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Prenatal maternal PTSD as a risk factor for offspring ADHD: A register-based Swedish cohort study of 553 766 children and their mothers
- Michael Borgert, Amandah Melin, Anna-Clara Hollander, Syed Rahman
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- European Psychiatry / Volume 67 / Issue 1 / 2024
- Published online by Cambridge University Press:
- 01 March 2024, e22
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Background
Attention-deficit hyperactivity disorder (ADHD) is highly heritable, though environmental factors also play a role. Prenatal maternal stress is suggested to be one such factor, including exposure to highly distressing events that could lead to post-traumatic stress disorder (PTSD). The aim of this study is to investigate whether prenatal maternal PTSD is associated with offspring ADHD.
MethodA register-based retrospective cohort study linking 553 766 children born in Sweden during 2006–2010 with their biological parents. Exposure: Prenatal PTSD. Outcome: Offspring ADHD. Logistic regression determined odds ratios (ORs) with 95% confidence intervals (CIs) for ADHD in the offspring. Adjustments were made for potential covariates, including single parenthood and possible indicators of heredity measured as parental ADHD and maternal mental disorders other than PTSD. Subpopulations, excluding children with indicators of heredity, were investigated separately.
ResultsIn the crude results, including all children, prenatal PTSD was associated with offspring ADHD (OR: 1.79, 95% CI: 1.37–2.34). In children with indicators of heredity, the likelihood was partly explained by it. Among children without indicators of heredity, PTSD was associated with offspring ADHD (OR: 2.32, 95% CI: 1.30–4.14), adjusted for confounders.
ConclusionsPrenatal maternal PTSD is associated with offspring ADHD regardless of indicators of heredity, such as parental ADHD or maternal mental disorder other than PTSD. The association is partly explained by heredity and socioeconomic factors. If replicated in other populations, preferably using a sibling design, maternal PTSD could be identified as a risk factor for ADHD.
Chapter 9 - Attention Deficit Hyperactivity Disorder in Adults
- Edited by Andrea Fiorillo, University of Campania “L. Vanvitelli”, Naples, Peter Falkai, Ludwig-Maximilians-Universität München, Philip Gorwood, Sainte-Anne Hospital, Paris
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- Mental Health Research and Practice
- Published online:
- 01 February 2024
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- 08 February 2024, pp 135-157
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Summary
Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder that persists into adulthood. We provide an overview of prevalence, diagnosis, and treatment. Future directions highlight key areas of progress. ADHD is not always an early childhood onset disorder; it may emerge as an impairing condition during the adolescent years. Transition from child to adult services is poor and greater efforts are needed to ensure effective treatment during this critical stage. There are sex differences in the expression of ADHD. Related to this, the diagnosis of ADHD is often missed in girls but is increasingly recognized in adult life. The impact of emotional instability as a core feature of ADHD on mental health is widely recognized. It is still the case that ADHD is often misdiagnosed for other common mental health conditions, and greater awareness of ADHD is needed among health care professionals. Prominent comorbidities include substance use and sleep problems. Finally, we consider the cognitive and neural processes that explain persistence of ADHD. The balance of default mode to task positive network activity may lead to core symptoms such as spontaneous mind wandering, and the role of saliency on task performance.
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.
8 Detection of Feigned ADHD through an Experimental MMPI-2 ADHD Validity Scale among U.S. Military Veterans
- Christopher T. Burley, Timothy J. Arentsen, Jennifer S. Seeley McGee, Katie M. Califano, Holly R. Winiarski, Marcy C. Adler, Brad L. Roper
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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. 693-694
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Objective:
The prevalence of ADHD diagnoses more than doubled in VA settings between 2009 and 2016 (Hale et al., 2020). However, attentional difficulties are not exclusive to ADHD and can also be seen in non-neurodevelopmental disorders, including depression, anxiety, substance use, and PTSD (Marshall et al., 2018, Suhr et al., 2008). Further, patients can easily feign symptoms of ADHD with few available instruments for accurate detection (Robinson & Rogers, 2018). Given the significant symptom overlap and rising rates of reported ADHD among Veterans, accurate detection of feigned ADHD is essential.
This study examined the utility of the experimental Dissimulation ADHD scale (Ds-ADHD; Robinson & Rogers, 2018) on the MMPI-2, in detecting feigned ADHD presentation within a mixed sample of Veterans.
Participants and Methods:In this retrospective study, 173 Veterans (Mage = 36.18, SDage = 11.10, Medu = 14.01, SDedu = 2.11, 88% male, 81% White, and 17% Black) were referred for neuropsychological evaluation of ADHD that included the MMPI-2 and up to 10 PVTs. Participants were assigned to a credible group (n=146) if they passed all PVTs or a non-credible group (n=27) if they failed two or more PVTs. Group assignment was also clinically confirmed. The Ds-ADHD was used to differentiate groups who either had credible or non-credible performance on cognitive measures. Consistent with Robinson and Rogers’ study, “true” answers (i.e., erroneous stereotypes) were coded as 1 and “false” answers were coded as 2, creating a 10- to 20-point scale. Lower scores were associated with a higher likelihood of a feigned ADHD presentation.
Results:Preliminary analyses revealed no significant group differences in age, education, race, or gender (ps > .05). An ANOVA indicated a significant difference between groups (F[1, 171] = 10.44, p = .001; Cohen’s d = .68) for Ds-ADHD raw scores; Veterans in the non-credible group reported more “erroneous stereotypes” of ADHD (M raw score = 13.33, SD = 2.20) than those in the credible group (M = 14.82, SD = 2.20). A ROC analysis indicated AUC of .691 (95% CI = .58 to .80). In addition, a cut score of <12 resulted in specificity of 91.8% and sensitivity of 18.5%, whereas a cut score of <13 resulted in specificity of 83.6% and sensitivity of 44.4%.
Conclusions:The Ds-ADHD scale demonstrated significant differences between credible and non-credible respondents in a real-world setting. Previously, this scale has primarily been studied within laboratory settings. Further, results indicate a cut score of <12 could be used in order to achieve adequate specificity (i.e., >90%), which were similar findings to a study examining SVT-based groups (Winiarski et al., 2023). These results differ slightly from prior research by Robinson and Rogers (2018), who indicated a cut score of <13 based on the initial simulation-based study. In similar clinical settings, where there are high rates of psychiatric comorbidity, a cut score of <12 may prove clinically useful. However, this cut-score was associated with low sensitivity within this mixed Veteran sample. Further research should focus on replicating findings within other clinical settings, including ones with larger non-credible samples.
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.
