Activation of brain attention systems in individuals with symptoms of ADHD

Previous research investigating attention and impulse control in individuals with Attention-Deficit/Hyperactivity Disorder (ADHD) has largely ignored the symptomatic differences among the three subtypes of ADHD: ADHD-Inattentive Type, ADHD-Hyperactive/Impulsive Type, and ADHD-Combined Type. The present study examined attention and impulse control by focusing on these subtypes. Based on their self-reported symptoms of ADHD, participants belonged to one of four groups: ADHD-Inattentive, ADHD-Hyperactive/Impulsive, ADHD-Combined, and control. Cortical activity was recorded from participants during performance of a Go/NoGo task. The event-related potentials (ERP) measured at frontal and posterior sites discriminated between the control group and participants with symptoms of ADHD. The control group consistently exhibited a higher P3 amplitude than all the ADHD groups. The main difference occurred at the frontal site, indicating that individuals with ADHD symptoms have deficits in the anterior attentional system, which mediates signal detection. Behavioral measures of signal sensitivity revealed that the ADHD-Inattentive and the ADHD-Hyperactive/Impulsive groups had more difficulty with the attention-demanding Go/NoGo respond-to-target task, while behavioral measures of response bias indicated that the ADHD-Hyperactive/Impulsive and the ADHD-Combined groups responded more liberally in the inhibition-demanding Go/NoGo suppress-to-target task.     

Cross-Sectional Age Analysis of Sleep Problems in 2 to 17 Year Olds with ADHD Combined,ADHD Inattentive,or Autism

Sleep problems are common in autism and ADHD. No study has compared sleep problems by age in 2 to 17 year olds with autism versus ADHD-Combined versus ADHD-Inattentive type. Mothers rated 1415 youth with autism and 1041 with ADHD on 10 Pediatric Behavior Scale sleep items. Nighttime sleep problems were most severe in autism, followed by ADHD-Combined, and then ADHD-Inattentive. Difficulty falling asleep, restless during sleep, and waking during the night were the most common problems. Adolescents slept more at night than other age groups, and youth who slept more at night were sleepier during the day. Sleep problems declined with age, but correlations were small. In adolescence, 63% with autism, 53% with ADHD-Combined, and 57% with ADHD-Inattentive had difficulty falling asleep. Given that the majority of children in all age groups had one or more sleep problem, developmentally appropriate interventions are needed to address sleep difficulties and limit their adverse effects.

     

Differences in paper-and-pencil versus computerized line bisection according to ADHD subtype and hand-use

Two versions of the line bisection task, paper-and-pencil and computerized, were administered to non-medicated children (5-12 years) with and without Attention-Deficit/Hyperactivity Disorder (ADHD). Fifteen children were classified with ADHD-Inattentive type (ADHD-I), 15 were classified with ADHD-Combined or Hyperactive-Impulsive type (ADHD-C), and 15 children served as controls. During the paper-and-pencil task, and irrespective of hand-use, participants with ADHD-C bisected lines with a right bias, whereas participants with ADHD-I showed a leftwards bias. Interestingly, during the computerized version, an opposite pattern of hemineglect was observed with a leftwards bias for participants with ADHD-C and a rightwards bias for participants with ADHD-I. These findings suggest that different task demands are associated with the paper-and-pencil and computerized tasks. The findings also suggest that the two subtypes differ according to their cognitive profile, and possibly differ as to their underlying neural impairment.     

Sleep among presentations of Attention-Deficit/Hyperactivity Disorder: Analysis of objective and subjective measures

Background/ObjectiveTo examine subjective and objective sleep patterns in children with different Attention-Deficit/Hyperactivity Disorder (ADHD) presentations. Method: We assessed 92 children diagnosed with ADHD (29 ADHD-Inattentive [ADHD-I], 31 ADHD-Hyperactive/Impulsive [ADHD-H/I], and 32 ADHD-Combined [ADHD-C)]) aged 7–11 years. The Pediatric Sleep Questionnaire (PSQ), Pediatric Daytime Sleepiness Scale (PDSS), and a sleep diary were used as subjective sleep measures, and polysomnography was used to objectively assess sleep quantity, quality, and fragmentation. Results: Subjective data showed impaired sleep in 12.7% of the sample. No significant differences were found between ADHD presentations in any objective and subjective sleep variable. Nevertheless, data on sleep fragmentation suggested a worse sleep continuity for the ADHD-H/I group, and correlation analyses confirmed that sleep is affected by age. Conclusions: Children with ADHD may suffer from sleep breathing problems and daytime sleepiness, as reported by their parents, even when their total sleep time and sleep efficiency are not affected. It seems that sleep in this population does not largely vary as a function of the ADHD presentation. Sleep in children with ADHD evolves with age.     

