The Cambridge Neuropsychological Test Automated Battery in The Assessment of Executive Functioning

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The Cambridge Neuropsychological Test Automated Battery in the

Assessment of Executive Functioning
Chapter · April 2014

DOI: 10.1007/978-1-4614-8106-5_11
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Chapter Title The Cambridge Neuropsychological Test Automated Battery in the

Assessment of Executive Functioning
Copyright Year 2014
Copyright Holder Springer Science+Business Media New York
Corresponding Author Family Name Wild
Particle
Given Name Katherine V.
Suffix
Organization Oregon Health and Science University
Address 3181 SW Sam Jackson Park Road,
Portland, OR, 97239, USA
Author Family Name Musser
Particle
Given Name Erica D.
Suffix
Organization Oregon Health and Science University
Address 3181 SW Sam Jackson Park Road,
Portland, OR, 97239, USA
Abstract Computerized administration of clinical instruments is not an entirely
new phenomenon. The first personal computers were introduced into
wide use in the 1970s. Rapid adoption of computer-based testing
paralleled this development. By the 1980s, the research literature was
replete with considerations of the inherent advantages and limitations
of automated assessment of a myriad of clinical domains. In particular,
the application of computers to the evaluation of cognition has been
widely studied. This body of research has generally fallen into one
of two categories: (1) the translation of existing standardized tests to
computerized administration and (2) the development of new computer
tests and batteries for the assessment of cognitive function. Somewhere
between these two categories are approaches that have adapted existing
tests in a new way using computer administration. The Cambridge
Neuropsychological Test Automated Battery (CANTAB) is an example
of a battery that has successfully combined standard cognitive test
paradigms with novel formats.
The Cambridge Neuropsychological
Test Automated Battery
1
2
11
in the Assessment of Executive 3
Functioning 4
Katherine V. Wild and Erica D. Musser 5
6 Computerized administration of clinical instruments ing floor and ceiling effects, potential for more 35
7 is not an entirely new phenomenon. The first per- standardized administration, multiple versions 36
8 sonal computers were introduced into wide use in applicable to repeated testing, and precisely 37
9 the 1970s. Rapid adoption of computer-based test- record accuracy and speed of response with a 38
10 ing paralleled this development. By the 1980s, the level of sensitivity not possible in standard 39
11 research literature was replete with considerations administrations. Another potential advantage of 40
12 of the inherent advantages and limitations of auto- computerized test batteries over traditional 41
13 mated assessment of a myriad of clinical domains. paper-and-pencil assessments is their flexibility 42
14 In particular, the application of computers to the in terms of immediate adjustment to performance 43
15 evaluation of cognition has been widely studied. levels. Many batteries have the capability of 44
16 This body of research has generally fallen into one automatically altering test order, presentation 45
17 of two categories: (1) the translation of existing rate, and level of difficulty in response to ongo- 46
18 standardized tests to computerized administration ing test performance. Such characteristics can be 47
19 and (2) the development of new computer tests and critical both in early detection and also in extend- 48
20 batteries for the assessment of cognitive function. ing the range of a test to be useful across the full 49
21 Somewhere between these two categories are range of cognitive performance in a given patient 50
22 approaches that have adapted existing tests in a population. 51
23 new way using computer administration. The In comparison with traditional neuropsycho- 52
24 Cambridge Neuro-psychological Test Automated logical assessment instruments, computerized 53
25 Battery (CANTAB) is an example of a battery that tests may also represent a potential cost savings 54
26 has successfully combined standard cognitive test not only with regard to materials and supplies but 55
27 paradigms with novel formats. also in the time required of the test administrator. 56
28 The transition from paper-and-pencil- to Moreover, the nature of the computerized instru- 57
29 computer- based assessment is not necessarily ments may allow administration by health-care 58
30 straightforward, and both methods of administra- clinicians other than neuropsychologists, allow- 59
31 tion have distinct advantages and drawbacks. ing greater scheduling flexibility in the reduced 60
32 Included among the multiple benefits of comput- need for administration by trained personnel. 61
33 erized tests that have been cited are their ability In the initial excitement of this new applica- 62
34 to cover a wider range of abilities while minimiz- tion of technology, however, some basic aspects 63
of test development may have been sacrificed. 64
One of the more persistent criticisms of comput- 65
[AU1] K.V. Wild (*) • E.D. Musser
Oregon Health and Science University, 3181 SW Sam
erized test batteries has been the general lack of 66
Jackson Park Road, Portland, OR 97239, USA adequately established psychometric standards 67
e-mail: wildk@ohsu.edu (Schlegel & Gilliland, 2007). Whether included 68
S. Goldstein and J.A. Naglieri (eds.), Handbook of Executive Functioning,

DOI 10.1007/978-1-4614-8106-5_11, © Springer Science+Business Media New York 2014
K.V. Wild and E.D. Musser
69 in the test development phase or as post hoc specific neural networks. The capability of a 114
70 analyses, basic indices of psychometric proper- computerized test battery with a well-defined
115
71 ties are essential to the widespread acceptance of theoretical foundation to dissect performance on 116
72 new cognitive test batteries. Schlegel and a test of executive function, for example, into 117
73 Gilliland (2007) have outlined the necessary ele- multiple related but independent factors is a 118
74 ments of quality assurance assessments for unique asset in furthering our knowledge of 119
75 computer-based batteries. They caution against brain–behavior relationships. 120
76 the acceptance of computerized adaptations of In its original format first presented over 20 121
77 paper-and-pencil tests based purely on face valid- years ago (Sahakian, 1990), the CANTAB con- 122
78 ity. Others have also warned that equivalence sisted of three batteries of tests designed to mea- 123
79 across these media cannot be assumed (Buchanan, sure visual memory, attention, and planning. 124
80 2002; Butcher, Perry, & Atlis, 2000; Doniger Over the years the battery has expanded to 125
81 et al., 2006). At a minimum, differences in com- include tests designed to assess visual and verbal 126
82 munication of instructions, stimulus presenta- memory, executive function, attention, decision- 127
83 tion, and response format may yield significant making and response control, and social cogni- 128
84 differences in test performance, particularly in an tion. In addition two short “induction” tests can 129
85 older population. Differences in computer expe- be used to familiarize participants with the 130
86 rience as an intervening variable in performance general testing milieu and response format. The 131
87 cannot be ignored. Failure to demonstrate equiva- publishers of the CANTAB have also assembled 132
88 lence between the examinee’s experience of com- “core batteries” for various diagnostic applica- 133
89 puter versus traditional test administration, tions such as attention-deficit/hyperactivity dis- 134
90 limited—and for the elderly in particular, per- order (ADHD), mild cognitive impairment 135
91 haps unfamiliar—response modality, and poorly (MCI), and schizophrenia, to provide focused 136
92 designed computer-person interface has been assessments of the cognitive domains relevant to 137
93 problematic in early iterations of this new each disorder. 138
94 methodology. The nature of automated tests such as the 139
CANTAB makes possible investigations of exec- 140
utive function across the life span. With minimal 141
95 CANTAB reliance on language, and continuous and imme- 142
diate adjustment to level of performance, the 143
96 The CANTAB was developed initially by adapt- CANTAB is well suited to help clarify age- 144
97 ing animal paradigms for cognitive testing related changes in specific executive abilities. 145
98 (Robbins et al., 1994; Sahakian & Owen, 1992). DeLuca et al. (2003) selected CANTAB tests 146
99 At the same time, careful analysis of the pro- thought to tap working memory, strategic plan- 147
100 cesses underlying each cognitive domain yielded ning, organization of goal-directed behavior, and 148
101 means for independent assessment of these pro- set-shifting in a study of a normative sample 149
102 cesses in a systematic and controlled fashion. For between the ages of 8 and 64. After administra- 150
103 example, in an adaptation of the widely used tion of the Spatial Span (SSP), Spatial Working 151
104 Tower of London test of planning, the CANTAB Memory (SWM), Tower of London, and Intra-/ 152
105 Stockings of Cambridge tasks involve two stages. Extra-Dimensional Set-Shifting (IED) tests to 93 153
106 In the first, the subject works out and executes a males and 101 females, the authors concluded 154
107 series of steps to replicate a presented configura- that the CANTAB was sensitive to age and gen- 155
108 tion; in the second, the subject must arrive at the der effects on executive function. 156
109 correct response by mentally solving the series of Another important parameter of test batter- 157
110 moves without actually moving the stimuli. The ies purported to be well suited to repeat admin- 158
111 multiple measures obtained during these tasks istration, and tracking of change over time or 159
112 are then related to discrete cognitive functions with intervention, is test-retest reliability. Lowe 160
113 that in turn are associated with activation of and Rabbitt (1998) administered all tests of the 161
11 The Cambridge Neuropsychological Test Automated Battery…
162 CANTAB on two occasions separated by 4 weeks. made to include those articles describing the 210
163 The authors hypothesized that practice effects most rigorous scientific methodology. 211
164 may be a more significant issue for tests that
165 assess frontal or executive functions than tests
166 of temporal function, as the former tend to rely CANTAB Tests 212
167 on identification of strategies for successful
168 performance. Further, as task novelty decreases The CANTAB can be administered by a trained 213
169 with repetition, practice effects and individual assistant without reliance on verbal instruction. 214
170 variability in improvement with repeat testing Responses are by touch screen or with a response 215
171 may be amplified. Participants, ages 60–80, button, depending on the task demands. Each 216
172 were selected to represent a range of ability as task begins with practice items at a basic level. 217
173 measured by a test of fluid intelligence. Practice The design and interface of the CANTAB tests 218
174 effects were found to vary with test, task diffi- thus attempt to minimize effects of computer 219
175 culty, level of intellectual ability, and outcome experience and computer-related anxiety. The 220
176 parameters. In general, test-retest correlations tests described below are those that assess execu- 221
177 were higher for tests of memory than for tests tive function and related domains; additional 222
178 of planning or working memory. More specifi- tests of verbal and visual memory and social cog- 223
179 cally, measures such as number of moves to nition that are part of the complete battery are 224
180 solution on the Tower of London had poor test- beyond the scope of this chapter but are described 225
181 retest correlations. On some tests higher intel- on their website (http://www.cambridgecogni- 226
182 ligence was related to greater improvement tion.com). 227
183 with practice, while on others the opposite was
184 true. Speed versus accuracy measures also dif- Attention Switching Task (Goldberg et al., 2005). 228
185 fered in their sensitivity to repeat testing. The The participant is initially instructed to press a 229
186 authors recommend the use of correction fac- left or right button in response to the direction in 230
187 tors for practice effects where available, or at a which an arrow in the center of the screen is 231
188 minimum, obtaining good baseline data by pointing. The second phase requires the partici- 232
189 allowing participants’ practice trials dependent pant to attend to a cue at the top of the screen that 233
190 on the task. will determine whether the response reflects the 234
191 The CANTAB has been used extensively in direction in which the arrow is pointing or the 235
192 research settings as well as in clinical trials and side of the screen on which the arrow is located. 236
193 has a published bibliography of over 700 articles Outcome measures include speed, accuracy, and 237 [AU2]
194 assessing over 100 disorders. For the purposes of types of errors (commission and omission), as 238
195 this review, discussion will be limited to those well as switch cost and congruency cost. 239
196 publications addressing deficits in executive
197 function. Further, we focus on a selection of diag- Intra-/Extra-Dimensional Set Shift (IED). This 240
198 nostic groups that represent some of the main tar- test, described as a computer-based analog of the 241
199 gets of research with this instrument. Thus, the Wisconsin Card Sorting Test, assesses set forma- 242
200 bulk of the discussion will review studies of tion and maintenance, shifting, and attentional 243
201 ADHDs and autism spectrum disorders (ASD) in flexibility. The task includes nine stages of 244
202 childhood, followed by an overview of work in increasing difficulty. The test initially presents 245
203 age-related cognitive decline, disorders of the two simple colored shapes and the participant 246
204 frontal lobe, and finally Huntington’s disease as must determine which one is correct in response 247
205 an exemplar of a progressive neurodegenerative to feedback. In successive stages when criterion 248
206 disorder with executive function implications. is reached (i.e., six correct responses), the rules 249
207 While it is beyond the scope of this chapter to and/or stimuli change, moving from intra- 250
208 summarize all relevant research efforts even in dimensional, in which colored shapes remain the 251
209 these diagnostic categories, every effort has been only relevant dimension, to extra-dimensional, 252
this figure will be printed in K.V. Wild and E.D. Musser
b/w
Fig. 11.1 One-touch stockings of Cambridge (left) and spatial working memory (right) tasks
253 in which the participant needs to shift between sequence spans. The initial span consists of two 285
254 white lines and colored shapes as relevant or boxes changing color up to a maximum of nine. 286
255 irrelevant dimensions. Among the multiple The test is discontinued after three consecutive 287
256 outcome measures are errors to criterion, number errors at a given span. Span length, errors, number 288
257 of trials and stages completed, and response of attempts, and latency are recorded. 289
258 latencies.
