Cognitive variability in adults with ADHD and AS: Disentangling the roles of executive functions and social cognition

Attention-deficit/hyperactivity disorder (ADHD) and Asperger's Syndrome (AS) share a heterogeneous cognitive profile. Studies assessing executive functions (EF) and social cognition in both groups have found preserved and impaired performances. These inconsistent findings would be partially explained by the cognitive variability reported in these disorders. First, the present study explored the inter-individual variability in EF and social cognition in both patient groups. Second, we compared differential characteristics and commonalities in the cognitive profiles of EF and social cognition between ADHD, AS and control adults. We assessed 22 patients with ADHD, 23 adults with AS and 21 matched typically developing subjects using different measures of EF (working memory, cognitive flexibility and multitasking) and social cognition (theory of mind and decision-making). Group comparisons and multiple case series analyses (MCSA) were conducted. The between-group comparisons showed an EF deficit in working memory in ADHD and a theory of mind (ToM) impairment in AS. The MCSA evidenced that, compared to controls, ADHD patients had a higher inter-individual variability in EF, while individuals with AS had a more heterogeneous profile in social cognition tasks compared to both groups. Finally, the AS and ADHD groups presented higher task-related variability compared to controls and shared a common heterogeneous profile in EF. This is the first study to compare variability in EF and social cognition profiles of ADHD and AS. We propose that heterogeneity in EF performance is a link between ADHD and AS which may explain the overlap of symptomatology between both diagnoses. In addition, patients with AS seem to show a unique heterogeneous profile in ToM which may explain the low probability of finding AS symptoms in patients with ADHD.     

Quality of life in older adults with ADHD: links to ADHD symptom levels and executive functioning deficits

Abstract

Purpose and aim: The overall aim of the present study was to examine quality of life in attention deficit hyperactivity disorder (ADHD) patients age ≥60 years. First, we compared older adults with ADHD to both healthy controls of the same age and younger adults with ADHD. Second, we examined executive functioning as a possible underlying factor for quality of life among older adults with ADHD.

Methods: The study included 158 participants in three groups: (1) older adults (60–75 years of age) with ADHD (n?=?42), (2) healthy controls of the same age (n?=?58), and (3) younger adults (age 18–45 years of age) with ADHD (n?=?56). The patients with ADHD were clinically-referred. Quality of life was examined through self-ratings and executive functioning was examined using both self-ratings and tests.

Results: Older adults with ADHD differed significantly from controls the same age on all aspects of quality of life, with large effect sizes. However, they showed similar levels of quality of life compared to younger adults with ADHD. The exception was psychological health, for which older adults displayed better quality of life compared to younger adults with ADHD. Executive deficits measured through self-ratings, especially working memory, were related to quality of life, sometimes also beyond the influence of ADHD symptom levels.

Conclusions: Older adults with ADHD show serious impairments in quality of life, that are comparable to the levels found for younger adults. Impairments may increase further as these individuals grow older and clinics need to meet the needs of this increasingly larger group of patients.     

Modulation of affective face processing deficits in Schizophrenia by congruent emotional sounds

Schizophrenia is a psychiatric disorder resulting in prominent impairments in social functioning. Thus, clinical research has focused on underlying deficits of emotion processing and their linkage to specific symptoms and neurobiological dysfunctions. Although there is substantial research investigating impairments in unimodal affect recognition, studies in schizophrenia exploring crossmodal emotion processing are rare. Therefore, event-related potentials were measured in 15 patients with schizophrenia and 15 healthy controls while rating the expression of happy, fearful and neutral faces and concurrently being distracted by emotional or neutral sounds. Compared with controls, patients with schizophrenia revealed significantly decreased P1 and increased P2 amplitudes in response to all faces, independent of emotion or concurrent sound. Analyzing these effects with regard to audiovisual (in)congruence revealed that P1 amplitudes in patients were only reduced in response to emotionally incongruent stimulus pairs, whereas similar amplitudes between groups could be observed for congruent conditions. Correlation analyses revealed a significant negative correlation between general symptom severity (Brief Psychiatric Rating Scale-V4) and P1 amplitudes in response to congruent audiovisual stimulus pairs. These results indicate that early visual processing deficits in schizophrenia are apparent during emotion processing but, depending on symptom severity, these deficits can be restored by presenting concurrent emotionally congruent sounds.     