Differences Between ADHD Inattentive and Combined Types on the CPT

Two samples of school-age boys with attention-deficit/hyperactivity disorder (ADHD-Combined and ADHD-Inattentive Types) and a non-ADHD control group were administered an AX version of the continuous performance task (CPT) to examine specific sustained attention deficits. Three levels of time-on-task were included to study performance declines, and 3 interstimulus intervals were included to examine vigilance deficits. As predicted by R. A. Barkley's and H. C. Quay's behavior inhibition deficit models (R. A. Barkley, 1997; H. C. Quay, 1997), the performance of the ADHD-Combined Type (ADHD-C) participants deteriorated more quickly than the other samples. No significant evidence of vigilance deficits among the inattentive (ADHD-IA) sample was found. These findings suggest that distinct criteria for the two ADHD subtypes may be warranted when the CPT is used for diagnostic assessment, and sustained attention-related declines in performance may be typical of the ADHD-C Type only.     

Social Learning,Social Disorganization,and Psychological Risk Factors for Criminal Gangs in a British Youth Context

ABSTRACT

Using longitudinal data from a British longitudinal cohort study (ALSPAC), the current study examines “developmental domains” from individual, peer, and community risk factors. Using four logistic regression models, we looked at 10 correlations between children’s experience with risk factors outlined by the literature and criminal gang association. Gang membership was associated with drug use, delinquent peers, and disorganized neighborhoods. Further, early diagnoses of childhood aggression, ADHD, depression, and Oppositional Defiant Disorder, were not associated with later, adolescent youth gang membership. Our results suggest community based programs that stem from social learning policies and collective efficacy militate against gang growth.     

Classroom Changes in ADHD Symptoms Following Clinic-Based Behavior Therapy

This study examined classroom behavioral outcomes for children with Attention-Deficit/Hyperactivity Disorder (ADHD) following their participation in a manualized, 10-week intervention called Family Skills Training for ADHD-Related Symptoms (Family STARS). Family STARS combined behavioral parent training (BPT) and child-focused behavioral activation therapy (CBAT). Participants were children ages 7–10 diagnosed with ADHD-Combined Type. Pre- and post-treatment teacher ratings of ADHD symptoms were compared using a single group, within-subjects research design. Intervention effectiveness was analyzed using paired-samples t-tests. Results indicated statistically significant classroom improvements for externalizing behaviors and attention problems with medium and large main effects (respectively) for the intervention. Possible implications for combining CBAT with BPT for the treatment of ADHD are discussed as well as the relevance of these results for improving the effectiveness and portability of empirically supported interventions.     

Differentiating between ADHD sub-types on CCPT measures of sustained attention and vigilance

The aim of the study was to test whether sustained attention and vigilance, often considered as the same phenomenon, dissociate on the Conners' Continuous Performance Test, and whether subjects with ADHD-Inattentive type and ADHD-Combined type differ with regard to these measures. Sixty-five healthy controls and 67 subjects with ADHD between 9 and 16 years of age participated in the study. The ADHD-I group performed below control children on Hit Reaction Time Block Change, considered to measure sustained attention and the ADHD-C group scored below controls on Hit Reaction Time Inter-Stimulus-Interval, considered to measure vigilance. Comparing the two clinical groups showed a test by group interaction, with ADHD-I subjects performing below ADHD-C subjects with regard to sustained attention and above ADHD-C subjects with regard to vigilance. Sustained attention on the CCPT correlated specifically with parent and teacher ratings of inattention, but not with ratings of hyperactivity-impulsivity, while vigilance correlated with all symptom ratings.     

