Visual behaviour of ADHD children during an attention test: an almost forgotten variable. Attention-Deficit Hyperactivity Disorder

The goal of this study was to examine whether looking away behaviour of ADHD children interferes with their test performance. ADHD and normal children carried out two continuous performance tests (CPTs): one with a regular interstimulus interval (ISI), and the other with an irregular ISI. Children were instructed to push a response button when a target stimulus was presented on the monitor. The children's visual behaviour was recorded and scored offline. A micro-analysis of the visual behaviour indicated that ADHD children timed their looking away behaviour in the regular CPT: i.e. they looked away from the monitor and back in the interval between two succeeding stimuli. As a result they did not miss stimuli. Timing of looking away was less possible in the CPT with the irregular ISI. In this condition, looking away interfered with the ADHD children's task accuracy. In sum, looking away behaviour had a negative effect on the accuracy of test performance of ADHD children when stimuli were unpredictable. Looking away behaviour was not associated with the slower reaction times of the ADHD children. Hence, the often reported slowness of ADHD children is not to be explained by their visual behaviour.     

Replication of the latent class structure of Attention-Deficit/Hyperactivity Disorder (ADHD) subtypes in a sample of Australian twins

BACKGROUND: Previous efforts to subtype Attention-Deficit/Hyperactivity Disorder (ADHD) using latent class analysis (LCA) applied to DSM-IV symptom profiles of adolescent female twins from Missouri (USA) have identified distinct classes within the domains of inattention, hyperactivity-impulsivity and combined-type problems. The objective of the current report is to determine if the latent class structure of ADHD subtypes can be replicated in a culturally distinct sample of female and male Australian twins. METHOD: LCA was applied to parent-report DSM-IV ADHD symptom profiles of N=2,848 child and adolescent Australian twins and compared to North American findings. Separate models were fitted for females (N= 1,432) and males (N= 1,416). RESULTS: The most congruent latent ADHD classes across samples included a non-symptomatic class, three mild-moderate and two severe classes. Also present within samples was a rare hyperactive-impulsive class and a unique class, the structure of which was idiosyncratic across samples. Mean symptom endorsement and individual symptom endorsement probabilities for each of the stable classes were similar across samples. Consistent with previous findings, there was substantial overlap between the DSM-IV inattentive and combined subtypes with the severe inattentive and severe combined latent classes. However, DSM-IV inattentive and combined subtypes were distributed over several latent classes in each sample, and a substantial proportion of individuals with no DSM-IV diagnosis were also assigned to these severe classes. CONCLUSIONS: Results from LCA using an Australian twin sample replicate six of the eight latent class subtypes previously reported using Missouri female twins and extend the findings to male twins. LCA and DSM-IV systems of ADHD classification identify different phenotypic groups, and the basis of this disparity merits further investigation.     

Stimulation seeking and hyperactivity in children with ADHD. Attention Deficit Hyperactivity Disorder

Thirty hyperactive and 30 non-hyperactive children were confronted with a delay, consisting of a waiting situation of 15 minutes, either with or without extra stimulation provided by the presentation of a videotape. The behaviour of the child during the waiting period was videotaped and later coded by two naive observers. In line with theories that emphasise the stimulation-seeking function of hyperactive behaviours, such as the optimal stimulation account and the delay aversion theory, a group by stimulation effect was hypothesised. For two categories of activity this was found, with ADHD children displaying more activity than non-ADHD children in the no-stimulation but not in the stimulation condition. These data provide support for the stimulation-seeking function of certain features of ADHD hyperactivity.     

Differences between preschool children with ODD, ADHD, and ODD+ADHD symptoms

BACKGROUND: This study examines differences between children (ages 3 to 6 years) who have the symptoms of oppositional defiant disorder (ODD) with or without attention-deficit/hyperactivity disorder (ADHD), ADHD alone, and a nonODD/ADHD comparison group. Parent (N=595) and teacher (N=538) ratings were obtained for children attending the same community early childhood programs and for youngsters evaluated in an outpatient clinic (N=224) using a DSM-IV-referenced rating scale. RESULTS: Differences between symptom groups varied depending on how they were configured (teacher versus parent ratings) and setting (clinic versus community). In general, the ODD+ADHD group received the highest (and the comparison group the lowest) ratings of severity for the symptoms of other disorders, difficulties with peers, and developmental deficits. Moreover, the clinical impact of comorbidity was largely additive. Differences between youngsters with ODD versus ADHD symptoms were most apparent for teacher-defined groups in the community sample and parent-defined groups in the clinic sample. CONCLUSIONS: Collectively, these findings provide preliminary evidence for the notion that ODD and ADHD may constitute distinct clinical entities in preschool-aged children and suggest that informant may be an important consideration in the formulation of diagnostic criteria.     

