Neuropsychological abilities of preschool-aged children who display hyperactivity and/or oppositional-defiant behavior problems.

This study focused on gaining a better understanding of the neuropsychological abilities of preschool-aged children who show elevated levels of hyperactivity and oppositional-defiance. It examined the performance of children aged 48 to 67 months on tests of attention/executive function, language, memory, and sensorimotor abilities, as measured by the NEPSY and Conners' K-CPT. Two hundred thirty-seven children were divided into four subgroups based on mothers' report of behavior using rating scales and a diagnostic interview: hyperactive only (HYP), oppositional-defiant only (OD), hyperactive and oppositional-defiant (HYP/OD), and nonproblem. Children in the HYP/OD group scored significantly worse than nonproblem children on four of nine subtests on the NEPSY, including one test of executive function, one test of language comprehension, and both tests of short-term verbal memory. However, only the test of executive function (Statue) showed significant predictive power, and, while specificity of this subtest was good, sensitivity was poor. On the K-CPT, a continuous performance test, children in both the HYP and HYP/OD groups performed worse than children in the OD and nonproblem groups. When the NEPSY Statue subtest and the K-CPT were used together, overall predictive power was .74. Results suggest that neuropsychological deficits can be observed among preschool children with hyperactivity, particularly when comorbid oppositional-defiance is present; however, moderate predictive power suggests that these tests should be used in conjunction with other methods of assessment.     

Examining Subtypes of Behavior Problems Among 3-Year-Old Children,Part I: Investigating Validity of Subtypes and Biological Risk-Factors

This study examined 3-year-old children who were classified as hyperactive (HYP), oppositional-defiant (OD), hyperactive and oppositional defiant (HYP/OD), and non-problem based on mothers' reports of behavior. Using fathers,' teachers,' and observers' ratings of children's behavior, concurrent validity was excellent for the HYP/OD group, moderate for the HYP group, and poor for the OD group. As predicted, both the HYP/OD and HYP groups reported more prenatal/perinatal birth complications and a greater family history of hyperactivity than did non-problem children. Furthermore, the HYP/OD group showed a greater family history of conduct disorder and oppositional defiant disorder (ODD) symptoms than did non-problem children; however, the HYP group also showed a greater family history of ODD than did non-problem children. Results suggest that as early as age 3, these behavior subtypes appear to be linked to biologically-based risk-factors in ways that are consistent with theories of the development of ADHD.     

Visual‐motor and executive functions in children born preterm: The Bender Visual Motor Gestalt Test revisited

Böhm, B., Lundequist, A. & Smedler, A.‐C. (2010). Visual‐motor and executive functions in children born preterm: The Bender Visual Motor Gestalt Test revisited. Scandinavian Journal of Psychology, 51, 376–384. Visual‐motor development and executive functions were investigated with the Bender Test at age 5½ years in 175 children born preterm and 125 full‐term controls, within the longitudinal Stockholm Neonatal Project. Assessment also included WPPSI‐R and NEPSY neuropsychological battery for ages 4–7 ( Korkman, 1990 ). Bender protocols were scored according to Brannigan & Decker (2003) , Koppitz (1963) and a complementary neuropsychological scoring system (ABC), aimed at executive functions and developed for this study. Bender results by all three scoring systems were strongly related to overall cognitive level (Performance IQ), in both groups. The preterm group displayed inferior visual‐motor skills compared to controls also when controlling for IQ. The largest group differences were found on the ABC scoring, which shared unique variance with NEPSY tests of executive function. Multiple regression analyses showed that hyperactive behavior and inattention increased the risk for visual‐motor deficits in children born preterm, whereas no added risk was seen among hyperactive term children. Gender differences favoring girls were strongest within the preterm group, presumably reflecting the specific vulnerability of preterm boys. The results indicate that preterm children develop a different neurobehavioral organization from children born at term, and that the Bender test with a neuropsychological scoring is a useful tool in developmental screening around school start.     

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.     

Examining Subtypes of Behavior Problems among 3-Year-Old Children,Part II: Investigating Differences in Parent Psychopathology,Couple Conflict,and Other Family Stressors

This study examined family stressors among 3-year-old children who were classified as hyperactive (HYP), hyperactive and oppositional defiant (HYP/OD), and non-problem based on mothers' reports of behavior. Children with HYP/OD were found to experience higher levels of family stressors than non-problem children on almost every family stressor variable. Compared to children with HYP, families of children with HYP/OD also tended to report more Axis II maternal psychopathology, Axis I paternal psychopathology, and high intensity couple conflict tactics. However, the HYP and HYP/OD group did not significantly differ on maternal Axis I psychopathology, paternal Axis II psychopathology, parental marital status, negative life events, frequency of couple conflict, or use of lower intensity couple conflict tactics. Parents of children with HYP and HYP/OD reported more negative life events, more maternal adult ADHD symptoms, and more maternal avoidance and verbal aggression during marital conflict than parents of non-problem children. Implications for treatment and etiology are discussed.     

