The Diagnostic Utility of Behavioral Checklists in Identifying Children with ADHD and Children with Working Memory Deficits

The present study investigated whether children with ADHD and those with working memory impairments have a common behavioral profile in the classroom. Three teacher checklists were used: the Conners’ teacher rating scale (CTRS), the behavior rating inventory of executive function (BRIEF), and the working memory rating scale. The Conners’ continuous performance test (CPT) was also included to determine whether there is a correspondence between performance on this widely used cognitive measure of attention deficits and teacher ratings of classroom behavior. All three behavior scales, but not the CPT, were able to successfully discriminate children with ADHD and those with working memory deficits from typically-developing children. Both the CTRS and the BRIEF discriminated a significant proportion of the children with ADHD from those with working memory deficits, indicating that while both groups exhibit behavioral problems in the classroom, they are characterized by differential attention profiles. The children with ADHD were identified on the basis of oppositional and hyperactive behavior, while those with working memory deficits were more inattentive.     

The Effects of Methylphenidate on Neural Substrates Associated with Interference Suppression in Children with ADHD: A Preliminary Study Using Event Related fMRI

Objective

The core deficit of attention deficit hyperactivity disorder (ADHD) is associated with frontal cortex and related circuitry. Children with ADHD and a medication history have shown atypical brain activation in prefrontal and striatal brain regions during cognitive challenge. We investigated two cognitive control operations such as interference suppression (IS) and response inhibition (RI) in children with ADHD. We also assessed the brain functions affected by the methylphenidate (MPH) effect by comparing the blood-oxygen level dependent (BOLD) signals in ADHD children on and off medication.

Methods

Eight children (9-11 years of age) with combined-type ADHD underwent rapid event-related functional magnetic resonance imaging (fMRI) during performance of a modified flanker task. Two fMRI (3.0 T) scans were conducted with a one week interval-one with MPH treatment and the other without. Functional maps were generated through group averaging and performance-based correlational analyses.

Results

Performances of the two cognitive control operations did not differ significantly between on-MPH and off-MPH status other than the reaction time to incongruent stimuli in ADHD children. In those affected by MPH treatment, an increased activation in the right prefrontal cortex during incongruent task was observed relative to a neutral trial in children with ADHD.

Conclusion

On the treatment of MPH, the ADHD children exhibited increased activation of the right frontal cortex during interference suppression. This finding suggested that MPH affected the right frontal cortex in ADHD compensating for a reduced level of interference suppression. Future studies will be required to ascertain the MPH effect of cognitive brain regions among large number of children with ADHD.     

Child Behavior Checklist Profiles of Children and Adolescents with and at High Risk for Developing Bipolar Disorder

In order to recognize behavioral patterns in children and adolescents at risk for developing bipolar disorder, this study examined Child Behavior Checklist (CBCL) profiles of bipolar offspring both with (BD group) and without (“at-risk” or AR group) bipolar disorder themselves. The BD youth had three CBCL subscale T scores ≥70 (attention problems, delinquent behavior, and aggression) and scored significantly higher than healthy comparison youth on all CBCL subscales. AR youth did not have any T scores ≥70; however, they scored higher than healthy comparisons in the anxiety/depression, attention problems, aggression, and withdrawal subscales. AR and BD youth differed significantly on all scales except somatic complaints and anxiety/depression.     

The Diagnostic Interview of Children and Adolescents for Parents of Preschool and Young Children: psychometric properties in the general population

There is a need for reliable and well-validated diagnostic measures for studying psychopathology in preschool and young children. The goal is to study the psychometric properties of the Diagnostic Interview for Children and Adolescents for Parents of Preschool and Young Children (DICA-PPYC) in the general population. A sample of 852 Spanish school children, aged 3 to 7 years, were randomly selected and screened for a double phase design. A total of 251 families were interviewed with the DICA-PPYC and 244 participated in a test-retest design. Different measures of psychopathology and functional impairment were also administered. Test-retest agreement with a mean interval of 8.8 days ranged from excellent to slight (kappa from 1 to 0.39) for DSM-IV-TR and from good to fair (kappa from 0.77 to 0.49) for Research Diagnostic Criteria-Preschool Age diagnoses. Attenuation between test and retest was not significant for the prevalence of diagnoses, although it was significant for the number of externalising and total symptoms in the interview. The diagnoses converged moderately with the CBCL and Dominic scores. The presence of diagnoses in the DICA-PPYC significantly differentiated preschoolers and young children who had used mental health services, were more impaired, and presented more severe psychopathology measured by dimensional scales. The DICA-PPYC is a reliable and valid semi-structured interview schedule for preschool and young children, and can serve to advance the knowledge and mental health care of this population.     

