Social Skills Differences among Attention-Deficit/Hyperactivity Disorder Types in a Chat Room Assessment Task

This study assessed social skills in 116 children aged 7-12 with ADHD-Combined Type (ADHD-C; n=33), ADHD-Inattentive Type (ADHD-I; n=45), and comparison children (n=38), with consideration of the role sluggish cognitive tempo (SCT) symptoms play in distinguishing profiles. Social skills were assessed using a novel computerized chat room task, in which participants were encouraged to join a conversation and type messages to interact with four computer-simulated peers. Every participant received the identical stimulus from the simulated peers, but was free to respond to it in his or her own unique way. Relative to comparison children, children with ADHD-C made off-topic and hostile responses; children with ADHD-I made off-topic responses, few responses and showed poor memory for the conversation. ADHD subtype differences remained after statistical control of IQ, reading achievement, typing skill, and comorbid disruptive behavior disorders. SCT symptoms, most prevalent among children with ADHD-I, predicted a distinct pattern of social withdrawal and lower hostility. Parent and teacher ratings and in-vivo observations of social skills correlate with this new measure.     

Deficit in Response Inhibition in Children with Attention Deficit/Hyperactivity Disorder (ADHD): Impact of Motivation?

To date, neuropsychological and psycho-physiological studies have revealed inconsistent results regarding an executive or motivational deficit explaining the response inhibition deficit in children with attention deficit/hyperactivity disorder (ADHD). Research on differentiating neuropsychological processes in ADHD subtypes is still scarce. Therefore, the motivational impact on response inhibition among boys with ADHD was examined in this study. In the first study, 19 boys with ADHD-combined type (ADHD-C) and 19 age-matched healthy control subjects performed a modified Go/No-Go task with the following experimental conditions: neutral, auditory feedback, reward, response cost, and reward/response cost. Performance and physiological data (heart rate and skin conductance responses) were recorded. In a second study with the modified Go/No-Go task, data for six children with ADHD-C, six with ADHD-inattentive subtype (ADHD-I), and six healthy control subjects were compared. Neither of the two studies revealed group by condition interactions. In study 1, boys with ADHD-C generally made more commissions and omissions compared to the control group. However, feedback significantly improved the response inhibition in all children. The heart rate of all children was increased in the two conditions of reward and reward/response cost. Study 2 revealed that children with ADHD-I responded more slowly and showed increased reaction time variability compared to both other groups. The present study supports an executive rather than a motivational deficit in the response inhibition among children with ADHD-C, though further results also indicate the role of auditory feedback on response inhibition. Additionally, the findings support the differentiation of ADHD-C and ADHD-I, suggesting that ADHD-I children are characterized by a sluggish cognitive tempo.     

Social functioning and emotional regulation in the attention deficit hyperactivity disorder subtypes

Compared 16 children with attention deficit hyperactivity disorder (ADHD) combined type (ADHD-C), 14 children with ADHD predominantly inattentive type (ADHD-I), and 17 controls on parent and teacher ratings of social status and performance, self-report of social knowledge and performance, and observations of behavior on an emotional regulation task. Analyses revealed distinct patterns of social dysfunction between ADHD subgroups. Children with ADHD-C were rated as showing more aggressive behavior; furthermore, they displayed emotional dysregulation characterized by high intensity and high levels of both positive and negative behavior. In contrast, children with ADHD-I were perceived as displaying social passivity and showed deficits in social knowledge on the self-report measure but did not evidence problems in emotional regulation. Regression analyses revealed that social performance, emotional regulation, and, to a lesser degree, social knowledge, were predictive of social status. The application of these findings to understanding the nature of the social deficits in the ADHD subtypes and directions for future research are discussed.     

不同亚型ADHD儿童的视通道时距估计能力

本研究选取ADHD混合型儿童11名,ADHD注意缺损型儿童13名以及正常儿童15名,通过"平均估计长度"、"平均估计误差百分比"、"估计变异值"三个指标,考察不同亚型ADHD儿童在时距复制和言语估计上的稳定性和精确性。研究发现,在视觉刺激条件下,ADHD儿童的时距估计缺损并不受时距长度的影响;ADHD混合型儿童在多项任务中所表现的稳定性和精确性都差,而ADHD缺损型儿童只是稳定性差,说明ADHD混合型是ADHD中更严重的亚类型;ADHD儿童在时距估计任务中稳定性差,反映了其状态调节能力的落后。     

