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Inattention in adults with ADHD: selective attention and negative priming
774
Abstracts /Archives
of Clinical Neuropsychology
IS (2000) 653450
Results from a multivariate analysis of variance (MANOVA) indicated that the 4 groups were not statistically significantly different on the neuropsychological measures, W&s Lambda = 0.824, F(57,880) = 1.034, p = 0.409, power=0.99. The results of the present study suggest that PTSD veterans perform at a similar level to demographically matched-control normals and to demographic and comorbid psychiatric controls. Differences between these negative findings and previous positive findings are most likely due to (a) a failure to carefully control confounding variables in previous studies, and/or (b) the sampling procedures used in the present study-a random sampling of all Vietnam era army veterans regardless of whether or not they are currently seeking treatment.
The relationship between psychopathology Andrikopolous .I
and cognitive performance
The impact of psychiatric illness on neuropsychological functioning has been studied extensively. The present study includes a carefully selected group of 49 consecutive outpatients administered neuropsychological testing, including the MMPI-2. Inclusion criteria required a self-reported memory complaint, an examination by a neurologist, and a CT or MRI of the brain. The final diagnoses in these patients included adjustment, mood, and somatoform disorders as the most likely explanation for their memory complaints. Any patient with psychosis was excluded. Twenty-six patients had a past or present history of psychiatric treatment. Mean scale elevations for the group that were at a T-score of 65 or above were D (68.04), f@ (65.49), Pt (66.61) and SC (65.88). A MMPI-2 Impairment Index (MII) was developed by adding the T-scores of the 10 basic clinical scales for each subject and dividing the total by 10. The average MI1 for the group was a T-score of 54 (SD=6). The 2 groups were then divided into a high psychopathology group (HPG = 2 1) and a low psychopathology group (LPG = 28) based on T-scores falling at or below the mean or above. The HPG has significantly higher scores on E;: Hs, D, Hy, Pd, Mf Pa, Pt, SC, and Si compared to the LPG. The 2 groups were compared on selected subtests of the WAIS-R (Information, Similarities, Arithmetic, Digit Span, Picture Completion, Digit Symbol Substitution, and Block Design), measures of attention (Symbol Digit Modalities, Trail Making and Line Cancellation), language (Token Test, Naming and Controlled Oral Word from the Multilingual Aphasia Examination), visuocognitive function (Judgment of Line Orientation and Facial Recognition Test) and psychomotor speed and dexterity (Finger Tapping and Grooved Pegboard). There were no differences between groups in age, education, history of psychiatric illness, or gender composition. The HPG performed significantly worse only on Digit Symbol Substitution (~~0.05). The present findings suggest that, at least for non-psychotic psychiatric outpatients, the effects of psychopathology on cognitive function are minimal. Small sample size is not likely to account for the lack of significance since it is comparable to other studies examining the same question. This study, however, differs from others in the strict selection criteria that allowed the ruling out of any potential organic cause that may explain why other studies have found more significant differences.
Inattention in adults with ADHD: selective attention and negative priming Martin RT Hayes K, Armstrong CL. Neurocognitive studies have attempted to explore the mechanisms that are responsible for the symptoms of inattention seen in ADHD. These mechanisms have been attributed to executive dysfunction, poor response inhibition, and/or a failure to inhibit irrelevant stimuli (defective selective
Abstracts /Archives
of Clinical Neuropsychology
775
I5 (2000) 653-850
attention). Children with ADHD have shown a strong response disinhibition, but adults have not. Children also often display deficits in selective attention. However, little research has been done in adults. We hypothesized that inattention occurs due to an inability to inhibit irrelevant information. We examined whether adults with ADHD would display a selective attention deficit in both a visual perceptual task and a word memory task using a negative priming paradigm. Adults with ADHD screened for co-morbidity, and healthy controls were matched in Vocabulary scores, but not age. They were asked to visually match nonsense designs in one task with stimuli devised by Treisman, and recall a word described by a definition in the other task developed by Yanev. We hypothesized that ADHD adults would not produce slower reaction times (RT) in matching the irregular shapes when the target was a previous distracter (ADHD n = 9; control n = 8). In the word memory task (ADHD n = 11; control n = lo), we predicted a lack of negative priming would be shown as similar lexical decision RTs to words the subject did and did not know. Controlling for age, the groups were not different in the RT on either task, but on the visual perceptual task, neither group showed a negative priming effect, nor were they different from each other. In the word memory task, negative priming occurred (both groups were slower to recognize words that they did not know vs. did know). However, there was a trend for the ADHD group to show a relative lack of negative priming when co-varied by age. Results suggest that adults with ADHD demonstrate a failure of selective attention in their inhibition of word memory searches, but not in visual perceptual matches.
