Relations Between Continuous Performance Test Performance Measures and ADHD Behaviors

The Conners' Continuous Performance Test (CPT) is a neuropsychological task that has repeatedly been shown to differentiate ADHD from normal groups. Several variables may be derived from the Conners' CPT including errors of omission and commission, mean hit reaction time(RT), mean hit RT standard error, d', and . What each CPT parameter actually assesses has largely been based upon clinical assumptions and the face validity of each measure (e.g., omission errors measure inattention, commission errors measure impulsivity). This study attempts to examine relations between various CPT variables and phenotypic behaviors so as to better understand the various CPT variables. An epidemiological sample of 817 children was administered the Conners' CPT. Diagnostic interviews were conducted with parents to determine ADHD symptom profiles for all children. Children diagnosed with ADHD had more variable RTs, made more errors of commission and omission, and demonstrated poorer perceptual sensitivity than nondiagnosed children. Regarding specific symptoms, generalized estimating equations (GEE) and ANCOVAs were conducted to determine specific relationships between the 18 DSM-IV ADHD symptoms and 6 CPT parameters. CPT performance measures demonstrated significant relationships to ADHD symptoms but did not demonstrate symptom domain specificity according to a priori assumptions. Overall performance on the two signal detection measures, d' and , was highly related to all ADHD symptoms across symptom domains. Further, increased variability in RTs over time was related to most ADHD symptoms. Finally, it appears that at least 1 CPT variable, mean hit RT, is minimally related to ADHD symptoms as a whole, but does demonstrate some specificity in its link with symptoms of hyperactivity.     

Aggressivity,inattention, hyperactivity,and impulsivity in boys at high and low risk for substance abuse

Aggressivity, inattention, hyperactivity, and impulsivity are cardinal dimensions of externalizing behavior problems of childhood. They are diagnostic and clinical features of childhood disorders, and are thought to be linked to the subsequent development of adult disorders such as substance abuse (SA). Little is known, however, about the convergent and discriminant validity of these four constructs. We used multiple measures to develop indices of aggressivity, inattention, hyperactivity, and impulsivity in a sample of 10- to 12-year-old boys (N=183) with and without a family history of SA. Data were taken from mother reports, child reports, teacher reports, and laboratory tasks. The study aims were (1) to test the convergent and discriminant validity of aggressivity, inattention, hyperactivity, and impulsivity; (2) to examine whether the data were consistent with a model specifying the four constructs as indicators of one superordinate factor; and (3) to differentiate boys with and without a family history of SA in construct scores. The results supported the convergent and discriminant validity of the four constructs. Although discriminable, the constructs covaried strongly and were consistent with a model specifying them as indicators of a single superordinate factor. Boys with a family history of substance abuse scored higher than control boys on aggressivity, inattention, and impulsivity scores, but the groups did not differ on hyperactivity scores. The results are discussed in terms of the role of childhood behavior problems in vulnerability to SA.This work was supported by the National Institute on Drug Abuse grant No. DA 05605.     

The interplay between executive control and motor functioning in Williams syndrome

Previous studies suggest that individuals with Williams syndrome (WS), a rare genetically based neurodevelopmental disorder, show specific weaknesses in visual attention and response inhibition within the visuospatial domain. Here we examine the extent to which impairments in attentional control extend to the visuomotor domain using a well‐validated measure of choice stepping reaction time (CSRT) in individuals with WS. We examined the interaction between executive control and visually guided stepping using a verbal fluency dual‐task or Go/NoGo paradigm during CSRT performance. Relationships between dual‐task and inhibitory stepping and behavioural inattention and hyperactivity were also examined. Our results showed clear dual‐task costs in stepping response times when performing a concurrent cognitive task in the WS group when compared to spatial and verbal ability matched typically developing controls. Although no group differences in stepping accuracy were observed between the WS and typically developing control groups, the WS group showed progressive slowing and more variable response times across the duration of the Go/NoGo task. These results suggest dysfunction in circuits involved in top‐down attentional control processes in WS. These findings provide novel evidence that core executive control deficits in WS extend to the visuomotor domain, and impact on ADHD‐related inattentive symptoms.     