Spatial Working Memory (SWM). Participants are 290
259 Stockings of Cambridge (Association). Based on asked to search through randomly arrayed boxes 291
260 the Tower of London test, the SOC is a measure to locate colored tokens within the boxes, in 292
261 of spatial planning in which the participant order to fill a column on the side of the display. 293
262 attempts to move colored balls to match a dis- The number of boxes is increased over trials to a 294
263 played pattern in the least possible number of maximum of eight boxes. Measures of latency, 295
264 moves. The time taken to complete the pattern, errors, and a measure of search strategy are 296
265 number of moves taken, and trials performed in among the main outcome measures for this task. 297
266 minimum number of moves are measured. Errors can be further analyzed as “between- 298
search” errors in which the subject returns to a 299
267 One-Touch Stockings of Cambridge (OTS). This box which has already been found to contain a 300
268 test relies on working memory in addition to spa- token and “within-search” errors in which a box 301
269 tial planning. In this task, two arrays of colored already opened and found to be empty earlier in 302
270 balls are presented. The participant’s task is to the same trial is touched (Fig. 11.1). 303
271 choose from a series of numbered boxes, the min-
272 imum number of moves required to achieve the Rapid Visual Information Processing (RVP). 304
273 upper display by rearranging the lower array. The In this test of sustained attention, a white box 305
274 response is based on working out the solution appears in the center of the screen, containing 306
275 without actually moving any balls. Outcome single digits that appear in random order. The 307
276 measures are based on speed and accuracy of participant’s task is to monitor the sequence of 308
277 response and include problems solved on first digits to match a target three-digit sequence. 309
278 choice, mean choices to correct response, latency Measures of latency, hits and misses, false alarms, 310
279 to first choice, and latency to correct choice. and rejections are tabulated. 311
280 Spatial Span (SSP). Described as a visual analog Cambridge Gambling Task (CGT). Used to assess 312
281 of the Digit Span Test, in this task white squares decision-making and risk-taking behavior, this 313
282 in an irregular array change color briefly in ran- task asks the participant to guess whether a yellow 314
283 dom sequences. The participant touches the boxes token is hidden in a red box or a blue box of ten 315
284 in the same order, or in reverse order, for varying boxes displayed across the screen. The proportion 316
317 of red to blue boxes varies, as does the percent of & Catroppa, 2001; Hughes & Graham, 2002; 361
318 “points” the participant chooses to gamble on the Kempton et al., 1999). 362
319 correctness of their choice. The test aims to However, more recent investigations into 363
320 separate out risk-taking from impulsivity, as the executive functioning in children have suggested 364
321 point percents are presented in ascending or that these processes develop much earlier than 365
322 descending order, forcing the participant to wait to once thought, beginning around 12 months of 366
323 make a high-risk bet. Outcome measures can age, with a burst in development around 8 years 367
324 include quality of decision-making (i.e., whether of age (Ardila & Roselli, 1994; Case, 1992; 368
325 the subject chose the more likely outcome), time DeLuca et al., 2003; Luciana & Nelson, 1998). 369
326 taken to choose, “bet” size, and risk adjustment. Additionally, these early increases in executive 370
functioning have been correlated with increased 371
327 Stop Signal Task (SST). This is a response inhibi- myelination and synaptogenesis in the frontal 372
328 tion test of two parts. In the first, participants are regions during these periods of growth (DeLuca 373
329 instructed to press a left- or right-hand button in et al., 2003; Espy, 1997; Kempton et al., 1999; 374
330 response to an arrow pointing in that direction. In Klingberg, 1997). Furthermore, life-span studies 375
331 the second set of trials arrows continue to appear of executive functioning show that a number of 376
332 but the response is to be withheld if an auditory domains, including short-term memory and 377
333 signal precedes the arrow presentation. Outcome sequencing, working memory, strategic planning 378
334 measures include direction errors, proportion of and organization, and attentional set-shifting, 379
335 successful stops, go-trial reaction time, stop-trial appear to be present and measurable between 380
336 errors, and stop signal reaction time. ages 8 and 10 years, with the greatest functional 381
gains in performance in each of these domains 382
appearing between 15 and 30 years of age, fol- 383
337 ssessing Executive Functioning
A lowed by a gradual decline in performance over 384
338 in Childhood time with aging (DeLuca et al., 2003). Thus, 385
there is much evidence to support the develop- 386
339 Until recently, little research had been conducted ment executive functioning in children, and as 387
340 on executive functioning in childhood, as it was such, there is an increased need to develop stan- 388
341 believed that these cognitive skills did not develop dardized executive functioning assessment mea- 389
342 until adolescence (DeLuca et al., 2003; Golden, sures that are appropriate for use with children. 390
343 1981; Hughes & Graham, 2002). This paucity of The increased interest in the childhood devel- 391
344 research on executive functioning in children has opment of executive functioning has been sparked 392
345 been tied to three major factors (DeLuca et al., by the study of clinical populations, as well as the 393
346 2003). First, it was thought that the prefrontal development of several new assessment methods, 394
347 cortex only became functionally mature late in which have been shown to be appropriate for use 395
348 development (i.e., late in adolescence or early with children (Hughes & Graham, 2002). Of par- 396
349 adulthood) (Golden, 1981; Stuss, 1992). Second, ticular interest, several neurodevelopmental disor- 397
350 several primate studies and early research on ders have been shown to be associated with specific 398
351 traumatic brain injuries suggested that juvenile impairments in executive functioning, with the 399
352 prefrontal lesions had little or no consequence greatest body of literature providing evidence for 400
353 until later in adulthood (Walker, Husain, Hodgson, these deficits in ADHD and ASD (Hughes & 401
354 Harrison, & Kennard, 1998). Third, as standard- Graham, 2002; Ozonoff, 1997). Specifically, chil- 402
355 ized measures of executive functioning were dren with ADHD have been shown to have deficits 403
356 designed to be difficult, these measures were primarily in inhibitory control, which is likely 404
357 often inappropriate for use with children, leaving rooted in frontostriatal circuitry and decreased vol- 405
358 this group of individuals without formal ume in dorsolateral prefrontal cortex, caudate, and 406
359 assessments of these domains of cognitive func- cerebellum, as well as difficulty with strategic flex- 407
360 tioning (Anderson, Anderson, Northam, Jacobs, ibility, planning, working memory, monitoring, 408
409 and sustained attention (Chamberlain et al., 2011). development. Specifically, these testing batteries 457
410 In contrast, executive functioning deficits in ASD can tap into a wide range of abilities, reduce floor 458
411 have been more often characterized by high-level and ceiling effects, reduce human error with 459
412 cognitive, nonspatial problems, such as deficits in more standardized formats, more precisely record 460
413 planning and set-shifting, as well as more second- speed and accuracy, reduce reliance on verbal 461
414 ary deficits in working memory (Hill, 2006). instructions and feedback, and increase the 462
415 Furthermore, numerous studies of preschoolers potential for widespread screening efforts across 463
416 have demonstrated that individual differences in broad age ranges (DeLuca et al., 2003; Wild, 464
417 executive functioning are correlated with individ- Howieson, Webbe, Seelye, & Kaye, 2008). In 465
418 ual differences in theory of mind, or the ability to particular, the CANTAB may be uniquely suited 466
419 attribute mental states to the self and others, which to the assessment of executive functioning in 467
420 is a well-established deficit among individuals children (Chamberlain et al., 2011; DeLuca et al., 468
421 with ASD (Hughes & Graham, 2002; Perner & 2003). The CANTAB has the benefit of being 469
422 Lang, 1999). widely used in academic studies with children 470
423 In addition to the growth of research in the from age 4 years and upwards (Chamberlain 471
424 domain of executive functioning deficits in neu- et al., 2011), with standardized scores and age- 472
425 rodevelopmental disorders, the study of norma- normative data available for individuals aged 473
426 tive development of executive functioning in 8–80 years (Chamberlain et al., 2011; DeLuca 474
427 childhood has also received increased attention. et al., 2003; Hughes & Graham, 2002). 475
428 This increased focus has resulted in the develop- Furthermore, the CANTAB has been shown to be 476
429 ment of numerous executive functioning assess- sensitive to impairments in school-aged children 477
430 ment measures, which propose to be appropriate with ADHD, ASD, and other neurodevelopmen- 478
431 for broad age groups (Hughes & Graham, 2002; tal disorders (Chamberlain et al., 2011; Hughes 479
432 Hughes, Plumet, & Leboyer, 1998; Manly et al., & Graham, 2002). In fact, recent reviews suggest 480
433 2001). However, children differ from adults in a that over 30 studies have utilized the CANTAB to 481
434 number of important ways, and to fully assess examine executive functioning deficits in 482
435 executive functioning in children, executive func- individuals with ADHD, and 20 studies have
483
436 tioning assessment measures must make accom- done so in individuals with ASD. We now turn 484
437 modations for these differences. Specifically, our attention to a review of these literatures 485
438 children have limited language abilities and tend beginning with ADHD. 486
439 to have poorer motivation than adults; thus, child-
440 appropriate measures of executive functioning
441 need to be easy to understand, relatively indepen- valuating Executive Functioning
E 487
442 dent of language skills, somewhat simplified, and Using CANTAB in ADHD 488
443 in order to maintain motivation, somewhat fun
444 (DeLuca et al., 2003; Hughes & Graham, 2002). According to DSM-IV criteria, ADHD includes 489
445 Furthermore, in order to assess the development the symptom domains of inattention/distraction 490
446 of executive functioning over time in both typi- and hyperactivity/impulsivity (American Psy- 491 [AU3]
447 cally developing and neurodevelopmentally chological Association, 2000). Impairments in 492
448 delayed populations, executive functioning executive functioning are suggested both by the 493
449 assessment tools must be standardized across core diagnostic criteria of ADHD, with dysregu- 494
450 broad age ranges and populations, allowing for lation of attention, behavior, and impulse control 495
