Perseverative Responses Research Articles

Neuropsychological and neuroanatomical correlates of perseverative responses in subacute stroke

Patients with left-sided neglect frequently show repetitive behaviour on the ipsilesional side, such as re-markings on cancellation tasks or extensive elaboration on drawings. It is unclear whether these perseverative responses occur as a symptom of hemi-neglect or inattention in general, and/or whether they are related to anatomical brain correlates such as lesion location, lesion side or volume. In a first study, we examined the prevalence and neuropsychological correlates of perseverative responses in 206 subacute stroke patients and 63 healthy controls. Perseverative responses were considered present when there was at least one re-marking on the Star Cancellation, and both the degree and spatial distribution of re-markings were examined. A distinction was made between hemi-neglect and non-lateralized inattention. Spatial and verbal working memory were assessed with the Corsi Block Span and the Digit Span. Verbal and non-verbal executive function was assessed with the Visual Elevator and Letter Fluency. Stroke patients without inattention demonstrated re-markings that were related to executive performance, and the degree of perseveration was equally distributed across the sheet. Hemi-neglect patients but not patients with generalized inattention demonstrated more re-markings than controls, suggesting that a lateralized spatial attention bias triggers the perseverative responses. Patients with left and right hemi-neglect showed the same prevalence of perseveration, but the distribution of re-markings was more lateralized towards the ipsilesional side in patients with right-hemispheric stroke. The degree of perseveration in patients with hemi-neglect was related to the severity of the neglect. The goal of the second study on a subset of patients (n = 127) was to determine the neuroanatomical correlates of perseverative responses in the early phase of stroke. Lesion anatomy was administered by indicating involvement of frontal, parietal, temporal, occipital lobe, caudate nucleus, lenticular nucleus and/or thalamus. Lesion volume was calculated using a manual tracing technique. Lesion analyses indicated that perseverative behaviour is strongly associated with lesions involving the caudate nucleus or the lenticular nucleus, independent of lesion volume. The caudate nucleus was an important correlate of perseveration independent of the presence of hemi-neglect. No association was found between lesion side and perseverative responses, in contrast to previous studies. In conclusion, a stroke involving the basal ganglia and the presence of (left- or right-sided) hemi-neglect are two important associates of perseverative responses in the subacute phase of stroke.

Learned irrelevance and response perseveration in a total change dimensional shift task

Thirty-six healthy participants received a discrimination learning task requiring the identification of a relevant stimulus dimension. After successful learning, the relevant dimension was shifted unannounced. All exemplars of the two dimensions presented after the shift were novel, implying a ‘total change’ design. In three experimental conditions, participants could either make only errors reflecting perseveration of responding to the former relevant dimension, continued ignoring of the former irrelevant dimension, or both. After the shift, the participants in the perseveration condition made fewer errors than did those in the other two conditions, which did not differ. These results imply a predominance of the learned irrelevance mechanism even when any direct transfer of learning about exemplars in the pre-shift phase is precluded.

Reduced attention and increased impulsivity in mice lacking NPY Y2 receptors: Relation to anxiolytic-like phenotype

Neuropeptide (NPY) Y2 receptors play an important role in some anxiety-related and stress-related behaviours in mice. Changes in the level of anxiety can affect some cognitive functions such as memory, attention and inhibitory response control. We investigated the effects of NPY Y2 receptor deletion (Y2 −/−) in mice on visual attention and response control using the five-choice serial reaction time (5-CSRT) task in which accuracy of detection of a brief visual stimulus across five spatial locations may serve as a valid behavioural index of attentional functioning. Anticipatory and perseverative responses provide a measure of inhibitory response control. During training, the Y2 −/− mice had lower accuracy (% correct), and made more anticipatory responses. At stimulus durations of 2 and 4 s the Y2 −/− were as accurate as the Y2 +/+ mice but still more impulsive than Y +/+. At stimulus durations of 0.25 and 0.5 s both groups performed worse but the Y2 −/− mice made significantly fewer correct responses than the Y2 +/+ controls. The anxiolytic drug diazepam at 2 mg/kg IP greatly increased the anticipatory responding of Y2 −/− mice compared to Y2 +/+. The anxiogenic inverse benzodiazepine agonist, FG 7142, at 10 mg/kg IP reduced the anticipatory responding of Y2 −/− but not Y2 +/+ mice. These data suggest that NPY Y2 receptors make an important contribution to mechanisms controlling attentional functioning and “impulsivity”. They also show that “impulsivity” of NPY Y2 −/− mice may depend on their level of anxiety. These findings may help in understanding the pathophysiology of stress disorders and depression.

