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The evaluation of performance validity is an essential part of any neuropsychological evaluation. Validity indicators embedded in routine neuropsychological tests offer a time-efficient option for sampling performance validity throughout the assessment while reducing vulnerability to coaching. By administering a comprehensive neuropsychological test battery to 57 adults with ADHD, 60 neurotypical controls, and 151 instructed simulators, we examined each test's utility in detecting noncredible performance. Cut-off scores were derived for all available outcome variables. Although all ensured at least 90% specificity in the ADHD Group, sensitivity differed significantly between tests, ranging from 0% to 64.9%. Tests of selective attention, vigilance, and inhibition were most useful in detecting the instructed simulation of adult ADHD, whereas figural fluency and task switching lacked sensitivity. Five or more test variables demonstrating results in the second to fourth percentile were rare among cases of genuine adult ADHD but identified approximately 58% of instructed simulators.

Neuropsychological assessments of attention are valuable sources of information in the clinical evaluation of adults with attention-deficit/hyperactivity disorder (ADHD). However, it is unclear whether the attention performance of adults with ADHD is stable or fluctuates over time, which is of great importance in the interpretation of clinical assessments. This study aimed to explore the stability of attention performance of adults with ADHD in repeated assessments at one-month intervals. Twenty-one adults diagnosed with ADHD took part in this study by completing selective attention and vigilance tests three times, each one month apart. Test scores of participants were compared with and interpreted based on test norms. A considerable proportion of 'below average' performance scores were observed in most of the variables of selective attention and vigilance in all three assessments. Further, selective attention and vigilance performance scores did not differ significantly between the three repeated assessments. Finally, the majority of participants received consistent test score interpretations across the three repeated assessments. This study confirms previous research and highlights abnormal selective attention and vigilance performance in adults with ADHD. Further, this study preliminarily demonstrates relatively stable attention performance across repeated assessments, which has the potential to support clinical assessment, treatment planning, and evaluation.

Background: Many clinical studies reported deficits in basic and complex cognitive functions in adults with Attention-Deficit/Hyperactivity Disorder (ADHD). However, the extent in which deficits in basic functions (i.e., processing speed and distractibility) contribute to complex cognitive impairments (i.e., working memory, planning, cognitive flexibility, memory functions) in adults with ADHD is not well-studied. So far, literature show only one study, revealing that basic functions explain 27-74% of executive dysfunctions. Yet, the authors reported that findings could be affected by the selection of neuropsychological tests. The goal of the present research is to replicate such a finding using a different sample and a different set of neuropsychological tests., Methods: Forty-eight adult patients with ADHD were compared with 48 healthy controls in basic cognitive functions, namely processing speed and distractibility and more complex cognitive functions, namely selective attention, cognitive flexibility, planning, working memory, verbal fluency, and verbal memory. Basic and complex cognitive functions were assessed using the Vigilance and Sustained Attention, Selective Attention, N-Back, Tower of London, Trail Making Test, Word Fluency, and Verbal Learning and Memory., Results and Conclusion: Logistic regression analyses showed that impairments in complex cognitive functions explained 25% of the variance in ADHD diagnosis. The explained variance dropped from 25% to 9% after considering basic functions of processing speed and distractibility. This 64% reduction highlights the importance of basic functions for impairments in complex functions in patients with ADHD., Competing Interests: The authors have declared that no competing interests exist.

Stigmatization represents a major barrier to treatment seeking across mental disorders. Despite this, stigma research on individual mental disorders remains in its infancy. Attention-deficit hyperactivity disorder (ADHD) in adults also represents an under-researched area-being far less studied than its child counterpart. This study examined the current state of public perceptions towards adult ADHD. A simulation group consisting of 105 participants performed the Weiss Functional Impairment Rating Scale (WFIRS) and Conners' Adult ADHD Rating Scales (CAARS) as though they had ADHD. These scores were compared to a group consisting of 98 individuals with adult ADHD and a group of 117 healthy individuals both groups being instructed to complete the WFIRS and CAARS to the best of their abilities. Simulators were found to overestimate impairments in adult ADHD (to a large effect) in the domains of hyperactivity, DSM-IV hyperactivity-impulsivity, DSM-IV total, work, school, (to a medium effect) in family and social, and (to a negligible-small effect) in inattention, impulsivity, DSM-IV inattention, and life skills when compared to the ADHD group, and in all domains (to a large effect) when compared to the control group. Current and retrospective ADHD symptoms were found to be associated with more accurate perceptions in a number of domains. Evidence for the presence of perceptions considered to be stigmatizing was found, with largest effects present in the domains of hyperactivity, impulsivity, impairments at work, school, and engagement in risky behaviour., (© 2020. The Author(s).)

