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Journal of Abnormal Child Psychology

, Volume 35, Issue 5, pp 729–744 | Cite as

Neurocognitive Functioning in AD/HD, Predominantly Inattentive and Combined Subtypes

  • Mary V. Solanto
  • Sharone N. Gilbert
  • Anu Raj
  • John Zhu
  • Sa`brina Pope-Boyd
  • Brenda Stepak
  • Lucia Vail
  • Jeffrey H. Newcorn
Article

Abstract

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, ad 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.

Keywords

AD/HD AD/HD subtypes Predominantly inattentive subtype Executive function Neuropsychology Endophenotype Combined subtype Wisconsin Card Sorting Task Posner Continuous Performance Test Tower of London Buschke Selective Reminding Test Delay aversion Sternberg 

Notes

Acknowledgments

This work was supported by the following grants to the first author from the National Institute of Child Health and Human Development: HD36688 and HD37803. We extend thanks to: Jim Swanson, Ph.D. and Tim Wigal, Ph.D. for providing the software and support for the Posner and Sternberg tasks; Eliu Turkel, Ph.D. for consultation on data extraction from MEL; and Jeffrey Halperin, Ph.D. for comments on the manuscript. We appreciate the assistance of Gina McSheffrey and Evelyn Velez with data compilation and entry. We extend our thanks to: Mary Cary Ambler, Learning Specialist at the Convent of the Sacred Heart, Greenwich, CT; Don Kramer, Principal of Our Lady of Good Counsel School, N.Y., N.Y.; and Sr. Josephine Cioffi, Principal of St. Ann Parish Elementary School, N.Y., N.Y. for their support of the project. We acknowledge with gratitude the contribution of all the children and parents who participated.