Wisconsin Card Sorting Test Performance after Putaminal Hemorrhagic Stroke

The purpose of this study was to compare the performance differences in the Wisconsin Card Sorting Test (WCST) between 55 patients with putaminal hemorrhage (PH) 3 months after stroke and 69 age-matched normal controls. Impairment on WCST was defined as performance greater than 1.64 standard deviation below the control mean. A multivariate analysis of covariance (MANCOVA) controlling for education yielded a significant main effect for group but not for education and interaction of group x education. Univariate analyses revealed significant between-group differences in five WCST measures, including perseverative errors (PE), perseverative responses (PR), conceptual-level responses (CLR), number of categories completed (NCC), and trials to complete the first category (TCC). For patients with PH, z-scores for two WCST indices were within the impaired range: TCC and PR. A high percentage of patients (40-47%) scored in the designated impaired range on NCC, PR, PE, and TCC. The WCST variables discriminated patients from controls with an overall accurate classification rate of 91.9%. Of these, the variables that contributed most to the differentiation between patients and normal controls were PE, CLR, and total number correct (TNC) (a standardized canonical discriminant function coefficient > 0.40). Finally, no significant hemispheric laterality effects emerged on any of the WCST variables. The results of this study provide further evidence of impaired mental set shifting in stroke patients with PH. The implications for rehabilitation professionals are discussed, and recommendations for further research are made.

Stuck in a rut: Perseverative response tendencies and the neuroticism-distress relationship.

Clinical views of neuroticism-linked distress often make reference to the perseverative sorts of mental processes that reinforce such experiences. The goal of the present 7 studies, involving 488 undergraduate participants, was to directly examine such perseverative processes. Individual differences in response perseveration were operationalized in terms of choice reaction time difficulties switching (vs. repeating) responses across consecutive trials. Response perseveration interacted with neuroticism in predicting negative emotion, dissatisfaction with life, and displays of negative emotion (Studies 1-4). Specifically, neuroticism-outcome relations were quite a bit stronger at high levels of perseveration. Additional studies (Studies 5-7) provided support for the convergent and discriminant validity of response perseveration. Overall, the results highlight the manner in which response perseveration reinforces experiences of negative emotion.

Sleep Deprivation in Rats Produces Attentional Impairments on a 5-Choice Serial Reaction Time Task

To develop a rodent model of the attentional dysfunction caused by sleep loss. The attentional performance of rats was assessed after 4, 7, and 10 hours of total sleep deprivation on a 5-choice serial reaction time task, in which rats detect and respond to brief visual stimuli. The rats were housed, sleep deprived, and behaviorally tested in a controlled laboratory setting. Ten male Long-Evans rats were used in the study. Rats were trained to criteria and subsequently tested in daily sessions of 100 trials at approximately 4:00 PM (lights on 8:00 AM-8:00 PM). Attentional performance was measured after 4, 7, 10 hours of total sleep deprivation induced by gentle handling. Sleep deprivation produced a monotonic increase in response latencies across the 4-hour, 7-hour, and 10-hour deprivations. Sleep deprivation also led to increased omission errors, but the overall number of perseverative and premature responses was unchanged. Subgroups of rats were differentially affected in the number of omission errors and perseverative responses. The effects of sleep deprivation on rats are compatible with a range of human findings on the effects of sleepiness on selective attention, psychomotor vigilance, and behavioral control. Rats also exhibited differential susceptibility to the effects of sleep deprivation, consistent with 'trait-like' susceptibility that has been found in humans. These findings indicate the feasibility of using the 5-choice serial reaction time task as an animal model for investigating the direct links between homeostatic sleep mechanisms and resulting attentional impairments within a single animal subject.

A composite neural network model for perseveration and distractibility in the Wisconsin card sorting test

A composite artificial neural network model is proposed to simulate the performance of the Wisconsin Card Sorting Test. The Wisconsin Card Sorting Test is a test of executive functions where prefrontal deficits are matched to some quantitative measures such as percentage of perseverative errors and number of failures to maintain set. In this work, the proposed model is used to simulate the performances of healthy subjects and patients with prefrontal involvement particularly on these measures. The model is designed in such a way that one of the subsystems, namely, the Hopfield network, serves as the working memory and the other, the Hamming block, as the hypothesis generator. The results show that the proposed relatively simple model is capable of simulating the wide range of the performances of both normal subjects and prefrontal patients on the Wisconsin Card Sorting Test. While lowering the Hamming distance in the Hamming block gave rise to progressively more perseverative responses, changing the threshold vector of the Hopfield network resulted in more set maintenance failures. The former manipulation disrupts the abstraction or mental flexibility and the latter sustained attention or perseverance both of which are the major functions of the prefrontal system.

