title: Does Childhood Executive Function Predict Adolescent Functional Outcomes in Girls with ADHD? Executive Impairment Determines ADHD Medication Response: Implications for Academic Achievement The Unity and Diversity of Executive Functions and Their Contributions to Complex “Frontal Lobe” Tasks: A Latent Variable Analysis The MTA at 8 years: prospective follow-up of children treated for combined-type ADHD in a multisite study. Executive dysfunction predicts nonresponse to fluoxetine in major depression. Adolescent substance use in the multimodal treatment study of attention-deficit/hyperactivity disorder (ADHD) (MTA) as a function of childhood ADHD, random assignment to childhood treatments, and subsequent medication. Parental Influence on Children with Attention-Deficit/Hyperactivity Disorder: II. Results of a Pilot Intervention Training Parents as Friendship Coaches for Children Childhood Executive Function Continues to Predict Outcomes in Young Adult Females with and Without Childhood-Diagnosed ADHD Evaluation of the Homework, Organization, and Planning Skills (HOPS) Intervention for Middle School Students with ADHD as Implemented by School Mental Health Providers.
abstract: We prospect ively followed an ethnically and socioeconomically diverse sample of preadolescent girls with ADHD ( n = 140 ) and matched comparison girls ( n = 88 ) over a period of 5 years , from middle childhood through early/mid-adolescence . Our aim was to examine the ability of measures of  childhood executive function ( EF )  to predict functional outcomes in adolescence . Measures of neuropsychological functioning comprised the childhood predictors , with academic , social , and global functioning serving as adolescent criterion measures . Results indicated that childhood EF predicted ( a ) academic achievement and social functioning across our entire sample ( independent of diagnostic group status ) and ( b ) global functioning only in girls with ADHD ( independent of IQ ) . These results highlight the non-specificity of EF deficits and suggest the importance of assessing and developing interventions that target EF impairments , particularly in those at high-risk for negative outcomes , in order to prevent long-term difficulties across a range of important functional domains Methylpheni date ( MPH ) often ameliorates attention-deficit/hyperactivity disorder ( ADHD ) behavioral dysfunction according to indirect informant reports and rating scales . The st and ard of care behavioral MPH titration approach seldom includes direct neuropsychological or academic assessment data to determine treatment efficacy . Documenting “ cool ” executive-working memory ( EWM ) and “ hot ” self-regulation ( SR ) neuropsychological impairments could aid in differential diagnosis of ADHD subtypes and determining cognitive and academic MPH response . In this study , children aged 6 to 16 with ADHD inattentive type ( IT ; n = 19 ) and combined type ( n = 33)/hyperactive-impulsive type ( n = 4 ) ( CT ) participated in double-blind placebo-controlled MPH trials with baseline and r and omized placebo , low MPH dose , and high MPH dose conditions . EWM/ SR measures and behavior ratings/classroom observations were rank ordered separately across conditions , with nonparametric r and omization tests conducted to determine individual MPH response . Participants were subsequently grouped according to their level of cool EWM and hot SR circuit dysfunction . Robust cognitive and behavioral MPH response was achieved for children with significant baseline EWM/SR impairment , yet response was poor for those with adequate EWM/ SR baseline performance . Even for strong MPH responders , the best dose for neuropsychological functioning was typically lower than the best dose for behavior . Findings offer one possible explanation for why long-term academic MPH treatment gains in ADHD have not been realized . Implication s for academic achievement and medication titration practice s for children with behaviorally diagnosed ADHD will be discussed This individual differences study examined the separability of three often postulated executive functions-mental set shifting ( " Shifting " ) , information updating and monitoring ( " Updating " ) , and inhibition of prepotent responses ("Inhibition")- and their roles in complex " frontal lobe " or " executive " tasks . One hundred thirty-seven college students performed a set of relatively simple experimental tasks that are considered to predominantly tap each target executive function as well as a set of frequently used executive tasks : the Wisconsin Card Sorting Test ( WCST ) , Tower of Hanoi ( TOH ) , r and om number generation ( RNG ) , operation span , and dual tasking .  Confirmatory factor analysis indicated that the three target executive functions are moderately correlated with one another , but are clearly separable . Moreover , structural equation modeling suggested that the three functions contribute differentially to performance on complex executive tasks . Specifically , WCST performance was related most strongly to Shifting , TOH to Inhibition , RNG to Inhibition and Updating , and operation span to Updating . Dual task performance was not related to any of the three target functions . These results suggest that it is important to recognize both the unity and diversity of executive functions and that latent variable analysis is a useful approach to study ing the organization and roles of executive functions OBJECTIVES To determine any long-term effects , 6 and 8 years after childhood enrollment , of the r