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Scores in Self-Report Questionnaires Assessing Adult ADHD Can Be Influenced by Negative Response Bias but Are Unrelated to Performance on Executive Function and Attention Tests. PSYCHOLOGICAL INJURY & LAW 2022. [DOI: 10.1007/s12207-022-09448-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
AbstractSelf-report questionnaires are in widespread use in the assessment of adults with suspected attention-deficit and hyperactivity disorder (ADHD). Notwithstanding the high degree of validity, these questionnaires are considered to possess, their stand-alone use in assessment for adult ADHD may result in false-positive diagnoses due to the risk of negative response bias. Most of the self-report questionnaires in typical use are based on the diagnostic systems DSM-5 or ICD-10. From a neuropsychological point of view, however, testing of various executive function abilities and attentional performance is important in the assessment of adult ADHD. The present study (N = 211) found no evidence linking executive function (working memory and inhibitory processes) and attentional performance (processing speed) to the results of a self-report questionnaire, the ADHS-LE. The number of failures on the three symptom or performance validity tests (SVT/PVT) used provided the sole, and significant, explanation for the response behavior reported on the ADHS-LE. Of these three SVT/PVTs (the German version of the Structured Inventory of Malingered Symptomatology, SIMS, the reliable digit span, and the standard deviation of simple reaction time), only the SIMS was found to be a significant predictor variable. In the clinical context of this study, 32.6% of subjects produced at least one invalid SVT/PVT result. The use of a more conservative criterion—failure on at least two of the three SVT/PVTs deemed to be feigning ADHD—reduced the proportion of participants generating invalid values to 5%.
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Hai T, Duffy HA, Lemay JA, Lemay JF. Impact of stimulant medication on behaviour and executive functions in children with attention-deficit/hyperactivity disorder. World J Clin Pediatr 2022; 11:48-60. [PMID: 35096546 PMCID: PMC8771318 DOI: 10.5409/wjcp.v11.i1.48] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 07/08/2021] [Accepted: 12/02/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Children with attention-deficit/hyperactivity disorder (ADHD) often exhibit behaviour challenges and deficits in executive functions (EF). Psychostimulant medications [e.g., methylphenidate (MPH)] are commonly prescribed for children with ADHD and are considered effective in 70% of the cases. Furthermore, only a handful of studies have investigated the long-term impact of MPH medication on EF and behaviour.
AIM To evaluate behaviour and EF challenges in children with ADHD who were involved in an MPH treatment trial across three-time points.
METHODS Thirty-seven children with ADHD completed a stimulant medication trial to study the short- and long-term impact of medication. Children with ADHD completed three neuropsychological assessments [Continuous Performance Test (CPT)-II, Digit Span Backwards and Spatial Span Backwards]. Parents of children with ADHD completed behaviour rating scales [Behaviour Rating Inventory of Executive Functioning (BRIEF) and Behaviour Assessment System for Children-Second Edition (BASC-2)]. Participants were evaluated at: (1) Baseline (no medication); and (2) Best-dose (BD; following four-week MPH treatment). Additionally, 18 participants returned for a long-term naturalistic follow up (FU; up to two years following BD).
RESULTS Repeated measure analyses of variance found significant effects of time on two subscales of BRIEF and four subscales of BASC-2. Neuropsychological assessments showed some improvement, but not on all tasks following the medication trial. These improvements did not sustain at FU, with increases in EF and behaviour challenges, and a decline in performance on the CPT-II task being observed.
CONCLUSION Parents of children with ADHD reported improvements in EF and behaviours during the MPH trial but were not sustained at FU. Combining screening tools and neuropsychological assessments may be useful for monitoring medication responses.
