Nutrition and Mental Health (NUTRISAM), Research Center for Behavioral Assessment (CRAMC), Department of Psychology, University Rovira i Virgili, Tarragona, Spain; Interdisciplinary Research Network for the PROmotion of Mental Health and Wellness EMocional in Young People (Red PROEM), Spain; Serra Húnter Fellow, University Rovira i Virgili, Spain
| | - Carmen Hernández-Martínez
- Research Group on Nutrition and Mental Health (NUTRISAM), Research Center for Behavioral Assessment (CRAMC), Department of Psychology, University Rovira i Virgili, Tarragona, Spain
| | - Josefa Canals-Sans
- Research Group on Nutrition and Mental Health (NUTRISAM), Research Center for Behavioral Assessment (CRAMC), Department of Psychology, University Rovira i Virgili, Tarragona, Spain; Interdisciplinary Research Network for the PROmotion of Mental Health and Wellness EMocional in Young People (Red PROEM), Spain.
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Haugan ALJ, Sund AM, Thomsen PH, Lydersen S, Nøvik TS. Executive functions mediate the association between ADHD symptoms and anxiety in a clinical adolescent population. Front Psychiatry 2022; 13:834356. [PMID: 36172514 PMCID: PMC9510657 DOI: 10.3389/fpsyt.2022.834356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 08/22/2022] [Indexed: 12/02/2022] Open
Abstract
Objective Attention-deficit/hyperactivity disorder (ADHD) is associated with a high prevalence of anxiety disorders in children and adolescents. The reasons for this association are poorly understood. Preliminary findings with young adults have suggested that executive functions and functional impairment may mediate the relationship between symptoms of ADHD and mixed anxiety and depressive symptoms. The objective of this study was to explore whether ADHD symptoms, executive functions and functional impairment predict anxiety in a clinical adolescent population. In addition, we investigated the possible mediating role of executive functions and functional impairment in this relationship. Method One hundred adolescents with ADHD and their parents completed the ADHD Rating Scale IV (ADHD RS-IV), the Behavior Rating Inventory of Executive Function (BRIEF), and the Weiss Functional Impairment Rating Scale (WFIRS) in relation to an RCT study. The adolescents also completed the Screen for Child Anxiety-Related Emotional Disorders (SCARED). Analyses were conducted using regression and a serial multiple mediator model. Results In the regression analyses, parent-rated ADHD symptoms were unable to predict anxiety, but ADHD inattention symptoms predicted anxiety in the self-ratings. Executive dysfunction and functional impairment predicted anxiety in both the parent- and self-reports. In the mediation analyses ADHD symptoms alone did not predict anxiety, but executive dysfunction mediated this relationship as expected. Functional impairment mediated this relationship indirectly through executive functions. The results were similar in the parent- and self- reports. Conclusion The results pinpoint executive dysfunction as an important treatment target for alleviating anxiety in adolescents with impairing ADHD symptoms.
