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Schachar R, Crosbie J. Biederman's Contribution to the Understanding of Executive Function in ADHD. J Atten Disord 2024; 28:895-904. [PMID: 38327019 DOI: 10.1177/10870547231222597] [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] [Indexed: 02/09/2024]
Abstract
OBJECTIVE To examine the theoretical and empirical contribution of Joe Biederman and his colleagues to the understanding of executive function (EF) and ADHD. METHOD We searched PubMed for references to EF in Biederman's publications and conducted a narrative review of this literature. RESULTS In 50 or more papers using neuropsychological tests, rating scales and measures of mind wandering, Biederman demonstrated that EF are evident in ADHD and closely linked to its underlying neurobiological and genetic risk. He argued that EF need to be monitoring to ensure comprehensive assessment and treatment, but could not be used as a diagnostic proxy. CONCLUSION Biederman built an innovative and impressive collaboration to address the issue of EF in ADHD. His work shows a commitment to understanding of EF in order to improve patient care. Biederman laid down a roadmap for research in ADHD and EF for the rest of the field to follow.
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Affiliation(s)
- Russell Schachar
- Neuroscicences and Mental Health, Department of Psychiatry, The Hospital for Sick Children, University of Toronto, ON, Canada
| | - Jennifer Crosbie
- Neuroscicences and Mental Health, Department of Psychiatry, The Hospital for Sick Children, University of Toronto, ON, Canada
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2
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Agha SS, Riglin L, Carbury R, Blakey R, Shakeshaft A, Thapar AK, Tilling K, Collishaw S, Stergiakouli E, Thapar A, Langley K. Young Adult ADHD Symptoms in the General Population and Neurocognitive Impairment. J Atten Disord 2024; 28:89-98. [PMID: 37864348 PMCID: PMC10676027 DOI: 10.1177/10870547231201870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2023]
Abstract
OBJECTIVE Neurocognitive impairments are associated with child and adult ADHD in clinical settings. However, it is unknown whether adult ADHD symptoms in the general population are associated with the same pattern of cognitive impairment. We examined this using a prospective, population-based cohort spanning birth to age 25 years. METHODS We examined associations between self-reported adult ADHD symptoms and cognitive task performance (attention and response inhibition) in adulthood and childhood. RESULTS Self-rated ADHD symptoms at age 25 were associated with poorer performance in age 25 cognitive tasks capturing ADHD-related functioning (attention B = -0.03, 95% CI [0.05, -0.01], p = .005; response inhibition B = -0.03, 95% CI [-0.05, -0.01], p = .002). CONCLUSIONS Neurocognitive impairments linked to adult ADHD symptoms in the general population, are similar to those found in people with childhood ADHD symptoms and are consistent with findings in adult ADHD clinical samples.
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Affiliation(s)
- Sharifah Shameem Agha
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, UK
- Cwm Taf Morgannwg University Health Board, Wales, UK
- Wolfson Centre for Young People’s Mental Health, Cardiff University, UK
| | - Lucy Riglin
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, UK
- Wolfson Centre for Young People’s Mental Health, Cardiff University, UK
| | - Rhian Carbury
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, UK
| | - Rachel Blakey
- MRC Integrative Epidemiology Unit, University of Bristol, UK
| | - Amy Shakeshaft
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, UK
- Wolfson Centre for Young People’s Mental Health, Cardiff University, UK
| | - Ajay K. Thapar
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, UK
- Wolfson Centre for Young People’s Mental Health, Cardiff University, UK
| | - Kate Tilling
- MRC Integrative Epidemiology Unit, University of Bristol, UK
| | - Stephan Collishaw
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, UK
- Wolfson Centre for Young People’s Mental Health, Cardiff University, UK
| | | | - Anita Thapar
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, UK
- Wolfson Centre for Young People’s Mental Health, Cardiff University, UK
| | - Kate Langley
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, UK
- School of Psychology, Cardiff University, UK
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3
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Tallberg P, Rastam M, Hallin AL, Perrin S, Gustafsson P. A longitudinal investigation of parental ratings and performance metrics for executive functioning and symptom severity in clinically referred youth with ADHD. APPLIED NEUROPSYCHOLOGY. CHILD 2023; 12:259-271. [PMID: 36126650 DOI: 10.1080/21622965.2022.2093113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
There remains a knowledge gap concerning the persistence of attention deficit hyperactivity disorder (ADHD) over the longer term. The current study aimed to investigate the change in parent-rated, and performance-based metrics of executive functioning (EF) and the relationship between these EF metrics and ADHD symptoms in individuals with ADHD from childhood/adolescence to young adulthood. This was done by examining possible improvements in parent-rated EF and performance-based measures of inattention and inhibition over a three-year interval and their relationship to ADHD outcomes in 137 clinically referred youth with ADHD (mean age = 12.4 years, SD = 3.1). Participants' parents completed the Behavior Rating Inventory of Executive Function (BRIEF) and the Swanson-Nolan-Pelham Scale at baseline and follow-up. Participants completed the Conners' Continuous Performance Test, Version II (CPT II) at baseline and follow-up. Statistical analyses were performed with Linear Mixed Models. The sex- and age-standardized measures Commission and Hit reaction time (RT) subscales of the CPT II and parent-rated metacognitive, and behavior regulation composites of the BRIEF were largely stable between measuring points. CPT Omissions, Hit RT standard error (reaction time variability), and parent-rated ADHD symptom scores improved slightly. BRIEF composites and reaction time variability were related to ADHD symptoms using longitudinal data. Overall, behavioral aspects of EF, as observed by parents in the home context, appear to play a significant role in the trajectory of childhood ADHD.
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Affiliation(s)
- Pia Tallberg
- Child and Adolescent Psychiatry, Department of Clinical Sciences, Lund University, Lund, Sweden
- Child and Adolescent Psychiatry, Region Skane, Lund, Sweden
| | - Maria Rastam
- Child and Adolescent Psychiatry, Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Psychiatry and Neurochemistry, Gillberg Neuropsychiatry Centre, University of Gothenburg, Gothenburg, Sweden
| | - Anne-Li Hallin
- Child and Adolescent Psychiatry, Region Skane, Lund, Sweden
| | - Sean Perrin
- Department of Psychology, Lund University, Lund, Sweden
| | - Peik Gustafsson
- Child and Adolescent Psychiatry, Department of Clinical Sciences, Lund University, Lund, Sweden
- Child and Adolescent Psychiatry, Region Skane, Lund, Sweden
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4
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Canu D, Ioannou C, Müller K, Martin B, Fleischhaker C, Biscaldi M, Beauducel A, Smyrnis N, van Elst LT, Klein C. Evidence towards a continuum of impairment across neurodevelopmental disorders from basic ocular-motor tasks. Sci Rep 2022; 12:16521. [PMID: 36192503 PMCID: PMC9530118 DOI: 10.1038/s41598-022-19661-z] [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] [Received: 09/30/2021] [Accepted: 09/01/2022] [Indexed: 11/18/2022] Open
Abstract
Findings of genetic overlap between Schizophrenia, Attention-Deficit/Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD) contributed to a renewed conceptualization of these disorders as laying on a continuum based on aetiological, pathophysiological and neurodevelopmental features. Given that cognitive impairments are core to their pathophysiology, we compared patients with schizophrenia, ADHD, ASD, and controls on ocular-motor and manual-motor tasks, challenging crucial cognitive processes. Group comparisons revealed inhibition deficits common to all disorders, increased intra-subject variability in schizophrenia and, to a lesser extent, ADHD as well as slowed processing in schizophrenia. Patterns of deviancies from controls exhibited strong correlations, along with differences that posited schizophrenia as the most impaired group, followed by ASD and ADHD. While vector correlations point towards a common neurodevelopmental continuum of impairment, vector levels suggest differences in the severity of such impairment. These findings argue towards a dimensional approach to Neurodevelopmental Disorders’ pathophysiological mechanisms.
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Affiliation(s)
- Daniela Canu
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Chara Ioannou
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Katarina Müller
- Psychotherapeutisches Wohnheim für Junge Menschen Leppermühle, Buseck, Germany
| | - Berthold Martin
- Psychotherapeutisches Wohnheim für Junge Menschen Leppermühle, Buseck, Germany
| | - Christian Fleischhaker
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Monica Biscaldi
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | - Nikolaos Smyrnis
- 2nd Psychiatry Department, National and Kapodistrian University of Athens, Medical School, University General Hospital "ATTIKON", Athens, Greece.,Laboratory of Cognitive Neuroscience and Sensorimotor Control, University Mental Health, Neurosciences and Precision Medicine Research Institute «COSTAS STEFANIS», Athens, Greece
| | - Ludger Tebartz van Elst
- Department of Psychiatry and Psychotherapy, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christoph Klein
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany. .,2nd Psychiatry Department, National and Kapodistrian University of Athens, Medical School, University General Hospital "ATTIKON", Athens, Greece. .,Department of Child and Adolescent Psychiatry, Medical Faculty, University of Cologne, Cologne, Germany.
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5
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Arnett AB, McGrath LM, Flaherty BP, Pennington BF, Willcutt E. Heritability and Clinical Characteristics of Neuropsychological Profiles in Youth With and Without Elevated ADHD Symptoms. J Atten Disord 2022; 26:1422-1436. [PMID: 35102766 PMCID: PMC9283222 DOI: 10.1177/10870547221075842] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE In the last decade, there has been an increase in research that aims to parse heterogeneity in attention deficit hyperactivity disorder (ADHD). The current study tests heritability of latent class neuropsychological subtypes. METHOD Latent class analysis was used to derive subtypes in a sample of school-age twins (N = 2,564) enriched for elevated ADHD symptoms. RESULTS Five neuropsychological profiles replicated across twin 1 and twin 2 datasets. Latent class membership was heritable overall, but heritability varied by profile and was lower than heritability of ADHD status. Variability in neuropsychological performance across domains was the strongest predictor of elevated ADHD symptoms. Neuropsychological profiles showed distinct associations with age, psychiatric symptoms and reading ability. CONCLUSION Neuropsychological profiles are associated with unique neurocognitive presentations, but are not strong candidate endophenotypes for ADHD diagnosis.
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Affiliation(s)
- Anne B. Arnett
- Division of Developmental Medicine, Boston Children’s Hospital, Brookline, MA
| | | | | | | | - Erik Willcutt
- Department of Psychology and Neuroscience, University of Colorado at Boulder, Boulder, CO
- Institute for Behavioral Genetics, University of Colorado at Boulder, Boulder, CO
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6
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Callahan BL, Shammi P, Taylor R, Ramakrishnan N, Black SE. Longitudinal Cognitive Performance of Older Adults With ADHD Presenting to a Cognitive Neurology Clinic: A Case Series of Change Up to 21 Years. Front Aging Neurosci 2021; 13:726374. [PMID: 34867269 PMCID: PMC8634492 DOI: 10.3389/fnagi.2021.726374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 10/22/2021] [Indexed: 11/25/2022] Open
Abstract
Background: The neuropsychological features of older adults with ADHD are largely unknown. This retrospective chart review aims to elucidate their cognitive trajectories using a case series of six older adults with ADHD presenting with memory complaints to a cognitive neurology clinic, whom we argue are a particularly relevant group to study due to their potential to mimic neurodegenerative syndromes. Methods: Participants were included if they were age 40 or older at intake, had ADHD based on DSM-5 criteria, and had cognitive data collected prior to 2014 with follow-up at least 5 years later. Results: Five men and one woman were included (M = 53.8 years at intake) and had an average of 135.0 months of follow-up data available. Despite notable between- and within-subject variability, cognition generally improved or remained stable across visits. Two participants experienced notable memory decline, but a global consideration of their performance in other domains suggests these deficits may be frontally-mediated. Conclusion: In this small sample, cognition remained generally unchanged across 5–21 years. Isolated impairments likely reflect substantial intra-individual variability across time and measures.
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Affiliation(s)
- Brandy L Callahan
- Department of Psychology, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, Calgary, AB, Canada
| | - Prathiba Shammi
- Dr. Sandra Black Centre for Brain Resilience, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Rebecca Taylor
- Dr. Sandra Black Centre for Brain Resilience, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | | | - Sandra E Black
- Dr. Sandra Black Centre for Brain Resilience, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
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7
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White matter abnormalities associated with ADHD outcomes in adulthood. Mol Psychiatry 2021; 26:6655-6665. [PMID: 34035475 PMCID: PMC8613296 DOI: 10.1038/s41380-021-01153-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 03/24/2021] [Accepted: 04/29/2021] [Indexed: 02/04/2023]
Abstract
It remains unclear if previously reported structural abnormalities in children with ADHD are present in adulthood regardless of clinical outcome. In this study, we examined the extent to which focal-rather than diffuse-abnormalities in fiber collinearity of 18 major white matter tracts could distinguish 126 adults with rigorously diagnosed childhood ADHD (ADHD; mean age [SD] = 34.3 [3.6] years; F/M = 12/114) from 58 adults without ADHD histories (non-ADHD; mean age [SD] = 33.9 [4.1] years; F/M = 5/53) and if any of these abnormalities were greater for those with persisting ADHD symptomatology. To this end, a tract profile approach was used. After accounting for age, sex, handedness, and comorbidities, a MANCOVA revealed a main effect of group (ADHD < non-ADHD; F[18,155] = 2.1; p = 0.007) on fractional anisotropy (FA, a measure of fiber collinearity and/or integrity), in focal portions of white matter tracts involved in visuospatial processing and memory (i.e., anterior portion of the left inferior longitudinal fasciculus, and middle portion of the left and right cingulum angular bundle). Only abnormalities in the anterior portion of the left inferior longitudinal fasciculus distinguished probands with persisting versus desisting ADHD symptomatology, suggesting that abnormalities in the cingulum angular bundle might reflect "scarring" effects of childhood ADHD. To our knowledge, this is the first study using a tract profile approach to identify focal or widespread structural abnormalities in adults with ADHD rigorously diagnosed in childhood.
