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Guo N, Fuermaier ABM, Koerts J, Mueller BW, Diers K, Mroß A, Mette C, Tucha L, Tucha O. Neuropsychological functioning of individuals at clinical evaluation of adult ADHD. J Neural Transm (Vienna) 2021; 128:877-891. [PMID: 33355692 PMCID: PMC8295106 DOI: 10.1007/s00702-020-02281-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 11/18/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Numerous studies showed that adults with attention deficit hyperactivity disorder (ADHD) suffer from impairments in a range of cognitive functions when compared to healthy controls. However, only little is known about the neuropsychological functions when compared to various clinical control groups and whether a distinct neuropsychological profile can be identified for adult ADHD. METHOD This retrospective study examined data of 199 outpatients referred for clinical evaluation of adult ADHD, allocated either to an ADHD group (n = 78) or to one of two clinical comparison groups, depending on whether they show indications (n = 71) or no indications (n = 50) for the presence of psychiatric disorders other than ADHD. All individuals performed a comprehensive neuropsychological test battery. RESULTS Data analysis revealed impairments in a range of cognitive functions in a substantial number of patients of all three groups. However, profiles of neuropsychological impairments were similar between groups. Furthermore, significant small- to medium-sized correlations between basic and higher-order cognitive functions were revealed in the ADHD group and the clinical comparison group with indications for psychiatric disorders other than ADHD. CONCLUSION Neuropsychological impairments are prominent in psychiatric outpatients seeking a clinical evaluation of adult ADHD but are not specific for ADHD. It is concluded that neuropsychological test performance may have limited incremental value to support the psychiatric differential diagnosis. Furthermore, a clinical trajectory may need to take into account that deficits in a range of higher-order cognitive functions can be substantially explained by deficits in basic cognitive functions.
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Affiliation(s)
- Nana Guo
- Department of Clinical and Developmental Neuropsychology, Faculty of Behavioral and Social Sciences, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, The Netherlands.
| | - Anselm B M Fuermaier
- Department of Clinical and Developmental Neuropsychology, Faculty of Behavioral and Social Sciences, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, The Netherlands
| | - Janneke Koerts
- Department of Clinical and Developmental Neuropsychology, Faculty of Behavioral and Social Sciences, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, The Netherlands
| | - Bernhard W Mueller
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, LVR Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Department of Psychology, University of Wuppertal, Wuppertal, Germany
| | - Katerina Diers
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, LVR Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Aaron Mroß
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, LVR Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | | | - Lara Tucha
- Department of Clinical and Developmental Neuropsychology, Faculty of Behavioral and Social Sciences, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, The Netherlands
- Department of Psychiatry and Psychotherapy, University Medical Center Rostock, Rostock, Germany
| | - Oliver Tucha
- Department of Clinical and Developmental Neuropsychology, Faculty of Behavioral and Social Sciences, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, The Netherlands
- Department of Psychiatry and Psychotherapy, University Medical Center Rostock, Rostock, Germany
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Onandia-Hinchado I, Pardo-Palenzuela N, Diaz-Orueta U. Cognitive characterization of adult attention deficit hyperactivity disorder by domains: a systematic review. J Neural Transm (Vienna) 2021; 128:893-937. [PMID: 33620582 DOI: 10.1007/s00702-021-02302-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 01/06/2021] [Indexed: 02/06/2023]
Abstract
Attention deficit hyperactivity disorder (ADHD) is reportedly the most frequent neurodevelopmental disorder diagnosed during childhood, and it is recognized as a common condition in adulthood. We review the evidence to help identify cognitive domains associated to deficits in adult ADHD. A systematic review with narrative synthesis was performed, assessing studies on adult ADHD, neuropsychology and research on involved cognitive domains in adults 18+ years old with an established diagnosis of ADHD, in seven electronic databases (PubMed, PsychInfo, WebOfScience, Embase, Scopus, OvidSPMedline, and Teseo), and Worldcat and OpenGrey grey literature databases. 93 studies were included for this review, encompassing findings from a total 5574 adults diagnosed only with ADHD, medication-naïve or non-medicated at the moment of the assessment and 4880 healthy controls. Adults diagnosed with ADHD may show, when compared to healthy controls, a cognitive profile characterized by deficits across all attention modalities, processing speed, executive function (mainly working memory and inhibition with emphasis on reward delay and interference control), verbal memory, reading skills, social cognition and arithmetic abilities. A cognitive characterization of adult ADHD by domains is established beyond the sole consideration of attention and executive function problems. Along with these, verbal memory, language (mainly reading), social cognition and arithmetic abilities may also contribute to a more comprehensive characterization of the cognitive profile in adult ADHD.
