Hostname: page-component-8448b6f56d-cfpbc Total loading time: 0 Render date: 2024-04-17T18:56:52.665Z Has data issue: false hasContentIssue false
  • English
  • Français

Attention deficit hyperactivity disorder (ADHD): gender- and age-related differences in neurocognition

Published online by Cambridge University Press:  20 August 2008

S. Bálint ,
P. Czobor ,
S. Komlósi ,
Á. Mészáros ,
V. Simon  and
I. Bitter
S. Bálint*
Affiliation:
Semmelweis University, Department of Psychiatry and Psychotherapy, Budapest, Hungary
P. Czobor
Affiliation:
Semmelweis University, Department of Psychiatry and Psychotherapy, Budapest, Hungary Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, USA
S. Komlósi
Affiliation:
Semmelweis University, Department of Psychiatry and Psychotherapy, Budapest, Hungary
Á. Mészáros
Affiliation:
Semmelweis University, Department of Psychiatry and Psychotherapy, Budapest, Hungary
V. Simon
Affiliation:
Semmelweis University, Department of Psychiatry and Psychotherapy, Budapest, Hungary
I. Bitter
Affiliation:
Semmelweis University, Department of Psychiatry and Psychotherapy, Budapest, Hungary
*
*Address for correspondence: S. Bálint, Semmelweis University, Department of Psychiatry and Psychotherapy, 1083 Budapest, Balassa u.6, Hungary. (Email: balint@psych.sote.hu)
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Despite the growing recognition that the clinical symptom characteristics associated with attention deficit hyperactivity disorder (ADHD) persist into adulthood in a high proportion of subjects, little is known about the persistence of neurocognitive deficits in ADHD. The objective was twofold: (1) to conduct a meta-analysis of neuropsychological studies to characterize attentional performance in subjects with adult ADHD by examining differences in ADHD versus normal control subjects; and (2) to investigate whether these differences vary as a function of age and gender.

Method

Twenty-five neuropsychological studies comparing subjects with adult ADHD and healthy controls were evaluated. Statistical effect size was determined to characterize the difference between ADHD and control subjects. Meta-regression analysis was applied to investigate whether the difference between ADHD and control subjects varied as a function of age and gender across studies.

Results

Tests measuring focused and sustained attention yielded an effect size with medium to large magnitude whereas tests of simple attention resulted in a small to medium effect size in terms of poorer attention functioning of ADHD subjects versus controls. On some of the measures (e.g. Stroop interference), a lower level of attention functioning in the ADHD group versus the controls was associated with male gender.

Conclusions

Adult ADHD subjects display significantly poorer functioning versus healthy controls on complex but not on simple tasks of attention, and the degree of impairment varies with gender, with males displaying a higher level of impairment.

Keywords

Adult attention deficit hyperactivity disorderageattentiongendermeta-analysis
Type
Original Articles
Information
Psychological Medicine , Volume 39 , Issue 8 , August 2009 , pp. 1337 - 1345
Copyright
Copyright © 2008 Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