Adults diagnosed with attention-deficit/hyperactivity disorder (ADHD) commonly experience impairments in multiple domains of daily living. Work has a central role in daily life and is susceptible to ADHD due to its cognitive demands. The present study seeks to examine the nature of work-related problems and impairments of adults with ADHD, and explores the association to ADHD symptoms and neuropsychological test performance. A community sample of 1231 individuals took part in this study and completed a set of questionnaires assessing ADHD symptoms and work-related problems. Furthermore, a clinical sample of 134 adults diagnosed with ADHD were recruited from an ADHD outpatient clinic, who completed the same set of questionnaires. A subsample of 51 patients with ADHD additionally performed a neuropsychological assessment using tests of attention and executive functions. Work-related problems were found both in individuals of the community sample with symptoms of ADHD and individuals diagnosed with ADHD. Individuals with ADHD reported work related problems particularly in not meeting their own standards and perceived potential, yet it less commonly manifests in negative performance evaluations at work or job loss. ADHD symptoms, in particular symptoms of inattention, were found to be strongly associated with work-related problems, whereas neuropsychological test performance was no meaningful predictor of functioning at work. This study emphasizes the susceptibility of individuals' functioning at work to ADHD symptoms and impairments associated with ADHD. ADHD related difficulties at work should be considered in the clinical evaluation and targeted screening at the work place to provide support when indicated., (© 2021. The Author(s).)

As attention-deficit/hyperactivity disorder (ADHD) is a feasible target for individuals aiming to procure stimulant medication or accommodations, there is a high clinical need for accurate assessment of adult ADHD. Proven falsifiability of commonly used diagnostic instruments is therefore of concern. The present study aimed to develop a new, ADHD-specific infrequency index to aid the detection of non-credible self-report. Disorder-specific adaptations of four detection strategies were embedded into the Conners' Adult ADHD Rating Scales (CAARS) and tested for infrequency among credible neurotypical controls (n = 1001) and credible adults with ADHD (n = 100). The new index' ability to detect instructed simulators (n = 242) and non-credible adults with ADHD (n = 22) was subsequently examined using ROC analyses. Applying a conservative cut-off score, the new index identified 30% of participants instructed to simulate ADHD while retaining a specificity of 98%. Items assessing supposed symptoms of ADHD proved most useful in distinguishing genuine patients with ADHD from simulators, whereas inquiries into unusual symptom combinations produced a small effect. The CAARS Infrequency Index (CII) outperformed the new infrequency index in terms of sensitivity (46%), but not overall classification accuracy as determined in ROC analyses. Neither the new infrequency index nor the CII detected non-credible adults diagnosed with ADHD with adequate accuracy. In contrast, both infrequency indices showed high classification accuracy when used to detect symptom over-report. Findings support the new indices' utility as an adjunct measure in uncovering feigned ADHD, while underscoring the need to differentiate general over-reporting from specific forms of feigning., (© 2021. The Author(s).)

