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Specific Cognitive Deficits in ADHD: A Diagnostic Concern in Differential Diagnosis

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Abstract

We present a critical account of existing tools used to diagnose children with Attention Deficit Hyperactivity Disorder and to make a case for the assessment of cognitive impairments as a part of diagnostic system. Surveys have shown that clinicians rely almost entirely upon subjective reports or their own clinical judgment when arriving at diagnostic decisions relating to this prevalent disorder. While information from parents and teachers should always be carefully considered, they are often influenced by a host of emotional and perceptual factors. It increases the possibility for misdiagnosis of a condition like ADHD. Recent experimental literature on ADHD has identified unique underlying cognitive dysfunction, specific to ADHD. Therefore, we propose that there is a need to incorporate information on cognitive mechanisms underlying ADHD and inculcate such information in the diagnostic system, which will provide a more sensitive as well as specific tool in differential diagnosis of ADHD.

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References

  • American Psychiatric Association (APA). (1994). Task force on DSM-IV. Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: American Psychiatric Press.

    Google Scholar 

  • Angold, A., Costello, E. J., & Erkanli, A. (1999). Comorbidity. Journal of Child Psychology and Psychiatry, 40, 57–87.

    Article  PubMed  Google Scholar 

  • Barkley, R. A. (1990). Attention deficit hyperactivity disorder: A handbook for diagnosis and treatment. New York: Guildford Press.

    Google Scholar 

  • Barkley, R. A. (1991). The ecological validity of laboratory and analogue assessment of ADHD symptoms. Journal of Abnormal and Child Psychology, 19, 149–178.

    Article  Google Scholar 

  • Barkley, R. A. (1997). Behavioral inhibition, sustained attention, and executive functions: Constructing a unifying theory of AD/HD. Psychological Bulletin, 121, 65–94.

    Article  PubMed  Google Scholar 

  • Barkley, R. A. (1998). Attention deficit hyperactivity disorder: A handbook for diagnosis and treatment (Second Edition ed.). New York: Guildford Press.

    Google Scholar 

  • Barkley, R. A., & Grodzinsky, G. M. (1994). Are test of frontal lobe function useful in the diagnosis of ADD. Clinical Neuropsychology, 8, 121–139.

    Article  Google Scholar 

  • Berlin, L., & Bohlin, G. (2002). Response inhibition, hyperactivity, and conduct problems among preschool children. Journal of Clinical and Child Psychology, 31, 242–251.

    Google Scholar 

  • Blane, M., & Marrocco, R. (2004). Cholinergic and Noradrenergic inputs to the posterior parietal cortex modulate the components of exogenous attention. In M. I. Posner (Ed.), Cognitive neuroscience of attention (pp. 313–325). New York: Guilford.

    Google Scholar 

  • Booth, J., Carlson, C. L., & Tucker, D. (2001). Cognitive inattention in the ADHD subtypes. Paper presented in the 10th meeting of the International Society for Research in Child and Adolescent Psychopathology. Canada: Vancouver.

    Google Scholar 

  • Conners, C. K. (1985). The computerized continuous performance test. Psychopharmacology Bulletin, 21, 891–892.

    PubMed  Google Scholar 

  • Conners, K. (1995). Conners’ continuous performance test computer program 3.0: Users manual. Canada: Muli-Health Systems, Inc.

    Google Scholar 

  • Conners, C. K. (2000). Conners’ CPT II for windows. North Tonowada, NY: Multihealth System.

    Google Scholar 

  • Doyle, A. E., Biederman, J., Seidman, L. J., et al. (2000). Diagnostic efficiency of neuropsychological test scores for discriminating boys with and without attention deficit-hyperactivity disorder. Journal of Consulting and Clinical Psychology, 68, 477–488.

    Article  PubMed  Google Scholar 

  • Dulcan, M., & Popper, C. (1991). Concise guide to child and adolescent psychiatry. Washington, DC: American Psychiatric Press.

    Google Scholar 

  • DuPaul, G. J., Guevremont, D. C., & Barkley, R. A. (1991). Attention deficit-hyperactivity disorder in adolescence: Critical assessment parameters. Clinical Psychology Review, 11, 231–245.

