Meta-analysis of intellectual and neuropsychological test performance in attention-deficit/hyperactivity disorder

Family screening for neurodevelopmental problems and its associations with child cognitive function enable tailored treatment for childhood obesity

AIM

To identify neurodevelopmental disorders in children with obesity, and investigate associations to cognitive functions as well as parents' self-reported neurodevelopmental problems.

METHODS

Eighty children were included at two outpatient obesity clinics in Sweden 2018-2019. Of these, 50 children without previously diagnosed neurodevelopmental disorders were screened, and so were their parents. Children who screened positive for neurodevelopmental problems were referred to a specialised psychiatry unit for further diagnosis. Test results of cognitive functioning were compared with the norm and between study groups by neurodevelopmental diagnoses.

RESULTS

Of the screened families, 17/50 children were diagnosed by the psychiatric unit with attention deficit-hyperactivity disorder (ADHD) and 15/82 parents screened positive for neurodevelopmental problems. Having a mother who screened positive for neurodevelopmental problems was associated with child ADHD (p < 0.05). The children's full-scale intelligence quotient (92.86 ± 12.01, p < 0.001) and working memory index (90.62 ± 12.17, p < 0.001) were lower than the norm. Working memory index was lower in children with ADHD compared to without ADHD: 84.76 ± 9.58 versus 94.09 ± 12.29 (p ≤ 0.01). Executive constraints were associated with verbal deviances.

CONCLUSION

Increased awareness is needed about the overlap between neurodevelopmental problems and obesity in obesity clinics.

Clinical segmentation in 22q11.2 deletion syndrome: Cognitive impairments and additional genetic load

The 22q11.2 deletion syndrome (22q11.2DS) is associated with high psychiatric morbidity. However, large phenotypic heterogeneity hampers early detection of 22q11.2DS individuals at highest risk. Here, we investigated whether individuals with 22q11.2DS can be subdivided into clinically relevant subgroups based on their severity of cognitive impairments and whether such subgroups differ in polygenic risk. Using a cross-sectional design, we examined the number of lifetime psychiatric diagnoses and polygenic risk scores for schizophrenia in an unselected nationwide biobank cohort of individuals with 22q11.2DS (n = 183). Approximately 35% of this sample, aged 10-30 years, had a history with one or more psychiatric diagnosis. In a representative nested subgroup of 28 children and youth, we performed additional comprehensive cognitive evaluation and assessed psychiatric symptoms. Unsupervised hierarchical cluster analysis was performed to divide the subgroup of 22q11.2DS individuals, based on their performance on the cognitive testing battery. This produced two groups that did not differ in mean age or gender composition, but were characterized by low cognitive (LF) and high cognitive (HF) functional levels. The LF group, which had significantly lower global cognitive functioning scores, also displayed higher negative symptom scores; whereas, the HF group displayed lower rate of current psychiatric disorders than the LF group and the reminder of the biobank cohort. The polygenic risk score for schizophrenia was insignificantly lower for the low functioning group than for the high functioning group, after adjustment. Cognitive functioning may provide useful information on psychiatric risk.

Neurodevelopmental disorders in children seeking obesity treatment- associations with intellectual ability and psychiatric conditions

Background

Neurodevelopmental disorders (NDD), psychiatric comorbidity and cognitive deficits are commonly seen in children with obesity; however, little is known about the overlap between these conditions. This study aimed to examine the undiagnosed and diagnosed frequency of NDDs and explore its association with psychiatric conditions and general intellectual ability (IQ) in children presenting for obesity treatment.

Methods

In this observational study at two outpatient obesity clinics during 2018-2019, 80 children (8-17 years) were consecutively recruited, and screened for NDD unless already diagnosed with an NDD. A psychiatric unit evaluated children who screened positive for NDD. Diagnoses and clinical background factors were collected from medical records. IQ was assessed with the Weschler Intelligence Scales and internalizing symptoms were assessed using the Beck Youth Inventories. Associations between background factors, IQ and internalizing symptoms were explored in relation to having an NDD or not.

Results

We found that 47/80 children had at least one NDD. Children with a diagnosed NDD before study start (n = 30) had significantly more comorbidities than children diagnosed after the study screening (n = 17) (P = .01). Greater cognitive impairment was seen in children with NDD compared with children without an NDD (P = .01). Also, 33/73 participants self-reported substantial internalizing symptoms. At follow-up, 21/79 participants, in addition to NDD, had been diagnosed with another psychiatric disorder. Ten of these were children that had been diagnosed with an NDD before study start.

Conclusion

The overlap between NDD, cognitive deficits and psychiatric conditions in children with obesity is an important consideration for clinical practice. Screening for these conditions may be necessary when providing targeted interventions.

Machine learning-enabled detection of attention-deficit/hyperactivity disorder with multimodal physiological data: a case-control study

BACKGROUND

Attention-Deficit/Hyperactivity Disorder (ADHD) is a multifaceted neurodevelopmental psychiatric condition that typically emerges during childhood but often persists into adulthood, significantly impacting individuals' functioning, relationships, productivity, and overall quality of life. However, the current diagnostic process exhibits limitations that can significantly affect its overall effectiveness. Notably, its face-to-face and time-consuming nature, coupled with the reliance on subjective recall of historical information and clinician subjectivity, stand out as key challenges. To address these limitations, objective measures such as neuropsychological evaluations, imaging techniques and physiological monitoring of the Autonomic Nervous System functioning, have been explored.

METHODS

The main aim of this study was to investigate whether physiological data (i.e., Electrodermal Activity, Heart Rate Variability, and Skin Temperature) can serve as meaningful indicators of ADHD, evaluating its utility in distinguishing adult ADHD patients. This observational, case-control study included a total of 76 adult participants (32 ADHD patients and 44 healthy controls) who underwent a series of Stroop tests, while their physiological data was passively collected using a multi-sensor wearable device. Univariate feature analysis was employed to identify the tests that triggered significant signal responses, while the Informative k-Nearest Neighbors (KNN) algorithm was used to filter out less informative data points. Finally, a machine-learning decision pipeline incorporating various classification algorithms, including Logistic Regression, KNN, Random Forests, and Support Vector Machines (SVM), was utilized for ADHD patient detection.

RESULTS

Results indicate that the SVM-based model yielded the optimal performance, achieving 81.6% accuracy, maintaining a balance between the experimental and control groups, with sensitivity and specificity of 81.4% and 81.9%, respectively. Additionally, integration of data from all physiological signals yielded the best results, suggesting that each modality captures unique aspects of ADHD.

CONCLUSIONS

This study underscores the potential of physiological signals as valuable diagnostic indicators of adult ADHD. For the first time, to the best of our knowledge, our findings demonstrate that multimodal physiological data collected via wearable devices can complement traditional diagnostic approaches. Further research is warranted to explore the clinical applications and long-term implications of utilizing physiological markers in ADHD diagnosis and management.

A quantitative analysis of fidgeting in ADHD and its relation to performance and sustained attention on a cognitive task

Introduction

Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder where hyperactivity often manifests as fidgeting, a non-goal-directed motoric action. Many studies demonstrate fidgeting varies under different conditions as a self-regulating mechanism for attention and alertness during cognitively demanding tasks. Fidgeting has also been associated with reaction time variability. However, a lack of standard variables to define and quantify fidgeting can lead to discrepancies in data and interpretability issues across studies. Furthermore, little is known about fidgeting in adults with ADHD compared to youth. This study aims to design a framework to quantify meaningful fidgeting variables and to apply them to test the relation between fidgeting and performance on a cognitive task, the Flanker, in adults with ADHD.

Method

Our study included 70 adult participants diagnosed with ADHD, aged 18-50 years (30.5 ± 7.2 years). Screening included a structured clinical interview, childhood, current self and current observer ratings of ADHD symptoms. Actigraphy devices were attached to the left wrist and right ankle during completion of a cognitive control, attention task (the Flanker). Laboratory testing was subsequently completed on a single day. The relation between task performance, reaction time variability and fidgeting was examined.

Results and Discussion

Our analysis revealed increased fidgeting during correct trials as defined by our new variables, consistent with previous observations. Furthermore, differences in fidgeting were observed between early and later trials while the percentage of correct trials were not significantly different. This suggests a relation between the role of fidgeting and sustaining attention. Participants with low reaction time variability, that is, those with more consistent reaction times, fidgeted more during later trials. This observation supports the theory that fidgeting aids arousal and improves sustained attention. Finally, a correlation analysis using ADHD-symptom rating scales validated the relevance of the fidget variables in relation to ADHD symptom severity. These findings suggest fidgeting may be a compensatory mechanism that aids in sustained attention for those with ADHD, although alternative explanations exist.

