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Medrano Nava E, Flores-Lázaro JC, Nicolini Sánchez H, Juárez García F. Effects of comorbidity on executive functions among children with ADHD, finding trends. APPLIED NEUROPSYCHOLOGY. CHILD 2024; 13:100-112. [PMID: 36395527 DOI: 10.1080/21622965.2022.2135440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
There is still no basic overview about the effect of various types of comorbidity in executive functions due to two main reasons: (1) the type and number of comorbidities in ADHD is significantly varied, (2) EFs are very diverse and have different neuropsychological properties. Our objective was to determine the effect of comorbid disorders (number and type) on the performance in a wide range (seven) of executive functions in a sample of children with ADHD. Fifty-five male children aged seven to nine years with ADHD were divided into six groups: G1 = ADHD only (ADHD-O), G1 = Oppositional defiant disorder (ODD), G3 = (anxiety/depressive disorder (ADD), G4 = ODD + ADD, G5 = ODD + learning disorder (LD), G6 = ODD + LD + conduct disorder (CD). The six groups exhibited different number of deficits in EFs; G1 showed only 1 deficit in contrast, G6 presented 11. Statistical analysis (ANOVA and logistic regression) identified three most affected EFs: Working memory, generation/classification of semantic categories, and inhibitory control. Alterations in EFs increased mainly in relation to the increase of the specific number and type of comorbidity. To date, no studies have addressed comorbidity from this perspective. A wide range approach of EF confirms the need to further study comorbidity in ADHD from a wide range/variety perspective and determine all possible combinations (number/type) to clarify its contribution to the complex neuropsychology functioning in ADHD.
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Affiliation(s)
- Eliana Medrano Nava
- Child Psychiatry Hospital, SAP-DJNN, Ministry of Health, Mexico City, Mexico
- Postgraduate program in Health Sciences, Faculty of Medicine, UNAM, Mexico City, Mexico
| | - Julio C Flores-Lázaro
- Child Psychiatry Hospital, SAP-DJNN, Ministry of Health, Mexico City, Mexico
- Psychology Faculty, UNAM, Mexico City, Mexico
| | - Humberto Nicolini Sánchez
- Genomics of Psychiatric and Neurodegenerative Diseases Laboratory, National Institute of Genomic Medicine (INMEGEN), Mexico City, Mexico
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ADHD symptoms as risk factor for PTSD in inpatients treated for alcohol use disorder. Psychiatry Res 2021; 300:113904. [PMID: 33872853 DOI: 10.1016/j.psychres.2021.113904] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 03/27/2021] [Indexed: 12/24/2022]
Abstract
Attention deficit hyperactivity disorder (ADHD) and post-traumatic stress disorder (PTSD) are more common in alcohol use disorder (AUD) patients than in the general population. Still, there is a lack of knowledge about the relationship between the two conditions in these patients. The main objective of this study was to examine the prevalence of ADHD symptoms, and the relationship between ADHD symptoms and PTSD in AUD inpatients in treatment. Data from 85 AUD patients were collected. The Adult ADHD Self-Report Scale (ASRS) was used to measure ADHD symptoms in all patients. Differences between groups split by PTSD diagnosis and by ASRS clinical cut-off were described, and the relationship between ADHD symptom level and PTSD was tested in a multiple regression model. Almost half the patients scored above ASRS cut-off and 14% had PTSD. Of the patients whose score was above cut-off on the ASRS 23% had PTSD, versus 7% among those below cut-off. Higher ASRS score was associated with PTSD even when age, sex and trauma were adjusted for. This study confirms the high level of ADHD symptoms in AUD patients in treatment. Diagnostic evaluation of PTSD is recommended in patients with ADHD attending inpatient treatment programs for AUD.
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Mayer JS, Bernhard A, Fann N, Boxhoorn S, Hartman CA, Reif A, Freitag CM. Cognitive mechanisms underlying depressive disorders in ADHD: A systematic review. Neurosci Biobehav Rev 2021; 121:307-345. [PMID: 33359622 DOI: 10.1016/j.neubiorev.2020.12.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 12/01/2020] [Accepted: 12/09/2020] [Indexed: 01/06/2023]
Abstract
The risk for major depressive disorder (MDD) is considerably increased in young adults with attention-deficit/hyperactivity disorder (ADHD) but underlying mechanisms are poorly understood. This review explores ADHD-specific neurocognitive impairments as possible underlying mechanisms for ADHD-depression comorbidity. Two systematic literature searches were conducted in EBSCOhost, PubMED, and Cochrane Reviews databases according to PRISMA guidelines. The first search identified 18 meta-analyses of cross-sectional and longitudinal studies on cognitive dysfunctions in MDD across the lifespan. The second search identified six original studies on reaction time variability in MDD. During acute depression, children and adults showed cognitive deficits that overlapped with some of the ADHD-related impairments. Findings from remitted patients, high-risk individuals, and few prospective studies suggest that a subset of these shared impairments, specifically executive dysfunctions (selective attention, verbal fluency, working memory) and long-term memory problems, are candidate pre-existing risk markers of depression. We discuss if and how these specific neurocognitive mechanisms may mediate developmental pathways from ADHD to depression. If replicated by longitudinal studies, these findings may guide future prevention strategies.
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Affiliation(s)
- Jutta S Mayer
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Frankfurt, Goethe University, Deutschordenstraße 50, 60528 Frankfurt am Main, Germany.
