To act or not to act, that’s the problem: Primarily inhibition difficulties in adult ADHD.

Forty-nine carefully diagnosed adults with persistent attention deficit/hyperactivity disorder (ADHD), who had never been medicated for their ADHD, were compared with 49 normal control adults matched for age and gender on a large battery of tests in five domains of executive functioning (inhibition, fluency, planning, working memory, and set shifting) and several other neuropsychological functions to control for nonexecutive test demands. After stringent controls for nonexecutive function demands and IQ, adults with ADHD showed problems in inhibition and set shifting but not in any of the other executive functioning domains tested. We argue that adult ADHD may be mainly a disorder of inhibition. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Executive functioning and olfactory identification in young adults with attention deficit-hyperactivity disorder.

Young adults with attention deficit-hyperactivity disorder (ADHD; N?=?105) were compared with a control group (N?=?64) on 14 measures of executive function and olfactory identification using a 2 (group) × 2 (sex) design. The ADHD group performed significantly worse on 11 measures. No Group × Sex interaction was found on any measures. No differences were found in the ADHD group as a function of ADHD subtype or comorbid oppositional defiant disorder. Comorbid depression influenced the results of only 1 test (Digit Symbol). After IQ was controlled for, some group differences in verbal working memory, attention, and odor identification were no longer significant, whereas those in inhibition, interference control, nonverbal working memory, and other facets of attention remained so. Executive function deficits found in childhood ADHD exist in young adults with ADHD and are largely not influenced by comorbidity but may be partly a function of low intelligence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Time perception and reproduction in young adults with attention deficit hyperactivity disorder.

Adults with attention deficit hyperactivity disorder (ADHD; n ?=? 104) were compared with a control group (n ?=? 64) on time estimation and reproduction tasks. Results were unaffected by ADHD subtype or gender. The ADHD group provided larger time estimations than did the control group, particularly at long intervals. This became nonsignificant after controlling for IQ. The ADHD group made shorter reproductions than the control group (15- and 60-s intervals) and greater reproduction errors (12-, 45-, 60-s durations). These differences remained after controlling for IQ and comorbid oppositional defiant disorder, depression, and anxiety. Only the level of anxiety contributed to errors (at 12-s duration) beyond the level of ADHD. Results extended findings on time perception in ADHD children to adults and ruled out comorbidity as the basis of the errors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Are there cognitive subtypes in adult attention deficit/hyperactivity disorder?

There has been increasing knowledge of the treatment, diagnosis, and demographics of adults with residual attention deficit/hyperactivity disorder (ADHD). However, less is known about the neuropsychological functioning in adults with residual ADHD. In comparing the clinical neuropsychological test performance of a group of adult clinic patients with residual ADHD (N = 30) with that of normal controls (N = 10), we found the patients performed worse on the Trail Making Test, a visual continuous performance test, and the "Brown-Peterson" Auditory Consonant Trigrams Test, but not on any other neuropsychological measures. This pattern indicated a deficit in the area of executive control type functioning, a functional deficit that could be linked to dysregulation of frontal lobe brain systems. Of equal interest was that patients diagnosed with ADHD/hyperactive impulsive type (ADHD+) and patients diagnosed with ADHD/inattentive type (ADHD-) had different types of executive system deficits. ADHD+ was associated with relative deficiency on the Wisconsin Card Sorting Test. ADHD- was associated with relative deficiency on the "Brown-Peterson" Auditory Consonant Trigrams Test, a measure of working memory, as well as less olfactory identification on a smell identification test. The data are discussed in terms of recent localization theories of frontal lobe function. The preliminary data suggest that the different cognitive weaknesses of ADD subtypes may be linked to dysregulation of separate frontal brain regions and/or neurotransmitter systems.     

Effect of age on event-based and time-based prospective memory.

The magnitude of age differences on event- and time-based prospective memory tasks was investigated in 2 experiments. Participants performed a working memory task and were also required to perform either an event- or time-based prospective action. Control participants performed either the working memory task only or the prospective memory task only. Results yielded age differences on both prospective tasks. The age effect was particularly marked on the time-based task. Performance of the event-based prospective task, however, had a higher cost to performance on the concurrent working memory task than the time-based task did, suggesting that event-based responding has a substantial attentional requirement. The older adults also made a significant number of time-monitoring errors when time monitoring was their sole task. This suggests that some time-based prospective memory deficits in older adults are due to a fundamental deficit in time monitoring rather than to prospective memory. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

A Meta-Analytic Review of Stopping Performance in Attention-Deficit/Hyperactivity Disorder: Deficient Inhibitory Motor Control?

