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)     

Effect of Methylphenidate on Time Perception in Children With Attention-Deficit/Hyperactivity Disorder.

The effects of methylphenidate (MPH) on performance of a time-production task were studied in 17 children with attention-deficit/hyperactivity disorder who participated in 1 test session on and 1 off MPH. Participants held a response lever down for at least 10 but no longer than 14 s. Administration of MPH had no effect on the number of correct responses or on the mean duration of lever holds. MPH administration significantly decreased timing response variability, increased holds of 10- to 11-s duration, and decreased lever holds of extremely short durations. These results indicate that administration of MPH resulted in more precise timing performance without changing the mean duration of lever holds, suggesting an enhancement in working memory. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Controlled Visuomotor Preparation Deficits in Attention-Deficit/Hyperactivity Disorder.

To the best of the authors' knowledge, there are no published reports on visuomotor preparation in attention-deficit/hyperactivity disorder (ADHD). This is unfortunate, because research suggests that ADHD is an output-related deficit, and suboptimal execution of tasks may be the result of incomplete visuomotor preparation. The authors compared 19 children with ADHD with 124 healthy and 120 pathological controls in terms of their performance (speed, speed variability, and accuracy) on the finger precuing test, a test measuring (automatic and controlled) visuomotor preparation. The data implied that children with ADHD have an impaired ability to engage in effortful, controlled visuomotor preparation activities. Fast, automatic response preparation was not affected by ADHD. In addition, children with ADHD showed more variability in overall test performance than other children. No group differences were found in response accuracy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

What Aspects of Peer Relationships Are Impaired in Children With Attention-Deficit/Hyperactivity Disorder?

Participants included 165 children with attention-deficit/hyperactivity disorder (ADHD; 130 boys, 35 girls) and their 1,298 same-sex classmates (1,026 boys, 272 girls) who served as raters. For each child with ADHD, a child of the same sex was randomly selected from the same classroom to serve as a comparison child, which yielded 165 dyads. Consistent with predictions, contrasted with the comparison children, those with ADHD were lower on social preference, higher on social impact, less well liked, and more often in the rejected social status category; they also had fewer dyadic friends. When liking ratings that children made versus received were examined, children with ADHD had less positive imbalance and greater negative imbalance relative to comparison children. Analyses that considered the types of peers who chose children with ADHD as friends or nonfriends demonstrated that children with ADHD were nominated as nonfriends by children of higher social preference and who were better liked by others. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of Recess on the Classroom Behavior of Children With and Without Attention-Deficit Hyperactivity Disorder.

The primary purpose of this study was to evaluate the effects of a traditional recess on the subsequent classroom behavior of children with a diagnosis of Attention-Deficit Hyperactivity Disorder (ADHD). In addition, the time of recess was matched to the behavior of the individual children diagnosed with ADHD based on prior assessment of their classroom behavior as a function of time of confinement in the classroom. All results were evaluated using single-case designs. Results showed that levels of inappropriate behavior were consistently higher on days when participants did not have recess, compared with days when they did have recess. Results also showed that the level of inappropriate behavior for all participants progressively increased over time on days when they did not have recess. However, this progressive increase did not occur on days when the participants had recess. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Differential Prefrontal Cortex Activation During Inhibitory Control in Adolescents With and Without Childhood Attention-Deficit/Hyperactivity Disorder.

The authors examined inhibitory control processes in 8 adolescents diagnosed with attention-deficit/ hyperactivity disorder (ADHD) during childhood and in 8 adolescent control participants using functional MRI with the Stimulus and Response Conflict Tasks (K. W. Nassauer & J. M. Halperin, 2003). No group differences in performance were evident on measures of interference control and/or response competition created by location and direction stimuli. However, the ADHD group demonstrated significantly greater activation of the left ventrolateral prefrontal cortex during interference control as well as greater activation of the left anterior cingulate cortex, right ventrolateral prefrontal cortex, and left basal ganglia during the dual task of interference control and response competition. The magnitude of the prefrontal and basal ganglia activation was positively correlated with severity of ADHD. Response competition alone did not yield group differences in activation. (PsycINFO Database Record (c) 2010 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)     

The Role of Children's Ethnicity in the Relationship Between Teacher Ratings of Attention-Deficit/Hyperactivity Disorder and Observed Classroom Behavior.

Significant ethnic differences have been consistently documented on attention-deficit/hyperactivity disorder (ADHD) teacher rating scales. Whether these ethnic differences result from a teacher rating bias or reflect actual classroom behavior patterns is unknown. Ethnic differences between Caucasian and African American (AA) elementary schoolchildren on teacher ratings and codings of observed classroom behavior were examined with latent variables. In structural equation models, correlations between teacher ratings and observed classroom behavior suggested nonbiased teacher ratings of AA schoolchildren with diagnosed ADHD. Ethnic differences were documented for both teacher ratings of ADHD and classroom behavior. Differences in classroom behavior were attenuated when the behavior of an average child in the classroom was taken into account. Multiple explanations for this pattern of results are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Intellectual functioning in adults with ADHD: A meta-analytic examination of full scale IQ differences between adults with and without ADHD.

