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Papers by Kjell Tore Hovik

Research paper thumbnail of Child Neuropsychology, Volume 21, 2015, List of Reviewers

Child Neuropsychology, 2015

Research paper thumbnail of A randomized controlled trial of Goal Management Training for executive functioning in schizophrenia spectrum disorders or psychosis risk syndromes

BMC Psychiatry

Background Executive functioning is essential to daily life and severely impaired in schizophreni... more Background Executive functioning is essential to daily life and severely impaired in schizophrenia and psychosis risk syndromes. Goal Management Training (GMT) is a theoretically founded, empirically supported, metacognitive strategy training program designed to improve executive functioning. Methods A randomized controlled parallel group trial compared GMT with treatment as usual among 81 participants (GMT, n = 39 versus Wait List Controls, n = 42) recruited from an early intervention for psychosis setting. Computer generated random allocation was performed by someone independent from the study team and raters post-intervention were unaware of allocation. The primary objective was to assess the impact of GMT administered in small groups for 5 weeks on executive functioning. The secondary objective was to explore the potential of the intervention in influencing daily life functioning and clinical symptoms. Results GMT improved self-reported executive functioning, measured with the B...

Research paper thumbnail of Executive Functioning in Everyday Life in Youth with Attention-Deficit/Hyperactivity Disorder and Autism Spectrum Disorders: A Two-Year Longitudinal Study

International Journal of Disability, Development and Education

Research paper thumbnail of Symptoms of ADHD in Children with High-Functioning Autism Are Related to Impaired Verbal Working Memory and Verbal Delayed Recall

PLoS ONE, 2013

Symptoms similar to those found in Attention-Deficit/Hyperactivity Disorder (ADHD) often occur in... more Symptoms similar to those found in Attention-Deficit/Hyperactivity Disorder (ADHD) often occur in children with Autism Spectrum Disorders (ASD). The objective of the current study was to compare verbal working memory, acquisition and delayed recall in children with High-Functioning Autism (HFA) to children with ADHD and typically developing children (TDC). Thirty-eight children with HFA, 79 with ADHD and 50 TDC (age 8-17) were assessed with a letter/number sequencing task and a verbal list-learning task. To investigate the possible influence of attention problems in children with HFA, we divided the HFA group into children with (HFA+) or without (HFA2) ''attention problems'' according to the Child Behaviour Checklist 6-18. The children with HFA+ displayed significant impairment compared to TDC on all three neurocognitive measures, while the children with HFA2 were significantly impaired compared to TDC only on the working memory and acquisition measures. In addition, the HFA+ group scored significantly below the HFA2 group and the ADHD group on the verbal working memory and delayed recall measures. The results support the proposition that children with HFA+, HFA2, and ADHD differ not only on a clinical level but also on a neurocognitive level which may have implications for treatment.

Research paper thumbnail of Can PC-based training boost working memory in ADHD preadolescents on medication? : a clinical intervention study

Author: Kjell Tore Hovik Title: Can PC-based training boost working memory in ADHD preadolescents... more Author: Kjell Tore Hovik Title: Can PC-based training boost working memory in ADHD preadolescents on medication? Supervisor: Jens Egeland Background: Children with ADHD suffer from impairments in working memory, and recent studies have documented significant gains in working memory (WM) in children diagnosed with ADHD after participating in a PC-based WM training program. Earlier studies have focused on unmedicated children, while a majority of Norwegian children diagnosed with ADHD take ADHD medication for the disorder. The main question addressed in this study is whether ADHD children on medication would also show significant improvements in WM after PC-based WM training. A second issue examined is whether the results favor one of two established, but diverging, non-unitary models of the construct working memory. Method: Sixty-six children diagnosed with F90.0 Hyperkinetic disorder (ICD-10) currently receiving treatment in the child psychiatric services in two Norwegian counties w...

Research paper thumbnail of Circulating Current Minimization Scheme for a Read-Only Memory

Research paper thumbnail of Executive Control and Emerging Behavior in Youth With Tourette’s Syndrome

Executive control refers to the mental processes involved in the monitoring and regulation of cog... more Executive control refers to the mental processes involved in the monitoring and regulation of cognition, emotion, and behavior, which are essential for normal development during childhood and adolescence. Tourette’s syndrome (TS) is considered a model for understanding developmental psychopathology due to the interaction of many genetic, environmental, and emerging factors influencing disease expression. This chapter examines the effect the emerging factors related to syndrome expression in TS can have on behavior over time during childhood and adolescence.

