Skip to main content
×
×
Home

Executive function and attention-deficit/hyperactivity disorder in Ugandan children with perinatal HIV exposure

  • M. D. Burkey (a1), S. M. Murray (a2), P. Bangirana (a3), I. Familiar (a4), R. O. Opoka (a5), N. Nakasujja (a3), M. Boivin (a4) (a6) and J.K. Bass (a2)...
Abstract
Background.

Attention-deficit/hyperactivity disorder (ADHD) is among the most commonly diagnosed mental disorders in childhood and is associated with substantial deficits in executive functioning and lost academic and occupational attainment. This study evaluates symptoms of ADHD and their association with neurocognitive deficits in a cohort of rural Ugandan children who were born to HIV-infected mothers.

Methods.

We assessed ADHD symptoms and executive function (including memory and attention) in a non-clinical sample of children born to HIV-infected mothers in rural eastern Uganda. Analyses included assessments of the psychometric properties, factor structure, and convergent and discriminant validity of the ADHD measure (ADHD-Rating Scale-IV); and executive function deficits in children meeting symptom criteria for ADHD.

Results.

232 children [54% female; mean age 7.8 years (s.d. 2.0)] were assessed for ADHD and executive function deficits. The ADHD measure showed good internal consistency (α = 0.85.) Confirmatory factor analysis showed an acceptable fit for the diagnostic and statistical manual of mental disorders (DSM-5) two-factor model. Subjects meeting DSM-5 symptom criteria for ADHD had worse parent-rated executive function on six out of seven subscales.

Conclusions.