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Affiliation(s)
- Anne-Lise Juul Haugan
- Department of Mental Health, Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU), Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Anne Mari Sund
- Department of Mental Health, Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU), Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Child and Adolescent Psychiatry, St. Olav University Hospital, Trondheim, Norway
| | - Per Hove Thomsen
- Department of Mental Health, Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU), Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Aarhus, Denmark
| | - Stian Lydersen
- Department of Mental Health, Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU), Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Torunn Stene Nøvik
- Department of Mental Health, Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU), Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Child and Adolescent Psychiatry, St. Olav University Hospital, Trondheim, Norway
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Chan ESM, Macias M, Kofler MJ. Does Child Anxiety Exacerbate or Protect Against Parent–Child Relationship Difficulties in Children with Elevated ADHD Symptoms? JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2022; 44:924-936. [PMID: 35967514 PMCID: PMC9360658 DOI: 10.1007/s10862-021-09922-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2021] [Indexed: 11/01/2022]
Abstract
Pediatric ADHD is associated with parent–child relationship difficulties. However, the extent to which these relations are attributable to specific ADHD symptom clusters (i.e., inattentive vs. hyperactive/impulsive), and the extent to which child anxiety symptoms may exacerbate or protect against these difficulties, remains unclear. To address these gaps in the literature, the current study combined multi-informant measures (parent, teacher, child) with a clinically-evaluated and carefully-phenotyped sample of 188 children with and without ADHD and anxiety (ages 8–13; 63 girls). Results indicated that child-reported anxiety (β = .46) and teacher-reported inattentive (β = .71) symptoms, and their interaction (β = -1.06), along with child age and IQ (β = -.14 to -.15), predict the extent to which parents perceive themselves as confident and competent parents (all p < .05). In contrast, only comorbid oppositional-defiant disorder conferred risk for increased parent-reported relational frustration, and we were unable to detect any reliable child-level demographic, diagnostic, or behavioral predictors of parent-reported discipline practices. These findings were robust to control for child demographic characteristics, clinical diagnoses, and intellectual functioning, with sensitivity analyses highlighting the importance of assessing ADHD inattentive vs. hyperactive/impulsive symptoms separately for understanding parenting outcomes. Taken together, the current findings suggest that child ADHD and anxiety symptoms may influence specific rather than broad-based aspects of the parent–child relationship, and produce differently valenced outcomes in the presence vs. absence of the other condition. Interestingly, it appears that the combination of greater child inattention and anxiety, rather than elevations in either symptom domain independently, predict adverse parenting outcomes in terms of reduced parental confidence.
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The three-year outcome of emotional symptoms in clinically referred youth with ADHD and their relationship to neuropsychological functions. Scand J Child Adolesc Psychiatr Psychol 2022; 10:72-86. [PMID: 35903554 PMCID: PMC9284941 DOI: 10.2478/sjcapp-2022-0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background Further knowledge is needed regarding long-term outcome of emotional symptoms, and the interplay between these symptoms and neuropsychological functioning in youth with attention deficit hyperactivity disorder (ADHD). Objective We aimed to explore the effect of performance-based neurocognitive functions and parent-rated behavioral executive functioning (EF) on self-rated and parent-rated internalizing symptoms longitudinally in clinically referred youth with ADHD (n = 137; mean age = 12.4 years). We also aimed to examine the change in self-rated emotional symptoms in the ADHD group and a Control group (n = 59; mean age = 11.9 years). Method At baseline, and three years later, parents completed rating scales of their child’s ADHD symptoms (Swanson Nolan Pelham Scale, Version IV – SNAP-IV), emotional symptoms (Five To Fifteen Questionnaire, Strengths, and Difficulties Questionnaire), and EF (Behavior Rating Inventory of Executive Function). At the same time, the child completed self-report measures of Anxiety, Depression, and Anger Inventories (the Beck Youth Inventories) and neurocognitive measures (Conner’s Continuous Performance Test, Version II (CPT-II), Working Memory and Processing Speed composites (Wechsler Intelligence Scales). Statistical analyses were linear and logistic mixed models. Results Using longitudinal data, parent- and self-ratings of emotional symptoms were associated with parent-ratings of EF behavior in youth with ADHD. Plan/organizing deficits were associated with Anxiety and Anger over and above other metacognitive subscales, while Emotional Control was related to Anger over and above other behavior regulation subscales. In the ADHD group, Anger symptoms improved across measuring points. When controlling for age, Anxiety, and Depression symptoms were largely stable in both groups, however at higher levels in the ADHD group. The differences in anxiety and depression symptoms across groups decreased over time. Conclusions The current study emphasizes the importance of identification, monitoring, and treatment of emotional symptoms, and behavioral aspects of EF in youth with ADHD.
