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Attention-deficit/hyperactivity disorder with obstructive sleep apnea: a treatment outcome study.

BACKGROUND: Children diagnosed with attention-deficit/hyperactivity disorder (ADHD), based on Diagnostic and Statistical Manual of Mental Disorders, Fourth edition (DSM-IV) criteria, may also have obstructive sleep apnea (OSA), but it is unclear whether treating OSA has similar results as methylphenidate (MPH), a commonly used treatment for ADHD. METHODS: This study enrolled 66 school-age children, referred for and diagnosed with ADHD, and 20 healthy controls. Polysomnography (PSG) performed after ADHD diagnosis showed the presence of mild OSA. After otolaryngological evaluation, parents and referring physicians of the children could select treatment of ADHD with MPH, treatment of OSA with adenotonsillectomy or no treatment. Systematic follow-up was performed six months after initiation of treatment, or diagnosis if no treatment. All children had pre- and post-clinical interviews; pediatric, neurologic, psychiatric and neurocognitive evaluation; PSG; ADHD rating scale, child behavior checklist (CBCL) filled out by parents and teacher; test of variables of attention (TOVA); and the quality of life in children with obstructive sleep disorder questionnaire (OSA-18). RESULTS: ADHD children had an apnea-hypopnea index (AHI)>1<5 event/hour; 27 were treated with MPH, 25 had adenotonsillectomy, and 14 had no treatment. The surgical and MPH groups improved more than the non-treatment group. When comparing MPH to post-surgery, the PSG and questionnaire sleep variables, some daytime symptoms (including attention span) and TOVA subscales (impulse control, response time and total ADHD score) improved more in the surgical group than the MPH group. The surgical group had an ADHD total score of 21.16+/-7.13 on the ADHD rating scale (ADHD-RS) post-surgery compared to 31.52+/-7.01 pre-surgery (p=0.0001), and the inattention and hyperactivity subscales were also significantly lower (p=0.0001). Finally, the results were significantly different between surgically and MPH-treated groups (ADHD-RS p=0.007). The surgical group also had a TOVA ADHD score lower than -1.8 and close to those obtained in normal controls. CONCLUSION: A low AHI score of >1 considered abnormal is detrimental to children with ADHD. Recognition and surgical treatment of underlying mild sleep-disordered breathing (SDB) in children with ADHD may prevent unnecessary long-term MPH usage and the potential side effects associated with drug intake.

Adenoidectomy↗

Family history and psychiatric comorbidity in persons with kleptomania.

The current study was constructed to examine the family history and psychiatric comorbidity of a group of persons with kleptomania. Thirty-one subjects with DSM-IV kleptomania were administered the Structured Clinical Interview for DSM-IV (SCID) and the Minnesota Impulse Disorders Inventory (MIDI). The Family History Research Diagnostic Criteria (FH-RDC) were used to collect information about psychiatric disorders in first-degree relatives. Subjects with kleptomania were more likely than comparison subjects to have any lifetime impulse-control disorder (chi2=12.569; df=1; P<.001) and to have a first-degree relative with an alcohol use disorder (chi2=6.994; df=1; P=.008) or any psychiatric disorder (chi2=12.056; df=1; P=.001). Persons with kleptomania appear to have a higher lifetime prevalence of impulse-control disorders and are more likely to have first-degree relatives with alcohol problems than are comparison subjects.

Adult↗

Comparison of buying behavior in depressed patients presenting with or without compulsive buying.

Compulsive buying is defined as repetitive impulsive and excessive buying leading to personal and familial distress. This study compares the buying behavior of depressed patients presenting with or without compulsive buying. The weight of promotional factors such as sales and advertising campaigns was systematically assessed. The impulsive nature of compulsive buying and the choice of items purchased were also investigated. For this purpose, we studied buying behavior among 52 inpatients diagnosed for major depressive episode with DSM-IV criteria. None of the patients presented mania or hypomania, obsessive-compulsive disorder, or alcohol or drug abuse or dependence disorder. We assessed the prevalence of compulsive buying and compared the "buying style" among patients with (CB+) and without (CB-) compulsive buying. The diagnosis of depression was assessed with the Mini International Neuropsychiatric Interview (MINI). The diagnosis of compulsive buying was made using standardized criteria and a specific rating scale. All patients answered a specific questionnaire assessing the phenomenology of the buying behavior. Twenty-one of 52 depressives presented with compulsive buying. The CB+ group was not more sensitive to promotional factors. They did not seek sales or use loans significantly more than others. Upon entering a shop, the CB+ subjects did not change their choice more often than others. CB+ subjects were significantly more often alone while shopping (85% of cases v61% of CB- group, p = .05). Most purchases from the CB+ group were self-gifts or gifts to others (50.4% v 23.5%, p = .003); 14.4% of purchases in the CB+ group (v 2.2% in CB- group, P = .045) were made because the patients believed their social status requires acquisition. Items to be bought were more often considered by CB+ subjects as occasions not to be missed (31.4% v15.1%, P = .03). Purchases were significantly (57% v 16%) less often used than expected by the CB+ group (P = .002). Most purchases, in addition, represented gifts for oneself or others and were used significantly less often than expected.

