Cognitive factors differentiating attention deficit–hyperactivity disorder with and without a comorbid mood disorder.

Mood disorders and attention deficit–hyperactivity disorder (ADHD) co-occur in 20–30% of children and adolescents diagnosed in both epidemiological and clinical studies, but little information is available regarding cognitive factors that may be relevant to the expression of co-occurring mood disorders and ADHD. This study examined whether ADHD with and without a comorbid mood disorder could be differentiated on the basis of cognitive factors associated with prominent theories of depression. Children meeting diagnostic criteria for ADHD (n?=?14) or ADHD and a comorbid mood disorder (n?=?27) were assessed on a variety of cognitive indices. Children in the comorbid group reported more negative views of themselves and a more depressogenic attributional style. Cognitive disturbances associated with A. T. Beck's (1967) cognitive model and attributional style theories of depression differentiate ADHD children with significant mood pathology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Disentangling the overlap between Tourette's disorder and ADHD

OBJECTIVE: To identify similarities and differences in neuropsychiatric correlates in children with Tourette's syndrome (TS) and those with ADHD. METHOD: The sample consisted of children with Tourette's syndrome with ADHD (N = 79), children with Tourette's syndrome without ADHD (N = 18), children with ADHD (N = 563), psychiatrically referred children (N = 212), and healthy controls (N = 140). RESULTS: Disorders specifically associated with Tourette's syndrome were obsessive compulsive disorder (OCD) and simple phobias. Rates of other disorders, including other disruptive behavioral, mood, and anxiety disorders, neuropsychologic correlates, and social and school functioning were indistinguishable in children with Tourette's and ADHD. However, children with Tourette's syndrome plus ADHD had more additional comorbid disorders overall and lower psychosocial function than children with ADHD. CONCLUSIONS: These findings confirm previously noted associations between Tourette's syndrome and OCD but suggest that disruptive behavioral, mood, and anxiety disorders as well as cognitive dysfunctions may be accounted for by comorbidity with ADHD. However, Tourette's syndrome plus ADHD appears to be a more severe condition than ADHD alone.     

Cognitive aspects of chronic depression.

Previous research on chronic depression has focused on its link with other mood disorders and Axis II personality disorders. However, there are few data examining whether the cognitive perspective applies to this condition. In this cross-sectional study, 42 outpatients with chronic depression were compared with 27 outpatients with nonchronic major depressive disorder and 24 never psychiatrically ill controls on cognitive variables thought to be related to vulnerability to depression (e.g., dysfunctional attitudes, attributional style, a ruminative response style, and maladaptive core beliefs). Both depressed groups were more elevated than a never-ill comparison group. However, chronically depressed individuals were generally more elevated on measures of cognitive variables than those with major depressive disorders even after controlling for mood state and personality disorder symptoms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Intellectual performance and school failure in children with attention deficit hyperactivity disorder and in their siblings.

Made psychiatric and intellectual assessments of 140 children with attention deficit hyperactivity disorder (ADHD), 120 normal controls, and their 303 siblings. The index children were White, non-Hispanic boys. ADHD children were more likely to have had learning disabilities, repeated grades, been placed in special classes, and received academic tutoring. They also did worse on the Wechsler Intelligence Scale for Children—Revised (WISC—R). Among ADHD probands, comorbid conduct, major depressive, and anxiety disorders predicted school placement more than school failure or WISC—R scores. However, the neuropsychological disability of all ADHD children could not be attributed to comorbid disorders because those without comorbidity had more school failure and lower WISC—R scores than normal controls. Intellectual impairment was also increased among siblings of ADHD children. This provides converging evidence that the ADHD syndrome is familial. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive styles and life events interact to predict bipolar and unipolar symptomatology.

This study examined the interaction of cognitive style (as assessed self-report and information-processing battery) and stressful life events in predicting the clinician-rated depressive and manic symptomatology of participants with Research Diagnostic Criteria lifetime diagnoses of bipolar disorder (n?=?49), unipolar depression (n?=?97), or no lifetime diagnosis (n?=?23). Bipolar and unipolar participants' attributional styles, dysfunctional attitudes, and negative self-referent information processing as assessed at Time 1 interacted significantly with the number of negative life events that occurred between Times 1 and 2 to predict increases in depressive symptoms from Time 1 to Time 2. Within the bipolar group, participants' Time 1 attributional styles and dysfunctional attitudes interacted significantly, and their self-referent information processing interacted marginally, with intervening life events to predict increases in manic symptoms from Time 1 to Time 2. These findings provide support for the applicability of cognitive vulnerability–stress theories of depression to bipolar spectrum disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attributions and expectations: A confluence of vulnerabilities in mild depression in a college student population.