    Article  Google Scholar 

  • Epstein, M. A., Shaywitz, S. E., Shaywitz, B. A., & Woolston, J. L. (1991). The boundaries of attention deficit disorder. Journal of Learning Disability, 24, 78–86.

    Article  Google Scholar 

  • Ernst, M., Kimes, A. S., London, E. D., Matochik, J. A., Eldreth, D., Tata, S., et al. (2003). Neural substrates of decision making in adults with attention deficit hyperactivity disorder. American Journal of Psychiatry, 160, 1061–1070.

    Article  PubMed  Google Scholar 

  • Garon, N. (2006). Decision making in children with adhd only, adhd-anxious/depressed, and control children using a child version of the iowa gambling task. Journal of Attentioanl Disorder, 9, 607–619.

    Article  Google Scholar 

  • Gordon, M. (1983). The Gordon diagnostic system. Dewitt, NY: Gordon Systems.

    Google Scholar 

  • Greenberg, L. M. (1996). Test of variables of attention: Professional manual (version 7.0). Los Alamitos, CA: Universal Attention Disorders.

    Google Scholar 

  • Greenberg, L. M., & Waldman, I. D. (1993). Developmental normative data on the test of variables of attention (T.O.V.A.). Journal of Child Psychology and Psychiatry, 34, 1019–1030.

    Article  PubMed  Google Scholar 

  • Greenham, S. L. (1998). Attention-deficit hyperactivity disorder and event-related potentials: Evidence for deficits in allocating attentional resources to relevant stimuli. Child Neuropsychology, 4, 67–80.

    Google Scholar 

  • Gupta, R., Kar, B.R., & Srinivasan, N. (2010). Cognitive markers of ADHD: Development of a diagnostic system (manuscript under review).

  • Gupta, R., Kar, B. R., & Thapa, K. (2006). Specific cognitive dysfunction in ADHD: An overview. In J. Mukherjee & V. Prakash (Eds.), Recent developments in psychology (pp. 153–170). New Delhi: DIPR.

    Google Scholar 

  • Halperin, J. M., Mattier, K., Bedi, G., Sharma, V., & Newcorn, J. H. (1992). Specificity of inattention, impulsivity and hyperactivity to the diagnosis of attention-deficit hyperactivity disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 190–196.

    Article  Google Scholar 

  • Hurt, J., & Naglieri, J. A. (1992). Performance of delinquent and nondelinquent males on planning, attention, simultaneous, and successive cognitive processing tasks. Journal of Clinical Psychology, 48, 120–128.

    Article  PubMed  Google Scholar 

  • Konver, R., Budman, C., Frank, Y., et al. (1998). Neuropsychological testing in adult attention deficit hyperactivity disorder: A pilot study. International Journal of Neuroscience, 96, 225–235.

    Article  Google Scholar 

  • Lambert, N. M., Sandoval, J., & Sassone, D. (1973). Prevalence of hyperactivity in elementary school children as a function of social system definers. American Journal of Orthopsychiatry, 48, 446–463.

    Article  Google Scholar 

  • Leube, D. T., Knoblich, G., Erb, M., Grodd, W., Bartels, M., & Kircher, T. T. (2003). The neural correlates of perceiving one’s own movements. Neuroimage, 20, 2084–2090.

    Article  PubMed  Google Scholar 

  • Logan, G. D. (1985). On the ability to inhibit simple thought and action II. Stop signal studies of repetition priming. Journal of Experimental Psychology, 2, 675–691.

    Google Scholar 

  • Loney, J., & Millich, R. (1982). Hyperactivity, inattention, and aggression in clinical practice. In M. Wolraich & D. Routh (Eds.), Advances in developmental behavior pediatrics. Greenwich, CT: JAI Press.

    Google Scholar 

  • Lovejoy, M. C., & Rasmussen, N. H. (1990). The validity of vigilance tasks in differential diagnosis of children referred for attention and learning problems. Journal of Abnormal Child Psychology, 18, 671–681.

