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Objectives:This study examined whether children with distinct brain disorders show different profiles of strengths and weaknesses in executive functions, and differ from children without brain disorder.Methods:Participants were children with traumatic brain injury (N=82; 8–13 years of age), arterial ischemic stroke (N=36; 6–16 years of age), and brain tumor (N=74; 9–18 years of age), each with a corresponding matched comparison group consisting of children with orthopedic injury (N=61), asthma (N=15), and classmates without medical illness (N=68), respectively. Shifting, inhibition, and working memory were assessed, respectively, using three Test of Everyday Attention: Children’s Version (TEA-Ch) subtests: Creature Counting, Walk-Don’t-Walk, and Code Transmission. Comparison groups did not differ in TEA-Ch performance and were merged into a single control group. Profile analysis was used to examine group differences in TEA-Ch subtest scaled scores after controlling for maternal education and age.Results:As a whole, children with brain disorder performed more poorly than controls on measures of executive function. Relative to controls, the three brain injury groups showed significantly different profiles of executive functions. Importantly, post hoc tests revealed that performance on TEA-Ch subtests differed among the brain disorder groups.Conclusions:Results suggest that different childhood brain disorders result in distinct patterns of executive function deficits that differ from children without brain disorder. Implications for clinical practice and future research are discussed. (JINS, 2017,23, 529–538)

The purpose of this study was to review the current literature on neuropsychological functioning in two groups of children requiring organ transplants (liver or heart) and present recent clinical data collected through the liver and cardiac transplantation programs at a large pediatric academic medical center.Data included in this study came from 18 patients who completed evaluations for heart transplant (n = 8) or liver transplant (n = 10) between the ages of 2 and 6 years (inclusive). Measures examining neurocognitive, emotional-behavioral, and adaptive functioning were collected as part of standard pre-transplant clinical neuropsychological evaluations. Within each organ group, mean scores were calculated and compared with normative population mean scores using one sample t-tests. In addition, non-parametric binomial tests were calculated to examine whether the proportion of individuals falling more than one standard deviation below the population mean was significantly greater in the patient groups than the normative population base rate of 16%.Patients in both groups performed below normative expectation in several neurocognitive and adaptive domains. However, neither group showed significant difficulties in behavioral or emotional regulation.Results from this study document cognitive delays in preschool-aged children undergoing evaluations for liver transplant or heart transplant, highlighting the importance of intervention and long-term monitoring of these two patient populations, as well as the need for neuropsychologist involvement with transplant teams.

While neuropsychological deficits in both “hot” and “cool” executive functions (EFs) have been documented among individuals with attention-deficit/hyperactivity disorder (ADHD), these EF deficits are not universal across all individuals with this diagnosis. One potential moderator of executive dysfunction may be the presence of comorbid oppositional defiant disorder (ODD). This study examined the association between “hot” and “cool” EFs and comorbid ODD in children with ADHD. Thirty-three children with ADHD and comorbid ODD (ADHD+ODD), 67 with ADHD without ODD (ADHD-ODD), and 30 typically developing controls participated. Children were 7–12 years of age. “Cool” EFs were assessed with a spatial span task and a card sorting test. “Hot” EFs were assessed using a delay discounting task and a gambling task. ADHD-ODD and ADHD+ODD groups performed more poorly on “cool” EF tasks than controls, but did not differ from each other. Furthermore, the number of ADHD symptoms, but not ODD symptoms, was associated with “cool” EF scores. The three groups did not differ on “hot” EF tasks and the number of ADHD or ODD symptoms was unrelated to “hot” EF scores. In sum, children with ADHD presented with “cool” EF deficits which appear to be unrelated to ODD comorbidity. However, “hot” EF deficits were not present among children with ADHD, irrespective of comorbid ODD status. (JINS, 2015,21, 584–595)

Objective: Although adolescents with ADHD report less driving experience, a greater proportion of adolescents with ADHD report receiving at least one ticket; however, no study has examined the severity of infractions committed by adolescent drivers with ADHD. Method: A total of 61 adolescents (28 ADHD, 33 controls) aged 16 to 17 with a valid driver’s license completed a self-report Driving History Questionnaire (DHQ), which asked about months of driving experience, negative driving outcomes, and severity of consequences. Results: A greater proportion of adolescents with ADHD reported receiving fines, points on their driver’s license, and remedial driving class. Furthermore, adolescents with ADHD reported attending a greater number of hours in remedial driving class, and a greater expense associated with fines. Conclusion: Importantly, ADHD-related negative driving outcomes manifest early in driving careers. Furthermore, increased negative consequences of poor and/or risky driving among adolescents with ADHD were evident despite having fewer months of independent driving.