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Affiliation(s)
- Tasmia Hai
- Werklund School of Education, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Hanna A Duffy
- Werklund School of Education, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Julie Anne Lemay
- Department of Paediatrics, Alberta Children's Hospital/Cumming School of Medicine, University of Calgary, Calgary, AB T3B 6A8, Canada
| | - Jean François Lemay
- Department of Paediatrics, Alberta Children's Hospital/Cumming School of Medicine, University of Calgary, Calgary, AB T3B 6A8, Canada
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Burrows K, Rysdyk S. Fast Tracking Assessment of Attention Deficit Hyperactivity Disorder in Tertiary Care. J Patient Exp 2022; 9:23743735221112210. [PMID: 35832606 PMCID: PMC9272168 DOI: 10.1177/23743735221112210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Current pediatric practice guidelines recommend children with complex attention deficit hyperactivity disorder (ADHD) receive a psychological evaluation. However, obtaining such an evaluation in a timely manner can be difficult. The authors present a framework for an economical, efficient, and efficacious approach to diagnosing complex ADHD based on a 5-year project to “fast track” these types of assessments in a tertiary care setting. Patients were triaged to the “fast track” for a streamlined assessment, by a psychologist, within a developmental pediatrics center. Assessment data, diagnoses, and recommendations were recorded for 79 participants. For most of the children, not only was ADHD confirmed, but diagnostic criteria were also met for at least one comorbid condition. For 64% of children the diagnostic picture changed, resulting in an ADHD diagnosis with corresponding changes to treatment planning. Fast track programming cut the wait time for evaluations in half. Preliminary data shows it is possible to clarify diagnoses for this complex population and provide much needed treatment recommendations in a timelier manner through utilization of a “fast track” approach to triage and assessment.
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Affiliation(s)
- Katherine Burrows
- Department of Pediatrics, Child Development, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Sarah Rysdyk
- Department of Pediatrics, Child Development, Medical College of Wisconsin, Milwaukee, WI, USA
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Lafavor T, Gimbel B, Olsen A, Travis A, Weber R. Relationship of parent-rated and objectively evaluated executive function to symptoms of posttraumatic stress and attention-deficit/hyperactivity disorder in homeless youth. Child Neuropsychol 2021; 28:768-790. [PMID: 34957916 DOI: 10.1080/09297049.2021.2016671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Compared to their stably housed peers, homeless, and highly mobile (HHM) youth experience disproportionately greater adversity and risk leading to a wide variety of poor developmental outcomes, and targeted interventions have the potential to mitigate such outcomes. A growing literature highlights the need for accurate diagnosis in high-risk populations given the considerable overlap between posttraumatic symptomology and behaviorally based disorders such as ADHD. Objective testing inferring neurobiological and circuit-based abnormalities in posttraumatic stress disorder (PTSD) and ADHD may provide a useful clinical tool to aid accurate diagnosis and treatment recommendations. This novel, exploratory study examined the relation between executive function (EF) as measured by objective testing and parent ratings with symptoms of posttraumatic stress and ADHD in 86 children (age 9 to 11) living in emergency homeless shelters. Parent-rated EF problems suggested broad impairment associated with ADHD symptoms but specific impairment in emotional/behavioral function associated with posttraumatic stress symptoms. While measures of inhibition and shifting EF were strongly associated with symptomology in bivariate correlations, they explained minimal variance in regression models. Internalizing behavior problems were associated with posttraumatic stress symptoms, while externalizing behavior problems were associated with ADHD symptoms. Implications for clinical practice and future research are discussed.