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8
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Kühl E, Geeraerts SB, Deković M, Schoemaker K, Bunte T, Espy KA, Matthys W. Trajectories of Executive Functions and ADHD Symptoms in Preschoolers and the Role of Negative Parental Discipline. Dev Neuropsychol 2021; 46:555-573. [PMID: 34711098 DOI: 10.1080/87565641.2021.1995736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
In the present study, we investigated whether the longitudinal growth trajectories of executive functions (EF) and Attention-Deficit/Hyperactivity Disorder (ADHD) symptoms are related. In addition, we investigated whether negative discipline moderated these longitudinal relations. The sample consisted of predominantly clinically referred preschoolers (N = 248, age 42-66 months at Time 1; 79.0% boys). Assessment occurred three times: at baseline, at 9 months, and at 18 months. EF was assessed with five EF tasks. ADHD symptoms (Child Behavior Checklist 1.5-5) were reported by parents. Groups of medium to high and low negative discipline were based on mother- and father-reports (Parenting Practices Inventory). Growth curve models showed that EF generally increased and ADHD symptoms generally decreased over time. Parallel process models showed that there was no relation between the change in EF and the change in ADHD symptoms over time, suggesting no co-development. However, higher EF at baseline was related to lower ADHD symptoms at baseline. This was irrespective of whether children were exposed to high or low negative discipline. Overall, the results suggest that, while EF and ADHD symptoms are related, they develop independently across the preschool years.
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Affiliation(s)
- Eva Kühl
- Department of Child and Adolescent Studies, Utrecht University, Utrecht, The Netherlands
| | - Sanne B Geeraerts
- Department of Child and Adolescent Studies, Utrecht University, Utrecht, The Netherlands
| | - Maja Deković
- Department of Child and Adolescent Studies, Utrecht University, Utrecht, The Netherlands
| | - Kim Schoemaker
- Department of Child and Adolescent Studies, Utrecht University, Utrecht, The Netherlands
| | | | - Kimberly A Espy
- Department of Neuroscience, Developmental & Regenerative Biology, College of Sciences, University of Texas at San Antonio and Department of Psychiatry & Behavioral Sciences, Long School of Medicine, University of Texas Health San Antonio, San Antonio, Texas, USA
| | - Walter Matthys
- Department of Child and Adolescent Studies, Utrecht University, Utrecht, The Netherlands.,Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands
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9
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Krieger V, Amador-Campos JA. Clinical presentations of attention-deficit/hyperactivity disorder (ADHD) in children and adolescents: comparison of neurocognitive performance. Child Neuropsychol 2021; 27:1024-1053. [PMID: 33928840 DOI: 10.1080/09297049.2021.1917530] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This study aimed to compare performance in working memory (WM), processing speed (PRS), and attention measures in children and adolescents with typical development (TD) and with Attention deficit hyperactivity disorder (inattentive [ADHD-I] or combined [ADHD-C]) presentations, and to determine the predictive ability of the measures mentioned to discriminate between ADHD presentations and TD. 260 children and adolescents, 138 with ADHD (70 ADHD-I and 68 ADHD-C) and 122 TD in two age cohorts (8-12 years; 13-16 years), were assessed with WM and PRS indexes of Wechsler Intelligence Scale for Children (WISC-IV) and the d2 attention test. Significant differences between ADHD and TD groups in the WISC-IV GAI scores were found in children but not in adolescents. Children and adolescents with both ADHD presentations performed poorly on the PRS index, while on the WM index only children exhibited difficulties. In the attention test, children with ADHD-C showed more impulsivity and more difficulties for processing speed, concentration and accuracy than ADHD-I and TD. In addition, both ADHD presentations had higher inattention scores than TD. ADHD adolescents performed worse than TD in processing speed, concentration and accuracy. ADHD groups showed more impulsivity and inattention than TD. Digit Span and Symbol Search (WISC-IV) and processing speed and accuracy (d2) successfully classified ADHD and TD in children, but in adolescents, only coding (WISC-IV) and accuracy (d2) successfully classified ADHD presentations and TD. The WISC-IV and d2 yield neuropsychological profiles which reflect age-related cognitive changes and may allow the adaptation of more tailored early interventions for ADHD.
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Affiliation(s)
- Virginia Krieger
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Barcelona, Barcelona, Spain
| | - Juan Antonio Amador-Campos
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Barcelona, Barcelona, Spain.,Institute of Neuroscience, University of Barcelona (UBneuro), Barcelona, Spain
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10
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Tallberg P, Rastam M, Perrin S, Hallin AL, Gustafsson P. A longitudinal investigation of cognitive functioning and its relationship to symptom severity and academic functioning in treatment seeking youth with AHDH. Scand J Child Adolesc Psychiatr Psychol 2021; 9:52-63. [PMID: 33928054 PMCID: PMC8077411 DOI: 10.21307/sjcapp-2021-007] [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] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background: Children with ADHD tend to present with poorer cognitive functioning leaving them more vulnerable to a range of negative outcomes. To date, only a handful of longitudinal studies have examined the stability of Wechsler composite scores in children and adolescents with ADHD, and none of them used a more recent version of the Wechsler Intelligence Scales for Children (WISC), than the WISC-III. Objective: The present study investigates the cognitive stability and its longitudinal relationship with the severity of the child’s ADHD symptoms and school grades. Method: Cognitive functioning was measured with the fourth editions of the WISC-IV or the Wechsler Adult Intelligence Scales (WAIS-IV) at baseline and at a 3-4-year follow-up in children with ADHD (n = 125, mean age = 11.40 years, SD = 3.27) and a Control group of schoolchildren (n = 59, mean age = 11.97 years, SD = 2.15). The stability of cognitive functioning and the relationship between cognitive functioning, ADHD and grades were evaluated using linear mixed models and logistic regression. Results: Standardized composite scores of Full scale IQ, Verbal Comprehension, and Processing Speed declined between baseline and follow-up in the ADHD group. ADHD symptom scores were associated with Working Memory scores. Together, the severity of concurrent ADHD symptoms and lower scores for verbal comprehension at baseline and follow-up were associated with an increased risk of not achieving grades at follow-up in youth with ADHD. Conclusions: Youth with ADHD often present with cognitive impairments, not improved over time. Together these increase the risk of poorer academic outcomes. Concurrent evaluation of symptom severity and cognitive functions can add potentially useful information in terms of treatment planning, and school supports to prevent school failure.
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Affiliation(s)
- Pia Tallberg
- Department of Clinical Sciences, Child and Adolescent Psychiatry, Lund University, Lund, Sweden
| | - Maria Rastam
- Department of Clinical Sciences, Child and Adolescent Psychiatry, Lund University, Lund, Sweden.,Department of Psychiatry and Neurochemistry, Gillberg Neuropsychiatry Centre, University of Gothenburg, Göteborg, Sweden
| | - Sean Perrin
- Department of Psychology, Faculty of Social Sciences, Lund University, Lund, Sweden
| | - Anne-Li Hallin
- Child and Adolescent Psychiatry, Region Skåne, Lund, Sweden
| | - Peik Gustafsson
- Child and Adolescent Psychiatry, Department of Clinical Sciences, Lund, Skåne University Hospital, Lund University, Lund, Sweden
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11
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Gray matter networks associated with attention and working memory deficit in ADHD across adolescence and adulthood. Transl Psychiatry 2021; 11:184. [PMID: 33767139 PMCID: PMC7994833 DOI: 10.1038/s41398-021-01301-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 02/14/2021] [Accepted: 03/02/2021] [Indexed: 02/01/2023] Open
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a childhood-onset neuropsychiatric disorder and may persist into adulthood. Working memory and attention deficits have been reported to persist from childhood to adulthood. How neuronal underpinnings of deficits differ across adolescence and adulthood is not clear. In this study, we investigated gray matter of two cohorts, 486 adults and 508 adolescents, each including participants from ADHD and healthy controls families. Two cohorts both presented significant attention and working memory deficits in individuals with ADHD. Independent component analysis was applied to the gray matter of each cohort, separately, to extract cohort-inherent networks. Then, we identified gray matter networks associated with inattention or working memory in each cohort, and projected them onto the other cohort for comparison. Two components in the inferior, middle/superior frontal regions identified in adults and one component in the insula and inferior frontal region identified in adolescents were significantly associated with working memory in both cohorts. One component in bilateral cerebellar tonsil and culmen identified in adults and one component in left cerebellar region identified in adolescents were significantly associated with inattention in both cohorts. All these components presented a significant or nominal level of gray matter reduction for ADHD participants in adolescents, but only one showed nominal reduction in adults. Our findings suggest although the gray matter reduction of these regions may not be indicative of persistency of ADHD, their persistent associations with inattention or working memory indicate an important role of these regions in the mechanism of persistence or remission of the disorder.
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12
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Distinct Patterns of Impaired Cognitive Control Among Boys and Girls with ADHD Across Development. Res Child Adolesc Psychopathol 2021; 49:835-848. [PMID: 33646480 DOI: 10.1007/s10802-021-00792-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2021] [Indexed: 11/27/2022]
Abstract
This study examined whether girls and boys with ADHD show similar impairments in cognitive control from childhood into adolescence and the developmental relationship between cognitive control and ADHD symptoms. Participants include 8-17-year-old children with ADHD (n = 353, 104 girls) and typically developing (TD) controls (n = 241, 86 girls) with longitudinal data obtained from n = 137. Participants completed two go/no-go (GNG) tasks that varied in working memory demand. Linear mixed-effects models were applied to compare age-related changes in cognitive control for each GNG task among girls and boys with ADHD and TD controls and in relation to ADHD symptoms. Boys with ADHD showed impaired response inhibition and increased response variability across tasks. In contrast, girls with ADHD showed impaired response inhibition only with greater working memory demands whereas they displayed increased response variability regardless of working memory demands. Analysis of age-related change revealed that deficits in cognitive control under minimal working memory demands increase with age among girls with ADHD and decrease with age among boys with ADHD. In contrast, deficits in cognitive control with greater working memory demands decrease with age among both boys and girls with ADHD compared to TD peers. Among children with ADHD poor response inhibition during childhood predicted inattentive symptoms in adolescence and was associated with less age-related improvement in inattentive symptoms. These findings suggest that girls and boys with ADHD show differential impairment in cognitive control across development and response inhibition in childhood may be an important predictor of ADHD symptoms in adolescence.
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13
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Øie MG, Sundet K, Haug E, Zeiner P, Klungsøyr O, Rund BR. Cognitive Performance in Early-Onset Schizophrenia and Attention-Deficit/Hyperactivity Disorder: A 25-Year Follow-Up Study. Front Psychol 2021; 11:606365. [PMID: 33519613 PMCID: PMC7841368 DOI: 10.3389/fpsyg.2020.606365] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 12/21/2020] [Indexed: 11/13/2022] Open
Abstract
Early-Onset Schizophrenia (EOS) and Attention Deficit-Hyperactivity Disorder (ADHD) are early- onset neurodevelopmental disorders associated with cognitive deficits. The current study represents the first attempt to compare these groups on a comprehensive cognitive test battery in a longitudinal design over 25 years in order to enhance our knowledge of particular patterns resulting from the interaction between normal maturational processes and different illness processes of these disorders. In the baseline study, 19 adolescents with schizophrenia were compared to 20 adolescents with ADHD and 30 healthy controls (HC), all between 12 and 18 years of age. After 13 years (T2) and after 25 years (T3) they were re-evaluated with the cognitive test battery. A cognitive Composite Score was used in a linear mixed model. The EOS group had a significant cognitive stagnation or deterioration from T1 to T2 compared to HC. However, the EOS group had the most positive change from T2 to T3, supporting a stable level of cognitive performance over the 25 year span. The ADHD group improved or had similar development as the HC group from T1 to T2. They continued to improve significantly compared to the HC group from T2 to T3. Individuals in the EOS group performed more impaired on the cognitive composite score compared to the HC group and the ADHD group at all three time points. Results might indicate a neurodevelopmental pathway of EOS with subnormal cognitive development specific in adolescence. In comparison, the ADHD group had a more consistent cognitive maturation supporting a maturational delay hypothesis of ADHD.
