Attention-Deficit/Hyperactivity Disorder Remission Is Linked to Better Neurophysiological Error Detection and Attention-Vigilance Processes

Abstract

BackgroundThe processes underlying persistence and remission of attention-deficit/hyperactivity disorder (ADHD) are poorly understood. We examined whether cognitive and neurophysiological impairments on a performance-monitoring task distinguish between ADHD persisters and remitters.MethodsOn average 6 years after initial assessment, 110 adolescents and young adults with childhood ADHD (87 persisters, 23 remitters) and 169 age-matched control participants were compared on cognitive-performance measures and event-related potentials of conflict monitoring (N2) and error processing (error-related negativity and positivity) from an arrow flanker task with low-conflict and high-conflict conditions. ADHD outcome was examined with parent-reported symptoms and functional impairment measures using a categorical (DSM-IV) and a dimensional approach.ResultsADHD persisters were impaired compared with controls on all cognitive-performance and event-related potential measures (all p < .05). ADHD remitters differed from persisters and were indistinguishable from control participants on the number of congruent (low-conflict) errors, reaction time variability, error-related negativity, and error-related positivity (all p ≤ .05). Remitters did not differ significantly from the other groups on incongruent (high-conflict) errors, mean reaction time, and N2. In dimensional analyses on all participants with childhood ADHD, ADHD symptoms and functional impairment at follow-up were significantly correlated with congruent errors, reaction time variability, and error-related positivity (r = .19–.23, p ≤ .05).ConclusionsCognitive and neurophysiological measures of attention-vigilance and error detection distinguished ADHD remitters from persisters. These results extend our previous findings with other tasks and indicate that such measures are markers of remission and candidates for the development of nonpharmacological interventions.

Novel Targets for Attention-Deficit/Hyperactivity Disorder Interventions: Can Potential Biomarkers Be Identified From Longitudinal Data?

“…For many, but not all, individuals with ADHD, the disorder emerges in childhood and exhibits a chronic course through adolescence and adulthood. Given that many individuals show a remitting course over development, critical research, such as Michelini, Kitsune et al’s (1) study reported in this issue, has focused on biological and behavioral correlates of long-term outcomes for individuals with ADHD that could elucidate mechanisms of recovery. Such research is important because of its potential to guide the development of novel interventions that will alter trajectories and confer enduring change rather than temporary symptomatic relief provided by currently available treatments.…”

“…Michelini, Kitsune et al’s (1) study builds on their previous work (2) that examined predictors of ADHD persistence and remission among 279 adolescents/young adults who had been evaluated for ADHD as children. Participants completed a modified Eriksen flanker task while neurophysiological markers of conflict monitoring (N2), and unconscious (ERN) and conscious error processing (Pe) were obtained.…”

“…Longitudinal studies like Michelini, Kitsune et al’s (1) are essential to help us better understand life course trajectories of ADHD and correlates of better or worse outcomes. However, the complex constructs under study pose challenges to researchers.…”

“…For example, how we define “persistence” and “remission” has enormous consequences for categorical analyses because group membership changes depending on: a) where the cut in number of symptoms is made, and b) whether impairment is taken into consideration (3). Michelini, Kitsune et al (1) defined Persistence as meeting DSM-IV symptom-level criteria and the presence of significant impairment as reported by parents. Remitters could present with five or more ADHD symptoms in either the inattentive or hyperactive-impulsive domain as long as functional impairment was not reported.…”

“…Michelini, Kitsune et al (1) found a fairly high rate of persistence with 79% of individuals who had been diagnosed with ADHD as children continuing to meet DSM-IV criteria for the disorder at follow-up. Persisters performed more poorly than controls on all measures.…”