Symposia
ADHD - Child
Lauren M. Friedman, Ph.D.
Assistant Professor
Arizona State University
Tempe, Arizona
Keith McBurnett, PhD
Professor
University of California, San Francisco
San Francisco, California
Stephen Hinshaw, PhD
Distinguished Professor
University of California, berkeley
Berkeley, California
Linda J. Pfiffner, Ph.D.
Professor
University of California San Francisco
San Francisco, California
Introduction: Children with ADHD-Inattentive Presentation (ADHD-I) differ significantly from those with the combined presentation. ADHD-I is associated with distinct attention profiles, reduced oppositionality, and greater social withdrawal. Evidence also suggests differing neurocognitive patterns including slower processing speed, poorer information processing, and reduced response preparation. Thus, treatment response, and factors that predict treatment response, may similarly vary. The present study expands prior findings examining predictors of treatment response among children with ADHD-I. Given that ADHD is a neurodevelopmental disorder and cognitive deficits are hypothesized as causal mechanisms for disorder-related symptoms and impairments, we examine working memory and processing speed predictors of response following behavioral intervention.
Methods: Data were collected as part of an RCT for children aged 7-11 with ADHD-I to examine a multicomponent behavioral intervention—the Child Life and Attention Skills (CLAS) program—relative to and Behavioral Parent Training only and Treatment As Usual. Our analyses include those who received active treatment (n = 148). Baseline neurocognitive performance was assessed using a standardized intelligence test (WISC-IV) and pre- and post-treatment outcome measures included parent and teacher-rated inattention (CSI), organizational skills (COSS), and overall impairment (IRS); teacher-rated academic skills (ACES); and parent-rated homework problems (HPC).
Results: Children with above average Processing Speed Index (≥95) evinced greater treatment response in inattention, organization, homework problems, academic motivation, and overall impairment (all ps< .05) relative to those with below average PSI. Working Memory Index (WMI) was not significantly related to treatment outcomes. However, when decomposed into storage (Digit Span subtest, DS) and executive (Letter Number Sequencing subtest, LNS) component processes, relations to treatment outcomes were evident for LNS but not DS, and moderating relations were observed to a limited extent (organization, overall impairment; p= .06 & .05).
Discussion: Results suggest that speeded processing abilities are an important predictor of treatment response for children with ADHD-I. Implications for personalized treatment approaches, and methods to improve speeded processing abilities during behavioral interventions (e.g., repeated practice to improve automaticity of skill use) will also be provided.