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"Research Findings:" Sustained attention is a fundamental cognitive function for young children's development. We investigated the effects of school-based audiovisual game training with parental involvement on sustained attention (SA) in 5-6-year-old Chinese children. Totally 75 children and their parents participated and were assigned into three groups. The School Practice Intervention (SPI) group and the Parental Involvement Intervention (PII) group underwent an eight-week audiovisual game training, while the No Intervention (NI) group participated in regular activities and received no intervention. We tested participants' visual and auditory sustained attention at four time points, i.e., pretest, middle test, posttest, and follow-up test. Results indicated that (1) children in PII and SPI groups had significantly greater visual and auditory sustained attention than the NI group in posttest and follow-up test; (2) the PII group showed better SA than the SPI group in posttest and follow-up test; (3) visual SA of experimental groups improved significantly since the middle test, while the improvement of auditory SA emerged since posttest. "Practice or Policy:" The play-based audiovisual training in a school setting effectively enhances SA for 5-6-year-olds, and parental involvement benefits the intervention. More efforts should be made to improve auditory sustained attention. The educational implications of these findings were discussed.

Objective: This study aimed to investigate the current status of cognitive development and central auditory processing development of preschool children with minimal and mild hearing loss (MMHL) in Nanjing, China. Method: We recruited 34 children with MMHL and 45 children with normal hearing (NH). They completed a series of tests, including cognitive tests (i.e., Wechsler Preschool and Primary Scale of Intelligence and Continuous Performance Test), behavioral auditory tests (speech-in-noise [SIN] test and frequency pattern test), and objective electrophysiological audiometry (speech-evoked auditory brainstem response and cortical auditory evoked potential). In addition, teacher evaluations and demographic information and questionnaires completed by parents were collected. Results: Regarding cognitive ability, statistical differences in the verbal comprehensive index, full-scale intelligence quotient, and abnormal rate of attention test score were found between the MMHL group and the NH group. The children with MMHL performed poorer on the SIN test than the children with NH. As for the auditory electrophysiology of the two groups, the latency and amplitude of some waves of the speech-evoked auditory brainstem response and cortical auditory evoked potential were statistically different between the two groups. We attempted to explore the relationship between some key indicators of auditory processing and some key indicators of cognitive development. Conclusions: Children with MMHL are already at increased developmental risk as early as preschool. They are more likely to have problems with attention and verbal comprehension than children with NH. This condition is not compensated with increasing age during the preschool years. The results suggest a possible relationship between the risk of cognitive deficit and divergence of auditory processing.

A social skills training has previously resulted in positive improvements in social skills among children and adolescents with autism spectrum disorder (ASD). This pilot study developed a play-based social skills training protocol for first-grade elementary children with ASD in Taiwan and determined its efficacy. Using a single-group pretest-posttest design, this study recruited seven first-grade elementary children with ASD aged 6-7 years. Seven children enrolled in a regular classroom participated in a 12-week play-based social skills training program which was led by an occupational therapist. The improvement of social skills was evaluated by occupational therapists through video coding and goal attainment scales. Caregivers and teachers were asked to complete the communication and socialization domains of the Vineland Adaptive Behavior Scale-Third Edition. The results showed significant improvements in the children's social skills performance between the pretest and posttest based on video coding and goal attainment scale. Significant improvements in the Vineland Adaptive Behavior Scale-Third Edition growth scale values of receptive and written language subdomains were observed. This study established an intervention protocol for first-grade children with ASD that could be used as a guide by clinical professionals who work with children with ASD who experience problems adapting to elementary school.

The present study examined longitudinal associations between preschoolers' executive function (EF) and adult educational attainment, impulse control, and general health directly and through its cascading effects on childhood and adolescent EF using a large, national, and prospective longitudinal sample of participants. Data were drawn from the National Institute of Child Health and Human Development study of Early Child Care and Youth Development (NICHD SECCYD) and included a diverse sample (52% male at birth; 76% White; 13% Black; 6% Hispanic; and 5% other; 14.23 mean years of maternal education) of 1,364 participants born in 1991 and followed through age 26. Four main findings emerged. First, we observed significant bivariate relations between EF measured at 54 months and adult educational attainment (r = 0.36, p < 0.01), and impulse control (r = 0.11, p = 0.01). Second, early EF measured during preschool and childhood explained variance in adult educational attainment and impulse control above and beyond adolescent EF. Third, childhood EF mediated the association between preschool EF and adult educational attainment and impulse control but did not operate through adolescent EF. Finally, neither preschool EF nor EF measured at other developmental stages predicted health during adulthood. Together, these findings shed light on the direct and cascading influences of EF across development on important domains of adult functioning.

The purpose of this study was to understand the relationship between executive functions and mathematical abilities to determine the contribution of these functions to math performance. In this study, 30 students were selected from among 4th graders of elementary school, in two groups with low achievement in mathematics (poor) and high achievement in mathematics (strong), such that their IQ and reading ability were as close as possible. These groups were measured and compared in terms of attention by means of continuous performance test and shifting by means of Wisconsin Card Sorting Test. The ANOVA and t-test showed that the low-achieving group stood significantly lower than the high-achieving group in shifting, which mirrors the effect of this function in math performance of the students. However, there was no significant difference between the two groups in terms of attention.

Objective: Despite strong evidence that inattentive and hyperactive/impulsive behaviors are associated with mathematical difficulties in school-age children, little research has been conducted to examine the link between these constructs before the start of formal education. The purpose of this study was to examine how different manifestations of inattentive and hyperactive/impulsive behaviors, as measured by different assessment tools, are related to early mathematics skills in preschoolers. Method: Eighty-two preschool children completed a measure of early mathematics and the Continuous Performance Test (CPT). Teachers rated children's behaviors using the Conners' Teacher Rating Scale--15 Item. Sixty-five of these children completed mathematics assessments 1 year later. Results: Teacher ratings of inattention were uniquely related to concurrent early mathematics skills, whereas CPT errors were uniquely predictive of early mathematics skills 1 year later. Conclusion: Findings have implications for the understanding and assessment of behavior problems that are associated with early mathematics difficulties. [This article was published in "Journal of Attention Disorders," v20 n8 p704-714 Aug 2016.]

