Examining relationships between executive functioning and delay aversion in attention deficit hyperactivity disorder

EFL Special Education Teachers' Perspectives: Evaluating Game-Based Learning for ADHD Behavioral Disorders

OBJECTIVE

The purpose of this study was to examine the perspectives of English as a Foreign Language Special Education teachers (EFLSE) regarding game-based learning approaches for addressing behavioral disorders in ADHD patients.

METHOD

The study involved a sample (n = 131) of EFLSE teachers who completed a questionnaire to determine how feasible, acceptable, and helpful they found game-based learning.

RESULTS

The study revealed that EFLSE teachers perceive game-based learning to be a feasible and acceptable method for engaging ADHD students and helping to maintain their attention during game-based learning activities. Nevertheless, implementation and individualized approaches are cited as challenges. Additionally, EFLSE teachers emphasized the benefits of game-based learning, including improved problem-solving, assessment methods, collaboration, and the acquisition of academic skills.

CONCLUSIONS

The study contributes insights for educators, policymakers, and researchers that can support the development of evidence-based interventions offering game-based learning for students with ADHD.

Brain mechanisms of temporal processing in impulsivity: Relevance to attention-deficit hyperactivity disorder

In this article, we critique the hypothesis that different varieties of impulsivity, including impulsiveness present in attention-deficit hyperactivity disorder, encompass an accelerated perception of time. This conceptualisation provides insights into how individuals with attention-deficit hyperactivity disorder have the capacity to maximise cognitive capabilities by more closely aligning themselves with appropriate environmental contexts (e.g. fast paced tasks that prevent boredom). We discuss the evidence for altered time perception in attention-deficit hyperactivity disorder alongside putative underlying neurobiological substrates, including a distributed brain network mediating time perception over multiple timescales. In particular, we explore the importance of temporal representations across the brain for time perception and symptom manifestation in attention-deficit hyperactivity disorder, including a prominent role of the hippocampus and other temporal lobe regions. We also reflect on how abnormalities in the perception of time may be relevant for understanding the aetiology of attention-deficit hyperactivity disorder and mechanism of action of existing medications.

Behavior Rating Inventory of Executive Function in Preschool (BRIEF-P) and Attention-Deficit and Hyperactivity Disorders (ADHD): A Systematic Review and Meta-Analysis of Floor and Ceiling Effects

BACKGROUND

ADHD is a neurodevelopmental disorder that is accompanied by executive challenges.

OBJECTIVES

To obtain evidence of the usefulness of the BRIEF-P and to analyze the possible ceiling and floor effect of its scores in the assessment of executive function in preschoolers with signs compatible with a possible diagnosis of ADHD.

METHOD

A search was performed in Science Direct, NCBI (PubMed), and ProQuest Education Journals during the period 2012-2022. We included studies that evaluated samples of individuals with symptomatology compatible with ADHD, with an age range between 2 and 6 years, published in English or Spanish. Of a total of 2538 articles, only seven met the inclusion criteria. The risk of bias was assessed using the QUADAS-2 questionnaire. The main variables were age and executive functioning.

CONCLUSIONS

Executive deficits in early-age individuals with symptoms compatible with ADHD are more extensive than just deficits in working memory. A floor effect has been found in tests associated with hot executive functions and a ceiling effect in cold executive functions. This makes it necessary to use different tests to assess executive performance in preschoolers with ADHD-compatible symptomatology and to design intervention proposals accordingly. The BRIEF-P is an instrument that facilitates obtaining a sensitive and discriminative executive profile, although it should be used in combination with other neuropsychological performance tests.

Developmental trajectory of hot and cold executive functions in children with and without attention deficit-hyperactivity disorder (ADHD)

BACKGROUND

Children with attention deficit hyperactivity disorder (ADHD) have a delayed development. Two main cognitive models of ADHD are executive (cold) and motivational (hot) models. In this study, we aimed to compare the development of hot and cold executive functions in children with and without ADHD.

METHODS AND PROCEDURES

Forty-six children with ADHD symptoms (56% boys) and forty-four typically developing controls (54% boys), in three age groups of 6-8, 8-10 and 10-12 years, were participated in the study. Go/No-Go Task (GNGT), One-Back Test (OBT) and Shifting Attention Test (SAT), Delay Discounting Test (DDT) and Balloon Analogue Risk Task (BART) were used for assessment.

OUTCOMES AND RESULTS

Children with ADHD showed lower performance in GNG, OBT, SAT, and BART, but intact performance in DDT. The tasks' performance was significantly different between three age groups in GNG and SAT, but similar in OBT and BART. The interaction effect was significant only for the BART measures.

