Johanna Jacoba Sandra Kooij

PsyQ, psycho-medical programs, the Hague · Expertise Center Adult ADHD

Background Sleep problems are common in adults with ADHD and may be bidirectionally associated with ADHD severity and other psychiatric symptoms. We investigated the prevalence of positive screenings for various sleep disorders, and their association with psychiatric comorbidities in a large sample of adults with ADHD from a specialized outpatient...

Background: ADHD is highly comorbid with Delayed Sleep Phase Syndrome (DSPS). Both are associated with obesity and diabetes, which can be caused by long-term dysregulations of appetite and glucose metabolism. This study explores hormones involved in these processes and the effects of chronotherapeutic interventions in a small sample of adults with...

Background: The diagnostics and treatment of attention-deficit/hyperactivity disorder (ADHD) in women remain insufficient. Fluctuations of reproductive hormones during the premenstrual period, postpartum period, and (peri)menopause are neglected, even though they impact ADHD symptoms and associated mood disorders. Therefore, we created a female-spe...

A comprehensive handbook covering current, controversial, and debated topics in psychiatric practice, aligned to the EPA Scientific Sections. All chapters been written by international experts active within their respective fields and they follow a structured template, covering updates relevant to clinical practice and research, current challenges,...

FASE, https://www.trialregister.nl/, #NTR3831.

Background Several underlying mechanisms potentially account for the link between sleep and attention deficit and hyperactivity disorder (ADHD), including inflammation. However, studies so far have been cross sectional. We investigate (a) the association between early childhood sleep and probable ADHD diagnosis in childhood and (b) whether childhoo...

Delayed sleep phase syndrome (DSPS) is the most common sleep disturbance in adults with attention-deficit/hyperactivity disorder (ADHD). We previously showed that chronotherapy with melatonin effectively advanced the dim-light melatonin onset (DLMO), a biomarker for the internal circadian rhythm, by 1.5 h and reduced ADHD symptoms by 14%. Melatonin...

Attention-Deficit Hyperactivity Disorder (ADHD) is a complex and heterogeneous neurodevelopmental condition for which curative treatments are lacking. Whilst pharmacological treatments are generally effective and safe, there is considerable inter-individual variability among patients regarding treatment response, required dose, and tolerability. Ma...

In this chapter the treatment with stimulant and other medications for ADHD, also in combination with other psychiatric medications, is explained and practical tips for finding the right dosage and timing are offered. Also treatment of the delayed sleep phase with sleep hygiene, melatonin and light therapy in adults with ADHD is described.KeywordsT...

Instruments for screening and diagnostic assessment of ADHD in adults are described.KeywordsDiagnostic instruments for ADHD in adultsScreeningDiagnostic assessment

The screening and diagnostic assessment of ADHD in adults are described, including the impairment resulting from the lifetime symptoms and comorbid psychiatric and physical conditions, in both work and relationships as well as in sexuality and health.KeywordsDiagnostic assessmentScreeningDiagnostic interview DIVA-5DSM-5 criteriaAge of onsetDysfunct...

The psychological treatment is described that is best combined with medical treatment, consisting of psycho education, coaching or cognitive behavior therapy, schema focussed therapy for ADHD, mindfulness, and relationship therapy, with a lot of examples from clinical practice.KeywordsPsycho educationCoachingCBTTipsMotivationAcceptanceSupportStruct...

Background Problems with emotional processing are widely reported in individuals with attention-deficit/hyperactivity disorder (ADHD). Although methylphenidate (MPH) effectively alleviates inattention and hyperactivity symptoms in ADHD, its effects on emotional processing and internalizing symptoms have remained elusive. While we previously found t...

Background: Misconceptions about ADHD stigmatize affected people, reduce credibility of providers, and prevent/delay treatment. To challenge misconceptions, we curated findings with strong evidence base. Methods: We reviewed studies with more than 2,000 participants or meta-analyses from five or more studies or 2,000 or more participants. We exclu...

This is the first study to assess the prevalence of symptoms of premenstrual dysphoric disorder (PMDD), episodes of postpartum depression symptoms (PPD) after first childbirth, and climacteric mood symptoms in Attention-Deficit/Hyperactivity Disorder (ADHD). 209 consecutive women (18–71 years) with ADHD completed the PMDD chapter of the Neuropsychi...

