Neuropsychological Profile Related with Executive Function of Chinese Preschoolers with Attention-Deficit/Hyperactivity Disorder: Neuropsychological Measures and Behavior Rating Scale of Executive Function-Preschool Version / 中华医学杂志(英文版)

<p><b>Background:</b>Previous studies have found that schoolchildren with attention-deficit/hyperactivity disorder (ADHD) showed difficulties in neuropsychological function. This study aimed to assess neuropsychological function in Chinese preschoolers with ADHD using broad neuropsychological measures and rating scales and to test whether the pattern and severity of neuropsychological weakness differed among ADHD presentations in preschool children.</p><p><b>Methods:</b>The 226 preschoolers (163 with ADHD and 63 controls) with the age of 4-5 years were included and assessed using the Behavior Rating Scale of Executive Function-Preschool Version (BRIEF-P) and a series of tests to investigate neuropsychological function.</p><p><b>Results</b>Preschoolers with ADHD showed higher scores in all domains of the BRIEF-P (inhibition: 30.64 ± 5.78 vs.20.69 ± 3.86, P < 0.001; shift: 13.40 ± 3.03 vs.12.41 ± 2.79, P = 0.039; emotional control:15.10 ± 3.53 vs.12.20 ± 2.46, P < 0.001; working memory: 28.41 ± 4.99 vs.20.95 ± 4.60, P < 0.001; plan/organize: 17.04 ± 3.30 vs.13.29 ± 2.40, P < 0.001) and lower scores of Statue (23.18 ± 7.84 vs.28.27 ± 3.18, P = 0.001), Word Generation (15.22 ± 6.52 vs.19.53 ± 7.69, P = 0.025), Comprehension of Instructions (14.00 ± 4.44 vs.17.02 ± 3.39, P = 0.016), Visuomotor Precision (P < 0.050), Toy delay (P = 0.048), and Matrices tasks (P = 0.011), compared with normal control. In terms of the differences among ADHD subtypes, all ADHD presentations had higher scores in several domains of the BRIEF-P (P < 0.001), and the ADHD-combined symptoms (ADHD-C) group had the poorest ratings on inhibition and the ability to Plan/Organize. For neuropsychological measures, the results suggested that the ADHD-C group had poorer performances than the ADHD-predominantly inattentive symptoms (ADHD-I) group on Statue tasks (F = 7.34, η = 0.12, P < 0.001). Furthermore, the ADHD-hyperactive/impulsive symptoms group had significantly poorer performances compared to the ADHD-C group in the Block Construction task (F = 4.89, η = 0.067, P = 0.003). However, no significant group differences were found between the ADHD-I group and normal control.</p><p><b>Conclusion:</b>Based on the combined evaluation of performance-based neuropsychological tests and the BRIEF-P, preschoolers with ADHD show difficulties of neuropsychological function in many aspects.</p>

