Objectives. The aim of this study was to compare the cognitive neuropsychological and the behavioral rating profiles of attention deficit/hyperactivity disorder (ADHD). Methods. Forty-two children diagnosed with ADHD (？？years, ) and 43 typically developing children ( years, ) participated. We measured symptom severity with behavioral rating scales, and we administered neuropsychological tasks to measure inhibitory performance, updating/working memory, and shifting ability. Results. On the basis of the three neuropsychological variables, the hierarchical cluster analytic method yielded a six-cluster structure. The clusters, according to the severity of the impairment, were labeled as follows: none or few symptoms, Moderate inhibition and mild shifting, moderate to severe shifting with moderate updating, moderate updating, severe updating with mild shifting, and severe updating with severe shifting. There were no systematic differences in inattention and hyperactive-impulsive behavior across the clusters. The comorbid learning disorder appeared more likely only in severe neuropsychological forms of ADHD. Conclusion. In sum, our results suggest that behavioral ratings and neuropsychological profiles converge only in the dimension of symptom severity and that atypicalities in executive functions may manifest in nonspecific everyday problems. 1. Introduction Attention deficit/hyperactivity disorder (ADHD) is one of the most frequent psychiatric disorders affecting approximately 5% of children [1, 2]. Despite its wide effects on social and academic achievements, the diagnosis has remained controversial [3]. The diagnosis of ADHD (DSM-5; [4]) is mostly based on clinical observations, parental (and rarely teacher) interviews, or rating scales, but the neuropsychological information is often missing from the protocol [5]. However, given the temporal and methodological instability (i.e., combining information from different sources) of the diagnosis [3], assessment cannot focus only on the behavioral ratings. Moreover, in order to develop a sufficient treatment plan, it is necessary to evaluate various impairments—including cognitive deficits in attention, executive functions (EF), and memory—affecting day-to-day functioning, and to determine the presence of any deficiency in adaptive skills and key competences. To point at this shortcoming of the diagnostic protocol, the aim of this study was to compare the cognitive neuropsychological and the behavioral rating profiles of ADHD. With respect to the neuropsychological impairments, children with ADHD show
References
[1]
U. P. Ramtekkar, A. M. Reiersen, A. A. Todorov, and R. D. Todd, “Sex and age differences in attention-deficit/hyperactivity disorder symptoms and diagnoses: implications for DSM-V and ICD-11,” Journal of the American Academy of Child and Adolescent Psychiatry, vol. 49, no. 3, pp. 217–228, 2010.
[2]
L. Scahill, M. Schwab-Stone, K. R. Merikangas, J. F. Leckman, H. Zhang, and S. Kasl, “Psychosocial and clinical correlates of ADHD in a community sample of school-age children,” Journal of the American Academy of Child and Adolescent Psychiatry, vol. 38, no. 8, pp. 976–984, 1999.
[3]
S. Valo and R. Tannock, “Diagnostic instability of DSM-IV adhd subtypes: effects of informant source, instrumentation, and methods for combining symptom reports,” Journal of Clinical Child and Adolescent Psychology, vol. 39, no. 6, pp. 749–760, 2010.
[4]
American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, American Psychiatric Association, Arlington, Va, USA, 5th edition, 2013.
[5]
I. S. Baron, “Attention-deficit/hyperactivity disorder: new challenges for definition, diagnosis, and treatment,” Neuropsychology Review, vol. 17, no. 1, pp. 1–3, 2007.
[6]
A. F. T. Arnsten and K. Rubia, “Neurobiological circuits regulating attention, cognitive control, motivation, and emotion: disruptions in neurodevelopmental psychiatric disorders,” Journal of the American Academy of Child and Adolescent Psychiatry, vol. 51, no. 4, pp. 356–367, 2012.
[7]
U. Pauli-Pott, S. Dalir, T. Mingebach, A. Roller, and K. Becker, “Attention deficit/hyperactivity and comorbid symptoms in preschoolers: differences between subgroups in neuropsychological basic deficits,” Child Neuropsychology, vol. 20, no. 2, pp. 230–244, 2014.
[8]
R. Martinussen and R. Tannock, “Working memory impairments in children with attention-deficit hyperactivity disorder with and without comorbid language learning disorders,” Journal of Clinical and Experimental Neuropsychology, vol. 28, no. 7, pp. 1073–1094, 2006.
[9]
E. G. Willcutt, A. E. Doyle, J. T. Nigg, S. V. Faraone, and B. F. Pennington, “Validity of the executive function theory of attention-deficit/ hyperactivity disorder: a meta-analytic review,” Biological Psychiatry, vol. 57, no. 11, pp. 1336–1346, 2005.
[10]
A. Miyake and N. P. Friedman, “The nature and organization of individual differences in executive functions: four general conclusions,” Current Directions in Psychological Science, vol. 21, no. 1, pp. 8–14, 2012.
