Multiple sources of attentional dysfunction in adults with Tourette's syndrome: Comparison with attention deficit-hyperactivity disorder.

Seventeen adult Tourette's syndrome (TS) patients, 17 adult attention deficit-hyperactivity disorder (ADHD) patients, and 17 adult controls completed a battery of attentional tests and self-report measures of ADHD and obsessive-compulsive disorder (OCD) symptoms. ADHD but not TS participants performed significantly worse than controls on tests of mental flexibility and psychomotor speed. Both the ADHD and TS groups, however, had significantly greater test performance variability as well as several outliers on most of the measures. Among TS patients, those with comorbid ADHD performed significantly worse than TS patients without ADHD on tests of mental flexibility and psychomotor speed, suggesting ADHD-related attentional impairment in TS. In addition, greater amounts of OCD symptomatology were associated with poorer test performance among TS patients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Can bipolar disorder-specific neuropsychological impairments in children be identified?

This study examined neuropsychological deficits among children with bipolar disorder while attending to its comorbidity with attention-deficit/hyperactivity disorder (ADHD). Seventy-three unmedicated children (ages 6-17 years) with Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) bipolar disorder plus ADHD (BPD + ADHD) were compared with 102 unmedicated children with ADHD without bipolar disorder, and 120 children without bipolar disorder or ADHD. Ninety-four percent of participants were Caucasian, 58% were male, and 42% were female. On average participants were of middle to upper socioeconomic status. Participants were assessed with a comprehensive neuropsychological battery and measures of academic achievement, school failure, and special education placement. Participants with BPD + ADHD and with ADHD were impaired in interference control, verbal learning, and arithmetic achievement and had higher rates of special school services. Across all of the measures of neuropsychological functioning, the only difference observed between youths with BPD + ADHD and youths with ADHD was that youths with BPD + ADHD performed more poorly on one measure of processing speed. Thus, comorbidity with ADHD may account for many of the neuropsychological deficits observed in children with bipolar disorder. (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)     

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)     

Reading and arithmetic in adolescents with autism spectrum disorders: Peaks and dips in attainment.

In describing academic attainment in autism spectrum disorders (ASD), results are typically reported at the group mean level. This may mask subgroups of individuals for whom academic achievement is incommensurate with intellectual ability. The authors tested the IQ, literacy, and mathematical abilities of a large group (N = 100) of adolescents (14–16 years old) with ASD. Seventy-three percent of the sample had at least one area of literacy or mathematical achievement that was highly discrepant (approximately 14 standard score points) from full-scale IQ (FSIQ). The authors focused on four subgroups with either word reading (“Reading Peak” and “Reading Dip”) or arithmetic (“Arithmetic Peak” and “Arithmetic Dip”) higher or lower than FSIQ. These subgroups were largely mutually exclusive and were characterized by distinct intellectual profiles. The largest was the “Arithmetic Peak” subgroup of participants, who presented with average intellectual ability alongside superior arithmetic skills and who were predominantly in a mainstream educational setting. Overall, the most pervasive profile was discrepantly poor reading comprehension, which associated with severity of social and communication difficulties. The high rate of uneven academic attainment in ASD has implications for educational practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Does Psychopathy Predict Institutional Misconduct Among Adults? A Meta-Analytic Investigation.

Narrative reviews have raised several questions regarding the predictive validity of the Hare Psychopathy Checklist-Revised (PCL-R; R. D. Hare, 2003) and related scales in institutional settings. In this meta-analysis, the authors coded 273 effect sizes to investigate the association between the Hare scales and a hierarchy of increasingly specific forms of institutional misconduct. Effect sizes for Total, Factor 1, and Factor 2 scores were quite heterogeneous overall and weakest for physically violent misconduct (rw = .17, .14, and .15, respectively). Moderator analyses suggested that physical violence effect sizes were smaller in U.S. prison samples (rw = .11) than in non-U.S. prison samples (rw = .23). Findings are discussed in terms of the utility of the Hare measures for decision-making in institutional and other contexts. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A meta-analytic review of the sensitivity of the Wisconsin Card Sorting Test to frontal and lateralized frontal brain damage.