451 more reliable and valid longitudinal assessments at the heart of the disorder, and disruptions to the 496
452 (Hughes & Graham, 2002). frontostriatal circuitry, as supported by neuroim- 497
453 Computerized testing batteries of executive aging studies, which have revealed reduced 498
454 functioning may help to address several of the volumes in the dorsolateral prefrontal cortex,
499
455 issues associated with the assessment of execu- caudate, and cerebellum (Seidman, Biederman, 500
456 tive functioning both in children and across Monuteaux, & Doyle, 2005; Valera, Faraone, 501
502 Murray, & Seidman, 2007). Specifically, children inhibition. These findings are similar to those that 550
503 with ADHD have been shown to have deficits in have been reported in other meta-analyses using 551
504 primarily inhibitory control, as well as difficulty other computerized SSTs, as well as other 552
505 with strategic flexibility, planning, working measures of inhibition, such as the Stroop task 553
506 memory, self-monitoring, and sustained attention (Boonstra, Oosterlaan, Sergeant, & Buitelaar, 554
507 (Chamberlain et al., 2011). 2005; Lijffijt, Kenemans, Leon, Verbaten, & van 555
508 The CANTAB has been widely used in the Engeland, 2005; Willcutt, Doyle, Nigg, Faraone, 556
509 study of executive functioning deficits associated & Pennington, 2005). Additionally, this deficit 557
510 with ADHD, as well as in the study of the effects has been observed in both children (Brophy, 558
511 of pharmaceutical treatment on both improving Taylor, & Hughes, 2002; DeVito et al., 2008; 559
512 executive functioning and reducing symptoms Goldberg et al., 2005; Rhodes, Coghill, & 560
513 among individuals with ADHD. In fact, in a Matthews, 2005) and adults (Aron, Dowson, 561
514 recent meta-analysis by Chamberlain et al. Sahakian, & Robbins, 2003; Chamberlain et al., 562
515 (2011), 13 studies examining performance on 2007; Clark et al., 2007; McLean et al., 2004; 563
516 CANTAB subtests compared participants with Turner, Clark, Dowson, Robbins, & Sahakian, 564
517 ADHD and typically developing controls. 2004). Thus, the deficit in inhibition appears to 565
518 According to this meta-analysis, medium to large be rather robust among individuals with ADHD 566
519 effects were observed in participants with ADHD (Garcia-Villamisar & Hughes, 2007). 567
520 when compared to typically developing controls These deficits have been associated with 568
521 on the CANTAB sub-domains of response inhibi- disrupted neural networks, including right infe- 569
522 tion, working memory, and executive planning, rior frontal gyrus, bilateral anterior cingulate 570
523 with smaller effects observed in attentional set- cortex, and the superior motor region (Clark 571
524 shifting (Chamberlain et al., 2011). An additional et al., 2007; Goldberg et al., 2005). Additionally, 572
525 review of the literature on the effects of salient inhibition is thought to be under the control of 573
526 drugs on executive functioning, as assessed by catecholamines, specifically dopamine and 574
527 the CANTAB, in individuals with ADHD norepinephrine, as several studies have shown 575
528 revealed that methylphenidate (Ritalin) improved that medications which alter dopaminergic and 576
529 working memory, modafinil improved planning, noradrenergic functioning improve inhibition 577
530 and methylphenidate, modafinil, and atomox- and stop signal reaction times among individu- 578
531 etine all improved inhibition (Chamberlain et al., als with ADHD (Aron et al., 2003; Chamberlain 579
532 2011). We now turn our attention to a more in- et al., 2007; DeVito et al., 2008; Turner et al., 580
533 depth examination of these literatures beginning 2004). Specifically, in an acute, double-blind, 581
534 with an examination of the literature on inhibi- placebo-controlled crossover study, Aron et al. 582
535 tion as assessed by the CANTAB in individuals (2003) found that methylphenidate ameliorated 583
536 with ADHD. the deficit in stop signal reaction time among 584
adults with ADHD, and DeVito et al. (2008) 585
537 Inhibition as Assessed by the CANTAB in ADHD. replicated these results in children. 586
538 Inhibition is assessed with the CANTAB using Additionally, Coghill, Rhodes, and Matthews 587
539 the SST, which is a classic stop signal response (2007) found that chronic treatment of ADHD 588
540 inhibition test. As described above, the meta- with methylphenidate improved performance 589
541 analysis by Chamberlain et al. (2011) found a on the SST among children. In contrast, 590
542 large deficit in stop signal reaction time when Rhodes, Coghill, and Matthews (2006) did not 591
543 individuals with ADHD were compared to typi- observe the amelioration of the slowed stop 592
544 cally developing individuals across four studies. signal reaction time among children with 593
545 Specifically, individuals with ADHD were found ADHD in a randomized, double-blind, placebo- 594
546 to have longer stop signal reaction times; how- controlled study with methylphenidate; how- 595
547 ever, individuals with ADHD did not differ from ever, it should be noted that this study utilized 596
548 controls with respect to their reaction times on go a low-dose design. Thus, it may be that dosing 597
549 trials, suggesting that the deficit is specific to and duration of treatment with methylphenidate 598
599 play a role in the treatment of disinhibition items in working memory. Meta-analytic results 646
600 among individuals with ADHD. suggest that the greatest impairments are in the 647
601 It should also be noted that similar results areas of between-search errors and strategy, with 648
602 were observed in acute, double-blind, placebo- individuals with ADHD having more errors and 649
603 controlled crossover studies with atomoxetine in worse strategy scores than typically developing 650
604 children (Gau & Shang, 2010b) and adults with controls. Furthermore, this is consistent with pre- 651
605 ADHD (Chamberlain et al., 2007), and modafinil vious meta-analytic work examining other SWM 652
606 has been shown to have similar effects in adults tasks revealing SWM deficits in ADHD 653
607 with ADHD (Turner et al., 2004). Therefore, the (Martinussen, Hayden, Hogg- Johnson, & 654
608 treatment effects do not appear to be specific to a Tannock, 2005; Willcutt et al., 2005). As with the 655
609 particular medication; however, these effects do observed effect on inhibition, the working mem- 656
610 appear to be limited to those medications that tar- ory deficit associated with ADHD has also been 657
611 get both norepinephrine and dopamine. observed in both children (Barnett et al., 2001; 658
612 Interestingly, the results observed among indi- Gau, Chiu, Shang, Cheng, & Soong, 2009; Gau 659
613 viduals with ADHD were also shown to be rele- & Shang, 2010a; Goldberg et al., 2005; Kempton 660
614 vant to healthy controls. In two acute, et al., 1999; Klingberg, Forssberg, & Westerberg, 661
615 double-blind, placebo-controlled studies with 2002; Rhodes, Coghill, & Matthews, 2004; 662
616 atomoxetine, one parallel and one crossover Vance, Maruff, & Barnett, 2003) and adults 663
617 design, significant increases in stop signal reac- (Chamberlain et al., 2007; Clark et al., 2007; 664
618 tion times were observed among healthy adult Dowson et al., 2004; Gropper & Tannock, 2009; 665
619 volunteers (Chamberlain et al., 2006, 2009). In McLean et al., 2004). The SWM deficit may 666
620 an fMRI study, the use of atomoxetine was found serve as an endophenotype of ADHD, as typi- 667
621 to increase right, frontal inferior cortex activation cally developing siblings of children with ADHD 668
622 during the CANTAB stop signal task among have also been shown to display deficits on this 669
623 healthy adult volunteers (Chamberlain et al., measure (Gau & Shang, 2010a). Additionally, 670
624 2009). However, mixed results have been poor performance on SWM in individuals with 671
625 observed in similar trials using both methylphe- ADHD has also been linked to poor academic 672
626 nidate and modafinil with some studies finding achievement among young adults and poor per- 673
627 increases in stop signal reaction time and some formance on progressive matrices tasks, increased 674
628 studies finding no treatment effects (Turner et al., motor activity, and poor inhibition among chil- 675
629 2003, 2004; Winder-Rhodes et al., 2009). Finally, dren (Clark et al., 2007; Gropper & Tannock, 676
630 in a single acute, double-blind, placebo- 2009; Klingberg et al., 2002). 677
631 controlled, parallel study with guanfacine in Again, the catecholamines, dopamine and 678
632 healthy adult volunteers, an overall global slow- norepinephrine, have been implicated in the defi- 679
633 ing of reaction time on both go and stop trials was cits in working memory observed among indi- 680
634 observed, suggesting that guanfacine may act as viduals with ADHD, as the medications which 681
635 a sedative, resulting in increased inhibition have been found to improve SWM in both chil- 682
636 (Muller et al., 2005). dren and adults with ADHD have all been shown 683
to target the production or to block the reuptake 684
637 Working Memory as Assessed by the CANTAB in of these neurotransmitters. Specifically, methyl- 685
638 ADHD. In addition to deficits in inhibition, defi- phenidate has been shown to improve perfor- 686
639 cits in working memory among individuals with mance on the CANTAB spatial working memory 687
640 ADHD have also been reported in a meta-analysis test in both children (Barnett et al., 2001; Bedard, 688
641 of ten studies with a large effect size (Chamberlain Martinussen, Ickowicz, & Tannock, 2004; 689
642 et al., 2011). In particular, working memory on Brophy et al., 2002; Hoare & Sevar, 2007; 690
643 the CANTAB is assessed with the SWM Task, Kempton et al., 1999; Mehta, Goodyear, & 691
644 which assesses an individual’s ability to retain Sahakian, 2004) and adults (Turner, Blackwell, 692
645 spatial information and manipulate remembered Dowson, McLean, & Sahakian, 2005). In contrast, 693
694 two studies found no effects of methylphenidate Kempton et al., 1999; Rhodes et al., 2005) with 741
695 on SWM among children, though both of these all but one study showing significant deficits in 742
696 were low-dose trials (Coghill et al., 2007; Rhodes accuracy among children with ADHD (Goldberg 743
697 et al., 2004). Methylphenidate was also observed et al., 2005). However, a single study of executive 744
698 to increase accuracy on the SWM task in healthy planning in adults with ADHD, using the
745
699 adults, with PET imaging results suggesting that Stockings of Cambridge subtest, found signifi- 746
700 improved performance was associated with cant deficits in executive planning among adults 747
701 increased binding of dopamine in the striatum with ADHD when compared to typically develop- 748
702 (Mehta, Calloway, & Sahakian, 2000). ing adults (McLean et al., 2004). 749
703 The effect of medications other than methyl- Among individuals with ADHD, performance 750
704 phenidate on SWM performance in individuals on the Stockings of Cambridge test appears to be 751
705 with ADHD is less conclusive with studies relatively unaffected by medication with the 752
706 reporting mixed results. In particular, atomox- majority of studies being conducted with methyl- 753
707 etine has been shown to improve spatial short- phenidate (Bedard et al., 2004; Coghill et al., 754
