Clinical case Study : Fabian, 13 years old, ADHD
Context : ADHD diagnostic made 4 years ago. No development peculiarities. Studies have been normal but requires enormous effort. Behavior is impulsive, sometimes aggressive. Slowness in everyday activities and maintaining attention over time is difficult.
WISC-V : Cognitive functioning is homogeneous and in the high average except the processing speed which strongly appears to slow down (low average zone / limit). Reasoning skills are excellent. Working memory is supported by the visual modality.
Test FEA : At the executive and attentional level, the slowdown is observed in a general way, and is amplified by attentional (D2-r) and executive (Change, subtest Inhibition) overflow effects; AARA). Flexibility is costly, as is maintaining attention and executive control. Initiation can be difficult (naming, subtest inhibition; AARA).
TEAC-ch : Impraticable since Fabian has already passed it 4 times with his previous neuropsychologist. The results would be inaccurate.
MindPulse : The perceptual motor speed is extremely slow (OEE: z=4.00) on this test, which is associated with a certain motor rigidity. A slight slowdown in executive velocity is also observed (z=1.12) indicating both a slowdown of the perceptual-motor and ideic sphere in Fabian. The accuracy is fragile, with 3 total errors (z=0.95). The adjustment in the face of difficulty is perfect (z=-0.09).
Specific error analysis highlights impulsivity with 2 anticipation errors (response before stimuli; z=1.75), which can also be related to motor rigidity; as well as a choice error that is normal for his age (z=0.54).
Fabian also presents very important attentional difficulties on this test, with major fluctuations throughout the 3 parts. These difficulties are central and partially explain the slowdown observed in this young man. An attentional eclipse (aberrant response) is observed at the end of the first part (z=0.91) suggesting a slight fragility in the voluntary maintenance of attentional control.
Conclusion : The MindPulse allows us to highlight that Fabian's slowdown, found in a moderate way at the WISC-V (IVT – Codes; Symbols) and in a variable way in the different FEA tests conventionally used (Inhibition – NEPSY-II; D2-r) is primarily a perceptual-motor slowdown that combines with a more moderate slowdown in executive speed.
This can result in a slowdown of the graphic gesture (Codes; D2-r) which is associated with an ideal slowdown (D2-r; Symbols; part Naming & Change of Inhibition) and generates the impression of overall slowness found in Fabian.
Attentional difficulties are found regardless of the test used, both through NEPSY-II's Auditory Attention & Associated Responses (AARA) and MindPulse, which however specifies the general alteration of attentional subsystems, with a lack of vigilance, selectivity and executive attention. This executive part appears preponderant in Fabian's profile, and is found in MindPulse as in the Associated Answers section of AARA.
Major difficulties in cognitive flexibility do not appear in the classic tests, except via the qualitative interpretation of certain scores (fluence comparison score; AA/AR comparison score) which mark more the difficulties of general executive control than the specification found in the executive subsystems in the MindPulse.
