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Bluschke A, Chmielewski WX, Roessner V, Beste C. Intact Context-Dependent Modulation of Conflict Monitoring in Childhood ADHD. J Atten Disord 2020; 24:1503-1510. [PMID: 27114409 DOI: 10.1177/1087054716643388] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: Conflict monitoring is well known to be modulated by context. This is known as the Gratton effect, meaning that the degree of interference is smaller when a stimulus-response conflict had been encountered previously. It is unclear to what extent these processes are changed in ADHD. Method: Children with ADHD (combined subtype) and healthy controls performed a modified version of the sequence flanker task. Results: Patients with ADHD made significantly more errors than healthy controls, indicating general performance deficits. However, there were no differences regarding reaction times, indicating an intact Gratton effect in ADHD. These results were supported by Bayesian statistics. Conclusion: The results suggest that the ability to take contextual information into account during conflict monitoring is preserved in patients with ADHD despite this disorder being associated with changes in executive control functions overall. These findings are discussed in light of different theoretical accounts on contextual modulations of conflict monitoring.
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Joyner RE, Wagner RK. Co-occurrence of Reading Disabilities and Math Disabilities: A Meta-Analysis. SCIENTIFIC STUDIES OF READING : THE OFFICIAL JOURNAL OF THE SOCIETY FOR THE SCIENTIFIC STUDY OF READING 2019; 24:14-22. [PMID: 32051676 PMCID: PMC7015531 DOI: 10.1080/10888438.2019.1593420] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Despite the importance of identifying individuals with reading disabilities, existing operational definitions of reading disability do not result in reliable identification. A large part of the problem arises from measurement error when a cut-point is imposed on a continuous distribution, especially for low base-rate conditions. One way to reduce measurement error is to include additional predictors in reading disability models. The present study examined co-occurring math disability as a possible additional criterion for predicting reading disability. Meta-analysis was used to examine the probability of individuals with reading disability also having a comorbid math disability. Possible moderators including age, severity of disability, and language were examined. The main result was an average weighted odds ratio of 2.12, 95% confidence interval [1.76, 2.55], indicating that students with a math disability are just over two times more likely to also have a reading disability than those without a math disability. Implications of the results are discussed.
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Parks KMA, Stevenson RA. Auditory and Visual Statistical Learning Are Not Related to ADHD Symptomatology: Evidence From a Research Domain Criteria (RDoC) Approach. Front Psychol 2018; 9:2502. [PMID: 30618933 PMCID: PMC6308122 DOI: 10.3389/fpsyg.2018.02502] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 11/26/2018] [Indexed: 12/02/2022] Open
Abstract
Statistical learning is an implicit process that allows individuals to track and predict incoming events from their environment. Given that information is highly structured over time, events become predictable, allowing these individuals to make better sense of their environment. Among the studies that have examined statistical learning in attention deficit/hyperactivity disorder (ADHD), findings have been mixed. Our goal was to examine whether increased ADHD symptomatology related to decreased auditory and visual statistical learning abilities. To investigate this, we examined the entire range of ADHD symptomatology using a Research Domain Criteria approach with a clinically reliable questionnaire in addition to well-established auditory and visual statistical learning paradigms. Total ADHD symptomatology was not related to auditory and visual statistical learning. An identical pattern emerged when inattention and hyperactivity components were separated, indicating that neither of these distinct behavioral symptoms of ADHD are related to statistical learning abilities. Findings from the current study converge with other studies but go beyond finding a lack of a significant relationship – through Bayesian analyses, these data provide novel evidence directly supporting the hypothesis that ADHD symptomatology and statistical learning are decoupled. This finding held for overall levels of ADHD symptomatology as well as the subdomains of inattention and hyperactivity, suggesting that the ability to pick up on patterns in both auditory and visual domains is intact in ADHD. Future work should consider investigating statistical learning in ADHD across ages and beyond auditory and visual domains.