References

  1. American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, D.C.: American Psychiatric Association.Google Scholar
  2. Applegate, B., Lahey, B. B., Hart, E. L., Biederman, J., Hynd, G. W., Barkley, R. A., et al. (1997). Validity of the age-of-onset criterion for ADHD: A report from the DSM-IV field trials. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 1211–1221.PubMedCrossRefGoogle Scholar
  3. Arnsten, A. F. T. (2001). Dopaminergic and noradrenergic influences on cognitive functions mediated by prefrontal cortex. In M. V. Solanto, A. F. T. Arnsten, & F. X. Castellanos (Eds.), Stimulant drugs and ADHD: Basic and clinical neuroscience (pp. 185–208). New York: Oxford University Press.Google Scholar
  4. Baker, S. C., Rogers, R. D., Owen, A. M., Frith, C. D., Dolan, R. J., Frackowiak, R. S. J., et al. (1996). Neural systems engaged by planning: A PET study of the Tower of London task. Neuropsychologia, 34(6), 515–526.PubMedCrossRefGoogle Scholar
  5. Barkley, R. A. (1997). Behavioral inhibition, sustained attention, and executive functions: Constructing a unifying theory of ADHD. Psychological Bulletin, 121, 65–94.PubMedCrossRefGoogle Scholar
  6. Barkley, R. A., DuPaul, G. J., & McMurray, M. B. (1991). Attention deficit disorder with and without hyperactivity: Clinical response to three dose levels of methylphenidate. Pediatrics, 87, 519–531.PubMedGoogle Scholar
  7. Bauermeister, J. J., Matos, M., Reina, G., Salas, C. C., Martinez, J. V., Cumba, E., et al. (2005). Comparison of the DSM-IV combined and inattentive types of ADHD in a school-based sample of Latino/Hispanic children. Journal of Child Psychology and Psychiatry, 46(2), 166–179.PubMedCrossRefGoogle Scholar
  8. Berg, E. A. (1948). A simple objective technique for measuring flexibility in thinking. Journal of General Psychology, 39, 15–22.PubMedCrossRefGoogle Scholar
  9. Berman, K. F., Ostrem, J. L., Randolph, C., Gold, J., Goldberg, T. E., Coppola, R., et al. (1995). Physiological activation of a cortical network during performance of the Wisconsin Card Sorting Test: A positron emission tomography study. Neuropsychologia, 33, 1027–1046.PubMedCrossRefGoogle Scholar
  10. Buschke, H., & Fuld, P. A. (1974). Evaluating storage, retention, and retrieval in disordered memory and learning. Neurology, 24, 1019–1025.PubMedGoogle Scholar
  11. Bush, G., Whalen, P. J., Rosen, B. R., Jenike, M. A., McInerney, S. C., & Rauch, S. L. (1998). The counting Stroop: An interference task specialized for functional neuroimaging—Validation study with functional MRI. Human Brain Mapping, 6, 270–282.PubMedCrossRefGoogle Scholar
  12. Castellanos, R. X., & Tannock, R. (2002). Neuroscience of attention-deficit/hyperactivity disorder: The search for endophenotypes. Nature Reviews Neuroscience, 3(8),617–628.PubMedGoogle Scholar
  13. Chhabildas, N., Pennington, B., & Willcutt, E. G. (2001). A comparison of the neuropsychological profiles of the DSM-IV subtypes of ADHD. Journal of Abnormal Child Psychology, 29, 529–540.PubMedCrossRefGoogle Scholar
  14. Cohen, J. (1988). Statistical power analysis for the behavioral sciences. (2nd ed.). Hillsdale, NJ: Erlbaum.Google Scholar
  15. Conners, C. K. (1994). The Conners’ Continuous Performance Test. Toronto: Multi-Health Systems.Google Scholar
  16. Conners, C. K., Sitarenios, G., Parker, J., & Epstein, J. N. (1998a). Revision and restandardization of the Conners’ Teacher Rating Scale (CTRS-R): Factor structure, reliability, and criterion validity. Journal of Abnormal Child Psychology, 26, 279–291.PubMedCrossRefGoogle Scholar
  17. Conners, C. K., Sitarenios, G., Parker, J. D. A., & Epstein, J. N. (1998b). The revised Conners’ Parent Rating Scale (CPRS-R): Factor structure, reliability, and criterion validity. Journal of Abnormal Child Psychology, 25, 257–268.CrossRefGoogle Scholar