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Affiliation(s)
- Merete G Øie
- Department of Psychology, University of Oslo, Oslo, Norway.,Department of Research, Innlandet Hospital Trust, Brumunddal, Norway
| | - Kjetil Sundet
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Elisabeth Haug
- Division of Mental Health, Innlandet Hospital Trust, Ottestad, Norway
| | - Pål Zeiner
- Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | - Bjørn R Rund
- Department of Psychology, University of Oslo, Oslo, Norway.,Vestre Viken Hospital Trust, Drammen, Norway
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14
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Mayer JS, Bernhard A, Fann N, Boxhoorn S, Hartman CA, Reif A, Freitag CM. Cognitive mechanisms underlying depressive disorders in ADHD: A systematic review. Neurosci Biobehav Rev 2021; 121:307-345. [PMID: 33359622 DOI: 10.1016/j.neubiorev.2020.12.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 12/01/2020] [Accepted: 12/09/2020] [Indexed: 01/06/2023]
Abstract
The risk for major depressive disorder (MDD) is considerably increased in young adults with attention-deficit/hyperactivity disorder (ADHD) but underlying mechanisms are poorly understood. This review explores ADHD-specific neurocognitive impairments as possible underlying mechanisms for ADHD-depression comorbidity. Two systematic literature searches were conducted in EBSCOhost, PubMED, and Cochrane Reviews databases according to PRISMA guidelines. The first search identified 18 meta-analyses of cross-sectional and longitudinal studies on cognitive dysfunctions in MDD across the lifespan. The second search identified six original studies on reaction time variability in MDD. During acute depression, children and adults showed cognitive deficits that overlapped with some of the ADHD-related impairments. Findings from remitted patients, high-risk individuals, and few prospective studies suggest that a subset of these shared impairments, specifically executive dysfunctions (selective attention, verbal fluency, working memory) and long-term memory problems, are candidate pre-existing risk markers of depression. We discuss if and how these specific neurocognitive mechanisms may mediate developmental pathways from ADHD to depression. If replicated by longitudinal studies, these findings may guide future prevention strategies.
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Affiliation(s)
- Jutta S Mayer
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Frankfurt, Goethe University, Deutschordenstraße 50, 60528 Frankfurt am Main, Germany.
| | - Anka Bernhard
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Frankfurt, Goethe University, Deutschordenstraße 50, 60528 Frankfurt am Main, Germany
| | - Nikola Fann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Frankfurt, Goethe University, Deutschordenstraße 50, 60528 Frankfurt am Main, Germany
| | - Sara Boxhoorn
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Frankfurt, Goethe University, Deutschordenstraße 50, 60528 Frankfurt am Main, Germany
| | - Catharina A Hartman
- Interdisciplinary Centre Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Centre Groningen, CC 72, P.O. Box 30.001, 9700 RB Groningen, the Netherlands
| | - Andreas Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Heinrich-Hoffmann-Str. 10, 60528 Frankfurt am Main, Germany
| | - Christine M Freitag
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Frankfurt, Goethe University, Deutschordenstraße 50, 60528 Frankfurt am Main, Germany
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15
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Michelini G, Cheung CHM, Kitsune V, Brandeis D, Banaschewski T, McLoughlin G, Asherson P, Rijsdijk F, Kuntsi J. The Etiological Structure of Cognitive-Neurophysiological Impairments in ADHD in Adolescence and Young Adulthood. J Atten Disord 2021; 25:91-104. [PMID: 29720024 PMCID: PMC7750664 DOI: 10.1177/1087054718771191] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Objective: Previous studies in children with ADHD identified two partially separable familial factors underlying cognitive dysfunction, but evidence in adolescents and adults is lacking. Here, we investigate the etiological structure of cognitive-neurophysiological impairments in ADHD in adolescents and young adults. Method: Factor analyses and multivariate familial models were run in 356 participants from ADHD and control sibling pairs aged 11 to 27 years on data on IQ, digit span forward (DSF) and backward (DSB), and cognitive-performance and event-related potential (ERP) measures from three cognitive tasks. Results: Three familial factors (cF1-3), showing substantial familial overlap with ADHD, captured the familial covariation of ADHD with nine cognitive-ERP measures. cF1 loaded on IQ, mean reaction time (MRT), and reaction-time variability (RTV); cF2 on DSF and DSB; and cF3 on number of errors and ERPs of inhibition and error processing. Conclusion: These results identify three partially separable etiological pathways leading to cognitive-neurophysiological impairments in adolescent and adult ADHD.
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Affiliation(s)
| | | | | | - Daniel Brandeis
- Heidelberg University, Mannheim,
Germany,University of Zurich, Switzerland
| | | | | | | | | | - Jonna Kuntsi
- King’s College London, UK,Jonna Kuntsi, King’s College London, Social,
Genetic & Developmental Psychiatry Centre, Institute of Psychiatry,
Psychology & Neuroscience, 16 De Crespigny Park, London SE5 8AF, UK.
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16
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Agnew-Blais JC, Polanczyk GV, Danese A, Wertz J, Moffitt TE, Arseneault L. Are changes in ADHD course reflected in differences in IQ and executive functioning from childhood to young adulthood? Psychol Med 2020; 50:2799-2808. [PMID: 31718730 DOI: 10.1017/s0033291719003015] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Attention-deficit hyperactivity disorder (ADHD) is associated with poorer cognitive functioning. We used a developmental, genetically-sensitive approach to examine intelligence quotient (IQ) from early childhood to young adulthood among those with different ADHD courses to investigate whether changes in ADHD were reflected in differences in IQ. We also examined executive functioning in childhood and young adulthood among different ADHD courses. METHODS Study participants were part of the Environmental Risk (E-Risk) Longitudinal Twin Study, a population-based birth cohort of 2232 twins. We assessed ADHD in childhood (ages 5, 7, 10 and 12) and young adulthood (age 18). We examined ADHD course as reflected by remission, persistence and late-onset. IQ was evaluated at ages 5, 12 and 18, and executive functioning at ages 5 and 18. RESULTS ADHD groups showed deficits in IQ across development compared to controls; those with persistent ADHD showed the greatest deficit, followed by remitted and late-onset. ADHD groups did not differ from controls in developmental trajectory of IQ, suggesting changes in ADHD were not reflected in IQ. All ADHD groups performed more poorly on executive functioning tasks at ages 5 and 18; persisters and remitters differed only on an inhibitory control task at age 18. CONCLUSIONS Differences in ADHD course - persistence, remission and late-onset - were not directly reflected in changes in IQ. Instead, having ADHD at any point across development was associated with lower average IQ and poorer executive functioning. Our finding that individuals with persistent ADHD have poorer response inhibition than those who remitted requires replication.
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Affiliation(s)
- Jessica C Agnew-Blais
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Andrea Danese
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- National and Specialist Child Traumatic Stress and Anxiety Clinic, South London and Maudsley NHS Foundation Trust, London, UK
| | - Jasmin Wertz
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
| | - Terrie E Moffitt
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Louise Arseneault
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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17
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James SN, Cheung CHM, Rommel AS, McLoughlin G, Brandeis D, Banaschewski T, Asherson P, Kuntsi J. Peripheral Hypoarousal but Not Preparation-Vigilance Impairment Endures in ADHD Remission. J Atten Disord 2020; 24:1944-1951. [PMID: 28363258 PMCID: PMC5617106 DOI: 10.1177/1087054717698813] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Objective: This study investigates whether impairments associated with persistent ADHD-impaired attention allocation (P3 amplitude), peripheral hypoarousal (skin conductance level [SCL]), and adjustment in preparatory state (contingent negative variation [CNV])-reflect enduring deficits unrelated to ADHD outcome or are markers of ADHD remission. Method: Young people with childhood ADHD (73 persisters and 18 remitters) and 144 controls were compared on neurophysiological measures during two conditions (baseline and fast-incentive) of a four-choice reaction time task. Results: ADHD remitters differed from persisters, and were indistinguishable from controls, on baseline P3 amplitude and fast-incentive CNV amplitude (p ≤ .05). ADHD remitters differed from controls (p ≤ .01), and were indistinguishable from persisters (p > .05), on baseline SCL. Conclusion: Preparation-vigilance measures were markers of ADHD remission, confirming previous findings with other measures. Yet, SCL-measured peripheral hypoarousal emerges as an enduring deficit unrelated to ADHD improvement. Future studies should explore potential compensatory mechanisms that enable efficient preparation-vigilance processes in ADHD remitters.
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Affiliation(s)
| | | | | | | | - Daniel Brandeis
- Heidelberg University, Germany
- University of Zurich, Switzerland
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18
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Rosello B, Berenguer C, Raga JM, Baixauli I, Miranda A. Executive functions, effortful control, and emotional lability in adults with ADHD. implications for functional outcomes. Psychiatry Res 2020; 293:113375. [PMID: 32798933 DOI: 10.1016/j.psychres.2020.113375] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 07/31/2020] [Accepted: 08/02/2020] [Indexed: 12/27/2022]
Abstract
Adults with diagnosis of childhood attention-deficit hyperactivity disorder (ADHD) experience impairments in self-regulation (SR). This study examined whether subgroups of these impairments can be established based on differentiable patterns. The relationships between these subgroups and a group without ADHD were then analyzed, focusing on functional outcomes. Executive functions, effortful control, and emotional lability, in addition to self-concept, quality of life, and different comorbidities, were evaluated in 61 adults with a childhood diagnosis of ADHD and 54 adults without ADHD. Latent profile analysis (LPA) revealed three ADHD classes based on different self-regulation indicators: "Normalized" (49.18%), "Moderate impairments" (27.86%), and "Severe generalized impairments" (22.96%), who were compared with a Non-ADHD group on different functional measures. The "Normalized" profile showed significantly less dysfunctionality than the other two profiles, and it only exhibited significant differences with respect to the Non-ADHD group on the Hyperactivity index. By contrast, the "Severe generalized impairments" group, with the lowest self-regulatory skills, was impaired on all the functional outcomes. Self-regulatory skills could be a key target in interventions for adults with ADHD.
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19
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Longitudinal Trajectories of Sustained Attention Development in Children and Adolescents with ADHD. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2020; 48:1529-1542. [PMID: 32889562 DOI: 10.1007/s10802-020-00698-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The present study characterizes changes in sustained attention ability over ages 9-14, and whether longitudinal trajectories of attention development differ between persistent ADHD, remitted ADHD and control groups. The Sustained Attention to Response Task (SART) was administered to 120 children with ADHD and 123 controls on three occasions between ages 9 and 14. Trajectories of sustained attention development, indicated by changes in SART performance (standard deviation of response time [SDRT], omission errors, and ex-Gaussian parameters sigma and tau), were examined using generalized additive mixed models. For all measures there was a significant main effect of age; response time variability and number of omission errors improved linearly as children aged. However, children with ADHD had significantly greater SDRT, tau and omission errors than controls across waves. There were no significant group differences in sigma, indicating that the greater overall response time variability (SDRT) observed in ADHD was likely driven by more intermittent long responses (larger tau). Trajectories of sustained attention performance did not differ between children with persistent ADHD or ADHD in remission. Longitudinal trajectories of sustained attention development are comparable between ADHD and controls, however children with ADHD (regardless of remission status) display a performance deficit equivalent to typical controls 1-3 years younger. Findings highlight the need for continued clinical support for children in remission from ADHD and provide support for tau as an endophenotype of ADHD.
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20
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The Course of Neurocognitive Functioning and Prediction of Behavioral Outcome of ADHD Affected and Unaffected Siblings. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2020; 47:405-419. [PMID: 30079436 PMCID: PMC6397140 DOI: 10.1007/s10802-018-0449-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Longitudinal studies on the course of neurocognitive functioning of children with ADHD and their unaffected siblings are scarce. Also, it is unclear to what extent that course is related to ADHD outcomes. A carefully phenotyped large sample of 838 Caucasian participants (ADHD-combined type: n = 339, unaffected siblings: n = 271, controls: n = 228; mean age at baseline = 11.4 years, mean age at follow-up = 17.3 years, SD = 3.2) was used to investigate differences in the course of neurocognitive functioning of ADHD affected and unaffected siblings versus controls, and to investigate the relationship between neurocognitive change and ADHD outcomes. At baseline, an aggregated measure of overall neurocognitive functioning and eight neurocognitive measures of working memory, timing (speed/variability), motor control, and intelligence were investigated. Outcomes at follow-up were dimensional measures of ADHD symptom severity and the Kiddie-Global Assessment Scale (K-GAS) for overall functioning. At follow up, affected and unaffected siblings trended to, or fully caught up with performance levels of controls on four (44.4%) and five (55.6%) of the nine dependent variables, respectively. In contrast, performance in remaining key neurocognitive measures (i.e. verbal working memory, variability in responding) remained impaired at follow-up. Change in neurocognitive functioning was not related to ADHD outcomes. Our results question the etiological link between neurocognitive deficits and ADHD outcomes in adolescents and young adults.
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21
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Miranda P, Cox CD, Alexander M, Danev S, Lakey JRT. In Quest of Pathognomonic/Endophenotypic Markers of Attention Deficit Hyperactivity Disorder (ADHD): Potential of EEG-Based Frequency Analysis and ERPs to Better Detect, Prevent and Manage ADHD. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2020; 13:115-137. [PMID: 32547262 PMCID: PMC7250294 DOI: 10.2147/mder.s241205] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 04/16/2020] [Indexed: 11/23/2022] Open
Abstract
Attention deficit hyperactivity disorder (ADHD) is a chronic heritable developmental delay psychiatric disorder requiring chronic management, characterized by inattention, hyperactivity, hyperkinectivity and impulsivity. Subjective clinical evaluation still remains crucial in its diagnosis. Discussed are two key aspects in the “characterizing ADHD” and on the quest for objective “pathognomonic/endophenotypic diagnostic markers of ADHD”. The first aspect briefly revolves around issues related to identification of pathognomonic/endophenotypic diagnostic markers in ADHD. Issues discussed include changes in ADHD definition, remission/persistence and overlapping-symptoms cum shared-heritability with its co-morbid cross-border mental disorders. The second aspect discussed is neurobiological and EEG-based studies on ADHD. Given the neurobiological and temporal aspects of ADHD symptoms the electroencephalograph (EEG) like NeuralScan by Medeia appears as an appropriate tool. The EEGs appropriateness is further enhanced when coupled with suitable behavior/cognitive/motor/psychological tasks/paradigms yielding EEG-based markers like event-related-potential (ERPs like P3 amplitudes and latency), reaction time variability (RTV), Theta:Beta ratio (TBR) and sensorimotor rhythm (SMR). At present, these markers could potentially help in the neurobiological characterization of ADHD and either help in identifying or lay the groundwork for identifying pathognomonic and/or endophenotypic EEG-based markers enabling its diagnosis, treatment and management.