Differences between subtypes of children with ADHD and simple attentional difficulties during an initial assessment

OBJECTIVE: To examine differences between subtypes of children with attention-deficit/hyperactivity disorder (ADHD), simple attentional difficulties and situational ADHD during an initial assessment. METHOD: In a single-centre study examination data of 205 children who had an initial assessment between January 1, 2002 and December 31, 2003 were retrospectively analyzed. The groups of children were compared with respect to their history features, neuromotor deficits, neuropsychological performance, and comorbid behavioural and developmental deficits by standardized test procedures and questionnaires. RESULTS: Children with ADHD more frequently have a positive family history of attentional symptoms than non-ADHD children. There is no difference between these groups with respect to the associated behavioural problems. Children classified as ADHD show more neuromotor problems and neuropsychological deficits than children with non-ADHD attentional problems. Children with ADHD subtype hyperactive/impulsive demonstrate better neuropsychological performance than children with subtypes inattentive and combined. Children with situational home-only or school-only ADHD show no clear differences in neuromotor behaviour, comorbid problems or neuropsychological performance. CONCLUSIONS: There are clear neuropsychological differences between children who fulfil the classification criteria of The Diagnostic and Statistical Manual of Disease, Fourth Revision (DSM-IV) for ADHD and children who are confronted daily with attentional difficulties, but do not fulfil the criteria for ADHD. In contrast, differences in behavioural comorbidities were not found, nor were differences found between home-only and school-only ADHD children.     

Understanding Barriers and Facilitators of Attention-Deficit/Hyperactivity Disorder Treatment Initiation and Adherence in Black and Latinx Children

ObjectiveDespite evidence that consistent treatment is important for Attention-Deficit/Hyperactivity Disorder (ADHD) management, ADHD treatment initiation and adherence remains suboptimal in minoritized children. The goal of this study was to explore barriers and facilitators to ADHD treatment initiation/adherence for minoritized children to further inform development of our family navigation intervention.MethodsUsing a virtual platform, we completed 7 focus group sessions (total n.ß=.ß26) and 6 individual interviews with representatives from 4 stakeholder groups: experienced caregivers of children with ADHD, caregivers of children newly diagnosed with ADHD, family navigators, and clinicians who care for children with ADHD. All caregivers identified as Black and/or Latinx. Separate sessions were conducted for each stakeholder group and caregivers had the option to attend an English or Spanish session. Using a thematic analysis strategy, barriers and facilitators to ADHD treatment initiation and/or adherence were coded in focus group/interview data and themes were identified across groups.ResultsThe primary barriers to ADHD treatment initiation and/or adherence identified for minoritized children were lack of support from school/healthcare/family members, cultural barriers, limited resources, limited access, and treatmentconcerns, with variability in endorsement across participants. Reported facilitators included caretakers having experience with ADHD, strong support, access to resources, andwitnessing their child...s functional improvement with treatment.ConclusionsCaregiver experience with and knowledge about ADHD, support, and access to resources facilitate ADHD treatment in minoritized children. The results from this study have the potential to improve ADHD treatment initiation/adherence and outcomes for minoritized children through the development of culturally tailored, multipronged interventions.     

Attentional functions in children and adolescents with ADHD,depressive disorders,and the comorbid condition

Background: Attention‐deficit hyperactivity disorder (ADHD) and depressive disorders (DDs) often co‐occur in children and adolescents, but evidence on the respective influence of these disorders on attention parameters is inconsistent. This study examines the influence of DDs on ADHD in a model‐oriented approach that includes selectivity and intensity attention parameters. Methods: Ten‐ to fifteen‐year‐olds with ADHD (n = 63), DDs (n = 61), ADHD+DDs (n = 64), and healthy controls (n = 64) completed a battery of tests including five neuropsychological tasks (i.e., alertness, sustained attention, divided attention, go/no‐go, and attentional set‐shifting). Results: All clinical groups showed attentional problems, especially in more complex attentional tasks and in the intensity aspects of attention. We observed the most severe attentional impairments in children with ADHD that was independent from a comorbid DD. Conclusion: The clinical groups were significantly different from the healthy control group, especially in more complex attentional tasks and in the intensity aspects of attention. Some differences between ADHD, DDs and ADHD+DDs groups were detected on neuropsychological attentional performance, but the effects were not strong enough to differentiate the clinical groups from each other.     