Although attention deficit hyperactivity disorder (ADHD) in adulthood is associated with marked cognitive impairment, research on metacognition in adult ADHD is scarce. Deficits in metacognition may have a negative impact on treatment adherence, functional outcomes, and everyday life. This study explores metacognition, specifically self-awareness of cognitive performance, in adults with ADHD by combining objective and subjective assessments. Forty-seven patients with ADHD and 47 control individuals completed a neuropsychological assessment battery including tests for attention, executive functions and memory (objective assessment), as well as questionnaires for cognitive functioning and symptom severity (subjective assessment; self- and informant-report). Participants evaluated their test performance of the objective assessment after test completion by selecting a percentile rank which was subtracted from their normed test result, yielding a discrepancy score. Compared to controls, adults with ADHD showed impairments in attention (medium effects) and memory (small and medium effects), but not in executive functions. The discrepancy scores between self-evaluation and cognitive performance revealed deficits in self-awareness of attentional functions (small effects), but not in executive functions and memory in patients with ADHD compared to controls. Discrepancy scores between self- and informant-reports of cognitive functioning revealed no significant differences. Adults with ADHD show impairments in metacognition in attentional functions, but may have intact metacognitive abilities in other domains. Patients with ADHD tend to overestimate their abilities, especially in attentional functions. Subjective and objective measures of metacognition may not correspond, highlighting the need for clinicians to not solely rely on patients' self-report in their assessment., (© 2021. The Author(s).)

Objective: Previous research indicated that adults with ADHD may have deficits in metacognition, yet the evidence base is scarce. This study aims to explore the existence and nature of metacognitive deficits in adults with ADHD, how psychopathology (such as inattention and depression) may affect metacognition and whether metacognition may impact daily functioning in adults with ADHD., Method: Forty-six adult patients with ADHD and 46 controls completed questionnaires for metacognition, psychopathology and daily functioning (subjective assessment; self- and informant report). Participants performed two attention tests in a neuropsychological assessment. After test completion, participants were asked to evaluate their performance with the help of a visual aid and this self-evaluation of test performance was compared with their actual test performance (objective assessment)., Results: Patients with ADHD reported large deficits in knowledge of cognition and medium deficits in regulation of cognition compared to controls. Self-evaluation of cognitive test performance revealed no significant deficits. Regression analyses revealed that psychopathology may explain a part of the variation in metacognition. Further regressions indicated that metacognition may account for a significant and meaningful proportion of variance in daily functioning, both self-rated and informant-rated., Conclusions: Current findings of compromised metacognitive functioning of adults with ADHD suggest that clinicians may not want to rely on patients' self-reports in the clinical assessment. Inattention predicted impairments in metacognition, pointing toward the importance of attention for awareness and metacognition. Finally, we recommend that metacognition is addressed in the treatment trajectory of patients with ADHD, given that aspects of metacognition were directly linked to impairments in daily functioning as rated by participants and their relatives.

The Everyday Life Attention Scale (ELAS) is a sensitive and reliable self-report questionnaire assessing attentional capacities of respondents in nine different situations of daily life. The ELAS has the potential to add relevant information to the clinical evaluation of attention deficits, to guide treatment planning, as well as to evaluate treatment outcome. The present study provides normative data of 1,874 Dutch speaking participants, ranging from 18 to 76 years of age, with mixed levels of education and a roughly equal distribution in gender. Normative data are calculated based on multiple linear regression models for each of the nine ELAS situations. In this article, the ELAS questionnaire as well as norm data are offered free of use. Use of normative ELAS data as presented in this study enables its use in clinical practice and research. Potential applications of the ELAS and future directions are discussed.