Advances in the treatment of pediatric brain tumors have led to an overall increase in survival rates, which in turn has led to increased identification of physical, cognitive, academic/vocational, and socioemotional sequelae among survivors. Research to date has shown radiotherapy to account for a significant amount of variance in neurocognitive outcomes. However, other predisposing factors have also been identified, and research into the relative role of the direct and indirect effects of medical, child-specific, and broader contextual/environmental factors on outcomes in this population is needed. This chapter describes our current knowledge of neuropsychological and associated functional outcomes among survivors of pediatric brain tumor as well as the current literature on associated predisposing factors, pathophysiology, and evidence-based interventions for remediation and prevention. Methodological issues are also discussed in order to provide context for understanding limitations of current findings and to identify important future directions.

OBJECTIVE: Sluggish cognitive tempo (SCT) symptoms are associated with social difficulties in children, though findings are mixed and many studies have used global measures of social impairment. The present study tested the hypothesis that SCT would be uniquely associated with aspects of social functioning characterized by withdrawal and isolation, whereas attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) symptoms would be uniquely associated with aspects of social functioning characterized by inappropriate responding in social situations and active peer exclusion. METHOD: Participants were 158 children (70% boys) between ages 7–12 years being evaluated for possible ADHD. Both parents and teachers completed measures of SCT, ADHD, ODD, and internalizing (anxiety/depression) symptoms. Parents also completed ratings of social engagement and self-control. Teachers also completed measures assessing asociality and exclusion, as well as peer ignoring and dislike. RESULTS: In regression analyses controlling for demographic characteristics and other psychopathology symptoms, parent-reported SCT symptoms were significantly associated with lower social engagement (e.g., starting conversations, joining activities). Teacher-reported SCT symptoms were significantly associated with greater asociality/withdrawal and ratings of more frequent ignoring by peers, as well as greater exclusion. ODD symptoms and ADHD hyperactive-impulsive symptoms were more consistently associated with other aspects of social behavior, including peer exclusion, being disliked by peers, and poorer self-control during social situations. CONCLUSIONS: Findings provide the clearest evidence to date that the social difficulties associated with SCT are primarily due to withdrawal, isolation, and low initiative in social situations. Social skills training interventions may be effective for children displaying elevated SCT symptomatology.

Pediatric abusive head trauma causes significant cognitive and behavioral morbidity, yet very few post-acute interventions exist to facilitate long-term recovery. To meet the needs of this vulnerable population, we piloted a web-based intervention with live coaching designed to improve positive parenting and child behavior. The efficacy of this parenting skills intervention was compared with access to Internet resources on brain injury. Participants included seven families (four randomized to the parenting intervention and three randomized to receive Internet resources). Parenting skills were observed and child behavior was rated at baseline and intervention completion. At completion, parents who received the parenting skills intervention showed significantly more positive parenting behaviors and fewer undesirable behaviors during play than parents who received access to Internet resources. Additionally, during play, children in the parenting skills intervention group were more compliant following parent commands than children in the Internet resources group. Lastly, parents who received the parenting intervention reported less intense oppositional and conduct behavior problems in their children post-intervention than did parents in the Internet resources group. These findings provide preliminary evidence for the use of this web-based positive parenting skills intervention to improve parenting skills and child behavior following abusive head trauma.