Improving Working Memory in Children with Attention-Deficit/Hyperactivity Disorder: The Separate and Combined Effects of Incentives and Stimulant Medication

Working memory (WM) is considered a core deficit in Attention-Deficit/ Hyperactivity Disorder (ADHD), with numerous studies demonstrating impaired WM among children with ADHD. We tested the degree to which WM in children with ADHD was improved by performance-based incentives, an analog of behavioral intervention. In two studies, WM performance was assessed using a visuo-spatial n-back task. Study 1 compared children (ages 9-12?years) with ADHD-Combined type (n?=?24) to a group of typically developing (TD) children (n?=?32). Study 1 replicated WM deficits among children with ADHD. Incentives improved WM, particularly among children with ADHD. The provision of incentives reduced the ADHD-control group difference by approximately half but did not normalize WM. Study 2 examined the separate and combined effects of incentives and stimulant medication among 17 children with ADHD-Combined type. Both incentives and a moderate dose of long-acting methylphenidate (MPH; ~0.3?mg/kg t.i.d. equivalent) robustly improved WM relative to the no-incentive, placebo condition. The combination of incentives and medication improved WM significantly more than either incentives or MPH alone. These studies indicate that contingencies markedly improve WM among children with ADHD-Combined type, with effect sizes comparable to a moderate dose of stimulant medication. More broadly, this work calls attention to the role of motivation in studying cognitive deficits in ADHD and in testing multifactorial models of ADHD.     

A preliminary investigation of reaction time variability in relation to social functioning in children evaluated for ADHD

Reaction time variability (RTV) is a ubiquitous phenomenon in Attention-Deficit/Hyperactivity Disorder (ADHD). Few studies have examined RTV in relation to functional outcomes such as social impairment in children with ADHD. In this exploratory study, we investigated whether RTV is associated with social functioning in children at risk for ADHD. Specifically, we explored the association between RTV (tau derived from correct go trials of a Stop-Signal task) and social functioning in 198 children ages 7–12 years referred for an ADHD evaluation. Social functioning measures included child and/or parent ratings of social competence, aggression, social problems, and impairment in relationships. In regression analyses that also included Oppositional Defiant Disorder symptoms and sex, higher RTV was significantly associated with lower ratings of social competence, and higher proactive/reactive aggression ratings on the child self-report measures. RTV was not significantly associated with parent report of social functioning or relationship impairment. This study provides preliminary evidence that RTV may be associated with social functioning in children at risk for ADHD. We propose that lapses of attention affecting cognitive control may also negatively impact social information processing thereby affecting social functioning. Replication is warranted and longitudinal studies are needed to investigate whether RTV predicts social dysfunction in ADHD.     

Utility of a CPT in Diagnosing ADHD among a Representative Sample of High-Risk Children: A Cautionary Study

Continuous performance tests (CPTs) are widely used in the assessment and study of attention deficit hyperactivity disorder (ADHD). Although CPTs have reliably found differences between children with ADHD and normal controls, discriminating between children with ADHD and children with subclinical levels of behavioral or cognitive problems is a more clinically relevant and difficult endeavor. Additionally, most studies use convenience samples from clinical care settings that may not represent the ADHD population as a whole. The current study assessed the utility of a clinically used CPT, the Test of Variables of Attention (TOVA), in distinguishing between children with ADHD and children with subclinical levels of attention/behavior problems. Participants constituted a representative sample of elementary school students at high risk for ADHD, including 116 children with ADHD and 51 subclinical controls. Results found no significant differences between the ADHD and subclinical group on CPT variables, and CPT performance did not reliably predict group membership. Implications of the findings are discussed.     

Utility of a CPT in diagnosing ADHD among a representative sample of high-risk children: a cautionary study.

Continuous performance tests (CPTs) are widely used in the assessment and study of attention deficit hyperactivity disorder (ADHD). Although CPTs have reliably found differences between children with ADHD and normal controls, discriminating between children with ADHD and children with subclinical levels of behavioral or cognitive problems is a more clinically relevant and difficult endeavor. Additionally, most studies use convenience samples from clinical care settings that may not represent the ADHD population as a whole. The current study assessed the utility of a clinically used CPT, the Test of Variables of Attention (TOVA), in distinguishing between children with ADHD and children with subclinical levels of attention/behavior problems. Participants constituted a representative sample of elementary school students at high risk for ADHD, including 116 children with ADHD and 51 subclinical controls. Results found no significant differences between the ADHD and subclinical group on CPT variables, and CPT performance did not reliably predict group membership. Implications of the findings are discussed.     

