Samenvatting

EXECUTIVE FUNCTIONING AND MOTIVATION IN ADHD

S. DOVIS, S. VAN DER OORD, R.W. WIERS & P.J.M. PRINS

ADHD symptoms are proposed to result from deficits in executive functioning (EF) and motivation. We discuss reinforcement effects on the assessment of working memory (the ef considered most impaired in ADHD) and its components (short-term memory and the central executive). Conclusions: (1) both executive- and motivational deficits give rise to the working memory (WM) problems of children with ADHD, (2) within both the combined subtype (ADHD-C) and the inattentive subtype of ADHD (ADD) 22% of children have motivational deficits, (3) 69% of children with ADHD-C and 37% of children with ADD are impaired on WM, (4) only children with ADHD-C are impaired on short-term memory, (5) WM and motivation represent independent neuropsychological domains, and (6) problems with task-persistence in ADHD-C result from motivational deficits.


2000 Weergaven
36 Downloads
Log in
‘[T]he power of attention is different, not only in different individuals, but also at different times’ (Crichton, 1798, p.255). Ruim tweehonderd jaar geleden onderkende de Schotse arts Alexander Crichton al het belang van de relatie tussen executief functioneren en motivatie bij mensen met aandachtsproblemen. Ook in het ADHD-onderzoek van nu speelt deze relatie een cruciale rol. Sebastiaan Dovis, Saskia van der Oord, Reinout Wiers en Pier Prins geven een uiteenzetting.

(Crichton, 1798, p.255)9 Attention Deficit-Hyperactivity Disorder (ADHD) is een in hoge mate erfelijke ontwikkelingsstoornis (Nikolas & Burt, 2010)31, die wereldwijd naar schatting vijf procent van de kinderen treft (Faraone et al., 2015)20. Kinderen met adhd hebben vaak moeite hun aandacht vast te houden, zijn chaotisch en slordig, snel afgeleid, vergeetachtig, praten veel, zijn vaak druk, bewegelijk, ongeduldig en impulsief (American Psychiatric Association, 2013)2. Deze kenmerken hebben vaak een negatieve invloed op het presteren op school en hun relaties met anderen binnen en buiten het gezin, wat weer kan leiden tot een negatief zelfbeeld (Barkley, 2006)4. Ook op volwassen leeftijd zorgt ADHD vaak voor problemen in het dagelijkse functioneren, onder andere in het gezin, op het werk en in sociale relaties (Barkley et al., 2008)5.

Hoewel ADHD wordt gediagnosticeerd op basis van gedragssymptomen, suggereert zowel theorie als onderzoek dat ADHD-symptomen veroorzaakt worden door onderliggende tekorten in onder andere executief functioneren en motivatie (bijv. Luman et