708 term memory among children in an acute, 2007; Mehta et al., 2004; Rhodes et al., 2006). 755
709 double-blind, placebo-controlled study (Gau & However, a single acute, double-blind, placebo- 756
710 Shang, 2010b), but no effects were observed in a controlled crossover study of adults did report 757
711 similar trial with adults (Chamberlain et al., increased accuracy on the Stockings of 758
712 2011). Similarly, modafinil improved short-term Cambridge test following treatment with 200 mg 759
713 spatial memory span in one acute, double-blind, of modafinil (Turner et al., 2004). Medication 760
714 placebo-controlled trial (Turner et al., 2004), but also appears to have an effect on accuracy on this 761
715 not another (Turner et al., 2005). Finally, in an task among healthy adults. Specifically, guanfa- 762
716 acute, double-blind, placebo-controlled cross- cine and modafinil have both been shown to 763
717 over study with healthy volunteers, guanfacine enhance performance accuracy and planning on 764
718 improved accuracy, but not strategy scores on the the Stockings of Cambridge in healthy adults in 765
719 CANTAB spatial working memory task, though acute, double-blind, placebo-controlled cross- 766
720 no studies of the effects of this medication on over and parallel designed studies (Jakala et al., 767
721 SWM among patients with ADHD were found 1999; Muller et al., 2005; Turner et al., 2003; 768
722 (Jakala et al., 1999). Winder-Rhodes et al., 2009). 769
723 Executive Planning as Assessed by the CANTAB Attentional Set-Shifting as Assessed by the 770
724 in ADHD. Another major deficit observed among CANTAB in ADHD. The CANTAB assesses 771
725 individuals with ADHD is in domain of executive attentional set-shifting using the IED task. 772
726 planning. With respect to the CANTAB, execu- According to a recent meta-analysis of eight 773
727 tive planning is assessed with the Stockings of studies, individuals with ADHD perform signifi- 774
728 Cambridge subtest. In a meta-analysis of six stud- cantly worse on the IED task than typically 775
729 ies using the CANTAB Stockings of Cambridge developing controls with respect to overall num- 776
730 task in ADHD, individuals with the disorder were ber of errors (Chamberlain et al., 2011). This was 777
731 showed to have deficits falling in the medium a somewhat smaller effect than others that have 778
732 effect size range on this executive planning task been reported previously, with deficits in atten- 779
733 (Chamberlain et al., 2011), which is similar to the tional set-shifting in the medium effect size range 780
734 effects sizes reported in previous meta-analyses for individuals with ADHD when compared to 781
735 of executive planning deficits in ADHD (Willcutt typically developing controls on the Wisconsin 782
736 et al., 2005). The majority of research examining Card Sorting Task (Willcutt et al., 2005). 783
737 executive planning deficits associated with Five studies comparing children with ADHD 784
738 ADHD using the Stockings of Cambridge subtest with typically developing controls reported 785
739 has been conducted with children (Brophy et al., reduced accuracy and stages completed among 786
740 2002; Gau et al., 2009; Gau & Shang, 2010a; the ADHD group with the greatest differences 787
788 observed in the final stages of the task, particu- (Elliot et al., 1997; Garcia-Villamisar & Hughes, 836
789 larly the extra-dimensional shifting stages 2007; Jakala et al., 1999; Muller et al., 2005; 837
790 (Gau et al., 2009; Gau & Shang, 2010a; Kempton Randall et al., 2005; Randall, Fleck, Shneerson, 838
791 et al., 1999; Rhodes et al., 2005; Vance et al., 2003). & File, 2004; Randall, Shneerson, Plaha, & File, 839
792 Additionally, Brophy et al. (2002) reported that 2003; Rogers, 1999; Turner et al., 2003, 2004), 840
793 while hard-to-manage children showed intact set- and in fact, both methylphenidate and modafinil 841
794 shifting, compared to typically developing chil- have been shown to impair extra-dimensional 842
795 dren, they made more perseverative and set-shifting in healthy adult volunteers (Randall 843
796 rule-based errors, suggesting that they performed et al., 2004; Rogers, 1999). As such, it may be 844
797 qualitatively differently from typically develop- that this domain of executive functioning is under 845
798 ing youth. In contrast, one study reported no such control of a unique system of neurotransmitter 846
799 difference among children with and without control other than the noradrenergic or dopami- 847
800 ADHD (Goldberg et al., 2005). Similarly, two nergic systems that these drugs typically target. 848
801 such studies have been conducted with adults
802 with one reporting significant differences Other Domains of Cognitive Functioning 849
803 between ADHD and controls on accuracy during Assessed by the CANTAB in ADHD. In addition 850
804 the extra-dimensional shifting stage (McLean to those aspects of executive functioning assessed 851
805 et al., 2004) and one reporting no such differ- by the CANTAB described above, assessments of 852
806 ences (Chamberlain et al., 2007). It should also sustained attention/vigilance are also relevant. In 853
807 be noted that healthy, unaffected siblings of chil- particular, the CANTAB rapid visual information 854
808 dren with ADHD also display impaired set- processing test assesses sustained attention and 855
809 shifting abilities, making more extra-dimensional vigilance, which is similar to several other con- 856
810 shift errors, suggesting that there may be a genetic tinuous performance tasks. Two studies found 857
811 component to this specific measure of executive that individuals with ADHD were less accurate at 858
812 functioning (Gau & Shang, 2010a). Thus, it may identifying targets (more commission errors) 859
813 be that while overall set-shifting ability remains than typically developing controls (Bedard et al., 860
814 somewhat intact among individuals with ADHD, 2004; Turner et al., 2004). Furthermore, it was 861
815 there may be both qualitative and quantitative also reported that both methylphenidate and 862
816 differences in performance on this task at greater modafinil reduced these errors in individuals 863
817 levels of difficulty, and these differences may with ADHD, while atomoxetine did not (Bedard 864
818 serve as an endophenotype of ADHD. et al., 2004; Chamberlain et al., 2006; Turner 865
819 This set-shifting deficit observed among indi- et al., 2004). Additionally, modafinil has been 866
820 viduals with ADHD also appears to be relatively shown to enhance performance, by increasing 867
821 unaltered by salient mediations. Only one acute, accuracy of identifying targets, among healthy 868
822 placebo-controlled parallel study of children with adult volunteers (Randall et al., 2005). 869
823 ADHD treated with methylphenidate reported
824 improved accuracy and stages completed follow- Summary of Executive Functioning Assessed by 870
825 ing treatment (Mehta et al., 2004), while several the CANTAB in ADHD. When assessed with the 871
826 others reported no such effect using similar study CANTAB, children with ADHD have been 872
827 designs using both children and adults treated shown to have deficits in inhibitory control and 873
828 with atomoxetine, methylphenidate, and working memory, as well as more secondary def- 874
829 modafinil (Chamberlain et al., 2007; Coghill icits in executive planning, strategic flexibility/ 875
830 et al., 2007; Rhodes et al., 2006; Turner et al., attentional set-shifting, and sustained attention 876
831 2005). Additionally, no studies have reported sig- (Chamberlain et al., 2011). Additionally, these 877
832 nificant improvements among healthy volunteers findings are congruent with neuroimaging studies 878
833 treated with atomoxetine, guanfacine, methyl- which have reported disruptions to the frontos- 879
834 phenidate, or modafinil in any of the nine triatal circuitry and specifically reduced volumes 880
835 published placebo-controlled studies reviewed
in the dorsolateral prefrontal cortex, caudate, and 881
882 cerebellum (Seidman et al., 2005; Valera et al., these deficits have been linked to several ASD- 927
883 2007). Finally, it has been shown that specific specific behaviors, including perseverative focus 928
884 salient drugs have an ameliorating effect on on details and the display of highly specific 929
885 executive functioning deficits in ADHD as interests. Furthermore, numerous studies of pre- 930
886 assessed by the CANTAB. Specifically, methyl- schoolers have demonstrated that individual 931
887 phenidate (Ritalin) has been demonstrated to differences in executive functioning are corre- 932
888 improve working memory, modafinil improves lated with individual differences in theory of 933
889 planning, and methylphenidate, modafinil, and mind, or the ability to attribute mental states to 934
890 atomoxetine all improve performance on tests of the self and others, which is a well-established 935
891 inhibition (Chamberlain et al., 2011). deficit in individuals with ASD (Hughes & 936
Graham, 2002; Perner & Lang, 1999). Taken 937
together, these findings suggest that executive 938
892 valuating Executive Functioning
E dysfunction in these domains may serve as an 939
893 Using CANTAB in Autism Spectrum endophenotype of ASD. We now turn our atten- 940
894 Disorders tion to specific domains of executive functioning 941
which have been assessed using CANTAB in 942
895 Turning our attention to autism and autism spec- individuals with autism and autism spectrum 943
896 trum disorders, these are a class of neurodevelop- disorders. 944
897 mental disorders characterized by impaired social
898 interaction and communication, as well as Executive Planning as Assessed by the CANTAB 945
899 restricted interests and repetitive behaviors in ASD. Executive planning refers to a complex, 946
900 (American Psychological Association, 2000). dynamic sequence of planned actions that must 947
901 The autism spectrum disorders include autism, be constantly monitored, reviewed, and updated. 948
902 Asperger’s syndrome, which lacks the delays in The CANTAB assesses executive planning with 949
903 cognitive development and language often the Stockings of Cambridge test. Individuals with 950
904 observed in autism, and pervasive developmental autism tend to perform worse than control groups 951
905 disorder-not otherwise specified (American on this task, including groups composed of indi- 952
906 Psychological Association, 2000). Overt symp- viduals with ADHD, Tourette’s syndrome, cogni- 953
907 toms of these disorders gradually begin around tive age-matched individuals with other 954
908 age 6 months and become well established by age developmental disabilities, and typically devel- 955
909 2 or 3 years (American Psychological Association, oping controls (Happe, Booth, Charlton, & 956
910 2000). Autism is associated with significant Hughes, 2005; Hill, 2006; Hughes, Russell, & 957
911 impairment and present in less than 1 % of all Robbins, 1994; Ozonoff et al., 2004; Sinzig, 958
912 youths with a 4:1 male-to-female ratio. However, Morsch, Bruning, Schmidt, & Lehmkuhl, 2008; 959
913 the prevalence of Asperger’s syndrome is some- Witwer & Lecavalier, 2008), suggesting that 960
914 what debated, as it is difficult to distinguish from there may be unique deficits in executive plan- 961
