The relationship between executive function abilities, adaptive behaviour, and academic achievement in children with externalising behaviour problems.

This study investigated (1) whether attention deficit/hyperactivity disorder (AD/HD) is associated with executive functioning (EF) deficits while controlling for oppositional defiant disorder/conduct disorder (ODD/CD), (2) whether ODD/CD is associated with EF deficits while controlling for AD/HD, and (3) whether a combination of AD/HD and ODD/CD is associated with EF deficits (and the possibility that there is no association between EF deficits and AD/HD or ODD/CD in isolation). Subjects were 99 children ages 6-12 years. Three putative domains of EF were investigated using well-validated tests: verbal fluency, working memory, and planning. Independent of ODD/CD, AD/HD was associated with deficits in planning and working memory, but not in verbal fluency. Only teacher rated AD/HD, but not parent rated AD/HD, significantly contributed to the prediction of EF task performance. No EF deficits were associated with ODD/CD. The presence of comorbid AD/HD accounts for the EF deficits in children with comorbid AD/HD+ODD/CD. These results suggest that EF deficits are unique to AD/HD and support the model proposed by R. A. Barkley (1997).

Predictors of risky driving among teen drivers with ADHD during U.S. COVID-19 shelter in place orders

Clinical expression and treatment response among children with comorbid obsessive compulsive disorder and attention-deficit/hyperactivity disorder

Although the relationship between attention-deficit/hyperactivity disorder (ADHD) and transport accidents has been shown, there is limited information on the relationship between medication and dose-response effects and transport accident risk. This study aims to determine whether young people with ADHD, including adolescents, are more prone to transport accidents than those without, and the extent to which methylphenidate (MPH) prescription in these patients reduces the risk. We identified 114 486 patients diagnosed with ADHD from Taiwan's National Health Insurance Research Database from 1997 to 2013. Using a Cox regression model, we compared the risk of transport accidents between ADHD and non-ADHD groups and estimated the effect of MPH on accidents. Furthermore, we applied a self-control case-series analysis to compare the risk of accidents during the medication periods with the same patients' non-medication periods. Male ADHD patients had a higher risk of transport accidents than non-ADHD individuals (adjusted hazard ratio [aHR] = 1.24, [95% confidence interval (CI) 1.10-1.39]), especially for those comorbid with epilepsy, oppositional defiant disorder/conduct disorder (ODD/CD), and intellectual disabilities (ID). Female ADHD patients showed no relationship, except for comorbid with autism spectrum disorder (ASD) or ID. We found a reduced risk of transport accidents in patients with ADHD with MPH medication than those without MPH, with a plausible dose-response relationship (aHR of 0.23 to 0.07). A similar pattern was found in self-controlled case-series analysis. Male patients with ADHD, especially those comorbid with epilepsy, ODD/CD, or ID, were at high risk of transport accidents. Female patients, when comorbid with ASD or ID, also exhibited a higher risk of accidents. MPH treatment lowered the accident risk with a dose-response relationship.

Several nonpsychotic psychiatric disorders in childhood and adolescence can precede the onset of schizophrenia, but the etiology of this relationship remains unclear. We investigated to what extent the association between schizophrenia and psychiatric disorders in childhood is explained by correlated genetic risk factors. Polygenic risk scores (PRS), reflecting an individual's genetic risk for schizophrenia, were constructed for 2588 children from the Netherlands Twin Register (NTR) and 6127 from the Avon Longitudinal Study of Parents And Children (ALSPAC). The associations between schizophrenia PRS and measures of anxiety, depression, attention deficit hyperactivity disorder (ADHD), and oppositional defiant disorder/conduct disorder (ODD/CD) were estimated at age 7, 10, 12/13, and 15 years in the 2 cohorts. Results were then meta-analyzed, and a meta-regression analysis was performed to test differences in effects sizes over, age and disorders. Schizophrenia PRS were associated with childhood and adolescent psychopathology. Meta-regression analysis showed differences in the associations over disorders, with the strongest association with childhood and adolescent depression and a weaker association for ODD/CD at age 7. The associations increased with age and this increase was steepest for ADHD and ODD/CD. Genetic correlations varied between 0.10 and 0.25. By optimally using longitudinal data across diagnoses in a multivariate meta-analysis this study sheds light on the development of childhood disorders into severe adult psychiatric disorders. The results are consistent with a common genetic etiology of schizophrenia and developmental psychopathology as well as with a stronger shared genetic etiology between schizophrenia and adolescent onset psychopathology.