  18. Culbertson, W. C., & Zillmer, E. A. (1998). The Tower of London (DX): A standardized approach to assessing executive functioning in children. Archives of Clinical Neuropsychology, 13, 285–301.PubMedCrossRefGoogle Scholar
  19. Culbertson, W. C., & Zillmer, E. A. (2001). Tower of London-Drexel University (TOLDX) Technical Manual (1st ed.). Tonawanda, N.Y.: Multi-Health Systems.Google Scholar
  20. Doyle, A., Biederman, J., Seidman, L., Weber, W., & Faraone, S. (2000). Diagnostic efficiency of neuropsychological test scores for disciminating boys with and without attention deficit hyperactivity disorder. Journal of Consulting and Clinical Psychology, 68, 477–488.PubMedCrossRefGoogle Scholar
  21. Eiraldi, R. B., Power, T. J., & Nezu, C. M. (1997). Patterns of comorbidity associated with subtypes of attention-deficit/hyperactivity disorder among 6- to 12-year-old children. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 503–514.PubMedCrossRefGoogle Scholar
  22. Epstein, J. N., Erkanli, A., Conners, C. K., Klaric, J., Costello, J. E., & Angold, E. (2003). Relations between Continuous Performance Test performance measures and ADHD behaviors. Journal of Abnormal Child Psychology, 31, 543–554.PubMedCrossRefGoogle Scholar
  23. Gaub, M., & Carlson, C. (1997a). Gender differences in ADHD: A meta-analysis and critical review. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 1035–1045.CrossRefGoogle Scholar
  24. Gaub, M., & Carlson, C. L. (1997b). Behavioral characteristics of DSM-IV ADHD subtypes in a school-based population. Journal of Abnormal Child Psychology, 25, 103–111.PubMedCrossRefGoogle Scholar
  25. Geurts, H. M., Verte, S., Oosterlaan, J., Roeyers, H., & Sergeant, J. A. (2004). ADHD subtypes: Do they differ in their executive functioning profile? Archives of Clinical Neuropsychology, 20(4), 457–477.PubMedCrossRefGoogle Scholar
  26. Golden, C. J. (1978). The Stroop color and word test: A manual for clinical uses. Chicago, IL: Stoelting.Google Scholar
  27. Gomez, R., Harvey, J., Quick, C., Scharer, I., & Harris, G. (1999). DSM-IV AD/HD: Confirmatory factor models, prevalence, and gender and age differences based on parent and teacher ratings of Australian primary school children. Journal of Child Psychology and Psychiatry, 40, 265–274.PubMedCrossRefGoogle Scholar
  28. Hartman, C. A., Willcutt, E. G., Rhee, S. H., & Pennington, B. F. (2004). The relation between sluggish cognitive tempo and DSM-IV ADHD. Journal of Abnormal Child Psychology, 32(5), 491–503.PubMedCrossRefGoogle Scholar
  29. Heaton, R. K. (1981). Wisconsin Card Sorting Test Manual. Odessa, Fl 33556: Psychological Assessment Resources, Inc.Google Scholar
  30. Hinshaw, S. P., Carte, E. T., Sami, N., Treuting, J. J., & Zupan, B. A. (2002). Preadolescent girls with attention-deficit/hyperactivity disorder: II. Neuropsychological performance in relation to subtypes and individual classification. Journal of Consulting and Clinical Psychology, 70, 1099–1111.PubMedCrossRefGoogle Scholar
  31. Houghton, S., Douglas, G., West, J., Whiting, K., Wall, M., Langsford, S., et al. (1999). Differential patterns of executive function in children with attention-deficit hyperactivity disorder according to gender and subtype. Journal of Child Neurology, 14, 801–805.PubMedGoogle Scholar
  32. Huang-Pollock, C. L., & Nigg, J. T. (2003). Searching for the deficit in attention deficit/hyperactivity disorder: The case of visuospatial orienting. Clinical Psychology Review, 23, 801–830.PubMedCrossRefGoogle Scholar
  33. Huang-Pollock, C. L., Nigg, J. T., & Halperin, J. M. (2006). Single dissociation findings of ADHD deficits in vigilance but not anterior or posterior attention systems. Neuropsychology, 20(4), 420–429.PubMedCrossRefGoogle Scholar