Association of COMT Val158Met Genotype With Executive Functioning Following Traumatic Brain Injury

Catechol-O-methyltransferase (COMT) is thought to functionally modulate dopamine neurons, thus likely influencing frontal-executive functioning. High enzyme activity (COMT Val) and low enzyme activity (COMT Met) are functional polymorphisms resulting from a G to A transition in exon 4 (codon 158) of the human COMT gene. Decreased cortical dopamine should result in poorer executive functioning. Therefore, the authors hypothesized that individuals with traumatic brain injury (TBI) and the low enzyme activity polymorphism would perform better on tests of executive functioning than individuals with the high enzyme activity polymorphism. One hundred thirteen individuals referred to the Defense and Veterans Brain Injury Center underwent a comprehensive TBI evaluation and were genotyped for the COMT polymorphism. Comparison of mean differences among the COMT genotype groups for several measures of aspects of executive functioning was conducted using analysis of variance (ANOVA) with adjustment for multiple comparisons. Homozygotes for the higher activity allele made more perseverative responses on the Wisconsin Card Sorting Test, while homozygotes for the lower activity allele had the least number of perseverative responses. While it cannot be determined whether TBI influenced the association of COMT Val158Met to executive functioning, these data extend the known relationship of genotype to executive performance seen in healthy comparison subjects and individuals with schizophrenia to individuals with TBI.

Association of COMT Val158Met Genotype With Executive Functioning Following Traumatic Brain Injury

Catechol-O-methyltransferase (COMT) is thought to functionally modulate dopamine neurons, thus likely influencing frontal-executive functioning. High enzyme activity (COMT Val) and low enzyme activity (COMT Met) are functional polymorphisms resulting from a G to A transition in exon 4 (codon 158) of the human COMT gene. Decreased cortical dopamine should result in poorer executive functioning. Therefore, the authors hypothesized that individuals with traumatic brain injury (TBI) and the low enzyme activity polymorphism would perform better on tests of executive functioning than individuals with the high enzyme activity polymorphism. One hundred thirteen individuals referred to the Defense and Veterans Brain Injury Center underwent a comprehensive TBI evaluation and were genotyped for the COMT polymorphism. Comparison of mean differences among the COMT genotype groups for several measures of aspects of executive functioning was conducted using analysis of variance (ANOVA) with adjustment for multiple comparisons. Homozygotes for the higher activity allele made more perseverative responses on the Wisconsin Card Sorting Test, while homozygotes for the lower activity allele had the least number of perseverative responses. While it cannot be determined whether TBI influenced the association of COMT Val158Met to executive functioning, these data extend the known relationship of genotype to executive performance seen in healthy comparison subjects and individuals with schizophrenia to individuals with TBI.

Persistent cognitive dysfunction in patients with obsessive‐compulsive disorder: A naturalistic study

The purpose of the present study was to investigate the changes in the cognitive dysfunctions of patients with obsessive-compulsive disorder (OCD) over a 1-year period of pharmacological treatment. Twenty-one OCD patients and 20 normal subjects underwent neuropsychological tests and clinical evaluations on three separate occasions (baseline, 4 months, and 1 year after the start of medications). OCD patients continued to show significant impairments in the following cognitive measures compared with the normal controls: accuracy of immediate and delayed recall on the Rey-Osterrieth complex figure tests, the numbers of responses on the category fluency test, the response time on the trail making test--part A, and the number of perseverative response and perseverative errors on the Wisconsin card sorting test. The findings in this study suggested that impaired performance on cognitive domains, such as visuospatial memory and verbal fluency may underline the pathology of OCD.

