Development and validation of an attention-deficit/hyperactivity disorder (ADHD) executive function and behavior rating screening battery

[Formula: see text] Visual selective attention and visual search performance in children with CVI, ADHD, and Dyslexia: a scoping review

Visual selective attention refers to the selection of relevant visual elements in a scene whilst ignoring irrelevant visual elements. Visual Selective Attention Dysfunctions (VSAD) are prevalent in children with Cerebral Visual Impairment (CVI), Attention Deficit Hyperactivity Disorder (ADHD), and Dyslexia. An important issue in the pediatric neuropsychological practice is how to discriminate between the task performance of these populations. We conducted a scoping review of the literature on visual search performance (VSP) in children with CVI, ADHD, and Dyslexia, aged 6-12 years. After a systematic selection process, 35 studies were included. Results suggest that all patient groups have some degree of impaired VSP compared to typically developing children. Children with CVI tend to react slower and less accurately. VSP impairments in children with ADHD are characterized by poor accuracy rather than reaction time. Children with Dyslexia tend to be slower and less accurate, depending on stimulus type. Besides VSAD, it is argued that other neurocognitive mechanisms might influence VSP, such as speed-accuracy trade-off or an executive functioning deficit in ADHD and a phonological deficit in Dyslexia. This paper further discusses the differences and similarities in visual search performance between the groups. The sparse data in children with an official diagnosis of CVI and the technical inconclusive data on children with ADHD and Dyslexia demonstrate complexity of discriminating between these populations in clinical practice based on VSP. New and more quantitative VSP parameters, such as eye tracking-based measures, may contribute to a refined classification among CVI, ADHD, and Dyslexia.

Differences in Executive Functioning in Children with Attention Deficit and Hyperactivity Disorder (ADHD)

In recent years, the interest in Attention Deficit and Hyperactivity Disorder (ADHD) and its relation to deficits in working memory (WM) and more specifically the different executive functions (EFs) has grown, to the point of confirming that these are quite frequent in this disorder. The aim of this study was precisely to explore differences in executive functioning of WM in fourth grade Primary school children with and without ADHD (26 and 29 children, respectively), introducing rigorous control measures in the tests used. Four EFs were analyzed: divided attention, updating, attentional shifting and inhibition, measured through four tasks, the dual-task paradigm (digits and box-crossing), the N-Back task, the Trail Making Test and the Stroop task, respectively. The results showed that participants with ADHD, compared to children with typical development (TD), exhibited a smaller verbal memory span as well as deficits in the attentional shifting and updating functions. However, a similar performance for the EF of inhibition was found for both groups of participants. Finally, an unexpected result was obtained with regard to the role of divided attention, as children with ADHD were less impaired when performing the double task than participants in the TD group.

Attention-deficit/hyperactivity disorder: the impact of methylphenidate on working memory, inhibition capacity and mental flexibility

ABSTRACT Objective To compare children with attention-deficit/hyperactivity disorder (ADHD), before and after the use of methylphenidate, and a control group, using tests of working memory, inhibition capacity and mental flexibility. Methods Neuropsychological tests were administrated to 53 boys, 9–12 years old: the WISC-III digit span backward, and arithmetic; Stroop Color; and Trail Making Tests. The case group included 23 boys with ADHD, who were combined type, treatment-naive, and with normal intelligence without comorbidities. The control group (n = 30) were age and gender matched. After three months on methylphenidate, the ADHD children were retested. The control group was also retested after three months. Results Before treatment, ADHD children had lower scores than the control group on the tests (p ≤ 0.001) and after methylphenidate had fewer test errors than before (p ≤ 0.001) Conclusion Methylphenidate treatment improves the working memory, inhibitory control and mental flexibility of ADHD boys.