The majority of adults with Attention-Deficit/Hyperactivity Disorder (ADHD) have a delayed circadian rhythm that is a characteristic of Delayed Sleep Phase Syndrome (DSPS). Treatment of DSPS may improve both the circadian rhythm and ADHD symptoms. In this three-armed randomized clinical trial, 51 adults (18–55 y) with ADHD and DSPS received sleep e...

Background Both attention-deficit/hyperactivity disorder (ADHD) and insomnia have been independently related to poorer quality of life (QoL), productivity loss, and increased health care use, although most previous studies did not take the many possible comorbidities into account. Moreover, ADHD and insomnia often co-occur. Symptoms of ADHD and ins...

Objective: To examine the naturalistic response to and cardiovascular side effects of stimulant medication in older adults with ADHD. Methods: Electronic Health Record (EHR) data of adult patients with ADHD (≥55 years) at the specialized PsyQ outpatient clinic for adult ADHD ( n = 113, 55-79 years) were collected. Response, cardiovascular status, s...

Objectives: This study evaluated the psychometrics of the Farsi translation of diagnostic interview for attention-deficit hyperactivity disorder (ADHD) in adults (DIVA-5) based on DSM-5 criteria. Methods: Referrals to a psychiatric outpatient clinic ( N = 120, 61.7% males, mean age 34.35 ± 9.84 years) presenting for an adult ADHD (AADHD) diagnosis,...

Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder characterized by core symptoms of inattention, impulsivity, and hyperactivity. ADHD has been considered for a long time as a childhood condition, fading as children grew up. Instead, ADHD changes its clinical presentation over the lifespan, but persists in most cases i...

Objectives: We evaluated the relationship between leukocyte telomere length (LTL) and sleep duration, insomnia symptoms, and circadian rhythm, to test whether sleep and chronobiological dysregulations are associated with cellular aging. Methods: Data from the Netherlands Study of Depression and Anxiety (N=2,936) were used at two waves six years ap...

The attention-deficit hyperactivity disorder (ADHD) is a neurobiological disorder that starts in childhood and persists in the majority of cases into adulthood. In adults with ADHD, intimate relationships may be problematic. Due to the lifetime symptoms of ADHD like inattentiveness, forgetfulness, mood swings and anger outbursts, as well as sensati...

The aim of this study was to examine whether ADHD is a dimensional trait in the adult general population. We studied whether an increased number of ADHD symptoms was associated with higher comorbidity, exposure to risk factors (childhood abuse and parental psychopathology), and disability. We ascertained whether even low numbers of ADHD symptoms we...

Study objectives: Insomnia and short or long sleep duration are important comorbid conditions in adults with attention-deficit hyperactivity disorder (ADHD), but reports of the association vary. In a general population study, we evaluated the relationship between ADHD symptom severity, insomnia symptoms, and sleep duration in adults. Methods: Da...

Objective: To identify risk factors for adverse driving outcomes and unsafe driving among adults with and without ADHD in a Dutch sample. Methods: In this cross-sectional study, validated self-report questionnaires were used to compare driving history and current driving behavior between 330 adults diagnosed with ADHD and 330 controls. Results:...

Purpose of review: Insomnia is diagnosed when there is dissatisfaction with sleep quantity or quality. It has a prevalence in the general population ranging from 31 to 56%. Insomnia has previously been associated with adult attention-deficit/hyperactivity disorder (ADHD). In this review, we address three topics: (1) the cross-sectional relationshi...

Background We examined whether current overall attention deficit hyperactivity disorder (ADHD), inattention, or hyperactivity symptom severities are associated with the current presence and persistent history of sleep problems. Methods N = 942 participants of the Netherlands Sleep Registry filled out online several validated questionnaires. Regres...

Background: Little is known about the long-term persistence and adherence of psychostimulant use in adults with attention-deficit/hyperactivity disorder (ADHD) and its relationship to their psychological well-being. Methods: The persistence and adherence to psychostimulants and psychological well-being were examined in adults with ADHD in a natu...

Objective Neuropsychological deficits are of major importance in ADHD, yet no previous studies have assessed clinically referred samples of older adults. The authors compared older adults with ADHD (60–75 years) with both younger adults with ADHD (18–45 years) and older healthy controls with regard to various neuropsychological deficits. Methods W...

