Classifying ADHD subtypes/presentations considering the joint effect of three levels of investigation

Abstract

Aim

Discriminant validity of the Attention Deficits/Hyperactive Disorders (ADHD) subtypes/presentations is not yet clear. The purpose of this study was to investigate joint contribution of the strongest factors of the three dimensions, namely psychopathology, neuropsychology and electrophysiology for subtyping of presentations.

Method

A sample of 104 boys aged 7–12 years was subdivided into three groups with ADHD combined (n = 22), inattentive (n = 25) and hyperactive/impulsive subtype (n = 14), and 43 typically developing controls (TDC). Children were investigated regarding the Child Behavior Checklist (CBCL), the Integrated Visual and Auditory Test (IVA), and EEG spectral power during eyes closed resting state. Subsequently, statistical analysis included discriminant functional analysis and principle component analysis.

Results

Neuropsychological parameters had the highest contribution in classifying of the groups. EEG parameters had no effect on differentiation of the groups, and among the psychopathological parameters, only the oppositional behavioral disorder score contributed to correctly classify 74.3% of the groups. Furthermore, we found four factors with eigenvalues higher than 1 in the ADHD and typical groups, with one factor characterized by four CBCL scales, another one by auditory and visual vigilance, speed and beta band power, the third by auditory and visual prudence, and forth by theta band power.

Conclusions

Our results demonstrated that ADHD subtypes/presentations can be differentiated from each other at different levels of investigation despite some clinical symptoms overlap. The results suggested that not only psychopathology but also the impairment of sensory processing should be assessed in children with ADHD in order to use this additional information for a jointly multilevel clinical intervention, which may improve treatment success.

Keywords:

• ADHD subtypes
• psychopathology
• neuropsychology
• neurophysiology

Acknowledgments

The authors thank Dr. Masoud Nosratabadi and Prof. Reza Rostami for helping us in data acquisition of the ADHD groups.

Disclosure statement

The authors state that there are no actual or potential conflicts of interest.

Additional information

Funding

This work was supported by the Cognitive Sciences and Technologies Council of Iran (95P31).

Notes on contributors

Mohammad Rostami

Mohammad Rostami: He received the Ph.D degree in cognitive psychology from the Institute for Cognitive and Brain Sciences, Shahid Beheshti University in 2019. He is currently working as a Post-Doc research fellow at the Department of Psychology, Allameh Tabatabaei University.

Reza Khosrowabadi

Reza Khosrowabadi: He received the Ph.D degree from Nanyang Technological University. After his PhD, he did a Post-Doc in neuroimaging at Duke-NUS Graduate Medical School and a Post-Doc in cognitive modeling at the Shahid Beheshti University. He is currently an assistant professor at the institute for cognitive and brain sciences.

Björn Albrecht

Bijorn Albrecht: He received his Ph.D. from the University of Göttingen and is an assistant professor for systems neuroscience at the Department for Child and Adolescent Psychiatry and Psychotherapy at the University Medical Center of Göttingen. His main research interests include the neurobiological basis of neurodevelopmental disorders, in particular ADHD, as potential starting points for intervention.

Aribert Rothenberger

Aribert Rothenberger: After his MD and qualification as a clinical neuropsychiatrist he later (1994-2017) was head and director of the Clinic for Child and Adolescent Psychiatry and Psychotherapy at the University Medical Center in Goettingen, Germany. After retirement, his research focus is still on the neurobiological background and treatment of child psychiatric disorders like Tourette syndrome and ADHD.

Hamidreza Pouretemad

Hamidreza Pouretemad: He received his Ph.D from the Department of Psychological Medicine, Institute of Psychiatry, London University in 1998. He is full professor of neuropsychology and the founder and the Dean of the Institute for Cognitive and Brain Sciences at Shahid Beheshti University.