Neurocognitive functioning in adults with attention-deficit/hyperactivity disorder

The performance of nine adults with attention-deficit/hyperactivity disorder (ADHD) was compared with the performance of 23 normal controls on computerized measures of target orientation, sustained attention, encoding speed, and motor output/response organization to determine the nature of the neurocognitive deficits of adults with ADHD. While the groups' performances on measures of sustained attention and encoding speed did not differ, significant group differences were seen on a task that targeted motor output/response organization. These data suggest that the neurocognitive difficulties of ADHD adults are not related to a primary deficit in sustained attentional functioning. Rather, the deficient information processing in ADHD adults is related to difficulties with motor output/response organization.     

Parent training for attention-deficit hyperactivity disorder: Its impact on parent functioning

This study examined changes in parent functioning resulting from parental participation in a behavioral parent training (PT) program specifically designed for school-aged children with attention-deficit hyperactivity disorder (ADHD). Relative to wait list controls, subjects who completed the nine-session PT program showed significant posttreatment gains in both child and parent functioning, which were maintained 2 months after treatment. In particular, there were PT-induced reductions in parenting stress and increases in parenting self-esteem, which accompanied parent-reported improvements in the overall severity of their child's ADHD symptoms. In addition to their statistical importance, these findings are discussed in terms of their clinical significance, utilizing methods developed by Jacobson and Truax (1991).This project was supported in part through BRSG grant S07RR05712-19 awarded to Arthur D. Anastopoulos by the Biomedical Research Support Program, Division of Research Resources, National Institutes of Health.     

A Rational-Emotive Treatment program with conduct disorder and attention-deficit hyperactivity disorder adolescents

This study investigated the effects of a 12-week treatment program, based on Rational-Emotive Therapy, with conduct disorder (CD) and attention-deficit hyperactivity disorder (ADHD) adolescents. Two independent homogeneous CD (N=12) and ADHD (N=12) groups were selected on the basis of the DSM-111-R and use of methylphenidate. The dependent variables were irrational thinking, depression, and anger. Lecture, discussion, and theYou Can Do It!Motivational Program video were used in the treatment intervention. Discriminant function analysis of pretest scores revealed that 96% of the students were correctly classified (CD=100%, ADHD=92%). Multivariate analysis of pre-posttest scores revealed that the CD group significantly changed on all dependent variables, while no significant differences were found with the ADHD group. A comparison of posttest scores on the measure of irrational thinking revealed that the CD group accepted responsibility for their upsetness and were more willing to change than the ADHD group. The results of the study are interpreted in terms of the distinguishing characteristics of each group.G. Barry Morris Ph.D., is Director of the Canadian Institute for Rational-Emotive Therapy. He is a Fellow and training supervisor in Rational-Emotive Therapy, a professor at the University of Saskatchewan, a licensed psychologist, and is engaged in private practice.     

Sustained attention and executive functioning performance in attention-deficit/hyperactivity disorder.

The aim of this study was to further refine the cognitive phenotype of attention-deficit/hyperactivity disorder (ADHD), with respect to the ability to sustain attention and executive functioning. Participants were 34 boys with ADHD (combined type) and 28 normal controls. The groups were closely matched for age and IQ. All participants were 12 years of age. Both groups performed a computerized sustained attention task and a response interference task. Measures related to speed, accuracy, and time on task were collected. We found that children with ADHD performed slower, less accurately, more impulsively, and with less stability than controls. Both groups produced more errors with increasing time on task, reflecting reduced vigilance. Importantly, no interaction with time on task was found. The overall pattern of results suggests that measures related to accuracy are more informative than measures related to speed of responding in refining the cognitive phenotype of ADHD.     

Differences in memory functioning between children with attention-deficit/hyperactivity disorder and/or focal epilepsy

Prior research has shown that attention-deficit/hyperactivity disorder (ADHD) and epilepsy are frequently comorbid and that both disorders are associated with various attention and memory problems. Nonetheless, limited research has been conducted comparing the two disorders in one sample to determine unique versus shared deficits. Hence, we investigated differences in working memory (WM) and short-term and delayed recall between children with ADHD, focal epilepsy of mixed foci, comorbid ADHD/epilepsy and controls. Participants were compared on the Core subtests and the Picture Locations subtest of the Children’s Memory Scale (CMS). Results indicated that children with ADHD displayed intact verbal WM and long-term memory (LTM), as well as intact performance on most aspects of short-term memory (STM). They performed worse than controls on Numbers Forward and Picture Locations, suggesting problems with focused attention and simple span for visual-spatial material. Conversely, children with epilepsy displayed poor focused attention and STM regardless of the modality assessed, which affected encoding into LTM. The only loss over time was found for passages (Stories). WM was intact. Children with comorbid ADHD/epilepsy displayed focused attention and STM/LTM problems consistent with both disorders, having the lowest scores across the four groups. Hence, focused attention and visual-spatial span appear to be affected in both disorders, whereas additional STM/encoding problems are specific to epilepsy. Children with comorbid ADHD/epilepsy have deficits consistent with both disorders, with slight additive effects. This study suggests that attention and memory testing should be a regular part of the evaluation of children with epilepsy and ADHD.     

