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Child Neuropsychology: A Journal onNormal and Abnormal Development inChildhood and AdolescencePublication details, including instructions for authors andsubscription information:http://www.tandfonline.com/loi/ncny20

Mental Genesis of Scripts inAdolescents With Attention Deficit/Hyperactivity DisorderClaude M.J. Braun a b , Lucie Godbout a b , Chantal Desbiens b

, Sylvie Daigneault a c , Francine Lussier a d & Isabelle Hamel-Hébert aa Centre de Neurosciences de la Cognition, Université du Québecà Montréal Montreal Que. Canadab Département de Psychologie Université du Québec à TroisRivières Canadac Centre Universitaire de Santé McGill, Hôpital de Montréal pourEnfants Canadad Centre d'Évaluation Neuropsychologique et d'OrientationPÉdagogique MontrÉal CanadaPublished online: 09 Aug 2010.

To cite this article: Claude M.J. Braun , Lucie Godbout , Chantal Desbiens , Sylvie Daigneault ,Francine Lussier & Isabelle Hamel-Hébert (2004) Mental Genesis of Scripts in AdolescentsWith Attention Deficit/Hyperactivity Disorder, Child Neuropsychology: A Journal onNormal and Abnormal Development in Childhood and Adolescence, 10:4, 280-296, DOI:10.1080/09297040490909332

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Child Neuropsychology2004, Vol. 10, No. 4, pp. 280–296

Mental Genesis of Scripts in AdolescentsWith Attention Deficit/Hyperactivity Disorder

Claude M.J. Braun1,2, Lucie Godbout1,2, Chantal Desbiens2, Sylvie Daigneault1,3,

Francine Lussier1,4, and Isabelle Hamel-Hebert11Centre de Neurosciences de la Cognition, Universite du Quebec a Montreal, Montreal, Que., Canada,

2Departement de Psychologie, Universite du Quebec a Trois Rivieres, Canada,3Centre Universitaire de Sante McGill, Hoopital de Montreal pour Enfants, Canada, and

4Centre d’�EEvaluation Neuropsychologique et d’Orientation Pedagogique, Montreal, Canada

ABSTRACT

Twenty nine ADHD adolescents and 29 age, IQ and gender matched normal comparison subjectscompleted 6 paper pencil tasks of mental script generation. Each task required the subject to generate 10chronologically ordered and necessary actions toward a goal. There were 3 levels of structure of thetasks (highly structured, moderately structured, unstructured) and each of these levels comprised afamiliar and an unfamiliar script. The ADHD group made more sequencing errors on all the scripts,significantly so on the highly structured unfamiliar and on the moderately structured unfamiliar scripttasks. The two groups were similar however with regard to the semantic structure (content) of the scriptsand the total number of actions generated. Errors of omission, commission and perseveration weresimilar for the two groups. The results are interpreted as supportive of Barkley’s (1997) frontal lobedysfunction model of ADHD.

INTRODUCTION

Attention deficit/hyperactivity disorder (ADHD) is

an important problem in North American society.

Between 3 and 5% of school children are affected,

engendering exorbitant costs in screening, school

failure, medication, special education, medical and

legal expenses (DSM-IV, 1996). ADHD children

often have severe problems with schooling de-

spite normal IQ (Mangina, Beuzeron-Mangina, &

Grizenko, 2000). It is commonly believed that

agitation and impulsiveness are the only cause of

inattention and distractiveness in ADHD. How-

ever, there are serious cognitive problems in

ADHD which are not reducible to agitation and

impulsiveness (Barkley, 1997).

The increasingly recognized neuropsychologi-

cal characterization of ADHD children consists of

a frontal lobe dysexecutive syndrome. Anatomo-

physiological findings in support of this interpreta-

tion, though other brain areas are abnormal too,

have been provided by numerous metabolic im-

aging studies (Bush et al., 1999; Rubia et al., 1999,

2000; Schweitzer et al., 2000; Spalletta et al.,

2001; Zametkin, Liebenauer, Fitzgerald, & King,

1993), and numerous topographical electroenceph-

alographic and evoked potential studies (Jonkman

et al., 1997; Pliszka, Liotti, & Woldorff, 2000;

Address correspondence to: Claude M.J. Braun, Ph.D., Full Professor, Centre de Neurosciences Cognitives,UQAM, C.P. 8888, Succ. Centre-Ville, Montreal, Que., Canada H3C 3P8. Tel.: þ1-514-987-3000 (4814). Fax:þ1-514-987-8952. E-mail: Braun.Claude@UQAM.CAAccepted for publication: August 21, 2003.

0929-7049/04/1004-280$16.00 # Taylor & Francis Ltd.DOI: 10.1080/09297040490909332

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Rothenberger et al., 2000; Silberstein et al., 1998;

but see Brandeis et al., 1998).

The outstanding cognitive impairments of

ADHD children, aside from sustained vigilance,

are of various executive functions (Aman,

Roberts, & Pennington, 1998; Carte, Nigg, &

Hinshaw, 1996; Dinn, Robbins, & Harris, 2001;

Gansler et al., 1998; Grodzinsky & Barkley, 1999;

Koziol & Stout, 1992; Lazar & Frank, 1998;

Lovejoy et al., 1999; Oie & Rund, 1999; Pineda,

Ardila, Rosselli, Cadavid, Mancheno, & Mejia,

1998; Rapport, Van Voorhis, Tzelepis, &

Friedman, 2001; Seidman, Biederman, Weber,

Hatch, & Faraone, 1998; Shue & Douglas, 1992).

However, the most articulated neuropsychological

account of ADHD must be credited to Barkley:

. . . functions that subserve self-regulation: non-

verbal working memory; the internalization of

speech; the self-regulation of affect, motivation,

and arousal; and reconstitution. These functions

permit the construction, execution, and control

of behavior by internally represented informa-

tion, which removes behavior from control by

the immediate context and brings it under the

control of time. ADHD disrupts this process

and returns control of behavior to the tem-

poral now. A blindness to past, future, and time

more generally, as well as an inability to direct

behavior toward the future and to sustain

it . . . (1997).

Barkley’s model of ADHD continues to receive

empirical support (see Sergeant, Geurts, &

Osterlaan, 2002, for a review). However, we

believe that the neuropsychological tests used, to

date, to investigate the type of executive functions

refered to by Barkley, are not optimal (Kerns,

McInerney, & Wilde, 2001). Tests such as the

Porteus Mazes Test, the Trail Making Test, the

Wisconsin Card Sorting Test, the Verbal Fluency

Test, do measure complex cognitive functions, but

they are not sufficiently meta-cognitive for that

particular purpose. These tests provide too rigid a

framework, too much structure, and vacillation of

attention will not necessarily much affect perfor-

mance if the subject can flit back and forth, to and

from the task. What is needed is a task which

heavily engages working memory over longer

periods of time, in which fleeting inattention will

affect performance. The Continuous Performance

Task answers well to this latter requirement and is

recognized as one of the most sensitive tests for

identifying ADHD. However, it is not very

specific to ADHD (Gallagher & Ader, 2001). A

go/no go task termed the ‘‘stop’’ task, measuring

response inhibition, is currently considered very

sensitive to ADHD and supports Barkley’s idea of

a deficit of response inhibition (Sergeant et al.,

2002). However, this task, like the CPT, does not

target the higher order deficit of anticipation

evoked by Barkley (described above) nor is it

believed to tap frontal as much as basal ganglia

function (Scheres, Oosterlaan, & Sergeant,

2001).

A task suited to test Barkley’s core character-

ization of ADHD should require ‘‘construction,

execution, and control of behavior by internally

represented information, which removes behavior

from control by the immediate context and brings

it under the control of time’’, and ‘‘sustained

direction of behavior toward the future’’. Such a

task exists, but has not yet made its way into

mainstream neuropsychological testing and has

never been administered to ADHD patients.

Mental Genesis of Scripts as a Frontal

Lobe Meta-Cognitive FunctionMental genesis of scripts has been under inves-

tigation in cognitive psychology for many years

(Schank & Abelson, 1977). Script generation was

first theorized neuropsychologically by Shallice

(1982, 1988) and then by Grafman (1989).

Shallice proposed that activities of daily living

consist of action sequences, which to be imple-

mented require mental schemata (scripts) in

which the ordering of individual actions is

highly constrained and involves numerous steps.