Introduction: Certain behaviors associated with high intellectual ability, such as inattention and early response, are often confused with attention deficit and hyperactivity disorder (ADHD), making correct diagnosis more difficult. The objective of the present study was to analyze the performance of students with high intellectual ability and students with ADHD in sustained attention and impulsivity. Method: Participants included a total of 25 children with high intellectual ability and mean age of 6.15 years, and 25 children with ADHD and mean age of 6.96 years. "Conner's Continuous Performance Test II" for Windows (CPT II) was administered to all participants. An ex post facto methodology was followed. The results were analyzed statistically, using SPSS, through a t test for independent samples. Results: Significant differences were found in Omissions, Hit Reaction Time, Reaction Time Standard Error and Hit Reaction Time at Change of Inter-Stimulus Interval Discussion and conclusions: (1) Children with high intellectual ability have significantly better consistency in response speed, better consistency in reaction times at different interstimulus intervals, and make greater errors of commission compared to students with ADHD. (2) Children with high intellectual ability perform significantly faster when answering correctly during the test. Performance tests such as the CPT-II for the measurement of attention and impulsivity represent an alternative assessment, with differential diagnosis between these populations. This process must be carried out by qualified personnel who have experience with both populations.

Selective sustained attention (SSA) is crucial for higher order cognition. Factors promoting SSA are described as exogenous or endogenous. However, there is little research specifying how these factors interact during development, due largely to the paucity of developmentally appropriate paradigms. We report findings from a novel paradigm designed to investigate SSA in preschoolers. The findings indicate that this task (a) has good psychometric and parametric properties and (b) allows investigation of exogenous and endogenous factors within the same task, making it possible to attribute changes in performance to different mechanisms of attentional control rather than to differences in engagement in different tasks. [This paper was published in the "Journal of Experimental Child Psychology," v114 n2 p275-294 Feb 2013 (EJ1006825).]

Adolescent cannabis use is associated with working memory impairment. The present randomized controlled trial assigned adolescents ages 14 to 21 enrolled in cannabis use treatment to receive either working memory training (experimental group) or a control training (control group) as an adjunctive treatment. Cognitive function, drug use, and other outcomes were assessed before and after training. We observed few differences in cognitive, functional, or self-reported drug use outcomes as a function of training group, although tetrahydrocannabinol (THC) urinalysis results favored the experimental group. These findings are similar to previous studies in substance users, which have shown limited transfer effects for working memory training.

On the basis of longitudinal data across 9 years, this study examined the contribution of sustained attention and executive function to the poor cognitive and socioemotional adjustment of school-age children whose mothers had depressive symptoms during the child's infancy. Mothers (N = 1,364) reported depressive symptoms across their child's infancy and early childhood. Maternal sensitivity was observed during laboratory interactions at 36 months. At school entry children's sustained attention and executive function were measured with computer-generated tasks. In third grade, cognitive and socioemotional adjustment was assessed with standardized tests and the reports of fathers and teachers. Using structural equation modeling, findings showed that (a) exposure to mothers' depressive symptoms during the child's infancy, independent of later exposure, uniquely predicted children's poor sustained attention and executive function at school entry; (b) deficits in children's sustained attention and executive function occurred because of depressed mothers' tendencies to display insensitive parenting behavior; and (c) these deficits explained in part relations between exposure to mothers' depressive symptoms in infancy and children's poor cognitive and socioemotional adjustment in third grade. Findings highlight the potential importance of children's exposure to mothers' depressive symptoms specifically during the child's infancy for disrupting the development of fundamental cognitive processes that may underlie the adjustment problems children of depressed mothers display in middle childhood.

Clinical reasoning requires thoughtful consideration of a variety of factors that contribute to the conceptualization of a case such as the reason for referral, school information, home environment, assessment outcomes, and behavioural observations made during assessments. The purpose of this article is to provide the reader with insight into the clinical reasoning involved in the assessment and intervention planning for an adolescent with oppositional defiant disorder. The reader will be guided through the authors' conceptualization of this case and suggestions for intervention.

The present study examined whether and how socioeconomic status (SES) predicts school achievement in science, technology, engineering, and math (STEM) using structural equation modeling and data from the National Institute of Child Health and Human Development Study of Child Care and Youth Development. The present inquiry addresses gaps in previous research linking SES and STEM achievement in high school. Results indicate that maternal education predicts the child's early environment, which itself predicts the development of executive function (EF) and language, and thereby, STEM achievement. Moreover, children's language ability and EF development influenced higher-order cognitive skills, such as relational reasoning, planning, and basic calculation skills. However, only relational reasoning strongly predicted high school math and science achievement, suggesting that relational reasoning, but not planning and calculation skills, was central to STEM thinking and learning.

The present study describes experiences associated with parenting children diagnosed with learning disabilities. Parents whose children were diagnosed with Attention Deficit Hyperactivity Disorder, dyslexia/language problems, and Asperger syndrome, related to poor performance at school, took part in the study. A qualitative study design was implemented, using three focus groups. The data obtained were analysed following an inductive thematic approach. Five major themes were identified: parenting emotions, diagnosis and cause, daily experiences, social relationships and concerns about the future. The parents in this study experienced a range of emotions, and assigned different explanations to the learning disability, depending on the diagnosis (attention, verbal or non-verbal). Daily experience, both at home and at school, was influenced by the child's specific impairment. All parents, independently of the diagnosis, believe a central role is played by social relationships and expressed concerns about their child's future development. Emotional interventions targeting these parents should take these considerations into account and address the specific type of learning disability.