Preschool Neuropsychological Measures as Predictors of Later Attention Deficit Hyperactivity Disorder

The present study examined preschool neuropsychological measures as predictors of school-age attention deficit hyperactivity disorder (ADHD). Participants included 168 children (91 males) who completed neuropsychological measures at ages 3 and 4, and who were evaluated for ADHD and oppositional defiant disorder at age 6. The Conners' Kiddie Continuous Performance Test (K-CPT), NEPSY Statue subtest, and a delay aversion task significantly distinguished at-risk children who later did and did not meet criteria for ADHD, with poor to fair overall predictive power, specificity, and sensitivity. However, only the K-CPT ADHD Confidence Index and battery added incremental predictive validity beyond early ADHD symptoms. This battery approach, which required impairment on at least 2 of the 3 significant measures, yielded fair overall predictive power, specificity, and sensitivity, and correctly classified 67 % of children. In addition, there was some support for the specificity hypothesis, with evidence that cool executive function measures (K-CPT and Statue subtest) tended to predict inattentive symptoms. These findings suggest that neuropsychological deficits are evident by preschool-age in children with ADHD, but neuropsychological tests may still misclassify approximately one-third of children if used alone. Thus, neuropsychological measures may be a useful component of early ADHD assessments, but should be used with caution and in combination with other assessment methods.

Neuropsychological and dimensional behavioral trait profiles in Costa Rican ADHD sib pairs: Potential intermediate phenotypes for genetic studies

Attention deficit hyperactivity disorder (ADHD) is associated with substantial functional impairment in children and in adults. Many individuals with ADHD have clear neurocognitive deficits, including problems with visual attention, processing speed, and set shifting. ADHD is etiologically complex, and although genetic factors play a role in its development, much of the genetic contribution to ADHD remains unidentified. We conducted clinical and neuropsychological assessments of 294 individuals (269 with ADHD) from 163 families (48 multigenerational families created using genealogical reconstruction, 78 affected sib pair families, and 37 trios) from the Central Valley of Costa Rica (CVCR). We used principal components analysis (PCA) to group neurocognitive and behavioral variables using the subscales of the Child Behavior Checklist (CBCL) and 15 neuropsychological measures, and created quantitative traits for heritability analyses. We identified seven cognitive and two behavioral domains. Individuals with ADHD were significantly more impaired than their unaffected siblings on most behavioral and cognitive domains. The verbal IQ domain had the highest heritability (92%), followed by auditory attention (87%), visual processing speed and problem solving (85%), and externalizing symptoms (81%). The quantitative traits identified here have high heritabilities, similar to the reported heritability of ADHD (70-90%), and may represent appropriate alternative phenotypes for genetic studies. The use of multigenerational families from a genetically isolated population may facilitate the identification of ADHD risk genes in the face of phenotypic and genetic heterogeneity.

Reconsidering "inattention" in attention-deficit hyperactivity disorder: implications for neuropsychological assessment and intervention

Attention-deficit hyperactivity disorder (ADHD) does not exist. This explicit statement needs elucidation of course given ADHD is a common neurodevelopmental disorder, but it provides the reader with the impetus to reconsider long-held beliefs about this condition and its treatment. Surely, there is a disorder called ADHD from which this thesis is framed, but primary attention and hyperactivity-impulsivity problems are mediated by different albeit interrelated brain systems. Like many neurodevelopmental disorders (e.g., learning disabilities, autism spectrum disorder), the medical and psychological professions have used a single, large inclusive ADHD diagnostic category to represent children with different etiologies for their overt symptoms. Despite neurobiological differences among children diagnosed with ADHD, the clinical position that attention-deficit or primary attention problems are sufficient for ADHD identification undermines clinical practice. This commonly accepted dubious position not only undermines the diagnostic utility of our neuropsychological measures, but it attenuates treatment effects as well. Supported with evidence from our ongoing ADHD research program, this data-based review will support these contentions and provide implications for diagnosis and treatment of children with attention problems.