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Affiliation(s)
- Theresa Lafavor
- School of Graduate Psychology, Pacific University, Hillsboro, OR, USA
| | - Blake Gimbel
- School of Graduate Psychology, Pacific University, Hillsboro, OR, USA
| | - Aarika Olsen
- School of Graduate Psychology, Pacific University, Hillsboro, OR, USA
| | - Alicia Travis
- School of Graduate Psychology, Pacific University, Hillsboro, OR, USA
| | - Rachel Weber
- The Compass Clinic, Vancouver, British Columbia, Canada
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Medina R, Bouhaben J, de Ramón I, Cuesta P, Antón-Toro L, Pacios J, Quintero J, Ramos-Quiroga JA, Maestú F. Electrophysiological Brain Changes Associated With Cognitive Improvement in a Pediatric Attention Deficit Hyperactivity Disorder Digital Artificial Intelligence-Driven Intervention: Randomized Controlled Trial. J Med Internet Res 2021; 23:e25466. [PMID: 34842533 PMCID: PMC8665400 DOI: 10.2196/25466] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/11/2020] [Accepted: 05/13/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Cognitive stimulation therapy appears to show promising results in the rehabilitation of impaired cognitive processes in attention deficit hyperactivity disorder. OBJECTIVE Encouraged by this evidence and the ever-increasing use of technology and artificial intelligence for therapeutic purposes, we examined whether cognitive stimulation therapy implemented on a mobile device and controlled by an artificial intelligence engine can be effective in the neurocognitive rehabilitation of these patients. METHODS In this randomized study, 29 child participants (25 males) underwent training with a smart, digital, cognitive stimulation program (KAD_SCL_01) or with 3 commercial video games for 12 weeks, 3 days a week, 15 minutes a day. Participants completed a neuropsychological assessment and a preintervention and postintervention magnetoencephalography study in a resting state with their eyes closed. In addition, information on clinical symptoms was collected from the child´s legal guardians. RESULTS In line with our main hypothesis, we found evidence that smart, digital, cognitive treatment results in improvements in inhibitory control performance. Improvements were also found in visuospatial working memory performance and in the cognitive flexibility, working memory, and behavior and general executive functioning behavioral clinical indexes in this group of participants. Finally, the improvements found in inhibitory control were related to increases in alpha-band power in all participants in the posterior regions, including 2 default mode network regions of the interest: the bilateral precuneus and the bilateral posterior cingulate cortex. However, only the participants who underwent cognitive stimulation intervention (KAD_SCL_01) showed a significant increase in this relationship. CONCLUSIONS The results seem to indicate that smart, digital treatment can be effective in the inhibitory control and visuospatial working memory rehabilitation in patients with attention deficit hyperactivity disorder. Furthermore, the relation of the inhibitory control with alpha-band power changes could mean that these changes are a product of plasticity mechanisms or changes in the neuromodulatory dynamics. TRIAL REGISTRATION ISRCTN Registry ISRCTN71041318; https://www.isrctn.com/ISRCTN71041318.
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Affiliation(s)
| | | | - Ignacio de Ramón
- Sincrolab Ltd, Madrid, Spain
- Laboratory of Computational and Cognitive Neuroscience, Centre for Biomedical Technology, Polytechnic University of Madrid, Pozuelo de Alarcón, Spain
- Faculty of Health, Camilo Jose Cela University, Villafranca del Castillo, Spain
| | - Pablo Cuesta
- Laboratory of Computational and Cognitive Neuroscience, Centre for Biomedical Technology, Polytechnic University of Madrid, Pozuelo de Alarcón, Spain
- Radiology Rehabilitation and Physiotherapy, Complutense University of Madrid, Madrid, Spain
| | - Luis Antón-Toro
- Laboratory of Computational and Cognitive Neuroscience, Centre for Biomedical Technology, Polytechnic University of Madrid, Pozuelo de Alarcón, Spain
- Department of Experimental Psychology, Faculty of Psychology, Complutense University of Madrid, Madrid, Spain
| | - Javier Pacios
- Laboratory of Computational and Cognitive Neuroscience, Centre for Biomedical Technology, Polytechnic University of Madrid, Pozuelo de Alarcón, Spain