Numerous research groups have consistently called for increased rigor within the evaluation of social programming to better understand pivotal factors to treatment outcomes. The underwhelming data on the essential features of social competence programs for students with behavior challenges may, in part, be attributed to the manner by which available measures are accessed within applied research. The growing literature highlighting the bidirectionality of executive functioning (EF) and social competence supports a comprehensive evaluation of EF within intervention outcomes. Existing data from a suite of four informant and performance measures frequented within EF literature were evaluated as a case example of the contribution of EF in relation to the impact of the Social Competence Intervention for Adolescents (SCI-A) curriculum on social competence. Analyses explored a more "child-world" approach to EF assessment within a context of general social competence gains. Key findings highlight students' improvements in broad, informant-based measures of executive function and in performance-based tasks designed to assess specific EF processes. Furthermore, these measures provide unique sources of information. Implications for the use of multisource executive function assessments within social competence interventions are discussed.

The present study explores the extent to which maternal attachment and teacher--student attachment-like relationships explain the socioemotional adaptation of students with disabilities. Participants consisted of 65 dyads of homeroom teachers and their students (from a middle-to-low-class area in Northern Israel) with learning disabilities (LD), attention deficit hyperactivity disorder (ADHD), and LD/ADHD-co-morbidity (mean age = 10.9). Students were assessed based on the maternal attachment security scale (ASS) and the appraisal of the teacher as a secure base scale. Homeroom teachers completed the student-teacher security scale. Third-party teachers reported on students' school adaptation. Results indicated that beyond the disability factor, secure teacher-student relationships reduced the students' externalising problem behaviours and improved student learning proficiencies that are considered to be affected by the adequacy of executive functioning. Additionally, maternal attachment reduced internalising problem behaviours. Implications for the protective role of teachers of students with disabilities and for research on teacher--student relationship quality are discussed.

The current longitudinal study used data from the National Institute of Child Health and Human Development (NICHD) Study of Early Child Care and Youth Development (SECCYD) to examine a model of development that emphasizes early caregiving environments as predictors of social emotional competence (including classroom competence). This path analysis model included features of parenting, emotion regulation, preschool language skills, and attention to predict child outcomes in 1st grade. Early caregiving environments were directly predictive of peer relationship satisfaction, oppositional behavior, social skills, and classroom competence over and above significant mediated effects through preschool self-regulation (language, inattention, and anger/frustration). These results suggest that the characteristics of supportive and stimulating caregiving shift in valence over time, such that qualities of the infant-child relationship that are significant in predicting early childhood outcomes are not the same as the caregiving qualities that move to the foreground in predicting primary school outcomes. Implications for school-readiness programming are discussed, including interventions in the early caregiving system to encourage sensitive and supportive parent-child interactions to bolster school readiness via the development of social-emotional competence.

More than 20?years ago, Minshew and colleagues proposed the Complex Information Processing model of autism in which the impairment is characterized as a generalized deficit involving multiple modalities and cognitive domains that depend on distributed cortical systems responsible for higher order abilities. Subsequent behavioral work revealed a related dissociation between concept formation and concept identification in autism suggesting the lack of an underlying organizational structure to manage increases in processing loads. The results of a recent study supported the impact of this relative weakness in conceptual reasoning on adaptive functioning in children and adults with autism. In this study, we provide further evidence of the difficulty relatively able older adolescents and adults with autism have with conceptual reasoning and provide evidence that this characterizes their difference from age- and ability-matched controls with typical development better than their differences in language. For verbal adults with autism, language may serve as a bootstrap or compensatory mechanism for learning but cannot overcome an inherent weakness in concept formation that makes information processing challenging as task demands increase.

The study examined the impact of two grammatical factors on marking Hebrew adjectives in agreement with plural nouns in adults with attention-deficit hyperactivity disorder (ADHD) compared with peers without ADHD. Participants were 36 adult speakers of Hebrew, who were administered a judgment test of 144 sentences, each containing an adjective in agreement with a plural noun in one of three different syntactic configurations--predicative adjectives, attributive adjectives in sentence-initial position, and attributive adjectives in sentence-final position. Noun suffixes were regular, semiregular (ambiguous), and irregular. Findings showed that participants with ADHD displayed lower accuracy and longer response time compared with controls. As morphological and morpho-syntactic difficulty simultaneously increased, participants with ADHD were significantly more likely to perform less well compared with controls on both accuracy and speed. These findings indicate that adults with ADHD might be suffering from a linguistic impairment exacerbated under more cognitively and linguistically demanding conditions.

Although previous research has established the association between early-grade mathematics knowledge and later mathematics achievement, few studies have measured mathematical skills prior to school entry, and few have investigated the predictive power of early gains in mathematics ability. The current paper relates mathematical skills measured at 54 months to adolescent mathematics achievement using multisite longitudinal data. We find that preschool mathematics ability predicts mathematics achievement through age 15, even after accounting for early reading, cognitive skills, and family and child characteristics. Moreover, we find that growth in mathematical ability between age 54 months and first grade is an even stronger predictor of adolescent mathematics achievement. These results demonstrate the importance of prekindergarten mathematics knowledge and early math learning for later achievement.

