Abstract
Attention-deficit hyperactivity disorder (ADHD) is a complex neurodevelopmental disorder that implies several-step process, and there is no single test to diagnose both ADHD and associated comorbidities, such as oppositional-defiant disorder (ODD), anxiety disorder, depression, and certain types of learning disabilities. The purpose of the present study was to examine correlations between behavioral and clinical symptoms by administering an extensive neuropsychological battery to a sample of children and adolescents from a developing country. The sample was divided into three groups: non-ADHD, ADHD-non-comorbid, and ADHD + comorbidity. A full neuropsychological battery and clinical assessment found that 105 children met DSM-5 criteria, of whom 46.6% had the predominantly inattentive presentation, 37.3% had combined presentation, and 16% were predominantly hyperactive/impulsive presentation. The internal correlation between neuropsychological tests did not reach statistical significance in the comparison between ADHD and non-ADHD cases (p < 0.17). Clinical ADHD cases, including both + comorbidity and non-comorbid groups, performed substantially worse on continuous performance test (CPT), working memory. Comparing ADHD-non-comorbid and ADHD + comorbidity groups, the latter did significantly worse on inhibitory control, time processing, and the level of perseveration response on CPT indexes, as well as on working memory performance and child behavior checklist (CBCL) tests particularly the CBCL-deficient emotional self-regulation test in the ADHD + comorbidity group. Children diagnosed as ODD or with conduct disorder showed close correlations between clinical CBCL profiles and externalized symptoms. Our findings suggest that ADHD + comorbidity and ADHD non-comorbid cases may be differentiated by a number of neuropsychological measures, such as processing speed, inhibitory control, and working memory, that may reflect different levels of involvement of the hot and cool executive domains, which are more impaired in cases of severe symptomatic-externalized behavior and emotional regulation problems. Therefore, profiles based on clinical and behavioral findings can help clinicians select better strategies for detecting neuropsychological impairment in Brazilian children with ADHD.
Highlights
Attention-deficit hyperactivity disorder (ADHD) affects approximately 5.9 and 7.1% of children and adolescents across different cultures and are characterized by persistent pattern of inattention, hyperactivity, and/or impulsivity [1, 2]
Of the remainder of the 154 children, those not meeting ADHD criteria were 49 (31.9%), of whom seven presented learning disabilities (14.3%), 10 (20.4%) had altered family dynamics, 16 (32.6%) had adaptive disorders, and 16 (32,6%) had a mental deficit (QI < 85)
Of the 105 children with DSM-5 ADHD for inattentiveness and/ or hyperactivity, 46 (44%) presented comorbidities, 30 (66.6%) presented anxiety disorder (AD), 11 (24.2%) had oppositionaldefiant disorder (ODD), and 3 (9%) had conduct disorders (CDs)
Summary
Attention-deficit hyperactivity disorder (ADHD) affects approximately 5.9 and 7.1% of children and adolescents across different cultures and are characterized by persistent pattern of inattention, hyperactivity, and/or impulsivity [1, 2]. Several studies showed a high prevalence of comorbidities of approximately 20–50% [3, 4], and children with ADHD tend to present learning difficulties, behavioral and conduct disorders (CDs), mood and motor problems, and delayed development of speech [5] Associations with comorbidities, such as oppositionaldefiant disorder (ODD), anxiety disorder (AD), depression disorder (DD), and learning disabilities (LD) require a more comprehensive multidisciplinary assessment. Many studies have recommended a neuropsychological evaluation for diagnostic and complementary determination of ADHD cases [7] Sustained attention tests, such as the continuous performance test (CPT) [8, 9] in addition to a broad spectrum of cognitive tests, scales, and questionnaires, have been used to determine specific deficits with emphasis on predominant disorders in associative areas related to attention and related to executive functions (EFs), such as functional memory and cognitive flexibility. Few studies applying Conners’ CPT have used the full potential of the test to analyze several dimensions of attention [9]
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