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Affiliation(s)
- Priya Miranda
- Department of Surgery and Biomedical Engineering, University of California Irvine, Irvine, California, USA
| | - Christopher D Cox
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Michael Alexander
- Department of Surgery and Biomedical Engineering, University of California Irvine, Irvine, California, USA
| | | | - Jonathan R T Lakey
- Department of Surgery and Biomedical Engineering, University of California Irvine, Irvine, California, USA
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22
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Executive and non-executive functions in low birthweight/preterm adolescents with differing temporal patterns of inattention. PLoS One 2020; 15:e0231648. [PMID: 32330149 PMCID: PMC7182186 DOI: 10.1371/journal.pone.0231648] [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] [Received: 07/19/2019] [Accepted: 03/29/2020] [Indexed: 11/19/2022] Open
Abstract
Objective This study assesses whether low birthweight/preterm (LBW/PT) adolescents with persistent inattention (PIA) have neuropsychological deficits that distinguish them from adolescents with school age limited inattention (SAL) and those largely unaffected (UA). Method Three latent classes (PIA, SAL, UA), derived from an earlier analysis of a LBW/PT birth cohort were compared on non-executive and executive functioning measures assessed at age 16. Results The PIA class displayed the poorest performance on executive functioning, which was exaggerated in the context of lower IQ. The PIA and the SAL classes had poorer performance on non-executive functioning relative to the UA class. Both types of functioning mediated the relationship of class to school service use and grade retention. Conclusion Neuropsychological impairment characterizes children and adolescents with inattention problems. Problems in executive functioning characterize the subset whose inattention persists through adolescence. Subsequent research can examine the potential for remediating these deficits to address academic and social problems.
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23
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Roselló B, Berenguer C, Baixauli I, Mira Á, Martinez-Raga J, Miranda A. Empirical examination of executive functioning, ADHD associated behaviors, and functional impairments in adults with persistent ADHD, remittent ADHD, and without ADHD. BMC Psychiatry 2020; 20:134. [PMID: 32204708 PMCID: PMC7092442 DOI: 10.1186/s12888-020-02542-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 03/11/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Previous studies suggest that childhood attention deficit hyperactivity disorder (ADHD) may continue in adulthood, producing adverse effects. Therefore, identifying factors that help to differentiate characteristics of ADHD persistence and remission has practical implications for evaluation and treatment. The first aim of this study was to analyze differences in executive functions (shift, working memory, inhibition, and plan/organize), symptoms associated with ADHD (inattention, hyperactivity, emotional lability, and self-concept), and functional impairments in adults with persistent ADHD (ADHD-P), with remittent ADHD (ADHD-R), and without ADHD (N-ADHD). The second aim was to study the contribution of functional impairments in these three groups based on executive functions and associated ADHD behaviors. METHODS Participants were 115 adults, 61 with a childhood ADHD diagnosis (40 persisters and 21 remitters) and 54 individuals with typical development. Self-reports were collected on executive functions, symptoms associated with ADHD, and functional impairments. Multivariate Analyses of Variance were conducted to test differences between the ADHD-P, ADHD-R, and N-ADHD groups on the evaluated variables. In addition, analyses were performed using two structural equation models with observed variables (path analyses). RESULTS The results indicated that significant executive and behavioral impairments and adverse functional outcomes in different life domains are related to the diagnostic persistence of ADHD. Recovery from the disorder is associated with better results, although hyperactivity/restlessness behaviors and plan/organize deficits continue to be present in remitter individuals. CONCLUSIONS The ADHD-P and ADHD-R groups showed some differences in their executive, behavioral, and functional impairments. Furthermore, the impairments in each group can be predicted by different executive functions and other symptoms associated with the disorder. These results should be taken into account in order to improve clinical practice.
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Affiliation(s)
- Belén Roselló
- grid.5338.d0000 0001 2173 938XDevelopmental and Educational Psychology, University of Valencia, Valencia, Spain
| | - Carmen Berenguer
- grid.5338.d0000 0001 2173 938XDevelopmental and Educational Psychology, University of Valencia, Valencia, Spain
| | - Inmaculada Baixauli
- grid.440831.a0000 0004 1804 6963Catholic University of Valencia S. Vicente Martir, Valencia, Spain
| | - Álvaro Mira
- grid.5338.d0000 0001 2173 938XDevelopmental and Educational Psychology, University of Valencia, Valencia, Spain
| | - Jose Martinez-Raga
- grid.5338.d0000 0001 2173 938XUnidad de Psiquiatría y Psicología Clínica, Hospital Universitario Dr. Peset, University of Valencia, Valencia, Spain
| | - Ana Miranda
- Developmental and Educational Psychology, University of Valencia, Valencia, Spain.
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Arnold LE, Hodgkins P, Kahle J, Madhoo M, Kewley G. Long-Term Outcomes of ADHD: Academic Achievement and Performance. J Atten Disord 2020; 24:73-85. [PMID: 25583985 DOI: 10.1177/1087054714566076] [Citation(s) in RCA: 167] [Impact Index Per Article: 41.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Objective: The aim of this study was to synthesize published data regarding long-term effects of ADHD on information learned (measured via achievement tests) and success within the school environment (academic performance). Method: A systematic search identified 176 studies (1980-2012) of long-term (≥2 years) academic outcomes with ADHD. Results: Achievement test outcomes (79%) and academic performance outcomes (75%) were worse in individuals with untreated ADHD compared with non-ADHD controls, also when IQ difference was controlled (72% and 81%, respectively). Improvement in both outcome groups was associated with treatment, more often for achievement test scores (79%) than academic performance (42%), also when IQ was controlled (100% and 57%, respectively). More achievement test and academic performance outcomes improved with multimodal (100% and 67%, respectively) than pharmacological (75% and 33%) or non-pharmacological (75% and 50%) treatment alone. Conclusion: ADHD adversely affects long-term academic outcomes. A greater proportion of achievement test outcomes improved with treatment compared with academic performance. Both improved most consistently with multimodal treatment.
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Affiliation(s)
| | - Paul Hodgkins
- Global Health Economics & Outcomes Research, Shire, Wayne, PA, USA.,Vertex Pharmaceuticals, Boston, MA, USA
| | | | - Manisha Madhoo
- Behavioural Health Medical Strategy, Shire, Wayne, PA, USA
| | - Geoff Kewley
- Learning Assessment & Neurocare Centre, West Sussex, UK
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25
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Attention Deficit Predicts Intellectual Functioning in Children with Neurofibromatosis Type 1. Int J Pediatr 2019; 2019:9493837. [PMID: 31915440 PMCID: PMC6930769 DOI: 10.1155/2019/9493837] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 07/10/2019] [Accepted: 08/23/2019] [Indexed: 11/18/2022] Open
Abstract
Aims Attention deficit hyperactivity disorder (ADHD) is one of the most frequent neurocognitive impairments in neurofibromatosis type 1 (NF1) and a well-known risk factor for intellectual dysfunction in general. Since NF1 is per se associated with intellectual difficulties, this comorbidity may be crucial for the cognitive development of affected patients. In our study, we investigated if attention deficits are associated with intellectual functioning in NF1 and if children with NF1 plus ADHD differ in their intellectual and attention profiles from children affected by NF1-only or ADHD only. Methods 111 children aged between 6 and 12 years (53 NF1 plus ADHD, 28 NF1-only, 30 ADHD-only) performed the German version of the intelligence test WISC-IV and a continuous performance test (T.O.V.A.) to assess attention functions. Parents completed questionnaires about everyday attention and executive functions (Conners 3®, BRIEF). Results Children with NF1 plus ADHD showed significantly lower intelligence test scores (full-scale IQ: 89.39 [1.40]) than patients with NF1-only (full-scale IQ: 101.14 [1.98]; p < .001), and intellectual functioning correlated significantly with attention performance in NF1 (p < .001). As compared to NF1-only, attention, and executive functioning were impaired on several dimensions (T.O.V.A., Conners 3® and BRIEF) in NF1 plus ADHD. ADHD-only was associated with significantly higher problem scores regarding hyperactivity/impulsivity and inattention (Conners 3®). NF1-only was associated with inattentiveness when compared to the normative sample of the T.O.V.A. Conclusion NF1 is associated with variable attention problems. Severe attention deficits appear to be a risk factor for intellectual dysfunction in NF1, more than NF1 without attention deficit. NF1 plus ADHD presents a specific cognitive profile, which differs from that of NF1 and from neurotypical ADHD.
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26
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Lundervold AJ, Halleland HB, Brevik EJ, Haavik J, Sørensen L. Verbal Memory Function in Intellectually Well-Functioning Adults With ADHD: Relations to Working Memory and Response Inhibition. J Atten Disord 2019; 23:1188-1198. [PMID: 25903587 DOI: 10.1177/1087054715580842] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Objective: To investigate verbal memory function with relation to working memory (WM) and response inhibition (RI) in adults with ADHD. Method: Verbal memory function was assessed by the California Verbal Learning Test-Second Edition (CVLT-II), WM by the Paced Serial Addition Test, and RI by the Color-Word Interference Test from Delis-Kaplan Executive Function System in a sample of adults with normal to high intellectual function (IQ). Results: The ADHD group (n = 74) obtained lower scores than controls on measures of learning, recall, and immediate memory (CVLT-II). WM and RI explained a substantial part of verbal memory performance in both groups. A group to executive function (EF) interaction effect was identified for the total number of intrusions and false positive responses on the CVLT-II recognition trial. Conclusion: Verbal memory performance only partially overlaps with EF in intellectually well-functioning adults with ADHD. Both EF and verbal memory function should be assessed as part of a neuropsychological evaluation of adults with ADHD. (J. of Att. Dis. XXXX; XX(X) XX-XX).
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Affiliation(s)
- Astri J Lundervold
- 1 Department of Biological and Medical Psychology, University of Bergen, Norway.,2 K. G. Jebsen Center for Research on Neuropsychiatric Disorders, University of Bergen, Norway
| | - Helene Barone Halleland
- 1 Department of Biological and Medical Psychology, University of Bergen, Norway.,2 K. G. Jebsen Center for Research on Neuropsychiatric Disorders, University of Bergen, Norway.,3 Department of Child and Adolescent Psychiatry, Hukeland University Hospital, Bergen, Norway
| | | | - Jan Haavik
- 4 Department of Biomedicine, University of Bergen, Norway.,5 Department of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Lin Sørensen
- 1 Department of Biological and Medical Psychology, University of Bergen, Norway
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Michelini G, Jurgiel J, Bakolis I, Cheung CHM, Asherson P, Loo SK, Kuntsi J, Mohammad-Rezazadeh I. Atypical functional connectivity in adolescents and adults with persistent and remitted ADHD during a cognitive control task. Transl Psychiatry 2019; 9:137. [PMID: 30979865 PMCID: PMC6461684 DOI: 10.1038/s41398-019-0469-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 01/10/2019] [Accepted: 03/23/2019] [Indexed: 12/12/2022] Open
Abstract
We previously provided initial evidence for cognitive and event-related potential markers of persistence/remission of attention-deficit/hyperactivity disorder (ADHD) from childhood to adolescence and adulthood. Here, using a novel brain-network connectivity approach, we aimed to examine whether task-based functional connectivity reflects a marker of ADHD remission or an enduring deficit unrelated to ADHD outcome. High-density EEG was recorded in a follow-up of 110 adolescents and young adults with childhood ADHD (87 persisters, 23 remitters) and 169 typically developing individuals during an arrow-flanker task, eliciting cognitive control. Functional connectivity was quantified with network-based graph-theory metrics before incongruent (high-conflict) target onset (pre-stimulus), during target processing (post-stimulus) and in the degree of change between pre-stimulus/post-stimulus. ADHD outcome was examined with parent-reported symptoms and impairment using both a categorical (DSM-IV) and a dimensional approach. Graph-theory measures converged in indicating that, compared to controls, ADHD persisters showed increased connectivity in pre-stimulus theta, alpha, and beta and in post-stimulus beta (all p < .01) and reduced pre-stimulus/post-stimulus change in theta connectivity (p < .01). In the majority of indices showing ADHD persister-control differences, ADHD remitters differed from controls (all p < .05) but not from persisters. Similarly, connectivity measures were unrelated to continuous outcome measures of ADHD symptoms and impairment in participants with childhood ADHD. These findings indicate that adolescents and young adults with persistent and remitted ADHD share atypical over-connectivity profiles and reduced ability to modulate connectivity patterns with task demands, compared to controls. Task-based functional connectivity impairments may represent enduring deficits in individuals with childhood ADHD irrespective of diagnostic status in adolescence/young adulthood.