Adult↗

[Efficiency of a gambling prevention program for youths: results from the pilot study].

UNLABELLED: A meta-analysis of North American studies indicates that the prevalence rate of pathological gambling varies between 4.4% and 7.4% among adolescents. Pathological gambling is thus not a phenomenon that suddenly appears once youths reach an adult age. On the contrary, significant contact with gambling occurs in childhood adolescence. For this reason, it is important to develop an effective gambling prevention program that will reduce the risk that youths will develop gambling problems. The information promoted in the prevention program our research team created and evaluated here teaches youths to recognize the traps of gambling activities, while enabling them to make an informed decision as to their eventual participation in those activities. The program is based on knowledge and recognition of key indices that can be easily identified as warning signs of a loss of control. It is predicted that youths who participate in this prevention program will improve their knowledge of gambling activities and will develop a more realistic attitude towards those activities than youths from a control group. The experimental group's problem-solving skills are also expected to improve. An experimental design (pre-test, post-test and follow-ups with control group) was used to evaluate the program's effectiveness. Overall, 1193 youths participated in this study. The prevention program involves three 60-minute meetings. The objectives of these meetings are the following: (meeting #1) improve youths' knowledge of gambling activities and help them acquire a more realistic attitude towards these activities; (meeting #2) teach a structured problem-solving approach to resist to peer-pressure; (meeting #3) inform youths of the consequences that may be associated with abusive participation in gambling and teach them to recognize warning signs of a loss of control over gambling habits. DEPENDENT VARIABLES: (a) knowledge of and attitudes towards gambling and gambling activities; (b) problem-solving skills; (c) frequency of participation in gambling activities; (d) discussion with relatives, friends and teachers regarding gambling activities and attention paid towards gambling habits among close friends and family. Participation in the gambling prevention program significantly improves youths' knowledge of the real probabilities of winning and the pitfalls included in gambling activities and favours the development of a more realistic attitude towards these activities. However, the participation in the prevention program does not help to improve their problem-solving skills. Nonetheless, it leads more youths to talk about gambling with their parents and teachers, and enables them to be more aware of the gambling habits of their friends and family. Finally, note that it was impossible to verify any decrease in gambling habits as the majority of participants (62%) were non or very occasional gamblers. However, no iatrogenic effect was observed on the frequency of participation in gambling activities. Aside the positive impact of the program on the attitudes and knowledge of students, participation in the preventive sessions contributed to create a dialogue with adults and increased youths' interest in the gambling habits of their friends and family. These discussions enabled the youths to validate the information they received during class, to consolidate what they learned during the prevention sessions, and favour the dissemination of this knowledge beyond the scope of the academic environment. The results obtained regarding youths' attitudes and knowledge demonstrate that attitude modification takes place progressively. However, once well assimilated, these new attitudes seem to take hold in a fairly durable way. On the other hand, acquisition of knowledge seems to take place immediately after the theoretical concepts are taught. Yet, they slightly decreased before stabilising a few months later. This suggests that assimilation of new knowledge may be optimized by the addition of an intervention session a couple of months after the end of the intervention. Even if it was impossible to verify any decrease in participants' gambling habits, it is possible to think that the impact of participation in the gambling prevention program could be observable and measurable within a few years. However, only a long-term follow-up study would make it possible to assess whether participation in the program does indeed contribute to decreasing gambling habits and the number of youths who regularly participate in gambling activities. Despite the non-significant results observed for problem-solving skills, it seems nonetheless important to include this component, which benefits from great theoretical support, especially within the framework of prevention programs targeting youths. However, the teaching method must be changed in order to maximize the intervention's effectiveness. Despite some methodological limitations observed during the evaluation of this program, the results obtained clearly demonstrate that participation in the prevention program significantly improves youths' attitudes and knowledge regarding gambling activities. The teaching of accurate knowledge and realistic attitudes towards gambling should help youths to recognize the cognitive traps inherent to gambling activities and thus contribute, over the long run, to decrease the number of youths with gambling problems.

