Are cognitive deficits in attention deficit/hyperactivity disorder related to the course of the disorder? A prospective controlled follow-up study of grown up boys with persistent and remitting course

Massachusetts General Hospital, Pediatric Psychopharmacology, Boston, MA, USA.
Psychiatry Research (Impact Factor: 2.47). 11/2009; 170(2-3):177-82. DOI: 10.1016/j.psychres.2008.09.010
Source: PubMed


To investigate the longitudinal course of cognitive functions in boys with persistent and remittent attention deficit/hyperactivity disorder (ADHD) from childhood into young adult years. Males (n=217) 15-31 years with and without ADHD were assessed at 3 time points over 10 years into young adulthood. Subjects were stratified into Remittent ADHD, and Persistent ADHD based on the course of ADHD. Cognitive domains included: 1) overall IQ (overall IQ, block design IQ, vocabulary IQ); 2) achievement scores in reading and math and measures of executive function (Wechsler arithmetic, digit span, digit symbol, Rey-Osterrieth, Wisconsin Card Sorting Test, and the Stroop Test). Cognitive outcomes were modeled as a function of group (Controls, Remittent ADHD, and Persistent ADHD), age, group by age interaction, and any demographic confounders using linear growth-curve models. There were no significant interaction effects of group by time. Main group effects indicated that persistent and remittent ADHD groups both had significantly lower scores on all cognitive outcomes compared with controls, and these did not differ between the ADHD subgroups Psychometrically defined cognitive deficits are relatively stable into young adult years and appear to be independent of the course of ADHD. More work is needed to help define the implications of these deficits in individuals with a remitting course of ADHD.