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Affiliation(s)
- Giorgia Michelini
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
- Department of Psychiatry and Behavioral Health, State University New York (SUNY) Stony Brook University, Stony Brook, NY, USA.
| | - Joseph Jurgiel
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Ioannis Bakolis
- Department of Biostatistics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Celeste H M Cheung
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Philip Asherson
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Sandra K Loo
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Jonna Kuntsi
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Iman Mohammad-Rezazadeh
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
- HRL Laboratories, Malibu, CA, USA
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28
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Franke B, Michelini G, Asherson P, Banaschewski T, Bilbow A, Buitelaar JK, Cormand B, Faraone SV, Ginsberg Y, Haavik J, Kuntsi J, Larsson H, Lesch KP, Ramos-Quiroga JA, Réthelyi JM, Ribases M, Reif A. Live fast, die young? A review on the developmental trajectories of ADHD across the lifespan. Eur Neuropsychopharmacol 2018; 28:1059-1088. [PMID: 30195575 PMCID: PMC6379245 DOI: 10.1016/j.euroneuro.2018.08.001] [Citation(s) in RCA: 321] [Impact Index Per Article: 53.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 06/25/2018] [Accepted: 08/07/2018] [Indexed: 02/07/2023]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is highly heritable and the most common neurodevelopmental disorder in childhood. In recent decades, it has been appreciated that in a substantial number of cases the disorder does not remit in puberty, but persists into adulthood. Both in childhood and adulthood, ADHD is characterised by substantial comorbidity including substance use, depression, anxiety, and accidents. However, course and symptoms of the disorder and the comorbidities may fluctuate and change over time, and even age of onset in childhood has recently been questioned. Available evidence to date is poor and largely inconsistent with regard to the predictors of persistence versus remittance. Likewise, the development of comorbid disorders cannot be foreseen early on, hampering preventive measures. These facts call for a lifespan perspective on ADHD from childhood to old age. In this selective review, we summarise current knowledge of the long-term course of ADHD, with an emphasis on clinical symptom and cognitive trajectories, treatment effects over the lifespan, and the development of comorbidities. Also, we summarise current knowledge and important unresolved issues on biological factors underlying different ADHD trajectories. We conclude that a severe lack of knowledge on lifespan aspects in ADHD still exists for nearly every aspect reviewed. We encourage large-scale research efforts to overcome those knowledge gaps through appropriately granular longitudinal studies.
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Affiliation(s)
- 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.
| | - Giorgia Michelini
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, Social, Genetic & Developmental Psychiatry Centre, London, UK
| | - Philip Asherson
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, Social, Genetic & Developmental Psychiatry Centre, London, UK
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Andrea Bilbow
- Attention Deficit Disorder Information and Support Service (ADDISS), Edgware, UK; ADHD-Europe, Brussels, Belgium
| | - Jan K Buitelaar
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Cognitive Neuroscience, Nijmegen, The Netherlands
| | - Bru Cormand
- Department of Genetics, Microbiology and Statistics, Faculty of Biology, Universitat de Barcelona, Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, Spain; Institut de Biomedicina de la Universitat de Barcelona (IBUB), Barcelona, Catalonia, Spain; Institut de Recerca Sant Joan de Déu (IR-SJD), Esplugues de Llobregat, Catalonia, Spain
| | - Stephen V Faraone
- Departments of Psychiatry and of Neuroscience and Physiology, State University of New York Upstate Medical University, New York, USA; K.G. Jebsen Centre for Neuropsychiatric Disorders, Department of Biomedicine, University of Bergen, Bergen, Norway
| | - Ylva Ginsberg
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
| | - Jan Haavik
- K.G. Jebsen Centre for Neuropsychiatric Disorders, Department of Biomedicine, University of Bergen, Bergen, Norway; Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Jonna Kuntsi
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, Social, Genetic & Developmental Psychiatry Centre, London, UK
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
| | - Klaus-Peter Lesch
- Division of Molecular Psychiatry, Center of Mental Health, University of Würzburg, Würzburg, Germany; Laboratory of Psychiatric Neurobiology, Institute of Molecular Medicine, I.M. Sechenov First Moscow State Medical University, Moscow, Russia; Department of Translational Neuroscience, School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, The Netherlands
| | - J Antoni Ramos-Quiroga
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain; Psychiatric Genetics Unit, Vall d'Hebron Research Institute (VHIR), Barcelona, Catalonia, Spain; Biomedical Network Research Centre on Mental Health (CIBERSAM), Barcelona, Catalonia, Spain; Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - János M Réthelyi
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary; MTA-SE NAP-B Molecular Psychiatry Research Group, Hungarian Academy of Sciences, Budapest, Hungary
| | - Marta Ribases
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain; Psychiatric Genetics Unit, Vall d'Hebron Research Institute (VHIR), Barcelona, Catalonia, Spain; Biomedical Network Research Centre on Mental Health (CIBERSAM), Barcelona, Catalonia, Spain
| | - Andreas Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Frankfurt am Main, Germany
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Sudre G, Mangalmurti A, Shaw P. Growing out of attention deficit hyperactivity disorder: Insights from the 'remitted' brain. Neurosci Biobehav Rev 2018; 94:198-209. [PMID: 30194962 DOI: 10.1016/j.neubiorev.2018.08.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 08/14/2018] [Accepted: 08/16/2018] [Indexed: 12/14/2022]
Abstract
We consider developmental and cognitive models to explain why some children 'grow out' of attention deficit hyperactivity disorder (ADHD) by adulthood. The first model views remission as a convergence towards more typical brain function and structure. In support, some studies find that adult remitters are indistinguishable from those who were never affected in the neural substrates of 'top-down' mechanisms of cognitive control, some 'bottom-up' processes of vigilance/response preparation, prefrontal cortical morphology and intrinsic functional connectivity. A second model postulates that remission is driven by the recruitment of new brain systems that compensate for ADHD symptoms. It draws support from demonstrations of atypical, but possibly beneficial, patterns of connectivity within the cognitive control network in adult remitters. The final model holds that some childhood ADHD anomalies show lifelong persistence, regardless of adult outcome, supported by shared reports of anomalies in remitters and persisters in posterior cerebral and striato-thalamic regions. The models are compatible: different processes driving remission might occur in different brain regions. These models provide a framework for future studies which might inform novel treatments to 'accelerate' remission.
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Affiliation(s)
- Gustavo Sudre
- Neurobehavioral Clinical Research Section, Social and Behavioral Research Branch, National Human Genome Research Institute, and The National Institute of Mental Health, NIH, United States
| | - Aman Mangalmurti
- Neurobehavioral Clinical Research Section, Social and Behavioral Research Branch, National Human Genome Research Institute, and The National Institute of Mental Health, NIH, United States
| | - Philip Shaw
- Neurobehavioral Clinical Research Section, Social and Behavioral Research Branch, National Human Genome Research Institute, and The National Institute of Mental Health, NIH, United States.
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Bozhilova NS, Michelini G, Kuntsi J, Asherson P. Mind wandering perspective on attention-deficit/hyperactivity disorder. Neurosci Biobehav Rev 2018; 92:464-476. [PMID: 30036553 PMCID: PMC6525148 DOI: 10.1016/j.neubiorev.2018.07.010] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 06/19/2018] [Accepted: 07/19/2018] [Indexed: 11/29/2022]
Abstract
Attention-Deficit/Hyperactivity Disorder (ADHD) is a common neurodevelopmental disorder associated with a range of mental health, neurocognitive and functional problems. Although the diagnosis is based on descriptions of behaviour, individuals with ADHD characteristically describe excessive spontaneous mind wandering (MW). MW in individuals with ADHD reflects constant mental activity which lacks topic stability and content consistency. Based on this review of the neural correlates of ADHD and MW, we outline a new perspective on ADHD: the MW hypothesis. We propose that altered deactivation of the default mode network, and dysfunctional interaction with the executive control network, leads to excessive and spontaneous MW, which underpins symptoms and impairments of ADHD. We highlight that processes linked to the normal neural regulation of MW (context regulation, sensory decoupling, salience thresholds) are deficient in ADHD. MW-related measures could serve as markers of the disease process, as MW can be experimentally manipulated, as well as measured using rating scales, and experience sampling during both cognitive tasks and daily life. MW may therefore be a potential endophenotype.
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Affiliation(s)
- Natali S Bozhilova
- King's College London, Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, Denmark Hill, De Crespigny Park, SE5 8AF, United Kingdom.
| | - Giorgia Michelini
- King's College London, Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, Denmark Hill, De Crespigny Park, SE5 8AF, United Kingdom
| | - Jonna Kuntsi
- King's College London, Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, Denmark Hill, De Crespigny Park, SE5 8AF, United Kingdom
| | - Philip Asherson
- King's College London, Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, Denmark Hill, De Crespigny Park, SE5 8AF, United Kingdom.
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31
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Uchida M, Spencer TJ, Faraone SV, Biederman J. Adult Outcome of ADHD: An Overview of Results From the MGH Longitudinal Family Studies of Pediatrically and Psychiatrically Referred Youth With and Without ADHD of Both Sexes. J Atten Disord 2018; 22:523-534. [PMID: 26396145 DOI: 10.1177/1087054715604360] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE We aimed to provide an overview of the Massachusetts General Hospital (MGH) Longitudinal Studies of ADHD. METHODS We evaluated and followed samples of boys and girls with and without ADHD ascertained from psychiatric and pediatric sources and their families. RESULTS These studies documented that ADHD in both sexes is associated with high levels of persistence into adulthood, high levels of familiality with ADHD and other psychiatric disorders, a wide range of comorbid psychiatric and cognitive disorders including mood, anxiety, and substance use disorders, learning disabilities, executive function deficits, emotional dysregulation, and autistic traits as well as functional impairments. The MGH studies suggested that stimulant treatment decreased risks of developing comorbid psychiatric disorders, substance use disorders, and functional outcomes. The MGH studies documented the neural basis of persistence of ADHD using neuroimaging. CONCLUSION The MGH studies provided various insights on symptoms, course, functions, comorbidities, and neuroscience of ADHD.
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Affiliation(s)
- Mai Uchida
- 1 Massachusetts General Hospital, Boston, USA.,2 Harvard Medical School, Boston, MA, USA
| | - Thomas J Spencer
- 1 Massachusetts General Hospital, Boston, USA.,2 Harvard Medical School, Boston, MA, USA
| | - Stephen V Faraone
- 3 SUNY Upstate Medical University, Syracuse, USA.,4 University of Bergen, Norway
| | - Joseph Biederman
- 1 Massachusetts General Hospital, Boston, USA.,2 Harvard Medical School, Boston, MA, USA
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Abstract
OBJECTIVES Amphetamine improves vigilance as assessed by continuous performance tests (CPT) in children and adults with attention deficit hyperactivity disorder (ADHD). Less is known, however, regarding amphetamine effects on vigilance in healthy adults. Thus, it remains unclear whether amphetamine produces general enhancement of vigilance or if these effects are constrained to the remediation of deficits in patients with ADHD. METHODS We tested 69 healthy adults (35 female) on a standardized CPT (Conner's CPT-2) after receiving 10- or 20-mg d-amphetamine or placebo. To evaluate potential effects on learning, impulsivity, and perseveration, participants were additionally tested on the Iowa Gambling Task (IGT) and Wisconsin Card Sorting Task (WCST). RESULTS Participants receiving placebo exhibited the classic vigilance decrement, demonstrated by a significant reduction in attention (D') across the task. This vigilance decrement was not observed, however, after either dose of amphetamine. Consistent with enhanced vigilance, the 20-mg dose also reduced reaction time variability across the task and the ADHD confidence index. The effects of amphetamine appeared to be selective to vigilance since no effects were observed on the IGT, WCST, or response inhibition/perseveration measures from the CPT. CONCLUSIONS The present data support the premise that amphetamine improves vigilance irrespective of disease state. Given that amphetamine is a norepinephrine/dopamine transporter inhibitor and releaser, these effects are informative regarding the neurobiological substrates of attentional control. (JINS, 2018, 24, 283-293).
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Abstract
Although a broad array of neurocognitive dysfunctions are associated with ADHD, it is unknown whether these dysfunctions play a role in the course of ADHD symptoms. The present longitudinal study investigated whether neurocognitive functions assessed at study-entry (mean age = 11.5 years, SD = 2.7) predicted ADHD symptom severity and overall functioning 6 years later (mean age = 17.4 years, 82.6 % = male) in a carefully phenotyped large sample of 226 Caucasian participants from 182 families diagnosed with ADHD-combined type. Outcome measures were dimensional measures of ADHD symptom severity and the Kiddie-Global Assessment Scale (K-GAS) for overall functioning. Predictors were derived from component scores for 8 domains of neurocognitive functioning: working memory, motor inhibition, cognitive inhibition, reaction time variability, timing, information processing speed, motor control, intelligence. Effects of age, gender, and pharmacological treatment were considered. Results showed that better working memory predicted lower ADHD symptom severity (R2 = 3.0 %), and less reaction time variability predicted better overall functioning (higher K-GAS-score, R2 = 5.6 %). Predictors were still significant with baseline behavior included in the models. The role of neurocognitive functioning in the long term outcome of ADHD behavior is discussed.