Motor coordination abilities are related to cognitive abilities and academic achievement in children with neurodevelopmental disorders. However, the similarities and differences of these relationships in children with autism spectrum disorder (ASD) and attention deficit/hyperactivity disorder (AD/HD) have not been explored. The purpose of this study was to investigate the relationship between motor coordination abilities, cognitive abilities, and academic achievement in Japanese children with ASD and AD/HD. Participants included 20 children with ASD, 20 children with AD/HD, and 20 typically developing children, matched for age and gender. Their motor coordination abilities were assessed with the Movement Assessment Battery for Children-2 (MABC-2). Furthermore, cognitive ability and academic achievement were assessed with the Kauffman Assessment Battery for Children-II (K-ABCII). Results demonstrated that the MABC-2 Total score significantly correlated with the K-ABCII Simultaneous processing, Planning, Total cognitive ability, Writing and Arithmetic scores in children with ASD. However, in children with AD/HD, there was no significant correlation between MABC-2 and K-ABCII subscale scores. The results of this study indicated that the relationship between motor coordination ability, cognitive ability, and academic achievement differs between ASD and AD/HD. This difference might indicate the non-similarity of neurological characteristics and encourage consideration for an approach that accommodates the features of neurodevelopmental disorders in children.

Developmental dyslexia (DD) and attention-deficit/hyperactivity disorder (ADHD) are two of the most common neurodevelopmental disorders among school-age children. These disorders frequently co-occur, with up to 40–50% of children with one diagnosis meeting criteria for the other, and similar percentages of children with either DD or ADHD exhibiting impaired executive functions (EF). Although both ADHD and EF deficits are common in dyslexia, there is little evidence about how ADHD and EF deficits specifically influence the brain basis of reading difficulty in dyslexia, and whether the influences of ADHD and EF on dyslexia can be disentangled. The goal of the current study was to investigate, at both behavioral and brain levels, whether reading performance in individuals with dyslexia is more strongly associated with EF or with diagnostic status of comorbid ADHD. We examined reading abilities and EF in children (8-13 years old) with typical reading ability, DD only, or both DD + ADHD. Across both groups with dyslexia, impaired EF was associated with greater impairment on measures loading onto a reading fluency, but not a reading accuracy, factor. There were no significant differences between the DD and DD + ADHD groups on measures of reading fluency or reading accuracy. During functional magnetic resonance imaging (fMRI) while performing a rhyme-matching reading task requiring phonological awareness, typically developing readers showed greater left-hemisphere reading network activation than children with DD or DD + ADHD. Children with DD and DD + ADHD did not show differential activation, but DD children with unimpaired EF showed greater activation than those with impaired EF in reading-related areas. Thus, ADHD status alone had no measurable influence on reading performance or brain activation. Impaired EF in dyslexia, independent of ADHD status, was associated with greater deficits in reading fluency and greater reductions of activation in response to print in the typical left-hemisphere reading network.