Objective: The current study examined whether (a) Attention-Deficit/Hyperactivity Disorder (ADHD) symptoms were associated with dysregulation of stress-related mechanisms, and (b) whether ADHD symptoms interact with affective disorders in their association with dysregulated stress-related mechanisms. Methods: Data were obtained from 2307 subject...

Background: Abnormal sensory sensitivity is a feature of autism-spectrum disorder (ASD), but is also reported in attention-deficit/hyperactivity disorder (ADHD). In many cases, ADHD and ASD are comorbid. This study investigated the prevalence of sensory hyper- and hyposensitivity among adults with ADHD, controlling for autistic symptoms. Method:...

Melanopsin-containing retinal ganglion cells play an important role in the non-image forming effects of light, through their direct projections on brain circuits involved in circadian rhythms, mood and alertness. Individual differences in the functionality of the melanopsin-signaling circuitry can be reliably quantified using the maximum post-illum...

Objective: ADHD may predispose to obesity, a metabolic syndrome component. Affective disorders are also associated with MetSyn and ADHD. This study examined whether ADHD confers any added risk of MetSyn and obesity-related associations in a large sample with varying stages of affective disorders. Method: Participants included 2,303 adults from t...

Introduction: ADHD is an often heritable, neurodevelopmental disorder with a prevalence of 4-5% in children and adults and about 3% in older adults. The disorder in older adults (> 55 years) is accompanied by similar comorbidities such as anxiety and depression, and social impairment as in younger age groups. Areas covered: An overview of the li...

Objective: We evaluated whether the association between Adult Attention-Deficit/Hyperactivity Disorder (ADHD) and Seasonal Affective Disorder (SAD) was mediated by the circadian rhythm. Method: Data of 2239 persons from the Netherlands Study of Depression and Anxiety (NESDA) were used. Two groups were compared: with clinically significant ADHD s...

Wywiad Diagnostyczny ADHD u dorosłych (DIVA) wydała DIVA Foundation, Haga, Holandia, sierpień 2010. Prace nad przekładem wersji oryginalnej (autorstwa Doroty Kooij) były możliwe dzięki wsparciu DIVA Foundation. Retranslację (autorstwa Doroty Kuipers) przeprowadzono przy wsparciu Medycyny Praktycznej. Za korektę merytoryczną odpowiadali: lek. Paweł...

Objective: This is the first study to examine self-reported seasonal differences in the severity of ADHD symptoms in adults from the general population. Method: Data were analyzed from N = 5,303 respondents participating in the second wave of the Netherlands Mental Health Survey and Incidence Study-2, a population-based study on mental health. A...

Objective: The aim of this study was to assess for the first time the criterion validity of the semi-structured Diagnostic Interview for ADHD in adults (DIVA 2.0), and its concurrent validity in comparison with the Conners' Adult ADHD Diagnostic Interview for DSM-IV (CAADID) and other ADHD severity scales, following the Diagnostic and Statistical...

Background: Comorbid ADHD symptoms may partly account for circadian rhythm disturbances in depression and anxiety disorders. Methods: Self-reported sleep characteristics of 2090 participants in the Netherlands Study of Depression and Anxiety were assessed using the Munich Chronotype Questionnaire. We defined 3 groups: healthy controls (HC), pers...

Background: Depression and ADHD often co-occur in clinical samples. Depression severity may be linked to ADHD symptomatology. We therefore assessed ADHD symptoms across clinical stages of major depressive disorder (MDD). Methods: We used 4-year follow-up data of the Netherlands Study of Depression and Anxiety (September 2008 until April 2011), i...

Introduction Attention Deficit Hyperactivity Disorder (ADHD) prevalence in the general adult population is estimated to be between 2–4%. Despite the high prevalence, until recently there was only one validated semi-structured interview available for the accurate diagnostic assessment of ADHD within the adult population: the Conners Adult ADHD Diagn...

ADHD bij volwassenen is inmiddels een erkende psychiatrische diagnose in Nederland en Europa. Onlangs is de ‘Richtlijn ADHD bij volwassenen, deel I, Diagnostiek en Medicamenteuze behandeling’ uitgebracht door de Nederlandse Vereniging voor Psychiatrie. ADHD gaat gepaard met veel comorbiditeit, en is vanwege de chroniciteit een complexe stoornis, di...