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Pathways from Birth Weight to ADHD Symptoms through Fluid Reasoning in Youth with or without Intellectual Disability. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2017; 46:729-739. [PMID: 28819875 DOI: 10.1007/s10802-017-0341-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Although individual differences in fluid reasoning reliably mediate predictions of attention-deficit/hyperactivity disorder (ADHD) symptoms from birth weight in youth with typical cognitive development (TD), it is unknown if this indirect effect operates similarly in the development of ADHD symptoms secondary to intellectual disability (ID). Thus, we evaluated mediation by fluid reasoning in a longitudinal sample of 163 youth (45% female) with (n = 52) or without (n = 111) ID who were followed prospectively from age 5 to age 13. At age 9, youth completed the Arithmetic subtest of the Wechsler Intelligence Scale for Children, a measure of fluid reasoning. At ages 9 and 13, mothers and teachers separately rated youth ADHD symptoms and mothers completed a diagnostic interview. Mediation was tested via path analysis with bootstrapped confidence intervals, and moderated mediation estimated whether indirect effects differed between ID and TD youth or based on youth IQ. Controlling for demographic factors and age 9 ADHD symptoms, age 9 Arithmetic mediated birth weight and multi-method/informant age 13 ADHD symptoms, such that birth weight positively predicted Arithmetic, which negatively predicted ADHD symptoms. Neither ID status nor IQ moderated the observed indirect effect through Arithmetic, suggesting that it was similar for ID and TD youth as well as across the range of youth IQs. These findings support previous evidence that fluid reasoning, as measured by Arithmetic, may causally mediate birth weight and ADHD symptoms, and suggest that this pathway operates similarly with respect to the development of ADHD symptoms in youth with ID.
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Karalunas SL, Gustafsson HC, Dieckmann NF, Tipsord J, Mitchell SH, Nigg JT. Heterogeneity in development of aspects of working memory predicts longitudinal attention deficit hyperactivity disorder symptom change. JOURNAL OF ABNORMAL PSYCHOLOGY 2017; 126:774-792. [PMID: 28782975 PMCID: PMC5657320 DOI: 10.1037/abn0000292] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The role of cognitive mechanisms in the clinical course of neurodevelopmental disorders is poorly understood. Attention Deficit Hyperactivity Disorder (ADHD) is emblematic in that numerous alterations in cognitive development are apparent, yet how they relate to changes in symptom expression with age is unclear. To resolve the role of cognitive mechanisms in ADHD, a developmental perspective that takes into account expected within-group heterogeneity is needed. METHOD The current study uses an accelerated longitudinal design and latent trajectory growth mixture models in a sample of children ages 7-13 years carefully characterized as with (n = 437) and without (n = 297) ADHD to (a) identify heterogeneous developmental trajectories for response inhibition, visual spatial working memory maintenance, and delayed reward discounting and (b) to assess the relationships between these cognitive trajectories and ADHD symptom change. RESULTS Best-fitting models indicated multiple trajectory classes in both the ADHD and typically developing samples, as well as distinct relationships between each cognitive process and ADHD symptom change. Developmental change in response inhibition and delayed reward discounting were unrelated to ADHD symptom change, while individual differences in the rate of visual spatial working memory maintenance improvement predicted symptom remission in ADHD. CONCLUSION Characterizing heterogeneity in cognitive development will be crucial for clarifying mechanisms of symptom persistence and recovery. Results here suggest working memory maintenance may be uniquely related to ADHD symptom improvement. (PsycINFO Database Record
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Affiliation(s)
- Sarah L. Karalunas
- Oregon Health & Sciences University, Department of Psychiatry
- Oregon Health & Sciences University, Department of Beahvioral Neuroscience
| | | | | | - Jessica Tipsord
- Oregon Health & Sciences University, Department of Psychiatry
| | - Suzanne H. Mitchell
- Oregon Health & Sciences University, Department of Psychiatry
- Oregon Health & Sciences University, Department of Beahvioral Neuroscience
- Oregon Institute of Occupational Health Science
| | - Joel T. Nigg
- Oregon Health & Sciences University, Department of Psychiatry
- Oregon Health & Sciences University, Department of Beahvioral Neuroscience
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Morgan JE, Caplan B, Tung I, Noroña AN, Baker BL, Lee SS. COMT and DAT1 polymorphisms moderate the indirect effect of parenting behavior on youth ADHD symptoms through neurocognitive functioning. Child Neuropsychol 2017; 24:823-843. [PMID: 28675949 DOI: 10.1080/09297049.2017.1346067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Although gene × environment interactions contribute to youth attention-deficit/hyperactivity disorder (ADHD) symptoms, the pathways mediating these influences are unknown. We tested genetic moderation of indirect effects from parenting behavior to youth ADHD symptoms through multiple neurocognitive factors. Two hundred and twenty-nine youth with and without ADHD were assessed at baseline (Wave 1; ages 5-10) and at a 2-year follow-up (Wave 2; ages 7-13). At Wave 1, youth completed a neurocognitive battery including measures of response inhibition, visuospatial working memory, and fluid reasoning, and a standardized parent-child interaction task yielding observational measures of positive and negative parenting. At Wave 2, youth psychopathology was rated by parents and teachers using multiple methods (i.e., structured interview, rating scale). We employed moderated multiple mediation and compared conditional indirect effects across youth genotypes at two biologically plausible genetic loci. Controlling for parent ADHD symptoms as well as youth demographic factors and co-occurring externalizing symptoms, these genetic factors moderated the indirect effect from Wave 1 parenting to multi-method/informant Wave 2 ADHD symptoms through Wave 1 neurocognitive functioning. This preliminary study is the first to identify genetic moderation of mediated effects underlying ADHD symptoms and suggests that specific gene × parenting interactions may underlie neurocognitive functioning deficits and subsequent ADHD.
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Affiliation(s)
- Julia E Morgan
- a Department of Psychology , UCLA , Los Angeles , CA , USA
| | - Barbara Caplan
- a Department of Psychology , UCLA , Los Angeles , CA , USA
| | - Irene Tung
- a Department of Psychology , UCLA , Los Angeles , CA , USA
| | | | - Bruce L Baker
- a Department of Psychology , UCLA , Los Angeles , CA , USA
| | - Steve S Lee
- a Department of Psychology , UCLA , Los Angeles , CA , USA
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Wilbertz G, Delgado MR, Tebartz Van Elst L, Maier S, Philipsen A, Blechert J. Neural response during anticipation of monetary loss is elevated in adult attention deficit hyperactivity disorder. World J Biol Psychiatry 2017; 18:268-278. [PMID: 26508322 DOI: 10.3109/15622975.2015.1112032] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVES Risky behaviour seriously impacts the life of adult patients with attention deficit hyperactivity disorder (ADHD). Such behaviours have often been attributed to their exaggerated reward seeking, but dysfunctional anticipation of negative outcomes might also play a role. METHODS The present study compared adult patients with ADHD (n = 28) with matched healthy controls (n = 28) during anticipation of monetary losses versus gains while undergoing functional magnetic resonance imaging (fMRI) and skin conductance recording. RESULTS Skin conductance was higher during anticipation of losses compared to gains in both groups. Affective ratings of predictive cues did not differ between groups. ADHD patients showed increased activity in bilateral amygdalae, left anterior insula (region of interest analysis) and left temporal pole (whole brain analysis) compared to healthy controls during loss versus gain anticipation. In the ADHD group higher insula and temporal pole activations went along with more negative affective ratings. CONCLUSIONS Neural correlates of loss anticipation are not blunted but rather increased in ADHD, possibly due to a life history of repeated failures and the respective environmental sanctions. Behavioural adaptations to such losses, however, might differentiate them from controls: future research should study whether negative affect might drive more risk seeking than risk avoidance.
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Affiliation(s)
- Gregor Wilbertz
- a Department of Psychology , University of Freiburg , Freiburg , Germany.,b Department of Psychiatry and Psychotherapy, Section for Experimental Neuropsychiatry , University Medical Centre Freiburg , Freiburg , Germany.,c Department of Psychiatry and Psychotherapy , Charité - Universitätsmedizin Berlin , Berlin , Germany
| | - Mauricio R Delgado
- d Department of Psychology , Rutgers University , Newark , NJ 07102 , USA
| | - Ludger Tebartz Van Elst
- b Department of Psychiatry and Psychotherapy, Section for Experimental Neuropsychiatry , University Medical Centre Freiburg , Freiburg , Germany
| | - Simon Maier
- b Department of Psychiatry and Psychotherapy, Section for Experimental Neuropsychiatry , University Medical Centre Freiburg , Freiburg , Germany
| | - Alexandra Philipsen
- b Department of Psychiatry and Psychotherapy, Section for Experimental Neuropsychiatry , University Medical Centre Freiburg , Freiburg , Germany.,e Medical Campus University of Oldenburg, School of Medicine and Health Sciences , Psychiatry and Psychotherapy - University Hospital , Karl-Jaspers-Klinik, Bad Zwischenahn , Germany
| | - Jens Blechert
- f Center for Cognitive Neuroscience, University of Salzburg , Salzburg , Austria.,g Department of Psychology, University of Salzburg , Salzburg , Austria
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Skogli EW, Andersen PN, Hovik KT, Øie M. Development of Hot and Cold Executive Function in Boys and Girls With ADHD. J Atten Disord 2017; 21:305-315. [PMID: 24626329 DOI: 10.1177/1087054714524984] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To investigate the development of executive function with pronounced emotional salience (hot EF) and less pronounced emotional salience (cold EF) in boys and girls with ADHD relative to typically developing (TD) children. METHOD Seventy-five children with ADHD and 47 TD children were assessed with hot and cold EF tests at baseline and after 2 years. RESULTS Despite considerable maturation, the ADHD group remained impaired on all cold EF tests relative to TD children after 2 years. There was no effect of gender on cold EF test results. Females with ADHD outperformed TD counterparts on hot EF at baseline. Females with ADHD showed deteriorating hot EF performance, while TD counterparts showed improved hot EF performance across time. CONCLUSION Enduring cold EF impairments after 2 years may reflect stable phenotypic traits in children with ADHD. Results indicate divergent developmental trajectories of hot EF in girls with ADHD relative to TD counterparts.
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Affiliation(s)
- Erik Winther Skogli
- 1 Innlandet Hospital Trust, Lillehammer, Norway.,2 University of Oslo, Norway
| | | | - Kjell Tore Hovik
- 1 Innlandet Hospital Trust, Lillehammer, Norway.,2 University of Oslo, Norway
| | - Merete Øie
- 1 Innlandet Hospital Trust, Lillehammer, Norway.,2 University of Oslo, Norway
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Michelini G, Kitsune GL, Cheung CHM, Brandeis D, Banaschewski T, Asherson P, McLoughlin G, Kuntsi J. Attention-Deficit/Hyperactivity Disorder Remission Is Linked to Better Neurophysiological Error Detection and Attention-Vigilance Processes. Biol Psychiatry 2016; 80:923-932. [PMID: 27591125 PMCID: PMC5120985 DOI: 10.1016/j.biopsych.2016.06.021] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 06/21/2016] [Accepted: 06/21/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND The processes underlying persistence and remission of attention-deficit/hyperactivity disorder (ADHD) are poorly understood. We examined whether cognitive and neurophysiological impairments on a performance-monitoring task distinguish between ADHD persisters and remitters. METHODS On average 6 years after initial assessment, 110 adolescents and young adults with childhood ADHD (87 persisters, 23 remitters) and 169 age-matched control participants were compared on cognitive-performance measures and event-related potentials of conflict monitoring (N2) and error processing (error-related negativity and positivity) from an arrow flanker task with low-conflict and high-conflict conditions. ADHD outcome was examined with parent-reported symptoms and functional impairment measures using a categorical (DSM-IV) and a dimensional approach. RESULTS ADHD persisters were impaired compared with controls on all cognitive-performance and event-related potential measures (all p < .05). ADHD remitters differed from persisters and were indistinguishable from control participants on the number of congruent (low-conflict) errors, reaction time variability, error-related negativity, and error-related positivity (all p ≤ .05). Remitters did not differ significantly from the other groups on incongruent (high-conflict) errors, mean reaction time, and N2. In dimensional analyses on all participants with childhood ADHD, ADHD symptoms and functional impairment at follow-up were significantly correlated with congruent errors, reaction time variability, and error-related positivity (r = .19-.23, p ≤ .05). CONCLUSIONS Cognitive and neurophysiological measures of attention-vigilance and error detection distinguished ADHD remitters from persisters. These results extend our previous findings with other tasks and indicate that such measures are markers of remission and candidates for the development of nonpharmacological interventions.
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Affiliation(s)
- Giorgia Michelini
- MRC Social, Genetic and Developmental Psychiatry Centre, London, United Kingdom
| | - Glenn L Kitsune
- MRC Social, Genetic and Developmental Psychiatry Centre, London, United Kingdom; Department of Psychological Medicine, London, United Kingdom
| | - Celeste H M Cheung
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; Department of Psychological Sciences, Centre for Brain and Cognitive Development, Birkbeck, University of London, London, United Kingdom
| | - 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, Zurich, Switzerland; Center for Integrative Human Physiology, Zurich, Switzerland; Neuroscience Center Zurich, University of Zurich, Zurich, Switzerland
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy , Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Philip Asherson
- MRC Social, Genetic and Developmental Psychiatry Centre, London, United Kingdom
| | - Gráinne McLoughlin
- MRC Social, Genetic and Developmental Psychiatry Centre, London, United Kingdom
| | - Jonna Kuntsi
- MRC Social, Genetic and Developmental Psychiatry Centre, London, United Kingdom.