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Available from: Sarah W Ball, Oct 02, 2015
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    • "Indeed, better performance on working memory, inhibition, and, sustained attention tasks has been reported in remittent compared to persistent ADHD (Bedard et al., 2010; Fischer, Barkley, Smallish, & Fletcher, 2005; Halperin et al., 2008). However, other studies were unable to document improvements in performance of executive function tasks (Biederman et al., 2009; Mick et al., 2011; van Lieshout et al., 2013). Measures of brain structure and function might augment our insight into the mechanisms underlying remission of ADHD by revealing normalization of brain function or by revealing compensatory changes (Fassbender & Schweitzer, 2006; Giedd & Rapoport, 2010; Rubia, 2002; Shaw, Gogtay, & Rapoport, 2010). "
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    ABSTRACT: Background: One neurodevelopmental theory hypothesizes remission of attention-deficit/hyperactivity disorder (ADHD) to result from improved prefrontal top-down control, while ADHD, independent of the current diagnosis, is characterized by stable non-cortical deficits (Halperin & Schulz, 2006). We tested this theory using resting state functional MRI (fMRI) data in a large sample of adolescents with remitting ADHD, persistent ADHD, and healthy controls. Methods: Participants in this follow-up study were 100 healthy controls and 129 adolescents with ADHD combined type at baseline (mean age at baseline 11.8 years; at follow-up 17.5 years). Diagnostic information was collected twice and augmented with magnetic resonance imaging (MRI) scanning at follow-up. We used resting state functional connectivity (RSFC) of the executive control network to investigate whether improved prefrontal top-down control was related to a developmental decrease in ADHD symptoms. In addition, we tested whether non-cortical RSFC, i.e., cerebellar and striatal RSFC, was aberrant in persistent and/or remittent ADHD compared to controls. Results: Higher connectivity within frontal regions (anterior cingulate cortex) of the executive control network was related to decreases in ADHD symptoms. This association was driven by change in hyperactive/impulsive symptoms and not by change in inattention. Participants with remitting ADHD showed stronger RSFC than controls within this network, while persistent ADHD cases exhibited RSFC strengths intermediate to remittent ADHD cases and controls. Cerebellar and subcortical RSFC did not differ between participants with ADHD and controls. Conclusions: In line with the neurodevelopmental theory, symptom recovery in ADHD was related to stronger integration of prefrontal regions in the executive control network. The pattern of RSFC strength across remittent ADHD, persistent ADHD, and healthy controls potentially reflects the presence of compensatory neural mechanisms that aid symptomatic remission.
    Cortex 09/2015; 73:62-72. DOI:10.1016/j.cortex.2015.08.012 · 5.13 Impact Factor
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    • "In addition, while the general role of neuropsychological tests in the diagnosis of ADHD is in question [28], executive deficits of ADHD patients measured by them are relatively stable from childhood on into young adulthood. These deficits appear to be independent of the remission of symptoms of inattention or hypercativity/impulsivity [29]. Thus, a possible relationship between executive functioning of adults with ADHD and Fi persisting into adulthood is conceivable. "
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    ABSTRACT: Background: While the number of symptoms of attention-deficit hyperactivity disorder (ADHD) decreases with age, a high proportion of adults with ADHD symptoms suffer from persistent functional impairment (Fi) linked to these symptoms. Our objective was to investigate the specific roles of two potentially important predictors of this Fi: the clinical symptom presentation and the deficit in executive functions (EFs). Methods: A total of 158 subjects from a community sample positively screened for ADHD were classified into two groups: those with and without Fi. Following a detailed diagnostic process, participants were administered a self-rating scale for ADHD symptoms as well as a neuropsychological test battery containing tests of EF and attention relevant as potential cognitive endophenotypes for ADHD. Results: The overall number as well as the number of inattentive, hyperactive and impulsive symptoms, confirmed both by examiner and self-report, were significantly higher among Fi subjects. The highest odds ratio for Fi was associated with impulsive symptoms. Additionally, self-reported complaints of problems with self-concept were significantly higher among Fi subjects. No significant relationship between Fi and neuropsychological measures of EF and attention was detected. Conclusions: This study revealed that the number of symptoms, in particular that of impulsivity, had a significant impact on Fi in adults with symptoms of ADHD. Furthermore, our results underline the importance of assessing complaints and behaviors related to self-concept, which are not included in DSM-IV diagnostic criteria of ADHD but nonetheless may be associated with functional outcome of the disorder.
    Comprehensive psychiatry 05/2013; 54(7). DOI:10.1016/j.comppsych.2013.04.002 · 2.25 Impact Factor
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    • "Another recent study that provides developmental insight into the association between ADHD and cognitive functioning prospectively followed boys with persistent ADHD, remittent ADHD, and without ADHD over ten years, and collected data at three points in time about IQ, achievement scores in reading and mathematics, and measures of executive function (Biederman et al., 2009). No group by time interaction effects was observed. "
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    ABSTRACT: This article provides an introduction to the October 2011 special issue of the Journal of School Health on "Healthier Students Are Better Learners." Literature was reviewed and synthesized to identify health problems affecting school-aged youth that are highly prevalent, disproportionately affect urban minority youth, directly and indirectly causally affect academic achievement, and can be feasibly and effectively addressed through school health programs and services. Based on these criteria, 7 educationally relevant health disparities were selected as strategic priorities to help close the achievement gap: (1) vision, (2) asthma, (3) teen pregnancy, (4) aggression and violence, (5) physical activity, (6) breakfast, and (7) inattention and hyperactivity. Research clearly shows that these health problems influence students' motivation and ability to learn. Disparities among urban minority youth are outlined, along with the causal pathways through which each adversely affects academic achievement, including sensory perceptions, cognition, school connectedness, absenteeism, and dropping out. Evidence-based approaches that schools can implement to address these problems are presented. These health problems and the causal pathways they influence have interactive and a synergistic effect, which is why they must be addressed collectively using a coordinated approach. No matter how well teachers are prepared to teach, no matter what accountability measures are put in place, no matter what governing structures are established for schools, educational progress will be profoundly limited if students are not motivated and able to learn. Particular health problems play a major role in limiting the motivation and ability to learn of urban minority youth. This is why reducing these disparities through a coordinated approach warrants validation as a cohesive school improvement initiative to close the achievement gap. Local, state, and national policies for implementing this recommendation are suggested.
    Journal of School Health 10/2011; 81(10):593-8. DOI:10.1111/j.1746-1561.2011.00632.x · 1.43 Impact Factor
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