The heterogeneity of attention‐deficit/hyperactivity disorder symptoms and conduct problems: Cognitive inhibition,emotion regulation,emotionality, and disorganized attachment

This study examined the contributions of several important domains of functioning to attention‐deficit/hyperactivity disorder (ADHD) symptoms and conduct problems. Specifically, we investigated whether cognitive inhibition, emotion regulation, emotionality, and disorganized attachment made independent and specific contributions to these externalizing behaviour problems from a multiple pathways perspective. The study included laboratory measures of cognitive inhibition and disorganized attachment in 184 typically developing children (M age = 6 years, 10 months, SD = 1.7). Parental ratings provided measures of emotion regulation, emotionality, and externalizing behaviour problems. Results revealed that cognitive inhibition, regulation of positive emotion, and positive emotionality were independently and specifically related to ADHD symptoms. Disorganized attachment and negative emotionality formed independent and specific relations to conduct problems. Our findings support the multiple pathways perspective on ADHD, with poor regulation of positive emotion and high positive emotionality making distinct contributions to ADHD symptoms. More specifically, our results support the proposal of a temperamentally based pathway to ADHD symptoms. The findings also indicate that disorganized attachment and negative emotionality constitute pathways specific to conduct problems rather than to ADHD symptoms.     

Emotional stimuli facilitate time perception in children with attention‐deficit/hyperactivity disorder

The aim of this study was to compare the effect of different emotional stimuli (neutral, positive, and negative) on time perception in children with attention‐deficit/hyperactivity disorder (ADHD) and normal children in dual‐task form. Five hundred and ninety‐nine students from primary schools were randomly selected. The Conner's Teacher Rating Scale (CTRS) questionnaire was completed by teachers. A total of 100 children with a score above the cut‐off point for the CTRS were further assessed using the Child Symptom Inventory‐4 (CSI‐4). A total of 34 children with ADHD and 31 controls completed an emotional time discrimination task in two blocks of 1000 and 2000 ms duration. Children were asked to compare three image groups: neutral with neutral, neutral with positive, and neutral with negative images. Children with ADHD had significantly better performance in the emotional time discrimination task across all conditions when compared with controls: On average, discrimination thresholds were approximately 35 ms shorter for the children with ADHD. Our results indicate that children with ADHD have higher sensitivity to time relative to controls in a situation in which they must distribute resources between temporal and emotional processing. On the basis of the interference effect and the working memory capacity hypothesis, this dividing of attention causes a decrease of time accuracy in normal children.     

注意缺陷多动障碍-发展性阅读障碍共患儿童的干预效果及其内在机理

注意缺陷多动障碍和发展性阅读障碍是两类常见的儿童神经发育障碍, 二者共患率高达25%~48%。共患问题不仅使儿童自身面临着严重的认知、行为和心理损害, 还给家庭、学校和社会带来了沉重的负担, 对共患儿童的干预是极为必要且重要的。以共患病理机制假说为基础, 可将既往共患儿童的干预研究划分为以下两大类：(1)基于表型假说的干预方案, 如药物干预、阅读干预以及二者联合干预, 相应方案干预效果的迁移性和稳定性均有待深入考究; (2)基于共同缺陷假说的干预方案, 如针对核心共同认知缺陷之一的加工速度问题的干预已初显成效, 但相关研究较少, 干预效果需更多研究进一步系统性地考察。最后就共患儿童的干预方案现状进行了反思和展望。     

Direct assessment of the cognitive correlates of attention deficit disorders with and without hyperactivity

The cognitive functioning of children identified as attention deficit disorder with hyperactivity (ADD/H) was compared to that of children identified as attention deficit disorder without hyperactivity (ADD/WO). Based on information on symptoms supplied by teachers, 20 ADD/H and 15 ADD/ WO children were selected according to DSM-III criteria from a large elementaryschool learning disabilities and behavior disorders population. For comparison purposes, 16 normal children from regular classrooms were also selected. Children from all three groups were evaluated with a battery of cognitive tests. Intelligence test scores differentiated the two ADD groups, with the ADD/H children obtaining significantly lower Full Scale IQ scores than both ADD/WO and control children. In addition, ADD/H children obtained significantly lower Verbal IQ scores than ADD/WO children. Both ADD groups performed more poorly than controls on Spelling and Reading Achievement, and the ADD/WO group performed more poorly on Math Achievement. The two ADD groups took longer to complete six Stroop and rapid naming tasks than the control groups but did not differ among themselves. The ADD/WO group made more errors on a visual matching task than the controls, but neither ADD group differed from controls on the accuracy of the Stroop tasks, rapid naming tasks, measures of receptive and expressive language, visual-motor integration, or sustained visual attention. The differences between the two ADD groups were fewer than expected on the basis of previous research and are more global than specific.The assistance of John Junginger, Jason Walker, and Cynthia Jones at various stages of the project is gratefully acknowledged. Particular thanks are extended to the teachers and staff of Clarke County schools.     

