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The behavior patterns of hyperactivity, impulsivity and inattention that would ultimately become recognized as Attention-Deficit Hyperactivity Disorder (ADHD) have been described for centuries. Nevertheless, in the past 35 years, advances in diagnostic methods, identification of biomarkers, and treatments have advanced at an exponential rate. ADHD is now recognized as the most common behavioral disorder of childhood, with risks extending well into adulthood for both males and females, leading to its identification as a significant public health issue. This historical neuropsychological review of ADHD emphasizes scientific highlights in the past 35 years related to ADHD, including the evolution of the diagnosis (from Hyperkinetic Reaction of Childhood to ADHD), influential theories (executive functions, cognitive-energetic, delay aversion), landmark treatment studies (Multimodal Treatment of ADHD [MTA] and Preschool ADHD Treatment Study [PATS]), and advances in brain mapping techniques (anatomic, functional, and resting state magnetic resonance imaging, diffusion tensor imaging). The review concludes by highlighting the challenges of studying and treating a heterogeneous neurodevelopmental disorder like ADHD, with emphasis on associated disorders and conditions (learning disabilities, sluggish cognitive tempo), special populations (girls, preschoolers, adults), and recommendations for scientific inquiry in the next 35 years. Neuropsychologists are well positioned to address the clinical and research challenges of the next generation of studies, especially involving advances in understanding the sexual dimor.phism, full developmental course, and dynamic risks associated with ADHD. (JINS, 2017, 23, 916–929)
The current study examined regional frontal lobe volumes based on functionally relevant subdivisions in contemporaneously recruited samples of boys and girls with and without attention-deficit/hyperactivity disorder (ADHD). Forty-four boys (21 ADHD, 23 control) and 42 girls (21 ADHD, 21 control), ages 8–13 years, participated. Sulcal–gyral landmarks were used to manually delimit functionally relevant regions within the frontal lobe: primary motor cortex, anterior cingulate, deep white matter, premotor regions [supplementary motor complex (SMC), frontal eye field, lateral premotor cortex (LPM)], and prefrontal cortex (PFC) regions [medial PFC, dorsolateral PFC (DLPFC), inferior PFC, lateral orbitofrontal cortex (OFC), and medial OFC]. Compared to sex-matched controls, boys and girls with ADHD showed reduced volumes (gray and white matter) in the left SMC. Conversely, girls (but not boys) with ADHD showed reduced gray matter volume in left LPM; while boys (but not girls) with ADHD showed reduced white matter volume in left medial PFC. Reduced left SMC gray matter volumes predicted increased go/no–go commission rate in children with ADHD. Reduced left LPM gray matter volumes predicted increased go/no–go variability, but only among girls with ADHD. Results highlight different patterns of anomalous frontal lobe development among boys and girls with ADHD beyond that detected by measuring whole lobar volumes. (JINS, 2011, 17, 1047–1057)
Interstimulus “jitter” involves randomization of intervals between successive stimulus events, and can facilitate performance on go/no-go tests among healthy adults, though its effect in clinical populations is unclear. Children with Attention-deficit/Hyperactivity Disorder (ADHD) commonly exhibit deficient response control, leading to increased intra-subject variability (ISV), which has been linked to anomalous functioning within frontal circuits, as well as their interaction with posterior “default mode” regions. We examined effects of interstimulus jitter on response variability in 39 children, ages 9–14 years (25 ADHD, 14 controls). Participants completed 2 computerized go/no-go tests: one with fixed interstimulus interval (ISI) and one with jittered ISI. Repeated measures analysis of variance (ANOVA) revealed a significant group–by test interaction, such that introduction of jitter produced a significant decrease in ISV among children with ADHD, but not among controls. Whereas children with ADHD were significantly more variable than controls on the go/no-go test with fixed ISI, their performance with jittered ISI was equivalent to that of controls. Jittering stimulus presentation provides a nonpharmacologic mechanism for improving response control in ADHD. This bottom-up approach may be mediated by increases in vigilance through noradrenergic circuits that facilitate maintenance of frontal circuits critical to response control. (JINS, 2010, 16, 388–393.)
Tourette Syndrome (TS) in children is associated with various neurobehavioral disorders including attention deficit hyperactivity disorder (ADHD). Children with TS and ADHD show some difficulties with neuropsychological tasks, but we do not know if children with TS alone have neuropsychological deficits. To assess specific cognitive differences among children with TS and/or ADHD, we administered a battery of neuropsychological tests, including 10 tasks related to executive function (EF), to 10 children with TS-only, 48 with ADHD-only, and 32 with TS+ADHD. Children in all groups could not efficiently produce output on a timed continuous performance task [Test of Variables of Attention (TOVA) mean reaction time and reaction time variability]. Children with TS-only appeared to have fewer EF impairments and significantly higher perceptual organization scores than children with TS+ADHD or ADHD-only. These findings suggest that deficiencies in choice reaction time and consistency of timed responses are common to all three groups, but children with TS-only have relatively less EF impairment than children with TS+ADHD or ADHD-only. (JINS, 1995, 1, 511–516.)
