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The term compensation is widely used in every-day language, in psychological research, and also discussed in the context of Attention Deficit Hyperactivity Disorder (ADHD). However, few studies have looked at psychological compensation in ADHD systematically and theory based. Compensation can be inferred if a deficit (i.e., a mismatch between skill and environmental demand) is counterbalanced by the investment of more effort, the utilization of latent or the acquisition of new skills. Based on the application of a theoretical framework (Bäckman & Dixon, 1992) to ADHD, I developed the following aims: (1) To reassess the awareness of deficits in ADHD and (2) to explore psychological compensation in a group with ADHD that accomplishes high achievement.
The results of Study 1 showed that children with ADHD did not overestimate their own skills compared to a group matched for academic achievement. In Study 2, college students with ADHD reported higher achievement motivation compared to college students without ADHD. Furthermore, results indicated that women with ADHD compensate by adopting compensatory effort and obsessive-compulsive behavior. Study 3 showed that female college students compensate for possible deficits in solving a flanker task by being overly cautious, which may reflect more obsessive-compulsive behavior.
The studies are discussed within the framework of psychological compensation. They add to the understanding of compensation in ADHD by (1) the reassessment of awareness of deficits in ADHD by including a group without ADHD but with low achievement, and by (2) suggesting that overly cautious behavior could be a form of psychological compensation in females with ADHD enabling them to enter college, leading to a late diagnosis and to good performance in cognitive tasks (i.e., flanker task).
Limitations are, that I did not test all components of the theoretical framework in one study and that I did not include adults with ADHD that did not enter college in Study 2 and 3 to test if achievement motivation or overly cautious behavior explains why some adults with ADHD gain admittance to higher education and show good performance in cognitive tasks and others do not.
Highligths
• Immune-inflammatory alterations might appear in subjects with ADHD.
• Blood levels of tumor necrosis factor-α might be reduced in individuals with ADHD.
• Individuals with ADHD might show elevated blood levels of interleukin-6.
Abstract
It has been observed that subclinical inflammation might be involved in the pathophysiology of attention deficit/hyperactivity disorder (ADHD). However, studies investigating peripheral blood levels of immune-inflammatory markers have provided mixed findings. We performed a systematic review and meta-analysis of studies comparing unstimulated serum or plasma levels of C-reactive protein (CRP) and cytokines in subjects with ADHD and healthy controls (the PROSPERO registration number: CRD 42021276869). Online searches covered the publication period until 30th Sep 2021 and random-effects meta-analyses were carried out. Out of 1844 publication records identified, 10 studies were included. The levels of interleukin (IL)-6 were significantly higher in studies of participants up to the age of 18 years (k = 10, g = 0.70, 95%CI: 0.10–1.30, p = 0.023) and after including those above the age of 18 years (k = 10, g = 0.71, 95%CI: 0.12–1.31, p = 0.019). In turn, the levels of tumor necrosis factor-α (TNF-α) were significantly lower in subjects with ADHD compared to healthy controls (k = 7, g = −0.16, 95%CI: −0.30 - -0.03, p = 0.020). Individual studies had a high contribution to the overall effect, since the overall effect was no longer significant after removing single studies. No significant differences were found with respect to the levels of CRP, IL-1β, IL-10 and interferon-γ. The present findings indicate that individuals with ADHD tend to show elevated levels of IL-6 and reduced levels of TNF-α. Larger and longitudinal studies recording potential confounding factors and comorbid psychopathology are needed to confirm our findings.
The main goal of the present study was the identification of cellular phenotypes in attention-deficit-/hyperactivity disorder (ADHD) patient-derived cellular models from carriers of rare copy number variants (CNVs) in the PARK2 locus that have been previously associated with ADHD. Human-derived fibroblasts (HDF) were cultured and human-induced pluripotent stem cells (hiPSC) were reprogrammed and differentiated into dopaminergic neuronal cells (mDANs). A series of assays in baseline condition and in different stress paradigms (nutrient deprivation, carbonyl cyanide m-chlorophenyl hydrazine (CCCP)) focusing on mitochondrial function and energy metabolism (ATP production, basal oxygen consumption rates, reactive oxygen species (ROS) abundance) were performed and changes in mitochondrial network morphology evaluated. We found changes in PARK2 CNV deletion and duplication carriers with ADHD in PARK2 gene and protein expression, ATP production and basal oxygen consumption rates compared to healthy and ADHD wildtype control cell lines, partly differing between HDF and mDANs and to some extent enhanced in stress paradigms. The generation of ROS was not influenced by the genotype. Our preliminary work suggests an energy impairment in HDF and mDAN cells of PARK2 CNV deletion and duplication carriers with ADHD. The energy impairment could be associated with the role of PARK2 dysregulation in mitochondrial dynamics.
Beyond well-established difficulties with working memory in individuals with attention deficit hyperactivity disorder (ADHD), evidence is emerging that other memory processes may also be affected. We investigated, first, which memory processes show differences in adults and adolescents with ADHD in comparison to control participants, focusing on working and short-term memory, initial learning, interference, delayed and recognition memory. Second, we investigated whether ADHD severity, co-occurring depressive symptoms, IQ and physical fitness are associated with the memory performance in the individuals with ADHD.
