Neuropsychological Abilities of Preschool-Aged Children Who Display Hyperactivity and/or Oppositional-Defiant Behavior Problems

The trajectory of maternal perinatal depressive symptoms predicts executive function in early childhood

BACKGROUND

Perinatal maternal depression may affect fetal neurodevelopment directly or indirectly via exposures such as smoking, alcohol, or antidepressant use. The relative contribution of these risk factors on child executive function (EF) has not been explored systematically.

METHODS

A prospective pregnancy cohort of 197 women and their children was studied to determine whether maternal depression diagnosis and the trajectory of maternal depressive symptoms (MDSs) from early pregnancy to 12 months postpartum predicts child EF at age 4 (measured using the preschool age psychiatric assessment, NEPSY-II, and Shape School task) using latent growth curve modeling. Indirect effects of smoking, alcohol, and antidepressant use were also formally tested.

RESULTS

Increasing maternal perinatal depressive symptoms over time predicted more inattentive symptoms, poorer switching, and motor inhibition, but not cognitive inhibition. When adjusted for multiple comparison, and after accounting for maternal cognition and education, the association with child inattentive symptoms remained significant. However, diagnosed depression did not predict child EF outcomes. Prenatal exposure to smoking, alcohol, and antidepressants also did not mediate pathways from depressive symptoms to EF outcomes. Our findings were limited by sample size and statistical power to detect outcome effects of smaller effect size.

CONCLUSIONS

This study suggests that increasing MDSs over the perinatal period is associated with poorer EF outcomes in children at age 4 - independent of prenatal smoking, drinking, or antidepressant use. Depressive chronicity, severity, and postpartum influences may play crucial roles in determining childhood outcomes of EF.

Incremental Validity of Multi-Method and Multi-Informant Evaluations in the Clinical Diagnosis of Preschool ADHD

OBJECTIVES

This study investigated the discriminative validity of various single or combined measurements of electroencephalogram (EEG) data, Conners' Kiddie Continuous Performance Test (K-CPT), and Disruptive Behavior Disorder Rating Scale (DBDRS) to differentiate preschool children with ADHD from those with typical development (TD).

METHOD

We recruited 70 preschoolers, of whom 38 were diagnosed with ADHD and 32 exhibited TD; all participants underwent the K-CPT and wireless EEG recording in different conditions (rest, slow-rate, and fast-rate task).

RESULTS

Slow-rate task-related central parietal delta (1-4 Hz) and central alpha (8-13 Hz) and beta (13-30 Hz) powers between groups with ADHD and TD were significantly distinct (p < .05). A combination of DBDRS, K-CPT, and specific EEG data provided the best probability scores (area under curve = 0.926, p < .001) and discriminative validity to identify preschool children with ADHD (overall correct classification rate = 85.71%).

CONCLUSIONS

Multi-method and multi-informant evaluations should be emphasized in clinical diagnosis of preschool ADHD.

Systematic Review and Meta-analysis: The Science of Early-Life Precursors and Interventions for Attention-Deficit/Hyperactivity Disorder

OBJECTIVE

To evaluate which early neurocognitive and behavioral precursors are associated with the development of attention-deficit/hyperactivity disorder (ADHD) and whether these are currently targeted in early interventions.

METHOD

We conducted 2 systematic reviews and meta-analyses of empirical studies to examine the following: (1) early-life (0-5 years) neurocognitive and behavioral precursors associated with familial likelihood for ADHD, an early ADHD diagnosis/elevated ADHD symptoms, and/or the presence of later-childhood ADHD; and (2) interventions delivered to children aged 0 to 5 years targeting the identified precursors or measuring these as outcomes. Standardized mean differences (Hedges' g) and pre-post-treatment change scores (SMD) were computed.