915 high-functioning autism, though it is also ning associated with autism spectrum disorders 962
916 believed to be less than 1 % of all youths with a that are not present in other forms of neurodevel- 963
917 male-to-female ratio ranging from 1.6:1 to 4:1 opmental disorders or psychopathology (Ozonoff 964
918 (Mattila et al., 2007). et al., 2004; Sinzig et al., 2008). Furthermore, 965
919 Executive functioning deficits in these disor- this impairment has been shown to be present in 966
920 ders have been more often characterized by high- children and adolescents with autism and to be 967
921 level cognitive, nonspatial problems, such as sustained over time in both cross-sectional and 968
922 deficits planning and set-shifting, as well as sec- longitudinal studies of individuals with autism 969
923 ondary deficits in inhibition and working mem- (Bramham et al., 2009; Garcia-Villamisar & 970
924 ory. Additionally, milder versions of these deficits Hughes, 2007). Additionally, impaired perfor- 971
925 have also been observed among first-degree, mance on the Stockings of Cambridge task has 972
926 healthy relatives of individuals with ASDs, and been observed among first- degree relatives of 973
974 individuals with autism spectrum disorders, et al., 2005; Lijffijt et al., 2005; Willcutt et al., 1020
975 suggesting that deficits in executive planning
2005), the picture is somewhat less clear in 1021
976 may serve as an endophenotype of the disorder individuals with autism spectrum disorders. 1022
977 (Hughes & Graham, 2002; Hughes, Plumet, & Specifically, inhibition (i.e., stop signal reaction 1023
978 Leboyer, 1999). time) on the SST has been shown to be relatively 1024
intact among children with autism spectrum dis- 1025
979 Attentional Set-Shifting as Assessed by the orders when compared both to children with 1026
980 CANTAB in ASD. The CANTAB assesses atten- ADHD and typically developing children 1027
981 tional set-shifting using the IED task. In general, (Corbett, Constantine, Hendren, Rocke, & 1028
982 individuals with autism spectrum disorders tend Ozonoff, 2009; Edgin & Pennington, 2005; 1029
983 to show deficits in attentional set-shifting and Geurts et al., 2009). However, children with 1030
984 cognitive flexibility, as illustrated by difficulties autism spectrum disorders have been shown to 1031
985 they have with perseverative and stereotyped display impaired vigilance and faster overall 1032
986 behaviors and interests (Hill, 2006), and individu- reaction times (i.e., both on go and stop trials) 1033
987 als with autism spectrum disorders tend to respond than typically developing children (Corbett et al., 1034
988 to the IED and other tasks like it, such as the 2009; Edgin & Pennington, 2005). Finally, quali- 1035
989 Wisconsin Card Sorting Task, with perseverative tative data suggest that children with autism 1036
990 responding especially when shifting to a new rule spectrum disorders tend to view the rules of this 1037
991 or demand (Geurts, Corbett, & Solomon, 2009; task as somewhat arbitrary and have been 1038
992 Hill, 2006; Landa & Goldberg, 2005; Ozonoff reported to develop maladaptive strategies when 1039
993 et al., 2004). This deficit in attentional set-shifting self-reported understanding of the goals of this 1040
994 among individuals with autism spectrum disor- task has been assessed (Hill, 2006). 1041
995 ders has been observed in both children (Geurts
996 et al., 2009; Landa & Goldberg, 2005; Ozonoff Working Memory as Assessed by the CANTAB in 1042
997 et al., 2004) and adults (Berger, Aerts, van ASD. As with inhibition, there is evidence that 1043
998 Spaendonck, Cools, & Teunisse, 2003). The defi- the primary deficits observed in tasks of work- 1044
999 cit has also been observed when individuals with ing memory as assessed by the CANTAB may 1045
1000 ASD are compared to individuals with other neu- be due to the use of maladaptive strategies or 1046
1001 rodevelopmental disorders and typically develop- poor understanding of the rules (Steele, 1047
1002 ing controls (Hughes et al., 1994) and when Minshew, Luna, & Sweeney, 2007). However, 1048
1003 matched according to age, the presence or absence there is evidence of individual differences and 1049
1004 of a learning disorder (Hughes et al., 1994), and/ heterogeneity in working memory skills both 1050
1005 or verbal and nonverbal developmental age among individuals with autism spectrum disor- 1051
1006 (Sinzig et al., 2008; Teunisse, Cools, van der and their fi rst-
degree relatives (Garcia- 1052
1007 Spaendonck, Aerts, & Berger, 2001). As with Villamisar & Hughes, 2007). For example, 1053
1008 executive planning, deficits in attentional set- healthy siblings of individuals with autism spec- 1054
1009 shifting have also been observed as assessed on trum disorders have been shown to have superior 1055
1010 the Stockings of Cambridge task among healthy SSPs, but there were no observed differences 1056
1011 parents and siblings of individuals with autism when compared to typically developing individ- 1057
1012 spectrum disorders (Hughes et al., 1999; Hughes uals with respect to working memory perfor- 1058
1013 & Graham, 2002). mance per se (Hughes et al., 1999). Others have 1059
shown improved visuospatial functioning among 1060
1014 Inhibition as Assessed by the CANTAB in ASD. all autism spectrum disorder probands (Lajiness 1061
1015 While there is a great deal of evidence to support & Menard, 2008). 1062
1016 deficits in inhibition among individuals with
1017 ADHD as assessed by the CANTAB using the Summary of Executive Functioning Assessed by 1063
1018 SST (Chamberlain et al., 2011), as well as a num- the CANTAB in ASD. Autism and autism spec- 1064
1019 ber of other assessments of inhibition (Boonstra trum disorders have been characterized by high- 1065
1066 level cognitive, nonspatial problems, such as deficits In a later study focused on CANTAB tests of 1111
1067 in planning and set-shifting, as well as secondary executive function, Robbins et al. (1998) reported 1112
1068 deficits in inhibition and working memory. results from a sample of healthy older adults. 1113
1069 These findings are congruent with neuroimaging Three hundred forty-one participants were 1114
1070 studies that have reported both structural abnor- administered with SWM, Stockings of 1115
1071 malities in the prefrontal cortexes of individuals Cambridge, and IED tests as well as CANTAB 1116
1072 with autism and reduced dorsolateral and ventro- tests known to demonstrate age-related decline 1117
1073 medial prefrontal cortex activity during these (i.e., tests of visual memory and learning). 1118
1074 tasks among individuals with autism when com- Greatest age-related declines were seen in atten- 1119
1075 pared to typically developing controls (Berger tional set-shifting, where the oldest age group 1120
1076 et al., 2003; Hill, 2006; Ozonoff et al., 2004). (75–79) made significantly more errors than the 1121
1077 Additionally, milder versions of these deficits rest of the group on extra-dimensional set shifts. 1122
1078 have been observed among first-degree, healthy On the Stockings of Cambridge planning task, 1123
1079 relatives of individuals with ASDs, suggesting older adults solved fewer problems in the mini- 1124
1080 that executive dysfunction in these domains may mum possible steps and had significantly longer 1125
1081 serve as an endophenotype of ASD. Finally, it response latencies than the youngest groups. 1126
1082 should be noted that additional research into the The authors conclude that their findings are con- 1127
1083 roles of executive functioning in distinguishing sistent with neuroimaging findings that have 1128
1084 specific subtypes of autism spectrum disorders is demonstrated age-associated changes in prefron- 1129
1085 needed. tal cortex and striatum in addition to regions of 1130
the temporal lobes. 1131
In an attempt to replicate these findings, 1132
1086 ssessing Executive Functioning
A Rabbitt and Lowe (2000) administered the 1133
1087 in Older Adults CANTAB to 162 healthy older adults between 1134
the ages of 60 and 80 years. Unlike the earlier 1135
1088 Despite its application to assessment of cognitive study, they found that tests of the CANTAB that 1136
1089 function in patients with disorders ranging from are established measures of temporal lobe func- 1137
1090 neurologic and psychiatric to metabolic and car- tion (e.g., paired associates learning) were more 1138
1091 diac, the CANTAB was originally developed for age-sensitive than the frontal tasks. For example, 1139
1092 use with older adults and those with dementia scores on the IED and Stockings of Cambridge 1140
1093 (Robbins et al., 1994). Robbins et al. (1994) tests did not correlate with age, while in a linear 1141
1094 administered the CANTAB as it existed in 1994 regression analysis, age predicted performance 1142
1095 to a large sample of healthy older participants on tests of visual memory. The authors conclude 1143
1096 between the ages of 55 and 80, to begin to that the so-called frontal tests of the CANTAB 1144
1097 describe the effects of age, gender, and intelli- are less sensitive to changes of normal aging than 1145
1098 gence on performance. Scores on those subtests the tests that assess memory functions. 1146
1099 were found to successfully differentiate between
1100 different age groups and levels of intellectual
1101 ability. Eleven performance variables (e.g., accu- isorders of Frontal Lobe Function
D 1147
1102 racy and latency scores, learning trials, and error and the CANTAB 1148
1103 scores) were included in a factor analysis, yield-
1104 ing four factors interpreted as representing gen- In describing aspects of executive function that 1149
1105 eral learning and memory, speed of responding, are sensitive to prefrontal cortical dysfunction, 1150
1106 executive processes, and visual perceptual abil- Robbins (1996) cites psychometric and neuroim- 1151
1107 ity. The factor structure was found to remain con- aging evidence to demonstrate the ability of rel- 1152
1108 sistent across age groups and IQ test scores, but evant CANTAB subtests to further characterize 1153
1109 with differential loadings across the four factors deficits in planning, working memory, and atten- 1154
1110 based on IQ test scores. tional set-shifting. For example, patients with 1155
1156 frontal lobe deficits exhibit impaired perfor- by Rahman, Sahakian, Hodges, Rogers, and 1204
1157 mance with extra-dimensional set-shifting on the Robbins (1999) further elucidates the heteroge- 1205
1158 CANTAB Intra-/Extra-Dimensional Set Shift test. neity of executive functions in the prefrontal cor- 1206
1159 Specifically, the impairment has been attributed tex. Eight patients with FTD were compared 1207
1160 to a specific failure of response inhibition based with age-matched healthy controls on a range of 1208
1161 on manipulation of test instructions to induce tests of memory and executive function. They 1209
1162 perseveration or learned irrelevance conditions, found that even in the relatively mild stages of 1210
1163 with frontal patients making more perseverative the disease, impairments were revealed that 1211
1164 errors (Owen et al., 1993). might not be demonstrated by more traditional 1212
1165 The two variations of the Tower of London neuropsychological test batteries. Specifically, 1213
1166 test, i.e., Stockings of Cambridge and OTS, are even in this small sample patients showed selec- 1214