Working memory – not processing speed – mediates fluid intelligence deficits associated with attention deficit/hyperactivity disorder symptoms

Attention deficit/hyperactivity disorder (ADHD) is a psychological condition characterized by inattention and hyperactivity. Cognitive deficits are commonly observed in ADHD patients, including impaired working memory, processing speed, and fluid intelligence, the three of which are theorized to be closely associated with one another. In this study, we aimed to determine if decreased fluid intelligence was associated with ADHD, and was mediated by deficits in working memory and processing speed. This study tested 142 young adults from the general population on a range of working memory, processing speed, and fluid intelligence tasks, and an ADHD self‐report symptoms questionnaire. Results showed that total and hyperactive ADHD symptoms correlated significantly and negatively with fluid intelligence, but this association was fully mediated by working memory. However, inattentive symptoms were not associated with fluid intelligence. Additionally, processing speed was not associated with ADHD symptoms at all, and was not uniquely predictive of fluid intelligence. The results provide implications for working memory training programs for ADHD patients, and highlight potential differences between the neuropsychological profiles of ADHD subtypes.     

Assessment of impulsivity and the development of self-control in students with attention deficit hyperactivity disorder.

We examined a combined approach of manipulating reinforcer dimensions and delay fading to promote the development of self‐control with 3 students diagnosed with attention deficit hyperactivity disorder. First, we administered a brief computer‐based assessment to determine the relative influence of reinforcer rate (R), reinforcer quality (Q), reinforcer immediacy (I), and effort (E) on the students' choices between concurrently presented math problems. During each session, one of these dimensions was placed in direct competition with another dimension (e.g., RvI involving math problem alternatives associated with high‐rate delayed reinforcement vs. low‐rate immediate reinforcement), with all possible pairs of dimensions presented across the six assessment conditions (RvQ, RvI, RvE, QvI, QvE, IvE). The assessment revealed that the choices of all 3 students were most influenced by immediacy of reinforcement, reflecting impulsivity. We then implemented a self‐control training procedure in which reinforcer immediacy competed with another influential dimension (RvI or QvI), and the delay associated with the higher rate or quality reinforcer alternative was progressively increased. The students allocated the majority of their time to the math problem alternatives yielding more frequent (high‐rate) or preferred (high‐quality) reinforcement despite delays of up to 24 hr. Subsequent readministration of portions of the assessment showed that self‐control transferred across untrained dimensions of reinforcement.     

Testing the ability of children with attention deficit hyperactivity disorder to accurately report the effects of medication on their behavior

Children with attention deficit hyperactivity disorder (ADHD) are often treated with central nervous system stimulants, making the evaluation of medication effects an important topic for applied behavior analysts. Because assessment protocols emphasize informant reports and direct observations of child behavior, little is known about the extent to which children themselves can accurately report medication effects. Double-blind placebo-controlled procedures were used to examine whether 6 children with ADHD could recognize the effects of their medication. The children were given math worksheets to complete for 15 min during each of 14 sessions while on medication and placebo. Children completed a self-evaluation form at the end of each session, and ratings were compared to observed behavior and academic performance. Results indicated that 3 children were able to accurately report their medication status at levels greater than chance, whereas the accuracy of reports by all children was related to dosage level, differences in behavior, and the presence of adverse effects. The implications of these results for placebo-controlled research, self-monitoring of dosage levels, and accuracy training are discussed.     