Research paper thumbnail of Executive control of cognition, emotion and behavior in children with Tourette’s syndrome. A two-year follow-up study

emotional development of children and adolescents with neuropsychiatric disorders". Funding and f... more emotional development of children and adolescents with neuropsychiatric disorders". Funding and facilities for the project were provided for by Innlandet Hospital Trust. Professor Merete Glenne Øie asked me to join the project in 2010. As my main supervisor and the Principal Investigator, her dedication and devotion to excellence in all aspects of the research and writing process have left a lasting impression. I am deeply grateful to my co-supervisor Professor Jens Egeland for his creative and insightful knowledge of clinical neuropsychology and statistics and how to unite these two universes, and to my cosupervisor Professor Kerstin Plessen for sharing with me her invaluable expertise in the field of Tourette's Syndrome and professionalism in the writing process. It has also been my fortune to have collaborated with a number of other outstanding researchers: Andrea Cavanna, Peter Isquith, Gerard Gioia, and Elkohon Goldberg, who have immeasurably broadened my research horizon. A heartfelt thanks to my fellow Phd students Erik Winther Skogli and Per Norman Andersen for their insight, commitment and playfulness in the face of a whirlwind of deadlines and reviews. My deep gratitude to the young participants and their caregivers who endured lengthy assessments, and the many clinicians who helped us assess close to 200 participants on two separate occasions. A special thanks to the 50 typically developing children, who I personally tested and who donated their time for the sake of research. Thanks to the Research Department of Innlandet Hospital Trust, and the Regional Resource Center for Autism, ADHD, Tourette's syndrome and Narcolepsy for financial support. My sincerest gratitude as well to my employers at Early intervention psychosis, Innlandet Hospital Trust Sanderud for their support during my research period, and the Child Mental Health Services Unit in Lillehammer for providing a base for research and the opportunity to practice Habit Reversal Training. A final note of deep appreciation to the Department of Psychology at the University of Oslo for allowing me to follow their Phd program.

Research paper thumbnail of Inside the Triple-Decker: Tourette’s Syndrome and Cerebral Hemispheres

The traditional standard definition and diagnostic criteria of Tourette’s syndrome (TS) are incom... more The traditional standard definition and diagnostic criteria of Tourette’s syndrome (TS) are incomplete and leave out significant aspects of TS neurobiology and symptomatology, the latter often misdiagnosed as a separate “comorbid” disorder. Guided by the insights from the studies of lateralized prefrontal lesions and hemi-Parkinsonian syndromes, we consider the consequences of predominantly left versus right frontostriatal dysfunction and introduce the concept of “hemi-Tourette’s syndromes.” Whereas one (mostly left frontostriatal dysfunction) is dominated by tics promptly diagnosed as TS, the other one (mostly right frontostriatal dysfunction) is dominated by excessive exploratory behaviors that are misdiagnosed as hyperactivity and thus as “comorbid” attention-deficit hyperactivity disorder. The conceptual and clinical definitions of TS should be revised and broadened to account for the features of both the left and right hemi-Tourette’s variants, as well as the combined variant.

Research paper thumbnail of Distinct Patterns of Executive Dysregulation Distinguish Children with Tourette Syndrome from Children with ADHD or Autism Spectrum Disorders

Everyday executive regulation was investigated in children with Tourette Syndrome (TS) compared w... more Everyday executive regulation was investigated in children with Tourette Syndrome (TS) compared with children with Inattentive or Combined subtypes of Attention-Deficit/ Hyperactivity Disorder (ADHD-I, ADHD-C), children with Autistic Spectrum Disorders (ASD) and Typically Developing Children (TDC). Method: Nineteen children with TS, 33 with ADHD-C, 43 with ADHD-I, 34 with ASD, and 50 TDC participated (8-17 yrs.). Parents completed the Behavior Rating Inventory of Executive Function (BRIEF). Results: Children with either TS, ADHD-C, ADHD-I or ASD had significantly greater executive function problems on all BRIEF scales compared with TDC. Children with TS or ADHD-C were higher than those with ADHD-I or ASD on the Inhibit scale, and children with ASD were higher than those with ADHD-I or ADHD-C on the Shift scale. Scale configurations dissociated TS from ASD on the Emotional Control (EC) and Shift scales, TS from ADHD-C on the EC and Inhibit scales, and TS from ADHD-I on the EC and Plan/Organize scales. Conclusion: Paired BRIEF scales successfully dissociated executive function problems in children with TS from other common neurodevelopmental disorders. Identifying a distinguishing pattern of executive dysregulation for children with TS using a rating scale and strategic scale classifications represents a promising tool for the clinician treating this group of children.

Research paper thumbnail of Similar impairments shown on a neuropsychological test battery in adolescents with high-functioning autism and early onset schizophrenia: a two-year follow-up study

Cognitive Neuropsychiatry

Introduction: Cognitive impairments are common in both Autism Spectrum Disorders (ASD) and schizo... more Introduction: Cognitive impairments are common in both Autism Spectrum Disorders (ASD) and schizophrenia, but it is unclear whether the pattern of difficulties is similar or different in the two disorders. This cross-sectional and longitudinal study compared the neuropsychological functioning in adolescents with ASD with adolescents with Early Onset Schizophrenia (EOS). Methods: At baseline and at two-year follow-up, participants were assessed with a brief neuropsychological test battery measuring executive functions, visual and verbal learning, delayed recall and recognition and psychomotor speed. Results: We found similar levels of neuropsychological impairment across groups and over time in the adolescents with ASD or EOS. Adolescents in both groups did not improve significantly on verbal learning, verbal delayed recall, visual learning, visual delayed recall or visual delayed recognition, and both groups performed poorer on verbal recognition. Both groups improved on measures of psychomotor processing and executive functions. Conclusion: The findings suggest that it may be difficult to differentiate adolescents with EOS and ASD based on neuropsychological task performance. An implication of the results is that adolescents with either disorder may benefit from a similar approach to the treatment of cognitive impairment in the disorders.