We assessed 205 participants with ADHD (mean age 25.8 years, SD 7.99) and 50 control participants (mean age 21.1 years, SD 5.07) on cognitive tasks including the digit span forward (DSF) and backward (DSB), the Rey Auditory Verbal Learning Test (RAVLT), and the vocabulary and matrix reasoning subtests of the Wechsler Abbreviated Scale of Intelligence. Participants with ADHD were additionally assessed on ADHD severity, depression symptoms and cardiorespiratory fitness. A series of regressions were run, with sensitivity analyses performed when variables were skewed.
ADHD-control comparisons were significant for DSF, DSB, delayed and recognition memory, with people with ADHD performing less well than the control participants. The result for recognition memory was no longer significant in sensitivity analysis. Memory performance was not associated with greater ADHD or depression symptoms severity. IQ was positively associated with all memory variables except DSF. Cardiorespiratory fitness was negatively associated with the majority of RAVLT variables.
Individuals with ADHD showed difficulties with working memory, short-term memory and delayed memory, as well as a potential difficulty with recognition memory, despite preserved initial learning.
The ability to delay gratification, to wait for a larger but delayed reward in the presence of a smaller but constantly available reward, has been shown to be predictive for various aspects of everyday life. For instance, preschool children who were better able to delay gratification achieved better school grades, a higher education, a better ability to cope with stress, as well as a reduced risk for being overweight or consume drugs up to 30 years later (Mischel et al., 2011). However, despite the importance of delay of gratification cognitive factors underlying individual differences are only poorly understood. Wittmann and Paulus (2008) suggested that individuals who overestimate the duration of time intervals experience waiting times as more costly and are, therefore, less likely to delay gratification. Furthermore, a recent study revealed an association between less accurate internal clock speed and a behavioral choice delay task (Corvi, Juergensen, Weaver, & Demaree, 2012). Further evidence for an association between temporal processing and delay of gratification can be derived from studies using clinical samples. For instance, children with attention-deficit/hyperactivity disorder (ADHD) consistently prefer smaller, immediate rewards over larger, delayed rewards and show impaired temporal processing (Sonuga-Barke, Bitsakou, & Thompson, 2010). However, no study has directly tested an association between a measure of temporal processing and a classical delay of gratification task in children with and without ADHD so far.
As part of a larger study, 64 children (29 with ADHD) aged between 8 to 12 years performed a version of an auditory duration discrimination task and a delay of gratification task. In the duration discrimination task, the children were presented with two unfilled intervals indicated by two brief tones each. The baseline interval lasted for 400 ms, while the comparison interval was always longer and adjusted up or down in 10 ms steps securing an accuracy of 80%. In the delay of gratification task, the children were instructed that they could either opt for one chocolate bar immediately or that they could wait to receive two chocolate bars. Unbeknownst to the children, the waiting time lasted 25 minutes but children were told that they could decide for the immediate chocolate bar at any time by ringing a bell.
Children with ADHD did not differ in their performance from children without ADHD in the duration discrimination task or the delay of gratification task. However, in the whole sample of children with and without ADHD, children who waited for the additional chocolate bar showed a better duration discrimination than children who failed to wait for the additional chocolate bar [t(62) = -2.52, p = .01].
We demonstrated an association between temporal processing ability and the ability to delay gratification. These results need to be replicated in further studies with larger sample sizes. Moreover, different tasks measuring temporal processing and delay of gratification should be used to further clarify the relationship of temporal processing, delay of gratification, and ADHD.
Objective: This study examines the interrelations of parenting practices, emotional climate, and household chaos in families with children with and without ADHD. In particular, indirect pathways from children’s ADHD symptomatology to inadequate parenting and negative emotional climate via household chaos were investigated. Method: Parenting, emotional climate, and household chaos were assessed using questionnaires and a speech sample of parents of 31 children with and 53 without ADHD, aged 7 to 13 years. Results: Group differences were found for certain parenting dimensions, the parent–child relationship, critical comments, and household chaos. While we found significant indirect effects between children’s ADHD and certain parenting dimensions through household chaos, no effects were found for any aspect of emotional climate. Conclusion: Children’s ADHD symptoms translate into inadequate parenting through household chaos, which underlines the need for interventions to improve household organization skills in parents of children with ADHD.
The cell—cell signaling gene CDH13 is associated with a wide spectrum of neuropsychiatric disorders, including attention-deficit/hyperactivity disorder (ADHD), autism, and major depression. CDH13 regulates axonal outgrowth and synapse formation, substantiating its relevance for neurodevelopmental processes. Several studies support the influence of CDH13 on personality traits, behavior, and executive functions. However, evidence for functional effects of common gene variation in the CDH13 gene in humans is sparse. Therefore, we tested for association of a functional intronic CDH13 SNP rs2199430 with ADHD in a sample of 998 adult patients and 884 healthy controls. The Big Five personality traits were assessed by the NEO-PI-R questionnaire. Assuming that altered neural correlates of working memory and cognitive response inhibition show genotype-dependent alterations, task performance and electroencephalographic event-related potentials were measured by n-back and continuous performance (Go/NoGo) tasks. The rs2199430 genotype was not associated with adult ADHD on the categorical diagnosis level. However, rs2199430 was significantly associated with agreeableness, with minor G allele homozygotes scoring lower than A allele carriers. Whereas task performance was not affected by genotype, a significant heterosis effect limited to the ADHD group was identified for the n-back task. Heterozygotes (AG) exhibited significantly higher N200 amplitudes during both the 1-back and 2-back condition in the central electrode position Cz. Consequently, the common genetic variation of CDH13 is associated with personality traits and impacts neural processing during working memory tasks. Thus, CDH13 might contribute to symptomatic core dysfunctions of social and cognitive impairment in ADHD.