Impact of executive functions on school and peer functions in youths with ADHD

Youths with attention-deficit/hyperactivity disorder (ADHD) are more likely to have social dysfunction at school. The authors explored the role of key executive functions (EF, i.e., spatial working memory and spatial planning) on school and peer functions in 511 youths with persistent ADHD according to the DSM-IV diagnostic criteria and 124 non-ADHD controls without any EF deficits. All the participants were assessed by a semi-structured psychiatric interview to confirm their previous and current diagnosis of ADHD and other psychiatric disorders and by the Spatial Working Memory (SWM) and Stocking of Cambridge (SOC) tasks. The participants and their parents reported the participants’ school functions and peer relationships. There were three ADHD subgroups: (1) ADHD with deficits in both SWM and SOC tasks (n = 121); (2) ADHD with deficit in either SWM or SOC task (n = 185); (3) ADHD without deficits in SWM or SOC task (n = 205). All the three ADHD groups, regardless of EF deficits, had lower school grade, poorer attitude toward school work, poorer school interactions, more behavioral problems at school, and more severe problems in peer relationships than non-ADHD controls. Multivariate analyses revealed positive associations between deficit in the SWM task and school and peer dysfunctions, and between deficits in the SOC task and impaired peer interactions. Older age and psychiatric comorbidity also contributed to increased risk of school and peer dysfunctions. Our findings suggest that deficits in EF, such as spatial working memory and planning, might be associated with school and peer dysfunctions.     

Empathic accuracy in adolescents with autism spectrum disorders and adolescents with attention-deficit/hyperactivity disorder

In research on theory of mind (ToM) in individuals with an autism spectrum disorder (ASD) mainly static mind-reading tasks were used. In this study both a static (Eyes Test) and a more naturalistic (empathic accuracy task) ToM measure were used to investigate the perspective taking abilities of adolescents with ASD (n = 13), adolescents with attention-deficit/hyperactivity disorder (ADHD; n = 13) and typically developing adolescents (n = 18). An innovative aspect concerns the standard stimulus tapes of the empathic accuracy task, which showed interactions between dyads of one adolescent with ADHD and one adolescent without ADHD. In this way, we were able to compare the ‘readability’ of the thoughts and feelings of adolescents with and without ADHD. The results clearly demonstrate the impairment in perspective taking abilities of adolescents with ASD, both on the static and naturalistic mind-reading task. Moreover, the empathic accuracy task seems to be a useful and promising method to assess ToM abilities in adolescents, with or without clinical problems. Finally, thoughts and feelings of target persons with ADHD seemed to be less easy to read than the thoughts and feelings of typically developing target persons.     

Is ADHD severity in adults associated with the lifetime prevalence of comorbid depressive episodes and anxiety disorders?

PurposeThe objective of the present study was to examine the association between ADHD severity and the lifetime prevalence of comorbid depressive episodes and anxiety disorders in adults with ADHD.Subjects/materials and methodsAnalyses were based on data of the Conner's Adult ADHD Rating Scale (CAARS) and a parent study examining the epidemiology of adult ADHD in 17 GP practices in Budapest, Hungary. Subjects between 18 and 60 years were included in the screening phase (n = 3529). Out of 279 positively screened subjects 161 participated in a clinical interview and completed the CAARS to confirm the diagnosis. We applied four diagnostic criteria: “DSM-IV”; “No-onset” (DSM-IV criteria without the specific requirement for onset); “Symptoms-only” (DSM-IV symptom criterion only); and “Reduced symptoms-only” (DSM-IV symptom criterion with a reduced threshold for symptom count). The MINI PLUS 5.0 was used to assess psychiatric comorbidity.ResultsADHD severity, as measured by the CAARS ADHD Index, showed a significant positive association with the prevalence of comorbid depressive episodes in all but the “ADHD_No-onset” group (“DSM-IV”: F[1.23] = 8.39, P = 0.0081; “No-onset”: F(1.27) = 0.97, P = 0.3346; “Symptoms-only”: F[1.55] = 30.79, P < 0.0001; “Reduced symptoms-only”: F(1.62) = 26.69, P < 0.0001).Discussion and conclusionResults indicate that ADHD symptom severity increases in association with lifetime comorbidity with depression.     