The author conducted 2 meta-analyses on the Wisconsin Card Sorting Test (WCST). The 1st compared participants with frontal lobe damage to those with posterior brain damage, whereas the 2nd compared participants with left and right frontal damage. Effect sizes based on the difference between groups were calculated for WCST variables and a composite measure. Effect sizes for these variables, except nonperseverative errors, indicated significantly poorer performance for participants with frontal damage. There were no significant differences for the left versus right comparisons. Moderator analyses using the composite measure for the frontal versus nonfrontal analyses indicated that the largest effect size was for dorsolateral damage. Though this study indicates that the WCST is sensitive to frontal lobe damage, caveats are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Repressor-sensitizer personality styles and associated levels of verbal ability, social intelligence, sex knowledge, and quantitative ability.

Utilized Byrne's Repression-Sensitization scale to assign 164 male undergraduates to repressor, neutral, or sensitizer groups. Scores from measures of verbal ability, social intelligence, sex knowledge, quantitative ability, and scholastic grades were obtained. Sensitizers, who use such defenses as intellectualization, rumination, and approach, were hypothesized to score higher on selected intellectual measures than repressors who use repression, denial, and avoidance. Results were opposite to those hypothesized, with repressors significantly exceeding sensitizers on 6 of 12 measures, using t tests. Sensitizers did not significantly exceed repressors on any of the measures. When verbal aptitude was held constant through covariance, the groups did not differ. It is concluded that repressors exceed sensitizers on verbal aptitude and that other obtained differences are artifacts of this variable. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Treatment of generalized anxiety disorder in older adults.

Older adults with generalized anxiety disorder (GAD; N=75; M age=67.1 years) were randomly assigned to cognitive-behavioral therapy (CBT), a discussion group (DG) organized around worry provoking topics, or a waiting period. Participants in both active conditions improved relative to the waiting list. Although CBT participants improved on more measures than DG participants, the authors found only 1 significant difference immediately after treatment and no differences at 6-month follow-up. Effect sizes were smaller than in younger samples, but CBT showed large effects and DG showed medium-sized effects. Overall, results indicate that brief treatment of late-life GAD is beneficial, but they provide only limited support for the superiority of CBT to a credible comparison intervention. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Memory capacity, selective control, and value-directed remembering in children with and without attention-deficit/hyperactivity disorder (ADHD).

Objective: The ability to select what is important to remember, to attend to this information, and to recall high-value items leads to the efficient use of memory. The present study examined how children with and without attention-deficit/hyperactivity disorder (ADHD) performed on an incentive-based selectivity task in which to-be-remembered items were worth different point values. Method: Participants were 6–9 year old children with ADHD (n = 57) and without ADHD (n = 59). Using a selectivity task, participants studied words paired with point values and were asked to maximize their score, which was the overall value of the items they recalled. This task allows for measures of memory capacity and the ability to selectively remember high-value items. Results: Although there were no significant between-groups differences in the number of words recalled (memory capacity), children with ADHD were less selective than children in the control group in terms of the value of the items they recalled (control of memory). All children recalled more high-value items than low-value items and showed some learning with task experience, but children with ADHD Combined type did not efficiently maximize memory performance (as measured by a selectivity index) relative to children with ADHD Inattentive type and healthy controls, who did not differ significantly from one another. Conclusions: Children with ADHD Combined type exhibit impairments in the strategic and efficient encoding and recall of high-value items. The findings have implications for theories of memory dysfunction in childhood ADHD and the key role of metacognition, cognitive control, and value-directed remembering when considering the strategic use of memory. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Diagnostic efficiency of neuropsychological test scores for discriminating boys with and without attention deficit–hyperactivity disorder.

A growing literature has documented group differences between boys with and without attention deficit–hyperactivity disorder (ADHD) on neuropsychological tests; however, whether or not such tests can discriminate individuals with ADHD from non-ADHD controls remains unclear. This study used conditional probability and receiver operating characteristic analyses to examine the efficiency of test-based diagnostic discriminations in a large sample of referred boys with and without ADHD. Single neuropsychological tests had limited discriminating ability at various cutoff scores. When multiple tests were used together, prediction of ADHD status improved but overall diagnostic efficiency remained limited. Diagnostic efficiency did not differ when medicated and nonmedicated index children were considered separately. Results suggest that children with ADHD show variable deficits on neuropsychological tests of attention and executive functions. Impairments on multiple neuropsychological tests are predictive of ADHD, but normal scores do not rule out the diagnosis. The prognostic implications of variable neuropsychological deficits in children with ADHD require further investigation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A multicenter, randomized clinical trial of a cognitive remediation program for childhood survivors of a pediatric malignancy.