Literatuurlijst

  1. Alloway, T., Gathercole, S.E., Kirkwood, H. & Elliott, J. (2009). The cognitive and behavioral characteristics of children with low working memory. Child Development, 80(2), 606-621.
  2. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Association.
  3. Baddeley, A.D. (2007). Working memory, thought and action. Oxford: Oxford University Press.
  4. Barkley, R.A. (2006). Attention-deficit hyperactivity disorder. A handbook for diagnosis and treatment (3d ed.). New York: Guilford Press.
  5. Barkley, R.A., Murphy, K.R. & Fischer, M. (2008). ADHD in Adults. What the Science Says. New York: Guilford Press.
  6. Boyer, B.E., De Vries, M. & Dovis, S. (2016). Tekorten in Executieve Functies. In P. Snellings & M. Zeguers (Eds.), Interventies in het Onderwijs: Leerproblemen (2e ed.). Den Haag: Boom Lemma.
  7. Burgess, G.C., Depue, B.E., Ruzic, L., Willcutt, E.G., Du, Y.P. & Banich, M. T. (2010). Attentional control activation relates to working memory in attention-deficit/hyperactivity disorder. Biological Psychiatry, 67(7),, 632-40.
  8. Coghill, D.R., Seth, S. & Matthews, K. (2014). A comprehensive assessment of memory, delay aversion, timing, inhibition, decision making and variability in attention deficit hyperactivity disorder: advancing beyond the three-pathway models. Psychological Medicine, 44(09), 1989-2001.
  9. Crichton, A. (1798). An inquiry into the nature and origin of mental derangement: Comprehending a concise system of the physiology and pathology of the human mind and a history of the passions and their effects. London, England: T. Cadell Hr. & W. Davies. (Reprinted by AMS Press, New York, 1976).
  10. Dovis, S., Agelink van Rentergem J. & Huizenga H.M. (2015a). Does Cogmed Working Memory Training Really Improve Inattention in Daily Life? A Reanalysis [Letter to the editor]. PLOS ONE, 10 (3), e85992.
  11. Dovis, S., Agelink van Rentergem J. & Huizenga H.M. (2015b). Does brain training really help ADHD? New Scientist, 3031, 54. Dovis, S., Agelink van Rentergem J. & Huizenga H.M. (2015c). Response to the Correction by Spencer-Smith and Klingberg: Unaddressed Concerns [Letter to the editor]. PLOS ONE, 10 (3), e86579
  12. Dovis, S., Van der Oord, S., Boendermaker W.J. & Prins, P J.M. (2014). Chessboardtask D. Theoretical Background and Parameters. Amsterdam: University of Amsterdam.
  13. Dovis, S., Van der Oord, S., Huizenga, H.M., Wiers, R.W., & Prins, P.J.M. (2015f). Prevalence and diagnostic validity of motivational impairments and deficits in visuospatial short-term memory and working memory in adhd subtypes. European Child & Adolescent Psychiatry, 24(5), 575-590.
  14. Dovis, S., Van der Oord, S., Wiers, R.W. & Prins, P.J.M. (2015e). ADHD Subtype Differences in Reinforcement Sensitivity and Visuospatial Working Memory. Journal of Clinical Child & Adolescent Psychology, 44(5), 859-874.
  15. Dovis, S., Van der Oord, S., Wiers, R.W. & Prins, P J.M. (2012). Can motivation normalize working memory and task persistence in children with attention-deficit/hyperactivity disorder? The effects of money and computer-gaming. Journal of Abnormal Child Psychology, 40(5), 669-681.
  16. Dovis, S., Van der Oord, S., Wiers, R.W. & Prins, P.J.M. (2015d). Improving Executive Functioning in Children with adhd: Training Multiple Executive Functions within the Context of a Computer Game. A Randomized Double-Blind Placebo Controlled Trial. PLOS ONE, 10(4), e0121651
  17. Dovis, S., Van der Oord, S., Wiers, R.W. & Prins, P.J.M. (2013). What Part of Working Memory is not Working in ADHD? Short-Term Memory, the Central Executive and Effects of Reinforcement. Journal of Abnormal Child Psychology, 41(6), 901-917. doi:10.1007/ s10802-013-9729-9
  18. Evans, S.W., Owens, J.S. & Bunford, N. (2014). Evidence-Based Psychosocial Treatments for Children and Adolescents with Attention-Deficit/Hyperactivity Disorder. Journal of Clinical Child & Adolescent Psychology, 43(4), 527-551.
  19. Fair, D.A., Bathula, D., Nikolas, M.A. & Nigg, J.T. (2012). Distinct neuropsychological subgroups in typically developing youth inform heterogeneity in children with adhd. Proceedings of the National Academy of Sciences of the United States of America, 109(17), 6769-74.
  20. Faraone, S.V., Asherson, P., Banaschewski, T., Biederman, J., Buitelaar, J.K. et al. (2015). Attention-deficit/hyperactivity disorder. Nature Reviews Disease Primers, 1, 15020.
  21. Glascoe, F.P. & Squires, J. (2007). Issues with the new developmental screening and surveillance policy statement. Pediatrics, 119, 861-863.
  22. Haenlein, M. & Caul, W.F. (1987). Attention Deficit Disorder with Hyperactivity: A Specific Hypothesis of Reward Dysfunction. Journal of American Academy of Child and Adolescent Psychiatry 26(3), 356-362.
  23. Hinfelaar, M.L. & Ten Brink, E. (2012). Een nieuw koers. Effectieve aansturing van kinderen met adhd in het (basis- en voorgezet) onderwijs. Amsterdam: Pearson.
