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Clock drawing performance in children with attention deficit hyperactivity disorder
690
Abstracts from the 19th Annual Meeting
Delta (r = -.5087, p < .05), and Theta (r = -.5408, p < .05) abnormalities were negatively correlated with T O V A Response Time. For the off-MPH group, it appears that slow wave activity is overrepresented in inattentiveness, information processing speed, and variability in attention. For both drug conditions, increases in slow activity in the delta and theta bandpasses are correlated with slower response time, which in turn likely reflects decreased information processing speed (Lubar et al., in press). Further examination revealed that the increased slow wave activity was not likely due to physical artifact. In summary, age-dependent Q E E G measures may reveal meaningful relationships in E E G data which may not be readily discernible otherwise.
Schafer, V., & Bunner, M. Auditory Processing in Clinic Referred Children with ADHD. Auditory processing was examined in 54 children (mean chronological age = 8.6) with A D H D , Primarily Inattentive Type (ADHD-PI) and 49 children with A D H D , Combined Type (ADHD-C). Auditory processing was measured with the Screening Test for Auditory Processing (SCAN). The SCAN includes subtests that measure the child's ability to repeat filtered words (Filtered Words subtest), the child's ability to repeat monaurally presented words with cafeteria noise in the background (Figure-Ground subtest), and the child's dichotic listening skills (Competing Words subtest). Each A D H D subtype was divided into impaired versus intact auditory processing groups based on their SCAN scores. Thirty-eight percent of the children with ADHD-PI and 18% of the A D H D - C group evidenced impaired auditory processing. Analysis of variance and exploratory pairwise comparisons were utilized to examine group differences on the SCAN total score. The A D H D - P I impaired auditory processing group was found to have significantly poorer total SCAN scores compared to the A D H D - C impaired auditory processing group. Implications for interventions and discussion of possible neurological correlates between auditory processing and A D H D are discussed. Kibby, M. Y., Cohen, M. J., & Hynd, G. W. Clock Drawing Performance in Children with Attention Deficit Hyperactivity Disorder. Clock drawing has been found to be sensitive to planning and organizational skills, along with constructional praxis and graphomotor abilities, in various adult populations. However, little research has been conducted with pediatric populations. As children with A D H D frequently display deficits in executive functioning, it was of interest to determine how they would perform on a clock drawing task. Participants included 41 children with A D H D (16 Predominantly Inattentive Type and 25 Combined Type) and 41 normal controls between the ages of 6 and 12 years who were matched for age, gender, and handedness. The clock drawing task developed by Edmonds et al. was utilized as it has separate scoring criteria for clock construction and conceptualization of time. Analyses with mixed factor A N O V A revealed that children with Predominantly Inattentive Type performed comparably to those with Combined Type on both clock face construction and setting the hands to the requested time (ps > .10). Nevertheless, children with A D H D as a group performed significantly worse than controls on both construction and hand placement (ps < .01). Backward regression was then used to determine which cognitive domains would be predictive of clock face construction and time conceptualization in children with A D H D . Independent measures were selected from the following domains: executive functioning (Wisconsin Card Sorting Test Perseverative Errors and Failure to Maintain Set), constructional praxis (Developmental Test of Visual Motor Integration, Block Design from the WISC-III), visual-spatial perception (Gestalt Closure
Abstracts from the 19th Annual Meeting
691
from the KABC), verbal reasoning (Similarities from the WISC-III), and language functioning (Peabody Picture Vocabulary Test-Revised, Formulated Sentences from the CELF-R). In terms of clock construction, four variables remained in the equation and successfully explained 43% of the variance in performance, including WCST Perseverative Errors and Failure to Maintain Set, Block Design, and the PPVT-R. In terms of hand placement, one variable remained in the equation and successfully explained 28% of the variance in performance: Gestalt Closure. Thus, it appears that children with A D H D present with poor clock drawing performance as compared to controls regardless of subtype, and executive functioning is a predictor of this reduced performance, along with visual-spatial functioning and receptive language.