| | - Anka Bernhard
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Frankfurt, Goethe University, Deutschordenstraße 50, 60528 Frankfurt am Main, Germany
| | - Nikola Fann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Frankfurt, Goethe University, Deutschordenstraße 50, 60528 Frankfurt am Main, Germany
| | - Sara Boxhoorn
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Frankfurt, Goethe University, Deutschordenstraße 50, 60528 Frankfurt am Main, Germany
| | - Catharina A Hartman
- Interdisciplinary Centre Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Centre Groningen, CC 72, P.O. Box 30.001, 9700 RB Groningen, the Netherlands
| | - Andreas Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Heinrich-Hoffmann-Str. 10, 60528 Frankfurt am Main, Germany
| | - Christine M Freitag
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Frankfurt, Goethe University, Deutschordenstraße 50, 60528 Frankfurt am Main, Germany
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Hamzeloo M, Mashhadi A, Fadardi JS, Ghahremanzadeh M. Adult attention deficit/hyperactivity disorder among the prison inmates: An investigation of the executive function differences and comorbidity effects. AUSTRALIAN JOURNAL OF PSYCHOLOGY 2020. [DOI: 10.1111/ajpy.12201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | - Ali Mashhadi
- Department of Psychology, Ferdowsi University of Mashhad, Mashhad, Iran,
| | - Javad S. Fadardi
- Department of Psychology, Ferdowsi University of Mashhad, Mashhad, Iran,
- School of Psychology, Bangor University, Bangor, Wales, UK,
- School of Community and Global Health, Claremont Graduate University, Claremont, California, USA,
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Brown J, Asp E, Carter MN, Spiller V, Bishop-Deaton D. Suggestibility and confabulation among individuals with Fetal Alcohol Spectrum Disorder: A review for criminal justice, forensic mental health, and legal interviewers. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2020; 73:101646. [PMID: 33246222 DOI: 10.1016/j.ijlp.2020.101646] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 06/19/2020] [Accepted: 11/03/2020] [Indexed: 06/11/2023]
Abstract
Fetal Alcohol Spectrum Disorders (FASD) are conditions arising from prenatal alcohol exposure which results in a range of neurodevelopmental deficits in areas including cognition, memory, language, executive functioning, emotional regulation, and adaptive functioning. Deficits in various neurodevelopmental areas can range from mild to severe, depending on many factors including the quantity and timing of alcohol exposure during the prenatal development period. During interviews in criminal justice, forensic mental health, and legal contexts (e.g., criminal investigations, cross examination, victim interviews, interviews for lawsuits, forensic evaluations, pre-sentence investigations), deficits associated with FASD may elevate the risk of suggestibility and confabulation. These issues can result in negative jurisprudence-related outcomes, including impulsive Miranda rights waivers, incorrect assumptions of competency, inaccurate or incomplete information gathering, misinterpretation of intent, witness reliability issues, court ordered treatment completion problems, probation and parole violations, false confessions, and false accusations. The aim of the present article is to explain the context in which these issues can arise and provide criminal justice, forensic mental health, and legal professionals with key guidelines that can assist in minimizing suggestibility and confabulation when interviewing persons with FASD. We hope that the suggestions and strategies presented in this article will reduce potential obstructions of justice and enhance the quality of information obtained from individuals impacted by FASD. A brief discussion is also provided to identify additional research and training opportunities needed to clarify "best practices" for professionals tasked with evaluating the challenges facing this unique population.
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Affiliation(s)
- Jerrod Brown
- American Institute for the Advancement of Forensic Studies, St. Paul, MN, USA.
| | - Erik Asp
- Department of Neurology, University of Iowa, Iowa City, IA, USA; Department of Psychology, Hamline University, St. Paul, MN, USA; Wesley & Lorene Artz Cognitive Neuroscience Research Center, Hamline University, St. Paul, MN, USA
| | - Megan N Carter
- University of Washington, Seattle, WA, USA; Department of Social and Health Services, Special Commitment Center, Steilacoom, WA, USA
| | | | - Deanna Bishop-Deaton
- College of Social and Behavioral Sciences, School of Forensic Psychology, Walden University, USA
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Stibbe T, Huang J, Paucke M, Ulke C, Strauss M. Gender differences in adult ADHD: Cognitive function assessed by the test of attentional performance. PLoS One 2020; 15:e0240810. [PMID: 33057383 PMCID: PMC7561166 DOI: 10.1371/journal.pone.0240810] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 10/05/2020] [Indexed: 12/03/2022] Open
Abstract
Introduction The aim of this study was to assess cognitive differences between male and female adults with Attention Deficit Hyperactivity Disorder (ADHD). Methods Patients with an ADHD diagnosis according to the DSM-IV guidelines were included in a cross-sectional study evaluating cognitive measures. 28 women and 41 men from ages 19 to 56 completed self-report questionnaires and performed a computer-based test of attentional performance (TAP). The TAP assesses cognitive functions highly affected in ADHD patients, including working memory, alertness and attention as well as behavioral control and response inhibition. Results There were no measurable differences in self-report scales assessing current symptomology between the sexes, however men scored higher on the scale for childhood symptoms. Performance measures for general wakefulness were comparable between men and women, while working memory and behavioral control test results differed. Females reacted significantly slower and more unstable for both the TAP Go/NoGo paradigm and working memory subtest, while also making more errors in the latter. Conclusions We found gender-specific effects regarding working memory and behavioral control in this sample of adult patients with ADHD. Further studies are warranted, examining whether these differences relate to differences in clinical presentation and comorbidity patterns between men and women.
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Affiliation(s)
- Tina Stibbe
- Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Saxony, Germany
| | - Jue Huang
- Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Saxony, Germany
| | - Madlen Paucke
- Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Saxony, Germany
| | - Christine Ulke
- Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Saxony, Germany
| | - Maria Strauss
- Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Saxony, Germany
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Nyström A, Petersson K, Janlöv AC. Being Different but Striving to Seem Normal: The Lived Experiences of People Aged 50+ with ADHD. Issues Ment Health Nurs 2020; 41:476-485. [PMID: 32267788 DOI: 10.1080/01612840.2019.1695029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This qualitative study explored the day-to-day life of people aged 50+ diagnosed with ADHD. A phenomenological-hermeneutical method was chosen for the analysis. Two themes including sub-themes were revealed. The first theme, Being different and trying to handle my inner self, concerned emotional self-regulation, emotional resilience, social skills, and personal resource management. The second theme, Trying to adapt to fit in with people around me, concerned relationships, work, and personal finances. The comprehensive understanding was interpreted as Being different but striving to seem normal.
