A prospective four-year follow-up study of children at risk for ADHD: psychiatric, neuropsychological, and psychosocial outcome

BACKGROUND: Attention-deficit hyperactivity disorder (ADHD) is a familial disorder that places the siblings of ADHD children at high risk for ADHD, conduct, mood, and anxiety disorders. Although the pattern of psychiatric risk has been well documented by prior family studies, neither the short- nor long-term outcome of these high-risk siblings has been prospectively examined. OBJECTIVE: To document the 4-year psychiatric, psychosocial, and neuropsychological outcome of the siblings of children with ADHD. METHOD: DSM-III-R structured diagnostic interviews and blind raters were used to conduct a 4-year follow-up of siblings from ADHD and control families. The siblings were also evaluated for cognitive, achievement, social, school, and family functioning. RESULTS: At follow-up, significant elevations of behavioral, mood, and anxiety disorders were found among the siblings of ADHD children. The high-risk siblings had high rates of school failure and showed evidence of neuropsychological and psychosocial dysfunction. These impairments aggregated among the siblings who had ADHD. CONCLUSIONS: The siblings of ADHD children are at high risk for clinically meaningful levels of psychopathology and functional impairment. In addition to supporting hypotheses about the familial transmission of ADHD, the results suggest that the high-risk siblings might be appropriate targets for primary preventive interventions.     

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.     

Diagnostic validity of the Luria-Nebraska Neuropsychological Battery—Children's Revision.

Compared the diagnostic validity of the Luria-Nebraska Neuropsychological Battery—Children's Revision (LNNB—C) and the Wechsler Intelligence Scale for Children—Revised (WISC—R) for 96 8–12 yr olds in 1 of 3 diagnostic groups: neurological, psychiatric, and normal controls. Interrater reliability was demonstrated. Separate stepwise discriminant analyses using 6 variables (subtest scores) selected by each test correctly classified 81% (LNNB—C) and 85% (WISC—R) of the psychiatric and neurological groups. No clear incremental validity for the use of the LNNB—C over the WISC—R was demonstrated. (23 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Nuances of assessment and treatment of ADHD in adults: A guide for psychologists.

Symptoms of childhood attention-deficit/hyperactivity disorder (ADHD) can persist into adulthood, although the majority of adults remain undiagnosed and untreated. Untreated ADHD can adversely affect school and work achievements, diminish self-confidence, damage interpersonal relationships, and significantly reduce quality of life. Psychologists can contribute significantly to meeting the need for diagnosis and treatment of adults with ADHD. Diagnosis is complicated; current guidelines were originally developed for diagnosing children, and symptoms are expressed differently in adults. In addition, many adults with ADHD have comorbid psychiatric disorders with overlapping symptoms. Correctly diagnosing ADHD requires a multifaceted approach to determine the chronicity, pervasiveness, and impairment critical to diagnosis. Psychologists can also focus therapy on changing environmental conditions, both internally and externally. A “difference” model, rather than a “defect” model, may empower participation in treatment medically and behaviorally. Collaboration with physicians to monitor responses to medicine—positive and adverse—during pharmacotherapy can improve the success of and adherence to treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relationships between Wechsler Scales and Quick Test IQs among disability applicants.

Relationships, including age, race, sex, and IQ level, between the Wechsler intelligence scales for children and adults (WISC, WISC—R, WAIS, WAIS—R) and the Quick Test (QT) were studied among 280 applicants for disability benefits in a private practice setting. Results were as follows: (a) The QT was more strongly related to the WAIS/WAIS—R than to the WISC—R; (2) although correlations between QT and the WAIS were higher for Blacks than for Whites, this bias disappeared with the WAIS—R; (3) the QT correlated slightly more highly for female subjects with the WAIS—R than for male subjects; and (d) all correlations between the QT and the WAIS—R were consistently higher than correlations between the QT and the WAIS. We conclude that the QT underestimates the WISC—R IQs by an average of 5 IQ points but provides a good approximation of WAIS—R IQs both for Blacks and Whites and for male and female subjects. This study also demonstrates that psychologists in private practice settings can use the product of their day-to-day work to investigate important questions that require empirical answers, which, in turn, can influence clinical practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relative usefulness of elevation, variability, and shape information from WISC—R, K-ABC, and Fourth Edition Stanford-Binet profiles in predicting achievement.