Differences in heterosocial behavior and outcomes of ADHD-symptomatic subtypes in a college sample

The purpose of this study was to explore heterosocial relational outcomes in a college-aged sample showing symptoms of Attention-Deficit/Hyperactivity Disorder (ADHD). Using questionnaires and a behavioral observation task, dating, sexual, and social outcomes were examined in three groups: 24 non-ADHD controls, 27 ADHD-Combined (ADHD/C) Type, and 13 ADHD-Primarily Inattentive (ADHD/IA) Type. The ADHD/IA group showed a consistent pattern of passivity and inexperience and was perceived relatively negatively by female confederates, whereas the ADHD/C group reported increased sexual drive and early dating experience. The effects of externalizing comorbidity differed by DSM-IV ADHD subtype. These findings indicate that ADHD-symptomatic adults differ by DSM-IV subtype in the manifestation of heterosocial deficits. Results suggest specific and divergent types of psychosocial intervention with ADHD/C versus ADHD/IA clients.     

Experiences of physical and relational victimization in children with ADHD: The role of social problems and aggression

The social risk factors for physical and relational peer victimization were examined within a mixed‐gender sample of children with and without attention‐deficit/hyperactivity disorder (ADHD). Participants were 124 children (ages 8–12 years; 48% boys), with 47% exhibiting sub‐clinical or clinical elevations in ADHD symptoms. ADHD and oppositional defiant disorder (ODD) symptom counts were assessed based on parent‐ and teacher‐reports; parents rated children's social problems and teachers rated children's use of physical and relational aggression and experiences of physical and relational victimization. A multiple mediator model was used to test whether there were indirect effects of ADHD or ODD symptoms on physical and relational victimization through social problems, physical aggression, or relational aggression. At the bivariate level, ADHD and ODD symptoms were both significantly associated with higher rates of physical and relational victimization. In the mediational model, there were significant indirect effects of ADHD symptoms on relational victimization via social problems, of ODD on relational victimization via relational aggression, and of ODD symptoms on physical victimization via physical aggression. Results suggest that there are distinct risk factors implicated in the physical and relational victimization of youth with ADHD and that the co‐occurrence of ODD symptoms is important to assess. Clinical implications for addressing victimization in children with ADHD are discussed.

     

Impulsivity and Attention Deficit-Hyperactivity Disorder: Subtype Classification Using the UPPS Impulsive Behavior Scale

This study examined the classification accuracy of the UPPS Impulsive Behavior Scale (UPPS) in discriminating several attention deficit/hyperactivity disorder (ADHD) subtypes, including predominantly inattentive type (ADHD/I), combined type (ADHD/C), and combined type with behavioral problems (ADHD/ODD), between each other and a non-ADHD control group using logistic regression analyses. The sample consisted of 88 children ranging in age from 9.0 years to 12.8 years, with a mean of 10.9 years. Children were predominantly male (74%) and Caucasian (86%) and in grades 3–7. Results indicated that the UPPS performed well in classifying ADHD subtypes relative to traditional diagnostic measures. In addition, analyses indicated that differences in symptoms between subtypes can be explained by specific pathways to impulsivity. Implications for the assessment of ADHD and conceptual issues are discussed.     

The neurocognition of conduct disorder behaviors: specificity to physical aggression and theft after controlling for ADHD symptoms

There is growing evidence that among the different conduct disorder (CD) behaviors, physical aggression, but not theft, links to low neurocognitive abilities. Specifically, physical aggression has consistently been found to be negatively related to neurocognitive abilities, whereas theft has been shown to be either positively or not related to neurocognition. The specificity of these links needs further examination because attention deficit hyperactivity disorder (ADHD) links to both physical aggression and neurocognitive variation. The development of self-reported physical aggression and theft, from age 11 to 17 years, was studied in a prospective at-risk male cohort via a dual process latent growth curve model. Seven neurocognitive tests at age 20 were regressed on the growth parameters of physical aggression and theft. The links between neurocognition and the growth parameters of physical aggression and theft were adjusted for ADHD symptoms at ages 11 and 15 (parent, child and teacher reports). Results indicated that verbal abilities were negatively related to physical aggression while they were positively associated with theft. However, inductive reasoning was negatively associated with increases in theft across adolescence. Symptoms of ADHD accounted for part of the neurocognitive test links with physical aggression but did not account for the associations with theft. These differences emphasize the importance of examining specific CD behaviors to better understand their neurodevelopmental mechanisms. They also suggest that youth who engage in different levels of physical aggression or theft behaviors may require different preventive and corrective interventions.     