32 Effects of Emotion Regulation and Emotional Lability/Negativity on Academic Achievement Among Youth With and Without ADHD
- Kathleen E. Feeney, Stephanie S. J. Morris, Karissa DiMarzio, Rosario Pintos Lobo, Katherine Schmarder, Garcia Susana, Erica D. Musser
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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. 821-822
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Objective:
Youth with attention-deficit/hyperactivity disorder (ADHD), characterized by symptoms of inattention and hyperactivity, often experience challenges with emotion regulation (ER) and/or emotional lability/negativity (ELN).1-3 Prior work has shown that difficulties with ER and ELN among young children contribute to lower academic achievement.4-6 To date, research examining associations between ADHD and academic achievement have primarily focused on the roles of inattentive symptoms and executive functioning.7-8 However, preliminary work among youth with ADHD suggests significant associations between disruptions in emotional functioning and poor academic outcomes.9-10 The current study will examine associations between ER, ELN, and specific subdomains of academic achievement (i.e., reading, spelling, math) among youth with and without ADHD.
Participants and Methods:Forty-six youth (52% male; Mage=9.52 years; 76.1% Hispanic/Latino; 21 with ADHD) and their parents were recruited as part of an ongoing study. Parents completed the Disruptive Behavior Disorders Rating Scale11 and Emotion Regulation Checklist12 about their child. Youth completed the Wechsler Abbreviated Scale of Intelligence-II13 and three subtests [Spelling (SP), Numerical Operations (NO), Word Reading (WR)] of the Wechsler Individual Achievement Test-III.14 Univariate analysis of variance assessed differences in emotional functioning and academic achievement among youth with and without ADHD. Correlation and regression analyses were conducted to examine the association between emotional factors and the three subtests of academic achievement.
Results:Youth with ADHD exhibited significantly higher ELN (M=30.7, SD=8.7) compared to their peers (M=23.2, SD=5.8), when controlling for child age, sex, and diagnoses of conduct disorder and/or oppositional defiant disorder [F(1,41)=8.96, p<.01, ŋp2=.18]. With respect to ER, youth with (M=24.8, SD=4.2) and without ADHD (M=25.8, SD=4.3) did not differ [F(1,41)=.51, p=.48]. Surprisingly, within this sample, ADHD diagnostic status was not significantly associated with performance on any of the academic achievement subtests [WR: F(1,41)=.29, p=.59; NO: F(1,41)=.91, p=.35; SP: F(1,41)=2.14, p=.15]. Among all youth, ER was significantly associated with WR (r=.31, p=.04) and SP (r=.35, p=.02), whereas ELN was associated with performance on NO (r=-.30, p=.04). When controlling for child age, sex, IQ, and ER within the full sample, higher ELN was associated with lower scores on the NO subtest (b=-.56, SE=.26, p=.04). The associations between higher ER and WR scores (b=1.12, SE=.51, p=.03), as well as higher ER and SP scores (b=1.47, SE=.56, p=.01), were significant when controlling for child age and sex, but not ELN and IQ (p=.73 and p=.64, respectively).
Conclusions:As expected, youth with ADHD had higher ELN, although they did not differ from their peers in terms of ER. Results identified distinct associations between ER and higher reading/spelling performance, as well as ELN and lower math performance across all youth. Thus, findings suggest that appropriate emotional coping skills may be most important for reading and spelling, while emotional reactivity appears most salient to math performance outcomes. In particular, ELN may be a beneficial target for intervention, especially with respect to improvement in math problem-solving skills. Future work should account for executive functioning skills, expand the academic achievement domains to include fluency and more complex academic skills, and assess longitudinal pathways within a larger sample.
80 Implications of Body Mass Index on Executive Functioning in Clinically Diagnosed Neurodiverse Children
- Laura A Campos, Sri Vaishnavi Konagalla, Jessica Smith, Jordan Linde, Madison Berl, Chandan Vaidya, Lauren Kenworthy
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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. 72-73
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Objective:
Childhood obesity is a serious health epidemic affecting the world today. Children who are obese earlier in life are more likely to stay obese and have an increased risk of poorer health outcomes later in life, such as diabetes and cardiovascular diseases. Obesity is also associated with deficits in executive function. Executive function (EF) is comprised of several distinct but interrelated abilities including working memory, planning, inhibition, and flexibility. Prior research suggests that obesity drives brain changes which implicate executive function structures. Our aim is to examine the relationship between childhood obesity and executive function in children with neurodevelopmental disorders.
Participants and Methods:These data are from an ongoing study on neural and behavioral phenotypes of executive functioning in children with developmental disabilities, primarily Attention-Deficit/Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD). Only study participants with complete BMI and BRIEF data were included in these analyses (n = 184). 134 representing (72.8%) of the participants were Male, 49 representing (26.6%) were Female, and 1 representing (.5%) were Gender nonconforming. 50 representing (27.2%) of the participants were between 8-9 years, 55 representing (29.9%) were between 10-11 years, and 80 representing (43.0%) were between 12-13 years. Average age was 11 years. 11 representing (6.0%) of the participants were underweight, 115 representing (62.5%) were healthy, 29 representing (15.8%) were overweight, and 29 representing (15.8%) were obese. Average BMI was 19.0, ranging from 13.2 to 36.3. 106 representing (57.6%) of the participants identified as White, 65 representing (35.3%) identified as BIPOC (2 Asian, 31 Hispanic/Latinx, 32 Black) and 13 representing (4.4%) identified as other/unspecified. 114 representing (61.9%) of the participants had a diagnosis of ADHD, ASD, or comorbid ASD and ADHD, 70 representing (38.1%) had a diagnosis of other. Average FSIQ-2 score was 106.98. Parents were asked to complete the Behavior Rating Inventory of Executive Function (BRIEF-2) and the Inhibit, Shift, Working Memory (WM), Planning, and Global Executive Composite (GEC) scales were used as the dependent measure in analyses. BMI (kg/mA2) was calculated based on CDC 2000 growth charts and classified into 4 mutually exclusive categories—underweight, healthy, overweight, and obese. There was a prediction that higher BMI would be associated with lower executive function.
Results:A one-way ANOVA revealed a statistically significant difference between groups (F(3,180) = 3.649, p = .014). A Tukey post hoc test revealed more Shift problems in the obese group (74.55 ± 11.7) compared to the overweight group (65.79 ± 11.6, p = .026). There was no statistically significant difference between the underweight/healthy and obese groups (p = .999/p = .054). There was no statistically significant difference in mean T-scores for the Inhibit, WM, Planning, or GEC scales.
Conclusions:Childhood obesity and executive function deficits are significant risk factors for adult health outcomes. Obesity and elevated executive function T-scores for flexibility are related in a group of children with neurodevelopmental disorders. Future investigation will explore the role of cortical thickness and medication in these data.