Adolescent↗

Psychiatric features of individuals with problematic internet use.

BACKGROUND: Problematic internet use has been described in the psychological literature as 'internet addiction' and 'pathological internet use'. However, there are no studies using face-to-face standardized psychiatric evaluations to identify behavioral characteristics, psychiatric comorbidity or family psychiatric history of individuals with this behavior. METHODS: Twenty individuals with problematic internet use were evaluated. Problematic internet use was defined as (1) uncontrollable, (2) markedly distressing, time-consuming or resulting in social, occupational or financial difficulties and (3) not solely present during hypomanic or manic symptoms. Evaluations included a semistructured interview about subjects' internet use, the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-IV (SCID-IV), family psychiatric history and the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) modified for internet use. RESULTS: All (100%) subjects' problematic internet use met DSM-IV criteria for an impulse control disorder (ICD) not otherwise specified (NOS). All 20 subjects had at least one lifetime DSM-IV Axis I diagnosis in addition to their problematic internet use (mean+/-SD=5.1+/-3.5 diagnoses); 14 (70.0%) had a lifetime diagnosis of bipolar disorder (with 12 having bipolar I disorder). LIMITATIONS: Methodological limitations of this study included its small sample size, evaluation of psychiatric diagnoses by unblinded investigators, and lack of a control group. CONCLUSIONS: Problematic internet use may be associated with subjective distress, functional impairment and Axis I psychiatric disorders.

Adult↗

Serotonin transporter polymorphisms and measures of impulsivity, aggression, and sensation seeking among African-American cocaine-dependent individuals.

Considerable evidence indicates that serotonergic mechanisms, particularly the serotonin transporter (5HTT), may mediate central effects of cocaine and may also be involved in impulsive and aggressive behavior. We investigated whether polymorphisms in the 5HTT gene were related to traits of impulsivity, sensation seeking, and aggression among cocaine abusers. Standardized measures of these personality traits were obtained in a sample of 105 severely affected cocaine-dependent African-American subjects and 44 African-American controls. Two polymorphisms of the 5HTT gene were examined involving the 5' promoter (5HTTLPR) region and a 17 base pair variable-number-tandem-repeat (VNTR) marker among cocaine patients. No significant relationships were observed between polymorphic variants of the 5HTTLPR and VNTR regions and scores on any of the trait measures. Similarly, demographic variables and measures of severity of substance use and depression were unrelated to allele frequencies or genotype distributions of the variants among cocaine patients. As expected, cocaine patients scored significantly higher on total scores of impulsivity, aggression, and sensation seeking compared to controls. The findings do not seem to support an association between these polymorphisms in the 5HTT gene and impulsive-aggressive traits among cocaine-dependent African-American individuals.

Adolescent↗

A novel approach to assess inter-rater reliability in the use of the Overt Aggression Scale-Modified.

The ability of raters to apply measures of efficacy accurately and reproducibly in clinical trials of psychotropic medications is vital to the validity of study data. In a large, multi-center trial using the Overt Aggression Scale-Modified (OAS-M), inter-rater reliability was evaluated using standardized patients (SP) in a live 'mock' interview. Thirty raters experienced in the OAS-M each interviewed two actors trained to portray patients with intermittent explosive disorder, borderline and antisocial personality disorder, and/or post-traumatic stress disorder. Inter-rater reliability of OAS-M scores was evaluated using the intra-class correlation coefficient (ICC). The joint reliability of the raters in the study with an expert rater was also assessed by an ICC. The ICC was 0.96 between the raters, and 0.98 between the raters and expert rater. Results suggest that SP can be utilized in rater assessment and that raters administering the OAS-M in this model of rater reliability assessment demonstrate a high level of consistency and reliability. The method described here may be useful in future assessments of inter-rater reliability.