Background: Attention-deficit/hyperactivity disorder (ADHD) has been associated with hyperfocus, a transient experience of enhanced attentional focus and diminished awareness of time and the environment., Aims: This study aims to investigate the association between the frequency, duration and pervasiveness of hyperfocus across different situations in adults with and without ADHD., Method and Procedures: Within a healthy sample (n = 1124), we analysed correlations between scores on the ADHD Rating Scale and self-reports of frequency, duration and pervasiveness of hyperfocus. An ADHD patient group (n = 78) was compared to matched healthy participants on all hyperfocus variables., Outcomes and Results: In healthy adults, the frequency of hyperfocus was positively correlated with ADHD traits; older age and higher education were correlated with fewer hyperfocus occurrences in a smaller number of situations. ADHD patients and matched controls did not differ in the occurrence, frequency, duration and pervasiveness of hyperfocus, but hyperfocus was less likely to occur in educational and social situations in ADHD patients., Conclusions and Implications: Hyperfocus experiences are not specific of ADHD patients. The divergent findings might reflect multiple hyperfocus dimensions (situational and motivational) assessed in different studies which need to be addressed in future research., (Copyright © 2020 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Attention deficit hyperactivity disorder (ADHD) in adulthood is associated with impairment of multiple aspects of cognition which adversely affect the individual's everyday functioning. However, little is known about how these impairments are intertwined. This study explores whether impairments in basic processes (processing speed and distractibility) in adults with ADHD explain impairments in higher order functions, namely executive functions, memory, and complex attention. Furthermore, it is explored whether pharmacological treatment with methylphenidate (MPH) affects basic processes and higher order functions. A between-subjects design compared patients with ADHD without stimulant drug treatment (N = 55) and patients with ADHD treated with MPH (N = 31) with a healthy control group (N = 80). A neuropsychological test battery assessing basic processes and higher order functions was administered. Hierarchical logistic regression analyses were performed to evaluate the contribution of basic processes to impairments in higher order functions. Patients with ADHD not treated with MPH showed impairments in basic processes and higher order functions compared to controls. The impairments in basic processes explained 41-43% of impairments in executive functions, 27-29% in memory, and 56-74% in complex attention. In patients with ADHD treated with MPH, basic processes were not impaired and did not contribute significantly to impairments of higher order functions. Basic processes may constitute part of the foundation of cognitive impairments in adult ADHD. MPH may improve cognitive performance, presumably through improving basic processes. Applying this information could optimize neuropsychological assessments and inform treatment strategies by targeting basic processes.

Introduction : The Structured Interview of Reported Symptoms (SIRS-2) utilizes various strategies in the detection of simulated psychiatric disorders. The present study aimed to examine which of these strategies proves most useful in uncovering feigned attention deficit hyperactivity disorder (ADHD) in adulthood. Method : One-hundred seventy-one individuals instructed to feign ADHD were compared to 46 genuine patients with ADHD as well as 99 neurotypical controls in their reports provided on the SIRS-2. Results : Responses provided by simulators resembled those of genuine patients with ADHD on all SIRS-2 subscales with the exception of a supplementary scale tapping Overly Specified symptom reports, where a moderate effect emerged ( d = 0.88). Classification accuracy remained low, with particularly poor sensitivity (sensitivity = 19.30%). Sensitivity was higher when the decision rules postulated in the first edition SIRS were applied instead of its successor's decision model, yet this increase in sensitivity came at the price of unacceptably low specificity. Conclusion : The present results call for a disorder-specific instrument for the detection of simulated ADHD and offer starting points for the development of such a tool.

This study describes the development and utility of a new self-report measure of attentional capacities of adults with Attention Deficit Hyperactivity Disorder (ADHD): the Everyday Life Attention Scale (ELAS). Different from previous attention scales, attentional capacities are rated for nine everyday situations. Study 1 investigated the factor structure, validity, and reliability of the ELAS in 1206 healthy participants. Confirmatory factor analysis supported a situation-specific approach which categorizes everyday attention into nine situation scales: Reading, Movie, Activity, Lecture, Conversation, Assignment, Cooking, Cleaning up, and Driving. Each scale was composed of ratings for sustained, focused, selective, and divided attention as well as motivation, and had good internal consistency. Most scales showed weak correlations with ADHD Symptoms, Executive Functioning, and Memory Efficacy. Study 2 further investigated the sensitivity of the ELAS in 80 adults with ADHD compared to matched healthy controls and a mixed clinical group of 56 patients diagnosed with other psychiatric disorders. Compared to healthy controls, patients with ADHD reported reduced attentional capacities with large effect sizes on all situation scales and had a substantially higher number of situations with impaired attention scores. The ELAS may become useful in the clinical evaluation of ADHD and related psychiatric disorders in adults.

