Trait Procrastination,Hoarding, and Continuous Performance Attention Scores

We examined the relationship between chronic procrastination, hoarding, attention deficit hyperactivity disorder (ADHD), and a computer measure of continuous performance with 84 adult patients evaluated for diagnoses. Patients were administered the General Procrastination Inventory, the Saving Inventory-Revised, the Adult ADHD Self-Report Scale and the IVA + Plus Continuous Performance Test. Procrastination scores correlated negatively with auditory attention scores, while self-reported hoarding tendencies correlated negatively with visual attention. Measures of procrastiation, hoarding, and ADHD were positively correlated. Implications and limitations of findings are discussed as well as directions for futher research.     

Predicting ADHD Symptoms in Adolescence from Early Childhood Temperament Traits

Extreme levels of certain temperament traits can be early markers of different developmental pathways of attention-deficit/hyperactivity disorder (ADHD). However, the long-term utility of using these traits as predictors of ADHD is not fully known. This study includes 64 male adolescents (M age = 13.5), who have been followed since birth as part of a longitudinal study. The primary aim was to test effortful control (EC), activity level, and anger, measured in early childhood – both with mother’s reports and laboratory assessments –as predictors of ADHD symptoms in adolescence. Further, we investigated the specificity of this prediction to the different ADHD symptom domains. The results demonstrated that early temperament dimensions of EC and activity level were predictive of ADHD symptoms about 10 years later, when the participants reached adolescence. Moreover, activity level showed specificity only to hyperactivity-impulsivity symptoms whereas EC was a predictor of the two symptom domains. Anger had a predictive correlation with ADHD symptoms; however, it did not have a unique predictive contribution. These results emphasize the relevance of EC and activity level in the developmental course of ADHD. Identification of early risk factors can lead to more efficient design and implementation of intervention programs.     

Clinical,Sociobiological, and Cognitive Predictors of ADHD Persistence in Children Followed Prospectively Over Time

With increasing awareness that ADHD is chronically disabling, a burgeoning literature has examined childhood clinical indicators of ADHD persistence. This study investigates whether childhood factors reflecting biological risk and cognitive reserve have additive predictive value for the persistence of ADHD that is unique beyond childhood indicators of disorder severity. One-hundred thirty children with ADHD (mean age = 8.9 years, 75 % male) were followed into adolescence (mean age = 14.0 years). Childhood ADHD and co-morbidities were assessed via interviews with parents and teachers; parental psychopathology was assessed via parent interview; exposure to neurobiological and psychosocial adversity were indexed by parent questionnaire; and cognitive reserve was evaluated through children’s performance on measures of IQ and executive functioning. Univariate analyses identified childhood inattention and hyperactivity-impulsivity, co-morbid oppositional defiant disorder, overall impairment, and paternal anxiety and depression as more prevalent amongst adolescents with persistent compared with remitted ADHD. Only child-level predictors remained significant in a final multivariate model. These results suggest that children who are most likely to experience persistent ADHD have a more severe clinical presentation in childhood, reflected by increased levels of inattention, oppositional behavior, and impairment. They also are more likely to have fathers with internalizing concerns, but these concerns do not uniquely predict ADHD persistence beyond child-level factors. Contrary to expectations, childhood adversity and cognitive functioning did not predict the course of ADHD.     

The Assessment of Hyperactivity and Attention (AHA): development and preliminary validation of a brief self-assessment of adult ADHD

A brief self-rating scale, the Assessment of Hyperactivity and Attention (AHA), was developed and validated using a "gold standard" DSM-based semi-structured interview. The sample consisted of 101 smokers (74% male, 73% Caucasian)-38.6% with no DSM-IV ADHD diagnosis, 10.9% with a childhood diagnosis only, and 50.5% with an adult diagnosis (requiring childhood diagnosis as well). The mean age SD was 33.7 9.7; participants smoked a mean of 19.0 5.6 cigarettes/day. Results indicate that the AHA has utility as a screening tool and as a self-report assessment of ADHD with sensitivity of .80, specificity of .60, positive predictive power of .67, negative predictive power of .75, kappa of .40, odds ratio of 6.15, and an area under the curve (receiver operating characteristic analysis) of .79. Given the high rate of ADHD among smokers, the AHA may be useful in identifying smokers who may need more in-depth clinical evaluation for attentional problems.     

