Neuropsychological Profiles Correlated with Clinical and Behavioral Impairments in a Sample of Brazilian Children with Attention-Deficit Hyperactivity Disorder

Abstract

Attention-deficit hyperactivity disorder (ADHD) is a complex neurodevelopmental disorder that implies several-step process, and there is no single test to diagnose both ADHD and associated comorbidities, such as oppositional-defiant disorder (ODD), anxiety disorder, depression, and certain types of learning disabilities. The purpose of the present study was to examine correlations between behavioral and clinical symptoms by administering an extensive neuropsychological battery to a sample of children and adolescents from a developing country. The sample was divided into three groups: non-ADHD, ADHD-non-comorbid, and ADHD + comorbidity. A full neuropsychological battery and clinical assessment found that 105 children met DSM-5 criteria, of whom 46.6% had the predominantly inattentive presentation, 37.3% had combined presentation, and 16% were predominantly hyperactive/impulsive presentation. The internal correlation between neuropsychological tests did not reach statistical significance in the comparison between ADHD and non-ADHD cases (p < 0.17). Clinical ADHD cases, including both + comorbidity and non-comorbid groups, performed substantially worse on continuous performance test (CPT), working memory. Comparing ADHD-non-comorbid and ADHD + comorbidity groups, the latter did significantly worse on inhibitory control, time processing, and the level of perseveration response on CPT indexes, as well as on working memory performance and child behavior checklist (CBCL) tests particularly the CBCL-deficient emotional self-regulation test in the ADHD + comorbidity group. Children diagnosed as ODD or with conduct disorder showed close correlations between clinical CBCL profiles and externalized symptoms. Our findings suggest that ADHD + comorbidity and ADHD non-comorbid cases may be differentiated by a number of neuropsychological measures, such as processing speed, inhibitory control, and working memory, that may reflect different levels of involvement of the hot and cool executive domains, which are more impaired in cases of severe symptomatic-externalized behavior and emotional regulation problems. Therefore, profiles based on clinical and behavioral findings can help clinicians select better strategies for detecting neuropsychological impairment in Brazilian children with ADHD.

Parenting stress among parents of children with Neurodevelopmental Disorders

“…However, when compared on internalizing disorders, the SpLD, ADHD and ASD groups reported higher levels of social withdrawal and anxiety/depression symptoms compared with the LD and TD groups. Although, studies comparing internalizing disorders in different NDDs are lacking, some researchers have highlighted the presence of emotional problems in ADHD, ASD and SpLD (Rizzutti et al, 2015). These findings suggest that child emotional and behavioral problems are significant sources of general parental stress.…”

Attention-Deficit/Hyperactivity Disorder Predominantly Inattentive Subtype/Presentation: Research Progress and Translational Studies

“…Previous studies have shown that children with ADHD-PI perform worse than the controls and individuals with ADHD-C on the omission measure of the Conner's CPT [37,38]. Therefore, it has been suggested that the impairment of this ability is highly associated with the inattention criteria of the disorder [37,38]. In another CPT study, ADHD-PI individuals performed worse than typically developing controls not only in measures of selective attention (omissions), but also in other areas of attentional functioning such as the ability to maintain a consistent response time throughout the task, vigilance, processing speed, sustained attention, and inhibitory control [39].…”

“…A meta-analysis that included different CPT versions concluded that one of the most impaired measures in individuals with ADHD is the number of omissions, which indicates a deficit in the ability to respond to target stimuli (i.e., selective attention) [36]. Previous studies have shown that children with ADHD-PI perform worse than the controls and individuals with ADHD-C on the omission measure of the Conner's CPT [37,38]. Therefore, it has been suggested that the impairment of this ability is highly associated with the inattention criteria of the disorder [37,38].…”

Group cognitive behavioral therapy for children and adolescents with ADHD

“…The neuropsychological evaluation included the following: the children's intellectual level was tested using the abbreviated (estimated IQ) Wechsler Intelligence Scale for Children (WISC-III), the attention test using the Conners' Continuous Performance Test (CCPT), the Automated Working Memory Assessment (AWMA) test, and the BRIEF (Behaviour Rating Inventory of Executive Functions) test. The psychiatric interview included a Brazilian version of MTA-SNAP-IV, the Child Behaviour Checklist (CBCL), and the Brazilian version of the Conners Rating Scale (see Rizzutti et al, 2015-for more details)…”