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Ahlers J, Baumgartner C, Augsburger M, Wenger A, Malischnig D, Boumparis N, Berger T, Stark L, Ebert DD, Haug S, Schaub MP. Cannabis Use in Adults Who Screen Positive for Attention Deficit/Hyperactivity Disorder: CANreduce 2.0 Randomized Controlled Trial Subgroup Analysis. J Med Internet Res 2022; 24:e30138. [PMID: 35442196 PMCID: PMC9069287 DOI: 10.2196/30138] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 08/25/2021] [Accepted: 02/09/2022] [Indexed: 11/13/2022] Open
Abstract
Background Prevalence rates for lifetime cannabis use and cannabis use disorder are much higher in people with attention deficit/hyperactivity disorder than in those without. CANreduce 2.0 is an intervention that is generally effective at reducing cannabis use in cannabis misusers. This self-guided web-based intervention (6-week duration) consists of modules grounded in motivational interviewing and cognitive behavioral therapy. Objective We aimed to evaluate whether the CANreduce 2.0 intervention affects cannabis use patterns and symptom severity in adults who screen positive for attention deficit/hyperactivity disorder more than in those who do not. Methods We performed a secondary analysis of data from a previous study with the inclusion criterion of cannabis use at least once weekly over the last 30 days. Adults with and without attention deficit/hyperactivity disorder (based on the Adult Attention deficit/hyperactivity disorder Self-Report screener) who were enrolled to the active intervention arms of CANreduce 2.0 were compared regarding the number of days cannabis was used in the preceding 30 days, the cannabis use disorder identification test score (CUDIT) and the severity of dependence scale score (SDS) at baseline and the 3-month follow-up. Secondary outcomes were Generalized Anxiety Disorder score, Center for Epidemiological Studies Depression scale score, retention, intervention adherence, and safety. Results Both adults with (n=94) and without (n=273) positive attention-deficit/hyperactivity disorder screening reported significantly reduced frequency (reduction in consumption days: with: mean 11.53, SD 9.28, P<.001; without: mean 8.53, SD 9.4, P<.001) and severity of cannabis use (SDS: with: mean 3.57, SD 3.65, P<.001; without: mean 2.47, SD 3.39, P<.001; CUDIT: with: mean 6.38, SD 5.96, P<.001; without: mean 5.33, SD 6.05, P<.001), as well as anxiety (with: mean 4.31, SD 4.71, P<.001; without: mean 1.84, SD 4.22, P<.001) and depression (with: mean 10.25, SD 10.54; without: mean 4.39, SD 10.22, P<.001). Those who screened positive for attention deficit/hyperactivity disorder also reported significantly decreased attention deficit/hyperactivity disorder scores (mean 4.65, SD 4.44, P<.001). There were no significant differences in change in use (P=.08), dependence (P=.95), use disorder (P=.85), attention deficit/hyperactivity disorder status (P=.84), depression (P=.84), or anxiety (P=.26) between baseline and final follow-up, dependent on positive attention-deficit/hyperactivity disorder screening. Attention deficit/hyperactivity disorder symptom severity at baseline was not associated with reduced cannabis use frequency or severity but was linked to greater reductions in depression (Spearman ρ=.33) and anxiety (Spearman ρ=.28). Individuals with positive attention deficit/hyperactivity disorder screening were significantly less likely to fill out the consumption diary (P=.02), but the association between continuous attention deficit/hyperactivity disorder symptom severity and retention (Spearman ρ=−0.10, P=.13) was nonsignificant. There also was no significant intergroup difference in the number of completed modules (with: mean 2.10, SD 2.33; without: mean 2.36, SD 2.36, P=.34), and there was no association with attention deficit/hyperactivity disorder symptom severity (Spearman ρ=−0.09; P=.43). The same was true for the rate of adverse effects (P=.33). Conclusions Cannabis users screening positive for attention deficit/hyperactivity disorder may benefit from CANreduce 2.0 to decrease the frequency and severity of cannabis dependence and attenuate symptoms of depression and attention deficit/hyperactivity disorder-related symptoms. This web-based program’s advantages include its accessibility for remote users and a personalized counselling option that may contribute to increased adherence and motivation to change among program users. Trial Registration International Standard Randomized Controlled Trial Number (ISRCTN) 11086185; http://www.isrctn.com/ISRCTN11086185
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Affiliation(s)