The effect of methylphenidate treatment on suspiciousness in children with ADHD alone or comorbid with ODD

Objective: To assess the level of the suspiciousness in children with attention deficit/hyperactivity disorder (ADHD) and comorbid oppositional defiant disorder (ODD) in comparison to ADHD alone and the response of suspiciousness symptoms to methylphenidate (MPH) treatment.

Methods: In this open-label comparative study, children with DSM-IV-TR ADHD, aged 8–18 years, with (N?=?30) or without (N?=?30) ODD received MPH treatment for 12 weeks. The severity of ODD symptoms was assessed by the Kiddie–Schedule for Affective Disorders and Schizophrenia. The severity of ADHD symptoms was assessed by the ADHD-Rating-Scale-IV and suspiciousness was assessed at baseline and at endpoint by a scale designed especially for assessment of suspiciousness and named Suspiciousness Rating Scale (SRS).

Results: Significant reductions in SRS scores were detected in both groups following MPH treatment (before and after: p?= .0012 and p?=?.0273, respectively). Only in the ADHD/ODD group a significant correlation was found between the rate of improvement in ADHD, as assessed by the ADHD–RS, and the reduction in suspiciousness, as assessed by the SRS (Spearman r?=?0.48, p?= .0066).

Conclusions: In addition to the beneficial effect of MPH treatment on ADHD and ODD symptoms it also diminishes suspiciousness. However, due to the small sample size further studies are needed to confirm the present results.     

Psychometric Evaluation of the Behavior Problems Inventory-01 and the Nisonger Child Behavior Rating Form with Children and Adolescents

This study was conducted to assess the psychometric properties of 2 assessment instruments, the Behavior Problems Inventory-01 (BPI-01; Rojahn, Matson, Lott, Esbensen, & Smalls, 2001 Rojahn, J., Matson, J. L., Lott, D., Esbensen, A. J. and Smalls, Y. 2001. The Behavior Problems Inventory: An instrument for the assessment of self-injury, stereotyped behavior, and aggressive/destructive behavior in individuals with developmental disabilities. Journal of Autism and Developmental Disorders, 31: 577–588. [Crossref], [PubMed], [Web of Science ®] , [Google Scholar]) and the Nisonger Child Behavior Rating Form (NCBRF; Aman, Tassé, Rojahn, & Hammer, 1996 Aman, M. G., Tassé, M. J., Rojahn, J. and Hammer, D. 1996. The Nisonger CBRF: A child behavior rating form for children with developmental disabilities. Research in Developmental Disabilities, 17: 41–57. [Crossref], [PubMed], [Web of Science ®] , [Google Scholar]). The sample consisted of 237 ethnically diverse children and adolescents with intellectual disabilities who ranged in age from 4 to 22 years. Reliability parameters included internal consistency, interteacher agreement, teacher-parent agreement, and test-retest reliability. Factorial validity was assessed first by bivariate Spearman rank (ρ) correlations and then by examining the factor structure fit via confirmatory factor analysis (CFA). Convergent and discriminant validity was assessed by multiple regression analyses across the 2 instruments. Reliability coefficients (internal consistency, interteacher agreement, and test-retest reliability) of the BPI-01 and of the NCBRF subscales ranged from fair to excellent and from poor to excellent, respectively. The CFA suggested a poor fit between the present and the original BPI-01 and NCBRF factor structures, although item-total correlations were reasonable. Convergent and discriminant validity between the BPI-01 and the NCBRF, however, was strong. Limitations of the study are discussed and recommendations for future studies are presented.     