Dissociable Contribution of 5-HT1A and 5-HT2A Receptors in the Medial Prefrontal Cortex to Different Aspects of Executive Control such as Impulsivity and Compulsive Perseveration in Rats

Serotonin (5-HT) receptors are increasingly recognized as major targets for cognitive enhancement in schizophrenia. Several lines of evidence suggest a pathophysiological role for glutamate NMDA receptors in the prefrontal cortex in schizophrenia and associated disorders in attention and executive functioning. We investigated how the interactions between 5-HT1A and 5-HT2A and glutamate NMDA receptor mechanisms in the medial prefrontal cortex (mPFC) contribute to the control of different aspects of attentional performance. Rats were trained on a five-choice serial reaction time (5-CSRT) task, which provides indices of attentional functioning (percentage of correct responses), executive control (measured by anticipatory and perseverative responses), and speed. The competitive NMDA receptor antagonist CPP (50 ng/side) was infused directly into the mPFC 5 min after infusion of either 8-OH-DPAT (30 and 100 ng/side) or M100907 (100 and 300 ng/side) into the same brain area. Impairments in attentional functioning induced by CPP were completely abolished by both doses of 8-OH-DPAT or M100907. In addition, M100907 abolished the CPP-induced anticipatory responding but had no effects on perseverative over-responding, while 8-OH-DPAT reduced the perseverative over-responding but had no effects on anticipatory responding induced by CPP. The selective 5-HT(1A) receptor antagonist WAY100635 (30 ng/side) antagonized the effects of 8-OH-DPAT (100 ng/side). 8-OH-DPAT at 30 ng/side reduced the latency of correct responses in controls and CPP-injected rats and lowered the percentage of omissions in CPP-injected rats. The data show that 5-HT1A and 5-HT2A receptors in the mPFC exert opposing actions on attentional functioning and demonstrate a dissociable contribution of 5-HT1A and 5-HT2A receptors in the mPFC to different aspects of executive control such as impulsivity and compulsive perseveration.

Effects of paradoxical sleep deprivation on the performance of rats in a model of visual attention

In the present work we sought to evaluate the effects of paradoxical sleep deprivation (PSD) on the performance of rats in the five-choice serial reaction time task, a test designed to assess attentional function. Adult male Wistar rats were trained to detect a brief (1 s) light stimulus randomly presented in one of five locations in a box specially designed for the task. After achieving stable performance, the animals were submitted to 96 h of sleep deprivation by the platform technique, in which the rats are placed on top of small platforms in a tank filled with water. During sleep, particularly during the paradoxical stage, the loss of muscle tone make the animals fall into the water, thus awakening them and so depriving of sleep. Performance in the task was assessed daily during the 96 h deprivation period and also during seven recovery days afterwards. Paradoxical sleep deprivation reduced accuracy on the on the third (72 h) and fourth (96 h) days of sleep deprivation compared to home-cage controls, and this impairment reverted soon after the beginning of the recovery period. Sleep-deprived animals also showed an increase in omissions in the first day of PSD and a reduction on the number of trials started on the fourth day of sleep deprivation. No significant group differences were observed in premature and perseverative responses, correct response latency and reward latency. Our results thus indicate that paradoxical sleep deprivation impairs attentional function.

A Qualitative Analysis of Inaccurate Responses on the Hooper Visual Organization Test

The present study investigated the types of inaccurate responses, i.e., Don't Know, Semantic, Visual (nonlinguistic), Phonological, Circumlocutory, and Perseverative, made on the Hooper Visual Organization Test by a heterogeneous sample of 68 brain-damaged and 63 substance abuse patients. The mean age of the brain-damaged and substance abuse groups were 46.0 (SD=13.5) and 43.7 (SD=12.9) yr., respectively. Analysis showed that the brain-damaged group made significantly more visual and perseverative responses than the substance abuse group. There was significantly more variance in the Visual responses than the Semantic responses for the brain-damaged group. The authors conclude that visuospatial ability is the primary factor for successful performance on this test.

Executive Functioning in Hyperactive Children as Young Adults: Attention, Inhibition, Response Perseveration, and the Impact of Comorbidity

