Coghill D R, Hayward D, Rhodes S M, Grimmer C, Matthews K
Division of Neuroscience, Medical Research Institute, University of Dundee, Ninewells Hospital, Dundee, UK.
NHS Tayside, Murray Royal Hospital, Perth, UK.
Psychol Med. 2014 Apr;44(5):1087-99. doi: 10.1017/S0033291713001761. Epub 2013 Jul 19.
Attention deficit hyperactivity disorder (ADHD) often, but not always, persists into adulthood. Investigations of the associations between clinical and biological markers of persistence can shed light on causal pathways. It has been proposed that compensatory improvements in executive neuropsychological functioning are associated with clinical improvements. This is the first study to test this hypothesis prospectively.
The clinical and neuropsychological functioning of 17 boys with ADHD (mean age 10.45 years at time 1; 14.65 years at time 2) and 17 typically developing (TYP) boys (mean age 10.39 years at time 1; 14.47 years at time 2) was tested on two occasions, 4 years apart. This was done using a battery of standardized neuropsychological tests that included tasks with high and low executive demands.
Clinical improvements were observed over time. Neuropsychological performance improvements were also evident, with ADHD boys developing with a similar pattern to TYP boys, but with a developmental lag. Whilst there was an association between reduced symptoms and superior performance at retest for one task with a high executive demand (spatial working memory), this was not seen with two further high executive demand tasks [Stockings of Cambridge and intra-dimensional extra-dimensional (ID/ED) set shifting]. Also, there was no association between change in executive functioning and change in symptoms. Baseline performance on the ID/ED set-shifting task predicted better clinical outcome. Only change in performance on the low executive demand delayed matching-to-sample task predicted better clinical outcome.
These data highlight the importance of longitudinal measurements of cognition, symptoms and treatment response over time in children and adolescents with ADHD.
注意力缺陷多动障碍（ADHD）常常（但并非总是）会持续到成年期。对持续性的临床和生物学标志物之间关联的研究能够揭示因果途径。有人提出，执行神经心理功能的代偿性改善与临床改善相关。这是第一项前瞻性检验该假设的研究。
对17名患有ADHD的男孩（第一次测试时平均年龄10.45岁；第二次测试时14.65岁）和17名发育正常（TYP）的男孩（第一次测试时平均年龄10.39岁；第二次测试时14.47岁）的临床和神经心理功能进行了两次测试，间隔4年。这是通过一系列标准化神经心理测试完成的，这些测试包括执行要求高和低的任务。
随着时间的推移观察到了临床改善。神经心理表现的改善也很明显，患有ADHD的男孩与发育正常的男孩发展模式相似，但存在发育滞后。虽然在一项执行要求高的任务（空间工作记忆）重测时症状减轻与表现优异之间存在关联，但在另外两项执行要求高的任务[剑桥长袜任务和维度内-维度间（ID/ED）转换任务]中未观察到这种关联。此外，执行功能的变化与症状的变化之间没有关联。ID/ED转换任务的基线表现预测了更好的临床结果。只有执行要求低的延迟匹配样本任务的表现变化预测了更好的临床结果。
这些数据凸显了对患有ADHD的儿童和青少年的认知、症状和治疗反应进行长期纵向测量的重要性。
