Attention-deficit/hyperactivity disorder: a neuropsychological perspective towards DSM-V

Assessing Adult ADHD: An Updated Review of Rating Scales for Adult Attention Deficit Hyperactivity Disorder (ADHD)

METHOD

Scholarly articles on adult ADHD between 1996 and 2022 were reviewed using the PRISMA guidelines. ADHD rating scales with multiple citations were selected and their psychometric properties and symptom coverage were analyzed.

RESULTS

Ten rating scales, with sound psychometric properties, were identified. Out of those reviewed two (BADDS and BAARS-IV) load on the inattentive domain of ADHD, while the rest focus on a comprehensive assessment of ADHD. Only one scale (BARRS-IV) incorporates an assessment of functional impairment. Some scales though widely utilized have not been adequately examined for their sensitivity.

CONCLUSIONS

Rating scales are reliable and valid, in the assessment of adult ADHD. We present a review of recent scales, with an expanded focus, to help clinicians make informed decisions on diagnosis, identifying targets and planning interventions accordingly.

The Clinical Manifestation, Executive Dysfunction, and Caregiver Strain in Subthreshold Attention-Deficit/Hyperactivity Disorder

OBJECTIVE

Subthreshold attention-deficit/hyperactivity disorder (ADHD) has been suggested to be a "morbid condition" which also needs medical attention.

METHODS

The present study recruited 89 children with subthreshold ADHD (sADHD), 115 children with diagnosed ADHD (cADHD), and 79 healthy controls (HC) to explore the clinical manifestation, executive functions (EFs) of sADHD, and the caregiver strain. The clinical manifestation was evaluated through clinical interviews and parent-reports. Executive functions were assessed both experimentally and ecologically. Caregiver strain was measured by a parent-reported questionnaire.

RESULTS

For the clinical manifestation, both sADHD and cADHD indicated impairments when compared with HC. The comorbidities and the scaled symptoms indicated that the externalizing behaviors were relatively less serious in sADHD than cADHD, whereas the internalizing behaviors between two groups were comparable. For ecological EFs, sADHD scored between cADHD and HC in inhibition and working memory. For experimental EFs, sADHD was comparable to cADHD in inhibition, shifting, and was worse than cADHD in verbal working memory. For the caregiver strain, all scores of sADHD were between that in cADHD and that in HC.

CONCLUSION

Our present findings supported the suggestion of subthreshold ADHD as "morbid condition," which should be treated with caution in clinical practice, especially for the internalizing behaviors and some key components of EFs.

Neuropsychological features in RASopathies: A pilot study on parent training program involving families of children with Noonan syndrome

Noonan syndrome (NS) is a clinical variable multisystem disorder caused by mutations in genes encoding proteins involved in the RAS/mitogen-activated protein kinase signaling pathway. NS is characterized by a distinctive facies, short stature, and congenital heart defects. Psychomotor delay, learning difficulties, and social deficits are also common. Furthermore, behavioral and attention problems can be reckoned as a key symptom in NS, with functioning resembling the patterns observed in attention deficit hyperactivity disorder (ADHD). The complex behavioral phenotype has great impact on the quality of life and raises demanding management issues also for patients' families. Parent management training (PMT) is recommended as first-line treatment for ADHD; however, no study has been performed to test the efficacy of PMT in NS, thus far. The aim of this pilot study is the implementation and evaluation of a PMT dedicated to NS families. Parents of seven children with NS were recruited and underwent to a 10-session PMT. Three different questionnaires were administered to both parents: Conners Parent Rating Scales, Parenting Stress Index Short Form (PSI-SF), and Alabama Parenting Questionnaire (APQ). Our findings on this first small cohort of families indicate that positive perception and satisfaction about the child and the interaction with him increased in mothers after the intervention, as measured respectively by PSI-SF difficult child (DC) and PSI-SF parent-child dysfunctional interaction (PCDI), while mothers' level of stress decreased after the PMT, as indicated by PSI-SF total scores. Furthermore, APQ positive parenting, which measures behaviors of positive relationship with the child, increased in mothers after the intervention. Statistical analysis on fathers' questionnaires did not show significant differences after the PMT sessions. This pilot study suggests that PMT is a promising intervention for parents of NS children with behavioral and ADHD symptoms. Changes in mothers' attitudes and distress indicate that behaviorally oriented programs may help parents to manage with NS phenotype.

Molecular Study of STin2 (Intron 2) Variant of the SLC6A4 Gene in Children and Adolescents with Attention-deficit Hyperactivity Disorder

Background: Attention-deficit hyperactivity disorder (ADHD) is one of the most familiar childhood psychiatric disorders. Various molecular genetic reviews indicate that genes are crucial in susceptibility to ADHD. The serotonin transporter gene (SLC6A4) has polymorphisms that correlate with ADHD. The association between ADHD and SLC6A4 gene variants in the Iranian population has not been investigated yet. Objectives: This study analyzed the STin2 (intron 2) variant of the SLC6A4 gene in Iranian children and adolescents with ADHD. Methods: In this retrospective case-control study, 86 ADHD patients and 99 healthy volunteers aged five to 14 were enrolled as the case and control groups, respectively. The STin2 (intron2) fragment of the SLC6A4 gene was amplified using specific primers by conventional PCR, and three STin2 alleles of the SLC6A4 gene (STin2.9, STin2.10, and STin2.12) were examined using the acrylamide gel method. Results: We found no significant difference between the ADHD and control groups in STin2.9 (34.9% vs. 39.4%, P-value = 0.824), STin2.10 (29.1% vs. 23.2%, P-value = 1.354), and STin2.12 (36% vs. 36.4%, P-value = 0.986) variants. Conclusions: There was no association between the frequency of STin2 variant alleles of the SLC6A4 gene and ADHD, but in the study of risk estimation, allele 10 of this variant was a risk allele in ADHD patients.

Attention-deficit hyperactivity disorder and executive dysfunction in preschool children. A comparison of NEPSY and BRIEF-P assessments

OBJECTIVE

The aim of the study was to explore prevalence, interrelations and accuracy of assessing psychopathology, intelligence, and executive functions (EF) in preschool children with ADHD (age 2.1-6.5 years).