Survivors of childhood cancer whose malignancy and/or treatment involved the central nervous system may demonstrate a consistent pattern of neurocognitive deficits. The present study evaluated a randomized clinical trial of the Cognitive Remediation Program (CRP). Participants were 6- to 17-year-old survivors of childhood cancer (N = 161; 35% female, 18% Hispanic, 10% African American, 64% Caucasian, 8% other) who were at least 1 year off treatment and who manifested an attentional deficit. They were enrolled at 7 sites nationwide. Two thirds of the participants were randomly assigned to cognitive remediation. All participants were assessed using a battery of academic achievement/neurocognitive tests and parent/teacher measures of attention. The CRP resulted in parent report of improved attention and statistically significant increases in academic achievement. Effect sizes were modest but were comparable with those for other clinical trials of brain injury rehabilitation and for psychological interventions in general. The CRP is presented as a potentially beneficial treatment for many survivors of pediatric cancer. Long-term clinical significance remains unproven. Further work is needed to improve effect sizes and treatment compliance and to address the needs of other populations with pediatric brain injury. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Efficacy of psychosocial treatments for geriatric depression: A quantitative review.

A meta-analysis of 17 studies examined the efficacy of psychosocial treatments for depression among older adults. Studies were included only if a comparison was made to a control condition (no treatment, delayed treatment, or placebo treatment) or another psychosocial intervention. Results indicated that treatments were reliably more effective than no treatment on self-rated and clinician-rated measures of depression. Effect sizes for studies involving participants with major depression disorder were also reliably different from zero, as were effect sizes from studies involving participants with less severe levels of depression. These findings compare favorably with several other quantitative reviews of treatments for depression. Results suggest more balanced presentations of the potential benefits of psychosocial interventions are warranted. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Quantitative brain magnetic resonance imaging in attention-deficit hyperactivity disorder

BACKGROUND: Anatomic magnetic resonance imaging (MRI) studies of attention-deficit hyperactivity disorder (ADHD) have been limited by small samples or measurement of single brain regions. Since the neuropsychological deficits in ADHD implicate a network linking basal ganglia and frontal regions, 12 subcortical and cortical regions and their symmetries were measured to determine if these structures best distinguished ADHD. METHODS: Anatomic brain MRIs for 57 boys with ADHD and 55 healthy matched controls, aged 5 to 18 years, were obtained using a 1.5-T scanner with contiguous 2-mm sections. Volumetric measures of the cerebrum, caudate nucleus, putamen, globus pallidus, amygdala, hippocampus, temporal lobe, cerebellum; a measure of prefrontal cortex; and related right-left asymmetries were examined along with midsagittal area measures of the cerebellum and corpus callosum. Interrater reliabilities were .82 or greater for all MRI measures. RESULTS: Subjects with ADHD had a 4.7% smaller total cerebral volume (P = .02). Analysis of covariance for total cerebral volume demonstrated a significant loss of normal right > left asymmetry in the caudate (P = .006), smaller right globus pallidus (P = .005), smaller right anterior frontal region (P = .02), smaller cerebellum (P = .05), and reversal of normal lateral ventricular asymmetry (P = .03) in the ADHD group. The normal age-related decrease in caudate volume was not seen, and increases in lateral ventricular volumes were significantly diminished in ADHD. CONCLUSION: This first comprehensive morphometric analysis is consistent with hypothesized dysfunction of right-sided prefrontal-striatal systems in ADHD.     

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)     

Predictive ability of the General Ability Index (GAI) versus the Full Scale IQ among gifted referrals.