Objectives: Several approaches, ranging from self-ratings of symptoms and impairments to objective neuropsychological testing, have been utilized during clinical evaluation in order to assess symptom and performance validity of individuals with attention-deficit/hyperactivity disorder (ADHD) in adulthood. Motor activity has not been considered yet in this context, which is surprising given that hyperactivity is a prominent characteristic of ADHD. Hence, the goal of the present study was to explore the incremental value of motor activity when assessing the credibility of individuals with adult ADHD at clinical evaluation., Method: Forty-six patients diagnosed with ADHD took part in the study. A simulation design was performed, in which 152 healthy individuals were allocated to either a control condition (n = 36) or one of three simulation conditions (n = 116), the latter requesting participants to feign ADHD. All participants completed a self-rating scale of cognitive functioning and performed a computerized test for vigilance. Body movements were recorded during vigilance testing via a motion tracker attached to the back of the participant's chair., Results: Patients with ADHD reported significantly more pronounced cognitive complaints and performed significantly poorer on the vigilance test than control participants. Simulators of ADHD, as compared to genuine patients, showed excessively low performance on the vigilance test. However, neither self-ratings of cognitive functioning nor measures of motor activity were suitable to distinguish genuine from feigned ADHD. A hierarchical logistic regression model showed that motor activity had no incremental value in detecting feigned ADHD when vigilance test performance has already been considered., Conclusions: Standard neuropsychological tests of vigilance may be useful to measure both performance and credibility of individuals with adult ADHD at clinical evaluation. In contrast, self-reports of symptoms and impairments, as well as measures of body movements, may not support the assessment of credibility in this context.

Objective: A growing body of research questions the reliance of symptom self-reports in the clinical evaluation of attention-deficit/hyperactivity disorder (ADHD) in adulthood. A recent study suggested that also impairment reports are vulnerable to noncredible responses, as derived from a simulation design using a global functional impairment scale. The present study aims to add evidence to this issue, by using an ADHD specific impairment scale in a simulation design on large samples., Method: Impairment ratings on the Weiss Functional Impairment Rating Scale (WFIRS) of 62 patients with ADHD were compared to 142 healthy individuals who were instructed to show normal behavior. Furthermore, impairment ratings of patients with ADHD were compared to ratings of 330 healthy individuals who were randomly assigned to one of four simulation conditions that were instructed to complete the scale as if they had ADHD., Results: Patients with ADHD reported higher levels of impairment than the healthy control group in all domains of life. Furthermore, individuals instructed to feign ADHD indicated higher levels of impairments in most domains of life compared to control participants and genuine patients with ADHD. The group differences between individuals feigning ADHD and individuals with genuine ADHD, however, were only small to moderate. Further analyses revealed that the WFRIS was not useful to successfully differentiate genuine from feigned ADHD., Conclusions: The present study confirms the conclusion that self-reported impairments are susceptible to noncredible responses and should be used with caution in the clinical evaluation of adult ADHD.

The assessment of performance validity is an essential part of the neuropsychological evaluation of adults with attention-deficit/hyperactivity disorder (ADHD). Most available tools, however, are inaccurate regarding the identification of noncredible performance. This study describes the development of a visuospatial working memory test, including a validity indicator for noncredible cognitive performance of adults with ADHD. Visuospatial working memory of adults with ADHD (n = 48) was first compared to the test performance of healthy individuals (n = 48). Furthermore, a simulation design was performed including 252 individuals who were randomly assigned to either a control group (n = 48) or to 1 of 3 simulation groups who were requested to feign ADHD (n = 204). Additional samples of 27 adults with ADHD and 69 instructed simulators were included to cross-validate findings from the first samples. Adults with ADHD showed impaired visuospatial working memory performance of medium size as compared to healthy individuals. Simulation groups committed significantly more errors and had shorter response times as compared to patients with ADHD. Moreover, binary logistic regression analysis was carried out to derive a validity index that optimally differentiates between true and feigned ADHD. ROC analysis demonstrated high classification rates of the validity index, as shown in excellent specificity (95.8%) and adequate sensitivity (60.3%). The visuospatial working memory test as presented in this study therefore appears sensitive in indicating cognitive impairment of adults with ADHD. Furthermore, the embedded validity index revealed promising results concerning the detection of noncredible cognitive performance of adults with ADHD. (PsycINFO Database Record, ((c) 2017 APA, all rights reserved).)

