The three-year outcome of emotional symptoms in clinically referred youth with ADHD and their relationship to neuropsychological functions

Mean values at baseline and follow-up, and standard deviations for the SNAP-IV, BRIEF, Conners’ CPT-II, and Wechsler Intelligence Scales at baseline and follow-up.

	ADHD group						Control group
	Baseline scores			Follow-up scores			Baseline scores			Follow-up scores
Measures	n	Mean	SD	n	Mean	SD	n	Mean	SD	n	Mean	SD
BYI
Anxiety	99	58.31	11.35	102	57.18	9.83	57	48.10	8.36	52	52.82	9.89
Depression	99	57.16	10.60	102	55.57	9.75	57	47.30	8.73	52	51.02	9.00
Anger	99	58.69	11.16	102	56.51	10.65	57	48.78	8.26	52	47.35	7.65
SNAP-IV
ADHD-combined	127	30.54	10.25	108	24.31	10.94
Inattention	128	18.04	5.05	108	15.11	6.30
Hyperactivity/Imp	127	12.40	13.14	108	9.20	6.23
BRIEF BRI	127	66.72	13.67	108	63.94	12.61
Inhibition	127	65.66	13.09	108	61.44	12.43
Flexibility	128	63.76	14.58	108	64.65	13.43
Emotional Control	128	63.48	12.92	108	60.92	13.11
Monitor	125	65.18	9.68	107	62.41	11.17
BRIEF MI	125	68.65	9.09	108	65.75	10.71
Initiate	128	65.23	9.50	108	64.48	10.72
Working Memory	128	71.01	9.87	108	67.35	11.83
Plan/Organize	122	67.98	10.00	106	64.96	11.38
Organize Materials	128	58.34	10.57	108	58.05	10.68
CPT-II
Confidence Index	133	63.01	20.00	101	55.31	20.46
CPT Omissions	133	58.08	15.36	101	53.16	15.62
CPT Commissions	133	53.60	9.06	101	55.70	12.46
CPT RT (mean)	133	53.42	12.54	101	52.62	10.88
CPT RT (SE)	133	58.15	10.49	101	54.47	12.15
Wechsler
Working Memory	125	82.03	12.95	94	85.71	11.70
Processing Speed	124	88.69	13.59	94	89.27	14.84

[i] ADHD: attention deficit hyperactivity disorder. BRI: behavioral regulation index. BRIEF: Behavior Rating Inventory of Executive Function. BYI: Beck Youth Inventories. CPT: continuous performance test. Hyperactivity/Imp: Hyperactivity/Impulsivity. MI: metacognition index. RT: reaction time. SE: standard error. SNAP-IV: Swanson-Nolan-Pelham scale, fourth edition.

The number of observations in the ADHD group varied due to partial attrition. 22 children in the ADHD group were too young to complete the BYI at baseline. The BYI was sex standardized in T scores (m = 50; SD = 10). The CPT II and BRIEF were age- and sex-standardized in T scores. Parent-rated SNAP-IV was measured as a summary scores. Higher scores indicate greater impairment in all measures except Wechsler Working Memory and Processing Speed (measured in age standardized IQ scores, m = 100, SD = 15).

Table 2

Estimates (b), 95% confidence intervals, and p-values for the effect of parent-rated EF and performance based neurocognitive tests and ADHD symptoms (measured at baseline and follow-up) on self-rated anxiety, depression and anger inventories at baseline and follow-up in the ADHD group.