Evidence for a General ADHD Factor from a Longitudinal General School Population Study

Recent factor analytic studies in Attention-Deficit/Hyperactivity Disorder (ADHD) have shown that hierarchical models provide a better fit of ADHD symptoms than correlated models. A hierarchical model includes a general ADHD factor and specific factors for inattention, and hyperactivity/impulsivity. The aim of this 12-month longitudinal study was to test the generalizability of the hierarchical models of ADHD within an elementary school population of 6–9 year old children (250 boys, 260 girls). Examination of differences as a function of informant (parent vs. teacher ratings), sex, and time was conducted. Six potential factor structures for the 18 items of the SWAN (Strengths and Weaknesses of ADHD-symptoms and Normal-behavior) scale were tested using confirmatory and exploratory factor analyses. Hierarchical models with a general ADHD factor and two or three specific factors best accounted for parent and teacher reports of symptoms for both boys and girls and at two time points separated by a 12-month interval. Findings indicate that the 18 SWAN items measure a common latent trait as well as orthogonal factors or dimensions of inattention and hyperactivity/impulsivity.     

Errors on a computer task and subclinical symptoms of attention‐deficit/hyperactivity disorder (ADHD)

Previous reports have found increased error rate for children with attention‐deficit/hyperactivity disorder (ADHD ) on response time (RT ) computer tasks. Here we attempt the conceptual replication and extension of two studies that examined error rate in a general population of children (N = 203). Study 1 followed Johnstone and Galletta but considered associations between scores on a dimensional measure of ADHD symptoms (rather than comparing those with or without an ADHD diagnosis) and the frequency of commission and omission errors. Study 2 followed Shiels, Tamm & Epstein and examined post‐error adjustment in the same group of children as for Study 1. Study 1 did not replicate previous findings of no increase in errors of commission in those with higher ADHD symptoms (Johnstone & Galletta). Instead, we found that younger children with lower ADHD symptoms were more likely to make commission errors, while omission errors did not vary with age. Study 2 replicated the previous finding of less RT slowing in children with more ADHD symptoms, extending this finding to a general population of children. Namely, as ADHD symptoms increase, RT slowing is less likely, putting children with higher ADHD symptoms at risk of additional errors. Overall, we extend previous ADHD research to typically developing children with ADHD symptoms.     

Parent–Adolescent Agreement on Disruptive Behavior Symptoms: A Multitrait-Multimethod Model

This study examined parent–adolescent agreement on reports of inattention, hyperactivity/impulsivity, and conduct disorder in 203 adolescents (94 girls, 109 boys) ranging in age from 13 to 18 years (M = 15.21, SD = 1.37). Results of confirmatory factor analyses provided additional evidence of construct validity for these traits in adolescents. Internal consistency was examined for parent reports and adolescent self-reports. In addition, correlational analyses were used in a multitrait-multimethod format (MTMM; D. T. Campbell & D. W. Fiske, 1959) to examine convergent and discriminant validity. Results showed that parents provided more consistent and valid reports of inattention and hyperactivity/impulsivity, whereas adolescents provided more consistent and valid reports of conduct disorder. In addition, interviews produced higher levels of convergence than rating scales. These findings are discussed in terms of implications for assessment of disruptive behavior disorders.     

Association between Inhibitory Control Capacity and Body Weight in Overweight and Obese Children and Adolescents: Dependence on Age and Inhibitory Control Component

It has been assumed that overweight individuals show weak inhibitory control capacity leading to a failure to resist external cues for palatable food and that this deficit underlies the recently reported empirical association between obesity and attention deficit/hyperactivity disorder (ADHD). In childhood and adolescence, empirical research on this issue is scarce. Here, the hypothesis is tested that high body weight is associated with weak inhibitory control performance and that this association is moderated by age.

The sample included 177 overweight and obese children and adolescents (BMI: M = 29.2, SD = 4.33; BMI-SDS: M = 2.45, SD = 0.43) between 8 and 15 years. Inhibitory control was assessed by a Go/No-Go task and an Interference Task. A principal component analysis yielded two components: impulsivity (fast but invalid responses) and inattention (highly variable reaction times).

