J.D. Ball

Neuropsychological Characteristics of Adults with ADHD: A Comprehensive Review of Initial Studies

The role of neuropsychological evaluation in the diagnosis of adults with Attention-Deficit/Hyperactivity Disorder (ADHD) is a growing area of research and clinical interest. Our review of the literature indicates that adults with ADHD demonstrate subtle impairments on select measures of attention and executive functions, auditory-verbal list learning, and complex information processing speed relative to normal controls. The validity of these findings is nonetheless hampered by several limitations, including methodological and sample variability, a restricted range of interpretive techniques, and uncertain discriminant validity. Recommendations are offered to advance the cognitive and neurobehavioral understanding of this disorder and to enhance the utility of neuropsychological methods for diagnosis and management of adults with ADHD.

Neuropsychological performance of adults with attention deficit hyperactivity disorder (ADHD): Diagnostic classification estimates for measures of frontal lobe/executive functioning

ADHD adults (N = 26) were compared to normal controls (N = 26) on 6 neuropsychological measures believed sensitive to frontal lobe-executive functioning. MANOVA analyses and subsequent univariate tests indicated that most of the neuropsychological measures discriminated between the two groups. To address clinical significance diagnostic classification rates were also generated for each measure individually, and for the battery as a whole. Levels of positive predictive power (PPP) for each of the 6 measures (83-100%) indicated that abnormal scores on these tests were good predictors of ADHD. However, estimates of negative predictive power (NPP) suggested that normal scores poorly predicted the absence of ADHD. When classification rates were calculated for the overall battery classification accuracy improved substantially. Thus, neuropsychological tests can differentiate adults suffering from ADHD from adults without ADHD, while also providing good classification accuracy. Finally, the pattern of neurobehavioral impairments exemplified through the Summary Index scores was interpreted as consistent with conceptualizations of ADHD depicting mild neurologic dysfunction in networks associated with the frontal lobes.

THE PREDICTION OF CHANGE: NORMATIVE NEUROPSYCHOLOGICAL TRAJECTORIES

While the application of normative standards is vital to the practice of clinical neuropsychology, data regarding normative change remains scarce despite the frequency of serial assessments. Based on 285 normal individuals, we provide co-normed baseline data with demographic adjustments and test-retest standardized regression based (SRB) models for three time points for several measures. These models delineate normal, expected change across time, and yield standardized z-scores that are comparable across tests. Using a new approach, performance on any previous trial was accounted for in the subsequent models of change, yielding serial normative formulas that model change trajectories rather than simple change from point to point. These equations provide indices of deviation from expected baseline and change for use in clinical or research settings.

NEUROPSYCHOLOGICAL FUNCTIONING OF HIV-INFECTED MALES

This article presents a Meta-Analysis of previous HIV-related neuropsychological research and new data from a study with methodological improvements over early investigations. In this study, the authors compared neuropsychological testing for three groups of adult male homosexuals: (a) HIV seronegative controls (n = 30), (b) HIV seropositive non-AIDS subjects (n = 27), and (c) diagnosed AIDS patients (n = 26). Groups were matched for age, education, and handedness, and subjects with other neurobehavioral risk factors were excluded. Subjects with AIDS performed worse than other groups on all tests, with 80% showing clinical impairment. HIV seropositive non-AIDS subjects differed from controls on 3 of 14 tests, with 33% showing clinical impairment. Group differences remained significant even after covarying for psychological distress, using the General Severity Index (GSI) of the Symptom Checklist-90-Revised as the covariate. These results are discussed in reference to findings from the Meta-Analysis of previous research and implications for future research.

Comparative utility of Barona Formulae, Wtar demographic algorithms, and WRAT-3 reading for estimating premorbid ability in a diverse research sample.

