Cynthia A. Riccio

The continuous performance test: a window on the neural substrates for attention?

Attention is a complex process whose disturbance is considered a core deficit in a number of disorders [e.g., Attention Deficit Hyperactivity Disorder (ADHD), schizophrenia]. In 1956, Rosvold and colleagues [J. Consult. Psychol. 20 (1956) 343.] demonstrated that the continuous performance test (CPT) as a measure of sustained attention was highly sensitive to brain damage or dysfunction. These findings have been replicated with various populations and with various versions of the CPT. The CPT is now cited as the most frequently used measure of attention in both practice and research. Across studies, results are consistent with models of sustained attention that involve the interaction of cortical (frontal, temporal, parietal), subcortical (limbic, basal ganglia), and functional systems including the pathways between the basal ganglia, thalamus, and frontal lobes. Right hemisphere involvement (asymmetric response) is also evident across multiple studies. As such, the CPT demonstrates sensitivity to dysfunction of the attentional system whether this is due to diffuse or more focal damage/dysfunction or in conjunction with any specific disorder. CPT performance can be viewed as symptom specific (attentional disturbance), but it is not disorder specific (e.g., ADHD). Implications for neuropsychological interpretation of CPT results are presented.

Test review: Delis-Kaplan executive function system.

The Delis-Kaplan Executive Function System (D-KEFS; Delis, Kaplan, & Kramer, 2001) represents the first set of executive tests co-normed on a large and representative national sample designed exclusively for the assessment of executive functions including flexibility of thinking, inhibition, problem solving, planning, impulse control, concept formation, abstract thinking, and creativity. The D-KEFS, composed of nine stand alone tests that can be individually or group administered, provides a standardized assessment of executive functions in children and adults between the ages of 8 and 89. Utilizing a “cognitive-process approach,” the D-KEFS tests allow examiners to systematically generate and evaluate relevant clinical hypotheses on executive functioning of a given examinee by comparing and contrasting performance on multiple testing conditions and using contrast measure scores and error analyses. A review of the administration, scoring and interpretation, test construction, standardization, and technical adequacy indicate that the D-KEFS holds much promise not only as a clinical instrument, but also as a research tool for increasing knowledge of the frontal-lobe functions.

Assessing culturally different students for attention deficit hyperactivity disorder using behavior rating scales.

Behavior rating scales are commonly used in the assessment of attention deficit-hyperactivity disorder (ADHD). However, there is little information available concerning the extent to which scales are valid with culturally different students. This study explored the use of the ADHD-IV Rating Scale School Version with male Caucasian (CA) and African American (AA) students from ages 5 to 18 years. Teachers rated AA students higher on all symptoms across all age groups. LISREL analysis indicated that scale does not perform identically across groups. This was supported by the results of multidimensional scaling with suggested that there is a different relation between items across groups. Implications for research and practice are discussed.

Validity of DSM-IV ADHD Predominantly Inattentive and Combined Types: Relationship to Previous DSM Diagnoses/Subtype Differences

UNLABELLED Since 1980, three different diagnostic nomenclatures have been published regarding attention-deficit hyperactivity disorder (ADHD). These changing conceptualizations and diagnostic criteria have generated considerable confusion. OBJECTIVE To examine the multidimensional DSM-IV ADHD criteria in relation to how children and adolescents with a previous DSM-III ADD diagnosis or a DSM-III-R ADHD diagnosis are diagnosed according to DSM-IV criteria. METHOD Children whose original diagnoses were according to DSM-III and DSM-III-R criteria received retrospective diagnoses according to DSM-IV criteria. RESULTS Predominantly inattentive (n = 30) and combined types (n = 26) were compared on their previous DSM-III and DSM-III-R diagnoses and on demographic, behavioral, cognitive, and comorbidity variables. Predominantly inattentive and combined type diagnoses corresponded with DSM-III ADD/WO and ADD/H diagnoses, respectively. The DSM-III-R ADHD diagnosis did not correspond with either DSM-IV subtype. Children with the combined type diagnosis had more externalizing codiagnoses, and their parents reported more externalizing, delinquent, and aggressive behaviors. Children with the predominantly inattentive type had more math learning disability codiagnoses. CONCLUSION Results support a multidimensional conceptualization of ADHD. There exists close correspondence between the DSM-III ADD/WO type and the DSM-IV predominantly inattentive type and between the DSM-III ADD/H type and the DSM-IV combined type.

Critical Issues in Response-To-Intervention, Comprehensive Evaluation, and Specific Learning Disabilities Identification and Intervention: An Expert White Paper Consensus

Developed in concert with the Learning Disabilities Association of America (LDA), this White Paper regarding specific learning disabilities identification and intervention represents the expert consensus of 58 accomplished scholars in education, psychology, medicine, and the law. Survey responses and empirical evidence suggest that five conclusions are warranted: 1) The SLD definition should be maintained and the statutory requirements in SLD identification procedures should be strengthened; 2) neither ability-achievement discrepancy analysis nor failure to respond to intervention alone is sufficient for SLD identification; 3) a “third method” approach that identifies a pattern of psychological processing strengths and weaknesses, and achievement deficits consistent with this pattern of processing weaknesses, makes the most empirical and clinical sense; 4) an empirically-validated RTI model could be used to prevent learning problems, but comprehensive evaluations should occur for SLD identification purposes, and children with SLD need individualized interventions based on specific learning needs, not merely more intense interventions; and 5) assessment of cognitive and neuropsychological processes should be used for both SLD identification and intervention purposes.

