Executive Functioning in Children with Asperger Syndrome,ADHD-Combined Type,ADHD-Predominately Inattentive Type,and Controls

The purpose of the study was to evaluate neuropsychological and behavioral rating measures of executive functions (EF) in children with two subtypes of ADHD, Asperger syndrome (AS), and controls. Relative to the control group, the clinical groups experienced more difficulty in EF. The AS group showed the most difficulty in emotional control, behavioral regulation, fluid reasoning, and planning compared to the ADHD groups. Number of symptoms of ADHD or AS was found to be significantly related to ratings of difficulty with behavior regulation, metacognition, and general behavioral regulation across the sample. These findings indicate that children with AS or ADHD may have a differing EF profile and thus, may respond differentially to interventions.     

Reading comprehension in adolescents with ADHD: Exploring the poor comprehender profile and individual differences in vocabulary and executive functions

The overall objective of this study was to investigate reading comprehension in youth with and without a prior diagnosis of attention-deficit hyperactivity disorder (ADHD). The first goal was to determine whether youth with and without ADHD matched in word reading ability exhibited differences in reading comprehension proficiency. The next goal was to determine whether good and poor comprehenders within the ADHD subgroup differed from each other on language and academic achievement measures. The third objective was to examine whether word recognition or oral vocabulary knowledge mediated the effect of ADHD symptoms on reading comprehension performance. Youth with ADHD scored significantly lower than the comparison youth on a standardized measure of reading comprehension. Relative to good comprehenders with ADHD, poor comprehenders with ADHD exhibited weaknesses in expressive vocabulary, mathematical reasoning, written expression, and exhibited more executive function (EF) difficulties as reported by the teacher. Expressive vocabulary and word reading, but not teacher EF ratings, accounted for unique variance in reading comprehension performance and mediated the relationship between ADHD symptoms and reading comprehension. Implications for further research and educational practice are discussed.     

Executive dysfunctions among boys with Attention Deficit Hyperactivity Disorder (ADHD): performance-based test and parents report

Difficulty in executive functions (EF) is a core symptom of ADHD. Yet, the EF assessments are still in controversy. It is still unclear whether the everyday implementation of EF can be assessed under laboratory conditions. Therefore, the purposes of the present study are: (a) to examine EF among boys with ADHD both in everyday behavior (as reported by parents) and in a performance-based test. (b) To examine correlations between the two tests. Both the Behavior Assessment of Dysexecutive Functions for Children (BADS-C) and the Behavior Rating Inventory of Executive Functions (BRIEF) were independently applied to 25 boys aged 8-11 years with ADHD and 25 age-matched typical boys. Results of the two assessments were compared between the two groups to indicate differences in EF. Correlations between the two assessments for all participants were evaluated. Overall, significant differences in EF were found between the two groups on both assessments. Significant correlations were found between BADS-C and BRIEF, specifically in metacognition but not in behavioral regulation. Findings indicate that poor EF manifests itself in everyday behavior. These difficulties are found in metacognitive and behavioral regulation components. Nevertheless, applying a valid ecological assessment of behavior regulation merits future research.     

Is there any incremental benefit to conducting neuroimaging and neurocognitive assessments in the diagnosis of ADHD in young children? A machine learning investigation

Given the negative trajectories of early behavior problems associated with ADHD, early diagnosis is considered critical to enable intervention and treatment. To this end, the current investigation employed machine learning to evaluate the relative predictive value of parent/teacher ratings, behavioral and neural measures of executive function (EF) in predicting ADHD in a sample consisting of 162 young children (ages 4–7, mean age 5.55, 82.6 % Hispanic/Latino). Among the target measures, teacher ratings of EF were the most predictive of ADHD. While a more extensive evaluation of neural measures, such as diffusion-weighted imaging, may provide more information as they relate to the underlying cognitive deficits associated with ADHD, the current study indicates that measures of cortical anatomy obtained in research studies, as well cognitive measures of EF often obtained in routine assessments, have little incremental value in differentiating typically developing children from those diagnosed with ADHD. It is important to note that the overlap between some of the EF questions in the BRIEF, and the ADHD symptoms could be enhancing this effect. Thus, future research evaluating the importance of such measures in predicting children’s functional impairment in academic and social areas would provide additional insight into their contributing role in ADHD.     