Shallice’s model proposes that mental scripts are

hierarchically organized: the top level component

(Supervisory Attentional System or SAS), dealing

with novel situations, is more frontal lobe

dependent, whereas the lower level component

(Contention Scheduler or CS), dealing with

routine action sequences and sub-sequences,

may be more tributary to subcortical areas (e.g.,

the basal ganglia). Script tasks have since been

operationalized in paper-pencil versions (inven-

tion and recitation of scripts) and have been

SCRIPT GENERATION IN ADHD 281

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shown to be highly sensitive to frontal lobe

lesions (Allain, Le Gall, Etcharry, Aubin, &

Emile, 1999; Godbout & Doyon, 1995; Le

Gall, Aubin, Allain, & Emile, 1993; Sirigu et al.,

1995, 1996) and to activate frontal cortex in

normal subjects (Crozier et al., 1999; Partiot,

Grafman, Sadato, Flitman, & Wild, 1996).

Godbout, Cloutier, Bouchard, Braun, and Gagnon

(2003) have shown however that depending on the

contents of the scripts (e.g., demands on spatial

representation), parietal lobe lesions may also

impair script generation. Furthermore, attempts to

neuropsychologically dissociate the SAS and CS

with script recitation tasks have failed to date. For

example, Godbout and Doyon (1995) found that

frontally lesioned patients were equally impaired

in routine and non-routine script generation.

Other groups found that the CS was not more

impaired than the SAS in Parkinson’s disease

(Choudhry & Saint-Cyr, 1998; Godbout &

Doyon, 2000; Zalla et al., 1998).

Grafman also recognized a hierarchy of mental

representation in mental scripts: some processing,

located at a more abstract level, involves repre-

sentation of the entire script, at least in terms of a

beginning, a body and an end (Grafman, 1989).

On the other hand, some processing, located at a

concrete level, only requires the identification

and enactment, by habit, of the appropriate node

in a sequence (Grafman, 1989). However, in dis-

tinction to Shallice, Grafman proposed that both

these levels are located in the frontal cortex

primarily.

General Purpose of the Present

Investigation: ADHD and Mental ScriptsThough there exists a corpus of research on

mental script generation in children, the construct

has never been operationalized in view of

standardized testing (Adams & Worden, 1986;

Rabinowitz & Valentine, 1984 (unpublished);

Toyama, 1993, in Japanese). In fact, there is no

established method for testing script generation in

children. We propose that script generation tasks

represent an optimized test of Barkley’s (1997,

1998) characterization of ADHD. The purpose of

this study was therefore to construct our own

script tasks for children in view of predicting that

ADHD adolescents should manifest an impair-

ment on tasks requiring mental genesis of long

scripts relative to normal comparison subjects.

METHOD

The ADHD ParticipantsTwenty nine Quebec francophone adolescents (23 righthanders and 6 left handers) were diagnosed accordingto DSM-IV criteria as having attention deficit/hyper-activity disorder (ADHD) by two hospital neuropsy-chologists with each case being legally diagnosedlikewise by a neurologist (21 boys, 8 girls). Twentycases were recruited by us from a hospital (MontrealChildren’s Hospital) and nine from a private neuro-psychology clinic (CENOP). Ethical clearance wasobtained from the university (UQTR) and hospitalethics committees and the children under 15 or parents(children 14 and younger) were contacted directly bythe treating psychologist, as specified by the hospital’sethics procedures, and the participants were offeredcompensation for travel to the university for testing($30.00 CAN) where they were tested individually. Ofthe cases initially selected to participate, 15% declined.The ADHD adolescents of the present study areseverely and exclusively affected by ADHD. Theyhad all transited through neuropsychological servicesof hospitals, they all answered to DSM-IV diagnosticcriteria, diagnosis of ADHD was formal for each caseon the part of a hospital based child neuropsychologistand a pediatric neurologist, and the observation ofpathological behavior (hyperactivity and/or inattentive-ness) was corroborated by a parent in all cases, and ahigh proportion of them were in special classes or hadfailed a year. Two thirds had taken or were takingmethylphenidate. Further inclusion criteria for theADHD group included a z score of more than 1.3 onthe Hyperactivity-Inattention subscale of the ConnersRating Scale – Revised for parents. However, because afew Conners scores were missing, in those cases, a zscore of 1.3 had to be surpassed on the ‘‘Attentionproblems’’ scale of the Child Behavior Checklist forparents, a measure established as relatively ‘‘selec-tively’’ sensitive to presence of ADHD (Geller, Warner,Williams, & Zimerman, 1998). Parental Conner’sRating Scale – Revised scores were available for 17ADHD participants. The average t-scores were 56 forthe ‘‘Oppositional’’ scale, 64 for the ‘‘Cognitiveproblems/Inattention’’ scale, 72 for the ‘‘Hyperactiv-ity’’ scale, and 68 for the ‘‘Hyperactivity index’’.Repeated measures ANOVA indicated that thesesubscales rated the ADHD participants as significantlymore ‘‘hyperactive’’ than ‘‘oppositional’’, F(7, 18)¼12.2, p< .0006, suggesting that, as a whole, the parents’judgment concured with the experts’ diagnosis of

282 CLAUDE M.J. BRAUN ET AL.

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ADHD. Twenty six ADHD participants had a CBCLcompleted by a parent in their neuropsychology file.Repeated measures ANOVA indicated that these sub-scales rated the ADHD participants as having sig-nificantly more ‘‘attention problems’’ than ‘‘somaticcomplaints’’, F(7, 18)¼ 37.5, p< .0001, suggesting againthat, as a whole, the parents’ judgment concured withthe experts’ diagnosis of ADHD. The mean ratings oneach subscale and SDs are presented in Figure 1.

The ADHD participants had to have been offmedication for at least 12 hr prior to testing, aninterval sufficient for complete clearance of Ritalinfrom the bloodstream, and return to baseline of itsknown acute neural and non-chronic behavioral effects(Kimko, Cross, & Abernethy, 1999).

The Normal ParticipantsTwenty nine normal Quebec francophone adolescents(17 boys and 12 girls, 26 right handers and 3 lefthanders), between 12 and 17 years of age, were retainedfrom an initial sample of 200 recruited in summercamps and schools. Because they were not displaced fortesting, they were not compensated financially. Theseparticipants were group tested (maximum¼ 20).

Matching of the Two GroupsThe two groups were age (t(56)¼ 0.39, ns) and IQmatched (t(56) ¼�0.14, ns). see Table 1. Paternal andmaternal occupations were described by the children

and rated by us at one of five possible levels,professional (P), specialized white collar (SW), spe-cialized blue collar (SB), unspecialized employee (US),unemployed (UE). The groups did not differ signifi-cantly on either of these variables (Wilcoxon 2 sampletest). The sex ratio also did not differ significantly asa function of group as assessed by the �2 test (seeTable 1).

Exclusion criteria for both groups included dyslexiaor dyscalculia, any neurological condition (head trau-ma, epilepsy, etc.), any other psychiatric problem(clinical depression, Gilles de la Tourette disorder, ananxiety syndrome, etc.) or substance abuse problem. AnIQ of 75 or more on Cattell’s Culture fair Intelligencetest was required for all subjects [the Cattell IQ scorescorrelated significantly with the WISC-III FSIQ scoresin the ADHD sample (r(23)¼ .69, p< .0004)].

All testing was carried out in the French language.

Tests and QuestionnairesThere are two datasets in this investigation. One con-sists of data drawn from the clinical files of the ADHDpatients (approximately 2 years prior to the currentinvestigation). The tests used from this data baseinclude anamneses, and tests mentioned in the previousparagraphs as selection criteria (Connors and CBCLquestionnaires). The WISC was also available from thefiles and was used to explore correlational patternswith script tasks: in particular, we were interested in

Fig. 1. Mean parental ratings on the Child Behavior Checklist-L, and standard deviations.

SCRIPT GENERATION IN ADHD 283

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Table 1. Participant Characteristics.

Sex Age (years) Handedness Paternal occupation Maternal occupationIntelligence

quotient

M F M SD R L P SW SB US UE P SW SB US UE M SD

Normal 17 12 14.2 1.2 3 26 0 1 9 7 0 1 5 4 8 3 98.2 10.5ADHD 21 8 14.1 1.5 8 21 3 5 5 5 0 2 4 3 6 1 98.6 11.5

Note. Missing data for occupations are due to children’s inability to describe parental occupation or absence of a biological parent. IQ scores are from Cattell’sCulture Fair Intelligence Test.

