Neuropsychological correlates of methylphenidate treatment in adult ADHD with and without depression.

The purpose of this study was to characterize the neuropsychological profiles of adult patients with attention deficit hyperactivity disorder (ADHD) alone and ADHD with active comorbid depression, and to evaluate changes in the neuropsychological profile in these two groups following a trial of methylphenidate. Forty patients with ADHD were classified into two groups based on their affective status resulting in a group of 21 patients with ADHD alone and 19 patients with ADHD and active comorbid symptoms of depression (ADHD-D). All subjects received a comprehensive neuropsychological evaluation including measures of cognitive, motor and affective functioning before and after treatment. Fifteen normal controls were also assessed at a yoked time interval. At baseline, both patient groups showed impairment in verbal memory, motor and processing speed, visual scanning, and auditory and visual distractibility. Following treatment, both patient groups showed improvement across all neuropsychological measures while controls remained relatively stable over time. Improvement in neuropsychological test performance was not related to gender, affective status or referral source. Patients with active comorbid symptoms of depression show a similar neuropsychological profile and appear equally likely to benefit from methylphenidate intervention as patients with ADHD alone.     

Diagnostic efficiency of neuropsychological test scores for discriminating boys with and without attention deficit-hyperactivity disorder

A growing literature has documented group differences between boys with and without attention deficit-hyperactivity disorder (ADHD) on neuropsychological tests; however, whether or not such tests can discriminate individuals with ADHD from non-ADHD controls remains unclear. This study used conditional probability and receiver operating characteristic analyses to examine the efficiency of test-based diagnostic discriminations in a large sample of referred boys with and without ADHD. Single neuropsychological tests had limited discriminating ability at various cutoff scores. When multiple tests were used together, prediction of ADHD status improved but overall diagnostic efficiency remained limited. Diagnostic efficiency did not differ when medicated and nonmedicated index children were considered separately. Results suggest that children with ADHD show variable deficits on neuropsychological tests of attention and executive functions. Impairments on multiple neuropsychological tests are predictive of ADHD, but normal scores do not rule out the diagnosis. The prognostic implications of variable neuropsychological deficits in children with ADHD require further investigation.     

The impact of specific language impairment on working memory in children with ADHD combined subtype.

The objective of this study was to examine the impact of comorbid specific language impairment (SLI) on verbal and spatial working memory in children with DSM-IV combined subtype Attention Deficit Hyperactivity Disorder (ADHD-C). Participants were a clinical sample of 812- to 1212-year-old children diagnosed with ADHD-C. A group of ADHD-C with SLI was compared to a group of ADHD-C without SLI, and a group of normal children, matched on age and nonverbal intelligence. The results show that ADHD-C children with SLI scored significantly lower than those without SLI and normal children, on verbal working memory measures only. Both ADHD groups performed normally on spatial working memory measures. It is concluded that working memory deficits are not a specific characteristic of ADHD but are associated with language impairments. The importance of screening for language disorders in studies of neuropsychological functioning in children with ADHD is emphasized.     

Neuropsychological measures probably facilitate heritability research of ADHD

Previous studies, in which cognitive and motor neuropsychological tasks were administered to 816 children from Attention-Deficit/Hyperactivity Disorder (ADHD)- and control-families, showed that various of these measures appeared useful for genetic research in ADHD by forming candidate endophenotypes: underlying, heritable, vulnerability traits that mark an enhanced liability for developing ADHD. The current study extends these findings by showing that six of these ten measures correlate more strongly between siblings than an ADHD composite, suggesting these measures may have a larger heritability than ADHD itself. Significant sibling cross-correlations also suggested that six of ten neuropsychological measures related to similar familial (and heritable) factors as ADHD, suggesting these measures to be useful for ADHD genetic research. An aggregated neuropsychological composite appeared to be the most powerful, since it correlated more strongly between siblings than most individual task measures. These findings suggest heritability research in ADHD will probably be facilitated by including neuropsychological measures.     

