Skip to main content

Advertisement

SpringerLink
Log in

Differential effects of anxiety and depressive symptoms on working memory components in children and adolescents with ADHD combined type and ADHD inattentive type

  • Original Contribution
  • Published:
European Child & Adolescent Psychiatry Aims and scope Submit manuscript

Abstract

Working memory (WM) deficits have been shown to be associated with core ADHD symptoms, worse academic achievement and peer-relationship problems. Internalizing symptoms, such as anxiety and depression, have also been associated with impaired WM performance. However, the association of anxiety and depression and WM performance remains unclear for children and adolescents with ADHD. Further, it is unknown how these comorbid conditions might affect WM performance in the two main ADHD subtypes. The association of anxiety and depression and the specific components of spatial (SWM) and verbal working memory (VWM) were examined in 303 children and adolescents with ADHD, combined type (ADHD-CT) and 77 ADHD, inattentive type (ADHD-IA) compared to 128 age- and gender-matched typically developing participants. The relationship between anxiety and depression and WM was assessed using multiple linear regression analyses and separate simple regression analyses. Higher levels of anxiety/depression were associated with (1) increased between-search errors in the typically developing participants alone, (2) a better strategy performance in the ADHD-CT group, and (3) a better spatial span performance in the ADHD-IA group. VWM was equally impaired in the ADHD-CT and ADHD-IA groups, independent of the levels of anxiety and depression. The results suggest that the effects of internalizing symptoms on WM differ in typically developing children and adolescents compared to those with ADHD. Further, high levels of anxiety and depression modified WM performance differently according to the specific ADHD subtypes. This might help explain contradictory findings observed in previous studies of mixed samples of participants with ADHD-CT and ADHD-IA.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. Achenbach TM (1991) Manual for the child behavior checklist/4–18 and 1991 profile. University of Vermont, Department of Psychiatry, Burlington

    Google Scholar 

  2. Achenbach TM, Conners CK, Quay HC, Verhulst FC, Howell CT (1989) Replication of empirically derived syndromes as a basis for a taxonomy of child/adolescent psychopathology. J Abnorm Child Psychol 17:299–323

    Article  CAS  PubMed  Google Scholar 

  3. Achenbach TM, Demenci L, Rescorla LA (2003) DSM-oriented and empirically based approaches to constructing scales from the same item pools. J Clin Child Adol Psych 32:328–340

    Article  Google Scholar 

  4. Alderson RM, Rapport MD, Hudec KL, Sarver DE, Kofler MJ (2010) Competing core processes in attention-deficit/hyperactivity disorder (ADHD): do working memory deficiencies underlie behavioral inhibition deficits? J Abnorm Child Psychol 38:497–507

    Article  PubMed  Google Scholar 

  5. American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders, third edition-revised (D.S.M.IV). American Psychiatric Association, Washington DC

    Google Scholar 

  6. Angold A, Costello EJ (1993) Depressive comorbidity in children and adolescents: empirical, theoretical, and methodological issues. Am J Psych 150:1779–1791

    CAS  Google Scholar 

  7. Baddeley AD (2001) Is working memory still working? American Psychology 56:851–864

    Article  CAS  Google Scholar 

  8. Barkley RA (2001) The inattentive type of ADHD as a distinct disorder: what remains to be done. Clin Psychol Sci Pract 8:489–501

    Article  Google Scholar 

  9. Barnett R, Vance ALA, Maruff P, Luk SL, Costin J, Pantelis C (2001) Abnormal executive function in attention deficit hyperactivity disorder: The effect of stimulant medication and age on spatial working memory. Psychol Med 31:1107–1115

    Article  CAS  PubMed  Google Scholar 

  10. Beck AT (1967) Depression: clinical, experimental, and theoretical aspects. Harper & Row, New York

    Google Scholar 

  11. Becker SP, Langberg JM, Luebbe AM, Dvorsky MR, Flannery AJ (2013) Sluggish cognitive tempo is associated with academic functioning and internalizing symptoms in college students with and without attention-deficit/hyperactivity disorder. J Clin Psychol. doi:10.1002/jclp.22046

    PubMed  Google Scholar 

  12. Bedard AC, Tannock R (2008) Anxiety, methylphenidate response and working memory in children with ADHD. J Attent Dis 11:546–557