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Affiliation(s)
- Anne Nyström
- Faculty of Health Sciences, Department of Nursing and Health Sciences, Kristianstad University, Kristianstad, Sweden
| | - Kerstin Petersson
- Department of Health Sciences, Faculty of Medicine, Lund University. Lund, Sweden
| | - Ann-Christin Janlöv
- Faculty of Health Sciences, Department of Nursing and Health Sciences, Kristianstad University, Kristianstad, Sweden
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Taitelbaum-Swead R, Kozol Z, Fostick L. Listening Effort Among Adults With and Without Attention-Deficit/Hyperactivity Disorder. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2019; 62:4554-4563. [PMID: 31747524 DOI: 10.1044/2019_jslhr-h-19-0134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Purpose Few studies have assessed listening effort (LE)-the cognitive resources required to perceive speech-among populations with intact hearing but reduced availability of cognitive resources. Attention/deficit/hyperactivity disorder (ADHD) is theorized to restrict attention span, possibly making speech perception in adverse conditions more challenging. This study examined the effect of ADHD on LE among adults using a behavioral dual-task paradigm (DTP). Method Thirty-nine normal-hearing adults (aged 21-27 years) participated: 19 with ADHD (ADHD group) and 20 without ADHD (control group). Baseline group differences were measured in visual and auditory attention as well as speech perception. LE using DTP was assessed as the performance difference on a visual-motor task versus a simultaneous auditory and visual-motor task. Results Group differences in attention were confirmed by differences in visual attention (larger reaction times between congruent and incongruent conditions) and auditory attention (lower accuracy in the presence of distractors) among the ADHD group, compared to the controls. LE was greater among the ADHD group than the control group. Nevertheless, no group differences were found in speech perception. Conclusions LE is increased among those with ADHD. As a DTP assumes limited cognitive capacity to allocate attentional resources, LE among those with ADHD may be increased because higher level cognitive processes are more taxed in this population. Studies on LE using a DTP should take into consideration mechanisms of selective and divided attention. Among young adults who need to continuously process great volumes of auditory and visual information, much more effort may be expended by those with ADHD than those without it. As a result, those with ADHD may be more prone to fatigue and irritability, similar to those who are engaged in more outwardly demanding tasks.
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Affiliation(s)
- Riki Taitelbaum-Swead
- Department of Communication Disorders, Ariel University, Israel
- Meuhedet Health Services, Tel Aviv, Israel
| | - Zvi Kozol
- Department of Physiotherapy, Ariel University, Israel
| | - Leah Fostick
- Department of Communication Disorders, Ariel University, Israel
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Cogo-Moreira H, Lúcio PS, Swardfager W, Gadelha A, Mari JDJ, Miguel EC, Rohde LA, Salum GA. Comparability of an ADHD Latent Trait Between Groups: Disentangling True Between-Group Differences From Measurement Problems. J Atten Disord 2019; 23:712-720. [PMID: 28478691 DOI: 10.1177/1087054717707047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The aim of this study is to investigate measurement invariance (MI) for an ADHD latent trait across different sociodemographic groups (sex, age, and maternal education), IQs, and co-occurring psychiatric diagnoses. METHOD Participants were 2,299 children aged 6 to 14 years. ADHD symptoms were assessed by parent report using the Development and Well-Being Assessment (DAWBA). MI was tested through multigroup confirmatory factor analysis and multiple indicators multiple causes models. RESULTS In a bifactor model including a general ADHD factor and three specific factors (hyperactivity, inattention, and impulsivity), invariance properties were demonstrated and no individual items showed differential functioning. The ADHD general factor was higher in boys and in those with psychiatric disorders. Younger age predicted hyperactivity. Lower IQ and higher level of education of the mother predicted inattention. CONCLUSION The ADHD trait, as measured by the DAWBA, functions in the same way, and with equivalent scale, revealing true differences in ADHD symptoms based on those.
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Affiliation(s)
| | - Patrícia Silva Lúcio
- 1 Federal University of São Paulo, Brazil.,2 State University of Londrina, Paraná, Brazil
| | | | | | - Jair de Jesus Mari
- 1 Federal University of São Paulo, Brazil.,4 National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, Brazil
| | - Eurípedes Constantino Miguel
- 4 National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, Brazil.,5 University of São Paulo, Brazil
| | - Luis Augusto Rohde
- 4 National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, Brazil.,6 Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Giovanni A Salum
- 4 National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, Brazil.,6 Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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10
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Metts AV, Keilp JG, Kishon R, Oquendo MA, Mann JJ, Miller JM. Neurocognitive performance predicts treatment outcome with cognitive behavioral therapy for major depressive disorder. Psychiatry Res 2018; 269:376-385. [PMID: 30173044 DOI: 10.1016/j.psychres.2018.08.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 08/07/2018] [Accepted: 08/09/2018] [Indexed: 12/20/2022]
Abstract
The current study examined the contribution of baseline neuropsychological functioning to the prediction of antidepressant outcome with cognitive behavioral therapy (CBT) for Major Depressive Disorder (MDD). We hypothesized that depressed participants who were more neurocognitively intact and had less rigid, negative thinking would respond better to CBT. Thirty-one MDD patients completed a comprehensive neuropsychological battery before initiation of CBT. A subgroup also completed a probabilistic reversal learning task. Depression severity was assessed with the Beck Depression Inventory (BDI); rigid, negative thinking was assessed with the Dysfunctional Attitudes Scale (DAS) and the Automatic Thoughts Questionnaire (ATQ) throughout treatment. Remitters were compared to non-remitters. Paradoxically, eventual remitters performed generally worse across the neuropsychological battery considered as a whole. Univariate testing showed a significant difference on only a single measure, the Continuous Performance Test d', when corrected for multiple comparisons. Baseline rigid, negative thinking did not predict treatment outcome. Results suggest that the structure of CBT may particularly benefit individuals with mild depression-related neurocognitive difficulties during a depressive episode. Further research is needed to examine these patient characteristics and their potential contribution to the mechanisms of CBT efficacy.
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Affiliation(s)
- Allison V Metts
- Department of Psychiatry, Columbia University, Molecular Imaging and Neuropathology Division, and New York State Psychiatric Institute, New York, NY, USA
| | - John G Keilp
- Department of Psychiatry, Columbia University, Molecular Imaging and Neuropathology Division, and New York State Psychiatric Institute, New York, NY, USA
| | - Ronit Kishon
- Department of Psychiatry, Columbia University, Depression Evaluation Service, and New York State Psychiatric Institute, New York, NY, USA
| | - Maria A Oquendo
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - J John Mann
- Department of Psychiatry, Columbia University, Molecular Imaging and Neuropathology Division, and New York State Psychiatric Institute, New York, NY, USA
| | - Jeffrey M Miller
- Department of Psychiatry, Columbia University, Molecular Imaging and Neuropathology Division, and New York State Psychiatric Institute, New York, NY, USA.
