INS NYC 2024 Program

Poster	Poster Session 10 Program Schedule 02/17/2024 09:00 am - 10:15 am Room: Majestic Complex (Posters 61-120) Poster Session 10: Neurodevelopmental \| Congenital Conditions Final Abstract #66 Explaining Heterogeneity: Identifying Subgroups of Adult Attention-Deficit/Hyperactivity Disorder Laura McGuigan, Marquette University, Milwaukee, United States Mary Simons, Marquette University, Milwaukee, United States Samantha Bradley, Marquette University, Milwaukee, United States James Hoelzle, Marquette University, Milwaukee, United States Category: ADHD/Attentional Functions Keyword 1: attention deficit hyperactivity disorder Keyword 2: neuropsychological assessment Keyword 3: attention Objective: It is well documented that the prevalence of first-time ADHD diagnoses in adulthood is rising (Danielson et al., 2023). Adults with ADHD present with varied patterns of neurocognitive impairment, psychological comorbidities, and functional difficulties, which can lead to unique diagnostic challenges. This study used latent profile analysis (LPA) to identify subgroups, or patient profiles, in a referred adult ADHD population. Prior LPA research on ADHD has primarily investigated children and considered a limited number of neurocognitive tasks (Cohen et al., 2023; Hulst et al., 2015). This study identified groups of individuals in a referred adult ADHD sample based on self-reported behavioral symptoms, emotional functioning, and performance on a comprehensive neuropsychological battery. The primary objective of this study was to inform our understanding of the heterogeneity observed in adult ADHD. Participants and Methods: The sample consisted of 259 adult patients referred for an ADHD evaluation (M age= 25.94; SD=7.83; 78% Caucasian; 54% male; M edu=14.24; SD=1.57). Seventeen profile indicator variables were included in the latent profile model to determine the optimal number of classes and characteristics that distinguished members of one group from another (Ostrander et al., 2008). Neuropsychological performance was measured through a comprehensive battery assessing domains of sustained attention, executive functioning, memory, working memory, and processing speed. Emotional functioning and ADHD symptoms were quantified via self-report measures. Criteria for LPA model selection was based on the Bayesian Information Criteria (BIC), the Vuong-Lo-Mendell-Rubin (VLMR) likelihood ratio test, and consideration of the smallest class size. Once the number of classes was determined, a one-way analysis of variance was conducted to evaluate neuropsychological, psychological, and behavioral differences across classes. The likelihood of ADHD diagnosis within each class, based on clinical interview rating and completion of ADHD self-report measures, was also assessed. Results: Up to seven profile solutions were modeled, and a four-class solution provided the best fit, as indicated by the lowest BIC value (BIC =22604, LL=−10759, number of parameters =106). Based on the mean scores across characteristics for each profile, the four classes were labeled as neuropsychiatrically distressed (30 patients [11.6%]), neuropsychiatrically resilient (50 patients [19.3%]), broad cognitive inefficiencies only (80 patients [30.9%]), and cognitive inefficiencies with preserved vigilance (99 patients [38.2%]). The likelihood of a patient receiving an ADHD diagnosis varied amongst groups, ranging from 80% (broad cognitive inefficiencies only group) to 61.6% (cognitive inefficiencies with preserved vigilance group). Conclusions: This research explored the heterogeneity of cognitive, behavioral, and emotional functioning in a referred adult ADHD sample. Results suggested significant variability, particularly in neuropsychological performance and mood. ADHD is a highly comorbid disorder, and it is not surprising that the neuropsychiatrically distressed group performed most poorly on cognitive measures (Gallagher & Blader, 2001). Interestingly, despite different patterns of neuropsychological functioning and rates of emotional symptoms, the likelihood of an ADHD diagnosis did not dramatically differ across groups. In summary, an appreciation of the heterogeneity in symptom presentation in adults with ADHD improves our conceptualization of the disorder and ability to offer specific treatment recommendations.

