Design Fluency in Children with ADHD and Comorbid Disorders

Abstract

Background: Attention deficit/hyperactivity disorder (ADHD) is often associated with frontal executive impairment in children. Oppositional defiant disorder (ODD) and anxiety disorders (AD) frequently accompany ADHD, but the impact of these comorbid disorders on cognition remains elusive. The five-point test (FPT), a design fluency task, has been shown to be sensitive to neurological damage, specifically to frontal lobe lesions in patients with brain injuries. The purpose of this study was to compare the performances of neurotypical children with that of children with ADHD, ADHD-ODD, and ADHD-AD on the FPT in order to examine whether these groups could be distinguished from one another based on their cognitive profile. Methods: A total of 111 children aged 8 to 11 years old participated in the study. Six measures from the FPT were used to characterize their performance. Results: Statistically significant differences between groups were observed for five of the six FPT measures. Essentially, children with ADHD-ODD made more repeated designs than the three other groups (control p > 0.001, ADHD p = 0.008, ADHD-AD p = 0.008), while children with ADHD-AD produced fewer total and correct designs than the control and ADHD groups (p = 0.009). Conclusions: This suggests that comorbidities have an additive impact on the cognitive profile of children with ADHD. Design fluency may be a sensitive measure for capturing the subtle cognitive deficits that are likely to be involved in these disorders.

Capturing Subtle Neurocognitive Differences in Children with and without Tourette Syndrome through a Fine-Grained Analysis of Design Fluency Profiles

“…The correlational analyses revealed a positive correlation between age and all FPT variables, except for repetitions and its ratio measure, and no relation with sex, confirming earlier studies showing an effect of age but no sex difference in design fluency performances [ 22 ]. The relationship between age and design fluency is consistent with studies on cognitive development in children and the FPT’s usefulness in characterizing this development [ 21 , 22 , 35 , 39 ]. Compared with inhibition (see [ 35 , 81 , 82 ] and cognitive flexibility [ 83 ], fluency would develop late as it actively involves strategizing, monitoring, and self-assessment.…”

“…Since comorbid disorders in TS represent a major confounding factor in neuropsychological studies [ 9 ], and given that the neurological anomalies observed in TS correlate with tic severity [ 50 ], we may expect such factors to be associated with cognitive impairments beyond the mere presence of a tic disorder. Furthermore, given the paucity of studies on design fluency in TS, the detailed analysis of the present study will contribute to the literature on the subject, add to existing research on the DF profiles in clinical pediatric populations (see [ 21 , 31 , 46 , 51 , 52 , 53 ]), and thus might provide evidence to guide clinicians through assessment.…”

“…Jones-Gotman and Milner [ 19 ] developed the first DF test analogous to verbal fluency. The task involves finding strategies to maximize the production of designs, while avoiding repeating patterns [ 20 , 21 , 22 , 23 ]. Successful performance, therefore, requires good visuomotor coordination as well as coordination of several EF, such as planning, initiation and self-monitoring skills, cognitive flexibility, inhibition of inappropriate responses, use of strategies, and creativity [ 24 , 25 , 26 , 27 ].…”

“…In addition to gaining a better understanding of cognitive functioning, the study of DF in a TS population allows the sort of deficits often observed in neurological conditions to be investigated, including frontal lobe dysfunction and other similarities with TS such as ADHD and obsessive-compulsive disorder (OCD) [ 21 , 31 , 44 , 45 , 46 , 47 ]. To date, only two studies have examined DF in TS.…”

The State of Monoamine Activity in Children with Tyc Hyperkinesis and the Combined Type of Attention Deficit Hyperactivity Disorder (ADHD)

“…В большей степени это относится к комбинированному типу СДВГ [2]. И хотя часть симптомов СДВГ, особенно гиперактивность, по мере взросления компенсируется, нарушение социальной адаптации и качество жизни пациентов ухудшается за счет присоединения сопутствующих депрессивных, тревожных, фобических и тикозных расстройств [3]. Симптомы сопутствующих психопатологических нарушений приобретают основное значение при ослаблении симптомов СДВГ и требуют медикаментозной коррекции и психотерапевтического вмешательства.…”