RESULTS

A total of 149 studies (165,095 participants) investigating 8 neurocognitive and behavioral domains met inclusion criteria for part 1. Multi-level random-effects meta-analyses on 136 studies revealed significant associations between ADHD and poorer cognitive (g = -0.46 [95% CIs: -0.59, -0.33]), motor (g = -0.35 [CIs: -0.48, -0.21]) and language (g = -0.43 [CIs: -0.66, -0.19]) development, social (g = 0.23 [CIs: 0.03, 0.43]) and emotional (g = 0.46 [CIs: 0.33, 0.58]) difficulties, early regulatory (g = 0.30 [CIs: 0.18, 0.43]) and sleep (g = 0.29 [CIs: 0.14, 0.44]) problems, sensory atypicalities (g = 0.52 [CIs: 0.16, 0.88]), elevated activity levels (g = 0.54 [CIs: 0.37, 0.72]), and executive function difficulties (g = 0.34 [CIs: 0.05, 0.64] to -0.87 [CIs: -1.35, -0.40]). A total of 32 trials (28 randomized, 4 nonrandomized, 3,848 participants) testing early interventions that targeted the identified precursors met inclusion criteria for part 2. Multi-level random-effects meta-analyses on 22 studies revealed significant intervention-related improvements in ADHD symptoms (SMD = 0.43 [CIs: 0.22, 0.64]) and working memory (SMD = 0.37 [CIs: 0.06, 0.69]).

CONCLUSION

Children aged 0 to 5 years with current or later-emerging ADHD are likely to experience difficulties in multiple neurocognitive/behavioral functions. Early interventions show some effectiveness in reducing ADHD symptoms, but their effects on neurocognitive/behavioral difficulties require further study.

Reading Comprehension Impairment in Children With Neurofibromatosis Type 1 (NF1): The Need of Multimodal Assessment of Attention

Attention span, which has been shown to have an impact on reading quality in many other conditions, is one of the main cognitive disorders of neurofibromatosis type 1 (NF1). The aim of this work is to observe the impact of attention on reading comprehension, in NF1 and non-NF1 children. A multicenter, cross-sectional study was conducted on 150 children (8-12 years old) with or without NF1 (75 NF1 vs 75 non-NF1; 72 female, 78 male), matched for age, sex, handedness, and reading level, thus forming a continuum from good to poor readers in both NF1 and non-NF1 groups. Children with intellectual deficiency or neurologic or psychiatric disorder were excluded. Attentional skills were assessed by combining a parent questionnaire (Child Behavior CheckList) and a performance-based assessment (Conner's Continuous Performance Test-Second Edition). Reading comprehension was assessed through a standardized reading comprehension test (ORLEC Lobrot). The performance-based attention scores were associated with text and sentence comprehension ability (P = .0235 and P = .0164, respectively), while indirect questionnaire attention scores were only associated with sentence comprehension (P = .0263). For both groups, the correlations between questionnaire and performance-based measures were low. We have shown that reading comprehension is greatly influenced by attention in NF1 and non-NF1, even if predictors of good reading comprehension also include IQ score and reading accuracy. Indirect observer-rated questionnaires and direct performance-based measures of attention do not assess the same variables, are linked to different components of reading skills, and are not interchangeable assessments of attention difficulties. Both assessments are complementary and must be used simultaneously, leading to recommendations that support multimodal assessment of attention.

Exploring the Variability in Reaction Times of Preschoolers at Risk of Attention-Deficit/Hyperactivity Disorder: an ex-Gaussian Analysis

Reaction times (RTs) are typically slower and more variable in individuals with attention-deficit/hyperactivity disorder (ADHD). Analysis of the ex-Gaussian RT distribution, which is described by mu, sigma (mean and standard deviation, respectively, of the normal distribution) and tau (that of exponential distribution), reveals that individuals with ADHD do not display overall slower RTs but have a high proportion of extremely slow RTs, represented by a high tau value. Although this is a vital component for describing ADHD-related RT variability in school-aged children, adolescents, and adults, it has not been thoroughly studied at the preschool age. We assessed 65 preschoolers at risk of ADHD and 98 typically developing preschoolers with the Conners' Kiddie Continuous Performance Test (K-CPT) and parental and teacher reports of ADHD symptoms. We found that preschoolers at risk of ADHD had greater values for RT standard deviation, sigma, and tau than typically developing preschoolers at long inter-stimulus intervals (ISIs) (3 s), but not at short ISIs (1.5 s). This suggests that attention problems in preschool children may only be apparent in the tasks with a relatively slow event rate. Our study demonstrates that the ex-Gaussian tau value is essential for describing the inattentive component of task performance in preschoolers with heightened ADHD symptoms. Furthermore, the fact that the tau effect was modulated by ISI suggests that the longer duration (3 s vs. 1.5 s) is a non-optimal energetic state in preschoolers at risk of ADHD, and that this might account for the subtle attentional flaw in task performance.