Anxiety relates to classroom executive function problems in students with ASD,but not ADHD

BackgroundAnxiety occurs at elevated rates in developmental disorders and has been linked to executive functioning (EF) deficits. EF is strongly related to academic outcomes, but the relationship between anxiety and EF in the classroom has not been examined.MethodWe explored this relationship in two neurodevelopmental disorders, autism spectrum disorders (ASD) and attention-deficit/hyperactivity disorder (ADHD), in order to evaluate the specificity of associations between parent-reported anxiety and teacher-reported EF deficits in the classroom setting.ResultsGreater anxiety was associated with more classroom EF-related problems in the ASD group, but not in the ADHD group. Item-level analysis of classroom EF problems in the ASD group revealed associations between anxiety and difficulties with task initiation, attention, and completion. Anxiety was not related to total or item-level teacher-reported EF problems in the ADHD group.ConclusionFurther investigation into disorder-specific mechanisms that lead to the manifestation of anxiety symptoms may pave the way for more effective treatment and favorable academic outcome. Anxiety is related to poor EF in the classroom for students with ASD, which has implications for treating anxiety to promote positive academic outcomes and incorporating EF supports and training into treatment models for anxiety. The lack of association between anxiety and EF for students with ADHD was unexpected and warrants further exploration.     

Executive functions and adaptive functioning in young adult attention-deficit/hyperactivity disorder.

Attention-deficit/hyperactivity disorder (ADHD) is associated with impairments in occupational, social, and educational functioning in adults. This study examined relations of adaptive impairment to ADHD symptom domains (inattentive-disorganized and hyperactive-impulsive) and to deficits in executive functioning (EF) in 195 well-characterized adults (105 ADHD, 90 non-ADHD, between ages 18 and 37). Participants completed a battery of EF measures as well as assessments of adaptive functioning. Confirmatory factor analyses were used to validate latent factors for adaptive functioning and EF. In a measurement model, weaker EF was associated with poorer adaptive functioning (r = -.30). When multi-informant composite variables for current inattentive-disorganized and hyperactive-impulsive ADHD symptoms were included in the structural model, EF no longer predicted adaptive functioning. While both symptom composites were similarly related to EF (inattentive-disorganized r = .36; hyperactive-impulsive r = .29), inattentive-disorganized symptoms accounted for more variance in adaptive functioning (67.2% vs. 3.6%). Furthermore, for retrospectively reported childhood symptoms of ADHD, only the inattentive-disorganized symptom domain was related to EF or adaptive impairment. These results suggest that, in adults with ADHD, inattentive-disorganized symptoms may be the primary contributor to key aspects of poorer adaptive function and may be the behavioral path through which EF deficits lead to adaptive impairment.     

ADHD among adolescents with intellectual disabilities: Pre-pathway influences

Children and adolescents with intellectual disabilities (ID) are at heightened risk for developing ADHD. However, the validity of ADHD as a diagnosis for youth with ID remains controversial. To advance research on validity, the present study examined the hypothesized precursors to ADHD in typically developing adolescents (TD) and adolescents with ID, specifically with regard to family history of ADHD, molecular genetics, and neuropsychological functioning. Results indicated that youth ADHD symptoms were related to parental ADHD symptoms regardless of the adolescent's cognitive functioning. Additionally, findings suggested that the DRD4 genetic variant and adolescent set-shifting abilities were related to adolescent ADHD symptoms independent of cognitive functioning. This study provides an initial investigation of the biological correlates of ADHD among youth with ID.     