Various Barona formulae, a WTAR algorithm based on demographic data, and WRAT-3 oral reading methods of estimating premorbid ability were compared in a diverse research sample of 119 subjects. These methods were correlated with one another and with a modified version of the Raven Standard Progressive Matrices. Descriptive data are provided to illustrate advantages and disadvantages of various methods of estimating premorbid ability when no formal intellectual testing is available. While predicting premorbid ability for individual subjects involves varying degrees of error, we found that the revised Barona formula was superior to the original formula for subjects at the upper end of ability level. When researchers have screened out learning disability and have subject samples with few individuals likely to be of superior premorbid intelligence, oral reading scores are a reasonable measure of premorbid ability. Otherwise, researchers are advised to use both demographic and oral reading methods to estimate premorbid ability.

Wechsler Verbal-Performance IQ discrepancies among psychiatric inpatients: Implications for subtle neuropsychological dysfunctioning

One hundred seventy-nine psychiatric inpatients were administered the WAIS-R and several neuropsychological and academic achievement tests. All subjects were assigned to three groups based on their WAIS-Rs VIQ-PIQ discrepancy scores: (i) Low Verbal (Verbal IQ < Performance IQ. by at least 13 points); (ii) Low Performance (Performance IQ < Verbal IQ by at least 13 points); and (iii) Equal (Verbal IQ-Performance IQ within 13 points). The Low Verbal group made significantly more errors on the Speech Sounds Perception Test, demonstrated lower spelling scores, evinced more aphasic signs, and had had more special education placements than did the Equal or Low Performance groups. The Low Performance subjects demonstrated significantly more signs of constructional dyspraxia and performed more poorly on the Grooved Pegboard test. The neuropsychiatric patients who had Verbal-Performance IQ discrepancies of at least one standard deviation may be at risk for specific, subtle neuropsychological deficits.

Modification and Factor Analysis of the Grief Experience Inventory in Non-Death Loss/Bereavement Situations

The Grief Experience Inventory (GEI), developed by Sanders, Mauger, and Strong in 1985, is a broad multidimensional measure of grief applicable to both death and non-death loss/bereavement situations. Further modification of the non-death GEI form was undertaken and employed in assessing grief reactions of mothers of brain-injured adolescents and young adults across three years, post-injury. Factor analysis of these data was computed and compared to factors derived from the original GEI General Reference Group. There were strikingly similar factor structures between the modified non-death form and the original GEI, affirming the rationale and method of inventory construction, and supporting the validity and strength of the GEI as a measure of grief in varied loss situations. Recommendations for future application are offered.

Clinical Outcomes of Mild Isolated Cerebral Ventriculomegaly in the Presence of Other Neurodevelopmental Risk Factors

The purpose of this study was to evaluate neuropsychological test data in school‐aged children whose fetal sonograms revealed mild isolated cerebral ventriculomegaly without asymmetry of the lateral ventricles.

Correlations for scores on the 180-item version of the MMPI-2 and the Neuroticism scale of the NEO-Personality Inventory.

64 normal adult controls (53 men, 11 women; M age 45.2 yr.) in a study of an estuary-associated syndrome were administered the MMPI–2-180 and the Neuroticism scale from the NEO-Personality Inventory. Pearson product-moment correlations between MMPI–2 scales and the Neuroticism scale were similar to those previously reported using the full-length MMPI. Correlations between MMPI–2 scales, D, Pt, Sc, and Si, and NEO-PI Neuroticism (range .44 to .52) suggest that many psychiatric conditions are associated with psychological distress of the type individuals high in trait neuroticism are prone to experience.

MMPI correlates of a controversial EEG pattern among adolescent psychiatric patients

Relative to adult MMPI studies, few investigations address adolescent correlates of the MMPI. A particularly neglected area of potential importance has been the relationship between adolescent MMPI profiles and electroencephalographic (EEG) disturbances. This study examined EEG recordings, MMPI results, and psychiatric diagnosis of 99 (49 male; 50 female) psychiatrically hospitalized adolescents. Because there was a high incidence of 14 and 6 per second positive spike EEG patterns among males, one-way analyses of variance (ANOVAs) were employed to compare MMPI results for 31 males with normal EEG patterns and 17 males with 14 and 6 per second positive spiking. The 14 and 6 per second positive spike EEG signal was related to significantly higher MMPI T score elevations on Hs, PD, and MF. The results are discussed in terms of their implications for both EEG and MMPI interpretations.