Early identification of Asperger syndrome in young children

This study was designed to identify items of the ADI-R that allow an early and sensitive identification of children with possible Asperger syndrome (AS). The aim was to obtain an economic short interview suitable for screening purposes. The study was based on data from a clinical sample of 5–18-year-old children and adolescents (mean age 10.9 years) with either Attention-Deficit Hyperactivity Disorder (ADHD; n = 43) or AS (n = 62). The introductory questions and 36 items, which contribute to the diagnostic algorithm of the ADI-R, were subjected to content analysis and stepwise discriminant function analysis. Eight meaningful items were found, which were shown to be good predictors of AS and to discriminate between the children with AS and those with ADHD. The short interview was especially useful for the assessment and screening of children up to 11 years in our sample, because in this subgroup, sensitivity was even higher (.92) and specificity was also excellent (.90). Eight items with high discriminatory power allowed sensitive and economic screening for young children with suspected AS.     

ADHD subtypes and neuropsychological performance in an adult sample

The study investigated, with an adult sample, the hypothesis that differences between subtypes of ADHD on neuropsychological tests contribute to the poor separation of ADHD and healthy groups on tests of this kind. Groups of ADHD inattentive (n = 16) and combined (n = 16) subtypes were carefully identified using DSM-IV criteria, and their performance on 14 measures of attention, memory, and executive function (EF) was compared between subtypes and between the two subtypes combined and a group of healthy controls (n = 30). Multivariate analyses showed statistically significant differences between the two subtypes, and between the two subtypes combined and the healthy controls. Importantly for the hypothesis, where differences for neuropsychological tests in terms of effect sizes between subtypes were largest, the differences in effect sizes between the two groups combined and controls were smallest (r = −0.64, 95% CI [−0.15, −0.87]).     

Executive functioning as a predictor of peer victimization in adolescents with and without an Autism Spectrum Disorder

The present study examined pragmatic language and executive functions (EF) as predictors of peer victimization in three groups: high-functioning adolescent boys with an Autism Spectrum Disorder (ASD) (n = 30); typically developing adolescent boys (n = 40); and adolescent boys (n = 22) without ASD with special education needs (SN). Controlling for age and bullying others, regression analyses revealed EF as measured by the Behavior Rating Inventory of Executive Functioning (Gioia et al., 2000) to be a significant predictor across all types of peer victimization (physical, social, and verbal) regardless of group membership. It is concluded that EF may play a pivotal role in explaining why some SN adolescents with and without ASD are at-risk for peer victimization.     

Daily life impairments associated with self-reported childhood/adolescent attention-deficit/hyperactivity disorder and experiences of diagnosis and treatment: Results from the European Lifetime Impairment Survey

The Lifetime Impairment Survey assessed impairment and symptoms of attention-deficit/hyperactivity disorder (ADHD) in children/adolescents from six European countries. Parents/caregivers of children/adolescents aged < 20 years with ADHD (ADHD group; n = 535) and without ADHD (control group; n = 424) participated in an online survey. History of ADHD diagnosis was self-reported. ADHD and control groups were compared using impairment and symptom scales; higher scores indicate greater impairment. Mean (SD) age at ADHD diagnosis was 7.0 (2.8) years, following consultation of 2.7 (2.6) doctors over 20.4 (23.9) months. Parents/caregivers (64%; 344/535) reported frustration with some aspect of the diagnostic procedure; 74% (222/298) were satisfied with their child's current medication. ADHD had a negative impact on children/adolescents in all aspects of life investigated. The ADHD group had a higher mean (SD) school impairment score (2.7 [0.7]) compared with the control group (2.1 [0.7]; P < 0.001) and were more likely to be in the bottom of their class (P < 0.001). These data provide insights into impairments associated with ADHD in childhood/adolescence, and identify areas for improvement in its management and treatment.     