This review discusses whether deficient inhibitory motor control is the core deficit of attention-deficit/hyperactivity disorder (ADHD). Inhibitory motor control is commonly assessed using the stop-signal paradigm. Since the last meta-analysis that was performed, 33 new studies have appeared. The current meta-analysis revealed a significant difference between ADHD patients and matched controls in stop latency (stop-signal reaction time) in both children and adults. Basic reaction time was significantly longer in children with ADHD, but not in adults, and there was a significant interaction between the elongation of the latency to stop and to respond in adults, but not in children. Deficient inhibitory motor control may be less crucial in children than in adults with ADHD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Executive Functioning, Memory, and Learning in Phenylketonuria.

The executive deficit hypothesis of treated phenylketonuria (PKU) suggests that dopaminergic depletion in the lateral prefrontal cortex leads to selective executive impairment. This was examined by comparing adults with PKU on a lifelong diet with a matched healthy control group. Those with PKU were impaired on selective and sustained attention, working memory (Self-Ordered Pointing), and letter fluency. However, they failed to show differential sensitivity to increased cognitive load on the attentional and working memory tasks, and they did not differ significantly on the remaining executive tasks (rule finding, inhibition, and multitasking). Nor did they differ significantly on recall or recognition memory. Overall, the findings provided little support for the executive deficit hypothesis. A possible explanation in terms of slowed information processing speed is explored. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Disentangling the adult attention-deficit hyperactivity disorder endophenotype: Parametric measurement of attention.

Attention deficit hyperactivity disorder (ADHD) persists frequently into adulthood. The decomposition of endophenotypes by means of experimental neuro-cognitive assessment has the potential to improve diagnostic assessment, evaluation of treatment response, and disentanglement of genetic and environmental influences. We assessed four parameters of attentional capacity and selectivity derived from simple psychophysical tasks (verbal report of briefly presented letter displays) and based on a “theory of visual attention.” These parameters are mathematically independent, quantitative measures, and previous studies have shown that they are highly sensitive for subtle attention deficits. Potential reductions of attentional capacity, that is, of perceptual processing speed and working memory storage capacity, were assessed with a whole report paradigm. Furthermore, possible pathologies of attentional selectivity, that is, selection of task-relevant information and bias in the spatial distribution of attention, were measured with a partial report paradigm. A group of 30 unmedicated adult ADHD patients and a group of 30 demographically matched healthy controls were tested. ADHD patients showed significant reductions of working memory storage capacity of a moderate to large effect size. Perceptual processing speed, task-based, and spatial selection were unaffected. The results imply a working memory deficit as an important source of behavioral impairments. The theory of visual attention parameter working memory storage capacity might constitute a quantifiable and testable endophenotype of ADHD. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Contraction of time in attention-deficit hyperactivity disorder.

Attention-deficit hyperactivity disorder (ADHD) has been associated with anomalies in dopamine systems. Recent advances in the understanding of the core cognitive deficits in ADHD suggest that dopamine dysfunction might be expressed through shortened time scales in reward-based learning. Here this perspective is extended by the conjecture that temporal span in working memory systems might generally be shortened. As a test of this conjecture the authors focus on the implicit memory system involved in rhythmic movement, assessing the minimum tempo at which rhythmic feeling can be sustained in adults with diagnosed ADHD and in a control group of normal adults. The authors found that people with ADHD do in fact have a rhythm cut-off that is faster in tempo than those without ADHD. This finding is consistent with the idea that impaired dopamine dynamics have systemic consequences for cognitive function, essentially recalibrating the clock that sets the time scale for the subjective experience of temporal events. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Adult age differences in episodic memory: Further support for an associative-deficit hypothesis.

This study further tested an associative-deficit hypothesis (ADH; M. Naveh-Benjamin, 2000), which attributes a substantial part of older adults' deficient episodic memory performance to their difficulty in merging unrelated attributes-units of an episode into a cohesive unit. First, the results of 2 experiments replicate those observed by M. Naveh-Benjamin (2000) showing that older adults are particularly deficient in memory tests requiring associations. Second, the results extend the type of stimuli (pictures) under which older adults show this associative deficit. Third, the results support an ADH in that older adults show less of an associative deficit when the components of the episodes used are already connected in memory, thereby facilitating their encoding and retrieval. Finally, a group of younger adults who encoded the information under divided-attention conditions did not show this associative deficit. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Study of Verbal Working Memory in Patients With Parkinson's Disease.