Dissociation of social cognition and executive function in frontal variant frontotemporal dementia

In this paper, we adopt a neurodevelopmental stance to examining frontal variant frontotemporal dementia (fv-FTD) by using experimental procedures from the literature on the growth of social behaviour in children to examine the deficits in social reasoning which may underpin behavioural disturbance in fv-FTD. We present the case of a 47-year-old man with a diagnosis of fv-FTD and severe antisocial behaviour. Tests of general neuropsychology and of executive function were performed. In addition, the patient, JM, was assessed on tasks which test theory of mind. Theory of mind develops in distinct stages through childhood and is a core ability to represent the thoughts and feelings of others, independent of the level of intellectual ability. The results indicate relatively intact general neuropsychological and executive function, but extremely poor performance on tasks of theory of mind. This indicates a dissociation of social cognition and executive function suggesting that in psychiatric presentations of fv-FTD there may be a fundamental deficit in theory of mind independent of the level of executive function. The implications of this finding for diagnostic procedures and possible behavioural management are discussed.     

Youths with ADHD with and without tic disorders: comorbid psychopathology, executive function and social adjustment

Attention deficit/hyperactivity disorder (ADHD) and tic disorders (TD) commonly co-occur. Clarifying the psychiatric comorbidities, executive functions and social adjustment difficulties in children and adolescents of ADHD with and without TD is informative to understand the developmental psychopathology and to identify their specific clinical needs. This matched case-control study compared three groups (n = 40 each) of youths aged between 8 and 16 years: ADHD with co-occurring TD (ADHD + TD), ADHD without TD (ADHD − TD) and typically developing community controls. Both ADHD groups had more co-occurring oppositional defiant disorder than the control group, and the presence of TD was associated with more anxiety disorders. TD did not impose additional executive function impairments or social adjustment difficulties on ADHD. Interestingly, for youths with ADHD, the presence of TD was associated with less interpersonal difficulties at school, compared to those without TD. The potential various directions of effects from co-occurring TD should be carefully evaluated and investigated for youths with 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.     

Cognitive and executive functions,social cognition and sense of coherence in adults with fetal alcohol syndrome

Abstract

Background: Primary disabilities in children with fetal alcohol syndrome (FAS) are the results of alcohol's teratogen effect on the fetal brain. Reduced cognitive and executive functions and social cognition are examples of such disabilities. Little is known about primary disabilities in adults with FAS as well as their sense of coherence (SoC). There is thus a need for knowledge about FAS in adulthood. Aims: To investigate cognitive and executive functions, social cognition and SoC in adults with FAS. Methods: Twenty adults with FAS (mean age: 30 years) were compared with 20 individuals matched on gender and age. Berg's Card-sorting Test-64, the Tower of Hanoi, Raven's Coloured Progressive Matrices, Digit Span, Faux Pas and the Swedish version of Antonovsky's Sense of Coherence Scale (SoC-29) were used. Results: The FAS group had a weak SoC and displayed deficits in the neuropsychological tests sensitive to cognitive and executive functions and social cognition. The FAS group's median SoC score was 112, lower than the comparison group's median of 133 (P < 0.001). The FAS group had median scores of 29.0 on Raven's Matrices. The median for Digit Span was 5 forwards and 3 backwards, lower than in the comparison group (P < 0.001). Conclusions: Reduced cognitive and executive functions and impaired social cognition are assumed to have a major impact on life for adults with FAS. We suggest that the findings showing that adults with FAS had a weak SoC, with particularly low scores on the manageability scale, reflect their experiences of living with those primary disabilities. Clinical implications: This study may enhance healthcare for individuals prenatally exposed to alcohol. In general, it contributes with knowledge about this group of individuals who need to be more visible in healthcare, and particularly, it demonstrates some of the neuropsychological disabilities they might have.     

Time processing in children and adults with ADHD

A time-processing deficit has been proposed as a neuropsychological candidate endophenotype for Attention Deficit Hyperactivity Disorder (ADHD), but its developmental trajectory still needs to be explored. In the present study, children (N = 33) and adults (N = 22) with ADHD were compared to normal controls on two time-processing tasks. For time reproduction, ADHD-related impairment was found in the full group, but not when adults were analyzed separately. For the discrimination of brief intervals, children and adults with ADHD showed different patterns of deficit. We conclude that in ADHD some time-processing deficits are still present in adults, but may take on age-related different forms.     