Motor abilities of adolescents with a disruptive behavior disorder: The role of comorbidity with ADHD

The aim of this study was to explore the incidence, type and severity of motor impairment in male adolescents with a disruptive behavior disorder (DBD) and evaluate the role of comorbid ADHD. The Bruininks–Oseretsky test of motor proficiency, Second Edition was administered to examine a detailed motor profile and to compare the motor abilities of individuals with DBD (n = 99) to those of controls (n = 87). Additional subgroup analyses were conducted within the clinical population and encompassed (1) analyzing differences in motor profiles between individuals diagnosed with oppositional defiant disorder (ODD) or conduct disorder (CD) and (2) comparing the motor profiles of individuals with or without comorbid ADHD. The results indicated that individuals with a DBD showed a mixed motor impairment profile. Even after controlling for IQ, the DBD group obtained significantly lower scores in comparison to controls. The ODD and CD subgroups showed a similar motor profile. Presence of comorbid ADHD did not produce major differences in the motor profile. As approximately 79% of the adolescents with a DBD suffered from motor impairment, motor ability needs to be adequately addressed in research as well as in clinical practice.     

Asleep-awake-asleep craniotomy: A comparison with general anesthesia for resection of supratentorial tumors

The anesthetic plan for patients undergoing awake craniotomy, when compared to craniotomy under general anesthesia, is different, in that it requires changes in states of consciousness during the procedure.This retrospective review compares patients undergoing an asleep-awake-asleep technique for craniotomy (group AW: n = 101) to patients undergoing craniotomy under general anesthesia (group AS: n = 77). Episodes of desaturation (AW = 31% versus AS = 1%, p < 0.0001), although temporary, and hypercarbia (AW = 43.75 mmHg versus AS = 32.75 mmHg, p < 0.001) were more common in the AW group. The mean arterial pressure during application of head clamp pins and emergence was significantly lower in AW patients compared to AS patients (pinning 91.47 mmHg versus 102.9 mmHg, p < 0.05 and emergence 84.85 mmHg versus 105 mmHg, p < 0.05). Patients in the AW group required less vasopressors intraoperatively (AW = 43% versus AS = 69%, p < 0.01). Intraoperative fluids were comparable between the two groups. The post anesthesia care unit (PACU) administered significantly fewer intravenous opioids in the AW group. The length of stay in the PACU and hospital was comparable in both groups.Thus, asleep-awake-asleep craniotomies with propofol-dexmedetomidine infusion had less hemodynamic response to pinning and emergence, and less overall narcotic use compared to general anesthesia. Despite a higher incidence of temporary episodes of desaturation and hypoventilation, no adverse clinical consequences were seen.     

Behavioral inhibition in children with learning disabilities

Children with reading disabilities (RD, n = 17), mathematical disabilities (MD, n = 22), combined reading and mathematical disabilities (RD + MD, n = 28) and control peers (n = 45) were tested on behavioral inhibition with a Go/no-go task in a picture, letter and digit-modality. In contrast to children without RD, children with RD made significantly more commission errors on alphanumeric (letter and digit) modalities compared to the non-alphanumeric picture modality. As compared to children without MD, children with MD made as much commission errors on the picture modality as on the letter modality. No significant interaction-effect was found between RD and MD. These results can be considered as evidence for behavioral inhibition deficits related to alphanumeric stimuli in children with RD but not in children with MD.     

Psychometric properties of the French Version of the Social Responsiveness Scale in autism spectrum disorder with or without attention deficit hyperactivity disorder

ObjectivesThe Social Responsiveness Scale (SRS) is an instrument that is commonly used to screen for Autism Spectrum Disorder (ASD). Attention Deficit Hyperactive Disorder (ADHD) frequently occurs with ASD and both disorders share some phenotypic similarities. In the present study, we aimed to determine the psychometric properties of the French version of the Social Responsiveness Scale (SRS) and its 5 subscales (social awareness, social cognition, social communication, social motivation, and autistic mannerisms) to discriminate between children with ADHD and those with ASD (differential diagnosis) and children with ADHD from those with a dual diagnosis of ADHD and ASD (comorbid diagnosis).MethodSRS total scores and the 5 subscores of the SRS were compared between 4 groups of children: ADHD (n = 32), ASD + ADHD (n = 30), ASD (n = 31) and typical neurodevelopment (TD; n = 30) children. The discriminant validity was estimated using the Area Under the ROC Curves (AUC).ResultsSRS Social cognition (AUC = 0.73) and Autistic mannerisms (AUC = 0.70) subscores were the most discriminating for differential diagnosis of ASD and ADHD. SRS total scores (AUC = 0.70), and Social communication (AUC = 0.66) and Autistic mannerisms (AUC = 0.75) subscores were the most discriminating for comorbid diagnosis of ASD among ADHD children.ConclusionThe SRS autistic mannerisms subscore was found to be clinically relevant for both differential diagnosis of ASD and ADHD and comorbid diagnoses of ASD among ADHD children but with a modest discriminant power.     