20 Clinical Utility of an Experimental Ds-ADHD Validity Scale in Detection of Feigned ADHD symptoms in a U.S. Military Population
- Holly R Winiarski, Timothy J Arentsen, Marcy C Adler, Christopher T Burley, Katie M Califano, Jennifer S Seeley-McGee, Brad L Roper
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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, p. 703
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Objective:
Accurate identification of Attention-Deficit/Hyperactivity Disorder (ADHD) is complicated by possible secondary gain, overlap of symptoms with psychiatric disorders, and face validity of measures (Suhr et al., 2011; Shura et al., 2017). To assist with diagnostic clarification, an experimental Dissimulation ADHD scale (Ds-ADHD; Robinson & Rogers, 2018) on the MMPI-2 was found to distinguish credible from non-credible respondents defined by Performance Validity Test (PVT)-based group assignment in Veterans (Burley et al., 2023). However, symptom and performance validity have been understood as unique constructs (Van Dyke et al., 2013), with Symptom Validity Tests (SVTs) more accurately identifying over-reporting of symptoms in ADHD (White et al., 2022). The current study sought to evaluate the effectiveness of the Ds-ADHD scale using an SVT, namely the Infrequency Index of CAARS (CII; Suhr et al., 2011), for group assignment within a mixed sample of Veterans.
Participants and Methods:In this retrospective study, 187 Veterans (Mage = 36.76, SDage = 11.25, Medu = 14.02, SDedu = 2.10, 83% male, 19% black, 78% white) were referred for neuropsychological evaluation of ADHD and administered a battery that included internally consistent MMPI-2 and CAARS profiles. Veterans were assigned to a credible group (n=134) if CII was <21 or a non-credible group (n=53) if CII was >21. The Ds-ADHD scale was calculated for the MMPI-2. Consistent with Robinson and Rogers (2018), “true” answers (i.e., erroneous stereotypes) were coded as 1 and “false” answers were coded as 2, creating a 10- to 20-point scale. Lower scores were associated with a higher likelihood of a feigned ADHD presentation.
Results:Analyses revealed no significant differences in age, education, race, or gender (ps > .05) between credible and non-credible groups. An ANOVA indicated a significant difference between groups (F[1,185] = 24.78, p <.001; Cohen’s d = 0.80) for Ds-ADHD raw scores. Veterans in the non-credible group reported more “erroneous stereotypes” of ADHD (M raw score = 13.23, SD = 2.10) than those in the credible group (M = 14.94, SD = 2.13). A ROC analysis indicated AUC of .72 (95% CI = .64 to .80). In addition, a Ds-ADHD cut score of <12 resulted in specificity of 94.5% and sensitivity of 22.6%, whereas a cut score of <13 resulted in specificity of 85.8% and sensitivity of 50.9%. When analyzing other CII cut scores recommended in the literature, results were essentially similar. Specifically, analyses were repeated when group assignment was defined by cut score of CII<18 and by removing an intermediate group (CII = 18 to 21; n=24).
Conclusions:The Ds-ADHD scale demonstrated significant differences between credible and non-credible respondents in a Veteran population. Results suggest a cut score of <12 had adequate specificity (.95) with low sensitivity (.23). This is consistent with findings using PVTs for group assignment that indicated a cut score of <12 had adequate specificity (.92) with low sensitivity (.19; Burley et al., 2023). Taken together, findings suggest that the Ds-ADHD scale demonstrates utility in the dissociation of credible from non-credible responding. Further research should evaluate the utility of the scale in other clinical populations.
88 Determining the Eye-Tracking Strategies Used in the Game “Spot the Missing Object (SMO)” by Simulator Malingerers, ADHD, and Non-ADHD
- Luis E Aguerrevere, Maximilian Gerhold, Stephen F. Austin
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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, p. 761
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Objective:
Typical evaluations of adult ADHD consist of behavior self-report rating scales, cognitive or intellectual functioning measures, and specific measures designed to measure attention. Boone (2009) suggested monitoring continuous effort is essential throughout psychological assessments. However, very few research studies have contributed to malingering literature on the ADHD population. Many studies have reported the adequate use of symptom validity tests, which assess effortful performance in ADHD evaluations (Jasinski et al., 2011; Sollman et al., 2010; Schneider et al., 2014). Because of the length of ADHD assessments, individuals are likely to become weary and tired, thus impacting their performance. This study investigates the eye movement strategies used by a clinical ADHD population, non-ADHD subjects, and malingering simulators when playing a common simple visual search task.
Participants and Methods:A total of 153 college students participated in this study. To be placed in the ADHD group, a participant must endorse four or more symptoms on the ASRS (N = 37). To be placed in the non-ADHD, participants should have endorsed no ADHD symptoms (N = 43). Participants that did not meet the above criteria for ADHD and not-ADHD were placed in an Indeterminate group and were not included in the analysis. A total of 20 participants were instructed to fake symptoms related to ADHD during the session. A total of twelve Spot the Difference images were used as the visual picture stimuli. Sticky by Tobii Pro (2020) was used for the collection of eye-movement data was utilized. Sticky by Tobii Pro is an online self-service platform that combines online survey questions with an eye-tracking webcam, allowing participants to see images from their home computers.
Results:Results indicated on the participants classified as Malingering had a significantly Visit Count (M = 17.16; SD= 4.99) compared to the ADHD(M = 12.53; SD= 43.92) and not-ADHD groups (M =11.51; SD=3.23). Results also indicated a statistically significant Area Under the Curve (AUC) = .784; SE = .067; p -.003; 95% CI = .652-.916. Optimal cutoffs suggest a Sensitivity of 50% with a False Positive Rate of 10%.
Conclusions:Results indicated that eye-tracking technology could help differentiate simulator malingerers from non-malingerers with ADHD. Eye-tracking research’ relates to a patchwork of fields more diverse than the study of perceptual systems. Due to their close relation to attentional mechanisms, the study’s results can provide an insight into cognitive processes related to malingering performance.
46 Exploring Social Cognition Deficits Characterised by Impulsive Responding in Children
- Ben Collins, Vicki A. Anderson
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- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 833-834
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Theory suggests that symptoms of Attention-deficit Hyperactivity Disorder (ADHD; e.g., hyperactivity and impulsivity) may be associated with social cognition deficits characterised by fast but erroneous processing of social cues. Despite this, prior research has provided mixed evidence for (a) deficits in social cognition skills and (b) a link between such deficits and poor social outcomes among children with ADHD. We sought to clarify this ambiguity by (a) exploring variation in social cognition skills across a mixed clinical and normative population and (b) examining the demographic, clinical, and dimensional symptom profiles of children presenting with reduced social cognition skills characterised by fast but erroneous processing.
