Long-term Outcome of Cognitive and Emotional Functioning in Young People with ADHD

Abstract: Clarification on how cognitive, executive and emotional functioning contribute to symptom reduction or improved function in childhood attention deficit hyperactivity disorder (ADHD) is needed to find additional treatment methods. The clinical utility of continuous performance test (CPT) (Conners’ CPT-II, QbTest) to complement rating scales in diagnostic assessments and treatment evaluations (QbTest) was examined using one dataset from clinical records of 118 treatment-seeking youth (ADHD, n = 80; non-ADHD, n = 38) (diagnostic) and one dataset of 56 youth treated for ADHD (treatment evaluation) (Paper I). The course of cognitive, executive, emotional functioning and their relationship with ADHD outcome was investigated in a clinical study group of 137 treatment-seeking youth with ADHD (Papers II, III, and IV). A control group (n = 59) participated in parts of papers II and IV. The youth completed the Wechsler Intelligence Scales, the Conners’ CPT II, and the Beck Youth Inventories at baseline and follow-upafter three years. Their parents completed the Swanson-Nolan-Pelham Scale, fourth edition (SNAP-IV), the Behavior Rating of Executive Function (BRIEF) at baseline and follow-up, the Five To Fifteen scale at baseline, and the Strengths and Difficulties Questionnaire at follow-up. The Conners’ CPT II was useful in diagnostic assessments of ADHD in cases with ambiguous parental/teacher ratings, and the QbTest was useful in identifying patients with a positive response to medical treatment (Paper I). Cognitive, executive, and emotional functioning were largely stable across measuring points in youth with ADHD when using standardized scores, except for worsening verbal functioning and improved reaction time variability (Papers II, III, and IV). Worsened BRIEF scores between baseline and follow-up were associated with ADHD symptom severity and overall functional impairment at follow-up. Selfand parent-rated internalizing symptoms were related to BRIEF composite scores. Verbal functioning predicted whether ADHD children at follow-up attained passing grades. In clinical practice, it is important to monitor cognitive, executive, and emotional functioning in youth with ADHD. Reducing stress and failure in daily life may decrease internalizing symptoms and enable youth with ADHD to manage better in school.