Objective: This study addresses if deficits in cognitive, attention, and inhibitory control performance in adults with ADHD are better explained by the disorder itself or by comorbid conditions. Method Adult patients with ADHD ("n" = 352) and controls ("n" = 94) were evaluated in the ADHD program of a tertiary hospital. The diagnostic process for ADHD and comorbidities was based on "Diagnostic and Statistical Manual of Mental Disorders" (4th ed.; "DSM-IV") criteria. Stepwise regression analyses evaluated the effect of ADHD, demographics, and comorbidities on the scores from Wechsler Adult Intelligence Scale-Revised, Continuous Performance Test, and Stroop Color and Word Test. Results: Patients with ADHD of both genders had worse performance on neuropsychological domains, even after adjustment for comorbidities. The presence of comorbid bipolar disorder and specific phobia are associated with more Stroop errors, whereas patients with generalized anxiety disorder present a longer execution time in Stroop. Conclusion: Neuropsychological deficits in adults with ADHD go beyond comorbidity. Specific comorbid disorders may influence the neuropsychological functioning in adults with ADHD. (Contains 2 tables.)

Individuals with attention deficit hyperactive disorder (ADHD) often have coexisting developmental coordination disorder (DCD). The positive therapeutic effect of methylphenidate on ADHD symptoms is well documented, but its effects on motor coordination are less studied. We assessed the influence of methylphenidate on motor performance in children with comorbid DCD and ADHD. Participants were 30 children (24 boys) aged 5.10-12.7 years diagnosed with both DCD and ADHD. Conners' Parent Rating Scale was used to reaffirm ADHD diagnosis and the Developmental Coordination Disorder Questionnaire was used to diagnose DCD. The Movement Assessment Battery for Children-2 and the online continuous performance test were administrated to all participants twice, with and without methylphenidate. The tests were administered on two separate days in a blind design. Motor performance and attention scores were significantly better with methylphenidate than without it (p less than 0.001 for improvement in the Movement Assessment Battery for Children-2 and p less than 0.006 for the online continuous performance test scores). The findings suggest that methylphenidate improves both attention and motor coordination in children with coexisting DCD and ADHD. More research is needed to disentangle the causality of the improvement effect and whether improvement in motor coordination is directly affected by methylphenidate or mediated by improvement in attention. (Contains 1 table and 2 figures.)

Although extant studies indicate that there is a strong association between attention deficit/hyperactivity disorder and reading ability in elementary school children, knowledge regarding the relation between inattentive and hyperactive/impulsive behaviors and emergent literacy in preschool children is less established. This study examined the unique and overlapping relations between measures that assess inattention and hyperactivity/impulsivity and emergent literacy skills in preschool children. Participants included 204 preschool children ("M" age = 56 months, 50.9% female, 79.8% European American). Behavioral rating scales were completed by teachers, and the Continuous Performance Test (CPT) and the Test of Preschool Early Literacy were completed by the preschoolers. Across measures, inattention was a unique correlate of emergent literacy skills, whereas hyperactivity/impulsivity was not. Both rating scales and the CPT indices of inattention were uniquely associated with emergent literacy skills. These results suggest that these measures are assessing different manifestations of inattention that are both unique correlates of early reading skills. (Contains 4 tables.)

The purpose of this study was to analyze the effects of an intensive psychosocial intervention on the executive functioning (EF) in children with ADHD. The treatment was carried out in a coordinated manner over a period of 10 weeks with 27 children with ADHD aged 7 to 10, their parents, and their teachers. A battery of neuropsychological tasks was applied to evaluate attention, interference control, verbal and visuospatial working memory, planning ability, and flexibility. The comparative analysis of the treated group of ADHD children and an untreated ADHD group showed significant differences that were especially important in visuospatial memory and planning in favor of the treated children, even when the scores in the pretreatment phase were included as covariables. Likewise, improvements were observed in the parents' and teachers' behavioral ratings of hyperactivity or impulsivity and inattention. The conclusion was drawn that psychosocial interventions with children with ADHD can have a positive effect on some executive functions. (Contains 4 tables.)

This study investigated whether major depression in adolescence is characterized by neurocognitive deficits in attention, affective decision making, and cognitive control of emotion processing. Neuropsychological tests including the Wechsler Abbreviated Scale of Intelligence, the Continuous Performance Test-Identical Pairs, the Attention Network Test, the Iowa Gambling Task, the Emotional Go-NoGo Task, and the Face Go-NoGo Task were administered to adolescents with Major Depressive Disorder (MDD) (n = 31) and psychiatric diagnosis free controls (n = 30). Findings indicated that compared with controls, depressed adolescents exhibited impaired sustained attention; a gender by group interaction on affective decision making such that depressed males tended to make less advantageous choices on the IGT; and an inverse pattern of correlations between depressive symptom counts and reaction time to affective stimuli, characterizing greater affective reactivity in depressed adolescents. Findings demonstrate that adolescents with MDD display selective neurocognitive impairments on tasks capturing "cool" and "hot" executive functioning. (Contains 4 tables.)

Inattention is among the most commonly referred problems for school-aged youth. Research suggests distinct mechanisms may contribute to attention problems in youth with anxiety disorders versus youth with attention deficit hyperactivity disorder (ADHD). This study compared children (8-17 years) with anxiety disorders (n = 24) and children (8-16 years) with ADHD (n = 23) on neurocognitive tests of both general and emotion-based attention processes. As hypothesized, children with ADHD demonstrated poorer selective and sustained attention, whereas youth with anxiety disorders demonstrated greater attentional bias toward threatening faces on a visual probe task. Findings suggest the neuropsychological differentiation of attention problems in anxious and ADHD children, despite potentially similar phenotypes. (Contains 3 tables.)

Objective: Exposure to heavy maternal cigarette smoking in pregnancy and severe maternal psychosocial stress during pregnancy appear to be important risk factors for the development of ADHD. This study aimed to determine whether these perinatal risk factors were associated with neuropsychological deficits commonly seen in ADHD. Method: We examined the effect of these two risk factors on measures of attentional control, motor inhibition, visual-motor integration, and fine motor coordination in a group of 81 children with ADHD, aged from 8 to 18 years. The neuropsychological battery included the Connors' Continuous Performance Test (CPT), the Stroop Color-Word Interference Test, the Beery Visual-Motor Integration Test, and the Purdue Pegboard Test. Results: Heavy maternal smoking during pregnancy was associated with slower reaction times (p less than 0.002), and reaction time variability (p less than 0.007) on the CPT. Conclusions: This study suggests a persistent negative effect of heavy prenatal maternal smoking on attentional control in children with ADHD. Future studies should examine the neurobiological basis and determine the degree to which inherited genetic susceptibility factors contribute to this finding. (Contains 4 tables.)