Tests of several executive functions (EFs) as well as direct observations of symptoms of attention deficit hyperactivity disorder (ADHD) during testing were collected at the young adult follow-up (M = 20 years) on a large sample of hyperactive (H; N = 147) and community control (CC; N = 71) children. The EF tasks included tests of attention, inhibition, and response perseveration. The H group was subdivided into those with and without ADHD (+ or w/o) at follow-up. The H+ADHD group made significantly more inhibition errors than the CC group on a Continuous Performance Test (CPT) and showed more ADHD symptoms while performing the CPT. The H+ADHD group also displayed more ADHD symptoms during a letter cancellation task than did both the hyperactive w/o ADHD and CC groups. Both H groups showed slower reaction times during a Card Playing Task. That subset of hyperactive probands with Conduct Disorder (CD) displayed significantly more perseverative responding on that task than did those without CD, but otherwise it did not differ on any other measures. Current level of anxiety contributed adversely to both CPT commission errors and ADHD behavior during the CPT. Comorbid depression did not contribute to any group differences on these tests. Although developmental improvements were found in both the H and the CC groups in their CPT inattention and inhibition scores since adolescence, the H groups remained distinguishable from the CC groups over this period. We conclude that formerly hyperactive children manifest greater EF deficits at follow-up in the areas of inattention, disinhibition, and slowed reaction time and greater ADHD behavior during testing, but these problems are mostly confined to those with current ADHD. Response perseveration, however, was limited to those hyperactive children with CD by follow-up, consistent with Quay's theory of these two disorders.

Phencyclidine-induced impairment in attention and response control depends on the background genotype of mice: reversal by the mGLU2/3 receptor agonist LY379268

Converging evidence implicates glutamate neurotransmission in attention and inhibitory response control. To investigate how the background genotype contributes to glutamate's effects on attention and response control, we examined how phencyclidine (PCP) affected the performance of a five-choice serial reaction time (5-CSRT) task in two inbred mouse strains, C57BL/6N and DBA/2N. We also tested a potent mGlu(2/3) receptor agonist, LY379268, against PCP's effects. Mice were trained on a 5-CSRT task, which measures visual attention and response control until they reached asymptotic performance. Both strains of mice were then injected intraperitoneally with 0.5, 1.5 or 3.0 mg/kg PCP. Doses of 1.0 and 3.0 mg/kg of LY379268 were injected subcutaneously to vehicle or PCP-treated mice. At asymptotic performance DBA/2N mice were less accurate and made more anticipatory responses than C57BL/6N. PCP impaired accuracy (% correct) and increased perseverative responses of DBA/2N mice at 1.5 mg/kg. However, at doses up to 3.0 mg/kg it had no effect on these measures in C57BL/6N. In DBA/2N mice 1.5 mg/kg PCP increased anticipatory responses far more than 3.0 mg/kg in C57BL/6N mice. No dose of LY379268 prevented the PCP-induced accuracy deficit of DBA/2N mice. The PCP-induced anticipatory and perseverative responding of DBA/2N mice was reduced by 3.0 mg/kg LY379268, while 1.0 and 3.0 mg/kg reduced anticipatory responding in C57BL/6N. The background genotype may determine the effects of PCP on attentional performance and the results confirm the importance of glutamate transmission in some aspects of this performance.

Response perseveration and sensitivity to reward and punishment in boys with oppositional defiant disorder

Response perseveration is the tendency to continue a response set for reward despite punishment. In the present study, response perseveration and sensitivity to reward and punishment were assessed in boys with oppositional defiant disorder (ODD). The study also examined the relation between punishment sensitivity and autonomic arousal. Nineteen ODD boys (mean age 9.8 years) and 20 normal control boys (NC) (mean age 9.7 years) were administered the door-opening task. In this task, the subject chooses either to open the next door or to stop playing; the opening of doors is initially rewarded and then increasingly punished. ODD boys opened more doors than NC boys. Following punishment, ODD boys took less time than NC boys before opening the next door, but did not differ from NC boys in time after reward. Mean skin conductance level was lower in ODD boys than in NC boys. The correlation coefficient between time after punishment and skin conductance level was moderately positive in the total sample. These results suggest that response perseveration in ODD boys is related to low punishment sensitivity and that skin conductance level is a marker of punishment sensitivity.

Cognitive Ability and Risk for Alcoholism: Short-Term Memory Capacity and Intelligence Moderate Personality Risk for Alcohol Problems.

This study tested the hypothesis that short-term memory (STM) capacity moderates the effect of social deviance on alcohol problems. Personality, cognitive ability, and alcohol use and abuse were assessed in the adult offspring of alcoholics (FHPs; n = 153) and the adult offspring of nonalcoholics (FHNs; n = 150). The results revealed that STM capacity moderated the effect of social deviance on alcohol problems, independent of intelligence. High social deviance and high-STM participants had fewer alcohol problems than did high social deviance and low-STM participants. Intelligence also moderated the effect of social deviance on alcohol problems in the same way, independent of STM capacity. FHPs had lower IQs, lower verbal ability, and more response perseveration than FHNs. The results suggest that working memory capacity moderates the risk for alcoholism associated with disinhibited traits.