The face and its emotion: right N170 deficits in structural processing and early emotional discrimination in schizophrenic patients and relatives

Previous studies have reported facial emotion recognition impairments in schizophrenic patients, as well as abnormalities in the N170 component of the event-related potential. Current research on schizophrenia highlights the importance of complexly-inherited brain-based deficits. In order to examine the N170 markers of face structural and emotional processing, DSM-IV diagnosed schizophrenia probands (n=13), unaffected first-degree relatives from multiplex families (n=13), and control subjects (n=13) matched by age, gender and educational level, performed a categorization task which involved words and faces with positive and negative valence. The N170 component, while present in relatives and control subjects, was reduced in patients, not only for faces, but also for face-word differences, suggesting a deficit in structural processing of stimuli. Control subjects showed N170 modulation according to the valence of facial stimuli. However, this discrimination effect was found to be reduced both in patients and relatives. This is the first report showing N170 valence deficits in relatives. Our results suggest a generalized deficit affecting the structural encoding of faces in patients, as well as the emotion discrimination both in patients and relatives. Finally, these findings lend support to the notion that cortical markers of facial discrimination can be validly considered as vulnerability markers.     

精神分裂症患者述情障碍与执行功能及情绪障碍的关系

目的 探讨精神分裂症患者的述情障碍与执行功能和焦虑、抑郁情绪之间的关系.方法 用多伦多述情障碍20个条目量表(TAS-20)、威斯康星卡片分类测试(WCST)、焦虑自评量表(SAS)和抑郁自评量表(SDS)对150例精神分裂症患者分别进行述情障碍、执行功能及焦虑和抑郁症状的评定,抽取TAS总分≥62为高分组(38例)和TAS总分≤53为低分组(42例),比较两组的WCST成绩并与TAS-20总分及各因子分进行相关分析.同时将SAS、SDS标准分与TAS-20进行相关分析.结果 述情障碍高分组的错误应答数、非持续性错误数、完成第一次分类应答数均高于低分组(P＜0.05);而高分组的完成分类数、正确应答数、正确应答百分数、概念化水平应答率则明显低于低分组(P＜0.01);相关分析显示,TAS-20的总分及因子分与WCST成绩呈负相关(P＜0.05),TAS-20的总分及因子分与SAS、SDS标准分呈正相关(P＜0.05).结论 精神分裂症患者的述情障碍与执行功能损害、负性情绪密切相关.     

Naltrexone alters the processing of social and emotional stimuli in healthy adults

Endogenous opioids have complex social effects that may depend on specific receptor actions and vary depending on the “stage” of social behavior (e.g., seeking vs. responding to social stimuli). We tested the effects of a nonspecific opioid antagonist, naltrexone (NTX), on social processing in humans. NTX is used to treat alcohol and opiate dependence, and may affect both mu and kappa-opioid systems. We assessed attention (“seeking”), and subjective and psychophysiological responses (“responding”) to positive and negative social stimuli. Based on literature suggesting mu-opioid blockade impairs positive social responses, we hypothesized that NTX would decrease responses to positive social stimuli. We also tested responses to negative stimuli, which might be either increased by NTX’s mu-opioid effects or decreased by its kappa-opioid effects. Thirty-four healthy volunteers received placebo, 25 mg, or 50 mg NTX across three sessions under double-blind conditions. At each session, participants completed measures of attention, identification, and emotional responses for emotional faces and scenes. NTX increased attention to emotional expressions, slowed identification of sadness and fear, and decreased ratings of arousal for social and nonsocial emotional scenes. These findings are more consistent with anxiolytic kappa-antagonist than mu-blocking effects, suggesting effects on kappa receptors may contribute to the clinical effects of NTX.     

Language,executive function and social cognition in the diagnosis of frontotemporal dementia syndromes

Abstract

Frontotemporal dementia (FTD) represents a spectrum of non-Alzheimer's degenerative conditions associated with focal atrophy of the frontal and/or temporal lobes. Frontal and temporal regions of the brain have been shown to be strongly involved in executive function, social cognition and language processing and, thus, deficits in these domains are frequently seen in patients with FTD or may even be hallmarks of a specific FTD subtype (i.e. relatively selective and progressive language impairment in primary progressive aphasia). In this review we have attempted to delineate how language, executive function, and social cognition may contribute to the diagnosis of FTD syndromes, namely the behavioural variant FTD as well as the language variants of FTD including the three subtypes of primary progressive aphasia (PPA): non-fluent/agrammatic, semantic and logopenic. This review also addresses the extent to which deficits in these cognitive areas contribute to the differential diagnosis of FTD versus Alzheimer’s disease (AD). Finally, early clinical determinants of pathology are briefly discussed and contemporary challenges to the diagnosis of FTD are presented.     