Neuropsychological research on adults with attention deficit hyperactivity disorder (ADHD) revealed considerable impairments in memory functions related to executive control. However, only limited evidence exists supporting the effects of pharmacological treatment using methylphenidate (MPH) on memory functions. The aim of the present study was, therefore, to explore the impact of MPH on various memory functions of adults with ADHD. Thirty-one adults with ADHD treated with MPH, 36 adults with ADHD not-treated with MPH, and 36 healthy individuals were assessed on several aspects of memory, including short-term memory, working memory, retrospective memory, prospective memory, and source memory. Multivariate statistical analyses were applied to compare memory functions between groups. Nonmedicated adults with ADHD showed considerable impairments in memory functions related to executive control. Adults with ADHD treated with MPH showed improved memory functions when compared to nonmedicated patients, but were still impaired when compared to healthy controls. The present study emphasized the severity of memory impairments of adults with ADHD. A pharmacological treatment with MPH appeared to improve memory, but does not normalize functioning. Additional treatment intervention (e.g., cognitive-behavioral therapy) is therefore necessary.

Neuropsychological research on adults with ADHD showed deficits in various aspects of attention. However, the majority of studies failed to explore the change of performance over time, so-called time-on-task effects. As a consequence, little is known about sustained attention performance of adults with ADHD. The aim of the present study was therefore to test the hypothesis of sustained attention deficits of adults with ADHD. Twenty-nine adults with ADHD and 30 healthy individuals were assessed on four 20-min tests of sustained attention, measuring alertness, selective attention, divided attention and flexibility. The deterioration of performance over time (time-on-task effects) was compared between patients with ADHD and healthy individuals to conclude on sustained attention performance. Compared to healthy individuals, patients with ADHD showed significant deficits of medium size in selective attention and divided attention. Furthermore, medium sustained attention deficits was observed in measures of alertness, selective attention and divided attention. This study supports the notion of sustained attention deficits of adults with ADHD., Competing Interests: The authors declare that they have no conflict of interest. Ethical approval All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent Informed consent was obtained from all individual participants included in the study.

Adults with attention deficit hyperactivity disorder (ADHD) suffer from various impairments of cognitive, emotional and social functioning, which can have considerable consequences for many areas of daily living. One of those areas is driving a vehicle. Driving is an important activity of everyday life and requires an efficient interplay between multiple cognitive, perceptual, and motor skills. In the present study, a selective review of the literature on driving-related difficulties associated with ADHD is performed, seeking to answer whether individuals with ADHD show increased levels of unsafe driving behaviours, which cognitive (dys)functions of individuals with ADHD are related to driving difficulty, and whether pharmacological treatment significantly improves the driving behaviour of individuals with ADHD. The available research provides convincing evidence that individuals with ADHD have different and more adverse driving outcomes than individuals without the condition. However, it appears that not all individuals with ADHD are affected uniformly. Despite various cognitive functions being related with driving difficulties, these functions do not appear helpful in detecting high risk drivers with ADHD, nor in predicting driving outcomes in individuals with ADHD, since impairments in these functions are defining criteria for the diagnoses of ADHD (e.g., inattention and impulsivity). Pharmacological treatment of ADHD, in particular stimulant drug treatment, appears to be beneficial to the driving difficulties experienced by individuals with ADHD. However, additional research is needed, in particular further studies that address the numerous methodological weaknesses of many of the previous studies., Competing Interests: The authors declare that they have no conflict of interest.