  34. Hudziak, J. J., Heath, A. C., Madden, P. F., Reich, W., Bucholz, K. K., Slutske, W., et al. (1998). Latent class and factor analysis of DSM-IV ADHD: A twin study of female adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 37, 848–857.PubMedCrossRefGoogle Scholar
  35. Ishihara, S. (1960). Ishihara Test for color blindness. Available: http://www.toledo-bend.com/colorblind/links.html [2006, July 13].
  36. Kaplan, E., Goodglass, H., & Weintraub, S. (1983). The Boston Naming Test. Philadelphia, PA: Lea & Febiger.Google Scholar
  37. Kempton, S., Vance, A., Maruff, P., Luk, E., Costin, J., & Pantelis, C. (1999). Executive function and attention deficit hyperactivity disorder: Stimulant medication and better executive function performance in children. Psychological Medicine, 29, 527–538.PubMedCrossRefGoogle Scholar
  38. Klorman, R., Hazel-Fernandez, L. A., Shaywitz, S. E., Fletcher, J. M., Marchione, K. E., Holahan, J. M., et al. (1999). Executive functioning deficits in attention-deficit/hyperactivity disorder are independent of oppositional defiant or reading disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 1148–1155.PubMedCrossRefGoogle Scholar
  39. Kovacs, M. (1992). Children’s depression inventory. North Tonawanda, NY: Multi-Health Systems.Google Scholar
  40. Lahey, B. B. (2001). Should the combined and predominantly inattentive types of ADHD be considered distinct and unrelated disorders? Not now, at least. Clinical Psychology: Science and Practice, 8, 494–497.CrossRefGoogle Scholar
  41. Lahey, B. B., Pelham, W. E., Schaughency, E. A., Atkins, M. S., Murphy, H. A., Hynd, G., et al. (1988). Dimensions and types of attention deficit disorder. Journal of the American Academy of the Child and Adolescent Psychiatry, 27, 330–335.CrossRefGoogle Scholar
  42. Lahey, B. B., Pelham, W. E., Stein, M. A., Loney, J., Trapani, C., Nugent K., et al. (1998). Validity of DSM-IV attention-deficit/hyperactivity disorder for younger children. Journal of the American Academy of Child and Adolescent Psychiatry, 37, 695–702.PubMedCrossRefGoogle Scholar
  43. Maedgen, J. W., & Carlson, C. L. (2000). Social functioning and emotional regulation in the attention deficit hyperactivity disorder subtypes. Journal of Clinical Child Psychology, 29, 30–42.PubMedCrossRefGoogle Scholar
  44. March, J., Parker, J., Sullivan, K., Stallings, P., & Conners, C. K. (1997). The Multidimensional Anxiety Scale for Children (MASC): Factor structure, reliability, and validity. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 554–565.PubMedCrossRefGoogle Scholar
  45. McBurnett, K., & Pfiffner, L. J. (2001). Symptom properties as a function of ADHD type: An argument for continued study of sluggish cognitive tempo. Journal of Abnormal Child Psychology, 29, 207–213.PubMedCrossRefGoogle Scholar
  46. McBurnett, K., Pfiffner, L. J., Willcutt, E., Tamm, L., Lerner, M., Ottolini, Y. L., et al. (1999). Experimental cross-validation of DSM-IV types of attention-deficit/hyperactivity disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 17–24.PubMedCrossRefGoogle Scholar
  47. Milich, R., Balentine, A., & Lynam, D. (2001). ADHD combined type and ADHD predominantly inattentive type are distinct and unrelated disorders. Clinical Psychology: Science & Practice, 8, 463–488.CrossRefGoogle Scholar
  48. Neuman, R. J., Todd, R. D., Heath, A. C., Reich, W., Hudziak, J. J., Bucholz, K. K., et al. (1999). Evaluation of ADHD typology in three contrasting samples: A latent class approach. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 25–33.PubMedCrossRefGoogle Scholar
  49. Nigg, J. T. (2005). Neuropsychologic theory and findings in attention-deficit/hyperactivity disorder: The state of the field and salient challenges for the coming decade. Biological Psychiatry, 57(11), 1424–1435.PubMedCrossRefGoogle Scholar