1167 thought to rely on different aspects of planning tive deficits as illustrated by performance on a 1215
1168 (actual motor sequencing vs. mental imagery). decision-making task (CGT), in which they 1216
1169 Functional neuroimaging studies in healthy con- made poorer risk adjustments in response to 1217
1170 trols have lent support for the different demands changing odds of success. Further, there was 1218
1171 placed by these two versions of a planning task; some evidence of impairment, some aspects of 1219
1172 while both activated dorsolateral prefrontal corti- attentional set-shifting, although the findings of 1220
1173 cal areas, the “mental” task activations were Owen et al. (1990) with regard to increased 1221
1174 greater on the right, while the “motor” format errors at the extra-dimensional shift stage were 1222
1175 placed greater demands on the left frontal regions not replicated. However, the FTD patients in this 1223
1176 (Owen, Doyon, Petrides, & Evans, 1996). These study did not differ from healthy controls in their 1224
1177 findings have been posited to be a result of dif- performance on tests of pattern or spatial recog- 1225
1178 ferential demands of the tasks on SWM and/or nition memory, SSP, working memory (SWM), 1226
1179 memory sequencing (Robbins, 1996). or planning (OTS). The authors conclude that 1227
1180 In an earlier study of planning and working these findings are consistent with evidence from 1228
1181 memory, 26 patients with frontal lobe excisions neuroimaging studies which suggests a progres- 1229
1182 were compared with age-matched controls on a sion of pathology in frontotemporal dementia 1230
1183 subset of CANTAB tests (Owen, Downes, from early orbitofrontal or ventromedial to more 1231
1184 Sahakian, Polkey, & Robbins, 1990). An aver- lateral prefrontal regions. 1232
1185 age of 3 years following surgery, patients were
1186 found to make significantly more search errors
1187 both within and between trials and had less suc- valuating Executive Functioning
E 1233
1188 cessful strategies on a test of SWM. On the Using the CANTAB in Huntington’s 1234
1189 Stockings of Cambridge planning task, they Disease 1235
1190 took more moves and solved fewer problems in
1191 the minimum possible moves than their healthy Since the discovery of the Huntington’s disease 1236
1192 counterparts. Further, they were significantly mutation, accurate determination of the genetic 1237
1193 slower to execute a response after a first move, status of at-risk individuals has made possible the 1238
1194 raising the possibility of impulsivity in initiat- study of cognitive function in preclinical HD 1239
1195 ing response prior to constructing a successful patients. Further, tracking of cognitive decline 1240
1196 solution. These same patients were unimpaired from the earliest stages can be related to the 1241
1197 relative to the healthy controls on a test of short- known pattern of progression of neuropathology, 1242
1198 term spatial memory. The authors identify from early involvement of the dorsal caudate 1243
1199 “strategy deficits” as a key component of per- nucleus to gradual deterioration throughout the 1244
1200 formance on both the working memory and frontostriatal system in a dorsal to ventral, ante- 1245
1201 planning tasks. rior to posterior, and medial to lateral direction 1246
1202 An examination of cognitive test performance (Watkins et al., 2000). Tests of the CANTAB 1247
1203 of patients with mild frontotemporal dementia have been widely used to trace the progression of 1248
1249 cognitive deficits in HD, adding to our under- In a similar effort to demonstrate qualitative 1295
1250 standing of the neural underpinnings of specific differences in cognitive decline consistent with 1296
1251 executive functions. Lawrence et al. (1998) com- known neuropathology, patients with Hunting 1297
1252 pared HD mutation carriers with no movement ton’s disease and Alzheimer’s disease were 1298
1253 disorders, with noncarriers on a battery of tests matched for level of dementia and compared on 1299
1254 known to be sensitive to the early changes of the tests of visual memory and executive function 1300
1255 disease. As hypothesized, they found mutation (Lange, Sahakian, Quinn, & Robbins, 1995). 1301
1256 carriers were more impaired in extra-dimensional Predictably, patients with HD had worse perfor- 1302
1257 shifting on a test of attentional set-shifting (IED), mance on tests of executive function including 1303
1258 which they attribute to a deficit in inhibitory con- SWM, planning, and set-shifting. However they 1304
1259 trol as demonstrated by increased perseverative were also significantly more impaired relative to 1305
1260 responses. Performance on tests of SSP, SWM, patients with AD on tests less clearly dependent on 1306
1261 and spatial planning was no different between executive function, including tests of visual pat- 1307
1262 groups, suggesting a specific pattern of cognitive tern recognition, SSP, and visuospatial paired 1308
1263 impairment in preclinical HD which is related to associates learning. It is possible that matching for 1309
1264 early basal ganglia dysfunction. The authors rec- level of dementia on the Mini Mental State 1310
1265 ommend the attentional set-shifting task as par- Examination (MMSE) while these patients with 1311
1266 ticularly sensitive to the earliest cognitive later-stage HD demonstrated fairly wide ranging 1312
1267 changes in HD, with implications for initiation of cognitive impairment; the pattern of deficits was 1313
1268 therapeutic interventions. nevertheless qualitatively different from that 1314
1269 Watkins et al. have further delineated specific of AD patients at a similar stage of disease 1315
1270 patterns of executive dysfunction in HD (Watkins progression. 1316
1271 et al., 2000). In a comparison of patients with In one of the few longitudinal studies of cog- 1317
1272 mild HD versus age-matched healthy controls, nitive decline in HD, Ho et al. (2003) followed a 1318
1273 patients had longer response latencies and made sample of patients with mild to moderate disease 1319
1274 more errors on the OTS task, while on a decision- for at least 3 years. While general cognitive abil- 1320
1275 making test (CGT), they were slower to respond ity remained unchanged, patterns of decline in 1321
1276 but were no different than controls on size of bet executive function were identified, such that 1322
1277 or impulsivity in response to changing risks and planning and set-shifting deteriorated over time. 1323
1278 rewards. The findings that HD patients were Specifically, measures of errors on the One- 1324
1279 impaired in planning but not in decision-making Touch Tower of London task and response laten- 1325
1280 are in keeping with the known progression of cies on the IED task were sensitive in detecting 1326
1281 pathology from early dorsal to later ventral cau- progression of cognitive impairment in this sam- 1327
1282 date involvement. Previous work has shown the ple. Interestingly, similar decline in performance 1328
1283 One-Touch Tower of London test to be sensitive on the Wisconsin Card Sorting Test, a widely 1329
1284 to dorsolateral prefrontal cortical damage, while used test of executive function, was not found, 1330
1285 impaired decision-making has been associated leading the authors to suggest that the practice 1331
1286 with orbitofrontal cortical lesions (Watkins et al., effects of learning a strategy make the WCST 1332
1287 2000). The authors relate their findings to those less useful in longitudinal assessment. Finally, 1333
1288 of Rahman et al. (1999) with FTD patients to they note that delineating the component features 1334
1289 illustrate the dissociation between deficits in of executive processes relies on tests capable of 1335
1290 decision-making and planning in these patient finer gradations of measurement that are sensitive 1336
1291 groups, consistent with the involvement of dorso- to change over time. Certainly, the growing body 1337
1292 lateral PFC and relative preservation of orbito- of evidence describing the progression of cogni- 1338
1293 frontal circuitry in early HD and the reverse tive decline has been consistent with the known 1339
1294 in FTD. frontostriatal pathology of Huntington’s disease. 1340
1341 Summary and Conclusions References 1385
American Psychological Association. (2000). Diagnostic 1386

1342 The tests of the CANTAB have been used exten- and statistical manual of mental disorders (4th ed.). 1387
1343 sively to assess cognitive performance in a wide Washington, DC: American Psychological Association. 1388
Anderson, V., Anderson, P., Northam, E., Jacobs, R., & 1389
1344 range of neurodegenerative and neurodevelop-
Catroppa, C. (2001). Development of executive 1390
1345 mental, psychiatric, and metabolic disorders, functions through late childhood and adolescence:
1391
1346 among others. The CANTAB has been shown to An Australian sample. Developmental Neuropsychology, 1392
1347 be useful in identifying and evaluating discrete 20, 385–406. 1393
Ardila, A., & Roselli, M. (1994). Development of lan- 1394
1348 components of important cognitive domains
guage, memory, and visuospatial abilities in 5- to 1395
1349 including those of memory, attention, and execu- 12-year-old children using a neuropsychological bat- 1396
1350 tive function. In doing so, it has provided substan- tery. Developmental Neuropsychology, 10, 97–120. 1397
1351 tial evidence for the neural underpinnings of Aron, A. R., Dowson, J. H., Sahakian, B. J., & Robbins, T. 1398
W. (2003). Methylphenidate improves response inhi- 1399
1352 specific cognitive functions (Fray, Robbins, &
bition in adults with attention-deficit/hyperactivity 1400
1353 Sahakian, 1996); these relationships will no doubt disorder. Biological Psychiatry, 54, 1465–1468. 1401
1354 be further elucidated by advances in neuroimag- Barnett, R., Maruff, P., Vance, A., Luk, E. S. L., Costin, J., 1402
1355 ing techniques. By comparing performances of Wood, C., et al. (2001). Abnormal executive function 1403
1356 different diagnostic groups, dissociations among in attention deficit hyperactivity disorder: The effect 1404
of stimulant medication and age on spatial working 1405
1357 specific cognitive abilities have been described memory. Psychological Medicine, 31, 1107–1115. 1406
1358 which help characterize the relationship between Bedard, A. C., Martinussen, R., Ickowicz, A., & Tannock, 1407
1359 neurological structure and function and the effects R. (2004). Methylphenidate improves visual-spatial 1408
1360 of different pathologies on those relationships. memory in children with attention-deficit/hyperactiv- 1409
ity disorder. Journal of the American Academy of 1410
1361 The theoretical basis for the development of Child & Adolescent Psychiatry, 43, 260–268. 1411
1362 the CANTAB, set as it was in the context of ani- Berger, H. J. C., Aerts, F. H. T., van Spaendonck, K. P. M., 1412
1363 mal models of neuropsychological function, has Cools, A. R., & Teunisse, J. P. (2003). Central coher- 1413
1364 served to yield a battery that can be used across ence and cognitive shifting in relation to social 1414
improvement in high-functioning young adults with 1415
1365 the life span and across all levels of ability. It is autism. Journal of Clinical and Experimental 1416