The Internal and External Validity of Sluggish Cognitive Tempo and its Relation with DSM–IV ADHD

Studies of subtypes of DSM-IV attention-deficit/hyperactivity disorder (ADHD) have provided inconsistent support for the discriminant validity of the combined type (ADHD-C) and predominantly inattentive type (ADHD-I). A large sample of children and adolescents with ADHD (N?=?410) and a comparison group without ADHD (N?=?311) were used to test the internal and external validity of sluggish cognitive tempo (SCT), a dimension characterized by low energy and sleepy and sluggish behavior. SCT scores were then incorporated in analyses of ADHD subtypes to test whether the discriminant validity of ADHD-C and ADHD-I could be improved by including SCT symptoms as part of the criteria for ADHD-I. Factor analyses of parent and teacher ratings indicated that six SCT items loaded on a factor separate from symptoms of ADHD and other psychopathology, providing important support for the internal validity of SCT. The external validity of SCT was supported by significant associations between SCT and measures of functional impairment and neuropsychological functioning when symptoms of ADHD and other psychopathology were controlled. However, contrary to initial predictions, high levels of SCT did not identify a subgroup of ADHD-I that was clearly distinct from ADHD-C. Instead, the current results suggest that DSM-IV inattention and SCT are separate but correlated symptom dimensions that are each independently associated with important aspects of functional impairment and neuropsychological functioning.     

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.     

Differences in cognitive control in children and adolescents with combined and inattentive subtypes of ADHD

The aim of the present study was to investigate the ability of children with attention deficit/hyperactivity disorder-combined subtype (ADHD-C) and predominantly inattentive subtype (ADHD-PI) to direct their attention and to exert cognitive control in a forced attention dichotic listening (DL) task. Twenty-nine, medication-naive participants with ADHD-C, 42 with ADHD-PI, and 40 matched healthy controls (HC) between 9 and 16 years were assessed. In the DL task, two different auditory stimuli (syllables) are presented simultaneously, one in each ear. The participants are asked to report the syllable they hear on each trial with no instruction on focus of attention or to explicitly focus attention and to report either the right- or left-ear syllable. The DL procedure is presumed to reflect different cognitive processes: perception (nonforced condition/NF), attention (forced-right condition/FR), and cognitive control (forced-left condition/FL). As expected, all three groups had normal perception and attention. The children and adolescents with ADHD-PI showed a significant right-ear advantage also during the FL condition, while the children and adolescents in the ADHD-C group showed a no-ear advantage and the HC showed a significant left-ear advantage in the FL condition. This suggests that the ADHD subtypes differ in degree of cognitive control impairment. Our results may have implications for further conceptualization, diagnostics, and treatment of ADHD subtypes.     

Axis I and II comorbidity in adults with ADHD

Ongoing debate over the validity of the attention-deficit/hyperactivity disorder (ADHD) construct in adulthood is fueled in part by uncertainty regarding implications of potentially extensive yet incompletely described comorbid Axis I and II psychopathology. Three hundred sixty-three adults ages 18 to 37 completed semistructured clinical interviews; informants were also interviewed, and best estimate diagnoses were obtained. Results were as follows: First, ADHD combined type (ADHD-C) had an excess of externalizing and internalizing Axis I disorders, suggesting a gradient-of-severity relationship between it and ADHD inattentive type (ADHD-I). Second, ADHD-C and ADHD-I did not differ in frequency of Axis II disorders. Third, however, ADHD overall was associated with increased rates of Axis II disorders, compared with rates in non-ADHD control participants, including both Cluster B (primarily borderline personality disorder) and Cluster C disorders. Fourth, ADHD incrementally accounted for clinician-rated global assessment of functioning scores above and beyond comorbid conditions or symptoms on either Axis I or Axis II. Results further inform nosology of ADHD in adults.     

Eating pathology among adolescent girls with attention-deficit/hyperactivity disorder

The authors investigated prospectively assessed eating pathology (body image dissatisfaction and bulimia nervosa symptoms) among an ethnically and socioeconomically diverse sample of adolescent girls with attention-deficit/hyperactivity disorder-combined type (ADHD-C; n=93), ADHD-inattentive type (ADHD-I; n=47), and a comparison group (n=88). The sample, initially ages 6-12 years, participated in a 5-year longitudinal study (92% retention rate). After statistical control of relevant covariates, girls with ADHD-C at baseline showed more eating pathology at follow-up than did comparison girls; girls with ADHD-I were intermediate between these two groups. Baseline impulsivity symptoms, as opposed to hyperactivity and inattention, best predicted adolescent eating pathology. With statistical control of ADHD, baseline peer rejection and parent- child relationship problems also predicted adolescent eating pathology. The association between punitive parenting in childhood and pathological eating behaviors in adolescence was stronger for girls with ADHD than for comparison girls. Results are discussed in terms of the expansion of longitudinal research on ADHD to include female-relevant domains of impairment, such as eating pathology.     