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determining the extent to which the Picture Arrange-ment subtest (a script task of sorts) could predictperformance on our experimental script tasks. Theother dataset derives from a more recent testing sessioncollected for the present report. At the time of the recenttesting session, a biographical questionnaire was com-pleted by all subjects informing us of the participant’sage, gender, socio-economic status of the parents,schooling, and application of inclusion and exclusioncriteria (ex: medication), and so forth. All the par-ticipants also completed the Cattell Culture Fair Scaleof Intelligence at that time, and all the participantscompleted the ensemble of script tasks, which aredescribed next.

Script TasksSix script generation tasks were created for this studyrespecting certain aspects of Shallice’s (1982) andGrafman’s (1989) models of script generation. Shalliceproposed that a frontal lobe cortical module, thesupervisory attentional system (SAS) controls non-routine (i.e., unfamiliar) aspects of script generation,while another module (probably outside of the frontalcortex), the contention scheduler (CS), controls routine(i.e., familiar) aspects. Grafman proposed that thereexists a hierarchy of abstractness in script generation,but that concrete (elementary or structured) andabstract (complex or unstructured) aspects of sequen-tialization are both primarily frontal lobe based. Tooperationalize these distinctions, we designed 6 un-timed tasks with three levels of structure, each suchlevel comprising two levels of familiarity (3�2¼ 6).Each task required sequencing of 10 actions.

Our understanding of Barkley’s model of ADHD ledus to expect that our ADHD cohort would have moredifficulty on our non-familiar than familiar tasks.Indeed, Barkley’s ‘‘behavioral inhibition’’ concept isobviously more akin to Shallice’s SAS (specialized forprocessing unfamiliar material) than his CS (special-ized for processing familiar material). Our under-standing of Barkley’s model of ADHD also led us toexpect that our ADHD cohort would have moredifficulty with the unstructured than structured scripttasks, relative to the normal comparison group. Indeed,it is generally recognized that unstructured situationsare harder to process in working memory and selec-tively compromize performance of frontal patients(Pillon, 1981).

A highly structured task (HST), resembling that ofSirigu (1995), consisted of 16 cards (5 in.�7 in.) withan action described in large type on each. The order ofpresentation was standardized to a fixed randomness.The subject was required to select the 10 most relevantof the 16 cards (there were 6 distractors) relative tothe goal – which was given by the experimenter. The

participant was then required to sequence these 10cards in chronological order. One goal was familiar(HST-F) to the subjects (preparing for sleep) and theother was relatively unfamiliar (HST-U: preparing anoutdoors expedition). An example (renting a videocas-sette) was given prior to testing (ex., going to the videostore, choosing a film, paying the fee, returninghome, . . .watching the movie, rewinding the cassette,returning to the store), see Table 2.

A moderately structured task (MST) consisted of acomplex picture, similar to the Cookie Theft scene ofGoodglass and Caplan (1983), which was to serve as astarting point of a series of 10 relevant actions derivingfrom the situation depicted and which the participantwas required to invent and chronologically sequence inwriting and to number in correct order. The goal to beenvisaged was explicitly given by the experimenter.The familiar scene (MST-F) was a christmas giftexchange (Aubry, 1988, see Fig. 2) and the unfamiliarscene (MST-U) was of somebody close to drowning(Luria, 1973, p. 215). The Goodglass and Caplan(1983) Cookie Theft image was used as an exampleprior to testing (ex: the boy falls, the girl shouts, themother looks over, . . . the mother scolds the children,the mother cleans up), see Table 3.

An unstructured task (UST), similar to Godbout andDoyon (1995) consisted of having subjects write inproper sequence the 10 most important actions requiredto attain a goal. Only the goal was explicitly given bythe experimenter, not the starting point. Subjects wereasked to number each action in the correct chronolo-gical order. The familiar goal (UST-F) was going toschool, and the unfamiliar (UST-U) was painting one’sroom. Prior to testing, an example (going to a birthdayparty) was given (receiving an invitation, choosing agift, buying the gift, . . . , thanking the hosts, leaving),see Table 4.

Scoring of the Script TasksThe scoring of script generation comprised a number ofdimensions. Frontal patients are known to manifestspectacular lack of judgment on estimation tasks(Shallice & Evans, 1978; Smith & Milner, 1984,1988). This trait could be construed as an excentric ornon-conventional response style (though, no suchintention should be inferred). An index of convention-alism, as in Godbout (1995) was thus scored bycalculating the extent to which productions corre-sponded to norm on the MST and UST only. Sixty threenormal children of the same age were the normativegroup. There were four categories of conventionalism:very frequent (at least 65% of the normative group),frequent (45–64%), infrequent (25–44%) and rare (lessthan 25%). Conventionalism quotients consisted of theproportion of responses in each category over the total

SCRIPT GENERATION IN ADHD 285

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multiplied by a 100. Ranges of correct reponses weredetermined by interjudge agreement of >90% (derivedfrom the data base of 200 normal children, as well aspersonal judgment of all the authors), for each scripttask. This allowed us to rate omission and commissionerrors. Omission errors (on the MST and UST) con-sisted of absence of responses belonging to essentialsemantic categories as defined both by individualjudgment of the rater and by semantic classes providedby (drawn from) the normative base. Commissionerrors (on the MST and UST) consisted of inappropriateirrelevant intrusions as judged by the rater, on the basisof personal judgment of the authors and a grid ofsemantic categories drawn from the normative base. Inaddition, sequence errors were rated against a gridprepared a priori, based on interjudge agreement (HST:100%, MST and UST: >90%). Frontal lobe patients are

known to perseverate (Benson et al., 1981; Jones-Gotman, Ptito, & Zatorre, 1984; Milner, 1964;Robinson, Heaton, Lehman, & Stilson, 1980; Teuber,1964). Thus, perseverative errors consisted of repeti-tion of an action (MST and UST only). McFie andThompson (1972) found that not moving the cards ofthe WAIS Picture Arrangement subtest was a reliableindex of mental inertia due to frontal lobe lesions. Wetransposed this inertia index to our highly structuredscript task. A resistence to inertia index (HST only)consisted of the distance of the cards from their originalposition (after completion), regardless of the correct-ness of the sequencing. Frontal impulsivity sometimesmanifests itself as an inability to respect details of therules (instructions) of a task, as much as, or more than,an impaired ‘‘performance’’ on the same task (Milner,1964). Disrespect of the instructions was thus also

Table 2. Goals and Actions Printed on Index Cards, in Correct Order, Followed by the Distractors.

Renting a video cassette Preparing for sleep Preparing an expedition

1. Going to the video store. 1. Taking the decisionto go to bed.

1. Inviting some friends togo on an expedition.

2. Choosing the movie. 2. Ending the activityin progress.

2. Choosing a destinationand a date.

3. Paying the fee. 3. Going to the bedroom. 3. Choosing a way to travelto the destination.

4. Going back home. 4. Getting undressed. 4. Making a list of thematerial required.

5. Inserting the videocassettein the video player.

5. Turning the light off. 5. Getting the material alreadyowned together.

6. Turning the TV on. 6. Lying down on the bed. 6. Verifying that the equipmentis in good condition.

7. Pressing the play buttonof the video player.

7. Drawing the covers. 7. Finding the equipmentthat is missing.

8. Watching the movie. 8. Closing one’s eyes. 8. Preparing the materialfor departure.

9. Rewinding the videocassette. 9. Relaxing. 9. Meeting for the departure.10. Returning the videocassette

to the store.10. Falling asleep. 10. Departing on the expedition.

DistractorsCutting one’s toenails. Putting on some music

to fall asleep.Telling the adventures that

happened to one’s friends.Asking the neighbor

for a suggestion.Watching television. Choosing good music.

Washing one’s hands. Finishing one’s homework. Asking those who do not wantto come their reasons for refusing.

Turning all the lights off. Dreaming. Brushing one’s teeth.Buying a bag of popcorn. Doing one’s room. Packing the chocolate well so

it does not melt.Putting one’s coat on. Getting dressed. Making sure that there is the same

number of girls and boys.

Note. In the renting a video cassette and preparing for sleep scripts, items 5 and 6 are interchangeable withoutpenalty.