APA (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th edn. American Psychiatric Association: Washington, DC.Google Scholar
Barkley, RA (1988). The effects of methylphenidate on the interactions of preschool ADHD children with their mothers. Journal of the American Academy of Child and Adolescent Psychiatry 27, 336–341.CrossRefGoogle ScholarPubMed
Barkley, RA (1997). Behavioral inhibition, sustained attention, and executive functions: constructing a unifying theory of ADHD. Psychological Bulletin 121, 65–94.CrossRefGoogle ScholarPubMed
Barkley, RA, Fischer, M, Edelbrock, CS, Smallish, L (1990). The adolescent outcome of hyperactive children diagnosed by research criteria: I. An 8-year prospective follow-up study. Journal of the American Academy of Child and Adolescent Psychiatry 29, 546–557.CrossRefGoogle ScholarPubMed
Begg, CB, Mazumdar, M (1994). Operating characteristics of a rank correlation test for publication bias. Biometrics 50, 1088–1101.CrossRefGoogle Scholar
Berry, CA, Shaywitz, SE, Shaywitz, BA (1985). Girls with attention deficit disorder: a silent minority? A report on behavioral and cognitive characteristics. Pediatrics 76, 801–809.CrossRefGoogle ScholarPubMed
Biederman, J, Faraone, SV, Monuteaux, MC, Bober, M, Cadogen, E (2004). Gender effects on attention-deficit/hyperactivity disorder in adults, revisited. Biological Psychiatry 55, 692–700.CrossRefGoogle Scholar
Biederman, J, Faraone, SV, Spencer, T, Wilens, T, Mick, E, Lapey, KA (1994). Gender differences in a sample of adults with attention deficit hyperactivity disorder. Psychiatry Research 53, 13–29.CrossRefGoogle Scholar
Biederman, J, Faraone, SV, Spencer, T, Wilens, T, Norman, D, Lapey, KA, Mick, E, Lehman, BK, Doyle, A (1993). Patterns of psychiatric comorbidity, cognition, and psychosocial functioning in adults with attention deficit hyperactivity disorder. American Journal of Psychiatry 150, 1792–1798.Google ScholarPubMed
Biederman, J, Mick, E, Faraone, SV (2000). Age-dependent decline of symptoms of attention deficit hyperactivity disorder: impact of remission definition and symptom type. American Journal of Psychiatry 157, 816–818.CrossRefGoogle ScholarPubMed
Biederman, J, Mick, E, Faraone, SV, Braaten, E, Doyle, A, Spencer, T, Wilens, TE, Frazier, E, Johnson, MA (2002). Influence of gender on attention deficit hyperactivity disorder in children referred to a psychiatric clinic. American Journal of Psychiatry 159, 36–42.CrossRefGoogle ScholarPubMed
Biederman, J, Petty, C, Fried, R, Fontanella, J, Doyle, AE, Seidman, LJ, Faraone, SV (2006). Impact of psychometrically defined deficits of executive functioning in adults with attention deficit hyperactivity disorder. American Journal of Psychiatry 163, 1730–1738.CrossRefGoogle ScholarPubMed
Borgaro, S, Pogge, DL, DeLuca, VA, Bilginer, L, Stokes, J, Harvey, PD (2003). Convergence of different versions of the continuous performance test: clinical and scientific implications. Journal of Clinical and Experimental Neuropsychology 25, 283–292.CrossRefGoogle ScholarPubMed
Bush, G, Frazier, JA, Rauch, SL, Seidman, LJ, Whalen, PJ, Jenike, MA, Rosen, BR, Biederman, J (1999). Anterior cingulate cortex dysfunction in attention-deficit/hyperactivity disorder revealed by fMRI and the Counting Stroop. Biological Psychiatry 45, 1542–1552.CrossRefGoogle ScholarPubMed
Conners, CK (1994). CPT: Conners Continuous Performance Test. Multi-Health Systems Inc.: North Tonawanda.Google Scholar
Conners, CK, Epstein, JN, Angold, A, Klaric, J (2003). Continuous performance test performance in a normative epidemiological sample. Journal of Abnormal Child Psychology 31, 555–562.CrossRefGoogle Scholar