Stability of executive function deficits in girls with ADHD: a prospective longitudinal followup study into adolescence

Neuropsychological deficits in the executive system are major sources of morbidity in individuals with attention-deficit/hyperactivity disorder (ADHD). We conducted a 5-year longitudinal study of girls with (N = 140) and without (N = 122) ADHD, aged 6-18 years at baseline. Neuropsychological functioning was assessed using standard neuropsychological testing assessing executive functions (EFs). Girls with ADHD were significantly more impaired than controls in all neuropsychological domains except set shifting. Despite variability in the stability of individual domains of EFs, the majority (79%) of girls with ADHD that met the categorical definition of executive function deficits (EFDs, defined as two or more EF tasks impaired) at baseline continued to have EFDs at the five-year followup. These findings document the stability of EFDs in girls with ADHD from childhood into adolescence.     

Stability of Executive Function Deficits in Girls with ADHD: A Prospective Longitudinal Followup Study into Adolescence

Neuropsychological deficits in the executive system are major sources of morbidity in individuals with attention-deficit/hyperactivity disorder (ADHD). We conducted a 5-year longitudinal study of girls with (N = 140) and without (N = 122) ADHD, aged 6–18 years at baseline. Neuropsychological functioning was assessed using standard neuropsychological testing assessing executive functions (EFs). Girls with ADHD were significantly more impaired than controls in all neuropsychological domains except set shifting. Despite variability in the stability of individual domains of EFs, the majority (79%) of girls with ADHD that met the categorical definition of executive function deficits (EFDs, defined as two or more EF tasks impaired) at baseline continued to have EFDs at the five-year followup. These findings document the stability of EFDs in girls with ADHD from childhood into adolescence.     

The relationship of malingering test failure to self-reported symptoms and neuropsychological findings in adults referred for ADHD evaluation

Diagnosis of adult attention-deficit/hyperactivity disorder (ADHD) adults is difficult, as neither symptom report nor neuropsychological findings are specific to ADHD. Few studies address the possibility that noncredible performance influences both symptom report and neuropsychological findings. The present study utilized archival data from young adults referred for concerns about ADHD, divided into three groups: (1) those who failed a measure of noncredible performance (the Word Memory Test; WMT), (2) those who met diagnostic criteria for ADHD, and (3) controls with psychological symptoms but no ADHD. Results showed a 31% failure rate on the WMT. Those who failed the WMT showed clinical levels of self-reported ADHD symptoms and impaired neuropsychological performance. Neither self-report measures nor neuropsychological tests could distinguish ADHD from psychological controls, with the exception of self-reported current hyperactive/impulsive symptoms and Stroop interference. Results underscore the effect of noncredible performance on both self-report and cognitive measures in ADHD.     

Psychiatric comorbidity in Korean children and adolescents with attention-deficit hyperactivity disorder: psychopathology according to subtype

It is well-known that more than 50% of attention-deficit hyperactivity disorder (ADHD) cases also have comorbid psychiatric disorders. We evaluated the comorbid psychopathology of Korean children and adolescents with ADHD using a standardized diagnostic instrument. The Korean Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version (K-SADS-PL-K) was administered and completed in 105 patients who had been referred to the outpatient and inpatient clinics at the Samsung Medical Center from March 2004 to May 2005. All of the cases were diagnosed as ADHD according to DSM-IV criteria. We analyzed their clinical characteristics and psychiatric comorbidities, and assessed the correlation of any comorbidity with gender, age and ADHD subtype. Among our 105 participants, 70 (66.7%) subjects were diagnosed with combined-type ADHD, 22 (21.0%) were the predominantly inattentive type, only 1 (1.0%) was determined to have the predominantly hyperactive-impulsive type of ADHD, and 12 (11.4%) were classified as not otherwise specified (NOS) ADHD. Eighty (76.2%) subjects had at least one comorbid disorder such as oppositional defiant disorder (n = 53, 50.5%), anxiety disorders (n = 35, 33.3%) and affective disorders (n = 15, 14.3%). Our patients ranged in age from five to 16 years. Among the factors including gender, age, and ADHD subtype, ADHD subtype was the only one significant to comorbidity in our study. The results of this study suggest that psychiatric comorbidity in Korean children with ADHD is similar to the results of previous studies in western countries. Out of all the ADHD subtypes, the combined-type group had a significantly higher ratio of comorbid disorders and psychopathologies.     