Neurocognitive performance of 5- and 6-year-old children who met criteria for attention deficit/hyperactivity disorder at 18 months follow-up: results from a prospective population study

The aim of this prospective study was to examine whether neurocognitive performance of children aged 5–6 years distinguished children who were later diagnosed with attention deficit/hyperactivity disorder (ADHD) or borderline ADHD from children without ADHD after adjustment for behavioral measures and to examine the influence of comorbid psychopathology. Out of a general population of 1,317 children, 366 children were selected on the basis of their scores on the Child Behavior Checklist (CBCL). Eighteen months later, the parents were interviewed using a standardized child psychiatric interview: 33 children were classified as ADHD and 75 children as borderline ADHD, and there were 258 children without ADHD. Children with rated ADHD were significantly impaired on measures of visuomotor ability and working memory compared to children without ADHD after adjustment for CBCL results. The performance of borderline ADHD children was in between that of children with and without ADHD. In addition, 4 groups of children were analyzed: 9 ADHD, 24 ADHD with comorbid oppositional defiant disorder/conduct disorder (ODD/CD), 59 ODD/CD, and 274 controls. Children with rated comorbid ADHD and ODD/CD performed significantly worse on these tasks compared to children with rated ODD/CD and control children while they did not differ from ADHD children. Our results imply that neurocognitive measures can contribute to the early identification of ADHD with and without comorbid ODD/CD.     

The association between risky decision making and attention-deficit/hyperactivity disorder symptoms: A preregistered assessment of need for cognition as underlying mechanism

Attention-Deficit/Hyperactivity Disorder (ADHD) is related to suboptimal decision making in experimental tasks and to real-life risk-taking behavior (RTB) such as substance abuse and unsafe traffic conduct. In this preregistered study, we tested whether these associations are mediated by need for cognition—the extent to which one tends towards, and enjoys, analytical thought. In a large sample of young adults (N = 463, M_age = 19.7 years), we tested whether need for cognition mediated the association between self-reported ADHD symptoms on the one hand and decision-making strategy complexity on an experimental gambling task and self-reported real-life RTB on the other hand. Preregistered confirmatory analyses indicated first that ADHD symptoms were positively associated with real-life RTB, but the association was not mediated by need for cognition. Second, ADHD symptoms were not related to decision-making strategy complexity, and need for cognition was not a significant mediator. Explorative analyses revealed that (a) need for cognition was associated with higher decision-making accuracy and slower reaction time; (b) need for cognition was related to inattentive but not to hyperactive/impulsive ADHD symptoms; (c) need for cognition was associated with health-related RTB but not interpersonal RTB; and (4) only the association between inattention and health-related RTB was mediated by need for cognition. We conclude that need for cognition is not a mediator in the association between ADHD symptoms and RTB. Additionally, we conclude that neither ADHD symptoms nor need for cognition predict decision-making strategy complexity. Implications for both future research and clinical practice are discussed.     

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

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

Relationships between cognition and literacy in children with attention-deficit/hyperactivity disorder: A systematic review and meta-analysis

Evidence suggests that cognitive and literacy difficulties are common for children with Attention-Deficit/Hyperactivity Disorder (ADHD). The current systematic review and meta-analysis investigated the relationship between cognition and literacy in children with ADHD. Ten thousand and thirty-eight articles were screened against the inclusion criteria and six eligible studies were retained for final review. Where two or more studies used comparable measures of cognition and literacy, a meta-analysis of the relationship between these measures was undertaken. A narrative synthesis of all included studies was also completed. There were medium effect sizes between working memory and aspects of reading, and small effect sizes between processing speed and reading. Inhibition and attention had differential relationships with aspects of literacy with varying effect sizes. This systematic review demonstrates differential relationships between aspects of literacy and cognition in children with ADHD. Further examination of these relationships is warranted to support intervention development.     

Cross-lateralisation in children with attention-deficit/hyperactivity disorder and motor skill performance

Cross-lateralisation and increased motor difficulties have been reported in children with attention-deficit/hyperactivity disorder (ADHD). Nevertheless, the question of how crossed (i.e. mixed preference) or uncrossed (i.e. same side preference) lateralisation impacts motor performance in children with ADHD has yet to be examined. In this study, previously validated observational measures of hand and foot preference were used to identify right-handed children with ADHD who display cross- (n = 29) and uncross-lateralisation (n = 31). An uncross-lateralised typically developing (TD) group (n = 32) was also identified, and included as a control. Motor performance was assessed with seven valid and reliable fine and gross motor tasks performed with both preferred and non-preferred limbs. Group, task and sex-related effects were examined. Findings revealed that male (but not female) cross-lateralised children with ADHD performed significantly worse, respectively, in two of the fine motor tasks (spiral tracing [p < .01], and dot filling [p < .05]). Results suggest that cross-lateralised hand and foot preference may affect complex motor skills in male children with ADHD. Furthermore, characteristics of ADHD may manifest differently in male and female children. Findings highlight the importance of considering both hand and foot preference when targeting motor interventions for children with ADHD.     