Social status of boys with both academic problems and attention-deficit hyperactivity disorder

Research findings regarding the impact of low achievement (LA) on the social status and social behavior of learning-disabled (LD) children have been equivocal. Reported findings suggested that a failure of previous studies to control for the impact of attention-deficit hyperactivity disorder (ADHD) may account for the lack of consensus among previous studies. The purpose of this investigation was to examine the relative contributions of LA, LD, and ADHD to problems in social status and social behavior. This was accomplished by assigning second-through sixth-grade boys to one of six groups: ADHD/LD,ADHD/LA, ADHD, LD, LA, and control. Results indicated that serious problems with peer rejection, peer popularity, and social behavior were the most strongly related to the combination of ADHD and LD. Discussion of the implications of current findings includes the importance of identifying appropriate behavioral and academic subgroups when investigating social status and behavior problems.     

Frontal lobe functioning in adolescents with attention deficit hyperactivity disorder

A prominent hypothesis regarding the etiology of attention deficit hyperactivity disorder (ADHD) is that its presence and magnitude reflect frontal lobe dysfunction. Past tests of this hypothesis have been inconsistent. The present study examined frontal lobe functioning in adolescents with ADHD. A sample of 10 ADHD adolescents and 10 controls between the ages of 12 and 17 served as participants for the study. The control group was matched on age (within six months) and gender. This study aided in clarifying past contradictory studies by using clearly defined criteria to determine ADHD, a representative age range of participants, carefully selected tests, and a control task. The two measures that were administered to assess frontal lobe functioning were the Wisconsin Card Sorting Test and the Stroop Color and Word Test. The Purdue Pegboard was used as a control measure that did not assess frontal lobe functioning. The findings indicate that the ADHD group performed significantly worse on the following: color score, color/word score, and interference score of the Stroop Color and Word Test; percent of perseverative responses, percent of perseverative errors, and number of completed categories of the Wisconsin Card Sorting Test. No differences were found on the Purdue Pegboard task.     

Categorization behaviour in adults,adolescents, and attention-deficit/hyperactivity disorder adolescents: A comparative investigation

Although significant progress has been made with respect to our understanding of categorization and concept learning behaviour in adults, much less is known about how this key capacity plays out with respect to more restrictive populations. This is unfortunate because much may be revealed about the nature of concept learning by examining the limits exhibited by special populations. With this tenet in mind, in what follows, we investigated key aspects of concept learning in terms of the unexplored comparative performance of three populations—adults, adolescents, and adolescents with attention-deficit/hyperactivity disorder (ADHD). To do so, we employed a novel parainformative experimental task involving categorical stimuli with four objects defined over three dimensions. The learning difficulty ordering for these types of three-dimensional stimuli has proven robust and has been replicated by several researchers. Indeed, in our experiment, we observed the same concept learning ordering in adults and adolescents, but not in ADHD adolescents: For example, the latter group showed greatly impaired categorization performance on stimuli characterized by an “exclusive-or” rule. However, categorization performance on such type of stimuli indicated good reliability in discriminating between adolescents with and without ADHD (receiver-operating characteristic, ROC?=?.82). We accurately predicted and accounted for these results using generalized invariance structure theory (GIST; Vigo, 2013. The GIST of concepts. Cognition, 129, 138–162), which posits that organisms detect invariance patterns in stimuli that are necessary precursors to concept formation.     

A psychoanalytic perspective on attention-deficit/hyperactivity disorder

Psychoanalysts have tended to view the diagnosis of AD/HD either with skepticism or as a contraindication to analytic treatment. The author reviews the history of this puzzling diagnostic entity, which is estimated to account for up to fifty percent of child referrals, and suggests that a psychoanalytic perspective on the underlying disturbance in ego functioning helps to clarify the nature of the symptom picture. Whatever the etiology, which may be compound, she suggests that psychoanalytic treatment, most often in conjunction with psychopharmacological therapy, can address the core disturbance in ego integration that creates the familiar triad of inattention, impulsivity, and hyperactivity.     

