Ying Qian

Do executive function deficits differentiate between children with Attention Deficit Hyperactivity Disorder (ADHD) and ADHD comorbid with Oppositional Defiant Disorder? A cross-cultural study using performance-based tests and the Behavior Rating Inventory of Executive Function

This study examined the differential executive dysfunction of children with attention deficit hyperactivity disorder (ADHD) and those with ADHD and oppositional defiant disorder (ODD) in Han Chinese. A total of 258 children (89 ADHD, 53 ADHD + ODD, 116 controls) completed performance-based executive function tests and had their everyday life executive skills rated by their parents using the Behavior Rating Inventory of Executive Function (BRIEF). Both the ADHD and ADHD + ODD groups performed worse than the controls in the Stroop and Trail-making tests and the BRIEF. The ADHD + ODD group were rated worse than the ADHD group on the BRIEF, but the two groups showed no significant difference in the performance-based tests. These findings suggest Han Chinese children with ADHD display executive dysfunction in performance-based tests and everyday life scenarios, in a similar way to findings in Western counterparts. However, children with ADHD + ODD showed more severe executive dysfunction in everyday life scenarios than those with ADHD only.

The developmental trajectories of executive function of children and adolescents with Attention Deficit Hyperactivity Disorder

This study examined the developmental trajectories of executive function (EF) of children and adolescents with Attention Deficit Hyperactivity Disorder (ADHD) in Han Chinese. Five hundred and fifteen children and adolescents with ADHD and 249 healthy controls took part in this study. All of them were administered four EF tests capturing inhibition, working memory, shifting and planning components. The participants were further divided into four age groups, 7-8, 9-10, 11-12, and 13-15 years old, respectively, for developmental trajectories comparison. The performance of the typical developing children and adolescents aged 7-15 were reported to get stable at age 11-12 for inhibition, working memory and planning, and kept developing till age 13-15 for shifting. For inhibition and shifting, participants with ADHD displayed similar performance to the healthy controls who were 2 years younger whereas they did poorer than the healthy controls of their same age. And at age 13-15, such poorer performance disappeared for inhibition but maintained for shifting. No significant differences were found between participants with and without ADHD in working memory and planning across all age groups. The current findings suggested, compared with healthy controls, Han Chinese children and adolescents with ADHD displayed delayed developmental trajectories on inhibition and shifting, whereas they showed similar trend of development on working memory and planning.

Executive function in children and adolescents with posttraumatic stress disorder 4 and 12 months after the Sichuan earthquake in China

BACKGROUND While several studies have found executive function deficits in adults and maltreated children with posttraumatic stress disorder (PTSD), there are few data on executive function in children and adolescents with PTSD related to natural disasters. The objective of this study was to test executive function changes over time in children and adolescents with PTSD after a magnitude 8.0 earthquake in Sichuan, China. METHOD A sample of 34 children and adolescents with diagnosed PTSD following the Sichuan earthquake and 66 matched controls exposed to the same earthquake but without PTSD participated in the study. Executive function was assessed using a battery of interviewer-rated neuropsychological tests and the guardian-rated Behavior Rating Scale of Executive Function (BRIEF) at 4- and 12-month after the earthquake. RESULTS Children and adolescents with PTSD performed similar to controls in executive function at 4-months after the earthquake. Both groups improved significantly in similar domains of cognition during the following 8 months. The PTSD group exhibited daily deficits in emotional control compared with the controls at the 4-month assessment, but the differences disappeared during the following 8 months. CONCLUSIONS Children and adolescents with PTSD related to a natural disaster have deficits only in the emotional control domain of executive function compared with controls exposed to the same disaster, but even these deficits did not persist.

Cognitive Function of Children and Adolescents with Attention Deficit Hyperactivity Disorder and Learning Difficulties: A Developmental Perspective