Attention Deficit Hyperactivity Disorder (ADHD)-related deficits in working memory, attention, and inhibitory control have been well documented on neuropsychological tests (see Hervey et al., 2004 & Willcutt et al., 2005 for meta-analytic reviews). In addition to these cognitive deficits, children with ADHD have higher levels of intra-individual variability in reaction times than typically-developing children (De Zeeuw et al., 2008; Epstein et al., 2011a; Klein, Wendling, Huettner, Ruder, & Peper, 2006; Vaurio, Simmonds, & Mostofsky, 2009). Researchers have proposed that reaction time (RT) variability may be a potential endophenotype for ADHD (Castellanos & Tannock, 2002), particularly since heritability of RT variability is high (Kuntsi & Stevenson, 2001; Andreou et al., 2007). Most studies have demonstrated increased RT variability using RT standard deviation (RTSD). However, more recent studies have used ex-Gaussian estimates and fast Fourier transform analyses to demonstrate that children with ADHD are not consistently slower or always more variable than typical children, but that children with ADHD tend to exhibit intermittent long reaction times during task performance (Hervey et al., 2006; Leth-Steensen, Elbaz, & Douglas, 2000; Vaurio et al., 2009). In addition, these instances of long reaction times in children with ADHD may be predictably periodic (Castellanos et al., 2005; Johnson et al., 2007; Vaurio et al., 2009). Although these analyses help to better describe the patterns of RT variability among children with ADHD, it remains unclear what these intermittent periods of long reaction times signify (Tamm et al., 2012). Multiple hypotheses exist postulating what RT variability represents in children with ADHD, including slower cognitive processing, deviant time perception (Kalff et al., 2005) and problems with state regulation (Sergeant, 2005). Several investigators have also posited that periods of long reaction times are indicative of lapses in attention (Leth-Steensen et al., 2000; Hervey et al., 2006), although this remains unsubstantiated. In an attempt to better understand RT variability, researchers have begun to examine its behavioral correlates. For example, does RT variability relate specifically to inattention? Studies examining differences between children with ADHD-Combined Type and children with ADHD-Predominantly Inattentive Type have shown that both groups have slower mean reaction times and greater RT variability than control groups, but have not indicated substantial differences between the two subtypes (Epstein et al., 2011a; Nigg, Blaskey, Huang-Pollock, & Rappley, 2002; Pasini, Paloscia, Alessandrelli, Porfirio, & Curatolo, 2007, Solanto et al., 2007). Correlational studies examining associations between RT variability and parent- and teacher-reported ADHD symptom domains have found that RT variability is related to composite scores of inattention more so than to hyperactivity/impulsivity (Nigg, 1999; Wahlstedt, 2009). However, a study examining relations between RT variability and individual ADHD symptoms found that RT variability was related to specific symptoms in both ADHD symptom domains (Epstein et al., 2003). Examining behavioral correlates of RT variability using parent- or teacher reports of ADHD behaviors may be limited as behavioral ratings provide general summaries of behavior over an extended period of time (e.g., last week) rather than temporally-specific, moment-by-moment, information about behavioral variability. Observational methods with temporal coding of inattentive behavior may better relate to RT variability than parent or teacher ratings. Indeed, using behavioral observations, children with ADHD exhibit more off-task behavior than controls (see Kofler, Rapport, & Alderson, 2008 for a meta-analytic review). Further, children with ADHD appear to exhibit greater within-subject variability in their off-task behavior than controls (Abikoff, Gittelman-Klein, & Klein, 1977; Lauth, Heubeck, & Mackowiak, 2006; Kofler et al., 2008). Using a continuous coding strategy, Rapport, Kofler, Alderson, Timko, and DuPaul (2009) found that compared with controls, children with ADHD stay on-task for shorter periods of time and exhibit greater variability in visual attention during academic assignment completion in the classroom. There is a limited literature examining relations between continuously observed ADHD behavior and neuropsychological indicators (Weis & Totten, 2004; Solanto et al., 2001). No study to date has examined neuropsychological-behavioral relations using RT variability as a neuropsychological indicator. Given the magnitude of between-group differences on RT variability outcomes (Epstein et al., 2011a) and the supposition that RT variability may be indicative of attentional lapses (Hervey et al., 2006; Leth-Steenson, et al., 2000), an examination of the behavioral correlates of RT variability using continuous behavioral observations provides the opportunity to increase our understanding of RT variability. The current study sought to build on the results reported by Epstein et al. (2011a). In this study, children with and without ADHD completed five computerized tasks, which tapped into various aspects of executive functioning. Analyses focused on group differences for a variety of reaction time performance indicators from these five tasks. Results indicated that children with ADHD had greater values of Ex-gaussian tau and the coefficient of variation (RTSD ÷ RT mean) than controls across all five tasks. In addition, group differences in accuracy were found on some of the tasks. No group differences were found for mu or sigma on any of the tasks (all ps ≤ .05). Along with completing the computerized tasks, participants also completed a math test, during which they were video-recorded. examined the relationship between indicators of RT variability on five neuropsychological tests and on-task behavior during an analogue math task among children with and without ADHD. We also included additional alternative neuropsychological indicators in order to examine whether the relationship between neuropsychological functioning and observed behavior was specific to RT variability.