Corbett, B, Stanczak, DE (1999). Neuropsychological performance of adults evidencing attention-deficit hyperactivity disorder. Archives of Clinical Neuropsychology 14, 373–387.CrossRefGoogle ScholarPubMed
DeSimonian, R, Laird, N (1986). Meta-analysis in clinical trials. Controlled Clinical Trials 7, 177–188.CrossRefGoogle Scholar
Dige, N, Wik, G (2005). Adult attention deficit hyperactivity disorder identified by neuropsychological testing. International Journal of Neuroscience 115, 169–183.CrossRefGoogle ScholarPubMed
Doyle, AE, Biederman, J, Seidman, LJ, Reske-Nielsen, JJ, Faraone, SV (2005). Neuropsychological functioning in relatives of girls with and without ADHD. Psychological Medicine 35, 1121–1132.CrossRefGoogle ScholarPubMed
Epstein, JN, Conners, CK, Sitarenios, G, Erhardt, D (1998). Continuous performance test results of adults with attention deficit hyperactivity disorder. Clinical Neuropsychologist 12, 155–168.CrossRefGoogle Scholar
Epstein, JN, Johnson, DE, Varia, IM, Conners, CK (2001). Neuropsychological assessment of response inhibition in adults with ADHD. Journal of Clinical and Experimental Neuropsychology 23, 362–371.CrossRefGoogle ScholarPubMed
Faraone, SV, Biederman, J, Doyle, A, Murray, K, Petty, C, Adamson, JJ, Seidman, L (2006). Neuropsychological studies of late onset and subthreshold diagnoses of adult attention-deficit/hyperactivity disorder. Biological Psychiatry 60, 1081–1087.CrossRefGoogle ScholarPubMed
Golden, CJ (1975). A group version of the Stroop color and word test. Journal of Personality Assessment 39, 386–388.CrossRefGoogle ScholarPubMed
Grevet, EH, Bau, CH, Salgado, CA, Fischer, AG, Kalil, K, Victor, MM, Garcia, CR, Sousa, NO, Rohde, LA, Belmonte-de-Abreu, P (2006). Lack of gender effects on subtype outcomes in adults with attention-deficit/hyperactivity disorder: support for the validity of subtypes. European Archives of Psychiatry and Clinical Neuroscience 256, 311–319.CrossRefGoogle ScholarPubMed
Hervey, AS, Epstein, JN, Curry, JF (2004). Neuropsychology of adults with attention-deficit/hyperactivity disorder: a meta-analytic review. Neuropsychology 18, 485–503.CrossRefGoogle ScholarPubMed
Holdnack, JA, Moberg, PJ, Arnold, SE, Gur, RC, Gur, RE (1995). Speed of processing and verbal learning deficits in adults diagnosed with attention deficit disorder. Neuropsychiatry, Neuropsychology, and Behavioral Neurology 8, 282–292.Google Scholar
Horn, WF, Wagner, AE, Ialongo, N (1989). Sex differences in school-aged children with pervasive attention deficit hyperactivity disorder. Journal of Abnormal Child Psychology 17, 109–125.CrossRefGoogle ScholarPubMed
Johnson, DE, Epstein, JN, Waid, LR, Latham, PK, Voronin, KE, Anton, RF (2001). Neuropsychological performance deficits in adults with attention deficit/hyperactivity disorder. Archives of Clinical Neuropsychology 16, 587–604.CrossRefGoogle ScholarPubMed
Katz, LJ, Wood, DS, Goldstein, G, Auchenbach, RC, Geckle, M (1998). The utility of neuropsychological tests in evaluation of attention-deficit/hyperactivity disorder (ADHD) versus depression in adults. Assessment 5, 45–52.CrossRefGoogle ScholarPubMed
Lovejoy, DW, Ball, JD, Keats, M, Stutts, ML, Spain, EH, Janda, L, Janusz, J (1999). Neuropsychological performance of adults with attention deficit hyperactivity disorder (ADHD): diagnostic classification estimates for measures of frontal lobe/executive functioning. Journal of the International Neuropsychological Society 5, 222–233.CrossRefGoogle ScholarPubMed
Mannuzza, S, Klein, RG, Bonagura, N, Malloy, P, Giampino, TL, Addalli, KA (1991). Hyperactive boys almost grown up. V. Replication of psychiatric status. Archives of General Psychiatry 48, 77–83.CrossRefGoogle ScholarPubMed
