Neurocognitive Functioning in AD/HD, Predominantly Inattentive and Combined Subtypes

Abstract

The Predominantly Inattentive (PI) and Combined (CB) subtypes of AD/HD differ in cognitive tempo, age of onset, gender ratio, and comorbidity, yet a differentiating endophenotype has not been identified. The aim of this study was to test rigorously diagnosed PI, CB, and typical children on measures selected for their potential to reveal hypothesized differences between the subtypes in specific neurocognitive systems (anterior vs. posterior attentional systems) and processes (arousal vs. activation). Thirty-four CB and 26 PI children meeting full DSM-IV criteria for subtype both in school and at home, without confounding reading disability or emotional disorder, were enrolled along with 20 typically developing children. Neurocognitive functions measured included attention, inhibitory control, working memory, learning, and executive functions. Tasks included the Stroop, Wisconsin Card Sorting Test, Continuous Performance Test (CPT). Buschke Selective Reminding Test, ad the Tower of London (TOL), as well as instruments developed by Posner and Sternberg, and tasks assessing the impact on reaction time of [corrected] varying preparatory intervals and stimulus/response complexity. After co-varying for IQ, subtypes differed primarily on measures of impulsivity during tests of vigilance (CPT) and executive function (TOL), with the CB group showing greater impulsivity than both other groups. In addition, the PI group showed worse performance than CB and control groups on the WISC-III Processing Speed Index. Whether analyzed with or without an IQ co-variate, there was no support in the data for hypothesized differences between subtypes in functioning of the anterior vs. posterior attentional systems, nor in involvement of arousal vs. activation processes. The results indicate that the PI and CB subtypes are best differentiated by ratings, observations and tests of cognitive tempo and behavioral impulsivity. Neuropsychological methods have yet to identify critical neuropsychological [corrected] substrates of these differences.

Effectiveness of Cognitive–Functional (Cog–Fun) Intervention With Children With Attention Deficit Hyperactivity Disorder: A Pilot Study

“…Nine children (64%) were diagnosed with combined-type ADHD, and 5 children (36%) were diagnosed with inattentive type ADHD, in accordance with the prevalence reported in the literature (Solanto et al, 2007). Four of the 14 treated children were medicated for ³6 mo before participation in this study and continued this intervention throughout follow-up.…”

Defining the Neural Substrate of the Adult Outcome of Childhood ADHD: A Multimodal Neuroimaging Study of Response Inhibition

“…It is noteworthy that adult severity of hyperactive-impulsive rather than inattentive symptoms accounted for these findings. This is in keeping with an influential model of ADHD, which links inhibitory deficits with hyperactive-impulsive symptoms While there is empirical support from neuropsychological studies for this model(25–28), there are also some conflicting reports(29–31). Prior neuroimaging studies have primarily examined ADHD-related inhibitory deficits using diagnostic categories and not included separate analyses of hyperactive-impulsive and inattentive symptom dimensions.…”

Examining Relationships Between Executive Functioning and Delay Aversion in Attention Deficit Hyperactivity Disorder

“…In contrast, as a group, children with ADHD were not more delay averse than their typically developing counterparts. Although this contradicts some previous research (Kuntsi, Oosterlaan, & Stevenson, 2001; Solanto et al, 2001; Sonuga-Barke, Auerbach, Campbell, Daley, & Thompson, 2005; Sonuga-Barke et al, 1992), it is consistent with other large-scale studies of children with ADHD (Bidwell, Willcutt, DeFries, & Pennington, 2007; Scheres, et al, 2006; Solanto et al, 2007). A failure to find group differences in delay aversion is contradictory to the delay aversion hypothesis.…”