Neuropsychological Measures in the Diagnosis of ADHD in Preschool: Can Developmental Research Inform Diagnostic Practice?

Objective: The diagnosis of ADHD in preschool is challenging. Behavioral ratings are less reliable, but the value of neuropsychological tests in the diagnosis of ADHD has been debated. Method: This article provides an overview of neuropsychological measures utilized in preschoolers with ADHD (3-5 years). In addition, the manuscript discusses the extent to which these measures have been tested for their diagnostic capacity. Results: The diagnostic utility of computerized continuous performance tests and working memory subtests from IQ-batteries has been demonstrated in a number of studies by assessing their psychometric properties, sensitivity, and specificity. However, findings from developmental and basic research attempting to describe risk factors that explain variance in ADHD show the most consistent associations of ADHD with measures of delay aversion. Conclusion: Results from developmental research could benefit studies that improve ADHD diagnosis at the individual level. It might be helpful to consider testing as a structured situation for behavioral observation by the clinician.

Continuous Performance Test Is Sensitive to a Single Methylphenidate Challenge in Preschool Children With ADHD

Objective: There is a lack of evidence-based diagnostic paradigms and personalized interventions for preschoolers with ADHD. This study aimed to evaluate the performance of preschoolers diagnosed with ADHD on a continuous performance test (CPT) before and after a single methylphenidate (MPH) challenge. Method: The Test of Variables of Attention (TOVA)-a CPT-was administered to 61 preschoolers (5.64 ± 0.69 years; 74% boys) with ADHD before and after a single MPH challenge (0.3 or 0.5 mg/kg). Baseline TOVA performance was correlated with Conners' Rating Scales (CRS) and compared with post-MPH TOVA performance. Results: A high rate of omission errors and several significant correlations between TOVA values and CRS scores were found at baseline. A single MPH administration improved TOVA performance significantly and was well tolerated. Conclusion: TOVA assessment may assist in the evaluation of the effect of MPH in preschoolers with ADHD and may help in planning interventions for them.

Association of the Conners' Kiddie Continuous Performance Test (K-CPT) Performance and Parent-Report Measures of Behavior and Executive Functioning

OBJECTIVE

To explore the relationship between the Conners' Kiddie Continuous Performance Test (K-CPT) performance and parent-report measures of child behavior and executive functioning, and clarify the role of sex in K-CPT performance in preschoolers.

METHOD

Mothers and children recruited to the Health Outcomes and Measures of the Environment Study with complete 5-year assessment data relevant to the analyses were included ( N = 127). We examined the association between K-CPT scores and Behavior Assessment System for Children-Second Edition (BASC-2) and Behavior Rating Inventory of Executive Function (BRIEF) scores, with covariate adjustment.

RESULTS

We found no significant associations between K-CPT, BASC-2, and BRIEF scores in the full sample. In sex-stratified analyses, we found unusually fast reaction time on K-CPT was related to executive control difficulties in girls, whereas unusually slow reaction time was related to the same difficulties in boys. Omission errors were associated with executive difficulties only in boys.

CONCLUSION

The K-CPT may prove to be a useful indicator for early onset of executive control difficulties in preschool-aged children.

Externalizing behavior from early childhood to adolescence: Prediction from inhibition, language, parenting, and attachment

The aim of the current research was to disentangle four theoretically sound models of externalizing behavior etiology (i.e., attachment, language, inhibition, and parenting) by testing their relation with behavioral trajectories from early childhood to adolescence. The aim was achieved through a 10-year prospective longitudinal study conducted over five waves with 111 referred children aged 3 to 5 years at the onset of the study. Clinical referral was primarily based on externalizing behavior. A multimethod (questionnaires, testing, and observations) approach was used to estimate the four predictors in early childhood. In line with previous studies, the results show a significant decrease of externalizing behavior from early childhood to adolescence. The decline was negatively related to mothers’ coercive parenting and positively related to attachment security in early childhood, but not related to inhibition and language. The study has implications for research into externalizing behavior etiology recommending to gather hypotheses from various theoretically sound models to put them into competition with one another. The study also has implications for clinical practice by providing clear indications for prevention and early intervention.

