Executive Dysfunction Symptoms Research Articles

The importance of including ADHD in the differential diagnosis in adults. About a case

IntroductionADHD is a diagnosis almost always made in childhood or adolescence and oftent difficult to make it new in adults because it is not thought of in the differential diagnosis process and for the lack of experience from adult devices. -ADHD in adults is characterized by symptoms of executive dysfunction, inattention, emotional dysregulation. The symptoms of impulsivity and hyperactivity tend to be less evident.Objectives-Frequently, the adult patient with ADHD comes to the consultation with a secondary symptom and the primary pathology is hidden and often not evident at first glance.Methods-A 20-year-old woman, university student, with no relevant medical or psychiatric history, without toxic habits, who attended her first consultation referred by her primary care physician for long-standing insomnia, restless legs and anxiety.-The patient’s underlying complaint and her bigger concern is her poor academic performance. It is striking that she has just started her third year at the university, the first year she did not pass any subjects, the second year she changed majors and only passed two, now she is repeating the course.-The examination did not reveal overt affective symptoms, nor psychotic symptoms or other notable psychopathology. The patient’s speech tended towards superficiality, inconcretion, it was salty, it was difficult for her to express herself, even suggesting a certain intellectual disability.-In the first consultation sleep study is requested. And referral to clinical psychology consultation for psychometric study.Results-She is administered Clinical interview and WAIS IV (Adult Intelligence Scale), Trail Making Test, d2 and Stroop, Diagnostic Interview for ADHD in adults (inattention items).-The WAIS-IV demonstrated global cognitive abilities within normality, although with significantly lower scores in the IMT and IVP indices which involve the functions of attention, concentration, mental control and short-term visual memory). Trail Making Test, d2, Stroop and Diagnostic Interview of ADHD in adults (inattention items) yielded profile results highly suggestive of Attention Deficit Disorder without Hyperactivity.-The insomnia subsided with a regimen of 7.5 mg of mirtazapine per day. Subsequently, after starting treatment with low-dose methylphenidate (20 mg/day), the patient improved very significantly, both academic performance and social functioning and mood, self-esteem and subjective well-being.Conclusions-We must always include ADHD in the differential diagnosis of a young adult patient when faced with a wide variety of consultation symptoms, especially if they report some type of deterioration or dysfunction in their social, family or academic life.-An adequate clinical evaluation supported, if possible, by psychometric tests is essential to reach the diagnosis, which allows establishing an effective treatment that modifies the patient’s overall prognosis.Disclosure of InterestNone Declared

A Single-Blind, Placebo Controlled Trial of Triple Beaded Mixed Amphetamine Salts in DSM-5 Adults With ADHD Assessing Effects Throughout the Day

Objective: To examine the effects of triple beaded mixed amphetamine salts (TB MAS) on ADHD and executive dysfunction symptoms throughout the day in adults with DSM-5 ADHD. Method: This was a 6 week, single-blind, placebo-lead in trial of TB MAS (12.5–37.5 mg/day); all participants received 2 weeks of single-blind placebo); one individual was a placebo responder and was discontinued. One of these 18 dropped after 1 week on 12.5 mg/day, while all others completed the trial and received 37.5 mg/day TB MAS. Results: There were significant effects of TB MAS on all clinical measures, including investigator overall symptoms (AISRS); self-report overall (ASRS), time-sensitive ADHD (TASS) scores throughout the day, impairment (CGI) and executive function scores (BRIEF-A). TB MAS was generally well tolerated. Conclusions: This study extends prior findings of TB MAS to adults with DSM-5 ADHD; it further re-validates findings of efficacy of TB MAS throughout the day.

Pre-treatment frontal beta events are associated with executive dysfunction improvement after repetitive transcranial magnetic stimulation for depression: A preliminary report

Repetitive transcranial magnetic stimulation (rTMS) is an established clinical treatment for major depressive disorder (MDD) that has also been found to improve aspects of executive functioning. The objective of this study was to examine whether oscillatory burst-like events within the beta band (15–29 Hz) prior to treatment could predict subsequent change in self-reported executive dysfunction (EDF) across a clinical course of rTMS for MDD. Twenty-eight adults (64% female) with MDD completed the self-report Frontal Systems Behavior Scale (FrSBe) and provided eyes-closed resting-state electroencephalography (EEG) before and after a clinical course of rTMS therapy for primary MDD. The rate, power, duration, and frequency span of transient EEG measured oscillatory beta events were calculated. Events within delta/theta and alpha bands were examined to assess for beta specificity. After controlling for improvement in primary depressive symptoms, a lower rate of beta events at F3, Fz, F4, and Cz prior to rTMS treatment was associated with a larger improvement in EDF after rTMS treatment. In addition, a decrease in beta event rate at Fz pre-to-post treatment was associated with a larger improvement in EDF after treatment. Results were largely specific to the beta band. In this study, the rate of frontrocentral beta events prior to treatment significantly predicted the likelihood of subsequent improvement in EDF symptoms following a clinical course of rTMS for MDD. These preliminary findings suggest the potential utility of EEG measured beta events and rTMS for targeting EDF across an array of neuropsychiatric disorders.