Poster

02/17/2024
09:00 am - 10:15 am
Room: Majestic Complex (Posters 61-120)

Poster Session 10: Neurodevelopmental | Congenital Conditions

Final Abstract #66

Explaining Heterogeneity: Identifying Subgroups of Adult Attention-Deficit/Hyperactivity Disorder

Laura McGuigan, Marquette University, Milwaukee, United States
Mary Simons, Marquette University, Milwaukee, United States
Samantha Bradley, Marquette University, Milwaukee, United States
James Hoelzle, Marquette University, Milwaukee, United States

Category: ADHD/Attentional Functions

Keyword 1: attention deficit hyperactivity disorder
Keyword 2: neuropsychological assessment
Keyword 3: attention

Objective:

It is well documented that the prevalence of first-time ADHD diagnoses in adulthood is rising (Danielson et al., 2023). Adults with ADHD present with varied patterns of neurocognitive impairment, psychological comorbidities, and functional difficulties, which can lead to unique diagnostic challenges. This study used latent profile analysis (LPA) to identify subgroups, or patient profiles, in a referred adult ADHD population. Prior LPA research on ADHD has primarily investigated children and considered a limited number of neurocognitive tasks (Cohen et al., 2023; Hulst et al., 2015). This study identified groups of individuals in a referred adult ADHD sample based on self-reported behavioral symptoms, emotional functioning, and performance on a comprehensive neuropsychological battery. The primary objective of this study was to inform our understanding of the heterogeneity observed in adult ADHD.

Participants and Methods:

The sample consisted of 259 adult patients referred for an ADHD evaluation (M age= 25.94; SD=7.83; 78% Caucasian; 54% male; M edu=14.24; SD=1.57). Seventeen profile indicator variables were included in the latent profile model to determine the optimal number of classes and characteristics that distinguished members of one group from another (Ostrander et al., 2008). Neuropsychological performance was measured through a comprehensive battery assessing domains of sustained attention, executive functioning, memory, working memory, and processing speed. Emotional functioning and ADHD symptoms were quantified via self-report measures. Criteria for LPA model selection was based on the Bayesian Information Criteria (BIC), the Vuong-Lo-Mendell-Rubin (VLMR) likelihood ratio test, and consideration of the smallest class size. Once the number of classes was determined, a one-way analysis of variance was conducted to evaluate neuropsychological, psychological, and behavioral differences across classes. The likelihood of ADHD diagnosis within each class, based on clinical interview rating and completion of ADHD self-report measures, was also assessed.

Results:

Up to seven profile solutions were modeled, and a four-class solution provided the best fit, as indicated by the lowest BIC value (BIC =22604, LL=−10759, number of parameters =106). Based on the mean scores across characteristics for each profile, the four classes were labeled as neuropsychiatrically distressed (30 patients [11.6%]), neuropsychiatrically resilient (50 patients [19.3%]), broad cognitive inefficiencies only (80 patients [30.9%]), and cognitive inefficiencies with preserved vigilance (99 patients [38.2%]). The likelihood of a patient receiving an ADHD diagnosis varied amongst groups, ranging from 80% (broad cognitive inefficiencies only group) to 61.6% (cognitive inefficiencies with preserved vigilance group).

Conclusions:

This research explored the heterogeneity of cognitive, behavioral, and emotional functioning in a referred adult ADHD sample. Results suggested significant variability, particularly in neuropsychological performance and mood. ADHD is a highly comorbid disorder, and it is not surprising that the neuropsychiatrically distressed group performed most poorly on cognitive measures (Gallagher & Blader, 2001). Interestingly, despite different patterns of neuropsychological functioning and rates of emotional symptoms, the likelihood of an ADHD diagnosis did not dramatically differ across groups. In summary, an appreciation of the heterogeneity in symptom presentation in adults with ADHD improves our conceptualization of the disorder and ability to offer specific treatment recommendations.