Research paper thumbnail of Gender Differences in the Relationship Between Changes in ADHD Symptoms, Executive Functions, and Self- and Parent-Report Depression Symptoms in Boys and Girls With ADHD: A 2-Year Follow-Up Study

Journal of attention disorders, Jan 22, 2016

This study was conducted to investigate the association between changes in ADHD symptoms, executi... more This study was conducted to investigate the association between changes in ADHD symptoms, executive functions (EFs), and depression symptoms in girls and boys with ADHD over a 2-year period. Thirty-six girls and 39 boys with ADHD, 18 typically developing (TD) girls and 29 TD boys (ages 9-16) were included. Assessments of EFs, ADHD symptoms, and self- and parent-report of depression symptoms were carried out. For girls, a reduction of inattention symptoms was associated with a decline in parent-rated depression symptoms. A reduction in hyperactivity/impulsivity was associated with a reduction in self-rated depression symptoms in boys, and an increase in girls. A reduction in inattention symptoms was associated with a modest increase in self-rated depression symptoms in both boys and girls. Gathering information from both the parents and the child with ADHD is important in determining how gender may be influencing symptom profiles.

Research paper thumbnail of Cognition, Emotion and Behavior in Children with Tourette's Syndrome and Children with ADHD-Combined Subtype-A Two-Year Follow-Up Study

PloS one, 2015

This two-year follow-up study investigates the course of and association among measures of cognit... more This two-year follow-up study investigates the course of and association among measures of cognitive control, focused attention, decision-making and symptom severity (anxiety, depression and behavior) in children and adolescents with Tourette's Syndrome (TS) or Attention-Deficit/Hyperactivity Disorder-Combined subtype (ADHD-C). 19 children with TS, 33 with ADHD-C, and 50 typically developing children (TDC) were examined with a battery of psychometric measures and rating forms at baseline and two-years later. All three groups improved likewise in measures of cognitive control over time, whereas only the TDC improved in focused attention. The group of children with TS with comorbidities performed more similar to the children with ADHD-C in cognitive control at T1 and T2, whereas the children with TS without comorbidities performed more similar to the TDC in cognitive control at T1 and T2. In the decision-making task, the children with TS (with or without comorbidities) preferred a...

Research paper thumbnail of Distinct Patterns of Everyday Executive Function Problems Distinguish Children With Tourette Syndrome From Children With ADHD or Autism Spectrum Disorders

Journal of attention disorders, Jan 24, 2014

The aim is to investigate the everyday executive function (EF) in children with Tourette syndrome... more The aim is to investigate the everyday executive function (EF) in children with Tourette syndrome (TS), Inattentive or Combined presentations of ADHD (ADHD-I/ADHD-C), autism spectrum disorders (ASD), and typically developing children (TDC). Nineteen TS, 33 ADHD-C, 43 ADHD-I, 34 ASD, and 50 TDC participated (8-17 years). Parents completed the Behavior Rating Inventory of Executive Function (BRIEF). TS, ADHD-C, ADHD-I, or ASD were rated with significantly more regulation problems on all scales compared with TDC. Considerable overlap of symptoms between clinical groups made differentiation difficult on individual scales. Scale configurations showed children with TS to have more problems with emotional control (EC) than cognitive flexibility in relation to children with ASD, more problems with EC than inhibitory control in relation to ADHD-C, and more problems with EC than planning/organizing in relation to ADHD-I. Paired BRIEF scales dissociated EF problems in children with TS from chi...

Research paper thumbnail of Associations Among Symptoms of Autism, Symptoms of Depression and Executive Functions in Children with High-Functioning Autism: A 2 Year Follow-Up Study

Journal of Autism and Developmental Disorders, 2015

This study investigated the course of and association among changes in autism symptoms, depressio... more This study investigated the course of and association among changes in autism symptoms, depression symptoms and executive functions (EF) in children with high-functioning autism (HFA). Thirty-four children with HFA and 45 typically developing children (age 9-16) were assessed at baseline and after 2 years. Children with HFA had impaired scores on all measures at both time points. According to parent reports, depressive symptoms decreased over time, while EF improved and autism symptoms were stable. Children's reports did not reveal less depressive symptoms over time. A positive association was found only between changes in autism symptoms and changes in symptoms of depression. A possible implication is that interventions aimed at either autism symptoms or symptoms of depression may improve the other.

