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Neuropsychological performance and attention-deficit hyperactivity disorder subtypes and symptom dimensions.

ABSTRACT: Characterization of clinical heterogeneity in attention-deficit hyperactivity disorder (ADHD) remains controversial. Neuropsychological and cognitive studies provide one type of validation data, but too often have considered only a narrow range of functional domains.The current study examined ADHD subtype and presentation differences across a broad range of neurocognitive domains in a large clinically characterized, community-recruited sample of 498 youth (213 control, 107 ADHD-primarily inattentive [ADHD-PI], 137 ADHD-combined [ADHD-C]), ages 6-17 years. Domains assessed included inhibition, working memory, arousal, processing speed, response variability, and temporal information processing.Youth with ADHD-C performed worse than youth with ADHD-PI in all domains, consistent with a severity model. Performance among a subgroup with a "restrictive inattentive" presentation indicated potential deficits in processing speed relative to other ADHD-PI youth, but no other effects. When all measures were included in the same model, cognitive control (executive functions, working memory, and memory span), arousal, and response variability each provided uniquely incremental statistical prediction of specific symptom dimensions and of subtype/presentation, but temporal information processing and processing speed did not.Results suggest the potential to consolidate multiple neurocognitive theories of ADHD, and that such consolidation will apply across putative clinical subtypes or presentations.

SUBMITTER: Nikolas MA

PROVIDER: S-EPMC3582377 | biostudies-literature | 2013 Jan

REPOSITORIES: biostudies-literature

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Neuropsychological performance and attention-deficit hyperactivity disorder subtypes and symptom dimensions.

Nikolas Molly A MA Nigg Joel T JT

Neuropsychology 20121112 1

<h4>Objective</h4>Characterization of clinical heterogeneity in attention-deficit hyperactivity disorder (ADHD) remains controversial. Neuropsychological and cognitive studies provide one type of validation data, but too often have considered only a narrow range of functional domains.<h4>Method</h4>The current study examined ADHD subtype and presentation differences across a broad range of neurocognitive domains in a large clinically characterized, community-recruited sample of 498 youth (213 co ...[more]

PMID: 23148496

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Project description:Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) criteria for attention deficit/hyperactivity disorder (ADHD) specify two dimensions of inattention and hyperactivity-impulsivity symptoms that are used to define three nominal subtypes: predominantly hyperactive-impulsive type (ADHD-H), predominantly inattentive type (ADHD-I), and combined type (ADHD-C). To aid decision making for DSM-5 and other future diagnostic systems, a comprehensive literature review and meta-analysis of 546 studies was completed to evaluate the validity of the DSM-IV model of ADHD. Results indicated that DSM-IV criteria identify individuals with significant and persistent impairment in social, academic, occupational, and adaptive functioning when intelligence, demographic factors, and concurrent psychopathology are controlled. Available data overwhelmingly support the concurrent, predictive, and discriminant validity of the distinction between inattention and hyperactivity-impulsivity symptoms, and indicate that nearly all differences among the nominal subtypes are consistent with the relative levels of inattention and hyperactivity-impulsivity symptoms that define the subtypes. In contrast, the DSM-IV subtype model is compromised by weak evidence for the validity of ADHD-H after first grade, minimal support for the distinction between ADHD-I and ADHD-C in studies of etiological influences, academic and cognitive functioning, and treatment response, and the marked longitudinal instability of all three subtypes. Overall, we conclude that the DSM-IV ADHD subtypes provide a convenient clinical shorthand to describe the functional and behavioral correlates of current levels of inattention and hyperactivity-impulsivity symptoms, but do not identify discrete subgroups with sufficient long-term stability to justify the classification of distinct forms of the disorder. Empirical support is stronger for an alternative model that would replace the subtypes with dimensional modifiers that reflect the number of inattention and hyperactivity-impulsivity symptoms at the time of assessment. (PsycINFO Database Record (c) 2012 APA, all rights reserved).

Project description:OBJECTIVE:To evaluate the efficacy of lisdexamfetamine dimesylate in adults with attention deficit hyperactivity disorder symptom subtypes who exhibit predominantly inattention, hyperactivity/ impulsivity, or combined symptom clusters. DESIGN/SETTING/PARTICIPANTS:This is a post-hoc analysis from a multicenter, one-year, open-label lisdexamfetamine dimesylate study in adults with attention deficit hyperactivity disorder previously completing two weeks or more in a four-week, randomized, placebo-controlled lisdexamfetamine dimesylate study, using Attention Deficit Hyperactivity Disorder Rating Scale IV symptom ratings as an attention deficit hyperactivity disorder subtype proxy (N=349). MEASUREMENTS:Attention Deficit Hyperactivity Disorder Rating Scale IV was measured at baseline of prior study and throughout the open-label study. Proxy subtypes were based on item scores of 2 (moderate) or 3 (severe), representing endorsement of at least six of nine symptoms on respective subscales; predominantly combined type endorsed at least six of nine symptoms on each subscale. Overall safety evaluations included treatment-emergent adverse events. RESULTS:At baseline, 93 of 345 participants exhibited predominantly inattention, 13 predominantly hyperactivity/ impulsivity, 236 combined symptom clusters, and three were unassigned. For the three subgroups, respectively, mean (standard deviation) Attention Deficit Hyperactivity Disorder Rating Scale IV total scores at baseline were 34.5 (4.02), 33.8 (3.27), and 43.6 (5.24); change from baseline to endpoint scores were -19.3 (9.48), -24.0 (7.22), and -27.3 (11.78). Mean (standard deviation) end-of-study lisdexamfetamine dimesylate dose was 57.7 (14.75), 53.1 (16.01), and 56.9 (14.94)mg/day, respectively.Treatment-emergent adverse events (>5%) were upper respiratory tract infection (21.8%), insomnia (19.5%), headache (17.2%), dry mouth (16.6%), decreased appetite (14.3%), irritability (11.2%), anxiety (8.3%), nasopharyngitis (7.4%), sinusitis (6.6%), decreased weight (6.0%), back pain (5.4%), and muscle spasms (5.2%). CONCLUSIONS:Lisdexamfetamine dimesylate was effective in participants with predominantly inattention, hyperactivity/ impulsivity, and combined attention deficit hyperactivity disorder symptom clusters. Groups exhibiting specific predominant subtype symptoms did not differ in clinical response to lisdexamfetamine dimesylate.

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Neuropsychological performance and attention-deficit hyperactivity disorder subtypes and symptom dimensions.

Publications

Neuropsychological performance and attention-deficit hyperactivity disorder subtypes and symptom dimensions.

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