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Specifying the Heterogeneity in Children with ADHD: Symptom Domains, Neuropsychological Processes, and Comorbidity
Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
2009 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Heterogeneity in children with Attention Deficit Hyperactivity Disorder (ADHD) symptoms is a well-known phenomenon. Empirically, this heterogeneity is evident in at least three different respects: expression of the two ADHD symptom domains (hyperactivity/impulsivity and inattention), neuropsychological impairments, and comorbid behavior problems. The major aim of the present thesis was to examine the heterogeneity characterizing children with ADHD symptoms to enhance our understanding by examining neuropsychological factors with regard to common and independent contributions, and specificity of the two ADHD symptom domains in relation to neuropsychological factors and comorbid behavioral problems. Particular emphasis is placed on prominent neuropsychological processes such as executive functions, state regulation and delay aversion. The present thesis is based on findings from four studies on community-based samples of children – studies involving concurrent and longitudinal designs as well as both categorical and dimensional approaches.

Results provide support for the notion that executive function and state regulation, but not delay aversion, constitute independent pathways to ADHD, primarily to symptoms of inattention. However, delay aversion was shown to have an effect in combination with state regulation on both hyperactivity/impulsivity and inattention. Additionally, symptoms of hyperactivity/impulsivity and inattention have different primary correlates concerning neuropsychological factors and comorbidity. More specifically, executive function, state regulation, internalizing problems and academic achievement were specifically related to inattention but not to hyperactivity/impulsivity. Oppositional Defiant Disorder (ODD) was specifically related to hyperactivity/impulsivity, but not to inattention.

The present thesis has contributed with important and new knowledge about the heterogeneity of children with ADHD symptoms concerning neuropsychological pathways, and specificity of the two ADHD symptom domains in relation to neuropsychological factors and comorbid behavioral problems. Knowledge such as this can help us understand how to identify more homogeneous ADHD subgroups, and contribute to the further development of multiple pathway models within this area of research.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis , 2009. , p. 101
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Social Sciences, ISSN 1652-9030 ; 47
Keywords [en]
ADHD, Heterogeneity, Hyperactivity/Impulsivity, Inattention, Neuropsychological Pathways, Comorbidity
Research subject
Psychology
Identifiers
URN: urn:nbn:se:uu:diva-9485ISBN: 978-91-554-7370-9 (print)OAI: oai:DiVA.org:uu-9485DiVA, id: diva2:173021
Public defence
2009-01-16, Sal IX, Universitetshuset, Uppsala, 13:15
Opponent
Supervisors
Available from: 2008-12-11 Created: 2008-12-11 Last updated: 2015-03-20Bibliographically approved
List of papers
1. ADHD symptoms and Executive Function Impairment: Early Predictors of Later Behavioral Problems
Open this publication in new window or tab >>ADHD symptoms and Executive Function Impairment: Early Predictors of Later Behavioral Problems
2008 (English)In: Developmental Neuropsychology, ISSN 8756-5641, E-ISSN 1532-6942, Vol. 33, no 2, p. 160-178Article in journal (Refereed) Published
Abstract [en]

This longitudinal study investigated ADHD symptoms and EF impairments in terms of continuity and cross-domain associations, as well as their predictive relations to a range of socioemotional problem behaviors. We applied a factorial ANOVA design to study additive and interactive effects in a sample of non-clinical preschool children (N = 87) and complemented these analyses with group contrasts. The results showed that early ADHD symptoms and EF impairments acted as predictors of continuing problems within each domain. However, it was only ADHD symptoms that predicted other aspects of socioemotional functioning such as dysfunctional emotional regulation and lower levels of social competence. There was no indication of interactive effects on any measure. In conclusion, our results showed that both ADHD symptoms and impaired EF act as early predictors of problem behaviors, although it is clear that predictions based on ADHD symptoms encompass a wider range of problems in early school age children.

National Category
Psychology
Identifiers
urn:nbn:se:uu:diva-97905 (URN)10.1080/87565640701884253 (DOI)000254626800004 ()18443975 (PubMedID)
Available from: 2008-12-11 Created: 2008-12-11 Last updated: 2017-12-14Bibliographically approved
2. Heterogeneity in ADHD: Neuropsychological Pathways, Comorbidity and Symptom Domains
Open this publication in new window or tab >>Heterogeneity in ADHD: Neuropsychological Pathways, Comorbidity and Symptom Domains
2009 (English)In: Journal of Abnormal Child Psychology, ISSN 0091-0627, E-ISSN 1573-2835, Vol. 37, no 4, p. 551-564Article in journal (Refereed) Published
Abstract [en]

The aim of the present study was to investigate different neuropsychological impairments and comorbid behavioral problems in relation to symptoms of Attention-Deficit/Hyperactivity Disorder (ADHD), studying the independent effects of different functions as well as specific relations to symptoms of hyperactivity/impulsivity and inattention. A community-based sample of school children (n∈=∈182; the higher end of the ADHD symptom range was oversampled) completed neuropsychological tasks designed to measure executive function (EF), state regulation and delay aversion. Behavioral symptoms were measured through parental and teacher ratings of the DSM-IV criteria for ADHD and Oppositional Defiant Disorder (ODD). Both categorical and dimensional analyses were used to acquire a deeper understanding of ADHD. The results supported the notion that EF and state regulation constitute independent pathways to ADHD, primarily to symptoms of inattention. In addition, the present study points to the importance of viewing ADHD as a heterogeneous condition also with regard to the differential impact of neuropsychological functioning and comorbidity on different ADHD symptom groups and the two ADHD symptom domains.

