Intellectual functioning and executive functions in children and adolescents with attention deficit hyperactivity disorder (ADHD) and specific learning disorder (SLD)

SLD with and without ADHD: Comparison of cognitive profiles

A quarter of children with Specific Learning Disorder (SLD) have a comorbid attention deficit hyperactivity disorder (ADHD), which impacts the testing of intelligence. ADHD is therefore treated before proceeding with the assessment of intelligence. It is expected that the treatment of ADHD will mitigate its effects on intelligence testing. Though this is frequently done in clinical practice, we could not find any study comparing IQ profiles of children having SLD with and without ADHD after treating ADHD to look for any changes between them. Therefore, we planned this study to compare the cognitive profiles of children having SLD with and without ADHD and describe any difference in their profiles. It was a retrospective cross-sectional study. We compared 695 children having SLD with treated ADHD to 721 children having SLD without ADHD on their WISC III profiles. We found that children having SLD with treated ADHD scored significantly lower on Digit Span and Coding. We suggest routine use of Cognitive Working Memory Training, peer tutoring, and task modifications in children having SLD with ADHD along with medicines and remedial education for better outcomes.

Cognitive functioning and clinical characteristics of children with non-syndromic orofacial clefts: A case-control study

Introduction

The higher rate of neuropsychiatric disorders in individuals with non-syndromic orofacial clefts has been well documented by previous studies. Our goal was to identify children with non-syndromic orofacial clefts that are at risk for abnormal neurodevelopment by assessing their developmental history and present cognitive functioning.

Materials and methods

A single-center, case-controlled study was carried out at the Department of Pediatrics of the University of Pécs in Hungary. The study consisted of three phases including questionnaires to collect retrospective clinical data and psychometric tools to assess IQ and executive functioning.

Results

Forty children with non-syndromic oral clefts and 44 age-matched controls participated in the study. Apgar score at 5 min was lower for the cleft group, in addition to delays observed for potty-training and speech development. Psychiatric disorders were more common in the cleft group (15%) than in controls (4.5%), although not statistically significant with small effect size. The cleft group scored lower on the Continuous Performance Test. Subgroup analysis revealed significant associations between higher parental socio-economic status, academic, and cognitive performance in children with non-syndromic orofacial clefts. Analyzes additionally revealed significant associations between early speech and language interventions and higher scores on the Verbal Comprehension Index of the WISC-IV in these children.

Discussion

Children with non-syndromic orofacial clefts seem to be at risk for deficits involving the attention domain of the executive system. These children additionally present with difficulties that affect cognitive and speech development. Children with non-syndromic orofacial clefts show significant skill development and present with similar cognitive strengths as their peers. Longitudinal studies with larger sample sizes are needed to provide more conclusive evidence on cognitive deficits in children with non-syndromic orofacial clefts at risk for neurodevelopmental difficulties.

The Effects of Different Theta and Beta Neurofeedback Training Protocols on Cognitive Control in ADHD

Neurofeedback (NF) is an important treatment for attention deficit/hyperactivity disorder (ADHD). In ADHD, cognitive control deficits pose considerable problems to patients. However, NF protocols are not yet optimized to enhance cognitive control alongside with clinical symptoms, partly because they are not driven by basic cognitive neuroscience. In this study, we evaluated different EEG theta and/or beta frequency band NF protocols designed to enhance cognitive control. Participants were n = 157 children and adolescents, n = 129 of them were patients with ADHD (n = 28 typically developing (TD) controls). Patients with ADHD were divided into five groups in the order of referral, with four of them taking part in different NF protocols systematically varying theta and beta power. The fifth ADHD group and the TD group did not undergo NF. All NF protocols resulted in reductions of ADHD symptoms. Importantly, only when beta frequencies were enhanced during NF (without any theta regulation or in combination with theta upregulation), consistent enhancing effects in both response inhibition and conflict control were achieved. The theta/beta NF protocol most widely used in clinical settings revealed comparatively limited effects. Enhancements in beta band activity are key when aiming to improve cognitive control functions in ADHD. This calls for a change in the use of theta/beta NF protocols and shows that protocols differing from the current clinical standard are effective in enhancing important facets of cognitive control in ADHD. Further studies need to examine regulation data within the neurofeedback sessions to provide more information about the mechanisms underlying the observed effects.