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scored (failing to enumerate one’s actions on the MSTor UST, failing to put the cards in the correct envelopeon the HST, inverting the order of card ranking on the

HST: 1 point each), as was the number of responses oneach task which could also conceivably index frontalinertia or impulsive commissiveness.

Table 3. Goals and Examples of Perfect (Error Free) Scripts for the Moderately Structured Example, Familiar Taskand Unfamiliar Task.

Dealing with the Cookie Theft Completing the christmasgift exchange

Saving the drowning person

1. The boy falls. 1. The woman finishes servingthe group.

1. Someone tells the victimto remain calm.

2. The little girl screams. 2. Someone proposes thatthe gifts be exchanged.

2. Someone calls anambulance.

3. The woman turns over to lookat the scene.

3. Everyone gets together. 3. The man throws the ropeto the victim.

4. The woman asks whetherthe boy is all right.

4. Someone distributesthe presents.

4. Several people pull on therope together.

5. The woman puts the plate she’sholding on the counter.

5. Everyone opens his/her gift(s). 5. The victim leaves the water.

6. The woman helps the boy up. 6. Each person looks at whathe/she received.

6. People take the victiminside the house.

7. The woman turns the water off. 7. Everybody expresseshappiness.

7. Someone gets the wetclothes of the victim off him.

8. The woman puts the stoolupright.

8. Each person thanks thosewho gave him/her a gift.

8. Someone covers the victimwith a warm blanket orfresh clothing.

9. The woman scolds thechildren.

9. Someone picks up the papersand boxes off the floor.

9. The ambulance arrives.

10. The woman cleans the water onthe floor.

10. The children play with theirnew toys.

10. The victim receivesmedical attention.

Note. Items 7 and 8 of the Cookie Theft script were considered invertable.

Fig. 2. Image used to solicit a familiar script in the MST-F. Reproduced from the Profil d’Efficience CognitiveSpontanee, Pierre Audy, Universite du Quebec, with permission.

SCRIPT GENERATION IN ADHD 287

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ProcedureThe project was cleared by hospital and universityethics committees. Participants of age 14 or moresigned a consent form. Those under 14 had previouslysecured one parent’s written consent. All subjectsunderwent the same procedure: they completed thebiographical questionnaire first, the Cattell Culture FreeIQ test next, the HST-F, the HST-U, the UST-F, theUST-U, the MST-F and the MST-U (pilot work hadshown us that the children had difficulty with the MSTwhen it was not preceded by the other tasks). Thenormal subjects were tested in groups ranging from 10to 40 in classrooms or in gymnasiums not being usedfor other purposes. The ADHD participants were testedindividually in a quiet testing room. All distributionswere tested for normality. A few script task measureswere not sufficiently normally distributed for para-metric testing. Normal distributions led to t-testsfor simple contrasts and ANOVAs for multilevel tests.The medians test was used as a t-test non-para-metric analog when necessary for testing the mainhypothesis.

RESULTS

Differences Between the ADHD

Children and Normal Comparison

Subjects on the Script Tasks

The total number of responses, resistence to iner-

tia index, conventionalism index, disrespect of

instructions, omission errors, commission errors,

and perseverations did not differ as a function of

group, whether on individual script tasks or all

tasks combined, see Table 5.

Sequence errors were significantly more fre-

quent in the ADHD group on the HST-U (t(56)¼�2.09, p< .05) and on the MST-U (Medians test,

z¼ 3.4, p< .0006), but not on any other individual

script task measure. An example of sequence error

observed in an ADHD participant on the HST-U

consisted of placing ‘‘Preparing the material for

departure’’ before ‘‘Making a list of the material

required’’, ‘‘Getting the material already owned to-

gether’’ and ‘‘Verifying that the equipment is in

good condition’’. An example of a sequence error

observed in an ADHD participant on the MST-U

consisted of placing ‘‘The victim leaves the water’’

before ‘‘Several people pull on the rope together’’,

see Table 5.

Sequence errors were further analyzed on the

entire data set by repeated measures ANOVA.

There were significant main effects of FAMIL-

IARITY (F(1, 55)¼ 42.4, p< .00001) and STRUC-

TURE (F(1, 55)¼ 79.6, p< .00001) and of GROUP

(F(1, 55)¼ 10.6, p< .003). However, no interac-

tions involving GROUP reached significance,

see Table 5.

Analyses of ADHD Subgroups

The ADHD subjects could be subdivided into three

groups relative to methylphenidate consumption:

having never consumed (N¼ 8), having consumed,

Table 4. Examples of Perfect (Error Free) Scripts for the Unstructured Example, Familiar Task and UnfamiliarTask.

Going to a birthday party Going to school Painting one’s room

1. Receiving an invitationto go to a birthday party.

1. Awakening. 1. Choosing the paint color.

2. Thinking of which gift to buy. 2. Getting out of bed. 2. Buying the paint and the accessories.3. Buying the gift. 3. Going to the bathroom. 3. Getting dressed with old clothes.4. Wrapping the gift. 4. Getting dressed. 4. Taking the pieces of furniture

out of the room.5. Going to the party. 5. Eating breakfast. 5. Shaking or mixing the paint well.6. Offering the gift. 6. Preparing lunch or pocket

money for lunch.6. Painting the room.

7. Wishing happy birthdayto the friend.

7. Taking the school bag. 7. Letting the walls dry.

8. Having fun with the friends. 8. Leaving home. 8. Painting the number of layersthat are necessary.

9. Thanking the hosts. 9. Going to school. 9. Cleaning and storing the accessories.10. Going back home. 10. Entering the school. 10. Replacing the content of the room.

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Table 5. Means and Standard Deviations (in Parentheses) of Each Measure for Each Script Task for the Normal and ADHD Groups.

Tasks and groups HST-F

normals

HST-F

ADHD

HST-U

normals

HST-U

ADHD

UST-F

normals

UST-F

ADHD

UST-U

normals

UST-U

ADHD

MST-F

normals

MST-F

ADHD

MST-U

normals

MST-U

ADHD

Task measures

Total number

of responses

10.0 (0.00) 9.90 (0.31) 10.0 (0.00) 9.97 (0.19) 10.0 (0.00) 9.93 (0.26) 9.93 (0.26) 9.79 (0.77) 9.86 (0.58) 9.59 (1.88) 9.86 (0.58) 9.72 (1.00)

Resistence to

inertia index

46.9 (5.0) 47.1 (5.6) 43.7 (5.5) 42.8 (5.09) NA NA NA NA NA NA NA NA

Conventionalism

index

NA NA NA NA 22.2 (3.91) 21.0 (4.47) 23.3 (2.34) 23.0 (3.09) 11.3 (5.25) 10.6 (6.54) 18.5 (4.83) 17.5 (4.75)

Disrespect of

instructions

0.03 (0.19) 0.07 (0.26) 0.07 (0.26) 0.10 (0.31) 0.10 (0.31) 0.03 (0.19) 0.10 (0.31) 0.03 (0.19) 0.10 (0.31) 0.03 (0.19) 0.10 (0.31) 0.00 (0.00)

Omission errors 1.31 (1.07) 1..27 (0.84) 0.34 (0.48) 0.28 (0.59) 2.21 (1.21) 2.72 (1.16) 3.17 (0.97) 3.21 (1.18) 3.07 (1.07) 3.00 (1.41) 0.93 (0.96) 0.72 (0.64)

Commission

errors

1.14 (0.64) 1.21 (0.90) 0.34 (0.48) 0.20 (0.56) 1.10 (1.57) 1.38 (1.68) 0.65 (0.93) 0.76 (1.09) 5.38 (2.03) 5.75 (2.40) 2.59 (1.90) 2.90 (1.92)

Perseverations NA NA NA NA 0.00 (0.00) 0.00 (0.00) 0.00 (0.00) 0.03 (0.19) 0.07 (0.26) 0.18 (0.56) 0.00 (0.00) 0.10 (0.31)

Sequence errors 0.90 (0.82) 1.14 (0.79) 1.76 (1.33) 2.55 (1.55) 0.07 (0.26) 0.14 (0.35) 0.17 (0.38) 0.31 (0.60) 0.03 (0.19) 0.17 (0.39) 0.03 (0.19) 0.55 (0.78)

Note. NA: non-applicable.