Effect of an Ecological Executive Skill Training Program for School-aged Children with Attention Deficit Hyperactivity Disorder: A Randomized Controlled Clinical Trial / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>As medication does not normalize outcomes of children with attention deficit hyperactivity disorder (ADHD), especially in real-life functioning, nonpharmacological methods are important to target this field. This randomized controlled clinical trial was designed to evaluate the effects of a comprehensive executive skill training program for school-aged children with ADHD in a relatively large sample.</p><p><b>METHODS</b>The children (aged 6-12 years) with ADHD were randomized to the intervention or waitlist groups. A healthy control group was composed of gender- and age-matched healthy children. The intervention group received a 12-session training program for multiple executive skills. Executive function (EF), ADHD symptoms, and social functioning in the intervention and waitlist groups were evaluated at baseline and the end of the final training session. The healthy controls (HCs) were only assessed once at baseline. Repeated measures analyses of variance were used to compare EF, ADHD symptoms, and social function between intervention and waitlist groups.</p><p><b>RESULTS</b>Thirty-eight children with ADHD in intervention group, 30 in waitlist group, and 23 healthy children in healthy control group were included in final analysis. At posttreatment, intervention group showed significantly lower Behavior Rating Inventory of Executive Function (BRIEF) total score (135.89 ± 16.80 vs. 146.09 ± 23.92, P= 0.04) and monitoring score (18.05 ± 2.67 vs. 19.77 ± 3.10, P= 0.02), ADHD-IV overall score (41.11 ± 7.48 vs. 47.20 ± 8.47, P< 0.01), hyperactivity-impulsivity (HI) subscale score (18.92 ± 5.09 vs. 21.93 ± 4.93, P= 0.02), and inattentive subscale score (22.18 ± 3.56 vs. 25.27 ± 5.06, P< 0.01), compared with the waitlist group. Repeated measures analyses of variance revealed significant interactions between time and group on the BRIEF inhibition subscale (F = 5.06, P= 0.03), working memory (F = 4.48, P= 0.04), ADHD-IV overall score (F = 21.72, P< 0.01), HI subscale score (F = 19.08, P< 0.01), and inattentive subscale score (F = 12.40, P< 0.01). Multiple-way analysis of variance showed significant differences on all variables of BRIEF, ADHD-rating scale-IV, and WEISS Functional Impairment Scale-Parent form (WFIRS-P) among the intervention and waitlist groups at posttreatment and HCs at baseline.</p><p><b>CONCLUSIONS</b>This randomized controlled study on executive skill training in a relatively large sample provided some evidences that the training could improve EF deficits, reduce problematic symptoms, and potentially enhance the social functioning in school-aged children with ADHD.</p><p><b>CLINICAL TRIAL REGISTRATION</b>http://www.clinicaltrials.gov; NCT02327585.</p>

Executive Function Training for Children with Attention Deficit Hyperactivity Disorder / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Accumulating evidence indicates that attention deficit hyperactivity disorder (ADHD) is associated with core deficits in executive function (EF) which predicts poorer academic and occupational functioning. This makes early intervention targeting EF impairments important to prevent long-term negative outcomes. Cognitive training is a potential ADHD treatment target. The present study aimed to explore the efficacy, feasibility, and acceptability of a cognitive training program (targeting child's multiple EF components and involving parent support in daily life), as a nonpharmacological intervention for children with ADHD.</p><p><b>METHODS</b>Forty-four school -age children with ADHD and their parents participated in 12 sessions of EF training (last for 12 weeks) and 88 health controls (HC) were also recruited. Training effects were explored using both neuropsychological tests (Stroop color-word test, Rey-Osterrieth complex figure test, trail making test, tower of Hanoi, and false-belief task) and reports of daily life (ADHD rating scale-IV, Conners' parent rating scale, and behavior rating inventory of executive function [BRIEF]) by analysis of paired sample t-test and Wilcoxon signed-rank test. The differences on EF performances between children with ADHD after training and HC were explored using multivariate analysis.</p><p><b>RESULTS</b>The results (before vs. after EF training) showed that after intervention, the children with ADHD presented better performances of EF both in neuropsychological tests (word interference of Stroop: 36.1 ± 14.6 vs. 27.1 ± 11.1, t = 4.731, P < 0.001; shift time of TMT: 194.9 ± 115.4 vs. 124.8 ± 72.4, Z = -4.639, P < 0.001; false-belief task: χ2 = 6.932, P = 0.008) and reports of daily life (global executive composite of BRIEF: 148.9 ± 17.5 vs. 127.8 ± 17.5, t = 6.433, P < 0.001). The performances on EF tasks for children with ADHD after EF training could match with the level of HC children. The ADHD symptoms (ADHD rating scale total score: 32.4 ± 8.9 vs. 22.9 ± 8.2, t = 6.331, P < 0.001) and behavioral problems of the children as reported by parents also reduced significantly after the intervention. Participants reported that the EF training program was feasible to administer and acceptable.</p><p><b>CONCLUSIONS</b>The EF training program was feasible and acceptable to children with ADHD and parents. Although replication with a larger sample and an active control group are needed, EF training program with multiple EF focus and parent involving in real-life activities could be a potentially promising intervention associated with significant EF (near transfer) and ADHD symptoms improvement (far transfer).</p>

Executive function characteristic in boys with attention deficit hyperactivity disorder comorbid disruptive behavior disorders / 北京大学学报(医学版)