The General Ability Index (GAI) is a composite ability score for the Wechsler Intelligence Scale for Children—Fourth Edition (WISC–IV) that minimizes the impact of tasks involving working memory and processing speed. The goal of the current study was to compare the degree to which the Full Scale IQ (FSIQ) and the GAI predict academic achievement in math and reading among a group of 88 children tested for gifted programming. All students had significant variability among their index scores on the WISC–IV. Whereas both the FSIQ and GAI significantly predicted standardized achievement test scores in reading and math, the FSIQ explained more of the variance. In sequential regression analyses, both working memory and verbal comprehension scores explained significant, unique variance in reading and math scores. However, measures of processing speed and perceptual reasoning did not account for significant amounts of variance in achievement scores over and above measures of working memory and verbal comprehension. The inclusion of working memory scores in calculation of the FSIQ appears to account for the difference in prediction between the FSIQ and the GAI. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Delay and reward choice in ADHD: An experimental test of the role of delay aversion.

Children with attention deficit/hyperactivity disorder (ADHD) choose smaller sooner (SS) over larger later (LL) rewards more than controls. Here we assess the contributions of impulsive drive for immediate rewards (IDIR) and delay aversion (DAv) to this pattern. We also explore the characteristics of, and the degree of familiality in, ADHD SS responders. We had 360 ADHD probands; 349 siblings and 112 controls (aged between 6 to 17 years) chose between SS (1 point after 2 s) and LL reward (2 points after 30 s) outcomes on the Maudsley Index of Delay Aversion (Kuntsi, Oosterlaan, & Stevenson, 2001): Under one condition SS choice led to less overall trial delay under another it did not. ADHD participants chose SS more than controls under both conditions. This effect was larger when SS choice reduced trial delay. ADHD SS responders were younger, had lower IQ, more conduct disorder and had siblings who were more likely to be SS responders themselves. The results support a dual component model in which both IDIR and DAv contribute to SS choice in ADHD. SS choice may be a marker of an ADHD motivational subtype. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Incidental and intentional sequence learning in youth-onset psychosis and attention-deficit/hyperactivity disorder (ADHD).

The goal was to compare incidental and intentional spatial sequence learning in youth-onset psychosis and ADHD. The authors tested 8- to 19-year-olds with psychosis or ADHD and healthy controls on a serial reaction time (RT) task and used manual and oculomotor measures to examine learning. Participants were also administered a block in which they were explicitly instructed to learn a sequence. As in our previous studies with healthy adults and children, oculomotor anticipations and RTs showed learning effects similar to those in the manual modality. Results showed intact sequence-specific learning but fewer oculomotor anticipations in both clinical groups during incidental learning. In intentional learning, only the psychosis group showed impairments compared to controls. There were no interactions between age and diagnosis. Thus, the psychosis group showed relatively preserved incidental learning despite impairments in intentional learning. Additionally, both clinical groups showed impairments in the ability to search for, extract, and anticipate regularities (whether the regularities were there or not), but not in the ability to respond to these regularities when they were there. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Validation of the Child Premorbid Intelligence Estimate method to predict premorbid Wechsler Intelligence Scale for Children-Fourth Edition Full Scale IQ among children with brain injury.

Determination of neuropsychological impairment involves contrasting obtained performances with a comparison standard, which is often an estimate of premorbid IQ. M. R. Schoenberg, R. T. Lange, T. A. Brickell, and D. H. Saklofske (2007) proposed the Child Premorbid Intelligence Estimate (CPIE) to predict premorbid Full Scale IQ (FSIQ) using the Wechsler Intelligence Scale for Children-4th Edition (WISC-IV; Wechsler, 2003). The CPIE includes 12 algorithms to predict FSIQ, 1 using demographic variables and 11 algorithms combining WISC-IV subtest raw scores with demographic variables. The CPIE was applied to a sample of children with acquired traumatic brain injury (TBI sample; n = 40) and a healthy demographically matched sample (n = 40). Paired-samples t tests found estimated premorbid FSIQ differed from obtained FSIQ when applied to the TBI sample (ps ≤ .01). When applied to healthy peers, estimated and obtained FSIQ did not differ (ps > .02). The demographic only algorithm performed well at a group level, but estimates were restricted in range. Algorithms combining single subtest scores with demographics performed adequately. Results support the clinical application of the CPIE algorithms. However, limitations to estimating individual premorbid ability, including statistical and developmental factors, must be considered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)