Community-based multiple-gate screening of children at risk for conduct disorder

The present study employed a multiple-gate screening procedure to identify children at risk for the development of conduct disorder. Measures of cross-setting disruptive behavior and parent discipline practices were administered in sequential fashion to screen a population of 7,231 children attending suburban elementary schools. Convergent validity of the respective gating measures was confirmed by significant correlations with adjustment constructs. Analyses of covariance performed between positive screens, negative screens, and low-risk comparison children on adjustment constructs at each gate supported the discriminative validity of the gating procedure. Hierarchical regression analyses demonstrated that the gating measures were predictive of diagnostic ratings of attention deficit hyperactivity disorder and oppositional defiant disorder that were obtained 18 months following the screening. A stepwise logistic regression analysis indicated that the best predictors of high-risk group membership were variables related to family process, including poor family communication and involvement, poor maternal coping skills, and an external parent locus of control.This study was supported by grant MH-46584 from the National Institute of Mental Health.     

Symptoms of Attention-Deficit/Hyperactivity Disorder and Social and School Adjustment: The Moderating Roles of Age and Parenting

This study examined the associations between symptoms of attention-deficit/hyperactivity disorder (ADHD) and social and school adjustment (academic performance, peer relationships, school social problems) and the moderating roles of children’s age and maternal parenting (affection and overprotection) in these associations. The sample consisted of 2,463 students who were in the first to ninth grade in northern Taiwan. Results from the linear mixed models demonstrated that ADHD symptoms were inversely associated with academic performance and positively associated with social adjustment problems. Further, children’s age and maternal parenting moderated the associations between ADHD symptoms and school and social adjustment. For example, maternal overprotection moderated the relation between hyperactivity and negative peer relationships (i.e., difficulty forming and maintaining friendships), such that this relation was stronger for children who experienced higher levels of overprotection than children who did not. Moreover, children’s age moderated the association between attention problems and decreased academic performance, such that this association was stronger for older children and adolescents than for younger children. Furthermore, children’s age and maternal affection interacted to influence the association between attention problems and school social problems (i.e., bullying, aggression, and peer rejection) with maternal affection acting as a buffer for older children (grades 4–6) only. These findings are discussed from a developmental psychopathology perspective.     

The relationship of compliance with inattention and hyperactivity/impulsivity

The aim of the study was to investigate the relationship between Attention Deficit Hyperactivity Disorder (ADHD) inattention and hyperactivity/impulsivity symptoms in predicting compliance. It was hypothesised that inattention symptoms are a better predictor of compliance than hyperactivity/impulsivity. There were two different groups of participants: 367 college students (both males and females) and 89 male prisoners. All participants had completed the Gudjonsson Compliance Scale (GCS) and the DSM-IV-TR (Screening) Checklist for adult ADHD symptoms. Significant correlations emerged between compliance and ADHD symptoms, but the correlations were higher for inattention than hyperactivity/impulsivity among both samples. This was confirmed by multiple regression analyses (hierarchical), which showed that the variance in compliance explained by ADHD inattention versus hyperactivity/impulsivity symptoms increased from 2% to 8% for college students and 8% to 24% for prisoners after entering inattention into the model (hyperactivity/impulsivity was entered first in the regression models). The findings suggest that inattention is a more powerful predictor of compliance than hyperactivity/impulsivity. This is a novel and an important finding.     

Differentiating Type A behaviour and hyperactivity using observed motivation during a reaction time task

In light of the previously found overlap between Type A behaviour as measured by the Matthews Youth Test for Health (MYTH) and hyperactivity scales, the overall aim of this study was to clarify the standing of MYTH‐defined Type A behaviour relative to hyperactivity and Attention‐Deficit/Hyperactivity Disorder (ADHD), using observed task motivation and performance on a choice reaction‐time task, the Complex Reaction Time (CRT) measure. This study included 21 boys exhibiting Type A behaviour, 22 ADHD boys, 20 non‐clinically hyperactive boys, and 20 non‐hyperactive boys, between the ages of 6 and 13 years. It was proposed that a differentiation of constructs would be possible using observed task motivation if the MYTH were a discriminantly valid measure of Type A behaviour. Results showed that the MYTH‐defined Type A group differed from the clinically diagnosed ADHD group, although it was markedly similar to the non‐clinical hyperactive group, displaying comparable CRT performance and low level of task motivation. Type A behaviour correlated to CRT performance and task motivation in a way which was conceptually more indicative of hyperactivity than of Type A behaviour, which questions the validity of the MYTH as a measure of the Type A construct. The MYTH Impatience subscale was found to be particularly impure with regard to hyperactivity. Copyright © 2003 John Wiley & Sons, Ltd.