Neuropsychological performance and attention-deficit hyperactivity disorder subtypes and symptom dimensions.

OBJECTIVE Characterization of clinical heterogeneity in attention-deficit hyperactivity disorder (ADHD) remains controversial. Neuropsychological and cognitive studies provide one type of validation data, but too often have considered only a narrow range of functional domains. METHOD The current study examined ADHD subtype and presentation differences across a broad range of neurocognitive domains in a large clinically characterized, community-recruited sample of 498 youth (213 control, 107 ADHD-primarily inattentive [ADHD-PI], 137 ADHD-combined [ADHD-C]), ages 6-17 years. Domains assessed included inhibition, working memory, arousal, processing speed, response variability, and temporal information processing. RESULTS Youth with ADHD-C performed worse than youth with ADHD-PI in all domains, consistent with a severity model. Performance among a subgroup with a "restrictive inattentive" presentation indicated potential deficits in processing speed relative to other ADHD-PI youth, but no other effects. When all measures were included in the same model, cognitive control (executive functions, working memory, and memory span), arousal, and response variability each provided uniquely incremental statistical prediction of specific symptom dimensions and of subtype/presentation, but temporal information processing and processing speed did not. CONCLUSION Results suggest the potential to consolidate multiple neurocognitive theories of ADHD, and that such consolidation will apply across putative clinical subtypes or presentations.

[1]  D. Safer.  Are Stimulants Overprescribed for Youths with ADHD? , 2000, Annals of clinical psychiatry : official journal of the American Academy of Clinical Psychiatrists.

[2]  R. Tannock,et al.  Working Memory Impairments in Children with Attention-Deficit Hyperactivity Disorder With and Without Comorbid Language Learning Disorders , 2006, Journal of clinical and experimental neuropsychology.

[3]  H. Geurts,et al.  ADHD subtypes: do they differ in their executive functioning profile? , 2005, Archives of clinical neuropsychology : the official journal of the National Academy of Neuropsychologists.

[4]  Joshua M. Langberg,et al.  Evidence for higher reaction time variability for children with ADHD on a range of cognitive tasks including reward and event rate manipulations. , 2011, Neuropsychology.

[5]  F. Castellanos,et al.  Characterizing cognition in ADHD: beyond executive dysfunction , 2006, Trends in Cognitive Sciences.

[6]  R. Engle.  Working Memory Capacity as Executive Attention , 2002 .

[7]  E. Willcutt,et al.  Instability of the DSM-IV Subtypes of ADHD from preschool through elementary school. , 2005, Archives of general psychiatry.

[8]  N. Risch,et al.  The continuous performance test, identical pairs version (CPT-IP): I. new findings about sustained attention in normal families , 1988, Psychiatry Research.

[9]  J. Henderson,et al.  Cognitive Control and Attentional Selection in Adolescents with ADHD Versus ADD , 2010, Journal of clinical child and adolescent psychology : the official journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53.

[10]  B. Pennington,et al.  Validity of the Executive Function Theory of Attention-Deficit/Hyperactivity Disorder: A Meta-Analytic Review , 2005, Biological Psychiatry.

[11]  P. S. Jensen.  ARE STIMULANTS OVERPRESCRIBED , 2000 .

[12]  J. McGough,et al.  Executive functioning among Finnish adolescents with attention-deficit/hyperactivity disorder. , 2007, Journal of the American Academy of Child and Adolescent Psychiatry.

[13]  E. Sonuga-Barke,et al.  Beyond the dual pathway model: evidence for the dissociation of timing, inhibitory, and delay-related impairments in attention-deficit/hyperactivity disorder. , 2010, Journal of the American Academy of Child and Adolescent Psychiatry.

[14]  S. Faraone,et al.  Psychiatric, neuropsychological, and psychosocial features of DSM-IV subtypes of attention-deficit/hyperactivity disorder: results from a clinically referred sample. , 1998, Journal of the American Academy of Child and Adolescent Psychiatry.

[15]  F. Castellanos,et al.  Varieties of Attention-Deficit/Hyperactivity Disorder-Related Intra-Individual Variability , 2005, Biological Psychiatry.

[16]  Jeffrey M. Halperin,et al.  Assessment of the Continuous Performance Test: Reliability and validity in a nonreferred sample. , 1991 .

[17]  R. Barkley,et al.  Comparison of the DSM-IV combined and inattentive types of ADHD in a school-based sample of Latino/Hispanic children. , 2005, Journal of child psychology and psychiatry, and allied disciplines.

[18]  I. Waldman,et al.  Sex differences in genetic and environmental influences on DSM-III-R attention-deficit/hyperactivity disorder. , 1999, Journal of abnormal psychology.

[19]  J. Nigg,et al.  Evaluating the endophenotype model of ADHD neuropsychological deficit: results for parents and siblings of children with ADHD combined and inattentive subtypes. , 2004, Journal of abnormal psychology.

[20]  J. McGough,et al.  Familial clustering of symptoms and disruptive behaviors in multiplex families with attention-deficit/hyperactivity disorder. , 2000, Journal of the American Academy of Child and Adolescent Psychiatry.

[21]  J. Epstein,et al.  Conners Rating Scales-Revised. , 1999 .

[22]  K. Jarratt,et al.  Differences in academic and executive function domains among children with ADHD Predominantly Inattentive and Combined Types. , 2006, Archives of clinical neuropsychology : the official journal of the National Academy of Neuropsychologists.

[23]  R. Ivry,et al.  Perception and production of temporal intervals across a range of durations: evidence for a common timing mechanism. , 1995, Journal of experimental psychology. Human perception and performance.