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40
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Qian Y, Chang W, He X, Yang L, Liu L, Ma Q, Li Y, Sun L, Qian Q, Wang Y. Emotional dysregulation of ADHD in childhood predicts poor early-adulthood outcomes: A prospective follow up study. RESEARCH IN DEVELOPMENTAL DISABILITIES 2016; 59:428-436. [PMID: 27744214 DOI: 10.1016/j.ridd.2016.09.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Revised: 07/28/2016] [Accepted: 09/30/2016] [Indexed: 05/23/2023]
Abstract
BACKGROUD Emotional dysregulation (EDR) is commonly seen in individuals with attention deficit hyperactive disorder (ADHD). But few are known about the influence of EDR on early-adulthood outcomes. AIMS To detect the relationship between emotional dysregulation (EDR) in childhood and the outcomes in early-adulthood of participants with attention deficit hyperactive disorder (ADHD). METHODS AND PROCEDURES Han Chinese children who met DSM-IV ADHD criteria were followed up into early adulthood. The subjects were divided into two groups (with or without EDR) according to the emotion control subscale of Behavior Rating Scale of Executive Function in childhood. In the follow-up interview, their clinical outcomes were assessed by the Conner's Adult ADHD Diagnostic Interview and the Structured Clinical Interview for DSM-IV-TR Axis I and II Disorders. Information on after-school tutoring and suspension of schooling was also collected as indices of educational outcomes. OUTCOMES AND RESULTS We followed up 68 out of 90 individuals when they reached early adulthood. Data analysis showed that EDR predicted HI symptoms of ADHD both in childhood (OR=10.28, p<0.01) and in early-adulthood (OR=4.07, p=0.01). And EDR in childhood had trend to predicted adult ODD (X2=3.93, p=0.05). The suspension of schooling was also predicted by EDR (OR=9.31, p=0.04). CONCLUSIONS AND IMPLICATIONS This study illustrated that EDR of children with ADHD, independent of co-occurring ODD, predicted poor long-term clinical and educational outcome in early-adulthood.
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Affiliation(s)
- Ying Qian
- Institute of Mental Health, Sixth Hospital, Peking University, Beijing, China; Key laboratory of Ministry of Health (Peking University), Beijing, China
| | - WeiLi Chang
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiaoxiao He
- Institute of Mental Health, Sixth Hospital, Peking University, Beijing, China; Key laboratory of Ministry of Health (Peking University), Beijing, China
| | - Li Yang
- Institute of Mental Health, Sixth Hospital, Peking University, Beijing, China; Key laboratory of Ministry of Health (Peking University), Beijing, China
| | - Lu Liu
- Institute of Mental Health, Sixth Hospital, Peking University, Beijing, China; Key laboratory of Ministry of Health (Peking University), Beijing, China
| | - Quangang Ma
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yueling Li
- Institute of Mental Health, Sixth Hospital, Peking University, Beijing, China; Key laboratory of Ministry of Health (Peking University), Beijing, China
| | - Li Sun
- Institute of Mental Health, Sixth Hospital, Peking University, Beijing, China; Key laboratory of Ministry of Health (Peking University), Beijing, China
| | - Qiujin Qian
- Institute of Mental Health, Sixth Hospital, Peking University, Beijing, China; Key laboratory of Ministry of Health (Peking University), Beijing, China.
| | - Yufeng Wang
- Institute of Mental Health, Sixth Hospital, Peking University, Beijing, China; Key laboratory of Ministry of Health (Peking University), Beijing, China.
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Hartman CA, Geurts HM, Franke B, Buitelaar JK, Rommelse NNJ. Changing ASD-ADHD symptom co-occurrence across the lifespan with adolescence as crucial time window: Illustrating the need to go beyond childhood. Neurosci Biobehav Rev 2016; 71:529-541. [PMID: 27629802 DOI: 10.1016/j.neubiorev.2016.09.003] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 07/29/2016] [Accepted: 09/04/2016] [Indexed: 10/21/2022]
Abstract
Literature on the co-occurrence between Autism Spectrum Disorder (ASD) and Attention-Deficit/Hyperactivity Disorder (ADHD) is strongly biased by a focus on childhood age. A review of the adolescent and adult literature was made on core and related symptoms of ADHD and ASD. In addition, an empirical approach was used including 17,173 ASD-ADHD symptom ratings from participants aged 0 to 84 years. Results indicate that ASD/ADHD constellations peak during adolescence and are lower in early childhood and old age. We hypothesize that on the border of the expected transition to independent adulthood, ASD and ADHD co-occur most because social adaptation and EF skills matter most. Lower correlations in childhood and older age may be due to more diffuse symptoms reflecting respectively still differentiating and de-differentiating EF functions. We plea for a strong research focus in adolescence which may -after early childhood- be a second crucial time window for catching-up pattern explaining more optimal outcomes. We discuss obstacles and oppportunities of a full lifespan approach into old age.
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Affiliation(s)
- Catharina A Hartman
- Department of Psychiatry, Interdisciplinary Center of Psychopathology and Emotion Regulation (ICPE) & Research School of Behavioral and Cognitive Neuroscience, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Hilde M Geurts
- Department of Psychology, Brain and Cognition, d'Arc, & Cognitive Science Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands; Dr Leo Kannerhuis, Autism Clinic, Amsterdam, The Netherlands
| | - Barbara Franke
- Department of Psychiatry, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Human Genetics, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jan K Buitelaar
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands; Karakter, Child and Adolescent Psychiatry University Center, Nijmegen, The Netherlands
| | - Nanda N J Rommelse
- Department of Psychiatry, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands; Karakter, Child and Adolescent Psychiatry University Center, Nijmegen, The Netherlands
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Svatkova A, Nestrasil I, Rudser K, Goldenring Fine J, Bledsoe J, Semrud‐Clikeman M. Unique white matter microstructural patterns in ADHD presentations-a diffusion tensor imaging study. Hum Brain Mapp 2016; 37:3323-36. [PMID: 27159198 PMCID: PMC5663221 DOI: 10.1002/hbm.23243] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 03/31/2016] [Accepted: 04/22/2016] [Indexed: 01/08/2023] Open
Abstract
Attention-deficit/hyperactivity disorder predominantly inattentive (ADHD-PI) and combined (ADHD-C) presentations are likely distinct disorders that differ neuroanatomically, neurochemically, and neuropsychologically. However, to date, little is known about specific white matter (WM) regions differentiating ADHD presentations. This study examined differences in WM microstructure using diffusion tensor imaging (DTI) data from 20 ADHD-PI, 18 ADHD-C, and 27 typically developed children. Voxel-wise analysis of DTI measurements in major fiber bundles was carried out using tract-based spatial statistics (TBSS). Clusters showing diffusivity abnormalities were used as regions of interest for regression analysis between fractional anisotropy (FA) and neuropsychological outcomes. Compared to neurotypicals, ADHD-PI children showed higher FA in the anterior thalamic radiations (ATR), bilateral inferior longitudinal fasciculus (ILF), and in the left corticospinal tract (CST). In contrast, the ADHD-C group exhibited higher FA in the bilateral cingulum bundle (CB). In the ADHD-PI group, differences in FA in the left ILF and ATR were accompanied by axial diffusivity (AD) abnormalities. In addition, the ADHD-PI group exhibited atypical mean diffusivity in the forceps minor (FMi) and left ATR and AD differences in right CB compared to healthy subjects. Direct comparison between ADHD presentations demonstrated radial diffusivity differences in FMi. WM clusters with FA irregularities in ADHD were associated with neurobehavioral performance across groups. In conclusion, differences in WM microstructure in ADHD presentations strengthen the theory that ADHD-PI and ADHD-C are two distinct disorders. Regions with WM irregularity seen in both ADHD presentations might serve as predictors of executive and behavioral functioning across groups. Hum Brain Mapp 37:3323-3336, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Alena Svatkova
- Department of PediatricsUniversity of MinnesotaMinneapolisMinnesota
- Multimodal and Functional Neuroimaging Research GroupCEITEC—Central European Institute of Technology, Masaryk UniversityBrnoCzech Republic
| | - Igor Nestrasil
- Department of PediatricsUniversity of MinnesotaMinneapolisMinnesota
| | - Kyle Rudser
- Division of BiostatisticsUniversity of MinnesotaMinneapolisMinnesota
| | - Jodene Goldenring Fine
- Department of Counseling, Educational Psychology, and Special EducationMichigan State UniversityEast LansingMichigan
| | - Jesse Bledsoe
- Department of Psychiatry and Behavioral SciencesUniversity of Washington School of MedicineSeattleWashington
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Lundwall RA, Rasmussen CG. MAOA Influences the Trajectory of Attentional Development. Front Hum Neurosci 2016; 10:424. [PMID: 27610078 PMCID: PMC4996824 DOI: 10.3389/fnhum.2016.00424] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 08/09/2016] [Indexed: 01/03/2023] Open
Abstract
Attention is vital to success in all aspects of life (Meck and Benson, 2002; Erickson et al., 2015), hence it is important to identify biomarkers of later attentional problems early enough to intervene. Our objective was to determine if any of 11 genes (APOE, BDNF, HTR4, CHRNA4, COMT, DRD4, IGF2, MAOA, SLC5A7, SLC6A3, and SNAP25) predicted the trajectory of attentional development within the same group of children between infancy and childhood. We recruited follow up participants from children who participated as infants in visual attention studies and used a similar task at both time points. Using multilevel modeling, we associated changes in the participant’s position in the distribution of scores in infancy to his/her position in childhood with genetic markers on each of 11 genes. While all 11 genes predicted reaction time (RT) residual scores, only Monoamine oxidase A (MAOA) had a significant interaction including time point. We conclude that the MAOA single nucleotide polymorphism (SNP) rs1137070 is useful in predicting which girls are likely to develop slower RTs on an attention task between infancy and childhood. This early identification is likely to be helpful in early intervention.
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Affiliation(s)
- Rebecca A Lundwall
- Development of Visual Cognition Laboratory, Department of Psychology, Brigham Young University Provo, UT, USA
| | - Claudia G Rasmussen
- Development of Visual Cognition Laboratory, Department of Psychology, Brigham Young University Provo, UT, USA
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44
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Fallu A, Dabouz F, Furtado M, Anand L, Katzman MA. A randomized, double-blind, cross-over, phase IV trial of oros-methylphenidate (CONCERTA(®)) and generic novo-methylphenidate ER-C (NOVO-generic). Ther Adv Psychopharmacol 2016; 6:237-51. [PMID: 27536342 PMCID: PMC4971598 DOI: 10.1177/2045125316643674] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE Attention-deficit/hyperactivity disorder (ADHD) is a common neurobehavioral disorder with onset during childhood. Multiple aspects of a child's development are hindered, in both home and school settings, with negative impacts on social, emotional, and cognitive functioning. If left untreated, ADHD is commonly associated with poor academic achievement and low occupational status, as well as increased risk of substance abuse and delinquency. The objective of this study was to evaluate adult ADHD subject reported outcomes when switched from a stable dose of CONCERTA(®) to the same dose of generic Novo-methylphenidate ER-C(®). METHODS Randomized, double-blind, cross-over, phase IV trial consisted of two phases in which participants with a primary diagnosis of ADHD were randomized in a 1:1 ratio to 3 weeks of treatment with CONCERTA or generic Novo-Methylphenidate ER-C. Following 3 weeks of treatment, participants were crossed-over to receive the other treatment for an additional 3 weeks. Primary efficacy was assessed through the use of the Treatment Satisfaction Questionnaire for Medication, Version II (TSQM-II). RESULTS Participants with ADHD treated with CONCERTA were more satisfied in terms of efficacy and side effects compared to those receiving an equivalent dose of generic Novo-Methylphenidate ER-C. All participants chose to continue with CONCERTA treatment at the conclusion of the study. CONCLUSION Although CONCERTA and generic Novo-Methylphenidate ER-C have been deemed bioequivalent, however the present findings demonstrate clinically and statistically significant differences between generic and branded CONCERTA. Further investigation of these differences is warranted.
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Affiliation(s)
- Angelo Fallu
- Clinique Woodward, 717, rue Woodward, DIEX Research Inc., Sherbrooke, QC, J1G 1W4, Canada
| | - Farida Dabouz
- FB2D Clinical Research Consulting, Montréal, Québec, Canada
| | - Melissa Furtado
- START Clinic for Mood and Anxiety Disorders, Toronto, ON, Canada
| | - Leena Anand
- START Clinic for Mood and Anxiety Disorders, Toronto, ON, Canada
| | - Martin A Katzman
- START Clinic for Mood and Anxiety Disorders, Toronto, ON, Canada
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45
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Ziereis S, Jansen P. Correlation of Motor Abilities and Executive Functions in Children With ADHD. APPLIED NEUROPSYCHOLOGY-CHILD 2016; 5:138-48. [DOI: 10.1080/21622965.2015.1038746] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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46
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Clarke TK, Lupton MK, Fernandez-Pujals AM, Starr J, Davies G, Cox S, Pattie A, Liewald DC, Hall LS, MacIntyre DJ, Smith BH, Hocking LJ, Padmanabhan S, Thomson PA, Hayward C, Hansell NK, Montgomery GW, Medland SE, Martin NG, Wright MJ, Porteous DJ, Deary IJ, McIntosh AM. Common polygenic risk for autism spectrum disorder (ASD) is associated with cognitive ability in the general population. Mol Psychiatry 2016; 21:419-25. [PMID: 25754080 PMCID: PMC4759203 DOI: 10.1038/mp.2015.12] [Citation(s) in RCA: 109] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 11/25/2014] [Accepted: 12/19/2014] [Indexed: 12/16/2022]
Abstract
Cognitive impairment is common among individuals diagnosed with autism spectrum disorder (ASD) and attention-deficit hyperactivity disorder (ADHD). It has been suggested that some aspects of intelligence are preserved or even superior in people with ASD compared with controls, but consistent evidence is lacking. Few studies have examined the genetic overlap between cognitive ability and ASD/ADHD. The aim of this study was to examine the polygenic overlap between ASD/ADHD and cognitive ability in individuals from the general population. Polygenic risk for ADHD and ASD was calculated from genome-wide association studies of ASD and ADHD conducted by the Psychiatric Genetics Consortium. Risk scores were created in three independent cohorts: Generation Scotland Scottish Family Health Study (GS:SFHS) (n=9863), the Lothian Birth Cohorts 1936 and 1921 (n=1522), and the Brisbane Adolescent Twin Sample (BATS) (n=921). We report that polygenic risk for ASD is positively correlated with general cognitive ability (beta=0.07, P=6 × 10(-7), r(2)=0.003), logical memory and verbal intelligence in GS:SFHS. This was replicated in BATS as a positive association with full-scale intelligent quotient (IQ) (beta=0.07, P=0.03, r(2)=0.005). We did not find consistent evidence that polygenic risk for ADHD was associated with cognitive function; however, a negative correlation with IQ at age 11 years (beta=-0.08, Z=-3.3, P=0.001) was observed in the Lothian Birth Cohorts. These findings are in individuals from the general population, suggesting that the relationship between genetic risk for ASD and intelligence is partly independent of clinical state. These data suggest that common genetic variation relevant for ASD influences general cognitive ability.