Learning disabilities and executive dysfunction in boys with attention-deficit/hyperactivity disorder

The effect of comorbid reading or arithmetic learning disabilities (LDs) on neuropsychological function in attention-deficit/hyperactivity disorder (ADHD) was studied. Participants were young males diagnosed with ADHD, with and without LD, and non-ADHD, non-LD male controls of similar age. LD was defined by combined regression-based and low-achievement classifications. Analyses adjusted for the effect of psychiatric comorbidity, age, and socioeconomic status on neuropsychological function. Children who had both ADHD and LD were significantly more impaired on both executive and nonexecutive functions than ADHD children without LD. Neuropsychological performance was most impaired in ADHD with combined arithmetic and reading disability. These data indicate that comorbid LD, especially arithmetic disability, significantly increases the severity of executive function impairment in ADHD.     

Executive function and attention deficit hyperactivity disorder: stimulant medication and better executive function performance in children.

BACKGROUND: Executive function deficits have been reported repeatedly in children with Attention Deficit Hyperactivity Disorder (ADHD). Stimulant medication has been shown to be effective in improving cognitive performance on most executive function tasks, but neuropsychological tests of executive function in this population have yielded inconsistent results. Methodological limitations may explain these inconsistencies. This study aimed to measure executive function in medicated and non-medicated children with ADHD by using a computerized battery, the Cambridge Neuropsychological Test Automated Battery (CANTAB), which is sensitive to executive function deficits in older patients with frontostriatal neurological impairments. METHODS: Executive function was assessed in 30 children with ADHD: 15 were stimulant medication naive and 15 were treated with stimulant medication. These two groups were compared to 15 age, sex and IQ matched controls. RESULTS: The unmedicated children with ADHD displayed specific cognitive impairments on executive function tasks of spatial short-term memory, spatial working memory, set-shifting ability and planning ability. Impairments were also seen on spatial recognition memory and delayed matching to sample, while pattern recognition memory remained intact. The medicated children with ADHD were not impaired on any of the above executive function tasks except for deficits in spatial recognition memory. CONCLUSIONS: ADHD is associated with deficits in executive function. Stimulant medication is associated with better executive function performance. Prospective follow-up studies are required to examine these effects.     

慢性抽动障碍儿童行为问题的对照研究

目的:比较伴与不伴注意缺陷多动障碍(ADHD)的慢性抽动障碍(CTD)儿童和ADHD以及正常对照儿童行为问题的差异。方法:对伴与不伴ADHD的CTD儿童和ADHD以及正常对照儿童采用儿童行为量表(CBCL)进行对比分析。结果:CTD ADHD组和ADHD组儿童总的行为问题发生率、CBCL多数因子分及行为问题总分与单纯CTD组和对照组比较,差异有统计学意义(P﹤0.05),而单纯CTD组和对照组两组间只有强迫、多动、攻击因子分和行为问题总分有统计学差异(P﹤0.05)。结论:伴有ADHD的CTD儿童与ADHD儿童相似,存在较高的行为问题发生率和较多的行为问题,提示伴有的ADHD是CTD儿童行为问题的主要来源。     

Comorbidity of ADHD and Dyslexia

Comorbidity of attention deficit hyperactivity disorder (ADHD) and reading disorder (RD) is frequent. Comorbid subjects show a neuropsychological profile characterized by failure of various cognitive functions with an additive-effect that can determine more severe functional deficits. Comorbid RD may be a marker for a group of children with ADHD with more severe cognitive deficits, and a worse neuropsychological, academic, and behavioral outcome. The article focuses on the link between RD and ADHD from an epidemiological, genetic, neurofunctional, neuropsychological, and therapeutic perspective and summarizes the characteristics of the comorbid phenotype.     

Clinical features of children with both ADHD and mania: does ascertainment source make a difference?

