Date of Degree

9-2015

Document Type

Dissertation

Degree Name

Ph.D.

Program

Psychology

Advisor(s)

Anil Chacko

Subject Categories

Clinical Psychology

Keywords

Attention-Deficit/Hyperactivity Disorder; Children/Adolescents; Cognitive Remediation; Emotion Regulation; Neuropsychology; Working Memory

Abstract

Evidence suggests that working memory (WM) impairment is a primary deficit in attention-deficit/hyperactivity disorder (ADHD), underlying core symptoms of the disorder and associated impairments. However, the relationship between deficits in different WM components and emotional problems specifically in ADHD has not yet been studied. Knowledge of the cognitive substrates contributing to emotional deficits in ADHD could inform efforts toward refining cognitive remediation as a treatment for emotion dysregulation in this population.

The first aim of this study (Aim 1) investigated whether WM deficits, as a global construct, were related to and mediated the relationship between ADHD and emotion dysregulation. The first sub-aim (Aim 1A) examined whether different components of WM, as defined by the traditional Baddeley Model (i.e., phonological loop, visuospatial sketchpad, central executive), were related to and differentially mediated emotion regulation deficits in ADHD. The second sub-aim (Aim 1B) examined whether WM constructs mediated the relationship of ADHD symptoms severity with degree of emotion dysregulation, after examining mediating effects of, and adjusting for, other factors related to emotional functioning. Other factors included inattention (relative to total ADHD symptoms), hyperactivity/impulsivity (relative to total ADHD symptoms), comorbid ODD symptoms, negative parenting behaviors, parental stress, and social skills deficits. Given a possible relationship between WM deficits and emotion dysregulation, Aim 2 investigated whether improvement in WM skills following cognitive remediation was related to improvement in emotion regulation ability.

Participants were youth with ADHD (ages 7 - 11 years) who were recruited for a larger treatment study investigating the augmentative and complementary effects of combined WM training and behavioral parent training. At a baseline visit, objective neuropsychological data measuring Baddeley components of WM ability and parent-ratings of emotion dysregulation, ADHD symptoms, comorbid ODD symptoms, parenting behaviors, and parental stress were collected (Aim 1). Teacher ratings of ADHD symptoms, ODD symptoms, and social skills were also collected at baseline. For Aim 2, participants were randomly assigned to an active or low-level, non-scaffolded ("placebo") condition of WM training. Upon the completion of WM training, WM deficits and parent-rated emotion dysregulation were again measured.

Aim 1 and sub-aims results: Deficits in WM, as a composite measure, were not associated with emotion dysregulation in this sample and, therefore, not included in the mediation model. With regard to the Baddeley components of WM, a deficit in the phonological loop was associated with parent-rated emotion dysregulation in ADHD (but not visuospatial sketchpad and central executive deficits). As such, the phonological loop factor was included in the mediation model. Lastly, a phonological loop deficit, comorbid ODD symptom severity, negative parenting behaviors (e.g., inconsistent use of discipline), parental stress, and social skills deficits together mediated the relationship between ADHD and emotion dysregulation. However, no variables contributed to the mediation above and beyond comorbid ODD symptom severity. Aim 2 Results: Improvement in overall WM functioning was significantly associated with better emotion regulation from pre-to-post WM training in the active group relative to the placebo group.

Results suggest that many factors, including a deficit in the phonological loop, contribute to emotional impairment in youth with ADHD, the strongest being severity of comorbid ODD symptoms. Results also suggest that, while comorbid ODD may contribute most strongly to emotion dysregulation in this study, improvements in total WM ability after cognitive remediation were nonetheless associated with improvement in emotion regulation skills. Taken together, cognitive remediation may have effects on emotional functioning in youth with ADHD; developing a more precise understanding of the neurocognitive substrates underlying emotional deficits in ADHD could thus inform treatment strategies.

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