CONCLUSIONS AND IMPLICATIONS

Children with ADHD compared to typically developing children, experience impaired hot and cold executive functions. The cognitive delay was found only in risky decision making as a hot executive function.

Assessment of 'Cool' and 'Hot' Executive Skills in Children with ADHD: The Role of Performance Measures and Behavioral Ratings

Executive dysfunction is an underlying characteristic of Attention Deficit/Hyperactivity Disorder (ADHD). Therefore, this study explored which measures of executive functions (EF) may lead to a better diagnostic prediction and evaluated whether participants were adequately assigned to the ADHD group based on the identified predictors. Seventeen 6- to 10-year-old children with ADHD were matched with 17 typically developing peers (TD) by age, gender, and non-verbal intelligence. Performance-based measures and behavior ratings of 'cool' and 'hot' EF were used. As expected, there was a significant group effect on the linear combination of measures, indicating that children with ADHD showed significant difficulties with EF compared to the TD group. In fact, significant differences were found in measures of short-term and working memory, planning, delay aversion, and EF-related behaviors, as reported by parents and teachers. However, the discriminant function analysis only revealed three significant predictors: the General Executive Composite of the Behavior Rating Inventory of Executive Function (Parent and Teacher Forms) and the Delay of Gratification Task, with 97.1% correct classifications. These findings highlight the importance and contribution of both behavioral ratings and 'hot' measures of EF for the characterization of ADHD in children.

An evaluation of the effect of methylphenidate on working memory, time perception, and choice impulsivity in children with ADHD

Individuals with Attention-Deficit Hyperactivity Disorder (ADHD) consistently exhibit a stronger preference for immediate rewards than for larger rewards available following a delay on tasks measuring choice impulsivity (CI). Despite this, however, there remains a dearth of studies examining the impact of stimulant treatment on CI as well as associated higher order (e.g., working memory [WM]) and perceptual (e.g., time perception) cognitive processes. The present study examines the effect of osmotic release oral system methylphenidate (OROS-MPH) on CI, WM and time perception processes as well as the relation among these processes before and after taking a regimen of OROS-MPH. Thirty-five children (aged 7-12 years) with a diagnosis of ADHD participating in a concurrent stimulant medication study were recruited to complete computerized assessments of CI, WM, and time perception. Children completed the assessments after administration of a placebo as well as their lowest effective dose of OROS-MPH following a 2-week titration period. The results from one-sample t-tests indicated that OROS-MPH improves both CI and WM in youth with ADHD but does not impact time perception. Further, results revealed no significant association among the various indices of cognitive performance while taking placebo or OROS-MPH. Overall, the findings suggest that while OROS-MPH improves both CI and WM in youth with ADHD, improvements in CI as a result of OROS-MPH are unlikely to be associated with the improvements in WM given the lack of association among the two. Future studies should consider alternate cognitive, emotional, and motivational mechanisms that may account for the impact of OROS-MPH on CI. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Clinical characteristics, neuroimaging findings, and neuropsychological functioning in attention-deficit hyperactivity disorder: Sex differences

Recent clinical studies, in both children/adolescents and adults, have shown the extreme neuropsychological heterogeneity of attention-deficit hyperactivity disorder (ADHD): specific neuropsychological deficits have been found only in a minority of individuals, with no direct correlation between discrete cognitive performances and the trajectory of clinical symptoms. Deficits in specific neuropsychological functions may be common in ADHD, but nevertheless no cognitive or neuropsychological profile may fully explain the disorder. Sex differences in the ADHD presentation, both at a neuropsychological and clinical level, also contribute to this clinical and neuropsychological heterogeneity. At a neuropsychological level, females with ADHD may show greater working memory problems, poorer vocabulary skills and worse visual spatial reasoning. Structural and functional imaging study also show discrete differences across sex; however, the great majority of clinical studies mainly or exclusively include male participants with insufficient data to draw firm conclusions on sex differences within the disorder. Here, we report the recent literature data, discussing still open research questions about the clinical presentation, neuroimaging findings, and neuropsychological functioning in ADHD with a focus on the impact of sex differences-a deeper insight in these unresolved issues may have relevant clinical and therapeutic implications for tailored, effective, and long-lasting interventions.

