Neuropsychological
Functioning of Individuals at
Clinical Evaluation of Adult
ADHD
Objectives
Adults with ADHD suffer from impairments in
several cognitive functions.
Not enough research was carried out to outline
the neuropsychological functions when compared
to other clinical control groups and whether or not
adult ADHD has a specific neuropsychological
profile.
ADHD Struggles
● Concentration
● Organisation
● Attention
● Thinking Before Acting
● Formulating Practical Goals
(American Psychological Association, 2008)
Perceptions of People with ADHD
•
Restless
•
Noisy
•
Obnoxious
•
Unable to Adjust to Shifting Circumstances
(American Psychological Association, 2008)
ADHD in Adulthood
Educational Achievement &
Employment
Financial Condition
Self Esteem
Quality of Life
Impairment in Cognitive Domains:
•
Attention
•
Processing Speed
•
Memory
•
Executive Functions
Under pharmacological stimulation with stimulants, neuropsychological functions
are known to improve but not to revert to the ‘norm’.
Method: Participants
•
•
248 participants suspected to
have ADHD were referred for
diagnostic assessment.
All participants underwent a
comprehensive diagnostic
evaluation.
•
1.
2.
3.
199 participants were included
in the final data analysis,
divided into three groups:
ADHD group (n=78)
Clinical Comparison Group (CCG;
n=71)
Clinical Comparison Group-Not
Diagnosed (CCG-ND; n=50).
Method
This study utilised a comprehensive diagnostic assessment approach, which
involved a combination of:
● Interviews
● Self-report scales
● Objective measures
● Neuropsychological tests
Method
self-report scales
Scale Used
What it Assesses
Wender Utah Rating Scale (WURS-K)
Childhood ADHD Symptoms
ADHD self-report scale (ADHS-SB)
Current ADHD Symptoms
Method
Neuropsychological tests for cognitive functions
Cognitive Functions ADHD (CFADHD) test battery.
Test used
What it Assesses
Stroop Interference Test
Interference
The Trail Making Test
Processing Speed and Flexibility
The Tower of London Test
Planning Ability
Go/No-Go Test
Inhibition
The SWITCH
Task Switching
Method
Neuropsychological tests for cognitive functions
Cognitive Functions ADHD (CFADHD) test battery.
Test used
What it Assesses
WAFS (Perceptual and Attention
Functions-Selective Attention)
Selective Attention
WAFV (Perceptual and Attention
Functions-Vigilance)
Vigilance
The 2-back version of the N-back
verbal task
Working Memory
5-Point Test
Figural Fluency
Method
Questionnaire as part of the CFADHD
Questionnaire Used
What it Assesses
The Questionnaire on Mental Ability
Self-reported Cognitive Deficits
Results
●
73% of the community sample were in paid employment. Of these 5-9% had problems in each
of the work items. In the ADHD symptom subgroup 37-53% had impairments. 27% of the
community sample and 55% of the ADHD sample were not in paid employment.
●
Of those who have ADHD more work related problems were observed. 20-23% had problems
with: getting fired, attendance, and performance evaluation. 55-69% reported problems with:
getting work done efficiently, and reaching their full potential.
Results
●
Group comparisons revealed that people with ADHD reported more work related problems with
most of the work items. 80% of the community sample has had either 0 or 1 work related problem
however, more than 80% of the ADHD sample had at least 1 problem. 69% had even more than 1.
A strong association was found between the WFIRS and ADHD symptoms, with the largest
association being found to inattention symptoms. Symptoms of hyperactivity were however, not
significant.
●
A third of the ADHD group had cognitive impairments in: selective attention, reaction time,
vigilance, flexibility and verbal fluency. Whilst impairments functioning in working memory and
planing were seen in only a fourth of the sample.
●
None of the test variables revealed significant associations to the WFIRS work score.
Discussion
●
All participants were seeking a clinical evaluation of adult ADHD as they thought they
were experiencing ADHD-like problems throughout their daily lives.
●
When compared to healthy control participants, adults with ADHD demonstrated
slower responses, a greater reaction time variability, and more omission within tests
of attention.
●
The CCG and CCG-ND, showed a similar pattern of neuropsychological functioning
and exhibit impairments in the same functions as individuals with ADHD
Discussion
The results from this study also indicate that neuropsychological assessment may have
limited ability to discriminate between adult ADHD and other psychiatric disorders but
using cognitive performance tests may contribute to the comprehensive understanding of
an individual's cognitive strengths and weaknesses as well as potentially also guide
treatment planning
A significant and medium-sized association between basic and higher-order cognitive
functions was found not only within the ADHD group but also in the CCG.
Strengths & Limitations
Strengths
●
●
●
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Sample is compared to clinical
control groups
Explores ADHD in adults
Extensive assessment for each
individual
Symptoms experienced as
children along with current
symptoms
Limitations
●
●
●
●
Sample had combined symptoms
and comorbid disorders
Only clinical indications, so
differentiation has to be regarded
with caution
Individuals may not have been
diagnosed
Assessment results were
accessible to patients and
clinicians
Conclusion
We chose this study because:
●
Comprehensive Assessment
●
Comparison with clinical control groups
●
Large Sample Size
●
Clinical Relevance: The findings emphasise the importance of considering deficits in
both basic and higher-order cognitive functions for intervention strategies in adults
with ADHD as well as provide insight for future interventions and treatments
•
Mairek Zahra: Introduction
•
Codie Xuereb: Methodology &
PowerPoint Formatting
•
Soamy Zammit Pace: Results
•
Jake Zahra: Discussion
•
Christina Xuereb: Strengths,
Limitations & Conclusion
References
American Psychological Association. (2008). Attention-Deficit Hyperactivity Disorder.
Https://Www.apa.org. https://www.apa.org/topics/adhd
Guo, N., Fuermaier, A. B. M., Koerts, J., Mueller, B. W., Diers, K., Mroß, A., Mette, C., Tucha, L., & Tucha,
O. (2021). Neuropsychological functioning of individuals at clinical evaluation of adult ADHD. Journal
of Neural Transmission, 128(7), 877–891. https://doi.org/10.1007/S00702-020-02281-0/TABLES/4