The reformulated model of learned helplessness assumes that attributional style has its impact on depression in part through the intermediary effect of pessimistic or negative expectations about the occurrence of future outcomes. A possible logical next step in testing the model is to measure jointly attributions and expectations and to examine their combined (interactive) contributions. We used a short-term longitudinal design to examine whether attributional style works in combination with other factors, such as expectations, to predispose individuals to depression. Consistent with the initial theoretical analysis, the interaction of attributional style and expectations predicted depression on the Beck Depression Inventory 6 weeks later. We also found that attributional style predicted depression 6 weeks later in interaction with initial level of depression. These findings support our confluence hypothesis, which assumes that vulnerability factors can combine interactively and qualify the effects of attributional style. These interaction-effect findings have implications for currently popular cognitive theories of depression and for previous research on vulnerability to depression that has examined only the effects of single cognitive variables (such as attributional style) considered alone. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Neuropsychological correlates of childhood attention-deficit/hyperactivity disorder: explainable by comorbid disruptive behavior or reading problems?

Questions remain as to whether neuropsychological processing deficits associated with child attention-deficit/hyperactivity disorder (ADHD) are accounted for by co-occurring disorders, especially in clinical samples. The authors examined ADHD and comorbid oppositional defiant, conduct, and reading disorders. Boys with ADHD displayed hypothesized deficits on effortful neuropsychological tasks regardless of categorical or dimensional control of comorbid antisocial behavior problems. The same result held when reading problems were controlled, although boys with ADHD plus reading disorder (n = 16) exhibited specific impairment on linguistic output tasks. Simultaneous control of reading and behavior problems yielded the same result. Overall, results suggest that in a clinical sample, difficulties on effortful neuropsychological tasks that require planning or controlled motor output pertain at least in part to ADHD and are not fully accounted for by comorbid conditions.     

Inhibition of cGMP mediated relaxation in small rat coronary arteries by block of CA++ activated K+ channels

Children with sleep disorders are often inattentive or hyperactive, and some carry a diagnosis of attention deficit/hyperactivity disorder (ADHD) until their sleep disorder is detected. However, the potential behavioral impact of undiagnosed sleep disorders is not known. We sought to determine whether children with higher levels of inattention and hyperactivity more frequently have symptoms of sleep-related breathing disorders (SRBDs) or periodic limb movement disorder (PLMD). We surveyed parents of 2-18-year-old patients at a child psychiatry clinic (n = 70) and a general pediatrics clinic (n = 73) to assess the children's behavior, snoring, complaints of restless legs at night, and daytime sleepiness. A validated pediatric sleep questionnaire provided the explanatory variables, and a scale for inattention and hyperactivity, derived from the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV), provided the dependent variable. Habitual snoring was more frequent (33%) among children who carried a diagnosis of ADHD than among the other children at the psychiatry or general pediatric clinics (11 and 9%, respectively, chi-square test, p = 0.01). Snoring scores, derived from six snoring- and SRBD-related question items, were associated with higher levels of inattention and hyperactivity. The complaint of restless legs and a composite score for daytime sleepiness showed some evidence, though less consistent, of an association with inattention and hyperactivity. The association of snoring with inattention and hyperactivity suggests that SRBDs and perhaps other sleep disorders could be a cause of inattention and hyperactivity in some children. If a causal effect is present, our data suggest that 81% of habitually snoring children who have ADHD--25% of all children with ADHD--could have their ADHD eliminated if their habitual snoring and any associated SRBD were effectively treated.     

Experimental modification of attribution processes.

Attributional style is hypothesized to be a causative factor in depression vulnerability; however, no studies to date have examined whether manipulation of attributional style influences depressed mood. The purpose of this study was to determine whether computer-based cognitive bias modification (CBM) procedures could modify attributional style and influence stress vulnerability. Participants were provided with multiple training trials that were intended to promote the use of either a positive or a negative attributional style. Compared with individuals in the negative attributional style condition, individuals in the positive attributional style condition showed decreased tendency to make self-deficient causal attributions for poor performance on a difficult anagram test. Furthermore, individuals in the positive attributional style condition reported less depressed mood in response to this academic stressor. These results suggest that attributional style is not invariable and can potentially be modified with CBM approaches. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Association of parental psychopathology to the comorbid disorders of boys with attention deficit-hyperactivity disorder.