How neuropsychology can inform our understanding of preschool ADHD: Clinical and research implications

Neuropsychological assessments in preschoolers have not received as much attention as in older children and adults. Attention-deficit/hyperactivity disorder (ADHD) is a common disorder that occurs in early childhood associated with poor academic and personal outcomes, such as learning and social difficulties. Preschoolers with ADHD may present cognitive deficits that are related with the ADHD symptoms of inattention, hyperactivity, and impulsivity, but may also interfere, beyond and above the ADHD symptoms, with everyday functioning. Most importantly, cognitive deficits in preschoolers seem to predict future ADHD symptoms. Yet, the practice of neuropsychological assessment in this age-group has been limited. The present selective review highlights the contribution of comprehensive neuropsychological assessments to the early identification of symptomatic preschoolers and to our understanding of the nature and developmental trajectory of ADHD.

Structural Brain Abnormalities of Attention-Deficit/Hyperactivity Disorder With Oppositional Defiant Disorder

BACKGROUND

Attention-deficit/hyperactivity disorder (ADHD) is associated with structural abnormalities in total gray matter, basal ganglia, and cerebellum. Findings of structural abnormalities in frontal and temporal lobes, amygdala, and insula are less consistent. Remarkably, the impact of comorbid oppositional defiant disorder (ODD) (comorbidity rates up to 60%) on these neuroanatomical differences is scarcely studied, while ODD (in combination with conduct disorder) has been associated with structural abnormalities of the frontal lobe, amygdala, and insula. The aim of this study was to investigate the effect of comorbid ODD on cerebral volume and cortical thickness in ADHD.

METHODS

Three groups, 16 ± 3.5 years of age (mean ± SD; range 7-29 years), were studied on volumetric and cortical thickness characteristics using structural magnetic resonance imaging (surface-based morphometry): ADHD+ODD (n = 67), ADHD-only (n = 243), and control subjects (n = 233). Analyses included the moderators age, gender, IQ, and scan site.

RESULTS

ADHD+ODD and ADHD-only showed volumetric reductions in total gray matter and (mainly) frontal brain areas. Stepwise volumetric reductions (ADHD+ODD < ADHD-only < control subjects) were found for mainly frontal regions, and ADHD+ODD was uniquely associated with reductions in several structures (e.g., the precuneus). In general, findings remained significant after accounting for ADHD symptom severity. There were no group differences in cortical thickness. Exploratory voxelwise analyses showed no group differences.

CONCLUSIONS

ADHD+ODD and ADHD-only were associated with volumetric reductions in brain areas crucial for attention, (working) memory, and decision-making. Volumetric reductions of frontal lobes were largest in the ADHD+ODD group, possibly underlying observed larger impairments in neurocognitive functions. Previously reported striatal abnormalities in ADHD may be caused by comorbid conduct disorder rather than ODD.

The Behavior Rating Inventory of Executive Function and Continuous Performance Test in Preschoolers with Attention Deficit Hyperactivity Disorder

OBJECTIVE

The aim of this study is to examine performance-based measures and behavioral ratings of executive functions (EF) as a component of preschool attention deficit hyperactivity disorder (ADHD).

METHODS

Twenty-one 4-to-6-year-old children with ADHD and 52 children with no psychopathology, matched on age, gender, socioeconomic status, and parental education, were enrolled. Parents were interviewed with the use of The Schedule for Affective Disorders and Schizophrenia for School-Age Children Present and Lifetime version. The Conners' Kiddie Continuous Performance Test (K-CPT) was administered to the children, and the Behavior Rating Inventory of Executive Function-Preschool version (BRIEF-P) and the Conners' Parent Rating Scale-Revised/Short Form (CPRS-R/S) were filled out by the parents.