Abstract 53: Frontal Functional Connectivity Networks and Executive Function Following Perinatal Stroke

Perinatal stroke causes most hemiparetic cerebral palsy and a lifetime of disability with no known prevention strategies. Two types of perinatal stroke predominate, arterial ischemic stroke (AIS) and periventricular venous infarction (PVI), dictating lesion-specific differences in outcomes. Executive functioning challenges and attention deficit hyperactivity disorder (ADHD) are more common in children with perinatal stroke (19-35%) than peers (5-7%). Resting state (RS) functional magnetic resonance imaging (fMRI) measures fluctuations in the blood-oxygen level dependent (BOLD) signal that may estimate network functional connectivity (FC). We evaluated relationships between FC in relevant frontal circuits, ADHD and executive function in children with perinatal stroke compared to typically developing controls (TDC). Participant recruitment was from a population-based research cohort (AIS N=32; PVI N=30; TDC N=59). MRI imaging included T1-weighted anatomical and resting state fMRI sequences. Subsequent seed-to-seed analyses quantified FC within frontoparietal (FPN), dorsal attention (DAN) and default mode networks (DMN). Parent questionnaires quantified executive function (Behavior Rating Inventory of Executive Function (BRIEF)) and ADHD symptoms (ADHD Rating Scale-5). Large group FC differences were observed within FPN, DAN and DMN networks where AIS had lower FC compared to both PVI and TDC. For stroke participants, higher FC within the DAN and FPN was associated with poorer cognitive function (BRIEF). By contrast, higher FC within the DMN was associated with better ADHD ratings. Differences within frontal functional networks appear to be related to poorer cognitive function such that increased FC between the lesioned and nonlesioned hemisphere is associated with symptoms of executive dysfunction and ADHD suggesting that developmental plasticity leads to complex network changes following early unilateral brain injury.

Identification of neurobehavioural symptom groups based on shared brain mechanisms.

Most psychopathological disorders develop in adolescence. The biological basis for this development is poorly understood. To enhance diagnostic characterization and develop improved targeted interventions, it is critical to identify behavioural symptom groups that share neural substrates. We ran analyses to find relationships between behavioural symptoms and neuroimaging measures of brain structure and function in adolescence. We found two symptom groups, consisting of anxiety/depression and executive dysfunction symptoms, respectively, that correlated with distinct sets of brain regions and inter-regional connections, measured by structural and functional neuroimaging modalities. We found that the neural correlates of these symptom groups were present before behavioural symptoms had developed. These neural correlates showed case-control differences in corresponding psychiatric disorders, depression and attention deficit hyperactivity disorder in independent clinical samples. By characterizing behavioural symptom groups based on shared neural mechanisms, our results provide a framework for developing a classification system for psychiatric illness that is based on quantitative neurobehavioural measures.

Posttraumatic Stress Disorder and executive dysfunction among children and adolescents: A Latent Profile Analysis

Background/ObjectiveThe current study aimed to examine the relationship between Posttraumatic Stress Disorder (PTSD) symptoms and executive dysfunction in children and adolescents after psychological trauma. MethodParticipants were 13,438 of children and adolescents aged 6 to 18 years exposed to the 2008 Wenchuan earthquake. PTSD and dysexecutive symptoms were assessed using the UCLA PTSD Reaction Index for Children and the Self-Report Dysexecutive Questionnaire. Latent Profile Analysis (LPA) was conducted using Mplus version 7.4. Subgroup differences in trauma exposure and quality of life were calculated using ANCOVA. ResultsA 4-class parallel model was found to best describe latent PTSD symptom profiles and executive dysfunction. Individuals in higher symptom groups showed more trauma exposure and lower quality of life. ConclusionsThis LPA study shed light on the relationship between PTSD and executive dysfunction symptoms in children and adolescents. The correlation between PTSD and executive dysfunction was maintained after individual differences were taken into consideration. Our findings provide a new view on how PTSD relates to executive dysfunction and several suggestions for treating child and adolescent PTSD patients.

6-months follow up of lisdexanfetamine in adolescent with attention deficit hyperactivity disorder comorbid with severe conduct disorder

IntroductionAdolescents with conduct disorders (CD) often associate symptoms of executive dysfunction and developmental history of attention deficit hyperactivity disorder (ADHD). There is high-quality evidence that psychostimulants have a moderate-to-large effect on conduct problems in youth with ADHD. Lisdexanfetamine (LXD) reduces impulsivity and others ADHD symptoms, has better daylong coverage and less abuse potential than others stimulants.AimsTo evaluate the efficacy of lisdexanfetamine associated to psychological and family interventions in these multi-problem cases.MethodThis work presents for discussion the preliminary measures of the effectiveness and security of LXD (range between 50–70 mg, during 6 months), prescribed to seven boys, ages 15 to 17 with ADHD comorbid with severe conduct disorders. All of them were living in a Young Offender Centre, received intensive psychological and psycho-educational treatment during 6 months before and during the use of LXD. Structured clinical assessment, ADHD and Conduct Disorder Scales were performed before the onset and followed 3 and 6 months.ResultsMeasures of ADHD, and CD symptoms improved at 3 and 6 months comparing to basal measures. Secondary effects were well tolerated and all patients showed a good adherence to treatment except for one of them who was drop out because of increase of anxiety.ConclusionsEvidence indicates that LXD can be beneficial and well tolerate for impulsive and aggressive behaviours in teenagers with ADHD and severe CD. Limitations are the small number of cases and those related to the controlled observation method used.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Managing executive dysfunction following acquired brain injury and stroke using an ecologically valid rehabilitation approach: a study protocol for a randomized, controlled trial