Objective: Patients with Attention-Deficit/Hyperactivity Disorder (ADHD) have a high prevalence of obesity. This is the first study to investigate whether circadian rhythm disruption is a mechanism linking ADHD symptoms to obesity. Methods: ADHD symptoms and two manifestations of circadian rhythm disruption: sleep problems and an unstable eating pa...

Objective: To explore how ADHD may have affected the lives of older adults who meet the diagnostic criteria of ADHD, but are unaware of their diagnosis. Our second aim was to examine whether the reported symptoms change over the life span. Method: A qualitative study was conducted. Seventeen Dutch older people (>65 years) diagnosed in this study...

Attention-deficit/hyperactivity disorder (ADHD) has been shown to continue into old age. Studies in children and younger adults show a reduction in hyperactive-impulsive symptoms, whereas the number of inattentive symptoms stays stable. The current study examined the lifetime stability of ADHD symptoms up to old age. Data on ADHD diagnosis and symp...

Background: Research illustrates cognitive deficits in children and younger adults with attention-deficit/hyperactivity disorder (ADHD). Few studies have focused on the cognitive functioning in older adults. This study investigates the association between ADHD and cognitive functioning in older adults. Methods: Data were collected in a cross-sec...

Many adult outpatients with attention-deficit/hyperactivity disorder (ADHD) report an oversensitivity to light. We explored the link between ADHD and photophobia in an online survey (N = 494). Self-reported photophobia was prevalent in 69% of respondents with, and in 28% of respondents without, ADHD (symptoms). The ADHD (symptoms) group wore sungla...

Comorbidity between Attention-Deficit/Hyperactivity Disorder (ADHD) and depression is high, also in older adults. Thus far it is not well understood why ADHD and depression are so strongly interrelated. One factor that may play a role in older adults with ADHD is an increased risk of experiencing adverse life events. Six year follow-up data were us...

Purpose To evaluate the QbTest as an objective measure versus self-reported ADHD Rating Scale (ADHD-RS) before and during stimulant treatment in adults with ADHD. Patients and methods We used the subjective ADHD Rating Scale (ADHD-RS), and the objective computerized QbTest, which is a 20-minute unconditional identical pairs test that measures atte...

Adult ADHD: Diagnostic Assessment and Treatment, Third Edition covers not only diagnostic assessment, but also comorbidity patterns as well as differential diagnosis of ADHD with for example bipolar disorder and borderline personality disorder. The symptom overlap and misdiagnosis of chronic fatigue syndrome in girls and women with the inattentive...

Attention deficit/hyperactivity disorder (ADHD) is linked to impaired executive functioning (EF). This is the first study to objectively investigate the effects of a long-acting methylphenidate on neurocognitive test performance of adults with ADHD. Twenty-two adults with ADHD participated in a 6-weeks study examining the effect of osmotic-release...

The authors wanted to examine the association between attention deficit hyperactivity disorder (ADHD) and personality characteristics and the potential mediating role of these characteristics in the relationship between ADHD and depression in older adults in the general Dutch population. Data from the Longitudinal Aging Study Amsterdam in 2008/2009...

Objective: To examine the associations between ADHD and social functioning and participation among older adults. Method: Data were used from the Longitudinal Aging Study Amsterdam (LASA). In 2008/2009, respondents were asked about social functioning and participation. A diagnostic interview to diagnose ADHD was administered among a subsample (N...

Adults with ADHD often have sleep problems that are caused by a delay of their internal circadian rhythm system. Such individuals are often typified as 'evening' or 'night' persons. This review focuses on the link between ADHD symptoms and the evening typology through multiple pathways. Etiology of the internal circadian rhythm system, the genetic...

This chapter guides the reader through the first part of the treatment of ADHD in adults. Treatment always starts with psychoeducation, and the special attitude of the therapist treating patients with ADHD is first discussed. Frequent asked questions and answers about ADHD and the treatment are addressed, as well as different forms of psychoeducati...

In this chapter, one is briefly introduced to some diagnostic tools for screening and diagnostic assessment of ADHD that can also be found in the appendix.

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This chapter describes the development of a comprehensive multimodal treatment program for adult ADHD by a specialized team at PsyQ in the Hague, the Netherlands. The treatment process from diagnostic assessment to discharge and relapse prevention is described, including the responsibilities of the different employees for each part of the process....