  50. Nigg, J. T., Blaskey, L. G., Huang-Pollock, C. L., & Rappley, M. D. (2002). Neuropsychological executive functions and DSM-IV subtypes. Journal of the American Academy of Child and Adolescent Psychiatry, 41, 59–66.PubMedCrossRefGoogle Scholar
  51. Nigg, J. T., Willcutt, E. G., Doyle, A. E., & Sonuga-Barke, J. S. (2005). Causal heterogeneity in Attention-Deficit/Hyperactivity Disorder: Do we need neuropsychologically impaired subtypes? Biological Psychiatry, 57(11), 1224–1230.PubMedCrossRefGoogle Scholar
  52. Pelham, W. E., Jr., Gnagy, E. M., Greenslade, K. E., & Milich, R. (1992). Teacher ratings of DSM-III-R symptoms for the disruptive behavior disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 31, 210–218.PubMedCrossRefGoogle Scholar
  53. Pope, S., Solanto, M. V., Tryon, W. W., & Stepak, B. (2005). Social skills in subtypes of children with AD/HD. Paper presented at the American Psychological Association, Wash, D.C.Google Scholar
  54. Posner, M., & Petersen, S. E. (1990). The attention system of the brain. Annual Review of Neuroscience, 13, 35–42.CrossRefGoogle Scholar
  55. Posner, M., & Raichle, M. (1994). Networks of attention, images of mind (pp. 152–179). New York: Scientific American.Google Scholar
  56. Power, T. J., Costigan, T. E., Eiraldi, R. B., & Leff, S. S. (2004). Variations in anxiety and depression as a function of ADHD subtypes defined by DSM-IV: Do subtype differences exist or not? Journal of Abnormal Child Psychology, 32(1), 27–37.PubMedCrossRefGoogle Scholar
  57. Rasmussen, E. R., Neuman, R. J., Heath, A. C., Levy, F., Hay, D. A., & Todd, R. D. (2004). Familial clustering of latent class and DSM-IV defined attention-deficit/hyperactivity disorder (ADHD) subtypes. Journal of Child Psychology and Psychiatry, 45, 589–598.PubMedCrossRefGoogle Scholar
  58. Romine, C. B., Lee, D. L., Wolfe, M. E., Homack, S., George, C., & Riccio, C. (2004). Wisconsin Card Sorting Test with children: A meta-analytic study of sensitivity and specificity. Archives of Clinical Neuropsychology, 19(8), 1027–1041.PubMedCrossRefGoogle Scholar
  59. Sanders, A. V. (1983). Towards a model of stress and human performance. Acta Psychologica, 53, 61–97.PubMedCrossRefGoogle Scholar
  60. Schachar, R., Tannock, R., Marriott, M., & Logan, G. (1995). Deficient inhibitory control in attention deficit hyperactivity disorder. Journal of Abnormal Child Psychology, 23, 411–437.PubMedCrossRefGoogle Scholar
  61. Scheres, A., Oosterlaan, J., Geurts, H., Morein-Zamir, S., Meiran, N., Schut, H., et al. (2004). Executive functioning in boys with ADHD: Primarily an inhibition deficit? Archives of Clinical Neuropsychology, 19(4), 569–594.PubMedCrossRefGoogle Scholar
  62. Schneider, W. (1990). Micro experimental laboratory. Pittsburgh, PA: Psychology Software Tools.Google Scholar
  63. Sergeant, J. A. (2005). Modeling Attention-Deficit/Hyperactivity Disorder: A critical appraisal of the cognitive-energetic model. Biological Psychiatry, 57(11), 1248–1255.PubMedCrossRefGoogle Scholar
  64. Sergeant, J. A., Geurts, H., & Oosterlaan, J. (2002). How specific is a deficit of executive functioning for Attention-Deficit/Hyperactivity Disodrer. Behavioural Brain Research, 130, 3–28.PubMedCrossRefGoogle Scholar
  65. Sergeant, J. A., & Scholten, C. A. (1983). A stages-of -information approach to hyperactivity. Journal of Child Psychology and Psychiatry, 24, 49–60.PubMedCrossRefGoogle Scholar
  66. Shaffer, D., Fisher, P., Dulcan, M., Davies, M., Piacentini, J., Schwab-Stone, M., et al. (1996). The NIMH Diagnostic Interview Schedule for Children Version 2.3 (DISC-2.3): Description, acceptability, prevalence rates, and performance in the MECA study. Journal of the American Academy of Child and Adolescent Psychiatry, 35, 865–877.PubMedCrossRefGoogle Scholar
  67. Sheslow, D., & Adams, W. (1990). Wide range assessment of memory and learning. Wilmington, DE: Jastak.Google Scholar