A Meta-Analytic Review of Sex Differences on Delay of Gratification and Temporal Discounting Tasks in ADHD and Typically Developing Samples

Objective: To examine whether males and females with ADHD differ in their preferences for delayed rewards, since there is some evidence that suggests a sex difference with typically developing (TD) samples. Method: We used meta-analyses to examine sex differences on delay of gratification and temporal discounting tasks in both TD and ADHD samples. We identified 28 papers with 52 effect sizes for children and adults, and calculated the average effect size for sex comparisons within TD and ADHD samples. Results: The estimated mean difference between TD males and TD females was negligible, but males with ADHD were more likely to choose the larger delayed rewards than females with ADHD. Meta-regressions indicated that task type, age, and reward type did not significantly predict sex differences. Conclusion: These findings suggest that females referred for ADHD may make less adaptive choices by preferring smaller immediate rewards over larger delayed rewards more often than males with ADHD. Implications of our findings are discussed.

ADHD and the Choice of Small Immediate Over Larger Delayed Rewards: A Comparative Meta-Analysis of Performance on Simple Choice-Delay and Temporal Discounting Paradigms

Objective: Impulsive choices can lead to suboptimal decision making, a tendency which is especially marked in individuals with ADHD. We compared two different paradigms assessing impulsive choice: the simple choice paradigm (SCP) and the temporal discounting paradigm (TDP). Method: Random effects meta-analyses on 37 group comparisons (22 SCP; 15 TDP) consisting of 3.763 participants (53% ADHD). Results: Small-to-medium effect sizes emerged for both paradigms, confirming that participants with ADHD choose small immediate over large delayed rewards more frequently than controls. Moderation analyses show that offering real rewards in the SCP almost doubled the odds ratio for participants with ADHD. Conclusion: We suggest that a stronger than normal aversion toward delay interacts with a demotivating effect of hypothetical rewards, both factors promoting impulsive choice in participants with ADHD. Furthermore, we suggest the SCP as the paradigm of choice due to its larger ecological validity, contextual sensitivity, and reliability.

Neural Correlates of the Dual-Pathway Model for ADHD in Adolescents

OBJECTIVE

The dual-pathway model has been proposed to explain the heterogeneity in symptoms of attention deficit hyperactivity disorder (ADHD) by two independent psychological pathways based on distinct brain circuits. The authors sought to test whether the hypothesized cognitive and motivational pathways have separable neural correlates.

METHODS

In a longitudinal community-based cohort of 1,963 adolescents, the neuroanatomical correlates of ADHD were identified by a voxel-wise association analysis and then validated using an independent clinical sample (99 never-medicated patients with ADHD, 56 medicated patients with ADHD, and 267 healthy control subjects). The cognitive and motivational pathways were assessed by neuropsychological tests of working memory, intrasubject variability, stop-signal reaction time, and delay discounting. The associations were tested between the identified neuroanatomical correlates and both ADHD symptoms 2 years later and the polygenic risk score for ADHD.

RESULTS

Gray matter volumes of both a prefrontal cluster and a posterior occipital cluster were negatively associated with inattention. Compared with healthy control subjects, never-medicated patients, but not medicated patients, had significantly lower gray matter volumes in these two clusters. Working memory and intrasubject variability were associated with the posterior occipital cluster, and delay discounting was independently associated with both clusters. The baseline gray matter volume of the posterior occipital cluster predicted the inattention symptoms in a 2-year follow-up and was associated with the genetic risk for ADHD.

CONCLUSIONS

The dual-pathway model has both shared and separable neuroanatomical correlates, and the shared correlate in the occipital cortex has the potential to serve as an imaging trait marker of ADHD, especially the inattention symptom domain.

Dietary effects on the determinants of food choice: Impulsive choice, discrimination, incentive motivation, preference, and liking in male rats

The current study sought to understand how long-term exposure to diets high in saturated fat and refined sugar affected impulsive choice behavior, discrimination abilities, incentive motivation, food preferences, and liking of fat and sugar in male rats. The results showed that 8 weeks of dietary exposure impaired impulsive choice behavior; rats exposed to diets high in processed fat or sugar were more sensitive to changes in delay, a marker of impulsivity. For the high-fat group, these deficits in impulsive choice may stem from poor time discrimination, as their performance was impaired on a temporal discrimination task. The high-fat group also showed reduced magnitude sensitivity in the impulsive choice task, and they earned fewer rewards during lever press training indicating potentially reduced incentive motivation. The high-fat group also developed a preference for high-fat foods compared to the chow and high-sugar group who both preferred sugar. In contrast, dietary exposure did not alter the liking of fat or sugar as measured by a taste reactivity task. Together, the results suggest that the alterations in impulsive choice, time discrimination, incentive motivation, and food preferences induced by consumption of a high-fat diet could make individuals vulnerable to overeating, and thus obesity.