Examining Subtypes of Behavior Problems Among 3-Year-Old Children,Part III: Investigating Differences in Parenting Practices and Parenting Stress

This study examined parenting of mothers and fathers of 3-year-old children who were classified as hyperactive (HYP), hyperactive and oppositional defiant (HYP/OD), and non-problem based on mothers' reports of behavior. Parents of children with HYP/OD were less warm, showed more negative affect, and more laxness than parents of non-problem children; however, contrary to prediction, they did not differ significantly from parents of children in the HYP group. Compared to mothers of non-problem children, mothers of children in the HYP/OD group reported significantly more parenting stress across all domains, whereas mothers of children in the HYP group only reported elevated levels of stress associated with having a difficult child. Theoretical and treatment implications are discussed.     

Relation of infant motor development with nonverbal intelligence,language comprehension and neuropsychological functioning in childhood: a population‐based study

Within a population‐based study of 3356 children, we investigated whether infant neuromotor development was associated with cognition in early childhood. Neuromotor development was examined with an adapted version of Touwen's Neurodevelopmental Examination between 9 and 20 weeks. Parents rated their children's executive functioning at 4 years. At age 6 years, children performed intelligence and language comprehension tests, using Dutch test batteries. At age 6–9 years, neuropsychological functioning was assessed in 486 children using the validated NEPSY‐II–NL test battery. We showed that less optimal neurodevelopment in infancy may predict poor mental rotation, immediate memory, shifting, and planning; but not nonverbal intelligence or language comprehension.     

Before and after entering school: The development of attention and executive functions from 6 to 8 years in Finnish children

In this 2‐year prospective follow‐up study we examined typical and atypical development of attention and executive function (AEF) across the transition to school. The NEPSY‐battery was used to evaluate the AEFs of the children before school at 6 years of age. Two subgroups, typical AEF (n = 25) and atypical AEF (n = 25), were formed according to the performance in AEF tasks. Children were assessed again at 8 years, when they were at the 2nd grade. The same subtests of the NEPSY‐battery and the ATTEX behavioral rating completed by a teacher were used. The effects of AEF deficits were compared with and without controlling for IQ. The group effect was significant in four out of the six NEPSY subtests used. The atypical AEF group had problems especially on subtests measuring motor inhibition both at the age of 6 and 8. The group‐time interaction effect was found in the subtest measuring attentional shifting. A catch‐up effect on shifting skills was observed in the atypical AEF group by the age of 8 years. In school at the 2nd grade, the early AEF problems were still observable, and related especially to inattention problems. Our results support the interpretation that inhibitory problems are at the core of executive dysfunction, that the problems are stable from preschool to 2nd grade, and that the effects of early AEF problems go over and beyond intellectual deficits. Our results also support the use of performance based measures of inhibition as an important part of the neuropsychological evaluation for school readiness.     

Neuropsychological characteristics and test behaviors of boys with early onset conduct problems.

School-age children and adolescents with conduct problems typically exhibit deficits in verbal IQ, language abilities, and executive functions. This study examined the extent to which this pattern was evident in a clinic group of preschool boys with early onset conduct problems who met criteria for oppositional defiant disorder (ODD) with and without attention deficit hyperactivity disorder (ADHD). A 2nd question focused on the strength of relation between clinic boys' uncooperative or inattentive test behaviors and their test performance. As expected, the clinic boys showed a neuropsychological profile highly similar to the one found in older conduct problem populations. Verbal tests distinguished clinic from matched comparison boys even after controlling for observers' ratings of disruptive behavior during testing. Clinic boys with ODD and ADHD had lower verbal and executive function scores than clinic boys with ODD alone. After general vocabulary knowledge and test behavior were controlled, clinic boys were found to have poorer vocabularies for describing affective states than comparison group boys.     