and omly assigned 14-month treatments in the NIMH Collaborative Multisite Multimodal Treatment Study of Children With Attention-Deficit/Hyperactivity Disorder ( MTA ; N = 436 ) ; to test whether attention-deficit/hyperactivity disorder ( ADHD ) symptom trajectory through 3 years predicts outcome in subsequent years ; and to examine functioning level of the MTA adolescents relative to their non-ADHD peers ( local normative comparison group ; N = 261 ) . METHOD Mixed-effects regression models with planned contrasts at 6 and 8 years tested a wide range of symptom and impairment variables assessed by  parent , teacher , and youth report . RESULTS In nearly every analysis , the originally r and omized treatment groups did not differ significantly on repeated measures or newly analyzed variables ( e.g. , grade s earned in school , arrests , psychiatric hospitalizations , other clinical ly relevant outcomes ) . Medication use decreased by 62 % after the 14-month controlled trial , but adjusting for this did not change the results . ADHD symptom trajectory in the first 3 years predicted 55 % of the outcomes . The MTA participants fared worse than the local normative comparison group on 91 % of the variables tested . CONCLUSIONS Type or intensity of 14 months of treatment for ADHD in childhood ( at age 7.0 - 9.9 years ) does not predict functioning 6 to 8 years later . Rather , early ADHD symptom trajectory regardless of treatment type is prognostic . This finding implies that children with behavioral and sociodemographic advantage , with the best response to any treatment , will have the best long-term prognosis . As a group , however , despite initial symptom improvement during treatment that is largely maintained after treatment , children with combined-type ADHD exhibit significant impairment in adolescence . Innovative treatment approaches targeting specific areas of adolescent impairment are needed BACKGROUND Functional brain imaging studies of major depression have consistently revealed hypometabolism or hypoperfusion in specific regions of the prefrontal cortex and basal ganglia . Studies of cognitive functioning in major depression have suggested that some but not all subjects exhibit cognitive deficits that are consistent with frontal-subcortical dysfunction , although the reasons for this heterogeneity are unclear . In this study , we explored this heterogeneity among depressed subjects by examining the relationship between cognitive functioning and treatment outcome . METHOD Subjects with major depression were administered a complete neuropsychological test battery prior to treatment with fluoxetine . RESULTS There were no significant differences between responders and nonresponders to fluoxetine in terms of age , educational achievement , number of past episodes of depression , and estimated premorbid IQ . However , nonresponders performed significantly worse than responders on several pretreatment measures of executive functioning , after controlling for baseline group differences in depression severity . LIMITATIONS The results are based on a small sample of primarily female subjects , result ing in low statistical power and less generalizability to sample s of male subjects with depression . CONCLUSIONS The findings suggest that subtle prefrontal dysfunction in subjects with major depression may be predictive of poor response with particular medications . Assessment of the executive functions may play a particular role in pretreatment identification of subjects likely to respond to specific medications OBJECTIVE To determine long-term effects on substance use and substance use disorder ( SUD ) , up to 8 years after childhood enrollment , of the r and omly assigned 14-month treatments in the multisite Multimodal Treatment Study of Children with Attention-Deficit/Hyperactivity Disorder ( MTA ; n = 436 ) ; to test whether medication at follow-up , cumulative psychostimulant treatment over time , or both relate to substance use/SUD ; and to compare substance use/SUD in the ADHD sample to the non-ADHD childhood classmate comparison group ( n = 261 ) . METHOD Mixed-effects regression models with planned contrasts were used for all tests except the important cumulative stimulant treatment question , for which propensity score matching analysis was used . RESULTS The originally r and omized treatment groups did not differ significantly on substance use/SUD by the 8-year follow-up or earlier ( mean age = 17 years ) . Neither medication at follow-up ( mostly stimulants ) nor cumulative stimulant treatment was associated with adolescent substance use/SUD . Substance use at all time points , including use of two or more substances and SUD , were each greater in the ADHD than in the non-ADHD sample s , regardless of sex . CONCLUSIONS Medication for ADHD did not protect from , or contribute to , visible risk of substance use or SUD by adolescence , whether analyzed as r and omized treatment assignment in childhood , as medication at follow-up , or as cumulative stimulant treatment over an 8-year follow-up from childhood . These results suggest the need to identify alternative or adjunctive adolescent-focused approaches to substance abuse prevention and treatment for boys and girls with ADHD , especially given their increased risk for use and abuse of multiple substances that is not improved with stimulant medication . Clinical trial registration information-Multimodal Treatment Study of Children With Attention Deficit and Hyperactivity Disorder ( MTA ) ; http:// clinical trials.gov/ ; NCT00000388 We report findings from a pilot intervention that trained parents to be “ friendship coaches ” for their children with Attention-Deficit/Hyperactivity Disorder ( ADHD ) . Parents of 62 children with ADHD ( ages 6–10 ; 68 % male ) were r and omly assigned to receive the parental friendship coaching ( PFC ) intervention , or to be in a no-treatment control group .  