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Guimarães-da-Silva PO, Rovaris DL, Silva KL, Karam RG, Rohde LA, Grevet EH, Bau CHD. Exploring neuropsychological predictors of ADHD remission or persistence during adulthood. Cogn Neuropsychiatry 2018; 23:321-328. [PMID: 30092701 DOI: 10.1080/13546805.2018.1506324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Paula O Guimarães-da-Silva
- a Department of Psychiatry, Faculdade de Medicina , Universidade Federal do Rio Grande do Sul , Porto Alegre , Brazil.,b ADHD Outpatient Program - Adult Division , Hospital de Clínicas de Porto Alegre , Porto Alegre , Brazil
| | - Diego L Rovaris
- a Department of Psychiatry, Faculdade de Medicina , Universidade Federal do Rio Grande do Sul , Porto Alegre , Brazil.,b ADHD Outpatient Program - Adult Division , Hospital de Clínicas de Porto Alegre , Porto Alegre , Brazil
| | - Katiane L Silva
- b ADHD Outpatient Program - Adult Division , Hospital de Clínicas de Porto Alegre , Porto Alegre , Brazil.,c CESUCA-Faculdade Inedi , Cachoeirinha , Brazil
| | - Rafael G Karam
- b ADHD Outpatient Program - Adult Division , Hospital de Clínicas de Porto Alegre , Porto Alegre , Brazil
| | - Luis A Rohde
- a Department of Psychiatry, Faculdade de Medicina , Universidade Federal do Rio Grande do Sul , Porto Alegre , Brazil.,b ADHD Outpatient Program - Adult Division , Hospital de Clínicas de Porto Alegre , Porto Alegre , Brazil.,d National Institute of Developmental Psychiatry for Children and Adolescents , Porto Alegre , Brazil
| | - Eugenio H Grevet
- a Department of Psychiatry, Faculdade de Medicina , Universidade Federal do Rio Grande do Sul , Porto Alegre , Brazil.,b ADHD Outpatient Program - Adult Division , Hospital de Clínicas de Porto Alegre , Porto Alegre , Brazil
| | - Claiton H D Bau
- a Department of Psychiatry, Faculdade de Medicina , Universidade Federal do Rio Grande do Sul , Porto Alegre , Brazil.,b ADHD Outpatient Program - Adult Division , Hospital de Clínicas de Porto Alegre , Porto Alegre , Brazil.,e Department of Genetics, Instituto de Biociências, Universidade Federal do Rio Grande do Sul , Porto Alegre , Brazil
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Torres I, Garriga M, Sole B, Bonnín CM, Corrales M, Jiménez E, Sole E, Ramos-Quiroga JA, Vieta E, Goikolea JM, Martínez-Aran A. Functional impairment in adult bipolar disorder with ADHD. J Affect Disord 2018; 227:117-125. [PMID: 29055259 DOI: 10.1016/j.jad.2017.09.037] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 07/18/2017] [Accepted: 09/23/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND It is well established that patients with either bipolar disorder (BD) or attention-deficit/hyperactivity disorder (ADHD) present functional impairment even when in remission. Nevertheless, research on functional impairment with adult patients with bipolar disorder comorbid to ADHD (BD+ADHD) is very scarce. The main objective of the current report was to evaluate the overall and specific domains of functioning, in patients with BD+ADHD compared to patients with pure bipolar disorder (pBD) and healthy controls (HCs). METHOD 162 subjects from 3 groups were compared: 63 pBD, 23 BD+ADHD and 76 HCs. All the patients with BD had been euthymic for at least 6 months and they were recruited at the Hospital Clinic of Barcelona. All the participants were assessed with the 17-item Hamilton Depression Rating Scale (HAM-D), the Young Mania Rating Scale (YMRS) and the Functioning Assessment Short Test (FAST). Clinical, and sociodemographic data were also recorded. RESULTS Clinical groups, pBD and BD+ADHD, showed lower overall functioning (p < 0.001) in each domain of the FAST scale compared to the HCs. Moreover, the Tukey post hoc test revealed that the BD+ADHD group showed a worse score than pBD in the cognitive domain of the FAST. However, after controlling for potential confounding variables, only the HDRS scores (p < 0.026) remained significant for the cognitive domain of the FAST. LIMITATIONS The small sample size of the comorbid BD+ADHD group. CONCLUSIONS Adult patients with BD+ADHD showed the worst scores in functioning compared with the HCs, but did not show more severe functional impairment than the pBD group except for the cognitive domain. Therefore our findings suggest that depressive symptoms in adults with BD+ADHD may negatively influence cognitive functioning. Further studies are needed to confirm our findings for the management of BD+ADHD.
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Affiliation(s)
- Imma Torres
- Bipolar Disorder Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Marina Garriga
- Bipolar Disorder Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Brisa Sole
- Bipolar Disorder Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Caterina M Bonnín
- Bipolar Disorder Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Montse Corrales
- ADHD Program, Department of Psychiatry, Hospital Universitari Vall d'Hebron, CIBERSAM, Barcelona, Catalonia, Spain
| | - Esther Jiménez
- Bipolar Disorder Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Eva Sole
- Bipolar Disorder Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Josep A Ramos-Quiroga
- ADHD Program, Department of Psychiatry, Hospital Universitari Vall d'Hebron, CIBERSAM, Barcelona, Catalonia, Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - Eduard Vieta
- Bipolar Disorder Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Jose M Goikolea
- Bipolar Disorder Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Anabel Martínez-Aran
- Bipolar Disorder Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.
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13
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Mostert JC, Hoogman M, Onnink AMH, van Rooij D, von Rhein D, van Hulzen KJE, Dammers J, Kan CC, Buitelaar JK, Norris DG, Franke B. Similar Subgroups Based on Cognitive Performance Parse Heterogeneity in Adults With ADHD and Healthy Controls. J Atten Disord 2018; 22:281-292. [PMID: 26374770 PMCID: PMC4884161 DOI: 10.1177/1087054715602332] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To characterize heterogeneity in adults with ADHD we aimed to identify subgroups within the adult ADHD spectrum, which differ in their cognitive profile. METHOD Neuropsychological data from adults with ADHD ( n = 133) and healthy control participants ( n = 132) were used in a confirmatory factor analysis. The resulting six cognitive factors were correlated across participants to form networks. We used a community detection algorithm to cluster these networks into subgroups. RESULTS Both the ADHD and control group separated into three profiles that differed in cognitive performance. Profile 1 was characterized by aberrant attention and inhibition, profile 2 by increased delay discounting, and profile 3 by atypical working memory and verbal fluency. CONCLUSION Our findings suggest that qualitative differences in neuropsychological performance exist in both control and ADHD adult individuals. This extends prior findings in children with and without ADHD and provides a framework to parse participants into well-defined subgroups.