Adult↗

The soft bipolar spectrum redefined: focus on the cyclothymic, anxious-sensitive, impulse-dyscontrol, and binge-eating connection in bipolar II and related conditions.

The bipolar II spectrum represents the most common phenotype of bipolarity. Numerous studies indicate that in clinical settings this soft spectrum might be as common--if not more common than--major depressive disorders. The proportion of depressive patients who can be classified as bipolar II further increases if the 4-day threshold for hypomania proposed by the DSM-IV is reconsidered. The modal duration of hypomanic episodes is 2 days; highly recurrent brief hypomania is as short as 1 day, and when complicated by major depression, it should be classified as a variant of bipolar II. Another variant of the bipolar II pattern is represented by major depressive episodes superimposed on cyclothymic or hyperthymic temperamental characteristics. The literature is unanimous in supporting the idea that depressed patients who experience hypomania during antidepressant treatment belong to the bipolar II spectrum. So-called alcohol- or substance-induced mood disorders may have much in common with bipolar II spectrum disorders, in particular when mood swings outlast detoxification. Finally, many patients within the bipolar II spectrum, especially when recurrence is high and the interepisodic period is not free of affective manifestations, may meet criteria for personality disorders. This is particularly true for cyclothymic bipolar II patients, who are often misclassified as borderline personality disorder because of their extreme mood instability. Subthreshold mood lability of a cyclothymic nature seems to be the common thread that links the soft bipolar spectrum. The authors submit this to represent the endophenotype likely to be informative in genetic investigations. Mood lability can be considered the core characteristics of the bipolar II spectrum, and it has been validated prospectively as a sensitive and specific predictor of bipolar II outcome in major depressives. In a more hypothetical vein, cyclothymic-anxious-sensitive temperamental disposition might represent the mediating underlying characteristic in the complex pattern of anxiety, mood, and impulsive disorders that bipolar II spectrum patients display throughout much of their lifetimes. The foregoing conclusions, based on clinical experience and the research literature, challenge several conventions in the formal classificatory system (i.e., ICD-10 and DSM-IV). The authors submit that the enlargement of classical bipolar II disorders to include a spectrum of conditions subsumed by a cyclothymic-anxious-sensitive disposition, with mood reactivity and interpersonal sensitivity, and ranging from mood, anxiety, impulse control, and eating disorders, will greatly enhance clinical practice and research endeavors. Prospective studies with the requisite methodologic sophistication are needed to clarify further the relationship of the putative temperamental and developmental variables to the complex syndromic patterns described herein. The authors believe that viewing these constructs as related entities with a common temperamental diathesis will make patients in this realm more accessible to pharmacologic and psychological approaches geared to their common temperamental attributes. The authors submit that the use of the term "spectrum" is distinct from a simple continuum of subthreshold and threshold cases. The underlying temperamental dimensions postulated by the authors define the disposition for soft bipolarity and its variation and dysregulation in anxious disorders and dyscontrol in appetitive, mental, and behavioral disorders, much beyond affective disorders in the narrow sense.

Affect↗

The medicalization of compulsive buying.

Compulsive buying has recently been the subject of numerous articles from both consumer research and psychiatric perspectives. Identified by some researchers as a compulsion and by others as an addiction, common solutions to the problem have included drug treatments, participation in self-help groups and cognitive behaviour therapy. The purpose of this article is to examine critically the labelling of compulsive buying in terms of medicalization from the perspective of both medical and non-medical social control of "deviant" consumers. We suggest that the attempt to categorize compulsive buying as an illness represents the ongoing trend to medicalize behavioural problems which may be better understood within the wider context of related phenomena such as the fiscal crisis of the 1980s and 1990s and the consumption-driven economy of North America.

Behavior, Addictive↗

Kleptomania: clinical characteristics and associated psychopathology.

A review of research on kleptomania--the syndrome of compulsive stealing--suggests that kleptomania may be a common disorder, especially among women, and that it may frequently be associated with other forms of psychopathology, such as mood, anxiety, and eating disorders. There appears to be a range of abnormal or non-antisocial stealing behaviours, all with impulsive and/or compulsive features. Kleptomania, as defined by modern criteria, may represent the most compulsive variant. Kleptomania may be related to mood disorder, and might be a form of 'affective spectrum disorder'.

Antisocial Personality Disorder↗

Psychopathic personality traits: heritability and genetic overlap with internalizing and externalizing psychopathology.

