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33 Does Comorbid Depression Impact Executive Functioning (EF) in Adults Diagnosed with ADHD?: A Comparison of EF Across Diagnoses in Clinically-Referred Individuals
- Haley V. Skymba, Gabriel P. Ovsiew, Nicole M. Durkin, Kyle J. Jennette, Zachary J. Resch, Jason R. Soble
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 640-641
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Objective:
Neurobiological and cognitive theories implicate deficits in executive function (EF) as a core facet of both depressive disorders and attention-deficit/hyperactivity disorder (ADHD), but empirical investigations inconsistently support this conclusion. Despite recognition of the likely bi-directional relationship of EF deficits to depression and ADHD, respectively, the extent to which comorbid depression might impact EF in adults remains unclear, considering more of the literature has examined children and adolescents. This study examined performance differences on EF measures in clinically-referred adults diagnosed with ADHD or a non-ADHD primary psychopathological condition in the presence/absence of comorbid depression.
Participants and Methods:This cross-sectional study included data from 404 adults referred for neuropsychological evaluation at a Midwestern academic medical center. In total, 343 met DSM-5 diagnostic criteria for ADHD (ADHD-all group:164 Predominantly Inattentive presentation [ADHD-I] and 179 Combined presentation [ADHD-C]) and 61 met criteria for a non-ADHD primary psychopathological condition (psychopathology group: 31 mood disorder, 17 anxiety disorder, and 13 posttraumatic stress disorder) when assessed via semi-structured clinical interview. All patients completed the Beck Depression Inventory-Second Edition (BDI-II) and five EF tests: Letter Fluency, Trail Making Test-Part B (Trails-B), Stroop Color and Word Test Color-Word trial (SCWT CW); and WAIS-IV Working Memory Index (WMI). Oneway MANOVAs assessed for significant EF differences between groups with high (BDI-II greater than or equal to 20) or low (BDI-II less than or equal to 19) depressive symptoms.
Results:When group diagnosis (ADHD-all vs. psychopathology) was examined in the context of high or low depression, a significant difference in EF performance emerged between groups, F(12, 1042.72)=2.44, p<.01, Wilk's A=.93, partial n2=.02, with univariate analyses indicating a significant difference in FAS-T between at least two of the groups (F(3, 397)=3.92 , p< .01, partial n2=.03). Tukey's HSD Test for multiple comparisons found that the mean value of FAS-T was significantly different between the ADHD-high depression and ADHD-low depression groups (p=.046 , 95% CI = [5.81, -.04]) as well as between the ADHD-low depression and psychopathology-high depression groups (p=.05, 95% CI = [-8.89, .00]). A one-way MANOVA examining differences between groups when distinguishing ADHD by subtype revealed a statistically significant difference in EF performance between groups, F(20, 1301)=1.85, p<.05, Wilk's A=.91, partial n2=.02, with univariate analyses indicating a statistically significant difference in FAS-T between at least two of the groups (F(5, 395) = 2.39 , p<.05, partial n2 = .03). However, Tukey's HSD Test for multiple comparisons found that the mean value of FAS-T was not significantly different between any of the groups.
Conclusions:Overall, results indicate that clinically-referred patients with ADHD perform comparably on tests of EF regardless of the presence or absence of comorbid depression. These findings have implications for conceptualizing EF weaknesses in neuropsychological profiles for individuals with ADHD and suggest examining factors beyond comorbid depression.
10 Performance between bilinguals and monolinguals: Anxiety as a moderating effect across executive functioning and processing speed in a multicultural cohort with ADHD symptoms
- Christopher Gonzalez, Demy Alfonso, Brian M Cerny, Karen S Basurto, John-Christopher A Finley, Gabriel P Ovsiew, Phoebe Ka Yin Tse, Zachary J Resch, Kyle J Jennette, Jason R Soble
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 425-426
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Objective:
Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder commonly associated with relative impairments on processing speed, working memory, and/or executive functioning. Anxiety commonly co-occurs with ADHD and may also adversely affect these cognitive functions. Additionally, language status (i.e., monolingualism vs bilingualism) has been shown to affect select cognitive domains across an individual’s lifespan. Yet, few studies have examined the potential effects of the interaction between anxiety and language status on various cognitive domains among people with ADHD. Thus, the current study investigated the effects of the interaction of anxiety and language status on processing speed, working memory, and executive functioning among monolingual and bilingual individuals with ADHD.