METHOD

We prospectively investigated 115 preschool outpatient children (91 boys, 24 girls, aged 4.3±1.0 years) with the clinical diagnosis of ADHD. Assessment included clinical history, background, psychosocial problems (CBCL, C-TRF), ADHD (DISYPS external ratings), cognitive performance (WPPSI-III, K-ABC), and executive functions (BRIEF-P, NEPSY).

RESULTS

We found a high frequency of dysexecutive problems in up to 64 % in the parental BRIEF-P assessments, up to 62 % in the BRIEF-P teachers' assessments, and 62 % in the NEPSY functional assessments. Parental and teachers' BRIEF-P scores were only correlated in one subscale, inhibition, and NEPSY and BRIEF-P were not correlated at all. It was found that 42.5 % of the children with noticeable findings had agreeing results in all three, and another 45 % in two tests.

CONCLUSIONS

About 2/3 of the ADHD preschool children had detectable EF dysfunctions. In order to assess dysexecutive problems, multi-method testing is mandatory.

Altered Functional Connectivity in Children with ADHD Revealed by Scalp EEG: An ERP Study

Attention deficit hyperactivity disorder (ADHD) is one of the most common neurodevelopmental brain disorders in childhood. Despite extensive researches, the neurobiological mechanism underlying ADHD is still left unveiled. Since the deficit functions, such as attention, have been demonstrated in ADHD, in our present study, based on the oddball P3 task, the corresponding electroencephalogram (EEG) of both healthy controls (HCs) and ADHD children was first collected. And we then not only focused on the event-related potential (ERP) evoked during tasks but also investigated related brain networks. Although an insignificant difference in behavior was found between the HCs and ADHD children, significant electrophysiological differences were found in both ERPs and brain networks. In detail, the dysfunctional attention occurred during the early stage of the designed task; as compared to HCs, the reduced P2 and N2 amplitudes in ADHD children were found, and the atypical information interaction might further underpin such a deficit. On the one hand, when investigating the cortical activity, HCs recruited much stronger brain activity mainly in the temporal and frontal regions, compared to ADHD children; on the other hand, the brain network showed atypical enhanced long-range connectivity between the frontal and occipital lobes but attenuated connectivity among frontal, parietal, and temporal lobes in ADHD children. We hope that the findings in this study may be instructive for the understanding of cognitive processing in children with ADHD.

Are Parent- and Teacher-Reported Executive Function Difficulties Associated With Parenting Stress for Children Diagnosed With ADHD?

Objective: To examine the relationship between parenting stress and parent- and teacher-reported executive function difficulties (EFDs) for childhood ADHD. Method: A secondary analysis using linear regression was conducted on parent- and teacher-completed Behavior Rating Inventory of Executive Function and Parenting Stress Indexes for 5- to 12-year-olds (n = 243) with ADHD. Results: The linear combination of teacher- and parent-reported EFDs accounted for 49% of the variance in child-related parenting stress. Teacher-reported school-based EFDs were relatively inconsequential, having accounted for only 3% of this variance. This stress is best explained by EFDs with emotional control in the school environment and parent-reported EFDs with emotional control, inhibit, monitor, and shift. Conclusion: Parent-reported EFDs, and less so school-based EFDs, are related to parenting stress, but only in regard to EFDs likely underpinning behavioral outbursts and those likely underpinning the daily hassles of providing specialized care to children with ADHD.

Visual exogenous and endogenous attention and visual memory in preschool children who stutter

PURPOSE

Attention develops gradually from infancy to the preschool years and beyond. Exogenous attention, consisting of automatic responses to salient stimuli, develops in infancy, whereas endogenous attention, or voluntary attention, begins to develop later, in the preschool years. The purpose of this study was to examine (a) exogenous and endogenous attention in young children who stutter (CWS) and children who do not stutter (CWNS) through two conditions of a visual sustained selective attention task, and (b) visual short-term memory (STM) between groups within the context of this task.

METHOD

42 CWS and 42 CWNS, ages 3;0-5;5 (years;months), were pair-matched in age, gender (31 males, 11 females per group), and socioeconomic status. Children completed a visual tracking task (Track-It Task; Fisher et al., 2013) requiring sustained selective attention and engaging exogenous and endogenous processes. Following each item, children were asked to recall the item they had tracked, as a memory check.

RESULTS

The CWS group demonstrated significantly less accuracy in overall tracking and visual memory for the tracked stimuli, compared to the CWNS group. Across groups, the children performed better in sustained selective attention when the target stimuli were more salient (the condition tapping both exogenous and endogenous attention) than when stimuli were less so (the condition tapping primarily endogenous processes).

CONCLUSIONS

Relative to peers, preschool-age CWS, as a group, display weaknesses in visual sustained selective attention and visual STM.

Attention behavior and hyperactivity and concurrent neurocognitive and social competence functioning in 4-year-olds from two population-based birth cohorts

Objective

We studied the associations between Attention Deficit Hyperactivity Disorder (ADHD) symptoms and the neurobehavioral status in two population-based birth cohorts.

Methods

Children (n = 467) were assessed by psychologists and teachers for neuropsychological functioning (McCarthy Scales, MCSA), inattention-hyperactivity symptoms (ADHD-DSM-IV form list) and social behavior (California Preschool Social Competence Scale, CPSCS). Regression models were used with covariate adjustment.

Results

Sixteen percent of children had ADHD-DSM-IV symptoms. MCSA scores were linearly associated with ADHD symptom scores (general cognitive Beta = −0.6 [−1.0; −0.3] per symptom), specifically inattention scores (general cognitive Beta = −1.8 [−2.3; −1.2]). CPSCS scores were associated with ADHD symptoms (Beta = −2.19 [−2.5; −1.9]). MCSA scores of executive function, perceptive-performance and quantitative sub-areas had stronger associations with ADHD symptoms.

Conclusions

Preschooler ADHD symptoms are associated with concurrent decrements in neurocognitive and social competence functioning. The association patterns are similar to those found in older children with ADHD symptomology (Marks et al., 2005 [36], Seidman, 2006 [46], Sonuga-Barke et al., 2003 [48], Yochman et al., 2006 [53]).