[11]
A. Miyake, N. P. Friedman, M. J. Emerson, A. H. Witzki, A. Howerter, and T. D. Wager, “The unity and diversity of executive functions and their contributions to complex “Frontal Lobe” tasks: a latent variable analysis,” Cognitive Psychology, vol. 41, no. 1, pp. 49–100, 2000.
[12]
J. E. Lehto, P. Juuj？rvi, L. Kooistra, and L. Pulkkinen, “Dimensions of executive functioning: evidence from children,” British Journal of Developmental Psychology, vol. 21, no. 1, pp. 59–80, 2003.
[13]
D. Sj？wall, L. Roth, S. Lindqvist, and L. B. Thorell, “Multiple deficits in ADHD: executive dysfunction, delay aversion, reaction time variability, and emotional deficits,” The Journal of Child Psychology and Psychiatry, vol. 54, no. 6, pp. 619–627, 2013.
[14]
K. K. Wu, S. K. Chan, P. W. L. Leung, W.-S. Liu, F. L. T. Leung, and R. Ng, “Components and developmental differences of executive functioning for school-aged children,” Developmental Neuropsychology, vol. 36, no. 3, pp. 319–337, 2011.
[15]
L. Carr, J. Henderson, and J. T. Nigg, “Cognitive control and attentional selection in adolescents with ADHD versus ADD,” Journal of Clinical Child & Adolescent Psychology, vol. 39, no. 6, pp. 726–740, 2010.
[16]
J. T. Nigg, E. G. Willcutt, A. E. Doyle, and E. J. S. Sonuga-Barke, “Causal heterogeneity in attention-deficit/hyperactivity disorder: do we need neuropsychologically impaired subtypes?” Biological Psychiatry, vol. 57, no. 11, pp. 1224–1230, 2005.
[17]
L. M. McGrath, B. F. Pennington, M. A. Shanahan et al., “A multiple deficit model of reading disability and attention-deficit/ hyperactivity disorder: searching for shared cognitive deficits,” Journal of Child Psychology and Psychiatry and Allied Disciplines, vol. 52, no. 5, pp. 547–557, 2011.
[18]
E. J. S. Sonuga-Barke, “Psychological heterogeneity in AD/HD—a dual pathway model of behaviour and cognition,” Behavioural Brain Research, vol. 130, no. 1-2, pp. 29–36, 2002.
[19]
E. G. Willcutt, R. S. Betjemann, L. M. McGrath et al., “Etiology and neuropsychology of comorbidity between RD and ADHD: the case for multiple-deficit models,” Cortex, vol. 46, no. 10, pp. 1345–1361, 2010.
[20]
R. Lambek, R. Tannock, S. Dalsgaard, A. Trillingsgaard, D. Damm, and P. H. Thomsen, “Validating neuropsychological subtypes of ADHD: how do children with and without an executive function deficit differ?” The Journal of Child Psychology and Psychiatry, vol. 51, no. 8, pp. 895–904, 2010.
[21]
B. A. Roberts, M. M. Martel, and J. T. Nigg, “Are there executive dysfunction subtypes within ADHD?” Journal of Attention Disorders, 2013.
[22]
R. A. Barkley, “Behavioral inhibition, sustained attention, and executive functions: constructing a unifying theory of ADHD,” Psychological Bulletin, vol. 121, no. 1, pp. 65–94, 1997.
[23]
American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR), American Psychiatric Association, Arlington, Va, USA, 2000.
[24]
á. Juhász, Logopédiai vizsgálatok kézik？nyve [The Manual of Examinations in Speech Therapy], Logopédiai Kiadó, Budapest, Hungary, 2007.
[25]
J. C. Raven, Guide to Using the Coloured Progressive Matrices, H.K. Lewis, New York, NY, USA, 1965.
[26]
G. J. DuPaul, T. J. Power, A. D. Anastopoulos, and R. Reid, ADHD Rating Scale-IV: Checklists, Norms, and Clinical Interpretation, Guilford Press, New York, NY, USA, 1998.
[27]
A. T. Beck, R. A. Steer, and M. G. Carbin, “Psychometric properties of the Beck depression inventory: twenty-five years of evaluation,” Clinical Psychology Review, vol. 8, no. 1, pp. 77–100, 1988.
[28]
J. F. Leckman, M. A. Riddle, M. T. Hardin et al., “The yale global tic severity scale: initial testing of a clinician-rated scale of tic severity,” Journal of the American Academy of Child and Adolescent Psychiatry, vol. 28, no. 4, pp. 566–573, 1989.
[29]
L. Scahill, M. A. Riddle, M. McSwiggin-Hardin et al., “Children's yale-brown obsessive compulsive scale: reliability and validity,” Journal of the American Academy of Child and Adolescent Psychiatry, vol. 36, no. 6, pp. 844–852, 1997.