Families of 62 children without ADHD were included as normative comparisons . PFC was administered in eight , 90-minute sessions to parents ; there was no child treatment component . Parents were taught to arrange a social context in which their children were optimally likely to develop good peer relationships . Receipt of PFC predicted improvements in children ’s social skills and friendship quality on play date s as reported by parents , and peer acceptance and rejection as reported by teachers unaware of treatment status . PFC also predicted increases in observed parental facilitation and corrective feedback , and reductions in criticism during the child ’s peer interaction , which mediated the improvements in children ’s peer relationships . However , no effects for PFC were found on the number of play date s hosted or on teacher report of child social skills . Findings lend initial support to a treatment model that targets parental behaviors to address children ’s peer problems We prospect ively followed an ethnically and socioeconomically diverse sample of preadolescent girls with ADHD ( n = 140 ) and matched comparison girls ( n = 88 ) over a period of 10 years , from middle childhood through late adolescence/young adulthood . Our aim was to examine the ability of childhood measures of executive function ( EF ) to predict functional outcomes at follow-up . Measures of EF comprised the childhood predictors , with academic , socioemotional , occupational , and global functioning serving as young adult criterion measures . Results indicated that childhood EF – particularly measures of global EF and working memory – predicted academic and occupational functioning across our entire sample ( independent of diagnostic group status ) , but diagnostic status ( ADHD versus comparison ) moderated the association between ( a ) working memory and reading achievement and ( b ) a global EF measure and suspensions/expulsions . That is , in the ADHD group , low working memory predicted poor reading scores and impaired global EF predicted higher suspensions/expulsions , but this was not the case in the comparison group . Overall , these results extend previous findings of associations between EF and adolescent outcomes in girls with and without ADHD into young adulthood . Findings continue to suggest the importance of assessing and developing interventions that target EF impairments early in life in order to prevent long-term difficulties across a range of important functional domains The purpose of the study was to evaluate the  Homework , Organization , and Planning Skills ( HOPS ) intervention for middle school students with Attention-Deficit/Hyperactivity Disorder ( ADHD ) as implemented by school mental health ( SMH ) providers using a r and omized trial design . Seventeen SMH providers from five school districts implemented the HOPS intervention . Forty-seven middle school students with ADHD ( grade s 6 - 8 ) were r and omly assigned to receive the HOPS intervention or to a waitlist comparison group .  Parent and teacher ratings of organizational skills and homework problems were collected pre- and post-intervention and at a 3-monoth follow-up , and school grade s were also collected . Intervention participants demonstrated significant improvements relative to the waitlist comparison across parent-rated organized action ( d = .88 ) , material s management ( d = .63 ) , planning ( d = 1.05 ) , and homework completion behaviors ( d = .85 ) . Intervention participants did not make significant improvements relative to the comparison group according to teacher ratings .  SMH providers were able to implement the HOPS intervention with fidelity despite the fact that no formal ongoing consultation was provided
target: Review of the evidence suggests that  task performance  may be useful in identifying individuals with ADHD at risk for academic impairment .
  However , the evidence is less compelling for identifying youth at risk for impaired social functioning or poor health outcomes .
  The review also found that task performance is likely useful for predicting response to treatment with methylpheni date .
  Across studies , evidence indicated that interpreting task performance in an integrated manner , such as a factor score or mean score , was more consistently useful for predicting outcomes of interest than interpreting performance from a single task .
background: The role that neuropsychological task performance plays in the assessment of Attention-Deficit/Hyperactivity Disorder ( ADHD ) is currently ambiguous , and findings are mixed regarding whether tasks have validity for diagnosing the disorder .
  Irrespective of their validity for diagnosing ADHD , neuropsychological tasks could provide valuable information to mental health professionals if they can inform recommendations for treatment targets and modalities .
  Therefore , this review sought to synthesize the available evidence related to the use of neuropsychological task performance as a tool for informing treatment planning for youth with ADHD .
  Review ed studies focused on examinations of associations between task performance and academic , social , and health outcomes , as well as response to treatment .