    Article  Google Scholar 

  13. Biederman J, Newcorn J, Sprich S (1991) Comorbidity of attention deficit hyperactivity disorder with conduct, depressive, anxiety, and other disorders. Am J Psych 148:564–577

    CAS  Google Scholar 

  14. Bloemsma JM, Boer F, Arnold R et al (2013) Comorbid anxiety and neuro-cognitive dysfunction in children with ADHD. Europ Child Adol Psych 22:225–234

    Article  Google Scholar 

  15. Castellanos FX, Tannock R (2002) Neuroscience of attention-deficit/hyperactivity disorder: the search for endophenotypes. Nat Rev Neuros 3:617–628

    CAS  Google Scholar 

  16. Cosgrove VE, Rhee SH, Gelhorn HL et al (2011) Structure and etiology of co-occurring internalizing and externalizing disorders in adolescents. J Abnor Child Psych 39:109–123

    Article  Google Scholar 

  17. Christiansen H, Oades RD, Psychogiou L, Hauffa BP, Sonuga-Barke EJ (2010) Does the cortisol response to stress mediate the link between expressed emotion and oppositional behaviour in attention-deficit/hyperactivity-disorder (ADHD)? Behav Brain Funct 15:6–45

    Google Scholar 

  18. Cohen J (1988) Statistical power analysis for the behavioural sciences. Erlbaum, Hillsdale

    Google Scholar 

  19. DeGroot A, Koot HM, Verhulst FC (1994) Cross-cultural generalizability of the child behaviour checklist cross-informant syndromes. Psychol Assesment 7:299–323

    Google Scholar 

  20. Dennis M, Francis DJ, Cirino PT, Schachar R, Barnes MA, Fletcher JM (2009) Why IQ is not a covariate in cognitive studies of neuro-developmental disorders. J Intern Neuropsychol Soc 15:331–343

    Article  Google Scholar 

  21. Diamond A (2005) Attention-deficit disorder (attention-deficit/hyperactivity disorder without hyperactivity): a neurobiologically and behaviorally distinct disorder from attention-deficit/hyperactivity disorder (with hyperactivity). Dev Psychopat 17:807–825

    Article  Google Scholar 

  22. De Trani M, Casini MP, Capuzzo F, Gentile S, Bianco G, Menghini D, Vicari S (2011) Executive and intellectual functions in attention-deficit/hyperactivity disorder with and without comorbidity. Brain Dev 33:462–469

    Article  PubMed  Google Scholar 

  23. Disner SG, Beevers CG, Haigh EAP, Beck AT (2011) Neural mechanisms of the cognitive model of depression. Nat Rev Neurosc 12:467–477

    Article  CAS  Google Scholar 

  24. Eley TC, Stevenson J (1999) Exploring the covariation between anxiety and depression symptoms: a genetic analysis of the effects of age and sex. J Child Psychol Psych 40:1273–1282

    Article  CAS  Google Scholar 

  25. Eysenck MW, Calvo MG (1992) Anxiety and performance: the processing efficiency theory. Cogn Emot 6:409–434

    Article  Google Scholar 

  26. Eysenck MW, Derakshan N, Santos R, Calvo MG (2007) Anxiety and cognitive performance: attentional control theory. Emotion 7:336–353

    Article  PubMed  Google Scholar 

  27. Favre T, Hughes C, Emslie G, Stavinoha P, Kennard B, Carmody T (2009) Executive functioning in children and adolescents with major depressive disorder. Child Neuropsychol 15:85–98

    Article  PubMed Central  PubMed  Google Scholar 

  28. Ferrin M, Taylor E (2011) Child and caregiver issues in the treatment of attention deficit-hyperactivity disorder: education, adherence and treatment choice. Fut Neurol 6:399–413

    Article  Google Scholar 

  29. Ferrin M, Vance A (2012) Examination of neurological subtle signs in ADHD as a clinical tool for the diagnosis and their relationship to spatial working memory. J Child Psychol Psych 53:390–400

    Article  Google Scholar 

  30. Franić S, Middeldorp CM, Dolan CV, Ligthart L, Boomsma DI (2010) Childhood and adolescent anxiety and depression: beyond heritability. J Am Acad Child Adol Psych 49:820–829