- Department of Experimental Psychology, Faculty of Psychology, Complutense University of Madrid, Madrid, Spain
| | - Javier Quintero
- Department of Psychiatry, University Hospital Infanta Leonor, Madrid, Spain
| | - Josep Antoni Ramos-Quiroga
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Group of Psychiatry, Mental Health and Addictions, Vall d'Hebron Research Institute, Barcelona, Spain
- Biomedical Network Research Centre on Mental Health, Barcelona, Spain
| | - Fernando Maestú
- Laboratory of Computational and Cognitive Neuroscience, Centre for Biomedical Technology, Polytechnic University of Madrid, Pozuelo de Alarcón, Spain
- Department of Experimental Psychology, Faculty of Psychology, Complutense University of Madrid, Madrid, Spain
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Dor-Ziderman Y, Zeev-Wolf M, Hirsch Klein E, Bar-Oz D, Nitzan U, Maoz H, Segev A, Goldstein A, Koubi M, Mendelovic S, Gvirts H, Bloch Y. High-gamma oscillations as neurocorrelates of ADHD: A MEG crossover placebo-controlled study. J Psychiatr Res 2021; 137:186-193. [PMID: 33684643 DOI: 10.1016/j.jpsychires.2021.02.050] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 02/18/2021] [Accepted: 02/22/2021] [Indexed: 10/22/2022]
Abstract
Attention Deficit Hyperactive Disorder (ADHD) is a common neurobehavioral disorder with a significant and pervasive impact on patients' lives. Identifying neurophysiological correlates of ADHD is important for understanding its underlying mechanisms, as well as for improving clinical accuracy beyond cognitive and emotional factors. The present study focuses on finding a diagnostic stable neural correlate based on evaluating MEG resting state frequency bands. Twenty-two ADHD patients and 23 controls adults were blindly randomized to two methylphenidate/placebo evaluation days. On each evaluation day state anxiety was assessed, a 2N-back executive function task was performed, and resting state MEG brain activity was recorded at three timepoints. A frequency-based cluster analysis yielded higher high-gamma power for ADHD over posterior sensors and lower high-gamma power for ADHD over frontal-central sensors. These results were shown to be stable over three measurements, unaffected by methylphenidate treatment, and linked to cognitive accuracy and state anxiety. Furthermore, the differential high-gamma activity evidenced substantial ADHD diagnostic efficacy, comparable to the cognitive and emotional factors. These results indicate that resting state high-gamma activity is a promising, stable, valid and diagnostically-relevant neurocorrelate of ADHD. Due to the evolving understanding both in the cellular and network level of high-gamma oscillations, focusing future studies on this frequency band bears the potential for a better understanding of ADHD, thus advancing the specificity of the evaluation of the disorder and developing new tools for therapy.
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Affiliation(s)
- Yair Dor-Ziderman
- Gonda Brain Research Center, Bar Ilan University, Ramat-Gan, Israel; Edmond J. Safra Brain Research Center, University of Haifa, Haifa, Israel
| | - Maor Zeev-Wolf
- Department of Education & Zlotowski Center for Neuroscience, Ben Gurion University of the Negev, Israel
| | | | - Dor Bar-Oz
- The Emotion-Cognition Research Center, Shalvata Mental Health Care Center, Hod-Hasharon, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Uriel Nitzan
- The Emotion-Cognition Research Center, Shalvata Mental Health Care Center, Hod-Hasharon, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Hagai Maoz
- The Emotion-Cognition Research Center, Shalvata Mental Health Care Center, Hod-Hasharon, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Aviv Segev
- The Emotion-Cognition Research Center, Shalvata Mental Health Care Center, Hod-Hasharon, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Abraham Goldstein
- Gonda Brain Research Center, Bar Ilan University, Ramat-Gan, Israel; Department of Psychology, Bar Ilan University, Ramat-Gan, Israel
| | - May Koubi
- The Emotion-Cognition Research Center, Shalvata Mental Health Care Center, Hod-Hasharon, Israel; Child and Adolescent Outpatient Clinic, Shalvata Mental Health Care Center, Hod-Hasharon, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Shlomo Mendelovic