Are there distinct cognitive and motivational sub-groups of children with ADHD?

BACKGROUND

Attention-deficit/hyperactivity disorder (ADHD) is proposed to be a neuropsychologically heterogeneous disorder that encompasses two distinct sub-groups, one with executive function (EF) deficits and one with delay aversion (DA). However, such claims have often been based on studies that have operationalized neuropsychological deficits using a categorical approach - using intuitive but rather arbitrary, clinical cut-offs. The current study applied an alternative empirical approach to sub-grouping in ADHD, latent profile analysis (LPA), and attempted to validate emerging subgroups through clinically relevant correlates.

METHODS

One-hundred medication-naïve children with ADHD and 96 typically developing children (6-14 years) completed nine EF and three DA tasks as well as an odor identification test. Parents and teachers provided reports of the children's behavior (ADHD and EF). Models of the latent structure of scores on EF and DA tests were contrasted using confirmatory factor analysis (CFA). LPA was carried out based on factor scores from the CFA and sub-groups were compared in terms of odor identification and behavior.

RESULTS

A model with one DA and two EF factors best fit the data. LPA resulted in four sub-groups that differed in terms of general level of neuropsychological performance (ranging from high to very low), odor identification, and behavior. The sub-groups did not differ in terms of the relative EF and DA performance. Results in the ADHD group were replicated in the control group.

CONCLUSIONS

While EF and DA appear to be dissociable constructs; they do not yield distinct sub-groups when sub-grouping is based on a statistical approach such as LPA.

Children's Sensitivity to Cost and Reward in Decision Making Across Distinct Domains of Probability, Effort, and Delay

Many behavioral paradigms used to study individuals' decision making tendencies do not capture the decision components that contribute to behavioral outcomes, such as differentiating decisions driven toward a reward from decisions driven away from a cost. This study tested a novel decision making task in a sample of 403 children (age 9 years) enrolled in an ongoing longitudinal study. The task consisted of 3 blocks representing distinct cost domains (delay, probability, effort) wherein children were presented with a deck of cards, each of which consisted of a reward and a cost. Children elected whether to accept or skip the card at each trial. Reward-cost pairs were selected using an adaptive algorithm to strategically sample the decision space in the fewest number of trials. Using person-specific regression models, decision preferences were quantified for each cost domain with respect to general tolerance (intercept), as well as parameters estimating the effect of incremental increases in reward or cost on the probability of accepting a card. Results support the relative independence of decision making tendencies across cost domains, with moderate correlations observed between tolerance for delay and effort. Specific decision parameters showed unique associations with cognitive and behavioral measures including executive function, academic motivation, anxiety, and hyperactivity. Evidence indicates that sensitivity to reward is an important factor in incentivizing decisions to work harder or wait longer. Dissociating the relative contributions of reward and cost sensitivity in multiple domains may facilitate the identification of heterogeneity in sub-optimal decision making.

Greater delay discounting among girls, but not boys, with ADHD correlates with cognitive control

Cognitive neuroscience models suggest both reward valuation and cognitive control contribute to reward-based decision-making. The current study examined the relationship between cognitive control and delay discounting (i.e., choosing smaller, immediate over larger, delayed rewards) in a large sample of boys and girls diagnosed with attention-deficit/hyperactivity disorder (ADHD; N = 95) and typically developing control children (TD; N = 59). Specifically, we examined performance on multiple measures of cognitive control (i.e., Go/No-Go task, Stop Signal task, and Spatial Span task) and delay discounting (i.e., Classic Delay Discounting and Real-Time Delay Discounting tasks), as well as the relationship between these measures. Results indicated that sex moderated the effects of group on task performance. Specifically, girls with ADHD, but not boys with the disorder, exhibited atypical delay discounting of real-time rewards. Results from correlational analyses indicated that delay discounting and cognitive control were not significantly correlated in the overall sample. Multiple regression analyses demonstrated that among girls with ADHD poorer spatial working memory and inhibitory control predicted greater real-time discounting. Collectively, findings provide support for distinct patterns of cognitive control and delay discounting among school-aged girls and boys with ADHD. Additionally, findings suggest that among girls with ADHD, those who exhibit relatively poor working memory and inhibitory control might be a particularly vulnerable subgroup with the greatest propensity to exhibit maladaptive decision-making.