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Affiliation(s)
- Kaitlyn M A Parks
- Department of Psychology, Western University, London, ON, Canada.,Brain and Mind Institute, Western University, London, ON, Canada
| | - Ryan A Stevenson
- Department of Psychology, Western University, London, ON, Canada.,Brain and Mind Institute, Western University, London, ON, Canada.,Program in Neuroscience, Western University, London, ON, Canada.,Department of Psychiatry, Western University, London, ON, Canada.,Centre for Vision Research, York University, Toronto, ON, Canada
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Tamayo-Orrego L, Osorio Forero A, Quintero Giraldo LP, Parra Sánchez JH, Varela V, Restrepo F. [Differential effects of attention deficit/hyperactivity disorder subtypes in event-related potentials]. ACTA ACUST UNITED AC 2015; 44:77-86. [PMID: 26578329 DOI: 10.1016/j.rcp.2015.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 10/22/2014] [Accepted: 02/02/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND To better understand the neurophysiological substrates in attention deficit/hyperactivity disorder (ADHD), a study was performed on of event-related potentials (ERPs) in Colombian patients with inattentive and combined ADHD. METHODS A case-control, cross-sectional study was designed. The sample was composed of 180 subjects between 5 and 15 years of age (mean, 9.25±2.6), from local schools in Manizales. The sample was divided equally in ADHD or control groups and the subjects were paired by age and gender. The diagnosis was made using the DSM-IV-TR criteria, the Conners and WISC-III test, a psychiatric interview (MINIKID), and a medical evaluation. ERPs were recorded in a visual and auditory passive oddball paradigm. Latency and amplitude of N100, N200 and P300 components for common and rare stimuli were used for statistical comparisons. RESULTS ADHD subjects show differences in the N200 amplitude and P300 latency in the auditory task. The N200 amplitude was reduced in response to visual stimuli. ADHD subjects with combined symptoms show a delayed P300 in response to auditory stimuli, whereas inattentive subjects exhibited differences in the amplitude of N100 and N200. Combined ADHD patients showed longer N100 latency and smaller N200-P300 amplitude compared to inattentive ADHD subjects. CONCLUSIONS The results show differences in the event-related potentials between combined and inattentive ADHD subjects.
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Affiliation(s)
- Lukas Tamayo-Orrego
- Laboratorio de Neurofisiología, Universidad Autónoma de Manizales, Manizales, Colombia
| | | | | | | | - Vilma Varela
- Facultad de Ciencias Sociales y Humanas, Universidad de Manizales, Manizales, Colombia
| | - Francia Restrepo
- Laboratorio de Neurofisiología, Universidad Autónoma de Manizales, Manizales, Colombia.
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5
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Likosky DS, Zhou W, Malenka DJ, Borden WB, Nallamothu BK, Skinner JS. Growth in medicare expenditures for patients with acute myocardial infarction: a comparison of 1998 through 1999 and 2008. JAMA Intern Med 2013; 173:2055-61. [PMID: 24061277 PMCID: PMC4454469 DOI: 10.1001/jamainternmed.2013.10789] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Medicare expenditures continue to grow rapidly, but the reasons are uncertain. OBJECTIVE To compare expenditures from 1998 through 1999 and 2008 for Medicare beneficiaries hospitalized for acute myocardial infarction (AMI). DESIGN, SETTING, AND PARTICIPANTS Cross-sectional analysis of a random 20% sample of fee-for-service Medicare beneficiaries admitted with AMI from 1998 through 1999 (n = 105,074) and a 100% sample for 2008 (n = 212,329). MAIN OUTCOMES AND MEASURES Per-beneficiary expenditures, standardized for price and adjusted for risk and inflation. Expenditures were measured across 4 periods: overall (index admission to 1 year), index (within the index admission), early (postindex admission to 30 days), and late (31-365 days). RESULTS Compared with the subjects from 1998 through 1999, those in 2008 were older and had more comorbidities but slightly less ischemic heart disease and cerebrovascular disease. Although there was a 19.2% decline in the rate of hospitalizations for AMI, overall expenditures per patient increased by 16.5% (absolute difference, $6094). Of the total risk-adjusted increase in expenditures, 25.6% occurred within 30 days (22.0% attributed