Scatter analysis of IQ profiles has a long and controversial history. The study was conducted to determine whether the validity of scatter information is any greater for 2 new IQ batteries, the Kaufman Assessment Battery for Children (K-ABC) and the Fourth Edition Stanford-Binet Intelligence Scale (SB4), than for the Wechsler Intelligence Scale for Children—Revised (WISC—R). Within a sample of referred children, numerical indexes were computed of profile elevation, shape, and variability for all IQ tests. Using hierarchical multiple regression with achievement scores as dependent variables, shape information was found that had marginal incremental validity over elevation as a predictor for the WISC—R, even less for the SB4, and virtually none for the K-ABC. Implications of these results are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Distinguishing anxiety and depression: Reexamination of the reconstructed Hamilton scales.

The discriminant validities of the original and the reconstructed Hamilton anxiety and depression scales (J. H. Riskind et al, 1987) were compared in patients who had principal Diagnostic and Statistical Manual of Mental Disorders-III—Revised (DSM-III—R) anxiety disorders with or without 1 or more comorbid mood disorders. The reconstructed anxiety and depression scales had better discriminant validity (scale intercorrelation?=?.61) than the original scales did (r?=?.78). However, the reconstructed scales shared considerable variance (about 37%), which was significantly higher than the shared variance (about 2%) reported by Riskind et al. Discriminant analyses showed that the reconstructed scales did not distinguish anxiety patients with comorbid mood disorders from those without comorbid mood disorders better than the original scales did. However, the reconstructed scales eliminate item overlap, an obvious source of artifactual correlations between scores on the Hamilton anxiety and depression scales. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

WISC-IV profiles in children with traumatic brain injury: Similarities to and differences from the WISC-III.

The Wechsler Intelligence Scale for Children—Fourth Edition (WISC–IV; D. Wechsler, 2003a) is often utilized to assess children with traumatic brain injury (TBI), although little information is available regarding its psychometric properties in these children. The current study examined WISC–IV performance in a sample of 61 children with TBI. As compared to the standardization sample, results indicated that the TBI group exhibited relative deficits on all subtest and index scores, with the greatest deficits on the Processing Speed Index (PSI) and Coding subtest scores. However, the Perceptual Reasoning Index score was not uniquely sensitive to brain injury, and the Cognitive Processing Index score was less sensitive to TBI than the PSI score. Also, the PSI did not uniquely predict learning and memory abilities, as had been reported in previous studies of the Wechsler Intelligence Scale for Children—Third Edition (WISC–III; D. Wechsler, 1991). The present findings indicate substantive differences between the WISC–III and WISC–IV profiles of children with TBI. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Luria-Nebraska Neuropsychological Battery—Children's Revision: Concurrent validity with three learning disability subtypes.

Concurrent validity of the Luria-Nebraska Psychological Battery—Children's Revision (LNNB—C) was studied in 82 learning disabled children who were divided into three groups according to Verbal and Performance IQ differences on the Wechsler Intelligence Scale for Children—Revised (WISC—R). The three groups, comparable in age and on WISC—R Full-Scale IQ scores, were designated auditory-linguistic (Verbal IQ?     

Learning disabilities and executive dysfunction in boys with attention-deficit/hyperactivity disorder.

The effect of comorbid reading or arithmetic learning disabilities (LDs) on neuropsychological function in attention-deficit/hyperactivity disorder (ADHD) was studied. Participants were young males diagnosed with ADHD, with and without LD, and non-ADHD, non-LD male controls of similar age. LD was defined by combined regression-based and low-achievement classifications. Analyses adjusted for the effect of psychiatric comorbidity, age, and socioeconomic status on neuropsychological function. Children who had both ADHD and LD were significantly more impaired on both executive and nonexecutive functions than ADHD children without LD. Neuropsychological performance was most impaired in ADHD with combined arithmetic and reading disability. These data indicate that comorbid LD, especially arithmetic disability, significantly increases the severity of executive function impairment in ADHD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Neuropsychological functioning in nonreferred siblings of children with attention deficit/hyperactivity disorder.