Participants and Methods:Participants were children and adolescents (N = 1,097) aged 4–18 years (M = 9.02, SD = 2.72) assessed using the Paediatric Evaluation of Emotions Relationships and Socialisation (PEERS), a child-direct, ecologically sensitive measure of social cognition. Latent profile analysis of standardised social cognition scores and response times for incorrect encoding of social cues (error-response times) was used to identify social cognition profiles. Differences between each profile in terms of demographics, clinical profiles, symptom dimensions, and social outcomes were explored.
Results:Four social cognition profiles were identified. Two profiles were identified as being of particular interest: one which captured typically developing children (TDC; n = 727), and another which was characterised by lower social cognition scores and faster error-response times (impulsive responding; n = 201). The remaining profiles captured the response styles of younger participants (n = 152) and children with more pervasive social cognition deficits (n = 17). Comparison of the two profiles of interest revealed a number of statistically significant differences (p < .05). Compared to the TDC group, the impulsive responding group had: higher SDQ scores for hyperactivity, conduct, emotional, and peer problems; lower IQ and prosocial scores, and; greater parent-perceived social function deficits. Children in this group were also more likely to be male and from a lower SES background. Clinically, 18% of children in the impulsive responding group had an ADHD diagnosis, and 14% had at lease one mental health diagnosis other than ADHD.
Conclusions:A large minority of children (~18%) demonstrate social cognition deficits characterised by fast but erroneous processing of social cues. Although the explorative nature of this study does not allow conclusions to be made about the causes of such deficits, it is reasonable to conclude that they are not reducible to clinically significant symptoms of hyperactivity-impulsivity — less than 1/5 of the children in this group had an ADHD diagnosis, and 2/3 of children in this group had no mental health diagnosis at all. Child-direct tools designed to detect individual differences in social cognition skills may be beneficial in identifying individuals who will benefit from social support or interventions aimed at reducing social cognition deficits despite being missed by more traditional screening measures (e.g., clinical diagnoses). Future work should focus on understanding the causal relationships between symptoms of hyperactivity-impulsivity, fast but erroneous processing of social cues, social cognition skills, and social outcomes for this group of children.
41 Adaptive Implementation of Cognitive Control in School-Aged Children with ADHD: A Diffusion-Model Analysis
- Tyler A Warner, Cynthia L Huang-Pollock
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- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 648-649
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Objective:
Because cognitive resources are limited, models of cognitive control predict that additional control is engaged only if it improves task performance. Increased response caution, which occurs when individuals increase the threshold of information needed before making a decision, is one example of cognitive control adaptation. While previous studies have measured increased response caution via increased reaction time, the diffusion model can be used to derive a boundary separation parameter that directly indexes response caution and eliminates capturing alternative influences on reaction time. This study aims to determine if school-aged children, either with or without ADHD, show adaptive changes in response caution during a set-shifting task. These groups have demonstrated mixed results when analyzing reaction time, so this study utilizes diffusion modeling to measure response caution more directly. The set-shifting task presents switches in a random order such that they cannot be predicted; therefore, increasing response caution is only adaptive following errors, called post-error slowing (PES), but not following switch trials. It is predicted that children will show increased response caution only when adaptive. If child with ADHD adapt their response caution fundamentally differently, then there will be individual differences in change in boundary separation.
Participants and Methods:Children ages 8-12 with (n=193) and without (n=70) ADHD completed the Navon set-shifting task. Participants saw one of four global shapes made up of local shapes and were asked to identify one or the other based upon the background color. Of the 144 trials, 70 presented a switch between global and local. Trials were presented in the same randomized order for all participants, self-paced, and followed by feedback on correctness. The diffusion model parameters boundary separation (a), drift rate (v), and nondecision time (Ter) were estimated by condition, including a) post-error versus after correct and b) post-switch versus post-same. For PES analyses, only participants with a sufficient number of errors for modeling were included (ADHD n=113, control n=19).
Results:Participants were slower on trials immediately following errors (F(1, 130)=119.76, p<.001, n2=.48) and switches (F(1, 261)=154.93, p<.001, n2=.37). In PES, slowing was attributable to increased boundary separation, F(1, 130)=16.11, p<.001, n2=.11, as well as slower drift rate and longer nondecision time (both p<.01, n2 >.05). However, as predicted, post-switch slowing was only attributable slower drift rate and longer nondecision time (both p<.001, n2 >.10), not increased boundary separation, F(1, 261)=0.77, p=.38, n2<.01. Overall, children with ADHD had slower drift rates (F(1, 261)=4.63, p<.001, n2=.10) and narrower boundary separation (F(1, 261)=10.56, p=.001, n2=.04). However, there were no ADHD x trial-type interactions for PES or post-switch (both p>.33, n2<.01).
Conclusions:School-aged children demonstrated increased response caution following errors, but not following switches. This demonstrates an adaptive use of cognitive control. The diffusion model was crucial in determining this, as reaction time slowed following switches for reasons unrelated to cognitive control. Additionally, although children with ADHD demonstrated slower drift rates and narrower boundary separation overall, they showed no differences when adapting response caution.
44 Functional Connectivity In The Default Mode Network Of ASD and ADHD
- Amritha Harikumar, Chao Zhang, Chase C. Dougherty, Jessica A. Turner, Andrew M. Michael
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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. 454-455
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Autism Spectrum Disorders (ASD) and Attention Deficit Hyperactivity Disorder (ADHD) are neurodevelopmental disorders with overlapping symptomatology and shared genetic makeup. Numerous previous studies have investigated ASD and ADHD using resting state functional networks. One functional network of particular interest is the Default Mode Network (DMN), as it has been shown to be abnormal in several mental disorders. Previous studies have investigated the DMN in ASD and ADHD separately but reported mixed trends of increased and decreased functional connectivity (FC) in the DMN in ASD and increased FC in ADHD. Additionally, little studies have investigated executive and attentional network dysfunction in the DMN for ASD and ADHD populations. To better understand the shared characteristics between ASD and ADHD, this study analyzed the DMN FC in children with ASD and ADHD.
Participants and Methods:Archival datasets from Autism Brain Imaging Data Exchange (ABIDE)-I and ADHD-200 datasets were used, with 33 ADHD, 35 ASD, and 32 typically developing (TD) males (ages = 7-17 years). After applying a standard pre-processing pipeline, 11 regions of interest (ROIs) from the Dosenbach-160 atlas were examined with 55 ROI pairs generated for the 100 subjects.