Evaluating the Psychometric Properties of the Conners Adult ADHD Rating Scales

Objective: Characterized by significant work-related impairments, difficulties with relationships, and higher rates of criminal behavior and substance abuse, ADHD is now understood as a disability that can persist throughout a lifetime. Differing opinions remain, however, regarding adult symptoms of ADHD, particularly with regard to gender differences. These issues add to the challenges of constructing a reliable and valid measure of ADHD for use with adults in research and practice. Method: We review the theoretical foundations of ADHD and psychometric properties of a major assessment device, the Conners' Adult ADHD Rating Scales (CAARS). Results: Results of the literature review found (a) a wide range of internal consistency estimates, with lowest values for the Diagnostic and Statistical Manual of Mental Disorders (DSM)-Hyperactive/Impulsive Symptoms subscale when completed by women, and (b) discriminant validity estimates in the same range as convergent validity estimates. Conclusion: These findings raise questions about the construct validity of the CAARS and suggest directions for future research.

Does Parent Stress Predict the Quality of Life of Children With a Diagnosis of ADHD? A Comparison of Parent and Child Perspectives

OBJECTIVE

There are indicators that parental psychological factors may affect how parents evaluate their child's quality of life (QoL) when the child has a health condition. This study examined the impact of parents' perceived stress on parent and child ratings of the QoL of children with ADHD.

METHOD

A cross-sectional sample of 45 matched parent-child dyads completed parallel versions of the KIDSCREEN-27. Children were 8 to 14 years with clinician diagnosed ADHD.

RESULTS

Parents who rated their child's QoL lower than their child had higher perceived stress scores. Parent stress was a unique predictor of child QoL from parent proxy-rated but not child-rated QoL scores.

CONCLUSION

Parents' perceived stress may play an important role in their assessments of their child's QoL, suggesting both parent and child perspectives of QoL should be utilized wherever possible. Interventions that target parent stress may contribute to improvements in the child's QoL.

Variation in Presentation, Diagnosis, and Management of Children and Adolescents With ADHD Across European Countries

OBJECTIVE

To characterize differences in presentation, diagnosis, and management of children/adolescents with ADHD in six European countries.

METHOD

Physicians abstracted clinical records for patients aged 6 to 17 years, diagnosed from 2004 to 2007 and treated for ≥2 years. Documentation included impairment due to core ADHD symptoms and additional ADHD symptoms/behaviors at diagnosis, diagnostic approach, and treatment modality.

RESULTS

Study included 779 patients treated by 340 physicians. Prevalence of ADHD subtypes (inattention, hyperactivity/impulsivity, or combined) was similar across countries. Mean scores for core and noncore symptom impairment varied and were highest in Italy and the United Kingdom. Variability was noted in diagnostic approach; 95% of physicians in the Netherlands used Diagnostic and Statistical Manual of Mental Disorders (4th edition) criteria versus 10% in Germany. Differences were reported for initial treatment modality, treatment switching, and physician-reported treatment outcomes.

CONCLUSION

European countries varied in diagnostic approaches and practice management of children/adolescents with ADHD.

Investigation of attention deficit hyperactivity disorder (ADHD) sub-types in children via EEG frequency domain analysis

AIM OF THE STUDY

To investigate the frequency domain effects and changes in electroencephalography (EEG) signals in children diagnosed with attention deficit hyperactivity disorder (ADHD).

PATIENTS AND METHODS

The study contains 40 children. All children were between the ages of 7 and 12 years. Participants were classified into four groups which were ADHD (n=20), ADHD-I (ADHD-Inattentive type) (n=10), ADHD-C (ADHD-Combined type) (n=10), and control (n=20) groups. In this study, the frequency domain of EEG signals for ADHD, subtypes and control groups were analyzed and compared using Matlab software. The mean age of the ADHD children's group was 8.7 years and the control group 9.1 years.

RESULTS

Spectral analysis of mean power (μV²) and relative-mean power (%) was carried out for four different frequency bands: delta (0--4 Hz), theta (4--8 Hz), alpha (8--13 Hz) and beta (13--32 Hz). The ADHD and subtypes of ADHD-I, and ADHD-C groups had higher average power value of delta and theta band than that of control group. However, this is not the case for alpha and beta bands. Increases in delta/beta ratio and statistical significance were found only between ADHD-I and control group, and in delta/beta, theta/delta ratio statistical significance values were found to exist between ADHD-C and control group.

CONCLUSION

EEG analyzes can be used as an alternative method when ADHD subgroups are identified.

DRD4 Gene Polymorphisms as a Risk Factor for Children with Attention Deficit Hyperactivity Disorder in Iranian Population

Background and Objective

Dopamine dysfunction is known to be associated with attention deficit hyperactivity disorder (ADHD). Dopamine D4 receptor gene (DRD4) is one of the important genes in this pathway. This study intended to investigate the variable number of tandem repeats (VNTR) in exon 3 of the DRD4 gene in Iranian children and adolescents.

Materials and Methods

In this study, 130 children with ADHD, aged 6–14 years, and 130 healthy children, within the same age range, were enrolled. All children were selected from northwest of Iran which have Caucasian ethnic background and are of a Turkic ethnic group. VNTR polymorphisms of the DRD4 gene were evaluated by PCR using exon 3-specific primers followed by agarose gel electrophoresis.

Findings

The Hardy-Weinberg principle and Chi-square test showed a significant difference in 4-repetition (4R) alleles between the ADHD (76.2%) and control (53.8%) groups (p = 0.004; X² = 17.39; df = 5). The least percentage of repetition alleles in both groups was 2R.

Conclusion

There is a significant correlation between the 4R alleles of DRD4 and ADHD in the northwest of Iran.

Does a child's language ability affect the correspondence between parent and teacher ratings of ADHD symptoms?

BACKGROUND

Rating scales are often used to identify children with potential Attention-Deficit/Hyperactivity Disorder (ADHD), yet there are frequently discrepancies between informants which may be moderated by child characteristics. The current study asked whether correspondence between parent and teacher ratings on the Strengths and Weakness of ADHD symptoms and Normal behaviour scale (SWAN) varied systematically with child language ability.

