ADHD subtype-specific cognitive correlates and association with self-esteem: a quantitative difference

Parviz Molavi,Mehriar Nadermohammadi,Michael A Nitsche,Mohammad Ali Salehinejad,Carmelo M Vicario,Habibeh Salvat Ghojehbeiglou

doi:10.1186/s12888-020-02887-4

Abstract

BackgroundAttention-deficit hyperactivity disorder (ADHD) is a major neurodevelopmental disorder with heterogeneous symptoms, subtypes, and cognitive deficits. Cognitive deficits are central to ADHD pathophysiology and one potential source of heterogeneity in ADHD. Subtype-specific cognitive correlates are not, however, well-studied. We explored cognitive correlates of ADHD subtypes based on the Wechsler Intelligence Scale for Children (WISC-IV) scores. We also assessed subtype-specific self-esteem rating in ADHD subtypes and explored its association with cognitive correlates.MethodsOne hundred thirty-nine children with ADHD (80.6% boy, 19.4% girl) were categorized into the predominantly “hyperactive (ADHD-H)”, “inattentive (ADHD-I)” and “combined (ADHD-C)” subtype based on their symptoms and scores on the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS-PL) and Conners Parent-Rating Scale (CPRS-RS). They were then individually administrated the WISC-IV and completed a self-esteem inventory. Group differences in the WISC-IV indices and their predictability in discriminating ADHD subtypes were analyzed.ResultsWe found a quantitative differentiation of cognitive abilities among ADHD subtypes with “working memory” as the most compromised cognitive domain. ADHD-I had the poorest cognitive profile while ADHD-H scored highest in all cognitive domains. Importantly, cognitive abilities were negatively correlated with inattention and positively correlated with hyperactive symptoms. Moreover, self-esteem ratings were positively correlated with the cognitive domains and were rated differently based on the subtypes. ADHD-H, with the highest cognitive strength, reported the highest level of self-esteem among all subtypes.ConclusionsADHD subtype-specific symptoms, cognitive deficits, and self-esteem problems should be considered for precise diagnosis and effective and personalized treatment in ADHD in light of further supporting evidence and assessments. Cognitive interventions might be more compatible with and effective in inattentive and combined subtypes of ADHD. Working memory improving-based interventions can benefit all ADHD subtypes. A supportive educational system in school and providing adjunct supportive interventions should be considered for children with ADHD as well.

Highlights

Attention-deficit hyperactivity disorder (ADHD) is a major neurodevelopmental disorder with heterogeneous symptoms, subtypes, and cognitive deficits
Cognitive profile differences in ADHD subtypes The results of analysis of variance (ANOVA) showed significant differences between ADHD subtypes that were revealed in the fullscale intelligence quotient (FSIQ) and all indices of Verbal Comprehension Index (VCI), Perceptual Reasoning Index (PRI), Work Memory Index (WMI), and Processing Speed Index (PSI) (Fig. 1, Table 2)
Bonferroni-corrected post hoc t-tests revealed that Predominantly inattentive (ADHD-I), compared to the ADHD-H, scored lower in the FSIQ (t = 4.21, p < 0.001) and all indices of VCI (t = 4.20, p < 0.001), PRI (t = 2.85, p = 0.013), WMI (t = 2.90, p = 0.011), and PSI (t = 4.84, p < 0.001)

Summary

Introduction

Attention-deficit hyperactivity disorder (ADHD) is a major neurodevelopmental disorder with heterogeneous symptoms, subtypes, and cognitive deficits. Especially executive dysfunctions, are central to ADHD psychopathology [3] and among the primary treatment targets by pharmacological [4] and novel treatment approaches [5, 6]. These cognitive deficits are heterogeneous in ADHD and individual differences in cognitive profile should be considered as well [7]. One aspect of heterogeneity in ADHD symptoms and cognitive deficits is its subtypes [8, 9] which includes a predominantly hyperactive (ADHDH), inattentive (ADHD-I), and combined (ADHD-C) subtype. These subtypes are discerned from each other by the presence of specific symptoms [10], little is known about neuro-functional and cognitive differentiation of ADHD subtypes [11]

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