Naming speed as a predictive diagnostic measure in reading and attentional problems

This study aimed to describe and compare naming speed abilities in children diagnosed with either Reading Learning Difficulties (RLD) or Attention Deficit/Hyperactivity Disorder (ADHD), or comorbidity for both (ADHD+RLD). To examine the explanatory power of naming speed and ADHD symptomatology in predicting group associations (while controlling for gender and age), the “Rapid Automatized Naming and Rapid Alternating Stimulus Tests” (RAN/RAS) were utilized. A sample of 101 children (age range = 5–16 years) was divided into four groups: RLD (n = 14), ADHD (n = 28), comorbid (n = 19), and control (n = 40). There were statistically significant differences in RAN/RAS results among the diagnostic groups. Moreover, discriminant analysis revealed that naming speed tasks significantly predicted reading and attentional problems, especially at earlier ages. These results demonstrate the potential usefulness of RAN/RAS in the diagnosis of reading and attentional problems, particularly if the children are aged from 5 to 9.     

The Influence of Child Gender on the Prospective Relationships between Parenting and Child ADHD

The aims of the current study were to (i) explore the potential bidirectional, prospective relationships between parenting and child ADHD, and (ii) explore whether these relationships differed on the basis of child gender. Data were obtained from waves 1 (children aged 4- to 5-years) to 5 (children aged 12- to 13-years) of the Longitudinal Study of Australian Child (LSAC) dataset (child cohort). In order to examine dimensions of both mothers’ and fathers’ parenting, a subsample of nuclear families with mothers, fathers and children present at all waves was extracted (final sample = 1932; sons = 981, daughters = 951). Child ADHD measures included the hyperactive-impulsive subscale of the strengths and difficulties questionnaire for symptoms, and parent-report question for diagnosis. Mothers and fathers completed scales on dimensions of Angry, Warm and Consistent Parenting. A cross-lagged panel model demonstrated (i) higher child ADHD symptoms at wave 1 led to a global increase in less-than-optimal parenting at wave 2, and (ii) child ADHD symptoms and Angry Parenting shared a prospective, bi-directional relationship (whereby increases in one predicted increases in the other over time) during earlier years of development. Latent growth curve models demonstrated that increases in Angry Parenting across time were significantly predicted by increases in child ADHD symptoms. A logistic regression demonstrated that both mothers’ and fathers’ Angry Parenting at wave 1 significantly predicted an ADHD diagnosis in children at wave 3. No predictive relationships differed between child genders; thus, it appears these prospective pathways are similar for both sons and daughters.     

Reliability, diagnostic efficiency, and validity of the Millon adolescent clinical inventory: examination of selected scales in psychiatrically hospitalized adolescents

This study examined the internal consistency, diagnostic efficiency, and validity of selected scales of the Millon adolescent clinical inventory (MACI; Millon et al., Manual for the Millon Adolescent Clinical Inventory, National Computer Systems, Minneapolis, MN, 1993). 241 psychiatrically hospitalized adolescents were administered the MACI and a battery of established self-report measures and a multidisciplinary team independently assigned DSM-IV psychiatric diagnoses at the time of discharge. The internal consistency of MACI scales ranged from 0.71 to 0.93. Conditional probabilities (sensitivity, specificity, positive predictive power, and negative predictive power) were calculated for selected disorders using independently generated clinical diagnoses as the standard. The diagnostic efficiencies for the selected scales were variable, with adequate performance for predicting classes of diagnoses but not for specific diagnoses. The MACI showed good criterion validity for most disorders, with participants with a clinical diagnosis having a significantly higher corresponding MACI scale score than participants not assigned that diagnosis. Concurrent validity, tested by correlating MACI scale scores with those of relevant, validated measures, was generally good. The MACI appears to be a psychometrically sound self-report instrument and appears valuable as a screening instrument for many problems found in adolescent psychiatric inpatients.     