Comparison of neuropsychological performances and behavioral patterns of children with attention deficit hyperactivity disorder and severe mood dysregulation

We aimed to investigate the similarities and differences in neuropsychological test performance, demographic features and behavioral patterns of children and adolescents with the attention deficit hyperactivity disorder combined type (ADHD-C), and the severe mood dysregulation (SMD). Study includes 112 children: 67 with ADHD-C, 24 with SMD and 21 healthy controls. These groups were identified by using the schedule for affective disorders, and schizophrenia for the school-age children-present and lifetime version (KSADS-PL) and the K-SADS-PL-SMD Module. Conners' Parent and Teacher Rating Scale-revised long form (CPRS-R:L and CTRS-R:L) and neuropsychological tests were administered to the research groups. ADHD-C group's performances in Wisconsin Card Sorting Test, Trail Making Test, Stroop Test TBAG form and Controlled Oral Word Association Test were significantly poorer than the control group's performances (p < 0.05). Performance of the SMD group was only descriptively intermediate between performances of the ADHD-C and control group. In the "Oppositional", "Hyperactivity", "Social Problems", "Impulsive", "Emotional Lability" and "Conners' Global Index" subscales of CPRS-R:L, the average scores of the SMD group were significantly higher than the ADHD-C and control group's average scores (p < 0.05). ADHD-C group (but not SMD) could be significantly differentiated from healthy controls with the neuropsychological tests used. SMD group could be differentiated from the ADHD-C and healthy control groups with CPRS-R:L; i.e., ADHD-C versus SMD could be differentiated at the behavioral level only.

A longitudinal study of neuropsychological functioning and academic achievement in children with and without signs of attention-deficit/hyperactivity disorder

OBJECTIVE

Attention-deficit/hyperactivity disorder (ADHD) in childhood is associated with poor academic functioning. Deficits in academic functioning have proven to be less responsive to intervention than behavioral deficits in this population, yet the causes of this academic underperformance are not well understood. The purpose of this study is to examine the relationship between ADHD and academic performance in elementary-aged children in a developmental context. To do this, we study important cognitive variables and academic achievement over a three-year timeframe.

METHOD

Based on teacher ratings of ADHD, children were divided into a high symptom group (n = 17) and a low symptom group (n = 34). A thorough battery of cognitive and academic tests was administered at Time 1 and again 2 years later. Cognitive measures focused specifically on working memory and response inhibition.

RESULTS

RESULTS indicate that children who have high levels of ADHD signs differ from their low-sign peers in academic achievement and in several cognitive domains. Differences in cognitive functioning show a developmental trend consistent with earlier developmental delays in response inhibition and later delays in working memory. Working memory appears to be particularly important in several academic domains. Importantly, in a longitudinal model, working memory was more predictive of math achievement for students demonstrating signs of ADHD than for those who did not.

CONCLUSION

The relationship between these cognitive variables and academic functioning are explicated in the domains of reading, math, and problem solving.

A neuropsychological perspective on attention problems in neurofibromatosis type 1

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

The effects of methylphenidate on cognitive function in children with attention-deficit/hyperactivity disorder

Focusing on behavioral criteria for attention-deficit/hyperactivity disorder (ADHD) diagnosis leads to considerable neuropsychological profile heterogeneity among diagnosed children, as well as variable response to methylphenidate (MPH) treatment. Documenting "cold" executive working memory (EWM) or "hot" self-regulation (SR) neuropsychological impairments could aid in the differential diagnosis of ADHD subtypes and may help to determine the optimal MPH treatment dose. In this study, children with ADHD inattentive type (n = 19), combined type (n = 33), and hyperactive-impulse type (n = 4) underwent randomized controlled MPH trials; neuropsychological, behavioral, and observational data were collected to evaluate the children's responses. Those with moderate or significant baseline EWM/SR impairment showed robust MPH response, whereas response for those with lower baseline impairment was equivocal. Implications for medication use and titration, academic achievement, and long-term treatment efficacy are examined.