Objectives: It has been shown that an increasing number of adults deliberately feign attention deficit hyperactivity disorder (ADHD), which demonstrates the need for new tests designed to detect feigned ADHD., Methods: An Embedded Figures Test (EFT) was developed for the detection of feigned ADHD in adulthood. EFT performance of 51 adults with ADHD was compared to the performance of 52 matched healthy individuals, as well as to 268 undergraduate students who were randomly allocated in a simulation design to one of four experimental conditions, i.e. a control group, a naïve simulation group, a symptom-coached simulation group or a test-coached simulation group. Furthermore, an independent sample of 11 adults with ADHD as well as a sample of 17 clinicians experienced in the work with adults with ADHD were assessed for further validation of the EFT., Results: The EFT was relatively easy to perform for both patients with ADHD and healthy comparisons as shown by low error rates and non-significant group differences. However, simulation groups differed from patients with ADHD by significant and large effects. An EFT index for the prediction of feigned ADHD was derived based on logistic regression coefficients. Receiver Operating Characteristics (ROC) demonstrated good classification accuracy of feigned ADHD relative to ADHD (AUC = 94.8%), i.e. high sensitivity (88%) and specificity (90%)., Conclusions: This study supports the utility of the EFT for the detection of feigned adult ADHD., Competing Interests: The authors have declared that no competing interests exist.

Adults with attention deficit hyperactivity disorder (ADHD) show attentional dysfunction such as distractibility and mind-wandering, especially in lengthy tasks. However, fundamentals of dysfunction are ambiguous and relationships of neuropsychological test parameters with self-report measures of ADHD symptoms are marginal. We hypothesize that basic deficits in sustaining attention explain more complex attentional dysfunction in persons with ADHD and relate to ADHD symptoms. Attentional function was analyzed by computing ex-Gaussian parameters for 3 time Blocks in a 20 min test of sustained alertness. Changes in performance across these blocks were analyzed by comparing adult persons with ADHD (n = 24) with healthy matched controls (n = 24) and correlated with neuropsychological measures of selective and divided attention as well as self-report measures of ADHD symptoms. We found a significantly steeper increase in the number of slow responses (ex-Gaussian parameter τ) in persons with ADHD with time on task in basic sustained alertness. They also performed significantly worse in tasks of sustained selective and divided attention. However, after controlling for an increase in τ during the alertness task, significant differences between groups disappeared for divided and partly selective attention. Increases in τ in the sustained alertness task correlated significantly with self-report measures of ADHD symptoms. Our results provide evidence that very basic deficits in sustaining attention in adults with ADHD are related to infrequent slow responses (=attentional lapses), with changes over time being relevant for more complex attentional function and experienced ADHD symptoms in everyday life., (© The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objective: The assessment of cognitive functions of adults with attention deficit hyperactivity disorder (ADHD) comprises self-ratings of cognitive functioning (subjective assessment) as well as psychometric testing (objective neuropsychological assessment). The aim of the present study was to explore the utility of these assessment strategies in predicting neuropsychological impairments of adults with ADHD as determined by both approaches., Method: Fifty-five adults with ADHD and 66 healthy participants were assessed with regard to cognitive functioning in several domains by employing subjective and objective measurement tools. Significance and effect sizes for differences between groups as well as the proportion of patients with impairments were analyzed. Furthermore, logistic regression analyses were carried out in order to explore the validity of subjective and objective cognitive measures in predicting cognitive impairments., Results: Both subjective and objective assessment tools revealed significant cognitive dysfunctions in adults with ADHD. The majority of patients displayed considerable impairments in all cognitive domains assessed. A comparison of effect sizes, however, showed larger dysfunctions in the subjective assessment than in the objective assessment. Furthermore, logistic regression models indicated that subjective cognitive complaints could not be predicted by objective measures of cognition and vice versa., Conclusions: Subjective and objective assessment tools were found to be sensitive in revealing cognitive dysfunctions of adults with ADHD. Because of the weak association between subjective and objective measurements, it was concluded that subjective and objective measurements are both important for clinical practice but may provide distinct types of information and capture different aspects of functioning., (PsycINFO Database Record (c) 2015 APA, all rights reserved.)