Inattention,working memory,and academic achievement in adolescents referred for attention deficit/hyperactivity disorder (ADHD)

This study investigated the role of inattention and working memory in predicting academic achievement in 145 adolescents aged 13 to 18 referred for attention deficit/hyperactivity disorder (ADHD). Path analysis was used to examine whether auditory-verbal and visual-spatial working memory would mediate the relationships between classroom inattention symptoms and achievement outcomes. Results provide support for the mediational model. Behavioral inattention significantly predicted both auditory-verbal and visual-spatial working memory performance. Auditory-verbal working memory was strongly associated with adolescents' achievement in reading and mathematics, while visual-spatial working memory was only associated with achievement in mathematics. The path from inattention symptoms to reading was partially mediated by the working memory variables, but the path from inattention to mathematics was not mediated by working memory. The proposed model demonstrated a good fit to the data and explained a substantial amount of variance in the adolescents' achievement outcomes. These findings imply that working memory is a risk factor for academic failure for adolescents with attentional problems.     

Group Narrative Therapy for Women With Attention‐Deficit/Hyperactivity Disorder

Women with attention‐deficit/hyperactivity disorder (ADHD) often struggle with the developmental challenges of adulthood and ADHD‐related problems. The authors provide specific clinical interventions from a narrative‐based group approach to help women with ADHD understand their symptoms, create strength‐based narratives, and apply these narratives to the developmental tasks of early adulthood.     

The effects of co‐occurring ADHD symptoms on electrophysiological correlates of cognitive control in young people with Tourette syndrome

Efficient cognitive control is implicated in tic control in young people with Tourette syndrome (TS). Attention‐deficit/hyperactivity disorder (ADHD) frequently co‐occurs with TS and is associated with impaired cognitive control. Young people with TS and ADHD (TS+ADHD) show poorer cognitive control performance than those with TS, but how co‐occurring ADHD affects underlying neural activity is unknown. We investigated this issue by examining behavioural and event‐related potential (ERP) correlates of cognitive control in young people with these conditions. Participants aged 9–17 with TS (n = 17), TS+ADHD (n = 17), ADHD (n = 11), and unaffected controls (n = 20) performed a visual Go/Nogo task during electroencephalography (EEG) recording. Behavioural performance measures (D‐prime, RT, reaction time variability, post‐error slowing) and ERP measures (N2, P3, error‐related negativity (ERN), error positivity (Pe)) were analysed in a 2 (TS‐yes, TS‐no) × 2 (ADHD‐yes, ADHD‐no) factorial analysis to investigate the effects of TS, ADHD, and their interaction. The results of these analyses showed that ADHD was associated with poorer performance and reduced amplitude of all ERPs, reflecting widespread cognitive control impairments. Tourette syndrome was associated with slowed RTs, which might reflect a compensatory slowing of motor output to facilitate tic control. There was no interaction between the TS and ADHD factors for any behavioural or ERP measure, indicating the impairing effects of ADHD on behaviour and electrophysiological markers of cognitive control were present in TS+ADHD and that RT slowing associated with TS was unaffected by co‐occurring ADHD symptoms.     

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

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

Latent Inhibition and Asymmetrical Visual-Spatial Attention in Children with ADHD

The research was designed to determine whether the purported hemispheric asymmetries that are associated with attention deficit/hyperactivity disorder (ADHD) affect performance on a selective attention visual search task, and whether any obtained asymmetry will be modulated by methylphenidate. Two groups of children (8–15 years) with ADHD, one with methylphenidate treatment (ADHD+) and one without (ADHD+), were compared to matched controls on a two-stage visual search task. The task assessed right–left visual field asymmetries and the effects of changing a previous distractor into a target. Such a procedure, related to latent inhibition (LI; poorer performance to a previously irrelevant stimulus than to a novel one), can provide evidence for dysfunctional processing of irrelevant stimuli. All three groups exhibited the LI effect. The ADHD group, however, exhibited less LI for left- than right-side targets, an effect absent in the control and ADHD+ groups, suggesting a lateralized attentional deficit for ADHD+ that was normalized by methylphenidate.