Subjective versus objective behavioral ratings following two analogue tasks: a comparison of socially phobic and non-anxious adolescents

Although results regarding objective social skills deficits in adults are inconsistent, research with youth have consistently demonstrated such deficits. Furthermore, research has consistently demonstrated subjective appraisal of social skill deficit in both youth and adults with social phobia or social anxiety. As a result, research has begun to examine the presence of a negative perceptual bias in individuals with social phobia and social anxiety. The purpose of the present study was to extend the findings of social skill deficits to an adolescent sample by investigating differences between adolescents with social phobia and non-anxious peers with regard to objective and subjective behavioral ratings. In addition, the presence of a negative perceptual bias was investigated by examining discrepancy scores between these ratings. The results of the current study provide support for the presence of social skill deficits in a socially phobic adolescent population and are the first to suggest that a limited negative bias exists in this population.     

External validity of children's self-reported sleep functioning: associations with academic,social, and behavioral adjustment

ObjectiveSeveral child-report measures of sleep functioning have been developed but very few studies have examined the external validity of child self-reported sleep in relation to daytime functioning. This study examined child-reported sleep in relation to teacher-rated psychopathology symptoms and also tested the hypothesis that child-reported sleep would be associated with poorer child- and teacher-reported functioning after controlling for demographics and psychopathology symptoms that are known to be associated with adjustment.MethodsParticipants were 175 children (81 boys, 94 girls) in 1st–6th grades (ages 6–13) and their teachers. Children completed the Sleep Self-Report. Teachers completed a measure of attention-deficit/hyperactivity disorder (ADHD), oppositional/conduct, and anxiety/depression symptoms. Children and teachers completed multiple measures of academic, behavioral, and social/peer functioning.ResultsChild-reported sleep was significantly associated with teacher-rated inattentive and internalizing symptoms, even after controlling for child demographics, hyperactivity-impulsivity, and conduct problems. Multilevel modeling analyses further indicated that, after controlling for child demographics and psychopathology symptoms, child-reported sleep problems were significantly associated with poorer child- and teacher-reported academic, behavioral, and social functioning (including increased reactive aggression, peer rejection, loneliness, and lower friendship satisfaction and self-worth).ConclusionsFindings provide initial support for the external validity of children's self-reported sleep functioning. Results of this study suggest that it may be clinically useful to screen for sleep problems by assessing for children's own perceptions of their sleep. Future studies should include both child- and parent-reported sleep functioning to further examine the utility of children's ratings of sleep functioning.     

An open trial of adjunctive donepezil in attention-deficit/hyperactivity disorder

OBJECTIVE: Despite available pharmacotherapeutics, a number of youths with attentiondeficit/ hyperactivity disorder (ADHD) continue to experience residual symptoms and prominent executive function (EF) deficits resulting in impairment in multiple domains. We sought to determine if donepezil, used adjunctively to stimulant medication, would improve residual symptoms of ADHD and EF deficits. METHODS: In a 12-week open trial, we treated 7 children and 6 adults who had ADHD and evidence of further EF deficits with adjunctive donepezil. All subjects were stabilized on stimulants, at which time donepezil was initiated at 2.5 mg daily and increased to a maximum of 10 mg over the 12-week trial. RESULTS: Of 13 subjects receiving medication, 7 completed the trial. There was no clinically or statistically significant improvement in the ADHD Rating Scale and the Executive Function Checklist, our primary outcome measures. A majority of individuals experienced nonserious adverse events. CONCLUSIONS: Results of this small open study suggest that donepezil augmentation of stimulants is not well tolerated and does not appear useful for the treatment of residual ADHD and/or EF deficits.     

Incremental Validity of Neuropsychological Assessment in the Identification and Treatment of Youth with ADHD

Comprehensive neuropsychological assessments for youth with ADHD allow for thorough consideration of co-occurring disorders and provide targeted recommendations for treating ADHD and comorbid conditions. This study offers a preliminary evaluation of the added value (compared to routine care) associated with neuropsychological assessment in the identification and treatment of ADHD in youth ages 3–17 years. First we describe a novel measure developed to evaluate broad-based outcomes for youth with ADHD following neuropsychological assessment. Next we compare parent ratings of child symptoms and quality of life between two groups of youth with ADHD: those who have recently received neuropsychological assessments (NP+), and those who have not (NP–). Participants were surveyed again 5 months after baseline to assess changes in symptoms, quality of life, and service utilization. While both groups experienced significant improvements in behavioral/emotional symptoms, the NP+ group had greater initiation of parent behavior management training and special education services and greater initiation of medication management over the follow-up period, compared with the NP– group. Satisfaction with neuropsychological assessment was high overall but slightly decreased over the course of the follow-up period. The findings offer preliminary support for the incremental efficacy of neuropsychological evaluation in the diagnosis and management of ADHD.     

