Cognitive and neurophysiological indicators of persistence or improvement of ADHD disorder

درمان adhd

The British Journal of Psychiatry Aug 2015

Cognitive and neurophysiological markers of ADHD persistence and remission

Celeste H. M. Cheung, Fruhling Rijsdijk, Gráinne McLoughlin, Daniel Brandeis, Tobias Banaschewski, Philip Asherson, Jonna Kuntsi

DOI: 10.1192/bjp.bp.114.145185

Background:
Attention deficit hyperactivity disorder (ADHD) continues in adolescence and early adulthood in about two-thirds of people.

Goals:

Investigation of cognitive and neurophysiological processes of persistence or improvement of ADHD.

Method:

A 6-year follow-up of recorded cognitive data, EEG brain waves, ERP event-related potential and actigraphy measurements from 110 individuals who had this disorder in childhood and 169 individuals in the control group.

Results:

Recovered subjects differed from those who remained impaired on measures of auditory readiness (CNV random negative changes, delta activity, reaction time variability and errors of omission), IQ and actigraph scores, but not on measures of inhibitory executive control or working memory. There was no difference (nogo-P3 domains, commission errors and reverse digit counting)

Conclusion:
Measures of auditory readiness were markers of improvement and improved concurrently with ADHD symptoms, whereas measures of motor control were insensitive to persistence or improvement. Regarding IQ intelligence, the combination of past and recent results shows a moderating role in the output result. These findings are consistent with previously recognized causes of ADHD cognitive disabilities. The strongest option for the development of non-pharmacological interventions such as cognitive games and neurofeedback is preparatory-awareness processes, which were symptoms of ADHD recovery.

Abstract

Background
Attention-deficit hyperactivity disorder (ADHD) persists in around two-thirds of individuals in adolescence and early adulthood.

Aims
To examine the cognitive and neurophysiological processes underlying the persistence or remission of ADHD.

Method
Follow-up data were obtained from 110 young people with childhood ADHD and 169 controls on cognitive, electroencephalogram frequency, event-related potential (ERP) and actigraph movement measures after 6 years.

Results
ADHD persisters differed from remitters on preparation-vigilance measures (contingent negative variation, delta activity, reaction time variability and omission errors), IQ and actigraph count, but not on executive control measures of inhibition or working memory (nogo-P3 amplitudes, commission errors and digit span backwards).

Conclusions
Preparation-vigilance measures were markers of remission, improving concurrently with ADHD symptoms, whereas executive control measures were not sensitive to ADHD persistence/remission. For IQ, the present and previous results combined suggest a role in moderating ADHD outcome. These findings fit with previously identified aetiological separation of the cognitive impairments in ADHD. The strongest candidates for the development of non-pharmacological interventions involving cognitive training and neurofeedback are the preparation-vigilance processes that were markers of ADHD remission.

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