The present study compared performance of children with
Attention-Deficit/Hyperactivity Disorder (ADHD) and high functioning
autism (HFA) with that of controls on 4 tasks assessing 2 components of
motor control: motor response inhibition and motor persistence. A total of
136 children (52 ADHD, 24 HFA, 60 controls) ages 7 to 13 years completed 2
measures of motor inhibition (Conflicting Motor Response and Contralateral
Motor Response Tasks) and 2 measures of motor persistence (Lateral Gaze
Fixation and NEPSY Statue). After controlling for age, IQ, gender, and
basic motor speed, children with ADHD performed significantly more poorly
than controls on the Conflicting Motor Response and Contralateral Motor
Response Tasks, as well as on Statue. In contrast, children with HFA
achieved lower scores than controls only on measures of motor persistence,
with no concomitant impairment on either motor inhibition task. These
results are consistent with prior research that has demonstrated
relatively spared motor inhibition in autism. The findings highlight the
utility of brief assessments of motor control in delineating the unique
neurobehavioral phenotypes of ADHD and HFA. (JINS, 2006,
Impaired imitation of skilled gestures is commonly reported in autism.
Questions, however, remain as to whether impaired imitation is associated
with a more generalized deficit in performance of gestures consistent with
a dyspraxia and whether the pattern of errors differs from that observed
in typically developing children. To address these questions, praxis in 21
high-functioning children with autism spectrum disorders (ASD) was
compared with 24 typically developing controls using a traditional
approach in which performance was evaluated through detailed examination
of error types. Children with ASD produced significantly fewer correct
responses not only during Gesture to Imitation, but also during Gesture to
Command and with Tool Use. The pattern of errors in ASD was similar to
that of controls with spatial errors being most common in both groups;
however, body-part-for-tool errors were more common in children with ASD,
suggesting dyspraxia is not entirely attributable to motor deficits. The
findings suggest that autism is associated with a generalized praxis
deficit, rather than a deficit specific to imitation. In a developmental
disorder such as autism, the findings may reflect abnormalities in
frontal/parietal–subcortical circuits important for acquisition
(i.e., learning) of sensory representations of movement and/or the
motor sequence programs necessary to execute them. (JINS, 2006,
This study assessed two relevant aspects of executive
dysfunction in children with either Tourette syndrome (TS)
or ADHD. Process variables derived from existing neuropsychological
measures were used to clarify the executive function construct.
Clustering of responses on measures of verbal fluency,
figural fluency, and verbal learning was examined to assess
strategic response organization. Rule breaks, intrusions,
and repetition errors were recorded to assess inhibition
errors. No significant differences were found among the
three groups (TS, ADHD, and controls) on tasks of response
organization (clustering). In our sample, both the ADHD
and the TS groups were largely free from executive function
impairment, and their performance on the fluency and list
learning tasks was in the average range. There was a significant
group difference on one of the disinhibition variables,
with both TS and ADHD groups showing significantly more
intrusions on verbal list learning trials than controls.
When more traditional total score variables were analyzed
among the three groups, there were no significant differences;
however, analysis of effect size revealed medium-to-large
effect sizes for Letter Word Fluency total score differences
(ADHD vs. controls), and for Semantic Word Fluency
total score differences (ADHD vs. TS), with the
ADHD group having weaker performance in both comparisons.
Results provide some support for the use and analysis of
process variables—particularly those related to inhibition
and intrusion errors, in addition to the total score variables
when assessing executive function deficits in children
with ADHD and TS. While group differences may be found,
children with uncomplicated TS should not routinely be
considered to have significant executive function impairments,
and when deficits are found, they may be attributable to
other comorbid disorders. (JINS, 2001, 7,
To examine the hypothesis that abnormalities in
those cognitive functions for which cerebellar components
have been implicated contribute to the pathophysiology
of autism, tests of judgment of explicit time intervals
and procedural learning were administered to 11 participants
with autism and 17 age-and-IQ-matched controls. Results
indicated that the group with autism demonstrated significant
impairments in procedural learning compared with the group
of controls. No significant difference in judgment of explicit
time intervals was found. The data suggest that deficits
in procedural learning may contribute to the cognitive
and behavioral phenotype of autism; these deficits may
be secondary to abnormalities in cerebellar–frontal
circuitry. (JINS, 2000, 6, 752–759.)
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