Research paper thumbnail of RCT of Working Memory Training in ADHD: Long-Term Near-Transfer Effects

PLoS ONE, 2013

Objective: The aim of the study is to evaluate the long-term near-transfer effects of computerize... more Objective: The aim of the study is to evaluate the long-term near-transfer effects of computerized working memory (WM) training on standard WM tasks in children with Attention-Deficit/Hyperactivity Disorder (ADHD). Method: Sixty-seven children aged 10-12 years in Vestfold/Telemark counties (Norway) diagnosed with F90.0 Hyperkinetic disorder (ICD-10) were randomly assigned to training or control group. The training group participated in a 25-day training program at school, while the control group received treatment-as-usual. Participants were tested one week before intervention, immediately after and eight months later. Based on a component analysis, six measures of WM were grouped into composites representing Visual, Auditory and Manipulation WM. Results: The training group had significant long-term differential gains compared to the control group on all outcome measures. Performance gains for the training group were significantly higher in the visual domain than in the auditory domain. The differential gain in Manipulation WM persisted after controlling for an increase in simple storage capacity. Conclusion: Systematic training resulted in a long-term positive gain in performance on similar tasks, indicating the viability of training interventions for children with ADHD. The results provide evidence for both domain-general and domain-specific models. Far-transfer effects were not investigated in this article.

Research paper thumbnail of Development of Hot and Cold Executive Function in Boys and Girls With ADHD: A 2-Year Longitudinal Study

Journal of Attention Disorders, 2014

Objective: To investigate the development of executive function with pronounced emotional salienc... more Objective: To investigate the development of executive function with pronounced emotional salience (hot EF) and less pronounced emotional salience (cold EF) in boys and girls with ADHD relative to typically developing (TD) children. Method: Seventy-five children with ADHD and 47 TD children were assessed with hot and cold EF tests at baseline and after 2 years. Results: Despite considerable maturation, the ADHD group remained impaired on all cold EF tests relative to TD children after 2 years. There was no effect of gender on cold EF test results. Females with ADHD outperformed TD counterparts on hot EF at baseline. Females with ADHD showed deteriorating hot EF performance, while TD counterparts showed improved hot EF performance across time. Conclusion: Enduring cold EF impairments after 2 years may reflect stable phenotypic traits in children with ADHD. Results indicate divergent developmental trajectories of hot EF in girls with ADHD relative to TD counterparts.

Research paper thumbnail of Dissociable Response Inhibition in Children With Tourette's Syndrome Compared With Children With ADHD

Journal of Attention Disorders, 2013

Objective: This study investigates whether performance in a verbal response task (Color-Word Inte... more Objective: This study investigates whether performance in a verbal response task (Color-Word Interference Test [CWIT]) and a motor response task (Conners' Continuous Performance Test [CCPT]) discriminates children with Tourette's Syndrome (TS), ADHD, and typically developing children (TDC). Method: Nineteen children with TS, 79 with ADHD, and 50 with TDC participated (8-17 years). Results: Children with TS committed significantly fewer errors in the verbal response task than those with ADHD. Moreover, children with TS but without ADHD performed better than TDC. Errors in motor task and speed of response did not distinguish between groups. A cautious tendency of response correlated positively with rates of tics in children with TS. Conclusion: Children with TS were superior in inhibiting a prepotent verbal response; however, comorbidity with ADHD in those children negatively influenced performance. Results support the hypothesis that levels of inhibitory control distinguish children with TS, ADHD, and TDC.

Research paper thumbnail of Differences in cognitive control in children and adolescents with combined and inattentive subtypes of ADHD

Child Neuropsychology, 2014

The aim of the present study was to investigate the ability of children with attention deficit/hy... more The aim of the present study was to investigate the ability of children with attention deficit/hyperactivity disorder-combined subtype (ADHD-C) and predominantly inattentive subtype (ADHD-PI) to direct their attention and to exert cognitive control in a forced attention dichotic listening (DL) task. Twenty-nine, medication-naive participants with ADHD-C, 42 with ADHD-PI, and 40 matched healthy controls (HC) between 9 and 16 years were assessed. In the DL task, two different auditory stimuli (syllables) are presented simultaneously, one in each ear. The participants are asked to report the syllable they hear on each trial with no instruction on focus of attention or to explicitly focus attention and to report either the right- or left-ear syllable. The DL procedure is presumed to reflect different cognitive processes: perception (nonforced condition/NF), attention (forced-right condition/FR), and cognitive control (forced-left condition/FL). As expected, all three groups had normal perception and attention. The children and adolescents with ADHD-PI showed a significant right-ear advantage also during the FL condition, while the children and adolescents in the ADHD-C group showed a no-ear advantage and the HC showed a significant left-ear advantage in the FL condition. This suggests that the ADHD subtypes differ in degree of cognitive control impairment. Our results may have implications for further conceptualization, diagnostics, and treatment of ADHD subtypes.

Research paper thumbnail of Few differences in hot and cold executive functions in children and adolescents with combined and inattentive subtypes of ADHD

Child Neuropsychology, 2014

The accuracy of the Content should not be relied upon and should be independently verified with p... more The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden.