The interference of local over global information processing in children with attention deficit hyperactivity disorder of the inattentive type

A classic finding in perception of compound patterns is normal individuals cannot skip global analysis in local-oriented processing, but they can successfully resist local analysis in global-oriented processing-the so-called global interference [1]. Recently, studies examining the role of brain hemisphere activity in the Navon task have indicated that the processing of global and local information can be, respectively, attributed to the right and left hemispheres. Moreover, many neuroimaging researches have revealed that certain core symptoms of attention deficit hyperactivity disorder (ADHD) are related to dysfunction of right hemisphere. These findings imply that global interference will be substantially less evident, and possibly even replaced by local interference in ADHD. The present study compared the performance of children with and without attention deficit hyperactivity disorder of the inattentive type (ADHD-I) in the processing of global and local information to examine the local interference hypothesis in ADHD. An ADHD-I group (n=15) and a paired control group (n=19) completed tasks using two versions of the Navon task, one requiring divided attention, in which no information was given to participants regarding the level at which a target would appear, and the other requiring selective attention, in which participants were instructed to attend to either the local or the global level. The results showed that children with ADHD-I exhibited local interference, regardless of which attention procedure was used. These results support the weak right hemisphere hypothesis in ADHD, and provide evidence against the deficit hypotheses for ADHD in the DSM-IV criteria [29], which postulates that inattention symptoms may manifest as a failure to provide close attention to details.     

A cross-cultural comparison between samples of Brazilian and German children with ADHD/HD using the Child Behavior Checklist

Introduction This study aims to assess cross-cultural similarities and differences in broadband psychopathology in two naturalistic clinical samples of children diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) combined type according to DSM-IV criteria or with Hyperkinetic Disorder (HD) according to ICD-10 criteria. Methods We compared two clinical samples of children with ADHD combined type (Brazil, N = 248) and HD (Germany; N = 154) to controls (Brazil N = 71; Germany N = 135) using the Child Behavior Checklist (CBCL). ROC-curves (Receiver Operating Characteristic) were determined to evaluate the discriminating validity of the CBCL Attention Problem scale. A two-factorial ANOVA was computed across all 8 scales of the CBCL. Results Although Brazilian parents reported significantly higher scores on all CBCL scales than German parents (P < 0.05), a similar CBCL profile was detected in both cultures. Conclusion Despite the use of different diagnostic systems (DSM-IV vs. ICD-10) and the presence of other clinical differences, the similar broadband psychopathological profile of the CBCL in the two samples provides evidence that dimensional symptoms associated with the categorical diagnosis of ADHD combined type might be comparable in two clinical settings with diverse cultural background.     

EEG characteristics and visual cognitive function of children with attention deficit hyperactivity disorder (ADHD)

Using visual and auditory continuous performance tests (CPT) and EEG, cognitive function and EEG power were investigated in patients with attention deficit hyperactivity disorder (ADHD). CPT and EEG were conducted for 44 ADHD children and 44 healthy controls of comparable age and sex. The EEG power tests include relative power of theta, alpha, and beta, and theta/beta and theta/alpha ratios. ADHD patients showed significantly higher theta relative power, lower beta relative power, and higher theta/beta ratio (p < 0.05). ADHD patients showed a significantly lower score of auditory CPT (p < 0.05). The EEG power characteristics were correlated significantly with the visual attention function in ADHD children (p < 0.01). Higher-order level cognitive dysfunction affects ADHD pathogenesis. Cortical hypoarousal effects on several mechanisms including the fronto-striatal circuitry may be implicated in the inhibition of prepotent and premature responses.     

Behavioral and cognitive correlates of the aperiodic (1/f-like) exponent of the EEG power spectrum in adolescents with and without ADHD

Efficient information processing facilitates cognition and may be disrupted in a number of neurodevelopmental conditions. And yet, the role of inefficient information processing and its neural underpinnings remains poorly understood. In the current study, we examined the cognitive and behavioral correlates of the aperiodic exponent of the electroencephalogram (EEG) power spectrum, a putative marker of disrupted, inefficient neural communication, in a sample of adolescents with and without ADHD (n = 184 n_ADHD = 87; M_age = 13.95 years, SD = 1.36). Exponents were calculated via FOOOF (Donoghue et al., 2020a) from EEG data recorded during an 8-minute baseline episode. Reaction time speed and variability, as well as drift diffusion parameters (including the drift rate parameter, a cognitive parameter directly related to inefficient information processing) were calculated. Adolescents with ADHD had smaller aperiodic exponents (a “flattened” EEG power spectrum) relative to their typically-developing peers. After controlling for ADHD, aperiodic exponents were related to reaction time variability and the drift rate parameter, but not in the expected direction. Our findings lend support for the aperiodic exponent as a neural correlate of disrupted information processing, and provide insight into the role of cortical excitation/inhibition imbalance in the pathophysiology of ADHD.     