1366 sensitive to early changes in cognition, to cogni- Neuropsychology, 25, 502–511. 1417
1367 tive decline, and to differences among distinct Boonstra, A. M., Oosterlaan, J., Sergeant, J. A., & 1418
1368 neuropathological conditions. Further, extensive Buitelaar, J. K. (2005). Executive functioning in adult 1419
ADHD: A meta-analytic review. Psychological 1420
1369 published research attests to its utility in describ- Medicine, 35, 1097–1108. 1421
1370 ing normal cognitive development as well as in Bramham, J., Ambery, F., Young, S., Morris, R., Russell, 1422
1371 measuring pharmacological treatment effects in A., Xenitidis, K., et al. (2009). Executive functioning 1423
1372 multiple disease states. The potential for wide- differences between adults with attention deficit 1424
hyperactivity disorder and autistic spectrum disorder 1425
1373 spread application of the CANTAB to clinical in initiation, planning, and strategy formation. Autism, 1426
1374 rather than research settings has not, however, 13, 245–264. 1427
1375 been fully investigated. It is possible that as Brophy, M., Taylor, E., & Hughes, C. (2002). To go or not 1428
1376 familiarity with computers becomes truly univer- to go: Inhibitory control in “hard to manage” children. 1429
Infant and Child Development, 11, 125–140. 1430
1377 sal across all age cohorts, current barriers, both Buchanan, T. (2002). Online assessment: Desirable or 1431
1378 perceived and actual, to their use with older pop- dangerous? Professional Psychology: Research and 1432
1379 ulations will dissipate. As computerized tests Practice, 33, 148–154. 1433
1380 become more ubiquitous in the clinical setting, Butcher, J. M., Perry, J. M., & Atlis, M. M. (2000). 1434
Validity and utility of computer-based test interpreta- 1435
1381 batteries such as the CANTAB that are based in tion. Psychological Assessment, 12, 6–18. 1436
1382 theory and extensively researched will offer a Case, R. (1992). The role of frontal lobes in the regulation 1437
1383 viable option for comprehensive assessment of of cognitive development. Brain and Cognition, 20, 1438
1384 cognitive function. 51–73. 1439
1440 Chamberlain, S. R., DelCampo, N., Dowson, J. H., just intact? Journal of Autism and Developmental 1501
1441 Muller, U., Clark, L., Robbins, T. W., et al. (2007). Disorders, 35, 729–745. 1502
1442 Atomoxetine improved response inhibition in adults Elliot, R., Sahakian, B. J., Matthews, K., Bannerjea, A., 1503
1443 with attention deficit hyperactivity disorder. Biological Rimmer, J., & Robbins, T. W. (1997). Effects of meth- 1504
1444 Psychiatry, 62, 977–984. ylphenidate on spatial working memory and planning 1505
1445 Chamberlain, S. R., Hampshire, A., Muller, U., Rubia, K., in healthy young adults. Psychopharmacology, 131, 1506
1446 DelCampo, N., Craig, K., et al. (2009). Atomoxetine 196–206. 1507
1447 modulates right inferior frontal activation during Espy, K. A. (1997). The shape of school: Assessing 1508
1448 inhibitory control: A pharmacological functional mag- executive
function in preschool children. 1509
1449 netic resonance imaging study. Biological Psychiatry, Developmental Neuropsychology, 13, 495–499. 1510
1450 65, 550–555. Fray, P. J., Robbins, T. W., & Sahakian, B. J. (1996). 1511
1451 Chamberlain, S. R., Muller, U., Blackwell, A. D., Clark, Neuropsychiatry applications of CANTAB. 1512
1452 L., Robbins, T. W., & Sahakian, B. J. (2006). International Journal of Geriatric Psychiatry, 11, 1513
1453 Neurochemical modulation of response inhibition and 329–336. 1514
1454 probabilistic learning in humans. Science, 311, Garcia-Villamisar, D., & Hughes, C. (2007). Supported 1515
1455 861–863. employment improves cognitive performance in adults 1516
1456 Chamberlain, S. R., Robbins, T. W., Winder-Rhodes, S. with autism. Journal of Intellectual Disability 1517
1457 E., Muller, U., Sahakian, B. J., Blackwell, A. D., et al. Research, 51, 142–150. 1518
1458 (2011). Translational approaches to frontostriatal dys- Gau, S. S., Chiu, C. D., Shang, C. Y., Cheng, A. T., & 1519
1459 function in attention-deficit/hyperactivity disorder Soong, W. T. (2009). Executive functions in adoles- 1520
1460 using a computerized neuropsychological battery. cence among children with attention-deficit/hyperac- 1521
1461 Biological Psychiatry, 69, 1192–1203. tivity disorder in Taiwan. Journal of Developmental 1522
1462 Clark, L., Blackwell, A. D., Aron, A. R., Turner, D. C., and Behavioral Pediatrics, 30, 525–534. 1523
1463 Dowson, J. H., Robbins, T. W., et al. (2007). Gau, S. S., & Shang, C. Y. (2010a). Executive functions as 1524
1464 Association between response inhibition and working endophenotypes in ADHD: Evidence from the 1525
1465 memory in adult ADHD: A link to right frontal cortex Cambridge Neuropsychological Test Battery 1526
1466 pathology? Biological Psychiatry, 16, 1395–1401. (CANTAB). Journal of Child Psychology and 1527
1467 Coghill, D. R., Rhodes, S. M., & Matthews, K. (2007). The Psychiatry, 51, 838–849. 1528
1468 neuropsychological effects of chronic methylphenidate Gau, S. S., & Shang, C. Y. (2010b). Improvement of exec- 1529
1469 on drug-naïve boys with attention-deficit/hyperactivity utive functions in boys with attention deficit hyperac- 1530
1470 disorder. Biological Psychiatry, 62, 954–962. tivity disorder: An open-label follow-up study with 1531
1471 Corbett, B. A., Constantine, L. J., Hendren, R., Rocke, D., once-daily atomoxetine. The International Journal of 1532
1472 & Ozonoff, S. (2009). Examining executive function- Neuropsychopharmacology, 13, 243–256. 1533
1473 ing in children with autism spectrum disorder, atten- Geurts, H. M., Corbett, B. A., & Solomon, M. (2009). The 1534
1474 tion deficit hyperactivity disorder and typical paradox of cognitive flexibility in autism. Trends in 1535
1475 development. Psychiatry Research, 166, 210–222. Cognitive Sciences, 13, 74–82. 1536
1476 DeLuca, C. R., Wood, S. J., Anderson, V., Buchanan, J., Goldberg, M. C., Mostofsky, S. H., Cutting, L. E., 1537
1477 Proffitt, T. M., Mahony, K., et al. (2003). Normative Mahone, E. M., Astor, B. C., Denckla, M. B., et al. 1538
1478 data from the Cantab. I: Development of executive (2005). Subtle executive impairment in children with 1539
1479 function over the lifespan. Journal of Clinical and autism and children with ADHD. Journal of Autism 1540
1480 Experimental Neuropsychology, 25, 242–254. and Developmental Disorders, 35, 279–293. 1541
1481 DeVito, E., Blackwell, A. D., Kent, L., Ersche, K. D., Golden, C. J. (1981). The Luria-Nebraska Children’s 1542
1482 Clark, L., Salmond, C. H., et al. (2008). The effects of Battery: Theory and formulation. In G. W. Hynd & G. 1543
1483 methylphenidate on decision making in attention- E. Obrzut (Eds.), Neuropsychological assessment and 1544
1484 deficit/hyperactivity disorder. Biological Psychiatry, the school-aged child (pp. 277–302). New York: 1545
1485 64, 636–639. Grune & Stratton. 1546
1486 Doniger, G. M., Dwolatzky, T., Zucker, D. M., Chertkow, Gropper, R. J., & Tannock, R. (2009). A pilot study of 1547
1487 H., Crystal, H., & Schweiger, A. (2006). Computerized working memory and academic achievement in col- 1548
1488 cognitive testing battery identifies mild cognitive lege students with ADHD. Journal of Attention 1549
1489 impairment and mild dementia even in the presence of Disorders, 12, 574–581. 1550
1490 depressive symptoms. American Journal of Happe, F., Booth, R., Charlton, R., & Hughes, C. (2005). 1551
1491 Alzheimer's Disease and Other Dementias, 21, 28–36. Executive function deficits in autism spectrum disor- 1552
1492 Dowson, J. H., McLean, A., Bazanis, E., Toone, B. K., ders and attention-deficit/hyperactivity disorder: 1553
1493 Young, S., Robbins, T. W., et al. (2004). Impaired spa- Examining profiles across domains and ages. Brain 1554
1494 tial working memory in adults with attention-deficit/ and Cognition, 61, 25–39. 1555
1495 hyperactivity disorder: Comparisons with perfor- Hill, E. L. (2006). Evaluating the theory of executive dysfunc- 1556
1496 mance in adults with borderline personality disorder tion in autism. Developmental Review, 24, 189–233. 1557
1497 and in control subjects. Acta Psychiatrica Ho, A. K., Sahakian, B. J., Brown, R. G., Barker, R. A., 1558
1498 Scandinavica, 110, 45–54. Hodges, J. R., Ane, M., et al. (2003). Profile of cogni- 1559
1499 Edgin, J. L., & Pennington, B. F. (2005). Spatial cognition tive progression in early Huntington’s disease. 1560
1500 in autism spectrum disorders: Superior, impaired, or Neurology, 61, 1702–1706. 1561
1562 Hoare, P., & Sevar, K. (2007). The effect of discontinua- stopping performance in attention-deficit/hyperactiv- 1622
1563 tion of methylphenidate on neuropsychological per- ity disorder: Deficient inhibitory motor control? 1623
1564 formance in children with attention deficit Journal of Abnormal Psychology, 114, 216–222. 1624
1565 hyperactivity disorder. Psychiatry Investigation, 4, Lowe, C., & Rabbitt, P. (1998). Test/re-test reliability of 1625
1566 76–83. the CANTAB and ISPOCD neuropsychological bat- 1626
1567 Hughes, C., & Graham, A. (2002). Measuring executive teries: Theoretical and practical issues. 1627
1568 functions in childhood: Problems and solutions. Neuropsychologia, 36, 915–923. 1628
1569 Adolescent Mental Health, 3, 131–142. Luciana, M., & Nelson, C. A. (1998). The functional 1629
1570 Hughes, C., Plumet, M. H., & Leboyer, M. (1998). Toward emergence of prefrontally-guided working memory 1630
1571 a cognitive phenotype for autism: Increased preva- systems in four- to eight-year-old children. 1631
1572 lence of executive dysfunction and superior spatial Neuropsychologia, 36, 273–293. 1632
1573 span amongst siblings of children with autism. Journal Manly, T., Anderson, V., Nimmo-Smith, I., Turner, A., 1633
1574 of Child Psychology and Psychiatry, 40, 1–14. Watson, P., & Robertson, I. H. (2001). The differential 1634
1575 Hughes, C., Plumet, M. H., & Leboyer, M. (1999). assessment of children’s attention: The test of every- 1635
1576 Towards a cognitive phenotype for autism: Increased day attention for children (TEA-Ch), normative sam- 1636
1577 prevalence of executive dysfunction and superior spa- ple and ADHD performance. Journal of Child 1637
1578 tial span amongst siblings of children with autism. Psychology and Psychiatry, 42, 1065–1081. 1638
1579 Journal of Child Psychology and Psychiatry, 40, Martinussen, R., Hayden, J., Hogg-Johnson, S., & 1639
1580 705–718. Tannock, R. (2005). A meta-analysis of working 1640
1581 Hughes, C., Russell, J., & Robbins, T. W. (1994). Evidence memory impairments in children with attention- 1641
1582 for executive dysfunction in autism. Neuropsychologia, deficit/hyperactivity disorder. Journal of the American 1642
1583 32, 477–492. Academy of Child and Adolescent Psychiatry, 44, 1643
1584 Jakala, P., Riekkinen, M., Sirvio, J., Koivisto, E., Kejonen, 377–384. 1644
1585 K., Vanhanen, M., et al. (1999). Guanfacine, but not Mattila, M. L., Kielinen, M., Jussila, K., Linna, S. L., 1645
1586 clonidine, improves planning and working memory Bloigu, R., Ebeling, H., et al. (2007). An epidemio- 1646
1587 performance in humans. Neuropsychopharmacology, logical and diagnostic study of Asperger syndrome 1647
1588 20, 460–470. according to four sets of diagnostic criteria. Journal of 1648
1589 Kempton, S., Vance, A., Maruff, P., Luk, E., Costin, J., & the American Academy of Child and Adolescent 1649
1590 Pantelis, C. (1999). Executive function and attention Psychiatry, 46, 636–646. 1650