Research paper thumbnail of Child Neuropsychology, Volume 21, 2015, List of Reviewers

Child Neuropsychology, 2015

Research paper thumbnail of A randomized controlled trial of Goal Management Training for executive functioning in schizophrenia spectrum disorders or psychosis risk syndromes

BMC Psychiatry

Background Executive functioning is essential to daily life and severely impaired in schizophreni... more Background Executive functioning is essential to daily life and severely impaired in schizophrenia and psychosis risk syndromes. Goal Management Training (GMT) is a theoretically founded, empirically supported, metacognitive strategy training program designed to improve executive functioning. Methods A randomized controlled parallel group trial compared GMT with treatment as usual among 81 participants (GMT, n = 39 versus Wait List Controls, n = 42) recruited from an early intervention for psychosis setting. Computer generated random allocation was performed by someone independent from the study team and raters post-intervention were unaware of allocation. The primary objective was to assess the impact of GMT administered in small groups for 5 weeks on executive functioning. The secondary objective was to explore the potential of the intervention in influencing daily life functioning and clinical symptoms. Results GMT improved self-reported executive functioning, measured with the B...

Research paper thumbnail of Executive Functioning in Everyday Life in Youth with Attention-Deficit/Hyperactivity Disorder and Autism Spectrum Disorders: A Two-Year Longitudinal Study

International Journal of Disability, Development and Education

Research paper thumbnail of Symptoms of ADHD in Children with High-Functioning Autism Are Related to Impaired Verbal Working Memory and Verbal Delayed Recall

PLoS ONE, 2013

Symptoms similar to those found in Attention-Deficit/Hyperactivity Disorder (ADHD) often occur in... more Symptoms similar to those found in Attention-Deficit/Hyperactivity Disorder (ADHD) often occur in children with Autism Spectrum Disorders (ASD). The objective of the current study was to compare verbal working memory, acquisition and delayed recall in children with High-Functioning Autism (HFA) to children with ADHD and typically developing children (TDC). Thirty-eight children with HFA, 79 with ADHD and 50 TDC (age 8-17) were assessed with a letter/number sequencing task and a verbal list-learning task. To investigate the possible influence of attention problems in children with HFA, we divided the HFA group into children with (HFA+) or without (HFA2) ''attention problems'' according to the Child Behaviour Checklist 6-18. The children with HFA+ displayed significant impairment compared to TDC on all three neurocognitive measures, while the children with HFA2 were significantly impaired compared to TDC only on the working memory and acquisition measures. In addition, the HFA+ group scored significantly below the HFA2 group and the ADHD group on the verbal working memory and delayed recall measures. The results support the proposition that children with HFA+, HFA2, and ADHD differ not only on a clinical level but also on a neurocognitive level which may have implications for treatment.

Research paper thumbnail of Can PC-based training boost working memory in ADHD preadolescents on medication? : a clinical intervention study

Author: Kjell Tore Hovik Title: Can PC-based training boost working memory in ADHD preadolescents... more Author: Kjell Tore Hovik Title: Can PC-based training boost working memory in ADHD preadolescents on medication? Supervisor: Jens Egeland Background: Children with ADHD suffer from impairments in working memory, and recent studies have documented significant gains in working memory (WM) in children diagnosed with ADHD after participating in a PC-based WM training program. Earlier studies have focused on unmedicated children, while a majority of Norwegian children diagnosed with ADHD take ADHD medication for the disorder. The main question addressed in this study is whether ADHD children on medication would also show significant improvements in WM after PC-based WM training. A second issue examined is whether the results favor one of two established, but diverging, non-unitary models of the construct working memory. Method: Sixty-six children diagnosed with F90.0 Hyperkinetic disorder (ICD-10) currently receiving treatment in the child psychiatric services in two Norwegian counties w...

Research paper thumbnail of Circulating Current Minimization Scheme for a Read-Only Memory

Research paper thumbnail of Executive Control and Emerging Behavior in Youth With Tourette’s Syndrome

Executive control refers to the mental processes involved in the monitoring and regulation of cog... more Executive control refers to the mental processes involved in the monitoring and regulation of cognition, emotion, and behavior, which are essential for normal development during childhood and adolescence. Tourette’s syndrome (TS) is considered a model for understanding developmental psychopathology due to the interaction of many genetic, environmental, and emerging factors influencing disease expression. This chapter examines the effect the emerging factors related to syndrome expression in TS can have on behavior over time during childhood and adolescence.