Profiles of everyday executive function in acquired and developmental disorders.

Executive function profiles were examined within and between several clinical disorders via the multi-domain Behavior Rating Inventory of Executive Function (BRIEF; Gioia, Isquith, Guy, & Kenworthy, 2000). Parent ratings of children with Inattentive and Combined types of Attention-Deficit/Hyperactivity Disorder (ADHD-I, ADHD-C), Autistic Spectrum Disorders (ASD), moderate and severe Traumatic Brain Injury (TBI), and Reading Disabilities (RD) were compared with controls. Profile analysis revealed significant (p<.01) and substantial (eta2>.10) differences in global elevations and in profile of scale elevations between diagnostic groups. ASD, ADHD-I and ADHD-C groups exhibited greater elevations across the BRIEF scales than did RD and Severe TBI groups, who were in turn more elevated than Moderate TBI and Control groups. The ADHD-C group was unique in its frequency and severity of inhibitory deficits, while the ASD group was distinguishable by its deficits in flexibility. Within diagnostic groups, relative risk for executive dysfunction was calculated with variability present in the frequency of clinically elevated scales. While the BRIEF captures executive profiles characteristic of specific disorders in the clinical setting, it is not diagnostic in its own right and is best used within the context of a broad based evaluation.     

Age-related trends in Stroop and conflicting motor response task findings.

Inhibition problems are reportedly at the heart of several childhood pathologies and learning disorders, but few instruments are available for their in-depth investigation. The main aim of the present study was to investigate the development of a capacity to inhibit automatic responses in young and middle childhood. For this purpose, 100 children between 6 and 11 years old were administered two tests that measure executive inhibition: an animal Stroop task (in a paper-and-pencil version of the computerized original proposed by Wright and colleagues in 2003) and a conflicting motor response task. Our results indicate that performance clearly improves in both tests during the course of a child's development and the data obtained with the paper-and-pencil animal Stroop task overlap with those obtained with the computerized version. When the task calls for a stronger inhibitory control (the incongruent situation in the Stroop task and in the opposite condition in the conflicting motor response test) the trend of the response times is less homogeneous, peaking in the youngest and oldest age brackets considered. The positivity and significance of the correlation coefficients between the two tests also suggest that the two measures are tapping cognitive abilities that are developing in a parallel fashion.     

Age-related trends in Stroop and conflicting motor response task findings

Inhibition problems are reportedly at the heart of several childhood pathologies and learning disorders, but few instruments are available for their in-depth investigation. The main aim of the present study was to investigate the development of a capacity to inhibit automatic responses in young and middle childhood. For this purpose, 100 children between 6 and 11 years old were administered two tests that measure executive inhibition: an animal Stroop task (in a paper-and-pencil version of the computerized original proposed by Wright and colleagues in 2003) and a conflicting motor response task. Our results indicate that performance clearly improves in both tests during the course of a child's development and the data obtained with the paper-and-pencil animal Stroop task overlap with those obtained with the computerized version. When the task calls for a stronger inhibitory control (the incongruent situation in the Stroop task and in the opposite condition in the conflicting motor response test) the trend of the response times is less homogeneous, peaking in the youngest and oldest age brackets considered. The positivity and significance of the correlation coefficients between the two tests also suggest that the two measures are tapping cognitive abilities that are developing in a parallel fashion.     

Attention Deficit Hyperactivity Disorder,differential diagnosis with blood oxygenation,beta/theta ratio,and attention measures

Attention Deficit Hyperactivity Disorder (ADHD) is one of the disorders causing the greatest impact, conditioning academic learning, quality of concentration, and capacity for self-regulation and control. The Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV-TR) establishes the most commonly accepted criteria for diagnosis (Inattentive: ADHD-I, Hyperactive/impulsive: ADHD-HI, and Combined: ADHD-C), but currently, diverse studies disagree about whether to address it as a continuum with different degrees of intensity (subtype structure) or as specific disorders (counterposed profiles). Prior research has tested the hypothesis of differential categories with performance measures and cortical activation. The goal proposed herein is to confirm these results, incorporating a new measure, near-infrared hemoencefalography (nir-HEG), in order to control cortical activation through levels of blood oxygenation. For this purpose, we used a sample of 205 children between 8 and 13 years (105 control group, 28 with ADHD-I, 35 with ADHD-HI, and 37 with ADHD-C), administering a continuous performance test (TOVA), quantified electroencephalogram (Q-EEG), and nir-HEG. Results reflect the counterposed profiles hypothesis instead of the degrees of intensity, although the latter is more habitual and generalized.     

