Evaluating relationships among clinical working memory assessment and inattentive and hyperactive/impulsive behaviors in a community sample of children.

OBJECTIVE: This study examined relationships between inattentive and hyperactive/impulsive behaviors and working memory (WM) functioning, and the utility of WM in categorical diagnosis of ADHD versus considering ADHD symptoms on a continuum. METHOD: The study included 50 male children (6-12 years). Inattentive and hyperactive/impulsive behaviors were measured by the Conners-3P parent report, and WM was assessed by the WISC-IV WM subtests and Working Memory Index (WMI). RESULTS: WISC-IV Arithmetic and Digit Span Backward were most consistently related to inattentive behaviors, and no WM measure was consistently related to ADHD hyperactive/impulsive behaviors. Arithmetic and Digit Span Backward also accounted for significant variance in inattentive behaviors and ADHD inattention symptoms, respectively. Neither the WMI nor the Arithmetic subtest correctly classified individuals diagnosed with ADHD. CONCLUSION: Measurement of inattentive behaviors on a continuum best characterized relationships between symptoms of ADHD and WM functioning; WM functioning did not have utility in categorical understanding of ADHD.

The incremental validity of a computerised assessment added to clinical rating scales to differentiate adult ADHD from autism spectrum disorder.

There is a clinical need for objective evidence-based measures that are sensitive and specific to ADHD when compared with other neurodevelopmental disorders. This study evaluated the incremental validity of adding an objective measure of activity and computerised cognitive assessment to clinical rating scales to differentiate adult ADHD from Autism spectrum disorders (ASD). Adults with ADHD (n=33) or ASD (n=25) performed the QbTest, comprising a Continuous Performance Test with motion-tracker to record physical activity. QbTest parameters measuring inattention, impulsivity and hyperactivity were combined to provide a summary score ('QbTotal'). Binary stepwise logistic regression measured the probability of assignment to the ADHD or ASD group based on scores on the Conners Adult ADHD Rating Scale-subscale E (CAARS-E) and Autism Quotient (AQ10) in the first step and then QbTotal added in the second step. The model fit was significant at step 1 (CAARS-E, AQ10) with good group classification accuracy. These predictors were retained and QbTotal was added, resulting in a significant improvement in model fit and group classification accuracy. All predictors were significant. ROC curves indicated superior specificity of QbTotal. The findings present preliminary evidence that adding QbTest to clinical rating scales may improve the differentiation of ADHD and ASD in adults.

Neuropsychiatric assessment of Gilles de la Tourette patients: comparative study with other hyperkinetic and hypokinetic movement disorders.

The role of the basal ganglia in conditions with co-occurring movement disorders and neuropsychiatric symptoms is not well known. It has been hypothesized that hyperkinesia -disinhibited behaviors and hypokinesia-inhibited behaviors result from an imbalance between the direct and indirect striatal output pathways, and that differential involvement of these pathways could account for the concurrent abnormalities in movement and behavior observed in these disorders. This study aimed to evaluate whether the pattern and the extent of the neuropsychiatric manifestations of patients with GTS, a hyperkinetic movement disorder of basal ganglia origin, differs from that of patients with other basal ganglia hyperkinetic (e.g., HD) or hypokinetic (e.g., PSP) movement disorders, and to determine whether patients with GTS show a greater frequency of hyperactive behaviors (e.g., agitation, irritability, euphoria, or anxiety) than PSP patients, and are comparable to patients with HD. The Neuropsychiatric Inventory (NPI), a scale with established validity and reliability, was administered to 26 patients with GTS (mean age, 30.2 +/- 2.2 years), and the results were compared with that of 29 patients with HD (mean age, 43.8 +/- 2 years) and 34 with PSP (mean +/- S.D. age, 66.6 +/- 1.2 years). There was no difference between the groups in the total NPI scores. However, there was a double dissociation in behaviors: patients with hyperkinetic disorders (HD and GTS) exhibited significantly more agitation, irritability, anxiety, euphoria, and hyperkinesia, whereas hypokinetic patients (PSP) exhibited more apathy. Patients with GTS showed greater scores than HD patients in all those scores differentiating HD and GTS from PSP patients (e.g., agitation, irritability, anxiety and euphoria), and were differentiated in a logistic regression analysis from both HD and PSP patients in having significantly more anxiety. We found that patients with GTS manifested predominantly hyperactive behaviors similar but more pronounced than those presented by patients with HD, while those with PSP manifested hypoactive behaviors. Based on our findings and the proposed models of basal ganglia dysfunction in these disorders, we suggest that the hyperactive behaviors in GTS are comparable to those observed in HD, being both secondary to an excitatory subcortical output through the medial and orbitofrontal cortical circuits, while in PSP the hypoactive behaviors are secondary to hypostimulation of these circuits. Abnormalities of other brain structures (e.g., amygdala, brainstem nuclei) may account for the significantly higher anxiety scores differentiating GTS from HD patients.