Willen, E., Espe-Pfeifer, P., Devaraju-Backhaus, S., Mahrou, M., Michael, D., Golden, C., & Burns, W. J. An Analysis of Attention and Learning Deficits in A D H D and LD Children. This study investigated the utility of the Wide Range Assessment of Memory and Learning (WRAML) in identifying performance differences between children with Attention Deficit Hyperactivity Disorder (ADHD) and those with a learning disability (LD). Fifty-nine children with A D H D only and 66 children with LD only were included in the study. All children received a comprehensive neuropsychological evaluation and behavioral assessment prior to receiving the above diagnoses. No significant differences in performance between the two groups were found on three of the W R A M L Indices; the General Memory Index (GMI), Verbal Memory Index, and Visual Memory Index. However, A D H D children were found to score significantly higher on the Learning Index than LD children (F = 6.37, p < .0l) despite the fact that these two groups had similar IQs (as measured by the WISC-III) and similar GMI scores. The Learning Index measures the examinee's ability to acquire new information over multiple trials. Of the three subtests comprising this index, a significant difference was found on the Visual Learning subtest, with the LD children performing more poorly than those with A D H D (F = 4.97, p < .03). The reason that this subtest may have accounted for the significant finding on the Learning Index is because it is the most complex of the three subtests, and the demands of implicit memory may be greater. It is likely that, for the A D H D child, a learning difficulty is more an attentional rather than storage problem per se, whereas for the LD child it may be the reverse. The child with LD may attend well to the information presented, but still not be able to process this information adequately.
Cuibertson, W. C., Ziilmer, E. A., & Di Pinto, M. The Relationship of a Neuropsychological Model of Inhibitory Control to the TOL Dx Performance of A D H D Children. Numerous theoretical models have been proposed to account for the etiology, symptom manifestation, and response to treatment of childhood attention-deficit hyperactivity disorder (ADHD). Attention is currently centering on Barkley's (1997) model of A D H D as a disorder of self-regulation, namely impaired inhibitory control. Inhibitory control involves three interrelated neuropsychological processes: (a) inhibiting the initial prepotent response to an event; (b) stopping an ongoing response, thus allowing the delay necessary to decide whether the response should be altered or continued; and (c) protecting this period of delay from disruption by competing stimuli (resistance to distraction). Children exhibiting A D H D are hypothesized to manifest deficits in these three interrelated processes. The Tower of London-Drexel (TOL °x) is a measure of executive planning that has been found to differentiate A D H D and control children (Culbertson & Zillmer, 1998a,b). Multivariant analysis (factor analysis) has revealed that
Abstracts from the 19th Annual Meeting
Delta (r = -.5087, p < .05), and Theta (r = -.5408, p < .05) abnormalities were negatively correlated with T O V A Response Time. For the off-MPH group, it appears that slow wave activity is overrepresented in inattentiveness, information processing speed, and variability in attention. For both drug conditions, increases in slow activity in the delta and theta bandpasses are correlated with slower response time, which in turn likely reflects decreased information processing speed (Lubar et al., in press). Further examination revealed that the increased slow wave activity was not likely due to physical artifact. In summary, age-dependent Q E E G measures may reveal meaningful relationships in E E G data which may not be readily discernible otherwise.
Schafer, V., & Bunner, M. Auditory Processing in Clinic Referred Children with ADHD. Auditory processing was examined in 54 children (mean chronological age = 8.6) with A D H D , Primarily Inattentive Type (ADHD-PI) and 49 children with A D H D , Combined Type (ADHD-C). Auditory processing was measured with the Screening Test for Auditory Processing (SCAN). The SCAN includes subtests that measure the child's ability to repeat filtered words (Filtered Words subtest), the child's ability to repeat monaurally presented words with cafeteria noise in the background (Figure-Ground subtest), and the child's dichotic listening skills (Competing Words subtest). Each A D H D subtype was divided into impaired versus intact auditory processing groups based on their SCAN scores. Thirty-eight percent of the children with ADHD-PI and 18% of the A D H D - C group evidenced impaired auditory processing. Analysis of variance and exploratory pairwise comparisons were utilized to examine group differences on the SCAN total score. The A D H D - P I impaired auditory processing group was found to have significantly poorer total SCAN scores compared to the A D H D - C impaired auditory processing group. Implications for interventions and discussion of possible neurological correlates between auditory processing and A D H D are discussed. Kibby, M. Y., Cohen, M. J., & Hynd, G. W. Clock Drawing Performance in Children with Attention Deficit Hyperactivity Disorder. Clock drawing has been found to be sensitive to planning and organizational skills, along with constructional