While controlling for age, gender, and maternal education level, we found that more obese children/adolescents showed more inattention. As indicated by a significant interaction effect, exclusively at younger ages, high impulsivity was associated with high body weight.

The results thus confirm a link between low inhibitory control capacity and high body weight and might point to a developmental period with heightened significance of impulsivity for weight gain.     

Incidental learning,distraction, and sustained attention in hyperactive and control subjects

Thirty-two children designated as hyperactive (ADD) were compared with an equal number of control subjects who were matched for age, sex, and verbal IQ. The subjects were tested on (1) a component selection task, measuring serial memory and incidental learning and (2) a cancellation task, assessing attentional variables and distractibility. No straightforward group differences were found on the component selection task, whereas hyperactive subjects made more omission and commission errors than controls on the cancellation task. It was concluded that a deficit in sustained attention and impulsivity best described the group differences. Age was also found to influence performance on a number of variables, including incidental learning on the component selection task and response rate and omission errors on the cancellation task. Because subjects in the hyperactive group were rated as extreme on a number of subscales not necessarily related to hyperactivity, the data were reexamined by multiple regression analyses. Subscales considered to be related both to hyperactivity and to conduct disorder were associated with different performance variables, indicating that each of these subscales provided some unique information.This study was supported by a grant from the Medical Research Council of New Zeland to the first author. The authors would like to thank the pupils and staff of Mt. Eden Normal Primary School and Newmarket School for taking part in the study, and the Auckland Education Board for granting approval for the study. We also thank Prof. J. S. Werry, Dr. J. Reeves, and Mrs. G. Elkind for assistance in locating some of the control subjects. Special thanks goes to Gail Elkind for assistance with the statistical analysis.     

A Comparison of the Neuropsychological Profiles of the DSM-IV Subtypes of ADHD

Recent research on the DSM-IV subtypes of attention-deficit/hyperactivity disorder (ADHD) has demonstrated that the subtypes differ in demographic characteristics, types of functional impairment, and profiles of comorbidity with other childhood disorders. However, little research has tested whether the subtypes differ in underlying neuropsychological deficits. This study compared the neuropsychological profiles of children without ADHD (n = 82) and children who met symptom criteria for DSM-IV Predominantly Inattentive subtype (ADHD-IA; n = 67), Predominantly Hyperactive Impulsive subtype (ADHD-HI; n = 14), and Combined subtype (ADHD-C; n = 33) in the areas of processing speed, vigilance, and inhibition. We hypothesized that children with elevations of inattention symptoms (ADHD-IA and ADHD-C) would be impaired on measures of vigilance and processing speed, whereas children with significant hyperactivity/impulsivity (ADHD-HI and ADHD-C) would be impaired on measures of inhibition. Contrary to prediction, symptoms of inattention best predicted performance on all dependent measures, and ADHD-IA and ADHD-C children had similar profiles of impairment. In contrast, children with ADHD-HI were not significantly impaired on any dependent measures once subclinical symptoms of inattention were controlled. Our results do not support distinct neuropsychological deficits in ADHD-IA and ADHD-C children, and suggest that symptoms of inattention, rather than symptoms of hyperactivity/impulsivity, are associated with neuropsychological impairment.     

Confirming the Factor Structure of Attention Deficit Hyperactivity Disorder Symptoms in Adult, Nonclinical Samples

Three separate models have been proposed to describe the factor structure of attention deficit hyperactivity disorder (ADHD) in the past 20 years. The Diagnostic and Statistical Manual of Mental Disorders-III (DSM-III, 1980) proposed 3 separate factors of inattention, hyperactivity, and impulsivity. The DSM-III-R (1987) proposed a single factor. The DSM-IV (1994) described the disorder as having 2 factors: hyperactivity/impulsivity and inattention. The following 2 studies employed confirmatory factor analysis to compare each of these models and 3 alternative models. University students completed questionnaires that assessed each of the 18 symptoms listed in the DSM-IV for ADHD. The 3-factor model fit the data significantly better than each of the other models in both studies. These findings suggest that a 3-factor model of inattention, hyperactivity, and impulsivity describes adult ADHD symptoms better than current alternatives.     