Research paper thumbnail of Executive control of cognition, emotion and behavior in children with Tourette’s syndrome. A two-year follow-up study

emotional development of children and adolescents with neuropsychiatric disorders". Funding and f... more emotional development of children and adolescents with neuropsychiatric disorders". Funding and facilities for the project were provided for by Innlandet Hospital Trust. Professor Merete Glenne Øie asked me to join the project in 2010. As my main supervisor and the Principal Investigator, her dedication and devotion to excellence in all aspects of the research and writing process have left a lasting impression. I am deeply grateful to my co-supervisor Professor Jens Egeland for his creative and insightful knowledge of clinical neuropsychology and statistics and how to unite these two universes, and to my cosupervisor Professor Kerstin Plessen for sharing with me her invaluable expertise in the field of Tourette's Syndrome and professionalism in the writing process. It has also been my fortune to have collaborated with a number of other outstanding researchers: Andrea Cavanna, Peter Isquith, Gerard Gioia, and Elkohon Goldberg, who have immeasurably broadened my research horizon. A heartfelt thanks to my fellow Phd students Erik Winther Skogli and Per Norman Andersen for their insight, commitment and playfulness in the face of a whirlwind of deadlines and reviews. My deep gratitude to the young participants and their caregivers who endured lengthy assessments, and the many clinicians who helped us assess close to 200 participants on two separate occasions. A special thanks to the 50 typically developing children, who I personally tested and who donated their time for the sake of research. Thanks to the Research Department of Innlandet Hospital Trust, and the Regional Resource Center for Autism, ADHD, Tourette's syndrome and Narcolepsy for financial support. My sincerest gratitude as well to my employers at Early intervention psychosis, Innlandet Hospital Trust Sanderud for their support during my research period, and the Child Mental Health Services Unit in Lillehammer for providing a base for research and the opportunity to practice Habit Reversal Training. A final note of deep appreciation to the Department of Psychology at the University of Oslo for allowing me to follow their Phd program.

Research paper thumbnail of Inside the Triple-Decker: Tourette’s Syndrome and Cerebral Hemispheres

The traditional standard definition and diagnostic criteria of Tourette’s syndrome (TS) are incom... more The traditional standard definition and diagnostic criteria of Tourette’s syndrome (TS) are incomplete and leave out significant aspects of TS neurobiology and symptomatology, the latter often misdiagnosed as a separate “comorbid” disorder. Guided by the insights from the studies of lateralized prefrontal lesions and hemi-Parkinsonian syndromes, we consider the consequences of predominantly left versus right frontostriatal dysfunction and introduce the concept of “hemi-Tourette’s syndromes.” Whereas one (mostly left frontostriatal dysfunction) is dominated by tics promptly diagnosed as TS, the other one (mostly right frontostriatal dysfunction) is dominated by excessive exploratory behaviors that are misdiagnosed as hyperactivity and thus as “comorbid” attention-deficit hyperactivity disorder. The conceptual and clinical definitions of TS should be revised and broadened to account for the features of both the left and right hemi-Tourette’s variants, as well as the combined variant.

Research paper thumbnail of Distinct Patterns of Executive Dysregulation Distinguish Children with Tourette Syndrome from Children with ADHD or Autism Spectrum Disorders

Everyday executive regulation was investigated in children with Tourette Syndrome (TS) compared w... more Everyday executive regulation was investigated in children with Tourette Syndrome (TS) compared with children with Inattentive or Combined subtypes of Attention-Deficit/ Hyperactivity Disorder (ADHD-I, ADHD-C), children with Autistic Spectrum Disorders (ASD) and Typically Developing Children (TDC). Method: Nineteen children with TS, 33 with ADHD-C, 43 with ADHD-I, 34 with ASD, and 50 TDC participated (8-17 yrs.). Parents completed the Behavior Rating Inventory of Executive Function (BRIEF). Results: Children with either TS, ADHD-C, ADHD-I or ASD had significantly greater executive function problems on all BRIEF scales compared with TDC. Children with TS or ADHD-C were higher than those with ADHD-I or ASD on the Inhibit scale, and children with ASD were higher than those with ADHD-I or ADHD-C on the Shift scale. Scale configurations dissociated TS from ASD on the Emotional Control (EC) and Shift scales, TS from ADHD-C on the EC and Inhibit scales, and TS from ADHD-I on the EC and Plan/Organize scales. Conclusion: Paired BRIEF scales successfully dissociated executive function problems in children with TS from other common neurodevelopmental disorders. Identifying a distinguishing pattern of executive dysregulation for children with TS using a rating scale and strategic scale classifications represents a promising tool for the clinician treating this group of children.

Research paper thumbnail of Similar impairments shown on a neuropsychological test battery in adolescents with high-functioning autism and early onset schizophrenia: a two-year follow-up study

Cognitive Neuropsychiatry

Introduction: Cognitive impairments are common in both Autism Spectrum Disorders (ASD) and schizo... more Introduction: Cognitive impairments are common in both Autism Spectrum Disorders (ASD) and schizophrenia, but it is unclear whether the pattern of difficulties is similar or different in the two disorders. This cross-sectional and longitudinal study compared the neuropsychological functioning in adolescents with ASD with adolescents with Early Onset Schizophrenia (EOS). Methods: At baseline and at two-year follow-up, participants were assessed with a brief neuropsychological test battery measuring executive functions, visual and verbal learning, delayed recall and recognition and psychomotor speed. Results: We found similar levels of neuropsychological impairment across groups and over time in the adolescents with ASD or EOS. Adolescents in both groups did not improve significantly on verbal learning, verbal delayed recall, visual learning, visual delayed recall or visual delayed recognition, and both groups performed poorer on verbal recognition. Both groups improved on measures of psychomotor processing and executive functions. Conclusion: The findings suggest that it may be difficult to differentiate adolescents with EOS and ASD based on neuropsychological task performance. An implication of the results is that adolescents with either disorder may benefit from a similar approach to the treatment of cognitive impairment in the disorders.