ObjectiveThe pathophysiology of attention-deficit/hyperactivity disorder (ADHD) is complicated by high rates of psychiatric comorbidities; thus, delineating unique vs shared functional brain perturbations is critical in elucidating illness pathophysiology. We investigated resting-state functional magnetic resonance imaging (rsfMRI)–complexity alterations among children with ADHD, oppositional defiant disorder (ODD), and obsessive-compulsive disorder (OCD), respectively, and comorbid ADHD, ODD, and OCD, within the cool and hot executive function (EF) networks.MethodWe leveraged baseline data from 9- to 10-year-old children in the Adolescent Brain and Cognitive Development (ABCD) Study. Data for children who singularly met all DSM-5 behavioral criteria for ADHD (n = 61), ODD (n = 38), and OCD (n = 48), respectively, were extracted, alongside data for children with comorbid ADHD, ODD, OCD, and/or other psychiatric diagnoses (n = 833). Data for a control sample of age-, sex-, and developmentally matched children were also extracted (N = 269). Voxel-wise sample entropy (SampEn) was computed using the LOFT Complexity Toolbox. Mean SampEn within all regions of interest (ROIs) of the EF networks was calculated for each participant. Hierarchical models with generalized estimating equations compared SampEn of comorbidity-free and comorbid ADHD, ODD, and OCD within the EF networks.ResultsSampEn was reduced in comorbidity-free ADHD and ODD in overlapping regions of both EF networks compared with the healthy controls, including the bilateral superior frontal gyrus, anterior/posterior cingulate gyrus, and bilateral caudate (Wald statistic = 5.682-10.798, p < .05, and Benjamini–Hochberg [BH] corrected), with ADHD additionally affected in the right inferior/middle frontal gyrus and bilateral frontal orbital cortex (Wald statistic = 7.231-9.420, p < 0.05, and BH corrected). Among comorbid presentations, the presence of ADHD symptomatology was associated with significantly lower SampEn in every ROI (z = −3.973 to −2.235, p < .05, and BH corrected).ConclusionADHD and ODD shared common impairments underlying the EF networks in the comorbidity-free presentations, with ADHD showing more widespread complexity reduction. When ADHD co-occurred with other psychiatric disorders, the reduction in SampEn extended beyond the regions affected in comorbidity-free ADHD, indicating that comorbidities amplify neural complexity deficits. In contrast, no significant SampEn alterations were observed in OCD, whether presented alone or in combination with ADHD.

Perceived social competence is one of the effective factors in improvement of self-esteem and self-efficacy in the adolescents affected by psychological disorders. The present study aims to investigate the effect of Emotional Intelligence Training (EIT) on social competence (SC) in the adolescents affected by attention deficit hyperactivity disorder (ADHD). This study is a quasi-experimental research with pretest-posttest design and control group. The population includes all the adolescents of 13-17 years who have referred to psychological treatment centers. The samples were selected by convenience sampling and one of the treatment centers was chosen to perform the study. Among the 135 adolescents receiving the ADHD diagnosis, 40 adolescents were assigned to two 20-people groups including the experimental and control groups by simple random sampling. Finally, the subjects of the experimental group received EIT for eight 45-min sessions. Data collection was done by Social Competence Questionnaire (SCQ, Prandin; 2006) that was filled by the subjects. The collected data was analyzed by SPSS-23. According to the findings, EIT has improved the components of social competence in the adolescents affected by ADHD (P˂0.01). The findings suggest that EIT provides the capacity of recognizing one’s own and others’ emotions and how to regulate and express them. So, it can be effective in social competence of the adolescents affected by ADHD.