OBJECTIVE: We evaluated the structural diagnostic results of children ascertained through an ADHD diagnosis with comorbid mania to determine if they have the same phenotype as children ascertained through a mania diagnosis with comorbid ADHD. METHOD: We compared a sample of children participating in a family genetic study of ADHD to a sample of children ascertained through a study of childhood mania. RESULTS: Similar correlates of ADHD and mania were observed in children satisfying criteria for both disorders irrespective of ascertainment source. CONCLUSIONS: Findings suggest that children with mania and ADHD have two disorders, their features not varying with the primary diagnostic focus. LIMITATIONS: The results may have been limited by small sample size. CLINICAL RELEVANCE: Because the coexistence of ADHD and mania seriously complicates the course and treatment of children, understanding the compatibility of these disorders has important clinical implications in the management of this population.     

Impact of gender and age on executive functioning: do girls and boys with and without attention deficit hyperactivity disorder differ neuropsychologically in preteen and teenage years?

ADHD is known to have neuropsychological correlates, characterized mainly by executive function (EF) deficits. However, most available data are based on studies of boys through age 12. Our goal was to assess whether girls with ADHD express neuropsychological features similar to those found in boys, and whether these impairments are found in both preteen and teen samples. Participants were 101 girls and 103 boys with DSM--III--R ADHD, and 109 comparison girls and 70 boys without ADHD, ages 9 to 17 years. Information on neuropsychological performance was obtained in a standardized manner blind to clinical status. Primary regression analyses controlled for age, socioeconomic status, learning disability, and psychiatric comorbidity. Girls and boys with ADHD were significantly more impaired on some measures of EFs than healthy comparisons but did not differ significantly from each other. With the exception of 1 test score there were no significant Sex × Diagnosis interactions. Moreover, there were no more significant interactions among age, gender, and diagnosis than would be expected by chance. Neuropsychological measures of EFs were comparably impaired in girls compared to boys with ADHD, and these impairments are found at ages 9 to 12 and ages 13 to 17. These findings suggest that executive dysfunctions are correlates of ADHD regardless of gender and age, at least through the late teen years.     

Clock face drawing in children with attention-deficit/hyperactivity disorder.

The clock drawing test has been found to be sensitive to visual-spatial perception, graphomotor skills, verbal reasoning, and executive functioning in adult patient populations, as well as frontal lobe maturation in normal children. Our study is among the first to assess the use of clock drawing as a neuropsychological measure in the pediatric population. Participants included 41 children with attention-deficit/hyperactivity disorder (ADHD) and 41 normal controls, ages 6-12 years, matched for age, gender, and handedness. Conceptualization of time and construction of the clock face were assessed separately using a scoring system normed on school-age children in an earlier study. Children with Predominantly Inattentive Type were found to perform similarly to those with Combined Type of ADHD. However, children with ADHD, regardless of subtype, performed significantly poorer than controls. Qualitative analysis of performance revealed errors that were subsequent to poor planning during task execution, consistent with executive dysfunction commonly present in children with ADHD. Further, multiple regression analysis demonstrated that a neuropsychological measure of executive functioning was predictive of clock construction performance in children with ADHD. Constructional praxis and receptive vocabulary also were predictive of clock construction ability. Implications of these findings are discussed.     

共患抽动障碍的ADHD儿童的脑电生物反馈治疗研究

目的:探讨脑电生物反馈治疗共患抽动障碍的注意缺陷多动障碍(ADHD)患儿的疗效。方法:对14例符合美国精神障碍诊断与统计手册第4版(DSM-IV)诊断标准,年龄7～14岁的共患抽动障碍的ADHD患儿进行平均为34次的脑电反馈治疗,治疗前后分别采用Conner父母问卷、Achenbach 量表和Rutter问卷评定行为水平,并测试中国韦氏记忆量表、韦氏儿童智力量表(C-WISC)、持续操作性测试(CPT)等项。抽动障碍严重程度采用耶鲁全面抽动严重程度量表(Yale Global Tic Severity Scale,YGTSS)进行评定。结果:治疗后Conner父母问卷多动指数(10.6±5.6)和Rutter问卷总分(11.5±8.6)较治疗前明显下降,分别为15.7±6.0和17.2±10.5,P<0.01。Achenbach 量表多动因子分治疗后较治疗前明显下降,治疗前后分别为13.2±7.4 和7.5±3.7, P<0.05。Conner父母问卷多动分数有所下降,但差异未达显著性(P>0.05)。治疗后,患儿韦氏记忆量表的记忆商(97.8±11.7)及C-WISC中注意/不分心因子分(106.3±10.6)均高于治疗前(分别为91.3±16.3和95.5±13.0),差异具有显著性(分别为P<0 .05,P<0.01)。在CPT测试中,平均反应时下降(治疗前后分别为523.3±86.7和464.3±68.2毫秒,P<0.05),正确率提高(治疗前后分别为90%和95%,P<0.05)。14例患儿运动抽动和发声抽动在     