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Affiliation(s)
- Jeanette C. Mostert
- Radboud university medical center, Department of Human Genetics, Nijmegen, The Netherlands,Radboud University Nijmegen, Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Nijmegen, The Netherlands
| | - Martine Hoogman
- Radboud university medical center, Department of Human Genetics, Nijmegen, The Netherlands
| | - A. Marten H. Onnink
- Radboud university medical center, Department of Human Genetics, Nijmegen, The Netherlands
| | - Daan van Rooij
- Radboud university medical center, Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Daniel von Rhein
- Radboud university medical center, Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Kimm J. E. van Hulzen
- Radboud university medical center, Department of Human Genetics, Nijmegen, The Netherlands
| | - Janneke Dammers
- Radboud university medical center, Department of Human Genetics, Nijmegen, The Netherlands
| | - Cornelis C. Kan
- Radboud university medical center, Department of Psychiatry, Nijmegen, The Netherlands
| | - Jan K. Buitelaar
- Radboud university medical center, Department of Psychiatry, Nijmegen, The Netherlands,Karakter Child and Adolescent Psychiatry University Center, Nijmegen, The Netherlands
| | - David G. Norris
- Radboud University Nijmegen, Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Nijmegen, The Netherlands
| | - Barbara Franke
- Radboud university medical center, Department of Human Genetics, Nijmegen, The Netherlands,Radboud university medical center, Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands,Radboud university medical center, Department of Psychiatry, Nijmegen, The Netherlands
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14
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Shura RD, Miskey HM, Williams VG, Jadidian A, Rowland JA. Informing Evidence-Based Assessment of ADHD in Veterans and Service Members. MILITARY PSYCHOLOGY 2017. [DOI: 10.1037/mil0000138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Robert D. Shura
- Mid-Atlantic Mental Illness Research, Education, and Clinical Center, W. G. (Bill) Hefner Veterans Affairs Medical Center, Salisbury, North Carolina, and Department of Psychiatry and Behavioral Medicine, Wake Forest School of Medicine
| | - Holly M. Miskey
- Mid-Atlantic Mental Illness Research, Education, and Clinical Center, W. G. (Bill) Hefner Veterans Affairs Medical Center, Salisbury, North Carolina, and Department of Psychiatry and Behavioral Medicine, Wake Forest School of Medicine
| | - Vanessa G. Williams
- Patient Care Services Psychology, Veterans Affairs Eastern Colorado Health Care System, Denver, Colorado
| | - Alex Jadidian
- Mental Health & Behavioral Sciences Service Line, W. G. (Bill) Hefner Veterans Affairs Medical Center, Salisbury, North Carolina
| | - Jared A. Rowland
- Mid-Atlantic Mental Illness Research, Education, and Clinical Center, W. G. (Bill) Hefner Veterans Affairs Medical Center, Salisbury, North Carolina, and Department of Neurobiology and Anatomy, Wake Forest School of Medicine
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15
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Torres I, Sole B, Corrales M, Jiménez E, Rotger S, Serra-Pla JF, Forcada I, Richarte V, Mora E, Jacas C, Gómez N, Mur M, Colom F, Vieta E, Casas M, Martinez-Aran A, Goikolea JM, Ramos-Quiroga JA. Are patients with bipolar disorder and comorbid attention-deficit hyperactivity disorder more neurocognitively impaired? Bipolar Disord 2017; 19:637-650. [PMID: 28941032 DOI: 10.1111/bdi.12540] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 07/30/2017] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Research on neurocognitive impairment in adult patients with comorbid bipolar disorder (BD) and attention-deficit hyperactivity disorder (ADHD) is very scarce. This study assessed the neurocognitive profile of a comorbid group (BD+ADHD) compared with that of pure BD (pBD) group, pure ADHD (pADHD) group and healthy controls (HCs). METHODS This was a three-site study comprising 229 subjects: 70 patients with pBD, 23 with BD+ADHD, 50 with pADHD, and 86 HCs. All patients with BD had been euthymic for at least 6 months. Neuropsychological performance was assessed using a comprehensive neurocognitive battery. RESULTS Our results showed that all the clinical groups had poorer performance than the HCs in all the neurocognitive domains except for executive functions. No significant differences were observed between the pBD and BD+ADHD groups in any of the cognitive domains, with these two groups showing greater impairment than the pADHD group in executive functions and visual memory. CONCLUSIONS Our results, although preliminary, suggest that the BD+ADHD group showed the same neurocognitive profile as pBD patients, most likely reflecting the same neurobiological basis. On the other hand, the pADHD group showed a more selective moderate impairment in attention.