Is Processing Speed (Gs) related to Hyperactivity (As a Narrow Cognitive Area of Gps): A Dimensional Approach to Heterogeneity of Clinical and WISC-IV Cognitive Profiles in ADHD From RDoC/HiTOP Perspective

OBJECTIVE

The aim of this study was to investigate the relationship between symptomatology and the Wechsler Intelligence Scale for Children, Fourth Edition (WISC-IV) cognitive profiles in Attention Deficit and Hyperactivity Disorder (ADHD), taking into account clinical heterogeneity.

METHOD

The WISC-IV was administered to 60 children aged 6 to 13 years with ADHD who had not previously taken psychotropic medication. Conners Teacher-Rating Scale (CTRS-R/L) and Conners Parent-Rating Scale (CPRS-R/L) were completed by parents and teachers.

RESULTS

We found a statistically significant positive correlation between the symptoms of hyperactivity/impulsivity and PSI (Processing Speed Index). A statistically significant negative correlation was found between the CTRS-R/L's DSM-IV Inattentive subscale and PRI (Perceptual Reasoning Index). No relationship was found between the inattention or hyperactivity/impulsivity symptomatology with Working Memory Index (WMI). WMI stood out as the most frequently reported weakness among the four index scores.

CONCLUSION

Considering the relationship between the cognitive domains of RDoC (Research Domain Criteria) and dimensions of HiTOP with the ADHD symptom clusters, the assessment of cognitive and behavioral symptoms may be useful for phenotyping ADHD. According to the CHC (Cattell-Horn-Carroll) theory; the positive correlation level between PSI, which is accepted as Gs, and hyperactivity/impulsivity symptoms in people with ADHD may be due to the fact that hyperactivity is one of the narrow cognitive domains of Gps.

A comparative analysis of children born with low birthweight and attention deficit hyperactivity disorder

BACKGROUND

We aimed to compare the profile of the Wechsler Intelligence Scale for Children Fourth Edition (WISC-IV) between Japanese schoolchildren born very preterm (VP) and with very low birthweight (VLBW) and those with attention deficit hyperactivity disorder (ADHD), and to identify the specific neurocognitive characteristics of VLBW/VP children.

METHODS

The VLBW/VP group in the present study included 50 (19 male, 31 female) first- to third-grade elementary school children born between January 2008 and February 2013 at Osaka Medical and Pharmaceutical University Hospital and Saiseikai Suita Hospital with birthweights <1,500 g and <32 gestational weeks. The ADHD group included 18 (13 male, 5 female) first- to third-grade elementary school children who visited Osaka Medical and Pharmaceutical University Hospital between January 2019 and October 2021. Full-scale intelligence quotient scores, four indices, and 12 subtests of the WISC-IV were calculated for all participants and compared between the VLBW/VP and ADHD groups. We assessed whether the patients' clinical history was associated with a low score on the cancellation task in the VLBW/VP group.

RESULTS

The WISC-IV profiles showed similar between-group patterns, and the VLBW/VP group had lower cancellation task scores than the ADHD group.

CONCLUSIONS

This is the first study to compare WISC-IV profiles between VLBW/VP children and those with ADHD. Further investigation is needed on the association between academic performance and the score of the cancellation task, and the neural mechanism of low performance for cancellation tasks in VLBW/VP children.