    Article  Google Scholar 

  31. Fray PJ, Robbins TW (1996) CANTAB battery: proposed utility in neurotoxicology. Neurotoxicol Teratol 18:499–504

    Article  CAS  PubMed  Google Scholar 

  32. Gau SS, Shang CY (2010) Executive functions as endophenotypes in ADHD: evidence from the Cambridge neuropsychological test battery (CANTAB). J Child Psychol Psych 51:838–849

    Article  Google Scholar 

  33. Gathercole SE, Alloway TP (2006) Practitioner review: short-term and working memory impairments in neuro-developmental disorders: diagnosis and remedial support. J Child Psychol Psych 47:4–15

    Article  Google Scholar 

  34. Geurts HM, Verté S, Oosterlaan J, Roeyers H, Sergeant JA (2005) ADHD subtypes: do they differ in their executive functioning profile? Arch Clin Neuropsychol 20:457–477

    Article  PubMed  Google Scholar 

  35. Goldman-Rakic PS (1995) Cellular basis of working memory. Neuron 14:477–485

    Article  CAS  PubMed  Google Scholar 

  36. Gomez R, Vance A, Gomez RM (2013) The factor structure of anxiety and depressive disorders in a sample of clinic-referred adolescents. J Abnorm Child Psychol. doi:10.1007/s10802-013-9787-z

  37. Gotlib IH, Lewinsohn PM, Seeley JR (1995) Symptoms versus diagnosis of depression: differences in psychosocial functioning. J Clin Consul Psychol 63:90–100

    Article  CAS  Google Scholar 

  38. Gotlib IH, Joormann J (2010) Cognition and depression: current status and future directions. Annu Rev Clin Psychol 27:285–312

    Article  Google Scholar 

  39. Günther T, Konrad K, De Brito SA, Herpertz-Dahlmann B, Vloet TD (2011) Attentional functions in children and adolescents with ADHD, depressive disorders, and the comorbid condition. J Child Psychol Psych 52:324–331

    Article  Google Scholar 

  40. Hinden BR, Compas BE, Howell DC, Achenbach TM (1997) Covariation of the anxious-depressed syndrome during adolescence: separating fact from artifact. J Clin Consul Psychol 65:6–14

    Article  CAS  Google Scholar 

  41. Jensen PS, Martin D, Cantwell DP (1997) Comorbidity of ADHD: implications for research, practice and DSM-V. J Am Acad Child Adol Psych 36:1065–1079

    Article  CAS  Google Scholar 

  42. Kaufman J, Birmaher B, Brent DA, Ryan ND, Rao U (2000) K-Sads-Pl. J Am Acad Chil Adol Psych 39:1208

    Article  CAS  Google Scholar 

  43. Kasper LJ, Alderson RM, Hudec KL (2012) Moderators of working memory deficits in children with attention-deficit/hyperactivity disorder (ADHD): a meta-analytic review. Clin Psychol Rev 32:605–617

    Article  PubMed  Google Scholar 

  44. Kendall PC, Cantwell DP, Kazdin AE (1989) Depression in children and adolescents: assessment issues and recommendations. Cogn Ther Res 13:109–146

    Article  Google Scholar 

  45. Kendall PC, Puliafico AC, Barmish AJ, Choudhury MS, Henin A, Treadwell KS (2007) Assessing anxiety with the child behaviour checklist and the teacher report form. J Anx Dis 21:1004–1015

    Article  Google Scholar 

  46. Kyte ZA, Goodyer IM, Sahakian BJ (2005) Selected executive skills in adolescents with recent first episode major depression. J Child Psychol Psych 46:995–1005

    Article  Google Scholar 

  47. Kofler MJ, Rapport MD, Bolden J, Sarver DE (2010) ADHD and working memory: the impact of central executive deficits and exceeding storage/rehearsal capacity on observed inattentive behavior. J Abnor Child Psychol 38:149–161

    Article  Google Scholar 

  48. Willcutt EG, Nigg JT, Pennington BF, Solanto MV, Rohde LA, Tannock R, Loo SK, Carlson CL, McBurnett K, Lahey BB (2012)Validity of DSM-IV attention deficit/hyperactivity disorder symptom dimensions and subtypes. J Abnorm Psychol 121:991–1010