to the index admission), and 74.4% happened 31 to 365 days after the index admission. Spending per beneficiary within 30 days increased by $1560 (7.5%), and spending between 31 and 365 days increased by $4535 (28.0%). Expenditures for skilled nursing facilities, hospice, home health agency, durable medical equipment, and outpatient care nearly doubled 31 to 365 days after admission. Mortality within 1 year declined from 36.0% in 1998 through 1999 to 31.7% in 2008; of the decline, 3.3% was in the 30 days following admission, and 1.0% was in days 31 to 365. CONCLUSIONS AND RELEVANCE Between 1998 and 2008, Medicare expenditures per patient with an AMI substantially increased, with about three-fourths of the increase in expenditures occurring 31 to 365 days after the date of hospital admission. Although current bundled payment models may contain expenditures within 30 days of an AMI, they do not contain spending beyond 30 days.
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Affiliation(s)
- Donald S Likosky
- Department of Cardiac Surgery, University of Michigan, Ann Arbor
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Johnstone SJ, Barry RJ, Clarke AR. Ten years on: a follow-up review of ERP research in attention-deficit/hyperactivity disorder. Clin Neurophysiol 2012; 124:644-57. [PMID: 23063669 DOI: 10.1016/j.clinph.2012.09.006] [Citation(s) in RCA: 118] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Revised: 09/03/2012] [Accepted: 09/10/2012] [Indexed: 11/28/2022]
Abstract
This article reviews the event-related potential (ERP) literature in relation to attention-deficit/hyperactivity disorder (AD/HD) over the years 2002-2012. ERP studies exploring various aspects of brain functioning in children and adolescents with AD/HD are reviewed, with a focus on group effects and interpretations in the domains of attention, inhibitory control, performance monitoring, non-pharmacological treatments, and ERP/energetics interactions. There has been a distinct shift in research intensity over the past 10 years, with a large increase in ERP studies conducted in the areas of inhibitory control and performance monitoring. Overall, the research has identified a substantial number of ERP correlates of AD/HD. Robust differences from healthy controls have been reported in early orienting, inhibitory control, and error-processing components. These data offer potential to improve our understanding of the specific brain dysfunction(s) which contribute to the disorder. The literature would benefit from a more rigorous approach to clinical group composition and consideration of age effects, as well as increased emphasis on replication and extension studies using exacting participant, task, and analysis parameters.
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Adi-Japha E, Fox O, Karni A. Atypical acquisition and atypical expression of memory consolidation gains in a motor skill in young female adults with ADHD. RESEARCH IN DEVELOPMENTAL DISABILITIES 2011; 32:1011-1020. [PMID: 21349685 DOI: 10.1016/j.ridd.2011.01.048] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2010] [Revised: 01/24/2011] [Accepted: 01/25/2011] [Indexed: 05/30/2023]
Abstract
Individuals with ADHD often show performance deficits in motor tasks. It is not clear, however, whether this reflects less effective acquisition of skill (procedural knowledge), or deficient consolidation into long-term memory, in ADHD. The aim of the study was to compare the acquisition of skilled motor performance, the expression of delayed--consolidation phase--gains and retention, in persons with and without ADHD. Thirty-two participants, 16 with ADHD, were trained on a sequence of finger movements using a well-established training protocol, and tested before training and immediately, 24h and 2 weeks after training. Both groups showed similar within-session gains in speed; additional, delayed gains were expressed at 24h, but less robustly in ADHD, and at 2 weeks post-training. However, while controls showed significant delayed gains in accuracy at 24h and 2 weeks post-training, accuracy deteriorated in ADHD from pre-training to 24h post-training and was only at pre-training levels by 2-weeks post-training. Our results demonstrate a latent memory consolidation phase in motor sequence learning, expressed as delayed gains in speed and a much delayed recovery of pre-training accuracy, in individuals with ADHD. However, both the acquisition and memory consolidation of motor skills are atypical in ADHD.