Parent characteristics and parent-child interactions in families of nonproblem children and ADHD children with higher and lower levels of oppositional-defiant behavior

This study examined parent-child interactions and parent characteristics in families of nonproblem children and attention deficit hyperactivity disorder (ADHD) children with lower (ADHD-LOD) and higher (ADHD-HOD) levels of oppositional-defiant behavior. Families of ADHD children were recruited from a parent training program. Observed and parent-reported child behavior problems were highest in the ADHD-HOD group. Observed parent behavior revealed few differences, but daily reports indicated that parents in both ADHD groups used more negative-reactive and fewer positive parenting strategies than control parents. Maternal psychological functioning differed between the ADHD and nonproblem groups, but not between the two ADHD groups. Fathers of ADHD-HOD children reported more psychological disturbance than controls. Parenting self-esteem was lowest in the ADHD-HOD group and highest in the nonproblem group. The results support the LOD and HOD distinction, but also suggest that, although certain difficulties are more common in the families of ADHD-HOD children, families of ADHD-LOD children also differ from controls on a number of dimensions.This research was supported by grants from the Medical Research Council of Canada and the British Columbia Health Research Foundation. Appreciation is extended to Josie Geller, Kim Behrenz, Susan Greaves, and Sonia Pietzsch who assisted with data collection and coding, and to the families who generously gave their time to participate in the research. Thanks also to two anonymous reviewers for their comments.     

Neurocognitive impairment in early adolescence following prenatal alcohol exposure of varying duration.

The aims of the study were, first, to perform a comprehensive assessment of neurocognitive status in early adolescence of children exposed to alcohol prenatally; and, second, to examine whether duration of exposure continues to be predictive of outcome at this age. Twenty-seven exposed 12-14-year-olds and 39 non-exposed 13-14-year-olds underwent neuropsychological assessments (WISC-III, NEPSY subtests) of attention and executive functions, language, visuomotor functions, and memory. The group of non-exposed children was used to develop preliminary test norms for the 13-14-year-old exposed children whereas published test norms could be used for the 12-year-olds. The results demonstrated neurocognitive impairment across all types of tasks. Impairment varied in degree according to the duration of alcohol exposure. Children exposed throughout pregnancy, most of who had diagnoses of Fetal Alcohol Syndrome (FAS) or Fetal Alcohol Effects (FAE), performed well below the average range. It was concluded that the neurocognitive effects of alcohol exposure tend to be widespread and generalized. Attention and executive functions do not seem to be selectively affected. Further, the relationship between duration of prenatal alcohol exposure and neurocognitive development continues to be significant in early adolescence.     

Neurocognitive Impairment in Early Adolescence Following Prenatal Alcohol Exposure of Varying Duration

The aims of the study were, first, to perform a comprehensive assessment of neurocognitive status in early adolescence of children exposed to alcohol prenatally; and, second, to examine whether duration of exposure continues to be predictive of outcome at this age. Twenty-seven exposed 12-14-year-olds and 39 nonexposed 13-14-year-olds underwent neuropsychological assessments (WISC-III, NEPSY subtests) of attention and executive functions, language, visuomotor functions, and memory. The group of non-exposed children was used to develop preliminary test norms for the 13-14-year-old exposed children whereas published test norms could be used for the 12-year-olds. The results demonstrated neurocognitive impairment across all types of tasks. Impairment varied in degree according to the duration of alcohol exposure. Children exposed throughout pregnancy, most of who had diagnoses of Fetal Alcohol Syndrome (FAS) or Fetal Alcohol Effects (FAE), performed well below the average range. It was concluded that the neurocognitive effects of alcohol exposure tend to be widespread and generalized. Attention and executive functions do not seem to be selectively affected. Further, the relationship between duration of prenatal alcohol exposure and neurocognitive development continues to be significant in early adolescence.     

Toward a Model of Neuropsychological Activity

The main purpose of this research was to establish the intercorrelations existing among different psychological and neuropsychological test scores in a normal and homogenous population. A second purpose was to attempt further step in the component analysis of cognitive activity measured by means of neuropsychological tests. A comprehensive neuropsychological test battery was assembled and individually administered to a 300-subject sample, aged 17–25 years-old. All of them were right-handed male university students. The battery included some basic neuropsychological tests directed to assess language, calculation abilities, spatial cognition, praxic abilities, memory, perceptual abilities, and executive functions. In addition, the Wechsler Adult Intelligence Scale was administered. Forty-one different scores were calculated. Correlations among the different test scores were analyzed. It was found that some of the tests presented a quite complex intecorrelation system, whereas other tests presented few or no significant correlations. Mathematical ability tests and orthography knowledge represented the best predictors of Full Scale IQ. A factor analysis with varimax rotation disclosed five factors (verbal, visuoperceptual, executive function, fine movements, and memory) accounting for 63.6% of the total variance. Implications of these results for a neuropsychological model about brain organization of cognition were analyzed.     