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Affiliation(s)
| | | | - Unai Diaz-Orueta
- Department of Psychology, Maynooth University, Room 3.11, John Hume Building, North Campus, Maynooth, Co. Kildare, Ireland.
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Bjerrum MB, Pedersen PU, Larsen P. Living with symptoms of attention deficit hyperactivity disorder in adulthood: a systematic review of qualitative evidence. JBI DATABASE OF SYSTEMATIC REVIEWS AND IMPLEMENTATION REPORTS 2017; 15:1080-1153. [PMID: 28398986 DOI: 10.11124/jbisrir-2017-003357] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Attention deficit hyperactivity disorder (ADHD) relates to four dimensions of behavior: inattentiveness, restlessness, impulsiveness and hyperactivity. Symptoms affect multiple areas of daily life such as academic performance and social functioning. Despite the negative effects of ADHD, people diagnosed with ADHD do not necessarily regard themselves as being impaired. However, it is unclear how adults with ADHD experience and manage their symptoms. OBJECTIVES To identify and synthesize the best available evidence on how adults experience living with ADHD. INCLUSION CRITERIA TYPES OF PARTICIPANTS Adults with confirmed ADHD diagnosis. PHENOMENA OF INTEREST How adults with ADHD experience and manage the symptoms of ADHD and links between protective factors provided by relatives, friends, fellow students, mentors and colleagues. TYPES OF STUDIES Studies based on qualitative data, including, but not limited to, designs within phenomenology, grounded theory, content analysis or ethnography. SEARCH STRATEGY A three-step search strategy identified published and unpublished qualitative studies from 1990 to July 2015. METHODOLOGICAL QUALITY Studies meeting the inclusion criteria were independently assessed by two reviewers using the standardized critical appraisal instrument from the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI). DATA EXTRACTION Data were extracted from 10 included studies using the JBI-QARI. DATA SYNTHESIS Qualitative research findings were synthesized using the JBI-QARI. RESULTS A total of 103 findings from 10 studies were aggregated into 16 categories that were meta-synthesized into four synthesized findings: "Adults are aware of being different from others and strive to be an integrated, accepted part of the community;" "Adults with ADHD are creative and inventive;" "Adults with ADHD develop coping strategies in striving for a healthy balance in life" and "For adults with ADHD, accomplishing and organizing tasks in everyday life is a challenge but it can also be rewarding." CONCLUSION Adults with ADHD have problems stemming from ADHD symptoms in relation to interacting in social relationships, academic functioning and being part of the community at the workplace and performing work tasks; they work harder to perform tasks and strive to be accepted and to be equal members of the community.Protective factors that support their ability to manage daily life with ADHD are personal strategies such as reminders and performing tasks within a given structure. Others close to them can assist by coaching, reminding them of appointments and so on. Superiors can assist by structuring the work tasks and setting up clear rules and limits for the tasks. Medication has proven to be very useful as it leads to less hyperactivity and enhances ability to stay focused and be more organized. Finally, insight into ADHD has a positive impact on the ability to manage the consequences of ADHD.Health professionals should, when advising adults with ADHD, fundamentally see them as persons who have a problem and not as problem persons, emphasize strategies adults themselves can apply such as structuring everyday tasks and informing them about positive effects and possible side effects of medication. Policy-makers could launch campaigns targeted at employers with information about the competencies adults with ADHD possess and how employers can benefit from these by structuring work tasks. When promoting employees with ADHD, it should be to positions with more advanced hands-on functions and not positions with administrative duties.