SC

RIP

TG

EN

ER

AT

ION

INA

DH

D2

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but having permanently abandoned that medica-

tion (N¼ 11), consuming at the time of the study

(N¼ 10). ANOVAs were performed comparing the

three groups. Dependent measures were amalga-

mated total number of responses, resistence to

inertia index, conventionalism index, disrespect of

instructions, sequence errors, omission errors,

commission errors and perseverations. The sub-

groups did not differ significantly on any of these

measures.

The ADHD subjects could also be subgrouped

into two categories with regard to schooling,

those in regular classes (N¼ 16) and those having

doubled one or more years or placed in special

education classes (N¼ 13). ANOVAs were com-

puted as above on the 6 amalgamated script task

measures. There were no significant differences

between groups.

Sex DifferencesANOVAs were performed comparing the three

groups as well as the two sexes. Dependent mea-

sures were amalgamated total number of responses,

resistence to inertia index, conventionalism index,

disrespect of instructions, sequence errors, omis-

sion errors, commission errors and perseverations.

There were no main effects of sex, nor did any

sex� group interactions reach significance.

Relations Between the Script

Tasks Measures

Intercorrelations of the various amalgamated script

task measures were generally not significant.

However, based on the ensemble of 58 subjects,

commission errors correlated with omission errors

(r¼ .7, p¼ .009) and with the resistence to inertia

index (r¼ .3, p¼ .02). Sequence errors correlated

with omission errors (r¼ .3, p¼ .02) and the

resistence to inertia index (r¼ .3, p¼ .02). In

addition, the omission errors correlated negatively

with number of items (r¼�.32, p¼ .02) and the

resistence to inertia index correlated negatively

with disrespect of instructions (r¼�.28, p¼ .04).

DISCUSSION

Methodological ConsiderationsThe strengths and weaknesses of the method are

the two sides of a same coin. The main strengths

of this study are: (a) recruitment of a truly clinical

sample of ADHD children, and (b) IQ matching

of the clinical and normal comparison samples.

To achieve the second of these objectives, a very

large sample of normal children had to be

sampled and tested for IQ, which was accom-

plished by a group testing procedure for the

normals. Group testing is not feasable for ADHD

children. Matching of the groups would have been

more stringent if both groups had been tested

individually. However, if group testing of the

normal comparison group versus individual test-

ing of the ADHD group had any effect at all in the

present study, the difference probably disfavored

performance of the normal comparison group

(more distraction in a group setting), thus pressing

against the research hypotheses. In other words,

this bias would most likely consist of our results

being less significant than they should have

otherwise been.

Because of stringent IQ matching in this study,

it is perhaps not surprising that most measures of

cognitive performance or style on the mental

script generation tasks did not distinguish the

two groups. The ADHD adolescents demonstrat-

ed that they understood and respected details of

the instructions for the script tasks, and were able

to exploit semantic memory as well as, and

similarly to, the normal comparison group (i.e.,

producing a range of contents similar to the

normals on open ended tasks such as the moder-

ately structured task and the unstructured task).

The ADHD adolescents were neither overly com-

missive (impulsive) nor omissive or inert or im-

poverished on any of the script tasks: their ability

to avoid all these types of errors is an indication

that they were paying attention to the task and

completing it to the end. Schwartz et al. (1998)

and Fortin, Godbout, and Braun (2002) found that

closed head injured patients manifest significant

rates of omission errors on script generation tasks

similar to our unstructured task: both authors

interpreted these as indicative of a failure of

attention, particularly of limited capacity systems

in working memory.

Sequence Errors and the Picture

Arrangement Subtest of the WISCHowever, one script measure, namely sequencing

errors, did identify an impairment of our ADHD

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subjects. Sequencing errors on script tasks such as

these will probably remind the reader of the

Picture Arrangement subtest of the WISC. How-

ever, the Picture Arrangement subtest of the

WISC is not optimal as a measure of frontal lobe

based executive function. It requires the subject to

sequence elements of a story invented not by the

subject but by David Wechsler. There is only one

correct answer, making it a test of mental

convergence, devoid of any possibility of diver-

gent thinking. It is a timed task, such that it

probably calls a lot upon the ‘‘G’’ factor rather

than being purely limited to the specific ability

aimed for. It permits recognition of the sense of

the story from a few key elements rather than

requiring creating a story per se. There are too few

elements to sequence (average¼ 5) to heavily tax

working memory. The stories are only partially

action-based, but also involve events affecting

passive protagonists. The task is clearly not

selectively affected by frontal lobe lesions

(Warrington, James, & Maciejewski, 1986), al-

though to be honest, virtually no such test exists.

Nevertheless, the Picture Arrangement subtest of

the WISC has indeed been found to be sensitive to

ADHD (Pineda et al., 1998). Even fathers of

ADHD children seem to have low performance on

this subtest (Casey, Cohen, Schuerholz, Singer, &

Denckla, 2000). However, Milich and Loney

(1979) had found that ‘‘hyperactive’’ children

with ‘‘minimal brain damage’’ had normal scores

on this subtest and weaker scores on other

subtests of the WISC. In the present experiment,

of the 26 ADHD participants who completed the

WISC-III, the Picture Arrangement subtest scale

score was in fact better (M¼ 10.15) than the

Information (M¼ 8.83), Similarities (M¼ 9.52),

Arithmetic (M¼ 9.04), Vocabulary (M¼ 9.43),

Comprehension (M¼ 8.64), Digit Span

(M¼ 7.2), and Coding (M¼ 8.65) subtests. Only

the Picture Completion (M¼ 10.32) and Bloc

Design (M¼ 11.92) subtests yielded better per-

formances in our ADHD group. Recall that only

two sequence error scores significantly distin-

guished our ADHD and normal participants,

namely on the highly structured unfamiliar tasks

and on the moderately structured unfamiliar task.

The Arithmetic subtest of the WISC correlated

more (r¼�.70) with the sequence error score of

the highly structured unfamiliar script task than

did the Picture Arrangement subtest (r¼�.58).

The Similarities subtest (r¼�.45) and the Cod-

ing subtest (r¼�.34) correlated more with

sequence errors on the moderately structured

unfamiliar task than did the Picture Arrangement

subtest (r¼�.33). In short, in principle, and

apparently in fact, the Picture Arrangement

subtest should not be taken as an analog of the

script tasks found here to be sensitive to presence

of ADHD.

Cognitive Interpretation of the Present

Results

The sample of ADHD adolescents investigated

here specifically manifested a deficit in the ability

to mentally assemble and then sequence long

chains of actions toward an externally imposed

and socially meaningful goal. This deficit is not

likely to be ascribable to methylphenidate med-

ication because the ADHD participants were

tested well after clearance of the medication and

because medication status held no relation to

performance in this sample. This impairment of

mental script generation cannot be claimed here

to explain specific school problems of the ADHD

children: their educational status was not related

to performance (special classes vs. regular) –

although performance on state-wide academic

tests would have been a much better criterion (this

was not available to us). We suspect that the

deficit is intrinsic to developmental ADHD and

relates to a frontal lobe dysfunction.

The highly structured task and the moderately

structured task were found to be significantly

sensitive to presence of ADHD, probably for

different reasons. The highly structured task, we

propose, was sensitive because of psychometric

advantages of a highly structured administration

procedure, task, and scoring system – and presence

of effective distractors. There was no measurement

error on this task, thus leading to low intra-group

variance. The moderately structured task was sen-

sitive, despite greater measurement error, probably

because the subject was required on this task to be

generative, imaginative, productive, under very

demanding constraints (i.e., incorporating the ele-

ments of the picture in the script). Why was the

unstructured task not significantly sensitive to

SCRIPT GENERATION IN ADHD 291

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ADHD? Perhaps it was the absence of pictorial

constraints which made that task less distracting

than the moderately structured task. Also, the

MST-U (saving a drowning person) may simply

have been less familiar to this cohort than the UST-

U (preparing an expedition).

Only the unfamiliar script tasks and not the

familiar ones were significantly sensitive to pre-

sence of ADHD, but recall that the ANOVA test

of the FAMILIARITY�GROUP interaction fell

short of two-tailed significance (the p was .06).

