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Cognitive Impairments Found With Attention-Deficit/Hyperactivity Disorder

(PSYCHIATRIC TIMES) - Over the past century, the syndrome currently referred to as attention-deficit/hyperactivity disorder (ADHD) has been conceptualized in relation to varying cognitive problems including attention, reward response, executive functioning, and other cognitive processes.1 More recently, it has become clear that whereas ADHD is associated at the group level with a range of cognitive impairments, no single cognitive dysfunction characterizes all children with ADHD.2,3 In other words, ADHD is not a one-size-fits-all phenomenon. Patients with this syndrome do not fit into any one category and present with widely differing co-occurring disorders—including varying cognitive profiles.

Thus, ADHD represents not a single disease entity but a heterogeneous group of patients who require differentiated analysis, assessment, and treatment. This article focuses on the cognitive presentation of children (and, to a lesser extent, adults) with ADHD.

ADHD subtypes

DSM-IV specifies that there are 3 subtypes of ADHD:

• Primarily inattentive

• Primarily hyperactive-impulsive

• Combined inattentive and hyperactive-impulsive

Much research has attempted to map particular cognitive problems to particular DSM-IV subtypes but, to date, there has been no consensus. Contemporary neuroscience has helped clarify that cognition and affect are closely related—cognitive computations depend heavily on emotional arousal and valence, just as affective response depends in part on cognitive evaluation.4

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