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Affiliation(s)
- Imma Torres
- Bipolar Disorder Unit, Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Brisa Sole
- Bipolar Disorder Unit, Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Montse Corrales
- ADHD Program, Department of Psychiatry, Hospital Universitari Vall d'Hebron, CIBERSAM, Barcelona, Catalonia, Spain
| | - Esther Jiménez
- Bipolar Disorder Unit, Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Sofia Rotger
- Psychiatric Service, Santa Maria University Hospital, IRB Lleida (Biomedicine Research, Institute), University of Lleida, Lleida, Catalonia, Spain
| | - Juan Francisco Serra-Pla
- ADHD Program, Department of Psychiatry, Hospital Universitari Vall d'Hebron, CIBERSAM, Barcelona, Catalonia, Spain
| | - Irene Forcada
- Psychiatric Service, Santa Maria University Hospital, IRB Lleida (Biomedicine Research, Institute), University of Lleida, Lleida, Catalonia, Spain
| | - Vanesa Richarte
- ADHD Program, Department of Psychiatry, Hospital Universitari Vall d'Hebron, CIBERSAM, Barcelona, Catalonia, Spain
| | - Ester Mora
- Children and Adolescents Center of Mental Health, Sant Joan de Déu Lleida, University of Lleida, IRB Lleida (Biomedicine Research Institute), Lleida, Catalonia, Spain
| | - Carlos Jacas
- ADHD Program, Department of Psychiatry, Hospital Universitari Vall d'Hebron, CIBERSAM, Barcelona, Catalonia, Spain
| | - Nuria Gómez
- ADHD Program, Department of Psychiatry, Hospital Universitari Vall d'Hebron, CIBERSAM, Barcelona, Catalonia, Spain
| | - Maria Mur
- Psychiatric Service, Santa Maria University Hospital, IRB Lleida (Biomedicine Research, Institute), University of Lleida, Lleida, Catalonia, Spain
| | - Francesc Colom
- Mental Health Program, Hospital del Mar Medical Research Institute (IMIM), CIBERSAM, Barcelona, Catalonia, Spain
| | - Eduard Vieta
- Bipolar Disorder Unit, Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Miquel Casas
- ADHD Program, Department of Psychiatry, Hospital Universitari Vall d'Hebron, CIBERSAM, Barcelona, Catalonia, Spain.,Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - Anabel Martinez-Aran
- Bipolar Disorder Unit, Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Jose M Goikolea
- Bipolar Disorder Unit, Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Josep A Ramos-Quiroga
- ADHD Program, Department of Psychiatry, Hospital Universitari Vall d'Hebron, CIBERSAM, Barcelona, Catalonia, Spain.,Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
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16
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Nie J, Zhang W, Chen J, Li W. Impaired inhibition and working memory in response to internet-related words among adolescents with internet addiction: A comparison with attention-deficit/hyperactivity disorder. Psychiatry Res 2016; 236:28-34. [PMID: 26778632 DOI: 10.1016/j.psychres.2016.01.004] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 11/12/2015] [Accepted: 01/04/2016] [Indexed: 12/29/2022]
Abstract
Impairments in response inhibition and working memory functions have been found to be closely associated with internet addiction (IA) symptoms and attention-deficit/hyperactivity disorder (ADHD) symptoms. In this study, we examined response inhibition and working memory processes with two different materials (internet-related and internet-unrelated stimuli) among adolescents with IA, ADHD and co-morbid IA/ADHD. Twenty-four individuals with IA, 28 individuals with ADHD, 17 individuals with IA/ADHD, and 26 matched normal controls (NC) individuals were recruited. All participants were measured with a Stop-Signal Task and 2-Back Task under the same experimental conditions. In comparison to the NC group, subjects with IA, ADHD and IA/ADHD demonstrated impaired inhibition and working memory. In addition, in comparison to internet-unrelated conditions, IA and co-morbid subjects performed worse on the internet-related condition in the Stop trials during the stop-signal task, and they showed better working memory on the internet-related condition in the 2-Back Task. The findings of our study suggest individuals with IA and IA/ADHD may be impaired in inhibition and working memory functions that might be linked to poor inhibition specifically related to internet-related stimuli, which will advance our understanding of IA and contribute to prevention and intervention strategies.
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Affiliation(s)
- Jia Nie
- School of Psychology, Central China Normal University, Hubei, China; Key Laboratory of Adolescent Cyberpsychology and Behavior (CCNU), Ministry of Education, Wuhan, China
| | - Wei Zhang
- School of Psychology, Central China Normal University, Hubei, China; Key Laboratory of Adolescent Cyberpsychology and Behavior (CCNU), Ministry of Education, Wuhan, China.
| | - Jia Chen
- School of Psychology, Central China Normal University, Hubei, China; Key Laboratory of Adolescent Cyberpsychology and Behavior (CCNU), Ministry of Education, Wuhan, China
| | - Wendi Li
- School of Psychology, Central China Normal University, Hubei, China; Key Laboratory of Adolescent Cyberpsychology and Behavior (CCNU), Ministry of Education, Wuhan, China
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17
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Mostert JC, Onnink AMH, Klein M, Dammers J, Harneit A, Schulten T, van Hulzen KJE, Kan CC, Slaats-Willemse D, Buitelaar JK, Franke B, Hoogman M. Cognitive heterogeneity in adult attention deficit/hyperactivity disorder: A systematic analysis of neuropsychological measurements. Eur Neuropsychopharmacol 2015; 25:2062-2074. [PMID: 26336867 PMCID: PMC4788979 DOI: 10.1016/j.euroneuro.2015.08.010] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 08/03/2015] [Accepted: 08/13/2015] [Indexed: 02/04/2023]
Abstract
Attention Deficit/Hyperactivity Disorder (ADHD) in childhood is associated with impaired functioning in multiple cognitive domains: executive functioning (EF), reward and timing. Similar impairments have been described for adults with persistent ADHD, but an extensive investigation of neuropsychological functioning in a large sample of adult patients is currently lacking. We systematically examined neuropsychological performance on tasks measuring EF, delay discounting, time estimation and response variability using univariate ANCOVA's comparing patients with persistent ADHD (N=133, 42% male, mean age 36) and healthy adults (N=132, 40% male, mean age 36). In addition, we tested which combination of variables provided the highest accuracy in predicting ADHD diagnosis. We also estimated for each individual the severity of neuropsychological dysfunctioning. Lastly, we investigated potential effects of stimulant medication and a history of comorbid major depressive disorder (MDD) on performance. Compared to healthy adults, patients with ADHD showed impaired EF, were more impulsive, and more variable in responding. However, effect sizes were small to moderate (range: 0.05-0.70) and 11% of patients did not show neuropsychological dysfunctioning. The best fitting model predicting ADHD included measures from distinct cognitive domains (82.1% specificity, 64.9% sensitivity). Furthermore, patients receiving stimulant medication or with a history of MDD were not distinctively impaired. To conclude, while adults with ADHD as a group are impaired on several cognitive domains, the results confirm that adult ADHD is neuropsychologically heterogeneous. This provides a starting point to investigate individual differences in terms of impaired cognitive pathways.