Cardiac defects represent the most common type of birth defect and children with these abnormalities are known to experience a variety of developmental and neuropsychological delays. Children receiving heart transplants may be at the highest risk for delays as they tend to represent the most severely ill patients with heart disease. This study investigates neurocognitive and adaptive functioning in 20 children under 2 years of age who were undergoing evaluation for heart transplant, comparing their performance to that of normative samples. The results indicate delays across various domains of neurocognition, including general cognitive, receptive language, expressive language, fine motor, and gross motor skills. In addition, adaptive and social-emotional functioning fell significantly below that of normative samples. No significant differences were found when comparing the test performance of patients with congenital heart defects (n = 12) to patients with cardiomyopathy (n = 8). Secondary analyses investigating the impact of genetic conditions, premature birth, and non-English language dominance showed minor changes in results across some domains, although this may have been due, at least in part, to decreased power to detect differences. Overall, this study's results support the need for early evaluation, intensive intervention (e.g., speech, occupational, and physical therapy), and continued monitoring of these patients' neurodevelopmental/neuropsychological functioning over time. Future research should examine longitudinal changes in development using both pre- and post-transplant data and should investigate the impact of early intervention.

We examined the feasibility of and parental satisfaction with a training programme for parents with children who had suffered traumatic brain injury (TBI). Families who did not have a home computer and/or webcam were loaned the necessary equipment. Skype was used for videoconferencing. After the initial treatment session in the family's home, the remaining nine sessions were conducted online. Each session had two parts: (1) a self-guided web session with information about a particular skill; (2) a videoconference session with the therapist. Three of the 20 families (15%) dropped out prior to the final 6-month follow-up visit. Of the remaining 17 families, 13 (65% of those enrolled) completed 9–14 sessions. Almost all of the caregivers (87%) said that the Skype sessions were helpful compared to a conventional office visit. Almost all parents were satisfied with the programme and the technology that was used. Parental satisfaction with the programme was not influenced by prior computer ownership or comfort with technology. The programme appears to be feasible for a wide range of parents of children with TBI and provides an alternative to conventional office-based sessions that may not be accessible to all families.

Objective: The purpose of the research study was to examine the manifestation of variability in reaction times (RT) in children with attention deficit hyperactivity disorder (ADHD) and to examine whether RT variability presented differently across a variety of neuropsychological tasks, was present across the two most common ADHD subtypes, and whether it was affected by reward and event rate (ER) manipulations. Method: Children with ADHD-combined type (n = 51), ADHD-predominantly inattentive type (n = 53), and 47 controls completed five neuropsychological tasks (Choice Discrimination Task, Child Attentional Network Task, Go/No-Go task, Stop Signal Task, and N-back task), each allowing trial-by-trial assessment of RTs. Multiple indicators of RT variability including RT standard deviation, coefficient of variation and ex-Gaussian tau were used. Results: Children with ADHD demonstrated greater RT variability than controls across all five tasks as measured by the ex-Gaussian indicator tau. There were minimal differences in RT variability across the ADHD subtypes. Children with ADHD also had poorer task accuracy than controls across all tasks except the Choice Discrimination task. Although ER and reward manipulations did affect children's RT variability and task accuracy, these manipulations largely did not differentially affect children with ADHD compared to controls. RT variability and task accuracy were highly correlated across tasks. Removing variance attributable to RT variability from task accuracy did not appreciably affect between-groups differences in task accuracy. Conclusions: High RT variability is a ubiquitous and robust phenomenon in children with ADHD. (PsycINFO Database Record (c) 2011 APA, all rights reserved). Language: en

