Can PC-based training boost working memory in ADHD preadolescents on medication? : a clinical intervention study

Children with ADHD suffer from impairments in working memory, and recent studies have documented significant gains in working memory (WM) in children diagnosed with ADHD after participating in a PC-based WM training program. Earlier studies have focused on unmedicated children, while a majority of Norwegian children diagnosed with ADHD take ADHD medication for the disorder. The main question addressed in this study is whether ADHD children on medication would also show significant improvements in WM after PC-based WM training. A second issue examined is whether the results favor one of two established, but diverging, non-unitary models of the construct working memory. The results indicate that ADHD children on medication can improve on neuropsychological measures of verbal and visuospatial short-term memory by training systematically on computerized working memory tasks; the same gains on more complex verbal and visuospatial WM tasks were not registered in the current study. Investigations into possible transfer effects of the short-term memory gains to math and reading abilities, and the long-term effects of the training on functioning at home and at school will be needed before any conclusions or recommendations can be made about the benefits of the training program

ADHD in girls and boys – gender differences in co-existing symptoms and executive function measures

Background: ADHD is diagnosed and treated more often in males than in females. Research on gender differences suggests that girls may be consistently underidentified and underdiagnosed because of differences in the expression of the disorder among boys and girls. One aim of the present study was to assess in a clinical sample of medication naïve boys and girls with ADHD, whether there were significant gender x diagnosis interactions in co-existing symptom severity and executive function (EF) impairment. The second aim was to delineate specific symptom ratings and measures of EF that were most important in distinguishing ADHD from healthy controls (HC) of the same gender. Methods: Thirty-seven females with ADHD, 43 males with ADHD, 18 HC females and 32 HC males between 8 and 17 years were included. Co-existing symptoms were assessed with self-report scales and parent ratings. EF was assessed with parent ratings of executive skills in everyday situations (BRIEF), and neuropsychological tests. The three measurement domains (co-existing symptoms, BRIEF, neuropsychological EF tests) were investigated using analysis of variance (ANOVA) and random forest classification. Results: ANOVAs revealed only one significant diagnosis x gender interaction, with higher rates of self-reported anxiety symptoms in females with ADHD. Random forest classification indicated that co-existing symptom ratings was substantially better in distinguishing subjects with ADHD from HC in females (93% accuracy) than in males (86% accuracy). The most important distinguishing variable was self-reported anxiety in females, and parent ratings of rule breaking in males. Parent ratings of EF skills were better in distinguishing subjects with ADHD from HC in males (96% accuracy) than in females (92% accuracy). Neuropsychological EF tests had only a modest ability to categorize subjects as ADHD or HC in males (73% accuracy) and females (79% accuracy). Conclusions: Our findings emphasize the combination of self-report and parent rating scales for the identification of different comorbid symptom expression in boys and girls already diagnosed with ADHD. Self-report scales may increase awareness of internalizing problems particularly salient in females with ADHD

Similar impairments shown on a neuropsychological test battery in adolescents with high-functioning autism and early onset schizophrenia: A two-year follow-up study

Introduction: Cognitive impairments are common in both Autism Spectrum Disorders (ASD) and schizophrenia, but it is unclear whether the pattern of difficulties is similar or different in the two disorders. This cross-sectional and longitudinal study compared the neuropsychological functioning in adolescents with ASD with adolescents with Early Onset Schizophrenia (EOS). Methods: At baseline and at two-year follow-up, participants were assessed with a brief neuropsychological test battery measuring executive functions, visual and verbal learning, delayed recall and recognition and psychomotor speed. Results: We found similar levels of neuropsychological impairment across groups and over time in the adolescents with ASD or EOS. Adolescents in both groups did not improve significantly on verbal learning, verbal delayed recall, visual learning, visual delayed recall or visual delayed recognition, and both groups performed poorer on verbal recognition. Both groups improved on measures of psychomotor processing and executive functions. Conclusion: The findings suggest that it may be difficult to differentiate adolescents with EOS and ASD based on neuropsychological task performance. An implication of the results is that adolescents with either disorder may benefit from a similar approach to the treatment of cognitive impairment in the disorders.acceptedVersio

A randomized controlled trial of Goal Management Training for executive functioning in schizophrenia spectrum disorders or psychosis risk syndromes

Background Executive functioning is essential to daily life and severely impaired in schizophrenia and psychosis risk syndromes. Goal Management Training (GMT) is a theoretically founded, empirically supported, metacognitive strategy training program designed to improve executive functioning. Methods A randomized controlled parallel group trial compared GMT with treatment as usual among 81 participants (GMT, n = 39 versus Wait List Controls, n = 42) recruited from an early intervention for psychosis setting. Computer generated random allocation was performed by someone independent from the study team and raters post-intervention were unaware of allocation. The primary objective was to assess the impact of GMT administered in small groups for 5 weeks on executive functioning. The secondary objective was to explore the potential of the intervention in influencing daily life functioning and clinical symptoms. Results GMT improved self-reported executive functioning, measured with the Behavior Rating Inventory of Executive Function – Adult version (BRIEF-A), significantly more than treatment as usual. A linear mixed model for repeated measures, including all partial data according to the principle of intention to treat, showed a significant group x time interaction effect assessed immediately after intervention (post-test) and 6 months after intervention (follow-up), F = 8.40, p .005, r .37. Improvement occurred in both groups in objective executive functioning as measured by neuropsychological tests, functional capacity, daily life functioning and symptoms of psychosis rated by clinicians. Self-reported clinical symptoms measured with the Symptoms Check List (SCL-10) improved significantly more after GMT than after treatment as usual, F = 5.78, p .019, r .29. Two participants withdrew due to strenuous testing and one due to adverse effects. Conclusions GMT had clinically reliable and lasting effects on subjective executive function. The intervention is a valuable addition to available treatment with considerable gains at low cost. Trial registration Registered at clinicaltrials.gov NCT03048695 09/02/2017.publishedVersio