BAIAP2基因多态与儿童注意缺陷多动障碍共患学习困难的关联分析

目的:探讨脑特异性血管发生抑制剂1相关蛋白2(BAIAP2)基因多态与儿童注意缺陷多动障碍(ADHD)共患学习困难(LD)的关联。方法:选取符合美国精神障碍诊断与统计手册第4版(DSM-IV)诊断标准731例共患LD的ADHD儿童和957例健康对照,采用高通量实时荧光定量PCR方法检测基因型,探讨BAIAP2基因的9个单核苷酸多态性(SNPs)位点与共患LD的儿童ADHD的关联。结果:BAIAP2的SNP位点rs8079626/G(病例对照频率0.638 vs.0.604)和rs4969385/T(0.179 vs.0.150)与儿童ADHD共患LD关联,rs3934492/C(0.572 vs.0.532)和rs4969385/T(0.180 vs.0.142)与男性儿童ADHD共患LD关联,rs4969239/G(0.426 vs.0.329)和rs4969358/A(0.472 vs.0.389)与女性儿童ADHD共患LD关联(均P0.05);由rs4969239-rs4969358-rs6565531-rs8079626组成的单体型AAGG与共患LD的儿童ADHD共患LD(0.100 vs.0.065)和男性儿童ADHD共患LD(0.101 vs.0.065)关联(均P0.05)。结论:BAIAP2基因多态性可能与汉族儿童ADHD共患LD的病理机制有关,且这种作用机制可能存在性别差异。     

Association of DRD4 in children with ADHD and comorbid conduct problems

Recent family and twin study findings suggest that ADHD when comorbid with conduct problems may represent a particularly familial and heritable form of ADHD. Although several independent groups have shown association between the DRD4 7 repeat allele and ADHD, others have failed to replicate this finding. Previous TDT analyses of UK and Eire samples had also been negative. We set out to further examine the role of DRD4 but selecting a subgroup of children with ADHD and comorbid conduct problems. Families were recruited from Manchester, Ireland, Birmingham and London clinics. From these, 67 children who fulfilled diagnostic criteria for ADHD and who displayed conduct disorder symptoms were selected. TDT analysis, which had previously yielded negative results for the total sample, showed evidence of association between DRD4 and "ADHD with conduct problems" (7 repeat allele-24 transmissions, 13 non-transmissions; one-tailed P=0.05). These results provide further support for the role of DRD4 in ADHD. Furthermore, these results when considered together with family and twin study findings, suggest that those children with ADHD and comorbid conduct problems may be particularly informative for molecular genetic studies of ADHD. Further work is needed to examine these phenotype issues.     

Can bipolar disorder-specific neuropsychological impairments in children be identified?

This study examined neuropsychological deficits among children with bipolar disorder while attending to its comorbidity with attention-deficit/hyperactivity disorder (ADHD). Seventy-three unmedicated children (ages 6-17 years) with Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) bipolar disorder plus ADHD (BPD + ADHD) were compared with 102 unmedicated children with ADHD without bipolar disorder, and 120 children without bipolar disorder or ADHD. Ninety-four percent of participants were Caucasian, 58% were male, and 42% were female. On average participants were of middle to upper socioeconomic status. Participants were assessed with a comprehensive neuropsychological battery and measures of academic achievement, school failure, and special education placement. Participants with BPD + ADHD and with ADHD were impaired in interference control, verbal learning, and arithmetic achievement and had higher rates of special school services. Across all of the measures of neuropsychological functioning, the only difference observed between youths with BPD + ADHD and youths with ADHD was that youths with BPD + ADHD performed more poorly on one measure of processing speed. Thus, comorbidity with ADHD may account for many of the neuropsychological deficits observed in children with bipolar disorder.