Background:The cognitive function of children with either attention deficit hyperactivity disorder (ADHD) or learning disabilities (LDs) is known to be impaired. However, little is known about the cognitive function of children with comorbid ADHD and LD. The present study aimed to explore the cognitive function of children and adolescents with ADHD and learning difficulties in comparison with children with ADHD and healthy controls in different age groups in a large Chinese sample. Methods:Totally, 1043 participants with ADHD and learning difficulties (the ADHD + learning difficulties group), 870 with pure ADHD (the pure ADHD group), and 496 healthy controls were recruited. To investigate the difference in cognitive impairment using a developmental approach, all participants were divided into three age groups (6–8, 9–11, and 12–14 years old). Measurements were the Chinese-Wechsler Intelligence Scale for Children, the Stroop Color-Word Test, the Trail-Making Test, and the Behavior Rating Inventory of Executive Function-Parents (BRIEF). Multivariate analysis of variance was used. Results:The results showed that after controlling for the effect of ADHD symptoms, the ADHD + learning difficulties group was still significantly worse than the pure ADHD group, which was, in turn, worse than the control group on full intelligence quotient (98.66 ± 13.87 vs. 105.17 ± 14.36 vs. 112.93 ± 13.87, P < 0.001). The same relationship was also evident for shift function (shifting time of the Trail-Making Test, 122.50 [62.00, 194.25] s vs. 122.00 [73.00, 201.50] s vs. 66.00 [45.00, 108.00] s, P < 0.001) and everyday life executive function (BRIEF total score, 145.71 ± 19.35 vs. 138.96 ± 18.00 vs. 122.71 ± 20.45, P < 0.001) after controlling for the effect of the severity of ADHD symptoms, intelligence quotient, age, and gender. As for the age groups, the differences among groups became nonsignificant in the 12–14 years old group for inhibition (meaning interference of the Stroop Color-Word Test, 18.00 [13.00, 25.00] s vs. 17.00 [15.00, 26.00] s vs. 17.00 [10.50, 20.00] s, P = 0.704) and shift function (shifting time of the Trail-Making Test, 62.00 [43.00, 97.00] s vs. 53.00 [38.00, 81.00] s vs. 101.00 [88.00, 114.00] s, P = 0.778). Conclusions:Children and adolescents with ADHD and learning difficulties have more severe cognitive impairment than pure ADHD patients even after controlling for the effect of ADHD symptoms. However, the differences in impairment in inhibition and shift function are no longer significant when these individuals were 12–14 years old.

Childhood predictors of persistent ADHD in early adulthood: Results from the first follow-up study in China

It is known that childhood attention-deficit/hyperactivity disorder (ADHD) persists into adulthood. Previous studies have demonstrated that gender, ADHD symptoms, functional impairment severity, medication treatment, IQ, comorbid with oppositional defiant disorder, conduct disorder and follow-up periods were associated with ADHD persistence in longitudinal samples of western population. In this study, we attempted to widely investigate the predictors particularly in a Chinese Han ADHD cohort. 399 children who met DSM-IV ADHD criteria were followed up into early adulthood. Ordinal logistic regression combined with survival analysis were conducted to examine the association of retrospectively reported childhood factors with adult ADHD persistence based on both categorical indicators and quantitative traits. 46.37% of the participants still met ADHD criteria in adulthood. Logistic models and survival analyses indicated that ADHD combined type appeared as a significant risk factor for ADHD persistence while superior IQ played a protective role even after controlling for the other potential confounders. When quantitative traits were applied, a number of hyperactivity/impulsivity symptoms and IQ still made significant contributions. In conclusion, our results indicated the syndromic continuity of ADHD. Further, a number of hyperactivity/impulsivity symptoms were a risk factor while higher IQ was protective for ADHD persistence.

Emotional dysregulation of ADHD in childhood predicts poor early-adulthood outcomes: A prospective follow up study.

BACKGROUD Emotional dysregulation (EDR) is commonly seen in individuals with attention deficit hyperactive disorder (ADHD). But few are known about the influence of EDR on early-adulthood outcomes. AIMS To detect the relationship between emotional dysregulation (EDR) in childhood and the outcomes in early-adulthood of participants with attention deficit hyperactive disorder (ADHD). METHODS AND PROCEDURES Han Chinese children who met DSM-IV ADHD criteria were followed up into early adulthood. The subjects were divided into two groups (with or without EDR) according to the emotion control subscale of Behavior Rating Scale of Executive Function in childhood. In the follow-up interview, their clinical outcomes were assessed by the Conners Adult ADHD Diagnostic Interview and the Structured Clinical Interview for DSM-IV-TR Axis I and II Disorders. Information on after-school tutoring and suspension of schooling was also collected as indices of educational outcomes. OUTCOMES AND RESULTS We followed up 68 out of 90 individuals when they reached early adulthood. Data analysis showed that EDR predicted HI symptoms of ADHD both in childhood (OR=10.28, p<0.01) and in early-adulthood (OR=4.07, p=0.01). And EDR in childhood had trend to predicted adult ODD (X2=3.93, p=0.05). The suspension of schooling was also predicted by EDR (OR=9.31, p=0.04). CONCLUSIONS AND IMPLICATIONS This study illustrated that EDR of children with ADHD, independent of co-occurring ODD, predicted poor long-term clinical and educational outcome in early-adulthood.