Unfamiliar script tasks should require greater

investment of working memory than familiar

ones. The solution to the problem cannot in the

former case at all be summoned from habit or

from memory. This of course, is a matter of

principle. However, the valid implementation of

fully ‘‘familiar’’ and ‘‘unfamiliar’’ script tasks

may require more research. The sensitivity of

frontal lobe lesions to constrained processing of

mental material in novel, artificial, unstructured

contexts has been observed and reported on many

occasions (Bornstein & Leason, 1985; Jones-

Gotman & Milner, 1977; Lezak, 1995; Petrides

& Milner, 1982). Shallice’s (1982, 1988) model of

script generation ascribed the effortful generation

of novel sequences to the prefrontal cortex (i.e.,

the SAS). Routine script generation, in his model,

was ascribed to the basal ganglia (i.e., the CS), a

lower system of representation of action, more

akin to procedural memory in his conception.

Script tasks have not been studied much in

neuropsychology as a function of varying imple-

mentations of the tasks (familiar vs. unfamiliar,

structured vs. unstructured, etc.) The present inves-

tigation demonstrates that performance on script

tasks depends very heavily on the type of imple-

mentation of the task. However, there was not

strong evidence that the varying implementations

of these tasks significantly differed from each other

in their ability to detect presence of ADHD.

It is possible that the sequencing impairment

observed here in the ADHD group globally

resulted from failure to verify their production.

The ADHD participants did enumerate their items

after seriation, but may have done this negli-

gently. A future study could improve on the

present one by verifying whether this is indeed

the case in ADHD.

Neuropsychological Interpretation

of the Present Results

Sequence errors on script generation tasks are the

hallmark of frontal lobe lesions. Normal semantic

structure, non-significant occurrence of omission,

commission or perseverative errors, in script

generation tasks, normal IQ, and a significant

impairment of sequencing, have also been reported

in frontal lobe patients (Allain et al., 1999; Fortin

et al., 2002; Godbout & Doyon, 1995; Godbout et

al., 2003; Sirigu et al., 1995, 1996). In short, the

current ADHD sample presents a profile rather

similar to that of frontal lobe patients.

Suppose, for a moment, that congenital ADHD

is a plausible model of frontal cortex dysfunction

(cf., Introduction). According to that perspective,

the pattern of results of the present investigation

as a whole equally supports both Grafman’s

(1989) and Shallice’s neuropsychological models

of script generation, though only weakly and

indirectly. Indeed, Grafman’s model would pre-

dict that lengthy script generation ought to be

more frontal lobe based than brief sequencing,

involved for example in the Picture Arrangement

subtest of the WISC-III – because in his model,

sequence is everything. The present ADHD

cohort was perfectly normal on the Picture

Arrangement subtest of the WISC but was sig-

nificantly impaired in sequencing in the several

script generation tasks. Shallice’s model would

predict that the ADHD group should have more

difficulty with unfamiliar than familiar scripts,

because in his model, the SAS is at the top of the

mental control hierarchy as is prefrontal granular

cortex in Luria’s general model (1973). Recall

that the trend to this effect reached significance,

but only at one tail. A caveat in this last regard is

that there is evidence of basal ganglia abnor-

mality, though less than in the frontal lobe, in

ADHD (Teicher et al., 2000). Considering that

Shallice associated the CS with the basal ganglia,

the one tailed effect is probably exactly what

should have been expected at best.

How do the Present Findings

Specifically Support Barkley’s

Neuropsychological Model of ADHD?

ADHD children are agitated, impulsive and

distracted in activities of daily living. However,

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to the surprise of many psychologists, they are not

that way in the brief active test segments of most

psychological tests, including IQ tests (though

they do need to be called to order on occasion).

This appears as a paradox. The present cohort of

ADHD adolescents was not impulsive, commis-

sive, omissive, scatterbrained, dysregulated, irre-

spective of instructions, mentally sluggish (inert),

or bizarre on our set of six script generation tasks.

They manifested a very high order impairment of

meta-cognition: an impairment of the ability to

mentally assemble and sequence long action

chains oriented toward a distant constrained goal.

We believe this approaches the core of Barkley’s

characterization of the ADHD child.

The results of this study did not however

provide more specific support for Barkley’s

model. First, we were not able to demonstrate

greater difficulty of the ADHD cohort with

unstructured than structured tasks, but in hind-

sight we attribute this more to limitations of our

own methodology than to a defect in Barkley’s

model. Second, we obtained only a trend indica-

tive of greater difficulty of the ADHD cohort on

unfamiliar than familiar script tasks. The trend

fell 1% short of one-tailed significance, indicating

to us a limitation of the power of our sampling

more than a defect in Barkley’s model.

Alternative Explanations of the Results

and Ideas for Further Research

Most of the script tasks of the current investiga-

tion comprised situations involving intensely

critical social exchange, particularly the two

script tasks eliciting significant sequence errors

in the ADHD group. Zentall, Casady, and

Javorsky (2001) seem to believe that poor

representation of social content in text compre-

hension and poor anticipation of outcomes from

text (a construct close to script generation) reflect

an important, if not the most important, impair-

ment in ADHD. The current investigation cannot

refute this interpretation. However, whether in

research on interpretation of texts and anticipation

of social outcomes, as in Zentall and colleagues,

or on script generation, the issue will be resolved

only by means of a comparison of two cognitively

matched tasks (equal demands on memory,

lexical and syntaxic processing, etc.): one involv-

ing non-social situations and the other involving

social situations.

Barkley’s model of executive function deficit in

ADHD is based on numerous reports of significant

impairment of ADHD subjects on tests or tasks

such as the Behavioral inhibition (or stop) task, the

Stroop test, fluency tests, the Self Ordered Pointing

Task, the Wisconsin Card Sorting Test, and various

towers tasks (see Sergeant et al., 2002, for an

excellent exhaustive review). What Barkley has

distilled from such reports is that there is a problem

of sustained attention, that is, of working memory,

in ADHD. This construct is compatible with the

more specific impairment of behavioral inhibition

proposed by Barkley as well as Zentall’s and

colleagues’ operationalization of a deficit of social

representation. But there is a third model of ADHD

which is also compatible with a general notion of

an impairment of working memory (or of what

appears to be working memory).

Scheres et al. (2001) have proposed that the

primary impairment in ADHD is of reward

mechanisms. These authors showed that beha-

vioral inhibition (operationalized with the stop

task) is significantly and selectively aggravated in

ADHD by manipulation of reward contingencies.

ADHD subjects are apparently pathologically

dependent upon immediate reward. Such a dis-

position could explain failure of ADHD subjects

on any task requiring ‘‘inherently’’ unrewarding

sustained task-constrained mental activity, includ-

ing script tasks. It also explains very nicely why

methylphenidate seems to be so effective in

ADHD (Vastag, 2001). Unfortunately, the design

of the investigation reported here does not allow

us to exclude the eventuality that our results may

have been due to an impairment of reward

mechanisms in ADHD. It would thus appear

desirable to investigate script generation in

ADHD anew, with controlled manipulation not

only of social content, as proposed above, but also

of item-by-item reward contingencies, so as to

test the model of Scheres and colleagues as well.

ACKNOWLEDGMENTS

This research was made possible by grants from theNatural Sciences and Engineering Council of Canada,

SCRIPT GENERATION IN ADHD 293

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the Fonds Concerte d’Action et de Recherche, theFonds de Recherche en Sante of Quebec, and financialsupport from l’Universite du Quebec a Montreal, all tothe first author.

REFERENCES

Adams, L.T., & Worden, P.E. (1986). Script develop-ment and memory organization in preschool andelementary school children. Discourse Processes, 9,149–166.

Allain, P., Le Gall, D., Etcharry, B.F., Aubin, G., &Emile, J. (1999). Mental representation of knowl-edge following frontal-lobe lesion: Dissociations ontasks using scripts. Journal of Clinical and Experi-mental Neuropsychology, 21, 643–665.

Aman, C.J., Roberts, R.J., & Pennington, B.F. (1998).A neuropsychological examination of the under-lying deficit in attention deficit hyperactivitydisorder: Frontal lobe versus right parietal lobetheories. Developmental Psychology, 34, 956–969.

Barkley, R.A. (1997). ADHD and the nature of self-control. New York: Guilford Press.

Barkley, R.A. (1998). Attention-deficit/hyperactivitydisorder, self-regulation, and time: Toward a morecomprehensive theory. Journal of Developmentaland Behavioral Pediatrics, 18, 271–279.

Benson, D.F., Stuss, D.T., Na€eesen, M.A., Weir, W.S.,Kaplan, E.F., Revine, H.L. (1981). The long-termeffects of prefrontal leukotomy. Archives of Neuro-logy, 38, 165–169.

