Processing Speed Predicts Behavioral Treatment Outcomes in Children with Attention-Deficit/Hyperactivity Disorder Predominantly Inattentive Type
Neuropsychological functioning underlies behavioral symptoms of attention-deficit/hyperactivity disorder (ADHD). Children with all forms of ADHD are vulnerable to working memory deficits and children presenting with the inattentive form of ADHD (ADHD-I) appear particularly vulnerable to processing speed deficits. As ADHD-I is the most common form of ADHD presented by children in community settings, it is important to consider how treatment interventions for children with ADHD-I may be affected by deficits in processing speed and working memory. We utilize data collected from 199 children with ADHD-I, aged 7 to 11 years, who participated in a randomized clinical trial of a psychosocial-behavioral intervention. Our aims are first to determine whether processing speed or working memory predict treatment outcomes in ADHD-I symptom severity, and second whether they moderate treatment effects on ADHD-I symptom severity. Results of linear regression analyses reveal that baseline processing speed significantly predicts posttreatment ADHD-I symptom severity when controlling for baseline ADHD-I symptom severity, such that better processing speed is associated with greater symptom improvement. However, predictive effects of working memory and moderation effects of both working memory and processing speed are not supported in the present study. We discuss study limitations and implications of the relation between processing speed and treatment benefits from psychosocial treatments for children with ADHD-I.
KeywordsADHD Inattentiveness Processing speed Clinical trial Psychosocial intervention
Compliance with Ethical Standards
This study was funded by the National Institute of Mental Health (MH077671).
Conflict of Interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.
Informed consent was obtained from all individual participants included in the study.
- Araujo Jiménez, E. A., Jané Ballabriga, M. C., Martin, A. B., Arrufat, F. J., & Giacobo, R. S. (2015). Executive functioning in children and adolescents with symptoms of sluggish cognitive tempo and ADHD. Journal of Attention Disorders, 19, 507–514. doi: 10.1177/1087054713495442.CrossRefPubMedGoogle Scholar
- Barkley, R. A. (1987). Defiant children: A clinician's manual for parent training. New York: Guilford Press.Google Scholar
- Bauermeister, J. J., Barkley, R. A., Bauermeister, J. A., Martínez, J. V., & McBurnett, K. (2012). Validity of the sluggish cognitive tempo, inattention, and hyperactivity symptom dimensions: Neuropsychological and psychosocial correlates. Journal of Abnormal Child Psychology, 40, 683–697. doi: 10.1007/s10802-011-9602-7.CrossRefPubMedGoogle Scholar
- Bidwell, L. C., Willcutt, E. G., DeFries, J. C., & Pennington, B. F. (2007). Testing for neuropsychological endophenotypes in siblings discordant for attention-deficit/hyperactivity disorder. Biological Psychiatry, 62, 991–998. doi: 10.1016/j.biopsych.2007.04.003.CrossRefPubMedPubMedCentralGoogle Scholar
- Biederman, J., Seidman, L. J., Petty, C. R., Fried, R., Doyle, A. E., Cohen, D. R., et al. (2008). Effects of stimulant medication on neuropsychological functioning in young adults with attention-deficit/hyperactivity disorder. Journal of Clinical Psychiatry, 69, 1150–1156. doi: 10.4088/JCP.v69n0715.CrossRefPubMedGoogle Scholar
- Cortese, S., Ferrin, M., Brandeis, D., Buitelaar, J., Daley, D., Dittmann, R. W., & Sonuga-Barke, E. J. S. (2015). Cognitive training for attention-deficit/hyperactivity disorder: Meta-analysis of clinical and neuropsychological outcomes from randomized controlled trials. Journal of the American Academy of Child & Adolescent Psychiatry, 54, 164–174. doi: 10.1016/j.jaac.2014.12.010.CrossRefGoogle Scholar
- Dennis, M., Francis, D. J., Cirino, P. T., Schachar, R., Barnes, M. A., & Fletcher, J. M. (2009). Why IQ is not a covariate in cognitive studies of neurodevelopmental disorders. Journal of the International Neuropsychological Society, 15, 331–343. doi: 10.1017/S1355617709090481.CrossRefPubMedPubMedCentralGoogle Scholar
- Fabiano, G. A., Vujnovic, R. K., Pelham, W. E., Waschbusch, D. A., Massetti, G. M., Pariseau, M. E., & Volker, M. (2010). Enhancing the effectiveness of special education programming for children with attention deficit hyperactivity disorder using a daily report card. School Psychology Review, 39, 219–239 Retrieved from http://search.proquest.com/docview/754058916?accountid=14496.Google Scholar
- Forehand, R., & McMahon, R. (1981). Helping the noncompliant child: A clinician’s guide to parent training. New York: Guilford Press.Google Scholar
- Gadow, K. D., & Sprafkin, J. (1994). Child symptom inventories manual. Stony Brook, NY: Checkmate Plus.Google Scholar
- Hellwig-Brida, S., Daseking, M., Petermann, F., & Goldbeck, L. (2010). Intelligenz- und aufmerksamkeitsleistungen von jungen mit ADHS [Components of intelligence and attention in boys with ADHD]. Zeitschrift für Psychiatrie, Psychologie und Psychotherapie, 58, 299–308. doi: 10.1024/1661-4747/a000040.CrossRefGoogle Scholar