Influence of color on number perseveration in a serial addition task.

The present study examined the influence of coloring the repeated number in a serial addition task that elicits perseveration in normal subjects. 110 undergraduates were administered the original, black-and-white version of the task, 112 other undergraduates the new, colored version. The task required adding the following numbers: 1000 + 40 + 1000 + 30 + 1000 + 20 + 1000 + 10. We predicted that, in the colored version, the enhanced saliency of the repeated number 1000 would reduce the incidence of perseverative errors. Results with the black-and-white version replicated our 1994 findings, i.e., the majority of subjects produced the perseverative response 5000 rather than the correct answer of 4100. Contrary to our expectation, color did not improve performance but rather increased both perseverative and nonperseverative errors. We speculate that the enhanced saliency of the 4 repeated 4-digit terms may have further distracted subjects from discovering the critical lure, namely, the repetitive digit changes in the partial sums at irrelevant positions, i.e., in the thousands and tens but never in the hundreds.

The Serotonin 5-HT2A Receptors Antagonist M100907 Prevents Impairment in Attentional Performance by NMDA Receptor Blockade in the Rat Prefrontal Cortex

We investigated whether 5-HT2A receptors contribute to the control of attentional performance by glutamate NMDA receptor mechanisms in the medial prefrontal cortex (mPFC). We examined the effects of NMDA receptor blockade in the mPFC on attentional performance by infusing a competitive glutamate NMDA receptor antagonist, 3-(R)-2-carboxypiperazin-4-propyl-1-phosphonic acid (CPP) into the mPFC of rats performing a task of divided and sustained visual attention. The five-choice serial reaction time task provides indices of attentional functioning (% correct responses), executive control (measured by anticipatory and perseverative responses) and speed. A dose of 10 ng CPP injected bilaterally into the mPFC increased anticipatory and perseverative responding; 50 ng reduced accuracy. Increasing the stimulus duration alleviated the CPP-induced accuracy deficit but did not reduce its effects on anticipatory and perseverative responses. CPP at 50 ng caused motor hyperactivity whereas lower doses had no effect. [R-(+)-(2,3-dimethoxyphenyl)-1-[2-(4-fluorophenylethyl)]-4-piperidine-methanol] (M100907) (M100907), a 5-HT2A receptor antagonist, injected subcutaneously at 10 and 40 microg/kg, had no effect on accuracy but dose dependently reversed the impairment induced by 50 ng CPP. Both doses of M100907 completely abolished CPP-induced anticipatory but not perseverative over-responding. At the dose of 40 microg/kg M100907 reversed CPP-induced motor hyperactivity. This study provides evidence that the prefronto-cortical glutamate NMDA system may make an important contribution to the control of attention and executive functions. It also indicates that 5-HT2A receptors may serve to optimize attentional selectivity and improve some aspects of executive control.

Executive function and ADHD: a comparison of children's performance during neuropsychological testing and real-world activities.

Current understanding of executive function deficits in Attention-Deficit/Hyperactivity Disorder (ADHD) is derived almost exclusively from neuropsychological testing conducted in laboratory settings. This study compared children's performance on both neuropsychological and real-life measures of executive function and processing speed. The Stroop and Wisconsin Card Sorting Task (WCST) were selected as neuropsychological measures, whereas route tasks in a videogame and at the zoo were used to index real-life measures. Participants comprised a community sample of 22 unmedicated boys with ADHD individually matched on age and IQ with 22 normally developing control boys. There were no group differences in executive function on the Stroop or zoo tasks, but the ADHD group exhibited deficits in set-shifting as assessed by the WCST (perseverative errors and responses) and videogame play (fewer challenges completed). Also, the ADHD group showed slowed processing speed on the Stroop (slower color naming) and zoo activity (longer time to complete task), as well as a slower rate of acquisition of the sorting rule on the WCST (more trials to complete first category). Efficient and flexible videogame play (number of challenges completed) was related positively to efficacy on the Stroop (number of items named correctly in the interference and two control conditions) and inversely related to set-shifting problems on the WCST (perseverative responses and errors). Also, problems in goal-directed behavior at the zoo (number of deviations from designated route) were related to problems in set-shifting on the WCST (perseverative responding). Children with ADHD exhibit impairments in executive function and processing speed in real-world activities as well as in neuropsychological testing. Cognitive deficits detected by standardized neuropsychological testing are related to performance difficulties in real-world activities.