The purpose of the research study was to determine whether ADHD- and texting-related driving impairments are mediated by extended visual glances away from the roadway. Sixty-one adolescents (ADHD = 28, non-ADHD = 33; 62% male; 11% minority) aged 16–17 with a valid driver’s license were videotaped while engaging in a driving simulation that included a No Distraction, Hands-Free Phone Conversation, and Texting condition. Two indicators of visual inattention were coded: 1) percentage of time with eyes diverted from the roadway; and 2) number of extended (greater than 2 seconds) visual glances away from the roadway. Adolescents with ADHD displayed significantly more visual inattention to the roadway on both visual inattention measures. Increased lane position variability among adolescents with ADHD compared to those without ADHD during the Hands-Free Phone Conversation and Texting conditions was mediated by an increased number of extended glances away from the roadway. Similarly, texting resulted in decreased visual attention to the roadway. Finally, increased lane position variability during texting was also mediated by the number of extended glances away from the roadway. Both ADHD and texting impair visual attention to the roadway and the consequence of this visual inattention is increased lane position variability. Visual inattention is implicated as a possible mechanism for ADHD- and texting-related deficits and suggests that driving interventions designed to address ADHD- or texting-related deficits in adolescents need to focus on decreasing extended glances away from the roadway.

Parent-teacher agreement on attention-deficit/hyperactivity disorder (ADHD) symptom ratings ranges from low to moderate. Most studies evaluating parent-teacher agreement have not assessed measurement invariance across raters. Hence, it is unclear whether discordance across raters is due to differing ADHD constructs across raters or other factors (e.g., subjective differences across raters). Additionally, the effect of development on parent-teacher agreement is relatively unknown. To address these limitations, the present study used parent and teacher ADHD ratings from a large (N = 6,659) developmentally diverse (ages 4-17) sample. Using exploratory structural equation modeling on half the sample, and then confirmatory factor analysis (CFA) on the other half of the sample, confirmed a 2-factor structure with significant cross-loadings for the 18 ADHD symptoms. CFA invariance analyses demonstrated that the 2-factor symptom structure was similar across raters and age groups. After confirming measurement invariance, the correlation between latent factors within and across raters was examined for each age group as well as across age groups. Parents reported greater severity of ADHD symptoms than did teachers, and both parents and teachers reported higher levels of hyperactivity/impulsivity in younger children than in older children and consistent levels of inattention across development. Finally, correlations between parent-teacher ratings of like factors were weak for inattention and moderate-strong for hyperactivity/impulsivity, and the magnitude of parent-teacher agreement did not vary across development. In conclusion, while parent and teacher ratings of ADHD behaviors are only weakly to moderately correlated, each reporter provides unique and valid clinical information as it relates to ADHD symptom presentation.

DK phocomelia/von Voss Cherstvoy syndrome is a rare condition characterized by upper limb and urogenital abnormalities and various brain anomalies. Previously reported cases have noted significant developmental delays, although no formal testing of cognitive abilities has been reported. In this paper we describe results from a comprehensive neuropsychological evaluation of a 12-year-old male with DK phocomelia syndrome. Test findings indicated mild impairment in intellectual functioning, with more significant impairment in adaptive skills and academic achievement. The neuropsychological profile converged with neurological findings, showing a distinct pattern of strengths and weaknesses that suggests functional compromise of posterior brain regions with relatively well-preserved functioning of more anterior regions. Specifically, impairments were evident in perceptual reasoning, visual perception, and visuomotor integration, whereas normal or near normal functioning was evident in memory, receptive language, social cognition, attention, and most aspects of executive functioning. To our knowledge this is the first report to describe the neurocognitive profile of an individual with DK phocomelia syndrome.