Objective:To answer the question whether executive function(EF) deficits are specific to attention deficit hyperactivity disorder(ADHD) or whether such deficits are also associated with disruptive behavior disorders(DBD),including oppositional defiant disorder(ODD) and conductive disorder(CD).Methods:A total of 19 pure ADHD boys,19 ADHD + DBD boys and 19 normal controls(criteria of DSM-Ⅳ) were collected as our samples.The groups were matched by age(less than 6 months).The research instruments included Stroop color-word task,Rey complex figure test,digit span test, trail making test,tower of Hanoi and verbal fluency test.Results:The differences of IQs weren't significant among three groups.(1) Both pure ADHD group and ADHD+DBD group performed worse(P0.05).(2) Pure ADHD group also showed deficits in the aspects of errors of Stroop 2,time and errors of Stroop 3, word interference time;immediate memory structure score of Rey complex figure test;time and errors of number-letter part and shifting time of trail making test;total time and steps of completing tower of Hanoi.The differences were significant(P

Effect of methylphenidate on executive function for children with attention deficit hyperactivity disorder / 北京大学学报(医学版)

Objective:To explore whether methylphenidate(MPH) can improve the executive function(EF) of attention deficit hyperactivity disorder(ADHD) children and the degree of the improvements.Method:We conducted an open study of 29 children(25 boys and 4 girls) who met DSM-Ⅳ criteria for ADHD.The variations of their EF before and after methylphenidate extended-release tablets [osmotic release oral system(OROS) methylphenidate] treatment were evaluated,and the differences of EF between 24 ADHD boys before and after treatment and 24 age-matched typically developing control boys were compared.The research instruments included Stroop color-word task,Rey complex figure test,digit span test,trail making test,tower of Hanoi and verbal fluency test.Results:The performances of errors in Stroop 1,time and errors of Stroops 2 and 4;the immediate memory and delay recalling of structure and detail score of RCFT;time of number-letter trail making,shifting time;total time and steps,rule violation of tower of Hanoi improved significantly after OROS methylphenidate treatment as compared with those before treatment.They were no significant differences between ante-and post-treatment. The initiation planning time of tower of Hanoi was significantly shorter after treatment as compared with that before treatment.Conclusion:This study suggests that methylphenidate can improve the executive function in the aspects of inhibition,visual working memory,set shifting and planning in ADHD children,and almost all aspects of EF can reach the normal level except the inhibition.

Executive function characteristic in boys with attention deficit hyperactivity disorder comorbid learning disabilities / 北京大学学报(医学版)

Objective:To study the executive function(EF)characteristics in boys with attention deficit hyperactivity disorder(ADHD)comorbid learning disabilities(LD).Methods:A total of 22 pure ADHD boys,22 ADHD + LD boys and 22 normal controls(by criteria of DSM-Ⅳ)were collected as our samples.The groups were matched by ages(less than 6 months)and ADHD subtypes.The research instruments included the Stroop color-word task,Rey complex figure test,digit span test,trail making test,tower of Hanoi and verbal fluency test.Results:The differences of VIQ weren't significant among the three groups;pure ADHD and ADHD+LD groups had lower PIQ than the control group;ADHD+LD boys had lower IQ than the controls.The performance in the EF tests:(1)Both pure ADHD and ADHD+LD groups performed worse in the aspects of time of number-letter part and shifting time,the repeat response of verbal fluency,and the differences were significant.But the differences between ADHD and ADHD+LD weren't significant.(2)ADHD+LD group also showed deficits in the aspects of time and errors of Stroops 2 and 4,time of Stroop 4,word interference time,the immediate memory and delayed recalling detail score of Rey complex figure test,time of number trail making,error steps(rule violation)of Tow of Hanoi,and the differences were significant.(3)Both ADHD+LD and pure ADHD groups made more errors in the naming color of the color-word card(Stroop part 4),and ADHD+LD boys performed worse than pure ADHD boys.Conclusion:The findings support the hypothesis that ADHD is related to EF deficit,whether or not comorbid LD.ADHD+LD showed significant difference in the aspects of inhibition,working memory,set shifting and fluency as compared with normal group,ADHD+LD boys perform more poorly than the pure ADHD boys.It's plausible that both ADHD and LD are associated with deficits of executive function.