- Joachim Ahlers
- Swiss Research Institute for Public Health and Addiction, University of Zurich, Zurich, Switzerland
| | - Christian Baumgartner
- Swiss Research Institute for Public Health and Addiction, University of Zurich, Zurich, Switzerland
| | - Mareike Augsburger
- Swiss Research Institute for Public Health and Addiction, University of Zurich, Zurich, Switzerland
| | - Andreas Wenger
- Swiss Research Institute for Public Health and Addiction, University of Zurich, Zurich, Switzerland
| | - Doris Malischnig
- Institute for Addiction Prevention, Office of Addiction and Drug Policy of Vienna, Vienna, Austria
| | - Nikolaos Boumparis
- Swiss Research Institute for Public Health and Addiction, University of Zurich, Zurich, Switzerland
| | - Thomas Berger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Lars Stark
- Arud Centre for Addiction Medicine, Zurich, Switzerland
| | - David D Ebert
- Clinical Department for Sport and Health Sciences, Technical University Munich, Munich, Germany
| | - Severin Haug
- Swiss Research Institute for Public Health and Addiction, University of Zurich, Zurich, Switzerland
| | - Michael P Schaub
- Swiss Research Institute for Public Health and Addiction, University of Zurich, Zurich, Switzerland
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Abstract
OBJECTIVE The adverse outcomes associated with ADHD are well known, but less is known about the minority of children with ADHD who may be flourishing despite this neurodevelopmental risk. The present multi-informant study is an initial step in this direction with the basic but unanswered question: Are there resilient children with ADHD? METHOD Reliable change analysis of the BASC-3 Resiliency subscale for a clinically evaluated sample of 206 children with and without ADHD (ages 8-13; 81 girls; 66.5% White/Non-Hispanic). RESULTS Most children with ADHD are perceived by their parents and teachers as resilient (52.8%-59.2%), with rates that did not differ from the comorbidity-matched Non-ADHD sample. CONCLUSION Exploratory analyses highlighted the importance of identifying factors that promote resilience for children with ADHD specifically, such that some child characteristics were promotive (associated with resilience for both groups), some were protective (associated with resilience only for children with ADHD), and some were beneficial only for children without ADHD.
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Mphahlele RM, Meyer A, Pillay BJ. Working memory and set-shifting in school-aged children classified as having attention-deficit hyperactivity disorder. S Afr J Psychiatr 2022; 28:1729. [PMID: 35169513 PMCID: PMC8831923 DOI: 10.4102/sajpsychiatry.v28i0.1729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 10/04/2021] [Indexed: 11/01/2022] Open
Affiliation(s)
- Ramatladi M Mphahlele
- Department of Behavioural Medicine, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Anneke Meyer
- Department of Behavioural Medicine, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Basil J Pillay
- Department of Behavioural Medicine, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Manoli A, Liversedge SP, Sonuga-Barke EJS, Hadwin JA. The Differential Effect of Anxiety and ADHD Symptoms on Inhibitory Control and Sustained Attention for Threat Stimuli: A Go/No-Go Eye-Movement Study. J Atten Disord 2021; 25:1919-1930. [PMID: 32513052 PMCID: PMC8427811 DOI: 10.1177/1087054720930809] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: This study examined the synergistic effects of ADHD and anxiety symptoms on attention and inhibitory control depending on the emotional content of the stimuli. Method: Fifty-four typically developing individuals (27 children/adolescents and 27 adults) completed an eye-movement based emotional Go/No-Go task, using centrally presented (happy, angry) faces and neutral/symbolic stimuli. Sustained attention was measured through saccade latencies and saccadic omission errors (Go trials), and inhibitory control through saccadic commission errors (No-Go trials). ADHD and anxiety were assessed dimensionally. Results: Elevated ADHD symptoms were associated with more commission errors and slower saccade latencies for angry (vs. happy) faces. In contrast, angry faces were linked to faster saccade onsets when anxiety symptoms were high, and this effect prevailed when both anxiety and ADHD symptoms were high. Conclusion: Social threat impacted performance in individuals with sub-clinical anxiety and ADHD differently. The effects of anxiety on threat processing prevailed when both symptoms were high.