Objective To examine changes in parent depression, psychological distress, parenting stress, and self-efficacy among participants in a randomized trial of a Web-based parent training program for pediatric traumatic brain injury (TBI). Methods Primary caregivers of 37 children aged 3 to 9 years who sustained a moderate/complicated mild to severe TBI were randomly assigned to the intervention or control group, and both groups were equipped with home Internet access. The online parent training program was designed to increase positive parenting skills and improve caregiver stress management. It consisted of 10 core sessions and up to 4 supplemental sessions. Each session included self-guided Web content, followed by a videoconference call with a therapist to discuss content and practice parenting skills with live feedback. Families in the control group received links to TBI Web resources. Results Parent income moderated treatment effects on parent functioning. Specifically, lower-income parents in the parenting skills group reported significant reductions in psychological distress compared with lower-income parents in the control group. No differences were found among higher-income parents for depression, parenting stress, or caregiver efficacy. Conclusions Parent training interventions post-TBI may be particularly valuable for lower-income parents who are vulnerable to both environmental and injury-related stresses.

This retrospective chart review study explored the relationship between suboptimal effort and post-concussion symptoms in pediatric mild traumatic brain injury (mTBI). Participants were 382 clinically referred children and adolescents between 8 and 16 years of age who sustained an mTBI. Suboptimal effort was identified using reliable digit span and age-corrected scaled scores from the Numbers subtest of the Children's Memory Scale (CMS); 20% of the sample were classified as non-credible performers. Chi-square analyses and t-tests were used to examine differences in post-concussion symptoms and neuropsychological test performance between credible and non-credible performers. Linear regression was used to examine whether CMS Numbers performance predicted post-concussion symptoms after controlling for baseline symptoms and other relevant demographic- and injury-related factors. We found that non-credible performers presented with a greater number of post-concussion symptoms as compared with credible performers. Additionally, non-credible performers demonstrated comparatively poorer performance on neuropsychological tests of focused attention and processing speed. These results suggest that children and adolescents with mTBI who fail effort testing might have a greater tendency to exaggerate post-concussion symptoms and cognitive impairment. The clinical implications of these findings are discussed.

Objective: This study examined neurocognitive and behavioral predictors of math performance in children with and without ADHD. Method: Neurocognitive and behavioral variables were examined as predictors of (a) standardized mathematics achievement scores, (b) productivity on an analog math task, and (c) accuracy on an analog math task. Results: Children with ADHD had lower achievement scores but did not significantly differ from controls on math productivity or accuracy. N-back accuracy and parent-rated attention predicted math achievement. N-back accuracy and observed attention predicted math productivity. Alerting scores on the attentional network task predicted math accuracy. Mediation analyses indicated that n-back accuracy significantly mediated the relationship between diagnostic group and math achievement. Conclusion: Neurocognition, rather than behavior, may account for the deficits in math achievement exhibited by many children with ADHD.

This pilot study examined changes in parenting skills and child behavior following participation in an online positive parenting skills program designed for young children with traumatic brain injury (TBI). Thirty-seven families with a child between 3 and 9years of age who sustained a moderate to severe TBI were randomly assigned to one of two interventions: online parenting skills training (n=20) or access to Internet resources on managing brain injury (n=17). Parent-child interaction observations and parent ratings of child behavior were collected pre- and post-treatment. Generalized estimating equations and mixed models were used to examine changes in parenting skills and child behavior problems as well as the moderating role of family income on treatment response. Participants in the parenting skills group displayed significant improvements in observed positive parenting skills relative to participants in the Internet resource group. Income moderated improvements in parent ratings of child behavior, with participants in the low-income parenting skills group and high-income Internet resource group reporting the greatest improvements in behavior. This is the first randomized controlled trial examining online parenting skills training for families of young children with TBI. Improvements in positive parenting skills and child behavior support the utility of this intervention, particularly for families from lower socioeconomic backgrounds. Language: en