Executive control of cognition, emotion and behavior in children with Tourette’s syndrome. A two-year follow-up study

The ability to exert executive control over aspects of cognition, emotion and behaviour in children and adolescents with TS deviates from typically developing children (TDC), and represents a potential threat to their health and well-being. Knowledge about these processes and their development over time in young persons with TS is scarce, and is essential for understanding and treating this group of vulnerable children. In the first study, we found that children with TS were superior in inhibiting a prepotent response compared with children with Attention-deficit/Hyperactivity Disorder (ADHD) and TDC, and that co-occurring ADHD in the children with TS negatively influenced performance (Hovik, Plessen, Skogli, Andersen, & Oie, 2013). This finding provided evidence in support of the hypothesis that levels of inhibitory control can distinguish children with TS, ADHD and TDC, and that some children with TS may overly inhibit when responding to certain stimuli. In the second study, we found that paired scales in the Behavior Rating Inventory of Executive Function (BRIEF) dissociated everyday executive behavior difficulties in children with TS from children with ADHD-Combined type (ADHD-C), ADHD-Inattentive type (ADHD-I) or high-functioning Autism Spectrum Disorder (ASD) (Hovik et al., 2014). The parents of the children with TS reported more emotional control difficulties in their children relative to other executive behavior problems compared with the children in the other groups. This finding provided evidence in support of the hypothesis that having TS involves significant difficulties controlling emotional behaviour in their everyday lives. In the third study, we found that an improvement in executive functioning (working memory, inhibition and mental flexibility) over a two-year period was not closely associated with fewer symptoms of anxiety or depression or increased control over emotional behavior in the children with TS or ADHD-C (Hovik et al., 2015). Although there was a significant decrease in depression symptoms after two years in the children with TS, the self-reported level of depression and anxiety symptoms in these children remained significantly higher compared with the TDC at follow-up. Important clinical implications of the results from the third study include the importance of assessing and treating emotional symptoms in children and adolescents with TS or ADHD-C during a critical time in their maturational development. The third study also provided evidence that children with TS preferred the more cautious choice compared with the children with ADHD-C when faced with making decisions with uncertain outcomes. Varying sensitivity to reinforcement contingencies is an important consideration in treating children and adolescents with behavior difficulties

Severity of Autism Symptoms and Degree of Attentional Difficulties Predicts Emotional and Behavioral Problems in Children with High-Functioning Autism; A Two-Year Follow-up Study

Children with autism often struggle with emotional and behavioral problems (EBP). This study investigated whether level of autism symptoms, attention problems or verbal IQ at baseline can predict EBP 2 years later in children with High-Functioning Autism (HFA). Thirty-four participants with HFA and 45 typically developing children (TD) (ages 9–16) were assessed with parent ratings of EBP, autism symptoms, attention problems, and a test of verbal IQ. The amount of autism symptoms and degree of attention problems at baseline significantly predicted EBP at follow-up, whereas verbal IQ did not. The findings from this study emphasize the importance of assessing and understanding the consequences of autism symptoms and attention problems when treating EBP in children with HFA. Furthermore, interventions aimed at improving ASD symptoms may positively affect the prevalence of EBP in children with HFA

Development of Hot and Cold Executive Function in Boys and Girls With ADHD: A 2-Year Longitudinal Study

Objective: To investigate the development of executive function with pronounced emotional salience (hot EF) and less pronounced emotional salience (cold EF) in boys and girls with ADHD relative to typically developing (TD) children. Method: Seventy-five children with ADHD and 47 TD children were assessed with hot and cold EF tests at baseline and after 2 years. Results: Despite considerable maturation, the ADHD group remained impaired on all cold EF tests relative to TD children after 2 years. There was no effect of gender on cold EF test results. Females with ADHD outperformed TD counterparts on hot EF at baseline. Females with ADHD showed deteriorating hot EF performance, while TD counterparts showed improved hot EF performance across time. Conclusion: Enduring cold EF impairments after 2 years may reflect stable phenotypic traits in children with ADHD. Results indicate divergent developmental trajectories of hot EF in girls with ADHD relative to TD counterparts

Development of Hot and Cold Executive Function in Boys and Girls With ADHD: A 2-Year Longitudinal Study

Objective: To investigate the development of executive function with pronounced emotional salience (hot EF) and less pronounced emotional salience (cold EF) in boys and girls with ADHD relative to typically developing (TD) children. Method: Seventy-five children with ADHD and 47 TD children were assessed with hot and cold EF tests at baseline and after 2 years. Results: Despite considerable maturation, the ADHD group remained impaired on all cold EF tests relative to TD children after 2 years. There was no effect of gender on cold EF test results. Females with ADHD outperformed TD counterparts on hot EF at baseline. Females with ADHD showed deteriorating hot EF performance, while TD counterparts showed improved hot EF performance across time. Conclusion: Enduring cold EF impairments after 2 years may reflect stable phenotypic traits in children with ADHD. Results indicate divergent developmental trajectories of hot EF in girls with ADHD relative to TD counterparts