The Factor Structure of ADHD – Different Models,Analyses and Informants in a Bifactor Framework

The methodological approach of exploratory structural equation modelling (ESEM) has only been applied once to the construct of Attention-deficit/hyperactivity disorder (ADHD). We decided to compare bifactor models based on confirmatory factor analyses (Bi-CFA) and exploratory equation modeling (Bi-ESEM) only, as there is a growing support of a bifactor structure of ADHD. To examine the factorial validity of the construct we compared three possible bifactor models. One model with two specific factors (inattention and hyperactivity/impulsivity), another model with three specific factors (inattention, hyperactivity and impulsivity) and an alternative, incomplete model with one general ADHD and two specific factors (inattention and impulsivity). We used parent- (N = 1386; Age: M = 11.70, SD = 3.18; Sex: 74.5 % male) and teacher-ratings (N = 110; Age: M = 11.27, SD = 3.04; Sex: 77.5 % male) from clinically referred children between the age of 6 and 18. The results indicate that both methods lead to equally good model fit and for both informants the reliable variance of the specific factor hyperactivity is almost completely explained by the general factor. However, in the teacher condition cross-loadings seem to be of particular importance. Across both methods and informants covariation among ADHD symptom items can be in most part attributed to a general ADHD factor as well as to three (inattention, hyperactivity and impulsivity) or two (inattention and impulsivity) weakly defined specific factors. Further research regarding associations between the specific factors of ADHD and other disorders (e.g. conduct disorder) should be conducted.     

Gender differences on the Five to Fifteen questionnaire in a non‐referred sample with inattention and hyperactivity‐impulsivity and a clinic‐referred sample with hyperkinetic disorder

Lambek, R., Trillingsgaard, A., Kadesjö, B., Damm, D. & Thomsen, P. H. (2010). Gender differences on the Five to Fifteen questionnaire in a non‐referred sample with inattention and hyperactivity‐impulsivity and a clinic‐referred sample with hyperkinetic disorder. Scandinavian Journal of Psychology 51, 540–447. The aim of the present study was to examine gender differences in children with inattention, hyperactivity, and impulsivity on the Five to Fifteen (FTF) parent questionnaire. First, non‐referred girls (n = 43) and boys (n = 51) with problems of attention and hyperactivity‐impulsivity and then clinic‐referred girls (n = 35) and boys (n = 66) with hyperkinetic disorder (HKD) were compared on the FTF. Results suggested that non‐referred boys were more hyperactive‐impulsive than non‐referred girls, whereas clinic‐referred boys and girl with HKD were more similar than dissimilar on the FTF questionnaire. Secondly, it was examined whether the application of gender mixed norms versus gender specific norms would result in varying proportions of clinic‐referred children with HKD being identified as impaired on the subdomains of the FTF questionnaire. Based on results it was concluded that the use of a gender mixed normative sample may lead to overestimation of impairment in boys with HKD, but the type of sample applied to define impairment on the FTF should depend on the purpose for applying the questionnaire.     

The validity of vigilance tasks in differential diagnosis of children referred for attention and learning problems

This study was conducted to evaluate the convergent and discriminant validity of vigilance measures of attention and impulsivity in children. One hundred children referred for evaluation of attention and learning problems were administered a battery of tests including two vigilance tasks, other laboratory measures of inattention and impulsivity, and parent and teacher ratings. It was predicted that vigilance task performance would correlate with teacher ratings and laboratory measures of inattention while correlations with ratings of aggressive behavior were predicted to be lower. Moderate correlations were obtained between the vigilance task scores and other laboratory measures of inattention and impulsivity. However, the vigilance scores did not correlate with teacher or parent ratings of behavior. A factor analysis, conducted to identify underlying dimensions of attention in the battery of tests, revealed strong source effects. The implications for use of vigilance measures in diagnosis are discussed.Portions of this paper were presented at the 1990 Learning Disabilities Association of America International Conference, Anaheim, California.     