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Affiliation(s)
- Merete B Bjerrum
- 1Department of Public Health, Section for Nursing Science, Aarhus University, Aarhus, Denmark 2Danish Centre of Clinical Guidelines 3Danish Centre of Systematic Reviews: a Joanna Briggs Institute Centre of Excellence, Department of Medicine and Technology, University of Aalborg, Aalborg, Denmark
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Abstract
OBJECTIVE Memory problems are a frequently reported symptom in adult ADHD, and it is well-documented that adults with ADHD perform poorly on long-term memory tests. However, the cause of this effect is still controversial. The present meta-analysis examined underlying mechanisms that may lead to long-term memory impairments in adult ADHD. METHOD We performed separate meta-analyses of measures of memory acquisition and long-term memory using both verbal and visual memory tests. In addition, the influence of potential moderator variables was examined. RESULTS Adults with ADHD performed significantly worse than controls on verbal but not on visual long-term memory and memory acquisition subtests. The long-term memory deficit was strongly statistically related to the memory acquisition deficit. In contrast, no retrieval problems were observable. CONCLUSION Our results suggest that memory deficits in adult ADHD reflect a learning deficit induced at the stage of encoding. Implications for clinical and research settings are presented.
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Potvin S, Charbonneau G, Juster RP, Purdon S, Tourjman SV. Self-evaluation and objective assessment of cognition in major depression and attention deficit disorder: Implications for clinical practice. Compr Psychiatry 2016; 70:53-64. [PMID: 27624423 DOI: 10.1016/j.comppsych.2016.06.004] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Revised: 06/07/2016] [Accepted: 06/07/2016] [Indexed: 11/17/2022] Open
Affiliation(s)
- Stéphane Potvin
- Department of Psychiatry, University of Montreal, Montréal, Canada
| | | | | | - Scot Purdon
- Department of Psychiatry, University of Alberta, Edmonton, Canada
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Sobanski E, Sirtl A, Alm B, Hennig O, Banaschewski T. Neuropsychological Functioning and Psychosocial Outcome in Adults with Attention-Deficit/ Hyperactivity Disorder. ZEITSCHRIFT FUR NEUROPSYCHOLOGIE 2015. [DOI: 10.1024/1016-264x/a000129] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
This study explores the association of neuropsychological functioning with ADHD-symptoms and psychosocial functioning in a clinical sample of 131 adults with ADHD. Neuropsychological functioning was assessed with the computerized Test Battery of Attentional Performance (TAP). Overall psychosocial impairment was assessed with the Global Assessment of Functioning Scale (GAF). Neuropsychological performance was impaired in 39.6 % of the ADHD-patients meeting a predefined impairment criterion of a perfomance reduction of 1.5 standard deviations below normative controls in ≥ 2 TAP-subtests; 28.4 % of the patients showed regular performance in all neuropsychological tests. Severity of neuropsychological impairment was inversely correlated to severity of psychosocial impairment (GAF score; = -.24, p < .001) but not to childhood or adult ADHD symptoms. Overall severity of neuropsychological impairment explained 10 % (p < .05) of variance of psychosocial impairment.