Bornstein, R.A., & Leason, M. (1985). Effects oflocalized lesions on the Verbal Concept AttainmentTest. Journal of Clinical and Experimental Neu-ropsychology, 7, 421–429.

Brandeis, D., van-Leeuwen, T.H., Rubia, K., Vitacco,D., Steger, J., Pascual-Marqui, R.D., & Steinhausen,H.C. (1998). Neuroelectric mapping reveals pre-cursor of stop failures in children with attentiondeficits. Behavioral Brain Research, 94, 111–125.

Bush, G., Frazier, J.A., Rauch, S.L., Seidman, L.J.,Whalen, P.J., Jenike, MA., Rosen, B.R., &Biederman, J. (1999). Anterior cingulate cortexdysfunction in attention-deficit/hyperactivity dis-order revealed by fMRI and the Counting Stroop.Biological Psychiatry, 45, 1542–1552.

Carte, E.T., Nigg, J.T., & Hinshaw, S.P. (1996).Neuropsychological functioning, motor speed, andlanguage processing in boys with and withoutADHD. Journal of Abnormal Child Psychology,24, 481–498.

Casey, M.B., Cohen, M., Schuerholz, L.J., Singer, H.S.,& Denckla, M.B. (2000). Language-based cognitivefunctioning in parents of offspring with ADHD co-

morbid for Tourette syndrome or learning disabil-ities. Developmental Neuropsychology, 17, 85–110.

Choudhry, R.K., & Saint-Cyr, J.A. (1998). Cognitiveplanning in Parkinson’s disease: Evidence for afrontal-striatal disorder. Personal communication,Toronto.

Crozier, S., Sirigu, A., Lehericy, S., van-de-Moortele,P.F., Pillon, B., Grafman, J., Agid, Y., Dubois, B., &LeBihan, D. (1999). Distinct prefrontal activations inprocessing sequence at the sentence and script level:And MRI study. Neuropsychologia, 37, 1469–1476.

Dinn, W.M., Robbins, N.C., & Harris, C.L. (2001).Adult attention-deficit/hyperactivity. disorder: Neu-ropsychological correlates and clinical presentation.Brain and Cognition, 46, 114–121.

DSM-IV. (1996). Manuel diatgnostique et statistiquedes troubles mentaux. Paris: masson.

Fortin, S., Godbout, L., & Braun, C.M.J. (2002).Cognitive structure of executive deficits in frontallylesioned head trauma patients performing activitiesof daily living. Cortex, 39, 273–291.

Gallagher, R., & Ader, J. (2001). The diagnosis andneuropsychological assessment of adult attentiondeficit/hyperactivity disorder. In J. Wasserstein, L.E.Wolf, & F.F. LeFever (Eds.), Adult attention deficitdisorder: Brain mechanisms and life outcomes.New York: New York Academy of Sciences.

Gansler, D.A., Fucetola, R., Krengel, M., Stetson, S.,Zimering, R., & Makary, C. (1998). Are therecognitive subtypes in adult attention deficit/hyper-activity disorder? Journal of Nervous and MentalDisease, 186, 776–781.

Geller, B., Warner, K., Williams, M., & Zimerman, B.(1998). Prepubertal and young adolescent bipolarityversus ADHD: Assessment and validity using theWASH-U-KSADS, CBCL and TRF. Journal ofAffective Disorders, 51, 93–100.

Godbout, L., Cloutier, P., Bouchard, C., Braun, C.M.J.,& Gagnon, S. (2003). Temporal and spatial dimen-sions of script generation following frontal andparietal lesions. Journal of Clinical and Experi-mental Neuropsychology (in press).

Godboult, L., & Doyon, J. (1995). Mental repre-sentation of knowledge following frontal-lobeor postrolandic lesion. Neuropsychologia, 33,1671–1696.

Godbout, L., & Doyon, J. (2000). Defective representa-tion of knowledge in Parkinson’s disease: Evidencefrom a script production task. Brain and Cognition,44, 490–510.

Goodglass, H., & Kaplan, E. (1983). The assessment ofaphasia and related disorders. Philadelphia: Lea &Febiger.

Grafman, J. (1989). Plans, actions and mental sets:Managerial knowledge units in the frontal lobes. InE. Perecman (Ed.), Integrating theory and practice

294 CLAUDE M.J. BRAUN ET AL.

Dow

nloa

ded

by [

Ista

nbul

Uni

vers

itesi

Kut

upha

ne v

e D

ok]

at 1

5:18

20

Dec

embe

r 20

14

in clinical neuropsychology (Chapter 4). Hillsdale:Lawrence Erlbaum Associates, 93–138.

Grodzinsky, G.M., & Barkley, R.A. (1999). Predictivepower of frontal lobe tests in the diagnosis ofattention deficit hyperactivity disorder. ClinicalNeuropsychology, 13, 12–21.

Jones-Gotman, M., & Milner, B. (1977). Design Fluency:The invention of non-sense drawings after focalcortical lesions. Neuropsychologia, 15, 653–674.

Jones-Gotman, M., Ptito, A., & Zatorre, R.J. (1984).Deficits cognitifs associes aux lesions cerebraleslocalisees. Revue Quebecoise de Psychologie, 5,83–104.

Jonkman, L.M., Kemner, C., Verbaten, M.N., Koelega,H.S., Camfferman, G., v.d.-Gaag, R.J., Buitelaar,J.K., & van-Engeland, H. (1997). Event-relatedpotentials and performance of attention-deficithyperactivity disorder: Children and normal con-trols in auditory and visual selective attention tasks.Biological Psychiatry, 41, 595–611.

Kerns, K.A., McInerney, R.J., & Wilde, N.J. (2001).Time reproduction, working memory, and beha-vioral inhibition in children with ADHD. ChildNeuropsychology, 7, 21–31.

Kimko, H.C., Cross, J.T., & Abernethy, D.R. (1999).Pharmacokinetics and clinical effectiveness ofmethylphenidate. Clinical Pharmacokinetics, 37,457–470.

Koziol, L.F., & Stout, C.E. (1992). Use of a verbalfluency measure in understanding and evaluatingADHD as an executive function disorder. Perceptualand Motor Skills, 75, 1187–1192.

Lazar, J.W., & Frank, Y. (1998). Frontal systemsdysfunction in children with attention-deficit/hyper-activity disorder and learning disabilities. Journal ofNeuropsychiatry and Clinical Neuroscience, 10,160–167.

Le-Gall, D., Aubin, G., Allain, P., & Emile, J. (1993).Script et syndrome frontal: a propos de deuxobservations./Scripts and the frontal lobe syndrome:Two observations. Revue de Neuropsychologie, 3,87–110.

Lezak, M. (1995). Neuropsychological assessment.New York: Oxford University Press.

Lovejoy, D.W., Ball, J.D., Keats, M., Stutts, M.L.,Spain, E.H., Janda, L., & Janusz, J. (1999). TI:Neuropsychological performance of adults withattention deficit hyperactivity disorder (ADHD):Diagnostic classification estimates for measures offrontal lobe/executive functioning. Journal ofthe International Neuropsychological Society, 5,222–233.

Luria, A.R. (1973). The working brain. New York:Basic Books.

Mangina, C.A., Beuzeron-Mangina, J.H., & Grizenko,N. (2000). Event-related brain potentials, bilateral

electrodermal activity and Mangina-Test perfor-mance in learning disabled/ADHD pre-adolescentswith severe behavioral disorders as compared toage-matched normal controls. International Journalof Psychophysiology, 37, 71–85.

McFie, J., & Thompson, J.A. (1972). Picture arrange-ment: A measure of frontal lobe function. BritishJournal of Psychiatry, 121, 547–552.

Milich, R.S., & Loney, J. (1979). The factor composi-tion of the WISC for hyperkinetic/MBD males.Journal of Learning Disabilities, 12, 491–495.

Milner, B. (1964). Some effects of frontal lobectomy inman. In D.J.W. Warren & K. Akert (Eds.), Thefrontal granular cortex and behavior. New York:McGraw-Hill.

Oie, M., & Rund, B.R. (1999). Neuropsychologicaldeficits in adolescent-onset schizophrenia comparedwith attention deficit hyperactivity disorder. Amer-ican Journal of Psychiatry, 156, 1216–1222.