Conclusion

Our study suggests that fidgeting may aid in sustained attention during the attention-demanding, cognitive control processes for adults with ADHD, with more fidgeting observed during correct trials and among participants with lower reaction time variability. Furthermore, the newly defined fidget variables were validated through a significant correlation with ADHD rating scales. By sharing our implementation of fidget variables, we hope to standardize and encourage further quantitative research into the role of fidgeting in ADHD.

Correlation of altered intrinsic functional connectivity with impaired self-regulation in children and adolescents with ADHD

BACKGROUND

Attention-deficit hyperactivity disorder (ADHD) has a high prevalence of co-occurring impaired self-regulation (dysregulation), exacerbating adverse outcomes. Neural correlates underlying impaired self-regulation in ADHD remain inconclusive. We aimed to investigate the impact of dysregulation on intrinsic functional connectivity (iFC) in children with ADHD and the correlation of iFC with dysregulation among children with ADHD relative to typically developing controls (TDC).

METHODS

Resting-state functional MRI data of 71 children with ADHD (11.38 ± 2.44 years) and 117 age-matched TDC were used in the final analysis. We restricted our analyses to resting-state networks (RSNs) of interest derived from independent component analysis. Impaired self-regulation was estimated based on the Child Behavioral Checklist-Dysregulation Profile.

RESULTS

Children with ADHD showed stronger iFC than TDC in the left frontoparietal network, somatomotor network (SMN), visual network (VIS), default-mode network (DMN), and dorsal attention network (DAN) (FWE-corrected alpha < 0.05). After adding dysregulation levels as an extra regressor, the ADHD group only showed stronger iFC in the VIS and SMN. ADHD children with high dysregulation had higher precuneus iFC within DMN than ADHD children with low dysregulation. Angular gyrus iFC within DMN was positively correlated with dysregulation in the ADHD group but negatively correlated with dysregulation in the TDC group. Functional network connectivity showed ADHD had a greater DMN-DAN connection than TDC, regardless of the dysregulation level.

CONCLUSIONS

Our findings suggest that DMN connectivity may contribute to impaired self-regulation in ADHD. Impaired self-regulation should be considered categorical and dimensional moderators for the neural correlates of altered iFC in ADHD.

Do Wechsler intelligence scales predict academic achievement in children with ADHD or autism? A systematic review and meta-analysis

Intelligence tests predict academic achievement in typically developed children, however if this is the case also in children with attention-deficit/hyperactivity disorder (ADHD) and/or autism spectrum disorder (ASD) is not clear. This systematic review and meta-analysis examined if Wechsler intelligence scales predict academic achievement and/or grades in children, ages 6-16 years, with ADHD and/or ASD. We searched the databases PubMed, PsycINFO and Education Research Complete for studies published between 2000 and 2023. We used the Newcastle-Ottawa Scale to assess risk of bias. Narrative synthesis and meta-analysis were performed. Twelve studies (ADHD n = 1,834, ASD n = 176) were included in the review, and six samples (ADHD n = 1,112) of those were included in the meta-analyses. The results of the meta-analyses showed moderate overall weighted correlations between IQ and word reading, written language, and mathematics respectively. Similarly, the overall weighted correlations between processing speed and the aforementioned domains of academic achievement were moderate. Meta-analysis with additional Wechsler scales composite scores could not be conducted. In the narrative synthesis, Full Scale IQ was associated with academic achievement in both ADHD and ASD, and grades in ADHD. The limited number of ASD participants and the heterogeneity of the samples need to be considered when interpreting results. Generally, the results indicate that Wechsler scales are valuable in predicting academic achievement in children with ADHD or ASD. Motivation and other factors related with academic achievement need to be further explored in these groups.

Reduced inhibition control ability in children with ADHD due to coexisting learning disorders: an fNIRS study

Introduction

Inhibition control, as the core component of executive function, might play a crucial role in the understanding of attention deficit/hyperactivity disorder (ADHD) and specific learning disorders (SLD). Inhibition control deficits have been observed in children with ADHD or SLD. This study sought to test in a multi-modal fashion (i.e., behavior and plus brain imaging) whether inhibition control abilities would be further deteriorated in the ADHD children due to the comorbidity of SLD.

Method

A total number of 90 children (aged 6-12 years) were recruited, including 30 ADHD, 30 ADHD+SLD (children with the comorbidity of ADHD and SLD), and 30 typically developing (TD) children. For each participant, a 44-channel functional near infrared spectroscopy (fNIRS) equipment was first adopted to capture behavioral and cortical hemodynamic responses during a two-choice Oddball task (a relatively new inhibition control paradigm). Then, 50 metrics were extracted, including 6 behavioral metrics (i.e., OddballACC, baselineACC, totalACC, OddballRT, baselineRT, and totalRT) and 44 beta values in 44 channels based on general linear model. Finally, differences in those 50 metrics among the TD, ADHD, and ADHD+SLD children were analyzed.

Results

Findings showed that: (1) OddballACC (i.e., the response accuracy in deviant stimuli) is the most sensitive metric in identifying the differences between the ADHD and ADHD+SLD children; and (2) The ADHD+SLD children exhibited decreased behavioral response accuracy and brain activation level in some channels (e.g., channel CH35) than both the ADHD and TD children.

Discussion

Findings seem to support that inhibition control abilities would be further decreased in the ADHD children due to the comorbidity of SLD.

From Consensus Statement to Pills to Pixels: New Innovations in Attention-Deficit/Hyperactivity Disorder Care

Objectives: This review aims to present recent innovations and advancements in attention-deficit/hyperactivity disorder (ADHD) care, encompassing international consensus statement, new medication formulations, digital therapeutics, and neurostimulation devices. Methods: A comprehensive literature search of relevant articles published in the past five years was conducted, emphasizing the evidence base, efficacy, safety, and practical implications of these advancements. Results: The World Federation of ADHD Consensus Statement offers an updated diagnostic and treatment framework rooted in global scientific evidence. There are several newer ADHD medication formulations, including a nonstimulant (Viloxazine extended release) and the first transdermal amphetamine patch approved to treat ADHD. These options offer some unique benefits to personalize treatment based on symptom profile, lifestyle, preferences, and response. Digital tools offer additional means to restructure environments for individuals with ADHD, reducing impairment and reliance on others. In addition, digital therapeutics enhance access, affordability, personalization, and feasibility of ADHD care, complementing or augmenting existing interventions. Trigeminal nerve stimulation emerges as a well-tolerated nonpharmacological, device-based treatment for pediatric ADHD, with initial trials indicating effect sizes comparable to nonstimulant medications. Conclusions: These innovations in ADHD care represent clinically significant new treatment options and opportunities for personalized care. Health care professionals should integrate these developments into clinical practice, mindful of individual patient and family needs and preferences. Future research should assess long-term outcomes, cost-effectiveness, and acceptability of these innovations.

Correlations between developmental trajectories of brain functional connectivity, neurocognitive functions, and clinical symptoms in patients with attention-deficit hyperactivity disorder

Several studies on attention-deficit hyperactivity disorder (ADHD) have suggested a developmental sequence of brain changes: subcortico-subcortical connectivity in children, evolving to subcortico-cortical in adolescence, and culminating in cortico-cortical connectivity in young adulthood. This study hypothesized that children with ADHD would exhibit decreased functional connectivity (FC) between the cortex and striatum compared to adults with ADHD, who may show increased FC in these regions. Seventy-six patients with ADHD (26 children, 26 adolescents, and 24 adults) and 74 healthy controls (25 children, 24 adolescents, and 25 adults) participated in the study. Resting state magnetic resonance images were acquired using a 3.0 T Philips Achieva scanner. The results indicated a gradual decrease in the number of subcategories representing intelligence quotient deficits in the ADHD group with age. In adulthood, the ADHD group exhibited lower working memory compared to the healthy control group. The number of regions showing decreased FC from the cortex to striatum between the ADHD and control groups reduced with age, while regions with increased FC from the default mode network and attention network in the ADHD group increased with age. In adolescents and adults, working memory was positively associated with brain activity in the postcentral gyrus and negatively correlated with ADHD clinical symptoms. In conclusion, the findings suggest that intelligence deficits in certain IQ subcategories may diminish as individuals with ADHD age. Additionally, the study indicates an increasing anticorrelation between cortical and subcortical regions with age in individuals with ADHD.

