空间工作记忆和战略形成的成年人诊断注意缺陷多动障碍毕业论文外文翻译.docx

空间工作记忆和战略形成的成年人诊断注意缺陷多动障碍毕业论文外文翻译.docx

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空间工作记忆和战略形成的成年人诊断注意缺陷多动障碍毕业论文外文翻译

Spatialworkingmemoryandstrategyformationinadultsdiagnosedwithattentiondeficithyperactivitydisorder

SusanYounga,*,RobinMorrisa,BrianTooneb,CarolynTysonc

Abstract

ThestudyinvestigatedproblemspatialworkingmemoryinADHDadults.Twenty-sevenpatientsdiagnosedwithADHDinadulthoodand27matchednormalcontrolsweretestedusingtheExecutiveGolfTask,atestthatalsomeasuresspatialstrategyformation.OveralltheADHDpatientsweresignificantlyimpaired,thedeficitincreasingwithtaskdifficulty.Theywerealsomoreimpairedonameasureoftaskstrategyformation,andwhentakingthisintoaccountintermsofmemoryperformancethepatientdeficitremained,suggestingthattheirspatialworkingmemorydeficitsarenotwhollyexplainedbyproblemswithstrategyformation.

1.Introduction

Workingmemoryisdefinedasacognitivesystemthatprovidestemporarystorageandmanipulationoftheinformationnecessaryforactivitiessuchasreasoning,languagecomprehensionandlearning（Baddeley,1992）.Thisprocessrequirestheabilitytoholdinformation‘‘on-line’’duringabrieftimeuntiladecisionandsubsequentresponseismade（Goldman-Rakic,1990）.Ithasbeenpostulatedthatthereisadissociationbetweenbasicmemorialrequirementsoftasksandtheirexecutivecomponentswhichcontrolresponseselection,e.g.theadoptionofanoverallstrategyorplan,ortheutilizationofspecificattentionalinhibitorymechanisms.Thusperformanceisdeterminedbytwofactors,onerelatedtoshort-termspatialmemoryandtheothertostrategicfactors（Robbins,1996）.Severalstudieshaveshownthatspatialworkingmemorydeficitsinpatientswithfrontallobeexcisionsmayberelatedtotheinefficientuseofaparticularsearchstrategy（Miotto,Bullock,Polkey,&Morris,1996;Owen,Downes,Sahakian,Polkey,&Robbins,1990;Owen,Morris,Sahakian,Polkey,&Robbins,1996）.Thissuggeststhatpartofthedeficitmayarisefromexecutivefailureanduseofastrategycanreducetheloadonmemorycausedbyinterferencefrompreviouschoices.

SpatialworkingmemorydeficitshavebeenfoundinstudiescomparingADHDandnormalchildren（Karatekin&Asarnow,1998;Gorenstein,Mammato,&Sandy,1989;Shue&Douglas,1992）.However,moststudieshavenotconsideredwhetherdeficitsinspatialworkingmemorymaybeaccountedforbyproblemswithstrategyformation.Theimportanceofstrategyhasbeenconsideredinotherneurologicalorpsychiatricdisorders.Forexample,strategyformationimpairmenthasbeenshowntobelinkedtospatialworkingmemoryimpairmentpatientswithfrontalexcisions（Miottoetal.,1996）butnotforpatientswithAspergersSyndrome（Morrisetal.,1999）.

ThecurrentstudyexploresspatialworkingmemorydeficitsandstrategyimpairmentofADHDadultsusingthecomputerisedExecutiveGolftask（cf.Feigenbaum,Polkey,&Morris,1996）,adevelopmentofthespatialworkingmemorytaskdesignedbyMorrisetal.（1988）.WorkingmemoryisofrelevanceintheinvestigationofadultADHDbecauseitisthoughttobeparticularlyimpairedinrelationtoothertypesofpsychiatricdisordersthathaveassociatedneuropsychologicaldeficits（Gallagher&Blader,2001）.ThishasbeenexploredinapreviousstudybyDowsonetal.（2004）usingadifferenttaskbutasimilarmethodology.IntheDowsonetal.（2004）studytheCANTABmethodofmeasuringspatialworkingmemoryinvolvesanarrayofspatiallocationsonascreeninwhichtheparticipanthastoavoidgoingbacktopreviouslysuccessfullocations.Theyfoundimpairmentsonreturnerrorsandassociatedpoorstrategywhenconductingthetasks.TheExecutiveGolftaskismoreakintoareallifeactivityinthat,aswellmeasuringspatialworkingmemoryitsimulatesa‘gameofgolf’,theparticipantsearchingforplacesinwhicha‘golfer’ispredictedtoputtaball,avoidingreturningtotheseplacesduringsubsequentsearches.Thegolfholesarepresentedusingthreedimensionalcomputergraphicswiththe‘golfer’presentedinthedistance.Thetaskhasagame-likeformat,withthe‘golfer’puttingtheballsintothegolfholeswhenacorrectgolfholehasbeenselectedbythe‘golfer.’Performancecanbeimprovedusingthestrategyoffollowingapredeterminedsearchsequence,beginningwithaparticularplaceandreturningtothesameplaceforeverynewsearchsequence.TheaimofthestudywastoinvestigatewhetherpatientswithADHDhadaspatialworkingmemorydeficitinadulthoodandtoestablishwhetherthedeficitpersistedifameasureofstrategyformationwascovariedintheanalysis.ItwashypothesisedthatADHDpatientswouldmakeagreaternumberoferrorsinrelationtoreturningtopreviouslysuccessfullocations（i.e.betweensubjecterrors）,andthatthisdeficitwouldincreasewithtaskdifficulty.