Our results demonstrate structural validity of the ADHD measure with this population, strong associations between ADHD symptom severity and poorer executive function, and higher levels of executive function problems in perinatally HIV-exposed Ugandan children with ADHD. These findings suggest that ADHD may be an important neurocognitive disorder associated with executive function problems among children in sub-Saharan African settings where perinatal HIV exposure is common.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Executive function and attention-deficit/hyperactivity disorder in Ugandan children with perinatal HIV exposure
      Available formats
      ×
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Executive function and attention-deficit/hyperactivity disorder in Ugandan children with perinatal HIV exposure
      Available formats
      ×
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Executive function and attention-deficit/hyperactivity disorder in Ugandan children with perinatal HIV exposure
      Available formats
      ×
Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/3.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
* Address for correspondence: M. Burkey, M.D, M.P.H, Division of Child and Adolescent Psychiatry, Johns Hopkins School of Medicine, 550 N. Broadway, Room 907, Baltimore, MD 21231, USA (Email: mburkey1@jhmi.edu)
References
Hide All
American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders, DSM-5. Arlington, VA.
Anderson, P (2002). Assessment and development of executive function (EF) during childhood. Child Neuropsychology 8, 7182.
Bakare, MO (2012). Attention deficit hyperactivity symptoms and disorder (ADHD) among African children: a review of epidemiology and co-morbidities. African Journal of Psychiatry (Johannesbg) 15, 358361.
Beddington, J, Cooper, CL, Field, J, Goswami, U, Huppert, FA, Jenkins, R, Jones, HS, Kirkwood, TB, Sahakian, BJ, Thomas, SM (2008). The mental wealth of nations. Nature 455, 10571060.
Biederman, J, Faraone, SV (2006). The effects of attention-deficit/hyperactivity disorder on employment and household income. Medscape General Medicine 8, 12.
Biederman, J, Monuteaux, MC, Doyle, AE, Seidman, LJ, Wilens, TE, Ferrero, F, Morgan, CL, Faraone, SV (2004). Impact of executive function deficits and attention-deficit/hyperactivity disorder (ADHD) on academic outcomes in children. Journal of Consulting and Clinical Psychology 72, 757.
Blanche, S, Tardieu, M, Rustin, P, Slama, A, Barret, B, Firtion, G, Ciraru-Vigneron, N, Lacroix, C, Rouzioux, C, Mandelbrot, L (1999). Persistent mitochondrial dysfunction and perinatal exposure to antiretroviral nucleoside analogues. The Lancet 354, 10841089.
Boivin, MJ (2002). Effects of early cerebral malaria on cognitive ability in Senegalese children. Journal of Developmental& Behavioral Pediatrics 23, 353364.
Boivin, MJ, Bangirana, P, Byarugaba, J, Opoka, RO, Idro, R, Jurek, AM, John, CC (2007). Cognitive impairment after cerebral malaria in children: a prospective study. Pediatrics 119, e360e366.
Boivin, MJ, Bangirana, P, Nakasujja, N, Page, CF, Shohet, C, Givon, D, Bass, JK, Opoka, RO, Klein, PS (2013). A year-long caregiver training program improves cognition in preschool Ugandan children with human immunodeficiency virus. The Journal of Pediatrics 163, 14091416. e5.
Boivin, MJ, Ruel, TD, Boal, HE, Bangirana, P, Cao, H, Eller, LA, Charlebois, E, Havlir, DV, Kamya, MR, Achan, J (2010). HIV-subtype A is associated with poorer neuropsychological performance compared to subtype D in ART-naïve Ugandan children. AIDS (London, England) 24, 1163.
Caldwell, BM, Bradley, RH (1984). Home Observation for Measurement of the Environment. University of Arkansas at Little Rock. Little Rock: Arkansas.
Chinawa, JM, Odetunde, OI, Obu, HA, Chinawa, AT, Bakare, MO, Ujunwa, FA (2014). Attention deficit hyperactivity disorder: a neglected issue in the developing world. Behavioural Neurology 2014, 694764
Clark, C, Prior, M, Kinsella, GJ (2000). Do executive function deficits differentiate between adolescents with ADHD and oppositional defiant/conduct disorder? A neuropsychological study using the Six Elements Test and Hayling Sentence Completion Test. Journal of Abnormal Child Psychology 28, 403414.
Collins, PY, Patel, V, Joestl, SS, March, D, Insel, TR, Daar, AS, Anderson, W, Dhansay, MA, Phillips, A, Shurin, S, Walport, M, Ewart, W, Savill, SJ, Bordin, IA, Costello, EJ, Durkin, M, Fairburn, C, Glass, RI, Hall, W, Huang, Y, Hyman, SE, Jamison, K, Kaaya, S, Kapur, S, Kleinman, A, Ogunniyi, A, Otero-Ojeda, A, Poo, MM, Ravindranath, V, Sahakian, BJ, Saxena, S, Singer, PA, Stein, DJ (2011). Grand challenges in global mental health. Nature 475, 2730.