Diagnostic utllity of discrepancies between intellectual and frontal/executive adults with ADHD: considerations for patients with above average IQ Woods Se Lovejoy
DY
functioning
among
Stutts ML, Ball JD, Fals-Stewart W
The present study evaluates an alternative method of neuropsychological test interpretation for the identification of attention-deficit/hyperactivity disorder (ADHD) in adults. The performance of 26 adult ADHD and 26 matched control subjects were analyzed in terms of measured discrepancies between intellectual functioning and scores on a battery of 6 established frontal/executive tests. Consistent with current literature showing strong relationships between IQ and executive measures, data from participants exhibiting above average intellectual functioning were analyzed using a 1 SD discrepancy criterion for impairment on the frontal/executive tasks. Conversely, participants demonstrating IQ scores in the average range and below were analyzed in terms of standard cut-off scores based on the available published normative data for each of the individual measures. Compared to the healthy controls, the ADHD adults demonstrated significantly greater impairment on the dependent measures, ultimately providing a large strength of association. A subsequent ROC curve analysis for the battery considered as a whole was highly significant, including excellent sensitivity and predictive values. In sum, the present study provides strong support for combined interpretive approaches to facilitate diagnostic accuracy for the classification of ADHD adults as compared to normal controls. The clinical and theoretical implications of this research are discussed.
Neuropsychological
correlates of adult attention deficit disorder (ADHD)
Ma&in RS. Attention deficit disorder (ADHD) is now considered a syndrome that can persist into adulthood. Despite recent research, there is still a paucity of data investigating neuropsychological deficits
Abstracts /Archives
of Clinical Neuropsychology
IS (2000) 653450
Results from a multivariate analysis of variance (MANOVA) indicated that the 4 groups were not statistically significantly different on the neuropsychological measures, W&s Lambda = 0.824, F(57,880) = 1.034, p = 0.409, power=0.99. The results of the present study suggest that PTSD veterans perform at a similar level to demographically matched-control normals and to demographic and comorbid psychiatric controls. Differences between these negative findings and previous positive findings are most likely due to (a) a failure to carefully control confounding variables in previous studies, and/or (b) the sampling procedures used in the present study-a random sampling of all Vietnam era army veterans regardless of whether or not they are currently seeking treatment.
The relationship between psychopathology Andrikopolous .I
and cognitive performance
The impact of psychiatric illness on neuropsychological functioning has been studied extensively. The present study includes a carefully selected group of 49 consecutive outpatients administered neuropsychological testing, including the MMPI-2. Inclusion criteria required a self-reported memory complaint, an examination by a neurologist, and a CT or MRI of the brain. The final diagnoses in these patients included adjustment, mood, and somatoform disorders as the most likely explanation for their memory complaints. Any patient with psychosis was excluded. Twenty-six patients had a past or present history of psychiatric treatment. Mean scale elevations for the group that were at a T-score of 65 or above were D (68.04), f@ (65.49), Pt (66.61) and SC (65.88). A MMPI-2 Impairment Index (MII) was developed by adding the T-scores of the 10 basic clinical scales for each subject and dividing the total by 10. The average MI1 for the group was a T-score of 54 (SD=6). The 2 groups were then divided into a high psychopathology group (HPG = 2 1) and a low psychopathology group (LPG = 28) based on T-scores falling at or below the mean or above. The HPG has significantly higher scores on E;: Hs, D, Hy, Pd, Mf Pa, Pt, SC, and Si compared to the LPG. The 2 groups were compared on selected subtests of the WAIS-R (Information, Similarities, Arithmetic, Digit Span, Picture Completion, Digit Symbol Substitution, and Block Design), measures of attention (Symbol Digit Modalities, Trail Making and Line Cancellation), language (Token Test, Naming and Controlled Oral Word from the Multilingual Aphasia Examination), visuocognitive function (Judgment of Line Orientation and Facial Recognition Test) and psychomotor speed and dexterity (Finger Tapping and Grooved Pegboard). There were no differences between groups in age, education, history of psychiatric illness, or gender composition. The HPG performed significantly worse only on Digit Symbol Substitution (~~0.05). The present findings suggest that, at least for non-psychotic psychiatric outpatients, the effects of psychopathology on cognitive function are minimal. Small sample size is not likely to account for the lack of significance since it is comparable to other studies examining the same question. This study, however, differs from others in the strict selection criteria that allowed the ruling out of any potential organic cause that may explain why other studies have found more significant differences.
