Research Article Summary
Kovner, R., Budman, C., Frank, Y., Sison, C., Lesser, M., & Halperin, J. (1998). Neuropsychological testing in adult attention deficit hyperactivity disorder: a pilot study. International Journal of Neuroscience, 96, 225-236.
As indicated by research, it is generally understood that the symptoms of attention-deficit hyperactivity disorder (ADHD) continues into adulthood, which can cause disruption of occupational and family life and generally underachievement in lifestyle. Furthermore, it has been found that diagnosing ADHD in adults is frequently problematic due to the lack of availability of vital personal information, especially that which pertains to patient’s childhood. Thus, a preliminary study was designed to explore whether objective neuropsychological testing may be useful adjunct in the diagnosis of adult ADHD.
Twenty-nine Caucasian subjects participated in the study with ages ranging from 18-57. Ten served as the control group and, according to DSM-IV criteria, 19 adults were diagnosed and assessed with ADHD. The control group contained 8 males and 2 females, while the ADHD group was comprised of 14 males and 5 females. A psychiatrist and neurologist independently evaluated each participant. However, it is unclear how to exactly apply DSM-IV criteria to adults since it usually helps generate a “best-estimate” diagnosis, not a solid analysis. Thus, the experimenters decided to use neuropsychological testing instead of other possible tests because it does not require historical information.
Neuropsychological testing consisted of a two and one half hour screening battery. This battery was comprised of tests that assess linguistic (WAIS-R/Boston Naming Test), visual-spatial perceptual (WAIS-R/Benton Test of Facial Recognition), academic (WRAT-R) and speed accuracy (Gates and MacGinitie Reading Test), attentional and inhibitory control (WAIS-R and Continuous Performance Test and Repeated Stimuli Continuous Test and Shifting Sets Test), personality (Beck Depression Inventory and Spielberg State and Trait Anxiety Scales), mnsetic and executive functions. These tests were administered in random order and were careful chosen and followed many important considerations.
Designed to determine which variables best discriminated the groups, receiver operating characteristic (ROC) curves were constructed to determine the sensitivity and specificity of the best measures both alone and in combination after preliminary analysis. Due to the large number of variables being studied, a more conservative level of alpha was chosen in order to determine significant differences between groups. Three neuropsychological variables were found to be significantly different (p<.001) – Digits Backwards from the Digit Span Subtest of the WAIS-R, mean reaction time from Shifting Sets Test, and reaction time variability from the same test. Moreover, ROC curve analysis indicated that there was a greater than 90% accuracy for classifying ADHD and non-ADHD patients with a combination of these measures.
The results of this pilot study suggest that adult ADHD patients may have deficits in reversing, inhibiting and re-engaging specific cognitive and motor sets. Yet, groups did not differ in attention (short-term and working memory). Recent research indicates that children with ADHD have difficulties with inhibitory control, as well, as with the capacity to re-engage specific response patterns after inhibition. This raises the possibility that these defects might be used to help discriminate adults with ADHD from patients without ADHD in a clinical setting.