  68. Solanto, M. V., Abikoff, H., Sonuga-Barke, E., Schachar, R., Logan, G., Wigal, T., et al. (2001). The ecological validity of delay aversion and response inhibition as measures of impulsivity in AD/HD: A supplement to the NIMH Multi-Modal Treatment Study of AD/HD. Journal of Abnormal Child Psychology, 29, 215–228.PubMedCrossRefGoogle Scholar
  69. Solanto, M. V., Wender, E. H., & Bartell, S. S. (1997). Effects of methylphenidate and behavioral contingencies on vigilance in AD/HD: A test of the reward dysfunction hypothesis. Journal of Child and Adolescent Psychopharmacology, 7, 123–136.PubMedCrossRefGoogle Scholar
  70. Sonuga-Barke, E. J. S. (2005). Causal models of Attention-Deficit/Hyperactivity Disorder: From common simple deficits to multiple developmental pathways. Biological Psychiatry, 57, 1231–1238.PubMedCrossRefGoogle Scholar
  71. Sonuga-Barke, E. J. S., Taylor, E., Sembi, S., & Smith, J. (1992). Hyperactivity and delay aversion—I. The effect of delay on choice. Journal of Child Psychology and Psychiatry, 33, 387–398.PubMedCrossRefGoogle Scholar
  72. Spreen, O., & Strauss, E. (1998). A compendium of neuropsychological tests, Bushke Selective Reminding Test (SRT) (pp. 282–295). Oxford.Google Scholar
  73. Sternberg, S. (1969). Discovery of processing stages: Extensions of Donders’ method. Acta Psychologica, 8, 276–315.CrossRefGoogle Scholar
  74. Tucker, D. M., & Williamson, P. A. (1984). Asymmetric neural control systems in human self-regulation. Psychological Review, 91, 185–215.PubMedCrossRefGoogle Scholar
  75. Waldman, I. D., & Gizer, I. R. (2006). The genetics of attention deficit hyperactivity disorder. Clinical Psychology Review, 26(4), 396–432.PubMedGoogle Scholar
  76. Wechsler, D. (1991). Manual for the Wechsler Intelligence Scale for Children—Third Edition. San Antonio, TX: The Psychological Corporation.Google Scholar
  77. Wechsler, D. (1992). The Manual for the Wechsler Individual Achievement Test. San Antonio, TX: The Psychological Corporation.Google Scholar
  78. Werry, J. S., Elkind, G. S., & Reeves, J. S. (1987). Attention deficit, conduct, oppositional, and anxiety disorders in children: III. Laboratory differences. Journal of Abnormal Child Psychology, 15, 409–428.PubMedCrossRefGoogle Scholar
  79. Wig, E. H., & Secord, W. (1989). The Test of Language Competence—Expanded ed.. San Antonio, Texas: The Psychological Corporation.Google Scholar
  80. Willcutt, E. G., Doyle, A. E., Nigg, J. T., Faraone, S. V., & Pennington, B. F. (2005). Validity of the executive function theory of Attention-Deficit/Hyperactivity Disorder: A meta-analytic review. Biological Psychiatry, 57, 1336–1346.PubMedCrossRefGoogle Scholar
  81. Willcutt, E. G., Pennington, B. F., Chhabildas, N. A., Friedman, M. C., & Alexander, J. (1999). Psychiatric comorbidity associated with DSM-IV ADHD in a nonreferred sample of twins. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 1355–1362.PubMedCrossRefGoogle Scholar
  82. Wolraich, M. L., Hannah, J. N., Pinnock, T. Y., Baumgaertel, A., & Brown, J. (1996). Comparison of diagnostic criteria for attention-deficit hyperactivity disorder in a county-wide sample. Journal of the American Academy of Child and Adolescent Psychiatry, 35, 319–324.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Mary V. Solanto
    • 1
  • Sharone N. Gilbert
    • 1
  • Anu Raj
    • 1
  • John Zhu
    • 2
  • Sa`brina Pope-Boyd
    • 1
  • Brenda Stepak
    • 3
  • Lucia Vail
    • 4
  • Jeffrey H. Newcorn
    • 1
  1. 1.Department of PsychiatryThe Mount Sinai School of MedicineNew YorkUSA
  2. 2.Department of PsychologyQueens CollegeNew YorkUSA
  3. 3.Atlantic Rehabilitation CenterMorristownUSA
  4. 4.Center for Intensive Treatment of Personality DisordersSt. Luke’s–Roosevelt Hospital CenterNew YorkUSA

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