Research paper thumbnail of Gender Differences in the Relationship Between Changes in ADHD Symptoms, Executive Functions, and Self- and Parent-Report Depression Symptoms in Boys and Girls With ADHD: A 2-Year Follow-Up Study

Journal of attention disorders, Jan 22, 2016

This study was conducted to investigate the association between changes in ADHD symptoms, executi... more This study was conducted to investigate the association between changes in ADHD symptoms, executive functions (EFs), and depression symptoms in girls and boys with ADHD over a 2-year period. Thirty-six girls and 39 boys with ADHD, 18 typically developing (TD) girls and 29 TD boys (ages 9-16) were included. Assessments of EFs, ADHD symptoms, and self- and parent-report of depression symptoms were carried out. For girls, a reduction of inattention symptoms was associated with a decline in parent-rated depression symptoms. A reduction in hyperactivity/impulsivity was associated with a reduction in self-rated depression symptoms in boys, and an increase in girls. A reduction in inattention symptoms was associated with a modest increase in self-rated depression symptoms in both boys and girls. Gathering information from both the parents and the child with ADHD is important in determining how gender may be influencing symptom profiles.

Research paper thumbnail of Cognition, Emotion and Behavior in Children with Tourette's Syndrome and Children with ADHD-Combined Subtype-A Two-Year Follow-Up Study

PloS one, 2015

This two-year follow-up study investigates the course of and association among measures of cognit... more This two-year follow-up study investigates the course of and association among measures of cognitive control, focused attention, decision-making and symptom severity (anxiety, depression and behavior) in children and adolescents with Tourette's Syndrome (TS) or Attention-Deficit/Hyperactivity Disorder-Combined subtype (ADHD-C). 19 children with TS, 33 with ADHD-C, and 50 typically developing children (TDC) were examined with a battery of psychometric measures and rating forms at baseline and two-years later. All three groups improved likewise in measures of cognitive control over time, whereas only the TDC improved in focused attention. The group of children with TS with comorbidities performed more similar to the children with ADHD-C in cognitive control at T1 and T2, whereas the children with TS without comorbidities performed more similar to the TDC in cognitive control at T1 and T2. In the decision-making task, the children with TS (with or without comorbidities) preferred a...

Research paper thumbnail of Distinct Patterns of Everyday Executive Function Problems Distinguish Children With Tourette Syndrome From Children With ADHD or Autism Spectrum Disorders

Journal of attention disorders, Jan 24, 2014

The aim is to investigate the everyday executive function (EF) in children with Tourette syndrome... more The aim is to investigate the everyday executive function (EF) in children with Tourette syndrome (TS), Inattentive or Combined presentations of ADHD (ADHD-I/ADHD-C), autism spectrum disorders (ASD), and typically developing children (TDC). Nineteen TS, 33 ADHD-C, 43 ADHD-I, 34 ASD, and 50 TDC participated (8-17 years). Parents completed the Behavior Rating Inventory of Executive Function (BRIEF). TS, ADHD-C, ADHD-I, or ASD were rated with significantly more regulation problems on all scales compared with TDC. Considerable overlap of symptoms between clinical groups made differentiation difficult on individual scales. Scale configurations showed children with TS to have more problems with emotional control (EC) than cognitive flexibility in relation to children with ASD, more problems with EC than inhibitory control in relation to ADHD-C, and more problems with EC than planning/organizing in relation to ADHD-I. Paired BRIEF scales dissociated EF problems in children with TS from chi...

Research paper thumbnail of Associations Among Symptoms of Autism, Symptoms of Depression and Executive Functions in Children with High-Functioning Autism: A 2 Year Follow-Up Study

Journal of Autism and Developmental Disorders, 2015

This study investigated the course of and association among changes in autism symptoms, depressio... more This study investigated the course of and association among changes in autism symptoms, depression symptoms and executive functions (EF) in children with high-functioning autism (HFA). Thirty-four children with HFA and 45 typically developing children (age 9-16) were assessed at baseline and after 2 years. Children with HFA had impaired scores on all measures at both time points. According to parent reports, depressive symptoms decreased over time, while EF improved and autism symptoms were stable. Children's reports did not reveal less depressive symptoms over time. A positive association was found only between changes in autism symptoms and changes in symptoms of depression. A possible implication is that interventions aimed at either autism symptoms or symptoms of depression may improve the other.