Costello, Anna B & Jason, Osborne (2005). Best practices in exploratory factor analysis: four recommendations for getting the most from your analysis. Practical Assessment Research & Evaluation 10(7). Available online: http://pareonline.net/getvn.asp?v=10&n=7
Devellis, RF (2011). Scale Development: Theory and Applications. Sage Publications: Los Angeles.
Diamond, A (2013). Executive functions. Annual Review of Psychology 64, 135168.
Dinno, A (2009). Implementing Horn's parallel analysis for principal component analysis and factor analysis. Stata Journal 9, 291.
Döpfner, M, Steinhausen, H-C, Coghill, D, Dalsgaard, S, Poole, L, Ralston, SJ, Rothenberger, A (2006). Cross-cultural reliability and validity of ADHD assessed by the ADHD Rating Scale in a pan-European study. European Child & Adolescent Psychiatry 15, i46i55.
Dupaul, GJ, Power, TJ, Anastopoulos, AD, Reid, R (1998). ADHD Rating Scale—IV: Checklists, Norms, and Clinical Interpretation. Guilford Press, New York.
Faraone, SV, Sergeant, J, Gillberg, C, Biederman, J (2003). The worldwide prevalence of ADHD: is it an American condition?. World Psychiatry 2, 104.
Fernald, LC, Weber, A, Galasso, E, Ratsifandrihamanana, L (2011). Socioeconomic gradients and child development in a very low income population: evidence from Madagascar. Developmental Science 14, 832847.
Gioia, GA, Espy, KA, Isquith, PK (2003). Behavior rating inventory of executive function, preschool version (BRIEF-P). Lutz, FL: Psychological Assessment Resources., Odessa, Florida.
Gioia, GA, Isquith, PK, Guy, SC, Kenworthy, L (2000). Test review behavior rating inventory of executive function. Child Neuropsychology 6, 235238.
Grantham-Mcgregor, S, Cheung, YB, Cueto, S, Glewwe, P, Richter, L, Strupp, B (2007). Developmental potential in the first 5 years for children in developing countries. The Lancet 369, 6070.
Greenberg, LM, Waldmant, ID (1993). Developmental normative data on the test of variables of attention (TOVA™). Journal of Child Psychology and Psychiatry 34, 10191030.
Harris, EL, Schuerholz, LJ, Singer, HS, Reader, MJ, Brown, JE, Cox, C, Mohr, J, Chase, GA, Denckla, MB (1995). Executive function in children with Tourette syndrome and/or attention deficit hyperactivity disorder. Journal of the International Neuropsychological Society 1, 511516.
Idro, R, Kakooza-Mwesige, A, Balyejjussa, S, Mirembe, G, Mugasha, C, Tugumisirize, J, Byarugaba, J (2010). Severe neurological sequelae and behaviour problems after cerebral malaria in Ugandan children. BMC Research Notes 3, 104.
Kashala, E, Tylleskar, T, Elgen, I, Kayembe, KT, Sommerfelt, K (2005). Attention deficit and hyperactivity disorder among school children in Kinshasa, Democratic Republic of Congo. African Health Sciences 5, 172181.
Kaufman, AS (2004). KABC-II: Kaufman Assessment Battery for Children. AGS Publishing: Shoreview, Minnesota.
Kerr, SJ, Puthanakit, T, Vibol, U, Aurpibul, L, Vonthanak, S, Kosalaraksa, P, Kanjanavanit, S, Hansudewechakul, R, Wongsawat, J, Luesomboon, W (2014). Neurodevelopmental outcomes in HIV-exposed-uninfected children versus those not exposed to HIV. AIDS Care 26, 13271335.
Klasen, H, Crombag, AC (2013). What works where? A systematic review of child and adolescent mental health interventions for low and middle income countries. Social Psychiatry Psychiatric Epidemiology 48, 595611.
Leibson, CL, Katusic, SK, Barbaresi, WJ, Ransom, J, O'brien, PC (2001). Use and costs of medical care for children and adolescents with and without attention-deficit/hyperactivity disorder. JAMA: the Journal of the American Medical Association 285, 6066.
Llorente, AM, Brouwers, P, Leighty, R, Malee, K, Smith, R, Harris, L, Serchuck, LK, Blasini, I, Chase, C (2014). An analysis of select emerging executive skills in perinatally HIV-1-infected children. Applied Neuropsychology: Child 3, 1025.
Lovejoy, DW, Ball, J, Keats, M, Stutts, ML, Spain, EH, Janda, L, Janusz, J (1999). Neuropsychological performance of adults with attention deficit hyperactivity disorder (ADHD): diagnostic classification estimates for measures of frontal lobe/executive functioning. Journal of the International Neuropsychological Society 5, 222233.
Mahone, EM, Cirino, PT, Cutting, LE, Cerrone, PM, Hagelthorn, KM, Hiemenz, JR, Singer, HS, Denckla, MB (2002). Validity of the behavior rating inventory of executive function in children with ADHD and/or Tourette syndrome. Archives of Clinical Neuropsychology 17, 643662.
Mahone, EM, Hoffman, J (2007). Behavior ratings of executive function among preschoolers with ADHD. The Clinical Neuropsychologist 21, 569586.
Mcgee, R, Feehan, M (1991). Are girls with problems of attention underrecognized? Journal of Psychopathology and Behavioral Assessment 13, 187198.