Irregular sleep-wake patterns and delayed sleep times are common in adults with attention-deficit/hyperactivity disorder, but mechanisms underlying these problems are unknown. The present case-control study examined whether circadian abnormalities underlie these sleep problems in a naturalistic home setting. We included 12 medication-naïve patients...

To increase insight into the effect of attention-deficit/hyperactivity disorder (ADHD) on health in general in older adults. Two-phase sampling side-study. Longitudinal Aging Study Amsterdam (LASA). Two hundred twenty-three randomly selected LASA respondents. Information was collected during home visits on physical health, medication use, and lifes...

Context ADHD komt bij 3-5 procent van de kinderen en volwassenen voor. Er was tot nu toe weinig bekend over deze stoornis bij ouderen. Uit recent Zweeds en Nederlands bevolkingsonderzoek blijkt ADHD ook bij ouderen voor te komen, in een vergelijkbare prevalentie als bij jongere mensen. Aan de hand van de beschikbare literatuur en een gevalsbeschrij...

Background: Medication non-adherence has an important impact on treatment efficacy and healthcare burden across a range of conditions and therapeutic areas. The aim of this analysis was to determine predictors of non-adherence and impact of non-adherence on treatment response in adults with attention-deficit/hyperactivity disorder (ADHD). Methods...

Objective To identify Attention Deficit Hyperactivity disorder (ADHD) in older adults, a validated screener is needed. This study evaluates the reliability and criterion validity of an ADHD screener for younger adults on its usefulness in a population-based sample of older adults. Methods Data were collected as a side study in the Longitudinal Agi...

In adult ADHD-patients from within and outside of Europe, Conners' Adult Attention-Deficit/Hyperactivity Disorder (ADHD) Rating Scale-Investigator Rated: Screening Version showed good internal consistency (Cronbach's α=0.930 and 0.938, respectively) and convergent validity (Pearson's correlation coefficients: 0.65-0.82, P<0.001) with the Clinical G...

BACKGROUND: Comorbidity between Attention-Deficit/Hyperactivity Disorder (ADHD) and depression and anxiety disorders in children and young to middle-aged adults has been well documented in the literature. Yet, it is still unknown whether this comorbidity persists into later life. The aim of this study is therefore to examine the comorbidity of anxi...

Little is known about the prevalence of attention-deficit hyperactivity disorder (ADHD) among older adults. To estimate the prevalence of the syndromatic and symptomatic DSM-IV ADHD diagnosis in older adults in The Netherlands. Data were used from the Longitudinal Aging Study Amsterdam (LASA). At baseline, 1494 participants were screened with an AD...

The shared genetic basis of attention deficit/hyperactivity disorder (ADHD) and substance use disorders (SUDs) was explored by investigating the association of candidate risk factors in neurotransmitter genes with both disorders. One hundred seven methadone maintenance treatment patients, 36 having an ADHD diagnosis, 176 adult patients with ADHD wi...

Patients with Attention-Deficit/Hyperactivity disorder (ADHD) have higher smoking rates, a younger age of smoking onset, and increased difficulty to stop smoking as compared to controls. Methylphenidate induced acute effects of increased smoking in laboratory studies, but long-term effects are unknown. We studied the acute and long-term relationshi...

Given high rates of comorbidity, lack of awareness and global acceptance, and varying guidelines for its management, adult ADHD may be an especially difficult condition to diagnose and treat. The objective of this review was to explore and characterize similarities and differences among comorbidities associated with adult ADHD. A review of the lite...

To explore the literature focusing on cultural influences in the diagnosis of adult ADHD and respective societal burden. A review of the literature over the past 10 years was performed using OVID. Although numerous articles focused on diagnosis and burden of adult ADHD, few focused on cultural factors influencing diagnosis. Like other mental health...

Two patients with a psychotic disorder who also met the diagnostic criteria for attention deficit hyperactivity disorder ADHD were treated with antipsychotics and methylphenidate. The first patient remained stable for many years with this combination treatment, whereas the second became psychotic several months after he had increased the dose of me...

Introduction ADHD occurs in 3–5% of children and adults. Yet little is known about ADHD in elderly. Objectives To review the literature and to present first Dutch epidemiological data on ADHD in elderly (VUmc/LASA and PsyQ). Aims The study aims to estimate the prevalence of ADHD in eldery and to correlate symptoms of ADHD with comorbidity pattern...