Genetic variant for behavioral regulation factor of executive function and its possible brain mechanism in attention deficit hyperactivity disorder

As a childhood-onset psychiatric disorder, attention deficit hyperactivity disorder (ADHD) is complicated by phenotypic and genetic heterogeneity. Lifelong executive function deficits in ADHD are described in many literatures and have been proposed as endophenotypes of ADHD. However, its genetic basis is still elusive. In this study, we performed a genome-wide association study of executive function, rated with Behavioral Rating Inventory of Executive Function (BRIEF), in ADHD children. We identified one significant variant (rs852004, P = 2.51e-08) for the overall score of BRIEF. The association analyses for each component of executive function found this locus was more associated with inhibit and monitor components. Further principle component analysis and confirmatory factor analysis provided an ADHD-specific executive function pattern including inhibit and monitor factors. SNP rs852004 was mainly associated with the Behavioral Regulation factor. Meanwhile, we found the significant locus was associated with ADHD symptom. The Behavioral Regulation factor mediated its effect on ADHD symptom. Functional magnetic resonance imaging (fMRI) analyses further showed evidence that this variant affected the activity of inhibition control related brain regions. It provided new insights for the genetic basis of executive function in ADHD.

DLGAP1 and NMDA receptor-associated postsynaptic density protein genes influence executive function in attention deficit hyperactivity disorder

To explore the association of DLGAP1 gene with executive function (EF) in attention deficit hyperactivity disorder (ADHD) children.

Effect of an Ecological Executive Skill Training Program for School-aged Children with Attention Deficit Hyperactivity Disorder: A Randomized Controlled Clinical Trial

Background: As medication does not normalize outcomes of children with attention deficit hyperactivity disorder (ADHD), especially in real-life functioning, nonpharmacological methods are important to target this field. This randomized controlled clinical trial was designed to evaluate the effects of a comprehensive executive skill training program for school-aged children with ADHD in a relatively large sample. Methods: The children (aged 6–12 years) with ADHD were randomized to the intervention or waitlist groups. A healthy control group was composed of gender- and age-matched healthy children. The intervention group received a 12-session training program for multiple executive skills. Executive function (EF), ADHD symptoms, and social functioning in the intervention and waitlist groups were evaluated at baseline and the end of the final training session. The healthy controls (HCs) were only assessed once at baseline. Repeated measures analyses of variance were used to compare EF, ADHD symptoms, and social function between intervention and waitlist groups. Results: Thirty-eight children with ADHD in intervention group, 30 in waitlist group, and 23 healthy children in healthy control group were included in final analysis. At posttreatment, intervention group showed significantly lower Behavior Rating Inventory of Executive Function (BRIEF) total score (135.89 ± 16.80 vs. 146.09 ± 23.92, P = 0.04) and monitoring score (18.05 ± 2.67 vs. 19.77 ± 3.10, P = 0.02), ADHD-IV overall score (41.11 ± 7.48 vs. 47.20 ± 8.47, P < 0.01), hyperactivity-impulsivity (HI) subscale score (18.92 ± 5.09 vs. 21.93 ± 4.93, P = 0.02), and inattentive subscale score (22.18 ± 3.56 vs. 25.27 ± 5.06, P < 0.01), compared with the waitlist group. Repeated measures analyses of variance revealed significant interactions between time and group on the BRIEF inhibition subscale (F = 5.06, P = 0.03), working memory (F = 4.48, P = 0.04), ADHD-IV overall score (F = 21.72, P < 0.01), HI subscale score (F = 19.08, P < 0.01), and inattentive subscale score (F = 12.40, P < 0.01). Multiple-way analysis of variance showed significant differences on all variables of BRIEF, ADHD-rating scale-IV, and WEISS Functional Impairment Scale-Parent form (WFIRS-P) among the intervention and waitlist groups at posttreatment and HCs at baseline. Conclusions: This randomized controlled study on executive skill training in a relatively large sample provided some evidences that the training could improve EF deficits, reduce problematic symptoms, and potentially enhance the social functioning in school-aged children with ADHD. Clinical Trial Registration: http://www.clinicaltrials.gov; NCT02327585.