BACKGROUND: Little research has examined genetic and environmental contributions to psychopathic personality traits. Additionally, no studies have examined etiological connections between psychopathic traits and the broad psychopathological domains of internalizing (mood and anxiety) and externalizing (antisocial behavior, substance abuse). The current study was designed to fill these gaps in the literature. METHOD: Participants were 626 pairs of 17-year-old male and female twins from the community. Psychopathic traits were indexed using scores on the Multidimensional Personality Questionnaire (MPQ). Symptoms of internalizing and externalizing psychopathology were obtained via structured clinical interviews. Structural equation modeling was used to estimate genetic and environmental influences on psychopathic personality traits as well as the degree of genetic overlap between these traits and composites of internalizing and externalizing. RESULTS: Twin analyses revealed significant genetic influence on distinct psychopathic traits (Fearless Dominance and Impulsive Antisociality). Moreover, Fearless Dominance was associated with reduced genetic risk for internalizing psychopathology, and Impulsive Antisociality was associated with increased genetic risk for externalizing psychopathology. CONCLUSIONS: These results indicate that different psychopathic traits as measured by the MPQ show distinct genetically based relations with broad dimensions of DSM psychopathology.

Adolescent↗

Personality subtyping and bulimia nervosa: psychopathological and genetic correlates.

BACKGROUND: There is empirical evidence suggesting that individuals with bulimia nervosa vary considerably in terms of psychiatric co-morbidity and personality functioning. In this study, latent profile analysis was used to attempt to identify clusters of bulimic subjects based on psychiatric co-morbidity and personality. METHOD: A total of 178 women with bulimia nervosa or a subclinical variant of bulimia nervosa completed a series of self-report inventories of co-morbid psychopathology and personality, and also provided a buccal smear sample for genetic analyses. RESULTS: Three clusters of bulimic women were identified: an affective-perfectionistic cluster, an impulsive cluster, and a low co-morbid psychopathology cluster. The clusters showed expected differences on external validation tests with both personality and eating-disorder measures. The impulsive cluster showed the highest elevations on dissocial behavior and the lowest scores on compulsivity, while the affective-perfectionistic cluster showed the highest levels of eating-disorder symptoms. The clusters did not differ on genetic variations of the serotonin transporter gene. CONCLUSIONS: This study corroborates previous findings suggesting that the bulimia nervosa diagnostic category is comprised of three classes of individuals based on co-morbid psychopathology and personality. These differences may have significant etiological and treatment implications.

Adolescent↗

Aggressiveness, not impulsiveness or hostility, distinguishes suicide attempters with major depression.

BACKGROUND: Impulsiveness, hostility and aggressiveness are traits associated with suicidal behavior, but also with borderline personality disorder (BPD). The presence of large numbers of BPD subjects in past attempter samples may distort the relative importance of each of these traits to predicting suicidal behavior, and lead to prospective, biological and genetic models that systematically misclassify certain subpopulations of suicidal individuals. METHOD: Two hundred and seventy-five subjects with major depressive disorder (MDD), including 87 with co-morbid BPD (69 past suicide attempters, 18 non-attempters) and 188 without BPD (76 attempters, 112 non-attempters) completed standard impulsiveness, hostility and aggressiveness ratings. Differences between past suicide attempters and non-attempters were examined with the sample stratified by BPD status. RESULTS: As expected, BPD subjects scored significantly higher than non-BPD subjects on all three trait measures. Stratifying by BPD status, however, eliminated attempter/non-attempter differences in impulsiveness and hostility in both patient subgroups. Past suicide attempters in each of the two subgroups of patients were only distinguished by higher levels of aggressiveness. CONCLUSIONS: Once BPD is accounted for, a history of aggressive behavior appears to be the distinguishing trait characteristic of suicide attempters with major depression, rather than global personality dimensions such as impulsiveness or hostility. Aggressiveness, and not these related traits, may be the ideal target for behavioral, genetic and biological research on suicidal behavior, as well as for the clinical assessment of suicide risk.

Adult↗

Prefrontal cortex dysfunction in patients with suicidal behavior.

