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      Reduced Working Memory Mediates the Link between Early Institutional Rearing and Symptoms of ADHD at 12 Years

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          Abstract

          Children who are raised in institutions show severe delays across multiple domains of development and high levels of psychopathology, including attention deficit/hyperactivity disorder (ADHD). Low performance in executive functions (EFs) are also common in institutionally reared children and often do not remediate following improvements in the caregiving environment. ADHD symptomatology also remains elevated even after children are removed from institutional care and placed in families. We investigate whether poor EF is a mechanism explaining elevated rates of ADHD in children reared in institutional settings in the Bucharest Early Intervention Project (BEIP). In the current study, we examine the potentially mediating role of poor EF in the association between institutionalization and symptoms of ADHD at age 12 years. A total of 107 children were assessed with the Cambridge Neuropsychological Test Automated Battery (CANTAB) on working memory, set-shifting and planning. We also obtained concurrent teacher reports on their levels of ADHD symptoms (inattention and impulsivity separately). Institutionalization strongly predicted elevations in symptoms of inattention and impulsivity at age 12 years ( ps < 0.01). Indices of working memory and planning were also associated with ADHD after controlling for potential confounders ( ps < 0.03). Mediation analyses revealed that poor working memory performance mediated the link between exposure to early institutionalization and higher scores of both inattention and impulsivity. These results replicate and extend the findings that we reported in the BEIP sample at age 8 years. Together, they suggest that compromised working memory is a key mechanism that continues to explain the strikingly high levels of ADHD in late childhood among children institutionalized in early life. Interventions targeting working memory may help to prevent ADHD among children exposed to institutional care.

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          Most cited references 40

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          Specific impairments of planning.

           T Shallice (1982)
          An information-processing model is outlined that predicts that performance on non-routine tasks can be impaired independently of performance on routine tasks. The model is related to views on frontal lobe functions, particularly those of Luria. Two methods of obtaining more rigorous tests of the model are discussed. One makes use of ideas from artificial intelligence to derive a task heavily loaded on planning abilities. A group of patients with left anterior lesions has a specific deficit on the task. Subsidiary investigations support the inference that this is a planning impairment.
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            Computerized training of working memory in children with ADHD--a randomized, controlled trial.

            Deficits in executive functioning, including working memory (WM) deficits, have been suggested to be important in attention-deficit/hyperactivity disorder (ADHD). During 2002 to 2003, the authors conducted a multicenter, randomized, controlled, double-blind trial to investigate the effect of improving WM by computerized, systematic practice of WM tasks. Included in the trial were 53 children with ADHD (9 girls; 15 of 53 inattentive subtype), aged 7 to 12 years, without stimulant medication. The compliance criterion (>20 days of training) was met by 44 subjects, 42 of whom were also evaluated at follow-up 3 months later. Participants were randomly assigned to use either the treatment computer program for training WM or a comparison program. The main outcome measure was the span-board task, a visuospatial WM task that was not part of the training program. For the span-board task, there was a significant treatment effect both post-intervention and at follow-up. In addition, there were significant effects for secondary outcome tasks measuring verbal WM, response inhibition, and complex reasoning. Parent ratings showed significant reduction in symptoms of inattention and hyperactivity/impulsivity, both post-intervention and at follow-up. This study shows that WM can be improved by training in children with ADHD. This training also improved response inhibition and reasoning and resulted in a reduction of the parent-rated inattentive symptoms of ADHD.
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              A developmental perspective on executive function.

              This review article examines theoretical and methodological issues in the construction of a developmental perspective on executive function (EF) in childhood and adolescence. Unlike most reviews of EF, which focus on preschoolers, this review focuses on studies that include large age ranges. It outlines the development of the foundational components of EF-inhibition, working memory, and shifting. Cognitive and neurophysiological assessments show that although EF emerges during the first few years of life, it continues to strengthen significantly throughout childhood and adolescence. The components vary somewhat in their developmental trajectories. The article relates the findings to long-standing issues of development (e.g., developmental sequences, trajectories, and processes) and suggests research needed for constructing a developmental framework encompassing early childhood through adolescence. © 2010 The Authors. Child Development © 2010 Society for Research in Child Development, Inc.
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                Author and article information

                Contributors
                Journal
                Front Psychol
                Front Psychol
                Front. Psychol.
                Frontiers in Psychology
                Frontiers Media S.A.
                1664-1078
                24 November 2016
                2016
                : 7
                Affiliations
                1Institute of Child Development Bucharest, Romania
                2Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill NC, USA
                3Department of Psychology, University of Washington, Seattle WA, USA
                4Harvard Medical School – Boston Children’s Hospital – Harvard Center on the Developing Child – Harvard Graduate School of Education, Boston MA, USA
                5Department of Human Development and Quantitative Methodology, University of Maryland, College Park MD, USA
                6Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, New Orleans LA, USA
                Author notes

                Edited by: Matthew William Geoffrey Dye, Rochester Institute of Technology, USA

                Reviewed by: Iris Wiegand, Max Planck Institute for Human Development, Germany; Vincent Joseph Samar, Rochester Institute of Technology, USA

                *Correspondence: Florin Tibu, florin.tibu@ 123456idc.ro

                This article was submitted to Cognitive Science, a section of the journal Frontiers in Psychology

                Article
                10.3389/fpsyg.2016.01850
                5121247
                Copyright © 2016 Tibu, Sheridan, McLaughlin, Nelson, Fox and Zeanah.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                Page count
                Figures: 1, Tables: 3, Equations: 0, References: 56, Pages: 9, Words: 0
                Funding
                Funded by: National Institute of Mental Health 10.13039/100000025
                Award ID: MH091363
                Categories
                Psychology
                Original Research

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