Results:Significant differences were noted between ASD-ADHD groups in attentional networks and executive functioning networks. Specifically, significant Group x VIQ interactions were noted for FC between the following pairs of regions: medial prefrontal cortex - ventromedial prefrontal cortex, anterior cingulate cortex -ventromedial prefrontal cortex, inferior temporal lobe - ventromedial prefrontal cortex, angular -ventromedial prefrontal cortex, angular -anterior cingulate cortex, inferior temporal lobe -ventrolateral prefrontal cortex, angular -superior frontal lobe, and intraparietal sulcus -superior frontal lobe. In the above FC pairs, FC in ADHD was negatively correlated with VIQ, with no correlation for ASD and positive correlation for TD. Previous literature has indicated that ADHD individuals demonstrate increased executive functioning deficits compared to ASD individuals. This study provides evidence at a neural level for these findings by demonstrating decreased FC trends in ADHD in attentional and executive functioning networks compared to ASD individuals. Group and VIQ main effects demonstrated mixed patterns across the three groups, as well as shared decreased FC in attention/executive networks for both ASD and ADHD groups.
Conclusions:In summary, this study found similar findings from previous studies regarding mixed connectivity patterns, as well as shared dysfunction between ASD and ADHD groups. These results help in solidifying the theory that ASD and ADHD share clinical and neural patterns which need to be examined further. Future directions include utilizing more ASD+ADHD comorbid individuals in studies comparing ASD and ADHD FC trends as well as seeking to further understand the neuropsychological and neuroimaging profiles in ASD and ADHD.
12 Does Executive Functioning Predict Diagnostic Timing of Autism?
- Alexis Khuu, Lauren Kenworthy, Allison Ratto
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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. 622-623
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Objective:
Executive functioning (EF) is impaired in autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD), and EF challenges are exacerbated in youth with ASD and ADHD (ASD+ADHD), which may impact diagnostic timing. We hypothesized youth with ASD+ADHD would be more impaired in EF (as opposed to other functional domains) compared to autistic youth without ADHD (ASD-only), with particular deficits in metacognition and inhibition. We also predicted youth with ASD+ADHD would be at significant risk for delayed ASD diagnosis and that greater EF challenges would predict earlier age of ASD diagnosis across groups.
Participants and Methods:Data from a clinical database was extracted for 400 youth who received a new diagnosis of ASD after age 5, either with a co-occurring diagnosis of ADHD (ASD+ADHD group: n=297; Mage of ASD diagnosis=10.49; 25.9% female; 48.1% white) or without a co-occurring ADHD diagnosis (ASD-only group: n=100; Mage of ASD diagnosis=12.02; 34.0% female; 44.7% white). EF was measured with the BRIEF-2 parent-report, and ASD symptom strength was measured with the SRS-2 School Age form. Independent samples t-tests investigated whether a) the ASD+ADHD group was uniquely impaired in EF compared to the ASD-only group, b) parents of ASD+ADHD report elevated EF problems, and c) the ASD+ADHD group was at significant risk for delayed ASD diagnosis. Pearson correlations examined the association between age of ASD diagnosis and EF for each diagnostic group. Hierarchical linear regressions further analyzed whether specific EF domains concurrently predicted age of ASD diagnosis, after controlling for the known predictors of assigned sex at birth, FSIQ, and ASD symptom strength.
Results:The ASD+ADHD group had greater challenges in overall EF (t=-6.42, p<.001), metacognitive skills (t=-6.47, p <.001), and inhibition skills (t=-7.06, p<.001). There was no significant difference in parent-reported autism symptoms between the ASD and ASD+ADHD groups (t=0.973, p=.331). The ASD+ADHD group received ASD diagnoses earlier than the ASD-only group (t=4.194, p<.001). In the ASD-only group, age of ASD diagnosis was not significantly correlated to overall EF, metacognitive skills, nor inhibition skills (ps>.05). In the ASD+ADHD group, ASD diagnosis was significantly related to overall EF (r(297)=.128, p=.027) and metacognitive skills (r(297)=.329, p<.001) but not inhibition skills (r(297)=.078, p=.180). Hierarchical linear regressions controlling for assigned sex at birth, FSIQ, and SRS-2 T-scores were used to determine whether these EF components significantly predicted age of ASD diagnosis. Overall EF did not predict age of ASD diagnosis in the ASD+ADHD group (ß=.034, t=1.417, p=.157), but metacognitive skills did (ß=.123, t=5.582, p<.001).
Conclusions:Our findings suggest youth with ASD+ADHD have greater impairment in overall EF, metacognition, and inhibition compared to ASD-only youth, despite similar levels of ASD traits, consistent with hypotheses. Contrary to our hypothesis, youth with ASD+ADHD in this sample were diagnosed with ASD earlier. However, results also suggest EF problems, specifically metacognitive deficits, predict later age of ASD diagnosis. Future research is needed to replicate findings and better understand how EF and other functional domains predict ASD diagnostic timing.
32 Associations between Childhood Attention Deficit Hyperactivity Disorder and Learning Disabilities and Cognition in Late Adulthood.
- Giuliana Vallecorsa, Marina Kaplan, Moira McKniff, Emma Pinksky, Molly Tassoni, Stephanie Simone, Sophia Holmqvist, Rachel Mis, Katherine Hackett, Tania Giovannetti
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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, p. 640
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There has been relatively little research on the effect of childhood attention difficulties/weaknesses and learning disabilities/differences on cognitive aging. This study examined associations between self-reported symptoms and diagnoses/concerns of childhood attention deficit hyperactivity disorder (ADHD) and reading or math learning disabilities (LD) and cognitive abilities in older adulthood. We hypothesized that cognitive weaknesses in childhood would be associated with cognitive abilities later in life.
Participants and Methods:The 25 individuals with healthy cognition or MCI were recruited from the greater Philadelphia area (Mage= 74.4; SD= 5.34; 40% men; 84%white) and completed a self-report questionnaire of childhood ADHD and LD. Specifically, participants rated their experience of ADHD symptoms of inattention and hyperactivity/impulsivity and indicated whether they had a past diagnosis of (or concerns regarding past) ADHD, math LD or language/reading LD Participants also completed tests of language, attention, episodic memory, executive function, and processing speed. Pearson or point-biserial correlation coefficients (r-values) indicating a medium effect size (.30 or greater) were interpreted as meaningful.
