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Yue X, Liu L, Chen W, Preece DA, Liu Q, Li H, Wang Y, Qian Q. Affective-cognitive-behavioral heterogeneity of Attention-Deficit/Hyperactivity Disorder (ADHD): Emotional dysregulation as a sentinel symptom differentiating "ADHD-simplex" and "ADHD-complex" syndromes? J Affect Disord 2022; 307:133-141. [PMID: 35367500 DOI: 10.1016/j.jad.2022.03.065] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 03/23/2022] [Accepted: 03/28/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Current DSM and ICD classifications of Attention-Deficit/Hyperactivity Disorder (ADHD) exclude emotional dysregulation (ED) in their diagnostic criteria, despite ED symptoms frequently co-occurring in ADHD and likely sharing common neurobiological substrates. In this study, we examined whether consideration of ED symptoms could delineate more informative "ADHD+ED" subphenotypes. METHOD 4106 children with ADHD were recruited. ED and inattentive (IA) and hyperactive/impulsive (HI) symptoms were profiled using latent class analyses (LCA). The derived latent class (LC) subphenotypes were evaluated and validated in relation to comorbidity patterns, executive functions, and functional impairments. RESULTS Five LC subphenotypes with ED symptoms were identified: IA/HI + ED profile (LC1); HI + ED profile (LC2); IA + ED profile (LC3); IA/HI profile (LC4); and IA profile (LC5). Cross-validation of the LCA model using support vector machine analysis confirmed 83% accuracy. ED positive (ED+ve) subphenotypes were associated with higher rates of oppositional defiant disorder, mood disorders, anxiety disorders, as well as more severe autistic traits and sluggish cognitive tempo symptoms. Higher rates of ecological executive functioning impairments (BRIEF ratings) were found among ED+ve subphenotypes (though no differences were detected by laboratory-based measures). Functional impairments were also more severe among participants with ED+ve subphenotypes. LIMITATIONS The data for our LCA were cross-sectional and based primarily on parent ratings. CONCLUSION Our classification model has parcellated IA, HI, and ED symptoms into novel informative subphenotypes. These classifications provide preliminary evidence that ED symptoms could serve as sentinel features to identify a potential "ADHD-complex" syndrome, which demarcates a more pervasive condition of greater severity, complexity, and impairment.
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Affiliation(s)
- Xinxin Yue
- Peking University Sixth Hospital/Institute of Mental Health, Beijing 100191, China; National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital) & NHC Key Laboratory of Mental Health (Peking University), Beijing 100191, China
| | - Lu Liu
- Peking University Sixth Hospital/Institute of Mental Health, Beijing 100191, China; National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital) & NHC Key Laboratory of Mental Health (Peking University), Beijing 100191, China
| | - Wai Chen
- Mental Health Service, Fiona Stanley Hospital, Perth, Australia; Graduate School of Education, University of Western Australia, Australia; School of Medicine, University of Notre Dame Australia, Fremantle, Australia; School of Psychology, Murdoch University, Perth, Australia; Curtin Medical School, Curtin University, Perth, Australia; The enAble Institute, Curtin University, Perth, Australia.
| | - David A Preece
- The enAble Institute, Curtin University, Perth, Australia; School of Psychology, Curtin University, Perth, Australia; School of Psychological Science, University of Western Australia, Perth, Australia
| | - Qianrong Liu
- Peking University Sixth Hospital/Institute of Mental Health, Beijing 100191, China; National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital) & NHC Key Laboratory of Mental Health (Peking University), Beijing 100191, China
| | - Haimei Li
- Peking University Sixth Hospital/Institute of Mental Health, Beijing 100191, China; National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital) & NHC Key Laboratory of Mental Health (Peking University), Beijing 100191, China
| | - Yufeng Wang
- Peking University Sixth Hospital/Institute of Mental Health, Beijing 100191, China; National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital) & NHC Key Laboratory of Mental Health (Peking University), Beijing 100191, China
| | - Qiujin Qian
- Peking University Sixth Hospital/Institute of Mental Health, Beijing 100191, China; National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital) & NHC Key Laboratory of Mental Health (Peking University), Beijing 100191, China.
