Kofler Michael J, Sarver Dustin E, Spiegel Jamie A, Day Taylor N, Harmon Sherelle L, Wells Erica L
a Department of Psychology , Florida State University , Tallahassee , USA.
b Department of Pediatrics, Center for Advancement of Youth , University of Mississippi Medical Center , Jackson , MS , USA.
Child Neuropsychol. 2017 Aug;23(6):733-759. doi: 10.1080/09297049.2016.1205010. Epub 2016 Jul 29.
Childhood attention-deficit/hyperactivity disorder (ADHD) is associated with impairments in peer, family, and academic functioning. Although impairment is required for diagnosis, children with ADHD vary significantly in the areas in which they demonstrate clinically significant impairment. However, relatively little is known about the mechanisms and processes underlying these individual differences. The current study examined neurocognitive predictors of heterogeneity in peer, family, and academic functioning in a well-defined sample of 44 children with ADHD aged 8-13 years (M = 10.31, SD = 1.42; 31 boys, 13 girls; 81% Caucasian). Reliable change analysis indicated that 98% of the sample demonstrated objectively-defined impairment on at least one assessed outcome measure; 65% were impaired in two or all three areas of functioning. ADHD children with quantifiable deficits in academic success and family functioning performed worse on tests of working memory (d = 0.68 to 1.09), whereas children with impaired parent-reported social functioning demonstrated slower processing speed (d = 0.53). Dimensional analyses identified additional predictors of peer, family, and academic functioning. Working memory abilities were associated with individual differences in all three functional domains, processing speed predicted social functioning, and inhibitory control predicted family functioning. These results add to a growing literature implicating neurocognitive abilities not only in explaining behavioral differences between ADHD and non-ADHD groups, but also in the substantial heterogeneity in ecologically-valid functional outcomes associated with the disorder.
儿童注意力缺陷多动障碍（ADHD）与同伴、家庭及学业功能受损有关。虽然诊断需要存在功能受损情况，但患有ADHD的儿童在出现临床显著受损的领域差异很大。然而，对于这些个体差异背后的机制和过程，我们知之甚少。本研究在一个明确界定的样本中，对44名8至13岁（M = 10.31，标准差 = 1.42；31名男孩，13名女孩；81%为白种人）的ADHD儿童，考察了同伴、家庭和学业功能异质性的神经认知预测因素。可靠变化分析表明，98%的样本在至少一项评估结果指标上表现出客观界定的功能受损；65%在两个或所有三个功能领域存在功能受损。在学业成就和家庭功能方面存在可量化缺陷的ADHD儿童，在工作记忆测试中的表现更差（d = 0.68至1.09），而父母报告的社交功能受损的儿童，其加工速度较慢（d = 0.53）。维度分析确定了同伴、家庭和学业功能的其他预测因素。工作记忆能力与所有三个功能领域的个体差异有关，加工速度预测社交功能，抑制控制预测家庭功能。这些结果进一步丰富了相关文献，表明神经认知能力不仅在解释ADHD组与非ADHD组之间的行为差异方面具有重要作用，而且在与该障碍相关的生态有效功能结果的显著异质性方面也具有重要作用。