Sustained attention and response inhibition in young children at risk for Attention Deficit/Hyperactivity Disorder

BACKGROUND: Studies of school-aged children, adolescents, and adults with Attention Deficit/Hyperactivity Disorder (ADHD) have variably shown ADHD-related impairment in both inhibitory control and sustained attention. However, few studies have examined ADHD-associated patterns of performance on these tasks among younger children (below age 7 years). METHODS: A combined continuous performance test and go/no-go task (CPT/GNG) and the Day-Night Stroop Task (DNST) were administered to an ethnically diverse sample of 3.44- to 6.95-year-old children rated by parents and teachers as being either high risk or low risk for ADHD. All children performed the DNST (N = 71) and a subset of the sample (N = 44) performed the CPT/GNG. Analyses assessed task validity as well as the effects of age and risk status. RESULTS: Significant main effects for age and risk status were found on all tasks. In addition, age x condition interactions were found for the CPT and DNST, which suggest that the tasks were sensitive to age-related changes in sustained attention and inhibitory control respectively. No significant risk status x condition interactions were found, suggesting that young children at risk for ADHD do not exhibit specific deficits in either inhibitory control or sustained attention. The most consistent effect related to risk status across tasks was the greater number of errors and longer and more variable reaction times on the part of children at risk for ADHD irrespective of condition. CONCLUSIONS: ADHD-associated decrements in performance on these tasks appear to be attributable either to generalized behavioral dysregulation or poor state regulation rather than to deficient inhibitory control.     

Time perception,phonological skills and executive function in children with dyslexia and/or ADHD symptoms

Background: Deficits in time perception (the ability to judge the duration of time intervals) have been found in children with both attention‐deficit/hyperactivity disorder (ADHD) and dyslexia. This paper investigates time perception, phonological skills and executive functions in children with dyslexia and/or ADHD symptoms (AS). Method: Children with dyslexia‐only (n = 17), AS‐only (n = 17), comorbid dyslexia+AS (n = 25), and typically developing controls (n = 42), matched for age and non‐verbal ability, were assessed on measures of phonological skills, executive function and time perception (duration discrimination and time reproduction). Results: Children with dyslexia were impaired on measures of phonological skill and duration discrimination compared to children without dyslexia (though problems on duration discrimination appeared to be attributable to mild symptoms of inattention in this group). In contrast, children with AS exhibited impairments on measures of both time perception and executive function compared to children without AS. Children with dyslexia+AS showed an additive combination of the deficits associated with dyslexia‐only and AS‐only. Conclusions: Dyslexia and AS appear to be associated with distinct patterns of cognitive deficit, which are present in combination in children with dyslexia+AS.     

Social and emotional adjustment in children affected with Gilles de la Tourette's syndrome: associations with ADHD and family functioning. Attention Deficit Hyperactivity Disorder

This study examined social-emotional functioning in children with Gilles de la Tourette's syndrome (TS) alone and children with TS and Attention Deficit Hyperactivity Disorder (ADHD). In addition, the contribution of family functioning to social competence was examined. Children with a clinical diagnosis of TS were recruited from the Yale Child Study Center TS specialty clinic. Unaffected control children were recruited through newspaper advertisements and announcements within the university and at area schools. The final sample consisted of 72 children (45 boys and 27 girls) between the ages of 8 and 14. Sixteen children met DMS-III-R criteria for TS, 33 children met criteria for TS and ADHD, and 23 children had no psychiatric diagnoses. Children with TS and ADHD evidenced more externalizing and internalizing behavior problems and poorer social adaptation than children with TS only or unaffected controls. Children with TS only were not significantly different from unaffected controls on most measures of externalizing behaviors and social adaptation but did exhibit more internalizing symptoms. Tic symptom severity was not associated with social, behavioral, or emotional functioning among children with TS, even after stratifying by medication status. However, ADHD diagnosis, obsessional symptom severity, and family functioning were significantly associated with social and emotional adjustment among TS children. Moreover, family functioning was associated with social and emotional adjustment even after controlling for TS and ADHD diagnostic status. These findings demonstrate that much of the social and behavioral dysfunction in children with TS is ADHD-specific and children with TS alone have a very different social-emotional profile than do those with TS plus ADHD. Finally, social-emotional adjustment in children with TS is best understood within the family context.     