RESULTS

All BRIEF-P and CPRS-R/S scores, the K-CPT measures of inattention and impulsivity were higher in the ADHD group. The CPRS-R/S ADHD index was strongly correlated with inhibition and related indexes in the BRIEF-P and was moderately correlated with inattention measures in the K-CPT.

CONCLUSION

The current study is one of the few to investigate the features of preschool ADHD with the use of behavioral ratings of EF and a performance-based measure. Our results suggest that the BRIEF-P was able to identify behavioral difficulties in inhibition and working memory and that the K-CPT identified difficulties indicating inattention. The findings of this study support the use of a combination of methods for a complete evaluation of preschoolers with inattentive and hyperactive/impulsive behavior, the application of rating scales for screening ADHD symptoms, and the measurement of behavioral correlates of EF, along with performance-based measures.

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 Predictors of ODD Symptom Dimensions in Young Children

Oppositional defiant disorder (ODD) is a commonly diagnosed childhood behavior disorder, yet knowledge of relations between ODD and early neuropsychological functions, particularly independent of attention deficit/hyperactivity disorder (ADHD), is still limited. In addition, studies have not examined neuropsy chological functioning as it relates to the different ODD symptom dimensions. Structural equation modeling was used to investigate how preschool neuropsychological functioning predicted negative affect, oppositional behavior, and antagonistic behavior symptom dimensions of ODD in 224 six-year-old children, oversampled for early behavior problems. Working memory, inhibition, and sustained attention predicted negative affect symptoms of ODD, controlling for ADHD, whereas delay aversion uniquely predicted oppositional behavior, controlling for ADHD. Delay aversion also marginally predicted antagonistic behavior, controlling for ADHD. Results demonstrate that different ODD symptom dimensions may be differentially predicted by different neuropsychological functions. The findings further underscore the importance of future research on ODD to take into account the possible heterogeneity of both symptoms and underlying neuropsychological functioning.

Correlates of preschool children's objectively measured physical activity and sedentary behavior: a cross-sectional analysis of the SPLASHY study

BACKGROUND

Identifying ways to promote physical activity and decrease sedentary time during childhood is a key public health issue. Research on the putative influences on preschool children's physical activity (PA) and sedentary behavior (SB) is limited and has yielded inconsistent results. Our aim was to identify correlates of PA and SB in preschool children.

METHODS

Cross-sectional data were drawn from the Swiss Preschoolers' Health Study (SPLASHY), a Swiss population-based cohort study. Of 476 two to six year old children, 394 (54% boys) had valid PA data assessed by accelerometry. Information on exposure data was directly measured or extracted from parental questionnaires. Multilevel linear regression modeling was used to separately assess associations between 35 potential correlates and total PA (TPA), moderate-to-vigorous PA (MVPA) and SB.

RESULTS

In total, 12 correlates from different domains were identified. TPA and MVPA were greater in boys than girls, increased with age and were positively associated with gross motor skills. Children from single parent families had a higher level of TPA and spent less time sedentary than those living with two parents. Time spent outdoors was positively associated with TPA and negatively with SB. The child's activity temperament was related all three outcomes, whereas parental sports club membership, living area per person and neighborhood safety were associated with SB only. Fixed and random factors in the final models accounted for 28%, 32% and 22% of the total variance in TPA, MVPA and SB, respectively. Variance decomposition revealed that age, sex and activity temperament were the most influential correlates of both, TPA and MVPA, whereas the child's activity temperament, time outdoors and neighborhood safety were identified as the most important correlates of SB.

CONCLUSIONS

A multidimensional set of correlates of young children's activity behavior has been identified. Personal factors had the greatest influence on PA, whereas environmental-level factors had the greatest influence on SB. Moreover, we identified a number of previously unreported, potentially modifiable correlates of young children's PA and SB. These factors could serve to define target groups or become valuable targets for change in future interventions.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN41045021 (date of registration: 21.03.14).

