Psycholinguistic profiling differentiates specific language impairment from typical development and from attention-deficit/hyperactivity disorder.

PURPOSE: Practitioners must have confidence in the capacity of their language measures to discriminate developmental language disorders from typical development and from other common disorders. In this study, psycholinguistic profiles were collected from 3 groups: children with specific language impairment (SLI), children with attention-deficit/hyperactivity disorder (ADHD), and children with typical development (TD). The capacity of different language indices to successfully discriminate SLI cases from TD and ADHD cases was examined through response operating characteristics curves, likelihood ratios, and binary logistic regression. METHOD: The Test of Early Grammatical Impairment (Rice & Wexler, 2001a), Dollaghan and Campbell's (1998) nonword repetition task, Redmond's (2005) sentence recall task, and the Test of Narrative Language (Gillam & Pearson, 2004) were administered to 60 children (7-8 years of age). RESULTS: Diagnostic accuracy was high for all 4 psycholinguistic measures, although modest reductions were observed with the SLI versus ADHD discriminations. Classification accuracy associated with using the Test of Early Grammatical Impairment and the Sentence Recall task was equivalent to using all 4 measures. IMPLICATIONS: Outcomes confirmed and extended previous investigations, documenting high levels of diagnostic integrity for these particular indices and supporting their incorporation into eligibility decisions, differential diagnosis, and the identification of comorbidity.

Attention deficit hyperactivity disorder erroneously diagnosed and treated as bipolar disorder.

OBJECTIVE: There is a dearth of literature on patients erroneously diagnosed and treated for bipolar disorder. METHOD: The authors report a case of an adult with attention deficit hyperactivity disorder erroneously diagnosed and treated for bipolar disorder for 6 years. At that point, methylphenidate was initiated. The patient was judged to be a good treatment responder with improvements noted in the clinical global impressions severity scale. It was seen that the improvement was maintained at a 6-month follow-up. CONCLUSION: The present case reflects the importance of careful differential diagnosis when evaluating for bipolar disorder.

Incidence of ADHD in adults with severe mental health problems.

The purpose of this study was to determine the prevalence rates of attention deficit hyperactivity disorder (ADHD) and comorbid disorders in an adult inpatient psychiatric setting. Patient charts were reviewed from a state hospital in the western United States. Of the 292 persons served in 2002, only 6 received a diagnosis of ADHD. Of these patients, 2 received additional diagnoses for Major Depression, 1 for General Anxiety and 1 for Bipolar Disorder. Five of the 6 ADHD participants had a history of substance abuse and 4 were diagnosed with Personality Disorders. None of the 6 diagnosed with ADHD received a diagnosis of Learning Disability. A variety of nonstimulant medications were utilized to treat these patients. Characteristics of adult psychiatric populations are reviewed. Prevalence, comorbidity and implications for future research regarding adult ADHD are discussed.

Relationships between the WISC-III and the Cognitive Assessment System with Conners' rating scales and continuous performance tests.

The aim of this study was to examine the relationships between intelligence, ratings of behavior, and continuous performance test scores for a sample of 117 children aged 6-16 years who were referred to a specialty clinic. The sample was comprised of children who had a primary (45%) or secondary (36%) diagnosis of ADHD. All children were given the Wechsler Intelligence Scale for Children Third Edition (WISC-III), Cognitive Assessment System (CAS), Conners' Continuous Performance Test (CPT), and Conners' Parent and Teacher Rating Scales--Revised, Long Form. Correlations between Conners' Behavior Rating Scale and Conners' Continuous Performance Test were uniformly low and non-significant (the highest correlation was .17). Correlations between the WISC-III and Conners' Parent Rating Scale were all non-significant, but Teacher Ratings showed significant correlations between most of the WISC-III factors and the Cognitive Problems/Inattention scores. Few significant correlations were found between CPT with the WISC-III and CAS. These results suggest that practitioners should expect to find a lack of consistency between the scores provided by these measures and should be conservative of their use in clinical settings.

The comorbidity of Pervasive Developmental Disorder and Attention Deficit Hyperactivity Disorder: results of a retrospective chart review.

OBJECTIVE: To determine if a sample of children meeting diagnostic criteria for a Pervasive Developmental Disorder (PDD) display symptoms and impairment related to Attention Deficit Hyperactivity Disorder (ADHD) sufficient to warrant a comorbid diagnosis of ADHD. Further, do children with PDD displaying such symptoms demonstrate more impairment in daily life activities than those children only having PDD? METHOD: A retrospective chart review was conducted on children (N = 57) diagnosed with the PDD's of Autism or PDD-Not Otherwise Specified (PDD-NOS), or ADHD. Comparative analysis of questionnaire and neuropsychological test data was completed to determine the severity of ADHD-like symptoms presenting among children with PDD. RESULTS: From the pool of subjects having PDD with sufficient data (N = 27), 7 or 26% met DSM-IV criteria for the combined type of ADHD. Nine or 33% met diagnostic criteria for the Inattentive Type of ADHD and 11 or 41% did not demonstrate a significant number of ADHD symptoms to warrant a comorbid diagnosis of ADHD. Results indicate that a subgroup of children with PDD displaying significant ADHD-like symptoms may in fact have ADHD thus warranting a comorbid diagnosis of ADHD. Current data did not suggest children with PDD and the combined type of ADHD demonstrated significantly more impairment in daily life functioning than those children only having PDD. However, this appeared likely the result of small sample size. The data, however, does indicate such children experience more difficulties in daily situations as rated by parents and teachers. CONCLUSION: These findings reinforce clinical observations indicating that some children with PDD may also experience an independent comorbid condition of ADHD, suggesting that a comorbid diagnosis of ADHD with PDD be considered in such cases. If further findings are replicated, the current exclusionary DSM-IV-TR criteria of making such a comorbid diagnosis should be re-considered.