The majority of the adults with ADHD have chronic difficulty to go to bed on time. This leads to a shorter sleep duration and daytime sleepiness that may aggravate the inattention problems of ADHD. This sleep pattern is also known as a delayed sleepphase, and the patients as ‘eveningtypes’. The other way round, eveningtypes have been associated wit...

Objective: The authors explored associations between ADHD symptoms, seasonal depressive symptoms, lifestyle, and health. Method: Adult ADHD patients (n = 202) and controls (n = 189) completed the ASESA questionnaire involving lifestyle, eating pattern, and physical and psychological health, and validated measures on ADHD and sleep. ASESA is the...

Objectives. Methylphenidate (MPH) is effective for adults with attention-deficit/hyperactivity disorder (ADHD). This study aimed to evaluate the efficacy and safety of OROS MPH in adults with ADHD. Methods. Randomized, double-blind study; 279 subjects received OROS MPH 54 or 72 mg/day, or placebo, for 13 weeks. Primary endpoint was the Conners' Adu...

Several linkage analyses implicated the chromosome 9q22 region in attention deficit/hyperactivity disorder (ADHD), a neurodevelopmental disease with remarkable persistence into adulthood. This locus contains the brain-expressed GTP-binding RAS-like 2 gene (DIRAS2) thought to regulate neurogenesis. As DIRAS2 is a positional and functional ADHD candi...

Attention-deficit hyperactivity disorder (ADHD) is a common behavioral disorder affecting about 4-8% of children. ADHD persists into adulthood in around 65% of cases, either as the full condition or in partial remission with persistence of symptoms. Pharmacological, animal and molecular genetic studies support a role for genes of the dopaminergic s...

Data on the relationship between core symptoms and daily functioning in adults with attention deficit hyperactivity disorder (ADHD) are limited. Daily functioning was assessed as part of an open-label extension, and associations with symptom scores were evaluated. After a 5-week double-blind study with adults with ADHD receiving osmotic-controlled...

Once the diagnosis has been established, ADHD in adults is treated most effectively with a combined approach consisting of psychoeducation, medication, coaching, and cognitive behavioral therapy (Kooij, 2003; Safren et al., 2005; Solanto et al., 2007; Weiss et al., 2001). This chapter offers a practical guide to the medication management of ADHD in...

Objective The scope of this presentation is to investigate the possible relationship between a delayed sleep phase and the timing of other activities, like meals and other disturbances of eating habits. Methods The literature will be reviewed and preliminary data from own research regarding these associations will be presented. Results The delaye...

We conducted a post-hoc analysis of the Long-Acting MethylpheniDate in Adult attention-deficit hyperactivity disorder (LAMDA) study to investigate predictors of response in adults with ADHD randomly assigned to Osmotic Release Oral System (OROS)(®)-methylphenidate hydrochloride (MPH) 18, 36 or 72 mg or placebo. LAMDA comprised a 5-week, double-blin...

Declarative memory deficits are common in untreated adults with attention-deficit hyperactivity disorder (ADHD), but limited evidence exists to support improvement after treatment with methylphenidate. The objective of this study was to examine the effects of methylphenidate on memory functioning of adults with ADHD. Eighteen adults with ADHD who w...

The tryptophan hydroxylase 1 and 2 (TPH1 and TPH2) genes encode the rate-limiting enzymes in the serotonin biosynthesis. Genetic variants in both genes have been implicated in several psychiatric disorders. For attention-deficit/hyperactivity disorder (ADHD) in children, the results are conflicting, and little is known about their role in adult ADH...

Attention deficit hyperactivity disorder (ADHD) is a common behavioral disorder affecting children and adults. It has been suggested that gene variants related to serotonin neurotransmission are associated with ADHD. We tested the functional promoter polymorphism 5-HTTLPR and seven single nucleotide polymorphisms in SLC6A4 for association with ADHD...

Forty-nine carefully diagnosed adults with persistent attention deficit/hyperactivity disorder (ADHD), who had never been medicated for their ADHD, were compared with 49 normal control adults matched for age and gender on a large battery of tests in five domains of executive functioning (inhibition, fluency, planning, working memory, and set shifti...