Results:On average, participants reported 3.48 symptoms of inattention and 2.56 symptoms of hyperactivity/impulsivity (i.e., at least six symptoms from either category are consistent with diagnostic criteria for ADHD). 16% of the sample reported childhood ADHD/attention difficulties, 48% reported childhood math LD/math difficulties, and 32% reported childhood language LD/difficulties. On cognitive tests, the sample performed in the average range, with considerable variability (i.e., norm-based, demographically adjusted T-scores ranged from 20-74). The relation between cognitive scores and report of childhood ADHD symptoms was weak and non-significant correlation (r<.18). By contrast, report of childhood ADHD/attention difficulties was associated with lower scores attention tests (r=.33). Report of childhood language LD/difficulties was associated with a worse overall cognitive composite (r=-.35) and executive function ability (r=-.35). Childhood math LD/difficulties was not meaningfully associated with lower scores on any of the cognitive tests administered. Unexpectedly, report of childhood cognitive difficulties also were associated with higher scores on cognitive tests, such that childhood ADHD/attention difficulties was associated with better performance on tests of episodic memory (r=.39), and childhood math LD/difficulties were associated with better performance on tests of language (r=-.37).
Conclusions:Current cognitive abilities in older adults may be influenced by lifelong cognitive weakness and academic difficulties. A history of ADHD and LD/difficulties should be considered in clinical neuropsychological assessment and future research on cognitive aging should consider ADHD/LD from a lifespan, developmental framework.
36 Reactivity to Loss and Its Relationship to Clinical Symptoms of ADHD in Adults
- Lauren T. Olson, David A.S. Kaufman, Fred W. Sabb, Edythe D. London, Robert M. Bilder
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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. 643-644
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Individuals with attention-deficit/hyperactivity disorder (ADHD) exhibit deficits in reward-based learning, which have important implications for behavioral regulation. Prior research has shown that these individuals show altered patterns of risky decision-making, which may be partially explained as a function of dysfunctional reactivity to rewards and punishments. However, research findings on the relationships between ADHD and punishment sensitivity have been mixed. The current study used the Balloon Analog Risk Task (BART) to examine risky decision-making in adults with and without ADHD, with a particular interest in characterizing the manner in which participants react to loss.
Participants and Methods:612 individuals (Mage = 31.04, SDage = 78.77; 329 females, 283 males) were recruited through the UCLA Consortium for Neuropsychiatric Phenomics (CNP). All participants were administered the Structured Clinical Interview for DSM-IV-TR (SCID-IV), which provided diagnoses used for group comparisons between adults with ADHD (n = 35) and healthy controls (n = 577). A computerized BART paradigm was used to examine impulsivity and risky decision-making, while participants also completed the Barratt Impulsiveness Scale (BIS-11), and ADHD participants completed the Adult Self-Report Scale-V1.1 (ASRS-V1.1). The BART presented two colors of balloons with differing probabilities of exploding, and participants were incentivized to pump the balloons as many times as possible without causing them to explode. The primary endpoint was "mean adjusted pumps", determined as mean across trials of the number of pumps on trials that did not end in explosion. An index of reactivity to loss was calculated as the difference between the mean adjusted pumps following an explosion and the mean adjusted pumps following trials in which the balloon did not explode.
Results:The ADHD and control groups did not differ on mean adjusted pumps across trials, but they did differ in their reactivity to explosion of balloons that followed the most pumps, incurring the greatest level of loss (F(1, 551) = 7.1, p < 0.01). Interestingly, ADHD participants showed a greater reactivity to loss on these balloons than controls (p < 0.05), indicating that they reduced their number of pumps following balloon explosions more than controls. For participants as a whole, there were small correlations between loss reactivity and scales of everyday impulsivity on the BIS-II (ps < 0.05). For ADHD participants, loss reactivity was unrelated to symptoms of inattention but was significantly correlated with symptoms of hyperactivity/impulsivity (p = 0.01) and total ADHD symptoms (p < 0.05) on the ASRS-V1.1.
Conclusions:In the context of a risky decision-making task, adults with ADHD showed greater reactivity to loss than controls, despite showing comparable patterns of overall performance during the BART. The magnitude of behavioral adjustment following loss was correlated with symptoms of hyperactivity/impulsivity in adults with ADHD, suggesting that loss sensitivity is clinically related to impulsive behavior in everyday life. These findings help to expand our understanding of motivational processing in ADHD and suggest new insight into the ways in which everyday symptoms of ADHD are related to sensitivity to losses and punishments.
27 Differentiating Attention-deficit/Hyperactivity Disorder (ADHD) Subtype Using Continuous Performance Tests Among Children with Comorbid ADHD and Anxiety
- Jennifer L. Osborne, Allison S. Shields, Katherine C. Paltell, Erin T. Kaseda, Alexandra C. Kirsch
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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. 635-636
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Continuous performance tests (CPT) are often considered the gold standard for the diagnosis attention-deficit/hyperactivity disorder (ADHD), particularly when parent and teacher rating scales are inconclusive. Prior work has indicated that CPT can also help differentiate between ADHD subtypes. However, the ability of CPT to differentiate ADHD subtype has not been examined among youth with comorbid ADHD and anxiety (ADHD+A). This is particularly concerning as the extant literature suggests that anxiety symptoms may exacerbate deficits associated with ADHD (e.g.. , working memory, attention) and attenuate others (e.g., inhibition); thus, anxiety may influence expected patterns on the CPT. This study therefore seeks to examine the role of ADHD subtype on the relationship between ADHD+A and performance on a CPT among youth with ADHD+A.
Participants and Methods:Participants included 54 children ranging from 6 to 20 years old (Mage=11.83, 54% female) who were diagnosed with ADHD+A via neuropsychological evaluation. In terms of ADHD subtype, 51.9% (n=28) were diagnosed with ADHD combined or ADHD primarily hyperactive and 48.1% (n=26) were diagnosed with ADHD primarily inattentive. Approximately 46.30% (N=25) of participants were medication naive. Analyses were conducted using data from the Conners Kiddie Continuous Performance Test -Second Edition (KCPT-2), Conners Continuous Performance - Second Edition (CPT-2) and the Conners Continuous Performance - Third Edition (CPT-3), which are part of the same family of performance-based attention measures. Independent samples t-tests were conducted to examine performance differences in aspects of attention (e.g., inattentiveness, sustained attention) and hyperactivity (e.g., impulsivity, inhibition).
Results:ADHD subtype was not significantly related to measures of inattentiveness. This includes the number of targets missed (omissions; (t(39)=-.532, p=.59)) and variability in response time (variability; (t(39)=-0.30, p=.77)). In terms of sustained attention, ADHD subtype was not related to variability in response speed across blocks (Hit SEBC/HRT Block Change; (t(39)=-0.26, p=.79)). Importantly, these results were consistent regardless of ADHD medication status. ADHD subtype was also not significantly related to impulsivity. This includes responses to nontargets (commissions; (t(39)=-1.05, p=.30)), random or anticipatory responding (perseverations; (t(39)=-0.19, p=.85)), and mean response speed of correct responses (HR; (t(39)=-0.72, p=.48)).