Research paper thumbnail of RCT of Working Memory Training in ADHD: Long-Term Near-Transfer Effects

PLoS ONE, 2013

Objective: The aim of the study is to evaluate the long-term near-transfer effects of computerize... more Objective: The aim of the study is to evaluate the long-term near-transfer effects of computerized working memory (WM) training on standard WM tasks in children with Attention-Deficit/Hyperactivity Disorder (ADHD). Method: Sixty-seven children aged 10-12 years in Vestfold/Telemark counties (Norway) diagnosed with F90.0 Hyperkinetic disorder (ICD-10) were randomly assigned to training or control group. The training group participated in a 25-day training program at school, while the control group received treatment-as-usual. Participants were tested one week before intervention, immediately after and eight months later. Based on a component analysis, six measures of WM were grouped into composites representing Visual, Auditory and Manipulation WM. Results: The training group had significant long-term differential gains compared to the control group on all outcome measures. Performance gains for the training group were significantly higher in the visual domain than in the auditory domain. The differential gain in Manipulation WM persisted after controlling for an increase in simple storage capacity. Conclusion: Systematic training resulted in a long-term positive gain in performance on similar tasks, indicating the viability of training interventions for children with ADHD. The results provide evidence for both domain-general and domain-specific models. Far-transfer effects were not investigated in this article.

Research paper thumbnail of Development of Hot and Cold Executive Function in Boys and Girls With ADHD: A 2-Year Longitudinal Study

Journal of Attention Disorders, 2014

Objective: To investigate the development of executive function with pronounced emotional salienc... more Objective: To investigate the development of executive function with pronounced emotional salience (hot EF) and less pronounced emotional salience (cold EF) in boys and girls with ADHD relative to typically developing (TD) children. Method: Seventy-five children with ADHD and 47 TD children were assessed with hot and cold EF tests at baseline and after 2 years. Results: Despite considerable maturation, the ADHD group remained impaired on all cold EF tests relative to TD children after 2 years. There was no effect of gender on cold EF test results. Females with ADHD outperformed TD counterparts on hot EF at baseline. Females with ADHD showed deteriorating hot EF performance, while TD counterparts showed improved hot EF performance across time. Conclusion: Enduring cold EF impairments after 2 years may reflect stable phenotypic traits in children with ADHD. Results indicate divergent developmental trajectories of hot EF in girls with ADHD relative to TD counterparts.

Research paper thumbnail of Dissociable Response Inhibition in Children With Tourette's Syndrome Compared With Children With ADHD

Journal of Attention Disorders, 2013

Objective: This study investigates whether performance in a verbal response task (Color-Word Inte... more Objective: This study investigates whether performance in a verbal response task (Color-Word Interference Test [CWIT]) and a motor response task (Conners' Continuous Performance Test [CCPT]) discriminates children with Tourette's Syndrome (TS), ADHD, and typically developing children (TDC). Method: Nineteen children with TS, 79 with ADHD, and 50 with TDC participated (8-17 years). Results: Children with TS committed significantly fewer errors in the verbal response task than those with ADHD. Moreover, children with TS but without ADHD performed better than TDC. Errors in motor task and speed of response did not distinguish between groups. A cautious tendency of response correlated positively with rates of tics in children with TS. Conclusion: Children with TS were superior in inhibiting a prepotent verbal response; however, comorbidity with ADHD in those children negatively influenced performance. Results support the hypothesis that levels of inhibitory control distinguish children with TS, ADHD, and TDC.

Research paper thumbnail of Differences in cognitive control in children and adolescents with combined and inattentive subtypes of ADHD

Child Neuropsychology, 2014

The aim of the present study was to investigate the ability of children with attention deficit/hy... more The aim of the present study was to investigate the ability of children with attention deficit/hyperactivity disorder-combined subtype (ADHD-C) and predominantly inattentive subtype (ADHD-PI) to direct their attention and to exert cognitive control in a forced attention dichotic listening (DL) task. Twenty-nine, medication-naive participants with ADHD-C, 42 with ADHD-PI, and 40 matched healthy controls (HC) between 9 and 16 years were assessed. In the DL task, two different auditory stimuli (syllables) are presented simultaneously, one in each ear. The participants are asked to report the syllable they hear on each trial with no instruction on focus of attention or to explicitly focus attention and to report either the right- or left-ear syllable. The DL procedure is presumed to reflect different cognitive processes: perception (nonforced condition/NF), attention (forced-right condition/FR), and cognitive control (forced-left condition/FL). As expected, all three groups had normal perception and attention. The children and adolescents with ADHD-PI showed a significant right-ear advantage also during the FL condition, while the children and adolescents in the ADHD-C group showed a no-ear advantage and the HC showed a significant left-ear advantage in the FL condition. This suggests that the ADHD subtypes differ in degree of cognitive control impairment. Our results may have implications for further conceptualization, diagnostics, and treatment of ADHD subtypes.

Research paper thumbnail of Few differences in hot and cold executive functions in children and adolescents with combined and inattentive subtypes of ADHD

Child Neuropsychology, 2014

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