Participants and Methods:The sample comprised of 407 consecutive adult patients diagnosed with ADHD. When asked about their language status, 67% reported to be monolingual (English). The Mean age of individuals was 27.93 (SD = 6.83), mean education of 15.8 years (SD = 2.10), 60% female, racially diverse with 49% Non-Hispanic White, 22% Non-Hispanic Black, 13% Hispanic/Latinx, 9% Asian/Pacific Islander, and 6% other race/ethnicity. Processing speed, working memory, and executive function were measured via the Wechsler Adult Intelligence Scale-Fourth Edition Processing Speed Index, Working Memory Index, and Trail Making Test B, respectively. Anxiety was measured via the Beck Anxiety Inventory (BAI). Three separate linear regression models examined the interaction between anxiety (moderator) and cognition (processing speed, working memory, and executive function) on language. Models included sex/gender and education as covariates with Processing Speed Index and Working Memory Index as the outcomes. Age, sex/gender, and education were used as covariates when Trail Making Test B was the outcome.
Results:Monolingual and bilingual patients differed in mean age (p < .05) but did not differ in level of anxiety, education, or sex/gender. Overall, anxiety was not associated with processing speed, working memory, and executive function. However, the interaction between anxiety and language status was significantly associated with processing speed (ß = -0.37, p < .05), and executive functioning (ß = 0.82, p < .05). No associations were found when anxiety was added as a moderator for the associations between language and working memory.
Conclusions:This study found that anxiety moderated the relationship between language status and select cognitive domains (i.e., processing speed and executive functioning) among individuals with ADHD. Specifically, anxiety had a greater association on processing speed and executive functioning performance for bilinguals rather than monolinguals. Future detailed studies are needed to better understand how anxiety modifies the relationship between language and cognitive performance outcomes over time amongst a linguistically diverse sample.
12 The Effect of Adverse Childhood Experiences on Minnesota Multiphasic Personality Inventory-2-Restructured Form Symptom Reporting Among Adult Neuropsychological Referrals
- Demy Alfonso, Christopher Gonzalez, Gabriel P Ovsiew, Zachary J Resch, Jason R Soble
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 696-697
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Objective:
Adverse childhood experiences (ACEs) is a broad construct that refers to negative events one may experience during childhood, including, but not limited to, childhood maltreatment, household dysfunction, and trauma. ACEs have consistently shown to be associated with negative physical and mental health outcomes. Although researchers have investigated the effects of trauma and abuse on personality measures, few studies have examined differences between those with high ACEs, low ACEs, and no ACEs on measures of personality in the context of neuropsychological evaluations.
Participants and Methods:The current study included 128 consecutive adult patients referred for outpatient neuropsychological evaluation of attention-deficit/hyperactivity disorder. The sample was 39.8% non-Hispanic White, 21.9% non-Hispanic Black, 16.4% Hispanic, 10.9% Asian/Pacific Islander, and 10.9% other race/ethnicity, with a mean age of 27.9 years (SD=6.3) and mean education of 16.1 years (SD=2.2). Multivariate analyses of variance were performed to evaluate differences on the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) between individuals who experienced high levels of ACEs (>4/10 on the Adverse Childhood Experiences Questionnaire), low levels of ACEs (1-3/10), and no ACEs (0/10).
Results:When analyzing Higher-Order (H-O) scales, there was a significant group difference in mean elevation on the Behavioral/Externalizing Dysfunction (BXD) scale, F(2,113)=3.124, p < .05, such that individuals in the high ACEs group evidenced higher scores than those in the low ACEs group (p < .05). Additionally, there were significant differences on several Restructured Clinical (RC) scales. Specifically, there were group differences on the Low Positive Emotions (RC2) scale, F(2,113)=3.427, p < .05, such that those in the low ACEs group evidenced higher scores than those in the no ACEs group (p < .05). The Antisocial Behavior (RC4) scale also had significant differences, F(2,113)=13.703, p < .001, such that those in the high ACEs group had higher scores than those in the low and no ACEs groups (p < .001). Finally, the Ideas of Persecution (RC6) scale yielded significant group differences, F(2,113)=4.793, p < .05, such that those in the high ACEs group evidenced higher scores than those in the low and no ACEs groups (p < .05).