[24]  Validity of the Sluggish Cognitive Tempo, Inattention, and Hyperactivity Symptom Dimensions: Neuropsychological and Psychosocial Correlates , 2012, Journal of abnormal child psychology.

[25]  R. Tannock,et al.  Temporal information processing in ADHD: Findings to date and new methods , 2006, Journal of Neuroscience Methods.

[26]  S. Hinshaw,et al.  Preadolescent girls with attention-deficit/hyperactivity disorder: II. Neuropsychological performance in relation to subtypes and individual classification. , 2002, Journal of consulting and clinical psychology.

[27]  R. Barkley,et al.  Frontal lobe functions in attention deficit disorder with and without hyperactivity: A review and research report , 1992, Journal of abnormal child psychology.

[28]  B. Pennington,et al.  A Comparison of the Neuropsychological Profiles of the DSM-IV Subtypes of ADHD , 2001, Journal of abnormal child psychology.

[29]  S. Mostofsky,et al.  Neuropsychological profile of executive function in girls with attention-deficit/hyperactivity disorder. , 2010, Archives of clinical neuropsychology : the official journal of the National Academy of Neuropsychologists.

[30]  Robert Reid,et al.  Adhd Rating Scale-IV: Checklists, Norms, and Clinical Interpretation , 1998 .

[31]  R. Barkley,et al.  Time perception and reproduction in young adults with attention deficit hyperactivity disorder. , 2001, Neuropsychology.

[32]  E. Sonuga-Barke,et al.  The dual pathway model of AD/HD: an elaboration of neuro-developmental characteristics , 2003, Neuroscience & Biobehavioral Reviews.

[33]  Madhu Boland.  Executive Functioning , 2014 .

[34]  T. Carr,et al.  Inhibitory Processes in Attention, Memory and Language , 1994 .

[35]  Danielle N. Pappas.  ADHD Rating Scale-IV: Checklists, Norms, and Clinical Interpretation , 2006 .

[36]  C. Hoven,et al.  Are stimulants overprescribed? Treatment of ADHD in four U.S. communities. , 1999, Journal of the American Academy of Child and Adolescent Psychiatry.

[37]  Gender differences in ADHD , 1997 .

[38]  D. Lynam,et al.  ADHD Combined Type and ADHD Predominantly Inattentive Type Are Distinct and Unrelated Disorders , 2006 .

[39]  Tanya E. Froehlich,et al.  What Causes ADHD? Understanding What Goes Wrong and Why , 2008 .

[40]  Heungsun Hwang,et al.  Inattention, working memory, and academic achievement in adolescents referred for attention deficit/hyperactivity disorder (ADHD) , 2011, Child neuropsychology : a journal on normal and abnormal development in childhood and adolescence.

[41]  Rosemary Tannock,et al.  Validity of DSM-IV attention deficit/hyperactivity disorder symptom dimensions and subtypes. , 2012, Journal of abnormal psychology.

[42]  J. Nigg,et al.  Neuropsychological executive functions and DSM-IV ADHD subtypes. , 2002, Journal of the American Academy of Child and Adolescent Psychiatry.

[43]  C. Carlson,et al.  Gender differences in ADHD: a meta-analysis and critical review. , 1997, Journal of the American Academy of Child and Adolescent Psychiatry.

[44]  J. Nigg,et al.  Delay discounting of reward in ADHD: application in young children. , 2011, Journal of child psychology and psychiatry, and allied disciplines.

[45]  E. Walker,et al.  Diagnostic and Statistical Manual of Mental Disorders , 2013 .

[46]  E. Kaplan,et al.  Delis-Kaplan Executive Function System , 2012 .

[47]  John O. Willis,et al.  Wechsler Intelligence Scale for Children–Fourth Edition , 2014 .

[48]  D. K. Marcus,et al.  Does attention-deficit/hyperactivity disorder have a dimensional latent structure? A taxometric analysis. , 2011, Journal of abnormal psychology.

[49]  Sharon Morein-Zamir,et al.  Executive functioning in boys with ADHD: primarily an inhibition deficit? , 2004, Archives of clinical neuropsychology : the official journal of the National Academy of Neuropsychologists.

[50]  S. Mostofsky,et al.  Process Examination of Executive Function in ADHD: Sex and Subtype Effects , 2008, The Clinical neuropsychologist.

[51]  S. Faraone,et al.  Family study of girls with attention deficit hyperactivity disorder. , 2000, The American journal of psychiatry.

[52]  R Tannock,et al.  Tapping and Anticipation Performance in Attention Deficit Hyperactivity Disorder , 2005, Perceptual and motor skills.

[53]  J. Nigg,et al.  Processing Speed Weakness in Children and Adolescents with Non-Hyperactive but Inattentive ADHD (ADD) , 2010, Child neuropsychology : a journal on normal and abnormal development in childhood and adolescence.

[54]  Jeffrey H. Newcorn,et al.  Neurocognitive Functioning in AD/HD, Predominantly Inattentive and Combined Subtypes , 2007, Journal of abnormal child psychology.

[55]  J. Nigg,et al.  Family psychiatric history evidence on the nosological relations of DSM-IV ADHD combined and inattentive subtypes: new data and meta-analysis. , 2006, Journal of child psychology and psychiatry, and allied disciplines.

[56]  Jeffrey H. Newcorn,et al.  Neurocognitive Functioning in AD/HD, Predominantly Inattentive and Combined Subtypes , 2009 .

[57]  J. Fletcher,et al.  Executive functioning deficits in attention-deficit/hyperactivity disorder are independent of oppositional defiant or reading disorder. , 1999, Journal of the American Academy of Child and Adolescent Psychiatry.

[58]  J. Nigg,et al.  Executive function in adolescents with ADHD. , 2007, Journal of the American Academy of Child and Adolescent Psychiatry.