- The Emotion-Cognition Research Center, Shalvata Mental Health Care Center, Hod-Hasharon, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Hila Gvirts
- Department of Behavioral Sciences and Psychology, Ariel University, Ariel, Israel
| | - Yuval Bloch
- The Emotion-Cognition Research Center, Shalvata Mental Health Care Center, Hod-Hasharon, Israel; Child and Adolescent Outpatient Clinic, Shalvata Mental Health Care Center, Hod-Hasharon, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
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7
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Al-Yagon M, Forte D, Avrahami L. Executive Functions and Attachment Relationships in Children With ADHD: Links to Externalizing/Internalizing Problems, Social Skills, and Negative Mood Regulation. J Atten Disord 2020; 24:1876-1890. [PMID: 28918685 DOI: 10.1177/1087054717730608] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: Theoretical models suggest multiple underlying pathways for ADHD and multiple risk factors' co-occurrence as impairing this population's affective, interpersonal, and behavioral adjustment. After comparing groups' executive functioning (EF) difficulties and attachment security with each parent, this study primarily aimed to examine four risk factors (ADHD, child-father attachment, child-mother attachment, EF) as possibly explaining children's socioemotional/behavioral measures (externalizing/internalizing behavior, social skills, negative mood regulation). Method: Participants were 100 children in Grades 5-6 (ages 11-12 years; M=11.45 years, SD=.50): 50 with formally diagnosed ADHD, and 50 with typical development (TD). Instruments were children's self-report measures and teachers' evaluation. Results: Significant group differences emerged on all EF measures and attachment relationships, and most socioemotional/behavioral measures. Findings demonstrated the significant contribution of children's ADHD, parental attachments, and, partially, EF difficulties in explaining children's socioemotional/behavioral adjustment. Conclusion: Children with ADHD, compared to children with TD, reported significantly larger EF deficits and a significantly higher incidence of insecure attachment to the father as well as a lower sense of trust and closeness to the mother. Outcomes highlighted the role of children's four risk factors (ADHD, child-father attachment, child-mother attachment, EF) in explaining their socioemotional/behavioral adjustment. The EF deficits contributed only to intrapersonal maladjustment.
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Krieger V, Amador-Campos JA, Guàrdia-Olmos J. Executive functions, Personality traits and ADHD symptoms in adolescents: A mediation analysis. PLoS One 2020; 15:e0232470. [PMID: 32374779 PMCID: PMC7202790 DOI: 10.1371/journal.pone.0232470] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 04/15/2020] [Indexed: 11/18/2022] Open
Abstract
Certain personality traits and cognitive domains of executive functions (EF) are differentially related to attention deficit hyperactivity disorder (ADHD) symptoms in adolescents. This study aimed to analyze the five-factor model (FFM) personality characteristics in adolescents with ADHD, and to examine whether EF mediate the relationships between FFM personality traits and ADHD symptoms. A comprehensive diagnostic assessment, including ADHD clinical interviews, ADHD rating scales, neuropsychological EF testing (i.e., working memory, flexibility and inhibition) and a personality assessment was carried out in a sample of 118 adolescents (75 ADHD and 43 control participants, 68% males), aged 12 to 16 years, and their parents and teachers. Adolescents with ADHD had lower scores than control participants on Conscientiousness and Agreeableness, and higher scores on Neuroticism. Structural equation models (SEM) showed that Conscientiousness directly influenced inattentive and hyperactive-impulsive symptoms, while Neuroticism, Agreeableness, and Extraversion directly affected hyperactive-impulsive symptoms. Only Conscientiousness exerted indirect effects on inattention, but not on hyperactivity-impulsivity symptoms, via EF; higher scores on Conscientiousness were related to higher scores on EF, which in turn were related to lower scores on inattentive symptoms. These findings corroborate the relationships between ADHD symptoms, FFM personality traits and EF and indicate the mediating effect of EF on the relationship between Conscientiousness and inattention.