praxis and graphomotor abilities, in various adult populations. However, little research has been conducted with pediatric populations. As children with A D H D frequently display deficits in executive functioning, it was of interest to determine how they would perform on a clock drawing task. Participants included 41 children with A D H D (16 Predominantly Inattentive Type and 25 Combined Type) and 41 normal controls between the ages of 6 and 12 years who were matched for age, gender, and handedness. The clock drawing task developed by Edmonds et al. was utilized as it has separate scoring criteria for clock construction and conceptualization of time. Analyses with mixed factor A N O V A revealed that children with Predominantly Inattentive Type performed comparably to those with Combined Type on both clock face construction and setting the hands to the requested time (ps > .10). Nevertheless, children with A D H D as a group performed significantly worse than controls on both construction and hand placement (ps < .01). Backward regression was then used to determine which cognitive domains would be predictive of clock face construction and time conceptualization in children with A D H D . Independent measures were selected from the following domains: executive functioning (Wisconsin Card Sorting Test Perseverative Errors and Failure to Maintain Set), constructional praxis (Developmental Test of Visual Motor Integration, Block Design from the WISC-III), visual-spatial perception (Gestalt Closure
Abstracts from the 19th Annual Meeting
691
from the KABC), verbal reasoning (Similarities from the WISC-III), and language functioning (Peabody Picture Vocabulary Test-Revised, Formulated Sentences from the CELF-R). In terms of clock construction, four variables remained in the equation and successfully explained 43% of the variance in performance, including WCST Perseverative Errors and Failure to Maintain Set, Block Design, and the PPVT-R. In terms of hand placement, one variable remained in the equation and successfully explained 28% of the variance in performance: Gestalt Closure. Thus, it appears that children with A D H D present with poor clock drawing performance as compared to controls regardless of subtype, and executive functioning is a predictor of this reduced performance, along with visual-spatial functioning and receptive language.
Willen, E., Espe-Pfeifer, P., Devaraju-Backhaus, S., Mahrou, M., Michael, D., Golden, C., & Burns, W. J. An Analysis of Attention and Learning Deficits in A D H D and LD Children. This study investigated the utility of the Wide Range Assessment of Memory and Learning (WRAML) in identifying performance differences between children with Attention Deficit Hyperactivity Disorder (ADHD) and those with a learning disability (LD). Fifty-nine children with A D H D only and 66 children with LD only were included in the study. All children received a comprehensive neuropsychological evaluation and behavioral assessment prior to receiving the above diagnoses. No significant differences in performance between the two groups were found on three of the W R A M L Indices; the General Memory Index (GMI), Verbal Memory Index, and Visual Memory Index. However, A D H D children were found to score significantly higher on the Learning Index than LD children (F = 6.37, p < .0l) despite the fact that these two groups had similar IQs (as measured by the WISC-III) and similar GMI scores. The Learning Index measures the examinee's ability to acquire new information over multiple trials. Of the three subtests comprising this index, a significant difference was found on the Visual Learning subtest, with the LD children performing more poorly than those with A D H D (F = 4.97, p < .03). The reason that this subtest may have accounted for the significant finding on the Learning Index is because it is the most complex of the three subtests, and the demands of implicit memory may be greater. It is likely that, for the A D H D child, a learning difficulty is more an attentional rather than storage problem per se, whereas for the LD child it may be the reverse. The child with LD may attend well to the information presented, but still not be able to process this information adequately.
Cuibertson, W. C., Ziilmer, E. A., & Di Pinto, M. The Relationship of a Neuropsychological Model of Inhibitory Control to the TOL Dx Performance of A D H D Children. Numerous theoretical models have been proposed to account for the etiology, symptom manifestation, and response to treatment of childhood attention-deficit hyperactivity disorder (ADHD). Attention is currently centering on Barkley's (1997) model of A D H D as a disorder of self-regulation, namely impaired inhibitory control. Inhibitory control involves three interrelated neuropsychological processes: (a) inhibiting the initial prepotent response to an event; (b) stopping an ongoing response, thus allowing the delay necessary to decide whether the response should be altered or continued; and (c) protecting this period of delay from disruption by competing stimuli (resistance to distraction). Children exhibiting A D H D are hypothesized to manifest deficits in these three interrelated processes. The Tower of London-Drexel (TOL °x) is a measure of executive planning that has been found to differentiate A D H D and control children (Culbertson & Zillmer, 1998a,b). Multivariant analysis (factor analysis) has revealed that