Identification of Oppositional Defiant Disorder in Young Adult College Students

Long-considered a disorder restricted to children and adolescents, more research is needed to understand how oppositional defiant disorder (ODD) affects adults. Recent research suggests that symptoms of ODD persist into adulthood and are associated with specific negative functional outcomes. This current study seeks to investigate the prevalence and associated impairments of ODD symptoms in young adults. Two large samples of college students between the ages of 18–24 years old (N =?1792; N =?1497) completed self-report measures of ODD symptoms, ADHD symptoms, psychiatric diagnoses, and functional impairments. Rates and internal consistency of ODD symptoms were calculated, and multiple regression was used to estimate the association between high levels of ODD severity scores and social and authority-related impairments, as well as online antagonistic behavior. In the two samples, the proportion of individuals reporting four or more symptoms of ODD was estimated to be 3.39 and 4.12% respectively, and did not vary significantly by gender. Higher ODD severity was associated with social impairment, online antagonistic behavior, and greater conflict with authority figures, even after controlling for ADHD symptoms and self-reported depression or anxiety diagnoses. ODD symptoms measured in college students demonstrate acceptable reliability and are uniquely associated with specific impairments. The findings from this study support greater consideration of ODD symptoms in adult populations.     

Neuropsychological Measures that Predict Progression from Mild Cognitive Impairment to Alzheimer's type dementia in Older Adults: a Systematic Review and Meta-Analysis

This study aimed to determine the extent to which cognitive measures can predict progression from mild cognitive impairment (MCI) to Alzheimer’s type dementia (AD), assess the predictive accuracy of different cognitive domain categories, and determine whether accuracy varies as a function of age and length of follow-up. We systematically reviewed and meta-analyzed data from longitudinal studies reporting sensitivity and specificity values for neuropsychological tests to identify individuals with MCI who will develop AD. We searched articles in Medline, Cochrane, EMBASE, PsycINFO, and the Web of Science. Methodological quality was assessed using the STARDem and QUADAS standards. Twenty-eight studies met the eligibility criteria (2365 participants) and reported predictive values from 61 neuropsychological tests with a 31-month mean follow-up. Values were pooled to provide combined accuracy for 14 cognitive domains. Many domains showed very good predictive accuracy with high sensitivity and specificity values (≥ 0.7). Verbal memory measures and many language tests yielded very high predictive accuracy. Other domains (e.g., executive functions, visual memory) showed better specificity than sensitivity. Predictive accuracy was highest when combining memory measures with a small set of other domains or when relying on broad cognitive batteries. Cognitive tests are excellent at predicting MCI individuals who will progress to dementia and should be a critical component of any toolkit intended to identify AD at the pre-dementia stage. Some tasks are remarkable as early indicators, whereas others might be used to suggest imminent progression.     

Development and validation of a new procedure for the diagnostic assessment of personality disorder: the Multidimensional Personality Disorder Rating Scale (MPDRS)

Data from a community-based prospective longitudinal study were used to investigate the utility of a structured assessment of the DSM-IV General Diagnostic Criteria for a Personality Disorder (PD). The Structured Clinical Interview for DSM-IV PDs (SCID-II) was administered to 154 adults. After completing the interview, an experienced clinician assessed the General Diagnostic Criteria for a PD using a structured rating scale. PD diagnoses, based solely on the rating scale data, demonstrated strong agreement with diagnoses obtained using the diagnostic thresholds for specific PDs (Kappa = 0.89). The sensitivity, specificity, predictive power, and internal reliability of the rating scale were satisfactory. PD diagnoses, based on both of the assessment procedures, were associated with substantial impairment and distress. These findings suggest that a structured assessment of the DSM-IV General Diagnostic Criteria for a Personality Disorder may constitute a useful alternative or supplement to standard assessments of the diagnostic thresholds for specific DSM-IV PDs.     