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Anker E, Ogrim G, Heir T. Verbal working memory and processing speed: Correlations with the severity of attention deficit and emotional dysregulation in adult ADHD. J Neuropsychol 2021; 16:211-235. [PMID: 34218514 PMCID: PMC9290636 DOI: 10.1111/jnp.12260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 06/18/2021] [Indexed: 12/02/2022]
Abstract
Objectives The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM‐5), emphasizes symptoms severity with regard to the diagnosis of attention deficit hyperactivity disorder (ADHD). Many clinicians use neuropsychological test results as objective measures of cognitive functions as part of the diagnostic work‐up. The aim of this study was to investigate whether the psychometric test results regarding verbal working memory and processing speed are useful as indicators of the severity of attention deficits and emotional dysregulation in adults with ADHD. Methods This observational cross‐sectional clinical study included 418 adults diagnosed with ADHD according to the DSM‐5. Attention deficit severity was defined based on the inattentive subscale of the Adult ADHD Self‐Report Scale. Emotional dysregulation was assessed with the Deficient Emotional Self‐Regulation scale. Verbal working memory was measured with the Working Memory Index (WMI), and processing speed was measured with the Processing Speed Index (PSI) from the Wechsler Adult Intelligence Scale, third edition. Results The full‐scale intelligence quotients of the participants were in the normal range, with expected reductions in verbal working memory and processing speed. Only processing speed was associated with attention deficits (β = −.056, p = .003). The association between the psychometric test result for verbal working memory and processing speed and that between the severity of attention deficits and emotional dysregulation were weak (R2 < .1) and mostly non‐significant. Conclusion The psychometric index scores for verbal working memory (WMI) and processing speed (PSI) seem to have limited utility as indicators of the severity of attention deficits and emotional dysregulation in adult ADHD patients.
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Affiliation(s)
| | - Geir Ogrim
- Østfold Hospital Trust, Norway.,Gillberg Neuropsychiatry Centre, University of Gothenburg, Sweden
| | - Trond Heir
- Institute of clinical Medicine, University of Oslo, Norway
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Hagstrøm J, Spang KS, Vangkilde S, Maigaard K, Skov L, Pagsberg AK, Jepsen JRM, Plessen KJ. An observational study of emotion regulation in children with Tourette syndrome. J Child Psychol Psychiatry 2021; 62:790-797. [PMID: 33368244 DOI: 10.1111/jcpp.13375] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 11/02/2020] [Accepted: 12/02/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Explosive outbursts occur in 25%-70% of children with Tourette syndrome (TS) and may cause more distress than the tics themselves. Previous studies have indicated that a comorbid diagnosis of attention-deficit/hyperactivity disorder (ADHD) is associated with emotional dysregulation in TS; however, this relationship has almost exclusively been studied using parent-reported questionnaires. METHODS We examined emotion regulation (ER) with an observational measure in 150 medication-naïve children aged 7-12 allocated to four groups: Forty-nine children with TS, 23 children with ADHD, 16 children with TS + ADHD, and 62 typically developing controls. We assessed participants' ER ability, as well as parent-child interactions in the context of a complex puzzle task, and coded the observed behavior with the Tangram Emotion Coding Manual (TEC-M). We examined group differences in ER, as well as associations between ER and severity of symptoms pertaining to TS and ADHD. RESULTS Children with TS did not differ from controls in their ER ability. However, children with ADHD and TS + ADHD had more problems with ER than those with TS only and controls. Finally, parents of children with ADHD displayed more tension during the experimental task. ER ability was not associated with tic severity nor premonitory urges; however, better ER ability was associated with less severe symptoms of ADHD. CONCLUSIONS This study is the first to evaluate ER with an observational, clinician-rated measure in a controlled social setting in children with TS. Our findings support earlier questionnaire-based studies by showing impaired ER in children with TS + ADHD, but not in children with TS without comorbidity. These findings inform our understanding of the phenomenology of emotional dysregulation in TS and the role of comorbid disorders.