ADHD and executive functioning deficits in OCD youths who hoard

Hoarding is common among youth with obsessive compulsive disorder (OCD), with up to 26% of OCD youth exhibiting hoarding symptoms. Recent evidence from adult hoarding and OCD cohorts suggests that hoarding symptoms are associated with executive functioning deficits similar to those observed in subjects with attention deficit hyperactivity disorder (ADHD). However, while hoarding behavior often onsets during childhood, there is little information about executive function deficits and ADHD in affected children and adolescents.The study sample included 431 youths (ages 6–17 years) diagnosed with OCD who participated in the OCD Collaborative Genetics Study and the OCD Collaborative Genetics Association Study and completed a series of clinician-administered and parent report assessments, including diagnostic interviews and measures of executive functioning (Behavior Rating Inventory of Executive Functioning; BRIEF) and hoarding severity (Hoarding Rating Scale-Interview; HRS-I).113 youths (26%) had clinically significant levels of hoarding compulsions. Youths with and without hoarding differed significantly on most executive functioning subdomains and composite indices as measured by the parent-rated BRIEF. Groups did not differ in the frequency of full DSM-IV ADHD diagnoses; however, the hoarding group had significantly greater number of inattention and hyperactivity symptoms compared to the non-hoarding group. In multivariate models, we found that overall BRIEF scores were related to hoarding severity, adjusting for age, gender and ADHD symptoms.These findings suggest an association between hoarding and executive functioning deficits in youths with OCD, and assessing executive functioning may be important for investigating the etiology and treatment of children and adolescents with hoarding and OCD.     

Executive and intellectual functions in attention-deficit/hyperactivity disorder with and without comorbidity

Background: Recent neuropsychological theories have targeted deficient executive functions (EF) as the main characteristic of Attention Deficit Hyperactivity Disorder (ADHD), but the nature of the neuropsychological deficits remains elusive and findings are heterogeneous. In particular, it is still unclear whether ADHD subtypes and comorbidity affect intellectual and executive functioning, because large variability has been found in different patient populations. Furthermore, the role of IQ in EF deficits in individuals with ADHD has been debated. Methods: The aim of the present research was to study in detail the relationship between EF, ADHD subtypes, and comorbid diagnosis by taking into account the potential role of IQ. For this purpose, 23 children (aged from 5 to 16 years; 20 males and 3 females) with a diagnosis of ADHD were selected. Results: Data show no differences between children with different subtypes of ADHD on measures of EF, but they evidence differences on EF measures in children with different comorbidities (internalizing versus externalizing disorder). Namely, compared to the internalizing disorders group, the children with externalizing disorders obtained significantly lower scores on different measures of EF (i.e., verbal working memory and categorical fluency), but these differences were strictly dependent on IQ level. Conclusions: Comorbidity patterns, rather than ADHD subtypes, appear to be more valid for defining the neuropsychological features of the ADHD endophenotype. Moreover, general intelligence seems to play a substantial role in the cognitive processes underling the disorder, especially in relation to externalizing aspects.     

Executive functioning in children with ASD + ADHD and ASD + ID: A systematic review

Executive functions (EF) are skills that impact an individual’s ability to flexibly and efficiently problem solve and react to their environment. Children with neurodevelopmental disorders (NDDs), such as autism spectrum disorder (ASD), commonly experience EF deficits. However, it is unclear how a co-occurring diagnosis of attention-deficit/hyperactivity disorder (ADHD) or intellectual disability (ID) impact EF in children with ASD. This study systematically reviewed 26 studies – within 24 journal articles – that examined EF among children with ASD + ADHD and ASD + ID. Results revealed many non-congruent findings regarding EF in children with ASD + ADHD and ASD + ID, including differences across performance-based and indirect measures of EF. Children with ASD + ADHD exhibited unique flexibility and shifting, inhibition, and attention deficits. Among children with ASD + ID, planning and organizing, flexibility and shifting, attention, behavior regulation, and global EF skills significantly differed from comparison groups. Notably, these findings were dependent on assessment type used (performance-based versus indirect). Furthermore, analyses of mean Z-scores suggest that children with ASD + ADHD and ASD + ID exhibited more severe EF impairments than children with ASD. These results may be used to inform assessment practices for differentiating and determining co-occurring diagnoses. Understanding unique EF deficits may also inform the development of targeted treatment and interventions.     