Memory in Early Onset Bipolar Disorder and Attention-Deficit/Hyperactivity Disorder: Similarities and Differences

Differentiating between early-onset bipolar disorder (BD) and attention-deficit/hyperactivity disorder (ADHD) can be difficult. Memory problems are commonly reported in BD, and forgetfulness is among the diagnostic criteria for ADHD. We compared children and adolescents with BD (n?=?23), ADHD combined type (ADHD-C; n?=?26), BD?+?ADHD-C (n?=?15), and 68 healthy controls on memory tests (Digit span, Children's Verbal Learning Test-II). Further analyses were performed on subgroups of BD (BD-I, BD-II/BD-NOS, with and without previous psychotic symptoms). All clinical groups demonstrated some problems with free recall, but the BD subgroup with a history of psychotic symptoms had a more pervasive problem that also included recognition and semantic clustering. The ADHD-C groups demonstrated the lowest performance on working memory. These data suggest that children and adolescents with BD and previously psychotic symptoms may have inefficient encoding of verbal material, whereas memory problems in ADHD-C appear more characterized by impaired free recall.     

A Comparison of the Neuropsychological Profiles of the DSM-IV Subtypes of ADHD

Recent research on the DSM-IV subtypes of attention-deficit/hyperactivity disorder (ADHD) has demonstrated that the subtypes differ in demographic characteristics, types of functional impairment, and profiles of comorbidity with other childhood disorders. However, little research has tested whether the subtypes differ in underlying neuropsychological deficits. This study compared the neuropsychological profiles of children without ADHD (n = 82) and children who met symptom criteria for DSM-IV Predominantly Inattentive subtype (ADHD-IA; n = 67), Predominantly Hyperactive Impulsive subtype (ADHD-HI; n = 14), and Combined subtype (ADHD-C; n = 33) in the areas of processing speed, vigilance, and inhibition. We hypothesized that children with elevations of inattention symptoms (ADHD-IA and ADHD-C) would be impaired on measures of vigilance and processing speed, whereas children with significant hyperactivity/impulsivity (ADHD-HI and ADHD-C) would be impaired on measures of inhibition. Contrary to prediction, symptoms of inattention best predicted performance on all dependent measures, and ADHD-IA and ADHD-C children had similar profiles of impairment. In contrast, children with ADHD-HI were not significantly impaired on any dependent measures once subclinical symptoms of inattention were controlled. Our results do not support distinct neuropsychological deficits in ADHD-IA and ADHD-C children, and suggest that symptoms of inattention, rather than symptoms of hyperactivity/impulsivity, are associated with neuropsychological impairment.     

The Structure of Psychopathology in a Community Sample of Preschoolers

Despite growing interest in the development of alternative diagnostic classification systems for psychopathology in young children, little is known about the adequacy of the DSM symptom structure for describing psychopathology in this population. This paper examines the fit of the DSM-IV emotional (ED) and disruptive behavior disorder (DD) symptom structure in a community sample of 796 4-year-old children. Using the parent-report Child Symptom Inventory (CSI), the best model fit for ED included separate factors for Social Phobia, Separation Anxiety Disorder, Generalized Anxiety Disorder, and Major Depressive Disorder. For DD, the best model included separate Attention Deficit Hyperactivity Disorder-Inattentive type (ADHD-I), Attention Deficit Hyperactivity Disorder-Hyperactive/Impulsive type (ADHD-HI), and Oppositional Defiant Disorder diagnoses. These findings support using DSM-IV nosology to classify EDs in a community sample of preschool children, and suggest differentiation of ADHD into ADHD-I and ADHD-HI.     

Interference Effects in a Numerical Stroop Paradigm in 9- to 12-year-old Children with ADHD-C

Attention deficit hyperactivity disorder (ADHD) is characterized by deficient self-regulation, poor attentional control, and poor response inhibition. To date, however, the extent to which these deficits affect basic interference control remains a matter of controversy. Secondly, ADHD has been reported to be associated with arithmetic deficits. It remains unclear whether such deficits are a secondary consequence of the above-mentioned characteristics of ADHD or whether basic numerical magnitude representations are also affected. In the present study we attempted to investigate these issues using a basic numerical interference paradigm.