METHOD

Parent and teacher SWAN questionnaires were returned for 200 children (aged 61-81 months); 106 had low language ability (LL) and 94 had typically developing language (TL). After exploring informant correspondence (using Pearson correlation) and the discrepancy between raters, we report inter-class correlation coefficients, to assess inter-rater reliability, and Cohen's kappa, to assess agreement regarding possible ADHD caseness.

RESULTS

Correlations between informant ratings on the SWAN were moderate. Children with LL were rated as having increased inattention and hyperactivity relative to children with TL; teachers, however, rated children with LL as having more inattention than parents. Inter-rater reliability of the SWAN was good and there were no systematic differences between the LL and TL groups. Case agreement between parent and teachers was fair; this varied by language group with poorer case agreement for children with LL.

CONCLUSION

Children's language abilities affect the discrepancy between informant ratings of ADHD symptomatology and the agreement between parents and teachers regarding potential ADHD caseness. The assessment of children's core language ability would be a beneficial addition to the ADHD diagnostic process.

Discrete Global but No Focal Gray Matter Volume Reductions in Unmedicated Adult Patients With Attention-Deficit/Hyperactivity Disorder

BACKGROUND

Gray matter reduction mainly in the anterior cingulate cortex, the basal ganglia, and the cerebellum has been reported in attention-deficit/hyperactivity disorder (ADHD). Yet, respective data remain contradictory and inconclusive. To clarify if structural alteration in these brain areas can be verified in a large cohort of adult patients and if a history of stimulant medication has an effect on brain structure, magnetic resonance imaging was performed in the context of a clinical trial on the efficacy of group psychotherapy, clinical management, methylphenidate, and placebo (Comparison of Methylphenidate and Psychotherapy in Adult ADHD Study Trial).

METHODS

Between January 2007 and August 2010, 1480 patients from seven study centers across Germany, aged 18 to 58, were prescreened; 518 were assessed for eligibility; 433 were randomized; and 187 were eligible for neuroimaging. The control group included 121 healthy volunteers. Structural magnetic resonance imaging data sets were acquired. Following strict quality control, 131 patient and 95 control data sets could be analyzed. All patients were unmedicated for at least 6 months. The established method of voxel-based morphometry (VBM8 segmentation and diffeomorphic anatomical registration through exponentiated lie normalization) was used to assess global and regional brain volumes.

RESULTS

Patients displayed subtle global cerebral volume reductions. There was no evidence of regional gray matter volume abnormalities. The inattentive ADHD subtype was linked to smaller volumes in the left dorsolateral prefrontal cortex. A history of previous medication did not modulate brain volumes.

CONCLUSIONS

ADHD in adulthood is associated with global rather than regional volumetric abnormalities. Previous use of stimulant medication does not seem to modify subsequent brain volumes in a significant way.

Neuropsicologia do Transtorno de Déficit de Atenção/Hiperatividade: Modelos Neuropsicológicos e Resultados de Estudos Empíricos

Resumo Diferentes modelos teóricos foram propostos para explicar os déficits neuropsicológicos e seu impacto no comportamento de indivíduos com Transtorno de Déficit de Atenção/Hiperatividade (TDAH). Os objetivos deste artigo serão apresentar os principais modelos neuropsicológicos do TDAH e possibilitar uma atualização acerca dos principais achados relacionados ao funcionamento neuropsicológico de pacientes com esse diagnóstico. Revisões e meta-análises sobre funcionamento executivo, aversão à resposta tardia, processamento temporal e variações intraindividuais no tempo de reação são apresentadas. O perfil neuropsicológico de pacientes com TDAH é heterogêneo e testes neuropsicológicos não são suficientemente sensíveis e específicos para realização do diagnóstico, embora sejam muito importantes na identificação do perfil cognitivo para estabelecimento de um plano de tratamento mais abrangente e adequado às necessidades especificas de cada paciente.

Executive Functioning in Subtypes of Attention Deficit Hyperactivity Disorder

INTRODUCTION

This study aims to evaluate executive functions (EF), such as inhibition, planning, working memory, and set shifting, in children with attention deficit hyperactivity disorder (ADHD) by comparing three ADHD subtype groups (ADHD-Inattentive, ADHD-Combined, and ADHD-Comorbid) and a normal control group.

METHODS

Participants included 147 children. In total, 111 children were assigned to the ADHD groups of the study. Each child was matched according to the WISC-R Full-Scale IQ-score, sex, and age and was grouped as follows: ADHD-Inattentive group (ADHD-I; n=37), ADHD-Combined (ADHD-C; n=37), ADHD-Comorbid group (ADHD-Comorbid with oppositional defiant disorder and/or conduct disorder; n=37), and control group (n=36). The tests used to assess the children were Conners' Parent and Teacher Rating Scales; Wechsler Intelligence Scale-Revised; Tower of London test; Wisconsin Card Sorting Test; Stroop Color-Word Test, and verbal fluency test. The data were analyzed by one-way ANOVA between subjects for all dependent variables.

RESULTS

Children in the ADHD-I group had significantly better performances in verbal working memory and verbal category shifting than children in the ADHD-C group. There was no significant difference between the ADHD-I and ADHD-C groups in terms of inhibition, set shifting, verbal fluency, cognitive flexibility, and planning. The ADHD-Comorbid group displayed more severe impairments in EF measures than the ADHD-C group; however, the severity was not statistically significant. EF performances of children in the control group were similar to children in the ADHD-I group but better than children in the ADHD-C and ADHD-Comorbid groups.

CONCLUSION

The outcome of the study indicated that subjects in the ADHD-Comorbid and ADHD-C groups had more severe EF deficits than subjects in the ADHD-I and control groups.