    Article  PubMed  Google Scholar 

  • Lynam, D. R. (1998). Early identification of the fledgling psychopath: Locating the psychopathic child in the current nomenclature. Journal of Abnormal Psychology, 107, 566–575.

    Article  PubMed  Google Scholar 

  • Maedgen, J. W. (2000). Social functioning and emotional regulation in the attention deficit hyperactivity disorder subtypes. Journal of Clinical Child Psychology, 29, 30–42.

    Article  PubMed  Google Scholar 

  • Moffitt, T. E. (1990). Juvenile delinquency and attention deficit disorder: Boys’ developmental trajectories from age 3 to age 15. Child Development, 61, 893–910.

    Article  PubMed  Google Scholar 

  • Nigg, J. T., Hinshaw, S. P., Carter, E. T., & Treuting, J. J. (1998). Neuropsychological correlates of childhood attention-deficit/hyperactivity disorder: Explainable by comorbid disruptive behavior or reading problems? Journal of Abnormal Psychology, 107, 468–480.

    Article  PubMed  Google Scholar 

  • Nigg, J. T., John, O. P., Blaskey, L. G., Huang-Pollock, C. L., Willcutt, E. G., Hinshaw, S. P., et al. (2002). Big five dimensions and ADHD symptoms: Links between personality traits and clinical symptoms. Journal of Personality and Social Psychology, 83, 451–469.

    Article  PubMed  Google Scholar 

  • Oberlin, B. G., Alford, J. L., & Marrocco, R. T. (2005). Normal attention orienting but abnormal stimulus alerting and conflict effect in combined subtype of ADHD. Behavior and Brain Research, 165, 1–11.

    Article  Google Scholar 

  • Oosterlaan, J., Logan, G. D., & Sergeant, J. A. (1998). Response inhibition in AD/HD, CD, comorbid AD/HD + CD, anxious and control children: A meta-analysis of studies with the stop task. Journal of Child Psychology and Psychiatry, 39, 411–426.

    Article  PubMed  Google Scholar 

  • Pennington, B. F., & Ozonoff, S. (1996). Executive functions and development of psychopathology. Journal of Child Psychology and Psychiatry Allied Discipline, 49, 51–87.

    Article  Google Scholar 

  • Posner, M., & Raichle, M. (1994). Images of mind. New York: Scientific American Library.

    Google Scholar 

  • Rabbit, P. M. (1968). Three kinds of error-signaling responses in a serial choice task. Quarterly Journal of Experimental Psychology, 20, 179–188.

    Article  Google Scholar 

  • Rielly, N. E., Cunningham, C. E., Richards, J. E., et al. (1999). Detecting attention deficit hyperactivity disorder in a communications clinic: Diagnostic utility of the Gordon Diagnostic System. Journal of Clinical and Experimental Neuropsychology, 23, 685–700.

    Article  Google Scholar 

  • Rueda, M. R., Fan, J., McCandliss, B. D., Halparin, J. D., Gruber, D. B., Lercari, L. P., et al. (2004). Development of attentional networks in childhood. Neuropsychologia., 42, 1029–1040.

    Article  PubMed  Google Scholar 

  • Sandberg, S. T., Wieselberg, M., & Shaffer, D. (1980). Hyperkinetic and conduct problem children in a primary school population: Some epidemiological considerations. Journal of Child Psychology and Psychiatry, 21, 293–311.

    Article  PubMed  Google Scholar 

  • Sandford, J. A. (1995). Intermediate visual and auditory continuous performance test: Administration and interpretation manual (version 1.2). Richmond, VA: Brain Train.

    Google Scholar 

  • Schachar, R., Chen, S., Logan, G. D., Ornstein, T. J., Crosbie, J., Ickowicz, A., et al. (2004). Evidence for an error monitoring deficit in attention deficit hyperactivity disorder. Journal of Abnormal Child Psychology, 18, 285–293.

    Article  Google Scholar 

  • Schachar, R., & Logan, G. (1990). Are hyperactive children deficient in attentional capacity? Journal of Abnormal Child Psychology, 18, 493–513.