Nine- to twelve-year-old children with ADHD-C (attention-deficit hyperactivity-disorder combined type) and control children without ADHD (each n = 16) were presented with two digits of possibly different physical sizes (e.g., 3 7). This numerical Stroop task requires subjects to make a magnitude classification concerning either the physical or the numerical stimulus dimension. The irrelevant dimension can be congruent (same response), incongruent (different response), or neutral (no response association).

Children with ADHD-C performed worse than control children in most analyses. The most important finding was a significant interaction of congruity effects with group in the numerical comparison task. Children with ADHD-C tended to show larger congruity and interference effects than controls, and these were not attributable to a speed-accuracy trade-off.

The results might reflect differential processing speeds, or a different degree of automatic activation of physical and numerical magnitudes in children with and without ADHD-C. Alternative explanations, such as insufficient inhibition of selective (domain-specific) attention are also discussed.     

激活水平对两亚型ADHD儿童反应执行与抑制能力的影响

研究选取了混合型ADHD儿童14名,注意缺陷型ADHD儿童16名以及正常儿童18名,考察了在不同激活水平下,两亚型ADHD儿童之间,及其与正常儿童之间的反应执行能力与抑制能力的异同。采用传统的go/no-go任务,并将刺激间的时间间隔设置为1秒、4秒、8秒三种条件,分别对应高、中、低三种激活水平。结果发现,(1)与正常儿童相比,ADHD儿童的反应执行能力更容易受到激活水平的影响,且两亚型ADHD儿童受到的影响模式基本一致。具体而言:在高激活水平下,ADHD儿童与正常儿童差异最小;在中、低激活水平下,ADHD儿童与正常儿童差异增大,表明ADHD儿童状态调节能力落后。(2)两亚型ADHD儿童的功能缺损模式不同,混合型儿童在状态调节和反应抑制两方面都存在缺损,且其反应抑制缺陷不受激活水平影响;注意缺陷型儿童仅在状态调节方面受损。     

Web-based administration of a personality questionnaire: Comparison with traditional methods

The World-Wide Web holds great promise as a mechanism for questionnaire-based research. But are data from Web-based questionnaires comparable to data from standard paper-and-pencil questionnaires? This study assessed the equivalence of the Ruminative Responses Scale in a Web-based format and in a paper-and-pencil format among introductory psychology, upper-level psychology, and non-psychology students. Internal consistency coefficients were comparable across the groups. The participants in the Web sample reported higher levels of self-focused rumination than did the other groups. Women in the Web sample reported more self-focused rumination than did women in the other groups. In the Web sample, results did not covary with access location. These results suggest that findings from Web-based questionnaire research are comparable with results obtained using standard procedures. The computerized Web interface may also facilitate self-disclosure among research participants.     

Interference effects in a numerical Stroop paradigm in 9- to 12-year-old children with ADHD-C.

Attention deficit hyperactivity disorder (ADHD) is characterized by deficient self-regulation, poor attentional control, and poor response inhibition. To date, however, the extent to which these deficits affect basic interference control remains a matter of controversy. Secondly, ADHD has been reported to be associated with arithmetic deficits. It remains unclear whether such deficits are a secondary consequence of the above-mentioned characteristics of ADHD or whether basic numerical magnitude representations are also affected. In the present study we attempted to investigate these issues using a basic numerical interference paradigm. Nine- to twelve-year-old children with ADHD-C (attention-deficit hyperactivity-disorder combined type) and control children without ADHD (each n = 16) were presented with two digits of possibly different physical sizes (e.g., 3 7). This numerical Stroop task requires subjects to make a magnitude classification concerning either the physical or the numerical stimulus dimension. The irrelevant dimension can be congruent (same response), incongruent (different response), or neutral (no response association). Children with ADHD-C performed worse than control children in most analyses. The most important finding was a significant interaction of congruity effects with group in the numerical comparison task. Children with ADHD-C tended to show larger congruity and interference effects than controls, and these were not attributable to a speed-accuracy trade-off. The results might reflect differential processing speeds, or a different degree of automatic activation of physical and numerical magnitudes in children with and without ADHD-C. Alternative explanations, such as insufficient inhibition of selective (domain-specific) attention are also discussed.