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Affiliation(s)
- Athina Manoli
- Queen Mary University of London, London, UK,Athina Manoli, Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, Old Anatomy Building, London EC1M 6BQ, UK.
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Yang Y, Yang B, Zhang L, Peng G, Fang D. Dynamic Functional Connectivity Reveals Abnormal Variability in the Amygdala Subregions of Children With Attention-Deficit/Hyperactivity Disorder. Front Neurosci 2021; 15:648143. [PMID: 34658751 PMCID: PMC8514188 DOI: 10.3389/fnins.2021.648143] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 09/06/2021] [Indexed: 11/17/2022] Open
Abstract
Objective: This study investigates whether the dynamic functional connectivity (dFC) of the amygdala subregions is altered in children with attention-deficit/hyperactivity disorder (ADHD). Methods: The dFC of the amygdala subregions was systematically calculated using a sliding time window method, for 75 children with ADHD and 20 healthy control (HC) children. Results: Compared with the HC group, the right superficial amygdala exhibited significantly higher dFC with the right prefrontal cortex, the left precuneus, and the left post-central gyrus for children in the ADHD group. The dFC of the amygdala subregions showed a negative association with the cognitive functions of children in the ADHD group. Conclusion: Functional connectivity of the amygdala subregions is more unstable among children with ADHD. In demonstrating an association between the stability of functional connectivity of the amygdala and cognitive functions, this study may contribute by providing a new direction for investigating the internal mechanism of ADHD.
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Affiliation(s)
- Yue Yang
- Children's Healthcare & Mental Health Center, Shenzhen Children's Hospital, Shenzhen, China
| | - Binrang Yang
- Children's Healthcare & Mental Health Center, Shenzhen Children's Hospital, Shenzhen, China
| | - Linlin Zhang
- Children's Healthcare & Mental Health Center, Shenzhen Children's Hospital, Shenzhen, China
| | - Gang Peng
- Children's Healthcare & Mental Health Center, Shenzhen Children's Hospital, Shenzhen, China
| | - Diangang Fang
- Children's Healthcare & Mental Health Center, Shenzhen Children's Hospital, Shenzhen, China
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Adult ADHD, executive function, depressive/anxiety symptoms, and quality of life: A serial two-mediator model. J Affect Disord 2021; 293:97-108. [PMID: 34175595 DOI: 10.1016/j.jad.2021.06.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 05/08/2021] [Accepted: 06/13/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Adult attention-deficit/hyperactivity disorder (ADHD) is associated with impaired executive function (EF), depressive/anxiety symptoms, and poor quality of life (QoL). In this study, we aimed to investigate correlations among these variables and to build a simple or serial mediation model for exploring the mechanisms between adult ADHD and QoL. METHODS This was a cross-sectional study. The sample included 223 participants with ADHD and 54 healthy volunteers. Participants were required to complete the following scales: ADHD Rating Scale (ADHD-RS), Brief Version of the World Health Organization Quality of Life Scale (WHOQOL-BREF), Behavior Rating Inventory of Executive Function-Adult Version (BRIEF-A), Self-rating Depression Scale (SDS) and Self-rating Anxiety Scale (SAS). Correlations among EF, depressive/anxiety symptoms and QoL were analyzed using Pearson correlation. The simple and serial mediation models were analyzed using PROCESS (version 3.3). RESULTS The correlations between EF and QoL, depressive/anxiety symptoms and QoL, and depressive/anxiety symptoms and EF were statistically significant. In ADHD adults with comorbidities, the correlation coefficients were between -0.19 and -0.47, -0.20 and -0.62, 0.28 and 0.50, respectively. In simple mediation models, EF and depressive/anxiety symptoms were significant mediators respectively between ADHD and QoL, respectively. In a serial two-mediator model, ADHD could affect QoL indirectly via EF and then via depressive/anxiety symptoms significantly. LIMITATIONS The average age was young, the degree of education was high, and only self-reported scales were relied on. CONCLUSIONS There is a mutual effect between EF and emotional symptoms. This was the first study to build a serial two-mediator model between ADHD and QoL, suggesting the importance of EF and depressive/anxiety symptoms.