Relations between response trajectories on the continuous performance test and teacher-rated problem behaviors in preschoolers

Although both the continuous performance test (CPT) and behavior rating scales are used in both practice and research to assess inattentive and hyperactive/impulsive behaviors, the correlations between performance on the CPT and teachers' ratings are typically only small-to-moderate. This study examined trajectories of performance on a low target-frequency visual CPT in a sample of preschool children and how these trajectories were associated with teacher-ratings of problem behaviors (i.e., inattention, hyperactivity/impulsivity [H/I], and oppositional/defiant behavior). Participants included 399 preschool children (mean age = 56 months; 49.4% female; 73.7% White/Caucasian). An attention deficit/hyperactivity disorder (ADHD) rating scale was completed by teachers, and the CPT was completed by the preschoolers. Results showed that children's performance across 4 temporal blocks on the CPT was not stable across the duration of the task, with error rates generally increasing from initial to later blocks. The predictive relations of teacher-rated problem behaviors to performance trajectories on the CPT were examined using growth curve models. Higher rates of teacher-reported inattention and H/I were uniquely associated with higher rates of initial omission errors and initial commission errors, respectively. Higher rates of teacher-reported overall problem behaviors were associated with increasing rates of omission but not commission errors during the CPT; however, the relation was not specific to 1 type of problem behavior. The results of this study indicate that the pattern of errors on the CPT in preschool samples is complex and may be determined by multiple behavioral factors. These findings have implications for the interpretation of CPT performance in young children.

Multimodal evaluation and management of children with concussion: using our heads and available evidence

BACKGROUND

Significant attention has been focused on concussions in children, but a dearth of research evidence exists supporting clinical evaluation and management.

AIM

The primary objective of this review paper is to describe a multimodal, developmentally adapted, standardized concussion assessment and active rehabilitation approach for children as young as 5 years old.

METHODS

This study reviews the CDC-funded research programme, including the development of tools for post-concussion symptom assessment involving the child and parent, measurement of specific neurocognitive functions and assessment of dynamic cognitive exertional effects.

RESULTS

A clinical approach to active, individualized, moderated concussion rehabilitation management is presented, including a 10-step guide to symptom management, with a specific focus on the school challenges faced by the recovering student.

CONCLUSION

To better inform concussion practice across the developmental age spectrum, a significant need exists for further research evidence to refine clinical assessment methods and develop effective treatment approaches.

Executive functions in preschoolers with ADHD, ODD, and comorbid ADHD-ODD: Evidence from ecological and performance-based measures

Executive functioning in 3-year-old preschoolers with attention-deficit hyperactivity disorder (ADHD), oppositional-defiant disorder (ODD), comorbid ADHD+ODD, and children without any of these conditions (control group) was examined. A community sample including 622 children was diagnosed using a diagnostic interview following DSM-IV criteria, and assessed using the Behavior Rating Inventory of Executive Function Preschool version (BRIEF-P) and the Kiddie-Conners' Continuous Performance Test. The children diagnosed with ADHD showed the poorest executive function (EF) profile in comparison with controls, and were closely followed up in this respect by the comorbid ADHD+ODD children. The ADHD and comorbid groups presented similar executive difficulties. The ODD group obtained mean scores statistically equal to those of controls in EF. These findings suggest that, in preschoolers, executive functioning deficits assessed with a performance-based measure or with behavioural descriptions are specific to children with ADHD, in comparison with those with ODD. This study contributes knowledge about EFs in two prevalent and comorbid disorders in preschool children, ADHD and ODD, knowledge that can help our understanding of specific deficits and the design of specific early intervention initiatives.

Inhibition and working memory in young preschool children with symptoms of ADHD and/or oppositional-defiant disorder

BACKGROUND

Early symptoms of attention deficit/hyperactivity disorder (ADHD) and oppositional-defiant disorder (ODD) are associated with deficits in cognitive self-regulatory processes or executive functions (EF)s. However, the hypothesis that neurocognitive deficits underlying the two disorders are already evident during early preschool years still has limited empirical support. The present study investigated associations between symptoms of ADHD and/or ODD and two core EFs, inhibition and working memory, in a large nonclinical sample of 3-year old children.

