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

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An Erratum to this article was published on 11 October 2007

An Erratum to this article was published on 11 October 2007

An Erratum to this article was published on 11 October 2007

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.

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Notes

  1. Latent class analysis (LCA) is a cluster-analytic method that has been used to examine the extent to which the 18 DSM-IV symptoms of AD/HD cluster together in large, population-based samples. Applied to parent ratings, LCA yielded eight latent classes, including three that overlap substantially, but not completely, with the three DSM-IV subtypes (Hudziak et al. 1998). Subtype-specific concordance in twin data suggests that LCA may afford a more genetically valid classification of AD/HD subtypes than do DSM-IV criteria (Rasmussen et al. 2004). Participants in the current study were re-assigned to groups based on application of latent class criteria to parent symptom ratings on the SNAP-IV (Neuman et al. 1999). Twenty-four of 34 (71%) subjects in the CB group met criteria for the “severe combined” latent class, 21 of 26 (81%) of PI subjects met criteria for the “severe inattentive” latent class; and 19 subjects were retained in the TC group.

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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.

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  1. Department of Psychiatry, The Mount Sinai School of Medicine, Box 1230, Gustave Levy Place, New York, NY, 10029-6574, USA

    Mary V. Solanto, Sharone N. Gilbert, Anu Raj, Sa`brina Pope-Boyd & Jeffrey H. Newcorn

  2. Department of Psychology, Queens College, New York, NY, USA

    John Zhu

  3. Atlantic Rehabilitation Center, Morristown, NJ, USA

    Brenda Stepak

  4. Center for Intensive Treatment of Personality Disorders, St. Luke’s–Roosevelt Hospital Center, New York, NY, USA

    Lucia Vail

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  1. Mary V. Solanto
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Correspondence to Mary V. Solanto.

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An erratum to this article can be found at http://dx.doi.org/10.1007/s10802-007-9170-z

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Solanto, M.V., Gilbert, S.N., Raj, A. et al. Neurocognitive Functioning in AD/HD, Predominantly Inattentive and Combined Subtypes. J Abnorm Child Psychol 35, 729–744 (2007). https://doi.org/10.1007/s10802-007-9123-6

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