Executive Function in Pediatric Bipolar Disorder and Attention-Deficit Hyperactivity Disorder: In Search of Distinct Phenotypic Profiles

Department of Psychiatry and Biobehavioral Science, University of California Los Angeles, Los Angeles, CA, USA.
Neuropsychology Review (Impact Factor: 4.59). 02/2010; 20(1):103-20. DOI: 10.1007/s11065-009-9126-x
Source: PubMed


Often, there is diagnostic confusion between bipolar disorder (BD) and attention-deficit hyperactivity disorder (ADHD) in youth due to similar behavioral presentations. Both disorders have been implicated as having abnormal functioning in the prefrontal cortex; however, there may be subtle differences in the manner in which the prefrontal cortex functions in each disorder that could assist in their differentiation. Executive function is a construct thought to be a behavioral analogy to prefrontal cortex functioning. We provide a qualitative review of the literature on performance on executive function tasks for BD and ADHD in order to determine differences in task performance and neurocognitive profile. Our review found primary differences in executive function in the areas of interference control, working memory, planning, cognitive flexibility, and fluency. These differences may begin to establish a pediatric BD profile that provides a more objective means of differential diagnosis between BD and ADHD when they are not reliably distinguished by clinical diagnostic methods.

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    • "With the exception of one inquiry (Udal et al., 2012), comparative studies (PBD vs. ADHD) tend to show no significant differences between either group on executive functions such as response inhibition (Rucklidge, 2006; Passarotti et al., 2010c), working memory (McCarthy et al., 2004; Passarotti et al., 2010a; Passarotti et al., 2010b), and cognitive flexibility (Rucklidge, 2006; Udal et al., 2013). These findings contradict previous researches that had relied on independent studies of both disorders instead of direct comparative studies (Walshaw et al., 2010). Similarly, studies geared at investigating verbal memory differences point out that deficits identified in PBD adolescents resemble those encountered in ADHD youth (Rucklidge, 2006; Udal et al., 2012). "
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    ABSTRACT: Background Pediatric bipolar disorder (PBD) has emerged as a field of research in which neuropsychological studies are continuously providing new empirical findings. Despite this, a comprehensive framework for neurocognitive impairments is still lacking, and most of the evidence remains unconnected. We addressed this question through a systematic review of neuropsychological research, with the aim of elucidating the main issues concerning this topic. Method A comprehensive search of databases (PubMed, PsycINFO) was performed. Published manuscripts between 1990 and January 2014 were identified. Overall, 124 studies fulfilled inclusion criteria. Methodological differences between studies required a descriptive review of findings. Results Evidence indicates that verbal/visual-spatial memory, processing speed, working memory, and social cognition are neurocognitive domains impaired in PBD youth. Furthermore, these deficits are greater among those who suffer acute affective symptoms, PBD type I, and/or attention deficit hyperactivity disorder (ADHD) comorbidity. In addition, several neurocognitive deficits imply certain changes in prefrontal cortex activity and are somewhat associated with psychosocial and academic disabilities. Strikingly, these deficits are consistently similar to those encountered in ADHD as well as severe mood dysregulation (SMD). Besides, some neurocognitive impairments appear before the onset of the illness and tend to maintain stable across adolescence. Finally, any therapy has not yet demonstrated to be effective on diminishing these neurocognitive impairments. Limitations More prolonged follow-up studies aimed at delineating the course of treatment and the response to it are warranted. Conclusions Despite noteworthy research on the neurocognitive profile of PBD, our knowledge is still lagging behind evidence from adult counterparts.
    Journal of Affective Disorders 09/2014; 166:297–306. DOI:10.1016/j.jad.2014.05.025 · 3.38 Impact Factor
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    • "These tests show excellent face validity based on well-established paradigms and demonstrate evidence of construct validity. We also provide additional evidence in showing that the association between both RT and inhibition with the attention symptoms is consistent with the literature (Walshaw et al. 2010). This approach is the same used in other domains of psychological testing (Block et al. 1974; Reynolds and Koback 1995), and while we show somewhat more moderate effect sizes than these psychometrically built instruments, our procedures are identical to other computerized test development. "
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    ABSTRACT: Understanding the relationship between brain and complex latent behavioral constructs like cognitive control will require an inordinate amount of data. Internet-based methods can rapidly and efficiently refine behavioral measures in very large samples that are needed for genetics and behavioral research. Cognitive control is a multifactorial latent construct that is considered to be an endophenotype in numerous neuropsychiatric disorders, including attention deficit/hyperactivity disorder (ADHD). While previous studies have demonstrated high correlations between Web- and lab-based scores, skepticism remains for its broad implementation. Here, we promote a different approach by characterizing a completely Web-recruited and tested community family sample on measures of cognitive control. We examine the prevalence of attention deficit symptoms in an online community sample of adolescents, demonstrate familial correlations in cognitive control measures, and use construct validation techniques to validate our high-throughput assessment approach. A total of 1214 participants performed Web-based tests of cognitive control with over 200 parent–child pairs analyzed as part of the primary study aims. The data show a wide range of “subclinical” symptomatology in a web community sample of adolescents that supports a dimensional view of attention and also provide preliminary narrow-sense heritability estimates for commonly used working memory and response inhibition tests. Finally, we show strong face and construct validity for these measures of cognitive control that generally exceeds the evidence required of new lab-based measures. We discuss these results and how broad implementation of this platform may allow us to uncover important brain–behavior relationships quickly and efficiently.
    Brain and Behavior 09/2013; 3(5):552-61. DOI:10.1002/brb3.158 · 2.24 Impact Factor
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    • "There is emerging evidence that SC and BD might share genetic susceptibility [49], [50]. Furthermore, these conditions have similar ages of onset, sex distributions, and prevalence [51]. "
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    ABSTRACT: Background The ability to integrate contextual information with social cues to generate social meaning is a key aspect of social cognition. It is widely accepted that patients with schizophrenia and bipolar disorders have deficits in social cognition; however, previous studies on these disorders did not use tasks that replicate everyday situations. Methodology/Principal Findings This study evaluates the performance of patients with schizophrenia and bipolar disorders on social cognition tasks (emotional processing, empathy, and social norms knowledge) that incorporate different levels of contextual dependence and involvement of real-life scenarios. Furthermore, we explored the association between social cognition measures, clinical symptoms and executive functions. Using a logistic regression analysis, we explored whether the involvement of more basic skills in emotional processing predicted performance on empathy tasks. The results showed that both patient groups exhibited deficits in social cognition tasks with greater context sensitivity and involvement of real-life scenarios. These deficits were more severe in schizophrenic than in bipolar patients. Patients did not differ from controls in tasks involving explicit knowledge. Moreover, schizophrenic patients’ depression levels were negatively correlated with performance on empathy tasks. Conclusions/Significance Overall performance on emotion recognition predicted performance on intentionality attribution during the more ambiguous situations of the empathy task. These results suggest that social cognition deficits could be related to a general impairment in the capacity to implicitly integrate contextual cues. Important implications for the assessment and treatment of individuals with schizophrenia and bipolar disorders, as well as for neurocognitive models of these pathologies are discussed.
    PLoS ONE 03/2013; 8(3):e57664. DOI:10.1371/journal.pone.0057664 · 3.23 Impact Factor
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