Neurotrophin-3 gene,intelligence, and selective attention deficit in a Korean sample with attention-deficit/hyperactivity disorder

Objective

Attention-deficit/hyperactivity disorder (ADHD) is a complex neurodevelopmental disorder with a strong genetic component. Neurotrophin-3 (NTF3), which participates in the differentiation and survival of dopaminergic and noradrenergic neurons, has been identified as a factor in the development of ADHD. We investigated the relationships between ADHD and NTF3 gene polymorphism.

Methods

We conducted a case–control analysis of 202 ADHD subjects and 159 controls, performed a transmission disequilibrium test (TDT) on 151 trios, and compared the intelligence quotient (IQ) and a continuous performance test (CPT) according to the genotype of two single-nucleotide polymorphisms (SNPs) (rs6332 and rs6489630) in the NTF3 gene.

Results

In the case–control and family-based analyses, NTF3 was not significantly associated with ADHD. However, in the ADHD probands, the subjects with AA genotype in the rs6332 SNP had significantly higher mean T-scores for commission errors on the CPT than did those with the AG genotypes (p = 0.045). The mean IQ of the ADHD probands who had the CC genotype of the rs6489630 SNP were higher compared with those who had the CT or TT genotype (p = 0.035). The mean T-score for response time on the CPT was higher in the subjects with TT genotype in the rs6489630 SNP compared to those with the CC or CT genotype, even after adjusting for the effect of IQ (p = 0.021).

Conclusions

These results provide preliminary evidence of an association between NTF3 and the intelligence and selective attention deficit in the Korean population.     

Factor Analysis of the Nisonger Child Behavior Rating Form in Children with Autism Spectrum Disorders

The Nisonger Child Behavior Rating Form (NCBRF) is a behavior rating scale designed for children and adolescents with mental retardation. The purpose of this study was to explore the psychometric properties of the NCBRF in a sample of 330 children and adolescents with autism spectrum disorders (ASDs). Parent and teacher ratings were independently submitted to both exploratory and confirmatory factor analysis. As reported with the original validation study, parent and teacher versions shared similar but somewhat different factor structures. Social competence items showed more similarity with the original solutions than did problem behavior items. Problem behavior items were distributed into a somewhat simpler five-factor solution for both rating forms. Self-injurious and stereotypic items loaded on two distinct subscales for the teacher form, but not on the parent form. Factor loadings and internal consistencies were generally lower than those reported for the original versions but still within the acceptable range. Confirmatory factor analyses indicated good fits for the social competence items and acceptable fits for the problem behavior items. Overall, results supported the construct validity of the NCBRF in children and adolescents with ASDs.     

Social and Behavioral Problems of Children with Agenesis of the Corpus Callosum

Archival data from a survey of parent observations was used to determine the prevalence of social and behavioral problems in children with agenesis of the corpus callosum (ACC). Parent observations were surveyed using the Child Behavior Checklist (CBCL) for 61 children with ACC who were selected from the archive based on criteria of motor development suggesting a relatively high general level of functioning. Younger children with ACC (ages 2–5) were rated as primarily having problems with sleep. Older children with ACC (ages 6–11) manifested problems in attention, social function, thought, and somatic complaints. The older children with ACC were also compared to CBCL data from 52 children with autism who were selected from a previous study. Children with ACC were generally less impaired than children with autism on nearly all scales, with significantly less severe problems in the areas of attention, anxiety/depression, social function, and unusual thoughts. A further questionnaire related to diagnostic criteria for autism indicated that some children with ACC had traits that are among those that contribute to the diagnosis of autism within the domains of social interaction and social communication, but fewer who manifest repetitive and restricted behaviors.     