Prevalence of ADHD in a sample of Italian students: A population-based study

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common diagnosis for children and adolescents, although the reported estimates for prevalence are extremely variable worldwide. In the present work we investigate the prevalence of ADHD in a sample of Italian students in a study divided in two phases. In Phase I, a total of 6183 schoolchildren (3178 males and 3005 females, aged range 5–15 years) were screened using the SDAI rating scale for teachers. In Phase II, the parents of children and adolescents who met high screen criteria according to SDAI (cut-off > 14; n = 471, 7.3%) were invited to complete a specific clinical-diagnostic assessment for ADHD with the help of an experienced clinician. Within the entire sample, 107 children dropped out and 12 had mental retardation, whereas 332 subjects (278 males and 54 females, age range 5–14 years) completed the Phase II of the study. One hundred ninety subjects (163 males and 27 females, male: female ratio 6:1, mean age 8 years) were diagnosed with ADHD, indicating a prevalence of 3%. ADHD subtypes included the following: combined (n = 108; 56.8%), inattentive (n = 48; 25.2%) and hyperactive/impulsive (n = 33; 17.3%).Our findings are in line with other reports of ADHD prevalence in the European Countries, and may contribute to underline the impact of this phenomenon in the population, and the need of achieving an improvement in the quality of the public health mental service for the prevention and treatment of ADHD.     

A comparison of tantrum behavior profiles in children with ASD,ADHD and comorbid ASD and ADHD

The present study was conducted to compare rates of tantrum behaviors in children with autism spectrum disorders (ASD) (n = 255), attention-deficit/hyperactivity disorder (ADHD) (n = 40) and children with comorbid ASD and ADHD (n = 47). Parents/guardians of children aged 3–16 years were surveyed about their children's behaviors using the Autism Spectrum Disorders-Comorbidity for Children (ASD-C-C). Children with ADHD alone differed from children with ASD alone and children with comorbid ASD and ADHD on rates of tantrum behaviors. Examination of individual tantrum behavior items indicated that children with comorbid ASD and ADHD have a more similar symptom presentation to children with ASD than children with ADHD. This study adds to the literature on the presentation of common co-occurring behaviors of ASD when there is comorbid ADHD. The implications of these findings may aid in the assessment and treatment of tantrum behaviors in children with comorbid ASD and ADHD.     

Association between early attention-deficit/hyperactivity symptoms and current verbal and visuo-spatial short-term memory

Deficits in short-term memory are common in adolescents with attention-deficit/hyperactivity disorder (ADHD), but their current ADHD symptoms cannot well predict their short-term performance. Taking a developmental perspective, we wanted to clarify the association between ADHD symptoms at early childhood and short-term memory in late childhood and adolescence. The participants included 401 patients with a clinical diagnosis of DSM-IV ADHD, 213 siblings, and 176 unaffected controls aged 8–17 years (mean age, 12.02 ± 2.24). All participants and their mothers were interviewed using the Chinese Kiddie Epidemiologic version of the Schedule for Affective Disorders and Schizophrenia to obtain information about ADHD symptoms and other psychiatric disorders retrospectively, at an earlier age first, then currently. The participants were assessed with the Wechsler Intelligence Scale for Children – 3rd edition, including Digit Span, and the Spatial working memory task of the Cambridge Neuropsychological Test Automated Battery. Multi-level regression models were used for data analysis. Although crude analyses revealed that inattention, hyperactivity, and impulsivity symptoms significantly predicted deficits in short-term memory, only inattention symptoms had significant effects (all p < 0.001) in a model that included all three ADHD symptoms. After further controlling for comorbidity, age of assessment, treatment with methylphenidate, and Full-scale IQ, the severity of childhood inattention symptoms was still significantly associated with worse verbal (p = 0.008) and spatial (p ranging from 0.017 to 0.002) short-term memory at the current assessment. Therefore, our findings suggest that earlier inattention symptoms are associated with impaired verbal and visuo-spatial short-term memory at a later development stage. Impaired short-term memory in adolescence can be detected earlier by screening for the severity of inattention in childhood.     