BackgroundWe have been investigating an ecologically valid strategy-training approach to enable adults with executive dysfunction to attain everyday life goals. Here, we report the protocol of a randomized controlled trial of the effects of this training compared to conventional therapy in a sample of community-dwelling adults with acquired brain injury and/or stroke.Methods/designWe will recruit 100 community-dwelling survivors at least six months post-acquired brain injury or stroke who report executive dysfunction during a telephone interview, confirmed in pre-training testing. Following pre-training testing, participants will be randomized to the ecologically valid strategy training or conventional therapy and receive two one-hour sessions for eight weeks (maximum of 15 hours of therapy). Post-testing will occur immediately following the training and three months later. The primary outcome is self-reported change in performance on everyday life activities measured using the Canadian Occupational Performance Measure, a standardized, semi-structured interview. Secondary outcomes are objective measurement of performance change from videotapes of treatment session, Performance Quality Rating Scale; executive dysfunction symptoms, Behavioural Rating Inventory of Executive Function – Adult; participation in everyday life, Mayo-Portland Adaptability Inventory Participation Index; and ability to solve novel problems, Instrumental Activities of Daily Living Profile.DiscussionThis study is of a novel approach to promoting improvements in attainment of everyday life goals through managing executive dysfunction using an ecologically valid strategy training approach, the Cognitive Orientation to daily Occupational Performance. This study compares the efficacy of this approach with that of conventional therapy. The approach has the potential to be a valuable treatment for people with chronic acquired brain injury and/or stroke.Trial registrationclinicaltrials.gov, Trial Identification Number: NCT01414348

Elevated Neurobehavioral Symptoms Are Associated With Everyday Functioning Problems in Chronic Methamphetamine Users

Chronic methamphetamine (MA) use is commonly associated with neural injury and neurocognitive deficits. The authors examined the nature and correlates of self-reported neurobehavioral symptoms (e.g., apathy, disinhibition, and executive dysfunction) in 73 individuals with histories of MA dependence (MA+) and 85 comparison participants with comparable demographics and risk histories. MA+ individuals endorsed significantly more severe neurobehavioral symptoms on the Frontal Systems Behavioral Scale, especially those of disinhibition and executive dysfunction. Elevations in neurobehavioral symptoms were independent of common comorbidities, including hepatitis C infection, attention-deficit/hyperactivity disorder (ADHD), mood disorders, and other substance-use factors. Notably, the severity of neurobehavioral symptoms was uniquely associated with self-reported decrements in instrumental activities of daily living in the MA-dependent sample. Findings indicate that chronic MA users may experience elevated neurobehavioral symptoms of disinhibition and executive dysfunction, potentially increasing their risk of functional declines.

Symptoms of Executive Dysfunction are Endemic to Secondary Psychopathy: An Examination in Criminal Offenders and Noninstitutionalized Young Adults

Psychopathy is a heterogeneous personality disorder exhibiting deficits in passive avoidance, emotional processing, and arousal. In a mixed-gender group (N = 293) of undergraduates and prisoners, we examined the relationship of multiple indices of primary and secondary psychopathy to components of executive dysfunction as measured by the Frontal Systems and Behavior Scale (FrSBe; Grace & Malloy, 2001). After controlling for demographic variables, we found strong associations between psychopathy and components of executive dysfunction (Rs = .55 to .70). Primary psychopathy was negatively, whereas secondary psychopathy was positively, predictive of symptoms indicative of executive dysfunction. When indices of primary and secondary psychopathy and indices of executive functioning were jointly included in a factor analysis, a two-factor solution was obtained. Secondary psychopathy and all subscales of the FrSBe loaded on a single factor, whereas indices of primary psychopathy loaded solely on a second factor. These findings underscore the role of prefrontal circuitry in psychopathy, and specifically implicate executive dysfunction in secondary psychopathy.

Contribution of the Left Dorsomedial Thalamus to Recognition Memory: a Neuropsychological Case Study

This study reports a patient with a unilateral left thalamic lesion which was centred on the dorsomedial thalamic nucleus. Cognitive neuropsychological assessment revealed a severe impairment in verbal memory and symptoms of executive dysfunction, in the presence of relatively intact visual and facial recognition, working memory, praxis, language and IQ. Verbal and visual recognition memory were investigated using the remember-know paradigm. The results indicated a profound impairment in recollection-driven verbal recognition memory. These results are discussed in the context of the role of the dorsomedial thalamic nucleus in recognition memory, and functional models of memory.