Executive Function in Attention-Deficit/Hyperactivity Disorder : Relationship of Comprehensive Attention, Stoop Color-Word, Children's Color Trails, and Wisconsin Card Sorting Tests

Jong-Man Seo; Hyo-Won Kim; Jin-Young Yeo; Eun-Ha Byun; Seockhoon Chung

doi:10.4306/jknpa.2012.51.2.59

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Seo, Kim, Yeo, Byun, and Chung: Executive Function in Attention-Deficit/Hyperactivity Disorder : Relationship of Comprehensive Attention, Stoop Color-Word, Children's Color Trails, and Wisconsin Card Sorting Tests

Original Article

Journal of Korean Neuropsychiatric Association

Journal of Korean Neuropsychiatric Association 2012; 51(2): 59-69.

Published online: 31 March 2012

DOI: https://doi.org/10.4306/jknpa.2012.51.2.59

Executive Function in Attention-Deficit/Hyperactivity Disorder : Relationship of Comprehensive Attention, Stoop Color-Word, Children's Color Trails, and Wisconsin Card Sorting Tests

Jong-Man Seo, MD¹, Hyo-Won Kim, MD, PhD¹, Jin-Young Yeo, MD², Eun-Ha Byun, MD², Seockhoon Chung, MD, PhD¹

¹Department of Psychiatry, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.

²Didim Psychiatric Clinic, Seoul, Korea.

Address for correspondence: Hyo-Won Kim, MD, PhD. Department of Psychiatry, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 136-736, Korea. Tel +82-2-3010-3414, Fax +82-2-485-8381, shingubi@amc.seoul.kr

Received 1 November 2011 Revised 20 February 2012 Accepted 12 March 2012

Abstract

Objectives

The objective of this study was to investigate the relationship of the Comprehensive Attention (CAT), Stoop Color-Word (STROOP), Children's Color Trails (CCTT), and Wisconsin Card Sorting Tests (WCST) in evaluating the executive function in attention-deficit/hyperactivity disorder (ADHD).

Methods

A total of 197 children and adolescents with ADHD (mean age 10.4±3.2 years, 173 boys) and 62 without ADHD (mean age 11.8±3.5 years, 48 boys) have completed the Swanson, Nolan, and Pelham-IV questionnaire (SNAP-IV), and also the CAT, STROOP, CCTT and WCST.

Results

The selective, sustained, divided attention and Flanker tests of the CAT significantly discriminated between the ADHD and non-ADHD groups. The results of the CCTT were significantly correlated with the results of the CAT only in the ADHD group. The results of the STROOP were associated with selective, sustained, divided attention and Flanker tests. The results of the WCST were significantly correlated with the scores of the Working Memory subtest of the CAT only in the non-ADHD group.

Conclusion

The results of this study suggest that the CAT has strong discriminant validity and moderate concurrent validity. The CAT could be a tool for the evaluation of the executive function of ADHD.

Keywords: Attention-deficit/hyperactivity disorder, Children's Color Trails Test, Comprehensive Attention Test, Executive function, Stroop Test, Wisconsin Card Sorting Test

Figures and Tables

Table 1

Demographic and clinical characteristics of children and adolescents with and without ADHD

^* : Comparisons were assessed using the Fisher's exact test. ADHD : Attention-deficit/hyperactivity disorder, FSIQ : Full scale intelligent quotient, SD : Standard deviation

Table 2

Comparison of the results of the CAT, CCTT, WCST and Stroop tests between children and adolescents with and without ADHD

^* : Numbers may not add up to the same total because of missing values, ^† : Test was not applied when it is not appropriate to age, ^‡ : Difference between the two groups was significant when corrected for multiple comparisons. ADHD : Attention-deficit/hyperactivity disorder, CAT : Comprehensive Attention Test, CCTT : Children's Color Trails Test, SNAP : Swanson, Nolan and Pelham-IV, WCST : Wisconsin Card Sorting test

Table 3

The area under the curve and 95% confidence interval from ROC analysis using the CAT, CCTT, WCST and Stroop tests to discriminate children and adolescents with ADHD from those without

^* : Numbers may not add up to the same total because of missing values or because test was not applied when it is not appropriate to age, ^† : Statistically significant discrimination ability of ADHD (AUC>0.5). 95% CI : 95% confidence interval, ADHD : Attention-deficit/hyperactivity disorder, AUC : Area under the curve, CAT : Comprehensive Attention Test, CCTT : Children's Color Trails Test, ROC : Receiver operating characteristic, WCST : Wisconsin Card Sorting test

Table 4

Pearson correlations between the CAT and WCST, CCTT, Stroop test in the subjects with ADHD (n=197)

^* : p<0.05, ^** : p<0.01, ^*** : p<0.001 when corrected for multiple comparison. CAT : Comprehensive Attention Tests, CCTT : Children's Color Trails Test, CCTT1 : CCTT1 time score, CCTT2 : CCTT2 time score, CCTT3 : CCTT interference score, SNAP1 : SNAP, Swanson, Nolan and Pelham-IV inattention score, SNAP2 : SNAP, Swanson, Nolan and Pelham-IV hyperactivity-impulsivity score, Stoop1 : Stroop Test Word score, Stoop2 : Stroop Test Color score, Stoop3 : Stroop Test Color-Word score, Stoop4 : Stroop Test Interference score, WCST : Wisconsin Card Sorting Test, WCST1 : Number of total errors (% ile); WCST2, Number of perseverative errors (% ile); WCST3, Number of nonperseverative errors (% ile); WCST4 : Categories completed, WCST5 : Trials to complete 1st category, WCST6 : Failure to maintain set

Table 5

Pearson correlations between the CAT and WCST, CCTT, Stroop test in subjects without ADHD (n=62)

^* : p<0.05 when corrected for multiple comparison. CAT : Comprehensive Attention Tests, CCTT : Children's Color Trails Test, CCTT1 : CCTT1 time score, CCTT2 : CCTT2 time score, CCTT3 : CCTT interference score, SNAP1 : SNAP, Swanson, Nolan and Pelham-IV inattention score, SNAP2 : SNAP, Swanson, Nolan and Pelham-IV hyperactivity-impulsivity score, Stoop1 : Stroop Test Word score, Stoop2 : Stroop Test Color score, Stoop3 : Stroop Test Color-Word score, Stoop4 : Stroop Test Interference score, WCST : Wisconsin Card Sorting Test, WCST1 : Number of total errors (% ile), WCST2 : Number of perseverative errors (% ile), WCST3 : Number of nonperseverative errors (% ile), WCST4 : Categories completed, WCST5 : Trials to complete 1st category, WCST6 : Failure to maintain set

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