Identification of attention-deficit-hyperactivity disorder and conduct disorder in Mexican children by the scale for evaluation of deficit of attention and hyperactivity

The objective was weighing the usefulness of a Spanish-language Scale for the evaluation of deficit of attention and hyperactivity (EDAH) to identify children with attention deficit-hyperactivity disorder (AD-HD) and conduct disorder (CD) in a sample of school-aged children. We studied 132 children from a government-run public elementary school previously selected by teachers as having learning and attention disorders. We screened children of the sample with parents’ and teachers’ EDAH and Diagnostic and Statistical Manual of Mental Disorders-IV edition Text Revision (DSM-IV-TR) questionnaires, and performed an interdisciplinary clinical examination for the final diagnosis. We found 81 children with AD-HD and 51 children without AD-HD. AD-HD was classified as follows: AD-HD-combined (-C), n = 32; AD-HD-inattentive (-I), n = 17 and AD-HD-hyperactive (-H), n = 32. Cronbach's alpha calculation for the EDAH parents’ questionnaire was 0.76, and for teachers, 0.80. Sensitivity of the teachers’ EDAH questionnaire was 0.94, and specificity, 0.91. Sensitivity of the parents’ EDAH questionnaire was 0.91, while specificity was 0.87. The data of EDAH parents’ and teachers’ questionnaires have a concordance of 93.1% and 80%, respectively. The correlation of scores among parents’ and teachers’ EDAH scales was significant. The correlation between results from parents’ and teachers’ DSM-IV-TR and EDAH questionnaires was also significant. Our results partially support the use of EDAH questionnaires for AD-HD and CD screening in Spanish-speaking populations.     

The Obsessive-Compulsive Symptom (OCS) scale of the Child Behavior Checklist: a comparison between Swedish children with Obsessive-Compulsive Disorder from a specialized unit, regular outpatients and a school sample

To evaluate the discriminative power of various items as reported by parents in the OCS-scale extracted from the Child Behavior Checklist (CBCL) problem scale and to compare findings with outcomes of previous validation studies. Children referred to a specialized child psychiatric Obsessive-Compulsive Disorder (OCD) clinic (OCD group) (n=185) receiving a formal OCD diagnosis according to DSM IV criteria based on interviews with the Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) were compared to a sample recruited from regular child and adolescent psychiatric outpatient clinics (CPO group) (n=177). Both samples were compared to a normative school sample (SS group) and all three groups were matched for age and gender. Thirty seven CBCL items, mostly representing core internalizing symptoms and parts of the thought problem scale as well as physical and sleep problems, were first identified. Ten of these items (including all discriminative items in previous validation studies) could distinguish children with OCD from CPO patients. In a subsequent analysis, the results of a logistic regression showed that four CBCL items, "Obsessions," "Fearful and Anxious," "Compulsions," and "Worries" remained significant predictors. These four OCS items and previously used CBCL OCS-scales were further examined by means of ROC-analysis showing that the "Obsessions" and "Compulsions" CBCL items were the strongest predictors. These two CBCL items performed well as screens for OCS symptoms in children and adolescents and the addition of similar CBCL items did not further increase sensitivity or specificity. It is suggested that parental responses on these two items could preferably be used as screen for OCD in children and adolescents in regular child psychiatric clinics.     

Comparing the executive attention of adult females with ADHD to that of females with sensory modulation disorder (SMD) under aversive and non-aversive auditory conditions

Certain behavioral expressions of sensory modulation disorder (SMD) such as distractibility, hyperactivity, and impulsivity are often similar to those of attention deficit/hyperactivity disorder (ADHD) in pediatric and adult populations. There is also a high comorbidity rate between these two diagnoses and absence of research regarding the objective neuropsychological differentiation between them. In the present study we employed a factorial design which enabled us to: (a) systematically examine the effects of SMD and ADHD on executive attention in a sample of adult females using a Stroop-like task, and (b) measure the effect of aversive conditions (sounds) on executive attention. The experimental measures used were the Stroop-like Location – Direction Task (SLDT) to assess executive attention and the battery of aversiveness to sounds (BAS), a standardized measure of aversive sounds that was developed for this study and enabled individual customization of aversive auditory sounds. Results revealed, as expected, a specific core deficit in executive attention for the ADHD factor. In addition to that, the present study provides an important, pioneering finding of SMD impairment in a unique combination of a cognitively demanding task with aversive sounds, providing preliminary objective evidence differentiating SMD from ADHD.     