Difficulties with emotion regulation affect the majority of youth with attention-deficit/hyperactivity disorder (ADHD) and predict greater functional impairment than ADHD symptoms alone. Deficits in executive functioning are also present for most children with ADHD, and have been linked with emotion regulation difficulties in both clinical and neurotypical populations throughout development. The current study was the first to assess all three core executive functions (working memory, inhibitory control, set shifting) simultaneously in a clinically-diverse sample of children with and without ADHD and common comorbidities and investigate the extent to which they uniquely predict emotion dysregulation. A sample of 151 children ages 8-13years (M = 10.36, SD = 1.52; 52 girls; 70.2% White/Non-Hispanic) were assessed using a criterion battery of executive functioning tasks, teacher-reported ADHD symptoms, and parent-reported emotion regulation. Results of the bias-corrected, bootstrapped conditional effects path model revealed that better-developed working memory predicted better emotion regulation (β = 0.23) and fewer ADHD symptoms (β = -0.21 to -0.37), that ADHD symptoms (β = -0.18 to -0.20) independently predicted emotion dysregulation, and that working memory exerted indirect effects on emotion regulation through both inattention and hyperactivity/impulsivity (β = 0.04-0.07). Sensitivity analyses indicated that these effects were generally robust to control for age, sex, executive function interrelations, and inclusion/exclusion of children with co-occurring ASD. These findings underscore the importance of working memory (relative to inhibitory control and set shifting) and its relations with ADHD symptoms for understanding children's emotion regulation skills, and may help explain the limited efficacy of first-line ADHD treatments, which do not target working memory, for improving emotion regulation skills.

ObjectiveTo explore the influences of digital media use on the core symptoms, emotional state, life events, learning motivation, executive function (EF) and family environment of children and adolescents diagnosed with attention deficit hyperactivity disorder (ADHD) during the novel coronavirus disease 2019 (COVID-19) pandemic.MethodA total of 192 participants aged 8–16 years who met the diagnostic criteria for ADHD were included in the study. Children scoring higher than predetermined cut-off point in self-rating questionnaires for problematic mobile phone use (SQPMPU) or Young’s internet addiction test (IAT), were defined as ADHD with problematic digital media use (PDMU), otherwise were defined as ADHD without PDMU. The differences between the two groups in ADHD symptoms, EF, anxiety and depression, stress from life events, learning motivation and family environment were compared respectively.ResultsWhen compared with ADHD group without PDMU, the group with PDMU showed significant worse symptoms of inattention, oppositional defiant, behavior and emotional problems by Swanson, Nolan, and Pelham Rating Scale (SNAP), more self-reported anxiety by screening child anxiety-related emotional disorders (SCARED) and depression by depression self-rating scale for children (DSRSC), more severe EF deficits by behavior rating scale of executive function (BRIEF), more stress from life events by adolescent self-rating life events checklist (ASLEC), lower learning motivation by students learning motivation scale (SLMS), and more impairment on cohesion by Chinese version of family environment scale (FES-CV). The ADHD with PDMU group spent significantly more time on both video game and social media with significantly less time spend on physical exercise as compared to the ADHD without PDMU group.ConclusionThe ADHD children with PDMU suffered from more severe core symptoms, negative emotions, EF deficits, damage on family environment, pressure from life events, and a lower motivation to learn. Supervision of digital media usage, especially video game and social media, along with increased physical exercise, is essential to the management of core symptoms and associated problems encountered with ADHD.

Little is known about executive functions among unaffected siblings of children with attention deficit/hyperactivity disorder (ADHD), and there is lack of such information from non-Western countries. We examined verbal and nonverbal executive functions in adolescents with ADHD, unaffected siblings and controls to test whether executive functions could be potential endophenotypes for ADHD. We assessed 279 adolescents (age range: 11-17 years) with a childhood diagnosis of DSM-IV ADHD, 136 biological siblings (108 unaffected, 79.4%), and 173 unaffected controls by using psychiatric interviews, the Wechsler Intelligence Scale for Children - 3rd edition (WISC-III), including digit spans, and the tasks involving executive functions of the Cambridge Neuropsychological Test Automated Battery (CANTAB): Intra-dimensional/Extra-dimensional Shifts (IED), Spatial Span (SSP), Spatial Working Memory (SWM), and Stockings of Cambridge (SOC). Compared with the controls, adolescents with ADHD and unaffected siblings had a significantly shorter backward digit span, more extra-dimensional shift errors in the IED, shorter spatial span length in the SSP, more total errors and poorer strategy use in the SWM, and fewer problems solved in the minimum number of moves and shorter initial thinking time in the SOC. The magnitudes of the differences in the SWM and SOC increased with increased task difficulties. In general, neither persistent ADHD nor comorbidity was associated with increased deficits in executive functions among adolescents with ADHD. The lack of much difference in executive dysfunctions between unaffected siblings and ADHD adolescents suggests that executive dysfunctions may be useful cognitive endophenotypes for ADHD genetic studies.

