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Neuropsychological and QEEG assessment of adult ADHD [Abstract]

Abstracts/Archives of Clinical Neuropsyehology 15 (2000) 653-850 689
ability to employ internal self-talk. It was hypothesized that children with ADHD would obtain lower
overall IQ scores on the UNIT. Further, blind review of performance on the 4 subscale quotients of the
UNIT predicted group membership. As expected, children with ADHD obtained lower overall IQ
scores and were categorized as having ADHD correctly with 80% accuracy through discriminant
analysis. Because of the complete nonverbal nature of the UNIT, the differences in performance may
be a result of deficits in the ability to use intemal self-talk by children with ADHD. The implications of
such results suggest that verbally mediated testing tools (e.g., WISC-III) provide limited information
about cognitive processing. Future studies are needed to address issues regarding more comprehensive
assessment and subsequent intervention for the learning needs of children with ADHD.
Comparison of Trail Making Part B and Oral Trail Making in assessing cognitive impairment
Franks SF,, Reed S.
The purpose of the present study was to directly compare the sensitivity of the Oral Trail Making
Test (TMT-O) with the Trail Making Test Part B (TMT-B) in determining severity of impairment in
cognitive flexibility. Subjects included 47 males and 63 females ranging in age from 17 to 94
(M = 63.2). The TMT-O and the TMT-B were administered as part of a comprehensive neuropsy-
chological evaluation. The order of administration of the 2 tests was counterbalanced. It was
hypothesized that the TMT-B would be more sensitive to impairments in cognitive flexibility than
TMT-O. Chi-square analysis indicated that significantly more patients were unable to complete the
TMT-B than were unable to complete the TMT-O (xz=4.645, p=0.0311). Additionally, signifi-
cantly fewer correct responses were made prior to the first error on the TMT-B (X= 12.44) than on
the TMT-O (M = 15.47); t (104)=3.26, p=0.0015. Results suggest that the integration of visual
scanning and motor execution required by the TMT-B is sufficient to place a substantially greater
demand on cognitive processes. The TMT-O may be a purer measure of cognitive flexibility than
the TMT-B. The use of both in a comprehensive battery may have utility in determining functional
implications of test results.
Neuropsychological and QEEG assessment of adult ADHD
White JN Jr, Lubar JF, Hutchens TA.
Current diagnosis of attention deficit hyperactivity disorder (ADHD) is based on subjective reports of
developmentally inappropriate behaviors across the 3 symptom domains of inattention, impulsivity,
and hyperactivity (Swanson, Castellanos, Murias, LaHoste, and Kennedy, 1998). Despite attempts to
identify the utility of neuropsychological tests in the evaluation of ADHD (Katz, Wood, Goldstein,
Auchenbach, and Geckle, 1998), objective psychological or physiological tests with adequate
sensitivity and specificity have not been established to replace a thorough clinical history as the basis
for diagnosis (Swanson et al., 1998).
Recently, Monastra et al. (1999) demonstrated the utility of quantitative electroencephalography
(QEEG) in the assessment of ADHD. The results of that study supported significant maturational
effects in cortical arousal in the prefrontal cortex accompanied by cortical slowing. The typical pattern
demonstrated was excess theta (4-8 Hz) and decreased beta (13-21 Hz), indicated by an increased
theta-beta power ratio in comparison to controls, a finding supporting earlier research (Chabot and
Serfontein, 1996; Lubar, 1997; Lubar, Swartwood, Swartwood, and Timmerman, 1995; Mann, Lubar,
Zimmerman, Miller, and Muenchen, 1991).
Abstracts / Archives of Clinical Neuropsychology 15 (2000) 653-850
In the present study, college-aged adults with and without ADHD were evaluated. QEEG
recordings were obtained during an eyes-closed baseline, an eyes-open baseline, during administration
of the Paced Auditory Serial Addition Task (PASAT), during the Wisconsin Card Sorting Test-
Computerized Version (WCST-CV), and while completing the Intermediate Visual and Auditory
Continuous Performance Test (IVA). The initial statistical analyses indicate further support of the use
of the theta-beta power ratio in the diagnosis of ADHD. However, the use of a different power ratio,
comparing activity in the low alpha (8-10 Hz) range to activity in the low beta (13-21 Hz) range,
appears to show greater diagnostic quality for these adults. Furthermore, this low alpha-beta power
ratio varies across neuropsychological tasks for both groups, with greatest differences between groups
frontally during the PASAT and the IVA and centrally during the WCST. Implications for combined
neuropsychological and QEEG assessment of adult ADHD are discussed.
A comparison of alternative devices of the Finger Tapping Test
McDermid R.
This study compared 2 versions of the Finger Tapping Test. In the standard version of the test, the
examiner uses a stop watch to keep track of the 10-second trial interval. Westem Psychological
Services markets an electronic device which has an internal timer that starts on the first tap and stops
counting taps when the 10 seconds have elapsed. The use of automatic timing is intended to increase
the accuracy of testing. At issue is whether these 2 tests are comparable in that the electronic device's
scores are evaluated by using norms and research based on the original device. If the use of the newer
device results in different scores, different norms should be used. Fifty-four participants were recruited
from psychology courses in a small undergraduate college in the Midwest. Participants indicating a
history of significant head injury or learning disability were excluded from the study. Participants were
randomly assigned to 1 of 2 orders of the task. In one condition, the standard form was used first and
then the electronic form was used. In the other condition, the order was reversed. Procedures described
in Reitan and Wolfson (1985) were used in both conditions. The Tactual Performance Test was
administered after the first trial of the Finger Tapping Test. This task was administered as part of
another study and to provide significant time between trials. A repeated measures ANOVA indicated
neither an order effect or an effect for the 2 versions of the test.
The Adjusting-PASAT: a new procedure for determining thresholds for speed of
information processing
Rees L, Tombaugh TN, Francis M.
Although the Paced Auditory Serial Addition Test (PASAT) has been shown to be a sensitive measure
of speed of information processing, its clinical utility has been restricted because patients find it to be
extremely stressful. The Adjusting-PASAT (Tombaugh, 1999) represents a recent attempt to make the
PASAT more 'user-friendly' while at the same time maintain or increase its sensitivity to deficits in
speed of information processing. This is accomplished by using a computer program which combines
the basic PASAT methodology with the psychophysical stair-step procedure that makes the inter-
stimulus interval (ISI) between the digits contingent on the 'correctness' of a response. The ISI
increases whenever an incorrect response occurs, and decreases whenever 2 consecutive correct
responses are made. This process continues to occur until the person reaches a threshold whereby he/
she is unable to accurately process the information. This procedure minimizes stress because the
... In this case, children with attentional deficit disorder may be developmentally delayed, and what neurofeedback suppresses is the dominant oscillating rhythm. This model is supported by a recent study showing that adults with attention deficit disorder exhibit this rhythm at higher frequencies than children, between 7-10 Hz (White, Lubar, & Hutchens, 2000). ...
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