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Affiliation(s)
- Julie Hagstrøm
- Mental Health Services, Child and Adolescent Mental Health Center, Capital Region of Denmark, Denmark
| | - Katrine S Spang
- Mental Health Services, Child and Adolescent Mental Health Center, Capital Region of Denmark, Denmark.,Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Copenhagen, Denmark
| | - Signe Vangkilde
- Mental Health Services, Child and Adolescent Mental Health Center, Capital Region of Denmark, Denmark.,Center for Visual Cognition, Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Katrine Maigaard
- Mental Health Services, Child and Adolescent Mental Health Center, Capital Region of Denmark, Denmark
| | - Liselotte Skov
- Department of Paediatrics, Copenhagen University Hospital Herlev, Herlev, Denmark
| | - Anne Katrine Pagsberg
- Mental Health Services, Child and Adolescent Mental Health Center, Capital Region of Denmark, Denmark.,Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jens Richardt Møllegaard Jepsen
- Mental Health Services, Child and Adolescent Mental Health Center, Capital Region of Denmark, Denmark.,Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS) and Center for Neuropsychiatric Schizophrenia Research (CNSR), Mental Health Centre Glostrup, University of Copenhagen, Copenhagen, Denmark
| | - Kerstin Jessica Plessen
- Mental Health Services, Child and Adolescent Mental Health Center, Capital Region of Denmark, Denmark.,Division of Child and Adolescent Psychiatry, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
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Do Childhood Emotional Lability and ADHD Symptoms Have Shared Neuropsychological Roots? JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2021. [DOI: 10.1007/s10862-020-09859-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Wei W, Yi X, Ruan J, Duan X, Luo H, Lv Z. Influence of collateral circulation on cerebral blood flow and frontal lobe cognitive function in patients with severe internal carotid artery stenosis. BMC Neurol 2019; 19:151. [PMID: 31277587 PMCID: PMC6612158 DOI: 10.1186/s12883-019-1380-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 06/26/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND This study aimed to investigate the cerebral blood flow (CBF) and frontal lobe cognitive function in severe internal carotid artery (ICA) stenosis patients with different types of collateral circulation. METHODS One hundred twenty-six patients with severe unilateral ICA stenosis were enrolled. Digital subtraction angiography (DSA) was performed to recruit patients with one of three common types of collateral circulation: anterior communicating artery (AcoA), posterior communicating artery (PcoA) and ophthalmic artery (OA). The hemodynamic parameters of the middle cerebral artery (MCA) were measured using transcranial Doppler (TCD), and the individual frontal lobe cognitive attention functions were evaluated using Word Fluency Test, Trail-Making Test (TMT), Digit Span, and Stroop Color Word Test (SCWT). The correlation between hemodynamic changes and the scores of all tasks was analyzed. RESULTS On the side of arterial stenosis, the CBF velocities were highest in AcoA group and lowest in the OA group. All patients performed worse in TMT and Digit Span than the matched normal controls. The AcoA group exhibited a lower pulsatility index (PI) and a longer response time in the Stroop task, but had a higher accuracy rate in the Stroop task and higher scores in Word Fluency Test than the PcoA and OA groups. In all the three groups, PI was positively correlated with the accuracy rate for Stroop interference effects. CONCLUSIONS Our findings suggested that the frontal lobe cognitive function of patients with ICA was impaired, and AcoA collaterals may be beneficial for selective attention functions, whereas OA collaterals may be associated with impairment of selective attention functions. Additionally, a high PI may be an indicator for identifying impaired selective attention in patients with severe ICA stenosis.
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Affiliation(s)
- Wei Wei
- Department of Neurology, the Affiliated Hospital of Southwest Medical University, No. 25 Taiping Road, Luzhou, 646000 Sichuan China
| | - Xingyang Yi
- Department of Neurology, People’s Hospital of Deyang City, Deyang, 618000 Sichuan China
| | - Jianghai Ruan
- Department of Neurology, the Affiliated Hospital of Southwest Medical University, No. 25 Taiping Road, Luzhou, 646000 Sichuan China
| | - Xiaodong Duan
- Department of Rehabilitation medicine, the Affiliated Hospital of Southwest Medical University, Luzhou, 646000 Sichuan China
| | - Hua Luo
- Department of Neurology, the Affiliated Hospital of Southwest Medical University, No. 25 Taiping Road, Luzhou, 646000 Sichuan China
| | - Zhiyu Lv
- Department of Neurology, the Affiliated Hospital of Southwest Medical University, No. 25 Taiping Road, Luzhou, 646000 Sichuan China
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