Heterogeneity in development of aspects of working memory predicts longitudinal attention deficit hyperactivity disorder symptom change

The role of cognitive mechanisms in the clinical course of neurodevelopmental disorders is poorly understood. Attention Deficit Hyperactivity Disorder (ADHD) is emblematic in that numerous alterations in cognitive development are apparent, yet how they relate to changes in symptom expression with age is unclear. To resolve the role of cognitive mechanisms in ADHD, a developmental perspective that takes into account expected within-group heterogeneity is needed.

METHOD

The current study uses an accelerated longitudinal design and latent trajectory growth mixture models in a sample of children ages 7-13 years carefully characterized as with (n = 437) and without (n = 297) ADHD to (a) identify heterogeneous developmental trajectories for response inhibition, visual spatial working memory maintenance, and delayed reward discounting and (b) to assess the relationships between these cognitive trajectories and ADHD symptom change.

RESULTS

Best-fitting models indicated multiple trajectory classes in both the ADHD and typically developing samples, as well as distinct relationships between each cognitive process and ADHD symptom change. Developmental change in response inhibition and delayed reward discounting were unrelated to ADHD symptom change, while individual differences in the rate of visual spatial working memory maintenance improvement predicted symptom remission in ADHD.

CONCLUSION

Characterizing heterogeneity in cognitive development will be crucial for clarifying mechanisms of symptom persistence and recovery. Results here suggest working memory maintenance may be uniquely related to ADHD symptom improvement. (PsycINFO Database Record

Neuropsychological Functioning in Adults With ADHD and Adults With Other Psychiatric Disorders

OBJECTIVE

The aim was to investigate how well neuropsychological measures can discriminate between adults with ADHD and those with other psychiatric disorders.

METHOD

Adults with ADHD and a clinical control group ( n = 110) were included. Neuropsychological functioning was investigated using measures of inhibition, working memory, set shifting, planning, fluency, reaction-time variability, and delay aversion.

RESULTS

Adults with ADHD performed more poorly compared with clinical controls with regard to all constructs. The effects of verbal memory, inhibition, set shifting, fluency, and delay aversion remained significant when controlling for IQ. However, when controlling for basic cognitive functions, only the effects of inhibition, fluency, and delay aversion were significant. Sensitivity ranged between 64% and 75%, and specificity between 66% and 81%.

CONCLUSION

Neuropsychological tests have a relatively poor ability to discriminate between adults with ADHD and clinical controls, but they may be used to identify individuals at particularly high risk for poor daily functioning.

Investigating the Impact of Cognitive Load and Motivation on Response Control in Relation to Delay Discounting in Children with ADHD

Attention-deficit/hyperactivity disorder (ADHD) is characterized by deficits in impulse control across a range of behaviors, from simple actions to those involving complex decision-making (e.g., preference for smaller-sooner versus larger later rewards). This study investigated whether changes in motor response control with increased cognitive load and motivational contingencies are associated with decision-making in the form of delay discounting among 8-12 year old children with and without ADHD. Children with ADHD (n = 26; 8 girls) and typically developing controls (n = 40; 11 girls) completed a standard go/no-go (GNG) task, a GNG task with motivational contingencies, a GNG task with increased cognitive load, and two measures of delay discounting: a real-time task in which the delays and immediately consumable rewards are experienced in real-time, and a classic task involving choices about money at longer delays. Children with ADHD, particularly girls, exhibited greater delay discounting than controls during the real-time discounting task, whereas diagnostic groups did not significantly differ on the classic discounting task. The effect of cognitive load on response control was uniquely associated with greater discounting on the real-time task for children with ADHD, but not for control children. The effect of motivational contingencies on response control was not significantly associated with delay discounting for either diagnostic group. The findings from this study help to inform our understanding of the factors that influence deficient self-control in ADHD, suggesting that impairments in cognitive control may contribute to greater delay discounting in ADHD.

Anticipatory Electrodermal Response as a Differentiating Somatic Marker Between Children with ADHD and Controls

Six children with Attention Deficit Hyperactivity Disorder (ADHD) and five control children between the ages of 9 and 11 years were administered an adapted version of the Iowa Gambling Task while measuring anticipatory electrodermal response (EDR). Anticipatory EDR measures were compared between groups. Results indicate that the ADHD group exhibited significantly lower autonomic reactivity to anticipated consequences, evidencing a neuropsychological profile similar to patients with lesions in the ventromedial prefrontal cortex.