- Kaufman, J., Birmaher, B., Brent, D., & Rao, U. (1997). Schedule for affective disorders and schizophrenia for school-age children-present and lifetime version (K-SADS-PL): Initial reliability and validity data. Journal of the American Academy of Child & Adolescent Psychiatry, 36, 980–988. doi: 10.1097/00004583-199707000-00021.CrossRefGoogle Scholar
- Lee, S., Burns, G. L., Snell, J., & McBurnett, K. (2014). Validity of the sluggish cognitive tempo symptom dimension in children: Sluggish cognitive tempo and ADHD-inattention as distinct symptom dimensions. Journal of Abnormal Child Psychology, 42, 7–19. doi: 10.1007/s10802-013-9714-3.CrossRefPubMedGoogle Scholar
- Martinussen, R., & Tannock, R. (2006). Working memory impairments in children with attention-deficit hyperactivity disorder with and without comorbid language learning disorders. Journal of Clinical and Experimental Neuropsychology, 28, 1073–1094. doi: 10.1080/13803390500205700.CrossRefPubMedGoogle Scholar
- Mayes, S. D., Calhoun, S. L., Chase, G. A., Mink, D. M., & Stagg, R. E. (2009). ADHD subtypes and co-occurring anxiety, depression, and oppositional-defiant disorder: Differences in Gordon diagnostic system and Wechsler working memory and processing speed index scores. Journal of Attention Disorders, 12, 540–550. doi: 10.1177/1087054708320402.CrossRefPubMedGoogle Scholar
- Nigg, J. T., Stavro, G., Ettenhofer, M., Hambrick, D. Z., Miller, T., & Henderson, J. M. (2005). Executive functions and ADHD in adults: Evidence for selective effects on ADHD symptom domains. Journal of Abnormal Psychology, 114, 706–717. doi: 10.1037/0021-843X.114.3.706.CrossRefPubMedGoogle Scholar
- Pfiffner, L. J. (2011). All about ADHD: The complete practical guide for classroom teachers (2nd ed.). New York: Scholastic.Google Scholar
- Pfiffner, L. J., Barkley, R. A., & DuPaul, G. (2006). Treatment of ADHD in school settings. In R. A. Barkley (Ed.), Attention deficit hyperactivity disorder: A handbook for diagnosis and treatment (3rd ed., pp. 547–589). New York: Guilford Press.Google Scholar
- Pfiffner, L. J., Hinshaw, S. P., Owens, E. B., Zalecki, C., Kaiser, N., Villodas, M., & McBurnett, K. (2014). A two-site randomized clinical trial of integrated psychosocial treatment for ADHD-inattentive type. Journal of Consulting and Clinical Psychology, 82, 1115–1127. doi: 10.1037/a0036887.CrossRefPubMedPubMedCentralGoogle Scholar
- Rossi, A. S. U., de Moura, L. M., de Mello, C. B., de Souza, A. A. L., Muszkat, M., & Bueno, O. F. A. (2015). Attentional profiles and white matter correlates in attention-deficit/hyperactivity disorder predominantly inattentive type. Frontiers in Psychiatry, 6, 1–10. doi: 10.3389/fpsyt.2015.00122.CrossRefGoogle Scholar
- Sonuga-Barke, E., Bitsakou, P., & Thompson, M. (2010). Beyond the dual pathway model: Evidence for the dissociation of timing, inhibitory, and delay-related impairments in attention-deficit/hyperactivity disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 49, 345–355. doi: 10.1097/00004583-201004000-00009.Google Scholar
- Todd, R. D., Rasmussen, E. R., Wood, C., Levy, F., & Hay, D. A. (2004). Should sluggish cognitive tempo symptoms be included in the diagnosis of attention-deficit/hyperactivity disorder? Journal of the American Academy of Child & Adolescent Psychiatry, 43, 588–597. doi: 10.1097/00004583-200405000-00012.CrossRefGoogle Scholar
- van Ewijk, H., Heslenfeld, D. J., Zwiers, M. P., Buitelaar, J. K., & Oosterlaan, J. (2012). Diffusion tensor imaging in attention deficit/hyperactivity disorder: A systematic review and meta-analysis. Neuroscience and Biobehavioral Reviews, 36, 1093–1106. doi: 10.1016/j.neubiorev.2012.01.003.CrossRefPubMedGoogle Scholar
- Wechsler, D. (2003a). Wechsler intelligence scale for children–fourth edition. San Antonio, TX: Psychological Corporation.Google Scholar
- Wechsler, D. (2003b). WISC-IV technical and interpretive manual. San Antonio, TX: Psychological Corporation.Google Scholar
- Weiler, M. D., Bernstein, J. H., Bellinger, D., & Waber, D. P. (2002). Information processing deficits in children with attention-deficit/hyperactivity disorder, inattentive type, and children with reading disability. Journal of Learning Disabilities, 35, 448–461. doi: 10.1177/00222194020350050501.CrossRefPubMedGoogle Scholar
- Wells, K. C., Abikoff, H., Abramowitz, A., Courtney, M., Cousins, L., Del Carmen, R., & Pfiffner, L. (1996). Parent training for attention deficit hyperactivity disorder: MTA study manual. Durham, NC: Duke University Medical Center.Google Scholar
- Willcutt, E. G., Chhabildas, N., Kinnear, M., DeFries, J. C., Olson, R. K., Leopold, D. R., & Pennington, B. F. (2014). The internal and external validity of sluggish cognitive tempo and its relation with DSM–IV ADHD. Journal of Abnormal Child Psychology, 42, 21–35. doi: 10.1007/s10802-013-9800-6.CrossRefPubMedPubMedCentralGoogle Scholar