Probing heterogeneity to identify individualized treatment approaches in autism: Specific clusters of executive function challenges link to distinct co-occurring mental health problems

LAY ABSTRACT

Many autistic people struggle with mental health problems like anxiety, depression, inattention, and aggression, which can be challenging to treat. Executive function challenges, which impact many autistic individuals, may serve as a risk factor for mental health problems or make treating mental health conditions more difficult. While some people respond well to medication or therapy, others do not. This study tried to understand if there are different subgroups of autistic young people who may have similar patterns of executive function strengths and challenges-like flexibility, planning, self-monitoring, and emotion regulation. Then, we investigated whether executive function subgroups were related to mental health problems in autistic youth. We found three different types of executive function subgroups in autistic youth, each with different patterns of mental health problems. This helps us identify specific profiles of executive function strengths and challenges that may be helpful with identifying personalized supports, services, and treatment strategies for mental health conditions.

Contextualizing Positionality, Intersectionality, and Intelligence in the Anthropocene

The geological epoch of the Anthropocene has challenged traditional definitions of what intellectual abilities are necessary to creatively problem-solve, understand, and address contemporary societal and environmental crises. If we hope to make meaningful changes to how our society addresses these complex issues and pave the way for a better future for generations to come, we must advance traditional theories and measures of higher-order abilities to reflect equity and inclusion. To this end, we must address global issues by integrating the complexities of intersectional identities as they impact our understanding of what constitutes intelligence in individuals, groups, and diverse communities. This re-envisioning of intelligence presents new complexities for understanding and challenges for our field beyond the boundaries of what has been previously touted by many disciplines, including psychology. It is an opportunity to re-envision what it means to be intelligent in a diverse global context while also honoring and recognizing the value of difference, positionality, and other ways of knowing.

Diagnostic Utility of Conners Continuous Performance Test-3 for Attention Deficit/Hyperactivity Disorder: A Systematic Review

OBJECTIVE

To review the literature on the utility of the Conners CPT-3 in persons with ADHD.

METHODS

A systematic review was conducted. Six databases were searched using inclusion criteria: research studies, year 2000+, English, and ages 8+. Two raters independently screened 1,480 title/abstracts and subsequently reviewed 399 full texts. Data extraction and critical appraisal were conducted. Reflective thematic analysis through inductive coding identified qualitative themes.

RESULTS

Thirteen studies met inclusion criteria with five themes identified. Five studies found CPT-3 was a weak or poor predictor of ADHD diagnosis while two found it was an adequate predictor. Two studies found CPT-3 could differentiate clients with comorbid ADHD/anxiety from ADHD or ADHD from obsessive-compulsive disorder. One found CPT-3 could not differentiate ADHD from ASD or comorbid ADHD/ASD.

CONCLUSIONS

Results revealed CPT-3 as a standalone measure is a weak or poor predictor of ADHD. Multiple measures for evaluating persons with ADHD are recommended.

Executive function deficits mediate the relationship between employees' ADHD and job burnout

Adults with Attention-Deficit/Hyperactivity Disorder (ADHD) often face significant deficits in executive function and adverse work-related outcomes. This study aimed to explore the role of executive function deficits in job burnout of employees with ADHD. We hypothesized that employees with ADHD, relative to employees without ADHD, will experience higher levels of job burnout and deficits in executive function. We also hypothesized that the ADHD-job burnout relationship would be mediated through executive function deficits, specifically by self-management to time and self-organization/problem-solving. A field study with 171 employees provided support for the research hypotheses and mediation model in which the employees' ADHD-job burnout relationship was mediated through executive function deficits. Additional mediation analyses indicated that the specific executive function of self-management to time and self-organization/problem-solving mediated the effect of ADHD on job burnout and its facets. Specifically, for physical fatigue, the mediation was realized through self-management to time, and for emotional exhaustion and cognitive weariness, the mediation was significant through self-organization/problem-solving. The present findings shed light on the relevance of referring ADHD among employees, their vulnerability to job burnout, and the role of executive function deficits in job burnout of employees with ADHD.

Review of Studies on Incremental Validity of Assessment Measures Used in Psychological Assessment of Attention-Deficit Hyperactivity Disorder

Few studies have summarized the literature relevant to the incremental validity of tools and procedures for the assessment of attention-deficit hyperactivity disorder (ADHD). The current project reviewed such studies published in the prior 18 years. Results from studies on the incremental validity of measures used in the assessment of ADHD were reviewed. Measures included symptom reports, clinical interviews, behavioral observation, continuous performance and other psychomotor tasks, intelligence tests, and measures of executive function. Twenty-nine published studies and two reviews were identified from 2004 to 2022. Incremental validity was determined using various statistics including R2, classification metrics, odds ratios, and post-test probabilities. Findings suggest that symptom reports from a collateral source and continuous performance test measures have incremental validity over self-reports and clinical interviews. Measures of intellectual and executive functioning did not show incremental validity in the diagnosis of ADHD. Findings are relevant to the practitioner, as they bear on the optimization of both the cost-effectiveness and the diagnostic accuracy of combined procedures in the assessment of ADHD.

Overactivated contextual visual perception and response to a single dose of methylphenidate in children with ADHD

The pathogenesis of overactivated visual perception in attention-deficit hyperactivity disorder (ADHD) remains unclear, which is interpreted as a cognitive compensation. The existing studies have proposed that perceptual abnormalities in neurodevelopmental disorders are associated with dysfunction of the contextual knowledge system, which influences the development and formation of perception. We hypothesized that alterations in contextual states may also be responsible for inducing perceptual abnormalities in ADHD. Therefore, the present study evaluated the characteristics of pre-stimulus alpha and its response to a single dose of methylphenidate (MPH). A total of 135 Chinese children participated in the first study, including 70 children with ADHD (age = 10.61 ± 1.93 years, female = 17) and 65 age- and sex-matched control children (age = 10.73 ± 1.93 years, female = 20). The second clinical trial included 19 Chinese children with ADHD (age = 11.85 ± 1.72 years, female = 4), with an identical visual spatial search task. Pre-stimulus alpha oscillations and P1 activity were significantly greater in children with ADHD than in the controls. Overactivated pre-stimulus alpha positively predicted P1. Both pre-stimulus alpha and P1 overactivation have beneficial effects on cognitive performance in children with ADHD. No intervening effect of a single dose of MPH on the compensatory activation of pre-stimulus alpha and P1 were observed. Our findings extended the perceptual activation to the contextual knowledge system, suggesting that compensatory perception in children with ADHD is more likely to be a top-down regulated cognitive operational process.

Is the Conners' continuous performance test helpful for assessing attention deficit hyperactivity disorder in a clinical setting?

BACKGROUND

Despite lacking validation for Norwegian populations, the Conners Continuous Performance Test II (CCPT-II) is applied to almost one-third of children receiving an ADHD diagnosis. However, evidence of the CCPT-II's ability to differentiate between children with and without ADHD is contradictory. Thus, this study examines how CCPT-II results correlate with ADHD symptoms reported by mothers and teachers in a sample representing ordinary child and adolescent mental health services and explores the extent to which the CCPT-II influences the diagnostic result.

METHODS

Correlations between CCPT-II results and ADHD Rating Scale scores and a clinical diagnosis of ADHD were analysed in children aged 6-15 years (N = 69) referred to a child and adolescent psychiatric outpatient clinic.

RESULTS

Total ADHD symptom scores rated by mothers correlated with hit reaction time (HRT) block change (.260), HRT inter-stimulus interval (ISI) change (.264) and CCPT-II overall index (.263), while hyperactivity subscale scores correlated with omissions (.285), HRT (.414) and variability (.400). In teachers' ratings, total ADHD and both subscale scores correlated with commissions (.280-.382), while hyperactivity scores correlated with variability (.265). A higher number of commissions was the only significant difference in CCPT-II performance between children diagnosed with and children without ADHD.

CONCLUSIONS

Correlations between CCPT-II results and ADHD symptoms were all small to moderate. As such, CCPT-II results should be interpreted with caution, because they correspond to a limited degree with other sources of information.

