Neuropsychological functioning of girls with attention-deficit/hyperactivity disorder followed prospectively into adolescence: Evidence for continuing deficits?

Abstract

Prospectively followed girls with attention-deficit/hyperactivity disorder (ADHD), along with a matched comparison sample, five years after childhood neuropsychological assessments. Follow-up neuropsychological measures emphasized attentional skills, executive functions, and language abilities. Paralleling childhood findings, the childhood-diagnosed ADHD group displayed moderate to large deficits in executive/attentional performance as well as rapid naming, relative to the comparison group, at follow-up (M age = 14.2 years). ADHD-Inattentive vs. ADHD-Combined contrasts were nonsignificant and of negligible effect size, even when a refined, "sluggish cognitive tempo" subgroup of the Inattentive type was examined. Although ADHD vs. comparison differences largely withstood statistical control of baseline demographics and comorbidities, control of childhood IQ reduced EF differences to nonsignificance. Yet when the subset of girls meeting diagnostic criteria for ADHD in adolescence were compared to the remainder of the participants, neuropsychological deficits emerged even with full statistical control. Overall, childhood ADHD in girls portends neuropsychological and executive deficits that persist for at least 5 years.Keywords attention-deficit hyperactivity disorder (ADHD); neuropsychology; executive function; longitudinal research; girls Neuropsychological measures tap a range of functions, including attention, inhibition, motor speed, and linguistic abilities. The construct of executive function (EF) refers to those neuropsychological skills, deemed essential for performance of complex human tasks, related to planning, set maintenance, set shifting, interference control, and working memory (e.g., Barkley, 1997;Pennington & Ozonoff, 1996). Considerable evidence exists that, in contrast Address correspondence to Stephen P. Hinshaw, Department of Psychology, Tolman Hall #1650, University of California, Berkeley, CA 94720-1650 (hinshaw@berkeley.edu). NIH Public Access Author ManuscriptNeuropsychology. Author manuscript; available in PMC 2010 September 1. Published in final edited form as:Neuropsychology. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript to non-diagnosed comparison individuals, samples of children and adults with attention-deficit/ hyperactivity disorder (ADHD) show significant neuropsychological deficits, particularly those linked with EF (see, for example, Hinshaw, Carte, Sami, Treuting, & Zupan, 2002;Klorman et al., 1999; Nigg, Blaskey, Huang-Pollack, & Rappley, 2002;Seidman, Biederman, Faraone, Weber, & Ouellette, 1997;Seidman et al., 2005; see reviews of Barkley, Grodzinsky, & duPaul, 1992;Hervey, Epstein, & Curry, 2004;Seidman et al., 2004; Sergeant, Guerts, & Oosterlaan, 2002). Such deficits appear on a number of different tests and are largely independent of comorbid conditions that accompany ADHD Seidman et al., 1997). Because EF deficits are particularly likely to predict continuing academic failure in youth with ADHD (Biederman et al., 2004) and because th...

Prospective follow-up of girls with attention-deficit/hyperactivity disorder into adolescence: Evidence for continuing cross-domain impairment.

“…We base our hypotheses on the above-cited literature and on our own previous findings of (a) major comorbidity and impairment in the present sample during childhood (Hinshaw, 2002;Hinshaw, Carte, Sami, Treuting, & Zupan, 2002) and (b) continuing crossdomain impairment at our follow-up in early to midadolescence (Hinshaw, Carte, Fan, Jassy, & Owens, 2007;Hinshaw et al, 2006;Mikami et al, 2008;Owens, Hinshaw, Lee, & Lahey, 2009). First, we predict that despite a continuing decline in reported symptoms of ADHD over time, particularly in the HI domain (see Hart, Lahey, Loeber, Applegate, & Frick, 1995;Loya et al, 2012), girls with childhood diagnosed ADHD will continue to show elevations in core symptomatology (ADHD-related, internalizing, and externalizing), young-adult relevant symptom areas (e.g., eating pathology; see, e.g., Biederman et al, 2010;Mikami et al, 2008), substance use severity (Hinshaw et al, 2006; but see also Babinski et al, 2011, for opposing findings), several aspects of impairment (service utilization, academic and global), and crucial outcomes such as self-injurious behavior and suicide attempts (see Chronis-Tuscano et al, 2010).…”

The neurobiological profile of girls with ADHD

“…Yet, most of the published research on children with ADHD is based on samples comprised primarily (or exclusively) of boys. Although boys are much more commonly diagnosed with ADHD than girls, and are more often treated [Derks et al, 2007], the functional and psychosocial impairment in girls with ADHD is well established [Greene et al, 2001;Staller and Faraone, 2006;Hinshaw et al, 2007;Ohan and Johnston, 2007]. While sex-specific behavioral differences in ADHD have been identified , the available research is yet to specify a clear behavioral or neurobiological profile distinct to girls with ADHD [Biederman et al, 1999[Biederman et al, , 2002Sharp et al, 1999;Seidman et al, 2006].…”

“…Behaviorally, symptoms of ADHD tend to decrease in severity with age in parallel with cortical maturation Hinshaw et al, 2007], such that by late elementary school age, the symptoms are more pronounced in boys (compared to girls) with ADHD. However, recent large-scale studies of preschool children with ADHD reveal that the opposite pattern may be true in the preschool years.…”

“…For example, a longitudinal examination of a large group of girls with ADHD showed that 55% of girls with the combined subtype (and 43% of those with the inattentive subtype) demonstrated performance-based executive dysfunction at baseline (including measures of working memory, planning, set maintenance, and set shifting), with 75 and 55% of girls with the combined and inattentive subtypes, respectively, showing executive dysfunction 5 years later [Hinshaw et al, 2007]. Further, some behavioral measures of executive control may have greater discriminative power in identifying those with ADHD than others, especially when sex differences in performance are taken into consideration.…”

Diversidade de resultados no estudo do transtorno de déficit de atenção e hiperatividade

“…Com efeito, do ponto de vista neuropsicológico, os déficits executivos nas meninas em idade escolar parecem ser análogos aos apresentados pelos meninos e, à semelhança do que já se referiu na caracterização dos tipos, também não são claras as diferenças de funcionamento executivo quando se contrastam os tipos combinado e desatento no sexo feminino (Hinshaw & cols., 2002). Resultados idênticos têm sido corroborados por estudos transversais e por estudos longitudinais que analisam o desempenho cognitivo dos sexos na infância e na adolescência ou no início da idade adulta (Fischer, Barkley, Smallish, & Fletcher , 2005;Hinshaw, Carte, Fan, Jassy & Owens¸ 2007;Rucklidge & Tannock, 2002;Seidman & cols., 2005).…”