Teachers' screening for attention deficit/hyperactivity disorder: comparing multinational samples on teacher ratings of ADHD

This study evaluates a measurement model for Attention Deficit/Hyperactivity Disorder (ADHD). The DSM-IV divides 18 symptoms into two groups, inattentive and hyperactive/impulsive. Elementary school teachers rated 21,161 children in 4 locations: Spain, Germany, urban US, and suburban US. Confirmatory factor analysis suggested that the 2-factor model (inattention, hyperactivity/impulsivity) shows the best fit. A third factor, impulsivity, was too slight to stand-alone. Children with academic performance problems were distinguished by inattention, but children with behavior problems typically had elevations in inattention, hyperactivity, and impulsivity. Between-site differences were statistically significant, but so small that we conclude that same measurement model fits all 4 samples in 2 continents.     

Do Parent and Teacher Report of ADHD Symptoms in Children Differ by SES and Racial Status?

Parent and teacher reports of symptoms of Attention Deficit Hyperactivity Disorder (ADHD) in children often differ from each other. These informant report differences may occur in systematic ways that vary by child socioeconomic status (SES) and race, but little is known about how SES and race together relate to parent and teacher report of ADHD symptoms in school-aged children. We examined the relationship between child SES, child race and parent and teacher reports of ADHD symptoms in two samples of school-aged Caucasian and African American children being evaluated for ADHD (N = 1056; N = 317). Multivariate regression was used to predict parent and teacher reports of ADHD symptoms from child SES, race, age, gender and interaction terms. The Wald test of parameter constraints was used to test the contrast between the predictors of interest and parent and teacher report of symptoms. In the second sample, we also examined observer report measures of ADHD symptoms during one-to-one testing and in the classroom. In both samples, lower SES was associated with higher levels of inattention symptoms, as reported by teachers, but not by parents. Lower SES was also associated with higher levels of hyperactivity/impulsivity symptoms, as reported by both teachers and parents. African American race was associated with higher levels of inattention and hyperactivity/impulsivity symptoms reported by teachers than reported by parents. Observer report measures showed a different pattern of associations with SES and race. Investigating how children’s SES and race influence cross-informant agreement on ratings of children’s behavior might lead to the development of better assessment practices and more accurate diagnoses for diverse child populations.     

Reliable Ratings or Reading Tea Leaves: Can Parent,Teacher, and Clinician Behavioral Ratings of Preschoolers Predict ADHD at Age Six?

To assess the relative ability of parent, teacher, and clinician behavioral ratings of preschoolers to predict ADHD severity and diagnosis at 6 years of age. Hyperactive/inattentive preschoolers [N?=?104, 75 % boys, Mean (SD) age?=?4.37 (0.47) years] were followed over 2 years (mean?=?26.44 months, SD?=?5.66). At baseline (BL), parents and teachers completed the ADHD-RS-IV and clinicians completed the Behavioral Rating Inventory for Children following a psychological testing session. At age 6, [Mean (SD) age?=?6.62 (0.35) years], parents were interviewed with the K-SADS-PL; teachers completed the ADHD-RS-IV; and laboratory measures of hyperactivity, impulsivity, and inattention were obtained from children. Hierarchical logistic and linear regression analyses examined which combination of BL ratings best predicted 6-year-old ADHD diagnosis and severity, respectively. At age 6, 56 (53.8 %) children met DSM-IV criteria for a diagnosis of ADHD. BL ratings from parent/teacher/clinician, parent/teacher and parent/clinician combinations significantly predicted children who had an ADHD diagnosis at age 6. Parent and clinician, but not teacher, behavior ratings were significant independent predictors of ADHD diagnosis and severity at 6-years-old. However, only clinician reports of preschoolers’ behaviors predicted laboratory measures of over-activity and inattention at follow-up. Cross-situationality is important for a diagnosis of ADHD during the preschool years. Among parents, teachers and clinicians, positive endorsements from all three informants, parent/teacher or parent/clinician appear to have prognostic value. Clinicians’ ratings of preschoolers’ inattention, impulsivity and hyperactivity are valid sources of information for predicting ADHD diagnosis and severity over time.     