Although attention has been given to the intellectual functioning of children with attention-deficit/hyperactivity disorder (ADHD) relative to their non-ADHD peers, few studies have examined intellectual functioning in adults with ADHD. The purpose of the current investigation was to examine differences in intellectual ability between adults with and without ADHD via a meta-analytic review. Of the 33 studies meeting inclusion criteria, primary analyses focused on 18 studies representing 1,031 adults with ADHD and 928 non-ADHD, nonclinical comparison adults and containing Wechsler Adult Intelligence Scale (WAIS; D. Wechsler, 1955, 1981, 1994) Full Scale IQ scores or estimates. A significant effect was found such that adults with ADHD scored lower than non-ADHD adults on WAIS intelligence tests. However, this difference was small and not clinically meaningful. The presence of several moderators reflecting characteristics of the ADHD samples and study methodology suggested that only a subset of adults with ADHD (e.g., those with comorbid disorders) may experience lower general intellectual ability relative to non-ADHD comparison adults. Implications of the findings for clinical and research settings are presented as well as suggestions for improving methodology and reporting in future research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Learning disabilities and executive dysfunction in boys with attention-deficit/hyperactivity disorder.

The effect of comorbid reading or arithmetic learning disabilities (LDs) on neuropsychological function in attention-deficit/hyperactivity disorder (ADHD) was studied. Participants were young males diagnosed with ADHD, with and without LD, and non-ADHD, non-LD male controls of similar age. LD was defined by combined regression-based and low-achievement classifications. Analyses adjusted for the effect of psychiatric comorbidity, age, and socioeconomic status on neuropsychological function. Children who had both ADHD and LD were significantly more impaired on both executive and nonexecutive functions than ADHD children without LD. Neuropsychological performance was most impaired in ADHD with combined arithmetic and reading disability. These data indicate that comorbid LD, especially arithmetic disability, significantly increases the severity of executive function impairment in ADHD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Adapting Psychotherapy to Meet the Needs of Adults With Attention-Deficit/Hyperactivity Disorder.

Requests for the assessment and treatment of attention-deficit/hyperactivity disorder (ADHD) among adult patients are on the rise. The findings from longitudinal research indicate that clinically significant symptoms persist into adulthood for many children diagnosed with ADHD. Many other patients' symptoms are not identified until they are in active treatment for other complaints in adulthood. Thus, psychotherapists are increasingly likely to encounter adult patients with ADHD-related issues. However, the same core symptoms of inattention, impulsivity, and hyperactivity that create functional problems in patients' lives also interfere with the effectiveness of psychotherapy. The aim of this article is to summarize the accumulated clinical and empirical wisdom about how to effectively adapt psychotherapy to meet the needs of adult patients with ADHD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Atomoxetine: A Selective Norepinephrine Reuptake Inhibitor for the Treatment of Attention-Deficit/Hyperactivity Disorder.

This column offers data related to attention deficit disorder with hyperactivity and related psychopharmacological treatments. The author focuses on atomoxetime, a selective norepinephrine reuptake inhibitor, and offers efficacy and safety data. Conclusions point out the limitations of stimulant use and praise the alleged non-abusive nature of atomoxetine. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Impact of Executive Function Deficits and Attention-Deficit/Hyperactivity Disorder (ADHD) on Academic Outcomes in Children.

The association between executive function deficits (EFDs) and functional outcomes were examined among children and adolescents with attention-deficit/hyperactivity disorder (ADHD). Participants were children and adolescents with (n = 259) and without (n = 222) ADHD, as ascertained from pediatric and psychiatric clinics. The authors defined EFD as at least 2 executive function measures impaired. Significantly more children and adolescents with ADHD had EFDs than did control participants. ADHD with EFDs was associated with an increased risk for grade retention and a decrease in academic achievement relative to (a) ADHD alone, (b) controlled socioeconomic status, (c) learning disabilities, and (d) IQ. No differences were noted in social functioning or psychiatric comorbidity. Children and adolescents with ADHD and EFDs were found to be at high risk for significant impairments in academic functioning. These results support screening children with ADHD for EFDs to prevent academic failure. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Contribution of Organizational Strategy to Verbal Learning and Memory in Adults With Attention-Deficit/Hyperactivity Disorder.

Statistical mediation modeling was used to test the hypothesis that poor use of a semantic organizational strategy contributes to verbal learning and memory deficits in adults with attention-deficit/hyperactivity disorder (ADHD). Comparison of 28 adults with ADHD and 34 healthy controls revealed lower performance by the ADHD group on tests of verbal learning and memory, sustained attention, and use of semantic organization during encoding. Mediation modeling indicated that state anxiety, but not semantic organization, significantly contributed to the prediction of both learning and delayed recall in the ADHD group. The pattern of findings suggests that decreased verbal learning and memory in adult ADHD is due in part to situational anxiety and not to poor use of organizational strategies during encoding. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A Psychophysical Measure of Attention Deficit in Children With Attention-Deficit/Hyperactivity Disorder.