Development of a Brief, Behavioral Homework Intervention for Middle School Students with Attention-Deficit/Hyperactivity Disorder

In contrast to the vast literature on treatments for children with attention-deficit/hyperactivity disorder (ADHD), there is a relative paucity of research examining the efficacy of psychosocial treatments for adolescents with ADHD. Furthermore, only a handful of ADHD treatment studies employ educational interventions to improve academic functioning, and no study to date has examined a parent training intervention for targeting homework problems in middle school students with ADHD. This is despite a majority of parents of adolescents with ADHD reporting academic issues as their primary concern. In order to address this treatment need and gap in the literature, a behaviorally based, family-school homework intervention program (HIP) was developed. Participants included 11 middle school students diagnosed with ADHD and their mothers. A multiple-baseline (MB) across participants design was used to assess intervention effects. Results from this single-subject design demonstrated improvement in parent-reported homework problems and ADHD symptoms, overall grade point average, and teacher-reported academic productivity. Further, this intervention demonstrated high levels of satisfaction as perceived by parents and moderate levels of satisfaction as perceived by adolescents. Well-controlled, group-design studies should be conducted to further evaluate the efficacy of the HIP for middle school students with ADHD. This research was supported by an American Psychological Association: Division 53 Dissertation Award and the Milton Dean Havron Social Sciences Award for Academic Excellence.     

The role of every-day executive function in social impairment and adaptive skills in Autism Spectrum Disorder with intellectual disability

BackgroundAlthough executive function (EF) deficits are a recognised component of the cognitive phenotype of Autism Spectrum Disorder (ASD), particularly in children without general intellectual delay, little is known about ecological measures of EF and their outcome correlates among individuals with ASD and co-occurring intellectual disability. This exploratory study examined every-day EF in the classroom among children and adolescents diagnosed with both ASD and intellectual disability (ASD-ID) and their correlations with social impairment and adaptive functioning.MethodTeachers of 40 children and adolescents diagnosed with ASD-ID completed the Behavior Rating Inventory of Executive Function, the Vineland Adaptive Behavior Scales, and the Social Responsiveness Scale.ResultsA global executive dysfunction profile was found in ASD-ID, with most prominent deficits occurring in shifting. Results also showed that metacognitive executive processes predicted adaptive communication skills above and beyond IQ and social impairment in ASD-ID.ConclusionsOur findings corroborate a specific metacognitive executive function-adaptive communication association in ASD. EF interventions might be important treatment targets for improving functioning, especially in the communicative domain, in ASD-ID.     

Informant Agreement in Behavior Ratings for Children with Epilepsy

The purpose of this study was to determine the degree of informant agreement for behavioral ratings of children with epilepsy. Informants completed Achenbach's 1991 scales: parents completed the Child Behavior Checklist (CBCL), teachers completed the Teacher's Report Form (TRF), and youth completed the Youth Self-Report Form of the CBCL (YSR). Analyses included degree of concordance of ratings as a function of informant, child gender, and condition severity (active vs inactive epilepsy). Results indicated that across all four types of raters (mothers, fathers, teachers, and adolescents) there was a similar pattern. Mothers' ratings tended to be the highest and youths' ratings tended to be the lowest across scales. In general, agreement among adult raters was greater than between youth and adults. Mothers and teachers reported more internalizing symptoms than did youth; mother, father, and teacher ratings on externalizing symptoms were not significantly different from each other. There were no significant effects of gender and condition severity on concordance among ratings although there were some interesting trends.     