  24. Kofler, M.J., Rapport, M.D., Bolden, J., Sarver, D.E., Raiker, J.S. & Alderson, R.M. (2011). Working memory deficits and social problems in children with adhd. Journal of Abnormal Child Psychology, 39(6), 805-817.
  25. Logan, G.D., Schachar, R J, & Tannock, R. (1997). Impulsivity and Inhibitory Control. Psychological Science, 8(1), 60-64.
  26. Luman, M., Tripp, G. & Scheres, A. (2010). Identifying the neurobiology of altered reinforcement sensitivity in adhd: a review and research agenda. Neuroscience and Biobehavioral Reviews, 34(5), 744-754.
  27. Ma, I., van Duivenvoorden, A. & Scheres, A. (2016). Interaction between reinforcement and inhibitory control in adhd: a review and research quidelines. Clinicical Psychology Review, 44, 94-111.
  28. Martinussen, R., Hayden, J., Hogg-Johnson, S. & Tannock, R. (2005). A meta-analysis of working memory impairments in children with attention-deficit/hyperactivity disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 44(4), 377-384.
  29. Mattel, M.S., Meck, W.H. & Lustig, C. (2003). Not “just” a coincidence: Frontal-striatal interactions in working memory and interval timing. Memory, 13(3/4), 441-448.
  30. Milich, R., Balentine, A.C. & Lynam, D.R. (2001). adhd combined type and adhd predominantly inattentive type are distinct and unrelated disorders. Clinical Psychology: Science and Practice, 8, 463-488.
  31. Nikolas, M.A. & Burt, S.A. (2010). Genetic and environmental influences on ADHD symptom dimensions of inattention and hyperactivity: A meta-analysis. Journal of Abnormal Psychology, 119(1), 1-17.
  32. Raiker, J.S., Rapport, M.D., Kofler, M.J. & Sarver, D.E. (2012). Objectively- Measured Impulsivity and Attention-Deficit/Hyperactivity Disorder (adhd): Testing Competing Predictions from the Working Memory and Behavioral Inhibition Models of adhd. Journal of Abnormal Child Psychology, 40(5), 699-713.
  33. Rapport, M.D., Chung, K.M., Shore, G. & Isaacs, P. (2001). A conceptual model of child psychopathology: implications for understanding attention deficit hyperactivity disorder and treatment efficacy. Journal of Clinical Child Psychology, 30(1), 48-58.
  34. Sagvolden, T., Johansen, E.B., Aase, H. & Russell, V.A. (2005). A dynamic developmental theory of attention-deficit/hyperactivity disorder (adhd) predominantly hyperactive/impulsive and combined subtypes. The Behavioral and Brain Sciences, 28, 397-419.
  35. Sarver, D.E., Rapport, M.D., Kofler, M.J., Raiker, J.S. & Friedman, L.M. (2015). Hyperactivity in Attention-Deficit/Hyperactivity Disorder (adhd): Impairing Deficit or Compensatory Behavior? Journal of Abnormal Child Psychology, 43(7), 1219-1232.
  36. Sergeant, J.A., Oosterlaan, J. & Van der Meere, J. (1999). Information Processing and Energetic Factors in Attention-Deficit/Hyperactivity Disorder. In H.C. Quay & A.E. Hogan (Eds.), Handbook of disruptive behavior disorders (pp. 75-104). New York: Kluwer Academic/ Plenum Publishers.
  37. Slusarek, M., Velling, S., Bunk, D. & Eggers, C. (2001). Motivational effects of inhibitory control in children with adhd. Journal of the American Academic of Child and Adolescent Psychiatry, 40(3), 355-363.
  38. Sonuga-Barke, E.J.S. (2011). Editorial: adhd as a reinforcement disorder – moving from general effects to identifying (six) specific models to test. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 52, 917-918.
  39. Sonuga-Barke, E.J.S., Bitsakou, P. & Thompson, M. (2010). Beyond the Dual Pathway Model: Evidence for the Dissociation of Timing, Inhibitory, and Delay-Related Impairments in Attention- Deficit/Hyperactivity Disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 49(4), 345-355.
  40. Strand, M.T., Hawk, L.W., Bubnik, M., Shiels, K., Pelham, W.E. & Waxmonsky, J.G. (2012). Improving working memory in children with attention-deficit/hyperactivity disorder: the separate and combined effects of incentives and stimulant medication. Journal of Abnormal Child Psychology, 40(7), 1193-207.
  41. Titz, C. & Karbach, J. (2014). Working memory and executive functions: effects of training on academic achievement. Psychological Research, 78(6), 852-868.
  42. Van der Veen-Mulders, L. & Van den Hoofdakker, B.J. (2011). BPTG: Behavioral Parent Training Groningen for children with adhdgroup format. Groninger gedragstherapeutische oudertraining voor kinderen met ADHD-groepsvariant. Groningen: Accare Universitair Centrum.
  43. Volkow, N.D., Wang, G.-J., Newcorn, J.H., Kollins, S.H., Wigal, T.L. et al. (2011). Motivation deficit in ADHD is associated with dysfunction of the dopamine reward pathway. Molecular Psychiatry, 16(11), 1147-1154.
  44. Willcutt, E.G., Nigg, J.T., Pennington, B.F., Solanto, M.V, Rohde, L.A. et al. (2012). Validity of DSM-IV attention deficit/hyperactivity disorder symptom dimensions and subtypes. Journal of Abnormal Psychology, 121(4), 991-1010.
  45. Zeeuw, P. de, Weusten, J., Dijk, S van., Belle, J. van & Durston, S. (2012). Deficits in cognitive control, timing and reward sensitivity appear to be dissociable in adhd. PloS One, 7, e51416.