Diagnostic efficiency of DSM-IV criteria for obsessive compulsive personality disorder in patients with binge eating disorder

This study examined the diagnostic efficiency of the DSM-IV criteria for obsessive compulsive personality disorder (OCPD) in patients with binge eating disorder (BED). Two hundred and eleven consecutive adult patients with axis I diagnoses of BED were reliably assessed with semi-structured diagnostic interviews. Conditional probabilities-sensitivity, specificity, positive predictive power (PPP), and negative predictive power (NPP)-were calculated for each of the eight criteria for OCPD, using the 'best-estimate' OCPD diagnosis as the standard. The diagnostic efficiencies of the OCPD criteria were variable, with three criteria failing to have predictive value (PPP<0.50). The best inclusion criterion (highest PPP) was 'Perfectionism,' which was also the overall most predictive criterion. The findings suggest ordering of the DSM-IV criteria for OCPD based on performance and call into question the utility of some criteria.     

How Do Elements of a Reduced Capacity to Withstand Uncertainty Relate to the Severity of Health Anxiety?

Intolerance of uncertainty (IU)—a multidimensional cognitive vulnerability factor—is associated with a variety of anxiety disorders and health anxiety (HA). To date, few studies have assessed whether IU dimensions (prospective and inhibitory IU) are differentially associated with HA and whether their contributions are independent of anxiety sensitivity (AS). This study addressed these issues using independent community (n = 155; 81% women) and undergraduate (n = 560; 86% women) samples. Results indicated that prospective IU, but not inhibitory IU, had significant positive associations with HA in community dwellers and undergraduate students. AS somatic and cognitive concerns were also significant predictors among both samples. In addition, severity of IU dimensions among individuals reporting elevated HA were compared against individuals diagnosed with generalized anxiety disorder, social anxiety disorder, panic disorder, and obsessive–compulsive disorder. Results indicated minimal differences between those with elevated HA and each of the anxiety disorder diagnoses. Findings lend support to the unique transdiagnostic nature of IU and support commonalities between HA and anxiety disorders.     

The predictive power of combined neuropsychological measures for attention-deficit/hyperactivity disorder in children.

The present study explores the predictive power of seven neuropsychological assessment tools used in combination in classifying children with attention-deficit/hyperactivity disorder (ADHD). Twenty-one ADHD boys and 22 community control children participated. Group differences were significant on the continuous performance test only; however, battery analysis did increase overall predictive power, which was moderate. This study highlights the difficulty in identifying consistent mean differences on tests of frontal/executive functioning across studies, as well as the need to assess the predictive validity of these tests in classifying children with ADHD. The study suggests that these tests may provide greater predictive validity when used in combination. Inconsistencies in the literature are discussed, with consideration of research methodology, the heterogeneity of the ADHD population, and comorbid diagnoses.     

The Predictive Power of Combined Neuropsychological Measures for Attention-Deficit/Hyperactivity Disorder in Children

The present study explores the predictive power of seven neuropsychological assessment tools used in combination in classifying children with attention-deficit/hyperactivity disorder (ADHD). Twenty-one ADHD boys and 22 community control children participated. Group differences were significant on the continuous performance test only; however, battery analysis did increase overall predictive power, which was moderate. This study highlights the difficulty in identifying consistent mean differences on tests of frontal/executive functioning across studies, as well as the need to assess the predictive validity of these tests in classifying children with ADHD. The study suggests that these tests may provide greater predictive validity when used in combination. Inconsistencies in the literature are discussed, with consideration of research methodology, the heterogeneity of the ADHD population, and comorbid diagnoses.     