The authors examined the nature of the working memory deficit in persons with Parkinson's disease (PD). Three hypotheses were tested: a limited storage capacity, an impaired executive component, and a reduction of psychomotor speed. Verbal working memory was assessed in 14 PD patients without dementia and 14 matched control participants. Participants were administered a classical verbal span test, working memory tasks that required either updating or manipulation capacities, and motor and psychomotor speed tasks. Patients' performance was comparable to that of control participants on the verbal span test. However, results on the working memory tasks indicated a deficit in manipulation with normal updating capacities. Motor and psychomotor slowing were found in the patient group, but slowing could not fully account for the impairment observed in the manipulation task. Results indicated that there is a genuine but selective working memory impairment in patients with PD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Interference control, working memory, concept shifting, and verbal fluency in adults with attention-deficit/hyperactivity disorder (ADHD).

In this study, the authors aimed to examine 4 domains of executive functioning in adults with attention-deficit/hyperactivity disorder (ADHD)--namely interference control, concept shifting, verbal fluency, and verbal working memory. Four groups of participants were included: (a) adults diagnosed with ADHD (ADHD-; n = 20), (b) adults diagnosed with both ADHD and 1 or more comorbid disorder(s) (ADHD+; n = 22), (c) adults referred for ADHD because of ADHD symptomatology but not diagnosed as such (non-ADHD; n = 34), and (d) healthy controls (n = 136). ADHD-related deficits (independent of comorbidity) were revealed for concept shifting and verbal working memory. In addition, the ADHD+ and non-ADHD groups displayed deficits in terms of general processing speed. Given that these deficits were not found in the ADHD- group, the authors contend that these deficits are likely attributable to comorbidity rather than ADHD itself. Contrary to the authors' expectations, these findings do not correspond with the cognitive subtype hypothesis. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Behavioral inhibition, sustained attention, and executive functions: Constructing a unifying theory of ADHD.

Attention deficit hyperactivity disorder (ADHD) comprises a deficit in behavioral inhibition. A theoretical model is constructed that links inhibition to 4 executive neuropsychological functions that appear to depend on it for their effective execution: (a) working memory, (b) self-regulation of affect–motivation–arousal, (c) internalization of speech, and (d) reconstitution (behavioral analysis and synthesis). Extended to ADHD, the model predicts that ADHD should be associated with secondary impairments in these 4 executive abilities and the motor control they afford. The author reviews evidence for each of these domains of functioning and finds it to be strongest for deficits in behavioral inhibitions, working memory, regulation of motivation, and motor control in those with ADHD. Although the model is promising as a potential theory of self-control and ADHD, far more research is required to evaluate its merits and the many predictions it makes about ADHD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Neuropsychological functioning in nonreferred siblings of children with attention deficit/hyperactivity disorder.

The goal of this study was to assess neuropsychological functioning in nonreferred siblings of children with attention deficit/hyperactivity disorder (ADHD). Participants were 156 siblings of ADHD probands with (N?=?40) and without (N?=?116) ADHD (according to criteria of the Diagnostic and Statistical Manual of Mental Disorders [3rd edition, revised; American Psychiatric Association, 1987]) and 118 siblings of non-ADHD normal controls of similar age, IQ, and grade level. Information on attention, executive, and memory functions was obtained in a standardized manner without knowledge of clinical status. Compared with siblings of controls, siblings with ADHD were significantly impaired on the Stroop test and on verbal learning and memory. In contrast, siblings without ADHD were similar to controls on virtually all measures. These data suggest that some executive, attention, and verbal learning deficits are found in nonreferred individuals with ADHD but that neuropsychological deficits are unlikely to constitute an endophenotype to ADHD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Numerical aberration of chromosome 17 is correlated with multiple primary cancer in colorectal carcinoma

In order to test the hypothesis that attention deficit hyperactivity disorder (ADHD) is related to deficits in somatosensory processing, 49 ADHD male children and 49 matched controls were tested on a wide range of tactile tasks, and somatosensory evoked potentials (SEP) were also recorded. In addition, parents' and teachers' ratings on the children's typical responses to tactile stimuli were obtained. The results show that the ADHD children were less skilled on suprathreshold, but not on threshold tasks than were the controls. Further, a larger percentage of ADHD children were 'tactile defensive'. Finally, the ADHD children showed larger-than-normal amplitudes of late, but not early components of the SEP. These data suggest that some aspects of somatosensory processing by ADHD children are deficient.     