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Affiliation(s)
- T-K Clarke
- Division of Psychiatry, University of Edinburgh, Edinburgh, UK,Division of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital, Edinburgh EH10 5HF, UK. E-mail:
| | - M K Lupton
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | | | - J Starr
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
| | - G Davies
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
| | - S Cox
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
| | - A Pattie
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
| | - D C Liewald
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
| | - L S Hall
- Division of Psychiatry, University of Edinburgh, Edinburgh, UK
| | - D J MacIntyre
- Division of Psychiatry, University of Edinburgh, Edinburgh, UK
| | - B H Smith
- Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - L J Hocking
- Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - S Padmanabhan
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - P A Thomson
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK,Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK,Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK,Medical Genetics Section, Molecular Medicine Centre, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - C Hayward
- Medical Genetics Section, Molecular Medicine Centre, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK,MRC Human Genetics, MRC IGMM, University of Edinburgh, Edinburgh, Scotland, UK
| | - N K Hansell
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - G W Montgomery
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - S E Medland
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - N G Martin
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - M J Wright
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - D J Porteous
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK,Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK,Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK,Medical Genetics Section, Molecular Medicine Centre, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK,MRC Human Genetics, MRC IGMM, University of Edinburgh, Edinburgh, Scotland, UK,Centre for Genomics and Experimental Medicine, Institute of Genetics and Molecular Medicine, University of Edinburgh, Western General Hospital, Edinburgh, UK
| | - I J Deary
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK,Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK,Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK,Medical Genetics Section, Molecular Medicine Centre, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK,MRC Human Genetics, MRC IGMM, University of Edinburgh, Edinburgh, Scotland, UK,Centre for Genomics and Experimental Medicine, Institute of Genetics and Molecular Medicine, University of Edinburgh, Western General Hospital, Edinburgh, UK,Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - A M McIntosh
- Division of Psychiatry, University of Edinburgh, Edinburgh, UK,Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
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Türkan BN, Amado S, Ercan ES, Perçinel I. Comparison of change detection performance and visual search patterns among children with/without ADHD: Evidence from eye movements. RESEARCH IN DEVELOPMENTAL DISABILITIES 2016; 49-50:205-215. [PMID: 26707929 DOI: 10.1016/j.ridd.2015.12.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 11/30/2015] [Accepted: 12/02/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND ADHD participants showed poorer change detection performance compared to participants without any diagnosis. The difficulty to detect changes in ADHD children might be due to their voluntary eye movement control and attentional deficits. AIMS To evaluate change detection performance and visual search patterns of children with ADHD and compare their performances with typically developing (TD) children. METHODS AND PROCEDURES 48 children (nADHD=24, nTD=24) participated (Mage=8 years, 10 months). Flicker paradigm was used to evaluate change detection performance, while eye movements were recorded during the experiment. RESULTS Change detection accuracies of TD children were higher compared to ADHD children. TD groups made longer fixations on the changed area and their first fixation duration was also longer than ADHD children which showed that TD children had longer fixation maintenance than ADHD children. CONCLUSIONS The change detection performance, which is associated with visual attention and memory, was found to be worse in ADHD children than TD children and these children made shorter fixations on the changed area than TD children. The findings were found to be in line with the difficulty to sustain attention in ADHD children that is necessary for encoding the scene properties and goal-oriented behavior.
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Affiliation(s)
| | - Sonia Amado
- Ege University, Department of Psychology, 35400 Izmir, Turkey
| | - Eyüp Sabri Ercan
- Ege University, Department of Child and Adolescent Psychiatry, 35100 Izmir, Turkey
| | - Ipek Perçinel
- Osmaniye Child and Adolescent Psychiatry Clinic, Osmaniye, Turkey
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48
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Francx W, Oldehinkel M, Oosterlaan J, Heslenfeld D, Hartman CA, Hoekstra PJ, Franke B, Beckmann CF, Buitelaar JK, Mennes M. The executive control network and symptomatic improvement in attention-deficit/hyperactivity disorder. Cortex 2015; 73:62-72. [PMID: 26363140 DOI: 10.1016/j.cortex.2015.08.012] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 07/17/2015] [Accepted: 08/11/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND One neurodevelopmental theory hypothesizes remission of attention-deficit/hyperactivity disorder (ADHD) to result from improved prefrontal top-down control, while ADHD, independent of the current diagnosis, is characterized by stable non-cortical deficits (Halperin & Schulz, 2006). We tested this theory using resting state functional MRI (fMRI) data in a large sample of adolescents with remitting ADHD, persistent ADHD, and healthy controls. METHODS Participants in this follow-up study were 100 healthy controls and 129 adolescents with ADHD combined type at baseline (mean age at baseline 11.8 years; at follow-up 17.5 years). Diagnostic information was collected twice and augmented with magnetic resonance imaging (MRI) scanning at follow-up. We used resting state functional connectivity (RSFC) of the executive control network to investigate whether improved prefrontal top-down control was related to a developmental decrease in ADHD symptoms. In addition, we tested whether non-cortical RSFC, i.e., cerebellar and striatal RSFC, was aberrant in persistent and/or remittent ADHD compared to controls. RESULTS Higher connectivity within frontal regions (anterior cingulate cortex) of the executive control network was related to decreases in ADHD symptoms. This association was driven by change in hyperactive/impulsive symptoms and not by change in inattention. Participants with remitting ADHD showed stronger RSFC than controls within this network, while persistent ADHD cases exhibited RSFC strengths intermediate to remittent ADHD cases and controls. Cerebellar and subcortical RSFC did not differ between participants with ADHD and controls. CONCLUSIONS In line with the neurodevelopmental theory, symptom recovery in ADHD was related to stronger integration of prefrontal regions in the executive control network. The pattern of RSFC strength across remittent ADHD, persistent ADHD, and healthy controls potentially reflects the presence of compensatory neural mechanisms that aid symptomatic remission.
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Affiliation(s)
- Winke Francx
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Cognitive Neuroscience, Nijmegen, The Netherlands; Radboud University Nijmegen, Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Nijmegen, The Netherlands.
| | - Marianne Oldehinkel
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Cognitive Neuroscience, Nijmegen, The Netherlands; Radboud University Nijmegen, Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Nijmegen, The Netherlands
| | - Jaap Oosterlaan
- VU University Amsterdam, Department of Clinical Neuropsychology, Amsterdam, The Netherlands
| | - Dirk Heslenfeld
- VU University Amsterdam, Department of Clinical Neuropsychology, Amsterdam, The Netherlands
| | - Catharina A Hartman
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, The Netherlands
| | - Pieter J Hoekstra
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, The Netherlands
| | - Barbara Franke
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Human Genetics, Nijmegen, The Netherlands; Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Psychiatry, Nijmegen, The Netherlands
| | - Christian F Beckmann
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Cognitive Neuroscience, Nijmegen, The Netherlands; Radboud University Nijmegen, Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Nijmegen, The Netherlands; Centre for Functional MRI of the Brain, University of Oxford, Oxford, United Kingdom
| | - Jan K Buitelaar
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Cognitive Neuroscience, Nijmegen, The Netherlands; Radboud University Nijmegen, Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Nijmegen, The Netherlands; Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, The Netherlands
| | - Maarten Mennes
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Cognitive Neuroscience, Nijmegen, The Netherlands; Radboud University Nijmegen, Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Nijmegen, The Netherlands
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Huang F, Qian Q, Wang Y. Cognitive behavioral therapy for adults with attention-deficit hyperactivity disorder: study protocol for a randomized controlled trial. Trials 2015; 16:161. [PMID: 25873090 PMCID: PMC4399752 DOI: 10.1186/s13063-015-0686-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 03/26/2015] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Attention-deficit hyperactivity disorder (ADHD) is a mental disorder beginning in childhood, and about half of patients have symptoms lasting into adulthood. Adult ADHD causes various impairments of emotional, self-esteem, and executive function and life quality aspects. Furthermore, adverse outcomes include academic and occupational failures, traffic accidents and substance abuse, which would be a family and social burden. A combination of medication and psychotherapy is recommended as the treatment for adult ADHD, and cognitive behavioral therapy (CBT) has been validated mostly with evidence-based researches. However, there has been a lack of randomized controlled trials of CBT for patients in China. Moreover, booster sessions of CBT for other disorders have proven effective in reducing recurrence and improving long-term outcomes, which has not been investigated for adult ADHD. This study will testify to the effect of CBT and explore the efficacy of subsequent booster sessions on adult ADHD. METHODS/DESIGN It is a three-armed randomized controlled trial to evaluate the efficacy of 12 weeks of CBT based on the published and validated manual and its booster sessions. The 12 weeks of CBT will be conducted weekly and will end at the 12th week, and then the booster sessions will be conducted monthly and end at the 24th week. There are three randomized groups, including a CBT with booster sessions group, a CBT group and a waiting group. Participants are outpatients of the Peking University Sixth Hospital who are diagnosed as having adult ADHD. The Primary efficacy endpoints are the scores of ADHD core symptoms at 12 and 24 weeks. Secondary endpoints include emotion, executive function, self-esteem, life quality and functional magnetic resonance imaging (fMRI) data at different time points, and the change within every group will also be analyzed. DISCUSSION This is the first study to explore the efficacy of booster sessions of CBT in adult ADHD as far as we know. The results might increase proof of efficacy of CBT for adult ADHD in China, and the results showing efficacy of the booster sessions would also benefit our clinical practice. TRIAL REGISTRATION Current Controlled Trials: NCT02062411, date of registration: 12 February 2014.
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Affiliation(s)
- Fang Huang
- Peking University Sixth Hospital/Institute of Mental Health, National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), No. 51, Hua Yuan Bei Lu, Haidian District, Beijing, 100191, China. .,Key Laboratory of Mental Health, Ministry of Health, Peking University, No. 51, Hua Yuan Bei Lu, Haidian District, Beijing, 100191, China.
| | - Qiujin Qian
- Peking University Sixth Hospital/Institute of Mental Health, National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), No. 51, Hua Yuan Bei Lu, Haidian District, Beijing, 100191, China. .,Key Laboratory of Mental Health, Ministry of Health, Peking University, No. 51, Hua Yuan Bei Lu, Haidian District, Beijing, 100191, China.
| | - Yufeng Wang
- Peking University Sixth Hospital/Institute of Mental Health, National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), No. 51, Hua Yuan Bei Lu, Haidian District, Beijing, 100191, China. .,Key Laboratory of Mental Health, Ministry of Health, Peking University, No. 51, Hua Yuan Bei Lu, Haidian District, Beijing, 100191, China.
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50
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Martinussen R, Mackenzie G. Reading comprehension in adolescents with ADHD: exploring the poor comprehender profile and individual differences in vocabulary and executive functions. RESEARCH IN DEVELOPMENTAL DISABILITIES 2015; 38:329-337. [PMID: 25589478 DOI: 10.1016/j.ridd.2014.12.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 12/08/2014] [Indexed: 06/04/2023]
Abstract
The overall objective of this study was to investigate reading comprehension in youth with and without a prior diagnosis of attention-deficit hyperactivity disorder (ADHD). The first goal was to determine whether youth with and without ADHD matched in word reading ability exhibited differences in reading comprehension proficiency. The next goal was to determine whether good and poor comprehenders within the ADHD subgroup differed from each other on language and academic achievement measures. The third objective was to examine whether word recognition or oral vocabulary knowledge mediated the effect of ADHD symptoms on reading comprehension performance. Youth with ADHD scored significantly lower than the comparison youth on a standardized measure of reading comprehension. Relative to good comprehenders with ADHD, poor comprehenders with ADHD exhibited weaknesses in expressive vocabulary, mathematical reasoning, written expression, and exhibited more executive function (EF) difficulties as reported by the teacher. Expressive vocabulary and word reading, but not teacher EF ratings, accounted for unique variance in reading comprehension performance and mediated the relationship between ADHD symptoms and reading comprehension. Implications for further research and educational practice are discussed.
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Affiliation(s)
- Rhonda Martinussen
- Ontario Institute for Studies in Education, University of Toronto, Canada.
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