Response execution and inhibitionin children with AD/HD and other disruptive disorders: the role of behavioural activation.

Item does not contain fulltextThis study was aimed at (a) replicating findings of slow and variable response execution and slow response inhibition in Attention Deficit/Hyperactivity Disorder (AD/HD), (b) investigating whether these deficits are specifically related to AD/HD or may also be observed in Oppositional Defiant Disorder (ODD), and children comorbid for AD/HD+ODD, and (c) examining the role of activation level in task performance of children with AD/HD. To meet these aims, the stop paradigm was administered at three levels of activation, using a slow, medium, and fast presentation rate of stimuli, to 4 groups of children: 24 AD/HD children, 21 children with ODD, 27 children with comorbid AD/HD+ODD, and 41 normal controls. As hypothesized, children with AD/HD exhibited a slow response execution process with considerable variability in the speed of responding compared to normal controls. Slow response execution was also observed in the comorbid AD/HD+ODD group but not in the pure ODD group. Larger variability in the speed of responding was common to all disruptive groups compared with controls. In contrast to our hypothesis, no group differences emerged for inhibitory functioning. Finally, the slow event rate condition caused a further deterioration in the speed of the response execution process in both the AD/HD group and ODD group

Speed of inhibition predicts teacher-rated medication response in boys with attention deficit hyperactivity disorder

Item does not contain fulltextThis study aimed at investigating whether one of the key deficits in Attention Deficit Hyperactivity Disorder (ADHD), slow response inhibition, predicted the response to methylphenidate (MPH) treatment. In order to address this issue, we used Stop Signal Reaction Times (SSRTs) measured at baseline in 20 medication-nave boys with ADHD as predictor, and parent and teacher ratings that were collected during a double-blind, placebo-controlled titration trial of MPH in the same group as outcome measures. Parent and teacher ratings were collected on primary scales, measuring ADHD symptoms, and secondary scales, measuring oppositional and disruptive behaviour. Placebo response and ADHD/Oppositional Defiant Disorder symptom severity at baseline were controlled for in the analyses. The SSRT did not predict the MPH response as measured by parent ratings, but it did predict the MPH response as measured by teacher ratings. This effect was specific for the ADHD scales. The slower SSRTs were, the less children benefited from MPH. Moreover, children with longer SSRTs needed higher doses of MPH for optimal symptom relief than children with shorter SSRTs. These findings have implications for clinicians who face the decision of which MPH dose to prescribe.18 p

Response Inhibition in Children With DSM-IV Subtypes of AD/HD and Related Disruptive Disorders: The Role of Reward

Item does not contain fulltextThe current study had four aims: (a) to replicate previous findings of slow response inhibition in Attention Deficit/Hyperactivity Disorder (AD/HD), (b) to explore whether poor response inhibition in children with AD/HD is a core problem or rather a result of an underlying problem related to reward, (c) to investigate the specificity of poor response inhibition and the role of reward in relation to AD/HD, and (d) to study whether findings would be different for three subtypes of AD/HD. In order to address these issues, a stop paradigm was administered under a reward condition and under a nonreward condition to an AD/HD group (n = 24), an Oppositional Defiant Disorder (ODD)/Conduct Disorder (CD) group (n = 21), a comorbid AD/HD + ODD/CD group (n = 27), and a normal control (NC) group (n = 41). Firstly, contrary to prediction, none of the Disruptive Behavior Disorder (DBD) groups differed from the NC group with respect to the speed of the inhibition process. Secondly, it was shown that children with AD/HD and children with comorbid AD/HD + ODD/CD, but not children with ODD/CD alone, slowed down more dramatically in the reward condition than normal controls. This finding was interpreted as a strategy to increase the chance of being rewarded in children with AD/HD and children with comorbid AD/HD + ODD/CD, but not in children with pure ODD/CD. Finally, analysis of AD/HD subtypes did not change the main findings of this study

The impact of specific language impairment on working memory in children with ADHD combined type

To access publisher full text version of this article. Please click on the hyperlink in Additional Links fieldThe objective of this study was to examine the impact of comorbid specific language impairment (SLI) on verbal and spatial working memory in children with DSM-IV combined subtype Attention Deficit Hyperactivity Disorder (ADHD-C). Participants were a clinical sample of 812- to 1212-year-old children diagnosed with ADHD-C. A group of ADHD-C with SLI was compared to a group of ADHD-C without SLI, and a group of normal children, matched on age and nonverbal intelligence. The results show that ADHD-C children with SLI scored significantly lower than those without SLI and normal children, on verbal working memory measures only. Both ADHD groups performed normally on spatial working memory measures. It is concluded that working memory deficits are not a specific characteristic of ADHD but are associated with language impairments. The importance of screening for language disorders in studies of neuropsychological functioning in children with ADHD is emphasized

Executive functioning in adult ADHD: a meta-analytic review

. CONCLUSIONS: Neuropsychological difficulties in adult ADHD may not be confined to executive functioning. The field is in urgent need of better-designed executive functioning tests, methodological improvements, and direct comparisons with multiple clinical groups to answer questions of specificit

ADHD subtypes: do they differ in their executive functioning profile?

