Attention deficit disorders

The core symptoms of attention deficit disorders are cognitive in nature (inattention, hyperactivity, and/or impulsivity). These cognitive deficits often reflect underlying brain circuitry dysfunction (including prefrontal regions) and of neurochemical transmission, including the dopamine and noradrenaline/norepinephrine pathways^1-5. Our recommended test battery for attention deficit disorders assesses the cognitive domains most likely to be impaired, as well as those likely to be affected by interventions.

The tests in this battery have detected cognitive impairment in ADHD across the age span with medium-large effect sizes, as well as detecting the effects of pharmacological interventions (e.g. methylphenidate, atomoxetine)³. The response inhibition test included in the battery, Stop Signal Task (SST), detects inferior frontal and anterior cingulate cortex hypoactivation in individuals with ADHD⁶; and drugs that show efficacy in the treatment of ADHD, such as atomoxetine, augment activation in right frontal cortical regions during this cognitive test⁷.

Research shows that cognitive impairment on the CANTAB tasks significantly mediates the relationship between reduced white matter brain integrity and impaired school functioning in ADHD⁸.

Measures

• Sustained attention
• Working memory
• Response inhibition

CANTAB Tests

• Spatial Working Memory (SWM): 4 minutes
• Rapid Visual Information Processing (RVP): 7 minutes
• Stop Signal Task (SST): 14 minutes

Research

Researchers have shown the sensitivity of these tests to cognitive dysfunction in ADHD.

_{Unpublished in-house meta-analysis of clinical trial data; Chamberlain et al., 2011; Gau & Huang, 2014; Fried et al., 2012}

Key References

Shaw M, Hodgkins P, Caci H, Young S, Kahle J, Woods AG, Arnold LE. A systematic review and analysis of long-term outcomes in attention deficit hyperactivity disorder: effects of treatment and non-treatment. BMC Med. 2012 Sep 4;10:99.

Biederman J, Faraone SV. Attention-deficit hyperactivity disorder. Lancet. 2005 Jul 16-22;366(9481):237-48.

Chamberlain SR, Robbins TW, Winder-Rhodes S, Müller U, Sahakian BJ, Blackwell AD, Barnett JH. Translational approaches to frontostriatal dysfunction in attention-deficit/hyperactivity disorder using a computerized neuropsychological battery. Biol Psychiatry. 2011 Jun 15;69(12):1192-203.

Seixas M, Weiss M, Müller U. Systematic review of national and international guidelines on attention-deficit hyperactivity disorder. J Psychopharmacol. 2012 Jun;26(6):753-65. 

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1. _{Chamberlain SR, Robbins TW, Sahakian BJ. The neurobiology of attention-deficit/hyperactivity disorder. Biol Psychiatry. 2007 Jun 15;61(12):1317-9.}
2. _{Kasparek T, Theiner P, Filova A. Neurobiology of ADHD From Childhood to Adulthood: Findings of Imaging Methods. J Atten Disord. 2015 Nov;19(11):931-43. 2013 Oct 4.}
3. _{Chamberlain SR, Robbins TW, Winder-Rhodes S, Müller U, Sahakian BJ, Blackwell AD, Barnett JH. Translational approaches to frontostriatal dysfunction in attention-deficit/hyperactivity disorder using a computerized neuropsychological battery. Biol Psychiatry. 2011 Jun 15;69(12):1192-203.}
4. _{Brennan AR, Arnsten AF. Neuronal mechanisms underlying attention deficit hyperactivity disorder: the influence of arousal on prefrontal cortical function. Ann N Y Acad Sci. 2008;1129:236-45.}
5. _{Del Campo N, Chamberlain SR, Sahakian BJ, Robbins TW. The roles of dopamine and noradrenaline in the pathophysiology and treatment of attention-deficit/hyperactivity disorder. Biol Psychiatry. 2011 Jun 15;69(12):e145-57.}
6. _{Hart H, Radua J, Nakao T, Mataix-Cols D, Rubia K. Meta-analysis of functional magnetic resonance imaging studies of inhibition and attention in attention-deficit/hyperactivity disorder: exploring task-specific, stimulant medication, and age effects. JAMA Psychiatry. 2013 Feb;70(2):185-98.}
7. _{Del Campo N, Chamberlain SR, Sahakian BJ, Robbins TW. The roles of dopamine and noradrenaline in the pathophysiology and treatment of attention-deficit/hyperactivity disorder. Biol Psychiatry. 2011 Jun 15;69(12):e145-57.}
8. _{Gau SS, Tseng WL, Tseng WY, Wu YH, Lo YC. Association between microstructural integrity of frontostriatal tracts and school functioning: ADHD symptoms and executive function as mediators. Psychol Med. 2015 Feb;45(3):529-43.}