No Evidence for Inhibitory Deficits or Altered Reward Processing in ADHD: Data From a New Integrated Monetary Incentive Delay Go/No-Go Task

OBJECTIVE

Cognitive and motivational factors differentially affect individuals with mental health problems such as ADHD. Here we introduce a new task to disentangle the relative contribution of inhibitory control and reward anticipation on task performance in children with ADHD and/or autism spectrum disorders (ASD).

METHOD

Typically developing children, children with ADHD,  ASD, or both disorders worked during separate sessions for monetary or social rewards in go/no-go tasks with varying inhibitory load levels. Participants also completed a monetary temporal discounting (TD) task.

RESULTS

As predicted, task performance was sensitive to both the effects of anticipated reward amount and inhibitory load. Reward amount had different effects depending on inhibitory load level. TD correlated with inhibitory control in the ADHD group.

CONCLUSION

The integration of the monetary incentive delay and go/no-go paradigms was successful. Surprisingly, there was no evidence of inhibitory control deficits or altered reward anticipation in the clinical groups.

Neuropsychological heterogeneity in preschool ADHD: investigating the interplay between cognitive, affective and motivation-based forms of regulation

There is a trend toward diagnosing ADHD prior to school entry. Despite this, there is a lack of studies investigating ADHD in the preschool years, at least studies including a large range of different neuropsychological functions. Our knowledge of the independent effects of different neuropsychological functions in relation to preschool ADHD is therefore limited. In order to address this issue, the present study investigated cognitive, affective, and motivation-based regulation in relation to ADHD symptoms in 104 preschool children (age M = 67.33 months, SD = 10.10; 65 % boys). Results showed that these regulatory processes were all significantly related to ADHD symptoms and that most of these relations remained after controlling for comorbid conduct problems. Most previous preschool studies have only included cognitive regulation, and to some extent motivation-based regulation. By also including affective regulation, we were able to explain a larger proportion of the variance in ADHD symptoms. However, it should be noted that the amount of variance explained was still small in comparison with what has been found in previous studies of school-aged children. This finding could be taken as an indication that further studies examining the nature of preschool ADHD are needed, and that it may be necessary to look beyond the neuropsychological factors that have been linked to the disorder in older children and adults.

Reward modulation of cognitive function in adult attention-deficit/hyperactivity disorder: a pilot study on the role of striatal dopamine

Attention-deficit/hyperactivity disorder (ADHD) is accompanied by impairments in cognitive control, such as task-switching deficits. We investigated whether such problems, and their remediation by medication, reflect abnormal reward motivation and associated striatal dopamine transmission in ADHD. We used functional genetic neuroimaging to assess the effects of dopaminergic medication and reward motivation on task-switching and striatal BOLD signal in 23 adults with ADHD, ON and OFF methylphenidate, and 26 healthy controls. Critically, we took into account interindividual variability in striatal dopamine by exploiting a common genetic polymorphism (3'-UTR VNTR) in the DAT1 gene coding for the dopamine transporter. The results showed a highly significant group by genotype interaction in the striatum. This was because a subgroup of patients with ADHD showed markedly exaggerated effects of reward on the striatal BOLD signal during task-switching when they were OFF their dopaminergic medication. Specifically, patients carrying the 9R allele showed a greater striatal signal than healthy controls carrying this allele, whereas no effect of diagnosis was observed in 10R homozygotes. Aberrant striatal responses were normalized when 9R-carrying patients with ADHD were ON medication. These pilot data indicate an important role for aberrant reward motivation, striatal dopamine and interindividual genetic differences in cognitive processes in adult ADHD.

Emotion dysregulation in attention deficit hyperactivity disorder

Although it has long been recognized that many individuals with attention deficit hyperactivity disorder (ADHD) also have difficulties with emotion regulation, no consensus has been reached on how to conceptualize this clinically challenging domain. The authors examine the current literature using both quantitative and qualitative methods. Three key findings emerge. First, emotion dysregulation is prevalent in ADHD throughout the lifespan and is a major contributor to impairment. Second, emotion dysregulation in ADHD may arise from deficits in orienting toward, recognizing, and/or allocating attention to emotional stimuli; these deficits implicate dysfunction within a striato-amygdalo-medial prefrontal cortical network. Third, while current treatments for ADHD often also ameliorate emotion dysregulation, a focus on this combination of symptoms reframes clinical questions and could stimulate novel therapeutic approaches. The authors then consider three models to explain the overlap between emotion dysregulation and ADHD: emotion dysregulation and ADHD are correlated but distinct dimensions; emotion dysregulation is a core diagnostic feature of ADHD; and the combination constitutes a nosological entity distinct from both ADHD and emotion dysregulation alone. The differing predictions from each model can guide research on the much-neglected population of patients with ADHD and emotion dysregulation.