Autism spectrum disorder symptoms in children with ADHD: A community-based study

This study examined the prevalence of autism spectrum disorder (ASD) symptoms in a community-based sample of children with attention-deficit/hyperactivity disorder (ADHD) and non-ADHD controls. We also examined the relationship between ASD symptoms and ADHD subtype, ADHD symptom severity and child gender. Participants were 6–10-year-old children (164 ADHD; 198 non-ADHD control) attending 43 schools in Melbourne, Australia, who were participating in the Children's Attention Project. ADHD was assessed in two stages using the parent and teacher Conners’ 3 ADHD index and the Diagnostic Interview Schedule for Children IV (DISC-IV). ASD symptoms were identified using the Social Communication Questionnaire (SCQ). Unadjusted and adjusted linear and logistic regression examined continuous and categorical outcomes, respectively. Children with ADHD had more ASD symptoms than non-ADHD controls (adjusted mean difference = 4.0, 95% confidence interval (CI) 2.8; 5.3, p < 0.001, effect size = 0.7). Boys with ADHD had greater ASD symptom severity than girls with ADHD (adjusted mean difference = 2.9, 95% CI 0.8; 5.2, p = 0.01, effect size = 0.4). Greater ADHD symptom severity was associated with greater ASD symptom severity (regression co-efficient = 1.6, 95% CI 1.2; 2.0, p < 0.001). No differences were observed by ADHD subtype. Greater hyperactive/impulsive symptoms were associated with greater ASD symptoms (regression coefficient = 1.0; 95% CI 0.0; 2.0, p = 0.04) however, this finding attenuated in adjusted analyses (p = 0.45). ASD symptoms are common in children with ADHD. It is important for clinicians to assess for ASD symptoms to ensure appropriate intervention.     

Differential fractional anisotropy abnormalities in adolescents with ADHD or schizophrenia

Schizophrenia and Attention-Deficit/Hyperactivity Disorder (ADHD) are associated with similar deficits in working memory, attention, and inhibition. Both disorders also involve abnormalities of white matter integrity, possibly reflecting neural communication disruptions. There are likely some regional white matter abnormalities that underlie the common cognitive impairment, though also some regional abnormalities unique to each disorder. We used diffusion tensor imaging (DTI) to compare white matter integrity, as indicated by fractional anisotropy (FA), in adolescents with schizophrenia (n = 15) or ADHD (n = 14) and healthy controls (n = 26). Schizophrenia patients had uniquely low FA, relative to the other two groups, in bilateral cerebral peduncles, anterior and posterior corpus callosum, right anterior corona radiata, and right superior longitudinal fasciculus. ADHD patients had uniquely high FA in left inferior and right superior frontal regions. Both clinical groups had lower FA than controls in left posterior fornix. The two disorders generally demonstrated distinct patterns of abnormal connectivity suggesting that common cognitive and behavioral deficits derive from distinct sources, though the posterior fornix may be involved in both disorders. Schizophrenia was associated with abnormally low FA in widespread circuitry indicative of general connectivity disruptions, whereas ADHD was associated with abnormally high FA in frontal networks that may indicate impaired branching of fibers.     

Increased clinical and neurocognitive impairment in children with autism spectrum disorders and comorbid bipolar disorder

Bipolar (BD) symptomatology is prevalent in children with autism spectrum disorders (ASD) and may lead to increased impairment. The current study compared clinical and neurocognitive impairment in children (7–13 years) diagnosed with ASD (n = 55), BD (n = 34), ASD + BD (n = 23), and a non-clinical control group (n = 27). Relative to the ASD group, the ASD + BD group reported elevated rates of aggression and delinquency, behavioral disorders, depression, obsessive-compulsive disorder, and suicidal ideation, and poorer performance on the Stroop Color-Word Test. Future research might address how best to improve diagnostic assessment and adapt treatment to meet the needs of this uniquely impaired population.     