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Affiliation(s)
- Jeanette C Mostert
- Department of Human Genetics, Radboud university medical center, Nijmegen, The Netherlands.,Donders Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
| | - A Marten H Onnink
- Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, The Netherlands
| | - Marieke Klein
- Department of Human Genetics, Radboud university medical center, Nijmegen, The Netherlands
| | - Janneke Dammers
- Department of Human Genetics, Radboud university medical center, Nijmegen, The Netherlands.,Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, The Netherlands
| | - Anais Harneit
- Department of Human Genetics, Radboud university medical center, Nijmegen, The Netherlands
| | - Theresa Schulten
- Department of Human Genetics, Radboud university medical center, Nijmegen, The Netherlands
| | - Kimm J E van Hulzen
- Department of Human Genetics, Radboud university medical center, Nijmegen, The Netherlands.,Donders Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
| | - Cornelis C Kan
- Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, The Netherlands
| | | | - Jan K Buitelaar
- Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, The Netherlands.,Department of Cognitive Neurosciences, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, The Netherlands
| | - Barbara Franke
- Department of Human Genetics, Radboud university medical center, Nijmegen, The Netherlands.,Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, The Netherlands
| | - Martine Hoogman
- Department of Human Genetics, Radboud university medical center, Nijmegen, The Netherlands
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18
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Mowinckel AM, Pedersen ML, Eilertsen E, Biele G. A meta-analysis of decision-making and attention in adults with ADHD. J Atten Disord 2015; 19:355-67. [PMID: 25477020 DOI: 10.1177/1087054714558872] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Deficient reward processing has gained attention as an important aspect of ADHD, but little is known about reward-based decision-making (DM) in adults with ADHD. This article summarizes research on DM in adult ADHD and contextualizes DM deficits by comparing them to attention deficits. METHOD Meta-analytic methods were used to calculate average effect sizes for different DM domains and continuous performance task (CPT) measures. RESULTS None of the 59 included studies (DM: 12 studies; CPT: 43; both: 4) had indications of publication bias. DM and CPT measures showed robust, small to medium effects. Large effect sizes were found for a drift diffusion model analysis of the CPT. CONCLUSION The results support the existence of DM deficits in adults with ADHD, which are of similar magnitude as attention deficits. These findings warrant further examination of DM in adults with ADHD to improve the understanding of underlying neurocognitive mechanisms.
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Affiliation(s)
| | | | | | - Guido Biele
- University of Oslo, Norway Norwegian Institute of Public Health, Oslo, Norway
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19
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Thissen AJAM, Luman M, Hartman C, Hoekstra P, van Lieshout M, Franke B, Oosterlaan J, Rommelse NNJ, Buitelaar JK. Attention-deficit/hyperactivity disorder (ADHD) and motor timing in adolescents and their parents: familial characteristics of reaction time variability vary with age. J Am Acad Child Adolesc Psychiatry 2014; 53:1010-1019.e4. [PMID: 25151424 DOI: 10.1016/j.jaac.2014.05.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Revised: 03/14/2014] [Accepted: 06/30/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE There is consistent evidence that attention-deficit/hyperactivity disorder (ADHD) is strongly related to impaired motor timing as reflected in decreased accuracy and increased reaction time variability (RTV). It is not known whether motor timing impairments are present in adolescents and adults with ADHD and their unaffected relatives to the same extent as has been reported in children, and whether ADHD and motor timing share familial underpinnings, as reflected in parent-offspring co-segregation and sibling cross-correlations. METHOD A total of 589 parents and 808 children/adolescents from families with ADHD and control families (parent/offspring average age: 48.6/17.3 years) were included. All participants were thoroughly assessed for ADHD and performed a 40-trial motor timing task (1-second interval production). Dependent neurocognitive measures included RT median (RTM: representing accuracy), RTV and ex-Gaussian component τ (τ: representing infrequent long response times). Generalized estimating equations were used for analyses. RESULTS Unaffected children from families with ADHD had RTV (but not RTM or τ) scores in between those of affected and control children. However, during middle-to-late adolescence, unaffected offspring were not impaired compared to control offspring and differed from ADHD probands, whereas during late adolescence/early adulthood, all offspring groups performed equally. Affected and unaffected parents of families with ADHD showed increased RTV compared to controls, regardless of age (not significant after adjusting for IQ). There were indications for shared familiality between RTV and ADHD as reflected by sibling cross-correlations and between RTM and ADHD as reflected by sibling cross-correlations and a maternal parent-offspring relation (parent-of-origin effect). CONCLUSIONS RTV and its familial characteristics are influenced by development during adolescence. Increased RTV in children with ADHD appears to reflect immaturities in their neurocognitive functioning. Maternal ADHD effects might be involved in transmission of RTM (not RTV), but overall RTM showed less compelling (familial) relationships with ADHD than RTV.
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Affiliation(s)
- Andrieke J A M Thissen
- Donders Institute for Brain, Cognition and Behaviour and Karakter Child and Adolescent Psychiatry University Center, Radboud University Nijmegen Medical Center, the Netherlands.
| | | | | | - Pieter Hoekstra
- University Medical Center Groningen, University of Groningen
| | | | - Barbara Franke
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Center
| | | | - Nanda N J Rommelse
- Donders Institute for Brain, Cognition and Behaviour and Karakter Child and Adolescent Psychiatry University Center, Radboud University Nijmegen Medical Center, the Netherlands
| | - Jan K Buitelaar
- Donders Institute for Brain, Cognition and Behaviour and Karakter Child and Adolescent Psychiatry University Center, Radboud University Nijmegen Medical Center, the Netherlands
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20
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Silva KL, Rovaris DL, Guimarães-da-Silva PO, Victor MM, Salgado CAI, Vitola ES, Contini V, Bertuzzi G, Picon FA, Karam RG, Belmonte-de-Abreu P, Rohde LA, Grevet EH, Bau CHD. Could comorbid bipolar disorder account for a significant share of executive function deficits in adults with attention-deficit hyperactivity disorder? Bipolar Disord 2014; 16:270-6. [PMID: 24286629 DOI: 10.1111/bdi.12158] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Accepted: 08/01/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The frequent comorbidity between attention-deficit hyperactivity disorder (ADHD) and bipolar disorder (BD) represents a challenge for disentangling specific impairments of each disorder in adulthood. Their functional impairments seem to be mediated by executive function deficits. However, little is known about the extent to which each executive function deficit might be disorder specific or explained by the comorbidity. The aim of the present study was to determine if comorbid BD could account for a significant share of executive function deficits when measured by the Wisconsin Card Sorting Test (WCST) in adults with ADHD. METHODS Adult patients with ADHD and healthy subjects were evaluated in the ADHD outpatient Program at the Hospital de Clínicas de Porto Alegre. Psychiatric diagnoses were based on DSM-IV criteria. WCST scores were compared by multivariate analysis of covariance among three groups: ADHD with BD (n = 51), ADHD without BD (n = 278), and healthy subjects (n = 91). RESULTS When compared to patients without BD and healthy subjects, patients with ADHD and comorbid BD showed lower scores in total correct answers (p = 0.003); higher scores in total errors (p = 0.004) and non-perseverative errors (p = 0.002); and completed fewer categories (p = 0.009). Patients with ADHD without BD did not differ from healthy subjects. CONCLUSIONS WCST impairments among patients with ADHD seem to be to a large extent attributable to comorbid BD. Although other executive function deficits (e.g., in the inhibitory control domain) have been demonstrated to accompany ADHD, the present findings suggest that set-shifting deficits are strongly related to comorbid BD.