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Affiliation(s)
- Esther Adi-Japha
- School of Education, Leslie and Susan Gonda Goldschmied Multidisciplinary Brain Research Center, Bar-Ilan University, Ramat-Gan 52900, Israel.
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Karatekin C, White T, Bingham C. Incidental and intentional sequence learning in youth-onset psychosis and Attention-Deficit/Hyperactivity Disorder (ADHD). Neuropsychology 2009; 23:445-59. [PMID: 19586209 DOI: 10.1037/a0015562] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The goal was to compare incidental and intentional spatial sequence learning in youth-onset psychosis and ADHD. The authors tested 8- to 19-year-olds with psychosis or ADHD and healthy controls on a serial reaction time (RT) task and used manual and oculomotor measures to examine learning. Participants were also administered a block in which they were explicitly instructed to learn a sequence. As in our previous studies with healthy adults and children, oculomotor anticipations and RTs showed learning effects similar to those in the manual modality. Results showed intact sequence-specific learning but fewer oculomotor anticipations in both clinical groups during incidental learning. In intentional learning, only the psychosis group showed impairments compared to controls. There were no interactions between age and diagnosis. Thus, the psychosis group showed relatively preserved incidental learning despite impairments in intentional learning. Additionally, both clinical groups showed impairments in the ability to search for, extract, and anticipate regularities (whether the regularities were there or not), but not in the ability to respond to these regularities when they were there.
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Affiliation(s)
- Canan Karatekin
- Institute of Child Development, Univeristy of Minnesota, Minneapolis MN 55455, USA.
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Swanson HL, Jerman O, Xinhua Zheng. Math Disabilities and Reading Disabilities. JOURNAL OF PSYCHOEDUCATIONAL ASSESSMENT 2009. [DOI: 10.1177/0734282908330578] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article synthesizes some of the published literature that selectively compares the cognitive functioning of children with math disabilities (MDs) with average-achieving children and poor readers (children with reading disabilities [RDs] or comorbid disabilities [RDs + MDs]). All studies in the synthesis report reading, IQ, and math scores for children with MDs and poor readers. A random coefficients model of effect sizes (ESs) show that (a) ESs between MD and normal achievers were moderated by variations in working memory and literacy, (b) ESs between MD- and RD-only children were moderated by working memory and problem solving, and (c) ESs between MD and MD + RD children were moderated by long-term memory and IQ scores. No support was found for the notion that the differentiation between MD children and poor readers (RD and MD + RD) was related to variations in reading across the reviewed studies.
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10
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Inoue Y, Inagaki M, Gunji A, Furushima W, Kaga M. Response switching process in children with attention-deficit-hyperactivity disorder on the novel continuous performance test. Dev Med Child Neurol 2008; 50:462-6. [PMID: 18355339 DOI: 10.1111/j.1469-8749.2008.02049.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We examined the effects of previous trials on subsequent trials on performance in the continuous performance test (CPT) in children with attention-deficit-hyperactivity disorder (ADHD). Thirty-five non-medicated children with ADHD (31 males, four females; mean age 9y 10mo [SD 2y 4mo]) and 33 comparison children (20 males, 13 females; mean age 10y [SD 2y 7mo]) were tested using a novel CPT, in which stimuli were presented with 50% target probability. Reaction time, reaction time variability, omission, and commission error rate were analyzed for two different types of trials in which different responses (switched trials) or the same responses (repeated trials) were required for two consecutive trials. Compared with the comparison group, children with ADHD showed a greater increase in commission error rate from repeated to switched trials, i.e. increased switch cost for commission error rate. On the other hand, omission error rate was not influenced by the previous trial in both ADHD and comparison groups. These results suggest that children with ADHD have trouble in response switching when an inhibitory process is involved.