Comparison of QEEG Reference Databases in Basic Signal Analysis and in the Evaluation of Adult ADHD

SUMMARY

Introduction. Despite the relatively widespread investigation of potential quantitative electroencephalographic (QEEG) characteristics of childhood attention deficit hyperactivity disorder (ADHD), relatively little is known about the possible QEEG characteristics of adult ADHD. In addition to general magnitude or power measures, or ratios of these measures, the additional analyses and comparisons provided by QEEG reference databases may prove useful in providing unique markers for adult ADHD.

Method. This investigation reports the findings of evaluations using three QEEG reference databases for a sample of ten adults previously diagnosed with ADHD. The packages used in the current investigation included the NeuroRep QEEG Analysis and Report System, the SKIL Topometric QEEG software package, and the NovaTech EEG EureKa3! QEEG analysis package.

Results. As compared with the respective databases, adults with ADHD appear to demonstrate higher levels of 8–10 Hz activity during both eyes-closed and eyes-open resting baselines. They also appear to demonstrate frontal involvement as evidenced by hypercoherence and hypercomodulation in frontal areas.

Conclusions. Each of the three QEEG reference databases appears to offer unique markers for adult ADHD. However, other apparent differences were found to be attributable to specific analysis packages rather than the clinical group itself. An investigation of basic signal analyses also revealed differences between the three packages. Results of the respective analyses and possible implications are discussed.     

Reliability and Validity of the Korean Version of the Parental Stress Scale for Children With Attention-Deficit/Hyperactivity Disorder

ObjectiveThis study standardizes the Parental Stress Scale (PSS) for Republic of Korean parents of children with attention-deficit/hyperactivity disorder (ADHD) and verifies its reliability and validity. MethodsData from 160 parents of children with ADHD who completed the following self-reported questionnaires were analyzed: the Korean ADHD Rating Scales, the Patient Health Questionnaire-9, the State–Trait Anxiety Inventory, the PSS, and the Global Assessment of Recent Stress Scale. All scale items were measured for reliability and validity, and the appropriate factors for measuring stress in Korean parents with ADHD children were extracted. ResultsExploratory and confirmatory factor analyses derived two sub-factors and 11 items. Goodness of fit was confirmed, and the scale was deemed suitable for explaining stress in parents of children with ADHD. ConclusionIn this study, the validity and reliability of the K-PSS-ADHD were investigated. We expect that the K-PSS-ADHD will be used as a basis for future studies on stress in parents of children with ADHD.     

Impairment of Concept Formation Ability in Children with ADHD: Comparisons between Lower Grades and Higher Grades

Objective

We investigated executive functions (EFs), as evaluated by the Wisconsin Card Sorting Test (WCST), and other EF between lower grades (LG) and higher grades (HG) in elementary-school-age attention deficit hyperactivity disorder (ADHD) children.

Methods

We classified a sample of 112 ADHD children into 4 groups (composed of 28 each) based on age (LG vs. HG) and WCST performance [lower vs. higher performance on WCST, defined by the number of completed categories (CC)] Participants in each group were matched according to age, gender, ADHD subtype, and intelligence. We used the Wechsler intelligence Scale for Children 3rd edition to test intelligence and the Computerized Neurocognitive Function Test-IV, which included the WCST, to test EF.

Results

Comparisons of EFs scores in LG ADHD children showed statistically significant differences in performing digit spans backward, some verbal learning scores, including all memory scores, and Stroop test scores. However, comparisons of EF scores in HG ADHD children did not show any statistically significant differences. Correlation analyses of the CC and EF variables and stepwise multiple regression analysis in LG ADHD children showed a combination of the backward form of the Digit span test and Visual span test in lower-performance ADHD participants significantly predicted the number of CC (R²=0.273, p<0.001).

Conclusion

This study suggests that the design of any battery of neuropsychological tests for measuring EF in ADHD children should first consider age before interpreting developmental variations and neuropsychological test results. Researchers should consider the dynamics of relationships within EF, as measured by neuropsychological tests.