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Adamo N, Michelini G, Cheung CHM, Buitelaar JK, Asherson P, Rijsdijk F, Kuntsi J. Does Co-Occurring Anxiety Modulate ADHD-Related Cognitive and Neurophysiological Impairments? J Atten Disord 2021; 25:1135-1145. [PMID: 31711346 DOI: 10.1177/1087054719879499] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: This study investigates whether anxiety modulates cognitive-performance, electrophysiological and electrodermal processes that we previously found impaired in individuals with ADHD. Method: Self-reported anxiety symptoms, cognitive-electrophysiological measures of response inhibition, working memory, attention, conflict monitoring, error processing, and peripheral arousal during three cognitive tasks were obtained from 87 adolescents and young adults with ADHD and 169 controls. We tested the association of anxiety symptoms with each measure and whether controlling for anxiety symptoms attenuates the ADHD-control difference for each measure. Results: Individuals with ADHD showed significantly elevated anxiety symptoms compared with controls. Only commission errors on a Continuous Performance Test (measuring response inhibition) were significantly associated with anxiety symptoms and only among controls, with the ADHD-control difference in this measure remaining significant. Conclusion: Using a wide range of cognitive, electrophysiological, and electrodermal measures, our investigation suggests, overall, limited malleability of these impairments in individuals with ADHD irrespective of their levels of anxiety.
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Affiliation(s)
| | | | | | - Jan K Buitelaar
- Radboud University Medical Center, Nijmegen, The Netherlands.,Karakter Child and Adolescent Psychiatry University Center, Nijmegen, The Netherlands
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19
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Friesen K, Markowsky A. The Diagnosis and Management of Anxiety in Adolescents With Comorbid ADHD. J Nurse Pract 2021. [DOI: 10.1016/j.nurpra.2020.08.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Kleine Deters R, Naaijen J, Rosa M, Aggensteiner PM, Banaschewski T, Saam MC, Schulze UME, Sethi A, Craig MC, Sagar-Ouriaghli I, Santosh P, Castro-Fornieles J, Penzol MJ, Arango C, Werhahn JE, Brandeis D, Franke B, Glennon J, Buitelaar JK, Hoekstra PJ, Dietrich A. Executive functioning and emotion recognition in youth with oppositional defiant disorder and/or conduct disorder. World J Biol Psychiatry 2020; 21:539-551. [PMID: 32212964 DOI: 10.1080/15622975.2020.1747114] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Objectives: Executive functioning and emotion recognition may be impaired in disruptive youth, yet findings in oppositional defiant disorder (ODD) and conduct disorder (CD) are inconsistent. We examined these functions related to ODD and CD, accounting for comorbid attention-deficit/hyperactivity disorder (ADHD) and internalising symptoms.Methods: We compared executive functioning (visual working memory, visual attention, inhibitory control) and emotion recognition between youth (8-18 years old, 123 boys, 55 girls) with ODD (n = 44) or CD (with/without ODD, n = 48), and healthy controls (n = 86). We also related ODD, CD, and ADHD symptom counts and internalising symptomatology to all outcome measures, as well as executive functioning to emotion recognition.Results: Visual working memory and inhibitory control were impaired in the ODD and CD groups versus healthy controls. Anger, disgust, fear, happiness, and sadness recognition were impaired in the CD group; only anger recognition was impaired in the ODD group. Deficits were not explained by comorbid ADHD or internalising symptoms. Visual working memory was associated with recognition of all basic emotions.Conclusions: Our findings challenge the view that neuropsychological impairments in youth with ODD/CD are driven by comorbid ADHD and suggest possible distinct neurocognitive mechanisms in CD versus ODD.