Conclusions:The extant literature suggests that CPT can help clinicians differentiate between ADHD subtypes. However, the results of this study indicate that there are no performance differences on the CPT among youth with comorbid ADHD and anxiety. There are several limitations to consider. First, this study had a relatively small sample size, which also limited the ability to examine ADHD primarily hyperactive/impulsive as a distinct subtype. Additionally, this study did not examine the effect of individual anxiety disorders (i.e., generalized anxiety disorder, specific phobias). Finally, these findings may not generalize to other standardized measures of attention or more ecologically valid measures. Despite these limitations, this study is an important step in understanding the relationship between ADHD+A and performance on attention measures. Clinicians should be cautious in using results from CPT to distinguish between ADHD subtype among children with comorbid anxiety.
2 Perimenopause, Menopause and ADHD
- Jeanette Wasserstein, Gerry A Stefanatos, Mary V Solanto
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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, p. 881
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Objective:
We previously reported the impact of hormonal changes during menopause on ADHD and associated symptoms. Here we provide findings from an expanded sample limited to those 46 and older.
Participants and Methods:Information was obtained from a reader survey sponsored by ADDitude Magazine. Responses were received from 3117 women of whom 2653 were 46 or older. Analyses were limited to this older group, since mean age of perimenopause is around 47 in the general population. The final sample ranged in age from 46 to 94 (mean=53) and 85% had been diagnosed with diagnosed with ADHD. Respondents were asked to indicate their age at diagnosis and the impact of 11 different symptoms or associated problems of ADHD at each of 5-time intervals: 0-9 years, 1019 years, 20-39 years, 40-59 years and 60+years. Co-morbidities were also considered.
Results:Changes in ADHD Symptoms: Sixty-one percent reported that ADHD had the greatest impact on their daily lives between 40 and 59 years of age. The largest group of respondents (43%) were first diagnosed between ages 41 and 50. The reported prevalence of inattention, disorganization, poor time-management, emotional dysregulation, procrastination, impulsivity and poor memory/brain fog increased over the life span. More than half indicated that a sense of overwhelm, brain fog & memory issues, procrastination, poor time-management, inattention/distractibility and disorganization had a 'life altering impact’ during the critical menopausal/perimenopausal window. By contrast, complaints about significant hyperactivity, impulsivity, social struggles and perfectionism remained fairly constant over the lifespan, and were not among the most common complaints (i.e., only endorsed by 25% to 35% of the sample). Interestingly, while 61% reported that ADHD had its greatest impact on daily life between 40-59, only 3% reported the same thing for age 60 and above. Thus, in this expanded sample the first diagnosis of ADHD was most common in adulthood and peaked in the perimenopausal years. ADHD was also again most disruptive during the perimenopausal/menopausal window of time. This shift was most pronounced for symptoms of poor memory/brain fog and 'feeling overwhelmed.' Symptoms either diminished or they adjusted as they moved out of the transition years.
Comorbid Symptoms: Anxiety and depression were most common (73% and 63%, respectively) consistent with the literature. Also elevated, but much less frequent here, were learning, eating and sensory processing disorders (i.e., 10%-13% each). Thus, depression and anxiety may be the most frequent correlates of an ADHD diagnosis, irrespective of age of onset.
Conclusions:Hormonal change during the climacteric often is associated with worsening of cognitive complaints. Such increased complaints can lead to a first diagnosis of ADHD during this period, as well as a worsening of symptoms in those previously diagnosed. Moreover, this hormonal shift may underlie this diagnosis in a subset of the individuals currently characterized as having adult-onset ADHD. Lessoning of complaints in those ages 60 and above raises questions regarding the underlying mechanisms for this change (e.g., physiologic adaptation, compensation or decreased life demands).
30 Examining the Bilingual Advantage in Executive Functioning in ADHD: A Retrospective Study
- Collin Lee, Christy Hom
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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. 638-639
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Several studies have found a bilingualism advantage on executive functioning tasks like cognitive flexibility, inhibitory control, switching, and working memory in typically developing populations. (Grote et al., 2015, Foy & Mann, 2014). However, some studies have found deficits in inhibitory control and switching for bilingual individuals with Attention Deficit/Hyperactivity Disorder (ADHD) compared to monolingual individuals and control groups (Bialystok et al., 2017, Mor et al., 2015). They suggest that this disadvantage is due to the burden of managing two language systems which perpetuates the executive dysfunction seen in ADHD. The current study aims to examine if there is a bilingualism advantage in other aspects of executive function, including inhibitory control, planning, problem solving, switching, and working memory among children and adults diagnosed with ADHD.
Participants and Methods:The medical records of 170 patients evaluated in an outpatient neuropsychology clinic from 20182022 were reviewed. Sixty participants diagnosed with ADHD, between the ages of 6 and 46 (61.67% male), comprised the final sample. Forty-one were monolingual and 19 were bilingual or multilingual. Language status was based upon patient or parental report. Outcomes on various direct and indirect measures of executive function were examined.
Results:Linear regression models, adjusting for age and sex, revealed a significant bilingual advantage on the following measures: Wechsler Intelligence Scale for Children- Fifth Edition (WISC-V) and Wechsler Adult Intelligence Scale - Fourth Edition (WAIS-IV) Digit Span Backwards and Digit Span Sequencing, WISC-V Picture Span, and Behavior Rating Inventory of Executive Function, 2nd Edition (BRIEF-2) Parent-Report Emotion Regulation Index (ERI). There were no significant differences in scores between monolinguals and bilinguals on the following measures: Delis-Kaplan Executive Function System (D-KEFS) Color-Word Interference Inhibition versus Combined Naming Contrast Score and Inhibition/Switching versus Inhibition Contrast Score, D-KEFS Trail Making Number-Letter Switching versus Combined Number Sequencing and Letter Sequencing Contrast Score, A Developmental Neuropsychological Assessment, 2nd Edition (NEPSY-2) Naming versus Inhibition Contrast Score and Switching versus Inhibition Contrast Score, Wisconsin Card Sort Task Learning to Learn Index, BRIEF-2 Parent-rated Behavioral Regulation Index (BRI), Cognitive Regulation Index(CRI), and Global Executive Composite(GEC), BRIEF-2 Self-rated BRI, ERI, CRI, and GEC, or BRIEF Adult Version BRI, Metacognitive Index, and GEC.