    Article  PubMed Central  PubMed  Google Scholar 

  49. Leigh E, Hirsch CR (2011) Worry in imagery and verbal form: effect on residual working memory capacity. Behav Res Ther 49:99–105

    Google Scholar 

  50. Lewinson PM, Rhode P, Seeley JR, Klein DN, Gotlib IH (2000) Natural course of adolescent major depressive disorder in a community sample: predictors of recurrence in young adults. Am J Psych 157:1584–1591

    Article  Google Scholar 

  51. Lonigan CJ, Carey MP, Finch AJ (1994) Anxiety and depression in children and adolescents: negative affectivity and the utility of self-reports. J Consult Clin Psychol 62:1000–1018

    Article  CAS  PubMed  Google Scholar 

  52. Lowe C, Rabbit P (1998) Test–re-test reliability of the CANTAB and ISPOCD neuropsychological batteries: theoretical and practical issues. Neuropsychologia 36:915–923

    Article  CAS  PubMed  Google Scholar 

  53. Manassis K, Tannock R, Young A, Francis-John S (2007) Cognition in anxious children with ADHD: a comparison of clinical and normal children. Behav Brain Funct 3:4

    Article  PubMed Central  PubMed  Google Scholar 

  54. Martinussen R, Hayden J, Hogg-Johnson S, Tannock R (2005) A meta-analysis of working memory impairments in children with ADHD. J Am Acad Chil Adol Psych 44:377–384

    Article  Google Scholar 

  55. Martinussen R, Tannock R (2006) Working memory impairments in children with attention-deficit hyperactivity disorder with and without comorbid language learning disorders. J Clin Exp Neuropsychol 28:1073–1094

    Article  PubMed  Google Scholar 

  56. Milich R, Balentine AC, Lynam DR (2001) ADHD combined type and ADHD predominantly inattentive type are distinct and unrelated disorders. Clin Psychol 8:463–488

    Google Scholar 

  57. Pasini A, Paloscia C, Alessandrelli R, Porfirio MC, Curatolo P (2007) Attention and executive functions profile in drug naive ADHD subtypes. Brain Dev 29:400–408

    Article  PubMed  Google Scholar 

  58. Pliszka SR, Hatch JP, Borcherding SH, Rogeness GA (1993) Classical conditioning in children with attention deficit hyperactivity disorder (ADHD) and anxiety disorders: a tests of Quay’s model. J Abnorm Child Psychol 21:411–423

    Article  CAS  PubMed  Google Scholar 

  59. Rapport MD, Chung KM, Shore G, Isaacs P (2001) A conceptual model of child psychopathology: implications for understanding attention deficit hyperactivity disorder and treatment efficacy. J Clin Child Psychol 30:48–58

    Article  CAS  PubMed  Google Scholar 

  60. Rhodes SM, Coghill DR, Matthews K (2005) Neuropsychological functioning in stimulant-naive boys with hyperkinetic disorder. Psychol Med 35:1109–1120

    Article  PubMed  Google Scholar 

  61. Richardson JT (2007) Measures of short-term memory: a historical review. Cortex 43:635–650

    Article  PubMed  Google Scholar 

  62. Robbins TW, James M, Owen AM, Sahakian BJ, McInnes L, Rabbitt P (1994) Cambridge neuropsychological test automated battery (CANTAB): a factor analytic study of a large sample of normal elderly volunteers. Dementia 5:266–281

    CAS  PubMed  Google Scholar 

  63. Rutter M (2011) Research review: child psychiatric diagnosis and classification: concepts, findings, challenges and potential. J Child Psychol Psych 52:647–660

    Article  Google Scholar 

  64. Shaw P, Gilliam M, Liverpool M, Weddle C, Malek M, Sharp W, Greenstein D, Evans A, Rapoport J, Giedd J (2011) Cortical development in typically developing children with symptoms of hyperactivity and impulsivity: support for a dimensional view of attention deficit hyperactivity disorder. Am J Psychiatry 168:143–151