Partiot, A., Grafman, J., Sadato, N., Flitman, S., &Wild, K. (1996). Brain activation during script eventprocessing. Neuroreport, 7, 761–766.

Petrides, M., & Milner, B. (1982). Deficits on subject-ordered tasks after frontal- and temporal-lobelesions in man. Neuropsychologia, 20, 249–262.

Pillon, B. (1981). Troubles visuo-constructifs etmethodes de compensation. Resultats de 85 patientsatteints de lesions cerebrales. Neuropsychologia, 19,375–383.

Pineda, D., Ardila, A., Rosselli, M., Cadavid, C.,Mancheno, S., & Mejia, S. (1998). TI: Executivedysfunctions in children with attention deficithyperactivity disorder. International Journal ofNeuroscience, 96, 177–196.

Pliszka, S.R., Liotti, M., & Woldorff, M.G. (2000). TI:Inhibitory control in children with attention-deficit/hyperactivity disorder: Event-related potentialsidentify the processing component and timingof an impaired right-frontal response-inhibitionmechanism. Biological Psychiatry, 48, 238–246.

Rabinowitz, M., & Valentine, K.M. (1984). A develop-mental comparison of script-based inference gen-eration. National Inst. of Mental Health (DHHS),Rockville, MD; National Science Foundation,Washington, DC. Research Reports #143.

Rapport, L.J., Van Voorhis, A., Tzelepis, A., &Friedman, S.R. (2001). Executive functioning inadult attention-deficit hyperactivity disorder. Clin-ical Neuropsychology, 15, 479–491.

Robinson, A.L., Heaton, R.K., Lehman, R.A.W., &Stilson, R.W. (1980). The utility of the WisconsinCard Sorting Test in detecting and localizing frontallobe lesions. Journal of Consulting and ClinicalPsychology, 48, 605–614.

Rothenberger, A., Banaschewski, T., Heinrich, H.,Moll, G.H., Schmidt, M.H., & van’t-Klooster, B.

SCRIPT GENERATION IN ADHD 295

Dow

nloa

ded

by [

Ista

nbul

Uni

vers

itesi

Kut

upha

ne v

e D

ok]

at 1

5:18

20

Dec

embe

r 20

14

(2000). TI: Comorbidity in ADHD-children: Effectsof coexisting conduct disorder or tic disorder onevent-related brain potentials in an auditory selec-tive-attention task. European Archives of Psychiatryand Clinical Neuroscience, 250, 101–110.

Rubia, K., Overmeyer, S., Taylor, E., Brammer, M.,Williams, S., Simmons, A., Andrew, C., &Bullmore, E.T. (1999). Hypofrontality in attentiondeficit hyperactivity disorder during higher ordermotor control: A study using fMRI. AmericanJournal of Psychiatry, 156, 891–896.

Rubia, K., Overmeyer, S., Taylor, E., Brammer, M.,Williams, S.C.R., Simmons, A., Andrew, C., &Bullmore, E.T. (2000). Functional frontalisationwith age: Mapping neurodevelopmental trajectorieswith fMRI. Neuroscience and BiobehavioralReviews, 24, 13–19.

Schank, R., & Abelson, R. (1977). Scripts plans goalsand understanding: An inquiry into human knowl-edge structures. Hillsdale, NJ: Lawrence ErlbaumAssociates.

Scheres, A., Oosterlaan, J., & Sergeant, J.A. (2001).Response inhibition in children with DSM-IV sub-types AD/HD and related disruptive behaviors: Therole of reward. Child Neuropsychology, 7, 172–189.

Schwartz, M.F., Montgomery, M.W., Buxbaum, L.J.,Lee, S.S., Carew, T.G., & Coslett, H.B. (1998).Naturalistic action impairment in closed headinjury. Neuropsychology, 12, 13–28.

Schweitzer, J.B., Faber, T.L., Grafton, S.T., Tune, L.E.,Hoffman, J.M., & Kilts, C.D. (2000). Alterations inthe functional anatomy of working memory in adultattention deficit hyperactivity disorder. AmericanJournal of Psychiatry, 157, 278–280.

Seidman, L.J., Biederman, J., Weber, W., Hatch, M., &Faraone, S.V. (1998). Neuropsychological functionin adults with attention-deficit hyperactivity dis-order. Biological Psychiatry, 44, 260–268.

Sergeant, J.A., Geurts, H., & Oosterlaan, J. (2002).How specific is a deficit of executive functioning forattention-deficit/hyperactivity disorder? BehavioralBrain Research, 130, 3–28.

Shallice, T. (1982). Specific impairments of planning.Philosophical Transactions of the Royal Society ofLondon B, 298, 199–209.

Shallice, T. (1988). From neuropsychology to mentalstructure (p. 462). New York: Cambridge UniversityPress.

Shallice, T., & Evans, M.E. (1978). The involvement ofthe frontal lobes in cognitive estimation. Cortex, 14,294–303.

Shue, K.L., & Douglas, V.I. (1992). TI: Attentiondeficit hyperactivity disorder and the frontal lobesyndrome. Brain and Cognition, 20, 104–124.

Silberstein, R.B., Farrow, M., Levy, F., Pipingas, A.,Hay, D.A., & Jarman, F.C. (1998). TI: Functional

brain electrical activity mapping in boys withattention-deficit/hyperactivity disorder, Archives ofGeneral Psychiatry, 55, 1105–1112.

Sirigu, A., Zalla, T., Pillon, B., Grafman, J., Agid, Y., &Dubois, B. (1995). Selective impairments in man-agerial knowledge following pre-frontal cortexdamage. Cortex, 31, 301–316.

Sirigu, A., Zalla, T., Pillon, B., Grafman, J., Agid, Y., &Dubois, B. (1996). Encoding of sequence andboundaries of scripts following prefrontal lesions.Cortex, 32, 297–310.

Smith, M.L., & Milner, B. (1984). Differential effectsto frontal-lobe lesions on cognitive estimation andspatial memory. Neuropsychologia, 22, 697–705.

Smith, M.L., & Milner, B. (1988). Estimation offrequency of occurrence of abstract designs afterfrontal or temporal lobectomy. Neuropsychologia,26, 297–306.

Spalletta, G., Pasini, A., Pau, F., Guido, G., Menghini,L., & Caltagirone, C. (2001). Prefrontal blood flowdysregulation in drug naive ADHD children withoutstructural abnormalities. Journal of Neural Trans-mission, 108, 1203–1216.

Teicher, M.H., Anderson, C.M., Polcari, A., Glod, C.A.,Maas, L.C., & Renshaw, P.F. (2000). Functionaldeficits in basal ganglia of children with attention-deficit/hyperactivity disorder shown with functionalmagnetic resonance imaging relaxometry. NatureMedicine, 6, 470–473.

Teuber, H.L. (1964). The riddle of frontal lobe functionin man. In D.J. Warren & K. Ackert (Eds.), Thefrontal granular cortex and behavior. New York:McGraw Hill.

Toyama, N. (1993). Mental development of ‘‘mean-ings’’ related to scripts: ‘‘Dining’’ script as anexample. Japanese Journal of Psychology, 64,378–383.

Vastag, B. (2001). Pay attention: Ritalin acts much likecocaine. Journal of the American Medical Associa-tion, 286, 905–906.

Warrington, E.K., James, M., & Maciejewski, C.(1986). The WAIS as a lateralizing and localizingdiagnostic instrument: A study of 656 patients withunilateral cerebral lesions. Neuropsychologia, 24,223–239.

Zalla, T., Sirigu, A., Pillon, B., Dubois, B., Grafman, J.,& Agid, Y. (1998). Deficit in evaluating pre-determinated sequences of script events in patientswith Parkinson’s disease. Cortex, 34, 621–628.

Zametkin, A.J., Liebenauer, L.L., Fitzgerald, G.A., &King, A.C. (1993). TI: Brain metabolism in teen-agers with attention-deficit hyperactivity disorder.Archives of General Psychiatry, 50, 333–340.

Zentall, S.S., Cassady, J.C., & Javorsky, J. (2001).Social comprehension of children with hyperactiv-ity. Journal of Attention Disorders, 5, 11–24.

296 CLAUDE M.J. BRAUN ET AL.

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nloa

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by [

Ista

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Uni

vers

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Kut

upha

ne v

e D

ok]

at 1

5:18

20

Dec

embe

r 20

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