The present study was designed to investigate the hypothesis that children with Attention Deficit Hyperactivity Disorder combined subtype (ADHD-C) have a generalized executive functioning (EF) [Barkley, R. A. (1997). Behavioural inhibition, sustained attention, and executive functions: Constructing a unifying theory of AD/HD. Psychological Bulletin, 121, 65-94; Barkley, R. A. (1997). ADHD and the nature of self-control. New York: The Guilford Press]. We tested whether ADHD-C and ADHD inattentive subtype (ADHD-I) can be differentiated from each other on EF measures. We compared 16 normally developing boys with 16 boys with ADHD-C and 16 with ADHD-I on five EF domains. The boys were all matched on age, IQ, and the presence of oppositional defiant disorder (ODD)/conduct disorder (CD). Despite carefully diagnosed groups and methodological controls, the results do not support the EF-hypothesis of ADHD-C. Children with ADHD-C differed from normal controls (NC) on tasks related to inhibition; they did not exhibit EF deficits on all EF tasks. Children with ADHD-C also exhibited deficits on non-EF tasks. Furthermore, the ADHD-C and ADHD-I subtypes did not differ from one another. Neuropsychological findings on the domains under study did not yield evidence for the distinctiveness of ADHD-C and ADHD-I subtypes. © 2004 National Academy of Neuropsychology. Published by Elsevier Ltd. All rights reserved

Motor timing deficits in community and clinical boys with hyperactive behaviour: The effect of methylphenidate on motor timing.

In a previous paper we showed that community children with hyperactive behavior were more inconsistent than controls in the temporal organization of their motor output. In this study we investigated: (1) various aspects of motor timing processes in 13 clinically diagnosed boys with attention deficit hyperactivity disorder (ADHD) who were compared to 11 community boys with hyperactive behavior and to a control group and (2) the effect of methylphenidate on the motor timing processes in the clinical group with ADHD in a double blind, cross-over, medication-placebo design, including 4 weeks of medication. The clinical group with ADHD, like the community group with hyperactivity, showed greater variability in sensorimotor synchronization and in sensorimotor anticipation relative to controls. The clinical group was also impaired in time perception, which was spared in the community group with hyperactivity. The persistent, but not the acute dose, of methylphenidate reduced the variability of sensorimotor synchronization and anticipation, but had no effect on time perception. This study shows that motor timing functions are impaired in both clinical and community children with hyperactivity. It is the first study to show the effectiveness of persistent administration of methylphenidate on deficits in motor timing in ADHD children and extends the use of methylphenidate from the domain of attentional and inhibitory functions to the domain of executive motor timing

EINAQ - A European educational initiative on Attention-Deficit Hyperactivity Disorder and associated problems

BACKGROUND: Continuing Medical Education (CME) plays an important role in quality management, especially as quality assurance, for the improvement of healthcare in child and adolescent psychiatry. This requires responsibility regarding quality standards of clinical practice throughout Europe as outlined by the European Union of Medical Specialists (UEMS). OBJECTIVE: Therefore, steps should be undertaken to improve specialists' medical care and harmonize it in Europe. Attention-Deficit Hyperactivity Disorder (ADHD) with its many co-existing developmental disorders/problems is the central healthcare problem in child and adolescent psychiatry with high impact on society. Therefore, it was chosen as the target. METHOD: A European Interdisciplinary Network for ADHD Quality Assurance (EINAQ) was founded, didactic material was developed and a faculty of experts from several European countries established to offer all over Europe harmonized courses on ADHD and associated problems. RESULTS: Pilot courses were given in Germany in 2003/2004 and were highly appreciated by the participants. Further courses in Germany and other European countries will take place in 2004. CONCLUSION: EINAQ seems to be on the right track to be part of CME and specialized networks for healthcare in ADHD to improve the provision for mental health problems in children and adolescents in Europe. Cooperative projects with official European bodies like the UEMS -- Section on Child and Adolescent Psychiatry/Psychotherapy and the European Society of Child and Adolescent Psychiatry could strengthen the impact of EINAQ

Inhibitory Deficits in reading disability depend on subtype: guessers but not spellers

In this study, children with the guessing subtype of dyslexia (who read fast and inaccurately) were compared with children with the spelling subtype (who read slowly and accurately) on three aspects of executive functioning (EF): response inhibition, susceptibility to interference from irrelevant information, and planning. It was found that guessers were impaired in their ability to inhibit inappropriate responding on all tasks used to assess EF (the stop signal task, the Stroop task, and the Tower of London task). This raises the question of whether the specific reading disorder of guessers may be linked to the same executive deficits which underlie ADHD. In order to unite a fast/inaccurate reading style with executive deficiencies, an attempt is made to incorporate the concept of executive control into models of lexical activation