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Affiliation(s)
- Virginia Krieger
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Barcelona, Barcelona, Spain
| | - Juan Antonio Amador-Campos
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Barcelona, Barcelona, Spain
- Institute of Neuroscience, University of Barcelona (UBneuro), Barcelona, Spain
- * E-mail:
| | - Joan Guàrdia-Olmos
- Institute of Neuroscience, University of Barcelona (UBneuro), Barcelona, Spain
- Department of Social Psychology and Quantitative Psychology, Faculty of Psychology, University of Barcelona, Barcelona, Spain
- UB institute of Complex Systems, University of Barcelona, Barcelona, Spain
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Koltermann G, Becker N, Lopes-Silva JB, Gomides MRDA, Paiva GM, Haase VG, de Salles JF. Are "cool" executive function impairments more salient in ADHD symptoms than in reading disability? Dement Neuropsychol 2020; 14:47-55. [PMID: 32206198 PMCID: PMC7077861 DOI: 10.1590/1980-57642020dn14-010008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Introduction: Reading disability (RD) and Attention Deficit Hyperactivity Disorder (ADHD)
symptoms often co-occur in school-age children. Methods: The present study evaluated the performance of 216 Brazilian children from
3rd and 4th grades on “cool” executive function
(EF) abilities and phonological processing. The children were divided into
three groups: those with ADHD symptoms only, those with RD only, and
controls. Results: MANOVA analyses, controlling for age and nonverbal intelligence, showed worse
performance for the RD group, compared to the ADHD symptoms group, on
measures of phonological processing (phonemic awareness, phonological
short-term memory, and lexical access) and “cool” EF components
(orthographic verbal fluency and processing speed). The ADHD symptoms group
did not differ from the control group on the majority of the “cool” EF
tasks. Compared to the control group, the ADHD symptoms group and the RD
group both showed significantly more errors in rapid automatized naming of
figures, which evaluates the inhibition component of EF; performance on this
task was similar for these groups. Conclusion: We conclude that children with RD have greater impairment in phonological
processing and “cool” EF compared to those with ADHD symptoms. Furthermore,
deficits in inhibitory control may be shared among children with both
conditions.
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Affiliation(s)
| | - Natália Becker
- Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil
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10
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Using the Delis–Kaplan Executive Function System Tower Test to Examine ADHD Sensitivity in Children: Expanding Analysis Beyond the Summary Score. JOURNAL OF PEDIATRIC NEUROPSYCHOLOGY 2019. [DOI: 10.1007/s40817-019-00068-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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11
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Langer N, Benjamin C, Becker BLC, Gaab N. Comorbidity of reading disabilities and ADHD: Structural and functional brain characteristics. Hum Brain Mapp 2019; 40:2677-2698. [PMID: 30784139 DOI: 10.1002/hbm.24552] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 01/16/2019] [Accepted: 02/06/2019] [Indexed: 12/12/2022] Open
Abstract
Reading disabilities (RD) and attention-deficit/hyperactivity disorder (ADHD) are two of the most common developmental disorders. RD and ADHD frequently co-occur, which raises questions about how the disorders interact and to what extent they can be differentiated. To date, the underlying neural mechanisms leading to RD-ADHD comorbidity (COM) are not understood. In this study, structural and functional magnetic resonance imaging (fMRI) were combined with comprehensive behavioral testing in order to characterize the behavior, brain structure, and neural correlates of executive function, phonological processing and reading fluency in 60 children with clinical diagnoses of RD, ADHD, or COM, and controls. Whole-brain analyses of variance were performed on cortical thickness values and on the data of the three fMRI tasks to investigate overall group differences. To validate these findings, a region of interest analysis was performed in regions that have previously been shown to exhibit group differences in children with RD or ADHD using the same paradigms. The neuroimaging results demonstrated structural and functional atypicalities for COM in regions that are frequently associated with deficits in children with isolated ADHD or RD. A combination of shared and distinctive brain alterations between the clinical groups was identified, supporting the multiple deficit model for ADHD, RD, and its comorbidity.