Objective: The study examines psychological well-being and self-concept in college students diagnosed with ADHD. Method: We surveyed 17 undergraduate college students with ADHD and 19 undergraduate controls concerning academic and emotional support received from family and friends. All students completed the Connor's Continuous Performance Test (CPT-II), Connor's Adult Rating Scale (CAARS), Tennessee Self-Concept Scale (TSCS:2) and Psychological Well-Being Scale (PWB). Results: Between group differences were significant for the CAARS and CPT-II, but not total self-concept (TSC) or global PWB. The strongest predictors for TSC were "environmental mastery" (PWB) for the ADHD group and "positive relations with others" (PWB) for the controls. Students with ADHD reported significantly higher paternal support than controls who reported significantly greater support from friends. Conclusion: College students with a diagnosis of ADHD may represent an especially resilient group. Future studies should investigate competencies of students with ADHD who have achieved success against the odds. (Contains 1 table and 1 figure.)

Objective: To determine if comorbid anxiety disorder is associated with differential response to immediate release methylphenidate (MPH-IR) in children with both ADHD and chronic multiple tic disorder (CMTD). Method: Children with (n = 17) and without (n = 37) diagnosed anxiety disorder (ANX) were evaluated in an 8-week, placebo-controlled trial with rating scales and laboratory measures. Results: The +ANX group obtained more severe parent, teacher, and child ratings of anxiety and more severe parent ratings of depression, tics, oppositional defiant disorder (ODD), and peer aggression than the -ANX group. Treatment with short-term MPH-IR was associated with improvement in ADHD, ODD, and peer aggression in the +ANX group. When controlling for ODD severity, there were no apparent group differences in therapeutic response to MPH-IR in children plus or minus ANX. There was little evidence that MPH-IR contributed to improvement in anxiety or depression symptoms in the +ANX group. There was some indication that children with comorbid anxiety may differentially experience greater increase in systolic blood pressure (0.5 mg/kg of MPH-IR greater than placebo). Conclusion: Findings suggest that the co-occurrence of diagnosed CMTD+ADHD+ANX represents a particularly troublesome clinical phenotype, at least in the home setting. Comorbid anxiety disorder was not associated with a less favorable response to MPH-IR in children with ADHD+CMTD, but replication with larger samples is warranted before firm conclusions can be drawn about potential group differences. (Contains 2 tables and 1 figure.)

Objective: The main aim of this study was to examine the age-dependent remission from ADHD in girls transitioning through childhood into adolescence and early adulthood. Method: We conducted a 5-year prospective follow-up study of 123 girls with ADHD and 106 non-ADHD control girls aged between 6 and 17 years at ascertainment. ADHD was considered persistent at follow-up if participants met full diagnostic criteria for "DSM-IV" ADHD or met residual criteria for "DSM-IV" ADHD with associated impairment (Global Age Forum [GAF] score less than 60). Results: By age 16 years, ADHD was persistent in 71% (95% CI = 61-79%) of girls with ADHD. Participants with persistent ADHD at follow-up had more psychiatric comorbidity, behavior problems, and functional impairment than girls with ADHD in remission. Remitted ADHD, however, continued to be associated with functional impairment relative to non-ADHD controls. Persistence at 5 years was predicted by increased behavioral impairment at baseline. Conclusion: This 5-year follow-up suggests that many girls with ADHD experience persistent symptoms and/or functional impairment through late adolescence and into early adulthood. (Contains 1 figure and 3 tables.)

Previous studies showed that the anterior cingulate cortex (ACC) is activated when individuals engage in attention and inhibitory control tasks. The present study examined whether ACC activity is associated with behavioral performance of the two tasks. Twenty normal and 20 children with autism spectrum disorders (ASDs) were subjected to neuropsychological assessments on attention and inhibitory control, as well as electroencephalography recording. Children with ASD performed significantly worse than normal children on attention tasks as shown in their poorer performance on the Digit Span test, the greater number of Omission Errors on both the Continuous Performance Test II and the Go/No-Go tasks. They also performed significantly worse than normal children on inhibitory control tasks as shown by the greater number of False Alarms on the Object Recognition and Hong Kong List Learning Test. Their ACC activities, as indicated by relative theta power, were found to be significantly lower than those of normal controls during performance of the Go/No-Go task. Depressed ACC activities were further found to be significantly associated with poorer performance in attention and inhibition. Clinical implications on the use of theta activities in the ACC as an indicator to monitor intervention progress in children with ASD were discussed. (Contains 3 figures and 4 tables.)

Methylphenidate (MPH) often ameliorates attention-deficit/hyperactivity disorder (ADHD) behavioral dysfunction according to "indirect" informant reports and rating scales. The standard of care behavioral MPH titration approach seldom includes "direct" neuropsychological or academic assessment data to determine treatment efficacy. Documenting "cool" executive-working memory (EWM) and "hot" self-regulation (SR) neuropsychological impairments could aid in differential diagnosis of ADHD subtypes and determining cognitive and academic MPH response. In this study, children aged 6 to 16 with ADHD inattentive type (IT; n = 19) and combined type (n = 33)/hyperactive-impulsive type (n = 4) (CT) participated in double-blind placebo-controlled MPH trials with baseline and randomized placebo, low MPH dose, and high MPH dose conditions. EWM/SR measures and behavior ratings/classroom observations were rank ordered separately across conditions, with nonparametric randomization tests conducted to determine individual MPH response. Participants were subsequently grouped according to their level of cool EWM and hot SR circuit dysfunction. Robust cognitive and behavioral MPH response was achieved for children with significant baseline EWM/SR impairment, yet response was poor for those with adequate EWM/SR baseline performance. Even for strong MPH responders, the best dose for neuropsychological functioning was typically lower than the best dose for behavior. Findings offer one possible explanation for why long-term academic MPH treatment gains in ADHD have not been realized. Implications for academic achievement and medication titration practices for children with behaviorally diagnosed ADHD will be discussed. (Contains 2 figures and 1 table.)

