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.
Similar content being viewed by others
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.
Angold, A., Costello, E. J., & Erkanli, A. (1999). Comorbidity. Journal of Child Psychology and Psychiatry, 40, 57–87.
Barkley, R. A. (1990). Attention deficit hyperactivity disorder: A handbook for diagnosis and treatment. New York: Guildford Press.
Barkley, R. A. (1991). The ecological validity of laboratory and analogue assessment of ADHD symptoms. Journal of Abnormal and Child Psychology, 19, 149–178.
Barkley, R. A. (1997). Behavioral inhibition, sustained attention, and executive functions: Constructing a unifying theory of AD/HD. Psychological Bulletin, 121, 65–94.
Barkley, R. A. (1998). Attention deficit hyperactivity disorder: A handbook for diagnosis and treatment (Second Edition ed.). New York: Guildford Press.
Barkley, R. A., & Grodzinsky, G. M. (1994). Are test of frontal lobe function useful in the diagnosis of ADD. Clinical Neuropsychology, 8, 121–139.
Berlin, L., & Bohlin, G. (2002). Response inhibition, hyperactivity, and conduct problems among preschool children. Journal of Clinical and Child Psychology, 31, 242–251.
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.
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.
Conners, C. K. (1985). The computerized continuous performance test. Psychopharmacology Bulletin, 21, 891–892.
Conners, K. (1995). Conners’ continuous performance test computer program 3.0: Users manual. Canada: Muli-Health Systems, Inc.
Conners, C. K. (2000). Conners’ CPT II for windows. North Tonowada, NY: Multihealth System.
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.
Dulcan, M., & Popper, C. (1991). Concise guide to child and adolescent psychiatry. Washington, DC: American Psychiatric Press.
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.
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.
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.
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.
Gordon, M. (1983). The Gordon diagnostic system. Dewitt, NY: Gordon Systems.
Greenberg, L. M. (1996). Test of variables of attention: Professional manual (version 7.0). Los Alamitos, CA: Universal Attention Disorders.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Maedgen, J. W. (2000). Social functioning and emotional regulation in the attention deficit hyperactivity disorder subtypes. Journal of Clinical Child Psychology, 29, 30–42.
Moffitt, T. E. (1990). Juvenile delinquency and attention deficit disorder: Boys’ developmental trajectories from age 3 to age 15. Child Development, 61, 893–910.
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.
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.
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.
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.
Pennington, B. F., & Ozonoff, S. (1996). Executive functions and development of psychopathology. Journal of Child Psychology and Psychiatry Allied Discipline, 49, 51–87.
Posner, M., & Raichle, M. (1994). Images of mind. New York: Scientific American Library.
Rabbit, P. M. (1968). Three kinds of error-signaling responses in a serial choice task. Quarterly Journal of Experimental Psychology, 20, 179–188.
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.
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.
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.
Sandford, J. A. (1995). Intermediate visual and auditory continuous performance test: Administration and interpretation manual (version 1.2). Richmond, VA: Brain Train.
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.
Schachar, R., & Logan, G. (1990). Are hyperactive children deficient in attentional capacity? Journal of Abnormal Child Psychology, 18, 493–513.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Weinberg, W. A., & Harper, C. R. (1993). Vigilance and its disorders. Neurologic Clinics, 11, 59–78.
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.
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.
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.
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.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
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
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10826-010-9369-4