Dimensions and Correlates of Attention Deficit/Hyperactivity Disorder and Sluggish Cognitive Tempo

The present study examined Sluggish Cognitive Tempo (SCT) in relation to ADHD symptoms, clinical diagnosis, and multiple aspects of adjustment in a clinical sample. Parent and teacher reports were gathered for 322 children and adolescents evaluated for behavioral, emotional, and/or learning problems at a university clinic. Confirmatory factor analyses (CFA) supported the presence of three separate, but correlated factors (SCT, inattention, and hyperactivity/impulsivity) in both parent and teacher ratings. As expected, SCT symptoms were greatest in youth with ADHD Inattentive type, but were also found in non-ADHD clinical groups. SCT symptoms were related to inattention, internalizing, and social problems across both parent and teacher informants; for parent reports, SCT was also related to more externalizing problems. Findings support the statistical validity of the SCT construct, but its clinical utility is still unclear.     

Agreement Between Parent and Teacher Ratings of Disruptive Behavior Disorders in Children with Clinically Diagnosed ADHD

This study investigated the agreement between parent and teacher ratings of DSM-IV symptoms of Attention Deficit Hyperactivity Disorder (ADHD) and related disorders: Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD). A sample of 55 children in the age range of 6–12 years with clinically diagnosed ADHD participated in the study. Parents and teachers were asked to complete the Disruptive Behavior Disorder Rating Scale (DBDRS; W. E., Pelham, E. M., Gnagy, K. E., Greenslade, & R. Milich, 1992). No association was found between parent and teacher ratings of inattention and hyperactivity/impulsivity. However, moderate to high levels of agreement were obtained for ratings of symptoms that characterized ODD and CD. The observed low levels of agreement between parent and teacher ratings of ADHD symptoms may be attributed to different perceptions of the problem behavior by parents and teachers, medication effects, or the situation specificity of children's behavior. It is recommended that the diagnostic criterion of symptom pervasiveness for the diagnosis of ADHD be operationalized more clearly.     

Emotions in Go/NoGo conflicts

On the basis of current emotion theories and functional and neurophysiological ties between the processing of conflicts and errors on the one hand and errors and emotions on the other hand we predicted that conflicts between prepotent Go responses and occasional NoGo trials in the Go/NoGo task would induce emotions. Skin conductance responses (SCRs), corrugator muscle activity, and startle blink responses were measured in three experiments requiring speeded Go responses intermixed with NoGo trials of different relative probability and in a choice reaction experiment serving as a control. NoGo trials affected several of these emotion-sensitive indicators as SCRs and startle blinks were reduced whereas corrugator activity was prolonged as compared to Go trials. From the pattern of findings we suggest that NoGo conflicts are not aversive. Instead, they appear to be appraised as obstructive for the response goal and as less action relevant than Go trials.     

Prenatal Smoke Exposure Predicts Hyperactive/Impulsive but Not Inattentive ADHD Symptoms in Adolescent and Young Adult Girls

We examined the longitudinal associations between prenatal tobacco smoke exposure (PSE) and attention‐deficit hyperactivity disorder (ADHD) symptom domains in adolescence and young adulthood. A sample of girls with ADHD combined presentation (N = 93), ADHD predominantly inattentive presentation (N = 47), and matched comparisons (N = 88) was assessed prospectively. Symptoms of hyperactivity/impulsivity (HI), inattention (IA), and oppositionality (oppositional defiant disorder) were measured via multiple informants 5 (M age = 14 years; retention rate = 92%) and 10 years (M age = 20 years; retention rate = 95%) following childhood ascertainment. PSE was captured via maternal self‐report. We used linear regressions to examine the prediction from PSE to both HI and IA in adolescence and early adulthood after stringent control of relevant confounding variables. PSE significantly predicted HI during adolescence and young adulthood across multiple informants but did not predict IA at either wave. Symptoms of HI may have partial etiological independence from IA symptoms. Copyright © 2015 John Wiley & Sons, Ltd.