Secondary attention-deficit/hyperactivity disorder following perinatal and childhood stroke: impact on cognitive and academic outcomes

This cross-sectional retrospective clinical research study examines a large group of children followed within a pediatric stroke program and a developmental attention-deficit/hyperactivity disorder (ADHD) clinic at the Hospital for Sick Children, between May 2004 and June 2016. All children with a history of stroke who participated in a neuropsychological assessment between the ages of 4 and 18 years were considered for inclusion. From a sample of 275 participants with a history of stroke, 36 children (13.1%) received a diagnosis of secondary ADHD. Children with secondary ADHD were younger at the time of stroke and more likely to be identified as having a presumed perinatal stroke and persistent seizures than children without secondary ADHD diagnoses. There were no differences in pattern of lesion, size, or laterality between children who developed secondary ADHD and those who did not. Children with secondary ADHD had the lowest scores across all cognitive and academic measures compared to children with stroke-only and developmental ADHD. Findings highlight the added risk of receiving a diagnosis of secondary ADHD following pediatric stroke. Implications for future research and directed intervention are discussed.     

Gait control in children with attention-deficit/hyperactivity disorder

The current profile of gait control in children with ADHD is incomplete and predominately based on children walking forward at a self-selected pace. There are no studies of potential gait deficits in this clinical population when walking in different directions in combination with varying rates of stepping that are freely selected and entrained to an external stimulus. The purpose of the current study was to address this lack of information by assessing gait of children aged 7–17 years with (n = 17) and without (n = 26) ADHD. Participants walked forward and backward along an electronically instrumented carpet at a self-selected stepping rate and in synchrony to a metronome that dictated an increased and decreased stepping rate. Using repeated measures analysis of covariance (ANCOVA) to assess spatiotemporal gait parameters, results showed that children with ADHD exhibited a significantly exaggerated, toes ‘turned out,’ foot position for all walking conditions compared to typically developing children. When walking backward, children with ADHD produced an increased step width, higher stepping cadence, and increased velocity. Additionally, coefficient of variation ratios indicated that children with ADHD produced greater variability of velocity, cadence, and step time for all walking conditions, and greater variability for stride length when walking at an increased stepping rate. Results were interpreted in terms of clinical significance and practical ramifications that inform rehabilitation specialists in designing therapies that ameliorate the reported gait deficits.     

Non-stimulant treatment of attention-deficit/hyperactivity disorder

Stimulants are a highly efficacious and safe treatment for attention-deficit/hyperactivity disorder (ADHD), with 75% to 90% of patients responding well if two different stimulants (amphetamine and methylphenidate) are used. Nonetheless, a subset of ADHD patients will either fail to respond to stimulants or have side effects that preclude their use (tics, severe loss of appetite, marked insomnia). For such patients, there are a number of non-stimulant agents that serve as second-line treatments. Tricyclic antidepressants (TCAs) are the most studied of these drugs. They are superior to placebo in the treatment of ADHD and may reduce abnormal movements in patients with ADHD/tic disorder. TCAs often produce side effects of sedation, dry mouth, and constipation. Bupropion is superior to placebo in the treatment of ADHD and has a more favorable side-effect profile than the TCAs. A new selective norepinephrine reuptake inhibitor, atomoxetine, has been shown to be efficacious in the treatment of ADHD and has recently received an approvable letter from the Food and Drug Administration. The a-agonists clonidine and guanfacine have also been used as alternative agents in ADHD, though the controlled data are more limited. A recent controlled clinical trial suggests a combination of methylphenidate and clonidine has advantages in the treatment of comorbid ADHD and tics over either medication alone. Clinical guidelines for each of these agents, as well as their use in combination with stimulants in comorbid conditions, will be discussed.     

A web-based intervention for elementary school teachers of students with attention-deficit/hyperactivity disorder (ADHD)

The goal of the present study was to determine whether a web-based medium is an effective tool for supporting knowledge, attitude, and behavior change in teachers of elementary school children with attention-deficit/hyperactivity disorder (ADHD). Nineteen teachers from Nova Scotia, Canada completed a 7-week intervention that consisted of presentations, web links, and discussion board activities related to different aspects of ADHD. Teachers' knowledge positively changed from pre- to post-intervention (p = .03), as did teachers' attitudes related to perceived control in their classrooms (p = .001) and competence in teaching (p < .0001). The study demonstrated that a web-based medium is a useful tool for knowledge creation and translation and has potential as a means of providing professional development to teachers about ADHD.