METHOD

Participants were 1045 children (554 boys, age 37-47 months), recruited from the population based Norwegian Mother and Child Cohort Study (MoBa). Relations between behavioral symptoms and measures of inhibition and working memory were studied both categorically and dimensionally.

RESULTS

Children with co-occurring symptoms of ADHD and ODD performed at a significantly lower level than typically developing children in 4 out of 5 EF measures. Symptoms of ADHD, both alone and in combination with ODD, were associated with reduced performance on tests of inhibition in the group comparisons. Dimensional analyses showed that performance within both EF domains contributed to variance primarily in ADHD symptom load. The associations between test results and behavioral symptoms remained significant after gender and verbal skills had been controlled.

CONCLUSION

Young preschoolers show the same pattern of relations between EF and behavioral symptoms of ADHD and/or ODD as previously described in older children diagnosed with ADHD and/or ODD. Effect sizes were generally small, indicating that measures of EF have limited clinical utility at this stage in development.

Association of ADHD symptoms and social competence with cognitive status in preschoolers

We aimed to investigate the association of attention-deficit hyperactivity disorder (ADHD) symptoms and social competence outcomes with cognitive status in preschool children. The study population was drawn from three birth cohorts belonging to the Spanish INMA (Infancia y Medio Ambiente) project: Menorca (n = 289), Ribera d'Ebre (n = 60), and Granada (n = 108). Children were assessed at the age of 4 years for cognitive functions (McCarthy Scales of Children's Abilities, MSCA) by psychologists and for inattention and hyperactivity symptoms (ADHD Criteria of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, ADHD-DSM-IV) and social competence (California Preschool Social Competence Scale) by their teachers. Multiple regression analyses were conducted to examine potential associations between behavioral outcomes (ADHD symptoms and social competence) and MSCA cognitive outcomes, adjusting for confounders. The presence of general ADHD symptoms (inattention, hyperactivity, or both) and poorer social competence both showed negative associations with cognitive outcomes. When we compared children according to ADHD subtypes, those with inattention symptoms alone and those with both inattention and hyperactivity symptoms showed significantly lower cognitive function scores in comparison to children with no ADHD symptoms. Behavioral dysfunctions in preschoolers may be associated with impairment of cognitive functions.

Conners' continuous performance test (CCPT-II) in children with ADHD, ODD, or a combined ADHD/ODD diagnosis

The current study investigated if results on the Conners' Continuous Performance Test (CCPT-II) could discriminate between children with ADHD (n = 59), ODD (n = 10), ADHD+ODD (n = 15), and normal controls (n =160), and how the results are associated with and explained by the intellectual function of the child. The sample was derived from the Bergen Child Study (BCS), a longitudinal, ongoing, population-based study of children's development and mental health. CCPT-II performance did not differentiate between the three diagnostic groups (i.e., ADHD, ODD, and ADHD+ODD). Children with ODD (with or without comorbid ADHD) did not differ from children in the control group on any CCPT-II parameters. Children with ADHD made statistically significant more errors of omissions and showed a more variable response time to targets than the control group. The correlations between CCPT-II measures and IQ were mild to moderate, and there was a statistically significant group difference in IQ: Children with ADHD, and children with ADHD+ODD, obtained lower IQ scores than normal controls. A hierarchical multiple regression analysis showed that IQ, but not diagnostic group status, was significant predictors of CCPT-II performance. CCPT-II performance should be interpreted with caution when assessing ADHD and/or ODD in children.

Assessment of attention in preschoolers

In the past two decades, there has been an increased interest in the assessment and treatment of preschool children presenting with concerns about attention problems. This article reviews the research and clinical literature involving assessment of attention and related skills in the preschool years. While inattention among preschoolers is common, symptoms alone do not necessarily indicate a disorder, and most often represent a normal variation in typical preschool child development. Thus, accurate identification of "disordered" attention in preschoolers can be challenging, and development of appropriate, norm-referenced tests of attention for preschoolers is also difficult. The current review suggests that comprehensive assessment of attention and related functions in the preschool child should include thorough review of the child's history, planned observations, and formal psychometric testing. The three primary methods of psychometric assessment that have been used to characterize attentional functioning in preschool children include performance-based tests, structured caregiver interviews, and rating scales (parent, teacher, and clinician). Among performance-based methods for measurement of attention in the preschool years, tests have been developed to assess sustained attention, selective (focused) attention, span of attention (encoding/manipulation), and (top-down) controlled attention--including freedom from distractibility and set shifting. Many of these tests remain experimental in nature, and review of published methods yields relatively few commercially available, nationally normed tests of attention for preschoolers, and an overall dearth of reliability and validity studies on the available measures.