Implicit cognition is impaired and dissociable in a head-injured group with executive deficits

Implicit or non-conscious cognition is traditionally assumed to be robust to pathology but Gomez-Beldarrain et al. recently showed deficits on a single implicit task after head injury. Laboratory research suggests that implicit processes dissociate. This study therefore examined implicit cognition in 20 head-injured patients and age- and IQ-matched controls using a battery of four implicit cognition tasks: a serial reaction time task (SRT), mere exposure effect task, automatic stereotype activation and hidden co-variation detection. Patients were assessed on an extensive neuropsychological battery, and MRI scanned. Inclusion criteria included impairment on at least one measure of executive function. The patient group was impaired relative to the control group on all the implicit cognition tasks except automatic stereotype activation. Effect size analyses using the control mean and standard deviation for reference showed further dissociations across patients and across implicit tasks. Patients impaired on implicit tasks had more cognitive deficits overall than those unimpaired, and a larger dysexecutive self/other discrepancy (DEX) score suggesting greater behavioural problems. Performance on the SRT task correlated with a composite measure of executive function. Head injury thus produced heterogeneous impairments in the implicit acquisition of new information. Implicit activation of existing knowledge structures appeared intact. Impairments in implicit cognition and executive function may interact to produce dysfunctional behaviour after head injury. Future comparisons of implicit and explicit cognition should use several measures of each function, to ensure that they measure the latent variable of interest.     

Differential profiles in auditory social cognition deficits between adults with autism and schizophrenia spectrum disorders: A preliminary analysis

Impairment in social cognition, including emotion recognition, has been extensively studied in both Autism Spectrum Disorders (ASD) and Schizophrenia (SZ). However, the relative patterns of deficit between disorders have been studied to a lesser degree. Here, we applied a social cognition battery incorporating both auditory (AER) and visual (VER) emotion recognition measures to a group of 19 high-functioning individuals with ASD relative to 92 individuals with SZ, and 73 healthy control adult participants. We examined group differences and correlates of basic auditory processing and processing speed. Individuals with SZ were impaired in both AER and VER while ASD individuals were impaired in VER only. In contrast to SZ participants, those with ASD showed intact basic auditory function. Our finding of a dissociation between AER and VER deficits in ASD relative to Sz support modality-specific theories of emotion recognition dysfunction. Future studies should focus on visual system-specific contributions to social cognitive impairment in ASD.     

Behavior ratings of executive function among preschoolers with ADHD

The Behavior Rating Inventory of Executive Function-Preschool Version (BRIEF-P; Gioia, Espy, & Isquith, 2003) was developed to assess executive function (EF) behaviors in children aged 2 to 5 years. We compared parent ratings of 25 preschool children with ADHD to 25 age-, sex-, and SES-matched controls from the BRIEF-P standardization sample. Children with ADHD were rated significantly higher than controls (p < .01) on all five primary scales (Inhibit, Shift, Emotional Control, Working Memory, Plan/Organize), and on all four indices (Inhibitory Self Control, Flexibility, Emerging Metacognition, General Executive Composite). The largest effect size was on the Working Memory scale. All five BRIEF-P clinical scales were significantly intercorrelated in the control group, and seven of ten scale intercorrelations were significant in the ADHD group. Within the ADHD group, the BRIEF-P Index scores were significantly correlated with ratings on the Conners' Parent Rating Scale, but only moderately correlated with an estimate of Verbal IQ. The BRIEF-P had low, non-significant correlations with performance-based measures of EF, and patterns of correlations were not significantly different than those between the BRIEF-P and non-EF measures (sensorimotor, receptive vocabulary). Similar to its predecessor, the BRIEF-P is sensitive to symptoms of ADHD, but appears to measure different elements of EF than those tapped by performance-based measures.     

