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Differences in Internalizing Symptoms and Cognitive Functioning in Adults with Attention-Deficit/Hyperactivity Disorder and Sluggish Cognitive Tempo

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Differences in Internalizing Symptoms and Cognitive Functioning in Adults with Attention-Deficit/Hyperactivity Disorder and Sluggish Cognitive Tempo Philadelphia College of Osteopathic Medicine DigitalCommons@PCOM PCOM Psychology Dissertations Student Dissertations, Theses and Papers 2021 Differences in Internalizing Symptoms and Cognitive Functioning in Adults with Attention-Deficit/Hyperactivity Disorder and Sluggish Cognitive Tempo Avery B. Ducey Philadelphia College of Osteopathic Medicine Follow this and additional works at: https://digitalcommons.pcom.edu/psychology_dissertations Part of the Clinical Psychology Commons Recommended Citation Ducey, Avery B., "Differences in Internalizing Symptoms and Cognitive Functioning in Adults with Attention-Deficit/Hyperactivity Disorder and Sluggish Cognitive Tempo" (2021). PCOM Psychology Dissertations. 570. https://digitalcommons.pcom.edu/psychology_dissertations/570 This Dissertation is brought to you for free and open access by the Student Dissertations, Theses and Papers at DigitalCommons@PCOM. It has been accepted for inclusion in PCOM Psychology Dissertations by an authorized administrator of DigitalCommons@PCOM. For more information, please contact [email protected]. Philadelphia College of Osteopathic Medicine School of Professional and Applied Psychology Department of Clinical Psychology DIFFERENCES IN INTERNALIZING SYMPTOMS AND COGNITIVE FUNCTIONING IN ADULTS WITH ATTENTION-DEFICIT/HYPERACTIVITY DISORDER AND SLUGGISH COGNITIVE TEMPO By Avery B. Ducey, MA, MS Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Psychology June 2021 DISSERTATION APPROVAL This is to certify that the thesis presented to us by Avery B. Ducey on the 7th day of May, 2021, in partial fulfillment of the requirements for the degree of Doctor of Psychology, has been examined and is acceptable in both scholarship and literary quality. iii Acknowledgements I would first like to thank my committee members for all the guidance and knowledge you have shared with me throughout this process. Dr. Rosenfield, thank you for believing in me as an applicant to this wonderful program and introducing me to the team at Penn Medicine. Your generous support and flexibility has been invaluable in guiding me through the dissertation process. Dr. DiTomasso, thank you for lending your statistical expertise to my dissertation. Your input challenged me to seek out and truly comprehend the knowledge of advanced statistics that enriched the content of this dissertation. Dr. Ramsay, thank you for your clinical mentorship and for always keeping me up to date by emailing me the latest articles and inviting me to research meetings. I would also like to thank Dr. Russel Barkley for sharing the full range of percentile norms for his Adult ADHD Rating Scales, which made many of the analyses in this dissertation possible. Thank you all for inviting me into the fascinating world of ADHD research. Additionally, I would like to thank Dr. Masey for over 3 years of mentorship and guidance. The opportunity to administer neuropsychological assessments with you on my first year of practicum and to continue working with you in various roles, helped to set the trajectory of my career as a psychologist in training. Thank you for imparting your skills, knowledge, and wisdom to me, and for inspiring me to pursue a career as a neuropsychologist. Last, but certainly not least, I would like to thank my parents, Ed and Donna, for giving me every opportunity to learn, persevere, improve, and grow into the man I am today. Without your limitless love and support I would not be here today. I love you both, and I’m so grateful for everything you have done for me. Thank you. iv Table of Contents Acknowledgements ............................................................................................................ iii Abstract ............................................................................................................................... 1 Chapter 1: Introduction ....................................................................................................... 2 Statement of the Problem ................................................................................................ 2 Purpose of the Study ....................................................................................................... 3 Hypotheses ...................................................................................................................... 4 Chapter 2: Review of the Literature .................................................................................... 7 Attention-Deficit/Hyperactivity Disorder in Adults ....................................................... 7 Sluggish Cognitive Tempo ........................................................................................... 10 Validating SCT. ........................................................................................................ 10 Depletion Models and SCT. ...................................................................................... 14 Nosology and Transdiagnostic Factors ......................................................................... 18 Internalizing and Externalizing Factors .................................................................... 19 Internalizing Disorders in Those With SCT and ADHD .............................................. 21 Neurological Research on ADHD ................................................................................ 28 Brain Structure and Function in ADHD ................................................................... 28 Neuropsychological Functioning in SCT and ADHD .............................................. 35 SCT and Neuropsychological Functioning ............................................................... 37 Utility of Neuropsychological Testing for ADHD and SCT .................................... 39 Executive Functioning .................................................................................................. 40 Executive Functioning in ADHD and SCT .............................................................. 42 Summary of Literature Review ..................................................................................... 45 v Hypothetical Models of SCT ........................................................................................ 46 Chapter 3: Method ............................................................................................................ 50 Participants .................................................................................................................... 50 Inclusion and Exclusion Criteria ............................................................................... 50 Measures of ADHD and SCT Symptoms ..................................................................... 51 Barkley Adult ADHD Rating Scales-Fourth Edition (BAARS-IV) ......................... 51 Conners Adult ADHD Rating Scale - Self-Report (CAARS) .................................. 52 Measures of Internalizing Symptoms ........................................................................... 53 Brown Attention Deficit Disorder Scale - Adult Version (BADDS) ....................... 54 Penn State Worry Questionnaire (PSWQ) ................................................................ 55 Beck Depression Inventory, Second Edition (BDI-II) .............................................. 55 Revised NEO Personality Inventory (NEO-PI-R) .................................................... 56 Measures of Cognitive Functioning .............................................................................. 57 Barkley Deficits in Executive Functioning Scale (BDEFS) ..................................... 58 Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV) ................................ 59 Procedures ..................................................................................................................... 59 Chapter 4: Results ............................................................................................................. 61 Diagnostic Group Creation ........................................................................................... 61 Demographic Analysis .................................................................................................. 62 Hypothesis 1 Analysis................................................................................................... 64 Hypothesis 2 Analysis................................................................................................... 74 Hypothesis 3 Analysis................................................................................................... 78 Exploratory Analyses .................................................................................................... 86 vi Diagnostic group differences in executive functioning ............................................ 86 Chapter 5: Discussion ....................................................................................................... 98 Interpretations and Implications ................................................................................. 100 Differences in Internalizing Symptoms Between Diagnostic Groups .................... 100 Differences in Cognitive Functioning Between Diagnostic Groups....................... 103 Predicting SCT Symptoms Based on Internalizing Symptoms, Cognitive Functioning, and ADHD Symptomatology ................................................................ 106 Limitations .................................................................................................................
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