Attention Deficit/Hyperactivity Disorder in Adults with Sleep Apnea

AAttention deficit hyperactivity disorder (ADHD) is a common childhood illness. In some patients, this illness may persist into adulthood and an association between ADHD and Obstructive Sleep Apnea (OSA) has been found in childhood. However, it is unclear how OSA and ADHD coincide in adulthood. Therefore, to explore the relationship between OSA and adult ADHD the current investigation utilized a clinically-based cross-sectional survey. Subjects consisted of 81 treatment-naïve OSA patients and 32 controls. Measures included each patient completed a questionnaire regarding sleep, Adult ADHD scale. Clinical information, body mass index, 36-item Short Form Health Survey (SF-36), Epworth Sleepiness Scale (ESS), Hospital Anxiety and Depression Scale, and polysomnography.The subjects with Apnea-Hypopnea Index (AHI) ≥ 5 events/h were defined as patients with OSA. The control group was accepted as individuals with AHI > 0 events/h. The prevalence of adult ADHD was not different between the patients with OSA and the control group [(7.4 % (6/75) vs. 6.3 % (2/30), p = 0.8, respectively]. OSA patients with ADHD, as compared with those without, had higher anxiety scores and poorer physical component scores of quality of life and higher ESS scores. ADHD scores in patients with OSA were associated with anxiety and depression scores and SF36 physical and mental component scores in bivariate analyses. Thus, in our sample ADHD was not a frequent illness in adult patients with OSA. However, in patients with OSA and ADHD higher levels of anxiety and daytime sleepiness and poorer quality of life was found.     

Greater delay discounting among girls,but not boys,with ADHD correlates with cognitive control

Cognitive neuroscience models suggest both reward valuation and cognitive control contribute to reward-based decision-making. The current study examined the relationship between cognitive control and delay discounting (i.e., choosing smaller, immediate over larger, delayed rewards) in a large sample of boys and girls diagnosed with attention-deficit/hyperactivity disorder (ADHD; N = 95) and typically developing control children (TD; N = 59). Specifically, we examined performance on multiple measures of cognitive control (i.e., Go/No-Go task, Stop Signal task, and Spatial Span task) and delay discounting (i.e., Classic Delay Discounting and Real-Time Delay Discounting tasks), as well as the relationship between these measures. Results indicated that sex moderated the effects of group on task performance. Specifically, girls with ADHD, but not boys with the disorder, exhibited atypical delay discounting of real-time rewards. Results from correlational analyses indicated that delay discounting and cognitive control were not significantly correlated in the overall sample. Multiple regression analyses demonstrated that among girls with ADHD poorer spatial working memory and inhibitory control predicted greater real-time discounting. Collectively, findings provide support for distinct patterns of cognitive control and delay discounting among school-aged girls and boys with ADHD. Additionally, findings suggest that among girls with ADHD, those who exhibit relatively poor working memory and inhibitory control might be a particularly vulnerable subgroup with the greatest propensity to exhibit maladaptive decision-making.     

Psychiatric Comorbidity in Children with Autism Spectrum Disorders: A Comparison with Children with ADHD

The present study was conducted with the aim to identify comorbid psychiatric disorders in children with autism spectrum disorders (ASD) (n = 40) and to compare those comorbidity rates to those in children with attention deficit hyperactivity disorder (ADHD) (n = 40). Participants were clinically referred children aged 7–18 years. DSM-IV classifications were used for the primary diagnosis (ASD/ADHD), while comorbid psychiatric disorders were assessed using a structured diagnostic interview, the structured clinical interview for DSM-IV, childhood diagnoses (KID-SCID). Twenty-three children with ASD (57.5 %) had at least one comorbid disorder, whereas 16 children with ADHD (40.0 %) were classified as having at least one comorbid disorder. No group differences were found with respect to this comorbidity rate or for the rate of comorbid externalizing disorders (ODD and/or CD). However, children with ASD had more comorbid internalizing disorders compared to children with ADHD. More specifically, children with ASD had higher rates of anxiety disorders, but not mood disorders. No associations between comorbidity and age or between comorbidity and the intelligence quotient was found. It is important for clinicians to always be aware of, and screen for, comorbidity, and to consider treatment for these comorbid disorders. In addition, research should focus on establishing valid and reliable screening tools as well as effective treatment options for these comorbid disorders.     