Attention Deficit Hyperactivity Disorder in the Light of the Epigenetic Paradigm

Attention deficit hyperactivity disorder (ADHD) is a highly prevalent neurodevelopmental disorder characterized by a definite behavioral pattern that might lead to performance problems in the social, educational, or work environments. In the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, the symptoms of ADHD were restricted to those associated with cognitive (attention deficit) and behavioral (hyperactivity/impulsivity) deficits, while deficient emotional self-regulation, a relevant source of morbidity, was left out. The etiology of it is complex, as its exact causes have not yet been fully elucidated. ADHD seems to arise from a combination of various genetic and environmental factors that alter the developing brain, resulting in structural and functional abnormalities. The aim of this paper was to review epigenetics and ADHD focused on how multidimensional mechanisms influence the behavioral phenotype.

Psychometrische Eigenschaften der „Testbatterie zur Aufmerksamkeitsprüfung für Kinder” (KITAP) in einer klinischen Stichprobe

An einer klinisch-sozialpädiatrischen Stichprobe von 225 Kindern im Alter von 6 – 10 Jahren wurden bis zu sechs Untertests der computerisierten „Testbatterie zur Aufmerksamkeitsprüfung für Kinder” (KITAP) durchgeführt. Außerdem wurden klinische Diagnosen nach ICD-10 erfasst und an Teilstichproben verschiedene Referenzvariablen erhoben (Intelligenz, Verhaltensratings). Die mittels der Split-half-Methode ermittelten Reliabilitätskennwerte fielen überwiegend vergleichbar mit den Daten der Normstichprobe und somit nicht durchgehend befriedigend aus. Die KITAP-Parameter zeigten überwiegend keine bedeutsamen Korrelationen mit der als Intelligenzmaß eingesetzten Kaufman-Assessment Battery for Children (K-ABC) und mit Verhaltensratings, einschließlich Ratings von Aufmerksamkeitsproblemen, von Eltern und Lehrern. Die differentielle Validität für klinische Gruppen (ADHS vs. Kinder ohne Aufmerksamkeitsprobleme; ADHS vs. Kinder mit Störungen des Sozialverhaltens, kombinierten Entwicklungsstörungen, umschriebenen Entwicklungsstörungen schulischer Fertigkeiten) konnte nicht belegt werden.

Phonemic verbal fluency is associated with pediatric anxiety disorders: evidence from a community study

BACKGROUND

Anxiety disorders typically begin in childhood and adolescence and predict risk for many problems throughout life. Although some neuropsychological correlates have been described, more research is needed, particularly in adolescents. This study compares neurocognitive characteristics of anxious adolescents with and without comorbidity to externalizing disorders to those of typically developing comparison (TDC) adolescents and adolescents with externalizing disorders alone.

METHODS

The study included 57 adolescents 12-18 years of age (TDC, n=23; anxiety, n=16; externalizing, n=11; comorbid, n=7). We used a neuropsychological battery to assess eight domains: Orientation, attention, visual perception, memory, arithmetic, language, praxis, and executive function.

RESULTS

Multivariate analysis of variance revealed a main effect of group in the neurocognitive domains evaluated (F8,48=2.32, p=0.034, ηp(2)=0.279). Post-hoc analysis revealed that executive functions score differed among groups, specifically in the task of verbal fluency (F[df=3]=5.01, p=0.004, ηp(2)=0.221), with both the anxious groups (anxiety and comorbid) presenting a lower score than the TDC and externalizing groups. This effect was independent of age, intelligence, and levels of education.

CONCLUSIONS

Verbal fluency is specifically impaired in adolescents with anxiety disorders. This extends results from neuroimaging research implicating prefrontal areas in pediatric anxiety disorder neurobiology, and has potential implications to new therapeutics.

Executive function in children with attention deficit/hyperactivity disorder: the NIH EXAMINER battery

Theories of attention deficit/hyperactivity disorder (ADHD) increasingly highlight the role of neuropsychological impairment in ADHD; however, a consistent and identifiable pattern of performance on tests is not well established. The National Institutes of Health (NIH) Executive Abilities: Measures and Instruments for Neurobehavioral Evaluation and Research (EXAMINER) battery provides measures of common variance across multiple executive function tests within specific domains and was used to characterize which executive functions are most affected in children with ADHD. Thirty-two children (24 male), ages 8-15 years (M = 12.02; SD = 2.29), diagnosed with ADHD and no comorbid disorder completed the NIH EXAMINER battery. Sixty age and gender matched healthy controls were chosen from a database of participants enrolled in the NIH EXAMINER multi-site study. Children with ADHD performed worse on the working memory score compared with the controls. No differences were found on the cognitive control or fluency scores. For children with ADHD, poorer working memory performance predicted parent report of child learning problems. Cognitive control and fluency scores did not predict learning problems. In summary, working memory emerges as a primary impairment in children with ADHD who have no comorbid disorders. Furthermore, working memory weaknesses may underlie the academic problems often seen in children with ADHD.

RETRACTED: A comparison of tantrum behavior profiles in children with ASD, ADHD and comorbid ASD and ADHD

This article has been retracted: please see Elsevier Policy on Article Withdrawal (http://www.elsevier.com/locate/withdrawalpolicy). This article has been retracted at the request of the Editor in Chief, after review by an independent panel of experts, due to evidence of a compromised peer review process and the failure of one author to disclose significant conflicts of interest. An independent peer-review process is a cornerstone of scientific integrity that allows for research to be scrutinized before publication to ensure that conclusions are anchored in sound methodology and objective interpretation of the results. Equally important is that the readership of research is fully informed about any potential competing interests that may have influenced the research process. This article is being retracted because it did not include a declaration of a conflict of interest of one author in relation to diagnostic tools which the paper endorses. The same author was also the Editor in Chief of the journal at the time of publication and evidence indicates that the paper was accepted without any independent peer review by external reviewers. The article is therefore retracted in accordance with the ethical guidelines of Elsevier: https://www.elsevier.com/about/policies/publishing-ethics and the Committee on Publication Ethics (COPE) https://publicationethics.org/files/retraction-guidelines.pdf.