[30]
D. V. Sheehan, Y. Lecrubier, K. H. Sheehan et al., “The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10,” Journal of Clinical Psychiatry, vol. 59, supplement 20, pp. 22–33, 1998.
[31]
C. J. Golden, Stroop Color and Word Test: A Manual for Clinical and Experimental Uses, Stoelting Co., Chicago, Ill, USA, 1978.
[32]
D. Wechsler, Wechsler Intelligence Scale for Children, The Psychological Corporation, San Antonio, Tex, USA, 1991.
[33]
S. Whitaker, “WISC‐IV and low IQ: review and comparison with the WAIS‐III,” Educational Psychology in Practice, vol. 24, no. 2, pp. 129–137, 2008.
[34]
R. K. Heaton, G. J. Chelune, J. L. Talley, G. G. Kay, and G. Curtiss, Wisconsin Card Sorting Test Manual: Revised and Expanded, Psychological Assessment Resources, Odessa, Fla, USA, 1993.
[35]
L. C. Morey, R. K. Blashfield, and H. A. Skinner, “A comparison of cluster analysis techniques withing a sequential validation framework,” Multivariate Behavioral Research, vol. 18, no. 3, p. 309, 1983.
[36]
A. von Eye and L. R. Bergman, “Research strategies in developmental psychopathology: dimensional identity and the person-oriented approach,” Development and Psychopathology, vol. 15, no. 3, pp. 553–580, 2003.
[37]
A. Vargha, Matematikai Statisztika Pszichológiai, Nyelvészetiés Biológiai Alkalmazásokkal. 2. Kiadás [Mathematical Statistics with Applications in Psychology, Linguistics, and Biology, Pólya Kiadó, Budapest, Hungary, 2nd edition, 2007.
[38]
P. F. A. de Nijs, R. F. Ferdinand, and F. C. Verhulst, “No hyperactive-impulsive subtype in teacher-rated attention-deficit/ hyperactivity problems,” European Child and Adolescent Psychiatry, vol. 16, no. 1, pp. 25–32, 2007.
[39]
J. Elia, M. Arcos-Burgos, K. L. Bolton, P. J. Ambrosini, W. Berrettini, and M. Muenke, “ADHD latent class clusters: DSM-IV subtypes and comorbidity,” Psychiatry Research, vol. 170, no. 2-3, pp. 192–198, 2009.
[40]
J. J. Hudziak, A. C. Heath, P. F. Madden, et al., “Latent class and factor analysis of DSM-IV ADHD: a twin study of female adolescents,” Journal of the American Academy of Child and Adolescent Psychiatry, vol. 37, no. 8, pp. 848–857, 1998.
[41]
J. J. Hudziak, M. E. Wadsworth, A. C. Heath, and T. M. Achenbach, “Latent class analysis of child behavior checklist attention problems,” Journal of the American Academy of Child and Adolescent Psychiatry, vol. 38, no. 8, pp. 985–991, 1999.
[42]
A. Kóbor, á. Takács, R. Urbán, and V. Csépe, “The latent classes of subclinical ADHD symptoms: convergences of multiple informant reports,” Research in Developmental Disabilities, vol. 33, no. 5, pp. 1677–1689, 2012.
[43]
R. J. Neuman, A. Heath, W. Reich et al., “Latent class analysis of ADHD and comorbid symptoms in a population sample of adolescent female twins,” Journal of Child Psychology and Psychiatry, vol. 42, no. 7, pp. 933–942, 2001.
[44]
R. J. Neuman, R. D. Todd, A. C. Heath, et al., “Evaluation of ADHD typology in three contrasting samples: a latent class approach,” Journal of the American Academy of Child and Adolescent Psychiatry, vol. 38, no. 1, pp. 25–33, 1999.
[45]
E. R. Rasmussen, R. J. Neuman, A. C. Heath, F. Levy, D. A. Hay, and R. D. Todd, “Replication of the latent class structure of attention-deficit/hyperactivity disorder (ADHD) subtypes in a sample of Australian twins,” Journal of Child Psychology and Psychiatry and Allied Disciplines, vol. 43, no. 8, pp. 1018–1028, 2002.
[46]
L. R. Bergman, D. Magnusson, and B. M. El-Khouri, Studying Individual Development in an Interindividual Context: A Person-Oriented Approach, Lawrence Erlbaum Associates, Mahwah, NJ, USA, 2003.
[47]
L. R. Bergman and B. M. El-Khouri, “Developmental processes and the modern typological perspective,” European Psychologist, vol. 6, no. 3, pp. 177–186, 2001.
[48]
J. B. Hale, L. A. Reddy, M. Semrud-Clikeman et al., “Executive impairment determines ADHD medication response: implications for academic achievement,” Journal of Learning Disabilities, vol. 44, no. 2, pp. 196–212, 2011.
[49]
S. Jonsdottir, ADHD and Its Relationship to Comorbidity and Gender, Rijksuniversiteit Groningen, Groningen, The Netherlands, 2006.