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Affiliation(s)
- Yuki Inoue
- Department of Developmental Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan.
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van Meel CS, Heslenfeld DJ, Oosterlaan J, Sergeant JA. Adaptive control deficits in attention-deficit/hyperactivity disorder (ADHD): the role of error processing. Psychiatry Res 2007; 151:211-20. [PMID: 17328962 DOI: 10.1016/j.psychres.2006.05.011] [Citation(s) in RCA: 135] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2005] [Revised: 04/21/2006] [Accepted: 05/04/2006] [Indexed: 11/25/2022]
Abstract
Cognitive performance of children with attention-deficit hyperactivity disorder (ADHD) is characterized by large moment-to-moment fluctuations in cognitive control reflected by a highly inconsistent and inaccurate response style. It has been suggested that abnormal error processing underlies this failure to implement adequate control. We investigated the error-related negativity (ERN), a negative deflection in the event-related potential (ERP) time-locked to erroneous responses in 16 rigorously screened ADHD boys aged 8-12 years and 16 age-matched normal control boys during a modified Eriksen flanker paradigm with two levels of time pressure. Children with ADHD responded as fast and regularly as controls, but committed significantly more errors, particularly when facing time pressure and response conflict. ADHD children produced shorter runs of correct responses than controls. In addition, with high time pressure, error runs were prolonged relative to control children, suggesting an increase in both frequency and magnitude of temporary lapses of control. ERP amplitude differences between correct and incorrect responses were diminished in ADHD children, whereas post-error slowing remained unaffected. This pattern of results indicates that a specific deficit in monitoring ongoing behaviour, rather than insufficient strategic adjustments, gave rise to performance limitations in ADHD. Findings are discussed in terms of anterior cingulate cortex (ACC) dysfunction, leading to a failure to predict the likelihood that an error occurs in a given context.
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Affiliation(s)
- Catharina S van Meel
- Department of Clinical Neuropsychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 1 1081 BT Amsterdam, The Netherlands.
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12
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Burgio-Murphy A, Klorman R, Shaywitz SE, Fletcher JM, Marchione KE, Holahan J, Stuebing KK, Thatcher JE, Shaywitz BA. Error-related event-related potentials in children with attention-deficit hyperactivity disorder, oppositional defiant disorder, reading disorder, and math disorder. Biol Psychol 2007; 75:75-86. [PMID: 17257731 PMCID: PMC3748593 DOI: 10.1016/j.biopsycho.2006.12.003] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2005] [Revised: 12/12/2006] [Accepted: 12/12/2006] [Indexed: 11/30/2022]
Abstract
We studied error-related negativity (ERN) and error positivity (Pe) during a discrimination task in 319 unmedicated children divided into subtypes of ADHD (Not-ADHD/inattentive/combined), learning disorder (Not-LD/reading/math/reading+math), and oppositional defiant disorder. Response-locked ERPs contained a frontocentral ERN and posterior Pe. Error-related negativity and positivity exhibited larger amplitude and later latency than corresponding waves for correct responses matched on reaction time. ADHD did not affect performance on the task. The ADHD/combined sample exceeded controls in ERN amplitude, perhaps reflecting patients' adaptive monitoring efforts. Compared with controls, subjects with reading disorder and reading+math disorder performed worse on the task and had marginally more negative correct-related negativities. In contrast, Pe/Pc was smaller in children with reading+math disorder than among subjects with reading disorder and Not-LD participants; this nonspecific finding is not attributable to error processing. The results reflect anomalies in error processing in these disorders but further research is needed to address inconsistencies in the literature.