A neuropsychological perspective on attention problems in neurofibromatosis type 1

Cognitive problems are common in children with neurofibromatosis type 1 and they can often complicate treatment. The current literature review examines cognitive functioning in neurofibromatosis type 1, with a specific focus on executive functioning. This includes exploration of how deficits in executive functioning are expressed in children with neurofibromatosis type 1 and how these deficits contrast with ADHD. The value of investigating subcomponents of executive functioning is discussed, as are implications for effective treatment and future research.

Phenotype refinement for comorbid attention deficit hyperactivity disorder and reading disability

Comorbidity between Attention Deficit Hyperactivity Disorder (ADHD) and reading disability (RD) is common; however, the heritability of this comorbidity is not well understood. This may be due to the complexity and heterogeneity of ADHD and RD phenotypes. Using alternative ADHD-RD sub-phenotypes instead of those arising from the DSM-IV may lead to greater success in the search for comorbid ADHD-RD susceptibility genes. Therefore, this study aims to refine ADHD-RD phenotypes into homogenous informative sub-phenotypes using latent class analysis (LCA). LCA was performed on 2,610 Australian twin families (6,535 individuals) in order to generate probabilistic genetically distinct classes that define ADHD-RD subtypes, including comorbidity, based on related symptom clusters. The LCA separated the phenotypes for ADHD and RD into nine classes. One class was unaffected; three classes demonstrated the three DSM-IV subtypes of ADHD, three subtypes showed different severities of RD, and two classes expressed a combination of RD and ADHD subtypes. LCA proved effective in refining the phenotypes of ADHD alone, RD alone, and ADHD-RD comorbidity, and its ability to classify them into homogenous groups based on clusters of symptoms, suggesting that the latent classes may be robust enough to use in molecular genetic studies.

Assessment of attention in preschoolers

In the past two decades, there has been an increased interest in the assessment and treatment of preschool children presenting with concerns about attention problems. This article reviews the research and clinical literature involving assessment of attention and related skills in the preschool years. While inattention among preschoolers is common, symptoms alone do not necessarily indicate a disorder, and most often represent a normal variation in typical preschool child development. Thus, accurate identification of "disordered" attention in preschoolers can be challenging, and development of appropriate, norm-referenced tests of attention for preschoolers is also difficult. The current review suggests that comprehensive assessment of attention and related functions in the preschool child should include thorough review of the child's history, planned observations, and formal psychometric testing. The three primary methods of psychometric assessment that have been used to characterize attentional functioning in preschool children include performance-based tests, structured caregiver interviews, and rating scales (parent, teacher, and clinician). Among performance-based methods for measurement of attention in the preschool years, tests have been developed to assess sustained attention, selective (focused) attention, span of attention (encoding/manipulation), and (top-down) controlled attention--including freedom from distractibility and set shifting. Many of these tests remain experimental in nature, and review of published methods yields relatively few commercially available, nationally normed tests of attention for preschoolers, and an overall dearth of reliability and validity studies on the available measures.

The impact of inattention and emotional problems on cognitive control in primary school children

OBJECTIVE

The present study investigated the predictive value of parent/teacher reports of inattention and emotional problems on cognitive control function in 241 children in primary school.

METHOD

Cognitive control was measured by functions of set-shifting and working memory as assessed by the Behavior Rating Inventory of Executive Function (BRIEF) and performance-based tests (i.e., Color Trail Test and Digit Span Test). Symptoms of inattention and emotional problems were measured with parent and teacher reports on Swanson Nolan and Pelham-IV questionnaire and Strengths and Difficulties Questionnaire, respectively.

RESULTS

Clinical symptoms of inattention and emotional problems explained the children's performance on test measures. However, symptoms of inattention made a significant contribution on all the selected measures of cognitive control, whereas reports concerning emotional problems uniquely explained the variance on the Shift scale from the BRIEF.

CONCLUSION

Valid information on cognitive control function in primary school children should thus include simultaneous information concerning problems of inattention and emotion.

The latent classes of subclinical ADHD symptoms: convergences of multiple informant reports

The purpose of the present study was to conduct latent class analysis on the Hyperactivity scale of the Strengths and Difficulties Questionnaire in order to identify distinct subgroups of subclinical ADHD in a multi-informant framework. We hypothesized a similar structure between teachers and parents, and differences in symptom severity across latent classes. Data was collected from a non-referred sample of children aged 8-13 years. We performed latent class analyses on parent (n = 383) and teacher (n = 391) ratings of the Hyperactivity scale items from both versions of the questionnaire. Those children who had ratings from both informants (n = 272) were included in the cross-informant analyses, in which the similar or equivalent classes across raters were determined. A three-class solution for parent report and a five-class solution for teacher report emerged in the subsample of boys. For girls, a three-class structure for parents and a four-class structure for teachers were optimal. Besides non-symptomatic groups, mild and severe combined classes, mild inattentive-impulsive classes, and among boys, a mild hyperactive-impulsive class was obtained. The cross-informant analyses demonstrated that quite similar subgroups were detached regardless of informant; however, the teacher classes were somewhat more elaborated. The results are in line with the previous latent class analytic studies, and support the combination of dimensional and categorical approaches. The importance of milder symptoms and sub-threshold ADHD categories are emphasized for the fields of neuropsychology, neuroscience, and education, as well as for diagnosis and personalized treatment.

Attention deficit hyperactivity disorder and sensory modulation disorder: a comparison of behavior and physiology

Children with attention deficit hyperactivity disorder (ADHD) are impulsive, inattentive and hyperactive, while children with sensory modulation disorder (SMD), one subtype of Sensory Processing Disorder, have difficulty responding adaptively to daily sensory experiences. ADHD and SMD are often difficult to distinguish. To differentiate these disorders in children, clinical ADHD, SMD, and dual diagnoses were assessed. All groups had significantly more sensory, attention, activity, impulsivity, and emotional difficulties than typical children, but with distinct profiles. Inattention was greater in ADHD compared to SMD. Dual diagnoses had more sensory-related behaviors than ADHD and more attentional difficulties than SMD. SMD had more sensory issues, somatic complaints, anxiety/depression, and difficulty adapting than ADHD. SMD had greater physiological/electrodermal reactivity to sensory stimuli than ADHD and typical controls. Parent-report measures identifying sensory, attentional, hyperactive, and impulsive difficulties varied in agreement with clinician's diagnoses. Evidence suggests ADHD and SMD are distinct diagnoses.