Conclusions:In sum, this study demonstrated that ACEs, particularly high levels of ACEs, are related to higher difficulties with problems with under-controlled and rule-breaking behaviors, low positive emotional responses, and beliefs that others pose a threat. As such, assessment of ACEs may serve an important role in characterizing patients’ psychological status as part of a comprehensive neuropsychological evaluation.
21 A Comparison of the Memory and Non-Memory Based Performance Validity Measures for Detecting Invalid Neuropsychological Test Performance among Individuals with and without Memory Impairment
- Humza M Khan, Maximillian A Obolsky, Gabriel P Ovsiew, Jason R Soble, Zachary J Resch
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 703-704
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Objective:
Few to no studies have directly compared the relative classification accuracies of the memory-based (Brief Visuospatial Memory Test-Revised Recognition Discrimination [BVMT-R RD] and Rey Auditory Verbal Learning Test Forced Choice [RAVLT FC]) and non-memory based (Reliable Digit Span [RDS] and Stroop Color and Word Test Word Reading trial [SCWT WR]) embedded performance validity tests (PVTs). This study’s main objective was to evaluate their relative classification accuracies head-to-head, as well as examine how their psychometric properties may vary among subgroups with and without genuine memory impairment.
Participants and Methods:This cross-sectional study included 293 adult patients who were administered the BVMT-R, WAIS-IV Digit Span, RAVLT and SCWT during outpatient neuropsychological evaluation at a Midwestern academic medical center. The overall sample was 58.0% female, 36.2% non-Hispanic White, 41.3% non-Hispanic Black, 15.7% Hispanic, 4.8% Asian/Pacific Islander, and 2.0% other, with a mean age of 45.7 (SD=15.8) and a mean education of 13.9 years (SD=2.8). Three patients had missing data, resulting in a final sample size of 290. Two hundred thirty-three patients (80%) were classified as having valid neurocognitive performance and 57 (20%) as having invalid neurocognitive performance based on performance across four independent, criterion PVTs (i.e., Test of Malingering Memory Trial 1, Word Choice Test, Dot Counting Test, Medical Symptom Validity Test). Of those with valid neurocognitive performance, 76 (48%) patients were considered as having genuine memory impairment through a memory composite band score (T<37 for (RAVLT Delayed Recall T-score + BVMT-R Delay Recall T-score/2).
Results:The average memory composite band score for valid neurocognitive scores was T = 49.63 as compared to T = 27.57 for genuine memory impairment individuals. Receiver operating characteristic [ROC] curve analyses yielded significant areas under the curve (AUCs=.79-.87) for all four validity indices (p’s < .001). When maintaining acceptable specificity (91%-95%), all validity indices demonstrated acceptable yet varied sensitivities (35%-65%). Among the subgroup with genuine memory impairment, ROC curve analyses yielded significantly lower AUCs (.64-.69) for three validity indices (p’s < .001), except RDS (AUC=.644). At acceptable specificity (88%-93%), they yielded significantly lower sensitivities across indices (19%-39%). In the current sample, RAVLT FC and BVMT-R RD had the largest changes in sensitivities, with 19% and 26% sensitivity/90%-92% specificity at optimal cut-scores of <10 and <2, respectively, for individuals with memory impairment, compared to 65% and 61% sensitivity/94% specificity at optimal cut-scores of <13 and <4, respectively, for those without memory impairment.
Conclusions:Of the four validity scales, memory-based embedded PVTs yielded higher sensitivities while maintaining acceptable specificity compared to non-memory based embedded PVTs. However, they were also susceptible to the greatest declines in sensitivity among the subgroup with genuine memory impairment. As a result, careful consideration should be given to using memory-based embedded PVTs among individuals with clinically significant memory impairment based on other sources of information (e.g., clinical history, behavioral observation).