Keywords
ADHD, Comorbidity, Heterogeneity, Hyperactivity, Inattention, Neuropsychological factors
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-97906 (URN)10.1007/s10802-008-9286-9 (DOI)000264879800008 ()19016322 (PubMedID)
Available from: 2008-12-11 Created: 2008-12-11 Last updated: 2017-12-14Bibliographically approved
3. Neuropsychological Deficits in Relation to Symptoms of ADHD: Independent contributions and interactions
Open this publication in new window or tab >>Neuropsychological Deficits in Relation to Symptoms of ADHD: Independent contributions and interactions
2009 (English)In: Child Neuropsychology, ISSN 0929-7049, E-ISSN 1744-4136, Vol. 15, no 3, p. 262-279Article in journal (Refereed) Published
Abstract [en]

The aim of the present study was to investigate possible independent and combined effects of inhibitory control, delay aversion, and RT variability in relation to symptoms of hyperactivity/impulsivity and inattention. A community-based sample of school children (N = 111) completed neuropsychological tasks designed to measure inhibitory control, delay aversion, and RT variability. Behavioral symptoms were measured through parental and teacher ratings of the DSM-IV criteria for ADHD and ODD. The results showed that inhibitory control and RT variability were primarily related to symptoms of inattention rather than hyperactivity/impulsivity. Further, out of the three neuropsychological factors studied, only inhibitory control contributed uniquely to the variance of ADHD symptoms. However, significant   interaction effects of delay aversion and RT variability on symptoms of both hyperactivity/impulsivity and inattention were found. This study shows the importance of searching for possible combined effects of neuropsychological factors to learn more about the different pathways that lead to ADHD symptoms in children.

Keywords
ADHD symptoms, Inhibitory control, Delay aversion, RT variability
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-97907 (URN)10.1080/09297040802524198 (DOI)000265291600005 ()19089681 (PubMedID)
Available from: 2008-12-11 Created: 2008-12-11 Last updated: 2017-12-14Bibliographically approved
4. DSM-IV-Defined Inattention and Sluggish Cognitive Tempo: Independent and Interactive Relations to Neuropsychological Factors and Comorbidity
Open this publication in new window or tab >>DSM-IV-Defined Inattention and Sluggish Cognitive Tempo: Independent and Interactive Relations to Neuropsychological Factors and Comorbidity
2010 (English)In: Child Neuropsychology, ISSN 0929-7049, E-ISSN 1744-4136, Vol. 16, no 4, p. 350-365Article in journal (Refereed) Published
Abstract [en]

The aim of the present study was to investigate the independent relations of DSM-IV-defined inattention and behaviors characteristic of sluggish cognitive tempo (SCT) to neuropsychological factors and problem behaviors often comorbid with attention deficit/hyperactivity disorder (ADHD). By controlling for symptoms of DSM-IV-defined inattention, unique relations to SCT could be ascertained. Additionally, interactive relations of DSM-IV-defined inattention and SCT were of interest. A community-based sample of school children (N = 209; the higher end of the ADHD-symptom range was oversampled) completed neuropsychological tasks designed to measure executive function (EF), sustained attention, and state regulation. Behavioral symptoms were measured using parental and teacher ratings of the DSM-IV criteria for ADHD and Oppositional Defiant Disorder (ODD). The results showed that these two domains of inattention, DSM-IV-defined inattention and SCT, have neuropsychological processes and comorbid behavioral problems in common. However, when controlling for the overlap, DSM-IV-defined inattention was uniquely related to EF and state regulation, while SCT was uniquely related to sustained attention. In addition, the results showed an interactive relation of DSM-IV-defined inattention and SCT to ODD. Findings from the present study support the notion that DSM-IV-defined inattention constitutes a somewhat heterogeneous condition. Such results can further our theoretical understanding of the neuropsychological impairments and comorbid behavioral problems associated with ADHD symptoms.

National Category
Psychology Psychiatry
Identifiers
urn:nbn:se:uu:diva-97908 (URN)10.1080/09297041003671176 (DOI)000279634400004 ()
Available from: 2008-12-11 Created: 2008-12-11 Last updated: 2017-12-14Bibliographically approved

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