Arousal dysregulation and executive dysfunction in attention deficit hyperactivity disorder (ADHD)

Attention deficit/hyperactivity disorder (ADHD) is a heterogeneous neurodevelopmental condition, that continues to have an elusive etiological background. A number of extant models and theories have historically intended to explain the many factors contributing to ADHD behaviors. One of the most accepted hypotheses has been the executive dysfunction theory associating reduction in executive control to abnormalities in structure and operational dysfunction of dopaminergic signaling networks. Nevertheless, executive functions are not always impaired in ADHD, and the literature describes other symptoms commonly reported suggesting individuals with ADHD would appear to suffer from a more general deficit. Another existing line of research, that has gained much attention recently, establishes that ADHD would have dysregulated states of brain arousal that would account for its commonly observed cognitive deficits and behavioral symptoms, described as the state regulation theory, which has now included measures of autonomic function. This article describes some important aspects that compose and challenge these two most influential theoretical constructs, executive dysfunction and state-regulation, based on their empirical evidence, implying the need to reevaluate the norms used to classify individuals and establish ADHD diagnosis. Large number of controversial results continue to exist within the study of ADHD biological and/or performance markers, possibly due to such heterogeneity and variability within the same diagnosis. The need to resolve these issues and establish newly revised diagnostic criteria for ADHD is critical, as therapeutic success depends on having accurately identified underlying neurophysiological factors in order to appropriately address them in treatment.

Measurement Invariance of the WISC-V across a Clinical Sample of Children and Adolescents with ADHD and a Matched Control Group

Measurement invariance of the Wechsler Intelligence Scale for Children, Fifth Edition (WISC-V) 10-primary subtest battery was analyzed across a group of children and adolescents with ADHD (n = 91) and a control group (n = 91) matched by sex, age, migration background, and parental education or type of school. First, confirmatory factor analyses (CFAs) were performed to establish the model fit for the WISC-V second-order five-factor model in each group. A sufficiently good fit of the model was found for the data in both groups. Subsequently, multigroup confirmatory factor analyses (MGCFAs) were conducted to test for measurement invariance across the ADHD and control group. Results of these analyses indicated configural and metric invariance but did not support full scalar invariance. However, after relaxing equality constraints on the Vocabulary (VC), Digit Span (DS), Coding (CD), Symbol Search (SS), and Picture Span (PS) subtest intercepts as well as on the intercepts of the first-order factors Working Memory (WM) and Processing Speed (PS), partial scalar invariance could be obtained. Furthermore, model-based reliability coefficients indicated that the WISC-V provides a more precise measurement of general intelligence (e.g., represented by the Full-Scale IQ, FSIQ) than it does for cognitive subdomains (e.g., represented by the WISC-V indexes). Group comparisons revealed that the ADHD group scored significantly lower than the control group on four primary subtests, thus achieving significantly lower scores on the corresponding primary indexes and the FSIQ. Given that measurement invariance across the ADHD and the control group could not be fully confirmed for the German WISC-V, clinical interpretations based on the WISC-V primary indexes are limited and should only be made with great caution regarding the cognitive profiles of children and adolescents with ADHD.

Masking effect of high IQ on the Rey Auditory Verbal Learning Test in an adult sample with attention deficit/hyperactivity disorder

OBJECTIVE

High intelligence (IQ) adults with attention-deficit/hyperactivity disorder (ADHD) often perform better on neuropsychological tests relative to average IQ adults with ADHD, despite commensurate functional impairment. This study compared adults with ADHD and high versus average IQ on the Rey Auditory Verbal Learning Test (RAVLT) to specifically assess this proposed masking effect of IQ on verbal learning/memory performance among those undergoing neuropsychological evaluation.

METHOD

RAVLT performance between patients with ADHD and average versus high Test of Premorbid Function-estimated IQ were compared. Latent growth curve modeling (LGCM) evaluated learning acquisition across trials.

RESULTS

RAVLT total learning, immediate, and delayed free recall performances were significantly better in the high IQ relative to the average IQ group. LGCM showed similar quadradic growth trajectories for both IQ groups. Both groups reported equivalent symptom severity and functional complaints in childhood and adulthood.

CONCLUSIONS

Adults with ADHD and high IQ performed normally on a verbal learning/memory test compared to adults with average IQ, who scored 0.5-1.0 standard deviations below the mean. These results suggest a masking of performance-based memory deficits in the context of higher IQ in adults with ADHD, supporting growing evidence that higher IQ masks neurocognitive deficits during the assessment of adults with ADHD.

Minnesota Multiphasic Personality Inventory-2-Restructured Form Profiles Among Adults With Attention-Deficit/Hyperactivity Disorder: Examining the Effect of Comorbid Psychopathology and ADHD Presentation

OBJECTIVE

Despite widespread use of the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF), it is surprisingly understudied among adults with attention-deficit/hyperactivity disorder (ADHD). This is significant as ADHD is a frequent referral for neuropsychological evaluation; however, the core symptom of attention difficulty is a nonspecific sequela of many psychological disorders. This study aimed to characterize MMPI-2-RF profiles among adults with ADHD and examine the effect of comorbid psychopathology.

METHOD

A large, demographically diverse sample of 413 consecutive adults referred for neuropsychological evaluation to assist with differential diagnosis of ADHD who completed the MMPI-2-RF was examined. Profiles of the 145 patients diagnosed with ADHD-only were compared to 192 with ADHD and a comorbid psychological disorder and a 55-patient non-ADHD psychiatric comparison group. Among the ADHD-only group, profiles also were compared based on ADHD-presentation type (Predominantly Inattentive vs. Combined presentation).

RESULTS

The ADHD/psychopathology and psychiatric comparison groups scored higher than the ADHD-only group across nearly all scales with widespread clinical elevations. Conversely, the ADHD-only group displayed an isolated elevation on the Cognitive Complaints scale. Comparison between ADHD presentations revealed several small-moderate significant differences, the largest of which occurred on the Externalizing and Interpersonal scales.

CONCLUSIONS

Adults with ADHD alone, and no other psychopathology have a unique MMPI-2-RF profile characterized by isolated elevation on the Cognitive Complaints scale. These results support use of the MMPI-2-RF in assessment of adults with ADHD as it can help distinguish ADHD alone from ADHD/comorbid psychopathology and identify relevant psychiatric comorbidities that may be contributing to patients' inattention complaints.

Neuropsychological Assessment of the Relationship of Working Memory with K-BIT Matrices and Vocabulary in Normal Development and ADHD Children and Adolescents

BACKGROUND

The present report tries to understand the possible relationship between working memory (WM) and intelligence measurements, using the direct scores of the Working Memory Test Battery for Children (WMTBC) and Kaufman's Brief Intelligence Test (K-BIT), in normal development (ND) and diagnosed attention deficit hyperactivity disorder (ADHD) children and adolescents.

RESULTS

Partial correlations, discounting the effect of age, showed a significant correlation in ND subjects between the central executive (CE) component of WM and the WM visuospatial sketchpad (VSS) component and the WM phonological loop (PL); also, significant correlations were obtained for the WM VSS with the K-BIT Matrices scores, the WM PL with the K-BIT Vocabulary, and the K-BIT Matrices scores with the K-BIT Vocabulary. For ADHD subjects, there were significant correlations between WM VSS and WM CE, and WM VSS and K-BIT Matrices. We tested the robustness of these correlations by selecting a small number of subjects through permutations; a robust correlation between WM CE and WM PL in ND, and between WM VSS and WM CE and WM VSS and K-BIT Matrices scores was obtained. These results were also supported by mediation analysis.

CONCLUSIONS

There is a relationship during development between WM as measured with WMTBC and general intelligence as measured with K-BIT in ND and ADHD subjects. The dysexecutive character of ADHD has been shown, given that by controlling for intelligence, the differences in WM performance between ND and ADHD disappear, except for WM CE. The results suggest that in ADHD subjects, the WM VSS component presents a more pivotal role during cognitive processing compared to ND subjects.

Clinical and Cognitive Features of Attention Deficit Hyperactivity Disorder with Intellectual Giftedness: A Systematic Review

A systematic review was carried out on publications from the last 15 years that have studied the effect of intellectual giftedness, defined as IQ > 115, on the clinical and cognitive features of ADHD. Studies indicate that about 15% of people with high IQ meet ADHD criteria. IQ has shown no effect on the pharmacological treatment, and comorbidity does not differ from that of other children with ADHD. High IQ-ADHD, compared to average IQ-ADHD, tends to show less severity in cognitive and behavioral symptoms, as well as a better prognosis; however high IQ may mask ADHD symptoms delaying diagnosis and treatment.