Conclusions:Bilingual status is associated with stronger auditory and visual working memory among people with ADHD, but not with stronger inhibitory control, switching, planning, or problem solving skills. At the same time, there were no significant differences between monolingual and bilingual ADHD patients on BRIEF parent- or self-rated behavioral or cognitive dysregulation. Our results suggest that bilingualism may confer an advantage in some aspects of executive function among a population with weak attention and executive function skills more broadly. Furthermore, we did not find any type of disadvantage for those who are bilingual. Future studies should examine whether lower parental ratings of emotion dysregulation among ADHD patients who are bilingual are due to bilingual children’s better ability to adapt to different situations or cultural differences in parenting practices.
39 Anxiety as a Longitudinal Compensatory Factor for Executive Functioning Abilities in Youth with ADHD
- Rebecca F Slomowitz, Erik G Willcutt, Sally J Wadsworth, Bruce F Pennington, Lauren M McGrath
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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. 646-647
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ADHD and anxiety symptoms are highly comorbid in childhood. While worse functional outcomes are typically expected for children with comorbid ADHD and anxiety symptoms, an emerging body of literature has suggested that anxiety symptoms may actually contribute to compensatory effects for executive functioning (EF) skills in children with ADHD symptoms. However, the results of studies investigating this claim have been quite mixed, possibly due to the use of smaller sample sizes and cross-sectional datasets. The current study extends the previous literature by examining the possible compensatory effects of anxiety symptoms in the context of ADHD symptoms on EF abilities (e.g., working memory [WM] and inhibition) both cross-sectionally and longitudinally in a large, well-validated sample.
Participants and Methods:547 children and adolescents (8-16 years) were included from a population-based sample of twins (CLDRC sample) with enrichment for reading and attention challenges. Participants were retested at a second time point approximately 5 years later. ADHD symptoms (inattention and hyperactivity-impulsivity) were measured by a DSM-based ADHD rating scale, anxiety symptoms were measured by the RCMAS, inhibition was measured by stop-signal reaction time (SSRT), and working memory was measured by Digit Span Backwards (WISC/WAIS-R/III). Covariates included age and sex assigned at birth. Multiple regression models examined cross-sectional and longitudinal associations between ADHD (inattention and H-I) symptoms, anxiety symptoms, and the interaction between ADHD and anxiety symptoms on WM and inhibition abilities.
Results:As expected, higher anxiety, inattention, and H-I symptoms were generally associated with lower inhibition and WM abilities both cross-sectionally and longitudinally. While no significant interactions between ADHD and anxiety symptoms were identified cross-sectionally at Time 1, significant interactions between Time 1 ADHD and anxiety symptoms predicted Time 2 inhibition scores. An inattention x anxiety interaction (p=.002) and a H-I x anxiety (p=.016) interaction significantly predicted Time 2 inhibition. Simple slopes analysis confirmed a compensatory interaction pattern, where ADHD symptoms showed a stronger association with inhibition weaknesses in children without anxiety symptoms compared to those with anxiety symptoms. This suggests that anxiety symptoms may be serving as a compensatory factor for children with ADHD symptoms as compared to their peers without ADHD symptoms.
Conclusions:These findings help clarify a previously mixed literature. Our findings suggest that the compensatory effect of anxiety symptoms on inhibition abilities in children with ADHD symptoms may be a developmental mechanism that takes time to emerge. The fact that the compensatory effect may take time to emerge may explain conflicting results within prior cross-sectional samples. These findings also have implications for research investigating the link between ADHD symptoms and EF abilities, as anxiety symptoms may be an important moderator to consider when attempting to explain why the correlation between ADHD symptoms and EF abilities is often weaker than expected. Finally, clinical implications for this work help to provide empirical evidence to support anecdotal experiences reported by individuals with ADHD and the clinicians who assess them, who often report that anxiety symptoms help them to improve EF performance.
35 Social Media Use Relates to Beliefs about Attention-Deficit/Hyperactivity Disorder (ADHD) Among Emerging Adults
- Grace J Lee, Kyra Fife, Lyndsey Fought, Tiffany Fowler, Julie Suhr
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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. 642-643
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There has been a surge in individuals seeking neuropsychological assessment for attention-deficit/hyperactivity disorder (ADHD) after watching social media created by people claiming to have ADHD. While online content may promote destigmatization of ADHD, self-diagnoses derived from social media use may contribute to the development of inaccurate illness beliefs. Individuals who feel strongly connected to social media that mentions personal anecdotes of ADHD might be more likely to believe they also have ADHD. We examined associations between social media search for ADHD and beliefs about everyday experiences being diagnostic of ADHD among adults concerned about having ADHD, as compared to a control group.
Participants and Methods:A cross-sectional online study included 320 university students (Mage=19.56±2.92; 72% female; 81% White) without history of ADHD. Participants who reported concern about having ADHD, with (n=43) or without other psychological history (n=73) rated whether 100 experiences taken from social media were diagnostic of ADHD, and then rated the amount of time they spent on social media searching for ADHD content. They then rated how often they personally experienced the symptoms. Participants who reported no concern about having ADHD (n=184) only rated how often they personally experienced the symptoms.
Results:Social media search for ADHD was related to total number of experiences believed to be diagnostic of ADHD among participants concerned about having ADHD without psychological history (r=.28, p=.03), but not for those with psychological history (r=.09, p=.57). For participants concerned about having ADHD (regardless of psychological history), social media search for ADHD was related to total number of symptoms personally experienced (rs=.48-.56, ps<.001) and to the number of symptoms endorsed at a clinical level (rs=.48, ps<.001). Total number of experiences believed to be diagnostic of ADHD was related to the number of symptoms personally experienced among participants concerned about having ADHD with psychological history (r=.53, p<.001; clinical level .47, p=.002), but not for those without psychological history (r=.14, p=.31; clinical level .19, p=.15). Of the 100 symptoms, 56 were believed to be diagnostic of ADHD by at least 50% of participants concerned about having ADHD. Of the 56, 43 were personally experienced at a clinical level by controls. For the 13 remaining symptoms not endorsed at a clinical level by controls, symptoms believed to be diagnostic of ADHD was related to symptoms personally experienced among participants concerned about having ADHD with psychological history (r=.53, p<.001; clinical level .52, p<.001), but not for those without psychological history (r=.14, p=.30; clinical level .19, p=.15).
Conclusions:Greater social media search for ADHD is related to higher symptom report among individuals concerned about having ADHD regardless of psychological history. However, individuals concerned about having ADHD without psychological history who engage in greater social media use appear to be more likely to believe that general symptoms are specifically due to ADHD. These individuals may be more prone to misattribute symptoms to ADHD. Nearly 77% of symptoms rated as diagnostic of ADHD were frequently experienced by individuals without concern about having ADHD, which demonstrates the high base rate of ADHD-like symptoms in the general population.