Objective: Attention deficit disorder (ADHD) is commonly associated with inhibitory dysfunction contributing to typical behavioral symptoms like impulsivity or hyperactivity. However, some studies analyzing intraindividual variability (IIV) of reaction times in children with ADHD (cADHD) question a predominance of inhibitory deficits. IIV is a measure of the stability of information processing and provides evidence that longer reaction times (RT) in inhibitory tasks in cADHD are due to only a few prolonged responses which may indicate deficits in sustained attention rather than inhibitory dysfunction. We wanted to find out, whether a slowing in inhibitory functioning in adults with ADHD (aADHD) is due to isolated slow responses., Methods: Computing classical RT measures (mean RT, SD), ex-Gaussian parameters of IIV (which allow a better separation of reaction time (mu), variability (sigma) and abnormally slow responses (tau) than classical measures) as well as errors of omission and commission, we examined response inhibition in a well-established GoNogo task in a sample of aADHD subjects without medication and healthy controls matched for age, gender and education., Results: We did not find higher numbers of commission errors in aADHD, while the number of omissions was significantly increased compared with controls. In contrast to increased mean RT, the distributional parameter mu did not document a significant slowing in aADHD. However, subjects with aADHD were characterized by increased IIV throughout the entire RT distribution as indicated by the parameters sigma and tau as well as the SD of reaction time. Moreover, we found a significant correlation between tau and the number of omission errors., Conclusions: Our findings question a primacy of inhibitory deficits in aADHD and provide evidence for attentional dysfunction. The present findings may have theoretical implications for etiological models of ADHD as well as more practical implications for neuropsychological testing in aADHD.

Executive dysfunction of adults with ADHD is often associated with poor self-awareness of problems, such as in emotional competence, emotional recognition, and driving competence. However, with regard to cognitive functioning, little is known about how adults with ADHD evaluate their own cognitive performance. A total of 77 adults with ADHD and 116 healthy adults were assessed with self-report scales measuring several aspects of cognition. Significance and effect sizes as well as the proportion of patients perceiving impairments were calculated. Further analysis was carried out on the frequency of patients perceiving various types of impairments. Adults with ADHD perceived themselves to have significant and severe dysfunction in all areas of cognition assessed as a group. Furthermore, the majority of patients reported multiple impairments in attention, memory and executive functioning. The present study demonstrated that adults with ADHD are aware of problems in cognitive functioning as shown by considerable perceived neuropsychological impairment in the majority of patients. Patients with ADHD tended to report cognitive impairments in multiple domains rather than impairments in specific functions.

Objectives: The context of memory experiences is referred to as source memory and can be distinguished from the content of episodic item memory. Source memory represents a crucial part of biographic events and elaborate memory experiences. Whereas individuals with attention deficit hyperactivity disorder (ADHD) were shown to have inefficient item memory, little is known about the context of memory experiences., Methods: The present study compared 37 adult patients with a diagnosed ADHD with 40 matched healthy participants on a word list paradigm. Memory functions of encoding, retention and source discrimination were assessed. Furthermore, standardized measures of memory and executive control were applied in order to explore a qualitative differentiation of memory components., Results: Adult patients with ADHD showed impaired performance in encoding of new information whereas the retention of encoded items was found to be preserved. The most pronounced impairment of patients with ADHD was observed in source discrimination. Regression models of cognitive functions on memory components supported some qualitative differentiation., Conclusions: Data analysis suggests a differential pattern of memory impairment in adults suffering from ADHD with a particular deficit in source discrimination. Inefficient source discrimination in adults with ADHD can affect daily functioning by limiting biographic awareness and disturbing general cognitive processes.

Objectives: Attention deficit hyperactivity disorder (ADHD) in adults has been associated with disturbances of attention and executive functions. Furthermore, impairments of verbal and figural retrospective memory were reported. However, little is known about the effects of ADHD on prospective memory, the execution of delayed intentions in the future., Methods: The present study compared the performance of 45 adult patients with ADHD not treated with stimulant medication with the performance of 45 matched healthy individuals on a paradigm of complex prospective memory which measured task planning, plan recall, self-initiation and execution. Furthermore, the contribution of other cognitive functions to prospective memory functioning was assessed, including measures of attention, executive functions and memory., Results: A large-scale impairment could be observed in task planning abilities in patients with ADHD. Only negligible to small effects were found for plan recall, self-initiation and execution. Inhibition was identified to contribute significantly to performance on task planning., Conclusions: The present findings suggest that four cognitive components contribute to the performance of prospective memory. Impairments of prospective memory mainly emerged from deficient planning abilities in adults with ADHD. Implications on behavioral based intervention strategies are discussed.