A longitudinal investigation of parental ratings and performance metrics for executive functioning and symptom severity in clinically referred youth with ADHD

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.

COGMED working memory training in children with Attention Deficit/Hyperactivity Disorder (ADHD): A feasibility study in Saudi Arabia

Working memory training has been proven effective for improving cognitive functioning in patients with Attention Deficit/Hyperactivity Disorder (ADHD). However, the feasibility of this type of training for children in Saudi Arabia has not been previously explored. We investigated the feasibility of implementing Cogmed Working Memory Training (CWMT) in a sample of 29 Saudi children with ADHD. We found no significant demographic or clinical differences between compliant and noncompliant children. Although compliant children were initially better at following instructions and reported better improvements in working memory and math skills compared to those who did not complete the CWMT, all children who participated in the program showed improvements in performing the CWMT tasks. Most parents found the Cogmed training feasible for their children, were satisfied and keen to continue with the program, and felt the training helped them to address their problems. Most children did not encounter any difficulties in using the software, and many families were, therefore, likely to continue using the techniques from the program. We conclude that CWMT for children with ADHD is feasible in Saudi Arabia. Larger case-controlled studies are needed to thoroughly investigate the effects of CWMT compared to other interventions in Saudi children with ADHD.

[Formula: see text] Does training working memory or inhibitory control produce far-transfer improvements in set shifting for children with ADHD? A randomized controlled trial

Children with ADHD show impairments in set shifting task performance. However, the limited available evidence suggests that directly training shifting may not improve shifting performance in this population. We hypothesized that this incongruence may be because impairments exhibited by children with ADHD during shifting tasks are due to deficits in other executive functions, as shifting tasks also engage children's working memory and/or inhibitory control abilities. This randomized controlled trial examined the extent to which neurocognitive training of working memory vs. inhibitory control can produce downstream (far-transfer) improvements in set shifting task performance. Children with ADHD ages 8-12 (M = 10.41, SD = 1.46; 12 girls; 74% White/Non-Hispanic) were randomized to either central executive training (CET; n = 25) or inhibitory control training (ICT; n = 29), two next-generation digital therapeutics previously shown to improve their intended neurocognitive targets. Two criterion set shifting tests were administered at pre- and post-treatment. Results indicated that ICT was superior to CET for improving shifting accuracy (treatmentxtime: p = .03, BF10 = 3.01, η2 = .09, d = 0.63). ICT was also superior to CET for improving shifting speed, albeit on only one of the two outcome tasks (p = .02, BF10 = 4.53, η2 = .08, d = 0.59). CET did not produce improvements in shifting speed or accuracy on either task (p > .52, BF01 > 2.62), but showed evidence for more general (non-shifting-specific) improvement in response times on one of the outcome tasks (shift trials, d = 0.70; non-shift trials, d = 0.68). Taken together, these findings confirm that inhibitory control is important for successful performance on shifting tests, and suggest that training inhibitory control may reflect a method for improving set shifting difficulties in children with ADHD.

Network Analysis of ADHD Symptoms and Cognitive Profiles in Children

Purpose

Although many studies have reported the cognitive profiles in attention-deficit/hyperactivity disorder (ADHD), the interactions between ADHD symptoms and the patients' cognitive profiles have not been carefully examined through the network analysis. Here, in this study, we systematically analyzed the ADHD patents' symptoms and cognitive profiles, and identified a set of interactions between ADHD symptoms and cognitive domains using the network approach.

Patients and Methods

A total of 146 children with ADHD, 6 to 15 years of age, were included in the study. All participants were assessed by the Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV) test. The patients' ADHD symptoms were evaluated by the Vanderbilt ADHD parent and teacher rating scales. GraphPad Prism 9.1.1 software was used for descriptive statistics and R 4.2.2 was used for network model construction.

Results

The ADHD children in our sample showed lower scores for full scale intelligence quotient (FSIQ), verbal comprehension index (VCI), processing speed index (PSI) and working memory index (WMI). Among all the ADHD core symptoms and comorbid symptoms, the academic ability, inattention symptoms and mood disorder showed direct interaction with the cognitive domains of WISC-IV. In addition, oppositional defiant of the ADHD comorbid symptoms, and perceptual reasoning of the cognitive domains exhibited the highest strength centrality in the ADHD-Cognition network based on parent ratings. Classroom behaviors of the ADHD functional impairment, and verbal comprehension of the cognitive domains exhibited the highest strength centrality in the network based on teacher ratings.

Conclusion

We highlighted the importance of considering the interactions between the ADHD symptoms and cognitive properties when designing the intervention plans for the ADHD children.

Sensitivity and Specificity of the ImPACT Neurocognitive Test in Collegiate Athletes and US Military Service Academy Cadets with ADHD and/or LD: Findings from the NCAA-DoD CARE Consortium

BACKGROUND AND OBJECTIVE

Computer-based neurocognitive tests are widely used in sport-related concussion management, but the performance of these tests is not well understood in the participant population with attention-deficit/hyperactivity disorder (ADHD) and/or learning disorder (LD). This research estimates the sensitivity and specificity performance of the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) computer-based neurocognitive test in identifying concussion in this population.

METHODS

Study participants consisted of collegiate university athletes and military service academy cadets from the National Collegiate Athletic Association-Department of Defense CARE Consortium who completed the ImPACT test between 2014 and 2021. Participants who self-identified as belonging to one of the subgroups of interest (ADHD with or without LD [ADHD:LD+/-], LD with or without ADHD [LD:ADHD+/-], ADHD and/or LD [ADHD a/o LD]) and completed a baseline (1874 ADHD:LD+/-, 779 LD:ADHD+/-, 2338 ADHD a/o LD) or 24-48 h post-concussion (175 ADHD:LD+/-, 77 LD:ADHD+/-, 216 ADHD a/o LD) ImPACT assessment were included. Sensitivity and specificity were calculated using a normative data method and three machine learning classification methods: logistic regression, classification and regression tree, and random forest.

RESULTS

Using the four methods, participants with ADHD:LD+/- had sensitivities that ranged from 0.474 to 0.697, and specificities that ranged from 0.538 to 0.686. Participants with LD:ADHD+/- had sensitivities that ranged from 0.455 to 0.688, and specificities that ranged from 0.456 to 0.588. For participants with ADHD a/o LD, sensitivities ranged from 0.542 to 0.755, and specificities ranged from 0.451 to 0.724.

CONCLUSIONS

For all subgroups and analytical methods, the results illustrate sensitivity and specificity values below typically accepted levels indicative of clinical utility. These findings support that using ImPACT alone may be insufficient to inform concussion diagnoses and encourages the use of a multi-dimensional concussion assessment.

Rare copy number variants in males and females with childhood attention-deficit/hyperactivity disorder

While childhood attention-deficit/hyperactivity disorder (ADHD) is more prevalent in males than females, genetic contributors to this effect have not been established. Here, we explore sex differences in the contribution of common and/or rare genetic variants to ADHD. Participants were from the Adolescent Brain and Cognitive Development study (N = 1253 youth meeting DSM-5 criteria for ADHD [mean age = 11.46 years [SD = 0.87]; 31% female] and 5577 unaffected individuals [mean age = 11.42 years [SD = 0.89]; 50% female], overall 66% White, non-Hispanic (WNH), 19% Black/African American, and 15% other races. Logistic regression tested for interactions between sex (defined genotypically) and both rare copy number variants (CNV) and polygenic (common variant) risk in association with ADHD. There was a significant interaction between sex and the presence of a CNV deletion larger than 200 kb, both in the entire cohort (β = -0.74, CI = [-1.27 to -0.20], FDR-corrected p = 0.048) and, at nominal significance levels in the WNH ancestry subcohort (β = -0.86, CI = [-1.51 to -0.20], p = 0.010). Additionally, the number of deleted genes interacted with sex in association with ADHD (whole cohort. β = -0.13, CI = [-0.23 to -0.029], FDR-corrected p = 0.048; WNH. β = -0.17, CI = [-0.29 to -0.050], FDR-corrected p = 0.044) as did the total length of CNV deletions (whole cohort. β = -0.12, CI = [-0.19 to -0.044], FDR-corrected p = 0.028; WNH. β = -0.17, CI = [-0.28 to -0.061], FDR-corrected p = 0.034). This sex effect was driven by increased odds of childhood ADHD for females but not males in the presence of CNV deletions. No similar sex effect was found for CNV duplications or polygenic risk scores. The association between CNV deletions and ADHD was partially mediated by measures of cognitive flexibility. In summary, CNV deletions were associated with increased odds for childhood ADHD in females, but not males.