This study examined whether particular forms of parental psychopathology are related to similar forms of comorbid psychopathology in offspring with attention deficit-hyperactivity disorder (ADHD). Parental disorders were assessed using maternal interviews, and child disorders were assessed using multiple-informant interviews for 111 clinic-referred boys (aged 7–12) with Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev.: American Psychiatric Association, 1987) ADHD. Associations between parental and child internalizing disorders and between parental and child externalizing disorders were found, but associations across categories of disorder (i.e., internalizing and externalizing) were not. Similar relationships were observed in 66 clinic-referred boys without ADHD. These findings support specific modes of familial transmission, in contrast to theories that comorbidity simply reflects more severe psychopathology in children with ADHD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Executive function in children with Tourette syndrome and/or attention deficit hyperactivity disorder

Tourette Syndrome (TS) in children is associated with various neurobehavioral disorders including attention deficit hyperactivity disorder (ADHD). Children with TS and ADHD show some difficulties with neuropsychological tasks, but we do not know if children with TS alone have neuropsychological deficits. To assess specific cognitive differences among children with TS and/or ADHD, we administered a battery of neuropsychological tests, including 10 tasks related to executive function (EF), to 10 children with TS-only, 48 with ADHD-only, and 32 with TS + ADHD. Children in all groups could not efficiently produce output on a timed continuous performance task [Test of Variables of Attention (TOVA) mean reaction time and reaction time variability]. Children with TS-only appeared to have fewer EF impairments and significantly higher perceptual organization scores than children with TS + ADHD or ADHD-only. These findings suggest that deficiencies in choice reaction time and consistency of timed responses are common to all three groups, but children with TS-only have relatively less EF impairment than children with TS + ADHD or ADHD-only.     

Rage attacks in children and adolescents with Tourette''s disorder: a pilot study

BACKGROUND: Sudden, explosive episodes of rage occur in a significant number of clinically referred children with Tourette's disorder and cause considerable psychosocial morbidity. The etiology of these symptoms is unknown. We conducted a pilot study of 12 consecutive children with Tourette's disorder and rage attacks to determine whether comorbidity of Tourette's-associated disorders is related to these symptoms. METHOD: Twelve consecutive children with Tourette's disorder who presented with rage attacks were evaluated, including 2 females and 10 males. Tourette's disorder diagnosis, presence of comorbid disorders, and tic severity were assessed using DSM-IV diagnostic criteria and standardized rating scales. RESULTS: All 12 children met diagnostic criteria for Tourette's disorder, obsessive-compulsive disorder (OCD), and attention-deficit/hyperactivity disorder (ADHD). Two children were also diagnosed with comorbid oppositional defiant disorder, and 4 children were diagnosed with comorbid conduct disorder. None of the subjects met diagnostic criteria for a mood disorder. All subjects had only mild tic severity. CONCLUSION: The clinical phenomenon of rage attacks in children with Tourette's disorder resembles intermittent explosive disorder and may reflect specific underlying neurologic disturbances. This pilot study suggests that rage attacks in Tourette's disorder may be related to the presence of comorbid disorders.     

Working memory demands impair skill acquisition in children with ADHD.

This study examined the process of cognitive skill acquisition under differential working memory (WM) load conditions in children with the primarily inattentive (n = 21) and the combined (n = 32) subtypes of childhood attention-deficit/hyperactivity disorder (ADHD) and compared the results with those of non-ADHD controls (n = 48). Children completed 2 tasks of cognitive skill acquisition: alphabet arithmetic and finger math. The tasks differed in the amount of WM required for execution (alphabet arithmetic required more) but were otherwise matched with respect to logical structure, design, and discriminatory power. As would be predicted if the WM of the to-be-learned task affected the ability of children with ADHD to develop automaticity for a complex cognitive skill, ADHD-related impairments in the development of automaticity were seen for alphabet arithmetic but not for finger math. Results not only are relevant to ongoing debate regarding the presence of effortful versus automatic cognitive deficits in ADHD but also have implications for the development of new psychoeducational interventions for children with ADHD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Temperament, personality, and the mood and anxiety disorders.

Reviews the literature on temperament, personality, and mood and anxiety disorders. The review is organized primarily around L. A. Clark and D. Watson's (1991) tripartite model for these disorders, but other influential approaches are also examined. Negative affectivity (or neuroticism) appears to be a vulnerability factor for the development of anxiety and depression, indicates poor prognosis, and is itself affected by the experience of disorder. Positive affectivity (or extraversion) is related more specifically to depression, may be a risk factor for its development, suggests poor prognosis, and also may be affected by the experience of disorder. Other personality dimensions (e.g., anxiety sensitivity, attributional style, sociotropy or dependency, autonomy or self-criticism, and constraint) may constitute specific vulnerability factors for particular disorders. It is suggested that more longitudinal and measurement-based research that jointly examines anxiety and depression is needed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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

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

Relationship of depressive, conduct, and comorbid disorders and social functioning in childhood