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Affiliation(s)
- Nicolas Langer
- Laboratories of Cognitive Neuroscience, Division of Developmental Medicine, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts.,Methods of Plasticity Research, Department of Psychology, University of Zurich, Zurich, Switzerland.,University Research Priority Program (URPP) Dynamics of Healthy Aging, Zurich, Switzerland.,Neuroscience Center Zurich (ZNZ), Zurich, Switzerland
| | - Christopher Benjamin
- Laboratories of Cognitive Neuroscience, Division of Developmental Medicine, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts.,Neurology, Neurosurgery & Psychology, Yale University, New Haven, Connecticut
| | - Bryce L C Becker
- Laboratories of Cognitive Neuroscience, Division of Developmental Medicine, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts.,University of California, Berkeley, California
| | - Nadine Gaab
- Laboratories of Cognitive Neuroscience, Division of Developmental Medicine, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
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Elosúa MR, Del Olmo S, Contreras MJ. Differences in Executive Functioning in Children with Attention Deficit and Hyperactivity Disorder (ADHD). Front Psychol 2017; 8:976. [PMID: 28676771 PMCID: PMC5476919 DOI: 10.3389/fpsyg.2017.00976] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 05/26/2017] [Indexed: 11/24/2022] Open
Abstract
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.
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Affiliation(s)
- M. Rosa Elosúa
- Psicología Básica I, Universidad Nacional de Educación a DistanciaMadrid, Spain
| | - Sandra Del Olmo
- Psicología Básica I, Universidad Nacional de Educación a DistanciaMadrid, Spain
- Hospital Clínico Universitario Lozano BlesaZaragoza, Spain
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13
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Moura O, Pereira M, Alfaiate C, Fernandes E, Fernandes B, Nogueira S, Moreno J, Simões MR. Neurocognitive functioning in children with developmental dyslexia and attention-deficit/hyperactivity disorder: Multiple deficits and diagnostic accuracy. J Clin Exp Neuropsychol 2016; 39:296-312. [PMID: 27617883 DOI: 10.1080/13803395.2016.1225007] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION This study aimed to investigate the neurocognitive functioning of children with developmental dyslexia (DD) and attention-deficit/hyperactivity disorder (ADHD). METHOD Four groups of children between the ages of 8 and 10 years participated in the study: typically developing children (TDC; N = 34), children with DD-only (N = 32), children with ADHD-only (N = 32), and children with DD+ADHD (N = 18). RESULTS Children with DD and ADHD exhibited significant weaknesses on almost all neurocognitive measures compared with TDC. Large effect sizes were observed for naming speed and phonological awareness. The comorbid group showed deficits consistent with both DD and ADHD without additional impairments. Results from binary logistic regression and receiver-operating characteristic (ROC) curve analyses suggested that some neurocognitive measures revealed an adequate sensitivity for the clinical diagnosis of both neurodevelopmental disorders. Specifically, naming speed and phonological awareness were the strongest predictors to correctly discriminate both disorders. CONCLUSIONS Taken together, the results lend support to the multiple cognitive deficit hypothesis showing a considerable overlap of neurocognitive deficits between both disorders.