Significant motivations and incentives exist for young-adult students to seek a diagnosis of attention-deficit/hyperactivity disorder (ADHD). With ADHD information readily accessible on the Internet, today's students are likely to be symptom educated prior to evaluation. This may result in false-positive diagnoses, particularly when students are motivated to convey symptoms. We evaluated the utility of ADHD symptom checklists, neurocognitive tests, and measures initially developed to detect feigned neurocognitive or psychiatric dysfunction (symptom validity tests [SVTs]). The performance of 31 undergraduates financially motivated and coached about ADHD via Internet-derived information was compared to that of 29 ADHD undergraduates following medication washout and 14 students not endorsing symptomatology. Results indicated malingerers readily produced ADHD-consistent profiles. Symptom checklists, including the ADHD Rating Scale and Conners's Adult ADHD Rating Scale-Self-Rating Form: Long, were particularly susceptible to faking. Conners's Continuous Performance Test--II findings appeared more related to motivation than condition. Promising results were seen with all cognitive SVTs (Test of Memory Malingering [TOMM], Digit Memory Test, Letter Memory Test, and Nonverbal-Medical Symptom Validity Test), particularly TOMM Trial 1 when scored using Trial 2 criteria. All SVTs demonstrated very high specificity for the ADHD condition and moderate sensitivity to faking, which translated into high positive predictive values at rising base rates of feigning. Combining 2 or more failures resulted in only modest declines in sensitivity but robust specificity. Results point to the need for a thorough evaluation of history, cognitive and emotional functioning, and the consideration of exaggerated symptomatology in the diagnosis of ADHD. (Contains 6 tables.)

Objective: A previous factor analysis of the Conners' Continuous Performance Test (CCPT) indicates that the test measures 5 sub-functions of attention, namely "focused attention," "hyperactivity/impulsivity," "sustained attention," "vigilance," and "change in control." The present study further analyzes the results from Egeland & Kowalik-Gran to test the construct- and criterion-validity of these factors. Method: Construct validity is tested by analyzing whether clinical groups known to be impaired in specified subprocesses actually differ with regard to factor scores. Comparison of CCPT factor scores from 282 individuals with ADHD, schizophrenia, affective disorders, brain injury, language disorders, and normal individuals gives validity to 4 factors, but not to the "vigilance" factor. Results: Other tests of controlled attention correlate only with focused attention, thus giving criterion validity to this factor and differential validity to the remaining 4 factors. Conclusion: Grouping scores on the CCPT into 4 or 5 sub-functions of attention may provide the clinician with a tool to differentiate between clinical groups. (Contains 1 figure and 4 tables.)

The present study investigated whether children with ADHD and those with working memory impairments have a common behavioral profile in the classroom. Three teacher checklists were used: the Conners' teacher rating scale (CTRS), the behavior rating inventory of executive function (BRIEF), and the working memory rating scale. The Conners' continuous performance test (CPT) was also included to determine whether there is a correspondence between performance on this widely used cognitive measure of attention deficits and teacher ratings of classroom behavior. All three behavior scales, but not the CPT, were able to successfully discriminate children with ADHD and those with working memory deficits from typically-developing children. Both the CTRS and the BRIEF discriminated a significant proportion of the children with ADHD from those with working memory deficits, indicating that while both groups exhibit behavioral problems in the classroom, they are characterized by differential attention profiles. The children with ADHD were identified on the basis of oppositional and hyperactive behavior, while those with working memory deficits were more inattentive.

Objective: To determine if adults with ADHD differed from children with ADHD, in assessing their performance on the Conners Continuous Performance Test (CPT). Method: ADHD-diagnosed adults (n = 13) and adults without ADHD (n = 17) were tested twice on the CPT and then completed self-evaluation and attribution surveys. Results: Nonmedicated ADHD-diagnosed adults performed significantly more poorly than controls; when medicated, they performed as well as controls and significantly better than when they were unmedicated. AD/HD adults evaluated their performance accurately, whether medicated or not. They also attributed their performance to medication significantly more than to ability or task difficulty. Conclusion: Unlike children, ADHD-diagnosed adults attributed their performance to medication rather than ability or task. It remains to be seen whether this difference is associated with lower self-esteem than non-ADHD adults or if the same outcome would occur in children with ADHD if they were also tested under naturalistic conditions. (Contains 1 table.)

Objective: To characterize the relationship between IQ and attention deficits in children with ADHD and to estimate the inattention-related mean influence on IQ when children are tested before stimulant drug treatment has been initiated. Method: Studies of various methodologies are reviewed. Results: Correlation studies show mostly weak associations between IQ scores and attention deficits. Meta-analyses report the average short-term stimulant treatment effect on IQ in children with ADHD to be 2 to 7 IQ points. Conclusion: The associations between IQ and attention deficits in ADHD are generally modest, with the mean influence on IQ probably amounting to 2 to 5 IQ points. This may serve as a benchmark when clinicians interpret the validity of IQ in this clinical population. (Contains 1 table.)