Attention deficit hyperactivity disorder (ADHD) is associated with early onset substance use disorders

We evaluated the association between attention deficit hyperactivity disorder (ADHD) and the age of onset of psychoactive substance use disorders (PSUD) in adults with ADHD. We hypothesized that ADHD and psychiatric comorbidity would be risk factors for early onset PSUD. We compared 120 referred adults having a clinical diagnosis of childhood-onset ADHD with 268 non-ADHD adults. All diagnoses were obtained using DSM-III-R based structured psychiatric interviews. We used group comparisons of age at onset and Cox proportional hazard models to examine the development of PSUD over time. ADHD was associated with earlier onset of PSUD independently of psychiatric comorbidity. Conduct and juvenile bipolar disorders conferred a significantly increased risk for early onset PSUD independently of ADHD. Psychiatric disorders commonly emerged before the onset of PSUD in both groups. Persistent ADHD with and without psychiatric comorbidity was associated with adolescent onset PSUD. In addition, comorbidity with conduct and juvenile bipolar disorders predicted very early onset PSUD in both ADHD and non-ADHD individuals. These findings confirm and extend previous findings documenting important associations between PSUD and psychiatric comorbidity including persistent ADHD.     

Cognitive processing deficits in poor readers with symptoms of reading disabilities and ADHD: More alike than different?

The cognitive differences among poor-reading children with characteristics of reading disabilities (RD) and attention deficit-hyperactivity disorder (ADHD) when compared with children with comorbid symptoms (RD + ADHD) and slow learners (SL) on measures of phonological and executive processing were investigated. No significant differences in performance emerged between the ability groups in phonological processing. The SL + ADHD & slow learners performed better than RD groups (RD alone and RD + ADHD) on the visual-spatial working memory (WM) factor score and the RD-alone group was inferior to RD + ADHD, SL + ADHD, and SL-alone groups on the verbal WM factor score. The results support the notion that poor readers, whether suffering from RD or ADHD symptoms, share a common phonological core deficit. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effects of attention on age-related relational memory deficits: Evidence from a novel attentional manipulation.

Healthy aging is often accompanied by episodic memory decline. Prior studies have consistently demonstrated that older adults show disproportionate deficits in relational memory (RM) relative to item memory (IM). Despite rich evidence of an age-related RM deficit, the source of this deficit remains unspecified. One of the most widely investigated factors of age-related RM impairment is a reduction in attentional resources. However, no prior studies have demonstrated that reduced attentional resources are the critical source of age-related RM deficits. Here, we used qualitatively different attention tasks and tested whether reduced attention for relational processing underlies the RM deficit observed in aging. In Experiment 1, we imposed either item-detection or relation-detection attention tasks on young adults during episodic memory encoding and found that only the concurrent attention task that involves relational processing disproportionately impaired RM performance in young adults. Moreover, by ruling out the possible confound of task difficulty on the disproportionate RM impairment, we further demonstrated that reduced relational attention is a key factor for the age-related RM deficit. In Experiment 2, we replicated the results from Experiment 1 by using different materials of stimuli and found that the effect of relational attention on RM is material general. The results of Experiment 2 also showed that reducing attentional resources for relational processing in young adults strikingly equated their RM performance to that of older adults. Thus, this study documents the first evidence that reduced attentional resources for relational processing are a critical factor for the relational memory impairment observed in aging. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Time Constraints and Resource Sharing in Adults' Working Memory Spans.

This article presents a new model that accounts for working memory spans in adults, the time-based resource-sharing model. The model assumes that both components (i.e., processing and maintenance) of the main working memory tasks require attention and that memory traces decay as soon as attention is switched away. Because memory retrievals are constrained by a central bottleneck and thus totally capture attention, it was predicted that the maintenance of the items to be recalled depends on both the number of memory retrievals required by the intervening treatment and the time allowed to perform them. This number of retrievals:time ratio determines the cognitive load of the processing component. The authors show in 7 experiments that working memory spans vary as a function of this cognitive load. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Neuropsychology of Adults With Attention-Deficit/Hyperactivity Disorder: A Meta-Analytic Review.

A comprehensive, empirically based review of the published studies addressing neuropsychological performance in adults diagnosed with attention-deficit/hyperactivity disorder (ADHD) was conducted to identify patterns of performance deficits. Findings from 33 published studies were submitted to a meta-analytic procedure producing sample-size-weighted mean effect sizes across test measures. Results suggest that neuropsychological deficits are expressed in adults with ADHD across multiple domains of functioning, with notable impairments in attention, behavioral inhibition, and memory, whereas normal performance is noted in simple reaction time. Theoretical and developmental considerations are discussed, including the role of behavioral inhibition and working memory impairment. Future directions for research based on these findings are highlighted, including further exploration of specific impairments and an emphasis on particular tests and testing conditions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)