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Affiliation(s)
- Renee Kleine Deters
- Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jilly Naaijen
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mireia Rosa
- Department of Child and Adolescent Psychiatry and Psychology, Clínic Institute of Neurosciences, Hospital Clínic de Barcelona, IDIBAPS, Barcelona, Spain
| | - Pascal M Aggensteiner
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Melanie C Saam
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Ulm, Germany
| | - Ulrike M E Schulze
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Ulm, Germany.,Department of Child and Adolescent Psychiatry, Centre for Psychiatry, Calw, Germany
| | - Arjun Sethi
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Michael C Craig
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ilyas Sagar-Ouriaghli
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Paramala Santosh
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Centre for Interventional Paediatric Psychopharmacology and Rare Diseases (CIPPRD), National and Specialist Child and Adolescent Mental Health Services, Maudsley Hospital, London, UK
| | - Josefina Castro-Fornieles
- Department of Child and Adolescent Psychiatry and Psychology, Clínic Institute of Neurosciences, Hospital Clínic de Barcelona, 2017SGR881, University of Barcelona, CIBERSAM, IDIBAPS, Barcelona, Spain
| | - María J Penzol
- Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain
| | - Celso Arango
- Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain
| | - Julia E Werhahn
- Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Daniel Brandeis
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany.,Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Barbara Franke
- Department of Human Genetics, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jeffrey Glennon
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jan K Buitelaar
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands.,Karakter Child and Adolescent Psychiatry University Center, Nijmegen, The Netherlands
| | - Pieter J Hoekstra
- Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Andrea Dietrich
- Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Fournier A, Gauthier B, Guay MC, Parent V. Design Fluency in Children with ADHD and Comorbid Disorders. Brain Sci 2020; 10:E172. [PMID: 32192012 PMCID: PMC7139708 DOI: 10.3390/brainsci10030172] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 03/12/2020] [Accepted: 03/13/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Attention deficit/hyperactivity disorder (ADHD) is often associated with frontal executive impairment in children. Oppositional defiant disorder (ODD) and anxiety disorders (AD) frequently accompany ADHD, but the impact of these comorbid disorders on cognition remains elusive. The five-point test (FPT), a design fluency task, has been shown to be sensitive to neurological damage, specifically to frontal lobe lesions in patients with brain injuries. The purpose of this study was to compare the performances of neurotypical children with that of children with ADHD, ADHD-ODD, and ADHD-AD on the FPT in order to examine whether these groups could be distinguished from one another based on their cognitive profile. METHODS A total of 111 children aged 8 to 11 years old participated in the study. Six measures from the FPT were used to characterize their performance. RESULTS Statistically significant differences between groups were observed for five of the six FPT measures. Essentially, children with ADHD-ODD made more repeated designs than the three other groups (control p > 0.001, ADHD p = 0.008, ADHD-AD p = 0.008), while children with ADHD-AD produced fewer total and correct designs than the control and ADHD groups (p = 0.009). CONCLUSIONS This suggests that comorbidities have an additive impact on the cognitive profile of children with ADHD. Design fluency may be a sensitive measure for capturing the subtle cognitive deficits that are likely to be involved in these disorders.
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Affiliation(s)
- Anaïs Fournier
- Department of Psychology, University of Sherbrooke, Longueuil, QC J4K 0A8, Canada; (A.F.); (V.P.)
| | - Bruno Gauthier
- Department of Psychology, University of Montreal, Laval Campus, Laval, QC H7N 0B6, Canada
| | - Marie-Claude Guay
- Department of Psychology, University of Quebec in Montreal, Montreal, QC H3C 3P8, Canada;
| | - Véronique Parent
- Department of Psychology, University of Sherbrooke, Longueuil, QC J4K 0A8, Canada; (A.F.); (V.P.)
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