Fried Ronna, Chan James, Feinberg Leah, Pope Amanda, Woodworth K Yvonne, Faraone Stephen V, Biederman Joseph
a Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD , Massachusetts General Hospital , Boston , MA , USA.
b Department of Psychiatry , Harvard Medical School , Boston , MA , USA.
J Clin Exp Neuropsychol. 2016;38(5):487-96. doi: 10.1080/13803395.2015.1127896. Epub 2016 Feb 23.
Both working memory (WM; a brain system that provides temporary storage and manipulation of the information) and attention-deficit/hyperactivity disorder (ADHD) have been associated with educational deficits. Since WM deficits are prevalent in children with ADHD, the main aim of the present study was to examine whether educational deficits are driven by working memory deficits or driven by the effect of ADHD itself.
Participants were referred youth with (N = 276) and without (N = 241) ADHD ascertained from pediatric and psychiatric sources. Assessment included measures of psychiatric, psychosocial, educational, and cognitive functioning. Education deficits were defined as grade retention or placement in special classes and were assessed using interviews and written rating scales. Working memory was assessed using the Wechsler Intelligence Scale for Children-Revised (WISC-R) Freedom from Distractibility (FFD) factor based on Digit Span, Arithmetic, and Coding.
Significantly more youth with ADHD had WM deficits than controls (31.9% vs. 13.7%, p < .05). In ADHD children, WM deficits were significantly (p < .01) associated with an increased risk for grade retention and placement in special classes as well as lower scores on reading and math achievement tests than for ADHD children without WM deficits. In contrast, no other differences were noted in other areas of functioning. Although WM deficits also had some adverse impact on educational and cognitive correlates in non-ADHD controls, these differences failed to attain statistical significance.
WM deficits significantly and selectively increase the risk for academic deficits and cognitive dysfunction in children with ADHD beyond those conferred by ADHD. Screening for WM deficits may help identify children with ADHD at high risk for academic and cognitive dysfunction.
工作记忆（一种为信息提供临时存储和操作的大脑系统）和注意力缺陷多动障碍（ADHD）均与教育缺陷有关。由于工作记忆缺陷在ADHD儿童中很普遍，本研究的主要目的是检验教育缺陷是由工作记忆缺陷驱动还是由ADHD本身的影响驱动。
参与者是从儿科和精神科来源确定的患有（N = 276）和未患有（N = 241）ADHD的转诊青少年。评估包括精神、心理社会、教育和认知功能的测量。教育缺陷被定义为留级或被安排到特殊班级，并通过访谈和书面评定量表进行评估。工作记忆通过基于数字广度、算术和编码的韦氏儿童智力量表修订版（WISC-R）注意力分散度（FFD）因子进行评估。
患有ADHD的青少年中存在工作记忆缺陷的明显多于对照组（31.9%对13.7%，p <.05）。在ADHD儿童中，与没有工作记忆缺陷的ADHD儿童相比，工作记忆缺陷与留级和被安排到特殊班级的风险增加显著相关（p <.01），并且在阅读和数学成绩测试中的得分更低。相比之下，在其他功能领域未发现其他差异。尽管工作记忆缺陷对非ADHD对照组的教育和认知相关性也有一些不利影响，但这些差异未达到统计学显著性。
工作记忆缺陷显著且选择性地增加了ADHD儿童出现学业缺陷和认知功能障碍的风险，超出了ADHD本身所带来的风险。筛查工作记忆缺陷可能有助于识别有学业和认知功能障碍高风险的ADHD儿童。