An epidemological study of obsessive compulsive disorder in adolescents from India

ObjectivesThere is scarce data on the prevalence of OCD among adolescents in India. This study reports point prevalence of OCD among school students (age 12–18 years) in the Kerala state of India and examines its association with ADHD, psychological distress, tobacco/alcohol abuse, suicide risk and history of sexual abuse.Method7560 students of 73 schools were self-administered the OCD subsection of Clinical Interview Schedule–Revised, the Composite International Diagnostic Interview (CIDI) for obsessive compulsive symptoms and other relevant instruments to identify OCD and related clinical measures. A diagnosis of ICD-10 OCD was derived through the CIS-R algorithm which required duration of at least 2 weeks and at least a thought/behavior to be resisted along with a cut-off score for severity and impairment.ResultsIn the sample, 50.3% were males with a mean age of 15.2 years (range of 12–18 years). The response rate was 97.3% (7380 valid responses). 0.8% (n = 61) fulfilled criteria for OCD with a male predominance (1.1 vs. 0.5%, p = 0.005). Prevalence was higher among Muslims and increased with age. Taboo thoughts (62.3%) and mental rituals (45.9%) were the commonest symptoms. Those with OCD had significantly higher suicidal thoughts (59 vs. 16.3%, p < 0.01) suicide attempts (24.6 vs. 3.8%, p < 0.01), ADHD (28 vs. 4%, p < 0.001), sexual abuse (24.6 vs. 4.2%, p < 0.01), and tobacco use (23 vs. 6.8%, p = 0.01). They also reported greater psychological distress and poorer academic performance.ConclusionsOCD is common among adolescents in India. Its associations with ADHD, sexual abuse, psychological distress, poorer academic performance and suicidal behavior are additional reasons for it to be recognized and treated early.     

Executive function and attention in young adults with and without Developmental Coordination Disorder – A comparative study

The current research aimed at examining the executive function (EF) of young adults with Developmental Coordination Disorder (DCD) in comparison to young adults without DCD. The study used a randomized cohort (N = 429) of young adults with DCD (n = 135), borderline DCD (n = 149) and control (n = 145), from a previous study. This initial cohort was asked to participate in the current study three to four years later. Twenty-five individuals with DCD (mean age = 24 years, 1 month [SD = 0.88]; 18 males), 30 with borderline DCD (mean age = 24 years, 2 month [SD = 0.98]; 18 males) and 41 without DCD (mean age = 25 years, 2 months [SD = 1.91]; 20 males) participated in this study. Participants completed the BRIEF-A questionnaire, assessing EF abilities and the WURS questionnaire, assessing attention abilities. The DCD and borderline DCD groups had significantly lower EF profiles in comparison with the control group but no significant differences were found between the DCD and borderline DCD groups. While a high percentage of attention problems were found in both DCD groups, the executive functioning profiles remained consistent even when using the attention component as a covariate. The study results suggest that young adults with DCD have EF problems which remain consistent with or without attention difficulties.     

Physical activity and self-determined motivation of adolescents with and without autism spectrum disorders in inclusive physical education

The main purpose of this study was to compare the objectively measured physical activity (PA) and the motivation process between adolescents with (n = 25) and without (n = 75) autism spectrum disorders (ASD) in inclusive physical education (PE); and assess the associations of the PA levels to a sequence of motivational processes. Independent t-tests revealed significant PA and motivational process differences between adolescents with and without ASD. External regulation was positively correlated with the percentage of time that adolescents with ASD spent in moderate PA (r₂₅ = 0.58, p < .01) and moderate-to-vigorous PA (r₂₅ = 0.50, p < .05), and this extrinsic motive was associated with their needs of being attached or related in the class (r₂₅ = 0.53, p < .01). No significant associations of PA in PE on the motivational sequences of adolescents without ASD were observed. It is concluded that adolescents with ASD had less PA levels in PE and lower motives toward PE than adolescents without ASD, and external regulation was important in facilitating PA participation in adolescents with ASD.