Symbol relations training improves cognitive functioning in students with neurodevelopmental disorders

Students with neurodevelopmental disorders [Specific Learning Disorders (SLD), Attention Deficit Hyperactivity Disorder (ADHD), Autism Spectrum Disorder (ASD)] often experience learning challenges due to underlying weaknesses in cognitive processes. As these are some of the most common conditions to impact functioning, the development of effective treatments is a priority for neuropsychologists. However, the task of designing effective cognitive interventions has proven one of the most difficult challenges for our field. The Arrowsmith Program uses a novel approach compared to other cognitive intervention programs. We hypothesized that intensive practice of one aspect of this program would lead to improved cognitive functions in students with neurodevelopmental disorders. Twenty-seven students with neurodevelopmental disorders (ages 9.4-18.4 years) were recruited from Arrowsmith schools. Cognitive baseline and post-intervention data were gathered using components of the Woodcock-Johnson IV Tests of Cognitive Abilities. The intervention consisted of 6 weeks of intensive practice of the Symbol Relations Task. W-scores were used in a paired sample t-test analysis to determine if cognitive skill improvement occurred. Significant improvements were found in several measures of neuropsychological assessment, in particular in the Cattell-Horn-Carroll broad abilities These results provide a foundation for further work examining the utility of this novel approach to cognitive intervention.

Neuropsychological Profile, Emotional/Behavioral Problems, and Parental Stress in Children with Neurodevelopmental Disorders

Background: The aim of our study was to trace a specific neuropsychological profile, to investigate emotional-behavioral problems and parental stress in children with Autism Spectrum Disorder Level 1/High functioning (ASD-HF), Specific Learning Disorders (SLD) and Attention Deficit/Hyperactivity Disorder (ADHD) disorders and to highlight similarities and differences among the three groups. Methods: We retrospectively collected the data from a total of 62 subjects with ASD-HF (n = 19) ADHD (n = 21), SLD (n = 22) and 20 typical development. All the participants underwent neuropsychological standardized test for the evaluation of cognitive profile (Wechsler Intelligence Scale for Children Fourth Edition—WISC-IV), behavioral and emotional problems (Child Behavior CheckList CBCL), and parental stress (Parental Stress Index Short Form—PSI-SF). The scores of the ASD-HF, ADHD, and SLD groups were compared using non-parametric statistic methods (Kruskall–Wallis H test and U Mann–Whitney for post-hoc analysis). Results: The ASD-HF group were significantly higher in all areas of the WISC-IV than the other two clinical groups. The SLD group performed significantly lower than ASD-HF in Working Memory Index. The SLD group showed lower scores on the somatic problems subscale than the other two groups. In the Difficult Child subscale of the PSI-SF, parents of ADHD children scored lower than the mothers of SLD subjects and higher than the fathers of SLD subjects. In all three groups there are specific deficiencies compared to the control group in the cognitive profile, behavioral and emotional problems, and parental stress. Conclusions: Our comparative analysis highlighted similarities and differences in three groups of children with different neurodevelopmental disorders, helping to better define cognitive, behavioral, and emotional characteristics of these children and parental stress of their parents.

Executive Functions in Neurodevelopmental Disorders: Comorbidity Overlaps Between Attention Deficit and Hyperactivity Disorder and Specific Learning Disorders

The present study examines the comorbidity between specific learning disorders (SLD) and attention deficit and hyperactivity disorder (ADHD) by comparing the neuropsychological profiles of children with and without this comorbidity. Ninety-seven schoolchildren from 8 to 14 years old were tested: a clinical sample of 49 children with ADHD (n = 18), SLD (n = 18) or SLD in comorbidity with ADHD (n = 13), and 48 typically-developing (TD) children matched for age and intelligence. Participants were administered tasks and questionnaires to confirm their initial diagnosis, and a battery of executive function (EF) tasks testing inhibition, shifting, and verbal and visuospatial updating. Using one-way ANOVAs, our results showed that all children in the clinical samples exhibited impairments on EF measures (inhibition and shifting tasks) when compared with TD children. A more specific pattern only emerged for the updating tasks. Only children with SLD had significant impairment in verbal updating, whereas children with ADHD, and those with SLD in comorbidity with ADHD, had the worst performance in visuospatial updating. The clinical and educational implications of these findings are discussed.

Comparative analysis of the WISC-IV in a clinical setting: ADHD vs. non-ADHD

BACKGROUND

The Wechsler Intelligence Scale for Children, 4th edition (WISC-IV) is a useful tool for revealing differences in cognitive ability. Using the WISC-IV, the study investigated the intelligence profile of Turkish children diagnosed with ADHD and compared their profile with that of a non-ADHD clinical sample.