Dependent variable	Crude/Models	Independent variable	n	b	95 % CI	p
Anxiety	Crude	BRIEF BRI	193	0.09	−0.07, 0.25	.131
	Crude	BRIEF MI	190	0.16	−0.02, 0.34	.031
	Crude	CPT-II Confidence Index	195	−0.001	−0.09, 0.09	.973
	Crude	Processing speed	181	0.05	−0.09, 0.19	.382
	Crude	Working Memory	182	−0.02	−0.18, 0.14	.752
	Crude	SNAP-IV ADHD-Combined	192	0.10	−0.06, 0.26	.113
		Initiate	188	0.10	−0.10, 0.29	.328
		Working Memory		−0.16	−0.34, 0.02	.074
	Model BRIEF MI	Plan/Organize		0.30	0.11, 0.50	.003
		Organization of materials		−0.14	−0.30, 0.02	.075
Depression	Crude	BRIEF BRI	193	0.09	−0.05, 0.23	.118
	Crude	BRIEF MI	190	0.23	0.05, 0.41	.001
	Crude	CPT-II Confidence Index	195	0.02	−0.05, 0.11	.632
	Crude	Processing Speed	181	0.04	−0.09, 0.17	.426
	Crude	Working Memory	182	−0.08	−0.24, 0.08	.154
	Crude	SNAP-IV ADHD-Combined	192	0.16	0.02, 0.30	.007
		Inattention	192	0.48	0.23, 0.73	< .001
	Model SNAP-IV	Hyperactivity/Impulsivity		−0.10	−0.33, 0.13	.389
		Initiate	188	0.09	−0.10, 0.28	.351
		Working Memory		0.01	−0.17, 0.19	.895
	Model BRIEF MI	Plan/Organize		0.18	−0.01, 0.38	.066
		Organization of Materials		−0.06	−0.21, 0.10	.445
Anger	Crude	BRIEF BRI	193	0.27	0.13, 0.41	< .001
	Crude	BRIEF MI	190	0.28	0.08, 0.48	< .001
	Crude	CPT-II Confidence Index	195	0.07	−0.02, 0.16	.049
	Crude	Wechsler Processing Speed	181	0.01	−0.15, 0.17	.854
	Crude	Wechsler Working Memory	182	−0.12	−0.29, 0.05	.050
	Crude	SNAP-IV ADHD-Combined	192	0.28	0.12, 0.44	< .001
		Inhibition	190	0.13	−0.24, 0.18	.114
		Emotional Control		0.23	−0.16, 0.22	.008
	Model BRIEF BRI	Flexibility		−0.10	0.03, 0.45	.176
		Monitor		0.06	−0.19, 0.14	.491
		Initiate	188	−0.03	−0.03, 0.29	.760
		Working Memory		0.03	0.06, 0.40	.779
	Model BRIEF MI	Plan/Organize		0.24	−0.26, 0.05	.027
		Organization of Materials		−0.02	−0.11, 0.22	.765
		CPT-II Omission	177	0.16	0.02, 0.31	.022
		CPT-II Commission		−0.01	−0.20, 0.19	.993
	Model performance-	CPT-II RT (mean)		0.01	−0.21, 0.22	.978
	based EF	CPT-II RT SE		0.01	−0.22, 0.23	.939
		Wechsler Processing speed		0.08	−0.05, 0.20	.237
		Wechsler Working memory		−0.10	−0.23, 0.04	.158
		Inattention	192	0.27	−0.01, 0.55	.061
	Model SNAP-IV	Hyperactivity/Impulsivity		0.30	0.05, 0.55	.018

[i] ADHD: attention deficit hyperactivity disorder. b: unstandardized estimate. BRI: behavioral regulation index. BRIEF: Behavior Rating Inventory of Executive Function. CPT: continuous performance test. MI: metacognition index. RT: reaction time. SE: standard error. SNAP-IV: Swanson-Nolan-Pelham scale, fourth edition.

The number of observations in the ADHD group varied due to partial attrition. The Anxiety Inventory (of the Beck Youth Inventories) was sex standardized in T scores (m = 50; SD = 10). The CPT II and BRIEF were age- and sex-standardized in T scores. Parent-rated SNAP-IV was measured as a summary score. Higher scores indicate greater impairment in all measures except Wechsler working memory and processing speed (measured in age standardized IQ scores, m = 100, SD = 15). Significant results in bold text.

Table 3

Odds ratios, 95% confidence intervals and p-palues for the effect of parent-rated EF and performance-based neurocognitive Tests and ADHD symptoms on parent-rated internalizing symptoms at baseline and follow-up.