Assessment of children's Type A behavior: relationship with negative behavioral characteristics and children and teacher demographic characteristics.

Thirty-two teachers rated Type A behavior, using Matthews Youth Test for Health, (MYTH) and negative characteristics of hyperactivity, negative peer relations, social withdrawal, and depression in 105 children, between the ages of 6 and 11, from lower to middle class Black and White families. Children's age, gender, race, and socioeconomic status (SES) and teachers' gender, grade taught, and years of teaching experience were not related to teachers' MYTH ratings. However, White teachers rated children higher on Type A behavior than Black teachers. Controlling for teacher race effects, MYTH total scores, rather than reflecting a global negative view of the child, showed a strong overlap with hyperactivity and were differentiated from social withdrawal and depression. The MYTH Impatience/Aggression factor was highly related to hyperactivity and negative peer interactions; the Competitiveness factor was associated with a lack of social withdrawal. The conclusions verify the multidimensional nature of children's Type A behavior pattern and the importance of rater demographic characteristics in the assessment of children's behavior.

Hyperactive boys in their classroom: assessment of teacher and peer perceptions, interactions, and classroom behaviors.

Teacher ratings, peer perceptions, peer interactions, and classroom behaviors of 17 hyperactive and 17 active elementary school-age boys, nominated by their teachers, were compared using multivariate analyses and planned comparisons in order to better describe and assess hyperactivity in its most probable setting--the classroom. Hyperactive boys were found to be significantly different from actives on measures from all data sources in that they were perceived and interacted more negatively. Cluster analyses of teacher ratings of 90 hyperactives from a clinical sample and 17 hyperactives from the current sample were used to discriminate among different types of hyperactives. Four types were named anxious, conduct problems, inattentive, and low problem hyperactives. The fact that six conduct problem hyperactives were found to be more disruptive and have higher activity level ratings than six inattentive hyperactives, when observed in their classrooms, points to the need to study and treat hyperactives as heterogeneous groups.

The assessment of impulsivity and mediating behaviors in hyperactive and nonhyperactive boys.

Twenty boys (6-8 years) rated by their teachers as hyperactive and a matched sample of nonhyperactive boys performed a task that required them to withhold responding for a set time interval in order to be rewarded (DRL 6-second schedule). Half of each group worked on a one-button console while the other half was provided with additional collateral buttons. Results indicated that hyperactive children were relatively unable to perform efficiently on the task, and that this deficit endured regardless of age, IQ, or experimental condition. DRL was thus found to discriminate accurately between teacher-rated and parent-rated hyperactive and nonhyperactive children. Furthermore, a wide variety of self-generated mediating behaviors was observed, and it was determined that a child's DRL performance was related to the kind of mediating behaviors he displayed. Results are discussed in terms of the clinical assessment of hyperactivity and the training of impulsive children.

Relationship among environmental and demographic variables and teacher-rated hyperactivity.

This study assessed the role of environmental and demographic factors in the occurrence of teacher-rated hyperactivity. The subject group consisted of 79 hyperactive and 81 nonhyperactive children ranging from 5 to 12 years of age. Parents of the subjects were interviewed to obtain information regarding the environmental and demographic factors of sex, race, birth order, number of siblings, frequency of change of residence, income level, mother's age, father's age, educational level of mother, educational level of father, parents' marital status, and the method of child discipline used in the home. Comparison between the the hyperactive and nonhyperactive groups suggested nonsignificant differences with the exception of sex (p less than .001), in which the ratio of hyperactive males to hyperactive females was 5:1.