McDermott, PA (1996). A nationwide study of developmental and gender prevalence for psychopathology in childhood and adolescence. Journal of Abnormal Child Psychology 24, 53–66.CrossRefGoogle ScholarPubMed
Muller, BW, Gimbel, K, Keller-Pliessnig, A, Sartory, G, Gastpar, M, Davids, E (2007). Neuropsychological assessment of adult patients with attention-deficit/hyperactivity disorder. European Archives of Psychiatry and Clinical Neuroscience 257, 112–119.CrossRefGoogle ScholarPubMed
Murphy, KR, Barkley, RA, Bush, T (2001). Executive functioning and olfactory identification in young adults with attention deficit-hyperactivity disorder. Neuropsychology 15, 211–220.CrossRefGoogle ScholarPubMed
Murphy, P (2002). Cognitive functioning in adults with attention-deficit/hyperactivity disorder. Journal of Attention Disorders 5, 203–209.CrossRefGoogle ScholarPubMed
Nigg, JT, Stavro, G, Ettenhofer, M, Hambrick, DZ, Miller, T, Henderson, JM (2005). Executive functions and ADHD in adults: evidence for selective effects on ADHD symptom domains. Journal of Abnormal Psychology 114, 706–717.CrossRefGoogle ScholarPubMed
Rapport, LJ, Van Voorhis, A, Tzelepis, A, Friedman, SR (2001). Executive functioning in adult attention-deficit hyperactivity disorder. Clinical Neuropsychologist 15, 479–491.CrossRefGoogle ScholarPubMed
Reitan, RM (1994). Ward Halstead's contributions to neuropsychology and the Halstead–Reitan Neuropsychological Test Battery. Journal of Clinical Psychology 50, 47–70.3.0.CO;2-X>CrossRefGoogle ScholarPubMed
Riordan, HJ, Flashman, LA, Saykin, AJ, Frutiger, SA, Carroll, KE, Huey, L (1999). Neuropsychological correlates of methylphenidate treatment in adult ADHD with and without depression. Archives of Clinical Neuropsychology 14, 217–233.CrossRefGoogle ScholarPubMed
Schoechlin, C, Engel, RR (2005). Neuropsychological performance in adult attention-deficit hyperactivity disorder: meta-analysis of empirical data. Archives of Clinical Neuropsychology 20, 727–744.CrossRefGoogle ScholarPubMed
Schweitzer, JB, Hanford, RB, Medoff, DR (2006). Working memory deficits in adults with ADHD: is there evidence for subtype differences? Behavioral and Brain Functions 2, 43.CrossRefGoogle ScholarPubMed
Seidman, LJ, Biederman, J, Weber, W, Hatch, M, Faraone, SV (1998). Neuropsychological function in adults with attention-deficit hyperactivity disorder. Biological Psychiatry 44, 260–268.CrossRefGoogle ScholarPubMed
Silverstein, SM, Como, PG, Palumbo, DR, West, LL, Osborn, LM (1995). Multiple sources of attentional dysfunction in adults with Tourette's syndrome: comparison with attention deficit-hyperactivity disorder. Neuropsychology 9, 157–164.CrossRefGoogle Scholar
Taylor, CJ, Miller, DC (1997). Neuropsychological assessment of attention in ADHD adults. Journal of Attention Disorders 2, 77–88.CrossRefGoogle Scholar
van Houwelingen, HC, Arends, LR, Stijnen, T (2002). Advanced methods in meta-analysis: multivariate approach and meta-regression. Statistics in Medicine 21, 589–624.CrossRefGoogle ScholarPubMed
Walker, AJ, Shores, EA, Trollor, JN, Lee, T, Sachdev, PS (2000). Neuropsychological functioning of adults with attention deficit hyperactivity disorder. Journal of Clinical and Experimental Neuropsychology 22, 115–124.CrossRefGoogle ScholarPubMed
Wechsler, D (1981). Wechsler Adult Intelligence Scale – Revised. The Psychological Corporation: New York.Google Scholar
Weiss, M, Murray, C (2003). Assessment and management of attention-deficit hyperactivity disorder in adults. Journal of the Canadian Medical Association 168, 715–722.Google ScholarPubMed