An efficacy study of a combined parent and teacher management training programme for children with ADHD

BACKGROUND

Several parent training programmes and behavioural teacher training programmes built on learning theory have been developed for problem prevention and treatment of attention-deficit/hyperactivity disorder (ADHD) and/or oppositional defiant disorder (ODD) during the last few decades. Group format has often been used for parent training but single-subject designs are more common in teacher training. More studies have focussed on pre-school children than on older children, and a minority have been conducted in public mental health settings.

AIM

This study aimed to evaluate a combined parent and teacher manual-based group training programme for children with ADHD conducted by the staff at a child and adolescent psychiatric clinic in Sweden.

METHOD

The intervention was a modified version of Barkley's programme. Children were randomized to an Intervention or a Control group. Sixty-one parents and 68 teachers answered questions about ADHD and ODD symptoms, and about behavioural problems when the study started and at a 3-month follow-up.

RESULTS

RESULTS showed that the intervention resulted in a reduction of the number of children who met DSM-IV criteria for ADHD and/or ODD. Effects were more pronounced in the home setting than in the school setting, and were further accentuated when both parents and teachers of the same child took part in the intervention. Teachers with more problematic classroom situations benefited most from the intervention.

CONCLUSION

The programme, "Strategies in Everyday Life", has, in a regular clinical setting, demonstrated promising effects on children's disruptive behaviour, and a clinical implication was to recommend involving both parents and teachers in the programme.

Modulation of attention-deficit/hyperactivity disorder symptoms by short- and long-acting methylphenidate over the course of a day

The purpose of this study was to investigate whether a long-acting methylphenidate formulation (MPH-ret) is as effective as two doses of immediate-release methylphenidate (MPH-IR) in reducing attention-deficit/hyperactivity disorder (ADHD) symptoms including inattention, impulsivity, and hyperactivity during the course of the day. Two groups of children (n=18 each) with ADHD aged between 8 and 12 years completed a continuous performance test in combination with a motion-tracking system four times a day within 8 hours. Inattention (standard deviation of reaction time), impulsivity (commission error rate), and hyperactivity (path length of the headband) were simultaneously measured. We included a control group (n=20) to rule out circadian fluctuations of attentional performance and motor activity. We observed a postlunch dip in attentional performance and an increasing trend of motor activity throughout the day whereas impulsivity remained stable in controls. The MPH-ret and MPH-IR groups had comparable treatment effects on measures of hyperactivity and inattention and normalized participant performance to control levels. In contrast, MPH-IR seems to have an advantage over MPH-ret in impulsivity treatments. Thus, our data suggest that it is crucial to assess the different domains of ADHD symptoms precisely over the course of a day to determine the optimal titration and stimulant formulation for a person with ADHD.

Nonlinear analysis of actigraphic signals for the assessment of the attention-deficit/hyperactivity disorder (ADHD)

Attention-deficit/hyperactivity disorder (ADHD) is the most common neurobehavioral disorder in children and adolescents; however, its etiology is still unknown, which hinders the existence of reliable, fast and inexpensive standard diagnostic methods. In this paper, we propose a novel methodology for automatic diagnosis of the combined type of ADHD based on nonlinear signal processing of 24h-long actigraphic registries. Since it relies on actigraphy measurements, it constitutes an inexpensive and non-invasive objective diagnostic method. Our results on real data reach 96.77% sensitivity and 84.38% specificity by means of multidimensional classifiers driven by combined features from different time intervals. Our analysis also reveals that, if features from a single time interval are used, the whole 24-h interval is the only one that yields classification figures with practical diagnostic capabilities. Overall, our figures overcome those obtained by actigraphy-based methods reported and are comparable with others based on more expensive (and not so convenient) adquisition methods.

Sleep disturbances in children with attention-deficit/hyperactivity disorder

In this article, we advocate the need for better understanding and treatment of children exhibiting inattentive, hyperactive, impulsive behaviors, by in-depth questioning on sleepiness, sleep-disordered breathing or problematic behaviors at bedtime, during the night and upon awakening, as well as night-to-night sleep duration variability. The relationships between sleep and attention-deficit/hyperactivity disorder (ADHD) are complex and are routinely overlooked by practitioners. Motricity and somnolence, the most consistent complaints and objectively measured sleep problems in children with ADHD, may develop as a consequence of multidirectional and multifactorial pathways. Therefore, subjectively perceived or reported restless sleep should be evaluated with specific attention to restless legs syndrome or periodic limb movement disorder, and awakenings should be queried with regard to parasomnias, dyssomnias and sleep-disordered breathing. Sleep hygiene logs detailing sleep onset and offset quantitatively, as well as qualitatively, are required. More studies in children with ADHD are needed to reveal the 24-h phenotype, or its sleep comorbidities.

Ciclo vigília/sono e o transtorno de déficit de atenção/hiperatividade

OBJETIVO: Analisar as relações entre ciclo vigília/sono e transtorno de déficit de atenção/hiperatividade. FONTES DE DADOS: Os artigos foram selecionados nas bases de dados SciELO e PubMed, utilizando-se "sono", "transtorno de déficit de atenção/hiperatividade", "atividade motora" e "crianças" como palavras-chave para a busca. SÍNTESE DOS DADOS: Embora os resultados de diferentes estudos sejam inconclusivos e, por vezes, contraditórios, não sendo possível estabelecer relações claras entre sono e transtorno do déficit de atenção/hiperatividade, observa-se que o sono das crianças diagnosticadas difere do sono de crianças que não possuem o transtorno, sugerindo que alterações de sono possam se relacionar ao transtorno do déficit de atenção/hiperatividade. CONCLUSÕES: A falta de marcadores biológicos e de conhecimento a respeito da sua etiologia gera dificuldades na determinação da real prevalência do transtorno do déficit de atenção/hiperatividade, além de limitar sua compreensão e a busca por novas formas de tratamento e prevenção. Embora dificuldades de sono sejam frequentemente relatadas na prática clínica e já tenham sido utilizadas como um dos critérios diagnósticos para o transtorno, pouco se sabe sobre a possível participação da privação de sono na etiologia do transtorno do déficit de atenção/hiperatividade.