Identifying Replicable Subgroups in Neurodevelopmental Conditions Using Resting-State Functional Magnetic Resonance Imaging Data

IMPORTANCE

Neurodevelopmental conditions, such as autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), and obsessive-compulsive disorder (OCD), have highly heterogeneous and overlapping phenotypes and neurobiology. Data-driven approaches are beginning to identify homogeneous transdiagnostic subgroups of children; however, findings have yet to be replicated in independently collected data sets, a necessity for translation into clinical settings.

OBJECTIVE

To identify subgroups of children with and without neurodevelopmental conditions with shared functional brain characteristics using data from 2 large, independent data sets.

DESIGN, SETTING, AND PARTICIPANTS

This case-control study used data from the Province of Ontario Neurodevelopmental (POND) network (study recruitment began June 2012 and is ongoing; data were extracted April 2021) and the Healthy Brain Network (HBN; study recruitment began May 2015 and is ongoing; data were extracted November 2020). POND and HBN data are collected from institutions across Ontario and New York, respectively. Participants who had diagnoses of ASD, ADHD, and OCD or were typically developing (TD); were aged between 5 and 19 years; and successfully completed the resting-state and anatomical neuroimaging protocol were included in the current study.

MAIN OUTCOMES AND MEASURES

The analyses consisted of a data-driven clustering procedure on measures derived from each participant's resting-state functional connectome, performed independently on each data set. Differences between each pair of leaves in the resulting clustering decision trees in the demographic and clinical characteristics were tested.

RESULTS

Overall, 551 children and adolescents were included from each data set. POND included 164 participants with ADHD; 217 with ASD; 60 with OCD; and 110 with TD (median [IQR] age, 11.87 [9.51-14.76] years; 393 [71.2%] male participants; 20 [3.6%] Black, 28 [5.1%] Latino, and 299 [54.2%] White participants) and HBN included 374 participants with ADHD; 66 with ASD; 11 with OCD; and 100 with TD (median [IQR] age, 11.50 [9.22-14.20] years; 390 [70.8%] male participants; 82 [14.9%] Black, 57 [10.3%] Hispanic, and 257 [46.6%] White participants). In both data sets, subgroups with similar biology that differed significantly in intelligence as well as hyperactivity and impulsivity problems were identified, yet these groups showed no consistent alignment with current diagnostic categories. For example, there was a significant difference in Strengths and Weaknesses ADHD Symptoms and Normal Behavior Hyperactivity/Impulsivity subscale (SWAN-HI) between 2 subgroups in the POND data (C and D), with subgroup D having increased hyperactivity and impulsivity traits compared with subgroup C (median [IQR], 2.50 [0.00-7.00] vs 1.00 [0.00-5.00]; U = 1.19 × 104; P = .01; η2 = 0.02). A significant difference in SWAN-HI scores between subgroups g and d in the HBN data was also observed (median [IQR], 1.00 [0.00-4.00] vs 0.00 [0.00-2.00]; corrected P = .02). There were no differences in the proportion of each diagnosis between the subgroups in either data set.

CONCLUSIONS AND RELEVANCE

The findings of this study suggest that homogeneity in the neurobiology of neurodevelopmental conditions transcends diagnostic boundaries and is instead associated with behavioral characteristics. This work takes an important step toward translating neurobiological subgroups into clinical settings by being the first to replicate our findings in independently collected data sets.

Acquisition of cognitive and communication milestones in infants with Down syndrome

BACKGROUND

Understanding the timing of developmental milestones in typical and clinical populations facilitates intervention planning and the early detection of risk for co-occurring conditions. Normative timing of developmental milestone achievement has been established for typically developing children. However, there is little information regarding the timing of cognitive and communication skill acquisition in young children with Down syndrome (DS). The objectives of this study are to (1) provide foundational information regarding the timing of cognitive and communication skill acquisition in infants with DS and (2) facilitate the early identification of infants with risk for co-occurring conditions.

METHOD

Seventy-four infants with DS (age range: 4-18 months) completed the Bayley Scales of Infant Development-III (Bayley 2006). Individual items from the cognitive and communication scales were selected for analysis. Parents provided information regarding their infant's developmental and family history.

RESULTS

The percentage of infants who attained each skill was calculated within 2-month age bands. For infants who did not show skill acquisition within each age band, the rates of prematurity, heart defects, corrective heart surgery and significant illness were calculated as well.

CONCLUSIONS

This study provides foundational information that can contribute to the formulation of a developmental schedule for cognitive and language milestone acquisition in infants with DS.

Neuropsychological and Symptom Predictors of Diagnostic Persistence in ADHD: A 25-Year Follow-up Study

BACKGROUND

This study extends long-term predictive research on ADHD by including both neuropsychological and symptom measures at baseline in adolescence as predictors of diagnostic persistence 25 years later.

METHODS

Nineteen males with ADHD and 26 healthy controls (HC; M/F = 13/13), were assessed in adolescence and 25 years later. Measurements at baseline included a comprehensive test battery measuring eight neuropsychological domains, an IQ estimate, the Child Behavior Checklist (CBCL), and the Global Assessment Scale of Symptoms. Differences between ADHD Retainers, Remitters, and HC were calculated with ANOVAs, and potential predictions of differences in the ADHD group by linear regression analyses.

RESULTS

Eleven (58%) participants retained their ADHD diagnoses at follow-up. Motor Coordination and Visual perception at baseline predicted diagnosis at follow-up. CBCL Attention problems at baseline in the ADHD group predicted variance in diagnostic status.

CONCLUSION

Lower-order neuropsychological functions related to motor function and perception are important long-time predictors of persistence of ADHD.

Is WISC-IV Working Memory Index associated with ADHD symptoms in 7-8-year-olds?

The Working Memory Index (WMI) in the Wechsler Intelligence Scale for Children (WISC) has been suggested to be associated with ADHD symptoms. The relationship between WMI and ADHD symptoms in the general population is not clear. The study aimed to examine the association between working memory (WM) and behavioral regulation (BR), and hyperactivity/inattention (HI) in a general population sample of 7-8-year-olds, and whether general intellectual functioning is associated with BR and HI. The study also examined if those with low WMI also fulfill elevated ADHD criteria. The study group (N = 865) was assessed with the WISC (Fourth edition), the Behavior Rating Inventory of Executive Function, the Strengths and Difficulties Questionnaire, and the Five to Fifteen Questionnaire, and divided into three groups based on WM function, and in relation to BR and/or HI problems. The associations between WM and BR, and WM and HI, including intellectual functioning as covariate, were examined. WM deficits were found in 22%, but the majority of those had no BR or HI problems. Four percent in the study group had WM deficits combined with BR and/or HI problems, and in about one third of those inattentive ADHD criteria were fulfilled. WM and prosocial behavior were associated with BR and HI. WM deficits measured with WISC WMI in 7-8-year-olds do not always signal BR and/or HI problems.

Validation of a Bayesian Diagnostic and Inferential Model for Evidence-Based Neuropsychological Practice

OBJECTIVE

Evidence-based diagnostic methods have clinical and research applications in neuropsychology. A flexible Bayesian model was developed to yield diagnostic posttest probabilities from a single person's neuropsychological score profile by utilizing sample descriptive statistics of the test battery across diagnostic populations of interest.

METHODS

Three studies examined the model's performance. One simulation examined estimation accuracy of true z-scores. A diagnostic accuracy simulation utilized descriptive statistics from two popular neuropsychological tests, the Wechsler Adult Intelligence Scale-IV (WAIS-IV) and Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). The final simulation examined posterior predictive accuracy of scores to those reported in the WAIS manual.

RESULTS

The model produced minimally biased z-score estimates (root mean square errors: .02-.18) with appropriate credible intervals (95% credible interval empirical coverage rates: .94-1.00). The model correctly classified 80.87% of simulated normal, mild cognitive impairment, and Alzheimer's disease cases using a four subtest WAIS-IV and the RBANS compared to accuracies of 60.67-65.60% from alternative methods. The posterior predictions of raw scores closely aligned to percentile estimates published in the WAIS-IV manual.