Unimpaired social cognition in adult patients with ADHD: brain volumetric and behavioral results

The present study aimed to investigate whether adult patients with attention deficit hyperactivity disorder (ADHD) show deficits in social cognition and to identify the structural neural correlates of social cognitive skills in ADHD. Twenty-six adult patients with ADHD and 26 matched healthy control participants performed the Movie for the Assessment of Social Cognition and underwent a structural magnetic resonance imaging scan. We compared theory of mind (ToM) performance between ADHD patients and healthy controls. Using voxel-based morphometry, we further compared gray matter volumes in regions that are critical for social cognition between the two groups and examined whether ToM performance was correlated with brain morphometry measures. We did not observe any between-group differences in ToM abilities or regional gray matter volumes. Across both groups, performance on affective aspects of ToM correlated positively with gray matter volumes in the medial part of the superior frontal gyri, which is typically involved in social cognition. This study is the first to relate brain structure to social cognitive abilities in adult patients with ADHD. Although our sample was small and heterogeneous, with half of the patients showing mild-to-moderate psychiatric comorbidities, our results may encourage longitudinal studies that relate social cognitive development in childhood and adolescence to brain maturation of ADHD patients.     

Stability of executive function deficits into young adult years: a prospective longitudinal follow-up study of grown up males with ADHD

OBJECTIVE: Although individuals with attention deficit-hyperactivity disorder (ADHD) commonly exhibit deficits in executive functions that greatly increase the morbidity of the disorder, all available information on the subject is cross sectional. METHOD: Males (n = 85) 9-22 years with ADHD followed over 7 years into young adulthood were assessed on measures of sustained attention/vigilance, planning and organization, response inhibition, set shifting and categorization, selective attention and visual scanning, verbal and visual learning, and memory. A binary definition of executive function deficits (EFDs) was defined based on a subject manifesting at least two abnormal tests 1.5 standard deviations from controls. RESULTS: The majority of subjects maintained EFDs over time (kappa: 0.41, P < 0.001; sensitivity: 55%, specificity: 85%, positive predictive value: 69%, and negative predictive value: 75%). CONCLUSION: Considering the morbidity of EFDs, these findings stress the importance of their early recognition for prevention and early intervention strategies. EFDs are stable over time.     

Behaviour in children with neurofibromatosis type 1: cognition,executive function,attention, emotion,and social competence

Aim This systematic review aimed to pull together the findings from research into behavioural systems and attention in children with neurofibromatosis type 1 (NF1) and to identify areas that need further study. Method Relevant papers were identified through searches of electronic databases (MEDLINE, PsycINFO, EMBASE) and manual searches through reference lists. In total, 5746 articles were identified and 57 met the inclusion criteria. The data were synthesized using the narrative approach, as the studies varied considerably in terms of participants and measures. Results The results of the review showed that intelligence, academic skills, visuospatial skills, social competence, and attention are impaired in children with NF1. Evidence of deficits in memory, motor functioning, language, and executive functions was less clear. Interpretation Research has made marked progress in outlining the behavioural phenotype of NF1. However, although the general areas of impairment are becoming better known, the exact nature of the impairment is still not understood in many areas of behaviour. Care needs to be taken with the way in which behavioural constructs are defined and measured, and the variability of problems in NF1 is a particular challenge. Nevertheless, research is steadily moving towards comprehensive understanding of behaviour in children with NF1.     

Impact of general cognition and executive function deficits on addiction treatment outcomes: Systematic review and discussion of neurocognitive pathways

This systematic review aims to examine growing evidence linking cognitive-executive functions with addiction treatment outcomes, and to discuss significant cognitive predictors drawing upon addiction neuroscience theory. We conducted a systematic search to identify studies using measures of general cognition and executive functions in patients with substance use disorders for the purpose of predicting two treatment outcomes: therapeutic adherence and relapse. Forty-six studies were selected, and sample characteristics, timing of assessments, and cognitive measures were analyzed. We observed significant methodological differences across studies, resulting in substantial variability in the relationships between cognitive-executive domains and treatment outcomes. Notwithstanding this variability, we found evidence of associations, of medium effect size, between general cognition and treatment adherence, and between reward-based decision-making and relapse. The link between general cognition and treatment adherence is consistent with emerging evidence linking limited cognitive-executive resources with less ability to benefit from talk therapies. The link between reward-based decision-making and relapse accords with decision neuroscience models of addiction. Findings may inform preclinical and clinical research concerning addiction treatment mechanisms.