Inattention in adults with ADHD: selective attention and negative priming Martin RT Hayes K, Armstrong CL. Neurocognitive studies have attempted to explore the mechanisms that are responsible for the symptoms of inattention seen in ADHD. These mechanisms have been attributed to executive dysfunction, poor response inhibition, and/or a failure to inhibit irrelevant stimuli (defective selective
Abstracts /Archives
of Clinical Neuropsychology
775
I5 (2000) 653-850
attention). Children with ADHD have shown a strong response disinhibition, but adults have not. Children also often display deficits in selective attention. However, little research has been done in adults. We hypothesized that inattention occurs due to an inability to inhibit irrelevant information. We examined whether adults with ADHD would display a selective attention deficit in both a visual perceptual task and a word memory task using a negative priming paradigm. Adults with ADHD screened for co-morbidity, and healthy controls were matched in Vocabulary scores, but not age. They were asked to visually match nonsense designs in one task with stimuli devised by Treisman, and recall a word described by a definition in the other task developed by Yanev. We hypothesized that ADHD adults would not produce slower reaction times (RT) in matching the irregular shapes when the target was a previous distracter (ADHD n = 9; control n = 8). In the word memory task (ADHD n = 11; control n = lo), we predicted a lack of negative priming would be shown as similar lexical decision RTs to words the subject did and did not know. Controlling for age, the groups were not different in the RT on either task, but on the visual perceptual task, neither group showed a negative priming effect, nor were they different from each other. In the word memory task, negative priming occurred (both groups were slower to recognize words that they did not know vs. did know). However, there was a trend for the ADHD group to show a relative lack of negative priming when co-varied by age. Results suggest that adults with ADHD demonstrate a failure of selective attention in their inhibition of word memory searches, but not in visual perceptual matches.
Diagnostic utllity of discrepancies between intellectual and frontal/executive adults with ADHD: considerations for patients with above average IQ Woods Se Lovejoy
DY
functioning
among
Stutts ML, Ball JD, Fals-Stewart W
The present study evaluates an alternative method of neuropsychological test interpretation for the identification of attention-deficit/hyperactivity disorder (ADHD) in adults. The performance of 26 adult ADHD and 26 matched control subjects were analyzed in terms of measured discrepancies between intellectual functioning and scores on a battery of 6 established frontal/executive tests. Consistent with current literature showing strong relationships between IQ and executive measures, data from participants exhibiting above average intellectual functioning were analyzed using a 1 SD discrepancy criterion for impairment on the frontal/executive tasks. Conversely, participants demonstrating IQ scores in the average range and below were analyzed in terms of standard cut-off scores based on the available published normative data for each of the individual measures. Compared to the healthy controls, the ADHD adults demonstrated significantly greater impairment on the dependent measures, ultimately providing a large strength of association. A subsequent ROC curve analysis for the battery considered as a whole was highly significant, including excellent sensitivity and predictive values. In sum, the present study provides strong support for combined interpretive approaches to facilitate diagnostic accuracy for the classification of ADHD adults as compared to normal controls. The clinical and theoretical implications of this research are discussed.
Neuropsychological
correlates of adult attention deficit disorder (ADHD)
Ma&in RS. Attention deficit disorder (ADHD) is now considered a syndrome that can persist into adulthood. Despite recent research, there is still a paucity of data investigating neuropsychological deficits