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Affiliation(s)
- Esther Sobanski
- Klinik Psychiatrie und Psychotherapie, Zentralinstitut für Seelische Gesundheit, Klinische Fakultät Mannheim, Universität Heidelberg
- AHG-Klinik für Psychosomatik, Bad Dürkheim
| | - Alexandra Sirtl
- Klinik Psychiatrie und Psychotherapie, Zentralinstitut für Seelische Gesundheit, Klinische Fakultät Mannheim, Universität Heidelberg
| | - Barbara Alm
- Klinik Psychiatrie und Psychotherapie, Zentralinstitut für Seelische Gesundheit, Klinische Fakultät Mannheim, Universität Heidelberg
| | - Oliver Hennig
- Klinik Psychiatrie und Psychotherapie, Zentralinstitut für Seelische Gesundheit, Klinische Fakultät Mannheim, Universität Heidelberg
| | - Tobias Banaschewski
- Klinik für Kinder- und Jugendpsychiatrie und -psychotherapie, Zentralinstitut für Seelische Gesundheit, Klinische Fakultät Mannheim, Universität Heidelberg
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Fuermaier AB, Tucha L, Koerts J, Aschenbrenner S, Weisbrod M, Lange KW, Tucha O. Cognitive Complaints of Adults With Attention Deficit Hyperactivity Disorder. Clin Neuropsychol 2014; 28:1104-22. [DOI: 10.1080/13854046.2014.964325] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Putnam MA, Tiersky LA, Freer BD, Pievsky MA. Defense Mechanisms and Cognitive Complaints: Assessing Cognitive Complaints and Self-Reported Defensive Styles. J Am Psychoanal Assoc 2014; 62:NP9-NP13. [PMID: 24973400 DOI: 10.1177/0003065114538098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Lineweaver TT, Brolsma JW. How you ask matters: an experimental investigation of the influence of mood on memory self-perceptions and their relationship with objective memory. Memory 2014; 22:1103-15. [PMID: 24383556 DOI: 10.1080/09658211.2013.870209] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Stronger relationships often emerge between mood and memory self-efficacy (MSE) than between MSE and memory abilities. We examined how social desirability, mood congruency and framing influence the mood-MSE relationship. Social desirability correlated with all self-report measures, and covarying social desirability diminished the mood-MSE relationship while enhancing the relationship between MSE and objective memory. Participants rated their memory more harshly on positively than neutrally or negatively worded MSE items. Current mood state did not affect MSE overall or when items were worded positively or neutrally. However, on negatively worded items, participants in a negative mood exhibited lower MSE than participants in a positive mood. Thus, both MSE and the mood-MSE relationship depended upon question wording. These results indicate that controlling social desirability and item framing on MSE questionnaires may reduce their confounding influence on memory self-perceptions and the influence of mood on self-reported abilities, allowing subjective memory to more accurately reflect objective memory in healthy and clinical populations.
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Affiliation(s)
- Tara T Lineweaver
- a Department of Psychology , Butler University , Indianapolis , IN , USA
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Wiig EH, Nielsen NP. A quick test of cognitive speed for comparing processing speed to differentiate adult psychiatric referrals with and without attention-deficit/hyperactivity disorders. Prim Care Companion CNS Disord 2012; 14:11m01273. [PMID: 22943032 DOI: 10.4088/pcc.11m01273] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Accepted: 11/09/2011] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVE This retrospective study used A Quick Test of Cognitive Speed (AQT) to compare processing speed and efficiency measures by adults with attention-deficit/hyperactivity disorder (ADHD) or non-ADHD psychiatric disorders and healthy controls. METHOD Color, form, and color-form combination naming tests were administered to 104 adults, ages 17-55 years, referred for psychiatric evaluation of possible ADHD. Thirty healthy adults were controls. Psychiatric intake procedures identified 64 adults with ADHD (ICD-10 and DSM-IV criteria) and 40 with mild psychiatric disorders without ADHD. The study was conducted from 2008 through 2010. RESULTS At intake, color, form, and color-form combination naming times (seconds) were longer and overhead [color-form combination - (color + form)] was larger for patients with ADHD than for non-ADHD patients and controls. In the ADHD group, color and form measures were in the normal range. Color-form combination was in the slower-than-normal speed (60-70 seconds) and overhead, a processing-efficiency measure, in the atypical range (> 10 seconds). In the non-ADHD patient and control groups, all AQT measures were in the normal range. Analysis of variance with post hoc analysis of log-normal values for color, form, and color-form combination and time for overhead indicated significant (Bonferroni P < .01) mean differences between the ADHD and other groups, but not between the non-ADHD and control groups. When using fail criteria for either color-form combination or overhead, the sensitivity for the ADHD group was 89%. CONCLUSIONS RESULTS support AQT as a possible complement to psychiatric intake procedures to differentiate adults with ADHD from those with mild psychiatric disorders, and they suggest that a controlled prospective study might be productive.
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Affiliation(s)
- Elisabeth Hemmersam Wiig
- Communication Disorders, Boston University, Boston, Massachusetts (Dr Wiig), and Department of Psychiatry, Hvidovre Hospital, Copenhagen, Denmark (Dr Nielsen)
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