Normative data on a battery of neuropsychological tests in the Han Chinese population

In order to develop normative data of a battery of neuropsychological tests in the mainland Chinese population, we examined the performance of 15 neuropsychological tests in 465 healthy subjects (231 males and 234 females) in a population‐based cohort study. The years of education were ranged between 1 and 23 years, and ages were ranged between 16 and 75 years old. The 15 neuropsychological tests cover five domains of neurocognitive functions including attention and speed of information processing, memory and learning, verbal function, visual constructive abilities, and executive function. We also assessed the effects of gender, age, educational attainment on the performance of these neuropsychological tests. The results showed that, as expected, educational attainment and age are the two main factors affecting performance in these tests. Educational attainment has the strongest predictive effect on all tests, while the majority of tests selected in this study are also affected by age at examination to varying degrees. The presented normative data will be useful for future studies in related clinical research, and be of value in transcultural neuropsychological studies.     

To what extent does bilingualism affect children's performance on the NEPSY?

Twenty-seven monolingual and 27 bilingual children aged between 6 and 7 years were assessed using the core subtests of the NEPSY, a children's neuropsychological assessment. Bilingual children scored lower than monolingual children in the Language domain and their performance was comparable with the monolingual children in the domains of Attention/Executive Functioning, Sensorimotor, Visuospatial, and Memory. The NEPSY correlates well with measures of academic achievement. It is concluded that the NEPSY is relatively insensitive to cultural factors and appears to be insensitive to bilingualism in the neuropsychological assessment of bilingual children in the United Kingdom.     

Effects of the EXAT neuropsychological multilevel intervention on behavior problems in children with executive function deficits

This is a clinical intervention study of children with executive function (EF ) deficits. A neuropsychological multimodal group intervention called EXAT (rehabilitation of EX ecutive function and AT tention) was developed at the Psychology Clinic of the University of Tampere. Based on the principles of neuropsychological rehabilitation and behavioral modification, EXAT combines child group training, parent training, and teacher consultations. The aims of this study were to investigate behavior problems before and after the intervention in children attending EXAT and in controls, and to compare intervention effects in hyperactive, inattentive, and EF subgroups based on the primary deficit described in the referral. The participants were 86 children (6–12 years) with a mean IQ of 91.4 attending EXAT and 45 controls. The participants’ parents and teachers completed the Conners’ Rating Scales‐Revised. In addition, the Strengths and Difficulties Questionnaire was completed by the parents attending EXAT . The parents reported statistically significant decreases with medium effect sizes for the CPRS ‐R subscales for impulsivity, hyperactivity, and oppositional behavior. In the controls within the same time interval, there was increase in restless and impulsive behavior, and a decrease in total problems. The teachers reported positive changes after the intervention in ADHD symptoms and anxiousness/shyness, but the effects sizes were small. The intervention effects were larger in the hyperactive subgroup. Positive intervention effects were related to a younger age, lower IQ , and simultaneous learning support. In conclusion, EXAT – a structured multilevel group intervention – has positive effects on children's behavior regulation skills by decreasing impulsivity and restless behavior.     

The relationship between parental report on the BRIEF and performance-based measures of executive function in children with moderate to severe traumatic brain injury.

The Behavior Rating Inventory of Executive Function (BRIEF) is a questionnaire that assesses parental observations of behaviors associated with executive function in children in the home environment. The current investigation examines the relationship between the BRIEF and individually-administered neuropsychological tests in children with traumatic brain injury. Forty-eight children with moderate to severe traumatic brain injury were administered the WISC-III and several performance-based tests of executive function (the Wisconsin Card Sorting Test, Trail Making Test Part B, verbal fluency), and a parent completed the BRIEF. Results indicate that the Metacognition Index from the BRIEF correlates with Verbal IQ, but none of the index scores from the BRIEF correlate with any of the performance-based tests of executive function. Results are discussed with respect to the ecological validity of standardized clinical neuropsychological tests of executive function.     

The frontal hypothesis of cognitive aging: factor structure and age effects on four frontal tests among healthy individuals

With 101 healthy aging adult participants, the authors investigated whether executive functions are a unitary concept. The authors established the factor structure of the Wisconsin Card Sorting Test (WCST; E. A. Berg, 1948), the Stroop color and word test (C. J. Golden, 1978), verbal fluency using the Controlled Oral Word Association Test (COWAT; Benton, 1967), and the Digits Backwards subtest of the Wechsler Adult Intelligence Scale-Revised (WAIS-R; D. Wechsler, 1981). The authors also evaluated the extent to which age and other demographic variables predicted common underlying properties of these frontal tests. Results revealed an age-related decline in executive abilities differentially reflected by the selected tasks. These data suggest caution using the COWAT to evaluate executive abilities in older people. The authors interpret findings to support the unitary view of executive abilities and the executive decline proposed by the frontal hypothesis.