The goal of this study was to assess neuropsychological functioning in nonreferred siblings of children with attention deficit/hyperactivity disorder (ADHD). Participants were 156 siblings of ADHD probands with (N?=?40) and without (N?=?116) ADHD (according to criteria of the Diagnostic and Statistical Manual of Mental Disorders [3rd edition, revised; American Psychiatric Association, 1987]) and 118 siblings of non-ADHD normal controls of similar age, IQ, and grade level. Information on attention, executive, and memory functions was obtained in a standardized manner without knowledge of clinical status. Compared with siblings of controls, siblings with ADHD were significantly impaired on the Stroop test and on verbal learning and memory. In contrast, siblings without ADHD were similar to controls on virtually all measures. These data suggest that some executive, attention, and verbal learning deficits are found in nonreferred individuals with ADHD but that neuropsychological deficits are unlikely to constitute an endophenotype to ADHD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Gender differences in the learning status of diabetic children.

Evaluated the learning status of 95 diabetic boys and girls and 97 matched controls using the Wechsler Adult Intelligence Scale—Revised (WAIS—R) IQ factors and school histories. Of interest was whether diabetic boys would evidence more learning difficulties. Results indicated that diabetic boys had significantly lower Freedom From Distractibility scores compared with the scores of diabetic girls and control Ss and lower Perceptual Organization scores compared with scores of control boys. Although group scores were still within the average range of functioning, a significantly high percentage of diabetic boys (40%) compared with diabetic girls (16%) had learning problems that warranted either special instructional services or grade retention. Diabetic children experienced more learning difficulties (24%) than controls (13%), supporting research findings that diabetes is associated with increased risk of learning problems. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Performance of children with ADHD on the Rey-Osterrieth complex figure: a pilot neuropsychological study

This study evaluates the performance of boys with Attention Deficit Hyperactivity Disorder (ADHD) on the Rey-Osterrieth Complex Figure (ROCF) taking into consideration familiality and comorbid psychiatric and learning disorders (LD). Sixty-five children with ADHD performed at developmentally lower levels of Copy Organization and Recall Style than did 45 controls. ADHD children with LD scored significantly lower on Copy Organization than did ADHD children without LD, whereas psychiatric comorbidity and familiality had no effect. These results suggest that a developmental analysis of the ROCF identifies organizational difficulties associated with ADHD and that these impairments cannot simply be attributed to comorbidities associated with ADHD.     

Axis I and II comorbidity in adults with ADHD.

Ongoing debate over the validity of the attention-deficit/hyperactivity disorder (ADHD) construct in adulthood is fueled in part by uncertainty regarding implications of potentially extensive yet incompletely described comorbid Axis I and II psychopathology. Three hundred sixty-three adults ages 18 to 37 completed semistructured clinical interviews; informants were also interviewed, and best estimate diagnoses were obtained. Results were as follows: First, ADHD combined type (ADHD-C) had an excess of externalizing and internalizing Axis I disorders, suggesting a gradient-of-severity relationship between it and ADHD inattentive type (ADHD-I). Second, ADHD-C and ADHD-I did not differ in frequency of Axis II disorders. Third, however, ADHD overall was associated with increased rates of Axis II disorders, compared with rates in non-ADHD control participants, including both Cluster B (primarily borderline personality disorder) and Cluster C disorders. Fourth, ADHD incrementally accounted for clinician-rated global assessment of functioning scores above and beyond comorbid conditions or symptoms on either Axis I or Axis II. Results further inform nosology of ADHD in adults. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Identifying a distinctive familial frequency band in reaction time fluctuations in ADHD.

Objective: Patients with ADHD are typically more variable in their reaction times (RT) than control children. Signal processing analyses have shown that time series RT data of children with ADHD have a distinctive low frequency periodic structure suggestive of a pattern of occasional spontaneous performance lapses. Here we use a fine-grained analysis of spectral power across a broader frequency range to differentiate the periodic qualities of ADHD time series RT data from (a) 1/frequency noise, and (b) control performance. We also assess the familiality of these frequencies by using a proband-sibling design. Method: Seventy-one children with ADHD, one of their siblings, and 50 control participants completed a simple RT task. Power across the RT frequency spectrum was calculated. The frequencies significantly differentiating the two groups were identified. Familiality was assessed in two ways: first, by comparing probands with their unaffected siblings and controls, and, second, by investigating the siblings of neuropsychologically impaired and unimpaired children with ADHD. Results: Analyses converged to highlight the potential importance of the .20–.26 Hz band in differentiating the periodic structure of ADHD RT time series data from both 1/frequency noise and control performance. This frequency band also showed the strongest evidence of familiality. Conclusions: RT performance of children with ADHD had a distinctive periodic structure. The band identified as most differentiating and familial was at a higher frequency than in most previous reports. This highlights the importance of employing tasks with faster interstimulus intervals that will allow a larger portion of the frequency spectrum to be examined. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Factor analysis of WISC—R with deaf and hard-of-hearing children.