METHOD

On the basis of the records of 257 drug-naïve patients (6-12years of age), ADHD (n=154) and non-ADHD (n=103) clinical groups were compared with respect to sociodemographic variables and WISC-IV scores.

RESULTS

The non-ADHD clinical group had higher full scale, index, and subtest scores, except for their scores in the Comprehension subtest. The scores on Working Memory, Processing Speed Indices, Similarities, and Matrix Reasoning subtests were especially lower in the ADHD group than in the non-ADHD group. The Similarities, Matrix Reasoning, and Digit Span subtests classified 83% of the children as having ADHD and identified 43.7% of the non-ADHD clinical controls.

CONCLUSION

In our study, we found differences in the WISC-IV profiles of the Turkish patients with ADHD. Moreover, the WISC-IV profile of the non-ADHD clinical group was different than that of the ADHD group. More prospective studies with larger groups of ADHD patients and further evaluations of executive function deficits can help clinicians better understand the differences in WISC-IV profiles.

[Intelligence structure and clinical features of school-age children with attention deficit hyperactivity disorder and specific learning disorder]

OBJECTIVE

To study the intelligence structure and clinical features of children with attention deficit hyperactivity disorder (ADHD) and specific learning disorder (SLD).

METHODS

A retrospective analysis was performed on 88 school-age children with ADHD. According to the presence or absence of SLD, they were divided into two groups: simple ADHD group with 45 children and ADHD+SLD group with 43 children. Intelligence structure and clinical features were compared between the two groups.

RESULTS

Compared with the simple ADHD group, the ADHD+SLD group had significantly lower verbal intelligence quotient (VIQ), performance intelligence quotient (PIQ), and full intelligence quotient (FIQ) (P<0.05), significantly lower scores of VIQ factors (including information, similarities, arithmetic, and recitation) (P<0.05), and significantly lower scores of PIQ factors (including picture completion, picture arrangement, block design, and object assembly) (P<0.05). The development of SLD was negatively correlated with FIQ, VIQ, and PIQ. It was also negatively correlated with the scores of intelligence structure factors (including information, similarities, arithmetic, recitation, picture completion, picture arrangement, block design, and object assembly) (P<0.05).

CONCLUSIONS

Children with ADHD and SLD have poorer FIQ, VIQ, and PIQ than those with ADHD alone, which mainly manifests as the weak abilities of most intelligence structure factors. It is necessary to pay attention to the management and intervention of SLD in school-age children with ADHD.

Facial Emotion Recognition in Children and Adolescents with Specific Learning Disorder

BACKGROUND

Some recent studies suggest that children and adolescents with different neurodevelopmental disorders perform worse in emotions recognition through facial expressions (ER) compared with typically developing peers. This impairment is also described in children with Specific Learning Disorders (SLD), compromising their scholastic achievement, social functioning, and quality of life. The purpose of our study is to evaluate ER skills in children and adolescents with SLD compared to a control group without learning disorders, and correlate them with intelligence and executive functions.

MATERIALS AND METHODS

Our work is a cross-sectional observational study. Sixty-three children and adolescents aged between 8 and 16 years, diagnosed with SLD, and 32 sex/age-matched controls without learning disorders were recruited. All participants were administered standardized neuropsychological tests, evaluating facial emotion recognition (NEPSY-II), executive functions (EpiTrack Junior), and intelligence profile (WISC-IV).

RESULTS

Emotion recognition mean score was significantly lower in the SLD group than in the controls group on the Mann-Whitney U test for unpaired samples (p < 0.001). The SLD group performed significantly lower than the control group in their abilities to identify neutral expressions, happiness, sadness, anger, and fear compared to controls (p < 0.001). ER scores were positively correlated to the executive functions scores. There was no correlation with the Total Intelligence Quotient scores but there is a significant positive correlation with Working Memory Index and Processing Speed Index measured by WISC.IV.

CONCLUSION

Our study showed that children and adolescents with Specific Learning Disorders have facial emotion recognition impairment when compared with a group of peers without learning disorders. ER abilities were independent of their global intelligence but potentially related to executive functions.