This study examined the effects of methylphenidate (MPH) on reaction time (RT) variability in children with attention deficit hyperactivity disorder (ADHD). Using a broad battery of computerized tasks, and both conventional and ex-Gaussian indicators of RT variability, in addition to within-task manipulations of incentive and event rate (ER), this study comprehensively examined the breadth, specificity, and possible moderators of effects of MPH on RT variability. A total of 93 children with ADHD completed a 4-week within-subject, randomized, double-blind, placebo-controlled crossover trial of MPH to identify an optimal dosage. Children were then randomly assigned to receive either their optimal MPH dose or placebo after which they completed five neuropsychological tasks, each allowing trial-by-trial assessment of RTs. Stimulant effects on RT variability were observed on both measures of the total RT distribution (ie, coefficient of variation) as well as on an ex-Gaussian measure examining the exponential portion of the RT distribution (ie, τ). There was minimal, if any, effect of MPH on performance accuracy or RT speed. Within-task incentive and ER manipulations did not appreciably affect stimulant effects across the tasks. The pattern of significant and pervasive effects of MPH on RT variability, and few effects of MPH on accuracy and RT speed suggest that MPH primarily affects RT variability. Given the magnitude and breadth of effects of MPH on RT variability as well as the apparent specificity of these effects of MPH on RT variability indicators, future research should focus on neurophysiological correlates of effects of MPH on RT variability in an effort to better define MPH pharmacodynamics.

A microanalysis of task events in a common go/no-go task was completed to examine how task events impact individual reaction times. Predictors of long reaction times were analyzed to better understand increased intra-individual variability (IIV) among children with ADHD compared with normal controls. Sixty-five children with ADHD and 65 normal controls matched on gender, ethnicity, and age completed a go/no-go task. Children across both groups were slower before and after omission errors than all other trials. They were also slower on the trial before successfully inhibiting their response to no-go trials. Children with ADHD exhibited a pronounced slowing on trials prior to omission errors and trials prior to successful inhibitions compared with the normal control group. Pre-error slowing in children with ADHD may represent the beginning stages of attentional disengagement that subsequently results in the absence of responding (i.e., errors of omission or successful inhibition). While these event-related increases in reaction time explain some of the increased IIV observed in children with ADHD, the removal of these trials did not remove the pronounced between-group differences in IIV, suggesting that additional unmeasured processes are contributing to IIV in children with ADHD. (JINS, 2010, 16, 138–147.)

IMPORTANCE This study extends the literature regarding attention-deficit/hyperactivity disorder (ADHD)-related driving impairments to a newly licensed, adolescent population. OBJECTIVE To investigate the combined risks of adolescence, ADHD, and distracted driving (cell phone conversation and text messaging) on driving performance. DESIGN, SETTING, AND PARTICIPANTS Adolescents aged 16 to 17 years with (n = 28) and without (n = 33) ADHD engaged in a simulated drive under 3 conditions (no distraction, cell phone conversation, and texting). During each condition, one unexpected event (eg, another car suddenly merging into driver's lane) was introduced. INTERVENTIONS Cell phone conversation, texting, and no distraction while driving. MAIN OUTCOMES AND MEASURES Self-report of driving history, average speed, standard deviation of speed, standard deviation of lateral position, and braking reaction time during driving simulation. RESULTS Adolescents with ADHD reported fewer months of driving experience and a higher proportion of driving violations than control subjects. After controlling for months of driving history, adolescents with ADHD demonstrated more variability in speed and lane position than control subjects. There were no group differences for braking reaction time. Furthermore, texting negatively impacted the driving performance of all participants as evidenced by increased variability in speed and lane position. CONCLUSIONS To our knowledge, this study is one of the first to investigate distracted driving in adolescents with ADHD and adds to a growing body of literature documenting that individuals with ADHD are at increased risk for negative driving outcomes. Furthermore, texting significantly impairs the driving performance of all adolescents and increases existing driving-related impairment in adolescents with ADHD, highlighting the need for education and enforcement of regulations against texting for this age group. Keywords: Driver distraction; Language: en