    Article  PubMed Central  PubMed  Google Scholar 

  65. Schatz DB, Rostain AL (2006) ADHD with comorbid anxiety: a review of the current literature. J Attent Dis 10:141–149

    Article  Google Scholar 

  66. Seidman LJ, Biederman J, Faraone SV, Milberger S, Norman D, Seiverd K (1995) Effects of family history and comorbidity on the neuropsychological performance of children with ADHD: preliminary findings. J Am Acad Chil Adol Psych 34:1015–1024

    Article  CAS  Google Scholar 

  67. Sergeant J (2000) The cognitive-energetic model: an empirical approach to attention-deficit hyperactivity disorder. Neurosci Biobehav Rev 24:7–12

    Article  CAS  PubMed  Google Scholar 

  68. Sonuga-Barke EJ (2003) The dual pathway model of AD/HD: an elaboration of neuro-developmental characteristics. Neurosci Biobehav Rev 27:593–604

    Article  PubMed  Google Scholar 

  69. Tabachnick BG, Fidell LS (2001) Using multivariate statistics, 4th edn. Lawrence Erlbaum, Mahway

    Google Scholar 

  70. Tannock R, Ickowicz A, Shachar R (1995) Differential effects of methylphenidate on working memory in ADHD children with and without comorbid anxiety. J Am Child Adolesc Psych 34:886–896

    Article  CAS  Google Scholar 

  71. Vance A (2005) ADHD, combined type in primary school age children: investigations of its association with oppositional defiant, dysthymic and anxiety disorders. In: Larimer MP (ed) Attention deficit hyperactivity disorder (ADHD) research. Nova Press, New York

    Google Scholar 

  72. Vance A, Ferrin M, Winther J, Gomez R (2013) Examination of spatial working memory performance in children and adolescents with attention deficit hyperactivity disorder, combined type (ADHD-CT) and anxiety. J Abnorm Child Psychol 41:891–900

    Article  PubMed  Google Scholar 

  73. Vloet TD, Konrad K, Herpertz-Dahlmann B, Polier GG, Günther T (2010) Impact of anxiety disorders on attentional functions in children with ADHD. J Affect Dis 124:283–290

    Article  PubMed  Google Scholar 

  74. Wechsler D (1991) Wechsler intelligence scale for children, 3rd edn. The Psychological Corporation, Texas

  75. Wilkinson GS (1993) Wide range achievement test 3 (WRAT-3). Wilmington, Delaware

    Google Scholar 

  76. Willcutt EG, Doyle AE, Nigg JT, Faraone SV, Pennington BF (2005) Validity of the executive function theory of attention-deficit/hyperactivity disorder: a meta-analytic review. Biol Psychiatry 57:1336–1346

    Article  PubMed  Google Scholar 

  77. Zakzanis KK, Leach L, Kaplan E (1998) On the nature and pattern of neuro-cognitive function in major depressive disorder. Neuropsychiatry Neuropsychol Behav Neurol 11:111–119

    CAS  PubMed  Google Scholar 

Download references

Acknowledgments

We thank Berta Ibañez and Koldo Cambra (Fundacion Servet) for statistical advice, and Jean Louise Sanders for style correction. M.F. received economic support from the Instituto de Salud Carlos III (ETS 07/90902, BAE 09/90088), Consejeria de Salud, Junta de Andalucia (EF-0029), Gobierno de Navarra (Beca Ayanz), and Fundacion Alicia Koplowitz.

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Academic Child Psychiatry Unit, Department of Paediatrics, Royal Children’s Hospital and Murdoch Children’s Research Institute, University of Melbourne, Parkville, VIC, 3052, Australia

    Alasdair Vance

  2. Institute of Psychiatry, London, UK

    Maite Ferrin

Authors
  1. Maite Ferrin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alasdair Vance
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Maite Ferrin.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (PDF 180 kb)

Supplementary material 2 (DOCX 95 kb)

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ferrin, M., Vance, A. Differential effects of anxiety and depressive symptoms on working memory components in children and adolescents with ADHD combined type and ADHD inattentive type. Eur Child Adolesc Psychiatry 23, 1161–1173 (2014). https://doi.org/10.1007/s00787-013-0509-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00787-013-0509-4

Keywords

Search

Navigation