    Article  PubMed  Google Scholar 

  • Schmitz, M., Cadore, L., Paczko, M., et al. (2002). Neuropsychological performance in DSM-IV ADHD subtypes: An exploratory study with untreated adolescents. Canadian Journal of Psychiatry, 47, 863–869.

    Google Scholar 

  • Sergeant, J. A., Oosterlaan, J., & van der Meere, J. (1999). Information processing and energetic factors in attention-deficit/hyperactivity disorder. In H. C. Quay & A. E. Hogan (Eds.), Handbook of disruptive behavior disorders (pp. 75–104). New York: Kluwer Academic/Plenum.

    Google Scholar 

  • de Swaab-Barneveld, H., Sonneville, L., Cohen-Kettenis, P., et al. (2000). Visual sustained attention in a child psychiatric population. Journal of the American Academy of Child and Adolescent Psychiatry, 39, 651–659.

    Article  PubMed  Google Scholar 

  • Swanson, J. M., Posner, M. I., Potkin, S., Bonforte, S., Youpa, D., Cantwell, D., et al. (1991). Activating tasks for the study of visual-spatial attention in ADHD children: A cognitive neuroanatomical approach. Journal of Child Neurology, 6S, S119–S127.

    Google Scholar 

  • Trommer, B. L., Hoeppner, J. B., Lorber, R., & Armstrong, K. (1988). Pitfalls in the use of a continuous performance test as a diagnostic tool in attention deficit disorder. Journal of Developmental and Behavioral Pediatric, 9, 339–345.

    Google Scholar 

  • van Meel, C. S., Heslenfeld, D. J., Oosterlaan, J., & Sergeant, J. A. (2007). Adaptive control deficits in attention-deficit/hyperactivity disorder (ADHD): The role of error processing. Psychiatry Research, 151, 211–220.

    Article  PubMed  Google Scholar 

  • Walcott, C. M. (2004). The relation between disinhibition and emotion regulation in boys with attention deficit hyperactivity disorder. Journal of Clinical and Child Adolescent Psychology, 33, 772–782.

    Article  Google Scholar 

  • Wang, B., Sui, M. Q., Wang, Y. F., & Fan, J. (2004). A preliminary study on the attentional networks of attention deficit hyperactivity disorder. Beijing Da Xue Xue Bao, 85, 370–373.

    Google Scholar 

  • Weinberg, W. A., & Brumback, R. A. (1992). The myth of attention deficit-hyperactivity disorder: Symptoms resulting from multiple causes. Journal of Child Neurology, 7, 431–445.

    Article  PubMed  Google Scholar 

  • Weinberg, W. A., & Harper, C. R. (1993). Vigilance and its disorders. Neurologic Clinics, 11, 59–78.

    PubMed  Google Scholar 

  • Wherry, J. N., Paal, N., Jolly, J. B., Balkozar, A., Holloway, C., Everett, B., et al. (1993). Concurrent and discriminant validity of the Gordon diagnostic system: A preliminary study. Psychology in the Schools, 1, 29–36.

    Article  Google Scholar 

  • Wiersema, J. R., van der Meere, J. J., & Roeyers, H. (2005). ERP correlates of impaired error monitoring in children with ADHD. Journal of Neural Transmission, 112, 1417–1430.

    Article  PubMed  Google Scholar 

  • Wigal, S. B., Gupta, S., Guinta, D., & Swanson, J. M. (1998). Reliability and validity of the SKAMP rating scale in a laboratory school setting. Psychopharmacol Bulletin, 34, 47–53.

    Google Scholar 

  • Wu, K. K., Anderson, V., & Castiello, U. (2006). Attention-deficit/hyperactivity disorder and working memory: A task switching paradigm. Journal of Clinical and Experimental Neuropsychology, 28, 1288–1306.

    Article  PubMed  Google Scholar 

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Correspondence to Rashmi Gupta.

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Gupta, R., Kar, B.R. Specific Cognitive Deficits in ADHD: A Diagnostic Concern in Differential Diagnosis. J Child Fam Stud 19, 778–786 (2010). https://doi.org/10.1007/s10826-010-9369-4

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