Objective: The Wender Utah Rating Scale (WURS) is used to retroactively assess ADHD symptoms. This study sought to determine whether the WURS actually functions as an index of dysfunctional personality traits. Method: Five hundred twenty-two adult participants completed the WURS and at least one of the following measures: Wechsler Adult Intelligence Scale--III (WAIS-III), Trails Making Test (Forms A and B), Conners' Continuous Performance Test, d2 Test of Attention, and the Personality Assessment Inventory (PAI). Results: The WURS correlated significantly with all PAI clinical and treatment scales; however, of the neuropsychological measures, only the CPT significantly correlated with the WURS score. Multiple regression analyses revealed a significant model that included clinical and treatment scales from the PAI as well as working memory and processing speed indexes from the WAIS-III that accounted for 39% of the variance in WURS scores. Conclusion: Performance on the WURS was more related to dysfunctional personality traits than to actual attentional performance in this young adult sample. (Contains 5 tables.)

Objective: The goal of this study was to contrast the cognitive phenotypes in boys with 47,XYY (XYY) karyotype and boys with 47,XXY karyotype [Klinefelter syndrome, (KS)], who share an extra copy of the X-Y pseudoautosomal region but differ in their dosage of strictly sex-linked genes. Methods: Neuropsychological evaluation of general cognitive ability, language, memory, attention, visual-spatial abilities, visual-motor skills, and motor function. Results: Study cohort: 21 boys with 47,XYY and 93 boys with 47,XXY (KS), age 4-17 years, and 36 age-matched control boys. Both the XYY and KS groups performed less well, on average, than the controls on tests of general cognitive ability, achievement, language, verbal memory, some aspects of attention, and executive function, and motor function. The boys with XYY on average had more severe and pervasive language impairment, at both simple and complex levels, and the boys with KS on average had greater motor impairment in gross motor function and coordination, especially in running speed and agility. Conclusions: The results from these large XYY and KS cohorts have important neurocognitive and educational implications. From the neurocognitive standpoint, the presenting findings afford an opportunity to gain insights into brain development in boys with XYY and those with KS. From the educational standpoint, it is critical that boys with XYY or KS receive appropriate educational interventions that target their specific learning challenges. These findings also provide important information for counseling clinicians and families about these disorders. (Contains 5 tables.)

Clinical trials targeting recently elucidated synaptic defects in fragile X syndrome (FXS) will require outcome measures capable of assessing short-term changes in cognitive functioning. Potentially useful measures for FXS were evaluated here in a test-retest setting in males and females with FXS (N = 46). Good reproducibility, determined by an interclass correlation (ICC) or weighted kappa (K) of 0.7-0.9 was seen for RBANS List and Story Memory, NEPSY Tower, Woodcock-Johnson Spatial Relations and the commissions score from the Carolina Fragile X Project Continuous Performance Test (CPT). This study demonstrates the feasibility of generating test profiles containing reliability data, ability levels required for test performance, and refusal rates to assist with choice of outcome measures in FXS and other cohorts with cognitive disability.

The purpose of this study was to determine if a relationship exists between purposeful heading in soccer and neuropsychological test performance. Automated Neuropsychological Assessment Metrics throughput scores were derived on seven subset variables that measure a variety of neurocognitive abilities. Simple Spearman's rank correlations were calculated between headers per game (HPG) and the criterion variables. Interestingly, math processing speed (Spearman's rho = 0.160) and continuous performance test #2 (rho = 0.124) had small but significant correlations; both showed improvement in performance pre- to postseason. There were no significant correlations between HPG and the other five variables. This study found no detrimental relationship between the number of purposeful headers and the neurocognitive measures in this population. (Contains 5 tables.)

The Predominantly Inattentive (PI) and Combined (CB) subtypes of AD/HD differ in cognitive tempo, age of onset, gender ratio, and comorbidity, yet a differentiating endophenotype has not been identified. The aim of this study was to test rigorously diagnosed PI, CB, and typical children on measures selected for their potential to reveal hypothesized differences between the subtypes in specific neurocognitive systems (anterior vs. posterior attentional systems) and processes (arousal vs. activation). Thirty-four CB and 26 PI children meeting full DSM-IV criteria for subtype both in school and at home, without confounding reading disability or emotional disorder, were enrolled along with 20 typically developing children. Neurocognitive functions measured included attention, inhibitory control, working memory, learning, and executive functions. Tasks included the Stroop, Wisconsin Card Sorting Test, Continuous Performance Test (CPT). Buschke Selective Reminding Test, and the Tower of London (TOL), as well as instruments developed by Posner and Sternberg, and tasks assessing the impact on reaction time varying preparatory intervals and stimulus/response complexity. After co-varying for IQ, subtypes differed primarily on measures of impulsivity during tests of vigilance (CPT) and executive function (TOL), with the CB group showing greater impulsivity than both other groups. In addition, the PI group showed worse performance than CB and control groups on the WISC-III Processing Speed Index. Whether analyzed with or without an IQ co-variate, there was no support in the data for hypothesized differences between subtypes in functioning of the anterior vs. posterior attentional systems, nor in involvement of arousal vs. activation processes. The results indicate that the PI and CB subtypes are best differentiated by ratings, observations and tests of cognitive tempo and behavioral impulsivity. Neuropsychological methods have yet to identify critical neurological substrates of these differences.

Using Ecological Systems Theory and stage sequential modelling procedures for detecting mediation, this study examined how early developmental contexts impact preschoolers' performances on a measure of sustained attention and impulse control. Data from 1273 European-American and African-American participants in the NICHD Study of Early Child Care were used to identify the potential mediators of the relation between early household income-to-need (INR) and 54-month impulsivity and inattention. Exploratory analyses were also conducted to determine whether the relationships between early income, home environment, parenting stress, and the outcome variables differ for African-American versus European-American-American children. We found modest support for the study hypothesis that 36-month home environment quality mediated the INR/attention relationship. INR accounted for more home environment score variance and home environment accounted for more Impulsivity score variance for African-American children. Home environments were related to inattention in the European-American, but not African-American, group. (Contains 8 tables.)