CONCLUSION

This model permits estimation of posttest probabilities for various combinations of neuropsychological tests across any number of clinical populations with the principal limitation being the accessibility of applicable reference samples. The model produced minimally biased estimates of true z-scores, high diagnostic classification rates, and accurate predictions of multiple reported percentiles while using only simple descriptive statistics from reference samples. Future nonsimulation research on clinical data is needed to fully explore the utility of such diagnostic prediction models.

Assessment of learning and memory impairments in adults with predominately inattentive versus combined presentation attention-deficit/hyperactivity disorder

This cross-sectional study compared adults diagnosed with Attention-Deficit/Hyperactivity Disorder-Inattentive (ADHD-I) and ADHD-Combined (ADHD-C) presentations with a non-ADHD group on verbal and visual learning and delayed recall using the Rey Auditory Verbal Learning Test (RAVLT) and Brief Visuospatial Memory Test-Revised (BVMT-R), respectively. Data from 380 predominately college student adult outpatients were used, with 155 who met criteria for ADHD-I, 165 who met criteria for ADHD-C, and 60 who did not meet criteria for ADHD but were diagnosed with a primary depressive or anxiety disorder or received no diagnosis. Each patient was administered the RAVLT and BVMT-R as part of a comprehensive neuropsychological evaluation. Significant main effects of study group were found, such that patients with ADHD-C demonstrated worse learning and delayed recall of both verbal and visual information than patients with ADHD-I and the non-ADHD group. Patients with ADHD-I performed comparably to the non-ADHD group, apart from visual learning and delayed recall. Notably, more patients in the ADHD groups had possible or probable learning and memory impairment compared to the non-ADHD group. Findings were consistent with previous research indicating that those with ADHD exhibit poorer verbal and visual learning and delayed recall than those without ADHD.

The Mediatory Role of Executive Functioning on the Association Between Sleep and Both Everyday Memory and ADHD Symptoms in Children and Youth With Down Syndrome

People with Down syndrome (DS) commonly experience challenges with sleep, executive functioning, everyday memory, and symptoms of attention deficit hyperactivity disorder (ADHD). A path analysis was conducted to determine if executive function mediated the relationship between sleep problems and both everyday memory and ADHD symptoms. Parents of 96 children and youth with DS completed questionnaires related to sleep, executive functioning, everyday memory, and ADHD symptoms. Results showed that executive functioning fully mediated the relation between sleep and both everyday memory and ADHD symptoms. Implications for education and intervention for children and youth with DS are discussed.

Mechanism-based groups of children with ADHD are associated with distinct domains of impairment

Person-oriented analyses are commonly used to identify subgroups of children with mental health conditions in the hopes that they will meaningfully inform the taxonomy, assessment, and treatment of psychological disorder. However, whether these data-driven groups are demonstrably better at predicting important aspects of adaptive functioning than standard DSM taxonomy has not been established. Using Attention-Deficit-Hyperactivity-Disorder (ADHD) as a model condition, we utilized dimensions of personality and cognitive ability to identify person-centered profiles of school-aged children (N=246) and evaluated the association of these profiles with critical areas of adaptive functioning. A single profile ("Conscientious") represented non-ADHD controls and was characterized by faster drift rate and higher executive functioning scores. Three profiles ("Disagreeable," "Negative Emotionality," and "Extraverted") were identified for children with ADHD. Drift rate, but not executive functioning, distinguished among ADHD profiles, which were also distinctly associated with comorbid externalizing and internalizing psychopathology, social skills, and academic achievement. In contrast, the Diagnostic and Statistical Manual (DSM) presentations were not informative and showed similar patterns of impairment across domains. Person-centered profiles of children with ADHD are associated with distinct adaptive functioning deficits and may be useful in informing clinical practice.

Intra-Subject Variability, Intelligence, and ADHD Traits in a Community-Based Sample

OBJECTIVE

The present study investigates the predictive validity of intra-subject variability (ISV) for ADHD traits in a community-based sample and the stability of the relationship between ISV and fluid intelligence (gf) across the continuum of ADHD traits.

METHOD

Age-residualized data from 426 participants (8-18 years, 6% ADHD) was used to investigate whether ex-Gaussian and DDM parameters derived from simple choice-reaction-time tasks can predict continuously assessed ADHD traits. Multiple-Group-Analyses and Latent-Moderated-Structural-Equations were used to test whether ADHD traits moderate the relationship between ISV and gf.

RESULTS

σ and μ of the ex-Gaussian model as well as DDM parameters drift rate (v) and boundary separation (a) significantly predicted general ADHD traits, while τ predicted attention difficulties specifically. Across the ADHD continuum, σ and v were significant predictors of gf.

CONCLUSION

The results confirm the link between ISV and ADHD. The relationship between ISV and gf appears stable across the ADHD continuum.

Clinical characteristics of children and adolescents with ADHD with or without methylphenidate prescription at their first diagnostic assessment

Attention Deficit/Hyperactivity Disorder (ADHD) is the most prevalent neurodevelopmental disorder diagnosed in the scholar age. It is associated with significant impairment in global functioning, and in moderate/severe presentations the outcome is critically dependent on pharmacological optimization of the multi-modal treatment. Methylphenidate (MPH) is the first-choice pharmacological treatment in children and adolescents with ADHD, with substantial evidence of significant efficacy and effectiveness on global functioning and symptoms' severity. There is some evidence supporting a few clinical and socio-demographic variables as predictors of pharmacological treatment prescription in children with ADHD independently of ADHD symptoms severity. However, it is warranted to investigate clinical and general psychopathological characteristics potentially associated with negative outcomes and the need for pharmacological treatment to inform appropriate prescription strategies. In this context, we compared 268 children and adolescents who were prescribed MPH (ADHD/MPH) for the first time after their first diagnostic assessment at our center, and 444 children and adolescents with ADHD (ADHD/noMPH) who were recommended non-pharmacological evidence-based interventions alone. ADHD/MPH group had higher severity of non-ADHD psychopathological symptoms compared to the ADHD/noMPH group, as documented by higher scores on the Child Behavior Checklist (CBCL) subscales, higher severity of ADHD symptoms, lower average IQ and lower adaptive levels independently of IQ. More specifically, beside externalizing symptoms, also internalizing symptoms were significantly higher in the ADHD/MPH group. The presence of significant non-ADHD psychopathology should be considered as a clinical factor associated with the need for MPH prescription in children and adolescents with ADHD.

Information-based multivariate decoding reveals imprecise neural encoding in children with attention deficit hyperactivity disorder during visual selective attention

Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder in school-age children. Attentional orientation is a potential clinical diagnostic marker to aid in the early diagnosis of ADHD. However, the underlying pathophysiological substrates of impaired attentional orienting in childhood ADHD remain unclear. Electroencephalography (EEG) was measured in 135 school-age children (70 with childhood ADHD and 65 matched typically developing children) to directly investigate target localization during spatial selective attention through univariate ERP analysis and information-based multivariate pattern machine learning analysis. Compared with children with typical development, a smaller N2pc was found in the ADHD group through univariate ERP analysis. Children with ADHD showed a lower parieto-occipital multivariate decoding accuracy approximately 240-340 ms after visual search onset, which predicts a slower reaction time and larger standard deviation of reaction time. Furthermore, a significant correlation was found between N2pc and decoding accuracy in typically developing children but not in children with ADHD. These observations reveal that impaired attentional orienting in ADHD may be due to inefficient neural encoding responses. By using a personalized information-based multivariate machine learning approach, we have advanced the understanding of cognitive deficits in neurodevelopmental disorders. Our study provides potential research directions for the early diagnosis and optimization of personalized intervention in children with ADHD.