Inattention, hyperactivity, and emergent literacy: different facets of inattention relate uniquely to preschoolers' reading-related skills

Although extant studies indicate that there is a strong association between attention deficit/hyperactivity disorder and reading ability in elementary school children, knowledge regarding the relation between inattentive and hyperactive/impulsive behaviors and emergent literacy in preschool children is less established. This study examined the unique and overlapping relations between measures that assess inattention and hyperactivity/impulsivity and emergent literacy skills in preschool children. Participants included 204 preschool children (M age = 56 months, 50.9% female, 79.8% European American). Behavioral rating scales were completed by teachers, and the Continuous Performance Test (CPT) and the Test of Preschool Early Literacy were completed by the preschoolers. Across measures, inattention was a unique correlate of emergent literacy skills, whereas hyperactivity/impulsivity was not. Both rating scales and the CPT indices of inattention were uniquely associated with emergent literacy skills. These results suggest that these measures are assessing different manifestations of inattention that are both unique correlates of early reading skills.

Executive function deficits in preschool children with ADHD and DBD

BACKGROUND

 Impairments in executive functions (EF) are consistently associated with attention deficit hyperactivity disorder (ADHD) and to a lesser extent, with disruptive behavior disorder (DBD), that is, oppositional defiant disorder or conduct disorder, in school-aged children. Recently, larger numbers of children with these disorders are diagnosed earlier in development, yet knowledge about impairments in clinically diagnosed preschool children and the role of comorbidity is limited. Therefore, the aim of the current study was to examine EF in clinically referred preschool children with a clinical diagnosis of ADHD, DBD and ADHD + DBD.

METHOD

Participants were 202 children aged 3.5-5.5 years, 61 with ADHD only, 33 with DBD only, 52 with comorbid ADHD + DBD and 56 typically developing children. Five EF tasks were administered.

RESULTS

Confirmatory factor analysis showed that the two-factor model (inhibition and working memory) fit the data better than a one-factor model in this clinical sample. Preschoolers with ADHD displayed inhibition deficits, also after controlling for IQ. Likewise, preschoolers with DBD displayed impaired inhibition, but when IQ was controlled differences were carried mostly by the effect on the task where motivational demands were high (i.e. when tangible rewards were used). This pattern was also found in the interaction between ADHD and DBD; impaired inhibition in the comorbid group, however, was more severe than in the DBD group. Regarding working memory, few group differences were found.

CONCLUSIONS

Clinically diagnosed preschool children with ADHD showed robust inhibition deficits, whereas preschool children with DBD showed impaired inhibition especially where motivational incentives were prominent. Severity of inhibition impairment in the comorbid group was similar to the ADHD group.

Executive control and dimensions of problem behaviors in preschool children

BACKGROUND

Despite the widespread recognition of the importance of executive control (EC) in externalizing psychopathology, the relation between EC and problem behavior has not been well characterized, particularly in typically developing preschoolers.

METHOD

Using the sample, battery of laboratory tasks, and latent variable modeling methods described in Wiebe, Espy, and Charak (2008), systematic latent dimensions of parent-rated problem behavior, measured by integrating scales from developmental and clinical traditions, were determined empirically, and then were related to EC.

RESULTS

Substantial relations between EC and problem behaviors were revealed by extracting the common variance of interest and eliminating extraneous variance, which were robust to estimated child intelligence and differed somewhat in preschool boys and girls.

CONCLUSION

Preschool EC measured by laboratory tasks appears to tap abilities that strongly and robustly support broad control processes enabling behavioral regulation across cognitive and emotional domains.