Inattention/hyperactivity is a childhood outcome of low birth weight. However, the mechanisms by which low birth weight leads to inattention/hyperactivity are unclear. This study examined arousal, activation, motor speed, and motor coordination as possible mechanisms, attending to sex differences. 823 children (400 males) from Detroit and surrounding suburbs were assessed with the Child Behavior Checklist and the Teacher Report Form and completed experimental tasks to assess vigilance and activation (Continuous Performance Test signal detection parameters) and motor output speed and control (Grooved Pegboard) at 6 years of age. The relationship between birth weight and inattention/hyperactivity was slightly, but not significantly, stronger for boys than for girls. Arousal, motor speed, and motor coordination significantly partially mediated the relationship between birth weight and inattention/hyperactivity for boys and girls. Moderated mediation was found for the pathway between motor coordination and inattention/hyperactivity such that this relationship was stronger for boys than for girls. Sex differences in the associated features of attention symptoms may reflect partially distinct etiological pathways.

Objective: To examine the ability of the flicker task to demonstrate greater utility in discriminating performance in young adults with and without ADHD compared to the Conners' CPT (CCPT). Method: Flicker task and CCPT performance were compared between an ADHD (n = 28) and control (n = 30) group of college students. Results: This study replicated previous flicker task findings, providing support for using the flicker task to demonstrate the robust nature of change blindness. However, the flicker task did not demonstrate better discriminative utility than the CCPT. Task-dependent measures correlated with ADHD rating scale indices of inattention and hyperactivity/impulsivity, indicating that CPTs lack symptom domain specificity. Conclusion: Results support the growing evidence that CPTs currently provide only modest utility for discriminating performance in adults with and without ADHD. Recommendations are provided regarding the future study of CPTs as a valid measure of ADHD performance and the potential utility of the flicker task. (Contains 2 figures and 4 tables.)

Objective/Method: The Conner's Continuous Performance Test (CPT) was administered to four groups of adult college students who self-referred for comprehensive psychoeducational evaluation and received either no diagnosis (n = 30) or a diagnosis of ADHD (n = 26), a psychiatric disorder (n = 17), or various cognitive deficits (n = 22). Results: The groups did not differ with respect to age, sex, race, or IQ. Although the ADHD group made more CPT errors of omission, had longer response times, and showed greater variability in responding than the other three groups, these differences did not reach statistical significance when analyzed parametrically using standard scores. But when the pattern of scores across the groups was analyzed nonparametrically, significant and interpretable results emerged. Conclusion: The CPT reliably differentiated between individuals with ADHD and both normal college students and individuals with psychiatric diagnoses but not persons with learning/cognitive disorders. (Contains 2 tables.)

Background: While studies have increasingly investigated deficits in reaction time (RT) and RT variability in children with attention deficit/hyperactivity disorder (ADHD), few studies have examined the effects of stimulant medication on these important neuropsychological outcome measures. Methods: 316 children who participated in the Multimodal Treatment Study of Children with ADHD (MTA) completed the Conners' Continuous Performance Test (CPT) at the 24-month assessment point. Outcome measures included standard CPT outcomes (e.g., errors of commission, mean hit reaction time (RT)) and RT indicators derived from an Ex-Gaussian distributional model (i.e., mu, sigma, and tau). Results: Analyses revealed significant effects of medication across all neuropsychological outcome measures. Results on the Ex-Gaussian outcome measures revealed that stimulant medication slows RT and reduces RT variability. Conclusions: This demonstrates the importance of including analytic strategies that can accurately model the actual distributional pattern, including the positive skew. Further, the results of the study relate to several theoretical models of ADHD.

This study examined the role of language, attention/impulse control, and mother-child play in predicting later peer competence by assessing 252 children at ages 3 and 8 years. Children born term (n = 90) or preterm (n = 162) were included to examine the question of how variability in skills influenced social outcomes and whether relations were comparable for these 2 groups known to vary in development. Path analyses, which were comparable for both groups, showed that social connectedness, compliance, and noncompliance with peer requests were predicted by concurrent language skills, whereas concurrent impulsivity and inattentiveness were important for understanding frustration tolerance/flexibility with peers. Three-year language and toy play skills showed indirect influences on peer competence through direct influences on 8-year language and inattention. These results indicate that early social and language skills contribute to various aspects of later competent peer play and highlight the importance of including multiple cognitive and behavioral factors in models examining peer competence. (Contains 5 tables and 1 figure.)

Objective: The purpose of this study was to assess heritability of activity, attention, and impulsivity by comparing young monozygotic (MZ) twins with dizygotic (DZ) twins using objective measures. Method: The OPTAx test is an infrared motion analysis to record the movement pattern during a continuous performance test. Seventeen MZ and 12 same sexed DZ twin pairs in the range of 6 to 12 years were tested. The zygosity was determined by DNA-fingerprinting. The measures under investigation were activity (microevents and spatial scaling), impulsivity (errors of commission), and attention (accuracy and variability). For statistical analyses, the classical model of Falconer and the ACE and ADE genetic model for twin data were applied in order to estimate the proportion of the variance in activity, impulsivity and attention that is due to genetic effects. Results: The respective coefficients of intraclass correlations in MZ twins ranged between 0.35 and 0.65 whereas for DZ twins the correlations were between 0.12 and 0.88. The heritability estimates resulting from both models were about 30% for 4 of the 5 measures, but none of these was significantly different from 0. Conclusion: We found no significant influence of genetic factors for activity, attention, and impulsivity. The authors conclude that further investigation of heritability of ADHD is necessary using larger sample sizes and objective measures. (Contains 4 tables.)