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Affiliation(s)
- Andrea Burgio-Murphy
- Department of Clinical and Social Sciences in Psychology, University of Rochester, Rochester NY 14627
| | - Rafael Klorman
- Department of Clinical and Social Sciences in Psychology, University of Rochester, Rochester NY 14627
| | - Sally E. Shaywitz
- Department of Pediatrics, Yale University Medical School, New Haven CT 06510
| | - Jack M. Fletcher
- Department of Psychology, University of Houston, Houston TX 77204
| | - Karen E. Marchione
- Department of Pediatrics, Yale University Medical School, New Haven CT 06510
| | - John Holahan
- Department of Pediatrics, Yale University Medical School, New Haven CT 06510
| | | | - Joan E. Thatcher
- Department of Clinical and Social Sciences in Psychology, University of Rochester, Rochester NY 14627
| | - Bennett A. Shaywitz
- Department of Pediatrics, Yale University Medical School, New Haven CT 06510
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Burmeister R, Hannay HJ, Copeland K, Fletcher JM, Boudousquie A, Dennis M. Attention Problems and Executive Functions in Children With Spina Bifida and Hydrocephalus. Child Neuropsychol 2007; 11:265-83. [PMID: 16036451 DOI: 10.1080/092970490911324] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This study addressed the incidence of Attention-Deficit/Hyperactivity Disorder (ADHD) subtypes in children with spina bifida meningomyelocele and shunted hydrocephalus (SBH) as well as differences in executive functions among these subtypes. Parent rating scales revealed that 31% of the group with SBH could be identified with AD/HD, mostly the Inattentive type (23%). The group with SBH differed from normal controls on cognitive measures of executive functions, but subtype differences were not significant. Multivariate tests showed that children with SBH were rated with greater difficulties on the Behavior Rating Inventory of Executive Function (BRIEF) compared to controls; those with SBH and any subtype of ADHD differed from those with SBH and no ADHD; and those with ADHD (Combined Type) differed significantly from those with ADHD (Predominantly Inattentive Type). Subtype differences on univariate tests in the latter comparison were significant on the BRIEF Inhibit scale, showing more disinhibition in those with SBH and ADHD (Combined Type), but no significant differences were apparent on the BRIEF Sustain, Shift, and Initiate scales. The results show that the incidence of ADHD in children with SBH exceeds the population rate, is represented by problems with inattention rather than with impulsivity and hyperactivity; and that as with non-brain injured individuals, subtype differences in cognitive function remain to more clearly delineated.
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Sergeant JA. Modeling attention-deficit/hyperactivity disorder: a critical appraisal of the cognitive-energetic model. Biol Psychiatry 2005; 57:1248-55. [PMID: 15949995 DOI: 10.1016/j.biopsych.2004.09.010] [Citation(s) in RCA: 353] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2004] [Revised: 09/08/2004] [Accepted: 09/20/2004] [Indexed: 01/12/2023]
Abstract
A number of theoretical models of attention-deficit/hyperactivity disorder (ADHD) have emerged in recent years that may be used as systematic guides for clinical research. The cognitive-energetic model (CEM) proposes that the overall efficiency of information processing is determined by the interplay of three levels: computational mechanisms of attention, state factors, and management/executive function (EF). The CEM encompasses both top-down and bottom-up processes and draws attention to the fact that ADHD causes defects at all three levels. These include cognitive mechanisms, such as response output; energetic mechanisms, such as activation and effort; and management/EF deficits. Increasing evidence suggests that inhibition deficits associated with ADHD may, at least in part, be explained in terms of an energetic dysfunction. The activation and effort energetic pools appear most relevant to ADHD, being directly related to response organization; however, further testing of CEM is critically dependent on the development of direct measures of these energetic pools. The CEM is a comprehensive model of ADHD but is not without limitations. In particular, further research is required to define more specifically the relationship between process dysfunction and state dysregulation in ADHD.
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Affiliation(s)
- Joseph A Sergeant
- Department of Clinical Neuropsychology, Vrije Universiteit, Amsterdam, The Netherlands.
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