ADHD and its neurocognitive substrates: A two sample Mendelian randomization study

Attention-deficit/hyperactivity disorder (ADHD) is associated with a wide array of neural and cognitive features, and other psychiatric disorders, identified mainly through cross-sectional associations studies. However, it is unclear if the disorder is causally associated with these neurocognitive features. Here, we applied a two-sample bidirectional Mendelian randomization (MR) study to summary GWAS data to explore the presence and direction of a causal effect between ADHD and a range of neurocognitive features and other psychiatric disorders. The inverse variance weighted method was used in the main analysis, and two MR methods (MR-Egger, weighted median) were used for robustness checks. We found that genetic risk for ADHD was causally associated with a decreased area of lateral orbitofrontal cortex. Conversely, we found that brain volume and some features of intrinsic functional connectivity had causal effects on ADHD risk. Bidirectional causal links were found between ADHD and adult general intelligence, as well as depression and autistic spectrum disorders. Such work highlights the important ties between ADHD and general cognitive ability, and suggest some neural features, previously merely associated with the disorder, may play a causal role in its pathogenesis.

DeepND: Deep multitask learning of gene risk for comorbid neurodevelopmental disorders

Autism spectrum disorder and intellectual disability are comorbid neurodevelopmental disorders with complex genetic architectures. Despite large-scale sequencing studies, only a fraction of the risk genes was identified for both. We present a network-based gene risk prioritization algorithm, DeepND, that performs cross-disorder analysis to improve prediction by exploiting the comorbidity of autism spectrum disorder (ASD) and intellectual disability (ID) via multitask learning. Our model leverages information from human brain gene co-expression networks using graph convolutional networks, learning which spatiotemporal neurodevelopmental windows are important for disorder etiologies and improving the state-of-the-art prediction in single- and cross-disorder settings. DeepND identifies the prefrontal and motor-somatosensory cortex (PFC-MFC) brain region and periods from early- to mid-fetal and from early childhood to young adulthood as the highest neurodevelopmental risk windows for ASD and ID. We investigate ASD- and ID-associated copy-number variation (CNV) regions and report our findings for several susceptibility gene candidates. DeepND can be generalized to analyze any combinations of comorbid disorders.

The three-year outcome of emotional symptoms in clinically referred youth with ADHD and their relationship to neuropsychological functions

Background

Further knowledge is needed regarding long-term outcome of emotional symptoms, and the interplay between these symptoms and neuropsychological functioning in youth with attention deficit hyperactivity disorder (ADHD).

Objective

We aimed to explore the effect of performance-based neurocognitive functions and parent-rated behavioral executive functioning (EF) on self-rated and parent-rated internalizing symptoms longitudinally in clinically referred youth with ADHD (n = 137; mean age = 12.4 years). We also aimed to examine the change in self-rated emotional symptoms in the ADHD group and a Control group (n = 59; mean age = 11.9 years).

Method

At baseline, and three years later, parents completed rating scales of their child’s ADHD symptoms (Swanson Nolan Pelham Scale, Version IV – SNAP-IV), emotional symptoms (Five To Fifteen Questionnaire, Strengths, and Difficulties Questionnaire), and EF (Behavior Rating Inventory of Executive Function). At the same time, the child completed self-report measures of Anxiety, Depression, and Anger Inventories (the Beck Youth Inventories) and neurocognitive measures (Conner’s Continuous Performance Test, Version II (CPT-II), Working Memory and Processing Speed composites (Wechsler Intelligence Scales). Statistical analyses were linear and logistic mixed models.

Results

Using longitudinal data, parent- and self-ratings of emotional symptoms were associated with parent-ratings of EF behavior in youth with ADHD. Plan/organizing deficits were associated with Anxiety and Anger over and above other metacognitive subscales, while Emotional Control was related to Anger over and above other behavior regulation subscales. In the ADHD group, Anger symptoms improved across measuring points. When controlling for age, Anxiety, and Depression symptoms were largely stable in both groups, however at higher levels in the ADHD group. The differences in anxiety and depression symptoms across groups decreased over time.

Conclusions

The current study emphasizes the importance of identification, monitoring, and treatment of emotional symptoms, and behavioral aspects of EF in youth with ADHD.

Paths to postsecondary education enrollment among adolescents with and without childhood attention-deficit/hyperactivity disorder (ADHD): A longitudinal analysis of symptom and academic trajectories

We examined developmental trajectories of attention-deficit/hyperactivity disorder (ADHD) symptoms, standardized achievement, and school performance for adolescents with and without ADHD who did and did not enroll in postsecondary education (PSE; N = 749; 79% boys; 63% White, 17% non-Hispanic Black, 10% Hispanic, and 10% other ethnicities). In a multisite study (recruitment based in New York, North Carolina, Pennsylvania, California, and Quebec), participants were originally enrolled between 1994 and 1998 at ages 7 to 9.9 and followed up through 2012 (M_age = 25 at final follow-up). Adolescents who eventually enrolled in PSE had less severe symptoms, but differences were modest and trajectories were similar over time. For all adolescents, standardized achievement trajectories declined up to two thirds of a standard deviation from ages 9 to 17. By the end of high school, the average GPA of adolescents with ADHD was three quarters of a point higher for those who eventually enrolled in PSE compared to those who did not. Overall, school performance mattered more than academic achievement for understanding eventual enrollment of adolescents with ADHD.

Genetics in the ADHD Clinic: How Can Genetic Testing Support the Current Clinical Practice?

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder with a childhood prevalence of 5%. In about two-thirds of the cases, ADHD symptoms persist into adulthood and often cause significant functional impairment. Based on the results of family and twin studies, the estimated heritability of ADHD approximates 80%, suggests a significant genetic component in the etiological background of the disorder; however, the potential genetic effects on disease risk, symptom severity, and persistence are unclear. This article provides a brief review of the genome-wide and candidate gene association studies with a focus on the clinical aspects, summarizing findings of ADHD disease risk, ADHD core symptoms as dimensional traits, and other traits frequently associated with ADHD, which may contribute to the susceptibility to other comorbid psychiatric disorders. Furthermore, neuropsychological impairment and measures from neuroimaging and electrophysiological paradigms, emerging as potential biomarkers, also provide a prominent target for molecular genetic studies, since they lie in the pathway from genes to behavior; therefore, they can contribute to the understanding of the underlying neurobiological mechanisms and the interindividual heterogeneity of clinical symptoms. Beyond the aforementioned aspects, throughout the review, we also give a brief summary of the genetic results, including polygenic risk scores that can potentially predict individual response to different treatment options and may offer a possibility for personalized treatment for the therapy of ADHD in the future.

Cognitive performance in children and adolescents with psychopathology traits: A cross-sectional multicohort study in the general population

Psychopathology and cognitive development are closely related. Assessing the relationship between multiple domains of psychopathology and cognitive performance can elucidate which cognitive tasks are related to specific domains of psychopathology. This can help build theory and improve clinical decision-making in the future. In this study, we included 13,841 children and adolescents drawn from two large population-based samples (Generation R and ABCD studies). We assessed the cross-sectional relationship between three psychopathology domains (internalizing, externalizing, dysregulation profile (DP)) and four cognitive domains (vocabulary, fluid reasoning, working memory, and processing speed) and the full-scale intelligence quotient. Lastly, differential associations between symptoms of psychopathology and cognitive performance by sex were assessed. Results indicated that internalizing symptoms were related to worse performance in working memory and processing speed, but better performance in the verbal domain. Externalizing and DP symptoms were related to poorer global cognitive performance. Notably, those in the DP subgroup had a 5.0 point lower IQ than those without behavioral problems. Cognitive performance was more heavily affected in boys than in girls given comparable levels of psychopathology. Taken together, we provide evidence for globally worse cognitive performance in children and adolescents with externalizing and DP symptoms, with those in the DP subgroup being most heavily affected.

Cognitive Developmental Trajectories in Adult ADHD Patients and Controls: A Comparative Study

OBJECTIVE

There is an updated conceptualization of whole-lifespan attention-deficit hyperactivity disorder (ADHD), promoted by awareness of probable persistence of impairment into adulthood. We investigated cognition trajectories from adolescence to mid-adulthood in ADHD.

METHOD

Data of 240 patients with ADHD and 244 healthy controls (HCs) were obtained; clinical symptoms and neuropsychological functions were assessed using the various tests.

RESULTS

Compared to HCs, patients with ADHD except 35 to 44 age interval showed lower full scale intelligence quotient. They showed decreased verbal comprehensive scores except in the 35 to 44 age interval and working memory scores in all intervals. In the Comprehensive Attention Test, patients with ADHD showed increased working memory error frequencies except in the 15 to 17 age interval and divided attention omission error in all intervals.

CONCLUSION

Adults with ADHD showed deficits not in simple attention but in complex attention, including divided attention and working memory.