The authors explored the temporal mechanism of attention deficit in children with attention-deficit/hyperactivity disorder (ADHD). In rapid serial visual presentation tasks in which two targets (T? and T?) were presented in close temporal proximity among distractors, participants tried to identify T? and detect T? in one (dual-task) experiment and only to detect T? in a second control (single-task) experiment. The sensitivity of T? detection was analyzed using signal detection theory. The attentional blink--the impairment in T? detection following the identification of T?--was increased in magnitude and protracted in the patients. Moreover, some ADHD children appeared to have a blink largely normal in magnitude but temporally displaced toward a later time. The authors hypothesize that a slower closing of the attention gate may mediate this specific attention impairment in ADHD children. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychosocial treatments for attention-deficit/hyperactivity disorder in adults: Current evidence and future directions.

As recently as 1997, the empirical database guiding the selection of psychosocial treatments for adults with attention-deficit/hyperactivity disorder (ADHD) could be summarized as "entirely anecdotal" (American Academy of Child and Adolescent Psychiatry, 1997, p. 107S). However, there is preliminary evidence supporting the use of psychosocial interventions (in conjunction with pharmacotherapy) tailored to meet the unique needs of adults with ADHD. The aim of this article is to review the current evidence base for psychosocial treatments for adult ADHD. We provide background information about adult ADHD, review the extant research of psychosocial treatments, summarize important aspects of psychotherapy for adults with ADHD, and offer suggestions for future research that may improve psychosocial services and treatment outcomes for this clinical population. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Relationship Between Neuropsychological Functioning and Driving Ability in Dementia: A Meta-Analysis.

A meta-analysis of 27 primary studies was conducted to examine the relationship between neuropsychological functioning and driving ability for adults with dementia. When studies using a control group were included, the relationship between cognitive measures and on-road or non-road driving measures was significant for all reported domains; mean correlations ranged from .35 to .65. Caregiver reports of driving ability and cognitive variables were correlated significantly only on measures of mental status and visuospatial skills. When studies using a control group were excluded, moderate mean correlations were observed for visuospatial skills and on-road or non-road measures, and for mental status with non-road tests. Other effects were small or nonsignificant. Implications for basing driving recommendations on neuropsychological testing are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Preadolescent girls with attention-deficit/hyperactivity disorder: II. Neuropsychological performance in relation to subtypes and individual classification.

This study examined executive functions, motor speed, and language processing in a diverse, preadolescent sample of 93 girls with attention-deficit-hyperactivity disorder (ADHD) combined type, 47 ADHD inattentive type, and 88 age- and ethnicity-matched comparison girls. Testing was performed without stimulant medication. All 10 neuropsychological variables showed significant omnibus subgroup differences, with 8 of 10 combined versus comparison contrasts significant (average effect size medium) and 6 of 10 inattentive versus comparison contrasts significant (average effect size small to medium), but only 2 of 10 combined versus inattentive contrasts significant (average effect size small). Results were robust to statistical control of demographic variables, comorbidities, and IQ. Discriminant function analysis revealed relatively high sensitivity but only modest specificity in predicting ADHD from comparison status from test performance; classification of the inattentive type was extremely poor. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The latent structure of attention-deficit/hyperactivity disorder in a clinic-referred sample.

The question of whether attention-deficit/hyperactivity disorder (ADHD) represents a continuum of attentional and executive dysfunction or a natural category has yet to be extensively investigated. Subjective report and neuropsychological data from 437 individuals referred for neuropsychological evaluation were analyzed using latent class and taxometric analyses (mean above minus below a cut [MAMBAC], maximum eigenvalue [MAXEIG], and latent mode [LMODE]). Results indicated no significant evidence for a taxonic representation of ADHD across multiple procedures and indicator sets. Similarly, there was no evidence that ADHD subtypes represent a qualitative distinction. These findings may suggest that current diagnostic conceptualizations are inadequate for accurately identifying and characterizing individuals with problems related to attention and executive dysfunction. Alternatively, the null findings may have resulted from inadequate indicator selection. A dimensional model may better facilitate accurate identification of individuals at risk for functional impairment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Wechsler Intelligence Scale for Children-Third and -Fourth Edition predictors of academic achievement in children with attention-deficit/hyperactivity disorder.

IQ and achievement scores were analyzed for 678 children with attention-deficit/ hyperactivity disorder (ADHD; 6-16 years of age, IQ≥80) administered the Wechsler Intelligence Scale for Children-Third Edition (WISC-III; n=586) and Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV, n=92). Approximately 76% of children in both samples were identified with a learning disability (LD). LD in written expression was more common than in reading or math. For both the WISC-III and the WISC-IV, full-scale IQ was the strongest single predictor of achievement in all areas. The verbal subtests comprising the Freedom from Distractibility/Working Memory Index (FDI/WMI) and Verbal Comprehension Index were more highly correlated with achievement scores than the nonverbal subtests on both the WISC-III and WISC-IV. The most powerful predictors of LD, however, were the FDI/WMI and Processing Speed Index (PSI) subtests. These findings suggest that verbal intelligence is more influential in determining level of academic achievement, whereas cognitive abilities assessed by FDI/WMI and PSI are more important in determining LD in children with ADHD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)