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Affiliation(s)
- Katiane L Silva
- ADHD Outpatient Program-Adult Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
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21
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Das D, Cherbuin N, Easteal S, Anstey KJ. Attention Deficit/Hyperactivity Disorder symptoms and cognitive abilities in the late-life cohort of the PATH through life study. PLoS One 2014; 9:e86552. [PMID: 24489743 PMCID: PMC3904910 DOI: 10.1371/journal.pone.0086552] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 12/12/2013] [Indexed: 11/18/2022] Open
Abstract
Attention Deficit/Hyperactivity Disorder (ADHD) is a common neuropsychiatric disorder that has not been well studied in older adults. In this study we examined relationships between ADHD symptoms and cognitive ability and compared them between middle-age (MA; 48-52 years) and older-age (OA; 68-74 years) adults sampled from the same population. ADHD, mood disorder symptoms and cognitive abilities were assessed in a large population-based sample (n = 3443; 50% male). We measured current ADHD symptoms using the adult ADHD Self-Report Scale (ASRS), which we found to have the same underlying structure in both cohorts. Older adults reported significantly lower levels of ADHD symptoms and 2.2% of the OA cohort scored equal or above the ASRS cut-off score of 14 (which has been previously associated with ADHD diagnosis) compared with 6.2% of MA adults. Symptom levels were not significantly different between males and females. Using multi-group structural equation modelling we compared ADHD symptom-cognitive performance relationships between the two age groups. Generally higher ADHD symptoms were associated with poorer cognitive performance in the MA cohort. However, higher levels of inattention symptoms were associated with better verbal ability in both cohorts. Surprisingly, greater hyperactivity was associated with better task-switching abilities in older adults. In the OA cohort ADHD symptom-cognition relationships are indirect, mediated largely through the strong association between depression symptoms and cognition. Our results suggest that ADHD symptoms decrease with age and that their relationships with co-occurring mood disorders and cognitive performance also change. Although symptoms of depression are lower in older adults, they are much stronger predictors of cognitive performance and likely mediate the effect of ADHD symptoms on cognition in this age group. These results highlight the need for age-appropriate diagnosis and treatment of comorbid ADHD and mood disorders.
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Affiliation(s)
- Debjani Das
- John Curtin School of Medical Research, The Australian National University, Canberra, Australian Capital Territory, Australia
- * E-mail:
| | - Nicolas Cherbuin
- Centre for Research on Ageing, Health and Wellbeing, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Simon Easteal
- John Curtin School of Medical Research, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Kaarin J. Anstey
- Centre for Research on Ageing, Health and Wellbeing, The Australian National University, Canberra, Australian Capital Territory, Australia
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22
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Dresler T, Barth B, Ethofer T, Lesch KP, Ehlis AC, Fallgatter AJ. Imaging genetics in adult attention-deficit/hyperactivity disorder (ADHD): a way towards pathophysiological understanding? Borderline Personal Disord Emot Dysregul 2014; 1:6. [PMID: 26401290 PMCID: PMC4574388 DOI: 10.1186/2051-6673-1-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Accepted: 10/18/2013] [Indexed: 11/10/2022] Open
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a common, early-onset and enduring developmental disorder whose underlying etiological and neurobiological processes are the current focus of major research. Research strategies have made considerable effort in elucidating the complex genetic architecture of ADHD and indicate various pathways from genotype to phenotype. Understanding ADHD as a neuropsychiatric disorder enabled to investigate markers of neural activity as endophenotypes to better explain the link from gene to symptomatology (the so-called imaging genetics approach). Overcoming the originally rather restrictive requirements for an endophenotype, imaging genetics studies are supposed to offer a much more flexible and hypothesis-driven approach towards the etiology of ADHD. Although 1) ADHD often persists into adulthood, thus remaining a prevalent disorder, and 2) imaging genetics provides a promising research approach, a review on imaging genetics in adult ADHD - as available for childhood ADHD (Durston 2010) - is lacking. In this review, therefore, findings from the few available imaging genetics studies in adult ADHD will be summarized and complemented by relevant findings from healthy controls and children with ADHD that are considered important for the adult ADHD imaging genetics approach. The studies will be reviewed regarding implications for basic research and possible practical applications. Imaging genetics studies in adult ADHD have the potential to further clarify pathophysiological pathways and mechanisms, to derive new testable hypotheses, to investigate genetic interaction effects and to partly influence practical applications. In combination with other research strategies, they can incrementally foster the understanding of relevant processes in a more comprehensive way. Current limitations comprise the incapability to discover new genes, a high genetic load in patients potentially obscuring the effect of single candidate genes, the mostly unknown heritability of the endophenotype and the heterogeneous manifestation of ADHD.
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Affiliation(s)
- Thomas Dresler
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany ; LEAD Graduate School, University of Tübingen, Tübingen, Germany
| | - Beatrix Barth
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany ; Graduate School of Neural and Behavioral Sciences, University of Tübingen, Tübingen, Germany
| | - Thomas Ethofer
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Klaus-Peter Lesch
- Division of Molecular Psychiatry, Department of Psychiatry, Psychosomatics and Psychotherapy, University of Würzburg, Würzburg, Germany
| | - Ann-Christine Ehlis
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Andreas J Fallgatter
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany ; LEAD Graduate School, University of Tübingen, Tübingen, Germany ; CIN, Center of Integrative Neuroscience, Excellence Cluster, University of Tübingen, Tübingen, Germany
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