1591 deficit hyperactivity disorder: Stimulant medication McLean, A., Dowson, J. H., Toone, B. K., Young, S., 1651
1592 and better executive function performance in children. Bazanis, E., Robbins, T. W., et al. (2004). Characteristic 1652
1593 Psychological Medicine, 29, 527–538. neurocognitive profile associated with adult attention- 1653
1594 Klingberg, T. (1997). Concurrent performance of two deficit/hyperactivity disorder. Psychological Medicine, 1654
1595 working memory tasks: Potential mechanisms of 34, 681–692. 1655
1596 interference. Cerebral Cortex, 8, 593–601. Mehta, M., Calloway, P., & Sahakian, B. J. (2000). 1656
1597 Klingberg, T., Forssberg, J., & Westerberg, H. (2002). Amelioration of specific working memory deficits by 1657
1598 Increased brain activity in frontal and parietal cortex methylphenidate in a case of adult attention deficit 1658
1599 underlies the development of visuospatial working hyperactivity disorder. Journal of Psychophar- 1659
1600 memory capacity during childhood. Journal of macology, 14, 299–302. 1660
1601 Cognitive Neuroscience, 14, 1–10. Mehta, M., Goodyear, I. M., & Sahakian, B. J. (2004). 1661
1602 Lajiness, R., & Menard, P. (2008). Brief report: An autistic Methylphenidate improves working memory and set- 1662
1603 spectrum subtype revealed through familial psychopa- shifting in ADHD: Relationships to baseline memory 1663
1604 thology coupled with cognition in ASD. Journal of capacity. Journal of Child Psychology and Psychiatry, 1664
1605 Autism and Developmental Disorders, 38, 982–987. 45, 293–305. 1665
1606 Landa, R. J., & Goldberg, M. C. (2005). Language, social, Muller, U., Clark, L., Lam, M. L., Moore, R. M., Murphy, 1666
1607 and executive functions in high functioning autism: A C. L., & Richmond, N. K. (2005). Lack of effects of 1667
1608 continuum of performance. Journal of Autism and guanfacine on executive and memory functions in 1668
1609 Developmental Disorders, 35, 557–573. healthy male volunteers. Psychopharmacology, 182, 1669
1610 Lange, K. W., Sahakian, B. J., Quinn, N. P., & Robbins, T. 205–213. 1670
1611 W. (1995). Comparison of executive and visuospatial Owen, A. M., Downes, J. J., Sahakian, B. J., Polkey, C. E., 1671
1612 memory function in Huntington’s disease and demen- & Robbins, T. W. (1990). Planning and spatial work- 1672
1613 tia of Alzheimer type matched for degree of dementia. ing memory following frontal lobe lesions in man. 1673
1614 Journal of Neurology, Neurosurgery, and Psychiatry, Neuropsychologia, 28, 1021–1034. 1674
1615 58, 598–606. Owen, A. M., Doyon, J., Petrides, M., & Evans, A. C. 1675
1616 Lawrence, A. D., Hodges, J. R., Rosser, A. E., Kershaw, (1996). Planning and spatial working memory exam- 1676
1617 A., French-Constant, C., Rubinsztein, D. C., et al. ined with positron emission tomography. European 1677
1618 (1998). Evidence for specific cognitive deficits in pre- Journal of Neuroscience, 8, 353–364. 1678
1619 clinical Huntington’s disease. Brain, 121, 1329–1341. Owen, A. M., Roberts, A. C., Hodges, J. R., Summers, B. 1679
1620 Lijffijt, M., Kenemans, J. L., Leon, J., Verbaten, M. N., & A., Polkey, C. E., & Robbins, T. W. (1993). Contrasting 1680
1621 van Engeland, J. (2005). A meta-analytic review of mechanisms of impaired attentional set-shifting in 1681
1682 patients with frontal lobe damage or Parkinson’s dis- tive to frontal lobe dysfunction in a large sample of 1741
1683 ease. Brain, 116, 1159–1179. normal volunteers: Implications for theories of execu- 1742
1684 Ozonoff, S. (1997). Components of executive function in tive functioning and cognitive aging. Journal of the 1743
1685 autism and other disorders. In J. Russell (Ed.), Autism International Neuropsychological Society, 4, 1744
1686 as an executive disorder (pp. 179–211). Oxford: 474–490. 1745
1687 Oxford University Press. Robbins, T. W., James, M., Owen, A. M., Sahakian, B. J., 1746
1688 Ozonoff, S., Cook, I., Coon, H., Dawson, G., Joseph, R. McInnes, L., & Rabbitt, P. (1994). Cambridge 1747
1689 M., Klin, A., et al. (2004). Performance on Cambridge Neuropsychological Test Automated Battery 1748
1690 Neuropsychological Test Automated Battery subtests (CANTAB): A factor analytic study of a large sample 1749
1691 sensitive to frontal lobe function in people with autis- of normal elderly volunteers. Dementia, 5, 266–281. 1750
1692 tic disorder: Evidence from the collaborative programs Rogers, S. J. (1999). Executive functions in young chil- 1751
1693 of excellence in autism network. Journal of Autism dren with autism. Child Development, 70, 817–832. 1752
1694 and Developmental Disorders, 34, 139–150. Sahakian, B. J. (1990). Computerized assessment of neu- 1753
1695 Perner, J., & Lang, B. (1999). Theory of mind and execu- ropsychological function in Alzheimer’s disease and 1754
1696 tive function: Is there a developmental relationship. In Parkinson’s disease. International Journal of Geriatric 1755
1697 S. Baron-Cohen, T. Tager-Flusberg, & D. Cohen Psychiatry, 5, 211–213. 1756
1698 (Eds.), Understanding other minds: Perspectives from Sahakian, B. J., & Owen, A. M. (1992). Computerized 1757
1699 developmental neuroscience (pp. 150–181). Oxford: assessment in neuropsychiatry using CANTAB: 1758
1700 Oxford University Press. Discussion paper. Journal of the Royal Society of 1759
1701 Rabbitt, P., & Lowe, C. (2000). Patterns of cognitive Medicine, 85, 399–400. 1760
1702 aging. Psychological Research, 63, 308–316. Schlegel, R. E., & Gilliland, K. (2007). Development and 1761
1703 Rahman, S., Sahakian, B. J., Hodges, J. R., Rogers, R. D., quality assurance of computer-based assessment bat- 1762
1704 & Robbins, T. W. (1999). Specific cognitive deficits in teries. Archives of Clinical Neuropsychology, 22S, 1763
1705 mild frontal variant frontotemporal dementia. Brain, S49–S61. 1764
1706 122, 1469–1493. Seidman, L., Biederman, J., Monuteaux, M. C., & Doyle, 1765
1707 Randall, D. C., Fleck, N. L., Shneerson, J. M., & File, S. A. E. (2005). Learning disabilities and executive dys- 1766
1708 E. (2004). The cognitive-enhancing properties of function in boys with attention deficit hyperactivity 1767
1709 modafinil are limited in non-sleep-deprived middle- disorder. Neuropsychology, 15, 544–556. 1768
1710 age volunteers. Pharmacology and Biochemical Sinzig, J., Morsch, D., Bruning, N., Schmidt, M. H., & 1769
1711 Behavior, 77, 547–555. Lehmkuhl, G. (2008). Inhibition, flexibility, working 1770
1712 Randall, D. C., Shneerson, J. M., Plaha, K. K., & File, S. memory, and planning in autism spectrum disorders 1771
1713 E. (2003). Modafinil affects mood but not cognitive with and without comorbid ADHD-symptoms. Child 1772
1714 function in healthy young volunteers. Human and Adolescent Psychiatry and Mental Health, 2, 1773
1715 Psychopharmacology, 18, 163–173. 1–12. 1774
1716 Randall, D. C., Viswanath, A., Bharania, P., Elsabagh, S. Steele, S. D., Minshew, N., Luna, B., & Sweeney, J. A. 1775
1717 M., Hartely, D. E., Shneerson, J. M., et al. (2005). (2007). Spatial working memory deficits in autism. 1776
1718 Does modafinil enhance cognitive performance in Journal of Autism and Developmental Disorders, 37, 1777
1719 young volunteers who are not sleep deprived? Journal 605–612. 1778
1720 of Clinical Psychopharmacology, 25, 175–179. Stuss, D. T. (1992). Biological and psychological devel- 1779
1721 Rhodes, S. M., Coghill, D. R., & Matthews, K. (2004). opment of executive functions. Brain and Cognition, 1780
1722 Methylphenidate restores visual memory but not 20, 8–23. 1781
1723 working memory function in attention deficit- Teunisse, J. P., Cools, A. R., van Spaendonck, K. P. M., 1782
1724 hyperkinetic disorder. Psychopharmacology, 175, Aerts, F. H. T., & Berger, H. J. C. (2001). Cognitive 1783
1725 319–330. styles in high-functioning adolescents with autistic 1784
1726 Rhodes, S. M., Coghill, D. R., & Matthews, K. (2005). disorder. Journal of Autism and Developmental 1785
1727 Neuropsychological effects of methylphenidate in Disorders, 31, 55–66. 1786
1728 stimulant drug-naïve boys with hyperkinetic disorder. Turner, D. C., Blackwell, A. D., Dowson, J. H., McLean, 1787
1729 Psychological Medicine, 35, 1–12. A., & Sahakian, B. J. (2005). Neurocognitive effects 1788
1730 Rhodes, S. M., Coghill, D. R., & Matthews, K. (2006). of methylphenidate in adults attention-deficit/hyperac- 1789
1731 Acute neuropsychological effects of methylphenidate tivity disorder. Psychopharmacology, 178, 286–295. 1790
1732 in stimulant drug-naïve boys with ADHD II-broader Turner, D. C., Clark, L., Dowson, J. H., Robbins, T. W., & 1791
1733 executive and nonexecutive domains. Journal of Child Sahakian, B. J. (2004). Modafinil improves cognitive 1792
1734 Psychology and Psychiatry, 47, 1184–1194. and response inhibition in adult attention deficit hyper- 1793
1735 Robbins, T. W. (1996). Dissociating executive functions activity disorder. Biological Psychiatry, 55, 1794
1736 of the prefrontal cortex. Philosophical Transactions of 1031–1040. 1795
1737 the Royal Society of London, 351, 1463–1471. Turner, D. C., Robbins, T. W., Clark, L., Aron, A. R., 1796
1738 Robbins, T. W., James, M., Owen, A. M., Sahakian, B. J., Dowson, J. H., & Sahakian, B. J. (2003). Relative lack 1797
1739 Lawrence, A. D., McInnes, L., et al. (1998). A study of of cognitive effects of methylphenidate in elderly male 1798
1740 performance on tests from the CANTAB battery sensi- volunteers. Psychopharmacology, 168, 455–464. 1799
1800 Valera, E. M., Faraone, S. V., Murray, K., & Seidman, L. Wild, K., Howieson, D., Webbe, F., Seelye, A., & Kaye, J. 1818
1801 J. (2007). Meta-analysis of structural imaging findings (2008). The status of computerized cognitive testing in 1819
1802 in attention-deficit/hyperactivity disorder. Biological aging: A systematic review. Alzheimer's & Dementia, 1820
1803 Psychiatry, 61, 1361–1369. 4, 428–437. 1821
1804 Vance, A. L., Maruff, P., & Barnett, R. (2003). Attention Willcutt, E. G., Doyle, A. E., Nigg, J. T., Faraone, S. V., & 1822
1805 deficit hyperactivity disorder, combined type: Better Pennington, B. F. (2005). Validity of the executive 1823
1806 executive function performance with longer-term psy- function theory of attention-deficit/hyperactivity dis- 1824
1807 chostimulant medication. Australian New Zealand order: A meta-analytic review. Biological Psychiatry, 1825
1808 Psychiatry, 37, 570–576. 57, 1336–1346. 1826
1809 Walker, R., Husain, M., Hodgson, T. L., Harrison, J., & Winder-Rhodes, S. E., Chamberlain, S. R., Idris, M., 1827
1810 Kennard, C. (1998). Saccadic eye movement and Robbins, T. W., Sahakian, B. J., & Muller, U. (2009). 1828
1811 working memory deficits following damage to human Effects of modafinil and prazosin on cognitive and 1829
1812 prefrontal cortex. Neuropsychologia, 36, 1141–1159. physiological functions in healthy volunteers. Journal 1830
1813 Watkins, L. H. A., Rogers, R. D., Lawrence, A. D., of Psychopharmacology, 24, 1649–1657. 1831
1814 Sahakian, B. J., Rosser, A. E., & Robbins, T. W. (2000). Witwer, A. N., & Lecavalier, L. (2008). Examining the 1832
1815 Impaired planning but intact decision making in early validity of autism spectrum disorder subtypes. Journal 1833
1816 Huntington’s disease: Implications for specific fronto- of Autism and Developmental Disorders, 38, 1834
1817 striatal pathology. Neuropsychologia, 38, 1112–1125. 1611–1624. 1835
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