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Articles   |    
Association Between Variation in Neuropsychological Development and Trajectory of ADHD Severity in Early Childhood
Khushmand Rajendran, Ph.D., M.S.W.; Joey W. Trampush, Ph.D.; David Rindskopf, Ph.D.; David J. Marks, Ph.D.; Sarah O’Neill, Ph.D.; Jeffrey M. Halperin, Ph.D.
Am J Psychiatry 2013;170:1205-1211. doi:10.1176/appi.ajp.2012.12101360
View Author and Article Information

Dr. Halperin has received honoraria from Novartis. The other authors report no financial relationships with commercial interests.

Supported by NIMH grant R01MH068286 (principal investigator, J.M.H.).

The first two authors contributed equally to this study.

From the Department of Psychology, Queens College, City University of New York; the Division of Psychiatry Research, Zucker Hillside Hospital and Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Glen Oaks, N.Y.; Clinical Brain Disorders Branch, the Genes, Cognition, and Psychosis Program, NIMH, Bethesda, Md.; Educational Psychology, Graduate Center, City University of New York; and Child Study Center, Langone Medical Center, New York University, N.Y.

Address correspondence to Dr. Halperin (jeffrey.halperin@qc.cuny.edu).

Copyright © 2013 by the American Psychiatric Association

Received October 28, 2012; Revised January 17, 2013; Revised February 18, 2013; Accepted February 25, 2013.

Abstract

Objective  This longitudinal study examined if changes in neuropsychological functioning were associated with the trajectory of symptoms related to attention deficit hyperactivity disorder (ADHD) and impairment between preschool and school age.

Method  The sample consisted of 3- and 4-year-old children (N=138) who were identified as being at risk for ADHD based on parent and teacher reports. Neuropsychological functioning was measured annually using the NEPSY at four time points (mean ages, 4.19, 5.36, 6.35, and 7.35 years). ADHD symptoms and impairment were assessed with semiannual parent and teacher reports using the ADHD Rating Scale–IV and the Children’s Problems Checklist at 10 time points (mean ages at baseline and final assessment, 4.19 and 8.81 years, respectively). Hierarchical linear modeling was used to assess the trajectories of change in neuropsychological functioning and ADHD severity as well as the association of change in neuropsychological functioning with change in ADHD severity over time.

Results  Baseline neuropsychological functioning was not significantly associated with the slope of change in ADHD severity. However, the magnitude of change in neuropsychological functioning was linearly associated with the trajectory of ADHD symptom severity and impairment, such that individuals with greater neuropsychological growth over time had a greater diminution of ADHD severity and impairment. Family socioeconomic status at baseline was significantly associated with initial ADHD severity and impairment, but not with change over time.

Conclusions  Interventions that enhance neuropsychological functioning at an early age may be beneficial in attenuating long-term ADHD severity and impairment.

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FIGURE 1. Trajectories of Change in ADHD Severity and Impairment From Early to Middle Childhood (N=138)a

a ADHD severity refers to the mean of parent and teacher ratings of symptoms and impairment.

FIGURE 2. Change in ADHD Severity at Different Levels of Change in Neuropsychological Functioninga

a ADHD severity refers to the mean of parent and teacher ratings of symptoms and impairment.

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TABLE 1.Characteristics of the Sample at Baseline in a Study of the Association of Neuropsychological Functioning With ADHD Severity and Impairment
Table Footer Note

a ADHD-RS-IV=ADHD Rating Scale–IV; CPC=Children’s Problem Checklist.

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TABLE 2.Association of Baseline Neuropsychological Functioning With Change in ADHD Symptom Severity and Impairment
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TABLE 3.Association of Change in Neuropsychological Functioning With Change in ADHD Symptom Severity and Impairment
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