Validity of the executive function theory of attention-deficit/hyperactivity disorder: a meta-analytic review.

One of the most prominent neuropsychologic theories of attention-deficit/hyperactivity disorder (ADHD) suggests that its symptoms arise from a primary deficit in executive functions (EF), defined as neurocognitive processes that maintain an appropriate problem-solving set to attain a later goal. To examine the validity of the EF theory, we conducted a meta-analysis of 83 studies that administered EF measures to groups with ADHD (total N = 3734) and without ADHD (N = 2969). Groups with ADHD exhibited significant impairment on all EF tasks. Effect sizes for all measures fell in the medium range (.46-.69), but the strongest and most consistent effects were obtained on measures of response inhibition, vigilance, working memory, and planning. Weaknesses in EF were significant in both clinic-referred and community samples and were not explained by group differences in intelligence, academic achievement, or symptoms of other disorders. ADHD is associated with significant weaknesses in several key EF domains. However, moderate effect sizes and lack of universality of EF deficits among individuals with ADHD suggest that EF weaknesses are neither necessary nor sufficient to cause all cases of ADHD. Difficulties with EF appear to be one important component of the complex neuropsychology of ADHD.     

Effectiveness and Sustainability of School-Based Interventions for Youth with or at Risk for ADHD

In a pre–post design study, we examined the effectiveness and sustainability of a school mental health program for youth with or at-risk for ADHD (n = 41) when implemented over the course of 4 years by district-employed school mental health professionals (SMHPs) in a rural community. In the program, children received a daily report card (DRC) intervention and teachers received behavioral consultation sessions twice a month. Parent and teacher ratings of symptoms and impairment were collected at pre-intervention (typically fall) and post-intervention (spring) of each academic year. According to parent ratings, children experienced significant improvement in academic functioning (effect size (ES) = .65) and overall functioning (ES = .57). Changes in parent-rated symptoms were in the expected direction, but small in magnitude (ranged from .22 to .32) and nonsignificant. Changes in teacher ratings of symptoms and impairment were nonsignificant. The ESs ranged from ?.12 (self-esteem) to .42 (inattention). Results are discussed in the context of current efforts to disseminate treatments for youth with ADHD and disruptive behavior disorders.     

High concordance of parent and teacher attention-deficit/hyperactivity disorder ratings in medicated and unmedicated children with autism spectrum disorders

Abstract Objective: Parent and teacher ratings of core attention-deficit/hyperactivity disorder (ADHD) symptoms, as well as behavioral and emotional problems commonly comorbid with ADHD, were compared in children with autism spectrum disorders (ASD). Method: Participants were 86 children (66 boys; mean: age=9.3 years, intelligence quotient [IQ]=84) who met American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV) criteria for an ASD on the Autism Diagnostic Interview-Revised (ADI-R) and the Autism Diagnostic Observation Schedule (ADOS). Parent and teacher behavioral ratings were compared on the Conners' Parent and Teacher Rating Scales (CPRS-R; CTRS-R). The degree to which age, ASD subtype, severity of autistic symptomatology, and medication status mediated this relationship was also examined. Results: Significant positive correlations between parent and teacher ratings suggest that a child's core ADHD symptoms-as well as closely related externalizing symptoms-are perceived similarly by parents and teachers. With the exception of oppositional behavior, there was no significant effect of age, gender, ASD subtype, or autism severity on the relationship between parent and teacher ratings. In general, parents rated children as having more severe symptomatology than did teachers. Patterns of parent and teacher ratings were highly correlated, both for children who were receiving medication, and for children who were not. Conclusions: Parents and teachers perceived core symptoms of ADHD and closely-related externalizing problems in a similar manner, but there is less agreement on ratings of internalizing problems (e.g., anxiety). The clinical implication of these findings is that both parents and teachers provide important behavioral information about children with ASD. However, when a clinician is unable to access teacher ratings (e.g., during school vacations), parent ratings can provide a reasonable estimate of the child's functioning in these domains in school. As such, parent ratings can be reliably used to make initial diagnostic and treatment decisions (e.g., medication treatment) regarding ADHD symptoms in children with ASDs.