Comorbidity of Central Auditory Processing Disorder and Attention-Deficit Hyperactivity Disorder

UNLABELLED Research has indicated that children with attention-deficit hyperactivity disorder (ADHD) demonstrate significant difficulty on tasks used to assess central auditory processing skills. These findings have raised the question of whether ADHD and central auditory processing disorder (CAPD) represent a singular disorder. OBJECTIVE The current study explored the incidence of ADHD in a group of 30 children who met diagnostic criteria for CAPD. METHOD Consecutive referrals specifically for this project were assessed on a variety of measures. In addition, rating scales were completed by teachers and structured interviews were completed with parents. RESULTS Results indicate that although the incidence rate of ADHD (50%) in this sample significantly exceeds that found in the normative population (p < .001), not all children with CAPD demonstrated behaviors consistent with diagnostic criteria for ADHD. Furthermore, there was a low incidence of any other behavioral disorder in this sample. In contrast, it was found that the sample as a whole demonstrated impaired language abilities. No significant differences emerged across cognitive, auditory, or language measures. CONCLUSION This study further supports the need for increased collaboration of those professionals who work with these children given the extent of overlap of language and behavioral difficulties in this sample.

Continuous performance tests are sensitive to ADHD in adults but lack specificity. A review and critique for differential diagnosis.

Abstract: Historically, the focus for Attention Deficit Hyperactivity Disorder (ADHD) has been on children, with considerable research and many opinions available in this area. More recently, the focus has been expanded to include ADHD in adults. Assessment of ADHD in adults is complicated by the high rate of co‐occurring disorders as well as symptom overlap with a number of disorders. One popular family of measures for the assessment of attention and executive control is the continuous performance test (CPT). A review of the available research on CPTs reveals that they are quite sensitive to CNS dysfunction. This is both a strength and a limitation of CPTs in that multiple disorders can result in impaired performance on a CPT. The high sensitivity of CPTs is further complicated by the multiple variations of CPTs available, some of which may be more sensitive or demonstrate better specificity to ADHD in adults than others. If CPTs are to be used clinically, further research will be needed to answer the questions raised by this review.

Assessment of Attention Deficit Hyperactivity Disorder (ADHD) Using the BASC and BRIEF

There has been an overwhelming increase in the number of children diagnosed with attention deficit hyperactivity disorder (ADHD). School and clinical psychologists play an important role in the assessment of a childs emotional and behavioral difficulties, including problems with attention. Various assessment measures, including behavioral rating forms such as the Behavior Assessment System for Children (BASC) and the Behavior Rating Inventory of Executive Function (BRIEF), are often used in the assessment of a childs behavior. The purpose of this article is to provide more knowledge to psychologists regarding the assessment of ADHD in children using the BASC and BRIEF. Results from this study indicated that the BASC and BRIEF scales appear to be measuring similar, but different, constructs pertaining to behaviors associated with ADHD, as well as similar study skills and learning problems. These findings suggest that children diagnosed with ADHD are rated lower on adaptive skills when compared to children with no diagnosis on the BASC. Use of the BASC and BRIEF in ADHD assessment appears promising and may generate additional areas in need of intervention.

Executive function and the Wisconsin card sorting test: Relationship with behavioral ratings and cognitive ability

The frontal lobes are thought to be responsible for executive functions, behavioral regulation, and social discourse. It has been proposed that frontal lobe dysfunction may be responsible for many deficits observed in children with attention‐deficit hyperactivity disorder (ADHD). The most widely accepted measure of executive function in adults is the Wisconsin Card Sorting Test (WCST; Heaton, 1981). The WCST has been interpreted as a measure of frontal lobe functioning in children as well. Although a number of studies have lent support to the involvement of the frontal lobes in developmental behavior disorders, results have not been consistently replicated using the WCST and other measures. Further, the sensitivity and specificity of the WCST as a measure of frontal lobe dysfunction has not been consistently demonstrated. The purpose of this study was to explore the relationship between performance on the WCST and behavioral measures commonly employed in the diagnosis of developmental behavior disorders a...

Gender and ethnic differences in ADHD as assessed by behavior ratings.

Attention-deficit/hyperactivity disorder (ADHD) is a common childhood disorder. Research suggests that ADHD is 4 to 9 times more frequent in males than females, and the possibility of underidentification in females and overidentification in males has been suggested as an explanation for these statistics.As part of the diagnostic process, teachers are frequently asked to complete behavior rating scales. There is a lack of empirical data concerning the extent to which gender differences are evident on such rating scales. This study investigated the use of the ADHD-IV Rating Scale-School Version, with male and female students from ages 5 to 18 years. Results suggest that the ADHD construct is consistent across gender; however, there are differences across gender and ethnicity. For Caucasian children, externalizing behaviors are most salient in terms of discriminating between males and females. Implications for research and practice are discussed.