OBJECTIVE: To examine the relationship of depressive, conduct, and comorbid disorders and social functioning in psychiatrically referred youths. METHOD: Subjects were 94 boys and 67 girls (mean age at initial assessment = 11.5 years) who were repeatedly evaluated with standardized instruments during a mean interval of 4.4 years. On the basis of their diagnoses during the follow-up, children were designated as having had depressive, conduct, or both (comorbid) disorders or other conditions. Two domains of social functioning were assessed: social competence and self-esteem. RESULTS: Longitudinal analyses revealed that at any given point in time, depressive, conduct, and comorbid disorders were associated with low social competence and depressive disorder also was associated with low self-esteem. At the approximate age of 15 years, on average, children with a history of conduct or comorbid disorders had lower social competence than did children with a history of depressive disorder, but these groups endorsed similar levels of self-esteem. CONCLUSION: Some areas of social dysfunction associated with comorbid depressive and conduct disorders appear to reflect mostly the effects of conduct disorder. The latter condition has a more severe and longer-term impact on children's social competence than does depression. In addition, whereas depression has an adverse effect on self-esteem, this effect appears to be temporary.     

Cognitive attributes of depression in children and adolescents.

This study explores whether cognitive attributes differentiate depressed children from those with other psychiatric disorders. The subjects were 108 children from 7 to 17 years of age. Forty-seven children were diagnosed as currently depressed, 30 as having had an episode of major depression within the last year (depressed-resolved), and 31 with diagnoses other than depression (nondepressed). The subjects completed the Piers-Harris Children's Self-Concept Scale, the Children's Hopelessness Scale, the Nowicki-Strickland Children's Locus of Control Scale, the Children's Attributional Styles Questionnaire, and the Children's Depression Inventory. The depressed children endorsed significantly lower self-esteem, more hopelessness, a more externalized locus of control, and a more depressive attributional style than the depressed-resolved or the nondepressed children. Thus, a depressive cognitive style can be documented in clinically depressed young people. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Self-Perceptions of Competence in Children With ADHD and Comparison Children.

The self-perceptions of children with attention-deficit/hyperactivity disorder (ADHD; n=487) were compared with those of children in a local normative comparison group (n=287), relative to teacher- and parent-rated perceptions of their competence. Children were participants in the ongoing follow-up portion of the Multimodal Treatment Study of Children with ADHD. Children with ADHD were much more likely than comparison children to overestimate their competence relative to adult report, regardless of who was used as the criterion rater (teacher, mother, or father). Examination by comorbidity subgroups revealed that children with ADHD inflated their self-perceptions the most in domains of greatest deficit. Gender effects also are reported. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Recent developments in the pharmacotherapy of attention-deficit/hyperactivity disorder (ADHD).

In comparison to other mental health disorders in pediatric populations, there seems to be compelling evidence-based support for both the efficacy of stimulant medication for children and adolescents with attention deficit/hyperactivity disorder (ADHD) and associated symptoms. Tricyclic antidepressants provide an alternative when stimulants are found to be ineffective or associated with too many adverse effects, particularly for children who have comorbid conditions including anxiety and depression. Finally, the alpha-adrenergic agents, although not approved for the management of ADHD, have been widely employed clinically, particularly for the treatment of impulsivity, overactivity, and aggression. Behavior therapy has been demonstrated to be effective for many of the functional impairments associated with ADHD. Research efforts are needed to examine these therapies either alone or in combination on the long-term outcome of children with ADHD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Child effects on communication between parents of youth with and without attention-deficit/hyperactivity disorder.

Numerous studies indicate interparental conflict causes child externalizing behavior. However, far less is known about the inverse relationship. Exploring this gap in the literature has clear implications for parents of children with externalizing disorders (e.g., attention-deficit/hyperactivity disorder [ADHD]). Adapting an experimental child behavior manipulation paradigm (Lang, Pelham, Atkeson, & Murphy, 1999; Pelham et al., 1997, 1998), parent couples of 9- to 12-year-old boys and girls with ADHD (n = 51) and without ADHD (n = 39) were randomly assigned to interact with a “disruptive” or “typical” confederate child. According to parent and observer ratings, parents interacting with disruptive confederates communicated less positively and more negatively with each other during and after the interactions than did parents who interacted with typical confederates. Observational coding also indicated that child effects on negative interparental communication were more noticeable among parents of youth with ADHD, particularly those with comorbid oppositional defiant disorder or conduct disorder, compared with parents of youth without ADHD. These findings extend results of prospective studies highlighting child effects on marital quality. (PsycINFO Database Record (c) 2010 APA, all rights reserved)