Introduction This study aims to assess whether electroencephalogram (EEG) spectral power change scores (e.g. task spectral power subtracted from resting state spectral power) across three different frequency bands, alpha (8–12 Hz), theta (4–7 Hz), and beta (13–30 Hz), predicts self-reported attention-deficit hyperactivity disorder (ADHD) symptoms using the Adult ADHD Self-Report Scale (ASRS) over and above self-reported executive function (EF) abilities using the Behavior Rating Inventory of Executive Function (BRIEF-A) Global Executive Composite (GEC) T-scores for adults. Methods Data were collected at a rural, mid-sized southeastern university (N = 52) and participants received course credit for participation. Participants self-reported ADHD symptoms and EF abilities before completing eyes open resting state and the attention network test (ANT), a common flanker task that measures ability to orient attention, stay alert, and resolve conflict (i.e. distractor arrows) while recording EEG spectral power at electrodes F3 and F4. Bivariate correlations determine associations between EEG measures and self-reported ADHD symptoms and EF abilities. Linear regressions were used to assess whether EEG change scores were predictive of ADHD symptoms over and above EF abilities. Results High correlation coefficients were found only when comparing the ASRS and BRIEF-A GEC T-scores (r = .822, p <.001). Regression analyses produced significant results indicating EEG spectral change scores were predictive of ADHD symptoms, over and above GEC T-Scores, for the alpha band but not the theta and beta bands. Additionally, we found an inverse relationship when comparing change scores in the alpha band across the right (F4) and left (F3) hemispheres supporting the theory of frontal asymmetry for individuals with increased ADHD symptoms. Conclusion This study is the first to assess the predictive ability of EEG spectral power change scores in predicting ADHD symptoms, which are not solely explained by deficits in executive control. Past research has indicated significant differences when comparing task and resting state spectral power indicating change scores might have some utility in measuring cognitive load, specifically in the alpha band, which has been associated with inhibition, working memory, and anticipation of stimuli. Further research should be conducted to assess the utility change scores might have in providing an objective measure related to a clinical population with ADHD.

B-11 * Gender Effects on Self-Awareness of Executive Functioning Deficits in Adolescents with ADHD

Executive dysfunction is a common symptom among patients with attention deficit hyperactivity disorder (ADHD) and/ or Mathematical Learning disability (MLD). Current research evidence indicates that anxiety can lead to numerous cognitive deficits. Therefore, by comparing executive functioning in children with ADHD/MLD, who have high and low levels of anxiety, the present study examined the probable role of anxiety in intensifying their problems in executive functions, especially verbal and visuospatial working memory. In a retrospective quasi-experimental study, 8-12 years old children, who were diagnosed with ADHD and MLD comorbidity were selected using purposive convenience sampling (n=85). They completed the multidimensional anxiety scale for children. Then, due to their scores on this scale, 20 children with high anxiety (1.5 standard deviations and more above the mean) and 20 children with low anxiety (1.5 standard deviations and more below the mean) were selected and placed in two groups. Then, executive functions assessment tasks, including the Tower of London test, Wechsler Memory Scale (WMS), and Benton’s Visual Retention Test, was carried out. Collected data were analyzed using an independent t-test. Findings showed that anxiety can be considered an intensifying factor in the executive functioning of children with ADHD and MLD. Therefore, executive functions can be improved by balancing the levels of anxiety and preventing further impairment of executive function in these children.