Multiple modes of impulsivity in Parkinson's disease

Cognitive problems are a major factor determining quality of life of patients with Parkinson's disease. These include deficits in inhibitory control, ranging from subclinical alterations in decision-making to severe impulse control disorders. Based on preclinical studies, we proposed that Parkinson's disease does not cause a unified disorder of inhibitory control, but rather a set of impulsivity factors with distinct psychological profiles, anatomy and pharmacology. We assessed a broad set of measures of the cognitive, behavioural and temperamental/trait aspects of impulsivity. Sixty adults, including 30 idiopathic Parkinson's disease patients (Hoehn and Yahr stage I–III) and 30 healthy controls, completed a neuropsychological battery, objective behavioural measures and self-report questionnaires. Univariate analyses of variance confirmed group differences in nine out of eleven metrics. We then used factor analysis (principal components method) to identify the structure of impulsivity in Parkinson's disease. Four principal factors were identified, consistent with four different mechanisms of impulsivity, explaining 60% of variance. The factors were related to (1) tests of response conflict, interference and self assessment of impulsive behaviours on the Barrett Impulsivity Scale, (2) tests of motor inhibitory control, and the self-report behavioural approach system, (3) time estimation and delay aversion, and (4) reflection in hypothetical scenarios including temporal discounting. The different test profiles of these four factors were consistent with human and comparative studies of the pharmacology and functional anatomy of impulsivity. Relationships between each factor and clinical and demographic features were examined by regression against factor loadings. Levodopa dose equivalent was associated only with factors (2) and (3). The results confirm that impulsivity is common in Parkinson's disease, even in the absence of impulse control disorders, and that it is not a unitary phenomenon. A better understanding of the structure of impulsivity in Parkinson's disease will support more evidence-based and effective strategies to treat impulsivity.

The impact of financial reward contingencies on cognitive function profiles in adult ADHD

Objectives

Although it is well established that cognitive performance in children with attention-deficit/hyperactivity disorder (ADHD) is affected by reward and that key deficits associated with the disorder may thereby be attenuated or even compensated, this phenomenon in adults with ADHD has thus far not been addressed. Therefore, the aim of the present study was to examine the motivating effect of financial reward on task performance in adults with ADHD by focusing on the domains of executive functioning, attention, time perception, and delay aversion.

Methods

We examined male and female adults aged 18–40 years with ADHD (n = 38) along with a matched control group (n = 40) using six well-established experimental paradigms.

Results

Impaired performance in the ADHD group was observed for stop-signal omission errors, n-back accuracy, reaction time variability in the continuous performance task, and time reproduction accuracy, and reward normalized time reproduction accuracy. Furthermore, when rewarded, subjects with ADHD exhibited longer reaction times and fewer false positives in the continuous performance task, which suggests the use of strategies to prevent impulsivity errors.

Conclusions

Taken together, our results support the existence of both cognitive and motivational mechanisms for the disorder, which is in line with current models of ADHD. Furthermore, our data suggest cognitive strategies of “stopping and thinking” as a possible underlying mechanism for task improvement that seems to be mediated by reward, which highlights the importance of the interaction between motivation and cognition in adult ADHD.

Domain-general and domain-specific aspects of temporal discounting in children with ADHD and autism spectrum disorders (ASD): a proof of concept study

It has been shown that delayed consumable rewards are discounted to a higher degree than money, which has been referred to as the "domain effect". Until now the effects of reward type on temporal discounting (TD) have mainly been studied in adults. Although there is evidence that children with attention-deficit/hyperactivity disorder (ADHD) tend to show steeper TD of money than typically developing peers or children with autism spectrum disorders (ASD), it remains untested whether the domain effect is also seen in children with ADHD and ASD. To explore this we compared TD of children (8-16 year) with ADHD, ASD and typically developing controls with five different reward types. Seventy-two participants with ADHD, 69 with ASD and 130 controls performed two hypothetical TD-tasks: a monetary TD-task and a TD-task with one of four alternative rewards (material rewards, rewarding activities, food, social rewards). TD was seen for all reward types, but the rate of discounting was steeper for food, praise and rewarding activities compared to money, and for food and praise compared to material rewards. For the ADHD and control groups, but not the ASD group, money and material rewards were equally highly discounted. High correlations between TD of money and of activities, food and material rewards were found. In conclusion, a domain effect was observed in typically developing children, as well as in children with ADHD or ASD, although the pattern was somewhat different for ASD children. Despite this domain effect, there is also evidence for a domain-general aspect in TD.