Is behavioral regulation in children with ADHD aggravated by comorbid anxiety disorder?

BACKGROUND

The present study investigated the impact of coexisting anxiety disorder in children with ADHD on their ability to regulate behavior.

METHOD

Parent reports on the Behavior Rating Inventory of Executive Function (BRIEF) in a comorbid group of children with ADHD and anxiety (n = 11) were compared to BRIEF reports in a group of children with a "pure" ADHD (n = 23), a "pure" anxiety (n = 24) and a group without any diagnosis (n = 104) in a 2 (ADHD vs. no ADHD) × 2 (anxiety vs. no anxiety) design.

RESULTS

The children with ADHD and anxiety disorder scored significantly higher on the Inhibit scale than children within the other three groups. Main effects of diagnosis appeared in ADHD children on the Inhibit, Emotional Control, and Working Memory scales, and on the Shift and Emotional Control scales in anxious children.

CONCLUSION

The results indicate that a behavioral dysregulation in ADHD children is aggravated by comorbid anxiety.

Clinical utility of ADHD symptom thresholds to assess normalization of executive function with lisdexamfetamine dimesylate treatment in adults

OBJECTIVES

This analysis assessed the relationship of various cutoff scores of the ADHD Rating Scale IV (ADHD-RS-IV) to levels of improvement in ADHD-related executive function (EF), measured by the Brown ADD Scale for Adults (BADDS), which may provide a measure of clinically meaningful EF improvement after ADHD treatment.

METHODS

Post hoc analysis of a 4-week, open-label, dose-optimization phase in a double-blind, placebo-controlled study of lisdexamfetamine dimesylate (LDX) in adults with ADHD. The BADDS for Adults, a validated, normed, self-report measure of EF in ADHD, provides a qualitative measure to rate treatment progress. The ADHD-RS-IV assesses current symptom status based on DSM-IV criteria. Postbaseline ADHD-RS-IV scores were categorized according to four cutoff criteria of symptom remission: (1) ADHD-RS-IV total score ≤ 18; (2) ADHD-RS-IV total score ≤ 10; (3) no ADHD-RS-IV item scored >1; and (4) ADHD-RS-IV total score ≤ 18 and ≤ 2 items per subscale with a score of 2. Sensitivity and specificity of criteria for identifying participants with optimal BADDS scores were assessed using receiver operating characteristics (ROC). Safety evaluation included treatment-emergent adverse events (TEAEs).

RESULTS

At endpoint, 85/127 participants had optimal BADDS scores. Linear ANOVA indicated limited overlap between BADDS and ADHD-RS-IV scores (r (2) = 0.20; P < 0.0001). Specificity was similar for criteria 1-4 (0.46, 0.39, 0.39, and 0.42), as were ROC (0.699, 0.776, 0.732, and 0.668). Sensitivity was high for criteria 2 and 3 (0.96, 0.92), lower for criteria 1 and 4 (0.72, 0.75). TEAEs were consistent with those of stimulants.

CONCLUSION

Criteria 2 and 3 had satisfactorily high sensitivity, but no criteria had adequate specificity. AUC comparison indicated that criteria 2 and 3 ADHD-RS-IV thresholds may be more accurate assessments of EF normalization as measured by the BADDS. The open-label design, small sample size, and selection criteria limit the applicability of these results to a larger treatment population.

Attention deficit/hyperactivity disorder: a focused overview for children's environmental health researchers

OBJECTIVES

Attention deficit/hyperactivity disorder (ADHD) is the most frequently diagnosed childhood neurobehavioral disorder. Much research has been done to identify genetic, environmental, and social risk factors for ADHD; however, we are still far from fully understanding its etiology. In this review we provide an overview of diagnostic criteria for ADHD and what is known about its biological basis. We also review the neuropsychological functions that are affected in ADHD. The goal is to familiarize the reader with the behavioral deficits that are hallmarks of ADHD and to facilitate comparisons with neurobehavioral deficits associated with environmental chemical exposures.

DATA SOURCES

Relevant literature on ADHD is reviewed, focusing in particular on meta-analyses conducted between 2004 and the present that evaluated associations between measures of neuropsychological function and ADHD in children. Meta-analyses were obtained through searches of the PubMed electronic database using the terms "ADHD," "meta-analysis," "attention," "executive," and "neuropsychological functions." Although meta-analyses are emphasized, nonquantitative reviews are included for particular neuropsychological functions where no meta-analyses were available.

DATA SYNTHESIS

The meta-analyses indicate that vigilance (sustained attention), response inhibition, and working memory are impaired in children diagnosed with ADHD. Similar but somewhat less consistent meta-analytic findings have been reported for impairments in alertness, cognitive flexibility, and planning. Additionally, the literature suggests deficits in temporal information processing and altered responses to reinforcement in children diagnosed with ADHD. Findings from brain imagining and neurochemistry studies support the behavioral findings.

CONCLUSIONS

Behavioral, neuroanatomical, and neurochemical data indicate substantial differences in attention and executive functions between children diagnosed with ADHD and non-ADHD controls. Comparisons of the neurobehavioral deficits associated with ADHD and those associated with exposures to environmental chemicals may help to identify possible environmental risk factors for ADHD and/or reveal common underlying biological mechanisms.

Explanatory models and help-seeking behavior for attention-deficit/hyperactivity disorder among a cohort of postsecondary students

The authors present findings from a qualitative descriptive study that explored how a diverse ethnic group of postsecondary students diagnosed with attention-deficit/hyperactivity disorder (ADHD) conceptualized their condition and how this conceptualization shaped their efforts to seek help. Kleinman's explanatory model, the organizing framework, called for participants to describe the etiology, symptom onset, pathophysiology, course, and treatment of ADHD. Twenty-seven participants from four academic institutions took part in the study. A common explanatory model of ADHD was not shared; however, gender and age differences were apparent. These finding have implications for nurses when providing culturally appropriate care to individuals with ADHD in their practice settings.