Mcgoey, KE, Dupaul, GJ, Haley, E, Shelton, TL (2007). Parent and teacher ratings of attention-deficit/hyperactivity disorder in preschool: the ADHD Rating Scale-IV Preschool Version. Journal of Psychopathology and Behavioral Assessment 29, 269276.
Mellins, CA, Elkington, KS, Leu, C-S, Santamaria, EK, Dolezal, C, Wiznia, A, Bamji, M, Mckay, MM, Abrams, EJ (2012). Prevalence and change in psychiatric disorders among perinatally HIV-infected and HIV-exposed youth. AIDS Care 24, 953962.
Mellins, CA, Malee, KM Journal of the International AIDS Society 2013 . 16:18593 Available online: http://www.jiasociety.org/index.php/jias/article/view/18593.
Mellins, CA, Smith, R, O'driscoll, P, Magder, LS, Brouwers, P, Chase, C, Blasini, I, Hittleman, J, Llorente, A, Matzen, E (2003). High rates of behavioral problems in perinatally HIV-infected children are not linked to HIV disease. Pediatrics 111, 384393.
Nozyce, ML, Lee, SS, Wiznia, A, Nachman, S, Mofenson, LM, Smith, ME, Yogev, R, Mcintosh, K, Stanley, K, Pelton, S (2006). A behavioral and cognitive profile of clinically stable HIV-infected children. Pediatrics 117, 763770.
Polanczyk, G, De Lima, M, Horta, B, Biederman, J, Rohde, L (2007). The worldwide prevalence of ADHD: a systematic review and metaregression analysis. American Journal of Psychiatry 164, 942948.
Puthanakit, T, Ananworanich, J, Vonthanak, S, Kosalaraksa, P, Hansudewechakul, R, Van Der Lugt, J, Kerr, SJ, Kanjanavanit, S, Ngampiyaskul, C, Wongsawat, J (2013). Cognitive function and neurodevelopmental outcomes in HIV-infected children older than 1 year of age randomized to early versus deferred antiretroviral therapy: the PREDICT neurodevelopmental study. The Pediatric Infectious Disease Journal 32, 501.
Ruel, TD, Boivin, MJ, Boal, HE, Bangirana, P, Charlebois, E, Havlir, DV, Rosenthal, PJ, Dorsey, G, Achan, J, Akello, C, Kamya, MR, Wong, JK (2012). Neurocognitive and Motor Deficits in HIV-Infected Ugandan Children With High CD4 Cell Counts. Clin Infect Dis. first published online February 4, 2012 doi:10.1093/cid/cir1037.
Stata Corporation (1985–2013). Stata Statistical Software Release 12.0: Programming. Stata Corporation: College Station, Texas.
The World Bank (2014). World Bank Open Data: Uganda Country Profile [Online]. Available: http://data.worldbank.org/country/uganda [Accessed 24 September 2014].
Thompson, B, Daniel, LG (1996). Factor analytic evidence for the construct validity of scores: A historical overview and some guidelines. Educational and Psychological Measurement 56, 197208.
Walker, SP, Wachs, TD, Grantham-Mcgregor, S, Black, MM, Nelson, CA, Huffman, SL, Baker-Henningham, H, Chang, SM, Hamadani, JD, Lozoff, B (2011). Inequality in early childhood: risk and protective factors for early child development. The Lancet 378, 13251338.
Wilens, TE, Biederman, J, Mick, E, Faraone, SV, Spencer, T (1997). Attention deficit hyperactivity disorder (ADHD) is associated with early onset substance use disorders. The Journal of Nervous and Mental Disease 185, 475482.
Willcutt, EG, Doyle, AE, Nigg, JT, Faraone, SV, Pennington, BF (2005). Validity of the executive function theory of attention-deficit/hyperactivity disorder: a meta-analytic review. Biological Psychiatry 57, 13361346.
Willoughby, MT (2003). Developmental course of ADHD symptomatology during the transition from childhood to adolescence: a review with recommendations. Journal of Child Psychology and Psychiatry 44, 88106.
Wolters, P, Brouwers, P (2005). Evaluation of neurodevelopmental deficits in children with HIV-1 infection. The Neurology of AIDS: Gendelman, HE, Grant, I, Everall, IP, Lipton, SA, Swindells, S (eds), Oxford University Press: Oxford, UK, pp. 667682.
World Health Organization (2003). Caring for Children and Adolescents with Mental Disorders: Setting WHO Directions. World Health Organization: Geneva.
World Health Organization (2011). Mental Health Atlas 2011. World Health Organization: Geneva.
Zeegers, I, Rabie, H, Swanevelder, S, Edson, C, Cotton, M, Van Toorn, R (2010). Attention deficit hyperactivity and oppositional defiance disorder in HIV-infected South African children. Journal of Tropical Pediatrics 56, 97102.
Zhang, S, Faries, DE, Vowles, M, Michelson, D (2005). ADHD Rating Scale IV: psychometric properties from a multinational study as a clinician-administered instrument. International Journal of Methods Psychiatric Research 14, 186201.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Global Mental Health
  • ISSN: -
  • EISSN: 2054-4251
  • URL: /core/journals/global-mental-health
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords

Metrics

Full text views

Total number of HTML views: 26
Total number of PDF views: 78 *
Loading metrics...

Abstract views

Total abstract views: 181 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 22nd June 2018. This data will be updated every 24 hours.