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Affiliation(s)
- Octávio Moura
- a Psychological Assessment and Psychometrics Laboratory, Faculty of Psychology and Educational Sciences , University of Coimbra , Coimbra , Portugal.,b Neurosciences, Neuropsychology and Cognitive Assessment group from the Cognitive and Behavioral Center for Research and Intervention (CINEICC) , University of Coimbra , Coimbra , Portugal
| | - Marcelino Pereira
- a Psychological Assessment and Psychometrics Laboratory, Faculty of Psychology and Educational Sciences , University of Coimbra , Coimbra , Portugal.,b Neurosciences, Neuropsychology and Cognitive Assessment group from the Cognitive and Behavioral Center for Research and Intervention (CINEICC) , University of Coimbra , Coimbra , Portugal.,c Faculty of Psychology and Educational Sciences , University of Coimbra , Coimbra , Portugal
| | - Cláudia Alfaiate
- d Pediatric Hospital , Coimbra University Hospitals , Coimbra , Portugal
| | - Eva Fernandes
- d Pediatric Hospital , Coimbra University Hospitals , Coimbra , Portugal
| | - Boavida Fernandes
- d Pediatric Hospital , Coimbra University Hospitals , Coimbra , Portugal
| | - Susana Nogueira
- d Pediatric Hospital , Coimbra University Hospitals , Coimbra , Portugal
| | - Joana Moreno
- c Faculty of Psychology and Educational Sciences , University of Coimbra , Coimbra , Portugal
| | - Mário R Simões
- a Psychological Assessment and Psychometrics Laboratory, Faculty of Psychology and Educational Sciences , University of Coimbra , Coimbra , Portugal.,b Neurosciences, Neuropsychology and Cognitive Assessment group from the Cognitive and Behavioral Center for Research and Intervention (CINEICC) , University of Coimbra , Coimbra , Portugal.,c Faculty of Psychology and Educational Sciences , University of Coimbra , Coimbra , Portugal
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Heidbreder R. ADHD symptomatology is best conceptualized as a spectrum: a dimensional versus unitary approach to diagnosis. ACTA ACUST UNITED AC 2015; 7:249-69. [PMID: 25957598 DOI: 10.1007/s12402-015-0171-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Accepted: 04/18/2015] [Indexed: 12/19/2022]
Abstract
The aim of this paper is to build a case for the utility of conceptualizing ADHD, not as a unitary disorder that contains several subtypes, but rather as a marker of impairment in attention and/or impulsivity that can be used to identify one of several disorders belonging to a spectrum. The literature will be reviewed to provide an overview of what is known about ADHD in terms of heterogeneity in symptomatology, neuropsychology, neurobiology, as well as comorbidity with other diseases and treatment options. The data from these areas of research will be critically analyzed to support the construct of a spectrum of disorders that can capture the great variability that exists between individuals with ADHD and can discriminate between separate disorders that manifest similar symptoms. The symptoms associated with ADHD can be viewed as dimensional markers that point to a spectrum of related disorders that have as part of their characteristics impairments of attention and impulsivity. The spectrum can accommodate symmetrically and asymmetrically comorbid psychiatric disorders associated with ADHD as well as the wide heterogeneity known to be a part of the ADHD disorder. Individuals presenting with impairments associated with ADHD should be treated as having a positive marker for a spectrum disorder that has as part of its characteristics impairments of attention and/or impulsivity. The identification of impairment in attention and/or impulsivity should be a starting point for further testing rather than being an endpoint of diagnosis that results in pharmacological treatment that may or may not be the optimal therapy. Rather than continuing to attribute a large amount of heterogeneity in symptom presentation as well as a high degree of symmetric and asymmetric comorbidity to a single disorder, clinical evaluation should turn to the diagnosis of the type of attentional deficit and/or impulsivity an individual has in order to colocate the individual's disorder on a spectrum that captures the heterogeneity in symptomatology, the symmetrical and asymmetrical comorbidity, as well as subthreshold presentation and other variants often worked into the disorder of ADHD. The spectrum model can accommodate not only the psychophysiological profiles of patients, but is also consistent with what is known about the functional heterogeneity of the prefrontal cortex as well as the construct that cognitive processes are supported by overlapping and collaborative networks.
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Affiliation(s)
- Rebeca Heidbreder
- PsychResearchCenter, LLC, 3669 Michaux Mill Drive, Powhatan, VA, 23139, USA.
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