BACKGROUND: Abnormal serotonergic neurotransmission has long been demonstrated in suicidal behavior. The dorsal and median raphe nuclei housing the main serotonergic cell bodies and the prefrontal cortex (PFC), particularly the ventral part innervated by the serotonergic system, have therefore been studied extensively in suicidal behavior research. However, only a few studies have described neuropsychological function impairment in suicidal patients. We investigated PFC-related neuropsychological function in patients with suicidal behavior, separating dorsolateral PFC (DLPFC)- and orbitofrontal cortex (OFC)-related functions. METHOD: We compared 30 euthymic patients with suicidal behavior aged 18-65 years with 39 control subjects, for the following neuropsychological domains: global intellectual functioning, reward sensitivity, initiation, inhibition, and working memory. Patients and controls were compared by means of univariate and multivariate analyses, adjusting for age at interview, level of education and mood state at the time of evaluation. Trait impulsivity, measured with the Barratt Impulsivity Scale version 10 (BIS-10), was also included as a covariate in a subset of analyses. RESULTS: Multivariate comparisons demonstrated significant executive function deficits in patients with suicidal behavior. In particular, we observed impairment in visuospatial conceptualization (p<0.0001), spatial working memory (p=0.001), inhibition (Hayling B-A, p=0.04; go anticipations, p=0.01) and visual attention (or reading fluency) (p=0.002). Similar results were obtained following adjustment for motor impulsivity as a covariate, except for spatial working memory. CONCLUSIONS: These deficits are consistent with prefrontal dysfunction in patients with suicidal behavior. Differentiation between DLPFC- and OFC-related neuropsychological functions showed no specific dysfunction of the orbitofrontal region in patients with suicidal behavior in our sample.

Adult↗

Betting on dopamine.

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Antipsychotic Agents↗

Perceived stress in kleptomania.

Kleptomania, defined as the recurrent failure to resist the impulse to steal, is associated with significant functional impairment. We hypothesized that people with kleptomania would report elevated levels of perceived stress. Sixteen subjects with DSM-IV kleptomania were administered the Perceived Stress Scale (PSS) and compared with 20 subjects with DSM-IV major depressive disorder (MDD). Change in PSS scores in response to treatment and the relationship between PSS scores and severity of kleptomania symptoms were analyzed. The subjects with kleptomania had a significantly greater mean baseline PSS score than the 20 subjects with MDD (t = 8.55, df = 34, p = .000). PSS scores were significantly correlated with severity of kleptomania symptoms (r = .71, p = .002), even when controlling for comorbid diagnoses (r = .67, p = .006). PSS scores significantly decreased during the course of treatment (t = 9.31, df = 15, p = .000). People with kleptomania have higher levels of perceived stress than people with MDD, and the perceived stress decreases as the kleptomania symptoms are treated.

Adult↗

DSM-IV-J criteria: a scoring error that may be modifying the estimates of pathological gambling among youths.

Previous studies have shown that prevalence rates among youths may be inflated due to a problem in understanding the questions of the SOGS-RA and DSM-IV-MR-J. This article reports another reason why prevalence rates of pathological gambling among youths may be inflated. In 1992, Fisher proposed 9 criteria (the DSM-IV-J) for diagnosing pathological gambling among youths, and formulated 12 questions (the Test questions) to identify the presence of these criteria. An analysis of a sample of studies using the DSM-IV-J reveals that some researchers have incorrectly used the 12 Test questions instead of the 9 criteria, which may have led to overestimated prevalence rates among youths. Other measurement issues may also be contributing to the overestimation of problem gambling in young people. The methodological implications of these issues are discussed.

Adolescent↗

Measuring impulsivity in school-aged boys and examining its relationship with ADHD and ODD ratings.

Seven different laboratory measures of impulsivity were administered to a group of 165 school-aged boys. Parents' and teachers' ratings of Attention Deficit and Hyperactivity Disorder and Oppositional/Defiant Disorder were also obtained. Factor analyses of impulsivity measures revealed the existence of a strong Inhibitory Control Factor including measures derived from Stop Task, the Continuous Performance Test, the Matching Familiar Figures Test, and the Circle Tracing Task. Other forms of impulsivity like resistance to interference, the Wisconsin Card Sorting Test and efficiency in the DRL Task loaded on a second independent factor. The Inhibitory Control factor was correlated with ADHD ratings, whereas the second factor was slightly related to the presence of ODD symptoms. Discussion is focused on the relevance of inhibitory control in impulsivity and ADHD research.

Attention Deficit Disorder with Hyperactivity↗