The co-occurrence of autism spectrum disorder and attention-deficit/hyperactivity disorder symptoms in parents of children with ASD or ASD with ADHD

Background: Autism spectrum disorder (ASD) and attention‐deficit/hyperactivity disorder (ADHD) share about 50–72% of their genetic factors, which is the most likely explanation for their frequent co‐occurrence within the same patient or family. An additional or alternative explanation for the co‐occurrence may be (cross‐)assortative mating, e.g., the tendency to choose a partner that is similar or dissimilar to oneself. Another issue is that of parent‐of‐origin effect which refers to the possibility of parents differing in the relative quantity of risk factors they transmit to the offspring. The current study sets out to examine (cross‐)assortative mating and (cross‐)parent‐of‐origin effects of ASD and ADHD in parents of children with either ASD or ASD with ADHD diagnosis. Methods: In total, 121 families were recruited in an ongoing autism‐ADHD family genetics project. Participating families consisted of parents and at least one child aged between 2 and 20 years, with either autistic disorder, Asperger disorder or PDD‐NOS, and one or more biological siblings. All children and parents were carefully screened for the presence of ASD and ADHD. Results: No correlations were found between maternal and paternal ASD and ADHD symptoms. Parental ASD and ADHD symptoms were predictive for similar symptoms in the offspring, but with maternal hyperactive‐impulsive symptoms, but not paternal symptoms, predicting similar symptoms in daughters. ASD pathology in the parents was not predictive for ADHD pathology in the offspring, but mother’s ADHD pathology was predictive for offspring ASD pathology even when corrected for maternal ASD pathology. Conclusions: Cross‐assortative mating for ASD and ADHD does not form an explanation for the frequent co‐occurrence of these disorders within families. Given that parental ADHD is predictive of offspring’ ASD but not vice versa, risk factors underlying ASD may overlap to a larger degree with risk factors underlying ADHD than vice versa. However, future research is needed to clarify this issue.     

What's in a game: the effect of social motivation on interference control in boys with ADHD and autism spectrum disorders

Background:  Children with attention deficit hyperactivity disorder (ADHD) and with autism spectrum disorders (ASD) are known to have cognitive control deficits. Some studies suggest that such deficits may be reduced when motivation is increased through tangible reinforcers. Whether these deficits can also be modulated by non-tangible reinforcers has hardly been studied.
Methods:  Therefore, the effect of social motivation on the ability to suppress irrelevant information (i.e., interference control) was investigated in 22 ADHD boys, 22 ASD boys, and 33 typically developing (TD) boys. An adapted Eriksen Flanker task was administered under a motivational condition in which the boys were told that they were competing with peers, and under a neutral condition in which standard instructions were given.
Results:  In comparison with TD boys, boys with ADHD were impaired even when no interference was present, while this was not the case for the ASD boys. All groups benefited from the motivation manipulation, i.e., their performance increased when they thought they were competing with peers. Although the boys with ADHD were still slower than TD boys when motivated, they performed as accurately as TD boys. Children with ASD also improved slightly in accuracy and response speed, but this did not reach significance.
Conclusion:  Children with ADHD are able to exert sufficient cognitive control when they are motivated, which is in line with the current models of ADHD. However, motivation seems to have a general effect on performance and is not solely related to cognitive control abilities. In contrast, this effect was not obtained in children with ASD.     

The role of the Child Health Services in the identification of children with possible Attention Deficit Hyperactivity Disorder/Deficits in Attention, Motor Control and Perception (ADHD/DAMP)

Literature concerning the role of the Child Health Services in the identification of children with possible Attention Deficit Hyperactivity Disorder/Deficits in Attention, Motor Control and Perception (ADHD/DAMP) is summarized in order to establish a background for evaluation, discussion and conclusion.     

Impaired conflict resolution and alerting in children with ADHD: evidence from the Attention Network Task (ANT)

Background: An important theory of attention suggests that there are three separate networks that execute discrete cognitive functions. The ‘alerting’ network acquires and maintains an alert state, the ‘orienting’ network selects information from sensory input and the ‘conflict’ network resolves conflict that arises between potential responses. This theory holds promise for dissociating discrete patterns of cognitive impairment in disorders where attentional deficits may often be subtle, such as in attention deficit hyperactivity disorder (ADHD). Methods: The Attentional Network Test (ANT), a behavioural assay of the functional integrity of attention networks, was used to examine the performance of 73 children with ADHD and 73 controls. Results: Performance on the ANT clearly differentiated the children with and without ADHD in terms of mean and standard deviation (SD) of reaction time (RT), the number of incorrect responses made and the number of omission errors made. The ADHD group demonstrated deficits in the conflict network in terms of slower RT and a higher number of incorrect responses. The ADHD group showed deficits in the alerting network in terms of the number of omission errors made. There was no demonstration of a deficit in the orienting network in ADHD on this task. Conclusions: The children with ADHD demonstrated deficits in the alerting and conflict attention networks but normal functioning of the orienting network.