Crude/Model	Independent Variables	n	OR [95% CI]	p
Crude	BRIEF BRI	215	1.08 [1.04, 1.12]	< .001
Crude	BRIEF MI	213	1.10 [1.04, 1.15]	< .001
Crude	CPT-II Confidence Index	212	1.01 [1.00, 1.02]	.109
Crude	Wechsler Processing Speed	197	1.00 [0.97, 1.03]	.887
Crude	Wechsler Working Memory	197	0.96 [0.93, 0.99]	.008
Crude	SNAP-IV ADHD-Combined	218	1.08 [1.03, 1.13]	< .001
Model SNAP-IV	Inattention	218	1.09 [1.02, 1.16]	.010
	Hyperactivity/Impulsivity		1.07 [1.02, 1.12]	.008
	Inhibition		0.98 [0.95, 1.02]	.367
Model BRIEF BRI	Emotional Control	211	1.05 [1.01, 1.09]	.011
	Flexibility		1.02 [0.99, 1.06]	.212
	Monitor		1.05 [1.01, 1.10]	.026
	Initiate		1.05 [1.01, 1.10]	.020
Model BRIEF MI	Working Memory	209	1.00 [0.96, 1.05]	.917
	Plan/Organize		1.04 [0.99, 1.09]	.088
	Organization of Materials		1.02 [0.98, 1.05]	.422
	CPT-II Omission		1.00 [0.97, 1.03]	.840
	CPT-II Commission		1.00 [0.96, 1.04]	.873
Model performance-based EF	CPT-II RT (mean)	193	0.97 [0.93, 1.02]	.242
	CPT-II RT (SE)		1.05 [1.00, 1.11]	.063
	Wechsler Processing Speed		1.01 [0.99, 1.04]	.259
	Wechsler Working memory		0.97 [0.94, 1.00]	.026

[i] ADHD = attention deficit hyperactivity disorder; OR = odds ratio; CI = confidence interval; SDQ = Strengths and Difficulties Questionnaire: BRIEF = Behavior Rating of Executive Function; BRI = Behavior Regulation Index; MI = Metacognitive Index; CPT-II = Conners’ Continuous Performance Test; SNAP-IV = Swanson-Nolan-Pelham scale, Fourth Edition.

The number of observations in the ADHD group varied due to partial attrition. Parent-Rated Internalizing Symptoms were measured using the Five to Fifteen questionnaire at baseline and the Strengths and Difficulties Questionnaire at follow-up, with a 90^th cut-off according to normative data. The CPT II and BRIEF were age- and sex-standardized in T scores. Parent-rated SNAP-IV was measured as a summary score. Higher scores indicate greater impairment in all measures except Wechsler working memory and processing speed (measured in age standardized IQ scores, m = 100, SD = 15). Significant results in bold text.

Table 4

Estimates (b), 95% confidence intervals, and p-values for the effect of follow-up time, and belonging to the ADHD group on Anxiety, Depression, and Anger subscales of the Beck Youth Inventories in the ADHD and the Control group, and slope differences across groups.

Model	Independent variables	b	95% CI	p
Anxiety	Slope ADHD group	−0.30	−0.96, 0.35	.361
	Slope Control group	1.55	0.63, 2.47	.001
	Slope difference	−1.85	−2.98, −0.72	0.002
Depression	Slope ADHD group	−0.49	−1.11, 0.12	.112
	Slope Control group	1.32	0.47, 2.17	.003
	Slope difference	−1.82	−2.86, −0.77	0.001
Anger	Slope ADHD group	−0.89	−1.54, −0.24	.008
	Slope Control group	−0.46	−1.37, 0.46	.328
	Slope difference	−0.44	−1.56, 0.69	0.444

[i] ADHD = attention deficit hyperactivity/impulsivity disorder; b = unstandardized estimate; CI = confidence interval. Significant results in bold text.

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DOI: https://doi.org/10.2478/sjcapp-2022-0008 | Journal eISSN: 2245-8875

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Language: English

Page range: 72 - 86

Published on: Jul 3, 2022

Published by: Center for Evidence-based Psychiatry

In partnership with: Paradigm Publishing Services

Publication frequency: 1 issue per year

Keywords:

ADHD,

emotional symptoms,

follow-up,

executive functioning,

youth

Related subjects:

Medicine,

Basic medical science,

Basic medical science, other

© 2022 Pia Tallberg, Kristina Svanberg, Anne-Li Hallin, Maria Rastam, Peik Gustafsson, Sean Perrin, published by Center for Evidence-based Psychiatry
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.

Volume 10 (2022): Issue 1 (January 2022)

The three-year outcome of emotional symptoms in clinically referred youth with ADHD and their relationship to neuropsychological functions

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