Introducing a forced-choice recognition task to the California Verbal Learning Test – Children’s Version

The importance of performance validity tests (PVTs) is increasingly recognized in pediatric neuropsychology. To date, research has focused on investigating whether PVTs designed for adults function similarly in children. The downward extension of adult cutoffs is counter-intuitive considering the robust effect of age-related changes in basic cognitive skills in children and adolescents. The purpose of this study was to examine the signal detection properties of a forced-choice recognition trial (FCR-C) for the California Verbal Learning Test – Children’s Version. A total of 72 children aged 6–15 years (M = 11.1 , SD = 2.6) completed the FCR-C as part of a larger neuropsychological assessment battery. Cross-validation analyses revealed that the FCR-C had good signal detection performance against reference PVTs. The first level of failure (≤14/15) produced the best combination of overall sensitivity (.31) and specificity (.87). A more conservative FCR-C cutoff (≤13) resulted in a predictable trade-off between sensitivity (.15) and specificity (.94), but also a net loss in discriminant power. Lowering the cutoff to ≤12 resulted in a slight improvement in specificity (.97) but further deterioration in sensitivity (.14). These preliminary findings suggest that the FCR-C has the potential to become the newest addition to a growing arsenal of pediatric PVTs.     

Quantitative EEG Assessment During Neuropsychological Task Performance in Adults with Attention Deficit Hyperactivity Disorder

This study evaluated the neuropsychological performance of adults with and without Attention Deficit Hyperactivity Disorder (ADHD) during the Paced Auditory Serial Addition Test (PASAT), Wisconsin Card Sorting Test: Computerized Version 3 (WCST), and the Integrated Visual and Auditory Continuous Performance Test (IVA). Quantitative electroencephalographic (QEEG) data were also collected during task performance to examine differences in cortical activity between groups and tasks. Results suggest that adults with ADHD demonstrated lower levels of performance on the PASAT and IVA, tasks that involve working memory and processing speed, and sustained attention, respectively. Adults with ADHD also had more upper alpha activity during the IVA. Lastly, for the ADHD group, an increased theta/beta ratio during the IVA was significantly related to poorer attentional performance. The current results support reinforcing specific types of cortical activity though EEG operant conditioning (neurofeedback) as a treatment option in adults with ADHD. This paper is based largely in part on a dissertation by J. Noland White in partial fulfillment of the requirements of his doctoral program at The University of Tennessee. Portions of this study have been presented in summary form at several professional conferences.     

The freedom from distraction factor in the attention deficit hyperactivity disorder: a short model

Attention deficit hyperactivity disorder (ADHD) usually presents a profile in which the freedom from distraction factor of the WISC-R (FDF) is affected to a greater extent than the verbal comprehension factor (VCF) and the perceptual organisation factor (POF). The formulation FDF< (VCF + POF)/2 has good sensitivity for ADHD. The aim of this study was to reduce the number of tests needed for the formulation FDF< (VCF + POF)/2, maintaining the sensitivity for ADHD and concordance with the complete formulation. A clinical sample of 167 children with ADHD is analysed (6-16 years). The cases of ADHD were defined according to DSM-IV criteria and they were assessed with WISC-R, Child Symptom Inventory and Social and Occupational Activity Assessment Scale. Lineal regression method was used to reduce the number of tests. The results showed that the short formulation reduces the number of tests by half and it has 83% sensitivity for ADHD. This formulation presents a good concordance with the complete version. The FDF is significantly lower than the VCF, POF and intellectual quotient in cases of ADHD. Comorbidity, social or school activity do not have a significant influence on the probability that FDF< (VCF + POF)/2.