Multiple deficits in ADHD: executive dysfunction, delay aversion, reaction time variability, and emotional deficits

BACKGROUND

The notion that ADHD constitutes a heterogeneous disorder is well accepted. However, this study contributes with new important knowledge by examining independent effects of a large range of neuropsychological deficits. In addition, the study investigated whether deficits in emotional functioning constitute a dissociable component of ADHD.

METHOD

The study included children with ADHD (n = 102; 7-13 years) and a control sample individually matched with regard to age and gender. The administered tasks were designed to tap into three different neuropsychological domains: executive functions (i.e., working memory, inhibition, and shifting), delay aversion, and reaction time variability. Parent ratings of emotion regulation and a test of emotion recognition were also included.

RESULTS

Children with ADHD differed significantly from controls on all measures, except for delay aversion and recognition of disgust. No main effects of gender or interaction effects of gender and group were found. More importantly, executive functioning, reaction time variability, and emotional functioning all contributed independently to distinguishing between children with ADHD and controls.

CONCLUSIONS

 The current study supports the view of ADHD as a heterogeneous disorder related to multiple neuropsychological deficits. In addition, emotional functioning appears to be an area of importance for ADHD that needs to be incorporated into future theoretical models.

Understanding phonological memory deficits in boys with attention-deficit/hyperactivity disorder (ADHD): dissociation of short-term storage and articulatory rehearsal processes

The current study dissociated and examined the two primary components of the phonological working memory subsystem--the short-term store and articulatory rehearsal mechanism--in boys with ADHD (n = 18) relative to typically developing boys (n = 15). Word lists of increasing length (2, 4, and 6 words per trial) were presented to and recalled by children following a brief (3 s) interval to assess their phonological short-term storage capacity. Children's ability to utilize the articulatory rehearsal mechanism to actively maintain information in the phonological short-term store was assessed using word lists at their established memory span but with extended rehearsal times (12 s and 21 s delays). Results indicate that both phonological shortterm storage capacity and articulatory rehearsal are impaired or underdeveloped to a significant extent in boys with ADHD relative to typically developing boys, even after controlling for age, SES, IQ, and reading speed. Larger magnitude deficits, however, were apparent in short-term storage capacity (ES = 1.15 to 1.98) relative to articulatory rehearsal (ES = 0.47 to 1.02). These findings are consistent with previous reports of deficient phonological short-term memory in boys with ADHD, and suggest that future attempts to develop remedial cognitive interventions for children with ADHD will need to include active components that require children to hold increasingly more information over longer time intervals.

Das ADHS-Camp

Die Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung (ADHS) ist eine der am häufigsten gestellten Diagnosen im Bereich der Kinder- und Jugendlichenpsychotherapie. Verschiedene Studien belegen die Wirksamkeit multimodaler Maßnahmen und verweisen dabei auf die Bedeutung der Verhaltenstherapie, deren Wirksamkeit bereits in verschiedenen Studien belegt wurde. Da sich viele Therapieangebote über einen langen Zeitraum erstrecken, wurde das ADHS-Camp als zeitökonomisches, intensivtherapeutisches Vorgehen entwickelt und dessen Wirksamkeit im Rahmen dieser Studie auf Langzeiteffekte (6 und 12 Monate nach Abschluss der Therapie) überprüft. Dies geschah unter Einbezug funktionsorientierter (neuropsychologischer) und verhaltensorientierter Testverfahren, wobei letztere von Eltern und Lehrern beurteilt wurden. Über die Berechnung von MAN(C)OVAS mit Messwiederholung zeigte sich, dass das ADHS-Camp zu einer signifikanten Verbesserung sowohl auf funktioneller als auch verhaltensorientierter Ebene führt. Auf der Verhaltensebene sehen Eltern einen stärkeren Einfluss als die Lehrer. Um zu gewährleisten, dass die Effekte nicht durch normale Reifungsprozesse beeinflusst sind, wurde das Alter als Kovariate aufgenommen. Es zeigt sich, dass das ADHS-Camp als eine wirkungsvolle Maßnahme bewertet werden kann. Erzielte Verbesserungen der Problemlage sind sowohl auf der funktionellen als auch der Verhaltensebene zeitstabil. Dies unterstreicht die Relevanz intensivtherapeutischer Maßnahmen zur Behandlung von ADHS bei Kindern.