The Wechsler Intelligence Scale for Children—Revised (WISC—R) was factor analyzed on a sample of 368 hard-of-hearing and deaf children (aged 6–16 yrs). Two factors emerged and were labeled Language Comprehension and Visual-Spatial Organization. The factor structure for the hard-of-hearing (n?=?77) and deaf (n?=?291) groups was identical. Deaf children of deaf parents earned significantly higher Verbal IQ and Performance IQ scores than did deaf children of hearing parents. There were no differences in IQ or subtest scores in interpreted vs signed administrations. Implications for assessing the cognitive abilities of hearing-impaired children are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Corpus callosum morphology in children and adolescents with attention deficit hyperactivity disorder: A meta-analytic review.

Several studies have examined corpus callosum (CC) morphology in children and adolescents with attention deficit hyperactivity disorder (ADHD). A meta-analysis of atypical brain morphology in children and adolescents with ADHD by Valera, Faraone, Murray, and Seidman (2006) reported a reduction in the splenium of the CC in this group compared with healthy controls. This meta-analysis undertook a more detailed examination of callosal morphology by also considering comorbid conditions and gender differences. The data from 13 studies were analyzed. Consistent with Valera et al. (2006), the splenium was smaller in children and adolescents with ADHD than in healthy controls. However, this result appears to be the result of a smaller splenium in females with ADHD. In addition, boys exhibited a smaller rostral body. There were no significant differences in CC measurements of studies that included ADHD samples with comorbid conditions. However, comorbidities were not consistently reported, making it difficult to accurately evaluate the impact of comorbidity on CC size. Additional research is needed to investigate whether gender differences reflect different ADHD subtypes. In addition, it is not known if these CC differences persist into adulthood. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Anxious children in adulthood: a prospective study of adjustment

OBJECTIVE: To prospectively examine psychosocial functioning in young adulthood for children and adolescents with anxiety disorders. METHOD: This 8-year prospective study compared psychosocial functioning in young adults (mean age 22 years) who had histories of early-onset anxiety disorders, comorbid anxiety and depressive disorders, or no history of psychiatric illness (NPI). Follow-up interviews assessed subjects' residential, educational, occupational, and marital status; utilization of mental health services; and psychological status RESULTS: Anxious subjects without histories of depression were less likely than NPI controls to be living independently. Anxious-depressed subjects were less likely than controls to be working or in school; more likely than purely anxious subjects to utilize mental health services; and more likely than both anxious and control subjects to report psychological problems, most frequently depression. CONCLUSIONS: Overall, results suggest that children with anxiety disorders are relatively well adjusted in young adulthood. However, a history of comorbid depression is prognostic of a more negative outcome.     

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)     

Delay and reward choice in ADHD: An experimental test of the role of delay aversion.

Children with attention deficit/hyperactivity disorder (ADHD) choose smaller sooner (SS) over larger later (LL) rewards more than controls. Here we assess the contributions of impulsive drive for immediate rewards (IDIR) and delay aversion (DAv) to this pattern. We also explore the characteristics of, and the degree of familiality in, ADHD SS responders. We had 360 ADHD probands; 349 siblings and 112 controls (aged between 6 to 17 years) chose between SS (1 point after 2 s) and LL reward (2 points after 30 s) outcomes on the Maudsley Index of Delay Aversion (Kuntsi, Oosterlaan, & Stevenson, 2001): Under one condition SS choice led to less overall trial delay under another it did not. ADHD participants chose SS more than controls under both conditions. This effect was larger when SS choice reduced trial delay. ADHD SS responders were younger, had lower IQ, more conduct disorder and had siblings who were more likely to be SS responders themselves. The results support a dual component model in which both IDIR and DAv contribute to SS choice in ADHD. SS choice may be a marker of an ADHD motivational subtype. (PsycINFO Database Record (c) 2010 APA, all rights reserved)