2.Methodology

2.1.Participants

Thestudyincluded27（21male,6female）adultADHDpatientsattheMaudsleyHospital,LondonUK.AllpatientsmettheDSM-IVcriteriaforADHDfollowingafullADHDassessment（seeYoung&Toone,2000）.Theassessmentincludedacomprehensivepsychiatricevaluationwhichincludedasemi-structuredinterviewbasedontheDSM-IVcriteriaforADHD.Eachpositiveself-ratinghadtobeendorsedbytheassessoronthebasisofsupplementaryquestioningorotherinformation（e.g.documentation）.AdditionallyaparentwasinterviewedtoestablishwhethertherewasahistoryofADHDfeaturesduringearlychildhood（i.e.beforetheageof7）.Thisjudgementwasbaseduponanunstructuredinterviewalthoughinaddition,andinordertoobtainafinalpositiverating,ascoreof15ormorewasrequiredontheConners’GlobalIndex-ParentScale[CGI-P]（Conners,2000）.ForcasesinwhichConners’ratingswereequivocal,afinalpositiveratingwasmadeifschoolreportsand/orotherchildhooddocumentationprovidedevidenceofhyperactivityandattentionaldifficulties.Ofthe27patients,22metcriteriaforADHD,CombinedType;3forADHD,PredominantlyInattentiveTypeand2forADHD,PredominantlyHyperactive-ImpulsiveType.

Allparticipantsweretestedoff-medication.Theyagreedtorefrainfromtakingstimulantmedicationfor48hpriortotheassessmentandconfirmedthiswhenseen.Exclusioncriteriaincludedahistoryoflearningdisability,ahistoryofseverepsychiatricdisorder（thisincludesschizophrenia,bipolarandmajordepressivedisorder）,aprimarydiagnosisofsubstanceabusedisorder,autisticdisordersand/orahistoryofneuropsychologicalimpairmentorheadinjury.Noneoftheparticipantsinthesamplefittedanyoftheseexclusioncriteriaandhencenonewereexcludedonthisbasis.Theirmeanagewas24.85years（SD=7.00,range16–42）.TheirmeanpredictedfullscaleIQfromtheIntelligenceQuotients（IQ）derivedfromtheNationalAdultReadingTest-Restandardised（NART-R）（Nelson,1982;Nelson&Willison,1991）was101（SD=20）andtheirmeanpaternalsocialclassscore,usingtheHMSOclassificationofoccupation,was2.93（SD=2.32）.

Patientswerecomparedwith27healthylocalcommunitycontrolsrecruitedthroughadvertisementsinGPHealthCentres.Controlsdidnotdiffersignificantlyfromthemonthefollowingvariables:

sex（15males,12females:

v2=2.08,df=1,p=.15）,age（mean=25.78,SD=4.89,Range18–36:

t（52）=.56,p=.58）predictedfullscaleIQ（mean=105,SD=16;t（52）=1.69,p=.10）andpaternalsocialclass（mean=2.59,SD=1.97:

t（52）=.57,p=.57）.

2.2.Testsandprocedure

TheExecutiveGolftaskispresentedonacolourmonitorwithatouchsensitivescreen.Theparticipantisshownfirstlyanimageofa‘golfcourse’anda‘golfer’.Thecoursehasavaryingnumberof‘golfholes’intowhichthegolfercan‘putt’a‘ball’.Initially,theparticipantisinstructedtoguessintowhichholetheballwillbeputtedandrespondbytouchingit.Ifcorrect,thecomputeremitsaspecifictoneandtheballisshowngoingintothehole.Forincorrectresponses,adifferenttoneisgiven,andtheparticipanthastotryagainuntilthecorrectholeisfound.Effectivelytheyareinstructedtosearcharoundtheholesuntiltheyfindthetargetone.Afterthis,thetargetholethenmovestoanewlocation.Onlyoneballcanbeputtedintoeachholeinanyonetrial,suchthat,onsubsequenttrialsearchestheparticipanthastoavoidchoosingpreviouslysuccessfullocations.Theparticipantisspecificallytoldtoavoidgoingbacktosuccessfulholesonsubsequentsearches.Aseriesofsearchesaremadeuntilalltheholeshavehadballsputtedintothem.Afteralltheholeshavehadballsputtedintothem,theword‘finished’ispresentedatthetopofthescreenandtheparticipantinformedthatanewtrialisabouttobeginwithnewballsandholes.

Thetaskcontainsfiveincreasinglevelsofdifficulty（i.e.levels2,3,4,6and8）representedbyanincreasingnumberofholesusedineachtrial.Eachlevelofdifficultyhasasetnumberoftrialsasfollows:

Level2hastwo;Levels3and4havethree;Levels6and8havefourtrials;（Levels5and7wereexcludedfromthedesigntokeepthelengthofthetestreasonablewhilstmaintainingthesizerange）.Theparticipantstartswiththeeasiertrialsandproceedstothemoredifficultones.Inordertopreventchanceselectionscausingvariabilityinthenumberofholesthatapersonneedstoexploreduringeachsearch,thenumberofsuchholestobetriedbeforefindingthetargetone（discountingresponsestopreviouslyusedholes）ispredeterminedbythecomputerinapseudo-randomfashion（i.e.thesamenumberofholesforeachperson）.

Foreachtrialthecomputerrecordstwotypesoferrors.Thefirst,BetweenSearchErrors,involvesselectingaholeintowhichaballhasalreadybeenputtedduringthattrial.